Dealing with randomness is a crucial aspect that cost-effectiveness analysis (CEA) tools need to address, but existing stochastic CEA tools have rarely examined risk and return from the perspective of global benefits. This paper proposes a stochastic CEA tool that supports medical decision-making from the perspective of global benefits of risk and return, the risk-adjusted incremental cost-effectiveness ratio (ICER). The tool has a traditional form of ICER but uses the risk-adjusted expected cost. Theoretically, we prove that the tool can provide marginal medical decisions that promote the risk-return level on global benefits within any intervention structure and can also serve as a discriminating condition for the optimal intervention structure. Numerical simulations within a framework of mean-variance support the conclusions in this paper.

Background: Falls risk assessment tools are used in hospital inpatient settings to identify pa-tients at increased risk of falls (which may be related to muscle loss/sarcopenia) to guide and target interventions for falls prevention. In 2022, Western Health, Melbourne, Australia, intro-duced a new falls risk assessment tool, the Western Health St. Thomas’ Risk Assessment Tool (WH-STRATIFY), a modified version of The Northern Hospital’s risk tool (TNH-STRATIFY), which replaced the Peninsula Health Risk Screening Tool (PH-FRAT). Aims: To determine the predictive accuracy of three falls risk assessment tools (PH-FRAT, TNH-STRATIFY and WH-STRATIFY) on admission to Geriatric Evaluation Management (GEM) units. Method: A retrospective observational study was conducted on four GEM units. Data was col-lected on 54 consecutive patients who fell during admission and 62 randomly sampled patients who did not fall between December 2020 and June 2021. Participants were scored against three falls risk assessment tools. The event rate Youden (Youden IndexER) indices were calculated and compared using default and optimal cut points to determine which tool was most accurate for predicting falls. Results: Using default cut points to compare falls assessment tools, TNH-STRATIFY had the highest predictive accuracy (Youden IndexER = 0.20, 95% confidence interval CI = 0.07, 0.34). The PH-FRAT (Youden IndexER = 0.01 and 95% CI = -0.04, 0.05) and WH-STRATIFY (Youden IndexER = 0.00 and 95% CI = -0.04, 0.03) were statistically equivalent and not predictive of falls compared to TNH-STRATIFY. When calculated optimal cut points were applied, predictive accuracy im-proved for PH-FRAT (Cut point 17, Youden IndexER = 0.14 and 95% CI = 0.01, 0.29) and WH-STRATIFY (Cut point 7, Youden IndexER = 0.18 and 95% CI = 0.00, 0.35). Overall, all tools had low predictive accuracy for falls. Conclusion: TNH-STRATIFY had the highest predictive accuracy for falls. The predictive accu-racy of WH-STRATIFY improved and was significant when the calculated optimal cut point was applied. The optimal cut points of falls risk assessment tools should be determined and validated in different clinical settings to optimise local predictive accuracy, enabling targeted falls risk mitigation strategies and resource allocation.

Melioidosis, or Whitmore's disease, is an infectious disease initiated by a bacteria known as Burkholderia pseudomallei. This bacteria is commonly found in contaminated soil and water. In Malaysia, the mortality from melioidosis infection was reported to be higher than in other infectious diseases. The research on melioidosis is still limited in Malaysia but slightly increasing. The article's objective was to seek all the melioidosis research related to mortality in Malaysia. The information from the selected papers was then abstracted into two sections; Section 1: Review of literature and Section 2: Findings on mortality from melioidosis in Malaysia. In Section 1, the information on transmission and clinical features of melioidosis, demographic, severity of melioidosis, a clinical signs of melioidosis, diagnosis of melioidosis, management of melioidosis, the economic burden of melioidosis, and incidence of mortality from melioidosis were discussed in this paper. Meanwhile, in Section 2, the findings on mortality of melioidosis in Malaysia were discussed according to eight published articles. It is important to manage patients with melioidosis with appropriate treatment and management to reduce severe complications, high fatality rate, and relapse. More published research on melioidosis will provide input to the clinicians on a more detailed understanding of how to improve the diagnosis of melioidosis and the prognosis factors of this disease.

Waterlogging induced by rain in urban areas has a potential risk impact on property and safety. This paper focuses on the impact of rain on waterlogging and evaluates the waterlogging risk in the central city of Shanghai. A simplified waterlogging depth model is developed in different areas with different drainage capacity and rainfall in consumption of simplifying the effect of complex terrain characteristics and hydrological situation. Based on urban waterlogging depth and its classification collection, a Rain-induced Urban Waterlogging Risk Model(RUWRM) is further established to evaluate waterlogging risk in the central city. The results show that waterlogging depth is closely linked with rainfall and drainage, with a linear relationship between them. More rainfall leads to higher waterlogging risk, especially in the central city with imperfect drainage facilities. Rain-induced urban waterlogging risk model can rapidly gives the waterlogging rank caused by rainfall with a clear classification collection. The results of waterlogging risk prediction indicate that it is confident to get the urban waterlogging risk rank well and truly in advance with more accurate rainfall prediction. This general study is a contribution that allows the public, policy makers and relevant departments of urban operation to assess the appropriate management to reduce traffic intensity and personal safety or strategy to lead to less waterlogging risk.

Close to half (45.4%) of 2.3 million breast cancers (BC) diagnosed in 2020 were from Asia. While the burden of breast cancer has been examined on the level of broad geographic regions, literature on more in-depth coverage of the individual countries and subregions of the Asian continent is lacking. This review examines the breast cancer burden in 47 Asian countries. Breast cancer screening guidelines and risk-based screening initiatives are discussed.

Canine leptospirosis is a zoonosis of epidemiological importance. Dogs are recognized as primary reservoirs of Leptospira interrogans serogroup Canicola and a source of infection to the environment through urine. This study aimed to determine the presence of antibodies against Leptospira in canines from 49 municipalities in the Department of Antioquia, Colombia. We performed a cross-sectional study of dogs included in a neutering control program. We collected 1335 sera samples, assayed by a microagglutination test (MAT), and performed PCR detection in 21 urine samples. We also surveyed 903 dog owners. We found a seroreactivity of 11.2% (150/1335) in Antioquia with titers 1:50. Municipalities with the highest number of cases were Belmira (46.1%), Turbo (34.5%), and Concepción (31.0%). L. santarosai was identified by phylogenetic analysis in one urine sample from the municipality of Granada. The most important factor associated with a positive result was the lack of vaccination against leptospirosis (PR 3.3, p < 0.014). Environmental factors such as water presence and bare soil around the household were also associated with Leptospira seroreactivity in the Department of Antioquia. We reviewed a national epidemiological surveillance database for human cases in those municipalities. We found a correlation between the high number of cases in canines and humans, especially in the Uraba. Serological and molecular results showed the circulation of Leptospira. Future public health efforts in the municipalities with the highest numbers of seroreactivity should be directed towards vaccination to prevent animal disease and decrease the probability of transmission of Leptospira. Dogs actively participate in the Leptospira cycle in Antioquia and encourage the implementation of vaccination protocols and coverage.

This study is follow-up of the steel shot transformation under the influence of environmental factors research (Lisin et al., 2022) and is the initial stage of investigating the iron behavior in soils during steel shot corrosion under a number of factors: the metallic lead in soils, atmospheric precipitation, excess organic matter. The results obtained show that corrosion of steel ammunition is a continuous process, including the formation of a poorly soluble rust crust on the surface of the steel and the mineralization of the metal until it is destroyed. As a result, the metal transformed into rust form, is a constant source of iron ions and dispersed rust particles migrating in soil waters and accumulating in soils. In addition, the aggregation of corrosion products of steel ammunition is the cause of a change in physical and mechanical properties of soils, which leads to a violation of the air and water migration regime of soils and an increase in surface runoff from the territories of shooting activity. The highest environmental risks are observed when steel ammunition is used on shooting areas where metallic lead intensifies steel shot corrosion rate, while the deposited steel shot activates the deterioration of previously encapsulated metal and — if steel and lead ammunition are used at the same time — slows down the encapsulation of newly deposited metallic lead, which catalyses the accumulation and migration of lead in environmental components.

Preeclampsia (PE) is associated with an increased risk of cardiovascular disease (CVD) in later life. Postpartum cardiovascular risk screening could identify patients who would benefit most from lifestyle interventions. However, there are no readily available methods to identify these high-risk women. We propose that placental lesions may be useful in this regard. Here, we sought to determine the association between placental lesions and lifetime CVD risk. Placentas from 85 PE women were evaluated for histopathological lesions. At 6 months postpartum, a lifetime cardiovascular risk score was calculated. Placental lesions were compared between CVD risk groups and the association was assessed using odds ratios. Multivariable logistic regression was used to develop prediction models for CVD risk with placental pathology. Placentas from high-risk women had more severe lesions of maternal vascular malperfusion (MVM) and resulted in a 3-fold increased risk of screening high-risk for CVD (OR 3.10[1.20-7.92]) compared to women without these lesions. MVM lesion severity was moderately predictive of high-risk screening (AUC 0.63[0.51,0.75]; sensitivity 71.8%[54.6,84.4]; specificity 54.7%[41.5,67.3]. When clinical parameters were added, the model’s predictive performance improved (AUC 0.73[0.62,0.84]; sensitivity 78.4%[65.4,87.5]; specificity 51.6%[34.8,68.0]. The results suggest that placenta pathology may provide a unique modality to identify women for cardiovascular screening.

This paper presents the behavior of decision makers, the possible choices and the strategies 1 resulting from the uncertainties related to the integration of renewable energies. Its uncertainties 2 are the risks associated with the volatility of renewable sources, the dynamics of energy production 3 as well as the planning and operation of the electricity grid. The goal is to model the risk-averse 4 decision-maker’s behavior and the choice of integrating renewable energies into the electrical system. 5 Following a bibliographic approach, we expose a methodology to model the decision-maker’s 6 behavior(risk aversion and predilection for risk) to risk taking. The risk-averse decision maker may 7 adopt nonlinear utility functions. Risk aversion is a behavior that reflects the desire to avoid risk 8 decisions and thus reduces the risk of adverse consequences. A decision support tool is provided to 9 the decision-maker to choose a best-fit strategy based on his preferences. The rational and risk-averse 10 decision-maker would seek to maximize a concave utility function instead of seeking to minimize its 11 cost. Taste or aversion to risk can be modeled by a thematic function of utility.

The present study was conducted to estimate the exposure and risk characterization of the children population of Serbia to Aflatoxin M1 (AFM1) from milk and milk-based food. A total of 3404 samples comprising of milk and different milk-based food samples were collected from various regions of Serbia from 2017 to 2019. Evaluation of the AFM1 exposure was carried out using the deterministic method, whereas risk characterization was evaluated with the calculation of the Margin of Exposure (MOE) and the risk of Hepatocellular Carcinoma (HCC). Detection rates for AFM1 in milk and milk-based food samples ranged between 2% and 79%, with the highest incidence (79%) and mean level (22.34  0,018 ng kg-1) of AFM1 was detected in pasteurized and UHT milk. According to the three consumption estimates, the values of EDI were higher for toddlers as compared with children. Children aged 1–3 years had the highest risk of exposure to AFM1 in milk, with an estimated daily intake of 0.164 and 0.193 ng kg-1 bw day-1 using a lower bound (LB) and the upper bound (UB) exposure scenarios, respectively. Such difference could result from the higher consumption versus weight. Based on the EDI found in this study, the risk of AFM1 due to consumption of milk and milk-based food was low since MOE values obtained were 10000. In addition, the risk of HCC cases/year/105 individuals of different age groups showed that the value of HCC using potency estimates of 0.0017 (mean) was maximum (0.00034) in the age group 1–3 years which indicates no health risk for the evaluated groups. The present study revealed the importance of controlling and preventing AFM1 contamination in milk through continuous monitoring and regular inspection to reduce the risk of AFM1 exposure, especially in children.

The global trend towards increased demand for organic food, greener environments, and the integration of biological control agents into pest management strategies has greatly enhanced the need for biological pesticides (biopesticides). Biopesticides are generally environmentally friendly and are made from micro-organisms or other natural substances. Despite their great potential, relatively few have been registered and commercialised in Nigeria compared to other African countries such as South Africa and Kenya. Biological active agents are so diverse such that ap-plying the same safety standards or environmental conditions to all of them is almost impossible. A review of risk assessment processes and comparative assessments of Nigeria's biopesticide regulations with other developing African countries and developed regions was conducted. Prolonged field testing, lack of bridged risk assessments and technical checklists have been identified as key factors hampering the timely development and commercialisation of biopesti-cides in Nigeria. Recommendations on necessary changes to the existing Nigeria biopesticide regulations have been made. Risk assessment matrices for microbial and biochemical biopesti-cides and a scientific/technical checklist have also been developed. Harmonisation and data ex-change among other countries in the region will also enhance the advancement of scientific and technical knowledge for sustainable regulation and cross-border trade.

Hotel water systems colonized with Legionella spp. have been the source of travel-associated Legionnaires’ disease and cases, clusters or outbreaks continue to be reported worldwide each year. A total of 132 hotels linked with travel-associated Legionnaires’ disease, as reported through the European Legionnaires’ Disease Surveillance Network, were inspected and tested for Legionella spp. during 2000–2019 by the public health authorities of the island of Crete (Greece). A total of 3,311 samples were collected: 1,885 (56.93%) from cold water supply systems, 1,387 (41.89%) from hot water supply systems, 37 (1.12%) were swab samples and two (0.06%) were soil. Of those, 685 (20.69%), were collected from 83 (62.89%) hotels, testing positive (≥ 50CFU/L) for Legionella pneumophila) serogroups 1-10, 12-14 and non-pneumophila species (L. anisa, L. erythra, L. tusconensis, L. taurinensis, L. birminghamensis, L. rubrilucens, L. londiniesis, L. oakridgensis, L. santicrusis, L. brunensis, L. maceacherii). The most frequently isolated L. pneumophila serogroups were 1 (27.92%) and 3 (17.08%). Significantly higher isolation rates were obtained from hot water supply systems (25.96%) versus cold water systems (16.98%) and swab samples (13.51%). A Relative Risk (R.R.) > 1 (p < 0.0001) was calculated for hot water temperature <55 °C (R.R.: 4.43), chlorine concentrations <0.2 mg/L (R.R.: 2.69), star rating <4 (R.R.: 1.73) and absence of Water Safety Plan implementation (R.R.: 1.57).

