Emergency department clinicians' views on implementing psychosocial care following acute paediatric injury: a qualitative study.

Introduction: The early post-trauma period is a key time to provide psychological support to acutely injured children. This is often when they present to emergency departments (EDs) with their families. However, there is limited understanding of the feasibility of implementing psychological support for children and their families in EDs. The aim of this study was to explore UK and Irish ED clinicians' perspectives on developing and implementing psychosocial care which educates families on their children's post-trauma psychological recovery.Methods: Semi-structured individual and group interviews were conducted with 24 UK and Irish ED clinicians recruited via a paediatric emergency research network.Results: Clinicians expressed that there is value in offering psychological support for injured children and their families; however, there are barriers which can prevent this from being effectively implemented. Namely, the prioritisation of physical health, time constraints, understaffing, and a lack of training. Therefore, a potential intervention would need to be brief and accessible, and all staff should be empowered to deliver it to all families.Conclusion: Overall, participants' views are consistent with trauma-informed approaches where a psychosocial intervention should be able to be implemented into the existing ED system and culture. These findings can inform implementation strategies and intervention development to facilitate the development and delivery of an accessible digital intervention for acutely injured children and their families.

The emergency department provides an opportunity for early trauma-informed care for acutely injured children and their families.Addressing psychological distress in emergency care for acutely injured children and their families should adopt a universal trauma-informed approach.The development of a paediatric trauma-informed intervention should consider barriers which can impact implementation into emergency care. Particular barriers highlighted by clinicians include staff shortages, time constraints, and high caseloads.

Potential prognostic determinants for FET::CREB fusion-positive intracranial mesenchymal tumor.

Intracranial mesenchymal tumor (IMT), FET::CREB fusion-positive is a provisional tumor type in the 2021 WHO classification of central nervous system tumors with limited information available. Herein, we describe five new IMT cases from four females and one male with three harboring an EWSR1::CREM fusion and two featuring an EWSR1::ATF1 fusion. Uniform manifold approximation and projection of DNA methylation array data placed two cases to the methylation class "IMT, subclass B", one to "meningioma-benign" and one to "meningioma-intermediate". A literature review identified 74 cases of IMTs (current five cases included) with a median age of 23 years (range 4-79 years) and a slight female predominance (female/male ratio = 1.55). Among the confirmed fusions, 25 (33.8%) featured an EWSR1::ATF1 fusion, 24 (32.4%) EWSR1::CREB1, 23 (31.1%) EWSR1::CREM, one (1.4%) FUS::CREM, and one (1.4%) EWSR1::CREB3L3. Among 66 patients with follow-up information available (median: 17 months; range: 1-158 months), 26 (39.4%) experienced progression/recurrences (median 10.5 months; range 0-120 months). Ultimately, three patients died of disease, all of whom underwent a subtotal resection for an EWSR1::ATF1 fusion-positive tumor. Outcome analysis revealed subtotal resection as an independent factor associated with a significantly shorter progression free survival (PFS; median: 12 months) compared with gross total resection (median: 60 months; p < 0.001). A younger age (< 14 years) was associated with a shorter PFS (median: 9 months) compared with an older age (median: 49 months; p < 0.05). Infratentorial location was associated with a shorter overall survival compared with supratentorial (p < 0.05). In addition, the EWSR1::ATF1 fusion appeared to be associated with a shorter overall survival compared with the other fusions (p < 0.05). In conclusion, IMT is a locally aggressive tumor with a high recurrence rate. Potential risk factors include subtotal resection, younger age, infratentorial location, and possibly EWSR1::ATF1 fusion. Larger case series are needed to better define prognostic determinants in these tumors.

The transfer of environmental contaminants (Brominated and Chlorinated dioxins and biphenyls, PBDEs, HBCDDs, PCNs and PFAS) from recycled materials used for bedding to the eggs and tissues of chickens.

