Minimal Risk Research Articles

Class-Balanced Regularization for Long-Tailed Recognition

AbstractLong-tailed recognition performs poorly on minority classes. The extremely imbalanced distribution of classifier weight norms leads to a decision boundary biased toward majority classes. To address this issue, we propose Class-Balanced Regularization to balance the distribution of classifier weight norms so that the model can make more balanced and reasonable classification decisions. In detail, CBR separately adjusts the regularization factors based on L2 regularization to be correlated with the class sample frequency positively, rather than using a fixed regularization factor. CBR trains balanced classifiers by increasing the L2 norm penalty for majority classes and reducing the penalty for minority classes. Since CBR is mainly used for classification adjustment instead of feature extraction, we adopt a two-stage training algorithm. In the first stage, the network with the traditional empirical risk minimization is trained, and in the second stage, CBR for classifier adjustment is applied. To validate the effectiveness of CBR, we perform extensive experiments on CIFAR10-LT, CIFAR100-LT, and ImageNet-LT datasets. The results demonstrate that CBR significantly improves performance by effectively balancing the distribution of classifier weight norms.

On regularization schemes for data-driven optimization based on Cressie–Read divergence and CVaR

On regularization schemes for data-driven optimization based on Cressie–Read divergence and CVaR

An efficient safest route prediction-based route discovery mechanism for drivers using improved golden tortoise beetle optimizer

ABSTRACT Several commercialised route recommendation systems only consider the metrics like cost, time, and distance. The essential metric ‘safety’ is neglected by the existent systems. It suggests only the short way and doesn’t include any safety information, such as crime awareness, road availability. This paper describes an inventive ideology to discover the safest route with minimal risk score for security of the road travellers. Hence, a new safety route navigation mechanism is developed to solve the challenges in the traditional route discovery approaches using deep learning. In the developed route discovery mechanism, the examination of the safest roads is done by the developed deep learning network, where the network is trained with the inputs obtained from the roads, such as road surface conditions, Road users, weather conditions, traffic conditions, accidental cases, and crime areas. The availability of the safest route will be determined by the ‘Long Short-Term Memory with Attention Mechanism’ (LSTM-AM). The route discovery is done with the help of a developed ‘Fitness-based Golden Tortoise Beetle Optimizer’ (FGTBO) with multi-objective constraints like distance, time, and road availability. The implementation outcome of the developed route discovery scheme will be validated with the traditional route discovery approaches concerning various measures.

Predicting Hypoglycemia and Hyperglycemia Risk During and After Activity for Adolescents with Type 1 Diabetes.

Objective: To predict hypoglycemia and hyperglycemia risk during and after activity for adolescents with type 1 diabetes (T1D) using real-world data from the Type 1 Diabetes Exercise Initiative Pediatric (T1DEXIP) study. Methods: Adolescents with T1D (n = 225; [mean ± SD] age = 14 ± 2 years; HbA1c = 7.1 ± 1.3%; T1D duration = 5 ± 4 years; 56% using hybrid closed loop), wearing continuous glucose monitors (CGMs), logged 3738 total activities over 10 days. Repeated Measures Random Forest (RMRF) and Repeated Measures Logistic Regression (RMLR) models were used to predict a composite risk of hypoglycemia (<70 mg/dL) and hyperglycemia (>250 mg/dL) within 2 h after starting exercise. Results: RMRF achieved high precision predicting composite risk and was more accurate than RMLR Area under the receiver operating characteristic curve (AUROC 0.737 vs. 0.661; P < 0.001). Activities with minimal composite risk had a starting glucose between 132 and 160 mg/dL and a glucose rate of change at activity start between -0.4 and -1.9 mg/dL/min. Time <70 mg/dL and time >250 mg/dL during the prior 24 h, HbA1c level, and insulin on board at activity start were also predictive. Separate models explored factors at the end of activity; activities with glucose between 128 and 133 mg/dL and glucose rate of change between 0.4 and -0.6 mg/dL/min had minimal composite risk. Conclusions: Physically active adolescents with T1D should aim to start exercise with an interstitial glucose between 130 and 160 mg/dL with a flat or slightly decreasing CGM trend to minimize risk for developing dysglycemia. Incorporating factors such as historical glucose and insulin can improve prediction modeling for the acute glucose responses to exercise.

