Prospective Risk Research Articles

Two-view topogram-based anatomy-guided CT reconstruction for prospective risk minimization

To facilitate a prospective estimation of the effective dose of an CT scan prior to the actual scanning in order to use sophisticated patient risk minimizing methods, a prospective spatial dose estimation and the known anatomical structures are required. To this end, a CT reconstruction method is required to reconstruct CT volumes from as few projections as possible, i.e. by using the topograms, with anatomical structures as correct as possible. In this work, an optimized CT reconstruction model based on a generative adversarial network (GAN) is proposed. The GAN is trained to reconstruct 3D volumes from an anterior-posterior and a lateral CT projection. To enhance anatomical structures, a pre-trained organ segmentation network and the 3D perceptual loss are applied during the training phase, so that the model can then generate both organ-enhanced CT volume and organ segmentation masks. The proposed method can reconstruct CT volumes with PSNR of 26.49, RMSE of 196.17, and SSIM of 0.64, compared to 26.21, 201.55 and 0.63 using the baseline method. In terms of the anatomical structure, the proposed method effectively enhances the organ shapes and boundaries and allows for a straight-forward identification of the relevant anatomical structures. We note that conventional reconstruction metrics fail to indicate the enhancement of anatomical structures. In addition to such metrics, the evaluation is expanded with assessing the organ segmentation performance. The average organ dice of the proposed method is 0.71 compared with 0.63 for the baseline model, indicating the enhancement of anatomical structures.

Association Between Visual Acuity and Prospective Fall Risk in Generally Healthy and Active Older Adults: The 3-Year DO-HEALTH Study

ObjectiveAlthough aging has a strong impact on visual acuity (VA) and falls, their interaction is understudied in generally healthy older adults. This study aimed to examine if and to what extent baseline VA is associated with an increased risk of all and injurious falls over 3 years in generally healthy community-dwelling older adults. DesignObservational analysis of DO-HEALTH, a double-blind, randomized controlled trial. Setting and ParticipantsMulticenter trial with 7 European centers: Zurich, Basel, Geneva (Switzerland), Berlin (Germany), Innsbruck (Austria), Toulouse (France), and Coimbra (Portugal), including 2157 community-dwelling adults aged 70 years and older without any major health events in the 5 years prior to enrollment, sufficient mobility, and good cognitive status. MethodsThe numbers of all and injurious falls were recorded prospectively by diary and in-person assessment every 3 months. Decreased VA at baseline was defined as better-eye VA lower than 1.0. We applied negative binomial regression models for all and injurious falls, adjusted for age, sex, prior falls, treatment allocation, study site, baseline body mass index, and use of walking aids. ResultsAmong the 2131 participants included in this analysis (mean age: 74.9 years, 61.7% were women, 82.6% at least moderately physically active), 1464 (68.7%) had decreased VA. Overall, 3290 falls including 2116 injurious falls were recorded over 3 years. Decreased VA at baseline was associated with a 22% increased incidence rate of all falls [adjusted incidence rate ratio (aIRR) = 1.22, 95% CI 1.07, 1.38, P = .003] and 20% increased incidence rate of injurious falls (aIRR = 1.20, 95% CI 1.05, 1.37, P = .007). Conclusions and ImplicationsOur findings suggest that decreased VA is an independent predictor of an about 20% increased risk of all and injurious falls, highlighting the importance of regular eye examinations and VA measurements for fall prevention, even in generally healthy and active older adults.

Advising the immunocompromised traveller: a review of immunocompromise at The London Hospital for Tropical Diseases Travel Clinic between 1st April 2019 and 30th April 2020.

