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This brief reports outlines a 9-month feasibility study aimed at introducing and evaluating a third-sector mental health recovery programme to support patients on an acute mental health ward transitioning to community discharge. The study outcome data indicates that the recovery programme improved self-reported well-being (p = 0.01) and self-reported recovery progress (p = 0.01). The sample size for this study is small, and the results should be interpreted with caution. Recommendations are made as to ways in which third sector recovery programmes can be further developed in inpatient mental health services. The study was a collaborative endeavour between NHS mental health services and a third sector mental health charity. The provision findings indicates that collaborative working between healthcare and third sector at the time of discharge from acute mental health care can improve service users’ well-being.

High-throughput methods are now routinely used to rapidly screen chemicals for potential hazard. However, hazard-based decision-making excludes important exposure considerations resulting in an inc...

Flexible, rapid, and predictive approaches that do not require the use of large numbers of vertebrate test animals are needed because the chemical universe remains largely untested for potential hazards. Development of robust new approach methodologies and nontesting approaches requires the use of existing information via curated, integrated data sets. The ecological threshold of toxicological concern (ecoTTC) represents one such new approach methodology that can predict a conservative de minimis toxicity value for chemicals with little or no information available. For the creation of an ecoTTC tool, a large, diverse environmental data set was developed from multiple sources, with harmonization, characterization, and information quality assessment steps to ensure that the information could be effectively organized and mined. The resulting EnviroTox database contains 91 217 aquatic toxicity records representing 1563 species and 4016 unique Chemical Abstracts Service numbers and is a robust, curated database containing high‐quality aquatic toxicity studies that are traceable to the original information source. Chemical‐specific information is also linked to each record and includes physico‐chemical information, chemical descriptors, and mode of action classifications. Toxicity data are associated with the physico‐chemical data, mode of action classifications, and curated taxonomic information for the organisms tested. The EnviroTox platform also includes 3 analysis tools: a predicted‐no‐effect concentration calculator, an ecoTTC distribution tool, and a chemical toxicity distribution tool. Although the EnviroTox database and tools were originally developed to support ecoTTC analysis and development, they have broader applicability to the field of ecological risk assessment. Environ Toxicol Chem 2019;9999:1–12. © 2019 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals, Inc. on behalf of SETAC.

Algal toxicity studies are required by regulatory agencies for a variety of purposes including classification and labeling and environmental risk assessment of chemicals. Algae are also frequently the most sensitive taxonomic group tested. Acute to chronic ratios (ACRs) have been challenging to derive for algal species because of the complexities of the underlying experimental data including: a lack of universally agreed upon algal inhibition endpoints; evolution of experimental designs over time and by different standardization authorities; and differing statistical approaches (e.g., regression versus hypothesis-based effect concentrations). Experimental data for developing globally accepted algal ACRs have been limited because of data availability, and in most regulatory frameworks an ACR of 10 is used regardless of species, chemical type or mode of action. Acute and chronic toxicity (inhibition) data on 17 algal species and 442 chemicals were compiled from the EnviroTox database (https://envirotoxdatabase.org/) and a proprietary database of algal toxicity records. Information was probed for growth rate, yield, and final cell density endpoints focusing primarily on studies of 72 and 96 h duration. Comparisons of acute and chronic data based on either single (e.g., growth rate) and multiple (e.g., growth rate, final cell density) endpoints were used to assess acute and chronic relationships. Linear regressions of various model permutations were used to compute ACRs for multiple combinations of taxa, chemicals, and endpoints, and showed that ACRs for algae were consistently around 4 (ranging from 2.43 to 5.62). An ACR of 4 for algal toxicity is proposed as an alternative to a default value of 10, and recommendations for consideration and additional research and development are provided.

