The current use of chemicals puts pressure on human and ecological health. Based on the Aarhus Convention, citizens have the right to have access to information on substances in their local environment. Providing this information is a major challenge, especially considering complex mixtures, as the current substance-by-substance risk assessment may not adequately address the risk of co-exposure to multiple substances. Here, we provide an overview of the currently available indicators in the Netherlands to explore current scientific possibilities to indicate the impacts of complex chemical mixtures in the environment on human health and ecology at the local scale. This is limited to impact estimates on freshwater species for 701 substances, impact estimates of four metals on soil organisms, and impacts on human health for particulate matter (PM10) and nitrogen dioxide (NO2) in air. The main limiting factors in developing and expanding these indicators to cover more compartments and substances are the availability of emission and concentration data of substances and dose-response relationships at the population (human health) or community (ecology) level. As ways forward, we propose; 1) developing cumulative assessment groups (CAGs) for substances on the European Pollutant Transfer and Release Register and Water Framework Directive substance lists, to enable the development of mixture indicators based on mixture risk assessment and concentration addition principles; 2) to gain insight into local mixtures by also applying these CAGs to emission data, which is available for soil and air for more substances than concentrations data; 3) the application of analytical non-target screening methods as well as effect-based methods for whole-mixture assessment.

UNASSIGNED: Organisms engineered with synthetic genes and genomes have the potential to play critical roles to address important issues in the environment, human health, and manufacturing. Engineered genetic biocontainment technologies are needed to manage the risks of unintended consequences when deploying these biological systems in consultation with the biosafety and biosecurity communities. Metrics measuring genetic biocontainment and a methodology to apply them are required to determine which genetic biocontainment technologies warrant further development for real-world applications. In this study, we develop and apply a systems analysis of the current technical landscape using expert opinion and a metric-based scoring system resulting in a semiquantitative comparative assessment of genetic biocontainment technologies in microorganisms.
UNASSIGNED: Genetic biocontainment technologies were evaluated according to multiple metrics, falling into two broad classes: feasibility and applicability. Specific genetic biocontainment example scenarios and generalized categories were scored with these metrics. Gap analysis was carried out, indicating particular areas where genetic biocontainment can be improved.
UNASSIGNED: Metric analysis scoring of feasibility and applicability enabled prioritization of genetic biocontainment technologies for real-world applications. Gap analysis showed that technology readiness and containment stability scored low for a number of scenarios and categories, indicating a general need for further development before they can be ready for deployment.
UNASSIGNED: Developing an assessment framework with defined metrics produced a straightforward system for evaluating genetic biocontainment strategies intended for various real-world applications. Use of the methodology also provided insights into existing gaps in genetic biocontainment strategies, and by altering the metrics, can be applied to other biotechnologies.

The presence of emerging contaminants (ECs) in drinking water sources is an increasing concern, yet limited data exists on their occurrence and risk in the upper Huaihe River Basin, an important agricultural region in Central China. This study investigated 70 ECs, including pesticide and antibiotics in surface water from drinking water source areas in Nanwan Reservoir along the upper reaches of the Huaihe River Basin to prioritize the ECs based on ecological risk and health risk assessment. A total of 66 ECs were detected in the surface water at least once at the selected 38 sampling sites, with concentrations ranging from 0.04 to 2508 ng/L. Ecological risk assessment using the risk quotient (RQ) method revealed high risks (RQ > 1) from 7 ECs in the dry season and 15 ECs in the wet season, with triazine pesticides as the main contributors. Non-carcinogenic risks were below negligible levels, but carcinogenic risks from neonicotinoid and carbamate pesticides and macrolide antibiotics were concerning for teenagers. Ciprofloxacin exhibited a high level of resistance risk during the wet season. A multi-indicator prioritization approach integrating occurrence, risk, and chemical property data ranked 6 pesticides and 3 antibiotics as priority pollutants. The results highlight EC contamination of drinking water sources in this agriculturally-intensive region and the need for targeted monitoring and management to protect water quality.

OBJECTIVE: This study develops a prioritization framework to aid healthcare funding decision making in health technology assessment (HTA) in Australia using a multiple criteria decision analysis (MCDA) approach.
METHODS: MCDA frameworks for HTAs were reviewed through literature survey to identify the initial criteria and levels within each criterion. Key stakeholders and experts were consulted to confirm these criteria and levels. A conjoint analysis using 1000Minds was undertaken with policy makers from the Department of Health to establish ranking criteria and weighting scores. Monte Carlo simulations were used to examine the sensitivity of findings to factors affecting the ranking and weighting scores. The MCDA was then applied to 6 examples of chronic care models or technologies projects to demonstrate the performance of this approach.
RESULTS: Five criteria (clinical efficacy/effectiveness, safety and tolerability, severity of the condition, quality/uncertainty, and direct impact on healthcare costs) were consistently ranked highest by healthcare decision makers. Among the criteria, patient-level health outcomes were considered the most important, followed by social and ethical values. The analyses were robust to inform the uncertainty in the parameter.
CONCLUSIONS: This study has developed an MCDA tool that effectively integrates key priorities for HTA reviews, reflecting the values and preferences of healthcare stakeholders in Australia. Although this tool aims to align the assessment process more closely with health benefits, it also highlights the importance of considering other criteria.

