Testing the Efficacy of a Brief, Self-Guided Mindfulness Ecological Momentary Intervention on Emotion Regulation and Self-Compassion in Social Anxiety Disorder: Randomized Controlled Trial

BACKGROUND

Theories propose that brief, mobile, self-guided mindfulness ecological momentary interventions (MEMIs) could enhance emotion regulation (ER) and self-compassion. Such changes are posited to be mechanisms of change. However, rigorous tests of these theories have not been conducted.

OBJECTIVE

In this assessor-blinded, parallel-group randomized controlled trial, we aimed to test these theories in social anxiety disorder (SAD).

METHODS

Participants with SAD (defined as having a prerandomization cut-off score ≥20 on the Social Phobia Inventory self-report) were randomized to a 14-day fully self-guided MEMI (96/191, 50.3%) or self-monitoring app (95/191, 49.7%) arm. They completed web-based self-reports of 6 clinical outcome measures at prerandomization, 15-day postintervention (administered the day after the intervention ended), and 1-month follow-up time points. ER and self-compassion were assessed at preintervention and 7-day midintervention time points. Multilevel modeling determined the efficacy of MEMI on ER and self-compassion domains from pretrial to midintervention time points. Bootstrapped parallel multilevel mediation analysis examined the mediating role of pretrial to midintervention ER and self-compassion domains on the efficacy of MEMI on 6 clinical outcomes.

RESULTS

Participants demonstrated strong compliance, with 78% (149/191) engaging in at least 80% of the MEMI and self-monitoring prompts. MEMI was more efficacious than the self-monitoring app in decreasing ER goal-directed behavior difficulties (between-group Cohen d=-0.24) and lack of emotional clarity (Cohen d=0.16) and increasing self-compassion social connectedness (Cohen d=0.19), nonidentification with emotions (Cohen d=0.16), and self-kindness (Cohen d=0.19) from pretrial to midintervention time points. The within-group effect sizes from pretrial to midintervention were larger in the MEMI arm than in the self-monitoring app arm (ER goal-directed behavior difficulties: Cohen d=-0.73 vs -0.29, lack of emotional clarity: Cohen d=-0.39 vs -0.21, self-compassion domains of social connectedness: Cohen d=0.45 vs 0.19, nonidentification with emotions: Cohen d=0.63 vs 0.48, and self-kindness: Cohen d=0.36 vs 0.10). Self-monitoring, but not MEMI, alleviated ER emotional awareness issues (between-group Cohen d=0.11 and within-group: Cohen d=-0.29 vs -0.13) and reduced self-compassion acknowledging shared human struggles (between-group Cohen d=0.26 and within-group: Cohen d=-0.23 vs 0.13). No ER and self-compassion domains were mediators of the effect of MEMI on SAD symptoms (P=.07-<.99), generalized anxiety symptoms (P=.16-.98), depression severity (P=.20-.94), repetitive negative thinking (P=.12-.96), and trait mindfulness (P=.18-.99) from pretrial to postintervention time points. Similar nonsignificant mediation effects emerged for all of these clinical outcomes from pretrial to 1-month follow-up time points (P=.11-.98).

CONCLUSIONS

Brief, fully self-guided, mobile MEMIs efficaciously increased specific self-compassion domains and decreased ER difficulties associated with goal pursuit and clarity of emotions from pretrial to midintervention time points. Higher-intensity MEMIs may be required to pinpoint the specific change mechanisms in ER and self-compassion domains of SAD.

TRIAL REGISTRATION

Open Science Framework (OSF) Registries; osf.io/m3kxz https://osf.io/m3kxz.

Review of the global evolution of regulations on single-use plastics and lessons drawn for Canada

Plastic pollution is a global problem and many countries are strengthening their regulations to mitigate the related environmental degradation and health risks and to support the development and deployment of circular economy for various types of plastics. As Canada also develops its strategy for regulating single-use plastic as one element of the plastic pollution, aligned federal and provincial policies are essential. This study presents an analysis of existing and emerging policies to provide guidance on Canada's future regulations. Qualitative and quantitative data regarding plastic regulations were gathered from similar countries including Australia, the United Kingdom, the European Union, the United States and relevant scientific articles. Analysis was also conducted of current Canadian regulations that both impact and guide the path for plastic regulation, international examples provided guidance for future Canadian regulations. The analysis found that there is a need for public education on the gravity of plastic pollution to gain their support; for establishing pioneering provinces or cities in plastic regulations to learn from and provide other cities with support; and to start with banning items with available alternatives, to be followed by phasing out other items that are more difficult to replace. The study also showed potential areas of improvement in impact data. The need for reliable regulatory performance data against a baseline scenario; consistency in methodology; and proper scoping to reduce the risk of displacement or exclusivity in policy were identified.

Drug dependence and prescribing ketamine for treatment-resistant depression in Australia and New Zealand

Ketamine is a restricted and regulated medication in Australia and New Zealand, which has implications when considering treatment for patients with treatment-resistant depression and a history of illicit drug use, abuse or dependence. Regulations governing prescription of ketamine for treatment-resistant depression vary between jurisdictions in Australia and New Zealand, though most restrict use in those with drug dependence. There is substantial variation in definitions of drug dependence used in each jurisdiction, and between the legal and clinical definitions, with the latter specified in the current International Classification of Diseases, Eleventh Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This paper reviews the literature assessing the risk of ketamine misuse and dependence in patients with a history of illicit drug use, abuse or dependence and presents recommendations for psychiatrists who prescribe ketamine in such patients with treatment-resistant depression.

Lifecycle of surgical devices: Global, environmental, and regulatory considerations

BACKGROUND

Technological advancements, improved surgical access, and heightened demand for surgery have fueled unprecedented device and supply turnover impelling wealthy hospitals to upgrade continually and sell, donate, recycle, or dispose of used, expired, antiquated, or surplus goods. This paper reviews the issues related to device and supply lifecycles and discusses the opportunities and challenges they present for sustainable surgical growth in low- and middle-income (LMICs) countries.

OBSERVATIONS

This review found, in LMICs countries, regulatory disparities persist that limit effective harmonization secondary to highly variable national policies and a lack of prioritized enforcement. Heterogeneity in the regulatory landscape, specifically in the classification, nomenclature, and identification of medical devices, encumbers effective regulation and distribution. Once devices are sold, donated, or reused in LMICs countries, complexities arise in regulatory compliance, maintenance, and appropriate use of these technologies. At the end of the lifecycle, waste management poses significant obstacles with limited resources hindering the implementation of best practices.

CONCLUSION

There are major disparities in access to quality surgical equipment and supplies around the world. Improved communication between relevant stakeholders and harmonization of manufacture and disposal regulations will be needed to ensure adequate and appropriate responses to these challenges.

TRIAL REGISTRATION NUMBER

Not applicable.

Midwifery Practice Leaders' Experiences of Practice Changes Early in the COVID-19 Pandemic: A Qualitative Exploration

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic generated considerable upheaval in all sectors of the US health care system, including maternity care. We focused this inquiry on midwifery practice leaders' experiences and perspectives on changes that occurred in their practices early in the pandemic.

METHODS

This was a qualitative descriptive study using thematic analysis. The data were responses to an open-ended question in a survey of pandemic-related employment and clinical practice changes. Findings are presented from a constructivist perspective, describing the experiences and perspectives of a group of US midwifery practice leaders during the initial phase of the COVID-19 pandemic.

RESULTS

Two main themes emerged from the analysis: demands on midwives and driving forces. Demands on midwives were 3-fold: clients' needs, modification of care, and midwives' needs. These encompassed the psychological, physical, and emotional toll that caring for women during the pandemic placed on midwives. Driving forces were those entities that spurred and directed change and included regulations, institutions, financial logistics, and team dynamics. Survey respondents in community (home and birth center) practices reported substantial increases in inquiries and client volume, and many respondents expressed concern about withdrawal of students from clinical placements.

