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Anthropogenic chemical pollution has the potential to pose one of the largest environmental threats to humanity, but global understanding of the issue remains fragmented. This article presents a comprehensive perspective of the threat of chemical pollution to humanity, emphasising male fertility, cognitive health and food security. There are serious gaps in our understanding of the scale of the threat and the risks posed by the dispersal, mixture and recombination of chemicals in the wider environment. Although some pollution control measures exist they are often not being adopted at the rate needed to avoid chronic and acute effects on human health now and in coming decades. There is an urgent need for enhanced global awareness and scientific scrutiny of the overall scale of risk posed by chemical usage, dispersal and disposal. Refereed/Peer-reviewed

Objectives This study hypothesized that left ventricular (LV) ejection fraction (EF) and global longitudinal strain (GLS) derived from 3-dimensional echocardiographic (3DE) images would better predict mortality than those obtained by 2-dimensional echocardiographic (2DE) measurements, and that 3DE-based LV shape analysis may have added prognostic value. Background Previous studies have shown that both LVEF and GLS derived from 2DE images predict mortality. Recently, 3DE measurements of these parameters were found to be more accurate and reproducible because of independence of imaging plane and geometric assumptions. Also, 3DE analysis offers an opportunity to accurately quantify LV shape. Methods We retrospectively studied 416 inpatients (60 ± 18 years of age) referred for transthoracic echocardiography between 2006 and 2010, in whom good-quality 2DE and 3DE images were available. Mortality data through 2016 were collected. Both 2DE and 3DE images were analyzed to measure LVEF and GLS. Additionally, 3DE-derived LV endocardial surface information was analyzed to obtain global shape indices (sphericity and conicity) and regional curvature (anterior, septal, inferior, lateral walls). Cardiovascular (CV) mortality risks related to these indices were determined using Cox regression. Results Of the 416 patients, 208 (50%) died, including 114 (27%) CV-related deaths over a mean follow-up period of 5 ± 3 years. Cox regression revealed that age and body surface area, all 4 LV function indices (2D EF, 3D EF, 2D GLS, 3D GLS), and regional shape indices (septal and inferior wall curvatures) were independently associated with increased risk of CV mortality. GLS was the strongest prognosticator of CV mortality, superior to EF for both 2DE and 3DE analyses, and 2D EF was the weakest among the 4 functional indices. A 1% decrease in GLS magnitude was associated with an 11.3% increase in CV mortality risk. Conclusions GLS predicts mortality better than EF by both 3DE and 2DE analysis, whereas 3D EF is a better predictor than 2D EF. Also, LV shape indices provide additional risk assessment.

This White Paper presents the foundational domains with examples of key aspects of competencies (knowledge, skills, and attitudes) that are intended for curriculum development and accreditation quality assessment for graduate (master’s level) education in applied health informatics. Through a deliberative process, the AMIA Accreditation Committee refined the work of a task force of the Health Informatics Accreditation Council, establishing 10 foundational domains with accompanying example statements of knowledge, skills, and attitudes that are components of competencies by which graduates from applied health informatics programs can be assessed for competence at the time of graduation. The AMIA Accreditation Committee developed the domains for application across all the subdisciplines represented by AMIA, ranging from translational bioinformatics to clinical and public health informatics, spanning the spectrum from molecular to population levels of health and biomedicine. This document will be periodically updated, as part of the responsibility of the AMIA Accreditation Committee, through continued study, education, and surveys of market trends.

Obstructive sleep apnea (OSA) is the most commonly seen clinical sleep disorder. STOP-Bang, a widely used screening tool, yields a composite score based on eight dichotomized items including male gender. This study was designed to validate STOP-Bang among clinically referred patients and tested alternative scoring designs on tool performance, with a focus on gender differences in OSA. STOP-Bang was administered to 403 female and 532 male subjects, followed by comprehensive sleep evaluation that included measurement of apnea-hypopnea indexes. Gender differences in STOP-Bang scores, OSA diagnosis, and severities were explored, and gender-specific alternative score cutoffs evaluated. Optimal operating points (OOP) were tested for female body mass index (BMI) and male neck circumference to inform STOP-Bang threshold refinement. Receiver operating characteristic curves were used to compare conventional and modified STOP-Bang. STOP-Bang performance by gender showed extremely low specificity in males at the recommended cutoff of ≥3. Better utility was presented at a cutoff of 4 or 5 among clinically referred patients irrespective of gender differences. Screening performance was improved by modifying BMI and/or neck circumference thresholds using gender-triaged OOP estimation. Three gender-based model revisions outperformed conventional STOP-Bang. Our study suggests that gender-specific consideration needs to be incorporated into the application of STOP-Bang in a clinically referred patient population with a higher risk of OSA. Alternative scoring systems may improve predictive performance of STOP-Bang.

