High-risk Period Research Articles

A Statistical Evaluation of the Occurence of Meningitis in Takum, Taraba State, Nigeria

Meningitis remains a critical public health issue in Nigeria, particularly within the dry season when environmental factors such as low humidity and dust elevate transmission risks. Using historical incidence data from 2012 to 2021, this study utilizes the Autoregressive Integrated Moving Average (ARIMA) model estimate and predict the occurrence of meningitis occurrences. Findings frm the study revealed that the ARIMA(1,1,0) model emerged as the optimal fit, capturing the seasonal patterns and temporal trends in meningitis cases. This study recommends the integration of ARIMA-based forecasting into Nigeria’s public health strategies to strengthen early warning systems, optimize resource deployment, and enable more proactive responses during high-risk periods.

Insights into cancer characteristics among SARS-CoV-2 infected hospitalized patients: a comprehensive analysis from the National Clinical Registry for COVID-19.

Cancer outcome is dependent on multiple predetermining factors including cancer, type of cancer and its related factors. This study aims to investigate the association between COVID-19 & cancer/cancer types, focusing on risk of in-hospital mortality within 30days of hospitalization of COVID-19 patients with cancer. We did a registry (National Clinical Registry for COVID-19) based retrospective observational study including 51,544 patients, of whom 976 were patients with cancer, admitted with COVID-19 between August 2020 and August 2023 across 42 hospitals of India. Out of 51,544 patients, 976 (1.8%) had cancer. Hematological malignancies made up 15.06% (147 cases), while solid cancers accounted for 29.5% (288 cases), with genitourinary (18.4%, 80 cases), gastrointestinal (15.2%, 49 cases), and lung cancers (10.1%, 34 cases) being the most common. Solid cancers had the highest in-hospital mortality rate at 25%. Survival analysis showed that cancer-related hazards were highest at admission but decreased to levels comparable with other morbidities within nine to ten days. For each cancer type, the hazard was significantly elevated compared to that of the cancer-free (Other Comorbidities and No Comorbiditiy) groups during the initial period of hospitalization. The use of Remdesivir, steroids, and anticoagulants reduced mortality risk, and prior COVID-19 vaccination was protective against mortality across all cancer types. This study shows that both cancer in general and specific cancer types significantly increase the risk of severe outcomes among SARS-CoV-2-infected patients, especially immediately after hospitalization. The findings highlight the need for close monitoring and personalized interventions for COVID-19 patients with cancer for at least 10days post-hospitalization, with a more specific high-risk period ranging from 7 to 18days depending on the type of cancer.

Development and Refinement of a Chatbot for Birthing Individuals and Newborn Caregivers: Mixed Methods Study.

The 42 days after delivery ("fourth trimester") are a high-risk period for birthing individuals and newborns, especially those who are racially and ethnically marginalized due to structural racism. To fill a gap in the critical "fourth trimester," we developed 2 ruled-based chatbots-one for birthing individuals and one for newborn caregivers-that provided trusted information about postbirth warning signs and newborn care and connected patients with health care providers. A total of 4370 individuals received the newborn chatbot outreach between September 1, 2022, and December 31, 2023, and 3497 individuals received the postpartum chatbot outreach between November 16, 2022, and December 31, 2023. We conducted surveys and interviews in English and Spanish to understand the acceptability and usability of the chatbot and identify areas for improvement. We sampled from hospital discharge lists that distributed the chatbot, stratified by prenatal care location, age, type of insurance, and racial and ethnic group. We analyzed quantitative results using descriptive analyses in SPSS (IBM Corp) and qualitative results using deductive coding in Dedoose (SocioCultural Research Consultants). Overall, 2748 (63%) individuals opened the newborn chatbot messaging, and 2244 (64%) individuals opened the postpartum chatbot messaging. A total of 100 patients engaged with the chatbot and provided survey feedback; of those, 40% (n=40) identified as Black, 27% (n=27) identified as Hispanic/Latina, and 18% (n=18) completed the survey in Spanish. Payer distribution was 55% (n=55) for individuals with public insurance, 39% (n=39) for those with commercial insurance, and 2% (n=2) for uninsured individuals. The majority of surveyed participants indicated that chatbot messaging was timely and easy to use (n=80, 80%) and found the reminders to schedule the newborn visit (n=59, 59%) and postpartum visit (n=66, 66%) useful. Across 23 interviews (n=14, 61% Black; n=4, 17% Hispanic/Latina; n=2, 9% in Spanish; n=11, 48% public insurance), 78% (n=18) of interviewees engaged with the chatbot. Interviewees provided positive feedback on usability and content and recommendations for improving the outreach messages. Chatbots are a promising strategy to reach birthing individuals and newborn caregivers with information about postpartum recovery and newborn care, but intentional outreach and engagement strategies are needed to optimize interaction. Future work should measure the chatbot's impact on health outcomes and reduce disparities.

