To explore prevalence estimates of fetal alcohol spectrum disorder (FASD) in high-income countries and the relationships between levels and patterns of alcohol consumption during pregnancy and FASD. Two scoping reviews of observational studies. We searched Medline, EMBASE, Maternity and Infant Care, and the Incidence and Prevalence Database until June 2024. Two reviewers screened studies independently using predefined criteria to address our two questions and extracted data on study design, diagnostic criteria, methods of collecting drinking history and details about levels and drinking patterns. We identified 41 relevant studies. Most were conducted in the Americas region (n=15) and had a cross-sectional design (n=26). The US Institute for Medicine diagnostic criteria were most frequently used for case ascertainment (n=22). Prevalence ranged from 5.8 (95% CI 4.6 to 7.1) to 170 000 (95% CI 161 000 to 178 000) per 1 000 000 general population. Estimates of associations between drinking levels/patterns and having a child diagnosed with FASD varied substantially. The lowest OR (95% CI) was 1.8 (0.3 to 12.2) for women who drank 1-1.9 drinks per drinking day compared with no alcohol and the highest was 61 (18.9 to 195.5) for women who drank any amount of alcohol during pregnancy compared with women who did not drink at all. FASD prevalence estimates in high-income countries and the risk of different levels and drinking patterns varied widely due to the use of different diagnostic criteria, sampling and alcohol consumption collection methods. Improving alcohol consumption collection methods will help enhance diagnostic certainty and the identification of at-risk groups.

Background/Objectives: The global population is ageing rapidly, with projections indicating that there will be over two billion individuals aged ≥60 years by 2050. Sarcopenia and frailty are major age-related syndromes associated with loss of muscle mass, reduced strength, and increased vulnerability, for which adequate protein and amino acid intake are key preventive factors. However, nationally representative data on dietary amino acid intakes and sources among older adults are lacking, particularly in Europe. Methods: This study aimed to address this gap by updating the Irish Food Composition Database (IFCD) (2011) with amino acid composition data and estimating amino acid intakes and dietary sources in older adults in Ireland (≥65 years) using data from the National Adult Nutrition Survey (2008–2010; n = 226). Results: Mean total amino acid intake was 76.2 g/day (1.0 g/kg body weight/day). Intakes of all essential amino acids were above the US Institute of Medicine (IOM) recommendations, with no significant differences observed between sexes or age groups (65–74 y, 75+ y). ‘Meat and meat dishes’ were the principal contributors to amino acid intake (28–47%), followed by ‘breads and rolls’, ‘milk and yoghurt’, and ‘fish and fish dishes’. Conclusions: This study provides the first nationally representative estimates of amino acid intakes in older adults in Europe, establishing a baseline for future dietary surveillance and informing protein quality assessment amid dietary transitions toward plant-based foods.

A fundamental transformation of the industrial safety management paradigm from a deterministic to a probabilistic and scholastic approach requires a reevaluation of the methodological basics of project management within the framework of risk and uncertainty theory. This study develops the conceptual apparatus of the integration of F. Knight’s classic risk theory, D. Bernoulli’s expected utility theory, R. Coase and O. Williamson's transaction cost theory, and the modern Project Management Body of Knowledge (PMBoK) methodology developed and supported by the US Institute of Project Management in order to form a comprehensive system for managing the modernization of occupational safety systems at hazardous production facilities. Based on the synthesis of neoclassical and institutional economic theories, a modified function for optimizing a safety project portfolio that considers not only direct economic effects but also the reduction of transactional costs resulting from inter-organizational coordination in the industrial safety system has been developed. The empirical verification of the model using data from the Federal State Statistics Service and the Federal Service for Labor and Employment for the period 2017–2024 has confirmed the statistical significance of institutional environment factors in determining the efficiency of modernization projects. The economic and mathematical model proposed is based on modifying H. Markowitz's portfolio theory, incorporating occupational safety risk components as a specific organizational asset that generates a negative correlation with traditional production risks. Calculations considering current macroeconomic conditions of September 2025 (Central Bank key rate 18 %, medium-term OFZ yield 14.5 %) demonstrate the potential achieving a Pareto-optimal state with safety investments at the level of 2.8–3.2 % of the enterprise's gross revenue, which corresponds to best practices in developed economies and ensures a 37–42 % reduction in integral risk while maintaining the profitability of core activities.

