Inherent Risk Research Articles

Green Protocol for the Synthesis of Luminescent Carbon Nanodots Derived from Murraya Koenigii Leaves and Urea: Enhancing Photoluminescence for Advanced Bioimaging.

We have synthesized Murraya Koenigii leaves powder-derived carbon nanodots (CNDs) by hydrothermal method. A tribute to our commitment to environmental sustainability is the unique composition of our CNDs, which are made entirely of natural carbon sources and a green solvent, water. Our further efforts to improve performance led us to start making nitrogen-doped CNDs. By using urea as a non-toxic source of nitrogen, we observed a substantial increase in fluorescence intensity, extending the usefulness and potential of these nanomaterials. We investigated the optical properties using UV-Vis and fluorescence spectroscopy. The other parameters, like structural and size-shape morphology, were analyzed using FTIR, XRD, and HR-TEM, respectively. The fluorescence spectroscopy demonstrated their capability to exhibit wavelength-dependent photoluminescence (PL), highlighting the potential of these CNDs for cell bioimaging applications. The fluorescence properties affirm their suitability for biomedical applications, as they do not involve any inherent risk to cells.

Exploring the impact of sepak takraw ball heading on brain injury risk: An analytical and experimental investigation

Sepak takraw, a unique sport resembling volleyball but played with the legs, is popular in Asia. Players often use their foreheads to receive the ball, exposing them to potential brain injuries. This research evaluates the potential for brain injuries from heading in sepak takraw. Using both analytical and experimental approaches, we developed a mathematical model adapted from soccer-related studies to predict peak linear acceleration (PLA). We also conducted laboratory experiments to measure PLA and peak rotational acceleration (PRA) using a ball launcher and an Anthropomorphic Test Device (ATD). The mathematical model demonstrated a high level of accuracy in PLA prediction, confirming its reliability. Comparative analysis with soccer and water polo studies revealed that the measured PLA, PRA, and Head Injury Criteria (HIC) values for sepak takraw are below suggested concussion thresholds, indicating a lower risk of brain injury. However, this assessment does not account for the cumulative effects of repetitive head impacts, which increase the risk of brain injury over time. Despite sepak takraw’s distinct play style, the findings indicate that while the inherent risk of head injury from single impacts may be low, the potential long-term effects of repetitive impacts warrant further investigation. This study enhances the understanding of sports-related brain injuries and highlights the need for further research into subconcussive impacts and the development of protective measures. Our research paves the way for more comprehensive investigations, including field experiments, which are crucial for a nuanced understanding of sepak takraw’s impact dynamics.

Microbiology, induction, and management practices to mitigate lameness caused by bacterial chondronecrosis with osteomyelitis in broiler chickens

Bacterial chondronecrosis with osteomyelitis (BCO) lameness is the most prevalent skeletal disorder in poultry, implicated by the inherent risk of the high growth rate of modern broilers. The non-synchronization of massive body mass accretion vs maturation of the structural bone induces vulnerability to bone microfracture and immunosuppression, leading to bacterial necrosis in the skeletal and thoracic vertebral bones, leg paralysis, and eventual death. BCO lameness also imposes animal welfare issues and confers food safety risks. A study in 20 broiler farms in Australia recorded 28% BCO lesions of the necropsied birds, while a study in commercial flocks in Europe reported 19% moderate-to-severe lameness symptoms. The high incidence of lameness in commercial broiler farms reduces production value and leads to a huge economic loss in the poultry industry. Managing BCO lameness in broiler poultry is more challenging than that of other species because the peak of lameness incidence emerges at the marketing age of broilers. Moreover, curative treatment of the affected broilers is arduous due to their larger populations but shorter production cycles. Thus, condemnation of clinically lame birds has been a common practice in broiler farms to prevent the transmission of highly contagious BCO throughout the broiler populations. This practice decreases the production value and increases the economic forfeits. Therefore, presenting intervention measures for managing and controlling BCO in broiler poultry is necessary. Knowledge of etiological agents, pathogenesis, detection, and experimental lameness models to evaluate the efficacy of the intervention measures is highly important in presenting approaches to mitigate BCO lameness. Thus, this review focuses on microbiology studies of BCO, models of creating experimental lameness, and intervention measures mitigating BCO lameness in broiler chickens.