Evolution of surgical management of pineal region tumors in the pediatric population: a 17-year experience at a single institution.

Pineal-region tumors have historically been challenging to treat. Advances in surgical techniques have led to significant changes in care and outcomes for these patients and this is well demonstrated by our single institution's experience over a 17-year-period in which the evolution of diagnosis, treatment, and outcomes of pineal tumors in pediatric patients will be outlined. We retrospectively collected data on all pediatric patients with pineal region lesions treated with surgery at Children's National Hospital (CNH) from 2005-2021. Variables analyzed included presenting symptoms, presence of hydrocephalus, diagnostic and surgical approach, pathology, and adverse events, among others. IRB approval was obtained (IRB: STUDY00000009), and consent was waived due to minimal risk to patients included. A total of 43 pediatric patients with pineal region tumors were treated during a 17-year period. Most tumors in our series were germinomas (n=13, 29.5%) followed by pineoblastomas (n=10, 22.7%). 27 of the 43 patients (62.8%) in our series received a biopsy to establish diagnosis, and 44.4% went on to have surgery for resection. The most common open approach was posterior-interhemispheric (PIH, transcallosal) - used for 59.3% of the patients. Gross total resection was achieved in 50%; recurrence occurred in 20.9% and mortality in 11% over a median follow-up of 47 months. Endoscopic third ventriculostomy (ETV) was employed to treat hydrocephalus in 26 of the 38 patients (68.4%) and was significantly more likely to be performed from 2011-2021. Most (73%) of the patients who received an ETV also underwent a concurrent endoscopic biopsy. No difference was found in recurrence rate or mortality in patients who underwent resection compared to those who did not, but complications were more frequent with resection. There was disagreement between frozen and final pathology in 18.4% of biopsies. This series describes the evolution of surgical approaches and outcomes over a 17-year-period at a single institution. Complication rates were higher with open resection, reinforcing the safety of pursuing endoscopic biopsy as an initial approach. The most significant changes occurred in the preferential use of ETVs over ventriculoperitoneal shunts. Though there has been a significant evolution in our understanding of and treatment for these tumors, in our series, the outcomes for these patients have not significantly changed over that time.

Stability-Indicating UPLC-PDA-QDa Methodology for Carvedilol and Felodipine in Fixed-Dose Combinations Using AQbD Principles

The development of analytical procedures, in line with the recent regulatory requirements ICH Q2 (R2) and ICH Q14, is progressing, and it must be able to manage the entire life cycle of the methodology. This is also applicable to and especially challenging for combinations of drug substances and dosage form. A reliable and efficient, stability-indicating, MS-compatible, reverse-phase ultra-performance liquid chromatographic (UPLC®) method was developed for the determination of carvedilol and felodipine in a combination oral dosage form. The development of the method, performed using analytical quality by design (AQbD) principles, was in line with the future regulatory requirements. Furthermore, the fixed-dose combination dosage forms are a clear solution to the polypharmacy phenomenon in the elderly population. The main factors evaluated were the mobile phase buffer, organic modifier, column, flow, and column temperature. The optimum conditions were achieved with a Waters Acquity HSS T3 (100 × 2.1 mm i.d., 1.8 µm) column at 38 °C, using ammonium acetate buffer (5 mM, pH 4.5) (Solution A) and MeOH (Solution B) as mobile phases in gradient elution (t = 0 min, 10% B; t = 1.5 min, 10% B; t = 12.0 min, 90% B; t = 13.0 min, 10% B; t = 15.5 min, 10% B) at a flow rate of 0.2 mL/min and UV Detection of 240 and 362 nm for carvedilol (CAV) and felodipine (FLP), respectively. The linearity was demonstrated over concentration ranges of 30–650 µg/mL (R2 = 0.9984) (CAV) and 32–260 µg/mL (R2 = 0.9996) (FLP). Forced degradation studies were performed by subjecting the samples to hydrolytic (acid and base), oxidative, and thermal stress conditions. Standard solution stability was also performed. The proposed validated method was successfully used for the quantitative analysis of bulk, stability, and fixed-dose combination dosage form samples of the desired drug product. Using the AQbD principles, it is possible to generate methodologies with improved knowledge, leading to high-quality data, lower operation costs, and minimum regulatory risk. Furthermore, this work paves the way for providing a platform of robust analytical methods for the simultaneous quantification of innovative on-demand new dose combinations.

