Minimal Risk Research Articles

Self-Medication Paths: A Descriptive Study Unveiling the Interplay Between Medical and Nonmedical Cannabis in Chronic Pain Management.

Cannabis is used by one-third of people living with chronic pain to alleviate their symptoms despite warnings from several organizations regarding its efficacy and safety. We currently know little about self-medication practices (use of cannabis for therapeutic purposes without guidance), mainly since the legalization of recreational cannabis in countries such as Canada has expanded the scope of this phenomenon. This study aimed to describe legal cannabis self-medication for pain relief in people living with chronic pain and to explore perceptions of the effectiveness and safety of cannabis. A cross-sectional descriptive study was performed among 73 individuals living with chronic pain and using cannabis (Quebec, Canada). Data collection using telephone interviews occurred in early 2023. Results indicated that 61.6% of participants reported using cannabis without the guidance of a health care professional (self-medication). Surprisingly, among those, 40.0% held a medical authorization. Overall, 20.6% of study participants were using both medical and legal nonmedical cannabis. Different pathways to self-medication were revealed. Proportion of women versus men participants self-medicating were 58.2% versus 70.6% ( P =0.284). In terms of perceptions, 90.4% of the sample perceived cannabis to be effective for pain management; 72.6% estimated that it posed no or minimal health risk. Cannabis research is often organized around medical versus nonmedical cannabis but in the real-world, those 2 vessels are connected. Interested parties, including researchers, health care professionals, and funding agencies, need to consider this. Patients using cannabis feel confident in the safety of cannabis, and many of them self-medicate, which calls for action.

Hygrothermal performance of hybrid multi-storey buildings under future climate scenarios

Climate change, energy efficiency, and carbon footprint objectives pose significant challenges to the hygrothermal performance of building structures in climates with extreme temperature variations. To meet long term sustainability targets, buildings designed for a lifespan of up to 100 years must exhibit resilience not only to current climate conditions but also to projected future scenarios. This study evaluated the hygrothermal performance of a hybrid log-concrete multi-storey building, combining the structural strength of concrete with the sustainable, moisture-regulating properties of wood, to address energy efficiency and moisture control challenges in subarctic climates. Onsite measurements were validated using numerical simulations to assess hygrothermal performance of log wall structure under climate change scenarios. Results showed minimal mould growth risk under present conditions, while future climate projections (RCP8.5 for 2080) indicated a maximum mould index of 1.32 near the exterior log surface. These findings highlight the resilience of log-based structures in cold climates and underscore the need for proactive moisture management under warmer, more humid future scenarios. Stable ideal indoor temperatures (averaging 21.56 °C to 22.09 °C) and effective moisture control (with a maximum average moisture excess of 0.89 g/m3) over the measurement period further demonstrate the suitability of hybrid log-concrete buildings for energy-efficient, moisture-regulating construction in cold climates. The study recommends surface treatments that allow vapour diffusion while preserving wood’s hygroscopic qualities to enhance durability in changing climates.

Lymphocyte subsets in pediatric acute lymphoblastic leukemia and their prognostic value.

To study the changes of lymphocyte subsets in children with acute lymphoblastic leukemia (ALL) at initial diagnosis and compare them with those of healthy children and patients who have achieved complete remission (CR). Furthermore, we aim to analyze the prognostic significance of lymphocyte subsets in these patients. From May 2011 to December 2015, 405 children with ALL were enrolled in this study. Peripheral blood was collected at the time of diagnosis, and lymphocyte subsets were detected by flow cytometry. Then, the percentages of lymphocyte subsets in each group were compared. In addition, survival and prognostic factor analyses were performed to determine the prognostic value of lymphocyte subsets. Lymphocyte subsets in children with ALL were dramatically different from those in healthy children and patients achieving CR. Additionally, lymphocyte subsets were correlated with different minimal residual disease and risk parameters. Furthermore, percentages of CD3+ T cells and CD4+ T cells and the ratio of CD4/CD8 were associated with different clinical outcomes. Multivariate analysis demonstrated the percentage of CD4+ T cell as an independent predictor for clinical prognosis. Lymphocyte subsets in pediatric ALL undergo dramatic changes and were related to prognosis, especially CD4+ T cells.

