Quantitative Risk Estimates Research Articles

Validation of the 2014 European Society of Cardiology Sudden Cardiac Death Risk Prediction Model in Hypertrophic Cardiomyopathy in a Reference Center in South America

Sudden cardiac death (SCD) is a common cause of death in hypertrophic cardiomyopathy (HC). Our aim was to conduct an external and independent validation in South America of the 2014 European Society of Cardiology (ESC) SCD risk prediction model to identify patients requiring an implantable cardioverter defibrillator. This study included 502 consecutive patients with HC followed from March, 1993 to December, 2014. A combined end point of SCD or appropriate implantable cardioverter defibrillator therapy was assessed. For the quantitative estimation of individual 5-year SCD risk, we used the formula: 1- 0.998(exp(Prognostic index)). Our database also included the abnormal blood pressure response to exercise as a risk marker. We analyzed the 3 categories of 5-year risk proposed by the ESC: low risk (LR) <4%; intermediate risk (IR) ≥4% to <6%, and high risk (HR) ≥6%. The LR group included 387 patients (77%); the IR group 39 (8%); and the HR group 76 (15%). Fourteen patients (3%) had SCD/appropriate implantable cardioverter defibrillator therapy (LR: 0%; IR: 2 of 39 [5%]; and HR: 12 of 76 [16%]). In a receiver-operating characteristic curve, the new model proved to be an excellent predictor because the area under the curve for the estimated risk is 0.925 (statistical C: 0.925; 95% CI 0.8884 to 0.9539, p <0.0001). In conclusion, the SCD risk prediction model in HC proposed by the 2014 ESC guidelines was validated in our population and represents an improvement compared with previous approaches. A larger multicenter, independent and external validation of the model with long-term follow-up would be advisable.

A framework for incorporating insurance in critical infrastructure cyber risk strategies

Smart critical infrastructure owners and operators are always looking for ways to minimize cyber risk while keeping a lid on cyber security expenditures. The insurance industry has been quantitatively assessing risk for hundreds of years to minimize risk and maximize profits. To achieve these goals, insurers continuously gather and analyze statistical data to improve their predictions, incentivize client investments in self-protection and periodically refine their models to improve the accuracy of risk estimates.This paper presents a framework that incorporates the operating principles of the insurance industry to provide quantitative estimates of cyber risk. The framework uses optimization techniques to suggest levels of investment in cyber security and insurance for critical infrastructure owners and operators. This analysis can be used to quantitatively formulate strategies to minimize cyber risk.

Method for the quantification of rupture probability in soft collagenous tissues.

A computational method is presented for the assessment of rupture probabilities in soft collagenous tissues. This may in particular be important for the quantitative analysis of medical diseases such as atherosclerotic arteries or abdominal aortic aneurysms, where an unidentified rupture has in most cases fatal consequences. The method is based on the numerical minimization and maximization of probabilities of failure, which arise from random input quantities, for example, tissue properties. Instead of assuming probability distributions for these quantities, which are typically unknown especially for soft collagenous tissues, only restricted knowledge of these distributions is taken into account. Given this limited statistical input data, the minimized/maximized probabilities represent optimal bounds on the rupture probability, which enable a quantitative estimation of potential risks of performing or not performing medical treatment. Although easily extendable to all kinds of mechanical rupture criteria, the approach presented here incorporates stretch-based and damage-based criteria. These are evaluated based on numerical simulations of loaded tissues, where continuum mechanical material formulations are considered, which capture the supra-physiological behavior of soft collagenous tissues. Numerical examples are provided demonstrating the applicability of the method in an overstretched atherosclerotic artery. Copyright © 2016 John Wiley & Sons, Ltd.

