bluuebunny/crossref_metadata_2025 huggingface dataset:
Juvenile Xanthogranuloma with Hematologic Changes in Dizygotic Twins: Report of Two Newborn Infants
Authors: Kobayashi Kenichiro , Imai Tsuyoshi , Adachi Soichi , Yoifuji Tohru , Furusho Kenshi , Kore‐eda Satoshi , Mizuno Kana , Okamoto Hiroyuki
Published: August 2010

Abstract: We describe the first reported instances of juvenile xanthogranuloma (JXG) in dizygotic twins. They had characteristic skin lesions and subcutaneous nodules as well as hepatomegaly, anemia, and thrombocytopenia. These extracutaneous symptoms improved in 5 months, coincident with the resolution of the skin lesions. Although most patients with JXG have only cutaneous symptoms, some show such dramatic extracutaneous manifestations that the possibility of malignant disease is occasionally the principle concern. It is therefore necessary to make a precise diagnosis based on specific immunohistochemical and ultra‐structural findings, and to evaluate for other organ involvement, including hematologic abnormalities.
Congenital Erosive and Vesicular Dermatosis Healing with Reticulated Supple Scarring: Report of Three New Cases and Review of the Literature
Authors: Sidhu‐Malik Navjeet K. , Resnick Steven D. , Wilson Barbara Braunstein
Published: August 2010

Abstract: Congenital erosive and vesicular dermatosis healing with reticulated, supple scarring is a rare disease with seven reported cases in the literature. This congenital cutaneous defect of unknown etiology presents with patchy or generalized erosions and vesicles at birth that heal with striking reticulated scarring. We report three new cases of this rare disease and review the literature.
Conradi‐Hünermann Syndrome with Unilateral Distribution
Authors: Corbi M. R. , Conejo‐Mir J. S. , Linares M. , Jimenez G. , Cañas T. Rodriguez , Navarrete M.
Published: August 2010

Abstract:Conradi‐Hünermann syndrome is a type of chondrodysplasia punctata characterized by skeletal, cutaneous, and ocular anomalies. Genetic heterogeneity and incomplete penetrance may explain the wide clinical spectrum. We report a 7‐day‐old girl, product of a preterm pregnancy and delivery, with ichthyosiform erythoderma on the right half of the body at birth, as well as patchy cutaneous involvement of the contralateral side. On physical examination, we observed an ipsilateral shortening of the leg and a lenticular opacity of the right eye. Histopathologic study showed parakeratotic hyperkeratosis with prominent follicular involvement and atrophy of the granular and spinous layers. The skin eruption disappeared during the first 2 months. At 2 months of age, radiologic examination revealed stippled calcifications in the ribs, vertebral, and paravertebral areas. The most important differential diagnosis was CHILD syndrome. We emphasize the importance of the histopathologic study in the differential diagnosis of both syndromes.
The Clinical Spectrum of Rudimentary Meningocele
Authors: M.Sc H. H. L. Chan , Fung J. W. K. , Lam W. M. , Choi P.
Published: August 2010

Abstract: Rudimentary meningocele is rare, only 50 cases having been reported. Clinically it may simulate dermoid cyst, lipoma, or nevus sebaceous. We present two cases of this uncommon condition, each with its own unique clinical features.
Childhood Discoid Lupus Erythematosus: A Report of Two Cases
Authors: McMullen E. A. , Armstrong K. D. B. , Bingham E. A. , Walsh M. Y.
Published: August 2010

Abstract: Discoid lupus erythematosus (DLE) is an uncommon disease in childhood. We present two patients initially diagnosed as impetigo and photosensitive eczema with impetigo, respectively, who failed to respond to topical and systemic antistaphylococcal agents and in whom a diagnosis of discoid lupus erythematosus subsequently became apparent.
Chilblain‐like Leukemia Cutis
Authors: Affleck Andrew G. , Ravenscroft Jane C , Leach Iain H.
Published: August 2010

Abstract:  We present a 6‐year‐old girl with an 8‐month history of fluctuating chilblain‐like lesions on the toes. A full blood count showed slight thrombocytopenia and monocytosis. A skin biopsy specimen showed a dense perivascular and superficial dermal cellular infiltrate which was CD3−, CD43+, and lysosyme + on immunocytochemistry, suggesting a monocytic origin. Juvenile myelomonocytic leukemia was diagnosed after a bone marrow biopsy and spontaneous marrow colony growth in culture.
Recurrent Vasculopathic Skin Lesions Associated with Homozygous Protein C Deficiency
Authors: Agras Pinar Isik , Ozdemir Handan , Baskin Esra , Ozbek Namik
Published: August 2010

Abstract:  Symptomatic protein C deficiency is a rare condition. Vasculopathy associated with hypercoagulable state in protein C deficiency has also been reported rarely. We described a boy who was diagnosed as having homozygous protein C deficiency during the neonatal period, when he developed purpura fulminans. At 7 years of age, he developed recurrent, painful, nonscarring, purpuric skin lesions. Histopathologic skin findings were compatible with those of vasculopathy. The histopathologic characteristics of these vasculopathic lesions and the pathogenetic mechanisms of their association with protein C deficiency are discussed.
A Case Simulating Ophthalomoplegic Migraine: Clinicopathological Study
Authors: Morimoto Kazuyoshi , Nagatani Masaaki , Mogami Heitaro
Published: August 2010

