A review of Health Canada's progress on human biomonitoring-based risk assessments and the path forward.

Since the launch of the Chemicals Management Plan (CMP) in 2006, Health Canada has initiated screening-level risk assessments (RAs) of approximately 4300 priority substances under the Canadian Environmental Protection Act, 1999 (CEPA). With the availability of nationally representative human biomonitoring (HBM) data, over 300 of these substances were assessed using HBM-based RA approaches. Qualitative and quantitative HBM-based RA approaches for the regulatory risk assessment of the general population of Canada were developed to increase the efficiency of screening the potential health risk of CMP priority substances. To support HBM-based RAs, several biomonitoring equivalents (BE) were derived to interpret HBM data. For some CMP substances, Health Canada conducted cumulative risk assessments of chemical mixtures using HBM data as measures of exposure. In 2023, CEPA was amended to include the assessment of populations who may be disproportionately impacted (vulnerable populations) and the cumulative effects of multiple chemicals. Going forward, Health Canada is exploring modern approaches in HBM-based RAs, including biomarkers of effect and non-traditional biomarkers (e.g., hair, nails) to address CEPA amendments. This manuscript will discuss Health Canada's progress in HBM-based RAs, and the possible path forward in using HBM data to strengthen human health risk assessments.

Contamination status, source analysis and exposure assessments of quinolone antibiotics in the south of Yancheng Coastal Wetland, China.

Yancheng coastal wetland, the largest coastal wetland in the west coast of the Pacific Ocean and the margin of the Asian continent, has significant environmental, economic and social effects on local human beings. The extensive contamination and potential risk of quinolone antibiotics (QNs) on local aquaculture and human health are still not clear until now. In this study, 52 surface sediment samples were collected to investigate the contamination status and polluted sources, and evaluate ecological risks of QNs in the south of Yancheng coastal wetland. The total contents of QNs ranged from 0.33 to 21.60 ng/g dw (mean value of 4.51 ng/g dw), following the detection frequencies of QNs ranging from 19.23 to 94.23%. The highest content of QNs occurred around an aquaculture pond dominated by flumequine. The total organic carbon contents of sediment were positively correlated with sarafloxacin and lomefloxacin (p < 0.05), indicating the enhanced absorption of these QNs onto sediments. Partial QNs, such as lomefloxacin, enrofloxacin, sarafloxacin and flumequine, presented the homology features originating from the emission of medical treatment and aquaculture. There was no potential risk of QNs to human beings but a potential risk to aquatic organisms (algae > plant > invertebrate). Totally, the management and protection of Yancheng coastal wetland should be of concern with aquaculture as the important industry.

Total Polyphenol Contents and Mineral Profiles in Commercial Wellness Herbal Infusions: Evaluation of the Differences between Two Preparation Methods.

The popularity of the consumption of wellness herbal teas is due to the many health-promoting properties they seem to possess. Modern preparation methods using coffee machines are also popular today. Therefore, the purpose of this research was to evaluate differences in infusions obtained by the traditional method using filters and by espresso coffee machines using pods. In this regard, different herbal materials were selected and purchased in two different types of herbal containers, and the corresponding infusions were analyzed for the contents of total polyphenols and mineral elements. Results showed that filter infusions had higher polyphenol and mineral contents than pod infusions, excluding Cd and Pb. For each of the plant materials used, differences due to the method of infusion preparation are highlighted. From a qualitative point of view, both methods of infusion preparation are valid, but the filter infusion method allows a higher transfer of minerals and polyphenols into the infusion, improving quality. The analyzed infusions can be safely consumed with respect to As, Cd, Pb, and Hg contents. Good amounts of polyphenols and Mn can be obtained by drinking a cup of any of the infusions analyzed, especially the mate infusion obtained by the filter technique, with amounts of 429 mg for polyphenols and 69.27% of the RDA for manganese.

A Multimorbidity Analysis of Hospitalized Patients With COVID-19 in Northwest Italy: Longitudinal Study Using Evolutionary Machine Learning and Health Administrative Data.

