Severe Harm Research Articles

Japanese patients’ preferences regarding disclosure of patient safety incidents: A survey study

Background Incident disclosure has proved its cultural sensitivity. To meet patient needs, this study aims to investigate Japanese preferences regarding incident disclosure. Methods An online panel questionnaire survey was conducted in Japan, and 840 valid responses were collected. A total of 191 (23%) respondents or their family members had incident experience. The respondents were asked to indicate their preferences regarding disclosure practice, specifically for incidents entailing moderate and severe harm. The chi-squared test was applied to examine preference differences. Results Mostly similar preferences were identified among Japanese respondents, regardless of their incident experience, age, and sex. For instance, they wished to be disclosed through face-to-face communication (92% in moderate and 92% in severe harm incidents), immediately after detection (63%; 65%), at the bedside, or in a consultation room (50%; 46%). The incident was likely to be disclosed by the healthcare provider most responsible/directly involved in the patient's care at the time of the incident (48%; 45%), accompanied by the team/department leader (50%; 56%) and patient safety manager (50%; 59%). If the incident entailed severe harm, top management members were also expected to be involved (45%); all details about the incident were expected to be informed (57%). Conclusions The findings reveal that Japanese patient preferences regarding incident disclosure are partly shared with Western countries and partly with other Asian countries. The unique Japanese preference for disclosure places is also identified. Recommendations for incident disclosure are then suggested and we believe this could be the first step toward supporting disclosure in Japanese healthcare organizations.

Sexual and Intimate Partner Violence Against Women with Schizophrenia: A Scoping Review

Background: Globally, 641 million women are touched by intimate partner violence (IPV), establishing it as the most prevalent form of violence affecting women. Women, who are already disproportionately affected by sexual and IPV, face an elevated risk when dealing with severe mental illnesses (SMI) compared to the general population. Schizophrenia, classified as an SMI, poses numerous obstacles that impact women’s ability to maintain employment, good health, and sustain stable relationships. Nevertheless, limited data exists on IPV against women with schizophrenia and its impact. Aims: The objective of this scoping review was to summarize the available literature on sexual and IPV against women with schizophrenia and underlie future avenues of research. Methods: We conducted an electronic search using keywords in the following databases: APA PsychInfo, PubMed, Scopus, Google Scholar and Psychology and Behavioral Sciences Collection. The search yielded a total of 6,099 articles. Upon title and abstract review, 97 articles were retained for full-text reading, after which 7 articles were included in this review. Results: The available articles reveal an association between sexual and IPV against women with schizophrenia. Younger women diagnosed with schizophrenia, especially those with low income or unemployed, are at a higher risk of experiencing sexual and IPV. This victimization increases the likelihood of suicide and exacerbates psychopathology. Conclusion: Research should examine care-setting interventions for women with schizophrenia, who are at increased risk of sexual and IPV, aiming to prevent severe harm. Implementation of preventive measures is essential for enhancing healthcare and societal transformation.

Implementation of Electronic Triggers to Identify Diagnostic Errors in Emergency Departments

