In this study, a dynamic mixture copula is used to estimate the marginal expected shortfall in the South African insurance sector. While other studies assumed nonlinear dependence to be static over time, our model capture time-varying nonlinear dependence between institutions and the market. In order to capture time-varying nonlinear dependence, the generalized autoregressive score (GAS) is used to model the dynamic copula parameters. Furthermore, our study implements a ranking that expresses to what degree individual insurers are systemically important in South Africa. We use daily stock return of five South African insurers listed in the Johannesburg Stock Exchange (JSE) from November 13, 2007 to June 15, 2020. We find that Sanlam and Discovery contribute the most to systemic risk, while Santam is found to be the least contributor to the overall systemic risk in the South African insurance sector. Our findings would be of paramount importance for the South African regulators as they would be informed that not only banks are systemically important, but some insurers also are systemically important financial institutions. Hence, stricter regulation of these institutions in the form of higher capital and loss absorbency requirements could be required based on the individual business activities undertaken by the company.

This scoping study aims to explore the relationships between urban green spaces (UGSs) and cancer. We followed the PRISMA extension for scoping reviews (protocol published in 2018). Eligibility criteria for papers were: 1) to be concerned with UGSs, 2) reporting effects of UGSs on cancer-related outcomes including direct or indirect measures, 3) reporting randomized controlled trials, prospective cohort studies, case studies, observational studies, non-comparative studies, 4) in English or French. The search covered primary studies in the published and unpublished (grey) literatures searching by hand and electronic databases (MEDLINE, Green File, CINAHL and ScienceDirect). Among 1703 records screened by two reviewers independently, 29 were included for qualitative synthesis. We classify the cancers concerned and the effects reported i.e. protective effect, risk or without association. The most investigated cancers are bladder, breast and lung cancer. Our study also identified contributing factors and their mediating effects between UGSs and cancer. Results highlight the wide variety of possible mediating factors between the use of green spaces and cancer occurrence, remission and/or prevention. Knowledge gaps and future research perspectives should be oriented to qualitative research on protective factors, the role of mental health in recovering from cancer and health inequalities.

This study investigates the country level determinants of liquidity synchronization and degrees of liquidity synchronization during economic growth volatility. As a non-diversifiable risk factor, liquidity co-movement shock spreads market wide and thus disrupts the overall functioning of the financial market. Firms in Asian markets operate in legal and regulatory environments distinct from those of firms analyzed in the previous literature. Comprehensive analyses of liquidity synchronicity in emerging markets are limited. A major knowledge gap pertaining to Asian emerging markets serves as the primary motivation for this study. Seven Asian emerging economies are selected from the MSCI emerging market index: Bangladesh, China, India, Indo-nesia, Malaysia, Pakistan and the Philippines for analysis from 2010 to 2019. The empirical findings show high levels of liquidity synchronicity in weaker economic and financial environments with low GDP growth, high inflation and interest rates and underdeveloped financial systems taking the form of low levels of private credit. Liquidity synchronicity is also affected by poor investor protection, political instability, weak rule of law and government ineffectiveness. Moreover, levels of liquidity synchronicity are higher in period of economic growth volatility.

Understanding the strength of the associations between perceived risk and individuals’ behavioral intentions to protect their health is important for determining appropriate risk communication strategies in communities impacted by lead contamination. We conducted a survey within communities of northern Idaho, USA (n = 306) near a Superfund megasite with legacy mining contamination. We empirically test a theoretical model based on the Health Belief Model. Survey respondents had higher intentions to practice health protective behaviors when they perceived the risk of lead contamination as severe, recognized the benefits of health protective behaviors, and considered the risks of lead contamination. Women reported higher behavioral intentions than men, but age and mining affiliation did not have an association. Survey comments indicated that perceptions about the long-term environmental remediation in the region influenced risk perceptions. Understanding risk perceptions, behavioral intentions, and related factors can aid public health agencies in tailoring risk communication for increasing protective behaviors in mining-impacted communities internationally.

We reviewed the association between seasonal influenza vaccination and the risk of SARS-CoV-2 infection or complicated illness or poor outcome (e.g. severe disease, need for hospitalization or ventilatory support, or death) among COVID-19 patients. None of the studies that were reviewed (n=12) found a significant increase in the risk of infection or in the illness severity or lethality, while some reported significantly inverse associations. Our findings support measures aimed at raising influenza vaccination coverage in the coming months.

Life evolved in an euxinic world with subsequent oxic 'invasion' leading to two parallel but interconnected biospheres, hydrogen sulphide (H₂S) and hydrogen peroxide (H₂O₂) exemplify these worlds respectively. Their concentration gradients have informational value in meromictic lakes. Similarly, it is posited, there exists a whole body chemocline in humans in which the two molecules form an inversely coupled oxic/sulphidic oscillator (OSO). The OSO is hormetic and characterised by a range of amplitudes and frequencies in health. Deviations from its baseline profile heralds the onset of SIRS before the appearance of clinical signs. Loss of oscillator status and transition to a steady state causes widespread intercellular and inter-organ communication failure presaging multi-organ dysfunction. The salient clinico-pathophysiological features of SIRS of any aetiology are emergent phenomena related to the OSO profile. Extent of recovery of organ function will mirror the recovery of the OSO profile thereby providing a tool to predict outcomes in SIRS.

Some herbicides exert hormetic or biphasic non-monotonic dose-response (NMDR), which is one of the major challenges for ecological risk assessment (ERA) of pesticides pollution. In this study, fish embryo toxicity test (FET) with Javanese medaka (Oryzias javanicus) to sublethal concentration of diuron was determined. Inverted U-shape heart rate was observed at 3 days post-exposure (dpe) and 7 dpe. However, at 13 dpe the heart rate (104 ± 2.90 heartbeat/min.) decreased in 10.00 mg.L-1 exposed-embryos. At 20 dpe, hatchability and survival rate were reduced in 5.00 mg.L-1 and 10.00 mg.L-1 exposed groups. Hormetic developmental deformities were observed in embryo-larvae of Javanese medaka. The results revealed a biphasic effect of low concentrations of diuron on some morphological and physiological features of Javanese medaka embryo-larvae, which might be attributed to endocrine disruption of this herbicide. Further studies to support these effects were recommended.

COVID-19 is a pandemic with no cure. There is an urgent need for low-cost interventions. Macroclimate work through affecting microclimate. In many situations, man-made microclimate, such as air conditioning, may override the effect of natural macroclimate in determining SARS-CoV-2 pathogenicity. Ambient temperature (AT) has been roughly associated to SARS-CoV-2 transmission. To translate into a feasible practice in controlling COVID-19 pandemic, in-depth and implementable knowledge of AT role in SARS-CoV-2 transmission should be unveiled. This study aimed to determine if there is a ‘safe’ temperature that is comfortable to human beings while significantly inhibitory for SARS-CoV-2 pathogenicity. Data on monthly new deaths or new cases per million population (MDPM or MCPM) and monthly cumulated days with more cases than the previous day (DI) from March 2 to June 30, 2020 were collected from all 118 countries with population over five million. Monthly average AT negatively correlated with the transmission parameters. A significant decrease in transmission was observed when AT reached above 20 ºC. Monthly average (not average high) AT of countries with MDPM <2, MCPM<10, or DI<=7 was found to be between 24.54 and 26.89 ºC (25.18 ºC on average) with average standard error of 4.81. Thus, average AT <20, 20-25, >25 ºC were considered as high, medium, and low risk AT. Furthermore, MDPM in countries with AT <20 ºC were 80.93, 50.23, 13.52, and 5.05 times of those in countries with AT >25 ºC in March, April, May, and June, respectively. MDPM low-risk rates (<2) in countries with AT >25 ºC were 100, 83.33, 52.73, and 52.46%, respectively. In countries with AT <20 ºC, the trends were opposite. Setting indoor temperature to 25 ºC could decrease the need of social distancing for containing SARS-CoV-2 transmission. Ventilation and sanitizing the air with ultraviolet light in nonbusiness hours may be additionally effective. Cooling indoor temperature too low may be a reason of COVID-19 outbreak in some high AT countries. Authorities and the general population can evaluate COVID-19 risk level and manipulate microclimate to reduce the risk anywhere anytime based on local day average AT.

We examine the profitability of the momentum and contrarian strategies in three South Asian markets i.e. Bangladesh, India and Pakistan. We also analyze, whether credit risk influences momentum and contrarian return for these markets from 2008 to 2014. We use Distance-to-default (DD) of Kealhofer, McQuown and Vasicek (KMV) model as a measure of credit risk. We calculate the credit risk and form the momentum and contrarian strategies of the firms on the basis of high, medium and low risk. We find that in all three markets, the momentum and contrarian returns are significant for medium and high credit risk portfolios and no momentum and contrarian returns for low credit risk portfolios.

Although the positive relationship between religion and environmental behavior is well-argued, empirical research about the relationship between religion and public pro-environmental behavior is relatively lacking. This paper aims to explore the group differences in the influence of religion on public pro-environmental behavior and the mediating role of environmental risk perception in religion and public pro-environmental behavior. Using the Chinese General Social Survey data in 2013 for empirical analysis, this study’s results show that there are group differences in the impact of religion on public pro-environmental behavior. Women with religious beliefs are more willing to engage in public pro-environmental behavior than those without religious beliefs. Religious believers over the age of 45 are more willing to participate in public pro-environmental behavior than those without religious beliefs. Political participants with religious beliefs are more willing to practice public pro-environmental behavior than those without religious beliefs. In addition, we found that environmental risk perception can act as partial mediation in religious and public pro-environmental behavior. In other words, religious beliefs are deeply embedded in local political and social culture. In order to correctly understand the relationship between religion and public pro-environmental behavior, it is necessary to consider religion in a specific cultural background.

The effects of climate change on yield and quality for different climate regions had high uncertainty. Risk assessment is an effective measure to assess the seriousness of the projected impacts for decision-makers. The modified quality model was used to simulate integrated impacts of climate change, environment and management on wheat yield and quality. Then, the Canadian Earth System Model (CanESM2) was used to forecast the daily meteorological data, and Statistical Down Scaling Model was used for downscaling. CERES-Wheat was combined with the forecasted meteorological data to simulate the future wheat yield and grain protein concentration (GPC). The risk of wheat yield and quality in three climatic regions of Shaanxi combined with two climate change scenarios of CanESM2 were assessed. Temperature increased 0.22-3.34 °C and precipitation increased 10-60 mm for RCP4.5 and RCP8.5. Elevated temperature and precipitation had positive effects on yield in all regions. The yield risk of most regions with climate change decreased 3.8%-25.1%. The GPC risk of all regions with climate change decreased 7.3%-27.2%. Irrigation decreased yield risk greatly in all regions, while had totally different effects for the three climatic regions. Yield risk with irrigation decreased 37.7%-52.1% in different climate. In contrast to previous studies, GPC risk with irrigation increased greatly 25.8%-28.9% in humid region, 3.9%-8.8% in sub-humid region, and decreased 37.7%-52.1% in semi-arid region. Climate change decreased yield risk and GPC risk together. While irrigation decreased yield risk greatly in all regions, had totally different effects for the three climatic regions.

Disease related malnutrition (DRM) is prevalent in hospitals and is associated with increased care needs, prolonged hospital stay, delayed rehabilitation and death. Nutrition care process related activities such as screening, assessment and treatment has been advocated by scientific societies and patient organizations but implementation is variable. We analyzed the cross-sectional nutritionDay database for prevalence of nutrition risk factors, care processes and outcome for medical patients. In 59126 medical patients included between 2006-2015 the prevalence of recent weight loss (45%), history of decreased eating (48%) and low actual eating (53%) was more prevalent than low BMI (8%). Each of these risk factors was associated with a large increase in 30 days hospital mortality. Nutrition care processes increases slightly with presence of risk factors but never done in more than 50% of patients. Only a third of patients not eating in hospital receive oral nutritional supplements or artificial nutrition. We suggest that political action should be taken to raise awareness and formal education on all aspects related to DRM for all stakeholders, to create and support responsibilities within hospitals, and to create adequate reimbursement schemes. Collection of routine and benchmarking data is crucial to tackle DRM.

Nowadays, environmental circumstances and business rules of organizations are complicate, active and uncertain, so, they cannot assurance their long- term survival through some actions such as, structural changes and methods or relying on creativity of some people in organization. Companies and organizations should prepare conditions to institutionalize entrepreneurial culture in their organization. Corporate entrepreneurship can improve the value of the organization. The entrepreneurial oriented organizations are more responsive for environment and market changes. Opportunity recognition is the base of being successful. The research is applied and in terms of method is descriptive. Data were analyzed, using Linear Regression and Multiple Moderated Regression (MMR) and SPSS software. In this research the effects of organizational entrepreneurship (innovation, proactiveness and risk-taking) on performance of the centers influenced by environmental factors (government’s strategies, competitiveness and technology) as moderating variables, were studied. Furthermore, the study presents that there is a significant positive relationship between organizational entrepreneurship and performance. Although the study does not show any significant moderating effect of environmental factors (Government’s strategies, competitiveness and technology) on the relationship between organizational entrepreneurship and performance, however, the result of the study manifests direct relationship between environmental factors and performance of such centers.

Microorganisms belonging to the Lactobacillus genus are naturally associated or deliberately added to fermented food products and are widely used in probiotic food additives and supplements. Moreover these bacteria normally colonize mouth, gastrointestinal (GI) tract and female genitourinary tract of humans. They exert multiple beneficial effects and are regarded as safe microorganisms. However, infections caused by lactobacilli, mainly endocarditis, bacteremia and pleuropneumonia occasionally occur. The relevance of Lactobacillus spp. as opportunistic pathogens in humans and related risk factors and predisposing conditions are illustrated in this review article with more emphasis on the species L. rhamnosus, that has been more often involved in infection cases. The methods used to identify this species in clinical samples, to distinguish strains and to evaluate traits that can be associated to pathogenicity, as well as future perspectives for improving the identification of potentially pathogenic strains are outlined.

