Trigger Values Research Articles

Investigating the occurrence and predictability of pitch angle scattering events at ADITYA-Upgrade tokamak with the electron cyclotron emission radiometer

This paper describes the experimental analysis and preliminary investigation of the predictability of pitch angle scattering (PAS) events through the electron cyclotron emission (ECE) radiometer signals at the ADITYA-Upgrade (ADITYA-U) tokamak. For low-density discharges at ADITYA-U, a sudden abnormal rise is observed in the ECE signature while other plasma parameters are unchanged. Investigations are done to understand this abrupt rise that is expected to occur due to PAS. The rise time is as fast as 100 μs with a single step and/or multiple step rise in ECE radiometer measurements. This event is known to limit the on-axis energy of runaway electrons. Being a repetitive event, the conditions of its repetitive occurrence can be investigated, thereby exploring the possibility of it being triggered and surveyed as an alternate runaway electron mitigation plan. Functional parameterization of such events with other discharge parameters is obtained and the possibility to trigger these events is discussed. PREDICT code is used to investigate the possible interpretations for the PAS occurrence through modeling and supporting the ECE observations. The trigger values so obtained experimentally are set as input criteria for PAS occurrence. Preliminary modeling investigations provide reliable consistency with the findings.

DETERMINING AGRICULTURAL INSURANCE PREMIUMS USING THE BLACK-SCHOLES APPROACH BASED ON LINEAR REGRESSION OF POTATO PRODUCTION AND PRICES

Price fluctuations, which often occur in the agricultural sector, cause farmers to experience losses when selling prices are not balanced with production costs. The government is trying to minimize farmers' losses by issuing an agricultural insurance program. One of the problems with agricultural insurance is determining the premium that farmers must pay so as not to disadvantage the insurance company. This paper explores the price of insurance premiums associated with potato cultivation in West Java, Indonesia. In addition, this research analyzes the factors that influence prices by focusing on the relationship between potato production levels and market prices. Therefore, a comprehensive data set of potato production data and associated prices is used. Regression analysis, as a statistical technique, is used to model the relationships. The Black-Scholes method then uses the obtained result to determine insurance premiums. This method is used due to a theoretical framework for pricing options that allows selecting an option's fair price using a structured, defined methodology that has been tried and tested. The premium values that depend on the trigger value are then obtained with a range of prices between IDR 5,687,670 and IDR 18,067,953 for an insured amount of IDR 39,403,000 per contract period. The premium price range allows farmers to choose the right agricultural insurance policy. It also allows insurance companies to determine insurance premiums for potato cultivation.

Establishment of typical values in cerebral thrombectomy according to the stroke anatomical region and procedure clinical outcome.

The aim of the study is to establish local diagnostic reference levels (DRLs) in cerebral thrombectomy, according to the anatomical region of ischemic stroke. This is a retrospective study from a single center involving 255 examinations. The proposed median values (P50) for thrombectomy are: 123Gy.cm2 for air kerma-area product (PKA) and 915mGy for air kerma (Ka,r). For middle cerebral artery (MCA) thrombectomies, the proposed DRLs are 118Gy.cm2 for PKA and 112Gy.cm2 for internal carotid artery (ICA). The Ka,r values for MCA and ICA are 849 and 775mGy, respectively. It was observed that 94.9% of patients presented grade 0 on the initial modified treatment in cerebral infarction (mTICI) scale, and after thrombectomy, 63.1% of patients reached a final mTICI grade of 3. Stents were implanted in 37 patients (14.5% of cases). It was concluded that 16.1% of patients exceeded one trigger value of the Safety in Radiological Procedures' recommended parameters. Establishing DRLs is an important tool for optimizing practices and is considered a standard for quality control.

The use of in vitro bioassays and chemical screening to assess the impact of a minimally processed vegetable facility on wastewater quality.