Missed diagnosis can lead to preventable patient harm. To develop and implement a portfolio of electronic triggers (e-triggers) and examine their performance for identifying missed opportunities in diagnosis (MODs) in emergency departments (EDs). In this retrospective medical record review study of ED visits at 1321 Veterans Affairs health care sites, rules-based e-triggers were developed and implemented using a national electronic health record repository. These e-triggers targeted 6 high-risk presentations for MODs in treat-and-release ED visits. A high-risk stroke e-trigger was applied to treat-and-release ED visits from January 1, 2016, to December 31, 2020. A symptom-disease dyad e-trigger was applied to visits from January 1, 2018, to December 31, 2019. High-risk abdominal pain, unexpected ED return, unexpected hospital return, and test result e-triggers were applied to visits from January 1, 2019, to December 31, 2019. At least 100 randomly selected flagged records were reviewed by physician reviewers for each e-trigger. Data were analyzed between January 2024 and April 2024. Treat-and-release ED visits involving high-risk stroke, symptom-disease dyads, high-risk abdominal pain, unexpected ED return, unexpected hospital return, and abnormal test results not followed up after initial ED visit. Trained physician reviewers evaluated the presence/absence of MODs at ED visits and recorded data on patient and clinician characteristics, types of diagnostic process breakdowns, and potential harm from MODs. The high-risk stroke e-trigger was applied to 8 792 672 treat-and-release ED visits (4 967 283 unique patients); the symptom-disease dyad e-trigger was applied to 3 692 454 visits (2 070 979 patients); and high-risk abdominal pain, unexpected ED return, unexpected hospital return, and test result e-triggers were applied to 1 845 905 visits (1 032 969 patients), overall identifying 203, 1981, 170, 116 785, 14 879, and 2090 trigger-positive records, respectively. Review of 625 randomly selected patient records (mean [SD] age, 62.5 [15.2] years; 553 [88.5%] male) showed the following MOD counts and positive predictive values (PPVs) within each category: 47 MODs (PPV, 47.0%) for stroke, 31 MODs (PPV, 25.8%) for abdominal pain, 11 MODs (PPV, 11.0%) for ED returns, 23 MODs (PPV, 23.0%) for hospital returns, 18 MODs (PPV, 18.0%) for symptom-disease dyads, and 55 MODs (PPV, 52.4%) for test results. Patients with MODs were slightly older than those without (mean [SD] age, 65.6 [14.5] vs 61.2 [15.3] years; P < .001). Reviewer agreement was favorable (range, 72%-100%). In 108 of 130 MODs (83.1%; excluding MODs related to the test result e-trigger), the most common diagnostic process breakdown involved the patient-clinician encounter. In 185 total MODs, 20 patients experienced severe harm (10.8%), and 54 patients experienced moderate harm (29.2%). In this retrospective medical record review study, rules-based e-triggers were useful for post hoc detection of MODs in ED visits. Interventions to target ED work system factors are urgently needed to support patient-clinician encounters and minimize harm from diagnostic errors.

A Data-Driven and Hybrid Approach for Real-Time Threshold-Based Landslide Prediction in Hilly Regions using Sensor Networks

ABSTRACT Landslides pose a constant threat to the Himalayan regions, causing severe harm to people and property, and disastrous consequences demand novel ways of early prediction and prevention. The study gives a comprehensive insight into real-time landslide prediction using data from several sensors. The study investigates the applicability of advanced machine learning algorithms such as Multiple Linear Regression (MLR), XGBoost (XGB), Random Forest (RF), and a hybrid MLR-LSTM model in predicting landslide disasters. Further, the performance of these models was evaluated by utilizing the evaluation metrics such as MSE, MAE, and RMSE. However, the hybrid MLR-LSTM model excels with MSE = 0.014, MAE = 0.140, and RMSE = 0.120. Additionally, the study demonstrates the hybrid model’s practical application by demonstrating the real-time alert generation method.

Duty of Candour legislation in post-colonoscopy colorectal cancer: a prospective cohort study.

This study investigated the application of Duty of Candour (DoC) legislation in the context of post-colonoscopy colorectal cancers (PCCRCs). DoC mandates transparent disclosure of notifiable safety incidents to patients in the English National Health Service, including incidences leading to severe or moderate harm. This study aimed to analyze the application of DoC in PCCRCs, improve understanding of the legislation, and identify challenges in DoC implementation. A national audit of PCCRCs was conducted between September 2021 and May 2022. PCCRCs were identified using linked administrative datasets, and root-cause analyses were performed using structured templates. "Avoidability" and harm were categorized into specific levels, and guidance was provided on improving consistency in judgments. 16% of 1724 PCCRCs resulted in major harm or death, of which 27% (75) were probably or definitely avoidable. Hospitals deemed DoC discharge necessary in only 53% of these cases. When including moderate harm, 11% of all PCCRCs would trigger DoC discharge, yet this was deemed necessary in only 45% of such cases. There is inconsistent application of DoC in PCCRC cases. Challenges include determining "avoidability" and harm, particularly when diagnosis is delayed. Clearer guidance and definitions of harm are needed to improve adherence to regulations.

