Fatality Risk Research Articles

Impact of uncertainty induced by fatality function on future tropical cyclone risk assessment

Tropical cyclones (TCs) are among the deadliest extreme events occurring under a warming climate. Future TC risk assessment depend on TC projection from climate models and impact function relating TC to its possible consequence. Few studies have explored the uncertainty of impact function in future TC risk assessment compared to uncertainty in future TC characteristics. In this study, we investigate the uncertainty in TC fatality risk assessment induced by geographic and TC category-dependence of fatality function. We focus on all provinces in the mainland of China with historically recorded TC-induced fatalities and examine their TC fatality risks by assessing the difference in the annual average fatalities between current and future climate conditions. Synthetic TCs derived from four climate models and fatality functions parameterized from three grouped historical TC disaster datasets are used to observe the uncertainty induced by climate model and fatality function. Results show that the changes in the TC frequency, wind, TC-induced rainfall intensity, and exposure due to climate change in each province are dependent on the climate models. And the changes in the annual average fatality of each province are dependent on both the climate models and fatality functions. Climate models play a dominant role in determining the spatial pattern of future risk, while the fatality functions can alter the direction and magnitude of the risk change for certain provinces. Our results highlight the role of fatality function in detecting future TC risk under climate change, and inspire further TC impact studies that consider the heterogeneity of both climate conditions and geographical locations.

Low-Cost Sensors Technologies for Monitoring Sustainability and Safety Issues in Mining Activities: Advances, Gaps, and Future Directions in the Digitalization for Smart Mining.

Nowadays, monitoring aspects related to sustainability and safety in mining activities worldwide are a priority, to mitigate socio-environmental impacts, promote efficient use of water, reduce carbon footprint, use renewable energies, reduce mine waste, and minimize the risks of accidents and fatalities. In this context, the implementation of sensor technologies is an attractive alternative for the mining industry in the current digitalization context. To have a digital mine, sensors are essential and form the basis of Industry 4.0, and to allow a more accelerated, reliable, and massive digital transformation, low-cost sensor technology solutions may help to achieve these goals. This article focuses on studying the state of the art of implementing low-cost sensor technologies to monitor sustainability and safety aspects in mining activities, through the review of scientific literature. The methodology applied in this article was carried out by means of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and generating science mapping. For this, a methodological procedure of three steps was implemented: (i) Bibliometric analysis as a quantitative method, (ii) Systematic review of literature as a qualitative method, and (iii) Mixed review as a method to integrate the findings found in (i) and (ii). Finally, according to the results obtained, the main advances, gaps, and future directions in the implementation of low-cost sensor technologies for use in smart mining are exposed. Digital transformation aspects for data measurement with low-cost sensors by real-time monitoring, use of wireless network systems, artificial intelligence, machine learning, digital twins, and the Internet of Things, among other technologies of the Industry 4.0 era are discussed.

Natural Radioactivity for some Types of Date in Al-Qasim Subdistrict, Babylon Governorate

The aim of the present study is to assess some radiological hazard risk parameters such as the annual effective dose (AED), Fatal Cancer Risk (FCR), Hereditary Cancer Risk (HCR), radium equivalent (Raeq), and Internal hazard index (Hin) due to specific activity of 238U, 232Th, and 40K in some samples of date in Al-Qasim subdistrict, Babylon governorate. The specific activity was measured using gamma-ray spectroscopy with NaI(Tl) doctor. The average values of the specific activity in unit Bq/kg for 238U, 232Th, and 40K were 10.83 ±1.22, 4.94 ±0.80, and 341.36 ±15.25, respectively. While, the average values of total AED, FCR×10-3, HCR×10-3, Raeq, and Hin were 0.210±0.018 mSv/y, 0.737±0.064, 0.198±0.008, 44.18±3.10 Bq/kg, and 0.148±0.011, respectively. The results show that, all values of 238U, 232Th, and 40K were lower than the global limit according to UNSCEAR 2008 (33 Bq/kg, 45 Bq/kg, and 420 Bq/kg), except two samples have 40K higher than global limit. these because increasing used chemical fertilizers by peasants. Also, it is found that all values of the radiological hazard risk parameters in the present study were lower than global limit according to UNSCEAR, ICRP, OECD, etc. So, it was concluded that the date samples in the present study does not cause any danger to the human health when its consumption.