Nutrient reference values (NRVs) serve as key benchmarks for assessing nutrient adequacy and informing dietary guidelines. However, their accuracy depends on the quality of the underlying evidence. In this Review, we evaluate the evidence base used by the US Institute of Medicine (IOM) and the European Food Safety Authority (EFSA) to establish NRVs for 21 micronutrients across all life stages. We assessed methodological approaches, sample sizes, publication timelines, and study durations and developed a classification of the quality of evidence based on these factors. Our findings highlight key limitations, including reliance on small and outdated studies, scarce experimental data, and the use of indirect methods such as balance studies and factorial modelling. Although EFSA incorporates more recent evidence than the IOM, gaps in the quality of evidence persist. Strengthening the evidence base through the use of direct, adequacy-related methods, large and long-term studies, and meta-analyses is essential for improving the accuracy of NRVs. Until more robust NRVs are established, our findings suggest that current NRVs are best used cautiously in nutritional assessments, that conclusions should be based on a subset of NRVs with at least a moderate quality of evidence, and that the existing uncertainties should be clearly communicated.

In the structure of the Soviet-American détente in the 1970s, issues of trade and cooperation in the field of science and technology occupied an important place. By the end of the 1960s, strategic parity had been achieved in the confrontation between the United States and the USSR. The arms race was perceived as a costly and unpromising venture. On the one hand, the temporary balance of military potential led to a decrease in direct confrontation and a reduction in the threat of war. On the other hand, it contributed to the spread of beliefs that intensified commercial ties, and the development of scientific and technological programmes would create a material basis for lasting peace. In Moscow, this idea acquired the status of a directive. In 1968, the director of the US Institute G. Arbatov drew the attention of the country’s leadership to the significant technological gap between the USSR and the United States, where the latest scientific discoveries were quickly introduced into the production of consumer goods, whereas in the USSR, the achievements of scientific and technological revolution were mainly available to the military-industrial complex. In 1971, the priority of introducing the achievements of the scientific and technological revolution into the production of consumer goods was fixed by the decisions of the 24th Congress of the CPSU. However, a year later, despite the opinions of experts from the academic community, this strategy began to be adjusted in favour of enterprises of the military-industrial complex. Based on the available historiographical heritage and documents of the Russian archives (Russian State Archive of Modern History, Russian State Archive of Economics), memoir sources, as well as documents of the American intelligence services, the State Department and the US Congress, the article shows how approaches to shaping policy towards the United States changed in Moscow during the 1970s, and what place was given in this policy to trade, economic, scientific, and technical cooperation. The conclusions substantiate the fact that initially, the focus on the scientific and technological revolution was important for L. Brezhnev and his supporters in the Soviet leadership. The achievement of the strategic goals of the USSR, namely, the improvement of the standards of living, consumer culture and people’s quality of life, creating a more attractive image of socialism – depended on how the country could technologically integrate into the new conditions. In this context, G. Arbatov, N. Inozemtsev, and their colleagues presented their recommendations. However, due to the “fading” of the superpowers’ détente between the late 1970s and early 1980s, their ideas were less in demand.

The controversy surrounding measles, mumps, and rubella (MMR) vaccination and autism has been ongoing for over 30 years. It is rooted in the parent-led grassroots movements of the 1990s; and a case-series clinical study in 1998 by Wakefield et al. This controversy cascaded through numerous observational studies and US Institute of Medicine reports, culminating in 2019 with a population-based observational study by Hviid et al. This study was hailed at the time by the US media and medical establishment as conclusive proof that the MMR vaccine does not increase the risk of autism, even among “genetically susceptible children”. However, as detailed in this critical review, Hviid et al. did not faithfully intend or interpret the data to test this hypothesis and, therefore, cannot possibly have falsified it. We elucidate methodological flaws, discrepancies, irreproducibility, and conflicts of interest for Hviid et al. In addition, the conclusion from Hviid et al. cannot be generalized to the CDC childhood vaccination schedule. All these salient features have remained oblivious to so many regulators, mainstream media, and professional associations in the USA. This reveals the need for more communication about the limitations of available evidence to facilitate informed consent for the childhood vaccination schedule.

