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During the course of surgical interventions, complications mostly occur in the postoperative period. Slight clinical indications can be observed, which precede a significant deterioration of the patient's condition. On the general ward vital parameters, such as heart and breathing frequencies are measured every 4-8 h. Even if the monitoring of critically ill patients is increased to every 2 h and the measurement of vital functions takes 10 min, the patient is only monitored for 120 min in a 24 h period and remains postoperatively on the general ward without monitoring for 22 out of 24 h. New wireless monitoring systems are available to continuously register some vital functions with the aid of wearable sensors. These systems can alert and alarm ward personnel if the patient's condition deteriorates. Although the optimal monitoring system does not yet exist and implementation of these new wireless monitoring systems might involve some risks, these new methods offer a great opportunity to optimize surveillance of postoperative patients on the general ward. [ABSTRACT FROM AUTHOR]

Studies the genetic differentiation in Orchesella cincta populations from various sites contaminated by heavy metals. Comparison of the toxic effects of cadmium and zinc on first generation laboratory animals; Growth responses for animals exposed to different concentrations of the chemicals; Growth rates of the sexes.

Abstract Environmental assessment for chemicals relies on models of fate, exposure, toxicity, risk, and impacts. Together, these models should provide scientific support for regulatory risk management decision-making, assuming that progress through the data-information-knowledge-wisdom (DIKW) hierarchy is both appropriate and sufficient. Improving existing regulatory processes necessitates continuing enhancement of interpretation and evaluation of key data for use in decision-making schemes, including ecotoxicity testing data, physical-chemical properties, and environmental fate processes. Yet, as environmental objectives also increase in scope and sophistication to encompass a safe chemical economy, testing, risk assessment, and decision-making are subject to additional complexity due to the ongoing interaction between science and policy models. Problems associated with existing design and implementation choices in science and policy have both limited needed development beyond chemo-centric environmental risk assessment modeling and constrained needed improvements in environmental decision-making. Without a thorough understanding of either the scientific foundations or the disparate evaluation processes for validation, quality, and relevance, this results in complex technical and philosophical problems that increase costs and decrease productivity. Both over- and under-management of chemicals are consequences of failure to validate key model assumptions, unjustified standardized views on data selection, and inordinate reification (i.e., abstract concepts are wrongly treated as facts). Highlights • Environmental assessment of chemicals relies on models of fate, exposure, toxicity, and risk. • as environmental protection objectives increase in sophistication regulatory processes increase in complexity. • Increased complexity results in increased costs and decreased productivity. • Key issues include unvalidated model assumptions, unjustified views on data selection, and inordinate reification. • Improvements needed: increased rigor in model design, data to information development, and validity/relevance determination. [ABSTRACT FROM AUTHOR]

Using the pollution-induced community tolerance (PICT) concept, thisarticle presents a rapid method for detecting toxic effects of contaminated soil on soil microbial communities and for elucidating the causal relationship between exposure history and toxic effects in exposed microbial communities. The method is based on the use of multiwellplates (Biolog(R)) for producing concentration versus effect relationships for (maximally) 95 different microbial metabolic activities. For this, artificial exposure in the multiwell plate is established tothe contaminant supposedly causing toxic effects in the field. The method was tested in a gradient of zinc-contaminated field plots by studying community tolerance to zinc. For most substrates the metabolicactivities showed an increased community tolerance for zinc with increased zinc concentration in the field. Consequently, PICT has evolved after 2.5 years of zinc exposure under field conditions. The perspectives for future use of the PICT concept in combination with the multiwell technique for demonstrating ecotoxicological effects at contaminated sites is exemplified by the comparison of Dutch soil quality criteria for zinc with the collected data. This comparison showed thatthe evolution of microbial-PICT for zinc has occurred at environmental concentrations near the Dutch intervention value, a quality criterion linked to remediation urgency. [ABSTRACT FROM AUTHOR]

