Low-risk Scenarios Research Articles

414. Culture Clash: A Comparison of Approach to Blood Culture Diagnostic Stewardship across 3 Emergency Departments in a Healthcare Network

Abstract Background Blood culture (BCx) diagnostic stewardship aids in accurately identifying microbial pathogens and guiding appropriate antibiotic therapy. We compared effects of a BCx algorithm (Fig 1) on BCx rates (BCx/100 ED visits) in the emergency department (ED) using two implementation approaches: 1) an intensive approach including weekly, individualized BCx appropriateness data feedback and modifications to electronic health record order sets, and 2) a passive approach with group-level, BCx appropriateness data feedback of a random BCx sample.Figure 1:ED Blood culture algorithmAlgorithm used by emergency department providers to determine if blood cultures are necessary Methods We performed a quasi-experimental pre-/post-intervention study from 12/1/2020 to 2/29/2024 using data from 3 academic-affiliated EDs. The BCx algorithm was introduced in 12/2022 in ED1. 7 ED providers reviewed BCxs ordered each week for appropriateness of BCx indication according to the algorithm and provided weekly, individualized feedback to colleagues regarding their performance in. In addition, BCx were removed from order sets for low-risk clinical scenarios, such as simple cystitis or community-acquired pneumonia. The algorithm was introduced to ED2 in 7/2023. In ED2, a pharmacist reviewed 5 BCx per week for appropriateness and one ED physician provided a secondary review when the clinical scenario was unclear. Feedback was provided to ED leadership every 2 months regarding appropriateness and BCx utilization. ED3 served as control and did not have the algorithm introduced. BCx rates were analyzed using interrupted time series models evaluating each ED separately. Incidence rate ratios (IRR) compared BCx rates before the intervention to BCx rates after the intervention.Figure 2.Monthly blood culture event rate (per 100 ED admissions) for the emergency department before (12/2020-11/2022) and after (12/2022-2/2024) the blood culture algorithm introduction. Intensive chart reviews occurred during 12/2022 to 5/2023. After that time only the algorithm was used without audit and feedback.β1= -0.004 (95% CI -0.0057, -0.0014, p-value <0.01)]. At the time of the intervention there was an acute drop measured by the β2 coefficient -0.16(95% CI -0.38, -0.01, p-value 0.04), followed by a slow increase in slope (β3= 0.007, 95% CI -0.003, 0.010,p-value 0.06). Results A total of 105,975 BCxs over 572,776 ED visits were included in the analysis. ED1 saw a 25% decrease in BCx rate with IRR 0.80 (95% CI 0.74, 0.86, p-value 0.01). (Fig 2) ED2 experienced a 4% decrease in BCx rate with IRR 0.72 (95% CI 0.54, 0.95, p-value 0.02). (Fig 3) ED3 did not experience any change (Fig 4).Figure 3.Monthly blood culture event rate (per 100 ED admissions) for emergency department 2 before (12/2020-6/2023) and after (7/2023-2/2024) the blood culture algorithm introduction. Random, small sampling of chart reviews occurred during 7/2023 to 2/2024.β1= -0.044 (95% CI -0.0059, -0.0028, p-value <0.01)]. At the time of the intervention there was an acute drop measured by the β2 coefficient -0.43(95% CI -0.83, -0.03, p-value 0.03), followed by an increase in slope (β3= 0.014, 95% CI 0.002, 0.025,p-value 0.02). Conclusion The BCx rate was most significantly impacted in ED1 by combining audit and feedback with modifications to the electronic medical record. However, both EDs saw drift back towards prior BCx utilization rates after the intervention. Sustainability can likely be improved by implementing computerized clinical decision support systems.Figure 4.Monthly blood culture event rate (per 100 ED admissions) for the emergency department from 12/2020 to 2/2024. No algorithm was used in this emergency department.β1= -0.004 (95% CI -0.0027, 0.0019, p-value 0.74)]. At the time of the intervention there was no significant change measured by the β2 coefficient 0.13 (95% CI -0.0241, 0.279, p-value 0.99), followed by stable slope (β3= -0.004, 95% CI -0.009, 0.002,p-value 0.17). Disclosures Rebekah W. Moehring, MD, MPH, FIDSA, FSHEA, UpToDate, Inc.: Author Royalties Jessica Seidelman, MD, MPH, 3M: Expert Testimony