Iron deficiency is the most common nutritional deficiency globally. Premenopausal women are at particular risk due to increased requirements for iron associated with menstrual blood loss and pregnancy. To prevent iron deficiency, recommended intakes have been developed based on physiological requirements for absorbed iron and iron bioavailability. However, iron bioavailability is difficult to estimate as it depends on the composition of the diet and an individual’s absorptive efficiency. Several algorithms have been proposed to estimate iron bioavailability from diets based on the form of the iron and the presence of absorption modifiers. These algorithms can be complex and often underestimate bioavailability. Recently, a new approach was developed by Dainty et al.(1,2), which is based on calculated iron requirements, total dietary iron intakes, and the distribution of serum ferritin concentration values in the population. This model has been used by the European Food Safety Authority to set recommended iron intakes for adults(3). In contrast, the recommended iron intakes for Australian adults are based on iron bioavailability estimates from the US Institute of Medicine, which were primarily derived from 15 free living US adults(4). Therefore, the aim of this study was to predict dietary iron absorption in a representative sample of premenopausal Australian women using the model developed by Dainty et al.(1,2) Dietary iron intake and serum ferritin data from the 2011–13 Australian National Nutrition and Physical Activity Survey and National Health Measures Survey were analysed in 503 premenopausal women aged 18–49 years. Women were excluded if they were pregnant or lactating, had elevated C-reactive protein, consumed iron-containing supplements, or misreported energy intake. Dietary iron intake was assessed via two non-consecutive 24-hour recalls. Usual daily iron intake was determined by the Multiple Source Method. Dietary iron absorption was estimated using the predictive model developed by Dainty et al.(1,2) and the Institute of Medicine’s distribution of individual dietary iron requirements(4). Mean (SD) usual dietary iron intake was 10.4 (2.6) mg/d. The prevalence of serum ferritin < 15 μg/L was 14.1% (95% CI: 10.2%, 19.3%), and < 30 μg/L was 37.0% (95% CI: 31.8%, 42.5%). Predicted dietary iron absorption at serum ferritin concentrations of < 15 μg/L was 29.5%, and at serum ferritin concentrations of < 30 μg/L it was 19%. Our findings do not support the bioavailability assumption of 18% used to develop the Australian recommended iron intakes for premenopausal women based on the need to maintain serum ferritin concentrations of 15 μg/L. Our results may be useful in revising the recommended iron intakes for Australian premenopausal women.

Introduction: Acne treatment options vary widely, with many patients using dietary supplements. Despite their popularity, these products pose safety concerns due to lack of FDA approval for safety or efficacy before release. The US Institute of Medicine sets Tolerable Upper Intake Levels (ULs) for nutrients, but there are no regulatory limits to prevent supplements from exceeding these ULs. Methods: On March 3, 2024, active ingredients from the top 50 best-selling acne supplements were collected from Amazon. Data were analyzed to identify ingredients and the frequency at which their dosages surpassed the ULs for different age groups. Results: The most prevalent active ingredients were zinc (40%), vitamin A (30%), diindolylmethane (DIM) (26%), vitamin E (26%), and selenium (24%). Thirty percent of all supplements contained at least one ingredient exceeding its UL for ages 9 to 13, 20% for ages 14-18, and 16% for ages 19 and older. Twenty-five percent of zinc-containing supplements and 33% of vitamin A-containing supplements exceeded the UL for any all groups. Discussion: Acne supplements frequently contain ingredients that surpass ULs, particularly zinc and vitamin A. Chronic toxicity from these nutrients can lead to significant health issues. Dermatologists should inquire about supplement use when prescribing treatments like isotretinoin to prevent toxicity risks.

