Identification Of Factors Research Articles

An integrated risk prioritization and determination of activity-wise delay (IRPAD) framework for enhancing schedule management in tunnel projects

PurposeThis study aims to develop a comprehensive framework for addressing delays in tunnel construction projects by leveraging predictable risk factors. Tunnel projects often encounter scheduling delays due to inherent complexities and uncertainties, necessitating a proactive approach to prevent project underperformance.Design/methodology/approachThe integrated risk prioritization and determination of activity-wise delay (IRPAD) framework is divided into four phases: identification and prioritization of risk factors, determination of activity-wise risk coefficients using MCDM-based methodology, obtaining the critical risk path, and developing an activity-wise risk matrix. Fault tree analysis (FTA) and event tree analysis (ETA) are employed to determine activity-wise risk coefficients based on expert responses.FindingsThe framework’s applicability in Indian tunnel projects is demonstrated through a real-world case study with 95% validation accuracy. The IRPAD framework enhances the delay analysis process and facilitates the provision of effective activity-wise mitigation measures.Practical implicationsThe IRPAD framework predicts delays in infrastructure projects thus enhancing resilience and sustainability, supporting SDGs 9 and 11. It can be applied to a wide range of construction projects to improve project performance.Originality/valueThis research introduces novel concepts such as the three fold activity-wise risk matrix and the critical risk path, contributing to the development of the IRPAD framework for delay reduction. This framework offers valuable insights to practitioners in the construction industry.

Emotional Risk Factors, Rumination, and Self-Criticism in Relation to Suicidal Ideation Among Chinese Depressive Outpatients.

Previous studies indicated that individuals with major depressive disorder (MDD) are at high risk of suicide, making the identification of risk factors in suicidal depressive outpatients essential for developing effective prevention and treatment strategies. This study aims to (1) identify emotional risk factors and (2) examine the relationship between cognitive markers-including rumination and self-criticism-and suicidal ideation among depressive outpatients. A total of 165 Chinese clinical outpatients with depression were recruited from local hospitals in Hong Kong. In our sample, 68% of patients with moderate depression and 87.5% of patients with severe depression reported experiencing suicidal thoughts. The results from the logistic regression revealed a significant interaction between rumination and self-critical thoughts in relation to suicidal ideation. Specifically, the ruminative patients with self-critical thoughts were more likely to have suicidal thoughts than those without self-critical thoughts. These findings align with the cognitive model of suicide, suggesting that maladaptive information processing and negative cognitive content are associated with an increased risk of suicide. The current findings have clinical implications for the future development of more specific and accurate mental health assessment, preventive programs, and psychotherapies for depressive outpatients.

Identification of Determinants That Reduce Women’s Safety and Comfort in Urban Public Spaces (UPS)

Urban development and population growth present new challenges for developing urban public spaces (UPS) in cities. The significance of cities as centers of integration of different socio-cultural groups is growing. Taking into account the diversity of needs and expectations of sensory-sensitive groups (women) as residents and users of urban public spaces is a key task facing modern city managers. Women’s public participation is relevant and important, because recognizing their needs and taking them into account in urban spatial policy contributes to creating cities tailored to the needs and expectations of residents and users, according to the principle of “everyone-important”. This article has goals for the identification of factors that reduce the safety and comfort of women’s activities and the most important architectural features UPS. The results of the research indicate that the determinants that reduce the friendliness of safety and comfort in UPS are a lack of lighting, lack of esthetics of space development, lack of benches and toilets, and street noise. A space tailored to women’s needs and expectations should be well-lit with a level walking and sidewalk surface and include architectural infrastructure elements such as adequate municipal sanitation (toilets), benches and urban furniture, with landscaped green space (squares, flowerbeds, trees), which is in line with the principles of universal design. This study’s results found that such factors can help create safe, egalitarian, and inclusive cities. They complete the research gap in the field of sustainable urban development and are key to developing gender-equitable urban planning and urban development policy practices.

