Medium Risk Research Articles

Occupational Exposure to Silica Dust and Silicosis Risk in Chinese Noncoal Mines: Qualitative and Quantitative Risk Assessment.

Despite increasing awareness, silica dust-induced silicosis still contributes to the huge disease burden in China. Worryingly, recent silica dust exposure levels and silicosis risk in Chinese noncoal mines remain unclear. We aimed to determine recent silica dust exposure levels and assess the risk of silicosis in Chinese noncoal mines. Between May and December 2020, we conducted a retrospective cohort study on 3 noncoal mines and 1 public hospital to establish, using multivariable Cox regression analyses, prediction formulas of the silicosis cumulative hazard ratio (H) and incidence (I) and a cross-sectional study on 155 noncoal mines in 10 Chinese provinces to determine the prevalence of silica dust exposure (PDE), free silica content, and total dust and respirable dust concentrations. The qualitative risk of silicosis was assessed using the International Mining and Metals Commission's risk-rating table and the occupational hazard risk index; the quantitative risk was assessed using prediction formulas. Kaplan-Meier survival analysis revealed significant differences in the silicosis probability between silica dust-exposed male and female miners (log-rank test χ21=7.52, P=.01). A total of 126 noncoal mines, with 29,835 miners and 4623 dust samples, were included; 13,037 (43.7%) miners were exposed to silica dust, of which 12,952 (99.3%) were male. The median PDE, free silica content, total dust concentration, and respirable dust concentration were 61.6%, 27.6%, 1.30 mg/m3, and 0.58 mg/m3, respectively, indicating that miners in nonmetal, nonferrous metal, small, and open-pit mines suffer high-level exposure to silica dust. Comprehensive qualitative risk assessment showed noncoal miners had a medium risk of silicosis, and the risks caused by total silica dust and respirable silica dust exposure were high and medium, respectively. When predicting H and I over the next 10, 20, and 30 years, we assumed that the miner gender was male. Under exposure to current total silica dust concentrations, median I10, I20, and I30 would be 6.8%, 25.1%, and 49.9%, respectively. Under exposure to current respirable silica dust concentrations, median I10, I20, and I30 would be 6.8%, 27.7%, and 57.4%, respectively. These findings showed that miners in nonmetal, nonferrous metal, small, and open-pit mines have a higher I and higher qualitative silicosis risk. Chinese noncoal miners, especially those in nonmetal, nonferrous metal, small, and open-pit mines, still suffer high-level exposure to silica dust and a medium-level risk of silicosis. Data of both total silica dust and respirable silica dust are vital for occupational health risk assessment in order to devise effective control measures to reduce noncoal mine silica dust levels, improve miners' working environment, and reduce the risk of silicosis.

Posterior assessment of occupational risks associated with work hardness based on workers’ subjective perception of their health

Work hardness causes health impairments in workers of some occupations. Posterior assessment should be considered priority one in health risk analysis instead of relying solely on results obtained by prior assessment based on descriptions of working condition. This paper presents the results obtained by posterior occupational risk (OR) assessment associated with work hardness; the assessment is based on analyzing workers’ subjective perception of their health (workers employed at a bearing production were used as an example). A survey was accomplished within this study followed by analyzing subjective perception of one’s health. It gave an opportunity to accomplish quantitative posterior OR assessment (that considered both likelihood of diseases and their severity) at the group and individual levels. Work hardness creates unacceptable group health risks associated with diseases of the musculoskeletal system and connective tissue (1.93•10-2–2.56•10-2), nervous system (4.03•10-2–6.77•10-2), genitourinary system (2.04•10-2–2.7•10-2) and cardio-vascular system (1.47•10-2–1.69•10-2). Such indicators as ‘weight of constantly lifted cargo and cargo moved by hand’ (35–58 %) and ‘uncomfortable working posture / working upright’ (29–54 %) make major contributions to the integral risk. Risk categories were adjusted at the individual level (considering parameters of the relationship that describe how likelihood of disease is influenced by work hardness, age and working records). This allowed establishing that OR was predominantly caused by diseases of the musculoskeletal system and connective tissue (‘medium risk’ for 19–83 % of the workers and ‘high risk’ for 75–81 %), nervous system (‘high risk’ for 84–85 % and ‘extremely high risk’ for 15–16 % of the workers) and genitourinary system (‘moderate risk’ for 1 %, ‘medium risk’ for 8 %, and ‘high risk’ for 87 %). Occupational health risk assessment allowed identifying priority indicators of work hardness (‘weight of constantly lifted cargo and cargo moved by hand’ and ‘uncomfortable working posture / working upright’) and establishing proper scope of relevant prevention activities at the group and individual level.