BACKGROUND: Multimorbidity is a significant public health concern, characterized by the coexistence and interaction of multiple preexisting medical conditions. This complex condition has been associated with an increased risk of COVID-19. Individuals with multimorbidity who contract COVID-19 often face a significant reduction in life expectancy. The postpandemic period has also highlighted an increase in frailty, emphasizing the importance of integrating existing multimorbidity details into epidemiological risk assessments. Managing clinical data that include medical histories presents significant challenges, particularly due to the sparsity of data arising from the rarity of multimorbidity conditions. Also, the complex enumeration of combinatorial multimorbidity features introduces challenges associated with combinatorial explosions. OBJECTIVE: This study aims to assess the severity of COVID-19 in individuals with multiple medical conditions, considering their demographic characteristics such as age and sex. We propose an evolutionary machine learning model designed to handle sparsity, analyzing preexisting multimorbidity profiles of patients hospitalized with COVID-19 based on their medical history. Our objective is to identify the optimal set of multimorbidity feature combinations strongly associated with COVID-19 severity. We also apply the Apriori algorithm to these evolutionarily derived predictive feature combinations to identify those with high support. METHODS: We used data from 3 administrative sources in Piedmont, Italy, involving 12,793 individuals aged 45-74 years who tested positive for COVID-19 between February and May 2020. From their 5-year pre-COVID-19 medical histories, we extracted multimorbidity features, including drug prescriptions, disease diagnoses, sex, and age. Focusing on COVID-19 hospitalization, we segmented the data into 4 cohorts based on age and sex. Addressing data imbalance through random resampling, we compared various machine learning algorithms to identify the optimal classification model for our evolutionary approach. Using 5-fold cross-validation, we evaluated each model's performance. Our evolutionary algorithm, utilizing a deep learning classifier, generated prediction-based fitness scores to pinpoint multimorbidity combinations associated with COVID-19 hospitalization risk. Eventually, the Apriori algorithm was applied to identify frequent combinations with high support. RESULTS: We identified multimorbidity predictors associated with COVID-19 hospitalization, indicating more severe COVID-19 outcomes. Frequently occurring morbidity features in the final evolved combinations were age>53, R03BA (glucocorticoid inhalants), and N03AX (other antiepileptics) in cohort 1; A10BA (biguanide or metformin) and N02BE (anilides) in cohort 2; N02AX (other opioids) and M04AA (preparations inhibiting uric acid production) in cohort 3; and G04CA (Alpha-adrenoreceptor antagonists) in cohort 4. CONCLUSIONS: When combined with other multimorbidity features, even less prevalent medical conditions show associations with the outcome. This study provides insights beyond COVID-19, demonstrating how repurposed administrative data can be adapted and contribute to enhanced risk assessment for vulnerable populations.

Bisphenol A-What Do We Know? A Global or Local Approach at the Public Health Risk Level.

BPA has demonstrated enormous multisystem and multi-organ toxicity shown mainly in animal models. Meanwhile, the effects of its exposure in humans still require years of observation, research, and answers to many questions. Even minimal and short-term exposure contributes to disorders or various types of dysfunction. It is released directly or indirectly into the environment at every stage of the product life cycle, demonstrating its ease of penetration into the body. The ubiquity and general prevalence of BPA influenced the main objective of the study, which was to assess the toxicity and health effects of BPA and its derivatives based on the available literature. In addition, the guidelines of various international institutions or regions of the world in terms of its reduction in individual products were checked. Bisphenol A is the most widely known chemical and perhaps even the most studied by virtually all international or national organizations, but nonetheless, it is still controversial. In general, the level of BPA biomonitoring is still too high and poses a potential threat to public health. It is beginning to be widely argued that future toxicity studies should focus on molecular biology and the assessment of human exposure to BPA, as well as its substitutes. The effects of its exposure still require years of observation, extensive research, and answers to many questions. It is necessary to continue to deepen the knowledge and interest of many organizations, companies, and consumers around the world in order to make rational purchases as well as future choices, not only consumer ones.

Attitudes of nurses and nurse managers towards violence risk assessment and management: A cross-sectional study in psychiatric inpatient settings.

