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Sixty percent of discrete surface water bodies in Europe do not meet the requirements for good ecological and chemical status and in Germany, the situation is even worse with over 90% of surface water bodies failing to meet the threshold. In addition to hydromorphological degradation, intensive land use and invasive species, chemical pollution is primarily considered to be responsible for the inadequate ecological status of the water bodies. As a quantitatively important source of micropollutants, wastewater treatment plants (WWTPs) represent an important entry path for chemical stressors. It is therefore important to analyze the effectiveness of the WWTPs in eliminating micropollutants and other chemical stressors to mitigate the negative impacts of the treated wastewater (WW) in aquatic ecosystems. Accordingly, in this study, we evaluated the impacts of two conventional, medium-sized WWTPs on their small receiving water systems in the southwestern region of Hessen in Germany during two sampling campaigns (spring and fall) using effect-based methods (EBM). We hypothesized that due to the insufficient elimination of micropollutants, a broad spectrum of toxic effects would be detected in conventionally treated WW and also in the receiving surface waters downstream the WWTPs. As EBMs a battery of in vitro assays and active biomonitoring using two in vivo assays were applied. The results supported our hypothesis and showed that the untreatedWWhad a very high baseline toxicity and also high endocrine and mutagenic activities. ConventionalWWtreatment, consisting of mechanical and biological treatment with nitrification, denitrification and phosphate precipitation, reduced baseline toxicity by more than 90% and endocrine activities by more than 80% in both WWTPs. Despite these high elimination rates, the remaining baseline toxicity, the endocrine, dioxin-like and mutagenic activities of the conventionally treated WW were so high that negative effects on the two receiving waters were to be expected. This was confirmed in the active monitoring with the amphipod Gammarus fossarum and the mudsnail Potamopyrgus antipodarum, as mortality of both species increased downstream of the WWTPs and reproduction in P. antipodarum was also affected. These results indicate that advanced WW treatment is needed to more effectively eliminate chemical stressors to prevent negative impacts of treated WW particularly in small receiving waters. [ABSTRACT FROM AUTHOR]

Volatile organic compounds (VOCs), with their ubiquitous presence across numerous global industries, pose multifaceted challenges, influencing air pollution and health outcomes. In response, countries such as the United States and Canada have implemented fenceline monitoring systems, enabling real-time tracking of organic solvents, including benzene. Initially, this focus was predominantly placed on the petroleum refining industry, but it has gradually been broadening. This investigation seeks to identify and analyze the specific VOCs produced in the tire manufacturing sector by utilizing both active and passive monitoring methodologies. The findings of the present study aim to recommend prioritized reduction strategies for specific VOCs. Percentage means the ratio of VOCs detected at the research site. At research target facility A, active monitoring demonstrated the presence of Methylene chloride (20.7%) and Carbon tetrachloride (15.3%), whereas passive monitoring identified Carbon tetrachloride (43.4%) and m,p-Xylene (20.8%). After converting these substances to their equivalent concentrations, we found a noteworthy correlation between the active and passive methodologies. At research target facility B, active monitoring detected n-Pentane (45.5%) and Isoprene (11.4%), while passive monitoring revealed Toluene (21.3%) and iso-Hexane (15.8%). Interestingly, even at sites like warehouses and test tracks where VOC concentrations were projected to be low, we observed VOC levels comparable to those in process areas. This underlines the fact that the dispersal of VOCs is considerably influenced by wind direction and speed. Specifically, in the tire manufacturing industry, emissions of Xylene and 3-Methylhexane, both having high photochemical ozone creation potential (POCP), contribute significantly to air pollution. However, the overall detection concentration in the tire manufacturing industry was detected at a low concentration of less than 2 μg/m3. This is less than 9 μg/m3, which is the standard for benzene, which has strong carcinogenicity regulations. This suggests that additional research is needed on synthetic rubber manufacturing rather than tire manufacturing. [ABSTRACT FROM AUTHOR]

Methotrexate (MTX) is characterized as first-line therapy although its indication of ectopic pregnancy is off-label use. We aimed to conduct a retrospective cohort study to investigate the incidence, characteristics of adverse drug reactions (ADRs) of MTX, provide valuable insights for medical workers. Basing on China Hospital Pharmacovigilance System (CHPS), a retrospective analysis was performed to evaluate the safety of MTX (n = 672). An active monitoring model was set to detect ADR signals from the hospital information system. Frequency, Common Terminology Criteria for Adverse Events (CTCAE) grade proportion and association of dose exposure with ADRs were presented as outcomes. The total incidence of ADRs was 54.0%. Anaemia (37.6%) was the most frequent ADR, followed by hepatic function abnormal (11.3%), hyperuricemia (6.1%), neutropenia (4.6%), leukopenia (4.0%), and dyslipidaemia (2.5%). For the composition of all ADRs, CTCAE grade one, two and three dominated for 86.3%, 12.1% and 1.6%, respectively. The severity of hepatic function abnormal was more serious in the two-dose exposed group (p =.021), while other types of ADRs had no statistical or clinical differences. Logistic regression analysis showed the incidence of any ADRs (OR 1.87 [1.31–2.64]; p =.001), hepatic function abnormal (OR 2.75 [1.69–4.48]; p <.001), dyslipidaemia (OR 5.15 [1.87–14.13]; p =.001) were significantly higher in the two-dose exposed group. After adjusted, the positive associations were still maintained. MTX is quite safe in ectopic pregnancy, despite its mild to moderate hematotoxicity, hepatotoxicity and nephrotoxicity. Taking CHPS can present the accurate denominator of the incidence of adverse drug reactions into account, our study advocates that it may have great potential to be used as an active monitoring tool for off-label drug use risk management. [ABSTRACT FROM AUTHOR]

Abstract The following work presents the first study applying the passive acoustic monitoring of anurans at lotic environments for a long time. This study aims to test the efficiency of the passive acoustic monitoring method and active monitoring in detecting anurans in lotic environments of Itinguçu State Park. Specifically, we tested whether species richness differs when comparing active and passive monitoring surveys. Therefore, this study aims to test the efficiency of the passive acoustic monitoring method and active monitoring in detecting anurans in lotic environments of the Itinguçu State Park. The passive acoustic monitoring period was 72 uninterrupted hours at each collection point with intervals of 45 days. Finally, species richness was calculated, and the efficiency of the methods was compared in different scenarios. Our results demonstrated that the park has species that vocalize day and night, but most at night, there is overlapping acoustic niche; waterfall environments harm the quality of recordings; and in lotic environments the active monitoring method was more efficient than the passive acoustic monitoring in all sampling scales. Although the passive acoustic monitoring was not as efficient in a low temporal scale, it tends to increase in efficiency with longer sampling duration.

Sixty percent of discrete surface water bodies in Europe do not meet the requirements for good ecological and chemical status and in Germany, the situation is even worse with over 90% of surface water bodies failing to meet the threshold. In addition to hydromorphological degradation, intensive land use and invasive species, chemical pollution is primarily considered to be responsible for the inadequate ecological status of the water bodies. As a quantitatively important source of micropollutants, wastewater treatment plants (WWTPs) represent an important entry path for chemical stressors. It is therefore important to analyze the effectiveness of the WWTPs in eliminating micropollutants and other chemical stressors to mitigate the negative impacts of the treated wastewater (WW) in aquatic ecosystems. Accordingly, in this study, we evaluated the impacts of two conventional, medium-sized WWTPs on their small receiving water systems in the southwestern region of Hessen in Germany during two sampling campaigns (spring and fall) using effect-based methods (EBM). We hypothesized that due to the insufficient elimination of micropollutants, a broad spectrum of toxic effects would be detected in conventionally treated WW and also in the receiving surface waters downstream the WWTPs. As EBMs a battery of in vitro assays and active biomonitoring using two in vivo assays were applied. The results supported our hypothesis and showed that the untreated WW had a very high baseline toxicity and also high endocrine and mutagenic activities. Conventional WW treatment, consisting of mechanical and biological treatment with nitrification, denitrification and phosphate precipitation, reduced baseline toxicity by more than 90% and endocrine activities by more than 80% in both WWTPs. Despite these high elimination rates, the remaining baseline toxicity, the endocrine, dioxin-like and mutagenic activities of the conventionally treated WW were so high that negative effects on the two receiving waters were to be expected. This was confirmed in the active monitoring with the amphipod Gammarus fossarum and the mudsnail Potamopyrgus antipodarum, as mortality of both species increased downstream of the WWTPs and reproduction in P. antipodarum was also affected. These results indicate that advanced WW treatment is needed to more effectively eliminate chemical stressors to prevent negative impacts of treated WW particularly in small receiving waters.

