Hazard Analysis Research Articles

Clinical Significance of Prior Ramucirumab Use on the Effectiveness of Nivolumab as the Third-Line Regimen in Gastric Cancer: A Multicenter Retrospective Study.

Because vascular endothelial growth factor inhibition has been suggested to improve immune cell function in the cancer microenvironment, we examined whether using ramucirumab (RAM) before nivolumab usage is more effective in advanced gastric cancer. This was a multicenter retrospective observational study. We analyzed patients who received nivolumab monotherapy as the third-line regimen for unresectable advanced or recurrent gastric cancer between October 2017 and December 2022. They were divided into the RAM (RAM-treated) group and the non-RAM (non-treated) group according to the RAM usage in the second-line regimen. The primary outcome was to compare the overall survival after nivolumab administration in the third-line regimen between the RAM and non-RAM groups. Fifty-two patients were included in the present study: 42 patients in the RAM group and ten patients in the non-RAM group. The median overall survival was significantly longer in the RAM group than in the non-RAM group (8.5months vs 6.9months, p<0.05). In the RAM group, patients without peritoneal metastasis had significantly better median overall survival than those with peritoneal metastasis (23.8months vs 7.7months, p=0.0033). Multivariate Cox-proportional hazards analyses showed that the presence of peritoneal metastasis (hazard ratio, 2.4; 95% confidence interval 1.0-5.7) alone was significantly associated with overall survival in the RAM group. The use of RAM prior to nivolumab monotherapy may contribute to prolonged survival in patients with gastric cancer, especially those without peritoneal metastasis.

Frailty and its association with readmissions in patients with rheumatoid arthritis: A national readmissions database study.

It remains unknown whether frailty status confers an increased risk of readmission in patients with rheumatoid arthritis (RA). From the 2018 Nationwide Readmissions Database (NRD), we identified adult patients (age ≥ 18years) admitted with a diagnosis of RA between January to June 2018. Utilizing validated Hospital Frailty Score, patients' frailty risk score was calculated at the time of index admission and categorized into frail (score ≥ 5) and non-frail (score < 5) groups. Our primary outcomes of interest were (1) 180- day readmission rate (2) inpatient mortality; secondary outcomes included prolonged length of stay, LOS (LOS ≥ 7days), and costs of hospitalization. Multivariable Cox proportional hazard analysis was performed to evaluate the independent effect of frailty adjusting for confounding variables. 133,187 patients met inclusion criteria, with mean age 67.7years, of whom 64,131 (48.1%) patients were categorized as frail. The rate of readmission was significantly higher in the frail (56.60%) compared to the non-frail group (30.61%). At index hospitalization, frail patients also had significantly higher inpatient mortality compared to non-frail patients (3.36% vs 0.39%, p < 0.005), longer LOS (26.24% vs 7.82%, p < 0.005). On multivariate analysis frailty was independently associated with a 9% increased risk of readmission (adjusted hazard ratio, 1.09; 95% confidence interval, 1.08 - 1.11). People with RA who are frail have higher rates of readmission than those who are not frail. These findings are crucial in identifying at-risk patients with RA and in discharge planning after hospitalization. Key Points • People with RA who are frail have higher rates of readmission than those who are not frail. • Frail RA patients are also at higher risk of hospitalization-related adverse outcomes, including inpatient mortality and longer hospital stay. • Sepsis is the most common cause for readmission identified in frail patients with RA. • These findings suggest that frailty may be a useful metric in identifying patients with RA at an increased risk of adverse health outcomes.

Landslide Hazard Prediction Based on UAV Remote Sensing and Discrete Element Model Simulation—Case from the Zhuangguoyu Landslide in Northern China

