The interaction between oceanographic, meteorological, and hydrological factors can result in an extreme flooding scenario in the low-lying coastal area, called compound flooding (CF) events. For instance, rainfall and storm surge (or high river discharge) can be driven by the same meteorological, tropical or extra-tropical cyclones, resulting in a CF phenomenon. The trivariate distributional framework can significantly explain compound events' statistical behaviour reducing the associated high-impact flood risk. Resolving heterogenous dependency of the multidimensional CF events by incorporating traditional 3-D symmetric or fully nested Archimedean copula is quite complex. The main challenge is to preserve all lower-level dependencies. An approach based on decomposing the full multivariate density into simple local building blocks via conditional independence called vine or pair-copulas is a much more comprehensive way of approximating the trivariate flood dependence structure. In this study, a parametric vine copula of a drawable (D-vine) structure is introduced in the trivariate modelling of flooding events with 46 years of observations of the west Coast of Canada. This trivariate framework searches dependency by combining the joint impact of annual maximum 24-hr rainfall and the highest storm surge and river discharge observed within the time ±1 day of the highest rainfall event. The D-vine structures are constructed in three alternative ways by permutation of the conditioning variables. The most appropriate D-vine structure is selected using the fitness test statistics and estimating trivariate joint and conditional joint return periods. The investigation confirms that the D-vine copula can effectively define the compound phenomenon's dependency. The failure probability (FP) method is also adopted in assessing the trivariate hydrologic risk. It is observed that hydrologic events defined in the trivariate case produce higher FP than in the bivariate (or univariate) case. It is also concluded that hydrologic risk increases (i) with an increase in the service design life of the hydraulic facilities and (ii) with a decrease in return periods.

Socioeconomic conditions and social attitudes are known to represent epidemiological determinants. Credible knowledge on socioeconomic driving factors of the COVID-19 epidemic is still incomplete. Based on a linear random effects regression, a predictive model is derived to estimate COVID-19 incidence in German rural districts from local socioeconomic factors and popularity of political parties in terms of their share of vote. Thereby, time series provided by Germany's public health institute (Robert Koch Institute) of weekly notified 7-day incidences per 100,000 inhabitants per district from the outset of the epidemic in 2020 up to December 1, 2021, have been used to construct the dependent variable. Local socioeconomic conditions including share of votes, retrieved from the Federal Statistical Office of Germany, have been used as potential risk factors. Popularity of the right-wing party Alternative for Germany (AfD) bears a considerable risk of increasing COVID-19 incidence both in terms of predicting the maximum incidences during three epidemic periods (alternatively, cumulative incidences over the periods are used to quantify the dependent variable) and in a time-continuous sense. Thus, districts with high AfD popularity rank on top in the time-average regarding COVID-19 incidence. The impact of the popularity of the Free Democrats (FDP) is markedly intermittent in the course of time showing two pronounced peaks in incidence but also occasional drops. A moderate risk emanates from popularities of the Green Party (GRÜNE) and the Christian Democratic Union (CDU/CSU) compared to the other parties with lowest risk level. Socioeconomic parameters like \emph{per capita} income, proportions of protection seekers and social benefit claimants, and educational level have negligible impact. To the contrary, incidence significantly increases with population density. In order to effectively combat the COVID-19 epidemic, public health policymakers are well advised to account for social attitudes and behavioural patterns reflected in local popularities of political parties, which are conceived as proper surrogates for these attitudes. Whilst causal relations between social attitudes and the presence of parties remain obscure, the political landscape in terms of share of votes constitutes at least viable predictive "markers" relevant for public health policy making.

Eating Disorders (ED) constitute a serious public health issue affecting predominantly women and appearing typically in adolescence or early adulthood. EDs are extremely difficult to treat as these disorders are ego-syntonic and many patients do not seek treatment. It is vital to focus on the development of successful early-intervention programs for individuals presenting at-risk and are on a trajectory towards developing EDs. This study is a randomized controlled trial evalu-ating an innovative digital gamified Acceptance and Commitment early-intervention program (AcceptME) for young females showing signs and symptoms of an ED and at high-risk for an ED. Participants (N=92; Mage=15.30 years, SD=2.15) received either AcceptME (N=62) or a waitlist control (N=30). Analyses indicated that the AcceptME program effectively reduced weight and shape concerns, with large effects when compared to waitlist controls. Most participants scored below the at-risk cut-off (WCS score<52) in the AcceptME at end-of-intervention (57.1%) com-pared to controls (7.1%) with odds of falling into the at-risk group being 14.5 times higher for participants in the control group. At follow-up, 72% of completers reported scores below the at-risk cut-off in the AcceptME group. The intervention also resulted in a decrease in ED symp-tomatology and increased body image flexibility. Overall, results suggest that the AcceptME program holds promise for early-intervention of young women at-risk for developing an ED.

Four discrete models using the exact spectral derivative discretization finite difference (ESDDFD) method are proposed for a chaotic five-dimensional, conformable fractional derivative financial system incorporating ethics and market confidence. Since the system considered was recently studied using the conformable Euler finite difference (CEFD) method and found to be hyperchaotic, and the CEFD method was recently shown to be valid only at fractional index , the source of the hyperchaos is in question. Through numerical experiments, illustration is presented that the hyperchaos previously detected is in part an artifact of the CEFD method as it is absent from the ESDDFD models.

There are evidences of shared biological mechanisms between obesity and hypertension during childhood in the adulthood, and loads of research literatures have proven that, it will cost the economies and health of nations profoundly if neglected. The Prevention and early diagnosis of cardiovascular risk factors such as overweight and hypertension is an essential strategy for control, effective treatment and prevention of its’ complications. The aim of the study is to assess the effect of school based Exercise and Life style Motivation Intervention (SEAL-MI) on adolescent's cardiovascular risk factors and academic performance. An experimental study was conducted among 1005 adolescents - 520 and 485 adolescents were randomly selected for control and study group, respectively. Demographic details and the data related to dietary habits, physical activity and sleep quality were collected by a structured interview questionnaire. The study group adolescents were given the SEAL-MI for six months which includes a school based rope exercise for 45 minutes per day for 5 days a week and a motivation intervention related to dietary habits, physical activity and sleep. Post-test 1 and 2 were done after 3 and 6 months of intervention. The prevalence of overweight among adolescents was 28.73% and prehypertension was 9.26%. Among overweight adolescents, the prevalence of prehypertension was found to be very high (32.25%). In post intervention, there was a significant reduction in weight, BP (p=0.000) and improvement in dietary habits, physical activity, sleep (p=0.000) and academic performance. A significant positive correlation was found between BMI and SBP (p=0.000) and BMI and academic performance (p=0.003). The linear regression analyses revealed that the gender (ß: 0.47, 95% CI: 0.39, 0.81), age (ß: 0.39, 95% CI: 0.17, 0.46), family income (ß: 0.2, 95% CI: 0.41, 0.5), residence (ß: 0.19, 95% CI: 0.01, 0.27) and type of family (ß: 0.25, 95% CI: 0.39, 0.02) had the strongest correlate with the BMI of the adolescents. Also, Mother’s education Mother’s education (ß: 0.35, 95% CI: 0.18, 0.59) had the strongest correlate with the SBP of the adolescents. In contrast, the DBP was negatively persuaded by age (ß: -0.36, 95% CI: 1.54, 0.29) and gender (ß: -0.26, 95% CI: 1.34, 0.12) of the adolescents. Regular practice of rope exercise and lifestyle modification such as diet, physical activity and sleep quality among adolescents prevent and control childhood CVD risk factors like overweight, hypertension. The SEAL-MI may lead to age appropriate development of adolescents and improves their academic performance and quality of life. Giving importance to the adolescents from urban habitat, from affluent nuclear family and catching them young will bring significant change in the disease burden.

Given that the outcome of hepatic arterial infusion chemotherapy (HAIC) with cisplatin for intrahepatic advanced hepatocellular carcinoma (HCC) is unclear, we aimed to compare prognostic factors for overall survival (OS) following HAIC with cisplatin versus sorafenib for intrahepatic advanced HCC using propensity score-matched analysis. We enrolled 348 patients with intrahepatic advanced HCC who received HAIC with cisplatin (n = 97) or sorafenib (n = 251) between June 2006 and March 2020. No significant difference was observed in OS between HAIC with cisplatin and sorafenib cohorts (median survival time [MST]: 13.9 vs. 12.7 months; p = 0.0989). To reduce confounding effects, 176 patients were selected using propensity score-matched analysis (n = 88 for each treatment). HAIC with cisplatin significantly prolonged OS compared with sorafenib (MST: 16.2 vs. 12.2 months; p = 0.0060). Following stratification according to the Child–Pugh classification, for both patients with class A (MST: 24.0 vs. 15.6 months; p = 0.0097) and class B (MST: 8.5 vs. 6.9 months; p = 0.0391), HAIC with cisplatin rather than sorafenib significantly prolonged OS. Our findings suggest that HAIC with cisplatin demonstrates longer prognostic effects than sorafenib in intrahepatic advanced HCC, regardless of the hepatic reserve.

China's implementation of public-private partnerships projects has been quite effective, involving infrastructure and other livelihood projects, a total of 19 industries, and an investment of nearly 1.5 trillion yuan. The characteristics of PPP projects such as long construction period and large investment amount determine the risks of PPP projects are also great, and the PPP projects of comprehensive environmental governance are also the same. The government and social capital use the PPP model to cooperate, and use the principal component analysis method to assess the risks of the entire life cycle of the comprehensive environmental governance PPP project. Therefore, it plays an important role in ensuring the smooth implementation of projects and reducing the losses caused by risks. According to the risk factors of the whole life cycle of the comprehensive environmental governance PPP project, an indicator system of 5 first-level indicators, 18 second-level indicators, and 43 third-level indicators has been established. Principal component analysis is used to analyze the influence weight of risk factors at each stage. The analysis shows that among the four stages, environmental pollution risk, project approval delay risk, completion risk, interest rate and financial fluctuation risk, and franchise life risk are the most influential risks in the implementation of PPP projects. Therefore, suggestions are made through the risk factors of each stage in the comprehensive environmental governance PPP project. For example, strengthen the response to the external environment risks of the comprehensive environmental governance PPP project, standardize the bidding and procurement of the comprehensive environmental governance PPP project, and strengthen the subsequent management of the transfer of the comprehensive environmental governance PPP project. In this way, the ability to resist risks of comprehensive environmental governance PPP projects is improved; the smooth implementation of the project is guaranteed, and the long-term development of comprehensive environmental governance PPP projects is promoted.

Smoking is a major risk factor for non-communicable diseases and remains a significant public health challenge in many lower- and middle-income countries (LMIC) including Namibia. The purpose of the study was to estimate the prevalence of smoking and its associated risk factors among HCWs and non-HCWs in Zambezi region. An exploratory cross-sectional survey was conducted between March and October 2020 among residents of the eight (8) constituencies of Zambezi region. Four hundred and sixty-one (461) respondents who had been residents of the selected constituencies for over five years and aged between 17-60 years were selected for the study. The main outcome measure was current cigarette smoking status. Descriptive statistics were used to summarize the socio-demographic characteristics of the respondents. We stratified data analysis by individual being health workers or non-health workers. A bivariate Pearson Chi-square test was used to determine the association between socio-demographic characteristics and the smoking status. Statistically significant variables in the bivariate analysis were used as predictors in the univariate and multivariate models. The response rate of potential participants was 95% (n=434). The mean (±SD) age of participant’s was 32.5 (± 11.34 years). Significant relationships were observed between smoking status and area of residency (constituency), gender, age category, level of education, age of onset of smoking and the daily smoking frequency. The majority of smokers (n=108) were none-HCWs with males being the majority (n=62). Age (p=0.001), education levels (p=0.001) and area of residency (p=0.022) were highly associated with smoking among none-HCW while marital status was associated with smoking among HCWs (p=0.013). In the final multivariate model, the odds of smoking among female non-HCWs were significantly lower (OR: 0.386; 95% CI: 0.228 – 0.655). Furthermore, the odds of smoking among this same group were lower among those who had secondary level education (OR: 0.178; 95% CI: 0.0659 – 0.483), post-secondary (OR: 0.117, 95% CI: 0.0412 – 0.330) and first stage tertiary (OR: 0.306: 95% CI: 0.106 – 0.881) compared to those who had primary school education. In conclusion, smoking prevalence among none HCWs and HCWs working in Zambezi included in the study was similar to that of the general Namibian population but higher than other neighboring countries within SADC. The results showed a need for the establishment of specific smoking related strategies that target HCWs to address smoking use parallel to the running of none HCWs which would ultimately decrease the smoking prevalence and improve health.

To assess the presence of organochlorine pollutants (OCP) in Alaskan sub-Arctic latitudes, we analyzed ice core and meltwater samples from Jarvis Glacier, a polythermal glacier in Interior Alaska. Jarvis Glacier is receding as atmospheric warming continues throughout the region, increasing opportunity for OCP transport both englacially and into the proglacial watershed. Across all meltwater and ice core samples we identify the pesticides DDT, DDE and DDD, α- HCH and ϒ-HCH. OCP concentrations in ice core samples were highest at the 7-14 m depth (0.51 ng/L of DDT) and decreased gradually approaching the bedrock at 79m. Meltwater concentrations from the proglacial creek slightly exceeded concentrations found in the ice core, potentially indicating aggregate OCP glacial loss, with peak OCP concentration (1.12 ng/L of DDD) taken in July and potentially associated to peak melt. Ongoing use of DDT to fight Malaria in Asia, and the extended atmospheric range of HCH may account for concentrations in near-surface ice, correlating with use and atmospheric transport. The opportunity for biota bioaccumulation of OCPs, or human uptake of OCPs from glacial meltwater, may increase as glacial melt continues.

This paper examines cognitive biases which affect the ability of decision makers to make rational decisions in an organizational context. The motivation for this analysis begins with the observation of catastrophic accidents caused by human error but in an organizational context. This paper expands on the concept of cognitive bias to define organizational biases which are the factors that affect decisions in an organizational context. The paper distinguishes between organizational biases, which are the focus of this paper, and individual biases, which are biases experienced by individuals but may have organizational consequences. The purpose of this paper is to identify methods to mitigate the risks of organizational accidents, accidents which involve many people operating at different levels of an organization. The methodology is to identify those decisions that would address the specific organizational biases. The focus of this paper is the decisions for mitigating the risks associated with decisions in an organizational context. Results are shown for seven organizational biases, six specific case studies, and four decision options. This paper concludes that organizational biases are intrinsically different from individual biases and that these differences lead to different decision options from those that mitigate individual biases; however, they may exist concurrently.