Апостериорная оценка профессионального риска, связанного с тяжестью трудового процесса, на основе анализа субъективного восприятия работниками своего здоровья

Work hardness causes health impairments in workers of some occupations. Posterior assessment should be considered priority one in health risk analysis instead of relying solely on results obtained by prior assessment based on descriptions of working condition. This paper presents the results obtained by posterior occupational risk (OR) assessment associated with work hardness; the assessment is based on analyzing workers’ subjective perception of their health (workers employed at a bearing production were used as an example). A survey was accomplished within this study followed by analyzing subjective perception of one’s health. It gave an opportunity to accomplish quantitative posterior OR assessment (that considered both likelihood of diseases and their severity) at the group and individual levels. Work hardness creates unacceptable group health risks associated with diseases of the musculoskeletal system and connective tissue (1.93•10-2–2.56•10-2), nervous system (4.03•10-2–6.77•10-2), genitourinary system (2.04•10-2–2.7•10-2) and cardio-vascular system (1.47•10-2–1.69•10-2). Such indicators as ‘weight of constantly lifted cargo and cargo moved by hand’ (35–58 %) and ‘uncomfortable working posture / working upright’ (29–54 %) make major contributions to the integral risk. Risk categories were adjusted at the individual level (considering parameters of the relationship that describe how likelihood of disease is influenced by work hardness, age and working records). This allowed establishing that OR was predominantly caused by diseases of the musculoskeletal system and connective tissue (‘medium risk’ for 19–83 % of the workers and ‘high risk’ for 75–81 %), nervous system (‘high risk’ for 84–85 % and ‘extremely high risk’ for 15–16 % of the workers) and genitourinary system (‘moderate risk’ for 1 %, ‘medium risk’ for 8 %, and ‘high risk’ for 87 %). Occupational health risk assessment allowed identifying priority indicators of work hardness (‘weight of constantly lifted cargo and cargo moved by hand’ and ‘uncomfortable working posture / working upright’) and establishing proper scope of relevant prevention activities at the group and individual level.

Socioeconomic inequalities, genetic susceptibility, and risks of depression and anxiety: A large-observational study

ObjectivesThis study aimed to investigate the interplay between genetic susceptibility and socioeconomic disparities on psychiatric disorders. MethodsIn this study, we utilized data from the UK Biobank to analyze the Generalized Anxiety Disorder (GAD)-7 scale (N = 74,425) and the Patient Health Questionnaire (PHQ)-9 (N = 74,101), along with the Index of Multiple Deprivation (IMD). The polygenic risk score (PRS) was calculated to assess the genetic risk associated with GAD-7/PHQ-9 scores, and the individuals were classified into low, medium, and high genetic risk groups according to tertiles of PRSs related to the GAD-7/PHQ-9. Linear regression models were used to explore the relationships between GAD-7/PHQ-9 scores and IMD scores in patients with different genetic susceptibilities. ResultsDisadvantaged socioeconomic status was associated with the risk of anxiety and depression across all strata of genetic risk, and stronger associations were shown for individuals with greater genetic susceptibility. From low to high genetic risk, the risk of psychiatric disorders increased for the GAD-7 (β = 0.002 to 0.032) and PHQ-9 (β = 0.003 to 0.045) scores. In addition, strong associations of high genetic risk with anxiety (β = 0.875) and depression (β = 1.152) were detected in the IMD quartile 4 group compared with the least deprivation quartile group. Furthermore, income and employment were estimated to contribute strongly to anxiety (βemployment = 7.331, βincome = 4.492) and depression (βemployment = 9.951, βincome = 6.453) in the high genetic risk group. ConclusionThe results suggest that we should pay more attention to psychiatric disorders with high genetic susceptibility and try to improve their socioeconomic status to prevent the development of psychiatric disorders.

