Low-risk Period Research Articles

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.

Utility of plasma anti-gSG6-P1 IgG levels in determining changes in Anopheles gambiae bite rates in a rural area of Cameroon

The applicability of the specific human IgG antibody response to Anopheles gambiae salivary Gland Protein-6 peptide 1 (gSG6-P1 salivary peptide) as a biomarker able to distinguish the level of exposure to mosquito bites according to seasonal variations has not yet been evaluated in Central African regions. The study aimed to provide the first reliable data on the IgG anti-gSG6-P1 response in rural area in Cameroon according to the dry- and rainy-season. Between May and December 2020, dry blood samples were collected from people living in the Bankeng village in the forest area of the Centre region of Cameroon. Malaria infection was determined by thick-blood smear microscopy and multiplex PCR. The level of IgG anti-gSG6-P1 response, was assessed by enzyme-linked immunosorbent assay. Anopheles density and aggressiveness were assessed using human landing catches. The prevalence of malaria infection remains significantly higher in the rainy season than in the dry season (77.57% vs 61.44%; p = 0.0001). The specific anti-gSG6-P1 IgG response could be detected in individuals exposed to few mosquito bites and showed inter-individual heterogeneity even when living in the same exposure area. In both seasons, the level of anti-gSG6-P1 IgG response was not significantly different between Plasmodium infected and non-infected individuals. Mosquito bites were more aggressive in the rainy season compared to the dry season (human biting rate-HBR of 15.05 b/p/n vs 1.5 b/p/n) where mosquito density was very low. Infected mosquitoes were found only during the rainy season (sporozoite rate = 10.63% and entomological inoculation rate-EIR = 1.42 ib/p/n). The level of IgG anti-gSG6-P1 response was significantly higher in the rainy season and correlated with HBR (p ˂ 0.0001). This study highlights the high heterogeneity of individual’s exposure to the Anopheles gambiae s.l vector bites depending on the transmission season in the same area. These findings reinforce the usefulness of the anti-gSG6-P1 IgG response as an accurate immunological biomarker for detecting individual exposure to Anopheles gambiae s.l. bites during the low risk period of malaria transmission in rural areas and for the differentiating the level of exposure to mosquitoes.

Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease

The clinical utility of stress cardiovascular magnetic resonance imaging (CMR) in stable chest pain is still debated, and the low-risk period for adverse cardiovascular (CV) events after a negative test result is unknown. To provide contemporary quantitative data synthesis of the diagnostic accuracy and prognostic value of stress CMR in stable chest pain. PubMed and Embase databases, the Cochrane Database of Systematic Reviews, PROSPERO, and the ClinicalTrials.gov registry were searched for potentially relevant articles from January 1, 2000, through December 31, 2021. Selected studies evaluated CMR and reported estimates of diagnostic accuracy and/or raw data of adverse CV events for participants with either positive or negative stress CMR results. Prespecified combinations of keywords related to the diagnostic accuracy and prognostic value of stress CMR were used. A total of 3144 records were evaluated for title and abstract; of those, 235 articles were included in the full-text assessment of eligibility. After exclusions, 64 studies (74 470 total patients) published from October 29, 2002, through October 19, 2021, were included. This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Diagnostic odds ratios (DORs), sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), odds ratio (OR), and annualized event rate (AER) for all-cause death, CV death, and major adverse cardiovascular events (MACEs) defined as the composite of myocardial infarction and CV death. A total of 33 diagnostic studies pooling 7814 individuals and 31 prognostic studies pooling 67 080 individuals (mean [SD] follow-up, 3.5 [2.1] years; range, 0.9-8.8 years; 381 357 person-years) were identified. Stress CMR yielded a DOR of 26.4 (95% CI, 10.6-65.9), a sensitivity of 81% (95% CI, 68%-89%), a specificity of 86% (95% CI, 75%-93%), and an AUROC of 0.84 (95% CI, 0.77-0.89) for the detection of functionally obstructive coronary artery disease. In the subgroup analysis, stress CMR yielded higher diagnostic accuracy in the setting of suspected coronary artery disease (DOR, 53.4; 95% CI, 27.7-103.0) or when using 3-T imaging (DOR, 33.2; 95% CI, 19.9-55.4). The presence of stress-inducible ischemia was associated with higher all-cause mortality (OR, 1.97; 95% CI, 1.69-2.31), CV mortality (OR, 6.40; 95% CI, 4.48-9.14), and MACEs (OR, 5.33; 95% CI, 4.04-7.04). The presence of late gadolinium enhancement (LGE) was associated with higher all-cause mortality (OR, 2.22; 95% CI, 1.99-2.47), CV mortality (OR, 6.03; 95% CI, 2.76-13.13), and increased risk of MACEs (OR, 5.42; 95% CI, 3.42-8.60). After a negative test result, pooled AERs for CV death were less than 1.0%. In this study, stress CMR yielded high diagnostic accuracy and delivered robust prognostication, particularly when 3-T scanners were used. While inducible myocardial ischemia and LGE were associated with higher mortality and risk of MACEs, normal stress CMR results were associated with a lower risk of MACEs for at least 3.5 years.

