What We Know about and What Is New in Primary Aldosteronism.

Primary aldosteronism (PA), a significant and curable cause of secondary hypertension, is seen in 5-10% of hypertensive patients, with its prevalence contingent upon the severity of the hypertension. The principal aetiologies of PA include bilateral idiopathic hypertrophy (BIH) and aldosterone-producing adenomas (APAs), while the less frequent causes include unilateral hyperplasia, familial hyperaldosteronism (FH) types I-IV, aldosterone-producing carcinoma, and ectopic aldosterone synthesis. This condition, characterised by excessive aldosterone secretion, leads to augmented sodium and water reabsorption alongside potassium loss, culminating in distinct clinical hallmarks: elevated aldosterone levels, suppressed renin levels, and hypertension. Notably, hypokalaemia is present in only 28% of patients with PA and is not a primary indicator. The association of PA with an escalated cardiovascular risk profile, independent of blood pressure levels, is notable. Patients with PA exhibit a heightened incidence of cardiovascular events compared to counterparts with essential hypertension, matched for age, sex, and blood pressure levels. Despite its prevalence, PA remains frequently undiagnosed, underscoring the imperative for enhanced screening protocols. The diagnostic process for PA entails a tripartite assessment: the aldosterone/renin ratio (ARR) as the initial screening tool, followed by confirmatory and subtyping tests. A positive ARR necessitates confirmatory testing to rule out false positives. Subtyping, achieved through computed tomography and adrenal vein sampling, aims to distinguish between unilateral and bilateral PA forms, guiding targeted therapeutic strategies. New radionuclide imaging may facilitate and accelerate such subtyping and localisation. For unilateral adrenal adenoma or hyperplasia, surgical intervention is optimal, whereas bilateral idiopathic hyperplasia warrants treatment with mineralocorticoid antagonists (MRAs). This review amalgamates established and emerging insights into the management of primary aldosteronism.

Key to the Treatment of Primary Aldosteronism in Secondary Hypertension: Subtype Diagnosis.

PURPOSE OF REVIEW: Primary aldosteronism (PA) is a leading global cause of secondary hypertension. Subtyping diagnosis of PA is the key to surgery, but accurate classification of PA is crucial but challenging in clinical diagnosis and treatment. The purpose of this review is to provide a summary of current literature and propose subtyping diagnosis flow chart to help us classify PA quickly and accurately. RECENT FINDINGS: Early diagnosis and accurate typing are essential for the timely treatment and appropriate management of PA. For most patients, adrenal venous sampling (AVS) is the central choice for typing diagnosis, but AVS is invasive and difficult to promote effectively. CT can help identify unilateral typical adenomas in select patients to avoid AVS. New radionuclide imaging has shown value in the diagnosis and classification of PA, which distinguishes adrenocortical hyperplasia from adenoma and can replace AVS in some patients. Accurately diagnosing unilateral PA is crucial for determining the appropriate treatment strategy for PA. The simple flow chart of PA subtyping diagnosis based on the current literature needs to be verified and evaluated by follow-up researches.

Systematic and Comprehensive Review of Clustering and Multi-Target Tracking Techniques for LiDAR Point Clouds in Autonomous Driving Applications.

Autonomous vehicles (AVs) rely on advanced sensory systems, such as Light Detection and Ranging (LiDAR), to function seamlessly in intricate and dynamic environments. LiDAR produces highly accurate 3D point clouds, which are vital for the detection, classification, and tracking of multiple targets. A systematic review and classification of various clustering and Multi-Target Tracking (MTT) techniques are necessary due to the inherent challenges posed by LiDAR data, such as density, noise, and varying sampling rates. As part of this study, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was employed to examine the challenges and advancements in MTT techniques and clustering for LiDAR point clouds within the context of autonomous driving. Searches were conducted in major databases such as IEEE Xplore, ScienceDirect, SpringerLink, ACM Digital Library, and Google Scholar, utilizing customized search strategies. We identified and critically reviewed 76 relevant studies based on rigorous screening and evaluation processes, assessing their methodological quality, data handling adequacy, and reporting compliance. As a result of this comprehensive review and classification, we were able to provide a detailed overview of current challenges, research gaps, and advancements in clustering and MTT techniques for LiDAR point clouds, thus contributing to the field of autonomous driving. Researchers and practitioners working in the field of autonomous driving will benefit from this study, which was characterized by transparency and reproducibility on a systematic basis.