Pediatric liver transplant for acute liver failure: Defining the standard nutrition and clinical evolution: An observational study.

Pediatric acute liver failure (PALF) is a clinical diagnosis in which previously asymptomatic children exhibit a rapid loss of liver function. To describe the clinical and nutrition conditions at admission and during hospitalization in patients with PALF who underwent liver transplantation (LT) at a referral center and establish a possible association between nutrition status and prognosis in this population. A prospective study was conducted on children underwent LT because of PALF. Nutrition assessment was performed at admission and repeated weekly until hospital discharge, and their relationships with clinical outcomes were tested. The study population consisted of 23 patients with a median age of 60 months and, in most cases, the etiology of acute liver failure (ALF) was indeterminate (69.6%). The majority of the patients were well nourished according to the z score body mass index-for-age (82.6%) and z arm circumference-for-age (zAC/A) (82.6%). A decline in nutrition status was observed in 47.6% of the patients, as indicated by a decrease in zAC. Clinical and nutrition improvement was demonstrated by the progressive increase in zAC, serum albumin levels, and phase angle (PA) values and by the reduction in C-reactive protein levels. There was no statistically significant relationship between nutrition status and clinical outcomes. Most children and adolescents with ALF presented adequate nutrition status at the time of LT, and some patients worsened their nutrition status during hospitalization, suggesting that post-LT is a period of high nutrition risk, and early nutrition therapy (NT) must be a priority in these patients.

Seasonality influences skin bacterial community structure and anti-Bd function in two anuran species

Microorganisms on amphibian skin reduce disease susceptibility and play an important role in pathogen defense. We hypothesized that anuran skin bacterial communities would change in response to seasonal variation and host species. To test this hypothesis, we used 16S rRNA amplicon sequencing to identify cutaneous bacterial communities of two frogs from the Qinling Mountains of China, Pelophylax nigromaculatus and Nanorana quadranus. We matched the amplicon sequence variants (ASVs) of microbes exhibiting protective effects against the pathogen Batrachochytrium dendrobatidis (Bd), using a database containing over 1900 16S rRNA gene sequences from amphibian skin bacteria. The results showed that seasonal variation had a stronger effect than host species on the structure (alpha-diversity, beta-diversity, species composition and abundance, and biomarkers) and anti-Bd function of cutaneous bacterial communities. These communities were highly dynamic but varied similarly between hosts. Their structural similarities were more consistent at the phylum level, but markedly less so at finer taxonomic levels. The highest relative abundance of anti-Bd reads was observed in P. nigromaculatus during summer, but anti-Bd reads were present in both frog species during different seasons. Therefore, the protective function of cutaneous microbial communities appears to be continuous despite between-species differences in anti-Bd ASV abundance. This observation does not directly explain why Bd infections have not been recorded in the region, butprovides important insight on anuran pathogen defense mechanisms. Our findings also suggest that specific seasons can be periods of high infection risk, with major implications for research on amphibian ecology and conservation.