Photochemical Transformation of Monochloramine Induced by Triplet State Dissolved Organic Matter

The photoexcited dissolved organic matter (DOM) could produce reactive intermediates, affecting chemical oxidant transformation in UV based advanced oxidation processes (AOPs). This study confirmed the critical role of triplet state DOM (3DOM*), generated from DOM photoexcitation, in the transformation of monochloramine (NH2Cl), a commonly used chemical oxidant and disinfectant in water treatment. NH2Cl (42.25 μM, as Cl2) was decayed by 17.4–73.4 % within 60 min, primarily due to 3DOM* , in DOM (2–30 mgC L−1) solutions irradiated by 365 nm, where NH2Cl has no absorption. The second-order quenching rate constants of triplet state model photosensitizers by NH2Cl were determined to be 0.95(± 0.04)–4.49(± 0.04)× 108 M−1 s−1 by using laser flash photolysis. As a reductant, 3DOM* reacted with NH2Cl through one-transfer mechanism, leading to amino radical (NH2•) generation, which then transferred to ammonia (NH4+, pKa 9.25) through H-abstraction by the phenolic moieties in DOM. Additionally, the intermediate product of 3DOM* oxidized by NH2Cl or those triplet state quinones can hydrolyze to form phenolic moieties, elevating NH4+ yield to higher than 99% upon 365 nm irradiation. These findings suggest that the widespread DOM can be applied to convert NH2Cl via 3DOM* with minimal toxic risks.

Detection of Heavy Metals in Some Edible Grains Obtained from Two Markets in Bauchi Metropolis, Nigeria

This study investigated the level of heavy metals (Cd, Cr, Cu, Fe, Pb and Zn) in grains sold in Central and Muda Lawal markets in Bauchi. Our objectives include assessing heavy metal concentrations in the grains and evaluating associated health risks. We utilized Atomic Absorption Spectrophotometry following acid digestion of grains to determine heavy metal concentrations. In Central market-sourced crops, the mean concentrations of Cd, Cr, Cu, Fe, Pb, and Zn were 0.06, 0.49, 0.21, 1.16, 0.15, and 0.17mg/kg respectively. Meanwhile, crops from Muda Lawal market exhibited mean concentrations of 0.06, 0.58, 0.17, 1.62, 0.1, and 0.22 mg/kg for Cd, Cr, Cu, Fe, Pb, and Zn, respectively. Cd, Cr, Cu, Pb, and Zn levels were below the permissible limits. However, Fe exceeded permissible limits in small beans, Syria maize, and white guinea corn from Central market, as well as in Syria maize, Pearl millet II, and white guinea corn from Muda Lawal market. The daily intake of Cd, Cu, and Pb from most studied crops exceeded the oral reference dose, posing potential health risks. Conversely, Cr, Fe, and Zn intake levels were within acceptable limits, posing minimal health risks. Hazard quotient and hazard index values were below 1, suggesting that crop consumption is unlikely to pose health risks.