Homo Viator 2020s: electrified and internet-based personal mobilities.

Homo Viator [traveling Man] refers in this article to the mobile individuals of the 2020s, gradually exposed to EVs (electric vehicles) and AVs (autonomous vehicles), as electricity-based and Internet-dependent personal road transport, respectively. This article examines the similarities and differences between the electrification and Internetizing of terrestrial personal mobilities and assesses the significance of these two trends for physically moving individuals, mobile society, and mobility-based urban space. EVs are already increasingly adopted, whereas AVs are still mostly being tested. Internet-based communications have already become universally adopted. Electricity and the Internet differ from each other, notably as far as the car industry is concerned, by their roles, modes of production, transmission channels, and storage. For individuals, EVs and AVs differ from each other in several ways: The degree of personal operations and the required accounting and licensing; the ability to move human-made products electronically; ergonomic aspects; travel and communications as an experience; and interactions with fellow individuals. From a societal perspective, the universal use of electricity and the Internet for road transport will require strict security assurance for their production and transmission. In addition, the importance of the relevant communications and electricity professions will grow. On yet another end, the ability to work during car riding may blur the buffer time between work and home. Spatially, EV-based cities will be quieter and cleaner ones, whereas AV-based cities will be characterized by removing traffic lights and road signs, coupled with the availability of more parking spaces.

Lp(a): a New Pathway to Target?

PURPOSE OF REVIEW: Over the past decades, genetic and observational evidence has positioned lipoprotein(a) as novel important and independent risk factor for cardiovascular disease (ASCVD) and aortic valve stenosis. RECENT FINDINGS: As Lp(a) levels are determined genetically, lifestyle interventions have no effect on Lp(a)-mediated ASCVD risk. While traditional low-density lipoprotein cholesterol (LDL-C) can now be effectively lowered in the vast majority of patients, current lipid lowering therapies have no clinically relevant Lp(a) lowering effect. There are multiple Lp(a)-directed therapies in clinical development targeting LPA mRNA that have shown to lower Lp(a) plasma levels for up to 90%: pelacarsen, olpasiran, and SLN360. Pelacarsen is currently investigated in a phase 3 cardiovascular outcome trial expected to finish in 2024, while olpasiran is about to proceed to phase 3 and SLN360's phase 1 outcomes were recently published. If proven efficacious, Lp(a) will soon become the next pathway to target in ASCVD risk management.

A prospective study on the application of HINTS in distinguishing the localization of acute vestibular syndrome.

BACKGROUND: Acute vestibular syndrome (AVS) is a common clinical syndrome in neurology clinics and emergency department. Canonical standard for AVS diagnosis requires the presence of persistent vertigo for more than 24 h. HINTS (head impulse-nystagmus-test of skew) is an emerging scheme in the diagnosis of AVS. In this prospective study, we evaluated the specificity and sensitivity of HINTS in distinguishing between central and peripheral AVS. METHODS: A cohort of 239 cases with complete clinical record was recruited in the study. All patients completed emergency brain CT examination to exclude hemorrhagic stroke. HINTS examination was conducted to distinguish between central AVS and peripheral AVS, and all patients completed head MRI, BAEP and vestibular function examinations within one week. Patients diagnosed as central AVS were subject to angiography (CTA/MRA/DSA), and patients with peripheral AVS were considered for a 3-month follow-up to correct the initial diagnosis. RESULTS: Patients with central AVS were associated with an elder age, higher incidences of hypertension, atrial fibrillation, family history of stroke and previous history of stroke. Posterior circulation cerebral infarction, vestibular migraine and cerebellitis were the dominant diseases associated with central AVS. The sensitivities of HIT, GE, and TS in the diagnosis of central AVS were 73.5%, 61.2%, and 26.5%, and the specificities were 97.9%, 92.6%, and 93.2% respectively. CONCLUSIONS: The sensitivity of HINTS for central AVS diagnosis is 89.8% and the specificity is 84.2%. HINTS is an easy-to-operate, low-cost, high-sensitivity and specific examination technique, which is practical in neurology outpatient clinics and emergency departments.