DISCUSSION

Midwifery practices experienced profound changes in their work environments during the COVID-19 pandemic, with both positive and negative characteristics. These challenges in providing birth care were similar to those reported in other countries. Results indicated existing guidance for maternity care during emergencies did not meet clients' needs. Coordinated planning for maternity care in future prolonged health emergencies should incorporate best practices and include midwives in the process.

Use of veterinary medicinal products in the Philippines: regulations, impact, challenges, and recommendations

Agricultural production is a major driver of the Philippine economy. Mass production of animal products, such as livestock and poultry farming, is one of the most prominent players in the field. Filipino farmers use veterinary medicinal products (VMPs) when raising agricultural animals to improve animal growth and prevent diseases. Unfortunately, the extensive use of VMPs, particularly antibiotics, has been linked to drug resistance in animals, particularly antibiotics. Antimicrobial gene products produced in animals due to the prolonged use of VMPs can passed on to humans when they consume animal products. This paper reviews information on the use of VMPs in the Philippines, including the regulations, their impact, challenges, and potential recommendations. The Philippines has existing legislation regulating VMP use. Several agencies were tasked to regulate the use of VMPs, such as the Department of Agriculture, the Department of Health, and the Philippine National Action Plan. Unfortunately, there is a challenge to implementing these regulations, which affects consumers. The unregulated use of VMPs influences the transmission of antibiotic residues from animals to crops to humans. This challenge should be addressed, with more focus on stricter regulation.

Where's the Disconnect? Exploring Pathways to Healthcare Coordinated for Youth Experiencing Homelessness in Toronto, Canada, Using Grounded Theory Methodology

About 900 youth experiencing homelessness (YEH) reside at an emergency youth shelter (EYS) in Toronto on any given night. Several EYSs offer access to healthcare based on youths' needs, including access to primary care, and mental health and addictions support. However, youth also require healthcare from the broader health system, which is often challenging to navigate and access. Currently, little is known about healthcare coordination efforts between the EYS and health systems for YEH. Using grounded theory methodology, we interviewed 24 stakeholders and concurrently analyzed and compared data to explore pathways to healthcare coordinated for youth who reside at an EYS in Toronto. We also investigated fundamental parts (i.e., norms, resources, regulations, and operations) within the EYS and health systems that influence these pathways to healthcare using thematic analysis. A significant healthcare coordination gap was found between these two systems, typically when youth experience crises, often resulting in a recurring loop of transition and discharge between EYSs and hospitals. Several parts within each system act interdependently in hindering adequate healthcare coordination between the EYS and health systems. Incorporating training for system staff on how to effectively coordinate healthcare and work with homeless populations who have complex health needs, and rethinking information-sharing policies within circles of care are examples of how system parts can be targeted to improve healthcare coordination for YEH. Establishing multidisciplinary healthcare teams specialized to serve the complex needs of YEH may also improve healthcare coordination between systems, and access and quality of healthcare for this population.

Heavy Metal Bioaccumulation in Peruvian Food and Medicinal Products

To better query regional sources of metal(loid) exposure in an under-communicated region, available scientific literature from 50 national universities (undergraduate and graduate theses and dissertations), peer-reviewed journals, and reports published in Spanish and English were synthesized with a focus on metal(loid) bioaccumulation in Peruvian food and medicinal products utilized locally. The study considered 16 metal(loid)s that are known to exert toxic impacts on humans (Hg, Al, Sb, As, Ba, Be, Cd, Cr, Sn, Ni, Ag, Pb, Se, Tl, Ti, and U). A total of 1907 individual analyses contained within 231 scientific publications largely conducted by Peruvian universities were analyzed. These analyses encompassed 239 reported species classified into five main food/medicinal groups-plants, fish, macroinvertebrates and mollusks, mammals, and "others" category. Our benchmark for comparison was the World Health Organization (Codex Alimentarius) standards. The organisms most frequently investigated included plants such as asparagus, corn, cacao, and rice; fish varieties like trout, tuna, and catfish; macroinvertebrates and mollusks including crab and shrimp; mammals such as alpaca, cow, chicken eggs, and milk; and other categories represented by propolis, honey, lichen, and edible frog. Bioaccumulation-related research increased from 2 to more than 25 publications per year between 2006 and 2022. The results indicate that Peruvian food and natural medicinal products can have dangerous levels of metal(loid)s, which can cause health problems for consumers. Many common and uncommon food/medicinal products and harmful metals identified in this analysis are not regulated on the WHO's advisory lists, suggesting the urgent need for stronger regulations to ensure public safety. In general, Cd and Pb are the metals that violated WHO standards the most, although commonly non-WHO regulated metals such as Hg, Al, As, Cr, and Ni are also a concern. Metal concentrations found in Peru are on many occasions much higher than what has been reported elsewhere. We conclude that determining the safety of food/medicinal products is challenging due to varying metal concentrations that are influenced not only by metal type but also geographical location. Given the scarcity of research findings in many regions of Peru, urgent attention is required to address this critical knowledge gap and implement effective regulatory measures to protect public health.

Recommendations for using artificial intelligence in clinical flow cytometry

Flow cytometry is a key clinical tool in the diagnosis of many hematologic malignancies and traditionally requires close inspection of digital data by hematopathologists with expert domain knowledge. Advances in artificial intelligence (AI) are transferable to flow cytometry and have the potential to improve efficiency and prioritization of cases, reduce errors, and highlight fundamental, previously unrecognized associations with underlying biological processes. As a multidisciplinary group of stakeholders, we review a range of critical considerations for appropriately applying AI to clinical flow cytometry, including use case identification, low and high risk use cases, validation, revalidation, computational considerations, and the present regulatory frameworks surrounding AI in clinical medicine. In particular, we provide practical guidance for the development, implementation, and suggestions for potential regulation of AI-based methods in the clinical flow cytometry laboratory. We expect these recommendations to be a helpful initial framework of reference, which will also require additional updates as the field matures.

Reductions of Plastic Microbeads from Personal Care Products in Wastewater Effluents and Lake Waters Following Regulatory Actions

Plastic microbeads were widely used as exfoliants in personal care products (PCPs; e.g., hand/body washes) in North America, but restrictions were imposed on their use in PCPs in the U.S. (2017) and Canada (2018). We provide the first assessment of whether restrictions are effectively reducing microbeads entering surface waters. We examined their abundance, character, and trends in wastewater treatment plant (WWTP) effluents in Toronto, Canada, from 2016 to 2019, and in adjacent Lake Ontario surface waters (2015 and 2018), encompassing the period before and after the bans. Microbeads isolated from PCPs purchased in 2015 provided a visual morphological key with "irregular" and "spherical" microbead categories. Median concentrations of irregular microbeads, composed of polyethylene plastic, declined by up to 86% in WWTP effluents from 8.4 to 14.3 particles/m3 before to 2.0-2.2 particles/m3 after the bans, while those of spherical microbeads, predominantly synthetic/polyethylene wax, ranged within 0.5-2.3 particles/m3 and did not differ before and after the bans since, as nonplastic, they were not regulated. Similarly, amounts of irregular microbeads declined relative to spherical microbeads in Lake Ontario, indicating that product changes may be influencing observations in lake waters. The results suggest that the Canadian and U.S. restrictions effectively and rapidly reduced plastic microbeads entering waters via WWTPs.