Functional mobility assessments (i.e., Timed Up and Go) are commonly used clinical tools for mobility and fall risk screening in the aging population. In this work, we proposed a new Mixed Reality (MR)-based assessment that utilized a Microsoft HoloLens^TM headset to automatically lead and track the performance of functional mobility tests, and subsequently evaluated its validity in comparison with reference inertial sensors. Twenty-two healthy adults (10 older, 12 young) participated in this study. An automated functional mobility assessment app was developed based on the HoloLens platform. Mobility performance was recorded with the headset built-in sensor and validated with reference inertial sensor (Opal, APDM) taped on the headset and lower back. Results indicate vertical kinematic measures by HoloLens was in good agreement with the reference sensor (Normalized RMSE ~ 10%). Additionally, the HoloLens-based test completion time was in perfect agreement with clinical standard stopwatch measure. Overall, our preliminary investigation indicates that it is possible to use an MR headset to automatically guide users to complete common mobility tests with good measurement accuracy, thus it has great potential to provide objective and efficient sensor-based mobility assessment.

The relationships among the potential causes of a car and motorcycle collision involving turn maneuvers as well as the perception of rear and front turn signal (on/off) configuration is examined in this paper. The investigation has been based on data pooled from the answers of a survey proposed to 136 people, with special regards to the correct detection of indicators aspect. Experimental videos have been realized during the tests campaign, both in urban and suburban areas, using a 360-camera attached to a motorcyclist’s helmet, reproducing vehicular conflicts able to potentially generate crash risks. The detection of the blinker was combined with other factors (e.g. age, gender, location of the test site, presence of the car behind tester vehicles and if the bikers are also habitual car or bike drivers) in a stepwise logistic regression that modelled the odds of detecting the turn signal turned on as a function of all of these factors. The results suggest the existence of a connection between the detection of the turn signal aspect and some of the variables considered (e.g. age, being a cyclist or a car driver and the presence of a protecting car).

Groundwater plays a pivotal role as the largest potable water sources in Bangladesh. However, the quality of the groundwater faces challenges due to xenobiotic compounds in it. Excess amount of arsenic (As) has already been found in groundwater in many parts of Bangladesh. Thus, this study was conducted to assess the water quality and associated human health risk in central Bangladesh. A total of 99 groundwater samples from the central part of Bangladesh were analyzed to assess human health risk due to high level of nitrate (NO3-) and other trace elements i.e. arsenic (As), iron (Fe), and manganese (Mn). It was found that NO3- concentration (253.17 mg/L) in the groundwater samples exceeds the recommended guideline value by the WHO (50 mg/L). Moreover, this study area also characterized with elevated concentration of As (19.44 µg/L), Fe (811.35 µg/L), and Mn (455.18 µg/L) in the groundwater. Non-carcinogenic human health risk was calculated by justifying HQ (Hazard Quotient) and HI (Hazard Index) and attributed potential conjunctive human health risks due to NO3-, As, Fe and Mn in the study area. Moreover, high carcinogenic risk was found due to As contamination in the groundwater samples in the study area.

Yogyakarta City is one of the big city which is located in Java Island, Indonesia. Yogyakarta City, including study area (Pleret Sub District), are very prone to earthquake hazards, because close to several active earthquake sources. For example, Sunda Megathrust which often generates a big earthquake which can affect the study area. The Sunda Megathrust extends from north to south and west to east along the Sumatra and Java Islands. Furthermore, an active normal fault called as Opak Fault pass through right in the middle of Study area and divides the study area into east and west zone. Recently, after the devastating earthquake in 2006, the population of the study area increases significantly. As a result, the housing demand is also increasing. However, due to the absence of earthquake building code in the study area, locals tend to build improper new houses. Furthermore, in some part of the mountainous area in the study area, there are some building found in unstable slopes area. Due to this condition, the multi-hazard and risk study needs to be done in Pleret. The increasing of population and improper houses in Pleret Sub-District can lead to amplify the impact. Thus, the main objective of this study is to assess the multi-hazards and risk of earthquake and other related secondary hazards such as ground amplification, liquefaction, and coseismic landslide. The method mainly utilised the geographic information system, remote sensing and was fit up by the outcrop study. The results show that the middle part of the study area has a complex geological structure. It was indicated by a lot of unchartered faults was found in the outcrops. Furthermore, the relatively prone areas to earthquake can be determined. In term of the coseismic landslide, the prone area to the coseismic landslide is located in the east part of the study area in the middle slope of Baturagung Escarpment. The highly potential area of liquefaction is dominated in the central part of the study area. In term of building collapsed probability, the result shows that the safest house based on statistical analysis is the residential house with the building attribute of wood structure, roof cast material, distance more than 15 km from the earthquake source, and located above the Nglanggran Formation. Finally, the multi-hazard and risk analysis show that the middle part of the study area is more vulnerable than the other part of Pleret Sub-District.

Keyhole neurosurgery implies reaching a target area inside the brain through an entry point specified by the neurosurgeon. In order to avoid complications, a risk assessment procedure must be done to establish the minimum risk trajectory from the entry point to the target area. The neurosurgeon establishes the risk values for the brain structure according to the type of intervention. The preset brain structure risk value is used to assess the risk value for each voxel of the brain. This paper proposes an improved risk assessment methodology based on the sum of N maximum risk values for each voxel. Then, risk assessment for a trajectory is done by adding the risk of all voxels that are part of the path. The safest trajectory is defined as the trajectory with the lower risk. Our proposed search trajectory methodology includes a Genetic Algorithm (GA) for finding the safest trajectories. The use of a GA drastically reduces the number of trajectories to analyze, speeding up the planning procedure. The achieved results were qualified by expert neurosurgeons as satisfactory. Our proposed method allows neurosurgeons to calibrate the surgical planning system by allowing them to establish the risk brain structure and the risk value for each structure.

This paper examines the effect of chronotype on the delinquent credit card payments and stock market participation through preference channels. Using an online survey of 455 individuals who have been working for 3 to 8 years in companies in mainland China, the results reveal that morningness is negatively associated with delinquent credit card payments. Morningness also indirectly predicts delinquent credit card payments through time preference, but this relationship only exists when individuals’ monthly income is at low and average level. On the other hand, financial risk preference accounts for the effect of morningness on stock market participation. Consequently, an additional finding is that morningness is positively associated with financial risk preference, which contradicts previous finding in the literature. Finally, based on the empirical evidence, we discuss the plausible mechanisms that may drive these relationships and the implications for theory and practice. The current study contributes to the literature by examining the links between circadian typology and particular financial behaviours of experienced workers.

OBJETIVE: This study analyses the views of four groups of healthcare professionals who may play a role in the management of suicidal behaviour. The goal was to identify key factors for suicide prevention in different areas of the healthcare system. METHODOLOGY: Qualitative research was conducted using focus groups made up of different healthcare professionals who participated in the identification, management and prevention of suicidal behaviour. Professionals included were primary care physicians, psychologists, psychiatrists and emergency physicians. RESULTS: ‘Suicide’ was amongst the most relevant terms that came up in discussions most of the times it appeared associated with words such as ‘risk’, ‘danger’ or ‘harm’. In the analysis by categories, the four groups of professionals agreed that interventions in at-risk behaviours are first in importance. Prevention was the second main concern with greater significance among psychiatrists. DISCUSSION: Primary care professionals claim for more time to address patients at risk for suicide and an easier access to and communication with the mental health network. Emergency care professionals have a lack of awareness of their role in the detection of risk for suicide in patients who seek attention at emergency care facilities for reasons of general somatic issues. Mental health care professionals are in high demand in case of self-harm but they would like to receive specific training in dealing with g suicidal behaviour.

Florida geologic units and soils contain a wide range in concentrations of naturally-occurring arsenic. The average range of bulk rock concentrations is 1 to 13.1 mg/kg with concentrations in accessary minerals being over 1,000 mg/kg. Soils contain natural arsenic concentrations of between 0.18 and 2.06 mg/kg with organic-rich soils having the highest concentrations. Anthropogenic sources of arsenic have added about 610,000 metric tons of arsenic into the Florida environment since 1970, thereby increasing background concentrations in soils. The anthropogenic sources of arsenic in soils include: pesticides (used in Florida beginning in the 1890’s), fertilizers, chromated copper arsenate (CCA)-treated wood, soil amendments, cattle-dipping vats, chicken litter, sludges from water treatment plants, and others. The default Soil Cleanup Target Level (SCTL) in Florida for arsenic in residential soils is 2.1 mg/kg which is below some naturally-occurring background concentrations in soils and anthropogenic concentrations in agricultural soils. A review of risk considerations shows that adverse health impacts associated with exposure to arsenic is dependent on many factors and that the Florida cleanup levels are very conservative. Exposure to arsenic in soils at concentrations that exceed the Florida residential cleanup level in residential environments does not necessarily pose a meaningful public health risk.

The purpose of this paper is to evaluate the timing of innovative investment in technology product life cycles using a compound binomial option with management flexibility. Considering the business cycles changes in the macroeconomic will affect consumer purchasing power. The focus is how to evaluate the optimal investment strategy and the project value. It was applied to different product stages (three stages including production innovation, manufacture innovation, and operation innovation) and factored to different risks to build a technology innovation strategy model. An aim of this study is the options premium of the best strategy timing for each innovation stage. Its application of the compound binomial options for the manufacture innovation will only be considered after the execution of the production innovation. The same condition is applied to the operation innovation, which will only be considered after the execution of the manufacture innovation. Then, this paper constructs the dynamic investment sequential decision model, assesses the feasibility of an investment strategy, and makes a decision on the appropriate project value and options premium for each stage under the possible change of Gross Domestic Product (GDP). This paper investigates the product life cycle innovation investment topic by using the compound binomial options method and will provide a more flexible strategy decision compared with other trend forecast criteria.

This work analyzes the severity and risk associated with Automatic Dependent Surveillance-Broadcast (ADS-B) message drop out in Detect and Avoid (DAA) function of Unmanned Aircraft System (UAS). Performance assessment of the Universal Access Transceiver (UAT) ADS-B message implies that in some cases ADS-B fails to update within a specified update interval, which is referred to as drop out in this work. ADS-B is a fundamental surveillance sensor for both class 1 and class 2 DAA systems. Message loss or drop out has been found as one of the common limitations of the ADS-B system. The key feature of this study is incorporating the update rate of real ADS-B data transmitted from the manned aircraft. The data were received from the Grand Forks International Airport, North Dakota. Monte Carlo method has been adopted to resolve encounter scenarios in the presence of drop out. The change in the alert triggered by the UAS DAA in the presence of ADS-B drop out has been investigated. Furthermore, the risk matrices are created to quantify the associated risk with drop out affected alerts. Simulation results depict that both the duration of drop out and DAA look-ahead time affect the alert-triggering function of UAS. With a small look- ahead window and longer duration of drop out, the number of warning alerts increases. Also, alerts are affected more during an overtaking encounter than that of a head-to-head encounter. A system-level analysis is also carried out to recognize the potential reasons behind the ADS-B drop out.

The purpose of the present study was to determine the relationship between healthy lifestyle behaviors, physical fitness and coronary risk factors in university students. 320 male and female (n_m:171; n_f:149) students from a university participated in this study voluntarily. For the determination of body composition and Body Mass Indexes (BMI), subjects’ height, body weight, and skinfold thickness were taken and body fat percentage (%Fat) was determined. Healthy lifestyle behaviors were determined using the healthy lifestyle behaviors questionnaire. Indicators of physical fitness included flexibility (sit-up) (F), muscle strength and endurance (isometric knee (KS), back strength (BS) and a total of shuttle (TS), sprint performance, BMI, and body fat percentage (%fat). Coronary heart disease risk factors included mean arterial blood pressure (systolic (SBP) and diastolic (DBP)), fasting blood levels of triglycerides (TG), total cholesterol (TC), hematocrit (HT), and hemoglobin (HM). Results indicated subjects have normal body mass index, body fat percentage, SBP, DBP, TG, TCF, BS, KS. The results of the Pearson Product Moment Correlation Analysis, indicated that SBP, DBP, TG, TCF, BS, KS for male and female was significantly correlated with flexibility (sit-up) (F), muscle strength and endurance (isometric knee (KS), back strength (BS) and total of shuttle (TS)), sprint performance. (p<0.01; p<0.05), In conclusion, the findings of the present study indicated that physical fitness and healthy lifestyle behaviors play a determinant role in coronary heart disease risk factors for male and female students from a university.

In this study, we examine the relationship of bank level lending and borrowing decisions and the risk preferences on the dynamics of the interbank lending We develop an agent-based model that incorporates individual bank decisions using the temporal difference reinforcement learning algorithm with empirical data of 6600 S. banks. The model can successfully replicate the key characteristics of interbank lending and borrowing relationships documented in the recent literatur A key finding of this study is that risk preferences at individual bank level can lead to unique interbank market structures which are suggestive of the capacity that the market responds to surprising

Although the European reports highlight an increase in community-acquired Legionnaires’ disease cases, the risk of Legionella spp. in private houses is underestimated. In Pisa (Italy) we performed a three-year survey on Legionella presence in 121 buildings with an independent hot water production (IB); 64 buildings with a central hot water production (CB); and 35 buildings with a solar thermal system for hot water production (TB). From all the 220 buildings Legionella spp. was researched in two hot water samples collected either at the recirculation point or at on the first floor and on the last floor, while the potable water quality was analyzed in three cold water samples collected at the inlet from the aqueduct network, at the exit from the autoclave, and at the most remove remote? tap. Legionella pneumophila sg1, Legionella pneumophila sg2-16 and not-pneumophila Legionella species were detected in 26% of the hot water networks, mostly in CB and TB. In these buildings we detected correlations between the presence of Legionella and the total chlorine concentration decrease or/and the increase of the temperature. Cold water resulted free from microbiological hazards, with the exception of Serratia liquefaciens and Enterobacter cloacae isolated at the exit from two different autoclaves. We observed an increase in total microbial counts at 22 and 37°C between the samples collected at the most remote taps compared to the ones collected at the inlet from the aqueduct. The study highlights a condition of potential risk for susceptible categories of population and supports the need for measures of risk assessment and control.