Rainfall-triggered landslides generally pose a high risk due to their sudden initiation, massive impact force, and energy. It is, therefore, necessary to perform accurate and timely hazard prediction for these landslides. Most studies have focused on the hazard assessment and verification of landslides that have occurred, which were essentially back-analyses rather than predictions. To overcome this drawback, a framework aimed at forecasting landslide hazards by combining UAV remote sensing and numerical simulation was proposed in this study. A slow-moving landslide identified by SBAS-InSAR in Tianjin city of northern China was taken as a case study to clarify its application. A UAV with laser scanning techniques was utilized to obtain high-resolution topography data. Then, extreme rainfall with a given return period was determined based on the Gumbel distribution. The Particle Flow Code (PFC), a discrete element model, was also applied to simulate the runout process after slope failure under rainfall and earthquake scenarios. The results showed that the extreme rainfall for three continuous days in the study area was 151.5 mm (P = 5%), 184.6 mm (P = 2%), and 209.3 mm (P = 1%), respectively. Both extreme rainfall and earthquake scenarios could induce slope failure, and the failure probabilities revealed by a seepage–mechanic interaction simulation in Geostudio reached 82.9% (earthquake scenario) and 92.5% (extreme rainfall). The landslide hazard under a given scenario was assessed by kinetic indicators during the PFC simulation. The landslide runout analysis indicated that the landslide had a velocity of max 23.4 m/s under rainfall scenarios, whereas this reached 19.8 m/s under earthquake scenarios. In addition, a comparison regarding particle displacement also showed that the landslide hazard under rainfall scenarios was worse than that under earthquake scenarios. The modeling strategy incorporated spatial and temporal probabilities and runout hazard analyses, even though landslide hazard mapping was not actually achieved. The present framework can predict the areas threatened by landslides under specific scenarios, and holds substantial scientific reference value for effective landslide prevention and control strategies.

Rate and predictors of loss to follow-up in HIV care in a low-resource setting: analyzing critical risk periods

BackgroundPatient loss-to-follow-up (LTFU) in HIV care is a major challenge, especially in low-resource settings. Although the literature has focused on the total rate at which patients disengage from care, it has not sufficiently examined the specific risk periods during which patients are most likely to disengage from care. By addressing this gap, researchers and healthcare providers can develop more targeted interventions to improve patient engagement in HIV care.MethodsWe conducted a retrospective cohort study on newly enrolled adult HIV patients at seven randomly selected high-volume health facilities in Ethiopia from May 2022 to April 2024. Data analysis was performed using SPSS version 26, with a focus on the incidence rate of LTFU during the critical risk periods. Cumulative hazard analysis was used to compare event distributions, whereas a Poisson regression model was used to identify factors predicting LTFU, with statistical significance set at p < 0.05.ResultsThe analysis included 737 individuals newly enrolled in HIV care; 165 participants (22.4%, 95% CI: 19.5–25.2) were LTFU by the end of two years, of which 50.1% occurred within the first 6 months, 29.7% within 7–12 months, and 19.4% from 13 to 24 months on ART. The overall incidence rate of LTFU was 18.3 per 1,000 PMO (95% CI: 15.9–20.6), with rates of 167.7 in the first 6 months, 55.4 in 7–12 months, and 18.1 in 13–24 months. Incomplete addresses lacking a phone number or location information (IRR: 1.61; 95% CI: 1.14, 2.27) and poor adherence (IRR: 1.78; 95% CI: 1.28, 2.48) were factors predicting the incidence rate of LTFU.ConclusionLTFU peaked in the first 6 months, accounting for approximately half of total losses, remained elevated from months 7–12, and stabilized after the first year of HIV care and treatment. Address information and adherence were predictors of LTFU. To effectively minimize LTFU, efforts should focus on intensive support during the first six months of care, followed by sustained efforts and monitoring in the next six months. Our findings highlight a critical period for targeted interventions to reduce LTFU in HIV care.

Development characteristics and hazard analysis of debris flow along the Emei to Mianning section of the Chengdu–Kunming Railway

Geological disasters in the Emei to Mianning section of the Chengdu–Kunming Railway located in southwestern China occur frequently, and many debris flow gullies are distributed along the line. Debris flows often cause damage to the railway and highway that threatens the safe operation of the original line and the double-track line. Along the railway, the debris flow outbreak risks are analyzed for 53 debris flow gullies using field survey, remote sensing interpretation, and numerical simulation. Their developmental characteristics were judged according to the code. The results are used for numerical simulation of debris flow to further determine the movement characteristics and the accumulation range of debris flow. The results are combined with high-definition satellite images to analyze the form of the railway passing from the mouth of the ditch and the simulation results to determine the impact on the safe operation of the Chengdu–Kunming Railway when the debris flow erupts. Finally, disaster prevention and mitigation projects are proposed, and the prevention and control effects of the proposed works are validated.