SYNOPSIS

We describe a 61‐year‐old woman with unilateral ophthalmoplegia with migraine type headache. Pathological examination revealed severe atrophy of the third cranial nerve as the result of vascular compression by the atheromatous posterior cerebral artery. Although the exact pathogenesis of ophthalmoplegic migraine (OM) is uncertain at the present time, this unique case with clinical and pathological observations suggests that vascular compression and the resulting ischemia of the third cranial nerve can closely simulate OM.
The Low Molecular Weight Heparin, Tinzaparin, in Thrombosis and Beyond
Authors: Mousa Shaker A.
Published: August 2010

Standard unfractionated heparin (UFH) has been in clinical use for over 50 years. The commercial use of low molecular weight heparins (LMWHs) began in the mid 1980s for hemodialysis and the prophylaxis of deep vein thrombosis (DVT). Initially, the clinical development of LMWHs was concentrated on the European continent. Subsequently, LMWHs were introduced in North America as well. In the initial stages of development of these drugs only nadroparin, dalteparin and enoxaparin were used. Subsequently, several other LMWHs such as ardeparin, tinzaparin, reviparin and parnaparin were introduced. LMWHs constitute a group of important medications with total sales reaching nearly 2.5 billion dollars with expanded indications reaching far beyond the initial indications for the prophylaxis of post‐surgical DVT. This review highlights the pharmacology of tinzaparin. Unlike other LMWHs, tinzaparin is prepared by enzymatic hydrolysis with heparinase, while various chemical depolymerization methods are used for the synthesis of other LMWHs. As compared with the standard heparin, LMWHs have different pharmacodynamic, and pharmacokinetic properties; they also differ in clinical benefits.
Clinical Use and Molecular Mechanisms of Action of Extract of Ginkgo biloba Leaves in Cardiovascular Diseases
Authors: Zhou Wei , Chai Hong , Lin Peter H. , Lumsden Alan B. , Yao Qizhi , Chen Changyi
Published: August 2010

Ginkgo biloba is one of the oldest living tree species that has been referred to as a living fossil. Extract from Ginkgo biloba leaves (GBE) is among the most commonly used herbal drugs and is popularized for its alleged tonic effect and possible curative and restorative properties. There is an increasing evidence of the potential role of GBE in treating cardiovascular diseases. We examined the history of GBE usage and reviewed the literature on its effects on the cardiovascular system. In the extensive studies involving cell cultures and animal models, GBE has been shown to exert its action through diverse mechanisms. GBE has been reported to have antioxidatant properties, to modify vasomotor function, to reduce adhesion of blood cells to endothelium, to inhibit activation of platelets and smooth muscle cells, to affect ion channels, and to alter signal transduction. In addition, relevant clinical trials with CBE are being carried out, particularly in the treatment of arterial and venous insufficiency and in the prevention of thrombosis. Finally, the controversial clinical findings and the possible adverse interactions between GBE and other drugs are discussed. This review underscores the potential benefits of Ginkgo biloba in cardiovascular diseases, highlights the gaps in our current research, and suggests the necessity for more rigorous systematic investigation of cardiovascular properties of CBE.
Colesevelam: Potential Uses for the Newest Bile Resin
Authors: Steinmetz Karen L. , Schonder Kristine S.
Published: August 2010

Colesevelam is the newest bile resin with a unique chemical structure. It binds to bile acids with higher affinity than traditional bile acid sequestrants and has fewer gastrointestinal side effects and drug interactions. Colesevelam is safe and efficacious alone or in combination with HMG‐CoA reductase inhibitors (statins) in reducing low‐density lipoprotein cholesterol (LDL‐C) levels. Despite this, the role of colesevelam in the treatment of hyperlipidemia remains limited, particularly in the face of new lipid lowering agents. As guidelines for cholesterol control become more stringent, the need to maximize therapeutic benefit through combination therapy will become increasingly more important. Colesevelam has a dose‐sparing effect on statin therapy, potentially decreasing the risk of unwanted side effects or drug‐drug interactions associated with statin use. This makes colesevelam a viable option for addition to a statin regimen when goal LDL‐C levels cannot be achieved with a statin alone. Additionally, anecdotal reports indicate that colesevelam may have potential benefits in certain patient populations that cannot tolerate other lipid lowering therapies, including organ transplant recipients, cholestatic liver disesase, and end‐stage renal disease. By recognizing the potential utility of colesevelam, clinicians can better manage those patients who are not able to tolerate first‐line therapies.
Clinical Use of Sirolimus‐Eluting Stents
Authors: Kirtane Ajay J. , Leon Martin B.
Published: August 2010

