Baseline Risk Assessment Research Articles

Exposure Factors vs. Bioaccessibility in the Soil-and-Dust Ingestion Pathway: A Comparative Assessment of Uncertainties Using MC2D Simulations in an Arsenic Exposure Scenario

Human Health Risk Assessment (HHRA) is a widely applied method to make decisions about the environmental status of sites affected by toxic substances. Its conclusions are affected by the variability and uncertainty of the input variables in the HHRA model. The aim of this work is to apply an algorithm based on 2D Monte Carlo simulations to integrate the variability and uncertainty of exposure factors, concentration, and bioaccessibility, reported by various information sources, to assess and compare their influence on the risk outcome. The method is applied to a specific case study of exposure of children to arsenic from accidental soil ingestion in a residential setting in the city of Madrid (Spain) by combining information from 12 studies. The consideration of the variability and uncertainty of the exposure parameters in the Baseline Risk Assessment (BRA, deterministic) resulted in a greater reduction in the numerical value of risk estimations than that produced by considering only the bioaccessibility factor. The results of the Probabilistic Risk Assessment (PRA) showed that the risk distribution was more sensitive to the variabilities of the accidental soil intake rate and the total arsenic concentration than to other variables such as bioaccessibility. In this case study, the uncertainty introduced by using the "default" reasonable maximum exposure factors in the HHRA model and the variability of the concentration term produce overestimates of risk that are at least in the range of those produced by omitting the bioaccessibility term. Thus, the inclusion of bioaccessibility is, alone, insufficient to improve the HHRA since the selection of the exposure factors can significantly affect the estimates of risk for the soil ingestion pathway. In other sites or for other contaminants, however, the role of the uncertainties associated with the bioaccesible fraction could be more pronounced. The method applied in this work may be useful in updating exposure factors to reduce uncertainties in HHRAs.

Prognostic value of Intermountain Risk Score for short- and long-term mortality in patients with cardiogenic shock.

There is a lack of current research examining the predictive value of the Intermountain Risk Score (IMRS) in patients with ST-segment elevation myocardial infarction (STEMI) caused by cardiogenic shock. Therefore, the purpose of this research was to investigate the ability of IMRS to predict short- and long-term mortality in patients with cardiogenic shock triggered by STEMI. The participants included 492 consecutive cardiogenic shock patients who underwent primary percutaneous coronary intervention following STEMI. The patients were separated into two groups depending on their survival status. The groups' baseline characteristics, laboratory data, echocardiographic variables, and risk assessments were then compared. Next, the IMRS score was tested for its ability to predict both short- and long-term mortality. In order to assess its accuracy, the prognostic value of the IMRS was also compared that of the SYNTAX score II (SSII). After adjustment for the characteristics in the univariable study, multivariable Cox regression analysis indicated that the IMRS and SSII were both independently associated with short- and long-term mortality in STEMI patients with cardiogenic shock. However, the receiver operating characteristic curves indicated that the IMRS outperformed the SSII in terms of predicting both short- and long-term mortality. This preliminary investigation showed that IMRS can predict both short- and long-term mortality in individuals with STEMI accompanied by cardiogenic shock.

Cardio-Oncology in Iran: Cardio-toxicity Registry

Advances in cancer treatment have resulted in a growing number of cancer survivors. However, powerful treatments such as chemotherapy, radiation treatments, and some cancer drugs are not without risks, including the potential for serious, long-term damage to the heart. Cardiology and oncology specialists often collaborate to mitigate these risks when treating cancer patients. This joining is known as cardio-oncology. The main goals of cardio-oncology are to screen for and actively manage modifiable cardiovascular risk factors and diseases in cancer patients. Cardio-oncology plays an increasingly active role at every stage of cancer therapy, including baseline risk assessment pretreatment, surveillance and prevention during treatment, response to acute complications, and assessment of survivors’ post-cardiotoxic treatments. Cancer treatment has been optimized through new treatment strategies. The first cardio-oncology clinic in Iran was instituted about 4 years ago (2017) at Shaheed Rajaei Cardiovascular Medical and Research Center in Tehran, which is the first cardio-oncology clinic in the Middle East. It provides care for cancer patients with a history of cardiovascular disease or risk for cardiotoxicity during cancer therapy. Also, all patients are enrolled in the multicenter cardio-oncology Toxicity Registry research database, and 13 other hospitals from different centers in the whole country are involved in the registry. The establishment of the cardio-oncology clinic with a focus on the patient registry is discussed in this article.

