Action Level Research Articles

Characterization of Telecare Conversations on Lifestyle Management and Their Relation to Health Care Utilization for Patients with Heart Failure: Mixed Methods Study.

Telehealth interventions where providers offer support and coaching to patients with chronic conditions such as heart failure (HF) and type 2 diabetes mellitus (T2DM) are effective in improving health outcomes. However, the understanding of the content and structure of these interactions and how they relate to health care utilization remains incomplete. This study aimed to characterize the content and structure of telecare conversations on lifestyle management for patients with HF and investigate how these conversations relate to health care utilization. We leveraged real-world data from 50 patients with HF enrolled in a postdischarge telehealth program, with the primary intervention comprising a series of telephone calls from nurse telecarers over a 12-month period. For the full cohort, we transcribed 729 English-language calls and annotated conversation topics. For a subcohort (25 patients with both HF and T2DM), we annotated lifestyle management content with fine-grained dialogue acts describing typical conversational structures. For each patient, we identified calls with unusually high ratios of utterances on lifestyle management as lifestyle-focused calls. We further extracted structured data for inpatient admissions from 6 months before to 6 months after the intervention period. First, to understand conversational structures and content of lifestyle-focused calls, we compared the number of utterances, dialogue acts, and symptom attributes in lifestyle-focused calls to those in calls containing but not focused on lifestyle management. Second, to understand the perspectives of nurse telecarers on these calls, we conducted an expert evaluation where 2 nurse telecarers judged levels of concern and follow-up actions for lifestyle-focused and other calls (not focused on lifestyle management content). Finally, we assessed how the number of lifestyle-focused calls relates to the number of admissions, and to the average length of stay per admission. In comparative analyses, lifestyle-focused calls had significantly fewer utterances (P=.01) and more dialogue acts (Padj=.005) than calls containing but not focused on lifestyle management. Lifestyle-focused calls did not contain deeper discussions on clinical symptoms. These findings indicate that lifestyle-focused calls entail short, intense discussions with greater emphasis on understanding patient experience and coaching than on clinical content. In the expert evaluation, nurse telecarers identified 24.2% (29/120) of calls assessed as concerning enough for follow-up. For these 29 calls, nurse telecarers were more attuned to concerns about symptoms and vitals (19/29, 65.5%) than lifestyle management concerns (4/29, 13.8%). The number of lifestyle-focused calls a patient had was modestly (but not significantly) associated with a lower average length of stay for inpatient admissions (Spearman ρ=-0.30; Padj=.06), but not with the number of admissions (Spearman ρ=-0.03; Padj=.84). Our approach and findings offer novel perspectives on the content, structure, and clinical associations of telehealth conversations on lifestyle management for patients with HF. Hence, our study could inform ways to enhance telehealth programs for self-care management in chronic conditions.

The influence of the daily salt-intake on the antihypertensive action and atrial natriuretic peptide level in patietns with angiotensin receptor neprilysin inhibition