Drug‐eluting stents, or intracoronary stents that combine the local delivery of antirestenotic pharmacologic therapies while maintaining the mechanical advantage of bare metal stents over balloon angioplasty alone, are a highly complex technology that have profoundly affected the practice of percutaneous coronary intervention over the last 5 years. These devices were designed specifically to treat the neointimal hyperplasia occurring after conventional bare metal stent placement, and have been remarkably successful in this regard. However, recent concerns have been raised regarding the long‐term safety of these devices, particularly when used outside of the specific patient and lesion subsets studied in the pivotal randomized trials that led to device approval by regulatory bodies within the United States and abroad. This review aims to present a brief description of the sirolimus‐eluting stent device platform and its mechanism of action, followed by an overview of current data regarding efficacy and safety regarding the clinical use of sirolimus‐eluting stent technology.
The underlying etiology of infantile spasms (West syndrome): Information from the United Kingdom Infantile Spasms Study (UKISS) on contemporary causes and their classification2
Authors: Osborne John P. , Lux Andrew L. , Edwards Stuart W. , Hancock Eleanor , Johnson Anthony L. , Kennedy Colin R. , Newton Richard W. , Verity Christopher M. , O’Callaghan Finbar J. K.
Published: August 2010

Purpose:  To examine the underlying etiology of infantile spasms from the United Kingdom Infantile Spasms Study (UKISS), using the pediatric adaptation of ICD 10.

Methods:  Infants were enrolled in a randomized controlled trial or a parallel epidemiologic study. Etiological information included history, examination, and investigations. The infants were classified as proven etiology, if a neurologic disease was identified; as no identified etiology, if no neurologic disease was identified; and as not fully investigated, if a major piece of information was missing. Proven etiology was subclassified using the pediatric adaptation of ICD 10. The results were then examined to identify further methods of classification.

Results:  Of 207 infants, 127 (61%) had proven etiology, 68 (33%) had no identified etiology, and 12 (6%) were not fully investigated. Etiologies were prenatal in 63, perinatal in 38, postnatal in 8, and 18 other. The most common etiologies were: hypoxic–ischemic encephalopathy (HIE) 21 (10%), chromosomal 16 (8%), malformations 16 (8%), stroke 16 (8%), tuberous sclerosis complex (TSC) 15 (7%), and periventricular leukomalacia or hemorrhage 11 (5%). The remaining 32 etiologies were all individually uncommon. Response to treatment is given for individual etiologies.

Discussion:  Our method of classification allows the reporting of results by individual diseases, disease groups, or categories and is structured and clear. It avoids the use of poorly defined terms such as symptomatic and cryptogenic. It can adapt to new neurologic diseases, such as gene defects, and can be used for comparison of different groups of infants, thereby aiding meta‐analysis.
Absence seizures: Individual patterns revealed by EEG‐fMRI
Authors: Moeller Friederike , LeVan Pierre , Muhle Hiltrud , Stephani Ulrich , Dubeau Francois , Siniatchkin Michael , Gotman Jean
Published: August 2010

Purpose:  Absences are characterized by an abrupt onset and end of generalized 3–4 Hz spike and wave discharges (GSWs), accompanied by unresponsiveness. Although previous electroencephalography–functional magnetic resonance imaging (EEG–fMRI) studies showed that thalamus, default mode areas, and caudate nuclei are involved in absence seizures, the contribution of these regions throughout the ictal evolution of absences remains unclear. Furthermore, animal models provide evidence that absences are initiated by a cortical focus with a secondary involvement of the thalamus. The aim of this study was to investigate dynamic changes during absences.

Methods:  Seventeen absences from nine patients with absence epilepsy and classical pattern of 3–4 Hz GSWs during EEG‐fMRI recording were included in the study. The absences were studied in a sliding window analysis, providing a temporal sequence of blood oxygen–level dependent (BOLD) response maps.

Results:  Thalamic activation was found in 16 absences (94%), deactivation in default mode areas in 15 (88%), deactivation of the caudate nuclei in 10 (59%), and cortical activation in patient‐specific areas in 10 (59%) of the absences. Cortical activations and deactivations in default mode areas and caudate nucleus occurred significantly earlier than thalamic responses.

Discussion:  Like a fingerprint, patient‐specific BOLD signal changes were remarkably consistent in space and time across different absences of one patient but were quite different from patient to patient, despite having similar EEG pattern and clinical semiology. Early frontal activations could support the cortical focus theory, but with an addition: This early activation is patient specific.
Independent Familial Transmission of Alcoholism and Opiate Abuse
Authors: Hill Shirley Y. , Cloninger C. Robert , Aye Frederick R.
Published: August 2010

Interviews were conducted with 32 alcoholics, 72 opiate addicts, and 42 alcoholic‐opiate addicts, and information was gained about the practices of their families. Alcoholism tended to cluster in families to a significant extent while, in contrast, alcoholism and opiate abuse did not occur in the same families significantly more or less often than expected by chance. Doubt is clearly cast on any unitary concept of addiction‐proneness.
A Review of Alcoholism Activities in Latin America
Authors: Katatsky Marilynn E.
Published: August 2010