Presenting predictions and performance of probabilistic models for clinical decision support in trauma care

IntroductionBoth predictions and performance of clinical predictive models can be presented with various verbal and visual representations. This study aims to investigate how different risk and performance presentations for probabilistic predictions affect clinical users’ judgement and preferences. MethodsWe use a clinical Bayesian Network (BN) model that has been developed for predicting the risk of Trauma Induced Coagulopathy (TIC). Three patient scenarios with different levels of TIC risk were shown to trauma care clinicians. The prediction and discriminatory performance of TIC BN were shown with each scenario using different charts in a random order. Bar charts, icon arrays and gauge charts were used for presenting the prediction. Receiver operating characteristic curves, true and false positive rate curves and icon arrays were used for presenting the performance. Risk judgement for patient scenarios, perceived accuracy for the predictions and the model, and preferences for charts were elicited using an online survey. ResultsA total of 25 clinicians evaluated 75 BN predictions. The choice of risk charts was associated with the risk score in the borderline medium-risk scenario. The choice of risk and performance charts interacts with the perceived accuracy of the predictions and model in the high and low-risk scenarios, respectively. The participants had varying but persistent preferences regarding risk presentation charts. Icon arrays were preferred for performance presentations. ConclusionsThe choice of presenting predictions and the performance of predictive models can affect risk and performance interpretation. Clinical predictive models should offer the flexibility of presenting predictions with different illustrations.

Context-Aware Adaptive Encryption: Integrating Sensitive Data Detection and Network intrusion detection for Dynamic Data Security and Encryption

In today's digital landscape, ensuring the security of sensitive data and protecting against network intrusions are critical challenges. This research project develops and evaluates a novel context-aware adaptive encryption system that integrates sensitive data detection, network intrusion detection, and dynamic encryption techniques to enhance data security. The proposed system employs deep learning models to identify sensitive information and machine learning algorithms to monitor network activity for potential intrusions. Upon detecting sensitive data or a security threat, the system automatically applies encryption with adjustable strength based on the context, increasing protection in high-risk situations. This approach minimizes unnecessary overhead in low-risk scenarios while maintaining robust security measures. Through simulations using real-world data, the system's effectiveness in accurately detecting sensitive information and network intrusions, as well as its capability to adapt encryption dynamically, is evaluated. The results demonstrate the potential of combining machine learning with adaptive security measures to create a responsive and efficient data protection system.

Which glaucoma patients should be monitored at home and exploration of clinician perceptions on home monitoring? a survey of glaucoma specialists in the UK

ObjectivesTo identify suitable patients for glaucoma home monitoring and explore clinicians’ perceptions of the possible benefits and risks of home monitoring within the National Health Service.DesignAn online survey composed of open-ended and closed-ended questions.SettingSecondary care.ParticipantsGlaucoma specialists registered with the UK and Eire Glaucoma Society.Outcome measuresAgreement with clinical scenarios.ResultsThe estimated response rate was 68% (n=49). Of 49 participants, 92% (n=45) were consultant ophthalmologists and 71% (n=35) had over 10-year experience. There was a poor agreement regarding an ideal glaucoma patient for home monitoring, with only one scenario achieving over 60% agreement. Most participants believed that home monitoring would be most suitable for low-risk scenarios, rather than high-risk, due to fear of missing progression. In relation to acceptability, key facilitators included the potential to increase healthcare capacity and promote patient safety. However, low clinician trust in equipment reliability and fear of patient harm were reported as concerns.ConclusionsThere was no clear consensus on which patients would benefit most from glaucoma home monitoring. While many clinicians believe home monitoring may enhance healthcare, there were also many concerns about the technologies themselves. Further work to address clinician concerns is warranted.Research Registry registration number6213.

