Absence Of Risk Research Articles

A Comprehensive Overview of Postbiotics with a Special Focus on Discovery Techniques and Clinical Applications.

The increasing interest in postbiotics, a term gaining recognition alongside probiotics and prebiotics, aligns with a growing number of clinical trials demonstrating positive outcomes for specific conditions. Postbiotics present several advantages, including safety, extended shelf life, ease of administration, absence of risk, and patentability, making them more appealing than probiotics alone. This review covers various aspects, starting with an introduction, terminology, classification of postbiotics, and brief mechanisms of action. It emphasizes microbial metabolomics as the initial step in discovering novel postbiotics. Commonly employed techniques such as NMR, GC-MS, and LC-MS are briefly outlined, along with their application principles and limitations in microbial metabolomics. The review also examines existing research where these techniques were used to identify, isolate, and characterize postbiotics derived from different microbial sources. The discovery section concludes by highlighting challenges and future directions to enhance postbiotic discovery. In the second half of the review, we delve deeper into numerous published postbiotic clinical trials to date. We provide brief overviews of system-specific trial applications, their objectives, the postbiotics tested, and their outcomes. The review concludes by highlighting ongoing applications of postbiotics in extended clinical trials, offering a comprehensive overview of the current landscape in this evolving field.

Risk of Relapse After COVID-19 Vaccination Among Patients With Multiple Sclerosis in France: A Self-Controlled Case Series.

People with multiple sclerosis (MS) have an increased risk of severe coronavirus infection due to their level of motor disability or exposure to certain immunosuppressive treatments. Thus, patients with MS have had priority access to coronavirus disease 2019 (COVID-19) vaccination. However, relapses after vaccination have been reported, leading some patients to not seek the recommended booster doses. The main objective was to estimate the risk of severe relapse after 1, 2, and 3 (booster) doses of COVID-19 vaccination in patients with MS. The secondary objectives were to assess the risk of relapse in clinically meaningful subgroups according to the type of vaccine, the characteristics of the patients, and the use of disease-modifying treatments (DMTs). We conducted a nationwide study using data from the French National Health Data System. Patients with MS were identified according to ICD codes, specific treatments, and reimbursement data up to March 31, 2022. Relapses requiring treatment with high-dose corticosteroids were identified. A self-controlled case series method was used to evaluate the risk of relapse associated with COVID-19 vaccines in the 45 days after vaccination. The associated risk was evaluated after 1, 2, or 3 (booster) doses and is expressed as overall incidence rate ratios (IRRs) and in subgroups of interest. Overall, 124,545 patients with MS were identified on January 1, 2021, and 82% received at least 1 dose of a COVID-19 vaccine (n = 102,524) until December 31, 2021, for a total of 259,880 doses. The combined IRR for MS relapse was 0.97 (0.91-1.03, p = 0.30). The same absence of risk was confirmed in various subgroups (age younger than 50 years, duration of MS < 10 years, use of DMT). A small increase in the relapse risk cannot be excluded after a booster dose (IRR 1.39 [1.08-1.80]) for patients with high MS activity, especially when not treated. There is no increased risk of relapse requiring corticosteroid therapy after COVID-19 vaccination for almost all patients. We cannot exclude an increased risk after the booster dose for patients who have had at least 2 relapses in the previous 2 years. This study provides Class III evidence that COVID-19 vaccination does not increase the risk of severe relapse in patients with MS.

Allergens grouping names on packaging: Are the substances similar enough to ensure safety? The worst case scenarios question this.

