Comparative Risk Analysis Research Articles

Comparative Outcomes and Risk Analysis of Stroke Incidence in Adult Patients on Dialysis

Comparative Outcomes and Risk Analysis of Stroke Incidence in Adult Patients on Dialysis

Comparative Outcomes and Risk Analysis of Kidney Replacement Therapy in Adult Patients with AKI

Comparative Outcomes and Risk Analysis of Kidney Replacement Therapy in Adult Patients with AKI

Comparative Analysis of Kinetic Responses and Injury Risk During Landing from 45 cm Height: A Study of Barefoot vs. Sports Shoes Conditions

Jumping and landing biomechanics are closely related to the risk of acute injury due to prolonged exposure to high-ground reaction forces in basketball-like sports, which can lead to lower-limb musculoskeletal injuries in the hip, knee, and ankle. Footwear greatly impacts jumping mechanics, but going barefoot provides a unique perspective on how the human body interacts with the ground. This study aims to find out the kinetic responses during drop landing from 45 cm height with and without sports shoe conditions. Twenty-five healthy young adults were volunteers for this study. Kinetic parameters were recorded and processed by using Quattro Jump force plat and Mars Quarter performance analysis software. Data were presented as mean ± SD values and statistical analysis was performed using statistical software package SPSS-26. The drop landing data of with and without shoe shows scattered parameters with maximum forces of 4706.12N and 5393.04N at 45 cm height, indicating a 66% and 75% risk of metatarsal injury. The stabilization force was 632.64N and 623.64N at 45 cm, reached at 0.58s and 0.66s respectively. Time from Max Force to MFBS Regression analysis indicated a low R-squared value and a random fit plot. In barefoot (without shoe) conditions, the initial contact force, and maximum force were 85.71% and 13.60% higher (250N and 5393.04N respectively) compared to landing with shoes (100N and 4706.12N). However, the stabilization force was higher (632.64N) when landing with shoes compared to landing barefoot (623.64N). As a result, the risk of musculoskeletal injuries and joint stress was higher when landing barefoot due to the higher initial contact force and maximum force. On the other hand, landing with shoes enhances balance and stability due to the higher stabilization force.

Daylight Saving Time Transitions and Risk of Heart Attack—a Systematic Review and Meta-Analysis.

The health risks of daylight saving time transitions are intensely debated. Disturbed circadian rhythms and lack of sleep after transitions might increase the risk of acute myocardial infarction (AMI). The only meta-analysis on the risk of AMI has now been considerably expanded. In this systematic review and meta-analysis (including meta-regressions and sensitivity analyses), we examine the frequency of AMI in the first few weeks after daylight saving time transitions (OSF registration www.doi.org/10.17605/OSF.IO/7CFKS). Eight databases were searched for pertinent literature up to September 2023. Authors were contacted for additional information. Study quality was rated using the Newcastle-Ottawa Scale. Twelve studies from ten countries were included in the meta-analysis. Nine were of adequate quality, and three were of good quality. The pooled relative risk (RR) of AMI after daylight saving time onset (spring) was 1.04 (95% confidence interval [1.02; 1.07], I2: 57.3%), and 1.02 ([0.99; 1.05], I2: 51.6%) after daylight saving time offset (autumn). Recalculation after the exclusion of one study with inconsistencies yielded pooled RR values of 1.04 [1.01; 1.06] and 1.00 [0.99; 1.02], with the spring results being heterogeneous (I2: 56.9%) and the autumn results homogeneous (I2: 17.1%). Current evidence suggests that there may be an increased risk of AMI after the spring transition, although there is moderate to marked heterogeneity among the studies that support this conclusion. More easily interpretable studies, such as those already conducted in the field of economics, should clarify associations with the aid of discontinuity regression and placebo tests. To this end, comparative risk analyses using years or places wherein daylight saving time was not practiced would be suitable.

Daylight Saving Time Transitions and Risk of Heart Attack.