Abstract Background The angiotensin receptor–neprilysin inhibitor (ARNI) is a drug which acts through angiotensin receptor blocking effect and the increase in atrail natriuretic peptide (ANP) through neprilysin inhibitor in hypertension (HT). These combined effects result in a reduced risk of hospitalization for heart failure or death from cardiovascular causes. ANP is also known for its various cardioprotective effects including vasodilator and natriuretic action. Acording to Guyton's pressure-natriuresis curve, the efficacy of angiotensin receptor blocker drugs is diminished in HT cases with high daily salt inatke. However, whether the effect of ARNI on HT is attenuated in patients with high daily salt intake remains unclear. Purpose The present study investigated the influence of a daily salt intake on the antihypertensive action and ANP level in patients with ARNI. Methods Fourty-four consecutive essential HT patients on ARNI were enrolled. Blood pressure and ANP level were measured at baseline (before taking ARNI) and 3 weeks later. ARNI (200mg) was prescribed and maintained during the study. In addtion, the daily salt intake was calculated using creatinine and natrium levels in urine, age, and body weight according to Japanese hypertensive guideline at baseline and 3 weeks later. Results The average age was 70±8 years old. About 50% (N=23) was male. The mean sytolic and diastolic blood pressure was 148±14mmHg and 89±10mmHg, respectively. The mean daily salt intake was 9.5±2.2 g/day at baseline. The mean ANP level was 529±300pg/ml. At follow up (3 weeks later), the mean systolic and diastolic blood pressure significanly went down to 132± 18 mmHg and 70± 9 mmHg, respectively (p=0.03). ANP level also increased from 529±300pg/ml to 793±580pg/ml. However, the mean daily salt intake was almost same as the baseline at 9.4±3.2 g/day. The patients were divided into 2 groups; high daily salt intake (N=20 with mean daily salt intake 10.5±1.7g/day)) and low daily salt intake (N=24 with 8.4±3.1g/day) groups compared to the baseline. The absolute and percentage changes in systolic blood pressure were almost same in the high and low daily salt intake groups (-12.7±15.8mmHg vs -13.7±14.2mmHg, p=0.75; -5.8±6.5% vs.-7.0±9.6%, p=0.58, respectively). However, the change rate in ANP level was significantly higer in the high daily salt intake group than in the low daily salt intake group (155±63 vs. 12±16%, p=0.01). Conclusion ARNI demonstrates effectiveness in lowering the blood pressure even in patients with higher salt intake, unlike angiotensin receptor blocker. In cases with high salt intake, the notable increase in ANP levels may contribute to decreasing blood pressure through vasodilator and natriuretic action.

Developing an mpox risk assessment matrix for social listening and infodemic insights generation

Abstract Issue Any effective response to an infodemic, requires prioritizing public health response on identified narrative themes that pose highest risk to health and well-being of populations. High-risk narratives often require more swift and far-reaching action and low-risk narratives require little or no response. Description of the problem Different countries are assigned different levels of risk to specific narratives or concerns, recognizing that for some issues there may be a large gap between the true public health threat and what is generating lots of conversations, concerns and press coverage that indicate a high degree of risk perception that may be unwarranted. WHO developed a risk matrix to apply to global analysis of questions, concerns and narratives about mpox, which resulted in biweekly infodemic intelligence reports that risk-assessed identified infodemic themes and corresponding recommendations for action. Results Risk assessment criteria were defined in the context of WHO’s global infodemic insights analysis for low, medium and high risk and positive sentiment in mpox global outbreak context before conducting the integrated analysis so that insights were reproducible and infodemic response actions were prioritized. This implemented the WHO/UNICEF training manual on 6 steps to produce an infodemic insights report, which includes tools on how to develop and apply a risk matrix for a specific public health question of concern and apply it in analysis. Lessons The approach resulted in rapid, systematic, reproducible and evidence-driven decision-making to respond to the infodemic accompanying the mpox global outbreak. Risk matrices must be adapted to the context of the public health event and the mandate of the health authority taking action. An mpox risk matrix for narratives included adaptation to reflect high-risk from stigmatizing narratives, as well as narratives circulating around or within LGBTQI+ communities. Key messages • A risk matrix must be developed and adapted to the context of each health emergency and level of health authority action. • Prioritization for rapid infodemic response based on a risk assessment is that it facilitates more effective response in a health emergency.

Roadblocks in Child Participation Practices in Academia and Civil Society

Abstract This article discusses the potential and pitfalls of children’s participation in academic and non-academic settings through a child participation project in Turkey by questioning various forms of childism from child and adult perspectives. We first and foremost acknowledge and emphasise the child’s position as a form of political resilience in a world where adult centrism has been the norm, regardless of differences in childhood experiences across cultures, social classes and age groups. Guided by this understanding, we engaged with two distinct fieldwork processes over the years and took steps toward achieving child participation at citizenship action level. In particular, we aimed to create a safe and open space for children from diverse backgrounds to come together, share their life issues, develop strategies to address their everyday problems and build a child-to-child participation network. However, we encountered several roadblocks to fully involving children in these processes. This article illustrates the perceptional and practical limitations we faced on the road that stem from competing dispositions held by children and stakeholders. To showcase the potential impact of our project, we highlight such obstacles as adultism among child participants, challenges of engaging academic research with stakeholders, and variations in motivation and interest among different social actors in the field of childhood. The obstacles are discussed with their implications in ways that they could be overcome.

