Quality Guidelines Research Articles

Fetal alcohol spectrum disorder resources for health professionals: a scoping review

ObjectivesThis scoping review aimed to identify and critically appraise resources for health professionals to identify, diagnose, refer, and support individuals with fetal alcohol spectrum disorder (FASD)—including the extent to which...

Numerical analysis on mechanical ventilation impact on indoor air quality in a basement

Indoor air quality (IAQ) in confined spaces like bank vaults and basements is influenced by complex factors such as building layout and HVAC systems. This study examines how mechanical ventilation impacts IAQ in a bank building's occupied basement vault, addressing significant challenges posed by pollutant exposure in these air-tight environments. This study advances safe IAQ in confined spaces, crucial for occupant health and safety, using CFD (ANSYS Fluent Workbench 16.0) and CONTAM 3.2 software for multi-zone ventilation and air quality analysis. It analysed three indoor pollutants: Radon (Rn), Carbon dioxide (CO2), and Particulate Matter (PM2.5), enhancing the reliability and applicability of the findings. The findings indicated that the simulated indoor pollutants concentrations did not exceed the indoor air quality guideline levels. The CFD simulations predicted average steady-state values of 27.2 Bq/m3 for Radon, 574.80 ppm for CO2, and 69.36 µg/m3 for PM2.5 in the basement. For different outdoor air floor rates, an optimal ventilation rate of 4.7 ACH and a cooling load of 17 kW were determined to maintain Radon concentrations below 15 Bq/m3. This provides a practical and actionable solution for maintaining safe IAQ in confined spaces, which is a significant step forward compared to similar studies. These results align with other experimental research, validating the use of numerical techniques in indoor air quality studies. By optimizing HVAC systems to maintain IAQ and minimize energy consumption, the study supports SDG 7 (Affordable and Clean Energy) by enhancing energy efficiency, SDG 3 (Good Health and Well-being) by reducing exposure to indoor pollutants, and SDG 11 (Sustainable Cities and Communities) by improving air quality management in confined spaces. The findings are particularly relevant for Africa, offering practical solutions, informing policy direction, and supporting the African Union's Agenda 2063 and SDGs 3, 7, and 11.

Methodological Quality of Pulmonary Arterial Hypertension Treatment Evidence-Based Guidelines: A Systematic Review Using the AGREE II and AGREE REX Tools.

Pulmonary arterial hypertension (PAH) is a progressive disease with a poor prognosis, and its management should be grounded in well-developed clinical practice guidelines (CPG). Thus, we critically assess the methodological quality of the available CPG for pharmacological treatments for PAH. A systematic review (CRD42023387168) was performed in PubMed, Cochrane, Embase, and Tripdatabase (Jan-2023). Eligible records were appraised by four reviewers using the Appraisal of Guidelines, Research, and Evaluation Collaboration tool (AGREE II) and the complementary tool for assessing recommendations' quality and certainty, AGREE REX. Descriptive statistics were used to summarize the data. Overall, 31 guidelines, mainly authored by professional societies (90%), targeting only physicians as primary users (84%), were identified. Guidelines presented a moderate overall quality (scores of 63% and 51% in AGREE II and AGREE REX, respectively), with a few domains showing slight improvements over the years. AGREE II "Scope and Purpose" (94%) and "Presentation Clarity" (99%) domains obtained the highest scores. The items related to "Stakeholder involvement," "Editorial independence," and "Clinical applicability" (AGREE REX) were fairly reported. Conversely, CPG lacks rigor in development (32% score, AGREE II), scarcely discusses the role of stakeholders, and provides deficient data on the implementation of recommendations (scores of 35% and 46% in AGREE II and AGREE REX, respectively). No differences in the quality of guidelines published by different developers or countries were observed (p > 0.05). Methodological weaknesses are common among guidelines addressing PAH treatment, especially regarding scientific rigor, stakeholders' values and preferences, and facilitators and barriers to implementability. Particular attention should be given to developing future guidelines.

Evaluating the properties that affect the quality of the charcoal product, determining the limits of toxic emissions during combustion, and studying their impact on human health.