Research on Obstacle Avoidance Strategy of Automated Heavy Vehicle Platoon in High-Speed Scenarios

Amidst the rapid progression of the road transport industry, the safety and efficiency of heavy-vehicle platoons have garnered significant attention. The study tackles the challenge of obstacle avoidance presented by vehicles owing to their considerable mass, delayed response times, and line-of-sight impediments, by introducing a cooperative obstacle avoidance system for heavy-vehicle platoons based on deep reinforcement learning. The system comprises three primary modules: perception, decision-making, and control. Initially, the perception module acquires real-time environmental data. Subsequently, the decision-making module formulates obstacle avoidance decisions based on the acquired data. Specifically, it implements a two-stage braking obstacle avoidance strategy under low collision risk scenarios, while employing a fifth-degree polynomial for planning and tracking obstacle avoidance paths under high collision risk conditions suitable for steering maneuvers. The control module utilizes the local multi-agent deep deterministic policy gradient (LADDPG) algorithm to train the heavy-vehicle platoon agents, ensuring the formation’s maintenance while mitigating collisions with other vehicles and obstacles. The effectiveness of the proposed system is substantiated through simulation experiments, demonstrating its adaptability to various traffic conditions, selection of suitable obstacle avoidance strategies, and significant enhancement of obstacle avoidance performance and heavy-vehicle platoon stability.

Aspirin therapy is associated with a lower risk of pregnancy loss in both JAK2- and CALR-mutated essential thrombocythemia-A Mayo Clinic study of 200 pregnancies.

Two-hundred pregnancies involving 100 women with essential thrombocythemia (ET) were accessed from Mayo Clinic databases (1990-2023). Median platelet count displayed a decline during pregnancy, nadiring at 48% of baseline, in the third trimester: 704-369 × 109/L. Live birth rate was 72%. Of 53 (27%) unintentional pregnancy losses, 48 (24%) occurred in the first trimester. Other fetal complications included preterm birth 3%, intrauterine growth retardation 3%, and stillbirth 1%. Maternal complications included major hemorrhage (7%), preeclampsia (6%), thrombosis (1%), and placental abruption (0.5%). Antepartum management included no specific therapy in 52 (26%), aspirin alone in 112 (56%), aspirin combined with cytoreductive drugs or systemic anticoagulants in 23 (12%), and other permutations in the remaining. Postpartum systemic anticoagulation was documented in 29 (15%) pregnancies. Unintentional first-trimester loss was predicted by prior fetal loss (43% vs. 18%; p < .01), diabetes mellitus (DM; 67% vs. 23%; p = .02), and absence of aspirin therapy (45% vs. 14%; p < .01); the salutary effect of aspirin therapy was independent of the other two risk factors and apparent in both high (presence of ≥1 risk factor; 33% vs. 61%; p = .07) and low (absence of both risk factors; 10% vs. 34%; p < .01) risk scenarios. The benefit of aspirin therapy, in preventing first-trimester loss, was significant in both JAK2-mutated (18% vs. 50%; p < .01) and CALR-mutated (8% vs. 43%; p < .01) cases. Aspirin use was also associated with a lower risk of venous thrombosis (0% vs. 3%; p = .03). By contrast, the use of systemic anticoagulation, antepartum or postpartum, did not influence fetal or maternal complication rates. CALR mutation and DM predicted maternal hemorrhage (13% vs. 4%; p = .05) and preeclampsia (33% vs. 5%; p = .03), respectively. The current study demonstrates the protective role of aspirin in preventing first-trimester loss in ET, independent of driver mutation status or other risk factors.

