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Child maltreatment (CM) is the abuse and neglect of children under the age of 18 years. Many types of CM lead to actual or potential harm to the child’s health. It is a widespread phenomenon and is well reported in Western countries in contrast with the Gulf countries. Reports documenting CM in Oman are now available; therefore, this review aimed to provide an overview of the state and patterns of CM in Oman. It also addresses the current child protection services (CPS) in Oman and the sociocultural constraints. All English-language relevant medical literature about CM in Oman that were published before January 2020 were included. This review can serve as a basic reference in the field of CM in Oman and should help to identify lacunas in the current CPS as well as provide guidance in the establishment of a more effective one. Keywords: Child Maltreatment; Child Protection Services; Child Advocacy; Oman.

Background Perinatal cannabis use is increasing, and clinician counselling is an important aspect of reducing the potential harm of cannabis use during pregnancy and lactation. To understand current counselling practices, we conducted a systematic review and integrative mixed-methods synthesis to determine “how do perinatal clinicians respond to pregnant and lactating patients who use cannabis?” Methods We searched 6 databases up until 2021-05-31. Eligible studies described the attitudes, perceptions, or beliefs of perinatal clinician about cannabis use during pregnancy or lactation. Eligible clinicians were those whose practice particularly focusses on pregnant and postpartum patients. The search was not limited by study design, geography, or year. We used a convergent integrative analysis method to extract relevant findings for inductive analysis. Results Thirteen studies were included; describing perspectives of 1,366 clinicians in 4 countries. We found no unified approach to screening and counselling. Clinicians often cited insufficient evidence around the effects of perinatal cannabis use and lacked confidence in counselling about use. At times, this meant clinicians did not address cannabis use with patients. Most counselled for cessation and there was little recognition of the varied reasons that patients might use cannabis, and an over-reliance on counselling focussed on the legal implications of use. Conclusion Current approaches to responding to cannabis use might result in inadequate counselling. Counselling may be improved through increased education and training, which would facilitate conversations to mitigate the potential harm of perinatal cannabis use while recognizing the benefits patients perceive.

The current study set out to determine the effect of diving on several physiological variables and stem cells in commercial divers for various years. Twelve divers and six non-divers were divided into three groups: 11 non-divers (1st group), two divers with a diving history of 5-6 years (2nd group), and three divers with a diving history of 9-10 years (3rd group). Physiological measurements of pulse, blood pressure, dynamic breathing functions, stem cells CD34+, and cortisol were performed before and after physical exertion during a day dive at a depth of 25-30 meters in the pressure room. The results showed a significant difference in pulse, blood pressure, stem cells, and cortisol, while no change in dynamic breathing functions after exertion. Further, diving for different years may positively affect biological changes of stem cells CD34+ in the adaptation process but may harm dynamic breathing functions. Therefore, periodic lung function evaluation should be encouraged to check for potential harm to divers. In our conclusion, diving for different years may have a positive effect on biological changes of stem cells CD34+ in the adaptation process, while a negative effect may be induced in a dynamic breathing function. Periodic lung function evaluation should be encouraged to monitor potential harm to the divers.

This article explores the ethical and social challenges in research with children exposed to forced labour, exploitation, and trafficking. It examines whether the participation of children in evidence generation has the potential to affect them and how the researcher avoids potential discomfort. This requires investigating the multiple issues and contexts that affect the children. Essentially, conducting a child-centred evidence generation is ethically reasonable based on how such investigation is carried out and on how a child is affected by the research activities. The process of recruiting participants, avoiding potential harm, ensuring privacy, anonymity and confidentiality corresponds to the best possible regulation, in full respect of the interests of children. What is pursued is a child-centred evidence generation, capable of responding in an acceptable way, from an ethical point of view to the question about the methodology of the research itself. In addition, child-centred research enhances the sharing of perspectives and insights, which break down the barriers of exclusion. Against this background, this article contributes to the identification, interpretation, and clarification of ethical and social questions that arise in relation to child-centred evidence generation. Similarly, it furthers awareness on the significance of ethical reflection and in making informed decisions and choices to mitigate against potential harm to participants during and after the research.

