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Hearing-impaired students often struggle in traditional classrooms where auditorybased teaching dominates, especially in abstract subjects like Economics. Standard approaches, such as sign language and written text, are insufficient in conveying complex concepts, resulting in poor academic achievements among these students. This paper examined the role of multimedia instructional package in enhancing academic achievement in Economics for hearing-impaired students. The study utilized a non-equivalent pretest-posttest control experimental group design, involving a total of 100 students from the International Model School for the Deaf in Afikpo. From this population, a sample of 58 SS1 students was randomly assigned to either the experimental group (32 students) who were taught using the Multimedia Instructional Package (MIP) or the control group (26 students) taught through sign language methods. Data were gathered using the Economics Achievement Test (EAT). The data analysis was conducted using mean and standard deviation to address the research questions, and an Independent Sample t-test with a significance level of 0.05 was applied to test the null hypotheses. The results indicated that students in the experimental group, taught with MIP, significantly outperformed those in the control group, exhibiting better comprehension, motivation, and academic achievement. The study concluded that incorporating MIP into special needs education, especially in subjects such as Economics, can foster a more inclusive and effective learning environment. It recommended that educators should adopt multimedia tools to improve outcomes for hearing-impaired students and suggests further research into the long-term effects of these instructional package across various subjects and student populations. [ABSTRACT FROM AUTHOR]

Objective: This study was to investigate the correlation between airway inflammation and lung function impairment in patients with bronchiectasis with different FEV, and to analyze the influencing factors of lung function impairment. Methods: 80 patients with bronchiectasis admitted to the respiratory department of our hospital from May 2022 to January 2024 were selected as research objects. General data of each group were analyzed, and lung function and airway inflammatory cytokine levels were compared in each group. Pearson linear analysis was used to analyze the relationship between lung function and airway inflammation in patients with bronchiectasis, and multi-factor Logisitic regression was used to analyze the influencing factors of lung function impairment in patients with bronchiectasis. Results: The FVC, FEV1/FVC and DLCO evaluation of the three groups were included in the study and the difference among the groups was compared. The results showed that the FVC, FEV1/FVC and FVC of the high FEV, group and the medium FEV, group were higher than those of the low FEV, group. FVC, FEV1/FVC and FVC in high FEV, group were higher than those in medium FEV, group (P<0.05). The levels of ESR, CRP, WBC, NEUT, PCT, IL-4, IL-6, IL-10 and TNF-a in the three groups were included in the study and the differences between the groups were compared. The levels of ESR, CRP, WBC, NEUT, PCT, IL-4, IL-6 and TNF-a in high and medium FEV, groups were lower than those in low FEV, group, and the levels of IL-10 were higher than those in low FEV₁ group (P<0.05). The levels of ESR, CRP, WBC, NEUT, PCT, IL-4, IL-6 and TNF-a in high FEV₁ group were lower than those in medium FEV₁ group, and the levels of IL-10 were higher than those in medium FEV, group(P<0.05). The results of Pearson linear analysis showed that FEV₁, FVC, FEV1/FVC and DLCO were positively correlated with airway inflammatory factors ESR, CRP, WBC, NEUT, PCT, IL-4, IL-6 and TNF-a, and negatively correlated with IL-10 in patients with bronchiectasis (P<0.05). Independent variables were set as the indicators with differences in comparison in the above data, including FVC, FEV1/FVC, DLCO, ESR, CRP, WBC, NEUT, PCT, IL-4, IL-6, IL-10, and TNF-a. The dependent variable was impaired lung function in patients with bronchiectasis. Multivariate Logisitic regression analysis was performed, and the results showed that The influential factors of impaired lung function in patients with bronchiectasis are FVC, FEV1/FVC, DLCO, ESR, CRP, WBC, NEUT, PCT, IL-4, IL-6, IL-10, TNF-α. Conclusion: Airway inflammation increases with the increase of FEV, level in patients with bronchiectasis, which is closely related to lung function and is an influential factor of lung function impairment. [ABSTRACT FROM AUTHOR]

Background: Prediabetes is a condition preceding the development of diabetes and is associated with an increased risk of a number of complications. The primary mode of management is thought to be lifestyle modification. Pharmacological therapy, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs), were not well addressed in the literature and were only evaluated in trials as secondary and exploratory outcomes with a limited sample size. Here, GLP-1RAs are evaluated as a comprehensive therapy approach for patients with prediabetes. Methods: A comprehensive search of Web of Science, SCOPUS, PubMed, and Cochrane was performed on May 5, 2023, to retrieve randomized controlled trials (RCTs) comparing the effect of GLP-1RAs to placebo and/or lifestyle modification on prediabetes reversion to normoglycemia, prevention of overt diabetes, glycemic control, anthropometric parameters, and lipid profiles. Review Manager (RevMan) version 5.4 was used. The quality of RCTs was assessed using the revised version of the Cochrane Risk of Bias Tool. GRADE was performed to evaluate the certainty of evidence. Results: Twelve trials involving 2903 patients in the GLP-1RAs group and 1413 in the control group were included in the meta-analysis. Low quality of evidence revealed that GLP-1RAs significantly increased the incidence of prediabetes reversion to the normoglycemic state [RR = 1.76, 95% CI (1.45, 2.13), P < 0.00001] and moderate quality of evidence showed that GLP-1RAs significantly prevented new-onset diabetes [RR = 0.28, 95% CI (0.19, 0.43), P < 0.00001]. Significant reductions in HbA1c, fasting plasma glucose, body weight, waist circumference, triglycerides, and LDL were observed in the GLP-1RAs arm (P < 0.05). However, higher incidences of gastrointestinal disorders were reported in the GLP-1RAs group (P < 0.05). Conclusions: GLP-1RAs combined with lifestyle modification proved to be a more effective therapy for managing prediabetic patients than lifestyle modification alone, with a tolerable safety profile. Future guidelines should consider GLP-1RAs as an adjunct to lifestyle modification in the management of prediabetic patients to provide better management and improve treatment adherence. [ABSTRACT FROM AUTHOR]

The motivations of disabled individuals to become entrepreneurs can be influenced by various factors. Throughout their careers and projects, entrepreneurs with disabilities may face multiple personal, social, and political obstacles. This research aims to develop a rigorous, systematic examination of the literature on the obstacles disabled people must overcome to become entrepreneurs. The literature review focused on analyzing ten articles from Web of Science and Scopus. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) is used to organize the field of research. This compilation of peer-reviewed research papers is necessary for academia and government to realize the vision of shared prosperity by 2030.

