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Natural barriers, encompassing stable geological formations that serve as the final bastion against radionuclide transport, are paramount in mitigating the long-term contamination risks associated with the nuclear waste disposal. Therefore, it is important to simulate and predict the processes and spatial-temporal distributions of radionuclide transport within these barriers. However, accurately predicting radionuclide transport on the field scale is challenging due to uncertainties associated with parameter scaling. This study develops an integrated evaluation framework that combines upscaled parameters, streamline transport models, and response surface techniques to systematically assess environmental risk metrics and parameter uncertainties across different scales. Initially, upscaling methods are established to estimate the prior interval of critical transport parameters at the field scale, and streamline models are derived by considering the radionuclides transport with a variety of physicochemical mechanisms and geological characterizations in natural barriers. To assess uncertainty ranges of the risk metrics related to upscaled parameters, uncertainty quantification is performed on the ground of 5000 Monte Carlo simulations. The results indicate that the upscaled dispersivity of fractured media (αLf) has a relatively high sensitivity ranking on release dose for all nuclides, and upscaled matrix sorption coefficient (Kd) of Pu-242 strongly affects breakthrough time and release dose of Pu-242. Facilitated by robust response surface with the lowest R2 of 0.89, it is shown that the release doses of Pu-242 and Pb-210 increase under conditions of low Kd and αLf, respectively. Furthermore, statistical analysis reveals that employing limited laboratory-scale parameters results in narrower confidence intervals for risk metrics, while upscaling methods better account for the highly heterogeneous properties of large-scale field conditions. The developed risk evaluation framework provides valuable insights for utilizing upscaled parameters and modeling radionuclide transport within natural barriers under various scenarios.

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Given the convenience of using plastics, addressing the growing concerns about their hazardous health effects is imperative. Consequently, a comprehensive risk assessment is necessary to gauge the potential harm microplastics pose. With its urgent call to action, this study aimed to investigate the indoor source and abundance of microplastics in private dental units during routine professional activities. The current analyzed microplastic quantity variations based on morphological characteristics, seasonal fluctuations and polymer-types. The polymer hazard index (PHI) was calculated to evaluate the significant human health risks posed to dental professionals by inhalation of microplastics. Dust samples were collected using a clean brush and steel pan from various flat and horizontal surfaces within each dental unit. The study found that clinical dental units had fewer microplastics (587 ± 184.9 MPs/g/day) than teaching hospitals (1083.80 ± 133.7MPs/g/day), with comparatively more abundance in winter (31 %). ATR-FTIR analysis determined polyethylene terephthalate to be a more abundant polymer (39 %). This study also found an average inhalation microplastic intake risk of 20.23 MP/g/day and 5259.85 MP/g/year for clinical and 29.45 MP/g/day and 765.12 MP/g/year for teaching hospital dental units. Female dental professionals have 1.1 times more microplastic inhalation risks than male dental professionals. According to PHI findings, overall minor to medium polymer risk was determined. In conclusion, this evidence-based research underscores the urgent need for a shift towards more sustainable practices in the dental healthcare sector. Dental professionals should prioritize using non-plastic material protective equipment and a proper ventilation system to reduce exposure to these particles.

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This research investigates the ecological impacts of heavy metals in downstream river sediments with a focus on carbon emission efficiency in agriculture under the environmental regulation context. In this study, thirty sediment samples have been taken from the downstream region of the Shichuanhe River located in Xi'an, Shaanxi province, China, to analyze the availability of heavy metals. The results show that there are high ecological impacts in relation to the heavy metals and that impacts the carbon emission efficiency in agriculture directly. The analysis has also found the importance of significant environmental regulations in the management of such risks. This research has offered a unique angle on the relationship between heavy metal pollution and agricultural carbon release and has given important information on the improvement of environmental control measures. The implications highlight the need for the implementation of measures to enhance the policies that will help to prevent the ecological threats that are connected with heavy metals in the agricultural areas and, thus, improve the management of the environment.

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The realization of a harmonious relationship between the natural environment and economic development has always been the unremitting pursuit of traditional mineral resource-based cities. With rich reserves of iron and coal ore resources, Laiwu has become an important steel production base in Shandong Province in China, after several decades of industrial development. However, some serious environmental problems have occurred with the quick development of local steel industries, with ground subsidence and consequent secondary disasters as the most representative ones. To better evaluate possible ground collapse risk, comprehensive approaches incorporating the common deformation monitoring with small-baseline subset (SBAS)-synthetic aperture radar interferometry (InSAR) technique, environmental factors analysis, and risk evaluation are designed here with ALOS PALSAR and Sentinel-1 SAR observations. A retrospect on the ground deformation process indicates that ground deformation has largely decreased by around 51.57% in area but increased on average by around -5.4 mm/year in magnitude over the observation period of Sentinel-1 (30 July 2015 to 22 August 2022), compared to that of ALOS PALSAR (17 January 2007 to 28 October 2010). To better reveal the potential triggering mechanism, environmental factors are also utilized and conjointly analyzed with the ground deformation time series. These analysis results indicate that the ground deformation signals are highly correlated with human industrial activities, such underground mining, and the operation of manual infrastructures (landfill, tailing pond, and so on). In addition, the evaluation demonstrates that the area with potential collapse risk (levels of medium, high, and extremely high) occupies around 8.19 km2, approximately 0.86% of the whole study region. This study sheds a bright light on the safety guarantee for the industrial operation and the ecologically friendly urban development of traditional steel production industrial cities in China.

