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

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

This research investigates the relationship among human knowledge, behavior, and risk as they relate to urban chicken husbandry in the U.S. Concern over zoonotic diseases has been on the rise, especially with increasing contact. In particular, avian influenza, or bird flu, Salmonella enterica (salmonella), and Escherichia coli (E. coli), can all cross species lines between people and poultry. This study analyzed knowledge and practices in urban chicken husbandry to assess how they relate to risk of disease acquisition, hypothesizing that certain practices associated with a lessened knowledge base may heighten the risk. This study used social surveys to examine the self-reported knowledge base of individuals involved in chicken husbandry as they relate to beliefs and behaviors associated with the care of these animals. These results identify key factors that may heighten the risk of disease transmission, and demonstrate that an increased knowledge base could act to lessen this risk.

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

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

The paper presents the results of the theoretical and practical research on developing the infrastructure for assessment of overall risk (explosion / occupational / terrorist attack) associated with unwanted events such as major accidents that can occur at explosive storehouses for civilian use. The scientific research outlined in this article was carried out within the Nucleu Project PN 16 43 02 15 - “Research on increasing safety levels at technical facilities for storage of explosives for civil use”.

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

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

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

Reducing under-five mortality is a key indicator of a country's overall development, yet in Angola, understanding the factors contributing to hospital deaths in this vulnerable demographic remains incomplete despite improvements in healthcare infrastructure and public health policies. With one of the highest under-five mortality rates in Sub-Saharan Africa, Angola grapples with significant challenges, including malaria, malnutrition, pneumonia, neonatal conditions, and intestinal infectious diseases, as leading causes of death among children. This study aimed to identify factors associated with these hospital deaths in children aged 28 days to five years admitted to DBPH in Luanda between May 2022 and June 2023. Utilizing a hospital-based case-control design, a total of 1020 children were studied, with 340 cases of hospital deaths. Notably, distal and intermediate determinants emerged as primary predictors of hospital mortality, revealing significant associations with maternal education status, maternal alcohol consumption during pregnancy, short hospital stays (≤24h), poor nutritional status, short interbirth intervals, maternal age ≤19 years, and maternal age ≥35 years. These findings underscore the preventable nature of most under-five hospital deaths and emphasize the urgent need to address social inequities and enhance the quality of primary healthcare services to effectively mitigate child mortality.

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

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

Simple summary This reassessment of the findings from our Phase I/II study seeks to evaluate the effectiveness of SBRT for treating local intermediate-high risk prostate cancer in the absence of androgen-deprivation therapy due to patient’s refusal, with a median follow-up of 6.5 years. Our primary focus is on analysing the treated areas compared to recurrence patterns in the seven patients who experienced local relapse. Additionally, we provide updated data on late toxicities of grade 2 or higher, both genitourinary and gastrointestinal. Abstract Objectives: We investigated spatial patterns between primary and recurrent tumor sites and assessed long-term toxicity after dose escalation stereotactic body radiation therapy (SBRT) to the dominant intraprostatic nodule (DIN). Materials and methods: In 33 patients with intermediate-high risk prostate cancer (PCa), doses up to 50 Gy were administered to the DIN. Recurrence sites were determined and compared to the original tumor development sites through multiparametric MRI and 68Ga-labelled prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (68Ga-PSMA-PET/CT) images. Overlap rates, categorized as 75% or higher for full overlap, and 25-74% for partial overlap, were assessed. Long-term toxicity is reported. Results: All patients completed treatment, with only one receiving concomitant androgen deprivation therapy (ADT). Recurrences were diagnosed after a median of 33 months (range: 17-76 months), affecting 13 out of 33 patients (39.4%). Intraprostatic recurrences occurred in 7 patients (21%), with ≥ 75% overlap in two, a partial overlap in another two, and no overlap in the remaining three patient. Notably, 5 patients with intra-prostatic recurrences had synchronous bone and/or lymph node metastases, while six patients had isolated bone or lymph node metastasis without intraprostatic recurrences. Extended follow-up revealed grade 2 or higher late GU and GI toxicity in 18% (n=6) and 6% (n=2) of the patients. Conclusions: Among patients with intermediate-high risk PCa undergoing focal dose-escalated SBRT without ADT, DIN recurrences were infrequent. When present, these recurrences were typically located at the original site or adjacent to the initial tumor. Conversely, relapses beyond the DIN and in extra-prostatic (metastatic) sites were prevalent, underscoring the significance of systemic ADT in managing this patient population. Advances in knowledge: focal dose escalated prostate SBRT prevented recurrences in the dominant nodule, however extra-prostatic recurrence sites were frequent.

The prognostic abilities of artificial intelligence and neuroscience in forensics and the criminal justice system stand as a reformatory paradigm for understanding any criminal conduct. While the use of artificial intelligence has been labeled transformational data analytical capabilities, neural predictive approaches also enable an intricate understanding of culpability and criminal propensities. The literature on the complex nature of neuroprediction and artificial intelligence, its ethical deliberations and its usability in curving recidivism are analyzed. This theoretical review elucidates the complex interplay, nuptial relationships and convergence of these relationships in the quest for justice. The consequences of not protecting individual rights in the criminal justice system are surveyed using grounded theory. The degree of acceptability and dependability of AI-generated evidence in legal proceedings are also reviewed. All these topics are yet to be contemplated under one roof to offer an argumentative view. The author expects to prompt readers and new commers to embrace more sociolegal and technological research before incorporating such research in the Indian Judiciary. The review focuses on the question of whether to blame such technology inclusion wholly or rather to prioritize the acquisition of bias-free pretrained datasets and processing models.

This cross-sectional, analytical, and observational study aimed to investigate the relationship between Visceral Adiposity Index (VAI) and anthropometric, biochemical, and insulin resistance (IR) parameters in Brazilians at risk of CVD. Biochemical parameters and anthropometric measurements were evaluated. The Pearson test was used to assess the correlation between VAI and anthropometric, biochemical, and IR parameters, with a predefined significance level of 5%. The analyzed sample consisted of 88 men and 72 women, with an average age of 58.78±13.48. VAI revealed noteworthy and positive correlations with all anthropometric parameters assessed (p&lt;0.0001). Furthermore, significant positive associations were noted between VAI and total cholesterol in women (p=0.0064), glycemia in men (p=0.0105), and LDL-c (p&lt;0.01) and triglycerides in both genders (p˂0.0001). A significant negative association was observed between VAI and HDL-c in both genders (p&lt;0.0001). Notably, the correlation between VAI and total cholesterol in men, glycemia in women, and CRP in both genders was not found to be significant. However, a significant relationship between VAI and IR parameters was observed in both sexes (p&lt;0.05). The results obtained from our study suggest that VAI functions as a simple and non-intrusive instrument, demonstrating significant effectiveness in identifying metabolic changes primarily associated with adipose tissue dysfunction, particularly dyslipidemia.

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

Background: Obesity is a global health crisis with a rapidly increasing prevalence among university students. Medical students are a unique population that may be at a higher risk of obesity due to the demanding nature of their studies and the associated stress. Objective: This study aimed to determine the prevalence of overweight, obesity, and the associated risk factors among medical students at Jazan University in Saudi Arabia. Methods: A cross-sectional study was conducted among 228 medical students from their 2nd to 6th academic years at the Faculty of Medicine, Jazan University. A self-administered questionnaire was used to collect data regarding sociodemographic characteristics, physical activity, dietary habits, comorbidities, medication use, family history, and lifestyle factors. Anthropometric measurements including height, weight, and waist circumference were recorded. Chi-square test and binary logistic regression were used to identify the risk factors associated with obesity. Results: The prevalence of overweight and obesity among the participants was 13.3% and 15% respectively. Hence, the combined prevalence of overweight and obesity is 28.3%. The mean weight was 63.39 ± 18.93 kilograms, and the mean height was 163.48 ± 9.78 centimeters. On the other hand, 17.3% of participants had underweight whereas 54.4% had normal BMI. Most of the participants (61%) did not engage in regular exercise. A high proportion consumed fruits (82.9%) and vegetables (58.8%) 3 or fewer days per week, and 84.2% consumed 3 or fewer meals per day. Fast food consumption more than 3 days per week was reported by 42.1% of participants. Obesity was not significantly associated with sociodemographic factors, physical activity, dietary habits, comorbidities, medication use, or family histories. However, those with a monthly family income of 15,000-24,999 riyals had significantly lower odds of obesity than those in the lowest income group (OR 0.230, p = 0.045). Conclusion: The prevalence of overweight and obesity among medical students at Jazan University is high. Although no significant associations were found between obesity and most risk factors, this study highlights the need for interventions that promote healthy lifestyles among medical students. Further research is needed to identify effective strategies for preventing and managing obesity in this population.

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

In the rapidly evolving FinTech sector, risk management is paramount for dealers and brokers. This paper underscores the significance and progression of risk management within this realm. Initially, it reviews the traditional risk management technologies and their inherent limitations. The discourse then shifts to contemporary solutions, specifically emphasizing the role of artificial intelligence, machine learning algorithms, and big data analytics in forecasting and mitigating potential risks. The paper also presents case studies of companies effectively utilizing these advanced techniques, highlighting their benefits in real-world scenarios. Additionally, it addresses forthcoming challenges, including regulatory compliance, data privacy issues, and the imperative for strengthened cybersecurity measures. The conclusion acknowledges that the adoption of these innovative technologies not only boosts operational efficiency but also markedly diminishes financial risks, thereby contributing to a more stable and reliable financial market

Floods are a common natural disaster whose severity in terms of duration, water resource volume, peak and accumulated rainfall-based damage are likely to differ significantly for different geographical regions. In this paper, we first propose a novel hourly flood index (SWRI24−hr−S), derived from normalising the existing 24-hourly water resources index (WRI24−hr−S) in literature, to monitor flash flood risks on an hourly scale. The proposed SWRI24−hr−S is adopted to identify a flood situation and derive its characteristics, such as the duration (D), volume (V) and peak (Q). The comprehensive result analysis establishes the practical utility of SWRI24−hr−S in identifying flood situations at seven study sites in Fiji between 2014 and 2018 and deriving their characteristics (i.e., D, V, and Q). Secondly, this study develops a vine copula-probabilistic risk analysis system that models the joint distribution of flood characteristics (i.e., D, V, and Q) to extract their joint exceedance probability for the seven study sites in Fiji, enabling probabilistic flood risk assessment. The vine copula approach, particularly suited to Fiji’s study sites, introduces a novel probabilistic framework for flood risk assessment. The results show moderate differences in the spatial patterns of joint exceedance probability of flood characteristics in different combination scenarios generated by the proposed vine copula approach. In the worst-case scenario, the probability of any flood event occurring where the flood volume, peak and duration are likely to exceed the 95th-quantile value (representing an extreme flood event) is found to be less than 5% for all study sites. The proposed hourly flood index and the vine copula approach can be feasible and cost-effective tools for flood risk monitoring and assessment. The methodologies proposed in this study can be applied to other data-scarce regions where only rainfall data is available, offering crucial information for flood risk monitoring, assessment, and the development of effective mitigation strategies.