The major trends in the development of alcoholism treatment programs in Latin America are described and analyzed, and the role of the PAHO/WHO in this field in the Americas is detailed.
Emergency Measurement of Stat, Timed, Serum Ethanol Levels for Medical Management
Authors: Senior John R. , Sloan Bruce P.
Published: August 2010

Because of a general impression that a substantial proportion of emergency medical problems requiring treatment or hospitalization was caused by unsuspected alcohol consumption, a study to question that impression was done on a population of urban emergency service patients. We evaluated blood samples taken from these patients for routine determinations for many reasons other than suspicion of alcohol use or abuse. Abnormalities in results of serum ethanol concentrations were found more frequently than abnormalities of concurrently determined serum electrolytes, urea nitrogen, or glucose. The frequency of abnormalities found was ethanol, 42%; carbon dioxide, 35%; glucose, 34%; chloride, 32%, sodium, 21%; potassium, 20%; and urea nitrogen, 13%. The high incidence of serum ethanol elevations in such hospital emergency service patients and the considerable potential usefulness of ethanol levels in diagnosis and management of a wide variety of medical problems suggest that determinations of stat, timed, serum ethanol concentrations are often indicated as an emergency study for urban populations.
The Effect of Ethanol on Heme and Porphyrin Synthesis
Authors: Ostroff James W.
Published: August 2010

Despite the inherent difficulties in interpreting in vivo data on the effects of alcohol, it appears quite evident that ethanol itself alters the metabolism of the porphyrins and in so doing directly influences heme and hemoglobin synthesis. The mechanism of ethanol‐induced iron overload remains elusive but, through observing the effects of phlebotomies and rechallenge with iron, the relationships of iron and alcohol to porphyria cutanea tarda are being more clearly defined. The control mechanisms of porphyrin synthesis by endogenous factors may be part of a more general red blood cell regulatory apparatus.
Novel test for microparticles in platelet‐rich plasma and platelet concentrates using dynamic light scattering
Authors: Xu Yan , Nakane Nobu , Maurer‐Spurej Elisabeth
Published: August 2010

BACKGROUND: The level and clinical importance of platelet (PLT)‐derived microparticles (PMPs) in PLT‐rich plasma (PRP) and PLT transfusions is largely unknown due to the lack of technology to routinely determine the number and size of PMP in PLT samples. Dynamic light scattering (DLS) is ideally suited to measure particles of submicron size but has previously been limited to the analysis of PLT‐free samples.

STUDY DESIGN AND METHODS: PMPs were enumerated in 81 PRP and 79 apheresis PLT concentrate (APC) samples from the same donors using ThromboLUX (LightIntegra Technology, Inc.), a new DLS PLT quality test. The ThromboLUX results were compared with flow cytometry. Phase contrast and differential interference contrast (DIC) microscopy were used to qualitatively determine PMP levels.

RESULTS: The relative counts of PMPs measured by flow cytometry strongly correlated with the relative light scattering intensities of the PMP determined by ThromboLUX in both PRP (R = 0.7596, p < 0.0001) and APC (R = 0.6572, p < 0.0001) samples. High or low PMP levels in PLT samples were confirmed by phase contrast and DIC microscopy. The mean PMP radius measured with ThromboLUX, an absolute sizing technology, was 117.1 ± 77.6 nm as determined from the distribution of PMP content in all PLT samples investigated in this study.

CONCLUSIONS: Correlation with flow cytometry and microscopy showed that ThromboLUX is well suited to measure PMP concentration and size distribution in PLT concentrate samples. In combination with noninvasive sampling, ThromboLUX could provide routine microparticle enumeration of PLT‐containing samples.
Weak D and DEL alleles detected by routine SNaPshot genotyping: identification of four novel RHD alleles
Authors: Silvy Monique , Simon Sophie , Gouvitsos Julia , Di Cristofaro Julie , Ferrera Virginie , Chiaroni Jacques , Bailly Pascal
Published: August 2010

BACKGROUND: Molecular RHD blood group typing is very efficient for managing donors and patients carrying any of the various molecular types of weak D and DEL. The purpose of the work was to develop a multiplex polymerase chain reaction (PCR) SNaPshot assay for simultaneous detection of weak D and DEL alleles that are prevalent in Europeans, Africans, and Asians.

STUDY DESIGN AND METHODS: Preliminary profiling was carried out on single‐nucleotide polymorphisms (SNPs) associated with 13 prevalent RHD alleles, that is, weak D Types 1, 2, 3, 4.0, 4.0.1, 4.1, 4.2, 5, 11, 15, and 17; RHD(IVS3+1g>a); and RHD(K409K). Multiplex PCR was used to amplify six RHD regions encompassing 14 SNPs. Identification was obtained by incorporation of the complementary dye single base at the 3′‐end of each probe‐primer. A prospective analysis was then carried out on 152 blood samples from patients (n = 53) and donors (n = 88) with equivocal RhD serology and pregnant women (n = 11).