Efficacy and Safety of Phoenix dactylifera L. Leaf Extract (WartOver®) in the Treatment of Cutaneous Warts: A Randomized, Double-Blind, Placebo-Controlled Trial

Background. Cutaneous warts are caused by the human papillomavirus that can affect a patient’s quality of life. Current treatments have high cost, low efficacy, adverse effects, and recurrence. Therefore, novel therapeutic approaches are needed. Complementary and Alternative Medicines (CAMs) are gaining popularity as a therapeutic approach. Phoenix dactylifera L. (date palm) is used in folk medicine to treat warts. Antiviral effects of P. dactylifera L. have been demonstrated due to its polyphenolic compounds, especially gallic acid and tannins in various studies. So, this trial evaluates the efficacy and safety of P. dactylifera L. leaf extract (formulated as WartOver®) as a novel treatment for cutaneous warts. Study Design. Based on the results of our previously published pilot clinical trial and the CONSORT guideline, this randomized, double-blind, and placebo-controlled study was performed on 70 eligible patients divided into intervention and placebo groups (N = 35/per group). Every 2 weeks, patients were examined to assess the rate of complete clearance, duration of treatment, patient satisfaction (measured using a Likert scale), and occurrence of any adverse effects and recurrence in a maximum of 12 weeks of treatment and at the 6-month follow-up. Results. Based on the intention-to-treat (ITT) analysis approach, complete clearance was achieved in 24 patients in the intervention group (68.57%; confidence interval 95% = 0.51–0.81), which was significantly higher than that in the placebo group (8.57%; CI 95% = 0.02–0.23, p&lt;0.0001). The time to complete clearance was 7.6 weeks (mean ± SD: 53.30 ± 17.17 days). The treatment was very satisfactory (Likert score of 4.24 ± 1.15 (mean ± SD)) with no recurrence or adverse effects. Conclusion. WartOver® is a novel efficacious treatment for cutaneous warts with minimal risk for adverse events or recurrence. Due to the rising popularity of CAM approaches in medicine, including herbal medicines, WartOver® can be a valuable choice for clinicians against cutaneous warts. This trial is registered with IRCT20200509047352N2.

OA05 Potential impact of European Medicines Agency measures to minimise risk of serious side effects on those using JAK inhibitors in the UK

Abstract Background/Aims Janus kinase inhibitors (JAKi) are effective therapies for rheumatoid arthritis (RA). However, concerns about their safety in certain 'at-risk' populations have resulted in risk minimisation measures introduced by European Medicines Agency (EMA) in January 2023, which limits JAKi prescription to certain patient subgroups unless no suitable alternative is available. The potential impact on current and future JAKi use in the UK is unknown. Using a national cohort study of patients who have already started their first JAKi, this analysis aimed to describe the proportion meeting ≥1 of these criteria and therefore may be impacted by these changes. Methods RA patients starting their first-ever JAK inhibitor (tofacitinib, baricitinib, upadacitinib, or filgotinib) therapy in the British Society for Rheumatology RA Biologics Register (BSRBR-RA) before 31st May 2022 (pre-EMA warning) were included. Patients with missing data in any EMA criteria related variables were excluded. Descriptive statistics were used to present patients' characteristics at the start of JAKi. This analysis defined four at-risk criteria assessed at the treatment start: 1) aged ≥65; 2) increased risk of major cardiovascular issues (history of hypertension, hyperlipidaemia, diabetes, ischaemic heart disease, or stroke); 3) current or past smokers; 4) increased risk of cancer (defined as prior cancer). The previous number of distinct biological disease-modifying antirheumatic drugs (bDMARDs) classes was described among those who met the criteria. Results A total of 1,362 patients starting their first JAKi were included, most commonly baricitinib (76%), followed by tofacitinib (16%; see Table). The cohort was 78% female, with an average age of 60. Among them, 28% of patients had received ≥3 prior bDMARDs classes. 80% percent of patients (1,090) met ≥1 EMA risk criterion, with the most common individual criterion current/past smoker (54%). Of those who met ≥1 risk criteria, 645 (59%) met ≥1 EMA risk criterion and 29% had already received ≥3 prior bDMARDs classes. Conclusion A very high proportion of patients, four-in-five, initiating JAKi in UK before the EMA advisory would have fallen into the ‘high-risk' category for whom prescribing would only be advised if no suitable alternatives were available. Whilst almost a third of them had previously received ≥3 different bDMARDs classes, it’s likely that many of them would have suitable alternatives. These data highlight the enormous impact of the recent licensing updates for JAKi class. Disclosure Z. Tian: None. L. Kearsley-fleet: None. J. Galloway: Honoraria; Abbvie, Galapagos, Janssen, Lilly, Novartis, Pfizer, UCB, Vifor. Grants/research support; Abbvie, Galapagos, GSK, Janssen, Pfizer. K. Watson: None. M. Lunt: None. K.L. Hyrich: Honoraria; Abbvie. Grants/research support; Pfizer, BMS.