In this study, I extend the Fama and French five-factor asset pricing model with a sixth factor, namely, carbon risk, to investigate its impact on equity returns. To measure carbon risk, a new factor ‘pollutant minus green,’ is developed using the difference between the weighted average returns of pollutant and green firms across 51 developed and emerging countries across four categories—North America, Europe, Emerging Markets, and the Asia Pacific. The results reveal that North America, Europe, and Asia Pacific markets have a carbon risk premium that gets eliminated in small-cap firms. The carbon risk factor is further tested in left-hand side (LHS) test asset portfolios and found to be more pronounced with size-effect anomaly; specifically, small stock firms report greater declining average returns because of more exposure than the mega-cap stocks to carbon dioxide emissions. Furthermore, size-effect anomaly prevails with profitability and investment factors across firms. Therefore, high profitability, as well as high investment small firms, show a greater decline than the big stock firms in average returns when their carbon dioxide emissions increase. The asset pricing model evaluation is carried out through the Gibbons, Ross, and Shanken test. The six-factor model directed at capturing carbon risk patterns in average equity returns performs better than the three-factor and five-factor models of Fama and French (1993 and 2015) in the majority of categories under 3x3 sorting and compete with both Fama and French model under 2x4x4 sorted LHS portfolios. The finding of this study offers various useful applications for investors, policymakers, brokers, corporations, governmental pollution abatement institutions, and other stakeholders who wish to obtain carbon risk premium.

This paper aims to delve into how gender dimensions observed before, during and after a disaster, have been addressed in two internationally recognised frameworks developed for reducing risks of disasters: Hyogo Framework Action (2005-2015) and Sendai Framework for Disaster Risk Reduction (2015-2030). Building on a systematic review, we evaluate 33 scholarly peer-reviewed journal articles, including book chapters and websites in areas of gender, disaster risk reduction and vulnerability. This study documents a comparative picture of these two frameworks and shows the practical implications of the Sendai Framework for Disaster Risk Reduction (SFDRR) by addressing women’s empowerment in the light of their active participation in disaster risk reduction process. The findings of the study suggest that the frameworks have discussed the reduction of women’s socioeconomic vulnerabilities, as well as encouraged their empowerment. Comparing the two frameworks, it appears in the current study that there has been a significant gap in the existing literature that does not explicitly document comparing and contrasting features of a gender lens in the policy documents.

This study addresses the peculiarities of the generation of slope movements in the context of road infrastructures and provide a predictive mapping of susceptibility to movements on slopes adjacent to road infrastructures (rockfalls). An inventory of slopes movements was mapped. From the development of the inventory of constant cases of mobilization that is used as a dependent variable, two statistical models can be obtained and compared for the same study area. One of them is based on the concept of frequency, whilst the other one is based on the application of a logistic regression. The results reveal the preponderant importance of lithology as a predictive variable, followed, at a considerable distance, by the slope gradient. Likewise, the importance of an unnatural and characteristic variable area of study, such as the presence of artificial cuts, is indicated as a causative factor. The results show a high degree of coincidence between the tendency of susceptibility predicted by the model, and the effective presence of empirical mobilization signs on the slopes, with Area Under Curve (AUC) values for Receiver Operating Characteristics (ROC) around 0.8.

The association between obesity and the risk of gliomas remains unclear. We sought to evaluate the potential association between general and abdominal obesity and the risk of gliomas based on a nationwide population-based cohort study of Koreans. Using data from the Korean National Health Insurance System cohort, 6,833,744 people older than 20 years who underwent regular national health examination in both 2009 and 2011 were followed until the end of 2017. We documented 4,771 glioma cases based on an ICD-10 code of C71 during the median follow-up period of 7.30 years. Individuals with a body mass index (BMI) ≥ 25.0 kg/m2 were at significantly higher risk of gliomas than those with a BMI < 25.0 kg/m2 (HR 1.08 CI 1.02-1.15). Individuals with a waist circumference (WC) ≥ 90 cm (males)/85 cm (females) also had a significantly higher risk of gliomas than those with a WC < 90 cm (males)/85 cm (females) (HR 1.16 CI 1.09-1.24). In the group with a BMI ≥ 25.0 kg/m2, individuals with abdominal obesity were at significantly higher risk of gliomas (HR 1.18 CI 1.09-1.27) than those without abdominal obesity. The role of abdominal obesity in this association was stronger in women than in men. To our knowledge, this is the first demonstration that obese people may be at higher risk of gliomas, especially centrally obese people from an Asian population with a BMI ≥ 25.0 kg/m2. Loss of visceral fat in people with abdominal obesity may reduce their risk of gliomas.

Cereals and their derivatives are the basis of human nutrition. However, cereals also contribute to the dietary exposure to toxic metals that may pose a risk. Strengthening food security and nutrition information is a high priority challenge for the Cape Verde Government. The toxic metals content (Cr, Ni, Sr, Al, Cd, Pb) has been determined in 126 samples of cereals and derivatives (rice, corn gofio, corn flour, wheat flour, corn, wheat) consumed in Cape Verde. Wheat flour samples stand out for registering the highest Sr (1.60 mg/kg), Ni (0.25 mg/kg) and Cr (0.13 mg/kg). The results show relevant Al levels (1.17 – 13.4 mg/kg) with its highest levels in corn gofio. The mean Pb average content in the cereals is 0.03 – 0.08 mg/kg with the highest level observed in corn gofio. The Al and Pb levels are lower in cereals without husks. A consumption of 100 g/day of corn gofio provide an intake of 1.34 mg Al/day (13.7% of the tolerable weekly intake established at 1 mg/kg bw/week) and 8 µg Pb/day (20% of the BMDL set at 0.63 µg/kg bw/day for nephrotoxic effects). The minimization of the dietary exposure of the Cape Verdean population to toxic metals is through the importation of higher quality cereals.

Starting from the importance of risk perception for taking certain preventive measures to protect people and their property from disasters, the subject of the research is to examine the factors influencing public perception of mythically-based human behavior in disaster conditions. Using the random sampling method, 250 adult respondents were surveyed in the city of Belgrade, using a specially created and adapted survey questionnaire. The results of the research show that there is no statistically significant influence of gender, age, educational and economic factors on the public perception of human behavior in disaster conditions. The results of the research can be used to improve strategies and campaigns based on risk assessment, aimed at improving the safety of people in disasters.

Background: The treatment plan of prosthetic restorations supported by dental implants require comprehensive scientific knowledge to deliver prostheses with good prognosis, even before the implant insertion. This review aims to analyze the main prosthetic determinants of the prognosis of implant-supported prostheses. Methods: A systematic review of the literature was conducted with a PICO question: "For partially or complete edentulous subjects treated with implant-supported prostheses, which prosthetic factors could affect clinical outcomes?". A literature search was performed electronically in PubMed (MEDLINE), Scopus and Cochrane Library with the following equation [PROGNOS* OR RISK] FACTOR IMPLANT DENTAL, and by hand search in relevant journals and throughout the selected papers. Results: This revision was carried out based on 50 papers focused on several prosthodontics-related risk factors that were grouped as follows: implant-connection, loading protocol, transmucosal abutments, prosthetic fit, provisionalization, type of retention, impression technique, fabrication technique, and occlusion. More than a half of the studies were systematic reviews (30%), meta-analysis (16%) or prospective evaluations of prosthesis with various kinds of events (18%). But also narrative reviews of literature (14%) and in vitro/animal studies (16%) were found. Conclusions: The current literature provides insufficient evidence for most of the investigated topics. However, based on the accumulated data, it seems reasonable to defend that the best treatment approach is the use of morse taper implants with transmucosal abutments, recorded by means of rigidly splinted copings through the pick-up technique, and screwed by milled prosthesis occlusally adjusted to minimize functional overloading.

Identifying and assessing risk is one of the most important processes in managing complex systems and requires careful consideration. The need for an effective, efficient approach to risk management is considerably more important for defense industries, because they are exposed to risk already in early stages of development. This paper uses Heterogeneity and Homogeneity analysis between risk factors with Cochran’s Q test and Multidimensional scaling in order to present the complexity of the risk factors relevant to defense SoS, and proposes a methodology for identifying, analyzing and monitoring the risks that they face. Findings from an in-depth analysis of 46 classified defense SoS shows a need to focus on three main risks faced by defense projects: insufficient human resources, changes in the original specifications, and lack of other (non-human) resources. The paper also presents some recommendations for minimizing risk factors in defense SoS.

In public health literature the risk of death or disease associated with a dietary, environmental of behavioral factor is most commonly denoted by odds ratio (OR), hazard ratio (HR) or risk ratio (RR). The ratio indices have several desirable statistical properties. However, the most important question is whether there are some evolved innate norms of perception of risk that people use and what they are. We conducted a simple one question survey of 98 individuals with different age, sex, educational and professional backgrounds. The respondents were asked to judge the relative perceived risk of four different hypothetical habits for which data on the percentage of people affected by the disease with and without the habit was given. They were asked to rank the risks for the four habits. Results showed that the habits that had the highest difference between probability of acquiring the disease were ranked high on risk perception. The probability ratios did not affect risk perception significantly. Further age, sex, profession or formal training in statistics did not affect the response significantly. Even individuals that were formally trained to use OR and HR as risk indicators, preferred using probability differences over ratios for judging their own risk in the perceived context. This preliminary inquiry into intuitive statistical perception suggests that designing statistical indices based on people’s innate perception may be a better strategy than trying to train people to understand the indices designed by expert statisticians.

Even though the rules for free movement of machinery within the European Union market have existed for more than 30 years, accidents related to their activities have constantly been achieving significant value. When designing the machine, a designer must stem from risk assessment, whereas all stages of its life cycle and ways of its use must be taken into consideration. In industrial operations, there is old machinery, which, although fulfilling its function reliably, the safety level is not in accordance with the developing requirements for their safe operation. The proposed methodology of assessment of the machinery safety condition comes out from the presupposition of the right application of steps of risk assessment and their reduction mainly by means of implementation of both effective and efficient preventive measures. The aim of the research applied in 3 operations, was to verify the method of machinery safety management. The created methodology based on 19 requirements for safety evaluates the level of the actual measures by means of the so-called criterion of current status and total efficiency of measures. Its output is the assessment of the efficiency level of implemented safety of each machine as well as of the whole operation.

Currently there is no multi-hazard risk assessment tool for determining the level of complexity to swiftwater and flood rescue incidents. Traditionally, the International Scale of River Difficulty is used but it is primarily for paddlers for use in a recreational context, without much consideration to the multitude of hazards faced in swiftwater and flood rescue environments. In response to this gap, the ECHO risk assessment tool has been developed and undergone initial testing. This tool provides for simple and rapid codification of multiple hazards and response considerations and is globally applicable. The tool also assigns a final risk assessment colour making the interpretation of the assessment easy to understand and communicate. Though the proposed tool shows potential, further research is needed before it should be operationalised.

Malaria is a disease spread by female mosquitos of the Anopheles genus. It is acutely prevalent in Sub-Saharan Africa, where 90% of malaria deaths occur annually. One Sub-Saharan African country historically impacted by malaria is Ethiopia. In the past twenty years, malaria prevalence has decreased throughout Sub-Saharan Africa; yet, anthropogenic environmental changes are changing the landscape of malaria. Scholarly literature has cited a positive relationship between hydroelectric dams and malaria in Sub-Saharan Africa. Ethiopia is currently expanding their hydroelectric infrastructure. The Gilgel Gibe III Dam is located on the Omo River in Southwestern Ethiopia. It began generating electricity in 2015 and its reservoir has a capacity of 14,700 million m3 of water. This research utilized Geographic Information Systems and Remote Sensing to identify populations at an increased risk of malaria due to Gilgel Gibe III Dam. Two different techniques were employed: the proximity approach and the remote sensing approach. The proximity approach was based on distance from the reservoir. It identified all populations living within three kilometers of the reservoir as being at an increased risk. The remote sensing approach evaluated the slope, elevation, water content, and land surface temperature of the study area to create a mosquito breeding habitat risk map. Then, populations living within three kilometers of the two main High-Risk areas were identified. This study suggests that mosquito breeding habitat risk is not equally distributed throughout the Gilgel Gibe III Reservoir. This causes certain populations to be at a heightened risk of malaria.

Three decades ago, human arsenic (As) contamination has been recognized in Ron Phibun, a sub-district with tin mining activity in southern Thailand. Since then different government bodies have attempted to mitigate the As-contamination problem by providing safe water in households. The most recent study conducted during 2000-2002 reported only a small fraction of population still had high urinary As level. Less attention has been paid to this issue afterwards. The present study aimed to re-assess the current situation, including human As contamination, water use behavior as well as identify risk factors of elevated As concentration among residents of Ron Phibun. The survey of 560 participants living in Ron Phibun with urinary As assessment was conducted. The median urinary As concentration of study participants was higher than normal. Consumption of shallow well water, a source generally considered as As-contaminated, was higher than a previous survey. A significant association was observed between urinary As concentrations and water sources for drinking and cooking. Gender and educational level were found to be associated with urinary As concentration. Significant associations between urinary As concentration and certain diseases (respiratory diseases, dermatitis, and dyslipidemia) were observed. The findings suggested further investigation of all water sources in the area for As contamination.

Identifying and assessing risk is one of the most important processes in managing complex systems and requires careful consideration. The need for an effective, efficient approach to risk management is considerably more important for defense projects based on systems of systems (SoS), because they are exposed to risk already in early stages of development. This paper uses advanced data science tools to present the complexity of the risk factors relevant to defense systems, and proposes a methodology for identifying, analyzing and monitoring the risks that they face. Findings from an in-depth analysis of 46 classified defense projects based on SoS shows a need to focus on three main risks faced by defense projects: uncertainty, the lack of clearly defined goals, and managing a system under constrained conditions. The paper also presents some recommendations for minimizing risk factors in SoS for defense projects.