European Commission Regulation (EU) n°2023/1545 introduced the concept of grouping names in the cosmetics sector in July 2023. These groups bring together allergenic substances with the same level of skin sensitization. Their purpose is to lighten the list of ingredients on cosmetic packaging, by grouping together substances deemed to be similar under the same name. As this classification is based on a single toxic effect - skin sensitization - the present study aims to analyse the relevance of these groupings with regard to other toxic effects of substances in the same group. This study was carried out by consulting an available database, various reports from 5 committees, 2 books and 5 articles in order to complete the toxicological profile of each substance. Then, in order to highlight any discrepancies within the classification, the worst cases were identified. For this purpose, the data for each substance in a group were compared, and in the event of greater criticality for a toxic effect, this was qualified as a worst case. In addition, similar toxic effects between several substances within the same group were also recorded. The aim of this additional research was to validate the definition of the grouping name and the similarities between substances in the same group. From the 17 grouping names, 5 presented worst cases. Two groups had 2 worst cases and the others only one. In total, from the 7 worst cases detected, 3 were due to the toxic effect "skin irritation". In most cases, the substances in the groupings shared the presence or absence of risk. Only the degree of risk criticality varied. Classification by grouping names appears justified regarding the similarities between substances, particularly in terms of skin sensitization. However, the presence of worst cases qualifies it and highlights the importance of being vigilant when assessing the risk of cosmetic products including these grouping names in their list of ingredients.

Health Risk Assessment for Reused Backwash Water from Saveh Water Treatment Plant

Background: The increase in population growth, industries and living standards have caused an increasing need for drinking water in many countries. The reuse of treated water and wastewater is one of the most important options to deal with water shortage. To ensure the correctness of this work, it is necessary that the health risk assessment be reassessed during use so that consumers do not face serious problems. In this regard, the assessment of health risks assessment for the water recovered from the backwashing wastewater of the Saveh water treatment plant was investigated. Methods: To reuse the backwash wastewater from the Saveh water treatment plant, the processes of primary sedimentation and coagulation (in the form of a test jar) were investigated. Metals and heavy metals like iron (Fe), aluminum (Al), lead (Pb), Arsenic (As) and cadmium (Cd) were examined to evaluate health risks. The initial settling time was 1 hour, the coagulant used was FeCl3 made in Iran, and heavy metal contents were also measured with an Inductively coupled plasma (ICP) device. Results: The value of HRIs for Al, Fe, As, Pb and Cd in the treated spent filter backwash water (SFBW) with primary sedimentation and coagulation was less than "1" and indicates the absence of risk. Conclusion: The treated backwash wastewater treated with primary sedimentation and coagulation processes as well as raw water of the Saveh have no harmful effects in terms of heavy metals, and its reuse will not pose a risk to the health of the consumer.

Assessment of the health risks associated with the consumption of bivalve mollusks potentially contaminated with phycotoxins from the coastal ecosystem of the Ebrié lagoon, Côte d'Ivoire.

This work focused on assessing of the risk associated with the consumption of bivalve mollusks, potentially contaminated with phycotoxins. The studied phycotoxins are saxitoxin (STX), okadaic acid (OA), dinophysistoxins (DTXs), yessotoxins (YTXs), pectenotoxins (PTX), azaspiracids (AZAs), and domoic acid (DA). These toxins were investigated in three species of bivalve mollusks (Anadara senilis, Crassostrea gasar, and Perna perna), originating from the Ebrié lagoon. Chemical analyses were carried out by LC-MS/MS, HPLC-FLD, and HPLC-UV. The level of OA and DTXs, STX, and DA was 10.92 µg OA eq./kg, 9.6 µg STX eq./kg, and 0.17 mg DA eq./kg, respectively. The level of PTXs and AZAs was 3.3 µg PTX-2 eq./kg and 13.86 µg AZA-1 eq./kg; that of YTXs was 0.01 mg YTX eq./kg. The daily exposure dose (DED) was 0.019 µg OA eq./kg bw for OA and DTXs; 0.285 µg DA eq./kg bw for DA; 0.006 µg PTX-2 eq./kg bw for PTXs; 0.016 µg STX eq./kg bw for STX; 0.01 µg YTX eq./kg bw for YTXs; and 0.024 µg AZA-1 eq./kg bw for AZAs for the oyster Crassostrea gasar. These estimated values are lower than the acute reference dose (ARfD) of each phycotoxin recommended by the European Food Safety Agency (EFSA). The risk of harmful effects is acceptable. The absence of risk is valid only for the study period (11 months) and concerns coastal populations living near the sampling points.

