Potential Contributory Factors Research Articles

Late Urinary Toxicity After Extreme or Moderate Hypofractionated Prostate Radiation Therapy in Patients With Prior Transurethral Resection of Prostate

PurposeTo study the late urinary toxicity in patients with prostate cancer with prior transurethral resection of prostate (TURP) and treated with hypofractionated prostate radiotherapy. MethodsPatients diagnosed with prostate cancer, with a prior TURP, and treated with moderate or extreme hypofractionated intensity modulated radiotherapy (MHRT or SBRT), were included in this study. Severity and duration of urinary symptoms observed during serial follow up after at least three months from radiotherapy were graded per CTCAE v5.0 using information from prospectively maintained institutional database. Impact of hypofractionation and other potential contributory factors on cumulative grade 2+ late urinary toxicity was analysed with univariable and multivariable binary logistic regression. ResultsTotal 203 eligible patients were included (MHRT=114, 64-68Gy/25#; SBRT=89, 35-37.5Gy/5#). Median time from TURP to radiotherapy was 10 months (IQR 7-16), similar for MHRT and SBRT. Overall, mean cavity volume was 1.17cc (IQR 0.5-1.35), while in MHRT and SBRT groups was 1.03 cc (IQR 0.4-1.15) and 1.27 cc (IQR 0.5-1.4), respectively. At a median follow up of 37 months, cumulative grade 3 and grade 2 late urinary toxicity was 8.4% (n=17) and 23.2% (n=47) respectively. Grade 3 symptoms were observed at median 29 months (IQR 19-62) after radiotherapy completion, lasting for a median duration of 8 months (IQR 2-14). Hematuria (6.4%) and urinary obstruction (3.4%) were the chief grade 3 symptoms. Multivariable analysis for age, diabetes, pelvic radiotherapy, fraction size, prostate volume, TURP to radiotherapy duration, and TURP cavity volume showed no significant association with late grade 2+ urinary toxicity. Conclusion: In this large cohort of patients with prior TURP and treated with hypofractionated prostate radiotherapy, incidence of severe late urinary adverse effects was <10%, mainly hematuria or urinary obstruction. Most of these were temporary, and no significant contributory factors were identified for late urinary morbidity after TURP and radiotherapy.

Burnout among community service doctors in South Africa.

Burnout in doctors is an important issue with far-reaching consequences. Community service doctors may be particularly vulnerable because of their specific roles (rural settings, junior positions and reduced supervision). This study aimed to determine the prevalence of burnout among community service doctors in South Africa (SA), the potential contributory and protective factors and the consequences thereof. This was a national study of community service doctors in SA. A quantitative, descriptive cross-sectional study was performed. The Maslach Burnout Inventory was used to measure burnout. The online questionnaire also included demographic data, workplace and individual characteristics. Of the 208 community service doctors analysed, 89% and 94% had high emotional exhaustion and depersonalisation, respectively, while 97% had a low personal accomplishment. Mental illness, financial difficulties, unmanageable volume of patients and female gender were found to be potential contributory factors. Having manageable patient volumes, satisfaction with their decision to study medicine, talking to colleagues and feeling supported by healthcare facility management were among the significant potential protective factors. Significant potential consequences of burnout included: leaving the government sector, ever being diagnosed with a mental illness, using alcohol as a coping mechanism and possible current major depression. Burnout among community service doctors in SA is highly prevalent with significant potential consequences. There are a number of modifiable possible contributory and protective factors identified that may be targets for mental health interventions.Contribution:Healthcare burnout research is lacking in the African and specifically SA context. This void includes community service doctors.

Healthcare commissioners' experience with antibiotic resistance during the COVID-19 pandemic in Saudi Arabia: a qualitative study.

