Severe Harm Research Articles

Harm Reduction Behavioral Activation Teletherapy for People Who Inject Drugs: Development, Feasibility, and Acceptability

People who inject drugs (PWID) experience severe substance-related harms and yet have low rates of engagement in substance use disorder treatment. Low-barrier and telepsychology interventions represent promising strategies for engaging PWID in treatment, but few studies have tested the feasibility of these approaches among non-treatment-seeking PWID. A behavioral activation (BA) treatment for substance use was adapted through a harm reduction lens to assist PWID in working toward healthy, meaningful lives and achieving their goals. This study aims to: (a) describe the development and harm reduction–focused adaptation of the BA intervention, and (b) examine the feasibility and acceptability of administering a telepsychology BA treatment for substance use among non-treatment-seeking PWID. We recruited N = 23 PWID (65.2% White; 52.2% women; mean age 35.4 ± 7.8 years) from syringe services programs into an open trial and n = 19 received up to eight sessions of BA over 4 weeks. Qualitative treatment feedback interviews occurred at posttreatment. Among those who attended ≥1 session of treatment, 84% attended a second assessment, and 58% attended ≥7 intervention sessions. Feasibility challenges were primarily related to participant vulnerabilities (e.g., hospitalization, incarceration, loss of access to technology). Participants indicated high acceptance of the intervention and its telepsychology format. In conclusion, while PWID face significant barriers to engaging in treatment, some also demonstrate a desire, willingness, and capacity for psychological intervention. Remote interventions may help increase feasibility of treatment participation. Future studies should examine longer harm reduction-focused treatments for PWID that balance barriers to initial engagement with the need to reinforce treatment gains and improve long-term outcomes.

Causes of medication administration errors and barriers to reporting as perceived by nurses in Saudi Arabia: A qualitative study.

Medication administration errors significantly impact patient safety, potentially leading to severe harm or fatality. Reporting such errors through active systems improves medication administration, thereby enhancing patient safety and the quality of care. However, in the context of Saudi Arabia, little is understood about the causes of medication administration errors and the obstacles hindering their reporting. This study aimed to explore nurses' perceptions of the causes of medication administration errors and the barriers to reporting them. The study employed a qualitative descriptive design, conducting face-to-face semi-structured interviews with 43 nurses from three hospitals in Taif Governorate, Saudi Arabia, between October and November 2023. Purposive sampling was used to recruit participants, and thematic analysis was utilized for data analysis. The following themes emerged regarding the causes of medication administration errors: order deficiencies, high workloads and staff shortages, and malpractice. Regarding the barriers to reporting errors, the emerging themes were fear of punishment and lack of support, lack of knowledge and awareness about reporting, and lack of feedback. This study reveals nurses' perceptions of the causes of medication administration errors and the barriers to reporting them. Recognizing and addressing these causes and barriers are essential for patient safety and the improvement of the healthcare environment. Efforts should be directed toward implementing interventions that address high workloads, enhance staff education and awareness, and promote a workplace culture conducive to reporting errors without fear of repercussions. Additionally, supportive mechanisms, such as feedback systems and resources for professional development, should be implemented to empower nurses to actively participate in error reporting and contribute to continuous improvement in medication administration practices.

Experimental analysis and safety assessment of thermal runaway behavior in lithium iron phosphate batteries under mechanical abuse

Mechanical abuse can lead to internal short circuits and thermal runaway in lithium-ion batteries, causing severe harm. Therefore, this paper systematically investigates the thermal runaway behavior and safety assessment of lithium iron phosphate (LFP) batteries under mechanical abuse through experimental research. Mechanical abuse experiments are conducted under different conditions and battery state of charge (SOC), capturing force, voltage, and temperature responses during failure. Subsequently, characteristic parameters of thermal runaway behavior are extracted. Further, mechanical abuse conditions are quantified, and the relationship between experimental conditions and battery characteristic parameters is analyzed. Finally, regression models for battery safety boundaries and the degree of thermal runaway risk are established. The research results indicate that the extracted characteristic parameters effectively reflect internal short circuit (ISC) and thermal runaway behaviors, and the regression models provide a robust description of the battery's safety boundaries and thermal runaway risk degree. This work sheds light on understanding thermal runaway behavior and safety assessment methods for lithium-ion cells under mechanical abuse.

