Detailed Risk Assessment Research Articles

A simple method for landslide risk assessment in the Rivière Aux Vases basin, Quebec, Canada

This research offers a simple approach for landslide risk assessment on a basin-scale in the Quebec Province of Canada, where landslides are common. Landslide inventory and distribution mapping are developed for the Aux Vases Watershed, the most landslide-affected area in the Saguenay region, for a detailed landslide hazard and risk assessment process. The study uses publicly available data from Google Earth images, published literature, Government data sources for topographic maps and landuse information, as well as the 2016 Census Profile of the Saguenay region of Quebec. ArcGIS software is used for spatial data processing and analyzing datasets to develop maps of landslide susceptibility, vulnerability, and lack of coping capacity, and a landslide risk map of the Aux Vases Watershed was developed. Landslide risk assessment is critical for minimizing the loss of life and property from potential landslides in the study area and empowers communities with useful information so they can make informed decisions to mitigate the risk and build coping capacities. In addition, risk reduction policies and strategies, public safety, and future development planning initiatives will benefit from this research.

Are Organizational Interventions Effective in Protecting Healthcare Worker Mental Health during Epidemics/Pandemics? A Systematic Literature Review.

It is unclear how to effectively protect healthcare workers’ mental health during infectious disease epidemics. Targeting the occupational determinants of stress may hold more promise than individual stress management, which has received more focus. Through a systematic review of the 2000–2021 English- and French-language scientific literature, we evaluated the effectiveness of organizational and psychosocial work environment interventions to protect healthcare workers’ mental health in an epidemic/pandemic context. Evidence from medium- and high-quality studies was synthesized using GRADE. Among 1604 unique search results, 41 studies were deemed relevant, yielding 34 low-quality and seven medium-quality studies. The latter reported on promising multi-component prevention programs that combined staffing adjustments, work shift arrangements, enhanced infection prevention and control, recognition of workers’ efforts, psychological and/or logistic support during lockdowns (e.g., accommodation). Our confidence in the effectiveness of reviewed interventions is low to very low, however, owing to methodological limitations. We highlight gaps in the reporting of intervention process and context elements and discuss theory and implementation failure as possible explanations for results. We conclude by urging authors of future studies to include and document detailed risk assessments of the work environment, involve workers in solution design and implementation and consider how this process can be adapted during an emergency.

Implementation of analytical quality by design and green chemistry principles to develop an ultra-high performance liquid chromatography method for the determination of Fluocinolone Acetonide impurities from its drug substance and topical oil formulations

An anti-inflammatory skin condition is treated with fluocinolone acetonide (FLA), a synthetic corticoid. The current study aims to develop a stability-indicating UPLC method for the determination of impurities present in fluocinolone acetonide and its topical oil formulation. The method development was performed by implementing Analytical Quality by Design (AQbD) and green chemistry principles. A detailed risk assessment was conducted based on the cause-and-effect relationship. d-optimal split-plot design was employed to screen the critical method parameters (CMPs). The central composite design (CCD) was employed to optimize the final method conditions. p-values for the model and lack of fit were <0.0001 and >0.05, respectively, which indicates the best fit statistical model for the studied responses (peak resolutions R1 – R5). The critical method attributes (CMAs) and CMPs such as the ratio of ACN: Water in mobile phase-B as 600:400 (v/v), the ratio of mobile phase-A & B in initial gradient program as 60:40, flow rate as 0.3 mL min−1, and column oven temperature as 50 °C were optimized from the CCD. The best possible separation among all components was achieved with a gradient elution using Waters Acquity UPLC HSS C18, 100 mm × 2.1 mm, 1.8 µm analytical column. The optimized gradient program is time (min)/%B: 0.0/40, 1.5/40, 6.0/60, 8.0/70, 9.0/80, 12.0/100, 15.0/100, 15.1/40 & 18.0/40. Optimization of diluent is highly critical for any oil-based formulations. The experimental results show that acetonitrile is the most suitable diluent for the current study. The method validation was executed in compliance with ICH and USP 〈1225〉 guidelines. Mean recovery of the impurities ranged between 95.7 and 105.7%, the correlation coefficient(r) was> 0.999, the RSD values (n = 6) ranged between 0.9 – 3.2% across the range for LOQ – 150% levels. The peaks from the specificity study did not interfere with the known and active analyte peaks. The major degradation products were identified as Imp-C, B, and A, and established their degradation pathways from FLA based on the stress studies. The method greenness was evaluated using GAPI, AGREE and analytical eco scale and found that the method is green.