Abstract ED05-01: Demystifying the Axilla: Challenging scenarios in the upfront surgery setting and after NAC

Abstract Management of the axilla has evolved significantly over time, with a trend toward less extensive axillary surgery. While historically, all patients underwent axillary lymph node dissection (ALND) due to the Halstedian belief that ALND was essential for the cure of breast cancer, advances in systemic therapy, radiotherapy, and understanding of tumor biology have resulted in the abandonment of ALND for a large proportion of patients having upfront surgery with limited nodal disease, and in those with no residual nodal disease after neoadjuvant systemic therapy. Over time, axillary management has become increasingly complicated, with significant variability in real-world management for different clinical scenarios. In this talk, we will address challenging scenarios in axillary management, both in the upfront surgery setting and after neoadjuvant chemotherapy (NAC). In the upfront surgery setting, we will address management of a positive sentinel node in patients treated with mastectomy, management of ≥ 3 positive sentinel nodes after lumpectomy or mastectomy, and the use of sentinel lymph node biopsy for patients with clinically node-positive hormone receptor (HR) positive/human epidermal growth factor receptor 2 (HER2) negative breast cancer. In the setting of patients receiving NAC, we will discuss the optimal approach to the axilla in patients with residual disease after NAC, and in those with locally advanced breast cancer. As we move away from ALND in low-risk scenarios where data from randomized and prospective trials have demonstrated oncologic safety, we await results from ongoing clinical trials to provide us with high-level evidence regarding the safety of omission of ALND in high-risk patients with more extensive nodal disease. Citation Format: A. Barrio. Demystifying the Axilla: Challenging scenarios in the upfront surgery setting and after NAC [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr ED05-01.

Characterization and health risk assessment of nine polychlorinated biphenyls in settled dust of residential buildings in a Middle Eastern area

Polychlorinated biphenyls (PCBs) are 209 persistent organic compounds with various applications in chemical, electrical and commercial industries. However, there is considerable evidence of environmental accumulation and potential adverse health effects of this compound. In this study, 40 indoor dust samples were randomly taken from Shiraz houses for the analysis of 9 PCB congeners (PCB-18, 28, 31, 44, 52, 138, 153, 189, 194). The dust samples were extracted with 100 ml dichloromethane/n-hexane/acetone in a Soxhlet appliance for 18 h and then analyzed using Gas Chromatography-Mass Spectrometry (GC-MS). The results showed that Σ9PCB were in the range of <dl – 9.31 ng/g and PCB-52, 31 and 28 were the predominant congeners. Moreover, houses with laminate floors had higher Σ9PCBs levels than the houses with ceramic floors. The hazard quotient (HQ) values for children and adults' exposure to 9 PCBs through ingestion route were lower than 1, indicating no adverse non-carcinogenic risk. Also, the incremental lifetime cancer risks (ILCRs) values were lower than 10−6 in low-risk and high-risk scenarios for the both age groups, which showed negligible carcinogenic risks arising from exposure to the analyzed PCBs. More studies focusing on biomonitoring and bioavailability approaches are recommended for future investigation to provide total intake of people to this pollutant from all routes of exposure.

Intra-abdominal fibromatosis following laparoscopic surgery for sigmoid colon cancer: A case report

Introduction: Desmoid tumors, also known as aggressive fibromatosis, are rare, benign, non-inflammatory, and fibroblastic tumors. Characterized by their locally aggressive behavior and the potential for recurrence, these tumors do not metastasize. Intra-abdominal desmoid tumors comprise 8% of all desmoid tumors. Case Report: This paper presents a case of a 50-year-old male, highlighting the diagnostic challenge posed by the incidental discovery of an intra-abdominal mesenteric mass in a patient previously treated for stage I sigmoid colon cancer by laparoscopic proctocolectomy. Multidisciplinary consensus favored surgical intervention, successfully revealing and removing a benign desmoid-type fibromatosis. The occurrence of intra-abdominal desmoid tumors after laparoscopic surgery for colorectal cancer is exceptionally rare, underscoring the unique nature of this case. Conclusion: During post-operative follow-up for colon cancer, the discovery of an intra-abdominal mass is often initially regarded as a sign of cancer recurrence and metastasis. Radiologists and oncologists may not immediately consider alternative causes. The incidentally discovered desmoid-type fibromatosis emphasizes the necessity for vigilant monitoring and consideration of diverse pathologies during follow-up, especially in low-risk scenarios.

