Risk Ratio Values Research Articles

Incidence, risk factors and outcomes of nosocomial infection in adult patients supported by extracorporeal membrane oxygenation: a systematic review and meta-analysis

BackgroundAn increasing number of patients requires extracorporeal membrane oxygenation (ECMO) for life support. This supportive modality is associated with nosocomial infections (NIs). This systematic review and meta-analysis aim to assess the incidence and risk factors of NIs in adult.MethodsWe searched PubMed, Scopus, Web of Science, and ProQuest databases up to 2022. The primary endpoint was incidence of NI. Secondary endpoints included time to infection, source of infection, ECMO duration, Intensive care and hospital length of stay (LOS), ECMO survival and overall survival. Incidence of NI was reported as pooled proportions and 95% confidence intervals (CIs), while dichotomous outcomes were presented as risk ratios (RR) as the effective index and 95% CIs using a random-effects model.ResultsAmong the 4,733 adult patients who received ECMO support in the 30 included studies, 1,249 ECMO-related NIs per 1000 ECMO-days was observed. The pooled incidence of NIs across 18 studies involving 3424 patients was 26% (95% CI 14–38%).Ventilator-associated pneumonia (VAP) and bloodstream infections (BSI) were the most common NI sources. Infected patients had lower ECMO survival and overall survival rates compared to non-infected patients, with risk ratio values of 0.84 (95% CI 0.74–0.96, P = 0.01) and 0.80 (95% CI 0.71–0.90, P < 0.001), respectively.ConclusionResults showed that 16% and 20% lower of ECMO survival and overall survival in patients with NI than patients without NI, respectively. However, NI increased the risk of in-hospital mortality by 37% in infected patients compared with non-infected patients. In addition, this study identified the significant positive correlation between ECMO duration and ECMO-related NI.

Electrocardiogram prediction of atrial fibrillation risk after stroke: A protocol for systematic review and meta-analysis.

Atrial fibrillation (AF) is one of the most common clinical arrhythmias. This study aims to predict the risk of post-stroke AF through electrocardiographic changes in sinus rhythm. We searched the MEDLINE (PubMed) and EMBASE databases to identify relevant research articles published until August 2023. Prioritized items from systematic reviews and meta-analyses were screened, and data related to AF detection rate were extracted. A meta-analysis using a random-effects model was conducted for data synthesis and analysis. A total of 32 studies involving electrocardiograms (ECG) were included, with a total analysis population of 330,284 individuals. Among them, 16,662 individuals (ECG abnormal group) developed AF, while 313,622 individuals (ECG normal group) did not. ECG patterns included terminal P-wave terminal force V1, interatrial block (IAB), advanced interatrial block, abnormal P-wave axis, pulse rate prolongation, and atrial premature complexes. Overall, 15,762 patients experienced AF during the study period (4.77%). In the ECG abnormal group, the proportion was 14.21% (2367/16,662), while in the control group (ECG normal group), the proportion was 4.27% (13,395/313,622). The pooled risk ratio for developing AF was 2.45 (95% confidence interval [CI]: 2.02-2.98, P < .001), with heterogeneity (I2) of 95%. The risk ratio values of alAB, P-wave terminal force V1, interatrial block, abnormal P-wave axis, pulse rate prolongation and atrial premature complexes were 4.12 (95% CI, 2.99-5.66), 1.47 (95% CI, 1.19-1.82), 2.54 (95% CI, 1.83-3.52), 1.70 (95% CI, 0.98-2.97), 2.65 (95% CI, 1.88-3.72), 3.79 (95% CI, 2.12-6.76), respectively. There is a significant correlation between ECG patterns and the occurrence of AF. The alAB exhibited the highest level of predictability for the occurrence of AF. These indicators support their use as screening tools to identify high-risk individuals who may benefit from further examinations or empirical anticoagulation therapy following stroke.

Association between Statins Administration and Influenza Susceptibility: A Systematic Review and Meta-Analysis of Longitudinal Studies.