Fruit- and vegetable-processing facilities may contaminate wastewater via contaminants found in the produce and disinfecting chemicals used. These contaminants may include agrochemicals, pesticides, and disinfectants such as chlorine and quaternary ammonium compounds (QACs). Some compounds may exhibit harmful endocrine-disrupting activity. This study investigated the impact of a minimally processed vegetable facility on wastewater quality via in vitro bioassays and chemical screening. Estrogen activity was assessed via a yeast estrogen screen (YES), and (anti-)androgenic and glucocorticoid activities were evaluated via an MDA-kb2 reporter gene assay. The samples were screened via gas and liquid chromatography-tandem mass spectrometry (GC-MS/MS and LC-MS/MS) to identify target compounds, and GC coupled with time-of-flight mass spectrometry (GC-TOFMS) was used for non-targeted screening. Sample complexity and chemical profiles were assessed using GC-TOFMS. Estrogenic activity was detected in 16 samples (n = 24) with an upper limit of 595 ± 37ng/L estradiol equivalents (EEqs). The final wastewater before discharge had an EEq of 0.23ng/L, which is within the ecological effect-based trigger value range for the estrogenic activity of wastewater (0.2-0.4ng/L EEq). Androgenic activity was detected in one sample with a dihydrotestosterone equivalent (DHTEq) value of 10 ± 2.7ng/L. No antiandrogenic activity was detected. The GC-MS/MS and LC-MS/MS results indicated the presence of multiple pesticides, nonylphenols, triclocarban, and triclosan. Many of these compounds exhibit estrogenic activity, which may explain the positive YES assay findings. These findings showed that wastewater from the facility contained detergents, disinfectants, and pesticides and displayed hormonal activity. Food-processing facilities release large volumes of wastewater, which may affect the quality of the water eventually being discharged into the environment. We recommend expanding conventional water quality monitoring efforts to include additional factors like endocrine activity and disinfectant byproducts.

Detection of anticoagulant medication errors by triggers

Medication errors can cause preventable adverse events. For example, inappropriate use of anticoagulants (AC) can result in bleeding and thromboembolic complications. Detection and analysis of AC medication errors allow to reveal deficiencies in the safety systems in healthcare organizations. The study was aimed to develop a method of systematic detection of anticoagulant medication errors for consequent audit, analysis and development of medication safety improvement measures. The study was conducted in the multidisciplinary hospital and included 4924 patients admitted from January 2019 to December 2021 who received AC. Three laboratory triggers (international normalized ratio ≥4, serum creatinine ≥133 μmol/l, and glomerulofiltration rate <30 ml/min/1.73 m2) helped to reveal 4304 cases. Their matching with patient's data helped to develop combined triggers. Two clinical pharmacologists reviewed all cases identified by combined triggers for checking medication errors. The trigger was considered positive when anticoagulant medication error was detected in the history selected by combined trigger. Of the 4924 patients 253 (5.3%) were selected by combined triggers. Combined trigger allowed to reduce the amount of medical health records audit by 97.3%. Medication errors were detected in 137 patients. Positive predictive value of selected combined triggers varied from 0 to 63.9%. Aggregated positive predictive value of all combined triggers amounted to 54.2%. AC medication errors were detected in 2.8% patients. Method of systematic detection of AC medication errors using combined triggers in all hospitalized patients receiving AC allowed to reveal typical medication errors for consequent analysis and elaboration of measures to reduce preventable patient harm in healthcare settings.

Priority screening of contaminants of emerging concern (CECs) in surface water: Comparing cell-based bioassays and exposure-activity ratios (EARs)

In this study, we compared a wide range of cell-based bioassays to the use of chemical analysis followed by exposure-activity ratio (EAR) and Toxicological Prioritization index (ToxPi) for prioritizing chemicals, sites, and hazard concerns in water samples. Surface water samples were collected from nine sites in three Central Pennsylvania streams and analyzed for a forty-six contaminants of emerging concern (CECs), including pesticides, personal care products, and pharmaceuticals. Cell-based reporter assays evaluated human and zebrafish molecular initiating events (MIEs) in endocrine and metabolic disruption, altered lipid metabolism, and oxidative stress. Bioassays showed that 12 out of 40 assays had at least one site with activity over the effect-based trigger (EBT) values. The receptors that exhibited the highest number of samples above the EBT that would be expected to cause toxicity were Aryl hydrocarbon receptor (AhR, human and zebrafish), Pregnane X Receptor (PXR), Estrogen Receptor-beta (ERB), and Androgen Receptor (AR). Characterizing the collection sites by their bioactivity aligned closely with the stream in which samples were collected. The sum of all EARs for each chemical indicated that the pharmaceutical Carbamazepine and the pesticides Carbaryl and Atrazine posed the greatest concern. However, predicted activity and site prioritization based on individual chemical analysis and calculated EAR were different than those measured by bioassay, indicating that biologically active chemicals are present in the samples that were not included in the targeted analytes. Taken together, these data show that chemical analysis and EAR analysis are beneficial for prioritization of chemicals, whereas mechanism-based bioassays are more inclusive of known as well as unknown chemical contaminants and thus of more use for overall water quality analysis and site prioritization.