Redefining the Mode of HIV Transmission through Analysis of Risk Attribution among the Reported HIV Cases from 1993 to 2021 in Bhutan.

Introduction The detailed risk assessment of the diagnosed HIV cases in Bhutan is an opportunity to carry out the risk analysis to generate evidence of wherein, under what context, and in which population groups most new infections are occurring. The evidence collected will help to test the current assumption of Bhutan experiencing diffused and generalized HIV epidemic. Methods This is a cross-sectional study using a quantitative method to assess the risk behavior of the diagnosed HIV cases from 1993 to 2019. The study also included secondary data analysis of those cases already captured by the routine case-based surveillance from 2020 to 2021. The data collection was done from 1 to 30 January 2022 in all the twenty districts of Bhutan. Descriptive statistical analysis was used to analyze the characteristics of the study population, and relationships were established using the Chi-square Test. We have sought ethics approval and obtained participants' informed consent. Results The risk attribution analysis showed that 81.94% of HIV infection among the reported HIV cases in Bhutan has occurred through high-risk heterosexuals and 8.88% through mother-to-child transmission, and parenteral transmission accounts for 1.58% and then 1.35% through homosexual. Of the 81.94% high-risk heterosexuals, 41.08% acquired through sex workers and clients of sex workers, 27.99% from HIV-infected persons, 12.64% from sex work, and 0.23% from injecting drug use. Conclusions This study has shed some light on a gradual epidemic shift from the current perceived diffused and generalized to the concentrated epidemic among subpopulation groups like female sex workers and their clients.

Technical assistance to support discussions on national risk management measures to address possible shortages of food and feed supply as a consequence of the Russian invasion of Ukraine

Some EU Member States depend to a great extent on feed imports from Ukraine. Following the Russian invasion of Ukraine, the supply chains are interrupted, and stakeholders informed the European Commission about possible imminent shortages, mainly for wheat, barley, maize, sunflower seeds, rapeseeds and soyabeans used for feed purposes. As a consequence, they announced to take steps to find alternative sources for importing these products. However, stricter maximum residue levels (MRLs) for pesticides in the EU (EU MRLs), may pose problems for imports if the MRLs in the country of origin were set at higher levels. Member States may make use of the possibility of Article 18(4) of Regulation (EC) No 396/2005 and set national temporary MRLs (tMRLs) in such exceptional circumstances, provided that those are safe for consumers based on a detailed risk assessment and that controls are put in place to ensure that consignments not complying with EU MRLs do not leave the national territory. In the current report, EFSA provides technical background information that is intended to support Member States who consider the implementation of Codex MRLs as national temporary MRLs and highlights certain options for flexibility in view of setting national temporary MRLs which are however very limited. This technical report does not anticipate any national risk management decisions, which falls under the responsibility of the national competent authorities.

Simplified approach for making risk decisions in a fast‐paced business environment

AbstractFor facilities where hazardous events of high consequences can happen, quantitative risk analysis (QRA) is used to determine whether the risk is tolerable against the risk criteria of the operating company or local regulations. Specific risk reduction measures may need to be defined and evaluated based on the QRA. A risk analysis considering both consequences and frequencies is typically time‐consuming and requires the collection of sufficient information regarding process, equipment, operation methods, weather, geographic conditions, the population, and so forth. Business management often requires prompt decisions in a fast‐paced business environment; therefore, the risk analysis must be done expediently to provide adequate information for business decisions. Some examples related to industrial gas facilities are summarized to show simplified analyses done to help define risk reduction measures and priorities in a shorter time frame than typically possible by using detailed quantitative risk assessment. Some generic methods for simplification are proposed.

