Moderate Risk Research Articles

Assessment of Microplastics and Potentially Toxic Elements in Surface Sediments of the River Kelvin, Central Scotland, United Kingdom.

Contamination of the environment by microplastics (MPs), polymer particles of <5 mm in diameter, is an emerging concern globally due to their ubiquitous nature, interactions with pollutants, and adverse effects on aquatic organisms. The majority of studies have focused on marine environments, with freshwater systems only recently attracting attention. The current study investigated the presence, abundance, and distribution of MPs and potentially toxic elements (PTEs) in sediments of the River Kelvin, Scotland, UK. Sediment samples were collected from eight sampling points along the river and were extracted by density separation with NaCl solution. Extracted microplastics were characterised for shape and colour, and the polymer types were determined through attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy. Pollution status and ecological risks were assessed for both the microplastics and PTEs. Abundance of MPs generally increased from the most upstream location (Queenzieburn, 50.0 ± 17.3 particles/kg) to the most downstream sampling point (Kelvingrove Museum, 244 ± 19.2 particles/kg). Fibres were most abundant at all sampling locations, with red, blue, and black being the predominant colours found. Larger polymer fragments were identified as polypropylene and polyethylene. Concentrations of Cr, Cu, Ni, Pb and Zn exceeded Scottish background soil values at some locations. Principal component and Pearson's correlation analyses suggest that As, Cr, Pb and Zn emanated from the same anthropogenic sources. Potential ecological risk assessment indicates that Cd presents a moderate risk to organisms at one location. This study constitutes the first co-investigation of MPs and PTEs in a river system in Scotland.

To What Extent Does Cardiovascular Risk Classification of Patients with Type 2 Diabetes Differ between European Guidelines from 2023, 2021, and 2019? A Cross-Sectional Study.

Background and Objectives: Type 2 Diabetes (T2DM) is intricately associated with an increased cardiovascular (CV) risk, highlighting the imperative for tailored intervention in the prevention and management of CV diseases. To assess the CV risk and subsequent interventions in patients with diabetes, the European Society of Cardiology (ESC) has been consistently developing and updating specific guidelines for risk assessment and patient management since 2019. The 2023 risk classification method has significantly changed, introducing a novel probability-based assessment through the implementation of SCORE2-Diabetes instrument. This marks a shift from the risk factor-based classification employed in the 2019 and 2021 methods, representing an innovative approach in risk assessment for individuals with T2DM. This study aims to evaluate the differences in the CV risk classification among hospitalized patients with T2DM using the three proposed methods within the Romanian population, a European population considered to be at very high cardiovascular risk. Materials and Methods: in a consecutive-case, population-based study design, 70 patients hospitalized with T2DM from a European population characterized by very high CV risk were assessed for CV risk using the three proposed methods. The differences between these classifications were subsequently analyzed. Results: In the study group, according to 2023 classification, one patient (1.4%) was classified with moderate CV risk, eight (11.4%) with high cardiovascular risk, and sixty-one (87.2%) with very high cardiovascular risk. A total of 36 patients (51.4%) were classified differently compared to 2021 criteria, the differences being statistically significant (p = 0.047), while 13 (18.6%) were different compared to 2019 criteria, the differences being statistically non-significant (p = 0.731). By comparing the 2021 to the 2019 ESC Guidelines recommendations, 40 patients had a one-step decrease in cardiovascular risk category, from very high to high risk. Conclusions: Most patients included in the analysis were classified as very high CV risk (87.2%). Within a European population characterized by very high CV risk, the SCORE2-Diabetes instrument proves to be a valuable tool, contributing to most step-ups in CV risk classes within the 2023 classification. In a very-high-risk demographic, the 2023 algorithm resulted in different classifications in contrast to the 2021 method but similar classifications observed with the 2019 method.

Menopausal Hormone Therapy in Women with Type 2 Diabetes Mellitus: An Updated Review.

