High-risk Category Research Articles

Inadequate identification of high cardiovascular risk and carotid plaques in rheumatoid arthritis patients by the 2024 Predicting Risk of Cardiovascular EVENTs and the 2013 Atherosclerotic Cardiovascular Disease algorithms: findings from a Mexican cohort.

The American College of Cardiology/American Heart Association introduced the Predicting Risk of Cardiovascular EVENTs (PREVENT™) algorithm to estimate the 10-year risk of developing cardiovascular disease. We aimed to assess the cardiovascular risk (CVR) reclassification among rheumatoid arthritis (RA) patients using traditional CVR algorithms-the 2024 PREVENT™ and the 2013 Atherosclerotic Cardiovascular Disease (ASCVD)-and the presence of carotid plaque (CP). This was a cross-sectional study nested of a RA patients' cohort. A certified radiologist performed a high-resolution B-mode carotid ultrasound to identify the presence of CP. The CVR evaluation was performed by a cardiologist, blinded to carotid ultrasound results, using the PREVENT™ and the ASCVD algorithms. Cohen's kappa (k) coefficient assessed concordance between high-risk classification by CVR algorithms and CP presence. ROC curve analysis evaluated the algorithms' capacity to identify RA patients with CP. The cutoff point was determined by the Youden-Index, with p < 0.05 as statistically significant. A total of 210 RA patients were included. The reclassification of CVR due to CP was 34.3% for the PREVENT™ algorithm and 30.0% for the ASCVD algorithm. Of these, 44.4% and 71.4%, respectively, were initially classified as low risk. Concordance between CVR algorithms and carotid ultrasound showed slight agreement (k = 0.032 and k = 0.130, respectively). The PREVENT™ algorithm did not identify more than one-third of high-CVR RA patients with indication of starting statin therapy based on carotid ultrasound findings. The PREVENT™ and ASCVD algorithms showed poor performance in identifying RA patients with CP. Key Points • The presence of CP was identified in more than a third of the evaluated RA patients (35.7%), classifying them as high CVR. • CVR reclassification by the presence of CP was observed in 34.3% RA patients with the PREVENTTM algorithm and in 30.0% RA patients with the ASCVD algorithm. • Most of the reclassified patients belonged to the low-risk category, 44.4% with the PREVENTTM algorithm and 71.4% with the ASCVD algorithm. • When evaluating the concordance between the ASCVD algorithm and the carotid ultrasound for high-risk classification, a slight agreement was found (k = 0.130).

POTENSI BAHAYA DAN RISIKO DENGAN METODE HIRADC PADA PROSES OPERASIONAL INDUSTRI PETROKIMIA PADA PERGANTIAN ADSORBENT 201-D PABRIK 1-B

The implementation of HIRADC (Hazard Identification Risk Assessment and Determinant Control) is one of the efforts that can be made to control potential hazards that cause work accidents. HIRADC (Hazard Identification Risk Assessment and Determinant Control) is the process of identifying hazards, assessing, and evaluating the risks contained in work activities and environments. The results of the risk evaluation are used to determine hazard control efforts so that they can reduce the level of risk that is likely to cause work accidents. The method used to complete the research results has achieved the expected objectives. The data presented uses a qualitative descriptive approach, which shows K3 in accordance with current conditions, developing policies, ongoing processes, and effects that occur or trends that are occurring in the company. These results are compared with data obtained in the field or from the HSE regarding the implemen- tation procedure of HIRADC (Hazard Identification Risk Assessment and Determi- nant Control) and compared with applicable standards. Based on the identification that has been carried out, 42 potential hazards have been identified from 21 stages of work activities, 6 of which are in the high risk category, 20 are in the low risk category, 16 are in the medium risk category. Furthermore, all these activities or processes are then analyzed in the HIRADC table and converted into percentages for each category to determine the risk priority. The results for the low risk level are 0.47%, the medium risk level is 0.38%, and the high risk level is 0.14%. This company has made efforts to reduce potential hazards in the work environment through substitution, engineering control, administrative control, and finally PPE

Efficacy of 18FDG-PET/CT in Detecting Synchronous Malignancies in Patients With Head and Neck Cancer: A Systematic Review and Meta-analysis.

