Potential Risk Research Articles

Unplanned revisits of older patients to the emergency department

IntroductionOlder patients currently represent up to 12%−24% of all emergency department (ED) visits. While increasing in number, they are also at high risk of revisits once discharged. The rate of ED revisits within 72 h is a key indicator of the quality of care in emergency medicine and varies between 1% and 15%. The reasons for ED revisits are natural course of illness, misdiagnosis, lack of homecare, and self-discharge against medical advice. However, the risk factors for ED revisits have not been fully investigated. Therefore, this study aimed to analyze the incidence of ED revisits and identify the risk factors for ED revisits within 72 h after ED discharge.MethodsIn this retrospective study, older patients (≥70 years) were consecutively enrolled if they presented with an Emergency Severity Index of 2 or 3 in a tertiary care ED in 2019, with discharge after the ED visit. The primary endpoint was the frequency of unplanned ED revisits within 72 h after ED discharge. The secondary endpoints were the reasons and potential risk factors for ED revisits. Univariate and multivariate logistic regression models were used.ResultsA total of 592 older patients were enrolled, of whom 30 (5.1%) revisited the ED within 72 h. Gastrointestinal diagnosis [odds ratio (OR), 2.9; 95% confidence interval [CI], 1.04–8.2; p = 0.043) and nausea in particular (OR, 3.5; 95% CI, 1.3–9.4; p = 0.016) were significant risk factors for ED revisits. Furthermore, discharge against medical advice (OR, 5.6; 95% CI, 1.7–18.1; p = 0.004) and ED presentation during the night (OR, 2.7; 95% CI, 1.2–6.1; p = 0.014) were significant risk factors for ED revisits within 72 h after discharge, respectively.ConclusionAlthough the frequency of ED revisits among older patients at 72 h after discharge tends to be low and most revisits were illness-related, all older patients need to be assessed for risk factors for ED revisits. Discharge should be carefully evaluated to improve patient safety and provide the best healthcare to this frail population.

CRISIS MANAGEMENT OF AN EDUCATIONAL INSTITUTION IN CONDITIONS OF MARTIAL LAW

The article reveals the peculiarities of crisis management of educational institutions in conditions of martial law. The current state of functioning of educational institutions in Ukraine is analyzed. The problems of educational institutions that have arisen as a result of Russia's armed aggression against Ukraine are outlined. An analysis of the research of Ukrainian scientists on the problems of crisis management of educational institutions in wartime is carried out. The essence of the concept of "crisis" is revealed, the causes, factors, symptomatic indicators and consequences of the social crisis in Ukraine are determined. The purpose of anti- crisis management of an educational organization and the peculiarities of performing the main management functions (planning, organization, motivation, control) in the context of the crisis associated with military operations on the territory of Ukraine are outlined. The ways to ensure the results of the educational institution's activities in the context of crisis in the context of systemic and crisis management are revealed. An algorithm for creating an anti-crisis management plan for an educational institution is proposed. Examples of the use of tools for analyzing the impact of environmental factors on the activities of an educational institution, projecting potential risks and threats are given. An indicative list of tasks of the crisis management team of an educational institution is presented. Attention is focused on the importance of the psycho-emotional state of teachers and support staff and the main tasks of the manager to maintain the microclimate in the team during the war.

Upcycling textile sludge into magnesium oxychloride cement: Physical properties, microstructure, and leaching behavior

