Framed in a context with an emerging economy and with a high percentage of school failure, this study aimed to identify the factors that turn students with socioeconomic disadvantages into resilient students. Two questions guided the research: Can resilience be supported in students in adverse socioeconomic situations? What factors influence building resilient students? A cross-sectional study was carried out from 2011 to 2015 in Chile, using a multilevel logistic regression model with three levels, considering the hierarchical data structure. The behavior of 63100 to 76400 sampled students was analyzed. Results show five relevant factors in building resilience: self-efficacy in language, minor aggressions and violence perceived by students, norms and values of the establishment, interest in study, and self-efficacy. Some risk factors identified were an atmosphere of less respect and trust, engagement in physical education activities and good performance in carrying them out. These results could orient educational leaders interested in supporting the educational community in order to improve the academic success of disadvantaged students.

Because of the widespread use of bisphenol analogues (BPs) as the alternatives to bisphenol A (BPA), they have attracted considerable attention for health risk in aquatic ecosystems. The occurrence and distribution of six BPs were researched in soluble phase (< 5 kDa), colloidal phase (5 kDa to 1 µm) and suspended particulate matter (SPM > 1 µm) in a water diversion project of Nanjing, China. Except for bisphenol Z, all BPs were detected in the two or three phases, the total concentrations of detected BPs were 161-613 ng/L, 5.19-77.2 ng/L and 47.5-353 ng/g for the soluble phase, colloidal phase and SPM, respectively. Among the detected compounds, BPA still the dominant BPs in the soluble and colloidal phases, followed by BPS, while BPAF was the major contaminant in SPM, followed by BPA. The mean contribution proportions of colloids were 1-2 orders of magnitude higher than SPM, suggesting that colloids have an obvious impact on regulating BPs’ environmental behaviors. In terms of spatial distribution, although the water diversion project could reduce the pollution levels of BPs, which might further affect the ecological security of the Yangtze River.

Owing to the widespread use of bisphenol analogues (BPs) as bisphenol A (BPA) alternatives, they have been recognized to constitute a health risk for aquatic ecosystems. The occurrence and distribution of six BPs were investigated in the truly dissolved phase (< 5 kDa), colloidal phase (5 kDa to 1 µm) and suspended particulate matter (SPM > 1 µm) in a water diversion project of Nanjing, China. With the exception of bisphenol Z, all BPs were detected in at least two phases, the total concentrations of detected BPs were 161-613 ng/L, 5.19-77.2 ng/L and 47.5-353 ng/g for the truly dissolved phase, colloidal phase and SPM, respectively. Among the detected compounds, BPA still the dominant BPs in the truly dissolved phase and colloidal phase, followed by BPS, while BPAF was the major contaminant in SPM, followed by BPA. The mean contribution proportions of colloids were 1-2 orders of magnitude greater than that of SPM, suggesting that colloids play an important role in regulating the environmental behaviors of BPs. In terms of spatial distribution, although the water diversion project could reduce the pollution levels of BPs, which might further affect the ecological security of the Yangtze River.

Many pilot-based initiatives have been developed to promote awareness and use of climate information services among vulnerable smallholder farmers in Africa through million-dollar investments. However, despite their experimental nature, these pilot projects have been successful in raising participating farmers’ awareness and use of climate information services and they can inform transferrable good practices. Through a systematic literature review approach, this review sought to understand ways in which these past pilot projects have contributed to climate risk management in the context of smallholder farming and the factors that led to their success. Results showed that climate information services main contribution to climate risk management has been through facilitating farm level decision making. Factors that led to success of the pilots include: use of downscaled information; building institutional partnerships to add value to climate information; involving farmers through the co-designing and co-developing process; face-to-face way of communication; embedding pre-seasonal workshops in the activities of local institutions for sustainability; using diversity of communication channels to enhance reach among others. These factors can be borrowed as good practices to inform future efforts focused on increasing adoption of climate information services among a wider population beyond pilot project reach.

This study aimed to investigate the airborne release of N-nitrosodimethylamine (NDMA) as a result of the dry heat cooking of some meats using charcoal grilling and pan broiling methods. Three types of meat, beef sirloin, pork belly, and duck, were chosen and cooked in a temporary building using the above methods. Air samples were collected in Thermosorb-N cartridges, which were qualitatively and quantitatively analyzed for NDMA using ultra-high performance liquid chromatography–mass spectrometry and high-performance liquid chromatography–fluorescence detection, respectively. Overall, the charcoal grilling method showed higher average NDMA concentrations than the pan broiling method for all types of meat. The highest average concentration was observed for charcoal-grilled beef sirloin (410 ng/m3) followed by pork belly, suggesting that meat protein content and cooking duration are important determinants of NDMA formation. Cancer risk assessment showed that the charcoal grilling of such meats can pose an additional cancer risk for restaurant customers.

Modern portfolio theory claims that diversification into non-correlated or negatively correlated activities reduces the overall risk of a portfolio. Considering the total income of a bank as a portfolio of interest income and non-interest income, this paper investigates how the variability of interest income and non- interest income, and covariance between interest income and non-interest income influence the various risk factors of banks. We set out a study in the Indian context. We have extracted data for the period 2005-2017 and employed an extended version of Ridge, Lasso and Elastics Net regression to take care of multi-collinearly in our data. We have considered 10-fold cross-validation techniques to get optimal values of tuning parameters for Ridge, Lasso, and Elastics Net regression (which is a convex combination of ridge and the LASSO). We have compared different regression techniques by comparing RMSE and R2. We observe that non-interest income is positively correlated with interest income in the Indian context, but it does stabilize variance, idiosyncratic risk & market risk (Beta) of Indian Banks.

Nanoparticles of graphene and carbon nanotubes are attractive materials for improvement of mechanical and barrier properties and functionality of biodegradable polymers for food packaging applications. However, the increase of the manufacture and consumption increases the probability of exposure of human and environment to such nanomaterials, this rising questions about the risks of nanomaterials since they can be toxic. For a risk assessment, it is crucial to know whether airborne nanoparticles of graphene and carbon nanotubes can be released from nanocomposites into the environment at their end-life, or they remain embedded in the matrix. In this work the release of graphene and carbon nanotubes from the poly(lactic) acid nanocomposite films were studied for the scenarios of: (i) biodegradation of matrix polymer at the disposal of wastes; and (ii) combustion and fire of nanocomposite wastes. Thermogravimetric analysis in air atmosphere, TEM, AFM and SEM were used to verify the release of nanoparticles from nanocomposite films. The three factors model was applied for the quantitative and qualitative risk assessment to the release of graphene and carbon nanotubes from nanocomposite wastes for these scenarios. Safety concern is discussed in respect to the existing regulations for nanowastes stream.

Philip Morris International (PMI) has developed the Population Health Impact Model (PHIM) to quantify, in the absence of epidemiological data, the effects of marketing a candidate modified risk tobacco product (cMRTP) on the public health of a whole population. Various simulations were performed to understand the harm reduction impact on the U.S. population over a 20-year period under various scenarios. The overall reduction in smoking attributable deaths (SAD) over the 20-year period was estimated as 934,947 if smoking completely went away and between 516,944 and 780,433 if cMRTP use completely replaces smoking. The reduction in SADs was estimated as 172,458 for the World Health Organization (WHO) 2025 Target and between 70,274 and 90,155 for the gradual cMRTP uptake. Combining the scenarios (WHO 2025 Target and cMRTP uptake), the reductions were between 256,453 and 268,796, depending on the cMRTP effective dose. These results show how a cMRTP can reduce overall population harm additionally to existing tobacco control efforts.

This case study is the first to be developed in the Middle East region to describe the timeline of the Middle East Respiratory Syndrome (MERS) epidemic events in Qatar along with the features of the implemented Emergency Risk Communication (ERC) activities. It sought to describe how the performed ERC strategy particularly during the first days (then over the course of the following phases) of the outbreak might have contributed to the authorities’ credibility, public trust, and outbreak control measures despite the overwhelming uncertainty. All of the relevant news stories during the period 24 Sep 2012 to 17 Mar 2014 were retrieved from a local daily, then were analyzed and interpreted before they were compiled and matched with the issued press releases, records of response activities and the public reactions along the course of the epidemic timeline. Despite the prevailing uncertainty, the health authorities’ early preparedness to the epidemic and its commitment to a proactive and open ERC strategy since the first days of the outbreak favored the authorities’ credibility and allowed for the quick initiation of the national response efforts during the course of the outbreak. However, there was some pitfalls as the print media reported some conflicting messages and paternalist approach during the early phases of the epidemic. Reliance solely on the print media is an acknowledged limitation to this study. Yet, it might be useful for emergency planners regarding what communication challenges to expect during the first days of a novel virus or similar threats.

Surgical smoke is produced by energy-based surgical instruments. The airborne volatile organic compounds (VOCs) from surgical smoke may have potential health risk. This study aimed to evaluate the evidence for the harmful effects on the operating theater staff. An internationally recognized evaluation model of health risk assessment (HRA) was adapted to preliminarily assess the health risks caused by VOCs in surgical smoke. Results of HRA indicated that non-carcinogenic risk indexes of VOCs did not exceed one, indicating that these pollutants didn't cause significant non-carcinogenic harm to the health of the operating theater staff. But the cancer risk indexes exposed to formaldehyde and benzene all exceed 10-5, which was higher than the suggested value of USEPA (10-6) and might cause potential harm to the health of the operating theater staff. Long-term exposure of such surgical smoke will be harmful to the health of the operating theater staff and have a great risk of cancer.

The paper discusses how joint damage and deterioration affect the seismic response of existing reinforced concrete frames with sub-standard beam-column joints. The available simplified modeling techniques are critically reviewed to propose a robust, yet computationally efficient technique for simulating the nonlinear behavior of substandard beam-column joints. Improvements over the existing models include simulation of the cyclic deterioration of joint stiffness and strength as well as pinching in the hysteretic response, implemented considering a deteriorating hysteretic rule. A fibre-section forced-based inelastic beam-column element is developed; considering improved material models and fixed-end rotation due to bond failure, rebars-slip and inelastic extension, to simulate the deteriorating cyclic behavior of existing pre-cracked beam-column members. For the assessment of frames with substandard exterior beam-column joints, a nonlinear model for the exterior joint is developed and validated through a full-scale quasi-static cyclic test performed on a substandard T-joint connection. The proposed model allows considering structural performance in risk assessment while accounting for true inelastic mechanisms at the joints.

Background: Macrophage inflammatory protein-1 alpha (MIP-1α) and C-reactive protein (CRP) are pro-inflammatory biomarkers that quantify clinical and subclinical inflammation in cardiac ischemia in cardiac inflammation and disease. Adiponectin is an anti-inflammatory marker associated with good health. The susceptibility of periodontitis patients to cardiovascular events needs to be evaluated. Objective: This study aims to assess the levels of biomarkers in periodontitis patients with and without acute myocardial infarction (AMI) compared to controls. Material and methods: Pro-inflammatory and anti-inflammatory analytes were examined by collecting unstimulated saliva from three groups (n = 20/each): healthy individuals, individuals with stage III periodontitis, and post-myocardial infarction patients with stage III periodontitis. The samples were collected within 48 hours of AMI. Results: Adiponectin levels were significantly lower in patients with periodontitis with and without AMI compared to controls, while CRP and MIP-1α were significantly higher in patients with periodontitis with and without AMI compared to controls. The highest titers for MIP-1α and CRP were detected among patients with periodontitis with and AMI. Conclusion: Our study provides evidence of the association between periodontitis and salivary analytes that occur in tandem with cardiovascular disease. The lower levels of Adiponectin and higher levels of CRP and MIP-1α in patients with periodontitis indicate that this condition is a potential risk factor for cardiovascular disease. The findings emphasize the importance of early detection and intervention for periodontitis patients to prevent cardiovascular events.

Patients with Peripheral-artery-disease (PAD) are prone to risks of major-adverse-limb-events (MALE), and major-adverse-cardiovascular-events (MACE). CHA2DS2-VASc is a prognostic score for Atrial fibrillation stroke risk, however, no study exists that evaluated its predictability for MALE and MACE in PAD patients. In this study, patients with PAD were stratified into four risk groups based on CHA2DS2-VASc score. Cox-proportional hazards models,10-fold cross-validation and Receiver operating characteristic (ROC) analyses were utilized to evaluate the predictability of CHA2DS2-VASc for predicting MALE, MACE, and MALE+MACE. Kaplan-Meier analysis estimated the survival-probability of risk-groups. CHA2DS2-VASc was found to be a significant predictor of MACE (hazard ratio (95% confidence interval; P) = 3.47 (0.99 - 12.18; 0.052), 4.12 (1.19 - 14.14; 0.024), and 5.06 (1.48 – 17.28; 0.009), for moderate-, high- and very-high-risk groups, respectively, while for MALE and MALE+MACE significance was achieved only for high-risk group. MACE demonstrated AUC > 0.8, good-discrimination (c-index > 0.8) and good-calibration. However, MALE and MALE+MACE models failed to achieve good performances. Based on all findings, CHA2DS2-VASc could potentially serve as a risk stratification score for predicting MACE in patients with PAD but failed to qualify as a good predictor for MALE.

In the event of an abrupt sunlight reduction scenario there is a time window that occurs between when food stores would likely run out for many countries (~6 months or less) and ~1 year when resilient foods are scaled up. A promising temporary resilient food is leaf protein concentrate (LPC). Although it is possible to extract LPC from tree biomass (e.g. leaves and needles), neither the yields nor the toxicity of the protein concentrates for humans from the most common tree species has been widely investigated. To help fill this knowledge gap, this study uses high-resolution mass spectrometry and an open source toolchain for non-targeted screening of toxins on five common North American coniferous species: Western Cedar, Douglas Fir, Ponderosa Pine, Western Hemlock, and Lodgepole Pine. The yields for LPC extraction from the conifers ranged from 1% to 7.5%. The toxicity screenings confirm that these trees may contain toxins that can be consumed in small amounts and additional studies including measuring the quantity of each toxin are needed. The results indicate that LPC is a promising candidate to be used as resilient food, but future work is needed before LPCs from conifers can be used as a wide-scale human food.

This research paper investigated the hedging effectiveness, dynamic dependence, safe haven ability, and portfolio diversification benefits of alternative assets (precious metals) with conventional and Islamic stock indices. The data covered the period from March 2011 to March 2021, and a copula model with switching dependence was utilized. The estimated transition probabilities demonstrated a high persistence of the same dependence regime in all estimated pairs. The research found that the use of precious metals with stocks for diversification is a favorable choice, proving them to be the best suitable solution to avoid risks. They also provide a save haven effect along with diversification benefits and reveal that risk reduction benefits vary with respect to portfolio types. The findings of the research indicate that negative shocks prompt investors to seek refuge in safe haven assets to safeguard their investments from extreme negative shocks. For most of the situations studied, precious metals provide the best and most effective hedge to stock returns. Overall, the addition of alternative assets to the stock portfolio reduces risks and provides better diversification benefits. Results vary depending on the circumstances of the country. These findings have practical implications for policymakers, fund managers, investors, and risk management practitioners, guiding them in their investment and risk management decisions.