Zusammenfassung. Uber- und Fehlversorgung, mit der entsprechenden Gefahrdung von Patienten und Verschwendung von Ressourcen im Gesundheitswesen, fuhrte vor knapp zehn Jahren zur internationalen «Choosing Wisely» Kampagne (CWC). In der Schweiz startete diese Bewegung 2014 / 15 unter dem Namen «Smarter Medicine» mit einer ersten Top-5-Liste fur die ambulante Allgemeine Innere Medizin (AIM), auf welche Interventionen besser zu verzichten sei. Die Wirksamkeit der internationalen CWC wurde schon fruh in Frage gestellt und ob die «Smarter Medicine» Top-5-Liste fur die ambulante AIM Uber- und Fehlversorgung wirksam reduziert, wissen wir nicht – es gibt kaum Daten dazu. Voraussetzungen dafur, dass Uber- und Fehlversorgung durch CWC wirksam verbessert werden kann, sind die wissenschaftliche Evidenz zu den Verzichtempfehlungen, eine glaubwurdige Herausgeberschaft, verlassliche Daten zur Evaluation und vor allem das Engagement von Offentlichkeit, Patienten, Fachgesellschaften und Gesundheitspolitikern. Ein weiterer Schlusselfaktor fur die spatere erfolgreiche Umsetzung ist der fruhe Einbezug der Anwender bei der Entwicklung von Empfehlungen. Mit diesem Fokus haben wir kurzlich zusammen mit 538 praktizierenden Hausarztinnen und Hausarzten neue Vorschlage von Interventionen entwickelt, auf die besser zu verzichten sei. Diese Vorschlage bilden die Basis fur die nachste Top 5 Liste fur die ambulante AIM. “Smarter Medicine” in ambulatory general internal medicine, at present and in future Abstract. Overuse and inappropriate care resulting in potential harm and unwarranted waste of healthcare resources were leading to the international “Choosing Wisely” campaign (CWC) almost a decade ago. In Switzerland, the movement started 2014 / 15 under the label “Smarter Medicine”, with a top-5 list of interventions better to avoid in ambulatory general internal medicine (GIM). Yet from the beginning of the international CWC campaign, its effectiveness has been questioned, and we don’t know if the “Smarter Medicine” top-5 list for ambulatory GIM efficiently is reducing overuse and inappropriate care, as there is almost no evaluation data available. The prerequisites for an efficient reduction of overuse and inappropriate care are a. the scientific evidence for the recommendations, b. the recommendations coming from a trusted source, c. reliable data for the evaluation, d. the active role of patients, the public, professional healthcare societies and politicians. Another key factor for a successful implementation is the involvement of the final users at an early stage of recommendation development. Keeping this in mind, we recently developed new suggestions for interventions better to avoid, in collaboration with 538 general practitioners. These suggestions lead to a next top-5 list for the ambulatory GIM.

The new U.S. Department of Justice and Federal Trade Commission Vertical Merger Guidelines focus on how vertical mergers are likely to affect static pricing incentives. While vertical mergers can create incentives to increase prices, they can also provide incentives to decrease prices. Which of the possible outcomes is likely to occur depends on details that are generally difficult to measure. Potential competition between dominant firms, the theory of potential harm to competition that the 1984 Department of Justice Merger Guidelines stressed, remains a more compelling rationale for blocking vertical mergers than the likely effect on static pricing incentives.

Statins, a class of lipid-lowering drugs, reduce morbidity and mortality in patients with established atherosclerosis-related cardiovascular disease. Early initiation of statin therapy after admission for acute coronary syndromes (ACS), stroke, or transient ischemic attack (TIA) is associated with improved cardiovascular outcomes. Moreover, high-dose statin treatment prior to coronary or carotid revascularization has been shown to reduce cardiovascular events in these patients. However, many patients may be undertreated, and a residual cardiovascular risk remains in current clinical practice. Despite the beneficial role of statins, their discontinuation rate among patients is still elevated leading to severe adverse cardiovascular events due to atherosclerotic plaque destabilization. In this review, we summarized the impact of statin treatment among patients, focusing on the initiation time-points as well as the potential harm derived by their discontinuation.

In this commentary, we examine whether we should reconsider the widespread use of the words ‘cancer prevention’ and replace them with the words ‘cancer risk reduction’. Our recommendation is because ‘risk reduction’ more accurately reflects what we know from cancer research, but more importantly recognizes the confusion and potential harm to patients from the inaccurate use of the words ‘cancer prevention’.

Analgesia within the intensive care unit (ICU) is often achieved via the utilization of opioids in alignment with current guidelines. Recent evidence has not only demonstrated the potential impact of opioids in suppression of immune function, but also the potential harm of immunosuppression of patients within the ICU. Despite the potential immunosuppression seen with opioids in this at-risk population, their use remains frequent. In this review, we highlight the potential immunomodulatory impact of opioids within the critically ill and considerations for their use.

The aim of this study was to investigate whether biomarkers of exposure (BoE) and potential harm (BoPH) are modified when smokers switch from smoking cigarettes to exclusive use of a tobacco heating product (THP) in an ambulatory setting. Participants in this randomised, controlled study were healthy volunteer smokers assigned either to continue smoking or switch to a THP, and a control group of smokers who abstained from cigarette smoking. Various BoE and BoPH related to oxidative stress, cardiovascular and respiratory diseases, and cancer were assessed at baseline and up to 180 days. In continuing smokers, BoE and BoPH remained stable between baseline and day 180, while THP users’ levels of most BoE reduced significantly, becoming similar to those in controls abstaining from cigarette smoking. Also at 180 days, significant changes in numerous BoPH, including total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, 8-epi-prostaglandin F2α type III, fractional concentration of exhaled nitric oxide and white blood cell count, were directionally consistent with lessened health impact. Our findings support the notion that the deleterious health impacts of cigarette smoking may be reduced in smokers who completely switch to using THPs. Supplementary Information The online version contains supplementary material available at 10.1007/s11739-021-02798-6.

Introduction: Anticoagulants are associated with significant harm when used in error, but there are limited data on potential harm of inappropriate treatment with direct oral anticoagulants (DOACs). We conducted a matched case-control study among atrial fibrillation (AF) patients admitting the hospital with a chronic treatment with DOACs, in order to assess factors associated with the risk of major bleeding. Methods: Patient data were documented using hospital’s computerized provider order entry system. Patients identified with major bleeding were defined as cases and were matched with controls based on the duration of treatment with DOACs and number of chronic medications. Appropriateness of prescribing was assessed based on the relevant clinical guidelines. Conditional logistic regression was used to evaluate the potential impact of safety-relevant prescribing errors with DOACs on major bleeding. Results: A total number of 509 eligible admissions were detected during the study period, including 64 cases of major bleeding and 445 controls. The prevalence of prescribing errors with DOACs was 33%. Most prevalent prescribing errors with DOACs were “drug dose too low” (16%) and “non-recommended combination of drugs” (11%). Safety-relevant prescribing errors with DOACs were associated with major bleeding [adjusted odds ratio (aOR) 2.17, 95% confidence interval (CI) 1.14-4.12]. Conclusion: Prescribers should be aware of the potential negative impact of prescribing errors with DOACs and understand the importance of proper prescribing and regular follow-up.