Menopause is accompanied by several metabolic adaptations, which are related to insulin resistance, increased total body fat mass, and central abdominal fat accumulation, predisposing women to type 2 diabetes mellitus (T2DM) development. Metabolic syndrome has a high prevalence in postmenopausal women, indicating the loss of estrogen protection on metabolic and cardiovascular health. Moreover, earlier age at menopause has been related to increased risk of T2DM. Menopausal hormone therapy (MHT) has favorable results in glucose metabolism. Indeed, it reduces the risk of T2DM in women without this condition and improves glycemic control in women with T2DM. Before MHT initiation in women with clinical indications, it is imperative to assess their cardiovascular disease (CVD) risk, using official electronic algorithms for score calculation. The latter will determine regimen, dose, and administration route of MHT. Oral estrogens are preferable in women with low CVD risk, while transdermal administration is indicated in those with moderate and high CVD risk, as the risk of stroke and venous thromboembolism (VTE) is increased with oral administration. Oral 17β-estradiol is usually preferred in women with T2DM, as this route has more beneficial effects on glucose metabolism. Oral estrogens are also suggested in perimenopausal or recently postmenopausal women with low CVD risk. Although oral estrogens have favorable effects when indicated, the risk of VTE or stroke should always be considered. Micronized progesterone, dydrogesterone, and transdermal norethisterone are the progestogens used in postmenopausal women with T2DM and intact uterus. MHT should not be initiated in women > 60years or > 10years in menopause, as there is an increased thromboembolic risk in women with established atherosclerosis and no additional cardiovascular benefit in women without atherosclerosis. In conclusion, MHT administration in postmenopausal women with T2DM can be safe and effective as long as the therapeutic regimen has been properly selected according to their cardiovascular, metabolic, and fracture risk.

Ecological risk assessment of potentially toxic elements (PTEs) in agricultural soil, vegetables and fruits with respect to distance gradient in proximity to lead-acid battery industry

Lead-acid battery industries in Bangladesh have proliferated in urban areas, leading to the release of significant amounts of potentially toxic elements (PTEs) and metalloids into the environment. This study aimed to assess the spatial distribution, sources, contamination status, and ecological risks in agricultural soils, vegetables, and fruits near these industries. Soil samples were collected from four sites at varying distances (0 m, 100 m, 250 m, and 500 m) around three lead-acid battery industries (AA, AB, and AC) in Dhaka and Gazipur Districts during June-July 2020. The concentrations of the Pb, As, Cd and Zn in agricultural soils were ranged between 8.40–116.61, 8.99–28.21, 0.03–1.28, and 25.38–68.72 mg/kg, respectively. The concentrations of Pb, As, and Cd were found to be considerably higher than background levels across all industries, with a gradual decrease in PTE concentrations from 0 m to 500 m. The contamination factor indicated high to moderate contamination in agricultural soils by As, Cd, and Pb, and low contamination by Zn. pollution load index, modified contamination degree, and nemerow comprehensive index revealed varying pollution levels in the vicinity of the industries, with AA and AB showing higher pollution compared to AC. The individual risk factors demonstrated significant risks associated with Cd and As exposure, while Pb and Zn posed lower risks. The potential ecological risk index indicated considerable ecological risk for AA (risk index = 192.41), moderate risk for AB (risk index = 111.80), AC (risk index = 65.08), respectively. Correlation and principal component analysis revealed strong positive associations (p < 0.01) among the chemical parameters and potentially toxic elements in soils, and demonstrated the lead-acid battery industry as the primary contamination source in the studied areas. There were strong positive relationships (p < 0.01) existed between As, Cd, and Zn in soils and vegetables; while a strong negative association found between As in soils with As in Fruits. The cluster analysis showed EC, OC, OM, Pb, As and Zn into separate group, implied their same source of origin as anthropogenic source. The metal uptake was in the decreasing order of Cd > Zn > As > Pb and Cd > Zn > Pb > As in vegetable and fruit samples, respectively and transfer factor analysis highlighted Cd and Zn as metals with higher absorption rates in vegetables and fruits. Among the industries, AA and AB were significantly impacted on soil quality, and considerable metal accumulation found on vegetables. The human health risk assessment results indicate a potential noncarcinogenic health hazard for the populations surrounding the industries (AA, AB, and AC). This is evidenced by the calculation of the total target hazard quotient and the hazard index, both of which exceeded the acceptable level (>1). However, the carcinogenic health risks arising from the consumption of potentially toxic elements are within threshold values. This study provides crucial insights into the environmental as well as health impact of lead-acid battery industries, emphasizing the urgency of implementing effective environmental management practices to mitigate their consequences.