Local adaptation in trait-mediated trophic cascades.

Predator-induced changes in prey foraging can influence community dynamics by increasing the abundance of basal resources via a trait-mediated trophic cascade. The strength of these cascades may be altered by eco-evolutionary relationships between predators and prey, but the role of basal resources has received limited attention. We hypothesized that trait-mediated trophic cascade strength may be shaped by selection from trophic levels above and below prey. Field and laboratory experiments used snails (Nucella lapillus) from two regions in the Gulf of Maine (GoM) that vary in basal resource availability (e.g. mussels), seawater temperature, and contact history with the invasive green crab, Carcinus maenas. In field and laboratory experiments, Nucella from both regions foraged on mussels in the presence or absence of green crab risk cues. In the field, Nucella from the northern GoM, where mussels are scarce, were less responsive to risk cues and more responsive to seawater temperature than southern Nucella. In the lab, however, northern Nucella foraged and grew more than southern snails in the presence of risk, but foraging and growth were similar in the absence of risk. We suggest that adaptation to basal resource availability may shape geographical variation in the strength of trait-mediated trophic cascades.

Examining uptake of electronic patient reported outcomes (ePRO) in a prospective study of immune-related adverse events (IR-AEs).

368 Background: Use of digital tools in cancer care, including those for collecting patient reported outcomes (PRO), is increasing. While ePRO has been shown to reduce site burden and offer flexibility to patients, examining ePRO uptake is important to inform future implementation and identify disparities. We evaluated factors associated with ePRO use in a prospective study examining predictors of IR-AEs in patients with solid tumors treated with immune checkpoint inhibitors. Methods: We used data from the SWOG Cancer Research Network trial S2013 (NCT04871542). At enrollment, patients completed baseline PROs on paper and were offered the option to complete follow-up PROs at prespecified times on paper or using a mobile ePRO application. Patients enrolled from study activation in August 2021 to June 12, 2023 were analyzed. We examined ePRO uptake overall and by age (&lt;65 v. ≥65 years), sex (male v. female), race (White v. Non-White), Hispanic ethnicity (yes v. no), and performance status (PS; 0 v. ≥1). For patients &lt;65 years, we examined ePRO use by insurance [private/other v. Medicaid/no insurance (M/NI)]. Factors that were statistically significant associated with ePRO use were used to calculate a risk score for non-use of ePRO, with levels of each factor coded as 0 (absence of risk) or 1 (presence). Total risk score was a sum of risk factors. Patients were classified based on the median risk score, and the association of risk level with ePRO use was examined. Two-sided Chi-squared tests at alpha=.05 were used for all comparisons. Results: We examined 1,118 patients with a median age of 69.5 years. 37.6% of patients were female and 90.2% were White. Only 9.3% of patients (N=104) opted to use ePRO. Patients &lt;65 years were more likely to use ePRO (13.9% v. 6.9%; p=.0001) as were patients with PS=0 (13.2% v. 6.5%; p=.0002). ePRO use was higher among patients of White race (9.5% v. 3.8%; p=.09) and non-Hispanic ethnicity (9.8% v. 3.4%; p=.10) but the differences were not statistically significant. For patients &lt;65 years, ePRO use was higher for those with private/other insurance compared to those with M/NI (17.0% v. 5.3%; p=.01). The risk score (range: 0-3) for all patients was based on age, PS, and insurance (private/other/Medicare v. M/NI), with 52% of patients classified as low risk (score = 0 or 1). Patients with a low risk score had higher ePRO uptake than high-risk patients (13.1% v. 5.7%; p&lt;.0001). Conclusions: The option to complete PROs on paper remains important for many patients. Few patients currently choose to use ePRO with uptake rates higher for patients who are younger, have private insurance, and better physical function. Presence of multiple adverse risk factors reduces the likelihood of using ePRO. Access to and familiarity with technology and presence of physical disabilities may be some factors driving these disparities. Future work will examine area-level factors associated with ePRO use.

