MiXie, an Online Tool for Better Health Assessment of Workers Exposed to Multiple Chemicals

There is increasing concern for workers facing multiple chemical exposure. The accumulation of information on occupational conditions indicates the need to incorporate the concept of multiple exposures in the risk assessment process and to develop tools for assessing the potential impacts of multiple exposures on workers’ health. Our objective is to describe the MiXie online decision-making tool that can be used to assess the risk of exposure to multiple chemicals. The description includes the development of MiXie, the structure of its toxicological database according to the target organ or the mode of action, and the algorithm for quantitative analysis of a mixture. Two case studies of its use in evaluating the risks of multiple exposures in real workplace situations are presented. The case study in the printing industry showed increased risk for four toxicological classes (central nervous system damage, ocular damage, skin damage, and ototoxicity) associated with co-exposure to four chemicals during maintenance operations. The MiXie analysis also showed the presence of carcinogenic substances in the mixture and a risk to the development of the foetus. The case study in nail salons showed the presence of carcinogenic and sensitizing chemicals and an increased risk to upper airways. MiXie helps preventers evaluate the possible additive effects of mixtures, providing an easy-to-read diagnosis to identify risks incurred by co-exposed employees. In addition, MiXie identifies risky occupational situations that would go unnoticed without a multiple substance approach.

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Assessment 360°: A Panoramic Framework for Assessing English Language Learners

Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations ◽

10.1044/cds17.2.37 ◽

2010 ◽

Vol 17 (2) ◽

pp. 37-56 ◽

Cited By ~ 9

Author(s):

Nancy Lewis ◽

Nancy Castilleja ◽

Barbara J. Moore ◽

Barbara Rodriguez

Keyword(s):

English Language Learners ◽

Language Learners ◽

English Language ◽

Linguistically Diverse ◽

Assessment Process ◽

Assessment Practices ◽

Her Family ◽

Diverse Student ◽

Many Sources

This issue describes the Assessment 360° process, which takes a panoramic approach to the language assessment process with school-age English Language Learners (ELLs). The Assessment 360° process guides clinicians to obtain information from many sources when gathering information about the child and his or her family. To illustrate the process, a bilingual fourth grade student whose native language (L1) is Spanish and who has been referred for a comprehensive language evaluation is presented. This case study features the assessment issues typically encountered by speech-language pathologists and introduces assessment through a panoramic lens. Recommendations specific to the case study are presented along with clinical implications for assessment practices with culturally and linguistically diverse student populations.

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Psychological Assessment And Consultation In Service of The Church: A Collaborative Case Study Using The Multi-Method Church Assessment Process

10.2986/tren.088-0017 ◽

2002 ◽

Author(s):

Heidi L. VERMEER QUIST

Keyword(s):

Psychological Assessment ◽

Assessment Process ◽

The Church

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PROBLEMS OF THE 2013 CURRICULUM:A CASE STUDY OF IMPLEMENTING ENGLISH ASSESSMENT IN THE 2013 CURRICULUM

JURNAL ELINK ◽

10.30736/e-link.v4i2.17 ◽

2016 ◽

Vol 4 (2) ◽

Author(s):

Arini Husnayain

Keyword(s):

English Teachers ◽

Assessment Process ◽

Teaching English

The objectives of this study are to explain the implementation of assessment process in teaching English based on curriculum 2013 and to identify the problems faced by English teachers of MAN Lamongan when teaching English based on curriculum 2013.Keywords: implementation, curriculum 2013, assessment

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O06 Baseline predictors of methotrexate-related adverse events in methotrexate-naïve patients with RA

Rheumatology ◽

10.1093/rheumatology/keab246.005 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Ahmad A Sherbini ◽

James M Gwinnutt ◽

Kimme L Hyrich ◽

Suzanne M M Verstappen ◽

Keyword(s):