Fatal Drug Overdose Risks of Health Care Workers in the United States : A Population-Based Cohort Study.

Despite an unprecedented increase in drug overdose deaths in the United States, the risks faced by U.S. health care workers, who often have access to controlled prescription drugs, are not known. To estimate risks for drug overdose death among health care workers relative to non-health care workers. Prospective cohort study. United States. Health care workers (n= 176 000) and non-health care workers (n= 1 662 000) aged 26 years or older surveyed in 2008 and followed for cause of death through 2019. Age- and sex-standardized drug overdose deaths were determined for 6 health care worker groups (physicians, registered nurses, other treating or diagnosing health care workers, health technicians, health care support workers, and social or behavioral health workers) and non-health care workers. Adjusted drug overdose death hazards (and 95% CIs) were also evaluated, with adjustment for age, sex, race/ethnicity, marital status, education, income, urban or rural residence, and region. Approximately 0.07% of our study sample died of a drug overdose during follow-up. Among health care workers, annual standardized rates of drug overdose death per 100 000 persons ranged from 2.3 (95% CI, 0 to 4.8) for physicians to 15.5 (CI, 9.8 to 21.2) for social or behavioral health workers. Compared with those for non-health care workers, the adjusted hazards of total drug overdose death were significantly increased for social or behavioral health workers (adjusted hazard ratio, 2.55 [CI, 1.74 to 3.73]), registered nurses (adjusted hazard ratio, 2.22 [CI, 1.57 to 3.13]), and health care support workers (adjusted hazard ratio, 1.60 [CI, 1.19 to 2.16]), but not for physicians (adjusted hazard ratio, 0.61 [CI, 0.19 to 1.93]), other treating or diagnosing health care workers (adjusted hazard ratio, 0.93 [CI, 0.44 to 1.95]), or health technicians (adjusted hazard ratio, 1.13 [CI, 0.75 to 1.68]). Results were generally similar for opioid-related overdose deaths and unintentional overdose deaths. Unmeasured confounding, uncertain validity of cause of death, and one-time assessment of occupation. Registered nurses, social or behavioral health workers, and health care support workers were at increased risk for drug overdose death, suggesting the need to identify and intervene on those at high risk. National Heart, Lung, and Blood Institute.

Elimination, Containment, and Mitigation of COVID-19: A Personal Story about International Travels.

The author and his wife report their unique experience of international travels during the COVID-19 pandemic, and discuss issues encountered in various countries. Narrated discussion of issues encountered during the COVID-19 pandemic. "Zero-COVID" versus "Living with COVID-19" strategies are compared. Children have unique issues with COVID-19 pandemic. Evaluation of efficacy of the approaches in pandemic with time should consider the main types of interventions (e.g., border management/quarantine; physical distancing; mask use; case isolation, testing and contact tracing; vaccination). The key metrics that can be used to compare the impacts of different strategies between the cities (e.g., cumulative case rate, cumulative mortality rate, case fatality risk, stringency index, economic performance) should be identified. Research in these approaches can help manage future pandemics in coronaviruses and emerging infections. The UK started with very loose mitigation ('herd immunity') and then switched to a suppression approach in 2021, followed by "living with the virus" approach. Whereas HK has been targeting towards elimination throughout. In between, countries like Singapore, Australia and New Zealand have shifted from zero-COVID strategy to living with the virus. It is easier to have effective social control measures in Hong Kong because it has clear borders and an authoritarian government, but it did not have a clear exit policy when Omicron spread.