Prestige and punishment: Status symbols and the danger of white elephants

This article identifies and unpacks the intrinsic potential for backlash in the pursuit of status symbols. While status loss has been associated with domestic pushback and reduced legitimacy for ruling governments, the literature on status is yet to examine how status-seeking can backfire even when a state can successfully claim to have acquired a status symbol. We contend that status backlashes are an inherent risk of status-seeking due to the multivocality of costly status symbols. Our heuristic framework for studying status backlashes proposes examining modes of critique that construe status symbols as irrational or unjustified costly endeavours, undermining their legitimating capacity and potentially even transforming them into a marker of stigma. Empirically, we identify three modes of critique present in reactions to Brazil’s hosting of the World Cup in 2014 and the Olympics in 2016. There, despite recognizing the symbolic value of hosting these mega-events, Brazilian audiences also criticized the government for the opportunity costs, vested interests and subservience that it entailed. Undertaking two shadow case studies – on the backlash against the United Kingdom’s renewal of its Trident nuclear weapons system and Norway’s engagement in military interventions between 1999 and 2012 – we document how these modes of critique associated with status symbols can travel across contexts.

Neurointerventional surveys between 2000 and 2023: a systematic review

BackgroundSurveys are increasingly used in neurointervention to gauge physicians’ and patients’ attitudes, practice patterns, and ‘real-world’ treatment strategies, particularly in conditions for which few, or no evidence-based, recommendations exist. While...

When Patient Voices Get Lost in Evidence Hierarchies: A Testimony of Rare Adverse Events and Participatory Epistemic Injustice in Drug Safety Monitoring

ABSTRACT We explore an unsolved challenge in the era of evidence-based medicine (EBM): the recognition of the patient as an epistemic agent or ‘knower’. While patients are increasingly acknowledged as carriers of values and preferences, it seems more challenging to acknowledge them as carriers of important causal information. In contrast, the science of pharmacovigilance depends on patient testimonies as valuable sources of causal evidence. This incompatibility can give rise to cases of what has been called participatory epistemic injustice. We analyse the testimony of a chronic pain patient and co-author of this article, Christine. Christine gives an auto-ethnographic account of her interactions with healthcare professionals trying to find the right pharmacological treatment for her condition. Through the analysis of her own story, she identifies some relevant themes for the epistemic interaction between healthcare professionals and chronic pain patients. We argue that such epistemic interactions are increasingly shaped by EBM and its conception of causality, which devalues patient subjective testimonies and emphasises statistical evidence. We conclude that outlier patients face an inherent risk of being left vulnerable to participatory epistemic injustice, particularly regarding the discovery of novel, rare adverse effects of medicines.

Chromosomal abnormalities in oocyte donor candidates: a French survey of over 8200 karyotypes.

To study karyotypes of more than 8,200 oocyte donor candidates in nulliparous or multiparous women compared to a reference population. A retrospective observational multicentric study. The study included two cohorts of oocyte donor candidates recruited between January 2005 and October 2021: multiparous women with at least one child at the time of recruitment, and nulliparous women. Both were compared to a reference population composed of female newborns from literature. Not applicable. Blood lymphocyte karyotype. A total of 8229 oocyte donor candidates from 22 fertility centers were included in this study. Nulliparous women (n=1890) and multiparous ones (n=6339) were compared to 8102 female newborns. Overall, 65 candidates were carriers of chromosomal abnormalities and were therefore excluded from the donation process (0.79%, 95% CI: 0.60-0.98). The occurrence of balanced structural chromosomal rearrangements was globally increased in the study population (0.49%, 95% CI: 0.34-0.64) compared to female newborns (0.24%, 95% CI: 0.34-0.64, p=0.0086). The number of reciprocal translocations was increased 5-fold in nulliparous oocyte donor candidates (0.37%, 95% CI: 0.10-0.64, p=0.013). The incidence of sex chromosome mosaicism was notably increased in multiparous oocyte donor candidates, with 17 cases (0.27%, 95% CI: 0.14-0.40, p=0.0052). Among chromosomal aberration carriers only two nulliparous women (one reciprocal translocation and one sex chromosome mosaicism) had fertility issues with a diagnosis of premature ovarian failure. In this comprehensive 16-years French experience of karyotyping in oocyte donor candidates, we confirmed an increased incidence of balanced structural chromosomal rearrangements, especially among those without children at the time of recruitment. Karyotyping could be considered to identify any chromosomal abnormalities that may not be easily detectable through medical questioning. These abnormalities pose an inherent genetic risk for gamete recipients if left undetected.