Investment Portfolio Optimization In Infrastructure Stocks Using The Mean-VaR Risk Tolerance Model

Infrastructure a crucial role in economic development and the achievement of Sustainable Development Goals (SDGs), with investment being a key activity supporting this. Investment involves the allocation of assets with the expectation of gaining profit with minimal risk, making the selection of optimal investment portfolios crucial for investors. Therefore, the aim of this research is to identify the optimal portfolio in infrastructure stocks using the Mean-VaR model. Through portfolio analysis, this study addresses two main issues: determining the optimal allocation for each infrastructure stock and formulating an optimal stock investment portfolio while minimizing risk and maximizing return. The methodology employed in this research is the Mean-VaR approach, which combines the advantages of Value at Risk (VaR) in risk measurement with consideration of return expectations. The findings indicate that eight infrastructure stocks meet the criteria for forming an optimal portfolio. The proportion of each stock in the optimal portfolio is as follows: ISAT (2.74%), TLKM (33.894%), JSMR (3.343%), BALI (0.102%), IPCC (5.044%), KEEN (14.792%), PTPW (25.863%), and AKRA (14.219%). The results of this study can serve as a foundation for better investment decision-making.

Two-view topogram-based anatomy-guided CT reconstruction for prospective risk minimization

To facilitate a prospective estimation of the effective dose of an CT scan prior to the actual scanning in order to use sophisticated patient risk minimizing methods, a prospective spatial dose estimation and the known anatomical structures are required. To this end, a CT reconstruction method is required to reconstruct CT volumes from as few projections as possible, i.e. by using the topograms, with anatomical structures as correct as possible. In this work, an optimized CT reconstruction model based on a generative adversarial network (GAN) is proposed. The GAN is trained to reconstruct 3D volumes from an anterior-posterior and a lateral CT projection. To enhance anatomical structures, a pre-trained organ segmentation network and the 3D perceptual loss are applied during the training phase, so that the model can then generate both organ-enhanced CT volume and organ segmentation masks. The proposed method can reconstruct CT volumes with PSNR of 26.49, RMSE of 196.17, and SSIM of 0.64, compared to 26.21, 201.55 and 0.63 using the baseline method. In terms of the anatomical structure, the proposed method effectively enhances the organ shapes and boundaries and allows for a straight-forward identification of the relevant anatomical structures. We note that conventional reconstruction metrics fail to indicate the enhancement of anatomical structures. In addition to such metrics, the evaluation is expanded with assessing the organ segmentation performance. The average organ dice of the proposed method is 0.71 compared with 0.63 for the baseline model, indicating the enhancement of anatomical structures.

The Comparison of Investment Portfolio Optimization Result of Mean-Variance Model Using Lagrange Multiplier and Genetic Algorithm

Investment portfolio optimization is carried out to find the optimal combination of each stock with the aim of maximizing returns while minimizing risk by diversification. However, the problem is how much proportion of funds should be invested in order to obtain the minimum risk. One approach that has proven effective in building an optimal investment portfolio is the Mean-Variance model. The purpose of this study is to compare the results of the Mean-Variance model investment portfolio optimization using Lagrange Multiplier method and Genetic Algorithm. The data used are stocks that are members of the LQ45 index for the period February 2020-July 2021. Based on the research results, there are five stocks that form the optimal portfolio, namely ADRO, AKRA, BBCA, CPIN, and EXCL stocks. The optimal portfolio generated by the Lagrange Multiplier method has a risk of 0.000606 and a return of 0.000726. Meanwhile, using the Genetic Algorithm resulted in a risk of 0.000455 and a return of 0.000471. Thus, the Genetic Algorithm method is more suitable for investors who prioritize lower risk. Meanwhile, the Lagrange Multiplier method produces a relatively higher risk, making it less suitable for investors who expect a small risk.