WHAT IS KNOWN ON THE SUBJECT: Workplace violence is a significant challenge in psychiatric hospital care. Some existing practices of violence risk assessment and management are based on nurses' intuition and clinical experience instead of structured tools. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Nurses and nurse managers consider violence risk assessment and management their responsibility. Still, nurses and nurse managers have mixed attitudes towards the use of validated risk assessment tools. The attitudes towards service users' positive risk-taking in nurses and nurse managers vary, with some nurses and nurse managers supporting its importance. WHAT ARE THE IMPLICATIONS FOR PRACTICE: Change in nurses' and nurse managers' attitudes towards risk assessment tools is required before their implementation into practice. More profound change in practices towards recovery-oriented care is required also in risk assessment. ABSTRACT: INTRODUCTION: Workplace violence is a prevalent issue in psychiatric inpatient care. Prevention efforts require the identification of at-risk service users using validated violence risk assessment tools. The shift in violence prevention emphasises preventive measures and collaborative risk assessment together with service users. Nurses have a central role in this process. Therefore, their attitudes are crucial when implementing evidence-based methods. AIM: To assess the attitudes of nurses and nurse managers towards violence risk assessment and management. METHOD: A cross-sectional online survey in Finnish psychiatric inpatient care. Data analysis was conducted with statistical methods. The STROBE guideline was used in reporting. RESULTS: Nurses (n = 142) valued risk assessment and felt that it was their responsibility. Attitudes towards service users' risk-taking as part of their recovery varied. Nurses had mixed attitudes regarding the effectiveness of risk assessment tools. Older participants and nurse managers had more positive attitudes towards risk assessment tools. DISCUSSION: The study findings highlight a feeling of responsibility of nurses towards violence risk assessment and at the same time their preference towards their own clinical judgement. IMPLICATIONS FOR PRACTICE: Understanding nurses' attitudes is crucial in training and implementation processes to address concerns, provide support and enhance positive attitudes.

Biological invasions are a population-level rather than a species-level phenomenon.

Biological invasions pose a rapidly expanding threat to the persistence, functioning and service provisioning of ecosystems globally, and to socio-economic interests. The stages of successful invasions are driven by the same mechanism that underlies adaptive changes across species in general-via natural selection on intraspecific variation in traits that influence survival and reproductive performance (i.e., fitness). Surprisingly, however, the rapid progress in the field of invasion science has resulted in a predominance of species-level approaches (such as deny lists), often irrespective of natural selection theory, local adaptation and other population-level processes that govern successful invasions. To address these issues, we analyse non-native species dynamics at the population level by employing a database of European freshwater macroinvertebrate time series, to investigate spreading speed, abundance dynamics and impact assessments among populations. Our findings reveal substantial variability in spreading speed and abundance trends within and between macroinvertebrate species across biogeographic regions, indicating that levels of invasiveness and impact differ markedly. Discrepancies and inconsistencies among species-level risk screenings and real population-level data were also identified, highlighting the inherent challenges in accurately assessing population-level effects through species-level assessments. In recognition of the importance of population-level assessments, we urge a shift in invasive species management frameworks, which should account for the dynamics of different populations and their environmental context. Adopting an adaptive, region-specific and population-focused approach is imperative, considering the diverse ecological contexts and varying degrees of susceptibility. Such an approach could improve and refine risk assessments while promoting mechanistic understandings of risks and impacts, thereby enabling the development of more effective conservation and management strategies.

Assessment of the surface water quality and primary health risk in urban wastewater and its receiving river Kathajodi, Cuttack of eastern India.