Efficacy of Olanzapine in Addition to Standard Triplet Antiemetic Therapy for Cisplatin-Based Chemotherapy

It is unknown whether olanzapine combined with triplet antemetic therapy is effective for all patients undergoing highly emetogenic chemotherapy. A secondary analysis of randomized clinical trials using olanzapine may provide insight into the effectiveness of olanzapine for chemotherapy-induced nausea and vomiting (CINV), including cisplatin. To examine the add-on effect of olanzapine according to risk factors for CINV. This preplanned secondary analysis evaluated results of the J-FORCE trial, a large double-blind, placebo-controlled phase 3 randomized clinical trial conducted in Japan from February 9, 2017, to July 18, 2018. Participants were enrolled from 26 participating hospitals across Japan and included patients aged 20 to 75 years who had a malignant tumor and were cisplatin-naive. The efficacy analysis population of the J-FORCE trial was analyzed according to allocation adjustment factors (sex [male or female], age [≥55 years or <55 years], and cisplatin dose [≥70 mg/m2 or <70 mg/m2]) and patient-related risk factors (history of motion sickness, drinking habit [defined as alcoholic drinks consumption in excess of occasional drinking], and history of morning sickness during pregnancy). Statistical analysis was performed from February 18 to April 18, 2020. Patients were randomized 1:1 to receive 5 mg of olanzapine or placebo combined with standard triplet antiemetic therapy. The primary end point was complete response (CR, defined as no vomiting and no use of rescue medication) in the delayed phase (24-120 hours after cisplatin-based chemotherapy administration). Secondary end points were CR, complete control, and total control in the acute, delayed, and overall phases for 6 CINV risk factors as well as time to treatment failure. The CR point estimates and 95% CIs of the differences between groups were calculated, and a Mantel-Haenszel test was performed. Of the 705 patients (mean [SD] age, 63.0 [9.2] years; 471 males [66.8%]) included in the efficacy analysis population; 581 patients (82.4%) were 55 years or older, and 526 (74.6%) were treated with a cisplatin dose of 70 mg/m2 or more. Risk difference (RD) for a CR in the delayed phase was significantly greater in the olanzapine group than the placebo group in males (RD, 12.6% [95% CI, 5.0%-20.1%]; P = .001); in females (RD, 14.5% [95% CI, 2.2%-26.3%]; P = .02); in those 55 years or older (RD, 11.1% [95% CI, 3.9%-18.2%]; P = .003) or younger than 55 years (RD, 23.6% [95% CI, 7.3%-38.3%]; P = .005); for a cisplatin dose of 70 mg/m2 or more (RD, 13.5% [95% CI, 5.9%-21.0%]; P < .001); for those without a history of motion sickness (RD, 13.9% [95% CI, 6.9%-20.6%]; P < .001); for those with a drinking habit (RD, 14.9% [95% CI, 6.1%-23.4%]; P = .001) or without a drinking habit (RD, 12.0% [95% CI, 2.5%-21.3%]; P = .01); and for those with a history of morning sickness during pregnancy (RD, 27.2% [9.7%-42.6%]; P = .002). In other subgroups, a delayed CR was higher in the olanzapine group than the placebo group, although not significantly higher. Results of this study suggest a benefit of using 5 mg of olanzapine plus triplet antiemetic therapy to counter CINV regardless of the presence or absence of risk factors. University Hospital Medical Information Network Clinical Trials Registry Identifier: UMIN000024676.