The resurgence risk of COVID-19 in China in the presence of immunity waning and ADE: A mathematical modelling study

The mass vaccination program has been actively promoted since the end of 2020. However, waning immunity, antibody-dependent enhancement (ADE), and increased transmissibility of variants make the herd immunity untenable and the implementation of dynamic zero-COVID policy challenging in China. To explore how long the vaccination program can prevent China at low resurgence risk, and how these factors affect the long-term trajectory of the COVID-19 epidemics, we developed a dynamic transmission model of COVID-19 incorporating vaccination and waning immunity, calibrated using the data of accumulative vaccine doses administered and the COVID-19 epidemic in 2020 in mainland China. The prediction suggests that the vaccination coverage with at least one dose reach 95.87%, and two doses reach 77.92% on 31 August 2021. However, despite the mass vaccination, randomly introducing infected cases in the post-vaccination period causes large outbreaks quickly with waning immunity, particularly for SARS-CoV-2 variants with higher transmissibility. The results showed that with the current vaccination program and 50% of the population wearing masks, mainland China can be protected at low resurgence risk until 8 January 2023. However, ADE and higher transmissibility for variants would significantly shorten the low-risk period by over 1 year. Furthermore, intermittent outbreaks can occur while the peak values of the subsequent outbreaks decrease, indicating that subsequent outbreaks boosted immunity in the population level, further indicating that follow-up vaccination programs can help mitigate or avoid the possible outbreaks. The findings revealed that the integrated effects of multiple factors: waning immunity, ADE, relaxed interventions, and higher variant transmissibility, make controlling COVID-19 challenging. We should prepare for a long struggle with COVID-19, and not entirely rely on the COVID-19 vaccine.

Willingness and uptake of the COVID-19 testing and vaccination in urban China during the low-risk period: a cross-sectional study

BackgroundRegular testing and vaccination are effective measures to mitigate the ongoing COVID-19 pandemic. Evidence on the willingness and uptake of the COVID-19 testing is scarce, and the willingness and uptake of vaccination may change as the pandemic evolves. This study aims to examine willingness and uptake of COVID-19 testing and vaccination during a low-risk period of the COVID-19 pandemic in urban China.MethodsA cross-sectional online survey was conducted among 2244 adults in urban China. Descriptive analyses were performed to compare the respondents’ willingness and uptake of COVID-19 testing and vaccination. Multivariate logistic regressions were fitted to investigate factors associated with the willingness and uptake of the two measures.ResultsIn early 2021, about half (52.45%) of the respondents had received or scheduled a COVID-19 test at least once, and a majority (95.63%) of the respondents were willing to receive testing. About two-thirds (63.28%) of the respondents had received/scheduled or were willing to receive a COVID-19 vaccine. Willingness and uptake of COVID-19 testing were not associated with socio-demographic characteristics, except for occupation. Being of older age, migrants, having higher educational attainment and secure employment were associated with a higher uptake of COVID-19 vaccination among the surveyed respondents, while willingness to vaccinate was consistent across socio-demographic characteristics among those who had not been vaccinated.ConclusionsBy early 2021, Chinese adults expressed almost universal willingness of COVID-19 testing and over half of adults have been tested, while the willingness and uptake of COVID-19 vaccination were relatively low at the low-risk period of the COVID-19 pandemic. Maintaining willingness of COVID-19 vaccination is critical and necessary, especially when the pandemic evolved into a low-risk period.