The mode of toxic action (MOA) is recognized as a key determinant of chemical toxicity and as an alternative to chemical class-based predictive toxicity modeling. However, MOA classification has never been standardized in ecotoxicology, and a comprehensive comparison of classification tools and approaches has never been reported. Here we critically evaluate three MOA classification methodologies using an aquatic toxicity data set of 3448 chemicals, compare the approaches, and assess utility and limitations in screening and early tier assessments. The comparisons focused on three commonly used tools: Verhaar prediction of toxicity MOA, the U.S. Environmental Protection Agency (EPA) ASsessment Tool for Evaluating Risk (ASTER) QSAR (quantitative structure activity relationship) application, and the EPA Mode of Action and Toxicity (MOAtox) database. Of the 3448 MOAs predicted using the Verhaar scheme, 1165 were classified by ASTER, and 802 were available in MOAtox. Of the subset of 432 chemicals with MOA assignments for each of the three schemes, 42% had complete concordance in MOA classification, and there was no agreement for 7% of the chemicals. The research shows the potential for large differences in MOA classification between the five broad groups of the Verhaar scheme and the more mechanism-based assignments of ASTER and MOAtox. Harmonization of classification schemes is needed to use MOA classification in chemical hazard and risk assessment more broadly.

© 2019 The Authors. Highlights • 9 recommendations digest recent developments in regulatory environmental risk assessment. • Efforts are necessary to make the translation of ecotoxicology into regulatory decisions more open and transparent. • They require concerted and sustained action from a variety of sectors and stakeholders. • Better evidence will lead to better decisions, sustainable innovation and a healthier environment.

The term nonhospice palliative care was developed to describe and differentiate palliative care that is delivered prior to the end of life. The purpose of this article is to better define and clarify this concept using Rodgers’s evolutionary concept analysis method. Attributes of nonhospice palliative care include (a) patient- and family-centered care, (b) holistic care, (c) interdisciplinary team, (d) early intervention, (e) quality of life-enhancing, (f) advanced care planning, (g) any age of the patient, (h) at any stage in illness, (i) care coordination, (j) concurrent curative treatment options, and (k) provided by primary and specialist providers. Nonhospice palliative care antecedents are serious illness, education, and access to services; consequences include benefits for the patient, family, provider, and health care system. Offering a clearly defined concept may allow for changes in health care to improve access to these services.

Derivation of Predicted No Effect Concentrations (PNECs) for aquatic systems is the primary deterministic form of hazard extrapolation used in environmental risk assessment. Depending on the data availability, different regulatory jurisdictions apply application factors (AFs) to the most sensitive measured endpoint to derive the PNEC for a chemical. To assess differences in estimated PNEC values, two PNEC determination methodologies were applied to a curated public database using the EnviroTox Platform ( www.EnviroToxdatabase.org ). PNECs were derived for 3647 compounds using derivation procedures based on example US EPA and a modified European Union chemical registration procedure to allow for comparisons. Ranked probability distributions of PNEC values were developed and 5th percentile values were calculated for the entire dataset and scenarios where full acute or full chronic data sets were available. The lowest PNEC values indicated categorization based on chemical attributes and modes of action would lead to improved extrapolations. Full acute or chronic datasets gave measurably higher 5th percentile PNEC values. Algae were under-represented in available ecotoxicity data but drove PNECs disproportionately. Including algal inhibition studies will be important in understanding chemical hazards. The PNEC derivation logic flows are embedded in the EnviroTox Platform providing transparent and consistent PNEC derivations and PNEC distribution calculations.

