Screening Tool For Risk Assessment Research Articles

New echocardiographic screening tool for left ventricular tract obstruction risk assessment in TMVR

BackgroundTranscatheter mitral valve replacement (TMVR) is an alternative to conventional surgery to treat severe mitral disease but its use is limited by the risk of left ventricular outflow tract obstruction (LVOTO). Screening depends on ECG-gated computed tomography (CT) that is not widely available and requires contrast. We developed and validated a transthoracic echocardiographic (TTE) method to assess the risk of LVOTO after TMVR with the Tendyne System. MethodsWe measured the LVOT longitudinal area on preoperative TTE dataset of patients screened for TMVR. The LVOT was measured as the box-area included by the aortic valve annulus, the anterior mitral leaflet (AML), the c-septum distance line, and the respective length of the AML on the interventricular septum. We analyzed the correlation between the TTE LVOT-box and the CT-measured neoLVOT area. Prediction performance for eligible patients was tested with ROC curves. ResultsThirty-nine patients were screened, out of 14 patients (36%) not eligible for TMVR, 8 had risk of LVOTO. We found a linear correlation between the TTE LVOT-box and the CT-measured Neo-LVOT (r = 0.6, p = 0.002). ROC curve showed that the method is specific and sensitive and the cut-off value of the measure LVOT-box is 350 mm2. ConclusionsThe proposed method is reliable to evaluate the risk of LVOTO after TMR with the Tendyne System. It is quick and easy and can be used as a first-line assessment in the outpatient clinic. Patients with LVOT-box <350 mm2 should not be further screened with ECG-gated cardiac CT.

Reproducibility and content validity of the Slovenian version of the STarT Back Screening Tool for chronicity risk assessment in patients with low back pain.

Chronic pain is the most common cause of impaired work ability and thus represents a significant social and economic burden. STarT Back Screening Tool (SBT) is the most often used screening tool for rapid identification and classification of patients for their risk of development of chronic low back pain, which is valid and reliable in the original English version and translation into other languages. The aim of the present study was to translate the SBT into Slovenian and to evaluate its content validity and reliability. We translated the SBT from English into Slovenian and back according to the standard protocol. We tested its metric properties on a group of patients with low back pain aged 18 to 65 years. The reliability of the reassessment was calculated using the ICC and specific agreement, while the content validity of the questionnaire was determined using the ceiling and floor effect. Of the 42 patients who participated in the study, 42.9% were at low risk, 33.3% were at moderate risk, and 23.8% were at high risk of developing chronic pain, according to the SBT. The ICC for the entire sample was 0.96 (95% CI 0.92-0.98). The Slovenian translation of the SBT showed excellent specific agreement between the initial and repeat assessments: 91.4% for the low-risk group, 85.7% for the moderate-risk group, and 95.2% for the high-risk group. In addition, it showed good content validity, as no ceiling or floor effects were detected. The Slovenian translation of the questionnaire is suitable for clinical use.

Risk assessment of post-myocardial infarction patients with preserved ejection fraction using 45-min short resting Holter electrocardiographic recordings.

Risk stratification for sudden cardiac death in post-myocardial infarction (post-MI) patients remains a challenging task. Several electrocardiographic noninvasive risk factors (NIRFs) have been associated with adverse outcomes and were used to refine risk assessment. This study aimed to evaluate the performance of NIRFs extracted from 45-min short resting Holter ECG recordings (SHR), in predicting ventricular tachycardia inducibility with programmed ventricular stimulation (PVS) in post-MI patients with preserved left ventricular ejection fraction (LVEF). We studied 99 post-MI ischemia-free patients (mean age: 60.5 ± 9.5 years, 86.9% men) with LVEF ≥40%, at least 40 days after revascularization. All the patients underwent PVS and a high-resolution SHR. The following parameters were evaluated: mean heart rate, ventricular arrhythmias (premature ventricular complexes, couplets, tachycardias), QTc duration, heart rate variability (HRV), deceleration capacity, heart rate turbulence, late potentials, and T-wave alternans. PVS was positive in 24 patients (24.2%). HRV, assessed by the standard deviation of normal-to-normal R-R intervals (SDNN), was significantly decreased in the positive PVS group (42 ms vs. 51 ms, p = .039). SDNN values <50 ms were also associated with PVS inducibility (OR 3.081, p = .032 in univariate analysis, and 4.588, p = .013 in multivariate analysis). No significant differences were identified for the other NIRFs. The presence of diabetes, history of ST-elevation MI (STEMI) and LVEF <50% were also important predictors of positive PVS. HRV assessed from SHR, combined with other noninvasive clinical and echocardiographic variables (diabetes, STEMI history, LVEF), can provide an initial, practical, and rapid screening tool for arrhythmic risk assessment in post-MI patients with preserved LVEF.

