土壤污染生态毒性效应评价研究进展

随着社会经济的高度发展,人类活动加剧,我国土壤污染问题突出,不仅威胁人体健康,同时也严重威胁动植物及微生物的安全,生态安全问题不容忽视。但是我国土壤污染风险管控目前主要关注人体健康,对生态系统的关注较少,缺乏土壤污染生态风险评估技术指南及基于生态风险的土壤环境质量基准及标准。准确评价土壤污染生态毒性效应,是制定土壤环境质量标准、实现生态风险评估及预警与管控的重要基础。针对土壤污染生态毒性效应评价问题,分别对土壤污染生态毒性效应特征、评价方法、评价终点、暴露-效应关系构建、生态毒性效应外推,以及群落水平与复合污染生态毒性效应评价等方面的关键问题展开了讨论,指出目前土壤污染生态毒性效应评价主要是基于单物种的急性毒性测试,利用个体和亚个体水平的指示物作为评价终点,缺乏针对群落及生态系统高水平评价终点的生态毒性效应评价方法,定量评价污染物尤其是复合污染物对土壤生物群落及生态系统的影响,是土壤污染生态毒性效应评价的关键问题和难点问题。建议今后重点开展以下3方面的工作1)群落及生态系统水平评价终点的筛选;2)土壤污染生态毒性效应环境影响因子识别及影响机制研究;3)土壤复合污染联合毒性效应定量评价及...     

An overview of techniques for linking high-dimensional molecular data to time-to-event endpoints by risk prediction models

Analysis of molecular data promises identification of biomarkers for improving prognostic models, thus potentially enabling better patient management. For identifying such biomarkers, risk prediction models can be employed that link high-dimensional molecular covariate data to a clinical endpoint. In low-dimensional settings, a multitude of statistical techniques already exists for building such models, e.g. allowing for variable selection or for quantifying the added value of a new biomarker. We provide an overview of techniques for regularized estimation that transfer this toward high-dimensional settings, with a focus on models for time-to-event endpoints. Techniques for incorporating specific covariate structure are discussed, as well as techniques for dealing with more complex endpoints. Employing gene expression data from patients with diffuse large B-cell lymphoma, some typical modeling issues from low-dimensional settings are illustrated in a high-dimensional application. First, the performance of classical stepwise regression is compared to stage-wise regression, as implemented by a component-wise likelihood-based boosting approach. A second issues arises, when artificially transforming the response into a binary variable. The effects of the resulting loss of efficiency and potential bias in a high-dimensional setting are illustrated, and a link to competing risks models is provided. Finally, we discuss conditions for adequately quantifying the added value of high-dimensional gene expression measurements, both at the stage of model fitting and when performing evaluation.     

Radon sources and impacts: a review of mining and non-mining issues

Radon is a ubiquitous natural carcinogen derived from the three primordial radionuclides of the uranium series (²³⁸U and ²³⁵U) and thorium series (²³²Th). In general, it is present at very low concentrations in the outdoor or indoor environment, but a number of scenarios can give rise to significant radiological exposures. Historically, these scenarios were not recognised, and took many centuries to understand the links between the complex behaviour of radon and progeny decay and health risks such as lung cancer. However, in concert with the rapid evolution in the related sciences of nuclear physics and radiological health in the first half of the twentieth century, a more comprehensive understanding of the links between radon, its progeny and health impacts such as lung cancer has evolved. It is clear from uranium miner studies that acute occupational exposures lead to significant increases in cancer risk, but chronic or sub-chronic exposures, such as indoor residential settings, while suggestive of health risks, still entails various uncertainties. At present, prominent groups such as the BEIR or UNSCEAR committees argue that the ‘linear no threshold’ (LNT) model is the most appropriate model for radiation exposure management, based on their detailed review and analysis of uranium miner, residential, cellular or molecular studies. The LNT model implies that any additional or excess exposure to radon and progeny increases overall risks such as lung cancer. A variety of engineering approaches are available to address radon exposure problems. Where high radon scenarios are encountered, such as uranium mining, the most cost effective approach is well-engineered ventilation systems. For residential radon problems, various options can be assessed, including building design and passive or active ventilation systems. This paper presents a very broad but thorough review of radon sources, its behaviour (especially the importance of its radioactive decay progeny), common mining and non-mining scenarios which can give rise to significant radon and progeny exposures, followed by a review of associated health impacts, culminating in typical engineering approaches to reduce exposures and rehabilitate wastes.     