Full automation of total metabolic tumor volume from FDG-PET/CT in DLBCL for baseline risk assessments

BackgroundCurrent radiological assessments of 18fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging data in diffuse large B-cell lymphoma (DLBCL) can be time consuming, do not yield real-time information regarding disease burden and organ involvement, and hinder the use of FDG-PET to potentially limit the reliance on invasive procedures (e.g. bone marrow biopsy) for risk assessment.MethodsOur aim is to enable real-time assessment of imaging-based risk factors at a large scale and we propose a fully automatic artificial intelligence (AI)-based tool to rapidly extract FDG-PET imaging metrics in DLBCL. On availability of a scan, in combination with clinical data, our approach generates clinically informative risk scores with minimal resource requirements. Overall, 1268 patients with previously untreated DLBCL from the phase III GOYA trial (NCT01287741) were included in the analysis (training: n = 846; hold-out: n = 422).ResultsOur AI-based model comprising imaging and clinical variables yielded a tangible prognostic improvement compared to clinical models without imaging metrics. We observed a risk increase for progression-free survival (PFS) with hazard ratios [HR] of 1.87 (95% CI: 1.31–2.67) vs 1.38 (95% CI: 0.98–1.96) (C-index: 0.59 vs 0.55), and a risk increase for overall survival (OS) (HR: 2.16 (95% CI: 1.37–3.40) vs 1.40 (95% CI: 0.90–2.17); C-index: 0.59 vs 0.55). The combined model defined a high-risk population with 35% and 42% increased odds of a 4-year PFS and OS event, respectively, versus the International Prognostic Index components alone. The method also identified a subpopulation with a 2-year Central Nervous System (CNS)-relapse probability of 17.1%.ConclusionOur tool enables an enhanced risk stratification compared with IPI, and the results indicate that imaging can be used to improve the prediction of central nervous system relapse in DLBCL. These findings support integration of clinically informative AI-generated imaging metrics into clinical workflows to improve identification of high-risk DLBCL patients.Trial RegistrationRegistered clinicaltrials.gov number: NCT01287741.Graphical

The Value of Troponin as a Biomarker of Chemotherapy-Induced Cardiotoxicity.

In cancer survivors, cardiac dysfunction is the main cause of mortality. Cardiotoxicity represents a decline in cardiac function associated with cancer therapy, and the risk factors include smoking, dyslipidemia, an age of over 60 years, obesity, and a history of coronary artery disease, diabetes, atrial fibrillation, or heart failure. Troponin is a biomarker that is widely used in the detection of acute coronary syndromes. It has a high specificity, although it is not exclusively associated with myocardial ischemia. The aim of this paper is to summarize published studies and to establish the role of troponin assays in the diagnosis of cardiotoxicity associated with various chemotherapeutic agents. Troponin has been shown to be a significant biomarker in the diagnosis of the cardiac dysfunction associated with several types of chemotherapeutic drugs: anthracyclines, anti-human epidermal growth factor receptor 2 treatment, and anti-vascular endothelial growth factor therapy. Based on the data available at this moment, troponin is useful for baseline risk assessment, the diagnosis of cardiotoxicity, and as a guide for the initiation of cardioprotective treatment. There are currently clear regulations regarding the timing of troponin surveillance depending on the patient’s risk of cardiotoxicity and the type of medication administered, but data on the cut-off values of this biomarker are still under investigation.