Beyond fear: Patients with posttraumatic stress disorder fail to engage in safety cues

• We used brain reactivity as a proxy of engagement in safety cues. • Reactivity of supramarginal gyrus was modulated by context and group. • Safety cues attenuated brain reactivity in healthy participants. • Patients with PTSD present an inappropriate engagement in safety cues. For survival, it is crucial to continuously evaluate the presence or absence of risk in the environment. Previously, a safety cue for the observation of aversive pictures attenuated their aversiveness in healthy participants. Here, we investigated whether patients with Posttraumatic Stress Disorder (PTSD) would fail to engage in safety cues using brain reactivity to aversive pictures as a proxy. Patients with PTSD ( n = 20) and control participants ( n = 23) were exposed to neutral and mutilation pictures. Before the presentation of pictures, a text informed that those were fictitious (“safe context”) or real-life scenes (“real context”); appropriate images were also shown to increase the credibility of the text. A voxel-wise approach identified valence-responsive regions for further testing of an interaction pattern. A GROUPxCONTEXTxVALENCE interaction was found in the right supramarginal gyrus spreading anteriorly to the postcentral gyrus - a region involved in the processing of peripersonal space and defensive reactions. Control participants showed, in the real context, increased BOLD response in the right supramarginal gyrus for mutilation pictures compared to neutral ones and, in the safe context, no significant difference between those pictures, indicating an attenuation of brain reactivity. Patients with PTSD presented high brain reactivity in both real and safe contexts. Patients with PTSD were under pharmacological treatment, and the time posttrauma and comorbidities were not assessed. Differently from controls, patients with PTSD did not show attenuation of brain reactivity, reflected by supramarginal response in the safe context. This suggests an inappropriate engagement in safety cues.

Impact of the risk of malnutrition on bleeding, mortality, and ischemic events in patients with acute myocardial infarction

Background & aimsData regarding the relationship between malnutrition and clinical outcomes of acute myocardial infarction (AMI) is limited. The study aims to evaluate the clinical impact of malnutrition in AMI patients after percutaneous coronary intervention (PCI). Methods and resultsThe COREA-AMI registries identified 10,161 AMI patients who underwent PCI from January 2004 to August 2014. Patients with geriatric nutritional risk index (GNRI) scores of <82, 82 to <92, 92 to <98, and ≥98 were categorized as having severe, moderate, mild malnutrition risk, and absence of risk, respectively. Associations of GNRI with Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding, all-cause death, and major cardiovascular events (MACEs; a composite of cardiovascular death, myocardial infarction, or ischemic stroke) were evaluated. Over 50% of AMI patients were malnourished, with 25.0%, 22.7%, and 4.9% having mild, moderate, and severe malnutrition risks, respectively. Over a median 4.9-year follow-up, patients with malnutrition risk had higher risks of BARC 3 or 5 bleeding (adjusted hazard ratios [aHRs], 1.27, 1.55, and 2.02 for mild, moderate, and severe, respectively; p < 0.001), all-cause death (aHRs, 1.26, 1.46, and 1.85 for mild, moderate, and severe, respectively; p < 0.001), and MACEs (aHRs, 1.14, 1.32, and 1.67 for mild, moderate, and severe, respectively; p < 0.001) than patients without risk. ConclusionElevated malnutrition risk was common among AMI patients undergoing PCI and was strongly associated with a higher risk of major bleeding, all-cause death, and major ischemic events.