Coronavirus disease (COVID-19) has caused mankind serious confusion, economic havoc and psychological distress. This study evaluated the level of knowledge, attitude and perception about COVID-19 pandemic, infection control and impact among veterinarians in Nigeria. A cross-sectional online survey was used to collect data from consenting respondents during implementation of lockdown in the country (April 23 - May 31, 2020). Purposive and chain referral sampling techniques were used to recruit 368 respondents from various sectors of the profession. The proportion of respondents surveyed 197/368 (53.5 %) were from the public sector, 35.3 % from private sector, 1.1 % were unemployed and 0.8 % retired. Majority of the respondents were males (72.8 %), within 30 – 39 years (39.7 %) and had 1 – 10 years work experience. Respondents displayed good level of knowledge about COVID-19 (72.4 % ± 9.9 %, range 44.1-91.2 %), with information mostly derived from TV/Radio (81.5%) and social media (81.0 %). The overall attitude level was poor and various determinants for good attitude among respondents were if they were above 60 years (p = 0.013), possessed postgraduate qualification ( p = 0.031), worked over 30 years post DVM (p = 0.001), had household members between 5 and 10 (p = 0.012), and were resident in states on total lockdown (p = 0.024). There was no correlation between the knowledge level score and respondents’ attitude towards the pandemic (p = 0.12). With increasing rate of COVID-19 transmission, research data are needed to develop evidence-driven strategies, policies and effective risk mitigations to reduce the pandemic’s adverse impacts.

Objectives Independent validation of risk scores after hip fracture is uncommon, particularly for evaluation of outcomes other than death. We aimed to assess the Nottingham Hip Fracture Score (NHFS) for prediction of mortality, physical function, length of stay and postoperative complications. Design Analysis of routinely collected prospective data partly collected by follow-up interviews. Setting and Participants Consecutive hip fracture patients were identified from the Northumbria hip fracture database between 2014-2018. Patients were excluded if they were not surgically managed or if scores for predictive variables were missing. Methods C-statistics were calculated to test the discriminant ability of the NHFS, Abbreviated Mental Test Score (AMTS), and ASA grade for in-hospital, 30- and 120-day mortality, functional independence at discharge, 30-days and 120-days, length of stay, and postoperative complications. Results We analysed data from 3208 individuals, mean age 82.6 (SD 8.6). 2192 (70.9%) were female. 194 (6.3%) died during the first 30-days, 1686 (54.5%) were discharged to their own home, 211 (6.8%) had no mobility at 120-days, 141 (4.6%) experienced a postoperative complication. The median length of stay was 18 days (IQR 8-28). For mortality, c-statistics for the NHFS ranged from 0.68-0.69, similar to ASA and AMTS. For postoperative mobility, the c-statistics for the NHFS ranged from 0.74-0.83, similar to AMTS (0.61-0.82) and better than the ASA grade (0.68-0.71). Length of stay was significantly correlated with each score (p<0.001 by Jonckheere-Terpstra test); NHFS and AMTS showed inverted U-shaped relationships with length of stay. For postoperative complications, c-statistics for NHFS (0.54-0.59) were similar to ASA grade (0.53-0.61) and AMTS (0.50-0.58). Conclusions and Implications The NHFS performed consistently well in predicting functional outcomes, moderately in predicting mortality, but less well in predicting length of stay and complications. There remains room for improvement by adding further predictors such as measures of physical performance in future analyses.

There is high prevalence of hypertension and is rapidly increasing around the world, despite the intervention programme implemented, this study aimed at estimating the prevalence rate, test of association between hypertension and risk factors and model hypertension rate. Data used was obtained from the health record of Federal Medical Centre, Keffi from January 2016 – January 2019. Ordinal logistic regression model was used; Model Fitting Information, Goodness-of-Fit, Pseudo R-Square and Test of Parallel Lines are fitted to the data sets to test the accuracy and correctness of the model. The results indicated that the overall prevalence of hypertension rate is high at 36.4%, among the adult population, body mass index and gender are statistically significant, and Age is not significant in the study. Individuals that are overweight are more likely to be hypertensive compare to other weights. At age 40 – 49 years which have the highest rate of 26.5% and the odd ratio is 0.75 compared to others. One year increase in age 30 – 39, the cumulative odd of being hypertensive is 0.91 while other independent variables are held constant. The odd ratio of female being hypertensive is 0.85, therefore the females are more likely to be hypertensive with 54.4% compared to the males at 45.6% . There is no presence of multicolinearity among the variables and Logit models were formulated to calculate probabilities of the various possible outcomes.

The complex systems that require safety are the Safety Critical Systems. Maintaining these systems is a big challenge. Now a days, safety is a very critical requirement for the latest systems. Safety critical systems must be safe. Different approaches to ensure quality and safety in safety critical systems has been discussed in this paper. A comparison is also conducted between these various approaches. Safety critical systems must remain more influential in future.

Controlling and managing risk is always a critical point for the managers, investors and even consultants. Having clear and better percepts about future can reduce the risk of fail. In addition it is important for a risk analyzer to consider the stakeholders views and senses about the risk. This research aimed at framing a comprehensive risk management model which builds up on stakeholder requirements and forecasting techniques. This conceptual model attempts to use the stakeholder’s points of view to write prefer and probable scenarios to neglect critical risks and increase the chance of success in long-term plannings. Using futures studies methods prepare decision makers for the possible upcoming events and donate them a powerful tool to handle the uncertainties cover the future.

The study of the distribution and health risk assessment is meaningful to provide basic data for environmental management．To investigate the pollution of potential toxic organics and their health risk to human beings, water samples were collected at 7 sites of main surface water of Beijing during wet and dry seasons respectively. The targeted 92 organics were detected, including phthalates (PAEs), volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs) and phenols. The results showed that: there were 56 organics detected out, and the number ratios of detected compounds to the total compounds of the same kind increased as the following: VOCs, phthalates, phenols, PAHs. 8 VOCs were detected in wet season, and 3 in dry season. The concentration of 2,2-Dichloropropane was highest as 10.62ug/L, while the concentrations of other VOCs were below 5ug/L; There were 11 phthalates detected during dry season. The content of Bis(2-methoxyethyl) phthalate was highest as 188.47ng/L; 17 phenols were found in samples during wet season, and the highest concentration was 1244.73ng/L for 4-nitrophenol; PAHs could be detected in all samples, and the detected compounds and the corresponding average concentrations were higher in wet seasons than those in dry seasons, which indicated that non-point pollution was possibly the main pollution source. The health risk assessment of the detected 56 pollutants by using a model from US EPA showed that, the risk caused by the four kinds of toxic organics in this study was in the acceptable ranges.

In last decades, growing migration flows have modified the obstetric clinical care, requiring specific attention by health care systems. The aim was to describe the phenomenon focusing on miscarriage (pregnancy loss at <20 weeks). Patients admitted for care at miscarriage in a six-year period (2012-17) were revised. Miscarriage rates in all ethnic groups, dichotomized in early (within the first 12 weeks of gestation) and late (at <20 weeks) pregnancy loss. Associations between women's characteristics (age, parity, inter-pregnancy interval (IPI)) were explored to elucidate any differences. A total of 1,940 patients were included, segregated in early (n = 1769, 91.2%) and late (n = 171, 8.8%) pregnancy losses. Caucasian ethnicity was the most common (87.9%), leaving the minority groups to 12.1%. Maternal age was higher among Caucasians women than other subgroups, in contrast to Asiatic patients. Nulliparity was observed in 1045 (53.9%) patient, more widespread among Caucasian and Maghrebins. A positive obstetric history counting at least one miscarriage was frequent, ranging from 22.2% to 75%, in particular among Asiatic women, while the recurrence in Caucasians. In Afro-Carribeans the most relevant rate of late miscarriage was found. By multiple regression modelling, maternal age, nulliparity and Afro-Carribean were identified as determinants. Maternal ethnicity should be considered in the management of pregnancy losses in combination with already well-defined risk factors, including age at miscarriare and nulliparity.

Objective:The application of information technology (IT( is fundamental in the hospitals to stay competitive.In this regard, recognizing the main risks to the implementation of IT in hospitals can provide vastopportunities to improve its efficiency and help to make strategic decisions. This study aimed tosearch for the main risks of implementation of IT projects in the hospitals of Tehran. Methods: This was a practical and cross-sectional study which was conducted in the 18 hospitals of Tehran,Iran, 2018; in which a sample of 65 members were studied. The required data were collected using a questionnaire to examine seven main risks, including market, project management, human resources, technical, organizational, financial, strategic risks. The collected data were analyzed using SPSS 19.0. Additionally, the method used to test the risks in this study was structural equation modeling, which was ran using LISREL 9.30. Results: The results showed that among the seven main risks of to the implementation of IT in hospitals, the highest and lowest means were related to the human resource risks and the market risks, respectively. Also, according to the SEM, human resource risks and market risks had the highest and lowest effects, respectively. Conclusion: Announcing the use of IT in the hospitals, holding conferences about new IT developments with employees, suitable training, encouraging them to use IT tools, providing a motivating atmosphere to use IT tools for employees, are a few effective ways of overcoming the human resource risks.

Liver cirrhosis is a chronic disease that is characterized by the presence of fibrosis and regeneration of nodules in the liver whose consequences are the development of portal hypertension and liver failure. Cirrhosis arises from a wide variety of chronic diseases, which progresses slowly after years or decades. Liver cirrhosis is a public health problem. It is usually associated with viral hepatitis, consumption of alcohol, metabolic syndrome, autoimmune processes, storage diseases, toxic substances, and medications. Cirrhosis is the fourteenth most common cause of death in adults throughout the world, the fourth in Europe and the ninth in the United States. The prevalence of this disease is underestimated because it is symptomatic it is not diagnosed in initial stages, and it usually goes to the decompensated stage at a rate of 5 to 7% per year. We review here the epidemiology, pathophysiology, etiology, and diagnosis of liver cirrhosis.

In this paper we analyze the relationship between bankruptcy risk and the corporate life cycle in Pakistan from 2005 to 2014. For this purpose, we run a Hierarchical Linear Mixed Model (HLM) for a sample of 301 non-financial listed firms in 12 different sectors. The empirical outcomes reveal that firms during introduction, growth and, decline stages (mature stage) of life-cycle experience higher (lower) bankruptcy risk. Moreover, in juxtaposition with growth stage, bankruptcy risk is higher at the introduction stage of life-cycle. These findings suggest that financial managers should be cautious about the financial fragility of the firm at each stage of corporate life-cycle. The results also entail that Pakistani firms do not follow a sequential pattern in their life-cycle rather they have the tendency to revert to a previous stage or jump to the next stage of life-cycle. This is the first study that empirically examines the association between firm life-cycle stage and corresponding bankruptcy risk and asserts that managers must incorporate the life-cycle effects into their financial planning and decision making for sustainable working of an enterprise.

This study examines the effect of market risk on the financial performance of 31 non-financial companies listed on the Casablanca Stock Exchange (CSE) over the period 2000-2016. We utilize three alternative variables to assess financial performance, namely return on assets, return on equity and profit margin. Next, we use the degree of financial leverage, the book-to-market ratio, and the gearing ratio as market risk variables. Besides, we employ the pooled OLS model, the fixed effects model, the random-effects model, the difference GMM and the system GMM models. The results show that market risk indicators have a negative and significant influence on the companies' financial performance. The elasticities are greater following the book-to-market ratio compared to the degree of financial leverage and the gearing ratio, respectively. In most cases, the firm size, the tangibility ratio, and the cash holdings ratio have a positive effect on financial performance, whereas the firms' age, the debt-to-income ratio, stock turnover, and leverage hurt the performance of these non-financial companies. Therefore, decision-makers and managers should mitigate market risk through appropriate strategies of risk management, such as derivatives and insurance techniques.

This research work focused on the risks we are faced with on our day to day activities, either directly or indirectly, which can gradually accumulates and results to communal crisis, religious crisis, socio-economic agitations and tribal crises. Nasarawa Eggon Local Government Area of Nasarawa State was used as case study and a well structure close–ended questionnaire was used for data collection as it relates to Controlled Self Risk Assessment (CSRA) and linear programming technique was used to analyze. The results proved that many of this processes were neglected in these communities, making them to be prone to incessant communal crisis. The study recommend that Government should strongly, as a matter of urgency address the unemployment rate, distribution of political position, schools, primary health care and equip security personnel with the modern technology facilities, which happen to record the highest risk level.

Hyperkalemia burden in non-dialysis CKD under nephrology care is undefined. We prospectively followed 2443 patients with two visits (referral and control with 12-month interval) in 46 nephrology clinics. Patients were stratified in four categories of hyperkalemia (sK≥5.0 mEq/L) by sK at visit 1 and 2: Absent (no-no), Resolving (yes-no), New Onset (no-yes), Persistent (yes-yes). We assessed competing risks of ESKD and death after visit 2. Age was 65±15 y, eGFR 35±17 mL/min/1.73 m2, proteinuria 0.40 (0.14-1.21) g/24h. In the two visits sK was 4.8±0.6 and levels ≥6 mEq/L were observed in  4%. Hyperkalemia was absent in 46%, resolving 17%, new onset 15% and persistent 22%. Renin-angiotensin-system inhibitors (RASI) were prescribed in 79% patients. During 3.6-year follow-up, 567 patients reached ESKD and 349 died. Multivariable competing risk analysis [sub-hazard ratio-sHR, 95%Confidence Interval-CI] evidenced that new onset [sHR 1.34, 95%CI 1.05-1.72] and persistent [sHR 1.27, 95%CI 1.02-1.58] hyperkalemia predicted higher ESKD risk versus absent, independently from main determinants of outcome including eGFR change. Conversely, no effect on mortality was observed. Results were confirmed by testing sK as continuous variable. Therefore, in CKD under nephrology care, mild-to-moderate hyperkalemia status is common (37%) and predicts per se higher ESKD risk but not mortality.

The three heat-induced coffee contaminants acrylamide, furfuryl alcohol (FA) and 5-hydroxymethylfurfural (HMF) were analyzed in a collective of commercial samples as well as in Coffea arabica seeds roasted under controlled conditions from very light Scandinavian style to very dark Neapolitan style profiles. Regarding acrylamide, average contents in commercial samples were lower than in a previous study in 2002 (196 compared to 303 µg/kg). The roasting experiment confirmed the inverse relationship between roasting degree and acrylamide content, i.e. the lighter the coffee the higher the acrylamide content. However, FA and HMF were inversely related to acrylamide and found in higher contents in darker roasts. Therefore, mitigation measures must consider all contaminants and not be focused isolatedly on acrylamide, specifically since FA and HMF are contained in much higher contents with lower margins of exposure compared to acrylamide.