Previous studies reported that the association between statins use and influenza infection was contradictory. A systematic review and meta-analysis of longitudinal studies were performed to determine the association between statins use and influenza susceptibility. The literature search was conducted in PubMed, Embase, and Web of Science, from each database's inception to 21 May 2023. The fixed effect model and random effects model were used for data synthesis. In our study, a total of 1,472,239 statins users and 1,486,881 statins non-users from five articles were included. The pooled risk ratio (RR) of all included participants was 1.05 (95% CI: 1.03-1.07), and there were still significant differences after adjusting for vaccination status. Of note, RR values in statins users were 1.06 (95% CI: 1.03-1.08) in people aged ≥60 years old and 1.05 (95% CI: 1.03-1.07) in participant groups with a higher proportion of females. Administration of statins might be associated with an increased risk of influenza infection, especially among females and elderly people. For those people using statins, we should pay more attention to surveillance of their health conditions and take measures to prevent influenza infection.

Treatments for Trauma-Induced Coagulopathy: Protocol for a Systematic Review and Meta-Analysis.

Trauma-induced coagulopathy (TIC) is a common and potentially life-threatening coagulopathy as a result of traumatic injury, characterized by abnormal blood clotting and bleeding. Although several treatments have been proposed for TIC, their effectiveness and safety remain unclear. Further, numerous systematic reviews and meta-analyses on trauma have been conducted; however, to our knowledge, there is no systematic review and meta-analysis that specifically focuses on TIC management. Therefore, a comprehensive synthesis of the available evidence on interventions for TIC is needed. This systematic review and meta-analysis aim to evaluate the effectiveness and safety of interventions for the management of TIC. We will conduct a systematic review and meta-analysis of randomized and nonrandomized controlled trials as well as observational studies regarding severe trauma in patients with TIC. The interventions will include administration of coagulation factor concentrates, tranexamic acid, and blood component products. The control group will be managed with an ordinal transfusion or administered placebo. The primary outcome will be in-hospital mortality. We will search the electronic databases of MEDLINE (PubMed), Web of Science, and the Cochrane Central Register of Controlled Trials. Two reviewers will independently screen the titles and abstracts, retrieve the full text of the selected articles, and extract essential data. We will apply uniform criteria for evaluating the risk of bias associated with individual randomized controlled trials and nonrandomized trials based on the Cochrane risk-of-bias tool. Risk ratio values will be expressed as point estimates with 95% CIs. Continuous variables will be expressed as the mean difference along with their 95% CIs and P values. We will assess the strength of evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. This review will be the first systematic review and meta-analysis providing information on the effectiveness and safety of interventions for the management of TIC, including the administration of coagulation factor concentrates, tranexamic acid, and blood component products. Ethics approval and patient consent were not required for this study protocol, as we conducted a systematic review and meta-analysis of publicly available data, without any direct involvement of human participants. We will summarize the selection of the eligible studies using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. The results will be presented in a table summarizing the evidence. The results of the meta-analysis will be depicted using figures and forest plots. This systematic review will provide updated information on the efficacy and safety of using coagulation factor concentrates, tranexamic acid, and blood component products for patients with TIC. To our knowledge, there is no systematic review and meta-analysis that specifically focuses on treatments for TIC. UMIN registry UMIN000050170; https://tinyurl.com/yr8pcrj6. DERR1-10.2196/49582.

Climate attribution time series track the evolution of human influence on North Pacific sea surface temperature

We apply climate attribution techniques to sea surface temperature time series from five regional North Pacific ecosystems to track the growth in human influence on ocean temperatures over the past seven decades (1950–2022). Using Bayesian estimates of the Fraction of Attributable Risk (FAR) and Risk Ratio (RR) derived from 23 global climate models, we show that human influence on regional ocean temperatures could first be detected in the 1970s and grew until 2014–2020 temperatures showed overwhelming evidence of human contribution. For the entire North Pacific, FAR and RR values show that temperatures have reached levels that were likely impossible in the preindustrial climate, indicating that the question of attribution is already obsolete at the basin scale. Regional results indicate the strongest evidence for human influence in the northernmost ecosystems (Eastern Bering Sea and Gulf of Alaska), though all regions showed FAR values > 0.98 for at least one year. Extreme regional SST values that were expected every 1000–10 000 years in the preindustrial climate are expected every 5–40 years in the current climate. We use the Gulf of Alaska sockeye salmon fishery to show how attribution time series may be used to contextualize the impacts of human-induced ocean warming on ecosystem services. We link negative warming effects on sockeye fishery catches to increasing human influence on regional temperatures (increasing FAR values), and we find that sockeye salmon migrating to sea in years with the strongest evidence for human effects on temperature (FAR ⩾ 0.98) produce catches 1.4 standard deviations below the long-term log mean. Attribution time series may be helpful indicators for better defining the human role in observed climate change impacts, and may thus help researchers, managers, and stakeholders to better understand and plan for the effects of climate change.