Perception About One Minute Perceptorship In Postgraduate Training of Ophthalmology

Objective: To evaluate the perception of postgraduate trainees of ophthalmology about One Minute Preceptorship. Study Design: Mixed method study Place and Duration of Study: Department of Ophthalmology Peshawar Medical College, Peshawar from Jun 2020 to Dec 2020. Methodology: Ten post graduate FCPS trainees of Ophthalmology were included in this study. The participants were introduced to and practiced One Minute Preceptorship for a period of 01 month in the outpatient clinic. A questionnaire for study was filled anonymously after taking an informed consent, which included ten closed ended and three open ended questions to assess the efficacy of One Minute Preceptorship model in improving practical skills like focused history taking, case presentation, clinical diagnosis and devising an effective management plan. Results: One Minute Preceptorship model is an effective learning and teaching tool for improving case presentation skills (90%), identifying disease presentation (70 %), clinical diagnosis (60%), identification of risk factors (80%) and understanding the management plan (70%).Qualitative analysis of One Minute Preceptorship model usage showed improved clinical evaluation skills, more efficient time consumption, prompt clinical diagnosis and provision of self-reflection to the learner. Conclusion: OMP model can be employed as an effective learning and teaching tool in an outpatient clinical setting in postgraduate Ophthalmology training.

Risk factors for postoperative hypokalemia in patients undergoing endoscopic pituitary adenoma resection: a retrospective cohort study.

Currently, endoscopic transsphenoidal surgery is the primary approach for treating pituitary tumors. While endoscopic surgery offers numerous advantages, it also comes with a series of potential surgical complications. Postoperative hypokalemia is a common complication, with mild cases presenting with atypical symptoms such as dizziness, headache, fatigue, and constipation, while severe cases can lead to arrhythmias, rhabdomyolysis, and even death. Therefore, early identification of risk factors for postoperative hypokalemia is crucial. This study aims to analyze the risk factors for hypokalemia after endoscopic pituitary tumor resection. This study included 168 patients who underwent endoscopic resection of pituitary tumors between 2019 and 2023. Patients were divided into hypokalemia group and non-hypokalemia group based on whether their postoperative serum potassium concentration was less than 3.0 mEq/L. Identifying independent risk factors through binary logistic regression analysis. Among the 168 patients, 18 (10.7%) cases experienced postoperative hypokalemia, with the majority occurring on the fourth day after surgery. The majority of patients did not exhibit clinical symptoms related to hypokalemia. The binary logistic regression analysis revealed that age (OR 1.09; 95% CI [1.03-1.15]; P = 0.001) and postoperative hypoalbuminemia on the first day (OR, 4.35; 95% CI [1.38-13.75]; P = 0.012) were associated with postoperative hypokalemia. Patients aged ≥50 years and those presenting with hypoalbuminemia on the first postoperative day were more likely to develop postoperative hypokalemia. Therefore, electrolyte monitoring should be enhanced in such patients postoperatively, especially to actively prevent hypokalemia on the 4th-5th postoperative day.

Review on assessing climate-change-induced risks to run-of-river hydropower infrastructure in Nepal

Abstract. Nepal annually invests millions of dollars in hydropower development, with a substantial portion of these funds allocated to civil infrastructure. Climate change, which impacts geological and hydrological conditions, poses a threat to civil components throughout hydropower project construction and operation. This causes budget overruns, project delays, and adverse consequences for society and the environment, ultimately resulting in multimillion-dollar losses. The identification of risk factors and their underlying causes, stemming from the impacts of climate change, constitutes a fundamental aspect of this study. This critical analysis primarily draws upon extensive literature reviews to pinpoint these factors (risk factors arising from climate change), emphasizing their economic and human impacts. This paper highlights the risks to run-of-river hydropower infrastructures in Nepal. The findings of the study can be used to develop and implement adaptation strategies to mitigate the risks posed by climate change to Nepal's vital hydropower sector.

