Risk Reduction Research Articles

Understanding Socioeconomic Risk and Vulnerability to Climate Change–Induced Disasters: The Case of Informal Settlements in KwaZulu-Natal, South Africa

This study employs a qualitative research approach to spatially delineate the risk and vulnerability of informal settlements in KwaZulu-Natal, South Africa. This comes after devastating floods that occurred in KwaZulu-Natal, South Africa, in April 2022. This disaster emphasised the necessity for South Africa to proactively address natural hazards by implementing risk reduction strategies rather than attempting to mitigate the impact after the damage has occurred. Evidence indicates that the risk and vulnerability associated with climate-induced disasters, such as flooding, are exacerbated by socioeconomic factors, including housing shortages, which compel individuals to construct dwellings in flood-prone areas. Opportunities exist to enhance the understanding of disaster risk reduction in Africa, and South Africa in particular, through science-informed initiatives employing spatial techniques, including geographic information systems, hazard exposure mapping, and socioeconomic risk and vulnerability mapping. These techniques are crucial for humanitarian planning focused on long-term risk reduction, early recovery, shelter, reconstruction, and psychosocial support for climate change disaster recovery. Furthermore, an understanding of the nature and location of areas with high disaster risk, such as flooding, is essential for the formulation of disaster risk reduction strategies, including early warning systems.

ThP1.13 - Short term safety outcomes of immediate pre-pectoral implant based reconstruction

Abstract Aims In the UK up to 43% of women undergo immediate breast reconstruction (IBR) following mastectomy for breast cancer. Implant reconstruction is the commonest form of breast reconstruction and pre-pectoral techniques have been introduced with the aim of improving cosmetic outcome and avoiding animation. To assess the safety of pre-pectoral implant based breast reconstruction (PPBR), including infection rates, 30 day re-admission to hospital, need for unplanned surgery and implant loss at 3 months. Methods A retrospective study of 80 consecutive women who underwent PPBR for breast cancer or risk reduction between October 2020 and October 2023. Demographic, operative and complication data were collected. Results Eighty women (70 cancer, 8 risk reducing and 2 cancer/risk reducing) underwent 94 PPBR procedures (80 Skin sparing mastectomies and 14 Nipple and skin sparing mastectomies) with a mean age of 51.5 (range 28 to 79) years and a BMI of 25.2 kg/m2. 7 (8.8%) of women were smokers. The mean implant size used was 385cc (range 160cc to 650cc) with a mean breast weight of 448.6g (range 45g to 1700g). 10 (12.5%) women required oral antibiotics for wound infection with a further 2 (2.5%) women requiring re-admission within 30 days for IV antibiotics. 17 (21.3%) developed a seroma with 8 (47.1%) requiring drainage. No implant losses were recorded within 3 months of reconstruction. Conclusion We have demonstrated that PPBR is a good option for patients of a wide age range with a large variation in breast size with minimal complications and no implant losses.

Efficacy of Adjunct Hemoperfusion Compared to Standard Medical Therapy on 28-Day Mortality in Leptospirosis Patients with Renal Failure and Shock: A Single-Center Randomized Controlled Trial

Hemoperfusion is a novel adjunct therapy that targets the dysregulated inflammatory events in severe sepsis. Previous studies have reported conflicting results on its efficacy and safety. This study was designed to assess the efficacy and safety of hemoperfusion among leptospirosis patients in septic shock and renal failure in terms of improvement in 28-day mortality, SOFA score, level of inflammatory markers, hemodynamics, and renal and pulmonary function. A total of 37 severe leptospirosis patients were enrolled and randomized into either standard medical therapy (SMT) alone, n = 20, or with hemoperfusion (HP), n = 17. Vital signs, urine output, vasopressor dose, PaO2/FiO2 (P/F) ratio, and biochemical parameters of patients from each treatment arm were compared. The hemoperfusion group showed a 36.84% (p = 0.017) risk reduction in 28-day mortality. Levels of procalcitonin, IL6, and lactate significantly decreased from baseline to day 7 in both groups. Statistically significant improvements in serum creatinine (p = 0.04) and PF ratio (p = 0.045) were observed in the hemoperfusion cohort. Intention-to-treat and per-protocol approaches showed that hemoperfusion increased the survival rate and decreased the mortality risk. This benefit for survival persisted even when patients were also receiving extracorporeal membrane oxygenation (ECMO), showing that hemoperfusion’s benefits are independent of ECMO use. Hemoperfusion is a safe and effective adjunct therapy for managing severe sepsis. It promotes earlier renal and pulmonary function recovery and improves the survival of septic shock patients.