Immunocompromised travellers (ICTs) face greater infectious and non-infectious travel-associated risks than their immunocompetent counterparts. Increasing travel and emergence of novel immunosuppressants poses great challenges for travel medicine practitioners to confidently provide up-to-date evidence-based risk management advice and pre-travel care for ICTs. We reviewed the records of ICTs attending the London Hospital for Tropical Diseases (HTD) Travel Clinic between 1st April 2019 and 30th April 2020 with the aim to describe demographic and travel characteristics, type, and severity of immunocompromise, the degree of risk associated with intended travel and evaluate travel advice. Of the 193 ICTs identified, immunocompromise was due to physiological reasons (42%), chronic infection (17.1%) and immunosuppressive therapy (16.6%). Median age was 38 (range 9 months to 84 years) and male to female ratio 0.75 (83:110). Travel was intended to 80 countries for a median of 16 days (range 2 to 3167), predominantly for leisure (53%), non-medical work (17%) and visiting friends and relatives (12%). Live vaccine safety dominated discussion in the pre-travel consultation. Existing guidelines arguably fell short in dealing with travel risks associated with hyper-specific conditions, targeted immunosuppressants and non-vaccine preventable infections. Our cohort represents a wide spectrum of immunocompromise, for whom we arguably need more measurable ways to approach travel-associated risks. We propose prospective qualitative participatory research to inform our unit of the priorities of ICTs in the pre-travel consultation. We further recommend the formation of a repository of specialists and formulary of complex cases to direct subsequent informative systematic review and prospective risk studies.

Does voluntary environmental, social, and governance disclosure impact initial public offer withdrawal risk?

AbstractDespite much research now being published on Environmental, Social, and Governance (ESG) investments and Initial Public Offerings (IPOs) withdrawal risk, there appears to be a lack of evidence on the prospective IPO withdrawal risk associated with voluntary disclosure of ESG policies. This paper investigates the influence of ESG disclosure on IPO withdrawal by comparing voluntary ESG disclosure to conventional IPOs in the international market. A large data set is employed here, containing 33,535 failed and successful IPOs from 1995 to 2019 from several nations with their own legal systems, cultural norms, and economic systems. The findings reveal that voluntary disclosure of ESG practices does significantly reduce the likelihood of an IPO withdrawal, by as much as 48%. These findings strongly suggest that organizations engaged in ESG activities perceive voluntary disclosure as an incentive, to adhere to social expectations. Consequently, reducing the asymmetry of information between IPO participants minimizes the withdrawal risk these companies face, hence diminishing doubts about their legitimacy. The results have consequences for IPO businesses, investors, researchers, and regulators.

Prospective systematic risk analysis of the digital technology use within pharmaceutical care

BackgroundDigital technologies are present in every phase of a drug lifecycle, from drug design and development to its dispensing and use. However, given the rapid development and implementation of digital solutions, their monitoring, evaluation, and risk assessment are limited and lacking. ObjectiveThis research is aiming to identify potential errors, quantify and prioritize associated risks in the context of certain technologies used in pharmaceutical care, as well as define corrective measures to improve patient safety and the quality of pharmaceutical care. MethodsA 10-member multidisciplinary team conducted Failure Mode and Effect Analysis (FMEA) to identify critical risks, their causes and effects, along with developing corrective measures within the selected digital health components: Telepharmacy, mHealth, Artificial intelligence (AI), and Software infrastructure and systems. Critical risks were determined by calculating risk priority numbers (RPNs) from severity, occurence, and detectability scores. ResultsThis study identified 42 risks regarding the 4 components. After calculating RPNs and the threshold RPN (RPN=30), 8 critical risks were identified. Corrective measures were proposed for these failure modes, after which the risks were re-evaluated (RPN sum was reduced from 414 to 156). The risk with the highest RPN value was Internet/identity fraud, while the rest included inadequate and incomplete data entry and management, flawed implementation, human and technology errors, and lack of transparency, personalization and infrastructure. For the critical risks, 42 different causes were recognized on a system, technological and individual level while their effects were discussed in terms of patient safety and business management in pharmacies. ConclusionDigitalization of pharmaceutical practice promises greater effectiveness of pharmaceutical care, but in order to achieve this, efforts, resources and initiatives must be directed toward timely identification of problems, appropriate monitoring, and building adequate infrastructure that can support safe implementation of digital tools and services despite the swift development of innovations.

Evolution of Intravenous Medication Errors and Preventive Systemic Defenses in Hospital Settings-A Narrative Review of Recent Evidence.