Avian influenza (AI) is a global problem impacting birds and mammals, causing economic losses in commercial poultry farms and backyard settings. In 2022, over 8,500 AI cases were reported worldwide, with the H5 subtype being responsible for many outbreaks in wild and domestic birds. In the territory of the Russian Federation, outbreaks of AI have been massively reported since 2020, both among domestic bird species and wild bird species. Wild migratory birds often serve as natural reservoirs for AI viruses, and interactions between bird species can lead to the emergence of new, highly pathogenic variants through genetic recombination between strains. In order to combat the widespread outbreaks of the disease and potential risks of further spread in 2021, monitoring studies were conducted in the Samara Oblast, the southeastern region of European Russian Federation. These studies aimed to diagnose and characterize circulating AI virus variants among wild migratory birds during waterfowl hunting in areas of mass nesting. Among the 98 shot birds, a highly pathogenic A/H5N1 AI virus was detected in a Eurasian Teal from the Bolshechernigovsky district. It was classified into clade 2.3.4.4 based on the cleavage site structure of HA. Phylogenetic analysis showed a high relatedness of the identified strain in the Samara Oblast with field isolates from Russia, Nigeria, Bangladesh, and Benin. The article emphasizes the importance of monitoring AI virus spread in both wild and poultry, highlighting the need for timely information exchange to assess risks. Further comprehensive studies are necessary to understand virus dissemination pathways.

ObjectiveTo characterize the incidence of laboratory confirmed pertussis cases by immunization status in Ninghai County， and to provide evidence for improving pertussis prevention and control strategy in Ninghai County.MethodsData of reported pertussis cases in Ninghai County from 2018 to 2019 were collected through the National Notifiable Infectious Disease Reporting System. The immunization history of vaccines related to pertussis was collected through the Ningbo Immunization Planning Information Management System and field investigation. Descriptive epidemiological methods were used to analyze the collected data.ResultsThe respiratory secretions collected in the 64 cases tested positive for nucleic acid of Bordetella pertussis bacilli， of which 56.25% aged 0‒1 year. They were mainly pre-school children. No adolescent or adult case was reported. All cases had whooping cough. Of the cases， 78.13% had an increase in white blood cell count， 62.5% had an increase in lymphocyte percentage， 59.38% had completed three or more doses of pertussis vaccination， 69.39% had a time interval of >1 year between the onset and last dose of pertussis vaccination， and 31.25% reported close contact with pertussis patients before the onset. The misdiagnosis rate of pertussis was as high as 92.19%. In contrast， the prevalence of anti-pertussis IgG antibody in health population was 1.05%.ConclusionFurther improvement in the laboratory testing capacity can help clarify the diagnosis of pertussis. Generally， children aged 0-1 year are mainly affected， of which vast majority have received at least one dose of pertussis vaccination. Clinical symptoms are characterized by whooping cough. Additionally， elevated white blood cells and lymphocytes should be on the alert to pertussis infection.

Abstract Background Developmental Dysplasia of the Hip (DDH) is one of the most common pediatric orthopedic disorders, affecting 1–3% of all newborns. The optimal treatment of centered DDH is currently under debate. This randomized controlled trial aims to study the (cost-)effectiveness of active monitoring versus abduction treatment for infants with centered DDH. Methods This is a multicenter, parallel-group, open-label, non-inferiority randomized controlled trial studying the (cost-)effectiveness of active monitoring versus abduction treatment for infants with centered DDH in fourteen hospitals in the Netherlands. In total, 800 infants with centered DDH (Graf IIa-/IIb/IIc), aged 10–16 weeks, will be randomly allocated to the active monitoring or abduction treatment group. Infants will be followed up until the age of 24 months. The primary outcome is the rate of normal hips, defined as an acetabular index lower than 25 degrees on an antero-posterior radiograph, at the age of 12 months. Secondary outcomes are the rate of normal hips at the age of 24 months, complications, time to hip normalization, the relation between baseline patient characteristics and the rate of normal hips, compliance, costs, cost-effectiveness, budget impact, health-related quality of life (HRQoL) of the infant, HRQoL of the parents/caregivers, and parent/caregiver satisfaction with the treatment protocol. Discussion The outcomes of this randomized controlled trial will contribute to improving current care-as-usual for infants with centered DDH. Trial registration Dutch Trial Register, NL9714, registered September 6, 2021. https://clinicaltrialregister.nl/en/trial/29596

Volatile Organic Compounds (VOCs) are prevalent emissions from a plethora of industries, known for their role in the formation of atmospheric ozone, thus contributing to secondary pollution. Both the United States and the European Union have presented various regulatory measures to mitigate VOC emissions. Nevertheless, the diversity of VOCs, some exhibiting carcinogenic properties, pose substantial challenges in devising comprehensive mitigation strategies. In light of this, the current study focuses on the synthetic rubber manufacturing industry, specifically analyzing VOCs with high emission volumes and elevated Photochemical Ozone Creation Potentials (POCPs). A total of 88 compounds, including PM-57 and TO-14A, were examined in this study. The Active and Passive monitoring methods, two out of the six recommended by the Environmental Protection Agency (EPA) for Fenceline monitoring, were employed. For business entity 'A', the Active method revealed the highest emission rates of n-butane (13.5%) and n-Pentane (12.8%). In contrast, the Passive method indicated styrene (9.4%) and toluene (8.1%) as the most prominently emitted compounds. Benzene, though detected at all points ranging from 1~3 µg/m³, is not manipulated in this industry, suggesting potential influence from neighboring enterprises. Compounds such as benzene, toluene, ethylbenzene, xylene, and styrene demonstrated convertible concentrations using both Active and Passive methods, detected within the range of 0~3 µg/m³. Notably, the average concentrations determined by both methods exhibited remarkable similarity. For business entity 'B', the Active method detected significant levels of n-hexane (45.0%) and methylcyclopentane (14.4%), whereas the Passive method identified high concentrations of n-hexane (37.7%) and isopentane (8.8%). A general pattern emerged where high concentrations were exhibited at points 9, 10, and 11, located within the production area, while points 1, 2, and 3 displayed lower concentrations, likely due to the influence of eastward wind patterns. In terms of compounds with high POCPs, business entity 'A' demonstrated substantial emission of n-butane (38.80%) and n-hexane (27.15%) using the Active method, and toluene (28.62%) and n-hexane (25.23%) via the Passive method. For business entity 'B', n-hexane emerged dominantly, detected at 84.57% using the Active method and 68.85% via the Passive method. This suggests that in the synthetic rubber manufacturing industry, n-hexane should be prioritized in formulating effective emission reduction strategies. [ABSTRACT FROM AUTHOR]