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

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

Pregnancy is a complex biological process which is associated with significant metabolic and hemodynamic changes of the maternal body which allow a normal fetal growth. The inability to adapt to these changes can affect the cardiovascular health. During pregnancy, women may experience mood swings, anxiety and emotional ambivalence. These symptoms can lead to stress and have a negative impact on the mental well-being of expectant mothers. It is crucial to know the aspects that can influence the development of cardiovascular problems among pregnant women in order to manage these cases properly. The current narrative review explores and summarizes the evidence regarding the impact of stress and anxiety on cardiovascular health in pregnant women. Understanding the physiological adaptations that the body undergoes throughout pregnancy is crucial for educating and supporting individuals as well as healthcare professionals. This enables them to recognize any risk factors or pathological conditions that may exacerbate pregnant women's health. In order to reduce maternal morbidity and mortality from cardiovascular disease, a psychological and cardiovascular risk factor screening that is done either before or during pregnancy may be able to identify situations that call for particular medical and/or psychological therapies.

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

Floods, recognized for their erratic behavior and devastating effects, are a significant threat as a natural disaster. In Brunei Darussalam, the impact of climate change is becoming increasingly evident through higher temperatures and an expected increase in annual rainfall (5.0mm per year from 2021 to 2050), highlighting the critical need for updated flood risk management techniques. In line with the climate resilience and adaptation objectives of WAWASAN 2035, this paper introduces an innovative approach—a cutting-edge flood risk management framework that utilizes the capabilities of big data analytics, sophisticated machine learning algorithms, and smart Internet of Things (IoT) sensors. Traditional methods, which rely on numerical and physical data modeling, often do not provide precise short-term flood forecasts. Our suggested framework uses machine learning to analyze real-time flood forecasting, sensor data and enhance warning systems, addressing the shortcomings of traditional approaches. The key advantage of this approach is its potential to drastically decrease flood-related damages, protect lives, and boost infrastructure resilience. This proposal is not only in aligns with Brunei's vision for a safe and climate-adaptable future but also marks a significant step forward in adopting innovative and sustainable flood risk management solutions amidst an evolving climate.

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

Risk management for technological hazards mainly focuses on the consequences on human lives. Although technological risk analysis evaluates environmental vulnerability, it does not reflect the consequences on environmentally exposed elements, such as rivers, water springs, flora, and fauna. This paper's objective was to propose a conceptual framework and create a multidisciplinary evaluation model for environmental risk analysis in the oil and gas industry. Initially, the problem was approached from a global perspective to justify the necessity of a holistic environmental risk analysis methodology in the oil industry, using environmental risk factors as well as underlying factors, such as environmental fragility and lack of resilience. The holistic assessment was carried out based on probabilistic risk analysis methodologies to obtain a holistic environmental risk index, HERI. This methodology was applied to an oil and gas industry company in Colombia. This allowed greater disaggregation of the results to establish priorities for risk reduction actions and identify the company's weaknesses.

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

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

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

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

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

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

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

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

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

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

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

Background: Urinary tract infection (UTI) is one of the commonest bacterial infections among reproductive age females. Untreated UTI in reproductive age female is associated with sexual dysfunction, cystitis, pyelonephritis and Pelvic inflammatory disease. At present, the antimicrobial resistance emergency has quadrupled worldwide and poses a serious threat to the treatment of patients. Thus, this study aimed to determine bacterial profile, antibiotic susceptibility pattern and associated risk factors of urinary tract infection among reproductive age females attending the Logbaba District Hospital Methods: A hospital-based cross-sectional study was conducted from January – July, 2023. Convenient sampling was employed to recruit 259 reproductive age females. Sociodemographic and risk factors information were obtained using a well-structured questionnaire. Mid-stream urine was collected and inoculated on cystine lactose electrolyte deficient media. Isolates were identified using API 20. Antibiotic sensitivity testing was performed using modified kirby-bauer susceptibility testing technique. Multivariate logistic regression model was used to assessed risk factors. A p-value < 0.05 was considered as statistically significant. Results: The overall prevalence of UTI among reproductive age females was 82/259 (31.66%). Symptomatic and asymptomatic patients reported a prevalence of 50/121(41.32%) and 32/138 (23.19%), respectively. Ages ranging from 21-30 years (AOR: 2.53 ,95% CI 1.32 – 4.43, p=0.006) and 31 – 40 years (AOR: 0.19 , 95% CI: 0.14- 0.54; p <0.0001), student (AOR: 1.8, 95% CI: 1.21 - 2.75; p = 0.010), history of UTI (5.34, 95% CI = 1.86 - 18.15; p = 0.03), symptomatic (AOR = 2.86, 95% CI1.78 - 4.67, p <0.0001) and secondary education (AOR: 0.13, 95% CI 0.08 - 0.32; p<0.0001) were predictors to UTI. Klebsiella Pneumoniae was the most frequent species 27 (32.9%), follow by E coli 22(26.8%), Staphylococcus aureus 16 (19.5%), CONS 8 (9.8%), Proteus mirabilis 6 (7.3 %) and Pseudomonas aeruginosa 3(3.7%). Majority of the isolates were sensitive to cefotaxime (87.80%), imipenem (85.7%), vancomycin (79.27%), Ofloxacillin (76.83%), Ceftriaxone (75.61%), Ciprofloxacin (74.39%), Gentamicin (71.95%) and Doxycycline (69.51%), and resistant to Amoxicillin (51.22%), cotrimoxazole (47.56%) and Azithromycin (31.71%) , All the isolates were multidrug drug resistant (100%) and Klebsiella Pneumoniae and E coli were the most multidrug drug resistant species Conclusion: In the present study, the prevalence of urinary tract infection among reproductive age females was high and considerably a high proportion of multidrug resistance was observed. This result will have a significant impact on the selection of appropriate antimicrobial agents for the treatment of urinary tract infection in the study area.

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

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

Atrial fibrillation (AF) is a common arrhythmia associated with various risk factors and significant morbidity and mortality. This article presents findings from a study involving 115 patients with permanent AF. The study examined demographics, risk factors, associated pathologies, complications, and anticoagulant therapy. The results showed a slight predominance of AF in males, with the highest incidence in individuals aged 75 and above. Common risk factors included arterial hypertension, dyslipidaemia, diabetes mellitus type 2, and obesity. Comorbidities such as congestive heart failure, mitral valve regurgitation, and pulmonary disorders were prevalent among the patients. Major complications included congestive heart failure, stroke, and myocardial infarction. Thromboembolic and bleeding risk assessment using CHAD2DS2-VASc and HAS-BLED scores demonstrated a high thromboembolic risk in all patients. The majority of patients were receiving novel oral anticoagulants (NOACs) before admission, while NOACs were also the most prescribed antithrombotic therapy at discharge. The study highlights the importance of risk factor management and appropriate anticoagulant therapy in AF patients to reduce complications and improve outcomes.

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

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

Abstract: Interface risks are inherent in every construction project from start to finish. Identifying and managing these risks effectively in every project phase is crucial for actualising project objectives. This paper shows a comprehensive framework showing several relationships between project stakeholders and how the interface risks between them that influence project execution are identified and managed for the overall construction project success. Firstly, literature review on interfaces and interface risks were car-ried out and how organisations managed interface risks were discussed and secondly, the collection of quantitative data was conducted by means of structured online questionnaires. The sample consisted of 205 construction project professionals who were selected randomly. This group included individuals with various roles in the construction industry, The data was analysed using descriptive statistical methods, including factor analysis, reliability assessment, and calculations of frequencies and percentages. Finally, the results showed all the factors, work culture and organisational approaches that influence interface risk management and ways to identify and manage interface risks effectively.

Lifetime cancer risk characterization of ambient PM-bound carcinogenic metals and polycyclic aromatic hydrocarbons (PAHs) were examined in the cities of Los Angeles (USA), Thessaloniki (Greece) and Milan (Italy), which share similar Mediterranean climates but are different in their urban emission sources and governing air quality regulations. The samples in Milan and Thessaloniki were mostly dominated by biomass burning activities whereas the particles collected in Los Angeles were primary impacted by traffic emissions. We analyzed the ambient PM2.5 mass concentration of Cadmium (Cd), Hexavalent Chromium (Cr(VI)), Nickel (Ni), Lead (Pb), as well as 13 PAH compounds in the PM samples, collected during both cold and warm periods at each location. The Pb exhibited the highest annual-average concentration in all 3 cities, followed by Ni, As, Cr(VI), Cd and PAHs, respectively. The cancer risk assessment based on outdoor pollutants was performed based on three different scenarios, with each scenario corresponding to a different level of infiltration of outdoor pollutants into the indoor environment. Thessaloniki exhibited rather high risk value associated with lifetime inhalation of As, Cr(VI) and PAHs. The highest cancer risk values were calculated in Milan where the lifetime risk of exposure to As, Cr(VI) and PAHs exceeded the US EPA standard across all scenarios by a considerable margin. The risk associated with Cr(VI) in Milan, which was the most significant among the investigated elements, ranged from (6.08±0.36)×10-6 to (9.82±0.58) ×10-6. In contrast, the estimated risks associated with metal and PAHs in Los Angeles were mostly comparable to the guideline value, even when the infiltration factor was assumed to be at peak. This observation highlights the impact of local air quality measures in improving the air quality and lowering the cancer risks in Los Angeles compared to the other two cities.