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Background: The PREVENT (Predicting Risk of cardiovascular disease EVENTs risk algorithm was developed to better reflect the impact of metabolic factors on cardiovascular risk. Objectives: The purpose of this study was to compare the relative performance of PREVENT with standard comparator algorithms (Framingham risk score, pooled cohort equation, SCORE2 [Systematic COronary Risk Evaluation2]) for risk stratification emphasizing the implications of weighing chronic kidney disease. Methods: A simulated cohort was created of males and females aged 40 to 75 years with and without other traditional risk factors and either normal estimated glomerular filtration rates (eGFR 90 or 60 ml/min/1.73 m2) or abnormal eGFR (45 or 30 ml/min/1.73 m2). The concordance and reclassification rates were calculated for each category of risk with emphasis on subjects characterized as moderate risk by the standard comparator algorithms. Results: PREVENT demonstrated increased risk with progressive decreases in eGFR. When the standard comparator algorithms identified moderate risk, PREVENT was concordant in 6% to 88% of simulations. In simulations with normal eGFR, PREVENT identified a lower risk in 18% to 88% and a higher risk in 0% to 12% of simulations. Conversely, with abnormal eGFR, PREVENT identified lower risk in 0% to 26% and higher risk in 4% to 94% of simulations. Conclusions: PREVENT substantially reclassifies risk and has the potential to alter prevention practice patterns. The tendency to assign a lower risk compared to standard algorithms when eGFR is normal may diminish implementation of preventive therapy. National health care systems need to monitor whether such changes improve overall public health.

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DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: Treatment for pulmonary hypertension includes medications with risk evaluation and mitigation strategy (REMS) programs. Health-system inpatient pharmacies dispensing these agents must comply with inpatient REMS dispensing criteria. Implementing a health-system policy with computerized provider order entry (CPOE) decision support may improve REMS compliance. METHODS: This was a retrospective, quasi-experimental study comparing REMS compliance before and after development of a policy with CPOE decision support that was implemented in August 2019. Patients 18 years of age or older with a diagnosis of pulmonary hypertension were included if they received at least one dose of an endothelin receptor antagonist or riociguat while hospitalized. Patients were included in the preintervention group if they were hospitalized between August 1, 2017, and August 31, 2019, and in the postintervention group if they were hospitalized between September 1, 2019, and August 31, 2021. The primary outcome was the REMS compliance rate. Secondary endpoints included the time to REMS compliance and independent factors associated with failed or delayed REMS compliance. RESULTS: A total of 150 patients were included, with 75 patients in both the pre- and postintervention groups. Compliance increased significantly from the preintervention (50%) to postintervention (92%) group (P < 0.001). Time to compliance was also significantly reduced from 770 minutes in the preintervention group to 140 minutes in the postintervention group (P = 0.031). Factors independently associated with REMS compliance were being in the postintervention group (odds ratio, 16.9; 95% confidence interval, 5.8-49.2) and being admitted to a pulmonary hypertension center for comprehensive care. (odds ratio, 7.8; 95% confidence interval, 2.9-21.2). CONCLUSION: A health-system policy with CPOE decision support improved both the rate of and time to compliance with inpatient REMS dispensing procedures.

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Cucumber (Cucumis sativus L.) is the world's most widely consumed salad vegetable, and it is frequently treated with pesticides to prevent pest and disease outbreaks. Pesticide residues in food commodities impede trade and pose a major health risk. Prior to residue estimation, the QuEChERS approach was validated utilising criteria such as limit of detection, limit of quantitation, linearity, accuracy, and precision. The residues of carbendazim, cypermethrin, ethion, profenofos, quinalphos, and triazophos were examined using a Gas Chromatograph equipped with an Electron Capture Detector or a Flame Photometric Detector and a high-performance liquid chromatography coupled to a photo diode array. The initial deposits of carbendazim, cypermethrin, ethion, profenofos, quinalphos, and triazophos at the prescribed dose were 1.235, 0.407, 0.817, 0.960, 0.628, and 0.985 mg/kg, respectively, with a pre-harvest interval of 5.58-11.30 days. According to the consumer risk evaluation data, the Hazard Quotient is less than one, and the Theoretical Maximum Dietary Intake is less than the Maximum Permissible Intake and Maximum Residue Limit, both of which are considered safe for human consumption at the authorised dose.