Kathajodi, the principal southern distributary of the Mahanadi River, is the vital source of irrigation and domestic water use for densely populated Cuttack city which receives anthropogenic wastes abundantly. This study assesses the contamination level and primary health status of urban wastewater, and its receiving river Kathajodi based on the physicochemical quality indices employing inductively coupled plasma mass spectroscopy and aligning with guidelines from the United States Environmental Protection Agency (USEPA) and WHO. The high WQI, HPI, and HEI in the catchment area (KJ2, KJ3, and KJ4) indicate poor water quality due to the influx of domestic waste through the primary drainage system and effluents of healthcare units. A high BOD (4.33-19.66 mg L-1) in the catchment indicates high organic matter, animal waste, bacteriological contamination, and low DO, resulting in deterioration of water quality. CR values beyond limits (1.00E - 06 to 1.00E - 04) in three locations of catchment due to higher Cd, Pb, and As indicate significant carcinogenic risk, while high Mn, Cu, and Al content is responsible for several non-carcinogenic ailments and arsenic-induced physiological disorders. The elevated heavy metals Cd, Cu, Fe, Mn, Ni, and Zn, in Kathajodi, could be due to heavy coal combustion, vehicle exhaust, and industrial waste. On the other hand, Cu, Fe, K, and Al could be from agricultural practices, weathered rocks, and crustal materials. Positive significant (p ≤ 0.05) Pearson correlations between physicochemical parameters indicate their common anthropogenic origin and similar chemical characteristics. A strong correlation of PCA between elements and physiological parameters indicates their role in water quality deterioration. Assessing the surface water quality and heavy metal contents from this study will offer critical data to policymakers for monitoring and managing public health concerns.

Contamination of ultraviolet absorbers in food: toxicity, analytical methods, occurrence and risk assessments.

Ultraviolet (UV) absorbers are chemical substances that are widely used as defenses against the damaging effects of solar radiations. UV absorbers, despite their benefits, are categorized as emerging pollutants because they have been demonstrated to be mutagenic, toxic, pseudo-persistent, bio-accumulative, and to have strong estrogenic effects. Because of their common use in personal care products, they continue to enter the environment. Several food samples, particularly those derived from aquatic sources, have been found to be contaminated with these compounds. Toxic effects on aquatic life, such as metabolic imbalance and developmental toxicity, result from the continued presence of UV absorbers in aquatic bodies. In addition, the degree of exposure to these pollutants in foods should be examined because there are certain risks associated with their consumption by humans. Therefore, this review focuses on the toxicity, analytical techniques, occurrence, and risk assessments of UV absorbers found in food.

Mapping the occurrence of Eustrongylides spp. in fish species caught from six lakes in Central Italy (Tuscany and Latium regions): Implications for local fishery supply chains.

In the present study, in order to expand the knowledge on the distribution of parasites of the genus Eustrongylides in never investigated Italian lacustrine areas of Tuscany and Latium, fish specimens from four Tuscan lakes (Bilancino, Chiusi, Montedoglio and San Cipriano) and two Latium lakes (Bolsena and Bracciano) were collected and analyzed. The parasitological analysis, consisting of a visual inspection followed by a chloro-peptic digestion, was performed on 1650 specimens belonging to 17 species: European perch (Perca fluviatilis), Pumpkinseed (Lepomis gibbosus), Pike-perch (Sander lucioperca), Largemouth black bass (Micropterus salmoides), Pike (Esox lucius), Big-scale sand smelt (Atherina boyeri), Tench (Tinca), European Whitefish (Coregonus lavaretus), Channel catfish (Ictalurus punctatus), Chub (Squalius cephalus), Rudd (Scardinius erythrophthalmus), Common bleak (Alburnus alborella), South European roach (Sarmarutilus rubilio), South European nase (Protochondrostoma genei), Italian riffle dace (Telestes muticellus), Goldfish (Carassius auratus), and Freshwater bream (Abramis brama). Eustrongylides spp. larvae were only found in one specimen of European perch caught in Bracciano Lake and purchased from a local fishmonger (P = 3.3%; MI = 1; MA = 0.03). The only isolated Eustrongylides spp. larva was submitted to molecular analysis of the ITS gene region and identified as E. excisus. This finding adds Bracciano Lake to the list of the several Italian lakes in which nematodes belonging to this genus have been reported. Even if the observed prevalence is currently low, the presence of the parasite in this local freshwater fish supply chain requires FBOs to adopt risk management measures to prevent contaminated products from reaching final consumer. Moreover, future investigations will show if the parasite expands in these areas.

Assessing the effectiveness of marine nature-based solutions with climate risk assessments.