In general, reliable studies are well designed and well performed, and enough details on study design and performance are reported to assess the study. For hazard and risk assessment in various legal frameworks, many different types of ecotoxicity studies need to be evaluated for reliability. These studies vary in study design, methodology, quality, and level of detail reported (e.g., reviews, peer-reviewed research papers, or industry-sponsored studies documented under Good Laboratory Practice [GLP] guidelines). Regulators have the responsibility to make sound and verifiable decisions and should evaluate each study for reliability in accordance with scientific principles regardless of whether they were conducted in accordance with GLP and/or standardized methods. Thus, a systematic and transparent approach is needed to evaluate studies for reliability. In this paper, 8 different methods for reliability assessment were compared using a number of attributes: categorical versus numerical scoring methods, use of exclusion and critical criteria, weighting of criteria, whether methods are tested with case studies, domain of applicability, bias toward GLP studies, incorporation of standard guidelines in the evaluation method, number of criteria used, type of criteria considered, and availability of guidance material. Finally, some considerations are given on how to choose a suitable method for assessing reliability of ecotoxicity studies. Integr Environ Assess Manag 2017;13:640-651. © 2016 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Multiple mode of action (MOA) frameworks have been developed in aquatic ecotoxicology, mainly based on fish toxicity. These frameworks provide information on a key determinant of chemical toxicity, but the MOA categories and level of specificity remain unique to each of the classification schemes. The present study aimed to develop a consensus MOA assignment within EnviroTox, a curated in vivo aquatic toxicity database, based on the following MOA classification schemes: Verhaar (modified) framework, Assessment Tool for Evaluating Risk, Toxicity Estimation Software Tool, and OASIS. The MOA classifications from each scheme were first collapsed into one of 3 categories: non–specifically acting (i.e., narcosis), specifically acting, or nonclassifiable. Consensus rules were developed based on the degree of concordance among the 4 individual MOA classifications to attribute a consensus MOA to each chemical. A confidence rank was also assigned to the consensus MOA classification based on the degree of consensus. Overall, 40% of the chemicals were classified as narcotics, 17% as specifically acting, and 43% as unclassified. Sixty percent of chemicals had a medium to high consensus MOA assignment. When compared to empirical acute toxicity data, the general trend of specifically acting chemicals being more toxic is clearly observed for both fish and invertebrates but not for algae. EnviroTox is the first approach to establishing a high‐level consensus across 4 computationally and structurally distinct MOA classification schemes. This consensus MOA classification provides both a transparent understanding of the variation between MOA classification schemes and an added certainty of the MOA assignment. In terms of regulatory relevance, a reliable understanding of MOA can provide information that can be useful for the prioritization (ranking) and risk assessment of chemicals. Environ Toxicol Chem 2019;38:2294–2304. © 2019 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals, Inc. on behalf of SETAC.

Hypothesis-based no-effect-concentration (NOEC) and regression-based x% effect concentration (ECx) values are common statistical approaches used to summarize ecotoxicological effects. Controversy over the NOEC model has prompted a movement toward discontinuation of the NOEC in favor of ECx, but the best x% effect surrogate for NOEC has not yet been determined. Historically, 10% and 20% effect concentrations (EC10 and EC20) have been treated as NOEC analogs. Given these measurements' importance to ecotoxicology, further understanding of the relationships between NOEC and EC10 or EC20 is crucial. In the present study, a metadataset of daphnid chronic toxicity tests was compiled to analyze the strength and significance of NOEC:EC10 and NOEC:EC20 relationships. The impact of endpoint (e.g., mortality, reproduction) and test condition parameters (e.g., pH, temperature) on NOEC:EC10 and NOEC:EC20 was evaluated. Mortality endpoints were most sensitive 51% of the time, with growth and reproductive endpoints constituting the remainder, underscoring the value of using multiple endpoints to evaluate toxic effects rather than relying on reproduction as the a priori most sensitive endpoint. When test condition parameters were less restricted (e.g., pH, hardness), the NOEC:EC20 association was more robust, suggesting that variability introduced by test implementation increased variability in ECx calculation. The analysis revealed that, overall, EC10 was a more suitable analog than EC20 for NOEC. Recommendations include refinement and reporting of the test parameters pH and hardness to minimize variability in ECx calculation.

