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Lake health assessment is the basis for lake ecosystem management and protection. A comprehensive index system is essential for diagnosing these problems. However, previous assessments may have neglected the integrity of lake ecosystems and assessed lake health from a partial perspective. Selecting the optimum indicators and constructing the index system in a rational and scientific way are key to lake health. Here, ecosystem integrity and services were incorporated into the lake assessment framework to guide the selection and arrangement of indices. Under this framework, a multilevel and multi-index system was constructed, which can provide a comprehensive diagnosis of lake ecosystems. The index system consists of five dimensions: organism structural integrity, habitat structural integrity, matter process integrity, hydrological process integrity, and social services function. Each dimension contained several basic indices, and a total of 16 indicators were selected for the basic index layer. Furthermore, the reference state was carefully selected and used to set the health level and health scores. In addition, a fuzzy binary comparison method was used to assign the optimum weights for each index. The framework was applied to Lake Baiyangdian to provide a comprehensive diagnosis. The overall status of the lake was sub-healthy. Structural and process integrity were impaired to some extent and assessed as unhealthy and sub-healthy, whereas services were assessed as healthy. The framework proposed a rational and balanced way to construct a comprehensive index system and incorporated social services, which is more accurate and reliable to provide a diagnosis result. It can also be widely applied, benefiting lake ecosystem management and protection and increasing public awareness of lake health.

The brushless direct-current (BLDC) motor is widely regarded as a promising and versatile electronically controlled motor. Ensuring its reliable operation is crucial for maintaining production efficiency and safety. The stator is essential to the functioning of BLDC motors, and the non-invasive health assessment of the stator can minimise operational disruptions to the motor while ensuring reliability. In this study, we propose a physics-informed long short-term memory network for the non-invasive assessment of BLDC motor stator health conditions. The proposed framework combines physics-informed neural networks (PINNs) with long short-term memory networks by optimising the structure and loss functions of the PINNs to thereby leverage the complementary strengths of neural networks and physical models to enhance their predictive capabilities. A case study involving a BLDC motor system validated the feasibility and effectiveness of the proposed method and yielded precise and reliable results. These results indicate that integrating physical information into deep learning methods is a promising approach by which to assess BLDC motor stator health.

Background: Occupational exposure to hazardous substances, particularly in involving metal cutting and welding industries, poses critical public health concern. This study assesses the health status of gas cutter workers, focusing on Pb exposure. Method: In this cross-sectional study, 40 participants with BLL ≥20 μg/dL were recruited from workers engaged in oxy-acetylene metal cutting. These workers were compared to an age-, sex-, and sociodemographic-matched control group (n = 42) from the same workplace. Health assessments including routine clinical and laboratory investigations along with BLL, and markers of calcium homeostasis were carried out. Results: Gas cutters exhibited significantly higher mean systolic BP and elevated SGOT levels, with similar prevalence of respiratory symptoms and musculoskeletal disorders in both groups. No significant differences were found in most hematological, liver, and renal parameters. However, gas cutters had significantly higher PTH levels and lower serum vitamin D levels. Pulmonary function tests indicated significantly reduced FVC, FEV1, FEV1/FVC ratio, FEF25-75 %, and PEFR in gas cutters, as well as markedly higher CRP levels. Conclusion: Gas cutters experience significant health impacts compared to controls, including elevated systolic BP, impaired pulmonary function, and disturbance in calcium homeostasis due to occupational Pb exposure. Higher CRP levels suggest notable inflammatory responses. These findings highlight the urgent need for targeted interventions and regular monitoring to mitigate health risks associated with Pb exposure among gas cutter workers.