RESULTS: After validation, our SNaPshot assay allowed direct genotyping of 82.9% of samples overall and 100% of samples harboring weak D Types 1, 2, 3, and 4.1 alleles. In the remaining 17.1% of samples overall, sequence investigation allowed accurate genotyping. In addition, four novel RHD alleles were identified, that is, RHD(S256P), RHD(L390L), RHD(F410V), and RHD(IVS4‐2a>g).

CONCLUSION: The SNaPshot assay described herein is a helpful supplementary tool for resolving doubtful RhD serology. By allowing accurate identification of weak D and DEL alleles this assay should allow better management of the donors and the patients genotyped weak D Types 1, 2, 3, and 4.1 who can receive D+ blood units.
Tolerable or Acceptable: A Comparison of Risk Regulation in the United Kingdom and in the Netherlands
Authors: Ale B. J. M.
Published: August 2010

In managing major accident hazards in industry risk, both the United Kingdom and the Netherlands use quantitative risk analysis and quantified risk criteria. These should be understood in the historical, legal, and political context in which they were drawn up. Even when criteria are numerically the same they do not necessarily mean the same thing. The legal and historical context differs widely between the two countries. Nevertheless, it is surprising that the final results in terms of land use and levels of risk are very similar.
Uncertainty and Sensitivity Analysis in Assessment of the Thyroid Cancer Risk Related to Chernobyl Fallout in Eastern France
Authors: Catelinois Olivier , Laurier Dominique , Verger Pierre , Rogel Agnès , Colonna Marc , Ignasiak Marianne , Hémon Denis , Tirmarche Margot
Published: August 2010

The increase in the thyroid cancer incidence in France observed over the last 20 years has raised public concern about its association with the 1986 nuclear power plant accident at Chernobyl. At the request of French authorities, a first study sought to quantify the possible risk of thyroid cancer associated with the Chernobyl fallout in France. This study suffered from two limitations. The first involved the lack of knowledge of spontaneous thyroid cancer incidence rates (in the absence of exposure), which was especially necessary to take their trends into account for projections over time; the second was the failure to consider the uncertainties. The aim of this article is to enhance the initial thyroid cancer risk assessment for the period 1991–2007 in the area of France most exposed to the fallout (i.e., eastern France) and thereby mitigate these limitations. We consider the changes over time in the incidence of spontaneous thyroid cancer and conduct both uncertainty and sensitivity analyses. The number of spontaneous thyroid cancers was estimated from French cancer registries on the basis of two scenarios: one with a constant incidence, the other using the trend observed. Thyroid doses were estimated from all available data about contamination in France from Chernobyl fallout. Results from a 1995 pooled analysis published by Ron et al. were used to determine the dose‐response relation. Depending on the scenario, the number of spontaneous thyroid cancer cases ranges from 894 (90% CI: 869–920) to 1,716 (90% CI: 1,691–1,741). The number of excess thyroid cancer cases predicted ranges from 5 (90% UI: 1–15) to 63 (90% UI: 12–180). All of the assumptions underlying the thyroid cancer risk assessment are discussed.
Probability Distributions for Showering and Bathing Water‐Use Behavior for Various U.S. Subpopulations
Authors: Wilkes Charles R. , Mason Andrea D. , Hern Stephen C.
Published: August 2010

It has been shown that bathroom‐type water uses dominate personal exposure to water‐borne contaminants in the home. Therefore, in assessing exposure of specific population groups to the contaminants in the water, understanding population water‐use behavior for bathroom activities as a function of demographic characteristics is vital to realistic exposure estimates. In this article, shower and bath frequencies and durations are analyzed, presented, and compared for various demographic groups derived from analyses of the National Human Activities Pattern Survey (NHAPS) database and the Residential End Uses of Water Study (REUWS) database as well as from a review of current literature. Analysis showed that age and level of education significantly influenced shower and bath frequency and duration. The frequency of showering and bathing reported in NHAPS agreed reasonably well with previous studies; however, durations of these events were found to be significantly longer. Showering frequency reported in REUWS was slightly less than that reported for NHAPS; however, durations of showers reported in REUWS are consistent with other studies. After considering the strengths and weaknesses of each data set and comparing their results to previous studies, it is concluded that NHAPS provides more reliable frequency data, while REUWS provides more reliable duration data. The shower‐ and bath‐use behavior parameters recommended in this article can aid modelers in appropriately specifying water‐use behavior as a function of demographic group in order to conduct reasonable assessments of exposure to contaminants that enter the home via the water supply.
Risk Analysis of Finnish Peacekeeping in Kosovo
Authors: Lehtomäki Kyösti , Pääkkönen Rauno J. , Rantanen Jorma
Published: August 2010