Climate change is a major development challenge to Ethiopia. Unless adaptation measures are widely implemented, climate change can set back development efforts and achievements by years. Recognizing this, the Government of Ethiopia (GoE) and civil society organizations have since recently been making considerable efforts to tackle the climate change problem. This paper documents the experience of CARE International in Ethiopia in facilitating bottom-up approaches to promote community-led disaster risk management and climate change adaptation planning through a participator scenario planning (PSP) methodology. PSP is a coordinated approach which leverages a variety of stakeholders' skills and mandates to explore potential climate change risks and their impacts, and then develop locally relevant and shared adaptation action plans that support livelihoods, social capital and ecosystem resilience. The approach has facilitated timely access to and communication of seasonal climate advisories which in turn is empowering communities to take advantage of opportunities that climate presents, which is a key part of adapting to climate change. The institutionalization of the approach by district and regional disaster prevention and food security coordination offices in the southern pastoral regions of Ethiopia encouraged integration of PSP into community livelihood adaptation and local government development planning, hence continuity of the process. Sustainability is expected to be fully achieved when local government planning processes recognize the importance of and provides resources for the participation of meteorological services and community forecasting experts to help refine plans on a seasonal basis, and for systems for dissemination of advisories. Key words: Climate Change, Disaster Risk Reduction, Adaptation, Pastoralism, Ethiopia,

This study investigates the incidence of prematurity and its impact on maternal and neonatal health at Maternity Hospital, Ouargla, in 2021. Using a multidisciplinary approach, the research explores global and regional trends in prematurity, focusing on challenges and opportunities within Algeria and the broader African context. The analysis includes maternal health indicators and fetal biomarkers to identify risk factors and enable early predictive measures. Key findings discuss the physical characteristics of preterm infants, organ immaturity complications, and long-term outcomes for both mothers and newborns. Additionally, the study considers cultural and societal influences on the perception and management of prematurity and highlights advancements in prenatal and neonatal care, including early detection tools and neonatal resuscitation techniques. Emphasizing family-centered care and the transition to home-based support, the research reviews cutting-edge treatments such as pharmacological and non-pharmacological interventions, stem cell therapies, and respiratory support advancements. Socioeconomic and environmental impacts on prematurity rates are also assessed, underscoring the importance of maternal education and social support networks. The study concludes with evidence-based recommendations for healthcare providers, policymakers, and researchers to improve maternal and neonatal outcomes and reduce prematurity rates.

The core principle of investment posits a direct correlation between risk and return. In the language of finance, "risk" refers to the degree of uncertainty or the likelihood of financial loss associated with an investment choice. Conventional wisdom holds that as investment risk escalates, investors expect higher returns as compensation for the increased risk they undertake. Yet, the interplay between risk and return is not always linear or predictable. This study utilized optimization modeling in the options market to investigate the risk-return relationship, focusing on how returns change with different risk levels. Concentrating on the short iron condor strategy, with its capped risk and return, the research aimed to maximize returns within various loss scenarios. This method clarified return levels at different risk thresholds and emphasized the short iron condor strategy's role in delineating the risk-return dynamics. Using 2023 data, research on the 14 most traded US equity and 9 ETF options, with maturities ranging from 5 to 20 days, identified a clear relationship between risk, measured by both maximum loss levels and price fluctuations, and potential returns in short iron condor strategies. While higher maximum loss limits led to larger potential returns, the risk-adjusted returns, expressed as the return-to-risk ratio, declined as risk increased. However, with increased price fluctuations, the potential return actually decreased due to the capped profit potential of the strategy, showing a different dynamic compared to maximum loss risk. Furthermore, longer time to maturity further reduced this ratio, highlighting that both the level of risk and the duration of the position play critical roles in determining returns. These findings emphasize the complex balance between risk and return, and the diminishing marginal benefits of increasing risk and holding periods in short iron condor strategies.

The increasing prevalence and heightened severity of extreme weather events, which are consequences of climate change, pose significant challenges to the global property insurance sector. This study examines the concurrent crises faced by insurance companies in maintaining profitability and by property owners in affording coverage, thereby necessitating a reevaluation of current insurance paradigms. We present an innovative approach that utilizes a back-propagation (BP) neural network to forecast insurance losses and guide strategic underwriting decisions in regions prone to perils. Our advanced model combines crucial factors such as the likelihood of extreme meteorological phenomena, insurance risk premiums, and capital adequacy ratios to predict impending losses and inform insurance policy formulation. Through an extensive analysis of nearly two decades of catastrophe data from the United States and New Zealand, we determine the model's effectiveness in anticipating insurance-related losses and providing strategic guidance to insurance entities. The study concludes with recommendations for insurers to enhance risk assessment, innovate products, collaborate with governments, invest in green projects, and establish dedicated climate risk management teams. The study contributes to the discourse on climate change adaptation in the insurance industry and offers practical solutions for navigating the complexities of extreme weather risk.

Cardiovascular diseases (CVDs), which comprise coronary heart disease, hypertension and stroke, collectively represent the number one cause of death globally. Atherosclerosis is the dominant cause of CVDs; and its risk factors are elevated levels of low-density lipoprotein-cholesterol and triglycerides, hypertension, cigarette smoking, obesity and diabetes mellitus. In addition, diverse evidence highlighted the role played by inflammation and clonal haematopoiesis, eventually leading to the immunity involvement. The human microbiota project and subsequent studies using next-generation sequencing technology have highlighted that thousands of different microbial species are present in the human gut. The disturbances in the gut microbiota (GM) composition, i.e., gut dysbiosis, have been associated with diseases ranging from localized gastrointestinal disorders to metabolic and cardiovascular illnesses. Of note, experimental studies suggested that GM, host immune cells and marine-derived ingredients work together to ensure the intestinal wall integrity. This review discusses current evidence concerning the links among GM, marine-derived ingredients and human inflammatory disease. In detail, we summarize the impact of fish-derived proteins and algae components, on CVDs risk factors and gut microbiome. Furthermore, we describe the interplay among these dietary components, probiotics/prebiotics and CVDs.

Purpose – This paper aims to investigate the role of forensic accounting skills in enhancing auditor self-efficacy towards fraud detection in Indonesia. In addition, explores the moderating effect of the implementation of Generalized Audit Software (GAS) and whistleblowing system on the relationship between accounting and auditing skills and auditor self-efficacy, as well as its role in enhancing fraud detection. Methodology– A cross-sectional survey was developed and distributed to 537 external auditors working in Indonesia. This study uses a multiple linear regression analysis method with multiple linear moderation models using WarpPLS 8.0 software. Findings – The study results indicate a significant direct relationship between practical communication skills, psychosocial skills, accounting and auditing skills, and auditor self-efficacy. However, technical and analytical factors do not affect auditor self-efficacy. The study's results indicate a significant direct relationship between auditor self-efficacy and fraud detection. It is revealed that implementing GAS moderates the relationship between auditor self-efficacy and fraud detection. In contrast, the study's results do not show a significant relationship between technical and analytical skills and auditor self-efficacy. Novelty– This research paper's originality lies in exploring the role of forensic accounting skills by using GAS and Whistleblowing systems to enhance auditor self-efficacy toward fraud detection in Indonesia.

Wind turbines are associated with noise pollution and make a significant impact on social and environmental stability. The surrounding activities affect the noise pollution in residential locations. It is significantly important that wind power asset owners proactively consider the impact to the surrounding environment while constructing and in the operational phase of wind farms. This will enable the investigation of potential solutions for mitigating public inconvenience. Regulatory authorities regularly demand that asset owners take noise level measurements to investigate the consequences to the public and the environment from wind farms; however, the local authorities do not consider low-frequency noise generation. This manuscript presents a noise risk assessment approach using fuzzy set theory. In this study, two wind farms were selected which are located in the north-central region of Sri Lanka and studied during the southwest monsoon, northeast monsoon and inter-monsoon seasons. Noise data were collected from wind turbines near the residential areas to investigate their impact on the environment and society. To perform noise risk assessment proactively in populated areas, and to identify the risk, a fuzzy logic-based expert system was presented in this study.

Introduction: Despite the well-documented benefits of smoking cessation interventions, the implementation and success of these programs in primary care settings often encounter significant barriers. A primary care provider’s personal smoking status has been identified as a potential barrier to tobacco treatment delivery. The aim of this qualitative study is to explore the experiences and perspectives of primary care providers regarding their role in, delivering smoking cessation interventions to patients based on their personal smoking status. Materials and methods: Semi-structured interviews were conducted with 22 primary care providers from 6 public primary care units in Central Macedonia Region, Greece. Thematic analysis was used to analyze data. Results: Healthcare providers who are current smokers may face unique challenges in effectively counseling patients on smoking cessation. On the contrast, non-smoking and especially previous smoking healthcare providers were noted to exhibit greater confidence and efficacy in delivering cessation support, often serving as role models for patients aiming to quit smoking. Participation in structured cessation training programs often catalyzed personal reflection among healthcare professionals regarding their own smoking behaviour. Conclusions: Personal smoking status of primary care providers impacts the delivery of tobacco treatment, affecting their credibility and effectiveness in providing cessation support. Understanding the complex factors that influence the delivery of smoking cessation interventions in primary care is crucial, as these settings represent a vital point of contact for reaching individuals who smoke and providing them with the necessary support to quit.

Hymenoptera, which includes honeybees, wasps, bumblebees, and hornets, is an order of the class Insecta whose venom can induce anaphylactic reactions in dogs. While several studies have investigated the natural histories and risk factors of Hymenoptera venom allergy (HVA) in humans, only limited information is available on canine patients. Therefore, the aim of this study was to identify risk factors leading to severe systemic reactions (SSR) and to explore the natural history of these patients. This was achieved with an inquiry into the case histories of 178 dogs that were stung by Hymenoptera between 2018 and 2022. Dogs under two years old, dogs that weighed under 10kg, purebred dogs and dogs that were stung in the oral cavity were at a greater risk of developing SSR. Almost two thirds of patients with SSR experienced the same or worse symptoms after subsequent stings and &gt; 40% of patients with local reactions developed SSR when stung again. Next to providing valuable clinical information of HVA in dogs, these findings strongly support the recommendation of venom immunotherapy (VIT) for patients with HVA.

Background/Objectives: With breast cancer (BC) survival improving due to optimized therapy, enhancing quality of life has become increasingly important. Both diagnosis and treatment, with their potential side effects, pose risks to mental well-being. Our study aimed to analyze the incidence and potential risk factors for mental disorders in BC patients. Methods: This retrospective analysis used claims data from AOK Baden-Wuerttemberg, including 11,553 BC patients diagnosed via ICD code C50 between 2010 and 2020 and 31,944 age-matched controls. Patients with mental disorders in the 12 months prior to diagnosis were excluded. Mental disorders were categorized into eight groups based on ICD codes: anxiety, obsessive-compulsive disorder, adjustment disorder, dissociative disorder, hypochondriac disorder, affective disorder, mania, and other neuroses. Results: Mental disorders were significantly more common in BC patients than in controls (64.2% vs. 38.1%, p<0.01, OR 2.91). In particular, hypochondriac, anxiety, affective, and adjustment disorders occurred significantly more often in BC patients. No differences were found for mania, bipolar disease, other neuroses, obsessive-compulsive- and dissociative disorder. Furthermore, endocrine therapy was associated with psychological comorbidities (OR 1.69, p<0.001), while primarily metastasized patients (Stage C) had a lower risk than adjuvant patients in stage A (OR 0.55, p<0.0001). Regarding surgical treatment, mastectomy patients showed lower rates of mental illnesses (61.2%) than those with breast-conserving treatment (71.6%) or especially breast reconstruction (78.4%, p<0.01). Breast reconstruction was also associated with more hypochondriac (p<0.01) and adjustment disorders (p<0.01). Conclusions: So, BC patients experience significantly more mental disorders than controls, particularly, when treated with endocrine therapy and breast reconstructive surgery.

To assess contamination levels, sources, and ecological health risks of potentially toxic elements (PTEs) in the sediments of Al Lith on the Saudi Red Sea coast, 25 samples were collected and analyzed for Zn, V, Cr, Cu, Ni, As, Pb, and Fe using ICP-AES. The average concentrations of PTEs (μg/g) were found in the following order: Fe (14259) > V (28.30) > Zn (22.74) > Cr (16.81) > Cu (12.41) > Ni (10.63) > As (2.66) > Pb (2.46). Contamination indices indicated that Al Lith sediments exhibited either no or minimal enrichment of PTEs, with concentrations below the low effects range. This suggests that the primary source of these PTEs is the basement rocks of the Arabian Shield and that they are unlikely to pose a substantial risk to benthic communities. The hazard index (HI) values for PTEs in both adults and children were below 1.0, indicating no significant non-carcinogenic risk. Lifetime cancer risk (LCR) values for Pb, As, and Cr in both adults and children were within acceptable or tolerable levels, posing no significant health threats. However, a few samples showed LCR values exceeding 1 × 10-4, indicating potential risks.

Nature-based solutions (NbS) have gained global attention for addressing societal challenges, benefiting biodiversity, and promoting human well-being. NbS have been increasingly recognized for their role in mitigating climate change impacts, such as coastal flooding. However, despite their integration into policy frameworks in Europe and parts of Africa, there remains limited empirical evidence regarding their effectiveness. This study seeks to address this gap by exploring the factors influencing perceptions and awareness of the effectiveness of NbS in coastal communities. A structured survey questionnaire was administered in three coastal communities—Kula, Oyorokoto, and Bonny—examining how perception, knowledge, and socio-economic factors affect the effectiveness of NbS. Results show that socio-economic factors such as age, education, and occupation significantly influence the perceived effectiveness of NbS. Additionally, awareness was found to have a stronger impact on effectiveness than perception. The study concludes that awareness-raising initiatives, particularly those focused on the protective benefits of mangroves, are crucial for enhancing the effectiveness of NbS. Conservation, afforestation, and restoration of coastal ecosystems are recommended as key strategies for promoting NbS and their role in climate resilience.