With the development of the pharmaceutical industry, halogenated hydrocarbons, which are the main raw materials and emissions of the pharmaceutical industry, may be defined as atmospheric emerging contaminants due to toxicity and low oxidation of the atmosphere. This study analyzed the volatile organic compounds (VOCs) emissions from four pharmaceutical companies located in the Yangtze River Delta. Samples were taken three times at each of the selected fixed and fugitive sampling sites in each company. Through testing, 141 VOCs were identified. The mean concentration and proportion of halogenated hydrocarbons from the four pharmaceutical companies were the highest of all the industries in the industrial park. They reached 18.9 ppm and 28.8 %, respectively. Fixed emissions of the companies exhibited the mean maximum concentration of dichloromethane and chlorobenzene, which are 11.4 ppm and 250.67 ppb. The mean concentration of fugitive emission of dichloromethane from the four companies in this study is lower than that of pharmaceutical companies in other studies. Newly detected halogenated hydrocarbons, such as 1,1-dichloropropanone and dichloronitromethane, present potential non-cancer and cancer risks to workers. Chlorobenzene was identified as a key potential cancer risk halogenated hydrocarbon the value of which reaches 0.00965. 2,6-dichloropyridine could be a potential emerging contaminant due to its lower MIR value and higher potential cancer risk. The study suggests that relevant pharmaceutical companies focus on the emissions of chlorobenzene and dichloromethane, which may be the atmospheric emerging contaminants for the pharmaceutical industry and focus on improve the treatment of waste gases in workshops and sewage stations.

In a field study, the impact of different levels of brewery sludge (BS) enrichment on Triticum aestivum L. (wheat plants) was examined in terms of growth, yield, heavy metal absorption, and potential health risks linked to plant consumption. Using a randomized complete block design with seven treatments and three blocks, the study showed that applying up to 12 t ha−1 brewery sludge significantly improved all agronomic parameters (except harvest index) compared to control and mineral-fertilized soil. Heavy metal translocation was generally low, except for Cu and Pb. The sequence of heavy metal translocation was Cu > Pb > Cd > Ni > Zn > Mn > Cr from soil to spikes and Cu > Zn > Mn > Pb > Ni > Cd > Cr from soil to grain. Heavy metal loads were mostly higher in roots than in the above-ground crop parts. The target hazard quotient (THQ), hazard index (HI), and target cancer risk (TCR) within wheat grain remained within safe limits for all BS treatments. Consequently, consuming this wheat grain is considered safe regarding heavy metals. Thus, utilizing brewery sludge at 12 t ha−1 as a fertilizer for wheat production and as an alternative method for sludge disposal is plausible.

Due to its advantages of having a high power-to-weight ratio and being energy-efficient, the electro-hydraulic servo pump control system (abbreviated as EHSPCS) is frequently employed in the industrial field, such as the electro-hydraulic servo pump control (EHSPC) servomotor for steam turbine valve regulation control. However, the EHSPCS has strong nonlinearity and time-varying features, and the factors that cause system performance degradation are complex. Once a system failure occurs, it may lead to serious accidents, causing serious casualties and economic losses. To address the above issues, a system health assessment method based on LSTM-GRNN-ANN (LGA) deep neural network is proposed in this paper. Firstly, with oil volume gas content, servo motor air-gap flux density, and system leakage coefficient as the health assessment performance indicators, a health assessment performance index system for the EHSPCS is built, Furthermore, the system performance index threshold is set. Secondly, an LGA deep neural network is constructed by combining LSTM, GRNN and ANN, and a deep neural network based on the LGA is used to create an EHSPCS health assessment model. Subsequently, system feature parameter extraction, algorithm design, and parameter debugging are carried out. Finally, an EHSPCS experimental platform is established, typical system failure simulation experiments are designed, and comparative experimental analysis is conducted. The experimental findings demonstrate that the average accuracy of the system health assessment model based on the LGA deep neural network suggested in this paper is 96.37%, compared to 89.84%, 87.99% for LSTM and GRNN, which validates the accuracy of the system health assessment model based on the LGA deep neural network.