This research focuses on examining the potential impact of charcoal briquettes and lumps on human health due to the emissions they release, and verifying their quality standards. Quality assessment was conducted using a device capable of measuring toxic gases to identify contaminants from various sources such as biomass, synthetic resins, coal, metals, and mineral matter. Toxicity assessments were carried out on five types of briquettes and two varieties of lump charcoal. All charcoal samples were subjected to elemental analysis (SEM/EDAX), including the examination of Ca, Al, Cr, V, Cu, Fe, S, Sr, Si, Ba, Pb, P, Mn, Rb, K, Ti, and Zn. The results showed that burning lump charcoal had toxicity indexes ranging from 2.5 to 5, primarily due to NOx emissions. Briquettes, on the other hand, exhibited higher toxicity indices between 3.5 and 6.0, with CO2 being the main contributor to toxicity. The average 24-h CO content of all charcoal samples exceeded the World Health Organization's 24-h Air Quality Guideline of 6.34ppm, with a measurement of 37ppm. The data indicates that most of the products tested did not meet the prevailing quality standard (EN 1860-2:2005 (E) in Appliances, solid fuels and firelighters for barbecuing-Part 2: Barbecue charcoal and barbecue charcoal briquettes-Requirements and test method, 2005), which specifies a maximum of 1% contaminants, with some products containing as much as 21% impurities. The SEM analysis revealed irregularly shaped grains with an uneven distribution of particles, and the average particle size distribution is quite broad at 5μm. Malaysia Charcoal had the highest calorific value at 32.80MJ/Kg, with the value being influenced by the fixed carbon content-higher carbon content resulting in a higher calorific value.

Ecotoxicity threshold values for 4-hydroxychlorothalonil, carbendazim, dimethoate and methoxyfenozide in fresh and marine waters: Part 1. Derivation of threshold values

Pesticide active ingredients are frequently detected in the rivers, creeks, wetlands, estuaries, and marine waters of the Great Barrier Reef (GBR) region and are one of the main contributors to poor water quality. Pesticide concentrations detected in the environment through water quality monitoring programs can be compared against estimates of ecologically “safe” concentrations (i.e., water quality guidelines) to assess the potential hazard and risk posed to aquatic ecosystems. Water quality guidelines are also required to estimate the aquatic risk posed by pesticide mixtures, which is used for the Reef 2050 Water Quality Improvement Plan pesticide target. Seventy-four pesticide active ingredients and their degradates are frequently detected in GBR catchment waterways, however many do not have water quality guidelines in the Australian and New Zealand Guidelines for Fresh and Marine Water Quality. The current study derives ecotoxicity threshold values (ETVs) as unendorsed guideline values for active ingredients in two fungicides (4-hydroxychlorothalonil (fungicide degradate) and carbendazim) and two insecticides (dimethoate and methoxyfenozide) that are commonly detected in GBR catchment waterways. The proposed ETVs have been derived using species sensitivity distributions, as recommended in the Australian and New Zealand nationally endorsed method for deriving water quality guidelines for aquatic ecosystem protection. Four ETVs were derived for each chemical with values that should theoretically protect 99, 95, 90 and 80 % of species (i.e., PC99, PC95, PC90, PC80, respectively). The PC99 and PC95 values for 4-hydroxychlorothalonil, carbendazim, dimethoate and methoxyfenozide were 0.49 μg/L and 4 μg/L, 0.029 μg/L and 0.45 μg/L, 0.11 μg/L and 5.8 μg/L and 0.19 μg/L and 2 μg/L, respectively. The ETVs will be used in an ecological hazard and risk assessment across GBR waterways in part two of this study. The ETVs can also be used to assess potential risk across Australia and internationally where monitoring data are available.