Special Issue: Agricultural Nanotechnology

Agricultural nanotechnology has considerable promise for addressing global agricultural production/security, biodiversity, and global warming issues. Current trends in publications and patents demonstrate that biotechnology technologies, particularly for crops, are being developed to improve agricultural productivity and disease management. In the current issue, we strongly advocate for the use of biosynthesized nanoparticles from a variety of sources, including plants, agricultural waste, and microbes, as a prerequisite for significant and in-depth study. Nanomaterials offer a wide range of practical uses in agriculture, including nanofertilizers, nanopesticides, nanoherbicides, nanosensors, and smart delivery systems for controlled agrochemical release. Additionally, nano-tools are employed for plant breeding and genetic manipulation. A thorough examination of the physicochemical soil properties of the agricultural fields where nanoparticles will be used will aid in minimizing their impact on plant and soil biota. Finally, and most importantly, we strongly recommend the inclusion of nanotoxicity, legislation, biosafety, and risk assessment as the top priorities when developing regulatory policies to address biosafety concerns. Starting today, thorough efforts must be carried out to advance and develop futuristic work based on recognized knowledge shortages.

Telemedicine in Otolaryngology in the Context of the End of the COVID-19 Public Health Emergency

At the onset of the COVID-19 pandemic, the US Department of Health and Human Services implemented a range of flexibilities to expedite the adoption of telehealth. As our specialty moved past the height of the pandemic and the use of telehealth transitioned from a necessity to a convenience, numerous health care providers (physicians, advanced practice providers, speech-language pathologists, and audiologists) recognized its benefits and continued to offer these services. In May 2023, the current administration terminated the COVID-19 public health emergency declaration, with some telehealth guidelines in effect until December 31, 2023, and others extended through December 31, 2024. Amidst the changing telehealth landscape, the objective of this commentary is to explain policy implications on Otolaryngology-Head and Neck Surgery and provide insight into how to best implement telehealth under these new guidelines.

Bacillus anthracis, "la maladie du charbon", Toxins, and Institut Pasteur

Institut Pasteur and Bacillus anthracis have enjoyed a relationship lasting almost 120 years, starting from its foundation and the pioneering work of Louis Pasteur in the nascent fields of microbiology and vaccination, and blooming after 1986 following the molecular biology/genetic revolution. This contribution will give a historical overview of these two research eras, taking advantage of the archives conserved at Institut Pasteur. The first era mainly focused on the production, characterisation, surveillance and improvement of veterinary anthrax vaccines; the concepts and technologies with which to reach a deep understanding of this research field were not yet available. The second period saw a new era of B. anthracis research at Institut Pasteur, with the anthrax laboratory developing a multi-disciplinary approach, ranging from structural analysis, biochemistry, genetic expression, and regulation to bacterial-host cell interactions, in vivo pathogenicity, and therapy development; this led to the comprehensive unravelling of many facets of this toxi-infection. B. anthracis may exemplify some general points on how science is performed in a given society at a given time and how a scientific research domain evolves. A striking illustration can be seen in the additive layers of regulations that were implemented from the beginning of the 21st century and their impact on B. anthracis research. B. anthracis and anthrax are complex systems that raise many valuable questions regarding basic research. One may hope that B. anthracis research will be re-initiated under favourable circumstances later at Institut Pasteur.

The Future of Municipal Wastewater Reuse Concentrate Management: Drivers, Challenges, and Opportunities

Water reuse is rapidly becoming an integral feature of resilient water systems, where municipal wastewater undergoes advanced treatment, typically involving a sequence of ultrafiltration (UF), reverse osmosis (RO), and an advanced oxidation process (AOP). When RO is used, a concentrated waste stream is produced that is elevated in not only total dissolved solids but also metals, nutrients, and micropollutants that have passed through conventional wastewater treatment. Management of this RO concentrate─dubbed municipal wastewater reuse concentrate (MWRC)─will be critical to address, especially as water reuse practices become more widespread. Building on existing brine management practices, this review explores MWRC management options by identifying infrastructural needs and opportunities for multi-beneficial disposal. To safeguard environmental systems from the potential hazards of MWRC, disposal, monitoring, and regulatory techniques are discussed to promote the safety and affordability of implementing MWRC management. Furthermore, opportunities for resource recovery and valorization are differentiated, while economic techniques to revamp cost-benefit analysis for MWRC management are examined. The goal of this critical review is to create a common foundation for researchers, practitioners, and regulators by providing an interdisciplinary set of tools and frameworks to address the impending challenges and emerging opportunities of MWRC management.

Neuronal Autophagy: Regulations and Implications in Health and Disease

Autophagy is a major degradative pathway that plays a key role in sustaining cell homeostasis, integrity, and physiological functions. Macroautophagy, which ensures the clearance of cytoplasmic components engulfed in a double-membrane autophagosome that fuses with lysosomes, is orchestrated by a complex cascade of events. Autophagy has a particularly strong impact on the nervous system, and mutations in core components cause numerous neurological diseases. We first review the regulation of autophagy, from autophagosome biogenesis to lysosomal degradation and associated neurodevelopmental/neurodegenerative disorders. We then describe how this process is specifically regulated in the axon and in the somatodendritic compartment and how it is altered in diseases. In particular, we present the neuronal specificities of autophagy, with the spatial control of autophagosome biogenesis, the close relationship of maturation with axonal transport, and the regulation by synaptic activity. Finally, we discuss the physiological functions of autophagy in the nervous system, during development and in adulthood.

Advancement of Autogenous Vaccines in the Poultry Industry

Autogenous vaccines, also known as "custom" vaccines, have become an essential instrument in the production veterinarian's toolbox for the control of emerging and evolving diseases. Autogenous vaccines require a reduced burden of U.S. Department of Agriculture licensing, making them rapidly accessible. Autogenous vaccines have made significant advancements in the ability to reduce disease within the poultry industry from a combination of several different advancements in regulation requirements, rapid and accurate diagnostic assessments, and improvements in manufacturing. The use of autogenous vaccines by poultry health professionals has also increased, and these custom-made products have been instrumental in combating diseases resulting from antigenic variants such as salmonellosis, colibacillosis, infectious coryza, infectious bursal disease, inclusion body hepatitis, viral enteritis, and viral arthritis and tenosynovitis.

A Critical Review on Hydrogen Based Fuel Cell Technology and Applications

The research in energy storage and conversion is playing a critical role in energy policy as the innovation and technological progress are essential for achieving the energy transition and climate neutrality goals. Hydrogen Fuel Cell technology is considered a strategic element in the pursuit of sustainable and clean energy solutions. This technology is increasingly gaining attention in recent years as a potential substitute to conventional non-renewable energy sources. Fuel cell technology can be employed for domestic/commercial use along with powering the transportation sector which currently employs the use of conventional battery systems. However, these systems pose severe limitations with respect to longer charging times and limited distance range. This review article aims at providing a comprehensive methodical overview of hydrogen-based fuel cell technology along with key concepts, present day scenarios, including overview of the market and industry trends, government policies and initiatives, along with major stakeholders involved in scaling up the technology for mass consumption. The outlook of fuel cells, including their capability to revolutionise the energy sector is discussed. The technological advancements and breakthroughs on the horizon along with the challenges and safety concerns related to the widespread acceptance of fuel cells are analysed.

Barriers to the implementation of occupational health and safety regulations in Lebanon

This study aims to explore the barriers that prevent the implementation of occupational health and safety regulations in Lebanon. A qualitative approach was adopted including a document analysis of the available legal documents pertaining to occupational health and safety at the national level and ten in-depth interviews with professionals in the field of occupational health and safety in Lebanon. Our findings show that the implementation of the occupational health and safety regulations in Lebanon is hindered by several barriers including the lack of a holistic legal framework, lack of promotion of a health and safety culture at work, insufficient number of labor inspectors, insufficient training for labor inspectors, lack of necessary tools and equipment, lack of an adequate documentation system, hierarchy within the Ministry of Labor, weak compliance, and the influence of the informal sector.