Adaptive Articulation Angle Preview-Based Path-Following Algorithm for Tractor-Semitrailer Using Optimal Control.

Most existing Path-Following Algorithms (PFAs) are developed for single-unit vehicles (SUVs) and rarely for articulated vehicles (AVs). Since these PFAs ignore the motion of the trailer, they may cause large tracking deviations and ride stability issues when cornering. To this end, an Adaptive Articulation Angle Preview-based Path-Following Algorithm (AAAP-PFA) is proposed for AVs. Different from previous PFAs, in this model, a simple linear vehicle dynamics model is used as the prediction model, and an offset distance calculated by an articulation angle is used as part of the preview distance. An adaptive posture control strategy is designed to trade off the trajectory tracking performance and lateral stability performance during the path-following process. Considering a large prediction mismatch caused by using a linear vehicle dynamics model, a feedback correction method is proposed to improve the robustness of the steering control. In the comparison simulation experiment with SUV-PFA, it is confirmed that the novel PFA has better adaptability to the contradictory relationship between tracking performance and lateral stability and has strong steering control robustness.

Simultaneous PAHs degradation, odour mitigation and energy harvesting by sediment microbial fuel cell coupled with nitrate-induced biostimulation.

The study investigates a bioremediation process of polycyclic aromatic hydrocarbons (PAHs) removal and odour mitigation combined with energy harvesting. Sediment microbial fuel cells (SMFCs) were constructed with the addition of nitrate in the sediment to simultaneously remove acid-volatile sulphide (AVS) and PAHs. With the combined nitrate-SMFC treatment, over 90% of the AVS was removed from the sediment in 6 weeks of the SMFC operation and a maximum of 94% of AVS removal efficiency was reached at Week 10. The highest removal efficiencies of phenanthrene, pyrene, and benzo[a]pyrene was 93%, 80%, and 69%, respectively. The maximum voltage attained for the combined nitrate-SMFC treatment was 341 mV. Illumina HiSeq sequencing revealed that the autotrophic denitrifiers Thiobacillus are the dominant genus. In electricity generation, both sulphide-oxidation and PAH-oxidation are the possible pathways. Besides, the addition of nitrate stimulated the growth of Pseudomonas which is responsible for the electricity generation and direct biodegradation of the PAHs, indicating a synergistic effect. The developed bioremediation process demonstrated the potential in the in-situ bioremediation process utilizing SMFC combined with nitrate-induced bioremediation.

Evaluation of Adrenal Vein Sampling Use and Outcomes in Patients With Primary Aldosteronism.