Mock assessment: Chronic prospective cumulative risk assessment

Abstract This Mock assessment is a part of the Framework Partnership Agreement between ANSES and EFSA with the help of RIVM to investigate the feasibility of a tiered approach proposed by EFSA for prospective chronic cumulative risk assessment (CRA). Three tiers address successively (i) a need for prospective CRA (Tier 0) using a deterministic approach to estimate the foreground exposure based on IEDI equation, (ii) a first estimation of prospective CRA (Tier I) using a probabilistic approach to estimate the background exposure at P99.9 and a deterministic approach to estimate the foreground exposure at mean or P97.5 consumption and (iii) a second estimation of prospective CRA (Tier II) using a probabilistic approach to estimate the background and foreground exposure at P99.9. ANSES tested this approach with an MRL application for the active substance fenamidone (with chronic effects on the thyroid) on lettuce, based on a new intended use currently under assessment at national level. For each Tier, the Margin of Exposure (MOE) was calculated for 9 populations with MCRA software using input data provided by EFSA and settings according to EFSA protocol. Different combinations of settings were tested as part of sensitivity analyses (consumption data, adjustment for additional uncertainties, cycle of monitoring data, etc.) and were used as the basis for discussion of different open points (trigger value in Tier 0, use frequency for the focal combination in tier II, ad hoc uncertainty analysis to account for additional uncertainties, etc.) to be addressed before prospective CRA could be implemented as a routine exercise. Finally, based on these discussions, recommendations were made to consolidate the approach for chronic prospective CRA.

Mock Assessment: Acute prospective cumulative risk assessment

Abstract This Mock assessment is a part of the Framework Partnership Agreement between ANSES and EFSA with the help of RIVM to investigate the feasibility of a tiered approach proposed by EFSA for prospective acute cumulative risk assessment (CRA). Three tiers address successively a need for prospective CRA (Tier 0), the safety of the MRL (Tier I) and the safety of the intended GAP (Tier II). ANSES tested this approach with an application for change of MRL for the active substance tefluthrin (with acute effects on functional alterations of the motor division) on carrot based on a new intended use. For each tier, the Margin of Exposure (MOE) was calculated for 9 populations with MCRA software using input data provided by EFSA. At P99.9 of exposure, all the adjusted MOET at Tier I and Tier II of all populations were below the threshold of 100. Different settings were tested (IESTI equation, consumption data, adjustment for uncertainties, cycle of monitoring data…). With respect to Tier I, the trigger value of 1000 for the MOETier 0 is pragmatic. In the vast majority of cases, when the MOETier 0 is above 1000, the MOETTier I would be above 100. With respect to Tier II, a MOETier 0 higher than 1000 ensures a MOETTier II above 100. Tier I could be considered a good first estimate for a prospective CRA with conservative parameters for the foreground. Two routes were tested to account for uncertainties. One was not possible. The second resulted in a new median multiplicative factor (MF)exposure*toxicology of 2.82 that differs significantly from the value of 5.13 found in the retrospective assessment. Despite the simplifications envisaged, the uncertainty analysis seems difficult to be implemented on a routine basis and it might be useful to define criteria to identify cases where an uncertainty analysis is really needed.

Pharmaceuticals in biota: The impact of wastewater treatment plant effluents on fish in Australia