368. THE ROLE OF PG-SGA SCORE IN PREDICTING SHORT- TERM POSTOPERATIVE COMPLICATIONS IN ESOPHAGEAL CANCER SURGERY

Abstract Background The preoperative nutritional status is increasingly recognized as a determinant of postoperative outcomes in esophageal cancer patients. This study examines the relationship between preoperative nutritional scores, particularly the Patient-Generated Subjective Global Assessment (PG-SGA), and the incidence of short-term postoperative complications. Methods A prospective cohort study was conducted on patients undergoing surgery for esophageal cancer across two Surgical Departments at University Hospitals in Athens, Greece. Preoperative nutritional status was assessed using the PG-SGA score. Patients were categorized based on the PG-SGA score into low to medium risk with score of 8 or less, and high risk with score of 9 or higher. Postoperative complications were classified according to the Clavien-Dindo system, and their association with nutritional status was statistically assessed. Results This study included 59 consecutive patients who underwent surgery for esophageal cancer with female-to-male ratio of 1:4.9 and a median age of 65.4 ± 10.4 years, 43 (72.9%) of whom had received neoadjuvant chemotherapy. Notable postoperative complications (Clavien- Dindo classification ≥III) occurred in 14 cases, including evisceration (n=1), hemorrhage (n=1), chyle leakage (n=1), anastomotic leak (n=8), pleural effusion requiring radiological intervention (n=2), and a persistent pneumothorax necessitating additional thoracic tube insertion (n=1). A statistically significant association was found between malnutrition, as indicated by the PG-SGA≥9, and the development of severe postoperative complications (Clavien- Dindo classification ≥III) (p = 0.034). Conclusion This study suggests that preoperative PG-SGA score is potentially significant predictors of short- term postoperative complications in esophageal cancer surgeries. Incorporating nutritional assessments into the preoperative evaluation may help identify high-risk patients and tailor perioperative care to improve surgical outcomes.

Contamination of Phthalic Acid Esters (PAEs) in Surface Sediment Samples Collected from Rao Cai River in Ha Tinh, Vietnam

In this report, the solid phase extraction technique combined with the gas chromatography-mass spectrometry method (GC-MS) was optimized to determine the contamination of nine phthalic acid esters (PAEs) in the surface sediment samples collected from Rao Cai River in Ha Tinh, Vietnam. The method detection limits (MDLs) were from 2.0 to 6.0 ng/g-dry weight (ng/g-dw). The recoveries of surrogate standards (PAE-d4) in both blank and real samples ranged from 79.6 to 94.3% (RSD < 8.7%). The total concentration of PAEs in the surface sediment samples was in the range of 72.4-1390 ng/g-dw (mean/median: 561/552 ng/g-dw). Among PAEs, di-(2-ethyl)hexyl phthalate (DEHP) was detected at the highest level in all samples. In contrast, dimethyl phthalate (DMP), diethyl phthalate (DEP), and dipropyl phthalate (DPP) were found at low frequency and concentration. Moreover, the risk quotient of PAEs in sediments was estimated based on the measured concentrations. Diisobutyl phthalate (DiBP) posed a medium risk for fish.

Research on Contract Risk Management of Hospital Construction Project based on Fuzzy Analytic Hierarchy Process

With Covid-2019 outbreak in December 2019, the number of medical infrastructure projects in infrastructure projects has increased. Although contract management is an important link of medical infrastructure project management but there is little quantitative research on the risk analysis. in this paper, firstly, three first-level risk indicators of contract risk management evaluation system are extracted by combing literature: contract drafting, contract signing and contract performance. Then, taking the contract management of a 3A hospital in Chengdu as an example, 12 second-level risk indicators are determined by fault tree method. Then, by experts scoring and statistically analyzing the risk points of 100 construction project contracts signed by the hospital from 2016 to 2020, the weight of secondary risk indicators is determined and the risk matrix is established. Then, the evaluation matrix of contract risk management evaluation system is established by 10 experts. Finally, the evaluation index system of contract risk management is obtained by combining the risk matrix with the evaluation matrix through fuzzy analytic hierarchy process, and the maximum membership degree method is adopted to complete the risk assessment. The research results show that there are high risks in the contract drafting stage and medium risks in the contract signing and contract performance stages in the contract management of a Grade A hospital in Chengdu. The author puts forward reasonable suggestions to improve the contract management level of hospital construction projects.