Cost implications and sustainable design for warehouses considering fire safety regulations

This paper explores the impact of sustainable design practices on warehouse construction costs in the context of fire safety regulations. The inherent fire risk during the operation of industrial facilities is a critical consideration in their design. This study evaluates various cost and technological aspects of sustainable solutions within the “design and build” framework, focusing on fire protection systems across three different fire zone configurations. The modeling analysis examines how fire zones influence smoke dispersion, temperature variations at a specific location above the fire source, and visibility. Numerical results reveal variations in smoke distribution among the three configurations, though these differences do not significantly affect evacuation efficiency. The findings indicate that increasing the number of fire zones within the warehouse can mitigate the potential impact of a fire. This research underscores that fire protection and evacuation conditions significantly affect investment costs.

Developing a novel anticipated inherent risk assessment approach applicable in early stages of process design

Inherently Safer Design (ISD), as one of the most fundamental approaches to process safety, focuses on the innate design features. Numerous tools have been developed to assess ISD and risk-based indices are one of the most elevated of them. Existing indices are limited in modelling consequences or are challenging to adapt in terms of probability. This study introduces the Anticipated Inherent Risk Index (AIRI), a robust tool for rapid risk assessment of the worst anticipated scenarios. It incorporates Furthest Effect Distance of the release from the largest connection, by software, and Representative Failure frequency, which is a relative dataset calculated from renown databases. This presents a relative risk map upon major consequences and their likelihood. AIRI applied to a PDH Fractionation Subunits shows that Heat Pump Compressor Suction Drum (AIRI≈3399) in PP Splitter Section, followed by Propylene Trim Condenser (AIRI≈1931) and PP Splitter Reboiler/Condenser (AIRI≈1798) are the equipment with the highest risk. AIRI is a competent tool for early high-level analysis of equipment risk, which gives useful indications on design and how to improve it. This tool also has the potential to be equipped with vaster frequency datasets and effects analysis and to be incorporated into other process safety studies.

Beyond the classroom: the evolving spectrum of ESD research in Japan

PurposeEducation for Sustainable Development (ESD) has been robustly endorsed through policy mechanisms, prompting numerous context-specific voluntary initiatives in Japanese schools and communities. However, this field remains in its infancy. This study aimed to investigate the literature on ESD in Japan to reveal research trends, identify research gaps and propose areas for future research, from early childhood to higher and non-formal education.Design/methodology/approachThis study employed a qualitative design with a Systematic Literature Review (SLR) approach to analyze 88 peer-reviewed empirical studies on ESD in Japan from 2005 to 2023.FindingsThis study has revealed an observable increase in the number of ESD-related publications, especially after 2015. Most studies emphasize formal education, particularly from elementary school to universities. These articles were categorized into seven thematic foci, with “Pedagogical Approaches and Material Development in ESD” being the most prevalent. There has been an evident shift in Japan from traditional lecture-style methods toward learner-centered ESD pedagogies. However, the country lags behind the global education community in terms of research on and the implementation of Teacher Education for Sustainable Development and the Whole-School Approach.Research limitations/implicationsThe study is confined to peer-reviewed, empirical publications in Japanese or English, potentially overlooking significant non-empirical works and studies in other languages. This limitation could mean missing out on broader insights and perspectives. Furthermore, as a qualitative analysis, there's an inherent risk of bias in interpreting data and categorizing themes. These constraints suggest caution in generalizing the findings and indicate areas for further research, such as expanding the linguistic and methodological scope and enhancing objectivity in analysis.Practical implicationsThe findings suggest a pressing need for Japan to refine its approach to ESD, particularly in teacher training and school management, aligning more closely with global practices. For practical application, this involves adopting more holistic teacher education programs and school management strategies that integrate ESD principles comprehensively. Recognizing the unique challenges of Japan's educational culture is crucial for developing tailored strategies that not only follow global best practices but also resonate locally. These insights aim to guide meaningful interventions, promoting an education system adept at addressing sustainability challenges.Originality/valueCategorizing the literature into formal and non-formal settings and subsequently into seven themes offers a clear depiction of the research trends. A comparison of Japan's specific advancements and challenges in ESD with global trends, particularly in pedagogy, teacher education and institutional management, highlights the areas needing further exploration.