Background: Bone metastases (BM) have a detrimental effect on survival for patients with solid cancers. Materials and methods: This systematic review respected the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results: When investigating OP as a risk factor for BM development, for breast cancer patients, some articles do not differentiate between intrinsic breast cancer subtypes. BMD does not seem to contribute in a significant manner when investigating Luminal A breast cancer. While researching breast cancer regardless of intrinsic subtype, untreated OP increases the risk of bone metastasis when compared to no OP group or treated OP group. In urological cancer cases, OP seems to predispose the patients to BM, especially early after diagnosis. Investigating risk factors for OP development in cancer patients resulted in the identification of 32 articles. Most articles identified risk factors for osteoporosis development in the context of breast cancer patients. Other commonly investigated solid cancers were prostate, other urological cancers, gynecological malignancies, and other less common subtypes of solid tumors. Discussion: While investigating OP as a risk factor for BM, it becomes clear that there is a high grade of heterogeneity in the behavior of each type of cancer in its dynamic concerning bone metastasis, and thus, OP might have different behaviors as a risk factor depending on the situation. Conclusion: There is a need for data regarding cancer subtypes that have not been explored concerning their interaction with the skeletal system in a low bone mineral density scenario.

The Association of Mutual Funds of India (AMFI) under the direction of the Securities and Exchange Board of India (SEBI) provided open access to various risk parameters with respect to MidCap and SmallCap funds on its website in February, 2024. This disclosure of month wise cross-sectional data depicting stress-test and liquidity analysis was hailed as a milestone as it provided a glimpse into inherent risk of mutual funds. The AMFI dataset consisted of 14 variables including stress test results, ownership concentration on both liability & asset sides, standard deviation on portfolio’s returns, portfolio beta, trailing 12-month PE ratio, portfolio turnover etc. Among these, the primary variable identified in grading mutual fund is the stress test parameter, expressed as number of days required to liquidate 50% and 25% of the portfolio respectively on a pro-rata basis under stress condition. A higher number of days to liquidate the portfolio under stress conditions represented higher risk for the investor. The objective of our paper is to test various neural network models which can help in predicting stress levels with the highest accuracy and specificity in MidCap and SmallCap mutual funds based on AMFI’s 14 parameters as predictors.Our study utilizes AMFI datasets available for MidCap and SmallCap mutual funds from February 2024 (inception period) to May 2024. To operationalize the analysis, the derived response variable was binned to represent high and low risk based on the time required for pro-rata liquidation of the portfolio. The study employed feed-forward neural networks, with the logistic regression as the step function, to model the relationships. Results suggest that the simpler neural network models with one hidden layer and two to three nodes show higher accuracy and specificity. Analysis also shows that more complex architectures do not always guarantee better performance as these models might suffer from higher bias. By leveraging advanced computational techniques, this study contributes to the ongoing discourse surrounding risk management and decision-making in the realm of mutual fund investments.

Background/Objectives: The pediatric definition of severe obesity (OB) depends on the body mass index (BMI) references. We evaluated different BMI derived metrics of the World Health Organization (WHO) system to define which cut-off is associated with the highest cardiometabolic risk (CMR); Methods: In this multicentric study data were obtained by 3727 youths (1937 boys; 2225 children, 1502 adolescents. severe OB was defined as BMI &gt;99th percentile (BMI99), BMI97 ≥120% or BMI Z-score &gt; 3 (WHO tables). The continuous CMR Z-score (sum of residual standardized for age and sex of waist-to-height ratio, systolic and diastolic blood pressure, triglycerides, and HDL-Cholesterol x -1) and the cluster of at least two CMR factors (hypertension, high triglycerides, low HDL-Cholesterol and high waist-to-height ratio) were calculated; Results: Continuous CMR Z-score was significantly higher both in children or adolescents with severe OB defined by 120% BMI97 compared to BMI &gt;99th (p &lt;0.0001), while it was lower only in adolescents with severe OB defined by 120% BMI97 compared to BMI Z-score &gt;3 (p &lt;0.0001). Compared to BMI97 ≥120%, BMI Z-score &gt;3 had higher specificity, but lower sensitivity in identifying children and adolescents with clustered CMR factors; Conclusions: The definition of severe OB based on BMI97 ≥120% is superior to BMI99 but it is inferior to BMI Z score &gt;3 as far as the association between severe OB and CMR factors is concerned. Pediatricians should take into consideration the implications of the use of different BMI metrics in those countries that recommend the WHO system.

Background/Objectives: Schizophrenia (SZ) is a severe psychiatric disorder characterized by a complex interplay of genetic, developmental, and environmental factors that significantly increase the risk of suicidal ideation (SI) and suicide attempts (SAs). This systematic review synthesizes current research on the developmental predictors of SI in individuals with SZ, aiming to delineate the multifactorial etiology of suicide within this population. Methods: A comprehensive search across Medline, PsycINFO, and EMBASE databases identified 23 eligible studies, emphasizing the varied methodological approaches and the global distribution of research efforts. Results: These studies demonstrate a robust association between early life adversities, particularly childhood trauma such as physical neglect, emotional abuse, and sexual abuse, and the increased prevalence of SI and SAs in SZ. This review also highlights the significant genetic factors associated with development of suicidality in SZ, suggesting that polymorphisms in inflammation-related genes and neurodevelopmental abnormalities may influence susceptibility to SI. Notably, family history of psychiatric conditions may exacerbate the risk of SI through both hereditary and environmental mechanisms. Environmental factors, including socioeconomic status and social support, are also implicated, underscoring the role of broader socio-environmental conditions influencing outcomes. Conclusions: This review supports the integration of biopsychosocial models in understanding SI in SZ, advocating for interventions addressing the complex interplay of risk factors and the need for longitudinal studies to elucidate the dynamic interactions between risk factors over time. This comprehensive understanding is crucial for developing targeted preventative strategies and enhancing the clinical management of SZ, aiming to reduce suicidality in this vulnerable population.

Background: Ensemble tree-based models such as Xgboost are highly prognostic in cardiovascular medicine, as measured by the Clinical Effectiveness Metric (CEM). However, their ability to handle correlated data, such as hospital-level effects, are limited. Objectives: The aim of this work is to develop a binary outcome mixed effects Xgboost (BME) model that integrates random effects at the hospital level. To ascertain how well the model handles correlated data in cardiovascular outcomes, we aims to assess its performance and compare it to fixed effects Xgboost and traditional logistic regression models. Methods: A total of 227,087 patients over 17 years of age, undergoing cardiac surgery from 42 UK hospitals between 1 Jan 2012 and 31 Mar 2019 were included. The dataset was split into two cohorts: Training/Validation (n = 157196; 2012-2016) and Holdout (n = 69891; 2017-2019). The outcome variable was 30 days mortality with hospitals considered as clustering variable. The logistic regression, mixed effects logistic regression, Xgboost and binary outcome mixed effects Xgboost (BME) were fitted to both standardized and unstandardized datasets across a range of sample sizes and the estimated prediction power metrics were compared to identify the best approach. Results: The exploratory study found high variability in hospital-related mortality across datasets, which supported the adoption of mixed effects models. Unstandardized Xgboost BME demonstrated marked improvements in predictor power over the Xgboost model at small sample size ranges, but performance differences decreased as dataset sizes increased. Generalized linear models (glm) and generalized linear mixed-effects models (glmer) models followed similar results, with Xgboost models excelling also at greater sample sizes. Conclusions: These findings suggest that integrating mixed effects into machine learning models can enhance their applicability in clinical settings where sample size is small such as rare conditions.

(1) Background: Heart rate variability (HRV) has emerged as a potential prognostic tool in cardiovascular diseases, offering individualized insights into autonomic nervous system activity. However, real-time HRV data during the acute phase of STEMI, particularly during percutaneous coronary intervention (PCI), was not previously explored. (2) Methods: This single-center, observational cohort study included 104 STEMI patients undergoing primary percutaneous coronary intervention (PCI). HRV parameters were measured using a wearable device (CE marked) during PCI, capturing dynamic responses. The association between HRV parameters and adverse outcomes, including in-hospital mortality and major adverse cardiovascular events (MACE), were assessed. (3) Results: HRV parameters significantly decreased after myocardial revascularization, particularly SDNN, RMSSD, pNN50, HF, SD1, and SD2/SD1 ratio. Significant associations were found between reduced SD2/SD1 ratio, approximate entropy, and adverse outcomes, including increased in-hospital mortality and MACE. The SD2/SD1 ratio was significantly lower in patients who died during the hospital stay (p = 0.008) compared to survivors. Approximate entropy was also significantly lower in deceased patients (p = 0.019). (4) Conclusions: Real-time HRV monitoring using wearable technology offers valuable data regarding dynamic physiological changes during primary PCI. The integration of HRV into routine clinical practice, facilitated by wearable devices, could improve the risk stratification and event prediction in STEMI patients.

Preoperative assessment is crucial in surgical care, traditionally relying on physical examinations and paper-based questionnaires. The emergence of digital tools like Pathpoint® ePOA represents a significant advancement, aiming to enhance the efficiency, accuracy, and standardisation of preoperative evaluations. Pathpoint® ePOA is a cloud-based platform designed to integrate seamlessly with Electronic Health Records (EHRs), providing a comprehensive, data-driven approach to preoperative assessments. It supports improved risk stratification, optimised resource allocation, and enhanced patient engagement through features such as customisable templates and real-time data integration.Current research highlights that digital preoperative tools like ePOA offer notable advantages, including increased clinical capacity, better complexity stratification, and improved patient follow-up. Despite these benefits, gaps remain in comparative studies, detailed clinical outcomes, and patient engagement strategies, indicating areas for further exploration. Pathpoint® ePOA adheres to rigorous safety standards and risk management protocols, ensuring reliability and data security while contributing to improved surgical outcomes. The benefit-risk ratio for ePOA is favourable, underscoring its potential to advance preoperative care by optimising clinical workflows and enhancing patient safety.

This qualitative study explores the challenges and successes in supplier development from the perspectives of procurement managers across diverse industries. Through in-depth interviews, key themes emerged, highlighting the critical role of communication, trust, performance measurement, capacity building, risk management, innovation, regulatory compliance, and technology integration in supplier relationship management. Procurement managers emphasized the importance of clear, continuous communication and trust-building activities to align objectives and foster collaborative partnerships. Performance measurement was crucial for evaluating and improving supplier performance, supported by capacity-building initiatives to enhance supplier capabilities. Risk management strategies focused on identifying and mitigating risks, while compliance efforts aimed to ensure adherence to industry standards. Innovation and technological integration were pivotal for driving efficiency and competitiveness, enabling faster time-to-market and improved product quality. Cultural sensitivity and relationship strengthening emerged as essential for navigating diverse cultural contexts and enhancing partnership effectiveness. Overall, the findings underscored positive outcomes including enhanced quality, cost efficiencies, and increased resilience within supply chains. This research contributes valuable insights into effective supplier management practices, emphasizing the strategic importance of supplier development initiatives for sustainable growth and competitive advantage in today's dynamic business environment.

In today's globalized economy, supply chain disruptions present significant challenges, impacting businesses' operational continuity and efficiency. This study delves into the ways businesses navigate these disruptions, with a particular emphasis on qualitative insights into risk management practices. The complexity and interconnectivity inherent in modern supply chains make them vulnerable to a broad spectrum of disruptions, ranging from natural disasters and geopolitical conflicts to technological failures and pandemics. Effective supply chain risk management requires a structured approach to identifying potential risks, evaluating their likelihood and potential impact, and formulating robust mitigation strategies. Employing a qualitative research methodology, this study gathers in-depth insights from semi-structured interviews with supply chain managers, industry experts, and executives. The findings underscore the necessity of proactive risk identification and comprehensive assessment processes. Advanced technologies, including artificial intelligence (AI), the Internet of Things (IoT), and blockchain, are highlighted as crucial tools for enhancing visibility and responsiveness within supply chains. Strategies such as diversifying suppliers and maintaining safety stock emerge as vital components of risk mitigation, ensuring supply continuity in the face of disruptions. Strong relationships with suppliers are pivotal, facilitating better information sharing and collaborative problem-solving. Leadership commitment to risk management and fostering a culture of resilience within organizations is also critical. Training programs and simulation exercises are identified as effective means of preparing employees to handle disruptions. Furthermore, adherence to regulatory compliance and a focus on sustainability are integral to maintaining long-term stability and reducing the risk of future disruptions.

This study explores the multifaceted role of culture in supply chain collaboration, focusing on how cultural differences shape communication, trust-building, negotiation, conflict resolution, risk management, and ethical standards. Utilizing a qualitative methodology, semi-structured interviews were conducted with 25 supply chain professionals from diverse cultural backgrounds and industries. The findings reveal that high-context cultures favor indirect communication and nuanced information exchange, which can lead to misunderstandings with partners from low-context cultures who prefer direct and explicit communication. Trust-building practices vary significantly, with high uncertainty avoidance cultures emphasizing formal agreements and procedural rigor, while low uncertainty avoidance cultures prioritize personal relationships and demonstrated reliability. Negotiation strategies also diverge, reflecting the underlying values of collectivism versus individualism, impacting the tactics and outcomes of supply chain negotiations. Conflict resolution approaches differ, with high power distance cultures favoring hierarchical and mediated solutions, and low power distance cultures preferring direct and egalitarian methods. The study highlights the need for adaptability to cultural changes and the development of cultural intelligence as essential competencies for managing cross-cultural supply chains. Additionally, cultural differences in risk management approaches and governance mechanisms affect the coordination and resilience of supply chains, while varying ethical standards influenced by cultural norms necessitate culturally sensitive strategies for promoting corporate social responsibility. The insights gained from this research underscore the importance of understanding and leveraging cultural differences to build stronger, more productive supply chain relationships, contributing to the broader literature on culture and supply chain management and offering practical implications for enhancing global supply chain collaboration.

Early-life adversity can profoundly impact individual development, yet some demonstrate resilience. Longitudinal studies tracking individuals over extended periods have aided our understanding of resilience and growth following adverse childhood experiences. This paper reviews insights from influential studies like the Kauai Longitudinal Study, the Adverse Childhood Experiences (ACE) Study, and the Dunedin Study. It explores key findings on risk and protective factors, adaptation trajectories, and long-term outcomes associated with resilience. Theoretical frameworks and methodological considerations are discussed. The paper examines how this research informs interventions, policies, and support systems for fostering resilience. It highlights the need for diverse samples, integrating biological and environmental factors, and investigating intergenerational impacts. By synthesizing longitudinal research, this paper elucidates complex pathways to resilience and positive development despite early adversity, offering insights for research and supporting vulnerable populations.