Quality of information for women seeking breast augmentation in the Internet

Background Recently published data show that many women interested in breast augmentation (BA) actively search the Internet for information. The Internet is currently the main source of information on this topic.Objectives Little is known about the quality of available information on the Internet concerning BA. The goal was to evaluate this in a systematic manner using a validated and reproducible tool.Methods Women (n = 96) unrelated to medicine were asked which keywords they would use to search the Internet if they were interested in BA. Five keywords were used. Qualitative and quantitative assessment was performed with the modified Ensuring Quality Information for Patients (EQIP) tool. A total of 2500 websites containing information on BA were identified using Google, Bing, Yahoo, Ask, and AOL.Results Out of 623 eligible websites, only 153 (25%) addressed more than 20 EQIP items. Scores were higher for encyclopaedias and academic websites compared to hospital and practitioner websites. The median EQIP score was only 15 (IQR = 12–20), and quantitative postoperative morbidity and mortality risk estimates were available in only 38% and 25% of the websites, respectively. Major complications (e.g. capsular contraction, implant safety) were mentioned in only 156 (25%) of the websites.Conclusions This is the first assessment of online patient information on BA using the EQIP tool. This analysis demonstrated several shortcomings in the quality of information provided to BA candidates. There is an immediate need for better informative and educational websites regarding BA procedures that are compatible with international quality standards for plastic surgery.

The Neglected Side of the Coin: Quantitative Benefit-risk Analyses in Medical Imaging.

While it is implicitly recognized that the benefits of diagnostic imaging far outweigh any theoretical radiogenic risks, quantitative estimates of the benefits are rarely, if ever, juxtaposed with quantitative estimates of risk. This alone - expression of benefit in purely qualitative terms versus expression of risk in quantitative, and therefore seemingly more certain, terms - may well contribute to a skewed sense of the relative benefits and risks of diagnostic imaging among healthcare providers as well as patients. The current paper, therefore, briefly compares the benefits of diagnostic imaging in several cases, based on actual mortality or morbidity data if ionizing radiation were not employed, with theoretical estimates of radiogenic cancer mortality based on the "linear no-threshold" (LNT) dose-response model.

Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta-analysis.

ObjectivesThis was a systematic review and meta‐analysis to evaluate the incidence of adverse events in adults undergoing procedural sedation in the emergency department (ED).MethodsEight electronic databases were searched, including MEDLINE, EMBASE, EBSCO, CINAHL, CENTRAL, Cochrane Database of Systematic Reviews, Web of Science, and Scopus, from January 2005 through 2015. Randomized controlled trials and observational studies of adults undergoing procedural sedation in the ED that reported a priori selected outcomes and adverse events were included. Meta‐analysis was performed using a random‐effects model and reported as incidence rates with 95% confidence intervals (CIs).ResultsThe search yielded 2,046 titles for review. Fifty‐five articles were eligible, including 9,652 procedural sedations. The most common adverse event was hypoxia, with an incidence of 40.2 per 1,000 sedations (95% CI = 32.5 to 47.9), followed by vomiting with 16.4 per 1,000 sedations (95% CI = 9.7 to 23.0) and hypotension with 15.2 per 1,000 sedations (95% CI = 10.7 to 19.7). Severe adverse events requiring emergent medical intervention were rare, with one case of aspiration in 2,370 sedations (1.2 per 1,000), one case of laryngospasm in 883 sedations (4.2 per 1,000), and two intubations in 3,636 sedations (1.6 per 1,000). The incidence of agitation and vomiting were higher with ketamine (164.1 per 1,000 and 170.0 per 1,000, respectively). Apnea was more frequent with midazolam (51.4 per 1,000), and hypoxia was less frequent in patients who received ketamine/propofol compared to other combinations. The case of laryngospasm was in a patient who received ketamine, and the aspiration and intubations were in patients who received propofol. When propofol and ketamine are combined, the incidences of agitation, apnea, hypoxia, bradycardia, hypotension, and vomiting were lower compared to each medication separately.ConclusionsSerious adverse events during procedural sedation like laryngospasm, aspiration, and intubation are exceedingly rare. Quantitative risk estimates are provided to facilitate shared decision‐making, risk communication, and informed consent.

Inhalation cancer risk assessment of hexavalent chromium based on updated mortality for Painesville chromate production workers.

