Elevated serum lactate in emergency department patients predicts hospital admission unrelated to diagnosis – but not more

Purpose: The value of lactate as a screening biomarker in the emergency department is debated. We analysed all unselected patients in the emergency department with serum lactate measured with regard to different outcome parameters.

Material and Methods: In a retrospective single centre study, we analysed all digitalized patient data of a two-week period of all patients ≥18 where a serum lactate was measured. The lactate levels as well as demographic and other laboratory data were correlated in a logistic regression analysis, univariable as well as multivariable, with the outcome parameters.

Results: A total of 1157 patients contacted the emergency department of which 587 were included. The average lactate level was 2,08?mmol/l (SD ±1.51, median 1.73). A total of 313 patients were admitted to hospital, 274 treated as outpatients. Their median lactate levels were 2.0?mmol/l (min/max 0.6–18?mmol/l) and 1.5?mmol/l (min/max 0.5–7.4?mmol/l), respectively. Univariable regression analysis for hospital admission showed an odds ratio of 1756 (p?p?=?0.004). There was no correlation with admission to ICU, length of stay or a relation to a certain diagnostic group.

Conclusions: Screening lactate levels in unselected emergency department patients do not have a clinical relevance yet.     

Comparative effects of insecticides with different mechanisms of action on Chrysoperla externa (Neuroptera: Chrysopidae): Lethal,sublethal and dose–response effects

The comprehensive knowledge that the delayed systemic and reproduction side effects can be even more deleterious than acute toxicity, has caused a shift in focus toward sublethal effects assessment on physiology and behavior of beneficial insects. In this study, we assessed the risks posed by some insecticides with different mode of action through lethal and delayed systemic sublethal effects on the pupation, adult emergence, and reproduction of the chrysopid Chrysoperla externa (Hagen, 1861; Neuroptera: Chrysopidae), an important predator in pest biological control. The maximum field recommended dose (MFRD) and twice (2×MFRD) for chlorantraniliprole, tebufenozide, and pyriproxyfen were harmless to C. externa. In contrast, all the tested chitin synthesis inhibitors (CSIs) were highly detrimental to the predator, despite of their lack of acute lethal toxicity. Therefore, the safety assumed by using IGRs toward beneficial insects is not valid for chrysopids. Dose–response data showed that although all CSIs have a similar mechanism of action, the relative extent of toxicity may differ (novaluron > lufenuron > teflubenzuron). For CSIs, the delayed systemic effects became obvious at adult emergence, where the predicted no observable effect dose (NOED) was 1/2 048 of the MFRD for novaluron (0.085 ng/insect), and 1/256 of the MFRD for both lufenuron (0.25 ng/insect) and teflubenzuron (0.6 ng/insect). Finally, this work emphasized the significance of performing toxicity risk assessments with an adequate posttreatment period to avoid underestimating the toxicities of insecticides, as the acute lethal toxicity assays may not provide accurate information regarding the long‐range effects of hazardous compounds.     

Oral Antibiotic Treatment of Mice Exacerbates the Disease Severity of Multiple Flavivirus Infections

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Science in Risk Assessment and Policy (SciRAP): An Online Resource for Evaluating and Reporting In Vivo (Eco)Toxicity Studies

(Eco)toxicity studies conducted according to internationally standardized test guidelines are often considered reliable by default and preferred as key evidence in regulatory risk assessment. At the same time regulatory agencies emphasize the use of all relevant (eco)toxicity data in the risk assessment process, including non-standard studies. However, there is a need to facilitate the use of such studies in regulatory risk assessment. Therefore, we propose a framework that facilitates a systematic and transparent evaluation of the reliability and relevance of (eco)toxicity in vivo studies for health and environmental risk assessment. The framework includes specific criteria to guide study evaluation, as well as a color-coding tool developed to aid the application of these criteria. In addition we provide guidance intended for researchers on how to report non-standard studies to ensure that they meet regulatory requirements. The intention of the evaluating and reporting criteria is to increase the usability of all relevant data that may fill information gaps in chemical risk assessments. The framework is publically available online, free of charge, at the Science in Risk Assessment and Policy (SciRAP) website: www.scirap.org. The aim of this article is to present the framework and resources available at the SciRAP website.     

The risk of establishment of aquatic invasive species: joining invasibility and propagule pressure

Invasive species are increasingly becoming a policy priority. This has spurred researchers and managers to try to estimate the risk of invasion. Conceptually, invasions are dependent both on the receiving environment (invasibility) and on the ability to reach these new areas (propagule pressure). However, analyses of risk typically examine only one or the other. Here, we develop and apply a joint model of invasion risk that simultaneously incorporates invasibility and propagule pressure. We present arguments that the behaviour of these two elements of risk differs substantially--propagule pressure is a function of time, whereas invasibility is not--and therefore have different management implications. Further, we use the well-studied zebra mussel (Dreissena polymorpha) to contrast predictions made using the joint model to those made by separate invasibility and propagule pressure models. We show that predictions of invasion progress as well as of the long-term invasion pattern are strongly affected by using a joint model.     

Ecological Risk Assessment Guidance and Procedural Documents: An Annotated Compilation and Evaluation of Reference Materials

The scientific approach toward ecological risk assessment (ERA) has advanced greatly during the 1990s. This growth has been accompanied by the development of ERA guidance by USEPA Headquarters, individual USEPA Regions, state environmental agencies, as well as international agencies. This compilation of ERA guidance and procedural documents identifies many of the existing ERA reference materials from the regulatory and/or governmental agency arena. In addition, this compilation provides annotations pertaining to the focus of each reviewed document, and compares/contrasts the approaches presented in the documents. As such, the evaluation provides insight into some of the qualities and levels of detail provided by each document. Examples of documents which are highlighted include recently published USEPA's “Guidelines for Ecological Risk Assessment;” USEPA's “Ecological Risk Assessment Guidance for Superfund;” the U.S. Army's “Procedural Guidelines for Ecological Risk Assessments;” and Environment Canada's “Ecological Risk Assessments Under the Canadian Environmental Protection Act.”     