Textile sludge is a by-product produced during the wastewater treatment process in the textile printing and dyeing industry. Textile sludge is rich in heavy metal elements, which makes it a potential risk to the surrounding environment. This study designs a magnesium oxychloride cement (MOC) components to solidify harmful substances in textile sludge and studies the influence of textile sludge ash (TSA) on the mechanical properties and microstructure of MOC samples. The results indicated that adding 5 %–20 % TSA is beneficial for increasing the compressive strength of air-cured MOC paste and improving its water resistance. Meanwhile, the MOC sample shows volume expansion in 168 h, which is related to the further hydration of residual MgO. Incorporating 10 %–20 % TSA substantially increased the volume expansion ratio of the mixture compared to plain MOC sample. In addition, the porosity of TSA-modified MOC after water curing did not change significantly compared to the sample before water curing, while the pore structure of plain MOC after water curing significantly coarsened. This is mainly because TSA reacts with MOC and generates Mg-Al-Cl-Si-H and Mg-Cl-Si-H gels, consequently improving the water stability of MOC sample. At the nanoscale, the 3/5-phase crystal and unreacted MgO content in the 15 % TSA-modified MOC sample is relatively reduced by 7.79 % and 25 %, respectively, compared to the plain sample, but the 13 % gel phase is detected. In addition, the MOC component can effectively solidify heavy metal elements in textile sludge. For the leachate of 20 % TSA-modified MOC paste, the Ni element is not detected, and its solidifying effect on heavy elements such as Zn and Mn exceeded 99 %.

Smart contract challenges and drawbacks for SME digital resilience

PurposeThis study aims to explore the key challenges and drawbacks of smart contracts (SCs) and how they impact digital resilience within small and medium enterprises (SMEs). Whilst this type of technology is seen as a step forward in terms of traceability, transparency and immutability to increase digital resilience, we argue that it should be approached with trepidation.Design/methodology/approachIn developing this paper, the authors conduct a systematic literature search using the Scopus database. Through this, we identified 931 relevant articles, of which 30 were used as the focus of this article. Thematic analysis was used as the analytical approach to develop themes and meaning from the data.FindingsIn this paper, there is an emphasis on the importance of understanding the potential risks associated with SC implementation, as well as identifying appropriate strategies for mitigating any negative impact. In our findings, we puts forward three key themes, namely legality, security and human error, which we argue are key smart contract challenges that impact SME digital resilience.Originality/valueIn this paper, we propose the notion of “centralised control in decentralised solutions”. This comes from the research highlighting SC weaknesses in digital resilience for SMEs. We argue that there is a need for standards, regulations and legislation to address these issues, advocating, ironically, a centralised approach to decentralised technology.

Towards a Conscious Digital Generation: Efforts to Increase Knowledge and Attitudes about Cybersex among Adolescents

The increasing prevalence of cybersex behavior among adolescents presents a growing concern, with potential risks to their physical and mental health. The ease of access and low cost associated with this behavior contribute to its proliferation. Based on interviews with students from X High School in Pariaman, it was found that a significant portion of the student population accesses pornography on the internet when exposed to online advertisements and during casual browsing. The primary objective of this initiative is to nurture a generation of digitally aware youth by enhancing their knowledge and shaping healthier attitudes regarding cybersex. The location of the activities was SMA X Pariaman City. A combination of active and passive approaches was employed. Active methods involved delivering lectures with prepared materials and informative video presentations. Passively, students were provided with informational leaflets and banners placed strategically in the school environment. Pre-test and post-test questionnaires were administered to gauge the effectiveness of the materials and videos in influencing participants' knowledge and attitudes. Statistical analysis, including the Wilcoxon test and Gain Score, reveals a notable increase in expertise and confirms the effectiveness of the counseling efforts. In summary, this program effectively enhances knowledge and attitudes about cybersex among adolescents, marking a significant step in addressing this pressing issue.