Background: While smokeless tobacco (ST) causes oral cancer and is associated with cardiovascular diseases, less is known about how its effects differ from other tobacco use. Biomarkers of potential harm (BOPH) can measure short-term health effects such as inflammation and oxidative stress. Methods: We compared BOPH concentrations [IL6, high-sensitivity C-reactive protein, fibrinogen, soluble intercellular adhesion molecule-1 (sICAM-1), and F2-isoprostane] across 3,460 adults in wave 1 of the Population Assessment of Tobacco and Health study (2013–2014) by tobacco use groups: primary ST users (current exclusive ST use among never smokers), secondary ST users (current exclusive ST use among former smokers), exclusive cigarette smokers, dual users of ST and cigarettes, former smokers, and never tobacco users. We estimated geometric mean ratios using never tobacco users, cigarette smokers, and former smokers as referents, adjusting for demographic and health conditions, creatinine (for F2-isoprostane), and pack-years in smoker referent models. Results: BOPH levels among primary ST users were similar to both never tobacco users and former smokers. Most BOPH levels were lower among ST users compared with current smokers. Compared with never tobacco users, dual users had significantly higher sICAM-1, IL6, and F2-isoprostane. However, compared with smokers, dual users had similar biomarker levels. Former smokers and secondary ST users had similar levels of all five biomarkers. Conclusions: ST users have lower levels of inflammatory and oxidative stress biomarkers than smokers. Impact: ST use alone and in combination with smoking may result in different levels of inflammatory and oxidative stress levels.

Background In contrast to cigarettes, electronic cigarette use (E-cigarettes) has grown substantially over the last decade. This is due to their promotion as both a safer alternative to cigarettes and as an aide to stop smoking. Critically, upon E-cigarette use, the user may be exposed to high doses of nicotine in addition to other compounds including flavouring chemicals, metal particulates and carbonyl compounds, particularly in highly vascularised tissues such as bone. However, there has been limited investigation into the impact of E-cigarette usage on bone physiology, particularly over extended time periods and there are no clinical recommendations regarding E-cigarette usage in relation to orthopaedic surgery. This literature review draws together data from studies that have investigated the impact of E-cigarette vapour and its major constituents on bone, detailing the models utilised and the relevant mechanistic and functional results. Main body Currently there is a lack of studies both in vivo and in vitro that have utilised E-cigarette vapour, necessary to account for changes in chemical composition of E-cigarette liquids upon vaping. There is however evidence that human bone and bone cells express nicotine receptors and exposure of both osteoblasts and osteoclasts to nicotine, in high concentrations may reduce their viability and impair function. Similarly, it appears that aldehydes and flavouring chemicals may also negatively impact osteoblast viability and their ability to form bone. However, such functional findings are predominantly the result of studies utilising bone cell lines such as MG-63 or Saos-2 cells, with limited use of human osteoblasts or osteoclasts. Additionally, there is limited consideration for a possible impact on mesenchymal stem cells, which can also play an import role in bone repair. Conclusion Understanding the function and mechanism of action of the various components of E-cigarette vapour in mediating human bone cell function, in addition to long term studies to determine the potential harm of chronic E-cigarette use on human bone will be important to inform users of potential risks, particularly regarding bone healing following orthopaedic surgery and injury.

Background A gradual number of hazardous substances may exist in food, posing a threat to consumers health. Traditional immunoassays, such as enzyme-linked immunosorbent assays (ELISA), lateral flow immunoassays (LFI), and chemiluminescence immunoassays (CLI) have been widely applied to analyze different hazards in food samples to ensure food safety. However, due to the low sensitivity and accuracy, the further application of traditional immunoassays was limited. Scope and approach In this review, the classification and potential harm of hazards in food were listed, while the principles and applications of ELISA, LFI, and CLI for the detection of different hazards in food samples were illustrated. Furthermore, to improve the detection performance, such as sensitivity and accuracy, we introduced the developmental trend of traditional immunoassays systematically. This review provided a comprehensive understanding of immunoassays for the detection of hazards in food samples. Key findings and conclusions Recent studies have utilized novel strategies to improve the performance of immunoassays. Typically, creating novel signal labels, and improving the support for signal labels, high-quality monoclonal antibody, specific recognition elements, heterologous detective antigen, and detection platform were comprehensively proposed. The future immunoassays should be ultrasensitive and multiple detection.

Electromagnetic interference (EMI) shielding materials are effective in eliminating unwanted electromagnetic interference and reduce the potential harm to human health. Among them, the EMI shieldin...

Objective After an initial medical misadventure, failure of recognition and continuing factors that could perpetuate the error are examined. Methods A critical evaluation of the continuum of care after the initial error was conducted through chart review and comparison to published standards. Results Analysis of the continuum of care after the original error demonstrated numerous system failures that should have alerted the providers to the initial error. Discussion Technology, electronic medical records, lack of critical communications, and short cuts have the potential to not recognize patient care safety issues and potential harm. Conclusions Medical errors are multifactorial. Blame casting and accusations are not productive. Critical analysis of systems/processes, current technology, eliminating shortcuts, and critical communications may increase patient safety.