Intravenous drug administration has been associated with severe medication errors in hospitals. The present narrative review is based on a systematic literature search, and aimed to describe the recent evolution in research on systemic causes and defenses in intravenous medication errors in hospitals. This narrative review was based on Reason's theory of systems-based risk management. A systematic literature search covering the period from June 2016 to October 2021 was conducted on Medline (Ovid). We used the search strategy and selection criteria developed for our previous systematic reviews. The included articles were analyzed and compared to our previous reviews. The updated search found 435 articles. Of the 63 included articles, 16 focused on systemic causes of intravenous medication errors, and 47 on systemic defenses. A high proportion (n = 24, 38%) of the studies were conducted in the United States or Canada. Most of the studies focused on drug administration (n = 21/63, 33%) and preparation (n = 19/63, 30%). Compared to our previous review of error causes, more studies (n = 5/16, 31%) utilized research designs with a prospective risk management approach. Within articles related to systemic defenses, smart infusion pumps remained most widely studied (n = 10/47, 21%), while those related to preparation technologies (n = 7/47, 15%) had increased. This narrative review demonstrates a growing interest in systems-based risk management for intravenous drug therapy and in introducing new technology, particularly smart infusion pumps and preparation systems, as systemic defenses. When introducing new technologies, prospective assessment and continuous monitoring of emerging safety risks should be conducted.

Risk of Parkinson's disease in people aged ≥50 years with new-onset anxiety: a retrospective cohort study in UK primary care.

A history of anxiety is more common in people with Parkinson's disease (PD). The prospective risk of PD in those newly presenting with anxiety and factors that increase the risk of PD in patients with anxiety have not been investigated. To investigate the incidence of PD in people with anxiety aged ≥50 years and clinical features associated with later diagnosis of PD in people with anxiety. A retrospective cohort study using UK primary care data between 2008 and 2018, assessing patients with new-onset anxiety aged ≥50 years. Weibull survival regression models were fitted and hazard ratios (HRs) for modelling time-to-PD was estimated in those with and without anxiety, and when determining the risk of developing PD in those with anxiety. Results were adjusted for sociodemographic and lifestyle factors, and relevant physical and mental health conditions. The risk of PD increased two-fold compared with the non-anxiety group after adjustment for age, sex, social deprivation, lifestyle factors, severe mental illness, head trauma, and dementia (HR 2.1, 95% confidence interval = 1.9 to 2.4). In those with anxiety, the presence of depression, hypotension, tremor, rigidity, balance impairment, constipation, sleep disturbance, fatigue, and cognitive impairment were associated with an increased risk of developing PD. The risk of developing PD was at least doubled in people with anxiety compared with those without. The clinical features of those who developed PD can help identify patients presenting with anxiety who are in the prodromal phase of PD.

Backwards walking speed reserve in persons with multiple sclerosis

BackgroundDecreased gait speed is common in persons with Multiple Sclerosis (PwMS) and has been associated with elevated fall risk. The walking speed reserve (WSR) indicates the ability to increase gait speed on demand and has previously been examined in PwMS. Backward walking is a sensitive measure of fall risk in PwMS; however, no studies have reported on the utility of backward walking speed reserve (BW-WSR) as a clinical assessment tool of functional mobility or fall risk in PwMS, nor have they associated this measure with cognition. Methods23 PwMS completed walking trials at their preferred walking speed (PWS) and maximal walking speed (MWS). Participants performed these walking trials in both the forward (FW) and backward direction (BW). The forward walking speed reserve (FW-WSR) was calculated as the difference between MWS and PWS in the forward direction, while the backward walking speed reserve (BW-WSR) was calculated as the difference between MWS and PWS in the back backward direction. Correlation analyses examined the relationship between the FW- and BW-WSR with clinical assessments of functional mobility (the timed up-and-go) as well as cognitive functioning (the Symbol Digit Modalities Test, the Brief Visuospatial Memory Test-Revised, the California Verbal Learning Test, and the Trail Making Test A and B). Correlations also examined the relationship between FW- and BW-WSR with prospective falls. ResultsA lower BW-WSR was associated with disease severity and poorer performance on clinical walking and balance assessment, as well as with decreased information processing speed and attentional performance. Interestingly, FW-WSR showed similar relations. Neither FW- or BW-WSR were associated with prospective risk in this small sample of PwMS. ConclusionThe BW-WSR did not offer a distinct advantage over other measures, such as the FW-WSR, PWS, or MWS, in the forward or backward direction. The selection of the most sensitive clinical measures of functional mobility and fall risk is crucial; our study holds valuable clinical implications for PwMS by providing novel insights into functional mobility assessments in PwMS.