Obesity and 30-day case fatality after hyperglycemic crisis hospitalizations in Korea: a national cohort study

Background: We determined the case fatality rate associated with hospitalization due to hyperglycemic crises and investigated the relationship between obesity status and case fatality for hyperglycemic crises.Methods: From the Korean National Health Insurance Service-National Sample Cohort, 729 adults who visited the emergency room or were hospitalized due to hyperglycemic crises between January 1, 2010, and December 31, 2019, were included. Preobesity or obesity was defined as a body mass index ≥23.0 kg/m2. Case fatality rates are presented as the proportion of adults who died within 30 days of hospitalization. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for 30-day fatalities according to preobesity or obesity status.Results: The 30-day case fatality rate for hyperglycemic crises was 11.2%. In those aged ≥65 years, the fatality rate was twice as high as that in those aged 20 to 64 years (13.8% vs. 6.8%). Adults with preobesity or obesity had a lower fatality rate than those with normal weight (9.5% vs. 14.0%). After adjustment for confounding variables, preobesity or obesity was found to be significantly associated with a decreased risk for 30-day case fatality compared to normal weight (HR, 0.63; 95% CI, 0.40–0.98).Conclusions: In Korea, hyperglycemic crises had a high fatality rate. Management needs to be improved to prevent hyperglycemic crises and reduce mortality.

Trends, Characteristics, and Maternal Morbidity Associated With Unhoused Status in Pregnancy

Unhoused status is a substantial problem in the US. Pregnancy characteristics and maternal outcomes of individuals experiencing homelessness are currently under active investigation to optimize health outcomes for this population. To assess the trends, characteristics, and maternal outcomes associated with unhoused status in pregnancy. This cross-sectional study analyzed data from the Healthcare Cost and Utilization Project National (Nationwide) Inpatient Sample. The study population included hospitalizations for vaginal and cesarean deliveries from January 1, 2016, to December 31, 2020. Unhoused status of these patients was identified from use of International Statistical Classification of Diseases, Tenth Revision, Clinical Modification code Z59.0. Statistical analysis was conducted from December 2022 to June 2023. Primary outcomes were (1) temporal trends; (2) patient and pregnancy characteristics associated with unhoused status, which were assessed with a multivariable logistic regression model; (3) delivery outcomes, including severe maternal morbidity (SMM) and mortality at delivery, which used the Centers for Disease Control and Prevention definition for SMM indicators and were assessed with a propensity score-adjusted model; and (4) choice of long-acting reversible contraception method and surgical sterilization at delivery. A total of 18 076 440 hospital deliveries were included, of which 18 970 involved pregnant patients who were experiencing homelessness at the time of delivery, for a prevalence rate of 104.9 per 100 000 hospital deliveries. These patients had a median (IQR) age of 29 (25-33) years. The prevalence of unhoused patients increased by 72.1% over a 5-year period from 76.1 in 2016 to 131.0 in 2020 per 100 000 deliveries (P for trend < .001). This association remained independent in multivariable analysis. In addition, (1) substance use disorder (tobacco, illicit drugs, and alcohol use disorder), (2) mental health conditions (schizophrenia, bipolar, depressive, and anxiety disorders, including suicidal ideation and past suicide attempt), (3) infectious diseases (hepatitis, gonorrhea, syphilis, herpes, and COVID-19), (4) patient characteristics (Black and Native American race and ethnicity, younger and older age, low or unknown household income, obesity, pregestational hypertension, pregestational diabetes, and asthma), and (5) pregnancy characteristics (prior uterine scar, excess weight gain during pregnancy, and preeclampsia) were associated with unhoused status in pregnancy. Unhoused status was associated with extreme preterm delivery (<28-week gestation: 34.3 vs 10.8 per 1000 deliveries; adjusted odds ratio [AOR], 2.76 [95% CI, 2.55-2.99]); SMM at in-hospital delivery (any morbidity: 53.8 vs 17.7 per 1000 deliveries; AOR, 2.30 [95% CI, 2.15-2.45]); and in-hospital mortality (0.8 vs <0.1 per 1000 deliveries; AOR, 10.17 [95% CI, 6.10-16.94]), including case fatality risk after SMM (1.5% vs 0.3%; AOR, 4.46 [95% CI, 2.67-7.45]). Individual morbidity indicators associated with unhoused status included cardiac arrest (AOR, 12.43; 95% CI, 8.66-17.85), cardiac rhythm conversion (AOR, 6.62; 95% CI, 3.98-11.01), ventilation (AOR, 6.24; 95% CI, 5.03-7.74), and sepsis (AOR, 5.37; 95% CI, 4.53-6.36). Results of this national cross-sectional study suggest that unhoused status in pregnancy gradually increased in the US during the 5-year study period and that pregnant patients with unhoused status were a high-risk pregnancy group.