Globally, pharmaceuticals and personal care products (PPCPs) are detected in surface waters receiving wastewater, yet their presence in biota, remain largely understudied. To address this, we conducted a study that measured 46 PPCPs in spot water samples and fish caught up- and downstream from wastewater treatment plants (WWTPs) in Victoria, Australia. We sampled 15 sites located along four waterways following a 3-site design: WWTP-discharge(‘hotspot’), ‘upstream’(∼2 km) and ‘downstream’(∼2 km). Spot water and fish were also sampled at reference sites >100 km from WWTP discharge (n = 3). Additionally, spot water samples were taken from WWTP effluent outflows (n = 3). From each locality, we analysed 3–12 fish (n = 131 total). In waterways, passive samplers (POCIS; ∼28d, n = 19 PPCPs) were also deployed. Individual fish (axial muscle) and water were analysed with LC-MS-MS. We found that PPCP concentrations in environmental surface water ranged from<0.02–0.97 μg/L. In WWTP effluent, the range was <0.02–1.4 μg/L. Of the 46 PPCPs analysed, 12 were detected in spot water samples and five in fish. In water, the highest concentration detected was for antidepressant venlafaxine (3 μg/L). The most frequently detected PPCPs: venlafaxine (54.9%), metoprolol (41.2%), propranolol (29.4%), carbamazepine (29.4%), caffeine (17.6%) and sulfamethoxazole (17.6%). Out of 131 fish analysed, 35 fish had detectable levels of PPCPs in the muscle tissue. The highest muscle concentrations were: venlafaxine (150 μg/kg, redfin perch), and sertraline (100 μg/kg, eel). Bioaccumulation factors ranged from 104 to 341L/kg for venlafaxine in redfins, 21-1,260L/kg for carbamazepine in redfins and eels, and 367-3,333L/kg for sertraline in eels. Based on our human health risk calculations for venlafaxine, carbamazepine, sertraline, triclosan, and caffeine, consumption of fish does not pose a significant risk to human health. Despite this, most of the detected PPCPs in surface waters exceeded 10 ng/L trigger value, which has led to further investigations by EPA. Our study highlights the need for using multiple lines of evidence for estimating risks of PPCPs.

Cumulative dietary risk assessment for French consumers exposed to succinate dehydrogenase inhibitor pesticides

Consumers are exposed to succinate dehydrogenase inhibitor (SDHI) pesticides through their diet. A cumulative dietary risk assessment for the French population has been performed with French monitoring data (2017–2021) and consumption data from INCA3. The calculation followed a two-tiered approach, using deterministic then probabilistic methods. It was carried out, using European health based guidance values (HBGV) derived for each active substance to characterise their toxicity. In Tier I, the calculated hazard index of 0.12 was below the threshold of 1 and in Tier II, the total margin of exposure at percentile 99.9 remains above the trigger value of 100 (1798 [1631–2311]). In Tier II, the three main risk drivers identified at the upper tail of the distribution were strawberries-fluopyram (19.1%), peaches-fluopyram (14.1%) and table grapes-boscalid (10.5%). Finally, the impact of the major sources of uncertainties was qualitatively evaluated. All together, they were considered of low impact on the outcomes. This work demonstrates the absence of unacceptable chronic risk related to the cumulative exposure of SDHI for French consumers during the 2017–2021 period.

Legacy effects of historical gold mining on floodplains of an Australian river

The gold rush at the end of the nineteenth century in south-eastern Australia resulted in the mobilization and re-deposition of vast quantities of tailings that modified the geomorphology of the associated river valleys. Previous studies of contamination risk in these systems have either been performed directly on mine wastes (e.g., battery sand) or at locations close to historical mine sites but have largely ignored the extensive area of riverine alluvial deposits extending downstream from gold mining locations. Here we studied the distribution of contaminant metal(loids) in the Loddon River catchment, one of the most intensively mined areas of the historical gold-rush period in Australia (1851–1914). Floodplain alluvium along the Loddon River was sampled to capture differences in metal and metalloid concentrations between the anthropogenic floodplain deposits and the underlying original floodplain. Elevated levels of arsenic up to 300 mg-As/kg were identified within the anthropogenic alluvial sediment, well above sediment guidelines (ISQG-high trigger value of 70 ppm) and substantially higher than in the pre-mining alluvium. Maximum arsenic concentrations were found at depth within the anthropogenic alluvium (plume-like), close to the contact with the original floodplain. The results obtained here indicate that arsenic may pose a significantly higher risk within this river catchment than previously assessed through analysis of surface floodplain soils. The risks of this submerged arsenic plume will require further investigation of its chemical form (speciation) to determine its mobility and potential bioavailability. Our work shows the long-lasting impact of historical gold mining on riverine landscapes.