A comprehensive evaluation of risk factors for mortality, infection and colonization associated with CRGNB in adult solid organ transplant recipients: a systematic review and meta-analysis

Background The burden of carbapenem-resistant gram-negative bacteria (CRGNB) among solid organ transplant (SOT) recipients has not been systematically explored. Here, we discern the risk factors associated with CRGNB infection and colonization in SOT recipients. Methods This study included observational studies conducted among CRGNB-infected SOT patients, which reported risk factors associated with mortality, infection or colonization. Relevant records will be searched in PubMed, Embase and Web of Science for the period from the time of database construction to 1 March 2023. Results A total of 23 studies with 13,511 participants were included, enabling the assessment of 27 potential risk factors. The pooled prevalence of 1-year mortality among SOT recipients with CRGNB was 44.5%. Prolonged mechanical ventilation, combined transplantation, reoperation and pre-transplantation CRGNB colonization are salient contributors to the occurrence of CRGNB infections in SOT recipients. Renal replacement therapy, post-LT CRGNB colonization, pre-LT liver disease and model for end-stage liver disease score increased the risk of infection. Re-transplantation, carbapenem use before transplantation and ureteral stent utilization increaesd risk of CRGNB colonization. Conclusion Our study demonstrated that SOT recipients with CRGNB infections had a higher mortality risk. Invasive procedure may be the main factor contribute to CRGNB infection.

An exploratory study on the association of multiple metals in serum with preeclampsia.

Individual metal levels are potential risk factors for the development of preeclampsia (PE). However, understanding of relationship between multiple metals and PE remains elusive. The purpose of this study was to explore whether eight metals [zinc (Zn), manganese (Mn), copper (Cu), nickel (Ni), lead (Pb), arsenic (As), cadmium (Cd), and mercury (Hg)] in serum had a certain relationship with PE. A study was conducted in Dongguan, China. The concentrations of metals in maternal serum were assessed using inductively coupled plasma mass spectrometry (ICP-MS). Data on various factors were collected through a face-to-face interview and hospital electronic medical records. The unconditional logistic regression model, principal component analysis (PCA) and Bayesian Kernel Machine Regression (BKMR) were applied in our study. The logistic regression model revealed that the elevated levels of Cu, Pb, and Hg were associated with an increased risk of PE. According to PCA, principal component 1 (PC1) was predominated by Hg, Pb, Mn, Ni, Cu, and As, and PC1 was associated with an increased risk of PE, while PC2 was predominated by Cd and Zn. The results of BKMR indicated a significant positive cumulative effect of serum metals on PE risk, with Ni and Cu exhibiting a significant positive effect. Moreover, BKMR results also revealed the nonlinear effects of Ni and Cd. The investigation suggests a potential positive cumulative impact of serum metals on the occurrence of PE, with a particular emphasis on Cu as a potential risk factor for the onset and exacerbation of PE. These findings offer valuable insights for guiding future studies on this concern.

Analysis of the Impact of Spokesperson Marketing on Brand Influence in the Context of Social Media

With the increasingly fierce market competition, brand marketing and spokesperson marketing have become important means for enterprises to enhance competitiveness. However, how to choose the right spokesperson, formulate effective marketing strategies and avoid potential risks are important issues facing enterprises. By using the methods of literature research and case analysis, this paper deeply studies the type segmentation and operation mechanism of spokesperson marketing, and analyzes the marketing methods, effects and potential risks of spokesperson combined with specific cases. The results show that selecting the right spokesperson and formulating effective marketing strategies are important to enhance brand awareness and reputation. Enterprises need to establish a sound spokesperson management system and effect evaluation system to ensure the standardization and effectiveness of spokesperson marketing activities. At the same time, this study also takes X and W as examples to explore the huge commercial value they bring to the brand as popular artists, as well as the operation mechanism and characteristics behind them. Through in-depth analysis of the types and effects of its endorsement activities, the study found that the spokesperson played an effective role as a bridge between the brand and consumers, transmitting brand information and promoting the promotion of sales and brand image. In addition, this study also discusses the strategies and potential risks of selecting spokesmen, which provides wise decision guidance for enterprises.