Sex disparity of lung cancer risk in non-smokers: a multicenter population-based prospective study based on China National Lung Cancer Screening Program.

Background:Non-smokers account for a large proportion of lung cancer patients, especially in Asia, but the attention paid to them is limited compared with smokers. In non-smokers, males display a risk for lung cancer incidence distinct from the females—even after excluding the influence of smoking; but the knowledge regarding the factors causing the difference is sparse. Based on a large multicenter prospective cancer screening cohort in China, we aimed to elucidate the interpretable sex differences caused by known factors and provide clues for primary and secondary prevention.Methods:Risk factors including demographic characteristics, lifestyle factors, family history of cancer, and baseline comorbidity were obtained from 796,283 Chinese non-smoking participants by the baseline risk assessment completed in 2013 to 2018. Cox regression analysis was performed to assess the sex difference in the risk of lung cancer, and the hazard ratios (HRs) that were adjusted for different known factors were calculated and compared to determine the proportion of excess risk and to explain the existing risk factors.Results:With a median follow-up of 4.80 years, 3351 subjects who were diagnosed with lung cancer were selected in the analysis. The lung cancer risk of males was significantly higher than that of females; the HRs in all male non-smokers were 1.29 (95% confidence interval [CI]: 1.20–1.38) after adjusting for the age and 1.38 (95% CI: 1.28–1.50) after adjusting for all factors, which suggested that known factors could not explain the sex difference in the risk of lung cancer in non-smokers. Known factors were 7% (|1.29–1.38|/1.29) more harmful in women than in men. For adenocarcinoma, women showed excess risk higher than men, contrary to squamous cell carcinoma; after adjusting for all factors, 47% ([1.30–1.16]/[1.30–1]) and 4% ([7.02–6.75]/[7.02–1])) of the excess risk was explainable in adenocarcinoma and squamous cell carcinoma. The main causes of gender differences in lung cancer risk were lifestyle factors, baseline comorbidity, and family history.Conclusions:Significant gender differences in the risk of lung cancer were discovered in China non-smokers. Existing risk factors did not explain the excess lung cancer risk of all non-smoking men, and the internal causes for the excess risk still need to be explored; most known risk factors were more harmful to non-smoking women; further exploring the causes of the sex difference would help to improve the prevention and screening programs and protect the non-smoking males from lung cancers.

Teen Riskiness During a Global Pandemic: A COVID-19 Case Study

Adolescent risk-taking is a normal part of human development. However, it’s this very behavior that leads to teen fatalities, poor mental health, and other unfortunate consequences. Societal changes, such as the pervasiveness of social media in the last two decades, have led to increases in risk-taking behaviors such as drug and alcohol use, sexual risk-taking, violence, and more . This beckons the question of how adolescents’ risk-taking behaviors are impacted, if at all, when other pervasive mediums or stress-inducing events are introduced into their lives —such as a global pandemic. 
 This present research used COVID-19 as a case study and sought to address the relationship between teen risks prior to and during the pandemic. This investigation examined teen engagement in baseline risk-assessments, such as cheating on school assignments or tests, underage drinking, and nicotine product use, and COVID-19 risk. COVID-19 risky behaviors included exposing oneself to potentially unsafe contacts — in other words not adhering to social distancing guidelines. COVID-19 risky mindset measurements included perceived COVID-19 health risk ratings and responses to engagement in COVID-19 risky activity hypotheticals. Factors such as familial average income and gender were included in the analysis. Findings suggest positive relationships between engagement in baseline risk-assessments and both riskier COVID-19 behaviors and mindset.

Cardiovascular Adverse Events and Mitigation Strategies for Chronic Myeloid Leukemia Patients Receiving Tyrosine Kinase Inhibitor Therapy.