Risk &amp; return analysis of oil and gas sector of India: A study of BSE indices

The Oil and Gas industry of India is growing rapidly and playing an important role for the development of Indian economy. The sector meets more than two third of the total primary energy needs of the country. The Oil & Gas Sector has been actively involved in putting India on the world map. The oil and gas industry has rebounded strongly throughout 2021, with oil prices reaching their highest levels in six years. While the industry’s recovery is better than expected, uncertainty remains over market dynamics in the coming year. The development of the Indian economy is greatly aided by the stock markets. In comparison to other industries, the Oil and Gas sector accounts for a significant portion of the Indian stock market. This study examines the risk-return relationship between the BSE Sensex and stocks in the oil and gas sector from 01st April 2017 to 31st March 2022. The present study has been conducted by taking return variables i.e. annual mean return, minimum and maximum. The standard deviation, variance and coefficient of variance were used as the measures of risk factors. This study investigates the correlation between risk and return of the BSE Sensex and Oil and Gas Sector stocks of BSE 30 i.e. Indian Oil Corporation, ONGC, Oil India Corporation Limited, Hindustan Petroleum Corporation Limited and Gas Authority of India Limited. The study is based on secondary data and the analysis was done for testing the presence or absence of risk and return of Oil and Gas Sector and for testing hypothesis, different statistical methods like correlation, regression, descriptive statistics and t-test have been employed.

Awareness and perception of accuracy of the Undetectable=Untransmittable message (U=U) in Italy: results from a survey among PLWHA, infectious-diseases physicians and people having unprotected sex

ABSTRACT Evidences on the absence of risk of sexual transmission of HIV by persons living with HIV/AIDS (PLWHA) with undetectable plasma HIV-RNA (HIV-RNA <200 copies/ml) led to the worldwide campaign “U = U” (undetectable = untransmittable). The purpose of this study was to evaluate the perceived accuracy of this message among PLWHA, HIV-negative people having unprotected sex (PHUS) and infectious diseases’ (ID) physicians in Italy. A nationwide survey has been conducted using three different anonymous questionnaires (for ID physicians, PLWHA and PHUS). A total of 1121 participants filled the questionnaires: 397 PLWHA; 90 physicians; 634 PHUS. Awareness of U = U message has been reported in 74%, 92% and 47% of PLWHA, ID physicians and PHUS, respectively. The perception of accuracy of the U = U message among those aware was reported as high in 80.4%, 79.5% and 67.3% of PLWHA, ID physicians and PHUS, respectively. Physicians perceived that 11% of PLWHA have a high rate of perception of U = U, whereas among PLWHA, only 34% reported definitive positive messages from physicians. Discrepancies between awareness and perception of accuracy of the message U = U in PLWHA and physicians have been found, suggesting still low confidence in the community regarding the message itself.

Chronic Cannabis Users: A New Special Population to Consider for Drug Development.

The use and acceptance of cannabis, either medically or recreationally, has substantially outpaced the collection of data necessary to evaluate it's use in any population. However, the mere widespread availability does not imply the absence of risk or confirmation of efficacy and should not be treated as such. There is enough data to suggest that not only does the potential for pharmacokinetic and metabolic interactions exist, but also that baseline characteristics for a given population could be different in chronic cannabis users. Either or both of these may impact the safety and efficacy profile for any new drug in development. As such, we encourage drug developers to consider that the cannabis user may very well be a special population that warrants its own clinical pharmacology evaluation.

A novel conceptual framework investigating the relationship between roadside advertising and road safety: The driver behaviour and roadside advertising conceptual framework

This paper proposes a conceptual framework to understand the relationship between roadside advertising signs, driver behaviour, and road safety outcomes. Roadside advertising signs are external distractions that may take a driver's attention away from safety-critical driving tasks, potentially increasing crash risk through driver distraction and inattention. Although studies report safety concerns, as a whole, the body of research in the field is inconclusive with inconsistent quality, making it difficult to draw firm conclusions. Definitive links between roadside advertising and road trauma are not yet evident, which has major consequences for road regulators' capacity to develop evidence-based policy to safely administer public roads. However, a lack of consistent evidence does not indicate an absence of risk but underscores its complexity. To address this problem, the Driver Behaviour and Roadside Advertising Conceptual Framework (DBRA framework) was developed to strategically investigate and conceptualise the phenomena of roadside advertising. A new term – “extended engagement” – has also been proposed to account for situations of prolonged attentional engagement with a roadside advertising sign. Further, it is posited that important variations in driving performance may be associated with a driver's extended engagement with a roadside advertising sign. Built on extant theories of driver behaviour and empirical research, the DBRA framework is designed to be a robust tool that encourages a common agenda for future roadside advertising research.