Some types of poultry bedding made from recycled materials have been reported to contain environmental contaminants such as polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs, dioxins), polychlorinated biphenyls (PCBs) brominated flame retardants (BFRs) polychlorinated naphthalenes (PCNs), polybrominated dioxins (PBDD/Fs), perfluoroalkyl substances (PFAS), etc. In one of the first studies of its kind, the uptake of these contaminants by chicken muscle tissue, liver, and eggs from three types of recycled, commercially available bedding material was simultaneously investigated using conventional husbandry to raise day old chickens to maturity. A weight of evidence analysis showed that PCBs, polybrominated diphenylethers (PBDEs), PCDD/Fs, PCNs and PFAS displayed the highest potential for uptake which varied depending on the type of bedding material used. During the first three to four months of laying, an increasing trend was observed in the concentrations of ΣTEQ (summed toxic equivalence of PCDD/Fs, PCBs, PBDD/Fs, PCNs and polybrominated biphenyls), NDL-PCBs and PBDEs in the eggs of chickens raised on shredded cardboard. Further analysis using bio-transfer factors (BTFs) when egg production reached a steady state, revealed that some PCB congeners (PCBs 28, 81, 138, 153 and 180) irrespective of molecular configuration or chlorine number, showed the highest tendency for uptake. Conversely, BTFs for PBDEs showed good correlation with bromine number, increasing to a maximum value for BDE-209. This relationship was reversed for PCDFs (and to some extent for PCDDs) with tetra- and penta- chlorinated congeners showing a greater tendency for selective uptake. The overall patterns were consistent, although some variability in BTF values was observed between tested materials which may relate to differences in bioavailability. The results indicate a potentially overlooked source of food chain contamination as other livestock products (cow's milk, lamb, beef, duck, etc.) could be similarly impacted.

Polybrominated dibenzo-p-dioxins (PBDDs) and - dibenzofurans (PBDFs) in cod (Gadus morhua) liver-derived products from 1972 to 2017.

Literature data on the occurrence and prevalence of polybrominated dibenzo-p-dioxins (PBDDs) and polybrominated dibenzofurans (PBDFs) in foods including seafood are scarce. In this study, a number of cod-derived products including medicinal grade cod liver oils sourced from Northern Atlantic waters (Iceland, Norway) and the Baltic Sea (Poland) during 1972-2001 and canned cod liver sourced from the Baltic Sea in 2017, showed detectable levels of PBDFs: such as 2,3,8-TrBDF at 0.57 to 5.249 pg g-1 fat and 1,2,3,4,6,7,8-HpBDF at <0.018 to 0.302 pg g-1 fat. PBDDs were not detected in the cod liver oils. Canned cod liver products showed low levels of 2,3,7,8-TeBDD in the range <0.017 to 0.022 pg g-1 whole weight and 1,2,3,7,8-PeBDD at <0.03 to 0.039 pg g-1 whole weight. These concentrations were computed to yield upper bound toxic equivalences (TEQs) of 0.14 to 0.17 pg g-1 for the oils and 0.12 to 0.25 pg g-1 for the canned products (0.08 pg g-1 ww for both products). The resulting supplementary and dietary intakes are low (0.02 to 0.11 pg kg-1 bm day-1 for the oils and 0.07 to 0.17 pg kg-1 bm week-1 for the canned livers) in comparison to the recently expressed tolerable weekly intake of 2 pg kg-1 bm week-1. However, the intakes are underestimates, as due to a lack of analytical standards not all PBDD/F TEQ contributing congeners could be included. The PBDD/F TEQ contributes to the cumulative toxicity arising from other contaminants such as chlorinated dioxins and polychlorinated biphenyls.

Dioxin-like polybrominated biphenyls (PBBs) and ortho-substituted PBBs in edible cod (Gadus morhua) liver oils and canned cod livers.