Tools exist to evaluate large ecotoxicity databases for risk assessment purposes, but these tools are less useful for alternative analytical purposes. In the present study, the authors developed the Stepwise Information-Filtering Tool (SIFT), a strategic method to select relevant, reliable data from a large ecotoxicity database; demonstrated utility in a case study of chronic toxicity data for statistical endpoint comparison purposes; and evaluated SIFT by comparison with 2 existing data evaluation methods. Environ Toxicol Chem 2015;34:1436–1442. © 2015 SETAC

Monitoring expression of the developmentally regulated genes shh, sox2, and tnnt1 by reverse transcriptase polymerase chain reaction (RT-PCR) allows determination of the rate of embryogenesis in zebrafish (Danio rerio) embryos without direct visual observation. The utility of combining this approach and morphological methods during toxicity studies was demonstrated with embryos developing at either 28.5 °C or 24.5 °C and with embryos exposed to sublethal doses of silver nanoparticles. Environ Toxicol Chem 2014;33:238–242. © 2013 SETAC

In general, reliable studies are well designed and well performed, and enough details on study design and performance are reported to assess the study. For hazard and risk assessment in various legal frameworks, many different types of ecotoxicity studies need to be evaluated for reliability. These studies vary in study design, methodology, quality, and level of detail reported (e.g., reviews, peer-reviewed research papers, or industry-sponsored studies documented under Good Laboratory Practice [GLP] guidelines). Regulators have the responsibility to make sound and verifiable decisions and should evaluate each study for reliability in accordance with scientific principles regardless of whether they were conducted in accordance with GLP and/or standardized methods. Thus, a systematic and transparent approach is needed to evaluate studies for reliability. In this paper, 8 different methods for reliability assessment were compared using a number of attributes: categorical versus numerical scoring methods, use of exclusion and critical criteria, weighting of criteria, whether methods are tested with case studies, domain of applicability, bias toward GLP studies, incorporation of standard guidelines in the evaluation method, number of criteria used, type of criteria considered, and availability of guidance material. Finally, some considerations are given on how to choose a suitable method for assessing reliability of ecotoxicity studies. Integr Environ Assess Manag 2017;13:640-651. © 2016 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental ToxicologyChemistry (SETAC).

Zebrafish (Danio rerio) are model organisms for testing developmental toxicity at the morphological level. In this study, influence of temperature (24.5-28.5°C) and silver nanoparticles on developmental staging, ear-eye distance, and ratio of ear-eye distance to inner ear diameter was investigated. As temperature decreased, all endpoints showed developmental delay, with differences between endpoints in amount and type of delay measured. Differences in developmental delay patterns were observed, with rate delays increasing over time when staging endpoints were utilized and rates remaining constant when using ear-eye measurements. Integrated predictive equations were created to normalize each endpoint for temperature. Influence of image rotation on ear-eye distance accuracy showed that more than 75% eye overlap during analysis is necessary to minimize error. Exposure to silver nanoparticles demonstrated a lack of consistency between developmental endpoints and highlighted the usefulness of a multi-endpoint approach when measuring changes to developmental timing.

Up to 70% of hospice patients are reported to experience dyspnea at end of life. Despite the high prevalence of this burdensome symptom, there is little in the literature to guide effective treatment. Assessment of subjective symptoms and objective signs as well as physical, psychospiritual, sociocultural, or environmental barriers is critical to an effective plan of care. The purpose of the article is to review the current literature on assessment and management of dyspnea in hospice patients and provide implications for hospice clinicians.