Introduction Most adult cigarette smokers who use e-cigarettes are dual cigarette and e-cigarette (CC-EC) users, yet little is known about relative consumption of cigarettes to e-cigarettes and any associated harm reduction. Methods Rate of substitution from cigarettes to e-cigarettes at week 6 and change in biomarkers of exposure and potential harm were examined among dual dual cigarette and e-cigarette users [64/114 (56%); 35 Black, 29 Latino] in an e-cigarette switching randomized trial. Results Dual users averaged 79% substitution of cigarettes for e-cigarettes at week 6, resulting in a reduction from baseline of 70.0 ± 54.1 cigarettes per week (p < .001). Total nicotine consumption remained stable (baseline: 1160.5 ± 1042.1 pg/mL of cotinine, week 6: 1312.5 ± 1725.9 pg/mL of cotinine, p = .47), while significant reductions were seen in the potent lung carcinogen 4-(methylnitrosamino)-1-(3-pyridul)-1-butanol (NNAL) (-55.9 ± 88.6 ng/ml, p < .001), carbon monoxide (-6.3 ± 8.6 ppm, p < .001), and self-reported respiratory symptoms (−3.3 ± 8.0, p = .002). No significant changes were found in blood pressure or spirometry. Greater substitution from cigarettes to e-cigarettes was associated with larger reductions in NNAL (r = −.29, p = .02). Conclusions The predominant dual-use pattern was characterized by regular e-cigarette and intermittent cigarette use. Findings demonstrate the short-term harm reduction potential of this dual-use pattern in Black and Latino smokers and suggest that the greatest benefit, aside from cessation of both products, is achieved by higher substitution of e-cigarettes for cigarettes. Findings need confirmation in a larger sample with longer follow-up in dual users with greater variability in the rate of substitution. ClinicalTrials.gov Identifier NCT03511001 Implications Findings suggest short-term harm reduction potential of dual cigarette-e-cigarette use for Black and Latino smokers. Results also demonstrate the heterogeneity of dual-use, with the greatest harm reduction seen in dual users with higher rates of substitution from cigarettes to e-cigarettes. Study results should be confirmed in a full clinical trial with long-term follow-up to evaluate maintenance of dual-use patterns and associated harm reduction potential over time.

Schwannoma of the brachial plexus can be present as a painless swelling without an upper limb functional or sensitivity deficiency. Thorough examinations, including MRI, are necessary to identify the nerves of origin and prevent potential harm.

It is very important to study the occurrence of high levels of particulate matter due to the potential harm to people's health and to the environment. In the present work we use a non-homogeneous Poisson model to analyse the rate of exceedances of particulate matter with diameter smaller that 2.5 microns (PM2.5). Models with and without change-points are considered and they are applied to data from Bogota, Colombia, and Mexico City, Mexico. Results show that whereas in Bogota larger particles pose a more serious problem, in Mexico City, even though nowadays levels are more controlled, in the recent past PM2.5 were the ones causing serious problems.

Despite aquatic invasive species (AIS) being a widely recognized threat to native biodiversity in streams on subtropical and tropical oceanic islands across the Pacific, AIS management has been constrained by concerns that methods of removal could result in more harm than good. In this study, we assessed the effectiveness and outcomes of combining hand-netting and streamside sequestration of native species with AIS removal via three-pass electrofishing tailored for Hawaiian Island watersheds. Removals were conducted in 13 watersheds on the island of O‘ahu following a before-after, control-impact design to assess how AIS removal and post-removal community reassembly varied by surface flow and target species of interest. We found that removals resulted in a sharp reduction in AIS densities without altering native species densities. Removal efficacy was greatest in streams with intermediate mean discharge irrespective of target group or pre-removal AIS densities. Long-term monitoring demonstrated that removals led to persistent shifts in community composition reflecting sustained reductions in AIS densities. These findings indicate that electrofishing can be a valuable tool for AIS management in Hawaiian and other subtropical Pacific island streams, so long as steps are taken to minimize potential harm to at-risk and culturally important native species.

In Korean women, a westernized lifestyle is associated with an increased risk of breast cancer. Fertility preservation has become an increasingly important issue for women with breast cancer, in accordance with substantial improvements in survival rate after cancer treatment. The methods of controlled ovarian hyperstimulation (COH) for fertility preservation in breast cancer patients have been modified to include aromatase inhibitors to reduce the potential harm associated with increased estradiol levels. Random-start COH and dual ovarian stimulation are feasible options to reduce the total duration of fertility preservation treatment and to efficiently collect oocytes or embryos. Using a gonadotropin-releasing hormone agonist as a trigger may improve cycle outcomes in breast cancer patients undergoing COH for fertility preservation. In young breast cancer patients with BRCA mutations, especially BRCA1 mutations, the possibility of diminished ovarian reserve may be considered, although further studies are necessary. Herein, we review the current literature on the practical issues surrounding COH for fertility preservation in women with breast cancer.