BACKGROUND: Primary aldosteronism (PA) occurs in 10%-20% of patients with resistant hypertension. Guidelines recommend adrenal vein sampling (AVS) to identify patients for surgical management. We evaluate the use of AVS in managing PA to better understand the selection and outcomes of medical versus surgical treatment. METHODS: A retrospective review was performed, and patients were divided into those who did (AVS) and did not have AVS (non-AVS). Demographics, aldosterone and renin levels, blood pressure, comorbidities, and antihypertensive medications were recorded. Reasons to defer AVS and medical versus surgical decision-making were examined and groups were compared. RESULTS: We included 113 patients; 39.8% (45/113) had AVS, whereas 60.2% (68/113) did not. Groups were similar in age, body mass index, and initial systolic blood pressure (SBP). In patients who underwent AVS, 31 of 45 (68.9%) had unilateral secretion and were referred for surgery, whereas 13 of 45 (28.9%) had bilateral secretion. Of the 31 referred for surgery, 26 underwent laparoscopic adrenalectomy, all cured; four refused surgery; and one counseled toward medical management by their physician. In 68 non-AVS patients, 6 (8.8%) underwent adrenalectomy without sampling and 2 with no clinical improvement. The remaining deferrals were because of normal or bilateral adrenal nodules on imaging (8/68, 11.8%); medical management due to poor surgical candidacy (12/68, 17.6%); patient refusal of intervention (13/68, 19.1%); or reasons not stated (28/68, 41.1%). At the follow-up, patients who underwent AVS had lower median SBP (135.4 mmHg versus 144.7 mmHg, P = 0.0241) and shorter follow-up (17.7 mo versus 54.0 mo, P < 0.0001). Surgically managed patients had biochemical resolution of PA with normalization of potassium levels (3.6 to 4.7mEq/L, P < 0.00001). CONCLUSIONS: AVS correctly selects patients for surgical management avoiding unnecessary surgery. However, despite guidelines, AVS is not always pursued as part of PA treatment, potentially excluding surgical candidates.

Toward Implementing the ADC Model of Moral Judgment in Autonomous Vehicles.

Autonomous vehicles (AVs)-and accidents they are involved in-attest to the urgent need to consider the ethics of artificial intelligence (AI). The question dominating the discussion so far has been whether we want AVs to behave in a 'selfish' or utilitarian manner. Rather than considering modeling self-driving cars on a single moral system like utilitarianism, one possible way to approach programming for AI would be to reflect recent work in neuroethics. The agent-deed-consequence (ADC) model (Dubljevic and Racine in AJOB Neurosci 5(4):3-20, 2014a, Behav Brain Sci 37(5):487-488, 2014b) provides a promising descriptive and normative account while also lending itself well to implementation in AI. The ADC model explains moral judgments by breaking them down into positive or negative intuitive evaluations of the agent, deed, and consequence in any given situation. These intuitive evaluations combine to produce a positive or negative judgment of moral acceptability. For example, the overall judgment of moral acceptability in a situation in which someone committed a deed that is judged as negative (e.g., breaking a law) would be mitigated if the agent had good intentions and the action had a good consequence. This explains the considerable flexibility and stability of human moral judgment that has yet to be replicated in AI. This paper examines the advantages and disadvantages of implementing the ADC model and how the model could inform future work on ethics of AI in general.

Simultaneous bilateral adrenal vein sampling for primary aldosteronism: useful tips to make it simple and safe.

Adrenal vein sampling (AVS) is the key test for subtyping patients with primary aldosteronism (PA) before referring those with unilateral disease for laparoscopic unilateral adrenalectomy. However, it is still not systematically used, despite guidelines recommendations, because it is still considered as an invasive, risky, and challenging procedure. Simultaneous bilateral catheterization is believed to add technical difficulties inherent with attempting to catheterize both adrenal veins at the same time, but can be useful to minimize differences between the sides due to timing. We herein report on the protocol for routine clinical use. Tips for preparation of the patient as well as optimal catheterization of adrenal veins and sampling are provided to propose a protocol that is easy, safe, and reliable. Key Points • Adrenal vein sampling is the reference standard in the case of primary aldosteronism to detect the hyper-functioning side and allow subsequent treatment. • Simultaneous bilateral adrenal vein sampling avoids bias related to sampling timing. • Some technical suggestions concerning patient preparation and catheterization are proposed to make simultaneous adrenal vein sampling easier and safer.

The Floccular Syndrome: Dynamic Changes in Eye Movements and Vestibulo-ocular Reflex in Isolated Infarction of the Cerebellar Flocculus.