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Volatile organic compounds (VOCs), with their ubiquitous presence across numerous global industries, pose multifaceted challenges, influencing air pollution and health outcomes. In response, countries such as the United States and Canada have implemented fenceline monitoring systems, enabling real-time tracking of organic solvents, including benzene. Initially, this focus was predominantly placed on the petroleum refining industry, but it has gradually been broadening. This investigation seeks to identify and analyze the specific VOCs produced in the tire manufacturing sector by utilizing both active and passive monitoring methodologies. The findings of the present study aim to recommend prioritized reduction strategies for specific VOCs. Percentage means the ratio of VOCs detected at the research site. At research target facility A, active monitoring demonstrated the presence of Methylene chloride (20.7%) and Carbon tetrachloride (15.3%), whereas passive monitoring identified Carbon tetrachloride (43.4%) and m,p-Xylene (20.8%). After converting these substances to their equivalent concentrations, we found a noteworthy correlation between the active and passive methodologies. At research target facility B, active monitoring detected n-Pentane (45.5%) and Isoprene (11.4%), while passive monitoring revealed Toluene (21.3%) and iso-Hexane (15.8%). Interestingly, even at sites like warehouses and test tracks where VOC concentrations were projected to be low, we observed VOC levels comparable to those in process areas. This underlines the fact that the dispersal of VOCs is considerably influenced by wind direction and speed. Specifically, in the tire manufacturing industry, emissions of Xylene and 3-Methylhexane, both having high photochemical ozone creation potential (POCP), contribute significantly to air pollution. However, the overall detection concentration in the tire manufacturing industry was detected at a low concentration of less than 2 μg/m3. This is less than 9 μg/m3, which is the standard for benzene, which has strong carcinogenicity regulations. This suggests that additional research is needed on synthetic rubber manufacturing rather than tire manufacturing.

Background: Developmental Dysplasia of the Hip (DDH) is one of the most common pediatric orthopedic disorders, affecting 1–3% of all newborns. The optimal treatment of centered DDH is currently under debate. This randomized controlled trial aims to study the (cost-)effectiveness of active monitoring versus abduction treatment for infants with centered DDH. Methods: This is a multicenter, parallel-group, open-label, non-inferiority randomized controlled trial studying the (cost-)effectiveness of active monitoring versus abduction treatment for infants with centered DDH in fourteen hospitals in the Netherlands. In total, 800 infants with centered DDH (Graf IIa-/IIb/IIc), aged 10–16 weeks, will be randomly allocated to the active monitoring or abduction treatment group. Infants will be followed up until the age of 24 months. The primary outcome is the rate of normal hips, defined as an acetabular index lower than 25 degrees on an antero-posterior radiograph, at the age of 12 months. Secondary outcomes are the rate of normal hips at the age of 24 months, complications, time to hip normalization, the relation between baseline patient characteristics and the rate of normal hips, compliance, costs, cost-effectiveness, budget impact, health-related quality of life (HRQoL) of the infant, HRQoL of the parents/caregivers, and parent/caregiver satisfaction with the treatment protocol. Discussion: The outcomes of this randomized controlled trial will contribute to improving current care-as-usual for infants with centered DDH. Trial registration: Dutch Trial Register, NL9714, registered September 6, 2021. https://clinicaltrialregister.nl/en/trial/29596 [ABSTRACT FROM AUTHOR]

Currently, there is no clear consensus regarding the role of active surveillance (AS) in the management of intermediate-risk prostate cancer (IRPC) patients. We aim to analyse data from the available literature on the outcomes of AS in the management of IRPC patients and compare them with low-risk prostate cancer (LRPC) patients. A comprehensive literature search was performed, and relevant data were extracted. Our primary outcome was treatment-free survival, and secondary outcomes were metastasis-free survival, cancer-specific survival, and overall survival. The DerSimonian–Laird random-effects method was used for the meta-analysis. Out of 712 studies identified following an initial search, 25 studies were included in the systematic review. We found that both IRPC and LRPC patients had nearly similar 5, 10, and 15 year treatment-free survival rate, 5 and 10 year metastasis-free survival rate, and 5 year overall survival rate. However, cancer-specific survival rates at 5, 10, and 15 years were significantly lower in IRPC compared to LRPC group. Furthermore, IRPC patients had significantly inferior long-term overall survival rate (10 and 15 year) and metastasis-free survival rate (15 year) compared to LRPC patients. Both the clinicians and the patients can consider this information during the informed decision-making process before choosing AS. [ABSTRACT FROM AUTHOR]

Purpose of Review: Standard DCIS management consists of surgery with consideration of adjuvant radiation and endocrine therapy. However, widespread recognition of the overdiagnosis and overtreatment burden in DCIS has led to a reevaluation of this standard. The purpose of this review is to summarize the foundational clinical trials in DCIS and to discuss ongoing efforts in treatment de-escalation. Recent Findings: Standard of care DCIS management is based on large high-quality randomized clinical trials. The results of those trials have been durable over more than a decade of follow-up. However, we now better appreciate that DCIS is a heterogeneous disease with variable risk of progression. Clinicopathologic and molecular tools are helping better define which patients with DCIS would benefit from de-escalation. Modern clinical trials have proven the safety of shorter and lower dose radiation regimens in low-risk patients, and results from active monitoring trials are highly anticipated. In addition, decision support tools, shared decision-making, and molecular testing promise to help guide patients through an increasingly complex decision-making process. Summary: Current treatment of DCIS has moved towards successful de-escalation of treatment for those patients with low risk of progression. Further incorporation of molecular tools will allow for personalized treatment based on individual risk and preferences. [ABSTRACT FROM AUTHOR]

Introduction: Few studies have evaluated meningioma patients' longer-term health-related quality of life (HRQoL) following diagnosis and treatment, particularly in those with incidental, actively monitored tumours. Methods: A single-center, cross-sectional study was completed. Adult patients with surgically managed or actively monitored meningioma with more than five years of follow-up were included. The patient-reported outcome measures RAND SF-36, EORTC QLQ-C30 and QLQ-BN20 were used to evaluate HRQoL. HRQoL scores were compared to normative population data. Outcome determinants were evaluated using multivariate linear regression analysis. Results: 243 patient responses were analyzed, and the mean time from diagnosis was 9.8 years (range 5.0–40.3 years). Clinically relevant, statistically significant HRQoL impairments were identified across several SF-36 and QLQ-C30 domains. Increasing education level (β = 2.9, 95% CI 0.9 to 4.9), P =.004), employment (β = 7.7, 95% CI 2.2 to 13.1, P =.006) and absence of postoperative complications (β=-6.7, 95% CI -13.2 to (-)0.3, P =.041) were associated with a better QLQ-C30 summary score. Other tumour and treatment variables were not. Conclusion: This study highlights the longer-term disease burden of patients with meningioma nearly one decade after diagnosis or surgery. Patients with actively monitored meningioma have similar HRQoL to operated meningioma patients. Healthcare professionals should be mindful of HRQoL impairments and direct patients to sources of support as needed. [ABSTRACT FROM AUTHOR]

This study aimed to shed light on the roles of the Sharia Supervisory Board (SSB) in carrying out their tasks, particularly in ensuring the compliance of Sharia banks and mitigating its risks at BNTB Syariah. Unless well carried out, it will result in several risks, mainly related to reputation and finance. Drawing on a qualitative research approach, this study garnered data from many sources, such as interviews, observations, and documentation. The data were analyzed using the descriptive-analytic method. The findings showed that (1) the involvement of SSB in carrying out their roles and monitoring the products of Sharia banks is portrayed by the three activities: (1) regular and accidental meetings discussing halal products, which were planned and already in the sale; (2) direct monitoring visiting the bank branches; and (3) undertaking coaching with a broader scope, such as explaining the sharia aspects before purchasing of products, and ethical outfit and service towards the costumers. These tasks resemble the so-called "DPS plus" (SSB plus). SSB also complied with the national Sharia council (DSN), excepts on certain items exclusive of the Fatwa of the National Sharia Advisory board (NSAB). The solution and mitigation offered by SSB in undertaking their tasks were always based on the Fatwa stipulated by the Islamic Ulema Council, following the Islamic jurisprudence and law. It was also found that risk mitigation was executed by promoting sharia financial literacy and active monitoring. [ABSTRACT FROM AUTHOR]