Multi-method combined analysis of urban flood risks and its influencing factors under low impact development

In previous studies, the mitigation of urban floods via low impact development (LID) has typically been expressed only in terms of runoff volume reduction. The impact of duration time and flow velocity on the flood risk has not been quantitatively analyzed. This paper takes the Beiyangyuan Campus of Tianjin University (national pilot sponge campus) as the study area. Based on the constructed SWMM and MIKE21 coupled model, the effects of LID on different flood characteristics are analyzed by setting LID removal scenarios. The results show that LID mainly mitigates urban floods by reducing the runoff volume, inundation area and risk area, and the reduction effect is approximately 15%–38%. The water depth, flow velocity and duration time are not sensitive to LID practices, and the reduction effect is basically below 10%. The flood risk and its influencing factors in the study area were analyzed using combined multi-methods based on water depth (WD), water depth & duration time (WD&DT), and hazard rating (HR). The results show that the central island with numerous LID practices has an almost undetected flood risk, and the high risk is mainly distributed in the northeast of the study area. Duration time is an important influencing factor on flood risk, and after adding consideration of duration time, the proportion of risk levels upgraded to moderate or high is more than 90%. Further analysis shows that insufficient drainage capacity of the pipe network leads to prolonged ponding, which is the primary cause of flood risk in the study area. Adding the consideration of flow velocity, the 27–36% low-risk area changes to moderate risk; multiple linear regression analysis shows that the contribution of flow velocity to the flood risk is minimal. The possibility of flow impact hazard in the study area is very low, and the cumulative frequency of water depth and flow velocity product (d·v) less than 0.04 m2/s is more than 98% in each scenario.

Analisis Manajemen Risiko Pada Proyek Konstruksi Jalan di Provinsi Jambi

In the implementation of road construction projects, there are often various obstacles that arise due to the risks that occur which result in not achieving the expected performance, quality and achievement of work results. The purpose of this study was to determine the risk factors that affect the implementation of work in the field and to determine the application of risk management in road construction projects. In this study, risk identification, risk analysis and risk response were carried out in the construction of road construction projects, especially road construction in Jambi Province. The research method used was by way of a survey distributing risk factor questionnaires and actions on risk factors to consultants. The assessment method uses a risk matrix assessment sourced from AS/NZS 4360: 2004. From the results of this study, it is found that the risk level for road construction work in Jambi Province is very high risk (very high) of 8%, high risk (High) of 7%, and a moderate risk of (Medium) of 16%.

Metal pollution in the topsoil of lands adjacent to Sahiwal Coal Fired Power Plant (SCFPP) in Sahiwal, Pakistan.

Coal fly ash from a coal fired power plant is a significant anthropogenic source of various heavy metals in surrounding soils. In this study, heavy metal contamination in topsoil around Sahiwal coal fired power plant (SCFPP) was investigated. Within distance of 0-10, 11-20, 21-30 and 31-40 km of SCFPP, total 56 soil samples were taken, 14 replicate from each distance along with a background subsurface soil sample beyond 60 km. Soil samples were subjected to heavy metals analysis including Fe, Cu and Pb by Atomic Absorption Spectrophotometer (AAS). Composite samples for each distance were analyzed for Al, As, Ba, Cd, Co, Cr, Mn, Mo, Ni, Se, Sr, Zn by Inductively Coupled Plasma (ICP). Pollution indices of exposed soil including Enrichment Factor (EF), Contamination Factor (CF), Geoaccumulation Index (Igeo), and Pollution Load Index (PLI) were calculated. Ecological risk index ([Formula: see text]) of individual metals and the Potential Ecological Risk Index (PERI) for all metals were determined. Soil samples within 40 km of SCFPP were significantly polluted with Pb (mean 2.81 ppm), Cu (mean 0.93 ppm), and Fe (mean 7.93 ppm) compared to their background values (Pb 0.45, Cu 0.3, and Fe 4.9 ppm). Some individual replicates were highly contaminated where Pb, Fe, and Cu values were as high as 6.10, 35.4 and 2.51 ppm respectively. PLI, Igeo, CF, and EF for metals classified the soil around CFPP as "moderate to high degree of pollution", "uncontaminated to moderately contaminated", "moderate to very high contamination", and "moderate to significant enrichment" respectively with average values for Cu as 2.75, 0.82, 3.09, 4.01; Pb 4.79, 1.56, 6.16, 7.76, and for Fe as 1.20, 0.40, 1.62, 3.35 respectively. Average Ecological Risk Index ([Formula: see text]) of each metal and Potential Ecological Risk Index (PERI) for all metals classified the soils as "low risk soils" in all distances. However, ([Formula: see text]) of Pb at a number of sites in all distances have shown "moderate risk". The linear correlation of physico-chemical parameter (EC, pH, Saturation %) and metals have recorded several differential correlations, however, their collective impact on Pb in 0-10 km, has recorded statistically significant correlation (p-value 0.01). This mix of correlations indicates complex interplay of many factors influencing metal concentrations at different sampling sites. The concentration of As, Cr, Co, Cd, and Zn was found within satisfactory limits and lower than in many parts of the world. Although the topsoil around SCFPP is largely recorded at low risk, for complete assessment of its ecological health, further research considering comprehensive environmental parameters, all important trace metals and variety of input pathways is suggested.