This study investigates the occurrence of polybrominated biphenyls (PBBs), a legacy flame retardant, in fishery products such as medicinal grade cod liver oils and canned liver products, sourced from the North Atlantic during 1972-2017. It also assesses the dietary and supplementary (the oils were commonly administered as dietary supplements to children and youth) intake of PBBs from these products. Summed ortho-PBB concentrations ranged from 770 to 1400 pg g-1 fat in the oils and from 99 to 240 pg g-1 whole weight in canned livers, with PBB-49, 52, 101 and 153 accounting for most of these levels. Among the more toxic non-ortho-PBBs, PBB-126 and PBB-169 were not detected, but PBB-77 concentrations ranged from 0.6 to 5.78 pg g-1 fat in the oils and 0.06-0.126 pg g-1 whole weight in canned livers. During 1972-1993, PBB contamination levels were similar for cod liver oils from the Baltic Sea and other North Atlantic regions, but over the timescale of the study, Baltic Sea products appear to show a decline in PBB concentrations. As PBB-77 was the only dioxin-like PBB detected in the samples, the corresponding supplementary (oils, 1972-2001) and dietary (cod liver from 2017) intakes were very low, at < 0.001 pg TEQ kg-1 bm d-1 (or < 0.01 pg TEQ kg-1 bm d-1 upper bound) for the sum of all the measured dioxin-like PBBs -four to six orders of magnitude lower than that arising from other dioxin-like contaminants that were shown to occur in these products, from earlier studies.

PBDEs in cod (Gadus morhua) liver products (1972-2017): Occurrence and human exposure.

PBDEs occur in a range of commonly consumed foods but there is very little current information on occurrence in dietary supplements such as cod liver oil or cod livers used as food. This study retrospectively investigated a number of these products, sourced from the Baltic Sea and North Atlantic, historically dating from 1972 to 2017. For the sum of 17 measured PBDEs (ΣPBDE), the concentrations ranged from 9.9 to 415 ng g-1 for the oils and from 10.5 to 13 ng g-1 for canned liver products. Concentrations in the oils were highest during the period from 1993 to 2001. For all samples, BDE-47 was the dominant congener with a maximum detected concentration of 308 ng g-1 in a Baltic cod liver oil from 1993. Human exposure to PBDEs from recommended doses were estimated for adults, teenagers and children. Depending on the age group, BDE-47 intakes ranged from 1.3 to 211.5 ng kg-1 bm day-1 (Baltic Sea), 2.9-12.7 ng kg-1 bm day-1 (Atlantic, Norway) and 1.1-4.8 ng kg-1 bm day-1 (Atlantic, Iceland). Intakes for the other dominant congeners, BDE-49, BDE-99 and BDE-100, were relatively low. The intake estimates of ΣPBDE were highest for Baltic cod liver oils ranging from 2.2 to 284.8 ng kg-1 bm day-1 for adults, 2.8-178 ng kg-1 bm day-1 for teenagers and 2.0-127.8 ng kg-1 bm day-1 for a child. Estimated weekly intake of ΣPBDE from canned cod liver was highest for adults, ranging from 17.6 to 25.1 ng kg-1 bm.

A retrospective investigation into the occurrence and human exposure to polychlorinated naphthalenes (PCNs), dibenzo-p-dioxins and furans (PCDD/Fs) and PCBs through cod liver products (1972-2017).

A retrospective analysis of a number of historical medicinal grade cod liver oil samples produced in Northern Europe revealed relatively high contamination levels of PCNs, PCDD/Fs and PCBs. The total toxic equivalence (TEQ) associated with PCDD/Fs, dl-PCBs and PCNs was in the range 95-427 pg g-1 for Baltic cod liver oils and from 70 to 148 pg g-1 for oils sourced from the North Atlantic. The corresponding range for canned cod liver products (Baltic Sea) sampled in 2017 ranged from 52 to 104 pg g-1 fat (33-34 pg g-1 ww). The contribution from PCBs to the overall TEQ toxicity was around 3-6-fold higher than from PCDD/Fs and ranged from 24 to 318 pg TEQ g-1ww. The estimated summed TEQ intakes of PCDD/Fs, dl-PCBs and dl-PCNs resulting from the consumption of the daily recommended doses was highest for the Baltic cod liver oils ranging from 16 to 293 pg kg-1 body mass (bm) day-1 for an adult, 20-183 pg kg-1 bm day-1 for a teenager and 15-131 pg kg-1 bm day-1 for a child. The contribution to daily adult TEQ intake from PCNs alone, although relatively small is estimated to contribute up to 5-fold above the recent EFSA proposed TWI of 2 pg kg-1 bm. The results indicate that although currently produced fish oils may undergo rigorous purification procedures and show low contaminant levels, cod livers sourced from the Baltic and consumed locally, continue to contribute substantially to the dietary intake of these contaminants.