The development of small scale hydroelectric power plants in Norway is determined by natural conditions, policies, attitudes and property rights. The owner of the river is the central decision maker. It is he who decides whether he will develop the power plant himself, Whether he wants to enter into a contract with an external investor and let him develop the power plant, whether he will sell his property rights or postpone the decisions. All available choices will involve risk. In order for him to make the best choice he must find the certainty equivalent to each of the choices and choose the one with the highest certainty equivalent. This is the first time the utility theory of John von Neumann and Oskar Morgenstern has been applied to decision makers in the hydro power industry in Norway.

Cardiovascular risk factors (CRFs) such as hypertension, high cholesterol, and diabetes are increasingly implicated in cognitive decline and cerebral small vessel disease (cSVD). White matter hyperintensities (WMH), a hallmark of cSVD, are strongly linked to cognitive impairment, but their underlying mechanisms remain unclear. Blood-brain barrier (BBB) dysfunction has been proposed as a potential contributor to WMH development. This study aimed to explore the relationships between CRFs, BBB integrity, and WMH burden. We analyzed 155 participants from the Biomarkers and Cognition Study, Singapore, assessing CRFs through blood tests for glucose and lipid profiles, alongside blood pressure measurements. WMH volume was quantified using MRI, and an in vitro assay evaluated the impact of plasma on BBB integrity using human brain microvascular endothelial cells. Results showed that plasma from participants with higher WMH burden correlated with increased BBB disruption, which was further associated with higher blood pressure, elevated blood glucose, and lipid levels. Both periventricular and subcortical WMH were linked to BBB disruption. These findings suggest that CRFs contribute to BBB dysfunction, promoting WMH development and cognitive decline in cSVD. Further research is needed to clarify the precise mechanisms driving these associations.

Vaccination against HPV significantly reduced the incidence of HPV-related le-sions worldwide. Considering the increasingly younger age of patients in the gynaecological office and the resulting earlier sexual initiation and potentially contact with the HPV virus, doctors need to have tools to verify the diagnosis. Nowadays, women plan motherhood later, so it is necessary to consider whether sexual treatment in the form of, among others, LEEP-conization may increase the risk of premature birth or difficulty dilating the cervix during labour.For this reason, to avoid overtreatment of LSIL changes, methylation testing may be considered. In patients with histopathologically confirmed HSIL during biopsy and ultimately a lower diagnosis - i.e., LSIL or no signs of atypia - methylation turned out to be a useful tool. We performed Pap-smear, HPV genotyping, punch biopsy, LEEP-conization (if needed) and methylation test in 108 women admitted to the District Public Hospital in Poland. Women with a negative methylation test result were significantly more likely to be ultimately diagnosed with LSIL (p=0.013). This means that in 85.7% of patients with HSIL, major cervical surgery could have been avoided if methylation was negative. Methylation testing, as well as dual-staining and diagnostics detecting mRNA transcripts of highly oncogenic types of HPV, might be used in future in the diagnosis of pre-cancerous conditions, mainly of the cervix, and in HPV-dependent cervical cancer screening. The methylation test may also be used in the diagnosis and identification of lesions within the cervical canal, including those located deep within the frontal crypts, not visible even during a professional colposcopic evaluation of the cervix, as well as within the crypts of the palatine tonsils - in diagnostics of head and neck diseases.

Atherosclerosis is a leading cause of cardiovascular disease, characterized by lipid accumulation and chronic inflammation within arterial walls. Early detection in young adults is crucial for preventing adverse cardiovascular events. This study investigates the associations between inflammatory indices, lipid biomarkers, and the presence of atherosclerosis in patients aged 18 to 55 years. Methods: A cross-sectional study was conducted involving 89 participants divided into two groups: 62 patients with documented atherosclerosis (main group) and 27 healthy controls without significant atherosclerosis. Comprehensive data—including demographic information, medication use, imaging results, laboratory parameters, and calculated inflammatory indices (SIRI, SII, AISI, NLR, PLR, MLR)—were collected. Statistical analyses included correlation assessments, group comparisons using the Mann-Whitney U test, logistic regression modeling, feature importance analysis with Random Forest and Gradient Boosting classifiers, receiver operating characteristic (ROC) curves, and K-means clustering. Results: Significant differences were observed between the main and control groups. Patients with atherosclerosis exhibited elevated inflammatory indices (SIRI, NLR, MLR, SII) and lipid profile abnormalities (higher TC and LDL-C, lower HDL-C). Lp(a) and ANGPTL3 levels were significantly higher in the main group (p < 0.001 and p < 0.01, respectively). Logistic regression identified SIRI and ANGPTL3 as significant predictors of atherosclerosis, with the model demonstrating high accuracy (77%) and sensitivity (93%). Feature importance analysis confirmed the significance of SIRI and ANGPTL3, alongside traditional lipid biomarkers, in predicting disease presence. ROC analysis showed excellent model performance (AUC > 0.80). Clustering analysis revealed two distinct patient subgroups characterized by predominant inflammatory profiles or lipid metabolism disturbances. Conclusions: Systemic inflammation and lipid abnormalities play significant roles in early atherosclerosis among young adults. Elevated SIRI and ANGPTL3 levels are potent predictors of disease presence. The integration of inflammatory indices and lipid biomarkers into predictive models enhances risk stratification and supports personalized medicine approaches. Further research with larger cohorts is warranted to validate these findings and inform targeted prevention and intervention strategies.

This study investigated the prevalence and associated risk factors of Lower Back Pain (LBP) among medical students of Alfaisal University, Riyadh, Saudi Arabia. A cross-sectional style was employed where 331 medical students were evaluated using the Oswestry Disability Index (ODI) supplemented with demographic and lifestyle questions. Data analysis allowed identification of LBP-risk factor relationships. The study revealed a 73.4% prevalence of LBP among Alfaisal University medical students with a 4.61 average severity. Female students, those who spent long hours on computers, and those who did not exercise were more likely to experience LBP. Higher disability degree was associated with participants aged &gt;21, used their devices for extended periods, and insufficient sleep. LBP is highly prevalent with several risk factors existing. These findings highlight the need for targeted interventions such as ergonomic/lifestyle improvements and reduced device use.

Background. National surveys reported on variable prevalence of chronic kidney disease (CKD) due to differences in characteristics of population, design, equations used to estimate glomerular filtration rate (eGFR) and definitions. The EH-UH 2 survey is the first study evaluating CKD prevalence, characteristics and awareness in Croatia. Methods. This was a cross-sectional nationwide observational study designed to assess the prevalence and cardio-kidney-metabolic risk factors in Croatia which included 1765 randomly selected subjects. We estimated the prevalence of CKD by means of albumin-to-creatinine ratio (ACR) and eGFR (CKD EPI equation). Comorbidities, anthropometric and social factors related to the prevalence of CKD were analyzed, and CV risk profile was evaluated. Results. The weighted prevalence of CKD (any stage), CKD stage ≥ G3A A2, and CKD defined only as eGFR < 60 ml/min/1.73 m2 were estimated at 17.1%, 9.8% and 7.9%, respectively. The prevalence was higher in men than in women (11.8% vs. 7.9%; p 30 mg/g was 15.1%. Older age, male gender, diabetes, ePWV, and uric acid were independently associated with CKD prevalence. The awareness of CKD of 9.5%. Unaware were older with lower income, less educated, having more frequently diabetes, hypertension (less frequently controlled) and milder renal impairment. Conclusion. In Croatia, the estimated prevalence of CKD is high, being more frequently presented in men than in women. CKD patients have unfavorable CV risk profile. The awareness of CKD is very low reflecting poor health literacy in general population but also in health care workers.

Violence against healthcare workers (HCWs) is a widespread, underreported and inadequately prevented problem. Only a few companies have efficient systems for assessing the extent of the phenomenon. In 2005, the health surveillance service of a public health company introduced a system that monitored violence experienced by HCWs by means of three items from the Violent Incident Form (VIF), integrated with departmental in-depth analyses using the participatory ergonomics group technique. In 2005, the annual rate of physical assaults was 8.2%, that of threats 12.0%, while the harassment rate was 19.6%. Over the past twenty years of observation (2005-2024), the percentage of workers who reported experiencing a physical attack in the previous year at their periodic medical examination, has fluctuated between 5.8% and 11.1%, except for the years 2020 and 2021 when, during the COVID-19 pandemic, the rate was 3.9% and 3.2%, respectively. During the same pandemic period, the annual threat rate that ranged from 9.4% to 20.1%, dropped to 7.7%, while the prevalence of harassment, that was between 13.5 and 19.6, fell to 7.2%. HCWs believe that (i) limiting visitor access (ii) a better balance of the demand for services and (iii) a better attitude towards HCWs were the causes of the reduced rate of violence during the pandemic. Recording the violence experienced during health surveillance is an economical, reliable and sustainable risk assessment method.

This review paper focuses on the joint toxicity and interaction of carbon-based nanomaterials (CNMs) with co-existing pollutants in aquatic environments. It explores the potential harmful effects of chemical mixtures on living organisms, emphasizing the importance of scientific mod-eling to predict mixed toxic effects. The study involved a systematic literature review to gather information on the joint toxicity and interaction between CNMs and various co-contaminants in aquatic settings. A total of 53 publications were chosen and analyzed, categorizing the studies based on the tested CNMs, types of co-contaminants, and the used species. Common test models included fish and microalgae, with zebrafish being the most studied species. The review under-scores the necessity of conducting mixture toxicity testing to assess whether the combined effects of CNMs and co-existing pollutants are additive, synergistic, or antagonistic. The development of in silico models based on the solid foundation of research data represents the best opportunity for joint toxicity prediction, eliminating the need in a great quantity of experimental studies.

This study examines the balancing between urban transportation security and supply chain efficiency amid global disruptions like the COVID-19 pandemic, attacks on maritime lanes, and geopolitical conflicts. The authors combine bibliometric network analysis and natural language processing (NLP) to review scholarly literature from 2017 to 2023. This approach identifies and visualizes evolving thematic trends. Findings reveal a shift towards integrating advanced technologies such as blockchain, AI, and IoT to enhance security without compromising efficiency. This study highlights the significance of integrating urban planning principles and sustainable practices to enhance transportation security and supply chain efficiency within urban environments. Actionable insights for policymakers and supply chain managers emphasize the adoption of integrated, technology-driven security solutions to foster resilient and sustainable supply chains. This research contributes to academic discourse by refining the understanding of evolving priorities in transportation security and supply chain management, offering both theoretical and practical implications for secure and efficient global supply chains.

The complexity of plastic polymers and even more so of additives has increased enormously in recent years. This makes the high-quality recycling of mixed plastic waste considerably more difficult. Some additives have now been strictly regulated or even completely banned for good reasons ('legacy additives'). Material or mechanical recycling generally utilises old plastics that still contain these substances. Consequently, products that are manufactured using such recyclates are contaminated with these harmful substances. We therefore recommend avoiding the use of these recyclates for products with intensive contact with consumers until further notice. We also show that the climate policy challenges for the plastics (and chemical) industry necessitate a defossilisation ('feedstock change'). This turnaround can only succeed if solely high-quality recycling takes place in future; recyclates should primarily replace virgin plastics. This can only work if used plastics with a high degree of homogeneity and known formulation are collected separately, as is already the case today with PET bottles. In this context, we would like to point out inconsistencies in the current legislation on the European emissions trading system.

The problem of energy poverty, when energy becomes unaffordable for some population group, is not only a problem for developing countries, but this phenomenon is appearing more and more often in European countries as well. In Europe, it is estimated that 50 to 125 million people are at risk of energy poverty. We hear more and more about energy poverty in connection with the current energy crisis and rising energy prices, but also as a result of insufficient use of renewable energy sources. Due to rising energy prices, we are increasingly hearing about deepening energy poverty in Slovakia as well. The aim of the contribution is to examine the development of energy poverty in Slovakia compared to other EU countries. The situation is studied from the view of the number of days of heating and cooling, the percentage of the population that cannot maintain adequate heat at home, the percentage of the population that has a lack of heat and the percentage of residents without enough heat. During the research, we used distribution analysis, trend analysis, analysis of variance and one-way analysis. The main results show that HDD index recorded decrease, CDD index recorded increase, and Energy poverty is most obvious in low-income group of inhabitants, having shortage of heat, when RES use contribute to mitigation of energy poverty. Solving the unfavorable situation with energy poverty is possible by increasing the share of Renewable energy sources in the gross final energy consumption for heating and cooling, primarily in residential buildings. The results provide information for policy makers in area of economic, social and environmental decision-making.

Ulleung County, one of the most medically vulnerable areas in South Korea, requires public attention because of the high incidence of liver cancer. This study was conducted as a part of the Ulleung Liver Cancer Prevention and Management Project. The purpose of this study was to estimate the community prevalence of hepatitis B and C viruses and to identify the associated risk factors. The Project’s interagency workgroup established a procedure for conducting blood sampling and health behavior surveys at the Ulleung Public Community Health Center. A total of 1,792 residents aged 40 years and older voluntarily participated in the study between 2019 and 2022. The hepatitis B surface antigen (HBs Ag) and hepatitis C virus antibody (anti-HCV) positive rates in Ulleung were 7.19% and 1.37%, respectively. Low education level and lifetime smoking were associated with HBsAg positivity, whereas cupping therapy at non-medical institutions was associated with anti-HCV positivity. The odds of HBs Ag positivity were lower among those with tattoos than among those without. There was a difference in the risk factors associated with hepatitis B and C viral infection. While a high HBs Ag positivity rate alone may not fully explain the high incidence of liver cancer in Ulleung, it may be a contributing factor.

Advanced air treatment systems have the potential to reduce airborne infection risk, improve indoor air quality (IAQ) and reduce energy consumption, but few studies reported practical implementation and performance. PlasmaShield®, an advanced multi-modal HVAC-integrated system was directly compared with a standard MERV-13 system in a post-surgical pediatric healthcare setting. The evaluation entailed monitoring of multi-size airborne particles, bioaerosols and key IAQ parameters. Measurements were made of outside air, recovery room supply air and air in the occupied space for 3 days prior to, and after, installation of the PlasmaShield system. Compared with the existing arrangement, very significant reductions in particle number concentrations were observed in the occupied space, especially with virus-like submicron particles. Significant reductions in airborne culturable bacteria and fungi were observed in the supply air, with more modest reductions in the occupied space. In the case of virus-like particles, there was an 8-fold improvement in equivalent clean air, suggesting a 5-fold infection risk reduction for long range exposure. The data suggest multiple benefits of airborne particle and biaerosol reduction, with applications beyond healthcare. Long term studies are recommended to confirm the combined IAQ, health and energy benefits.