Quantitative relationship between free sugars intake and early childhood caries among preschoolers in Sri Lanka

IntroductionBefore implementing the WHO sugar recommendations, more studies are needed concerning its application to given contexts. ObjectiveTo identify free sugars intake levels associated with a minimum caries risk in primary dentition MethodsUsing probability proportionate to size technique and cluster sampling, 813 children aged 4-5-years were selected from preschools in the Colombo district, Sri Lanka. A 67-item quantitative food frequency questionnaire was developed and validated to evaluate free sugars intake. Dental caries was assessed clinically using dmft index. For the selection of cut-off values for free sugars intake levels, ROC curves were used. ResultsThe median (IQR) amount of free sugars intake was 57.9 (33.2 -95.8) g/day or 21.1% (12.5%-35.9%) of total energy requirement, with a frequency of 4.0 (2.7-6.1) times/day. Dental caries prevalence was 42.9% (n=349). Among all possible risk factors, free sugars intake as a percentage of total energy requirement (p<0.001) and frequency of free sugars intake (p<0.001) were significantly associated with the presence of dental caries. The percentage of free sugars that discriminates against a possible highest number of children with dental caries (99%) was determined as 4%, of the total energy requirement of a child, which is approximately 12g/day (3 level teaspoons/day). Sugar intake once a day has a 97% sensitivity in identifying children with dental caries. These cut-off values do not differ among the group who brush twice a day with fluoridated toothpaste. ConclusionFor optimal caries prevention, children's free sugar intake to less than 5% of their total energy intake or consume less frequently than once daily.

Organophosphate esters in Tianshan glacier runoff: Occurrence, degradation, risk, and flux

Organophosphate esters (OPEs) are a class of chemicals of emerging concern. However, little is known about the environmental behavior, transformation and ecological risk of OPEs in mid-latitude glacial environments. This study investigated the concentration and composition characteristics of organophosphate triesters (tri-OPEs) and organophosphate diesters (di-OPEs) in the runoff of Urumqi No. 1 Glacier and Koxkar Glacier in the Tianshan Mountains, and estimated the output of them from glacial rivers. The total concentration of tri-OPEs (Σ13tri-OPEs) was 8565 pg/L in glacier surface meltwater and 6568 pg/L in proglacial rivers. Di-OPEs exhibited lower concentrations, with 99 pg/L and 117 pg/L (Σ10di-OPEs) in glacier surface meltwater and proglacial rivers, respectively. Tri-OPEs exhibited clear diurnal variations, which are presumed to be related to environmental temperature, while di-OPEs did not show an obvious trend. Although risk quotients (RQs) indicated that the concentrations of OPEs pose minimal risk to the glacier aquatic environment, the Toxicological Priority Index (ToxPi) score results showed that tris(2-chloroethyl) phosphate (TCEP) has the highest priority and therefore requires more attention. The total output flux of OPEs (Σ13tri-OPEs and Σ10di-OPEs) in glacial rivers throughout the entire Tianshan region was estimated to be ∼ 847 kg/year. Given the continuity of glacial melting and the accumulation of emerging pollutants in glaciers, the process of melting poses an increasing risk to freshwater resources, warranting heightened attention.

Interferon-gamma driven elevation of CXCL9: a new sepsis endotype independently associated with mortality

Endotype classification becomes the cornerstone of understanding sepsis pathogenesis. Macrophage activation-like syndrome (MALS) and immunoparalysis are the best recognized major endotypes, so far. Interferon-gamma (IFNγ) action on tissue macrophages stimulates the release of the cytotoxic chemokine CXCL9. It was investigated if this mechanism may be an independent sepsis endotype. In this cohort study, 14 patient cohorts from Greece, Germany and Italy were studied. The cohorts were 2:1 randomly split into discovery and validation sets. Sepsis was defined by the Sepsis-3 definitions and blood was sampled the first 24h from meeting the Sepsis-3 definitions. Concentrations of IFNγ, CXCL9, IP-10 (IFNγ induced protein-10), soluble CD163 and ferritin were measured. The endotype of IFNγ-driven sepsis (IDS) was defined in the discovery set as the combination of a) blood IFNγ above a specified cut-off associated with the minimal risk for immunoparalysis (defined as ≥8000 HLA-DR receptors on CD45/CD14-monoytes); and b) increase of CXCL9. Results were compared to the validation set. 5503 patients were studied; 3670 in the discovery set and 1833 in the validation set. IDS was defined as IFNγ more than 3pg/ml and CXCL9 more than 2200pg/ml. The frequency of IDS in the discovery set was 19.9% (732 patients; 95% confidence intervals-CIs 18.7-21.3%) and in the validation set 20.0% (366 patients; 95% CIs 18.2-21.9%). Soluble CD163, a marker of macrophage activation, was greater in IDS and IDS had features distinct from MALS. The mortality in IDS patients was 43.0% (315 patients; 95% CIs 39.5-46.6%) in the discovery set and 40.4% in the validation set (148 patients; 95% CIs 35.5-45.5%) (p=0.44 compared to patients of the discovery set). IDS was an independent risk factor for death in the presence of other endotypes, severity scores and organ dysfunctions of the multivariate model [hazard ratio 1.71 (95% CIs 1.45-2.01) in the discovery set and 1.70 (95% CIs 1.34-2.16) in the validation set]. Decreases of IFNγ and CXCL9 blood levels within the first 72h were associated with better outcome. IDS is a new sepsis endotype independently associated with unfavorable outcome. Hellenic Institute for the Study of Sepsis; Horizon 2020 project ImmunoSep; Swedish Orphan BioVitrum AB (publ) and German Federal Ministry of Education and Research.