Cardiovascular (CV) risk mitigation is an important consideration in the management of chronic myeloid leukemia (CML) patients. Although BCR-ABL1 inhibition by tyrosine kinase inhibitors (TKI) has led to a significant improvement in prognosis, the majority of CML patients will require indefinite TKI therapy. Given the success of therapy, there has been a shift in focus to include CV care as part of routine patient management. To optimize outcomes, both patient-specific comorbidities and a detailed understanding of the cardiotoxicity safety profiles imparted by each TKI should be considered during agent selection. Clinicians face the challenge of early detection and management of these cardiotoxicities while balancing the risk-benefit ratios of maintaining life-saving cancer therapy. Advanced practitioners play a critical role in CML patient management that extends to the recognition and management of TKI-associated side effects. They should be cognizant of the potential for TKI-associated cardiotoxicities along with appropriate baseline risk assessments, active surveillance, and mitigation strategies as part of a collaborative team effort with cardio-oncologists.

UK guideline for the use of HIV post-exposure prophylaxis2021.

We present the updated British Association for Sexual Health and HIV (BASHH) guidelines for post-exposure prophylaxis (PEP) to HIV following sexual exposures, occupational exposures and other nonoccupational exposures in the community. This serves as an update to the 2015 BASHH guideline on PEP following sexual exposures and the 2008 Expert Advisory Group on AIDS guidelines on HIV PEP. We aim to provide evidence-based guidance on best clinical practice in the provision, monitoring and support of PEP for the prevention of HIV acquisition following sexual, occupational and other nonoccupational exposures in the community. The guideline covers when to prescribe PEP, what antiretroviral agents to use and how to manage PEP. This includes (i) evidence of PEP efficacy; (ii) evidence relating to individual-level efficacy of antiretroviral therapy to prevent the sexual transmission of HIV; (iii) data on the detectable (transmissible) prevalence of HIV in specific populations; (iv) risk of HIV transmission following different types of sexual and occupational exposure; (v) baseline risk assessment; (vi) drug regimens and dosing schedules; (vii) monitoring PEP; (viii) baseline and follow-up blood-borne virus testing; (ix) the role of PEP within broader HIV prevention strategies, for example, HIV pre-exposure prophylaxis (PrEP). The guideline also covers special scenarios such as PEP in pregnancy, breastfeeding and chronic hepatitis B virus infection, and when PEP should be considered in people using HIV PrEP. The guidelines are aimed at clinical professionals directly involved in PEP provision and other stakeholders in the field. A proforma to assist PEP consultations is included. A public consultation process was undertaken prior to finalizing the recommendations.

Combined Evaluation of Geriatric Nutritional Risk Index and Modified Creatinine Index for Predicting Mortality in Patients on Hemodialysis.

The geriatric nutritional risk index (GNRI) and modified creatinine index (mCI) are surrogate markers of protein-energy wasting in patients receiving hemodialysis. We aimed to examine whether a combined evaluation of these indices improved mortality prediction in this population. We retrospectively investigated 263 hemodialysis patients divided into two groups, using 91.2 and 20.16 mg/kg/day as cut-off values of GNRI and mCI, respectively. The resultant four groups were reshuffled into four subgroups defined using combinations of cut-off values of both indices and were followed up. During the follow-up period (median: 3.1 years), 103 patients died (46/103, cardiovascular causes). Lower GNRI and lower mCI were independently associated with all-cause mortality (adjusted hazard ratio (aHR) 4.96, 95% confidence intervals (CI) 3.10–7.94, and aHR 1.92, 95% CI 1.22–3.02, respectively). The aHR value for the lower GNRI and lower mCI group vs. the higher GNRI and higher mCI group was 7.95 (95% CI 4.38–14.43). Further, the addition of GNRI and mCI to the baseline risk assessment model significantly improved the C-index of all-cause mortality (0.801 to 0.835, p = 0.025). The simultaneous evaluation of GNRI and mCI could be clinically useful to stratify the risk of mortality and to improve the predictability of mortality in patients on hemodialysis.

Risk assessment for endometrial cancer in women with abnormal vaginal bleeding: Results from the prospective IETA-1 cohort study.