When Hope Fades: Considering Self-Esteem, Depression, Social Support, Loneliness in The Context of Suicide Prevention

Individuals engaging in suicidal ideation or making suicide attempts are a substantial demographic group to investigate preventive mental health due to inherent high risks associated with potential outcomes of suicidal behaviors for public health. Factors increasing the likelihood of suicide might include self-esteem, depression, social support, loneliness, or certain demographic profiles, and the purpose of this study is to synthesize these variables to advocate for effective strategies to intervene in cases of suicide. Specifically, this commentary aims to identify suicidal coping mechanisms and psychological resilience factors among suicidal individuals through the enhancement of self-esteem, intervention of depressive symptoms, and promotion of connectedness. Through discussing the determinants that might play a role in the onset of suicidal thoughts and suicide attempts, this paper has important implications for suicide prevention strategies and the identification of psychological resilience factors that can predict suicidal thoughts and suicide attempts in individuals.

Identification of risk factors for necrotizing enterocolitis in twins: a case-control matching analysis of over ten-years’ experience

ObjectiveThe identification of risk factors is crucial for the clinical prevention and diagnosis of necrotizing enterocolitis (NEC). Monochorionic twins (MCT), due to the high genetic homogeneity, provided a valuable model for investigating the risk factors of various diseases. This study aimed to explore the risk factors for NEC using MCT.MethodsA retrospective review was conducted on the medical records of monochorionic twins (MCT) treated at Guangzhou Women and Children’s Medical Center from January 2012 to March 2023. We compared perinatal condition, feeding and preceding condition between MCT pairs with NEC (NEC MCT) and without NEC(No NEC MCT).Logistic regression analysis was utilized to identify independent risk factors.ResultIn 85 pairs of monochorionic twins (MCT), NEC occurred in one twin in 78.8% of cases, whereas both twins were affected in 21.2% of cases. In the final cohort of 60 pairs of MCT, several parameters were found to differ significantly between NEC MCT group and No NEC MCT group. Compared to No NEC MCT group, the incidence of umbilical cord abnormalities was significantly higher in the NEC MCT group (25% vs. 8.3%, P = 0.014). Meanwhile, NEC MCT group showed higher prevalence of SGA infants (48.3% vs. 21.7%, P = 0.002) and sFGR (38.3% vs. 6.7%, P = 0.000). Furthermore, TTTs (13.3% vs. 3.3%, P = 0.027) and septicemia (25% vs. 5%, P = 0.002) were more common in NEC MCT group. In a multivariable logistic regression model, sFGR (OR 6.81,95%CI 2.1–21.9, p = 0.001) was eventually output as an independent risk factor.ConclusionNon-genetic factors play a predominant role in the pathogenesis of NEC. Umbilical cord abnormalities, SGA, sFGR, TTTs and septicemia significantly increase the risk of NEC. sFGR is an independent risk factor of NEC.

Sport, Choice and Social Class: Reading Indian Female Sports Life Writings

Sports form a continuous part of any culture, created and sustained for entertainment, pleasure, competition and bonding; founded on certain standards, interests, requirements, and resources of the sports community. Yet, the classification of some sports as ‘elite’ goes unrecognised simply because it appears to be natural and moreover it is always ‘how things are’. Traditional theories of class indicate that economic differentiation is the reason for various choices in the society. On the other hand Bourdieu has suggested that economic capital is not the only element influencing one’s choice and there are other multiple non-economic criteria too. Taking into account Bourdieu’s class concepts we seek to identify the non-economic factors that have led sportspersons in India to their choice of sport. Narrative analysis is performed for autobiographies of two female sportspersons, Saina Nehwal and Mary Kom, to highlight the different parameters that have influenced their choice of sport. The identification of such non-economic factors like a person’s mental strength, level of angst, resilience, emotional and financial well-being, and others, provide insight into the stratifications that impact sports culture in India.

Insights into fetomaternal outcomes in pre-eclampsia: A tertiary care center descriptive study