Effect of an early music intervention on emotional and neurodevelopmental outcomes of preterm infants at 12 and 24 months.

Few studies have found long-term effects of early musical environmental enrichment in the NICU on preterm infant's development. This study examines how early music enrichment affects emotional development and effortful control abilities in 12- and 24-month-old very preterm (VPT) infants. One hundred nineteen newborns were recruited, including 83 VPTs and 36 full-term (FT) infants. The VPT infants were randomly assigned to the music intervention (44 VPT-Music) or control (39 VPT-control) groups. VPT-Music infants listened specifically designed music intervention from the 33rd week of gestation until hospital discharge. At 12 and 24 months, children were clinically evaluated using the Bayley-III Scales of Infant and Toddler Development and the Laboratory Temperament Assessment Battery, and at 24 months, with 3 additional episodes of the Effortful Control Battery. Our analysis showed that during a fear eliciting task, the VPT-Music group expressed lower level of fear reactivity and higher positive motor actions than VPT-controls and FT infants. At 24 months, the VPT-music group had lower scores for negative motor actions in the joy task, compared to both VPT-control and FT groups. In addition, both FT and VPT-music had higher scores of sustained attention compared to VPT-controls, but the contrasts were not significant. No significant effects on mental, language and motor outcomes were identified and for all three dimensions of the ECBQ. The present study suggests that an early music intervention in the NICU might influence preterm children's emotional processing at 12 and 24 months. Limitations and suggestions for future research are highlighted.

Language Teacher Researcher Identity Construction in Activity: Navigating Entanglement of Two English PSTs in Undergraduate Thesis Work in the Indonesian Context

ABSTRACT Addressing the issue of colonial humanism ideologies plaguing undergraduate thesis work of English pre-service teachers in the Indonesian context and perpetuating the dichotomy of teacher and researcher identities, this study explored two pre-service teachers’ entanglements in their day-to-day praxes of undergraduate thesis work as a site of identity construction by framing it in the lens of postcolonial, posthuman and transnational Cultural-Historical Activity Theory. Orienting toward movement of actions and praxes, they actively participated in entanglements of identity construction by making visible layers of contradictions and continuously maneuvering the contradictions to achieve meaningful outcomes in each praxis. The contradictions at the micro level further revealed contradictions at the meso level of actions and the macro level of networked activity systems at the institutional level, indicating the pivotal role of understanding their micro level of praxes to unveil issues hindering undergraduate thesis to serve as a democratic space to generate meaningful knowledge.

“The Action Level®”

“The Action Level®”

The investigation prospect application of alcohol-water extract of lingonberry as antimicrobial, anti-fungi and antioxidant pharmaceutical

Infection diseases is a worldwide important problem for medicine and pharmacy. Every year 13.7 million people die from bacterial infections in the world. Thus, the search of new compounds with antimicrobial and anti-fungi activity is topical for today. The object of the study was lingonberry leaf 60% extract. The content of phenylpropanoids derivatives was evaluated by spectrophotometric method of analysis, whereas organic acids by alkalimetric method; antioxidant power was found by potentiometric method; antibacterial and antifungal activity was assessed by the method of “wells”. According to the results of the study, it was shown that the lingonberry leaf extract is inferior to the green tea leaf extract in terms of the content of phenolic compounds, catechins, hydroxycinnamic and organic acids, but flavonoids dominate in the lingonberry extract. The study found that lingonberry leaf extract has a high level of antioxidant activity. When comparing the levels of antioxidant action of lingonberry extract with green tea extract and the «gold standard» – аepigallocatechin-3-O-gallate in one concentration of 0.03 mol/L, it was found that lingonberry extract had the best result. Escherichia coli bacteria was the most sensitive to the extract whereas Pseudomonas aeruginosa was the most resistant. This work shows that 60% ethanolic lingonberry leaf extract has potent antioxidant, antimicrobial and antifungal effects. According to the obtained results, it can be concluded that 60% V. vitis-idaea leaf extract is promising for the development of new antimicrobial, antifungal and antioxidant pharmaceutical.