The health risks of daylight saving time transitions are intensely debated. Disturbed circadian rhythms and lack of sleep after transitions might increase the risk of acute myocardial infarction (AMI). The only meta-analysis on the risk of AMI has now been considerably expanded. In this systematic review and meta-analysis (including meta-regressions and sensitivity analyses), we examine the frequency of AMI in the first few weeks after daylight saving time transitions (OSF registration www.doi.org/10.17605/OSF.IO/7CFKS). Eight databases were searched for pertinent literature up to September 2023. Authors were contacted for additional information. Study quality was rated using the Newcastle-Ottawa Scale. Twelve studies from ten countries were included in the meta-analysis. Nine were of adequate quality, and three were of good quality. The pooled relative risk (RR) of AMI after daylight saving time onset (spring) was 1.04 (95% confidence interval [1.02; 1.07], I2: 57.3%), and 1.02 ([0.99; 1.05], I2: 51.6%) after daylight saving time offset (autumn). Recalculation after the exclusion of one study with inconsistencies yielded pooled RR values of 1.04 [1.01; 1.06] and 1.00 [0.99; 1.02], with the spring results being heterogeneous (I2: 56.9%) and the autumn results homogeneous (I2: 17.1%). Current evidence suggests that there may be an increased risk of AMI after the spring transition, although there is moderate to marked heterogeneity among the studies that support this conclusion. More easily interpretable studies, such as those already conducted in the field of economics, should clarify associations with the aid of discontinuity regression and placebo tests. To this end, comparative risk analyses using years or places wherein daylight saving time was not practiced would be suitable.

Using comparative extinction risk analysis to prioritize the IUCN Red List reassessments of amphibians

AbstractAssessing the extinction risk of species based on the International Union for Conservation of Nature (IUCN) Red List (RL) is key to guiding conservation policies and reducing biodiversity loss. This process is resource demanding, however, and requires continuous updating, which becomes increasingly difficult as new species are added to the RL. Automatic methods, such as comparative analyses used to predict species RL category, can be an efficient alternative to keep assessments up to date. Using amphibians as a study group, we predicted which species are more likely to change their RL category and thus should be prioritized for reassessment. We used species biological traits, environmental variables, and proxies of climate and land‐use change as predictors of RL category. We produced an ensemble prediction of IUCN RL category for each species by combining 4 different model algorithms: cumulative link models, phylogenetic generalized least squares, random forests, and neural networks. By comparing RL categories with the ensemble prediction and accounting for uncertainty among model algorithms, we identified species that should be prioritized for future reassessment based on the mismatch between predicted and observed values. The most important predicting variables across models were species’ range size and spatial configuration of the range, biological traits, climate change, and land‐use change. We compared our proposed prioritization index and the predicted RL changes with independent IUCN RL reassessments and found high performance of both the prioritization and the predicted directionality of changes in RL categories. Ensemble modeling of RL category is a promising tool for prioritizing species for reassessment while accounting for models’ uncertainty. This approach is broadly applicable to all taxa on the IUCN RL and to regional and national assessments and may improve allocation of the limited human and economic resources available to maintain an up‐to‐date IUCN RL.

A proposed framework for defining the relationship between complexity, project categorization, and project risk management: Case study of a medical company in Morocco

Recent financial crises have highlighted the utmost importance of implementing risk management practices, as exemplified by the profound repercussions of the COVID-19 pandemic. Moreover, we witnessed the rise of various initiatives within the medical sector, specifically in the fields of biomedicine, hospitals, and pharmaceuticals, across Africa, with a notable emphasis on Morocco. The government in Morocco has implemented measures to foster investment and encourage participation from companies and stakeholders. Taking into account an indeterminate and volatile future, it becomes imperative for organizations to establish robust risk management strategies to navigate successfully through these uncertainties. This research paper concentrates on the convergence of complexity, project categorization, and risks. We propose a novel approach to the implementation of the Risk Management Process, utilizing the Enterprise Risk Management framework. By establishing Risk Management rules within the context of a “complex” project, we observed enhanced performance and improved risk management through the holistic consideration of interdependencies rather than treating them as separate entities. Additionally, to substantiate this interdependency, we conducted a comparative analysis of the project's risk and complexity between 2020 and 2022.

Comparative Analysis of Risks and Their Impacts on the Banking Stability of Islamic and Conventional Banks in the MENA Region

This study aims to analyze and compare the impact of risks on banking stability associated with Islamic banks in comparison to their conventional counterparts in the MENA region. In this process, we first examine the correlation between liquidity risk and credit risk. Secondly, we assess whether these two types of risks are related to banking stability within both categories of banks. Using the PVAR (Panel Vector Auto Regression) econometric model on a sample of 110 conventional and Islamic banks in the MENA region, our results indicate that liquidity risk and credit risk exhibit a negative relationship in both types of banks. Furthermore, our findings suggest that there is no correlation between these risks and banking stability in both types of banks. Our conclusions have significant implications for banking institutions regarding the strategies and approaches required to manage these risks and ensure the stability of their banking operations.