ObjectiveTo investigate the association between personal history, anthropometric features and lifestyle characteristics and endometrial malignancy in women with abnormal vaginal bleeding.MethodsProspective observational cohort assessed by descriptive and multivariable logistic regression analyses. Three features—age, body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters), and nulliparity—were defined a priori for baseline risk assessment of endometrial malignancy. The following variables were tested for added value: intrauterine contraceptive device, bleeding pattern, age at menopause, coexisting diabetes/hypertension, physical exercise, fat distribution, bra size, waist circumference, smoking/drinking habits, family history, use of hormonal/anticoagulant therapy, and sonographic endometrial thickness. We calculated adjusted odds ratio, optimism‐corrected area under the receiver operating characteristic curve (AUC), R2, and Akaike's information criterion.ResultsOf 2417 women, 155 (6%) had endometrial malignancy or endometrial intraepithelial neoplasia. In women with endometrial cancer median age was 67 years (interquartile range [IQR] 56–75 years), median parity was 2 (IQR 0–10), and median BMI was 28 (IQR 25–32). Age, BMI, and parity produced an AUC of 0.82. Other variables marginally affected the AUC, adding endometrial thickness substantially increased the AUC in postmenopausal women.ConclusionAge, parity, and BMI help in the assessment of endometrial cancer risk in women with abnormal uterine bleeding. Other patient information adds little, whereas sonographic endometrial thickness substantially improves assessment.

Assessing the prognostic utility of smoldering multiple myeloma risk stratification scores applied serially post diagnosis

The Mayo-2018 smoldering multiple myeloma (SMM) risk score is used routinely in the clinical setting but has only been validated at diagnosis. In SMM patients, the progression risk decreases over time. However, the utility of applying risk stratification models after diagnosis is unknown. We retrospectively studied 704 SMM patients and applied the Mayo 2018 and IMWG-2020 risk stratification models at annual landmark timepoints up to 5 years post diagnosis. The Mayo-2018 and IMWG-2020 models reliably stratified patients based on progression risk when applied post diagnosis. The respective 2-year progression risk in Mayo-2018 high risk patients versus IMWG-2020 intermediate-high risk patients was 51% versus 62% at the 1-year landmark and 47% versus 45% at the 4-year landmark. We showed that patients categorized at Mayo-2018 high-risk at follow-up had a similar risk of progression if the baseline risk assessment was low-intermediate versus high-risk (HR 1.04, 95% CI 0.46–2.36, p = 0.931 at 5-year landmark). Patients migrating to a higher risk category during follow up had a higher progression risk compared to patients with stable/decreased risk categorization. Our findings support the use of these risk scores post-diagnosis and suggest that patients evolving to a high-risk category may benefit from early intervention therapeutic approaches.

Lifetime Risk Assessment of Lung Cancer Incidence for Nonsmokers in Japan Considering the Joint Effect of Radiation and Smoking Based on the Life Span Study of Atomic Bomb Survivors

Background: The lifetime risk of lung cancer incidence due to radiation for nonsmokers is overestimated because of the use of the average cancer baseline risk among a mixed population, including smokers. In recent years, the generalized multiplicative (GM)-excess relative risk (ERR) model has been developed in the life span study of atomic bomb survivors to consider the joint effect of radiation and smoking. Based on this background, this paper discusses the issues of radiation risk assessment considering smoking in two parts.Materials and Methods: In Part 1, we proposed a simple method of estimating the baseline risk for nonsmokers using current smoking data. We performed sensitivity analysis on baseline risk estimation to discuss the birth cohort effects. In Part 2, we applied the GM-ERR model for Japanese smokers to calculate lifetime attributable risk (LAR). We also performed a sensitivity analysis using other ERR models (e.g., simple additive (SA)-ERR model).Results and Discussion: In Part 1, the lifetime baseline risk from mixed population including smokers to nonsmokers decreased by 54% (44%–60%) for males and 24% (18%–29%) for females. In Part 2, comparison of LAR between SA- and GM-ERR models showed that if the radiation dose was ≤200 mGy or less, the difference between these ERR models was within the standard deviation of LAR due to the uncertainty of smoking information.Conclusion: The use of mixed population for baseline risk assessment overestimates the risk for lung cancer due to low-dose radiation exposure in Japanese males.