Prospective risks from climate change impacts in ocean and coastal systems are urging the implementation of nature-based solutions (NBS). These are climate-resilient strategies to maintain biodiversity and the delivery of ecosystem services, contributing to the adaptation of social-ecological systems and the mitigation of climate-related impacts. However, the effectiveness of measures like marine restoration or conservation is not exempt from the impacts of climate change, and the degree to which they can sustain biodiversity and ecosystem services remains unknown. Such uncertainty, together with the slow pace of implementation, causes decision-makers and societies to demand a better understanding of NBS effects. To address this gap, in this study, we use the risk mitigation capacity of marine NBS as a proxy for their effectiveness while providing a toolset for the implementation of the method. The method considers environmental data and relies on expert elicitation, allowing us to go beyond current practice to evaluate the effectiveness of NBS in reducing habitat or species risks under different future socio-political and climate-change scenarios. As a result, we present a ready-to-use tool, and supporting materials, for the implementation of the Climate Risk Assessment method and an illustrative example considering the application of the NBS "nature-inclusive harvesting" in two shellfisheries. The method works as a rapid assessment that guarantees comparability across sites and species due to its low data or resource demand, so it can be widely incorporated to adaptation policies across the marine realm.

Digital Response to Physical Crises: The Role of an E-Health Platform in the 2023 Southern Turkey Earthquakes.

The catastrophic earthquakes that struck Southern Turkey in 2023 highlighted the pressing need for effective disaster management strategies. The unprecedented scale of the crisis tested the robustness of traditional healthcare responses and highlighted the potential of e-health solutions. Despite the deployment of Emergency Medical Teams, initial responders - primarily survivors of the earthquakes - faced an enormous challenge due to their lack of training in mass-casualty situations. An e-health platform was introduced to support these first responders, offering tools for drug calculations, case management guidelines, and a deep learning model for pediatric X-ray analysis. This commentary presents an analysis of the platform's use and contributes to the growing discourse on integrating digital health technologies in disaster response and management.

Distribution and Risk Assessment of Organophosphate Esters in Agricultural Soils and Plants in the Coastal Areas of South China.

Organophosphate esters (OPEs) are frequently used as flame retardants and plasticizers in various commercial products. While initially considered as substitutes for brominated flame retardants, they have faced restrictions in some countries due to their toxic effects on organisms. We collected 37 soil and crop samples in 20 cities along the coast of South China, and OPEs were detected in all of them. Meanwhile, we studied the contamination and potential human health risks of OPEs. In soil samples, the combined concentrations of eight OPEs varied between 74.7 and 410 ng/g, averaging at 255 ng/g. Meanwhile, in plant samples, the collective concentrations of eight OPEs ranged from 202 to 751 ng/g, with an average concentration of 381 ng/g. TDCIPP, TCPP, TCEP, and ToCP were the main OPE compounds in both plant and soil samples. Within the study area, the contaminants showed different spatial distributions. Notably, higher OPEs were found in coastal agricultural soils in Guangdong Province and crops in the Guangxi Zhuang Autonomous Region. The results of an ecological risk assessment show that the farmland soil along the southern coast of China is at high or medium ecological risk. The average non-carcinogenic risk and the carcinogenic risk of OPEs in soil through ingestion and dermal exposure routes are within acceptable levels. Meanwhile, this study found that the dietary intake of OPEs through food is relatively low, but twice as high as other studies, requiring serious attention. The research findings suggest that the human risk assessment indicates potential adverse effects on human health due to OPEs in the soil-plant system along the coast of South China. This study provides a crucial foundation for managing safety risks in agricultural operations involving OPEs.

Environmental Risk Assessment in Community Care: A Scoping Review.

Community care encompasses inherent risks for both clients and healthcare providers. Maintaining a safe environment for the delivery of care services ensures that any risk of unintentional or intentional personal harm is minimised. The aim of this scoping review is to (a) provide an overview of existing knowledge by summarising the current literature and (b) identify gaps pertaining to understanding and managing environmental risk in community care settings. Guided by the Population/Concept/Context approach and PRISMA guidelines, this paper used two questions to answer how a score-based tool for assessing client suitability in community care is developed and how an environmental screening tool assists with reducing risk to community care workers. Literature searches of CINAHL, PubMed (Medline), Web of Science and PsychINFO databases were conducted between September 2023 and November 2023. We included full text articles published from 2018 to 2023. The following four broad areas were identified as key components in the structure of an environmental screening tool: environmental factors, health factors, socioeconomic factors and cultural factors. The results of this review provide valuable information which can be utilised by care organisations to develop and/or refine tools to ensure the safety and wellbeing of workers within the community care sector.