Most young female cancer survivors are at minimal risk for obstetric problems.

Most young female cancer survivors are at minimal risk for obstetric problems.

Effectiveness of the Additional Risk Minimisation Measures for Valproate Among Healthcare Professionals and Patients: A Cross-Sectional Survey in Six European Countries.

To assess the impact of the 2018 European additional risk minimisation measures (aRMMs) regarding the use of valproate in women of childbearing potential (WCBP) and during pregnancy. A cross-sectional, non-interventional survey conducted in six European countries among 1982 healthcare professionals (HCPs) (July-October 2020) and 779 WCBP treated with valproate for epilepsy, bipolar disorder or other indications (August 2020-February 2021). HCPs were prescribing physicians (neurologists, psychiatrists, paediatricians and GPs), gynaecologists and pharmacists. Prespecified criteria were defined for success in the dimensions of awareness, knowledge and behaviour (correct answers to ≥ 80% of questions at individual level) and overall success (≥ 90%/80% successful HCPs/patients respectively, in the behaviour dimension and one of the two other dimensions). HCPs and patients did not meet the success criteria either overall or in any dimension. Highest success rates were in the behaviour dimension for gynaecologists (71.7%), pharmacists (49.7%) and patients (51.2%), and in the awareness dimension for prescribing physicians (23.6%). HCPs reported being unfamiliar with some educational materials and lacked knowledge of detailed prescribing conditions for valproate and the need for contraception regardless of sexual activity. More than 50% of patients were aware of the relevant patient materials and knew about the teratogenic risks of valproate. Self-reported levels of awareness, knowledge and behaviour varied considerably by HCP type and among patient respondents. Further investigation is needed into why certain measures of the pregnancy prevention programme are not well known and followed, to improve their effectiveness. This will be addressed in a qualitative study which will be based on interviews with HCPs and patients.

Evaluation of Heavy Metal Contamination in Amaranthus hybridus (Spinach)

Heavy metals contamination in edible plants poses significant risks to human health and environmental sustainability. This study evaluates heavy metal contamination in Amaranthus hybridus L. (spinach) collected from three sites: Nyabunkaka River, Kogin Sarki, and Mayo-Gwoi River in Jalingo, Taraba State, Nigeria. The study aimed to determine the levels of lead (Pb), cadmium (Cd), chromium (Cr), zinc (Zn), copper (Cu), nickel (Ni), manganese (Mn), and cobalt (Co) in spinach samples using Atomic Absorption Spectrophotometry (AAS). Results revealed that Pb concentration in spinach from Nyabunkaka slightly exceeded the FAO permissible limit, while Cd, Cr, Zn, Cu, Ni, Mn, and Co levels in all samples were below FAO reference values, indicating minimal contamination risks. These findings highlight the potential environmental pollution near Nyabunkaka River and suggest that spinach from the selected areas remains largely safe for human consumption, except for slight Pb contamination. The study emphasizes the need for continuous monitoring to ensure food safety.