A Mini-Review on Metal Oxide Semiconductor Gas Sensors for Carbon Monoxide Detection at Room Temperature

Carbon monoxide can cause severe harm to humans even at low concentrations. Metal Oxide Semiconductor (MOS) carbon monoxide gas sensors have excellent sensing performance regarding sensitivity, selectivity, response speed, and stability, making them very desirable candidates for carbon monoxide monitoring. However, MOS gas sensors generally work at temperatures higher than room temperature, and need a heating source that causes high power consumption. High power consumption is a great problem for long-term portable monitoring devices for point-of-care or wireless sensor nodes for IoT application. Room-temperature MOS carbon monoxide gas sensors can function well without a heater, making them rather suitable for IoT or portable applications. This review first introduces the primary working mechanism of MOS carbon monoxide sensors and then gives a detailed introduction to and analysis of room-temperature MOS carbon monoxide sensing materials, such as ZnO, SnO2, and TiO2. Lastly, several mechanisms for room-temperature carbon monoxide sensors based on MOSs are discussed. The review will be interesting to engineers and researchers working on MOS gas sensors.

Landmine Detection using An Advanced Embedded Microcontroller

During warfare, the detection of landmines is of utmost importance for safely deploying armed vehicles in enemy territory. These vehicles, known as main battle tanks, are crucial for following the path set by manually operated pilot tanks, in order to prevent any damage or distractions to the battle tanks and to minimize casualties among defense crews. Our landmine-detecting robotic vehicles serve the primary purpose of identifying landmines across a large expanse of the defense field. The detonation of these landmines can result in severe harm to soldiers and even release toxic pollutants into the environment. Traditionally, the robots are deployed prior to the commencement of war in the war-based area, where they play a critical role in saving the lives of soldiers

Developing a process to measure actual harm from medication errors in paediatric inpatients: From design to implementation.

The potential harm associated with medication errors is widely reported, but data on actual harm are limited. When actual harm has been measured, assessment processes are often poorly described, limiting their ability to be reproduced by other studies. Our aim was to design and implement a new process to assess actual harm resulting from medication errors in paediatric inpatient care. Prescribing errors were identified through retrospective medical record reviews (n =26 369 orders) and medication administration errors through direct observation (n =5137 administrations) in a tertiary paediatric hospital. All errors were assigned potential harm severity ratings on a 5-point scale. Multidisciplinary panels reviewed case studies for patients assigned the highest three potential severity ratings and determined the following: actual harm occurrence and severity level, plausibility of a link between the error(s) and identified harm(s) and a confidence rating if no harm had occurred. Multidisciplinary harm panels (n =28) reviewed 566 case studies (173 prescribing related and 393 administration related) and found evidence of actual harm in 89 (prescribing = 22, administration = 67). Eight cases of serious harm cases were found (prescribing = 1, administration = 7) and no cases of severe harm. The panels were very confident in 65% of cases (n =302) where no harm was found. Potential and actual harm ratings varied. This harm assessment process provides a systematic method for determining actual harm from medication errors. The multidisciplinary nature of the panels was critical in evaluating specific clinical, therapeutic and contextual considerations including care delivery pathways, therapeutic dose ranges and drug-drug and drug-disease interactions.

Liraglutide improved the reproductive function of obese mice by upregulating the testicular AC3/cAMP/PKA pathway.