Background Popular movement-based injury risk screens have been shown to lack predictive precision, leading to interest in multifactorial models. Furthermore, there is a lack of research regarding injury risk assessment for those currently or planning to be recreationally active. This study aims to provide injury risk insights by analyzing multifactorial injury risk models and as-sociated clinical measures in the U.S. population. Methods Data related to injury, inflammatory markers, physical functioning, body composition, physical activity, and other variables from 21,033 respondents were extracted from NHANES. Odds ratios for self-reported injury were calculated for single predictors and risk models. Case-control and principal component analyses (PCA) were conducted to elucidate confounders and identify risk factor clusters, respectively. Receiver operating characteristic analysis was used to test the precision of a risk factor cluster to identify pain points and functional difficulties. Results Sociodemographic, individual, and lifestyle factors were strongly associated with higher odds of injury. Increases in fibrinogen and C-reactive protein were significantly associated with all risk groups. Membership to the high-risk group (age over 40, obesity, no muscle-strengthening activities, sedentary lifestyle, and low back pain) predicted at least one functional difficulty with 67.4% sensitivity and 87.2% specificity. In the injury group, bone turnover markers were higher, yet confounded by age and there was a significantly higher prevalence of self-reported osteoporosis compared to the control. In males, low testosterone was associated with injury, and higher estradiol was associated with pain and functional difficulties. In females, higher levels of follicle-stimulating hormone were associated with functional difficulties. PCA revealed four high-risk profiles, with markers and activities showing distinct loadings. Conclusion A comprehensive approach to injury risk assessment should consider the nexus of aging, lifestyle, and chronic disease to enhance tailored injury prevention strategies, fostering safe and effective physical activity participation and reducing the burden of musculoskeletal disorders.

Cardiovascular diseases (CVDs) remain the leading cause of mortality. Traditional approaches to diagnosing and treating CVDs often involve interpretation, which can lead to errors. The emergence of Artificial Intelligence (AI) and Machine Learning aids the management of CVDs. AI examines amounts of data and identifies patterns offering solutions for disease detection, risk prediction, and patient care. The American Heart Association's 2023 Scientific Sessions (AHA23) showcased studies that highlight AIs potential to revolutionize cardiac healthcare. This article presents a review of these cutting-edge studies exploring how AI is applied in health, the outcomes of these applications, and their implications for clinical practice. The insights gained from this review will contribute to the discussion on AI's role in healthcare and its capacity to enhance outcomes.

This paper performs a comprehensive analysis of the wind energy potential of onshore regions in Greece with emphasis on quantifying the volume risk and the spatial covariance structure. Optimization techniques are employed to derive efficient wind capacity allocation plans (also known as generation portfolios) incorporating different yield aspirations. The generation profile of minimum variance and other optimal portfolios along the efficient frontier are subject to rigorous evaluation using a fusion of descriptive and statistical methods. In particular, principal component analysis is employed to estimate factor models and investigate the spatiotemporal properties of wind power generation, providing valuable insights into the persistence of volume risk. The overarching goal of the study is to employ a set of statistical and mathematical programming tools guiding investors, aggregators and policy makers in their selection of wind energy generating assets. The findings of this research challenge the effectiveness of current policies and industry practices, offering a new perspective on wind energy harvesting with a focus on the management of volume risk.

Chromosomal instability (CIN), defined by variations in the number or structure of chromosomes from cell to cell, is recognized as a distinctive characteristic of cancer, associated with the ability of tumors to adapt to challenging environments. CIN has been recognized as a source of genetic variation that leads to clonal heterogeneity (CH). Recent findings suggest a potential association between CIN and CH with the prognosis of BC patients, particularly in tumors expressing the epidermal growth factor receptor 2 (HER2+). In fact, information on the role of CIN in other BC subtypes, including luminal B BC, is limited. Additionally, it remains unknown whether CIN in luminal B BC tumors, above a specific threshold, could have a detrimental effect on the growth of human tumors, or if low or intermediate CIN levels could be linked to a more favorable BC patient prognosis when contrasted with elevated levels. Clarifying these relationships could have a substantial impact on risk stratification and the development of future therapeutic strategies aimed at targeting CIN in BC. This study aimed to assess CIN and CH in tumor tissue samples from ten patients with luminal B BC, and compared them with established clinicopathological parameters. The results of our study show that luminal B BC patients exhibit intermediate CIN and stable aneuploidy, both of which correlated with lymphovascular invasion. These findings suggest that evaluating CIN, CH and aneuploidy could improve risk stratification, the prediction of clinical outcomes and future therapeutic approaches in luminal B BC patients.

Smoker’s paradox usually refers to the common observation of a favourable outcome of smoker patients in acute myocardial infarction. The interpretation of this phenomenon is still controversial and not fully explained. We aimed at assessing whether smoking could be associated with mortality in a large cohort of prospectively enrolled patients with ST segment elevation myocardial infarction (STEMI) referred to primary percutaneous coronary intervention (pPCI). From April 2006 to December 2018 a population of 2456 STEMI patients treated with primary PCI were prospectively enrolled in the MATRIX registry. Ischemic time, clinical, demographics, angiographic data and 1-year follow-up were collected. Among 2546 patients admitted with STEMI 1007 (41%) were current smokers. Smokers were 10 years younger and had lower crude in-hospital and 1-year mortality (1.5% vs 6%, p&lt;0.0001 and 5% vs 11%, p&lt;0.0001), shorter ischemic time (203 [147-299] vs 220 [154-334] minutes, p=0.002) and shorter decision time (60 [30-135] vs 70 [36-170] minutes, p=0.0063). After propensity-matching, age, cardiogenic shock and low TIMI score were associated with in-hospital mortality, while smoking habit was still associated with reduced mortality. Smoking was also associated with reduced death rate at 1-year follow-up (HR 0.54, 95% CI [0.37 - 0.78]; p&lt;0.001). Our data show a protective link between smoking status and mortality in patients with STEMI, the so called “smoker’s paradox”. This could be explained not only by the shorter ischemic time and younger age of the smoking population but also by a specific pathogenetic effect of smoking underlying the onset of STEMI and response to therapies.

Aim: Utilizing the subjective experience of nurse executives who have supervised nurses during a major disaster in a hospital setting, this study aims to describe the subjective experience of nurse executives (NE) who have supervised nurses’ response to major disaster. This paper will focus on strategies to support nursing response to disaster, specifically to strengthen resiliency and the ability to maintain function despite the shock of disaster, including those caused by climate changes. Methods: Semi-structured interviews were conducted with 11 hospital-based nurse executives who supervised nurses during some of the worst natural and human-made disasters in different regions of the United States. A phenomenological approach was used to analyze and describe emerging themes from qualitative data. Results: Three Nurse Executives demonstrated theme saturation for mitigation steps to augment traditional disaster readiness activities: 1.) Assessment of Human Infrastructure: Daily Skills Needed During Disaster Response, 2.) Identification and Study of Failure Points & Metrics, 3.) Strengthening Human Infrastructure: Rectifying Deficiencies), and 4.) Monitoring Metrics & Making Corrections During Conventional Periods. Conclusion: Mitigation steps may improve outcomes in hospital function during conventional times; therefore, may improve resiliency and the ability to maintain functions during major disasters, including climate change.

Background: School meals represent a significant supply of nutrients for children in Brazil, especially those in conditions of social vulnerability. Objectives: This study aimed to assess the levels of arsenic (As), cadmium (Cd), and lead (Pb) in meals served in public elementary schools in four municipalities in the state of Bahia, Brazil, and assess the risk posed to children's health. Methods: Ninety-six samples were collected from 16 schools, freeze-dried, and subjected to microwave-assisted digestion. The As, Cd, and Pb levels were determined by graphite furnace atomic absorption spectrometry. The risk assessment was based on calculating each element's hazard quotient (HQ). Results: None of the samples reached or exceeded the tolerable levels for the elements analyzed. Pb was the metal that obtained the most significant result, reaching maximum levels of 39-157 µg.kg-¹. Conclusions: No element exceeded the PTWI proposed by JECFA; thus, the toxic metal content in school meals poses a negligible risk to children´s health.

Lump sum contracts are specific contracts used in the construction industry to give owners financial certainty and decrease risk while incentivizing contractors to finish projects on schedule and within budget. This article discusses the usage of lump sum contracts in construction projects, covering the types of projects appropriate for lump sum contracts, critical considerations for entering a lump sum contract, and the tender and preliminary expenses involved. The article also covers lump sum contracts' benefits and drawbacks and how owners and contractors allocate risk. Finally, the difficulties of implementing lump sum contracts, such as potential disagreements over scope changes and quality issues, are investigated. In general, lump sum contracts can be a valuable tool for managing construction projects, but their execution necessitates careful planning and collaboration to ensure successful completion.

Cardiovascular comorbidity is a common companion of psoriasis and psoriatic arthritis (PsA). Recently, a significant link has been found between the HLA-Cw6 allele and a better cardiometabolic profile in these patients. We aimed to check this finding in our setting. Cross-sectional observational study (n: 572 psoriasis patients, 30% with PsA). Different study variables were collected in detail, as well as classic cardiometabolic risk factors. The distribution of the HLA-Cw6 allele and the IFIH1/MDA5 gene variants previously linked to disease risk was determined in the study cohort and stratified according to the cardiometabolic comorbidity. Linear and logistic regression models were constructed to analyze these associations. The study cohort included 309 men and 263 women, mean age 46.7 years (SD 14.5), mean disease duration 19.4 years (SD 14.8). We confirmed the known association between HLA-Cw6 and type I psoriasis (familial, severe, early onset). Psoriasis severity (OR: 2.14), female sex (OR: 1.63), and the IFIH1/MDA5 rs1990760 TT genotype (OR: 1.62) were significantly related to PsA, while HLA-Cw6 resulted protective (OR: 0.65). HLA-Cw6 carriers showed lower waist perimeter, lower BMI, and lower risk of both hypertension (OR: 0.52, p<0.001) and diabetes (OR: 0.36, p<0.001), but these findings were no longer apparent upon adjusted regression models. No IFIH1/MDA5 gene variant was associated with any cardiometabolic risk factor. The influence of HLA-Cw6 on the cardiometabolic risk profile of psoriatic patients seems to be explained by other factors (age, sex, duration of the disease or arthritis) and not by this biomarker itself.

Intermediate CAG expansions in the gene ataxin-2 (ATXN2) are a known risk factor for ALS, but little is known about their role in FTD risk. Moreover, their contribution to the risk and phenotype of patients might vary in populations with different genetic background. The aim of this study was to assess the relationship of intermediate CAG expansions in ATXN2 with the risk and phenotype of ALS and FTD in the Spanish population. Repeat-Primed PCR was performed in 620 ALS and 137 FTD patients in three referral centers of Spain to determine the exact number of CAG repeats. In our cohort, ≥27 CAG repeats in ATXN2 was associated with a higher risk of developing ALS (odds ratio [OR] = 2.666 [1.471-4.882]; p = 0.0013), but not FTD (odds ratio [OR] = 1.446 [0.558-3.574]; p = 0.44). Moreover, ALS patients with ≥27 CAG repeats in ATXN2 showed shorter survival rate compared to those with &lt;27 repeats (hazard ratio [HR] 1.74 [1.18, 2.56], p = 0.005), more frequent limb onset (odds ratio [OR] = 2.34 [1.093-4.936]; p = 0.028), as well as family history of ALS (odds ratio [OR] = 2.538 [1.375-4.634]; p = 0.002). Intermediate CAG expansions of ≥27 repeats in ATXN2 are associated with ALS risk, but not with FTD, in the Spanish population. ALS patients carrying an intermediate expansion in ATXN2 show more frequent limb onset, but worse prognosis than those without expansions. In patients carrying C9orf72 expansions, the intermediate ATXN2 expansion might increase the penetrance and modify the phenotype.

The present work provides continuity with studies where currently the industrial market is characterized by a highly variable demand in terms of quantities and flexibility of manufacturing or mass customization, which translates into a more demanding production context in terms of the continuous changes required to the production systems, the effect of which results in an increase in the fatigue subjected to the machines that make up the production systems. On the other hand, current production systems tend to use highly communicative and sensorized cyber-physical systems; these characteristics can be used to integrate them into decision-assisted systems in order to improve the availability of the industrial plant. The assisted system developed focuses on collecting and taking advantage of historical knowledge of industrial plant failures and breakdowns. By ideally integrating the Reliability Centered Maintenance (RCM) methodology and Case-Based Reasoning (CBR) algorithms implemented in a Java application, it is possible to design maintenance plans adjusted to a real and changing operational context of any industrial plant. As a result, faster and more accurate decisions are made, as they are based on data. This article focuses on improving certain aspects of the developed assisted system by adding more value to it by incorporating Fuzzy Logic (FL) techniques. The aim is to improve the way of entering information about risk factors and their relative importance, by incorporating natural language, instead of a numerical score, resulting in increased precision in the calculation of the Risk Priority Number (RPN) of the new cases incorporated into the assisted system.

Having as objective to reach a circular economy, it is important to maximize the Physical Asset’s Life Cycle. The evaluation of Physical Assets Life Cycle may have several approaches which may provide different results. These differences may not be very significant, but must be taken into consideration, because they have consequences in the manager decision. This permits to have a wider time interval to decide when to withdrawal the Physical Asset or to renewal it, and or if this ought to continue functioning because the profits are higher than the expenses, what allows to diminish waste and increase sustainability. These are some aspects that are discussed in this paper, which presents several models to evaluate the Physical Assets Life Cycle, considering the market value, devaluations methods and a more generalized way of Fisher’s Equation, which can include the Risk tax, among others. The results are discussed supported in data for simulation, which are used for each Econometric Model aiming to evaluate the differences among them. In all Models they are considered not only the expenses, namely of Investment and Functioning, but also the Profits, which permit to evaluate the Physical Asset Life Cycle in a holistic way. The models are very versatile, allowing to evaluate quantitatively the changing in the maintenance policies, the energy prices variations, the risk evaluation, the variation of profits according to the real market, and so on. The results demonstrated the robustness of the approach described and that maximize the Physical Assets Life Cycle allowing to minimize the consumption of world resources and, by consequence, it contributes for a more sustainable world.

To quantitatively estimate the risk of power system operation under extreme rainfall, a multi-scenario stochastic risk assessment method is proposed. First, a scenario generation scheme considering waterlogged faults of power facilities is constructed based on the storm water management model (SWMM) and the extreme learning machine method. These scenarios will be merged to several typical scenario sets for further processing. The outage of power facilities will induce power flow transfer which may consequently lead to transmission lines’ thermal limit violation. Semi-invariant and Gram-Charlier level expansion methods are adopted to analytically depict the probability density function and cumulative probability function of each line’s power flow. The optimal solution is performed by a particle swarm algorithm to obtain proper load curtailment at each bus, and consequently the violation probability of line thermal violations can be controlled within an allowable range. The volume of load curtailment as well as their importance are considered to quantitatively access the risk of power supply security under extreme precipitation scenarios. The effectiveness of the proposed method is verified in case studies based on the IEEE 24-bus system.