A review of approaches to assessment of potential radon hazard of land plots

According to Rosstat statistics, in recent years there has been a tendency in the Russian Federation to increase the intensity of construction, while both the number of buildings put into operation and their total area are increasing. The assessment of the potential radon hazard of land plots for construction provides the possibility of timely inclusion of the necessary protective (preventive) measures against radon in the design of buildings. This is a legal requirement in cases where the density of radon flux from the ground surface within the building area exceeds the established hygienic standards (action levels). The paper presents a review of Russian and foreign approaches to assessing the potential radon hazard of land plots conducted within the framework of engineering and environmental surveys. The current regulatory requirements to radiation safety indicators of land plots for construction of residential, public and industrial buildings and facilities in the Russian Federation are analyzed. The main drawbacks of the algorithm for determining the potential radon hazard of land plots, used in the current guidelines MU 2.6.1.2398-08 approved at the federal level more than 15 years ago, are described. Critical remarks (the unsuitability of the value of density of radon flux from the ground surface for designing radon protective and mitigation (remedial) measures, lack of consideration of seasonal variations of radon flux density, etc.) accumulated over the years as a result of practical application of these guidelines are presented. Benefits and drawbacks of foreign approaches to assessing the potential radon hazard of the territory based on the results of measurements of radon concentration in soil gas, as well as the very possibility of a transition in Russian regulations from the density of radon flux from the ground surface to the radon concentration in soil gas, are analyzed. Some rational proposals of various Russian research teams on improving the algorithm for determining the potential radon hazard of land plots are considered.

Study of Animal Owners’ Knowledge of Helminthiasis in Cats at Mayda Animal Care and iVet Clinic Dramaga, Bogor

Animal owners often overlook helminthiasis because it does not cause specific clinical symptoms in mild infections. This study aimed to analyze the medical records of helminthiasis in cats and determine the knowledge of animal owners about helminthiasis through questionnaires at Mayda Animal Care and iVet Clinic Dramaga, Bogor. A cross-sectional study was used to analyze medical record data and then compared using descriptive methods with a secondary data approach. Data analysis was performed using the Chi-square test. The findings of helminthiasis cases in cats at Mayda Animal Care during January–December 2022 amounted to 102 cases, while at iVet Clinic Dramaga, there were 50 cases. Based on the Chi-square test, this study reported a significant correlation (p < 0.05) between age and the level of action and education with the level of understanding of animal owners on helminthiasis at Mayda Animal Care and iVet Clinic Dramaga, Bogor.

Social Support as a Catalyst for Environmental Awareness in Indonesia

General Background: Environmental awareness is crucial for communities to preserve ecosystems and prevent environmental degradation. Social support can play a significant role in fostering this awareness. Specific Background: In rural communities like Tutur village, Pasuruan regency, environmental awareness and social support are often interconnected. However, the extent to which social support influences environmental awareness remains underexplored. Knowledge Gap: While studies have examined environmental education and awareness, few have investigated the role of social support as a driving factor in increasing environmental responsibility in village settings. Aims: This study aims to examine the influence of social support on environmental awareness among the residents of Tutur village, focusing on the relationship between these variables using quantitative methods. Results: The findings from simple linear regression analysis reveal that social support has a significant effect on environmental awareness, indicating that residents with stronger social ties exhibit higher levels of concern and action toward environmental preservation. Novelty: This study offers a novel insight by quantitatively demonstrating the direct relationship between social support and environmental awareness in rural communities, highlighting social dynamics as a key factor in environmental education. Implications: The results suggest that enhancing social support networks through community-driven initiatives can significantly improve environmental consciousness and foster sustainable tourism development, particularly in rural areas like Tutur village. This study provides a basis for future research on integrating social support frameworks into environmental sustainability strategies, particularly in regions with strong communal ties. Highlights: Social support boosts environmental awareness in community residents. Strong community ties enhance responsibility for environmental preservation. Findings promote initiatives to improve environmental consciousness and tourism. Keywords: environmental awareness, social support, Tutur village, quantitative research, sustainability

A Statewide Program to Test and Reduce Lead in Drinking Water at Schools and Child Cares.