The occurrence of antibiotic resistance (AR) has become a critical issue during the Novel coronavirus disease 2019 (COVID-19) pandemic. This study explores the experiences of healthcare commissioners with AR during the COVID-19 pandemic, identifies challenges, and provides recommendations for combating AR during pandemics. This qualitative study was multi-centered and used a phenomenological approach. Semi-structured interviews were conducted between December 2022 and January 2023 among 11 health commissioners using video calls. Seven themes emerged from the data, including knowledge of AR and its consequences, the antibiotic prescription system, the future of AR and potential contributory factors, the impact of COVID-19 on AR and their relationship, the experience of AR during the COVID-19 pandemic in healthcare facilities, barriers that prevent the misuse of antibiotics during pandemics, and recommendations regarding antibiotic resistance during pandemics. The findings of this study could be used to inform policy and practice for government healthcare workers (HCWs) and the public. Furthermore, this study identified the main challenges of AR during the pandemic, and the recommendations of health commissioners were provided accordingly. Such recommendations could be beneficial on a national and international scale to reduce the impact of future pandemics on AR. COVID-19: Novel coronavirus disease 2019; AR: Antibiotic Resistance; IPC: Infection prevention and control; MDRO: multi-drug resistant organism; ASP: Antimicrobial Stewardship Program; HCW: Healthcare worker; KSA: Kingdom of Saudi Arabia; WHO: World Health Organization; MOH: Ministry of Health; MOEWA: Ministry of Environment, Water, and Agriculture; AMR: Antimicrobial Resistance; PHCC: Primary Healthcare Center.

Medication Safety Gaps in English Pediatric Inpatient Units: An Exploration Using Work Domain Analysis.

Medication is a common cause of preventable medical harm in pediatric inpatients. This study aimed to examine the sociotechnical system surrounding pediatric medicines management, to identify potential gaps in this system and how these might contribute to adverse drug events (ADEs). An exploratory prospective qualitative study in pediatric wards in three hospitals in the north of England was conducted between October 2020 and May 2022. Analysis included a documentary analysis of 72 policies and procedures and analysis of field notes from 60 hours of participant observation. The cognitive work analysis prompt framework was used to generate a work domain analysis (WDA) and identify potential contributory factors to ADEs. The WDA identified 2 functional purposes, 7 value/priority measures, 6 purpose-related functions, 11 object-related processes and 14 objects. Structured means-ends connections supported identification of 3 potential contributory factors-resource limitations, cognitive demands, and adaptation of processes. The lack of resources (equipment, materials, knowledge, and experience) created an environment where distractions and interruptions were unavoidable. Families helped provide practical support in medicines administration but were largely unacknowledged at an organizational level. There was a lack of teamwork with regards to medication with different professionals responsible for different parts of the system. Mandated safety checks on medicines were frequently omitted because of limited resources and perceived redundancy. Interventions to support adherence to safety policies were also often bypassed because they created more work. The WDA has provided insights into the complex system of medication safety for children in hospital and has facilitated the identification of potential contributory factors to ADEs. We therefore advocate (in priority order) for processes to involve parents in the care of their children in hospital, development of skill-mix interventions to ensure appropriate expertise is available where it is needed, and modified checking procedures to permit staff to use their skills and judgment effectively and efficiently.

Seasonal coral-algae interactions drive White Mat Syndrome coral disease outbreaks

Ocean warming drives not only the increase of known coral disease prevalence but facilitates the emergence of new undescribed ones too. As climate change is restructuring coral ecosystems, novel biological interactions could lead to an increase in coral disease in both tropical and marginal coral communities. White Mat Syndrome (WMS) represents one such emerging coral disease, with outbreaks associated with high algal interactions and seasonal summer temperatures. However, the mechanisms behind its pathogenesis, modes of transmission and causative pathogens remain to be identified. Ex situ infection experiments pairing the coral Porites heronensis together with local potential contributory factors show that the macroalga Gelidium elegans hosts and proliferates the WMS microbial mat. This pathogenic consortium then infects adjacent corals, leading to their mortality. WMS was also observed to transmit following the fragmentation of the microbial mat, which was able to infect healthy corals. Sulfur-cycling bacteria (i.e., Beggiatoa, Desulfobacter sp., Arcobacteraceae species) and the free-living spirochete Oceanospirochaeta sediminicola were found consistently in both WMS and G. elegans consortia, suggesting they are putative pathogens of WMS. The predicted functional roles of these pathogenic consortia showed degradative processes, hinting that tissue lyses could drive mat formation and spread. Coral-algae interactions will rise due to ongoing ocean warming and coral ecosystem degradation, likely promoting the virulence and prevalence of algal-driven coral diseases.