Implementation of Safety Management of Selected Construction Companies in Manila

In the 1980s, the safety management system (SMS) was created to reduce material waste and the risk of accidents and fatalities in the construction industry. With the correct SMS deployment, construction companies can reduce safety-related difficulties. This study assessed the current status of construction safety management intending to determine the level of implementation of selected construction companies with category AAA in Manila, Philippines. A survey was done to determine the SMS implementation level in terms of lack of control, basic cause, immediate cause, incident, and accident. The researcher used the quantitative method of research with the survey questionnaire as the main tool in gathering data. Architects, engineers, safety officers, and skilled workers were the respondents of the study. The gathered data were statistically treated with the use of Frequency, Percentage, Weighted Mean, Kruskal Wallis, Man Whitney U-test, and Spearman Rho Correlation. The overall results showed that the level of the selected construction companies in Manila is somewhat implemented. The results of this study are helpful to the industry as well because they can improve the understanding of SMS among industry professionals and aid in better SMS deployment at work.

COVID-19 infection and mortality among non-pregnant indigenous adults in Mexico 2020-2022: Impact of marginalisation.

Indigenous individuals have higher rates of mortality and poverty in Mexico and more than half are marginalised, and COVID-19 pandemic aggravated the existing burden of health disparities. We aimed to analyse the effects of being indigenous and marginalised on coronavirus (COVID-19) infection fatality in Mexico. We identified 3 424 690 non-pregnant, COVID-19 positive adults ≥19 years in the Mexico national COVID-19 database with known date of symptom. We used demographic information, indigenous status, marginalisation status, and co-morbidities in binary logistic regression to predict mortality, adjusting for covariates, including hospitalisation, admission to the intensive care unit (ICU), and mechanical ventilation use. We also assessed the interaction between indigenous status and marginalisation. Marginalisation was much higher among indigenous (53.7%) compared to non-indigenous individuals (4.8%). COVID-19 fatalities were approximately 20 years older (64.4 and 63.0 years) than survivors (44.7 and 41.2 years) among indigenous vs non-indigenous individuals, respectively. The unadjusted risk of COVID-19 fatality among indigenous individuals was nearly two-fold (odds ratio (OR) = 1.92)) compared to non-indigenous individuals (OR = 1.05). COVID-19 fatality was higher among highly marginalised individuals (upper quartile) (OR = 1.51; 95% confidence interval (CI) = 1.49-1.54). Marginalised indigenous individuals had a significantly lower likelihood of ICU admission compared to non-indigenous non-marginalised individuals. The likelihood of mechanical ventilation for indigenous individuals was 4% higher compared to non-indigenous individuals. Indigenous marginalised individuals had a significantly lower probability of mechanical ventilation compared to non-indigenous non-marginalised individuals. COVID-19 comorbidity risks of fatality significantly differed between the two groups in the Cox survival analysis. In the fully adjusted model, indigenous individuals were 4% more likely to die from COVID-19 compared to non-indigenous. Indigenous, marginalised individuals with COVID-19 had higher risk of hospitalisation and ICU admission than non-indigenous patients. Marginalised, indigenous individuals were less likely to receive mechanical ventilation compared to non-indigenous, but had a higher risk of COVID-19. Indigenous individuals had a 4% higher COVID-19 mortality risk COVID-19 compared to non-indigenous individuals. Improved community medical care and augmented health services in rural hospitals could mitigate barriers to health care access in indigenous, marginalised populations.