Integrated Assessment and Agricultural Planning in Selenium-Rich Hilly Soils: A Case Study on Land Use, Heavy Metal Contamination, and Nutrient Element Distribution

The strategic development of selenium-enriched soil cultivation is essential for effective agricultural land management. This research explores the sustainable utilization of selenium-rich soils in Qiongzhong County, Hainan Island. An extensive evaluation was conducted on 7266 surface soil samples, assessing the selenium concentrations, nutrient levels, heavy metals, pH values, and soil organic matter (SOM). In addition, analyses of 70 samples for organochlorine compounds and PAHs were performed. The results indicated average selenium content of 0.46 mg/kg, with 55.2% of the samples surpassing the selenium enrichment threshold of 0.4 mg/kg. According to the GB15618-2018 standards, 127 samples (1.75%) showed medium or high chromium-associated risks. No contamination from organochlorine compounds or PAHs was found, including the 16 priority-controlled PAHs with an average concentration of 30.3 µg/kg, confirming the soil’s high quality. The correlation and factor analysis identified surface enrichment as the main factor influencing selenium accumulation, presenting minimal environmental risks. Consequently, three categories of selenium-rich soil were defined: selenium-rich, pollution-free, and high-nutrient selenium-rich soil. Recommendations based on the soil characteristics and existing agricultural practices were made for the cultivation of selenium-rich vegetables, rubber, and nuts. This study lays a foundation for the sustainable management of selenium-rich soils, providing insights for further research and decision-making to optimize these resources, thus promoting environmental protection and agricultural sustainability.

Immunogenicity and safety of DTPW-HEPB-HIB (PRP-T) vaccine (Pentavac) in infants aged 2–7 months: a post marketing phase 4 clinical trial study

Background.Vaccines play a critical role in safeguarding public health, particularly for children. It is imperative to proactively address safety concerns to uphold trust in their effectiveness and safety. Skepticism surrounding vaccines can have significant adverse effects on the overall well-being of the entire population, potentially leading to individuals opting out of vital vaccinations, thereby posing risks to public health. Thus, ensuring confidence in vaccine safety remains paramount.Materials and methods.This phase four clinical trial was conducted as a post-marketing study (PMS) on 2 to 7 month old healthy infants (N = 539) to evaluate immunity and safety of Indian pentavalent vaccine containing Diphtheria, Tetanus, Pertussis, Hepatitis B and Haemophilus influenza type b [DTPW-HEP B-HIB (PRP-T)/PENTAVAC] in four different centers at Tehran province. Blood samples were collected from eligible infants before receiving the vaccine (2 months of age) and 1 month after the third dose (7 months of age) to determine antibodies against all antigens in the pentavalent vaccine using ELISA.Results.The results indicated that the immune responses demonstrated seroprotection and protective antibody levels after three doses of the vaccine for Haemophilus influenza b, diphtheria, tetanus, hepatitis B virus andBordetella pertussiswere 99.1%, 98.7%, 99.8%, 99.4% and 69.6%, respectively. Statistical analysis showed that the P-value for all vaccine components was similar (P 0.001). The five most common side effects reported were mild fever (10%), erythema at the vaccination site (9.1%), inflammation (4.3%), pain at the vaccination site (3.3%), and restlessness (2.6%).Conclusion.This study’s findings demonstrated a significant increase in antibody levels against all five vaccine components. In light of these results, it can be concluded that the Pentavalent vaccine is not only effective in enhancing immunity against multiple diseases but also presents minimal risk of side effects in the study population. These findings contribute to the body of evidence supporting the safety and efficacy of vaccines, underscoring their crucial role in protecting public health.

Adaptive Learning for Dynamic Features and Noisy Labels.

Applying current machine learning algorithms in complex and open environments remains challenging, especially when different changing elements are coupled and the training data is scarce. For example, in the activity recognition task, the motion sensors may change position or fall off due to the intensity of the activity, leading to changes in feature space and finally resulting in label noise. Learning from such a problem where the dynamic features are coupled with noisy labels is crucial but rarely studied, particularly when the noisy samples in new feature space are limited. In this paper, we tackle the above problem by proposing a novel two-stage algorithm, called Adaptive Learning for Dynamic features and Noisy labels (ALDN). Specifically, optimal transport is firstly modified to map the previously learned heterogeneous model to the prior model of the current stage. Then, to fully reuse the mapped prior model, we add a simple yet efficient regularizer as the consistency constraint to assist both the estimation of the noise transition matrix and the model training in the current stage. Finally, two implementations with direct (ALDN-D) and indirect (ALDN-ID) constraints are illustrated for better investigation. More importantly, we provide theoretical guarantees for risk minimization of ALDN-D and ALDN-ID. Extensive experiments validate the effectiveness of the proposed algorithms.