Landscape ecological risk evaluation coupled with ecosystem service improvement and its spatial heterogeneity analysis: a case study of the Yellow River Source Area

The ecological environment of the Yellow River Source Area (YRSA) is crucial to the Qinghai-Tibet Plateau, and its ecological risk management is important for the ecological protection and sustainable development of the Qinghai-Tibet Plateau. this study improves the traditional evaluation method of landscape ecological risk(LER) based on ecosystem services and detects its spatial heterogeneity by using Geodetector. The study results are as follows: (1) The temporal distribution of LER in the YRSA is similar to its landscape vulnerability. In the past 20 years, the areas of its high, medium-high, medium, and medium-low ecological risk areas have been converted to low ecological risk areas to varying degrees. (2) Overall, the spatial difference in LER in the YRSA is significant, mainly dominated by HH and HL clustering. Meanwhile, the Moran’I index of the LER Index decreases year by year, indicating that the spatial aggregation of the LER decreases and the spatial autocorrelation weakens year by year. (3) Climatic factors have the most significant influence on the ecological risk of the landscape in the YRSA, followed by topographic factors and anthropogenic factors.

Occurrence, Source Apportionment, and Risk Assessment of Antibiotics in Mangrove Sediments from the Lianzhou Bay, China.

In recent years, the widespread application of antibiotics has raised global concerns, posing a severe threat to ecological health. In this study, the occurrence, source, and ecological risks of 39 antibiotics belonging to 5 classes in mangrove sediments from Lianzhou Bay, China, were assessed. The total concentrations of the antibiotics (∑39 antibiotics) ranged from 65.45 to 202.24 ng/g dry weight (dw), with an average of 142.73 ± 36.76 ng/g dw. The concentrations of these five classes of antibiotics were as follows: Sulfonamides (SAs) > Tetracyclines (TCs) > Fluoroquinolones (QUs) > Penicillin (PCs) > Macrolides (MLs). The spatial distribution of antibiotics varied as high tidal zone > middle tidal zone > low tidal zone. The total organic carbon (TOC), pH, nitrate (NO3--N), and nitrite (NO2--N) of the sediment significantly influenced the distribution of antibiotics (p < 0.05). A source analysis identified untreated sewage from aquaculture as the primary source of antibiotics in the local mangrove. A risk assessment revealed that ciprofloxacin, norfloxacin, ofloxacin of QUs, and tetracycline of TCs exhibited medium risks to algae in certain sampling sites, while other antibiotics exhibited low or no risks to all organisms. Nevertheless, the total risk of all the detected antibiotics to algae was medium in 95% of the sites. The overall ecological risk level of antibiotics in the middle tidal zone was slightly lower than in the high tidal zone and the lowest in the low tidal zone. In summary, the experimental results provided insights into the fate and transport behaviors of antibiotics in mangrove sediments from Lianzhou Bay.

Enterprise Credit Risk Assessment Based on Hybrid Fuzzy Synthetic Evaluation Model

This article uses a hybrid fuzzy synthetic evaluation model to evaluate the credit risk of Shouguang vegetable enterprises, and designs four risk levels: impact degree, occurrence probability, risk manageability and government support level. The model uses average score technology to calculate the scores of secondary indicators, primary indicators and evaluation targets at each level, uses sorting technology to sort secondary indicators and primary indicators at each level, and uses fuzzy synthetic evaluation technology to construct Shouguang enterprise credit risk evaluation. The model uses the geometric mean method to calculate the comprehensive score, and summarizes the comprehensive score results to make decisions. Among them, the data in this article comes from a questionnaire, which was completed by a total of 41 professionals who have a better understanding of the credit risks of Shouguang vegetable companies Through calculation, the comprehensive credit risk score of Shouguang Vegetable Enterprise is 2.8585. The risk is medium risk. Banks can lend based on the operation of specific enterprises. The calculation results also show that the risk assessment results at different levels are not completely consistent. The main first-level risk indicators at the first three levels are "enterprise technological innovation" and "enterprise financial status", and the main first-level risk indicators at the last level are "Enterprise management level" and "enterprise development plan". Indicators related to corporate technological innovation and financial status are the main influencing indicators of the credit risk of Shouguang vegetable companies.