To assess the diagnostic accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (18FDG-PET/CT) in detecting second primary malignancies (SPMs) in patients with treatment naïve head and neck squamous cell carcinoma (HNSCC). Medline, Embase, Cochrane Library, and Scopus searched from 1946 to December 2022. Studies reporting the performance of 18FDG-PET/CT in patients with treatment-naïve, index HNSCC for detection of SPMs were included. The reference standard was histopathology, clinical follow-up over the duration of study, and other imaging modalities. Multiple investigators completed depth full-text analysis. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed. Methodologic and diagnostic accuracy data were abstracted independently by multiple investigators. Risk of bias assessment was conducted using the Quality Assessment of Diagnostic Accuracy Studies tool independently. Bivariate random-effects model meta-analysis and multivariable meta-regression modeling were used. Seventeen studies examining 4624 patients with a total of 475 SPMs were included in the final analysis. Eleven studies were found to be at low risk for bias, while the rest were in the high-risk category. 18FDG-PET/CT demonstrated pooled sensitivity and specificity of 0.73 (95% confidence interval [CI]: 0.49-0.88) and 0.99 (95% CI: 0.98-1.00) in detecting SPMs. Further subsite analysis revealed varied diagnostic performance across different anatomical regions, with sensitivity and specificity of esophageal SPMs being 0.47 (0.30-0.64) and 0.99 (0.98-1.00), and sensitivity and specificity of 0.86 (0.73-0.94) and 0.99 (0.98-1.00) for head and neck SPMs. Finally, this imaging modality showed sensitivity and specificity of 0.92 (0.84-0.96) and 0.99 (0.98-1.00) for lung SPMs. The findings of this study suggest varied accuracy of 18FDG-PET/CT in detecting SPMs during initial workup for HNSCC, highlighting the importance of screening modalities such as esophagoscopy in high-risk patients.

Development of machine learning-based models to predict congenital heart disease: A matched case-control study

BackgroundThe current congenital heart disease (CHD) prediction tools lack adequate interpretability and convenience, hindering the development of personalized CHD management strategies. We developed a machine learning-based risk stratification model for CHD prediction. MethodsThis study utilized data from 1,759 participants in a case-control study of CHD conducted across six birth defects surveillance hospitals located in Xi’an, Shaanxi Province, Northwest China, spanning from January 2014 to December 2016. The data was partitioned into training and testing datasets with a ratio of 7:3. Predictors were selected from a total of 47 input variables through the Least Absolute Shrinkage and Selection Operator (LASSO). Five machine learning algorithms were used to build the CHD risk prediction models. Model performance was assessed based on a range of learning metrics, including the area under the receiver operating characteristic curve (AUROC), F1 score, and Brier score. Permutation feature importance was employed to elucidate the prediction model. The best-performing model was used to conduct the risk scores. ResultsThe eXtreme Gradient Boosting (XGB) model demonstrated superior performance among CHD prediction models, achieving an AUROC of 0.772 (95 % CI 0.728, 0.817) in the testing dataset and 0.738 (0.699, 0.775) in the external validation dataset. The pivotal predictors (top 3) identified by the model included living in rural areas, the low wealth index, and folic acid supplements (<90 days). The resultant risk score exhibited robust calibration capabilities. Utilizing the risk scores, participants were stratified into low, moderate, and high-risk categories, signifying substantial variations in CHD risk. ConclusionThis study underscores the feasibility and efficacy of employing a machine learning-based approach for CHD prediction. The risk scores exhibited potential in identifying pregnant women at high risk for fetal CHD, offering valuable insights for guiding primary prevention and CHD management.