The exposure-response for hexavalent chromium (Cr(VI))-induced lung cancer among workers of the Painesville Ohio chromate production facility has been used internationally for quantitative risk assessment of environmental and occupational exposures to airborne Cr(VI). We updated the mortality of 714 Painesville workers (including 198 short-term workers) through December 2011, reconstructed exposures, and conducted exposure-response modeling using Poisson and Cox regressions to provide quantitative lung cancer risk estimates. The average length of follow-up was 34.4 years with 24,535 person-years at risk. Lung cancer was significantly increased for the cohort (standardized mortality ratio (SMR)=186; 95% confidence interval (CI) 145–228), for those hired before 1959, those with >30-year tenure, and those with cumulative exposure >1.41 mg/m3-years or highest monthly exposures >0.26 mg/m3. Of the models assessed, the linear Cox model with unlagged cumulative exposure provided the best fit and was preferred. Smoking and age at hire were also significant predictors of lung cancer mortality. Adjusting for these variables, the occupational unit risk was 0.00166 (95% CI 0.000713–0.00349), and the environmental unit risk was 0.00832 (95% CI 0.00359–0.0174), which are 20% and 15% lower, respectively, than values developed in a previous study of this cohort.

A Comparative Analysis of Quantitative Operational Risk Measurement Methods

The number of well-known firms joining the list of entities such as Enron, WorldCom, Sumitomo Corp., all of which lost millions of dollars as a result of inadequate operational risk management systems, increases dramatically with each passing year. This has increased the amount of interest in this marginalised aspect of risk. The quantitative estimation and measurement of operational risk proved necessary with the implementation of new operational risk management strategies in companies and financial institutions. Basel Committee on Banking Supervision recommendations, which request banks to use quantitative methods in their operational risk management are an additional motivation to use quantitative methods of estimating operational risk. This article reviews the most important quantitative methods of estimating and measuring operational risk.

Inconsistencies in Risk Analyses for Ambient Air Pollutant Regulations.

This article describes inconsistencies between health risk analyses that the U.S. Environmental Protection Agency (EPA) uses to support its decisions on primary National Ambient Air Quality Standards (NAAQS), and in the associated Regulatory Impact Analyses (RIAs) that accompany each NAAQS rulemaking. Quantitative risk estimates are prepared during the NAAQS-setting deliberations using inputs derived from statistical associations between measured pollutant concentrations and health effects. The resulting risk estimates are not directly used to set a NAAQS, but incorporated into a broader evidence-based rationale for the standard that is intended to demonstrate conformity with the statutory requirement that primary NAAQS protect the public health with a margin of safety. In a separate process, EPA staff rely on the same risk calculations to prepare estimates of the benefits of the rule that are reported in its RIA for the standard. Although NAAQS rules and their RIAs are released simultaneously, the rationales used to set the NAAQS have become inconsistent with their RIAs' estimates of benefits, with very large fractions of RIAs' risk-reduction estimates being attributed to populations living in areas that will already be attaining the respective NAAQS. This article explains the source of this inconsistency and provides a quantitative example based on the 2012 revision of the fine particulate matter (PM2.5 ) primary NAAQS. This article also demonstrates how this inconsistency is amplified when criteria pollutant co-benefits are calculated in RIAs for non-NAAQS rules, using quantitative examples from the 2011 Mercury and Air Toxics Standards and the currently proposed Clean Power Plan.

One-Carbon Metabolic Factors and Risk of Renal Cell Cancer: A Meta-Analysis.