Derivation of a clinical prediction score for the diagnosis of clinically significant symptomatic carotid artery disease.

Emergent vascular imaging identifies a subset of patients requiring immediate specialized care (i.e. carotid stenosis > 50%, dissection or free-floating thrombus). However, most TIA patients do not have these findings, so it is inefficient to image all TIA patients in crowded emergency departments (ED). Our objectives were to derive and internally validate a clinical prediction score for clinically significant carotid arterydisease in TIA patients. This was a planned secondary analysis of a prospective cohort study from 14 Canadian EDs. Among 11555 consecutive adult ED patients with TIA/minor stroke symptoms over 12 years, 9882 had vascular imaging and were included in the analysis. Our main outcome was clinically significant carotid artery disease, defined as extracranial internal carotid stenosis ≥ 50%, dissection, or thrombus in the internal carotid artery, with contralateral symptoms. Of 9882 patients, 888 (9.0%) had clinically significant carotid artery disease. Logistic regression was used to derive a 13-variable reduced model. We simplified the model into a score (Symcard [Symptomatic carotid artery disease] Score), with suggested cut-points for high, medium, and low-risk stratification. A substantial portion (38%) of patients were classified as low-risk, 33.8% as medium risk, and 28.2% as high risk. At the low-risk cut-point, sensitivity was 92.9%, specificity 41.1%, and diagnostic yield 1.7%. This simple score can predict carotid artery disease in TIA patients using readily available information. It identifies low-risk patients who can defer vascular imaging to an outpatient or specialty clinic setting. Medium-risk patients may undergo imaging immediately or with slight delay, depending on local resources. High-risk patients should undergo urgent vascular imaging.

In vitro assessment of cementation of CAD/CAM fabricated prostheses over titanium bases. A systematic review.

The objective of this study is to investigate the outcomes of clinically relevant laboratory studies regarding the cementation of implant-supported restorations over ti-bases. The present study has been conducted according to PRISMA statement. An electronic search was performed, including publications up to March 2024, to identify studies investigating the parameters affecting the cementation between ti-bases and CAD/CAM prostheses. An assessment of the internal validity was performed, using a custom-made risk of bias tool (QUIN). From the included studies, 40.1% were reported on luting systems, 25% on ti-base surface treatment, 25% on restoration surface, 21.8% on restoration material, and 18.7% on ti-base height. The majority of the included studies were associated with a medium risk of bias. In the absence of micro-retentive features, air-abrasion of ti-bases with a minimum height of 3.5 mm can be beneficial for restoration's retention. The bonding performance can vary not only between different bonding systems but also for different applications within the same system, based on a restoration's material and surface treatment as well as on ti-base height and surface treatment. The height of the ti-base seems to be the prevailing factor as it constitutes the prerequisite for other modifications of the bonding surfaces to have an advantageous effect. Since the parameters that can affect bonding performance between ti-base and restoration can interact with each other, it is important for the clinician to focus on verified bonding protocols.

VIGILÂNCIA SANITÁRIA DAS BOAS PRÁTICAS DE FABRICAÇÃO NAS INDÚSTRIAS ALIMENTÍCIAS PERTENCENTES A GERÊNCIA REGIONAL DE SAÚDE DE SÃO JOÃO DEL REI

Health Surveillance, defined as a set of actions capable of eliminating, reducing, or preventing health risks, carries out health control through inspections, which enable the detection of this risk. In this sense, Food Industries are evaluated through verification of Good Manufacturing Practices (GMP) to ensure the sanitary control of food consumed by the population. Therefore, this work aimed to evaluate the Good Manufacturing Practices of five (5) Food Industries inspected by VISA/GRS/SJDR. To this end, the research method used was the analysis of the checklist of Good Manufacturing Practices in Food Producer/Industrializing Establishments contained in Annex II of Resolution RDC 275/2002 ANVISA. The results found demonstrated that in the period of 5 years (2010 to 2014) in relation to compliance with Good Practice items there was an improvement, even though the majority classified themselves as group 2 (medium risk) at the end of the period. When the list is stratified, it is clear that “Industry and Commerce I.O.” highlighted the isolated attention to sub-items. Finally, it was concluded that continuous monitoring of food producing industries is necessary for constant improvement of sanitary control actions in the food area with a view to protecting the health of the population.