Driving Sustainability: Carbon Footprint, 3D Printing, and Legislation concerning Electric and Autonomous Vehicles

In recent years, there has been a remarkable development in the technology and legislation related to electric and autonomous vehicles (i.e., EVs/AVs). This technological advancement requires the deployment of the most up-to-date supporting infrastructure to achieve safe operation. Further infrastructure is needed for Level 5 vehicles, namely the introduction of super-fast wireless 5G technology. To achieve harmony between the rapid technological advancement of EVs/AVs and environmental preservation, enacting legislation related to their sustainable use is vital. Thus, this manuscript provides a review of the technological development of EVs/AVs, with a special focus on carbon footprints and the implementation of additive manufacturing using recycled materials. While EVs have a 12.13% increased carbon footprint compared to conventional vehicles, AVs with basic and advanced intelligence features have an increased carbon footprint of 41.43% and 99.65%, respectively. This article emphasizes that the integration of 3D-printed components has the potential to offset this impact with a substantial 60% reduction. As a result, custom-made solutions involving 3D printing are explored, leading to greater speed, customization, and cost-effectiveness for EVs/AVs. This article also lists the advantages and disadvantages of the existing legislation in Spain, the United Kingdom, and the western Balkans, demonstrating various approaches to promoting electric mobility and the development of autonomous vehicles. In Spain, initiatives like the MOVES program incentivize EV adoption, while the UK focuses on expanding the EV market and addressing concerns about EVs' quiet operation. In the western Balkans, the adoption of legislation lags behind, with limited incentives and infrastructure for EVs. To boost sales, legal mechanisms are necessary to reduce costs and improve accessibility, in addition to offering subsidies for the purchase of EVs. To this end, an analysis of the incentive measures proposed for the development and use of renewable power sources for the supply of energy for EVs/AVs is presented.

Zoonotic Pathogens Associated with Pet and Feeder Murid Rodent Species: A Global Systematic Review

Background: Pet and feeder rodents are one of the main sources of emerging infectious diseases. These rodents are purchased from pet shops, breeders, and online. Consequently, some of these rodents may subtly transmit diseases as they may be asymptomatic to certain pathogens. Materials and Methods: We systematically searched four academic databases viz. Google Scholar, PubMed, Web of Science, and Scopus to determine zoonotic pathogens associated with pet and feeder rodents globally. Our searches were performed in R statistical software using the packages "metagear" and "revtool". Results: We found 62 studies reporting on zoonotic pathogens between 1973 and 2022 from 16 countries representing 4 continents, namely Africa, Europe, Asia, and North America. The review identified 30 zoonotic pathogens isolated from pet and feeder rodents, including the African pygmy mouse (Mus minutoides), brown rat (Rattus norvegicus), and the house mouse (Mus musculus). The greatest number of pathogens was reported from the United States, followed by Togo and the United Kingdom. Bacterial pathogens were the most prevalent. However, the Seoul virus and rat bite fever (Streptobacillus moniliformis) were the most studied pathogens, found in more than one country, with reported outbreak cases. Most of the zoonotic pathogens were isolated from rodents acquired from pet shops. Conclusions: We recommend that pet and feeder rodents purchased from pet shops should be regularly screened for potential zoonotic pathogens as some of these animals may not show clinical signs of the illness. There is also a critical need to develop strict regulations and policies, especially in underdeveloped and developing regions for an effective surveillance process, which will include early detection, rapid response, and control of zoonotic diseases globally.

[Seine-et-Marne's health subdirectorate at the heart of prevention]

The health service is closely linked to many entities within the fire and rescue service. This makes it possible to be a force for proposals on the implementation of measures for the safety of all but also on themes related to well-being at work. This facet is exciting with many human and technical interactions.

Improving pulse oximetry accuracy in dark-skinned patients: technical aspects and current regulations

Recent concerns regarding the clinical accuracy of pulse oximetry in dark-skinned patients, specifically in detecting occult hypoxaemia, have motivated research on this topic and recently reported in this journal. We provide an overview of the technical aspects of the issue, the sources of inaccuracy, and the current regulations and limitations. These insights offer perspectives on how pulse oximetry can be improved to address these potential limitations.

Single-Particle ICP-MS/MS Application for Routine Screening of Nanoparticles Present in Powder-Based Facial Cosmetics

The short- and long-term impacts of nanoparticles (NPs) in consumer products are not fully understood. Current European Union (EU) regulations enforce transparency on products containing NPs in cosmetic formulations; however, those set by the U.S. Food and Drug Administration are lacking. This study demonstrates the potential of single-particle inductively coupled plasma tandem mass spectrometry (spICP-MS/MS) as a screening method for NPs present in powder-based facial cosmetics (herein referred to as FCs). A proposed spICP-MS/MS method is presented along with recommended criteria to confirm particle presence and particle detection thresholds in seven FCs. FC products of varying colors, market values, and applications were analyzed for the presence of Bi, Cr, Mg, Mn, Pb, Sn, Ag, Al, and Zn NPs based on their ingredient lists as well as those commonly used in cosmetic formulations. The presence of NPs smaller than 100 nm was observed in all FC samples, and no correlations with their presence and market value were observed. Here, we report qualitative and semi-quantitative results for seven FC samples ranging in color, brand, and shimmer.

Cleaning Up without Messing Up: Maximizing the Benefits of Plastic Clean-Up Technologies through New Regulatory Approaches

As the global plastics crisis grows, numerous technologies have been invented and implemented to recover plastic pollution from the environment. Although laudable, unregulated clean-up technologies may be inefficient and have unintended negative consequences on ecosystems, for example, through bycatch or removal of organic matter important for ecosystem functions. Despite these concerns, plastic clean-up technologies can play an important role in reducing litter in the environment. As the United Nations Environment Assembly is moving toward an international, legally binding treaty to address plastic pollution by 2024, the implementation of plastic clean-up technologies should be regulated to secure their net benefits and avoid unintended damages. Regulation can require environmental impact assessments and life cycle analysis to be conducted predeployment on a case-by-case basis to determine their effectiveness and impact and secure environmentally sound management. During operations catch-efficiency and bycatch of nonlitter items, as well as waste management of recovered litter, should be documented. Data collection for monitoring, research, and outreach to mitigate plastic pollution is recommended as added value of implementation of clean-up technologies.

Bifunctional Single Atom Catalysts for Rechargeable Zinc-Air Batteries: From Dynamic Mechanism to Rational Design

Ever-growing demands for rechargeable zinc-air batteries (ZABs) call for efficient bifunctional electrocatalysts. Among various electrocatalysts, single atom catalysts (SACs) have received increasing attention due to the merits of high atom utilization, structural tunability, and remarkable activity. Rational design of bifunctional SACs relies heavily on an in-depth understanding of reaction mechanisms, especially dynamic evolution under electrochemical conditions. This requires a systematic study in dynamic mechanisms to replace current trial and error modes. Herein, fundamental understanding of dynamic oxygen reduction reaction and oxygen evolution reaction mechanisms for SACs is first presented combining in situ and/or operando characterizations and theoretical calculations. By highlighting structure-performance relationships, rational regulation strategies are particularly proposed to facilitate the design of efficient bifunctional SACs. Furthermore, future perspectives and challenges are discussed. This review provides a thorough understanding of dynamic mechanisms and regulation strategies for bifunctional SACs, which are expected to pave the avenue for exploring optimum single atom bifunctional oxygen catalysts and effective ZABs.