Integrated software system for improving medical equipment management

The evolution of biomedical technology has led to an extraordinary use of medical devices in health care delivery. During the last decade, clinical engineering departments (CEDs) turned toward computerization and application of specific software systems for medical equipment management in order to improve their services and monitor outcomes. Recently, much emphasis has been given to patient safety. Through its Medical Device Directives, the European Union has required all member nations to use a vigilance system to prevent the reoccurrence of adverse events that could lead to injuries or death of patients or personnel as a result of equipment malfunction or improper use. The World Health Organization also has made this issue a high priority and has prepared a number of actions and recommendations. In the present workplace, a new integrated, Windows-oriented system is proposed, addressing all tasks of CEDs but also offering a global approach to their management needs, including vigilance. The system architecture is based on a star model, consisting of a central core module and peripheral units. Its development has been based on the integration of 3 software modules, each one addressing specific predefined tasks. The main features of this system include equipment acquisition and replacement management, inventory archiving and monitoring, follow up on scheduled maintenance, corrective maintenance, user training, data analysis, and reports. It also incorporates vigilance monitoring and information exchange for adverse events, together with a specific application for quality-control procedures. The system offers clinical engineers the ability to monitor and evaluate the quality and cost-effectiveness of the service provided by means of quality and cost indicators. Particular emphasis has been placed on the use of harmonized standards with regard to medical device nomenclature and classification. The system's practical applications have been demonstrated through a pilot evaluation trial.     

Are cancer risks associated with exposures to ionising radiation from internal emitters greater than those in the Japanese A-bomb survivors?

After ingestion or inhalation of radionuclides, internal organs of the human body will be exposed to ionising radiation. Current risk estimates of radiation-associated cancer from internal emitters are largely based on extrapolation of risk from high-dose externally exposed groups. Concerns have been expressed that extrapolated risk estimates from internal emitters are greatly underestimated, by factors of ten or more, thus implying a severe underestimation of the true risks. Therefore, data on cancer mortality and incidence in a number of groups who received exposure predominantly from internal emitters are examined and excess relative risks per Sv are compared with comparable (age at exposure, time since exposure, gender) matched subsets of the Japanese atomic bomb survivor cohort. Risks are examined separately for low LET and high LET internal emitters. There are eight studies informative for the effects of internal low LET radiation exposure and 12 studies informative for the effects of internal high LET radiation. For 11 of the 20 cancer endpoints (subgroups of particular study cohorts) examined in the low LET internal emitter studies, the best estimate of the excess relative risk is greater than the corresponding estimate in the Japanese atomic bomb survivors and for the other nine it is less. For four of these 20 studies, the relative risk is significantly (2-sided P < 0.05) different from that in the Japanese atomic bomb survivors, in three cases greater than the atomic bomb survivor relative risk and in one case less. Considering only those six low LET studies/endpoints with 100 or more deaths or cases, for four out of six studies/endpoints the internal emitter risk is greater than that in the Japanese atomic bomb survivors. For seven of the 24 cancer endpoints examined in the high LET internal emitter studies the best estimate of the ERR in the internal emitter study is greater than the corresponding estimate in the Japanese atomic bomb survivors and for the other 17 it is less. For six studies, the relative risk is significantly (2-sided P < 0.05) different from that in the Japanese atomic bomb survivors, in one case greater than the atomic bomb survivor relative risk and in five cases less. Considering only those eight high LET studies/endpoints with 100 or more deaths or cases, for five out of eight studies/endpoints the internal emitter risk is greater than that in the Japanese atomic bomb survivors. These results suggest that excess relative risks in the internal emitter studies do not appreciably differ from those in the Japanese atomic bomb survivors. However, there are substantial uncertainties in estimates of risks in the internal emitter studies, particularly in relation to lung cancer associated with radon daughter (alpha particle) exposure, so a measure of caution should be exercised in these conclusions.     