Occurrence of polybrominated diphenylethers, hexabromocyclododecanes, bromophenols and tetrabromobisphenols A and S in Irish foods.

The occurrence of polybrominated diphenyl ethers (PBDEs), hexabromocyclododecanes (HBCDs), tetrabromobisphenol A (TBBPA) and other phenolic brominated flame retardants (BFRs) in Irish foodstuffs has been assessed. A total of 53 food samples including eggs, milk, fish, fat and offal were tested. Eighty-one percent of the samples contained at least one measurable PBDE congener. The most abundant and frequently occurring congeners were BDE-47, BDE-49, BDE-99, BDE-100 and BDE-209 with the highest concentrations found in fish, fat and eggs. Summed concentrations for the measured PBDEs ranged from 0.02 µg/kg to 1.37 µg/kg whole weight. At least one HBCD stereoisomer was found in twenty-six percent of the samples with α-HBCD being the most frequently detected. The highest concentrations were found in fat and oily fish samples. TBBPA was only detected in one farmed salmon sample at 0.01 µg/kg. Bromophenol residues were found in fourteen out of the 53 samples, specifically in eggs and fish, with concentrations ranging from 0.28 to 0.98 µg/kg whole weight. These data contribute to the EU-wide EFSA risk assessment on these contaminants that is currently underway.

Mixed halogenated dioxins/furans (PXDD/Fs) and biphenyls (PXBs) in food: occurrence and toxic equivalent exposure using specific relative potencies.

The occurrence of nineteen mixed halogenated (bromo-chloro) dibenzo-p-dioxins, dibenzofurans (PXDD/Fs) and biphenyls (PXBs) in a range of foods (n>100) was investigated. The analytical methodology used dual activated carbon column fractionation with high resolution mass spectrometric measurement (13,500-15,000 res). Occurrence was observed in most commonly consumed foods but the most frequent detections of these environmental contaminants were made in shellfish and offal. The concentrations of the individual compounds were condensed into toxic equivalents (TEQs) using recently reported relative potency values. Although representing only a small subset of the full range of toxic PXDD/Fs and PXBs, the TEQs estimated for these compounds ranged from 0.2% to approximately 15% (depending on the food matrix) of the corresponding TEQ for the fully chlorinated analogues. This finding is of great toxicological importance as it implies that a potentially greater magnitude of TEQ could be associated with the full range of toxic PXDD/Fs and PXBs, thus making a significant contribution to dioxin-like toxicity from the diet, to human exposure.

Mixed brominated/chlorinated dibenzo-p-dioxins, dibenzofurans and biphenyls: Simultaneous congener-selective determination in food.

Of the 4600 individual poly-halogenated (bromo-chloro) dibenzo-p-dioxins, dibenzo-furans (PXDD/Fs) and 9180 poly-halogenated biphenyls (PXBs), 19 compounds were selected for analysis in food, based on current toxicological knowledge, chemical configuration, type and degree of halogenation, and the limited knowledge on environmental occurrence levels. The selection was also tempered by the availability of reliable analytical standards. The analytical methodology designed to allow simultaneous determination of PXDD/Fs and PXBs, was based on internal standardisation with (13)C(12) labelled compounds and high resolution mass spectrometry and involved a new separation procedure using dual activated carbon column fractionation. In order to unambiguously measure these compounds a practical, higher mass resolution (13,500-15,000 res) was used, coupled with a judicious choice of analyte ions and relative ion ratios. Further specificity was incorporated by exploiting the differences in chromatographic retention from those of potential interferants. The methodology was validated and used to measure occurrence levels of these contaminants in different matrices such as milk, meat, fish, eggs, offal, shellfish and soil. The limits of detection achieved by this methodology ranged from 0.005 to 0.02ngkg(-1) fat for foods. The analyses revealed the presence of both PXDD/Fs and PXBs, with the latter occurring to a greater extent, followed by PXDFs. This work represents the first targeted approach to measuring a range of individual PXDD/Fs and PXBs simultaneously.

Polychlorinated naphthalenes (PCNs): congener specific analysis, occurrence in food, and dietary exposure in the UK.