Gastrointestinal stromal tumors mimicking as gynecological tumors-A case series

ABSTRACT Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors that arise from interstitial cells of Cajal. Due to vague presentation, location and confusing imaging studies, they tend to mimic gynaecological tumors. They usually diagnosed intra-operative and histopathology followed by tumor specific receptors such as KIT, CD34, CD 117 and DOG 1 are mainstay of diagnosis of GIST. Prognosis of GISTs depends on mitotic rate, tumor size and organ of origin. Resection of mass with tumor free margins is the target of treatment. L ymphadenectomy is not routine. Chemotherapy with tyrosine kinase inhibitors such as Imatinib, Dasatinib, Sorafenib and follow- up depend upon risk category. In this case series, there were four cases with vague symptoms misdiagnosed as gynaecological tumors are reviewed. Preoperatively tumors assumed to be of gynaecological origin were found to be case of GISTs intra-operatively and confirmed by presence of cajal’s cells histopathology and mainly by DOG 1, CD117 and tyrosine kinase inhibitor receptors on immunohistochemistry. All belonged to high risk category of GISTs. Any abdomino-pelvic mass detected on ultrasonography and with unusual presentation presenting at primary health centre the possibility of non-gynecological tumors especially GISTs should be kept in mind and should be referred to higher centres for further investigation and proper management.

Tumor budding and lymphovascular invasion as prognostic factors in p16-positive oropharyngeal squamous cell carcinomas.

We aimed to validate the prognostic significance of tumor budding (TB) in p16-positive oropharyngeal squamous cell carcinomas (OPSCC). We analyzed digitized H&E-stained slides from a multicenter cohort of five large university centers consisting of n = 275 cases of p16-positive OPSCC. We evaluated TB along with other histological parameters (morphology, tumor-stroma-ratio, lymphovascular invasion (LVI), perineural invasion) and calculated survival outcomes using both univariate and multivariate analyses. TB was identified as an independent prognostic parameter, with TB-high cases showing inferior outcomes in univariate (HR: 3.08, 95%-CI: 1.71-5.54) and multivariate analyses (HR: 4.03, 95%-CI: 1.65-9.83). Similarly, LVI remained an independent prognostic factor (HR: 3.00, 95%-CI: 1.22-7.38). A combined classification including TB and LVI stratified cases into low-, intermediate- and high-risk categories. We could not detect correlations between TB and the number of lymph node metastases or between TB and an extracapsular extension of lymph node metastases. In addition to LVI, we could identify TB as an independent prognostic factor in p16-positive OPSCC in this multicenter study cohort. Thus, evaluating TB along with LVI in a combined scheme for prognostication might help to establish a more personalized treatment regimen for patients with p16-positive OPSCC.

Advanced AI-Driven Prediction of Pregnancy-Related Adverse Drug Reactions.

Ensuring drug safety during pregnancy is critical due to the potential risks to both the mother and fetus. However, the exclusion of pregnant women from clinical trials complicates the assessment of adverse drug reactions (ADRs) in this population. This study aimed to develop and validate risk prediction models for pregnancy-related ADRs of drugs using advanced Machine Learning (ML) and Deep Learning (DL) techniques, leveraging real-world data from the FDA Adverse Event Reporting System. We explored three methods─Information Component, Reporting Odds Ratio, and 95% confidence interval of ROR─for classifying drugs into high-risk and low-risk categories. DL models, including Directed Message Passing Neural Networks (DMPNN), Graph Neural Networks, and Graph Convolutional Networks, were developed and compared to traditional ML models like Random Forest, Support Vector Machines, and XGBoost. Among these, the DMPNN model, which integrated molecular graph information and molecular descriptors, exhibited the highest predictive performance, particularly at the preferred term level. The model was validated against external data sets from SIDER and DailyMed, demonstrating strong generalizability. Additionally, the model was applied to assess the risk of 22 oral hypoglycemic drugs, and potential substructure alerts for pregnancy-related ADRs were identified. These findings suggest that the DMPNN model is a valuable tool for predicting ADRs in pregnant women, offering significant advancement in drug safety assessment and providing crucial insights for safer medication use during pregnancy.

Evaluation of Modified Frailty Index for Predicting Postoperative Outcomes after Upper Extremity Replantation and Revascularization Procedures.