Locoregional therapy with curative intent (CLRT) followed by salvage liver transplantation (SLT) in case of hepatocellular carcinoma (HCC) recurrence is an alternative to primary liver transplantation (LT) in selected patients with HCC.We performed a systematic review and meta-analysis of studies comparing the survival of patients treated with CLRT versus LT, stratified by the stage of liver disease, extent of cancer, and whether SLT was offered or not.We included 48 studies involving 9835 patients (5736 patients with CLRT and 4119 patients with primary LT). Five-year overall survival (OS) and disease-free survival (DFS) was worse for all categories of CLRT combined, than for primary LT (odds ratio [OR] for OS, 0.59; 95% confidence interval [CI], 0.48-0.71; P0.01). However, 5-year OS for CLRT and primary LT was not significantly different among patients with (i) Child-A cirrhosis and (ii) single HCC lesion, although DFS was worse. When SLT was offered after CLRT, intention-to-treat analysis showed no significant difference in 5-year OS (OR, 1.0; 95% CI, 0.6-1.7) between CLRT-SLT and primary LT, though noninferiority could not be shown. Only 32.5% patients with HCC recurrence after CLRT actually received SLT, as the rest were not medically eligible. Thus, the DFS was worse with CLRT-SLT (OR, 0.31; 95% CI, 0.2-0.6) compared with LT.CLRT-SLT may be offered as first-line therapy to patients with HCC and well-compensated cirrhosis instead of primary LT because it may lead to better utilization of donor liver. However, a large proportion of patients with HCC recurrence after CLRT may not be candidates for SLT.

The Niger Delta has a long history of oil and gas exploration and production, but this has come with a heavy environmental cost arising from oil spills and other pollution events. Two oil spills in Ogoniland in 2008/9 were by far the largest in terms of both duration (149 days combined) and magnitude (82,939,170 l combined), but little is understood about the extent of impact of these events because traditional field-based surveys are virtually impossible in this region. In this study, the normalised difference vegetation index, a technique used for measuring plant health, was applied to multi-temporal satellite images to delineate an extensive area of 393 km2 that has experienced vegetation mortality resulting from the oil pollution. These effects persist to present and are exacerbated by continuing subsequent spill events. Independently collected field samples confirmed the high concentrations of hydrocarbon pollutants in the impact area. The extensive tidal river network and mangrove swamps have facilitated the spread of oil, with the delta becoming a sink for the oil that is dispersed but not removed. Over 1 million people live within the area contaminated by oil and have potentially been exposed to pollution through direct and indirect pathways over a prolonged period. The population in the impact area is particularly vulnerable to chronic illness due to its young age structure and pre-existing very low life expectancy. Hence, there is an urgent need to mitigate the impacts of the pollution on environmental and human health. The novelty of this work is that satellite remote sensing allows the impacts of pollution to be monitored across large areas in a geographically remote and challenging environment. The outputs from this study could be used to guide the future spatial targeting of the limited remediation resources that are available, to achieve positive outcomes. © 2021 Elsevier B.V.

© 2016 Elsevier Inc. Acute lung injury (ALI) is the clinical syndrome associated with histopathologic diffuse alveolar damage. It is a common cause of acute respiratory symptoms and admission to the intensive care unit. Diagnosis of ALI is typically based on clinical and radiographic criteria; however, because these criteria can be nonspecific, diagnostic uncertainty is common. A multidisciplinary approach that synthesizes clinical, imaging, and pathologic data can ensure an accurate diagnosis. Radiologists must be aware of the radiographic and computed tomographic findings of ALI and its mimics. This article discusses the multidisciplinary diagnosis of ALI from the perspective of the imager.

One of the biggest challenges faced by Sierra Leonean farmers is pest control. Birds, rodents, insects, crustaceans and other organisms can drastically reduce yields. In order to prevent these organisms from destroying their crop, farmers use pesticides. However there are reports that these chemicals are being misused and such misuse is having a negative impact on the environment and the health of the farmers.This research study aimed to investigate the use of pesticides in rice fields and its potential effects on the environment and on the farmers of Sierra Leone. Five hundred farmers and one hundred health workers across the country were interviewed. Fifty focus group discussions were also completed. Field observations were also undertaken to see how farmers apply pesticides to their farms and the possible threats these methods have on human health and the environment. It is clear that a wide range of pesticides are used by rice farmers in Sierra Leone with 60% of the pesticides used entering the country illegally. Most farmers have no knowledge about the safe handling of pesticides as 71% of them have never received any form of training. The pesticides kill both target and non-target organisms some of which enter the food chain.Cases of health problems such as nausea, respiratory disorders and blurred vision investigated in this research are significantly higher among farmers who use pesticides than those who do not use pesticides. Cases of pesticide intoxication are not investigated by health workers but results obtained from interviews with them also indicated that cases of pesticides related symptoms are significantly higher in environments where pesticides are used than those in which pesticides are not used. Keywords: Pesticides, Environment, Health

Serial assessments of left ventricular ejection fraction (LVEF) are customary in patients with breast cancer receiving trastuzumab. Radionuclide angiography (RNA) is often used; however, a typical monitoring schedule could include 5 scans in a year. We evaluated the proportion of imaging-related ionizing radiation attributable to RNA in 115 patients with breast cancer, from 3 medical centers in the United States, Ireland, and Japan, who completed 12 months of trastuzumab treatment. Estimated radiation dose (ERD) was used to calculate exposure associated with imaging procedures spanning the 18 months before and after trastuzumab therapy. In addition, 20 cardiologists and oncologists from participating centers were surveyed for their opinions regarding the contribution of RNA to overall radiation exposure during trastuzumab treatment. When RNA was used to monitor LVEF, the mean ERD from imaging was substantial (34 ± 24.3 mSv), with the majority attributable solely to RNA (24.7 ± 14.8 mSv, 72.6%). Actual ERD associated with RNA in this population differed significantly from the perception in surveyed cardiologists and oncologists; 70% of respondents believed that RNA typically accounted for 0% to 20% of overall radiation exposure from imaging; RNA actually accounted for more than 70% of ERD. In conclusion, RNA was used to monitor LVEF in most patients in this cohort during and after trastuzumab therapy. This significantly increased ERD and accounted for a greater proportion of radiation than that perceived by surveyed physicians. ERD should be taken into account when choosing a method of LVEF surveillance. Alternative techniques that do not use radiation should be strongly considered.