Does smoking cessation affect postoperative healing following oral surgery among smokers? – a systematic review

BackgroundIt is well documented that smokers suffer increased risk of postoperative complications after medical surgery, for example delayed healing and increased risk of infection. It is also known that preoperative smoking cessation can reduce the risk of these complications. Because of this there are guidelines regarding preoperative smoking cessation in non-oral medical surgery. There are however no specific guidelines regarding oral surgical procedures, such as surgical extractions, dentoalveolar surgery, periodontal surgery, or dental implantation. Nevertheless, it is common that dentists and oral surgeons recommend smoking cessation pre to oral surgical procedures. The aim with this systematic review was to see if there are any evidence in the literature, supporting preoperative smoking cessation in oral surgical procedures.MethodsA systematic search of the electronic databases PubMed, Scopus, Web of Science, and Cochrane was conducted to identify studies addressing the effect of preoperative smoking cessation in oral surgical procedures. Included publications were subjected to preidentified inclusion criterion. Six examiners performed the eligibility and quality assessment of relevant studies. Risk of bias was assessed using ROBINS-I and RoB 2. Certainty assessment was carried out using GRADE.ResultsThe initial search resulted in 2255 records, and after removal of 148 duplicates, 16 articles met an acceptable level of relevance. These were read in full text, whereof 12 articles were excluded, due to different intervention, outcome, or study design than stated in the review protocol. One study remained with moderate risk of bias and three were excluded due to high risk of bias.ConclusionThis systematic review could not determine the effect of smoking cessation pre to oral surgical procedures, in smokers. This indicates lack of knowledge in the effects of smoking cessation. We also conclude a lack of knowledge in how to design smoking cessation in the most effective way.

Non-linear relationship between the body roundness index and metabolic syndrome: data from National Health and Nutrition Examination Survey (NHANES) 1999-2018.

Obesity is an important characteristic manifestation of metabolic syndrome (MetS), and body roundness index (BRI) is one of the anthropometric indicators associated with obesity. However, studies on the relationship between BRI and MetS risk are limited. We aimed to explore the relationship between baseline BRI and MetS in the USA population. Our study used data from the National Health and Nutrition Examination Survey from 1999 to 2018, ultimately enrolling and analysing 47303 participants. Data-driven tertiles were used to categorise BRI levels, and multivariate logistic regression models were fitted to investigate the association of BRI with MetS in adults. In addition, receiver operating characteristic curve analysis was used to assess the ability of BRI to predict MetS. The distribution of BRI was different across ethnic groups with a gradual decrease in the proportion of non-Hispanic Whites and other races. In addition, BRI was significantly associated with traditional cardiovascular risk factors. Univariate regression analysis indicated BRI to be a moderate risk factor for MetS, and multivariate logistic regression analysis found that BRI remained an independent risk factor for MetS. After adjusting for confounding variables, a non-linear relationship was found between BRI levels and the prevalence of MetS. More importantly, BRI predicted MetS with the largest AUC among anthropometric measures. In summary, elevated baseline BRI levels are independently associated with the development of MetS, and baseline BRI may assist in identifying patients at risk for MetS, leading to early and optimal treatment to improve their outcomes.

Safety assessment of existing glass curtain wall based on fuzzy entropy and comprehensive cloud

The occurrence of safety incidents for existing glass curtain walls (EGCWs) pronounced menace to the security of both lives and property. Undertaking safety assessment for EGCWs carries essential practical significance. However, current fuzzy evaluation methods overlook the uncertainty of indicator weights and the intricacies of rank attribution. In response, this paper proposes a novel approach to the safety assessment of EGCWs. This research establishes a framework of evaluation indicators for EGCWs and divides the safety ranks of each indicator into four tiers: Safe, Mild risk, Moderate risk, and High risk. Quantitative and qualitative indicators are quantified via the variable fuzzy cloud algorithm and cloud model. The information cloud combination weighting method is introduced to determine the weight clouds of indicators. Finally, a two-dimensional assessment result is derived using an improved fuzzy comprehensive evaluation method and fuzzy entropy. The exemplified outcomes demonstrate that this approach captures the safety status of evaluation subjects based on risk ranks, and fuzzy entropy addresses two issues: inconsistent level attribution and the comparison of identical risk ranks. The appraisal method further unveils the safety details of EGCWs, with findings that align consistently with the actual situation.