A lead testing act was passed in Colorado mandating that all licensed child care facilities and public schools serving fifth grade and lower test all drinking water locations for lead by May 31, 2023. Colorado's Water Quality Control Division created the Test & Fix Water for Kids program to implement this act. Aspects of the program included establishing a database, outreach and education, technical assistance, lead analyses at the Colorado State Laboratory, remediation, and reimbursement. Of a total of 6000 licensed child care providers and public elementary schools, 4500 entities enrolled and tested 53 000 water samples for lead at drinking water fixtures. Testing results showed that 93% (46 000 total) of the fixtures tested were below the 5 parts per billion (ppb) action level. As a result, 7% (3700) of the fixtures tested were above the action level. Of the fixtures that tested above 5 ppb, 47% were classroom faucets. Many of these faucets had not been used since COVID-19 when several schools switched to using bottle fillers. The program identified all fixtures associated with low usage as well as older fixtures to be replaced with lead-free options to reduce lead levels below 5 ppb. Almost 600 000 children have been protected from potential exposure to lead in drinking water through this program. This article outlines the methods of launching a statewide lead testing program and the importance of testing fixtures for lead in drinking water in early childhood education buildings.

Enhancing infection control in dialysis at a resource limited public healthcare institute: A cross-sectional study on microbiological quality assessment of dialysis water and dialysate

PurposeTo evaluate the microbiological quality of dialysis water and dialysate samples from hemodialysis units at a tertiary care government hospital and to assess the use of culture, endotoxin and periodicity of testing these assays to guide the actions of monitoring the quality of hemodialysis fluids, implement preventive and corrective actions, and improve the safety and outcomes of the dialysis process. MethodsA cross-sectional study was conducted at a 250-bedded super-specialty government hospital with a 24/7 hemodialysis unit equipped with 40 dialysis machines. Dialysis water and dialysate samples were collected monthly and analysed for microbial contamination and endotoxin levels as per AAMI guidelines. Bacterial cultures were done using Reasoner's Agar plates, and endotoxin analysis was performed using gel clot assay. Interpretation of results was based on predefined thresholds. ResultsAmong the 740 samples processed for microbial culture 19.6 % and 80.4% were unacceptable and acceptable respectively.Among the acceptable samples 10.5 % were at action level. At the end of 2 days of incubation, 15.2%dialysis water samples and 5.1%dialysate samples had unacceptable levels of bacterial colonies and at 5days additional 10.6 % dialysis water samples and 7.7%dialysate samples were unacceptable. 21.5 % of the samples tested for endotoxin had unacceptable levels. ConclusionsRegular monitoring of water quality in government healthcare hemodialysis units is crucial for quality of care, timely preventive and corrective actions for mitigating adverse outcomes. Processing cultures for 5–7 days is essential for detecting all contaminated specimens. While there might be a link between endotoxin levels and bacterial contamination, both endotoxin testing and bacterial culture independently are vital for evaluating water quality in dialysis settings. A comprehensive approach integrating various testing methods is necessary to uphold patient safety and enable necessary improvements.

Estimation of radon annual effective dose and excess lung cancer risk for the residents of KufrKhal, Jordan

This study aims to measure radon gas concentration, calculate the annual effective dose, and calculate excess lung cancer risk in KufrKhal-Jerash north of Jordan. Radon is a radioactive gas located everywhere and contributes more than 40% of people’s total dose from natural radiation. The Risk concerns have resulted from the increase in mortality due to lung cancer in KufrKhal. About 117 well-calibrated dosimeters were among the study area’s districts (Hill 1, Hill 2, Hill 3, and village center). Each dosimeter consists of a plastic cup with known dimensions and a piece of solid state nuclear track detector (SSNTD) type CR-39 fixed in the inner bottom of the cup. After 90 days, the retrieved detectors were chemically etched, and the track density (tracks.cm−2) was determined. The results showed that the average radon concentrations drastically varied between the districts of KufrKhal (17.1–128.8 Bqm−3). However, the mean radon values in different districts are closely related (64.4–75.5 Bq.m−3). The lowest concentration (17.1 Bqm−3) was found in the Hill 1 district, and the highest value (128.8 Bqm−3) was found in the village center. However, the overall radon concentration in KufrKhal was approximately 69.2 Bqm−3. This value is within the range of the national average level (43.2 – 77.4 Bq.m−3) and way below the national action level (200 Bq.m−3). Furthermore, the corresponding values of the annual effective dose (AED) and the excess lung cancer risk (ELCR) for dwellers in this village were calculated to be 1.8 mSv.y−1 and 0.2%, respectively. These values, according to Jordan’s national regulations are acceptable.