ATP-based assessments of recent cleaning and disinfection for high-touch surfaces in low-resource shared toilets

Quality improvements and reduction of disease risk for low-resource shared sanitation facilities require cleanliness assessment approaches that are both rigorous and practical. Using Adenosine Triphosphate (ATP) bioluminescence testing, we assessed contamination on high-touch (HT) surfaces (inner door handles) at 32 shared toilet sites in Kisumu, Kenya. In public toilets, contamination was lowest after cleaning and disinfection (C&D) with 0.5% chlorine solution (adjusted difference in mean log10 Relative Light Units per 100 cm2 (aDiff): −1.61; CI: −2.43, −0.59), followed by C&D with 0.1% chlorine solution (aDiff: −1.16; CI: −1.77, −0.55). ATP levels were not associated with overall observable toilet cleanliness and had poor agreement with visually assessed HT surface cleanliness. Our findings demonstrate the utility of this field-feasible method for detecting the impact of recent C&D in low-resource shared toilets, a novel setting for ATP cleanliness testing, while also highlighting the importance of using effective C&D procedures and addressing HT surfaces within cleaning protocols.

Prevention of Recurrent Spontaneous Preterm Delivery Using Probiotics (Clostridium butyricum, Enterococcus faecium, and Bacillus subtilis; PPP Trial): Protocol for a Prospective, Single-Arm, Nonblinded, Multicenter Trial

Background The rate of recurrent spontaneous preterm delivery (sPTD) ranges between 27% and 34% and is 22.3% in Japan. Although it currently remains unclear whether probiotics prevent sPTD, retrospective studies recently reported a reduction in the rate of recurrent sPTD with the administration of probiotics including Clostridium spp., which induce regulatory T cells that play an important role in maintaining pregnancy. Objective The objective of this trial is to evaluate the preventative effects of available oral probiotics, including Clostridium butyricum, on recurrent sPTD. Methods This is a prospective, single-arm, nonblinded, multicenter trial in Japan. The sample size required for this trial is 345 pregnant women with a history of sPTD, considering a clinically significant reduction in the relative risk of 30% (risk ratio=0.7). The primary endpoint is the rate of recurrent sPTD at <37 weeks of gestation. The secondary endpoints are the rate of sPTD at <34 weeks of gestation, the rate of recurrent sPTD at <28 weeks of gestation, the ratio of intestinal Clostridium spp. (detected by next-generation sequencing), and bacterial vaginosis (using the Nugent score). Results The trial procedures were approved by the Clinical Research Review Board of Toyama University Hospital (SCR2020008) on March 31, 2021. The trial was registered on the Japan Registry of Clinical Trial website on April 28, 2021. Recruitment began on May 1, 2021, and the trial is estimated to finish on March 31, 2025. Conclusions The findings will clarify the rate of recurrent sPTD following probiotic administration including Clostridium butyricum. Outcomes from this trial will inform clinical practice and guide future randomized controlled trials. Trial Registration Japan Registry of Clinical Trials jRCTs041210014; https://jrct.niph.go.jp/latest-detail/jRCTs041210014 International Registered Report Identifier (IRRID) DERR1-10.2196/59928