The research team interviewed over 90 Finnish battalion members in Kosovo, visited 22 units or posts, registered its observations, and made any necessary measurements. Key persons were asked to list the most important risks for occupational safety and health in their area of responsibility. Altogether, 106 accidents and 40 cases of disease resulted in compensation claims in 2000. The risks to the peacekeeping force were about twice those of the permanent staff of military trainees in Finland. Altogether, 21 accidents or cases of disease resulted in sick leave for at least 3 months after service. One permanent injury resulted from an explosion. Biological, chemical, and physical factors caused 8 to 9 occupational illnesses each. Traffic accidents, operational factors, and munitions and mines were evaluated to be the three most important risk factors, followed by occupational hygiene, living conditions (mold, fungi, dust), and general hygiene. Possible fatal risks, such as traffic accidents and munitions and explosives, received a high ranking in both the subjective and the objective evaluations. One permanent injury resulted from an explosion, and two traffic accidents involved a fatality, although not of a peacekeeper. The reduction of sports and military training accidents, risk‐control programs, and, for some tasks, better personal protection is considered a development challenge for the near future.
Toward Cost‐Benefit Analysis of Acute Behavioral Effects of Toluene in Humans
Authors: Benignus Vernon A. , Bushnell Philip J. , Boyes William K.
Published: August 2010

There is increasing interest in being able to express the consequences of exposure to potentially toxic compounds in monetary terms in order to evaluate potential cost‐benefit relationships of controlling exposure. Behavioral effects of acute toluene exposure could be subjected to cost‐benefit analysis if the effects of toluene were quantitatively compared to those of ethanol ingestion, which has been monetized for applied contexts. Behavioral effects of toluene and ethanol were quantified by meta‐analysis of studies from the peer‐reviewed literature describing their effects on choice reaction time (reaction time in a test requiring a subject to choose among two or more alternatives before responding). The internal doses of these compounds were estimated by a general physiological and toxicokinetic (GPAT) simulation from exposure parameters provided in the reports. The reported effects were converted to a common metric (proportion of baseline) and related to the estimated internal doses of toluene and ethanol, from which dose‐effect equations were fitted. The estimated effect of toluene was compared to the estimated effect of ethanol on the same dependent variable by deriving a dose‐equivalence equation (DEE) to express the dose of toluene as an equivalent dose of ethanol on the basis of equal effect magnitude. A nomogram was constructed by GPAT simulation to relate the environmental exposure concentration of toluene to the equivalent effect magnitude of a range of ethanol internal doses. Behavioral effects and their evaluation are determined by internal doses, which in turn are determined by a variety of variables. In addition to concentration and duration of exposure, which determine internal dose by pharmacokinetic processes, the activity level of exposed persons is a major factor. This analysis provides a continuous function of the consequences of toluene exposure expressed as ethanol‐equivalent doses within confidence limits. The resulting function has the potential to estimate the monetary values of behavioral deficits caused by a range of exposures to toluene from existing monetized information on ethanol.
Bringing Social Standards into Project Evaluation Under Dynamic Uncertainty
Authors: Knudsen Odin K. , Scandizzo Pasquale L.
Published: August 2010

Society often sets social standards that define thresholds of damage to society or the environment above which compensation must be paid to the state or other parties. In this article, we analyze the interdependence between the use of social standards and investment evaluation under dynamic uncertainty where a negative externality above a threshold established by society requires an assessment and payment of damages. Under uncertainty, the party considering implementing a project or new technology must not only assess when the project is economically efficient to implement but when to abandon a project that could potentially exceed the social standard. Using real‐option theory and simple models, we demonstrate how such a social standard can be integrated into cost‐benefit analysis through the use of a development option and a liability option coupled with a damage function. Uncertainty, in fact, implies that both parties interpret the social standard as a target for safety rather than an inflexible barrier that cannot be overcome. The larger is the uncertainty, in fact, the greater will be the tolerance for damages in excess of the social standard from both parties.
Influence of Routine Slaughtering on the Evolution of BSE: Example of British and French Slaughterings
Authors: Jacob Christine , Magal Pierre
Published: August 2010

The aim of this article is to build a methodology allowing the study and the comparison of the potential spread of BSE at the scale of countries under different routine slaughtering conditions in order to evaluate the risk of nonextinction due to this slaughtering. We first model the evolution in discrete time of the proportion of animals in the latent period and that of infectives, assuming a very large branching population not necessarily constant in size, two age classes, less than 1‐year‐old animals, and adult animals. We analytically derive a bifurcation parameter ρ0allowing us to predict either endemicity or extinction of the disease, which has the meaning of an epidemiological reproductive rate. We show that the classical reproductive numberR0cannot be used for prediction if the size of the population, when healthy, does not remain stable throughout time. We illustrate the qualitative results by means of simulations with either the British routine slaughtering probabilities or the French ones, the other conditions being assumed identical in both countries. We show that the French probabilities lead to a higher risk of spread of the disease than the British ones, this result being mainly due to a smaller value of the routine slaughtering probability of the adult animals in France than in Great Britain.
Risk Analysis for Critical Asset Protection
Authors: McGill William L. , Ayyub Bilal M. , Kaminskiy Mark
Published: August 2010