Twitter Sentiment About the US Federal Tobacco 21 Law: Mixed Methods Analysis

BACKGROUND

On December 20, 2019, the US "Tobacco 21" law raised the minimum legal sales age of tobacco products to 21 years. Initial research suggests that misinformation about Tobacco 21 circulated via news sources on Twitter and that sentiment about the law was associated with particular types of tobacco products and included discussions about other age-related behaviors. However, underlying themes about this sentiment as well as temporal trends leading up to enactment of the law have not been explored.

OBJECTIVE

This study sought to examine (1) sentiment (pro-, anti-, and neutral policy) about Tobacco 21 on Twitter and (2) volume patterns (number of tweets) of Twitter discussions leading up to the enactment of the federal law.

METHODS

We collected tweets related to Tobacco 21 posted between September 4, 2019, and December 31, 2019. A 2% subsample of tweets (4628/231,447) was annotated by 2 experienced, trained coders for policy-related information and sentiment. To do this, a codebook was developed using an inductive procedure that outlined the operational definitions and examples for the human coders to annotate sentiment (pro-, anti-, and neutral policy). Following the annotation of the data, the researchers used a thematic analysis to determine emergent themes per sentiment category. The data were then annotated again to capture frequencies of emergent themes. Concurrently, we examined trends in the volume of Tobacco 21-related tweets (weekly rhythms and total number of tweets over the time data were collected) and analyzed the qualitative discussions occurring at those peak times.

RESULTS

The most prevalent category of tweets related to Tobacco 21 was neutral policy (514/1113, 46.2%), followed by antipolicy (432/1113, 38.8%); 167 of 1113 (15%) were propolicy or supportive of the law. Key themes identified among neutral tweets were news reports and discussion of political figures, parties, or government involvement in general. Most discussions were generated from news sources and surfaced in the final days before enactment. Tweets opposing Tobacco 21 mentioned that the law was unfair to young audiences who were addicted to nicotine and were skeptical of the law's efficacy and importance. Methods used to evade the law were found to be represented in both neutral and antipolicy tweets. Propolicy tweets focused on the protection of youth and described the law as a sensible regulatory approach rather than a complete ban of all products or flavored products. Four spikes in daily volume were noted, 2 of which corresponded with political speeches and 2 with the preparation and passage of the legislation.

CONCLUSIONS

Understanding themes of public sentiment-as well as when Twitter activity is most active-will help public health professionals to optimize health promotion activities to increase community readiness and respond to enforcement needs including education for retailers and the general public.

Time to consider animal data governance: perspectives from neuroscience

Introduction

Scientific research relies mainly on multimodal, multidimensional big data generated from both animal and human organisms as well as technical data. However, unlike human data that is increasingly regulated at national, regional and international levels, regulatory frameworks that can govern the sharing and reuse of non-human animal data are yet to be established. Whereas the legal and ethical principles that shape animal data generation in many countries and regions differ, the generated data are shared beyond boundaries without any governance mechanism. This paper, through perspectives from neuroscience, shows conceptually and empirically that there is a need for animal data governance that is informed by ethical concerns. There is a plurality of ethical views on the use of animals in scientific research that data governance mechanisms need to consider.

Methods

Semi-structured interviews were used for data collection. Overall, 13 interviews with 12 participants (10 males and 2 females) were conducted. The interviews were transcribed and stored in NviVo 12 where they were thematically analyzed.

Results

The participants shared the view that it is time to consider animal data governance due to factors such as differences in regulations, differences in ethical principles, values and beliefs and data quality concerns. They also provided insights on possible approaches to governance.

Discussion

We therefore conclude that a procedural approach to data governance is needed: an approach that does not prescribe a particular ethical position but allows for a quick understanding of ethical concerns and debate about how different positions differ to facilitate cross-cultural and international collaboration.

Characterization of key information sections in informed consent forms posted on ClinicalTrials.gov

Introduction

Recent revisions to the US Federal Common Rule governing human studies funded or conducted by the federal government require the provision of a "concise and focused" key information (KI) section in informed consent forms (ICFs). We performed a systematic study to characterize KI sections of ICFs for federally funded trials available on ClinicalTrials.gov.

Methods

We downloaded ICFs posted on ClinicalTrials.gov for treatment trials initiated on or after the revised Common Rule effective date. Trial records (n = 102) were assessed by intervention type, study phase, recruitment status, and enrollment size. The ICFs and their KI sections, if present, were characterized by page length, word count, readability, topic, and formatting elements.

Results

Of the 102 trial records, 76 had identifiable KI sections that were, on average, 10% of the total length of full ICF documents. KI readability grade level was not notably different from other sections of ICFs. Most KI sections were distinguished by section headers and included lists but contained few other formatting elements. Most KI sections included a subset of topics consistent with the basic elements of informed consent specified in the Common Rule.

Conclusion

Many of the KI sections in the study sample aligned with practices suggested in the preamble to the revised Common Rule. Further, our results suggest that some KI sections were tailored in study-specific ways. Nevertheless, guidelines on how to write concise and comprehensible KI sections would improve the utility and readability of KI sections.

Healthcare lobbying and campaign finance activities of vision-related professional societies, 2015 to 2022

Purpose

To compare the lobbying expenditures and political action committee (PAC) campaign finance activities of the American Academy of Ophthalmology (AAO), American Society of Cataract and Refractive Surgery (ASCRS), and American Optometric Association (AOA) from 2015 to 2022.

Methods

Financial data were collected from the Federal Election Commission and OpenSecrets database. Analysis was performed to characterize and compare financial activity among the organizations. P < 0.05 was considered significant and all analyses were two-sided.

Results

From 2015 to 2022, the AAO, ASCRS, and AOA spent $6,745,000, $5,354,406, and $13,335,000 on lobbying, respectively. The AOA's annual lobbying expenditure (median, $1,725,000) was significantly greater than AAO's ($842,500, P = 0.03) and ASCRS's ($694,289, P < 0.001). In PAC donations, OPHTHPAC, affiliated with AAO, received $3,221,737 from 2079 donors (median, $900); eyePAC, affiliated with ASCRS, received $506,255 from 349 donors ($500); and AOA-PAC received $6,642,588 from 3641 donors ($825). Compared to eyePAC, median donations to OPHTHPAC (P = 0.01) and AOA-PAC (P = 0.04) were significantly higher. In campaign spending, OPHTHPAC contributed $2,728,500 to 326 campaigns (median, $5000), eyePAC contributed $293,500 to 58 campaigns ($3000), and AOA-PAC contributed $5,128,673 to 617 campaigns ($5500). eyePAC's median campaign contribution was significantly lower than the AOA's (P < 0.001) and AAO's (P = 0.007). Every PAC directed most of its contributions toward Republican campaigns; eyePAC donated the highest proportion (64.9%).

Conclusions

AOA was more assertive in shaping policy by increasing lobbying expenditures, fundraising, and donating to a greater number of election campaigns.

Comparative Study of Ochratoxin A Exposure through the Intake of Cereal Products in Two Climatic Moroccan Regions

The present study aims to compare ochratoxin A (OTA) exposure through the intake of three cereal derivative products (bread, pasta and semolina) in two different Moroccan climatic regions (littoral and continental). OTA weekly intakes from cereal products were calculated using a deterministic approach for each region. Results showed a statistically significant difference (p < 0.05) of OTA exposure between the two regions. Indeed, the median OTA exposure was estimated at 48.97 ng/kg b.w./week in the littoral region, while it was estimated at 6.36 ng/kg b.w./week in the continental region. The probabilistic approach showed that, due to uncertainties, the 95th percentile of weekly OTA exposure associated with the three cereal products ranged from 66.18 to 137.79 (95% CI) with a median of 97.44 ng/kg body weight (b.w.)/week. Compared to the threshold of 100 ng/kg b.w./week, 95% of the cumulative distributions predicted an exceedance frequency between 0.42 and 17.30% (95% CI), with an exceedance frequency median of 4.43%. Results showed that cereal derivatives constitute an important vector of OTA exposure and cause a significant exceedance of toxicological reference value among large consumers in the littoral region, which suggests the urgency of reconsidering the maximum regulatory limit (MRL) set for OTA (3 µg/kg) in cereal derivatives by Moroccan authorities.