The incidence of male reproductive dysfunction is increasing annually, and many studies have shown that obesity can cause severe harm to male reproductive function. The mechanism of male reproductive dysfunction caused by obesity is unclear, and there is no ideal treatment. Identification of effective therapeutic drugs and elucidation of the molecular mechanism involved in male reproductive health are meaningful. In this study, we investigated the effects of the GLP-1 receptor agonist liraglutide on sex hormones, semen quality, and testicular AC3/cAMP/PKA levels in high-fat-diet-induced obese mice. Obese mice and their lean littermates were treated with liraglutide or saline for 12weeks. Body weight was measured weekly. Fasting blood glucose (FBG) was measured using a blood glucose test strip. The serum levels of insulin (INS), luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone (T), free testosterone (F-TESTO), estradiol (E2), and sex hormone binding globulin (SHBG) were detected using ELISA. The sperm morphology and sperm count were observed after Pap staining. The mRNA and protein expression levels of testicular GLP-1R and AC3 were measured by RT-qPCR and Western blot, respectively. Testicular cAMP levels and PKA activity were detected using ELISA. Liraglutide treatment can decrease body weight, FBG, INS, HOMA-IR, E2 and SHBG levels; increase LH, FSH, T, and F-TESTO levels; increase sperm count; decrease the sperm abnormality rate; and increase GLP-1R and AC3 expression levels and cAMP levels and PKA activity in testicular tissue. Liraglutide can improve the sex hormone levels and semen quality of obese male mice. In addition to its weight loss effect, liraglutide can improve the reproductive function of obese male mice, which may also be related to the upregulation of AC3/cAMP/PKA pathway in the testis. This work lays the groundwork for future clinical studies.

Mentally healthy living after pandemic social distancing: a study of older Canadians reveals helpful anxiety reduction strategies.

Throughout the COVID-19 pandemic, older Canadians were the most at risk of severe physical harm, including death, and their return to post-COVID life was expected to be especially anxiety-provoking. A study was conducted to obtain nationally representative evidence of older Canadians' self-perceived anxiety levels and their strategies to manage or mitigate it as public health restrictions were lifting. This study had a cross-sectional descriptive design. An e-survey was used to collect data from 1327 Canadians aged 60+ stratified by age, sex, and education to resemble the larger general population. Participants completed the Geriatric Anxiety Scale (GAS-10) and indicated which of the 16 Centre for Addictions and Mental Health's (2022) Coping with Stress and Anxiety strategies they were using to manage or mitigate their anxiety when social distancing was lifting. Descriptive statistics, Pearson correlation, and multiple regression analysis were used to explore the data. While, on average, older Canadians were mildly anxious, nearly one-quarter of responders rated their anxiety as severe. Age, sex, perceived health, were statistically significant correlates of anxiety. Six coping strategies were associated with significantly lower anxiety scores. Moreover, accepting some fear and anxiety as normal, challenging worries and anxious thoughts, and practising relaxation/meditation appeared to increase anxiety. Older Canadians used multiple strategies to manage or mitigate their anxiety, and seemingly, with more successful than detrimental tries. Practitioners have much to learn and understand about older people's mental health promotion efforts after social distancing, now and for future pandemics.

A novel method in COPD diagnosing using respiratory signal generation based on CycleGAN and machine learning

Objective The main goal of this research is to use distinctive features in respiratory sounds for diagnosing Chronic Obstructive Pulmonary Disease (COPD). This study develops a classification method by utilizing inverse transforms to effectively identify COPD based on unique respiratory features while comparing the classification performance of various optimal algorithms. Method Respiratory sounds are divided into individual breathing cycles. In the data standardization and augmentation phase, the CycleGAN model enhances data diversity. Comprehensive analyses for these segments are then implemented using various Wavelet families and different spectral transformations representing characteristic signals. Advanced convolutional neural networks, including VGG16, ResNet50, and InceptionV3, are used for the classification task. Results The results of this study demonstrate the effectiveness of the mentioned method. Notably, the best-performing method utilizes Wavelet Bior1.3 after standardization in combination with InceptionV3, achieving a remarkable 99.75% F1-score, the gold standard for classification accuracy. Conclusion Inverse transformation techniques combined with deep learning models show significant accuracy in detecting COPD disease. These findings suggest the feasibility of early COPD diagnosis through AI-powered characterization of acoustic features. Motivation and Significance The motivation behind this research stems from the urgent need for early and accurate diagnosis of Chronic Obstructive Pulmonary Disease (COPD). COPD is a respiratory disease that poses many difficulties when detected late, potentially causing severe harm to the patient’s quality of life and increasing the healthcare burden. Timely identification and intervention are crucial to reduce the progression of the disease and improve patient outcomes.

