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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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.

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 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.

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.

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.

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.

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.

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).

This qualitative research explores Supplier Relationship Management (SRM) practices within the e-commerce fashion industry, aiming to uncover key strategies and their impacts. Through semi-structured interviews with supply chain managers, procurement officers, and supplier representatives, critical themes emerged: communication, trust, risk management, sustainability, and digital technologies. Effective communication, characterized by transparency and regular updates, emerged as pivotal for aligning expectations and resolving issues promptly. Trust-building practices, including fair dealings and formal agreements, were essential in fostering long-term partnerships, reducing transaction costs, and enhancing collaboration. Robust risk management strategies, such as supplier diversification and contingency planning, were identified as crucial for mitigating disruptions and ensuring supply chain resilience. Sustainability was highlighted as a strategic imperative, driven by ethical sourcing and environmental standards, supported by technologies like blockchain for transparency. The transformative role of digital technologies—supply chain management software, blockchain, IoT, and data analytics—was evident in enhancing visibility and decision-making across global supply chains. Viewing suppliers as strategic partners, rather than mere vendors, promoted collaborative innovation and mutual growth. Despite challenges like cultural differences and regulatory complexities, opportunities exist to enhance SRM through integrated best practices. By prioritizing effective communication, trust-building, risk management, sustainability, and digital innovation, companies can strengthen supplier relationships, optimize supply chain performance, and achieve competitive advantage in the e-commerce fashion sector.

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

This qualitative study explores the pivotal role of Supplier Relationship Management (SRM) in enhancing resilience within e-commerce supply chains. In an era marked by rapid digital transformation and global interconnectedness, the resilience of supply chains has become a strategic imperative for organizations striving to maintain operational efficiency and meet customer expectations. Through semi-structured interviews with supply chain managers, procurement officers, and strategic sourcing specialists across diverse industries, this research investigates the strategies, challenges, and outcomes associated with SRM practices. Findings reveal that effective communication and collaboration are fundamental to successful SRM, fostering trust, transparency, and responsiveness in supplier relationships. Strategic risk management through proactive identification and mitigation strategies enables organizations to navigate uncertainties such as economic fluctuations and geopolitical tensions. SRM implementation yields significant organizational benefits, including improved supply chain efficiencies, enhanced product quality, and increased customer satisfaction. However, challenges such as technological complexities, cultural differences among global suppliers, and regulatory compliance issues underscore the need for adaptive strategies and digital investments. The integration of digital technologies such as AI and blockchain enhances SRM effectiveness by enabling real-time data exchange, predictive insights, and decision-making capabilities. Ultimately, SRM emerges as a cornerstone of sustainable growth and competitive advantage in e-commerce, empowering organizations to optimize supply chain performance and resilience amidst dynamic market conditions.

This qualitative study explores the transformative role of Supplier Relationship Management (SRM) in the context of e-commerce, focusing on the integration of digital technologies and evolving supplier interactions. As digital advancements such as artificial intelligence, blockchain, data analytics, cloud computing, and the Internet of Things (IoT) reshape traditional SRM practices, e-commerce companies are experiencing significant improvements in efficiency, transparency, and collaboration. This research employs semi-structured interviews, document analysis, and case studies to examine the impact of these technologies on SRM, identify key collaborative practices, and assess risk management strategies. Findings indicate that digital integration enhances decision-making, streamlines operations, and fosters deeper, trust-based supplier relationships. AI facilitates predictive analytics and automates processes, while blockchain provides transparency and reduces fraud. Data analytics supports informed sourcing decisions and risk mitigation, and cloud platforms improve real-time collaboration. IoT enhances supply chain visibility, allowing for better inventory management. Despite these benefits, challenges such as high implementation costs, integration difficulties, data privacy concerns, and security risks remain significant barriers. Collaboration practices, including joint development, shared resources, and coordinated marketing, contribute to innovation and mutual growth, emphasizing the need for effective communication and trust. Risk management strategies, such as scenario planning and supplier diversification, are crucial for maintaining supply chain resilience. Strategic alignment between e-commerce companies and suppliers, including goal congruence and capability matching, is essential for seamless coordination and competitive advantage. The study underscores the importance of a holistic approach to SRM, integrating technology, collaboration, risk management, and strategic alignment to navigate the complexities of supplier relationships in the digital age. These insights provide a framework for e-commerce companies to optimize their SRM practices and achieve sustainable growth in a dynamic marketplace.

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.

.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

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.

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.

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.