Evaluation of Future-Integrated Urban Water Management Using a Risk and Decision Analysis Framework: A Case Study in Denver–Colorado Metro Area (DCMA)

This study examines the DCMA concerning the future risk of the water security status. We considered three risk factors: population growth, economic growth, and natural water supply–demand differences. In the risk analysis part, we consulted with experts from several sectors including academia, Non-Governmental Organizations (NGOs), and industry, to predict that the probability of future water stresses in high-, medium-, and low-risk scenarios are 0.73, 0.24, and 0.03, respectively. In the decision analysis part, we adopted two multiple criteria decision analysis (MCDA) approaches that include multiple attribute value theory (MAVT) and analytic hierarchy process (AHP) methods to evaluate the best alternative decision to alleviate future water stresses in the DCMA. The sensitivity analysis demonstrates that, although expanding existing water reservation might be a solution to tackle the challenge, the best option really closely connects to the weighting scheme of the criteria considered in the framework. This study provides a valuable risk and decision analysis framework to analyze the water security status associated with the future water supply and demand gap decrease caused by three risk factors: population growth, climate change, and natural water supply.

Research on the suitability of telework in the context of COVID-19

PurposeCoronavirus disease 2019 (COVID-19) has made telecommuting widely valued, but different individuals have different degrees of acceptance of telecommuting. This article aims to identify suitable individuals for telework and to clarify which types of workers are suitable for what level of telework, set scientific, reasonable hybrid work ratios and processes and measure their suitability.Design/methodology/approachFirst, two working scenarios of different risk levels were established, and the theory of planned behavior (TPB) was used to introduce latent variables, constructing a multi-indicator multi-causal model (MIMIC) to identify suitable individuals, and second, constructing an integrated choice and latent variable (ICLV) model of the working method to determine the suitability of different types of people for telework by calculating their selection probabilities.FindingsIt is possible to clearly distinguish between two types of suitable individuals for telework or traditional work. Their behavior is significantly influenced by the work environment, which is influenced by variables such as age, income, attitude, perceived behavioral control, work–family balance and personnel exposure level. In low-risk scenarios, the influencing factors of the behavioral model for both types of people are relatively consistent, while in high-risk scenarios, significant differences arise. Furthermore, the suitability of telework for the telework-suitable group is less affected by the pandemic, while the suitability for the non-suitable group is greatly affected.Originality/valueThis study contributes to previous literature by: (1) determining the suitability of different population types for telework by calculating the probability of selection, (2) dividing telework and traditional populations into two categories, identifying the differences in factors that affect telework under different epidemic risks and (3) considering the impact of changes in the work scenario on the suitability of telework for employees and classifying the population based on the suitability of telework in order to avoid the potential negative impact of telework.

The interaction between cortisol and testosterone predicts leadership within rock hyrax social groups

Group movement leadership is associated with higher risks for those in the front. Leaders are the first to explore new areas and may be exposed to predation. Individual differences in risk-taking behavior may be related to hormonal differences. In challenging circumstances, such as risk-taking leadership that may pose a cost to the leader, cortisol is secreted both to increase the likelihood of survival by restoring homeostasis, and to mediate cooperative behavior. Testosterone too has a well-established role in risk-taking behavior, and the dual-hormone hypothesis posits that the interaction of testosterone and cortisol can predict social behavior. Based on the dual-hormone hypothesis, we investigated here whether the interaction between testosterone and cortisol can predict risk-taking leadership behavior in wild rock hyraxes (Procavia capensis). We used proximity loggers, observations, and playback trials to characterize hyrax leaders in three different leadership contexts that varied in their risk levels. In support of the dual-hormone hypothesis, we found that cortisol and testosterone interactions predict leadership that involves risk. Across different circumstances that involved low or high levels of risk, testosterone was positively related to leadership, but only in individuals (both males and females) with low levels of cortisol. We also found an interaction between these hormone levels and age at the low-risk scenarios. We suggest that the close social interactions and affiliative behavior among hyrax females within small egalitarian groups may make female leadership less risky, and therefore less stressful, and allow female leaders to influence group activities.