Upper extremity (UE) replantation and revascularization are challenging surgical procedures, with survival rates being 50 to 90%. Preoperative risk stratification is challenging yet crucial as patients with comorbid conditions face increased complications. This study assesses the predictive value of the modified 5-item frailty index (5-mFI) for postoperative complications in these procedures. A retrospective study was done using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2011-2021) for UE replantation/revascularization. The 5-mFI score assigned points for comorbidities including pulmonary disease, heart failure, diabetes, hypertension, and functional status (0-5 scale; 1 point to each). 5-mFI scores stratified patients into <2 (low-risk) or ≥2 (high-risk) categories. Of 2,305 patients, the mean age and body mass index (BMI) were 53.13 years and 28.53 kg/m2, respectively. The 5-mFI ≥2 cohort experienced higher rates of all-cause complications, systemic complications, unplanned readmissions, and return to the operating room on univariate analysis. There was no significant difference in wound complication rates. Multivariable logistic regression showed that a higher 5-mFI was significantly associated with increased risks of all-cause mild and severe systemic complications. Wound complications, length of stay over 30 days, unplanned readmission, and return to the operating room were higher in high-risk patients, however not statistically significant. 5-mFI is an effective tool for evaluating risk in UE replantation and revascularization, correlating high scores with significantly increased postoperative complications. High-risk patients with 5-mFI ≥2 also had more reoperations and readmissions. The use of 5-mFI in preoperative assessments can help personalize management, enhancing patient selection and care quality in these complex reconstructions.

Microplastic contamination and environmental risks in the Beas River, western Himalayas

The Western Himalayan mountains, with several riverine systems, are considered one of the most fragile environments in the world. Among them is Beas, a primary river that provides essential ecosystem benefits to thousands of indigenous people in North India. One of the major pollutants, microplastics (MPs), are ubiquitous contaminants, yet their occurrence in the Beas and ecological risk factors remain largely unexplored. Due to extensive tourism and urban-related burdens, the usage and release of enormous amounts of plastics and MPs into the Beas are apparent. Here, we investigated the extent of MPs pollution and subsequent environmental risks in water and sediments from Beas along a stretch of 300 km. Our results showed that MPs were abundant and widely distributed, with the abundance range (mean ± SE) being 46–222 (112.27 ± 12.43) items/L in water and 36–896 (319.47 ± 49.25) items/kg in sediment samples. We found significant differences in MPs’ abundance in water but not sediments among the five sampling sites. There was a significant positive correlation between population size and the abundance of MPs, with the highest abundance in populated Kullu and the lowest loads at the remote Dhundi Glacier. Fibers and film were common morphotypes; most items measured <1 mm. Of the eleven polymers identified, the majority were polyethylene. The pollution load index ranged up to 4.99 (low-risk category); however, the polymer hazard index exceeded 1000 (highest-risk category), and the potential ecological risk index was 13,761 (extreme-risk category) at selected sites. This study fills a crucial knowledge gap and raises concerns about the possible impact on human health, as many riparian residents depend on Beas as their primary source of potable water. Our findings may assist governmental agencies in formulating comprehensive eco-friendly policies and advancing environmentally sustainable strategies in vulnerable locales adjoining the Beas waterway.

Seismic Vulnerability Index Mapping Based on PGA, GSS, and MMI Values in Pasar Ujung Kepahiang Village

Pasar Ujung Village is located in Kepahiang District, which has the highest growth rate and population compared to other sub-districts in Kepahiang Regency, with a growth rate of 1.63% and a population of 53,066 thousand people. As one of the efforts to minimize the occurrence of damage due to earthquake disasters in Pasar Ujung Village, Kepahiang, it is necessary to map the seismic vulnerability index using the microtremor method. The research was conducted in Pasar Ujung Village, Kepahiang. Measurement points were placed at 28 points with a distance of approximately 200 m between points. Primary data used in this study came from microtremor surveys with A0 and f0 values. The results of the study are also included in the high-risk category for the social impact of earthquake disasters with an MMI value of more than 7. Based on the PGA map, it shows that the research location is quite prone to damage due to earthquakes, with a PGA value of &gt; 564gal. Based on the PGA value obtained, the value is classified as instrumental intensity scale VI-VIII with shaking strength in the strong to very strong category. The magnitude of the earthquake, the depth of the source, and the distance of the earthquake source from the research location also contribute. The thickness of the surface sediment layer can be a consideration for people who will carry out development.

Trend in incidence and clinicopathological characteristics of prostate cancer in Northern Tanzania: analysis from a population based cancer registry data 2015-2021.