Waste electrical and electronic equipment (WEEE) has become one of the major global concerns in solid waste management due to its continuously increasing volume and adverse effects on the environment and human health. This study aims to use the relative potential risk as a specific device to prioritize 8 WEEE types in Thailand based on contents and toxicity of toxic metals in printed circuit boards (PCBs), including arsenic, cadmium, chromium, copper, and lead, in terms of potential harm indicator (PHI) and quantity of PCBs. The results indicated that the most significant type of WEEE based on relative potential risk is liquid crystal display television, while the least significant types of WEEE are refrigerator and washing machine. However, PCBs also contain precious metals (gold, silver, and palladium) which are crucial for WEEE recycling economy. Thus, the ratio between precious metals and toxic heavy metal was determined as a simple tool to assess the cost and benefit. According to the results, mobile phone has been the highest economic wealthiest while refrigerator has been the lowest. The findings in this study will be useful as a tool for policy makers to decide the sustainable WEEE management.

Purpose: To study the features of the clinical and functional state of the eyes in children after laser damage to the retina. Material and methods: We examined six patients who incurred retinal photodamage (nine eyes) after using a laser pointer. Results: It was shown that laser-induced damage to the macula led to a decrease in vision in five of the nine eyes, which correlated with changes in the parameters of the rhythmic and macular electroretinogram. The main pathognomonic symptom of photo damage to the macula is the presence of signs of local destruction of the pigment epithelium and the ellipsoid zone of the retina, according to optical coherence tomography (OCT). In two cases, after a macular burn, a neovascular membrane formed, which led to an irreversible decrease in vision. Conclusion: Uncontrolled use of household laser devices (pointers) by children can lead to severe visual impairment. For this reason, the main priority should be prevention, conducting active sanitary and educational work, informing teachers, parents, and children about the potential harm, and timely detection and treatment of retinal photodamage.

Background: Relationships between cigarette filter ventilation levels, biomarkers of exposure (BOE) and potential harm (BOPH), and harm perceptions were examined. Methods: Filter ventilation levels in cigarette brands were merged with Wave 1 (2013–2014) Population Assessment of Tobacco Use and Health study. Data were restricted to smokers who reported a usual brand and not regular users of other tobacco products. BOEs included nicotine, tobacco-specific nitrosamines, volatile organic compounds (VOC), and polycyclic aromatic hydrocarbons. BOPHs measured inflammation and oxidative stress. Perceived harm was assessed as self-reported risk of one's usual brand compared with other brands. Results: Filter ventilation ranged from 0.2% to 61.1% (n = 1,503). Adjusted relationships between filter ventilation and BOE or BOPH were nonsignificant except for VOC N-acetyl-S-(phenyl)-L-cysteine (PHMA) and high-sensitivity C-reactive protein (hsCRP). In pairwise comparisons, PHMA was higher in quartile (Q) 4 (4.23 vs. 3.36 pmol/mg; P = 0.0103) and Q3 (4.48 vs. 3.36 pmol/mg; P = 0.0038) versus Q1 of filter ventilation and hsCRP comparisons were nonsignificant. Adjusted odds of perceiving one's own brand as less harmful was 26.87 (95% confidence interval: 4.31–167.66), 12.55 (3.01–52.32), and 19.18 (3.87–95.02) times higher in the Q2, Q3, and Q4 of filter ventilation compared with Q1 (P = 0.0037). Conclusions: Filter ventilation was not associated with BOE or BOPH, yet smokers of higher ventilated cigarettes perceived their brand as less harmful than other brands compared with smokers of lower ventilated cigarettes. Impact: Research to understand the impact of this misperception is needed, and remedial strategies, potentially including a ban on filter ventilation, are recommended.

Glycidyl ester (GE) has attracted worldwide attention due to its potential harm to human health. The GE in edible oil forms during the deodorization process of the oil refining, where antioxidants are used to inhibit its formation. To replace unsafe conventional synthetic antioxidants with natural antioxidants, sesame oil (SO) was used to inhibit the formation of GE in corn oil (CO), palm oil (PO), and rice bran oil (RO) during the deodorization process. The results showed that the content of GE in SO, CO, PO and RO followed the decreasing order of RO (1395.88 μg/kg) > PO (376.84 μg/kg) > CO (303.24 μg/kg) > SO (133.19 μg/kg). The concentration of diacylglycerol (DAG) in SO, CO, PO and RO followed the decreasing order of RO (11.64%) > PO (7.56%) > CO (4.11%) > SO (2.59%). The content of GE in oil could be affected by at least three factors: (i) unsaturated fatty acids could promote the formation of GE in oil; (ii) antioxidants in oil could inhibit the formation of GE by scavenging free radicals; and (iii) DAG, as a precursor, could lead to the formation of GE. This result suggested that SO could inhibit the formation of GE in CO, PO and RO. This indicated that when SO was added at 50%, its inhibitory effect was equivalent to that of tert-butylhydroquinone added at 0.02%.

Purpose of review To review the mechanisms how intermittent feeding regimens could be beneficial in critically ill patients. Recent findings Large randomized controlled trials (RCTs) have failed to demonstrate consistent benefit of early, enhanced nutritional support to critically ill patients, and some trials even found potential harm. Although speculative, the absence of a clear benefit could be explained by the continuous mode of feeding in these trials, since intermittent feeding regimens had health-promoting effects in healthy animals and humans through mechanisms that also appear relevant in critical illness. Potential protective mechanisms include avoidance of the muscle-full effect and improved protein synthesis, improved insulin sensitivity, better preservation of circadian rhythm, and fasting-induced stimulation of autophagy and ketogenesis. RCTs comparing continuous versus intermittent feeding regimens in critically ill patients have shown mixed results, albeit with different design and inclusion of relatively few patients. In all studies, the fasting interval was relatively short (4-6 h maximum), which may be insufficient to develop a full fasting response and associated benefits. Summary These findings open perspectives for the design and clinical validation of intermittent feeding regimens for critically ill patients. The optimal mode and duration of the fasting interval, if any, remain unclear.