Preeclampsia and eclampsia remain significant challenges in both maternal and perinatal health worldwide, with a pronounced impact in regions such as India, where access to comprehensive maternal care can be limited. The objective of this study was to examine the outcomes for both mothers and babies, along with the complications linked to severe cases of preeclampsia and eclampsia, within a tertiary healthcare facility situated in South India. : Sixty-five pregnant women diagnosed with severe preeclampsia or eclampsia were enrolled in this descriptive observational study conducted at a tertiary care teaching hospital, Chennai, spanning from March 2023 to December 2023. Inclusion criteria comprised women with singleton pregnancies exhibiting severe preeclampsia (defined by blood pressure ≥160/110 mmHg and 1+ or more albuminuria) or eclampsia. Exclusion criteria included chronic hypertension, multiple pregnancies, chronic renal disease, connective tissue disorder, neurological complications, and refusal of consent. Data on sociodemographic variables, obstetric characteristics, maternal symptoms, and complications were collected using a structured questionnaire. Maternal and fetal well-being were assessed through biochemical, radiological, and nonstress tests.: The results revealed that 80% of the study population with severe preeclampsia or eclampsia fell within the age group of 21-30 years, with 49.2% aged between 26-30 years. Majority (60%) were primigravida. Common maternal symptoms included headache (60%), oedema (76.9%), with fewer experiencing epigastric pain (3.1%) and vaginal bleeding (15.4%). Complications observed were HELLP syndrome (12.35%), placental abruption (7.7%), and eclampsia (10.8%). Perinatal outcomes included intrauterine fetal death (4.6%), fetal growth retardation (23.1%), low birth weight (30.8%), respiratory distress syndrome (4.6%), and stillbirth (1.5%), with 35.4% being normal births.This study emphasises the substantial impact of severe preeclampsia and eclampsia on the health of both mothers and fetuses, underscoring the importance of thorough antenatal care, prompt identification of risk factors, and timely interventions to minimise negative consequences. There is a clear call for additional research to investigate and implement effective strategies for prevention and management, aiming to decrease the morbidity and mortality rates associated with these hypertensive disorders during pregnancy.

Determination of Factors Affecting Wage Differentiation in EU Countries

This study aims to identify the determinants of wage differentiation in European Union (EU) countries using panel data analysis. The literature review provides an overview of previous studies on wage differentiation, the current situation of wage differentiation in the EU, and the potential determinants and consequences of wage differentiation. The analysis shows that many potential variables influence wages and that direct modeling is problematic. However, the application of factor analysis led to the identification of significant factors, namely the economic strength of a country, the level of digitalization and working conditions, investment, and the unemployment rate. These findings are consistent with the existing literature. The robustness analysis of the results is provided. The conclusion offers recommendations for increasing wages based on the research results.

Transcriptome analysis of fruit development and identification of key transcription factors related to anthocyanin pathway in cultivated octoploid strawberry

Transcriptome analysis of fruit development and identification of key transcription factors related to anthocyanin pathway in cultivated octoploid strawberry

Identification of Host Factors Interacting with Movement Proteins of the 30K Family in Nicotiana tabacum.

The interaction of viral proteins with host factors represents a crucial aspect of the infection process in plants. In this work, we developed a strategy to identify host factors in Nicotiana tabacum that interact with movement proteins (MPs) of the 30K family, a group of viral proteins around 30 kDa related to the MP of tobacco mosaic virus, which enables virus movement between plant cells. Using the alfalfa mosaic virus (AMV) MP as a model, we incorporated tags into its coding sequence, without affecting its functionality, enabling the identification of 121 potential interactors through in vivo immunoprecipitation of the tagged MP. Further analysis of five selected candidates (histone 2B (H2B), actin, 14-3-3A protein, eukaryotic initiation factor 4A (elF4A), and a peroxidase-POX-) were conducted using bimolecular fluorescence complementation (BiFC). The interactions between these factors were also studied, revealing that some form part of protein complexes associated with AMV MP. Moreover, H2B, actin, 14-3-3, and eIF4A interacted with other MPs of the 30K family. This observation suggests that, beyond functional and structural features, 30K family MPs may share common interactors. Our results demonstrate that tagging 30K family MPs is an effective strategy to identify host factors associated with these proteins during viral infection.

Risk Factors for Invasive Surgical Site Infections Among Adult Single Liver Transplant Recipients at Duke University Hospital in the Period 2015-2020.