Executive Summary: 1) We recommend that ultrasound should be used to guide thoracentesis to reduce the risk of complications, the most common being pneumothorax. 2) We recommend that ultrasound guidance should be used to increase the success rate of thoracentesis. 3) We recommend that ultrasound-guided thoracentesis should be performed or closely supervised by experienced operators. 4) We suggest that ultrasound guidance be used to reduce the risk of complications from thoracentesis in mechanically ventilated patients. 5) We recommend that ultrasound should be used to identify the chest wall, pleura, diaphragm, lung, and subdiaphragmatic organs throughout the respiratory cycle before selecting a needle insertion site. 6) We recommend that ultrasound should be used to detect the presence or absence of an effusion and approximate the volume of pleural fluid to guide clinical decision-making. 7) We recommend that ultrasound should be used to detect complex sonographic features, such as septations, to guide clinical decision-making regarding the timing and method of pleural drainage. 8) We suggest that ultrasound be used to measure the depth from the skin surface to the parietal pleura to help select an appropriate length needle and determine the maximum needle insertion depth. 9) We suggest that ultrasound be used to evaluate normal lung sliding pre- and postprocedure to rule out pneumothorax. 10) We suggest avoiding delay or interval change in patient position from the time of marking the needle insertion site to performing the thoracentesis. 11) We recommend against performing routine postprocedure chest radiographs in patients who have undergone thoracentesis successfully with ultrasound guidance and are asymptomatic with normal lung sliding postprocedure. 12) We recommend that novices who use ultrasound guidance for thoracentesis should receive focused training in lung and pleural ultrasonography and hands-on practice in procedural technique. 13) We suggest that novices undergo simulation-based training prior to performing ultrasound-guided thoracentesis on patients. 14) Learning curves for novices to become competent in lung ultrasound and ultrasound-guided thoracentesis are not completely understood, and we recommend that training should be tailored to the skill acquisition of the learner and the resources of the institution.

Focused cardiac ultrasonography (FCU) is the use of ultrasonography as an adjunct to physical examination at the point of care. There are ample data supporting the fact that noncardiology trained users using small ultrasonography devices can assess left ventricular (LV) enlargement, LV systolic dysfunction, right ventricular (RV) enlargement, left atrial (LA) enlargement, LV hypertrophy, pericardial effusion, and right atrial (RA) pressure elevation more accurately than performing a physical examination. In addition, FCU-trained providers may have skills to perform ultrasonography imaging of body systems outside the heart to supplement their cardiac evaluation. FCU training, including didactic education, proctored imaging, independent imaging, and image interpretation, has been established by several specialties and medical schools. Cardiologists should embrace FCU in their facilities, as the clinical value to patient care is clear. Cardiologists have the responsibility to maintain excellence in the practice of echocardiography while enabling the use of ultrasonography by other medical professionals to augment their clinical assessments conventionally based on physical examination alone.

Echocardiogram report is an important tool to describe and communicate findings noted in an Echocardiography exam. The report completeness, i.e., whether significant changes from prior studies were compared, is a key indicator to measure the quality of an Echocardiography lab. We proposed an NLP-based method to extract key findings that were compared with prior studies, which will be used to evaluate report completeness. The precision, recall, and f-score in detecting key findings are all above 96%.

Structured echocardiogram reporting system uses predefined finding codes (FCs) that correspond to one-sentence descriptions to report medical findings. Exploring the latent relationships between FCs will facilitate the efficiency and accuracy in reporting by developing strategies such as automatically correlating clinical findings or detecting mutual exclusive findings. In this work, we propose an unsupervised learning model to explore the rich latent relationships between FCs and to learn representations for FCs utilizing narratives of findings. Experimental results on a data set containing structured reports collected from a real clinical institute show the effectiveness of our method.

Aims The aim of this study was to determine the mechanism of tricuspid regurgitation (TR) progression in pulmonary arterial hypertension (PAH) and its effect on survival. Methods and results We studied 88 patients with PAH and functional TR (mean pulmonary artery pressure 49 ± 14 mmHg; 43% idiopathic PAH) who had serial echocardiograms. TR progression ( n = 35) was defined as ≤mild TR on Echo 1 and ≥moderate TR on Echo 2. TR regression ( n = 17) was defined as ≥moderate TR on Echo 1 and ≤mild TR on Echo 2. Stable TR ( n = 36) was defined as ≤mild TR on both echoes. TR progression was associated with an increase in pulmonary artery systolic pressure (PASP, 62 ± 22–92 ± 23 mmHg, P < 0.0001), right ventricular (RV) enlargement, mainly at mid-ventricular level, increased RV sphericity (6.1 ± 1.7–6.9 ± 1.8, P = 0.004), tricuspid annular (TA) dilatation (4.0 ± 0.7–4.6 ± 0.7 cm, P < 0.0001), and increased tricuspid valve (TV) tenting area (2.0 ± 0.7–2.5 ± 1.0 cm 2 , P = 0.0003). TR regression was associated with a reduction in PASP (84 ± 15–55 ± 18 mmHg, P < 0.0001), reverse RV remodelling with a reduction in RV sphericity (6.3 ± 1.4–5.5 ± 1.0, P = 0.02), and a reduction in TA size (4.1 ± 0.7–3.6 ± 0.7 cm, P = 0.02) and TV tenting (2.1 ± 0.7–1.3 ± 0.5 cm 2 , P = 0.0002). TR progression was associated with all-cause mortality (log-rank P = 0.0007). Conclusion In PAH, TR progression was associated with worsening pulmonary hypertension and adverse RV and TV apparatus remodelling. TR progression is associated with poor outcome in PAH.