Globally, prostate cancer is a common disease among men. However, limited epidemiological data exists regarding prostate cancer in Tanzania. Consequently, there is insufficient evidence to convince policymakers of the need to combat this health issue. The study aimed to assess the prevalence, trends and clinicopathological characteristics of prostate cancer in northern Tanzania. This cross-sectional study with chart review utilised data from the Kilimanjaro cancer registry, identifying all adult men diagnosed with cancer from January 2015- December 2021. The study recorded variables such as subject age, symptoms, Gleason score, prostate specific antigen (PSA) and metastatic statuses at presentation. Risk stratification followed American Society of Medical Oncology criteria, including low, intermediate and high-risk categories. The analysis was conducted using STATA version 17. Over the study period, 5164 adult men were registered, with prostate cancer accounting for 1619(31.4%) and showing an increase trend in incidence. The mean age at presentation was 73.9(± 10.1) years, and the majority of study subjects were from Kilimanjaro region 1200(74.1%). After applying exclusion criteria, 714 subjects with histologically confirmed diagnoses of prostate cancer remained. Of these, 710(99.4%) were symptomatic at presentation, with lower urinary tract symptoms being the most common symptoms in 548(76.8%). The median PSA at presentation was 109(36.2-263) ng/mL with 349(51.1%) having a PSA of > 100ng/mL. Gleason group grades 4 and 5 accounted for 207(29.5%) and 219(31.2%), respectively. A total of 178(43.6%) subjects had metastatic disease at presentation. The treatment of choice for a large proportion of subject 440(94.6%) was androgen deprivation therapy. The burden of prostate cancer in northern Tanzania is high and the majority of subjects present with symptoms. A large proportion of subjects have metastatic disease at initial presentation, emphasizing the need for prostate cancer screening.

A Reanalysis: SRSS-IE Internalizing Cut Scores to Support Data-Informed Decision-Making Efforts in Elementary Schools

We report findings of this replication study, examining the internalizing subscale (SRSS-I4) of the revised version of the Student Risk Screening Scale for Internalizing and Externalizing behavior (SRSS-IE 9) and the internalizing subscale of the Teacher Report Form (TRF). Using the sample from 13 elementary schools across three states with 195 K–5 students, we replicated the initial data analytic plan used to determine initial cutting scores. Results from logistic regression and receiver operator characteristic curves suggested the following preliminary SRSS-I4 risk categories: 0–1 low, 2 moderate, and 3–12 high risk for internalizing behavior patterns relative to the TRF internalizing subscale score. Results yielded adequate levels of sensitivity and specificity for the first cut, and questionable sensitivity for the upper cut. We planned to conduct subsequent analysis to address the nested nature of the data. Yet, most teachers completed the TRF for one student making this not possible. We discuss limitations and directions for future research, calling for replication with larger samples to facilitate nesting given schoolwide screening practices involve teachers screening multiple students. We also encourage consideration of two risk categories: 0–1 for low and 2+ for a risk category, not distinguishing between moderate- and high-risk categories.

ASSESSMENT OF RISK FACTORS AND FOLLOW-UP OUTCOMES FOR HEARING LOSS IN HIGH-RISK NEONATES

Objective: Hearing loss in neonates, particularly those in high-risk categories such as NICU graduates, can significantly impede speech, cognitive, and psychosocial development. Early detection and management are pivotal to mitigating these risks. Methods: A prospective observational study was conducted on 425 neonates at SDM Medical College and Hospital, utilizing Otoacoustic Emissions (OAE) for initial auditory screening. This study assessed the incidence of hearing loss in relation to neonatal risk factors, including birth weight, ABO incompatibility, and maternal health conditions. Results: A majority of the neonates (58.82%) were screened within 3-7 d post-birth. Notable risk factors impacting hearing outcomes included low birth weight, with 11.53% of neonates weighing between 1.0 and 1.50 kg. The initial failure rates in OAE screenings were low, with 2.59% failing in the right ear, 1.18% in the left, and 0.94% in both ears. Conclusion: The study underscores the efficacy of early hearing screenings in identifying potential hearing loss in neonates, especially those exposed to multiple risk factors. Continuous and comprehensive monitoring is crucial for these high-risk groups to facilitate timely and effective interventions.