MP26-16 PERFORMANCE OF PROMPT-PROSTATE GENETIC SCORE IN A JAPANESE COHORT

You have accessJournal of UrologyProstate Cancer: Detection & Screening II (MP26)1 Sep 2021MP26-16 PERFORMANCE OF PROMPT-PROSTATE GENETIC SCORE IN A JAPANESE COHORT Vi Nguyen, Shusuke Akamatsu, Fady Ghali, Arman Walia, Naoki Terada, Hidewaki Nakagawa, Osamu Ogawa, and A. Karim Kader Vi NguyenVi Nguyen More articles by this author , Shusuke AkamatsuShusuke Akamatsu More articles by this author , Fady GhaliFady Ghali More articles by this author , Arman WaliaArman Walia More articles by this author , Naoki TeradaNaoki Terada More articles by this author , Hidewaki NakagawaHidewaki Nakagawa More articles by this author , Osamu OgawaOsamu Ogawa More articles by this author , and A. Karim KaderA. Karim Kader More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002023.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The benefit of prostate specific antigen (PSA)-based prostate cancer (PCa) screening is greatly debated due to the high number needed to screen/treat to garner a mortality benefit. Risk adapted screening has emerged as an important strategy. Although germline single nucleotide polymorphism (SNP) testing for PCa risk stratification has been validated in Caucasian men, studies are warranted in other ethnicities. We sought to investigate the performance of Prompt-prostate genetic score (PGS) among Japanese men. METHODS: Case-control genetic and phenotypic data was obtained from 1281 Japanese men between 2015-2017 presenting for prostate biopsy. Prompt-PGS was calculated using weighted odds ratios for 40 PCa-associated SNPs. Chi-square and t-test analyses were performed for categorical and continuous variables using SPSS. Receiver operating characteristic (ROC)-plots were utilized to calculate area under the curve (AUC). RESULTS: Seven hundred seventy-three men were diagnosed with PCa (60.3%). Median age was 69 (37-91), 6.2% (n=80) had family history (FH) of PCa, 24.1% (n=309) had an abnormal DRE, and 55.7% (n=714) of men underwent an MRI prior to biopsy; of those, 75.6% (n=540) were abnormal, defined as PIRADS 4 or greater. Median PSA and PSA density (PSAD) were 7.15 (0.03-14426) and 0.25 (0.002-265.67). Median Prompt-PGS for men with and without PCa was 1.03 (0.17-5.62) and 0.82 (0.12-4.39; p<0.001). Significant independent predictors of PCa included age, abnormal DRE, abnormal MRI, PSA, PSAD, and Prompt-PGS. ROC plot analyses revealed that the addition of Prompt-PGS strengthens the predictive power of age and FH (AUC 0.67 vs 0.72), and that this baseline risk assessment is improved in an additive fashion when taking into account abnormal DRE, PSA, PSAD, and abnormal MRI (Figures 1a&b). CONCLUSIONS: Baseline assessment of PCa risk is substantially improved by including Prompt-PGS in this Japanese cohort in which FH was not predictive. When baseline risk is supplemented by adding DRE, PSA and PSAD, the model performs so well that MRI does not result in improved performance. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e469-e469 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vi Nguyen More articles by this author Shusuke Akamatsu More articles by this author Fady Ghali More articles by this author Arman Walia More articles by this author Naoki Terada More articles by this author Hidewaki Nakagawa More articles by this author Osamu Ogawa More articles by this author A. Karim Kader More articles by this author Expand All Advertisement Loading ...