Novel Technological Advances to Protect People Who Exercise or Work in Thermally Stressful Conditions: A Transition to More Personalized Guidelines

Background: Prevention plays a key role in ensuring health and safety and is particularly important in scenarios when life is threatened. Adverse thermal conditions are experienced by billions of people daily, affecting the human capacity for thermoregulation and increasing the risks of life-threatening accidents, diseases, and fatalities. The aim of this study was to develop and validate a new, freely accessible method that will ultimately allow health, as well as exercise and labour organizations, to predict and potentially mitigate the physiological strain experienced by people who exercise or work in thermally stressful environmental conditions. Methods: First, we used concurrent technological advances and thermophysiological modelling to (i) develop a mobile phone application that predicts the physiological heat strain experienced by individuals conducting physical activity in adverse environmental conditions, and (ii) provide them with individualized heat mitigation strategies. Second, to examine the construct validity of the newly developed mobile phone application, core body temperature was recorded using gastrointestinal thermometry in 37 healthy soldiers during different activities. These data were used to examine the predictive capacity of our application in pre-classifying individuals with an increased risk of experiencing elevated physiological heat strain during work based on the guidelines (core body temperature ≥ 38 °C) of the World Health Organization. Results: The core body temperature predictions made by the mobile phone application were positively related (r = 0.57, p &lt; 0.05) with the actual physiological measurements taken by our participants (mean absolute error: 0.28 °C). More importantly, our application correctly predicted 93% of occurrences of elevated physiological heat strain and 90% of those that were not (overall accuracy: 92%). Conclusions: Mobile phone applications integrating thermophysiological models can predict the physiological heat strain experienced by an individual, but it remains to be studied whether the suggested heat mitigation strategies can reduce or prevent adverse impacts.

Factors associated with the development of a lethal hospital outcome in patients with pulmonary embolism in different age groups

Background. The study of the tactics of managing patients with pulmonary embolism in the hospital period allows to find new approaches to treatment to reduce mortality. At the same time, it is known that the risk factors for death in patients of different age categories differ.&#x0D; Aim. To study the features of the course of the disease and risk factors for a fatal hospital outcome in patients with pulmonary embolism in different age groups of participants in the All-Russian registry, which was named SIRENA (RusSIan REgister of pulmoNAry embolism).&#x0D; Material and methods. The study included 570 patients with pulmonary embolism (database of the SIRENA multicenter registry in 20182019), who underwent a standard examination. They were divided into two groups according to age: the first group was 1869 years old inclusive (n=369), the second group was 70 years and older (n=201). Differences in clinical history, laboratory and instrumental parameters in the studied groups of patients were assessed. Statistical comparison of data was performed using the MannWhitney test, Pearson test, and Fisher's exact test. For a quantitative description of the closeness of the association of a sign with the outcome of the disease, the odds ratio with a 95% confidence interval was determined.&#x0D; Results. In the group of patients aged 1869 years, deaths occurred 3 times less frequently than in the group of patients aged 70 years and older (8.9 vs 26.3%; p 0.0001). The risk of death increases in the presence of atrial fibrillation by 2.6 times (p=0.032), anemia with hemoglobin 113 g/l by 4.3 times (p=0.0002), chronic kidney disease by 5.5 times (p=0.001), increase in blood creatinine 125 mmol/l 5.8 times (p 0.001). Additional risk factors in patients aged 70 years and older are ischemic heart disease (p=0.02), a history of stroke (p=0.003), and immobilization for 12 months prior to hospitalization (p 0.0001).&#x0D; Conclusion. In patients aged 1869 years, atrial fibrillation, anemia, and impaired renal function are fatal risk factors; at the age of 70 years and older, along with these, previous immobilization and comorbid cardiovascular pathology have an adverse effect.

Attitudes of parents towards influenza vaccine in the Eastern Mediterranean Region: A multilevel analysis