Biosimilars for the next decade in Latin America: a window of opportunity

INTRODUCTION

Biosimilars are gaining popularity in Latin America (LA). The biosimilars market is expected to grow rapidly over the next decade as a cost-effective alternative to expensive patented biologics. The drivers for the growing demand include needs for affordable health care, the prevalence of chronic diseases, expiration of patents for numerous biologic medicines and the advent of artificial intelligence (AI). Countries such as Argentina, Brazil and Mexico have implemented regulatory frameworks for the approval of biosimilars as well as for investment in local manufacturing capacity, sale, and distribution. Some LA countries face challenges related to low quality institutional frameworks and deficient public policies for regulatory harmonization of these medicines.

AREAS COVERED

The aim of this article is to analyze the broad window of opportunity for biosimilars in LA (Brazil, Mexico and Argentina) in the next decade, considering their regulations and institutional quality, as well as an affordable cost for patients with chronic diseases and highlight the biosimilars approved in the three countries studied. Likewise, the future contribution of AI in the drug R&D process is considered.

EXPERT OPINION

Preparing the next decade of biosimilars in LA will involve improving international regulatory frameworks, institutional quality, investments and capacity in R&D (competencies, infrastructure, and AI).

Livestock hauler and dairy farmer perspectives about cull dairy cattle transport and cattle transport regulations in British Columbia, Canada

Dairy cows are usually culled and transported from the farm when they no longer meet the farm's standards for production or are not needed for milk production. Some cows are transported while in poor condition and may deteriorate further during transport. In February 2020, Canadian federal animal transport regulations were revised with the aim to minimise risks to livestock during transport; changes that may impact cull dairy cows included defining compromised cattle and limiting their maximum transport time. This study conducted semi-structured interviews with dairy farmers (n = 6) and cattle haulers (n = 4) in British Columbia, Canada, to gain an in-depth understanding of the effect of the regulations on their practices when shipping and transporting dairy cows to slaughter. Interviews were transcribed in Otter.ai and thematically coded in NVivo 12. While farmer and hauler participants recognised the importance of animal welfare during transport and described practices such as shipping mobile animals to reduce the risk that cows would become non-ambulatory during transport, they also described little change in shipping and transport practices due to the new regulations. Among interviewed participants, barriers to compliance with the regulations appear to be low knowledge of, and mixed or negative attitudes towards the regulations. Participants also described how they felt a lack of communication along the transport chain and limited transport and slaughter infrastructure made compliance difficult. Possible suggestions to remedy these barriers include providing educational resources about the regulations and encouraging communication about cow fitness for transport between responsible parties in the transport chain.

Understanding the Role of Therapy Dogs in Human Health Promotion

Dogs may provide humans with a range of physical, mental and social benefits. Whilst there is growing scientific evidence of benefits to humans, there has been less focus on the impact to canine health, welfare and ethical considerations for the dogs. The importance of animal welfare is increasingly acknowledged, indicating that the Ottawa Charter should be extended to include the welfare of non-human animals supporting the promotion of human health. Therapy dog programmes are delivered across a variety of settings including hospitals, aged care facilities and mental health services, highlighting the important role they play in human health outcomes. Research has shown that that there are biomarkers for stress in humans and other animals engaged in human-animal interactions. This review aims to assess the impact of human-animal interactions on therapy dogs engaged in providing support to human health. While challenging, it is paramount to ensure that, within the framework of One Welfare, the welfare of therapy dogs is included, as it is a key factor for future sustainability. We identified a range of concerns due to the lack of guidelines and standards to protect the wellbeing of the dogs engaged in these programmes. Extension of the Ottawa Charter to include the welfare of non-human animals with leveraging through a One Welfare approach would promote animal and human health beyond current boundaries.

Artificial intelligence in medical device software and high-risk medical devices - a review of definitions, expert recommendations and regulatory initiatives

INTRODUCTION

Artificial intelligence (AI) encompasses a wide range of algorithms with risks when used to support decisions about diagnosis or treatment, so professional and regulatory bodies are recommending how they should be managed.

AREAS COVERED

AI systems may qualify as standalone medical device software (MDSW) or be embedded within a medical device. Within the European Union (EU) AI software must undergo a conformity assessment procedure to be approved as a medical device. The draft EU Regulation on AI proposes rules that will apply across industry sectors, while for devices the Medical Device Regulation also applies. In the CORE-MD project (Coordinating Research and Evidence for Medical Devices), we have surveyed definitions and summarize initiatives made by professional consensus groups, regulators, and standardization bodies.

EXPERT OPINION

The level of clinical evidence required should be determined according to each application and to legal and methodological factors that contribute to risk, including accountability, transparency, and interpretability. EU guidance for MDSW based on international recommendations does not yet describe the clinical evidence needed for medical AI software. Regulators, notified bodies, manufacturers, clinicians and patients would all benefit from common standards for the clinical evaluation of high-risk AI applications and transparency of their evidence and performance.

Modification in Applying Appendix D of 40 CFR Part 61 to Heated Solid Radionuclide Materials With High Melting and Boiling Points

ABSTRACT

Appendix D of Title 40 Part 61 of the US Code of Federal Regulations (CFR) provides a procedure that US Department of Energy (US DOE) facility owners and operators can use to estimate radionuclide emissions to the atmosphere for dose calculations instead of measuring emissions for minor sources under the 40 CFR Part 61, Subpart H, National Emission Standards for Emissions of Radionuclides Other Than Radon From Department of Energy Facilities, regulation. The procedure assumes that any radioactive material heated above 100 °C is completely vaporized and emitted to the atmosphere. In 1991, the US DOE Oak Ridge Reservation (ORR) requested approval to use different release fractions (RFs) for uranium because of its high melting and boiling points. In response to the request, the US Environmental Protection Agency (US EPA) Region IV approved the use of modified RFs for elemental uranium provided no reaction had taken place to alter its chemical form. In 2015, the ORR requested approval to use different RFs for tungsten, again because of its high melting and boiling points. EPA Region IV approved the use of modified RFs for heated radioactive tungsten metal. In accordance with the two precedents set for heating uranium and radioactive tungsten metals, in 2016, the ORR requested approval to use modified RFs in a similar fashion for other radioactive solid metals and compounds with melting and boiling points above 500 °C that might be heated above 100 °C in future research projects and experiments. EPA Region IV again granted approval to use modified RFs for the list of compounds. This note discusses the proposed modified RFs and their development.

Processes for Designing Innovative Biomedical Hardware to Use in Space and on Earth

The new era of space exploration is increasing the astronaut's number and diversity in low orbit and beyond. The influx of such a diverse crew population will also increase the need for medical technologies to ensure safe and productive missions. Such a need represents a unique opportunity to innovate and develop diagnostics and treatment tools to meet future needs. Historically, terrestrial regulatory oversight of biomedical design processes was considered separate from spaceflight regulatory processes because it did not address spaceflight constraints. These constraints challenge the creative development of unique solutions for use in space. Translation between healthcare innovation in spaceflight to healthcare on Earth and vice versa requires understanding the commonalities, unique needs and constraints. This manuscript provides a framework for comparing Earth-space design processes and a perspective on the best practices to improve healthcare equity and health outcomes.