Upcycling process of mill scale waste into high-value ceramic products

Ceramic industry consumes large amounts of raw materials, including costly and environmental impact iron based-pigments. Steel rolling (SR) and wire drawing (WD) waste, rich in iron (>67 wt %), present a viable alternative. This study aims to develop high value stoneware pastes for tableware products by substituting commercial pigments with SR and WD. The influence of incorporation content (3, 5 and 10 wt %) and pre-treatments (sieving at 250, 150 and 63 μm, and grinding followed by sieving at 63 μm) on the samples properties was assessed including weight loss, firing shrinkage, apparent density, flexural resistance, and water absorption. The laboratory scale results revealed that darker hues, ranging from grey to reddish, were obtained when SR and WD were incorporated in the stoneware paste (beige colour). The smaller the particle size, more homogeneous is the developed colour, which is intensified as higher is the incorporation level.The prototypes (plates) were characterized in terms of thermal shock, edge impact, cracking and microwaves resistance, water absorption, and leaching behaviour, demonstrating that they met the industrial requirements. Thermal shock resistance was enhanced and the levels of leached Fe, Pb, Cd, Ni, Cr, Mo, V, Zn, and Cu, were below permissible limits (EU Ceramic Directive 84/500/EEC, Decree-Law n°152/2017, Decree-Law n°236/98 and WHO Guidelines for Drinking-Water Quality) confirming their effective immobilization. Concluding, this work shows the viability of using mill scale waste as a valuable secondary raw material in stoneware pastes acting as a chromophore agent. Dark colours are obtained while preserving the product technical characteristics, promoting sustainable production and reducing landfilled waste.

Hospital falls clinical practice guidelines: a global analysis and systematic review.

Hospital falls continue to be a persistent global issue with serious harmful consequences for patients and health services. Many clinical practice guidelines now exist for hospital falls, and there is a need to appraise recommendations. A systematic review and critical appraisal of the global literature was conducted, compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Web of Science, Embase, CINAHL, MEDLINE, Epistemonikos, Infobase of Clinical Practice Guidelines, Cochrane CENTRAL and PEDro databases were searched from 1 January 1993 to 1 February 2024. The quality of guidelines was assessed by two independent reviewers using Appraisal of Guidelines for Research and Evaluation Global Rating Scale and Appraisal of Guidelines of Research and Evaluation Recommendation Excellence (AGREE-REX). Certainty of findings was rated using Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative Research. Data were analysed using thematic synthesis. 2404 records were screened, 77 assessed for eligibility, and 20 hospital falls guidelines were included. Ten had high AGREE-REX quality scores. Key analytic themes were as follows: (i) there was mixed support for falls risk screening at hospital admission, but scored screening tools were no longer recommended; (ii) comprehensive falls assessment was recommended for older or frail patients; (iii) single and multifactorial falls interventions were consistently recommended; (iv) a large gap existed in patient engagement in guideline development and implementation; (v) barriers to implementation included ambiguities in how staff and patient falls education should be conducted, how delirium and dementia are managed to prevent falls, and documentation of hospital falls. Evidence-based hospital falls guidelines are now available, yet systematic implementation across the hospital sector is more limited. There is a need to ensure an integrated and consistent approach to evidence-based falls prevention for a diverse range of hospital patients.

Assessment of colonoscopy skill using machine learning to measure quality: Proof-of-concept and initial validation.

Background and study aims Low-quality colonoscopy increases cancer risk but measuring quality remains challenging. We developed an automated, interactive assessment of colonoscopy quality (AI-CQ) using machine learning (ML). Methods Based on quality guidelines, metrics selected for AI development included insertion time (IT), withdrawal time (WT), polyp detection rate (PDR), and polyps per colonoscopy (PPC). Two novel metrics were also developed: HQ-WT (time during withdrawal with clear image) and WT-PT (withdrawal time subtracting polypectomy time). The model was pre-trained using a self-supervised vision transformer on unlabeled colonoscopy images and then finetuned for multi-label classification on another mutually exclusive colonoscopy image dataset. A timeline of video predictions and metric calculations were presented to clinicians in addition to the raw video using a web-based application. The model was externally validated using 50 colonoscopies at a second hospital. Results The AI-CQ accuracy to identify cecal intubation was 88%. IT ( P = 0.99) and WT ( P = 0.99) were highly correlated between manual and AI-CQ measurements with a median difference of 1.5 seconds and 4.5 seconds, respectively. AI-CQ PDR did not significantly differ from manual PDR (47.6% versus 45.5%, P = 0.66). Retroflexion was correctly identified in 95.2% and number of right colon evaluations in 100% of colonoscopies. HQ-WT was 45.9% of, and significantly correlated with ( P = 0.85) WT time. Conclusions An interactive AI assessment of colonoscopy skill can automatically assess quality. We propose that this tool can be utilized to rapidly identify and train providers in need of remediation.