High performance Co3O4/Sn-ZnO nanocomposite photocatalyst for removal of methylene blue dye

Methylene blue is a toxic, carcinogenic, and non-biodegradable synthetic dye discharged from factories and industries that causes severe harm to human health and environmental pollution. Therefore, in this work, Co3O4/Sn-ZnO nanocomposite was synthesized using a simple sol–gel method for efficient photocatalytic removal of methylene blue dye in an aqueous basic medium. The structural, optical, photoluminescence, morphological, and compositional properties were studied. The XRD result revealed that the crystal size increases as the full width at half maxima (FWHM) decreases when Co3O4 are coupled with Sn-ZnO. From UV-visible diffusive reflectance and photoluminescence spectroscopies, a narrowing of the band gap and a reduction of the charge carrier’s recombination rate were observed, respectively. The photocatalytic efficiency and degradation rate constant of 95.1% and 0.03251 min−1 were recorded for methylene blue dye upon the use of optimized catalyst dosage of 60 mg Co3O4/Sn-ZnO nanocomposite catalyst under an irradiation time of 100 min at room temperature for optimized pH value of 9 in an aqueous basic medium.

The harms of terminology: why we should reject so-called “frontier AI”

In the mid-2023, promoters of artificial intelligence (AI) as an “existential risk” coined a new term, “frontier AI,” that refers to “highly capable foundation models that could possess dangerous capabilities sufficient to pose severe risks to public safety.” Promoters of this new term were able to disseminate it via the United Kingdom (UK) government’s Frontier AI Taskforce (formerly the Foundation Models Taskforce) as well as the UK’s AI Safety Summit, held in November 2023.I argue that adoption of the term “frontier AI” is harmful and contributes to AI hype. Promoting this new term is a way for its boosters to focus the public conversation around the AI-related risks they think are most important, namely “existential risk”—a scenario in which AI is able to bring about the destruction of humanity. Simultaneously, “frontier AI” is a re-branding exercise for the large-scale generative machine learning (ML) models that have been shown to cause severe and pervasive harms (including psychological, social, and environmental harms). Unlike “existential risk,” these harms are actual rather than theoretical, whereas the term “frontier AI” moves our collective focus away from actual harms to focus on hypothetical doomsday scenarios.Moreover, “frontier AI” as a term invokes the colonial mindset, further reinscribing the harmful dynamics between the handful of powerful Western companies who produce today’s generative AI models and the people of the “Global South” who are most likely to experience harm as a direct result of the development and deployment of these AI technologies.

Glutathione ligand self-assembly enables luminescence from Au15 nanoclusters for highly sensitive and selective monitoring of blood Pb(II) ions

Lead Pb(II) ions is a cumulative toxicant that impacts several biological systems and poses severe harm to young children. Accurate Pb(II) ions monitoring is thus of paramount importance. Here, we present the synthesis and application of glutathione-capped Au15 nanoclusters (Au15(SG)13) as a luminescence probe for the accurate and selective monitoring of blood Pb(II). The introduction of Pb(II) ions triggers orderly self-assembly of Au15 nanoclusters, resulting in the formation of rigid shell around Au nuclei. This limits the localized vibration of the glutathione ligands and their interaction with water molecules, greatly reducing non-radiative energy loss, and thereby enhancing the photoluminescence signal. Consequently, Au15(SG)13 nanoclusters exhibit high sensitivity for Pb(II) detection. The detection signal displays a linear relationship with Pb(II) over a wide detection range (0–800 μg/L), demonstrating a substantial sensitivity of 35.29 μg/L. Moreover, the developed nanoclusters show superior selectivity for Pb(II) ions, distinguishing them from other prevalent heavy metals. This work pave the way for the development of advanced Pb(II) sensors with high sensitivity and selectivity.