Management and Utilization Strategy of Water Resources for Rice Production

Declination of available water resources is threatening the dry season crop production in Bangladesh. Sustainable water management is crucial need to meet future food production. This study was aimed to determine futuristic water management strategy for rice cultivation. Both surface and groundwater is getting scarce in north-west region, whereas abundant of fresh surface water creating opportunities to irrigate dry season crops in south-central region. This study has outlined irrigation management for rice cultivation and groundwater utilization in water scarce area of north-west region. More than 75% of annual rainfall occurred during monsoon and crops other than monsoon often faced water shortage. Timely establishment of T. Aus rice on 01 May accounted average 183 mm supplemental irrigation for north-west and south-west region. Transplanting of T. Aman rice before 24 July found the low risk period of drought and gave about 1 t ha-1 yield advantage than late transplanting after 15 October. Supplemental irrigation in drought year gave up to 26% yield advantage than the rain-fed condition of T. Aman rice in experimental plot. Over exploitation of groundwater by famers for crop cultivation makes the groundwater status worsen. Farmers used 38% excess water than the actual requirement for Boro rice cultivation. For that annual groundwater withdrawal was higher than annual recharge causing groundwater level depletion in most of the districts. Groundwater table went below suction limit of shallow tubewell (STW) during dry season and thus it become unable to operate. Improved distribution system with plastic pipe, buried pipe could save about 25% of irrigation water. Alternate wetting and drying (AWD) irrigation method saved 20-25% water than farmer’s practice. Application of these on-farm water management technologies in Boro rice reduced water demand and made the groundwater balance positive as well as reduced the groundwater withdrawal pressure. On the contrary, irrigation with less saline surface water resources in river and canals of south central regions could expand Boro production and increased land productivity. Intervention of low lift pump with plastic pipe distribution in non-saline tidal areas could increase land productivity. Besides, trapped freshwater in to the canals inside the polders and re-excavation of these canals would make crop intensification. Thus, additional food production could help to achieve sustainable development goal and sustained food security. Bangladesh Rice J. 25 (1) : 37-50, 2021

Association Between Future Orientation and Anxiety in University Students During COVID-19 Outbreak: The Chain Mediating Role of Optimization in Primary-Secondary Control and Resilience.

The unfamiliar and menacing epidemic has undoubtedly increased the anxiety of students. Therefore, the strategies to reduce anxiety are urgently required. The present study principally investigated a protective mechanism of future orientation in anxiety during the low-risk period of COVID-19 outbreak. The study was conducted in 528 non-infected students (range = 16–24 years) recruited from five universities in China. The participants completed questionnaires between January 22, 2021, and January 24, 2021. Chain intermediary analyses were performed after controlling for gender and age. Results indicated that future orientation lowers anxiety through (a) optimization in primary and secondary control, (b) resilience, and (c) chain mediating path of optimization in primary and secondary control coupled with resilience. We investigated how individuals deal with risk factors after encountering adversity and how their psychological flexibility stimulates and promotes them to achieve a well-adapted developmental state. This study provided reference suggestions on reducing anxiety levels during an emergency.

Effects of Atmospheric Fine Particulate Matter and Its Carrier Microbes on Pulmonary Microecology in Patients with COPD.