Using music to reduce anxiety and stress in patients undergoing coronary angioplasty: A randomized clinical trial protocol

In the current health context, there is a widespread increase in chronic non-communicable diseases that predominantly affect the cardiovascular system. Recent epidemiological data in Brazil indicate a rise in these diseases, which can result in severe harm to patients, including death. This study aims to present a study protocol to evaluate the effect of music in reducing anxiety and stress in patients undergoing coronary angioplasty. A randomized, controlled, double-blind clinical trial will be conducted with 52 patients undergoing coronary angioplasty. The patients will be randomly assigned to one of two groups: a Control Group or an Experimental Group, to assess the effect of music on anxiety and stress. Two key points will be considered to evaluate the intervention's impact: data on patients' anxiety and stress, collected through structured forms, will be gathered both before and after the intervention, along with an assessment of vital signs. The primary expected outcome is a reduction in anxiety and stress, while the secondary expected outcome is stability in vital signs.

Colorectal Cancer Symptoms and Risk Factors - A Review

Colorectal cancer is a type of cancer that affects the colon (large intestine) or rectum. It is one of the most common types of cancer worldwide. It can cause severe harm and death. The risk of colorectal cancer increases with age. Most cases affect people over 50 years old. Common symptoms include diarrhoea, constipation, blood in the stool, abdominal pain, unexplained weight loss, fatigue, and low iron levels. Many people will not have symptoms in the early stages of the disease. The risk of colorectal cancer can be reduced by eating a healthy diet, staying physically active, not smoking tobacco and limiting alcohol. Regular screenings are crucial for early detection. Colon cancer is the second leading cause of cancer-related deaths worldwide. In 2020, more than 1.9 million new cases of colorectal cancer and more than 930 000 deaths due to colorectal cancer were estimated to have occurred worldwide. Large geographical variations in incidence and mortality rates were observed. The incidence rates were highest in Europe and Australia and New Zealand, and the mortality rates were highest in Eastern Europe. By 2040 the burden of colorectal cancer will increase to 3.2 million new cases per year (an increase of 63%) and 1.6 million deaths per year (an increase of 73%). Incidence rates of colorectal cancer have been decreasing in high-income countries, largely as a result of effective screening programmes. The prognosis for colorectal cancer varies depending on the stage at diagnosis. Early-stage cancers have higher survival rates than advanced-stage cancers. Timely diagnosis, appropriate treatment, and regular follow-up care are important for improving survival rates and quality of life.

A Nursing Home Clinician Survey to Explain Gabapentinoid Increases

ObjectivesSurvey nursing home (NH) clinicians about the indications for NH gabapentinoid use, the factors driving increased prescribing, and their experiences with gabapentinoid deprescribing. DesignOnline clinician survey. Setting and ParticipantsNH clinicians prescribing gabapentinoids in US NHs. MethodsAn anonymous survey of NH prescribers was conducted using SurveyMonkey from March 15 to July 1, 2024. Recruitment employed crowdsourcing, targeting the membership of NH clinician organizations. A multidisciplinary team developed the instrument. Content focused on the magnitude of gabapentinoid prescribing for different, previously identified, indications, as well as clinician deprescribing experiences and perspectives. ResultsSixty-two self-identified NH prescribers participated: 76% white, 55% female, 77% physicians. One-third had geriatric training certifications. Most NH gabapentinoids were started in other care settings by non-NH clinicians. Gabapentinoid prescribing initiated in NHs was principally off-label for pain syndromes. Although prescribing solely for psycho-behavioral symptoms was rare, most clinicians reported that gabapentinoids have some utility in treating these symptoms and consequently may be preferred over alternative analgesics when psycho-behavioral symptoms coexist with pain. Gabapentinoid deprescribing occurs infrequently and is deprioritized relative to opioid reduction efforts. Most clinicians acknowledged potential gabapentinoid side effects; however, severe harms were rarely observed, and half agreed that gabapentinoids are generally safe and well-tolerated. Seventy-nine percent perceive gabapentinoids as safer and better tolerated than opioids, 57% than benzodiazepines, and 40% than antipsychotics. Conclusions and ImplicationsAn opportunity exists to increase NH safety by prioritizing gabapentinoid gradual dose reduction requirements. Because so many prescriptions originate outside NHs, any reduction effort should emphasize deprescribing across all care settings. Clinicians’ perceptions of gabapentinoids as reasonable but unmonitored alternatives to opioids and psychotropics contribute to their increased use. Safety and efficacy data supporting such prescribing for nonapproved indications in NHs is lacking. Existing NH psychotropic reporting and reduction mandates should include gabapentinoids regardless of indication.