Characterization of temperature and humidity effects on extreme heat stress under global warming and urban growth in the Pearl and Yangtze River Deltas of China

With global warming accelerating, the heavily populated and rapidly urbanized coastal regions of the Pearl River Delta (PRD) and the Yangtze River Delta (YRD) stand as representative areas with mounting concerns about extreme heat stress. This study analyzes differentiated effects of temperature (TAS) and relative humidity (RH) on human heat stress measured by wet-bulb globe temperature (WBGT) in those urban regions based on machine learning and mathematical derivation, while also examining the impacts of global warming and urbanization on prospective heat risks. To generate fine-scale climate projections targeted at the PRD and YRD, two global projections forced by Representative Concentration Pathway (RCP) 8.5 scenario are dynamically downscaled using non-hydrostatic Regional Climate Model version 4.7 (RegCM4), with the urban density and extent updated every year based on Shared Socioeconomic Pathways 5-8.5 (SSP5) scenario, thereby incorporating the transient urban growth into future projections. The bias-corrected downscaled simulations effectively capture the distinct interdependencies between TAS and RH on WBGT across different regions, similar to the observed patterns during the historical period. While the absolute contribution of TAS to WBGT is larger than RH regardless of warming levels and regions, the relative increase in RH becomes more pronounced with warming. Under RCP8.5 scenario, unprecedentedly extreme WBGT is projected to emerge in the far future (2080–2099). In contrast, the effect of urbanization appears to be more dominant in the near future (2030–2049) as urban density under SSP5 scenario is projected to peak around the 2040s and gradually decrease afterwards. The reduction of RH is found in the intensely urbanized areas locally, but it does not significantly lower WBGT because the positive contribution of increased TAS is more dominant. As a result, highly urbanized regions still exhibit higher WBGT compared to other areas. In addition, urban heat island effect is more pronounced for compact areas with high urban density (i.e., PRD) and at night. Despite the smaller temperature increase from urban heat island effect compared to global warming, it can play a critical role in exacerbating heat stress, adding to the already dangerous humid and hot conditions.

Polycyclic aromatic compounds (PACs) in industrial soils from northwestern of China: occurrence, distribution, exposure risk, and implications on risk-based controls.

Some Polycyclic Aromatic Compounds (PACs) such asnitrated-PAHs (NPAHs), oxygenated-PAHs (OPAHs) and methyl-PAHs (MPAHs) have attracted significant concern due to derivatives have greater potential to be more toxic at low environmental concentrations compared to their PPAHs, particularly in petrochemical industrial region and its surrounding areas surface soils in China.Hence, this article provides an insight into the fate, sources, impacts, and relevance to the external environment of PAH-derivatives based on important emissions source. Moreover, prospective health risk due to their exposure has also been discussed. In this study, the concentration (10-3ng/g) of Ʃ18PPAHs, Ʃ11MPAHs, Ʃ12NPAHs, and Ʃ4OPAHs in the park were 9.67 ± 1.40, 3.24 ± 0.54, 0.03 ± 0.02 and 0.19 ± 0.65, respectively, which were 4.47, 3.89, 2.04 and 1.17 times than of them surrounding the region. A decreasing trend of the low molecular weight (2-4Rings) contribution to the total amount of PAHs, while the fraction of high molecular weight (5-6Rings) species showed the opposite trend. According to the principal component analysis (PCA) and diagnostic ratios indicated PAHs in the soil samples have mixed sources from industrial activities, solid fuel combustion, and heavy traffic. Despite the high concentrations of MPAHs and OPAHs, the toxicity equivalency quotients (TEQs) of them were not calculated due to the lack of toxic equivalent factors (TEF), thus current studies on PAH and derivatives could have underestimated their exposure risks. The quality and sustainable management of soils are crucial for human health and sustainable development, while there is lack of public awareness of the severe issue of soil pollution. It is recommended to conduct more intensive monitoring and regional assessments in the future.