Historically, Physalis physalis massive stranding events have been infrequent and poorly documented. However, their occurrence can have significant impacts on human health and the stability of coastal ecosystems. In this study we analyze the largest P. physalis stranding event historically recorded affected Cuba’s northwestern coast in December 2022. We counted all colonies during the massive event along ~ 3 km coast, within a 5 m stripe. Density, dimorphic form (left/right-handed), and colony size were quantified using 0.25 m2 quadrat placed every 50 m, 10 m from shoreline. Eighty-five people were stung, with 38 having strong allergic reactions, resulting in a health risk. Over ten thousand colonies were recorded, with the highest mean colony density (29.3 per m2) ever reported. The massive stranding coincided with the lowest Arctic Oscillation index (-2.59) in the past 11 years during December, likely linked to climate change. This led to the emergence of northeasterly winds reaching speeds of up to 24 km/h. Wind direction and speed, coupled with the dominance of left-handed colonies (71.4%), suggest the Sargasso Sea as the possible source of the bloom. The high prevalence of juvenile P. physalis colonies (68 %) likely aligns with the autumn breeding season in the northern hemisphere. The potential causes of P. physalis blooms are still poorly understood. Systematic monitoring of the distribution and abundance of this species should be a research priority considering the potential risk to human health and that the blooms could become more frequent and affect other areas in the Atlantic, given climate change and increasing eutrophication of the oceans.

The current study explores the problem of illiquidity in the corporate bond market and examines a broad set of liquidity proxies through empirical investigation. Purpose: The purpose of this paper is to give solution to the global issue of illiquidity in the corporate bond market. The problem is identified by many researchers and this paper attempts to find out the viable solution of the "fungibility route" as an alternative to the "liquidity route". Design/ Methodology: An Analysis of a sample size of 2,34,772 trade data of corporate bonds and a sample size of 2,00,607 trade data of G-securities is done to identify the problem. Findings / Solution proposed: A mathematical model based on credit risk differential and sensitivity differential is proposed to find out the fair value at which an illiquid bond can be swapped by a liquid bond. To arrive at the fair value of the illiquid bond, we have calculated risk adjusted discount rate using modified duration and credit risk differential. With our solution, it is possible to enhance the liquidity of the bond not directly but through fungibility route. Originality: the research is first of its kind in which solution is given to the global problem of corporate bond illiquidity. To execute the trade in the fungibility route, proposed parties involved are the Fungibility platform, the initiator, and the bidder. The derived fair value would facilitate trade and serve as an exit strategy for illiquid bond holders worldwide.

Decomposed fuzzy sets are the resent extension of intuitionistic fuzzy sets by incorporating functional and dysfunctional points of views to the definition of membership functions. This paper extends the Technique of Order Preference Similarity to the Ideal Solution (TOPSIS) method to the Decomposed Fuzzy TOPSIS (DF TOPSIS) method and applies it to a multi-criteria risk-based supplier selection problem under fuzziness. DF TOPSIS involves finding a positive ideal solution and a negative ideal solution and measuring the distance of each alternative to these solutions. The final ranking is obtained based on the proportion of distances to the positive and negative ideal solutions. The developed DF TOPSIS method incorporates the accuracy and consistency of expert judgments, enhancing the decision-making process. A sensitivity analysis is also presented in order to show the robustness of the obtained rankings by DF TOPSIS.

Since 2017 Cartagena UNESCO World Heritage has threatened to be categorized as "in Danger" by UNESCO. This research analyzes two main critical aspects, Governance and Current state of the Site. Regarding Governance, the study aims to identify strengths, weaknesses, opportunities and treats in the UNESCO Site. Exemplary heritage management systems are studied to propose an adaptable management approach specifically for Cartagena. On the other hand, a comprehensive analysis is conducted utilizing a photographic report that highlights the major issues arising from inadequate heritage management. Hyperspectral images obtained from a previous study are employed to identify vegetation and asbestos-cement roofs within the cultural heritage Site. The study reveals that the ambiguity surrounding decision-making authority for heritage management, distributed between the Mayor's Office and the Ministry of Culture, is a primary challenge. This fragmentation has resulted in duplicated efforts and a lack of coordinated action, significantly compromising the conservation and protection of the cultural heritage Site. Moreover, twelve current shortcomings of cultural heritage in Cartagena are identified through authors' five-year on-site regular visits, photographic reports and observation. To address the prevailing concerns, a new line of command for cultural heritage management is proposed as the most effective means of tackling these challenges. Additionally, general recommendations are presented to mitigate the existing problems and prevent the classification of Cartagena's heritage as "at risk" by UNESCO in the near future. This research provides a scientific perspective, drawing upon years of experience studying heritage and residing in the city, devoid of political influences or conflicts of interest.

China's gradually increasing assertiveness at the international level marked the beginning of several influential geopolitical projects. The biggest of these is the Belt and Road Initiative, which will be the subject of this post. The Chinese government initiated the BRI in 2013 to revive the historic Silk Road. The name of the new initiative was chosen based on well-known historical parallels, emphasizing the ideological component of China's current position. At the same time, neo-mercantilism prevails in China, and we can say that all roads lead to China, which means that the current nature of Chinese strategic planning corresponds to the increasingly important role of the state in international relations and strengthens its position in the world economy. The aim of the paper is to use the methods of analysis, synthesis, deduction, induction, comparison, and explanation to analyse Chinese investments that flow into various sectors worldwide, but especially into the countries participating in the Belt and Road Initiative from 2013 to the present. The largest such sector is the energy sector, which we will look at in more detail in the post. Finally, the contribution will be focused on predicting the development of further investments based on the available information as well as our own suggestions and recommendations to make them more efficient.

Identifying productive, profitable and less risky cropping systems is important for sustaining farm-based livelihoods in the context of climatic uncertainties and market volatility in many developing nations. Reductionist field crop research identifies the best-bet solutions based on treatment replicates at a single point in time, which may not account for price instability under climatic uncertainties and volatile markets. Keeping this in mind, we estimated productivity, profitability and weather-related risk from eleven different rice-based cropping systems (eight existing and three potential systems) in the coastal region of West Bengal, India. Information on the crop management practices, yield and prices of the component crops of these eleven cropping systems, under ’best,’ ’normal’ and ‘worst’ situations (scenario), were collected through a ques-tionnaire survey on50 farms of Gosaba Block, West Bengal, India. Irrespective of the scenarios, the rice-lathyrus systems, followed by rice-onion and rice-lentil systems recorded the lowest rice-equivalent yields and system yields. However, the highest rice-equivalent yields and system yields were recorded for rice-chilli systems, followed by rice-tomato and rice-potato-green gram systems. Per hectare total paid-out cost (TPC) of rice-tomato systems was higher, followed by rice-chilli, rice-potato-green gram and rice-potato systems. However, irrespective of seasonal conditions (best, normal and worst), rice-chilli systems gave a higher net return followed by rice-tomato and rice-potato-green gram systems. The rice-fallow system recorded the lowest value for both parameters. Under the worst seasonal conditions, the rice-onion system gave a negative net return. Under all the scenarios, the highest B:C ratio was observed for rice-chilli, rice-tomato, rice-potato-green gram and rice-potato systems. The cumulative probability distribution of the rice-tomato system showed first-degree stochastic dominance over other systems and the rice-chilli system showed second-degree stochastic dominance over the rest of the systems. Only the rice-onion system had a small chance (< 1%) of a negative net return, while the rest of the cropping systems were highly likely to get a positive net return. Taking productivity, economics, and risk assessment of different rice-based systems into account, rice-vegetable systems, especially rice-tomato and rice-chilli among the existing systems and rice-potato-green gram system among the potential systems, can be recommended for sustainable intensification in these coastal saline tracts of the region. We also discuss additional socio-economic factors explored by in-depth in-terviews with the farmers, which might influence the adoption and upscaling of these cropping systems in the region.

INTRODUCTION There have been several advances in the treatment of hepatitis C virus (HCV) infection which have resulted in major reductions in the morbidity and mortality from liver-associated disease. These are not widely available in the Caribbean, due in part, to lack of knowledge of the epidemiology of infections with HCV. As efforts are made to eliminate HCV from the region, these and other existing barriers such as lack of an established database on HCV must be addressed. This review seeks to identify gaps in the knowledge of HCV in the Caribbean with respect to seroprevalence, genotype distribution and general epidemiologic characteristics. MATERIALS AND METHODS The literature for the period January 1, 2005, to October 2022, was reviewed to gather country specific data on HCV across the Caribbean. References were identified through indexed journals accessed through established databases. The usage pattern of HCV drugs was determined from data obtained from Pharmacists and Infectious Diseases Specialists across the region. RESULTS The prevalence of HCV in the Caribbean was 1.5%; the region should therefore be considered an area of moderate prevalence. Notably, data from specific countries were limited. The prevalence of HCV among intravenous drug users (21.9-58.8%); persons living with HIV/AIDS (0.8 to 58.5%); prisoners (32.8-64%) and men who have sex with men (MSM) (0.8-6.9%) was generally higher than in the general population (0.8-2.3%). Genotype 1 (83% was most prevalent followed by genotypes 2 (7.2%) and 3(2.1%), respectively. Drugs currently being used for treatment of HCV infections across the Caribbean include Epclusa (Sofosbuvir/velpatasvir), and Harvoni (Ledipasvir/sofosbuvir). Some of these drugs, are only available in the private sector and are sourced externally whenever needed. CONCLUSION There is a paucity of current data on the seroprevalence of HCV in the Caribbean and well-designed prospective studies are indicated to drive the implementation of treatment and control programs for HCV in the region. Barriers which need to be first overcome include unavailability and high cost of drugs used to treat HCV infections, injecting drug use and limited access to medical care and laboratory testing.

In this paper, we introduce the application of Type-I fuzzy inference systems (FIS) as an alternative to improve the prioritization in the FMECA analysis applied in cyber-power grids. Classical FMECA assesses the risk level through the Risk Priority Number (RPN). The multiplication between three integer numbers computes this, called risk factors, representing the severity, occurrence, and detectability of each failure mode and are defined by a team of experts. The RPN does not consider any relative importance between the risk factors and may not necessarily represent the real risk perception of the FMECA team members, usually expressed by natural language; this is the main FMECA shortcoming criticized in the literature. Our approach considers fuzzy variables defined by FMECA experts to represent the uncertainty associated with the human language and a rule base consisting of 125 fuzzy rules to represent the risk perception of the experts. To test our approach, we select a cyber-power grid previously analyzed by the authors using the classical FMECA. The results reveal our proposed fuzzy approach as promissory to represent the uncertainty associated with expert knowledge and to perform an accurate prioritization of failure modes in the context of electrical power systems.

The ability to identify and rank risk is essential for efficient and effective supervision of financial service firms, such as banks and insurers. Risk ranking ensures limited resources are allocated where they are most needed. Today, automatic risk identification within insurance supervision primarily relies on quantitative metrics based on numerical data (e.g. returns). The purpose of this work is to assess whether Natural Language Processing (NLP) and cognitive networks can achieve similar automated risk ranking and identification by analysing textual data, i.e. NIDT=829 investor transcripts from Bloomberg. To this aim, this work explores and tunes 3 NLP techniques: (1) keyword extraction enhanced by cognitive network analysis; (2) valence/sentiment analysis; and (3) topic modelling. Results highlight that keyword analysis, enriched by term frequency-inverse document frequency scores and semantic framing through cognitive networks, could detect events of relevance for the insurance system like cyber-attacks or the COVID-19 pandemic. Cognitive networks were found to highlight events that related to specific financial transitions: The semantic frame of "climate" grew in size by +538% between 2018 and 2020 and outlined an increased awareness that agents and insurers expressed towards climate change. A lexicon-based sentiment analysis achieved a Pearson’s correlation of ρ=0.16 (p&lt;0.001,N=829) between sentiment levels and daily share prices. Although relatively weak, this finding indicates that insurance jargon is insightful to support risk supervision. Topic modelling is considered less amenable to support supervision, because of a lack of results’ stability and an intrinsic difficulty to interpret risk patterns. We discuss how these automatic methods could complement existing supervisory tools in automated risk ranking.

Abstract: The aim of the present study was to identify the age and sex-related associations between marital status with PA and TV time. We used data from Vigitel, an annual telephone survey started in 2006 in Brazil. We applied a complex sample logistic regression model to estimate the odds for PA and TV time comparing marital statuses according to age and sex subgroups, independent of obesity, hypertension, diabetes, self-assessed poor health, and smoking. Our sample included 561,837 individuals with a TV time &gt; 3 h/day (prevalence = 25.2%) and PA &gt; 150 min/week (prevalence = 35%). Compared to single individuals, married men and women were less likely to watch TV more than 3 h/day in participants &gt; 30 years old. When compared to single, married participants were less likely to do more than 150 min of PA/week at younger age groups. Married women older than 40 years were more likely to do more than 150 min of PA/week than the single ones, while there were no differences among married men by age group. In conclusion, married individuals are less likely to spend more than 3 hours a day watching TV than single individuals. Single men and women were more likely to do more than 150 min of PA/week at younger age groups and married women older than 40 years were more likely to do 150 min of PA/week than single women.

Since the exploitation of mineral resources results in the release of radionuclides, and consuming radionuclides affects public health in the short and long term. A case study of the environmental radiation impact from coal mining and germanium processing was carried out in southwest China. The coal mines contain germanium and uranium and have been exploited for more than 40 years. The farmlands around the site of coal mining and germanium processing have been contaminated by the solid waste and mine water in some extend since then. Samples of crops have been collected from contaminated farmlands in research area. The research area covers a radius of 5 km, in which there are 2 coal mines located. 210Pb and 210Po have been analyzed as the key radionuclides during monitoring program. The average activity concentrations of 210Pb and 210Po in the crops were 1.38 and 1.32 Bq/kg in cereals, 4.07 and 2.19 Bq/kg in leafy vegetables and 1.63 and 1.32 Bq/kg in root vegetables. The annual effective doses due to the ingestion of 210Pb and 210Po in consumed crops have been estimated for adult residents living in research area. The average annual effective dose was 0.336mSv/a, while the minimum was 0.171 mSv/a and the maximum was 0.948 mSv/a. The results show that crops grown on contaminated farmland contained an enhanced level of radioactivity concentration. Ingestion doses of local residents in research area were significantly higher than the China average level of 0.112 mSv/a, and the world average level of 0.042 mSv/a through 210Pb and 210Po in crops intake respectively.

(1) Background: Mouse-mammary tumor virus (MMTV) might play a role in the etiology of some breast cancers in humans. The purpose of our study was to identify MMTV DNA sequences in breast tissue samples from breast cancer patients operated in our regional center from Romania. (2) Methods: We have selected 75 patients with non-metastatic breast cancer treated with curative intent and searched with PCR the MMTV-like DNA sequence in the breast cancer tissue and normal breast tissue obtained from the same patients. (3) Results: None of the examined samples was positive for MMTV-like target sequences on PCR. (4) Conclusions: We could not prove that MMTV plays a role in the etiology of breast cancer in our patient group. This finding is similar to findings of other geographically related research groups and might be due to the fact that only the Mus musculus domesticus mouse species was proven to carry infectious MMTV, but not the Mus musculus musculus species, which is specific to South-Eastern Europe and some parts of Asia.

