Effects of Bushen-Jiangya granules on blood pressure and pharmacogenomic evaluation in low-to-medium-risk hypertensive patients: study protocol for a randomized double-blind controlled trial

Introduction Hypertension is one of the most important risk factors for cardiovascular disease, and its control rates remain low worldwide. The most effective strategy is that patients with hypertension should be diagnosed and treated early. Preliminary studies showed that the Bushen Jiangya granule (BSJY) could suppress ventricular hypertrophy and inflammatory responses, lower blood pressure, and protect the target organs of hypertension. We designed a randomized, double-blind, placebo-controlled trial to evaluate the efficacy of BSJY in patients with low-to-medium risk hypertension. Methods and analysis This trial is a one-center, randomized, double-blind, placebo-controlled study. A total of 260 participants will be randomized in a 1:1 ratio to an experimental group (BSJY plus amlodipine) and a control group (placebo plus amlodipine). The trial cycle will last 8 weeks. The primary outcome is the change in 24-h average systolic and diastolic blood pressure. The secondary outcomes include heart rate variability, pharmacogenomic evaluation, improvement in TCM syndrome, and serum pro-inflammatory/anti-inflammatory cytokines between the two groups. The safety of medication will also be evaluated. All the data will be recorded in electronic case report forms and analyzed by SPSS V.22.0. Ethics and dissemination This study has been approved by the Research Ethics Committee of Guang’anmen Hospital, China Academy of Chinese Medical Sciences in Beijing, China (No. 2019-186-KY-01). The participants are volunteers, understand the process of this trial, and sign an informed consent. The results of this study will be disseminated to the public through peer-reviewed journals and academic conferences. Discussion We hypothesize that patients with low-to-medium-risk hypertension will benefit from BSJY. If successful, this study will provide evidence-based recommendations for clinicians. Trial registration Chinese Clinical Trial Registry ChiMCTR1900002876. Registered in November 2019

Evaluating the Presence of Pesticide Residues in Organic Rice Production in An Giang Province, Vietnam

The presence of pesticide residues was investigated in the organic rice production model in An Giang province, Vietnam. A total number of sixteen pesticide residues was been recorded during the investigation. Based on their contamination rate, they are classified as follows. The high-risk group includes tricyclazole (80%). The medium-risk group includes chlorpyrifos (47%), isoprothiolane (47%), difenoconazole (40%), propiconazole (40%), hexaconazole (40%), chlorfenapyr (33%), azoxystrobin (20%), and cypermethrin (20%). The low-risk group includes metalaxyl & metalaxyl-M, paclobutazol, niclosamide, chlorfenson, fipronil, fipronil-desulfinyl, and fenoxanil, which were detected with a contamination rate of 7%. There were seven insecticides, seven fungicides, one snail killer, and one growth regulator.

Effects of Composite Attachments on Orthodontic Clear Aligners Therapy: A Systematic Review

This systematic review aims to highlight the differences between different clear aligner therapies that differ in the presence of attachments or in attachment configuration. Eight electronic databases were searched up to March 2020. Two authors independently proceeded to study selection, data extraction, and risk of bias assessment. The analysis of the results was carried out examining six groups of movements (mesio-distal tipping/bodily movement; anterior bucco-lingual tipping/root torque; posterior bucco-lingual tipping/expansion; intrusion; extrusion; rotation). Five clinical trials were selected and all of them showed a medium risk of bias. Literature showed that attachments mostly increase the effectiveness of orthodontic treatment with clear aligners, improving anterior root torque, rotation, and mesio-distal (M-D) movement; they are also important to increase posterior anchorage. However, some articles showed contradictory or not statistically significant results. Attachments also seem to improve intrusion, but the evidence about this movement, as well as extrusion, is lacking. No studies evaluated posterior bucco-lingual tipping/expansion. Further clinical trials are strongly suggested to clarify the influence of attachments and their number, size, shape, and position on each orthodontic movement.

Investment Risk Tolerance amongst South African University Students in the Vaal Triangle Area

Analysing students risk tolerance during the investor life cycle is imperative to students and financial planners alike, to facilitate the implementation of suitable investments and investment strategies. Students in universities do not have the required knowledge to invest and this is why an investment framework was created to assist, guide and inform students of what stage of the individual investor life cycle that they are in and suggest suitable investment strategies. The article implemented a quantitative approach, using secondary data analysis. The data used for the analysis is from a self-administered questionnaire in 2017 that was distributed to a sample of 396 students from two higher education institutions in the Vaal Triangle region. Two validated risk tolerance scales were used to analyse students risk tolerance levels. The objective of this paper was to determine the risk tolerance levels of students in the Vaal Triangle region. The two results from the 13-item scale and the single-item scale for measuring risk tolerance indicated that the students have a medium risk tolerance level.