The effect of light intensity has been explored in relation to endocrine functions and reproduction in pigs, but effects on health and behaviour are scarcely documented. The objective of this study was to evaluate the effects of different light intensities on behaviour, health and growth of growing-finishing pigs. An experiment was conducted on a commercial farm equipped with light-emitting diode-based luminaires creating four light intensity treatments: low (45 lux), medium (198 lux), high (968 lux) and spatial gradient of intensity (from 71 lux to 330 lux). Per treatment, 112 pigs were studied in two batches of eight pens. Once every two weeks behaviours such as exploration, positive and negative social interactions, play and abnormal behaviours were observed. Health issues were assessed weekly and included biting lesions, skin lesions, leg and respiratory disorders. The average daily gain over the experiment was calculated and after slaughter carcasses were inspected. Generalised linear mixed models were used for the analysis of behaviours, binary health scores, carcass abnormalities, ordinal logistic regression for multilevel health scores, and linear mixed models for average daily gain. Interactions between intensity and week were found for some behaviours (i.e., exploration, negative social interactions and abnormal behaviour) and health issues (i.e., tear stains, conjunctivitis, body lesions, bursitis and tail lesions). However, none of the treatments consistently outperformed another one. Light treatments did not affect pig growth and carcass abnormalities. These variable results support studies suggesting that pigs are adaptable to light intensities, and inconsistencies over weeks might have been caused by environmental factors that could not be controlled in a commercial farm setting. To conclude, tested light intensities had no clear effects on pig behaviour, health and growth.

Background: Forced migrants are at risk of developing mental illness, yet challenges remain with underutilization of mental healthcare among this population. This study examined the implementation of the Refugee Health Screener-13 (RHS-13) in the health assessment for forced migrants in eight primary health care centres in Stockholm Region, Sweden. Methods: A mixed-methods convergent parallel design was used, combining nurses self-reported quantitative data on the levels and reasons for RHS-13 use in the health assessment with qualitative interview data on the barriers and facilitators for RHS-13 use. The Consolidated Framework for Implementation Research (CFIR) was used as a coding framework for the qualitative analysis. Results: Levels of RHS-13 use varied between primary health care centres, resulting in two groups: three centres with high-level (65–92%) and five centres with low-level (0–36%) implementation. Factors related to the tool itself, as well as the inner and outer context, influenced the use of RHS-13. Language barriers, insufficient time, and lack of trust in the validity and utility of RHS-13 were the main barriers, while its availability in many languages and that it was perceived as an important complement to the health assessment were the main facilitators. Conclusion: RHS-13 contributes to the standardization of assessing mental health in the health assessment. Identifying context-based implementation strategies and addressing language and time issues as well as nurses trust in the tool's utility are recommended to enhance the use of RHS-13.

This study explores the generalization of heterogeneous medical data for monitoring anomalies and changes over time using fuzzy intervals. The most important feature of these intervals is saving the parameter value as a membership function from the interval [0, 1]. An example illustrating this method is the blood count parameters of an oncological patient recorded for three years with a monthly frequency. Over 20 typical measurements of these features are considered, and eight with the highest variance are selected. The registration of the overall picture of changes, a synthesis of eight fuzzy intervals, allowed for observing a systematic improvement in health. This approach allows the doctor to take a holistic view of the patient’s health (based on blood tests), avoiding the dilemma of which parameters are less and which are more important. The Mamdani fuzzy inference system was used to assess the patient’s health status. The study presents the actual results of medical measurements, and the GitHub repository contains measurement data.