Life is supported by metabolism, a vital physiological activity. It guarantees enough energy available to power every cellular activity. The primary cellular substrate, glucose, is where the majority of the energy needed by the cell to support all other life activities and the growth of living creatures is derived. The quality of life is greatly impacted by any disease or flaw that alters the metabolism of glucose. There is no known cure for the metabolic illness known as diabetes. As diabetes is so varied, the only effective treatments would be based on precision medicine and a molecular strategy. This review covers a wide range of topics, including the ability to recognize the various forms of diabetes, the anthropogenic and genetic influence of the cause of diabetes, the severity of the various forms of diabetes, its potential existential risk, the disease burden, and clinical methods for diagnosing them. The most recent research goes on to recommend ways to ameliorate the disease, including diet-based management, biotherapies, and other individual lifestyle choices. Futuristic therapy using molecular biology approach was suggested. Recent research found a direct correlation between an individual's lifestyle and the rate of gene mutation in diabetes. There is an existential risk associated with the sickness as the rate of the spread of the disease among population globally is faster than the world's population growth rate. It is possible to think of diabetes as a silent pandemic.

For children born with congenital heart defects (CHD), extracorporeal life support may be necessary. This study aimed to investigate the outcomes of children on extracorporeal membrane oxygenation (ECMO), focusing on various risk factors, including the type of CHD. The study was conducted as a retrospective single-center analysis at the Children's Hospital Zurich. All patients with CHD who required ECMO (veno-arterial or veno-venous) between 2009 and 2019 were included. Among the 88 patients, 36 (41%) had a single ventricle heart defect while 52 (59%) had a biventricular heart defect. Out of the total patients, 25 (28%) survived, with 7 (8%) having a single ventricle heart defect and 18 (20%) having a biventricular heart defect. Statistical analysis with a p-value of 0.19 revealed no significant difference in survival rates between the two groups. At the one-year follow-up, all children who survived to discharge were still alive. The rate of complications on ECMO was higher in children with a single ventricle (odds ratio [OR] 1.57, 95% confidence interval [CI] 0.67 - 3.7). The occurrence of a second ECMO run was more frequent in patients with a single ventricle compared to those with a biventricular physiology (22% vs. 9.6%). Although the study did not identify a significant difference in survival rates, it did indicate that patients with a single ventricle faced a higher risk of complications during ECMO and a greater likelihood of requiring a second ECMO run.

Background: The diagnosis of metabolic syndrome (MetS) is a challenge in people with spinal cord injury (SCI). We aimed at identifying clinical risk factors or early markers of MetS in SCI that would facilitate a timely diagnosis and implementation of preventive/therapeutic strategies. Methods: 168 patients with chronic (>1 year) SCI underwent clinical and biochemical evaluations. MetS was diagnosed according to modified criteria of the International Diabetes Federation validated in people with SCI. Results: MetS was diagnosed in 56 of 132 men (42.4%) and 17 of 36 women (47.2%). At univariate regression analyses, putative predictors of MetS were an older age, a higher number of comorbidities, a lower insulin-sensitivity, the presence and intensity of pain, a shorter injury duration, a poorer leisure time physical activity (LTPA) and an incomplete motor injury. At the multiple regression analysis, a significant independent association with MetS only persisted for a poorer LTPA in minutes/week (OR: 0.998, 95%CI: 0.996, 0.999) and more severe pain symptoms as assessed by numeral rating scale (OR: 1.353, 95%CI: 1.085, 1.793). Conclusions: In patients with SCI, intense pain symptoms and poor LTPA may suggest a high likelihood of MetS, regardless of age, SCI duration, motor disability degree, insu-lin-sensitivity and comorbidities.

In a context of exponential demographic growth, the imbalance between human resources and public health problems is impelling us to envision other solutions to the difficulties faced in the diagnosis, prevention and large-scale management of the most common diseases. Cardiovascular diseases represent the leading cause of morbidity and mortality worldwide. A large-scale screening program would make it possible to promptly identify patients with high cardiovascular risk in order to manage them adequately. Optical coherence tomography-angiography (OCT-A), as a window into the state of the cardiovascular system, is a rapid, reliable, and reproducible imaging examination that enables prompt identification of at-risk patients through the use of automated classification models. One challenge that limits the development of computer-aided diagnostic programs is the small number of open-source OCT-A acquisitions available. To facilitate the development of such models, we have assembled a set of images of the retinal microvascular system from 499 patients. It consists of 814 angiocubes as well as 2005 en face images. Angiocubes were captured with a swept-source OCT-A device of patients with varying overall cardiovascular risk. To the best of our knowledge, our dataset, RASTA, is the only publicly available dataset comprising such a variety of images from healthy and at-risk patients. This dataset will enable the development of generalizable models for screening of cardiovascular diseases from OCT-A retinal images.

Different toll collection types of vehicles and different distribution of tollbooths lead to the toll plaza diverging area becoming a typical vehicle weaving area with frequent crossing behaviors and conflicts on highways. This study aims to identify contributing factors to conflict risks of four vehicle-following patterns in a toll plaza diverging area by developing random parameters ordered logit models with heterogeneity in means and variances. The model can flexibly capture the unobserved heterogeneity of the contributing factors in different vehicle-following patterns. Real-world vehicle trajectory data obtained from the toll plaza diverging area in Nanjing, China, are used for model estimation. The results show that vehicle-following patterns with the same toll collection types have higher percentage of severe conflict risks. The average acceleration of the following vehicles, lane marking indicator, the initial lanes and lane-changes of vehicles are significantly associated with the collision risk levels. The standard deviation of surrogate safety measures of all vehicles in sub-segments are found differ significantly between vehicle-following patterns. Furthermore, a series of likelihood ratio tests are adopted to test the spatial dependence in sub-segments of the diverging area. The findings of this study could provide valuable information for safety improvement in toll plazas.

The functions of annexin A1 (ANXA1) that is expressed on membranes and in cytoplasmic granules have been fully described. Nonetheless, the role of this protein in protecting against DNA damage in the nucleus is still emerging and requires further investigation. Here, we investigated the involvement of ANXA1 in DNA damage response in placental cells. Placenta was collected from ANXA1 knockout mice (AnxA1-/-) and pregnant women with gestational diabetes mellitus (GDM). The placental morphology and ANXA1 expression, which are related to the modulation of cellular response markers in the presence of DNA damage, were analyzed. Total area of AnxA1-/- placenta was smaller because of reduced labyrinth zone, enhanced DNA damage, and impaired base excision repair (BER) enzymes, which resulted in the induction of apoptosis in the labyrinthine and junctional layers. The placentas from pregnant women with GDM showed reduced expression of AnxA1 in the villous compartment, increased DNA damage, apoptosis, and reduction of enzymes involved in the BER pathway. Our translational data provide valuable insights into the possible involvement of ANXA1 in the response of placental cells to oxidative DNA damage and represent advancement in investigations on the mechanisms involved in placental biology.

The effects of global warming combined with the progressive expansion of urbanization have considerably increased exposure to urban flooding and runoff widespread erosion risk, also causing shallow landslides and mud flows, respectively in urbanized areas of lowland and hill/foothill environments. Increasing urban flooding resilience has become a priority at virtually all levels of governance. The analysis of a different hazard scenarios, in which various hydro-meteorological conditions and management alternatives are examined, should act as the basis for the effective design and evaluation of interventions to improve urban flooding resilience. Turin Metropolitan Area (TMA), located in north-western Italy, represents a unique case due to its complex orography, with a mountainous sector in the west side and a flat or hilly part in the east side. During the warm season, these environmental conditions make the urban area prone to severe atmospheric convection causing frequent hailstorms and rainstorms of high intensity that may impact on urban infrastructures (i.e., drainage system and road network), thus requiring an adequate management as a key factor to reducing risk and losses. The urban areas of TMA are monitored by polarimetric Doppler weather radars and by a dense rain gauges network. Analyzing several case studies of urban flooding, this research work assesses the feasibility of a meteorological radar early warning system based on the identification of rainfall thresholds that characterize urban flooding, occurring in the lowlands, and the runoff erosion phenomena affecting the urbanized hills and foothills.

This study aimed to investigate the occurrence of the artificial sweetener aspartame (E951) in a wide range of foods and beverages sampled by food control authorities in Germany between 2000 and 2022. The dataset was obtained through the Consumer Information Act. The results showed that aspartame was present in a wide range of product groups tested, most commonly in powdered drink bases (84%) and flavored milk drinks (78%). In the solid food groups, the highest mean aspartame content was found in chewing gum (1543 mg/kg, n=241), followed by sports foods (1453 mg/kg, n=125), fiber supplements (1248 mg/kg, n=11), powdered drink bases (1068 mg/kg, n=162), and candies (437 mg/kg, n=339). Liquid products generally had the highest aspartame content in diet soft drinks (91 mg/l, n=2021), followed by regular soft drinks (59 mg/l, n= 574), flavored milk drinks (48 mg/kg, n=207), and mixed beer drinks (24 mg/l, n=40). These results suggest that aspartame is widely used in foods and beverages in Germany and that certain product groups contain higher concentrations of the sweetener than others. However, the levels of aspartame found were generally within the legal limits set by the European Union. These findings provide the first comprehensive overview of aspartame in the German food market and may be particularly useful in informing the forthcoming working groups of the WHO International Agency for Research on Cancer (IARC) and the WHO/FAO Joint Expert Committee on Food Additives (JECFA), which are in the process of evaluating the human health hazards and risks associated with the consumption of aspartame.