Changes in Concurrent Meteorological Extremes of Rainfall and Heat under Divergent Climatic Trajectories in the Guangdong–Hong Kong–Macao Greater Bay Area

Concurrent meteorological extremes (CMEs) represent a class of pernicious climatic events characterized by the coexistence of two extreme weather phenomena. Specifically, the juxtaposition of Urban Extreme Rainfall (UER) and Urban Extreme Heat (UEH) can precipitate disproportionately deleterious impacts on both ecological systems and human well-being. In this investigation, we embarked on a meticulous risk appraisal of CMEs within China’s Greater Bay Area (GBA), harnessing the predictive capabilities of three shared socioeconomic pathways (SSPs) namely, SSP1-2.6, SSP3-7.0, and SSP5-8.5, in conjunction with the EC-Earth3-Veg-LR model from the CMIP6 suite. The findings evidence a pronounced augmentation in CME occurrences, most notably under the SSP1-2.6 trajectory. Intriguingly, the SSP5-8.5 pathway, typified by elevated levels of greenhouse gas effluents, prognosticated the most intense CMEs, albeit with a temperate surge upon occurrence. Additionally, an ascendant trend in the ratio of CMEs to the aggregate of UER and UEH portends an escalating susceptibility to these combined events in ensuing decades. A sensitivity analysis accentuated the pivotal interplay between UER and UEH as a catalyst for the proliferation of CMEs, modulated by alterations in their respective marginal distributions. Such revelations accentuate the imperative of assimilating intricate interdependencies among climatic anomalies into evaluative paradigms for devising efficacious climate change countermeasures. The risk assessment paradigm proffered herein furnishes a formidable instrument for gauging the calamitous potential of CMEs in a dynamically shifting climate, thereby refining the precision of prospective risk estimations.

Ecological risk assessment, source identification and spatial distribution of organic contaminants in terms of mucilage threat in streams of Çanakkale Strait Basin (Türkiye)

In this study, the spatial distributions of organic contamination stressors in water of fluvial habitats in the Çanakkale Strait (ÇS) watershed were investigated and the data were assessed in terms of human health and mucilage threat. Seven significant riverine ecosystems flowing into the ÇS were defined in the basin. Water samples were taken in the spring season (2023), when the phytoplankton communities reach their highest densities. Then they were tested for a total of 8 limnological parameters.The Nutrient Pollution Index (NPI) and Water Quality Index (WQI) were applied to assess the comprehensive quality characteristics of waters. The Hazard Quotient (HQ) and Hazard Index (HI) were applied to indicate the prospective non-carcinogenic human health risks of organic stressors. Principal Component Analysis (PCA) and Cluster Analysis (CA) were applied to categorize the investigated habitats and define the sources of investigated contamination parameters. Also, Geographic Information System (GIS) was used to make an effective assessment through visualization.The determined spatial mean values of the measured variables in ÇS watershed as follows: 18.21 °C for temperature, 8.51 mg/L for DO, 4.57 NTU for turbidity, 3.95 mg/L for suspended solids, 1.11 mg/L for NO3–N, 0.012 mg/L for NO2–N; 0.173 mg/L for PO4–P and 2.32 mg/L for BOD. It has been determined that the organic pollution loads and water temperature values of the investigated sub-basins increase from the upstream to the downstream locations and Çanakkale Stream was recorded as the riskiest fluvial habitat for the ÇS watershed. According to the results of health risk assessment indices, non-carcinogenic risks of organic pollutants would not be expected for all age groups.

A modified CEUS risk stratification model for adnexal masses with solid components: prospective multicenter study and risk adjustment.