In 2021, the San Diego Natural History Museum (SDNHM) received funding from the US Institute of Museum and Library Services (IMLS) to improve the condition, management, and accessibility of the dry Marine Invertebrate Collection (IMLS MA-249928-OMS-21). The collection is one of the oldest at the museum and dates back to the founding of the San Diego Society of Natural History in 1874. It is a large, dry collection of primarily gastropods and bivalves and is estimated to contain nearly five million specimens in over 91,000 specimen lots, which include 135 holotypes and 856 paratypes. The collection has lacked dedicated staff for nearly 25 years and suffered from data inaccessibility and inadequate physical and taxonomic curation (Fig. 1). However, this project attempts to mitigate previous issues through increased staff dedication, specimen digitization, collection analysis, and rehousing. The research value of the collection cannot be overstated, both in terms of geographic and temporal uniqueness. While the collection is worldwide in representation, it houses some of the earliest known collections from the museum’s focal region: southern California and the peninsula of Baja California. The collection also houses an important regional collection of land snails, perhaps the most impacted fauna of the current mass extinction (Cowie et al. 2017, Regnier et al. 2009). Historically, each specimen lot in the collection was recorded on a paper catalog card (Fig. 2). After scanning all cards, Optical Character Recognition (OCR) was employed with moderate results. The OCR dataset required large-scale data cleaning in Microsoft Excel to produce an initial digital dataset. Iterative bulk updates to select fields using data keys helped minimize the number of fields for manual review. Manual review of remaining fields for each database record was completed by trained volunteers. This approach maximized our dataset’s quality and culminated in the collection’s first publicly accessible digital specimen catalog. The SDNHM Marine Invertebrate Collection records can be found online via InvertEBase-Symbiota portal (Gries et al. 2014). Using the digitized collection records, data analyses yielded an incredible geographic spread, extreme data quality disparities, many unlabeled specimens and outdated scientific names. Approximately 20% of catalog cards and their associated digital records lack scientific names. But for a majority of these specimens, the determination exists either as a name on the in-drawer card or the card is unlabeled but within an identified species grouping in the drawer. Thousands of specimens have been updated through this process already and are now also digitally discoverable. A tree map was generated to graphically show the relative proportion of localities based on number of species lots (Fig. 3). There are specimens from every state in the United States and from nearly every country in the world. However, the collection spread is shallow, with the mean number of records per country only 29. A number of records contain only vague locality information. Approximately 5% of records don’t have country information and include very general data like “Pacific Ocean”, while 16% of records have only country level information. Lastly, only about 30% of the collection records have associated collection dates. In an attempt to improve this data weakness, collector “date bands” based on birth and death dates are added to the dataset allowing for certain kinds of scientific studies. Alongside digital advancements, this project improved physical storage through the purchase of more space-efficient cabinets and replacement of wood drawers, and increased accessibility by expediting specimen retrieval through drawer reorganization, labeling with updated scientific names, and creation of an efficient specimen locator system Fig. 4. This project provides the foundation for future curatorial and scholarly work in the collection, through enhanced collection accessibility and ease-of-use. A refined triage strategy informed by the digitized collection and aided by organizational improvements of this project will guide upcoming efforts for potential deaccession of irrelevant materials. We are exploring collaborations with other institutions and research initiatives to maximize the scientific impact of the collection. The SDNHM is now positioned to reintroduce its Marine Invertebrate Collection as a leading, efficient, and lasting resource.