Prevalence and risk factors of erectile dysfunction in cirrhotic patients: An observational study

ABSTRACT Background Erectile dysfunction (ED) is a prevalent complication observed in male patients with liver cirrhosis; however, there is limited understanding of the etiological determinants responsible for its occurrence. The objective of this investigation is to explore potential contributory factors that underlie the development of ED in male patients with liver cirrhosis. Method A cross-sectional study was conducted on 200 male patients with liver cirrhosis, who were divided into three groups according to the Child score. ED was studied using the International Index of Erectile Function (IIEF-5) Questionnaire and penile Doppler. Results The prevalence of ED among the cirrhotic patients was 80%, and it was more frequent in patients with advanced liver disease (Child C). Penile venous leakage was observed in 20% of cirrhotic patients, which increased to 28.6% in those with advanced liver cirrhosis. Multivariate logistic regression analysis showed that age, low albumin levels, elevated INR, high hemoglobin levels, and Child C were predictors of ED in cirrhotic patients. Conclusion Several clinical variables have been identified as potential contributors to the development of erectile dysfunction (ED) in patients with cirrhosis. These variables include advanced age, decreased levels of albumin, elevated INR, increased hemoglobin levels, and Child C classification. Early identification and treatment of these factors could potentially improve the quality of life for cirrhotic patients with ED. Notably, patients with ED in this population were observed to have elevated levels of INR, serum bilirubin, and hemoglobin, as well as reduced levels of serum albumin.

Time to Extubation Among ARDS Subjects With and Without COVID-19 Pneumonia.

Pneumonia from COVID-19 that results in ARDS may require invasive mechanical ventilation. This retrospective study assessed the characteristics and outcomes of subjects with COVID-19-associated ARDS versus ARDS (non-COVID) during the first 6 months of the COVID-19 pandemic in 2020. The primary objective was to determine whether mechanical ventilation duration differed between these cohorts and identify other potential contributory factors. We retrospectively identified 73 subjects admitted between March 1 and August 12, 2020, with either COVID-19-associated ARDS (37) or ARDS (36) who were managed with the lung protective ventilator protocol and required >48 h of mechanical ventilation. Exclusion criteria were the following: <18 years old or the patient required tracheostomy or interfacility transfer. Demographic and baseline clinical data were collected at ARDS onset (ARDS day 0), with subsequent data collected on ARDS days 1-3, 5, 7, 10, 14, and 21. Comparisons were made by using the Wilcoxon rank-sum test (continuous variables) and chi-square test (categorical variables) stratified by COVID-19 status. A Cox proportional hazards model assessed the cause-specific hazard ratio for extubation. The median (interquartile range) mechanical ventilation duration among the subjects who survived to extubation was longer in those with COVID-19-ARDS versus the subjects with non-COVID ARDS: 10 (6-20) d versus 4 (2-8) d; P < .001. Hospital mortality was not different between the two groups (22% vs 39%; P = .11). The competing risks Cox proportional hazard analysis (fit among the total sample, including non-survivors) revealed that improved compliance of the respiratory system and oxygenation were associated with the probability of extubation. Oxygenation improved at a lower rate in the subjects with COVID-19-associated ARDS than in the subjects with non-COVID ARDS. Mechanical ventilation duration was longer in subjects with COVID-19-associated ARDS compared with the subjects with non-COVID ARDS, which may be explained by a lower rate of improvement in oxygenation status.