Background Context Eosinophilic granulomas (EGs) of the sacrum have been reported in fewer than 10 patients. Treatment algorithms for these tumors remain poorly defined; there are no reports of treating solitary sacral EG with radiation therapy (RT). Purpose This study aimed to describe the presentation, treatment, and outcome of sacral EG in an adult patient with intractable pain and radiculopathy, treated in a novel fashion with RT. Study Design/Setting The study design was a case report from a tertiary cancer referral center. Methods Patient records, imaging, and pathology were reviewed. Results A 35-year-old man received 20 Gy of radiation to his S1 EG lesion. He subsequently developed vertebra plana of S1 causing symptomatic L5–S1 stenosis, but 15 months after RT treatment was free of pain or tumor recurrence. Conclusion Radiation therapy is an effective treatment option for sacral EG causing severe axial pain and neural impingement.

The process of high solid anaerobic digestions (HSAD) was developed to reduce water usage, increase organic loading rate (OLR), reduce nutrient loss in digestate and avoid or decrease the dewatering of digestate. However, the operation of HSAD is currently constrained by low rates and extents of methane production high operational costs. Several published investigations have been conducted to study the effects of inhibition, temperature, moisture, and reactor design on the efficiency of HSAD. However, low moisture and poor mixing, which are required for the dilution and diffusion of metabolites, have been reported to be the major causes of low methane yield in HSAD. In order to optimize the operation of HSAD, technological integration has to be considered, especially thermo–mesophilic digestion, co-digestion, mixing and integration of two or more reactors. This paper provides a critical review of recent research on HSAD while focusing on how these studies can be integrated to improve HSAD.

As the global population is expected to reach 9 billion by 2050, humanity needs to balance an ever increasing demand for food, energy and natural resources, with sustainable management of ecosystems and the vital services that they provide. The intensification of agriculture, including the use of fertilisers from finite sources, has resulted in extensive soil degradation, which has increased food production costs and CO2 emissions, threatening food security. The Bioenergy sector has significant potential to contribute to the formation of a circular economy. This paper presents the scientific, regulatory and socioeconomic barriers to the use of the nutrient waste streams from biomass thermal conversion (ash) and anaerobic digestion (digestate) as sustainable soil amendments for use in place of traditional fertilisers. It is argued that whilst the ability of combined ash and digestate to remedy many threats to ecosystems and provide a market to incentivise the renewable bio-energy schemes is promising, a step-change is required to alter perceptions of ‘waste’, from an expensive problem, to a product with environmental and economic value. This can only be achieved by well-informed interactions between scientists, regulators and end users, to improve the spread and speed of innovation with this sector. Keywords: Digestate, Biomass ash, Soil conditioner, Environmental impact, Ecosystems, Regulation

10 páginas.-- 3 figuras.-- 70 referencias.-- Ortega Calvo, J. J. et al.., The bioavailability of organic chemicals in soil and sediment is an important area of scientific investigation for environmental scientists, although this area of study remains only partially recognized by regulators and industries working in the environmental sector. Regulators have recently started to consider bioavailability within retrospective risk assessment frameworks for organic chemicals; by doing so, realistic decision-making with regard to polluted environments can be achieved, rather than relying on the traditional approach of using total-extractable concentrations. However, implementation remains difficult because scientific developments on bioavailability are not always translated into ready-to-use approaches for regulators. Similarly, bioavailability remains largely unexplored within prospective regulatory frameworks that address the approval and regulation of organic chemicals. This article discusses bioavailability concepts and methods, as well as possible pathways for the implementation of bioavailability into risk assessment and regulation; in addition, this article offers a simple, pragmatic and justifiable approach for use within retrospective and prospective risk assessment., All authors participated at the SETAC Europe SESSS10 symposium on bioavailability (http://sesss10.setac.eu/). They utilized of the presentations and the discussions at the symposium to write this paper. During the preparation of the symposium and this manuscript, J.-J.O.-C. was supported by the Spanish Ministry of Science and Innovation (CGL2013-44554-R). The support given by ECETOC for open access publication of this article is gratefully acknowledged.

Background A multidisciplinary team at a major academic medical center established an Acutely Decompensated Heart Failure Clinical Pathway (ADHFCP) program to reduce inpatient readmission rates among patients with heart failure which, among several interventions, included an immediate consultation from a cardiologist familiar with an ADHFCP patient when the patient presented at the Emergency Department (ED). This study analyzed how that program impacted utilization of services in the ED and its subsequent effect on rates of admission from the ED and on disposition times. Methods ADHFCP inpatient visits were retrospectively risk stratified and matched with non-program inpatient visits to create a control group. A Cox survival model analyzed the ADHFCP's impact on patients' likelihood to visit the ED. Multivariable ANOVA evaluated the impact of the program on the patients' likelihood of being admitted when presenting at the ED. The ADHFCP's impact on bed-to-disposition time in the ED was evaluated by Wilcoxon's rank-sum test, as were doses of diuretics administered in the ED. Results The survival analysis showed no impact of the ADHFCP on patients' likelihood of visiting the ED, but ADHFCP patients presenting to the ED were 13.1 (95% CI: 3.6–22.6) percentage points less likely to be admitted. There was no difference in bed-to-disposition times, but ADHFCP patients received diuretics more frequently and at higher doses. Conclusions Improved communication between cardiologists and ED physicians through the establishment of an explicit pathway to coordinate the care of heart failure patients may decrease that population's likelihood of admission without increasing ED disposition times.