Hypothesis-based no-effect-concentration (NOEC) and regression-based x% effect concentration (ECx) values are common statistical approaches used to summarize ecotoxicological effects. Controversy over the NOEC model has prompted a movement toward discontinuation of the NOEC in favor of ECx, but the best x% effect surrogate for NOEC has not yet been determined. Historically, 10% and 20% effect concentrations (EC10 and EC20) have been treated as NOEC analogs. Given these measurements' importance to ecotoxicology, further understanding of the relationships between NOEC and EC10 or EC20 is crucial. In the present study, a metadataset of daphnid chronic toxicity tests was compiled to analyze the strength and significance of NOEC:EC10 and NOEC:EC20 relationships. The impact of endpoint (e.g., mortality, reproduction) and test condition parameters (e.g., pH, temperature) on NOEC:EC10 and NOEC:EC20 was evaluated. Mortality endpoints were most sensitive 51% of the time, with growth and reproductive endpoints constituting the remainder, underscoring the value of using multiple endpoints to evaluate toxic effects rather than relying on reproduction as the a priori most sensitive endpoint. When test condition parameters were less restricted (e.g., pH, hardness), the NOEC:EC20 association was more robust, suggesting that variability introduced by test implementation increased variability in ECx calculation. The analysis revealed that, overall, EC10 was a more suitable analog than EC20 for NOEC. Recommendations include refinement and reporting of the test parameters pH and hardness to minimize variability in ECx calculation.

Tools exist to evaluate large ecotoxicity databases for risk assessment purposes, but these tools are less useful for alternative analytical purposes. In the present study, the authors developed the Stepwise Information-Filtering Tool (SIFT), a strategic method to select relevant, reliable data from a large ecotoxicity database; demonstrated utility in a case study of chronic toxicity data for statistical endpoint comparison purposes; and evaluated SIFT by comparison with 2 existing data evaluation methods.

At a machining center used to produce transmission parts, aerosol instrumentation was used to quantitatively study mist generation and to evaluate the performance of an air cleaner for controlling the mist. This machining center drilled and tapped holes at rotational speeds of 1000 to 3000 rpm. During most machining operations, the metal-working fluid (MWF) was flooded over the part. To facilitate metal chip removal during some operations, MWF was pumped through the orifices in some tools at a pressure of 800 psi. These machining operations were performed in a nearly complete enclosure that was exhausted to an air cleaner at a flow rate of 1.1 m3/sec (2400 ft3/m). Although the use of high-pressure MWF increased the mist concentration by about 200%, it did not affect the mist size distribution. The observed penetration through the air cleaner appeared to be mostly consistent with the manufacturer's specifications on the air cleaner's filters. During the testing, MWF was observed to accumulate in the bottom of the filter housing and may have been reentrained due to air motion or mechanical vibration.

Monitoring expression of the developmentally regulated genes shh, sox2, and tnnt1 by reverse transcriptase polymerase chain reaction (RT-PCR) allows determination of the rate of embryogenesis in zebrafish (Danio rerio) embryos without direct visual observation. The utility of combining this approach and morphological methods during toxicity studies was demonstrated with embryos developing at either 28.5 °C or 24.5 °C and with embryos exposed to sublethal doses of silver nanoparticles.

Researchers from the National Institute for Occupational Safety and Health (NIOSH) applied Hazard and Operability (HAZOP) analysis to examine hazards during the use of anhydrous ammonia by farmers. This analysis evaluated the storage, transfer, and application of anhydrous ammonia, identifying credible hazard scenarios, practical solutions, and research needs. Ninety-five findings were developed that are of use to farmers, distributors of ammonia and application equipment, and manufacturers of application equipment. The findings generally involve training, equipment design changes, preventive maintenance, and material compatibilities. The HAZOP team found that additional safety features need to be developed or implemented. The study also pointed out where correct operator procedure and preventive maintenance can prevent inadvertent releases. Other inadvertent releases are caused by incompatible materials, or by using equipment in ways other than intended. Several examples of the findings are given to emphasize the HAZOP technique and the high-risk scenarios. Strategies for dissemination to the agricultural community are presented.