Risk attitudes are relevant factors affecting the production and investment decisions at farm level. They are key factors that are related to farmers’ attitudes towards environment and climate change. Several methodological approaches are available to measure the level of stated risk of an economic agent. The Multiple Price List (MPL) method is one of the methods that is gaining relevance. In this study we apply the MPL and relate the risk outcomes with farmers’ characteristics and their perception towards environment and climate change. Data was collected using a face to face survey carried out for a group of 370 agricultural producers of the irrigation district located in northwest of Mexico. Results showed an average risk of about 0.32, locating the agricultural producers of the region in a group with risk aversion, according to the MPL scale. The heterogeneity analysis showed that the socioeconomic factors and the perceptions towards climate change are related to the farmers´ stated risk level. Farmers who are young women with propensity to use public support to invest were shown to be greater risk lovers. Farmers in the region have perceived climate change to a greater extent like floods, hail, diseases and pests, and changing vegetation.

Portfolio weights solely based on risk avoid estimation error from the sample mean, but they are still affected from the misspecification in the sample covariance matrix. To solve this problem, we shrink the covariance matrix towards the Identity, the Variance Identity, the Single-index model, the Common Covariance, the Constant Correlation and the Exponential Weighted Moving Average target matrices. By an extensive Monte Carlo simulation, we offer a comparative study of these target estimators, testing their ability in reproducing the true portfolio weights. We control for the dataset dimensionality and the shrinkage intensity in the Minimum Variance, Inverse Volatility, Equal-risk-contribution and Maximum Diversification portfolios. We find out that the Identity and Variance Identity have very good statistical properties, being well-conditioned also in high-dimensional dataset. In addition, the these two models are the best target towards to shrink: they minimise the misspecification in risk-based portfolio weights, generating estimates very close to the population values. Overall, shrinking the sample covariance matrix helps reducing weights misspecification, especially in the Minimum Variance and the Maximum Diversification portfolios. The Inverse Volatility and the Equal-Risk-Contribution portfolios are less sensitive to covariance misspecification, hence they benefit less from shrinkage.

Some of the recent large-scale national projects in South Korea are delayed or suspended due to belated responses to risk occurring on site. Currently, the Far East District (FED) project is being implemented to relocate the US Army bases from Yongsan to Pyeongtaek. Because of lack of experience and understanding about the characteristics of such a project, the deadline of taking over to the US Army Korea has been missed. This study identifies problems of each participant in the Yongsan Relocation Plan (YRP) of the US Army Korea with respect to construction project management and establishes a risk management strategy reflecting characteristics of FED project. To derive significant risk factors influencing YRP, various field data like weekly and monthly reports and other reports on construction condition are analyzed, and experts’ advices are collected and a survey is conducted. Mediators and latent variables are ultimately obtained. Furthermore, a structural equation model is used to both analyze and evaluate complex causal relations among many variables of YRP. The impact of risk factors on the schedule, quality and cost of the project is analyzed. In particular, the case of Site A is examined to see how the project is affected by those risk factors.

Introduction: Ambient air pollution is major global health problem and commercial drivers are particularly exposed to it. No systematic assessment of the health risks associated with occupational exposure to ambient air pollution in this population has been carried out. Methods: We conducted a systematic review using a protocol-driven strategy. Papers published from inception to 20th April 2018 in MEDLINE, EMBASE, CINAHL, African journals online, Cochrane library, ISRCTN and WHO ICTRP databases were screened for inclusion by two independent reviewers. Original articles with at least an available abstract in English or French were included. Results: The initial search retrieved 1454 published articles of which 20 articles were included. 3 Studies reported a significant difference in white blood cells (106/L) among commercial motorcyclists compared to rural inhabitants (5.041±1.209 vs 5.900±1.213,p=0.001), an increased risk of lung cancer (RR=1.6, 95%CI 1.5-1.8) in bus drivers and an increased standardized mortality ratio (SMR) in bus drivers from Hodgkin’s lymphoma (SMR 2.17, 95%CI 1.19-3.87) compared to white collar workers. Other studies also found that drivers had more oxidative DNA damage and chromosome breaks. 4 papers failed to demonstrate that the drivers were more exposed to air pollution than the controls. 3 other studies also reported no significant difference in lung function parameters and respiratory symptoms. The genetic polymorphisms of detoxifying enzymes were not also homogeneously distributed compared to the controls. Conclusion: There is some evidence that occupational exposure to ambient air pollution among commercial drivers is associated with adverse health outcomes but the existing literature is limited with few studies of small sample size, methodological weaknesses and contradictory findings. Further research is recommended.

Uncertainty is the main source of risk of geological hazards in tunnel engineering. Uncertainty information not only affects the accuracy of evaluation results, but also affects the reliability of decision-making schemes. Therefore, it is necessary to evaluate and control the impact of uncertainty on risk. In this study, the problems in existing entropy-hazard model such as inefficient decision-making and failure of decision-making are analysed, and an improved uncertainty evaluation and control process are proposed. Then the tolerance cost, the key factor in the decision-making model, is also discussed. It is considered that the amount of change in risk value (R1) can better reflect the psychological behaviour of decision-makers. Thirdly, common attribute decision models, such as the expected utility-entropy model, are analysed, and then the viewpoint of different types of decision-making issues that require different decision methods is proposed. The well-known Allais paradox is explained by the proposed methods. Finally, the engineering application results show that the uncertainty control idea proposed here is accurate and effective. This research indicates a direction for further research into uncertainty, and risk control, issues affecting underground engineering works.

Philippines as an archipelago and tropical country, which is situated near the Pacific ocean, faces uncertain rainfall intensities. This makes environmental, agricultural and economic systems affected by precipitation difficult to manage. Time series analysis of Philippine rainfall pattern has been previously done, but there is no study investigating its probability distribution. Modeling the Philippine rainfall using probability distributions is essential, especially in managing risks and designing insurance products. Here, daily and cumulative rainfall data (January 1961 - August 2016) from 28 PAGASA weather stations are fitted to probability distributions. Moreover, the fitted distributions are examined for invariance under subsets of the rainfall data set. We observe that the Gamma distribution is a suitable fit for the daily up to the ten-day cumulative rainfall data. Our results can be used in agriculture, especially in forecasting claims in weather index-based insurance.

Background. Increasing evidence demonstrate that concentration of protein in infant formula >1.9g/100Kcal with high levels of insulinogenic aminoacids is associated with accelerated weight gain, increased fat mass accumulation and risk of adiposity. Purpose of this study was to conduct a systematic review to determine the metabolic effects in infants feed with infant formula optimized in protein. Methods. Systematic review was conducted according PRISMA Statement. RCTs with one intervention group (infant formula with 1.6-1.9gr of protein/100Kcal) and at least one comparative control group (infant formula with >1.9gr of protein/100Kcal) were included. Standardized mean differences (SMD), through random model were calculated. Results. 15 RCT were included. Optimized protein in infant formula was associated with less gain of BMI at 24 months of follow-up (SMD -0.25, IC95% -0.36 to -0.13, p 0.01) and less fat mass accumulation (SMD -0.68, IC95% -0.98 to -0.37, p 0.01). Optimized protein was also associated to less gain of weight, weight/age Z-score, weight/length Z-score, BUN (mmol/dL) and IGF1 (ng/ml). No effect on length/age Z-score was observed. Conclusions. Robust evidence showed optimized protein (1.6gr/100Kcal to 1.9gr/100Kcal) in infant formula is associated with metabolic benefits in infants with less weight gain, BMI and fat mass accumulation.

The topic of the article refers to expressions used to address the psychosocial risk linked to the workplace violence. The article bases on the Polish-French comparison, using analysis of definitions, legal acts and public statistics. The purpose is to show social differences, in the context of mobbing and “harcèlement moral”, that surface from ratified definitions of these phenomena and public statistics. The final conclusions are the effect of a compilation of results of analysis and available literature. The choice of the two European, diverse areas of comparison for the diagnosis - Poland and France - is the result of selection of the method of data content analysis, chosen by the author because of the availability of the scientific resources essential for the article and accessible during an academic stay in Centre d'Etudes de l'Emploi in France.

Websites and applications use personalisation services to profile their users, collect their patterns and activities and eventually use this data to provide tailored suggestions. User preferences and social interactions are therefore aggregated and analysed. Every time a user publishes a new post or creates a link with another entity, either another user, or some on-line resource, new information is added to the user profile. Exposing private data does not only reveal information about single users' preferences, increasing their privacy risk, but can expose more about their network that single actors intended. This mechanism is self-evident on \emph{social networks} where users receive suggestions based on their friends' activity. We propose an information theoretic approach to measure the differential update of the anonymity risk for time-varying user profiles. This expresses how privacy is affected when new content is posted and how much third party services get to know about the users when a new activity is shared. We use real Facebook data to show how our model can be applied on a real world scenario.

Adaptation to climate change is being addressed in many domains. This means that there are multiple perspectives on adaptation; often with differing visions resulting in disconnected responses and outcomes. Combining singular perspectives into coherent, combined perspectives that include multiple needs and visions can help to deepen the understanding of various aspects of adaptation and provide more effective responses. Such combinations of perspectives can help to increase the range and variety of adaptation measures available for implementation or avoid maladaptation compared with adaptations derived from a singular perspective. The objective of this paper is to present and demonstrate a framework for structuring the local adaptation responses using the inputs from multiple perspectives. The adaptation response framing has been done by: (i) contextualizing climate change adaptation needs; (ii) analyzing drivers of change; (iii) characterizing measures of adaptation; and (iv) establishing links between the measures with a particular emphasis on taking account of multiple perspectives. This framework was demonstrated with reference to the management of flood risks in a case study Can Tho, Vietnam. The results from the case study show that multiple perspective framing of adaptation responses enhance the understanding of various aspects of adaptation measures, thereby leading to flexible implementation practices.

This review of current research into at-risk programs serves to categorise and characterise existing programs and to evaluate the contribution of these programs to assisting students at-risk from marginalised backgrounds. This characterisation questions the (sometimes) implicit assumptions and the consequences of those assumptions inherent in and behind these various accounts. This involves a synthesis and reformulation, based on epistemological standpoints, both explicit and implied, of the various researchers. Using as a lens the (various and varied) understandings of social justice and the goals of education (Gale & Densmore, 2000; 2003) I identify three sometimes overlapping and sometimes contesting standpoints in relation to at-risk students, characterised as instrumentalist or rational technical, social constructivist or individualist and critical transformative or empowering. I argue that programs ‘which simply seek to achieve change in the individual young people are doomed to failure’ (Stewart, 1998, 4) and that a critical transformative understanding of at-risk may deliver improved outcomes for young people by challenging ‘the school context in which the young people are located’ (Stewart, 1998, 4).

The past is an important lesson for facing the future with greater awareness. In this context, school plays a key role to spread knowledge on natural phenomena and to promote behavior change. Together with researchers, teachers can be strong allies to build more resilient future citizens. The Istituto Nazionale di Geofisica e Vulcanologia (INGV) school training activities provide tools to get ready for the next earthquake and/or tsunamis. About 5000 students from both Middle schools (ISCED 2) and High schools (ISCED 3) were involved in active learning activities based on a flipped-up approach during special online scientific events in the Pandemic. Online lab activities were conducted respectively during the European Researchers’ Night (“Earthquakes: history teaches us the future: researchers for a day with experimentation in didactics for ESL”) and during the World Water Day 2021 and the World Earth Day 2021 (“Tsunamis: history teaches us the future researchers for a day with experimentation in didactics for ESL”). These two Episodes of Situated Learning (ELS) experiences triggered students’ interest, favoring remote learning, developing life skills, focusing on historical seismic studies of both past earthquakes and tsunamis.

To proactively manage information security, enterprises often employ information security risk assessment techniques. Asset value - which is used to calculate the financial impact of possible threats - is one of the key parameters of information security risk. However, assets in a system are rarely independent, and their values are typically interdependent. Asset owners and IT teams may hold different views as regards these values, and there is thus the need to reduce subjectivity in a qualitative risk assessment. The research entails the development of a conceptual framework derived from the literature to minimize subjectivity, and the design of a system based on those concepts. The study uses the Unified Modeling Language as a design tool and puts forward an object-oriented model for defining asset values, in which the relationships between assets, vulnerabilities and related threats are identified. A “segregation of duties” approach is integrated into the risk management system to mitigate against subjectivity and better determine asset values. Survey responses from 16 practitioners working in the private and public sectors confirm the validity of the approach, but suggest it may be more workable in larger organisations where resources allow dedicated risk professionals to operate.

The ISO 2859 and ISO 3951 series provide acceptance sampling procedures for lot inspection, allowing both sample size and acceptance rule to be determined, starting from a specific value either for the consumer or producer risk. However, insufficient resources often make it difficult to implement “ISO sampling plans.” In cases where the sample size is determined by external constraints, the focus shifts from determining sample size to determining consumer and producer risks. Moreover, if the sample size is very low (e.g. one single item), prior information should be included in the statistical analysis. For this reason, it makes sense to work within a Bayesian theoretical framework, such as that described in JCGM 106. Accordingly, the approach from JCGM 106 is adopted and broadened so as to allow application to lot inspection. The discussion is based on a “real-life” example of lot inspection on the basis of a single item. Starting from simple assumptions, expressions for both the prior and posterior distributions are worked out, and it is shown how the concepts from JCGM 106 can be reinterpreted in the context of lot inspection. Conceptual differences regarding the definition of consumer and producer risks in JCGM 106 and in the ISO acceptance sampling standards are elucidated and a numerical example is provided.