Background: Surgical site infections (SSI) are frequent complications after elective abdominal surgery. We designed the Enhanced PeriOperative Care and Health Protection programme (EPO2CH) care bundle, comprising of intraoperative high fractional inspired oxygen; intraoperative goal-directed fluid therapy; active preoperative, intraoperative and postoperative warming; glucose control and treatment of hyperglycaemia (> 10 mmol L- 1) in diabetics as well as non-diabetics; and wound irrigation before closure using an aqueous antiseptic. We hypothesise that EPO2CH added to standard care reduces the incidence of SSI compared to standard care alone for elective abdominal surgery.Methods: This trial is designed as an open label, pragmatic randomised controlled parallel-group multicentre superiority trial. The primary endpoint is the incidence of SSI, defined by the Centers for Disease Control and prevention, within 30 days after surgery. The incidence of SSI is assessed using the Dutch national complication register and medical chart review. Secondary endpoints include the SSI incidence within 90 days, incidence of anastomotic leakage at 30 and 90 days, the incidence of incisional hernia within 1 year, mortality within 1 year and 5 years, quality of life, health and disability, and cost-effectiveness. Primarily, an intention-to-treat analysis will be performed to estimate the relative risk using a log binomial model. If not feasible, a logistic regression will be used to estimate the odds ratio. A per-protocol analysis will also be performed. Furthermore, the attributive effect of the distinct interventions will be explored.Discussion: The results of the EPO2CH trial will determine if the EPO2CH bundle is effective to prevent SSI incidence for patients undergoing elective abdominal surgery. Details of the statistical analysis are described in this Statistical Analysis Plan (SAP).Trial Registration: Registration number: Dutch Trial Register Trial NL5572 . Registered on March 3, 2016. SAP version: V1.0, January 8, 2020. This SAP has been written based on study protocol V10. [ABSTRACT FROM AUTHOR]

Purpose: Body weight and body composition may change during and after adjuvant or neo-adjuvant chemotherapy for breast cancer. However, most studies did not include a comparison group of women without cancer, thus could not assess whether observed changes differed from age-related fluctuations in body weight and body composition over time. We assessed changes in body composition during and after chemotherapy in breast cancer patients compared with age-matched women not diagnosed with cancer.Methods: We recruited 181 patients with stage I-IIIb breast cancer and 180 women without cancer. In patients, we assessed body composition using a dual-energy X-ray scan before start of chemotherapy (T1), shortly after chemotherapy (T2), and 6 months after chemotherapy (T3); for the comparison group, the corresponding time points were recruitment (T1) and 6 (T2) and 12 (T3) months.Results: Fifteen percent of patients and 8% of the comparison group gained at least 5% in body weight between T1 and T3. Among the comparison group, no statistically significant changes in body weight, or body composition were observed over time. Body weight of patients significantly increased from baseline (72.1 kg ± 0.4 kg) to T2 (73.3 kg ± 0.4 kg), but decreased to 73.0 kg ± 0.4 kg after chemotherapy (T3). Lean mass of patients significantly increased from 43.1 kg ± 0.5 kg at baseline to 44.0 kg ± 0.5 kg at T2, but returned to 43.1 kg ± 0.5 kg at T3. There were no differential changes in fat mass over time between patients and the comparison group.Conclusions: Changes in body weight and body composition during and after chemotherapy for early stage breast cancer were modest, and did not differ substantially from changes in body weight and body composition among women without cancer. [ABSTRACT FROM AUTHOR]

Sustainability assessments provide scientific support in decision procedures towards sustainable solutions. However, in order to contribute in identifying and choosing sustainable solutions, the sustainability assessment has to fit the decision context. Two complicating factors exist. First, different stakeholders tend to have different views on what a sustainability assessment should encompass. Second, a plethora of sustainability assessment methods exist, due to the multi-dimensional characteristic of the concept. Different methods provide other representations of sustainability. Based on a literature review, we present a protocol to facilitate method selection together with stakeholders. The protocol guides the exploration of i) the decision context, ii) the different views of stakeholders and iii) the selection of pertinent assessment methods. In addition, we present an online tool for method selection. This tool identifies assessment methods that meet the specifications obtained with the protocol, and currently contains characteristics of 30 sustainability assessment methods. The utility of the protocol and the tool are tested in a case study on the recovery of resources from domestic waste water. In several iterations, a combination of methods was selected, followed by execution of the selected sustainability assessment methods. The assessment results can be used in the first phase of the decision procedure that leads to a strategic choice for sustainable resource recovery from waste water in the Netherlands. [ABSTRACT FROM AUTHOR]