Risk Factors Associated with Medication Administration Errors in Children: A Prospective Direct Observational Study of Paediatric Inpatients.

Limited evidence exists regarding medication administration errors (MAEs) on general paediatric wards or associated risk factors exists. The aim of this study was to identify nurse, medication, and work-environment factors associated with MAEs among paediatric inpatients. This was a prospective, direct observational study of 298 nurses in a paediatric referral hospital in Sydney, Australia. Trained observers recorded details of 5137 doses prepared and administered to 1530 children between 07:00h and 22:00h on weekdays and weekends. Observation data were compared with medication charts to identify errors. Clinical errors, potential severity and actual harm were assessed. Nurse characteristics (e.g. age, sex, experience), medication type (route, high-risk medications, use of solvent/diluent), and work variables (e.g. time of administration, weekday/weekend, use of an electronic medication management system [eMM], presence of a parent/carer) were collected. Multivariable models assessed MAE risk factors for any error, errors by route, potentially serious errors, and errors involving high-risk medication or causing actual harm. Errors occurred in 37.0% (n=1899; 95% confidence interval [CI] 35.7-38.3) of administrations, 25.8% (n=489; 95% CI 23.8-27.9) of which were rated as potentially serious. Intravenous infusions and injections had high error rates (64.7% [n=514], 95% CI 61.3-68.0; and 77.4% [n=188], 95% CI 71.7-82.2, respectively). For intravenous injections, 59.7% (95% CI 53.4-65.6) had potentially serious errors. No nurse characteristics were associated with MAEs. Intravenous route, early morning and weekend administrations, patient age ≥ 11 years, oral medications requiring solvents/diluents and eMM use were all significant risk factors. MAEs causing actual harm were 45% lower using an eMM compared with paper charts. Medication error prevention strategies should target intravenous administrations and not neglect older children in hospital. Attention to nurses' work environments, including improved design and integration of medication technologies, is warranted.

Review on Structural Adjustment Strategies of Titanium‐Based Metal Oxide Dimensionally Stable Anodes in Electrochemical Advanced Oxidation Technology

Emerging organic pollutants and refractory pollutants in water bodies have caused severe harm to the ecological environment and human health. Electrochemical advanced oxidation processes (EAOPs) are currently one of the most effective oxidation methods to deal with refractory organic pollutants. Electrode materials serve as the most critical component in influencing the EAOP performance. Dimensionally stable anodes (DSAs) have the advantages of dimensional stability, structural diversity, chemical stability, low oxygen evolution potential and long service life, etc. Herein, several types of Ti‐based metal oxide DSAs (Ti/MOx DSAs) commonly used in EAOPs in the past 5 years, including Ti/IrO2, Ti/RuO2, Ti/PbO2, Ti/Sb–SnO2, and Ti/TiO2, are introduced. The modification methods including metal doping, composition adjustment, nanostructure construction, introduction of intermediate layers, compositing with carbon materials, and formation of 3D structures as well as the applications of these modified Ti‐based DSAs in EAOP for the rapid degradation of various organic pollutants are summarized and their advantages and current shortcomings of electrodes are pointed out. Finally, the Ti‐based DSA's current limitations and future development prospects are concluded.

Comparison between proactive and retroactive models of medication reconciliation in patients hospitalized for acute decompensated heart failure.