Abstract: Objective: To assess both individual and interactive effects of prenatal medical conditions depression and Diabetes, and health behaviors including smoking during pregnancy on infant birth defects. Methods: The data for this research study were collected by the Pregnancy Risk Assessment Monitoring System (PRAMS) in 2018. Birth certificate records were used in each participating jurisdiction to select a sample representative of all women who delivered a live-born infant. Complex sampling weights were used to analyze the data with a weighted sample size of 4,536,867. Descriptive statistics were performed to explore frequencies of the independent and dependent variables. Bivariate and multivariable analyses were conducted to examine associations among the independent and dependent variables. Results: The results indicate and significant interaction between the variables smoking and Depression and Depression and Diabetes (OR= 3.17; p-value <0.001 and OR= 3.13; p-value <0.001 respectively). Depression during pregnancy was found to be strongly associated with delivering an infant with a birth defect (OR= 1.31, P-value < 0.001). Conclusion: Depression during pregnancy and its interaction with smoking and Diabetes are vital in determining birth defects in infants. The results indicate that birth defects in the United States can be lowering Depression in pregnant women.

The widespread integration and growing dependence among currency, stock and commodity markets make these markets often very vulnerable to shocks and at risk of collapse at the same time. As a result, these trends threaten the sustainability of the entire financial system. In this study, we explore the spillovers and nonlinear dependences between the seven major foreign ex-change rates, crude oil and gold prices, a global stock price index, and oil and stock implied volatility indices as proxy variables for global risk factors by em-ploying directional spillover network approach. We also use multi-scale de-composition method and nonlinear causality test between these variables to capture multi-level relationships at short and long horizons. Major findings are summarized as follows. First, from the multi-scale decomposition analysis, we identify that Granger causality test results and the direction and strength of return spillovers change with the level of decomposition. Second, the results of nonlinear causality tests show variation in both the significance and direction of Granger causality relationships between the decomposed currency and other series at different timescales, especially for the decomposed oil, gold, and OVX series. Third, the measured directional spillover indices identify the EUR as the largest contributor of connectedness to the other series. The central role of the EUR is a net transmitter of connectedness to gold, oil, the GBP, JPY, and CHF.

Outcomes of repeated decision--making processes may be affected by adversarial actors, without being noticed. Adversaries may try to gain knowledge about a particular decision--making process, identify its decision--makers, and guess which underlying decision support model is used. Then they can simulate the process, and craft different scenarios to affect its decision outcomes. Therefore, designers of decision support systems need to incorporate this in the decision modeling phase. The purpose of this study is to demonstrate this for the repeated decision--making in a patent application process. In this process, two sequential decision outcomes can be affected by adversarial actors: a company's decision to which type of patent office to send a patent request to, and the decision of a specialized patent officer to grant an application, or not. It is motivated that the company's decision--maker is \emph{bounded} rational. A theory for information--theoretic bounded rational decision--making under uncertainty proposed by Ortega et al.\ is adopted to model this type of decision--maker. A framework is provided to simulate a number of scenarios that adversaries may deploy to affect decision outcomes of a repeated patent application decision--making process. The framework is also utilized for statistically testing the presence of the scenarios, and to demonstrate how to discourage adversaries from deploying them.

The present study aims to develop a risk-based approach to find optimal solutions for life extension management for offshore wind farms based on Markowitz’s modern portfolio theory, adapted from finance. The developed risk-based approach assumes that the offshore wind turbines (OWT) can be considered as cash-producing tangible assets providing positive return from the initial investment (capital) with a given risk attaining the targeted (expected) return. In this regard, the present study performs a techno-economic life extension analysis within the scope of the multi-objective optimisation problem. The first objective is to maximise the return from the overall wind assets, while the latter aims to minimise the risk associated with obtaining the return. In formulating the multi-dimensional optimisation problem, the life-extension assessment considers the results of a detailed structural integrity analysis, free-cash-flow analysis, and probability of project failure, local and global economic constraints. Further, the risk is identified as the variance from the expected mean of return on investment. The risk-return diagram is utilised to classify the OWTs of different classes using an unsupervised machine learning algorithm. The optimal portfolios for the various required rate of return are recommended for different stages of life extension.

The global coronavirus (COVID-19) pandemic has created a whole new set of risks in construction industries generating unprecedented delays, disruptions, and uncertainty on construction projects, and has forced the industries in adopting more sophisticated technologies while combating the reduced workforce on job sites. Further, the post-pandemic era of construction is expected to be a lot different as the industries will embrace the technology as the augmentation and collaboration strategy. Thus, it will be extremely hard to sustain for construction industries in the absence of effective risk management. The existing risk plans need to be inspected for their capability of handling new risks arising from COVID-19 and the project managers will need to make the necessary revisions as needed. This paper discusses on past (NORM), present (NEW NORM), and future (Post COVID-19 NORM) of the construction industry and highlights key strategies for managing projects and construction risks during and post COVID-19 pandemic.

In the last decade, readily available electronic devices have created unprecedented opportunities for teens to access a wide variety of information and media – both positive and negative – on the internet. Despite the increasing number of initiatives taking place worldwide intended to assess and mitigate the online risks encountered by children and adolescents, there is still a need for a better understanding of how adolescents use the internet and what consequences they may face. We conducted a cross sectional online survey of a convenience sample of 733 8th and 9th grade students in Utah. The survey contained eight questions regarding students’ exposure to three types of online risk scenarios: content risk, contact risk, and commercial risk. Independent variables included students’ online behaviors, use of social media and private messaging apps, and adult supervision of online activities. Logistic and negative binomial regression models indicated that female gender, social media use, and chatting with strangers were associated with exposure to multiple unsafe online scenarios. Our results provide critical information to practitioners involved in the development of educational initiatives by building a profile of potentially risky online behaviors and allow them to tailor their initiatives to meet the needs of more vulnerable populations.

This paper shows the influence of CCP’s collateralization on the pricing of the Credit Default Swaps (CDS). A narrowly variant in the way the CDS seller decides over the resources in the settlement comes with a substantial change on the elements that determine the price of the CDS.

Caesarean scar ectopic pregnancy (CSEP) is an uncommon form of ectopic pregnancy. This review defines types of CSEP, discusses pathophysiology, clinical presentation and diagnosis and compares common treatment options and outcomes. The pathophysiology is not yet fully understood. One third of patient are asymptomatic. In symptomatic patients vaginal bleeding and pelvic pain which is usually misdiagnosed as threatened or missed abortion. The main principles of treatment for CSEP are early diagnose, quick management, and maintain reproductive function as much as possible. Up to date; no consensus or guidelines for the treatment and management of CSEP. Management of CSEP depends on the clinical presentation and gestational age. Significant controversy exists regarding management, for this reason, several factors should be considered including age of the patient, myometrial thickness, clinical symptoms, hemodynamic status, fertility preservation.

Stakeholder input into the decision-making process when developing public health programs and policies is crucial. This article presents an innovative approach, involving online participation with a wide group of stakeholders located in different geographic locations, for policy consensus by research methodology. The results of the project have been used to propose assumptions regarding a strategy for preventing blood-borne diseases in Poland. The research was conducted iteratively using a multi-stage qualitative methodology to explore risk assessment involving blood-borne infections. The final output of the entire project is a list of key problems/challenges and solutions associated with medical and nonmedical services that are connected to the breakage of tissue continuity. Qualitative research is rare in risk assessment as priority is usually given to statistical data and end-points (quantitative studies ). Statistical data on health risk allows to assess the health implications, while the methodology applied also allowed diagnosis of the processes leading to these effects. In addition to policy preparation for blood-borne illnesses, the methodology employed in the study can also be used to successfully explore other areas of public health policy decisions.

Cold brew coffee has emerged as a new trend during the last decade. However, “cold brew” is an extraction style of ground roasted coffee with water at less than body temperature (typically 8°C or room temperature) rather than a beverage per se. Cold brew extraction poses several challenges including the need of specific optimization depending on the multivariate influences of coffee variety and processing, roast degree, grinding, dosage, water composition, turbulence, brew system (drip, immersion etc.), time and temperature. While cold brew is typically characterized by a floral sweetness, over-extraction may lead to abundant acidity and bitterness. To avoid this, an extraction degree of 70% was suggested using rather shorter times (i.e. 2 h at 15°C with 80 g/L coffee with optimized medium roast profiles). Due to the lack of sterilizing temperatures during preparation, cold brew is special in the coffee sector because hygiene and food safety aspects pose specific challenges for food industry. To avoid microbiological contamination and spoilage, cold brew should be as freshly prepared as possible and shelf-life should be minimized.

COVID-19 is an infectious disease spreading through human touch. This study explored the risk perception and knowledge towards COVID-19 infection among Bangladeshi adult participants. Two self-administered online surveys were administered at two different time points from 26-31 March 2020 (Early lockdown) and 11-16 May 2020 (Late lockdown) through social media on 1005 respondents (322 and 683 participants, respectively) during COVID-19 lockdown period in Bangladesh. Univariate and multiple linear regression models were used to examine factors associated with risk perception and knowledge towards COVID-19. The mean knowledge (8.4 vs. 8.1, P=0.022) and risk perception (11.2 vs. 10.6, P < 0.001) scores differ significantly between early and late lockdown. Compared to the early lockdown period, the scores for perceived risk of contracting COVID-19 decreased significantly while public knowledge about COVID-19 was lower but not statistically significant. Female participants who practiced high quarantine particularly those who did so at the public health order during the lockdown reported increased knowledge towards the spread of COVID-19 and perceived high risk of contracting COVID-19. Education intervention using awareness to increase public knowledge and perception towards COVID-19 in Bangladesh should target male participants who practiced low quarantine and are less worried about the spread of such novel coronavirus even as the physical distancing persists.

Draconian defensive measures have been implemented to combat the COVID-19 pandemic outbreak. These important measures constitute a vital current priority but do little to increase communal immunity and avoid future outbreaks. A longer-term exit strategy for a sustainable return to normalcy has yet to be identified. The development of vaccines or effective therapeutics could largely solve the problem, but their timely development cannot be guaranteed. In this setting, and under the expected societal isolation fatigue from extended social distancing, we here propose the idea that at some point after the outbreak’s peak, hospitals, in addition to providing care for infected people who need it, could also be involved in the development of a controlled exit strategy designed to avoid future outbreaks. We postulate that controlled voluntary deliberate infection in a hospital setting and under continuous and close medical observation may offer a safer alternative compared to random en-masse exposure. We discuss potential risks and benefits, highlighting the need for careful consideration of the associated critical ethical issues.