An assessment of cancer centre level designation and guideline adherent care in those with rectal cancer: A population based retrospective cohort study

BackgroundInstitutions providing care to individuals with cancer are organized based on available resources and treatments offered. It is presumed that increasing levels of care will result in improved quality of care and outcomes. The objective is to determine whether Cancer Level Designation is associated with guideline adherent care and/or survival. MethodsThis is a retrospective study of individuals within the Ontario Rectal Cancer Cohort, a population-level database including all adults undergoing surgical resection for rectal cancer between 2010 – 2019 were included in Ontario, Canada. The primary exposure was Cancer Centre Level Designation as defined by Cancer Care Ontario (i.e., Level 1/2 = regional cancer center; Level 3 = affiliate cancer center; Level 4 = satellite cancer center). The primary outcomes were guideline adherent care and survival. Associations were determined using one-way analysis of variances and a multivariable Cox proportional hazards model. Results12,399 patients were included with 54 % from a Level 1/2 centre, 33 % from a Level 3 centre and 13 % from a Level 4+ centre. All assessed aspects of guideline adherent care were associated with cancer centre level designation. Unadjusted 5-year overall survival was associated with cancer centre level designation (Level 1/2 79.5 % vs. Level 3 79.1 % vs. Level 4/non-designated 75.4 %, P = 0.003). Adjusted Cox Proportional Hazard Analysis for overall survival found the following: Level 4/5 HR 1.11 (95 %CI 0.99 – 1.25); Level 3 HR 1.01 (95 % CI 0.93 – 1.11); Level 1/2 1 [Referent group]. ConclusionsIncreasing Cancer Centre Level Designation was associated with higher likelihood of receiving the appropriate investigations and treatments in those with rectal cancer and may also be associated with survival. Policy SummaryFuture work should consider the centralization of complex rectal cancer care as well as quality improvement initiatives aimed at enhancing guideline adherent care across all centres managing rectal cancer.

Boosting Algorithms for the Accident Severity Classification

&lt;div&gt;&lt;i&gt;Background:&lt;/i&gt; Road accident severity estimation is a critical aspect of road safety analysis and traffic management. Accurate severity estimation contributes to the formulation of effective road safety policies. Knowledge of the potential consequences of certain behaviors or conditions can contribute to safer driving practices. Identifying patterns of high-severity accidents allows for targeted improvements in terms of overall road safety. &lt;i&gt;Objective:&lt;/i&gt; This study focuses on analyzing road accidents by utilizing real data, i.e., US road accidents open database called “CRSS.” It employs advanced machine learning models such as boosting algorithms such as LGBM, XGBoost, and CatBoost to predict accident severity classification based on various parameters. The study also aims to contribute to road safety by providing predictive insights for stakeholders, functional safety engineering community, and policymakers using KABCO classification systems. The article includes sections covering theoretical methodology, data analysis, model development, evaluation, performance metrics, and implications for improving road safety measures by comparing the performance of different boosting algorithms on the CRSS dataset. This study aims to identify the most effective machine learning algorithm to integrate into our product line in the near future, enabling accurate prediction of both accident severity and occurrence. &lt;i&gt;Results and Conclusions:&lt;/i&gt; This study addresses challenges in evaluating performance metrics for different severity classes within unbalanced datasets, emphasizing the impact of dominant classes like Class O (O = no apparent injury) on overall accuracy. The investigation reveals the limitations and conservatism associated with imbalanced data in boosting models, hinting at a potential ceiling in their performance around 80%. Comparative analysis of algorithms, including CatBoost, XGBoost, and LGBM, demonstrates comparable performance even in the case of applying KNN algorithm for pre-processing, based on various metrics, especially accuracy, &lt;i&gt;F&lt;/i&gt;&lt;sub&gt;1&lt;/sub&gt;-score, ROC-AUC, and PR-AUC for all severity classes. XGBoost with KNN algorithm did not show any significant performance improvement compared to the XGBoost without KNN algorithm. The study includes performance metrics, such as &lt;i&gt;F&lt;/i&gt;&lt;sub&gt;1&lt;/sub&gt;-score, CM upper triangle, ROC-AUC, and PR-AUC applied to an accident analysis case study. Future work directions involve extending the application of CatBoost, XGBoost, and other algorithms to diverse datasets, exploring the capabilities of deep neural networks, refining dataset preparation for accuracy improvement, and creating unified tools for hazard analysis and risk assessment.&lt;/div&gt;

Risk factors for intracerebral hemorrhage by five specific bleeding sites: Japan Public Health Center-based Prospective Study.