Most research on the impact of medication reconciliation on patient safety focused on the retroactive model, with limited attention given to the proactive model. This study was conducted to compare the proactive and retroactive models in patients hospitalized for acute decompensated heart failure. This prospective, quasi-experimental study was conducted over six months, from June to November 2022, at the cardiology unit of an academic hospital in Iran. Eligible patients were those hospitalized for acute decompensated heart failure using a minimum of five regular medications before admission. Medication reconciliation was performed in 81 cases using the proactive model and in 81 using the retroactive model. 556 medications were reconciled using the retroactive model, and 581 were reconciled using the proactive model. In the retroactive cases, 341 discrepancies (both intentional and unintentional) were identified, compared to 231 in the proactive cases. The proportion of patients with at least one unintentional discrepancy was significantly lower in the proactive cases than in the retroactive cases (23.80% versus 74.03%). Moreover, the number of unintentional discrepancies was significantly lower in the proactive cases compared to the retroactive cases (22 out of 231 discrepancies versus 150 out of 341 discrepancies). In the retroactive cases, medication omission was the most frequent type of unintentional discrepancy (44.00). About, 42.70% of reconciliation errors detected in the retroactive cases were judged to have the potential to cause moderate to severe harm. While the average time spent obtaining medication history was similar in both models (00:27 [h: min] versus 00:30), the average time needed to complete the entire process was significantly shorter in the proactive model compared to the retroactive model (00:41 min versus 00:51). This study highlighted that the proactive model is a timely and effective method of medication reconciliation, particularly in improving medication safety for high-risk patients.

Protecting Future Generations Through Minilateralism: Climate Clubs and Normative Legitimacy

Despite three decades of global climate negotiations and high expectations for the 2015 Paris Agreement, global emissions continue to grow. To protect future generations from severe harm, scholars, environmentalists, and politicians alike explore potential supplements to the United Nations Framework Convention on Climate Change process. One potential supplement is climate clubs of a type where a small number of “enthusiastic” countries embark on ambitious mitigation efforts while encouraging other, more “reluctant” countries to join. Previous research has shown that this club type possesses a significant potential for expanding membership and eventually becoming highly effective in reducing global emissions. A common criticism of climate clubs, however, is that they lack legitimacy. Assessing this criticism, we argue that climate clubs of the type considered here can be normatively legitimate. The main challenge for normative legitimacy concerns climate clubs’ use of incentives, particularly negative incentives, to attract members. However, we argue that even negative incentives for participation can be legitimate, assuming they meet a set of relevant legitimacy criteria—including that the club respects human rights, provides a comparative benefit, maintains institutional integrity, implements only proportional incentives, and fulfills a requisite set of epistemic criteria. We also argue that the normative legitimacy of climate clubs’ use of incentives for compliance is less challenging than the normative legitimacy of their use of incentives for participation.

A novel neural network-based framework to estimate oil and gas pipelines life with missing input parameters

Dry gas pipelines can encounter various operational, technical, and environmental issues, such as corrosion, leaks, spills, restrictions, and cyber threats. To address these difficulties, proactive maintenance and management and a new technological strategy are needed to increase safety, reliability, and efficiency. A novel neural network model for forecasting the life of a dry gas pipeline system and detecting the metal loss dimension class that is exposed to a harsh environment is presented in this study to handle the missing data. The proposed strategy blends the strength of deep learning techniques with industry-specific expertise. The main advantage of this study is to predict the pipeline life with a significant advantage of predicting the dimension classification of metal loss simultaneously employing a Bayesian regularization-based neural network framework when there are missing inputs in the datasets. The proposed intelligent model, trained on four pipeline datasets of a dry gas pipeline system, can predict the health condition of pipelines with high accuracy, even if there are missing parameters in the dataset. The proposed model using neural network technology generated satisfactory results in terms of numerical performance, with MSE and R2 values closer to 0 and 1, respectively. A few cases with missing input data are carried out, and the missing data is forecasted for each case. Then, a model is developed to predict the life condition of pipelines with the predicted missing input variables. The findings reveal that the model has the potential for real-world applications in the oil and gas sector for estimating the health condition of pipelines, even if there are missing input parameters. Additionally, multi-model comparative analysis and sensitivity analysis are incorporated, offering an extensive comprehension of multi-model prediction abilities and beneficial insights into the impact of various input variables on model outputs, thereby improving the interpretability and reliability of our results. The proposed framework could help business plans by lowering the chance of severe accidents and environmental harm with better safety and reliability.