Metabolic-associated fatty liver disease and risk of esophagogastric cancer: a systematic review and meta-analysis.

Metabolic-associated fatty liver disease (MAFLD) has been found to be strongly linked to several diseases. Although previous studies have explored the association between MAFLD and extrahepatic cancers, research on the relationship between MAFLD and gastric carcinoma (GC) and esophageal carcinoma (EC) is relatively scarce and requires updating. Therefore, the objective of this study is to conduct a comprehensive investigation into the association between MAFLD and GC or EC. We conducted a comprehensive search for relevant studies published up to 5 August 2022, using the PubMed, Embase and Web of Science databases. To estimate the risk ratio (RR) and the 95% confidence interval (CI), we employed a random-effects model. We also conducted subgroup analyses based on study characteristics. The protocol for this systematic review is registered in the Prospero database under the registration number CRD42022351574. Our analysis included eight eligible studies, comprising a total of 8 629 525 participants. We found that the pooled RR values for the risk of GC in patients with MAFLD were 1.49 (95%CI: 1.17-1.91), whereas the pooled RR values for the risk of EC in patients with MAFLD were 1.76 (95%CI: 1.34-2.32). Based on our meta-analysis, we conclude that there is a significant association between the presence of MAFLD and the development of GC and EC.

Meta‑analysis of the efficacy and safety of nifekalant in the conversion of atrial fibrillation.

Atrial fibrillation (AF) is the most common type of supraventricular tachyarrhythmia. Nifekalant is a new class III antiarrhythmic drug approved for the treatment of ventricular tachyarrhythmias, but its effectiveness in converting AF to sinus rhythm remains unclear. The present analysis aimed to investigate the effect of nifekalant in the conversion of AF. PubMed, Cochrane Library and China National Knowledge Infrastructure databases were systematically used to search relevant studies published between 1999 (data at which the drug was first approved for marketing in Japan) and 2022. Randomized clinical trials, prospective studies and retrospective studies on the use of nifekalant for AF were screened. The study metrics included the success rate of the conversion of AF, the mean time to conversion, the success rate of 12 months after a single AF catheter ablation procedure and the incidence of adverse events. The eligible studies screened included six randomized clinical trials, three prospective studies and three retrospective studies, totalling 12 studies with 1,162 patients. The risk ratio (RR) for successful conversion in the nifekalant and control groups was 1.95 [95% confidence interval (CI), 1.23-3.08; P=0.005] and the mean difference for the mean time to conversion was -1.73 [95% CI, -2.69-(-0.77); P=0.0004]. Statistically significant differences were observed between nifekalant and control groups. Subgroup analysis revealed a statistically significant difference in the success rate of conversion following catheter ablation in the nifekalant group compared with the amiodarone group and the RR value was 1.95 (95% CI, 1.37-2.77; P=0.0002). Statistically significant difference was observed compared with the electrical cardioversion group and the RR value was 0.90 (95% CI, 0.84-0.98; P=0.01). However, the combined RR values for the two groups were 1.18 (95% CI, 0.85-1.65; P<0.0002). The RR value for adverse events was 0.85 (95% CI, 0.51-1.43; P=0.55), with no statistically significant differences between nifekalant and control groups. In conclusion, the results demonstrated that the success rate and time to conversion in the nifekalant group were improved compared with those in the control group, particularly after catheter ablation, and the conversion effect with nifekalant was significantly improved compared with that in the control group.

Analysis and Comparison of Early Childhood Nutritional Outcomes Among Offspring of Chinese Women Under the Chinese 2021 and US 2009 Gestational Weight Gain Guidelines