Background: Drinking water quality is crucial for human health and well-being. This study evaluated the impact of replacing old asbestos pipelines with modern Polyvinyl Chloride (PVC) ones on drinking water quality in the North Sinai governorate of Egypt. Ninety-two water samples were collected from nine locations along the pipeline from Qantara water station to El-Arish city, and their microbiological and chemical characteristics were assessed. Methods: This investigation was carried out during June and July 2019 to evaluate the drinking water in two distribution nets; old asbestos distribution pipes and new Polyvinyl Chloride water tubes (PVC). Microbiological analyses such as most probable number (MPN), total bacterial count (TBC), chemical assessments (water pH, electrical conductivity; EC, dissolved organic carbon; DOC), and health risk index (HRI) for multi-element concentrations were conducted. Standard analyses were followed to assess the water quality index (WQI) and Metal index (MI) and study the improvement percentage in the element's concentrations. Results: The highest values of TBC were in the city center district (219 CFUs mL−1), followed by Abu Saqual (184 CFUs mL−1), Resa (174 CFUs mL−1), and recently constructed pipes (80 CFUs mL−1). The pH (7.52 - 7.50) and EC (320 to 958 dSm−1) were within permissible limits. No bacterial indicators of fecal pollution were found in all drinking water samples. Results showed that the modern pipeline network significantly improved the concentrations of 23 elements, with the most significant improvements observed in cadmium (66.2%) and potassium (40.7%). HRI results for multi-element concentrations showed an impact on human health in Abu Saqual. WQI showed a decrease of 30% in toxic element concentration in the current pipelines, and MI assessment showed safe concentrations. Conclusion: Drinking water's biological and chemical properties significantly improved, which matched global guideline standards. Our findings highlight the importance of regularly monitoring and updating drinking water infrastructure to ensure safe and high-quality drinking water.

Hydropower, wind power, and photovoltaic power generation are the most common clean energy sources and are important ways to achieve “carbon neutrality” and “carbon peak”. With the adjustment of China’s energy structure, wind power and photovoltaic power generation have entered the peak period of development, but the above two forms of power generation have a certain degree of instability, which has increased the risk of safe and stable operation of the power grid. In contrast, hydroelectric power generation has good stability, and giving full play to the excellent peak and frequency modulation functions of hydro-generator sets is of great significance to ensuring the safe and stable operation of the power grid. This requires the hydro-generator unit to have good reliability during the service period. Through the evaluation of the unit’s health status, the unit’s health status can be predicted, and the maintenance strategy can be given to eliminate the fault in the budding state. This article summarizes the health status assessment methods of hydro-turbine generator sets, and puts forward five health status levels: “healthy”, “good”, “attention”, “abnormal” and “dangerous”. This paper has carried out a quantitative calculation on the health status of a certain hydraulic turbine. The results show that the degree of health of the turbine is “healthy”, “good”, “attention”, “abnormal” and “dangerous” respectively and the degrees are 0.065, 0.632, 0.279, 0.024, 0. According to the principle of maximum membership, it can be judged that the turbine is in “good” status. The evaluation result is consistent with the actual operation of the unit, indicating that the evaluation method studied in this paper has a certain practicability and can provide scientific guidance for the health evaluation of the hydroelectric generating unit.

Ball bearings are essential components of electromechanical systems, and their failures significantly affect the service lifetime of these systems. For highly reliable and safety-critical electromechanical systems in energy and aerospace sectors, early bearing fault detection and quantification are crucial. The vibration measurements of bearing fatigue faults, i.e., spalls, are typically induced by multiple excitation mechanisms depending on the fault size and the operating conditions. This data article contains vibration datasets for faulty ball bearings, including the common vibration excitation mechanisms for various fault sizes and operating conditions. These faults are artificially seeded on bearing races by a precise machining process to emulate realistic fatigue faults. This data article is beneficial for better understanding the vibration signal characteristics under different fault sizes and for validating condition monitoring methods for various industrial and aerospace applications.