Background Hospitalizations in patients with heart failure (HF) remain high despite advances in treatment. While implantable pulmonary artery pressure monitors (Abbott CardioMEMS) reduce readmissions in largely white and male cohorts, their efficacy in poor, minority populations are not known. We hypothesized that a nurse-driven program using the CardioMEMS device could reduce HF hospitalizations in such patients. Methods 22 high-utilizing patients (86% non-white, 55% female) with NYHA Class III HF were implanted with a CardioMEMS following a hospital admission for HF. Data from the CardioMEMS guided a speciallytrained nurse in adjusting medications. Enrolled patients were matched using 30 clinical and demographic variables with contemporaneous control HF patients who received usual care. Each patient's hospitalizations were recorded for 6 months and compared using Fisher's exact test. Results Patients who received a CardioMEMS experienced a 61% decrease in HF-related readmission and a 70% reduction in HF-related ED visits (p Conclusion A nurse-driven CardioMEMS program reduces HF-related hospitalization and ED visits among high-risk, low-socioeconomic, urban patients.

Objective: To evaluate the impact of body mass index (BMI) on vitamin D status following ergocalciferol therapy. Methods: A retrospective evaluation of patients aged 18 years and older with a baseline serum 25(OH)D < 30 ng/mL who received prescription ergocalciferol 50 000 IU at any dose between July 2009 and November 2011 was conducted. Patients were included if pre- and posttreatment 25(OH)D levels were available within 3 months of therapy. Results: Two hundred and thirteen patients were included in the study with 52% having a BMI ≥30 kg/m2. Thirty-eight different ergocalciferol regimens were prescribed, and the majority of patients (66.2%) received a regimen consisting of 50 000 IU once weekly for variable durations. Mean 25(OH)D levels increased from 18.8 ± 6.6 ng/mL at baseline to 35.0 ± 13.8 ng/mL with 61.0% (n = 130) of patients having attained vitamin D sufficiency, 25(OH)D ≥ 30 ng/mL, with their prescribed ergocalciferol regimen. Obese patients with a BMI ≥30 were less likely to attain vitamin D sufficiency following replacement than patients with a BMI 2 (52% vs 71%; P = .0161). Conclusion: Our study demonstrated an overall moderate response rate to replacement therapy with ergocalciferol and considerable variability in vitamin D replacement strategies initiated by primary care providers. Based on our findings, elevated BMI ≥30 kg/m2 may impact the likelihood of attaining vitamin D sufficiency with ergocalciferol.

A realistic understanding of contaminant sources is required to set appropriate control policy. Forensic chemical methods can be powerful tools in source characterization and identification, but they require a multiple-lines-of-evidence approach. Atmospheric receptor models, such as the US Environmental Protection Agency (USEPA)'s chemical mass balance (CMB), are increasingly being used to evaluate sources of pyrogenic polycyclic aromatic hydrocarbons (PAHs) in sediments. This paper describes the assumptions underlying receptor models and discusses challenges in complying with these assumptions in practice. Given the variability within, and the similarity among, pyrogenic PAH source types, model outputs are sensitive to specific inputs, and parsing among some source types may not be possible. Although still useful for identifying potential sources, the technical specialist applying these methods must describe both the results and their inherent uncertainties in a way that is understandable to nontechnical policy makers. The authors present an example case study concerning an investigation of a class of parking-lot sealers as a significant source of PAHs in urban sediment. Principal component analysis is used to evaluate published CMB model inputs and outputs. Targeted analyses of 2 areas where bans have been implemented are included. The results do not support the claim that parking-lot sealers are a significant source of PAHs in urban sediments. Integr Environ Assess Manag 2014;10:279–285. © 2013 SETAC

With traditional sandstone oil reservoirs coming to the end of their useful lives, there is interest in extracting oil and gas from shale and carbonate rocks. Recovered samples often contain hydrocarbon material, sometimes in a fairly mobile form, sometimes in a tarry form. There is also an interest in studying forms of porous carbon, such as biochar, both for their soil-remedial properties, and for carbon sequestration. Biochars, depending on heat-treatment temperature and duration, also frequently contain residual hydrocarbon matter. There are two techniques that will be discussed: Proton NMR Relaxation (NMRR) and NMR Cryoporometry (NMRC) [10.1016/j.physrep.2008.02.001]. This study applies proton NMR Relaxation to characterise the quantity and mobility of hydrocarbon matter in dried shale and carbonate rock and biochar pores. Curve-fitting is applied to the Free Induction Decays (FIDs) and Carr–Purcell–Meiboom–Gill (CPMG) echo trains to quantify the measurements. This study also applies NMR Cryoporometry, to measure structure: pore-size distribution and pore volumes of the rock, and of the stable carbon skeleton. It has the significant advantage of being usable even when there are liquids and volatile components already in the pores. In porous rocks, combining mobility and structural information will provide a measure of the difficulty of removing the tar/oil from the rock. In biochar, combining the mobility of the labile components with the structural information for the stable biochar skeleton will inform calculations of lifetime of the labile components within the biochar. The NMRC data will also inform estimates of the lifetime of the biochar carbon skeleton.