As a result of decades of austerity, the economies of the Eurozone are experiencing under-investment and crumbling infrastructures in an era of extremely severe emergencies as the cli-mate change and aggressive global competition. The private savings glut of the rich and the strict fiscal rules suggest a crowding-in approach in partnership with big finance in a new age of in-fra-structures. If governments mint public infrastructures into investable assets, they can gen-erate steady returns for investors and asset managers who look after pensions and insurances schemes and unlock trillions now devoted to welfare state. For the big finance to accept to be partner, however, governments must take the task of de-risking returns. Innovation technology and macro-financial literacy can synergically act to enhance this new de-risking role to address in a financially sustainable way the intense phenomena of Natural Hazards (NHs) that can severely compromise economic growth. This is precisely the aim of our Public-Private Partnership (PPP) among the Department of Economics, Management and Institutions of the University of Naples and a Knowledge Transfert Management, the Department of Engineering and the Aca-demic Spin-Off “STRAIN”, of the University of Campania. Our PPP has been contributing to the eval-uation and mitigation of NHs such as floods, landslides and earthquakes since 2012. The ex-tremely advanced results of this multi-stakeholder partnership ensure a better knowledge of NHs which, as evidenced in the paper, is the fundamental input for the desired Public-Private In-surance Programmes (PIPPs).

The Western Balkans region is persistently vulnerable to natural hazards, inadequate infrastructure, and limited institutional capacities, necessitating a collaborative approach to disaster risk management. This paper presents a comprehensive project led by the Scientific-Professional Society for Disaster Risk Management (NSD-URVs) in Belgrade, aiming to establish and strengthen a regional network of experts in disaster risk management. The project focuses on building expertise, facilitating knowledge exchange, promoting expert coordination, and enhancing cross-border collaboration. Key activities include developing a web platform, organising an international conference, and advocating for regional policies that integrate best practices and innovations in disaster risk management. The expected outcomes are the establishment of a cohesive network, enhanced expertise and coordination, and improved preparedness and responsiveness to disasters. By leveraging collective expertise and resources, this initiative aims to fortify the region's resilience against potential disasters. Addressing the identified gaps and implementing the proposed policy recommendations can significantly enhance the region's resilience to natural hazards. Future research should focus on the implementation and impact of these recommendations to ensure continuous improvement in disaster preparedness and response.

The lack of application of management models that allow strategies to be converted into action and then measure their results in order to apply improvement actions to meet the objectives in small and medium-sized companies (SMEs); they generate problems in their management causing the closure of their operations unexpectedly; To mitigate the risks of closure and bankruptcy with the support of ICT, an alternative was presented considering that risk management is important in decision making at a strategic, tactical and operational level. The objective is to design a prototype to mitigate risks and prevent threats to avoid the closure of this type of company. Through the analysis of related articles, applying sequences of methodological steps; It was determined that the proposed results are aimed at how to identify and mitigate the risks and threats that cause their bankruptcy and closure. Prototypes resulted that allow mitigating risks, preventing threats and minimizing vulnerabilities in the management of SMEs. It was concluded that the proposed prototype to detect threats and vulnerabilities provides an optimal security model for small and medium-sized companies; As a result of the simulations, a security percentage of 77.92% was established, which means that the greater the number of risks and threats, the greater the probability that a small and medium-sized company will close.

A number of epidemiological studies have implicated elevated iron levels with higher risks of cardiometabolic diseases, including the metabolic syndrome (MetS). MetS is a pathologic clustering of metabolic derangements characterized by central obesity, insulin resistance, hypertension, and dyslipidemia, which can all lead to increased cardiovascular disease morbidity and mortality. However, it remains unclear whether a causal association exists between higher iron status and MetS and its associated risk components. Using the data from the Taiwan Biobank (TWB) (19,012 males; 42,340 females) and of the European Whites from the UK Biobank (UKB) (128,549 males; 142,817 females), we first constructed ethnic- and sex-specific hemoglobin-polygenic risk scores (Hb-PRS) as instrumental variable (IV) for iron status with the Hb-associated SNPs we previously identified from genome-wide association studies (GWAS). We then conducted Mendelian randomization (MR) analyses to elucidate the causal role of elevated iron (either Hb-PRS quintiles or continuous Hb-PRS) on various metabolic components. MR-Egger regressions determined the potential pleiotropic effects of the constructed Hb-PRSs, while the causal relationship of Hb-PRS with anemia served as a control in the analyses. The mean Hb concentration range corresponding to the Hb-PRS quintiles is relatively narrow in both UKB (14.91-15.21 g/dL for males and 13.39-13.71 g/dL for females) and TWB (14.79-15.28 g/dL for males and 12.78-13.21 g/dL for females). In these windows of Hb-PRSs, we found differential associations of Hb-PRS with diabetes (T2D) or hyperglycemia (HGY) as compared to other MetS components. The highest quintiles of Hb-PRSs were causally associated with greater risks of hypertension (HTN) and hypertriglyceridemia (DLP) (i.e., [Taiwanese HC males: Q5 vs. Q1 ORHTN = 1.10 (1.00–1.21), p = 0.0473, Q4 vs. Q1 ORDLP = 1.10 (1.00–1.22), p = 0.0485; European White males: ORHTN = 1.05 (1.01–1.09), p = 0.0194, ORDLP = 1.04 (1.00–1.08), p = 0.0468]). Interestingly, we obtained a consistent negative causal association between increasing Hb-PRS quintiles and T2D or HGY risk across all sex subgroups (i.e., [Taiwanese HC females: ORHGY = 0.89 (0.84–0.95), 0.88 (0.83–0.94), 0.87 (0.82–0.93), 0.86 (0.81–0.92) from Q2 to Q5; European White females: ORHGY = 0.92 (0.87–0.98), 0.91 (0.86–0.97), 0.93 (0.87–0.98), 0.87 (0.82–0.93) from Q2 to Q5; all p &lt; 0.05]. The positive causal relationships between Hb-PRSs and diastolic blood pressure (DBP) and triglycerides (TG) but inverse causal association with glucose (GLU) and glycated hemoglobin (HbA1c) further corroborated such findings. There is, however, a lack of causal association with central obesity (CO), while a U-shaped type of causality was observed for gout (GT) or hyperuricemia (HUA). Sensitivity analyses, which excluded subjects based on self-reports of health conditions or medications and hospital episode statistics data, revealed similar results. Our MR studies confirm a modest causal relationship between propensity of elevated iron status and increased risk of HTN and DLP. We have further observed that modestly lower iron levels causally contribute to the development of T2D. Further validation and elucidation of the underlying biological mechanisms are highly warranted.

Soil-transmitted helminthiasis (STH), a neglected tropical disease (NTD) remains a major health problem all over the world including Ghana, which has STH prevalence of 25.4%. To control the disease, the government of Ghana currently concentrates on implementing mass drug administration (MDA) efforts focusing only among school-aged children. However, various studies have suggested that focusing on only a specific group for MDA may not be cost-effective. Moreover, some adults such as teachers and school-workers spend large fraction of their time with children, who shed more parasite in environment due to unhygienic behavior, and thus have a higher risk of getting infected as compared to other adults. In this study we use a mathematical model to evaluate age-structured and risk-based policies for implementing MDA while capturing transmission dynamics of STH in Ghana. A cost model was developed that included various costs related to MDA to study cost-effectiveness of current policies of MDA in Ghana against novel policies to control STH in Ghana. We carry out analysis for five different scenarios— I: no MDA (baseline), II: current MDA policy (focusing children) in Ghana, III: MDA for different age groups (adults and children groups) for unlimited budget, IV: MDA for different age groups with limitations of number of individuals treated, and, V: MDA for different groups based on their risk of getting infected (adults school workers (high-risk group), adults non-school workers and children groups). Our results suggest that it might be more cost-effective to allocate treatment through MDA to at least some proportion of adults along with children. In case of unlimited budget, the best strategy in Scenario IV would be to treat approximately 22% of adults and approximately 45% of children. The most cost-effective among the 5 scenarios is suggested through scenario V, where high-risk adults group and children are provided MDA at higher level than low-risk adults. In conclusion, age-structured and risk-based allocation of treatment and resources is crucial to reducing STH load in developing countries.

Background: Cognitive decline (CD) is a significant concern in Parkinson's disease (PD), highlighting the need for reliable risk prediction models for early intervention. This study used machine learning (ML) techniques to predict the CD risk over five-year in early-stage PD. Methods: Data from the Early Parkinson's Disease Longitudinal Singapore (2014 to 2018) was used to predict CD defined as a one-unit annual decrease or a one-unit decline in Montreal Cognitive Assessment (MoCA) over two consecutive years. Four ML methods—AutoScore, Random Forest, K-Nearest Neighbors and Neural Network—were applied using baseline demographics, clinical assessments and blood biomarkers. Model performance was evaluated using area under the curve (AUC), sensitivity and specificity. Results: Variable selection identified key predictors of CD, including education year, diastolic lying blood pressure, diastolic standing blood pressure, systolic lying blood pressure, Hoehn and Yahr scale, body mass index, phosphorylated tau at threonine 181, total tau, Neurofilament light chain and suppression of tumorigenicity 2. Random Forest was the most effective, achieving an AUC of 0.93 (95% CI: 0.89, 0.97), using 10-fold cross-validation. Conclusion: ML-based models offer potential for early identification of patients at high risk of CD, facilitating targeted interventions and improving patient outcomes in PD management.

We study the Mean-Risk model, where risk is measured by the Modified CoVaR \[ \CoVaR^{\leq}_{\alpha, \beta}(X|Y) = VaR_\beta ( X \;| \; Y + VaR_\alpha (Y) \leq 0).\] We prove that in Gaussian setting, for sufficiently small $\beta$, such model has a solution.

This paper proposes a novel hybrid model that integrates Failure Mode and Effects Analysis (FMEA), Rank Order Centroid (ROC) and COmbined COmpromise SOlution (COCOSO) to improve risk assessment and prioritization of failure modes. A case study in the healthcare sector will be conducted to validate the effectiveness of the proposed model. ROC is used to assign weights to the FMEA criteria (severity, occurrence and detectability). COCOSO is then applied to create a robust ranking of failure modes by considering multiple criteria simultaneously. The results of the case study show that the hybrid FMEA-ROC-COCOSO model improves the accuracy and objectivity of risk prioritization. It effectively identifies critical failure modes, outperforming traditional FMEA. The hybrid approach not only improves risk management decision making, leading to better mitigation strategies and higher system reliability, but also reduces the complexity typically found in FMEA hybrid models. This model provides a more comprehensive risk assessment tool suitable for application in different industries.

Abstract Introduction: Despite the determination to succeed in eliminating neglected tropical diseases, these have been increasing within certain endemicities, particularly in depriving region. Objective: This study aimed to assess the relative burden of neglected tropical diseases in rural and urban slum settings in Eastern Ethiopia. Methods: A comparative cross-sectional study was conducted from February 25 to April 30, 2024 with a multistage random sampling technique used. A survey tool with the integration of the spectrum was employed. Data were entered using Epi-Data version 3.1 and analyzed using STATA 16. Descriptive statistics and multivariable logistic regression analysis was used to identify the risk factors and the level for statistical significance was declared at p-value < 0.05 with 95 % CI. Result: The response rate was 93 % and the mean age of house heads was 31.6 (Range; 18. 63) with 5.7 average family size. The overall prevalence of NTDs among study participants was 22.6 % (95% CI; 20.2, 25.2); urban slum it was 15 % (95% CI; 12.2, 18.4) while it was 29.8 % (95% CI; 26, 33.9) in rural. Though there is no statistically significant difference, the relative prevalence of NTDs in rural to urban was two. The multivariable analysis provided that the risk factors associated with NTDs were government employment (AOR: 12.5 (1.17, 132.4)), good income (AOR: 0.13 (.03, 0.57)), Child playing with soil (AOR: 5.8 (1.52, 22.0)); child hand washing at critical times ( AOR: 11.2 (1.7, 74.9)), presence of flies in the child faces (AOR: 20.3 (4.7, 88.6)) and type of drinking water sources (AOR: 0.11 (0.02, 0.73)). Conclusion: the burden of NTDs was moderate in the study area dominated by STH, Trachoma, and scabies. Socio economic and WASH factors were found to be associated with NTDs. Collaborated efforts among stakeholders are crucial to prevent and control NTDs.

Background: There is paucity of evidence on the association of genetic propensity for hippocampal atrophy with cognitive outcomes. Therefore, we examined the relationship of a Polygenic Risk Score for hippocampal atrophy (PRShp) with the incidence of amnestic mild cognitive impairment (aMCI) and Alzheimer’s disease (AD) as well as the rates of cognitive decline. Methods: Participants were drawn from the population based HELIAD cohort. Comprehensive neuropsychological assessments were performed at baseline and follow-up. PRShp was derived from the summary statistics of a large GWAS for hippocampal volume. Cox proportional hazards models as well as generalized estimating equations (GEEs) were used to evaluate the association of PRShp with the combined incidence of aMCI/AD and cognitive changes over time, respectively. All models were adjusted for age, sex, education, and Apolipoprotein E (APOE) genotype. Results: Our analysis included 618 older adults, among whom 73 developed aMCI/AD after an average follow-up of 2.96±0.8 years. Each additional SD of PRShp elevated the relative hazard for incident aMCI/AD by 46%. Participants at the top quartile of PRShp had almost three times higher risk of converting to aMCI/AD compared to the lowest quartile group. Higher PRShp scores were also linked to steeper global cognitive and memory decline. The impact of PRShp was greater among women and younger adults. Conclusions: Our findings support the association of PRShp with aMCI/AD incidence and with global cognitive and memory decline over time. PRS association was sex and age dependent, suggesting that these factors should be considered in genetic modelling for AD.