Information on the occurrence of toxicologically significant polychlorinated naphthalenes (PCNs) in food, or on human exposure, is sparse. In this work, PCN congeners (PCNs 52, 53, 66/67, 68, 69, 71/72, 73, 74, and 75) were selected for analysis, based on the available literature on current occurrence and toxicology, and limited by the commercial availability of reference standards. The analytical methodology used cold solvent extraction of prehydrolyzed samples fortified with internal standards ((13)C(10) labeled PCNs), activated carbon and basic alumina purification, and measurement by HRGC-HRMS. The investigation showed PCN occurrence in all studied foods: meat, milk, fish, dairy and meat products, eggs, poultry, vegetables, fruits, etc. The most frequently detected congeners were PCN 52, PCNs 66/67, and PCN 73. The highest concentrations were observed in fish (maximum value of 37 ng/kg w.w. for the sum of the measured congeners). The dioxin-like toxicity (PCN TEQ) associated with these concentrations is 1-2 orders of magnitude lower than those reported for chlorinated dioxins or PCBs in food and, on the basis of dietary intakes estimated using very conservative assumptions regarding concentrations of these contaminants in the UK, the levels of PCNs alone in food do not suggest any toxicological concerns.

Brominated dioxins (PBDD/Fs) and PBDEs in marine shellfish in the UK.

The occurrence of brominated dioxins (PBDD/Fs) and polybrominated diphenyl ethers (PBDEs) was investigated in commonly consumed species of marine shellfish in the UK. Individual samples of Pacific oysters (Crassostrea gigas), native oysters (Ostrea edulis), mussels (Mytilus edulis), scallops (Pecten maximus), and cockles (Cerastoderma edule) were collected from different coastal regions between 2006 and 2007. Samples of a particular species from each site were composited and 60 samples were analysed. Polybrominated dibenzofurans (PBDFs) occurred more frequently and generally at a higher level than polybrominated dibenzodioxins (PBDDs), except for 237-TriBDD, which was the predominant PBDD/F congener in some species, notably oysters. This profile may reflect the environmental distribution of these compounds and the effects of removal mechanisms, such as degradation, selective uptake and metabolism. PBDEs were detected in all samples. The dominant congeners were BDEs 47, 49, 99 and 100 and, to a lesser extent, BDEs 66 and 154. The occurrence of BDE-209 was observed in most samples and appears to be species selective, with the highest values occurring almost exclusively in mussels and cockles. Among the species studied, oysters and mussels displayed relatively higher levels of both sets of contaminants; native oysters, in particular, showed elevated levels of 237-TriBDD (up to 14.5 ng/kg). In general, contaminant levels appeared to be consistent with the extent of local industrialisation with lower levels observed in more remote areas such as the north of Scotland. Polybrominated biphenyls (PBBs) were also measured, and PBBs 49, 52 and 77 were the most frequently detected, although levels were very low. Dietary intakes, estimated for PBDD/Fs, showed that 237-TriBDD from single portions of oysters constituted a high proportion of the total dietary intake of the congener but, otherwise, dietary intakes of PBDD/Fs from shellfish were relatively low.

Brominated and chlorinated dioxins, PCBs and brominated flame retardants in Scottish shellfish: methodology, occurrence and human dietary exposure.