Automatic Method for Detecting Deformation Cracks in Landslides Based on Multidimensional Information Fusion

As cracks are a precursor landslide deformation feature, they can provide forecasting information that is useful for the early identification of landslides and determining motion instability characteristics. However, it is difficult to solve the size effect and noise-filtering problems associated with the currently available automatic crack detection methods under complex conditions using single remote sensing data sources. This article uses multidimensional target scene images obtained by UAV photogrammetry as the data source. Firstly, under the premise of fully considering the multidimensional image characteristics of different crack types, this article accomplishes the initial identification of landslide cracks by using six algorithm models with indicators including the roughness, slope, eigenvalue rate of the point cloud and pixel gradient, gray value, and RGB value of the images. Secondly, the initial extraction results are processed through a morphological repair task using three filtering algorithms (calculating the crack orientation, length, and frequency) to address background noise. Finally, this article proposes a multi-dimensional information fusion method, the Bayesian probability of minimum risk methods, to fuse the identification results derived from different models at the decision level. The results show that the six tested algorithm models can be used to effectively extract landslide cracks, providing Area Under the Curve (AUC) values between 0.6 and 0.85. After the repairing and filtering steps, the proposed method removes complex noise and minimizes the loss of real cracks, thus increasing the accuracy of each model by 7.5–55.3%. Multidimensional data fusion methods solve issues associated with the spatial scale effect during crack identification, and the F-score of the fusion model is 0.901.

Usage of Information technology for the success of managing various stages of the COVID-19 pandemic

This study explores the crucial role of Information and Communication Technology (ICT) in managing the COVID-19 pandemic, focusing on its impact on surveillance, contact tracing, patient monitoring, telemedicine, artificial intelligence (AI), vaccination logistics, communication, and public education. ICT has facilitated the collection and analysis of real-time data, enabling authorities to make informed decisions about containment strategies. Digital contact tracing systems have been instrumental in limiting the virus's spread, while remote patient monitoring and telemedicine have allowed healthcare services to continue with minimal transmission risk. AI and machine learning have enhanced the speed and accuracy of COVID-19 diagnosis, and ICT has streamlined vaccine distribution and monitoring to ensure equitable access. Additionally, online platforms have played a key role in public education, fostering collaboration among researchers and promoting interdisciplinary research efforts. The study emphasizes that the continued integration of ICT into healthcare systems is critical for addressing future global health crises. However, policymakers must invest in ICT infrastructure, bridge the digital divide, and ensure that marginalized populations have equitable access to these technologies. The findings highlight the importance of ongoing ICT development to improve healthcare outcomes in future pandemics and suggest that collaboration across sectors is essential for maximizing the potential of these digital tools. Ultimately, ICT has been pivotal in the effective management of the COVID-19 pandemic and will be vital in future crisis preparedness.

Engineering and design of a last mile novel helmet concept

Modern society witnessed a remarkable surge in urban mobility with the proliferation of micro-mobility sharing services. However, this transformation has also led to a worrisome increase in severe accidents and injured users. In addition, conventional helmets are significantly lacking in sustainability. This research investigates the feasibility and safety aspects of a novel bicycle helmet concept using cork as a protective liner. In comparison to traditional synthetic foams, cork offers eco-friendly advantages, such as recyclability and superior protection against multiple impacts. The newly proposed helmet is designed to provide enhanced sustainability and convenience, maintaining compliance with the EN 1078:2012+A1 standard whilst offering the capability to flatten for easy storage and transportation. Numerical simulations were conducted to optimise the design concept, and impact tests, in accordance with the European standard, were performed using physical prototypes categorised into three types of design configuration. The results from the standard impact test were outstanding, with the best performing configuration demonstrating a performance 36.8% below the standard’s threshold. This falls within the average performance range of a regular bicycle helmet made entirely of petrol-derived materials. Furthermore, it exhibited safe head injury criterion levels, indicating a minimal risk of severe head injury.

