Understanding the Variable Drivers of Toxicity for the Broad Class of Carbon Nanotubes and Nanofibers from U.S. Facilities

Pulmonary exposure to carbon nanotubes or nanofibers (CNT/F) is known to induce inflammation, toxicity, or tumorigenesis, and is a concern in the occupational setting. U. S. facility employees are at risk of inhalation exposure of multi-walled carbon nanotubes and carbon nanofibers during primary and secondary manufacturing. To date, only one MWCNT, Mitsui-7 has been classified as possibly carcinogenic to humans (Group 2B), while all other materials were subsequently categorized as unclassifiable (Group 3). This class of material has recently been listed as a high priority to the International Agency for Research on Cancer due to this significant knowledge gap. Furthermore, expressed desire to better understand the toxicity profiles of these materials has emerged from the National Institute for Occupational Safety and Health. While human research to date is limited, the use of in in vivo and in vitro model systems can be implemented for the assessment of toxicity outcomes following respiratory exposure to CNT/F. The goal of this study was to generate an accurate an effective safety profile of MWCNT and CNFs from U. S. facilities, and to adapt a multi-disciplinary approach using machine learning to identify pertinent physicochemical characteristics that act as drivers of these toxicity outcomes. This study established toxicity profiles from male C57BL6/J mice aged 8-10 weeks exposed to either 4 or 40 µg of one of nine different CNT/F via oropharyngeal aspiration as well as human epithelial BEAS-2B cells (0-24 µg/ml), differentiated THP-1 cells (0-120 µg/ml), and human fibroblasts (0-2 µg/ml) for four primary outcomes of genotoxicity, inflammation, pathology, and translocation. The nine materials used in this study had a wide range of characteristics including diameter (6-397 nm), length (0.1-50 µm), surface area (18-238 m2/g), aspect ratio (2-1396), residual metal catalyst (0.3-6.2 %), density (0.007-0.220 g/cm3), etc., to consider. Toxicity profiles were generated regarding these four primary toxicity outcomes, and both supervised and unsupervised machine learning was used to identify the key drivers of these adverse health effects. While some physicochemical characteristics were determined to be key drivers of specific toxicity outcomes, different characteristics were essential when considering other toxicity endpoints. No single characteristic could be used as a toxicity predictor, therefore, multifactorial processes, or combination of characteristics, were necessary for an accurate and effective prediction model for responses. The study identified physicochemical drivers of CNT/F toxicity using an integrated approach, combining experimental evidence with computational modeling, with potential for broad application. This study provides necessary information for the consideration of the potential human health effects that can result from CNT/F exposure. The safety profiles and identified drivers of toxicity may be useful for future predictive risk assessment studies and translational studies as well as contributing to safety-by-design for future material designs

Politics of recognition: what can a human rights perspective contribute to understanding users' experiences of involvement in mental health services?

This historically situated, UK-based review of New Labour's human rights and mental health policy following the 1998 Human Rights Act (HRA) and 2007 Mental Health Act (MHA), draws on Klug's identification of three waves of human rights. These occurred around the American and French Revolutions, after World War II, and following the collapse of state communism in 1989, and the article assesses impacts on mental health policy up to and including the New Labour era. It critiques current equality and rights frameworks in mental health and indicates how they might be brought into closer alignment with third wave principles

Validation of ICD-9-CM diagnosis codes for surgical site infection and noninfectious wound complications after mastectomy

BACKGROUNDFew studies have validated ICD-9-CM diagnosis codes for surgical site infection (SSI), and none have validated coding for noninfectious wound complications after mastectomy.OBJECTIVESTo determine the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes in health insurer claims data to identify SSI and noninfectious wound complications, including hematoma, seroma, fat and tissue necrosis, and dehiscence, after mastectomy.METHODSWe reviewed medical records for 275 randomly selected women who were coded in the claims data for mastectomy with or without immediate breast reconstruction and had an ICD-9-CM diagnosis code for a wound complication within 180 days after surgery. We calculated the positive predictive value (PPV) to evaluate the accuracy of diagnosis codes in identifying specific wound complications and the PPV to determine the accuracy of coding for the breast surgical procedure.RESULTSThe PPV for SSI was 57.5%, or 68.9% if cellulitis-alone was considered an SSI, while the PPV for cellulitis was 82.2%. The PPVs of individual noninfectious wound complications ranged from 47.8% for fat necrosis to 94.9% for seroma and 96.6% for hematoma. The PPVs for mastectomy, implant, and autologous flap reconstruction were uniformly high (97.5%–99.2%).CONCLUSIONSOur results suggest that claims data can be used to compare rates of infectious and noninfectious wound complications after mastectomy across facilities, even though PPVs vary by specific type of postoperative complication. The accuracy of coding was highest for cellulitis, hematoma, and seroma, and a composite group of noninfectious complications (fat necrosis, tissue necrosis, or dehiscence).Infect Control Hosp Epidemiol 2017;38:334–339</jats:sec

A central line care maintenance bundle for the prevention of central line–associated bloodstream infection in non–intensive care unit settings