The most commonly consumed shellfish species produced in Scotland - mussels, oysters and scallops - were investigated for the occurrence of a range of brominated and chlorinated contaminants in order to establish current levels and estimate human dietary exposure. Flesh from individual sub-samples was representatively pooled and 35 composites were analysed for brominated and chlorinated dioxins (PBDD/Fs, PCDD/Fs), brominated and chlorinated biphenyls (PBBs, PCBs), polybrominated diphenyl ethers (PBDEs), hexabromocyclododecanes (HBCDs) and tetrabromobisphenol A (TBBPA). The analytical methodology used (13)C(12) labelled surrogates of the target compounds, with GC coupled to (usually) high resolution MS, and LC-MS/MS for HBCD and TBBPA analysis. Positive identifications were made in the majority of samples for most analytes with the exception of TBBPA and most PBDD congeners measured. None of the levels detected for PCDD/F and PCB were above the maximum permitted levels specified in European Union regulations. The levels of brominated furans predominated over brominated dioxins, reflecting the environmental distribution and source emission profiles of these contaminants, and relatively high levels of the tri-brominated congeners were observed. Levels of the flame retardant chemicals reflected current and legacy use, with appreciable concentrations of PBDEs and HBCDs (predominantly alpha-HBCD) but far lower levels of PBBs. TBBPA was not detected in any of the species. In general, mussels and oysters displayed relatively higher levels of contamination than scallops, although the gonad tissue of the latter showed significant levels of brominated dioxins. The estimated adult dietary intakes of PCDD/Fs and PCBs arising from the consumption of a typical portion of these foods in combination with an otherwise average UK diet were in the range 0.5-0.6 pg World Health Organisation (WHO)-toxic equivalent (TEQ)(2005)/kg bodyweight per day. These estimated dietary intakes are well within the Tolerable Daily Intake for dioxins and dioxin-like PCBs of 2 pg WHO-TEQ(2005)/kg bodyweight/day endorsed by the independent expert Committee on Toxicology of Chemicals in Food, Consumer Products and the Environment. The corresponding intakes for sumPBDEs and sumHBCDs were 5.6-6.1 and 5.9-7.9 ng/kg bodyweight/day respectively.

Development and validation of an analytical method for total amitraz in fruit and honey with quantification by gas chromatography-mass spectrometry.

The EU maximum residue limit (MRL) definition for amitraz is 'the sum of amitraz plus all its metabolites containing the 2,4-aniline moiety, expressed as amitraz'. A rapid and sensitive method has been developed and validated in-house for the determination of total amitraz in pears, strawberries, oranges and honey. Samples were hydrolysed (under acidic followed by alkaline conditions) to convert amitraz to 2,4-dimethyaniline, which was then partitioned into 2,2,4-trimethylpentane prior to quantification by gas chromatography-mass spectrometry. The method was validated at 0.02 and 0.1 mg kg(-1) amitraz (well below MRL requirements) with a lowest calibrated level (LCL) for 2,4-dimethylaniline of 0.002 mg kg(-1) (equivalent to 0.0024 mg kg(-1) amitraz). A single partition step yielded recoveries of approximately 60% (with % CV values in the range 3.3-8.2), which is satisfactory for screening purposes. A second partition increased recoveries by 10-20%, making the method suitable for the quantification of residues.

Measurement uncertainty associated with sample processing of oranges and tomatoes for pesticide residue analysis.

The homogeneity of analytical samples and the stability of pesticides during the sample processing of oranges and tomatoes were evaluated. The mean concentrations of 14C-labeled chlorpyrifos in analytical portions (subsamples) after processing show that homogeneity is dependent on sample type as well as the processing procedure. The homogeneity of analytical samples of tomatoes processed cryogenically was much better than those processed at ambient temperature. For tomatoes, the minimum analytical portion masses required for between-analytical portion variation of < 0.3 Ho were 110 and 5 g for processing at ambient and cryogenic temperatures, respectively. Results for orange showed that analytical portion sizes of 5 g provided sufficient homogeneity from both sample processing procedures. Assessments of pesticide stability demonstrated that most were relatively stable during processing at either ambient or cryogenic temperatures. However, some pesticides, including dichlofluanid, chlorothalonil, tolylfluanid, and dicloran, appeared to suffer much greater losses (>20%) during processing at ambient temperature. For these analytes, loss is interpreted as chemical degradation.

Semiautomated determination of pesticides in water using solid phase extraction disks and gas chromatography-mass spectrometry.

A method based on semiautomated solid phase extraction using octadecyl-bonded silica disks and gas chromatography-mass spectrometry, operated in selected ion monitoring mode, allows detection and quantification of approximately 100 pesticides and transformation products in drinking water. Samples (500 mL) were passed through the disk, and the retained pesticides were eluted with acetone and ethyl acetate. Typical recoveries for pesticides at 0.1 microg L(-1) in water were in the range of 72-120% with relative standard deviations less than 20%. Calibration curves were linear over the range of 0.025-0.5 microg mL(-1) (equivalent to a concentration range in drinking water of 0.05-1.0 microg L(-1)).