The cerebellar flocculus is a critical structure involved in the control of eye movements. Both static and dynamic abnormalities of the vestibulo-ocular reflex (VOR) have been described in animals with experimental lesions of the flocculus/paraflocculus complex. In humans, lesions restricted to the flocculus are rare so they can become an exceptional model to contrast with the clinical features in experimental animals or in patients with more generalized cerebellar diseases. Here, we examined a 67-year-old patient with an acute vestibular syndrome due to an isolated infarct of the right flocculus. We evaluated him multiple times over 6 months-to follow the changes in eye movements and vestibular function-with caloric testing, video-oculography and head-impulse testing, and the anatomical changes on imaging. Acutely, he had an ipsilateral-beating spontaneous nystagmus, bilateral gaze-evoked nystagmus, borderline impaired smooth pursuit, and a complete contraversive ocular tilt reaction. The VOR gain was reduced for head impulses directed contralateral to the lesion, and there was also an ipsilesional caloric weakness. All abnormalities progressively improved at follow-up visits but with a considerable reduction in volume of the affected flocculus on imaging. The vestibular and ocular motor findings, qualitatively similar to a previously reported patient, further clarify the "acute floccular syndrome" in humans. We also add new information about the pattern of recovery from such a lesion with corresponding changes in the size of the affected flocculus on imaging.

An Improved Azimuth Angle Estimation Method with a Single Acoustic Vector Sensor Based on an Active Sonar Detection System.

In this paper, an improved azimuth angle estimation method with a single acoustic vector sensor (AVS) is proposed based on matched filtering theory. The proposed method is mainly applied in an active sonar detection system. According to the conventional passive method based on complex acoustic intensity measurement, the mathematical and physical model of this proposed method is described in detail. The computer simulation and lake experiments results indicate that this method can realize the azimuth angle estimation with high precision by using only a single AVS. Compared with the conventional method, the proposed method achieves better estimation performance. Moreover, the proposed method does not require complex operations in frequencydomain and achieves computational complexity reduction.

Accelerated Evaluation of Automated Vehicles Safety in Lane-Change Scenarios Based on Importance Sampling Techniques.

Automated vehicles (AVs) must be thoroughly evaluated before their release and deployment. A widely used evaluation approach is the Naturalistic-Field Operational Test (N-FOT), which tests prototype vehicles directly on the public roads. Due to the low exposure to safety-critical scenarios, N-FOTs are time consuming and expensive to conduct. In this paper, we propose an accelerated evaluation approach for AVs. The results can be used to generate motions of the other primary vehicles to accelerate the verification of AVs in simulations and controlled experiments. Frontal collision due to unsafe cut-ins is the target crash type of this paper. Human-controlled vehicles making unsafe lane changes are modeled as the primary disturbance to AVs based on data collected by the University of Michigan Safety Pilot Model Deployment Program. The cut-in scenarios are generated based on skewed statistics of collected human driver behaviors, which generate risky testing scenarios while preserving the statistical information so that the safety benefits of AVs in nonaccelerated cases can be accurately estimated. The cross-entropy method is used to recursively search for the optimal skewing parameters. The frequencies of the occurrences of conflicts, crashes, and injuries are estimated for a modeled AV, and the achieved accelerated rate is around 2000 to 20 000. In other words, in the accelerated simulations, driving for 1000 miles will expose the AV with challenging scenarios that will take about 2 to 20 million miles of real-world driving to encounter. This technique thus has the potential to greatly reduce the development and validation time for AVs.

Distribution and assessment of heavy metal toxicity in sediment cores from Bizerte Lagoon, Tunisia.

To examine the state of pollution of Bizerte Lagoon which is exposed to intense anthropogenic pressure, two sediment cores were taken at two sites, one undergoes the dual effects of both marine waters arriving from the Mediterranean Sea through the Channel, and also of freshwater from the Tinja River; the other core is located at the center of the lagoon where water depth is maximal (12 m). Heavy metal concentrations in the two cores were assessed, with calculated enrichment factors and geo-accumulation indexes. Core sediments were also studied for chemical speciation and their monosulfide contents were measured. Results from enrichment factors and geo-accumulation indexes show an accumulation of Cd, Zn, Cr, and Pb, while chemical speciation revealed a risk only from Cd and Mn. Comparison of sequential extraction values with those of acid volatile sulfides revealed that non-toxic effects may be caused by any of the studied metals in the sediment.