ObjectiveThe aim of this paper was to analyse the influence of atmospheric fine particulate matter (AFPM) and atmospheric microorganisms on the pulmonary microecology of chronic obstructive pulmonary disease (COPD) patients in northeast China.MethodsCollected bronchoalveolar lavage fluid (BALF) of COPD patients in the high-risk period (group A) and low-risk period (group B) of AFPM inhalation and samples of AFPM in the same time range (group C) were collected. DNA sample sequencing, the bacterial abundance, and diversity bioinformatics of BALFs were performed by methods of Illumina MiSeq™ platform and Mothur and Uclust.ResultsA total of 58 samples were sequenced, including 22 samples from group A, 26 samples from group B and 10 samples from group C. A total of 2,005,790 bacterial sequences and 34,256 bacterial numbers were detected. Group B had the highest bacterial diversity of the three groups. Group B also had the highest bacterial abundance index value. There were differences in the classification of bacterial colonies for the three groups at the genus level. The types of bacteria in group C were more numerous than other groups, and group B was higher than group A, which indicates that there were more bacteria in BALF during the high-risk period of AFPM inhalation. The detection rates of Streptococcus, Mycoplasma, Roche, Pushia, Chlamydia trachomatis and Brucella for group C were significantly higher than group A. The COG and KEGG databases’ difference analysis results for the bacterial gene function abundance of group A and group B were 40.7% in group A and 38.9% in group B (R=0.098, P=0.006). The human disease abundance in group A and group B was 1.16% and 1.12%, respectively (P>0.05).ConclusionThe increase in the concentration of AFPM can increase the diversity and abundance of bacteria in the BALF of stable COPD patients.Clinical Trial Registration Number2020XS04-02.

Environmental surveillance of SARS-CoV-2 RNA in wastewater systems and related environments in Wuhan: April to May of 2020

Wastewater-based epidemiology (WBE) has emerged as an effective environmental surveillance tool in monitoring fecal-oral pathogen infections within a community. Congruently, SARS-CoV-2, the etiologic agent of COVID-19, has been demonstrated to infect the gastrointestinal tissues, and be shed in feces. In the present study, SARS-CoV-2 RNA was concentrated from wastewater, sludge, surface water, ground water, sediment, and soil samples of municipal and hospital wastewater systems and related environments in Wuhan during the COVID-19 middle and low risk periods, and the viral RNA copies quantified using reverse transcription quantitative polymerase chain reaction (RT-qPCR). From the findings of this study, during the middle risk period, one influent sample and three secondary effluents collected from waste water treatment plant 2, as well as two samples from Jinyintan Hospital wastewater system influent were SARS-CoV-2 RNA positive. One sludge sample collected from Guanggu Branch of Tongji Hospital, which was obtained during the low risk period, was also positive for SARS-CoV-2 RNA. These study findings demonstrate the significance of WBE in continuous surveillance of SARS-CoV-2 at the community level, even when the COVID-19 prevalence is low. Overall, this study can be used as an important reference for contingency management of wastewater treatment plants and COVID-19 prevention and control departments of Wuhan.

Willingness and Uptake of the COVID-19 Testing and Vaccination in Urban China: An Online Cross-Sectional Survey at Early 2021

Background: Regular testing and vaccination are effective measures to mitigate the ongoing COVID-19 pandemic. Few studies have focused on COVID-19 testing and vaccination uptake may change as the pandemic continues. This study aims to examine willingness and uptake of COVID-19 testing and vaccination during a low-risk period of the COVID-19 pandemic in urban China.Methods: A cross-sectional online survey was conducted among 2244 adults in urban China. Descriptive analyses were performed to compare the respondents’ willingness and uptake of COVID-19 testing and vaccination. Multivariate logistic regressions were fitted to investigate the factors associated with willingness and uptake of the two measures.Findings: In early 2021, 52.45% of the respondents had received or scheduled a COVID-19 test at least once, and a majority (95.63%) were willing to receive testing. 63.28% of the respondents had received/scheduled or were willing to receive a COVID-19 vaccine. Willingness and uptake of COVID-19 testing were not associated with socio-demographic characteristics, except for occupation. Being of older age, migrants having higher educational attainment and secure employment were associated with a higher uptake of COVID-19 vaccination among the surveyed respondents, while willingness to vaccinate was consistent across socio-demographic characteristics among those who had not been vaccinated.Interpretation: Chinese adults expressed almost universal willingness of COVID-19 testing and relatively low willingness of COVID-19 vaccination at the low-risk period of the COVID-19 pandemic, independent from their socio-demographic characteristics. Maintaining willingness of COVID-19 vaccination are key especially when the pandemic evolved into a low-risk period.Funding Information: ZH acknowledges financial support from the National Natural Science Foundation of China (No. 71874034) and the Three-Year Initiative Plan for Strengthening Public Health System Construction in Shanghai (2020-2022) (GWV-10.1-XK23). Declaration of Interests: None.Ethics Approval Statement: The study was approved by the Institutional Review Board of the School of Public Health, Fudan University (IRB#2020-12-0861). Respondents provided e-consent for their participation in the survey.