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Cucumis sativus , Contaminación de Alimentos , Organotiofosfatos , Residuos de Plaguicidas , Cucumis sativus/química , Residuos de Plaguicidas/análisis , Contaminación de Alimentos/análisis , Medición de Riesgo , Organotiofosfatos/análisis , Triazoles/análisis , Carbamatos/análisis , Piretrinas/análisis , Plaguicidas/análisis , Humanos , Exposición Dietética/estadística & datos numéricos , Monitoreo del Ambiente/métodos , Bencimidazoles , Compuestos Organotiofosforados

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Resource utilization of waste masks has become an urgent scientific issue. In this work, with sustainably, waste masks and biomass were co-pyrolysis with oxygen limitation to prepare mask-based biochar (MB). Then, urea was introduced to prepare novel nitrogen modified mask-based biochar (NMB) via a one-step hydrothermal synthesis method. The adsorption characteristics of NMB on the emerging environmental pollutant, bisphenol A (BPA), were evaluated via batch adsorption tests. Moreover, the physicochemical properties of the materials were characterized with various advanced techniques. Also, the roles of waste masks and nitrogen modification were explored. The adsorption mechanisms of NMB on BPA were revealed as well as the performance differences between different adsorbents. The results showed that waste masks participated in thermochemical reactions, shaped the microsphere structure of biochar, and increased the types of surface functional groups. The nitrogen modification enriched the surface elemental composition and activated the specific surface area via the mesopore. These would enhance the adsorption performance. The maximum adsorption of BPA by NMB was 62.63 mg·g-1, which was approximately 2.35-5.58 times higher than that of the control materials. Temkin model and pseudo-second-order model optimally simulate the isothermal and kinetic adsorption, respectively. The adsorption mechanisms are jointly by physical and chemical adsorption, which mainly includes π-π interaction, hydrogen bonding, intraparticle diffusion, surface adsorption, and ion exchange. After discussion and evaluation, NMB has lower preparation process cost (7.21 USD·kg-1) and safety, with potential for environmental applications. This study aims to expand new ideas for the comprehensive utilization of waste masks and the preparation of eco-friendly materials. Moreover, it provides a theoretical basis for the removal of BPA.

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Compuestos de Bencidrilo , Biomasa , Carbón Orgánico , Nitrógeno , Fenoles , Compuestos de Bencidrilo/química , Carbón Orgánico/química , Adsorción , Fenoles/química , Nitrógeno/química , Cinética

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Potentially toxic elements (PTEs), especially arsenic in drinking water, pose significant global health risks, including cancer. This study evaluates the groundwater quality in Giresun province on the Black Sea coast of Türkiye by analyzing twelve groundwater resources. The mean concentrations of macronutrients (mg/L) were: Ca (10.53 ± 6.63), Na (6.81 ± 3.47), Mg (3.39 ± 2.27), and K (2.05 ± 1.10). The mean levels of PTEs (µg/L) were: Al (40.02 ± 15.45), Fe (17.65 ± 14.35), Zn (5.63 ± 2.59), V (4.74 ± 5.85), Cu (1.57 ± 0.81), Mn (1.02 ± 0.76), As (0.93 ± 0.73), Cr (0.75 ± 0.57), Ni (0.41 ± 0.18), Pb (0.36 ± 0.23), and Cd (0.10 ± 0.05). All PTE levels complied with WHO drinking water safety guidelines, and overall water quality was excellent. The heavy metal evaluation index (HEI < 10) and heavy metal pollution index (HPI < 45) indicate low pollution levels across all stations. Irrigation water quality was largely adequate, as shown by the magnesium hazard (MH), sodium adsorption ratio (SAR), Na%, and Kelly's ratio (KR). The total hazard index (THI) values consistently remained below 1, indicating no non-carcinogenic health risks. However, at station 10 (city center), the cancer risk (CR) for adults due to arsenic was slightly above the threshold (1.44E-04). Using principal component analysis (PCA), positive matrix factorization (PMF), and geographic information system (GIS) mapping, the study determined that most PTEs originated from natural geological formations or a combination of natural and human sources, with minimal impact from human activities. These findings highlight the safety and reliability of the groundwater sources studied, emphasizing their potential as a long-term, safe water supply for nearby populations.