Awareness and Use of the After-Visit Summary Through a Patient Portal: Evaluation of Patient Characteristics and an Application of the Theory of Planned Behavior.

BACKGROUND: Patient portals are being used to provide a clinical summary of the office visit or the after-visit summary (AVS) to patients. There has been relatively little research on the characteristics of patients who access the AVS through a patient portal and their beliefs about the AVS. OBJECTIVE: The aim was to (1) assess the characteristics of patients who are aware of and access the AVS through a patient portal and (2) apply the Theory of Planned Behavior (TPB) to predict behavioral intention of patients toward accessing the AVS provided through a patient portal. METHODS: We developed a survey capturing the components of TPB (beliefs, attitude, perceived norm, and perceived behavioral control). Over a 6-month period, patients with a patient portal account with an office visit in the previous week were identified using our organization's scheduling system. These patients were sent an email about the study and a link to the survey via their portal account. We applied univariate statistical analysis (Pearson chi-square and 1-way ANOVA) to assess differences among groups (aware/unaware of AVS and accessed/did not access AVS). We reported means and standard deviations to depict belief strengths and presented correlations between beliefs and attitude, perceived norm, and perceived behavioral control. We used hierarchical regression analysis to predict behavioral intention toward accessing the AVS through the patient portal. RESULTS: Of the 23,336 patients who were sent the survey, 5370 responded for a response rate of 23.01%. Overall, 76.52% (4109/5370) were aware that the AVS was available through the patient portal and 54.71% of those (2248/4109) accessed the AVS within 5 days of the office visit. Patients who accessed the AVS had a greater number of sessions with the portal (mean 119, SD 221.5) than those who did not access the AVS (mean 79.1, SD 123.3, P<.001); the difference was not significant for awareness of the AVS. The strongest behavioral beliefs with accessing the AVS were being able to track visits and tests (mean 2.53, SD 1.00) followed by having medical information more readily accessible (mean 2.48, SD 1.07). In all, 56.7% of the variance in intention to access the AVS through the portal was accounted for by attitude, perceived norm, and perceived behavioral control. CONCLUSIONS: Most users of a patient portal were aware that the AVS was accessible through the portal. Patients had stronger beliefs about accessing the AVS with the goal of timely and efficient access of information than with engaging in their health care. Interventions to improve patient access of the AVS can focus on providers promoting patient beliefs about the value of the AVS for tracking tests and visits, and timely and efficient access of information.

Acartia tonsa eggs as a biomonitor to evaluate bioavailability/toxicity of persistent contaminants in anoxic/sulfidic conditions: The case of cadmium and nickel.

The evaluation of toxicity due to persistent pollutants in anoxic aquatic environments has met with various problems, as most test organisms can not withstand oxygen lack and exposure to free sulfide. We evaluated the suitability of the eggs of the brackish copepod Acartia tonsa for bioassays in anoxic/sulfidic conditions: when exposed to deep hypoxia and free sulfide, the eggs become quiescent and are able to resume hatching after restoring normoxic conditions. Tests with cadmium and nickel were performed in normoxic and deeply hypoxic conditions and in anoxic water containing H2S or H2S+FeSO4 on an equimolar basis. Active and quiescent eggs showed equivalent sensitivity to the metals, both suffering significant reductions in hatching success at 89µM Cd and 17µM Ni. As expected on the basis of the SEM/AVS model, Cd toxicity was almost completely suppressed in presence of sulfides. Dissolved Cd concentration drastically dropped and hatching success was generally >80%, as against values <6% observed in sulfide-free water, indicating that the applied experimental procedure can simulate metal-sulfide interaction. Ni toxicity was only slightly reduced by the presence of sulfides. High dissolved Ni concentrations were detected and mean hatching percentages were ≤32%, suggesting that Ni bioavailability/toxicity was only partially controlled by excess reactive sulfides. The results suggest that A. tonsa eggs could be a useful biomonitor to evaluate toxicity due persistent contaminants in anoxic conditions and the role of sulfides in reducing metal bioavailability/toxicity.