Elucidating exposure risks associated with the most widely used agrochemicals and their metabolites in celery agrosystems are vital for food safety and human health. The occurrence, distribution, dissipation and metabolism of imidacloprid (IMI), acetamiprid (ACE), thiamethoxam (THM) and difenoconazole (DIF) in celery tissues reflected by initial depositions, uptake characteristics, half-lives, concentration variations. DIF exhibited unacceptable ecological risk to soil organisms under multi-risk evaluation models, including toxicity exposure ratio, risk quotient, and BITSSD model. The joint dietary risks of target pesticides were 37.273-647.454% and 0.400-2522.016% based on deterministic and probabilistic models, with non-carcinogenic risks of 30.207-85.522% and 1.229-2524.662%, respectively. Children aged 1-6 years suffered the highest exposure, with the leaves posing higher risk than other tissues. Long-term exposure risks should be continuously assessed for ecological sustainability and human health, given the widespread usage and cumulative effects of target pesticides, especially for rural children., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Abstract Objective: To examine general practitioners’ views about how health assessments for older people should be conducted. Methods: General practitioners were randomly sampled from a national database of medical practitioners and invited to complete a survey. Survey items explored general practitioners’ views about essential components of a 75+ Health Assessment and who should assess each component, consultation time, use of standardised templates and tools, and home visits. Results: Overall, 185 (19.2%) general practitioners participated. Of 61 items presented, 24 were rated ‘essential’ by ≥70% of practitioners, with an average estimated consultation time of 65 minutes. Of the 24 essential items, it was perceived that 21 could be assessed by either a general practitioner or clinic nurse. Most practitioners indicated a standardised template (86%) and standardised tools for complex issues (79%) should be used, and home visits conducted (75%). Conclusions: General practitioners agreed on 24 items as essential for every health assessment, with assessments estimated to take more than one hour. Implications for public health: Increases to remuneration for prolonged assessments or mechanisms for improving efficiency and quality of assessments are needed. Acceptable mechanisms may include standardised patient‐reported tools, standardised templates and the use of non‐medical staff to assist with assessments.

Performance assessment can play an effective role in providing quality services in healthcare organizations. To develop and compete, hospitals need a performance evaluation system to measure the effectiveness and efficiency of their programs, processes, and workforce. However, hospital data are often uncertain, imprecise, or unknown. In this paper, a fuzzy stochastic data envelopment analysis (DEA) method based on the slacks-based measure of efficiency (SBM) is presented and employed to evaluate the performance of 11 hospitals in an urban setting. Due to the multiplicity of the initially identified criteria, an integrated algorithm based on Decision-Making Trial and Evaluation Laboratory (DEMATEL) and Analytic Network Process (ANP) is used to determine the main and effective criteria. The result of the algorithm shows that the criterion “total inpatient visits” is the most important criterion in this evaluation. Finally, the proposed model is implemented based on different levels of significance, and the performance of each unit is determined in uncertain conditions.

Background & Aims: Malnutrition often remains undetected in older persons, leading to increased health problems and comorbidity, prolonged hospital stays and readmissions. In 2020, data from the interRAI Home Care (interRAI HC) instrument was used to determine malnutrition status according to some of the criteria of the Global Leadership Initiative on Malnutrition (GLIM). The interRAI HC instrument showed to be effective as a screening tool for the risk of malnutrition. The goal of the present study is to use the interRAI Long Term Care Facilities (interRAI LTCF) instrument for nursing home residents to identify factors related to older people's health that are significantly associated with the development of malnutrition., Methods: This study analyzes data collected in the period 2019-2023 from nursing home residents, 65 or older, with a follow-up period of 1 year. After applying the GLIM criteria to the available interRAI LTCF data, a cross-sectional sample a longitudinal sample were analyzed by means of bivariate analysis. Factors included in the bivariate analysis were based in previous studies and expert opinion. Unadjusted and adjusted regression models were built to explore associations between several potential risk factors and nutritional status., Results: The sample consisted of 5598 older people with a mean age of 83.98 ± 7.30 years old and 71.2 % being female. Most people needed extensive assistance with activities of daily living (70.9%) and had at least a mild cognitive impairment (63.9%). According to the GLIM definition using the interRAI items, 8.43% of the residents were malnourished and 4.67% of the residents became malnourished over the period of 1 year. The final adjusted logistic regression yielded significant odds ratios for seven determinants: age (O.R. 1.03; C.I.: 1.01; 1.04), depressive symptoms (O.R.: 1.32; 1.01; 1.73), assistance needed for walking (O.R. 1.49; C.I.: 1.13; 1.95), wandering behavior (O.R. 1.16; C.I.: 1.01; 1.33), falls (O.R. 1.17; C.I.: 1.02; 1.35), visual impairment (O.R. 1.22; C.I.: 1.05; 1.42) and diabetes (protective factor - O.R.: 0.67; C.I.: 0.46; 0.98)., Conclusions: The study showed the main risk factor for malnourishment in nursing home residents, such as age, depressions, assistance for walking, wandering and visual impairment. These significant factors can be used to identify people at risk of malnourishment. Periodically screening residents with the interRAI LTCF can help identify malnourished residents or residents at risk of malnourishment., Competing Interests: Conflict of interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

