Critical Risk Factors Research Articles

Flexibility in Enhancing Supply Chain Resilience: Developing a Resilience Capability Portfolio in the Event of Severe Disruption

The current study aimed to determine alternative configurations of supply chain resilience strategies for managing supply chain performance (SCP) during a severe disruption. To do this, a multi-method and multi-study approach was adopted. Phase 1 of the study employed a qualitative approach to explore supply chain risk factors and their mitigation strategies during the COVID-19 pandemic. In Phase 2, the quality function deployment technique was used alongside quantitative case studies to determine the most critical risk factors and most crucial resilience strategies. The final phase, Phase 3, used fuzzy set qualitative comparative analysis to determine the alternative portfolio of strategies for SCP to create flexibility when employing resilience strategies. The results revealed that implementing resilience strategies alone is ineffective in improving SCP, while resilience strategies combined with the nullification of risk factors enhance SCP. The study also revealed two alternative configurations of resilience strategies to tackle the relevant risk factors. These findings can be used to guide managers toward identifying the most suitable configuration of resilience strategies to manage severe and unprecedented supply chain risk. The alternative configurations of resilience strategies can also provide flexibility to managers in deciding the best course of action for their firms.

Reduced Immunogenicity of COVID-19 Vaccine in Obese Patients with Type 2 Diabetes: A Cross-Sectional Study.

The global pandemic of coronavirus infection 2019 (COVID-19) was an unprecedented public health emergency. Several clinical studies reported that heart disease, lung disease, diabetes, hypertension, dyslipidemia, and obesity are critical risk factors for increased severity of and hospitalization for COVID-19. This is largely because patients with these underlying medical conditions can show poor immune responses to the COVID-19 vaccinations. Diabetes is one of the underlying conditions most highly associated with COVID-19 susceptibility and is considered a predictor of poor prognosis of COVID-19. We therefore investigated factors that influence the anti-SARS-CoV-2 spike IgG antibody titer after three doses of vaccination in patients with type 2 diabetes. We found that obesity was associated with low anti-SARS-CoV-2 spike IgG antibody titers following three-dose vaccination in type 2 diabetics. Obese patients with type 2 diabetes may have attenuated vaccine efficacy and require additional vaccination; continuous infection control should be considered in such patients.

The correlation study between TOP2A gene expression in circulating tumor cells and chemotherapeutic drug resistance of patients with breast cancer

BackgroundPatients with breast cancer (BC) at advanced stages have poor outcomes because of high rate of recurrence and metastasis. Biomarkers for predicting prognosis remain to be explored. This study aimed to evaluate the relationships between circulating tumor cells (CTCs) and outcomes of BC patients.Patients and methodsA total of 50 female were enrolled in this study. Their diagnoses were determined by clinical characteristics, image data, and clinical pathology. CTC subtypes and TOP2A gene expression on CTCs were detected by CanPatrol™ technology and triple color in situ RNA hybridization (RNA-ISH), which divided into epithelial CTCs (eCTCs), mesenchymal CTCs (MCTCs), and hybrid CTCs (HCTCs) based on their surface markers. Hormone receptor, including estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2) expression, was measured by immunohistochemistry (IHC) method before treatment. The risk factors for predicting recurrence and metastasis were calculated by COX risk regression model. The progression-free survival (PFS) of patients was determined using Kaplan–Meier survival curve.ResultsThe patients with a large tumor size (≥ 3 cm) and advanced tumor node metastasis (TNM) stages had high total CTCs (TCTCs) (P < 0.05). These patients also had high TOP2A expression level. COX risk regression analysis indicated that TOP2A expression levels in TCTCs, ER + , HER-2 + , and TNM stages were critical risk factors for recurrence and metastasis of patients (P < 0.05). The PFS of patients with ≥ 5 TCTCs, ≥ 3 HCTCs, and positive TOP2A expression in ≥ 3 TCTCs was significantly longer than that in patient with < 5 TCTCs, < 3 HCTCs, and TOP2A expression in < 3 TCTCs (P < 0.05). In contrast, the PFS of patients with positive hormone receptors (ER + , PR + , HER-2 +) also was dramatically lived longer than that in patients with negative hormone receptor expression.ConclusionsHigh TCTC, HCTCs, and positive TOP2A gene expression on CTCs were critical biomarkers for predicting outcomes of BC patients. Positive hormone receptor expression in BC patients has significant favor PFS.