Mechanism of vitamin C alleviating the immunotoxicity of 17α-methyltestosterone in Carassius auratus

BackgroundIn recent years, the use of endocrine-disrupting chemicals (EDCs) has become increasingly common, leading to severe environmental pollution and harm to aquatic organisms. 17α-Methyltestosterone (MT) is a synthetic androgen that can cause immunotoxicity in aquaculture, affecting fish health. To address this issue, this study aimed to investigate the effect of Vitamin C (VC) on MT-induced immunotoxicity and determine the optimal VC supplementation.ResultsCarassius auratus was exposed to 50 ng/L MT and treated with 25, 50, and 150 mg/kg VC for 7, 14, and 21 d. Morphological indicators, histological characteristics, hepatic antioxidant capacity, and immune-related gene expression were analyzed. Additionally, RNA-seq was performed on the liver tissues of the control, MT, and MT + 25 mg/kg VC groups after 21 d. Results showed that, MT treatment significantly increased liver malondialdehyde content and inhibited immune-related gene expression (TNF-α, IL-8, INF-γ, IL-10, Caspase-9, and IGF-I), causing oxidative stress and immunotoxicity, leading to hepatic steatosis. However, supplementation with 25–50 mg/kg VC effectively alleviated the MT-induced damage to the hepatic structure and immune system. RNA-seq revealed significant enrichment of differentially expressed genes in multiple signaling pathways, including the mTOR, MAPK, and Wnt pathways.ConclusionsIn summary, 25–50 mg/kg VC alleviated inhibitory effect of MT on immune-related genes in C. auratus liver, reducing MT-induced tissue damage. VC not only alleviated inflammation, oxidative stress, and immunotoxicity induced by MT through the regulation of the mTOR, MAPK, and Wnt signaling pathways, but also indirectly enhanced cellular antioxidant defense mechanisms by regulating the NRF2 pathway. This provides a theoretical basis for VC application in aquaculture, improving fish health and increasing efficiency.

Root causes behind patient safety incidents in the emergency department and suggestions for improving patient safety - an analysis in a Finnish teaching hospital.

Adverse events occur frequently at emergency departments (ED) because of several risk factors related to varying conditions. It is still unclear, which factors lead to patient safety incident reports. The aim of this study was to explore the root causes behind ED-associated patient safety incidents reported by personnel, and based on the findings, to suggest learning objectives for improving patient safety. The study material included incident reports (n = 340) which concerned the ED of a teaching hospital over one year. We used a mixed method combining quantitative descriptive statistics and qualitative research by inductive content analysis and deductive Ishikawa root cause analysis. Most (76.5%) incidents were reported after patient transfer from the ED. Nurses reported 70% of incidents and physicians 7.4%. Of the reports,40% were related to information flow or management. Incidents were evaluated as no harm (29.4%), mild (46%), moderate (19.7%), and severe (1.2%) harm to the patient. The main consequences for the organization were reputation loss (44.1%) and extra work (38.9%). In the qualitative analysis, nine specific problem groups were found: insufficient introduction, adherence to guidelines and protocols, insufficient human resources, deficient professional skills, medication management deficiencies, incomplete information transfer from the ED, language proficiency, unprofessional behaviour, identification error, and patient-dependent problems. Six organizational themes were identified: medical staff orientation, onboarding and competence requirements; human resources; electronic medical records and information transfer; medication documentation system; interprofessional collaboration; resources for specific patient groups such as geriatric, mental health, and patients with substance abuse disorder. Entirely human factor-related themes could not be defined because their associations with system factors were complex and multifaceted. Individual and organizational learning objectives were addressed, such as adherence to the proper use of instructions and adequate onboarding. System factors caused most of the patient safety incidents reported concerning ED. The introduction and training of ED -processes is elementary, as is multiprofessional collaboration. More research is needed about teamwork skills, patients with special needs and non-critical patients, and the reporting of severe incidents.