Validation of a violence risk screening for youth in psychiatric inpatient care-a pilot study of V-RISK-Y.

The reason for this study was the void of validated risk assessment screening tools for violence in adolescence psychiatry. Our aims were to test the predictive validity and feasibility of a pilot version of the Violence Risk Screening for Youth (V-RISK-Y). The V-RISK-Y was based on a violence risk screen for adults, the V-RISK-10, and adapted to adolescents, resulting in 12 risk items that are scored for (a) presence and (b) relevance for future violence. In this naturalistic, prospective observational study, the V-RISK-Y was scored at admission and compared with recorded episodes of violent acts and threats during hospital stay. The target population was all 92 patients admitted to the emergency department of adolescent psychiatry at Oslo University Hospital for 1 year, of which 67 patients were scored with the V-RISK-Y at admission and constituted the study sample. The predictive validity of the V-RISK-Y for violent behavior showed an AUC of 0.762 (p = 0.006). Staff approved the screener and found it to be equally or better usable than the V-RISK-10, which was previously used in the department. Still, a high proportion of raters failed to follow the scoring instructions of relevance scores, reducing feasibility. The results must be interpreted within the limits of a pilot study and low power. We conclude that results suggest changes of certain parts of the V-RISK-Y and provide a basis for testing a revised edition of the screener in a more comprehensive study, preferably with a multicenter design.

Integrating PrEP in maternal and child health clinics in Kenya: analysis of a service availability and readiness assessment (SARA) survey.

Risk of HIV acquisition is high during pregnancy and postpartum, and pre-exposure prophylaxis (PrEP) is recommended for peripartum populations. Integrating PrEP into maternal and child health (MCH) clinics is feasible and acceptable. Understanding clinics' service availability and readiness is essential for effective scale up. The PrEP in Pregnancy, Accelerating Reach and Efficiency study (PrEPARE; NCT04712994) engaged PrEP-experienced facilities previously linked to a programmatic or research study in Western Kenya to document available services and commodities via a modified service availability and readiness assessment (SARA) survey with 20 PrEP tracer items covering: staffing/guidelines, services/equipment, and medicines/commodities. Facilities' prior study engagement occurred between 2017 and 2019; SARA survey data was collected between April 2020 and June 2021. Descriptive statistics were stratified by prior study engagement. ANOVA tests assessed associations between facility characteristics and gaps. Fisher's tests assessed differences in commodity availability and stockouts. Of the 55 facilities surveyed, 60% had received PrEP training in the last two years, 95% offered PrEP integrated into MCH, and 64% and 78% had both auditory and visual privacy in PrEP and HIV testing service (HTS) delivery spaces, respectively. Supervision frequency was heterogeneous, but 82% had received a supervision visit within 3 months. Availability of commodities was variable and the most commonly unavailable commodities were PrEP in MCH (71% available) and risk assessment screening tool (RAST) and PrEP cards (60% and 75% available, respectively). The number of service and commodity gaps per facility ranged from zero to eight (median: 3; IQR: 2, 5). The most frequent gaps were: PrEP training and risk assessment cards (40% each), lack of privacy in PrEP (36%) and HIV testing services (31%) spaces, PrEP pills in MCH (29%), and PrEP cards (25%). There were no differences in mean number of gaps by county, previous study engagement, or public vs. private status. Level 4 facilities had fewer gaps (mean 2.2) than level 2, 3, and 5 facilities (mean 5.7, 4.5, and 5.3 respectively; p < 0.001). PrEP service availability and readiness was generally high across MCH facilities. However, there is a need for increased frequency of provider training and supportive supervision focused on fidelity. To address key commodity stockouts such as PrEP pills, implementation of electronic logistics management information systems may be needed. Targeting these gaps is essential to effectively scale up integrated PrEP delivery, especially among facilities with limited infrastructure.