We estimated the risk of blood clots after COVID-19 vaccination accounting for the roles of vaccination in reducing the infection rate, and indirectly lowering the risk of blood clots caused by infection. A self-controlled case series method was used to examine the association between blood clots and COVID-19 vaccination. To deal with the bias due to under-reported infection among non-hospitalized subjects, a case-control study was used to compare the risk of blood clots in infected subjects to control subjects who were hospitalized due to physical injury. We found increased risks of blood clots after vaccination (incidence rate ratio is 1.13, 95% confidence interval (CI): [1.03, 1.24] after the first dose and 1.23, 95% CI: [1.13,1.34] after the second dose). Furthermore, vaccination attenuated the increased risk of blood clots associated with infection (odds ratio (OR) = 2.16, 95% CI: [1.93, 2.42] in unvaccinated versus OR=1.46, 95% CI: [1.25, 1.70] in vaccinated). A causal model was used to explain and weigh up possible risk factors for blood clots after COVID-19 vaccination. After accounting for vaccine efficacy against infection and the protection against infection-associated blood clots, receiving the COVID-19 vaccines decreases the risk of blood clots, especially during high infection rate period.

The study is dedicated to analyzing the complex interaction between Artificial Intelligence (AI) and the Internet of Things (IoT) with institutional structures in the context of sustainable development. This work examines the impact of these technologies on economic and social development, identifying their potential advantages and risks. Methodologically, the research relies on information gathering and case study analysis, assessing the impact of technology in various domains, from smart cities to the manufacturing sector. The findings emphasize the necessity of integrating technological innovations into broader social and environmental initiatives, highlighting the importance of institutional transformations for achieving environmental sustainability.

Keywords: Marine Coasts; Protected Areas; Defense and Conservation; Asbestos Cement Materials; Wastes; Contamination; Human Health Risk; Medical Geology.

Debates on climate change challenges around the world are moving in favour of nature-based solutions (NBS) as potential mitigation and adaptation options. Mangroves and associated blue carbon ecosystems are nature-based solutions against sea level rise and other coastal hazards. As such, protecting the existing mangrove forests and restoration of the degraded areas is integral in this aspect. However, conventional mangrove restoration approaches in high-energy areas result in poor performance due to the removal of seedlings by waves. Here, we assessed the efficacy of using modified Riley Encasement Methods in the restoration of eroding intertidal areas of Gazi Bay, Kenya. Vegetation and soil baseline data were collected in 49 square plots of 100m2; established along belt transects perpendicular to the waterline. The following mangrove vegetation data was collected; species composition, tree height (m), and stem diameter (cm); from which the importance value index (IV), basal area and standing density (stems/ha) were derived. Sediment cores were made in the center of each square plot for carbon and grain size analysis. Mangrove (Rhizophora mucronata) planting adopted a randomized complete block design (RCBD) in which the planting area was divided into three blocks (A, B, C). Within each block, treatments (bamboo and different-sized PVC pipes) were randomly assigned locations. Results show that seedlings grown within PVC encasements had high survival and growth rates, surpassing bamboo and control groups. This implies that PVC pipes offer better protection from external factors. These findings are critical in highlighting potential enhancements for the effectiveness of PVC pipes in mangrove restoration. They also reinforce on the need to consider the incorporation of PVC encasements as an alternative mangrove restoration technique in high-energy locations.

Retinoids are vitamin A derivatives and include trans-retinoic acid, isotretinoin, tamibarotene, and bexarotene, all of which are currently available for clinical use. The clinical development of retinoid therapy for neuroblastoma has a history spanning more than four decades. The most promising agent is isotretinoin, which can contribute to improving event-free survival in patients with high-risk neuroblastoma by approximately 10 % when administered over six months as maintenance therapy. Although isotretinoin is regarded as an essential component in the standard clinical management of high-risk neuroblastoma, its use for this purpose in the US and EU is off-label. To promote isotretinoin use in Japan as a treatment for neuroblastoma, our clinical research team is planning to launch an investigator-initiated, registration-directed clinical trial. The present review article discusses the basic science behind retinoid therapy, pre-clinical / clinical evidence on neuroblastoma, the concept of the proposed clinical trial, and prospects for this therapy.

This article explores the relationship between metabolic syndrome and cardiovascular disease, providing a comprehensive overview of its risk factors and prevalence. Metabolic syndrome, characterized by a cluster of interconnected risk factors, significantly increases the likelihood of developing cardiovascular disease and type II diabetes. The study, conducted over a one-year period, involved 117 patients with ages between 30 to 79 years old. Various elements such as gender, age, education level, background, smoking, alcohol consumption, dietary aspects, physical activity, and their contribution in developing the metabolic syndrome, were analysed.Central adiposity and high blood pressure emerged as prominent elements of the condition. The findings underscore the importance of a healthy lifestyle in the prevention and management of metabolic syndrome. Encouraging regular physical activity, maintaining a balanced diet, rich in fresh vegetables and fruits, and avoiding harmful behaviours, such as smoking or alcohol consumption, are essential in reducing the risk of metabolic syndrome and its associated cardiovascular complications. The study highlights the need for public health initiatives, as well as individualized preventive strategies to combat the rising prevalence of metabolic syndrome. Through promoting awareness of its risk factors and implementing effective interventions, healthcare professionals can contribute to better cardiovascular health worldwide. Further research in this area will continue to enhance our understanding of the metabolic syndrome and refine preventive and therapeutic approaches for its management.

Cervical carcinogenesis is the leading cause of cancer related death in women and the role of high-risk human papillomavirus (HR-HPV) as a possible risk factor in the development of this cancer is well recognised. Despite the availability of multi-therapeutic approaches, there is still a major concern regarding the prevention of metastatic dissemination and excessive tissue injuries. Therefore, it is imperative to develop a safer and more efficient treatment modality. Ficus Carica, a natural plant, has shown potential therapeutic properties through its fruit latex when applied to HPV-positive cervical cancer cell lines. However, the mechanisms of action of Ficus Carica (fig) latex are not well understood. This study aims to provide a deeper insight into the biological activities of fig latex on human cervical cancer cell lines expressing high-risk HPV types 16 and 18. The data obtained from this study reveals that fig latex influences the expression of genes in-volved in "Class I MHC-mediated antigen presentation" as well as "Antigen processing: Ubiquitination and Proteasome degradation." These genes play a crucial role in host immune surveillance and the resolution of infection. Findings from this study suggest that fig latex may enhance T cell responses against oncogenic HPV, which could be beneficial for the clearance of early-stage cancer.

The Victorian Government Inquiry into wildfires that killed 173 people in 2009 has driven an Australian policy shift from self-evacuation or staying and defending a well-prepared property (‘go or stay’) to self-evacuation under catastrophic fire weather (‘leave early’). The Inquiry also led to the establishment of national ‘performance standards’ for Private Fire Shelters (PFS, that also known as bunkers). Nonetheless, incorporation of PFS into national bushfire policy remains embryonic with only Victoria having streamlined accreditation and planning approval processes. Arguments against PFS include potentially engendering complacency about preparing dwellings to survive fire and encourage risky behavior in response to a fire threat. Counteracting these arguments is research that shows that residents without PFS have low engagement with bushfire preparation and typically delay evacuation. In any case, because wildfire is unpredictable it is accepted that self-evacuation plans must have fallback positions that include sheltering ‘in place’ from the bushfire, making properly used and well maintained PFS an important element of bushfire safety. A less discussed barrier to PFS uptake outside Victoria appears to hinge on a lack of clarity about obligations for their design, certification, and consistency with planning approvals. The escalating Australian fire crisis demands much greater research and development in legal frameworks, policy and planning processes for PFS, as well as design and construction standards.

Abstract: This is a retrospective study of patients admitted to Jackson Hospital, Montgomery, Alabama with a diagnosis of COVID-19 from January 1, 2021, to February 15, 2022. The independent variable used in the models were patient sex, age, race, BMI category, daily D-dimer categories, categories of anticoagulation doses (Enoxaparin 40 mg VS. Enoxaparin 80 mg VS Enoxaparin 1mg/kg or equivalent), bleeding episodes, and vaccination status. The three different categories of anticoagulation doses were considered for the purpose of the study. Results: The study reviewed a total of one hundred (100) hospitalized patients. Intermediate-dose anticoagulation was found to be the optimal dose as only fourteen percent (14%) patients died compared to a thirty-six percent (36%) and fifty percent (57%) death rate among those treated with low-dose and high-dose anticoagulation, respectively. The multivariate linear regression model predicting patient oxygen requirements revealed D-Dimer and bleeding status to be statistically significant predictors with a p value of <0.01. For the patients who had a D-dimer value ≥ 2 µg/mL, the oxygenation requirement was predicted to be 31 L higher than those with a D-dimer <2 µg/mL (99% CI; p<0.01). When mean D-dimer and corresponding oxygen requirements were calculated per hospitalization days category, the D-dimer levels and oxygen requirements were noted to follow the same trends indicating both values tended to increase and decrease simultaneously. Conclusion: The study concludes daily D-dimer trends can predict COVID-19 patient survival or daily oxygen requirements indicating D-dimer can be the miracle molecule for COVID-19 prognosis.

In various domains such as energy, manufacturing, and maritime, cyber-physical systems (CPS) have seen increased interest. Both academia and industry have focused on the cybersecurity aspects of such systems. The assessment of cyber risks in CPS is a popular research area with many existing approaches that aim to suggest relevant methods and practices. However, few works have addressed the extensive and objective evaluation of the proposed approaches. In this paper, a standard-aligned evaluation methodology is presented and empirically conducted to evaluate a newly proposed cyber risk assessment approach for CPS. The approach, which is called FMECA-ATT&CK is based on Failure Mode, Effects & Criticality Analysis (FMECA) risk assessment process and enriched with the semantics and encoded knowledge in the Adversarial Tactics, Techniques, and Common Knowledge framework (ATT&CK). Several experts were involved in conducting two risk assessment processes, FMECA-ATT\&CK and Bow-Tie, against two use cases in different application domains, particularly an autonomous passenger ship (APS) as a maritime use case and a digital substation as an energy use case. This allows for the evaluation of the approach based on a group of characteristics, namely, applicability, feasibility, accuracy, comprehensiveness, adaptability, scalability, and usability. The results highlight the positive utility of FMECA-ATT&CK in model-based, design-level, and component-level cyber risk assessment of CPS with several identified directions for improvements. Moreover, the standard-aligned evaluation method and the evaluation characteristics have been demonstrated as enablers for the thorough evaluation of cyber risk assessment methods.

In its 8th Malaysia Plan (MP*), the Malaysian government has given nanotechnology development a high priority and has been made a Strategic Research (SR) programme. Consequently, an exhaustive and long-term approach is essential. Additionally, specific laws are required to provide an optimal health and safety environment for workers. Consequently, the current study intends to assist Malaysian policymakers in promoting improved safety, risk assessment, and management for nanotechnology workplaces, as well as drafting a comprehensive policy for the recently released DOSH guideline in 2018. Utilizing a unique methodology, this study evaluated the assessment and management of nanotechnology health and safety risks in Malaysia using the international risk governance council (IRGC) framework. In addition to document analysis, n = 20 semi-structured interviews were conducted with representatives of several nanotechnology platforms to collect data that was then analyzed thematically. The research evaluated current workplace safety regulations and laws. Consequently, we propose a future dynamic strategy for Malaysian nanotechnology with more favourable upgrades supported by increased concentrations in the following areas: I policy creation, ii) comprehensive management system, iii) knowledge transfer, and iv) infrastructure management. In addition, the findings highlight the need of cross-sectional communication in bridging existing gaps. This study laid the groundwork for a more systematic and comprehensive health and safety strategy.

A critical aspect of coronary heart disease (CHD) care and secondary prevention is ensuring patients have access to evidence-based information. The purpose of this review is to summarise the guiding principles, content, context and timing of information and education that is beneficial for supporting people with CHD and potential communication strategies including digital interventions. We conducted a scoping review involving searching four databases (Web of Science, PubMed, CINAHL, Medline) for articles published from January 2000 to August 2022. Literature was identified through title and abstract screening by expert reviewers. Evidence was synthesised according to the review aims. Results demonstrated that information-sharing, decision-making, goal-setting, positivity and practicality are important aspects of secondary prevention and should be patient-centred and evidenced based with consideration of patient need and preference. Initiation and duration of education is highly variable between and within people, but hence communication and support should be regular and ongoing. In conclusion, text messaging programs, smartphone applications and wearable devices are examples of digital health strategies that facilitate education and support for patients with heart disease. There is no one size fits all approach that suits all patients at all stages and hence flexibility and a suite of resources and strategies is optimal.

Flood events and their associated damages have escalated significantly in the last few decades. To add to the gruesome situation, many reports and studies warn that flood risk would aggravate significantly in future periods due to significant alterations in the climate patterns and socio-economic dynamics. Floodplain mapping is looked upon as a viable option to tackle this global issue as it provides both quantitative and qualitative information on flood dynamics. Moreover, with the increasing availability of global data and enhancement in computational simulations, it has become easier to simlate flooding patterns at large scales. This study deter-mines the usability of publicly available datasets in capturing flood hazards over Canada. Run-off data set from the North American Regional Reanalysis (NARR), along with a few other rele-vant inputs are fed to CaMa-Flood, a robust global hydrodynamic model to generate flooding patterns for 1 in 100 and 1 in 200-yr return period events over Canada . The simulated maps are compared and validated with the existing maps of a few flood-prone regions in Canada, thereby establishing their performance over both regional and country-scale. Later, the simulated flood-plain maps are used in conjunction with property related information at 34 cities (within the top 100 populous cities in Canada) to determine the degree of exposure due to flooding in 1991, 2001, and 2011. The results indicate that around 80 percent of inundated spots belong to high and very-high hazard classes in a 200-yr event, which is roughly 4 percent more than simulated for 100-yr event. NARR derived floodplain maps perform very well while compared over the six flood-prone regions. While analyzing the exposure of properties to flooding, we notice an in-crease in the number during the last three decades, with the maximum rise observed in Toronto, followed by Montreal, and Edmonton. To disseminate the extensive flood-related information, a web-based public tool, Flood Map Viewer (http://www.floodmapviewer.com/) is developed. The development of the tool was motivated by the commitment of the Canadian government to provide $63 M over the next three years for the completion of flood maps for higher-risk areas. The study reaches out to demonstrate how publicly available datasets can be utilized with a lesser degree of uncertainty in representing flooding patterns over large regions. The flood re-lated information derived from the study can be used along with vulnerability for quantifying flood risk, which will help in developing appropriate pathways for resilience building for long-term sustainable benefits.