BackgroundNutrients related to one-carbon metabolism were previously shown to be significantly associated with the risk of cancer. The aim of this meta-analysis was to evaluate potential relationships between one-carbon metabolic factors and renal cell cancer (RCC) risk.MethodsPubMed, EMBASE, and Cochrane Library databases were searched through March 2015 for observational studies of quantitative RCC risk estimates in relation to one-carbon metabolic factors. The relative risks (RRs) with 95% confidence intervals (CIs) measured the relationship between one-carbon metabolic factors and RCC risk using a random-effects model.ResultsOf the 463 citations and abstracts identified by database search, seven cohorts from five observational studies reported data on 133,995 individuals, and included 2,441 RCC cases. Comparing the highest with the lowest category, the pooled RRs of RCC were 0.72 (95%CI: 0.52–1.00; P = 0.048) for vitamin B12. In addition, an increase in folic acid supplementation of 100 μg/day was associated with a 3% lower risk of RCC (RR, 0.97; 95%CI: 0.93–1.00; P = 0.048). Similarly, an increase of 5 nmol/L of vitamin B2 was associated with a reduced risk of RCC 0.94 (95%CI: 0.89–1.00; P = 0.045). Sensitivity analyses suggested that a higher serum vitamin B6 might contribute to a reduced risk of RCC (RR, 0.83; 95%CI: 0.77–0.89; P < 0.001).ConclusionsHigher levels of serum vitamin B2, B6, B12, and folic acid supplementation lowered the risk of RCC among the study participants.

Characterization and risk assessment of polycyclic aromatic hydrocarbons (PAHs) in urban atmospheric Particulate of Tehran, Iran.

In this study, atmospheric concentrations of particulate-bound polycyclic aromatic hydrocarbons (PAHs) in Tehran megacity were determined to investigate the concentration, distribution, and sources of PAHs in PM10. The health risk from exposure to airborne BaPeq through inhalation pathway was also assessed. Toxic equivalency factors (TEFs) approach was used for quantitative risk estimate, and incremental lifetime cancer risk (ILCR) was calculated. PM10 samples were collected at ten sampling locations during the summer 2013 and winter 2014 by using two independent methods of field sampling. The PM10 concentration in winter (89.55 ± 15.56μgm(-3)) was 1.19 times higher than that in summer (75.42 ± 14.93μgm(-3)). Sixteen PAHs were measured with the total average concentrations of PAHs ranged from 56.98 ± 15.91 to 110.35 ± 57.31ngm(-3) in summer and from 125.87 ± 79.02 to 171.25 ± 73.94ngm(-3) in winter which were much higher than concentrations measured in most similar studies conducted around the world. Molecular diagnostic ratios were used to identify PAH emission sources. The results indicated that gasoline-driven vehicles are the major sources of PAHs in the study area. Risk analysis showed that the mean and 90% probability estimated inhalation ILCRs were 7.85 × 10(-6) and 16.78 × 10(-6), respectively. Results of a sensitivity analysis indicated that BaP concentration and cancer slope factor (CSF) contributed most to effect on ILCR mean.

Status of CO2storage in deep saline aquifers with emphasis on modeling approaches and practical simulations

Carbon capture and storage (CCS) is the only viable technology to mitigate carbon emissions while allowing continued large-scale use of fossil fuels. The storage part of CCS involves injection of carbon dioxide, captured from large stationary sources, into deep geological formations. Deep saline aquifers have the largest identified storage potential, with estimated storage capacity sufficient to store emissions from large stationary sources for at least a century. This makes CCS a potentially important bridging technology in the transition to carbon-free energy sources. Injection of CO2 into deep saline aquifers leads to a multicomponent, multiphase flow system, in which geomechanics, geochemistry, and nonisothermal effects may be important. While the general system can be highly complex and involve many coupled, nonlinear partial differential equations, the underlying physics can sometimes lead to important simplifications. For example, the large density difference between injected CO2 and brine may lead to relatively fast buoyant segregation, making an assumption of vertical equilibrium reasonable. Such simplifying assumptions lead to a range of simplified governing equations whose solutions have provided significant practical insights into system behavior, including improved estimates of storage capacity, easy-to-compute estimates of CO2 spatial migration and pressure response, and quantitative estimates of leakage risk. When these modeling studies are coupled with observations from well-characterized injection operations, understanding of the overall system behavior is enhanced significantly. This improved understanding shows that, while economic and policy challenges remain, CO2 storage in deep saline aquifers appears to be a viable technology and can contribute substantially to climate change solutions.