Determinant Factors of Microbial Drinking Water Quality at the Point of Use in Rural Ethiopia: A Case Study of the South Gondar Zone

Access to safe drinking water is a fundamental human need for health and well-being implemented globally by the United Nations under Sustainable Development Goal (SDG) 6. Storing drinking water is common in rural areas of Ethiopia due to off-premises water sources and intermittent piped water supply. However, this practice can lead to further contamination during collection, transport, and storage, posing a risk to public health. The objective of this study was to identify the determinant factors of drinking water quality at the point of use in the rural setting of northwestern Ethiopia, South Gondar zone. A questionnaire survey was conducted, and water samples from 720 households were collected during the wet and dry seasons. The determinant factors were identified using the multivariable logistic regression model. About 39.2% of the surveyed households had basic water supply services, 41.9% were using unimproved sources, and 8.3% were using surface water. Only 9.4% were using basic sanitation services, and 57.2% were practicing open defecation. Safe water storage was practiced by 84.3% of households, while only 2% engaged in household water treatment. About 14% of dry and 8% of wet season samples from the storage were free from fecal coliform bacteria. Furthermore, 52.9% of dry and 62.2% of wet season samples fell under the high microbial health risk category. The season of the year, the water source type, storage washing methods, and the socioeconomic status of the household were identified as key predictors of household drinking water fecal contamination using the multivariable logistic regression model. It was observed that the drinking water in households had a high load of fecal contamination, posing health risks to consumers. To tackle these problems, our study recommends that stakeholders should enhance access to improved water sources, implement source-level water treatment, increase access to improved sanitation facilities, advocate for safe household water management practices, and endorse household water treatment methods.

Cumulative Psychosocial and Health Disparities in US Adolescent Cigarette Smoking, 2002 to 2019.

Understanding disparities in adolescent cigarette smoking is important for effective prevention. We investigated disparities in adolescent smoking based on cumulative reported psychosocial/health risk among respondents ages 12-17 years in the US National Survey of Drug Use and Health from 2002 to 2019. Multivariable regression estimated associations of cumulative risk, survey years, and their interaction predicting past-month and daily smoking. Eleven psychosocial/health variables associated with youth smoking formed composite measures of cumulative risk, categorizing risk as Low (0-2), Moderate (3-4), or High (5+). The main outcomes were weighted past-month and daily smoking by cumulative risk and time, examining prevalence and proportional change across years. Among 244,519 adolescents, greater cumulative risk predicted higher smoking prevalence across all outcomes. Compared to the Low-risk category, past-month smoking odds (adjusted odds ratio, 95%CI) were 9.14 (8.58-9.72) and 46.15 (43.38-49.10) times greater in the Moderate- and High-risk categories. For daily smoking, odds were 14.11 (11.92-16.70) and 97.32 (83.06-114.03) times greater among the Moderate- and High-risk categories. Regarding proportional change, the Low-risk category exhibited the steepest decline in past-month smoking from 2002-2003 to 2018-2019 (-85.1%), followed by the Moderate- (-79.2%) and High-risk (-65.7%) categories. Daily smoking declined more steeply among the Low- (-96.5%) and Moderate- (-90.5%) than High-risk category (-86.4%). Cumulative risk is a robust predictor of adolescent smoking. While record-setting reductions in adolescent smoking extend across risk categories, disparities favoring youth with fewer risks are evident throughout. Recognizing cumulative risk can inform the development of more targeted and effective prevention efforts.

Penilaian Penerapan Good Manufacturing Practices (GMP) pada Proses Produksi Dimsum (Studi Kasus : UMKM XYZ)