Evaluating the risk factors for intracerebral hemorrhage is indispensable for primary prevention. However, the pathogenesis varies depending on the bleeding site, and few prospective studies have explored risk factors in detail for each site. The Japan Public Health Center-based Prospective Study is a prospective study comprising a population-based sample of Japanese adults in 1990 (Cohort I) and in 1993 (Cohort II). A total of 34,137 participants (11,907 men and 22,230 women) were enrolled in this study and followed up until 2009 for Cohort I and until 2012 for Cohort II. The association between risk factors (age, sex, blood pressure, serum cholesterol, triglycerides, blood glucose, body mass index, smoking, and drinking status) and intracerebral hemorrhage by its bleeding site (lobes, putamen, thalamus, cerebellum, and brainstem) was assessed using Cox proportional hazards analysis. During a median 20-year follow-up, 571 intracerebral hemorrhage events occurred. Hypertension was associated with an increased risk of total intracerebral hemorrhage, but not lobar hemorrhage. The multivariable hazard ratio (95% confidence intervals) was 2.09 (1.75-2.50) for total intracerebral hemorrhage. In contrast, a low serum total cholesterol level was associated only with lobar hemorrhage (1.73 (1.01-2.96)). Heavy drinking was associated with the risk of total and putamen hemorrhage, and obesity was associated with the risk of putamen hemorrhage. The present study identified different risk factors depending on the bleeding site of intracerebral hemorrhage.

Deep-learning CT imaging algorithm to detect usual interstitial pneumonia pattern in patients with systemic sclerosis-associated interstitial lung disease: association with disease progression and survival.

Interstitial lung disease (ILD) is the most common cause of death in patients with systemic sclerosis (SSc), although disease behavior is highly heterogeneous. While a usual interstitial pneumonia (UIP) pattern is associated with worse survival in other ILDs, its significance in SSc-ILD is unclear. We sought to assess the prognostic utility of a deep-learning HRCT algorithm of UIP probability in SSc-ILD. Patients with SSc-ILD were included if HRCT images, concomitant lung function tests, and follow-up data were available. We used the Systematic Objective Fibrotic Imaging analysis Algorithm (SOFIA), a convolution neural network algorithm which provides probabilities of a UIP pattern on HRCT images. These were converted into the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED)-based UIP probability categories. Decline in lung function was assessed by mixed-effect model analysis and relationship with survival by Cox proportional hazards analysis. 522 patients were included in the study. 19.5% were classified as UIP not in the differential, 53.5% as low probability of UIP, 25.7% as intermediate probability of UIP, and 1.3% as high probability of UIP. A higher likelihood of UIP probability expressed as PIOPED categories was associated with worse baseline FVC, as well as with decline in FVC (p= 0.008), and worse 15-year survival (p= 0.001), both independently of age, gender, ethnicity, smoking history, and baseline FVC or Goh et al. staging system. A higher probability of a SOFIA-determined UIP pattern is associated with more advanced ILD, disease progression, and worse survival, suggesting that it may be a useful prognostic marker in SSc-ILD.

Simplified site response analysis for regional seismic risk assessments

Seismic risk assessment on a regional scale requires an estimation of ground motion intensity and its spatial variation over large geographical areas. This task is particularly challenging in the presence of very soft soil deposits where significant amplification occurs at specific frequencies that are often referred to as local resonances. It is often not feasible to conduct a nonlinear site response analysis at thousands of sites of interest across a region such as an urban area due to the computational effort involved and the required detailed information on soil profiles at each site. Thus, in regional seismic risk analyses the hazard is typically represented by a field of response spectral ordinates estimated by ground motion models. This study proposes a simplified site response analysis procedure to improve the characterization of spectral ordinates to be used in regional seismic risk assessments. In the proposed procedure, reduced-order models are used to conduct site response analysis using very few parameters to transform response spectra at rock outcrop into response spectra at the surface of each of the sites. A particular emphasis is given to soft-soil sites characterized by low shear-wave velocities overlaid on rock or firm soils. A non-uniform continuous shear beam model with a parabolic variation of shear modulus along the depth and modal damping is used in combination with Random Vibration Theory. It is shown that the proposed approach provides better estimates than those of ground motion models or physics-based ground motion simulation models which often cannot capture the local resonances. Site-specific validation of the shear beam model and overall simplified site response analysis is performed at four soft-soil sites in San Francisco, California. Despite its simplicity, it is shown that the proposed procedure adequately captures the amplitudes and spectral shapes of the motions. It is also shown that in conjunction with ground motion models or physics-based models, the proposed simplified site response analysis procedure can be used to efficiently simulate the seismic hazard on a regional scale through an example of a regional seismic hazard analysis of 160 softer soil sites in Downtown San Francisco during the Loma Prieta earthquake.