To evaluate the additional advantages of integrating contrast-enhanced ultrasound (CEUS) into the Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound (US) for the characterization of adnexal lesions with solid components. This prospective multicenter study recruited women suspected of having adnexal lesions with solid components between September 2021 and December 2022. All patients scheduled for surgery underwent preoperative CEUS and US examinations. The lesions were categorized according to the O-RADS US system, and quantitative CEUS indexes were recorded. Pathological results served as the reference standard. Univariable and multivariable analyses were performed to identify risk factors for malignancy in adnexal lesions with solid components. Receiver operating characteristic (ROC) curve analysis was employed to assess diagnostic performance. A total of 180 lesions in 175 women were included in the study. Among these masses, 80 were malignant and 100 were benign. Multivariable analysis revealed that serum CA-125, the presence of acoustic shadowing, and peak intensity (PI) ratio (PImass/PIuterus) of solid components on CEUS were independently associated with adnexal malignancy. The modified CEUS risk stratification model demonstrated superior diagnostic value in assessing adnexal lesions with solid components compared to O-RADS US (AUC: 0.91 vs 0.78, p < 0.001) and exhibited comparable performance to the Assessment of Different NEoplasias in the adnexa (ADNEX) model (AUC 0.91 vs 0.86, p = 0.07). Our findings underscore the potential value of CEUS as an adjunctive tool for enhancing the precision of diagnostic evaluations of O-RADS US. The promising performance of the modified CEUS risk stratification model suggests its potential to mitigate unnecessary surgeries in the characterization of adnexal lesions with solid components. • The additional value of CEUS to O-RADS US in distinguishing between benign and malignant adnexal lesions with solid components requires further evaluation. • The modified CEUS risk stratification model displayed superior diagnostic value and specificity in characterizing adnexal lesions with solid components when compared to O-RADS US. • The inclusion of CEUS demonstrated potential in reducing the need for unnecessary surgeries in the characterization of adnexal lesions with solid components.

Causal relationship between gut microbiota and risk of esophageal cancer: evidence from Mendelian randomization study.

The causative implications remain ambiguous. Consequently, this study aims to evaluate the putative causal relationship between gut microbiota and Esophageal cancer (EC). The genome-wide association study (GWAS) pertaining to the microbiome, derived from the MiBioGen consortium-which consolidates 18,340 samples across 24 population-based cohorts-was utilized as the exposure dataset. Employing the GWAS summary statistics specific to EC patients sourced from the GWAS Catalog and leveraging the two-sample Mendelian randomization (MR) methodology, the principal analytical method applied was the inverse variance weighted (IVW) technique. Cochran's Q statistic was utilized to discern heterogeneity inherent in the data set. Subsequently, a reverse MR analysis was executed. Findings derived from the IVW technique elucidated that the Family Porphyromonadaceae (P = 0.048) and Genus Candidatus Soleaferrea (P = 0.048) function as deterrents against EC development. In contrast, the Genus Catenibacterium (P = 0.044), Genus Eubacterium coprostanoligenes group (P = 0.038), Genus Marvinbryantia (P = 0.049), Genus Ruminococcaceae UCG010 (P = 0.034), Genus Ruminococcus1 (P = 0.047), and Genus Sutterella (P = 0.012) emerged as prospective risk contributors for EC. To assess reverse causal effect, we used EC as the exposure and the gut microbiota as the outcome, and this analysis revealed associations between EC and seven different types of gut microbiota. The robustness of the MR findings was substantiated through comprehensive heterogeneity and pleiotropy evaluations. This research identified certain microbial taxa as either protective or detrimental elements for EC, potentially offering valuable biomarkers for asymptomatic diagnosis and prospective therapeutic interventions for EC.

Sedentary Lifestyle and Prospective Health Risks: A Pilot Study Among Bangladeshi Corporate Professionals

Physical inactivity is one of the global health problems due to increased automation, moving less than before causing people to an elevated risk of developing various health conditions like obesity, hypertension, heart disease, etc. Most of the aforementioned diseases are linked to unhealthy lifestyles that are quite preventable. Although very few studies have been done related with sedentary lifestyle and its risks in Bangladesh, no study was focused on corporate professionals whom are at high health risk due to their job nature. This study therefore aims to explore the sedentary lifestyle and associated health and lifestyle related factors that might play role in the worsening of healthy life. Results of our study concluded that professionals belonging to age group between 25-29 years are most likely heading towards the risk zone of developing sedentary lifestyle associated risk according to WHO guidelines on sedentary lifestyle especially high body mass index (BMI 25 and more). Among the studied participants 78% were smokers and 21% were alcoholics. Moreover, 63% corporates reported that they could sleep 6 hour or less in a day, while 64% of the participants claimed that their stress level is high (7 to 10) in a 10 scale. Almost one fourth (24%) of the participants informed that they did not do any format of physical activity, and 26% participants were working for 5 years or more. Our data adequately pointed out some leading risk factors among the corporates that directly or indirectly provoke prospective health risks as described in numerous number of previous studies. Bangladesh Pharmaceutical Journal 27(1): 73-84, 2024 (January)