Radiographic evaluation of the distance between the restoration margin and the alveolar bone crest in dental implant patients: A retrospective study.

OBJECTIVES: The recently introduced Implant Disease Risk Assessment (IDRA) identifies a restoration margin-alveolar bone crest (RM-AC) distance of less than 1.5 mm as a key risk factor for peri­implant disease among eight major risk factors. This study evaluated the impact of the RM-AC distance on marginal bone loss (MBL) through radiographic analysis. METHODS: This retrospective cross-sectional study included 77 partially edentulous patients (39 females and 38 males, aged 22 to 76 years) with 202 platform-switched conical connection implants, cement-retained, implant-supported fixed restorations, and bone-level implants placed between 2016 and 2021. Dental implants were followed for least 6 to 36 months at follow up functional loading. Study participants were categorized into Group A (RM-AC distance ≤ 1.5 mm, n = 69) and Group B (RM-AC distance > 1.5 mm, n = 133). Twelve patients in Group B and five patients in Group A had no history of periodontal disease. The MBL was measured radiographically from the most coronal point of the implant shoulder to the alveolar bone, and the RM-AC distance was measured from the restoration margin to the alveolar crest. Multinomial logistic regression analysis was used for statistical evaluation. RESULTS: The incidence of MBL in Group A was statistically significant and 3.42 times higher than that in Group B. The rate of MBL in periodontitis Stage 4 was found to be 26.31 times higher than that in periodontitis Stage 2. The incidence of MBL was 6.097 and 5.02 times higher with increasing implant diameter and length, respectively. CONCLUSION: This study conclusively demonstrates that RM-AC distance ≤ 1.5 significantly increases the risk of MBL, particularly in patients with a history of periodontal disease. CLINICAL SIGNIFICANCE: This study highlights the critical role of maintaining an RM-AC distance greater than 1.5 mm in the prevention of MBL, particularly in patients with a history of periodontal disease. Since implant diameter and length have a significant impact on the risk of MBL, it emphasizes that implant demographics should also be carefully evaluated.

Architecture and Development Framework for a Web-Based Risk Assessment and Management Platform Developed on WordPress to Address Opioid Overdose.

The number of overdose-related fatalities continues to reach historic levels across Canada, despite ongoing efforts by authorities. To reduce mortality, a clinical trajectory ranging from preventative measures to crisis intervention, skill training to treatment, and risk assessment to risk management needs to be supported. The web-based Risk Assessment and Management Platform (RAMP) was developed to realize this concept and to empower people who use drugs through an integrated tool that allows them to better understand and manage their risk of overdose. This paper outlines the architecture and development of RAMP, which is built on the WordPress platform. WordPress components are mapped onto a 3-tier architecture that consists of presentation, application, and database layers. The architecture facilitates the development of a modular software that includes several features that are independent in functionality but interact with each other in an integrated platform. The relatively low coupling and high coherence of the features may reduce the cost of maintenance and increase flexibility of future developments. RAMP's architecture comprises a user interface, conceptual framework, and backend layers. The RAMP front end effectively uses some of the WordPress' features such as HTML5, CSS, and JavaScript to create a mobile, friendly, and scalable user interface. The RAMP backend uses several standard and custom WordPress plug-ins to support risk assessment and monitoring, with the goal of mitigating the impacts and eliminating risks together. A rule-based decision support system has been hard-coded to suggest relevant modules and goals to complement each user's lifestyle and goals based on their risk assessment. Finally, the backend uses the MySQL database management system and communicates with the RAMP framework layer via the data access layer to facilitate a timely and secure handling of information. Overall, RAMP is a modular system developed to identify and manage the risk of opioid overdose in the population of people who use drugs. Its modular design uses the WordPress architecture to efficiently communicate between layers and provide a base for external plug-ins. There is potential for the current system to adopt and address other related fields such as suicide, anxiety, and trauma. Broader implementation will support this concept and lead to the next level of functionality.

Exploring honey bee toxicological data as a proxy for assessing dimethoate sensitivity in stingless bees.