Chemical characterization, source identification and potential health effects of PM2.5-bound non-polar organic compounds over a COALESCE network site - Bhopal, India

Year-long (2019) measurements of carbonaceous aerosols were performed at Bhopal, a regionally representative site as a part of the COALESCE (Carbonaceous Aerosol Emissions, Source apportionment and Climate Impacts) campaign. Aerosol-associated non-polar organic compounds (NPOCs) were analysed using thermal desorption (TD) Gas chromatography/Mass spectrometry (TD-GC/MS). The annual average of the total organic carbon (OC), elemental carbon (EC), and analysed PAHs (Polycyclic Aromatic Hydrocarbons), and n-alkanes were, 9.74 ± 9.47 μg m−3, 2.13 ± 3.12 μg m−3, 10.43 ± 5.49 ng m−3, and 114.93 ± 49.24 ng m−3, respectively. PAHs diagnostic ratios suggested emissions from petroleum, grass, wood, and coal combustion. Combustion derived PAHs (CombPAHs) accounted for 72.5 % of the total measured PAHs. During wintertime, based on Pyr/BaP ratio (∼0.6), gasoline exhaust emissions were higher compared to diesel exhaust emissions. The weak correlations between PAHs and meteorological parameters suggested that variations in PAH levels are primarily driven by alterations in emission sources. Total PAHs were correlated moderately with BrC (r2 = 0.60). The estimated lifetime lung cancer risk (LLCR) values on exposure to 16 USEPA priority PAHs (5 × 10−5) demonstrated that PAH levels in this region pose moderate health risks. Given observations from only campaign mode short-term measurements of NPOCs over India, this work provides a more comprehensive understanding of the concentrations, seasonal variations, and sources of n-alkanes and health risk associated with particle bound PAHs over the data-poor central Indian region.

Associations Between Mid-Life Psychosocial Measures and Estimated Late Life Amyloid Burden: The Atherosclerosis Risk in Communities (ARIC)-PET Study.

Psychosocial factors are modifiable risk factors for Alzheimer's disease (AD). One mechanism linking psychosocial factors to AD risk may be through biological measures of brain amyloid; however, this association has not been widely studied. To determine if mid-life measures of social support and social isolation in the Atherosclerosis Risk in Communities (ARIC) Study cohort are associated with late life brain amyloid burden, measured using florbetapir positron emission tomography (PET). Measures of social support and social isolation were assessed in ARIC participants (visit 2: 1990-1992). Brain amyloid was evaluated with florbetapir PET standardized uptake value ratios (SUVRs; visit 5: 2012-2014). Among 316 participants without dementia, participants with intermediate (odds ratio (OR), 0.47; 95% CI, 0.25-0.88), or low social support (OR, 0.43; 95% CI, 0.22-0.83) in mid-life were less likely to have elevated amyloid SUVRs, relative to participants with high social support. Participants with moderate risk for social isolation in mid-life (OR, 0.32; 95% CI, 0.14-0.74) were less likely to have elevated amyloid burden than participants at low risk for social isolation. These associations were not significantly modified by sex or race. Lower social support and moderate risk of social isolation in mid-life were associated with lower odds of elevated amyloid SUVR in late life, compared to participants with greater mid-life psychosocial measures. Future longitudinal studies evaluating mid-life psychosocial factors, in relation to brain amyloid as well as other health outcomes, will strengthen our understanding of the role of these factors throughout the lifetime.