A Regional Multiple Stressor Risk Assessment of the Codorus Creek Watershed Applying the Relative Risk Model

The relative risk model (RRM) used in Port Valdez, AK, and in Oregon's Willamette/McKenzie Watershed was applied to the Codorus Creek Watershed in south central Pennsylvania. The assessment evaluated the relative risk model for its applicability for ranking ecological risks within the Codorus Creek Watershed. The Codorus Creek Watershed approach included ranking stressors and habitats for regions within the watershed. Geographical Information Systems were vital in compiling and comparing stressor and habitat spatial data from regions in the watershed. The risk of ecological impacts to degrade assessment endpoints were calculated and ranked by quantitatively determining the interactions of the stressors and habitats as defined in the conceptual site model. Uncertainty assessment was conducted and the impact upon the relative ranks and risk conclusions evaluated. To determine regional risks, risk management information was gathered identifying areas to be protected, areas of high stress, and areas where additional information is needed. The results supported the applicability of the RRM and suggested areas and stressors for restoration efforts in the Codorus Creek Watershed. Two critical sets of conclusions were drawn from the assessment. First, in the Codorus Creek Watershed, the most significant stressor is agriculture land use, the most significantly impacted endpoint is water quality, and the most vulnerable habitats are those for macroinvertebrates and warm-water fish. Second, this risk assessment demonstrates the feasibility of using the RRM for assessing risk from multiple stressors on habitats with multiple assessment endpoints in an eastern watershed.     

城市生态风险评价研究进展

随着城市化发展和城市人居环境的恶化,城市生态风险越来越受到关注,但尚缺乏有关城市生态风险评价的深入系统研究.本文依据城市生态学原理及生态风险评价框架从驱动力、风险源、风险受体与评价终点,以及生态风险综合评价方法等方面对城市生态风险评价研究进行综述.指出城市经济社会活动类型与程度是城市生态风险产生的主要驱动力;城市生态系统不同等级功能实体和城市整体是城市生态风险评价中的风险受体;城市生态风险评价终点包括城市生态系统结构、过程、功能要素,以及城市整体水平的性质和功能变化;耦合了社会经济需求的生态系统模型是城市生态风险评价方法的发展方向.未来城市生态风险评价研究应明确生态风险管理具体目标,确定综合性评价终点,建立多指标评价体系和综合评价方法.     

Environmental Risk Controllability and Management of VOCs during Remediation of Contaminated Sites

The environmental risk controllability assessment system and its method of controlling volatile organic compounds (VOCs) during remediation of contaminated sites are established in this article based on soil vapor extraction (SVE) technology. According to the properties of VOCs and the technical and operational characteristics of the site remediation process, the environmental risk controllability index system includes environmental risk identification, risk source analysis, and risk assessment. Environmental risk management during site remediation was focused on technical control methods and engineering control technologies. Specifically, acceptance based on risk management was suitable for low-risk levels such as RRI3 and RRI4. Furthermore, control methods for high-level risk (RRI1 or RRI2) could be developed along with transformation and control, combined with the necessary emergency risk plan.     