There has been significant progress in detection of bloodstream pathogens in recent decades with the development of more sensitive automated blood culture detection systems and the availability of rapid molecular tests for faster organism identification and detection of resistance genes. However, most blood cultures in clinical practice do not grow organisms, suggesting that suboptimal blood culture collection practices (e.g., suboptimal blood volume) or suboptimal selection of patients to culture (i.e., blood cultures ordered for patients with low likelihood of bacteremia) may be occurring. A national blood culture utilization benchmark does not exist, nor do specific guidelines on when blood cultures are appropriate or when blood cultures are of low value and waste resources. Studies evaluating the potential harm associated with excessive blood cultures have focused on blood culture contamination, which has been associated with significant increases in health care costs and negative consequences for patients related to exposure to unnecessary antibiotics and additional testing. Optimizing blood culture performance is important to ensure bloodstream infections (BSIs) are diagnosed while minimizing adverse events from overuse. In this review, we discuss key factors that influence blood culture performance, with a focus on the preanalytical phase, including technical aspects of the blood culture collection process and blood culture indications. We highlight areas for improvement and make recommendations to improve current blood culture practices among hospitalized patients.

Recently some general agreements have been achieved regarding the current status of work addiction. One of the key criteria for conceptualizing a behavioral addiction is the harm caused by the behavior. It has been argued that in the case of work addiction, special attention should be devoted to the potential harm that the behavior causes for the recipients of the work or coworkers. This paper constitutes a narrative literature review of the literature suggesting an association between work addiction of a manager and harm caused to other employees and recipients of their work. Based on this review, it can be concluded that the existing data provide strong premises suggesting that work-addicted managers may cause significant harm to themselves, other employees, organizations, and recipients of their work. It includes potential indirect effects through creating an environment conducive to work addiction and its consequences among employees. However, there are very few studies directly investigating the harm and costs caused by work-addicted managers. This paper constitutes an attempt to integrate certain aspects of clinical and organizational research into work addiction and stimulate further integrations in this area.

Human papillomavirus (HPV) is the most common sexually transmitted disease in the U.S. Data on knowledge, attitudes, and beliefs related to HPV vaccination among college students are limited. The purpose of this study was to provide a comprehensive description of the variables influencing HPV vaccination uptake and intention among college students. This study employed a cross sectional descriptive quantitative design. Survey data were collected online from the 181 college students, aged 18-25 years. The data were analyzed to identify the students' attitudes toward HPV vaccine (perceived potential harm, effectiveness, barriers, and uncertainty), knowledge of HPV and HPV vaccine, and their intention of receiving the vaccine in the next 6 months. Descriptive statistics, Chi-square tests, ANOVA, and logistic regressions were conducted to examine the correlates of vaccination intention and uptake. Among 181 participants, 101 (55.8%) were had received at least one dose of HPV vaccine, 52 (28.7%) intended to receive HPV vaccine, and 28 (15.5%) did not intend to receive HPV vaccine. On average, participants responded correctly to less than half of the questions on the HPV knowledge and HPV vaccine knowledge scales, and those who were vaccinated were significantly more knowledgeable than their counterparts. Multivariate logistic regression showed HPV vaccine knowledge and uncertainty were significant factors associated with HPV vaccine uptake. Providing education designed to improve HPV and HPV vaccination knowledge and decrease feelings of uncertainty could improve college students' HPV vaccination uptake.

We have tested the feasibility of thermal grills, a harmless method to induce pain. The thermal grills consist of interlaced tubes that are set at cool or warm temperatures, creating a painful “illusion” (no tissue injury is caused) in the brain when the cool and warm stimuli are presented collectively. Advancement in objective pain assessment research is limited because the gold standard, the self-reporting pain scale, is highly subjective and only works for alert and cooperative patients. However, the main difficulty for pain studies is the potential harm caused to participants. We have recruited 23 subjects in whom we induced electric pulses and thermal grill (TG) stimulation. The TG effectively induced three different levels of pain, as evidenced by the visual analog scale (VAS) provided by the subjects after each stimulus. Furthermore, objective physiological measurements based on electrodermal activity showed a significant increase in levels as stimulation level increased. We found that VAS was highly correlated with the TG stimulation level. The TG stimulation safely elicited pain levels up to 9 out of 10. The TG stimulation allows for extending studies of pain to ranges of pain in which other stimuli are harmful.

Deprescribing has mostly developed in older adult care as a strategy to reverse the potential harm to older adults of receiving too many inappropriate medicines. There are many studies in older adult care that show that by deprescribing medicines, prescribers are able to improve patient function, generate a higher quality of life, and reduce bothersome signs and symptoms. However, there have been few comparable studies in mental health. Overprescribing or inappropriate prescribing has also become an issue for mental health care. However, it commonly relates to psychotropic medicines and, in particular, to antidepressants, benzodiazepines, z hypnotics, antiepileptics, such as pregabalin, and to multiple psychotropic prescribing. In other areas of therapy associated with physical health, the concerns have generally been those of under prescribing. This paper discusses how relevant deprescribing is to mental health care and some of the issues to consider.