One crucial challenge confronting operators worldwide is how to ensure that everything runs smoothly as well as how to monitor the network. The monitoring system should be accurate, easy to use, and quick enough to reflect network performance in a timely way. Passive network monitoring is an excellent tool for this. It could be used to look for issues with a single network device or a large-scale issue affecting the whole LAN or core network. However, passive network monitoring is not limited to issue resolution; it could also be used to generate network statistics and measure network performance. As shown in this review, it is a very strong tool, as seen by the sheer volume of data published on Google Scholar. The main objective of this review is to analyze and comprehend monitoring measurements for quality of service to serve as a resource for future research and application. Essential terms and concepts of network monitoring and their quality of service are presented. Network monitoring measurements (which can be passive, active, or hybrid) and their wireless network monitoring tools (which can be public domain or commercial tools) are also covered in terms of relevance, advantages, and disadvantages. Finally, the review is summarized. [ABSTRACT FROM AUTHOR]

Volatile Organic Compounds (VOCs) are prevalent emissions from a plethora of industries, known for their role in the formation of atmospheric ozone, thus contributing to secondary pollution. Both the United States and the European Union have presented various regulatory measures to mitigate VOC emissions. Nevertheless, the diversity of VOCs, some exhibiting carcinogenic properties, pose substantial challenges in devising comprehensive mitigation strategies. In light of this, the current study focuses on the synthetic rubber manufacturing industry, specifically analyzing VOCs with high emission volumes and elevated Photochemical Ozone Creation Potentials (POCPs). A total of 88 compounds, including PM-57 and TO-14A, were examined in this study. The Active and Passive monitoring methods, two out of the six recommended by the Environmental Protection Agency (EPA) for Fenceline monitoring, were employed. For business entity ‘A’, the Active method revealed the highest emission rates of n-butane (13.5%) and n-Pentane (12.8%). In contrast, the Passive method indicated styrene (9.4%) and toluene (8.1%) as the most prominently emitted compounds. Benzene, though detected at all points ranging from 1~3 µg/m³, is not manipulated in this industry, suggesting potential influence from neighboring enterprises. Compounds such as benzene, toluene, ethylbenzene, xylene, and styrene demonstrated convertible concentrations using both Active and Passive methods, detected within the range of 0~3 µg/m³. Notably, the average concentrations determined by both methods exhibited remarkable similarity. For business entity ‘B’, the Active method detected significant levels of n-hexane (45.0%) and methylcyclopentane (14.4%), whereas the Passive method identified high concentrations of n-hexane (37.7%) and isopentane (8.8%). A general pattern emerged where high concentrations were exhibited at points 9, 10, and 11, located within the production area, while points 1, 2, and 3 displayed lower concentrations, likely due to the influence of eastward wind patterns. In terms of compounds with high POCPs, business entity ‘A’ demonstrated substantial emission of n-butane (38.80%) and n-hexane (27.15%) using the Active method, and toluene (28.62%) and n-hexane (25.23%) via the Passive method. For business entity ‘B’, n-hexane emerged dominantly, detected at 84.57% using the Active method and 68.85% via the Passive method. This suggests that in the synthetic rubber manufacturing industry, n-hexane should be prioritized in formulating effective emission reduction strategies.

Background: Drug-induced kidney injury (DIKI) is one of the most common complications in clinical practice. Detection signals through post-marketing approaches are of great value in preventing DIKI in pediatric patients. This study aimed to propose a quantitative algorithm to detect DIKI signals in children using an electronic health record (EHR) database. Methods: In this study, 12 years of medical data collected from a constructed data warehouse were analyzed, which contained 575,965 records of inpatients from 1 January 2009 to 31 December 2020. Eligible participants included inpatients aged 28 days to 18 years old. A two-stage procedure was adopted to detect DIKI signals: 1) stage 1: the suspected drugs potentially associated with DIKI were screened by calculating the crude incidence of DIKI events; and 2) stage 2: the associations between suspected drugs and DIKI were identified in the propensity score-matched retrospective cohorts. Unconditional logistic regression was used to analyze the difference in the incidence of DIKI events and to estimate the odds ratio (OR) and 95% confidence interval (CI). Potentially new signals were distinguished from already known associations concerning DIKI by manually reviewing the published literature and drug instructions. Results: Nine suspected drugs were initially screened from a total of 652 drugs. Six drugs, including diazepam (OR = 1.61, 95%CI: 1.43-1.80), omeprazole (OR = 1.35, 95%CI: 1.17-1.54), ondansetron (OR = 1.49, 95%CI: 1.36-1.63), methotrexate (OR = 1.36, 95%CI: 1.25-1.47), creatine phosphate sodium (OR = 1.13, 95%CI: 1.05-1.22), and cytarabine (OR = 1.17, 95%CI: 1.06-1.28), were demonstrated to be associated with DIKI as positive signals. The remaining three drugs, including vitamin K1 (OR = 1.06, 95%CI: 0.89-1.27), cefamandole (OR = 1.07, 95%CI: 0.94-1.21), and ibuprofen (OR = 1.01, 95%CI: 0.94-1.09), were found not to be associated with DIKI. Of these, creatine phosphate sodium was considered to be a possible new DIKI signal as it had not been reported in both adults and children previously. Moreover, three other drugs, namely, diazepam, omeprazole, and ondansetron, were shown to be new potential signals in pediatrics. Conclusion: A two-step quantitative procedure to actively explore DIKI signals using real-world data (RWD) was developed. Our findings highlight the potential of EHRs to complement traditional spontaneous reporting systems (SRS) for drug safety signal detection in a pediatric setting. [ABSTRACT FROM AUTHOR]

Ductal carcinoma in situ (DCIS) accounts for approximately 30% of new breast cancer diagnoses. However, our understanding of how normal breast tissue evolves into DCIS and invasive cancers remains insufficient. Further, conclusions regarding the mechanisms of disease progression in terms of histopathology, genetics, and radiology are often conflicting and have implications for treatment planning. Moreover, the increase in DCIS diagnoses since the adoption of organized breast cancer screening programs has raised concerns about overdiagnosis and subsequent overtreatment. Active monitoring, a nonsurgical management strategy for DCIS, avoids surgery in favor of close imaging follow-up to de-escalate therapy and provides more treatment options. However, the two major challenges in active monitoring are identifying occult invasive cancer and patients at risk of invasive cancer progression. Subsequently, four prospective active monitoring trials are ongoing to determine the feasibility of active monitoring and refine the patient eligibility criteria and follow-up intervals. Radiologists play a major role in determining eligibility for active monitoring and reviewing surveillance images for disease progression. Trial results published over the next few years would support a new era of multidisciplinary DCIS care., Competing Interests: The author has no potential conflicts of interest to disclose., (Copyright © 2024 The Korean Society of Radiology.)

Currently, there is no clear consensus regarding the role of active surveillance (AS) in the management of intermediate-risk prostate cancer (IRPC) patients. We aim to analyse data from the available literature on the outcomes of AS in the management of IRPC patients and compare them with low-risk prostate cancer (LRPC) patients. A comprehensive literature search was performed, and relevant data were extracted. Our primary outcome was treatment-free survival, and secondary outcomes were metastasis-free survival, cancer-specific survival, and overall survival. The DerSimonian–Laird random-effects method was used for the meta-analysis. Out of 712 studies identified following an initial search, 25 studies were included in the systematic review. We found that both IRPC and LRPC patients had nearly similar 5, 10, and 15 year treatment-free survival rate, 5 and 10 year metastasis-free survival rate, and 5 year overall survival rate. However, cancer-specific survival rates at 5, 10, and 15 years were significantly lower in IRPC compared to LRPC group. Furthermore, IRPC patients had significantly inferior long-term overall survival rate (10 and 15 year) and metastasis-free survival rate (15 year) compared to LRPC patients. Both the clinicians and the patients can consider this information during the informed decision-making process before choosing AS.