Risks and Harms to Physicians Reporting Hematologic Adverse Drug Reactions (ADRs) to Health Authorities

Background : The Southern Network on Adverse Reports group (SONAR) has previously identified severe risks and harms to physicians who reported serious ADRs to Heath Authorities related to solid-tumor oncology pharmaceuticals. (eClinMed, PLOS One, Journal of Scientific and Professional Integrity) We investigated whether similar risks and harms occurred to clinicians/scientists who reported hematology-associated ADRS. Methods: Quotes were abstracted from media coverage or Health Authority hearings for individual hematology drugs. Results : Risks and harms were reported in regulatory agency or government agency meetings by eight clinician/scientists physicians who led phase-3 pharmaceutical-sponsored clinical trials (Olivieri N (U Toronto, NEJM 1996, Singh G, Stanford, unpublished 2004), Buse J (U of North Carolina, unpublished 1999, Henke M (Abteilung Universitatsklinik, Lancet 2003, Mangano D (UCSF, NEJM 2005), Topol E and Nissen S (Cleveland Clinic JAMA 2004), meta-analyses (n = 2) (Bennett C (Northwestern, JAMA 2008, Mangano D (UCSF, NEJM 2006); database analyses (n = 1) (Mangano D (UCSF, NEJM 2004), case-control studies (n = 1) (Brass L, Yale, NEJM 2005) and an independent safety review (n = 1) (Solomon S, Harvard, JAMA 2005) including lawsuits, loss of job, public harassment and loss of grants. Three physicians lost academic positions (Topol, Olivieri, Mangano), two physicians lost federal grants (Olivieri, Bennett), and one FDA scientist (Graham) was demoted. ADR findings resulted in drug removal (n = 7; Vioxx, Avandia, Bextra, Celebrex, Trasylol, Phenyl propanolamine, Hydroxy-ethyl starch), revised indications (n = 2) (Procrit, Aranesp 2007, 2008, 2010)) or 10-year delay in FDA-approval (n = 1) (Fereprox). Median time from FDA approval to ADR identification was 8 years (Range, 4 years (Bextra) to 62 years PPA)). Numbers of persons reportedly seriously injured or dying from 1 ADR was 10,00 (Procrit)- 270,000 (Vioxx) (median 120,000). Manufacturer allegations that resulted in pharmaceutical companies actions included violation of secrecy agreement (n = 2) (Fererpox, PPAs) and public reporting of proprietary data (n = 11). Pharmaceutical companies paid $600,000 (Fereprox) to $5.8 billion (Vioxx) in fines and settlements. Discussion: Twelve physicians experienced severe threats and/or harms after reporting hematologic-associated ADRs to Health Authorities and/or in major publications. We suggest physicians not sign secrecy agreements that might jeopardize public safety (as currently established by almost all US medical universities) and should partner with independent drug safety monitoring boards (DSMBs) on ADR evaluations to monitor safety concerns of drugs and medical devices.

Accurate and efficient prediction of atmospheric PM1, PM2.5, PM10, and O3 concentrations using a customized software package based on a machine-learning algorithm.

Particulate matter (PM) and ozone (O3) pollution have been attracting increasing attention recently due to their severe harm to human health. PM and O3 are secondary pollutants, and there remain significant challenges in accurately and efficiently predicting their concentrations in the atmosphere. In this study, one-year monitoring data of PM1, PM2.5, PM10, and O3 concentrations as well as meteorological parameters and concentrations of various precursors (i.e., nitrogen oxides, SO2, CO, alkanes, aldehydes, and ketones) are obtained at a monitoring site in central China's Hunan province. The eXtreme Gradient Boosting model is trained and tested to achieve efficient and accurate predictions of the concentrations of the four pollutants. The effects of different datasets, input features, and model parameters on the prediction accuracy are investigated. Principal component analysis is employed to further reduce the dimensions of features, increasing the prediction efficiency. Finally, all model training and prediction processes are incorporated in an executable application using the PyQt5 framework to build a user interface. The customized software supports user-defined modeling. The software can simultaneously predict PM1, PM2.5, PM10, and O3 concentrations, making the prediction process convenient.