Low Donor Site Morbidity Associated With Tricortical Calcaneal Bone Graft.

Autologous grafting is widely used in orthopaedic surgery because of its high osteogenic capacity, immunologic compatibility, for the absence of risk of disease transmission, and for not requiring a bone bank. The posterior-superior calcaneal tuberosity is an option for obtaining a cortical and cancellous structural bone. This study aims to describe the operative technique and complications observed at the donor site of the posterior-superior calcaneal tuberosity. Patients who underwent graft harvesting from the posterior-superior calcaneal tuberosity were retrospectively evaluated by pain outcomes, imaging tests, and intra- and postoperative complications. Twenty patients with a median age of 69 years (range 48-77) and follow-up of 16 months (12-26) were assessed. Median postoperative pain at the donor site was 0 (0-6), with 2 patients reporting persistent local pain. No case of Achilles tendon rupture or intra- or postoperative calcaneal fracture were identified. One patient developed a superficial infection that was quickly resolved using oral antibiotic therapy. The posterior-superior calcaneal tuberosity is an alternative source of autologous graft with low donor site morbidity. Level IV, case series.

Non-invasive respiratory support strategies in COVID-19

Non-invasive respiratory support strategies in COVID-19

Prognostic value of malnutrition using geriatric nutritional risk index in patients with coronary chronic total occlusion after percutaneous coronary intervention

Malnutrition is associated with poor prognosis in a wide range of chronic illnesses, however, the impact of malnutrition on long-term outcomes of patients at advanced stages of atherosclerosis, coronary chronic artery occlusion (CTO), is not known. This study aims to investigate the relationship between malnutrition and adverse cardiovascular events in patients with CTO after percutaneous coronary intervention (PCI). Baseline malnutrition risk was determined in 669 patients with CTO after PCI in this study. All patients were divided into 3 groups according to 3 categories of the geriatric nutritional risk index (GNRI): moderate to severe, GNRI of <92 (n=70); low, GNRI of 92-98 (n=197); and absence of risk, GNRI of ≥98 (n=402). The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiovascular events (MACE). Average age in this study was 65.32±9.97 years old. More than one-third of patients were at risk of malnutrition (moderate to severe: 10.5%; low: 29.4%; and absence of risk: 60.1%). Over a median follow-up of 33 months, compared to those with absent risk for malnutrition, moderate to severe risk was associated with significantly increased risk for the all-cause death, cardiovascular death and MACE (hazard ratio [HR]: 2.90, 95% confidence interval [CI]: 1.43 to 5.87, P for trend=0.002; HR: 3.72, 95% CI: 1.42 to 9.77, P for trend=0.010; HR: 1.76, 95% CI: 1.02 to 3.03, P for trend=0.040; respectively) after adjustment for baseline variables. Moreover, addition of the GNRI score significantly raised the predictive value for the all-cause death (0.383, p=0.004 and 0.022, p=0.011, NRI and IDI respectively), cardiovascular death (0.488, p<0.001 and 0.013, p=0.014, NRI and IDI respectively) and MACE (0.368, p=0.004 and 0.014, p=0.008, NRI and IDI respectively) as compared to traditional factors. Malnutrition assessed by the GNRI score on admission was an independent predictor for adverse cardiovascular events in CTO patients after PCI. Addition of the GNRI score to the existing risk prediction model significantly increased the predictive ability for cardiovascular events in CTO patients after PCI.