Invasive primary surgical site infections (IP-SSI) are a severe complication of liver transplant surgery. Identification of risk factors for IP-SSI is critical to IP-SSI prevention. All adult single liver transplants performed at Duke University Hospital in the period 2015-2020 were reviewed for IP-SSI occurring within 90 d of transplant. Risks for IP-SSI were identified using least absolute shrinkage and selection operator variable selection procedure. A 2-sided P value of <0.05 was considered statistically significant. IP-SSI were identified in 34/470 (7.2%) adult single liver transplants. Repeat transplantation, spilt liver, Roux-en-Y biliary anastomosis, anastomotic leak, and post-transplant renal replacement therapy were positively associated with IP-SSI. IP-SSI were associated with increased length of index transplant hospitalization (24.5 versus 10.0 d, P < 0.01) and 1-y all-cause mortality (14.7% versus 4.1%, P = 0.02). Gram positive bacteria were the main pathogens (51.7%), followed by Gram negative bacteria (24.1%) and Candida (24.1%). Multidrug resistance bacteria increased over time (27.3% in 2015 versus 66.7% in 2020, P = 0.17). In the setting of routine antimicrobial prophylaxis and an overall low rate of IP-SSI, surgical factors were the main determinants of IP-SSI among adult liver transplant recipients. IP-SSI had a negative impact on the length of index transplant hospitalization and 1-y mortality. While the surgical factors associated with an increased risk of IP-SSI are not easily modifiable, their impact may be best contained by close clinical monitoring and tailored antimicrobial therapy.

A new scoring system to predict fatal accidents in General Aviation and to facilitate emergency control centre response

Numerous accidents occur with General Aviation aircraft every year. To date, pre-emptive prediction of survival or death is impossible. The current study aims to identify significant factors elementary to predict survival after General Aviation (GA) aircraft accidents. The Implementation of a scoring system, including these factors, may facilitate emergency control centre response. Data of flight accidents over a 20-year period (extracted from the German Federal Bureau of Aircraft Accident Investigation [BFU]) was analysed for fixed-wing motorized small aircrafts below 5,700 kg MTOW. Factors of interest were analysed using Chi2- and Mann–Whitney-U-Tests. Logistic regression was used to establish a score to calculate the probability of a fatal outcome after an aircraft accident. The BFU lists 1,595 GA aircraft accidents between 2000 and 2019. The factors “third quarter of the year” (p = 0.04), “last quarter of the year” (p = 0.002), “fire” (p < 0.0001), “distance from airport > 10 km” (p < 0.0001), “landing” (p < 0.0001) and “cruise” (p < 0.0001), significantly correlated positively or negatively with a fatal outcome. “Take-off”, “approach”, “month”, “day of the week”, “persons on board above three”, “night-time” and “icing conditions” showed no significant correlation. Using logistic regression “third quarter of the year” and “cruise” were excluded when using the B-STEP method. Including the four significant parameters, the score showed a strong effect with f2 = 0.709. The analysis of GA aircraft accidents in Germany enabled the identification of relevant factors and establishment of a new scoring system for survival prediction after small aircrafts accidents below 5,700 kg MTOW. The implementation of the scoring system in emergency control centres in the context of digital development and artificial intelligence can improve emergency response planning and distribution.

Identification of novel transcription factors regulated by H3K27 acetylation in myogenic differentiation of porcine skeletal muscle satellite cells.

H3K27 acetylation (H3K27ac) is crucial in muscle development as it regulates gene expression. Dysregulation of H3K27ac level has been linked to muscle-related diseases such as Duchenne muscular dystrophy, yet the mechanisms through which H3K27ac influences myogenic differentiation are not fully understood. Here, we utilized the SGC-CBP30 drug, a CBP/p300 bromodomain inhibitor, to reduce H3K27ac level and investigated its effect on myogenic differentiation of porcine skeletal muscle satellite cells. The results demonstrated an increased H3K27ac level during normal muscle satellite cell differentiation. We found that the addition of SGC-CBP30 resulted in a reduced level of H3K27ac based on ATAC-seq and CUT&Tag data. Our analysis revealed that a cluster characterized by reduced levels of H3K27ac and increased levels of H3K27me3 was enriched with motifs corresponding to Bach2, MafK, and Fosl2 transcription factors. Furthermore, knockdown of Bach2, MafK, and Fosl2 produced a similar suppression effect on myogenic differentiation. Taken together, our study contributes to a better understanding of how H3K27ac influences myogenic differentiation.