Purpose: Patients diagnosed with ductal carcinoma in situ (DCIS) face trade-offs when deciding among different treatments, including surgery, radiation, and endocrine therapy. A less chosen option is active monitoring. While evidence from clinical trials is not yet available, observational studies show comparable results for active monitoring and immediate treatment on cancer outcomes in select subgroups of patients. We developed and tested a web-based decision support tool (DST) to help patients explore current knowledge about DCIS and make an informed choice. Methods: The DST, an interactive web application, was informed by literature reviews and formative work with patients, breast surgeons, and health communication experts. We conducted iterative interviews to evaluate the DST content among women with and without a history of breast cancer, as well as breast cancer experts. For usability testing, we conducted an online survey among women with and without a history of breast cancer. Results: For content evaluation, 5 women with and 10 women without a history of DCIS were interviewed. The sample included 11 White and 4 non-White women, with a mean age of 64 years. The expert sample consisted of 5 attendings and a physician assistant. The feedback was used to add, clarify, or reorganize information in the DST. For usability testing, 22 participants with a mean age of 61 years were recruited including 15 White and 7 Black women and 6 women with a history of DCIS. The mean usability score was 3.7 out of 5. Most participants (86%) found that the DST provided unbiased information about treatments. To improve usability, we reduced the per-page content and added navigation cues. Conclusion: Content and usability evaluation showed that the DST helps patients explore trade-offs of active monitoring and immediate treatment. By adopting a personalized approach, the tool will enable informed decisions aligned with patients' values and expectations. [ABSTRACT FROM AUTHOR]

Background: Ductal carcinoma in situ (DCIS) is an in-situ (pre-cancerous) breast malignancy whereby malignant cells are contained within the basement membrane of the breast ducts. Increasing awareness that some low-risk forms of DCIS might remain indolent for many years has led to concern about overtreatment, with at least 3 clinical trials underway internationally assessing the safety of active monitoring for low-risk DCIS. This study aimed to understand healthcare professionals’ (HCPs) views on the management options for patients with DCIS. Methods: Qualitative study using semi-structured interviews with HCPs involved in the diagnosis and management of DCIS in Australia and New Zealand. Interviews were audio-recorded, transcribed and analysed thematically using Framework Analysis method. Results: Twenty-six HCPs including 10 breast surgeons, 3 breast physicians, 6 radiation oncologists, and 7 breast care nurses participated. There was a strong overall consensus that DCIS requires active treatment. HCPs generally felt uncomfortable recommending active monitoring as a management option for low-risk DCIS as they viewed this as outside current standard care. Overall, HCPs felt that active monitoring was an unproven strategy in need of an evidence base; however, many acknowledged that active monitoring for low-risk DCIS could be appropriate for patients with significant co-morbidities or limited life expectancy. They believed that most patients would opt for surgery wherever possible. Conclusions: This study highlights the important need for robust randomised controlled trial data about active monitoring for women with low-risk DCIS, to provide HCPs with confidence in their management recommendations and decision-making.

Abstract Background Optimal management strategies for clinically localised prostate cancer are debated. Using median 10-year data from the largest randomised controlled trial to date (ProtecT), the lifetime cost-effectiveness of three major treatments (radical radiotherapy, radical prostatectomy and active monitoring) was explored according to age and risk subgroups. Methods A decision-analytic (Markov) model was developed and informed by clinical input. The economic evaluation adopted a UK NHS perspective and the outcome was cost per Quality-Adjusted Life Year (QALY) gained (reported in UK£), estimated using EQ-5D-3L. Results Costs and QALYs extrapolated over the lifetime were mostly similar between the three randomised strategies and their subgroups, but with some important differences. Across all analyses, active monitoring was associated with higher costs, probably associated with higher rates of metastatic disease and changes to radical treatments. When comparing the value of the strategies (QALY gains and costs) in monetary terms, for both low-risk prostate cancer subgroups, radiotherapy generated the greatest net monetary benefit (£293,446 [95% CI £282,811 to £299,451] by D’Amico and £292,736 [95% CI £284,074 to £297,719] by Grade group 1). However, the sensitivity analysis highlighted uncertainty in the finding when stratified by Grade group, as radiotherapy had 53% probability of cost-effectiveness and prostatectomy had 43%. In intermediate/high risk groups, using D’Amico and Grade group > = 2, prostatectomy generated the greatest net monetary benefit (£275,977 [95% CI £258,630 to £285,474] by D’Amico and £271,933 [95% CI £237,864 to £287,784] by Grade group). This finding was supported by the sensitivity analysis. Prostatectomy had the greatest net benefit (£290,487 [95% CI £280,781 to £296,281]) for men younger than 65 and radical radiotherapy (£201,311 [95% CI £195,161 to £205,049]) for men older than 65, but sensitivity analysis showed considerable uncertainty in both findings. Conclusion Over the lifetime, extrapolating from the ProtecT trial, radical radiotherapy and prostatectomy appeared to be cost-effective for low risk prostate cancer, and radical prostatectomy for intermediate/high risk prostate cancer, but there was uncertainty in some estimates. Longer ProtecT trial follow-up is required to reduce uncertainty in the model. Trial registration Current Controlled Trials number, ISRCTN20141297: http://isrctn.org (14/10/2002); ClinicalTrials.gov number, NCT02044172: http://www.clinicaltrials.gov (23/01/2014).

Objectives: To estimate the lifetime health and economic outcomes of selecting active surveillance (AS), radical prostatectomy (RP), or radiation therapy (RT) as initial management for low- or favorable-risk localized prostate cancer.Methods: A discrete-event simulation model was developed using evidence from published randomized trials. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Costs were included from a public payer perspective in Australian dollars. Outcomes were discounted at 5% over a lifetime horizon. Probabilistic and scenario analyses quantified parameter and structural uncertainty.Results: A total of 60% of patients in the AS arm eventually received radical treatment (surgery or radiotherapy) compared with 90% for RP and 91% for RT. Although AS resulted in fewer treatment-related complications, it led to increased clinical progression (AS 40.7%, RP 17.6%, RT 19.9%) and metastatic disease (AS 13.4%, RP 6.1%, RT 7.0%). QALYs were 10.88 for AS, 11.10 for RP, and 11.13 for RT. Total costs were A$17 912 for AS, A$15 609 for RP, and A$15 118 for RT. At a willingness to pay of A$20 000/QALY, RT had a 61.4% chance of being cost-effective compared to 38.5% for RP and 0.1% for AS.Conclusions: Although AS resulted in fewer and delayed treatment-related complications, it was not found to be a cost-effective strategy for favorable-risk localized prostate cancer over a lifetime horizon because of an increase in the number of patients developing metastatic disease. RT was the dominant strategy yielding higher QALYs at lower cost although differences compared with RP were small. [ABSTRACT FROM AUTHOR]

In active monitoring, the position of the instrument may influence the accuracy and productivity of machining. This influence is considered in the present work for the example of CNC circular plunge grinding. Practical recommendations are made regarding the use of active monitoring in setting up the grinding cycle. Options for taking account of the length of the machined surface in the design of optimal plunge-grinding cycles are considered. [ABSTRACT FROM AUTHOR]

Ductal carcinoma in situ (DCIS) is a nonobligate precursor to invasive cancer that classically presents as asymptomatic calcifications on screening mammography. The increase in DCIS diagnoses with organized screening programs has raised concerns about overdiagnosis, while a patientcentric push for more personalized care has increased awareness about DCIS overtreatment. The standard of care for most new DCIS diagnoses is surgical excision, but nonsurgical management via active monitoring is gaining attention, and multiple clinical trials are ongoing. Imaging, along with demographic and pathologic information, is a critical component of active monitoring efforts. Commonly used imaging modalities including mammography, ultrasound, and MRI, as well as newer modalities such as contrast-enhanced mammography and dedicated breast PET, can provide prognostic information to risk stratify patients for DCIS active monitoring eligibility. Furthermore, radiologists will be responsible for closely surveilling patients on active monitoring and identifying if invasive progression occurs. Active monitoring is a paradigm shift for DCIS care, but the success or failure will rely heavily on the interpretations and guidance of radiologists.