Equine infectious anaemia and mechanical transmission: man and the wee beasties.

There is no credible evidence that the lentivirus that causes equine infectious anaemia (EIA) replicates in invertebrates. The virus persistently infects its equid hosts and is often present in blood in significant quantities. Blood-feeding arthropods thus have the potential to transfer the virus between hosts, especially if their feeding on the first host is interrupted and immediately continued on a second host. The general details and dynamics of mechanical transmission are included in this paper, as this agent presents an excellent model. Mechanical transmission can be effectively controlled if the dynamics and interactions of the host, virus and vector populations are understood. Efficient transmission is proportional to the amount of agent found in the source material, the environmental survival of the agent, the number of vector feedings, the number of interrupted feedings, vector refeeding, the proximity of infected and naive hosts, host population density, and the length of time during which vectors and hosts are in contact. Establishing firm quantitative risk estimates for EIA is impossible, mainly because the virus content in blood can change exponentially from day to day. The EIA virus can be transmitted by horse flies for at least 30 minutes after feeding on a horse with acute signs of EIA, butthe probability of a horse fly being interrupted and completing its blood feeding on a second host at a distance of 50 m is very low, and the separation of infected and uninfected equids by 200 m breaks transmission. The statements above assume that human interactions are absent or do not contribute to the risk of virus transmission; however, the risk from human interventions, such as the too-often-used procedure of administering > 200 ml of plasma to foals, can easily be more than 10(7) times greater than the risk posed by a single horse fly. Controlling EIA depends upon the identification of persistently infected equids by serological testing because other methods of identifying infective virus orviral genetic material are less accurate or impractical.

Effects of personalized colorectal cancer risk information on laypersons’ interest in colorectal cancer screening: The importance of individual differences

ObjectiveTo evaluate how personalized quantitative colorectal cancer (CRC) risk information affects laypersons’ interest in CRC screening, and to explore factors influencing these effects. MethodsAn online pre-post experiment was conducted in which a convenience sample (N=578) of laypersons, aged >50, were provided quantitative personalized estimates of lifetime CRC risk, calculated by the National Cancer Institute Colorectal Cancer Risk Assessment Tool (CCRAT). Self-reported interest in CRC screening was measured immediately before and after CCRAT use; sociodemographic characteristics and prior CRC screening history were also assessed. Multivariable analyses assessed participants’ change in interest in screening, and subgroup differences in this change. ResultsPersonalized CRC risk information had no overall effect on CRC screening interest, but significant subgroup differences were observed. Change in screening interest was greater among individuals with recent screening (p=.015), higher model-estimated cancer risk (p=.0002), and lower baseline interest (p<.0001), with individuals at highest baseline interest demonstrating negative (not neutral) change in interest. ConclusionEffects of quantitative personalized CRC risk information on laypersons’ interest in CRC screening differ among individuals depending on prior screening history, estimated cancer risk, and baseline screening interest. Practice implicationsPersonalized cancer risk information has personalized effects—increasing and decreasing screening interest in different individuals.

Evaluating Evidence for Association of Human Bladder Cancer with Drinking-Water Chlorination Disinfection By-Products

Exposure to chlorination disinfection by-products (CxDBPs) is prevalent in populations using chlorination-based methods to disinfect public water supplies. Multifaceted research has been directed for decades to identify, characterize, and understand the toxicology of these compounds, control and minimize their formation, and conduct epidemiologic studies related to exposure. Urinary bladder cancer has been the health risk most consistently associated with CxDBPs in epidemiologic studies. An international workshop was held to (1) discuss the qualitative strengths and limitations that inform the association between bladder cancer and CxDBPs in the context of possible causation, (2) identify knowledge gaps for this topic in relation to chlorine/chloramine-based disinfection practice(s) in the United States, and (3) assess the evidence for informing risk management. Epidemiological evidence linking exposures to CxDBPs in drinking water to human bladder cancer risk provides insight into causality. However, because of imprecise, inaccurate, or incomplete estimation of CxDBPs levels in epidemiologic studies, translation from hazard identification directly to risk management and regulatory policy for CxDBPs can be challenging. Quantitative risk estimates derived from toxicological risk assessment for CxDBPs currently cannot be reconciled with those from epidemiologic studies, notwithstanding the complexities involved, making regulatory interpretation difficult. Evidence presented here has both strengths and limitations that require additional studies to resolve and improve the understanding of exposure response relationships. Replication of epidemiologic findings in independent populations with further elaboration of exposure assessment is needed to strengthen the knowledge base needed to better inform effective regulatory approaches.