In order to facilitate watershed management, we developed an expansive river health assessment method based on a fuzzy matter-element extension model in this study that developed based on the transitive hierarchies and degree of membership from improved fuzzy optimization theory. Eight characteristics of river flow, namely, the morphology, flow, water quality, river habitat, aquatic organisms, riparian zone, flood control safety, and level of the water supply, were investigated in this study to establish a system of indices to assess river health. We apply the above method to a river health assessment in the Luanhe River as sub-healthy. The results show that the method is accurate for the river health assessment compared with the actual conditions in Luanhe river. Moreover, the river health assessment method described in this study covers the different health states of river ecosystems, including the natural function and the social service function of a river. It is a reasonable river health assessment method that can evaluate river health status systematically, comprehensively and accurately. Therefore, this method is reasonable and effective and can be used to assess the ecological health of rivers in other regions.

Rugao city is a typical longevity area taking shallow groundwater as the primary drinking water source. To determine the relationship between longevity and groundwater conditions, the hydrogeochemical characteristics and related causes of potable groundwater were investigated. On this basis, the water quality index (WQI) and hazard index (HI) of groundwater were evaluated. Meanwhile, the nutrient indicators beneficial to human health, like Ca and Mg concentrations, were also considered to explore the relationship. The results were as following: (1) 91.3% of water samples fell under the Ca/Mg–HCO3 water type, which resulted from the dissolution of silicate rock. Na, Cl-, Br, B in groundwater emanated from seawater intrusion. The abnormal concentrations of NO3− and As also indicated that anthropogenic activities had exerted significant influences on groundwater quality. (2) The average WQI value was 30.19, which meant that the overall groundwater quality in Rugao city was pretty good. However, 8 water samples were found to have HI values above 1, which might be attributed to the high concentration of As (maximum value 0.0407 mg/L; mean value 0.0076 mg/L). In general, low WQI and HI values corresponded to towns with a high longevity population; what’s more, WQI and HI values of Rugao city were lower than those of non-longevity areas. (3) Comparing with adjacent non-longevity areas, the potable groundwater in Rugao city had the characteristics of high Ca (mean value 123.57 mg/L), high Mg (mean value 50.33 mg/L) and high SO42- (mean value 525.19 mg/L). The daily intake of Ca and Mg from drinking water could meet 12.4% and 22.4% of daily Ca and Mg requirements, respectively. Also, the areas where the Sr and B concentrations were higher usually had higher life expectancy. The high concentrations of Ca, Mg, SO42-, Sr and B in drinking water, as well as low WQI and HI values, probably contribute to physical health and longevity. This research helps provide an insight into the relationship between groundwater quality and health and can serve as a reference for drinking water quality management.