Selection of Areas for Effective GNSS Spoofing Attacks to a Vehicle-mounted MSF System based on Scenario Classification Models

The inherent vulnerability of the Global Navigation Satellite System (GNSS) leads to the ease of implementation of spoofing attacks. The latest GNSS spoofing attack schemes still suffer from low success rate, long attack time, and poor concealment. To improve the success rate, an efficient GNSS spoofing attack method for a vehicle-mounted Multi Sensors Fusion (MSF) system is proposed based on the scenario classification models with a spatial database. Firstly, the influence of the two typical urban scenarios, which are 1) the road with buildings on both sides and 2) tunnels, on the GNSS spoofing attack is analyzed. Then a dynamic Bayesian network model considering the sky visibility generated with the 3D building models and tunnel models inside the spatial database is established to quantify the difficulty of the attack. Furthermore, the scenarios of the victim can be classified into high-risk and low-risk scenarios. When the vehicle is just out of the tunnel or in open scenarios, attackers can select these high-risk scenarios and implement aggressive spoofing attacks. Then the efficiency of the GNSS spoofing attack can be significantly improved. Finally, the proposed attack scheme is demonstrated by actual world data with simulated spoofing attacks in urban areas.

Novel strategies in liver graft preservation-The French perspective.

Given the increasing graft shortage, the transplant community is forced to use so called marginal liver grafts with a higher susceptibility to ischemia-reperfusion injury. This exposes the recipient to a higher risk of graft failure and post-transplant complications. While static cold storage remains the gold standard in low-risk transplant scenarios, dynamic preservation strategies may allow to improve outcomes after transplantation of marginal liver grafts. Two dynamic preservation strategies, end-ischemic hypothermic oxygenated perfusion (HOPE) and continuous normothermic machine perfusion (cNMP), have been evaluated in randomized clinical trials. The results show improved preservation of liver grafts after cNMP and reduction of post-transplant biliary complications after HOPE. In comparison to cNMP, HOPE has the advantage of requiring less logistics and expertise with the possibility to return to default static cold storage. Both strategies allow to assess graft viability prior to transplantation and may thus contribute to optimizing graft selection and reducing discard rates. The use of dynamic preservation is rapidly increasing in France and results from a national randomized trial on the use of HOPE in marginal grafts will soon be available. Future applications should focus on controlled donation after circulatory death liver grafts, split grafts and graft treatment during perfusion. The final aim of dynamic liver graft preservation is to improve post-transplant outcomes, increase the number of transplanted grafts and allow expansion of transplant indications.

Are Non-animal Systemic Safety Assessments Protective? A Toolbox and Workflow.

An important question in toxicological risk assessment is whether non-animal new approach methodologies (NAMs) can be used to make safety decisions that are protective of human health, without being overly conservative. In this work, we propose a core NAM toolbox and workflow for conducting systemic safety assessments for adult consumers. We also present an approach for evaluating how protective and useful the toolbox and workflow are by benchmarking against historical safety decisions. The toolbox includes physiologically based kinetic (PBK) models to estimate systemic Cmax levels in humans, and 3 bioactivity platforms, comprising high-throughput transcriptomics, a cell stress panel, and in vitro pharmacological profiling, from which points of departure are estimated. A Bayesian model was developed to quantify the uncertainty in the Cmax estimates depending on how the PBK models were parameterized. The feasibility of the evaluation approach was tested using 24 exposure scenarios from 10 chemicals, some of which would be considered high risk from a consumer goods perspective (eg, drugs that are systemically bioactive) and some low risk (eg, existing food or cosmetic ingredients). Using novel protectiveness and utility metrics, it was shown that up to 69% (9/13) of the low risk scenarios could be identified as such using the toolbox, whilst being protective against all (5/5) the high-risk ones. The results demonstrated how robust safety decisions could be made without using animal data. This work will enable a full evaluation to assess how protective and useful the toolbox and workflow are across a broader range of chemical-exposure scenarios.