Uncovering the features of industrial odors-derived environmental complaints and proactive countermeasures by using machine-learning

Industrial odor-derived environmental complaints pose an emerging and far-reaching challenge in cities worldwide with intensive industries. Developing effective odor complaint management strategies is essential for mitigating the public impact of industrial odors. Based on a typical case of persistent tire manufacturing odors affecting local communities, we proposed an environmental complaint risks (ECR) prediction model using machine-learning (ML) approaches, which combined complaints with temporal-resolution manufacturing-meteorology-environment data. Through intensive match-making between ML algorithms and multi-source parameters, Random Forest models can achieve a reliable ECR-prediction model performance with an average ROC-AUC of 0.79at a monthly timescale, indicating the effectiveness of ML-based ECR prediction models. The interpretable ML model quantitively depicted the underlying mechanisms of ECR prediction, driven by process emission behaviors, local wind direction, and historical high-risk period. Furthermore, to mitigate predictable ECR within a future period, we designed a model framework that integrated ECR prediction models with an adaptive optimization genetic algorithm. This enabled the proactive management by precisely and dynamically allocating limited resources of emission regulatory to high-ECR periods in advance. The strategy was proven effective, achieving a significant 24.7% average reduction in the overall ECR forecast during a period with intensive complaints. Overall, this study proposed a data-driven model framework that efficiently helps the multi-stakeholders shift from passive response to proactive ECR management, thereby enhancing the environmental and social sustainability.

Cardiac lymphatics undergo distinct remodeling during hypertrophic and nonhypertrophic pregnancy.

Lymphatic vessels of the heart undergo dynamic remodeling in response to physiological and pathological cardiovascular events such as development, adult cardiac maintenance, and injury repair. During pregnancy, the cardiovascular system undergoes physiological changes to meet the increased demand for blood supply to the fetus. These extensive physiological changes make pregnancy and delivery a high-risk period in a woman's life. However, whether and how cardiac lymphatics change during pregnancy is largely undefined. Therefore, we used whole mount immunofluorescent labeling and quantitative morphometric analysis to characterize the changes in cardiac lymphatic vasculature during pregnancy using two genetically distinct inbred mouse strains, C57BL/6J and BALB/cJ. When compared with age-matched, nonpregnant C57BL/6J control mice, the hearts of C57BL/6J dams in late pregnancy [gestation day 17.5 (G17.5)] undergo physiological hypertrophy. However, there were no significant changes in the cardiac lymphatic vasculature. In contrast, BALB/cJ mice do not exhibit pregnancy-induced cardiac hypertrophy at G17.5 compared with age-matched, nonpregnant mice. Yet interestingly, the cardiac lymphatic vasculature of pregnant BALB/cJ dams undergoes extensive morphological changes, including decreased lymphatic length, number of end points, and vessel branch-point junctions on the ventral side of the heart. These findings underscore the complexity of genetic and physiological factors that contribute to the heterotypic remodeling of cardiac lymphatics during late pregnancy.NEW & NOTEWORTHY Cardiac lymphatics remodel in response to physiological and pathological stresses. This study is the first to investigate cardiac lymphatic vessel changes during pregnancy. BALB/cJ mice, which do not undergo pregnancy-induced cardiac hypertrophy, show decreased lymphatic length, number of end points, and junctions on the ventral side during pregnancy. In contrast, C57BL/6J mice, which undergo pregnancy-induced cardiac hypertrophy, had no such changes. These findings underscore the complexity of genetic and physiological factors contributing to cardiac lymphatic remodeling.

Risk Prediction and Prevention Strategies Used by the Financial Industry Are Supported by Artificial Intelligence Technologies

With the advancement of artificial intelligence (AI) and big data technology, traditional financial management faces challenges in meeting modern needs. China's financial sector, although late to start, is embracing AI to mitigate risks like business and credit risks. This study explores risk prediction and avoidance methods in finance using AI. It employs elementary catastrophe theory to analyze dynamic system discontinuity, identifying high-risk periods when the calculated financial stress index (FSI) exceeds 1. Each unit increase in FSI affects its lag period by 0.7327 units. Macro-economic pressure, reflected in the macroeconomic pressure index (MSI), significantly impacts FSI, with the current period having a more pronounced effect than the lag period. Financial institutions must evolve talent into hybrid professionals and invest in AI to enhance risk management while pursuing profitability.

Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist's role, part 2: Complications, postrevascularization care, and quality improvement.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the later phases of inpatient care are reviewed. Published descriptions and validation of clinical pharmacist roles specific to the acute management of STEMI are limited. This high-risk period from presentation through revascularization, stabilization, and hospital discharge involves complex pharmacotherapeutic decision points, many operational medication needs, and multiple layers of quality oversight. A companion article reviewed STEMI pharmacotherapy from emergency department presentation through revascularization. Herein we complete the pharmacotherapy review for the STEMI patient across the inpatient phases of care, including the management of peri-infarction complications with vasoactive and antiarrhythmic agents, considerations for postrevascularization antithrombotics, and assessments of supportive therapies and secondary prevention. Key guideline recommendations and literature developments are summarized from the clinical pharmacist's perspective alongside suggested pharmacist roles and responsibilities. Considerations for successful hospital discharge after STEMI and pharmacist involvement in associated institutional quality improvement efforts are also provided. We aim to support inpatient pharmacy departments in advancing clinical services for this critical patient population and call for further research delineating pharmacists' impact on patient and institutional STEMI outcomes.

Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist's role, part 1: Patient presentation through revascularization.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the critical initial phases of care are reviewed. Despite established value in the emergency department (ED), cardiac care, and intensive care settings, there is currently little published literature describing or supporting clinical pharmacist roles in the acute management of STEMI. The high-risk period from hospital presentation through revascularization and stabilization involves complex pharmacotherapeutic decision points, many operational medication needs, and multiple layers of quality oversight. While rife with opportunities for pharmacists to optimize care, this timeframe appears inconsistently targeted by clinical pharmacy services, which may halt after ED evaluation and then resume upon postcatheterization cardiac unit admission. Herein we review the key pharmacotherapeutic modalities and considerations for the patient with STEMI across the critical initial phases of care. These include supportive therapies prior to revascularization, the host of antithrombotics involved in revascularization by percutaneous coronary intervention and/or fibrinolysis, and other periprocedural medications. Important practice guidelines and clinical resources are summarized from the clinical pharmacist perspective, and roles and responsibilities of the responding pharmacist are suggested. A companion article will extend the review to periprocedural adverse event management, key early decision-making regarding long-term risk reduction, and pharmacist involvement in institutional quality improvement efforts. We aim to support inpatient pharmacy departments in advancing clinical services for this critical patient population, and we call for further research delineating pharmacist impact on patient and institutional STEMI outcomes. Patients presenting with STEMI rapidly traverse multiple phases of care and receive a host of antithrombotic and supportive medications during acute management, presenting many important pharmacotherapeutic decision points and roles for pharmacists.

Relationship Between Primary School Teachers' COVID-19 Fear Levels and COVID-19 Vaccine Attitudes After the Start of Face-to-face Education During the Pandemic Period: A School Health Study.

Starting face-to-face education while the COVID-19 pandemic was ongoing was a risk for public health. Determining teachers' initial reactions to public health practices during this high-risk period may contribute to the redesign of public health and school nursing policies. The aim of this research is to examine the relationship between primary school teachers' COVID-19 fear levels and COVID-19 vaccine attitudes. The research has a descriptive correlational design. The data were obtained from teachers working in primary schools (n = 430). Simple random sampling method was used in the data collection process. Data were obtained with the Scale of Attitudes Towards COVID-19 Vaccine and Fear of COVID-19 Scale. In the study, 50.5% of teachers reported that they were afraid of catching COVID-19, 41.9% said their risk of catching COVID-19 was "high," and 87.7% reported that they voluntarily got the COVID-19 vaccine. Of the teachers, 4.6% (n = 20) stated that they regretted getting vaccinated. A positive and significant relationship was found between teachers' Fear of COVID-19 Scale and COVID-19 Vaccine Attitude Scale scores (r = 0.133, p < 0.001). During the pandemic, it was observed that teachers' fear level of COVID-19 increased with the start of face-to-face education. In addition, it is seen that teachers started to have doubts about some public health practices. This may indicate that public health nurses should take a more active role in school health practices.