Both academic literature and global organizations have emphasized the need for responsible water consumption, as stated in the Sustainable Development Goal 12. However, individuals’ water-saving behaviors in their current state are not enough. This situation entails a resistance to change (RC) in consumer habits and a lack of perceived risk of scarcity. The novelty of this study lies in examining the influence of RC (through its emotional, cognitive, and confidence components) and perceived risk on water-saving intention. Interviews (n = 384) were conducted in the southeast Mediterranean area of Spain by interviewers using a paper-and-pencil questionnaire. The results of the structural equation modeling show that the perceived risk and the components of cognitive rigidity and negative emotions exert a direct influence on water-saving habits and an indirect influence on water-saving intention. None of the components of RC directly influence intention, and a lack of confidence in the outcomes of water saving does not influence water-saving habits or water-saving intention. In addition to the results obtained, the novelty of the work lies in the idea that in order to influence the perception of the risk of water scarcity through awareness campaigns, it is better to use an emotional message rather than showing facts or information, because this does not drive water saving behavior.

This study aimed to quantify the extent of heavy metal, non-metal and metalloid level of Campomanesia adamantium pulp obtained from area crossed by road of the high large vehicle traffic and intensive agriculture modern farm, and for monitoring the health risks associated with pulp human consumption. For this purpose, three spots located between this area, ripe fruits were collected in roadside, bush and margin-farm. Pulp samples were digested by microwave-assisted equipment, and mineral elements were quantified by ICP OES. The mineral elements average demonstrated no statistical difference observed between this pulp (p > 0.05). The heavy metals and metalloid concentrations that exceeded FAO/WHO standards are ordered Pb > As > Mo > Co > Ni > Mn > Cr. Therefore, among these metalloid and heavy metals, As, Pb and Cr were found higher in farm-margin > roadside > bush (1.5 × 10^-3, 1.1 × 10^-3 and 6.2 × 10^-4) respectively. Therefore, As is the most important metalloid with higher levels in farm-margin, roadside and bush (1.5 × 10^-3, 1.1 × 10^-3 and 6.2 × 10^-4 > 10^-6–10^-4 and 3.33, 2.30 and 1.34 > 1) respectively, to total cancer risk and hazard quotient, if 100 g daily of pulp are consumed.

The novel coronavirus SARS-CoV-2 likely emerged from a wildlife source with transmission to humans followed by rapid geographic spread throughout the globe and severe impacts on both human health and the global economy. Since the onset of the pandemic, there have been many instances of human-to-animal transmission involving companion, farmed and zoo animals, and limited evidence for spread into free-living wildlife. The establishment of reservoirs of infection in wild animals would create significant challenges to infection control in humans and could pose a threat to the welfare and conservation status of wildlife. We discuss the potential for exposure, onward transmission and persistence of SARS-CoV-2 in an initial selection of wild mammals (bats, canids, felids, mustelids, great apes, rodents and cervids). Dynamic risk assessment and targeted surveillance are important tools for the early detection of infection in wildlife, and here we describe a framework for collating and synthesising emerging information to inform targeted surveillance for SARS-CoV-2 in wildlife. Surveillance efforts should be integrated with information from public and veterinary health initiatives to provide insights into the potential role of wild mammals in the epidemiology of SARS-CoV-2.

Background and objectives: Induction of labor (IOL) is an event that occurs in up to one-quarter of pregnancies; less is known about the outcomes and safety of IOL in obese pregnant woman; no data is available on misoprostol vaginal insert (MVI) IOL in high-risk pregnancy obese women. Objectives: (1) to evaluate the rate of successful IOL with 200 μg MVI in obese (Body Mass Index - BMI over 30 kg/m2) high-risk pregnant women: late-term pregnancy, hypertension or diabetes, compared to obese non-high-risk ones; (2) to evaluate the safety profile of MVI in high-risk pregnancy obese patients. Study design: We conducted a cross-sectional study in "Filantropia" Clinical Hospital, Bucharest, Romania, from June 2017 to September 2019 (28 months). From a total of 11,096 registered live births, IOL was performed in 206 obese patients; 74 obese high-risk pregnant patients matched the inclusion criteria; of these, 33.8% pregnancies (n=25) were late-term (41 – 41+6 weeks), 43.2% (n=32) had associated pathologies (hypertension and diabetes); labor induction was guided using a standardized protocol. We evaluated the maternal and gestational age, parity, fetal tachysystole, hyper-stimulation, initial cervical status, time from induction to delivery, drug side effects, mode of delivery, and neonatal outcomes. Results: (a) The overall successful labor induction rate, evaluated by the vaginal delivery rate, was 71.6% (n=53), spontaneously or instrumentally assisted; 28.4% (n=21) births were unsuccessful MVI IOL, converted into caesareans. (b) No significant differences were found regarding the maternal outcomes; in terms of perinatal outcomes of safety, four cases of high-risk pregnancies vaginally delivered were associated with neonatal intensive care unit (NICU) admissions and a one-minute Apgar score under seven (5.4%). Most cases with adverse effects of misoprostol have been managed conservatively, except for three emergency C-section cases. Conclusions: Misoprostol vaginal insert is a safe choice in IOL in obese high-risk pregnancies with good maternal and perinatal outcomes.

Background: Dental professions are at high risk of contracting novel corona virus (COVID-19) infections during the dental procedure due to the droplets and aerosols generated during various dental procedures on infected patients. To prevent and avoid the cross-infection of the infection to dental professionals or the patients attending the dental clinic, good knowledge of the infection and its prevention mechanisms is mandatory among the professionals. Until to date, there is no pooled estimate on the knowledge,attitude and practice (KAP) of dental professionals to COVID-19 in the globe. Hence, this study aimed to determine the pooled estimate of KAP of dental professionals in this pandemic disease. Methods: Article search was done electronically using Medline, Scopus, Web of Science, EMBASE, SciELO and Google Scholar from June 1, 2020 to August 20, 2020. All studies that assessed the KAP of dental professionals to COVID-19 were searched and included in this review after passing the inclusion criteria. The pooled analysis of their knowledge (sign and symptom, mode of transmission and prevention mechanisms), attitude (their concern, intention to treat suspected patients) and practice (face mask usage, hand washing and alcohol based hand rub usage, handshaking practice, deferred procedures and checkup of patients temperature) was computed using RevMan 5.3 and random effect model was used. The presence of publication bias was assessed using the funnel plot. Results: Twelve articles with a total of 5,362 study participants were included in this study. The pooled estimate revealed that 59.91% of the dental professionals had good knowledge of the signs and symptoms of COVID-19. Two-third of dental professionals know the prevention mechanisms of the infection, and 70.13% had enough knowledge of the transmission modalities of the infection. The professional attitude revealed that only 36.43% of the participants had intention to treat a patient with cough or suspected COVID-19 (36.43%, 95%CI: 8.57, 64.29). Moreover, 47.85% of the dentists were concerned about their life, and the fate of their profession due to this pandemic disease (47.85%, 95%CI: 26.74, 68.97). The pooled analysis showed only 50.86% (95%CI: 18.64, 83.09) of the study participants worn face mask and 52.63% (95%CI: 10.54, 94.71) had avoided handshaking practice during this pandemic period. Non-emergency dental procedures were canceled by 83.98%. Conclusion: The dental professional KAP is not optimal. Thus, dental professionals should be aware of the recently updated knowledge about COVID-19 and practice according to the standards of treatment guidelines, and the recommended infection control measures in dental settings. Moreover, as saliva and droplets are the major sources of infection, dentists should follow essential protocols to regulate droplet and aerosol contamination in the dental practice

Among others, road traffic, industrial emissions, commercial activities, smoking and cooking are considered as major contributing factors for the increasing levels of pollutants in atmosphere. High levels of potentially toxic metals and microbes in atmosphere, especially in indoor air, may pose serious threat to human health. Therefore, concentration and associated health risks of potentially toxic trace metals (Cd, Cr, Cu, Fe, Mn, Pb, and Zn) and their risk to human health, and microbial load in indoor air was assessed using air condition (AC) filter dust samples collected from 5 locations representing residential, agricultural and industrial settings of Eastern Province, Kingdom of Saudi Arabia. The levels of trace metals varied considerably among sampling areas, with the highest levels of Cr and Cd recorded in the Industrial-area sites followed by the Agricultural and Urban-Residential sites. The highest levels of Pb and Fe were found in the Agricultural area sites followed by the Industrial and Urban-Residential area sites. The metals in dust sample, especially Cd, Cr and Pb, showed a considerable health risk through dermal pathway. Among the sites, the highest hazard quotient for these metals was found for Al-Qatif-Industrial areas sites and among the metals it was the highest for Cd. The cancer risk from the metals contained in AC filter dust was negligible. Samples collected from Agricultural and Industrial area sites were substantially contaminated with bacteria and fungi, respectively. Bacterial contaminants were mostly Gram Negative, with considerable antibiotic resistance and haemolytic activity. Thus, indoor air quality as assessed by AC filter dust depicted that a considerable health risk could be posed by the trace heavy metals and microorganisms for a long-term exposure. Furthermore, this study demonstrated that AC filters dust could be a unique and reliable test sample for the assessment of indoor environment.

World statistics demonstrate that around 970 million people around the globe suffer from mental health problems (Ritchie & Roser, 2019), a major proportion of which comprised of adolescents and young adults (UNODC, 2018). Also, because of increased mental health issues the problems like substance use, suicide, depression, anxiety, and stress are also increasing (Armstrong, 2019; Bandelow & Michaelis, 2015; Ritchie & Roser, 2018; United Nations Office on Drugs and Crime [UNODC], 2019). It is thus a dire need to address the issue. The present coneptual paper proposed the role of transpersonal gratitude, emotional intelligence, and life contentment for reducing mental health risk among the adolescents and young adults.

Total Hip Arthroplasty is one of the most successful surgery. However, due to the worldwide growing population life expectancy and the related incidence of age-dependent bone diseases, a growing number of cases of intra-operative fractures lead to revision surgery with high rates of morbidity and mortality. Surgeons choose the type of the implant, either cemented or cementless prosthesis, on the basis of the age, the quality of the bone and the general medical conditions of the patients. Generally, no quantitative measures are available to assess the intra-operative fracture risk. Consequently, the decision-making process is mainly based on medical operators’ expertise and qualitative information obtained by imaging. Motivated by this scenario, we here propose a mechanical-supported strategy to assist surgeons in their decisions, by giving intelligible maps of the risk fracture which take into account the interplay between actual strength distribution inside the bone tissue and its response to the forces exerted by the implant. To this end, we produce charts and patient-specific synthetic “traffic-light” indicators of fracture risk, by making use of ad hoc analytical solutions to predict the stress levels in the bone by means of CT-based mechanical and geometrical parameters of the patient. We felt that, if implemented in a friendly software or proposed as an app, the strategy could constitute a practical tool to help the medical decision-making process, in particular with respect to the choice of adopting cemented or cementless implant

The recent detection of SARS-CoV-2 RNA in feces has led to speculation that it can be transmitted via the fecal-oral/ocular route. This review aims to critically evaluate the incidence of gastrointestinal (GI) symptoms, the quantity and infectivity of SARS-CoV-2 in feces and urine, and whether these pose an infection risk in sanitary settings, sewage networks, wastewater treatment plants, and the wider environment (e.g. rivers, lakes and marine waters). Overall, severe GI dysfunction is only evident in a small number of COVID-19 cases, with 11 ± 2% exhibiting diarrhea and 12 ± 3% exhibiting vomiting and nausea. In addition to these cases, SARS-CoV-2 RNA can be detected in feces from some asymptomatic, mildly- and pre-symptomatic individuals. Fecal shedding of the virus peaks in the symptomatic period and can persist for several weeks, but with declining abundances in the post-symptomatic phase. SARS-CoV-2 RNA is occasionally detected in urine, but reports in fecal samples are more frequent. The abundance of the virus genetic material in both urine (ca. 10²-10⁵ gc/ml) and feces (ca. 10²-10⁷ gc/ml) is much lower than in nasopharyngeal fluids (ca. 10⁵-10¹¹ gc/ml). There is strong evidence of multiplication of SARS-CoV-2 in the GI tract and infectious virus has occasionally been recovered from both urine and stool samples. The level and infectious capability of SARS-CoV-2 in vomit remain unknown. In comparison to enteric viruses transmitted via the fecal-oral route (e.g. norovirus, adenovirus), the likelihood of SARS-CoV-2 being transmitted via feces or urine appears lower due to the lower relative amounts of virus present in feces/urine. The biggest risk of transmission will occur in clinical and care home settings where secondary handling of people and urine/fecal matter occurs. In addition, while SARS-CoV-2 RNA genetic material can be detected by in wastewater, this signal is greatly reduced by conventional treatment. Our analysis also suggests the likelihood of infection due to contact with sewage-contaminated water (e.g. swimming, surfing, angling) or food (e.g. salads, shellfish) is extremely low or negligible based on very low predicted abundances and limited environmental survival of SARS-CoV-2. These conclusions are corroborated by the fact that over eight million global cases of COVID-19 have occurred, but exposure to feces or wastewater has never been implicated as a transmission vector.

Since the beginning of the year 2020, the global healthcare system has been challenged by the threat of the SARS-COV 2 virus. Molecular, antigen, and antibody testing are the mainstay to identify infected patients and fight the virus. Molecular and antigen tests that detect the presence of the virus are relevant in the acute phase only. Serological assays detect antibodies to the Sars-CoV-2 virus in the recovering and recovered phase. Each testing methodology has its advantages and disadvantages. To evaluate the test methods, sensitivity (percent positive agreement - PPA) and specificity (percent negative agreement – PNA) are the most common metrics utilized, followed by the positive and negative predictive value (PPV and NPV), the probability that a positive or negative test result represents a true positive or negative patient. In this paper, we illustrate how patient risk and clinical costs are driven by false-positive and false-negative results. We demonstrate the value of reporting PFP (probability of false positive results), PFN (probability of false negative results), and costs to patients and healthcare. These risk metrics can be calculated from the risk drivers of PPA and PNA combined with estimates of prevalence, cost, and Reff number (people infected by one positive SARS COV-2).

Cardiovascular diseases (CVDs) constitute the first cause of death among the population of developing and developed countries. Atherosclerosis, which is a disorder with multifactorial etiopathogenesis, underlies most CVDs. The available literature includes ample research studies on the influence of classic cardiovascular (CV) risk factors. However, environmental exposure to heavy metals, among other substances, is still an unappreciated risk factor of CVDs. This study aimed to assess the concentration of some heavy metals (copper (Cu), zinc (Zn), manganese (Mn), cobalt (Co), and iron (Fe)) in the blood serum of postmyocardial infarction (post-MI) patients and patients free from myocardial infarction (MI) as well as estimate the relationship between the occurrence of MI and increased concentration of heavy metals. The concentration of heavy metals (Cu, Zn, Mn, Co, and Fe) was assessed using the inductively coupled plasma mass spectrometry technique in a group of 146 respondents divided into two groups: post-MI group (study group (SG), n = 74) and group without cardiovascular event (CVE) having a low CV risk (control group (CG), n = 72). The concentration of the analyzed heavy metals was higher in SG. All the heavy metals showed a significant diagnostic value (p < 0.001). The highest value of area under the curve (AUC) was observed for manganese (Mn) (0.955; 95% confidence interval (CI) = 0.922–0.988), while the lowest value was found for zinc (Zn) (0.691; 95% CI = 0.599–0.782). In one-dimensional models, high concentrations of each of the analyzed heavy metals significantly increased the chances of having MI from 7-fold (Cu) to 128-fold (Mn). All the models containing a particular metal showed a significant and high discrimination value for MI occurrence (AUC 0.72–0.92). Higher concentrations of Cu, Zn, Mn, Co, and Fe were found to considerably increase the chances of having MI. Considering the increasingly higher environmental exposure to heavy metals in recent times, their concentrations can be distinguished as a potential risk factor of CVDs.