Biological traits of organisms are expected to provide increased mechanistic understanding of species-environment relationships. Linking traits to environmental conditions is, however, not straightforward, as traits are interconnected within species and can affect the adaptive value of each other. The aim of our study was to evaluate the importance of these trait interrelationships for understanding environmental responses of freshwater macroinvertebrates., To this end, we investigated whether environmental responses of macroinvertebrates sharing a given trait were consistent or differed according to their taxonomy or to their other traits. We divided the macroinvertebrates into groups based on single traits (49 single-trait modalities), on taxonomy (10 orders) and on their overall trait profile (10 trait profile groups [ TPGs], defined using self-organising maps clustering). Abundances of each of these 69 groups were related to 24 environmental variables using boosted regression tree ( BRT) modelling, to assess the environmental responses of single traits, orders and TPGs., Cross-validated predictive power ( R2) of the BRT models ranged from < 1% to 38%. Environmental responses of macroinvertebrates sharing a given trait were inconsistent and varied according to order and/or TPG. Single-trait responses often reflected the responses of the most abundant taxonomic group expressing the trait, suggesting that analysis of trait responses simply revealed patterns in habitat use by the most abundant species and not necessarily mechanistic relationships., Further, taxa from the same TPG (hence showing large overlap in their traits) but belonging to different orders showed different environmental responses. This indicates that the order a taxon belongs to confers unique information related to its evolutionary history that was not captured by our 49 trait modalities. However, groupings by orders cannot replace trait-based approaches, since TPGs also revealed differences in trait profiles within some orders, which were associated with different environmental responses., Our results highlight the importance of considering multiple rather than single traits when linking macroinvertebrates to environmental variables, including the potential information conveyed by evolutionary history. [ABSTRACT FROM AUTHOR]

The European Union's REACH regulation has introduced Socio-Economic Analyses as a new decision support tool in the domain of chemical policy-making. This paper presents a pragmatic method to review the replacement of chemicals in processes or products in terms of the environmental impact. The aim of this work is to develop a broadly accepted method for environmental impact assessment as part of Socio-Economic Analyses. The method consists of a stepwise and tiered approach for Environmental Impact Assessment whereby the expected impact of the replacement of chemicals is assessed via Risk Characterization Ratios and toxic pressure quantification (expressed as a Potentially Affection Fraction of species), and – if relevant – via a Persistency, Bioaccumulation potential and Toxicity score. The working of the method is demonstrated by the replacement of chemical substances in detergents, gutters and Expanded Polystyrene. Of the three replacements, for gutters, the reduction of the toxic pressure on the aquatic compartment was highest. Based on 50% effect concentrations the Potentially Affection Fraction of species due to the use of zinc gutters was relatively high (15%), while it was 0.6% after replacement by PVC gutters. This indicates that PVC gutters have a lower direct impact on aquatic biodiversity than zinc gutters. This paper demonstrates that even with limited data the proposed method can be used to move from risk indicators to impact indicators. The tiered approach allows finding the most appropriate level of analysis in a cost and resource efficient way. The method allows comparison of results of different scenarios and as such allows selecting the most preferable alternative from an environmental perspective. This is useful in the context of socio-economic analysis and as such, this method is available as a decision-support tool under REACH and other chemical policy frames such as the United Nations Environment Program. [ABSTRACT FROM AUTHOR]

Abstract: This paper presents the policy framework of contaminated site management in The Netherlands and the corresponding risk assessment tools, including innovations that have taken place since an overview was published in 1999. According to the Dutch Soil Protection Act assessment framework, soils are subdivided into three quality classes: clean, slightly contaminated and seriously contaminated. Historic cases of slightly contaminated soils are managed in a sustainable way by re-use of soil material within a region on the basis of risk-based and land use specific Maximal Values and Background Values. In case of serious soil contamination remediation is in principle necessary and the urgency of remediation has to be determined based on site-specific risks for human health, the ecosystem and groundwater. The major risk assessment tools in The Netherlands are the CSOIL exposure model (human health risks and food safety), Species Sensitivity Distributions and the Soil Quality Triad (ecological risks), along with a procedure to assess the risks due to contaminant spreading to and in the groundwater. Following the principle ‘simple if possible, complex when necessary’, tiered approaches are used. Contaminated site practices are supported with web-based decision support systems. [Copyright &y& Elsevier]