Background/objective: A retrospective study was conducted to access better understanding of the prevalence and risk factors of OIs in HIV-positive individuals, informing targeted interventions and enhancing overall health outcomes. Methods: Medical records 212 of patients (61.79% female, 38.21% male) were accessed to extract relevant information for the study. Fisher’s exact test revealed significant associations between gender, substance abuse, healthy diet practices, and having single or multiple partners with the development of opportunistic infections.Results: A total of 212 HIV-positive patients were enrolled, with a majority being female (61.79%) and adults aged between 25 and 65 years (68.87%). Most participants were single (83.02%), unemployed (66.9%), and had a history of substance abuse (61.79%). The prevalence of opportunistic infections was 15.09%, with pulmonary tuberculosis being the most common (75%), followed by extrapulmonary tuberculosis (18.75%) and herpes zoster (6.25%). Females were less likely to develop opportunistic infections compared to males (OR=0.26; 95% CI: 0.12 to 0.57; p=0.0007). Patients not using substances were less likely to develop opportunistic infections (OR=0.32; 95% CI: 0.13 to 0.82; p=0.0170). Those with unhealthy diet practices were significantly more likely to develop opportunistic infections (OR=8.46; 95% CI: 3.56 to 20.53; p<0.0001). Patients with multiple partners were more likely to develop opportunistic infections (OR=3.33; 95% CI: 1.27 to 9.26; p=0.0250). Conclusion: These findings highlight the importance of addressing these factors in the management of HIV-positive patients to reduce the risk of opportunistic infections.

In recent years, the assessment of damage scenarios of urban communities has become one of the central themes in local government policies, aimed at promoting effective seismic risk mitigation and improving the efficiency of rescue systems to manage emergencies. In Italy, the seismic hazard has become a topic issue since the 1982 Irpinia earthquake, and several ventures have been promoted to face the seismic mitigation of complex residential districts. The objective of this research is to define the damage scenarios of the city of Florence, where 97% of the building stock is designed without anti-seismic prescriptions. The urban vulnerability of Florence has been assessed on the basis of the current approaches available in technical literature, and it has been combined with the knowledge provided by the recent investigation on the subsoil. Once the possible damage scenarios have been defined, the resilience of the area has been determined and the population involved in the evacuation has been estimated.

Background: Rabies, a zoonotic disease caused by the Lyssavirus genus, is widely distributed and a significant cause of human death in Africa and Asia. This study aimed to investigate human rabies exposure and associated risk factors in Northwest Ethiopia. Methods: The study encompassed four zones, seven districts, and four kebeles from each district. The research team developed a questionnaire for data collection. Results: A total of 642 households were interviewed. The present study highlighted an exposure to rabies of 10.47%.”. Over 98% of residents displayed a strong understanding of rabies, with 99.69% correctly identifying rabies as a zoonotic disease. However, 80.22% of the interviewees believed that traditional medicine can treat the disease. Only 21.93% of victims were subjected to post-exposure prophylaxis. More than 87% of exposed residents were affected by the dogs. Of that, 48.70% were bitten by their own dogs. Metema district had the highest risk of exposure (p < 0.001) compared to the other six that were investigated. Dog ownership (p<0.05) and a higher number of households (p<0.01) were also identified as risk factors for rabies exposure. Conclusion: Residence, low education levels, high household density, free-roaming dogs, and dog ownership are key risk factors for rabies exposure. Public health awareness campaigns are crucial to emphasize the risks associated with animal bites.

Indoor air quality (IAQ) is a critical determinant of human health, with fungal contamination posing significant risks. In 2023, a total of 160 samples were collected from 40 selected rooms. These samples were cultured on Sabouraud Dextrose Agar (SDA) medium using a portable air sampler and incubated at 28°C for 7 days. Initial identification of fungal isolates was performed based on their morphology. Suspected isolates underwent further analysis using internal transcribed spacer (ITS) rDNA analysis. The results revealed 11 species across 8 genera in various rooms. The most prevalent fungi were Aspergillus niger (183 CFU) , Penicillium chrysogenum (139 CFU) and Cladosporium halotolerans (135 CFU). On the other hand, Curvularia hawaiiensis and A. ustus were rarely isolated (10 and 19 respectively). Effective treatment involves a combination of preventive measures, such as controlling humidity and ensuring proper ventilation, alongside targeted interventions like antifungal treatments and thorough cleaning. Continuous monitoring and management of indoor environments are essential to reduce fungal contamination, enhance air quality, and protect human health from the harmful effects of airborne fungi. This abstract underscore the importance of addressing indoor fungal contamination to promote safer, healthier living and working spaces.

Objective: African Americans (AA) carry the largest burden for almost every type of cancer in the US and are also more likely to die from cancer. Approximately 10% of cancers can be explained by a hereditary factor and detected earlier. Many AA however have inequitable access to hereditary cancer risk assessment (HCRA) tools and information, further exacerbating cancer disparities. Innovative communication strategies to promote community-based HCRA information have promise to bridge AA to optimal primary cancer screening. The current pilot study followed a participatory process where researchers engaged with a Community Advisory Board (CAB) to explore how Communication Asset Mapping could assist Lay Health Advisors with dissemination of evidence-based HCRA information within AA faith communities. Methods: The research team and CAB conducted exploratory community group discussions with residents (N=21) guided by Communication Infrastructure Theory, and a community-engaged mapping process to inform the development of a Communication Asset Mapping (CAM) dissemination strategy. Results: Themes included: (1) Optimal locations (e.g. community centers) within identified networks (specified neighborhood networks) should have representatives who are trusted ambassadors to assist with HCRA information dissemination; (2) Trusted community member voices should fully represent the trusted network; and (3) Well-known and frequented geographic locations should be a true representation of participants’ neighborhoods for creating a robust health information network concerning HCRA. Conclusion: CAB and community residents appreciated the engagement process however, felt the impact was limited due to missing community voices within their neighborhoods to identify communication assets within the network for optimal HCRA information dissemination. CAM therefore is an important public health strategy in identification of trusted networks. The strategy was also helpful in pinpointing people who are critical communicators of emerging health information akin to HCRA.

Sick leave is influenced by various modifiable lifestyle factors and sex differences. This study examines the impact of body mass index, fruit and vegetable consumption, physical activity, smoking, and alcohol consumption on sick leave among Serbia's working population, focusing on sex differences. Data from the 2019 National Health Survey of Serbia were analyzed, focusing on a representative sample of 4,652 individuals aged 18-65. Chi-square tests and logistic regression models assessed the relationships between lifestyle factors and sick leave, adjusting for sociodemographic, work-related, and health-related variables. Among respondents, 15.8% reported sick leave in the past 12 months, with higher rates among women in both, short-term (13.9% vs. 10.6%) and long-term sick leave (3.4% vs. 2.2%). For men, obesity (OR = 2.6), poor dietary habits (fruit OR = 2.1; vegetables OR = 2.8), smoking (OR = 1.9), and risky alcohol consumption (OR = 4.1) significantly increase the likelihood of sick leave. In women, smoking (OR = 1.8) and risky alcohol consumption (OR = 3.1) are major predictors, while BMI and physical activity show less impact. Fruit and vegetable consumption and physical activity have inconsistent effects on sick leave, indicating the need for further research. This study identifies obesity, poor dietary habits, smoking, and alcohol consumption as key predictors of sick leave in men. In women, smoking and risky alcohol consumption are major predictors. Smoking is a risk factor for both sexes, while risky alcohol consumption emerges as a prominent predictor and is a significant predictor overall. These findings highlight the need for targeted public health interventions to address these lifestyle factors and reduce sick leave rates. Further research is needed to clarify the roles of dietary habits and physical activity in influencing sick leave.

The rapid proliferation of Internet of Things (IoT) devices has transformed various sectors, from smart homes to industrial systems. However, this growth has introduced significant security risks due to the increased attack surface and diverse nature of IoT devices. This paper presents a comprehensive assessment of IoT security risks and explores effective mitigation strategies. We first categorize the primary risks associated with IoT, including data breaches, device manipulation, and network vulnerabilities. Using a multi-layered approach, we analyze these risks in different contexts, such as consumer IoT, industrial IoT, and healthcare. The study then reviews existing security frameworks and protocols, highlighting their strengths and limitations. We propose a hybrid mitigation strategy combining encryption, access control, and anomaly detection to enhance IoT security. Furthermore, we discuss the role of regulatory standards and best practices in reinforcing IoT security. The findings underscore the need for a proactive and adaptive security posture to address evolving threats in the IoT landscape.

Cardiovascular diseases (CVDs) and their risk factors are a major cause of illness and death worldwide, especially in low- and middle-income countries like Cameroon. Physiotherapist-led health promotion (PLHP) has proven effective in improving health and reducing CVD risks. Understanding patient perspectives is crucial for designing effective, context-specific PLHP interventions. This study explored patients' views, experiences, perceived usefulness, acceptability, and preferred methods of PLHP through a sequential explanatory mixed-methods approach. The quantitative data highlights a significant burden of CVD conditions and risk factors among patients seen in physiotherapy services. Qualitatively, three themes were identified and included: 1) perspectives and experiences of people at risk or with CVDs (pwCVDs) on PLHP; 2) Perceived usefulness and acceptability of PLHP; 3) Preferred delivery methods of PLHP. Participants reported positive feedback on PLHP and physiotherapy services. Barriers to effective PLHP included high workloads for physiotherapists, limited service access in rural areas, and prohibitive costs. Despite these challenges, participants expressed strong confidence in physiotherapists' competence, though they also called for improved regulation and ongoing professional development. PLHP components, especially physical treatment and dietary advice, were deemed highly useful and acceptable. Patients suggested various delivery methods, including peer support groups, home visits, and mass media interventions. This study highlights the need to improve the scope of practice, competence of physiotherapists and accessibility of physiotherapy services in Cameroon for pwCVDs. It is necessary to adopt multidisciplinary approaches to achieve better outcomes for risk factors like diabetes and hypertension in context.

The integration of Artificial Intelligence (AI) in the FinTech industry has substantially reshaped operational workflows, product innovation, and risk management, all of which influence company valuation. This study investigates the impact of AI-enhanced multilayer networks on FinTech valuation. Utilizing a novel scalable multilayer network model with AI-driven Copula Nodes, the research reveals that operational efficiency is a significant driver of market value. However, the findings emphasize the necessity of a balanced strategy that integrates AI across all operational layers, particularly in risk management and product innovation, to maximize valuation. This study offers a comprehensive framework that enhances understanding of AI’s complex role in FinTech valuation, providing critical insights for industry stakeholders.

We use Fourier analysis to access risk in financial products. With it we analyze price changes of e.g. stocks. Via Fourier analysis we scrutinize quantitatively whether the frequency of change is higher than a change in (conserved) company value would allow. If it is the case, it would be a clear indicator of speculation and with it risk. The entire methods or better its application is fairly new. However, there were severe flaws in previous attempts; making the results (not the method) doubtful. We corrected all these mistakes by e.g. using Fourier transformation instead of discrete Fourier analysis. Our analysis is reliable in the entire frequency band, even for frequency of 1/1d or higher if the prices are noted accordingly. For the stocks scrutinized we found that the price of stocks changes disproportionally within one week which clearly indicates speculation. It would be an interesting extension to apply the method to crypto currencies as these currencies have no conserved value which makes normal considerations of volatility difficult.

Asbestos, also known by its commercial name of amianthus, has been a widely used material in various industries due to its unique properties. However, its extensive use has led to serious consequences for human health, most notably asbestosis, an irreversible chronic lung disease. Asbestosis increases the risk of lung cancer and malignant meso-thelioma both fatal diseases. To understand the role of asbestos in human health, applied sciences such as microscopy (optical and scanning electron microscopy) and geochemistry are fundamental to characterize the mineral fibers. In previous work we used these technics to characterize the fibers and, in this paper, we explore their issues associated with asbestos and asbestosis, as well as the challenges of science communication strategies to effectively inform society and workers about these risks. The lack of scientific culture, in general, leads to the lack of public awareness of risks, and to address these challenges, it is essential to implement effective communication and outreach plans and strategies, including the visualization of the fibers to understand why there may be a problem if inhaled. Educational campaigns, guidelines and plans that are informative and action-able, targeting workers, communities and the public about asbestos risks are very im-portant. General knowledge of mineralogy and geochemistry is needed and providing proper scientific communication and dissemination may help to cover the knowledge gap. We use examples and experience in Spain and Italy to illustrate this subject.

Lessons learned and risk-based outcomes from modernising the Australian Standard for post-mortem inspection and disposition judgement of beef, sheep, goat and pig carcases are described. Initial Risk Profiles identified priorities for quantitative assessments. The main difficulty encountered was the paucity of quantified performance of current inspection. Resolving this involved acquiring gross abnormality data representing regional production/proportional abattoir volumes, the range of gross abnormalities appearing nationally, proportional occurrence at carcase sites, and seasonality to enable comparisons. Evidence and discussion are provided for associated challenges experienced including preventing contamination, use of food chain information to support amendment, inspection as a part of industry Quality Assurance and opportunities to improve inspector training. Criteria considered by the Competent Authority for determination of equivalence of alternative post-mortem inspection techniques included comparisons of public health risk, non-detection rates for gross abnormalities, and microbial contamination resulting from inspection activities, as appropriate. Most gross abnormalities detected arose from animal health and welfare conditions affecting wholesomeness and did not present as food safety hazards. Non-detection rates between current and alternative inspection (observation) were negligible. A Quantitative Risk Assessment for Cysticercus bovis was conducted. Carcases with multiple gross abnormalities predominantly reflected historic infections (prior septicaemia) where trimming achieved wholesomeness unless cachexic.

Background: Shoulder pain is the third most common musculoskeletal issue in primary care, affecting up to 50% of patients six months post-consultation, leading to significant functional impairments and societal costs, especially due to sick leave. Shoulder injuries are particularly prevalent among 'overhead athletes' in sports like swimming, volleyball, and handball, with high injury rates reported annually. Screening tools like the Arm Care Screen (ACS) have been used to identify athletes at risk of shoulder injuries effectively. However, their applicability to the general population is less understood. This study aimed to assess the discriminant validity of a modified ACS (MACS) in detecting musculoskeletal risk factors among non-athletes. Methods: A prospective cross-sectional study was conducted with 30 asymptomatic subjects over 18, excluding those with a history of shoulder injuries or surgeries. The MACS, comprising four tests, was administered, and its diagnostic performance was evaluated through sensitivity, specificity, predictive values, and likelihood ratios. Results: Results indicated low sensitivity (0%-47.62%) and variable specificity (55.56%-100%), suggesting that MACS may not effectively identify risk factors in the general population. Positive and negative predictive values were inconsistent, highlighting the need for non-athlete-specific screening tools. Conclusion: While the MACS showed promise in athletes, its application in the general population requires further refinement. The study underscores the necessity for tailored screening methods to enhance early detection and prevention of musculoskeletal issues in diverse populations.