Quality of Life Among Saudi Parents of Children With Attention-Deficit/Hyperactivity Disorder: A Cross-Sectional Study.

Background Attention-deficit/hyperactivity disorder (ADHD) in children can adversely impact parental quality of life (QoL). However, limited research exists among families in Saudi Arabia, especially in understudied regions like Jazan. This study was designed to determine the QoL in parents of children with ADHD in Jazan, Saudi Arabia. Methodology This cross-sectional study was conducted in the Jazan region of Saudi Arabia from June 2023 to December 2023. Online questionnaires were used to collect data from parents of children with ADHD residing in the country.A structured questionnaire was developed in consultation with the National Institute for Children's Health Quality (NICHQ) guidelines. The total sample size was 276. The study participants were recruited through convenient non-random snowballing sampling where the promotion of the questionnaire web link aided in reaching the required sample size of the study. Participants aged more than 18 years, residents of the Jazan area, and both genders were included. R software was used for data analysis. Results The study, involving 275 participants, revealed that 45 (16%) children were diagnosed with ADHD by doctors, with a higher prevalence among males 36 (80%). The NICHQ scale identified ADHD in 50 (18%) participants, with the predominant subtypes being inattentive 28 (56%), hyperactive/impulsive 28 (56%), and combined 19 (38%). The median QoL score was 8.6, with good QoL reported by 51.27% of parents and poor QoL by 48.73%. Gender significantly influenced QoL (p < 0.01), with 57% of males and 43% of females reporting good QoL, while 61% of females and 39% of males reported poor QoL. Oppositional defiant symptoms were significantly associated with poorer QoL (p < 0.05). There was a notable alignment between ADHD diagnoses from parental reports and the NICHQ scale. Conclusions This cross-sectional study found that parents of children with ADHD behaviors, especially those exhibiting oppositional defiant symptoms, experienced significantly lower QoL, particularly in personal fulfillment and psychosocial well-being. The findings emphasize the need for culturally tailored psychosocial interventions in Saudi Arabia to improve parental coping and QoL, benefiting overall family well-being and child outcomes.

Botanical and pharmacognostic investigation of Strobilanthes kalimantanensis.

Under a hidden waterfall in the interior of the tropical rainforest of East Kalimantan, a new medicinal plant that produces essential oil (EO) was found with the name Strobilanthes kalimantanensis. The aim was to investigate the botanical and evaluate the pharmacognostic characteristics of S. kalimantanensis leaves from East Kalimantan, Indonesia. Pharmacognostic studies can provide recommendations for establishing quality control standards or guidelines for cultivating, harvesting, and processing S. kalimantanensi s to ensure the consistent and reliable quality of medicinal products. Characteristic methods of S. kalimantanensis leaves include botanical macroscopic, fluorescence, physicochemical, and phytochemical evaluation. The plant characteristics of this plant are similar to S. kunthia and S. reptans but can be differentiated in the leaves and flowers. Fluorescence assay with sodium hydroxide 5% shows unique characteristics of secondary metabolites based on their ability to form dark green with black precipitate in Ultraviolet 365 nm. The physicochemical characteristics showed yield, water content, water-soluble, ethanol soluble, total ash value, and acid-insoluble ash. Phytochemicals showed the presence of alkaloids, polyphenols, terpenoids, and EO containing 23% trans-anethole. This evaluation report details the chemical composition, identity, and safety of S. kalimantanensis leaves.