OBJECTIVE: Atopic dermatitis (AD) is an inflammatory skin condition affecting both mental and physical health. Although research has shown reduced physical activity levels among patients with AD, there is a scarcity of studies examining baseline mobility, which refers to the standard level of functional ambulation or movement capability. We analyzed the relationship between AD and baseline mobility among U.S. adults ages 20 to 59, utilizing the National Health and Nutrition Examination Survey (NHANES). METHODS: We merged three, 2-year cycles of NHANEs data (2001-2006). Patients were categorized as having "impaired mobility" by the following question: "Because of a health problem, do you have difficulty walking without using any special equipment?" Multivariable logistic regression analyses were performed using STATA/SE 18.0. RESULTS: Our analysis included 6,540 participants. The prevalence of impaired mobility was 7.1 percent among patients with AD and 3.9 percent among those without AD. This difference was statistically significant among patients aged 20 to 59 after adjusting for potential confounding variables (adjusted odds ratio [AOR], 1.65; 95% CI, 1.19-3.25; P=0.010). Subgroup analysis showed increased rates of impaired mobility among males with AD (AOR, 2.55; 95% CI, 1.21-5.40; P=0.016), and among adults aged 40 to 59 (AOR, 1.94; 95% CI, 1.03-3.68; P=0.042). LIMITATIONS: Limitations to our study include lack of specificity in the survey questionnaire, self-reporting bias, and an age limit of 59 years old. CONCLUSION: Our study demonstrated a statistically significant elevation in impaired mobility among individuals with AD compared to those without AD. This underscores the importance of comprehensive care for AD patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: The maintenance of oral hygiene and subsequent health related issues in visually handicapped children is a challenging task. Hence, tools must be used to ensure good oral health in these children. The study aimed to analyze the effectiveness of preventive programs on oral health using specialized audio and tactile aids in visually impaired school children. MATERIALS AND METHODS: 100 visually handicapped children were selected for the study. They were divided into two groups: Group A (Training using Braille) and Group B (training by means of audio aids). Children were trained using appropriate tools and oral health was assessed using Plaque and Gingival bleeding indices. STATISTICAL ANALYSIS: Independent ‘T-test’ was used for comparing mean ± SD values. RESULTS: Statistically significant improvements in both plaque and gingival bleeding indices were obtained on follow-up observations at 3rd and 6th months. CONCLUSION: The use of specialized tactile and audio tools significantly improved the oral health status of visually impaired school children.

Histone deacetylase-8 (HDAC8) is a unique member of class I Zn2+-dependent metalloenzyme of the classical histone deacetylases owing to its highly structural and kinetic characterization. Of interest, the diminution in the expression level of HDAC8 and or the impaired activity of the enzyme has been correlated with various pathophysiological events, such as neuroblastoma cancer, chronic obstructive pulmonary disease (COPD), Cornelia de Lange syndrome (CdLs) and other metabolic dysfunction. Notwithstanding, HDAC8 has been considered a high priority drug target, and because of the therapeutic benefits associated with HDAC8 inhibitors, the majority of the current research is geared toward searching for inhibitors of this enzyme. In addition, the potential for treating metabolic and age-related diseases by activation is gradually gaining attention. However, currently only a few researchers have reported on the biochemical significance of activators of HDAC8 and the information gathered further indicates that the combination of both activators and inhibitors could be a promising therapeutic strategy toward dissecting the role of HDAC8 in associated diseases. Therefore, the primary aim of this review is to elaborate on the prospects of combining HDAC8 activators and inhibitors for disease treatments due to HDAC8 diminution or impaired activity.

Para taekwondo is a combat sport martial art that requires fast reaction times for successful defense during fighting. The current classification system is based on the function and the effective length of the upper limbs, which affects the athlete's ability to block. Therefore, this study aimed to investigate the differences between the different classes in the athlete's ability to block and move around the ring. A total of 87 Para taekwondo (K42, K43, and K44) athletes' data were analyzed. Each participant engaged in the blocking reaction time test in a fighting stance with the left leg in front, the right leg in front, and the legs parallel in random order. A foot-stepping reaction test was performed to anlyze how the athletes moved in various directions. The results indicated no significant differences between the classes for the lower body foot stepping reaction times and the upper body blocking performance times. The stimulated blocking time of the Para taekwondo athletes ranged from 0.79 to 0.97 s Furthermore, the neurological group (0.86 ± 0.09 s) was significantly slower than the amputation/dysmelia group (0.81 ± 0.07 s). We thus concluded that the neurologically impaired athletes were disadvantaged and therefore belonged in a separate class. [ABSTRACT FROM AUTHOR]

Abstract Background Physical and functional losses due to aging and diseases decrease human mobility, independence, and quality of life. This study is aimed at summarizing and quantifying these losses in order to motivate solutions to overcome them with a special focus on the possibilities by using lower limb exoskeletons. Methods A narrative literature review was performed to determine a broad range of mobility-related physical and functional measures that are affected by aging and selected cardiovascular, respiratory, musculoskeletal, and neurological diseases. Results The study identified that decreases in limb maximum muscle force and power (33% and 49%, respectively, 25–75 yrs) and in maximum oxygen consumption (40%, 20–80 yrs) occur for older adults compared to young adults. Reaction times more than double (18–90 yrs) and losses in the visual, vestibular, and somatosensory systems were reported. Additionally, we found decreases in steps per day (75%, 60–85 yrs), maximum walking speed (24% 25–75 yrs), and maximum six-minute and self-selected walking speed (38% and 21%, respectively, 20–85 yrs), while we found increases in the number of falls relative to the number of steps per day (800%), injuries due to falls (472%, 30–90 yrs) and deaths caused by fall (4000%, 65–90 yrs). Measures were identified to be worse for individuals with impaired mobility. Additional detrimental effects identified for them were the loss of upright standing and locomotion, freezing in movement, joint stress, pain, and changes in gait patterns. Discussion This review shows that aging and chronic conditions result in wide-ranging losses in physical and sensory capabilities. While the impact of these losses are relatively modest for level walking, they become limiting during more demanding tasks such as walking on inclined ground, climbing stairs, or walking over longer periods, and especially when coupled with a debilitating disease. As the physical and functional parameters are closely related, we believe that lost functional capabilities can be indirectly improved by training of the physical capabilities. However, assistive devices can supplement the lost functional capabilities directly by compensating for losses with propulsion, weight support, and balance support. Conclusions Exoskeletons are a new generation of assistive devices that have the potential to provide both, training capabilities and functional compensation, to enhance human mobility.