Detection of crack on concrete surfaces using image processing techniques

Cracks on the concrete surface are one of the earliest indications of structural disintegration under maintenance; further the continual exposure can cause severe harm to the environment. The manual method of crack detection is time-consuming. Since the manual approach fully depends on the specialist’s data and experience, it lacks perspicacity within quantitative analysis. This study establishes a MATLAB® programme on image process techniques for automatic crack recognition and analyses. An image pre-processing theme combines multiple adaptive filtering and contrast enhancement based on the image that may improve the removal of background noise. Then, for removing isolated noise spots, it tends to develop a local adaptive threshold segmentation formula combined with an image morphological operator. The goal of this Gray intensity adjustment methodology is to improve the accuracy of the crack detection results. Furthermore, the results show that the target crack is identified on the concrete surface, additionally classified as its crack type and its properties are extracted.

The Susceptibility of Malaysian Rice Brands To Sitophilus oryzae and The Potential Application of Zinc Oxide Nanoparticles For Control Purposes

The rice weevil, Sitophilus oryzae, is an insect pest that can pose severe harm to stored grains. Rice weevils, both adults and larvae, cause significant economic losses because they can infest a wide range of plants and stored goods. Nanoparticle insecticides are created and studied to replace the overly-used synthetic chemical insecticides. The purpose of this study is to investigate the susceptibility of several commercialized rice brands towards S. oryzae infestation and to assess the toxicity of different types of zinc oxide (ZnO) against S. oryzae. The study involved twelve rice brands, and S. oryzae infestation rates were observed in the laboratory for 17 weeks. The infestation rates were obtained at the end of the observation period. To obtain the required dosages of 0.1, 0.2, 0.4, and 0.8% (w/w), four different concentrations of each type of ZnO nanoparticle that had undergone various reactivity modifications were mixed with rice for bioassays test. S. oryzae has been proven to be susceptible to almost all commercialized rice brands studied in this research. Based on the data, it can be concluded that the ZnO nanoparticle modified with gamma-ray is the most effective at controlling S. oryzae, as 100% mortality was seen after three days of treatment at concentrations between 0.4 to 0.08% (w/w). The slow emergence of pests in monitored rice brands is attributed to the protectants and their residue, which work by eradicating eggs and adults that have consumed the grain. Zinc oxide type 7A is the most toxic towards S. oryzae because of its exposure to gamma-ray which has the highest energy compared to neutron and beta rays. This results in the release of more active molecules to act on the pest.

Bullying of LGBTQ+ children and adolescents in schools: understanding the phenomenon, consequences, and international standards with a focus on the polish context.

Bullying refers to repetitive, aggressive behavior intended to harm or intimidate others. Cyberbullying extends this aggression to digital platforms, involving harassment via social media, texts, or emails. These forms of bullying are particularly damaging to LGBTQ+ youth, who often face discrimination based on their sexual orientation or gender identity. In the context of LGBTQ+ individuals, bullying and cyberbullying can lead to severe emotional and psychological harm, contributing to higher rates of depression, anxiety, and suicidal ideation. Despite extensive global efforts and campaigns to combat homophobia, LGBTQ+ students continue to face significant challenges, with the situation in Poland being notably severe. The review highlights various forms of bullying, including physical, verbal, and social aggression, and underscores the alarming involvement of school personnel in perpetuating such behaviors. The focus on the Polish context enriches the global discourse on LGBTQ+ rights and highlights the critical need for targeted interventions to support vulnerable youth in regions with prevalent conservative and religious sentiments.

Australian Dentists' Knowledge of the Consequences of Interpretive Errors in Dental Radiographs and Potential Mitigation Measures.