Objectives: COVID-19, a respiratory disease caused by SARS-COV2 and transmitted from person-to-person through viral droplets remains a global pandemic. There is a need to understand the transmission modes, populations at risk, and how to mitigate the spread and case fatality in the United States (US) and globally. The current study aimed to assess the global COVID-19 transmission and case fatality, examine similar parameters by countries and determine evidence-based practice in extreme epidemiology response in epidemic curve flattening and case fatality reduction. Methods: A cross-sectional ecologic design was used to assess the preexisting data on confirmed COVID-19 cases and mortality in March 2020 from the CDC, WHO, Worldodomter, and STATISTA. A rapid assessment between March 23^rd and 31^st, 2020, was utilized for the extreme epidemiology response. The case fatality, termed fatality proportion, was examined using mortality in relation to confirmed cases involving the world, United States of America (USA), United Kingdom (UK), Italy, France, Spain, China, Germany, India and South Korea. Results: The COVID-19 is a global pandemic, with the US as the epicenter for transmission, representing 20.9% of all confirmed cases worldwide, while Italy is the epicenter for case fatality, 30.6% of mortality as at 03/31/ 2020. The fatality proportion (FP) in Italy was 11.4%, Spain (8.8%), France (6.8%) and UK (6.4%). Despite the increased number of confirmed cases, the lowest FP was observed in Germany (0.96%) and South Korea (1.66%). There is increasing linear tends in transmission in the US, R²=0.97 as well as positive daily percentage change, ranging from 1.27% to 20.5%. Conclusions: The USA remains the epicenter for COVID-19 transmission, while Italy is the epicenter for case fatality. The observed relatively low case fatality in Germany and South Korea is due to an “extreme epidemiology” response through the application of Wuhan, China’s early data on COVID-19 transmission control measures and optimized patient care. These data are suggestive of relaxing the clinical guidelines in the United States in COVID-19 testing, application of contact tracing and testing, case isolation and most importantly enhancing resources for case management and social and physical distancing globally, hence epidemic curve flattening and case fatality reduction.

Land use and land cover change (LULCC) is a critical factor for enhancing the soil erosion risk and land degradation process in the Wabi Shebelle Basin. Up-to-date spatial and statistical data on basin-wide erosion rates can provide an important basis for planning and conservation of soil and water ecosystems. The objectives of this study were to examine the magnitude of LULCC and consequent changes in the spatial extent of soil erosion risk, and identify priority areas for Soil and Water Conservation (SWC) in the Erer Sub-Basin, Wabi Shebelle Basin, Ethiopia. The soil loss rates were estimated using an empirical prediction model of the Revised Universal Soil Loss Equation (RUSLE) outlined in the ArcGIS environment. The estimated total annual actual soil loss at the sub-basin level was 1.01 million tons in 2000 and 1.52 million tons in 2018 with a mean erosion rate of 75.85 t ha^–1 y^–1 and 107.07 t ha^–1 y^–1, respectively. The most extensive soil loss rates were estimated in croplands and bare land cover, with a mean soil loss rate of 37.60 t ha^–1 y^–1 and 15.78 t ha⁻¹ y⁻¹, respectively. The soil erosion risk has increased by 18.28% of the total area, and decreased by 15.93%, showing that the overall soil erosion situation is worsening in the study area. We determined SWC priority areas using the Multi-Criteria Decision Rule (MCDR) approach, indicates that the top three levels identified for intense SWC account for about 2.50%, 2.38%, and 2.14%, respectively. These priority levels are typically situated along the steep slopes in Babile, Fedis, Fik, Gursum, Gola Oda, Haramaya, Jarso, and Kombolcha districts that need emergency SWC measures.

In 2014, the International Union for Conservation of Nature adopted the Red List of Ecosystems (IUCN RLE) criteria as the global standard for assessing risks to terrestrial, marine, and freshwater ecosystems. Identifying and quantifying the impacts of biodiversity assessments on the status of nature is key to justifying continued investment in assessments and enabling strategic planning to maximize future impact. In this policy perspective, we use an established impact evaluation framework to identify the impacts of the IUCN RLE since its inception. To date, 1,397 ecosystem units in 100 countries have been assessed following the IUCN RLE protocol. Systematic assessments are complete or underway in more than 25 countries and two continental regions (the Americas and Europe). Countries with established ecosystem red lists have already used them to inform legislation, land-use planning, protected area expansion, monitoring and reporting, and ecosystem management. IUCN RLE indices based on systematic assessments have high potential to inform global biodiversity reporting for the Aichi Targets and the United Nations Sustainable Development Goals. Expanding the coverage of IUCN RLE assessments, building capacity to undertake them, and establishing stronger policy instruments to manage red-listed ecosystems will be key to maximizing conservation impacts over the coming decades.

Purpose: Expanded carrier screening (ECS) informs couples of their risk of having offspring affected by certain genetic conditions. Limited data exists assessing the actions and reproductive outcomes of at-risk couples (ARCs). We describe the impact of ECS on planned and actual pregnancy management in the largest sample of ARCs studied to date. Methods: Couples who elected ECS and were found to be at high risk of having a pregnancy affected by at least one of 176 genetic conditions were invited to complete a survey about their actions and pregnancy management. Results: Three hundred ninety-one ARCs completed the survey. Among those screened before becoming pregnant, 77% planned or pursued actions to avoid having affected offspring. Among those screened during pregnancy, 37% elected prenatal diagnostic testing (PNDx) for that pregnancy. In subsequent pregnancies that occurred in both the preconception and prenatal screening groups, PNDx was pursued in 29%. The decision to decline PNDx was most frequently based on the fear of procedure-related miscarriage, as well as the belief that termination would not be pursued in the event of a positive diagnosis. Conclusions: ECS results impacted couples’ reproductive decision-making and led to altered pregnancy management that effectively eliminates the risk of having affected offspring.

Throughout the world, disabilities people have worse health prospects, lower education levels, lower economic participation, and higher poverty rate in comparative terms to people without disabilities. For disabilities people achieve better, more long-lasting prospects, we must empower these people and remove barriers that restrict them from participating in the community have access to quality education, to find decent work and have their voices heard. In statistical terms, a very useful alternative that can provide support and monitoring of public policies in this area is proposing to be used continuously. A risk index called risk index disabled person who is to assess which factors are associated to this risk, as well as the intensity and direction of each of these factors, yielding a final score that can be sorted or classified according to the probability of people acquire a certain disability. In the Brazilian case, we propose the use of techniques such as binary and ordinal logistic regression to select the most significant factors using criteria such as AIC, BIC and DIC. Calculate the risk probability for different disabilities (see, hear, move and intellectual) and number of disabilities to the dataset Sample of respondents for Full Questionnaire at IBGE 2010 Census. In this work, by using stereotype ordinal logistic model with ordinal response, it was possible to improve the fit quality, to be compared with binary response logistic model. By using ordinal response merged the disability risk for different severity degree and amount of deficiencies. Mains conclusions were: i)the model required a smaller number of explanatory variables was intellectual or mental and greater number was disabilities; ii) the most sensitive adjust was using stereotype ordinal logistic; iii) different disabilities aren´t homogenous as the different predictor variables, and finally; iv) higher incidence of risks were noted visual disability, living in the northeast, female, age 80, yellow race, instruction level until incomplete fundamental, works production form their own consumption and high number of children.

Persistent cervical infection with high-risk Human papillomaviruses (hrHPVs) is a necessary, but not sufficient, condition for the development of cervical cancer. Therefore, there are other co-factors facilitating the hrHPV carcinogenic process, one of which is smoking. In order to assess the effect of smoking on high-risk (hr) HPV DNA positivity and on the expression of HPV E7 oncoprotein, as a surrogate of persistent hrHPV infection, we used data from women recruited for the PIPAVIR project, which examined the role of E7 protein detection in cervical cancer screening. Women were tested for hrHPV DNA, using Multiplex Genotyping and E7 protein, using a novel sandwich ELISA method, and gave information on their smoking habits. Among 1473 women, hrHPV prevalence was 19.1%. The odds ratio (OR) for hrHPV positivity of smokers compared to non-smokers was 1.785 (95%CI: 1.365-2.332, p<0.001). The ORs for E7 positivity, concerning hrHPV positive women, ranged from 0.720 to 1.360 depending on the E7 detection assay used, but this was not statistically significant. Smoking increases the probability of hrHPV infection, and smoking intensity is positively associated to this increase. Smoking is not related to an increased probability of E7 protein positivity for hrHPV positive women.

A reliability-based criterion to estimate strength amplification factors for buildings with asymmetric yielding located within a seismic region presenting different soil conditions is proposed and applied. The approach involves the calculation of the mean annual rate of exceedance of structural demands of systems with different levels of asymmetric yielding. Two simplified mathematical expressions are developed considering different soil conditions of the valley of Mexico. The mathematical expressions depend on the ductility of the structural systems, their level of asymmetric yielding, their fundamental vibration period and the dominant period of the soil. In addition, the proposed expressions are compared with that recommended by the current Mexico City Building Code (MCBC). Since the expressions are developed with the help of simplified structural systems, the validity of such expressions is corroborated by comparing the expected ductility demand of multi-degree of freedom (MDOF) structural systems with respect to that of their equivalent simplified systems. Both structural representations are associated with a given annual rate of exceedance value of an engineering demand parameter. The expressions proposed in this study will be incorporated in the new version of the MCBC.

Understanding the vulnerability of areas and the likelihood of specific disasters, particularly earthquakes, is one of the most important issues in Iran. One of the major concerns in Iran is the resilience of rural communities. The present study is devoted to spatial analysis of risk in rural areas and the evaluation of preparedness in the rural districts of the city of Abhar. In particular, this study evaluates the resilience to earthquakes. The research was conducted in two parts in which the first part has used the VIKOR Multiple criteria decision making model as well as the employment of this model in the ArcGis. The second part of the study used field studies, in the form of questionnaires, to evaluate the readiness of the local population against the risks of earthquakes. Four indicators, individual, physical, economic abilities and access, were assessed. The population included rural districts, where statistical samples were villagers. Results of the spatial analysis indicated that 15 villages are in the high-risk areas, 24 villages were in the medium-risk areas and all other villages were in low-risk areas. In terms of readiness of the locals, the results indicated a lack of planning with regards to the four mentioned indicators.

Georgia is ranked fifth highest among states for rates of HIV diagnosis. About 4% of persons living with HIV infection in the United States reside in Georgia, and almost 19% of these people do not know their HIV status. The present study examined the trends and associated factors of HIV testing among adults in Georgia between 2010 and 2014 by analyzing data of the Behavioral Risk Factor Surveillance System (BRFSS). A total of 30,791 persons aged ≥18 years were identified who responded to the question “Have you ever been tested for HIV?” Overall, there were 11,543 respondents who had been tested for HIV, with a decrease in percentage from 49.4% in 2010 to 43.7% in 2014 (p<0.001). Factors associated with HIV testing were being black (p<0.001), being younger than 55 years (p<0.001), single (p=0.02), attaining education level above high school (P<0.001), engaging in HIV high-risk behaviors (p<0.001), and not having healthcare coverage (p=0.03). Overall in Georgia, there has been a decline in the temporal trend of HIV testing, and more than half of adults have never been tested for HIV. For reducing HIV transmission in Georgia, enhancing access and utilization of HIV testing should be a public health priority.

Several cities are experiencing an increase in flood hazard and exposure, and consequentially in flood risk, attributable to the coupled effect of climate change and urbanization. Non-structural protection strategies demonstrate significant potential in the short term for mitigating hydraulic risk in urban areas, particularly where the implementation of structural measures is impeded by a complex urban environment. This work proposes an Early Warning System (EWS) for fluvial floods developed for the city of Palermo (Italy). It is based on the preliminary definition of po-tential Flood Event Scenarios (FESs) as a function of typical potential precursors. Each FES pre-dicts first points of flooding, flood areas and water depths, also providing specific hazard maps for people, vehicles, and buildings. The EWS uses rainfall depth-duration thresholds to assess the expected hydrograph as a function of rainfall forecasts and the water stage observed in real time at an upstream section of the river crossing the city. This last also allows for estimating the ante-cedent wetness conditions. Based on this information, the EWS retrieves an expected FES from a pre-built library with a preannouncement time up to 36 h. The EWS is here successfully tested on a historical flood event.

Recent wastewater testing suggests the poliovirus is reemerging, raising questions about the efficacy of the current inactivated polio vaccine and mass vaccination to eradicate poliomyelitis. The present study reassessed reported outcomes from the placebo-control study of the 1954 Salk inactivated poliomyelitis vaccine field trial, which studied a population of 1,829,916 U.S. school children from the first three grades. The placebo-control study of the trial reported that the polio vaccine was 80% to 90% effective in reducing cases of laboratory confirmed paralytic poliomyelitis, 60% to 70% effective against type 1 of the virus, and greater than 90% effective against types 2 and 3 of the poliovirus. However, these outcomes are reported as relative risk reductions, and the absolute risk reductions of the 1954 polio vaccine field trial were never reported to the public. The present paper’s analysis reveals to the public for the first time that the inactivated poliomyelitis vaccine's absolute risk reduction of laboratory confirmed paralytic poliomyelitis in the placebo-control study is 0.01% to 0.02%, an extraordinarily low clinical effect that impugns the Salk polio vaccine’s reported effectiveness. Furthermore, absolute risk reductions for the three poliovirus types are 0.01%, 0.00%, and 0.01%, respectively. Outcome reporting bias in the 1954 inactivated poliomyelitis vaccine field trial casts doubt on eradication of the poliovirus through mass vaccination.

The use of mindfulness techniques as a cutting-edge tactic to reduce catastrophic risk in the chemical sector is examined in this study. Constructed from fundamental design principles and conventional safety measures, mindfulness provides an additional method for addressing the behavioural and cognitive aspects of risk management. The study looks at the safety paradigms' development, the historical background of significant industrial accidents, and the theoretical foundations of mindfulness in high-reliability businesses. Through the promotion of increased consciousness, better judgement, and better communication, mindfulness has the potential to build a safer culture that is more resilient. The study investigates practical implementation challenges and the measurable outcomes of mindfulness-based interventions in high-risk industrial settings. This multidisciplinary study adds to the continuing conversation about industrial safety by offering insightful information to safety experts, business executives, and legislators. The necessity for additional empirical research to measure the effectiveness of mindfulness therapies in various chemical industry situations is emphasised in the paper's conclusion.