An approach to risk categorization of Products of Animal Origin imported into the United Kingdom

There are thousands of potential hazards associated with imported foods and to achieve an excellent food safety record, resources need to be focused on higher-risk foods and preventive mechanisms.We were tasked to develop an automated tool to assess public health risks from imported foods across multiple countries of origin, hazards and product types to replace manually conducted single product-hazard qualitative import assessments.In this paper we describe the generic import assessment of risk to consumers from importing foodborne microbiological hazards into the UK, to identify those higher-risk foods. A risk categorization approach was developed as recommended by international standards laid out in the CODEX principles and guidance by FAO and WHO on food control. The approach combines an assessment of the inherent risk of the commodity (product characteristics), and any hazard mitigation or control measures undertaken in the producing country (control characteristics) and incorporates real-world global data relating to food safety incidents over a three-year time window (compliance) for that product.With the broad diversity of foods imported, food stuffs are grouped into commodity groups using the codes in the international Harmonised System of classification. The mapping of trade into commodity groups and the scoring system developed to estimate risk are presented.Results by exporting country were generated for 16 selected public health hazards identified from global food safety incident data using expert elicitation.To ensure the approach is dynamic, can keep pace with global trends, and uses resources efficiently, the assessment has been automated and predominantly uses data that is global, publicly available and routinely updated.The results support risk managers in their regular reassessment of the controls that should be placed on foodstuffs imported into the UK.

Postoperative Outcomes of Fontan Operation in a Multicenter Italian Study. How Far Have We Gone? Early Outcomes After Fontan Operation.

Despite the clinical results of the Fontan operation have certainly improved, it still presents with an inherent surgical risk of death and early morbidities. This is a retrospective clinical study of children undergoing Fontan operation in 9 congenital cardiac centers in Italy between 1990 and 2023. Clinical and surgical data were collected via a dedicated RedCap database. Primary outcome was cohort's mortality, also considering different decades, while secondary outcomes were postoperative complications and reintervention. In the last 3 decades, there were 897 patients undergoing Fontan operation, M/F 512/384, median age: 4.5years (IQR 3.3-6.4), median weight 16kg (IQR 14-22). A first palliation was deemed necessary in 710 patients (80%), and most patients underwent a staged Fontan (93%); an extracardiac conduit was used in 790 patients (88%). Postoperative complications (mild to severe) occurred in 410 patients (46%), and early reinterventions were required in 66 patients (7.5%). Overall operative mortality was 1.7% (15 patients). Age at Fontan greater than 4years was associated with an early need for transcatheter reintervention (adj p value = 0.037) and a higher incidence of postoperative complications (adj p value = 0.017). The Fontan operation has seen significant improvements in immediate outcomes, notably a remarkable reduction in overall mortality to just 1.35% in the last decade. While minor complications have remained steady, there has been a substantial decrease in major early complications, deaths, and the need for reinterventions. Notably, patients aged over 4years seem to face a higher risk of postoperative morbidity, underscoring the critical role of age in preoperative assessment and management strategies for Fontan patients.

'I Think the First Priority is Physically Safe First, Before You Can Actually Get Psychologically Safe': Staff Perspectives on Psychological Safety in Inpatient Mental Health Settings.

While the concept of psychological safety has been gaining momentum, research concerning psychological safety in inpatient mental health wards is lacking. To investigate how psychological safety is conceptualised by healthcare staff in inpatient mental health units, and what barriers and facilitators exist. Reflexive Thematic Analysis was used to analyse 12 interviews. Participants conceptualised psychological safety as feeling safe from physical harm, being able to develop meaningful relationships and feeling valued at work. Participants often did not feel physically safe at work, which led them to feel psychologically unsafe. Barriers to psychological safety were reliance on agency workers, punitive management approaches and the inherent risk in working with mental health inpatients. Facilitators included appropriate staffing ratios and skill mix, being able to form meaningful relationships and having access to support. The emphasis on the physical safety element within psychological safety means that existing definitions of psychological safety require extension for the mental healthcare context. However, large-scale research is needed to further understand experiences of psychological safety in this group. A better understanding of the dimensions of psychological safety in inpatient mental health settings could support the development of tools to investigate psychological safety interventions. Organisations could support psychological safety through regular staff supervision and improved staffing ratios and skill mix.