Safety of elective enteral access in elderly patients: a comparative analysis of perioperative risk

BackgroundElderly patients can encounter torpid hospitalizations that are often characterized by malnutrition. In this setting, enteral feeding may facilitate improvement in nutritional status. The aim of this study is to compare perioperative outcomes of elderly (≥65 years-old) and non-elderly (<65 years-old) patients undergoing elective enteral access placement. MethodsAdult patients who underwent enteral access procedures between 2018-2020 at a tertiary care facility were reviewed retrospectively. Differences in baseline characteristics between non-elderly and elderly patients were adjusted using entropy-balanced weights. Subsequently, multivariable logistic and linear regressions were developed to evaluate the association between elderly status and outcomes of interest. Results914 patients with enteral access met inclusion criteria, of whom 471 (51.5%) were elderly. Compared to non-elderly patients, elderly individuals more commonly received percutaneous gastrostomy and had a higher burden of comorbidities as measured by the Charlson Index. Multivariable risk adjustment generated a strongly balanced distribution of baseline covariates between patient groups. After adjustment, despite no significant association with in-hospital mortality, reoperation, or time to goal feeds, elderly status was linked to an approximately 8-day reduction in length of stay (95%CI -14.28 to -2.30, p=0.007), as well as significantly lower odds of total parenteral nutrition (AOR 0.59, 95%CI 0.37-0.94, p=0.026) and non-elective readmission (AOR 0.65, 95%CI 0.49-0.86, p=0.003). Elderly status was also associated with significantly greater odds of non-home discharge (AOR 1.58, 95%CI 1.17-2.13, p=0.003). ConclusionDespite having more comorbidities than their non-elderly counterparts, elderly patients experienced favorable nutritional and perioperative outcomes after enteral access placement.

Comparative Analysis of Financial Market Volatility and Correlation Risk During the Great Recession and the COVID-19 Pandemic

This paper offers a starting point for reflection on the similarities and differences of the impact on financial markets of the Great Recession of 2008 and of the Covid-19 pandemic of 2020 in terms of volatility and correlation risk among the most significant financial indexes in Europe. More precisely, the dataset employed includes the daily returns of Ftse100, CaC40, Dax30 and FtseMib40, with reference to the two time periods in which the two major crises manifested their effects on the markets. We use two different methodological approaches: the analysis of the daily conditional variance using various families of GARCH models and the study of the weekly realized volatility using HAR models. Furthermore, the estimation of the dependence structure of the GARCH residuals using copula functions is performed.

Gender-based comparative analysis of knee injury risk during cutting maneuvers in non-professional athletes: a kinetic and kinematic perspective.

Gender-based comparative analysis of knee injury risk during cutting maneuvers in non-professional athletes: a kinetic and kinematic perspective.

A Classification of Cloud Services and Their Security Assessment in the Healthcare Industry

The role of cloud-based services in healthcare settings is crucial in the 21st century. This paper discusses their advantages and tools in hospitals, clinics, and diagnostic centers, categorizing existing applications and services into data storage, computing power, networking, PaaS, SaaS, data analytics, business intelligence, and project management. It also provides an in-depth analysis of security and risk assessment issues in cloud-based services, supported by case studies. Additionally, it includes a comparative risk analysis diagram of secured versus non-secured cloud systems in healthcare. Finally, the paper concludes with recommendations for future work. Key Words: Healthcare facilities, diagnostic centers, cloud services, information technology systems, security, risk analysis.

What was first and what is next in selecting device-aided therapy in Parkinson's disease? Balancing evidence and experience.