No consensus exists on whether acute aerobic exercise alters the glomerular filtration rate in older adults. Objective: To assess the immediate effects of three aerobic exercise intensities on the estimated glomerular filtration rate (eGFR) in healthy, sedentary older adults. Methods: Eighteen healthy, sedentary older adults (12 men and eight women) voluntarily participated in the study. The participants underwent three standardized aerobic exercise tests (100%, 80%, and 60% of the maximal heart rate) on a bicycle ergometer. Blood samples were collected to determine cholesterol, triacylglycerol, glucose, serum creatinine (Cr), Cystatin C (CysC) concentrations, and eGFR. Results: eGFR and serum concentrations of Cr and CysC were not modified at any exercise intensity. There was a negative correlation between blood total cholesterol vs. eGFR (R= -0.512, R= -0.582, R= -0.531; p &lt;0.05) at rest, 60%, and 100% of the maximal heart rate, respectively. Besides, a negative correlation existed between age vs. eGFR at 60% of the maximal heart rate (R= -0.516; p &lt;0.05). Conclusion: Short-time aerobic exercise of low, moderate, and vigorous intensity did not significantly affect eGFR and is considered safe for kidney function in healthy, sedentary older adults.

Background: Molecular genetic events are among the numerous factors affecting the clinical course of papillary thyroid carcinoma (PTC). Recent studies have demonstrated that aberrant expression of miRNA, as well as different thyroid-related genes, correlate with the aggressive clinical course of PTC and unfavorable treatment outcome, which opens up new avenues for using them in personalization of the treatment strategy for patients with PTC. In the present work, our goal was to assess the applicability of molecular markers in preoperative diagnosis of aggressive variants of papillary thyroid cancer. Methods: The molecular genetic profile (expression levels of 34 different markers and BRAF mutation) was studied for 108 cytology specimens collected by fine-needle aspiration biopsy in patients with PTC having different clinical manifestations. Results: Statistically significant differences with adjustment for multiple comparisons (p &lt; 0.0015) for clinically aggressive variants of PTC were obtained for four markers: miRNA-146b, miRNA-221, FN1, and CDKN2A. Weak statistical correlation (0.0015&lt; р&lt;0.05) was observed for miRNA-31, -375, -551b, -148b, -125b, mtDNA, CITED1, TPO, HMGA2, CLU, NIS, SERPINA1, TFF3, and TMPRSS4. Conclusions: The recurrence risk of papillary thyroid carcinoma can be preoperatively predicted using miRNA-221, the fibronectin and cyclin-dependent kinase inhibitor 2A genes.

The normative and safeguarding role of ethics and law in the development of biomedical science and technology, as well as their importance in promoting the progress of the industry, analyzed the key role of ethics and law in the field of biomedical science and technology, by restricting scientific research behavior, protecting the rights and safety of subjects, providing a solid guarantee for scientific research activities, and promoting the healthy development of biomedical science and technology. At the same time, the positive role of ethics and law in promoting international cooperation and exchange of biomedical science and technology is also discussed, which will inject strong impetus into the global development of biomedical science and technology. In addition, through case analysis, the paper demonstrates the key role of ethical review in the field of biomedical science and technology, as well as the importance of law in maintaining market order, protecting subjects' rights and interests, and fairness and justice. The successful practice of ethics and law in the development of biomedical science and technology is emphasized, which proves that following ethical principles and legal framework is the key factor to promote the progress of biomedical science and technology. This paper explores the important role of ethics and law in the development of biomedical science and technology, and provides valuable reference and guidance for practitioners in the industry. By following ethical principles and legal norms, we will jointly promote the prosperity and development of biomedical science and technology, and contribute to the common progress of human health.

From the existing millions of fungal species only a few cause disease. In this study, we investigated invasive fungal infections in the head and neck over a 19-year period (2005 to 2024) at a large academic healthcare system. Among 413 cases, 336 were noninvasive, and 77 were invasive. The highest incidence of invasive infections occurred in the sinonasal cavities, with a 15-fold difference compared to other sites. Most infections affected adults over 40 years old. The most common organisms were Mucorales (51%), hyaline molds (29%), and Candida (11%). Risk factors included malignancy, transplant, diabetes, and illicit drug use. Mortality was high in patients with malignancy and/or transplant. Infections affecting the mandible were usually a complication of osteoradionecrosis and were associated with coinfection of Candida and Actinomyces. At other sites, infections were rare and were usually the result of penetrating injuries or immunosuppression. Treatment typically involved a combination of antifungals and surgical procedures.

Background: Modulator therapies improve weight and body mass index (BMI) in cystic fibrosis (CF) patients. We aimed to compare the nutritional risk index (NRI) in adult CF patients receiving modulator (MT) or only non-modulator (conventional) therapies (non-MT). Methods: A single-center prospective cohort study was conducted between June-December 2023. The NRI based on weight gain and albumin was calculated at beginning and end of a 12 weeks period in both groups. This design was pragmatic, since based on individual patient access to MT for 12 weeks. Results: 107 patients were included [mean (SD) age: 23.85 (4.98) years, 54.7% male, 46.7% MT]. In the MT group, mean (SD) weight (kg) and albumin (g/dL) increased significantly [changes: +3.09 (2.74) and +0.17 (0.37); p

Emergence of COVID-19 had profound impact on global stock markets, including Indian mar-ket. Key indices like NIFTY50 and Sensex dropped by approximately 40% within two months in 2020, which also affected major mutual funds, leading to significant depreciation of their Net Asset Value. Securities and Exchange Board of India (SEBI) allows mutual funds to use deriva-tives for hedging purposes, capped at 100% of the scheme's net assets covering debt, equity, and derivatives. However, circular amendment by SEBI in January-2019 permitted covered call strat-egies on constituent stocks of Sensex and NIFTY50 for mutual fund schemes, excluding ETFs and Index Funds. This study investigated whether mutual funds increased their derivative us-age as risk mitigation strategy during COVID-19 pandemic, analyzing derivative holdings from 2019-2023. Surprisingly, findings indicated a decline in derivative holdings in 2020 compared to pre-pandemic levels. Statistical tests and performance evaluation metrics such as T-test, F-test, Treynor Ratio, Sharpe Ratio, and Jensen's calculations were employed to assess mutual fund performance. Although derivative-holding mutual funds didn't outperform benchmarks in aver-age returns, it showcased significantly reduced volatility, offering investors favorable risk-return trade-offs. research sheds light on derivative utilization in Mutual Fund industry, potentially in-forming regulators, fund managers, and investors in their decision-making

This study investigates the complex role of financial risks in the context of public–private partnerships (PPPs) in India and their relationship to the amount and extent of investments made by private partners (s). We hypothesize that subsidies, bid criteria, and risk have a positive relationship with investments made by private partners. A project’s leverage moderates these relationships. Regression was used to analyze the hypotheses using SPSS 24 and PROCESS Macro. Data from the World Bank were collected from 2009 to 2019 for the study variables. Interestingly, our research finds support for these relationships that may seem contrary to some commonly-held notions of risk relationships, such as – the government using ‘viability gap’ funding to attract private investment and ‘leverage’ does not moderate the relationship between risk assumed and private investment. This study is among the first to recognize and elaborate on financial risk relationships, specifically in the context of Indian PPPs. These findings are significant for both private and public participants in terms of financial considerations in PPP projects, especially in emerging markets.

Background and Objectives: High job strain is worsening the outcome in coronary artery disease, CAD. Severe dissatisfaction on workplace, imbalance between high demands , and low rewards, are affecting the quality of life, and diminishing the duration of life, especially in CAD patients. Our study included two samples : CAD patients (experimental group), and without CAD patients, but with traditional risk factors (control group). The main objective of the study was the role played by high sensitivity C reactive protein, hs CRP, and microalbuminuria, as mediators of job strain and CAD relationship. Secondary objectives were the following: identification of the most vulnerable patients( with significant job strain) and intervention towards this category, for cardiovascular events prevention (primary or secondary). Materials and Methods: The utilized methods were the following : clinical exam; electrocardiogram; echocardiogram; non contrast enhanced computed chest tomography; laboratory findings ( lipid profile, glycemia, hs CRP, microalbuminuria); type D scale, DS 14; depression questionnaire, PHQ-9; and satisfaction with work scale, SWWS. Results: The highest values for hs CRP and microalbuminuria were noticed in patients with the lowest Likert score, for both samples CAD, and without CAD patients. The highest job strain was noticed in females. More than half of CAD patients ,with low Likert scores, revealed myocardial infarction. Conclusions: Microalbuminuria and hs CRP were statistical significant in the study as intercessors, in job strain and CAD relationship. The most vulnerable patients for vascular events were females, in both groups : CAD and “CAD waiting desk”. In CAD sample, the vascular vulnerability was also increased by high job strain.

This study explores how the covid-19 pandemic affected some psychological factors in people who got tattoos during or after the lockdown, the psychological factors assessed were self-esteem, risk taking behaviour, body image and locus of control. The study used a quantitative, between-subjects design to investigate the experiences of participants who acquired tattoos during the pandemic compared to those who did not. The results showed that participants who got a tattoo during the pandemic reported higher levels of self-esteem and body image satisfaction compared to those who did not get a tattoo. Furthermore, the findings suggest that individuals with tattoos may have a more external locus of control. Participants with tattoos exhibited higher levels of risk-taking behaviour compared to those without tattoos, furthermore sex affected risk-taking behaviour in tattooed individuals, and females with tattoos displayed a higher risk taking tendency than their tattooed male counterparts. Further research needs to be done while acknowledging the limitations of this study. Overall, this study is pivotal in establishing how the pandemic may have affected the aforementioned psychological factors in people with tattoos. It also adds to the growing body of literature in body modification and psychology.

Background: The study aimed to investigate the association between environmental tobacco smoke exposure and the risk of wheezing among rural and urban preschool children in Mpumalanga province, South Africa, an area associated with poor air quality. Methods: In this study, parents/caregivers of preschool children (n=3145) completed a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Data were analysed using multiple logistic regression models. Results: The overall prevalence of Wheeze ever was 15.14%, with a higher prevalence in urban pre-schoolers than rural pre-schoolers (20.71% vs 13.30 %, P<0.000). Moreover, the total prevalence of asthma ever was 2.34%. The prevalence was greater in urban pre-schoolers than in rural pre-schoolers (3.92% vs 1.81%, P<0.001). In the final adjusted model, both urban and rural area children who lived with one or more people who smoked in the same household (WE: OR 1.44, 95% CI 1.11-1.86) (CW: OR 2.09, 95% CI 1.38-3.16) and (AE: OR 2.49, 95% CI 1.12-5.54) were found to have an increased likelihood of having Wheeze Ever, Current Wheeze and Asthma Ever as compared to those who lived with non-smokers. Conclusions: The implementation of smoking limits and prohibition is crucial in areas that are frequented or utilized by children. Hence, it is imperative for healthcare providers to actively champion the rights of those who do not smoke within the society, while also endorsing legislative measures aimed at curtailing the extent of tobacco smoke exposure.

(1) Background: The prediction of cervical lesions evolution is a challenge for clinicians. The prospective study aimed to determine and compare the predictive accuracy of cytology, HPV genotyping, and p16/Ki67 dual staining alone or in combination with personal risk factors for the prediction of progression, regression or persistence of cervical lesions in human papillomavirus (HPV)-infected patients; (2) Methods: This prospective study included HPV-positive patients with or without cervical lesions that underwent follow-up. Descriptive statistics and sensitivity analysis for individual or combined index tests were used for data analysis; (3) Results: The highest predictive performance for the progression of cervical lesions was achieved by a model that comprised a Pap smear suggestive of high-grade squamous intraepithelial lesion (HSIL), the presence of 16/18 HPV strains, a positive p16/Ki67 dual staining result along with the presence of at least 3 clinical risk factors, which had a sensitivity (Se) of 74.42%, a specificity of 97.92%, an area under the receiver operating curve (AUC) of 0.961, and an accuracy of 90.65%. The prediction of cervical lesions regression or persistence was modest; (4) Conclusions: Multiple testing or new biomarkers should be used to improve HPV-positive patient surveillance, especially for cervical lesion regression or persistence prediction.

Despite ample warning and significant lead time, global society has not acted sufficiently to combat climate change, and global carbon dioxide emissions are now about 60% higher today than in 1990 [1]. This paper uses marine fisheries as an analog model to compare with the many similar management issues faced with global climate change. Both marine fisheries and global climate change are complex systems that have similar properties that make management very difficult. A simple fishery prototype model is used to educate citizens about similar issues of dynamic complexity found in climate change models. We highlight how our slow reaction time to global climate change can be thought of as a mismatch between our cognitive abilities and the nature of global collective problems. Understanding the history and system structure of marine fisheries can provide insight into managing global climate change. We suggest ways to improve communication between science and citizens for updating mental models and changing climate policy.

The aim of the study was to compare the standard baseline imaging, with extended radiological staging. To assess our hypothesis, we performed a prospective, single-centre study which included 132 participants recruited between October 2015 and March 2020. Descriptive statistics, the Friedman and chi-squared tests were performed and p &lt; 0.05 was considered significant. Patients were grouped into two cohorts, CT scan cohort (n=87) and PET-CT cohort (n=43). In the first group the originally determined disease stage changed in 36.8 % of cases, in second group in 51.2 %. The consistency between assessment of axillary lymph nodes by imaging (cN) and the postoperative pathology report (pN) was evaluated. In most cases, clinical and pathological evaluation of involved nodes was consistent, for CT scan the result was χ2(1) = 18.98; p &lt; 0.001, for PET-CT the result was χ2(1) = 6.41; p = 0.03. Highly customized radiation therapy defined as dose boost within the involved lymph nodes, not covered by surgeon, was applied in nine patients.

The hepatitis E virus (HEV) is a zoonotic pathogen with a variety of hosts, including pigs, which act as reservoirs. In industrialized countries, sporadic cases caused by genotype 3, contracted by ingestion of contaminated uncooked or undercooked meat, have been reported. However, in developing countries, HEV infection is mainly dominated by genotype 2 and often associated with poor hygiene conditions and drinking water supplies. In West Africa, HEV infection and its circulation in domestic fauna are very poorly documented. The aim of this study was to assess the presence of HEV in pork sold in Saint-Louis. Meat products were collected between 20 and 25 August 2022 in three location of Saint-Louis region. After purchasing 250 g of sample, we minced 2 g of sample for extraction of total nucleic acids using the Purelink™ Viral DNA/RNA kit and then RT-PCR using the One-Taq™ One-Step RT-PCR kit targeting the HEV ORF2 genomic region. The products obtained were visualized on a 1% agarose gel. Of a total of 74 samples, divided into pork meat (n=65) and pork liver (n=9), 5.4% (n=4) were tested positive for HEV. In both cases, 2 samples were positive, representing a rate of 3.1% and 22.2% for meat and pork liver respectively. All new viral sequences obtained form a monophyletic group within HEV genotype 3. These preliminary results reveal a potential circulation of HEV in the pig population. The high proportion of contamination in the pork liver samples highlights a major risk associated with their consumption.