Adequate nutrition is important for health at all life stages with micronutrients having an important role in long term health, cognition, healthy development and ageing(1). The aim of this study was to estimate the prevalence of inadequate intakes and risk of excessive intakes of micronutrients among adults aged 19-64 years and 65 years and over, from a nationally representative sample of adults in Ireland.Analyses were based on the National Adult Nutrition Survey II (NANS II) (2020-21) of 19-92 year olds in the Republic of Ireland (n 1000) (19-64y: 718, ≥65y: 282) (www.iuna.net). Food and beverage intake data (including nutritional supplements) were collected via two independent 24-hour telephone dietary recalls (at least 7 days apart, with each day of the week accounted for in the sampling plan). To assist with the recall, older adults (≥65years) were asked to record their foods the day before the dietary recall and all participants were provided with a photographic food atlas before the scheduled dietary recall. Nutrient intakes were estimated using Nutritics© based on UK food composition data which was updated to include recipes of composite dishes, nutritional supplements, fortified foods and generic Irish foods that were commonly consumed. Usual intakes of micronutrients were calculated via the NCI-method using SAS© Enterprise Guide. The prevalence of inadequate intakes of micronutrients (excluding energy under-reporters)(2) was estimated using estimated average requirements established by the US Institute of Medicine (IOM) (vitamin D)(3), the UK Department of Health (DOH) (thiamin, vitamin B12)(4) and the European Food Safety Authority (EFSA) (all other micronutrients)(5). The risk of excessive intake was evaluated by comparing intakes to tolerable upper intake levels (ULs) established by the US Food and Nutrition Board (vitamin C, iron)(6) and EFSA (all other micronutrients)(7).Among those aged 19-64 years, a large proportion of adults had inadequate intakes of vitamin D (61%), vitamin C (41%), folate (37%), calcium (32%), zinc (28%), vitamin B6 (26%), riboflavin (23%), vitamin A (16%) and iron (8%; up to 14% for females). Similarly, a large proportion of adults aged 65 years and over had inadequate intakes of vitamin D (48%), vitamin C (43%), folate (36%), zinc (35%), calcium (31%), vitamin B6 (29%), riboflavin (21%), vitamin A (13%) and iron (11%; up to 13% for females).The proportion of adults with intakes exceeding the UL was negligible for retinol, vitamins D, E, C, B6, preformed niacin, folic acid, calcium and iron (19-64y: <0.3%; ≥65y: <0.7%) and for zinc (19-64y: 2%; ≥65y: 1%).These findings indicate that based on current dietary patterns, significant numbers of adults in Ireland have inadequate intakes of key micronutrients and highlight the need to investigate targeted dietary strategies to address these low intakes among this population group.

As reported by the FAO, in 2022, approximately 735 million people experienced undernourishment, underscoring the critical need for effective strategies to address micronutrient deficiencies. Among these strategies, the mass fortification of staple foods, particularly rice—a dietary staple for half of the global population—has emerged as one of the most effective approaches. Conventional milling processes diminish the nutritional content of rice, necessitating the development of fortification methods to enhance its nutrient profile. This study investigates advanced fortification techniques to improve the nutritional value of rice, focusing on vitamins B1, B2, and B6, with guidelines from the US Institute of Medicine’s Dietary Reference Intakes. The results indicate that implementing ultrasonic treatments and optimal soaking conditions (60 °C for 60 min) significantly enhances the absorption of these vitamins. Effective parameters included a concentration of 1500 ppm for vitamin B1 and higher levels for vitamins B2 and B6, with a rice-to-vitamin solution ratio of 1:4. These conditions yielded an absorbed vitamin B1 content of 1050 mg/kg, bringing the fortified rice closer to meeting recommended intake levels. Given the global average daily consumption of 100 g of rice per person, this research demonstrates the feasibility of fortifying rice to address nutrient deficiencies effectively and contribute to improved dietary health worldwide. Further enhancement of vitamin B2 and B6 levels remains essential for optimal fortification, highlighting the potential of fortified rice as a sustainable solution for improving global nutrition.