Low levels of persistent organic pollutants in sediments of the Doce River mouth, South Atlantic, before the Fundão dam failure

The Doce River mouth (DRM) was severely impacted by the rupture of the Fundão Dam in 2015, considered the greatest Brazilian environmental tragedy in terms of tailings volume released (>40 million m3) and traveled distance (~600 km until the Atlantic Ocean). Environmental monitoring has been performed since then, but background levels are scarce or absent to Persistent Organic Pollutants (POPs), making impact assessments difficult. In the current study, we presented the baseline levels, inventories, and risk assessment of the POPs polychlorinated biphenyl (PCBs) and organochlorinated pesticides (OCPs), in surface sediment of the DRM. Samples were collected in December 2010 and July 2011, i.e., four years before the Fundão dam failure. The total PCBs and the OCPs (Aldrin, HCHs, and Chlordanes) were detected in both sampling campaigns, with levels up to 9.50 and 1.64, 0.28, and 0.63 ng g-1, respectively. The decrease of the Doce River flow was the main factor contributing to seasonal variations in the spatial distribution, and to a slight decline in the levels and frequency of the analyzed POPs in sediments collected in the dry season (July 2011). Environmental risk assessment, inventories, and total mass results suggest a low potential of PCBs and OCPs accumulation before the dam failure. This is the first POPs assessment in the study area that helped identify some unexpected impacts of the Fundão dam failure and contributed to the understanding of POPs cycles in the Southern Atlantic, data that are still scarce in the region.

Health and safety control measures and MR quality control results in the MRI units of two public hospitals within the Mangaung metropolitan

This study aimed to identify risks and hazards in the magnetic resonance imaging (MRI) units, and assess the quality compliance of the scanners within two public hospitals in Mangaung. This is a follow-up study from a previously published study that measured static magnetic fields and radiofrequency magnetic fields in the MRI units included here. An observational checklist was used to identify risks and hazards which were later fed into a baseline risk assessment to classify and review existing control measures in the MRI units of hospitals A and B. The availability of MRI Health and Safety measures were benchmarked against the latest American College of Radiology (ACR) MRI safety requirements. The probability of risk occurrence and severity of hazards were assigned a score ranging from improbable (1) to very likely (5) and minimal (1) to irreversible effect (5). The weekly quality control test results obtained from both units were measured against the ACR quality control acceptable criteria. Similar risks were observed in both MRI units but the multiplication of probability and consequence in all risk categories resulted in a moderate risk-rating score of 12.3 for hospital A and 13.1 for hospital B. Lack of demarcation of four MRI safety zones, ferromagnetic detectors, 5-gauss line, and access control in both units scored above 15 and were classified as high risk. The defective air-cooling systems influenced the temperature of the scanner room, which affected the apparent diffusion coefficient (ADC) measurements performed from 1.5 T Siemens. On a 3.0 T Philips, a low contrast object detectability had 29 spokes for ACR T2, while the percent integral uniformity for image intensity uniformity was 78.2 %. High and moderate risks observed in both units could be reduced by the implementation of an effective health and safety programme. The ambient temperature within the scanner room should be maintained at 21 °C to attain well-performing ADC measurements and RF subsystems should be visually inspected and maintained regularly to obtain optimal image quality.

Long-term spatio-temporal trends in extreme wave events in the Niger delta coastlines.

Wave climate in the marginal seas and estuaries provide baseline information, risk assessments and essential insight into coastal design, structure and engineering projects. This paper investigates the Spatio-temporal trends in extreme Significant Wave Height (SWH) in the Niger Delta coastlines. For the study domain, European Centre for Medium-Range Weather Forecasts (ECMWF) global atmospheric reanalysis ERA-Interim and wave hindcast data covering 37 years (January 1, 1980–December 31, 2016), derived from WAVEWATCH III (WW3) model were used in the analysis. The largest 99th percentile approach was used to analyze extreme SWH values. Results showed near neutral and negative trends over the region. The trends are generally insignificant for the 100-year return period. The sharp variation in extreme SWH between 1998 and 2000 resulted from a strong El Nino and La Nina phenomenon, which is associated with the weakening and strengthening of the West-African Monsoon.