The Short-Term Assessment of Risk and Treatability (START) is deemed the most appropriate instrument for assessing violence risks and management because of its balanced approach between dynamic risk and protective factors. Although several facets of reliability and predictive validity of this tool were strong, its inter-rater reliability, construct validity, and implementation in Asian population were under-investigated. The objective of this research was to examine the inter-rater reliability and construct validity of the START: Thai version within forensic psychiatric inpatients. The participants consisted of 118 forensic psychiatric inpatients hospitalized at Galya Rajanagarindra Institute in Thailand. Trained mental health professionals (i.e., psychiatrists, forensic nurses, clinical psychologists, social workers, and occupational therapists) assessed each participant across twenty domains of the Thai START. The inter-rater reliability was examined using the intraclass correlation coefficient and a confirmatory factor analysis for ordinal data was used to test the construct validity of the scale. The main finding showed a good-to-excellent inter-rater reliability and supported two relational constructs (i.e., strength vs vulnerability subscales) of the Thai START. The Thai START is a promising tool for using in Thai forensic psychiatric setting but some items were not significant in contributing to the scale. This study also provides the guideline for implementing the tool in non-Western forensic psychiatric populations.

Deep reinforcement learning (DRL) has achieved significant results in many Machine Learning (ML) benchmarks. In this short survey we provide an overview of DRL applied to trading on financial markets, including a short meta-analysis using Google Scholar, with an emphasis on using hierarchy for dividing the problem space as well as using model-based RL to learn a world model of the trading environment which can be used for prediction. In addition, multiple risk measures are defined and discussed, which not only provide a way of quantifying the performance of various algorithms, but they can also act as (dense) reward-shaping mechanisms for the agent. We discuss in detail the various state representations used for financial markets, which we consider critical for the success and efficiency of such DRL agents. The market in focus for this survey is the cryptocurrency market.

A total of 281 guano samples were collected from caves (N = 181) in 8 European countries (Bulgaria, Czech Republic, France, Hungary, Italy, Romania, Slovakia and Slovenia) and attics in the Czech R. (N = 100). The correlation of detection of mycobacteria between Ziehl-Neelsen (ZN) microscopy and culture examination and qPCR was strong. ZN microscopy was positive in guano from caves (58.6%) more than double than positivity in guano from attics (21.0%; P &lt;0.01). From 89 mycobacterial isolates (73 isolates from cave guano and 16 isolates from attics’ guano) 68 (76.4%) isolates of 19 sp., ssp. and complex were identified as members of 3 Groups (M. fortuitum, M. chelonae, and M. mucogenicum), and 4 Complexes (M. avium, M. terrae, M. vaccae, and M. smegmatis). A total of 20 isolates (22,5%) belonged to risk group 1 (environmental saprophytes), 48 isolates (53.9%) belonged to risk group 2 (potential pathogens), and none of isolates belonged to risk group 3 (obligatory pathogens). When comparing bat guano collected from caves and attics, differences (P&lt;0.01; Mann-Whitney test) were observed for the electrical conductivity, total carbon, total organic and total inorganic carbon. None difference (P&gt; 0.05; Mann-Whitney test) was found for pH and oxidation-reduction potential parameters.

: Chemical accidents can occur anywhere. The need for chemical management in Korea was realized following the 2012 Gumi hydrofluoric acid accident in 2012. The Chemicals Control Act was enacted in 2015. This system evaluates the risks (high, medium, low) and consequent safety management at all plants that handle hazardous chemical substances. However, the system was criticized as excessive when most plants were designated high-risk without considering their size. Thus, laboratories and hospitals handling very small quantities were subject to regulation. Accordingly, in 2021 Korea revised the system to include off-site consequence analyses and a Korean-style risk analysis. Plants handling very small quantities, such as laboratories and hospitals, were exempt from regulation. In this study, plating and paint manufacturing companies, which were classified as high-risk in the previous system, even though they were medium-size business plants, were re-evaluated as low-risk plants. In the Korean-style risk analysis, it is possible to see at a glance what is lacking in the plants, such as cooperation between local residents and local governments and the construction of safety facilities according to the type of accident scenario. The revised system is a reasonable regulation for medium business plants.

Background: During the COVID-19 pandemic, hygiene behaviors such as keeping distance, avoid-ing masses, wearing face masks and adhering to hand hygiene recommendations became impera-tive. The current study aims to determine factors interrelating with hygiene behaviors. Methods: 4,049 individuals (1,305 male, 2,709 female, aged 18-80 years) were recruited from rehabilitation clinics or freely on the internet and surveyed via online questionnaire between May 2020 and August 2021. Socio-demographics, hygiene behaviors, emotions (fear), life-satisfaction, risk factors and disability as well as communication were assessed. Results: Prevalence for hygiene behaviors was: keeping the distance 84.9%, avoiding mass gatherings 84.6%, wearing face masks 96.5% and hand hygiene 80.7%. Hygiene behaviors were significantly related to fear with linear and quad-ratic associations. Conclusion: Individuals with disabilities, risk factors and psychological symp-toms are more compliant. Especially hand hygiene should be targeted to achieve higher compli-ance rates. A medium level of fear is more functional than too elevated fear. Behavioral interven-tions and targeted communication aiming at improving different behaviors in orchestration can help individuals to remain healthy and maintain a high life-satisfaction. Thereby, communication in the healthcare setting is imperative and all involved individuals should become more aware of this to ensure high hygiene standards and patient safety.

Reassessment of the fatigue life for wind turbines structural components is typically performed using deterministic methods with the same partial safety factors as used for the original design. However, in relation to life extension, the conditions are generally different from the assumptions used for calibration of partial safety factors; and using a deterministic assessment method with these partial safety factors might not lead to optimal decisions. In this paper, the deterministic assessment method is compared to probabilistic and risk-based approaches, and the economic feasibility is assessed for a case wind farm. Using the models also used for calibration of partial safety factors in IEC61400-1 ed. 4 it is found that the probabilistic assessment generally leads to longer additional fatigue life than the deterministic assessment method. The longer duration of the extended life can make life extension feasible in more situations. The risk-based model is applied to include the risk of failure directly in the economic feasibility assessment and it is found that the reliability can be much lower than the target for new turbines, without compromising the economic feasibility.

(1) Aims: To analyse the relationship between demographic and clinical characteristics and particular kinds of suicidal behaviour and its relationship with a nurse-led suicide prevention program. (2) Methods: A 5-year cross-sectional study design. Study performed in the region of Osona (Catalonia) during 2013-2017. Suicidal behaviour was classified as suicidal ideation, interrupted self-directed violence, suicide attempt and completed suicide. (3) Results: The sample included 753 patients ─ of whom 53 died by suicide─ and encompassed 931 suicidal behaviour episodes. Men represented 38.4% of the sample but 81.1% of deaths by suicide. Mental disorders were associated with suicidal behaviour in 75.4% of the sample. 66.4% of the individuals were engaged in the nurse-led Suicidal Behaviour Case Management Program, of which 0.8% (n=4) died by suicide. (4) Conclusion: The main risk factors were female sex for suicidal behaviour, and male sex and older age for suicide. Mental disorders, widowhood and retirement were also associated with suicide. A high proportion of patients was engaged to the nurse-led suicide prevention program with a low proportion of suicides.

The rising incidence of complex illnesses and their costs have revolutionized basic research, patient management, and societal needs. Between 70 to 90% of the risk of developing a disease is due to the air we breathe, the water we drink, and the surroundings in which we work and live. Visibly polluted, infectious or not, the fact remains that we are more than ever exposed to environmental risks. Air pollution is the fourth most prevalent deadly risk factor worldwide and by far the leading risk factor for hundreds of diseases, including respiratory infections, inflammatory illness, and cancer. Thus, an unhealthy environment can be considered as a pandemic, affecting 280 million people and claiming 12 million deaths every year. Although critical for identifying of the people at risk, the causal environment components (pollutants and/or the microbiome), and the affected physiological mechanisms are not well understood. Herein, we consider the dysregulation of macroautophagy (hereafter referred to as ‘autophagy’), as the mechanism at the heart of an immediate response to environmental stress. We discuss the missing link between the autophagy gene variations, and the exposome in the susceptibility, prognosis, and management of complex diseases when embracing personalized medicine.

COVID-19 (2019-nCoV) is a pandemic disease with an estimated mortality rate of 3.4% (estimated by the WHO as of March 3, 2020). Until now there is no antiviral drug and vaccine for COVID-19. The current overwhelming situation by COVID-19 patients in hospitals is likely to increase in the next few months. About 15 percent of patients with serious disease in COVID-19 require immediate health services. Rather than waiting for new anti-viral drugs or vaccines that take a few months to years to develop and test, several researchers and public health agencies are attempting to repurpose medicines that are already approved for another similar disease and have proved to be fairly effective. This study aims to identify FDA approved drugs that can be used for drug repurposing and identify biomarkers among high- risk and asymptomatic groups. In this study gene-disease association related to COVID-19 reported mild, severe symptoms and clinical outcomes were determined. The high-risk group was studied related to SARS-CoV-2 viral entry and life cycle by using Disgenet and compared with curated COVID-19 gene data sets from the CTD database. The overlapped gene sets were enriched and the selected genes were constructed for protein-protein interaction networks. Through interactome, key genes were identified for COVID-19 and also for high risk and asymptomatic groups. The key hub genes involved in COVID-19 were VEGFA, TNF, IL-6, CXCL8, IL10, CCL2, IL1B, TLR4, ICAM1, MMP9. The identified key genes were used for drug-gene interaction for drug repurposing. The chloroquine, lenalidomide, pentoxifylline, thalidome, sorafenib, pacitaxel, rapamycin, cortisol, statins were proposed to be probable drug repurposing candidates for the treatment of COVID-19. However, these predicted drug candidates need to be validated through randomized clinical trials. Also, a key gene involved in high risk and the asymptomatic group were identified, which can be used as probable biomarkers for early identification.

Risk-based redispatch optimization is proposed as a methodology to support the Transmission System Operator (TSO) with preventive remedial actions obtained by extending the security constrained unit commitment/economic dispatch with constraints resulting from the risk assessed for the power system. Although being heuristic, the methodology is based on comprehensive dynamic security assessment as time-domain simulations are used, allowing to express the degree of all types of instabilities, e.g., caused by contingencies, in monetary terms. Therefore, the risk is assessed as the expected value of the cost incurred by the TSO. Such approach forms a new pathway to including risk in planning procedures already used by TSOs. Results obtained for the IEEE39 dynamic power system, with costs assigned to load shedding and generator tripping due to single transmission lines short-circuits, are shown as a reference case.

In this paper, we study a generalised CIR process with externally-exciting and self-exciting jumps, and focus on the distributional properties and applications of this process and its aggregated process. The first and second moments of this jump-diffusion process are used to calculate the insurance premium based on mean-variance principle. The Laplace transform of the aggregated process is derived, and this leads to an application for pricing default-free bonds which could capture the impacts of both exogenous and endogenous shocks. Illustrative numerical examples and comparisons with other models are also provided.

Warming of the climate system is unequivocal, and many of the observed changes are unprecedented over five decades to millennia. Globally the atmosphere and ocean is increasingly getting warmer, the amount of ice on the earth is decreasing over the oceans, and the sea level has risen. According to Intergovernmental Panel on Climate Change, the total increasing temperature globally averaged combined land and surface between the average of the 1850-1900 period and the 2003 to 2012 period is 0.78 °C (0.72 to 0.85). But should we prepare for such the relatively small change? The importance is not the mean of the warming but the considerable likelihood of climate change that could trigger extreme natural hazards. The impact and the risk of climate change associated with railway infrastructure have not been fully addressed in the literature due to the difference in local environmental parameters. On the other hand, the current railway network in Malaysia, over the last decade, has been significantly affected by severe weather conditions such as rainfall, lightning, wind and very high temperatures. Our research findings point out the extremes that can lead to asset system failure, degraded operation and ultimately, delays to train services. During the period of flood, the embankment of the track can be swept away and bridge can be demolished, while during drought, the embankment of the track can suffer from soil desiccation and embankment deterioration, high temperature increases the risk of track buckling and high winds can result in vegetation or foreign object incursion on to the infrastructure as well as additional quasi-static burden exerted. This review is of significant importance for planning and design of the newly proposed high speed rail link between Malaysia and Singapore.

With the gradual development and integration of artificial intelligence into various industries, there is also a great range of integration in the financial industry. Therefore, this article focuses on the trend prediction model and financial risk management problems of deep reinforcement learning (DRL), one of the largest branches of artificial intelligence, in the cryptocurrency market. In addition, in the experimental part of this paper, the artificial intelligence machine learning Long short-term memory network (LSTM) model is used to make effective time series prediction and analysis on the relevant data of the cryptocurrency market, so as to make a large-scale analysis to improve the accuracy of market trend prediction and the effectiveness of risk management. In addition, in this experiment, technology-related indicators, emotional states of financial market customers and other content related to large language models are combined. While optimizing investment strategy by using deep reinforcement learning algorithm, machine learning prediction model is also used to capture the time dependence of financial market. The experimental results also show that the predicted results are consistent with the actual value. Therefore, the model has high practical application value in predicting the time series price trend of cryptocurrency in the financial market and indicates that the integrated DRL model framework can further optimize and manage the price and trading strategy of the financial market. Future research should focus on improving the LSTM model and incorporating more features to improve prediction accuracy and adapt to market changes.

This review aims to show, by an analysis of the literature on the topic, that hyperinsulinemia associated with insulin resistance is a multiple risk factor for type 2 diabetes, cardiovascular diseases, cellular senescence and cancer, and neurodegenerative diseases. This condition is progressively increasing in developed and developing countries, and its prevalence has now exceeded 50% of the general population. Since it is asymptomatic or poorly symptomatic, it can last for many years before manifesting itself in the form of type 2 diabetes mellitus, cardiovascular disease, neoplasm, cognitive impairment or dementia, therefore determining enormous social and health care costs. For these reasons, we strongly believe that a screening plan for this pathology should be implemented, in order to identify affected subjects and promptly start them on preventive treatment.

This qualitative study investigates the management of supplier risks in e-commerce through relationship management strategies, focusing on trust-building, communication practices, digital technology integration, risk assessment methodologies, challenges, innovation initiatives, and ethical considerations. The research aims to provide nuanced insights into how e-commerce companies navigate the complexities of global supply chains to mitigate operational, financial, and reputational risks associated with supplier relationships. Through semi-structured interviews with 20 key stakeholders in the e-commerce sector, data were collected and analyzed using thematic analysis. The findings underscored the foundational role of trust in establishing resilient supplier relationships, facilitated by transparent communication, consistent performance evaluation, and mutual respect for contractual obligations. Effective communication practices, supported by digital platforms and technologies such as AI, blockchain, IoT, and cloud computing, enhanced operational transparency and decision-making capabilities across supply chains. The study identified diverse approaches to risk assessment, from qualitative evaluations to quantitative models utilizing predictive analytics and scenario planning. However, participants highlighted challenges including geopolitical uncertainties, trade disruptions, regulatory changes, and cultural barriers, necessitating adaptive strategies and diversified sourcing options. Innovation initiatives such as joint product development and technology adoption were crucial in enhancing supply chain agility and competitive advantage. Ethical considerations emerged as a critical aspect, influencing supplier selection criteria, CSR initiatives, environmental sustainability practices, and labor standards compliance. Integrating ethical guidelines into supplier contracts reinforced corporate values and enhanced brand reputation. Overall, this study contributes practical implications for e-commerce practitioners seeking to enhance supply chain resilience, mitigate supplier risks, and sustain competitive advantage in a dynamic global marketplace.