In 2009, the US National Academy of Medicine (NAM) released revised gestational weight gain (GWG) guidelines, which were established primarily for White North American women and may be unsuitable for Asian women. In 2021, the Chinese Nutrition Society (CNS) released its GWG guidelines, but their applicability requires re-examination. To compare the differences between the CNS and NAM recommendations for GWG in association with health outcomes in the offspring of Chinese women. In this bidirectional cohort study, children in China were recruited at age 3 years from 2017 to 2018, with 2 follow-up visits over the next 2 years (between September 2017 and September 2020). Information during pregnancy was retrieved from medical records. Data analysis was performed from October 2021 to January 2022. GWG was classified as insufficient, appropriate, or excessive according to the CNS and NAM guidelines separately. Children's height, weight, fat mass, fat-free mass, and percentage of body fat were measured at each visit. Body mass index, fat mass index, fat-free mass index, weighted κ score, risk ratio values, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. A total of 3822 children (1996 boys and 1826 girls; mean [SD] age, 3.79 [0.30] years) were enrolled; after exclusions, 3170 term singleton children were recruited and were followed at 4 and 5 years of age. According to the CNS guidelines, the prevalence rates were 14.1% for insufficient GWG, 48.1% for appropriate GWG, and 37.9% for excessive GWG, whereas the rates according to NAM guidelines were 39.7% for insufficient GWG, 37.2% for appropriate GWG, and 23.1% for excessive GWG. The weighted κ value for the classification agreement between the 2 guidelines was 0.530 (95% CI, 0.510-0.550). For the appropriate GWG group, the rates for low nutritional levels did not differ between the 2 guidelines, but the rates for high nutritional levels were significantly lower under CNS guidelines than under NAM guidelines. When the sensitivity, specificity, PPV, and NPV with respect to the mothers who maintained appropriate GWG were used to estimate the nonhigh nutritional status of their offspring, generally higher values based on the CNS guidelines were found compared with those based on the NAM recommendations. These findings suggest that the GWG recommendations promulgated by the NAM are higher than the CNS guidelines, with the latter more suitable for Chinese women.

Association between Prescribers' Perceptions of the Utilization of Medication for Opioid Use Disorder and Opioid Dependence Treatability.

Background: Medication for opioid use disorder (MOUD) has been proven to be effective, yet the perceptions or beliefs of prescribers of MOUD may have a substantial impact on their prescribing and dispensing of MOUD and their patients’ accessibility and utilization of MOUD services. We examined the associations of the perceptions of medical and pharmacy professionals regarding MOUD with sociodemographic characteristics, personal experiences with substance use disorders, and perceptions of opioid treatment. Method: Data were collected via telephone or online survey from March to August 2021, in Texas, to assess medical and pharmacy professionals’ perceptions of MOUD. Our sample included 542 participants who completed the survey. A multinomial logistic regression analysis was conducted to assess perceptions of MOUD, its use, and their correlates. Results: The participants had a mean age of 35 years (SD = 7.13) and had worked, on average, 6.90 years (SD = 5.37) in their current positions. The majority of the participants were males (50.93%) and medical professionals (82.01%). More than one third of the participants believed MOUD did not lead to abstinence or recovery (36.16%). Those who had personal experiences with a substance use disorder were more likely to believe that MOUD could be a replacement drug for previously misused substance(s) (RRR = 2.06, 95% CI = 1.19, 3.59) and that MOUD did not lead to abstinence or recovery (RRR = 2.34, 95% CI = 1.40, 3.91). However, the risk ratio values were lower for those who believed that a stigma against MOUD was a barrier for patients initiating and adhering to MOUD (MOUD is a replacement drug for previously misused substances (initiation RRR = 0.43, 95% CI = 0.19, 0.93 and adhering RRR = 0.30, 95% CI = 0.13, 0.71) or MOUD does not lead to abstinence or recovery (initiation RRR = 0.26, 95% CI = 0.13, 0.54 and adhering RRR = 0.36, 95% CI = 0.17, 0.78)). The various perceptions of the utilization of MOUD were not statistically different between medical and pharmacy professionals. Conclusion: Perceptions, experience with substance use disorder, and stigma against the utilization of MOUD influenced negative perceptions about MOUD. An innovative strategy is needed to improve medical and pharmacy professionals’ perceptions of MOUD, while efforts are being made to promote the use of MOUD for patients with opioid use disorders.

Age-Associated Risk of Liver-Related Adverse Drug Reactions.

ObjectiveAging population is generally considered more sensitive to adverse drug reactions (ADRs). Yet, big data-based quantitative evidence currently does not exist to support this concept. This study aims to investigate age-associated risks of liver-related ADR (L-ADR).MethodsSpontaneous reporting data from 2012 to 2016 were retrieved from the China National ADR Monitoring System. The risk ratio (RR) was used to quantify the relative risk of L-ADR of each age group. The reporting odds ratio (ROR) was used to quantify the correlation with the risk of L-ADR of each drug category or drug in older adults.ResultsTotally, 64,702 L-ADR reports were retrieved, covering ages from 1 to 116, with a median age of 49. The RR values increased exponentially with the increase of age, which indicates that the relative risk of L-ADR increased by 33% for every 10-year increase in age. The age cutoff point for relative high risk of L-ADR was estimated at 52.0 years old (RR = 1). In 17 categories composed of 270 drugs, the top 3 drug categories with a high correlation to the risk of L-ADR in older adults were antiarrhythmic (ROR, 5.75; 95% CI: 4.45–7.42), antilipemic (ROR, 4.77; 95% CI: 4.53–5.02), and antihypertensive (ROR, 2.97; 95% CI: 2.59–3.41).ConclusionsThis research illustrates quantitatively that aging is a potential risk factor for L-ADR, with a 33% increase in relative risk for every 10-year increase in age. Risk management should be addressed for older adults when those drugs with a high correlation to the risk of L-ADR are used.