BackgroundSeasonal influenza vaccines (SIVs) can protect against influenza and substantially reduce the risk of influenza-related hospitalizations and fatalities in children. This study aimed to assess parental attitudes towards SIVs in the Eastern Mediterranean region (EMR). MethodsThrough an anonymous online survey conducted in 19 countries in the EMR, parents or caregivers over 18 years who had at least one child above 6 months filled out the Parent Attitudes about Childhood Vaccines questionnaire. As data had two levels; country and individual factors, we utilized multilevel binary logistic regression models. ResultsIn total, 6992 respondents filled out the questionnaire. Of them, 47.4 % were residents of middle-income countries, 72.4 % of the mothers were between 26 and 45 years old, 56.5 % had at least a university degree, and approximately 51.6 % were unemployed. Nearly 50.8 % of the respondents were hesitant to vaccinate their children against seasonal influenza. Parental attitudes towards seasonal influenza vaccination differed significantly between countries, p < 0.001. The main predictors of parental seasonal influenza vaccine hesitancy (VH) were parents vaccination (odds ratio (OR) = 0.42, 95 % CI = 0.32–0.55, p < 0.001)), the mother's education if mother educated vs. who did not receive any education (OR ranged from 0.48 to 0.64, p < 0.05), living in low-income countries (OR = 0.52, 95 % CI = 0.35–0.77, p < 0.01), mountain residence (0.69, 95 % CI = 0.49–0.99, p < 0.05), health workers as a source of information (OR = 0.70, 95 % CI = 0.58–0.85, p < 0.001), children vaccination against COVID-19 (OR = 0.52, 95 % CI = 0.41–0.65, p < 0.001), not receiving routine vaccinations (OR = 1.93, 95 % CI = 1.09–3.44, p = 0.025), and if parents respondents could not remember whether their child had suffered from seasonal influenza in the previous year (OR = 1.57, 95 % CI = 1.33–1.84, p < 0.001). ConclusionA high seasonal influenza VH rate was found in the EMR. Health authorities should implement different interventions targeting the identified modifiable risk factor to increase vaccine uptake among children, especially those at risk of complication from seasonal influenza infection.

Understanding and modeling willingness-to-pay for public policies to enhance road safety: A perspective from Pakistan

Evaluating road safety improvements becomes important because it can assist policymakers in allocating economic resources to improve safety and implementing effective policy interventions. As such, this study aims to estimate the value of road safety risk measures using a new modeling approach for willingness-to-pay (WTP). Specifically, this study integrates a machine learning technique (decision tree) with a correlated random parameters Tobit with heterogeneity-in-means model. The decision tree identifies a priori relationships for higher-order interactions, while the model captures unobserved heterogeneity and the correlation between random parameters. The proposed modeling framework examines the determinants of public WTP for improving road safety using a sample of car drivers from Peshawar, Pakistan. WTP for fatal and severe injury risk reductions is estimated and used to calculate the values of corresponding risk reductions, which can be used for monetizing the cost of road traffic crashes in the country. Modeling results reveal that most respondents are willing to contribute to road safety improvement policies. Further, the model also uncovers significant heterogeneity in WTP corresponding to the safer perception of the overall road infrastructure and perceived risk of accident involvement. Systematic preference heterogeneity is also found in the model by including higher-order interactions, providing additional insights into the complex relationship of WTP with its determinants. Further, the marginal effects of explanatory variables indicate different sensitivities toward WTP, which can help to quantify the impacts of these variables on both the probability and magnitude of WTP. Overall, the proposed modeling framework has a twofold contribution. First, the modeling framework provides valuable insights into the determinants of public WTP, mainly when the heterogeneous effects of variables are interactive. Second, its implementation and consequent findings shall help prioritize different road safety policies/projects by better understanding public sensitivity to WTP.

Inequity in the global distribution of monkeypox vaccines.

Monkeypox (mpox) has been a public health emergency of international concern that emerged in mid-2022 and has spread to 110 countries. The clinical findings of the disease vary according to the seriousness of the cases. Although its case fatality risk has not been high, a significant percentage of patients require hospitalization. In this context, local initiatives were taken to extend the limited supply of vaccines against the disease; however, such measures have not been sufficient to contain the spread of cases and ensure an equitable distribution of health resources. As a result, endemic regions of low-income countries continue to have insufficient access to mpox vaccination. Despite this and considering the global scope of the disease, there is still little discussion in the literature about the difficulties in achieving adequate vaccination coverage rates for the target population of interest. In this article, we briefly discussed general aspects of the disease, including its surveillance, the current global context of challenges for mpox vaccination, and issues on global allocation of health resources as well as proposed related recommendations.