Risk Stratification of Acute-Onset Chest Pain: SVEAT Score Versus HEART and TIMI Scores.

Introduction Acute chest pain is a frequently encountered symptom in the emergency department. Despite the availability of various chest pain risk scores, their effectiveness in identifying low-risk patients suitable for safe and early discharge is inadequate. Moreover, clinical data collected at the initial stage, which has valuable discriminatory ability, is often underutilized. This study aims to assess the effectiveness of the Symptoms, history of Vascular disease, ECG, Age, and Troponin I (SVEAT) score in predicting major adverse cardiovascular events (MACE) in acute-onset chest pain, compared with the pre-existing History, ECG, Age, Risk factors, and Troponin I (HEART) and Thrombolysis In Myocardial Infarction (TIMI) scores. Methodology This prospective study utilizing non-probability convenience sampling was conducted in the emergency medicine department of a tertiary care hospital in Rawalpindi,Pakistan, for a period of five months from July 2022 to November 2022. The study included patients aged >45 years who presented primarily with chest pain lasting for at least five minutes but less than 24 hours and with a lack of acute ECG changes indicative of ST-elevation acute coronary syndrome (STE-ACS). Patients who were hemodynamically unstable were excluded. All patients were assessed for the calculation of SVEAT, TIMI, and HEART scores. All patients were followed for a period of 30 days to assess the incidence of MACE. Results A total of 60 patients were included. The mean age was 61.5±9.1 years while 31 (51.7%) patients were females. Diabetes was the most prevalent comorbidity (n=32; 53.3%). Regarding MACE, nine (15%) patients developed ACS and underwent percutaneous coronary intervention (PCI). Two patients (3.3%) experienced heart failure. Six (10%) patients also underwent PCI in the absence of ACS while two (3.3%) patients developed sudden cardiac death. Area-under-curve (AUC) values were determined for SVEAT (0.843; 95%CI: 0.74-0.94), TIMI (0.742; 95%CI: 0.62-0.86), and HEART scores (0.840; 95%CI: 0.74-0.94). A cut-off level of 3.5 SVEAT points obtained a sensitivity of 63.2% and specificity of 75.6% in predicting 30-day MACE. Conclusion SVEAT score potentially lacks the appropriate sensitivity level to predict a significant number of major adverse cardiovascular events compared to contemporary risk stratification scores. Therefore, the SVEAT criteria need re-evaluation as a screening tool for risk assessment in acute chest pain.

Utilization of the Fordham Risk Screening Tool (FRST) for Violence Risk Assessment in an Emergency Department.

Violence is a critical problem in the emergency department (ED) and patients experiencing mental health crises are at greater violence risk; however, tools appropriate for assessing violence risk in the ED are limited. Our goal was to evaluate the utility of the Fordham Risk Screening Tool (FRST) in reliability assessing violence risk in adult ED patients with acute mental health crises through evaluation of test characteristics as compared to a reference standard. We evaluated performance of the FRST when used with a convenience sample of ED patients undergoing acute psychiatric evaluation. Participants underwent assessment with the FRST and an established reference standard, the Historical Clinical Risk Management-20, version 3 (HCR-20, v3). Diagnostic performance was assessed through evaluation of test characteristics and area under the receiver operating characteristic (AUROC) curve. Psychometric assessments examined the measurement properties of the FRST. 105 participants were enrolled. In comparison to the reference standard, the AUROC for the predictive ability of the FRST was 0.88 (SE 0.39), 95% CI: 0.81-0.96. Sensitivity was 84% (95% CI: 69-94%) while specificity was 93% (95% CI: 83-98%). The positive predictive value was 87% (95% CI: 73-94%) and negative predictive value was 91% (95% CI: 83-86%). Psychometric analyses provided reliability and validity evidence for the FRST when used in the ED setting. Findings support the potential utility of the FRST when used to assess violence risk in adult ED patients experiencing a mental health crisis. Future research with more diverse populations and ED settings is warranted.