基于Android系统的医院设备共享服务管理系统

为了提高设备利用率,大多医院将部分设备集中放置于病区服务中心,供全院科室共享使用,但是设备的借用、归还登记依然采用手工模式,这种模式工作效率低下且数据统计难度大。为了解决该问题,本文设计开发了一套基于Android系统的医院设备共享服务管理系统。该系统利用二维码作为设备唯一识别标识,利用Android移动终端软件扫描设备二维码获取该设备基础信息,并通过Web Service接口从数据服务器中获取设备详细信息后进行共享服务管理操作。该软件系统采用Java+MVC框架开发,利用SQL Server 2008实现设备信息存储、共享。通过对徐州医科大学附属医院病区服务中心200余台设备的日常共享服务管理的实际应用与测试,该系统能很好的优化医院设备共享服务管理流程,提高了设备管理人员工作效率。     

Mechano-biology in the thoracic aortic aneurysm: a review and case study

An aortic aneurysm is a permanent and localized dilatation of the aorta resulting from an irreversible loss of structural integrity of the aortic wall. The infrarenal segment of the abdominal aorta is the most common site of aneurysms; however, they are also common in the ascending and descending thoracic aorta. Many cases remain undetected because thoracic aortic aneurysms (TAAs) are usually asymptomatic until complications such as aortic dissection or rupture occurs. Clinical estimates of rupture potential and dissection risk, and thus interventional planning for TAAs, are currently based primarily on the maximum diameter and growth rate. The growth rate is calculated from maximum diameter measurements at two subsequent time points; however, this measure cannot reflect the complex changes of vessel wall morphology and local areas of weakening that underline the strong regional heterogeneity of TAA. Due to the high risks associated with both open and endovascular repair, an intervention is only justified if the risk for aortic rupture or dissection exceeds the interventional risks. Consequently, TAAs clinical management remains a challenge, and new methods are needed to better identify patients for elective repair. We reviewed the pathophysiology of TAAs and the role of mechanical stresses and mathematical growth models in TAA management; as a proof of concept, we applied a multiscale biomechanical analysis to a case study of TAA.     

The central equipment pool, an opportunity for improved technology management

A model for a central equipment pool managed by a clinical engineering department has been presented. The advantages to patient care and to the clinical engineering department are many. The distribution of portable technology that has been traditionally managed by the materials management function is a logical match to the expanding role of clinical engineering departments in technology management. Accurate asset management tools have allowed us to provide reliable measures of infusion pump utilization, permitting us to predict future needs as programs expand. Thus we are more actively involved in strategic technology planning. The central equipment pool is an excellent opportunity for the clinical engineering department to increase its technology management activities.     

2022年冬奥会崇礼赛区多重压力下生态风险评价

冬奥会这类重大体育赛事对举办城市的经济转型、城市功能升级、竞争力提升等方面具有助推效应,而其带来的生态影响也不容小觑。近年随着赛事规模的不断扩大和户外场馆的建设,冬奥会导致的生态风险愈加突出。然而,对于规模大、历时长的冬奥会复杂生态风险目前还缺乏定量评价方法。研究旨在探讨一种区域生态风险评价方法,即相对风险模型,并基于地理信息系统（GIS）定量评价冬奥会赛前准备阶段多重压力下的生态风险。选择2022年冬奥会崇礼赛区为案例区,构建压力-生境-终点三大要素组成的相对风险模型,将整个崇礼划为6个风险分区,辨识了冬奥会赛前阶段包括各种人类生产、建设活动和自然因素的11类压力（威胁）、6类生境和4个评价终点,并确定了压力和生境的分级标准。压力分级评价结果显示,道路和交通活动的得分最高,得分最低的是火灾。生境相对等级评价表明,河流栖息地的得分最高,得分最低的是湿地与景区滑雪场。从不同生态终点得分看,生物多样性的风险最高,娱乐休闲风险最低。总体区域风险评价表明,VI区四台嘴乡冬奥场馆核心区的风险得分最高,而风险最低的为III区,包括石嘴子乡和驿马图乡。最后,对相对风险评价的不确定性进行分析,并讨论其优缺点。总之,尽管存在不确定性,相对方法模型仍被认为是评估和优先考虑多个资产的多重压力风险的稳健方法,也是决策者确定管理行动优先级的有用筛选工具。研究证明了相对风险模型方法评估2022年冬奥会主办地风险的可行性,研究结果明确了崇礼区恢复工作的重点区域和压力,对冬奥会的可持续管理和地方发展具有重要参考价值。     