Background: The maintenance of oral hygiene and subsequent health related issues in visually handicapped children is a challenging task. Hence, tools must be used to ensure good oral health in these children. The study aimed to analyze the effectiveness of preventive programs on oral health using specialized audio and tactile aids in visually impaired school children., Materials and Methods: 100 visually handicapped children were selected for the study. They were divided into two groups: Group A (Training using Braille) and Group B (training by means of audio aids). Children were trained using appropriate tools and oral health was assessed using Plaque and Gingival bleeding indices., Statistical Analysis: Independent 'T-test' was used for comparing mean ± SD values., Results: Statistically significant improvements in both plaque and gingival bleeding indices were obtained on follow-up observations at 3 rd and 6 th months., Conclusion: The use of specialized tactile and audio tools significantly improved the oral health status of visually impaired school children., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

This case report describes the experience of caring for a 28-year-old man with diffuse axonal injury (DAI). During hospitalization, the patient experienced sudden altered consciousness and sensory disturbance, which resulted in caregiver role strain. Problems during the nursing period included disturbed sensory perception, impaired swallowing, and caregiver role strain. To promote the patient's recovery of daily activity, interventions for the patient and caregiver were planned separately. The intervention for the patient included multisensory stimulation and swallowing training. To promote the caregiver's knowledge of the disease course and improve the caregiver's daily nursing skill, we employed a humanoid diagram and clock drawing exercise. Our experience described herein can help promote recovery in patients with DAI and assist overwhelmed caregivers. [ABSTRACT FROM AUTHOR]

Background: Non-variceal upper gastrointestinal bleeding (NVUGIB) is still a common and life-threatening disease, thus it would have a big impact on medical care cost. However, little is known about risk factors for increased medical care cost in NVUGIB patients.Aim: The purpose of the study was to clarify predictor of requiring high medical care cost in NVUGIB patients. Patients who underwent endoscopic hemostasis due to NVUGIB between April 2012 and March 2015 were included in this retrospective study. We analyzed the association between patients' background including activity of daily livings (ADL) and high medical care cost using logistic regression model. Medical care cost was calculated in reference to the "Diagnosis Procedure Combination" which is diagnosis-dominant case-mix system in Japan. The cutoff value of high medical care cost was defined as its first quartile. ADL was assessed according to Katz-6 score. We defined impaired ADL patient who revealed Katz-6 score more than 1.Results: A total of 128 consecutive patients were included in this study. Median medical care cost was 5323 USD (IQR 3661-8172 USD). There were 13 patients (10%) in impaired ADL group. In univariate analysis, age and impaired ADL before admission revealed significant association with high cost. Of these, impaired ADL was an only independent risk factor [odds ratio 15.3 (95% CI 2.49-183)] in multivariate analysis.Conclusion: Impairment in ADL before admission was an independent predictor for high medical care cost with NVUGIB patients. [ABSTRACT FROM AUTHOR]

Objectives: To develop a new assessment tool, the ICIQ‐Cog, to measure the disease‐related impact of incontinence in cognitively impaired adults and the effort associated with the care of this population, and to present the initial psychometric properties of this tool and outline the possible clinical implications. Participants and Methods: The ICIQ‐Cog consists of two scales: a 12‐item scale measuring disease‐specific bother (ICIQ‐Cog‐P) and a four‐item scale assessing efforts associated with care of people with incontinence and cognitive impairment (ICIQ‐Cog‐C). Data on 60 nursing home residents with incontinence and cognitive impairment were obtained in a test–retest research design. The psychometric properties of the ICIQ‐Cog were examined using a combination of classic and item response theory methods. Results: Factor analyses resulted in a three‐factor solution for the ICIQ‐Cog‐P, with interrelated factors. Rasch analysis showed a good model fit when collapsing response categories. The ICIQ‐Cog‐C fitted to one dimension. The ICIQ‐Cog tool provided reliable measures in terms of internal consistency (0.69–0.82) and retest reliability (0.71–0.83). The preliminary results on external validity showed that the ICIQ‐Cog assessed disease‐specific aspects linked to the group of cognitively impaired people with incontinence. Conclusion: The ICIQ‐Cog tool has appropriate psychometric and clinometric properties and is therefore useful for making decisions about treatment in cognitively impaired adults with incontinence. [ABSTRACT FROM AUTHOR]

Purpose: to develop information technology for technical and tactical training of skilled basketball players with hearing impairments. Material : the study involved 24 women's national team athletes Ukrainian Basketball hearing impaired (age - 25-30 years). Technical protocols were processed 12 games from the World Cup and Europe, XXII Summer Deaflympics. Fixed number of shots and hit free throws, steals, rebounds and on its offensive rebounds, fouls and errors. Results : the developed system of tactical training basketball players with hearing impairments. Accentuation was made of the prevalence of method visibility while developing tactical interactions. The main result was the development of the author's method of video tutorials with animated illustrations. Also, use the lamp LS Line-3-65-12-C to control the training process athletes. Conclusions : there was a significant improvement in competitive activity athletes. Athletes performed significantly more hits from the foul line and successful shots from long range compared to main rivals. Also increased the number of interceptions in games. Application of information technology had an impact on the competitive result: basketball team of Ukraine took the second place in the Deaflympics in Sofia in 2013.