Falls are a major public health problem among older adults, therefore predicting the risk of having falls in the near future is of great importance for health and social systems worldwide. Nowadays, prospective fall risk assessment relies on clinical and functional mobility assessment tools, such as the Timed Up and Go (TUG) test. Recently, wearable inertial measurement unit (IMU) sensors measurements have been proposed for fall detection. We hypothesize that the IMU readings captured during TUG test realizations can provide prospective fall risk prediction. In this study, analysis by deep learning convolutional neural networks (CNN) and recurrent neural networks (RNN) were used for fall prediction based on features extracted from IMU data acquired during TUG test realizations. Data is obtained from a cohort of 106 older adults wear-ing a wireless inertial sensor with a sampling frequency of 100 Hz while performing the TUG test. Prospective fall incidence was obtained in a six-month follow-up period and used as the ground truth for the supervised training and validations of the deep learning and competing machine learning approaches. Further data collection could lead to potential fall risk biomarker. A repeated hold out cross-validation process using 75 subjects for training and 31 subjects for testing was carried out. Best results were achieved by a bidirectional long short-term memory (BLSTM), obtaining an accuracy of 0.83 and AUC of 0.73 with good sensitivity and specificity values.

Flood protection infrastructures are crucial for enhancing the resilience of societies exposed to natural hazards. Newly designed infrastructures are evaluated for sustainability using a coherent and internationally recognized method defined by the International Hydropower Association (IHA). However, older structures require a different assessment approach. Popescu et al. (2024) proposed a modified IHA protocol, mHSAP, which identifies opportunities for improvement and develops a sustainability evaluation framework for existing infrastructures. This paper applies the modified protocol to evaluate the sustainability of two types of flood protection structures: a unique canal system for flood-drought protection of an urban area and a flood protection dyke. The time of operation of over 250 years, and respectively over 50 years. The application of the modified framework demonstrates its advantages in identifying areas for improvement in operating the flood protection structure, such that it is maintained sustainable. It also illustrates how Romanian water boards can use such tools to facilitate collaboration between structure owners and stakeholders, allowing them to assess the risks and effects of flooding on society. Potentially water boards, could use the results of the method to account for the effects of climate change and addressing the issue in a coordinated and efficient manner. Through these two examples from Romania, we also show that the mHSAP framework has the potential to actively support the fulfillment of the United Nations Agenda 2030 Sustainable Development Goals (SDGs).

With the rapid development of electric vehicles, the infrastructure for charging stations is also expanding quickly, and the failure rate of charging piles is increasing. To address the effective op-eration and maintenance of charging stations, a method based on the XGBoost algorithm for electric vehicle DC charging stations is proposed. An operation and maintenance system is constructed based on state analysis, considering the operation status of the charging station and users' charging habits. Factors such as driving and charging habits, road traffic, and charging station equipment are taken into account. The training sample data is established using historical data, online monitoring data, and external environmental data, and the charging station status evaluation model is trained using the XGBoost algorithm. Based on the condition assessment results, a risk assessment model is established in combination with fault parameters. Risk tracking of the charging station is conducted using the lack of power supply (ENC), evaluating the risk level of each station, and determining the operation and maintenance order. The optimal operation and maintenance model for DC charging stations, aimed at achieving both economic and reliable goals, is constructed to determine the op-eration and maintenance schedule for each station. The results of the case study demonstrate that the state evaluation and operation and maintenance strategy can significantly improve the relia-bility of the system and the overall benefits of operation and maintenance while meeting the re-quired standards.

Objectives: The goal of this pilot study was to validate and introduce a new AI tool (algorithm), providing and comparing (1) the periodontal/peri-implant diagnosis between professional (specialist) and automated tool, (2) risk assessment and prognostication with the algorithm, and (3) establish cut-off limits for clinically significant disease with a new score system (GF-PeDRA score). Methods: All patients were evaluated by two evaluators, and in case of any divergence, the case was revisited and discussed until clarification and definition. The validation sample constituted 221 patients. The AI tool (GF-PeDRA©) had eighteen parameters to be assessed, involving systemic and local predictors, achieving an octadecagon (an eighteen-sided polygon). The parameters were: (1) The highest probing depth (PD); (2) Number of interproximal sites with bone loss; (3) The highest clinical attachment loss (CAL); (4) Maximum radiographic bone loss (RBL); (5) Bleeding on probing (% BoP); (6) Bone loss pattern; (7) Tooth loss including periodontally hopeless teeth planned for extraction; (8) Evidence of progression over five years; (9) Need for complex rehabilitation; (10) Patient’s age; (11) CAL and biofilm accumulation; (12) Smoking; (13) Diabetes; (14) Extension and distribution of the disease; (15) Peri-implant disease; (16) Other systemic conditions (other than diabetes); (17) Furcation involvement; and (18) Necrotizing lesion. A new score system (GF-PeDRA© score) based on the percentual of the octadecagon area is obtained; if the area was ≥0% to ≤9%, the prognosis is good; ≥10% and ≤ 24%, it is fair; ≥25% and ≤37%, poor; ≥38% and ≤49%, it is questionable; and between ≥50% to ≤100%, the prognosis is hopeless. Results: 221 patients were enrolled, with a mean age of 46.73. 5301 teeth were examined. 187 non-smokers (84.62%) and 34 smokers (15.38%) were included. 193 (87.33%) patients did not have diabetes, whereas 28 (12.67%) had. Comparing the diagnosis between both evaluators, k=0.83; all disagreed cases were re-discussed, and a final decision/diagnosis was reached. After this, the diagnosis found was contrasted with the diagnosis achieved by GF-PeDRA© and a perfect agreement was observed, 100% (k=1.0). 28 patients were diagnosed as periodontally healthy, 55 with plaque-induced gingivitis, and 138 with periodontitis. Only one case of molar/incisor pattern was observed. No peri-implant disease or necrotizing condition was found. The mean CAL found was 3.19 mm; 25 patients (11.31%) had a furcation involvement. The mean percentual of BoP found was 28.67% (median = 19%; maximum: 100%; minimum: 100%); and the mean PD was 5.31 mm. The mean of the new GF-PeDRA© score (ranging from 0% to 100%) was 28.64%, with a median of 32.2% (minimum: 0.6% and maximum: 64.1%). Then, analyzing the GF-PeDRA© score of 221 patients enrolled, 48 (21.73%) were sorted as a Good prognosis for periodontal treatment, 43 (19.45%) had a Fair prognosis, 43 (19.45%) had a Poor prognosis, 68 (30.77%) had a Questionable prognosis, and 19 (8.60%) had a Hopeless prognosis. Conclusion: The new AI tool (GF-PeDRA©) was validated and proved to be extremely helpful in diagnosing and providing risk assessment and prognosis.

The risk classification of barrier lake is the key to conducting emergency treatment in a scientific manner. Such difficulties are faced as short time for risk evaluation, complex evaluation indicators, difficulty in obtaining information quickly and quantifying index weights. Based on this, this paper constructs a quantitative risk classification model for barrier lakes based on D-AHP. On the basis of studies on nearly 100 cases of barrier lakes, an 8-factor evaluation index system and quantitative classification are proposed. The methods of rapid calculation of reservoir capacity curve of barrier lake and intelligent identification of particles on the surface of barrier body were developed, which realized the rapid acquisition of 8-factor evaluation index information in emergency environment. The D-AHP method dealt with inconsistent weight assignment to evaluation factors by experts, which helped achieve weight quantification of 8 factors. The risk assessment on15 barrier lakes such as Tangjiashan barrier lake show that the conclusion drawn with risk classification method proposed in this paper is basically consistent with that of the traditional table-lookup method. However, the table-lookup method ignores cumulative loss’s impacts on the risk level of barrier lakes, and considers the extremely severe loss of barrier lakes as a sufficient condition for the evaluation level to be grade I, and thus a deviation in the evaluation. The risk classification method proposed in this paper is more reasonable and reliable.

Background/Objectives: RAS is associated with coronary artery disease (CAD), exacerbation of arterial hypertension and progression to heart failure, but remains frequently unrecognised in clinical practice. Methods: We conducted a systematic review and meta-analysis of studies by pooling data of patients undergoing CAG due to suspected or stable CAD that received a bilateral renal artery angiography; Results: A total of 31 studies with 31,689 patients were included (mean age 63.2±8.7 years, 20.9% were female). Overall, 13.4% (95%CI 10.5-16.7%) of patients undergoing coronary angiography had significant RAS, with 6.5% (95% CI 4.5-8.9%) and 3.7% (95%CI 2.5-5.2%) having severe and bilateral RAS. The mean weighted proportion of patients with 3-vessel coronary disease (3VD) was 25.1 (95%CI 19.6-30.9%) while 4.2% (95%CI 2.6-6.2%) had leftmain (LM) coronary disease. Patients with RAS compared to those without RAS were significantly older (mean difference - MD 4.2 years, (95%CI 3.8-4.6). The relative risk of RAS was greater for the female sex (risk ratio, 95%CI; RR 1.3, 1.03-1.57), presence of diabetes (RR 1.2, 1.10-1.36), arterial hypertension (RR 1.3, 1.21-1.46), dyslipidemia (RR 1.1, 1.06-1.14), peripheral artery disease-PAD (RR 2.1, 1.40-3.16), chronic kidney disease-CKD (RR 2.6, 2.04-3.37), 3VD (RR 1.6, 1.30-1.87), and LM disease (RR 1.8, 1.28-2.47). Smoking had a neutral effect on the risk of RAS occurrence (RR 1.0, 0.94-1.06); Conclusions: RAS is common in patients undergoing coronary angiography. CKD, PAD, older age, and severe CAD were among the strongest predictors for the presence of significant RAS.

The issue of climate change represents a significant global risk that demands immediate attention. However, higher education frequently fails to incorporate global perspectives and intricate transdisciplinary matters. In order to integrate global and transdisciplinary aspects into the curriculum of a technical university with a focus on computer science, a Master's programme has been developed. The programme's objective is to situate global risk at the core of the curriculum, thereby encouraging scientists to work beyond the boundaries of their respective disciplines. The paper considers the challenges that science and higher education must address to facilitate pathways towards a peaceful and sustainable future. It argues for a shift in focus from short-term and localised issues to a more holistic approach, emphasising the importance of considering universal problems. The curriculum, as developed, may be regarded as a guide for future university efforts in the fields of global risk and climate change.

Background: Research has consistently shown increased drug use among lesbian, gay, bisexual, transgender, intersex, queer/questioning, and asexual (LGBTQIA+) individuals. This is particularly the case among LGBTQIA+ adolescents. Substance use within this vulnerable community can propagate mental health issues leading to psychiatric disorders, self-harm and even suicide. Therefore, the objective of this scoping review was to evaluate the determinants of drug use among LGBTQIA+ adolescents. Methods: A comprehensive search of mainly primary research was conducted using several databases. Peer-reviewed articles published between 2018 and 2023 were included. The scoping review was conducted using the framework outlined by Joanna Briggs Institute (JBI) and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses- Extension for Scoping Reviews (PRISMA-ScR) statement. Results: A total of 29 articles (including 400194 participants) were included in the analysis. The articles reported that the main determinants of drug use among LGBTQIA+ adolescents include homelessness, peer-peer interactions, mental health, and protective factors. The articles reported that mental health issues, which are mainly triggered by rejection, were the main determinants of drug use among LGBTOIA+ adolescents. Conclusion: Findings from this scoping review provide relatively reliable evidence that homelessness, mental health, peer-peer interactions, and protective factors are the main determinants of illicit drug use among LGBTQ+ adolescents. Rigorous studies that include large sample sizes, and systematic reviews are needed to further confirm these findings and assist in developing interventions to combat the unusually high level of drug use among this group.

Unheralded cardiac arrest among previously healthy young people without antecedent illness, months or years after COVID-19 vaccination, highlights the urgent need for risk stratification. The most likely underlying pathophysiology is subclinical myopericarditis and reentrant ventricular tachycardia or spontaneous ventricular fibrillation that is commonly precipitated after a surge in catecholamines during exercise or the waking hours of terminal sleep. Small patches of inflammation and/or edema can be missed on cardiac imaging and autopsy, and the heart can appear grossly normal. This paper reviews evidence linking COVID-19 vaccines to cardiac arrest where unfortunately the majority of victims have had no antecedent clinical evaluation. We propose a comprehensive strategy for evaluating cardiovascular risk post-vaccination, incorporating detailed patient history, antibody testing, and cardiac diagnostics in the best attempt to detect abnormalities before sudden cardiac death. This approach aims to identify individuals at higher risk of cardiac events after COVID-19 vaccination and guide appropriate clinical management. It is prudent for each primary care physician to have a pre-established plan when addressing this issue in their practice.

Corporate governance has received increasing attention from practitioners and politicians after the collapse of large companies due to accounting errors and failure to disclose information that reflects the true financial condition of companies. Voluntary risk disclosure includes several aspects, including financial risks, including risks of interest rate, exchange rate, liquidity as well as risks of operations. In Jordan, the most common type of business is family businesses, where boards of directors usually serve the interests of the family that owns the majority stake in the company.This study identifies the moderate effect of family in the link joining the audit committee with the voluntary risk disclosure of financial institutions in Jordan. It's population is the Jordanian commercial banks registered and operating in Jordan during the period extending from 2017 to 2023.Significantly, it concluded with revealing that the characteristics of the audit committee; namely, independence, experience, and committee size, obviously impact disclosure of voluntary risk in the selected banks. However, the results made it obvious that the number of audit committee meetings did not affect the degree of voluntary risk disclosure. In addition, the results view family ownership as moderately affecting the relationship joining some audit committee characteristics with voluntary risk disclosure.

Cannabidiol (CBD), a non-psychotropic main component of the Cannabis plant, is approved as a drug in the European Union (EU) under the name “Epidyolex”. However, the approval process as a food ingredient under the Novel Food Regulation was paused by the European Food Safety Authority (EFSA) due to a lack of safety data. Nevertheless, there is a growing, unregulated market in which CBD is advertised with various health claims and different dosage instructions. Of particular concern is its toxic effect on the liver and possible reproductive toxicity in humans. Studies suitable for calculating a benchmark dose were identified from the available data. Animal studies yielded a Benchmark Dose Lower Confidence Limit (BMDL) of 43 mg/kg bw/day, which translates into a safe human dose of approximately 15 mg/day. Only a Lowest Observed Adverse Effect Level (LOAEL) of 4.3 mg/kg bw/day could be identified from the human data. This updated risk assessment confirmed the Health-based Guidance Value (HBGV) of 10 mg/day based on human LOAEL. Despite existing data gaps, preliminary regulation appears advisable as the current form of the gray CBD market is unacceptable from the standpoint of consumer safety and protection.