Dental radiographs, typically taken and interpreted by dentists, are essential for diagnosis and effective treatment planning. Interpretive errors in dental radiographs, stemming from failures of visual and cognitive processes, can affect both patients and clinicians. This survey aimed to assess the dental practitioners' perceptions of the consequences of these errors and potential measures to minimize them. This online anonymized survey assessed Australian dental practitioners' perceptions of the consequences of these errors and potential mitigation measures using ranking, Likert scale, and open-ended questions. The data were analyzed using descriptive statistics and bivariate analysis. Participants identified undertreatment (72%) and legal implications (82%) as the most significant consequences of interpretive errors, whereas severe harm to patients was deemed the least likely. Dental practitioners placed a greater emphasis on maintaining a high level of competence and the well-being of their patients. Utilizing high-quality images (63.9%) and appropriate radiographs (59.7%) were identified as the most effective measures to minimize interpretive errors. Participants showed hesitancy regarding the reliance on machine learning as a clinical decision-making tool. The survey provides valuable practical insights into the consequences and targeted measures to minimize the occurrence of interpretive errors. Efforts to minimize interpretive errors should address patient safety and practitioners' concerns about professional reputation and business viability. The study also suggests further research into the role of machine learning algorithms in reducing interpretive errors in dentistry.

Emission Risk and Inhibition Technology of Asphalt Fume from Crumb Rubber Modified Asphalt

Crumb rubber-modified asphalt mixtures have been proven to have extensive utilization value in road engineering. However, the rubber releases more fumes during the construction period, which causes severe harm to human health and the environment. This research focused on the emission risk of asphalt fume from crumb rubber-modified asphalt, and then the inhibition technology was also optimized. Firstly, the emission behavior and the hazardous evaluation of the asphalt fume from crumb rubber-modified asphalt were investigated. Then, the characteristics of the inhibition materials were evaluated. Finally, the reduction in the emission of inhibited crumb rubber-modified asphalt fume was identified, and the optimized formula was determined based on the inhibition effect, rheological properties, and cost. The results indicate that crumb rubber-modified asphalts release more fume components with an increment in the temperature and crumb rubber content. Desulfurized rubber reduces the release of H2S and NO. Benzene compounds, including paraxylene, toluene, and benzene, are the most released pollutants that harm human health, especially DS CRA 20% and CRA 50%. Kaolin powder and expanded graphite have a sufficient pore structure and volume, the addition of which reduces the release of pollutants while possibly promoting the release of NO and H2S. Their addition also has a significant control effect on the release of particulate matter at 170 °C and 185 °C. With the consideration of emissions, rheological properties, and cost, CRA 40%-EG2%-KL2% was determined as the optimization formula. This research is helpful to the application of crumb rubber-modified asphalt in road construction and maintenance.

Flower-like ZnO/BiOI p–n heterojunction composite membrane composed of nanosheets for enhanced photodegradation of water-soluble pollutant and high efficiency oil–water emulsion separation

The emulsified oil wastewater produced from the petrochemical industries and people’s daily life would cause severe harm to the ecological environment if improperly treated. Thus, the development of membranes with efficient oil–water separation and self-cleaning property remains a key global research direction. In this study, p-n heterojunctions membrane with BiOI@ZnO hierarchical flower-like-nanosheets structures (BiOI@ZnO@SSM) has been successfully fabricated through two-step electrodeposition method. The BiOI@ZnO@SSM is capable of separating water and oil from emulsified oil wastewater and performing efficient adsorption and photocatalytic degradation of organic pollutants in water. The separation efficiency of BiOI@ZnO@SSM for numerous oil-in-water (O/W) emulsions exceeded 99.3 % as well as a fast permission flux up to 299.8 L·m−2·h−1. And the degradation efficiency of BiOI@ZnO@SSM for Rhodamine B (RhB) can reach to 99.0 % in 80 min under visible-light irradiation, which is 1.5 times as high as that of ZnO@SSM. The obviously enhanced photocatalytic activity of BiOI@ZnO@SSM is due to the formation of p-n heterojunction between p-type BiOI and n-type ZnO, which broadens the light absorption range, promotes the effective separation and prolongs the lifetime of electron and hole pair and realizes efficient degradation of organic pollutants. Meanwhile, multidimensional and hierarchical nanoflowers structure is not only helpful to improve the utilization of light, but also can increase more catalytic active sites. After ten cycles, this membrane maintained high emulsion separation efficiency of 99.6 % and the photodegradation efficiency remained above 94.5 %, demonstrating its good recyclability and stability. This durable and multifunctional heterojunction composite membrane with a flower-like structure is of great application potential in dealing with practically emulsified wastewater.