Abstract 1025: OvaPrint - a novel cfDNA methylation liquid biopsy for cancer risk assessment in high grade serous ovarian carcinoma

Abstract Background: High grade serous ovarian carcinoma (HGSOC) is a highly lethal gynecologic malignancy with a typical 5-year survival rate of 40% or less when diagnosed with late-stage disease. There is currently no single effective screening tool for high risk or community-based risk assessment for HGSOC and multivariate tests for preselected patients are suboptimal. In women with a known pelvic mass, surgery followed pathological assessment is currently the only definitive way to diagnose HGSOC. About 15% of women with a suspicious mass will have HGSOC and less than 15% will present with stage 1 cancer. A liquid biopsy assay based on cell-free (cf)DNA enables non-invasive dynamic assessment of disease status in patients with cancer where cfDNA methylation is particularly promising for detection of early stage HGSOC. The goal of the current study is to develop a cfDNA methylation liquid biopsy that can be used for the screening and risk assessment for HGSOC. Methods: Tissue and plasma samples were acquired under informed consent from multiple commercial and academic sources. Reduced representation bisulfite sequencing (RRBS) was performed on 33 HGSOC tissues as well as 8 normal ovary and 13 normal fallopian tube controls. Differentially methylated regions (DMRs) were called between HGSOC and normal controls using metilene and DSS. DMR calls with p-values &amp;lt; 0.05 and |αβ| &amp;gt; 0.45 (n = 1677 DMRs) were used to generate a targeted tissue-based methylation assay using the myBaits® hybrid probe capture platform (Daicel Arbor Biosciences). Next, targeted enrichment was performed on bisulfite converted plasma cfDNA on an independent set of 84 HGSOC samples (27 stage 1, 20 stage 2, 37 stage 3) and 100 samples from patients with benign ovarian masses. Mean beta value across DMRs were used to train a novel cfDNA methylation classifier model called OvaPrintTM to discriminate HGSOC from benign masses using a repeated 3-fold cross validation approach to obtain an unbiased estimate of the performance of the classifier. The average cross validated score for each sample was used to generate a receiver operator characteristic (ROC) curve. Results. RRBS analysis on HGSOC tissue and normal tissue controls demonstrated excellent separation of HGSOC from normal tissue samples using the selected DMRs. OvaPrintTM testing in an independent cohort of 184 plasma samples discriminated HGSOC from benign tumors with a high sensitivity and specificity (area under curve (AUC) = 0.931) using cfDNA methylation. Conclusions: OvaPrintTM is a novel cfDNA methylation liquid biopsy that can be used for effective cancer risk assessment for HGSOC in women presenting with pelvic masses. Citation Format: David N. Buckley, Gerald Gooden, Lee Shulman, Monica Newman, Mona Guo, Ben Yi Tew, Lynda Roman, Juan Pablo Lewinger, Bodour Salhia. OvaPrint - a novel cfDNA methylation liquid biopsy for cancer risk assessment in high grade serous ovarian carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1025.

The Antenatal Risk Questionnaire: Identifying mothers at risk of developing perinatal mental illness

Perinatal mental illness (PMI) often goes undiagnosed and untreated. Early identification of risk factors can help women receive timely intervention to reduce associated child and maternal comorbidities. This article considers the use of a validated screening tool to identify maternal risk factors of developing PMI. An analysis of a perinatal mental health policy, literature review and project implementation plan were carried out to explore current gaps in the research. Validated perinatal mental health risk assessment screening tools are being used across the world but not in the UK. It is concluded that the Antenatal Risk Questionnaire should be recommended for health visiting practice to promote early identification of PMI and intervention, which can improve outcomes for families.