Early-life and parental predation risk shape fear acquisition in adult minnows.

Exposure to predation risk can induce a fearful baseline state, as well as fear reactions toward novel situations (i.e., neophobia). Some research indicates that risk exposure during sensitive periods makes adults more prone to acquiring long-term fearful phenotypes. However, chronic risk can also lead to ignoring threats in order to maintain other activities. We sought to assess how a relatively long period of low risk, experienced either early in life or by the previous generation, influences fear behaviour acquired from a short period of high risk as adults. We used fathead minnows as study subjects and simulated predation risk with repeated exposures to conspecific chemical alarm cues. The period of high risk experienced by adults induced typical fear behaviour (baseline freezing and neophobia), whereas the early-life low-risk period 1year prior caused only a reduction in baselineforaging. We found no evidence that the early-life risk significantly altered the fear acquired from the adult-risk period. However, in a second experiment, a low-risk period during the parental generation interacted with a high-risk period experienced by the adult offspring. The combination of both risk periods heightened baseline freezing despite parental risk having little effect independently. Hence, our study provides evidence that parental risk exposure can lead to an additive intergenerational effect on fear acquisition in minnows.

A spatiotemporal early warning system for dengue outbreak in Guangzhou, China

Background : Dengue fever has become a big public concern in Guangzhou after the unprecedented dengue outbreak in 2014. However, there was no efficient early warning system to help public health authorities to control dengue outbreaks several months in advance. Methods : Here, we built a spatio-temporal early warning system based on the Bayesian spatio-temporal probabilistic forecasts. A spatio-temporal Bayesian hierarchical model was formulated, using monthly dengue cases, from 2011 to 2017, for 167 townships as the response variable. Explanatory variables included temperature anomaly (averaged over the preceding 3 months), relative humidity, road density and dengue relative risk lagged by 3 months. To assess the performance of this model, we compared the observed and predicted dengue incidence rate (DIR) in each township in September, 2014 (high risk period) and September, 2015 (low risk period). We calculated the probability of dengue incidence falling into predefined categories. We defined the low, medium, and high risk categories as dengue case is lower than 1, between 1 and 10, and higher than 10. To assess the performance of warning system, we calculate the rank probability skill score (RPSS), which measures the improvement of the probabilistic forecast skill relative to the skill of a benchmark forecast. We calculated the benchmark probability by long-term average distribution of dengue cases in Guangzhou, September, 2011-2017. Results : Similar spatial pattern was found between observed DIR and predicted DIR, both in high and low epidemic risk period. R-square value (0.783) indicate good agreement between observed and predicted log DIR. Skill was high in townships in the downtown area with high risk of dengue, indicating warning system performed well. Conclusions : This early warning system may be useful to prevent the next dengue outbreak, not only before the peak dengue season each year, but also to assign medical resources accurately at fine geographic scale.

Marker-based crop model-assisted ideotype design to improve avoidance of abiotic stress in bread wheat.

Wheat phenology allows escape from seasonal abiotic stresses including frosts and high temperatures, the latter being forecast to increase with climate change. The use of marker-based crop models to identify ideotypes has been proposed to select genotypes adapted to specific weather and management conditions and anticipate climate change. In this study, a marker-based crop model for wheat phenology was calibrated and tested. Climate analysis of 30 years of historical weather data in 72 locations representing the main wheat production areas in France was performed. We carried out marker-based crop model simulations for 1019 wheat cultivars and three sowing dates, which allowed calculation of genotypic stress avoidance frequencies of frost and heat stress and identification of ideotypes. The phenology marker-based crop model allowed prediction of large genotypic variations for the beginning of stem elongation (GS30) and heading date (GS55). Prediction accuracy was assessed using untested genotypes and environments, and showed median genotype prediction errors of 8.5 and 4.2 days for GS30 and GS55, respectively. Climate analysis allowed the definition of a low risk period for each location based on the distribution of the last frost and first heat days. Clustering of locations showed three groups with contrasting levels of frost and heat risks. Marker-based crop model simulations showed the need to optimize the genotype depending on sowing date, particularly in high risk environments. An empirical validation of the approach showed that it holds good promises to improve frost and heat stress avoidance.