“It has been the most difficult time in my career”: A qualitative exploration of UK obstetric sonographers’ experiences during the COVID-19 pandemic

IntroductionSubstantial changes were made to the provision of pregnancy ultrasound services during the COVID-19 pandemic with the intention of minimising virus transmission and maintaining service continuity. Published literature describing the impact of the pandemic on obstetric sonographers is predominantly quantitative in nature, however statistics cannot fully convey sonographers’ voices. This study aimed to gain a deeper understanding of the lived experiences of UK obstetric sonographers performing pregnancy ultrasound scans during the pandemic. MethodsA UK-wide, online, anonymous cross-sectional survey on Qualtrics XM™ was open to responses between 9th March and 6th May 2021. Whilst this survey contained some quantitative elements, open questions were included to capture additional qualitative detail from respondents about their perceptions and experiences of scanning during the pandemic. Key themes were generated from free text responses using thematic analysis. Results: Written responses were received from 111/138 sonographers participating in the survey. Five themes were generated, depicting the impact of the pandemic on obstetric sonographers: 1) continuity in a crisis; 2) decisions about me, without me; 3) battle scars – the lasting damage of COVID-19; 4) what people think I do vs. what I really do; and 5) the human touch. A cross-cutting theme was sonographers’ feelings of disconnection from senior figures and expectant parents which created a sense of abandonment and distrust. ConclusionSurvey respondents’ self-reported experiences of ineffective leadership and management, and perceived lack of understanding of the complexity of the sonographer role are potential contributory factors in the high levels of moral injury and occupational burnout reported within the workforce during the pandemic.

Abstract No. 254 Gender Discrepancy in Interventional Radiology: Potential Contributory Factors at the Resident Level

Abstract No. 254 Gender Discrepancy in Interventional Radiology: Potential Contributory Factors at the Resident Level

Gender disparities in industry compensation and research payments among neurointerventional surgeons in the USA

BackgroundThe purpose of this study is to examine the presence of gender disparity represented by industry payments and research funding within the field of interventional neuroradiology.MethodsPayment information was collected using...

Multiple overlapping risk factors for childhood wheeze among children in Benin

BackgroundThe African continent is currently facing an epidemiological transition characterized by a shift from communicable to non-communicable diseases. Prominent amongst the latter are allergies and asthma. In that context, wheeze has multiple potential contributory factors that could include some of the endemic helminth infections, as well as environmental exposures, such as household air pollution. We sought to determine the relative importance of these risk factors among children in Benin.MethodsWe included 964 children aged 6–14 years living in the commune of Comé, south–west Benin. All children were participants in the longitudinal monitoring cohort of the DeWorm3 trial designed to evaluate multiple rounds of community mass treatment with albendazole for interruption of the transmission of soil transmitted helminths (STH). We administered a standard ISAAC questionnaire to determine the presence of wheeze. In addition, we assessed exposure to household air pollution and to other potential allergy-inducing factors, dietary intake and anthropometry. Using STH infection status assessed at the pretreatment baseline timepoint, we used multivariate statistical modelling, controlling for covariates, to investigate associations between wheeze and the different factors measured.ResultsThe prevalence of wheezing history was 5.2%, of current wheezing was 4.6% and of severe wheezing was 3.1%, while STH infections were found in 5.6% of children. These profiles did not vary as a function of either age or gender. Infection with Ascaris lumbricoides, but not hookworm species, was significantly associated with both current wheeze (adjusted Odds Ratio (aOR) = 4.3; 95% CI [1.5–12.0]) and severe wheeze (aOR = 9.2; 95% CI [3.1–27.8]). Significant positive associations with current wheeze, independent of each other and of STH infection status, were also found for (i) use of open cookstoves (aOR = 3.9; 95% CI [1.3–11.5]), (ii) use of palm cakes for fire lighting (aOR = 3.4; 95% CI [1.1–9.9]), (iii) contact with domestic animals and/or rodents (aOR = 2.5; 95% CI [1.1–6.0]), (iv) being overweight (aOR = 9.7; 95% CI [1.7–55.9]). Use of open cookstoves and being overweight were also independent risk factors for severe wheeze (aOR = 3.9; 95% CI [1.1–13.7]) and aOR = 10.3; 95% CI [1.8–60.0], respectively).ConclusionsChildren infected with A. lumbricoides appear to be at elevated risk of wheeze. Deworming may be an important intervention to reduce these symptoms. Improving cooking methods to reduce household air pollution, modifying dietary habits to avoid overweight, and keeping animals out of the house are all additional measures that could also contribute to reducing childrens’ risk of wheeze. Policymakers in LMIC should consider tailoring public health measures to reflect the importance of these different risk factors.