The high diversity and distinctive characteristics of stingless bees pose challenges in utilizing toxicity test results for agrochemical registrations. Toxicity assessments were performed on 15 stingless bee species, along with the honey bee, using the insecticide dimethoate, following adapted OECD protocols. Median lethal doses over 24 h (24 h-LD50) were determined for exposure routes (acute oral or contact) and species. Species sensitivity distribution (SSD) curves were constructed and the 5% hazard doses (HD5) were estimated based on 24 h-LD50 values. The SSD curve was adjusted as the body weight and dimethoate response were correlated. Lighter bees (<10 mg) had lower 24 h-LD50 values. Contact exposure for adjusted HD5 suggested insufficient protection for Melipona mondury, whereas the oral exposure HD5 indicated no risks for the other 14 species. Comprehensive risk assessments are crucial for understanding the agrochemical impact on stingless bees, emphasizing the need for a broader species range in formulating conservation strategies.

Size Distributions and Health Risks of Particulate Polycyclic Aromatic Hydrocarbons in the Atmosphere at Coastal Areas in Ningbo, China.

Most current research focusing on the health risk assessments of particulate polycyclic aromatic hydrocarbons (PAHs) have not analyzed the size distributions and human respiratory deposition rates. In the present study, size-separated particulate matter (PM) was collected in the coastal area of Ningbo using an Anderson eight-stage air sampler over a 1-year period (2014-2015). The 16 US Environmental Protection Agency priority PAHs associated with PM were pretreated with rapid solvent extraction and analyzed by gas chromatography-mass spectrometry. The respiratory exposure assessment was determined using the multiple-path particle dosimetry (MPPD) model. The results show that all PAHs exhibited bimodal distribution with one mode peak in accumulation mode (0.43-0.65 µm) and another mode peak in coarse mode (4.7-5.8 µm). In addition, a low coefficient of divergence of PAHs between PM2.1 and PM2.1-10 indicated a high spatial heterogeneity in source factor contribution and formation mechanism. The deposition fluxes (tracheobronchial + pulmonary) of PM were highest for children in the size range of 3.3 µm < particle diameter (Dp) < 9 µm, while for males and females the highest fluxes occurred in the size range of 1.1 µm < Dp < 2.1 µm. The depositions of coarse PM in children were significantly higher than those in adults. The benzo[a]pyrene equivalent (BaPeq) depositions of dibenz[a,h]anthracene ranged from 1.4e-04 to 0.015 ng h-1, which were highest among the PAHs. The PAHs on particles with Dp >4.7 µm contributed approximately three times more to children than to males and females. Therefore, the toxicity of coarse PM to children needed attention. The incremental lifetime cancer risks (ILCR) for children, males, and females were estimated to be 2.92 × 10-7, 1.82 × 10-7, and 2.38 × 10-7, respectively, which were below the cancer risk guideline value (10-6). These ILCR values were much lower than the risks calculated without considering particle size distributions and respiratory depositions. The combination of the size-segregated sampling technique and the MPPD model can effectively avoid the overestimation of human respiratory exposure. Environ Toxicol Chem 2024;43:1364-1377. © 2024 SETAC.

External validation and update of the International Medical Prevention Registry on Venous Thromboembolism bleeding risk score for predicting bleeding in acutely ill hospitalized medical patients: a retrospective single-center cohort study in Japan.