Relationship between Vitamin D Status in Acute Ischemic Stroke for Assessing Initial Severity and Short-Term Outcome in a Tertiary Level Hospital, Bangladesh

Recent studies suggest that vitamin D, a neuroprotective prohormone, which has a potential protective role against neurovascular injury. Low vitamin D levels were modestly associated with risk of stroke and stroke fatality. Objective: This study aimed to investigate the relationship of vitamin D status among acute ischemic stroke patients for assessing initial severity and short-term outcome. Methods: Fifty one acute ischemic stroke patients and 51 matched healthy control subjects participated in the study. Subjects were divided according to vitamin D level into deficient, insufficient, and sufficient groups. National Institute of Health Stroke Scale (NIHSS) on admission and after 72h and modified Rankin Scale (mRS) on discharge and after 3months were performed for all patients. Results: Acute ischaemic stroke patients (9.8%) had significantly lower serum vitamin D levels compared to healthy subjects (5.8%). In patients, serum vitamin D level ranged from 5 to 41ng/ml with a mean of 19.4±9.98ng/ml. In controls, serum vitamin D levels ranged from 6 to 48ng/ml with a mean of 30.3±10.48 ng/ml. Vitamin D deficiency and insufficiency were significantly prevalent among stroke patients (66.7%) compared to healthy controls (51.9%). Significant correlation was detected between serum vitamin D and NIHSS scores on admission and after 72hrs (p=0.007). Significant correlation was also detected between serum vitamin D and mRS scores on discharge and after 3months (p=0.004). The patients with 'not sufficient' vitamin D (i.e. deficient and insufficient) were 11.2 time more likely to report severe stroke (p=0.006). Conclusion: Vitamin D deficiency increases the risk of acute ischemic stroke and is associated with increased initial stroke severity and worse short-term outcome. J. of Sci. and Tech. Res. 4(1): 119-128, 2022

PTFS07-03-23 Olive Oil Intake and Fatal Dementia Risk in Two Large Prospective U.S. Cohort Studies

PTFS07-03-23 Olive Oil Intake and Fatal Dementia Risk in Two Large Prospective U.S. Cohort Studies

Development and validation of a nomogram to predict the recurrence of eyelid sebaceous gland carcinoma.

Eyelid sebaceous gland carcinoma (SGC) is a malignancy with fatal risk, high recurrence rate, and pagetoid spread. Thus, recurrence risk prediction and prompt treatment are extremely important. This study aimed to develop a nomogram to predict SGC recurrence based on potential risk factors. We conducted a retrospective study to train and test a nomogram based on the clinical data of 391 patients across our hospital (304) and other grass-roots hospitals (87). After Cox regression, predictors included in the nomogram were selected, and sensitivity, specificity, concordance index (C-index), etc., were calculated to test their discrimination ability. After a median follow-up period of 4.12 years, SGC recurred in 52 (17.11%) patients. The 1-, 2-, and 5-year recurrence-free survival rates were 88.3%, 85.4%, and 81.6%, respectively. We examined five risk factors, such as lymph node metastasis at initial diagnosis (hazard ratio [HR], 2.260; 95% confidence interval [CI], 1.021-5.007), Ki67 (HR, 1.036; 95% CI, 1.020-1.052), histology differentiation degree (HR, 2.274; 95% CI, 1.063-4.865), conjunctival pagetoid infiltration (HR, 2.100; 95% CI, 1.0058-4.167), and orbital involvement (HR, 4.764; 95% CI, 1.436-15.803). The model had good discrimination in both internal and external test sets. The model had good discrimination in both internal and external test sets. The sensitivity of the internal test and external test set were 0.722 and 0.806, respectively, and specificity of the internal test and external test set were 0.886 and 0.893, respectively. We examined the potential risk factors for eyelid SGC recurrence and constructed a nomogram, which complements the TNM system in terms of prediction, indicating that our nomogram has the potential to reach clinical significance. This nomogram has the potential to assist healthcare practitioners in promptly detecting patients who are at an elevated risk and in tailoring clinical interventions to meet their individualized needs.

Intrinsic and effective severity of COVID-19 cases infected with the ancestral strain and Omicron BA.2 variant in Hong Kong.