The impact of performance degree on players: Exploring player enjoyment and engagement in the dynamic of game process

This study explores the intricate dynamics between player performance, reward frequency, and unpredictability in gaming experiences within the context of game refinement theory. It introduces three key concepts: m (inherent game risk), k (player skill level), and N (reward frequency concerning reinforcement learning), and investigates how their interplay influences player engagement and enjoyment. The research aims to contribute theoretical advancements in game design, user experience, and behavioral psychology by employing the motion-in-mind model. The findings reveal that highly skilled players (lower k) derive greater enjoyment due to their ability to navigate uncertainties efficiently, reaching an equilibrium where the measure of game refinement (GR) equals the measure of unpredictability (AD). The study examines how players transition from k=3 (average skill) to k=2 (high skill), leading to a heightened gaming perception akin to perfect players. The research uncovers relationships between player skill (k), game risk (m), and reward frequency (N). Furthermore, we extend previous research by observing the ratio of GR and AD values (denoted as ϕ) to explore the balance between entertainment and surprise in different game types, providing valuable perspectives for practitioners and academicians.

HealthyTrailsBR – The prevalence of running-related injuries and cramps, and the description of personal and running characteristics in Brazilian trail runners: a cross-sectional study

BackgroundPhysical activity in natural environments, such as trail running, is a way to nurture physical and mental health. However, running has an inherent risk of musculoskeletal injuries. ObjectivesTo investigate the prevalence of running-related injuries (RRI) and cramps, and to describe the personal and training characteristics of Brazilian trail runners. MethodsA total of 1068 trail runners were included in this observational cross-sectional study. The participants had at least six months of trail running experience. The data were collected between April 2019 and February 2020 through an online and self-reported survey. ResultsThe point prevalence of RRIs was 39.2 % (95 % credible interval [CrI]: 36.3, 42.1). The body region with the highest point prevalence was the knee. The 12-month period prevalence of RRIs was 69.2 % (95 %CrI: 66.4, 72.0). The body region with the highest 12-month period prevalence was the lower leg. 1- and 12-month period prevalence of cramps was 19.5 % (95 %CrI: 17.1, 21.9) and 36.0 % (95 %CrI: 33.0, 38.8), respectively. Triceps surae was the muscle most affected by cramps. ConclusionsTwo in 5 (40 %) trail runners reported being injured at the time of data collection, and about 2 of 3 reported previous RRIs in the last 12 months. The most prevalent injured body regions were the knee and the lower leg. One in 5 trail runners reported cramps in the last month, increasing to 36 % in the last 12 months. Knowing better the characteristics of the population and the burden of health conditions may inform better decisions regarding implementation actions toward trail running practice.

INav-based, Automated Coronary Magnetic Resonance Angiography for the Detection of Coronary Artery Stenosis (iNav-AUTO CMRA)

BackgroundCoronary computed tomography angiography (CCTA) is recommended as the first line diagnostic imaging modality in low to intermediate risk individuals suspected of stable coronary artery disease (CAD). However, CCTA exposes patients to ionising radiation and potentially nephrotoxic contrast agents. Invasive coronary angiography (ICA) is the gold-standard investigation to guide coronary revascularisation strategy, however, invasive procedures incur an inherent risk to the patient. Coronary magnetic resonance angiography (Coronary MRA) avoids these issues. Nevertheless, clinical implementation is currently limited due to extended scanning durations, inconsistent image quality, and consequent lack of diagnostic accuracy. Several technical Coronary MRA innovations including advanced respiratory motion correction with 100% scan efficiency (no data rejection), fast image acquisition with motion-corrected undersampled image reconstruction and deep-learning (DL)-based automated planning have been implemented and now await clinical validation in multi-centre trials. MethodsThe objective of the iNav-AUTO CMRA prospective multi-centre study is to evaluate the diagnostic accuracy of a newly developed, state-of-the-art, standardised, and automated Coronary MRA framework compared to CCTA in 230 patients undergoing clinical investigation for CAD. The study protocol mandates the administration of oral beta-blockers to decrease heart rate to below 60bpm and the use of sublingual nitroglycerine spray to induce vasodilation. Additionally, the study incorporates the utilisation of standardised postprocessing with sliding-thin-slab multiplanar reformatting, in combination with evaluation of the source images, to optimize the visualisation of coronary artery stenosis. DiscussionIf proven effective, Coronary MRA could provide a non-invasive, needle-free, yet also clinically viable, alternative to CCTA. Trial RegistrationThis study is registered at clinicaltrials.gov (NCT05473117).