Research on electric vehicle load forecasting considering regional special event characteristics

With the rise of electric vehicles and fast charging technology, electric vehicle load forecasting has become a concern for electric vehicle charging station planners and operators. Due to the non-stationary nature of traffic flow and the instability of the charging process, it is difficult to accurately predict the charging load of electric vehicles, especially in sudden major events. In this article, We proposes a high-precision EV charging load forecasting model based on mRMR and IPSO-LSTM, which can quickly respond to the epidemic (or similar emergencies). Firstly, the missing data in the original EV charging load data are supplemented, and the abnormal data are corrected. Based on this, a factor set is established, which included five epidemic factors, including new confirmed cases, the number of moderate risk areas, the number of high risk areas, epidemic situation and epidemic prevention policies of the city, and other factors such as temperature. Secondly, the processed load data and other data in the influencing factor set are normalized, and the typical characteristic curve is established for personalized processing of the relevant data of epidemic factors, so as to improve the sensitivity of load response to epidemic changes and the ability to capture special data (peak and valley values and turning points of load). Then the maximum relevant minimum redundancy (mRMR) is used to select the optimal feature set from the set of influencing factors. Then, the processed load data and its corresponding optimal selection are input into the IPSO-LSTM model to obtain the final prediction result. Finally, taking the relevant data of EV charging load in a city in China from November 2021 to April 2022 (the city experienced two local epidemics in December 2021 and March 2022 respectively) as an example, the model is evaluated and compared with other models under the forecast period of 1 h. Meanwhile, the performance of the model under different foresight periods (2 h, 4 h, 6 h) is compared and analyzed. The results show that the model has good stability and representativeness, and can be used for EV charging load prediction under the COVID-19 pandemic.

Cardiac effects of deferasirox in transfusion-dependent patients with myelodysplastic syndromes: TELESTO study.

Iron overload from repeated transfusions has a negative impact on cardiac function, and iron chelation therapy may help prevent cardiac dysfunction in transfusion-dependent patients with myelodysplastic syndromes (MDS). TELESTO (NCT00940602) was a prospective, placebo-controlled, randomised study to evaluate the iron chelator deferasirox in patients with low- or intermediate-1-risk MDS and iron overload. Echocardiographic parameters were collected at screening and during treatment. Patients receiving deferasirox experienced a significant decrease in the composite risk of hospitalisation for congestive heart failure (CHF) or worsening of cardiac function (HR = 0.23; 95% CI: 0.05, 0.99; nominal p = 0.0322) versus placebo. No significant differences between the arms were found in left ventricular ejection fraction, ventricular diameter and mass or pulmonary artery pressure. The absolute number of events was low, but the enrolled patients were younger than average for patients with MDS, with no serious cardiac comorbidities and a modest cardiovascular risk profile. These results support the effectiveness of deferasirox in preventing cardiac damage caused by iron overload in this patient population. Identification of patients developing CHF is challenging due to the lack of distinctive echocardiographic features. The treatment of iron overload may be important to prevent cardiac dysfunction in these patients, even those with moderate CHF risk.

HEAL Africa score to predict failure of surgical repair of obstetric urethro-vaginal fistula in the Democratic Republic of the Congo

IntroductionObstetric fistula (OF) repair surgery aims to restore the anatomical and functional integrity of the urinary tract, allowing affected women to regain their dignity and quality of life. However, in some cases, this surgical repair may fail. The objective of this study was to develop a predictive score to identify factors associated with the failure of surgical repair of obstetric urethro-vaginal fistula (FSROUVF) in the Democratic Republic of the Congo (DRC).MethodsThis is an analytical cross-sectional study of 358 patients with obstetric urethro-vaginal fistula (OUVF) who received surgical repair. We conducted bivariate and multivariate analyses. Score discrimination was assessed using the receiver operating characteristic (ROC) curve, C-index, and score calibration according to the Hosmer-Lemeshow test.ResultsSurgical repair of OUVF failed in 24.86% of cases (89/358). After logistic modelling, 6 criteria predicted FSROUVF: the use of intravaginal indigenous products (AOR = 3.59; 95% CI: 1.51–8.53), the presence of fibrosis (AOR = 6.37; 95% CI: 1.70–23.82), the presence of 2 or more fistulas in the same patient (AOR = 7.03; 95% CI: 3.14–15.72), the total urethral damage (AOR = 3.29; 95% CI: 1.36–7.95), the fistula size > 3 cm (AOR = 5.65; 95% CI: 2.12–15.01), and the postoperative infection (AOR = 351.10; 95% CI: 51.15–2409.81). A score of 0 to 14 was obtained, with a value ≤5 points indicating a low risk of FSROUVF, a value between 6 and 8 indicating a moderate risk, and a value ≥9 points corresponding to a high risk of FSROUVF. The area under the ROC curve of the score is 0.938 with a sensitivity of 60.67%, a specificity of 96.28%, a positive predictive value of 84.38%, and a negative predictive value of 88.10%.ConclusionWe report a FSROUVF rate in the DRC approaching a quarter of operative patients. Predictors of failure included fibrosis, presence of 2 or more fistulas, total urethral involvement, fistula size greater than 3 cm, postoperative infection, and use of intravaginal indigenous products. These factors are constitutive of the HEAL Africa score, which once validated, may have value in pre-operative counselling of patients. This study could be valuable for policy and strategies to address the problem of OUVF in the DRC and in resource limited settings more generally.