The qualitative research on the influence of supply chain risk management (SCRM) on marketing strategies during economic uncertainty explores the complex interplay between these two critical areas. Conducted through in-depth interviews with industry professionals across various sectors, the study examines how organizations manage supply chain risks and adapt their marketing strategies in response to challenges such as natural disasters, geopolitical tensions, economic downturns, and pandemics. The findings reveal that these risks significantly impact marketing efforts by causing supply shortages, delays, increased costs, and demand fluctuations, necessitating rapid adjustments in promotional activities, pricing strategies, and communication with customers. Key strategies for integrating SCRM with marketing include leveraging technology for real-time supply chain monitoring, building strong supplier relationships, diversifying supply sources, and enhancing communication and collaboration between supply chain and marketing teams. These practices enable organizations to enhance their resilience and responsiveness, ensuring that marketing strategies are aligned with the evolving realities of the supply chain. The study also identifies challenges such as organizational silos, lack of cross-functional collaboration, resistance to change, and limited technological capabilities, which can hinder effective integration. Addressing these barriers through fostering collaboration, investing in technology, and promoting change management is essential for achieving successful integration. The outcomes of this integration include improved supply chain resilience, enhanced customer satisfaction, increased marketing agility, and a stronger competitive position. The research underscores the importance of a holistic and adaptive approach to integrating SCRM with marketing strategies, providing valuable insights for organizations seeking to navigate economic uncertainty and sustain their growth in a rapidly changing environment.

This study comprehensively explores Serbia's Disaster (Risk) Management System, aiming to critically evaluate its inherent strengths and weaknesses. Using descriptive-analytical methods and qualitative interpretation, SWOT analysis was applied to collect data from scientific papers, books, and institutional reports. This study delves deeply into the nuances of Serbia's Disaster Management Framework, revealing a nuanced landscape of strengths, weaknesses, and strategic improvement opportunities. Identified strengths underscore a robust foundation characterized by proficient professionals, state-of-the-art technology, and cohesive teamwork, all pivotal for effective emergency preparedness and response. Conversely, weaknesses underscore pressing imperatives for enhancements in regulatory enforcement, resource allocation, and infrastructure upgrades, presently hampering the framework's efficacy and response readiness. This research contributes to the ongoing discourse on disaster risk management and serves as a catalyst for further scholarly inquiry and policy formulation. By mapping out the structure of Serbia’s Disaster (Risk) Management Framework and integrating diverse data sources, the study enriches theoretical models and lays the groundwork for practical policy interventions. Its findings, including precise recommendations for policy reform and strategic improvements, provide valuable insights for policymakers, emergency management experts, and stakeholders seeking to enhance disaster preparedness and response capabilities on both national and global scales.

This review focuses on the emerging evidence for the association between estimated cardiorespiratory fitness (eCRF) and metabolic risk factors. Given the challenges associated with directly measuring cardiorespiratory fitness (CRF) in large populations, eCRF presents a practical alternative for predicting metabolic health risks. A literature search identified six relevant cohort studies from 2021 to 2024 that investigated the association of eCRF with hypertension, hyperglycemia, dyslipidemia, and obesity. The review findings highlight a consistent inverse relationship between higher eCRF and lower incidence of metabolic risks in line with CRF cohort studies. This review highlights the importance of low eCRF as a primordial indicator for metabolic risks and underscores the need for broader application. Future research directions should include exploring eCRF's predictive accuracy across diverse populations and health outcomes and testing its real-world applicability in healthcare and public health settings.

Background: In recent years, whole blood parameters and derivatives have been used as prognostic criteria in the course of the disease in various diseases. The prognostic nutritional index (PNI), the systemic immune-inflammation index (SII), the neutrophil-lymphocyte ratio (NLR) have been adapted as an indicator of inflammation and have been widely studied to define the severity of inflammation in some diseases. The aim of this study was to evaluate the relationship between parameters such as NLR, SII, PNI, controlling nutritional status (CONUT) score, nutritional risk index (NRI) and with immunonutrition status and disease activity in patients with ischemic stroke of small vessel, large vessel and other etiologies. Methods: We retrospectively evaluated the records of 1454 consecutive ischemic stroke patients hospitalized in the emergency department of Gaziosmanpasa Education and Research Hospital from 2019 to 2023. Results: Of the 1350 SVO patients included in the study, 58.8% had small vessel, 29.3% had large vessel and 11.9% had other etiologies. There was a significant difference between the 3 etiology groups for PNI and CONUT. The median PNI was 47.03 (41.33-52.85) in the other etiology group, 35.29 (33.69-37.25) in the small vessel group, and 34.11 (30.23-36.87) in the large vessel group. The CONUT median was 5(5-6) in the small vessel group, 5(4-6) in the large vessel group and 4(4-4) in the other etiology group. In addition, CONUT and PNI were also found to be independent risk factors for death. A negative significant correlation was observed between PNI and NLR (r:-0.692), SII (r:-0.591), CONUT (r:-0.685). Significant correlations were observed between CONUT and NLR (r:0.402), SII (r:0.312). Conclusion: PNI and SII were significantly associated with disease activity. PNI, CONUT and NRI as a more accurate prognostic indicator of nutritional status in patients with ischemic stroke of small vessel, large vessel and other etiologies. NLR and SII may be important predictive markers in the course and prognosis of stroke.

Capturing atmospheric CO2 and storing it in natural rock systems (i.e., alkaline earth silicate and hydroxide minerals) through carbonation reactions is a promising greenhouse gas mitigation research, and largely depends on the use of hydrated ultramafic rocks (serpentinites), which are widespread in orogenic belts around the globe. The Jurassic ophiolites in the Southern Apennines represent a natural analogue and a great opportunity for the mineralogical sequestration of CO2. Serpentinites of the Pollino ophiolite Massif have been widely studied for their mineralogical, petrographic, and chemical characteristics, providing major findings on their impact on environmental and human health issues. Serpentinites here have been divided into cataclastic and massive types based on their structures and are characterized by pseudomorphic and vein textures. The mineralogy of the studied serpentinites consists of lizardite, antigorite, clino-crysotile, Cr-chlorite, magnetite, tremolite, actinolite, pyroxene and calcite, and the most commonly occurring serpentine minerals are polymorphs of serpentine including lizardite, clino-crysotile and antigorite. Systematic petrographic and mineralogical studies of serpentinites in ophiolites, such as those outcropping in the Southern Apennines can represent a starting point for the study of natural materials, which can be used for CO2 storage and sequestration. A particular attention must be given to those carbonate phases, produced by carbonation processes to check whether the serpentinites of the Pollino Massif can be used for the induced mineral Carbon Capture Storage (CCS). If successful, this technique and the Pollino Massif serpentinites can become highly significant in safeguarding the health of our planet's climate.

At 12:28 UTC (8:28 PM, local time) on 15 January 2023, a shallow, moderate earthquake with a magnitude (Mw) of 4.7 and a depth of one (1) kilometer shook the northern part of Leyte Island in the central part of the Philippines. The ground shaking was felt at PHIVOLCS Earthquake Intensity Scale (PEIS) VI, (very strong) equivalent to Modified Mercalli Intensity (MMI) VI in areas along the strike of the Leyte segment of the Philippine Fault. Even though this earthquake is classified as moderate in size, significant geologic, structural, and socio-economic impacts were documented. Most of the earthquake impacts that include surface rupture, liquefaction, and mass movements are limited near the epicentral area. The earthquake produced an 8-km-long surface rupture, the first documented rupture generated by a magnitude &lt;6 along the Philippine Fault, and is unusual in other surface rupturing earthquakes worldwide. It injured 18 persons and damaged 434 residential buildings and 26 public infrastructures which amounts to about 500 thousand US dollars. Structural damages were caused by surface rupture and/or poor engineering construction practices. Analysis of the seismic waveform and recorded peak ground acceleration (PGA) suggests that the subsurface geology influenced the ground motion amplification in an area near the epicenter. Based on the hypocenter, focal mechanism solution, aftershock distribution, and actual field observation, the causative fault for this event is the northern end of the Philippine Fault – Leyte segment. Moderate in size, this earthquake emphasizes the need and importance of documenting moderate-sized earthquakes as a tool and guide for medium and long-term earthquake risk assessment and resiliency.

Obesity is a worldwide epidemic; hence it is crucial to understand how it can be effectively prevented/treated. Thus, obesity should be tackled considering that it is a multifactorial condition. This work examines a wide range of factors and attempts to understand which contribute most to variability in overweight/obesity. Eighty-four subjects with overweight/obesity were recruited. Dietary baseline information was obtained by analyzing three 24-hour recalls. Resting metabolic rate was measured using indirect calorimetry, physical activity through accelerometry, cardiometabolic parameters were determined in blood samples and body composition by anthropometry and bioimpedance. Factor analysis of principal components (PCA) was carried out (SPSS v22.0). Large interindividual variability was observed in dietetic, biochemical, and physical activity measurements (coefficient of variation ≥30%), but body composition was homogeneous. Volunteers had an unbalanced diet and low physical activity. PCA reduced the 26 analyzed variables into 7 factors, accounting for 81,5% of total data variability. The main factor was the ‘‘caloric and lipid factor’’ related to diet, responsible for 25.9% of total variability, followed by ‘‘adiposity factor’’ (16,9%) and ‘‘cardiometabolic risk factor’’ (13,2%). Diet seems to be the factor that contributes the most to data variability in people with overweight/obesity, especially the intake of lipids, energy and proteins.

This paper explores the application of fisheries management theories to broader environmental issues, including climate change and biodiversity conservation. It underscores the inherent trade-off in fisheries between yield and resource conservation, identifying harvesting as a significant environmental burden. Early recognition of the sustainability concept aimed to address challenges like economic discounts and the tragedy of the commons, contributing to the issue of overfishing. These insights extend beyond fisries to other environmental concerns, particularly climate change. The development of adaptive management, initially tailored to address uncertainties and non-stationarity in fisheries, has found application in diverse environmental issues. Recognizing humans as integral parts of ecosystems highlights the impossibility of achieving zero environmental impact when utilizing natural resources. The paper advocates for passive restoration to prevent overfishing, leveraging nature's resilience. While goals like complete biodiversity restoration are inherent in fisheries, their relevance may not be immediately apparent to other environmentalists. Despite ongoing discussions on the sustainability of ecosystem services, legislation often tends to favor the long-term maximization of fisheries yield. The paper calls for mutual understanding of theories and experiences across various environmental fields, including fisheries, to enhance collaborative efforts in each field.

To address the problems of wind abandonment in the regional integrated energy system (RIES), which occurs when cogeneration unit operates in a heat-determined electricity operation mode, and the low efficiency of the energy storage system in a low-temperature environment, we propose an optimal scheduling method for RIES based on fine energy storage and wind power dissipation. First, a fine energy storage model is established on the source side and the conditional value at risk(CvaR) theory is used to quantify the uncertainty of wind power; then a combined heat and power demand response mechanism is introduced on the load side to reduce the peak-to-valley difference between heat and power loads, and to promote the consumption of wind power. Finally, with the objective of minimizing the total cost of RIES optimal dispatch, the example is solved on the MATLAB platform. The simulation results show that compared with the traditional model, the proposed model is not only more adaptable to the low-temperature environment, but also can effectively improve the system economy and wind power consumption.

Successful implementation of antibiotic stewardship programs (ASP) requires a well-structured approach involving all stakeholders. Despite embracing key responsibilities, nurses’ role remains poorly defined, preventing consistent engagement. We conducted a scoping survey to assess knowledge, attitude and perception of nurses towards nurse-led initial sepsis risk evaluation using the sepsis risk calculator (SRC) of newborns admitted to the mother-baby unit. Single-center, cross-sectional study. Study link was sent to all full-time nurses in mother-baby unit. Survey centered around knowledge of unit’s ASP and attitude and perception towards nurse-led initial sepsis risk evaluation. 89% response rate. 100% agreed that SRC reduced antibiotic use and 66% felt nurse-led sepsis risk evaluation will enhance nurse involvement, but this was offset by extra burden of work (66%) and low confidence in differentiating stable from clinically unstable infants (46%). Other facilitating factors included greater nurse/patient ratio (100%), targeted education (89%) and incorporation of the SRC into EMR (78%). Only 11% were willing to serve as champions for it. There was no significant correlation to age or experience however, greater number of fresh grads were interested in championing this effort. Our study identifies a need for strong foundation of knowledge and greater nurse/patient ratio as two main factors for improving nurse-led use of the SRC. Multi-site studies scoping barriers to nursing involvement for successful implementation of ASPs are necessary.

Patient safety is a top priority for all healthcare systems globally. Promoting the adoption of policies for reporting and learning from errors is an important strategy for improving care safety. Therefore, the aim of our study was to detect how much patient safety culture influences the reporting of adverse events and the use of the incident reporting tool. The study protocol was developed according to PRISMA guidelines. Articles were searched electronically in PubMed/MEDLINE, the COCHRANE library, and Google Scholar by two independent reviewers, and those that met the eligibility criteria were included. Synthesis of qualitative data from included studies was performed by graphical descriptive statistical analysis. The results of the systematic review showed that health care organizations' increasing focus on staff development of a safety culture has led to a significant increase in incident reporting rates over the years. Moreover, in situations where safety culture is placed at the top of the nations, there is a higher frequency of incident reporting. An efficient incident reporting system should be an essential foundation for healthcare organizations, as it allows them to collect experiences and data and provide feedback to healthcare providers and staff involved in care.