An Audit to Assess the Quality of Ward Referrals Sent to City Hospital Liaison Psychiatry Team From Inpatients Wards D15, D17and D27, Between July 2021 to September 2021

AimsLiaison psychiatry provides psychiatric care to medical patients. Patients include those attending emergency departments, general hospital inpatients and outpatients. Liaison teams work hand in hand with several general hospital teams to offer advice, review and manage these patients. Over the last few months, the Liaison service in City Hospital have been receiving many inappropriate referrals. Inappropriate referrals are defined as patients who are referred to services, with one of the following reasons: 1.Insufficient presenting complaint2.No documented Past psychiatric history3.Insufficient Mental state Examination (MSE)4.No risk assessment5.No documented Drug/alcohol history6.Patients having not consented to referral.7.If one or more of the above criteria is not metOur aim was to evaluate the appropriateness of the referrals received from D15, D17, D27 inpatients wards in City Hospital over a 3-month period from July to September 2021. These wards were chosen as they commonly refer patients to liaison services.MethodsWe collated data retrospectively on the nature of all referrals from D15, D17 and D27 ward over a 3-month period. The patient referral portal was used, and referral content of each patient was analysed. An audit tool was devised to assess whether the referrals followed the liaison referral pathway and guidelines set by NHS England for referral structure to liaison services.Results18 patients were referred to the Liaison psychiatry from the three wards over the three-month period. We observed 77.8% (n = 14) of the referrals having insufficient information for the presenting complaints, whilst 22.2% (n = 4) of them did not state past psychiatric history. Approximately 94.4%(n = 17) did not state sufficient details of MSE. In 83.3% (n = 15) of referrals appropriate detailed risk assessment was not done, 27.8% (n = 5) of them did not have alcohol/ drug use stated and 22.2% (n = 4) of patients referred did not consent to the referral being made.ConclusionThe results demonstrated that ward referrals lack quality and contain inadequate information to allow for safe screening of patients and for the implementation of appropriate actions by the liaison team. A possible reason for inappropriate referrals may be due an existing knowledge gap and lack of confidence taking detailed psychiatric histories, assessing risk, and performing MSE in non-psychiatric trainees making referrals to liaison services.

P136 Methotrexate osteopathy - clinical and radiological characteristics in a case series of twenty-one patients