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Monitoreo del Ambiente , Agua Subterránea , Metales Pesados , Contaminantes Químicos del Agua , Calidad del Agua , Agua Subterránea/química , Medición de Riesgo , Contaminantes Químicos del Agua/análisis , Metales Pesados/análisis , Mar Negro , Humanos , Agua Potable/química , Arsénico/análisis

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Amidst the global antimicrobial resistance (AMR) crisis, antibiotic resistance has permeated even the most remote environments. To understand the dissemination and evolution of AMR in minimally impacted ecosystems, the resistome and mobilome of wetlands across the Qinghai-Tibetan Plateau and its marginal regions were scrutinized using metagenomic sequencing techniques. The composition of wetland microbiomes exhibits significant variability, with dominant phyla including Proteobacteria, Actinobacteria, Bacteroidetes, and Verrucomicrobia. Notably, a substantial abundance of Antibiotic Resistance Genes (ARGs) and Mobile Genetic Elements (MGEs) was detected, encompassing 17 ARG types, 132 ARG subtypes, and 5 types of MGEs (Insertion Sequences, Insertions Sequences, Genomic Islands, Transposons, and Integrative Conjugative Elements). No significant variance was observed in the prevalence of resistome and mobilome across different wetland types (i.e., the Yellow River, other rivers, lakes, and marshes) (R=-0.5882, P=0.607). The co-occurrence of 74 ARG subtypes and 22 MGEs was identified, underscoring the pivotal role of MGEs in shaping ARG pools within the Qinghai-Tibetan Plateau wetlands. Metagenomic binning and analysis of assembled genomes (MAGs) revealed that 93 out of 206 MAGs harbored ARGs (45.15 %). Predominantly, Burkholderiales, Pseudomonadales, and Enterobacterales were identified as the primary hosts of these ARGs, many of which represent novel species. Notably, a substantial proportion of ARG-carrying MAGs also contained MGEs, reaffirming the significance of MGEs in AMR dissemination. Furthermore, utilizing the arg_ranker framework for risk assessment unveiled severe contamination of high-risk ARGs across most plateau wetlands. Moreover, some prevalent human pathogens were identified as potential hosts for these high-risk ARGs, posing substantial transmission risks. This study aims to investigate the prevalence of resistome and mobilome in wetlands, along with evaluating the risk posed by high-risk ARGs. Such insights are crucial for informing environmental protection strategies and facilitating the management of water resources on the Qinghai-Tibetan Plateau.

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Humedales , Medición de Riesgo , Tibet , Farmacorresistencia Microbiana/genética , Microbiota/efectos de los fármacos , Farmacorresistencia Bacteriana/genética , China , Bacterias/genética , Bacterias/efectos de los fármacos , Bacterias/clasificación , Metagenómica , Antibacterianos/farmacología , Monitoreo del Ambiente , Secuencias Repetitivas Esparcidas

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Aim: Hepatic safety data assessment from the TURALIO® (pexidartinib) Risk Evaluation and Mitigation Strategy (tREMS) Program. Methods: Retrospective 3-year assessment (August 2019 to June 2022) of hepatic events from the TURALIO® (pexidartinib) Risk Evaluation and Mitigation Strategy Program. Results: A total of 451 patients, 369 prescribers, 2 wholesalers/distributors and 2 pharmacies were enrolled and certified. Twenty-one (4.7%) patients met the criteria for a hepatic adverse event or laboratory abnormality suggestive of serious and potentially fatal liver injury, all with onset within 2 months of therapy. No new hepatic safety signals were identified. Conclusion: Results are consistent with the phase 3 ENLIVEN trial data. Liver enzyme monitoring, combined with early intervention, including dose modification and discontinuation, conducted in patients treated with pexidartinib mitigate the risk of potential hepatotoxicity.

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Safety findings from the 3-year data collected in the TURALIO^® Risk Evaluation and Mitigation Strategy ProgramPexidartinib (TURALIO^®) is an oral drug that is used to treat adults with tenosynovial giant cell tumor (TGCT) that cannot be fixed with surgery. TGCTs are rare, noncancerous tumors that cause pain, stiffness and difficulty moving. Pexidartinib works by blocking a protein that helps these tumors grow. Before pexidartinib, there were no good treatments for TGCT and surgery often could not remove all the tumors, so they would frequently grow back.Pexidartinib was approved in 2019 after a clinical trial showed it worked well in adults with TGCT. However, pexidartinib can sometimes cause serious liver harm for some patients. To handle this risk, a program called the tREMS (TURALIO^® Risk Evaluation and Mitigation Strategy) was established to ensure that pexidartinib is used safely.The tREMS Program teaches doctors, pharmacists and patients about the safe use of pexidartinib and potential liver risks and enrolls patients in a registry to watch their health. Doctors and pharmacies must be certified, and patients need regular liver tests. In the first 3 years, 451 patients and 369 doctors joined the program. Unintended liver issues were found in around 5% of patients, a rate that is about the same as that seen in pexidartinib clinical trials, and no new safety concerns were found. About half of patients with liver issues could reverse them by stopping pexidartinib. No patient had permanent liver damage, needed a transplant or died from liver problems. These results show that the tREMS Program is working well to keep patients with TGCT safe while taking pexidartinib.