Clinical characteristics and prognosis analysis of pseudomonas aeruginosa bloodstream infection in adults: a retrospective study

Pseudomonas aeruginosa bloodstream infections (PA BSIs) in adults, especially those complicated by sepsis, are associated with high rates of morbidity and mortality. Early identification of risk factors for both mortality and sepsis-induced coagulopathy (SIC) is critical to optimizing patient management and improving outcomes. We conducted a retrospective analysis of 118 adult patients diagnosed with PA BSIs at the Affiliated Hospital of Xuzhou Medical University from January 2022 to February 2024. Univariate analysis was employed to identify significant clinical factors, followed by multivariate stepwise logistic regression to determine independent predictors of mortality and SIC. Based on these findings, nomogram models were constructed and evaluated using the area under the receiver operating characteristic curve (AUC), Bootstrap resampling, and calibration plots to assess model performance. Empiric sensitive antibiotic therapy (ESAT) (OR = 0.039, P < 0.001), coronary artery disease (CAD) (OR = 10.315, P = 0.010), and invasive mechanical ventilation (OR = 3.926, P = 0.020) emerged as significant predictors of mortality. In contrast, elevated C-reactive protein (CRP) (OR = 1.011, P = 0.003), procalcitonin (PCT) (OR = 1.030, P = 0.005), and lower hemoglobin levels (OR = 0.963, P = 0.004) were independently associated with SIC. The AUC of mortality prediction model is 0.908, while the SIC prediction model yielded an AUC of 0.817. The predictive models developed in this study demonstrate early identification of mortality rates and SIC risk in PA BSI patients, which may have the potential to guide timely therapeutic interventions and improve clinical outcomes in this high-risk population.

Identification of Factors Leading to Unfit Medical Products and Other Health Commodities, Disposal Management and Related Perceived Consequences to Health Supply Chain in Rwanda. Case of Rwanda Medical Supply Ltd and Medical &amp; Allied Service Solutions Ltd

Abstract Background Unfit medical products, especially poor quality / damaged / expired / and phased out (no longer accepted for use) are among health challenges that need careful attention and adequate management in developing countries health supply chains, including Rwanda. Not only does medical wastage affect the public health in general, but also it affects financial capabilities. Actually, according to the Management Science for Health, countries on average spend about 25% of their total health expenditure on medicines, and a significant part of the funds expended on critical drugs is wasted. Objectives The main objective of this study is to identify the factors leading to unfit medical products and related perceived consequences to the supply chain management in Rwanda. Specific Objectives I. To identify the most commonly found unfit medical products in RMS and MEDIASOL. II. Explore factors contributing to unfit medico-pharmaceuticals in RMS and MEDIASOL. III. To explore perceived consequences of unfit medical products to the supply chain management in RMS and MEDIASOL. IV. To explore the disposal methods of unfit pharmaceuticals management in RMS and MEDIASOL Methods The mixed method research design used, data were collected from 20 key informant by doing interview, A questionnaire containing open questions was used and cross-sectional study were used both focusing on identify the most commonly found unfit medical products in RMS and their management, then the shared data were transcribed and translated by the researchers. Main ideas from each Key informant were merged under each theme and sub themes by reading and then rereading to identify common words, phrases and perceptions that were coded. Quantitative data were coded and analyzed using SPSS and EXCEL software. Results The study found that the most common unfit medico-pharmaceuticals are the laboratory commodities, malaria commodities and program products including quinine, and Haloperidol retard 50mg/ml injection and Insulin combinations, the study indicated that the Lack of local manufacturers of pharmaceutical products according to market needs; Change of medical products protocols; Minimum shelf life not specified while ordering the products; and Lack of accurate data to facilitate quantification were highlighted by the respondents as the main factors leading to unfit medicinal products. And the study found that the total unfit products were 3% of the average annual loss in unfit medicinal products compared to the total stock. The study recommended that further research should be done on this topic especially by exploring effective mechanisms and strategies to mitigate the wastage of medical products and other health commodities in Rwanda. Conclusions Medical products are critical for preserving lives in morbid diseases, yet they can get unfit from their intended use for different identified reasons in this study as presented in the summary of factors leading to unfit medical products. Those factors are for example the: Low consumption rate of some products; Sudden change of medical treatment protocols; Procurements without specific minimum required shelf life of products at arrival; etc. Then, were identified twenty-three (23) common unfit products also presented in the results, as well as the perceived consequences of unfit medical products to the supply chain; and three main applied disposal methods are incineration, plastic materials recycling and reuse of unfit products for other purposes. Future studies are needed to explore this important topic more broadly and come up with sustainable strategies to properly manage the medical products throughout the entire supply chain