When tomorrow comes: A prospective risk assessment of a future artificial general intelligence-based uncrewed combat aerial vehicle system

There are concerns that Artificial General Intelligence (AGI) could pose an existential threat to humanity; however, as AGI does not yet exist it is difficult to prospectively identify risks and develop requisite controls. We applied the Work Domain Analysis Broken Nodes (WDA-BN) and Event Analysis of Systemic Teamwork-Broken Links (EAST-BL) methods to identify potential risks in a future ‘envisioned world’ AGI-based uncrewed combat aerial vehicle system. The findings suggest five main categories of risk in this context: sub-optimal performance risks, goal alignment risks, super-intelligence risks, over-control risks, and enfeeblement risks. Two of these categories, goal alignment risks and super-intelligence risks, have not previously been encountered or dealt with in conventional safety management systems. Whereas most of the identified sub-optimal performance risks can be managed through existing defence design lifecycle processes, we propose that work is required to develop controls to manage the other risks identified. These include controls on AGI developers, controls within the AGI itself, and broader sociotechnical system controls.

Predicting water ecosystem services under prospective climate and land-use change scenarios in typical watersheds distributed across China

Water-related ecosystem services (WES) critical to anthropogenic-related water security are being severely degraded, primarily due to climate and land-use change. Clarifying future trends in WES (i.e., water yield and water purification services) will contribute to water resource sustainability. However, most existing studies are single case studies and rarely consider the combined impacts of climate change and land-use change on ecosystem services, resulting in patterns that cannot be adequately summarized. In this study, the “Annual Water Yield” module of the InVEST model was used to estimate water yield and the “Nutrient Delivery Ratio” module was used to analyze water purification services. In order to compare the impacts of different natural conditions and geographic locations on water ecosystem services, 17 typical watersheds throughout China were selected as study areas. Coupled scenarios were also considered when setting climate and land-use scenarios to predict prospective (2020–2100) evolutionary trends in WES. The response of WES under different scenarios was also assessed. Results show that climate change is more likely to affect water yield services than water purification services. The impact of land use on water purification services is more pronounced than its impact on water yield services. Climate change contributed > 90 % to water yields in 15 out of the 17 watersheds, contributed 79.4 % in the Hei River watershed, while only contributing 11.2 % in the Yarkant River watershed. The influence of climate change on total nitrogen (TN) output in eight of the watersheds was greater than that of land-use change, especially in the Min River and Mintuo River watersheds, for which the contribution was > 95 %. Furthermore, water purification services in nine of the watersheds were more affected by land-use change, especially in the Dongting Lake and Hei River watersheds, for which the contribution was > 95 %. The aim of this study is to assist in the planning of sound water resource measures while developing sustainable management strategies to help relevant water resource sectors cope with prospective risks and challenges.

Epicardial fat thickness in patients with gestational diabetes mellitus and its association with N-terminal pro-brain natriuretic peptide.