농촌지역 청소년의 정서증진을 위한 생명존중 프로그램 연구

This study is a study on a respect for life program to improve the emotions of youth inrural areas. Adolescence is a period greatly influenced by the social and culturalenvironment. In particular, growth progresses rapidly both physically and mentally, anddevelopmental and environmental stress is experienced in the process of findingself-identity. Crisis management also deals with emotional confusion and frustration. Thereis a shortage. This study was conducted using a self-administered Google questionnairetargeting rural youth in Region D. The survey period is from September 1 to October 30,2023, and a survey was conducted after the respect for life program. The survey toolswere emotional regulation, self-esteem, and stress. As a result of the study, adolescentswere emotionally unstable and showed characteristics such as falling into depression orshowing strong rebelliousness or aggression even to the slightest stimulus. Awareness ofrespect for life is a very important issue during adolescence. In particular, critical riskfactors for suicide include stress, depression, and low self-esteem, and positive protectivefactors include improved self-esteem and positive emotions. This study aimed to giveyouth positive awareness of the value of respect for life and the importance of respect forlife through respect for life education. In addition, this study analyzes the current situationof youth and suggests the effectiveness of respect for life for improving the quality of lifeof youth in rural areas as well as their emotions.

The secondary prevention of coronary heart disease in US adults 75 Years and older in daily practice: Results from the National Health and Nutrition Examination Survey 1999–2018 survey

BackgroundPharmacologic therapies, risk factor control, and lifestyle alterations were independently proven to reduce long-term cardiovascular events. However, comprehensive research examining the extent to which individuals aged 75 and above in the United States adhere to national guidelines for the secondary prevention of coronary heart disease is limited. Therefore, the primary objective of this study was to examine the current state of secondary prevention of coronary heart disease in persons 75 years of age and older in the United States and to examine the factors that contribute to inadequate drug utilization and poor control of numerous risk factors. MethodsWe identified patients over 75 years of age with coronary heart disease based on the National Health and Nutrition Examination Survey from 1999 to 2018 and analyzed the adequacy of risk factor control and adherence to lifestyle and medication recommendations to assess the effectiveness of coronary heart disease management. Logistic regression analysis was used to identify factors associated with uncontrolled risk factors or noncompliance with recommended medications. ResultsWe collected information from 1566 known coronary heart disease patients aged ≥75 years of age. The majority were at target goals for blood pressure (58.88%), low-density lipoprotein cholesterol (66.85%), and glycated hemoglobin (76.12%). Only 27.8% and 36.06% were at targets for body mass index and waist circumference, respectively. 91.95% reported smoking cessation, 85.98% followed recommended alcohol consumption, whereas only 10.34% reported sufficient physical activity. For β blockers, angiotensin -converting enzyme inhibitors/angiotensin receptor blockers, statins, and antiplatelet drugs, the utilization of indicated therapy was 54.41%, 49.36%, 54.79%, and 19.03%, respectively (6.26% for all 4 medications). The results of the logistic regression analysis demonstrated that diabetes mellitus and metabolic syndrome were critical markers of numerous uncontrolled risk variables as well as noncompliance with medication regimens. ConclusionsA vast majority of coronary heart disease patients ≥75 years in the USA exhibited suboptimal overall control of critical coronary heart disease risk factors. For this patient population, more knowledge is necessary to enable patients to receive continuous support, guidance, and counseling.

Biomarkers of Physical and Mental Health for Prediction of Parkinson's Disease: A Population-Based Study from 15 European Countries

Early diagnosis of Parkinson's disease (PD) is critical for optimal treatment. However, the predictive potential of physical and mental health in PD is poorly characterized. We evaluated the potential of multiple demographic, physical, and mental factors in predicting the future onset of PD in older adults aged 50 years or older from 15 European countries. Individual study participants were followed over four waves of the Survey of Health, Ageing, and Retirement in Europe (SHARE) from 2013-2020. Of 57,980 study participants, 442 developed PD during the study period. We identified male sex and advancing age from the sixth decade of life onward as significant predictors of future PD. Among physical factors, a low handgrip strength (HGS; men <27 kg, women <16 kg), being bothered by frailty, and recent falls were significantly associated with future PD. Among mental factors, a higher depression (Euro-D depression score >6) emerged as an independent predictor of future PD. Finally, the presence of hypertension or Alzheimer's disease (AD) increases the risk of future PD. Altogether, male sex, advancing age, low HGS, frailty, depression, hypertension, and AD were identified as critical risk factors for future PD. Our results may be useful in the early identification and treatment of populations at risk for PD.