Avian influenza (AI) is a global problem impacting birds and mammals, causing economic losses in commercial poultry farms and backyard settings. In 2022, over 8,500 AI cases were reported worldwide, with the H5 subtype being responsible for many outbreaks in wild and domestic birds. In the territory of the Russian Federation, outbreaks of AI have been massively reported since 2020, both among domestic bird species and wild bird species. Wild migratory birds often serve as natural reservoirs for AI viruses, and interactions between bird species can lead to the emergence of new, highly pathogenic variants through genetic recombination between strains. In order to combat the widespread outbreaks of the disease and potential risks of further spread in 2021, monitoring studies were conducted in the Samara Oblast, the southeastern region of European Russian Federation. These studies aimed to diagnose and characterize circulating AI virus variants among wild migratory birds during waterfowl hunting in areas of mass nesting. Among the 98 shot birds, a highly pathogenic A/H5N1 AI virus was detected in a Eurasian Teal from the Bolshechernigovsky district. It was classified into clade 2.3.4.4 based on the cleavage site structure of HA. Phylogenetic analysis showed a high relatedness of the identified strain in the Samara Oblast with field isolates from Russia, Nigeria, Bangladesh, and Benin. The article emphasizes the importance of monitoring AI virus spread in both wild and poultry, highlighting the need for timely information exchange to assess risks. Further comprehensive studies are necessary to understand virus dissemination pathways., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Glazunova, Krasnova, Bespalova, Sevskikh, Lunina, Titov, Sindryakova and Blokhin.)

Background: Indoor pollution is a real threat to human health all over the world. Indoor pollution derives from indoor sources (e.g. smoking, gas stoves, coated furniture) as well as from outdoor sources (e.g. industries, vehicles). Long-term monitoring measurements in indoor environments are missing to a large extent due to a lack of simple to operate measuring devices. Mosses proved well as biomonitors in hundreds of studies. Nevertheless, indoor use has been extremely scarce. Therefore, this study aimed to determine indoor and outdoor pollution by active biomonitoring using moss as well as NO2 samplers to analyse outdoor and indoor levels of pollution. We exposed moss (Pleurozium schreberi) for 8 weeks indoors and outdoors in 20 households in the city of Girona, Spain. Al, Cr, Cu, Zn, Sn, Cd, Pb, Mo, and Sb were analysed by moss-samplers. Additionally, NO2 was measured with Palmes diffusion tubes. Results: Compared to the pre-exposure analysis, concentrations of almost all elements both on indoor and outdoor mosses increased. Except for Cd, all metals and NO2 had, on average, higher concentrations in outdoor mosses than at corresponding indoor sites. However, some 20% of the samples showed inverse patterns, thus, indicating both indoor and outdoor sources. Indoor/outdoor correlations of elements were not significant, but highest for markers of traffic-related pollution, such as Sn, Sb, and NO2. The wide range of indoor–outdoor ratios of NO2 exemplified the relevance of indoor sources such as smoking or gas cooking. Though mostly excluded in this study, a few sites had these sources present. Conclusions: The study at hand showed that moss exposed at indoor sites could be a promising tool for long-time biomonitoring. However, it had also identified some drawbacks that should be considered in future indoor studies. Increments of pollutants were sometimes really low compared to the initial concentration and therefore not detectable. This fact hampers the investigation of elements with low basic element levels as, e.g. Pt. Therefore, moss with real low basic levels is needed for active monitoring, especially for future studies in indoor monitoring. Cloned material could be a proper material for indoor monitoring yet never was tested for this purpose. [ABSTRACT FROM AUTHOR]

Ductal carcinoma in situ (DCIS) is an in-situ (pre-cancerous) breast malignancy whereby malignant cells are contained within the basement membrane of the breast ducts. Increasing awareness that some low-risk forms of DCIS might remain indolent for many years has led to concern about overtreatment, with at least 3 clinical trials underway internationally assessing the safety of active monitoring for low-risk DCIS. This study aimed to understand healthcare professionals' (HCPs) views on the management options for patients with DCIS. Qualitative study using semi-structured interviews with HCPs involved in the diagnosis and management of DCIS in Australia and New Zealand. Interviews were audio-recorded, transcribed and analysed thematically using Framework Analysis method. Twenty-six HCPs including 10 breast surgeons, 3 breast physicians, 6 radiation oncologists, and 7 breast care nurses participated. There was a strong overall consensus that DCIS requires active treatment. HCPs generally felt uncomfortable recommending active monitoring as a management option for low-risk DCIS as they viewed this as outside current standard care. Overall, HCPs felt that active monitoring was an unproven strategy in need of an evidence base; however, many acknowledged that active monitoring for low-risk DCIS could be appropriate for patients with significant co-morbidities or limited life expectancy. They believed that most patients would opt for surgery wherever possible. This study highlights the important need for robust randomised controlled trial data about active monitoring for women with low-risk DCIS, to provide HCPs with confidence in their management recommendations and decision-making. • First study to explore HCPs' in-depth views on active monitoring for low-risk DCIS. • HCPs generally feel uncomfortable recommending active monitoring for low-risk DCIS. • Active monitoring may be considered for patients with significant co-morbidities or limited life expectancy. • Need for robust randomised controlled trial data on active monitoring for DCIS. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer is the most common cancer among men in the UK. Prostate-specific antigen testing followed by biopsy leads to overdetection, overtreatment as well as undertreatment of the disease. Evidence of treatment effectiveness has lacked because of the paucity of randomised controlled trials comparing conventional treatments. Objectives: To evaluate the effectiveness of conventional treatments for localised prostate cancer (active monitoring, radical prostatectomy and radical radiotherapy) in men aged 50–69 years. Design: A prospective, multicentre prostate-specific antigen testing programme followed by a randomised trial of treatment, with a comprehensive cohort follow-up. Setting: Prostate-specific antigen testing in primary care and treatment in nine urology departments in the UK. Participants: Between 2001 and 2009, 228,966 men aged 50–69 years received an invitation to attend an appointment for information about the Prostate testing for cancer and Treatment (ProtecT) study and a prostate-specific antigen test; 82,429 men were tested, 2664 were diagnosed with localised prostate cancer, 1643 agreed to randomisation to active monitoring (n = 545), radical prostatectomy (n = 553) or radical radiotherapy (n = 545) and 997 chose a treatment. Interventions: The interventions were active monitoring, radical prostatectomy and radical radiotherapy. Trial primary outcome measure: Definite or probable disease-specific mortality at the 10-year median follow-up in randomised participants. Secondary outcome measures: Overall mortality, metastases, disease progression, treatment complications, resource utilisation and patient-reported outcomes. Results: There were no statistically significant differences between the groups for 17 prostate cancer-specific (p = 0.48) and 169 all-cause (p = 0.87) deaths. Eight men died of prostate cancer in the active monitoring group (1.5 per 1000 person-years, 95% confidence interval 0.7 to 3.0); five died of prostate cancer in the radical prostatectomy group (0.9 per 1000 person-years, 95% confidence interval 0.4 to 2.2 per 1000 person years) and four died of prostate cancer in the radical radiotherapy group (0.7 per 1000 person-years, 95% confidence interval 0.3 to 2.0 per 1000 person years). More men developed metastases in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring, n = 33 (6.3 per 1000 person-years, 95% confidence interval 4.5 to 8.8); radical prostatectomy, n = 13 (2.4 per 1000 person-years, 95% confidence interval 1.4 to 4.2 per 1000 person years); and radical radiotherapy, n = 16 (3.0 per 1000 person-years, 95% confidence interval 1.9 to 4.9 per 1000 person-years; p = 0.004). There were higher rates of disease progression in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring (n = 112; 22.9 per 1000 person-years, 95% confidence interval 19.0 to 27.5 per 1000 person years); radical prostatectomy (n = 46; 8.9 per 1000 person-years, 95% confidence interval 6.7 to 11.9 per 1000 person-years); and radical radiotherapy (n = 46; 9.0 per 1000 person-years, 95% confidence interval 6.7 to 12.0 per 1000 person years; p

