'Toxic' and 'Nontoxic': confirming critical terminology concepts and context for clear communication

If 'the dose makes the poison', and if the context of an exposure to a hazard shapes the risk as much as the innate character of the hazard itself, then what is 'toxic' and what is 'nontoxic'? This article is intended to help readers and communicators: anticipate that concepts such as 'toxic' and 'nontoxic' may have different meanings to different stakeholders in different contexts of general use, commerce, science, and the law; recognize specific situations in which terms and related information could potentially be misperceived or misinterpreted; evaluate the relevance, reliability, and other attributes of information for a given situation; control actions, assumptions, interpretations, conclusions, and decisions to avoid flaws and achieve a desired outcome; and confirm that the desired outcome has been achieved. To meet those objectives, we provide some examples of differing toxicology terminology concepts and contexts; a comprehensive decision-making framework for understanding and managing risk; along with a communication and education message and audience-planning matrix to support the involvement of all relevant stakeholders; a set of CLEAR-communication assessment criteria for use by both readers and communicators; example flaws in decision-making; a suite of three tools to assign relevance vs reliability, align know vs show, and refine perception vs reality aspects of information; and four steps to foster effective community involvement and support. The framework and supporting process are generally applicable to meeting any objective.

Value of clinical factors in selecting postmenopausal women with rheumatoid arthritis for bone densitometry.

Criteria to decide which patients with rheumatoid arthritis (RA) should be examined by dual energy x ray absorptiometry (DXA) are currently not available. The rheumatologists from Amsterdam have proposed preliminary criteria based on clinical risk factors (age, disease activity, and functional status). These criteria are preliminary and not widely accepted but might be helpful in practice. The value of the proposal in a group of Spanish postmenopausal women with RA is analysed. METHODS DXA (lumbar spine and femoral neck) was performed in 128 patients recruited from a clinical setting, and the proposed criteria were applied. T and Z scores were established for a Spanish reference population. RESULTS The mean (SD) age of the patients was 61.3 (10.7) and mean duration of the postmenopausal period 14.5 (10.1) years. Mean duration of RA was 13.7 (7.7) years. Mean C reactive protein was 22 (21) mg/l; mean erythrocyte sedimentation rate 26 (18) mm/1st h; and mean Health Assessment Questionnaire score 1.25 (0.79). Ninety (70%) patients fulfilled the proposed criteria. Their sensitivity for the diagnosis of osteoporosis (T score ¿¿2.5 SD) was 86% and their specificity, 43%. Positive predictive value was 54% and negative predictive value, 79%. CONCLUSIONS The proposed criteria seem a good screening method for the selection of those patients with RA whose bone mineral density should be assessed as the sensitivity and negative predictive value are acceptable.

Lettre d'un ancien professeur en medecine de la faculté de Paris, a M. Vandermonde, auteur du Journal de medecine, censeur royal, &c. Pour servir de réponse à la Lettre d'un médecin de province à un médecin de Paris . Cette lettre fait la troisiéme piéce d'un ecrit intitulé Recueil de plusieurs piéces concernant le Traité des tumeurs & ulceres, &c.

Comprend : Lettre d'un médecin de province à un médecin de Paris

[Illustrations de De Americaensche Zeerovers...] / [Non identifié] ; Alessandre Olivier Exquemelin dit Oexmelin, aut. du texte

Comprend : [Planche entre pp. 42-43. Portrait de Rock.] [Cote : BNF B11901] ; [Planche en regard du folio 3v ° paginé 46. Portrait de] François Lolonois. [Cote : BNF C39549] ; [Planche en regard de la p. 60. Scène de torture. Un soldat arrache le coeur d'un homme et le fait manger à un autre.] [Cote : BNF C54751] ; [Planche en regard de la p. 82. Scène de massacre.] [Cote : BNF C54752] ; [Planche en regard de la p. 88. Scène de bataille. Prise d'une ville.] [Cote : BNF C76835] ; [Planche en regard de la p. 98. Scène de tortures et de massacres.] [Cote : BNF C76836] ; [Planche dépliante en regard de la p. 102. Combat naval.] [Cote : BNF D4698] ; [Planche dépliante en regard de la p. 130. Carte de Panama.] [Cote : BNF C54753] ; [Planche dépliante en regard de la p. 132. La ville de] Panama. [Cote : BNF C30662]