In this exploratory study, the authors surveyed clinical supervisors (n = 138) regarding their knowledge of their supervisees' problems of professional competency (PPC). Findings suggest the majority have observed a supervisee with PPC working towards licensure. Further, those that have supervised a supervisee with PPC have been negatively impacted by these interactions (e.g., increased their workload, increased their stress). [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is mainly characterized as the malignant and impaired growth of rectal cells in the intestinal region. Direct medical cost is related to resources, which are directly used in treating the patient, that mainly includes the cost of drugs, diagnostic, treatment, follow-up, rehabilitation, and hospital admission. The objective of this study is to estimate and analyze direct medical costs attributable to CRC in Jordan. A retrospective analysis of a cohort patients treated for CRC data has been performed to determine direct medical costs attributable to CRC in Jordan. The prevalence-based approach has been used in addition to the “bottom up” approach to accumulate 1-year time costs of CRC. Demographic, clinical, and economic data have been collected and analyzed using SPSS for windows. Costs were estimated by a bottom-up approach, in which each service component was identified and valued at the most detailed level, to provide greater transparency and reliability in economic evaluation of health care services. This study quantified the economic burden associated with CRC by Jordanian patients in King Abdullah University Hospital from the perspective of health care providers (public sector). Total CRC cost in the year 2014 was estimated to JD 695,608, and the most expensive stage for all sites was stage 4 reaching a cost of JD 5147. Advanced disease stages were associated with an increase in total cost and chemotherapy costs. In conclusion, results of this study propose that direct medical costs associated with CRC are considerable. Most of the cost was devoted for medications, primarily chemotherapy. Advanced stages were associated with higher cost and largest number of patients. [ABSTRACT FROM AUTHOR]

The main goal of early detection of hearing impairment in children is early intervention. There is growing interest in early detection of hearing impairment in developing countries. The main purpose of this study was to investigate the spoken language development in severe to profound hearing impaired children and compared their speech intelligibility with normal hearing children at the same age. Nine severe to profound hearing impaired children below 2 years old out of the primer 42 cases were selected for this survey. They receive aural habilitation and also speech therapy after beginning the speech production. Speech intelligibility test of these children was recorded on audio-tape, when they read five questions which can be answered with one word only, at the age of 4, 5 and 6 in comparison with 27 normal hearing children at the same age. At the age of 4 the mean speech intelligibility score of the studied group was 31.77% (SD 12.17) and the control was %96 (SD 2.23). At the age of 5, this score was %51.22 (SD 14.42), the control one 97.85% (SD 1.93). Finally at age 6 it was 72% (SD 18.97) for hearing–impaired group and 99.22% (SD 1.18) in control one. Severe to profound hearing impaired children acquired spoken language but not at the same level. In general, their speech development showed about 2 to 3 years delay. Their speech intelligibility was acceptable for severe group around the age 6 but almost semi–intelligible for profound group at the same age.

The patients, the elderly and disabled people (with physical and/or psychological limits because of their ages or disabilities) constitute a substantial part of society. Library and library services are known to play therapeutic roles in their lives. Therefore, either as a branch of a public library or independently, the libraries should endeavour to develop services for their needs, taking into account the special conditions and circumstances of the patients, the elderly and the disabled. The latest version of these guidelines was published and compiled by a working group lead by Nancy Mary Panella in 2000 and it aimed to identify the essential features of such services and to provide suggestions tailored to local needs and circumstances. This paper is the translation of the aforementioned guidelines. [ABSTRACT FROM AUTHOR]

The age-related changes in cell viability and osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) play pivotal roles in the fracture healing process, especially in geriatric individuals. This study was designed to explore the age-related changes in murine BMSCs and the regulation of osteogenic differentiation in aged BMSCs in vitro. Notch signaling pathway took part in the regulation of osteogensis, while the relationship between Notch and the osteogenic differentiation in aged BMSCs has not been reported yet. BMSCs harvested from the bone marrow of young, adult, and aged C57BL/6 mice were cultured in osteogenic and adipogenic differentiation media. Histochemical staining results indicated that the osteogenic ability of BMSCs gradually decreased with aging, whereas the adipogenic ability increased. Cell activity assays showed that the proliferative and migrated capacity did not decline with aging significantly. According to real-time PCR and Western blotting results, the aged cells exhibited higher Notch signaling expression level than the younger ones did. After the aged BMSCs being treated with γ-secretase inhibitor, however, Notch activity was changed and the aging-imparied osteogenic ability reverted to a normal level. This study demonstrated that the decreased bone formation capacity in aged BMSCs had relationship with the transdifferentiation between osteogenesis and adipogenesis, which would be regulated by Notch signaling pathway and the attenuated osteogenesis in aged BMSCs could be promoted when the inhibition of Notch pathway. [ABSTRACT FROM AUTHOR]

Objectives: There are limited studies on the factors that can predict the presence of impaired clinical insight specifically in an Emergency Room (ER) psychiatric patient population. The objective of this study is to examine the factors that can predict the likelihood that a patient presenting to the ER will have impaired clinical insight. Methods: Nineteen independent demographic and clinical factors contained on data assessment tools for 337 patients assessed by the crisis team in the ER over 6 months were compiled and analysed using SPSS Version 20 with univariate analyses and logistic regression. Results: Patients who were unemployed or had a history of self-harm or had psychotic symptoms on mental state examination were about two, three and six times, respectively, more likely to have impaired clinical insight compared with those who were employed, had no history of self-harm or had no psychotic symptoms on mental state examination, controlling for other factors in the logistic regression model. Conclusion: Patients who are unemployed, have a history of self-harm or have psychotic symptoms following as psychiatric assessment in the ER may benefit from an insight-oriented psychotherapy. [ABSTRACT FROM AUTHOR]

Context. Free-ranging mammals contribute to faecal pollution in United States water bodies. However, research into wildlife impact on water quality is dependent upon unreliable data (e.g. data uncertainty, unknown importance of parameters). Aims. Our goal was to determine the potential impacts of common free-ranging mammal species and their management on Escherichia coli in the study floodplain. Our objectives for this research were to construct a model from study area-and literature-derived data, determine important species for E. coli deposition, and conduct sensitivity analyses on model parameters to focus future research efforts. Methods. We constructed a model that incorporated parameters for four wildlife species known to contribute E. coli in central Texas: raccoons (Procyon lotor), white-tailed deer (Odocoileus virginianus), Virginia opossums (Didelphis virginiana), and wild pigs (Sus scrofa). These parameters were (1) population density estimates, (2) defaecation rates, (3) defaecation areas, (4) E. coli concentration in faecal material estimates, and (5) E. coli survival. We conducted sensitivity analyses on the model parameters to determine relative importance of each parameter and areas for additional study. Key results. We found that adjustment of raccoon and Virginia opossum population densities had higher impacts on E. coli in the floodplain than similar changes in other species across all spatial and seasonal variations. We also found that the changes in E. coli survival, E. coli concentration in raccoon faecal material, and defaecation rates had the highest impacts on E. coli in the floodplain. Conclusions. Our sensitivity analyses indicated that the largest impacts to projected E. coli loads were from changes in defaecation rates followed by E. coli concentration in faecal material and E. coli survival. Watershed planners, ranchers, and regulators must be cautioned that faecal deposition patterns are location specific and could significantly impact which species are considered the most important contributors. Implications. Although all parameters require more research, we recommend that researchers determine defaecation rates for contributing species due to their relatively large impacts on E. coli in comparison to the other parameters. We also suggest additional research in free-ranging wildlife faecal morphology (form and structure) and area of deposition. Finally, species-specific E. coli survival studies for free-ranging wildlife should be conducted. [ABSTRACT FROM AUTHOR]