Horizontal-flow constructed wetlands by phytoremediation using vetiver grass, common reed, and canna lily as tertiary wastewater treatment for the reduction of pollutant concentrations of ammonia, phosphates, and nitrates

Abstract The discharge of untreated wastewater into rivers and water bodies poses significant environmental and public health risks. High concentrations of contaminants like heavy metals and pharmaceuticals disrupt rivers, exacerbating waterborne diseases, and leading to unsafe water in the Philippines. This study proposed the use of horizontal-flow constructed wetlands as a tertiary treatment method utilizing the plants: vetiver grass, common reed, and canna lily, to reduce pollutant concentrations in wastewater. This is to ensure compliance with water quality guidelines and general effluent standards under the Class SB Category, water suitable for fishery, tourist zones, and recreational activities. The research investigated the efficiency of phytoremediation beds in removing pollutants from wastewater under fixed hydraulic retention times. The efficiency of reducing pollutants and adsorption isotherms (Freundlich and Langmuir) were calculated to analyze the results of the sampling. Phytoremediation bed 1 demonstra ted efficient ammonia removal by 64.64%. Phytoremediation bed 2 was proficient in reducing nitrates at 83.85%, while phytoremediation bed 3 effectively reduced phosphate to an average of 26.26%, achieved after a 6-hour retention time. In addition, Freundlich adsorption isotherm was observable in most parameters in phytoremediation bed 1 such as ammonia as nitrogen, TDS, COD, and DO. Phytoremediation bed 3 exhibited the same adsorption isotherm on ammonia as nitrogen. Conclusively, the phytoremediation system met the Department of Environment and Natural Resources - Updated Water Quality Guidelines and General Effluent Standard (GES) for all parameters tested.

Distribution, Source, and Contamination of Heavy Metals in Coastal Sediments of Jeddah, Red Sea, Saudi Arabia.

The study investigates heavy metal (HM) contamination in coastal sediments of Jeddah along Red Sea coast, analyzing spatial distribution and sources. 24 samples underwent (ICP-AES) for Fe, Al, Mn, Ni, Pb, Zn, Cu, Cr, Co, Sr, V, and As. HM averages followed Fe ˃ Al ˃ Sr ˃ Mn ˃ Zn ˃ V ˃ Cu ˃ Ni ˃ Cr ˃ As ˃ Co ˃ Pb. Contamination indices revealed severe Sr enrichment, minor As and Co enrichment, and no enrichment for other HMs. Sediment quality guidelines suggest Ni, Cu, Zn, and As risks to benthic communities at some sites, while Cr and Pb pose minimal risk. Multivariate analysis indicates natural sources for Fe, Al, Mn, Ni, Zn, Cu, Cr, Co, and V, and anthropogenic sources for Sr, As, and Pb, linked to agriculture, industry, and urbanization. Increased Sr values may stem from seawater acidification impacting calcitic corals and molluscs.

Clinical Practice Guideline Development in Pediatric Emergency Medicine Departments Across the United States: A Cross-sectional Study.

This cross-sectional study aimed to assess the process of clinical practice guideline (CPG) development in pediatric emergency medicine departments (PEDs) across the United States, with a focus on identifying areas for improvement to enhance the quality of CPGs. An electronic survey was distributed to PEDs with pediatric emergency medicine fellowship programs. Respondents were asked about their CPG development processes (ie, guideline committee composition, consideration of conflicts of interest, grading recommendations, guideline training opportunities) based on the Appraisal of Guidelines, Research, and Evaluation (AGREE II) tool as well as implementation and monitoring. Univariate analysis was used to assess associations between the number of AGREE II elements adhered to and annual patient volume. Of the 84 PEDs surveyed, 44 (52.4%) responded, representing institutions from 28 states. Most PEDs (97.7%, n = 43) reported developing their own guidelines, citing the need to improve care quality and standardize patient care as primary reasons. Although most guideline committees included multidisciplinary team members (74.4%, n = 32), routine patient involvement in committees was rare (11.6%, n = 5), and barriers such as time and resource constraints hindered their inclusion. Formal training for committee members in guideline development was uncommon (18.6%, n = 8). There was an association between higher annual patient volume and the number of AGREE II elements adhered to (P = 0.03). Few PEDs considered potential conflicts of interest among committee members (13.6%, n = 6). Over half of surveyed PEDs (54.5%, n = 24) lacked a systematic approach to grading recommendations. Educational materials and workshops were the most common guideline implementation strategies. Our findings highlight need for improvement in the CPG development process in PEDs. Including patients in committees, providing formal training for committee members, and adopting a rigorous approach to grading recommendations are crucial steps toward enhancing guideline quality. Emphasizing these improvements has the potential to improve the quality of CPGs for pediatric emergency care.