Dimsum is a high-risk food category because it uses basic ingredients of chicken meat and these ingredients have a water content of around 65-80% and a high pH of around 6-7, as well as easily degraded and easy to grow microorganisms. This study aims to assess the application of GMP in the production process in Aceh Dimsum Micro, Small and Medium Enterprises (UMKM) and the application of GMP is the basic requirement for granting a distribution permit certificate for the Deep Food (MD) category by the Food and Drug Supervisory Agency (BPOM). In this study, the assessment of the application of GMP in dimsum production process was carried out using the Gap Assessment method by assessing the suitability and non-conformity of the GMP aspects applied. The assessment is carried out by giving value weight to the finding of nonconformity based on the category of nonconformity. From the results of the research that has been carried out, conformity findings, nonconformity findings, and GMP aspect findings that are not applied to the production process are obtained. There are 17 points of conformity findings applied from 12 aspects of GMP. There were 51 points of nonconformity findings found from 21 aspects of GMP. There are 2 points of aspects that do not apply or are not used to UMKM from 2 aspects of GMP (aspects of internal testing laboratories and aspects of water, ice, gas and energy (electricity, fuel). Based on the amount of value weighted obtained from the findings of nonconformity, the score obtained by UMKM is around a score of 78. Based on this score, the level (rating) of UMKM is rating D. The conclusion that can be drawn is that UMKM need to make improvements to the discrepancies found in the production process.

Abstract A066: Could ancestry play a role in cancer development? Insights from a risk assessment and early detection test of naturally occurring cancers in companion dogs

Abstract Companion dogs have a lifetime cancer risk similar to that of humans. This excess risk, as compared to what is seen in other species, seems to be due to our recent success in outliving our evolutionarily adapted lifespan. For cancers to develop, a cancer-permissive environment must be present, which may exist months or even years before a tumor becomes detectable. We have developed the Shine On Suspicion (SOS) test; a flow cytometry based test to detect these changes that lead to a cancer-permissive environment. To make this test actionable, we combined it with eBAT, a novel bispecific ligand-targeted toxin that targets emerging cancer cells and the inflammatory niche to disrupt cancer formation. The Shine On Study used machine- learning algorithms to determine cancer risk based on a training set of 97 dogs with known conditions and a test set of 209 adult dogs with no evidence of cancer or other chronic diseases. Dogs assigned to the low-risk category had a less than 4% chance of developing cancer within 400 days after testing, whereas dogs assigned to the high-risk category had a nearly 25% chance of developing cancer in that timeframe. By 1,450 days, more than 50% of dogs assigned to the high-risk category developed cancer. Surprisingly, the SOS test’s specificity varied by breed. In Boxers and Portuguese Water Dogs the test accurately predicted the risk of hemangiosarcoma and other malignancies, whereas for Golden Retrievers, the test accurately predicted the risk for hemangiosarcoma, but no significant difference in the development of other cancers was observed between high-risk and low-risk groups. This suggests that the contribution of the cancer-permissive environment detected by the SOS test interacts with heritable factors, i.e., those defined by ancestry in creating the overall cancer risk state. To date, eBAT interception has been administered to 9 dogs, with only 1 potentially developing cancer 2 years after treatment. The drug is well-tolerated and shows promising outcomes. Future research aims to refine the SOS test, understand breed-specific responses, and explore the identity and function of niche- forming cells to improve cancer prevention strategies and their applicability to humans. Citation Format: Ashley J Schulte, Taylor A DePauw, Ali Khammanivong, Mitzi Lewellen, Lauren Burt, Rose Dicovitsky, Amber L Winter, Kathleen M Stuebner, Andrea Chehadeh, Sara Pracht, Christopher Ober, Kari L Anderson, Esther Nell, Antonella Borgatti, Michael S Henson, Erin B Dickerson, Aaron L Sarver, Daniel A Vallera, Gary R Cutter, Jaime F Modiano. Could ancestry play a role in cancer development? Insights from a risk assessment and early detection test of naturally occurring cancers in companion dogs [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr A066.

Abstract 4115231: Higher Global Registry of Acute Coronary Events Score is Associated with Lower Invasive Coronary Angiograpy Use