Graft Loss in Pediatric and Young Adult Kidney Transplantation in New Zealand: Who Is at Greatest Risk and When?

Much is reported regarding the detrimental effect of transfer to adult services for adolescent and young adult (AYA) kidney transplant (KT) recipients. However, AYA recipient age independent of time post-KT, and not relating to transfer of care, is also a strong predictor of graft loss. We assessed KT graft survival if experiencing solely pediatric (PO) or adult services (AO) versus transfer from pediatric to adult services (PTA). A retrospective cohort analysis of all first kidney transplant recipients between birth-24 years of age, from 2000 to 2019 in New Zealand. Participant identification and data were obtained via the Australia and New Zealand Dialysis and Transplantation registry. Primary outcome was graft survival stratified by service type. Cox proportional hazard modeling assessed independent risk factors of graft loss. Two hundred forty-four children and AYA with a median follow-up of 7.3 years were included. Graft survival stratified by service provision group was not different. The incidence rate of graft loss was 37, 34, and 45 per 1000 persons per year for PO, PTA, and AO respectively. Crude age-specific graft failure rates were highest for 22-24-year-olds with inferior outcomes starting from age 16, peaking at 24 years. Older adolescence and young adulthood reflect a high-risk period for KT loss. Transfer to adult services was not associated with worse graft survival compared to those experiencing either AO or PO alone. Improved models of care are needed to improve graft survival in this vulnerable population within New Zealand.

Seasonal activity and phoresy rates of Nitidulid beetles (Coleoptera: Nitidulidae) captured in stands with oak wilt infections in northern Michigan, USA.

Nitidulid beetles (Coleoptera: Nitidulidae), the overland vectors of the Bretziella fagacearum fungus that causes oak wilt, were monitored in infection centers in Quercus rubra stands in northern Michigan, USA using baited, wind-oriented traps for 2 years. First nitidulid captures, accounting for <1.5% of total annual captures, occurred in late April in both years (<50 cumulative degree days [DDs]; base 10°C). A total of 1,188 and 735 beetles representing 19 and 18 species were captured in 2018 (18 traps; 3 sites) and 2019 (16 traps; 4 sites), respectively. Ground traps (1.5 m high) captured more beetles and species than traps on canopy branches of red oaks. Most nitidulids (81-86%) were captured in May and June, but frequent precipitation and cool spring temperatures extended activity into early July in 2019. In 2018, 336 beetles representing 12 species were screened for B. fagacearum spores, but only 20 beetles from 4 species bore viable spores. Mycelial mats on red oaks killed were 4-fold more abundant in 2019 than in 2018. Of the 225 beetles screened in 2019, 56 beetles representing 6 species had viable spores. Nearly all (96%) spore-bearing beetles in both years were captured in late May or June. In bimonthly xylem samples collected from healthy trees, large earlywood vessels, presumably more vulnerable to infection than latewood, were present from May to June in 2018 and until early July in 2019. Results are consistent with mid-May to mid-July high-risk periods designated in current state and regional guidelines for oak wilt management.

Risk assessment for the surface water quality evaluation of a hydrological basin

This paper proposes a risk assessment methodology for evaluating the surface water quality of hydrological basins based on physico-chemical parameter concentrations. Considering the Douro River basin in Portugal and monthly recorded dissolved oxygen and conductivity parameter measurements in 18 water sampling stations from January 2002 to December 2013, the work intends to answer the research question of identifying the riskiest periods for water pollution in the year and classifying the water sampling stations in terms of risk for water pollution. The methodology consists first in determining the pollution risk implied by the physico-chemical parameters, based on the monthly water station measurements, using six different risk measures, namely mean, variance, loss probability, entropy, mean excess loss and value at risk. The risk values are ordered according to each risk measure and a final ranking is established through a ranking aggregation method. The final ranking permitted identifying the high risk period as ranging from May to October and the low risk period from November to April. Furthermore, July was classified as riskiest month concerning the dissolved oxygen concentration, and August as riskiest month regarding the conductivity levels. On the other hand, the ranking allowed classifying the water sampling stations, previously grouped in clusters, in terms of similar risk for water pollution: six sampling stations in the west of the basin formed the riskiest cluster in the dry period considering the dissolved oxygen concentrations, and four of those stations formed also the riskiest cluster concerning the conductivity levels.