Safety of low weight gain or weight loss in pregnancies with class 1, 2, and 3 obesity: a population-based cohort study

The risk to public health conferred by the Omicron variant is still not completely clear, although its numerous gene mutations have raised concerns regarding its potential for increased transmissibility and immune escape. In this study, we test the compatibility of the different primers and probes available in different commercial kits sold internationally with all the sequences of SARS-CoV-2 analyzed in Algeria until March 2023. The Algerian SARS-CoV-2 Omicron variant sequences were aligned with the Muscle tool using Genious software. We also used primers and probes sequences of seven international RT-qPCR kits; CDC China, Charite Germany, HKU Hong Kong, NIH Thailand, NIID Japan, CDC US, and Pasteur Institute. We used the primer check v2.0 developed by VIROSCIENCE LAB, To identify the different mutations located at the level of primers and probes about the Algerian sequences of SARS-CoV2. Statistical tests were carried out by calculating the test. We found regarding the Forward primer sequences that the two Thailand and Japan kits are less specific to the Algerian version of the SARS-CoV-2 Omicron variant genome compared to the other kits (p=10-6). Furthermore, regarding the Reverse primers and fluorescent Probes, the three kits; Thailand, Japan, and CDC US; are less effective (p=10-6). Regarding all primers and probes, this work allowed us to conclude that the four RT-qPCR kits: CDC China, Charite Germany, NHD Hong Kong, and Pasteur Institute seem to be more specific for the Algerian omicron genome detection and therefore for diagnosis of COVID-19 in Algeria.

The provision of surgical care in Canada requires substantial improvement. In this commentary, we use the US Institute of Medicine's framework for assessing the quality of health care to explore system-wide challenges that affect surgical outcomes in Canada. Challenges include surgical wait times, long travel times for surgery, human resource constraints, equitable access to surgery, limited collection of data about the surgical pathway, a lack of transparency in the reporting of surgical outcomes and a lack of incentives for hospital systems to achieve high-quality outcomes. We propose solutions supported by available literature to help overcome some of these challenges.

Critical data on the impacts of fluoride (F) in food systems along the Eastern Africa Rift Valley System (EARS) is needed for public health risk assessment and for the development of strategies for ameliorating its deleterious effects among the affected communities. Long-term F overexposure causes dental and skeletal fluorosis, and leads to neurotoxicity, which impacts several important body functions. Investigating F exposure pathways is of essence to inform and safeguard public health of the affected communities. The current study assessed the F levels in potatoes (Solanum tuberosum L.), beans (Phaseolus vulgaris L.) and garden peas (Possum sativa) from Nakuru County, Kenya, by potentiometric analysis using F ion-selective electrodes. It then evaluated the risk factors for excessive human exposure to F through contaminated foodstuffs. The mean F levels in the potatoes (8.50 ± 4.70 mg/kg), beans (8.02 ± 4.12 mg/kg) and peas (4.99 ± 1.25 mg/kg) exceeded recommended dietary allowances (RDA) level of 4 mg/kg endorsed by US Institute of Medicine for the different categories of people. The F distribution trends in beans and potatoes reflected the environmental patterns of F contamination of the study area but the spatial extent Fin the peas indicated existence of partial resistance of the pea plants to environmental F uptake. The results indicated that both the beans and the potatoes were more liable to accumulating greater amounts of F from the environment than garden peas and that all the three foodstuffs contained high F levels that posed greater risk of F overexposure and its deleterious impacts among the young children, male populations, and in people of greater body weight and high physical activity levels.

Talc is a hydrous magnesium sheet silicate used in cosmetic powders, ceramics, paints, rubber, and many other products. We conducted a systematic review of the potential carcinogenicity of genitally applied talc in humans. Our systematic review methods adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and incorporated aspects from the US Institute of Medicine (IOM, now the National Academy of Medicine) and several US EPA frameworks for systematic reviews, evaluating and integrating the epidemiological, animal, and mechanistic literature on talc and cancer. We conducted a comprehensive literature search. Detailed data abstraction and study quality evaluation, adapting the Toxic Substances Control Act (TSCA) framework, were central to our analysis. The literature search and selection process identified 40 primary studies that assessed exposure to talc and female reproductive cancer risks in humans (n = 36) and animals (n = 4). The results of our evaluation emphasize the importance of considering biological plausibility and study quality in systematic review. Integrating all streams of evidence according to the IOM framework yielded classifications of suggestive evidence of no association between perineal application of talcum powders and risk of ovarian cancer at human-relevant exposure levels. We also concluded that there is suggestive evidence of no association between genital talc application and endometrial cancer, and insufficient evidence to determine whether a causal association exists between genital talc application and cervical cancer based on a smaller but largely null body of literature.