Assessing Critical Entities: Risk Management for IoT Devices in Ports

Integrating Internet of Things (IoT) devices into port operations has brought substantial improvements in efficiency, automation, and connectivity. However, this technological advancement has also introduced new operational risks, particularly in terms of cybersecurity vulnerabilities and potential disruptions. The primary objective of this scientific article is to comprehensively analyze and identify the primary security threats and vulnerabilities that IoT devices face when deployed in port environments. This includes examining potential risks, such as unauthorized access, cyberattacks, malware, etc., that could disrupt critical port operations and compromise sensitive information. This research aims to assess the critical entities associated with IoT devices in port environments and develop a comprehensive risk-management framework tailored to these settings. It also aims to explore and propose strategic measures and best practices to mitigate these risks. For this research, a risk-management framework grounded in the principles of ORM, which includes risk avoidance, reduction, sharing, and retention strategies, was developed. The primary outcome of this research is the development of a comprehensive risk-management framework specifically tailored for IoT devices in port environments, utilizing Operational Risk-Management (ORM) methodology. This framework will systematically identify and categorize critical vulnerabilities and potential threats for IoT devices. By addressing these objectives, the article seeks to provide actionable insights and guidelines that can be adopted by port authorities and stakeholders to safeguard their IoT infrastructure and maintain operational stability in the face of emerging threats.

Prosigna Assay for Treatment Decisions in Early Breast Cancer: A Decision Impact Study.

Introduction: Therapeutic decisions in early breast cancer are based on clinico-pathological features which are subject to intra- and inter-observer variability. This single-center decision impact study aimed to evaluate the effects of the Prosigna assay on physicians' adjuvant treatment choices. Methods: Between 09/2017 and 02/2018, formalin-fixed tumor samples from 52 newly diagnosed, postmenopausal, hormone receptor-positive, HER2-negative breast cancer (T1-T2; pN0-N1a) patients were analyzed. Pre-test clinical judgements and Prosigna test results were compared. Results: The mean age was 59 (42-77). Invasive ductal carcinoma (79.2%), grade 2 (52.8%) and T1c-N0 tumors (43.4%) were represented. There was 40.4% discordance between the pre- and post-test risk of recurrences. No significant change was observed in the clinical intermediate risk category, while there was a net reclassification of low-risk patients into a high Prosigna recurrence risk group. In addition, clinically determined intrinsic subtypes were 34.6% discordant with the Prosigna results, which is largely driven by the reclassification of the luminal A tumors into the Prosigna-assessed luminal B group. Before the Prosigna test, endocrine treatment was the primary choice in 20 patients (39.2%), and chemotherapy was recommended to 31 patients (60.8%). Overall, the Prosigna assay led to a change in treatment choice for one patient. Conclusions: Although conventional risk assessment methods are relatively inexpensive with shorter turnaround times, their accuracy and value for risk reduction are suboptimal. According to our results, the Prosigna assay was found to be a relevant tool for the clinical decision making process. Long-term follow-up of these patients will elucidate the potential benefits of using multigene molecular tests as biomarkers for treatment.

Major mistakes or errors in the use of trial sequential analysis in systematic reviews or meta-analyses – the METSA systematic review