Yield of Head Computed Tomography Examinations for Common Psychiatric Presentations and Implications for Medical Clearance From a 6-Year Analysis of Acute Hospital Visits

This cross-sectional study uses single health system data on acute hospital visits over 6 years to determine the yield of head computed tomography examinations for actionable pathology in common psychiatric presentations and to characterize low-risk scenarios in which imaging may be avoidable.

Risk in one is not risk in all: snails show differential decision making under high- and low-risk environments

Predation is a major force that shapes prey phenotypes, species interactions and ecological communities. Prey respond to variation in predation risk and intensity by either increasing or decreasing vigilance and balancing energy requirements under high- or low-risk scenarios. We test the possible mechanism of sensory adaptation and decision making while responding to risk in the pond snail Lymnaea stagnalis . We maintained three risk treatment groups (no risk, low risk and high risk) for 20 days before testing them under multiple cognitive and behavioural challenges involving a predatory stimulus. Under a configural learning procedure where snails learned to forgo feeding when encountering food in the presence of a predatory threat, the high-risk group snails did not show learning/memory formation. However, when high-risk group individuals were transferred to a no-risk environment for 20 days, they were able to form configural learning memory. In a social interaction trial, snails from the no-risk group reduced interactions under threat whereas the high-risk group showed no change between risk environments. All risk groups responded similarly to an operant conditioning training under predation threat that enhanced memory. The decreased antipredator response of the high-risk group in comparison to the low-risk groups shows that snails are able to respond to risk based on past experience, especially when there exists a trade-off between survival and antipredator response. The variation in response to predation threat under different circumstances provides evidence of decision making rather than sensory adaptation as the mechanism involved in prey response. Our study combines multiple phenotypic responses to elucidate animal decision making under different intensities of risk and highlights the importance of experience in shaping antipredator responses. • We tested snails' responses (sensory adaptation/decision making) to predation risk. • Two cognitive tests and one social behavioural assay were used as response. • High-risk group animals showed weaker antipredator responses. • Response variation across risk groups support a decision-making mechanism at work.

A preliminary assessment of microplastics in indoor dust of a developing country in South Asia.

Microplastics (MPs) pollution is an emerging global environmental concern. Considering the high fraction of time people spend indoors, the human population can be directly exposed to this contamination through indoor dust. This preliminary study evaluates MPs' abundance and human health risk assessment in the deposited indoor dust. A total of forty dust samples (n = 20) were collected from homes in two different cities (Pakistan) in steel mesh pouches using the vacuum cleaner. The identification and quantification of MPs were conducted with a stereo microscope, whereas the qualitative assessment was performed with Fourier transform infrared spectroscopy (FTIR). The US EPA parameters to calculate the human health risk assessment were used to determine MPs' risk per-day/month/year. Overall, microfibers were the dominant category, followed by microfilms, micro-fragments, and nurdles. The chemical categorization of MPs was revealed as polyester, polyethylene, copolymers of polypropylene, and polyurethane. In Lahore, an average abundance of 241.45 (items/m2) MPs were observed compared to Sahiwal, with 162.1 (items/m2). More than 90% of the identified MPs were microfibers, with higher detection frequency and abundance inLahorethan Sahiwal. The human health risk assessment revealed high exposure risk because of indoor MPs. Moreover, toddlers were more vulnerable as compared to adults at both low and high exposure risk scenarios. There is an imminent need to conduct in-depth risk assessment focusing on the respirable fraction of MPs.