(272) Evidence-Based Strategies for Preventing Lower-Limb Complications Secondary to Prolonged use of the Dorsal Lithotomy Position

Abstract Introduction Patient positioning at the time of surgery plays a critical role in determining patient outcomes. Specific to patients undergoing genital gender-affirming surgery (gGAS), these patients are required to be placed in the lithotomy position to access the pelvis and perineum for their procedures. Lower-extremity injury due to prolonged surgical time in the lithotomy position can have significant post-operative morbidity affecting patient outcomes. This risk is increased in patients undergoing gGAS procedures due to high surgical complexity and especially long operative times as compared to other surgical procedures. Careful attention must be placed on the patient’s specific position perioperatively due to potential injury risk. Prolonged stasis can cause injuries ranging from mild soft-tissue injuries which rapidly resolve, such as mild pressure injuries to bony prominences, to severe injuries including pressure ulcers, nerve injuries, rhabdomyolysis, and compartment syndrome. These complications can have lasting impact on the patient, with associated morbidity and mortality risk, and can also impact healthcare systems through additional dollars spent caring for patients who suffer these complications and their associated rehabilitation, and legal recourse on behalf of the patient who suffered these severe complications. Objective Our study aimed to describe our technique for preventing lower extremity injuries in the dorsal lithotomy position, and to evaluate our positioning-related post-operative complications and rates. Methods We describe our technique for lower-limb positioning in the dorsal lithotomy position, with an emphasis on injury prevention for patients undergoing gGAS. We assessed positioning-related outcomes and complications among patients undergoing gGAS for prolonged periods (>300 minutes) in the lithotomy position between January 2017 to March 2023. Results A total of 227 patients underwent 310 gGAS procedures were included in our study (156 masculinizing: 154 feminizing gGAS procedures). Mean operative time was 495.5 minutes +/- 156.5 minutes (SD) (Range 300–1095 minutes) (Table 1a). A total of 6/227 (2.6%) patients (2 masculinizing and 4 feminizing surgical patients) had transient, self-limited LE pain post-operatively. No (0%) patients had major or chronic complications including chronic nerve injury, pressure ulcers, rhabdomyolysis or compartment syndrome (Table 1b). Our patient positioning employs the use of ½ inch foam placed to surround the lower extremity, ensuring that all at-risk areas of compression are adequately protected when placing the patient’s leg in the Allen stirrups whilst in the lithotomy position (Figure 1). In addition, a perioperative list is also utilized with regular leg checks every 1.5–2 hours with nursing documentation and also, ensuring patients are able to move their lower extremities without any pain post-operatively (Figure 2). Conclusions Our study is the first to describe a specific technique and outline strategies for protecting the lower extremities to prevent injuries in patients undergoing prolonged surgical procedures in the lithotomy position. The low complication rates associated with our technique warrants attention to further refine this technique, and, to integrate these strategies into operating-room programs across diverse specialties. Disclosure No.

Live‐bait industry as a pathway for movement of nonnative and invasive species: Implications for conservation of native Texas fishes

AbstractObjectiveLive‐bait species are widely used in recreational fishing throughout the United States. However, the use of invasive fish species as live bait has been identified as a common pathway for their introduction into aquatic ecosystems. We assessed the role that the live‐bait industry has in facilitating the introduction of nonnative and invasive species into Texas rivers. We focused on two invasive cyprinodontid species, the Sheepshead Minnow Cyprinodon variegatus and Gulf Killifish Fundulus grandis, which are believed to have been introduced into inland Texas rivers via bait‐bucket releases by anglers.MethodsWe conducted telephone and in‐person surveys of live‐bait shops in Texas on a seasonal basis (summer, fall, winter, spring) for 1 year. Locally owned bait shops and regional aquaculture facilities and hatcheries were included in the surveys.ResultSurveys did not reveal the presence of these invasive cyprinodontids in inland bait shops but did reveal the sale of nonnative Goldfish Carassius auratus and their black color morph, the black salty goldfish. Surveys conducted among inland and coastal live bait shops confirmed the sale of only one nonnative bait fish and six bait items native only to certain regions of Texas. Telephone surveys with aquaculture industry experts revealed that the aquaculture industry was also facilitating the movement of nonnative game and nongame fish species throughout the state.ConclusionGiven the potential for nonnative and invasive species to negatively affect recipient aquatic ecosystems, the continued distribution of such species within the aquaculture industry represents a potential threat in Texas. Our findings highlight the need for close monitoring of the live‐bait industry in the state to prevent further introductions into inland waters and reduce potential ecological risks to native fish populations and overall ecosystem functions and services.