OBJECTIVE: To evaluate a central line care maintenance bundle to reduce central line-associated bloodstream infection (CLABSI) in non-ICU settings. DESIGN: Before-after trial with 12 month follow-up period. SETTING: 1250-bed teaching hospital. PARTICIPANTS: Patients with central lines on eight general medicine wards. Four wards received the intervention and four served as controls. INTERVENTION: A multifaceted catheter care maintenance bundle consisting of educational programs for nurses, update of hospital policies, visual aids, a competency assessment, process monitoring, regular progress reports, and consolidation of supplies necessary for catheter maintenance. RESULTS: Data were collected for 25,542 catheter-days including 43 CLABSI (rate = 1.68 per 1,000 CL-days) and 4,012 catheter dressing observations. Following the intervention, a 2.5% monthly decrease in the CLABSI incidence density was observed on intervention floors, but this was not statistically significant (95% confidence interval (CI); −5.3 – 0.4). On control floors, there was a smaller, but marginally significant decrease in CLABSI incidence during the study (change in monthly rate = −1.1%; 95% CI, −2.1 - −0.1). Implementation of the bundle was associated with improvement in catheter dressing compliance on intervention wards (78.8% compliance pre-intervention vs. 87.9% during intervention/follow-up; p<0.001) but improvement was also observed on control wards (84.9% compliance pre-intervention vs. 90.9% during intervention/follow-up; P = .001). CONCLUSIONS: A multi-faceted program to improve catheter care was associated with improvement in catheter dressing care, but no change in CLABSI rates. Additional study is needed to determine strategies to prevent CLABSI in non-ICU patients

Influence of shear-thinning blood rheology on the laminar-turbulent transition over a backward facing step

Cardiovascular diseases are the leading cause of death globally and there is an unmet need for effective, safer blood-contacting devices, including valves, stents and artificial hearts. In these, recirculation regions promote thrombosis, triggering mechanical failure, neurological dysfunction and infarctions. Transitional flow over a backward facing step is an idealised model of these flow conditions; the aim was to understand the impact of non-Newtonian blood rheology on modelling this flow. Flow simulations of shear-thinning and Newtonian fluids were compared for Reynolds numbers (Re) covering the comprehensive range of laminar, transitional and turbulent flow for the first time. Both unsteady Reynolds Averaged Navier-Stokes (k &amp;#x100000; w SST) and Smagorinsky Large Eddy Simulations (LES) were assessed; only LES correctly predicted trends in the recirculation zone length for all Re. Turbulent-transition was assessed by several criteria, revealing a complex picture. Instantaneous turbulent parameters, such as velocity, indicated delayed transition: Re = 1600 versus Re = 2000, for Newtonian and shear-thinning transitions respectively. Conversely, when using a Re defined on spatially averaged viscosity, the shear-thinning model transitioned below the Newtonian. However, recirculation zone length, a mean flow parameter, did not indicate any difference in the transitional Re between the two. This work shows a shear-thinning rheology can explain the delayed transition for whole blood seen in published experimental data, but this delay is not the full story. The results show that to accurately model transitional blood flow, and so enable the design of advanced cardiovascular devices, it is essential to incorporate the shear-thinning rheology, and to explicitly model the turbulent eddies

Incidence of surgical site infection following mastectomy with and without immediate reconstruction using private insurer claims data

OBJECTIVE: The National Healthcare Safety Network classifies breast operations as clean procedures with an expected 1–2% surgical site infection (SSI) incidence. We assessed differences in SSI incidence following mastectomy with and without immediate reconstruction in a large, geographically diverse population. DESIGN: Retrospective cohort study. PATIENTS: Commercially-insured women aged 18–64 years with ICD-9-CM procedure or CPT-4 codes for mastectomy from 1/1/2004–12/31/2011. METHODS: Incident SSIs within 180 days after surgery were identified by ICD-9-CM diagnosis codes. The incidence of SSI after mastectomy +/− immediate reconstruction was compared by the chi-square test. RESULTS: From 2004–2011, 18,696 mastectomy procedures among 18,085 women were identified, with immediate reconstruction in 10,836 (58%) procedures. The 180-day incidence of SSI following mastectomy with or without reconstruction was 8.1% (1,520/18,696). Forty-nine percent of SSIs were identified within 30 days post-mastectomy, 24.5% between 31–60 days, 10.5% between 61–90 days, and 15.7% between 91–180 days. The incidence of SSI was 5.0% (395/7,860) after mastectomy-only, 10.3% (848/8,217) after mastectomy plus implant, 10.7% (207/1,942) after mastectomy plus flap, and 10.3% (70/677) after mastectomy plus flap and implant (p<0.001). The SSI risk was higher after bilateral compared with unilateral mastectomy with (11.4% vs. 9.4%, p=0.001) and without (6.1% vs. 4.7%, p=0.021) immediate reconstruction. CONCLUSIONS: SSI incidence was two-fold higher after mastectomy with immediate reconstruction than after mastectomy alone. Only 49% of SSIs were coded within 30 days after operation. Our results suggest stratification by procedure type will facilitate comparison of SSI rates after breast operations between facilities

Supporting Distant Familial Relationships with the Internet of Things

In this paper we discuss the opportunities of ‘off the shelf’ Internet of things technologies to be used to support closeness in interpersonal relationships. We give our motivation to study IoT on technologies to support distant interpersonal relationships. We present two designs, ‘SmartLamps’ and ‘Connected Rings’, which use IoT technology to foster experiences of relatedness between distant families. We present some of the challenges faced while evaluating these devices using ‘in the wild’ research

Recent advances in the application of stable isotope ratio analysis in forensic chemistry

This review paper updates the previous literature in relation to the continued and developing use of stable isotope ratio analysis in samples which are relevant to forensic science. Recent advances in the analysis of drug samples, explosive materials, and samples derived from human and animal samples are discussed. The paper also aims to put the use of isotope ratio mass spectrometry into a forensic context and discuss its evidential potential