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Channelized right-turn lanes (CRTLs) in urban areas have been effective in improving the efficiency of right-turning vehicles but have also presented negative impacts on pedestrian movement. Pedestrians experience confusion regarding the allocation of road space when crossing crosswalks within these areas, leading to frequent conflicts between pedestrians and motor vehicles. In this paper, considering the characteristics of pedestrian-vehicle conflicts at channelized right-turn lanes as well as the ambiguity and uncertainty of the causes, a comprehensive assignment combined with a cloud model is proposed as a risk evaluation model for pedestrian-vehicle conflicts. The study established a risk indicator system based on three aspects of the transportation system: pedestrians, motor vehicles, and the road environment. Combining the analytic hierarchy process (AHP), grey relational analysis (GRA), and entropy weighting method (EWM) to get the weights of indicator combinations, and then using the cloud model to realize quantitative and qualitative language transformation to complete the risk evaluation. This study employs specific road segments in Qingdao as a validation case for model analysis. The results indicate that the model's evaluation outcomes exhibited a significant level of agreement with the findings from field investigations during both peak and off-peak periods. It is demonstrated that the model has good performance for the safety assessment of pedestrian-vehicle conflicts at CRTL, and it also reflects the ability of the model to assess fuzzy randomness problems. It provides participation value for urban pedestrian-vehicle safety problems as well as applications in other fields.

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Accidentes de Tránsito , Peatones , Humanos , Medición de Riesgo/métodos , Accidentes de Tránsito/prevención & control , Modelos Teóricos , Planificación Ambiental , Seguridad , Entropía , China , Caminata , Vehículos a Motor , Conducción de Automóvil

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To explore the characteristics and evaluate the risk of heavy metals in groundwater at a typical smelter-contaminated site, this study focuses on a representative a historical arsenic smelting plant in Southwest China, where the primary historical products were metallic arsenic (∼1000 tons/year) and arsenic trioxide (∼2000 ton/year). The results demonstrated As and Pb as the main pollutants in soil, and As and Cd as main pollutants in groundwater through soil profiling and quarterly groundwater analysis. The maximum As and Pb in the surface soil were 76800 and 2290 mg/kg, respectively, with As vertically infiltrating the deep gravel-sand layer (18-20 m). The groundwater pollution distribution progressively increased along flow direction, influenced by seasonal surface runoff and infiltration fluctuations. The groundwater pollutant concentrations during the dry season notably surpassed those during the wet season, with maximum As and Cd concentrations of 111.64 mg/L and 19.85 µg/L during the dry season, respectively. Furthermore, the analytic hierarchy process (AHP) was applied to evaluate the comprehensive risk of contaminated-site across pollution source load, regional groundwater intrinsic vulnerability, and evaluation of nearby sensitive receptors. The results revealed that the carcinogenic risk of lead in surface soil was moderate to high, while arsenic posed a high carcinogenic risk, contributing to an overall carcinogenic risk proportion of 89.6% in surface soil. Exposure through groundwater intake was identified as the primary pathway, with carcinogenic and noncarcinogenic risks exceeding those through skin contact. The final weights result demonstrated that the principal risk factors are the intrinsic arsenic load and protective target characteristics of regional groundwater at this site. This study provides a reference for comprehensive assessments of similarly contaminated industrial and smelting sites.

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Arsénico , Monitoreo del Ambiente , Agua Subterránea , Metales Pesados , Contaminantes del Suelo , Contaminantes Químicos del Agua , Agua Subterránea/química , China , Metales Pesados/análisis , Contaminantes Químicos del Agua/análisis , Medición de Riesgo , Contaminantes del Suelo/análisis , Arsénico/análisis , Metalurgia

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Introduction: Cardiovascular surgery risk prediction models are widely applied in medical practice. However, they have been criticized for their low methodological quality and scarce external validation. An additional limitation added in Latin America is that most of these models have been developed in the United States or Europe, which present marked geographical differences. The objective of this study is to characterize the postoperative clinical events of cardiovascular surgeries with the use of cardiopulmonary bypass pump in a local setting and to evaluate the prediction of postoperative mortality using the EuroSCORE II predictive model. Methods: Cross-sectional study in an urban university hospital in Buenos Aires. Patients ≥21 years of age were included, with a clinical indication for on-pump cardiovascular surgery. Patients with incomplete clinical data regarding EuroSCORE II variables or in-hospital survival, ≥95 years of age, or undergoing heart transplantation were excluded. Results: 195 patients were enrolled. Postoperative mortality estimated by EuroSCORE II presented a clear underestimation of risk (3.0% vs 7.7%). Discrimination (AUC = 0.82; 95% CI 0.74-0.92) and goodness of fit of the model were adequate (χ2 = 7.91; p = 0.4418). The most frequent postoperative complications were postoperative heart failure (35.9%), vasoplegic shock (13.3%), and cardiogenic shock (10.26%). Conclusion: The EuroSCORE II is an appropriate tool to discriminate between different risk categories in patients undergoing on-pump cardiovascular surgery, although it underestimates the risk.