Regulatory issues and ethical considerations in cross-cultural neuropsychology with a special emphasis on Limited English Proficiency

Regulations addressing provision of healthcare services to individuals from diverse cultures and with limited English proficiency (LEP) are reviewed and balanced against ethical considerations with respect to a provider's competency in conducting such services. Federal regulations require providers at institutions receiving Federal financial assistance to provide services to individuals without allowing factors such as LEP to act as barriers to those services. However, regulations addressing these factors are not absolute, and must be applied reasonably, with respect to: the number of individuals who speak a particular language in an area, the criticalness of the services, and the costs to and resources of the provider's institution. Thresholds based on numbers of individuals speaking a language requiring provision of language assistance services are reviewed. It is also noted that a provider's competency in conducting a particular service to patients from diverse backgrounds may be factored as a resource, while accessing appropriate tools and knowledge to provide services to a particular group may be factored as a cost. A review of relevant issues pertaining to competence in conducting cross-cultural evaluations with an emphasis on LEP is presented, followed by case samples in which potential conflicts between regulations and provider ethical obligations are resolved.

Consumers' Preferences for Chicken Fed on Different Processed Animal Proteins: A Best-Worst Analysis in Italy

The increase in meat consumption expected in the next decade will require more and more proteins for animal feeding. The recent amendments to the European "BSE Regulation" allow the use of insects and porcine-based meals in poultry farming, providing novel, sustainable substitutes for vegetable fodder. While the technological and nutritional properties of novel feeds containing processed animal proteins are widely recognized, far less is known about consumers' acceptance of meat produced by animals fed on animal-based meals. In the present research, a best-worst survey was applied to estimate consumers' preferences for chicken fed on plants, insects, or porcine-based meals using a sample of 205 Italian consumers. Furthermore, product price, type of farming, and "Free-from" labeling were considered in the analysis to evaluate the relative importance of feed ingredients compared to other important attributes of meats. The results show that the most relevant attributes are type of farming and "Free-from" claims, while type of feed represents the third attribute in order of importance. Notably, both insect and porcine flour are considered as negative characteristics of the product, suggesting that mandatory labeling signaling the use of these feeds would negatively impact on the value of chicken meat.

Ayurvedic Doctors Cannot Prescribe Allopathic Medicines-National Consumer Dispute Redressal Commission Judgement

Purvish M. ParikhWe describe the facts of the matter and the court's decision in a case of an Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) doctor being found guilty of deficiency of service by prescribing allopathic medicines that were associated with known complications. The case details include the allegation, the defense, and the court's judgement. Details of the concerned acts, circulars, and regulations, as well as court case laws, are described. The regulations allow AYUSH doctors to prescribe allopathic medicines under certain circumstances, which were not adhered to in this case.

Meaningless Use: Assessing Compliance With a Clinically Meaningless Emergency Department Documentation Requirement

Introduction A New York State initiative requests that Emergency Department (ED) providers document in the electronic health record (EHR) each admitted patient's employment status and, if applicable, their mode of commute. This initiative diverts them from their primary duties and increases the likelihood they will either disregard the request or input incorrect information to complete the data fields as fast as possible. This study intends to understand how well providers adhere to this regulation, which, while important for society as a whole, has little clinical relevance, especially in the ED, where the focus is to identify and treat emergent conditions. We hypothesized that clinician-collected employment data would contain many more "N/A" responses than registration-collected employment data (the "gold standard").  Methods We took a randomly selected convenience sample of 100 patients admitted from the ED and compared each patient's provider-entered response to the employment data field to the registration-recorded response. The EHR operates such that the "Employment" field must be completed in order to complete the admission electronically. Data fields collected were: last name, first name, date of birth, medical record number, date and time of arrival, date and time of admission, attending physician, resident physician (if there was one), mid-level provider (if there was one), provider-entered employment status, registration-entered employment status, admitting service (eg, Medicine, Surgery, OB/Gyn), and disposition level (eg, ICU). We assessed the percent of employment data that was concordant between the provider's entry and the registration clerk's entry. We also assessed for the potential confounding variable of how busy the ED was at time of admission, as providers may not take ask about employment or enter such data during particularly busy times. Finally, we interviewed providers to elicit reasons they did not enter accurate data. Statistical significance was set a priori at p <0.05. Results One hundred six patients were screened; six were excluded because one of the authors (MR) was their attending physician. For 92 of the remaining 100 patients, providers recorded employment as "N/A," and for eight patients they recorded "retired." For seven of these eight patients, provider entry matched registration entry (87.5% concordance). To adjust for whether how busy the ED was may have impacted the accuracy of data entry, admissions were categorized according to what time of day the patient was admitted. There was no statistically significant correlation between how busy the ED was and accuracy of data entry. The majority of providers stated they responded "NA" because the employment information was unrelated to the ED visit.  Conclusion In New York, for each patient admitted from the ED, the ED provider is requested to enter the patient's job information and, if they commute to work, the method they use. However, this takes providers' attention away from what they should be doing most: diagnosing and treating patients. This study highlights the unintended consequence of requesting data fields that are not clinically relevant and, from the patient and provider perspective, are not good investments of time and energy and distract from the clinical visit. Persons interpreting such clinically irrelevant data should do so with caution, as the results are unlikely to reflect the truth of what the questions intend to determine.

A Bibliometric Analysis of Scientific Research Publications Related to Pesticide Poisoning in the South Asian Countries

Pesticide self-intoxication leading to suicide is a widespread phenomenon in India. Implementing regulations prohibiting the use of highly toxic pesticides in agriculture has proven effective in reducing the overall suicide rate in various South Asian countries without compromising agricultural production. In this study, we conducted a bibliometric analysis of scientific publications on pesticide poisoning in South Asian countries using various databases, including PubMed, Scopus, and Web of Science, using relevant Medical Subject Heading (MeSH) terms. To analyze the data, we employed R Studio and Microsoft Excel 2019, which enabled us to collect information on the number of scientific publications, citation frequency, and keyword trends. Our analysis involved 417 articles, and the results indicated a crucial need for greater awareness and improved management of pesticide poisoning in South Asian countries. Our findings provide valuable insights for policymakers and offer guidelines for pesticide control.

Applications of artificial intelligence in clinical management, research and health administration: imaging perspectives with a focus on hemophilia

INTRODUCTION

Joints of persons with hemophilia are frequently affected by repetitive hemarthrosis. In this paper concepts, perks and quirks of the use of artificial intelligence (AI), machine learning (ML) and deep learning are reviewed within clinical and research contexts of hemophilia and other blood-induced disorders' patient care, targeted to the imaging diagnosis of hemophilic joints, under the perspective of different stakeholders (radiologists, hematologists, nurses, physiotherapists, technologists, researchers, managers and patients/caregivers).

AREAS COVERED

Rubrics that determine the suitability of the utilization of AI in blood-induced disorders' patient care, including diagnosis and follow-up of patients are discussed, focusing on features in which AI can replace or augment the role of radiology in the clinical management and in research of patients. Insights on features in the design and conduct of AI projects in which the human intervention remains critical are provided.

EXPERT OPINION

The author discusses research concepts in radiogenomics, and challenges of the utilization of AI in different healthcare fields such as patient safety, data sharing and privacy regulations, workforce education and future jobs' shortage. Finally, the author proposes alternatives and potential solutions to mitigate challenges in successfully deploying ML algorithms into clinical practice.