Background: Refugees have increased health risks due to factors related to their country of origin, the migration itself and the receiving country. Based on systematic general health assessments of newly arrived refugees, we aimed to study the characteristics with regard to background, migration and health needs. Methods: All refugees (children/adolescents and adults) arriving in Aarhus, Denmark from 1 January 2014 to 1 November 2018 were offered a general health assessment by a doctor including: medical history, a physical examination and blood samples. Results: A cohort of 1431 (of 1618 invited, (88.4%) participants accepted the health assessment. The most commonly found health conditions in children were vitamin D deficiency (28.3%), elevated serum-IgE (34%) and lack of immunity against vaccine-preventable diseases (measles 20.1%, polio 3.9%). In adults, vitamin D deficiency (34.6%), IgE elevation (30%), latent tuberculosis (20.3%) and symptoms of PTSD (15.9%) were most prevalent. We found participants from Southern Asia (Iran, Afghanistan and Pakistan) to be overrepresented with regard to vitamin D deficiency, vitamin B12 deficiency and symptoms of PTSD. Furthermore, we found that origin in Africa was associated with latent tuberculosis. In total, 63.8% of examined refugees had one or more health problems requiring further testing, treatment or follow-up. Conclusions: A comprehensive health assessment among recently arrived refugees showed multiple health issues to address, and demonstrates the need of systematic health assessments for resettling refugees.

Background: There are several standards that offer explicit guidance on good practice in systematic reviews (SRs) for the medical sciences; however, no similarly comprehensive set of recommendations has been published for SRs that focus on human health risks posed by exposure to environmental challenges, chemical or otherwise. Objectives: To develop an expert, cross-sector consensus view on a key set of recommended practices for the planning and conduct of SRs in the environmental health sciences. Methods: A draft set of recommendations was derived from two existing standards for SRs in biomedicine and developed in a consensus process, which engaged international participation from government, industry, non-government organisations, and academia. The consensus process consisted of a workshop, follow-up webinars, email discussion and bilateral phone calls. Results: The Conduct of Systematic Reviews in Toxicology and Environmental Health Research (COSTER) recommendations cover 70 SR practices across eight performance domains. Detailed explanations for specific recommendations are made for those identified by the authors as either being novel to SR in general, specific to the environmental health SR context, or potentially controversial to environmental health SR stakeholders. Discussion: COSTER provides a set of recommendations that should facilitate the production of credible, high-value SRs of environmental health evidence, and advance discussion of a number of controversial aspects of conduct of EH SRs. Key recommendations include the management of conflicts of interest, handling of grey literature, and protocol registration and publication. A process for advancing from COSTER’s recommendations to developing a formal standard for EH SRs is also indicated.

Virus surveillance in wildlife is important to understanding ecosystem health, taxonomy, and evolution. Nevertheless, viruses in reptiles, and specifically in squamates, continue to be understudied. Herein, we conducted a health assessment on the critically endangered Galapagos pink land iguana (Conolophus marthae) and the vulnerable Galapagos land iguana (Conolophus subcristatus). We collected oral and/or cloacal swabs from 47 clinically healthy iguanas and tested for adenovirus (cloacal swabs, n = 47) and herpesvirus (oral swabs, n = 45) using broad-spectrum PCRs. Two out of 38 (5.3 %) Galapagos pink land iguanas tested positive for herpesvirus, while no herpesvirus was detected in all Galapagos land iguanas (n = 7). Both herpesviral sequences were identical between them and divergent (61.9 % amino acid identity) when compared to the closest herpesvirus sequences available in GenBank/EMBL/DDBJ. The genetic distance between this and other herpesviruses is consistent with its classification as a novel virus species. All iguanas were negative for adenovirus. This is the first description of a herpesvirus in iguanas of the Galapagos islands, and the first report of a potential pathogen for the iconic Galapagos pink land iguana. Further research is needed to understand the implications of this virus in the conservation and management of one of the most endangered iguana species in the world., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