Groundnut is an important cash crop and a diet component for rural households in sub-Saharan Africa. However, Aflatoxin contamination remains a barrier to promoting groundnut-based food products as food levels above maximum limit (ML) can adversely affect human health. Three objectives were set, namely, (i) to characterize the post-harvest operations and risk factors affecting aflatoxin contamination, (ii) to assess aflatoxin incidence in on-farm stores and, iii) to assess agronomic practices that can be integrated to improve yield and reduce aflatoxin contamination. The average aflatoxin levels in on-farm stores were 11.3-16.4μg/kg, in which the proportions of ML were 25.7% at 4μg/kg, 56.3% at 15μg/kg, and 80% at 20μg/kg (~5-7 months after harvest). The application of Aflasafe® resulted in safe or no aflatoxin contamination across the locations. Significant hazards identified during postharvest operations include intermittent rain at harvest and drying (6.5), insect pests attacks after harvest (6), prolonged harvest to stripping interval (6.6), drying on bare ground (6.2), storing on bare floor (6.9), use of poorly efficient shelling machines (6.5), and re-use of rejected nut (6.1). This study provides solutions to minimize aflatoxin risk if appropriate technologies (e.g. improved variety, fertilizer, rhizobia inoculant, and Aflasafe®) and policies are deployed.

Research interest in the occurrence, distribution, fate, and toxicity of N-(1,3-Dimethylbutyl)-N’-phenyl-p-phenylenediamine (6PPD) quinone, a derivative of the tire amino antioxidant 6PPD in urban environments, has surged. While several studies have found that 6PPD quinone exhibits acute, reproductive, and behavioral toxicity as well as mutagenicity and hepatotoxicity in aquatic and terrestrial animals, its environmental exposure data are fragmented and lack coherence across the source-to-exposure continuum, making it difficult to use for risk assessment and regulatory purposes. The present work developed an aggregate exposure pathway (AEP) framework to integrate the exposure data. An AEP network was developed for the atmospheric deposition of 6PPD quinone from tire wear in the Pearl River Delta, which led to human exposure. The 6PPD quinone research was organized, visualized, and evaluated with pertinent knowledge gaps identified using the weight of evidence assessment. Eight key exposure states were identified, with only two having high confidence levels and three having low confidence levels. Empirical support for the key transitional relationships decreased from High to Low from the source to the target site, indicating an urgent need for downstream mechanistic data. The proposed AEP framework integrated diverse 6PPD quinone research, facilitating a mechanistic understanding of the source-to-outcome continuum, as well as the development of quantitative predictive models for future research and environmental regulation.

This study investigates the evolving corporate governance mechanisms within the context of an emerging economy. Addressing a literature gap, we analyse the influence of corporate governance and earnings quality on idiosyncratic risk in an emerging economy. In particular, this research explores the impact of corporate governance practices and earnings quality on idiosyncratic risk. For this purpose, we utilise a sample of 75 non-financial firms listed on the Pakistani equity market over nine years from 2010 to 2018. Employing the generalised method of moments, the findings of our empirical analysis reveal that firms with robust governance mechanisms and higher earnings quality experience minimal idiosyncratic risk. These outcomes provide valuable insights for standard setters, regulatory authorities, policymakers, and other stakeholders, emphasising the importance of governance mechanisms and earnings management in mitigating idiosyncratic return volatility.

The study examines the risk and protective factors in childhood for boys and girls who engage in unlawful behavior, through the lens of developmental criminology. This field explores the elements contributing to the emergence of antisocial and prosocial behaviors in childhood, which are linked to the increase or desistance of delinquency in later years. To enhance understanding in this domain, the study analyzes risk and protective factors associated with criminality in children across various levels: individual, family, and community. Utilizing a systematic review grounded in the PRISMA method, the study identifies and categorizes a range of factors, including conduct problems, socio-emotional competencies, biological determinants, social exclusion, interpersonal relationships, institutional governance, family adversity, caregiver characteristics, and family composition. This review underscores the significance of recognizing risk and protective factors in child development to design interventions at multiple levels, aiming to prevent antisocial behavior proactively.

Enhancing residents' purchasing intention of prepared dishes is crucial for the sustainable development of the prepared dishes industry. Understanding how residents' cognition influences their purchasing intentions can provide valuable insights for developing and refining industry policies. Based on the theory of distributed cognition, this study utilizes questionnaire data from urban residents in Beijing and Shanghai, and employs Structural Equation Modeling to explore the influence of cognition on the continuous purchasing intention of Chinese urban residents towards prepared dishes. The study results reveal that: (1) individual and geographical power significantly positively impact on residents' continuous purchasing intentions of prepared dishes, while cultural power perception does not have a significant effect. (2) Risk perception partially mediates the effect of personal and geographical power on continuous purchasing intention and fully mediates the effect of cultural power on continuous purchasing intention. Recommendations include: (1) The government should enhance standardization and supervision to create a favorable consumption environment; (2) Enterprises should provide more objective and transparent information to improve residents' knowledge of prepared dishes and establish a good reputation.

In today's highly digitized and globalized financial environment, the need to protect payment systems from risk is more urgent than ever. Artificial intelligence (AI) technology is rapidly becoming a key tool in this space, with machine learning algorithms, big data analytics, and real-time monitoring enabling AI to effectively detect and prevent fraudulent activity, optimize risk management processes, and deliver intelligent services. AI not only improves the security and efficiency of payment systems, but also significantly improves customer satisfaction and loyalty. With the continuous development of AI technology and financial payment technology, the financial payment industry will usher in more innovations and changes in the future, further optimizing the payment process, improving payment efficiency, and ensuring payment security.

Teledermatology, the dermatological consultation and diagnosis via digital communication technologies, has become increasingly important in modern healthcare. The integration of teledermatology into clinical practice has gained significant interest, especially during the COVID-19 pandemic. Numerous studies have shown the effectiveness and reliability of teledermatology, with high levels of patient satisfaction and diagnostic accuracy. Pathpoint® eDerma is a cloud-based dermatology platform that aims to streamline the documentation and management of dermatological conditions. It offers several clinical benefits, including faster diagnosis, reduced unnecessary procedures, improved access to care, and cost savings. The platform follows a comprehensive risk management plan and complies with safety regulations. It undergoes regular recertification and reviews to ensure its safety and effectiveness. The clinical evaluation of eDerma confirms its ability to deliver significant clinical benefits while effectively mitigating risks. The benefit-risk ratio of eDerma is highly acceptable, supporting its use in clinical settings to enhance dermatological care.

This qualitative study explores supplier selection criteria from the perspectives of procurement professionals across diverse industries. Supplier selection is crucial for organizational efficiency and performance, influenced by factors beyond traditional cost considerations. The research aims to uncover nuanced criteria such as quality assurance, supplier reliability, innovation capability, sustainability practices, strategic alignment, relational dynamics, and risk management strategies. These criteria reflect a shift towards holistic evaluation frameworks that integrate economic, social, and environmental dimensions in procurement decision-making. Methodologically, the study employed semi-structured interviews with 30 procurement professionals, ensuring depth and diversity in perspectives. Thematic analysis was used to identify recurring themes and patterns, illuminating the complexities and strategic importance of supplier selection processes. Findings highlight the strategic role of suppliers in driving innovation, enhancing supply chain resilience, and supporting organizational goals. Moreover, the study underscores the significance of sustainable sourcing practices, ethical considerations, and effective supplier relationships in fostering long-term partnerships and mitigating operational risks. Practical implications suggest that organizations should adopt integrated approaches to supplier selection, leveraging data-driven insights and technological advancements to optimize decision-making. By prioritizing strategic alignment, fostering collaborative partnerships, and implementing robust risk management strategies, organizations can navigate uncertainties, capitalize on market opportunities, and sustain competitive advantage.

This study is a retrospective analysis aimed to understand the incidence and risk factors of proximal junctional kyphosis (PJK) following long instrumented spinal fusion from L1 to the sacrum in patients with mild to moderate sagittal imbalance. It recruited consecutive patient undergone instrumented fusion from L1 to the sacrum for degenerative lumbar disease between June 2006 and November 2019 in a single institution. The patients’ preoperative clinical data, muscle status at T12-L1 on magnetic resonance images, and sagittal spinopelvic parameters were analyzed. Univariate analysis was used to compare clinical and radiographic data between PJK and non-PJK patients. Logistic regression analysis was used to investigate the independent risk factors for PJK. A total of 56 patients were included in the study. The mean age at surgery was 67.3 years and mean follow-up period was 37.3 months. Seven were male and 34 were female. PJK developed in 23 (41.1%) out of 56; of these patients, 20 (87.0%) developed PJK within postoperative 1 year. On univariate analysis between PJK and non-PJK patients, PJK group showed more frequent osteoporosis, lower body mass index, smaller cross-sectional area (CSA) and more fat infiltration (FI) in erector spinae muscle at T12-L1, larger preoperative TLK and PT with statistical significance (p&lt;0.05). On logistic regression analysis, severe (&gt;50%) FI in erector spinae muscle (OR=43.60, CI 4.10-463.06, R2N =0.730, p=0.002) and osteoporosis (OR=20.49, CI 1.58-264.99, R2N =0.730, p=0.021) were statistically significant. Preexisting severe (&gt;50%) fat infiltration in erector spinae muscle and osteoporosis were significant independent risk factors associated with PJK following instrumented fusion from L1 to the sacrum, but age was not a risk factor.

Obesity has increasingly become a worldwide epidemic, as demonstrated by epidemiological and clinical studies. Obesity may lead to development of a broad spectrum of cardiovascular diseases (CVDs), such as coronary heart disease (CHD), hypertension, heart failure (HF), cerebrovascular disease, atrial fibrillation (AF), ventricular arrhythmias, and sudden cardiac death (SCD). In addition to hypertension, there are other cardiometabolic risk factors (CRFs) such as visceral adiposity, dyslipidemia, insulin resistance, diabetes, elevated levels of fibrinogen, and C-reactive protein and others, all of which increase the risk of CVD events. Mechanisms involved between obesity and CVD mainly include insulin resistance, oxidative stress, inflammation, and adipokines dysregulation, which cause maladaptive structural and functional alterations of the heart, particularly left ventricular (LV) remodeling and diastolic dysfunction. Natural products of plants, provide a diversity of nutrients and different bioactive compounds, including phenolics, flavonoids, terpenoids, carotenoids, anthocyanins, vitamins, minerals, fibers, and others, which possess a wide range of biological activities including antihypertensive, antilipidemic, antidiabetic, and other activities, thus conferring cardiometabolic benefits. In this review, we discussed the main therapeutic interventions using extracts from herbs and plants in preclinical and clinical trials with protective properties targeting CRFs. Molecular mechanisms and therapeutic targets of herbs and plants extracts for the prevention and treatment of CRFs are also reviewed.

This article explores the application of machine learning techniques, specifically focusing on ensemble methods like Random Forests, for detecting fraudulent activities in digital financial transactions. Highlighting the evolution from traditional statistical approaches to modern machine learning models, it underscores the effectiveness of Random Forests in handling the inherent challenges of imbalanced datasets typical in fraud detection scenarios. Using a Kaggle dataset of credit card transactions, the study optimizes Random Forest parameters through rigorous parameter tuning, achieving significant improvements in model performance metrics such as Area Under the Curve (AUC). The findings underscore the critical role of machine learning in enhancing fraud detection capabilities, emphasizing the ongoing evolution and future potential of these methodologies in financial risk management.

Manufacturing firms need to streamline their initiatives in line with 17 sustainable development goals (SDGs) 2030 as a means for improving performance. This research adapts SDG’s goals 8 decent job and economic growth’ as a measure of performance, in examine the effect of corporate sustainability strategies on performance of manufacturing firms. Census sampling technique was used in cross sectional survey of 900 multi-industry managers from one hundred and fifty (150) manufacturing firms in Kano, Nigeria. A five Likert scale, well-structured questionnaire was used in collecting data, analysed by Structural Equation Modelling SEM PLS Package. The study shows positive and significant effect of eco-efficiency, and positive and insignificant effect of both legitimation and risk mitigation strategies on performance respectively. The study concluded that the positive and significant effects of eco efficiency initiatives could be due to benefits derived from total quality management system, energy monitoring, and process safety management reflected in sustainability oriented visionary leadership of the managers. The positive and insignificant effects of legitimation initiatives could be as a result of huge spending on sustainability reporting, and corruption. The positive and insignificant effect of risk mitigation could be due to pro-activeness of the firms’ managers in tackling risk through sustainability oriented visionary leadership. The study recommended firms should adopt conservative eco-efficiency initiatives for improving performance and stop adopting extroverted legitimation and introverted risk mitigation strategies as both have no significant effect on performance. Future researchers should use longitudinal research design using financial metrics adopting the same independent variables in other economic sectors.

The dynamic and unpredictable nature of modern supply chains necessitates the development of resilient systems capable of withstanding various disruptions. This qualitative study examines the impact of collaborative practices on supply chain resilience, providing an in-depth analysis of their contributions to the robustness and adaptability of supply chains. Through extensive interviews with industry professionals, including supply chain managers, logistics coordinators, and strategic planners, the study identifies key collaborative practices—such as information sharing, joint decision-making, and coordinated response strategies—that significantly enhance resilience. These practices facilitate proactive risk management, improve response times during disruptions, and foster innovation through shared knowledge and resources. Thematic analysis of the collected data reveals that strong relationships among supply chain partners and integrated approaches that leverage each participant's strengths are crucial for effective risk mitigation and recovery. Additionally, the study underscores the role of technology in enabling real-time information sharing and decision-making, which are essential for effective collaboration. The findings highlight the importance of investing in robust collaborative networks and adopting supportive technologies to enhance communication and coordination. This research contributes to the existing body of knowledge by offering a nuanced understanding of how strategic implementation of collaborative practices can build more resilient supply chains. It provides practical recommendations for businesses seeking to improve their resilience, emphasizing the qualitative aspects of collaboration and its impact on supply chain management. Overall, this study presents a comprehensive exploration of how collaboration can bolster supply chain resilience, offering valuable insights for practitioners and scholars focused on creating stable and sustainable supply chain operations in the face of growing uncertainties.