Management of Dyslipidemia and Hypertension – Journey Mapping in the Philippines

Literature was reviewed semi-systematically with the purpose of generating Philippines-specific data for the patient journey stages for dyslipidemia and hypertension, namely, awareness, screening, diagnosis, treatment, adherence, and control. A structured search was conducted on EMBASE and MEDLINE databases for studies published in English in the last 10 years, whose full text was available. An unstructured search was conducted on Google, and websites of health ministries and international organizations, without any limits. The last search was run for dyslipidemia on 12.11.2019 and for hypertension on 28.07.2020. For dyslipidemia, six records out of 590 records were retrieved, and for hypertension, seven records and one unpublished conference presentation out of 160 records retrieved, were included in the final synthesis. The review estimated that in the Philippines, the prevalence of dyslipidemia was 38.8%, while 59.0% of patients were undergoing treatment, with 44.2% of patients achieving control. Prevalence of hypertension was 27.5% and estimated rates at different stages of patient journey were- awareness- 61.5%, screening- 3.2%, diagnosis- 39.7%, treatment- 65.4%, adherence- 57%, and control- 57.6%. Potential contributory factors for low assessment rates and suboptimal management include low doctor-to-population ratio, inadequate time for screening and counseling, absence of locally validated tools for cardiovascular screening, low awareness and utilization of clinical practice guidelines, and some misperceptions of current treatment recommendations. Effective training of physicians, patient education initiatives, and multi-sectoral coordination are some of the recommendations to improve the status of management of dyslipidemia and hypertension in the Philippines.

Wound care in hidradenitis suppurativa

AbstractThe normal healing of a wound requires the body to progress through the three phases of wound repair: inflammation, tissue formation, followed by tissue remodeling. In patients with hidradenitis suppurativa, this normal wound healing progression may be impaired at various timepoints due to comorbid diseases, concomitant medical therapies, and disease‐specific considerations. These factors can impact both surgical and nonsurgicalnonsurgical hidradenitis wounds. Comprehensive wound care in hidradenitis, therefore, involves a thorough assessment of potential contributory factors and adjustments of modifiable factors.

197P Lung cancer in lung transplant recipients

Malignancies rank the third cause of death after solid organ transplantation. Lung cancer is reported to be 20-25-times higher in transplant patients compared to the general population with an incidence of 0.1-4.1 % in lung transplant recipients. Potential contributory factors are increasing age, smoking history and immunosuppression. Lung cancer can be transmitted from the donor to recipient, as a finding in the explanted lung or newly formed.

Obesity, Smoking and Stress: Exploring Correlates of Stress

The objective of the study was to explore the potential correlates of stress. The stress was measured on some common symptoms like feeling tension, headache, abnormal appetite, blood pressure, physical energy, feeling tired. The data was collected from Faisalabad district using a planned questionnaire covering information concerning different stress indicators and life habits. Marital status, Gender, habit of late hours working, educational level, smoking, and BMI were considered to be potential contributory factors. Using cross-tabulation and chi-square test of association, marital status (p-value=0.0398), late working habit (p-value=0.0005), education (p-value=0.0133) were found to be associated with stress. In addition, smoking habit (p-value &lt;0.0001) and BMI (p-value &lt;0.0001) were highly associated with stress. It was found that gender is not significantly associated with stress (p-value=0.2815).