Bioassay predictive values for chemical health risks in drinking water

Bioanalytical tools can be used for assessment of the chemical quality of drinking water and its sources. For water managers it is important to know the probability that a bioassay response above an established health-based ‘effect-based trigger value’ (EBT) indeed implies a harmful chemical (mixture) concentration. This study presents and applies a framework, based on Bayes’ theorem, to derive such risk probabilities for bioassay responses. These were evaluated under varying (in silico) chemical mixture concentrations relevant to drinking water (sources), with toxicity data for six in vitro assays from the ToxCast database. For single chemicals and in silico mixtures, the negative predictive value (NPV) was 100 % for all assays. For water managers, this means that when a bioassay response is below the EBT, a chemical risk is reliably absent, and no further action is required. The positive predictive value (PPV) increased with increasing chemical concentrations (2 µg/L) up to 40–80 %, depending on the assay. For in silico mixtures of increasing numbers of chemicals, the PPV did not increase until higher sum concentrations (>2–10 µg/L). Hence, the ability to accurately signal a harmful chemical (mixture) using bioassays will be lowest for highly diverse, low-concentration chemical mixtures. For water managers, this means in practice that further investigations after an EBT exceedance will, in many cases, not reveal chemicals at harmful concentrations. A solution offered is to increase the trigger value for positive responses to achieve a higher PPV and maintain the EBT for negative responses to ensure an optimal NPV.

Application of national early warning score in assessing postoperative illness severity in elderly patients with gastrointestinal illnesses.

Population aging is a social problem that is being faced in most countries. To apply the National Early Warning Score (NEWS) for an early warning on the vital signs and consciousness of elderly patients who are hospitalized in the gastrointestinal surgical department and to provide a reference for early detection of changes in illness severity in elderly patients by studying the correlation between NEWS value and changes in illness severity. We enrolled 528 elderly patients who were hospitalized in the gastrointestinal surgical department of a tertiary grade A hospital in Guizhou Province between June 2020 and May 2021, to analyze how NEWS max value correlates with illness severity and obtain the optimal NEWS cutoff value for both potentially critically ill and critically ill elderly patients using the receiver operating characteristic (ROC) curve. There were statistically significant differences in NEWS values between elderly patients with various illness severities (P< 0.05). NEWS values correlated positively with illness severity (r= 0.605, P< 0.001). Based on the ROC curve, early warning trigger values for NEWS to identify potentially critically ill, critically ill and terminally ill elderly patients were 6, 7 and 8, respectively. The area under the curve (AUC) for potentially critically ill, critically ill and terminally ill elderly patients was 0.907, 0.921 and 0.939, respectively. NEWS performed better in detecting patient illness severity than Modified Early Warning Score (MEWS) in AUC, sensitivity, specificity, and Youden's index, with statistically significant differences (P< 0.05). An early warning on the vital signs and consciousness of hospitalized elderly patients using NEWS can facilitate advanced detection of changes in illness severity of elderly patients by medical staff and enable timely treatment, thus significantly lowering the risks of illness deterioration.

Beyond the Drinking Water Directive: The use of reporter gene assays as an added tool for effect-based monitoring of polycyclic aromatic hydrocarbons and polychlorinated biphenyls in drinking water sources

Polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs) are legacy organic micropollutants (OMPs) that are sporadically detected in drinking water (DW) sources. The European Drinking Water Directive requires EU member states to monitor 5 PAHs in DW and its sources. The Dutch national regulations require 6 additional PAHs to be monitored and 7 polychlorinated biphenyls (PCBs). These indicator compounds act as representatives for large compound classes. PCBs alone comprise 209 congeners, it is evident that conventional chemical target analysis (GC-tQ-MS) alone is not sufficient to monitor these entire compound classes. This study investigated the application of reporter gene assays as effect-based methods (EBMs) to monitor PAHs and PCBs in DW sources. Herein, it was assessed what added value the bioassays can bring compared to the current approach of chemical target analysis for PCBs and PAHs. Regulated and non-regulated PAHs and PCBs were tested in four bioassays to determine the relative potency factors (RPFs) for these compounds. Non-regulated congeners were found to be active in the PAH-CALUX and anti-AR CALUX. An assessment of surface water (SW) spiked with standard mixtures containing PAHs and PCBs confirmed the predictable behavior of the PAH-CALUX. Moreover, the bioassay was able to detect AhR-mediated activity caused by non-regulated PAHs and PCBs, whereas this would have been missed by conventional chemical target analysis. Last, a field study was conducted in Dutch DW sources at six sampling moments. The PAH-CALUX detected AhR-mediated activity at all sampling moments and an ecological effect-based trigger (EBT) value was exceeded on multiple accounts. Combined application of GC-tQ-MS and the PAH-CALUX ensures compliancy with monitoring legislation and provides additional insights into potential hazards to humans and the environment.