Radiologists are faced with ever-increasing challenges in the needs of the practice, in both private and academic settings. Targeted information about protecting and maintaining the physical, mental, and emotional health of the radiologist is highly limited. Impairment is a functional classification that implies that the individual affected by a disease is unable to perform specific activities. Radiologists can suffer from the same illnesses as any human being, which include substance abuse and addiction, as well as chronic infectious diseases such as human immunodeficiency virus, hepatitis B and C, and tuberculosis. This article is intended to educate radiologists and leaders about various forms of physician impairment. It provides discussion of the challenges related to such impairment and provides tools and resources to address the impaired radiologist. [ABSTRACT FROM AUTHOR]

Objective:The objectives of this study were to estimate the prevalence of designated driving in the United States, compare these results with those from the 1996 National Roadside Survey, and explore the demographic, drinking, and trip characteristics of both designated drivers and their passengers. Methods:The data used were from the 2007 National Roadside Survey, which randomly stopped drivers, administered breath tests for alcohol, and administered a questionnaire to drivers and front seat passengers. Results:Almost a third (30%) of nighttime drivers reported being designated drivers, with 84 percent of them having a blood alcohol concentration of zero. Drivers who were more likely to be designated drivers were those with a blood alcohol concentration that was over zero but still legal; who were under 35 years of age; who were African American, Hispanic, or Asian; and whose driving trip originated at a bar, tavern, or club. Over a third of passengers of designated drivers reported consuming an alcoholic drink the day of the survey compared to a fifth of passengers of nondesignated drivers. One fifth of passengers of designated drivers who reported drinking consumed 5 or more drinks that day. Conclusions:Designated driving is widely used in the United States, with the majority of designated drivers abstaining from drinking alcohol. However, because designated driving separates drinking from driving for passengers in a group traveling together, this may encourage passengers to binge drink, which is associated with many adverse health consequences in addition to those arising from alcohol-impaired driving. Designated driving programs and campaigns, although not proven to be effective when used alone, can complement proven effective interventions to help reduce excessive drinking and alcohol-impaired driving. [ABSTRACT FROM PUBLISHER]

Context. The role of wildlife in faecal pollution of water bodies (deposition of Escherichia coli (E. coli)) is not well understood. Current water-quality and land-use planning research largely relies on unreliable wildlife data (e.g. poor sourcing of abundance estimates, population density estimates applied to multiple fundamentally different areas, suspect or insufficiently described data collection techniques) Aims. Our goal for the present research was to investigate deposition of E. coli into a floodplain by free-ranging mammals. Objectives of the research were to determine the density of important free-ranging meso-and large mammals in the study area, determine faecal E. coli loads for each species, and evaluate spatial data on species-specific faecal deposition. Methods. We conducted our research in south-eastern Texas, USA,ontwo cattle ranches bisected by Cedar Creek (44-km long). Cedar Creek has elevated E. coli concentrations. We conducted mark-recapture and mark-resight population density estimates (2008/09) for meso- and large mammals in the study areas. We collected faecal samples from all captured wildlife. We also conducted transects through the study area to determine faecal-deposition patterns. Key results. We found that raccoons (Procyon lotor), wild pigs (Sus scrofa), Virginia opossums (Didelphis virginiana) and white-tailed deer (Odocoileus virginianus) all had substantial faecal E. coli loads and population densities, thus implying an important role in E. coli deposition into the study floodplain. All species were widely distributed through the floodplain. Conclusions. Free-ranging mammals contribute E. coli to floodplains and potentially affect water quality. We determined that fours pecies commonly found in floodplains throughout North America all contributed E.coli to the study floodplain, thus implying mammal E. coli contributions in many locations and this is potentially important for E. coli management. Implications. Improved locally specific mammal population estimates and estimates of locally derived E. coli concentration will improve floodplain and water-quality models that often depend on data of various quality. Additionally, our analyses demonstrated the need for continued research into the role of wildlife in E. coli deposition. [ABSTRACT FROM AUTHOR]

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Abstract: Aims: When non-alcohol drugs are detected in blood samples from apprehended drivers in Norway, individualised expert opinions are required to evaluate degree of impairment. For alcohol, legislative limits have been in use since 1936. To harmonize the current practice for driving under the influence of alcohol and non-alcohol drugs, a judicial reform with legislative limits for non-alcohol drugs has been suggested. Methods: Impairment limits, representing drug concentrations in blood likely to be accompanied by a degree of impairment comparable to a blood alcohol concentration (BAC) of 0.02%, were proposed for 20 psychotropic drugs, including the most prevalent benzodiazepines, cannabis, GHB, hallucinogens and opioids. Limits for graded sanctions, representing drug concentrations in blood likely to induce impairment comparable to BACs of 0.05% and 0.12%, were defined for 13 of the 20 substances. The suggested limits were based on assessments of impairment after single doses of the drugs in naïve individuals. The proposed limits will not apply to individuals with valid prescriptions for medicinal drugs, where the present system with individualised expert evaluations will be maintained. Conclusion: Norway is the first country planning to implement legislative limits for non-alcohol drugs corresponding to impairment seen at increasing BACs. The background and justification for the suggested limits are presented herein. [Copyright &y& Elsevier]

This section presents summaries of reviews on nursing-related issues from evidence review organizations. These include strategies for healthcare teams and team-based practice, the interaction between behaviour and speech and language difficulties, and acute adverse reactions of rapid Rituximab infusion among adult patients with chronic lymphocytic leukaemia and non-Hodgkin lymphoma.

The article presents summaries of research on nursing-related issues. One study concluded that the negative beliefs and attitudes regarding body size should be considered in the development of health promotion initiatives in order to improve children's self-esteem. Another study looked at the inequalities and the mental health of young people. A study examined the intervention strategies which support self-care activities across disease and impairment groupings.