Renal damage and old age: risk factors for thrombosis in patients with ANCA-associated vasculitis.

Thrombosis in ANCA-associated vasculitis (AAV) was prevalent and has been neglected in Chinese patients. This study tried to describe the clinical characteristics, identify the risk factors, and investigate the causal relationship between AAV and venous thromboembolism (VTE) by two-sample Mendelian randomization (MR) analysis. In this retrospective, observational study, we included all hospitalized AAV patients from Jan 2013 to Apr 2022 in Peking Union Medical College Hospital. We collected their clinical data for multivariate regression analysis to determine the risk factors for thrombosis. The nomogram was constructed by applying these risk factors to predict thrombosis in AAV patients. As for MR analysis, we selected single nucleotide polymorphisms (SNPs) related to AAV from published genome-wide association studies and extracted the outcome data containing deep vein thrombosis (DVT) and pulmonary embolism (PE) from the UK biobank. 1203 primary AAV patients were enrolled, and thrombosis occurred in 11.3%. Multivariate regression suggested that older than 65 years, EGPA, neurological involvement, lung involvement, significantly elevated serum creatinine (> 500µmol/L), and elevated D-dimer were associated with thrombosis in AAV patients. The model demonstrated satisfied discrimination with an AUC of 0.769 (95% CI, 0.726-0.812). MR analysis showed that EGPA could increase the risk of developing DVT and PE (OR = 1.0038, 95%CI = 1.0035-1.0041, P = 0.009). Thrombosis was not rare in Chinese patients with AAV. Renal damage and old age emerged as critical risk factors for thrombosis. EGPA might have a potential causal relationship with DVT and PE.

Risk analysis of electrical power grids in India using best-worst method and grey causal modelling

PurposeThe study aims to identify the possible risk factors for electricity grids operational disruptions and to determine the most critical and influential risk indicators.Design/methodology/approachA multi-criteria decision-making best-worst method (BWM) is employed to quantitatively identify the most critical risk factors. The grey causal modeling (GCM) technique is employed to identify the causal and consequence factors and to effectively quantify them. The data used in this study consisted of two types – quantitative periodical data of critical factors taken from their respective government departments (e.g. Indian Meteorological Department, The Central Water Commission etc.) and the expert responses collected from professionals working in the Indian electric power sector.FindingsThe results of analysis for a case application in the Indian context shows that temperature dominates as the critical risk factor for electrical power grids, followed by humidity and crop production.Research limitations/implicationsThe study helps to understand the contribution of factors in electricity grids operational disruptions. Considering the cause consequences from the GCM causal analysis, rainfall, temperature and dam water levels are identified as the causal factors, while the crop production, stock prices, commodity prices are classified as the consequence factors. In practice, these causal factors can be controlled to reduce the overall effects.Practical implicationsFrom the results of the analysis, managers can use these outputs and compare the risk factors in electrical power grids for prioritization and subsequent considerations. It can assist the managers in efficient allocation of funds and manpower for building safeguards and creating risk management protocols based on the severity of the critical factor.Originality/valueThe research comprehensively analyses the risk factors of electrical power grids in India. Moreover, the study apprehends the cause-consequence pair of factors, which are having the maximum effect. Previous studies have been focused on identification of risk factors and preliminary analysis of their criticality using autoregression. This research paper takes it forward by using decision-making methods and causal analysis of the risk factors with blend of quantitative and expert response based data analysis to focus on the determination of the criticality of the risk factors for the Indian electric power grid.

Assessment of risk factors for nephrolithiasis in Rawat.

Objective: To identify the risk factors for nephrolithiasis among all patients found to have nephrolithiasis on renal sonography. The study will help us report the incidence of renal stones in this area, and as they cause significant morbidity and high costs of healthcare, and guide towards the introduction of public health measures to reduce the incidence of nephrolithiasis. Study Design: Descriptive, Questionnaire Based Cross-sectional study. Setting: Watim General Hospital, Rawalpindi. Period: Jul 1st, 2023 to Sep 30th, 2023. Material &amp; Methods: The data of all adult patients who underwent renal sonography and were documented to have nephrolithiasis was obtained through physician administered questionnaires from the ultrasound department records. Data was then entered and analyzed by using the Statistical Package for the Social Sciences (SPSS), version 16. Results: Data was collected on 115 patients, of these, 57% were males. 48% of the patients were aged between 18-30 years of age. 54% of the patients belonged to lower socio-economic class. 55% of them had low water intake, and 81% consumed non-purified water. 51% patients also had a positive family history. 81% of the patients had less intake of citrus fruits and 37% of them never exercised. Conclusion: Many significant risk factors were assessed. Awareness campaigns and preventive health measures should be implemented addressing the critical risk factors. This will help decrease the burden on patients, and on the health care system.