This article proposes a quantitative risk assessment and management framework that supports strategic asset‐level resource allocation decision making for critical infrastructure and key resource protection. The proposed framework consists of five phases: scenario identification, consequence and criticality assessment, security vulnerability assessment, threat likelihood assessment, and benefit‐cost analysis. Key innovations in this methodology include its initial focus on fundamental asset characteristics to generate an exhaustive set of plausible threat scenarios based on a target susceptibility matrix (which we refer to as asset‐driven analysis) and an approach to threat likelihood assessment that captures adversary tendencies to shift their preferences in response to security investments based on the expected utilities of alternative attack profiles assessed from the adversary perspective. A notional example is provided to demonstrate an application of the proposed framework. Extensions of this model to support strategic portfolio‐level analysis and tactical risk analysis are suggested.
Life Cycle Risks for Human Health: A Comparison of Petroleum Versus Bio‐Based Production of Five Bulk Organic Chemicals
Authors: Roes Alexander L. , Patel Martin K.
Published: August 2010

This article describes the development and application of a generic approach to the comparative assessment of risks related to the production of organic chemicals by petrochemical processes versus white biotechnology. White biotechnology, also referred to as industrial biotechnology, typically uses bio‐based feedstocks instead of the fossil raw materials used in the petrochemical sector. The purpose of this study was to investigate whether the production of chemicals by means of white biotechnology has lower conventional risks than their production by petrochemical processes. Conventional risks are the risks of well‐established processes, and not those related to genetically modified microorganisms and plants. Our approach combines classical risk assessment methods (largely based on toxicology), as developed by the life cycle assessment (LCA) community, with statistics on technological disasters, accidents, and work‐related illnesses. Moreover, it covers the total process chain for both petrochemical and bio‐based products from cradle to grave. The approach was applied to five products: the plastics polytrimethylene terephthalate (PTT), polyhydroxyalkanoates (PHA), polyethylene terephthalate (PET), polyethylene (PE), and ethanol. Our results show that the conventional risks related to the white biotechnology products studied are lower than those of the petrochemical products. However, considering the uncertainties with respect to the ranges of input data, the (incomplete) coverage of emissions by the environmental priority strategies (EPS) 2000 method, and the uncertainties of the assumptions made in this study (i.e., large to very large), the differences in results between bio‐based and petrochemical products fall into the uncertainty range. Because of this, future research is necessary to decrease the uncertainties before we can conclude that the conventional risks of biotechnologically produced chemicals are lower than those of fossil‐fuel‐derived chemicals.
Development of a Screening Approach to Interpret Human Biomonitoring Data on Volatile Organic Compounds: Reverse Dosimetry on Biomonitoring Data for Trichloroethylene
Authors: Liao Kai H. , Tan Yu‐Mei , Clewell Harvey J.
Published: August 2010

A screening approach is developed for volatile organic compounds (VOCs) to estimate exposures that correspond to levels measured in fluids and/or tissues in human biomonitoring studies. The approach makes use of a generic physiologically‐based pharmacokinetic (PBPK) model coupled with exposure pattern characterization, Monte Carlo analysis, and quantitative structure property relationships (QSPRs). QSPRs are used for VOCs with minimal data to develop chemical‐specific parameters needed for the PBPK model. The PBPK model is capable of simulating VOC kinetics following multiple routes of exposure, such as oral exposure via water ingestion and inhalation exposure during shower events. Using published human biomonitoring data of trichloroethylene (TCE), the generic model is evaluated to determine how well it estimates TCE concentrations in blood based on the known drinking water concentrations. In addition, Monte Carlo analysis is conducted to characterize the impact of the following factors: (1) uncertainties in the QSPR‐estimated chemical‐specific parameters; (2) variability in physiological parameters; and (3) variability in exposure patterns. The results indicate that uncertainty in chemical‐specific parameters makes only a minor contribution to the overall variability and uncertainty in the predicted TCE concentrations in blood. The model is used in a reverse dosimetry approach to derive estimates of TCE concentrations in drinking water based on given measurements of TCE in blood, for comparison to the U.S. EPA's Maximum Contaminant Level in drinking water. This example demonstrates how a reverse dosimetry approach can be used to facilitate interpretation of human biomonitoring data in a health risk context by deriving external exposures that are consistent with a biomonitoring data set, thereby permitting comparison with health‐based exposure guidelines.
Systemic Valuation of Strategic Preparedness Through Application of the Inoperability Input‐Output Model with Lessons Learned from Hurricane Katrina
Authors: Crowther Kenneth G. , Haimes Yacov Y. , Taub Gideon
Published: August 2010

The U.S. Department of Homeland Security (DHS) has mandated all regions to “carefully weigh the benefit of each homeland security endeavor and only allocate resources where the benefit of reducing risk is worth the amount of additional cost” (DHS, 2006, p. 64). This mandate illuminates the need to develop methods for systemic valuation of preparedness measures that support strategic decision making. This article proposes an analysis method that naturally emerges from the structure of the inoperability input‐output model (IIM) through which various regional‐ and sector‐specific impact analyses can be cost‐effectively integrated for natural and man‐made disasters. The IIM is described extensively in a companion paper (Lian et al., 2007). Its reliance on data classifications structured by the U.S. Census Bureau and its extensive accounting of economic interdependencies enables us to decompose a risk analysis activity, perform independent assessments, and properly integrate the assessment for a systemic valuation of risk and risk management activity. In this article, we account for and assess some of the major impacts of Hurricanes Katrina and Rita to demonstrate this use of the IIM and illustrate hypothetical, reduced impacts resulting from various strategic preparedness decisions. Our results indicate the capability of the IIM to guide the decision‐making processes involved in developing a preparedness strategy.
Predicting Severity of Foreign Body Injuries in Children in Upper Airways: An Approach Based on Regression Trees
Authors: Berchialla Paola , Snidero Silvia , Stancu Alexandru , Scarinzi Cecilia , Corradetti Roberto , Gregori Dario ,   the ESFBI Study Group
Published: August 2010