A Comparative Risk Assessment of Genetically Engineered,Mutagenic, and Conventional Wheat Production Systems

Wheat (Triticum aestivum L.) varieties produced using modern biotechnologies, such as genetic engineering and mutagenic techniques, have lagged behind other crop species, but are now being developed and, in the case of mutagenic wheat, commercially grown around the world. Because these wheat varieties have emerged recently, there is a unique opportunity to assess comparatively the potential environmental risks (human health, ecological, and livestock risks) associated with genetically engineered, mutagenic, and conventional wheat production systems. Replacement of traditional herbicides with glyphosate in a glyphosate-tolerant (genetically engineered) wheat system or imazamox in an imidazolinone-tolerant (mutagenic) wheat system may alter environmental risks associated with weed management. Additionally, because both systems rely on plants that express novel proteins, the proteins and plants themselves may impose risks. The purpose of our study was to examine comparatively the multiple aspects of risk associated with different wheat production systems in the US and Canada using the risk assessment paradigm. Specifically, we used tier 1 quantitative and qualitative risk assessment methods to compare specific environmental risks associated with the different wheat production systems. Both glyphosate and imazamox present lower human health and ecological risks than many other herbicides associated with conventional wheat production systems evaluated in this study. The differences in risks were most pronounced when comparing glyphosate and imazamox to herbicides currently with substantial market share. Current weight-of-evidence suggests that the transgenic CP4 EPSPS protein present in glyphosate-tolerant wheat poses negligible risk to humans, livestock, and wildlife. Risk for mutated AHAS protein in imidazolinone-tolerant wheat most likely would be low, but there are not sufficient effect and exposure data to adequately characterize risk. Environmental risks for herbicides were more amenable to quantitative assessments than for the transgenic CP4 EPSPS protein and the mutated AHAS protein.     

部队医院医疗风险管理存在的问题及对策分析

目的:近年来,医疗纠纷屡见不鲜,其中不乏军队医院。为此,我们对目前部队医院的医疗风险管理情况进行分析,深入总结军队医院管理存在的问题,并提出相应的对策以加强部队医院医疗风险的防范工作。方法:采取调查问卷方法对10所部队医院的一线医护人员就医疗风险相关问题进行调查,并对结果进行分析。结果:工龄低于5年的医务人员发生医疗风险的比率高于工作5年以上的人员;外科和妇产科医疗风险发生率较高;三级甲等医院医疗风险管理体系较三级乙等更完善。医院的管理制度、医务人员的工龄、科室的设置、风险教育及工作量等均与医疗风险的发生有着密切的关系。结论:部队医院应建立健全的风险预警系统与评价体系,提高医院对医疗风险的管理能力。医务人员应加强风险意识和法制意识,重视医患沟通,以促进医患关系和谐,从而减少或避免医疗纠纷的发生。     

Institutional responsibilities in contamination control in research animals and occupational health and safety for animal handlers

The mechanisms for controlling microbial contamination in research animals are similar to those for preventing exposure among animal handlers to naturally occurring pathogens, research-related biohazards, or animal allergens. Research and resource preservation are the primary goals of each approach, and an appropriate assessment of risk is their foundation. The identification of potential risks enables the implementation of relevant risk management or control measures. This article summarizes the components of an occupational health and safety program for animal handlers, including screening, training, work practices, effective use of engineering controls, selection and use of personal protective equipment, and emergency response protocols. The features of a risk assessment and risk management program and the level of interaction and training required to implement and sustain the program correlate well with programs designed to control microbial contamination in laboratory animals. This article includes an explanation of the five Ps of risk assessment and risk management. Pathogens and the proposed experimental procedures account for the first two Ps; the other three focus on training and awareness of the personnel involved in the experiment, protective equipment and work practices, and factors associated with the place (or facility) where the research will be conducted. Animal handlers comprehension and knowledge determine the success of any containment program, and so this review also includes a discussion of critical teaching points for animal handlers and of the importance of evaluating personnel to verify their proficiency and competence in required protocols.     