Abstract Background/Aims Methotrexate osteopathy was originally described in the 1980s as a combination of bone pain, osteoporosis and insufficiency fractures in paediatric patients receiving high-dose methotrexate for leukaemia. Since then, cases of insufficiency fractures in patients on long-term, low-dose methotrexate for rheumatic disease have been sporadically reported as methotrexate osteopathy. This case series aims to characterise the clinical and radiological features of this poorly defined condition. Methods Patients were identified by searching the MRI reports of rheumatology patients in NHS Lothian for the term ‘insufficiency fracture’ and asking consultant rheumatologists to submit cases where methotrexate osteopathy was suspected. Patient demographics, clinical and radiological features were analysed. Results We identified 21 patients with insufficiency fractures taking long-term methotrexate. The mean age at presentation with methotrexate osteopathy was 66.9± 9.5 years. 20 of the patients (95%) were women. 18 of the patients (86%) had rheumatoid arthritis. The average BMI of the cohort was 25.7± 5.4. The average duration of methotrexate use was 7.5± 4.5 years. The most common sites of fracture were the calcaneus (12 patients, 57%) and the metaphysis of the distal tibia (13 patients, 62%). Other frequent fracture sites included the proximal tibia, talus, and distal femur. 13 of the patients (62%) had more than one fracture and 12 (57%) had bilateral fractures. 12 of the patients (57%) required an MRI to identify the fracture and there was an average delay of 4.8± 4.0 months between the initial presenting symptoms and imaging confirming a fracture. Osteoporosis was found in 12 of the 15 patients (80%) who had a DEXA scan, with an average T-score of -2.23± 1.14 for the spine and -2.64± 0.78 for the femoral neck. 14 of the 21 (66.6%) patients received antiresorptive osteoporosis treatment. Only 2 of the patients (9.5%) were on long-term steroids at the time of diagnosis. Conclusion Methotrexate osteopathy should be suspected in patients on long-term methotrexate with unexplained pain in the lower limbs. There are often multiple, bilateral fractures which most commonly affect the distal tibia and calcaneus. Fractures may not be visible on X-ray, and pain from the fractures may mimic synovitis, causing a delay in diagnosis. A high index of suspicion and detailed imaging with MRI is often required to identify insufficiency fractures associated with methotrexate osteopathy. If the condition is suspected, a detailed fracture risk assessment should be organised, and the cessation of methotrexate considered. Disclosure A.T. Merriman: None. J. Foley: None. J. Golla: None. E. McRorie: None. B. Hauser: None.

Human Exposure Assessment of Mixed Metal/Loids at and Near Mega-Scale Open Beaching Shipwrecking Activities in Bangladesh

Pollution from shipwrecking is growing into a major occupational and environmental health concern worldwide, especially in the lower-middle-income countries where workers and residents may be exposed to potentially high levels of dispersed metal/loids due to decades of improper waste disposal. This study is the first to report the urinary biomarkers estimating the exposure of metal/loids and associated significant determinants in residents working and/or living at and near a major open beaching shipwrecking yard in Bangladesh. The concentrations of 17 elements were measured in urine and drinking water samples (125 each) using a validated ICP-MS method. Hydration variations of urine were best adjusted by specific gravity. Significantly higher (p < 0.001) urinary metal/loids load including cadmium and molybdenum in the occupational (70–80% of shipwrecking workers) and environmental exposure groups (72–75% of the local population) compared to the control site and international reference values suggest a significant health threat. Gender and age effects on the variation of urinary metal/loid concentrations were insignificant. However, fertilizer/pesticide users had higher nickel concentrations. Quantile regression analyses suggested the impacted locations with shipwrecking activities are significant predictors of exposure. The participants from the shipwrecking yards and the adjoining east, north, and south sites experienced significant exposure to metal/loids, which may be largely governed by wind-associated dispersion of contaminants. Water metal/loid concentrations were lower than the guideline values set by WHO and Bangladesh except for manganese in 63% of water samples. However, the elevated urinary concentrations of cadmium and thallium were significantly correlated to their concentration in water. This biomonitoring approach could be used as a background study to facilitate a more detailed exposure and health risk assessment to inform a management strategy for residents exposed to contaminated environmental matrices and dietary sources.

Context specific HIV risk: evidence from screening into the southern pre-exposure prophylaxis study (SPECS)

ABSTRACT While Pre-exposure prophylaxis (PrEP) is efficacious in preventing HIV, little is known about PrEP use among those on community supervision. The Southern Pre-Exposure Prophylaxis Study (SPECS) investigates barriers and facilitators for PrEP initiation and use among adults on community supervision (e.g., probation, parole). Challenges to PrEP use in this setting are abundant. SPECS uses a mixed-methods sequential design, including a multi-site, prospective cohort study in three southern states – North Carolina, Florida, and Kentucky. This analysis describes individual demographic, criminal legal, and HIV risk factor characteristics, by site and enrollment status. Pooled association analyses accounted for site via stratified statistical tests. Between June 2019-March 2020, SPECS screened 702 individuals and enrolled 276 participants (39%). Of those who were eligible, 98% agreed to enroll. Age, gender, and sexual orientation varied by enrollment and by site, while race/ethnicity varied by site but not enrollment status. Criminal legal histories varied by enrollment and HIV risk factors varied by site. SPECS provides a granular and detailed assessment of HIV risk in three diverse southern settings. It highlights how the level and type of HIV risk varies by location and by nature of criminal legal involvement and calls for the need for context-specific interventions for HIV prevention.