An Improved Estimation of Multiple-Point Fault Probabilities if the Faults Have Different Periodic Latencies

Fault tree analysis (FTA), reliability block diagrams (RBD) and event tree analysis (ETA) are established methods for assessing potential risks of hazardous events, in particular when resulting from coincidental events. Combining the Boolean algebra, probability theory and reliability data, they allow quantitative estimation of intrinsic risks from technical equipment like machinery control, aerospace systems or vehicle functions, among many others.&#x0D; The quantitative reliability theory was mainly developed between the 1960s and the 1980s. At that time, simplifications and approximations for the mathematical formulae were needed to achieve calculation results within acceptable time, regarding restricted computer resources.&#x0D; Our investigation revealed that some of these simplifications and approximations, often assumed as precise calculations in secondary literature, can lead to wrong results in quantitative risk assessment. When faults are combined, and individual latency periods exist, the currently established approximations may lead to results which are too optimistic in comparison with a precise probabilistic approach.&#x0D; This publication proposes a new approximation for the computation of the related probabilities. The approach provides an upper-bound estimation. Using the developed formulae, the under-estimation of multipleevent probabilities can be avoided.&#x0D; In addition, certain vagueness and over-simplification in the probabilistic treatment of events with latency periods can be eliminated. Examples of related shortcomings in the literature can be found, down to the early roots of reliability theory.

Long-Term Outcome After Resection of Huge Hepatocellular Carcinoma ≥ 10 cm: Single-Institution Experience with 471 Patients.

Tumor recurrence is very common after resection of huge hepatocellular carcinoma (HCC). This study intended to evaluate early recurrence and long-term outcomes in patients with huge HCC ≥ 10 cm after primary resection and treatment of recurrence. Recurrence and survival outcomes were retrospectively evaluated in 471 patients with huge HCCs who underwent resection between January 2000 and April 2012. Mean tumor diameter was 13.6 ± 3.1 cm, with 93 % of patients having single tumors. Anatomic and R0 resection rates were 91.1 and 89.4 %, respectively. Perioperative mortality rate was 1.7 %. Tumor recurrence and patient survival rates were 62.2 and 69.2 % at 1 year and 76.0 and 35.5 % at 5 years, respectively. Of patients with recurrence, 92.5 % received specific treatment. Median patient survival period after initial intrahepatic recurrence was 16 months. Tumor volume did not affect recurrence or survival outcomes. Independent risk factors for tumor recurrence and patient survival were serum alpha-fetoprotein ≥ 100 ng/mL, hypermetabolic uptake on positron emission tomography, satellite nodules, and microvascular invasion. These four factors were used to develop a risk prediction model, in which 1-year HCC recurrence rates in patients with 0, 1, 2, 3, and 4 risk factors were 18.7, 30.3, 58.7, 79.0, and 92.1 %, respectively, and their 1-year patient survival rates were 100, 97.0, 75.5, 63.9, and 42.1 %, respectively. In patients with huge HCCs, hepatic resection with active recurrence treatment resulted in improved long-term survival. Our 4-factor risk prediction model appears to contribute to quantitative postoperative risk estimation for early HCC recurrence and patient survival in patients with HCC ≥ 10 cm.

Quantitative Evaluation of the Environmental Impact Quotient (EIQ) for Comparing Herbicides.