A retrospective study of Quality Control of Fresh Frozen Plasma (FFP) using Factor VIII levels in Central Blood Transfusion Services Indonesian Red Cross

Background: According to a report from the Ministry of Health of the Republic of Indonesia, there are 470 blood transfusion units in Indonesia (235 units managed by PMI, 220 units managed by the government, four units of health services provinces, nine units of vertical hospital BTUs, two unit’s Indonesian police and army hospital) distributed in 38 provinces. With so many BTUs spread throughout Indonesia, each BTU must have the same quality standards to maintain and improve blood services. Therefore, it is necessary to carry out Quality Control of the blood component products produced. Quality control is critical in safely and effectively processing blood and other components. A quality concept comprises quality control, assurance, and management. The laboratory service should have a quality control system. Quality testing and monitoring of blood components for transfusion have led to manufacturing or development. Factor VIII levels are internal quality control parameters required for quality analysis of Fresh Frozen plasma (FFP). As per international standard guidelines and government national regulations (PMK 91/2015) for quality assurance of FFP, 1% of all the units prepared, or four units per month, are tested for stable coagulation factors, including Factor VIII levels. Objective: This study aims to evaluate factor VIII levels in each units FFP to ensure the availability of high-quality products with maximum therapeutic and minimal risk to recipients. Methods: The retrospective data were collected from Research and Development CBTS Indonesian Red Cross archives from 1 January 2019 to 30 April 2023. Out of total 284 units FFP collected from Blood Transfusion Unit Indonesian Red Cross from Sumatera Island (Lampung Province, Palembang City, Pekanbaru City), DKI Jakarta Province (CBTS IRC), Jawa Barat Province (Depok City, District of Bekasi City, District of Bogor City), Banten Province (Tangerang City, District South of Tangerang City), Government Hospital (Fatmawati Hospital BTU), Army Hospital (RSPAD Gatot Soebroto BTU) were tested Quality Control with semi-automated Sysmex CA50 and automated Sysmex CA620 to determine of factor VIII levels in each unit FFP. Results: A total of 284 units of FFP were tested, and mean factor VIII levels were 1,2 IU/mL with a range of 0,3 IU/mL-5,3 IU/mL, the normal range measure being &gt; 0,7 IU/mL. Only 4,9 % (14/284) FFP units were inappropriate from the standard, while 95,1 % (270/284) FFP units could be accepted criteria standard. Conclusion: We conclude that there are still those below-standard Quality FFP products from blood transfusion units; it is necessary to increase the processing of blood components so that the coagulation factors are maintained. From taking blood collecting, transporting, and shipping, it is required to carry out quality control to produce products that meet national and international standards.

Early Non-Surgical Correction of Newborn Ear Deformity

Otoplasty has been described for nearly 200 years for children and adults. Although auricular deformity has been recognized in newborns, treatment options were lacking. With the development of ear molding techniques, newborn ear deformities can now be corrected non-surgically. However, these techniques have distinct limitations with much dependent on the age of initiation of treatment and deformities present. Awareness of these early interventions is therefore crucial in order to initiate treatment in the early developmental period when the ear is still malleable. During the first few weeks of life, the ears are malleable, and the ears are rapidly growing, relatively. Therefore, the neonatal period provides a unique opportunity to contour the ears properly. Different techniques have been developed. However, the premise is that the ears are stabilized in a favorable contour continuously for several weeks to hold into proper position. This procedure carries minimal risk and can be quite efficacious, preventing a child from needing surgery later in life.

Balancing act: evaluating non-target risks of feral cat management in conservation reserves

Context Predation by feral cats continues to place substantial pressure on native Australian wildlife, contributing to significant population declines and localised extirpations of susceptible species. In Western Australia (WA), the registration of the poison bait Eradicat® provides a tool to help manage these introduced predators, but only in areas where the risk to non-target species is considered acceptable. The red-tailed phascogale (Phascogale calura), a small carnivorous marsupial now restricted to vegetation remnants in the highly fragmented agricultural zone of south-western WA (i.e. the Wheatbelt), is one species that may be vulnerable to lethal ingestion. Aim To investigate the impact of repeated Eradicat® baiting, to control feral cats, on the activity levels of the red-tailed phascogale, focusing on populations in two Wheatbelt conservation reserves. Methods We established a novel approach to monitoring red-tailed phascogales by using tree-mounted camera trap arrays in an area with feral cat management using ground-delivered Eradicat® baits, and two control zones with no feral cat management. We examined changes in activity levels (detection rate and occupancy) based on camera trap detections, before and after Eradicat® application, across two autumn and two spring baiting events. We also investigated non-target bait uptake using camera traps. Key results Although a small number of baits (7/60) was removed by red-tailed phascogales from the field of view of a camera, our results showed no overall impact of Eradicat® on their activity levels within the study area. Tree-mounted camera traps proved to be highly effective and efficient at detecting red-tailed phascogales. To maximise camera detections, the optimal time for monitoring red-tailed phascogales is during autumn, prior to male die-off. Conclusions Our results suggested that the risk posed to red-tailed phascogale populations from the repeated use of Eradicat® baits is likely to be low. Implications Integrating the application of Eradicat® to control feral cats with existing fox control in conservation reserves that support populations of red-tailed phascogales is likely to pose minimal risk to the species.