Recent Updates on Nanocosmeceutical Skin Care and Anti-Aging Products.

Nanotechnology is an innovative area of science that deals with things smaller than 100 nanometers. The influence of nanotechnology in the cosmetic industry is overwhelming since it can enhance the properties attained by the particles at the nano level, including color, solubility, etc, and can also promote the bioavailability of API. A plethora of nanomaterials can be employed in cosmetics, including organic and inorganic nanoparticles. Unlike orthodox carriers, they facilitate easy penetration of the product into the skin, thereby increasing the stability and allowing a controlled drug release so that they can permeate deeper into the skin and start revitalizing it. Nanomaterials rejuvenate the skin by forming an occlusive barrier to inhibit the loss of water from the skin's surface and thereby moisturize the skin. Nano-cosmeceuticals are used to provide better protection against UV radiation, facilitate deeper skin penetration, and give long-lasting effects. Although they still have some safety concerns, hence detailed characterization or risk assessments are required to fulfill the standard safety requirements. In this review, an attempt is made to make a brief overview of various nanocosmeceuticals skincare and anti-aging products.

Common-sense model of self-regulation to cluster fibromyalgia patients: results from a cross-sectional study in Italy.

Fibromyalgia is a severe and disabling chronic pain syndrome affecting millions of people worldwide. Various patients' subgroups were identified using different atheoretical measures, hardly effective to tailor treatments. Previous literature findings showed the relevance of fibromyalgia patients' illness perceptions in adjusting to the disease. The present study aims to identify clusters of fibromyalgia patients based on their illness perceptions and investigate whether they can differ across pain, mood, physical functioning, catastrophising, and pain acceptance measures. Fifty-three newly referred fibromyalgia patients completed clinical and psychological questionnaires. Patients' subgroups were created by applying hierarchical cluster analysis to their answers to Illness Perception Questionnaire-Revised subscales. Potential differences across subgroups in outcome variables were tested. Cluster analysis identified two patient groups. Group A (32 patients) had a higher representation of fibromyalgia as a chronic disease with severe consequences, lower beliefs in personal and treatment control, and a higher fibromyalgia-related emotional distress than group B (21 patients). Clusters did not differ on pain intensity and duration. Group A, compared to group B, showed worse physical functioning and overall impairment due to fibromyalgia, a poorer psychological condition, a higher tendency to catastrophise, and less pain acceptance. Study findings reveal two fibromyalgia subgroups differing in emotional suffering and impairment despite similar pain intensity and duration. Patients' illness perceptions and attitudes towards pain, like catastrophising and acceptance, might be critical in adjusting to the disease. A detailed assessment of such risk and protective factors is critical to differentiate patients' subgroups with different needs and thus offering tailored treatments.

Conditional release and cannabis use: Concerns and challenges for community reintegration.

This article, which serves as a perspective review, delves into the complexities of cannabis use among individuals preparing for or already on conditional release (CR). These complexities include an association between cannabis use and mental illness and dealing with the fact that the use of illicit substances, such as cannabis, is against CR rules, leading to potential revocation. A focus of this article is the deleterious effects cannabis and synthetic derivatives of cannabis can have for individuals on CR. The article concludes with six-specific recommendations for managing cannabis use in this population with a focus on careful and detailed risk assessments that considers the relationship between substance use and dangerousness, the role of protective factors, the need for a detailed conditional release plan, inpatient and community-based interventions aimed at increasing individual autonomy, and education on the dangers of cannabis use for both the treatment team and the insanity acquittee.