Based on a wealth of evidence, aspirin is one of the cornerstones of secondary prevention of cardiovascular disease. However, despite several studies showing efficacy also in primary prevention, an unopposed excess risk of bleeding leading to a very thin safety margin is evident in subjects without a clear acute cardiovascular event. Overall, the variability in recommendations from different scientific societies for aspirin use in primary prevention is a classic example of failure of simple risk stratification models based on competing risks (atherothrombosis vs. bleeding), perceived to be opposed but intertwined at the pathophysiological level. Notably, cardiovascular risk is dynamic in nature and cannot be accurately captured by scores, which do not always consider risk enhancers. Furthermore, the widespread use of other potent medications in primary prevention, such as lipid-lowering and anti-hypertensive drugs, might have reduced the benefit of aspirin in recent trials. Some authors, drawing from specific pathophysiological data, have suggested that specific subgroups might benefit more from aspirin. This includes patient with diabetes and those with obesity, as well as considering sex-based differences. Moreover, molecular analysis of platelet reactivity has been proposed. A beneficial effect of aspirin has also been demonstrated for the prevention of cancer, especially colorectal. This review explores evidence and controversies concerning the use of aspirin in primary prevention, considering new perspectives in order to develop a personalized approach.

Supply chain risk management (SCRM) is a critical aspect of contemporary business operations, necessitated by the complex and interconnected nature of global supply chains. This qualitative research delves into the intricacies of SCRM through in-depth interviews with industry experts, aiming to unravel the multifaceted nature of supply chain risks and the strategies employed for mitigation. Key themes emerged, including the diverse sources of risks encompassing operational, financial, environmental, and geopolitical factors, highlighting the need for a comprehensive approach to risk management. Challenges such as limited visibility, resource constraints, and organizational silos were identified, underscoring the importance of addressing these barriers to enhance SCRM effectiveness. Strategies for risk mitigation encompassed technological investments for enhanced visibility and predictive capabilities, collaboration and information sharing among supply chain partners, and the integration of sustainability principles into risk management practices. Leadership, organizational culture, and continuous learning emerged as critical factors in driving effective SCRM practices, emphasizing the need for proactive and adaptable approaches to navigate evolving risks. Overall, this study contributes to the existing body of knowledge on SCRM by providing valuable insights for practitioners and academics, and underscores the importance of holistic and proactive approaches to enhance supply chain resilience and agility in today's dynamic business environment.

Coastal zones experience increasing climatic and human pressures, which lead to growing risks and tipping points (TPs) under future scenarios and natural resource scarcity. To avoid crossing TPs with irreversible coastal losses, this paper proposes the development of adaptation pathways based on advanced coastal oceanography and engineering knowledge that enables an objective assessment of evolving coastal risks. These pathways feature sequential interventions, combining conventional engineering works with nature-based solutions (NbS), steered by simulations and observations as a function of available coastal resources (space and sediment) and risks for infrastructure and socioeconomic assets. Such an adaptation has been developed for urban and peri-urban Mediterranean beaches, considering conventional coastal engineering together with NbS. Both types of interventions are assessed in terms of key physical variables, which serve to evaluate performance and estimate TPs. This analysis supports the new coastal protection and management plan promoted by the local government and the coastal adaptation plan of the central government. The approach and results illustrate the potential of adaptation pathways for beach sustainability, enhancing the compatibility between short/long-term coastal protection objectives under present/future climate and management scenarios. The adaptation pathways development underpins an increasing stakeholder cooperation to achieve shared decisions for coastal sustainability.

The use of chemical pesticides in agriculture contributes to soil, water and air pollution, biodiversity loss and can harm non-target species. The European Commission has already established a Harmonized Risk Indicator to quantify the progress in reducing the risks linked to pesticides. Therefore, there is an increasing need to promote biopesticides or so-called low-risk pesticides (LRP). Extract from Melaleuca alternifolia – tea tree oil (TTO) is known for its antiseptic, antimicrobial, antiviral, antifungal, and anti-inflammatory properties. Tea tree oil has been extensively studied in pest management as well as in the pharmaceutical and cosmetic industry and there are already products based on its active substances on the market. This review focuses on the overall evaluation of tea tree oil in terms of effectiveness and safety as a biopesticide for the first time. The collected data can be an added value for further evaluation of tea tree oil in terms of the authorization extension as a fungicide in 2026.

This study investigates the factors influencing consumers' intentions to purchase overseas travel packages via social media in Thailand, with a focus on consumer trust and perceived risks. A mixed-methods approach was employed, combining qualitative and quantitative research techniques. In the qualitative phase, the Fuzzy Set Delphi Method was applied to gather expert consensus from 19 participants. For the quantitative phase, a survey was conducted among 600 individuals who had experience purchasing overseas travel packages on social media in Thailand. First-order and second-order confirmatory factor analyses were used to examine the relationships between eight identified factors: social media influencer, e-WOM, trust, perceived risk, brand image, rating review, personal attitude, and destination image. The results indicate that trust and perceived risk are the most significant factors affecting purchase intention. Trust plays a crucial role in customers' decision-making processes, while perceived risk influences their tendency to avoid purchasing packages if the risk is perceived as high. The insights gained from this study contribute to the understanding of factors influencing purchase intentions for overseas travel packages through social media in Thailand, providing valuable information for travel agencies to develop effective marketing strategies.

Purpose: This study aimed to identify the risk factors for acute pancreatitis (AP) and its impact on outcomes in Polish children treated for ALL. Methods: The study group included 2303 children who received intensive chemotherapy for ALL. The group was subdivided into patients with at least one episode of AP and those who did not develop AP following treatment for ALL. Results: The cumulative incidence of AP in the study group was 4.08%. Older age was an independent risk factor for AP development (OR 1.05; 95%CI: 1.006 – 1.098; p=0.03). The overall mortality related to AP was 2.13%. The probabilities of disease-free survival (p-DFS) and event-free survival (p-EFS) were 0.84 vs. 0.86, log-rank: p=0.65 and 0.75 vs. 0.80, log-rank: p=0.12, respectively in both subgroups. A total of 22 out of 94 patients (23.4%) with AP were re-exposed to asparaginase (ASP) during the subsequent phases of the treatment. Only one re-exposed to ASP patient (4.5%) developed a second episode of AP. There were no significant differences in p-DFS and p-EFS between patients re-exposed and not re-exposed to asparaginase (0.78 vs. 0.86, log-rank p=0.27 and 0.63 vs. 0.79, log-rank p=0.09 respectively). Conclusions: The incidence of AP in children with ALL is low and related to the patient’s age. AP development doesn’t seem to impact p-DFS and p-EFS in children with ALL. The recurrence of AP following re-exposure to asparaginase in patients with ALL and a history of AP is low (4.5%). Re-exposure to asparaginase after the first episode of AP doesn’t improve either p-DFS or p-EFS in children with ALL.

Background and Objectives. Prevalence of GERD is increased among individuals with obesity and RYGB is considered as the most effective procedure to control GERD and obesity. However, some patients continue to have GERD after RYGB. The aim of the study was to investigate the prevalence and the risk factors of GERD after RYGB. Material and Methods. This prospective study included 180 patients operated with RYGB and followed for on average of 12.2 (0.6) years. 126 (70%) patients agreed to participate in online consultations and provided data on weight, GERD symptoms, filled GERD-HRQL, TFEQ-18 and GSRS questionnaires. Results. The average age before surgery was 42.7 (10.5) years and BMI was 45.2 (6.4) kg/m2. 128 (71.1%) were females and preoperative GERD was diagnosed in 74 (41.1%) patients. At 12 years follow-up the mean %EBMIL and %TWL were 60.37 and 25.73, respectively. The median %WR was 18.0 (39.0). The GERD was present in 30 (23.8%) patients, of whom 12 (40%) continued to have GERD symptoms and 18 (60%) developed de novo GERD. The GERD-HRQL score significantly decreased from 3.0 (8.0) at baseline to 2.0 (5.0) (p=0.028) at 12 years. GSRS Diarrhea and Indigestion median scores increased significantly, from 1.33 (0.67) to 1.5 (2.42) (p 3.2.

The COVID-19 pandemic has shown varying effects on adolescents’ mental health, psychosocial functioning, risk behaviours, and victimisation. This study aims to examine the changes reported by a sample of Swedish adolescents (N=1607) at the end of the first year of the pandemic in relation to these factors. Data was collected with an electronic survey between September 2020 and February 2021, targeting upper-secondary high school students (aged 15-19 years). The results indicate a relatively low overall impact of the pandemic on Swedish upper-secondary school students, with notable gender differences. Compared to females, a higher percentage of male adolescents reported experiencing elevated levels of anxiety, depression, sleep disturbances, anger, and increased illicit drug use as consequences of the pandemic. In contrast, females demonstrated an increase in several salutogenic behaviours. Victimisation rates generally decreased during this period. These findings underscore the importance of heightened awareness among professionals within schools, social services, and healthcare settings regarding the distinct challenges encountered by a larger portion of male adolescents during the COVID-19 pandemic in Sweden.

Background: Autonomic balance measurement (ABM) is a valuable tool in clinical practice for assessing the functioning of the autonomic nervous system (ANS), which controls involuntary bodily functions. Here we summarize the current understanding of the utility of autonomic balance measurement in clinical practice. Methods: A narrative review of relevant literature was conducted, focusing on studies investigating the use of autonomic balance measures in various clinical settings. Results: ABM holds potential benefits in clinical practice, including aiding in diagnosing autonomic dysfunction, monitoring treatment efficacy, and predicting potential health complications. ABM can be crucial for diagnosing various conditions, including cardiovascular diseases (Heart failure, arrhythmias, and hypertension), neurological disorders (Parkinson's disease, Alzheimer's disease, and diabetic neuropathy), in sports medicine athletes can undergo ABM to optimize training regimens, enhance performance, assessing the impact of training stress, preventing overtraining, and promoting overall well-being and probably to assess potential health risks, in metabolic syndromes ABM can aid in the early detection of autonomic neuropathy, a diabetes-related complication, allowing for timely intervention and better management of the disease, and psychiatric disorders (Anxiety, depression, and post-traumatic stress disorder). In addition, ABM can be helpful in monitoring of treatment efficacy, by tracking changes in autonomic balance, clinicians can assess if treatments for conditions impacting the autonomic nervous system are effective. ABM can also be helpful in predicting outcomes by facilitating early recognition of future health complications in certain populations. However, limitations exist, including non-specificity, variability in measurements, and limited evidence for routine use in specific clinical settings. Conclusion: Incorporating autonomic balance measurement into routine clinical assessments provides a more comprehensive understanding of a patient's health. It complements traditional diagnostic methods, offering additional insights into the body's regulatory mechanisms. While autonomic balance measurement offers potential benefits, careful interpretation and consideration of its limitations are crucial for its effective use in clinical practice. ABM remains a valuable and versatile tool in clinical practice for a deeper understanding of the autonomic nervous system, enabling early detection, targeted interventions, and improved management of various medical conditions across different specialties.

Alternative fertilizations are essential to minimize the deteriorating effects of chemical fertilizers on soil and water quality/health. Accordingly, the present work investigated the effects of combined organic-inorganic fertilization (COIF) on wheat and rice yields, soil nutrients, and soil Cd accumulation. Hence, seven different treatments were set up: control (CK); conventional fertilization (CF); optimized fertilization (OF); organic fertilizer replacing 25% (T1) and 50% (T2) of OF; and organic nitrogen (N) replacing 25% (M1) and 50% (M2) of OF-N. Overall, significant increases occurred in the yields of COIF crops. Compared with the CF, the highest wheat and rice yields happened in M1 treatment (approximately by18.5%) (P &lt; 0.05). COIF slightly alleviated soil acidification, and improved the cation exchange capacity (CEC) of the study soils. Besides, COIF treatments significantly increased the contents of total phosphorus, total potassium, available phosphorus, and available potassium by 6.35 to 16.9 %, 3.17 to 10.9 %, 5.53 to 28.7 %, and 2.6 to 12 %, respectively (P &lt;0.05). Nevertheless, negligible increases took place in Cd content of COIF soils compared with the CK. Altogether, our results concluded on 25% replacement of OF-N by organic N (M1) to effectively improve the fertility/ecological sustainability of the study soils.

The contribution of readymade garment (RMG) industry is immense behind the rapid development of some countries with emerging economies. This industry is empowering these countries to provide employment opportunities for millions of people. However, the health as well as safety issues of the workers in this industry are often ignored, particularly in these developing countries. In recent times, because of the several undesirable and obnoxious conditions that exist in their working environments, they are vulnerable to various health related problems which are increasing at a staggering rate. The main purpose of this paper is to assess and prioritize the major health related problems faced by these garment workers in these countries where the economy is flourishing. In addition, the main hazards responsible for these health perils are also quantified. Data were collected from three different garment factories situated in different locations of Bangladesh. Thirty workers from each factory rated the frequency and severity of 14 health related issues. The health risks were then assessed and prioritized through risk priority number (RPN). Afterwards, three experts provided their opinion on the main hazards prevalent in the workplace of almost every garment factory in this country. These hazards were grouped into four main classes which are: 1) Physical 2) Ergonomic 3) Chemical and 4) Psychological hazards. The main classes were later divided into sub classes also. Best-worst method (BWM) was then applied to analyze these hazards by assessing their relative weights depending on the experts’ judgement. The results showed that the health issues faced by the workers in three different garment factories varied to some extent. The results obtained from the experts’ opinion indicated that physical hazards in the workplace are the most detrimental ones whereas the chemical hazards were the least harmful.