A Perspective on the Rupture States of Complex Earthquake Scenarios in the 2023 USGS Seismicity Model for the Western U.S. Faults

Abstract The 2023 U.S. Geological Survey (USGS) seismicity model for faults in the western United States (USGS-SMF-WUS) includes many earthquake scenarios (EQS) that rupture multifault sections (MFS), reflecting decades of observations that large crustal earthquakes often rupture sections of different neighboring faults in complex ways. Many of the complex MFS scenarios include rupture sections, on different faults, that are not contiguous, with spacing up to 15 km. The USGS-SMF-WUS uses an inversion methodology, referred to as magnitude-rate optimization, to optimally formulate the occurrence rates of the EQS in such a way that they collectively release the accumulating seismic moment rates on faults, at subsection level, defined by various types of geologic, geodetic, and seismologic data and constraints. This raises questions about the treatment of the MFS scenarios in the USGS-SMF-WUS regarding their rupture states and how that could potentially impact the magnitude-rate optimization and ground motions (GMs) for hazard analysis. Among many different possible rupture states for the MFS earthquakes, the two extreme scenarios could be visualized as (1) a series of noncontiguous sections rupturing in such a way that their total seismic moment and GM footprints are scaled with the sum of their rupture areas and (2) a series of noncontiguous triggered events, grouped together based on the spacing between the participating fault sections and other criteria, each releasing seismic moment and generating GM footprints that are scaled with its own rupture area. It will be shown later that the average slips on the participating sections for these two extreme rupture states would not be the same. In addition, the GM footprints from these two rupture states would be different and the differences are frequency dependent. This is especially the case when considering the complexity of rupture directivity on the participating fault sections in the USGS-SMF-WUS. It is the objective of this study to explore and discuss the implications of the triggered rupture state assumption in estimating the average slips and GM footprints of the MFS earthquakes in the USGS-SMF-WUS.

A Methodologic Approach to Study Large and Complex Landslides: An Application in Central Apennines

The evaluation of landslide hazards in seismic areas is based on a deterministic analysis, which is unable to account for various uncertainties in the analysis process. This paper focuses on the probabilistic local seismic hazard analysis and extends the results to the landslide hazard analysis to consider both the uncertainties of the ground deformations and the strengths. The work studies the areas between Nibbiano and Sant’Erasmo hamlets in the Camerino municipality located in central Italy, where all constructions present evidence of damage caused by both the seismic sequence of 2016–2017 and the slope instability. An exhaustive geological and geophysical investigation has clarified the geological, geomorphological, and hydrogeological characteristics of the area, enabling a new characterization of material stress-strain behaviour. The study reveals that the low stiffness of the debris covers, and their fair degree of permeability contribute to potential instability scenarios triggered by both intense rainfall and the effects of strong earthquakes. The goal was to utilize the results to support local urban planning because in-depth knowledge of the possible evolutionary scenarios of the slopes is fundamental to the management of the degree of danger for structures, especially for people. Moreover, it was shown once again how a multi-source approach, with different investigation techniques, cannot be ignored for the study of the evolution of complex landslides.

Global Leadership Initiative on Malnutrition Criteria and Immunonutritional Status Predict Chemoadherence and Survival in Stage II/III Gastric Cancer Treated with XELOX Chemotherapy.