Bisphenol A and Risk Management Ethics

It is widely recognized that endocrine disrupting compounds, such as Bisphenol A, pose challenges for traditional paradigms in toxicology, insofar as these substances appear to have a wider range of low‐dose effects than previously recognized. These compounds also pose challenges for ethics and policymaking. When a chemical does not have significant low‐dose effects, regulators can allow it to be introduced into commerce or the environment, provided that procedures and rules are in place to keep exposures below an acceptable level. This option allows society to maximize the benefits from the use of the chemical while minimizing risks to human health or the environment, and it represents a compromise between competing values. When it is not possible to establish acceptable exposure levels for chemicals that pose significant health or environmental risks, the most reasonable options for risk management may be to enact either partial or complete bans on their use. These options create greater moral conflict than other risk management strategies, leaving policymakers difficult choices between competing values.     

Meta-analysis of clinical trials with competing time-to-event endpoints

Recommendations for the analysis of competing risks in the context of randomized clinical trials are well established. Meta-analysis of individual patient data (IPD) is the gold standard for synthesizing evidence for clinical interpretation based on multiple studies. Surprisingly, no formal guidelines have been yet proposed to conduct an IPD meta-analysis with competing risk endpoints. To fill this gap, this work details (i) how to handle the heterogeneity between trials via a stratified regression model for competing risks and (ii) that the usual metrics of inconsistency to assess heterogeneity can readily be employed. Our proposal is illustrated by the re-analysis of a recently published meta-analysis in nasopharyngeal carcinoma, aiming at quantifying the benefit of the addition of chemotherapy to radiotherapy on each competing endpoint.     

On assessing surrogacy in a single trial setting using a semicompeting risks paradigm

Summary .  There has been a recent emphasis on the identification of biomarkers and other biologic measures that may be potentially used as surrogate endpoints in clinical trials. We focus on the setting of data from a single clinical trial. In this article, we consider a framework in which the surrogate must occur before the true endpoint. This suggests viewing the surrogate and true endpoints as semicompeting risks data; this approach is new to the literature on surrogate endpoints and leads to an asymmetrical treatment of the surrogate and true endpoints. However, such a data structure also conceptually complicates many of the previously considered measures of surrogacy in the literature. We propose novel estimation and inferential procedures for the relative effect and adjusted association quantities proposed by Buyse and Molenberghs (1998, Biometrics 54, 1014–1029). The proposed methodology is illustrated with application to simulated data, as well as to data from a leukemia study.     

Scientific and societal considerations in selecting assessment endpoints for environmental decision making

It is sometimes argued that, from an ecological point of view, population-, community-, and ecosystem-level endpoints are more relevant than individual-level endpoints for assessing the risks posed by human activities to the sustainability of natural resources. Yet society values amenities provided by natural resources that are not necessarily evaluated or protected by assessment tools that focus on higher levels of biological organization. For example, human-caused stressors can adversely affect recreational opportunities that are valued by society even in the absence of detectable population-level reductions in biota. If protective measures are not initiated until effects at higher levels of biological organization are apparent, natural resources that are ecologically important or highly valued by the public may not be adequately protected. Thus, environmental decision makers should consider both scientific and societal factors in selecting endpoints for ecological risk assessments. At the same time, it is important to clearly distinguish the role of scientists, which is to evaluate ecological effects, from the role of policy makers, which is to determine how to address the uncertainty in scientific assessment in making environmental decisions and to judge what effects are adverse based on societal values and policy goals.