Background: Healthcare workers are exposed to several hazardous chemicals in the workplace that can result in numerous adverse health effects. Several published studies from many different countries have documented the presence of metabolites from antineoplastic drugs in the urine of healthcare workers and demonstrated contaminated working surfaces with these agents. This study is a literature review that aims to compare the prevalence and degree of exposure to cyclophosphamide (CP), ifosfamide (IFO), and methotrexate (MTX) in physicians, nurses, and pharmacists in the hospital setting. Methods: An extensive search was conducted on PubMed, Google Scholar, HINARI, OARE, and Science Direct where applicable research about healthcare workers and antineoplastic drugs exposure were identified. Medical Subject Headings (MeSH) keywords: occupational exposure, antineoplastic drugs (cytotoxic drugs, cyclophosphamide, ifosfamide, methotrexate), hazardous chemicals, healthcare workers (healthcare professionals, nurses, pharmacists, physicians), hospital setting, and adverse health outcomes were used. Thereafter, relevant articles from 2000 to 2020 were selected to perform this literature review. Results: Review of literature demonstrated that cyclophosphamide was the most prevalent contaminant in the hospital setting. Additionally, pharmacists are among the group of healthcare workers with the highest prevalence of antineoplastic agents in urine samples while nursing stations had the highest rate of surface contamination. Conclusion: There is an urgent need to develop a system to monitor and detect the pathway of environmental exposure to antineoplastic drugs in the healthcare setting, and to evaluate the effectiveness of the existing protective measures. Well designed studies focusing on improving the standard safety precautions is a priority to protect healthcare workers.

Genome-wide association studies (GWAS) have successfully revealed numerous susceptibility loci for obesity. PREDATORR study (2014) shows that in Romania, 34,6% of adults aged 20-79 y/o are overweight, 31,4% are obese with a high risk of cardiometabolic complications, a number that puts almost 67% of Romania's population in the abnormal weight group. Our study aims to investigate the current staus of genetic foundation in metabolic disease associated with obesity, applied to a pilot group of patients specifically examining the impact of known polymorphisms and their haplotype of six food intake-regulating genes: leptin (LEP), leptin receptor (LEP-R), serotonin receptor (5HTR2A), ghrelin (GHRL), neuropeptide Y (NPY) and fat-mass and obesity-associated (FTO) with the following polymorphisms: LEP A-2548G, LEPR A-223G, 5HTR2A G-1439A, GHRL G-72T, NPY T-29063C, FTO A-T and body mass index (BMI). A notable link between the LEP-2548 rs7799039 gene's AG genotype and the risk of obesity was observed, particularly pronounced in males aged 40-49, with an approximately sevenfold increased likelihood of obesity. The 5HTR2A rs6311 AA genotype was associated with a higher BMI, not statistically significant. The FTO rs9939609 gene's AA genotype emerged as a significant predictor of obesity risk. Besides these significant findings, no substantial associations were observed with the LEPR, 5HTR2A, GHRL and NPY genes. Haplotype association analysis showed a suggestive indication of GRGMLA (rs7799039, rs1137101, rs6311, rs696217, rs16139, rs9939609 sequence) haplotype with susceptibility effect towards obesity predisposition. Linkage disequilibrium (LD) analysis showed statistically significant associations between LEP and LEPR gene (p = 1e-04), LEP and GHRL gene (p = 0.0047), GHRL and FTO gene (p=0.03). The outcomes of this study, to our knowledge, one of the very few on the Romanian population, aimed to be a starting point for further research on the targeted interventional strategies to reduce cardiometabolic risks.

Plantation-based farmer cooperatives play an important role in promoting agricultural modernization and increasing farmer income, and the management of business risks of such cooperatives not only influences the development of the cooperatives themselves, but also concerns the interests of farmers. Based on the survey data of 226 sample cooperatives from Guizhou province, this article uses factor analysis to measure business risks of plantation-based farmer cooperatives and carries out empirical tests on influence factors of business risks through structural equation model. According to the research results, the ordering of business risks of plantation-based farmer cooperative based on their significance is as follows: market risk > policy risk > natural risk > technical risk > management risk. Influence factors including policy environment, economic environment, social service environment, technical environment, resource endowment of the cooperative and manager characteristics have significant positive influence on the cooperative, with economic environment and manager characteristics generating relatively stronger influence and social service environment generating relatively weaker influence. Through this research, several policy implications on driving high-quality development of plantation-based farmer cooperative are made, including specifying supportive policies of plantation-based farmer cooperative, improving economic environment of agricultural market, upgrading agricultural infrastructure, depending reform of land transfer system, and enhancing internal management of the cooperative.

Anastomotic Leakage (AL) remains the main cause of post-esophagectomy morbidity and mortality. Early detection can avoid sepsis and reduce morbidity and mortality. This study evaluates the diagnostic accuracy of the NUn-score and its components as early detectors of AL. This single centre observational cohort study included all esophagectomies from 2010-2020. C-reactive Protein (CRP), Albumin (Alb) and White cell count (WCC) were analyzed and Nun-scores calculated. Area under the curves (AUC) were used to assess their predictive accuracy. Seventy-four of the 668 patients (11%) developed an AL. CRP and the NUn-score proved to be good diagnostic accuracy tests on POD2 (CRP AUC:0,859; Nun-score AUC:0,869) and POD4 (CRP AUC:0,924; Nun-score AUC:0,948). A 182mg/L CRP cut-off on POD4 yielded a 87% sensitivity, 88% specificity, a negative predictive value (NPV) of 98% and a positive predictive value (PPV) of 47,7%. A Nun score cut-off&gt;10 resulted in 92% sensitivity, 95% specificity, 99% NPV and 68% PPV. Albumin and WCC have limited value in the detection of post-esophagectomy AL. Elevated CRP and a high NUn score on POD4 provide a high accuracy to predict AL after esophageal cancer surgery. Their high negative predictive value allows to select patients who can safely proceed with enhanced recovery protocols.

Myotonic dystrophy is a hereditary disorder with systemic involvement. The Italian Neuro-Cardiology Network (INCN-RNC) is a unique collaborative experience involving neurology units combined with cardio-arrhythmology units. The INCN facilitates the creation of integrated neuro-cardiac teams in Neuromuscular Disease Centers for the management of cardiovascular involvement in the treatment of MD1.

The study examines the return performance and resilience to market volatility of the recently introduced Environment, Social/Sustainable, and Governance (ESG) weight-tilted Hang Seng Index (HSIESG) compared to its parent, the Hang Seng Index (HSI). The ESG-infused index has a higher mean return and lower return volatility than the parent index, although the differences are statistically and economically insignificant, a result consistent with the high correlation between the two index returns. Most important, the ESG weighted-tilted index is more resilient to volatility spikes than the parent index and therefore has lower downside risks. The overall results show that stocks with high ESG ratings are less susceptible to trading pressures triggered by volatility-induced turnovers. The paper contributes to the literature by providing significant incremental information on the emerging market for ESG-related equity products in Hong Kong.

In contrast to its traditional form, in which large, powerful companies were solely and exclusively responsible for supplies, manufacturing, and distribution, the supply chain has undergone substantial change over the past half-century. Today, nearly all supply chain processes are outsourced, thanks to the efforts of innovative, modern companies. The degree of risk associated with contemporary supply chains is greater than the majority of supply chain managers acknowledge, according to an accumulation of studies, analysts, and news outlets. Vulnerabilities within the supply chain remain a significant challenge for numerous organizations. Inadequate management of these risks—which include, but are not limited to, natural disasters, acts of terrorism, cyber assaults, the credit crisis, pandemic scenarios, and war—could lead to significant declines in profitability, productivity, revenue, competitive advantage, and other metrics. Concerns regarding the risk assessment of the supply chain remain unresolved. The objective of this article is to present a risk evaluation framework that can be effectively implemented in the assessment of supply chain risks. This study makes a fundamental contribution to the body of knowledge by providing supply chain managers with a practical instrument for assessing their processes, irrespective of the mathematical underpinnings or the diverse variables employed in risk assessment. A case study from an automotive EMS production is used to compare the outcomes of multiple aggregation methods; the conclusions are then validated by risk and FMEA specialists from the same factory.

This study addresses the escalating threat of data theft ransomware, a form of cyberattack that exfiltrates sensitive information from victim networks and demands ransom for its non-disclosure. Unlike traditional crypto-ransomware, data theft ransomware leverages various infiltration techniques to gain unauthorized access and control over critical data assets. The study introduces a novel Moving Target Defense (MTD) framework, specifically designed for the Windows operating system environment, to counter these sophisticated attacks. MTD increases the unpredictability of the system by dynamically altering its configurations, thereby disrupting the adversary's ability to execute successful attacks. Our research includes the development and empirical evaluation of the MTD framework, demonstrating its effectiveness in reducing ransomware operational capabilities through quantitative analysis, qualitative observations, and statistical significance testing. We also explore the challenges and complexities involved in implementing MTD in real-world scenarios and propose strategies to overcome these barriers. The study concludes with recommendations for future research directions and the potential of MTD in enhancing cybersecurity defense mechanisms.

The construction industry is notable contributors to atmospheric dust particulate emissions. The particulate matter (PM) produced in construction processes contains a range of chemically hazardous substances, posing significant health risks (HR) to individuals. The occupational health hazards research in construction has become a focal point of interest internationally. Initiated in the early 2000s, there has been a growing demand within the construction research community for the creation of a unified PM database that encapsulates a wide array of construction activities. Previous studies have endeavored to establish a PM database for various construction contexts, yet they have fallen short in thoroughly addressing the diversity of construction materials and the levels of toxic substances (TS) within the PM. This study validates the proof of value that HR associated with construction processes can be measured using PM and TS datasets generated from various work processes using a variety of construction materials. This was accomplished through a semi-automated Building Information Modeling (BIM)-based plugin, which streamlines the assessment of occupational HR in construction projects alongside ongoing work processes. To validate the practicality of the Health Risk Index (HRI) determination via this BIM plugin, a case study on a real renovation project was executed. This system provides construction supervisors with a tool to visually assess the HR of daily operations, thereby facilitating the adoption of preemptive measures to protect the health of construction workers.

In the present work, a study has been carried out on the contamination of heavy metals in urban dust deposited on the roads of the city of Cartagena (Spain), in order to know the content of metals such as Ni, Zn, Pb, Cd, Cr and Cu. Likewise, the possible relationship of the concentration of heavy metals with the color of the sample, level of magnetism and traffic density was studied. Contamination was evaluated using several indices such as contamination factor (CF), enrichment factor (EF), geoacumulation index (Igeo), pollutant load index (PLI) and ecological risk index (RI). A total of 88 samples were taken in the urban area of Cartagena, and the metals were determined by acid digestion and measured by inductively coupled plasma mass spectrometry. The concentration of heavy metals in urban dust from Cartagena was Zn (672 mg/kg) &gt; Cu (248.9 mg/kg) &gt; Pb (227 mg/kg) &gt; Cr (82.7 mg/kg) &gt; Ni (47.7 mg/kg) &gt; Cd (4.1 mg/kg). Contamination levels were high in Pb, Zn, Cd and Cu, according to environmental indices. A correlation was found between magnetism and metal concentration, which was repeated for all metals except Cd. Dark-colored samples contained higher metal concentrations than light-colored samples. Meanwhile, streets with medium and low traffic intensity were found to have higher concentrations of heavy metals. This study's objective was to identify pollution hotspots caused by heavy metals in dust in the urban ecosystem of Cartagena city.

This article combines the traditional definition of portfolio risk with minimum spanning tree based “interconnectedness risk" to improve the equal risk contribution portfolio performance. We use betweenness centrality to measure an asset’s importance in a market graph (network). After filtering the complete correlation network to a minimum spanning tree, we calculate the centrality score and convert it to a centrality heuristic. We develop an adjusted variance-covariance matrix using the centrality heuristic, to bias the model to assign peripheral assets in the minimum spanning tree higher weights. We test this methodology using the constituents of the S&amp;P 100 index. The results show that the centrality equal risk portfolio can improve upon the base equal risk portfolio returns, with a similar level of risk. We observe that during bear markets, the centrality-based portfolio can surpass the base equal risk portfolio risk.

Background: This study, conducted in October 2017 at two Canadian universities, aimed to explore the relationships between gender expression, protective coping strategies, alcohol saliency, and high-risk alcohol use. Methods: Validated scales were employed to assess these variables using survey data. Multivariate analyses were conducted to investigate the associations between these factors and high-risk drinking. Results: The study revealed significant associations between high-risk drinking and androgynous gender roles (OR=1.58, 95% CI: 1.19-2.10) as well as among self-reported males (OR=2.21; 95% CI: 1.77-2.75). Additionally, protective behavioral strategies were inversely related to high-risk drinking (OR=0.95; 95% CI: 0.94-0.96), while higher alcohol saliency exhibited a positive correlation with high-risk drinking (OR=1.12; 95% CI: 1.11-1.14). Conclusions: These findings underscore the importance of considering gender, alcohol saliency beliefs, and protective behavioral strategies in the development and refinement of interventions aimed at reducing high-risk alcohol use on Canadian campuses.

Mosquito-borne diseases (MBDs) are a group of illnesses transmitted by mosquitoes and can be caused by bacteria, viruses, or parasites. These diseases represent a significant global burden of infectious diseases, including morbidity and mortality. This systematic review delves into the multifaceted factors contributing to the spread of mosquito-borne diseases (MBDs) in the Middle East and North Africa (MENA) region. Following PRISMA guidelines, a thorough analysis of peer-reviewed articles from May 1990 to Jan 2023 was conducted, highlighting the interplay of population, environmental, disease, and mosquito factors in disease transmission and prevalence. The review incorporated 31 studies that revealed a complex relationship between various risk factors and the presence of MBDs. Significant associations were observed with age, certain occupations, environmental conditions such as rainfall and temperature, sanitation practices, specific pathogen variants, clinical symptoms, and Aedes aegypti mosquitoes. Conversely, gender, socioeconomic status, educational status, and certain sanitation-related factors showed inconsistent association with the spread of MBDs. The review underscores the need for targeted interventions, including vector control, improved sanitation, and educational campaigns to mitigate the spread of MBDs in the MENA region. This review could guide research studies to address data gaps and assist in developing effective surveillance programs in the MENA region. This work emphasizes the need for region-specific public health strategies and further research to understand and curb the burden of these diseases effectively.