Abstract: Objective: To evaluate the risk factors associated with the initiation of driving under the influence (DUI) among Hispanics in a longitudinal and nationally-representative sample of adolescents and young adults. Specifically, this study tests the effect of demographic variables, individual-level risk factors, and eco-processes (e.g., peer drug use, parental involvement) during adolescence on DUI among Hispanic young adults. Methods: Data were derived from 1734 Hispanic adolescents surveyed for the National Longitudinal Study of Adolescent Health (Add Health). Survey logistic regression procedures were used to examine the effects of nativity status on DUI initiation, to evaluate the independent effect of each risk factor (demographic, individual-level, and eco-processes), and to identify whether and to what extent these factors are associated with the initiation of DUI. Results: The overall prevalence of DUI initiation was 18.3%. Differences were observed in the rates of DUI initiation by nativity status: first-generation immigrants reported the lowest rates of DUI initiation (15.4%) when compared with second-generation US-born Hispanic youth (17.4%) and third-generation and beyond US-born Hispanic youth (21.5%). US-born Hispanic youth were also more likely to report higher frequency of alcohol use (t =3.46, p =0.001) and marijuana use (t =2.34, p =0.021) compared to immigrant adolescents. After adjusting for a number of risk factors, men (OR=2.86), marijuana users (OR=1.98), and those who reported feeling safe in their neighborhoods (OR=2.02) were at an increased risk DUI initiation. Conclusions: Findings provide support for the “immigrant paradox”: immigrant youth reported lower rates of DUI initiation and other high-risk behaviors when compared with US-born Hispanic youth. [Copyright &y& Elsevier]

Abstract: Introduction: Blood samples from 733 drivers suspected of driving under the influence of alcohol in the province of Ontario from 2001 to 2005 were retrospectively examined. Methods: Samples were analyzed for alcohol content by headspace gas chromatography with flame ionization detection. Drivers ranged in age from 15 to 83years old with the majority of blood samples obtained from males (n =623, 85%). Of the 704 cases where quantifiable numerical values were obtained, blood alcohol concentrations ranged from 13 to 414mg/100mL (mean 172mg/100mL) for males and 10 to 425mg/100mL (mean 173mg/100mL) for females. The majority of these drivers (n =640/704, 90.9%) had blood alcohol concentrations of 80mg/100mL and greater at the time of sampling. Analysis for alcohol was undertaken in all cases. However, additional toxicological examinations for drugs was conducted on a case-by-case basis based on the submitted case history and/or where there were requests for additional drug analysis, or where such analysis would be probative in the absence of the detection of alcohol at a concentration that could cause impairment. Results: Therefore, analyses for drugs were only performed in a small subset of 42 cases (6%). Thirty-four of these cases had positive drug findings, with Δ9-tetrahydrocannabinol being the most frequently encountered drug (n =18), followed by benzoylecgonine/cocaine (n =8), morphine (n =6), lorazepam (n =5) and diphenhydramine (n =4). The majority of individuals were involved in some type of motor vehicle accident (n =658, 89.8%), with single motor vehicle accidents (n =412, 56.2%) being the most common, followed by multiple motor vehicle accidents (n =169, 23%). Injuries (n =309, 42.1%) were the main cause of individuals not being able to provide breath samples with specific, non-life threatening injuries (n =178, 24.3%) representing the highest percentage of cases. The majority of incidents (n =449, 61.3%) occurred between Friday and Sunday reaching a peak on Saturday (n =174, 23.7%). Incidents occurred throughout the day, with the majority of events (n =449/705, 63.7%) for which a time was provided occurring between 6:01 pm and 3:00 am, and the peak number of incidents occurring between 9:01 pm and midnight (n =168/705, 23.8%). Conclusion: However, these data demonstrate that ‘‘drugged driving” does occur and that further, comprehensive investigation is needed to determine the frequency and type of drug use by Ontario drivers. [Copyright &y& Elsevier]

Driving is a classic example of visually guided behavior in which the eyes move before some other action. When approaching a bend in the road, a driver looks across to the inside of the curve before turning the steering wheel. Eye and steering movements are tightly linked, with the eyes leading, which allows the parts of the brain that move the eyes to assist the parts of the brain that control the hands on the wheel. We show here that this optimal relationship deteriorates with levels of breath alcohol well within the current UK legal limit for driving. The eyes move later, and coordination reduces. These changes lead to bad performance and can be detected by an automated in-car system, which warns the driver is no longer fit to drive.Neuropsychopharmacology (2008) 33, 849–858; doi:10.1038/sj.npp.1301458; published online 16 May 2007 [ABSTRACT FROM AUTHOR]

Our ageing medical workforce poses many challenges, not the least of which is acknowledging the contributions of ageing practitioners who continue to practise safely and competently while ensuring that those who are incompetent by virtue of impairment are identified, assessed and either rehabilitated or encouraged to retire. Hitherto, there has been little attempt to review approaches to impairment on a national basis in Australia, let alone with a focus on older doctors. Information regarding pathways for dealing with impairment was obtained from the websites and confirmed by representatives of regulatory bodies of every state or territory in Australia. Using a prevention model we outline the current Australian regulatory processes, address some of the barriers and suggest some solutions to dealing with the older impaired doctor. Much of the focus in dealing with the older impaired doctor is tertiary prevention based, that is, reducing the negative influence of established impairment. There is some uniformity in the way that Australian regulatory bodies deal with impairment that espouses the dual goals of protecting the public and rehabilitating the doctor. The approach is typically individualized and multi-levelled, beginning with assessment followed by rehabilitation where appropriate. A range of secondary and primary prevention measures is proposed for dealing with the problem of the older impaired doctor. These include educating the medical community, encouraging early notification and facilitating career planning and timely retirement of older doctors. This will have benefits both in protecting the public as well as preventing an undignified and humiliating end to often-unblemished careers in medicine. [ABSTRACT FROM AUTHOR]