Process hazards review (PHR) techniques have generally been applied by large, sophisticated companies in the nuclear, aerospace, and chemical process industries. There remains, however, a large population of smaller distributors and consumers of hazardous materials which could benefit equally from the application of PHR. These consumers unfortunately are generally less sophisticated and individually lack the necessary resources required to apply such state-of-the-art safety techniques. Where common processes can be identified, it is possible to conduct a more generic PHR that will provide a sound technical basis for recognizing and preventing the development of hazards wherever these processes are used. Some facility-specific issues will always need to be considered, but the existence of the generic PHR should make the conduct of a PHR by each facility considerably easier and less costly. Researchers from the National Institute for Occupational Safety and Health (NIOSH) contracted with DNV Technica Inc. to lead a hazard and operability study (HAZOP) of agricultural handling of anhydrous ammonia, from the receipt of ammonia at the retail distribution centre to the application of the ammonia by farmers to the fields. The multidisciplinary HAZOP team consisted of representatives from NIOSH, an agricultural chemical trade association, an ammonia producer, state ammonia facility inspectors, a retail distributor, and an equipment manufacturer. Several participants were part-time farmers with ammonia application experience. Some specific aspects of applying the HAZOP technique in the context of this study, the findings obtained, and the plans to disseminate the important safety information developed during the course of the PHR are discussed. Finally, it is suggested that this approach could prove to be a useful addition to the product stewardship activities of chemical producers.

•RECENT EVENTS around the world have emphasized the need for health care facilities to prepare to deal with biological threats, including smallpox. •AT WALTER REED Army Medical Center, Washington, DC, administrators recognized the need for a policy on handling patients with smallpox in the OR and asked a group of students to create a template policy for care of patients with smallpox in need of surgery. •THIS ARTICLE provides a brief history of smallpox, concerns surrounding smallpox today, and smallpox characteristics with which perioperative personnel should be familiar, as well as a guideline for treating patients in the OR who have smallpox. AORN J 80 (October 2004) 681–689

Methylene chloride, a potential occupational carcinogen, is one of the principal solvents used for furniture stripping. Methylene chloride exposures among workers in furniture stripping operations have been found to be high. This article describes a furniture stripping operation at a sheltered workshop before and after the ventilation system was modified. Previous to ventilation system modifications, workers who were stripping furniture had exposures to methylene chloride ranging from 600 to 1150 ppm. These high exposures and an evaluation of the ventilation system prompted the design and installation of a modified ventilation system. Primary modifications included installing a local ventilation hood, decreasing the velocity of makeup air entering the stripping area, removing a contaminated charcoal adsorption bed and improving work practices. The modified system was arranged into three configurations that included a slot hood, a downdraft hood, and a combination slot and downdraft hood. The three configurations were evaluated over a three-day period, and it was found that they controlled the worker's personal exposures to methylene chloride while stripping to 28 ppm for the combination configuration, 30 ppm for the downdraft configuration, and 34 ppm for the slot configuration. Although the exposures are above the proposed Occupational Safety and Health Administration permissible exposure level of 25 ppm, these results show a substantial improvement over the existing ventilation system. The ventilation system described is applicable to other furniture stripping facilities if rinse area local ventilation is improved.

Background : Uncontrolled hemorrhage is one of the leading causes of death in both combat and civilian trauma. This study was designed to compare the arterial blood pressures at which rebleeding occurred when a hemostatic agent, ExcelArrest™, was used compared with a standard pressure dressing. Materials and Methods : This study was a prospective, experimental, and mixed research design. Swine were assigned to one of two groups: ExcelArrest™ (n=5) or a control consisting of standard pressure dressings (n=5). Investigators generated a complex groin injury. The femoral artery and vein were transected and allowed to bleed for 60 s in each pig. After 60 s, ExcelArrest™ was poured into the wound. The control group underwent the same procedures, but without treatment with the hemostatic agent. After 5 min of direct pressure, a standard pressure dressing was applied. After 30 min, dressings were removed and the systolic blood pressure (SBP) was increased incrementally using intravenous phenylephrine until rebleeding occurred. Statistical Analysis : A multivariate ANOVA and a least significant difference were used to analyze the data. Results : ExcelArrest™ was more effective in preventing rebleeding compared to a standard pressure dressing (P