The female population with gestational diabetes mellitus (GDM) has a postpartum profile with increased cardiovascular (CV) risk factors and heightened prospective CV risk. Epicardial fat tissue was reported to be related to cardiometabolic diseases as metabolically active adipose tissue and natriuretic peptides (NPs) have been shown to have metabolic effects. This study's aim was to determine the relationship between epicardial fat thickness (EFT) and NPs in the female population diagnosed with GDM. The study involved 161 pregnant women: 96 with GDM, and 65 healthy controls. GDM was diagnosed following the American Diabetes Association (2013) norms for diagnosing diabetes. All patients underwent echocardiography to measure EFT. N-terminal pro-brain natriuretic peptide (NT-proBNP) and other parameters were quantified in blood samples. The Independent Samples t-test, Pearson's correlation test, and a multivariable logistic regression analysis (LRA) were performed for statistical evaluation. A p-value <0.05 was considered statistically significant. Fasting (91.46±14.29 mg/dl vs. 82.18±8.21 mg/dl) (p<0.001), first-hour (202.30± 21.60 mg/dl vs. 161.57±16.21 mg/dl) (p<0.001), and second-hour (176.95±20.43 mg/dl vs. 130.93±16.95 mg/dl) glucose levels (p<0.001), fasting insulin level (14.54±3.50 mUL/mL vs. 11.51±2.04 mUL/mL; p<0.001), and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) value (3.28±0.99 vs. 2.31±0.45; p<0.0001) in GDM Group were significantly higher than Control Group. The GDM Group also had significantly increased EFT values compared to the Control Group (4.74±0.65 mm vs. 3.77±0.66 mm; p<0.0001), whereas NT-proBNP levels of diabetic women were considerably lower compared to controls (21.59±19.86 pg/ml vs. 39.74±33.96 pg/ml; p<0.0001). In addition, EFT thickness and the NT-proBNP level were determined to be significantly negatively correlated (r=-32, p<0.0001). EFT evaluation might play a prognostic role in detecting cardiometabolic risk associated with potential disorders such as GDM. This study showed a potential interplay between epicardial adipose tissue and NPs secreted by cardiomyocytes and practical effects on fat metabolism in GDM subjects.

Prospective early adulthood risk factors for vasomotor symptoms in the Coronary Artery Risk Development in Young Adults study.

Previous studies have assessed potential risk factors for vasomotor symptoms (VMS) beginning in midlife. We examined whether early adulthood risk factors predict VMS trajectories over time. We performed a secondary data analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based cohort. We included women who answered questions about VMS at three or more examinations (n = 1,966). We examined whether risk factors at baseline (when participants were aged 18-30 y; average age, 25 y) and the year 15 (Y15) exam (at ages 33-45 y; average age, 40 y) were associated with VMS trajectories from Y15 through Y35. Logistic regression models were used to evaluate the associations with VMS trajectories. We identified three trajectories of VMS presence: minimal (40%), increasing over time (27%), and persistent (33%). Baseline factors associated with persistent VMS over time included Black race, less than a high school education, depressive symptoms, migraines, cigarette use, and at Y15 hysterectomy. Baseline factors associated with increasing VMS over time included Black race and lower body mass index. Risk factors for bothersome VMS were similar and also included thyroid disease, although thyroid disease was not associated with persistence of VMS over time. Associations were similar among women who had not undergone hysterectomy and in Black and White women. Risk factors for VMS may be identified in early adulthood. Further examination of risk factors such as migraines and depressive symptoms in early adulthood may be helpful in identifying therapies for VMS.

Chemometrics Assisted Formulation of Glimepiride Nanosuspension for Solubility Enhancement in Diabetic Therapy—A Systematic Approach

AbstractGlimepiride (GLM), a third‐generation sulfonylurea oral hypoglycemic medication, is used to treat type II diabetes. Admittedly, it has a low bioavailability, a relatively short half‐life (t1/2), and high toxicity. To address the issue, a nanosuspension of poorly soluble GLM is designed using a Quality‐by‐Design (QbD) method, to enhance its solubility. Prospective risk factors are identified and assessed using Critical Material Attribute (CMAs) and Critical Processing Parameter (CPPs) to evaluate the targets by Taguchi orthogonal array (OA) design and to study the effects of formulation and process variables on dependent variables. The amount of Polyvinylpyrrolidone (PVP) (X2), agitation time (X5), and concentration of Poloxamer (X7) are found as significant parameters (p &lt; 0.05), and are further optimized using the Box Behnken Design as response surface methodology model. The optimized GLM nanosuspension 1) has mean particle size (PS), zeta potential, viscosity (VS), and percentage cumulative drug release (CDR%) of 258.17 nm, −25.2 mV, 1.087cPs, and 98.52%, respectively. The pattern of drug release is fitted to Non‐Fickian kinetics. The study results in an economic and efficient nano formulation with enhanced solubility.