Effects and contributory factors of sulfur-fumigation on the efficacy and safety of medicinal herbs evaluated by meta-analysis

Ethnopharmacological relevanceSulfur-fumigation undoubtedly alters the chemical and metabolic profiles, but controversially affects the efficacy and safety of medicinal herbs. Aim of the studyTo comprehensively evaluate the effects of sulfur-fumigation on the efficacy and safety of medicinal herbs using a meta-analysis approach and further investigate the potential contributory factors. Materials and methodsLiteratures were retrieved on PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Chinese VIP Information and Wanfang, and the outcomes involved activities and toxicities were extracted using standard data extraction forms. The effects of sulfur-fumigation on the efficacy and safety of medicinal herbs were evaluated by meta-analysis approaches. ResultsA total of sixteen studies were included in this study. Sulfur-fumigation reduced the efficacies of medicinal herbs with immune activity [thymus index (SMD = −1.81; P < 0.00001); spleen index (SMD = −1.11; P < 0.0001)], anti-oxidative activity [MDA (SMD = 2.60; P = 0.04); SOD (SMD = −2.21; P < 0.00001)], analgesic activity [heat tolerate time (SMD = −2.51; P = 0.001); writhing time (SMD = 0.36; P = 0.006)], anti-platelet aggregation activity (SMD = −1.84; P = 0.001), and anti-inflammatory activity [ear swelling degree (SMD = 0.47; P = 0.006)]. The reductions might be ascribed to sulfur-fumigation significantly reduced the contents of active ingredients in medicinal herbs, leading to dramatic decrease in the absorption of these ingredients and their metabolites in vivo. Furthermore, sulfur-fumigation induced the toxicities of medicinal herbs, mainly on hepatotoxicity, which might due to fumigation-induced residues of sulfur dioxide and heavy metal, and generations of sulfur-containing derivatives and toxic metabolites. Besides, administrated with sulfur-fumigated medicinal herbs with high sulfur ratio and/or higher dosage showed more significant toxicity. ConclusionSulfur-fumigation reduced the efficacy and safety of medicinal herbs, indicating sulfur-fumigation might not a feasible approach to process medicinal herbs. However, with obvious limitations, much more rigorous designed-trials are still needed to confirm the conclusion.

Undetected Respiratory Depression in People with Opioid Use Disorder

BackgroundOpioid-related deaths are increasing globally. Respiratory complications of opioid use and underlying respiratory disease in people with Opioid Use Disorder (OUD) are potential contributory factors. Individual variation in susceptibility to overdose is, however, incompletely understood. This study investigated the prevalence of respiratory depression (RD) in OUD treatment and compared this to patients with chronic obstructive pulmonary disease (COPD) of equivalent severity. We also explored the contribution of opioid agonist treatment (OAT) dosage, and type, to the prevalence of RD. MethodsThere were four groups of participants: 1) OUD plus COPD (‘OUD-COPD’, n = 13); 2) OUD without COPD (‘OUD’, n = 7); 3) opioid-naïve COPD patients (‘COPD’n = 13); 4) healthy controls (‘HC’n = 7). Physiological indices, including pulse oximetry (SpO2%), end-tidal CO2 (ETCO2), transcutaneous CO2 (TcCO2), respiratory airflow and second intercostal space parasternal muscle electromyography (EMGpara), were recorded continuously over 40 min whilst awake at rest. Significant RD was defined as: SpO2%< 90% for > 10 s, ETCO2 per breath > 6.6 kPa, TcCO2 overall mean > 6 kPa, respiratory pauses > 10 s ResultsAt least one indicator was observed in every participant with OUD (n = 20). This compared to RD episode occurrence in only 2/7 HC and 2/13 COPD participants (p < 0.05,Fisher’s exact test). The occurrence of RD was similar in OUD participants prescribed methadone (n = 6) compared to those prescribed buprenorphine (n = 12). ConclusionsUndetected RD is common in OUD cohorts receiving OAT and is significantly more severe than in opioid-naïve controls. RD can be assessed using simple objective measures. Further studies are required to determine the association between RD and overdose risk.