Role of Serum Magnesium on Insulin Resistance in Overweight and Obese Children.

Background Childhood obesity has become a global epidemic, with projections indicating it could affect 25% of children under 16 by 2050. This rise poses significant health risks, including early onset of type 2 diabetes and cardiovascular diseases. Recent research has shown a correlation between insulin action and magnesium levels, highlighting the link between low serum magnesium levels and obesity. This study aimed to investigate the relationship between serum magnesium levels and obesity in children aged 5-16 years, to compare overweight and obese adolescents with age- and gender-matched controls, and to determine the association between insulin resistance and decreased serum magnesium levels. Methodology At a tertiary hospital, this 1.5-year cross-sectional comparativestudy investigated the relationship between magnesium levels in the blood and insulin resistance in children aged 5-16. Cases met the 2015 revised Indian Academy of Pediatrics (IAP) growth charts for overweight or obesity in comparison to age-matched healthy controls. Exclusions included secondary causes of obesity and medical complications affecting magnesium. Assessments involved clinical history, examination, and fasting blood tests for insulin resistance indices. Results Compared to the controls, overweight children showed that mean serum magnesium levels are lower (1.03 mEq/l vs. 1.85 mEq/l, p<0.001); they were also reflected in higher anthropometric measures, which include body mass index (BMI) and body fat percentage. Cases had significantly higher metabolic markers like fasting insulin, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) index, and lipid profiles, whereas systolic blood pressure although showing recognized differences did not significantly differ. Conclusion The study underscored the importance of detecting magnesium levels on insulin resistance in overweight and obese children.

TUBERCULOSIS PREVENTION BEHAVIOR AND RELATED FACTORS (STUDY AT NAIBONAT PRIMARY HEALTH CENTER, KUPANG REGENCY, 2023)

Background: Tuberculosis (TB) Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, which attacks the lungs and other organs. Purpose: To determine the relationship between the level of knowledge, attitudes, and preventive actions of Tuberculosis disease and TB incidence in the Naibonat Health Center working area 2023. Methods: The research design used was case-control by conducting analytical observations. Using a simple random sampling technique, the sample consisted of 41 cases and 41 controls. Data analysis used the chi-square test at a significance level of 95%. (α = 0.05). Results: Based on the research shows that there is a significant relationship between knowledge (p=0.00; OR=5.98), attitude (p=0.00; OR=4.66), TB prevention actions (p=0.01; OR=5.20) on the incidence of TB at the Naibonat Primary Health Center. Conclusion: The knowledge, attitudes, and preventive measures are significantly related to the incidence of pulmonary TB in the Naibonat Health Center working area. The community is expected to be able to pay attention to the environment where they live, have clean living behavior, and be able to participate in educational activities/socialization (counseling) related to Pulmonary TB conducted by health centers, NGOs, or health workers which help increase public knowledge.

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“The Action Level®”

Development and Validation of Methodologies for the Identification of Specialized Pro-Resolving Lipid Mediators and Classic Eicosanoids in Biological Matrices.