Objectives: Errors in medication administration are common, with many interventions suggested to reduce them. For intravenous infusion–related errors, “smart infusion devices” incorporating dose error reduction software are widely advocated. Our aim was to explore the role of smart infusion devices in preventing or contributing to medication administration errors using retrospective review of 2 complementary data sets that collectively included a wide range of errors with different levels of actual or potential harm. Methods: We reviewed 216 medication administration errors identified from an observational study in clinical practice and 123 medication incidents involving infusion devices reported to a national reporting system. The impact of smart infusion devices in preventing or contributing to these errors was assessed by the research team and an expert panel. Results: The data suggest that use of any infusion device rather than gravitational administration may have prevented 13% of observed errors and 8% of reported incidents; additional reductions may be possible with standalone smart infusion devices, and further potential reductions with smart infusion devices integrated with electronic prescribing and barcode administration systems. An estimated 52% to 73% of errors that occurred with traditional infusion pumps could be prevented with such integrated smart infusion devices. In the few cases where smart infusion devices were used, these contributed to errors in 2 of 58 observed errors and 7 of 8 reported incidents. Conclusions: Smart infusion devices not only prevent some medication administration errors but can also contribute to them. Further evaluation of such systems is required to make recommendations for policy and practice.

Objective. To share the experience of endovascular interventions in pregnant women and women in labor, gained by national team “obstetric cardiology”. Materials and methods. The algorithm of medical support was presented, including the cases of cardiosurgical interventions performance , for pregnant women with critically severe pathology of the heart, which was based on actual recommendations and own experience. Into the clinic of Amosov National Institute of Cardiovascular Surgery during 6.5 yrs (12.2013 - 05.2020) 145 women-patients were admitted to hospital, in 79 of them cardiosurgical intervention was done. Endovascular cardiosurgical operations were performed in 36 patients, and the hybrid - in 2. Urgent and emergency endovascular interventions were performed in 17 women-patients with various terms of pregnancy (15 - 35 weeks) and in 2 women in labor. Conditionally-elective cardiosurgical interventions were performed in 17 women-patients on various terms of pregnancy (as a rule, in II trimester) and in 2 women in labor. In 34 patients the interventions were performed with fetus in utero. Early and late maternal mortality was absent. One «programmed» loss of the fetus have occurred on 12-th week of pregnancy with the inborn heart failure. Modern views on impact of ionized radiation and contrast substances on fetus were presented, and the methods of lowering of their potential harm. Conclusion. There was trusted, that while applying strict indications for performance of endovascular interventions during pregnancy, these methods of diagnosis and treatment are more secure in comparison with «open» operative interventions and may be performed under supervision of experienced multidisciplinary team, taking into account the pregnancy term and the fetus defense.

In the current study we sought to examine the relationships between workaholism, work-leisure conflict, and work stress. Workaholism is related to many negative consequences to both the employee and the organization. It is vital, then, to examine these outcomes in order to find ways to reduce potential harm. As such, self-report measures were used to study whether work-leisure conflict would strengthen the relationship between workaholism and work stress, and if work-leisure conflict acts as a mediator between workaholism and work stress. The sample consisted of 346 working adults from various occupations and backgrounds. The results indicated workaholism was positively correlated with work stress. Additionally, work leisure conflict was positively correlated with both workaholism and work stress. Moreover, work-leisure conflict was a significant mediator between workaholism and work stress, however, the results did not indicate a moderation effect for work-leisure conflict on the relationship between workaholism and work stress. Organizational implications, limitations, and future directions are discussed.

Purpose: The marketing effort of e-cigarettes producers makes youths and adolescents less alert about the potential harm of e-cigarettes. The trend of e-cigarette use among vocational school students becomes increasingly severe in China. This study is to reveal the psychological process that plays a critical role in affecting students’ e-cigarette susceptibility. Method: This study uses the time-lagged data collected from 835 vocational school students in China and the structural equation modelling. Findings: This study finds that the more inclusive attitude towards e-cigarettes makes vocational school students more easily undertake the cognitive process of disengagement belief, which in turn can boost the level of their e-cigarette susceptibility. In addition, such mediation process is shown to be weaker for those displaying the high-level e-cigarette health literacy. Implications: In the future, it is essential to help youths and adolescents built a correct understanding of e-cigarettes from multisource (e.g., schools and governments).

Background Food can readily be tainted by pathogenic microorganisms, turning it into a stigmatized poison with potential harm to the consumer. To date, 31 identified and countless unidentified pathogens have been reported as accountable for foodborne illness globally. Approximately 66% of illnesses originate solely from pathogenic bacteria, and the association of these microorganisms in mono- and mixed-biofilms may increase bacterial intoxication and infection-linked problems in humans. Scope and approach Bacterial species live in close proximity to each other, share matrix components, and build three-dimensional rigid biofilm structures in nature. Due to their strong phenotypic heterogeneity and natural resistance to common sanitizers and disinfectants, mono- and mixed-bacterial biofilms can remain in food and on the surfaces of food processing appliances after sanitizing treatment. Green synthesis of “eco-friendly” anti-biofilm agents has become the necessary response to the occurrence of mono- and mixed-bacterial biofilms, in order to avoid the negative effects of conventional chemical and physical approaches on human health and the environment. Key findings and conclusions Advanced research has already proved the potential and efficacy of several microbe-derived anti-biofilm agents. This current review investigates the concerns associated with both mono- and mixed-bacterial biofilms and their control by biological anti-biofilm agents in different food industries. Moreover, this review highlights the recent achievements, existing limitations, and possible technical suggestions for further development of broad-spectrum microbe-derived anti-biofilm agents for the food industry.