BACKGROUND: The International Medical Prevention Registry for Venous Thromboembolism (IMPROVE) Bleeding Risk Score is the recommended risk assessment model (RAM) for predicting bleeding risk in acutely ill medical inpatients in Western countries. However, few studies have assessed its predictive performance in local Asian settings. METHODS: We retrospectively identified acutely ill adolescents and adults (aged ≥ 15 years) who were admitted to our general internal medicine department between July 5, 2016 and July 5, 2021, and extracted data from their electronic medical records. The outcome of interest was the cumulative incidence of major and nonmajor but clinically relevant bleeding 14 days after admission. For the two-risk-group model, we estimated sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively). For the 11-risk-group model, we estimated C statistic, expected and observed event ratio (E/O), calibration-in-the-large (CITL), and calibration slope. In addition, we recalibrated the intercept using local data to update the RAM. RESULTS: Among the 3,876 included patients, 998 (26%) were aged ≥ 85 years, while 656 (17%) were hospitalized in the intensive care unit. The median length of hospital stay was 14 days. Clinically relevant bleeding occurred in 58 patients (1.5%), 49 (1.3%) of whom experienced major bleeding. Sensitivity, specificity, NPV, and PPV were 26.1% (95% confidence interval [CI]: 15.8-40.0%), 84.8% (83.6-85.9%), 98.7% (98.2-99.0%), and 2.5% (1.5-4.3%) for any bleeding and 30.9% (95% CI: 18.8-46.3%), 84.9% (83.7-86.0%), 99.0% (98.5-99.3%), and 2.5% (1.5-4.3%) for major bleeding, respectively. The C statistic, E/O, CITL, and calibration slope were 0.64 (95% CI: 0.58-0.71), 1.69 (1.45-2.05), - 0.55 (- 0.81 to - 0.29), and 0.58 (0.29-0.87) for any bleeding and 0.67 (95% CI: 0.60-0.74), 0.76 (0.61-0.87), 0.29 (0.00-0.58), and 0.42 (0.19-0.64) for major bleeding, respectively. Updating the model substantially corrected the poor calibration observed. CONCLUSIONS: In our Japanese cohort, the IMPROVE bleeding RAM retained the reported moderate discriminative performance. Model recalibration substantially improved the poor calibration obtained using the original RAM. Before its introduction into clinical practice, the updated RAM needs further validation studies and an optimized threshold.

Safety and Effectiveness of the High-Sensitivity Cardiac Troponin HEART Pathway in Patients With Possible Acute Coronary Syndrome.

BACKGROUND: The HEART Pathway (History, Electrocardiogram, Age, Risk factors, Troponin) can be used with high-sensitivity cardiac troponin to risk stratify emergency department patients with possible acute coronary syndrome. However, data on whether a high-sensitivity HEART Pathway (hs-HP) are safe and effective is lacking. METHODS: An interrupted time series study was conducted at 5 North Carolina sites in 26 126 adult emergency department patients being investigated for possible acute coronary syndrome and without ST-segment-elevation myocardial infarction. Patients were accrued into 16-month preimplementation and postimplementation cohorts with a 6-month wash-in phase. Preimplementation (January 2019 to April 2020), the traditional HEART Pathway was used with 0- and 3-hour contemporary troponin measures (Siemens). In the postimplementation period (November 2020 to February 2022), a modified hs-HP was used with 0- and 2-hour high-sensitivity cardiac troponin (Beckman Coulter) measures. The primary safety and effectiveness outcomes were 30-day all-cause death or myocardial infarction and 30-day hospitalizations. These outcomes and early discharge rate (emergency department discharge without stress testing or coronary angiography) were determined from health records and death index data. Outcomes were compared preimplementation versus postimplementation using χ2 tests and multivariable logistic regression to adjust for potential confounders. RESULTS: Preimplementation and postimplementation cohorts included 12 317 and 13 809 patients, respectively, of them 52.7% (13 767/26 126) were female with a median age of 54 years (interquartile range, 42-66). Rates of 30-day death or MI were 6.8% (945/13 809) postimplementation and 7.7% (948/12 317) preimplementation (adjusted odds ratio, 1.00 [95% CI, 0.90-1.11]). hs-HP implementation was associated with 19.9% (95% CI, 18.7%-21.1%) higher early discharges (post versus pre: 63.6% versus 43.7%; adjusted odds ratio, 2.22 [95% CI, 2.10-2.35]). The hs-HP was also associated with 16.1% (95% CI, 14.9%-17.3%) lower 30-day hospitalizations (postimplementation versus preimplementation, 31.4% versus 47.5%; adjusted odds ratio, 0.51 [95% CI, 0.48-0.54]). Among early discharge patients, death or myocardial infarction occurred in 0.5% (41/8780) postimplementation versus 0.4% (22/5383) preimplementation (P=0.61). CONCLUSIONS: hs-HP implementation is associated with increased early discharges without increasing adverse events. These findings support the use of a modified hs-HP to improve chest pain care.