Lipid mediators, which include specialized pro-resolving mediators and classic eicosanoids, are pivotal in both initiating and resolving inflammation. The regulation of these molecules determines whether inflammation resolves naturally or persists. However, our understanding of how these mediators are regulated over time in various inflammatory contexts is limited. This gap hinders our grasp of the mechanisms underlying the disease onset and progression. Due to their localized action and low endogenous levels in many tissues, developing robust and highly sensitive methodologies is imperative for assessing their endogenous regulation in diverse inflammatory settings. These methodologies will help us gain insight into their physiological roles. Here, we establish methodologies for extracting, identifying, and quantifying these mediators. Using our methods, we identified a total of 37 lipid mediators. Additionally, by employing a reverse-phase HPLC method, we successfully separated both double-bond and chiral isomers of select lipid mediators, including Lipoxin (LX) A4, 15-epi-LXA4, Protectin (PD) D1, PDX, and 17R-PD1. Validation of the method was performed in both solvent and surrogate matrix for linearity of the standard curves, lower limits of quantitation (LLOQ), accuracy, and precision. Results from these studies demonstrated that linearity was good with r2 values > 0.98, and LLOQ for the mediators ranged from 0.01 to 0.9 pg in phase and from 0.1 to 8.5 pg in surrogate matrix. The relative standard deviation (RSD) for inter- and intraday precision in solvent ranged from 5% to 12% at low, intermediate, and high concentrations, whereas the RSD for the inter- and intraday variability in the accuracy ranged from 95% to 87% at low to high concentrations. The recovery in biological matrices (plasma and serum) for the internal standards used ranged from 60% to 118%. We observed a marked ion suppression for molecules evaluated in negative ionization mode, while there was an ion enhancement effect by the matrix for molecules evaluated in positive ionization mode. Comparison of the integration algorithms, namely, AutoPeak and MQ4, and approaches for calculating signal-to-noise ratios (i.e., US Pharmacopeia, relative noise, peak to peak, and standard deviation) demonstrated that different integration algorithms tested had little influence on signal-to-noise ratio calculations. In contrast, the method used to calculate the signal-to-noise ratio had a more significant effect on the results, with the relative noise approach proving to be the most robust. The methods described herein provide a platform to study the SPM and classic eicosanoids in biological tissues that will help further our understanding of disease mechanisms.

Investigation of musculoskeletal symptoms, work postures, quantification of muscle activity, and estimation of grip/push forces among sonographers

AbstractDue to the physical nature of their work, sonographers are exposed to many musculoskeletal disorder risk factors, including awkward posture, repetitive movements, forceful manual exertion, and static muscle contractions, especially in the upper limbs. The current study is an investigation of musculoskeletal disorders among sonographers, caused by various occupational risk factors via different sonographic scan types. During the first phase of this study, the musculoskeletal symptoms and work postures of 29 subjects were investigated. During the second phase, muscle activity was quantified, and grip/push forces were estimated using the data obtained from 10 volunteer sonographers. 82% of sonographers experienced musculoskeletal symptoms. Based on the final scores and action levels obtained via rapid upper limb assessment, while performing scans of left regions; ergonomic changes and interventions were found necessary, to relieve stress on the sonographer's body. The results of muscular activity per muscle and scan type, showed that the mean muscle activity of the middle deltoid muscle was significantly higher during the right abdominal scan (17.64% maximum voluntary contraction [MVC]), compared to those of thyroid (12.54% MVC) and left abdominal (7.32% MVC) scans. Additionally, mean grip and push forces during both abdominal scans were significantly higher than those during the thyroid scan. Despite an injury risk during all scans, risk factor impact was different among scan types. This groundbreaking study represents the first that captures and measures both grip and push forces simultaneously, which may prove helpful while investigating corrective interventions or optimizing design of sonography robots and ergonomic probes in future studies.

Estimating the impact of the proposed Lead and Copper Rule Improvements

AbstractLead in drinking water can lead to serious health effects, including neurodevelopmental issues and heart disease. In December 2023, the U.S. Environmental Protection Agency (EPA) proposed the Lead and Copper Rule Improvements (LCRI), which lower the Lead and Copper Rule's (LCR's) lead action level (AL) from 15 parts per billion (ppb) to 10 ppb and require both first‐ and fifth‐liter sampling and 90th percentile compliance calculations based on the highest lead levels at sites with lead service lines. A methodology for estimating the likelihood a system will have an AL exceedance (ALE) under the LCRI was developed using Michigan LCR compliance data and applied to national LCR compliance data. Findings were compared to EPA's estimates, indicating EPA may have underestimated the percent of smaller systems (serving 3300) with ALEs and overestimated the percent of larger systems (serving &gt; 10,000), thus underestimating costs and overestimating the benefits of this rulemaking.