Smart pump technology is relatively new, and uncertainty exists regarding best practices for development and management of the drug libraries in these devices. In Canadian hospitals, IV smart pumps and their drug libraries are created and maintained according to recommendations from Accreditation Canada and guidelines from the US Institute for Safe Medication Practices (ISMP). Current compliance with these standards in Canada is unknown. However, neither organization provides specific operational steps detailing how to effectively create and manage a drug library, which leaves significant room for interpretation. Furthermore, the human resources dedicated to creation and management of these libraries in accordance with guidelines and standards are unknown. To describe current compliance with standards and guidelines for smart pump drug libraries; the processes used for drug library set-up, management, training, and support; and the resources currently used for these activities in Canadian hospitals. A 43-question online survey was made available in spring 2021 to multidisciplinary team members involved in implementation of IV smart pumps and/or management of drug libraries in Canadian hospitals. A total of 55 complete or partial responses were received. Most responses indicated that standards set by Accreditation Canada and ISMP were not being met, with only 30% (14/47) updating their libraries at least quarterly and 47% (20/43) performing quality reviews at least every 6 months. Although the majority of respondents reported regular monitoring of compliance, 30% (11/37) did not perform such monitoring. Results further indicated variation across Canadian hospitals in set-up, management, training, and support related to drug libraries, as well as variation in the human resources available for these activities. Canadian health authorities and organizations are not meeting current ISMP and Accreditation Canada standards for smart pumps. Variation exists in terms of strategies for creating and managing drug libraries, as well as in the training and resources needed to support these initiatives. Canadian health authorities and organizations should prioritize meeting these standards and should closely review the resources required to do so.

ObjectiveThis study reviewed Australian jurisdictional cancer plans to: (i) assess alignment of survivorship-related objectives with recommendations from the 2006 US Institute of Medicine (IOM) survivorship report, and (ii) identify objectives in assessing survivorship outcomes.MethodsCurrent government cancer plans were identified and reviewed for inclusion of survivorship-related objectives, which were coded based on alignment with the 10 IOM recommendations, as well as content relating to outcome assessment and measurement.ResultsTwelve policy documents were identified from seven Australian states and territories. There was variability in the number of IOM recommendations addressed (between 3 and 8 of 10), the number of survivorship-related objectives (between 4 and 37 per jurisdiction) and the number of survivorship-related outcomes (between 1 and 25 per jurisdiction). Recommendations for raising awareness of survivorship, quality measures and models of survivorship care were more consistently addressed in jurisdictional plans. Recently updated plans appeared to have more survivorship-focused objectives. The importance of measuring survivorship outcomes was highlighted in all 12 cancer plans. Quality of life, other patient reported outcomes, and 5-year survival rates were the most commonly suggested outcomes. There was no consensus on metrics to assess survivorship outcomes, and little detail regarding how to measure proposed outcomes.ConclusionAlmost all jurisdictions included survivorship-focused objectives within cancer plans. There was considerable variation in (i) alignment with IOM recommendations, and (ii) focus on survivorship-related objectives, outcomes and outcome measures. Opportunity exists for collaboration and harmonisation of work to develop national guidelines and standards of quality survivorship care.