Background: There is an exponential increase in caesarean sections with epidemic proportions worldwide, which is considered as a serious public health issue that influences negatively both maternal and childhood health. Aims: This study aimed to evaluate the associations between pre-dominant maternal risk factors and the prevalence of caesarean section in a representative sample of women from Greece. Methods: This is a cross-sectional study conducted on 5182 healthy, re-productive-aged women from 11 geographically diverse Greek areas after applying specific inclu-sion and exclusion criteria. Statistical analysis was applied to evaluate the impact of maternal so-ciodemographic, anthropometric, lifestyle and perinatal factors in the risk of caesarean section de-liveries. Results: A high prevalence of 56.4% of caesarean section deliveries was recorded in the study population. The incidence of caesarean sections reached to 51.5% in private hospitals in which an increasing rate of 47.5% for planned caesarean sections were noticed. Older maternal age, pre-pregnancy overweight and obesity, excess gestational weight gain, high rates of preterm birth, better economic status, smoking habits, and private type of birth hospital were significantly related with enhanced risk of caesarean section, independently of multiple confounding factors. Conclu-sions: Our study revealed that caesarean section rates are continuously increase, while several maternal risk factors, including especially pre-pregnancy overweight/obesity and excess gestational weight gain, cumulatively raise its prevalence which further increase the risk for postnatal adverse outcomes for both the mothers and their children. Emergent public health policies and strategies should be promoted to confront the predominant maternal risk factors-related with caesarean sec-tion and inform future mothers how to be prevented from them by applying healthier nutritional and lifestyle habits and to select caesarean section only due to emergency medical reasons. Alarmingly enough, targeted nutritional intervention strategies are strongly recommended to ef-fectively reduce the prevalence of maternal pre-pregnancy overweight/obesity and the excess gestational weight gain, which in turn may minimize the risk of childhood overweight/obesity.

From 2020 to 2023 many people around the world were forced to wear masks for large proportions of the day based on mandates and laws. We aimed to study the potential of face masks for the content and release of inanimate toxins. A scoping review of 1003 studies was performed (database search in PubMed/MEDLINE, qualitative and quantitative evaluation). Twenty-four studies were included (experimental time 17 min to 15 days) evaluating content and/or release in 631 masks (273 surgical, 228 textile and 130 N95 masks). Most studies (63%) showed alarming results with high micro- and nanoplastics (MPs and NPs) release and exceedances could also be evidenced for volatile organic compounds (VOCs), xylene, acrolein, per-/polyfluoroalkyl substances (PFAS), phthalates (including di(2-ethylhexyl)-phthalate, DEHP) and for Pb, Cd, Co, Cu, Sb and TiO₂. Of course, masks filter bacteria, dirt and plastic particles and fibers from the air we breathe and have specific indications, but according to our data they also carry risks. Depending on the application, a risk-benefit analysis is necessary. However, mask mandates during the SARS-CoV-2 pandemic have been generating an additional source of potentially harmful exposition to toxins at population level with almost zero distance to the airways.

The global transport sector of the world economy contributes about 15% of the Greenhouse Gas (GHGs) emissions in the world today. The University of Saskatchewan has pursued the green energy transition over the years. They have spearheaded diverse sustainability projects and agendas, due to the importance of curbing climate change and advancing sustainability. The transport system in the university campus is one area of focus where the Sustainability Office plans to introduce some innovations, as a way of curbing GHG emissions while also advancing sustainability practice in the university campus. The study carried out an economic benefit analysis on the campus fleet (consisting of 91 ICE vehicles) to determine if it is economically or financially feasible to transition from Internal Combustion Engine (ICE) or PVs (Petrol Vehicles) to Electric Vehicles (EVs). The analysis used RETScreen Expert software for analyzing renewable energy technology projects. The variables of Payback Period (PBP), cash flow projections, savings made from transitioning (fuel cost savings and energy cost savings), Benefit-Cost-ratio, GHG emission reduction potential, etc. were analyzed. The findings revealed that the GHG emission from the campus fleet will be reduced by 100% (this will result in the removal of about 298.1 tCO₂ from the environment). Also, the fleet manager will save approximately $129,049 (88.9%) in fuel costs. Apart from these, the return on investment will be achieved in year 5 (all things being equal), but can be reduced to year 2 if the vehicles are put into constant and active use (eliminating most idle times. Also, the Sustainability Office will be making a GHG reduction revenue of $14,906.

The aim of this study was to evaluate the acceptability and feasibility of a theory-derived sedentary workplace intervention (single arm, pre-post design) for police office staff. Twenty-four staff participated in an 8-week intervention incorporating an education session, team competition with quick response (QR) codes, team trophy, and weekly leaderboard newsletters, a self-monitoring phone app, and electronic prompt tools. The intervention supported participants to reduce and break up their sitting time with three minutes of incidental movement every 30 minutes at work. Feasibility and acceptability were assessed using mixed methods via the RE-AIM QuEST and PRECIS-2 frameworks. The intervention was highly pragmatic in terms of eligibility, organisation, adherence, outcome, and analysis. It was slightly less pragmatic on recruitment and setting. Delivery and follow-up were more explanatory. Reach and adoption indicators demonstrated feasibility among police staff, across a range of departments, who were demographically similar to participants in previous office-based multi-component interventions. The intervention was delivered mostly as planned with minor deviations from protocol (Implementation fidelity). Participants perceived the intervention components as highly acceptable. Preliminary results showed improvements in workplace sitting and standing, as well as small improvements in weight and positive affect. Evaluation of the intervention in a fully powered randomised controlled trial to assess behaviour and health outcomes is recommended.

Economic risks for livestock production are caused by volatile commodities and market conditions, but also by environmental drivers like increasing uncertainties due to weather anomalies and global warming. These risks impact the gross margin of farmers and can stimulated investment decisions. For confined pig and poultry production, farmers can reduce the environmental impact by implementing specific adaptation measures to reduce heat stress. A simulation model driven by meteorological data was used to calculate heat stress impact as a projection for 2030. For a business-as-usual livestock building, the indoor climate for several adaptation measures was calculated. The weather-related value-at risk quantified the economic risks caused by global warming and the stochastic component of the weather. The results show that only energy-saving adaptation measures to reduce the inlet air temperature are appropriate to reduce the economic risk to the level of the year 1980. The efficiency of other adaptation measures to reduce heat stress is distinctly lower. The results in this study can support the decision making of farmers concerning adaptation management and investments. It can inform agricultural policy design as well as technological development.

Electricity distribution network operators face several operational constraints in the provision of safe and reliable power given that investments for network area reinforcement must be commensurate with improvements in network reliability. This paper provides an integrated approach for assessing the impact of different operational constraints on distribution network reliability by incorporating component lifetime models, time-varying component failure rates as well as the monetary cost of customer interruptions in an all-inclusive probabilistic methodology that applies a time-sequential Monte Carlo simulation. A test distribution network based on the Roy Billinton test system is modelled to investigate the system performance when overloading limits are exceeded as well as when preventive maintenance is performed. Standard reliability indices measuring the frequency and duration of interruptions, and the energy not supplied are complemented with a novel monetary reliability index. The comprehensive assessment includes not only average indices but also their probability distributions to adequately describe the risk of customer interruptions. Results demonstrate the effectiveness of this holistic approach as the impacts of operational decisions are assessed from both reliability and monetary perspectives. This informs network planning decisions through optimum investments and consideration of customer outage costs.

In light of the urgency raised by the COVID-19 pandemic, global investment in wildlife virology is likely to increase, and new surveillance programs will identify hundreds of novel viruses that might someday pose a threat to humans. Our capacity to identify which viruses are capable of zoonotic emergence depends on the existence of a technology—a machine learning model or other informatic system—that leverages available data on known zoonoses to identify which animal pathogens could someday pose a threat to global health. We synthesize the findings of an interdisciplinary workshop on zoonotic risk technologies to answer the following questions: What are the prerequisites, in terms of open data, equity, and interdisciplinary collaboration, to the development and application of those tools? What effect could the technology have on global health? Who would control that technology, who would have access to it, and who would benefit from it? Would it improve pandemic prevention? Could it create new challenges?

NASA mission systems proposals are often compared using an equivalent system mass (ESM) framework wherein all elements of technology to deliver an effect- its components, operations and logistics of delivery- are converted to effective masses since this has a known cost scale in space operations. To date, ESM methods and the tools for system comparison have not considered complexities wherein systems that serve a mission span multiple transit and operations stages, such as would be required to support a crewed mission to Mars, and thus do not account for the different mass equivalency factors operational during each period and the inter-dependencies of the costs across the mission. Further, ESM does not account well for the differential reliabilities of the underlying technologies. Less reliability should incur an equivalent mass cost for technologies that might otherwise provide a mass advantage. We introduce an extensions to ESM to address these limitations and show that it provides a direct method for analyzing, optimizing and comparing different mission systems. We demonstrate our extended ESM (xESM) calculation with crop production technologies -- an aspect of the developing offworld biomanufacturing suite -- since it represents a case with strong coupling among stages of the mission and a relatively high-risk profile.

The aim of this cross-country research is to examine how the profit and loss sharing mudarabah investment deposits are classified and disclosed in the financial statement of Islamic banks. The cross-country study examined the financial statements of fifty-one fully-fledged Islamic banks. The results of the data analysis show that Islamic banks disclose the mudarabah investment account in different ways. The absence of standardized disclosure for mudarabah investment deposit confuses the stakeholders. This research suggests to the regulators to fully or partially adopt the AAOIFI standards specifically for Islamic financial institutions.

The introduction of the Internet of Things (IoT), i.e. the interconnection of embedded devices over the Internet, has changed the world we live in from the way we measure, make calls, print information and even the way we get energy in our offices or homes. The convenience of IoT products, like CCTV cameras, IP phones, and oscilloscopes, is overwhelming for end-users. In parallel, however, security issues have emerged and it is essential for infrastructure providers to assess the associated security risks. In this paper, we propose a novel method to detect IoT devices and identify the manufacturer, device model, and the firmware version currently running on the device using the page source from the web user interface. We performed automatic scans of the large-scale network at the European Organization for Nuclear Research (CERN) to evaluate our approach. Our tools identified 233 IoT devices that fell into eleven distinct device categories and included 49 device models manufactured by 26 vendors from across the world.

Accurate and reliable project cost estimates are fundamental to achieve successful municipal capital improvement (CIP) programs. Engineering cost estimates typically represent critical information for key decision makers to authorize and efficiently allocate the necessary funds for construction, budgeting, to generate a request for proposals, contract negotiations, scheduling, etc. for these reasons, cost estimators are using different estimating methods and approaches that allow for required levels of accuracy. As the project’s scope becomes more detailed and the potential risks are identified and/or the project design stage progresses these cost estimates are revised and updated. In this paper, the most common project cost estimation methods and approaches were collected and categorized into two main groups of (1) probabilistic and (2) deterministic methods. Under these groups overall ten different methods were identified and discussed addressing their requirements, advantages, and shortcomings, including the potential risk that can positively or negatively affect the project’s cost outcome. This paper will be a good resource for professionals who are in budget development and/or are seeking to a better understanding of different methods in determining an appropriate base cost margin and produce a meaningful and reliable project cost estimate.

The purpose of work is to quantify the changes of the organism functional reserves during the successive phases of the human health Space-Time Continuum (STC) on the basis of postulates of reliability complex systems theory. The study is devoted to the problem of age-related human involution, which is evaluated not from the causal, but from the kinetic point of view. The analysis of 10 most important basic life support systems of human body — cardiovascular (CVS), respiratory (RS), nervous (NS), digestive (DS), endocrine (ES), immune (IS), excretory (EXS), brain (BS), musculo-skeletal (MSS), hematopoietic (HS) was carried out. Based on this analysis two levels of ensuring the reliability of organism’s work were revealed: sequential and parallel. The system of logical equations for reduced sequential system is: Ys1 = CVS ∧ RS ∧ BS, where ∧ is the notation for the conjunctions of set elements. The system of logical equations for the reduced parallel system is: Ys2 = NS ∨ DS ∨ ES ∨ IS ∨ HS ∨ EXS ∨ MSS ,where ∨ is the disjunction of the scheme elements. Visualization of human STC changes the concept of the kinetics of age-related changes in the organism and the role of determinants of health as a stable factor accompanying a uniform, smooth transition from the most pronounced functions of the body to their gradual extinction. For human STC is formulated the following regularity kinetics of involutionary processes: after 30 years of age in the human body morphological changes regress in arithmetic progression, and the functions of organs in a geometric one. Assumption of health as a state redundancy of functions is suggested.

The extensive use of engineered nanoparticles (ENPs) such as zinc oxide nanoparticles (ZnO NPs) in various commercial fields has spurred significant concern about its possible toxicological effects of ZnO NPs on human health and eco-system. Therefore, it is substantial to understand the aggregation phenomena which could attenuate this effect. This data article provides information on aggregation of ZnO NPs under the influence of various parameters of water chemistry. Moreover, Taguchi orthogonal array L27(313) design matrix was used to evaluate the effect of multiple parameters in aqueous solution. The data were obtained from single beam UV-Vis spectrophotometer (Optizen 2120 UV, Mecasys, Korea) using Optizenview 4.2.5 PC interference software, Fourier transform infrared spectrometer (FT/IR-4700, spectroscopy, JASCO Analytical Instruments, Easton, USA) and particle electrophoresis (NanoZS, Zetasizer, Malvern Instruments Ltd, Worcestershire, UK). The dataset draws attention on dominant parameters influencing aggregation of ZnO NPs in water. The analysis of variance (ANOVA) data revealed that electrolyte concentration, type and natural organic matter (NOM) concentration were the most significant parameters. Furthermore, FT-IR data presents a possible mechanism of ZnO NPs stabilization in the presence of different NOM. This data will be helpful for the development of environmental risk assessment strategies and prediction of fate and mobility of other ENPs in the aquatic environment.

Very little is known about laboratory confirmed blood stream infections (LCBIs) in neonatal intensive care units (NICUs) in resource-limited settings. The aim of this cohort study was to determine the incidence, risk factors, and causative agents of LCBIs in a level-2 NICU in India. The diagnosis of LCBIs was established using the Centre for Disease Control, USA criteria. A predesigned questionnaire containing risk factors associated with LCBIs was filled-in. A total of 150 neonates (43% preterm) were included in the study. The overall incidence of LCBIs was 31%. The independent risk factors for LCBIs were: preterm neonates (relative risk (RR) 2.23), duration of NICU stay more than 14 days (RR 1.75), chorioamnionitis in the mother (RR 3.18), premature rupture of membrane in mothers (RR 2.32), neonate born through meconium-stained amniotic fluid (RR 2.32), malpresentation (RR 3.05), endotracheal intubation (RR 3.41), umbilical catheterization (RR 4.18), and ventilator-associated pneumonia (RR 3.17). The initiation of minimal enteral nutrition was protective from LCBIs (RR 0.22). The predominant causative organisms were gram-negative pathogens (58%). The results of the present study can be used to design antibiotic interventions to reduce LCBIs in resource-limited settings.