Calculation of Rice Farming Insurance Premium Price in Magelang City Based on Rainfall Index with Black-Scholes Method

Indonesia is a country with two seasons, the rainy season and the dry season. Unstable rainfall can affect rice production and may cause crop failure. The amount of rice production in Indonesia, one of which is in Magelang City, is quite large, so the losses that may be experienced are quite significant. Therefore, a way to reduce the impact of losses experienced by farmers is needed, one of which is through the rice farming insurance program. The purpose of this study is to determine the premium price of rice farming insurance based on rainfall index based on the exit value and trigger value in each growing season. Insurance using the rainfall index can provide protection to farmers due to too little rainfall or too much rainfall. Too much rainfall can cause damage to rice plants resulting in crop failure. The premium calculation method uses the Black-Scholes principle, while the exit value and trigger value are determined by the Historical Burn Analysis method. The result of this study is to obtain various trigger values and exit values as well as premiums that must be paid by farmers in each normal, high, and low (dry) rainfall condition. This value determines the premium price obtained for normal rainfall which is IDR 735,739.66 to IDR 871,698.64, for high rainfall the premium price obtained is IDR 1,404,184.75 to IDR 1,643,307.75, and for low rainfall (dry season) it is IDR 5,541,806.10 to IDR 6,689,629.88.

Endocrine disrupting chemicals in Italian drinking water systems: Insights from a three-year investigation combining chemical and effect-based tools

Drinking water quality can be compromised by endocrine-disrupting chemicals (EDCs). Three phenolic compounds [bisphenol A (BPA), nonylphenol (NP), and 4-octylphenol (OP)] and three hormones [17β-estradiol (E2), estrone (E1), and 17α-ethinylestradiol (EE2)] were analyzed as EDCs potentially occurring in source and drinking water from three full-scale drinking water treatment plants (DWTPs) in the Romagna area (Italy) by a combined approach of HPLC-MS/MS target analysis and effect-based tests for estrogenicity and genotoxicity. The EDC removal efficiency was evaluated at different steps along the treatment process in the most advanced DWTP. NP prevailed in all samples, followed by BPA. Sporadic contamination by OP and E1/E2 appeared only in the source waters; EE2 was never detected. No estrogenic or genotoxic activity was found, except for two samples showing estrogenicity well below the effect-based trigger value suggested for drinking water safety (0.9 ng/L EEQ). BPA and NP levels were largely below the threshold value; however, increases were observed after the intermediate steps of the treatment chain. The good quality of the water relied on the last step, i.e. the activated carbon filtration. DWTPs may represent an extra source of EDCs and monitoring chemical occurrence at all steps of the process is advisable to improve efficiency.

Toxicity of Imidacloprid Against Melipona scutellaris (Latreille, 1811): Preliminary Risk Analysis

The study aimed to evaluate the oral toxicity of the pesticide Imidacloprid Nortox 400 SC® on native bees (Melipona scutellaris) and assess the potential risk associated with visiting crops treated with this product. Biotest was conducted using eight concentrations with triplicates. The lethal concentration (LC50) was determined through oral exposure, and the oral lethal dose (LD50) was estimated based on dietary consumption values. The hazard quotient (HQ) was then calculated using the LD50 value. The LD50 value for imidacloprid Nortox 400 SC® at 6h was 0.025 μg a.i. bee-1. Regarding the environmental risk to the species, the acute oral risk quotient exceeded the trigger value by 200 to 480 times across all evaluated crops. Additionally, the risk of product drift exceeded the trigger value within 50 meters of harvest. These results suggest that, during phase 1, it was not possible to dismiss the possibility of foliar spraying affecting M. scutellaris bees.

Clinical and serological characterization of acute pleuropericarditis suggests an autoinflammatory pathogenesis and highlights risk factors for recurrent attacks.