Whether Immunostimulants Are Effective in Susceptible Children Suffering From Recurrent Respiratory Tract Infections: A Modeling Analysis Based on Literature Aggregate Data.

Immunostimulants are gradually being used in the prevention and treatment of recurrent respiratory tract infections in susceptible children, but their drug effects have not been quantified. The purpose of this study was to confirm the efficacy of immunostimulants in the prevention and treatment of recurrent respiratory tract infections in susceptible children. A model-based meta-analysis was used to describe the time course of placebo and immunostimulants in the prevention of respiratory tract infections in children. The cumulative number of respiratory tract infections was used as an indicator of efficacy. A meta-analysis was used to analyze the incidence of drug-related adverse events. Fourteen articles with 2400 pediatric subjects were finally included in the analysis. The results showed that the cumulative number of respiratory tract infections increased linearly with time, with the incidence of respiratory tract infections in the placebo group being 0.65 (95% confidence interval [CI], 0.55-0.75) per month. OM-85 BV and pidotimod reduced the incidence of respiratory tract infections by 0.21 (95%CI, 0.16-0.26) and 0.19 (95%CI, 0.17-0.21) compared to placebo per month, respectively. Pidotimod and OM-85 BV can effectively reduce the incidence of respiratory tract infections in susceptible children, with no significant increase in the incidence of drug-related adverse events when compared with placebo (risk ratio values were 1.07 [95%CI, 0.66-1.71] and 1.31 [95%CI, 0.54-3.19], respectively). This study provides quantitative support for the application of immunostimulants for the prevention of recurrent respiratory tract infections in children.

Incidence of Recurrent Exertional Heat Stroke in a Warm-Weather Road Race

Background and Objectives: Exertional heat stroke (EHS) survivors may be more susceptible to subsequent EHS; however, the occurrence of survivors with subsequent EHS episodes is limited. Therefore, the purpose of this study was to evaluate the incidence of participants with repeated EHS (EHS-2+) cases in a warm-weather road race across participation years compared to those who experienced 1 EHS (EHS-1). Materials and Methods: A retrospective observational case series design was utilized. Medical record data from 17-years at the Falmouth Road Race between 2003–2019 were examined for EHS cases. Incidence of EHS-2+ cases per race and average EHS cases per EHS-2+ participant were calculated (mean ± SD) and descriptive factors (rectal temperature (TRE), finish time (FT), Wet Bulb Globe Temperature (WBGT), age, race year) for each EHS was collected. Results: A total of 333 EHS patients from 174,853 finishers were identified. Sixteen EHS-2+ participants (11 males, 5 females, age = 39 ± 16 year) accounted for 11% of the total EHS cases (n = 37/333). EHS-2+ participants had an average of 2.3 EHS cases per person (range = 2–4) and had an incidence rate of 2.6 EHS per 10 races. EHS-2+ participants finished 93 races following initial EHS, with 72 of the races (77%) completed without EHS incident. Initial EHS TRE was not statistically different than subsequent EHS initial TRE (+0.3 ± 0.9 °C, p > 0.050). Initial EHS-2+ participant FT was not statistically different than subsequent EHS FT (−4.2 ± 7.0 min, p > 0.050). The years between first and second EHS was 3.6 ± 3.5 year (Mode: 1, Range: 1–12). Relative risk ratios revealed that EHS patients were at a significantly elevated risk for subsequent EHS episodes 2 years following their initial EHS (relative risk ratio = 3.32, p = 0.050); however, the risk from 3–5 years post initial EHS was not statistically elevated, though the relative risk ratio values remained above 1.26. Conclusions: These results demonstrate that 11% of all EHS cases at the Falmouth Road Race are EHS-2+ cases and that future risk for a second EHS episode at this race is most likely to occur within the first 2 years following the initial EHS incident. After this initial 2-year period, risk for another EHS episode is not significantly elevated. Future research should examine factors to explain individuals who are susceptible to multiple EHS cases, incidence at other races and corresponding prevention strategies both before and after initial EHS.