Occurrence and distribution of legacy and novel brominated flame retardants in river and sediments in southwest China: A seasonal investigation

Brominated flame retardants (BFRs) and their substitutes are prevalent in the environment, especially near industrial point sources. In non-point source pollution areas, it is crucial to investigate the seasonal pollution characteristics to identify the pollution sources. In this study, compositional profiles, seasonal variations, and ecological risks of legacy BFRs and novel BFRs (NBFRs) in the water and sediment from the Tuojiang River located in southwest China were investigated. The results indicated that ΣBFRs ranged from not detected (n.d.) to 42.0 ng/L in water and from 0.13 to 17.6 ng/g in sediment, while ΣNBFRs ranged from n.d. to 15.8 ng/L in water, and from 0.25 to 6.82 ng/g in sediment. A significant seasonal variation was observed in water and sediments with high proportions of legacy BFRs (median percentage of 68.8% and 51.3% in water and sediment) in the dry season, while NBFRs (median percentage of 53.2% and 71.6% in water and sediment) exhibited predominance in the wet season. This highlighted the importance of surface runoff and atmospheric deposition as important sources of NBFRs in aquatic environments. Moreover, there were high ratios of decabromodiphenyl ethane (DBDPE) and BDE-209 (average: 1.38 and 2.76 in dry and wet season) in sediments adjacent to the residual areas, indicating a consumption shift from legacy BFRs to NBFRs in China. It was observed that legacy BFRs showed higher ecological risks compared to NBFRs in both water and sediment environments, with BDE-209 posing low to medium risks to sediment organisms. This study provides better understanding of contamination characteristics and sources of legacy BFRs and NBFRs in non-point source pollution areas.

Effect of RDN on long-term blood pressure in refractory hypertensive patients with different cardiovascular risk stratification

Objective: To investigate the long-term therapeutic effects and safety of renal denervation (RDN) on hypertensive patients with different cardiovascular risks, as well as its impact on adverse events, cardiovascular death and all-cause mortality. Methods: This was a single-center, single-arm, real-world retrospective study. Patients with refractory hypertension who underwent RDN at Tianjin First Central Hospital from July 6, 2011 to December 23, 2015 were enrolled and divided into either a high or intermediate-low risk group based on baseline cardiovascular risk. The treatment responsiveness of hypertensive patients with different cardiovascular stratification to RDN was assessed by comparing the results of office blood pressure, home blood pressure, and 24-h ambulatory blood pressure monitoring at 1, 5, and 11 years after RDN. Long-term safety of RDN was assessed by creatinine, and estimated glomerular filtration rate (eGFR) at 1 and 11 years after RDN. In addition, the total defined daily dose (DDD) of antihypertensive medications and the incidence of long-term adverse events, cardiovascular deaths, and all-cause deaths after RDN were followed up 11 years after RDN in person or by telephone. Results: A total of 62 patients with refractory hypertension, aged (50.2±15.0) years, of whom 35 (56.5%) were male, were included. There were 35 cases in high-risk group and 27 cases in low and medium risk group. The decrease in clinic systolic blood pressure (high risk vs. low-medium risk: (-38.0±15.1) mmHg vs. (-25.0±16.6) mmHg(1 mmHg=0.133kPa),P=0.002), home self-measured systolic blood pressure ((-28.4±12.7) mmHg vs. (-19.7±13.1) mmHg,P=0.011) and clinic systolic blood pressure 11 years after RDN ((-43.0±18.4) mmHg vs. (-27.8±17.9) mmHg,P=0.003) in the high-risk group was significantly higher than that in the low-medium risk group. The differences in heart rate and the decrease in total DDD number of antihypertensive drugs between the two groups were not statistically significant (all P>0.05). Creatinine and eGFR levels in the two groups at 1 and 11 years after RDN were not statistically significant when compared with the baseline values (all P>0.05). The cumulative cardiovascular mortality rate was 1.6% (1/62) and 8.1% (5/62), and the cumulative all-cause mortality rate was 3.2% (2/62) and 11.3% (7/62) at 5 and 11 years after RDN, respectively. The differences in the incidence rate of adverse events, cardiovascular mortality, and all-cause mortality rate between the two groups were not statistically significant (all P>0.05). Conclusions: RDN has long-term antihypertensive effect and good safety. Hypertensive patients who belong to the high-risk stratification of cardiovascular risk may respond better to RDN treatment.