In this study, eight potential toxic elements (PTEs) and stable isotope ratios (δ 13 C and δ 15 N) were analyzed in three dominant fish species of the Beibu Gulf, namely Saurida tumbil, Pennahia macrocephalus and Upeneus sulphureus. The mean contents (mg/kg, dry weight) of As, Cd, Cr, Cu, Mn, Ni, Pb and Zn in the three species of fish were 10.94, 0.11, 0.55, 2.00, 5.80, 0.47, 0.39, 41.70, respectively. Cr, Mn and Pb showed potential biomagnification effects in fish bodies while Cu and Zn were biodiluted through the food chain. The results of the health risk assessment showed that the total hazard quotient (THQ) ranged from 0.11 to 0.32 and 1.34 to 1.70 and the total carcinogenic risk (TCR) ranged from 5.44 × 10 -4 to 1.35 × 10 -3 and 6.35 × 10 -3 to 1.57 × 10 -2 for adults and children, respectively. These results suggest that consumption of the three fish species by adults lead to carcinogenic health risks and consumption of the three fish species by children would result in significant adverse health effects., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Peer physical examination is a clinical teaching-learning approach used for decades because of the convenient sample of peers for practicing. However, this approach has limitations when learning to assess abnormalities and threatens psychologically safe learning. A wearable simulator system was designed for learning physical examination skills to minimize ethical and learning challenges., Sample: The sample consisted of fifty prelicensure nursing students and ten faculty in an upper Midwest university., Method: The wearable simulator was constructed into a vest with RFID tags and ribcage landmarks. An observational, evaluative design was used for participants to rate seven categories during a one-hour evaluation session of the wearable simulator worn by a standardized patient trained to portray an individual with pneumonia., Results: Satisfaction was rated highly among participants. More than 80% of student participants indicated the wearable simulator promotes privacy and reduces embarrassment., Conclusion: The wearable simulator system offers a promising teaching-learning alternative with scenario-specific auscultation and palpation feedback to provide a safe, repeatable, and consistent simulation experience.

Sea turtles are considered as bio-indicators for monitoring the efficiency of restoration measures to reduce marine litter impacts on health. However, the lack of extended and standardised empirical data has prevented the accurate analysis of the factors influencing litter ingestion and the relationships with individual health. Historic data collected from 1988 and standard data collected from 2016 were harmonised to enable such analyses on necropsied loggerhead turtles (Caretta caretta) in eight Mediterranean and North-East Atlantic countries. Litter was found in 69.24 % of the 1121 individuals, mostly single-use and fishing-related plastics. Spatial location, sex and life history stage explained a minor part of litter ingestion. While no relationships with health could be detected, indicating that all individuals can be integrated as bio-indicators, the mechanistic models published in literature suggest that the high proportion of plastics in the digestive contents (38.77 % per individual) could have long-term repercussions on population dynamics., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier Ltd.)

Objectives: To evaluate the efficacy and safety of anti-interleukin-5 class therapy agents in the treatment of eosinophilic asthma and the financial impact of these drugs on the Brazilian and Mato Grosso public health systems., Methods: The literature review in important databases was guided by a structured research question including patient or population, intervention, comparator, outcome and type of study. The retrieved studies went through a screening, selection, data extraction, and methodological quality assessment process. A model with two scenarios, one with mepolizumab and the other with benralizumab, was created for budget impact analysis., Results: Evidence indicated that anti-interleukins-5 have an acceptable safety profile and can reduce exacerbation rates by up to 50% in the population with eosinophilic asthma; however, they showed no significant difference in quality of life. The adoption of these drugs in the Brazilian health system can impact the budget from R$ 40,379,731.50 to R$ 140,301,211.34 depending on the drug incorporated, considering a time horizon of 5 years. From the perspective of the state of Mato Grosso, the budget impact may reach, in the fifth year, an amount of R$ 1,301,210.58 and R$ 2,050.687.62 for the scenarios with mepolizumab and benralizumab, respectively., Conclusion: Anti-interleukins-5 are promising treatments for eosinophilic asthma because they minimise exacerbations and are well tolerated and safe. The financial impact is large, implying that technology costs may be a barrier to accessing this treatment class., (Copyright © 2021 ISPOR--The professional society for health economics and outcomes research. Published by Elsevier Inc. All rights reserved.)