Body mass index as a dominant risk factor for metabolic syndrome among indonesian adults: a 6-year prospective cohort study of non-communicable diseases

BackgroundNon-communicable diseases (NCDs), notably cardiovascular disease and type 2 diabetes mellitus, are largely driven by metabolic syndrome (MetS), a cluster of critical risk factors. Despite extensive research, the progression of MetS, especially in Indonesia, has received limited attention. This research tracks adult MetS risk dynamics in a populous Bogor District cohort, providing crucial insights into its evolving nature.MethodsThis prospective open cohort study analysed secondary data from the Special Research - Cohort Study of Non-Communicable Diseases by the Ministry of Health, Republic of Indonesia from 2011 to 2018. The final sample was 1,376 Indonesian adult participants, all residents of Bogor District. MetS outcome, dietary assessment, physical activity, and biomarkers were analysed every two consecutive years.ResultsThe risk of overweight and obese participants developing MetS was 2.4 and 4.4 times higher, respectively (95% CI: 1.176–3.320 and 3.345–5.740) than those with body mass index (BMI) in the normal range. Participants who reported less intentional physical exercise had a MetS risk 1.5 times higher (95% CI: 1.034–2.109) than those with more intentional physical exercise. The role of diet is also significant, evidenced by a 30% reduction in MetS risk for people with fat intakes in the 2nd quartile compared to the 1st quartile (95% CI: 0.505–0.972). Meanwhile, a carbohydrate intake in the 2nd quartile increased the risk of MetS 1.5 times (95% CI: 1.063–2.241) in comparison with the 1st quartile.ConclusionsNotably, participants with underweight BMI exhibited the highest cumulative survival of MetS, while those with obese BMI recorded the lowest cumulative survival. There is an urgent need for strategic interventions to enhance the existing early detection and NCD monitoring program. This involves a targeted focus on promoting a community-based healthy lifestyle in the Bogor District. The study emphasizes the importance of tailored public health measures to address specific risk factors identified in the local context, aiming to mitigate the prevalence and impact of MetS in the population.

Genetic determinants of blood pressure and heart rate identified through ENU-induced mutagenesis with automated meiotic mapping.

We used N-ethyl-N-nitrosurea-induced germline mutagenesis combined with automated meiotic mapping to identify specific systolic blood pressure (SBP) and heart rate (HR) determinant loci. We analyzed 43,627 third-generation (G3) mice from 841 pedigrees to assess the effects of 45,378 variant alleles within 15,760 genes, in both heterozygous and homozygous states. We comprehensively tested 23% of all protein-encoding autosomal genes and found 87 SBP and 144 HR (with 7 affecting both) candidates exhibiting detectable hypomorphic characteristics. Unexpectedly, only 18 of the 87 SBP genes were previously known, while 26 of the 144 genes linked to HR were previously identified. Furthermore, we confirmed the influence of two genes on SBP regulation and three genes on HR control through reverse genetics. This underscores the importance of our research in uncovering genes associated with these critical cardiovascular risk factors and illustrate the effectiveness of germline mutagenesis for defining key determinants of polygenic phenotypes that must be studied in an intact organism.

Risk factors and clinical characteristics of surgical site infections in athletes undergoing Achilles tendon repair surgery.