Assessment of coastal vulnerability using AHP and machine learning techniques

Vila Belmiro is a significant development in the coastal urban scenario and is nestled along the rugged cliffs of the southern coast of Brazil. Cyclones caused tremendous damage to the shore, destroying infrastructure, eroding the coast, flooding, and displacing people. Determining such low-lying regions' coastal vulnerability index is crucial for developing efficient mitigation strategies and enhancing readiness for calamities. In light of this viewpoint, the current study attempted to determine the Coastal Vulnerability Index (CVI) using the analytical hierarchical process (AHP). The study combined the Physical Vulnerability Index (PVI) and the Social Vulnerability Index (SVI) to create the Coastal Vulnerability Index. This study generated the LULC layer for Vila Belmiro using machine learning techniques and Random Forest based model. A component of the process was evaluating the parameters pairwise based on their importance and relevance to the study's objective. The CVI assessment classified 19.28 Sq.km of the coastline, including Solemar, São Vicente, Santo, and Ponta Da Praia, as very high risk. High-risk areas, such as São Vicente, Vila Caicara, and Guaruja, span 25.26 Sq.km. Medium risk was observed across 16.85 Sq.km, covering Praia Grande, Nova Mirim, and Balneario Praia. Low-risk regions, including Japui and Jarfim Guaiuba, extend over 13.54 Sq.km. Lastly, 10.78 Sq.km of the coastline, including Canto Do Forte, were classified as very low risk. These measurements highlight the varying levels of vulnerability along the coastline. The study concluded that coastal vulnerability zones were effectively identified and assessed, enhancing understanding and management of coastal risks. Planning and mitigating future cyclones can benefit from the identified vulnerable zones. The current study included machine learning, remote sensing, Geographic Information System (GIS), and advanced facilities that were spatially integrated with AHP approaches.

Telemedicine Alert API Engine System for Vital Signs.

Telemedicine is used to assist and support remote medical care for patients. Our objective was to build up a REST Webservices alert engine that receives clinical parameters from patients of vital signs and basic laboratories to monitor patients remotely. We built a REST API using FHIR, so it can interoperate with other applications, send data to be processed, and receive a response. If the API detects a health risk situation, it sends an alert about the medical parameters that are controlled. The results of the processed data, news and alert, can return synchronously or asynchronously, at the same time that the data to be processed is being sent. The alerts generated can be automatically sent to a web service, mail or WhatsApp of the physician. The alert message comes out as normal, low, medium and high risk. The presented approach establishes communication that enables timely health information exchange. We conducted an experiment (with fictitious data) where we sent several queries by Postman. Finally, we evaluated the communication to be successful by manual checking. The use of the API significantly improves the monitoring of chronic patients. Many works show the effectiveness of telemedicine to improve the control of certain chronic diseases. In addition, telemedicine interventions were also found to significantly improve other health outcomes. Our API enables us to transfer data and produce alerts successfully. This gives us hope that a future with ubiquitous healthcare information interoperability is possible using our system.

Identification of key anthropogenic and land use factors and ecological risk assessment of dissolved polycyclic aromatic hydrocarbons (PAHs) and organochlorine pesticides (OCPs) in an urbanized estuary in China