The scarcity and pollution of freshwater are extremely crucial issues today and the expansion of water reuse have been considered as an option to reduce its impact. This study aims to assess the efficiency of an integrated greywater treatment system and hydroponic lettuce production as a part of a green wall structure and to evaluate the health risk associated with the production and consumption of lettuce through quantitative microbial risk assessment (QMRA) and chemical health risk assessment. The study was conducted based on the unique configuration of source separation system; on-site greywater treatment system; green wall structure as a polishing step; and hydroponic lettuce production in the green wall structure. The final effluent from the system was used to grow three lettuce varieties by adding urine as a nutrient solution. Both water samples and plant biomass were collected and tested for E. coli and heavy metals contamination. The system has gained a cumulative 5.1 log10 reduction of E. coli in the final effluent and no E. coli found in the plant biomass. QMRA results indicated that the system attained the health-based targets, 10–6 DALYs per person per year. Similarly, health risk index (HRI) and targeted hazard quotient (THQ) results did not exceed the permissible level, thus the chemical health risk concern was insignificant.

Patients from regions without stem cell transplant (SCT) facilities often seek treatment abroad and return home for post-transplant care. While extensive data exists on GVHD and its risk factors, the prevalence of GVHD in international SCT patients returning to countries without transplant facilities, where multiple factors compromise post-transplant care, is not well documented. We screened 149 transplant recipients and analyzed data from 91 who received transplants abroad and were followed at our center from January 2019 to December 2022. This observational study used data from electronic medical records (EMR) and employed descriptive statistics, inferential tests, and relative risk calculations with forest plots to analyze GVHD prevalence and key risk factors. Of the recipients, 31.8% were residents from nine countries living in the UAE, and 67.2% were UAE citizens. Adults comprised 48.3% of the recipients, and 51.7% were pediatric. Hematological malignancies were the most common indication (49%), primarily in adults. Siblings were the majority of donors (52.6%), followed by related donors (23.09%), and unrelated donors (8.9%). Most (69.2%) received HLA-identical transplants followed by 21.9% who received haploidentical. Among adults, 62.2% developed GVHD, compared to 26% of pediatric patients. Recipients with related HLA-identical donors had a 50% GVHD prevalence, while those with unrelated identical donors had 71%. The overall GVHD prevalence was 50% among the 87.9% who received allogeneic SCTs. Despite favorable factors, GVHD prevalence remains high. Larger multicenter studies are needed to identify and assess the impact of contributing factors.

The purpose of this study is to explore the effect of Environment, Social, and Governance (ESG) scores on Return on Assets (ROA), Risk-Adjusted Return on Capital (RAROC), and Tobin's Q on firm performance. This study used 37 non-financial companies listed on the IDX between 2018 and 2022 in Indonesia companies. Linear and nonlinear panel data regression methods were used on the ESG score and its pillars, resulting in eight different models. The study found a U-shaped impact of ESG scores and social and environmental pillars on ROA. There is a positive linear relationship between ESG scores and the environmental and governance pillars with RAROC, while the social pillar shows an inverted U-shaped effect. However, ESG and its environmental and social pillars have a negative linear relationship with Tobin's Q. The findings suggest the need to manage ESG initiatives strategically, aligning them with financial objectives and awareness of how ESG factors relate to profitability.

Renal cell carcinoma (RCC) accounts for approximately 90-95% of all kidney cancers in adults, with the clear cell RCC (ccRCC) the most frequently identified subtype. RCC is known for its responsiveness to immunotherapy, making it an area of significant research interest. Immune checkpoint (IC) molecules, which regulate immune surveillance, are established therapeutic targets in RCC. The aim of this study was to analyze the influence of polymorphisms in genes HVEM and CD160 on susceptibility to ccRCC and patient overall survival (OS) with over a ten-year period of observation. We genotyped three HVEM single nucleotide polymorphisms (SNPs): rs1886730, rs2234167, and rs8725, and two CD160 SNPs: rs744877 and rs2231375, in 238 ccRCC patients and 521 controls. Our findings indicated that heterozygosity within rs2231375 and/or rs2234167 increases ccRCC risk. Furthermore, in women, heterozygosity within additional HVEM SNPs, rs8725 and rs1886730, is associated with an increased ccRCC risk. The presence of a minor allele for rs1886730, rs2234167, rs8725, and rs2231375 was also correlated with certain clinical features of the disease. Moreover, the rs1886730 SNP was found to be associated with patients' OS. In conclusion, our study highlights an association between HVEM and CD160 polymorphisms and the risk of developing ccRCC as well as patient’s OS.

Biochar (BC) is a carbonaceous material obtained by pyrolysis at 200−1000 °C in the limited presence of O2 of different vegetable and animal biomass feedstocks. BC has demonstrated great potential, mainly in environmental applications, due to its high sorption ability and persistent free radicals (PFRs) content. These characteristics enable BCs to carry out the direct and PFRs-mediated removal/degradation of environmental organic and inorganic contaminants. The types of PFRs possibly present in BC depend mainly on the pyrolysis temperature and the kind of pristine biomass. Since they also can cause ecological and human damage, a systematic evaluation of the environmental behavior, risks, or management techniques of BC-derived PFRs is urgent. PFRs generally could consist of a mixture of carbon- and oxygen-centered radicals, and of oxygenated carbon-centered radicals, depending on the pyrolytic conditions. Here, to promote a more productive and beneficial use of BC and related PFRs and stimulate further studies to make them environmentally safer and less hazardous to humans, we have first reviewed the most common methods used to produce BC, its main environmental applications, the primary mechanisms by which BC remove xenobiotics, as well as the reported mechanisms for PFRs formation in BCs. Secondly, we have discussed the PFRs environmental migration and transformation; we have reported the main PFRs-mediated applications of BCs to degrade inorganic and organic pollutants, the correlated environmental potential risks, and the possible strategies to limit them.

Grasping the spatial and temporal patterns of forest fires, along with the key factors that drive them and the ability to forecast such events accurately, is essential for the successful management of forests. In China's southern region, forest fires significantly endanger the ecological system, public safety, and economic well-being. Through the application of Geographic Information Systems (GIS) and LightGBM (Light Gradient Boosting Machine) model, this study investigates the determinants of fire incidents and formulates a predictive model for forest fire occurrences, alongside a zoning strategy, within the Central-South area. The results indicate: (i) Spatially, fire points exhibit significant clustering and autocorrelation characteristics; (ii) The Central-South Forest Fire Prediction Model shows exceptional accuracy, reliability, and predictive power, with high performance metrics across training and validation sets, including over 85% accuracy, precision, recall, and F1 scores, along with AUC values above 89%, underscoring its efficacy in forecasting forest fires and distinguishing between fire events; (iii) Throughout the year, forest fire risks in the Central-South region of China vary by region and season, with risk spikes from March to May in Guangdong, Guangxi, Hunan, Hubei, and Hainan. From June to August, localized risks are observed in Heyuan and Huangshi, while from September to November, an increase in risk is noted in Guangdong (Meizhou, Heyuan, Shaoguan), Guangxi (Nanning, Hezhou, Yulin), and Hunan (Binzhou, Yongzhou, Hengyang) due to cooler, drier conditions and leaf litter accumulation. From December to February, the risk continues in specific areas across Guangdong, Guangxi, Hunan, and Hubei.

Cervical cancer, primarily caused by high-risk human papillomavirus (HR-HPV) types 16 and 18, is a major global health concern. Persistent HR-HPV infection can progress from reversible pre-cancerous lesions to invasive cervical cancer, which is driven by the oncogenic activity of human papillomavirus (HPV) genes, particularly E6 and E7. Traditional screening methods, including cytology and HPV testing, have limited sensitivity and specificity. This review explores the ap-plication of p16/Ki-67 dual-staining cytology for cervical cancer screening. This advanced im-munocytochemical method allows for simultaneously detecting p16 and Ki-67 proteins within cervical epithelial cells, offering a more specific approach for triaging HPV-positive women. Dual staining and traditional methods are compared, demonstrating their high sensitivity and negative predictive value but low specificity. The increased sensitivity of dual staining results in higher detection rates of CIN2+ lesions, which is crucial for preventing cervical cancer progression. However, its low specificity may lead to increased false-positive results and unnecessary biopsies. The implications of integrating dual staining into contemporary screening strategies, particularly considering the evolving landscape of HPV vaccination and changes in HPV genotype prevalence are also discussed. New guidelines and further research are necessary to elucidate the long-term effects of integrating dual staining into screening protocols.

Breast cancer is the most common cause of mortality due to cancer for woman both in Lithuania and worldwide. Chances of survival after diagnosis differ significantly depending on the stage of disease at the time of diagnosis and other factors. One way to estimate survival is to construct a Kaplan-Meier estimate for each factor value separately. However, in cases when it is impossible to observe a large number of patients (for example, in case of countries with lower numbers of inhabitants) dividing data into subsets, say, by stage at diagnosis may lead to results where some subsets contain too little data so that results of Kaplan Meier (or any other) method will become statistically incredible. The problem may become even more acute if the researcher would like to use more risk factors, such as stage at diagnosis, sex, place of living, treatment method, etc. Alternatively, Cox models are used to analyse survival data with covariates, and they don’t require dividing the data into subsets according to chosen risks factors (hazards).

Conflicts are frequent within the complex professional environment of the construction industry. If claims cannot be overcome amicably, they result in disputes that lead to litigation. Identification of the causes of these claims and their impact on the duration, cost, and quality of the final project is expected to facilitate the prevention of unsuccessful performance of construction contracts. The novelty of this study is that after codifying the most common causes of construction contract claims derived from the extant literature, they are further investigated in terms of their probability of occurrence and the perceived impact they have on the project completion time, its total cost, and quality. Based on calculated relative importance indices from expert opinion, this paper proposes probability and severity of impact values for 39 common causes of claims in the construction industry. These can be applied to calculate their risk values for stakeholders in public construction contracts to plan mitigation measures of contractual claims. The findings show that the top five riskiest causes of contractual claims in the Greek construction industry are changes in quantities, work, or scope, design quality deficiencies or errors, payment delays, delays in work progress, and the financial failure of the contractor.

The 3D/3D+ multidimensional geriatric assessment tool provides an optimal model of emergency care for patients aged 75 and over who attend the Emergency Department (ED). The baseline, or static, component (3D) stratifies the degree of frailty prior to the acute illness, while the current, or dynamic, component (3D+) assesses the multidimensional impact caused by the acute illness and helps to guide the choice of care facility for patients upon their discharge from the ED. The objective of this study was to evaluate the prognostic value of the 3D/3D+ to predict short- and long-term adverse outcomes in ED patients aged 75 years and older. Multivariable logistic regression models were used to identify the predictors of mortality 30 days after 3D/3D+ assessment. Two hundred and seventy-eight patients (59.7% women) with a median age of 86 years (interquartile range: 83-90) were analysed. According to the baseline component (3D), 83.1% (95%CI: 78.2-87.3) presented some degree of frailty. The current component (3D+) presented alterations in 60.1% (95%CI: 54.1-65.9). The choice of care facility at ED discharge indicated by the 3D/3D+ was considered appropriate in 96.4% (95%CI: 93.0-98.0). Thirty-day all-cause mortality was 19.4%. Delirium and functional decline were the dimensions on the 3D/3D+ that were independently associated with 30-day mortality. These two dimensions had an area under receiver operating characteristic of 0.80 (95%CI: 0.73-0.86) for predicting 30-day mortality. 3D/3D+ enhances the provision of comprehensive care by ED professionals, guides them in the choice of patients’ discharge destination, and has a prognostic validity that serves to establish future therapeutic objectives.

The Canadian Prairies are associated with high natural hydroclimatic variability including the frequent periodic occurrence of droughts and pluvials. These extremes carry various risks in-cluding significant damage to the economy, environment and society. The well-documented level of damage necessitates further risk assessment and planned reductions to vulnerability, particu-larly in light of a warming climate. A logical starting point involves awareness and information about the changing characteristics of such climate extremes. We focus on the compound occurrence of droughts and pluvials as the risks from this type of event are magnified compared to the hy-droclimatic extremes in isolation. Also, research on compound droughts and pluvials is limited. Therefore, the purpose of this paper is to synthesize recent literature concerning the risks of com-pound droughts and pluvials, including examples of past occurrences, with a focus on the Cana-dian Prairies. Since literature from the Prairies is limited, global work is also reviewed. Rela-tionships between drought and pluvials are characterized using the SPEI Global Monitor for the Prairies, emphasizing the recent past, and through synthesis from the Prairie literature. That re-search mostly considers drought and pluvials as separate events, but is integrated here to charac-terize the relationships of these extremes. Examples of periods of compound droughts and exces-sive rainfall provide insights into the regional hydroclimatic variability. Furthermore, most lit-erature on future projections strongly suggests that this variability is likely to increase, mainly driven by anthropogenic climate change. These findings suggest means of decreasing vulnerabil-ity and associated damages. Although the study area is the Canadian Prairies, the work is rele-vant to other regions that are becoming more vulnerable to increasing risks of and vulnerabilities to such compound extremes.

The sensitivity of exercise ECG is marginally sufficient for detection of mild reduction of coronary blood flow in patients with early coronary atherosclerosis. Here we describe the application of new technique of ECG registration/analysis – ultrahigh resolution ECG (UHR ECG) – for early detection of myocardial ischemia (MIS). The utility of UHR ECG vs. conventional ECG (C ECG) was tested in anesthetized rats and pigs. Transmural MIS was induced in rats by the ligation of the left coronary artery (CA). In pigs, subendocardial ischemia of variable extent was produced by stepwise inflation of balloon within the right CA causing 25-100% reduction of its lumen. In rats, a reduction in power spectral density (PSD) in high-frequency (HF) channel of UHR ECG was registered at 60 s after ischemia (power 0.81±0.14 vs. 1.25±0.12 mW at baseline, p<0.01). This was not accompanied by any ST segment elevation on C ECG. In pigs, PSD in HF channel of UHR ECG was significantly decreased at 25% reduction of CA lumen, while ST segment on C ECG remained unchanged. In conclusion, UHR ECG enabled earlier detection of transmural MIS compared to C ECG. PSD in HF-channel of UHR ECG demonstrated greater sensitivity in the settings of subendocardial ischemia.