Headache neuroimaging: A survey of current practice, barriers, and facilitators to optimal use.

The objective of this study was to understand current practice, clinician understanding, attitudes, barriers, and facilitators to optimal headache neuroimaging practices. Headaches are common in adults, and neuroimaging for these patients is common, costly, and increasing. Although guidelines recommend against routine headache neuroimaging in low-risk scenarios, guideline-discordant neuroimaging is still frequently performed. We administered a 60-item survey to headache clinicians at the Veterans Affairs health system to assess clinician understanding and attitudes on headache neuroimaging and to determine neuroimaging practice patterns for three scenarios describing hypothetical patients with headaches. Descriptive statistics were used to summarize responses, stratified by clinician type (physicians or advanced practice clinicians [APCs]) and specialty (neurology or primary care). The survey was successfully completed by 431 of 1426 clinicians (30.2% response rate). Overall, 317 of 429 (73.9%) believed neuroimaging was overused for patients with headaches. However, clinicians would utilize neuroimaging a mean (SD) 30.9% (31.7) of the time in a low-risk scenario without red flags, and a mean 67.1% (31.9) of the time in the presence of minor red flags. Clinicians had stronger beliefs in the potential benefits (268/429, 62.5%) of neuroimaging compared to harms (181/429, 42.2%) and more clinicians were bothered by harms stemming from the omission of neuroimaging (377/426, 88.5%) compared to commission (329/424, 77.6%). Additionally, APCs utilized neuroimaging more frequently than physicians and were more receptive to potential interventions to improve neuroimaging utilization. Although a majority of clinicians believed neuroimaging was overused for patients with headaches, many would utilize neuroimaging in low-risk scenarios with a small probability of changing management. Future studies are needed to define the role of currently used red flags given their importance in neuroimaging decisions. Importantly, APCs may be an ideal target for future optimization efforts.

UK Women's Views of the Concepts of Personalised Breast Cancer Risk Assessment and Risk-Stratified Breast Screening: A Qualitative Interview Study.

Simple SummaryRisk-based breast screening will involve tailoring the amount of screening to women’s level of risk. Therefore, women at high-risk may be offered more frequent screening and over a longer period of time than those at low risk for whom less screening may be recommended. As this will involve considerable changes to the NHS Breast Screening Programme, it is important to explore what women in the UK think and feel about this approach. Analysis of in-depth interviews revealed that some women would find both high and low-risk screening options acceptable whereas others were resistant to the prospect of reduced screening if they were assessed as low-risk. We also found that the idea of risk-based screening had little influence on the attitudes of women who were already sceptical about breast screening. These findings highlight the communication challenges that will be faced by those introducing risk-based screening and suggest a need for tailored support and advice.Any introduction of risk-stratification within the NHS Breast Screening Programme needs to be considered acceptable by women. We conducted interviews to explore women’s attitudes to personalised risk assessment and risk-stratified breast screening. Twenty-five UK women were purposively sampled by screening experience and socioeconomic background. Interview transcripts were qualitatively analysed using Framework Analysis. Women expressed positive intentions for personal risk assessment and willingness to receive risk feedback to provide reassurance and certainty. Women responded to risk-stratified screening scenarios in three ways: ‘Overall acceptors’ considered both high- and low-risk options acceptable as a reasonable allocation of resources to clinical need, yet acceptability was subject to specified conditions including accuracy of risk estimates and availability of support throughout the screening pathway. Others who thought ‘more is better’ only supported high-risk scenarios where increased screening was proposed. ‘Screening sceptics’ found low-risk scenarios more aligned to their screening values than high-risk screening options. Consideration of screening recommendations for other risk groups had more influence on women’s responses than screening-related harms. These findings demonstrate high, but not universal, acceptability. Support and guidance, tailored to screening values and preferences, may be required by women at all levels of risk.