Digitalization has fundamentally changed the global economy and will continue to do so. This study investigates how the US Federal Reserve and US Treasury may work together to use decentralized finance (DeFi) systems to promote economic growth in local communities. The study looks into the potential for transformation and the difficulties in incorporating DeFi into conventional financial institutions. Research shows that the use of cash as a means of payment is widely expected to decline in the future. As a result, the public’s ability to make transactions using central bank money may decline rapidly. This study's goals are to solve economic issues, promote innovation, and increase financial efficiency. The use of in-depth interviews, theme analysis, case studies, stakeholder perspectives, comparative analysis, and document analysis is suggested as part of a qualitative research methodology. The goal of these approaches is to offer a sophisticated comprehension of the dynamics of collaboration and the consequences of DeFi integration in the context of the Federal Reserve-Treasury relationship. Important data sources that are necessary to answer the research question are indicated, such as US Treasury statistics, Federal Reserve publications, DeFi platforms, and International Monetary Fund economic indicators. Informed decision-making and policy formation may pave the way for a more inclusive and efficient financial ecosystem, which will eventually drive regional economic growth in the United States and promote monetary sovereignty for the aforementioned monetary entities. This can be achieved by investigating creative collaboration tactics between the Federal Reserve and the US Treasury.

Background and objectives: Due to resistance and lack of treatment options, hospital-acquired Acinetobacter baumannii (A. baumannii) infections are associated with high mortality. The aim of this study was to identify the characteristics and outcomes of patients with infections caused by multidrug resistant A. baumannii in a tertiary-care teaching hospital and to determine the risk factors for in-hospital mortality. Materials and methods: A retrospective cohort study including 196 patients with A. baumannii strains isolated from different clinical specimens in the Hospital of the Lithuanian University of Health Sciences in 2016, 2017 and 2020, 2021 was conducted. Data on patients’ characteristics, comorbid diseases, treatment, length of hospital and ICU stay, outcome were collected. To determine risk factors for in-hospital mortality, logistic regression analysis was performed. Results: There were 60 (30.6%) women 136 (69.4%) men with a mean age of 61.7 ± 16.6 years (range, 52–74). More than three-fourths (76.5%, n = 150) of the patients had at least one comorbid disease. The highest number of A. baumannii strains were isolated from patients hospitalized in ICUs (43.4%, n = 85). A. baumannii strains producing three types of β-lactamases were more frequently isolated from women than men (77.8 % vs. 22.2%, p = 0.006). Infections caused by A. baumannii strains producing two types of β-lactamases were significantly more often treated with combination therapy than infections caused by strains producing one type of β-lactamase (78.9% vs. 60.0%, p = 0.019). Patients with A. baumannii strains producing two different types of β-lactamases (AmpC plus KPC, AmpC plus ESBL, or ESBL plus KPC) stayed significantly shorter at the ICU compared to patients with A. baumannii strains not producing β-lactamases (median of 9, IQR 2–18, vs. median of 26, IQR 7–38, p = 0.022). Death occurred in 58.7% (n = 115) of patients. Logistic regression analysis showed that combination therapy, length of hospital stay of < 10 days after A. baumannii infection, age of > 58 years, and absence of co-infection were independent predictors of in-hospital mortality. Conclusions: Patients with infection caused by A. baumannii strains producing two different types of β-lactamases were more frequently treated with combination therapy. Mortality of patients with multidrug resistant A. baumannii infection was high, and it was associated with patient’s age, length of hospital stay after the diagnosis of A. baumannii infection, absence of co-infection, and combination treatment.

Osteoarthritis and chronic pancreatitis comorbidity are insufficiently studied, and the reciprocal impact of these conditions remains poorly understood. This study aimed to investigate potential predictors for the development of osteoarthritis and chronic pancreatitis comorbidity, as well as complications associated with this comorbidity. A cohort of 150 patients was categorized into three groups: a control group (n=30), patients with osteoarthritis (n=68), and patients with comorbid osteoarthritis and chronic pancreatitis (n=52). Potential predictors for comorbidity development and associated complications were explored. The study revealed that concurrent osteoarthritis and chronic pancreatitis exacerbate each other's progression and contribute to malnutrition. Body Mass Index (BMI) emerged as a potential predictor for chronic pancreatitis development in osteoarthritis patients. In osteoarthritis patients, fecal elastase-1 levels were identified as potential predictors for exocrine pancreatic insufficiency. Factors such as WOMAC total score, fecal elastase-1, C-reactive protein (CRP), ferritin, retinol, tocopherol, 25-hydroxy vitamin D3, and BMI were found to influence comorbidity development between osteoarthritis and chronic pancreatitis. Additionally, Gastrointestinal Symptom Rating Scale-Diarrhea Syndrome (GSRS-DS), Gastrointestinal Symptom Rating Scale-Constipation syndrome (GSRS-CS), Qualitative Assessment of the Symptoms and Impact of Pancreatic Exocrine Insufficiency domain A (PEI-Q-A), retinol, tocopherol, and iron were identified as potential predictors for exocrine pancreatic insufficiency in osteoarthritis patients. In conclusion, the comorbidity of osteoarthritis and chronic pancreatitis exacerbates disease progression and complications, necessitating further investigation.

Gastrointestinal bleeding (GIB) after heart transplantation (HT) remains a significant clinical issue. The study aimed to explore its incidence, trends, outcomes and clinical predictors of GIB in HT patients. Adult patients who underwent HT between 2015 and 2021 at Union Hospital were recruited and divided into two groups based on the presence or absence of postoperative GIB. Primary outcomes were evaluated by follow-up. Independent predictors of GIB after HT were identified by logistic regression analysis. A nomogram prediction model was constructed according to these independent variables, and the accuracy of the model was assessed using the receiver operating characteristic (ROC) curve and the calibration curve. Among 461 patients, 40 (8.7%) developed GIB post-HT. HT patients with postoperative GIB exhibited higher in-hospital, 30-day, 90-day and 1-year mortality (all P < 0.05). Multivariate analysis identified age, preoperative warfarin, postoperative continuous renal replacement therapy and postoperative nasogastric tube as independent risk factors for GIB following HT. The nomogram prediction model was performed using the 4 variables. The area under the curve (AUC) of this model was 0.852(95% CI: 0.787-0.917, P < 0.001) and the calibration curve was close to the ideal diagonal line. GIB following HT is associated with a poor clinical prognosis. The constructed nomogram, incorporating its independent risk factors, demonstrated a favorable predictive value for GIB.

The energy transition is a complicated process that involves changing production and consumption habits, boosting the use of renewable energy sources, and reducing greenhouse gas emissions. This article examines the management of risks associated with this shift, focusing on investment, commercial, technological, regulatory, and environmental challenges. The paper proposes an effective way for dealing with new difficulties by assessing risks and the management techniques that accompany them. Furthermore, as a critical component of the energy revolution, the concept of Nearly Zero Energy Buildings (NZEB) is given, with a focus on the ambitions of INGV – Irpina Headquarters and the EU regulatory framework. Finally, the actions and methods employed to achieve the NZEB objectives are discussed, including the utilization of cutting-edge technologies and renewable energy sources. Furthermore, the concept of Nearly Zero Energy Buildings (NZEB) is introduced as an important component of the energy transition, with an emphasis on the European regulatory framework and the ambitions of the INGV – Irpina Headquarters. Finally, the interventions and techniques employed to achieve the NZEB targets are highlighted, such as the employment of advanced technologies and renewable energy resources. This study contributes significantly to understanding the processes and issues associated with the energy transition and the implementation of NZEB, hence boosting sustainability in the construction sector.

Previous reviews have investigated machine learning (ML) models used to predict the risk of developing preeclampsia but have not described how the ML models are intended to be deployed throughout pregnancy or feature performance. The aim of this study is to provide an overview of the existing ML models and their intended deployment patterns and performance along with identified features of high importance. This review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed, Engineering Village, and the Association for Computing Machinery were searched between January and February 2024. A total of 86 studies were found of which 14 were included. Out of 12 studies, eight showed the intent to use the ML model as a single-use, two intended a dual-use, and two intended multiple-use. A total of seven studies listed the features of the highest importance. Systolic and diastolic blood pressure were listed along with mean arterial pressure to be of high importance. Out of four studies intending to use the ML model more than a single-use, three of them were conducted in the years 2023 and 2024, whereas the remaining study is from 2011. No ML model emerged as superior across the subgroups of PE. Utilizing body mass index and either mean arterial pressure or diastolic blood pressure and systolic blood pressure may benefit the performance. The deployment patterns are mainly single use being within the gestation weeks 11+0 to 14+1.

Objective: This study aimed to explore potential interventions or preventive measures to reduce the incidence of falls among the elderly in the Madinah region, and to provide recommendations for healthcare professionals, policymakers, and community stakeholders to enhance fall prevention strategies and improve the overall well-being of the elderly population in this area. Methods: The study adopted a cross-sectional study design, and was carried out in the Madinah region using convenient physical assignment among of Saudi and non-Saudi local residents aged 65 years and over. Questionnaire surveys were circulated and demographic characteristics were collected, including participants’ fall experience and health status data over the past year, in order to assess the incidence of falls among the elderly population. This design allows for the collection of data at a single point in time, aiming to evaluate the prevalence, risk factors, and consequences of falls among the target population. Results: A total of 189 participants were recruited to the study, and the data indicated that the prevalence of falls among those aged 65 years and older in the past year was 41.5%. We found that 73% of the participants had experienced falls and post-fall injuries within the past 12 months. There were minimal differences in terms of physical handicapped cases found between those with and without a fall history. Logistic regression analysis revealed a significant link between fall experience and maximum bite force. Conclusion: There is a high prevalence of falls in the elderly population in the Madinah region. Our study reveals that 50.79% of our elderly participants had experienced more than one fall during the preceding year. Some preventable risk factors were identified in an analysis of their daily routines. The impacts of these risk factors have potential consequences for their healthy lives.

In this study, a critical review was carried out using the Web of ScienceTM Core Collection database to analyse the scientific literature published to date to identify lines of research and future perspectives on the presence of chemical pollutants in beer brewing. Beer is one of the world's most popular drinks and the most consumed alcoholic beverage. However, a widespread challenge with potential implications for human and animal health is the presence of physical, chemical and/or microbiological contaminants in beer. Biogenic amines, heavy metals, mycotoxins, nitrosamines, pesticides, acrylamide, phthalates, bisphenols, microplastics and, to a lesser extent, hydrocarbons (aliphatic chlorinated and polycyclic aromatic), carbonyls, furan-derivatives, polychlorinated biphenyls and trihalomethanes are the main chemical pollutants found during the beer brewing process. Pollution sources include raw materials, technological process steps, the brewery environment and packaging materials. Different chemical pollutants have been found during the beer brewing process, from barley to beer. Brewing steps such as steeping, kilning, mashing, boiling, fermentation and clarification are critical in reducing the levels of many of these pollutants. As a result, their residual levels are usually below the maximum levels allowed by international regulations.

Parkinson's disease (PD) is a common neurodegenerative disorder characterized by the loss of dopaminergic neurons and the buildup of misfolded alpha-synuclein proteins. While its exact cause remains unknown, several factors may influence its development. This review examines how factors like chronic constipation, head injuries, cholesterol and uric acid levels, pesticide exposure, smoking, NSAIDs, and caffeine intake may affect PD risk. Chronic constipation appears to be linked to a higher risk of PD, potentially serving as an early warning sign. Head injuries, especially mild-to-moderate ones, may also play a role in increasing PD risk. Surprisingly, higher levels of cholesterol seem to protect against PD, while lower levels of uric acid might increase the risk in the presence of some differences according to gender type. Exposure to certain pesticides is associated with a higher PD risk. NSAIDs, on the other hand, may or may not have a protective effect, with conflicting evidence. Interestingly, caffeine and tobacco smoking appear to lower the PD risk. Further studies are needed to fully understand the complex interplay between these factors and PD. It's also important to remember that these are just general trends, and individual risk factors will vary depending on a person's unique genetic makeup, medical history, and overall health.

OBJECTIVE: To investigate the value of serum inflammatory factor levels in acute ischemic stroke patients after revascularization therapy in assessing acute prognosis. METHODS: 94 patients with acute ischemic stroke who underwent revascularization therapy admitted to our hospital from January 01, 2022 to January 01, 2024 were studied. The main evaluation index was modified Rankin Scale score (mRS) after 3 months, and patients with mRS score >2 were categorized into the poor prognosis group, and the rest were the good prognosis group. As well as the treatment of revascularization in all patients was used as a division into a thrombus extraction group and an intravenous thrombolysis group. Logistic regression analysis was applied to explore the independent risk factors for the prognosis of patients treated with recanalization for acute ischemic stroke. RESULTS: Two groups with good (59 cases) and poor (35 cases) prognosis were divided according to the mRS score. There were some differences in age, gender, emergency GLU, INR, whether they had diabetes or hypertension and other contents between the two groups, but the differences were not statistically significant. The NIHSS score, hospitalization days, previous cardiac history, hospitalization days, LDL, fasting glucose, IL-6, and TNF-a at the time of admission were lower than those in the poor prognosis group, and the difference was statistically significant. In the patients in the embolization group, there were some differences in age, gender, emergency GLU, INR, whether they had diabetes or hypertension and other contents between the two groups, but the differences were not statistically significant. The pre-hospital NHISS score, IL-6, and TNF-a of patients in the good prognosis group were lower than those in the poor prognosis group, and the difference was statistically significant. CONCLUSION: IL-6 and TNF-α may be used as predictors of prognosis after revascularization therapy for acute ischemic stroke, and this conclusion also applies to patients in the embolization group.