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Introducción: Los modelos de predicción de riesgo de cirugías cardiovasculares se aplican ampliamente a la práctica médica. Sin embargo, han sido criticados por su baja calidad metodológica y escasa validación externa. En América Latina se agrega la limitación de que la mayoría de estos modelos fueron desarrollados en Estados Unidos o Europa, existiendo diferencias geográficas marcadas. Objetivo: El objetivo de este estudio es caracterizar los eventos clínicos postoperatorios de cirugías cardiovasculares con uso de bomba de circulación extracorpórea en un escenario local y evaluar la predicción de mortalidad postoperatoria del modelo predictivo EuroSCORE II. Métodos: Corte transversal en un hospital universitario urbano de Buenos Aires. Se incluyeron a pacientes ≥21 años de edad, con indicación de cirugía cardiovascular con uso de bomba. Se excluyeron a pacientes con datos clínicos incompletos respecto a las variables del EuroSCORE II o respecto a la sobrevida intrahospitalaria, con ≥95 años de edad o sometidos a trasplante cardíaco. Resultados: Se enrolaron 195 pacientes. La mortalidad postoperatoria estimada por el EuroSCORE II presentó una clara subestimación del riesgo (3,0% vs 7,7%). La discriminación (AUC = 0,82; IC95% 0,74-0,92) y la bondad del ajuste del modelo fueron adecuadas (χ2 = 7,91; p = 0,4418). Las complicaciones postoperatorias más frecuentes fueron insuficiencia cardíaca postoperatoria (35,9%), shock vasopléjico (13,3%) y shock cardiogénico (10,26%). Conclusión: El EuroSCORE II es una herramienta apropiada para discriminar entre diferentes categorías de riesgo en pacientes sometidos a cirugías cardiovasculares con uso de bomba, si bien subestima el riesgo.

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Circulación Extracorporea , Complicaciones Posoperatorias , Humanos , Femenino , Masculino , Persona de Mediana Edad , Medición de Riesgo/métodos , Circulación Extracorporea/efectos adversos , Anciano , Estudios Transversales , Factores de Riesgo , Procedimientos Quirúrgicos Cardiovasculares/efectos adversos , Argentina , Mortalidad Hospitalaria , Adulto

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Heavy metal pollution in farmland soil can affect the growth, development, and yield of vegetable crops, as well as the quality and taste of vegetables, and can be continuously transmitted and enriched through the food chain, which ultimately poses a certain hazard to human health in the long term. Therefore, in order to investigate the distribution characteristics of soil heavy metals after years of multi-crop planting of vegetables supplied to Hong Kong, predict their ecological risks, and analyze the causes of pollution formation, 477 surface soil samples of vegetable fields supplied to Hong Kong in Ningxia were collected for three consecutive years from 2019 to 2021, and the contents and distribution characteristics of eight heavy metals, namely, As, Cd, Cr, Hg, Pb, Cu, Zn, and Ni were analyzed. The soil heavy metal pollution status of vegetable fields supplied to Hong Kong in Ningxia was evaluated using the single-factor pollution index method, Nemero's comprehensive pollution index method, land accumulation index method, and potential ecological risk index method, and the sources of heavy metals in vegetable fields supplied to Hong Kong in Ningxia were analyzed using the Pearson's correlation analysis and the principal component analysis method. The results showed that the mean values of As, Cd, Cr, Hg, Cu, and Zn in the soils of Ningxia's vegetable fields were higher than the background values of Ningxia soils, but the contents of all eight heavy metals were lower than the risk screening values of domestic agricultural soils; in terms of spatial distribution, As, Cr, and Ni showed contiguous high values in the northwestern, central, and southern parts of the study area, whereas Pb, Zn, Cd, Hg, and Cu showed high values in the northwestern and southern parts of the study area. The single-factor index method and the Nemero's comprehensive pollution index method showed that the soil of Ningxia's vegetable farmland for Hong Kong was at the clean level as a whole. The results of the ground accumulation index method showed that the pollution in the study area was mainly Hg and Cd pollution, and the pollution areas were mainly concentrated in the northwest and south of the study area. The potential ecological risk index showed that Hg and Cd were the main risk elements, among which Hg was dominated by moderate, strong, and very strong ecological risks, accounting for 44.65 %, 44.65 %, and 1.26 %, respectively, and Cd was dominated by moderate and strong risks, accounting for 65.83 % and 3.56 %. The comprehensive Pearson correlation analysis and principal component analysis showed that the pollution sources of eight heavy metals could be divided into three categories, namely, natural sources:Cu, Zn, Pb, As, Ni, and Cr; agricultural sources:Cd; and industrial and agricultural sources:Hg. From a comprehensive point of view, the heavy metals of the soil in the fields of vegetables supplied to Hong Kong had not exceeded the standard, and the environmental conditions of the soil were good, such that the production of vegetables supplied to Hong Kong by Ningxia was at a safe level overall. The results of the study can provide a theoretical basis for the safe utilization of soil in vegetable fields and the green production of vegetables supplied to Hong Kong in Ningxia, which were aimed to provide help for the safe production of vegetable fields supplied to Hong Kong, the rational application of fertilizers, agronomic planning, and the adjustment of planting structure.