Current Global Occurrence of Carbapenem-Resistant Klebsiella pneumoniae (CRKP) Infections in Hospitalized Patients: A Literature Review

Antimicrobial resistance (AMR) is an escalating global issue. One of the primary resistance mechanisms is the ability of microbes to deactivate antimicrobial drugs through the production of expanded-spectrum β-lactamases enzymes (ESBL), such as carbapenemases. Among the pathogens associated with multidrug resistance, Klebsiella pneumoniae has a high frequency, particularly in hospital settings. This study presents a narrative review of the literature from the scientific databases of the National Library of Medicine (PubMed) and the Cochrane Library on the occurrence of carbapenem-resistant K. pneumoniae (CRKP) infections in hospitalized patients, identifying current studies that may contribute to understand the spread of resistant bacteria. The review was conducted in September 2023 with the aim of summarizing evidence. Inclusion and exclusion criteria were applied, and 20 articles were included, covering the continents of the America, Africa, Asia, and Europe, to select the most recent studies about CRKP. In the studies analyzed, nosocomial isolates predominantly originated from sputum samples, followed by urine and blood. Molecular analysis revealed that most microorganisms exhibiting resistance to carbapenems harbored the blaKPC, blaNDM, and blaOXA-48 genes. However, there is epidemiological variation among continents, underscoring the need for more knowledge about genetic diversity and the implementation of active surveillance culture programs to facilitate prompt action with appropriate therapy and minimal patient risk. These findings indicate a necessity for heightened vigilance by hospital infection control committees to prevent potential spread and outbreaks of bacteria carrying carbapenem resistance genes.

Selective binding of cationic fibrinogen-mimicking chitosan nanoparticles to activated platelets and efficient drug release for antithrombotic therapy

Thrombosis is the main cause of catastrophic events including ischemic stroke, myocardial infarction and pulmonary embolism. Acetylsalicylic acid (ASA) therapy offers a desirable approach to antithrombosis through a reduction of platelet reactivity. However, major bleeding complications, severe off-target side effects, and resistance or nonresponse to ASA greatly attenuate its clinical outcomes. Herein, we report a cationic fibrinogen-mimicking nanoparticle, denoted as ASA-RGD-CS@TPP, to achieve activated-platelet-targeted delivery and efficient release of ASA for safer and more effective antithrombotic therapy. This biomimetic antithrombotic system was prepared by one-pot ionic gelation between cationic arginine-glycine-aspartic acid (RGD)-grafted chitosan (RGD-CS) and anionic tripolyphosphate (TPP). The platform exhibited selective binding to activated platelets, leading to efficient release of ASA and subsequent attenuation of platelet functions, including the remarkable inhibition of platelet aggregation through a potent blockage of cyclooxygenase-1 (COX-1). After intravenous administration, ASA-RGD-CS@TPP displayed significantly prolonged circulation time and successful prevention of thrombosis in a mouse model. ASA-RGD-CS@TPP was demonstrated to significantly enhance antithrombotic therapy while showing minimal coagulation and hemorrhagic risks and excellent biocompatibility in vivo as compared to free ASA. This platform provides a simple, safe, effective and targeted strategy for the development of antithrombotic nanomedicines.

Brainstem cavernous hemangioma with improvement of Holmes tremor on excision.

An 8-year-old boy presenting with left-angle paralysis, tremor in upper and lower extremities, and diplopia was diagnosed with hemorrhage from a mesencephalic cavernous hemangioma. He underwent hemangiomectomy through the occipital transtentorial approach 4weeks post-hemorrhage, after which Holmes tremor (HT) markedly reduced. A year later, hemangioma has not recurred; he is now independent in his daily activities. Early intervention in the subacute stage allows for the complete removal of brainstem cavernomas (BSCs), with minimal risk of complications or sequelae. Proper timing and surgical approach for BSCs can prevent re-bleeding and improve HT after an initial hemorrhage, without any lasting negative consequences.