Relationship of Body Mass Index and Waist Hip Ratio with Insulin Resistance in Polycystic Ovarian Syndrome Patients

Background: Polycystic Ovarian Syndrome (PCOS) is the most common endocrinopathy among young women. Insulin resistance is a key feature in the pathogenesis of PCOS. Obesity, which is frequently associated with PCOS women, seems to amplify the degree of insulin resistance. The aim of the study is to investigate the relationship of insulin resistance with obesity in PCOS patients.&#x0D; Materials and methods: This was a hospital based cross-sectional study comprising fifty (50) diagnosed PCOS patients aged between 20 and 40 years. This study was carried out in the Department of Biochemistry, Chittagong Medical College (CMC) and inpatients, outpatient Department of Gynaecology and Obstetrics, Chittagong Medical College Hospital (CMCH). Samples were taken by non-probability purposive sampling. Results: The percentage of Insulin Resistance (IR) was 60% in this study. Mean age of PCOS patients was 30.6±0.65years. Obese PCOS patients with insulin resistance were 46% and overweight PCOS patients with IR were 48% in this study. There were also significant positive association of IR with increased BMI and waist hip ratio. Additionally 06% non-obese PCOS patients showed IR in this study cases.&#x0D; Conclusions: This study suggested that abdominal obesity was a good predictor of IR among PCOS patients. So, waist circumference or waist hip ratio may be used as a screening tool for IR risk assessment among PCOS patients as an inexpensive, noninvasive and easy-to-detect marker. Hence early diagnosis and proper preventive management of these patients will reduce the reproductive complications.&#x0D; IAHS Medical Journal Vol 4(2), December 2021; 3-7

Modeling pesticide residue uptake by leguminous plants: a geocarpic fruit model for peanuts.

Pesticide residues are frequently found in leguminous plants; however, no modeling approaches predict residue concentrations in edible legume seeds. In this study, a geocarpic fruit model, simplified for neutral organic compounds, was proposed for high-throughput simulations (over 700 pesticides) of the residue uptake by peanut plants, which characterized three scenarios, namely (i) pesticide foliar application during the pre-seed development stage, (ii) foliar application during the seed development stage, and (iii) soil contamination before plant germination. In the foliar application scenario, in general, lipophilic pesticides have high simulated residue unit doses (RUDs, residue concentrations in plants per 1.0kg ha-1 of pesticide application) in peanut leaves owing to intensified uptake via surface deposition, whereas hydrophilic pesticides have high simulated RUDs in peanuts because the uptake of residues via diffusion is enhanced. For the soil-contamination scenario, organic compounds with moderate lipophilicity have a high bioconcentration potential (i.e. the soil-plant system) in leaves and peanuts, due to large transpiration stream concentration factors (TSCFs) that boost the uptake via transpiration. The simulation results have some degrees of agreement with field measurements, indicating that the proposed model can be used as a screening tool for dietary risk assessment of pesticides in peanuts. In future research, pH-dependent physicochemical properties (e.g. soil-water partition coefficient and TSCF) and degradation rate constants of chemicals need to be refined to improve the simulation analysis. © 2022 Society of Chemical Industry.

Performance of NUTRIC score to predict 28-day mortality in critically ill patients after replacing APACHE II with SAPS 3.