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Monitoreo del Ambiente , Metales Pesados , Contaminantes del Suelo , Verduras , Metales Pesados/análisis , Contaminantes del Suelo/análisis , Verduras/crecimiento & desarrollo , Verduras/química , Hong Kong , Medición de Riesgo , China , Suelo/química

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The microplastics (MPs), a novel pollutant, and heavy metals (HMs) significantly affect soil ecology. The study investigated HMs and MPs in Qianxi's high geological background soil, established a model for risk evaluation with MPs types and shapes, and proposed a two-dimensional comprehensive index model for MPs-HMs combined pollution and risk evaluation criterion. The results revealed a high soil Cd concentration, with a mean value of 0.38 mg·kg-1. Additionally, soils from soybean-wheat intercropping-potato-corn rotation (SWI-PCR) exhibited significantly higher concentrations of Hg, As, and Pb compared with those from soybean-wheat intercropping-corn rotation (SWI-CR). Moreover, the soil exhibited a high abundance of MPs (8667.66 ± 3864.26 items·kg-1), mainly characterized by PS and fiber. The mean of adjusted ecological risk index (ARI) for MPs in soil was 525.27, indicating a grade 3 risk. The two-dimensional combined index (TPI) was used to assess the ecological risk of MPs-HMs combined pollution, exhibiting an exceedance rate of 56 % with a mean of 445.07. The risk level of the combined pollution was graded as 6, indicating high risk. The microplastic risk evaluation model and the comprehensive evaluation method of combined pollution established in this study provide a reference for the future risk evaluation of multi-pollutant combined pollution.

RESUMEN

AIMS/INTRODUCTION: Individuals with diabetes are at high risk of developing cardiovascular events. The present study investigated the predictive value of the cardio-ankle vascular index (CAVI) when added to the Systematic Coronary Risk Evaluation 2-Diabetes (SCORE2-Diabetes) risk algorithm to predict cardiovascular events in the Asian population. MATERIALS AND METHODS: The SCORE2-Diabetes risk was assessed in 1,502 patients with diabetes, aged 40-69 years. Then, we further stratified each 10-year risk category with a CAVI value of 9.0. The primary outcomes (composite of all causes of death, myocardial infarction, stroke and hospitalization for heart failure) were assessed over 5 years. RESULTS: The mean age of the population was 59.8 ± 6.4 years. The proportion of 10-year risk according to the SCORE2-Diabetes risk of low, moderate, high and very high risk identified at 7.2, 30.0, 27.2 and 35.6%, respectively. The mean CAVI value was 8.4 ± 1.4, and approximately 35.4% of the patients had CAVI ≥9.0. The SCORE2-Diabetes risk algorithm independently predicted the primary outcomes in patients with diabetes (hazard ratio 1.18, 95% confidence interval [CI] 1.13-1.22), whereas CAVI did not (hazard ratio 1.03, 95% CI 0.89-1.18). The C-index for the primary outcomes of the SCORE2-Diabetes risk algorithm alone was 0.72 (95% CI 0.67-0.77). The combination of SCORE2-Diabetes and CAVI, both in the continuous value and risk groups, did not improve discrimination (C-index 0.72, 95% CI 0.67-0.77 and 0.68, 95% CI 0.64-0.74, respectively). CONCLUSIONS: Adding the CAVI to the SCORE2-Diabetes risk algorithm did not improve individual risk stratification in patients with diabetes.

Asunto(s)

Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Valor Predictivo de las Pruebas , Rigidez Vascular , Humanos , Diabetes Mellitus Tipo 2/complicaciones , Persona de Mediana Edad , Femenino , Masculino , Anciano , Medición de Riesgo/métodos , Adulto , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/diagnóstico , Pueblo Asiatico/estadística & datos numéricos , Algoritmos , Factores de Riesgo , Pronóstico , Índice Vascular Cardio-Tobillo , Estudios de Seguimiento

RESUMEN

In January 2023, the Food & Drug Administration modified the Risk Evaluation and Mitigation Strategy program regulating mifepristone to allow direct dispensation from retail pharmacies. In June 2023, we conducted a random, distributive survey of pharmacies in California using secret shopper methodology to investigate the feasibility of accessing mifepristone. One pharmacy had mifepristone immediately available (<24 hours), and misoprostol availability was limited. Accessibility to misoprostol varied by type of pharmacy (p < 0.01), but not by region. Even in a reproductive freedom state, access to mifepristone and misoprostol from outpatient retail pharmacies remains limited.