Abstract 4114597: Spontaneous coronary artery dissection: Case series and review of associated cardiovascular risks

Background: Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of ACS, myocardial infarction, and sudden death particularly among young women and individuals with few conventional atherosclerotic risk factors. We reveiwed possible risk factors that could predispose to SCAD. Methods: We reviewed 13 consecutive patients presenting with SCAD across three different institutions over a period of 5 yrs and determined risk fatcors associated with this disase entity. Results: 13 patients presented with SCAD represented % 0.5 of the total number of patients who underwent cardiac cathaterizations for chest pain requiring admissions. 11/13 (84%) were female. 5/13 (38%) were Caucasian or Hispanic, and 3/13 (23%) were African-American. Mean age age was 49.3 + years. 8/13 (61%) had associated hyperlipidemia with LDL levels &gt; than 110 mg/dL, 9/13 (64%) had an A1c &lt; 5.6% and only 1/13 (0.07%) had A1c of 6.4%. HTN was present in 6/13 (46%) of patients, and family history of SCD or heart disease were only seen in 2/13 (15%). None of the patients had features suggestive of associated fibromuscular dysplasia or connecive tissue disease. D-dimer was elevated in 5/13 (38%) with average value of 1578 ng/dL. Inflammatory markers were reviewed, only 3 patient has had ESR and CRP ordered, and only 1/3 had a mildly elevated CRP 3.9 mg/dL. Only 1/13 (0.07%) required intervention which was due to further drop in her ejection fraction requiring PCI, with improvement in her symptoms. All patients were treated with dual anti-platelet therapy for 1 year, 1 was discontinued due to persitent chest pain and decision was made to treat with only aspirin. Traditionally, risks for SCAD were thought to be due to non-atheresclerotic factors, however our case series shows that more then 60% of patients had elevated LDL's and 46% with hypertension, implying that traditional atheresclerotic risk factors should not be ignored and may play a crucial role. Autoimmune diseases were not found in any of our patients. Conclusion and implications: In this series patients who had SCAD had conventional risk factors of CAD including HLD and hypertension. The variability of co morbidities makes the identification of specific risk factors very difficult and none of the patients had Fibromuscular dysplasia or any signs of inflammation. Elevated D Dimer was also seen in a majority of patients, and all but one was managed medically with a favorable outcome

Exploring factors influencing pedestrian accident severity: a multi-source study in the city of Berlin

BackgroundRoad safety remains a critical concern in Europe’s transport sector. In urban areas, where 40% of total road fatalities occur, pedestrians are particularly vulnerable, since according to road safety data accidents involving a pedestrian are 2.8 and 15 times more probable to be fatal than in rural areas and motorways respectively. In line with the Vision Zero concept and the European Commission’s directives, many EU members are taking steps to improve road safety. Accordingly, the identification of the key factors behind pedestrian accident occurrence and pedestrian accident severity in urban areas is ever more relevant.MethodologyThe proposed methodology employs traditional logistic regression models and artificial neural networks, using accident data from Berlin, Germany, sourced from the Berlin Open Data portal. The dataset comprises information on 3,257 accidents involving pedestrians in 2018 or 2019, including details about involved vehicles, accident details, and injury severity information. Additionally, the dataset was augmented with average network speed data from Uber Movement and road network information from Geographic Information System (GIS) applications.ResultsFormal analysis results indicated several factors as significant to accident severity, such as involvement of bicycle or heavy vehicles, lighting conditions, speed limit and accident type. Additionally, a comparison between modelling approaches shows a clear performance advantage of ANNs over statistical models. Research findings provide insight for various stakeholders working to enhance pedestrian safety in urban areas.