Abstract A034: A new international program to accelerate novel therapeutics for brain tumors: presenting the brain tumor research novel therapeutics accelerator

Abstract Each year, we see many journal manuscripts highlighting successful pre-clinical experiments for potential new brain tumor therapies. Only a few of these therapies move forward into successful clinical trials. Indeed, developing a comprehensive translational program covers many aspects, including but not limited to, medicinal chemistry, blood brain barrier penetration, tumor heterogeneity, delivery, commercialization, and navigating the regulatory environment. Because of this, bringing a successful translational project from bench to bedside requires access to a diverse set of cutting-edge expertise to give promising therapies the best chance of succeeding. Recognizing that this journey is not easy to navigate, the Tessa Jowell Brain Cancer Mission has launched an international Brain Tumor Research Novel Therapeutics Accelerator (BTR-NTA). This program is led by an international group of drug development and brain tumor experts who provide independent guidance to researchers to position their therapeutic along a realistic pathway to clinical trials. The BTR-NTA is open to any international academic and industry researchers developing a medicinal product, delivery technology or device for brain tumors. The BTR-NTA welcomes groups at any stage of pre-clinical or clinical work. Academics and smaller biotech’s could benefit from feedback on their pre-clinical studies and plans for commercialization, while larger pharmaceutical companies could benefit from access to brain tumor specific expertise and patient input into clinical trial design. Researchers can apply to BTR-NTA twice a year, and if accepted will go through the following process: 1. Complete an application form covering work to date and future plans under strict confidentiality agreements; 2. Attend an in-person meeting with a tailored group of experts to further discuss their work; and 3. Receive a comprehensive written report from the BTR-NTA committee with feedback on strengths and weaknesses and guidance on next steps. The expert committee dedicates half a day to reviewing the applicants’ work in-person, and extensive time pre- and post-meeting. Throughout the process, applicants receive up to 150 hours of expert input. The multidisciplinary nature of the review committee spans the entirety of the drug development pathway to support longitudinal collaboration and avoid a siloed approach to research. The BTR-NTA was designed after a similar program in another rare disease field yielded impressive results. Thanks to charitable funding, the BTR-NTA is free to academics and at low cost for industry. The BTR-NTA aims to help address barriers for researchers by highlighting potential pitfalls or risks, providing multi-disciplinary feedback on work to date, giving constructive guidance on next steps and strengthening international collaboration in the brain tumor field. The ultimate goal of the BTR-NTA is to enable researchers with therapy for brain tumors to navigate the drug development journey and make it to the clinic in a low-cost and timely way. Citation Format: Nicky Huskens, Charlotte Aitken, Katie Bushby. A new international program to accelerate novel therapeutics for brain tumors: presenting the brain tumor research novel therapeutics accelerator [abstract]. In: Proceedings of the AACR Special Conference on Brain Cancer; 2023 Oct 19-22; Minneapolis, Minnesota. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_1):Abstract nr A034.

Analysis of trace elements in processed products of grapes and potential health risk assessment.