This study investigated dissolved PAHs and OCPs in Quanzhou Bay estuaries, assessed their ecological risk, and examined anthropogenic impacts on contaminant distribution. Results showed that dissolved ∑24PAH concentrations ranged from 117 to 709 ng/L (mean: 358 ng/L), with dominance of 2-ring PAHs (Naphthalene, 1-Methylnaphthalene, and 2-Methylnaphthalene). Dissolved DDT levels ranged from 0.06 to 0.49 ng/L (mean: 0.28 ng/L), while HCBz concentrations varied from 0.02 to 0.44 ng/L (mean: 0.20 ng/L). PAHs were higher in the north due to urbanization and transport, while OCPs showed higher levels in the south due to historical agricultural use. Rural areas, water bodies, and wetlands significantly influenced the behavior of PAHs according to Spearman correlation and lasso regression analyses. Quanzhou Bay was categorized as a low to medium risk area based on dispersion simulation and ecological risk assessment, highlighting implications for future sustainable development and policy planning. CapsuleThe coupled relationship between human activities and the distribution of dissolved PAHs and OCPs in urbanized estuaries was explored using statistical methods and GIS technology, providing valuable insights into environmental processes and pollutant control policies.

Remote monitoring of cardiac implantable electronic devices to predict acute clinical decompensation events.

Heart failure (HF) patients are at constant risk of decompensation, and urgent hospital admissions can be life-threatening events. Monitoring biological variables has been proved to be an important mechanism to anticipate decompensations. TriageHF is a validated diagnostic algorithm tool available on Medtronic® cardiac implantable electronic devices that combines physiological data to stratify a patient's risk of HF hospitalization in the following 30 days in low, medium or high risk. We aimed to evaluate the utility of TriageHF algorithm to predict the occurrence of acute clinical decompensation events (ACDE), including HF and non-HF cardiovascular events, within a 30-day period in a population of HF patients with reduced ejection fraction. We reviewed the transmissions received by the Medtronic® Carelink™ Network between August 2022 and July 2023. The heart failure risk status (HFRS) and the device parameters contributing to that risk, from the previous 30 days, were collected, along with the occurrence of ACDEs within 30 days. We retrospectively assessed 207 transmissions from the 64 patients included in the study. Among the 93 medium HFRS transmissions, 16 (17.2%) resulted in ACDEs. For the 21 high HFRS transmissions, 10 (47.6%) resulted in ACDEs. Considering the ACDEs, 60.7% were preceded by an alarm-initiated transmission. Except for heart rate variability, each diagnostic parameter demonstrated effectiveness in stratifying risk for ACDEs. Optivol® and the Combined Heart Rhythm showed independent association with ACDEs (p<.001). Patients with medium and high HFRS were, respectively, 8.6 and 29.1 times more likely to experience an ACDE in the next 30 days than low risk patients. A medium-high HFRS conferred a sensitivity of 92.9% and a NPV of 97.8% for an ACDE. TriageHF is a useful method for predicting ACDEs and has the potential to trigger medical actions to prevent hospitalizations.

Research Quality of Clinical Trials Reported for Foods with Function Claims in Japan, 2023-2024: Evaluation Based on a Revised Tool to Assess Risk of Bias in Randomized Trials.

The Foods with Function Claim was introduced in Japan in April 2015 to make more products available that are labeled with health functions. A product's functionality of function claims must be explained by the scientific evidence presented in clinical trials (CTs) or systematic reviews, but the quality of recent CTs is unclear. The purpose of this study was to evaluate the risk of bias (RoB) using "a revised tool to assess risk (RoB 2)" published in 2018 for notifications based on all recent CTs published on the Consumer Affairs Agency website. A total of 38 submitted papers based on CTs that were published on the Consumer Affairs Agency website during the period from 1 January 2023 to 30 June 2024 were eligible. The RoB 2 tool provides a framework for considering the risk of bias in the findings of any type of randomized trial. This tool with five domains was used to evaluate the quality of research methods. Eligible CTs were assessed as "low risk" (11%, n = 4), "medium risk" (13%, n = 5), and "high risk" (76%, n = 29). A number of highly biased papers were published. Bias occurred in all five domains, especially "bias in selection of the reported result (Domain 5)", which was the most serious ("high risk"; 75%). For elements correlated with RoB, there was no significant difference (p = 0.785) in the RoB 2 score between for-profit and academic research in the author's affiliated organization. There was no significant difference (p = 0.498) in the RoB score between the published year categories of 2000-2019 and 2020-2024, and no significant difference (p = 0.643) in the RoB score between English and Japanese language publications. Overall, the quality of the latest CTs submitted after 2023 was very low, occurring in all five domains, and was most serious for "bias in selection of the reported result (Domain 5)".