BackgroundSystematic reviews and data synthesis of randomised clinical trials play a crucial role in clinical practice, research, and health policy. Trial sequential analysis can be used in systematic reviews to control type I and type II errors, but methodological errors including lack of protocols and transparency are cause for concern. We assessed the reporting of trial sequential analysis.MethodsWe searched Medline and the Cochrane Database of Systematic Reviews from 1 January 2018 to 31 December 2021 for systematic reviews and meta-analysis reports that include a trial sequential analysis. Only studies with at least two randomised clinical trials analysed in a forest plot and a trial sequential analysis were included. Two independent investigators assessed the studies. We evaluated protocolisation, reporting, and interpretation of the analyses, including their effect on any GRADE evaluation of imprecision.ResultsWe included 270 systematic reviews and 274 meta-analysis reports and extracted data from 624 trial sequential analyses. Only 134/270 (50%) systematic reviews planned the trial sequential analysis in the protocol. For analyses on dichotomous outcomes, the proportion of events in the control group was missing in 181/439 (41%), relative risk reduction in 105/439 (24%), alpha in 30/439 (7%), beta in 128/439 (29%), and heterogeneity in 232/439 (53%). For analyses on continuous outcomes, the minimally relevant difference was missing in 125/185 (68%), variance (or standard deviation) in 144/185 (78%), alpha in 23/185 (12%), beta in 63/185 (34%), and heterogeneity in 105/185 (57%). Graphical illustration of the trial sequential analysis was present in 93% of the analyses, however, the Z-curve was wrongly displayed in 135/624 (22%) and 227/624 (36%) did not include futility boundaries. The overall transparency of all 624 analyses was very poor in 236 (38%) and poor in 173 (28%).ConclusionsThe majority of trial sequential analyses are not transparent when preparing or presenting the required parameters, partly due to missing or poorly conducted protocols. This hampers interpretation, reproducibility, and validity.Study registrationPROSPERO CRD42021273811

Combining machine learning (ML) and participatory rural appraisal (PRA) for disaster risk preparedness (DRP): Evidence from the poorest region of Luzon, Philippines

In the field of social science, disaster risk preparedness (DRP) is considered immeasurable due to its multidimensional nature, making it infamously difficult to quantify. The current measurements are costly, labor-intensive, and time-consuming. Consequently, policymakers struggle to target policies effectively when implementing disaster risk reduction management initiatives. By combining Participatory Rural Appraisal (PRA) and Machine Learning (ML) to train and test community-based system datasets, this work proposes novel approaches to DRP in the poorest region of Luzon, Philippines. We utilized sophisticated econometrics models along with ML categorization methods. Through the analysis of 34 locales and 4 sectors within a disaggregation system over 429 ensemble runs using cross-validation techniques, we then combined the results. The Support Vector Machine (SVM) classifier achieved the highest accuracy of 91.55 % randomly and 94.53 % within the pipeline, surpassing all other models. It also confirms the current relationship between DRP and multidimensional attributes (a total of 21 factors) in terms of correlation and causation. Our work showcases the potential of ML for disaster risk prediction, potentially reducing costs, saving labor, and optimizing time, especially in the most impoverished areas of the Philippines. Ultimately, through extensive PRA, the outcomes have provided different localities with tools for targeting policies in disaster risk management.

Comparison of Cranial Cruciate Ligament Rupture Incidence among Parous and Nulliparous Rottweiler Bitches: Evidence from a Lifetime Cohort Study Supporting a Paradigm of Pregnancy-Associated Protection against Subsequent Non-Reproductive Disease Outcomes.

Emerging evidence in women supports the notion that pregnancy may reset disease resistance, thereby providing protection against subsequent adverse health outcomes, but this hypothesis has not been adequately explored in domestic dogs. Cranial cruciate ligament (CCL) rupture is a degenerative orthopedic disease that frequently affects pet dogs, and its risk has been associated with disruption of the reproductive hormone axis. Our research team is conducting a lifetime cohort study of purebred Rottweilers in North America that have lived 30% longer than breed-average. Detailed medical and reproductive histories of 33 nulliparous and 32 parous Rottweilers were generated from questionnaires and review of medical records. Interviews with owners of bitches in the nulliparous group served to limit selection bias, confirming that in no instance was the reason for nulliparity based upon the owner's suspicion that a bitch had a heightened risk for CCL rupture. The risk of CCL rupture associated with parity and other exposure variables was estimated using multivariate logistic regression. Overall, CCL rupture was diagnosed in 17 of 65 (26%) bitches. Median age at first litter and CCL rupture were 3.6 and 6.5 years, respectively. Compared to nulliparous, parous bitches had a significant 94% reduction in CCL rupture risk adjusted for duration of ovary exposure, overweight body condition, dietary pattern, habitual physical activity, and work/sport activity [ORadjusted (95% CI) = 0.06 (0.01-0.46); (p = 0.006)]. The observed parity-associated CCL rupture risk reduction remained robust in sensitivity analysis excluding six nulliparous bitches for which decision not to breed was based on diagnosis of hip or elbow dysplasia, conditions which may be genetically linked to CCL rupture [ORadjusted (95% CI) = 0.08 (0.01-0.58); (p = 0.01)]. This work sets the stage for replication studies in other canine populations that should begin to explore the mechanistic basis for parity-associated CCL rupture risk reduction and to pursue other non-reproductive health outcomes in bitches whose incidence or severity may be parity-sensitive.