Effect of Genetic-Environmental Interaction on Chinese Childhood Myopia.

Objective The purpose of this study was to evaluate the effect of genetic-environmental interaction on myopia in Chinese children aged 6 to 9 years. Methods Students had the physical examination and were required to provide basic demographic information. Their families were asked to fill in a questionnaire concerning factors related to myopia. Multiple regression analysis was performed, and adjusted risk ratio values were calculated to assess the role between gene and environment. Value of the environmental and genetic index (EGI) was calculated to demonstrate the effect of genetic-environmental interaction on myopia. Results The prevalence of myopia maintained at a high level. EGI was calculated as 0.125 suggesting that genetic factors may play the 12.5% role in the formation of myopia and environmental factors may play a role of 87.5% in the formation of myopia. Conclusions For young pupils aged 6 to 9 years, myopia prevalence maintained at a high level, and duration of homework time and staring at electronic screen were the strongest factors associated with myopia. The calculated value of EGI was low, which suggests that environmental factors may play the leading role in the formation of myopia. A long-term follow-up research to improve the accuracy value of EGI is our next job.

Neighborhood-Level Social Disadvantage and Risk of Delirium Following Major Surgery.

Delirium is a common postoperative complication associated with prolonged length of stay, hospital readmission, and premature mortality. We explored the association between neighborhood-level characteristics and delirium incidence and severity, and compared neighborhood- with individual-level indicators of socioeconomic status in predicting delirium incidence. A prospective observational cohort of patients enrolled between June 18, 2010, and August 8, 2013. Baseline interviews were conducted before surgery, and delirium/delirium severity was evaluated daily during hospitalization. Research staff evaluating delirium were blinded to baseline cognitive status. Two academic medical centers in Boston, MA. A total of 560 older adults, aged 70 years or older, undergoing major noncardiac surgery. The Area Deprivation Index (ADI) was used to characterize each neighborhood's socioeconomic disadvantage. Delirium was assessed using the Confusion Assessment Method (CAM) long form. Delirium severity was calculated using the highest value of CAM Severity score (CAM-S) occurring during daily hospital assessments (CAM-S Peak). Residing in the most disadvantaged neighborhoods (ADI > 44) was associated with a higher risk of incident delirium (12/26; 46%), compared with the least disadvantaged neighborhoods (122/534; 23%) (risk ratio (RR) (95% confidence interval (CI)) = 2.0 (1.3-3.1). The CAM-S Peak score was significantly associated with ADI (Spearman rank correlation, ρ = 0.11; P = .009). Mean CAM-S Peak scores generally rose from 3.7 to 5.3 across levels of increasing neighborhood disadvantage. The RR (95% CI) values associated with individual-level markers of socioeconomic status and cultural background were: 1.2 (0.9-1.7) for education of 12 years or less; 1.3 (0.8-2.1) for non-White race; and 1.7 (1.1-2.6) for annual household income of less than $20,000. None of these individual-level markers exceeded the ADI in terms of effect size or significance for prediction of delirium risk. Neighborhood-level makers of social disadvantage are associated with delirium incidence and severity, and demonstrated an exposure-response relationship. Future studies should consider contextual-level metrics, such as the ADI, as risk markers of social disadvantage that can help to guide delirium treatment and prevention.