Peter Alagona, MD[⁎][1] Gerard Aurigemma, MD[‡][2] Javed Butler, MD, MPH[§][3] Don Casey, MD, MPH, MBA[∥][4] Ricardo Cury, MD[#][5] Scott Flamm, MD[¶][6] Tim Gardner, MD[⁎⁎][7] Rajesh Krishnamurthy, MD[††][8] Joseph Messer, MD[⁎][1] Michael W. Rich, MD[‡‡][9] Henry

The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines. ispartof: Journal of the American Society of Echocardiography vol:28 issue:1 pages:1-39 ispartof: location:United States status: published

with the advent of real-time 3-dimensional transesophageal echocardiography (3d tee), rapid creation of high-quality, true-to-life images of mitral valve anatomy and pathology has become possible in the vast majority of patients ([1][1]). In addition to common mitral valve lesions, such as

Background Stress-induced cardiomyopathy (SCM) is characterized by transient apical wall motion abnormalities of the left ventricle (LV) in the absence of obstructive coronary artery disease. Although the echocardiographic findings of SCM mimic those of left anterior descending coronary artery ischemia or infarction (LAD), the regional LV wall motion pattern and degree of RV involvement may differ. Methods We sought to systematically assess regional LV and RV function with myocardial strain imaging to assess if ventricular involvement may differ between SCM and LAD. Results This was a retrospective cohort study, with 3 groups: patients with SCM ( n =55), patients with LAD ( n =36), and 37 normal subjects. All the patients had a comprehensive transthoracic echocardiographic examination, including assessment of longitudinal strain (LS). Global LV longitudinal strain was markedly decreased in both the SCM and LAD groups. However, SCM patients differed by more severe involvement the mid-inferolateral, mid-inferior, apical-lateral, and apical-inferior segments. When compared to the LAD patients, SCM patients had significantly more RV involvement both visually and quantitatively (27–42% versus 0–25%). Predictors of SCM included visually reduced RV systolic function, abnormal TAPSE, RVS′ and RV LS in the apical segment. Of the LV variables, regional LS in the mid-inferior and apical-inferior segments could differentiate the groups. Conclusions Our results suggest that RV involvement and the pattern of LV regional LS abnormalities may help differentiate SCM from LAD disease during echocardiographic imaging.

Publicly available data can potentially examine the relationship between environmental exposure and public health, however, it has not yet been widely applied. Arsenic is of environmental concern, and previous studies mathematically parameterized exposure duration to create a link between duration of exposure and increase in risk. However, since the dose metric emerging from exposure duration is not a linear or explicit variable, it is difficult to address the effects of exposure duration simply by using mathematical functions. To relate cumulative dose metric to public health requires a lifetime physiologically-based pharmacokinetic (PBPK) model, yet this model is not available at a population level. In this study, the data from the U.S. total diet study (TDS, 2006–2011) was employed to assess exposure: daily dietary intakes for total arsenic (tAs) and inorganic arsenic (iAs) were estimated to be 0.15 and 0.028 μg/kg/day, respectively. Meanwhile, using National Health and Nutrition Examination Survey (NHANES, 2011–2012) data, the fraction of urinary As(III) levels (geometric mean: 0.31 μg/L) in tAs (geometric mean: 7.75 μg/L) was firstly reported to be approximately 4%. Together with Bayesian technique, the assessed exposure and urinary As(III) concentration were input to successfully optimize a lifetime population PBPK model. Finally, this optimized PBPK model was used to derive an oral reference dose (Rfd) of 0.8 μg/kg/day for iAs exposure. Our study also suggests the previous approach (by using mathematical functions to account for exposure duration) may result in a conservative Rfd estimation. Keywords: PBPK model, Dose response, Bayesian simulation, Arsenic, Publicly available data

ObjectivesThe objective of this study was to examine the similarities and differences in Caucasian (C) and African-American (AA) patients with bicuspid aortic valve (BAV) with respect to morphology, severity of aortic stenosis/insufficiency, and aortic dilation.BackgroundBAV is a common congenital valve abnormality, accounting for a large number of valve replacements.MethodsA total of 229 patients with the diagnostic code BAV were identified retrospectively from our computerized adult echocardiographic database, which consists of 91,896 studies performed at the University of Chicago Medical Center from 1998 to 2009, representing 40,878 patients. Of those, 183 patients with BAV were included in this retrospective BAV single-center cohort study and reanalyzed with a comprehensive assessment of aortic dimensions, aortic valve morphology and function, clinical cardiovascular risk factors, and patient characteristics.ResultsOf the 183 patients with BAV, 138 were C and 45 were AA. Our echocardiographic database encompasses approximately 65% AA, 31% C, and 4% other races, for an estimated frequency of BAV in AA patients of 0.17% and a frequency in C patients of 1.1% (p = 0.001). There were no significant inter-racial differences regarding sex, height, weight, hyperlipidemia, diabetes, tobacco use, cardiac medications, and left ventricular ejection fraction. The AA cohort was older (age 50 ± 17 years vs. 43 ± 17 years, p < 0.05) and had a higher prevalence of hypertension (51% vs. 24%, p < 0.05). After adjusting for comorbidities, aortic dimensions were larger in C (C vs. AA: annulus, 2.4 ± 0.4 vs. 2.1 ± 0.4 cm; sinuses of Valsalva, 3.4 ± 0.7 vs. 3.1 ± 0.6 cm; sinotubular junction, 3.0 ± 0.6 vs. 2.6 ± 0.5 cm; and ascending aorta, 3.5 ± 0.7 vs. 3.2 ± 0.5 cm; all p values

Resistive plate chambers will be used in the Daya Bay reactor neutrino experiment to help veto backgrounds created by cosmic-ray muons. The mass production of RPCs began in 2008 and by the end of 2009, 1600 RPCs (3500 m2) had been produced and tested. This paper describes the production and quality control procedures, and quality assurance using cosmic-ray testing.