Rheumatoid Arthritis ◽

Adverse Events ◽

Health Assessment ◽

Prevalence Rates ◽

Clinical Predictors ◽

Research Support ◽

Related Data ◽

Increased Risk ◽

One Year

Abstract Background/Aims Methotrexate (MTX) is the most common treatment for rheumatoid arthritis (RA). The prevalence of adverse events (AEs) associated with MTX treatment for RA have been studied extensively, but there are limited data on the predictors of these AEs. This study aims to summarise the prevalence rates of MTX AEs, including gastrointestinal (GI), neurological, mucocutaneous, and elevated alanine transaminase (ALT) enzyme, and to identify baseline demographic and clinical predictors of these AEs. Methods The Rheumatoid Arthritis Medication Study (RAMS) is a UK multi-centre prospective cohort study of patients with RA starting MTX for the first time. Relevant demographic, medication, clinical and disease related data were collected at baseline. AEs were reported at six and twelve months follow-ups. The prevalence rates of AEs were calculated based on the proportions of patients who reported having had an AE within one year of follow-up. The associations between candidate baseline predictors and AEs were assessed using multivariable logistic regression. Results A total of 2,089 patients were included with a mean age of 58.4 (standard deviation: 13.5) years, 1390 (66.5%) were women. 1,814 and 1,579 patients completed the 6 and 12 months follow-up visits, respectively. The prevalence rates of the AEs within one year of follow-up were: GI = 777 (40.6%), mucocutaneous = 441 (23.1%), neurological = 487 (25.5%), elevated ALT (> upper limit of normal [ULN]) = 286 (15.5%). Younger age and being a woman were associated with increased risk of GI AEs, (age: OR 0.97 per year increase in age, 95% CI 0.98, 1.00; male sex: OR 0.58 vs female, 95% CI 0.46, 0.74) (Table 1). Higher baseline Health Assessment Questionnaire (HAQ) score was an independent predictor of GI, mucocutaneous, and neurological AEs. Furthermore, having ALT >1xULN at baseline or history of diabetes was associated with increased risk of subsequent ALT elevation during the study follow-up. Conclusion In patients with RA starting MTX, GI AEs were the most commonly reported AEs during the first year of follow-up. The identified predictors of AEs may facilitate discussions between clinicians and patients prior to commencing MTX, and may lead to increased adherence and consequently improved effectiveness. Disclosure A.A. Sherbini: None. J.M. Gwinnutt: Grants/research support; BMS. K.L. Hyrich: Member of speakers’ bureau; Abbvie. Grants/research support; Pfizer, UCB, BMS. S.M.M. Verstappen: Consultancies; Celltrion. Member of speakers’ bureau; Pfizer. Grants/research support; BMS.

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A Methodology for Harmonizing Safety and Health Scales in Occupational Risk Assessment

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094849 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4849

Author(s):

Zuzhen Ji ◽

Dirk Pons ◽

John Pearse

Keyword(s):

Risk Assessment ◽

Health And Safety ◽

Assessment Method ◽

Assessment Process ◽

Successful Implementation ◽

Health Issues ◽

Public Health Perspective ◽

Chronic Health ◽

Risk Assessment Method

Successful implementation of Health and Safety (H&S) systems requires an effective mechanism to assess risk. Existing methods focus primarily on measuring the safety aspect; the risk of an accident is determined based on the product of severity of consequence and likelihood of the incident arising. The health component, i.e., chronic harm, is more difficult to assess. Partially, this is due to both consequences and the likelihood of health issues, which may be indeterminate. There is a need to develop a quantitative risk measurement for H&S risk management and with better representation for chronic health issues. The present paper has approached this from a different direction, by adopting a public health perspective of quality of life. We have then changed the risk assessment process to accommodate this. This was then applied to a case study. The case study showed that merely including the chronic harm scales appeared to be sufficient to elicit a more detailed consideration of hazards for chronic harm. This suggests that people are not insensitive to chronic harm hazards, but benefit from having a framework in which to communicate them. A method has been devised to harmonize safety and harm risk assessments. The result was a comprehensive risk assessment method with consideration of safety accidents and chronic health issues. This has the potential to benefit industry by making chronic harm more visible and hence more preventable.

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The DWQ-EMR Embedded Tool to Enhance the Family Physician-Caregiver Connection: A Pilot Case Study

Geriatrics ◽

10.3390/geriatrics6010029 ◽

2021 ◽

Vol 6 (1) ◽

pp. 29

Author(s):

Kristina Marie Kokorelias ◽

Einat Danieli ◽

Sheila Dunn ◽

Sid Feldman ◽

David Patrick Ryan ◽

...

Keyword(s):

Family Caregivers ◽

Best Practice ◽

Data Gathering ◽

Family Physicians ◽

Efficient Manner ◽

Efficient Access ◽

Increased Risk ◽

Starting Point ◽

To Receive

The number of family caregivers to individuals with dementia is increasing. Family physicians are often the first point of access to the health care system for individuals with dementia and their caregivers. Caregivers are at an increased risk of developing negative physical, cognitive and affective health problems themselves. Caregivers also describe having unmet needs to help them sustain care in the community. Family physicians are in a unique position to help support caregivers and individuals with dementia, but often struggle with keeping up with best practice dementia service knowledge. The Dementia Wellness Questionnaire was designed to serve as a starting point for discussions between caregivers and family physicians by empowering caregivers to communicate their needs and concerns and to enhance family physicians’ access to specific dementia support information. The DWQ aims to alert physicians of caregiver and patient needs. This pilot study aimed to explore the experiences of physicians and caregivers of people using the Questionnaire in two family medicine clinics in Ontario, Canada. Interviews with physicians and caregivers collected data on their experiences using the DWQ following a 10-month data gathering period. Data was analyzed using content analysis. Results indicated that family physicians may have an improved efficacy in managing dementia by having dementia care case specific guidelines integrated within electronic medical records. By having time-efficient access to tailored supports, family physicians can better address the needs of the caregiver–patient dyad and help support family caregivers in their caregiving role. Caregivers expressed that the Questionnaire helped them remember concerns to bring up with physicians, in order to receive help in a more efficient manner.