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

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

How Do Flemish Laying Hen Farmers and Private Bird Keepers Comply with and Think about Measures to Control Avian Influenza?

Competent authorities of many countries, including Belgium, impose control measures (preventing wild bird access to feeders and water facilities, indoor confinement of captive birds, or fencing off outdoor ranges with nets) on professional and non-professional keepers of birds to prevent the spread of avian influenza (AI). Flemish laying hen farmers (FAR, n = 33) and private keepers of captive birds (PRI, n = 263) were surveyed about their opinion on and compliance with AI measures legally imposed during the most recent high-risk period before this survey in 2021. Participants answered questions on a 5-point Likert scale (1 = the worst, 3 = neutral, and 5 = the best). FAR indicated better compliance with the AI measures than PRI, except for net confinement. FAR indicated that they and other poultry farmers complied better with AI measures than PRI. Additionally, PRI indicated that they better complied than other PRI keepers. FAR regarded the AI measures as more effective than PRI. To prevent the spread of AI more effectively, national authorities could focus on information campaigns explaining to private bird keepers the need for the various control measures that they impose. If these campaigns fail, local authorities may need stricter enforcement or alternative ways to increase compliance.

Expansion or retrenchment: Corporate investment reactions to external security risks

Intensifying power competition has raised the need to understand how corporations react to international security dynamic challenges. Using data on Chinese A-share listed companies from 2012 to 2022, we developed an index to measure external security risk and empirically study the influence of external security risks on corporate investment behavior. These findings indicate that corporations reduce real investment and increase financial asset allocation when external security risk is high. Meanwhile, corporations tend to expand overseas investments to enhance international diversification and turn toward low-risk regions. The technology and strategic emerging sectors exhibit a higher preference for real investment during periods of high external security risk. Furthermore, entrepreneurs’ family-nation sentiment can inhibit corporate financial investment and promote real investment. This study contributes to understanding how the external security environment shapes corporate investment strategies. It also demonstrates how entrepreneurial spirit can influence corporate investment decisions during periods of high security risk.

Risk of Traumatic Intracranial Hemorrhage After Stroke: A Nationwide Population-Based Cohort Study in Taiwan.

Stroke and traumatic intracranial hemorrhage (tICH) are major causes of disability worldwide, with stroke exerting significant negative effects on the brain, potentially elevating tICH risk. In this study, we investigated tICH risk in stroke survivors. Using relevant data (2017-2019) from Taiwan's National Health Insurance Research Database, we conducted a population-based retrospective cohort study. Patients were categorized into stroke and nonstroke groups, and tICH risk was compared using a Cox proportional-hazards model. Among 164 628 patients with stroke, 1004 experienced tICH. Patients with stroke had a higher tICH risk than nonstroke counterparts (adjusted hazard ratio [HR], 3.49 [95% CI, 3.17-3.84]). Subgroup analysis by stroke type revealed higher tICH risk in hemorrhagic stroke survivors compared with ischemic stroke survivors (HR, 5.64 [95% CI, 4.97-6.39] versus 2.87 [95% CI, 2.58-3.18], respectively). Older patients (≥45 years) with stroke had a higher tICH risk compared with their younger counterparts (<45 years), in contrast to younger patients without stroke (HR, 7.89 [95% CI, 6.41-9.70] versus 4.44 [95% CI, 2.99-6.59], respectively). Dementia and Parkinson disease emerged as significant tICH risk factors (HR, 1.69 [95% CI, 1.44-2.00] versus 2.17 [95% CI, 1.71-2.75], respectively). In the stroke group, the highest tICH incidence density occurred 3 months after stroke, particularly in patients aged >65 years. Stroke survivors, particularly those with hemorrhagic stroke and those aged ≥45 years, face elevated tICH risk. Interventions targeting the high-risk period are vital, with fall injuries potentially contributing to tICH incidence.