Background Accurate segmental mitral valve (MV) analysis is essential for surgical planning. Although real-time three-dimensional (3D) transesophageal echocardiography has improved the ability to visualize the MV, accurate localization of MV pathology from 3D transesophageal echocardiographic images still remains experience dependent. Three-dimensional parametric maps of the MV obtained from these images further simplify the visualization of MV anatomy. The aims of this study were to examine whether 3D parametric maps of the MV could improve the diagnostic accuracy in localizing pathology and to determine their usefulness for readers with different levels of training. Methods Five novice (American Society of Echocardiography [ASE] level 2), three intermediate-level (ASE level 3; 500 MV cases) readers interpreted MV segmental anatomy in 50 patients (30 with degenerative MV disease, 20 with normal MVs). All readers reviewed two-dimensional and 3D transesophageal echocardiographic and 3D parametric maps at sequential weekly sessions. The results were compared with surgical findings. Results Expert readers were the most accurate irrespective of image type. Novice readers were the least accurate and commonly misinterpreted P2 and P3 scallops. Their accuracy was highest when interpreting 3D parametric maps (from 87% with two-dimensional transesophageal echocardiography to 92%). Intermediate readers' accuracy fell between the other two groups irrespective of image type and showed no change with the use of parametric maps. Conclusions This is the first study to show that the interpretation of 3D parametric maps improves the accuracy of localization of MV pathology by novice readers. Therefore, parametric maps should be used routinely by less experienced readers during the assessment of degenerative MV disease.

Growth is an important indicator of child health; however, measurements are frequently inaccurate and unreliable. This article reviews the literature on linear growth measurement error and describes methods used to develop and evaluate an evidence-based clinical practice guideline on the measurement of recumbent length and stature of infants, children, and adolescents. Systematic methods were used to identify evidence to answer clinical questions about growth measurement. A multidisciplinary team critically appraised and synthesized the evidence to develop clinical practice recommendations using an evidence-based practice rating scheme. The guideline was prospectively evaluated through internal and external reviews and a pilot study to ensure its validity and reliability. Adoption of the clinical practice guideline can improve the accuracy and reliability of growth measurement data.

Despite improvements in treatments for heart failure in the last 30 years, significant barriers exist for underserved populations including access to care, nonadherence to prescribed treatments, and lack of support for self-management. Community health workers (CHW) are specially trained lay-people

The use of ultrasound has developed over the last 50 years into an indispensable first-line test for the cardiac evaluation of symptomatic patients. The technologic miniaturization and improvement in transducer technology, as well as the implementation of educational curriculum changes in residency training programs and specialty practice, have facilitated the integration of focused cardiac ultrasound into practice by specialties such as emergency medicine. In the emergency department, focused cardiac ultrasound has become a fundamental tool to expedite the diagnostic evaluation of the patient at the bedside and to initiate emergent treatment and triage decisions by the emergency physician.

Heart failure is a major source of cardiovascular morbidity, including acute decompensations requiring hospitalization. Because most therapeutic interventions in acute heart failure target optimization of cardiac output and volume status, accurate assessment of these parameters at the point of care is critical to guide management. However, physician bedside assessments of left ventricular (LV) function and volume status have limited accuracy. Traditional echocardiographic platforms, while useful for assessing ventricular and valvular function and volume status, have limitations for bedside use or frequent serial evaluation. Handcarried cardiac ultrasound devices, with their substantially lower costs, portability, and ease of use, circumvent many of the limitations of traditional echocardiographic platforms. The diagnostic capabilities of handcarried devices provide the opportunity for ultrasound assessment of LV function and serial bedside evaluation of volume status in patients with acutely decompensated heart failure.

Background Although the use of facilitated reporting to generate echocardiographic reports has many advantages over traditional dictation and transcription, it is not perfect, because physicians can still select finding codes that are in conflict with each other. Methods The investigators developed a tool allowing the creation of combinations of finding codes that should not be (contradictory) or are typically not found (inconsistent) together and then analyzed a historical collection of finalized echocardiographic reports to determine the frequency with which reporting discrepancies were present. Results A total of 96,772 reports were evaluated over an 11-year period. The frequencies of contradictory findings in final reports were 4.0%, 3.6%, and 7.1% for transthoracic echocardiography, transesophageal echocardiography, and stress echocardiography, respectively. Nearly a quarter (24.1%) of finalized transthoracic reports and 10.1% of transesophageal reports had findings that were inconsistent with each other. Conclusions This study demonstrates that facilitated reporting of echocardiographic studies, using a discrete set of finding codes, allows the generation of rules that can be used to identify discrepancies and alert readers to the need to correct or review their interpretations.