The aim of this study was to compare the cost-effectiveness and quality-adjusted life years (QALYs) of active monitoring (AM), radical prostatectomy (PR), and external-beam radiotherapy with neoadjuvant hormone therapy (RT) for localized prostate cancer. Microsimulations of radical prostatectomy, 3D-conformal radiotherapy, or active monitoring were performed using Medicare reimbursement schedules and clinical trial results for a target population of men aged 50–69 years with newly diagnosed localized prostate cancer (T1-T2, NX, M0) over a time horizon of 10 years. Quality-adjusted life years (QALYs) and costs were assessed and sensitivity analyses performed. Monte Carlo simulations revealed that the mean cost for AM, PR, and RT were $15,654, $18,791, and $30,378, respectively, and QALYs were 6.96, 7.44, and 7.9 years, respectively. The incremental cost-effectiveness ratio (ICER) was $6,548 for PR over AM and $68,339 for RT over PR. Results were sensitive to the number of years of follow-up and procedure cost. With relaxed assumptions for AM, the ICER of PR and RT met the societal willingness to pay (WTP) threshold of $50,000 per QALY. Compared with AM, PR was highly cost-effective. RT and PR for localized prostate cancer can be cost-effective, but RT must offer increased QALYs or decreased procedural costs to be cost-effective compared to PR. Newer and cheaper radiotherapy strategies like stereotactic body radiotherapy may play a crucial role in future early prostate cancer management.

Active vaccine pharmacovigilance complements the standard passive or spontaneous surveillance system, which suffers from low reporting rates. This study aimed at utilizing population-based structures to report and profile adverse events following immunization (AEFI) with the measles and rubella vaccine (MR), or MR in combination with the bivalent oral polio vaccine (bOPV 1&3) (MR & bOPV), during mass vaccination in Uganda. Caretakers of children at home (less than 5 years) and schoolgoing children were followed up on and encouraged to report any AEFIs on day one, 2–3 days, 10 days, and 14 days after vaccination at school by their teachers and at-home, community-based village health teams. Out of 9798 children followed up on, 382 (3.9%) reported at least one AEFI, and in total, 517 AEFIs were reported. For MR, high temperature (21%), general feeling of weakness (19.3%), and headache (13%) were the most reported AEFIs, though there were variations on the days when they were reported. For the combination dose of MR & bOPV, high temperature (44%), rash (17%), general feeling of weakness (13%), and diarrhoea (8%) were the most common adverse events following immunization reported by caretakers. All 382 children cleared the AEFIs within 2 days, with 343 (90%) children reporting mild or moderate AEFIs and only 39 (10%) reporting severe AEFIs. The reported AEFIs are known and are mentioned in the vaccine leaflets with similar severity classification. Rates of AEFIs differed with the number of days after receiving the immunization. Conclusion: Active surveillance for AEFIs provides additional important information to national vaccine regulatory bodies. It reassures the public that vaccines are safe and that their safety is being taken seriously in Uganda, which would improve vaccine acceptability and confidence in the health system. Piggybacking on existing structures such as village health team members (for children at home) and teachers (for schoolgoing children) facilitates reaching vaccine recipients and increases reporting rates. Therefore, studies using active reporting of AEFIs should be conducted at regular intervals to report the overall incidence of AEs and to monitor trends and changes.

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The paper illustrates the development and the application of an active monitoring system, and analyzes the investigated dynamic behaviour of the structure where the system is applied. The system is installed on a 250 m suspended arch steel bridge that has been instrumented with sensors of different type. This work focuses on the employed methodologies and obtained results related to the dynamic monitoring of the bridge. The use of the Operational Modal Analysis techniques with data-driven stochastic subspace identification algorithms allows the extraction of the structural dynamic characteristics: natural frequencies, damping ratios, and mode shapes. These data are in overall accordance with those calculated through the computational model utilized by the active monitoring system. Besides, the definition of a range of scattering of modal parameters, under specific conditions, has been obtained. The bridge has very low vibration frequencies, below 1 Hz for all significant modes. The outcomes indicate that the estimation of dynamic characteristics and the corresponding accuracy is influenced by several factors, including the length of the accelerometric acquisitions and the followed specific procedures. The impact of environmental factors, with particular reference to the temperature, is examined. Compared to the damping ratio, the natural frequency shows higher estimation accuracy and marked sensitivity to the environmental factor. Consequently, in the selection of benchmark for damage detection, it should be taken into account that the two modal parameters have specific criticalities. Once that the modal parameter has been chosen, values outside the estimated uncertainty range can be considered as alarm triggers. [ABSTRACT FROM AUTHOR]

The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer (PCa) randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy. To determine report outcomes according to treatment received in men in randomised and treatment choice cohorts. This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy. Two cohorts included 1643 men who agreed to be randomised; 997 declined randomisation and chose treatment. Health-related quality of life impacts on urinary, bowel, and sexual function were assessed using patient-reported outcome measures. Analysis was carried out based on treatment received for each cohort and on pooled estimates using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores. According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p = 0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p = 0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6 mo) and urinary incontinence (55% at 6 mo) after surgery, and of sexual dysfunction (88% at 6 mo) and bowel dysfunction (5% at 6 mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and outdating of the interventions being evaluated during the lengthy follow-up required in trials of screen-detected PCa. Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group. More than 90 out of every 100 men with localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are much better after active monitoring, but the risks of spreading of prostate cancer are more common. Prostate cancer is very common, affecting about one in nine men during their lifetime, but most do not die or develop complications. The ProtecT trial randomised men with prostate-specific antigen-detected localised prostate cancer to active monitoring (AM), radical prostatectomy, or radiotherapy, and followed them up for 10 yr. We found that >90 out of every 100 men with localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring (AM), surgery, or radiotherapy. Side effects on sexual and bladder function are much better after AM than after radical treatments, but the risks of spreading of prostate cancer are greater after AM. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the cost-effectiveness and quality-adjusted life years (QALYs) of active monitoring (AM), radical prostatectomy (PR), and external-beam radiotherapy with neoadjuvant hormone therapy (RT) for localized prostate cancer. Microsimulations of radical prostatectomy, 3D-conformal radiotherapy, or active monitoring were performed using Medicare reimbursement schedules and clinical trial results for a target population of men aged 50–69 years with newly diagnosed localized prostate cancer (T1-T2, NX, M0) over a time horizon of 10 years. Quality-adjusted life years (QALYs) and costs were assessed and sensitivity analyses performed. Monte Carlo simulations revealed that the mean cost for AM, PR, and RT were $15,654, $18,791, and $30,378, respectively, and QALYs were 6.96, 7.44, and 7.9 years, respectively. The incremental cost-effectiveness ratio (ICER) was $6,548 for PR over AM and $68,339 for RT over PR. Results were sensitive to the number of years of follow-up and procedure cost. With relaxed assumptions for AM, the ICER of PR and RT met the societal willingness to pay (WTP) threshold of $50,000 per QALY. Compared with AM, PR was highly cost-effective. RT and PR for localized prostate cancer can be cost-effective, but RT must offer increased QALYs or decreased procedural costs to be cost-effective compared to PR. Newer and cheaper radiotherapy strategies like stereotactic body radiotherapy may play a crucial role in future early prostate cancer management. [ABSTRACT FROM AUTHOR]