Quantitative Risk Assessment and Evolution Trajectory of China’s Iron Ore Resource

The resource security system is a complex system. Strategic mineral resource is of great importance to national security and economic development. Iron ore is one of the 24 strategic mineral resource determined by the Chinese government. Based on the broad connotation of resource security, we put forward the risk assessment model of resource security named 3E (Enduring, Economic, Environmental) model and establish a complete risk assessment index system for iron ore. In this paper, the entropy method is used to determine the weight of each index, we evaluate the comprehensive risk of iron ore from 2000 to 2016, and analyse the results of risk assessment in detail. The results show that the supply risk is on the rise, which has the greatest impact on the comprehensive risk. Moreover, the fluctuation of economic risk is more stable, and the environmental risk is decreasing. The comprehensive risk index of China’s iron ore increased firstly and then declined. From 2000 to 2007, it was a relatively low-risk period; from 2008 to 2010, the risk was increased; 2011-2013 was a high-risk period; and 2014 to 2016, there was a reduction in risk. In order to effectively control the risk of iron ore, this paper puts forward some suggestions from several aspects.

The time lag prior to the rise in glucose requirements to maintain stable glycaemia during moderate exercise in a fasted insulinaemic state is of short duration and unaffected by the level at which glycaemia is maintained in Type 1 diabetes.

To determine the duration of the low hypoglycaemia risk period after the start of moderate-intensity exercise performed under basal insulinaemic conditions and whether this period is affected by the level at which glycaemia is maintained under these conditions. This was a prospective, randomized counterbalanced study. Eight participants with Type 1 diabetes (mean ± sd age 21.5 ± 4.0 years) underwent either a euglycaemic (5-6 mmol/l) or hyperglycaemic clamp (9-10 mmol/l) on separate days and were infused with insulin at basal rates and [6,6-2 H]glucose while cycling for 40 min at 50% maximum oxygen consumption rate. The main outcome measures were the glucose infusion rates required to maintain stable glycaemia and glucoregulatory hormone levels, and rates of glucose appearance and disappearance. During the first 20 min of exercise, the glucose infusion rate did not increase significantly, irrespective of the level at which glycaemia was maintained, but increased acutely between 20 and 25 min under both conditions. Maintaining higher glycaemia resulted in higher glucose infusion rate during, but not early post-exercise. With the exception of epinephrine, the glucoregulatory hormone levels and rates of glucose appearance and disappearance were similar between conditions. Irrespective of the levels at which glycaemia is maintained, there is a 20-min low exogenous glucose demand period during which the exogenous glucose requirements to maintain stable glycaemia do not increase during moderate exercise performed at basal insulin level.