Cardiovascular disease (CVD) is considered to be one of the leading health issues in Thailand. CVD not only contributes to an increase in the number of hospital admissions year on year but also impacts on the rising health care expenditure for the treatment and long-term care of CVD patients. Therefore, this study is aimed at examining the impacts of risk reduction strategies on the number of CVD hospital admissions, Disability-Adjusted Life Years (DALYs) and the costs of hospitalisation. To estimate such impacts a CVD cost-offset model wasapplied using a Microsoft Excel spreadsheet. The number of the mid-year population was classified by age, gender and the CVD risk factor profiles from the recent Thai National Health Examination Survey (NHES) IV. This survey was chosen as the baseline population. The CVD risk factor profiles included age, gender, systolic blood pressure, total cholesterol, and smoking status. The Asia-Pacific Collaborative Cohort Study (APCCS) equation was applied to predict the probability of developing CVD over the next eight-year period. Estimates on the following were obtained from the model: (1.) the CVD events both fatal and non-fatal; (2.) the difference between the projected number of deaths and the actual number of deaths in that population; (3.) the number of patients who are expected to live with CVD; (4.) the DALYs from the estimated number of fatal and non-fatal events; (5.) the cost of hospital admissions. Four CVD risk strategy scenarios were investigated as follows: (1.) the do nothing scenario; (2.) the optimistic scenario; (3.) achieve the UN millennium development goal; and (4.) the worst-case scenario. The findings showed that over the next eight years there are likely to be 3,297,428 recorded cases of CVD; 5,870,049 cases of DALYs; and, approximately ฿57,000 million, ($1.9 billion), is projected as the total cost of hospital admissions. However, if the current health policy can reduce the levels of risk factors as defined in the optimistic scenario or such policy meets the specifications of the UN millennium development goal,there would be a significant reduction in the number of hospital admissions. These are estimated to be a reduction of 522,179 male and 515,416 female cases. With these results it is expected that health care costs would save approximately ฿9,000 million, ($298.3 million), for CVD and 900,000 million of DALYs over the next eight years. However, if there is an upward trend in the risk factors as predicted in the worst-case scenario, then there will be an increase of 428,220 CVD cases; consequently, DALYs cases may rise by 766,029 while the hospitalisation costs may increase by approximately ฿7,000 million, ($232.1 million). Based on our findings, reducing the levels of CVD risk factors in the population will drastically reduce: (1.) the number of CVD cases; (2.) DALYs cases; and (3.) health care costs. Therefore it is recommended that the health policy should enhance the primary prevention programs which would be targeted at reducing the CVD risk factors in the population.

In Taiwan, colorectal cancer is ranked second and third in terms of mortality and cancer incidence, respectively. In addition, medical expenditures related to colorectal cancer are considered to be the third highest. While advances in treatment strategies have provided cancer patients with longer survival, potentially harmful second primary cancers can occur. Therefore, second primary colorectal cancer analysis is an important issue with regard to clinical management. In this study, a novel predictive scheme was developed for predicting the risk factors associated with second colorectal cancer in patients with colorectal cancer by integrating five data mining classification techniques, including support vector machine, random forest, multivariate adaptive regression splines, extreme learning machine, and extreme gradient boosting. In total, 4,287 patients in the datasets provided by three hospital tumor registries were used. Our empirical results revealed that this proposed predictive scheme provided promising classification results and the identification of important risk factors for predicting second colorectal cancer based on accuracy, sensitivity, specificity, and area under the curve metrics. Collectively, our clinical findings suggested that the most important risk factors were the combined stage, age at diagnosis, BMI, surgical margins of the primary site, tumor size, sex, regional lymph nodes positive, grade/differentiation, primary site, and drinking behavior. Accordingly, these risk factors should be monitored for the early detection of second primary tumors in order to improve treatment and intervention strategies.

Abstract: Purpose – In this article we lay out the change management practices adopted by financial firms in small states within the Eurozone. We determine whether these organisations have the ability to identify triggers for change (Red Flags) and subject them to eight thematic elements to understand whether management practices can continue to exist and support operational environments, even when unexpected circumstances affect their day to day operations and processes. In doing this we examine the extent to which the eight thematic elements from the model designed by Dalli Gonzi, (2019) (The Dali Model) can assist organisations in risk identification and business continuity planning. Design/methodology/approach – A self-administered questionnaire purposely designed for this study was administered to personnel working in internal controls within financial institutions of small Eurozone states. The participants were asked to grade statements using a 5-point Likert scale, ‘1’ being ‘totally disagree’ and ‘5’ being totally agree’ to the statement posed under the thematic elements forming the basis of the Dali Model. Findings – Factor analysis provided support for the eight hypothesised dimensions of the decision-making model: connection, capacity, governance, network, policy, training, process improvement, standards. Originality/value – The study provides a better understanding and support of “best practice” in change management through an understanding and assessment of the eight factors that are the basis of this model. It addresses practical recommendations to ensure application to a wider frame of use.

Among the array of structurally and toxicologically diverse mycotoxins, aflatoxins have attracted the most interest of scientific research due to their high toxicity and incidence in foods and feeds. Despite the undeniable progress made in various aspects related to aflatoxins, the ultimate goal consisting of reducing the associated public health risks worldwide is far from being reached due to multiplicity of social, political, economic, geographic, climatic, and development factors. However, a reasonable degree of health protection is attained in industrialized countries owing to their scientific, administrative, and financial capacities allowing them to use high-tech agricultural management systems. Less fortunate situation exists in equatorial and sub-equatorial developing countries mainly practicing traditional agriculture managed by smallholders for subsistence, and where the climate is suitable for mould growth and aflatoxin production. A situation that worsens by the climatic change being increasingly suitable for aflatoxigenic mold growth and toxin production. Accordingly, it is difficult to harmonize the regulatory standards of aflatoxins worldwide, which prevents agri-foods of developing countries from access to the market of industrialized countries. To tackle the multi-facetted aflatoxin problems, actions should be taken collectively by the international community involving scientific research, technological and social development, environment protection, awareness promotion, etc. International cooperation should foster technology transfer and exchange of pertinent technical information. This review presents the main historical discoveries leading to our present knowledge on aflatoxins and the challenges that should be addressed presently and in the future at various levels to ensure higher health protection for everybody. In short, it aims to elucidate where we come from and where we should go in terms of aflatoxin research/development.

Coal combustion in thermal power plants releases ash. Ash is reported to cause different adverse health hazards in humans and other organisms. Owing to the presence of radionuclides, it is also considered as a potential radiation hazard. In this study, based on the surface radiation measurements and relevant ancillary data, expected radiation risk zones were identified with regard to the human population residing near the Thermal Power Plant. With population density as the risk determining criteria, about 20% of the study area was at ‘High’ risk and another 20% of the study area was at ‘Low’ risk zone. The remaining 60% was under medium risk zone. Based on the findings remedial measures which may be adopted have been suggested.

Cryptocurrencies like Bitcoin rely on a proof-of-work system to validate transactions and prevent attacks or double-spending. A new proof-of-work is introduced which seems to be the first number theoretic proof-of-work unrelated to primes: it is based on a new metric associated to the Collatz algorithm whose natural generalization is algorithmically undecidable: the inflation propensity is defined as the cardinality of new maxima in a developing Collatz orbit. It is numerically verified that the distribution of inflation propensity slowly converges to a geometric distribution of parameter $0.714 \approx \frac{(\pi - 1)}{3}$ as the sample size increases. This pseudo-randomness opens the door to a new class of proofs-of-work based on congruential graphs.

Disposable absorbent hygiene products have evolved for superior performance, enhancing the convenience of daily lives. Yet the use of disposable hygiene pads has brought safety concerns on chemical exposure, and significant efforts have been made to assess the potential risks associated with use of hygiene pads. This article intends to overview the safety assessment framework of diapers and feminine pads, which includes hazard identification, hazard characterization, exposure assessment, risk characterization, and postmarket risk management. Risk assessment of various constituents are reviewed for quantification methods and conservative estimation of exposure parameters. By reviewing the up-to-date considerations in risk assessment, we aim to provide insightful discussion on safety evaluation of current versions of disposable absorbent products. More clinical testing and postmarket surveillance are needed for continuous monitoring of potential health impacts of advanced products and constituents.

Excessive vibration of temporary grandstand owing to crowd has lateral rhythmic motions can cause human in panic, which attracted increasing attention in recent years. This paper focuses on experiments that a temporary grandstand occupied 20 participants is oscillated by a shaking table with a series of random waves and induced by crowd with rhythmic swaying motions at lateral direction, respectively. And then a series of vibration perception questionnaires about crowd reaction are obtained. Evaluation of annoying level derives in concept of degree of membership and annoying rate method is proposed, then the human health risk of vibration serviceability of temporary grandstand is assessed with acceleration vibration dose value(VDV). From these results it is clear that standing crowd is more tolerant to vibration than seated crowd. The measured vibrations generated by crowd activities on temporary grandstand can cause panic in crowd. New relationship between the annoyance rate and structural acceleration VDV at logarithmic coordinate is proposed. The findings of this study can be utilized to manage the vibration of temporary grandstand and assess the human health risk.

This study analyses the short-run hydro generation scheduling for the wind power differences from the contracted schedule. The approach for construction of the joint short-run marginal cost curve for the hydro-wind coordinated generation is proposed and applied on the real example. This joint short-run marginal cost (SRMC) curve is important for its participation in the energy markets and for economic feasibility assessment of such coordination. The approach credibly describes the short-run marginal costs which this coordination bears in “real life”. The approach is based on the duality framework of a convex programming and as a novelty combines the shadow price of risk mitigation capability and the water shadow price. The proposed approach is formulated as a stochastic linear program and tested on the case of the Vinodol hydropower system and the wind farm Vrataruša in Croatia. The result of the case study is a family of 24 joint short-run marginal cost curves.