We describe the manifestations and course of patients with pleuropericarditis (PP). Serum parameters were analyzed to evaluate the contribution of autoimmune and autoinflammatory mechanisms to PP pathogenesis. Finally, we outline risk factors for recurrent PP attacks. Electronic medical records of the University Hospital Heidelberg were screened for PP diagnosis between the years 2009 and 2021. A total of 164 patients were detected and compared to patients suffering from systemic lupus erythematosus (SLE)-associated PP. Follow-up data were collected until January 2023. In 57.3% of a total of 164 PP cases, no trigger was identified (idiopathic PP). The clinical manifestations were similar in subgroups with different triggers (idiopathic, post-cardiac injury and post-infectious). None of the patients in the idiopathic-PP (i-PP) group fulfilled the diagnostic criteria of an autoimmune disease and the i-PP group could be clearly discriminated by clinical, epidemiological and serological means from the control cohort of SLE-associated PP. After a median follow-up of 1048 days, the majority of PP patients (72.7%) had at least one PP relapse. Univariate analyses showed that CRP, SAA (serum amyloid A), troponin T, NT-BNP and post-cardiac injury were negatively correlated, while the presence of fever and an idiopathic trigger were positively correlated with recurrence of PP. Multivariate analyses showed that fever, an idiopathic trigger and low SAA values were risk factors for PP recurrence. This study highlights that most cases of PP are idiopathic and PP cases with various triggers have an identical clinical phenotype. Our data suggest that the clinical, epidemiological and serological characteristics of idiopathic PP considerably differ from patients with PP caused by autoimmune disease like SLE. We further demonstrate that PP has a high risk of recurrence and identify factors associated with this risk, allowing for a targeted secondary prophylaxis.

Validation of the Turkish version of the Modified Early Obstetric Warning System (MEOWS) chart.

The Modified Early Obstetric Warning System (MEOWS) is a score-based or color-coded system that detects changes in physiological parameters and enables earlier diagnosis and care of worsening obstetric patients. The aim of this study is to evaluate the tool's performance and contribute to its use in Türkiye by translating MEOWS into Turkish. This prospective and descriptive study, approved by the local ethics committee, included 350 obstetric in-patients who gave birth at Samsun Training and Research Hospital, Gynecology and Children's Hospital between April and August 2022. The study involved patients with a gestational week greater than 28 weeks and up to six weeks postpartum. The average age of the patients was 28.9±5.9 (18-40) years, with trigger values occurring in 34.6% (n=121) and morbidity occurring in 30.9% (n=108) of the cases. The most common trigger among the individual physiological indicators was high systolic blood pressure (28.3%). When the performance of MEOWS was evaluated, a statistically significant correlation was found between trigger and morbidity (Kappa=0.605; p<0.001). The sensitivity of MEOWS in estimating morbidity was 77.78% (95% confidence interval [CI]: 68.76-85.21%), specificity was 84.71% (95% CI: 79.55-89.00%), Positive Predictive Value (PPV) was 69.42% (95% CI: 62.40-75.64%), Negative Predictive Value (NPV) was 89.52% (95% CI: 85.67-92.43%), and accuracy was 82.57% (95% CI: 78.18-86.40%). MEOWS was found to be an effective screening tool for predicting morbidity in this study and performs well in Turkish with sufficient sensitivity, specificity, and accuracy. However, the inclusion of long-term results would provide a more comprehensive understanding of the effectiveness of MEOWS.

Application of the Historical Burn Analysis Method in Determining Rainfall Index for Crop Insurance Premium Using Black-Scholes

Indonesia is an agricultural country where rice sector has a high risk of production loss or crop failure. Agricultural Insurance is one of the government programs that helps farmers secure their farms. The aim of this final assignment is to obtain rainfall index to determine crop insurance premiums. The rainfall index is being carried out using Historical Burn Analysis which will produce exit values and trigger values for the index window January 2014 - December 2022 using secondary data from the Bali Climatology Station. In this study, Microsoft Excel 2016 was used as an application tool. The Black-Scholes method is used to calculate the premium in Jembrana Regency. The calculation of the rainfall index using the Historical Burn Analysis formula in determining agricultural insurance premiums using Black-Scholes can be used very well, the result show that the insurance premium value is very high where the lowest premium is IDR 6,654,075 and the highest premium is IDR 6,781,555.