Defining Survivorship Trajectories Across Patients With Solid Tumors

Survivorship involves a multidisciplinary approach to surveillance and management of comorbidities and secondary cancers, overseen by oncologists, surgeons, and primary care physicians. Optimal timing and coordination of care, however, is unclear and often based on arbitrary 5-year cutoffs. To determine high- and low-risk periods for all tumor types that could define when survivorship care might best be overseen by oncologists and when to transition to primary care physicians. In this pan-cancer, longitudinal, observational study, excess mortality hazard, calculated as an annualized mortality risk above a baseline population, was plotted over time. The time this hazard took to stabilize defined a high-risk period. The percent morality elevation above age- and sex-matched controls in the latter low-risk period was reported as a mortality gap. The US population-based Surveillance, Epidemiology, and End Results database defined the cancer population, and the US Census life tables defined controls. Incident cases of patients with cancer were separated into tumor types based on International Classification of Diseases for Oncology definitions. Population-level data on incident cancer cases was compared with the general US population. Overall mortality and cause of death were reported on observed cancer cases. A total of 2 317 185 patients (median age, 63 years; 49.8% female) with 66 primary tumor types were evaluated. High-risk surveillance period durations ranged from less than 1 year (breast, prostate, lip, ocular, and parathyroid cancers) up to 19 years (unspecified gastrointestinal cancers). The annualized mortality gap, representing the excess mortality in the stable period, ranged from a median 0.26% to 9.33% excess annual mortality (thyroid and hypopharyngeal cancer populations, respectively). Cluster analysis produced 6 risk cluster groups: group 1, with median survival of 16.2 (5th to 95th percentile range [PR], 10.7-40.2) years and median high-risk period of 2.5 (PR, 0-5.0) years; group 2, 8.3 (PR, 5.1-23.3) and 2.5 (PR, 4.0-8.0) years; group 3, 2.8 (PR, 1.4-3.7) and 7.0 (PR, 6.0-11.1) years; group 4, 1.6 (PR, 1.5-1.8) and 6.0 (PR, 5.1-11.4) years; group 5, 0.8 (PR, 0.5-1.2) and 0.8 (PR, 0.5-1.2) years; and group 6, 0.5 (PR, 0.4-0.8) and 12.0 (PR, 9.3-12.9) years, respectively. Subanalyses of selected tumor types in these groups revealed that stratifying on stage and histologic type can change the risk cluster and guidance for care. These findings indicate that a standardized 5-year surveillance period is inadequate for some cancers while excessive for others. High-risk cancers require the most resources with the longest high-risk period, highest persistent baseline mortality risk, and longest period of primary cancer mortality, all arguing for longer follow-up with an oncologist in these cancers.

Negative Press Coverage, Litigation Risk, and Audit Opinions in China

Exploiting a legal regime change in China in 2005 that significantly increased auditors’ civil liability, we reexamine why auditors are more likely to issue modified audit opinions (MAOs) to clients who receive negative press coverage before audit report dates. We find that negative press coverage prior to the audit report date significantly increases the probability for auditors to issue MAOs during 2001-2009, consistent with findings using the U.S. data. More importantly, we find that such a positive relation does not exist in the low litigation risk period (2001-2004) and is present only in the high litigation risk period (2006-2009). Moreover, first-reported negative press coverage and repeated negative press coverage affects audit opinions differently. While neither affects the probability of MAOs in the low litigation risk period, only first-report negative press coverage increases the probability of MAOs in the high litigation risk period. Finally, additional analyses on regulatory sanctions in the year after negative press coverage rule out the possibility that the observed no relation between auditors’ MAOs and negative press coverage in the low litigation risk period is due to slack regulatory sanctions in that period. Taken together, our findings suggest that auditors increase the probability of issuing MAOs to firms receiving negative press coverage to mitigate a perceived increase in litigation risk stemming from negative press coverage in the high litigation risk period.