Association of Economic Policies With Hypertension Management and Control

Economic policies have the potential to impact management and control of hypertension. To review the evidence on the association between economic policies and hypertension management and control among adults with hypertension in the US. A search was carried out of PubMed/MEDLINE, Cochrane Library, Embase, PsycINFO, CINAHL, EconLit, Sociological Abstracts, and Scopus from January 1, 2000, through November 1, 2023. Included were randomized clinical trials, difference-in-differences, and interrupted time series studies that evaluated the association of economic policies with hypertension management. Economic policies were grouped into 3 categories: insurance coverage expansion such as Medicaid expansion, cost sharing in health care such as increased drug copayments, and financial incentives for quality such as pay-for-performance. Antihypertensive treatment was measured as taking antihypertensive medications or medication adherence among those who have a hypertension diagnosis; and hypertension control, measured as blood pressure (BP) lower than 140/90 mm Hg or a reduction in BP. Evidence was extracted and synthesized through dual review of titles, abstracts, full-text articles, study quality, and policy effects. In total, 31 articles were included. None of the studies examined economic policies outside of the health care system. Of these, 16 (52%) assessed policies for insurance coverage expansion, 8 (26%) evaluated policies related to patient cost sharing for prescription drugs, and 7 (22%) evaluated financial incentive programs for improving health care quality. Of the 16 studies that evaluated coverage expansion policies, all but 1 found that policies such as Medicare Part D and Medicaid expansion were associated with significant improvement in antihypertensive treatment and BP control. Among the 8 studies that examined patient cost sharing, 4 found that measures such as prior authorization and increased copayments were associated with decreased adherence to antihypertensive medication. Finally, all 7 studies evaluating financial incentives aimed at improving quality found that they were associated with improved antihypertensive treatment and BP control. Overall, most studies had a moderate or low risk of bias in their policy evaluation. The findings of this systematic review suggest that economic policies aimed at expanding insurance coverage or improving health care quality successfully improved medication use and BP control among US adults with hypertension. Future research is needed to investigate the potential effects of non-health care economic policies on hypertension control.

Assessment of mercury concentrations in fur, liver, and brain tissue from necropsied southern sea otters (Enhydra lutris nereis)

AbstractSouthern sea otters (Enhydra lutris nereis) are a federally listed threatened keystone species of the California kelp forest ecosystem and a sentinel species, indicating environmental health. Mercury (Hg) is a bioaccumulative neurotoxin that poses a threat to high trophic‐level species such as marine mammals. We quantified total Hg (THg) concentrations in fur, brain, and liver tissues of necropsied southern sea otters (n = 44) that stranded along the California coast from 2010 to 2019. THg concentrations differed significantly between fur and brain, and between liver and brain. Tissue type explained 64%, and sex explained only 3.3% of overall THg variability (0.48–46.1 μg/g dry weight). All individuals had liver Hg concentrations measuring well under the proposed lower‐limit low risk guideline for harp seals, Pagophilus groenlandicus. However, six sea otters exceeded the liver THg moderate risk threshold for terrestrial furbearers to which sea otters are closely related. These data represent baseline THg concentrations in fur, brain, and liver of the southern sea otter and build upon previous studies in various sea otter subspecies. Research on sea otter Hg tolerance and continued monitoring are needed to clarify potential health risks associated with the tissue concentrations observed in this study.

Degrees of vulnerability to poverty: a low-income dynamics approach for Chile

AbstractI propose an empirical framework to identify different degrees of vulnerability to poverty using two vulnerability lines that classify currently non-poor people into risk groups: high, moderate and low risk of falling into poverty in the next period. The latter corresponds to the income secure middle class. My approach makes two contributions. First, it extends recent research that defines the middle class using a vulnerability threshold by introducing a new subdivision of the vulnerable group that would be useful in practice for public policy objectives. Second, it uses two models to predict both the probability of entering poverty and household income as part of the estimation procedures. The former controls for initial conditions effects and attrition bias, and the latter addresses the retransformation problem. I apply my approach to Chile using longitudinal data from the P-CASEN 2006–2009. The resulting vulnerability cut-offs (using the upper-middle-income country poverty line) are $20.0 per person per day for the low vulnerability line and $9.9 pppd for the high vulnerability line (both in 2011 PPP). My vulnerability lines differ significantly from those estimated in previous research on vulnerability and the middle class in Latin America. I argue that previous research has underestimated the size of the population at risk of falling into poverty and overestimated the growth of the middle class. Misclassifying the vulnerable as middle class limits their access to anti-poverty policies.