Assessment of Cardiovascular Risk in Transgender Patients Presenting for Gender-Affirming Care

BackgroundThe transgender population is rapidly growing in the United States and abroad. Transgender men and women are marginalized as a result of their transgender status, with resultant health repercussions. This and other factors such as increased substance use, mental health disorders, violence, and chronic stress may place transgender individuals at higher risk for cardiovascular disease. Additionally, many transgender patients pursue gender-affirming hormone therapy, which has been linked to increased rates of some cardiovascular events such as metabolic syndrome, venous thromboembolism, and stroke. Despite the likelihood of elevated cardiovascular risk in this population, there is a paucity of published data about the cardiovascular risk of this population. MethodsWe present baseline cardiovascular data from a transgender population at a large tertiary care center prior to the initiation of hormone therapy. ResultsThe described transgender population had much higher rates of mental health disorders and substance use than the general population. Furthermore, there were high rates of undiagnosed and untreated comorbidities, such as hypertension and dyslipidemia, that increase risk for cardiovascular disease. Baseline risk assessment using the ASCVD (Atherosclerotic Cardiovascular Disease) and QRISK3 calculators showed higher-than-expected cardiovascular risk, particularly given the young age of our patient population. ConclusionsTransgender individuals are at high baseline cardiovascular risk. These data help fill some important knowledge gaps in this patient subgroup, and provide us with much-needed data to help guide our management and counseling of individuals seeking this type of care.

Cardio-oncology: rationale, aims and future directions.

Cardiovascular comorbidity among cancer patients is a growing clinical problem with the dramatic improvements in cancer survival. Cardio-oncology has developed as a new medical field dedicated to addressing the complex issues faced by patients who have both cancer and cardiovascular disease. This article explains to the reader what cardio-oncology services provide and the nature of cardiovascular problems caused by the growing array of modern cancer therapies. The list of potentially cardiotoxic cancer therapeutic agents is ever growing and dedicated cardio-oncology experts are required to tackle cardiovascular complications with minimal delay to necessary cancer therapy. Cardio-oncology services originated in academic centres but are now being set up around the world in all hospitals and clinics that provide care to cancer patients. Cardio-oncology plays an increasingly active role at every stage of cancer therapy including baseline risk assessment pretreatment, surveillance and prevention during treatment, response to acute complications and assessment in survivors post cardiotoxic treatments. New treatment strategies exist to optimize cancer treatment so it can be completed safely. In the present review, we explore the rationale, aims and roles of cardio-oncology, as well as future directions, which will certainly require multidisciplinary international collaboration.

Development and testing of Diabetes Complications Risk Educational Tool (DiREcT) for improving risk perception among patients with diabetes mellitus: a mixed method study

The problem of type 2 diabetes mellitus and its complications are threateningly increasing in the existing health scenario. The awareness and perception about risk of developing complications and role of self-care practices for glycemic control are very important. This study aimed to develop and validate an educational tool for improving perception about risk of getting complications among patients with diabetes mellitus. This mixed method study was conducted in a tertiary hospital. Known risk factors of diabetic complications were identified from literature and drafted based on their strength of association. A panel of eight experts from different departments was constituted to evaluate the risk factors, and the tool was finalised after three rounds using Delphi technique. Content and construct validity of the developed tool were also assessed by the panel. A pilot study among 50 patients with diabetes mellitus was done to assess the effectiveness of the tool. The DiREcT tool developed had 11 risk factors of diabetic complications, each categorised into low, moderate and high risk. On baseline risk assessment, 60% of the participants were in high-risk category for glycemic control. Patient’s perception about risk of developing complications increased from 26 to 60% by using the tool. More than 80% of the participants reported that the tool is simple and easy to understand. The DiREcT tool was effective in changing perception of developing complications among patients with diabetes mellitus. It can be used by the healthcare provider at the primary healthcare level for both educating and monitoring of patients with high risk.