Effects of Weather on Traffic Collisions in Edmonton, Canada

Three years of hourly traffic collision data and associated weather data for the city of Edmonton, Alberta, Canada, were analyzed. Using a matched-pair analysis to compare periods of adverse weather with similar periods without adverse weather, the effect of weather on traffic collisions in Edmonton was assessed. Adverse weather took the form of strong winds (>35 km h−1), precipitation (>0.10 mm h−1), or limited visibility (<1.0 km). Risk ratio (RR) values were calculated to determine the relative increase in accidents resulting from each type of weather, as well as for multiple types of concurrent weather. Analysis was performed for collisions that resulted in property damage only (PDO) and severe collisions that resulted in injuries. To determine whether specific types of collisions were more likely to occur during adverse weather, RR values were determined for multiple types of collisions, such as following too closely or failing to stop at a traffic signal. Our results show that adverse weather affects traffic collisions in a variety of ways. Horizontal visibility less than 200 m and strong winds above 45 km h−1, while relatively infrequent in Edmonton, typically resulted in an increase in overall collisions (RR = 3.40 and 1.17, respectively). Precipitation, which is far more common to Edmonton, posed an increased risk to drivers. The type of precipitation was also clearly a factor. The RR value for PDO collisions was higher during periods of snowfall (1.90) than during periods of rainfall (1.28), but the RR value for collisions resulting in injuries (1.37) was higher than the value for PDO collisions during periods of rainfall. Collisions during snowfall had a higher RR value (1.90) for PDO collisions than for collisions resulting in injuries (1.55), and both were higher than the RR values for either type of collision during rainfall, suggesting that snowfall is a greater threat to driving safety than rainfall. For both precipitation types, a higher rate of precipitation was associated with increased risk and a larger number of collisions. Some collision types were clearly affected by the type of precipitation. Vehicles left the road resulting in property damage at far higher RR values during snowfall (3.36) than during periods of rainfall (1.09). Furthermore, analysis of collision types identify that two collisions with nearly identical actions, stopping at a stop sign and stopping at a traffic signal, have very different risks during adverse weather. Stopping at stop signs appears to be far more difficult than stopping at traffic signals during precipitation events and has a higher associated risk. Lastly, we identify a puzzling concern: our results show that Edmonton drivers do not perceive periods of rainfall as presenting a hazard, resulting in a disproportionately high number of injuries during rainfall.

Clinical Efficacy and Safety of Tanreqing Injection for Pulmonary Infection in Patients with Tuberculosis: A Meta-Analysis.

Tanreqing injection (TRQ) is often used in the treatment of pulmonary infection in patients with tuberculosis (TB). But its efficacy and safety are still unclear; to further reveal its efficacy and safety, the authors systematically evaluated all relevant trials. The authors searched published trials using the search strategy as (Tanreqing OR "Tanreqing injection") AND ("Tuberculosis" [MeSH] OR Tuberculosis OR TB) in Embase, PubMed, CNKI, VIP, Wanfang Database, CBM and CENTRAL, and ongoing trials in Chinese and U.S. clinical trials and World Health Organization International Clinical Trials Registry Platform (WHO-ICTRP) (established to January 2017). The authors evaluated the methodological bias risk of all included trials using the Cochrane evaluation handbook of randomized controlled trials (RCTs) (5.1.0), extracted data following the PICO principles, and synthesized the data using meta-analysis. Twenty-six RCTs involving 2404 patients were included. In TRQ alone versus antibiotics, the merged risk ratio (RR) values and their confidence interval (95% CI) of meta-analysis for overall efficacy, lesion absorption, and bacterial clearance were as follows: 1.05 (0.99-1.10), 0.98 (0.89-1.08), and 1.36 (1.09-1.70). All differences were not statistically significant. In TRQ plus antibiotics versus antibiotics, the RR values and their 95% CI of overall efficacy, lesion absorption, and bacterial clearance were as follows: 1.17 (1.10-1.25), 1.24 (1.11-1.38), and 1.61 (1.36-1.90). All differences were statistically significant. Except for the bacterial clearance, sensitivity analyses showed that the overall efficacy had good stability. TRQ may have the same overall efficacy as antibiotics in pulmonary infection in patients with TB. TRQ plus antibiotics may improve the clinical efficacy. TRQ may have synergistic effect to antibiotics through bacteriostatic activity and eliminating inflammatory mediators. Its antibacterial activity may be better than some antibiotics and does not increase adverse drug reaction. But all these need new evidences for further investigation.

Comparison of methods: Attributing the 2014 record European temperatures to human influences

AbstractThe year 2014 broke the record for the warmest yearly average temperature in Europe. Attributing how much this was due to anthropogenic climate change and how much it was due to natural variability is a challenging question but one that is important to address. In this study, we compare four event attribution methods. We look at the risk ratio (RR) associated with anthropogenic climate change for this event, over the whole European region, as well as its spatial distribution. Each method shows a very strong anthropogenic influence on the event over Europe. However, the magnitude of the RR strongly depends on the definition of the event and the method used. Across Europe, attribution over larger regions tended to give greater RR values. This highlights a major source of sensitivity in attribution statements and the need to define the event to analyze on a case‐by‐case basis.