Background Although carotid intima–media thickness (CIMT) assesses the structural properties of the carotid artery, it does not assess the mechanical properties of the vessel. Methods The carotid arteries of 71 adult patients were evaluated with CIMT, and automated border detection computed vessel stiffness, compliance, elasticity, and distensibility. Results CIMT and mechanical properties were differentially affected by traditional cardiac risk factors, with age dominating for CIMT, and age, diabetes, and smoking dominating for mechanical variables. There was a moderate linear correlation between CIMT and the distensibility coefficient ( r = −0.54), but there were weak associations with other parameters of dynamic vessel function. When patients were separated into risk groups, the mechanical vascular parameters' classification frequently differed from the CIMT classification. This was particularly notable for patients with intermediate CIMT values, who were reclassified as low or high risk by mechanical parameters 45% of the time. Conclusion We found that it is feasible to assess the cross-sectional area of the carotid artery using automatic border detection, which allows a novel method of determining carotid mechanical properties. These functional characteristics are often discordant with CIMT, suggesting that mechanical properties may be an important adjunct to the CIMT when evaluating the carotid artery.

Background The estimation of left ventricular filling pressure (LVFP) remains a critical component in the management of patients with known or suspected acute heart failure syndromes. Although right heart catheterization (RHC) remains the gold standard, several noninvasive parameters, including clinical assessment, B-type natriuretic peptides (BNP), and echocardiography can approximate LVFP. We sought to use a combination of these measures to noninvasively predict high or low LVFP in a population referred for RHC. Methods and Results The study consisted of validation of hand-carried ultrasound (HCU)-derived measurement of mitral E/E′ against standard echocardiograms in 50 patients, as well as direct comparison of jugular venous pressure (JVP), a clinical congestion score, HCU-derived E/E′ and maximum inferior vena cava diameter (IVCmax), and BNP with pulmonary capillary wedge pressure (PCWP) in another 50 patients. The mean age was 61 years, ejection fraction 40%, JVP 9 cm, BNP 948 pg/mL, IVCmax 2.1 cm, E/E′ 13, and PCWP 21. All parameters performed well in determining PCWP ≥15 mm Hg, with clinical score performing the worst (area under the receiver-operator characteristic curve [AUC] 0.74), and IVCmax performing the best (AUC 0.89). JVP, in combination with HCU-derived parameters and BNP performed better than any of the individual tests alone (AUC 0.97 for combination of all 3). Conclusions Clinical score, JVP, HCU indices, and BNP perform well at identifying patients with a PCWP ≥15 mm Hg. Use of these indices alone or in combination can be used to identify and potentially monitor patients with high LVFP in the inpatient and outpatient settings.

Advances in cardiac ultrasound have included the development of larger, more powerful platforms with advanced imaging features and quantitative analysis packages. However, a parallel yet polar opposite development has also occurred: the introduction of smaller, less powerful platforms with limited imaging capabilities has sparked a new genre of cardiac imaging. Several terms are used to describe these platforms. The American Society of Echocardiography Task Force on New Technology has recommended the term hand-carried cardiac ultrasound. The clinical use models for hand-carried ultrasound take advantage of their portability and ease of use compared with larger platforms. These benefits and use models are the subject of this review.

Objectives We sought to compare the value of serial assessment with hand-carried ultrasound (HCU) of the inferior vena cava (IVC) with brain natriuretic peptide (BNP) to identify patients with acute decompensated heart failure (ADHF) who will be readmitted or seek emergency department treatment after hospital discharge. Background Congestive heart failure (CHF) is a leading cause for hospitalization and, once hospitalized, patients with CHF frequently are readmitted. To date, no reliable index exists that can be used to predict whether patients with ADHF can be discharged with low readmission likelihood. Methods A total of 75 patients who were admitted with a primary diagnosis of ADHF were followed. All patients were assessed at admission and discharge with the use of routine clinical evaluation, BNP measurement, and HCU evaluation of the IVC by physicians with limited training in ultrasound. Results During the 30-day follow-up, 31 patients were rehospitalized or presented to the emergency department. Patients who were subsequently readmitted could not be differentiated from those who were not readmitted by their demographics, comorbidities, vital signs, presence of symptoms/signs suggestive of persistent congestion, hospital length of stay, or net volume removal. Routine laboratory tests, including assessment of renal function, also failed to predict readmission with the exception of serum sodium. Although admission BNP was similar in patients readmitted and not readmitted, pre-discharge log-transformed BNP was greater in patients who subsequently were readmitted. Patients who required repeat hospitalization had a larger IVC size on admission as well as at discharge. In addition, patients who were readmitted had persistently plethoric IVCs with lower IVC collapsibility indexes. At discharge, only serum sodium, log-transformed BNP, IVC size, and collapsibility were statistically significant predictors of readmission. Conclusions This study confirms that, once hospitalized, patients with CHF frequently are readmitted. Bedside evaluation of the IVC with a HCU device at the time of admission and discharge, as well as pre-discharge BNP, identified patients admitted with ADHF who were more likely to be readmitted to the hospital.

An everyday example of a nonholonomic mechanical system is a pencil rolling on an inclined plane. Aspects of the motion are discussed in various approximations, of which the most realistic assumes rolling without sliding and that a constant fraction of the pencil’s kinetic energy is retained after each collision with the plane.

An exceptional view of the heart through quality ultrasound imaging of the cardiovascular system was the theme of the 18th Annual Scientific Sessions of the American Society of Echocardiography, which took place in Seattle, Washington, from June 16 to 20, 2007. This meeting showcased how the latest