Monitoring and Risk Assessment of Pesticide Residues in Fishery Products Using GC-MS/MS in South Korea.

The aim of this study was to assess the risk of pesticide contamination in aquaculture and its impact on fishery products. We conducted an assessment of 300 samples collected from nine regions in South Korea, including various types of seafood, such as freshwater fish, marine fish, crustaceans, and shellfish. Pesticide residues in seafood were analyzed using GC-MS/MS after sample preparation using a modified QuEChERS method, revealing the presence of eight pesticides (4,4'-DDE, 4,4'-DDT, boscalid, isoprothiolane, oxadiazon, pendimethalin, thifluzamide, and trifluralin) across seven fish species (carp, far eastern catfish, crucian carp, eel, Chinese muddy loach, mirror carp, and sea bass). Following the grouping of DDE with DDT, a risk assessment of fishery products was conducted. After the estimated daily intake (EDI) of fish was calculated and compared with the acceptable daily intake (ADI), the health risk index (HI, %ADI) of the detected pesticides was evaluated and found to be 1.07% or lower. The results suggest that the consumption of domestically farmed fish products in South Korea poses minimal health risks associated with pesticide residues.

Salivary and urinary assessment of fluoride and silver ion concentrations after silver diamine fluoride application in children: a prospective cohort study.

The purpose of the study was to determine the fluoride (F) and silver (Ag) ions levels in the saliva and urine of healthy children after silver diamine fluoride (SDF) application on dental carious lesions. Sixty children (4-6years with ≥ 3 caries lesions) were recruited from the outpatient department of Pediatric Dentistry. From each child, 3ml unstimulated saliva samples were collected at baseline, one hour, and 24h after SDF application. Similarly, 3ml urine samples were collected prior to and after 24h of SDF application. F and Ag ion concentrations were determined by fluoride ion-selective electrode (ISE) and inductively coupled plasma mass spectrometry (ICPMS), respectively. The mean ± standard deviation (SD) baseline, 1-h, and 24-h salivary F concentrations (ppm) were 0.07 ± 0.07, 0.93 ± 0.48, and 0.19 ± 0.19, respectively, while the mean baseline and 24-h urinary F concentrations (ppm) were 0.33 ± 0.20ppm and 0.43 ± 0.25ppm, respectively. The mean baseline, 1-h, and 24-h salivary Ag concentrations (ppb) were 4.22 ± 3.15, 4198 ± 350, and 56.93 ± 37, respectively. The mean baseline and 24-h urinary Ag concentrations (ppb) were 2.80 ± 2.93ppb and 4.72 ± 4.0ppb, respectively. There were statistically elevated F and Ag ion concentrations at 1h and 24h after SDF application as compared to the baseline. Salivary and urinary F and Ag ions concentrations elevated significantly at 24h following SDF applications in children. A significant high recovery of these ions in urine indicates minimal systemic absorption, thus intermittent topical application of 38% SDF has a minimal risk of toxicity.

Linking genetic counseling communication skills to patient outcomes and experiences using a community-engagement and provider-engagement approach: research protocol for the GC-PRO mixed methods sequential explanatory study

IntroductionIn over 50 years since the genetic counseling (GC) profession began, a systematic study of GC communication skills and patient-reported outcomes in actual sessions across multiple clinical specialties has never...

Breast Cryoablation, From the AJR "How We Do It" Special Series.

Breast cryoablation is a minimally invasive image-guided percutaneous procedure to treat fibroadenomas and early-stage breast cancer utilizing liquid nitrogen or argon gas to create extremely cold temperatures that devitalize targeted tissue. Although more long term data are needed, this outpatient procedure is well tolerated and carries minimal risks, including non-target thermal injury that can be mitigated by careful planning and proper technique. Building a sustainable breast cryoablation service in a radiology practice poses several practical considerations, such as training proceduralists, purchasing equipment, recruiting patients, and understanding the revenue cycle. This article describes aspects of the radiologist's role in this procedure, including implementation of a breast ablation program, patient selection, technical details related to intervention, and expected postprocedural outcomes.