Background: Use of invasive coronary angiography (ICA) and the selection of other interventions in patients who present with NSTEMI should be guided by clinical risk stratification. National guidelines recommend ICA use in patients with intermediate and high risk scores. The Global Registry of Acute Coronary Events (GRACE) score is a commonly used risk score that is based on clinical characteristics available at the time of admission. Aim: Examine if patients with NSTEMI with higher risk stratification scores are more likely to have ICA. Methods: This cross-sectional study included all patients who presented with NSTEMI to an academic medical center that serves a rural population over a 12-month period. Data were derived from the American College of Cardiology Chest Pain – MI Registry data collected by trained abstractors at the facility and were verifed by the study team. Additional data needed to calculate the GRACE Score were abstracted by the study team. GRACE Scores were categorized into low (1-88), moderate (89-118), and high (119-263) risk. Multivariable logistic regression was used to test if higher GRACE scores are more associated with ICA use controlling for patient factors not included in the GRACE Score and further examined by GRACE score category. Results: The total sample size was 434 patients (Mean age 65±13.8, 36% female and 36% Black). Patients transferred from outlying facilities accounted for 40% of the sample. ICA was performed for 94% of the patients. Increasing GRACE score was associated with lower ICA use (aOR 0.98, 95% CI 0.97-0.99). Odds of ICA use between the low-risk group and the intermediate risk group (aOR 0.60, 95% CI 0.19-1.91) did not significantly differ. Patients in the high-risk category were less likely to undergo ICA compated to low-risk patients (aOR 0.22, 95% CI 0.07-0.62). Conclusions: Use of ICA decreased as GRACE score increased in this patient sample, suggesting that additional factors beyond GRACE score likely influence ICA use in patients who presented with NSTEMI during this time period. Influence of patient factors as well as provider and patient risk aversion on ICA selection must be explored to better understand incongruence with guideline recommendations.

Redesign of work facilities at the tofu pressing station with a participatory ergonomic approach

Tahu Palda is a small and medium-sized micro business in the food industry that produces tofu. This factory has been producing tofu since 2005, located in North Aceh. The workers in this tofu usually five workers, with an average of 7 working hours per day. Based on the observations at several workstations, initial data indicate that the dominant work posture is standing, bending, and lifting heavy loads such as a 20 kg weight for pressing and lifting a mold holder with a 15 kg load. This is done continuously for 7 working hours each day. Based on the results of the distribution of the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), it was found that workers at the station experience complaints such as back pain, lower back pain, and upper arm pain due to the high frequency of lifting heavy loads. If this continues to be neglected, it can lead to work-related diseases such as musculoskeletal disorders. The assessment of workers' posture using the Rapid Entire Body Assessment (REBA) method shows that the score obtained for the job of pouring soybean paste is 7, which means a moderate risk, the job of lifting the press weight is 5, which means a moderate risk, and the job of flipping molds has a score of 10, which falls into the high-risk category and needs improvement. Improvements were made using a participatory ergonomics approach, resulting in the decision to redesign the tofu press tool to fit the workers' body anthropometry. The anthropometric calculations for the height range of the press support tool and cutting tool are 141.1 cm, the press support range is 68.78 cm, the width of the press tool is 49.4 cm, the height of the tray is 4.54 cm, and the height of the tray holder is 103.85 cm.

Exploring Variations in Lumbar Canal Width: An MRI Study on Asymptomatic Patients by Age and Gender.

Background: Lumbar spinal stenosis is a common degenerative condition, especially in older adults, leading to significant morbidity. Age, gender, and lumbar level variations in spinal canal width are critical in assessing stenosis risk. Many patients exhibit radiographic narrowing without clinical symptoms. This study analyzed the risk of lumbar stenosis by age, gender, and lumbar levels (L1-S1) using the MRI of patients without clinical signs of narrowing. Materials and Methods: This retrospective study included 120 patients, aged 20 to 75, who underwent lumbar MRI for unrelated reasons. Spinal canal widths were measured at five lumbar levels (L1-2 to L5-S1), and stenosis risk was classified as low, borderline, or high based on narrowing thresholds. Data were grouped by age and gender to assess the stenosis risk distribution. Results: The analysis revealed a progressive increase in stenosis risk from the upper to lower lumbar levels. At L4-5 and L5-S1, females aged 61-75 exhibited the highest proportions in borderline- and high-risk categories. While most patients were classified as low risk, many older patients showed radiographic narrowing without clinical symptoms. Males generally had wider canals and lower risk. Conclusions: Age and gender significantly impact lumbar stenosis risk, particularly in older females. The findings highlight the importance of clinical correlation despite radiographic evidence of stenosis and suggest potential for AI-based detection systems in enhancing assessments of spinal canal narrowing.