Guidelines for interpreting the International Code of Nomenclature of Prokaryotes and for preparing a Request for an Opinion

In this paper the Judicial Commission provides general guidance for interpreting the International Code of Nomenclature of Prokaryotes (ICNP) and specific assistance to authors, reviewers and editors of a Request for an Opinion, or of other suggestions related to the ICNP. The role of the Judicial Commission is recapitulated, particularly with respect to the processing of such Requests. Selected kinds of nomenclature-related proposals are discussed that are unsuitable as the basis for a Request. Particular emphasis is put on Requests for placing names or epithets on the list of nomina rejicienda, and a dichotomous identification key is provided to guide potential authors of a Request that targets the name of a species or subspecies because of issues with its type strain. To this end, the criteria for the valid publication of such names under the ICNP are revisited. Aspects of other kinds of Requests are also addressed. The study is based on a comprehensive review of all Judicial Opinions issued since the publication of the Approved Lists in 1980. One goal of this paper is to assist potential authors in deciding whether their concern should be the subject of a Request, and if so, in composing it with the greatest chance of success. It is also clarified how to obtain additional help regarding nomenclature-related issues.

Medicaid Coverage for Podiatric Care: A National Survey

OBJECTIVES

Medicaid provides health insurance for low-income people meeting specific eligibility requirements. It is funded and administered by both the federal and state governments; this decentralization leads to vastly different programs across the country. The objective of this legal surveillance project was to describe state-by-state differences in podiatric care coverage for nonelderly adults across Medicaid programs.

METHODS

We used policy surveillance, a form of advanced legal mapping. It is the systematic collection and analysis of written policies across jurisdictions. Policy surveillance captures the important features of law through a rigorous scientific process to turn these policies into structured, quantitative legal data that are suitable for further evaluation or modeling. Data for the 51 jurisdictions were current as of September 1, 2020.

RESULTS

The vast majority of jurisdictions (82%) covered podiatric services for all classes of Medicaid beneficiaries, but the rules, restrictions, and limitations around coverage differed. Twenty-five jurisdictions had no limits on the number of podiatric visits during a specified period; 26 jurisdictions indicated a cap. Ten jurisdictions had no explicit limitations on coverage of routine foot care, whereas 33 jurisdictions covered routine foot care only when medically necessary or with a triggering condition. Eight jurisdictions did not cover routine foot care at all, and 28 jurisdictions required prior authorizations.

CONCLUSIONS

Podiatric care coverage, which is often preventive, varies greatly by state. This variability in coverage, which has not been previously tracked at the level of detail provided in our study, has implications for cost and health outcomes. The value of podiatric care is especially apparent in Medicaid populations. The compilation of these data can serve as a valuable resource for clinicians, researchers, and policy makers.

Reshaping EU Legislation for Air Pollution Control: Main Features of the Proposed Directive in Comparison with the US Legislation

Abstract

In October 2022, the European Commission released a draft of a new Directive aimed at securing more effective control and prevention of outdoor air pollution in Europe through the recasting and update of previous European legislation. The proposal is intended to reshape the current regulations in the field within the EU and its implementation at the Member State level and achieve lower air pollution in light of the recent advancements in environmental health and novel indications in the field from the World Health Organization. In addition, the proposed Directive provides a legal framework for air pollution control that falls within the wider legal context of the EU Green Deal and NextGenerationEU initiatives. The new rules are also remarkably consistent with corresponding and updated US regulations, though stricter in terms of air pollution control and more open to interactions with local authorities. In sum, the proposed EU Directive appears to take better stock of the emerging scientific evidence on the adverse effects of air pollution and may provide an effective legal instrument for adequate public health protection.

Child Stunting Reduction in Aceh Province: Challenges and a Way Ahead

INTRODUCTION

Indonesia ranks the fifth highest in child stunting among Asian countries. Aceh, a westernmost province in Indonesia recorded the highest prevalence of stunting in children under two years old in the nation. Our study investigated the current government efforts on child stunting reduction activities since the introduction of Governor Regulation No. 14/2019.

METHODS

The study investigated the current efforts of Aceh governments and relevant actors on child stunting reduction using in-depth interviews, document reviews and focus group discussions.

RESULTS

Thirty-five (35) respondents including policy makers were interviewed, four focus group discussions (15 each group) were conducted, and various official documents were reviewed. Various challenges for reducing child stunting in Aceh were identified: inadequate knowledge and skills of Posyandu cadres on child stunting; reluctance to consume iron and folic acid (IFA), and supplementary foods (PMT Bumil) by many pregnant women due to perceived annoying effects and unappetizing taste; work engagement, insufficient breast milk production and inadequate support from husbands failing to achieve exclusive breastfeeding among nursing women; inadequate provision of complementary fortified foods for children 6-23 months; lack of clean water, waste management and WASH practices.

CONCLUSION

The intervention on both nutrition-specific and nutrition-sensitive factors was found to be insufficient in Aceh. Although WASH (water, sanitation and hygiene) practices are the most important contributors to child stunting, only the health agency plays a singular role in reduction efforts by focussing on specific factors. Coordination between relevant agencies to address both factors is required to achieve the effectiveness of child stunting reduction and prevention in Aceh.

The evolution of pharmacovigilance ecosystems: Does Moore's law invite the use of Occam's razor?

AIMS

Moore's law predicts the doubling of complexity of integrated circuits every 2 years; Kryder's corollary assumes a doubling of data storage every 13 months. With the increasing volume of legislation, pharmacovigilance systems today are inherently complex, and the emphasis has shifted from reactive (responding to emerging risks) to planned, active, risk-proportionate approaches operating throughout the life cycle of medicines.

METHODS

Exploration of the drivers for increasing complexity of pharmacovigilance systems, focusing on regulatory environment, data management and evaluation.

RESULTS

Evaluation of postmarketing data plays an increasingly important role in pharmacovigilance. There is great interest on the part of all stakeholders in optimizing the use of these data. Innovative approaches, including pharmacogenetics and passive measures (sensors), will lead to increased complexity and volumes of data and inevitably to an increase in the volume of case reports. There is a multiplicity of regulations and guidelines on how to manage these data, with an inherent lack of harmonization.

CONCLUSION

We summarize the current characterization of safety data types, sources and the classification of these data. Using this benchmark, we discuss the future requirements of an effective pharmacovigilance ecosystem, keeping the principle of parsimony in mind. In this complex, continuously and rapidly changing environment, there is a need for a return to simplicity and pragmatism. The application of Occam's razor could help to support the rapid provision of new, affordable medicines with a positive benefit to risk profile.

Sri Lanka's response to prescribed drug misuse: is it enough?

A wide range of medications are being misused by people the world over and Sri Lanka is no exception. Reasons for this misuse are manyfold. Regulatory bodies, prescribers, dispensers, as well as the general public, have significant roles to play in mitigating the misuse of prescribed medications and their harmful consequences.

Factors impacting the detection of weed seed contaminants in seed lots

BACKGROUND

The setting and following of phytosanitary standards for weed seeds can lessen the impacts of weeds on agriculture. Standards adopted by seed companies, laboratories and regulators ensure the contamination rates do not exceed some thresholds. Globally sample size standards are set based on the amount needed to obtain a contaminant in a random sample of the seed lot, not detectability. New Zealand requires a 95% confidence that the maximum pest limit of 0.01% of quarantine weed seed contamination is not exceeded in an imported seed lot. We examined 24 samples each containing approximately 150 000 seeds of either perennial ryegrass (12 samples) or white clover seeds (12 samples) that were then spiked with seeds (contaminants) from 12 non-crop species (3-8 seeds of each). We considered factors that may impact detection rates: shape, color, size, and texture relative to the crop, and technician (including a commercial seed laboratory).

RESULTS

A linear mixed model fitted to the data indicated significant observer, crop, and seed color, shape, and size effects on detection. Detectability increased by 20% ± 7.7 (± standard error) when seeds had a distinct shape or color (28% ± 8.1), or were larger (23% ± 8.7) rather than smaller, relative to the crop. Commercial laboratory identifications were usually correct at the level of genus, and species for common weeds, but some misidentifications occurred.

CONCLUSION

Sample sizes for border inspections should be based on detectability of regulated weed seeds in the crop in combination with weed risk for the crop and location. © 2022 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.