Mammographic screening reduces breast cancer mortality but may lead to the overdiagnosis and overtreatment of low-risk breast cancers. Conservative management may reduce the potential harm of overtreatment, yet little is known about the impact upon quality of life. To quantify women's preferences for managing low-risk screen detected ductal carcinoma in situ (DCIS), including the acceptability of active monitoring as an alternative treatment. Utilities (cardinal measures of quality of life) were elicited from 172 women using visual analogue scales (VASs), standard gambles, and the Euro-Qol-5D-5L questionnaire for seven health states describing treatments for low-risk DCIS. Sociodemographics and breast cancer history were examined as predictors of utility. Both patients and non-patients valued active monitoring more favourably on average than conventional treatment. Utilities were lowest for DCIS treated with mastectomy (VAS: 0.454) or breast conserving surgery (BCS) with adjuvant radiotherapy (VAS: 0.575). The utility of active monitoring was comparable to BCS alone but was rated more favourably as progression risk was reduced from 40% to 10%. Disutility for active monitoring was likely driven by anxiety around progression, whereas conventional management impacted other dimensions of quality of life. The heterogeneity between individual preferences could not be explained by sociodemographic variables, suggesting that the factors influencing women's preferences are complex. Active monitoring of low-risk DCIS is likely to be an acceptable alternative for reducing the impact of overdiagnosis and overtreatment in terms of quality of life. Further research is required to determine subgroups more likely to opt for conservative management. • This is the first study to value the QoL of active monitoring for breast cancer. • Screen detected ductal carcinoma in situ (DCIS) may be subject to overdiagnosis and thus overtreatment. • Women with low-risk DCIS would prefer less invasive treatment in terms of QoL. • Active monitoring is valued an acceptable alternative to surgery and radiotherapy. • More research is needed on how to de-escalate and balance the effects of treatment. [ABSTRACT FROM AUTHOR]

In the case report, we present a case of a 54 years old man with proven low grade prostate cancer who opted for an active monitoring -- active surveillance. We describe the development of the disease in 18 monts with progression -- carcinoma transfer to a higher degree. The patient is monitored according to the recommended schedule for active monitoring to control the levels of PSA, clinical endorectal digital examination and MRI. We present a process dissemination along the peripheral zone with the possible effect of repeated biopsies on the process dissemination. Marginally, we discuss the issue of active surveillance and the ability of MR to detect cancer progression. [ABSTRACT FROM AUTHOR]

Most people is aware that outdoor air pollution can impact human health, including indoor air pollution. Human exposure to air pollutants indicate that indoor levels of pollutants may be two to five times, and occasionally more than 100 times, higher than outdoor levels. These levels of indoor air pollutants are of particular concern because most people spend about 90 percent of their time indoors. In this manuscript we monitored indoor pollutants in a school building with two different methodologies (active and passive monitoring). We demonstrated that, even if in general the registered pollutants showed concentration below the threshold defined by WHO guidelines, the active monitoring is able to catch peaks of concentrations linked to particular school activities, such as educational arts, including single emitting episodes. The use of the monitoring equipment in continuous facilitated the identification of the pollution sources in a timely manner, identifying the impact of the best management practices on the microclimate, and particularly on internal temperature and CO2 concentrations. [ABSTRACT FROM AUTHOR]

In the past two decades, active seismology studies in Russia have made use of powerful (40- and 100-ton) low-frequency vibrators. These sources create a force amplitude of up to 100 tons and function in the 1.5-3, 3-6 and 5-10 Hz frequency bands. The mobile versions of the vibrator have a force amplitude of 40 tons and a 6-12 Hz frequency band. Registration distances for the 100 ton vibrator are as large as 350 km, enabling the refracted waves to penetrate down to 50 km depths. Vibrator operation sessions are highly repeatable, having distinct "summer" or "winter" spectral patterns. A long profile of seismic records allows estimating of fault zone depths using changes in recorded spectra. Other applications include deep seismic profiling, seismic hazard mapping, structural testing, stress induced anisotropy studies, seismic station calibration, and large-structure integrity testing. In more detail, these questions are discussed in reports of our colleagues from Novosibirsk. This report is devoted mainly to powerful low-frequency vibrators, their theoretical description and design. Besides, problems of vibroseismic monitoring of engineering constructions are briefly elucidated.

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Background: Several randomised control trials comparing conservative management (watchful waiting/observation/active monitoring) and radical treatments (radical prostatectomy/radiotherapy) for localised prostate cancer with at least more than 10 years of follow-up (median) have been published with conflicting findings. The primary aim of this study was to determine all-cause mortality and prostate cancer-related mortality between conservative management and radical treatment for localised prostate cancer. Methods: All randomised clinical trials were searched in MEDLINE, EMBASE, PubMed and CENTRAL from their inception until September 2018. Results: Four trials were eligible (n = 3211) for inclusion in the data synthesis. In patients who had radical treatment, the incidence of all-cause mortality and prostate cancer-related mortality (three trials, 3069 patients) were reduced (with odds ratio, i.e. 95% confidence interval (CI)), of 1.37 (1.14–1.64), ρ < 0.001, low quality of evidence and odd ratio (95% CI) of 1.74 (1.31–2.30), ρ < 0.001, low quality of evidence, respectively). The radical treatment group was associated with reduced incidence of distant metastases, the odds ratio (95% CI) being 1.87 (1.48–2.36), ρ < 0.001, low quality of evidence. However, patients who were randomised to radical treatment had a significantly higher incidence of erectile dysfunction (the odds ratio (95% CI) being 0.62 (0.39–0.98), ρ = 0.04, very low quality of evidence) and urinary incontinence (odds ratio (95% CI) of 0.42 (0.21–0.86), ρ = 0.02, very low quality of evidence). Conclusions: In summary, radical treatments reduce all-cause mortality, and prostate cancer-related and distant metastases, at the expense of higher incidence of erectile dysfunction and urinary incontinence. The general quality of evidence ranged from very low to low. Level of evidence: 1a PROSPERO Registration Number: CRD42017072687 [ABSTRACT FROM AUTHOR]

Continuous monitoring of network resources enables to make more-informed resource allocation decisions but incurs overheads. We investigate the trade-off between monitoring costs and benefits of accurate state information for a routing problem. In our approach link delays are modeled by Markov chains or hidden Markov models. The current delay information on a link can be obtained by actively monitoring this link at a fixed cost. At each time slot, the decision maker chooses to monitor a subset of links with the objective of minimizing a linear combination of long-run average delay and monitoring costs. This decision problem is modeled as a Markov decision process whose solution is computed numerically. In addition, in simple settings we prove that immediate monitoring cost and delay minimization leads to a threshold policy on a filter which sums up information from past measurements. The lightweight method as well as the optimal policy are tested on several use-cases. We demonstrate on an overlay of 30 nodes of RIPE Atlas that we obtain delay values close to the performance of the always best path with an extremely low monitoring effort when delays between nodes are modeled with hierarchical Dirichlet process hidden Markov models. [ABSTRACT FROM AUTHOR]