ObjectivesThe Nutrition Risk in the Critically Ill (NUTRIC) score has been advocated as a screening tool for nutrition risk assessment in critically ill patients. It was developed and validated to predict 28-day mortality using Acute Physiology and Chronic Health Evaluation II (APACHE II) score as one of its components. However, nowadays the Simplified Acute Physiology Score 3 (SAPS 3) demonstrates better performance. We aimed to test the performance of NUTRIC score in predicting 28-day mortality after replacement of APACHE II by SAPS 3, and the interaction between nutrition adequacy and mortality.MethodsAdult patients who received nutrition therapy and remained >3 days in intensive care unit were retrospectively evaluated. In order to replace APACHE II component, we used ranges of SAPS 3 with similar predicted mortality. Discrimination between these tools in predicting 28-day mortality was assessed using the ROC curve, calibration was evaluated with calibration belt, and correlation with intraclass correlation. The relationship between nutritional adequacy and mortality was assessed in a subgroup with available data.Results542 patients were analyzed (median age of 78 years old, 73.4% admitted for non-surgical reasons and 28-day mortality was 18.1%). Mortality prediction discrimination did not differ between tools (p>0.05), but showed a good agreement (intraclass correlation 0.86) with good calibration. In the subgroup analysis for nutritional adequacy (n = 99), no association with mortality was observed.ConclusionPerformance of NUTRIC score with SAPS 3 is similar to the original tool. Therefore, it might be used in settings where APACHE II is not available.

Nationwide and Regional PM2.5-Related Air Quality Health Benefits From the Removal of Energy-Related Emissions in the United States.

Clean energy policy can provide substantial health benefits through improved air quality. As ambitious clean energy proposals are increasingly considered and adopted across the United States (US), quantifying the benefits of removal of such large air pollution emissions sources is crucial to understanding potential societal impacts of such policy. In this study, we estimate health benefits resulting from the elimination of emissions of fine particulate matter (PM2.5), sulfur dioxide, and nitrogen oxides from the electric power, transportation, building, and industrial sectors in the contiguous US. We use EPA's CO‐Benefits Risk Assessment screening tool to estimate health benefits resulting from the removal of PM2.5‐related emissions from these energy‐related sectors. We find that nationwide efforts to eliminate energy‐related emissions could prevent 53,200 (95% CI: 46,900–59,400) premature deaths each year and provide $608 billion ($537–$678 billion) in benefits from avoided PM2.5‐related illness and death. We also find that an average of 69% (range: 32%–95%) of the health benefits from emissions removal remain in the emitting region. Our study provides an indication of the potential scale and distribution of public health benefits that could result from ambitious regional and nationwide clean energy and climate mitigation policy.

The Fall Risk Screening Scale Is Suitable for Evaluating Adult Patient Fall.

(1) Background: This study aimed to test the feasibility of utilizing the screening tool for fall risk assessment in adult inpatient and verify its accuracy in a medical center in Taiwan. (2) Methods: This study retrospectively collected all adult fall cases among inpatients occurring in the general wards of a medical center between 1 January 2013 and 31 December 2015. This inpatient fall risk screening scale was measured by the sensitivity, specificity, and accuracy. (3) Results: There were 1331 (0.4%) falls among a total of 357,395 inpatients during this period. Factors predictive of falling risk included: age, consciousness, body shift assistance, use of fall risk medications, fall history, dizziness or weakness, toileting, and impaired mobility. Using the eight-factor assessment, two was the best cutoff point for identifying the fall risk group, with area under Receiver Operating Characteristic (ROC) curve (AUC) = 0.817, sensitivity = 80.93%, specificity = 73.0%, accuracy = 73.03%, and likelihood ratio = 11.48. (4) Conclusions: The accuracy of the eight-item fall risk assessment tool created for this study was validated. These results can serve as a reference for institutions to develop more effective fall risk assessment scale for inpatients, enabling clinical nurses to identify and more comprehensively assess the groups at highest risk for falling during their hospital stay.