The entry of a small item into the upper airways is one of the leading causes of injuries in children up to 14 years old. The aim of this study is to characterize types of objects causing choking along with the features of the children involved in the accident and compare results with current standards. The European Survey on Foreign Bodies Injuries Study (ESFBI) collected data on foreign body injuries from 19 European countries. The data from ESFBI were selected according to the ICD‐9‐CM codes 933 (foreign body in the pharynx and larynx) and 934 (foreign body in the trachea, bronchi, and lungs). Both a classification tree and a linear discriminant analysis (LDA) have been set up to predict the probability that an injured child experiences a hospitalization. The classification tree provides flowchart‐type decision rules and allows for analyzing the impact of the item features, the children characteristics, and the circumstances of the accidents on the severity of the foreign body injuries. Results showed that children younger than 3.5 who are involved in an accident have a high probability to experience a hospitalization.
Regulatory False Positives: True, False, or Uncertain?
Authors: Cox Louis Anthony
Published: August 2010

Hansen et al. (2007) recently assessed the historical performance of the precautionary principle in 88 specific cases, concluding that “applying our definition of a regulatory false positive, we were able to identify only four cases that fit the definition of a false positive.” Empirically evaluating how prone the precautionary principle is to classify nonproblems as problems (“false positives”) is an excellent idea. Yet, Hansen et al.'s implementation of this idea applies a diverse set of questionable criteria to label many highly uncertain risks as “real” even when no real or potential harm has actually been demonstrated. Examples include treating each of the following as reasons to categorize risks as “real”: considering that a company's actions contaminated its own product; lack of a known exposure threshold for health effects; occurrence of a threat; treating deliberately conservative (upper‐bound) regulatory assumptions as if they were true values; treating assumed exposures of children to contaminated soils (by ingestion) as evidence that feared dioxin risks are real; and treating claimed (sometimes ambiguous) epidemiological associations as if they were known to be true causal relations. Such criteria can classify even nonexistent and unknown risks as “real,” providing an alternative possible explanation for why the authors failed to find more false positives, even if they exist.
Probabilistic Fault Tree Analysis of a Radiation Treatment System
Authors: Ekaette Edidiong , Lee Robert C. , Cooke David L. , Iftody Sandra , Craighead Peter
Published: August 2010

Inappropriate administration of radiation for cancer treatment can result in severe consequences such as premature death or appreciably impaired quality of life. There has been little study of vulnerable treatment process components and their contribution to the risk of radiation treatment (RT). In this article, we describe the application of probabilistic fault tree methods to assess the probability of radiation misadministration to patients at a large cancer treatment center. We conducted a systematic analysis of the RT process that identified four process domains: Assessment, Preparation, Treatment, and Follow‐up. For the Preparation domain, we analyzed possible incident scenarios via fault trees. For each task, we also identified existing quality control measures. To populate the fault trees we used subjective probabilities from experts and compared results with incident report data. Both the fault tree and the incident report analysis revealed simulation tasks to be most prone to incidents, and the treatment prescription task to be least prone to incidents. The probability of a Preparation domain incident was estimated to be in the range of 0.1–0.7% based on incident reports, which is comparable to the mean value of 0.4% from the fault tree analysis using probabilities from the expert elicitation exercise. In conclusion, an analysis of part of the RT system using a fault tree populated with subjective probabilities from experts was useful in identifying vulnerable components of the system, and provided quantitative data for risk management.
The Risk Screening for Indoor Air Pollution Chemicals in Japan
Authors: Azuma Kenichi , Uchiyama Iwao , Ikeda Koichi
Published: August 2010

In recent years, public health problems caused by indoor air pollution have been drawing strong public concern in Japan. After conducting extensive exposure assessment, governmental agencies have taken effective measures to solve the problem; for instance, “Guidelines for indoor air quality (IAQ)” of 13 chemicals, for example, formaldehyde, toluene, and xylene, has been established. Thousands of chemicals have been identified in the indoor environment. Priority rating of those chemicals, however, was not based on the health risk level. We developed a risk‐screening scheme for indoor air pollution chemicals and analyzed the current status of the risk levels of those chemicals in Japan. We researched scientific knowledge of health hazards and exposure surveys of indoor air pollution chemicals in Japan, and classified those chemicals based on the health risk level estimated from the scheme. The risk levels of 93 chemicals were characterized and six chemicals (formaldehyde, acrolein, 1,4‐dichlorobenzene, benzene, tetrachloroethylene, and benzo(a)pyrene) were classified in the highest risk category.