Crash risk prediction using sparse collision data: Granger causal inference and graph convolutional network approaches

Applying deep learning techniques in predicting traffic crashes provides a possibility to achieve the vision of “zero fatalities” by implementing a proactive safety countermeasure. The overly sparse distribution of crashes hinders high-precision prediction of crash risks in urban areas. The lack of effective crash association analysis also reduces the interpretability of the prediction model. To address these gaps, this paper proposes a novel method, Priori Spatial and Temporal Causal Graph Convolutional Network (PST-CGCN) for predicting crash risk based on causal inference and graph convolutional network. In PST-CGCN, a data enhancement strategy utilizing historic priori spatial and temporal knowledge is employed to improve the distinguishability between crash data, then a graph convolutional network based on causal association is designed. The focus of this study is to shift attention from using multiple data sources to predict traffic risk to exploring the intrinsic temporal and spatial causal relationship between traffic crashes in different regions. Results from the NYC case study show that PST-CGCN model performs best compared with seven baseline models on three indicators, identifying high crash risk periods and areas in short-term forecasting. The results of ablation experiments on the PST-CGCN demonstrate the rationality of each component in the framework. Besides, gradient analysis combined with causal association is applied to explore directed causal relationships between regions, which enhances the model’s interpretability.

The Prevalence of Tobacco Product Use Among Students in the Faculty of Medicine at Pamukkale University and Their Views on the Smoke-Free Campus Implementation.

Tobacco use is an important risk factor for more than 20 types of cancer, especially cardiovascular and respiratory diseases, and many other health problems. Cigarettes are one of the most commonly used tobacco products in the world, and they can cause both physical and mental addiction. Adolescence is known to be the highest-risk period in terms of addiction among all age groups. As a result, smoke-free campus practices have become even more important in universities. This study investigates the prevalence of smoking among Pamukkale Medical School students and their views and behaviors regarding smoke-free campus practices. This cross-sectional study was conducted with 548 medical students at Pamukkale Universıty Faculty of Medicine during the academic year 2021-2022, between April 1-29, 2022. A face-to-face interview was conducted. Students' smoking status and their views about a smoke-free campus were assessed. In the questionnaire, the independent variables were socio-demographic characteristics, duration of staying in a smoke-free environment, smoking status in the place of residence, areas where smoking is most common, Fagerström nicotine dependence level, knowledge about smoke-free campus applications and campuses with the smokefree application. The Statistical Package for the Social Sciences version 21.0 package program was used to analyze the data. Descriptive statistics are presented with numbers and percentages for categorical variables, while the arithmetic mean and standard deviation are used for continuous variables. The chi-square test was used to compare categorical variables,and the Kolmogorov-Smirnov analysis was used to test the compatibility of data to normal distribution. The student smoking rate increased significantly as the number of semesters increased (P = .021). The smoking rate of male students was higher than that of female students (P = .001). The smoking rate of students living with their family or relatives was lower (P = .020). Smokers (14.7%) were more likely to have heard about the introduction of smoke-free zones on campus than nonsmokers (11%) (P = .280). 81.4% of students affirmed the statement, "The number of smoke-free rooms should be increased," and 84.3% responded, "I support the existence of smoke-free spaces." Nonsmoking students (90.8%) are more likely to agree that smoke-free spaces should be increased than those who smoke (57.7%) (P < .001). Among the students, 17.6% of nonsmokers and 37.8% of smokers find the information about smoke-free spaces sufficient (P < .001). The rate of those who consider smoke-free space inspections to be sufficient is lower for nonsmoking students than for nonsmokers (P = .017). Nonsmokers (89.5%) support the existence of smoke-free spaces to a higher degree than smokers (71.2%) (P < .001). One-third of Pamukkale University Faculty of Medicine students smoke, and smoking rates are higher among men and those who do not live with family or relatives. All participants strongly support the existence of smoke-free zones (84.3%), while a proportion of tobacco users (31.4%) support the implementation of a smoke-free campus. Student opinions of the smoke-free zones and the smoke-free campus application are more positive among nonsmokers than smokers.