Achilles tendon ruptures are common in athletes, requiring surgical intervention. However, the risk of surgical site infections (SSIs) post-surgery poses significant challenges. This study aims to analyse the risk factors and microbial aetiology associated with SSIs in athletes undergoing Achilles tendon repair. A comprehensive retrospective analysis was conducted from May 2021 to July 2023. The study included 25 patients with SSIs (case group) and 50 patients without SSIs (control group) post Achilles tendon repair surgery. Inclusion criteria encompassed patients with medically confirmed Achilles tendon ruptures who underwent surgical repair. Exclusion criteria included prior tendon pathologies and significant chronic illnesses. Diagnostic criteria for SSIs involved symptoms like elevated body temperature and localized tenderness, along with laboratory confirmations such as positive microbiological cultures. The study utilized VITEK® 2 for bacterial identification and involved statistical analyses like univariate and multivariate logistic regression. The study identified Staphylococcus aureus as the primary pathogen in SSIs. Significant risk factors included lack of prophylactic antibiotic use, presence of diabetes, open wounds and prolonged surgery duration. Univariate analysis revealed stark contrasts in these factors between infected and non-infected groups, while multivariate analysis underscored their importance in SSI development. S. aureus emerged as the predominant pathogen in SSIs post Achilles tendon repair. Critical risk factors such as absence of prophylactic antibiotics, diabetes, open wounds and extended surgery duration play a vital role in SSIs. Addressing these factors is essential for better postoperative outcomes in Achilles tendon repair surgeries.

Identification of key potential infection processes and risk factors in the computed tomography examination process by FMEA method under COVID-19

PurposeTo identify the key infection processes and risk factors in Computed Tomography (CT) examination process within the standard prevention and control measures for the COVID-19 epidemic, aiming to mitigate cross-infection occurrences in the hospital.MethodThe case hospital has assembled a team of 30 experts specialized in CT examination. Based on the CT examination process, the potential failure modes were assessed from the perspective of severity (S), occurrence probability (O), and detectability (D); they were then combined with corresponding risk prevention measures. Finally, key infection processes and risk factors were identified according to the risk priority number (RPN) and expert analysis.ResultsThrough the application of RPN and further analysis, four key potential infection processes were identified, including “CT request form (A1),” “during the scan of CT patient (B2),” “CT room and objects disposal (C2),” and “medical waste (garbage) disposal (C3)”. In addition, eight key risk factors were also identified, including “cleaning personnel does not wear masks normatively (C32),” “nurse does not select the vein well, resulting in extravasation of the peripheral vein for enhanced CT (B25),” “patient cannot find the CT room (A13),” “patient has obtained a CT request form but does not know the procedure (A12),” “patient is too unwell to continue with the CT scan (B24),” “auxiliary staff (or technician) does not have a good grasp of the sterilization and disinfection standards (C21),” “auxiliary staff (or technician) does not sterilize the CT machine thoroughly (C22),” and “cleaning personnel lacks of knowledge of COVID-19 prevention and control (C33)”.ConclusionHospitals can publicize the precautions regarding CT examination through various channels, reducing the incidence of CT examination failure. Hospitals’ cleaning services are usually outsourced, and the educational background of the staff employed in these services is generally not high. Therefore, during training and communication, it is more necessary to provide a series of scope and training programs that are aligned with their understanding level. The model developed in this study effectively identifies the key infection prevention process and critical risk factors, enhancing the safety of medical staff and patients. This has significant research implications for the potential epidemic of major infectious diseases.

Is hemodiafiltration superior to high-flow hemodialysis in reducing all-cause and cardiovascular mortality in kidney failure patients? A meta-analysis of randomized controlled trials.

Hemodiafiltration (HDF) and high-flux hemodialysis (hf-HD) are different methods of kidney replacement therapy (KRT) used for the treatment of kidney failure patients. A debate has raged over the last decade about the survival benefit of patients with the use of HDF compared with hf-HD, but with divergent results from randomized controlled trials. Therefore, this study aimed to perform a meta-analysis to compare HDF and hf-HD regarding all-cause and cardiovascular mortality. PubMed and Cochrane databases were searched until July 19, 2023, for randomized clinical trials comparing HDF and hf-HD in patients on maintenance dialysis. A meta-analysis was performed using Stata 16.1, applying fixed or random effect models according to the heterogeneity between studies. Of the 496 studies found, five met the inclusion criteria. Compared with the hf-HD group, the risk ratio (RR) for all-cause mortality with HDF use was 0.76 (95% CI: 0.67-0.88, I2 = 0%). HDF was associated with lower cardiovascular mortality, although the sensitivity analysis showed that the result differed between scenarios. Subgroup analysis showed lower all-cause mortality among patients without diabetes in the HDF group compared with hf-HD (RR 0.66, 95% CI: 0.51-0.81, I2 = 0%), but not in diabetic patients (RR = 0.89, 95% CI: 0.65-1.12, I2 = 0.0%). A subgroup analysis considering convection volumes was not performed, but the studies with the highest weight in the meta-analysis described convection volume as more than 20 L/session. More clinical studies considering critical risk factors, such as advanced age and preexisting cardiovascular disease, are needed to confirm the supremacy of HDF over hf-HD on the survival of patients treated by these two forms of kidney replacement therapy.