Open-Loop Audio-Visual Stimulation (AVS): A Useful Tool for Management of Insomnia?

Audio Visual Stimulation (AVS), a form of neurofeedback, is a non-pharmacological intervention that has been used for both performance enhancement and symptom management. We review the history of AVS, its two sub-types (close- and open-loop), and discuss its clinical implications. We also describe a promising new application of AVS to improve sleep, and potentially decrease pain. AVS research can be traced back to the late 1800s. AVS's efficacy has been demonstrated for both performance enhancement and symptom management. Although AVS is commonly used in clinical settings, there is limited literature evaluating clinical outcomes and mechanisms of action. One of the challenges to AVS research is the lack of standardized terms, which makes systematic review and literature consolidation difficult. Future studies using AVS as an intervention should; (1) use operational definitions that are consistent with the existing literature, such as AVS, Audio-visual Entrainment, or Light and Sound Stimulation, (2) provide a clear rationale for the chosen training frequency modality, (3) use a randomized controlled design, and (4) follow the Consolidated Standards of Reporting Trials and/or related guidelines when disseminating results.

Assessment of heavy metals pollution using AVS-SEM and fractionation techniques in Edku Lagoon sediments, Mediterranean Sea, Egypt.

A method is presented to evaluate the fractionation of metals (Fe, Zn, Cu, Pb, Cd and Ni), acid volatile sulfide (AVS) and simultaneously extracted metals (SEM) in Edku lagoon sediments. Thirteen sediment samples were collected from the study area in the period of 2010-2011 to assess the potential bioavailability and toxicity of the selected metals. According to classification of the Interim Sediment Quality Quidelines (ISQG), five stations near the drains exhibited 10% toxic probability. The high AVS and low ∑SEM ranges in Summer were identified as 6-138 and 0.86-3.3 µmol g(-1) dry wet, respectively which are referring to the low mobility of heavy metals in this season and vice versa for winter (2.5-23.9 and 1.16-3.82 µmol g(-1) dry wet, respectively). According to the evaluation of USEPA, all sediment samples showed ∑SEM/AVS < 1 and ΣSEM-AVS < 0 and this indicates that Edku lagoon sediments didn't cause any adverse effects. Meanwhile, the calculations of the global contamination factor (GCF) and the individual contamination factors (ICF) using fractionation technique gave values of 111.644 and 84.555 in El Bosily drain and station 1 near the cages of fish farm, respectively due to possible contamination. Interestingly, the collected data refer that the mobility and bioavailability of heavy metals in Edku lagoon sediments posed a low risk of adverse biological effects due to cadmium, copper, lead, nickel and zinc in all evaluated stations.

Innovations in Practice: Further evidence on the effectiveness of the strengths and difficulties added value score as an outcome measure for child and adolescent services.

BACKGROUND: The Strengths and Difficulties Added Value Score (SDQ AVS) uses a large epidemiological study to predict follow-up parental SDQ scores for the evaluation of routine outcomes. METHOD: We tested the prediction of the SDQ AVS derived from a national population survey separately on scores for the waiting list control and intervention groups in a randomised controlled trial. If the SDQ AVS is to be clinically useful, it needs to function as expected across different populations. RESULTS: In the control arm, the SDQ AVS predicted an effect size of 0.15 (95% CI -0.01-0.30) compared to an expected effect size of 0, as the children in this arm received no treatment. In the experimental arm, the SDQ AVS predicted an effect size of 0.62 (95% CI 0.42-0.83) compared to the study effect size of 0.53. Change scores overestimated the effect size in both arms (control 0.50 95% CI 0.34-0.66, intervention 0.85 95% CI 0.66-1.04). CONCLUSION: Our findings suggest that the SDQ AVS adjusts for spontaneous improvement, regression to the mean and attenuation.