Water quality dynamics and underlying controls in the Halton Region, Ontario.

We assessed the hydrochemistry of 15 watersheds in the Halton Region, southern Ontario, in high resolution (n > 500 samples across n > 40 streams) to characterize water quality dynamics and governing controls on major and trace element concentrations in this rapidly urbanizing region. In 2022, major water quality parameters were generally in line with historic monitoring data yet significantly different across catchments, e.g., in specific conductance, turbidity, phosphate and chloride, and trace element concentrations. Distinct hydrochemical signatures were observed between urban and rural creeks, with urban stream sections and sites near the river mouths close to Lake Ontario having consistently higher chloride (up to 700mg/L) and occasional enrichment in nutrients levels (up to 8 and 20mg/L phosphate and nitrate, respectively). Particularly upper reaches exhibited hydrochemical signatures that were reflective of the catchment surface lithologies, for instance through higher dissolved Ca to Mg ratios. Unlike for chloride and phosphate, provincial water quality guidelines for trace elements and heavy metals were seldom surpassed (on < 10 occasions for copper, zinc, cadmium, and uranium). Concentrations of other trace elements (e.g., platinum group elements or rare earth elements) were expectedly low (< 0.3µg/L) but showed spatiotemporal concentration patterns and concentration-discharge dynamics different from those of the major water quality parameters. Our results help improve the understanding of surface water conditions within Halton's regional Natural Heritage Systems and demonstrate how enhanced environmental monitoring can deliver actionable information for watershed decision-making.

Modeling air pollution around major dumpsites in Lagos State using geospatial methods with solutions

Air pollution is gradually becoming a major health concern globally and Nigeria is especially susceptible to air pollution Available data indicates that vehicular traffics, industries, wildfire and biomass burning are significant sources of air pollutants such as Particulate Matter PM, Carbon Monoxide CO, Nitrogen Dioxide NO2, Sulphur Dioxide SO2 and Volatile Organic Compounds VOCs in the air in Lagos State. The aim of this study is to perform geospatial modelling of air pollution around Olusosun and Solous dumpsites in Lagos State. The study analyses, assesses, and predicts air pollution emission in these dumpsites and examines their possible health impact on residents. Using both ground and satellite-based data, different GIS techniques were used to model this pollution concentration. These methods include Kriging, Regression, and Landfill Gas Emissions Model (LANDGEM) which helps to analyse, model and predict the air pollutant levels around these dumpsite. The average pollution level of Particulate Matter with a diameter that is 2.5 micrometers (PM2.5) in Olusosun was 94.29 μg/m3 while those in Solous was 94.12 μg/m3 over a 24 h period. This is way above the Air Quality Guideline recommended by the WHO which is 15 μg/m3 over a 24 h period. This is similar to the high pollution level of NO2 which was 237.64 μg/m3 in Olusosun and 255.84 μg/m3 in Solous as against the WHO Air Quality Guideline of 25 μg/m3 over a 24 h period. SO2 level is also varyingly high in Olusosun and Solous. The reading of 109.27 μg/m3 in Olusosun is considerably high as compared to the reading of 43.82 μg/m3 in Solous. However, both readings are relatively higher than the Air Quality Guideline recommended by the WHO which was 40 μg/m3. The CO air quality level of 0.55 mg/m3 in Olusosun and 0.52 mg/m3 in Solous is within the accepted level of the Air Quality Guideline recommended by the WHO. This shows that CO is not a pollution threat in the major dumpsites in Lagos. This is similar to the readings of PM5 and PM10 which are within the WHO Air Quality Guidelines over a 24 h period. The Moderate Resolution Imaging Spectroradiometer (MODIS) data shows a trend of increasing concentration of PM2.5 over the 5 study months due to an increase in the quantity of waste disposal, which shows that high waste disposal is directly proportional to high level of PM2.5. It is recommended that living farther (more than 15 km) away from the dumpsites can reduce the high risk of air pollution and its related diseases for residents. Also, there is need for proper incineration and maintenance of waste to reduce the level of air and other pollutants in and around the dumpsites.