Various indicators of pesticide environmental risk have been proposed, and one of the most widely known and used is the environmental impact quotient (EIQ). The EIQ has been criticized by others in the past, but it continues to be used regularly in the weed science literature. The EIQ is typically considered an improvement over simply comparing the amount of herbicides applied by weight. Herbicides are treated differently compared to other pesticide groups when calculating the EIQ, and therefore, it is important to understand how different risk factors affect the EIQ for herbicides. The purpose of this work was to evaluate the suitability of the EIQ as an environmental indicator for herbicides. Simulation analysis was conducted to quantify relative sensitivity of the EIQ to changes in risk factors, and actual herbicide EIQ values were used to quantify the impact of herbicide application rate on the EIQ Field Use Rating. Herbicide use rate was highly correlated with the EIQ Field Use Rating (Spearman’s rho >0.96, P-value <0.001) for two herbicide datasets. Two important risk factors for herbicides, leaching and surface runoff potential, are included in the EIQ calculation but explain less than 1% of total variation in the EIQ. Plant surface half-life was the risk factor with the greatest relative influence on herbicide EIQ, explaining 26 to 28% of the total variation in EIQ for actual and simulated EIQ values, respectively. For herbicides, the plant surface half-life risk factor is assigned values without any supporting quantitative data, and can result in EIQ estimates that are contrary to quantitative risk estimates for some herbicides. In its current form, the EIQ is a poor measure of herbicide environmental impact.

Assessment of lead pollution in topsoils of a southern Italy area: Analysis of urban and peri-urban environment

Exposure to lead (Pb) may affect adversely human health. Mapping soil Pb contents is essential to obtain a quantitative estimate of potential risk of Pb contamination. The main aim of this paper was to determine the soil Pb concentrations in the urban and peri-urban area of Cosenza–Rende to map their spatial distribution and assess the probability that soil Pb concentration exceeds a critical threshold that might cause concern for human health. Samples were collected at 149 locations from residual and non-residual topsoil in gardens, parks, flower-beds, and agricultural fields. Fine earth fraction of soil samples was analyzed by X-ray Fluorescence spectrometry. Stochastic images generated by the sequential Gaussian simulation were jointly combined to calculate the probability of exceeding the critical threshold that could be used to delineate the potentially risky areas. Results showed areas in which Pb concentration values were higher to the Italian regulatory values. These polluted areas were quite large and likely, they could create a significant health risk for human beings and vegetation in the near future. The results demonstrated that the proposed approach can be used to study soil contamination to produce geochemical maps, and identify hot-spot areas for soil Pb concentration.

Impact of smoking on the risk of pancreatitis: a systematic review and meta-analysis.

Background and objectiveCigarette smoking may increase the risk of developing pancreatic cancer, although its impact on pancreatitis has only been discerned in recent years. However, the results of previous studies differ. We performed a meta-analysis to provide a quantitative pooled risk estimate of the association of cigarette smoking with pancreatitis.MethodA literature search of the MEDLINE and Embase databases was conducted, and studies were selected that investigated the association of cigarette smoking with pancreatitis. Summary relative risks (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model.ResultsTwenty-two studies were included. The summary RRs (95% CI) associated with ever, current and former smokers for acute and chronic pancreatitis (AP/CP) were as follows: 1.51 (1.10, 2.07)/3.00 (1.46, 6.17), 1.42 (1.08, 1.87)/2.72 (1.74, 4.24), and 1.22 (0.99, 1.52)/1.27 (1.00, 1.62), respectively. Moreover, studies that analyzed both AP and CP were also summarized: 1.73 (1.18, 2.54) for ever smokers, 1.67 (1.03, 2.68) for current smokers and 1.56 (1.16, 2.11) for former smokers, respectively. There was no evidence of publication bias across the studies.ConclusionThe evidence suggests a positive association of cigarette smoking with the development of pancreatitis. It is possible that smoking cessation may be a useful strategy for the management of pancreatitis.