Meniscus Injuries in Soccer.

Soccer is considered the most popular sport in the world. The game involves frequent agile maneuvers, such as rapid accelerations/decelerations and pivoting, and carries an inherent risk of high-speed collisions, which can lead to lower extremity injury. Knee and meniscus injuries can cause significant pain and disability, precluding participation in the sport. Understanding the diagnosis and management of meniscal injuries in soccer players is essential to the care of these athletes. This paper reviews meniscal anatomy, biomechanics, and mechanisms of injury; discusses the work-up, diagnosis, and management of meniscus injuries; and reports on rehabilitation, return to sport, and outcomes after meniscal injuries in soccer players.

So, you cannot vent: A deep dive into other explosion protection methods

AbstractCurrent NFPA standards for managing combustible dust hazards require equipment with an explosion hazard to be protected from the effects of deflagration. These protections include deflagration venting in accordance with NFPA 68, Standard on Explosion Protection by Deflagration Venting, 2023 Edition, or oxidant concentration reduction, combustible concentration reduction, deflagration suppression, or deflagration pressure containment, via NFPA 69, Standard on Explosion Protection Systems, 2024 Edition. It makes sense to choose the simplest and most cost‐effective option based on the inherent design and risk of the operation. Implementation of any one of these protection methods requires an understanding of the method and all the associated requirements. While the basic methods are fairly straightforward, the associated requirements are often less understood. In this paper, the author will introduce the basic methods and take a deep dive into the associated requirements of each method of protection. Based on the author's experience in evaluating protection systems, common misunderstandings will be highlighted, for example, the margin of safety to apply and the operational limits required to be developed and documented for oxidant concentration reduction systems.

Thorough perioperative and anesthetic considerations for cerebellar syndrome induced by posterior fossa tumors

Posterior fossa tumors are relatively rare pathologies, predominantly observed in pediatric populations. Nevertheless, there have been documented cases in adults, where these tumors are often associated with a higher prevalence of vascular lesions compared to those found in children. Given the inherent high mortality risk associated with this condition, meticulous anesthetic management is paramount. A comprehensive evaluation of patient-specific factors, including existing comorbidities, hemodynamic stability, and neurological status, is essential. Moreover, perioperative considerations such as patient positioning, the choice of anesthetic technique, and the duration of the surgical procedure must be carefully planned to optimize outcomes. This article presents a case review of a young adult patient with no significant medical history who was diagnosed with a posterior fossa tumor. The discussion encompasses the anatomical considerations of this pathology, critical preoperative assessments, anesthetic strategies tailored to this surgical context, and an analysis of the patient’s postoperative course.

Patient safety during transfers from critical care: developing and assessing a checklist.

Critically ill patients often need to be transferred from the intensive care unit (ICU) to the imaging department. This can compromise their safety, not only because of the inherent risk of deterioration but also because of the potential for incidents due to the inadequate preparation of medicines, equipment and monitoring. Using a patient transfer checklist can reduce the risk of human factor errors. This article reports on a quality improvement project conducted at the ICU of an acute hospital trust in the Midlands to develop and evaluate a patient transfer checklist. The checklist was developed based on guidance from the Intensive Care Society and evaluated using retrospective incident reports, an audit of staff compliance and a user survey. Using a transfer checklist in the ICU is likely to reduce patient safety incidents during transfers, but a shift in workplace culture may be needed to enhance incident reporting.