Diabetic dyslipidemia: A screening tool for cardiovascular risk assessment

Introduction: Dyslipidemia is the most common threat in connection to developing cardiac disorders in type two diabetes mellitus. It has a role in the eventual development of atherosclerosis and increased mortality and morbidity. The present study was conducted to determine the lipoprotein abnormalities found in type two diabetic patients in the Mangalore region in South India. Methods: A cross-sectional study was conducted involving 95 types two diabetic patients. A fasting venous blood sample was obtained from these patients. The levels of different lipoproteins were estimated using the VITROS 5600 automatic analyzer. The patients were divided into two groups for comparison based on their duration of diabetes mellitus. The statistical tools used were the independent t-test for the comparison of the means of both quantitative variables and the Chi-square test for the proportion comparisons. The statistical package used was the Statistical Package for Social Sciences (SPSS) version 22. Results: According to the results of this study, deranged lipid profile levels were seen in most of the diabetic patients in group two. It was observed that about 67.3% of the patients in group 2 had higher serum cholesterol levels while a relatively lower number had a high level of cholesterol in group one. There was a significant (p-value of &lt; 0.001) association between the two groups. There was an insignificant association between diabetes mellitus and high-density lipoprotein levels. In this study, triglyceride levels were also very high in most of the diabetic patients (p-value of 0.003), further increasing the risk of obesity and metabolic syndrome. Very low-density lipoprotein and low-density lipoprotein levels were also significantly increased with a significant p-value. Conclusion: Most diabetic patients tend to have dyslipidemias. Screening them for dyslipidemias may be useful to prevent insulin resistance, atherosclerosis, and metabolic syndrome. Drugs like statins inhibit the rate-limiting step of cholesterol biosynthesis, leading to a lower blood cholesterol. This may help to normalize their lipid profiles and to prevent severe adverse outcomes like coronary artery disease and stroke in diabetic patients. A healthy lifestyle and dietary modifications may also help to promote good health in the patients with diabetes mellitus.

Vertical Hydraulic Gradient Estimation in Clay Till, Using MiHPT Advanced Direct‐Push Technology

AbstractThe vertical transport of contaminants from source areas is employed in many risk assessment models and screening tools in order to estimate the contaminant mass discharge (CMD) into underlying aquifers. The key parameters for estimating CMD are the contaminant source area and concentration, and the vertical water flux, the latter of which depends on the vertical hydraulic conductivity and the vertical hydraulic gradient in the subsurface. This study focuses on advancing the use of the combined membrane interface probe hydraulic profiling tool (MiHPT) to investigate the vertical hydraulic gradient across a clay till overlying a sandy aquifer at a contaminated site in Denmark. Only the HPT is necessary for the estimate of vertical hydraulic gradient. The hydraulic head, clay till thickness, and resulting vertical hydraulic gradients found using the MiHPT compared well with observations from nearby nested wells. The parameter with the largest discrepancy was the thickness of the clay till. The advantage of the MiHPT is its relatively quick depth discrete access to information regarding subsurface permeability, vertical hydraulic gradients and contaminant distribution across a site. In this case study, performance of additional dissipationtests during the HPT log to acquire determination of the vertical hydraulic gradient increased the cost by 3% compared to standard HPT logs.

Occurrence and spatial distribution of dioxin and dioxin-like compounds in topsoil of Taranto (Apulia, Italy) by GC-MS analysis and DR-CALUX® bioassay

The aim of the present study was to assess the occurrence and spatial distribution of PCDD/Fs and dioxin-like compounds in topsoils of Taranto (Apulia Region), one of the most heavily industrialized and contaminated area of Southern Italy. A combined approach of chemical analysis by GC-MS/MS and AhR reporter gene bioassay was applied in a subset of topsoil samples (n = 20) collected in 2017-18 from ten sites embracing three levels of risk (from high to low) in the framework of a large survey inside Taranto municipality. TCDD-BEQs and GC-MS/MS TEQWHO and TEQTHEORETICAL revealed a decreasing trend with the distance from main industrial settings and landfill areas. A strong correlation between TCDD-BEQs and TEQWHO values (R2 = 0.85) and TEQTHEORETICAL (R2 = 0.88) was also found. In 3 out of 10 topsoil investigated, BEQs and TEQWHO/THEORETICAL resulted above Italian National Regulatory Limits for ∑PCDD/Fs in green, private and recreational used soils (10 ng TEQ/kg d.w. D.Lgs 152/2006) and for ∑PCDD/F/dl-PCBs in agricultural and farming soil (6 ng TEQ/kg d.w. D.M. 46/2019). GC-MS/MS pattern revealed the highest prevalence of dl-PCBs in 6 out of 10 sites, followed by PCDFs and PCDDs. Those sites are all located in proximity of main industrial steel and iron ore sinter plant, steel plant’s landfills and illegal dumping sites. An update on occurrence and spatial distribution of PCDD/Fs and dl-PCBs contamination of Taranto urban soils was obtained and the DR-CALUX® bioassay was further recommended as a suitable screening tool for environmental and human risk assessment.