粤北南岭大宝山矿流域山水林田湖草修复阻力与优先级分析

遵循“防源、控流、治汇”理念,以粤北南岭大宝山矿区作为风险源,以所在流域为研究区,分析研究区主要阻力因素,采用最小累积阻力模型建立区域生态阻力面;利用Jenks自然断点法,分析生态修复优先级,提出分区治理重点和对策。研究结果表明：研究区综合阻力系数处于9-32之间,各评价指标的阻力面空间分布格局相似,其阻力值呈现出东南部大,西北部小的空间格局;长期的矿业开采污染了流域生态环境,且距离矿区越近的区域生态修复的优先性越高。将研究区分为4个优先级区,各区修复优先性依次为Ⅰ区 > Ⅱ区 > Ⅲ区 > Ⅳ区。Ⅰ区重点在于治水,提高pH、降低重金属有效态含量和增加地表植被覆盖度。Ⅱ区重点在于河流治理与治土,确保污染减排,增强拦泥库的废水调节。Ⅲ区、Ⅳ区核心在治土,逐步改善土壤条件。研究结果为修复项目在时空尺度上落地和科学治理提供科学依据。     

Space use of a non-native species,the European hare (<Emphasis Type="Italic">Lepus europaeus</Emphasis>), in habitats of the southern vizcacha (<Emphasis Type="Italic">Lagidium viscacia</Emphasis>) in Northwestern Patagonia,Argentina

Two medium-sized herbivores with high trophic overlap coexist on rocky outcrops in the Patagonian landscape: the southern vizcacha (Lagidium viscacia), which is a native rock specialist, and the European hare (Lepus europaeus), which is a non-native species. We determined the patterns of space use related to distance from outcrops and analyzed spatial overlap between the two species. There were significant differences between the two species in the use of space adjacent to outcrops. The southern vizcacha mainly uses short and medium distances from the outcrop (up to 40 m), whereas the hare’s greatest activity was recorded at distances greater than 50 m. However, there is a partial overlap at medium distances (30–40 m) among both herbivores. Although, in general terms, there is no significant spatial overlap between hares and southern vizcachas, their biological characteristics and the high dietary overlap between the species allow us to predict that, if resources become scarce, the hare could extend its area of activity, as what happens elsewhere, and exploit food resources near outcrops, increasing the vulnerability of vizcacha colonies.     

Improving Risk Assessment: Priorities for Epidemiologic Research

The Epidemiology Work Group at the Workshop on Future Research for Improving Risk Assessment Methods, Of Mice, Men, and Models, held August 16 to 18, 2000, at Snowmass Village, Aspen, Colorado, concluded that in order to improve the utility of epidemiologic studies for risk assessment, methodologic research is needed in the following areas: (1) aspects of epidemiologic study designs that affect doseresponse estimation; (2) alternative methods for estimating dose in human studies; and (3) refined methods for dose-response modeling for epidemiologic data. Needed research in aspects of epidemiologic study design includes recognition and control of study biases, identification of susceptible subpopulations, choice of exposure metrics, and choice of epidemiologic risk parameters. Much of this research can be done with existing data. Research needed to improve determinants of dose in human studies includes additional individual-level data (e.g., diet, co-morbidity), development of more extensive human data for physiologically based pharmacokinetic (PBPK) dose modeling, tissue registries to increase the availability of tissue for studies of exposure/dose and susceptibility biomarkers, and biomarker data to assess exposures in humans and animals. Research needed on dose-response modeling of human studies includes more widespread application of flexible statistical methods (e.g., general additive models), development of methods to compensate for epidemiologic bias in dose-response models, improved biological models using human data, and evaluation of the benchmark dose using human data. There was consensus among the Work Group that, whereas most prior risk assessments have focused on cancer, there is a growing need for applications to other health outcomes. Developmental and reproductive effects, injuries, respiratory disease, and cardiovascular disease were identified as especially high priorities for research. It was also a consensus view that epidemiologists, industrial hygienists, and other scientists focusing on human data need to play a stronger role throughout the risk assessment process. Finally, the group agreed that there was a need to improve risk communication, particularly on uncertainty inherent in risk assessments that use epidemiologic data.     

Benchmark Dose Profiles for Joint‐Action Quantal Data in Quantitative Risk Assessment

Summary Benchmark analysis is a widely used tool in public health risk analysis. Therein, estimation of minimum exposure levels, called Benchmark Doses (BMDs), that induce a prespecified Benchmark Response (BMR) is well understood for the case of an adverse response to a single stimulus. For cases where two agents are studied in tandem, however, the benchmark approach is far less developed. This article demonstrates how the benchmark modeling paradigm can be expanded from the single‐dose setting to joint‐action, two‐agent studies. Focus is on response outcomes expressed as proportions. Extending the single‐exposure setting, representations of risk are based on a joint‐action dose–response model involving both agents. Based on such a model, the concept of a benchmark profile (BMP) – a two‐dimensional analog of the single‐dose BMD at which both agents achieve the specified BMR – is defined for use in quantitative risk characterization and assessment. The resulting, joint, low‐dose guidelines can improve public health planning and risk regulation when dealing with low‐level exposures to combinations of hazardous agents.