Investigation of a suspected alcohol or drug impaired driving (DUID) case ideally contains several key elements, including a trained officer documenting observations of driving and subject behavior, and collection of a biological specimen for comprehensive toxicology testing. There is currently no common standard of practice among forensic toxicology laboratories in the United States as to which drugs should be tested for, and at what analytical cutoff. Having some uniformity of practice among laboratories would ensure that drugs most frequently associated with driving impairment were consistently evaluated, that appropriate methods were used to screen and confirm the presence of drugs, and that more accurate data were collected on the extent of drug use among drivers. A survey of United States laboratories actively involved in providing analytical support to the Drug Evaluation and Classification Program identified marijuana, benzodiazepines, cocaine, prescription and illicit opiates, muscle relaxants, amphetamines, CNS depressants, and sleep aids used as hypnotics, as being the most frequently encountered drugs in these cases. This manuscript presents recommendations as to what specific members of these drug classes should at a minimum be tested for in the investigation of suspected DUID cases. Additionally we include recommendations for analytical cutoffs for screening and confirmation of drugs in blood and urine. Adopting these guidelines would ensure that the most common drugs would be detected, that laboratories could compare epidemiological findings between jurisdictions, and that aggregate national statistics on alcohol and drug use in drivers involved in fatal injury collisions were representative of the true rates of drug use in the driving population. [ABSTRACT FROM AUTHOR]

Objective To study the effect of matrix metalloproteinase-9 (MMP-9) on ventricular remodeling and involvement of angiotensin II (Ang II). Methods Thirty-six adult male Wistar rats were randomly divided into control (n = 12), MMP-9 (n = 12), and MMP-9 + olmesartan (n = 12) groups. Recombinant MMP-9 (2.1 ng/g) was injected intraperitoneally twice a week. Olmesartan (3 mg/kg) was given by oral gavage once daily. Animals were treated for 4 or 8 weeks. Cardiac function was assessed by echocardiography followed by histological analysis. The messenger RNA (mRNA) and protein levels of MMP-9 in myocardial tissues were analyzed by reverse transcription polymerase chain reaction and Western blotting, respectively. Serum levels of Ang I, II, angiotensin converting enzyme (ACE) and MMP-9 were determined by enzyme-linked immunosorbent assay (ELISA). Results MMP9 administration for 4 or 8 weeks increased mRNA and protein levels of MMP-9 in myocardial tissues, serum levels of MMP-9, Ang I, II and ACE, and left ventricular mass index (LVMI) but decreased collagen volume fraction (CVF) compared with the control group (all P < 0.05). Cardiomyocyte cell size was significantly enlarged and disorganized with cytoplasmic lysis and necrosis in the MMP-9 group. After olmesartan treatment, myocardial MMP-9 mRNA and protein levels, serum levels of MMP-9 and Ang II, and LVMI were lower, and CVF was higher with significant improvement in myocardial morphology and cardiac function (all P <0.05). Conclusion Recombinant MMP-9 treatment induces ventricular remodeling and cardiac dysfunction by up-regulating Ang II. [ABSTRACT FROM AUTHOR]

When approaching a bend in the road, a driver looks across to the inside kerb before turning the steering wheel. Eye movements and steering are tightly linked, with the eyes leading, which means that the oculomotor controller can assist the neural centres controlling steering. This optimum coordination is observed for all drivers; but despite being the preferred solution to the motor-control problem of successfully steering along a winding road, the question remains as to how crucial such coordinated eye and steering movements are for driving performance. Twenty subjects repeatedly drove a simulated stage of the World Rally Championship, aiming to complete the course in the fastest possible time. For the first six repetitions they used the usual coordination of eye movements and steering; for drives 7–12 they were instructed to fixate on a small spot in the centre of the screen (centre gaze). Prevention of coordination in this way impaired their performance (drives 6 and 7 compared), dramatically increasing their time taken to complete the course, equivalent to slipping 19 places down the leader board in the actual rally stage. This indicates that the usual pattern of eye movements correlated with steering is crucial for driving performance. Further experiments are suggested to reveal whether any attentional demand associated with keeping the eyes still contributes to the loss in performance. [ABSTRACT FROM AUTHOR]

Abstract: Background and Objective: To compare clinical profiles and risk of diabetes between subjects with transient (trIGT) and persistent (pIGT) impaired glucose tolerance in Taiwan. Study Design and Setting: In the pIGT group, IGT was diagnosed in two consecutive periods (1992–1994 and 1995–1996); in the trIGT group, the diagnosis was IGT at the baseline but normal glucose tolerance in the second period. The normal group was defined by fasting plasma glucose &#60; 6.1 mmol/L and 2-hour post-load plasma glucose &#60; 7.8 mmol/L in both periods. All three groups were considered eligible subjects for further follow up (1998–1999). Results: Among 298 nondiabetic subjects at baseline, there were 29 new cases of diabetes diagnosed according to 1999 WHO criteria in 1,614.3 person-years of follow-up (1.79%/year; 95% CI=1.14–2.44%/year). Among subjects with normal, trIGT, or pIGT, the incidence rates were 0.73%/year (8/1,093.0; 95% CI=0.22–1.24%/year), 2.57%/year (7/272.2; 95% CI=0.67–4.47%/year), and 5.62%/year (14/249.1; 95% CI=2.68–8.56%/year), respectively. Conclusion: The group with trIGT had abnormal glucose tolerance and β-cell dysfunction, which may represent an earlier stage than the group with pIGT in development of type 2 diabetes. Moreover, pIGT, insulin resistance, and β-cell dysfunction played independent roles in the deterioration from IGT to diabetes. [Copyright &y& Elsevier]

Despite development of many chemotherapeutic regimens, colorectal cancer continues to have a high mortality. One of the major new potential therapies is interleukin-12, a heterodimeric cytokine produced by antigen presenting cells. In vitro and in vivo studies have demonstrated the role of interleukin-12 in stimulating a cell-mediated anti-tumor response against a number of colon adenocarcinoma tumor models. However, it is unknown whether patients with colorectal cancer have impaired interleukin-12 production. A study was performed to investigate production of interleukin-12 preoperatively and the relationship between these levels and disease stage at surgery.Preoperative peripheral blood mononuclear cells from colorectal cancer patients and agematched controls were stimulated by Staphylococcus aureus Cowan's Strain 1 (0.0075 percent wt/vol) in vitro for 24 hours. Expression of interleukin-12 was then assessed by enzyme-linked immunosorbent assay. A single pathologist assessed the tumors for stage according to TNM and Dukes classifications.Twenty-eight patients with colorectal cancer and 14 controls were recruited for the study. Interleukin-12 production was significantly impaired in patients with colorectal cancer compared with controls (P=0.014), especially those with advanced disease: Dukes C, P=0.001 and T4, P<0.05.Interleukin-12 production is impaired in patients with colorectal cancer, especially those with advanced disease, suggesting a defective Th1-mediated anti-tumor response. These patients may well benefit from exogenous interleukin-12 treatment. [ABSTRACT FROM AUTHOR]