Enhancing the health benefits of air quality improvement: a comparative study across diverse scenarios.

In many studies, linear methods were used to calculate health benefits of air quality improvement, but the relationship between air pollutants and diseases may be complex and nonlinear. In addition, previous studies using reference number as average number of diseases may overestimate the health benefits. Therefore, the nonlinear model estimation and resetting of the reference number were very important. Hospital admission data for coronary heart disease (CHD), meteorological data, and air pollutant data of Zibo City from 2015 to 2019 were collected. The generalized additive model (GAM) was used to explore the association between air pollutants and hospital admission for CHD, and to evaluate the effects on health benefits under different reference number settings. A total of 21,105 hospitalized cases for CHD were reported in Zibo during the study period. The results of the GAM showed there was a log-linear exposure-response relationship between O3 and hospital admissions for CHD, with RR (relative risk) of 1.0143 (95% CI: 1.0047 ~ 1.0239). There were log-nonlinear exposure-response relationships between PM10, PM2.5, SO2, and hospital admissions for CHD. With the increase of pollutants concentrations, the risk for hospital admission showed a trend of increasing first and then decreasing. Compared with the average hospital admissions as the reference number, health benefits calculated by hospital admissions predicted by the GAM model yielded lower. Using the World Health Organization air quality guidelines as reference, attributable fractions of O3, PM10, and PM2.5 were 1.97% (95% CI: 0.63 ~ 3.40%), 11.82% (95% CI: 8.60 ~ 15.24%), and 11.82% (95% CI: 8.79 ~ 15.04%), respectively. When quantifying health benefits brought by improving air quality, corresponding calculation methods should first be determined according to the exposure-response relationships between air pollutants and outcomes. Then, applying the average hospital admissions as reference number may overestimate health benefits resulting from improved air quality.

A Guideline for Guidelines: A Novel Method to Assess the Helpfulness of Medical Guidelines.

Background/Objectives: The recommendations included in medical guidelines (GLs) provide important help to medical professionals for making clinical decisions regarding the diagnosis and treatment of various diseases. However, there are no systematic methods to measure the helpfulness of GLs. Thus, we developed an objective assessment of GLs which indicates their helpfulness and quality. We hypothesized that a simple mathematical analysis of 'Recommendations' and 'Evidence' would suffice. Methods: As a proof of concept, a mathematical analysis was conducted on the '2020 European Society of Cardiology Guidelines on Sports Cardiology and Exercise in Patients with Cardiovascular Disease Guideline' (SCE-guideline). First, the frequencies of Classes of Recommendations (CLASS) and the Levels of Evidence (LEVEL) (n = 159) were analysed. Then, LEVEL areas under CLASS were calculated to form a certainty index (CI: -1 to +1). Results: The frequency of CLASS I ('to do') and CLASS III ('not to do') was relatively high in the SCE-guideline (52.2%). Yet, the most frequent LEVEL was C (41.2-83.8%), indicating only a relatively low quality of scientific evidence in the SCE-guideline. The SCE-guideline showed a relatively high CI (+0.57): 78.4% certainty and 21.6% uncertainty. Conclusions: The SCE-guideline provides substantial help in decision making through the recommendations (CLASS), while the supporting evidence (LEVEL) in most cases is of lower quality. This is what the newly introduced certainty index showed: a tool for 'quality control' which can identify specific areas within GLs, and can promote the future improvement of GLs. The newly developed mathematical analysis can be used as a Guideline for the Guidelines, facilitating the assessment and comparison of the helpfulness and quality of GLs.

The quality of guidelines on the pancreatic perioperative enhanced recovery after surgery: a systematic quality appraisal using AGREE II instrument.