Comprehensive evaluation of risk factors for the development and complications of chemotherapy-induced febrile neutropenia

Febrile neutropenia is a serious adverse effect of chemotherapy. It can lead to complications and death, as well as delays in treatment, chemotherapy dose reductions, compromised treatment efficacy, and reduced survival. The assessment of the patient-related risk factors plays a significant role in the prevention of febrile neutropenia and its complications. In the case of intermediate-risk chemotherapy, the patient-related factors contribute to the estimation of an overall febrile neutropenia risk as well as to timely planning of primary prophylaxis using growth factors. Patients presenting with febrile neutropenia undergo a detailed initial risk assessment for serious complications so that an appropriate treatment can be selected. Recommendations given by the guidelines outline the classification of and risk factors for febrile neutropenia complications. The use of patient-related factors and validated tools for the risk assessment of complications makes it possible to optimize the treatment for each patient and to reduce the risk of morbidity and mortality due to febrile neutropenia.

Prospective environmental risk screening of seven advanced materials based on production volumes and aquatic ecotoxicity

The number and volume of advanced materials being manufactured is increasing. In order to mitigate future impacts from such materials, assessment methods that can provide early indications of potential environmental risk are required. This paper presents a further development and testing of an environmental risk screening method based on two proxy measures: aquatic ecotoxicity and global annual production volumes. In addition to considering current production volumes, this further developed method considers potential future production volumes, thereby enabling prospective environmental risk screening. The proxy measures are applied to seven advanced materials: graphene, graphene oxide, nanocellulose, nanodiamond, quantum dots, nano-sized molybdenum disulfide, and MXenes. Only MXenes show high aquatic ecotoxicity, though the number of test results is still very limited. While current production volumes are relatively modest for most materials, several of the materials (graphene, graphene oxide, nanocellulose, nano-sized molybdenum disulfide, and MXenes) have the potential to become high-volume materials in the future. For MXenes, with both high aquatic ecotoxicity and high potential future production volumes, more detailed environmental risk assessments should be considered. For the other materials with high potential future production volumes, the recommendation is to continuously monitor their aquatic ecotoxicity data. Based on the application of the proxy measures combined with future scenarios for production volumes, we recommend this environmental risk screening method be used in the early development of advanced materials to prioritize which advanced materials should be subject to more detailed environmental assessments.

Risk Assessment of Contaminants in Sewage Sludge Applied on Norwegian Soils

Risk Assessment of Contaminants in Sewage Sludge Applied on Norwegian Soils

Teacher plants — Indigenous Peruvian-Amazonian dietary practices as a method for using psychoactives