Parkinson's disease (PD) progresses with motor fluctuations emerging several years after treatment initiation. Initially managed with oral medications, these fluctuations may later necessitate device-aided therapy (DATs). Globally, various DATs options are available, including continuous subcutaneous apomorphine infusion, deep brain stimulation, levodopa-carbidopa intestinal gel, levodopa-entacapone-carbidopa intestinal gel, and subcutaneous foslevodopa/foscarbidopa infusion, each with its complexities. Hence, matching complex patients with suitable therapy is critical. This review offers practical insights for physicians managing complex PD cases. Balancing evidence and experience is vital to select the most suitable DATs, considering factors like disease stage and patient preferences. Comparative analysis of DATs benefits and risks provides essential insights for clinicians and patients. Treatment sequences vary based on availability, patient needs, and disease progression. Less invasive options like apomorphine are often preferred initially, followed by other DATs if needed. Patient selection requires comprehensive evaluations, including motor function and cognitive status. Follow-up care involves symptom monitoring and adjusting medications. Customized treatment plans are essential for optimizing PD management with DATs.

Abstract PO5-01-11: Breast Cancer Index and comparative analysis of late distant recurrence risk with results from the TEAM trial

Abstract Background: Individualized risk assessment of distant recurrence (DR) is critical for early-stage HR+ breast cancer patients, as prolonged risk of recurrence continues even after completing 5 years of adjuvant endocrine therapy. The Breast Cancer Index (BCI) is a guideline-endorsed, validated gene expression assay that provides an individualized risk of overall (0-10y) and late (5-10y) DR and predicts the likelihood of benefit from extended endocrine therapy. The current BCI assay reports prognostic risk estimates based on tamoxifen-treated patients from the Stockholm (STO-3) cohort for node-negative (N0) patients, enrolled between 1976 through 1990 and a retrospective cohort from Massachusetts General Hospital (MGH) for patients with 1 to 3 positive nodes (N1), diagnosed between 1993 and 2007, of which approximately 50% were tamoxifen-treated. More recently, additional validation was completed in the Tamoxifen and Exemestane Adjuvant Multinational (TEAM) trial, in which patients were enrolled between 2001 and 2006. Here, individualized DR risk estimates from the TEAM trial were compared with those from Stockholm and MGH cohorts. Methods: For the TEAM translational study, BCI testing was performed blinded to clinical outcome and BCI and BCIN+ risk scores were calculated as previously described. A total of 2910 postmenopausal patients with HR+ breast cancer, including 1285 N0 and 1625 N1 patients, who remained DR-free for five years were analyzed to determine the risk of late DR. Cox proportional hazard models using Breslow estimates were used to calculate the risk of late DR as a function of continuous BCI risk scores. Results: Late DR risk estimates from both the TEAM trial and the Stockholm/MGH cohorts are summarized in the table below. In N0 patients, comparison of 5-10y risk estimates of late DR observed in TEAM patients were higher than those in the Stockholm cohort for BCI scores less than 8.0, but reduced for BCI scores greater than 8.0. Risk estimates differed by 1.5% for a BCI score of 0 and -4.3% for a BCI score of 10. A similar pattern was observed for N1 patients between the TEAM and MGH cohorts, with risk estimates from TEAM trial being higher for BCI scores less than 8.0 but reduced for BCI scores greater than 8.0 compared to those from the MGH cohort. Conclusions: BCI prognostic validation in the TEAM trial enabled the characterization of DR risk that is more compatible with the current standard of care in the US, as postmenopausal patients were all treated with at least 2-3 years or 5 years of primary adjuvant endocrine therapy with an aromatase inhibitor. Results from the TEAM study provide a more representative assessment of late DR risk to guide individualized treatment decision-making for HR+ early-stage breast cancer patients. Table. Citation Format: John MS Bartlett, Yi Zhang, Gregory Pond, Jenna Wong, Keying Xu, Melanie Spears, Elizabeth Mallon, Karen Taylor, Annette Hasenburg, Christos Markopoulos, Luc Dirix, Caroline Seynaeve, Cornelis J.H. van de Velde, Daniel Rea, Adam Brufsky, Olle Stål, Dennis Sgroi, Catherine Schnabel, Kai Treuner, Jane Bayani. Breast Cancer Index and comparative analysis of late distant recurrence risk with results from the TEAM trial [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-01-11.

Comparative Analysis of Risk and Return of Manufacturing Companies: A Five-Year Study-(2019-2023)

The study employs both quantitative and qualitative research approaches to assess the historical performance of a selected group of Manufacturing companies in terms of risk-adjusted returns. In order to evaluate the risk and return profiles of Manufacturing companies, a number of financial measures are looked at, such as ROI, beta coefficients, and stock price volatility. To further assist investors, financial experts, and policymakers, the study also investigates the connection between economic and financial variables and stock returns. The research process includes gathering information from primary and secondary sources, choosing Manufacturing firms according to predetermined standards, and using statistical analysis tools like regression and correlation analysis. The results underscore the variation in the financial performance and risk profiles of Manufacturing firms, underscoring the significance of making well-informed investment decisions tactics and market forecasts in the ever-changing manufacturing industry. For investors looking to maximise their investment returns inside the Manufacturing Companies, the findings provide practical insights.