Asunto(s)

Mifepristona , Misoprostol , Farmacias , Evaluación y Mitigación de Riesgos , Misoprostol/administración & dosificación , Mifepristona/administración & dosificación , Humanos , California , Femenino , Accesibilidad a los Servicios de Salud , Estados Unidos , Aborto Inducido/métodos , Abortivos no Esteroideos/administración & dosificación , United States Food and Drug Administration , Embarazo

RESUMEN

INTRODUCTION: Long-acting injectable buprenorphine (LAI-bup) formulations have advantages over transmucosal buprenorphine (TM-bup), but barriers may limit their utilization. Several policies shifted during the COVID-19 pandemic to promote buprenorphine access. The federal government expanded telemedicine treatment for opioid use disorder and Kentucky (KY) Medicaid lifted prior authorization requirements (PAs) for LAI-bup (i.e., Sublocade®). This retrospective cohort study evaluated changes in LAI-bup access, utilization, and retention before and after these policy changes in KY. METHODS: Individual-level TM-bup and LAI-bup dispensing record data from KY's prescription drug monitoring program examined LAI-bup utilization and retention, without a >30-day gap in coverage, for patients starting a new episode of LAI-bup treatment. Two key time periods were examined: pre-policy changes (Apr 1, 2019 - Dec 31, 2019) and post-policy changes (Apr 1, 2020 - Dec 31, 2020). Data on PA requests among Medicaid managed care organizations and availability of LAI-bup Risk Evaluation and Mitigation Strategy (REMS)-certified pharmacies were also obtained. A multivariable Cox proportional hazard regression model analysis compared pre- versus post-policy period treatment discontinuation. RESULTS: The number of patients initiating LAI-bup increased from 211 to 481 over the two periods. By the end of the post-policy period, 24.3 % of eligible patients were retained on LAI-bup, versus 12.5 % in the pre-policy change period. The adjusted hazard ratio, comparing discontinuation during the post- versus pre-policy change periods, was 0.70 (95 % confidence interval: 0.55-0.89). There were also more REMS-certified pharmacies and providers in the post-policy change period. CONCLUSIONS: LAI-bup access, utilization, and retention increased after several policy changes.

Asunto(s)

Buprenorfina , COVID-19 , Preparaciones de Acción Retardada , Tratamiento de Sustitución de Opiáceos , Trastornos Relacionados con Opioides , Humanos , Kentucky/epidemiología , Estudios Retrospectivos , Trastornos Relacionados con Opioides/tratamiento farmacológico , Trastornos Relacionados con Opioides/epidemiología , COVID-19/epidemiología , Buprenorfina/administración & dosificación , Buprenorfina/uso terapéutico , Femenino , Masculino , Adulto , Preparaciones de Acción Retardada/uso terapéutico , Tratamiento de Sustitución de Opiáceos/métodos , Persona de Mediana Edad , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Estados Unidos/epidemiología , Medicaid/legislación & jurisprudencia , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Inyecciones , Política de Salud/legislación & jurisprudencia , Autorización Previa/legislación & jurisprudencia , Telemedicina

RESUMEN

This study investigates potentially toxic elements (PTEs) in the surface sediments of the Abdal River system, a critical water source for Samsun province, Türkiye, due to the presence of the Çakmak Dam. PTE concentrations, measured in mg/kg, show significant variability: Hg (0.03) < Cd (0.26) < As (10.98) < Pb (13.88) < Cu (48.61) < Ni (62.45) < Zn (70.97) < Cr (96.28) < Mn (1015) < Fe (38357). Seasonal variations were observed, in particular increased concentrations of As, Cd and Pb in summer (p < 0.05). Contamination and ecological risk indices (mHQ, EF, Igeo, CF, PLI, Eri, mCd, NPI, PERI, MPI, and TRI) indicate moderate to low levels of contamination, suggesting potential ecological effects. Health risk assessments suggest minimal risks to human health from sediment PTEs. Statistical analyses (PCC, PCA and HCA) improve the understanding of the sediment environment and contamination sources, while the coefficient of variation assists in source identification.

Asunto(s)

Monitoreo del Ambiente , Sedimentos Geológicos , Ríos , Contaminantes Químicos del Agua , Sedimentos Geológicos/química , Ríos/química , Medición de Riesgo , Contaminantes Químicos del Agua/análisis , Metales/análisis , Metales Pesados/análisis