Adjuvant chemotherapy is crucial for the treatment of advanced gastric cancer. However, various factors negatively impact chemoadherence, with malnutrition after gastrectomy being a critical determinant. This study aims to analyze the impact of malnutrition, assessed through the Global Leadership Initiative on Malnutrition (GLIM) and other immunonutritional indices, on chemoadherence and its subsequent effect on survival. This retrospective study included 116 patients who underwent curative gastrectomy and received oxaliplatin and capecitabine (XELOX). Preoperative nutritional status was assessed using the GLIM criteria along with other immunonutritional indices, such as the prognostic nutritional index (PNI), C-reactive protein-to-albumin ratio (CAR), neutrophil-lymphocyte ratio (NLR), controlling nutritional status (CONUT) score, and modified Glasgow Prognostic Score (mGPS). Chemotherapy adherence was measured using relative dose intensity (RDI). Statistical analyses included least absolute shrinkage and selection operator (LASSO) regression to identify the key predictors of RDI and Cox proportional hazards models and assess the impact on survival. Overall, 116 patients were included in this analysis. In the multivariate analysis using LASSO regression, higher GLIM severity was independently associated with a lower RDI (coefficient = -0.0216; p < 0.01). Other significant factors influencing RDI included older age (p < 0.01), female sex (p = 0.02), higher mGPS (p = 0.03), higher CONUT score (p = 0.04), and higher CAR (p = 0.05), all of which were associated with a lower RDI. The Cox proportional hazards analysis revealed that higher RDI was significantly associated with better survival (hazard ratio [HR] = 0.06; p < 0.005). This study highlights the critical role of immunonutritional status, particularly as measured using the GLIM criteria, in maintaining adherence to chemotherapy and improving survival outcomes in patients with gastric cancer. Routine preoperative nutritional assessments using GLIM can help identify high-risk patients, and early nutritional interventions may improve chemotherapy adherence and outcomes. These findings support the integration of nutritional strategies, specifically targeting those identified by the GLIM, into standard care to enhance the efficacy and survival of chemotherapy.

Reduction in the incidence of cognitive impairment and related costs through an innovative health awareness programme in rural Japan.

This study examined the impact of the Center of Healthy Aging Program (CHAP) on the cognitive function and economic burden associated with dementia. This observational study utilised Iwaki cohort data. We included participants with mini-mental state examination (MMSE) scores and categorised them into pre- and post-CHAP groups based on their year of entry into the cohort (before 2013 or after) (index year). We defined participants with suspected severe cognitive impairment and suspected mild cognitive impairment using their MMSE scores, with their incidence being the first observation meeting these definitions during the follow-up period. We compared the incidence rates between the pre- and post-CHAP groups using Cox proportional hazard analysis. Medical and caregiving costs were estimated based on the projected number of residents in Iwaki area with suspected mild cognitive impairment and sSCI during hypothetical 10 years of the CHAP implemented or not and compared. Of the 2,569 participants, 1716 and 853 were included in the pre- and post-CHAP groups, respectively. The incidence rate of suspected mild cognitive impairment was significantly lower in the post-CHAP group even after adjusted known factors associated with cognitive disorders. No cases of suspected severe cognitive impairment occurred in the post-CHAP group during the follow-up period. Estimated costs of JPY 1,628,450 (USD 11562.00 or EUR 10259.24, JPY 100 = USD 0.71 or EUR 0.63) and JPY 789,560 (USD 5605.88 or EUR 4974.23) per person per year were projected after 10 years with and without the CHAP, respectively. We demonstrated a reduction in the incidence rate of suspected mild cognitive impairment among residents who participated in the CHAP and a decrease in the medical and caregiving costs associated with suspected severe cognitive impairment.

Seaweed Farming in Tanzania: A Study of Working Practices and Geospatial Analysis of Occupational Hazards and Adverse Health Outcomes

ABSTRACT Objective Work in seafood harvesting and processing has been associated with a range of occupational hazards and associated health problems. However, limited information exists regarding the occupational health risks among workers engaged in seaweed handling. Methods A cross-sectional study was conducted to map seaweed co-operatives (n = 45), assess working practices, and identify common work-related symptoms, occupational hazards, and interventions in seaweed farming sites (n = 24), across three regions of Zanzibar, Tanzania. Results Seaweed farming in Zanzibar primarily involves the cultivation of Eucheuma Spinosum, with the majority of workers being women. Common work-related symptoms identified include musculoskeletal symptoms, mainly affecting the wrist (87%), back (84%) and lower limbs (73%). Furthermore, a significant proportion of workers were reported to have skin problems (80%) as well as heat and asthma-related symptoms (51%). Walk-through hazard evaluations of work sites identified a range of occupational hazards, with ergonomic (58–68%), biological (50–63%) and chemical (55–65%) hazards obtaining higher scores across the three regions. Geospatial analysis revealed regional variations in occupational hazards and work-related symptom prevalence, with Unguja South having a statistically significant (p < .05) higher mean prevalence of skin symptoms (95%) and Mjini Magharibi region reporting a higher prevalence of lower limb pain (100%), back pain (100%), and heat-related symptoms (90%). Despite the high hazard scores, interventions were generally lacking across all regions. Conclusion Occupational health hazards and adverse health outcomes vary across seaweed farming and processing regions. Tailored interventions will be key to improving workplace health and safety of workers engaged in this sector.