UNASSIGNED: The COVID-19 pandemic has brought severe health consequences among older adults and posed ethical challenges. The aim of this study was to explore the impacts of COVID-19 on the health and medical care of older adults in Ethiopia and associated ethical implications, regardless of older adults\' COVID-19 infection status.
UNASSIGNED: In this qualitative study, we followed an inductive exploratory approach based on reflexive thematic analysis. We conducted semistructured interviews between March 2021 and November 2021 with 20 older adults and 26 health professionals who were selected from healthcare facilities and communities in Ethiopia using purposive and snowball sampling techniques. We audio-recorded, transcribed, translated, and inductively analyzed the interviews using thematic analysis.
UNASSIGNED: Participants reported that the pandemic compromised the accessibility and quality of both COVID and non-COVID healthcare services for older adults, which negatively impacted older adults\' health conditions and medical care. Moreover, participants elaborated on the health conditions and care of older patients with COVID-19 and highlighted that older COVID-19 patients often have severe health conditions, do not get adequate COVID-19 care, and may receive lower priority for admission to intensive care units compared to younger patients when resources are limited.
UNASSIGNED: Results of this study showed that practices of COVID-19 care and measures may have led to adverse consequences such as limited availability and access to aged care in Ethiopia, which could have further health consequences on older patients. Our results contribute to a better understanding of ethical issues such as distributive justice and prioritization arising in the healthcare of older patients in times of global pandemic. It is imperative for local and international health policymakers and ethicists to further analyze and address the challenges that compromise the accessibility and continuity of quality care for older persons during a public healthcare crisis.

The release of chemicals into the environment presents a significant threat to aquatic ecosystems dependent on the proximity to emission sources and seasonal dynamics of emission and mobilization. While spatial-temporal information on water pollution in Europe is increasing, there are substantial knowledge gaps on seasonal pollution dynamics in tropical countries. Thus, we took Lake Victoria South Basin in western Kenya as a case study to identify spatial and seasonal hot spots of contamination, quantified toxic risks to different groups of organisms, and identified seasonal risk drivers. For this purpose, we analyzed grab water samples from five rivers with agricultural and wastewater treatment plants in their catchment in four different seasons. We used liquid chromatography coupled to high resolution mass spectrometry (LC-HRMS) with a target list of 785 organic micropollutants. A total of 307 compounds were detected with concentrations ranging from 0.3 ng/L to 6.6 μg/L. Using a Toxic Unit (TU) approach based on mixture toxicity to standard test organisms, crustaceans were identified as the most affected group followed by algae and fish. For crustaceans, chronic risk thresholds were exceeded in 96 % of all the samples, while 56 % of all samples are expected to be acutely toxic, with the highest risk in February during the dry season. High toxic unit values for algae and fish were recorded in July dry season and May wet season. Diazinon, imidacloprid, clothianidin and pirimiphos-methyl were the major drivers for crustacean toxicity while triclosan and different herbicide mixtures drive risks to algae in dry and wet seasons, respectively. A total of 18 chemicals were found to exceed acute and chronic environmental risk thresholds. With this study, strong spatial-temporal patterns of pollution, risks and risk drivers could be confirmed informing prioritization of monitoring and abatement to enhance water quality and reduce toxic risks.

Discovery of emerging pollutants in breast milk will be helpful for understanding the hazards to human health. However, it is difficult to identify key compounds among thousands present in complex samples. In this study, a method for screening compounds with bioaccumulation potential was developed. The method can decrease the number of compounds needing structural identification because the partitioning properties of bioaccumulative compounds can be mapped onto GC×GC chromatograms through their retention behaviors. Twenty pooled samples from seven provinces in China were analyzed. 1,286 compounds with bioaccumulation potential were selected from over 3,000 compounds. Sixty-two compounds, including aromatic compounds, phthalates, and phenolics etc., were identified with a high level of confidence and then quantified. Among them, twenty-seven compounds were found for the first time in breast milk. Three phthalate plasticizers and two phenolic antioxidants were found in significantly higher concentrations than other compounds. A toxicological priority index approach was applied to prioritize the compounds considering their concentrations, detection frequencies and eight toxic effects. The prioritization indicated that 13 compounds, including bis(2-ethylhexyl) phthalate, dibutyl phthalate, 1,3-di-tert-butylbenzene, phenanthrene, 2,6-di-tert-butyl-1,4-benzoquinone, 2,4-di-tert-butylphenol, and others, showed higher health risks. Meanwhile, some compounds with high risk for a particular toxic effect, such as benzothiazole and geranylacetone, were still noteworthy. This study is important for assessing the risks of human exposure to organic compounds.