Universal social welfare orderings and risk

How to evaluate and compare social prospects when there may be a risk on i) the actual allocation people will receive; ii) the existence of these future people; and iii) their preferences? This paper investigate this question that may arise when considering policies that endogenously affect future people, for instance climate policy. We show that there is no social ordering that meets minimal requirements of fairness, social rationality, and respect for people's ex ante preferences. We explore three ways to avoid this impossibility. First, if we drop the ex ante Pareto requirement, we can obtain fair ex post criteria that take an (arbitrary) expected utility of an equally-distributed equivalent level of well-being. Second, if the social ordering is not an expected utility, we can obtain fair ex ante criteria that assess uncertain individual prospects with a certainty-equivalent measure of well-being. Third, if we accept that interpersonal comparisons rely on VNM utility functions even in absence of risk, we can construct expected utility social orderings that satisfy of some version of Pareto ex ante.

Sex‐specific differences in the response of prey to predation risk

Abstract The non‐consumptive effects of predation risk can strongly affect prey behaviour and fitness with emergent effects on community structure and ecosystem functioning. Prey may respond differently to predation risk based on key traits such as sex, but the influence of sex‐specific variation is typically explored in species with strong sexual dimorphism. However, sex‐specific responses to predation risk may arise even in prey species lacking sexual dimorphisms based on differences in the relative cost of reproduction. Using a rocky intertidal food chain, we conducted a laboratory mesocosm experiment to explore sex‐specific responses of morphologically similar, reproductively mature prey (the snail Nucella lapillus) to predation risk and whether risk affected female fecundity. We found that predation risk suppressed prey growth only in males via effects on growth efficiency, suggesting that sex‐specific disparities may arise due to differences in the energy required for reproduction and/or the costs of mounting a physiological stress response. Moreover, while risk did not affect overall female fecundity, it eliminated the positive relationship between female size and fecundity observed in the absence of risk. We hypothesize that these sex‐specific disparities arise due to differences in the energy required for reproduction and/or the costs of mounting a physiological stress response. Reproduction is likely more energetically costly for females than males, so females may display weaker antipredator responses in order to maintain energetic reserves needed for reproduction. Our results suggest that sex‐specific responses may be an important component of inter‐individual differences in prey responses to risk and influence prey population growth and demography even in species lacking sexual dimorphism. A free Plain Language Summary can be found within the Supporting Information of this article.

Physiological and biochemical responses to acute environmental stress and predation risk in the blue mussel, Mytilus edulis

The effects of climate change and associated increases in temperature on organisms are a major focus of scientific research, but how these impacts play out within ecological contexts is complex and hence often ignored. For example, the influence of predation risk (nonconsumptive effects, NCEs) can alter behavior, creating scenarios where individual physiological responses depend on the interaction between abiotic conditions, such as temperature, and the presence of risk in the environment. Yet a mechanistic understanding of how the interplay among abiotic and biotic stressors, especially NCEs, shapes the short-term physiological performance of intertidal organisms remains limited. From both physiological and biochemical perspectives, we explored the short-term interaction between temperature, feeding history, and predation risk from a predatory snail (Nucella lapillus) on the intertidal mussel (Mytilus edulis). We measured heart rate, key aerobic (citrate synthase) and anaerobic (cytosolic malate dehydrogenase) metabolic enzymes, and total antioxidant capacity to elucidate metabolic strategies utilized by mussels in short-term, multi-stressor events. After 60 min of continuous exposure to increased temperature and predation risk, heart rate and aerobic capacity were primarily impacted by temperature, whereas total cytosolic malate dehydrogenase activity displayed an antagonistic relationship in response to the combined effects of feeding history and predation risk. In contrast, total antioxidant capacity displayed a three-way interaction among all treatments (feeding history, temperature and predation risk), driven by opposing thermal responses between fed and starved mussels in the absence of risk. Our results suggest that although mussels are fairly tolerant of acute stress events, the interaction of feeding history and predation risk may prevent them from launching a coordinated stress response when thermal stress is high.