Incidence and risk factors of post-stroke seizure among ischemic stroke patients

BackgroundPost-stroke seizure (PSS) increases morbidity and mortality after ischemic stroke, but a comprehensive understanding of its incidence and risk factors is lacking. We report the rate and risk factors of PSS at a single institution. MethodsA retrospective cohort study of adult acute ischemic stroke patients between 2018 and 2022 at a comprehensive stroke center was conducted. Patients with a history of seizures, additional stroke during index admission, or death within 7 days of stroke onset were excluded. Early PSS was defined as a new seizure occurring ≤7 days after stroke onset, while late PSS occurred >7 days after stroke onset. Multivariable logistic regression and cox proportional hazard analysis was conducted. Results1211 participants met inclusion criteria. Patients were a mean age of 67.82 and were primarily male (58.7 %), white (72.6 %), and non-Hispanic (91.9 %). Incidence of PSS was 8.8 % (n = 106), of which 53.8 % (n = 57) were early and 46.2 % (n = 49) were late. Bivariate analysis identified younger age, diabetes, baseline National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early Computed Tomography Score ≤5, cortical involvement, and hemorrhagic transformation as significant in the development of PSS. Multivariable cox proportional hazard analysis identified cortical involvement (hazard ratio [HR]: 2.31, 95 % confidence interval [CI] [1,29, 4.14]), NIHSS ≥ 21 (HR: 1.82, 95 % CI [1.02, 3.22]),and younger age (HR: 0.97, 95 % CI [0.96, 0.98]) as significant PSS predictors. ConclusionPSS occurred in 8.8 % of patients presenting with ischemic stroke. Hemorrhagic transformation, cortical involvement, high NIHSS, and younger age were significant predictors of PSS.

Arterial Stiffness Associated with Long-Term Major Adverse Cardiac Events in Patients of Primary Aldosteronism.

As a novel parameter for risk prediction, artery stifiness may hold promise in refining risk assessment strategies, guiding therapeutic interventions, and ultimately improving cardiovascular outcomes in patients with primary aldosteronism (PA). To investigate the correlation between brachial-ankle pulse wave velocity (baPWV), an indicator of arterial stiffness, and the occurrence of major adverse cardiovascular events (MACEs) in patients with PA under a primary prevention design. Among the 830 patients included in the final analysis, 113 (13.6%) developed inciden t MACEs over a median follow-up period of 5.8 years, with a crude rate of 23.2 per 1000 person-years. Multivariable Cox proportional hazards analyses revealed that baPWV was an independent risk factor for incident MACEs, with an adjusted hazard ratio of 1.01 (P = 0.028). The generalized additive model identified a cut-off value of 2000 cm/s for baPWV, which was independently associated with incident MACEs, with a hazard ratio of 1.72 (P = 0.045). Subgroup analyses revealed that PA patients who were mineralocorticoid receptor antagonist (MRA) users and had high baPWV had a significantly higher risk of incident MACEs (HR = 3.34; P < 0.001), while the risk was not significant in patients who underwent adrenalectomy (P = 0.062). Furthermore, the addition of baPWV to the cardiovascular Framingham risk score significantly improved the category-free net reclassification index (0.308, P < 0.001). Our study found that 13.6% of patients with PA developed MACEs after a median follow-up of 5.8 years. Our findings highlight the potential utility of baPWV as a tool for risk stratification in PA patients in primary prevention, whereas adrenalectomy appears to mitigate this risk irrespective of baPWV. The measurement of baPWV could be a valuable addition to hypertension screening programs for primary prevention, providing additional predictive information for the potential occurrence of MACEs.