Ethnopharmacological relevanceIndigenous groups of the Amazon have developed intricate methods for the application of psychoactives, among which particularly the dieta or diet method of Peruvian-Amazonian traditional medicine stands out. It is a retreat-like intervention involving lengthy periods of social, behavioural, and alimentary restrictions, while ingesting specially prepared plant substances. The interplay of the dietary conditions and plants ingested sensitizes the dieter to receive healing, strength, guidance, and knowledge. From a clinical scientific point of view, the method has remained largely underexplored, but seems more pertinent than ever given the increasing interest in Amazonian psychoactive preparations including ayahuasca (Banisteriopsis caapi) and the burgeoning field of psychedelic-assisted therapies in general. Aim of the studyThis study offers a descriptive account and emic interpretation of the Peruvian-Amazonian dieta. More specifically we document in detail the procedure, its context and purpose of application, effects, modes of action, adverse effects, and risks, from the perspectives of a sample of Peruvian traditional healers. The Peruvian-Amazonian dieta is a multi-purpose method for making use of medicinal plants, many of which (but not all), are psychoactive; the current work especially focuses on its therapeutic applications in conjunction with psychoactives. MethodsWe interviewed 16 healers working in the Ucayali, San Martín, and Loreto provinces of Peru using a semi-structured interview approach. Interviews were audio-recorded and transcribed verbatim. The extensive data derived from these interviews were analysed by means of computer-assisted manifest qualitative content analysis using a theory-advancing approach. Over 500 coded text segments were categorized, resulting in 7 main theme clusters and corresponding sub-themes. ResultsThe interviewed healers described a complex intervention with multifaceted applications (treatment, prevention, training) and effects in various domains (body, mind, spirit, energy). The process was portrayed as transformative, with benefits attributed to the effects of the so-called teacher plants in conjunction with the diet's conditions, along with the skill of the healer guiding the intervention. Further, a detailed risk assessment revealed sophisticated safety measures and tools designed to address adverse responses. The importance of adequate training of the healer that administers the diet was particularly highlighted in this context. ConclusionsThe dieta is a central therapeutic concept and tool in Peruvian-Amazonian traditional medicine and a unique method for using psychoactive plants. Multidisciplinary health research that includes traditional treatment methods from Indigenous cultures, Amazonian and other, should not be neglected in the current global interest in psychedelic therapies; such research may in the long-term contribute to a more inclusive psychedelic research paradigm as well as healthcare practice in countries where rich traditional healing systems exist, and perhaps beyond. It may also contribute to the recognition of the Indigenous healers as not only historical forerunners, but also current leading experts in psychedelic medicine.

Chlorinated polyfluoroalkyl ether sulfonic acids in fish, dust, drinking water and human serum: From external exposure to internal doses.

Exposure to per- and polyfluoroalkyl substances (PFASs) has raised significant public health concerns due to their persistence and toxicity in the human body. Here, we aimed to investigate the characteristics of exposure to chlorinated polyfluoroalkyl ether sulfonic acids (Cl-PFESAs) and legacy PFASs and the relative contribution from different external pathways to human exposure. Three Cl-PFESAs and fourteen legacy PFASs were detected in human serum, fish, indoor dust and drinking water collected from Shijiazhuang, China. Results showed that 6:2 Cl-PFESA was the third most predominant compound, with an average concentration of 2.70ng/mL in serum, which was lower than those of perfluorooctane sulfonate (PFOS) and perfluorooctane acid (PFOA) (14.79 and 4.91ng/mL). The estimated daily intake of 6:2 Cl-PFESA via dust ingestion (mean: 0.008ng/kg bw/day) was found to be highest among all detected PFASs, while the highest value via fish and drinking water was found for PFOS and PFOA (0.438-9.799 and 0.034-0.155ng/kg bw/day), respectively. The similar composition of PFASs between serum and fish suggests that fish consumption is a major contributor to human exposure to PFASs. However, the increasing ratios of EDIindoor dust/EDIfish for PFOS, PFOA and 6:2 Cl-PFESA indicated that the contribution of dust ingestion for PFASs, especially 6:2 Cl-PFESA, could not be ignored. The modeled serum concentrations of 6:2 Cl-PFESA higher than its observed levels hint at its gradually increasing exposure levels in the general population. Combined with the lower modeled levels of PFOS than the observed levels, the substituent with 6:2 Cl-PFESA for PFOS is obvious in China. Therefore, further studies on contributions from more detailed external sources and risk assessments of Cl-PFESAs are recommended, especially for some vulnerable subpopulations, considering their widespread exposure and similar environmental behaviors compared with those of their predecessors.