Exploring the Critical Risk Factors of Public–Private Partnership City Hospital Projects in Turkey

Governments face challenges in delivering essential public services due to their limited funds. This has led to an increasing reliance on the Public–Private Partnership (PPP) model, an alternative financing model involving a long-term collaboration between the private and public sectors to provide public services. Turkey, as a developing country facing financial limitations, has embraced the PPP model to address urgent public needs. Over the past decade, the Turkish Government has extensively utilized the PPP model, particularly in executing city hospital projects. However, investors have faced challenges in project execution due to various risk factors. Therefore, the main objective of this study is to explore the critical risk factors associated with PPP city hospital projects in Turkey. In this context, a comprehensive literature review was conducted to identify potential risks related to PPP city hospital projects. A questionnaire survey was implemented to assess the probability of occurrence and the severity of the impact of these risk factors. The collected data underwent analysis to determine the priority of these risk factors. The findings revealed that the top five most critical risk factors in PPP city hospital projects in Turkey are “foreign exchange rate fluctuations”, “inflation rate volatility”, “high finance costs”, “fiscal issues”, and “economic crises”. Conversely, “unavailability of equipment” was identified as the least significant risk factor. The insights gained from this research can offer valuable guidance for prospective investors interested in participating in PPP city hospital projects in Turkey and other developing countries with similar conditions.

Risk evaluation of mega infrastructure construction supply chain in engineering-procurement-construction projects: an integrated fuzzy AHP and fuzzy DEMATEL approach

PurposeThe paper covers mega infrastructure construction supply chain (MICSC) in Engineering-Procurement-Construction (EPC) projects, where the frequent occurrence of risk incidents has greatly affected human life. The research aims to establish a risk evaluation index system for MICSC in EPC projects, exploring what risk factors lead to risk incidents and measure the importance and causality of all these risk factors.Design/methodology/approachThe research applies a combination of quantitative and qualitative analysis methodology to process data sequentially. In the first place, risk factors for MICSC in EPC projects are extracted and identified from literature survey and expert interviews. In the second place, an integration model fuzzy Analytic Hierarchy Process (f-AHP) and fuzzy Decision-making Trial and Evaluation Laboratory (f-DEMATEL) is constructed to comprehensively analyze all these risk factors.Findings12 primary risk factors and 36 secondary risk factors comprise the risk evaluation index system for MICSC in EPC projects from 178 literature and 5 professionals. The results indicate that Political Situation (F1), Social Security (F2) and Management Mode (F8) are critical risk factors, where F1 and F2 are cause factors and F8 is an effect factor.Originality/valueThere are three main contributions of this paper. First and foremost, from the perspective of the research content, no other study has been able to assess risk factors for MICSC in EPC projects, while embedding nine phases of the whole project life cycle and six subjects of stakeholders into a risk evaluation index system. Additionally, from the perspective of research method, a combined model incorporating f-AHP and f-DEMATEL is constructed to avoid the one-sidedness of a single model. Last but not least, from the perspective of practical significance, focusing on the critical risk factors, a series of effective measures are formulated to make appropriate management decisions for nodal enterprises of MICSC, which can improve their risk management capabilities.

Critical Risk Factors influencing Time Schedule of Residential Projects in Pakistan

Delays in residential construction projects are common issues in both developing and developed countries. This research aims to identify the key reasons behind these delays in Pakistan. When the projects run behind schedule, this can lead to problems such as exceeding the budget, reduced productivity at the construction site, and potentially lower quality work. The study involved a detailed survey using questionnaires that were addressed to industry professionals. Their responses were used to rank the critical factors causing delays. The most significant factors were found to be fluctuating material prices, financial challenges for contractors, underestimating project duration, poor site management, inexperienced contractors, ineffective project management, communication gaps among project stakeholders, shortage of skilled workers, changes in project design, unqualified contractors, and inadequate project planning. Identifying these critical factors through the Relative Importance Index (RII) method can help in addressing and preventing delays in Pakistan's construction projects, ensuring timely completion and better project outcomes in the future.