Despite making remarkable strides in improving health outcomes, Malawi faces concerns about sustaining the progress achieved due to limited fiscal space and donor dependency. The imperative for efficient health spending becomes evident, necessitating strategic allocation of resources to areas with the greatest impact on mortality and morbidity. Health benefits packages hold promise in supporting efficient resource allocation. However, despite defining these packages over the last two decades, their development and implementation have posed significant challenges for Malawi. In response, the Malawian government, in collaboration with the Thanzi la Onse Programme, has developed a set of tools and frameworks, primarily based on cost-effectiveness analysis, to guide the design of health benefits packages likely to achieve national health objectives. This review provides an overview of these tools and frameworks, accompanied by other related analyses, aiming to better align health financing with health benefits package prioritization. The paper is organized around five key policy questions facing decision-makers: (i) What interventions should the health system deliver? (ii) How should resources be allocated geographically? (iii) How should investments in health system inputs be prioritized? (iv) How should equity considerations be incorporated into resource allocation decisions? and (v) How should evidence generation be prioritized to support resource allocation decisions (guiding research)? The tools and frameworks presented here are intended to be compatible for use in diverse and often complex healthcare systems across Africa, supporting the health resource allocation process as countries pursue Universal Health Coverage.

The primary objective of this study was to enhance the operational efficiency of the current healthcare system by proposing a quicker and more effective approach for healthcare providers to deliver services to individuals facing acute heart failure (HF) and concurrent medical conditions. The aim was to support healthcare staff in providing urgent services more efficiently by developing an automated decision-support Patient Prioritization (PP) Tool that utilizes a tailored machine learning (ML) model to prioritize HF patients with chronic heart conditions and concurrent comorbidities during Urgent Care Unit admission. The study applies key ML models to the PhysioNet dataset, encompassing hospital admissions and mortality records of heart failure patients at Zigong Fourth People\'s Hospital in Sichuan, China, between 2016 and 2019. In addition, the model outcomes for the PhysioNet dataset are compared with the Healthcare Cost and Utilization Project (HCUP) Maryland (MD) State Inpatient Data (SID) for 2014, a secondary dataset containing heart failure patients, to assess the generalizability of results across diverse healthcare settings and patient demographics. The ML models in this project demonstrate efficiencies surpassing 97.8% and specificities exceeding 95% in identifying HF patients at a higher risk and ranking them based on their mortality risk level. Utilizing this machine learning for the PP approach underscores risk assessment, supporting healthcare professionals in managing HF patients more effectively and allocating resources to those in immediate need, whether in hospital or telehealth settings.

Pharmaceuticals are considered as contaminants of emerging concern, and their occurrence in diverse environmental matrices has been described during the last 25 years. Nonetheless, pharmaceutical occurrence has not been evenly described worldwide, and reports from some geographical areas such as most parts of Latin America are scarce. This work aims to address the situation of water pollution due to pharmaceuticals in Latin America by means of two main goals: i. First, reviewing the monitoring studies performed in Latin America on this topic (period 2009-2024), which were conducted in Brazil, Mexico, Colombia, Ecuador, Peru and Argentina, to highlight the most frequently detected compounds from each therapeutic group in the region. ii. Second, analyzing the case of Costa Rica through the hazard assessment and prioritization of pharmaceuticals based on the monitoring performed in this country (years 2011; 2018-2019). The monitoring in Costa Rica comprised a total of 163 sampling points: wastewater treatment plants (WWTPs) (14 urban WWTPs plus two landfill WWTPs; total samples n = 44 influents and n = 34 effluents), nine hospital effluents (n = 32), wastewater from livestock farms (six swine farms and seven dairy farms; n = 23 influents and n = 37 effluents), 64 continental surface water sampling points (n = 137), and 61 coastal seawater sampling points (n = 61). Risk assessment of detected concentrations by the hazard quotient (HQ) approach (period 2018-2019) revealed a total of 25 medium or high-hazard compounds (out of 37 detected compounds). The prioritization approach (which included the Frequency of Appearance (FoA), the Frequency of PNEC exceedance (FoE), and the Extent of predicted no-effect concentration (PNEC) exceedance (EoE)), showed a critical list of nine pharmaceuticals: caffeine, diphenhydramine, acetaminophen, lovastatin, gemfibrozil, ciprofloxacin, ibuprofen, doxycycline and norfloxacin. These compounds should be taken into account as a first concern during the implementation of environmental policies related to pharmaceutical products in the region.