Introduction. This retrospective study aimed to compare the risk factors for vascular calcification (VC) between pre-hemodialysis (HD) and prevalent HD adult patients while investigating associations with calcification biomarkers. Methods. Baseline data from 30 pre-HD and 85 HD patients were analyzed, including iPTH, vitamin D, FGF23, fetuinA, sclerostin, and VC scores (Adragao method). Multivariable linear regression identified VC predictors. Results: The prevalence of VC was similar in both groups, but HD patients had more pronounced VC scores ≥6. Pre-HD patients were older, with higher prevalence of Balkan endemic nephropathy, hypertension, and less frequent use of calcium phosphate binders. Both groups exhibited similar patterns of hyperphosphatemia, low vitamin D, and iPTH levels. In HD group normal phosphate was significantly common in patients with VC, whereas hyperphosphatemia was significantly common in patients without VC. Fetuin-A levels were higher in pre-HD patients, while FGF23 was elevated in HD patients. In pre-HD patients, male gender was associated with reduced VC risk, while in HD patients, malignancies and serum phosphate levels were negative VC predictors. Conclusion: Effective monitoring and tailored treatment of VC in CKD are still focused on phosphate regulation. Besides, mineral disturbances, hormones and biomarkers regulation, and patient-specific variables need to be considered.

This comprehensive review delves into the intricate relationship between Sodium-GlucoseCo-Transporter 2 (SGLT2) inhibitors and AF, highlighting the multifaceted actions of thesedrugs and their significant cardiovascular benefits. Mechanisms: SGLT2 inhibitors inducesubstantial hemodynamic changes, impacting blood pressure, adipose tissue function, andinflammation. They enhance glycemic control while potentially reducing oxidative stress andinflammation, and they modulate atrial electrophysiology, collectively contributing to the reductionof AF risk. Clinical Evidence: This review synthesizes a wealth of clinical evidence,drawing from observational studies and randomized controlled trials, consistently demonstratinga correlation between SGLT2 inhibitors, particularly dapagliflozin and empagliflozin, anda decreased risk of AF. This protective effect is most pronounced in patients with type 2 diabetesand heart failure, underscoring their potential as therapeutic agents for high-risk populations.Potential Benefits: SGLT2 inhibitors offer a spectrum of potential benefits, includingsubstantial reductions in AF risk, particularly in patients with type 2 diabetes and heart failure.These drugs have consistently demonstrated benefits in reducing heart failure hospitalizations,cardiovascular mortality, and stroke risk, which indirectly contribute to better AF management.Furthermore, SGLT2 inhibitors exhibit renoprotective properties by slowing theprogression of chronic kidney disease and reducing albuminuria, offering substantial benefitsfor AF patients with comorbid kidney disease. Metabolic improvements involving weight loss,blood pressure reduction, and favorable changes in lipid profiles contribute to enhanced cardiovascular health and reduced AF risk. Originally designed for diabetes management, thesemedications offer a holistic approach to AF risk reduction, particularly in patients with type 2diabetes and heart failure.

Although corporate social responsibility (CSR) initiatives have gained increased significance within the restaurant industry during the pandemic, there is a lack of understanding of how customers’ perceived risks influence their dining intentions for effective crisis response. This study investigates the relationship between perceived CSR, restaurant image, and dining intentions during the crisis. In addition, the study examines three types of perceived risks (quality, health, and environmental) associated with restaurants and their influence on perceived CSR, restaurant image, and dining intentions during this period. The results demonstrate that perceived CSR positively impacts a restaurant’s image and concurrently reduces perceived risks among consumers during the coronavirus disease 2019 (COVID-19) pandemic. Furthermore, perceived health risks have a negative influence on customers’ dining intentions. This study offers valuable insights into the theoretical foundations and managerial implications of CSR’s effects and risk management, particularly in the context of future pandemics within the restaurant industry.

It is essential to consider the factors that affect early childhood development because doing so can help identify potential risks and window of opportunity for intervention to improve outcomes for children. However, identifying risk and protective factors in early childhood requires careful consideration of several challenges and an integrated approach that recognises the complex and dynamic nature of development. The purpose of this study was to identify and describe the prevalent psychosocial risk and protective factors in the early childhood development phase, using an ecological perspective. The study employed a quantitative cross-sectional study using a random sampling technique. The final sample consisted of 505 caregivers of children aged 5 years old and younger. This study revealed that the most prevalent protective factors include child self-regulation, parent-child warmth, family management and collective efficacy but more importantly social support. While risk factors may exist this is mitigated by social support as it moderates and buffers against the effects of risk factors, as indicated by the various research studies cited.

This study delves into heterosexual identity-behavior discordance, exploring the interaction between sexual identification and behavior in U.K. Analyzing representative 2010 data from the British population (N=12,472), the research categorizes participants into different groups: nonheterosexual, concordant heterosexual, and three discordant heterosexual categories (closeted, experimenters, and desisters). These groups were compared in terms of sociodemographics, attitudes towards sexuality, risk behaviors and health indicators. Discordance was associated with permissive social attitudes, including behaviors such as adultery and one-night stands, and with increased substance abuse and risky sexual behaviors, especially among the closeted. Surprisingly, physical and mental health of discordant heterosexuals was similar to concordant heterosexuals, in contrast to the poorer health of nonheterosexuals. Due to the significant variations in lifestyles and health indicators among different groups, this study highlights the importance of providing targeted services and interventions.

The current global financial sector is dedicated to providing customers with more advanced and strategic services. With channels like internet banking, mobile phone banking, and telephone banking, the industry delivers multi-channel banking services to satisfy its clients. The COVID-19 pandemic has directly impacted the global economy, as well as the financial sector, with the banking sector facing lockdown initiatives to curb the virus's spread. As a result, mobile payment methods have been favored by people over physical money for transactions. This study analyzes the factors that influenced mobile banking usage during the pandemic in Sri Lanka.. Convenience sampling was used, comprising of 200 online questionnaires conducted among customers in Sri Lanka. The collected data was analyzed using descriptive analysis, exploratory factor analysis, and multiple linear regression through IBM SPSS 25. Research findings revealed that trust and risk were significant factors affecting mobile banking usage in Sri Lanka. Trust had a positive effect while Risk negatively effects to the mobile banking usage. Ease of use and Usefulness were irrelevant factors during the COVID-19 pandemic in Sri Lanka.

In Pakistan, bats are one of the dominant mammals that play an important role in the ecosystem in terms of pollination, seed dispersal, and control of pest insects. Bats have also played an im-portant role in the emergence and transmission of zoonotic pathogens; however, most current studies focus on viral pathogens, not potential bacterial pathogens. This study was designed to estimate the prevalence and antibiotic profiling of Staphylococcus (S.) aureus in oral and rectal samples from bats captured in northern Pakistan and to determine the factors associated with in-fection. Two hundred individual bats of five species: Pipistrellus javanicus (n = 17), Pipistrellus pipistrellus (n = 10), Rhinopoma microphyllum (n = 48), Rousettus leschenaultii (n = 124), and Scotophilus kuhlii (n = 1) were captured for non-lethal collection of oral and rectal samples to iso-late S. aureus. Bats were sampled from three sites: a natural cave, a man-made castle, and an an-imal shed, in Khyber Pakhtunkhwa and Punjab provinces. Oral (n = 200) and rectal (n = 200) swabs were collected from each individual bat using sterile cotton swabs specifically for use in bacteriological studies. Each isolate of bacteria was identified by using phenotypic tests and con-firmed as S. aureus based on PCR assay. Out of a cumulative four hundred samples, 80 swabs were positive for S. aureus including 47 rectal and 33 oral swabs. Prevalence of S. aureus infection varied significantly among species, with Rousettus leschenaultii exhibiting the highest prevalence (n = 77; 37.90%). In addition to bat species, prevalence varied significantly among habitats but not between sex, age class, or reproductive status. This study confirmed the occurrence of S. aureus in oral and rectal microbiota of bats in Pakistan. Importantly, S. aureus isolates showed resistance to tetracycline, gentamicin, and erythromycin and carried resistant genes such as TetK, TetM, Erma, and aacA-D. In this regard, efforts should be taken to educate the local communities on how to minimize exposure to an antibiotic-resistant bacterial pathogen through contact with bats while simultaneously increasing the awareness of protecting bats as a vital component of our ecosystem.

Subway construction is often in a complex natural and human-machine operating environment, and that complicated setting leads to subway construction more prone to safety accidents, which can cause substantial casualties and monetary losses. Thus, it is necessary to investigate the safety risks of subway construction. The existing literature on the identification and assessment of subway construction safety risks(SCSR) is susceptible to the influence of subjective factors. Moreover, although existing studies have explored the interrelationships between different risks, these studies usually analyze the interrelationships of single risks, lack the study of risk chain transfer relationships, and fail to find out the key path of risk transfer. Therefore, this paper innovatively combines text mining, association rules and complex networks to deep mine subway construction safety incident reports and explore risk transfer process. Firstly, it uses text mining technology to identify subway construction safety risk; Then, association rules are introduced to explore the causal relationships among safety risk; Finally, the key safety risk and important transfer paths of subway construction safety accidents (SCSA) are obtained based on the complex network model. Research results show that (a) improper safety management, unimplemented safety subject responsibilities, violation of operation rules, non-perfect safety responsibilities system and insufficient safety education and training are the key safety risk in SCSA; (b) two shorter key risk transfer paths in the subway construction safety network can be obtained: insufficient safety education and training→lower safety awareness→violation of operation rules→safety accidents; insufficient safety checks or hidden trouble investigations→violation of operation rules→safety accidents; (c) in the process of risk transfer, the risk can be controlled by controlling the key nodes or cutting off the transfer path. The results of the study provide new ideas and methods for SCSR identification and influence element mining, which help safety managers propose accurate subway construction safety risk control measures.

Hepatitis E virus (HEV) is a zoonotic foodborne virus with an annual infection prevalence of 20 million human cases, which seriously affects public health and economic development in both developed and developing countries. To better understand the epidemiology of HEV in the Centre of Portugal, a cross-sectional study was conducted from 2016 to 2023 with sera samples from wild ungulates. The seroprevalence and risk factors for HEV seropositivity were evaluated in the present study. Specifically, antibodies against HEV were determined by a commercial enzyme-linked immune-sorbent assay (ELISA). Our results show that in the 650 sera collected from 298 wild red deer and 352 wild boars from Portugal, 9.1% red deer (95% confidence interval [CI]: 6.312.9%) and 1.7% wild boar (95% CI: 0.63.3%) were positive for antibodies to HEV. Regarding age, the seropositivity in juvenile wild ungulates was 1.3% (95% CI: 0.273.72%) and 7.2% in adults (95% CI: 4.910.11%). Logistic regression models investigated risk factors for seropositivity. The odds of being seropositive was 3.6 higher in adults than in juveniles (95% CI: 1.7218.11%) and the risk was 4.2 higher in red deer than in wild boar (95% CI: 1.64–10.69%). Both wild ungulate species were exposed to HEV. The higher seroprevalence in red deer suggests that this species may have a major contribution to the ecology of HEV in the Centre of Portugal. Further research is important to understand how wildlife affects the epidemiology of HEV infection in Portugal.

Drinking water, in addition to the best-known chemical and biological agents, contains radionuclides of both natural and artificial origin, which can contribute significantly to the overall effective dose received by the population. The Italian Decree Law 28/2016, implementing 2013/51/EURATOM Directive, establishes the activities for risk management and the parameter values for different radionuclides activity concentrations. In addition to the institutions involved, annually the National Inspectorate for Nuclear Safety and Radiation Protection (ISIN), publishes the monitoring reports of environmental radioactivity in Italy, including radioactivity in drinking water. The purpose of the study was to integrate ISIN reports with 2018 to 2020 data by collecting measurements performed by institutional laboratories to obtain a more complete information and adding, for the Campania region, some data not yet published. This new updated report was not significantly different from ISIN’s one, meaning that those publications are nevertheless extremely representative of the radioactivity in Italian drinking water. However, the study allowed to obtain a more detailed data also including measurements not considered in ISIN reports, for instance, radon-222 activity concentrations. This may be of great usefulness for all radiation protection stakeholders in order to ensure environmental protection, pollution prevention and the population safety.

Rapid proliferation of traditional gold mining sites in Kédougou a Southeast region in Senegal, led to mass population migration from the neighboring West African countries and rapid expansion of small mining villages with poor hygiene and sanitation conditions. An outbreak of hepatitis E was reported in 2014 with several cases of febrile jaundice among traditional mine workers. In this study, we analyzed both HEV IgM and IgG seroprevalence and the associated risk factors of infection by testing any suspected case and contacts collected from February 2012 to November 2014. RNA-negative sera from suspected cases and contacts were tested for anti-HEV IgM and anti-HEV IgG. A total of 799 sera were collected from 290 suspected cases, 470 contacts and 39 individuals with missing information. The median age of the cohort study was 19 years (1-88 years) with a male/female sex-ratio of 1.9. We found an overall prevalence of 43.68% (332/760) of anti-HEV IgM and 38.15% (290/760) of anti-HEV IgG sera. Our data provide new insights into the HEV epidemiology and point to the crucial need to estimate the disease’s burden in Kédougou and assess the viral mechanisms driving the disease’s severity in pregnant women.

Prior research has extensively examined the relationship between religion and accrual-based earnings management. However, there is currently little research in the relationship between religion and real (non-accrual) earnings management, especially in Europe. This paper aims to fill this research gap and examines whether and how the effect of religion could be linked with firms’ real earnings management activities. Four hypotheses are developed and tested with our results providing indications that the degree of overall religiosity is negatively and significantly associated with real earnings management. Furthermore, when investigating the effects of different religions in Europe, Christianity and Islam have the opposite impact on firms’ real earnings management activities. Overall, our paper indicates that in European countries, the religious environment can mitigate firms’ manipulations on earnings.

In this paper, we address the following research question: Is feasibility to use an artificial intelligence system to predict the risk of student failure in a course based solely on their performance in prerequisite courses? Adopting a machine learning-based quantitative approach, we implement Course Prophet, the prototype of a predictive system that maps the input variables representing student performance to the target variable, i.e., the risk of course failure. We evaluate multiple machine learning methods and find that the Gaussian process with Matern kernel outperforms other methods, achieving the highest accuracy and a favorable trade-off between precision and recall. We conduct this research in the context of the students pursuing a Bachelor’s degree in Systems Engineering at the University of Córdoba, Colombia. In this context, we focus on predicting the risk of failing the Numerical Methods course. In conclusion, the main contribution of this research is the development of Course Prophet, providing an efficient and accurate tool for predicting student failure in the Numerical Methods course based on their academic history in prerequisite courses.