Earthquake Risk Analysis for Disaster Management and Mitigation in Central Lombok

This research focuses on analyzing the risk of earthquake disasters in Central Lombok Regency for disaster management and mitigation purposes that can be implemented in the future. This disaster risk analysis has been prepared using a methodology adapted to the Regulation of the Head of the National Disaster Management Agency Number 02 of 2012 concerning General Guidelines for Disaster Risk Analysis, as well as referring to other guidelines applicable at national level ministries/institutions. Central Lombok Regency faces significant risks related to earthquakes, especially in the coastal, southern and central areas. The risk index value is obtained from data analysis related to the hazard, vulnerability and capacity components for each potential disaster grouped into 3 (three) levels/classes, namely 0-0.333 for low class, &gt; 0.333-0.666 for medium class, and &gt;0.666-1 for high class. The index values are different for each disaster, except for the regional capacity index which applies the same to all regions. The Central Lombok Regency disaster risk assessment was carried out at the village/sub-district level. Detailed results of the analysis of each disaster risk assessment index for all potential disasters in Central Lombok Regency are described for each component determining disaster risk assessment. The results of this research show that the highest risk of earthquake disasters is in East Praya at 31%, then the moderate disaster risk is in the Jonggat and Pringgarata areas at 65%, and the low risk is in the North Batuliang area at 68%.

Are Tai Chi and Qigong effective in the treatment of traumatic brain injury? A systematic review

BackgroundTraumatic brain injury (TBI) adversely affects both young and old and is a growing public health concern. The common functional, psychological, and cognitive changes associated with TBI and recent trends in its management, such as recommending sub-threshold aerobic activity, and multi-modal treatment strategies including vestibular rehabilitation, suggest that Tai Chi/Qigong could be beneficial for TBI. Tai Chi and Qigong are aerobic mind-body practices with known benefits for maintaining health and mitigating chronic disease. To date, no systematic review has been published assessing the safety and effectiveness of Tai Chi/Qigong for traumatic injury.MethodsThe following databases were searched: MEDLINE, CINAHL Cochrane Library, Embase, China National Knowledge Infrastructure Database, Wanfang Database, Chinese Scientific Journal Database, and Chinese Biomedical Literature Database. All people with mild, moderate, or severe TBI who were inpatients or outpatients were included. All Types of Tai Chi and Qigong, and all comparators, were included. All measured outcomes were included. A priori, we chose “return to usual activities” as the primary outcome measure as it was patient-oriented. Cochrane-based risk of bias assessments were conducted on all included trials. Quality of evidence was assessed using the grading of recommendation, assessment, development, and evaluation (GRADE) system.ResultsFive trials were assessed; three randomized controlled trials (RCTs) and two non-RCTs; only two trials were conducted in the last 5 years. No trial measured “return to normal activities” or vestibular status as an outcome. Four trials - two RCTs and two non-RCTS - all found Tai Chi improved functional, psychological and/or cognitive outcomes. One RCT had a low risk of bias and a high level of certainty; one had some concerns. One non-RCTs had a moderate risk of bias and the other a serious risk of bias. The one Qigong RCT found improved psychological outcomes. It had a low risk of bias and a moderate level of certainty. Only one trial reported on adverse events and found that none were experienced by either the exercise or control group.ConclusionBased on the consistent finding of benefit in the four Tai Chi trials, including one RCT that had a high level of certainty, there is a sufficient signal to merit conducting a large, high quality multi-centre trial on Tai Chi for TBI and test it against current trends in TBI management. Based on the one RCT on TBI and Qigong, an additional confirmatory RCT is indicated. Further research is indicated that reflects current management strategies and includes adverse event documentation in both the intervention and control groups. However, these findings suggest that, in addition to Tai Chi’s known health promotion and chronic disease mitigation benefits, its use for the treatment of injury, such as TBI, is potentially a new frontier.Systematic review registrationPROSPERO [CRD42022364385].