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Cutaneous anthrax outbreak associated with handling dead animals, Rhino Camp sub-county: Arua District, Uganda, January–May 2018

One Health Outlook ◽

10.1186/s42522-021-00040-z ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Vivian Ntono ◽

Daniel Eurien ◽

Lilian Bulage ◽

Daniel Kadobera ◽

Julie Harris ◽

...

Keyword(s):

Health Workers ◽

Clinical Sample ◽

Health Centre ◽

Skin Lesions ◽

Suspected Case ◽

Prevention Measures ◽

Multiple Exposures ◽

Increased Risk ◽

Control And Prevention ◽

Cutaneous Anthrax

Abstract Background On 18 January 2018 a 40 year old man presented with skin lesions at Rhino Camp Health Centre. A skin lesion swab was collected on 20 January 2018 and was confirmed by PCR at Uganda Virus Research Institute on 21 January 2018. Subsequently, about 9 persons were reported to have fallen ill after reporting contact with livestock that died suddenly. On 9 February 2018, Arua District notified Uganda Ministry of Health of a confirmed anthrax outbreak among humans in Rhino Camp sub-county. We investigated to determine the scope and mode of transmission and exposures associated with identified anthrax to guide control and prevention measures. Methods We defined a suspected cutaneous anthrax case as onset of skin lesions (e.g., papule, vesicle, or eschar) in a person residing in Rhino Camp sub-county, Arua District from 25 December 2017 to 31 May 2018. A confirmed case was a suspected case with PCR-positivity for Bacillus anthracis from a clinical sample. We identified cases by reviewing medical records at Rhino Camp Health Centre. We also conducted additional case searches in the affected community with support from Community Health Workers. In a retrospective cohort study, we interviewed all members of households in which at least one person had contact with the carcasses of or meat from animals suspected to have died of anthrax. We collected and tested hides of implicated animals using an anthrax rapid diagnostic test. Results We identified 14 case-patients (1 confirmed, 13 suspected); none died. Only males were affected (affected proportion: 12/10,000). Mean age of case-persons was 33 years (SD: 22). The outbreak lasted for 5 months, from January 2018–May 2018, peaking in February. Skinning (risk ratio = 2.7, 95% CI = 1.1–6.7), dissecting (RR = 3.0, 95% CI = 1.2–7.6), and carrying dead animals (RR = 2.7, 95% CI = 1.1–6.7) were associated with increased risk of illness, as were carrying dissected parts of animals (RR = 2.9, 95% CI 1.3–6.5) and preparing and cooking the meat (RR = 2.3, 95% CI 0.9–5.9). We found evidence of animal remains on pastureland. Conclusion Multiple exposures to the hides and meat of animals that died suddenly were associated with this cutaneous anthrax outbreak in Arua District. We recommended public education about safe disposal of carcasses of livestock that die suddenly.

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Multiple benthic indicators are efficient for health assessment of coral reefs subjected to petroleum hydrocarbons contamination: A case study in the Persian Gulf

Journal of Hazardous Materials ◽

10.1016/j.jhazmat.2020.124993 ◽

2020 ◽

pp. 124993

Author(s):

Mahshid Oladi ◽

Mohammad Reza Shokri

Keyword(s):

Coral Reefs ◽

Persian Gulf ◽

Petroleum Hydrocarbons ◽

Health Assessment ◽

Benthic Indicators ◽

The Persian Gulf

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Carcinogenic Risk Assessment of Complex Mixtures

Toxicology and Industrial Health ◽

10.1177/074823378900500520 ◽

1989 ◽

Vol 5 (5) ◽

pp. 851-867 ◽

Cited By ~ 39

Author(s):

D. Krewski ◽

T. Thorslund ◽

J. Withey

Keyword(s):

Risk Assessment ◽

Low Dose ◽

Synergistic Effects ◽

Carcinogenic Risk ◽

Complex Mixtures ◽

Multiple Exposures ◽

Polycyclic Aromatic ◽

Carcinogenic Substances ◽

Carcinogenic Risk Assessment ◽

Potential Use

Although procedures for assessing the carcinogenic risks associated with exposure to individual chemicals are relatively well developed, risk assessment methods for mixtures of chemicals are still in the developmental stage. In this paper, we examine the difficulties in assessing the risks of exposure to complex mixtures, with special reference to the potential for synergistic effects among the compo nents of the mixture. Statistical models for describing the joint action of multiple exposures are reviewed, and their implications for low-dose risk assessment are examined. The potential use of pharmacokinetic models to describe the metabolism of mixtures is also considered. Application of these results in regulating mixtures of carcinogenic substances is illustrated using examples involving multiple contaminants in drinking water and polycyclic aromatic hydrocarbons produced from combustion sources.

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