Raisins and grape pekmez are consumed commonly by human all over the globe. Consumption of contaminated foods may be the likely pathway of heavy metal exposure. Therefore, the objectives of the present research were to quantify trace elements concentration in raisins and grape pekmez produced from locally grown grapes in Gonabad and to assess non-carcinogenic (HQ and HI) and carcinogenic (total cancer risk, CRt) health risks caused by trace elements exposure via oral intake of these products for children, teenagers, and adults. For this purpose, a totally 30 (15 raisins and 15 grape pekmez) samples were purchased from the vineyard gardeners and examined for ten trace elements including As, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, and Zn. The HI values signaled that the studiedpopulation consuming these products is at risk. The HQ, HI, and CRt values of the elements were in order of children > teenagers > adults. The highest cancer risk contribution was attributed to As and Ni for all the studied age groups in both raisins and grape pekmez samples. However, it is recommended that the concentration of trace elements in the soil and crops of the study area and its related health risks be regularly monitored to avoid significant health risks in the future.

Applying Human Factors and Systems Simulation Methods to Inform a Multimillion-Dollar Healthcare Decision.

This article describes a case study of a collaborative human factors (HF) and systems-focused simulation (SFS) project to evaluate potential patient and staff safety risks associated with a multimillion-dollar design and construction decision. The combined integration of HF and SFS methods in healthcare related to testing and informing the design of new environments and processes is underutilized. Few realize the effectiveness of this integration in healthcare to reduce risk and improve decision-making, safety, design, efficiency, patient experience, and outcomes. This project showcases how the combined use of HF and SFS methods can provide objective evidence to help inform decisions. The project was initiated by a healthcare executive team looking for an objective, user informed analysis of a current connector passageway between two existing buildings. The goal was to understand the implications of keeping the current route for simultaneous use for public and patients service flow versus building and financing a new passageway for separate flow and transport. An interprofessional team of intensive care unit professionals participated in two simulations designed to test the current connector. A failure mode and effects analysis and qualitative debrief feedback was used to evaluate risks and potential failures. The evaluation resulted in data that enabled informed executive decision making for the most effective, efficient, and safest option for public, staff, and patient transport between two buildings. This evaluation resulted in the decision to go forward with building a multimillion-dollar new connector passageway to improve integrated care and transport.

Assessing the vulnerability of urban drinking water intakes to water scarcity under global change: A bottom-up approach

Drinking water intakes (DWIs) face significant pressure due to global changes, including urbanization and climate change. The common approach relies mainly on climate projections generated by global climate models to simulate large scale hydroclimatic conditions. However, it is crucial to discern the impact of global changes on water scarcity at the local level, including in regions where available data are limited. This paper proposes an approach that focuses on studying the vulnerability of surface DWIs to low water levels and water demand in current and future climates within a cold-climate region.Low flows at DWIs were simulated using historical water level data obtained from hydrometric stations situated along the studied river. After defining four scenarios for climate change and anthropogenic activities affecting raw water withdrawals at DWIs, the full potential range of level variations was simulated. This study employed a combined water scarcity index derived from two sub-indices based on water level and water demand. The resulting index ranges from 0 to 1, where a higher value indicates a greater vulnerability to water scarcity. The simulation results demonstrate the vulnerability of water scarcity in both current and future climates.The calculated index, selecting the current vulnerability to water scarcity for the five studied DWIs, ranged from 0.61 to 0.76. The results for the vulnerability of these DWIs under future climate conditions exhibited significant variability across the different scenarios representing possible maximum daily withdrawal. These scenarios were defined to encompass a spectrum of options related to the government's policy for drinking water conservation strategy implementation. While exploring the full range of potential risks, the study's results demonstrated that the DWIs were especially vulnerable to anthropogenic changes affecting water demand.The framework developed in this study can provide a decision-support basis for municipalities and water managers to adapt to global change and achieve greater water supply resilience.