In 2007, the US Institute of Medicine recommended that every emergency department (ED) appoint pediatric emergency care coordinators (PECCs). Despite this recommendation, our national surveys showed that few (17%) US EDs reported at least 1 PECC in 2015. This number increased slightly to 19% in 2016 and 20% in 2017. The current study objectives were to determine the following: percent of US EDs with at least 1 PECC in 2018, factors associated with availability of at least 1 PECC in 2018, and factors associated with addition of at least 1 PECC between 2015 and 2018. In 2019, we conducted a survey of all US EDs to characterize emergency care in 2018. Using the National ED Inventory-USA database, we identified 5514 EDs open in 2018. This survey collected availability of at least 1 PECC in 2018. A similar survey was administered in 2016 and identified availability of at least 1 PECC in 2015. Overall, 4781 (87%) EDs responded to the 2018 survey. Among 4764 EDs with PECC data, 1037 (22%) reported having at least 1 PECC. Three states (Connecticut, Massachusetts, and Rhode Island) had PECCs in 100% of EDs. The EDs in the Northeast and with higher visit volumes were more likely to have at least 1 PECC in 2018 (all P < 0.001). Similarly, EDs in the Northeast and with higher visit volumes were more likely to add a PECC between 2015 and 2018 (all P < 0.05). The availability of PECCs in EDs remains low (22%), with a small increase in national prevalence between 2015 and 2018. Northeast states report a high PECC prevalence, but more work is needed to appoint PECCs in all other regions.

BackgroundPrevious studies have suggested that gestational weight gain (GWG) outside an optimal range increases the risks of neurodevelopmental disorders (NDDs) in offspring including autism spectrum disorder (ASD), intellectual disability (ID), and attention deficit/hyperactivity disorder (ADHD). The sequential development of the fetal brain suggests that its vulnerability may vary depending on the timing of exposure. Therefore, we aimed to investigate the associations of not only gestational age-standardized total GWG (GWG z-scores) but also the rate of GWG (RGWG) in the second and third trimesters with risks of NDDs in offspring.MethodsIn this population-based cohort study, we used maternal weight data from antenatal care records collected for 57,822 children born to 53,516 mothers between 2007 and 2010 in the Stockholm Youth Cohort. Children were followed from 2 years of age to December 31, 2016. GWG z-scores and RGWG (kg/week) in the second and third trimesters were considered as continuous variables in cox regression models, clustered on maternal identification numbers. Nonlinear relationships were accommodated using restricted cubic splines with 3 knots. RGWG were also categorized according to the 2009 US Institute of Medicine (IOM) guidelines for optimal GWG. According to the IOM guidelines, the optimal rate of GWG for the second and third trimesters for underweight, normal weight, overweight, and obese categories were 0.44–0.58, 0.35–0.50, 0.23–0.33, and 0.17–0.27 kg/week, respectively.ResultsDuring a mean follow-up of 5.4 years (until children were on average 7.4 years old), 2205 (3.8%) children were diagnosed with NDDs, of which 1119 (1.9%) received a diagnosis of ASD, 1353 (2.3%) ADHD, and 270 (0.5%) ID. We observed a J-shaped association between total GWG z-score and offspring risk of NDDs, with higher total GWG (GWG z-score = 2) associated with 19% increased risk of any NDD (95% CI = 3–37%) and lower total GWG (GWG z-score = − 2) associated with 12% increased risk of any NDDs (95% CI = 2–23%), compared to the reference (GWG z-score = 0). In the second trimester, lower RGWG (0.25 kg/week) was associated with a 9% increased risk of any NDD diagnosis (95% CI = 4–15%) compared to the median of 0.57 kg/week, with no apparent relationship between higher RGWG and risk of NDDs. In the third trimester, there was no apparent association between lower RGWG and risk of NDDs, though higher RGWG (1 kg/week) was associated with a 28% increased risk of NDD diagnosis (95% CI = 16–40%), compared to the median (0.51 kg/week). When considering categorized RGWG, we found that slow weight gain in the second trimester followed by rapid weight gain in the third trimester most significantly increased the risk of ADHD (HRadjusted = 1.55, 1.13–2.13) and ID (HRadjusted = 2.53, 1.15–5.55) in offspring. The main limitations of our study are the relatively few years for which detailed GWG data were available and the relatively short follow-up for the outcomes, limiting power to detect associations and misclassifying children who receive an NDD diagnosis later in childhood.ConclusionsThe relationship between maternal weight gain and children’s risk of NDDs varied according to timing in pregnancy, with the greatest risks associated with slow weight gain in the second trimester and rapid weight gain in the third trimester.