Association of Peri-partum Blood Energy Metabolites with Post-partum Puerperal Metritis in Crossbred Cows

Present study estimated certain blood energy metabolites during peri-partum period in crossbred cows that did and did not develop post-partum puerperal metritis (PM) and analyzed their association with ensuing PM. Glucose, total-cholesterol, urea-nitrogen (PUN), non-esterified fatty acids (NEFA) and β-hydroxybutyrate (BHBA) concentrations were estimated in blood plasma samples collected from pluriparous cows (n = 20) at 2 (wk-2) and 1 week (wk-1) before expected date of calving, on d + 1, d + 7 and d + 14 after calving. The PM cows had significantly lower glucose but higher BHBA than normal cows between d + 1 and d + 14. Between wk-2 to d + 14, PM cows had significantly lower total-cholesterol but higher NEFA and NEFA:total-cholesterol ratio than healthy cows. Moreover, PUN:BHBA ratio was significantly lower in PM cows than normal cows on d + 14. Receiver-operating characteristic analysis indicated that NEFA:total-cholesterol ratio had higher area under curve (AUC) at wk-2 (AUC = 0.91) and wk-1 (AUC = 0.96) than other metabolites. However, as compared to other metabolites, AUC was higher on d + 1 (AUC = 0.92) and on d + 7 (AUC = 0.98) for NEFA and on d + 14 (AUC = 1.0) for BHBA. Estimated risk ratio values indicated that NEFA:total-cholesterol ratio at wk-2 and wk-1 were significantly associated with 8.55 times higher risk of PM than other metabolites. Moreover, NEFA, BHBA and NEFA:total-cholesterol values were associated with >8.55 times higher risk of PM during post-partum period. Thus, it may be concluded that cows, which developed PM suffered with negative energy balance around parturition. Ratio of NEFA: total-cholesterol at wk-2 and wk-1 could be helpful for early identification of PM with higher accuracy in crossbred cows.

The Effect of Genetic Admixture in an Association Study: Genetic Polymorphisms and Chromosome Aberrations in a Colombian Population Exposed to Organic Solvents

The human population is heterogeneous in genetic susceptibility, chromosomal instability and disease risk; all factors which depend on inherited genetic constitution and acquired nongenetic environmental and occupational factors. Recently, special attention has been directed to the identification of sources of potential bias in population studies of gene-environment interactions including genetic admixture. The aim of this study was to evaluate the effect of genetic admixture in the association of genetic polymorphisms and chromosome aberrations (CA) in a population exposed to organic solvents. We assessed genetic admixture via 34 genetic ancestry informative markers (AIMs) in 398 Colombian individuals. We report a statistically significant difference of higher CA frequency in individuals' below-average European component, and in individuals' above-average Native American component after adjusting for covariates. In addition, the confounding risk ratio values are ≥10% than the adjusted risk ratio, suggesting that population stratification is a confounding factor in this gene-environment association study. Furthermore, after adjusting for individual admixture proportions and covariates, the results demonstrate that glutathione-S-transferase M1 (GSTM1)-null is associated with CA frequency increase. These results suggest that gene-environment association studies that involve recently admixed populations should take into consideration population stratification as a confounding factor and suggest GSTM1-null as a genetic marker associated with CA frequency increase.

A Quantitative Approach for Ranking Human Health Risks from Pesticides in Irish Groundwater

ABSTRACT This study aims to quantitatively assess the risk of pesticides (used in Irish agriculture) and their degradation products to groundwater and human health. This assessment uses a human health Monte-Carlo risk-based approach that includes the leached quantity combined with an exposure estimate and the No Observed Adverse Effect Level (NOAEL) as a toxicity ranking endpoint, resulting in a chemical intake toxicity ratio statistic (R) for each pesticide. A total of 34 active substances and their metabolites registered and used in the agricultural field were evaluated. MCPA obtained the highest rank (i.e., in order of decreasing human health risk), followed by desethly-terbuthylazine and deethylatrazine (with risk ratio values of 1.1 × 10−5, 9.5 × 10−6, and 5.8 × 10−6, respectively). A sensitivity analysis revealed that the soil organic carbon content and soil sorption coefficient were the most important parameters that affected model predictions (correlation coefficient of –0.60 and –0.58, respectively), highlighting the importance of soil and pesticide properties in influencing risk estimates. The analysis highlights the importance of taking a risk-based approach when assessing pesticide risk. The model can help to prioritize pesticides, with potentially negative human health effects, for monitoring programs as opposed to traditional approaches based on pesticide leaching potential.