To evaluate the quality of guidelines on the pancreatic perioperative enhanced recovery after surgery both domestically and internationally, providing reference and reference for clinical practice. Systemically retrieved in the guideline websites, professional association websites and databases, such as up to date, BMJ Best Practice, PubMed, Embase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wan Fang Data, China Science and Technology Journal Database(VIP), China Biology Medicine disc (CBMdisc), Medlive, Guidelines International Network(GIN), National Guideline Clearinghouse(NGC), National Institute for Health and Care Excellence(NICE), Registered Nurses Association of Ontario(RNAO), Scottish Intercollegiate Guidelines Network(SIGN), Joanna Briggs Institute Library(JBI), including guidelines and expert consensus on enhanced postsurgical recovery in pancreatic surgery published as of December 20, 2023. The Appraisal of Guidelines for Research and Evaluation II(AGREE II) tool was applied to evaluate the quality of the guidelines by four assessors. This study included seven guidelines, all of which were rated as Grade B in terms of quality, with ICC coefficients ranging from 0.752 to 0.884, indicating a high level of consistency. When formulating guidelines in the future, it is recommended to use AGREE II as a reference, emphasizing the standardization of the guideline development process and methods, fully considering patients' values and preferences, focusing on the applicability of the guidelines, and striving to create high-quality evidence-based recommendations.

Associations of long-term exposure to low-level PM2.5 and brain disorders in 260,922 middle-aged and older adults

Long-term exposure to high-level ambient PM2.5 was associated with increased risks of brain disorders, while the associations remain uncertain when the exposure is lower than current air quality standards in numerous countries. This study aimed to assess the effects of PM2.5 exposure on the brain system in the population with annual mean concentrations ≤15 μg/m3. We analyzed data from 260,922 participants without preexisting brain diseases at baseline in the UK Biobank. The geographical distribution of PM2.5 in 2010 was estimated by a land use regression model and linked with individual residential address. We investigated associations of ambient PM2.5 with incident neurological (dementia, Parkinson's diseases [PD], epilepsy, and migraine) and psychiatric (major depressive disorder [MDD] and anxiety disorder) diseases through Cox proportional hazard models. We further estimated the links with brain imaging phenotypes by neuroimaging analysis. Results showed that in the population with PM2.5 concentrations ≤15 μg/m3, each interquartile range (IQR, 1.28 μg/m3) increment in PM2.5 was related to incidence risks of dementia, epilepsy, migraine, MDD, and anxiety disorder with hazard ratios of 1.08 (95% confidence interval [CI]: 1.03, 1.13), 1.12 (1.05, 1.20), 1.07 (1.00, 1.13), 1.06 (1.03, 1.09), and 1.05 (1.02, 1.08), respectively. We did not observe a significant association with PD. The association with dementia was stronger among the population with poor cardiovascular health (measured by Life's Essential 8) than the counterpart (P for interaction = 0.037). Likewise, per IQR increase was associated with specific brain imaging phenotypes, including volumes of total brain (β = −0.036; 95% CI: −0.050, −0.022), white matter (−0.030; −0.046, −0.014), grey matter (−0.030; −0.042, −0.017), respectively. The findings suggest long-term exposure to ambient PM2.5 at low-level still has an adverse impact on the neuro-psychiatric systems. The brain-relevant epidemiological assessment suggests that each country should update the standard for ambient PM2.5 following the World Health Organization Air Quality Guidelines 2021.

Potential Early Effect Biomarkers for Ambient Air Pollution Related Mental Disorders.

Air pollution is one of the greatest environmental risks to health, with 99% of the world's population living where the World Health Organization's air quality guidelines were not met. In addition to the respiratory and cardiovascular systems, the brain is another potential target of air pollution. Population- and experiment-based studies have shown that air pollution may affect mental health through direct or indirect biological pathways. The evidence for mental hazards associated with air pollution has been well documented. However, previous reviews mainly focused on epidemiological associations of air pollution with some specific mental disorders or possible biological mechanisms. A systematic review is absent for early effect biomarkers for characterizing mental health hazards associated with ambient air pollution, which can be used for early warning of related mental disorders and identifying susceptible populations at high risk. This review summarizes possible biomarkers involved in oxidative stress, inflammation, and epigenetic changes linking air pollution and mental disorders, as well as genetic susceptibility biomarkers. These biomarkers may provide a better understanding of air pollution's adverse effects on mental disorders and provide future research direction in this arena.