Folie à deux, gémellité et grossesse. À propos d’un cas

Folie à deux (or shared delusional disorder) has always questioned about a possible transmission of delusional disorders. Cases of folie à deux in monozygotic twins with a common genetic and environmental history, raise the issue of the different etiological hypotheses. Folie à deux is a rare disease. Ninety percent of the cases occur in the same family, with a majority of women (sisters association). Twinship is a specific relationship, where a common history is combined with a genetic background and a dual and unique relationship. Many twin studies have been published in the 1970s, regarding schizophrenia. The concordance rate of the disease is from 41 to 65% in monozygotic twins versus 0 to 28% in dizygotic twins. This article presents a case of folie à deux in monozygotic female twins. One was pregnant. The first part of the paper reports the case and recalls the different definitions of the disorder. A second part reviews published cases of the illness in twins. The third part treats about twin studies and schizophrenia. A fourth part reports data about delusional disorders in pregnancy. Eventually we discuss our reported case. Folie à deux was first described by Lasègue and Falret in 1877. They reported cases of shared delusional disorder, involving two persons or more. The first subject presented a delusional disorder. The second one, influenced by the first subject, was often most vulnerable. The treatment was based on separating the two delusioned persons. This nosological concept has been early criticized. Separation did not always improve symptoms. CIM-10 classification describes an “Induced delusional disorder”, and DSM-IV a “shared delusional disorder”. Literature shows many clinical forms of the disease. Folie simultanée should be the simultaneous occurrence of two genetically driven delusional disorders, as schizophrenia. Folie imposée involves a vulnerable person in contact with another one who suffers a delusional disorder. Folie communiquée should have a genetic origin but there are less data on it. Many articles discuss those clinical forms, and some of the reported cases of folie à deux could actually have been folie simultanée. The occurrence of a simultaneous delusional disorder in twins questions about the genetic or environmental etiology of folie à deux. Scarcity of the disorder and lack of epidemiological data leads to biases and limits the studies. First episodes of delusional disorders in pregnant women are rare. Affective disorders occur more frequently during and there are few data on delusional disorder in pregnancy. Pregnancy has been described as a low-risk period for schizophrenia, but on the other hand, it is a specific time leading to personal and familial changing, which could be considered as a period of vulnerability. This example of shared delusional disorder in monozygotic twins is a good illustration of the interactions between common genetic background, common and individual environmental histories, and a particular twin relationship, at the junction of nature and nurture. We consider the clinical history reported as a case of “folie induite”, or induced delusional disorder, because of the vulnerability induced by pregnancy.

High prevalence of cardiac autonomic dysfunction and T-wave alternans in dialysis patients

Chronic hemodialysis (HD) patients have an elevated risk of sudden cardiac death (SCD), particularly in the 24 hours before the first HD of the week. Temporal changes in cardiac autonomic dysfunction, as characterized by abnormalities in heart rate variability (HRV) and heart rate turbulence (HRT), along with T-wave alternans (TWA), may contribute to this dispersion of risk. This study sought to determine the prevalence of abnormal HRV, HRT, and TWA in HD patients and to compare their temporal distribution among periods of variable SCD risk. HRV, HRT, and TWA were analyzed from 72-hour Holter monitors in HD patients, and results were compared among the 24-hour high-risk period before the first dialysis session of the week, the 24-hour intermediate-risk period beginning with the weeks' first dialysis, and the low-risk period the day after the first dialysis. Positive cut points were standard deviation of all normal R-R intervals ≤70 ms for HRV, onset ≥0% and/or slope ≤2.5 ms/R-R for HRT, and ≥53 μV for TWA. Of 41 enrollees, 28 (46% male, age 55 ± 12, ejection fraction 57% ± 11%) had sufficient data for analysis. Abnormalities were prevalent with 82%, 75%, and 96% of patients reaching threshold for HRV, HRT, and TWA in at least one 24-hour period, respectively. There was no significant difference in the prevalence of abnormal measures among dialytic intervals nor in the intraindividual distribution of abnormal measures (P >.05 for all). Abnormal HRV, HRT, and TWA are prevalent in HD patients and may indicate heightened SCD risk. No significant correlation was observed among these measures and recognized periods of variable risk.

Assessment of occupational exposure to leptospirosis in a sheep-only abattoir

This study estimated the frequency of exposure of meat workers to carcasses infected with Leptospira serovars Hardjobovis or Pomona in a sheep-only abattoir in New Zealand. A stochastic spreadsheet model was developed to assess the daily risk of exposure of eviscerators, meat inspectors and offal handlers to live leptospires in sheep carcasses from May to November 2004 (high-risk period), and from December 2004 to June 2005 (low-risk period). The average sheep processed per day were 225 for an eviscerator, 374 for a meat inspector, and 1123 for an offal handler. The median daily exposures during high- and low-risk periods were 11 [95% distribution interval (DI) 5-19] and three (95% DI 1-8) infected carcasses/day for eviscerators, 18 (95% DI 9-29) and six (95% DI 2-12) for meat inspectors, and 54 (95% DI 32-83) and 18 (95% DI 8-31) for offal handlers, respectively. Stochastic risk modelling provided evidence that processing of sheep carcasses exposed meat workers regularly to live leptospires with substantial seasonal variation.