Understanding that organizational communication is crucial for the consistent functioning of any establishment, this research assesses its influence on work-life balance, organizational climate, and job satisfaction among Portuguese firefighters, a rarely studied group. Effective organizational communication is identified as a potential pathway for nurturing a favorable work setting and bolstering employee contentment, essential elements of work-life balance. Data compiled from a group of 102 firefighters, using a sociodemographic questionnaire, the Work Social Climate Scale, and Portuguese versions of the ICA Communication Audit Survey Instrument and the Labor Satisfaction Questionnaire S20/23, unveil multiple significant correlations among various dimensions of the ICA, the Work Social Climate Scale, and communication metrics. Explicitly, correlations were discerned between received and sent communications and aspects of implication, support, and cohesion. Links were also evident between desired communications and the control dimension. Positive and statistically significant relationships were further observed between received and sent communications, all five satisfaction dimensions, necessary outgoing communications and the physical environment, and required outgoing communications and benefits, highlighting the pivotal role of adept communication in augmenting work-life balance, organizational climate, and job satisfaction among firefighters.

Background: In Malaysia, the mortality from melioidosis infection was reported to be higher than in other infectious diseases. The research on melioidosis is still limited in Malaysia but slightly increasing. Objective: To give an overview of the study designs, statistical methods and comparison of research in identifying the predictors of melioidosis mortality in Malaysia between January 2010 to December 2021. This review articles were divided into two sections; Section 1: Review of literature and Section 2: Findings on predictors of melioidosis mortality in Malaysia. Data sources: Pubmed/Medline. Study Eligibility Criteria: Original English-language articles were abstracted. The articles that identified the predictors of melioidosis from mortality in Malaysia only included. Letters to the editor, editorials, reviews, systematic reviews, meta-analysis, case reports and any other ineligible articles were excluded. Results: A total of 7 studies were identified related to predictors of melioidosis mortality in Malaysia. From the selected articles, all of the data were retrospectively collected. Six out of 7 articles (85.7%) used the logistic regression in identifying the predictors of melioidosis mortality. Only 1 (14.3%) used advanced survival analysis methods of Cox regression analysis. Conclusion: Logistic regression methods remain the most common methods of analysis in publications on predictors of melioidosis mortality in Malaysia while retrospective research designs are favoured. There is a limitation of research in predictors of melioidosis mortality and the use of advanced statistical techniques reported using the melioidosis data in Malaysia. More published research on melioidosis will provide input to the clinicians on a more detailed understanding of how to improve the diagnosis of melioidosis and the prognosis factors of this disease.

The broad and rapid application of new genomic techniques (NGTs) such as CRISPR-Cas has led to a fast increase in the number of genetically modified crops. With the recently published EU Commission’s (EC) regulatory proposal on plants generated with NGTs (July 5, 2023) the process of admission of such genetically modified plants is aimed to get accelerated and simplified. NGT plant applications shall be categorized based on their molecular characteristics into category 1 NGT (NGT1) and category 2 NGT (NGT2), which is in divergence from the current legislation centered around Directive 2001/18/EC. In the regulatory proposal NGT2 plants are envisioned to undergo a reduced risk assessment while for NGT1 plants no risk assessment is foreseen at all. To demonstrate were the path of the proposal leads to in practice, we applied the proposed criteria for categorization to a list of NGT plant applications that are currently in the commercialization pipeline. A key finding is that out of those plant applications affected by the EC proposal, 94% would be classified as NGT1 and thus would receive a market approval without risk assessment, monitoring and sufficient labeling provisions. The remaining 6% of applications would be classified as NGT2 plants for which, in deviation from the current regulation, an adapted risk assessment is proposed. A screening of intended traits in the pipeline highlights that certain NGT1 plants can pose similar environmental risks (e.g. invasiveness) compared to other genetically modified organisms (GMOs), as defined in Directive 2001/18/EC. For example, NGT1 applications based on RNAi technology can exhibit insecticidal effects with potential side effects on non-target organisms (i.e. other insects). Our quantitative and case-specific elaboration on how the current EC regulatory proposal would affect the environment, health or consumer protection will be informative for decision makers and politicians.

Background and Objectives: Previous studies revealed anti-angiogenic, antiproliferative and anti-inflammatory effects of Vitamin D on cancer cells. Although this body of evidence supported the correlation of high Vitamin D levels with reduced incidence rates for various malignancies, contradictory results were reported regarding non-melanoma skin cancer (NMSC). Aim of this overview was to summarize the available evidence from the existing pool of systematic reviews and meta-analyses, focusing on Vitamin D serum status, dietary intake, and Vitamin D receptor (VDR) polymorphisms in correlation to NMSC incidence. Materials and Methods: A literature search in electronic databases was conducted from inception to January 2023. Inclusion criteria were systematic reviews and meta-analyses published in peer-reviewed journals, evaluating Vitamin D serum levels, dietary and/or supplementary intake, or VDR gene polymorphisms, and reporting data on NMSC. Results: A total of 10 studies were included in the data analysis models. A positive association between Vitamin D serum levels and NMSC is highlighted. However, dietary/supplementation of Vitamin D doesn’t exhibit a likewise strong linkage to NMSC. Despite the contradictory findings, VDR polymorphisms may play a crucial role in the intricate NMSC pathogenesis. Conclusions: This umbrella review showed that high Vitamin D levels are associated with increased NMSC incidence, potentially due to its direct correlation with increased sun exposure. Further research on VDR polymorphisms is suggested to explore their true effect size on NMSC risk.

Objectives: The aim of our current study was to analyze whether the use of important measures of methodological quality and reporting of randomized clinical trials published in the field of cardiovascular disease research have changed over time. Further aim was to investigate whether there was an improvement over time in the ability of these trials to provide a good estimate of the true intervention effect. Methods We conducted two searches in the Cochrane Central Register of Controlled Trials (CENTAL) database to identify cardiovascular clinical research trials published in either 2012 or 2017. Randomized clinical trials (RCTs) trials in cardiovascular disease research with adult participants were eligible to be included. We randomly selected 250 RCTs for both publication year 2012 and 2017. Trial characteristics, data on measures of methodological quality and reporting were extracted and risk of bias for each trial was assessed. Results As compared to 2012 in 2017 there were significant improvements in the reporting of the presence of a data monitoring committee (42.0% in 2017 compared to 34.4% in 2012), and a positive tendency of registering cardiovascular disease research RCTs in clinical trial registries (83.6% in 2017 compared to 72.0% in 2012). On the other hand, we also observed that significantly fewer RCTs reported sample size calculation (60.4% in 2017 compared to 98.4% in 2012) in 2017 as compared to 2012. RCTs in 2017 were more likely to have low overall risk of bias ( RoB ) than in 2012 (29.2% in 2017compared to 21.2% in 2012). Conclusion: As compared to 2012 in 2017 there were significant improvement in some, but not all the important measures of methodological quality. Although more trials in the field of cardiovascular disease research had a lower overall RoB in 2017, the improvement over time was not consistently perceived in all RoB domains.

Rice cultivation is the main agricultural activity in Asia, and it results in an enormous amount of agricultural waste, that are usually disposed-off by burning, causing serious environmental health and climate problems. Pakistan is the tenth largest producer in the world and the fourth exporter of rice in the world. To date, there are no studies targeting Pakistan’s profile monitoring its contribution in open burning emissions from rice straw waste. This study presents the characterization of PCDD/Fs, PCBs and PAHs emissions from three samples of rice straw collected from the main rice cultivation regions of Pakistan (Punjab, Sindh and Azad Jammu and Kashmir) in relation to the role of metal-based agricultural additives. PCDD/Fs, PCBs and PAHs emissions were quantified using a fixed grid system biomass plant and measuring the macro-pollutants online and sampling the organic micro-pollutants and metals in isokinetic mode, followed by ISO and CEN standards methods. In addition, role of agrochemicals was monitored in terms of metal catalysis resulted in POPs emissions. This study provides the characterization of most relevant group of pollutants (metals, PCDD/Fs, PCBs and PAHs) as a result of agricultural waste combustion. The rice straw samples from AJK showed high values of organochlorine micro-pollutants compared to the values followed by samples from Punjab and Sindh, i.e., respectively, ∑PCDD/F (2594>1493>856 pg/Nm³) and ∑PCB (41>38>30 pg/Nm³). Whereas the organic micro-pollutants ∑PAH, indicators of incomplete combustion (PICs), were recorded high in the samples from Sindh followed by Punjab and AJK. This study supports the idea that the phenomena that lead to the formation of PCDD/F and PCB are influenced not only by poor combustion but also by the presence of metal catalysts or precursors in the burned fuel.

: For a long time, atherosclerosis has been regarded as a mere lipid deposit in the blood vessels. However, in the recent years a growing body of experimental and clinical evidence have highlighted the role of inflammation and immunity as a central mechanism of disease. Moreover, in the last decade the coming of next-generation sequencing and its application to large human population has broken the barrier between inflammation and cancer. Indeed, acquired mutation in key genes related to the control of hematopoiesis and myeloproliferation have paved the way to establish the new concept of clonal hematopoiesis of indeterminate potential. This phenomenon is being considered not such “indeterminate”, but as an emerging cardiovascular risk factor. Thus, this may explain the mechanisms of myeloproliferation and inflammation in atherosclerosis. And in a bidirectional journey, it has helped to explain the extremely high cardiovascular risk in cancer survivors, in particular in myeloprolfierative neoplasm patients. A deeper understanding of these mechanisms may pave the way for the future early diagnosis and potential preemptive treatments of the leading worldwide cause of death.

Dual antiplatelet therapy (DAPT), comprising aspirin and a P2Y12 receptor inhibitor, is the cornerstone of post-percutaneous coronary intervention treatment to prevent stent thrombosis and reduce the risk of adverse cardiovascular events. The selection of an optimal DAPT regimen, considering the interplay of various antiplatelet agents, patient profiles, and procedural characteristics, remains an evolving challenge. Traditionally, a standard duration of 12 months has been recommended for DAPT in most patients. While contemporary guidelines provide general frameworks, DAPT modulation with longer or shorter treatment courses followed by aspirin or P2Y12 inhibitor monotherapy are evolving towards an individualized strategy to optimize the balance between efficacy and safety. This review comprehensively examines the current landscape of DAPT strategies after coronary stenting, with a focus on emerging evidence for treatment individualization.

Aims: Chronic coronary syndrome is associated with several risk factors, such as dyslipidemia and hypertension. AIP has been demonstrated to be a biochemical risk factor for coronary artery disease (CAD). This study aimed to determine whether AIP is an effective parameter for estimating obstructive CAD. Methods and Results: A total of 345 patients (mean age 62,2±10,3; 63% male) who underwent coronary angiography were included in this study. Obstructive CAD is defined as having one or more vessels with a stenosis of≥50%. Depending on the presence of obstructive CAD, all patients were divided into two groups. The AIP was significantly higher in the obstructive coronary artery group (AIP; 0,49±0,26 vs. 0,58±0,27, p=0,002). In univariate analysis, AIP was significantly associated with obstructive coronary artery disease [OD:3,74 (CI95% 1,62-8,64), P=0,020]. The AIP was further adjusted for confounding risk factors in three multivariate analysis models. Therefore, all three models showed a significant association. According to ROC analysis, 0.49 is the cut-off value for AIP, and a value above 0.49 indicates 50% coronary artery stenosis Conclusions: AIP may be used in the assessment of cardiovascular risk in patients with stable angina pectoris, and it may also be used to estimate obstructive CAD.

The inaugural AIDS Program in Brazil was established in São Paulo in 1983, with the Instituto Adolfo Lutz appointed for laboratory assistance. Subsequently, research on HIV infections and HIV/HTLV (HIV/HTLV-1 and HIV/HTLV-2) co-infections were conducted. This narrative review focuses on studies from the Immunology Department (1983–2017) that significantly influenced AIDS diagnosis or provided epidemiological data such as prevalence rates, sex, age, and risk factors. Ten studies, encompassing over 8,000 individuals, are discussed. During 1983–1985, nearly all AIDS cases were attributed to homosexual/bisexual men aged 31 years old. Subsequently, heterosexual men and women emerged as risk groups owing to intravenous drug use (IDU) and/or unprotected sexual intercourse with AIDS patients or multiple partners per year. From 1985 onwards, vertical transmission led to child infections. HIV/HTLV co-infection rates decreased over time, initially associated with male IDU, and in the 2010s, with females, IDU, and individuals aged &gt;40 years. Trends in HIV and HIV/HTLV co-infections among younger men and women (&lt;30 years of age) were observed from 2015–2017. The changing characteristics and risk groups for HIV and HIV/HTLV co-infections over the years underscore the necessity for ongoing public policies to prevent retrovirus transmission, particularly among adolescents and young adults.

This paper contextualises the common queries of "why is crypto crashing?" and "why is crypto down?", the research transcends beyond the frequent market fluctuations to unravel how cryptocurrencies fundamentally work and the step-by-step process on how to create a cryptocurrency. The study examines blockchain technologies and their pivotal role in the evolving Metaverse, shedding light on topics such as how to invest in cryptocurrency, the mechanics behind crypto mining, and strategies to effectively buy and trade cryptocurrencies. Through an interdisciplinary approach, the research transitions from the fundamental principles of fintech investment strategies to the overarching implications of blockchain within the Metaverse. Alongside exploring machine learning potentials in financial sectors and risk assessment methodologies, the study critically assesses whether developed or developing nations are poised to reap greater benefits from these technologies. Moreover, it probes into both enduring and dubious crypto projects, drawing a distinct line between genuine blockchain applications and Ponzi-like schemes. The conclusion resolutely affirms the continuing dominance of blockchain technologies, underlined by a profound exploration of their intrinsic value and a reflective commentary by the author on the potential risks confronting individual investors.

Bisphenol A (BPA) has been identified as one of endocrine disrupting chemicals (EDCs). Due to its massive production (over 700,000 tons per year) and the extensive use of BPA-based plastics (i.e., polycarbonate and epoxy resin) in Taiwan, it was thus included into a toxic substance by the Ministry of Environment. This work surveyed the updated information about the production of BPA and its environmental distributions in Taiwan over the past decade. Furthermore, the regulatory strategies and countermeasures for managing the environmental risks of BPA by the Taiwan government were summarized to show the cross-ministerial efforts under the relevant acts, including the Toxic and Concerned Chemical Substances Control Act (TCCSCA), the Food Sanitation Management Act (FSMA) and the Commodity Inspection Act (CIA). The findings showed that most of the monitoring data showed far below the acceptable risks. However, the people may pose an adverse threat to the aquatic environment and human health via ecological and food chains. In addition, some countermeasures were further recommended to echo the international actions on environmental endocrine disruptors in recent years.