Objective To investigate myocardial apoptosis and the expression of apoptosis-related proteins [B-cell lymphoma-2 (Bcl-2) and Bax], cardiac hypertrophy, and function in spontaneously hypertensive rats (SHR) during aging. Methods Male SHR (n = 36) and Wistar-Kyoto rats (WKY, n = 30) were monitored for their cardiac function from 14 to 102 weeks of age using echocardiography. Myocardial apoptosis in the subendocardium and subepicardium was analyzed using TUNEL staining. The apoptosis-related proteins (Bcl-2 and Bax) were assessed by Western blot analysis. Results Left ventricular mass index (LVMI) in SHR increased progressively with age. Left ventricular ejection fraction (LVEF) showed no significant difference from 14 to 66 weeks of age, but decreased significantly in SHR from 84 to 102 weeks of age. The apoptotic index (APOI) of myocardial cells in SHR increased with age, in which subendocardial APOI (APOI-endo) increased at 66 weeks and was significantly higher than the age-matched WKY (9.83 ± 3.97 vs. 4.03 ± 2.06, P < 0.05). Additionally, the subepicardial APOI (APOI-epi) increased significantly at 84 weeks of age (P < 0.05). Bax/Bcl-2 ratio was higher in SHR than WKY at 66 weeks (3.98 ± 0.80 vs. 0.29 ± 0.06, P < 0.05), and enhanced further at 102 weeks of age (10.54 ± 1.60 vs. 0.70 ± 0.13, P < 0.05). Myocardial APOI was positively correlated with LVMI (r = 0.83, P < 0.01), negatively with LVEF in 66–102 weeks (r = −0.81, P < 0.01), and positively with Bax/Bcl-2 ratio (r = 0.79, P < 0.01). Conclusion Myocardial apoptosis increases with aging and is associated with progressive left ventricular remodeling and cardiac dysfunction in SHR. [ABSTRACT FROM AUTHOR]

Objectives: Postpartum mothers with gestational diabetes may remain with either type 2 diabetes mellitus, impaired glucose tolerance or impaired fasting glucose. Our aim in this study was to identify maternal variables that could predict 1 or more of these conditions., Methods: In 193 singleton pregnancies with gestational diabetes, we applied bivariate logistic regression and receiver-operating characteristic curves to data from the index glucose-challenge test that allowed the diagnosis of gestational diabetes., Results: Receiver-operating characteristic curves of fasting glucose from the index glucose-challenge test predicted impaired fasting glucose and type 2 diabetes mellitus combined, with a sensitivity of 100%, false-positive rate of 40.5%, area under the curve of 0.849, p=0.004 and positive predictive value 45%, and with a cutoff point of 4.7 mmol/L., Conclusions: At the time of diagnosis of gestational diabetes during pregnancy, a basal glucose level of ≥4.7 mmol/L on index glucose-challenge test indicates a 45% probability of either type 2 diabetes mellitus or impending diabetes early postpartum., (Copyright © 2020 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Purpose: Safety data on commonly used herbal medicinal (HM) products (HMPs) and marketed in Ghana are scarce. We assessed the sub-chronic toxicity of three most-patronised commercial antimalarial HMPs in Kumasi, Ghana., Method: Top three HMPs (designated as herbal products 'A' (HPA), 'B' (HPB) and 'C' (HPC)) were selected after a mini-survey and sub-chronic toxicity evaluation conducted in accordance with Organisation for Economic Co-operation and Development (OECD) 407 guidelines. Control rats received clean water while test groups received daily adult human dose (DAHD), 5× DAHD or 10× DAHD of either HPA, HPB or HPC for 30 days. Rats were killed on day 31 to obtain biochemical, haematology and histology samples for analysis. Data were analysed by one-way analysis of variance (ANOVA) and post hoc Tukey's test., Results: The three HMPs produced alterations in liver morphology predominantly characterised by prominent foci of fatty change with scattered hepatocytes containing intracytoplasmic fat globules and congested central veins and sinusoids. The lungs showed alveolar with evidence of inflammation and foci of epithelial sloughing. Alveolar spaces were also obscured by debris and inflammatory cells. HPA and HPC produced scattered intensely congested heart vessels while HPB(10) produced haemorrhage and amorphous exudates within the heart. All HMPs produced neither treatment-related deaths nor significant change in haematological and biochemical parameters, except for HPA and HPB which decreased (P<0.05) aspartate aminotransferase (AST) and HPB, which elevated (P<0.05) fasting blood glucose (FBG)., Conclusion: Data from the present study suggest the potential of the herbal products (HPs), HPA, HPB and HPC, to cause major organ-system dysfunction or damage. We advise cautious use of these products and recommend further safety evaluation in chronic toxicity models., (© 2020 The Author(s).)

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Background Treatment results of small molecule tyrosine kinase inhibitors (TKIs) have been improved, but cancer treatment-related cardiac dysfunction (CTRCD) has become a problem. However, the CTRCD risk of TKIs has not been fully clarified, and monitoring indicators have not been established. Therefore, in order to detect CTRCD early, we aimed to pinpoint the TKIs that needs attention. Method Data from the Japanese Adverse Drug Event Report database from April 2004 through January 2018 was used. In this study, a total of 25 TKIs in monotherapy were studied in principle to avoid the presence of concomitant medication. We examined the relationship between heart failure and TKIs with a reporting odds ratio (ROR) which is a signal detection by data mining Method. The 95% confidence interval lower limit value > 1 was taken as a signal. We also confirmed the target kinase and heart failure alert in the package insert of the TKIs. Result Signals of heart failure were detected in 10 (Alectinib, Axitinib, Bosutinib, Dasatinib, Imatinib, Osimertinib, Pazopanib, Ponatinib, Ruxolitinib and Sunitinib) of the 25 TKIs, and ABL-1, VEGFR and PDGFR were common in the target kinases. Signals were also detected in Alectinib, Bosutinib and Osimertinib, but their package inserts did not alert for heart failure. Death cases were also included in reported heart failure cases. Conclusion Knowledge of the ten TKIs or drugs having ABL-1, VEGFR, PDGFR as the target kinase that signal for a risk of heart failure may lead to the early detection of adverse events by monitoring. There are also serious cases for three drugs for which the risk of heart failure is unknown, so we suggest that it is necessary to conduct periodic monitoring. [ABSTRACT FROM AUTHOR]