Background: Substance use continues to be on the rise in the United States and has been linked to new onset cardiovascular (CVDs) and cerebrovascular disorders (CeVDs) leading to hospitalizations. We aimed to study the association of different subtypes of substance use disorders (SUDs) among hospitalized patients, with the different subtypes of CVDs and CeVDs, using the National Inpatient Sample (NIS) Database. Additionally, we aimed to assess the odds of hospitalizations with new onset CVDs and CeVDs among patients with different types of SUDs. Methods: A retrospective study of the NIS database (2016-2017) using the ICD-10-CM codes was performed. The hospitalizations with a secondary diagnosis of SUDs were identified. Weighted univariate analysis using the chi-square test and multivariate survey logistic regression analysis was performed to evaluate for the incidence, prevalence, and odds of association between vascular events and SUDs. Results: There were a total of 58,259,589 hospitalizations, out of which 21.42% had SUDs. Out of all the hospitalized patients between the age 18-50, more patients had SUDs than not (31.83%, p< 0.0001). This difference existed for all the different subtypes of SUDs including alcohol related disorder (42.61%), amphetamine dependence (76.17% vs 31.83%), cannabis related disorder (75.17%), cocaine related disorders (57.87%), hallucinogen related disorder (82.91%), inhalant related disorders (67.25%), opioid related disorders (52.86%), and nicotine dependence (35.72%). We found a significant association of acute ischemic stroke with amphetamine dependence (OR 1.23, 95%CI 1.14-1.33), cocaine related disorders (1.17, 1.12-1.23) and nicotine dependence (1.42, 1.40-1.43). Similarly, the association of intracerebral hemorrhage was higher with amphetamine dependence (2.58, 2.26-2.93), and cocaine related disorders (1.62, 1.46-1.79). The association of subarachnoid hemorrhage was noted to be higher with amphetamine dependence (1.82, 1.48-2.24) and nicotine dependence (1.47, 1.39-1.55). In terms of association of cardiovascular disorders with SUDs,the patients with myocardial infarction had higher odds of nicotine dependence (1.85, 1.83-1.87) than not, Similarly, the patients with angina pectoris were noted to have a higher association with cocaine related disorders (2.21, 1.86-2.62), and those with atrial fibrillation had a higher association alcohol related disorders (1.14, 1.11-1.17). Conclusion: Our study demonstrates the variability of CVD and CeVD in patients hospitalized for SUD. Findings from our study may help promote increased awareness and early management of these events. Further studies are needed to evaluate specific effects of frequency and dose on the incidence and prevalence of CVD and CeVD in patients with SUD.

Background: Multi-drug resistance organisms (MDRO) often cause increased morbidity, mortality, and length of stays (LOS). However, there is uncertainty whether the infection of MDRO increase the morbidity, mortality, and ICU-LOS. Objective: This study performed to determine the prevalence of MDRO in ICU, site of infection and the association of MDRO or site of infection with mortality. Secondary outcome was determined by ascertaining the association of MDRO or site of infection with (ICU-LOS). Methods: A retrospective cohort study was performed with adult sepsis patients in ICU. Univariate and multivariate (MVA) logistic regression with cox regression modeling were performed to compute the association of MDRO on ICU-mortality. MVA modelling was performed for ICU-LOS predictors. Results: Out of 228 patients, the isolated MDRO was 97 (42.5%) of which 78% were gram-negative bacteria. The mortality rate among those with MDRO was 85 (37.3%). The hospital acquired infection (HAI) was significantly predictor for ICU-LOS in univariate linear regression (R² = 0.034, P=0.005). In MVA linear regression, both Enterococcus faecalis infection and acinetobacter baumannii (AC) -MDRO were predictors for ICU-LOS with (R² = 0.478, P<0.05). In the univariate cox regression, only the infection with AC- MDRO was a risk factor for ICU-mortality with [ HR =1.802 (95% CI: 1.2 – 2.706; P = 0.005)]. Conclusions: Identifying risk factors for MDRO highlight the appropriate administration of empirical antibiotics and effectively control of source of infection which would reduce mortality and ICU-LOS. The usage of broad- spectrum antibiotics should be limited for those having substantial risk factors to acquire MDRO.

Background: Over 900,000 cases of COVID-19 and 23,000 deaths have been reported till 13 July in India. Preserving the limited healthcare workforce is part of the strategy against the pandemic. Mortality and morbidity data have a role in customising this strategy. At this time, there is no published study on COVID-related mortality among doctors or other healthcare workers in India. Methods: A multi-pronged search was made for all reported deaths linked with COVID-19 among doctors in India. Details of COVID-linked deaths reported by mainstream media and by multiple professional social media sources were collected, screened, verified and analysed. Violent deaths occurring in the setting of pandemic-related work were separately listed. Deaths from other diseases were excluded. Results: Among 108 COVID-linked deaths among doctors, there were four pandemic-related violent deaths including three road accidents and a suicide. Of the 104 non-violent deaths, 55.5% were below 60 years of age, while 29.6% and 21% were below the age of 50 and 40 respectively. The average age at death was 56.3 (range 22 - 96). Over half of the deaths occurred among general practitioners, while surgical specialties accounted for 27% of the mortality. The geographic distribution of deaths of doctors correlated with the reported number of COVID-19 patients in each state. The total number of COVID-related healthcare worker deaths was 136, out of which eight (5.8%) were violent, and occurred in young individuals with an average age of 27.8 years. Conclusions: The majority of the 104 COVID-related non-violent deaths among doctors (55.5%) occurred below the age of 60. The average at death was 56.6 years. The states with highest number of COVID-19 cases had greater number of doctor deaths. Violent deaths among young healthcare workers in the setting of the pandemic requires special attention.

The planning and decision-making for a distributed energy supply concept in complex actor structures like in districts calls for the approach to be highly structured. Here, a strategy with strong use of energetic simulations is developed, the core elements are presented and research gaps are identified. The exemplary implementation is shown using the case study of a new district on the former Oldenburg airbase in northwestern Germany. The process is divided into four consecutive phases, which are carried out with different stakeholder participation and use of different simulation tools. Based on a common objective, a superstructure of the applicable technologies is developed. Detailed planning is then carried out with the help of a multi-objective optimal sizing algorithm and Monte Carlo based risk assessment. The process ends with the operating phase, which is to guarantee a further optimal and dynamic mode of operation. The main objective of this publication is present the core elements of the planning processes and decision-making framework based on the case study and to find and identify research gaps that will have to be addressed in the future.

Wave energy converter (WEC) arrays deployed in coastal regions may create physical disturbances potentially resulting in environmental stresses. Presently, limited information is available on the nature of these physical disturbance or the resultant effects. A quantitative Spatial Environmental Assessment Tool (SEAT) for evaluating potential effects of wave energy converter (WEC) arrays on nearshore hydrodynamics and sediment transport is presented for the central Oregon coast (USA) through coupled numerical model simulations of an array of WECs. Derived climatological wave conditions were used as inputs to the model to allow for the calculation of risk metrics associated with various hydrodynamic and sediment transport variables such as maximum shear stress, bottom velocity, and change in bed elevation. The risk maps provided simple, quantitative, and spatially-resolved means of evaluating physical changes in the vicinity of a hypothetical WEC array in response to varying wave conditions. Near-field risk of sediment mobility was determined to be moderate in the lee of the densely spaced array, where the potential for increased sediment deposition could result in benthic habitat alteration. Modifications to the nearshore sediment deposition and erosion patterns were observed near headlands and topographic features, which could have implications for littoral sediment transport. The results illustrate the benefits of a risk evaluation tool for facilitating coastal resource management at early market marine renewable energy sites.

Changes in extreme weather patterns are expected under climate change. In this study, a risk assessment was conducted using 4 building damage history datasets and 33 weather datasets (precipitation, wind speed, snow, and temperature) from 230 regions in South Korea to quantitatively analyze and predict building damage caused by potential future natural disasters. Decision tree analysis was used to evaluate building damage risk in 230 regions. The decision tree model to determine the risk of flood, gale, and typhoon was generated, which excluded gales, with less damage. The weight (variable importance) and limit value (damage limit) of the weather variables ware derived using the decision tree model. Using these two factors, we assessed the building damage risk in 230 regions in South Korea until 2100. The number of regions at risk of flood damage increased by more than 30% in average. Conversely, regions at risk of snowfall damage decreased by more than 90%. The regions at risk of typhoons decreased by 57.5% on average, and the number of regions at high risk of typhoon damage increased by up to 62.5% in RCP 8.5. These results can be used as objective data to minimize future building damage throughout South Korea, representing the first step towards sustainable development in the region with respect to disaster response.

High fructose and sugar-sweetened soft drink (SSSD) intakes are associated with elevated blood uric acid concentrations and increased risk of gout and cardiovascular disease. Fruits are naturally high in fructose but their effect on cardiometabolic risk is unknown. We examined the effect on serum uric acid and cardiometabolic risk factors of consuming fructose from either fruit or SSSD in overweight adults. 48 healthy, overweight (BMI≥ 28 kg/m²) men (n=21) and women (n=20) were randomised to either a fruit (n = 19) or SSSSD (n = 22) intervention for 4 weeks. The fruit group received 6 items of fresh and dried fruit per day and the SSSD group received 955ml of SSSD per day with treatments matched for energy and fructose content. Serum uric acid concentrations were significantly reduced in men in the fruit group compared to the SSSD group (difference 57.2 μmol/L [95% CI: 16.4, 98.0], p= 0.008) but there was no difference amongst women (1.3 μmol/L [95%CI: -9.5, 6.9], p= 0.295). There differences in weight change or other cardiometabolic risk factors. These findings suggest no need to restrict fruit intake in individuals with elevated serum uric acid concentrations, such as those with gout.

Introduction: There are no clear guidelines to support adequate nutrition and growth for our neonates. We have used the difference in weight Z-score medians between birth and discharge (∆ Z-score) to assess the nutritional outcomes in EpicLatino. The ∆ Z-score is often negative, accounting for the desirable fluid contraction at birth that sends the preterm baby usually between 0.5-1 weight Z-score point down the curve. From then on, most researchers accepted a healthy and safe growth parallel to the intrauterine rate. No consensus on the optimal timing for assessment or the ideal growth monitoring tool has been achieved, and an ongoing debate persists on the appropriate terminology to express poor postnatal growth.Methods: We analyzed data from the past 8 years (2015-2022) in surviving home to at least 34 weeks corrected age infants with ≤ 32 weeks gestational age at birth (GA). We conducted a series of statistical comparisons with variables that have been mentioned as potential causes of poor nutrition in the literature. We used the weight ∆ Z-score from birth to discharge as a surrogate for nutrition. We obtained the weight median and interquartile range (IQR) from all the EpicLatino units. We also calculated the correlation between weight ∆ Z-score and gestational age and head circumference (HC) at discharge.Results: There were 480 cases that meet the established criteria. Gestational age at birth, necrotizing enterocolitis (NEC), unit of origin, rupture of membranes (ROM) > 24 hours, temperature at admission, and intraventricular hemorrhage (IVH) were significantly different. There was a negative correlation between ∆ Z-score and corrected gestational age at discharge. Head circumference at discharge also correlated with weight ∆ Z-score.Discussion: There is an important variability in the different units of origin. Also, when looking for risk factors, we confirmed that the characteristics of the study population are determinant to extrauterine growth restriction (EUGR) at discharge. As is known, these associations do not establish causality, some of these variables may identify the challenge of nourishing a sick or very small preterm infant, but the unit of origin variable identifies nutrition policies and practices that can be modified through a quality improvement program.

Since the early 2000s, high-risk E. coli clones that presented a highly virulent and multidrug resistance profile have been identified, and their genome is completely sequenced. Molecular techniques make it possible to follow the evolution and spread of those clones in different parts of the world. The results of several studies monitoring the emergence of new high-risk E. coli clones showed an increase in the number of clones and the virulence strategies and in the emergence of clones with the ability to cause intestinal and urinary infections combined with a multidrug resistance profile. We certainly can't stop the emergence of new high-risk clones. The remaining questions are: How can we use the knowledge about E. coli high-risk clones to our advantage in the war against multidrug antibiotic resistance? How can we stop the spread of those clones and improve diagnostic and treatment stewardship? This is a challenge that requires collaboration and shared knowledge.

Malignant melanoma and urological cancers originate from different tissues and organs, yet several studies highlight connections between these malignancies, including common risk factors, genetic predispositions, and immunological pathways. Research indicates that individuals with a history of melanoma have an elevated risk of developing renal cell carcinoma (RCC), while those with RCC are more likely to develop melanoma. Shared factors such as a personal or family history of cancer, UV radiation exposure, smoking, and obesity have all been linked to an increased incidence of various cancer types. A major link between malignant melanoma and urological cancers is the presence of shared genetic mutations and familial cancer syndromes. Key mutations, including germline mutations in BRCA1, MITF, CDKN2A, TP53, and alterations in the PI3K/AKT pathway, significantly contribute to the risk of both types of malignancies. Personalized medicine, which tailors prevention and treatment strategies to an individual’s genetic, environmental, and lifestyle factors, has significantly improved cancer care. The primary aim is to select the most effective treatment for each patient, maximizing therapeutic outcomes, reducing side effects, and minimizing the risk of drug resistance. Advances in genomics and immunology are driving the development of personalized therapies that target specific molecular pathways and immune responses common to both melanoma and urological cancers. Angiogenesis inhibitors and checkpoint inhibitors have demonstrated notable success in treating these cancers, with tumor mutational burden serving as a valuable biomarker for predicting the efficacy of immune checkpoint inhibitors.

Mobile devices (MD) are used by mobile cloud computing (MCC) customers users because of their 11 portability and robust connectivity and the ability to house and operate third-party applications 12 (apps). However, the apps installed on a MD may pose data security risks to the MD owner and to 13 other MCC users, especially when the requested permissions include access to sensitive data (e.g., 14 user’s location and contacts). Calculating the risk score of an app or quantifying its potential 15 harmfulness based on user input or on data gathered while the app is actually running may not 16 provide reliable and sufficiently accurate results to avoid harmful consequences. This study 17 develops and evaluates a risk assessment framework for Android-based MDs that does not depend 18 on user input or on actual app behaviour. Rather, an app risk evaluator assigns a risk category to 19 reach resident app based on the app’s classification (benign or malicious) and the app’s risk score. 20 The app classifier (a trained machine learning model) considers the permissions and the intents 21 requested by the app. The apps risk score is calculated by a probabilistic function based on the 22 app’s use of a set of selected dangerous permissions. The results from the testing of an instance of 23 the framework on a MD with real-life resident apps indicated that the proposed security solution 24 was effective and feasible.

Ménière's disease (MD) has an unclear cause. The microvascular dysregulation of the inner ear has been increasingly pointed as a potential contributor. This study investigates the prevalence of cardiovascular risk factors (CVRFs) in MD patients compared to those with posterior circulation cerebral infarction (POCI). CVRFs like hypertension, diabetes, dyslipidemia, obesity, coronary heart disease, and smoking were assessed in both MD and POCI patients. Brain MRI identified POCI etiology as "small vessel occlusion" (SVO) or "other etiology" (OE). The study included 64 MD and 84 POCI patients. Compared to MD, POCI OE showed a higher prevalence of CVRFs across various age groups, including hypertension, diabetes, dyslipidemia, and smoking. Notably, the odds of having POCI OE were significantly higher for individuals with hypertension and smoking. On the other hand, POCI SVO showed similar prevalence of CVRFs compared to MD. This study reveals no significant difference in CVRF prevalence between MD and smaller vessel POCI. However, a clear distinction emerges when comparing MD to POCI with involvement of larger blood vessels. Further research is needed to confirm these findings and explore potential shared risk factors between POCI (SVO) and MD.