Hazard Analysis for Massive Civil Aviation Safety Oversight Reports Using Text Classification and Topic Modeling

There are massive amounts of civil aviation safety oversight reports collected each year in the civil aviation of China. The narrative texts of these reports are typically short texts, recording the abnormal events detected during the safety oversight process. In the construction of an intelligent civil aviation safety oversight system, the automatic classification of safety oversight texts is a key and fundamental task. However, all safety oversight reports are currently analyzed and classified into categories by manual work, which is time consuming and labor intensive. In recent years, pre-trained language models have been applied to various text mining tasks and have proven to be effective. The aim of this paper is to apply text classification to the mining of these narrative texts and to show that text classification technology can be a critical element of the aviation safety oversight report analysis. In this paper, we propose a novel method for the classification of narrative texts in safety oversight reports. Through extensive experiments, we validated the effectiveness of all the proposed components. The experimental results demonstrate that our method outperforms existing methods on the self-built civil aviation safety oversight dataset. This study undertakes a thorough examination of the precision and associated outcomes of the dataset, thereby establishing a solid basis for furnishing valuable insights to enhance data quality and optimize information.

Coexistence of Non-Lower Body Mass Index and Exercise Habits Reduce Readmission in Older Patients With Heart Failure.

To investigate the impact of body mass index (BMI) and exercise habits on readmission rates among older patients with heart failure. Ninety-seven older patients admitted for heart failure (median age: 81 years; 57.7% male) were included in the study. Patients were categorized into four groups based on the presence or absence of lower BMI and/or the absence of exercise habits. Lower BMI was defined as BMI<20.3 kg/m2 at discharge and exercise habits were defined as engaging in 30 or more minutes of moderate or vigorous exercise at least once a week. The primary outcome was all-cause readmission during the 1-year follow-up period. The patients were distributed across four groups: lower BMI/non-exerciser (n=24, 24.7%), lower BMI/exerciser (n=22, 22.7%), non-lower BMI/non-exerciser (n=21, 21.6%), and non-lower BMI/exerciser (n=30, 30.9%). Forty-six patients (47.4%) experienced readmission during the 1-year follow-up period. In a cox proportional hazard analysis, non-lower BMI/exerciser remained an independent prognostic factor even after adjusting for confounding factors (non-lower BMI/exerciser vs. lower BMI/non-exerciser: hazard ratio, 0.26; 95% confidence interval, 0.08-0.83; p=0.022). The coexistence of non-lower BMI and regular exercise habits may reduce readmission during the 1-year in older patients with heart failure. Therefore, it is imperative to conduct appropriate nutritional assessments for patients with lower BMI at discharge. Additionally, promoting and monitoring sustained physical activity after discharge is crucial for older patients with heart failure.

Incidence and Predictors of Appropriate Implantable Cardioverter Defibrillator Therapy in Japanese Ischemic Heart Disease Patients.

Although the efficacy of an implantable cardioverter defibrillator (ICD) in preventing sudden cardiac death is well established, the incidence and predictors of appropriate ICD therapy in Japanese ischemic heart disease (IHD) patients remain unclear. We retrospectively studied Japanese 141 IHD patients undergoing transvenous ICD or cardiac resynchronization therapy with a defibrillator (CRT-D) implantation for primary or secondary prevention at Hirosaki University Hospital. Over a mean (±SD) follow-up period of 5.5±2.8 years, the incidence of appropriate ICD therapy was similar in the primary and secondary prevention groups, although it was relatively more frequent in the first 2 years in the secondary prevention group. Four patients died due to sustained ventricular tachycardia (VT) or ventricular fibrillation (VF), mainly due to post-shock pulseless electrical activity. Once patients had received their first appropriate ICD therapy, 49.2% received second appropriate ICD therapy within 6 months. Cox proportional hazard analysis revealed that sustained VT as an index life-threatening ventricular tachyarrhythmia before ICD/CRT-D implantation was an independent predictor of appropriate ICD therapy, but VF was not. The incidence of appropriate ICD therapy was comparable in primary and secondary prevention among Japanese IHD patients. We need to recognize the high-risk period for second appropriate ICD therapy after the first therapy and sustained VT as index life-threatening ventricular tachyarrhythmia as a risk factor for appropriate ICD therapy.