Further Insights Into the Beck Hopelessness Scale (BHS): Unidimensionality Among Psychiatric Inpatients.

Short versions of the Beck Hopelessness Scale have all been created according the Classical Test Theory, but the use and the application of this theory has been repeatedly criticized. In the current study, the Item Response Theory approach was employed to refine and shorten the BHS in order to build a reasonably coherent unidimensional scale whose items/symptoms can be treated as ordinal indicators of the theoretical concept of hopelessness, scaled along a single continuum. In a sample of 492 psychiatrically hospitalized, adult patients (51.2% females), predominantly with a diagnosis of Bipolar Disorder type II, the BHS was submitted to Mokken Scale Analysis. A final set of the nine best-fitting items satisfied the assumptions of local independency, monotonicity, and invariance of the item ordering. Using the ROC curve method, the IRT-based 9-item BHS showed good discriminant validity in categorizing psychiatric inpatients with high/medium suicidal risk and patients with and without suicide attempts. With high sensitivity (>.90), this newly developed scale could be used as a valid screening tool for suicidal risk assessment in psychiatric inpatients.

Tryptophan-like fluorescence as a high-level screening tool for detecting microbial contamination in drinking water

Regular monitoring of drinking water quality is vital to identify contamination of potable water supplies. Testing for microbial contamination is important to prevent transmission of waterborne disease, but establishing and maintaining a water quality monitoring programme requires sustained labour, consumables and resources. In low resource settings such as developing countries, this can prove difficult, but measuring microbial contamination is listed as a requirement of reaching the UN's Sustainable Development Goal 6 for water and sanitation. A nine-month water quality monitoring programme was conducted in rural Malawi to assess the suitability of tryptophan-like fluorescence (TLF), an emerging method for rapidly detecting microbial contamination, as a drinking water quality monitoring tool. TLF data was compared with thermotolerant coliforms (TTCs, E. coli) and inorganic hydrochemical parameters. A large (n = 235) temporal dataset was collected from five groundwater drinking water sources, with samples collected once or twice weekly depending on the season. The results show that TLF can indicate a broader contamination risk but is not as sensitive to short term variability when compared to other faecal indicators. This is likely due to a broad association of TLF with elevated DOC concentrations from a range of different sources. Elevated TLF may indicate preferential conditions for the persistence of TTCs and/or E. coli, but not necessarily a public health risk from microbial contamination. TLF is therefore a more precautionary risk indicator than microbial culturing techniques and could prove useful as a high-level screening tool for initial risk assessment. For widespread use of TLF to be successful, standardisation of TLF values associated with different levels of risk is required, however, this study highlights the difficulties of equating TLF thresholds to TTCs or E. coli data because of the influence of DOC/HLF on the TLF signal.

High-Throughput Vascular Screening by ARTSENS Pen During a Medical Camp for Early-Stage Detection of Chronic Kidney Disease.

Intervention in the early stages of cardiovascular and kidney diseases is proven to be more effective in preventing disease progression. Large artery stiffness measurement can be a potential early predictor of future risks. The purpose of the study reported in this work was to demonstrate the feasibility of our ARTSENS® Pen device as a high-throughput vascular screening tool for risk assessment. The study was performed during a medical camp conducted for awareness and early-stage detection of kidney diseases. Screening procedures included biosample tests and blood pressure measurements. Alongside, various clinically relevant measures of the arterial stiffness were evaluated using the ARTSENS® Pen, by measuring vessel wall dynamics via our proprietary image-free ultrasound algorithms. Stiffness measurement from the left common carotid artery on 85 participants could be completed within 4 hours, employing two units of ARTSENS® Pen; this also includes time taken for all the procedures enlisted in the study protocol. The associations of carotid stiffness indices with age-, gender-, and risk factor-dependent variations were established.