Ageing rate of older adults affects the factors associated with, and the determinants of malnutrition in the community: a systematic review and narrative synthesis

BackgroundMalnutrition negatively impacts on health, quality of life and disease outcomes in older adults. The reported factors associated with, and determinants of malnutrition, are inconsistent between studies. These factors may vary according to differences in rate of ageing. This review critically examines the evidence for the most frequently reported sociodemographic factors and determinants of malnutrition and identifies differences according to rates of ageing.MethodsA systematic search of the PubMed Central and Embase databases was conducted in April 2019 to identify papers on ageing and poor nutritional status. Numerous factors were identified, including factors from demographic, food intake, lifestyle, social, physical functioning, psychological and disease-related domains. Where possible, community-dwelling populations assessed within the included studies (N = 68) were categorised according to their ageing rate: ‘successful’, ‘usual’ or ‘accelerated’.ResultsLow education level and unmarried status appear to be more frequently associated with malnutrition within the successful ageing category. Indicators of declining mobility and function are associated with malnutrition and increase in severity across the ageing categories. Falls and hospitalisation are associated with malnutrition irrespective of rate of ageing. Factors associated with malnutrition from the food intake, social and disease-related domains increase in severity in the accelerated ageing category. Having a cognitive impairment appears to be a determinant of malnutrition in successfully ageing populations whilst dementia is reported to be associated with malnutrition within usual and accelerated ageing populations.ConclusionsThis review summarises the factors associated with malnutrition and malnutrition risk reported in community-dwelling older adults focusing on differences identified according to rate of ageing. As the rate of ageing speeds up, an increasing number of factors are reported within the food intake, social and disease-related domains; these factors increase in severity in the accelerated ageing category. Knowledge of the specific factors and determinants associated with malnutrition according to older adults’ ageing rate could contribute to the identification and prevention of malnutrition. As most studies included in this review were cross-sectional, longitudinal studies and meta-analyses comprehensively assessing potential contributory factors are required to establish the true determinants of malnutrition.

Automatic frequency estimation of contributory factors for confined space accidents

Although the dangers of working in confined spaces have been known for many years, fatal accidents related to working in confined spaces still frequently occur. Considerable research has been conducted to identify potential contributory factors of confined space incidents through analyzing accident reports. However, accident databases are usually read and interpreted manually by human experts. The process of analyzing confined space accident reports can be time-consuming and labor-intensive. As the number of accident records increases, it is difficult for the experts to manually review all the reports. Moreover, different individuals may reach various conclusions from the same accident report. Some analysts may fail to capture all the meaningful and relevant causal factors. Automatic information extraction using special rules and ontology-based approaches can be used to mine reports of confined space accidents. However, such approaches tend to suffer from the problem of weak generalization. To overcome this limitation and improve the performance of contributory factors analysis, an improved deep learning based framework is proposed in this paper to automatically extract and classify contributory factors from confined space accident reports using BERT-BiLSTM-CRF and CNN models. Research results suggested that the proposed framework can be used as a feasible method to qualitatively and quantitatively explore the contributory factors of confined space accidents. By analyzing a large quantity of confined space accident reports, the frequency of contributory factors can be estimated automatically. This outcome is helpful to significantly improve the risk assessment quality of confined space works.

Elucidation of the biochemical pathways involved in two distinct cut-surface discolouration phenotypes of lettuce

To understand better the biochemistry and underlying genetic control of postharvest discolouration in lettuce, an F7 recombinant inbred population (Saladin x Iceberg) was grown in field trials and phenotyped. We identified two distinct discolouration phenotypes, pinking and browning, which were negatively correlated at the phenotypic level and located six QTL associated with pinking and five QTL associated with browning plus two QTL associated with total discolouration which could not be attributed to either type, on an improved genetic map. Candidate genes underlying QTL were investigated. Plants showing extremes of discolouration were also grown under controlled environment conditions. Lines showing extreme phenotypes from both environments were used for transcriptome profiling and differentially expressed transcripts associated with pinking and browning were identified. Involvement of the phenylpropanoid, flavonoid and terpenoid biosynthesis pathways were indicated in the development of discolouration, with the point of divergence for development of the different discolouration phenotypes localised to the phenylpropanoid pathway. Other biochemistry including amino acid metabolism was also implicated with environmental factors including temperature, water availability and physical stress indicated as potential contributory factors. Differential transcriptional control may be involved in regulating discolouration, potentially through stereochemical selection.