X-RAY-GUIDED ENDOVASCULAR SURGERY FOR SUBCLAVIAN STEAL SYNDROME (CLINICAL CASE)

Defining the sequence and methods of revascularization in patients with multifocal atherosclerosis should be associated with a minimal risk of adverse events and identification of predictors of adverse outcomes of operations, which is of great importance for improving the results of surgical treatment. We present a clinical case of successful treatment of a patient with multifocal atherosclerosis. The case included atherosclerotic disease of the left subclavian artery with complete steal syndrome of the brachiocephalic arteries, arteries of the lower limbs and arteries of the heart. It is shown that, when choosing a method for treating multifocal atherosclerosis, treatment should begin with preserving and restoring blood supply to the brain, and followed by restoring blood supply to other body parts.

Can a chest pain virtual ward be used to safely manage patients with low-risk acute coronary syndrome?

Abstract Background Acute coronary syndrome (ACS) accounts for approximately 2-6% of emergency department (ED) presentations and contributes at least 20% of the overall acute hospital admissions(1-3). Patients presenting with low-risk ACS may be suitable for remote monitoring(4) while awaiting angiogram in chest pain virtual ward(CPVW) thereby improving patient flow and resource utilisation. Purpose We aimed to assess outcomes for patients with low-risk ACS admitted in a district general hospital with a view to establish an onboarding pathway for CPVW whilst ensuring a safe monitoring without effecting the readmission rate or all-cause mortality. Methods We retrospectively analysed the Myocardial Ischaemia National Audit Project (MINAP) registry of from March 2022 to April 2023 for patients who presented to ED with a diagnosis of confirmed ACS. Patients were stratified into low-risk (GRACE score &amp;lt;140, HEART score &amp;lt;4, non-dynamic ECG, non-dynamic troponin, without ongoing chest pain), all other patients were deemed intermediate-to-high-risk ACS. Baseline demographics, the total length of acute admission days, waiting time before and after coronary investigation ,adverse events (escalation of therapy, death)whilst awaiting for invasive inpatient angiogram were calculated. The primary endpoint was 30-day readmission and all-cause mortality. Results 1077 patients were coded as ACS diagnosis in ED. 561(52.1%) had a confirmed diagnosis of ACS. Data to allow stratification was available for 538 patients, included in final analysis. 377(70.1%) were male with a mean age of 66.8 ± SD 13.1 years. A significant number of patients had other comorbidities, including hypertension (66.1%), diabetes (45.3%), hyperlipidaemia (51.3%), and previous history of IHD (46.5%). Total number of patients stratified into low-risk ACS was 55(10.2%), intermediate-to-high-risk group contained 483(89.8%) patients. The median total-length-of-stay (LOS) for low-risk ACS patients was 4 days(IQR 2-7), waiting time to have an inpatient angiogram was 3 days(IQR 0-5), and discharge time post-angiogram was 1 day(IQR 0-2). 4 patients(7.3%) in low-risk cohort required CCU admission for GTN infusion due to ongoing chest pain, among them 3 patients(5.5%) had abnormal coronary angiogram. 5 patients(9.1%) in low-risk cohort were readmitted due to chest pain post-angiogram and no patients had 30-days or 1-year all-cause mortality. The result depicts 51 patients from low-risk cohort would have been eligible for CPVW reducing the LOS from median 4 days to 1-2 days, this is a saving of 102-153 acute bed days per year. Assuming the costing of a bed day is £320 this equates to £32,640 - £48,960 cost saving without any adverse outcomes. Conclusion Our data suggests that there is a large cost saving with minimal risk in managing patients with low-risk ACS via a CPVW. This pathway of management is likely to have benefit in patient flow and resource utilisation in our district general hospital trust.Comparison of different ACS cohortsCPVW flow-diagram