Understanding severity of infections with SARS-CoV-2 and its variants is crucial to inform public health measures. Here we used COVID-19 patient data from Hong Kong to characterise the severity profile of COVID-19. Time-varying and age-specific effective severity measured by case-hospitalization risk and hospitalization-fatality risk was estimated with all individual COVID-19 case data collected in Hong Kong from 23 January 2020 through to 26 October 2022 over six epidemic waves. The intrinsic severity of Omicron BA.2 was compared with the estimate for the ancestral strain with the data from unvaccinated patients without previous infections. With 32,222 COVID-19 hospitalizations and 9,669 deaths confirmed over 6 epidemic waves, the time-varying hospitalization fatality risk dramatically increased from below 10% before the largest fifth wave of Omicron BA.2, to 41% during the peak of the fifth wave when hospital resources were severely constrained. The age-specific fatality risk in unvaccinated hospitalized Omicron cases was comparable to the estimates for unvaccinated cases with the ancestral strain. During epidemics predominated by Omicron BA.2, fatality risk was highest amongst older unvaccinated patients. Omicron has comparable intrinsic severity to the ancestral Wuhan strain although the effective severity is substantially lower in Omicron cases due to vaccination.

Blood alcohol concentration as a measure of risk among pedestrian fatalities in the U.S., 2016–2020

Objective In the United States, deaths among pedestrians have increased dramatically since 2009 relative to other vulnerable road users, with substance use described as an important risk factor. This study aimed to explore blood alcohol concentrations (BAC g/dL) among pedestrian fatalities in the United States between 2016 and 2020. Exploring the presence of alcohol among pedestrian cases will support targeted interventions designed to reduce risk. Methods This study utilized pedestrian fatality and alcohol screening data provided by the Fatality Analysis Reporting System (FARS). Logistic models were examined to identify statistical associations (ORs, 95% CI) by age, race, and sex relative to positive BAC exposure (BAC > 0.0 g/dL), mild exposure (BAC > 0.0 < .079 g/dL), moderate to severe alcohol exposure (BAC 0.08–.299 g/dL), and severe exposure (BAC ≥ 0.30 g/dL). Results Between 2016 and 2020, 33,375 pedestrian fatalities were reported to FARS with 75.1% of cases retained for analysis (n = 25,077). Fatalities were more likely to be White (69.3%), male (69.9%), and between 25-64 years of age (67.3%). 74.0% of fatalities were tested for alcohol, with 40.9% screening positive. Females, cases ≥ 75 years of age, and those identified as Asians reported the lowest odds of being positive for alcohol exposure. Conclusions Results suggest an ongoing threat to pedestrians due to alcohol consumption and that exposure odds vary by demographic characteristics. Unfortunately, analytical approaches to understanding the roles played by drugs and alcohol among vulnerable road users tend to be marginalized in the literature. Analytical, evidence-based investigations are needed to curtail the risk of pedestrian fatalities in the U.S.

Unraveling preference heterogeneity in willingness-to-pay for enhanced road safety: A hybrid approach of machine learning and quantile regression

Investing in road safety enhancement programs highly depends on the economic valuation of road traffic accidents and their outcomes. Such evaluation underpins road safety interventions in cost-benefit analysis. To this end, understanding and modeling public willingness-to-pay for enhanced road safety have received significant attention in the past few decades. However, despite considerable modeling efforts, some issues still persist in earlier studies, namely, (i) using standard regression approaches that assume a homogeneous impact of explanatory variables on willingness-to-pay, not accounting for heterogeneity, and depends on a priori distribution of the dependent variable, and (ii) the absence of higher-order interactions from models, leading to omitted variable bias and erroneous model inferences. To overcome this critical research gap, our study proposes a new modeling framework, integrating a machine learning technique (decision tree) to identify a priori relationships for higher-order interactions and a quantile regression model to account for heterogeneity along the entire range of willingness-to-pay. The proposed framework examines the determinants of willingness-to-pay for enhanced road safety using a sample of car drivers from Peshawar, Pakistan. Modeling results indicate that variables not significant in a linear model become significant at specific quantiles of the willingness-to-pay distribution. Further, including higher-order interactions among the explanatory variables provides additional insights into the complex relationship between willingness-to-pay and its determinants. In addition, willingness-to-pay for fatal and severe injury risk reductions is estimated at different quartiles and used to calculate the values of corresponding risk reductions. Overall, the proposed framework provides a better understanding of public sensitivities to willingness-to-pay for enhanced road safety.