Assessing drinking water quality in Eloued, south-East Algeria, using the groundwater pollution index (GPI) and the synthetic pollution index (SPI) model.

Groundwater quality degradation is a significant environmental issue worldwide, with potentially severe economic consequences and harm to ecosystems and biodiversity. This can directly affect human health, particularly in developing countries where rapid and uncontrolled urbanization is on the rise. Groundwater is the primary resource for meeting the water needs of the Eloued region, located in southeastern Algeria. Water is considered unfit for human consumption if its physico-chemical elements exceed national or international standards or guidelines. We used the GPI and SPI indices to evaluate the quality of groundwater suited for drinking. Groundwater samples were obtained from 22 wells at depths of more than 250m. Standard analytical procedures were used to determine the physicochemical characteristics of the collected samples, which included pH, EC, TDS, Na+, Ca+2, Mg+2, K+, Cl-, HCO3-, SO4-2, NO3-, NO2-, NH4+ and PO4-3. Multivariate statistical analysis and GIS techniques were used to process the results. The results of the selected physicochemical parameters were compared with World Health Organization (WHO) guidelines to determine the quality of drinking water. The findings indicate that the waters of the terminal complex aquifer are salty and contain medium to high quantities of main ions that surpass the established drinking water limits. The primary ions' relative abundance is Cl- > SO4-2 > HCO3- > NO3 for anions and Na+ > Ca+2 > Mg+2 > K+ for cations. Groundwater chemical types were dominated by Na+, Ca+2, Cl-, and SO4-2. Principal Component Analysis (PCA) showed that alteration and dissolution of carbonates, evaporates, salts, partly silicates, and evaporation, are the main reasons affecting the chemical composition of water in Eloued. The GPI results show that 18.18%, 54.54%, and 27.27% of the water samples were classed as lightly polluted, moderately polluted, or substantially polluted for drinking purposes, respectively. According to the SPI study, 9.09%, 36.36%, 36.36%, and 18.18% were considered drinkable, mildly contaminated, moderately polluted, and seriously polluted for drinking purposes, respectively. According to the GPI and SPI models' geographical distribution maps, potable water is generally scarce and concentrated in the northeastern section of the research area, near the town of Ourmes.

How Online Patient-Provider Communication Alleviates Psychological Distress Among Patients with Chronic Diseases: The Role of Perceived Patient-Centered Communication and Adaptive Coping Strategies

ABSTRACT Chronic diseases, which require long-term continuous care due to the long clinical courses, may cause severe harm to the psychological well-being of a large population in the U.S. Providing convenient and affordable access to healthcare, online patient-provider communication (OPPC) is considered a potentially effective means in safeguarding psychological well-being among patients with chronic diseases. However, what underlying mechanism OPPC helps patients deal with psychological issues is largely unknown in the context of chronic diseases. Thus, drawing on the health communication pathway model, this study seeks to address the gap by investigating the psychological and behavioral mechanism of how OPPC alleviates psychological distress among patients with chronic diseases. Analyzing secondary data derived from the Health Information National Trends Survey (HINTS 5, Cycle 3, N = 879), this study reveals that OPPC can elicit perceptions of patient-centered communication (PCC) and facilitate patients to take adaptive coping strategies, including problem-oriented and emotion-oriented coping, thus alleviating psychological distress among patients with chronic diseases. However, only emotion-oriented coping in this process significantly reduces psychological distress. On this basis, this study advances the understanding of the therapeutic effect of OPPC among patients with chronic diseases and extends the health communication pathway model by examining the role of patient-provider communication in facilitating adaptive coping strategies.