Phthalates Induce Neurotoxicity by Disrupting the Mfn2-PERK Axis-Mediated Endoplasmic Reticulum-Mitochondria Interaction.

Di-(2-ethylhexyl) phthalate (DEHP), as the most common phthalate, has been extensively used as a plasticizer to improve the plasticity of agricultural products, which pose severe harm to human health. Mitochondrial dynamics and endoplasmic reticulum (ER) homeostasis are indispensable for maintaining mitochondria-associated ER membrane (MAM) integrity. In this study, we aimed to explore the effect of DEHP on the nervous system and its association with the ER-mitochondria interaction. Here, we showed that DEHP caused morphological changes, motor deficits, cognitive impairments, and blood-brain barrier disruption in the brain. DEHP triggered ER stress, which is mainly mediated by protein kinase R-like endoplasmic reticulum kinase (PERK) signaling. Moreover, DEHP-induced mitofusin-2 (Mfn2) downregulation results in imbalance of the mitochondrial dynamics. Interestingly, DEHP exposure impaired MAMs by inhibiting the Mfn2-PERK interaction. Above all, this study elucidates the disruption of the Mfn2-PERK axis-mediated ER-mitochondria interaction as a phthalate-induced neurotoxicity that could be potentially developed as a novel therapy for neurological diseases.

Never events in plastic surgery: An analysis of surgical burns and medical malpractice litigation

IntroductionBurns and fires in the operating room are a known risk and their prevention has contributed to many additional safety measures. Despite these safeguards, burn injuries contribute significantly to the medical malpractice landscape. The aim of the present study is to analyze malpractice litigation related to burn and fire injuries in plastic and reconstructive surgery, identify mechanisms of injury, and develop strategies for prevention. MethodsThe Westlaw and LexisNexis databases were queried for jury verdicts and settlements in malpractice lawsuits related to burn and fire injuries that occurred during plastic surgery procedures. The Boolean terms included “burn & injury & plastic”, “fire & injury & “plastic surg!”” in Westlaw, and “burn & injury & “plastic surg!””, “fire & injury & “plastic surg!”” in LexisNexis. ResultsA total of 46 cases met the inclusion criteria for this study. Overheated surgical instruments and cautery devices were the most common mechanisms for litigation. Plastic surgeons were defendants in 40 (87%) cases. Of the included cases, 43% were ruled in favor of the defendant, while 33% were ruled in favor of the plaintiff. Mishandling of cautery devices 6 (13%), heated surgical instruments 6 (13%), and topical acids 2 (4%) were the most common types of errors encountered. ConclusionNever events causing burn injury in plastic and reconstructive surgery are ultimately caused by human error or neglect. The misuse of overheated surgical instruments and cauterizing devices should be the focus for improving patient safety and reducing the risk of medical malpractice. Forcing functions and additional safeguards should be considered to minimize the risk of costly litigation and unnecessary severe harm to patients.

Interaction between Microplastics and Pathogens in Subsurface System: What We Know So Far

Microplastics (MPs) are abundant in soil and the subsurface environment. They can co-transport with pathogens or act as vectors for pathogens, potentially causing severe ecological harm. The interaction of MPs with pathogens is an important topic. To describe the origins and features of MPs in the subsurface environment, we evaluated relevant studies conducted in the laboratory and field groundwater habitats. We explore the interactions between pathogens and microplastics from three perspectives including the respective physicochemical properties of microplastics and pathogens, external environmental factors, and the binding between microplastics and pathogens. The effects of some interaction mechanisms and environmental factors on their co-transport are discussed. The key factors affecting their interaction are the particle size, specific surface area, shape and functional groups of MPs, the zeta potential and auxiliary metabolic genes of pathogens, and the hydrophobicity of both. Environmental factors indirectly affect MPs and the interaction and co-transport process of pathogens by changing their surface properties. These findings advance our knowledge of the ecological behavior of MPs–pathogens and the associated potential health hazards.