A modified QuEChERS-based UPLC-MS/MS method for rapid determination of multiple antibiotics and sedative residues in freshwater fish

Antibiotics and sedatives are used in freshwater fish culture and transportation, and residue in freshwater fish pose potential risks to human health. Therefore, a throughput method was developed to detect antibiotic and sedative residues in fish, simultaneously quantifying 68 antibiotics and 9 sedatives in freshwater fish using a modified QuEChERS extraction method and UPLC-MS/MS. Matrix-matched calibrations demonstrated good correlation coefficients (R2 > 0.995), with a recovery range of 66.2–118.5%. The intra-day and inter-day relative standard deviation (RSD) were below 9.7% and 12.8%, respectively. The limits of detection (LOD) and quantification (LOQ) were 0.08–1.46 μg/kg and 0.25–4.86 μg/kg, respectively. 68.8% of analytes had weak matrix effects, and 13.0% had moderate matrix effects. In addition, diazepam and many types of antibiotics were detected in30 freshwater fish. The validation parameters were in agreement with the acceptable criteria of the Codex guidelines. The method was effective in analyzing antibiotic and sedative residues in freshwater fish.

Association between long-term sedentary behavior and depressive symptoms in U.S. adults

The study aimed to investigate the association between long-term sedentary behavior (LTSB) and depressive symptoms within a representative sample of the U.S. adult population. Data from NHANES 2017–2018 were used, encompassing information on demographics, depressive symptoms, physical activity (PA), and LTSB. Depressive symptoms were identified using the Patient Health Questionnaire (PHQ-9), with “depressive symptoms” defined as a PHQ-9 score of ≥ 5, and “moderate to severe depressive symptoms (MSDS)” defined as a PHQ-9 score of ≥ 10. PA and LTSB were assessed through the Global Physical Activity Questionnaire, where LTSB was interpreted as sedentary time ≥ 600 min. Restricted Cubic Spline (RCS) curves were utilized to observe potential nonlinear relationships. Binary Logistic regressions were conducted to analyze the associations. A total of 4728 participants (mean age 51.00 ± 17.49 years, 2310 males and 2418 females) were included in the study. Among these individuals, 1194 (25.25%) displayed depressive symptoms, with 417 (8.82%) exhibiting MSDS. RCS curves displayed increased risk of depressive symptoms with prolonged sedentary duration. Logistic regression models indicated significant associations between LTSB and depressive symptoms (OR 1.398, 95% CI 1.098–1.780), and LTSB and MSDS (OR 1.567, 95% CI 1.125–2.183), after adjusting for covariates. These findings suggest that LTSB may act as a potential risk factor for both depressive symptoms and MSDS in the studied population.

Insights into the Relationship between Periodontitis and Systemic Sclerosis Based on the New Periodontitis Classification (2018): A Cross-Sectional Study.

(1) Background: This study aimed to assess the periodontitis burden in systemic sclerosis patients and the possible association between them, and the degree to which some potential risk factors and two potential diagnostic biomarkers may account for this association. (2) Methods: This cross-sectional study included a test group (systemic sclerosis patients) and a control group (non-systemic sclerosis patients). Both groups benefited from medical, periodontal examination and saliva sampling to determine the salivary flow rate and two inflammatory biomarkers (calprotectin, psoriasin). A systemic sclerosis severity scale was established. (3) Results: In the studied groups, comparable periodontitis rates of 88.68% and 85.85%, respectively, were identified. There were no significant differences in the severity of periodontitis among different systemic sclerosis severity, or in the positivity for anti-centromere and anti-SCL70 antibodies. Musculoskeletal lesions were significantly more common in stage III/IV periodontitis (n = 33, 86.84%) than in those in stage I/II (n = 1, 100%, and n = 3, 37.5%, respectively) (p = 0.007). Comparable levels of the inflammatory mediators were displayed by the two groups. There were no significant differences in calprotectin and psoriasin levels between diffuse and limited forms of systemic sclerosis. (4) Conclusions: Within the limitations of the current study, no associations between systemic sclerosis and periodontitis, or between their risk factors, could be proven.