Comparative Analysis of Risk and Return of IT Companies

The study focuses on evaluating the historical performance of selected IT companies in terms of risk-adjusted returns, utilizing both quantitative and qualitative research methods. Various financial metrics, including stock price volatility, beta coefficients, and return on investment (ROI), are examined to assess the risk and return profiles of IT companies. Additionally, the study explores the relationship between economic and financial indicators and stock returns to provide insights for investors, financial analysts, and policymakers. The research methodology involves data collection from primary and secondary sources, selection of IT companies based on specific criteria, and statistical analysis techniques such as regression analysis and correlation analysis. The findings highlight the diversity in financial performance and risk profiles among IT companies, emphasizing the importance of informed decision-making for investment strategies and market predictions in the dynamic landscape of the IT sector. The findings offer actionable insights for investors seeking to optimize their investment outcomes within the IT Companies

Comparative analysis of postural stability and risk of falling and developing disability among overweight and obese women over 40 years

BackgroundIncreased body mass index (BMI) adversely affects the mechanics of the musculoskeletal system. It is known that obese people have poorer postural stability and mobility-related outcomes compared to normal weight people, but there is limited research comparing overweight and class 1 obese people, two consecutive and prevalent BMI categories. AimsTo compare postural stability, functional mobility, and risk of falling and developing disability between overweight and obese women, and to investigate the relationship of BMI and body weight with the outcomes. MethodsThirty women with class 1 obesity and 30 overweight women were included. Standing postural stability with eyes-open and eyes-closed and stability limits were assessed using the Prokin system. The Timed Up and Go Test (TUG) was used to assess functional mobility and risk of falling (≥11 s) and developing disability (≥9 s). ResultsThe average center of pressure displacements on the y-axis (COPY) obtained during quiet standing with both eyes-open and eyes-closed were higher in obese women than overweight women (p < 0.05) and the effect sizes were moderate for the results. The COPY values in the eyes-open and eyes-closed conditions were correlated with BMI (r = 0.295 and r = 0.285, p < 0.05). Furthermore, the COPX value in the eyes-open condition and the TUG score were correlated with body weight (r = 0.274 and r = 0.257, p < 0.05). ConclusionsObese women had poorer static standing stability in the anteroposterior direction than overweight women, while functional mobility and risk of falling and developing disability did not differ. Furthermore, BMI and body weight were related to poorer static standing stability.

A Comparative Analysis of Risk and Return Among chosen companies against the Benchmark Index in NSE.

In the current scenario of high volatility in the stock exchange, it's crucial for investors to make informed decisions. The surge of millennial investors into the market, aiming for substantial returns, highlights the importance of a solid grasp of statistical tools and measures for sound decision-making. This study delves into the risk and return analysis of various stocks alongside their benchmark indices to decode the stock movements in relation to the market. The primary goal for any investor is to amplify profits while minimizing risks. This research aids investors by offering insights into various statistical methods for analyzing stock risks and returns.

(095) Comparative Analysis of Absolute Risk in Testosterone versus Clomiphene Therapy: A Bayesian Analysis of Adverse Effects