Microbial associations for pneumonia causative agents and level of their resistance to antimicrobial drugs during a new coronavirus infection pandemic

Introduction. Bacterial coinfection and secondary bacterial infection are considered critical risk factors for the severity and mortality of SARS-CoV-2-caused pneumonia. The aim of the study was to analyze a pattern of microbial associations between K. pneumoniae and A. baumannii isolated from the lower respiratory tract discharge and sectional material (lung tissue) of patients diagnosed with pneumonia, and to compare resistance level in monoculture and associations during new coronavirus infection pandemic. Materials and methods. A bacteriological study of 2689 sputum and bronchial washing samples from patients at infectious diseases hospitals, and 1411 lung pathological material samples was carried out. Bacterial isolates were identified by mass spectrometry. Antibiotic sensitivity for isolates was determined by the disk diffusion method. Genetic determinants of resistance to beta-lactam antibiotics were detected by PCR. Statistical data processing was performed using SPSS version 22 software. Results. K. pneumoniae and A. baumannii isolates were predominantly found in two- and three-pathogen associations. It was established that the resistance level of K. pneumoniae isolates in association with A. baumannii is significantly higher compared to that in monoculture for all antimicrobial drugs studied. At the same time, K. pneumoniae in combination with Candida spp. vs monoculture showed significantly lower level of resistance to ciprofloxacin, amikacin, cefotaxime, ceftazidime and amoxicillin/clavulanic acid. K. pneumoniae isolates carried resistance determinants to extended-spectrum beta-lactamases: OXA-48 — (22.5%), OXA-51 — (5.6%), OXA-23 — (4.2%), KPC — 70.9%, NDM — 7%. Of these, 14.1% of strains had the ability to co-produce serine carbapenemases OXA-48 and KPC. Sputum and lung tissue A. baumannii isolates exhibited extremely high multiple resistance regardless of their associations with other microorganisms. Microbiome species similarity in the lower respiratory tract and lung tissue discharge was revealed. The proportion of lung tissue vs sputum resistant strains of K. pneumoniae and A. baumannii was significantly higher. Conclusion. The detection of of multiple drug resistant K. pneumoniae and A. baumannii isolates as well as their associations may indicate aggravated pneumonia severity.

Risk Prioritization tools for emerging and epidemic-prone diseases: A One Health scoping review

Background and Aim: The threat of emerging and epidemic-prone diseases is a significant public health concern and there is an urgent need to work on the prevention and control of these diseases. In view of the limited time and other resources available to the animal and human health sector, it is crucial to prioritize the most essential and critical risk factors and diseases. This scoping review aims to document the available disease and risk prioritization tools by evaluating their characteristics and suitability from the One Health perspective. Materials and Methods: Databases such as PubMed, Scopus, and Google Scholar were used to extract available tools for prioritization. We compared and synthesized the objective of the tool, methodology and prioritization process of the available tools. Results: A total of six tools, including One Health Zoonotic Disease Prioritization, European Centre for Disease Prevention and Control, Strategic Toolkit for Assessing Risks, One Health Systems Mapping and Analysis Resource Toolkit, Health Hazard Assessment and Prioritization tool, Risk Ranger, are included in this scoping review. Various prioritization methods are available; however, multi-criteria decision analysis is the most commonly used. Conclusion: A thorough analysis showed that different tools employ different prioritizing approaches, including mixed-method, quantitative, and qualitative approaches. The summary of the findings suggests the development of a new robust tool with a One Health approach, which will focus on risk prioritization and disease prioritization. Keywords: disease prioritization, prioritization in public health, prioritization tool, risk prioritization.

Perioperative Opioid-Related Harms: Opportunities to Minimize Risk.

Although substantial attention has been given to opioid prescribing in the United States, opioid-related mortality continues to climb due to the rising incidence and prevalence of opioid use disorder. Perioperative care has an important role in the consideration of opioid prescribing and the care of individuals at risk for poor postoperative pain- and opioid-related outcomes. Opioids are effective for acute pain management and commonly prescribed for postoperative pain. However, failure to align prescribing with patient need can result in overprescribing and exacerbate the flow of unused opioids into communities. Conversely, underprescribing can result in the undertreatment of pain, complicating recovery and impairing well-being after surgery. Optimizing pain management can be particularly challenging for individuals who are previously exposed to opioids or have critical risk factors, including opioid use disorder. In this review, we will explore the role of perioperative care in the broader context of the opioid epidemic in the United States, and provide considerations for a multidisciplinary, comprehensive approach to perioperative pain management and optimal opioid stewardship.