Bonfire night is a worldwide phenomenon given to numerous annual celebrations characterised by bonfires and fireworks. Since Thailand has no national ambient air quality standards for metal particulates, it is important to investigate the impacts of particulate injections on elevations of air pollutants and ecological health impacts resulting from firework displays. In this investigation, Pb and Ba were considered potential firework tracers because their concentrations were significantly higher during the episode and lower than/comparable with minimum detection limits during other periods, indicating that their elevated concentrations were principally due to pyrotechnic displays. Pb/Ca, Pb/Al, Pb/Mg, and Pb/Cu can be used to pin-point emissions from firework displays. Air mass backward trajectories (72 h) from the Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) model indicated that areas east and north-east of the study site were the main sources for the air transportation. Although the combined risk associated with levels of Pb, Cr, Co, Ni, Zn, As, Cd, V, and Mn was far below the standards mentioned in international guidelines, the lifetime cancer risks associated with As and Cr levels exceeded US-EPA guidelines, and may expose inhabitants of surrounding areas of Bangkok to elevated cancer risk.

In areas with strongly seasonal climates, local people often use complex strategies to manage agricultural production shortages, including diverse activities such as hunting, selling and consuming non-agricultural products, and wage labor. We surveyed all the households in a village in northern Laos to evaluate how such livelihood activities varied during years with differing agricultural production conditions. We compared two years with normal rice production conditions (2010, 2012) and one year with a severe rice shortage (2011) due to a rodent outbreak. Earning wages inside and outside the village was the most important activity for mitigating rice shortages, followed by selling livestock and using/selling non-timber forest products. Villagers also borrowed rice from a village rice bank. Most cash income was earned from selling rice. We concluded that a balance of traditional risk management activities under the swidden system (e.g., raising livestock) with the more recent rice bank system and wages from the market economy will be critical for the sustainable development of mountain villages in northern Laos. Permanent crops and monocultures tend to make local livelihoods more dependent on a single crop, but maintaining the traditional swidden system will help local people to manage agricultural production shortages.

Data dealing with the assessment of heavy metal pollution in road dusts in Jeddah, Saudi Arabia and its implication to human health risk of human exposure to heavy metals, are scarce. Road dusts were collected from five different functional areas (traffic areas TA, parking areas PA, residential areas RA, mixed residential commercial areas MCRA and suburban areas SA) in Jeddah and one in rural area (RUA) in Hada Al Sham. We aimed to measure the pollution levels of heavy metals and estimate their health risk of human exposure applying risk assessment models described by USEPA. Using geo-accumulation index (I_geo), the pollution level of heavy metals in urban road dusts was in the following order Cd > As > Pb > Zn > Cu > Ni > Cr > V > Mn > Co > Fe. Urban road dust was found to be moderately to heavily contaminated with As, Pb and Zn, and heavily to extremely contaminated with Cd. Calculation of enrichment factor (EF) revealed that heavy metals in TA had the highest values compared to that of the other functional areas. Cd, As, Pb, Zn and Cu were severely enriched, while Mn, V, Co, Ni and Cr were moderately enriched. Fe was consider as a natural element and consequently excluded. The concentrations of heavy metals in road dusts of functional areas were in the following order: TA > PA > MCRA > SA > RA > RUA. The study revealed that both children and adults in all studied areas having health quotient (HQ) < 1 are at negligible non-carcinogenic risk. The only exception was for children exposed to As in TA. They had an ingestion health quotient (HQ_ing) 1.18 and a health index (HI) 1.19. The most prominent exposure route was ingestion. The cancer risk for children and adults from exposure to Pb, Cd, Co, Ni, and Cr was found to be negligible (< 1 x 10^-6).

Extreme climates such as droughts and hot extremes, may result in marked damage to crop yields and threaten regional and global food security. Maize is a major grain crop in Liaoning Province, severely affected by drought and hot events. The objective of this study is to advance an approach to estimate the risk of crop yield reduction under the compound dry-hot events (CDHE) in Liaoning Province. Results show that the ratio of stations experiencing compound dry-hot events during the twelfth leaf and maturity stage tended to increase on the time scale. On a spatial scale, the frequency of compound dry-hot events in central Liaoning Province was relatively low during the whole and various reproductive periods of maize. In addition to the twelfth leaf, western Liaoning Province is prone to compound dry-hot events. The high-risk area for the occurrence of the compound dry-hot events in maize is Chaoyang City, located in the western part of Liaoning Province, and the cities in the low-risk area account for about 64.3% of the total number of cities in Liaoning Province, mainly in the central and northern parts of Liaoning Province. Generally, this study emphasizes focusing on the impacts of compound dry-hot events on agricultural production and provides an index to assess the risk of compound dry-hot events on maize production.

This qualitative research investigates the impact of price inflation on sustainable supply chains within the renewable energy sector. Through in-depth interviews with stakeholders, it explores how price inflation influences sourcing, production, distribution, and stakeholder relationships. Findings reveal that price inflation poses significant challenges to project economics, supply chain dynamics, and stakeholder relationships, necessitating proactive risk management, innovation, and collaboration. Strategies such as hedging, diversification, and scenario analysis mitigate the impact of price inflation on project viability and financial resilience. Government policies and regulatory frameworks play a crucial role in shaping responses to price inflation, with stable regulatory environments and incentives fostering investment and innovation in renewable energy projects. Innovation emerges as a critical strategy for addressing price inflation challenges, with advancements in technology and digitalization enhancing supply chain efficiency and resilience. Stakeholder collaboration and engagement are essential for mitigating the impact of price inflation, promoting transparency, trust, and cooperation among supply chain partners. By understanding the complexities of price inflation and implementing effective strategies, companies can enhance the resilience and sustainability of renewable energy supply chains, contributing to the transition towards a more sustainable energy future.

Limited knowledge is available about the association between autistic spectrum disorder (ASD) and precocious puberty. Our study examined the association between the two medical conditions, and the effect modification by sex and neuropsychiatric comorbidities in a nationwide population. To compare the risk of precocious puberty between ASD and non-ASD cases, we conducted Cox regression analysis, using ASD as exposure and time-to-precocious puberty as outcome. We adjusted for sex, attention-deficit/hyperactivity disorder (ADHD), tics disorder, obsessive–compulsive disorder (OCD), anxiety disorder, intellectual disability, and epilepsy. We performed a moderation analysis to examine the potential moderating effects by sex or comorbidities. Patients with ASD were prone to have precocious puberty, with an adjusted hazard ratio (aHR) of 1.80 (95% CI: 1.61-2.01). For the effect modification, sex, specifically females, moderated the association between ASD and precocious puberty, with relative excess risk due to interaction (RERI) 7.35 (95% CI 4.90-9.80). No significant effect modification was found for any of the comorbidities within the scope of additive effect modification. We found that patients with ASD were prone to precocious puberty, regardless of sex or comorbid neuropsychiatric disorders. Girls with ASD are at particularly higher risk to develop precocious puberty.

Background This study aimed to identify the prominent risk factors that may trigger danger signals of early onset of vascular deregulation in T1D. The risk factors we have identified may serve as dual-purpose biomarkers of rapid diagnosis that offer prospective tailor-made resolution therapeutics. Methods The healthy control (HC) was compared with individuals diagnosed with T1D for the risk factors of vascular deregulation in published research studies from year 2013 to 2023. The PubMed, Web of Science and Google Scholar databases were searched from 1/1/2013 to 1/9/2023. The risk of bias was assessed with the Cochrane (ROBINS-I ) tool, which is relevant to clinical subjects. A random effect model for continuous data was followed and analysed by RevMan 5.4 and GraphPad Prism software. Results 80 relevant case-control studies having 5293 HC and 7492 T1D patients were included. The age and sex-matched HC consisted of persons free of disease and not under any medication while clinical subjects of all age groups were included. 28 risk factors were grouped into six primary outcome models, all of which favoured the T1D synonymous with a high risk of CVD. Conclusions Our findings have strong implications for improving the quality of life and health economics related to vascular disease in T1D. HbA1c% is the most effective biomarker, followed by FBG, LDL-C, and AI% which the clinicians could evaluate using a simple blood test or non-invasive techniques. (Protocol registered at https://www.crd.york.ac.uk/prospero/ CRD42022384636).

.Bacground: Sepsis remains a major health challenge worldwide, characterized by a dysre-gulated host response to infection, leading to high mortality and morbidity in intensive care units (ICUs). The Fibrosis 4 (FIB-4) index, originally developed to assess liver fibrosis in hepatitis C patients, has recently been explored for its potential prognostic value in sepsis patients. Method: This study retrospectively analyzed 309 sepsis patients admitted to the Internal Me-dicine and Anaesthesia ICUs between December 12, 2021, and December 15, 2023, to inves-tigate the relationship between FIB-4 levels, Acute Physiology and Chronic Health Evaluation (APACHE), and Sequential Organ Failure Assessment (SOFA) and clinical outcomes. Results: The study found that higher FIB-4 measurements were statistically significantly asso-ciated with increased 28-day mortality, with a cut-off value of 4.9 providing a sensitivity of 54.92% and specificity of 74.25%. Logistic regression analysis indicated that elevated Conclusion:FIB-4 levels were a significant predictor of early mortality, suggesting that the FIB-4 index could serve as a valuable prognostic tool in assessing the severity and prognosis of sepsis patients.

Traditional path planning algorithms have drawbacks in unmanned vehicle path planning, such as low efficiency, unsuitability for dynamic environments, and high computational complexity. To address these issues, this paper proposes a dynamic path planning method for unmanned vehicles that combines the A* algorithm with an improved Dynamic Window Approach (DWA). Firstly, a collision risk function is incorporated into the DWA algorithm to evaluate scores based on the braking distance corresponding to the current vehicle speed and the distance to obstacles, determining whether timely braking or obstacle avoidance is feasible. The earlier the braking or obstacle avoidance, the higher the score, thereby enhancing the evaluation algorithm of the DWA. Secondly, the key points extracted by the A* algorithm are used as temporary target points for the DWA algorithm, reducing the eight search directions to five. Finally, the key points of the A* algorithm’s path are set as the temporary end points for the DWA algorithm, integrating the two algorithms to plan a smoother curved path that can avoid unknown and dynamic obstacles. Simulation data demonstrates that compared to traditional artificial potential field methods, RRT, and Dijkstra’s algorithm, the new fusion algorithm reduces time by 11.71 seconds, a decrease of 6.9%, and shortens path length by 3.093 meters, a reduction of 4.16%, while increasing average linear velocity by 2.9%. The proposed algorithm ensures smoother paths while also making paths more rational and efficient

(1) Introduction: The COVID-19 pandemic presented unique challenges for patients and healthcare providers, especially for those working with obesity and related health problems. E-health has emerged as a crucial tool for the follow-up of users undergoing bariatric surgery during this period, allowing remote monitoring of users' health status and providing access to virtual consultation with health professionals. This study aims to analyze the impact of the use of telemedicine during the COVID-19 pandemic on the results of bariatric surgery and user satisfac-tion with this follow-up. (2) Method: Observational study with retrospective data collection. The variables were divided into several groups: health data, associated comorbidities, quality of life, quality of sleep and satisfaction with telemedicine monitoring. (3) Results: Surgery significantly affected weight loss, in general more than 75% loss of excess weight. Comorbidities, like the qual-ity of life, were reversed over time, with 50% of subjects maintaining excellent levels. Although most users were satisfied with the monitoring, the variables had no relationship. (4) Conclusions: The follow-up assured by telemedicine did not alter the results of bariatric surgery, which may allow us to infer that it may be an option to consider for regular monitoring of the post-bariatric surgery process.