In recent years, the digital economy has played an increasingly important role in enhancing productivity, fostering growth, and facilitating the emergence of digital banking. With the widespread adoption of digital financial services for financial inclusion, the banking sector is experiencing a demand for digital transformation. It is important to note that despite the many advantages of this change, it also disrupts the familiar banking experience that customers have grown to expect, as well as introducing potential risks to maintaining customer protection at previous levels. Many critics have raised concerns regarding customer protection and potential exposure to various risks that may arise from digital financial services, which may result in both financial and non-financial losses. These risks can impact customer retention as dissatisfied customers may switch to alternative service providers. Additionally, reputation can be affected since merely offering digital financial services may not sufficiently safeguard customers. To remain competitive, financial institutions must deliver a secure experience that aligns with customer expectations while considering economic factors and societal needs. This is why it is essential to comprehend the severity of the risk factors that influence the protection of customers in the realm of digitalized banking services and products. In this study, five factors have been identified that influence customer protection when using digital financial services in Pakistan. Based on the analysis conducted using SmartPLS, it appears that all the factors proposed in this study have a significant and positive impact on the protection of customers. In particular, the information provided remains of paramount importance when it comes to determining the level of protection that a customer is entitled to within digital financial services, followed by responsiveness, privacy, authentication, and encryption mechanisms. Due to these findings, the implementation of enhanced information security management principles becomes imperative for the development and progress of the Pakistani digital banking industry.

Objective: The goal of this review is to provide a succinct, yet comprehensive, guide to the an-tepartum management of multiple gestations. Methods: This narrative review on twins and multiple gestation provides a concise guide for providers with this ever-growing patient population. PubMED was utilized for literature search. Each reference was evaluated and graded for quality of evidence by US Preventative Services Task Force and Cochrane Review guidelines. Screening, surveillance, and management strategies are delineated succinctly and organized by type of multiple gestation being managed from the lowest risk dichorionic twin pair to the increasingly escalating risks of twins and higher order multiples sharing a placenta and/or amniotic sac. Results: The incidence of twin pregnancies has grown over the past several years, due in large part to delayed reproductive timing and surge in assisted reproductive technologies. Twin pregnancies are associated with higher morbidity for both gravidas and offspring, warranting evidence-based approach in counseling and management. Conclusions: We note the important differences among multiples in chorionicity and amnionicity, in the importance of close surveillance and early delivery. Graded clinical pearls and evi-dence-based recommendations are presented to guide obstetric providers.

The assessment of soil contamination in the vicinity of integrated siderurgical plants is of outmost importance for agroecosystems and human health, and sensitive techniques should be employed for accurate assessment of chemical elements (metals, potential toxic elements, rare earths, radioelements) in soil and further evaluation of potential ecological and safety risk. In this paper a total of 45 major, minor and trace elements (Al, As, Au, Ba, Br, Ca, Cd, Ce, Co, Cr, Cs, Cu, Dy, Eu, Fe, Hf, Hg, I, K, La, Mg, Mn, Mo, Na, Nd, Ni, Pb, Rb, Sb, Sc, Sm, Sn, Sr, Ta, Tb, Th, Ti, Tm, U, V, W, Y, Yb, Zn and Zr) were quantified in soils located around a large siderurgical works (Galati, SE Romania) using instrumental neutron activation analysis (INAA) in combination with X-ray fluorescence (XRF) and inductively coupled plasma mass spectrometry (ICP-MS). The statistical analysis results and vertical distribution patterns for three depths (0-5 cm, 5-20 cm, 20-30 cm) indicate inputs of toxic elements in the sites close to the ironmaking and steelmaking facilities and industrial wastes dumping site. For selected elements, a comparison with historical, legislated and world reported concentration values in soil was performed and depth migration, contamination and toxic risk indices were assessed. The distribution of major, rock forming elements was closer to the Upper Continental Crust (UCC), and to the Dobrogea loess, finding confirmed by the ternary diagram of the incompatible trace elements Sc, La and Th, as well as by the La to Th rate. At the same time, the La/Th vs. Sc and Th/Sc vs. Zr/Sc bi-plots suggested a felsic origin and a weak recycling of soils mineral components.

The effects of climate change health impacts on urban health care systems and vulnerable populations are a researched topic with foundations on urban risk management, urban health methodologies, and sustainable urbanization. As climate change is a dynamic and transformative global issue the gap between adaptation and mitigation efforts and urban planning relies, among other things, in the limitations of previous studies of risk management structures tailored to the existing strategy to calculate the uncertainties and predict their influence on urban systems and subsystems. Moreover, as climate and health is a well-researched issue, it is also complex as the methodologies and strategic approach to minimize health risks of climate change is intrinsically contingent to risk methodologies and policy-making processes that are efficient with support of knowledge-based information. This paper emphasis the need for focusing on urban health risk management methods that serves to identify potential opportunities, and then manage and take action to prevent adverse health effects. It also emphasizes the probability of events and their consequences, which are measurable both qualitatively and quantitatively.

Accurate measurement of systemic financial risk is critical to maintaining the stability of financial markets. Taking China as the subject of investigation, the Chinese Financial Stress Index (CFSI) indicator system was con-structed by integrating six dimensions and employing Gray Relation Analysis (GRA) for dimensionality reduction of the indicators. The CFSI was derived using the Attribute Hierarchy Model (AHM) method with the Criteria Importance Through the Intercriteria Correlation (CRITIC) method, and an Improved Gravitational Search Algorithm (IGSA) optimized Radial Basis Function Neural Network (RBFNN) was proposed for out-of-sample prediction of CFSI trends from 2024 to 2026. By analyzing the trend of financial pressure indicators, the relationship between financial pressure and economic activity can be effectively identified. The research findings indicate that: (1) The CFSI is capable of accurately reflecting the current financial stress situation in China; (2) The IGSA-RBFNN demonstrates good robustness and generalization capabilities, predicting that the CFSI index will reach a peak value of 0.543 by the end of 2024, and there exists a regular pattern of stress rebound towards the end of each year. The novel methodology benefits policymakers and regulatory authorities to formulate preventive measures and risk management by identifying potential risks and vulnerabilities in advance.

Due to the growth of tourism, mining and manufacturing, economy of the Hainan Island, southern China has swiftly expanded, but also poses a risk of soil pollution by mercury (Hg) due to the traffic and mineral processing. In order to investigate the characteristics of soil Hg pollution in the Hainan Island and assess the health risk, a total of 239 samples were gathered from five representative regions across the island. A vehicle-mounted potable mercury analyzer was used to measure the atmospheric Hg and soil Hg concentrations in the collected samples. The results indicate that the soil Hg concentration of the five sub-study areas exhibits notable fluctuations, which was found to be influenced by various factors, including wind direction, mining activities, and economic development conditions. The degree of Hg pollution was assessed using both the Single Pollution Index Method and the Geoaccumulation Index Method. The results showed that although nearly half of the sampling points were contaminated, the current soil Hg level does not pose a non-carcinogenic risk to human health.

Purpose: Pancreatic cancer (PAAD) is one of the most lethal malignancies. Immunotherapy is largely ineffective in PAAD. T-cell exhaustion contributes to the resistance for immunotherapies. We investigated the prognostic potential of T cell exhaustion-related genes (TEXGs). Methods: Single-cell RNA (scRNA) sequencing dataset from TISCH, and bulk sequencing datasets from TCGA and GTEx were applied to screen differently expressed TEXGs. Kaplan-Meier survival, LASSO regression, and Univariate/Multivariate Cox regression analysis were performed to construct TEXGs risk model. This model was used to predict the prognosis, tumor immune microenvironment, and immunotherapy response. PAAD cohorts from ICGC and GSE71729 datasets were used to validate this risk model. Pan-cancer expression of SPOCK2 was performed in TISCH database. Results: A six-gene (SPOCK2, MT1X, LIPH, RARRES3, EMP1, and MEG3) risk model was constructed. Low-risk PAAD patients had longer survival time in both training dataset (TCGA-PAAD, n=178) and validation datasets (ICGC-PACA-CA, ICGC-PAAD-US, and GSE71729, n=412). Multivariate Cox regression analysis demonstrated that the risk score was an independent prognostic variable for PAAD. High-risk patients correlated with cancer-related KEGG pathway enrichment, higher mutation frequency of KRAS and TP53 genes, and immunosuppressive status. Immunohistochemistry staining confirmed the changes of TEXGs in clinical samples. Moreover, pan-cancer scRNA sequencing datasets from TISCH analysis indicated that SPOCK2 might be a novel marker of exhausted CD8+ T cells. Conclusion: In conclusion, we established and validated a T cell exhaustion-related prognostic signature for PAAD patients. Moreover, our study suggests that SPOCK2 may be a novel marker of exhausted CD8+ T cells.

This paper introduces the exponential time differencing (ETD) technique as a numerical method to solve efficiently American vulnerable options pricing. We address several challenges, including removing cross-derivative terms through appropriate transformations, treating early-exercise opportunities using the penalty method, and substituting fixed boundary conditions with corresponding one-sided finite differences. The proposed method is shown to be both accurate and efficient through numerical experiments, which also compare the results with existing methods and analyse the numerical stability and convergence rate.

This study sought to spatially characterise and explain the differences of peoples’ perceptions on the impact of COVID-19 based on the socio-economic disparities in Gauteng, using choropleth mapping and Geographically Weighted Regression (GWR). Results indicate that respondents from relatively vulnerable municipalities like Merafong, Mogale City and Lesedi reported life being worse, information scant, and overall despondency being high since COVID-19. These are areas that fall under the High to Very High categories in terms of the Socio-economic Risk Index. GWR results, however, did not show a high explanatory power on the COVID-19 variables se-lected for the research, based on R2 values. For instance, the residual in overall satisfaction with life after COVID-19 was the lowest (-0.5 to 0.5) in the less affluent districts of the Rand West City and Sedibeng. Residual variables on life changes after COVID-19 were also the lowest in the southern parts of the same districts, with other low values almost evenly distributed throughout the province for the variable ‘Government information on COVID-19 was scant’. Although overestimation and underestimation existed, most were relatively low falling between -1.5 to -0.5 and distributed evenly across the province. In sum, however, the findings point to the complexity of socio-economic factors in spatially characterising social risk and vulnerability. Additionally, the negative sentiments expressed by people from the more vulnerable locations in the province emphasise the need for more targeted interventions by government to cushion the residents of the province to the continued negative impacts of COVID-19.

Survival models have become popular for credit risk estimation. Most current credit risk survival models use an underlying linear model. This is beneficial in terms of interpretability but is restrictive for real-life applications since it cannot discover hidden nonlinearities and interactions within the data. This study uses discrete time survival models with embedded neural networks as estimators of time to default. This provides flexibility to express nonlinearities and interactions between variables, and hence allows for models with better overall model fit. Additionally, the neural networks are used to estimate Age-Period-Cohort (APC) models so that default risk can be decomposed into time components for loan age (maturity), origination (vintage) and environment (e.g., economic, operational and social effects). These can be built as general models, or as local APC models for specific customer segments. The local APC models reveal special conditions for different customer groups. The corresponding APC identification problem is solved by a combination of regularization and fitting the decomposed environment time risk component to macroeconomic data, since the environmental risk is expected to have a strong relationship with macroeconomic conditions. Our approach is shown to be effective when tested on a large publicly available US mortgage data set. This novel framework can be adapted by practitioners in the financial industry to improve modelling, estimation and assessment of credit risk.

Purpose: To identify factors linked with nutritional risk via the Malnutrition Universal Screening Tool scale assessment among critically ill patients from a hospital in Cali (Colombia). Materials and methods: A retrospective, analytical observational study was conducted with patients admitted to an intensive care unit (ICU). Sociodemographic, clinical, hematological, and biochemical parameters were analyzed, as well as their association with nutritional risk and patient mortality. Binary logistic regression was applied to outline nutritional risk. Results: Overall, 28.4% prevalence of elevated nutritional risk was observed. An association was found between nutritional risk and hemoglobin and hematocrit values, primary diseases accounting for ICU admission, gastrointestinal symptoms, and nutritional support route (p < 0.05). Mortality was 11.6% and it was correlated with nutritional risk, hemoglobin, and blood urea nitrogen. Conclusions: Gastrointestinal symptoms and the type of nutritional support received during hospitalization may increase nutritional risk, whereas polycythemia was a protective factor. We found an associative model to determine nutritional risk with high specificity and an adequate diagnostic validity index.

To ensure sustainability of the future power grid, the rate of expansion of distributed renewable energy resources (DRER) has introduced operational challenges. These includes managing transmission constraints with DRER power injection, dispatching DRER efficiently, managing system frequency and ensuring sufficient reactive power for voltage support. Coupled with the intensification of wildfires, power infrastructure across the United States faces challenges to minimize the impact to maintain system reliability and resiliency. This research embarks on a comprehensive evaluation, beginning with an in-depth historical analysis to delineate regions most susceptible to wildfires. Utilizing a multidimensional approach, the study assesses wildfire-induced risks to power grids, by integrating historical wildfire occurrences, real-time wildfire proximities, Moderate Resolution Imaging Spectroradiometer (MODIS) derived vegetation metrics, and system parameters, by employing Principal Component Analysis (PCA) based optimal weights, leading to the formulation of a novel risk factor model. This risk factor has the potential to be the key to ensuring the resilience of a renewable-rich smart grid when faced with a severe weather event. Our model’s applicability was further verified through an empirical assessment, selecting representative networks from diverse regions, providing insights into the geographical variability of risk factors. Ultimately, this study offers stakeholders and policymakers a comprehensive tool-set, empowering decisions regarding infrastructure investments, grid reinforcements, and strategic power rerouting to ensure consistent energy delivery using risk assessment against wildfire.

Objective: To evaluate which risk factors contribute directly or indirectly to Toxoplasma gondii infection in patients with ocular toxoplasmosis. Methods: Between 2018-2020, a total of 306 patients were selected, and treated at the Retinology Outpatient Clinic of the Specialty Hospital of Sāo José do Rio Preto, in the state of São Paulo. After the fundoscopy test, the Enzyme Linked Fluorescent Assay (ELFA) was used to determine IgG and IgM class anti-Toxoplasma gondii antibodies. Results: The results showed that individuals aged 60 years or older, and women who had a previous pregnancy, (p=0.000, OR= 8.137 and 95 % CI = 2.562 – 25.844), (p=0.016, OR= 7.395 and CI 95 % = 1,449 – 37,725) respectively, were 48.6 % more likely to develop ocular toxoplasmosis. Conclusion: In this way, previous pregnancy is a risk factor for the reactivation of toxoplasma, as well as for the generation of retinochoroiditis in previously infected women.