Comparison of GRACE and TIMI risk scores in the prediction of in-hospital and long-term outcomes among East Asian non-ST-elevation myocardial infarction patients

Background Risk stratification in non-ST segment elevation myocardial infarction (NSTEMI) determines the intervention time. Limited study compared two risk scores, the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores in the current East Asian NSTEMI patients. Methods This retrospective observational study consecutively collected patients in a large academic hospital between 01/01 and 11/01/2017 and followed for 4 years. Patients were scored by TIMI and GRACE scores on hospital admission. In-hospital endpoints were defined as the in-hospital composite event, including mortality, re-infarction, heart failure, stroke, cardiac shock, or resuscitation. Long-term outcomes were all-cause mortality and cardiac mortality in 4-year follow-up. Results A total of 232 patients were included (female 29.7%, median age 67 years), with a median follow-up of 3.7 years. GRACE score grouped most patients (45.7%) into high risk, while TIMI grouped the majority (61.2%) into medium risk. Further subgrouping the TIMI medium group showed that half (53.5%) of the TIMI medium risk population was GRACE high risk (≥ 140). Compared to TIMI medium group + GRACE < 140 subgroup, the TIMI medium + GRACE high-risk (≥ 140) subgroup had a significantly higher in-hospital events (39.5% vs. 9.1%, p < 0.05), long-term all-cause mortality (22.2% vs. 0% p < 0.001) and cardiac death (11.1% vs. 0% p = 0.045) in 4-year follow-up. GRACE risk scores showed a better predictive ability than TIMI risk scores both for in-hospital and long-term outcomes. (AUC of GRACE vs. TIMI, In-hospital: 0.82 vs. 0.62; long-term mortality: 0.89 vs. 0.68; long-term cardiac mortality: 0.91 vs. 0.67, all p < 0.05). Combined use of the two risk scores reserved both the convenience of scoring and the predictive accuracy. Conclusion GRACE showed better predictive accuracy than TIMI in East Asian NSTEMI patients in both in-hospital and long-term outcomes. The sequential use of TIMI and GRACE scores provide an easy and promising discriminative tool in predicting outcomes in NSTEMI East Asian patients.

Occupational Exposure to SARS-CoV-2 and Risk of Infection Among Healthcare Personnel

Objective: To assess the rate and factors associated with healthcare personnel (HCP) testing positive for SARS-CoV-2 after an occupational exposure Design: Retrospective cohort study Setting: Academic medical center with sites in Minnesota, Wisconsin, Arizona, and Florida Subjects: HCP with a high or medium risk occupational exposure to a patient or other HCP with SARS-CoV-2 Methods: We reviewed the records of HCP with significant occupational exposures from March 20th, 2020 through December 31st, 2020. We then performed regression analysis to assess the impact of demographic and occupational variables to assess their impact on the likelihood of testing positive for SARS-CoV-2 Results: A total of 2,253 confirmed occupational exposures occurred during the study period. Employees were the source for 57.1% of exposures. Overall, 101 (4.5%) HCP tested positive in the postexposure period. Of these, 80 had employee sources of exposure and 21 had patient sources of exposure. The post exposure infection rate was 6.2% when employees were the source, compared to 2.2% with patient sources. In a multivariate analysis, occupational exposure from an employee source had a higher risk of testing positive compared to a patient source (OR 3.22 95% CI (1.72-6.04)). Gender, age, high-risk exposure, and HCP role were not associated with increased risk of testing positive. Conclusions: The risk of acquiring COVID-19 following a significant occupational exposure is relatively low, even in the pre-vaccination era. Exposure to an infectious coworker carries a higher risk than exposure to a patient. Continued vigilance and precautions remain necessary in healthcare settings.

Studi Kasus: Kejadian Bruselosis Pada Sapi Potong Di Kabupaten Barru Provinsi Sulawesi Selatan Tahun 2015-2017

There is still lack of bruselosis in beef cattle in Barru District, South Sulawesi. The aim of this study was to analyze data about the temporary distribution of disease by measuring spreading speed, and spatial distribution by mapping risk areas for bruselosis over the past three years. The data of this study was collected using the records from Dinas Peternakan and conducting interviews using structured questionnaires. This research was a descriptive study by measuring the incidence rate and describing the risk map using geographic information system (GIS). The results of this study indicate that, based on the incidence rate, the average of distribution rate of bruselosis in beef cattle in Barru is 5 cases per 10 000 heads/year. This incidence rate always decreases every year. There was no sub-district that classified as high risk. There was one area that classified as medium risk namely sub-district of Mallusetasi. Control measure that have been carried out by goverment were successful to reduce the spread of disease. Keywords: Beef cattle; Bruselosis; Incidence rate; Occurrence; Risk. Abstrak Informasi mengenai penyebaran kejadian penyakit pada sapi potong di Kabupaten Barru Sulawesi selatan masih kurang. Penelitian ini bertujuan menganalisis data distribusi kejadian penyakit secara temporal dengan mengukur kecapatan penyebaran, dan secara spasial dengan memetakan wilayah berisiko bruselosis selama tiga tahun terakhir. Data dalam penelitian ini menggunakan rekapan dari Dinas Peternakan dan wawancara mendalam menggunakan kuesioner terstruktur. Penelitian ini mengunakan metode deskriptif dengan mengukur incidence rate dan menggambarkan peta risiko menggunakan geographic information system. Hasil penelitian ini menunjukkan bahwa berdasarkan incidence rate, kecepatan rata-rata penyebaran bruselosis pada sapi potong di Kabupaten Barru sebesar 5 kasus per 10 000 ekor/tahun. Nilai incidence rate tersebut selalu menurun setiap tahunnya. Kejadian penyakit paling tinggi terjadi di Kecamatan Mallusetasi dengan incidence rate sebesar 35 kasus per 10 000 ekor/tahun. Terdapat satu wilayah yang tergolong ke dalam risiko sedang, yaitu Kecamatan Mallusetasi. Tindakan pengendalian yang telah dilakukan oleh pemerintah setempat dikatakan berhasil dalam menekan tingkat kejadian penyakit. Kata kunci: Bruselosis; Incidence rate; Risiko; Sapi potong; Tingkat kejadian