Authorities and governmental bodies strongly emphasize the importance of residents preparing for natural disasters, particularly underscoring the significance of readiness for geophysical hazards like earthquakes. In this study, which represents comparative quantitative research, the levels and predictors of the impact on preparedness for earthquake-induced disasters in South-Eastern Europe countries such as Montenegro, North Macedonia, and Serbia are examined. Using the snowball sampling technique (online questionnaire), a survey of 1245 respondents (Montenegro (n = 400), North Macedonia (n = 345), and Serbia (n = 500) was conducted from February 2023 to February 2024. The paper is based on the central hypothesis that the most significant predictor of earthquake preparedness in Montenegro, North Macedonia, and Serbia is age, followed by gender and education. Multivariate regression analysis was used to determine the extent to which five scores of the subscales (household preparedness, community preparedness, disaster preparation, earthquake risk awareness, reinforced house) were associated with seventh demographic and socio-economic variables. In addition to the mentioned analysis, other statistical analyses such as T-test, one-way ANOVA analysis, and Pearson correlation were also utilized. The results indicate that age emerges as a predictor in various aspects of earthquake-induced disaster preparedness and awareness in most models, followed by education. These findings confirm the significance of respondents' age in determining levels of preparedness and earthquake awareness. Overall, in North Macedonia, respondents recorded the highest ratings (M = 3.52) for household preparedness for earthquakes, compared to Montenegro (M = 2.98) and Serbia (M = 3.26), where the lowest ratings were recorded. Research findings, taking into account cultural characteristics, can serve as a basis for the development of targeted interventions, strategies, policies, and programs aimed at improving the level of societal preparedness for earthquake-induced disasters.

Smoking is a pervasive global health concern associated with a myriad of diseases, but its impact on cellular aging, particularly in relation to telomeres, is increasingly recognized. Telomeres, protective caps at the ends of chromosomes, play a crucial role in maintaining genomic integrity. This review critically examines the existing evidence on the association between smoking and telomere atrophy, exploring the molecular mechanisms involved and the implications for accelerated aging and heightened disease risk. The comprehensive analysis encompasses both cross-sectional and longitudinal studies, elucidating potential gender and age disparities. Insights into the molecular pathways linking smoking to telomere shortening are discussed, along with the broader implications for public health. The review concludes by outlining potential interventions and suggesting future research directions in this critical area.

Background: Atypical teratoid/rhabdoid tumor (AT/RT) is an uncommon and aggressive pediatric central nervous system neoplasm. However, a universal clinical consensus or reliable prognostic evaluation system for this malignancy is lacking. Our study aimed to develop a risk model based on comprehensive clinical data to assist in clinical decision-making. Methods: We conducted a retrospective study by examining data from the Surveillance, Epidemiology, and End Results (SEER) repository, spanning 2000 to 2019. The external validation cohort was sourced from the Children's Hospital Affiliated to Chongqing Medical University, China. To discern independent factors affecting overall survival (OS) and cancer-specific survival (CSS), we applied Least Absolute Shrinkage and Selection Operator (LASSO) and Random Forest (RF) regression analyses. Based on these factors, we structured nomogram survival predictions and initiated a dynamic online risk-evaluation system. To contrast survival outcomes among diverse treatments, we used propensity score matching (PSM) methodology. Molecular data with the most common mutations in AT/RT were extracted from the Catalogue of Somatic Mutations in Cancer (COSMIC) database. Results: The annual incidence of AT/RT showed an increasing trend (APC, 2.86%; 95% CI:0.75-5.01). Our prognostic study included 316 SEER database participants and 27 external validation patients. The entire group had a median OS of 18 months (range 11.5 to 24 months) and median CSS of 21 months (range 11.7 to 29.2). Evaluations involving C-statistics, DCA, and ROC analysis underscored the distinctive capabilities of our prediction model. An analysis via PSM highlighted that individuals undergoing triple therapy (integrating surgery, radiotherapy, and chemotherapy) had discernibly enhanced OS and CSS. The most common mutations of AT/RT identified in the COSMIC database were SMARCB1, BRAF, SMARCA4, NF2, and NRAS. Conclusions: In this study, we devised a predictive model that effectively gauges the prognosis of AT/RT and briefly analyzed its genomic features, which might offer a valuable tool to address existing clinical challenges.

Abstract: Wildfires in forest ecosystems exert substantial ecological, economic, and social impacts. The effectiveness of fire management hinges on precise pre‐fire risk assessments to inform mitigation efforts. This study aims to investigate the relationship between predictions from pre‐fire risk assessments and outcomes observed through post‐fire burn severity analyses. In this study, forest fire risk was assessed with the Fuzzy Analytical Hierarchy Process, in which fire behavior factors were used as input. The degree of burn was determined using the Random Forest method using 11519 training points and 400 test points on Sentinel‐2 satellite images in three different classes. According to the results obtained from 266 selected test points located within the forest boundaries, all primary factors showed an increased effect in areas with high burn severity. Climate, in particular, emerged as the most influential factor, accounting for 52% of the overall impact. However, in cases of high fire severity, climate proved to be the most effective risk factor, ac‐counting for 67%. It followed by topography with 50% accuracy at high fire intensity. In the risk assessment is based on the FAHP method, climate was assigned the highest weight value among other factors with 32.2%. Topography emerged as the second most effective risk factor with 27 %. To evaluate the results more comprehensively both visually and statistically, two regions with different stand canopy characteristics were selected within the study area. While high burn severity had the highest accuracy in Case 1 area, moderate burn severity had the highest in Case 2 area. During the days when the fire continued, the direction of spread was obtained from MODIS images. In this way, the fire severity depending on the direction of fire progression was also interpreted. Through an analysis of various case studies and existing literature, the research underscores both the strengths and limitations inherent in predicting forest fire behavior‐based pre‐fire risk assessments. Furthermore, it emphasizes the necessity of continuous improvement to increase the success of forest fire management.

Background: Although lower extremity revascularization is commonly performed in hemodialysis patients, poor prognosis remains a major problem. Protein-energy wasting is reportedly associated with chronic inflammation and advanced atherosclerosis in hemodialysis patients. We investigated the association between the geriatric nutritional risk index (GNRI) as a surrogate marker of protein-energy wasting, C-reactive protein (CRP), and their joint roles in the prediction of amputation and/or mortality. Methods: We enrolled 800 patients successfully underwent lower extremity revascularization. Patients were divided into low, middle and high tertile (T1, T2 and T3) according to GNRI and CRP levels, respectively. Results: Amputation-free survival rates for 8 years were 47.0%, 56.9%, and 69.5% in T1, T2, and T3 of the GNRI, and 65.8%, 58.7%, and 33.2% for T1, T2, and T3 of CRP, respectively (p<0.0001 for both). Declined GNRI [adjusted hazard ratio (aHR) 1.78, 95% confidence interval (CI) 1.24-2.59, p=0.0016 for T1 vs. T3] and elevated CRP (aHR 1.86, 95%CI 1.30-2.70, p=0.0007 for T3 vs. T1) were independent predictors of amputation and/or mortality. In the combined setting of both variables, the risk was 3.77-fold higher (95% CI 1.97-7.69, p<0.0001) in the T1 of GNRI with T3 of CRP than in the T3 of GNRI with T1 of CRP. Conclusions: Patients with pre-procedural decreased GNRI and elevated CRP levels frequently experienced amputation and/or mortality, and a combination of both variables could more accurately stratify the risk.

This study aimed to assess the prevalence and identify risk factors for schistosomiasis among school-aged children in low- and middle-income communities. A retrospective cross-sectional study was conducted, involving the examination of 24 034 children for Schistosoma haematobium ova. Data were analyzed using IBM Statistical Package for the Social Sciences (SPSS) version 27. Logistic regression was employed to determine the factors associated with schistosomiasis. The overall prevalence of schistosomiasis in the study population was 75%, with higher rates observed in rural-dominated areas, particularly Bushbuckridge (73%) and Nkomazi (51%). Age, a history of bilharzia, and the presence of blood in urine were significantly associated with schistosomiasis, while being a female child was found to be a protective factor. This study underscores the importance of implementing robust screening procedures and the necessity for health education to mitigate the high prevalence of schistosomiasis and prevent its further spread.

Over the last decade, highly pathogenic avian influenza (HPAI) has severely affected poultry production systems across the globe. In particular, massive pre-emptive depopulation of all poultry within the certain distance has raised concerns regarding animal welfare and food security. Thus, alternative approaches to reducing unnecessary depopulation, such as risk-based depopulation, are highly demanded. This paper proposes a data-driven method to generate a rule table and risk score for each farm to identify preventive measures against HPAI. To evaluate the proposed method, 105 cases of HPAI occurring in a total of 381 farms in Jeollanam-do from 2014 to 2023 were evaluated. The accuracy of preventive measure identification was assessed for each case using both the conventional culling method and the proposed data-driven method. The evaluation showed that the proposed method achieved an accuracy of 84.19%, significantly surpassing the previous 10.37%. The result was attributed to the proposed method reducing the false-positive rate by 83.61% compared with the conventional method, thereby enhancing the reliability of identification. The proposed method is expected to be utilized in selecting farms for monitoring and management of HPAI.