Hematopoietic Cell Transplantation-Comorbidity Index Score Is Correlated with Treatment-Related Mortality and Overall Survival following Second Allogeneic Hematopoietic Cell Transplantation in Children

Allogeneic hematopoietic cell transplantation (HCT) can lead to considerable complications and treatment-related mortality (TRM); therefore, a detailed assessment of risks is essential. The Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI) can predict both TRM and overall survival (OS). Although the HCT-CI has been validated as a useful tool for first HCT, its potential utility for second HCT has not yet been investigated. Here we aimed to evaluate the utility of the HCT-CI score in assessing the risk of TRM and OS in the setting of a second allogeneic HCT. This was a retrospective analysis of all pediatric patients (age <21 years) who underwent a second allogeneic HCT at UCSF Benioff Children's Hospital San Francisco between 2008 and 2019. According to their HCT-CI, patients were classified as "low risk" with an HCT-CI of 0 or "intermediate-high risk" with an HCT-CI ≥1. A total of 59 patients were included in the study. Our primary endpoint was TRM, observed at 100 days, 180 days, 1 year, and last follow-up following HCT, and our secondary endpoint was OS at 1 year and at 5 years or last follow-up. We also evaluated outcomes of patients admitted to the pediatric intensive care unit based on the HCT-CI score. Seventy-six percent of patients had an HCT-CI of 0. The most frequent comorbidities were pulmonary, seen in 7 patients (12%; 95% CI, 5% to 23%), including 5 (71%) with moderate and 2 (29%) with severe comorbidities. The OS and the cumulative incidence of TRM at 1 year for the entire cohort were 81% (95% CI, 69% to 90%) and 12% (95% CI, 5% to 22%), respectively. The cumulative incidence of TRM and OS at 1 year showed a significant correlation with HCT-CI score; TRM was 4% (95% CI, 1% to 13%) for an HCT-CI of 0 versus 36% (95% CI, 13% to 60%) for an HCT-CI ≥1 (P < .001), and OS was 89% (95% CI, 75% to 99%) for an HCT-CI of 0 versus 57% (95% CI, 28% to 78%) for an HCT-CI ≥1 (P=.003). After adjusting for covariates, HCT-CI continued to be associated with both TRM (P=.004) and OS (P=.003). In addition, comparing patients with malignancies and nonmalignant disorders, disease-free-survival at last follow-up was higher in the nonmalignant disorder group and also was influenced by the HCT-CI score in each group (P=.0035). There also was a significant difference in outcomes of patients admitted to the pediatric intensive care unit; 15 patients (68%) with an HCT-CI of 0 were alive at last follow-up, compared with only two (22%) with an HCT-CI ≥1 (P=.016). HCT-CI has an impact on TRM and OS and may serve as a predictor of outcomes of second allogeneic transplantation. Although this study was conducted in a relatively small sample, it is the first to investigate the utility of the HCT-CI score in predicting outcomes after a second allogeneic HCT in pediatric recipients. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

Groundwater contamination risk assessment based on advection-dispersion equation

The consequences of contaminated groundwater can seriously affect sustainable development; present and future generations being seriously affected by inadequate drinking water quality, loss of water supply, degraded surface water systems, high remediation costs, more expenses for other water supplies, and likely health issues. Therefore, an effective way to protect groundwater resources is by assessing the risk of groundwater contamination. An assessment of groundwater pollution should be performed to determine the level of risk posed by soil and groundwater contamination and establish if remediation strategies are required to protect controlled waters from site-derived contamination. Furthermore, if remediation is deemed necessary, site-specific remedial targets should be derived. A case study is presented, where a Conceptual Site Model was derived based on a “Source-Pathway-Receptor” exposure mechanism using historical information. Primary sources of contamination at the site are residual contamination within the soil and groundwater, and samples were collected from the site and tested in the laboratory; the concentration of water samples was compared to Romanian Drinking Water Standards. The following potential migration pathways have been identified: Leaching from soil and Migration of contaminated groundwater. The Detailed Quantitative Risk Assessment (DQRA) has modelled the leaching of contaminants from the site via infiltration and vertical migration to the groundwater and subsequent lateral groundwater migration, with dilution and attenuation process active, to the compliance point, using Ogata-Banks equation. The results of this assessment indicate that the concentration of contaminants does not represent a significant risk to controlled waters.