Over 50 years ago, Silent Spring awoke the world to the environmental and human health risks of the era’s pesticides. Industry pushed back, but eventually many of these chemicals were banned. Although this was a victory, similar battles play out each time evidence surfaces about the potential harm of new agrochemicals.

Background: Traditionally, safety and improving safety in the treatment of pregnant women has involved identifying risks that lead to errors or adverse events, and implementing strategies to mitigate potential harm. There is research that suggests that other factors such as a lack of service, lack of care or a lack of quality also contribute to participants feeling unsafe. Currently there is no evidence-based research on the psychological aspects of the safety of massage during pregnancy. Purpose: The present study aim was to investigate women’s perceptions and experiences of the safety of massage during pregnancy. This included exploring what attributes of the clinician or practice and events that occur during the massage helped pregnant women feel safe. Setting: Phone interview with participants from Victoria, New South Wales and Queensland. Participants: 20 women who received massage whilst pregnant. Research Design: Qualitative design using thematic analysis. Results: There were five main themes related to safety and massage: 1) Autonomy— able to voice my needs and be heard; 2) Pregnancy massage is more than just a massage; 3) When my therapist is experiencedand qualified, I feel safer; 4) The continuity of the massage industry’s message about the safety of massage; and 5) Decision-making around massage safety. Conclusions: Safety is made up of not only the treatment that massage therapists provide, but also the environment they provide it in and how they administer both the treatment and the consultation. The lack of cohesion in messaging about the safety of massage during pregnancy makes women doubt the safety of massage.

OBJECTIVE: To compare the 2015 and 2019 AGS Beers Criteria® of potentially inappropriate medications in the elderly. DATA SOURCES: American Geriatrics Society 2015 and 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication (PIM) Use in Older Adults published literature. STUDY SELECTION/DATA EXTRACTION: The literature was reviewed, compared, and summarized to identify pertinent changes and updates to the AGS Beers Criteria of PIMs in the elderly. DATA SYNTHESIS: The AGS Beers Criteria® contains a list of potentially inappropriate medications that should be used with caution, avoided, notable drug-drug interactions, and drugs that should be dose-adjusted based on kidney function in the older adult. The updated AGS Beers Criteria® also includes removal of medications that are no longer sold in the United States, have a low usage rate, provide low evidence of harm, and/or the potential harm is not unique to the older adult. CONCLUSION: The AGS Beers Criteria® is intended to improve and optimize the care of the geriatric population. It serves as a guide to minimize older adults' exposure to PIMs whenever possible. As with previously published updates to the AGS Beers Criteria®, the 2019 update outlines the following: recommendations, rationale, and quality of the recommendations, as well as the strength of the recommendations.

This study focuses on how anomalies advocate in money laundring practices in Indonesia by providing analysis of the law and reporting functions in government regulation No. 43 year 2015. Government Regulation No. 43 year 2015 is obliging the advocate profession to report suspicious financial transactions to the PPATK. This research also aims to determine the implementation of PPATK in carrying out its duties as one of the institutions that supervise the travel flow of financial funds in Indonesia, especially from various professions that have potential harm to the country, Besides, also know the policies and applications and attitudes of the advocacy profession who are often involved in the practice of money laundring, as well as the conflict of interest that occurs from the PPATK with the advocate. This certainly caused PPATK to see the flow of funds often clash between the law and government regulation number 43 year 2015. With this law the confidentiality of the advocate profession has been assured, because the advocate has an internationally known lawyer-client privilege principle , which is not to convey the Considered confidential (confidential) except for the permits or orders of his clients so feared from this clash suspected the occurrence of business to do money laundring practices.

The belief that, for the individual patient, the benefit of prompt and continued use of antimicrobials outweighs any potential harm is a significant barrier to improved stewardship of these vital agents. Antimicrobial stewardship may be perceived as utilitarian rationing, seeking to preserve the availability of effective antimicrobials by limiting the development of resistance in a manner which could conflict with the immediate treatment of the patient in need. This view does not account for the growing evidence of antimicrobial-associated harm to individual patients. This review sets out the evidence for antimicrobial-associated harm and how this should be balanced with the need for prompt and appropriate therapy in infection. It describes the mechanisms by which antimicrobials may harm patients including: mitochondrial toxicity; immune cell toxicity; adverse drug reactions; selection of resistant organisms within a given patient; and disruption of the microbiome. Finally, the article indicates how the harms of antimicrobials may be mitigated and identifies areas for research and development in this field.

The marked decrease in the number of mainland tourists visiting Taiwan may turn from a temporary phenomenon to a normalized one because of the potential harm it represents to the Taiwan tourism ind...

It is undeniably a great challenge to adequately weigh the benefits and harms of tumor-specific therapy near the end of life and to find the right time for changing the objective of therapy to palliative care alone. In a curative situation, the “survival” benefit of the treatment outweighs its potential harm due to side effects. However, things are different when the possibility of cure is ruled out. Important prerequisites to avoid overly zealous care are adequate communication about the therapeutic options and consensus between the doctor and the patient with regard to the (realistic) therapeutic goal, a realistic estimated prognosis and early integration of palliative care.