The human-elephant conflict: mapping the elephant area and the level of conflict vulnerability in the Mila Landscape, Pidie District, Aceh, Indonesia

Elephants are designated as endangered animals because their population in the wild continues to decline. One of the causes of its extinction is the threat of conflict between elephants and humans. The conflict between Sumatran elephants and humans in Aceh continues to increase every year, but there is no resolution to this conflict. This study was aimed to analyse the level of risk of elephant-human conflict in the Mila area and map the conflict areas. The method used was the observation method with the purposive sampling technique. The data was analysed using the disaster risk formula. The results of the analysis of the risk level of elephant-human conflict in Mila District showed that the high-risk level was in Tuha Lala Village (35.24%), Babah Jurong Village (35.22%) and Kumbang Village (35.04%). The level of risk was moderate in Krueng Lala Village (27.64%), Andeue Mosque Village (30.38%) and Dayah Andeue Village (33.38%). Meanwhile, areas with a low-risk level were Kulu Village (21.65%) and Dayah Sinthop Village (20.32%). The mapping of conflict risk areas was coloured red for high risk, yellow for medium risk and green for low risk. The conclusion in this study is that Tula Lala Village, Babah Jurong Village and Kumbang Village are areas with high conflict marked in red. Krueng Lala Village, Andeu Mosque Village and Andeue Dayah Village are areas with moderate conflict which are marked in yellow. Meanwhile, Kulu Village and Dayah Sinthop Village are areas with low conflict marked in green.

Analisis Keamanan Sistem Informasi Akademik (SIAKAD) Universitas XYZ Menggunakan Metode Vulnerability Assessment

The use of academic information systems (siakad) has become mandatory for universities in providing user convenience in online academic administrative activities. However, sometimes college siakad has security holes that irresponsible people can take advantage of by hacking. This study aims to identify security vulnerabilities at XYZ Siakad University. The method used in this study is a vulnerability assessment method. A university syakad will conduct an initial vulnerability assessment by doing footprinting to get information related to XYZ syakad after that a vulnerability scan is carried out using vulnerability assessment tools to identify vulnerabilities and the level of risk found. Based on the vulnerability of the XYZ university's vulnerabilities, it is quite good, with a high risk level of 1, a medium risk level of 6 and a low risk level of 14. Researchers provide recommendations for improvements related to the findings of security holes in XYZ university Siakad from XSS (Cross Site Scripting) attacks, Clickjacking, Brute Force, Cross-site Request Forgery (CSRF) and Sniffing.

Comparative Analysis of Obstetric Hemorrhage Risk Prediction Tools

Objective Hemorrhage risk prediction tools were developed in response to rising rates of obstetric hemorrhage (OBH). The California Maternal Quality Care Collaborative (CMQCC) risk prediction tool classifies patients as low, medium, and high risk for OBH based on individual risk factors. At our institution, Magee-Womens Hospital (MWH), a unique OBH risk prediction tool was derived from the CMQCC tool that differs through its use of weighted risk factors and distinctive laboratory value cutoffs. Our objective is to compare this enhanced institution-specific tool to the CMQCC tool. Study Design This study was a retrospective cohort analysis of delivery admissions from a single health care network. Admission OBH risk scores were assigned to each patient using both the MWH and CMQCC scores. Cohen's kappa estimated agreement. Scoring systems and maternal outcomes were compared using chi-square test. Composite morbidity included transfusion, hysterectomy, uterine artery embolization, and intensive care unit admission. Results A total of 21,843 delivery admissions were included. A moderate association was observed between scoring systems (kappa 0.41, p < 0.001). The CMQCC tool categorized 16,184 (74%) patients as low risk, 4,664 (21%) as medium risk, and 995 (5%) as high risk. The MWH tool categorized 13,137 (60%) patients as low risk, 8,113 (37%) as medium risk, and 593 (3%) as high risk. The MWH score recategorized CMQCC low-risk patients to a higher stratum 26% of the time. CMQCC high-risk patients were recategorized to a lower stratum 82% of the time. Both the MWH and CMQCC tools were able to differentiate OBH-related morbidity across risk strata. The MWH tool independently predicted risk of composite morbidity within each stratum of the CMQCC score. Conclusion Both the MWH and CMQCC tools independently distinguish risk of composite morbidity. Adding weighted values to individual risk factors further discriminates risk of morbidity. This suggests it may be reasonable to adapt the CMQCC tool to reflect institutional populations and resources. Key Points