Investigating the 96h LC<Sub>50</Sub> of Mercury and Cadmium on <i>Channa punctatus</i> (Bloch): A Comparative Acute Toxicity Bioassay

Acute and chronic exposure of heavy metals exerts detrimental effect at the cellular level and is a rising global concern. The pollutants once introduced in the water bodies, subsequently enters the food chain, and poses risks not only to the aquatic organisms, but to the human consumers as well. Therefore, understanding the toxicological level of these metals is vital for assessing the severity of potential risks. The study aimed to conduct a comparative analysis of the acute toxicity of mercury and cadmium on Channa punctatus through a 96-hour bioassay. It was carried out in a semi-static laboratory condition following the standard guidelines. The behavioural, and mortality response was recorded at the 24, 48, 72, and 96 h of exposure duration for both toxicants. The results demonstrated distinct differences in toxicity levels between mercury and cadmium. The 96h-LC50 value for cadmium was measured at 6.19 mg/l, while for mercury, it was significantly lower at 0.44 mg/l. It was revealed that even the trace concentration of metals can induce toxicity, if given for a prolonged period of time. Furthermore, the study observed heightened toxicity of mercury, exerting adverse effects at lower concentrations compared to cadmium within the same exposure duration.

Tutorial on survival modeling with applications to omics data.

Identification of genomic, molecular and clinical markers prognostic of patient survival is important for developing personalized disease prevention, diagnostic and treatment approaches. Modern omics technologies have made it possible to investigate the prognostic impact of markers at multiple molecular levels, including genomics, epigenomics, transcriptomics, proteomics and metabolomics, and how these potential risk factors complement clinical characterization of patient outcomes for survival prognosis. However, the massive sizes of the omics datasets, along with their correlation structures, pose challenges for studying relationships between the molecular information and patients' survival outcomes. We present a general workflow for survival analysis that is applicable to high-dimensional omics data as inputs when identifying survival-associated features and validating survival models. In particular, we focus on the commonly used Cox-type penalized regressions and hierarchical Bayesian models for feature selection in survival analysis, which are especially useful for high-dimensional data, but the framework is applicable more generally. A step-by-step R tutorial using The Cancer Genome Atlas survival and omics data for the execution and evaluation of survival models has been made available at https://ocbe-uio.github.io/survomics.

Role of Medical and Nursing Practitioners in Times of Pandemic: Lessons Learned from the COVID-19 Crisis and Future Prospects

Context: The coronavirus disease 2019 (COVID-19) pandemic adversely affected the operation of health systems and services and dramatically increased the responsibilities of health professionals. Medical and nursing practitioners are an integral part of health care. They shouldered an important role in the fight against the novel coronavirus despite the potential risks. Evidence Acquisition: The present article applied a narrative approach to examine the nature and scope of the medical and nursing professions, especially during a pandemic or epidemic, and to describe the societal impact of the recent public health emergency. This study also analyzed the experience gained from the pandemic and how this could be used to ethically guide health services and clinicians through similar crises in the future. Results: The COVID-19 crisis revealed ethical dilemmas related to the retention of balance between the commitment to duty and the discretion to opt out. Health workers' obligation to treat derives from their professional role and is based on scientific, moral, and legal grounds. A pandemic mandates health staff to work at the limits of their competencies and entails the risk of infection with the pathogen, physical exhaustion, and emotional stress. The tremendous toll on society and health care due to the spread of a pathogen needs to be managed. The responsibility of clinicians to care for the sick is at the core of any successful response to a pandemic. Protective measures, safety training, sustainable working hours, and moral and fiscal compensation are essential prerequisites for the fulfillment of their tasks. Conclusions: Despite the reduced clinical severity associated with new variants, individual and collective fatigue among doctors and nurses continues to exist. The most recent epidemiological indicators show that the COVID-19 pandemic is still progressing but with a decelerating rhythm. In addition, preparation for a potentially catastrophic future pandemic is appropriate. Therefore, there is no time for complacency. All the involved parties need to ensure that health professionals uphold the mission of their profession.