Objectives: To evaluate the relationship between the type of conization, the volume and dimensions of the cone, with the persistence/recurrence of CIN 2-3, presence of affected margins and post-cone HR-HPV positivity. Methods: 227 women treated with LLETZ and histologically confirmed CIN2-3 were evaluated between 1996 and 2006 and followed up until June 2016. Age, type of resection according to IFCPC 2011, volume, cone dimensions, margins were studied. of resection, post-cone high-risk human papillomavirus (HR-HPV) status and viral load. Determinants of HR-HPV positivity were estimated using unconditional logistic regression and time to recurrence was assessed using Kaplan-Meier curves. Results: Persistent/recurrent CIN2-3 was found in 12 cases (5.2%), type 1 conization was performed in 81 patients, with 5 recurrences (6.1%), type 2 in 101 patients, with 6 recurrences (5 .9%) and type 3 resection in 45 women, with 1 recurrence (2.2%). Volume and dimensions were not associated with recurrence. The Log-Rank Test did not show a significant difference between the 3 treatments (p= 0.18). The free margins in type 1 were 37%, in type 2 resection 61% and in type 3 71% (p=0.001). Resection type 1 had 15% HR-HPV post positive cone, type 2 reached 16% and type 3 had 9%, this difference being non-significant (p=0.58). The incidence of recurrence at 36 months in type 1 resection was 0.08%, in type 2 treatment it was 0.04% and in type 3 resection it was 0.0%. Conclusions : Type 3 resection had a higher proportion of free margins and lower post-cone HR-HPV positivity, with a lower incidence of persistence/recurrence.

Introduction: Desmoid tumor (DT) is a rare benign neoplasm rising from muscle aponeurosis, having been associated mostly with trauma or pregnancy. DT has an infiltrative and locally aggressive growth pattern and usually does not metastasize. However, it has a high recurrence and complication rate. When they occur in pregnancy, are all pregnancies and deliveries taken as individual case for optimal management by the physicians and midwifes, who need to be cautious in finding the optimal delivery mode for patients, which depends on tumor size, location, behavior and past history. Study Objectives: We present a case report of a large desmoid tumor of the anterior abdominal wall in a 29-year-old woman in pregnancy, presenting a delivery problem, which resolved in surgical management. Moreover, we are bringing a systematic review of the literature to provide an overview on pathomechanism, symptoms, diagnostics and treatment management of the pregnant women affected by DT. Results: The authors report a case of pregnant women who underwent systemic oncological treatment for abdominal wall desmoid tumor and have been pregnant afterwards. The observational conservative management was chosen with an elective cesarean section at the 38+4 pregnancy week with uncomplicated postpartum follow-up. Conclusion: Pregnancy-associated desmoid tumors are very rare and optimal management of this tumor is not well established, despite some guidelines for non-pregnant patients. The authors reviewed the literature focusing on the actual modern management of desmoid tumors at all, including patients during the pregnancy, as well.

The increasing prevalence of periprosthetic femoral fractures, specifically in the vicinity of the hip, has emerged as a significant issue in recent times. Consequently, there is a need for a thorough examination to enhance the effectiveness of management and treatment approaches. The findings emphasized a significant disparity in the occurrence and characteristics of these fractures, as multiple studies have highlighted the efficacy of various treatment strategies, such as open reduction and internal fixation, as well as the utilization of cortical strut allografts. Furthermore, the research has identified potential risk factors that have an impact on the characteristics of fractures, providing valuable insights that could be crucial in the development of preventive strategies. This research provides a thorough examination of periprosthetic femoral fractures, highlighting the importance of a cohesive treatment algorithm to improve the handling of such fractures. Moreover, it promotes the need for a collaborative endeavor in conducting research in this field, cultivating a more profound comprehension that has the potential to drive progress in therapeutic approaches, ultimately enhancing patient results over an extended period of time. It is crucial that forthcoming research endeavors persist in expanding upon these discoveries, striving towards a unified methodology in tackling this substantial clinical obstacle.

The water quality index (WQI) and irrigational index for groundwater were studied in the northeastern section of the Manipur Valley in northeast India. Water samples were collected in 2022 during the pre-monsoon season. To compute the water quality index for drinking water, the basic chemical parameters of total hardness, pH, electrical conductivity, total dissolved solids, Ca2+, Na+, Fe, Mg2+, Mn, Cl-, and HCO3, were used. The assessment of bacteriological quality is also done, which is crucial for overall water quality evaluation, alongside physical and chemical analyze. For determining irrigation suitability, irrigational indices such as sodium absorption ratio, sodium percentage, and magnesium hazard were calculated. WQI, %Na+, SAR, magnesium hazard, permeability Index and total hardness indicate that most water samples are harmless for irrigation and drinking purpose. They have affirmative relationships indicating that these characteristics are interdependent. Approximately 25% of the Piedmont zone groundwater is found to be unfit for agricultural and drinking usage. The encrustation of gypsum, halite, and evaporation into the Disang shares accelerate the dissolution of ions in Piedmont water, resulting in quality degradation. According to Gibbs plots, Durov Scatter Plot, and Hill Piper Trilinear Diagram of water dominated the rock-weathering process, while hydro chemical facies progressed from the beginning to the intermediate stage of Chadha's graphical representation illustrates the progression of hydro chemical processes in surface water. Therefore, proper integrated water resource management and development are required for effective water resource utilization, particularly around the Piedmont zone. To prevent a water crisis, groundwater resources must be managed sustainably. The current study also concentrated on a bibliometric examination of groundwater management and access to gauge the state of the field.

There are two purposes for this article. The first purpose is to perform a reiew of previous research on global supply chain management (GSCM) principles that can adapt and survive adversity, such as the COVID-19 pandemic. The second purpose is to put forth a conceptual framework for the GSCM that is sustainable in the event of future turbulence similar to that experienced during the COVID-19 pandemic. With regard to the issues raised, the article posits the following questions. Is there, perhaps, a sustainable post-COVID-19 pandemic GSCM? Can the COVID-19 pandemic-related international logistics system (GSC) turbulences be predicted with certainty using these sustainable post-COVID-19 pandemic GSCM concepts? Putting it all together, the paper concludes that, while debatable, sustainable GSCM is feasible and can be accomplished utilizing JIT, supply chain mitigation, and supply chain visibility, as demonstrated by the manufacturing firms referenced in the article.

Background: This study aimed to estimate the prevalence of sexualized drug use (SDU) in gay, bisexual, and other men who have sex with men living with HIV (HIV+GBMSM) in Madrid during 2019/2020 and compare it with data from 2016/2017. Methods: We analysed the frequency of SDU in a sample of HIV+GBMSM attending HIV clinics, who participated in an anonymous online survey regarding sexual behaviour and recreational drug use. The association between SDU, sexual risk behaviours, and STIs was evaluated. The methodology employed in the present study(U-SEX-2) in 2019/2020 was consistent with that of a previous study(U-SEX-1) in 2016/2017. Results: The study included 424 HIV+GBMSM, with a mean age of 40(10.43) years. Overall, 94% (396) reported being sexually active. Additionally, 33% (140) had been diagnosed with an STI within the previous year. Moreover, 54% (229) had used drugs in the last year, 25% (107) engaged in SDU, and 15% (17) reported engagement in slamsex. After adjusting for confounding factors, SDU was associated with STIs, fisting, unprotected anal intercourse, and having &gt; 24 sexual partners in the last year. According to the DUDIT test scores, 76% (81) probably had problematic drug use (≥6 points), and 5% (8) probable drug dependence (≥25 points). When comparing the U-SEX-1(2016/2017) data with the U-SEX-2(2019/2020) data, no significant differences were found in the proportion of participants practicing SDU or slamsex. Conclusion: The prevalence of SDU among HIV+GBMSM has remained high in recent years and without significant changes. We observed a clear association between SDU, high-risk sexual behaviors, STIs, and the risk of drug related problems.

Background: In March 2020, a COVID-19 outbreak associated with the Falles Festival in Borriana, Spain, led to significant infections. Methods: In June 2022, we conducted a cross-sectional follow-up study of 473 socially engaged adults aged 18 to 64, examining the cumulative experience after SARS-CoV-2 infection and vaccination responses. Data included demographic details, lifestyle habits, medical history, infection records, and vaccinations from a population-based vaccine registry. Blood samples were analyzed for SARS-CoV-2 antibodies and cellular immunity. We employed a doubly robust inverse weighted probability analysis to estimate the booster vaccine dose's impact on long COVID prevalence and symptom count. Results: 28.1% of participants met the WHO criteria for long COVID, with older individuals showing higher rates. Not complying with long COVID criteria associated with factors including O blood group, higher occupational status, physical activity, three vaccine doses, strong SARS-CoV-2-S-reactive IFNγ‐producing‐CD8+ response, and infection during the Omicron period. Conversely, increased age, high or low social activity, underlying health conditions, a severe initial COVID episode, and reinfection associated with higher long COVID likelihood. A booster dose, compared to one or two doses, reduced long COVID risk by 74% (95% CI: 56.4% to 91.7%) and symptom count by 55.2% (95% CI: 31.6% to 78.7%). Conclusion: Long COVID was prevalent in a significant portion of those who contracted COVID-19, underscoring the need for sustained follow-up and therapeutic strategies. Vaccinations, notably the booster dose, had a substantial beneficial effect on long-term infection outcomes, affirming the vaccination’s role in mitigating SARS-CoV-2 infection consequences.

The aim of this paper is to study the main areas in which Artificial Intelligence (AI) will impact the field of project management that relates to cost, risk and scheduling. The research model was based on a previous study of the ten project management knowledge areas presented in the PMI’s PMBOK 6th edition where project schedule-, cost- and risk management knowledge areas were identified as being the ones most likely to be affected by the development of AI. A group of experts that participated in the study agreed that AI will affect the project management profession in the future. Different elements of the three knowledge areas were considered to be affected more by AI than others. The schedule baseline is the element believed to be affected the most out of the project schedule management elements. For project cost management, the estimation of resource cost is believed to be affected the most. In the case of project risk management, the application of AI will have the strongest impact on the probability and impact format.