Abstract Introduction Clomiphene is a selective estrogen receptor modulator used to induce ovulation by increasing luteinizing (LH) and follicle-stimulating hormone (FSH) levels. Since the 1970’s, it has been used in males with hypogonadism as an alternative to testosterone therapy as it does not suppress the hypothalamic-pituitary-gonadal axis. Objective While there have been systematic reviews looking at the effectiveness of clomiphene, we sought to better characterize the average testosterone levels, as well as the rate of deep venous thrombosis (DVT), myocardial infarction (MI), stroke, and polycythemia in clomiphene vs. testosterone users. Methods We performed a retrospective chart review for 537 men with a hypogonadism diagnosis that were seen by two urology providers at our center. Of these 537 patients, 84 presented with prior use or were prescribed clomiphene. We measured the incidence of DVT, MI, stroke, polycythemia and average testosterone levels with clomiphene. Statistical analysis was conducted using both a beta binomial and linear model. Results Patients receiving testosterone (n=217) versus clomiphene (n=84) demonstrated a 99% chance of higher mean levels of testosterone (Difference=216.55, 95% CrI = 20.67-408.16). Among those taking testosterone or clomiphene at the final visit (N=237; testosterone n=185; clomiphene=52) adverse events included, polycythemia (n=28), one DVT, VTE’s (n=4), MI’s (n=4), and strokes (n=4). The absolute risk (AR) of experiencing at least one of these events (i.e. polycythemia, DVT, VTE, MI or stroke) was 13.8% (95% CrI = 10.1-17.9%) and 3.1% (95% CrI = 0.44-9.4%) for testosterone and clomiphene respectively (Absolute Risk Difference (ARD) = 10.5% (95% CrI = 3.4-15.7%); Posterior Probability (ARD&amp;gt;0) &amp;gt; 0.99. The AR of polycythemia was 12.6% (95% CrI = 8.9-16.7%) and 1.5% (95% CrI = 0.1-7.4%) for testosterone and clomiphene respectively (ARD = 10.7% (95% CrI = 4.3-15.6%); Posterior Probability (ARD &amp;gt; 0) &amp;gt; 0.99. The AR of stroke was 0.94% (95% CrI = 0.14-2.98%) and 1.56% (95% CrI = 0.1-7.4%) for testosterone and clomiphene respectively (ARD = -0.6% (95% CrI = -6.5-2.1%); Posterior Probability (ARD &amp;lt; 0) = 0.64. The AR of MI was 1.4% (95% CrI=0.33-3.8%) and 1.5% (95% CrI=0.1-7.4%) for testosterone and clomiphene respectively (ARD = 1.3% (95% CrI = -0.36-3.73%); Posterior Probability (ARD &amp;gt; 0) = 0.96. The AR of DVT was 0.37% (95% CrI = 0.01-1.99%) and &amp;lt;0.00001% (95% CrI = &amp;lt;0.00001-1.6%) for testosterone and clomid respectively (ARD = 0.30% (95% CrI = -1.24-1.92%); Posterior Probability (ARD &amp;gt; 0) = 0.88. Conclusions The absolute risk of experiencing at least one of the events was found to be significantly higher in patients receiving testosterone compared to those receiving clomiphene. The results should be interpreted with caution, given the broad credible intervals due to its small size. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.

A comparative analysis of regional infection risk due to wastewater recontamination in the Mezquital Valley, Mexico

Urban wastewater reuse for agriculture provides reliable nutrient-rich water, reduces water stress, and strengthens food systems. However, wastewater reuse also presents health risks and characterizing the spatial dynamics of wastewater can help optimize risk mitigation. We conducted comparative risk analysis of exposure to wastewater in irrigation canals, where we compared those exposed to a) treated vs. untreated wastewater, and b) wastewater upstream vs. downstream from communities in the Mezquital Valley. The canal system with treated wastewater was sampled prior to being treated, directly after treatment, as well as before and after it flowed through a community. Along the canal system that carried untreated wastewater, we sampled before and after a community. We quantified the concentrations of bacterial, protozoal, and viral pathogens in the wastewater. Pathogen concentration data were used to calculate measures of relative risk between sampling points. Wastewater treatment reduced predicted bacterial pathogen infection risk in post-treatment locations (RR = 0.73, 95 % CI 0.61, 0.87), with no evidence of similar reductions in Giardia or viral pathogens (RR = 1.02, 95 % CI 0.56, 1.86 and RR = 1.18, 95 % CI 0.70, 2.02 respectively). Although infection risk decreased further down the canals, infection risk increased for bacterial pathogens after our sentinel community (RR = 1.94, 95 % 1.34, 2.86). For Giardia and viral pathogens infection risk was elevated but not significantly. We found similar evidence for increases in risk when comparing the treated section of the canal system with a canal section whose wastewater was not treated, i.e., the risk benefits of wastewater treatment were lost after our sentinel community for bacteria (RR = 5.27 vs. 2.08 for sampling points before and after our sentinel community respectively) and for Giardia (RR = 6.98 vs. 3.35 respectively). The increase in risk after transit through communities could have resulted from local community recontamination of the treated wastewater stream.