Key role of NH4+-N in the removal of oxacillin during managed aquifer recharge: Reconsidering the recharge limitation

Frequent occurrence of trace antibiotics in reclaimed water is concerning, which inevitably causes aquifer contamination in the case of managed aquifer recharge (MAR). Global governments have formulated strict reclaimed water standards to ensure the safety of water reuse. Recent studies have found that improved antibiotics removal is intimately associated with high ammonia-oxidizing activity. However, the role of NH4+-N in the removal of residual antibiotics of reclaimed water during MAR remains unknown. NH4+-N removal and the effects of ammonia oxidation on antibiotics biodegradation in the aquifer are the most significant facts for solving the above collision. In this work, the effects of NH4+-N (0, 1 and 5 mg/L) in a model refractory antibiotic (oxacillin (OXA), 100 μg/L) attenuation were deciphered by employing three individual simulated MAR columns, which so called N0, N1 and N5. The results showed that 5 mg/L NH4+-N in influent upregulated the abundance of amo genes by 28.9 %-68.0 % in N5. And the enriched functional genes encoding key degradation enzymes enhanced the OXA removal by 18.7 % and alleviated the oxidative stress caused by antibiotics. Subsequently, antibiotic resistance genes (ARGs), mobile gene elements (MGEs) and human bacterial pathogens (HBPs) abundance were all significantly decreased. Moreover, the intimate association between ammonia-oxidizing microorganisms (AOM) and candidate OXA degraders based on microbial network analysis further supported the significance of AOM on OXA biodegradation. This study provides comprehensive evidence that appropriate amounts of NH4+-N are beneficial in antibiotics and antibiotic resistance risk reduction, providing compelling insights for refine NH4+-N recharge limitation.

Addressing disaster-related internal displacement through participatory initiatives

One of the most severe consequences of disasters on people's lives is displacement. When their homes or places of habitual residence are too badly damaged, and their support networks or socioeconomic resources do not allow them to repair and stay in disaster-affected areas, they are forced to leave their homes temporarily or forever. In disaster risk reduction practice, it is therefore essential to take displacement in consideration and incorporate measures to prevent it, or mitigate it as much as possible.The Internal Displacement Monitoring Centre (IDMC), which has been recognized by the United Nations as a key provider of data on internal displacement at the global level, started documenting promising and successful initiatives that have managed to do so in various countries and disaster contexts. One of the main takeaways from this research is that participatory approaches that involve affected communities tend to be much more impactful and sustainable than others.From drought-affected communities in sub-Saharan Africa to urban settlements repeatedly ravaged by Monsoon floods in Asia, this brief practitioner article presents selected case studies to show how participation can contribute to overcoming some of the most frequent challenges of prevention and response to disaster displacement around the world.

Exploration of Mental Health Elements in Chemsex Behavior: Interventions, Influencing Factors, and Attitudes towards Risk and Harm Reduction in Spain

In recent years, there has been an increase in the practice of chemsex, which is becoming an increasingly serious public health problem. The complex interaction between chemsex and mental health underscores the need to understand the psychological, social, and environmental factors that influence this practice. Methods: A qualitative descriptive phenomenological study was conducted in the community of Madrid, Spain to explore the depth of the chemsex phenomenon through a thematic analysis. Between April and June 2024, interviews were conducted with 15 MSM (gay, bisexual, and other men who have sex with men) who participate in these practices, using purposive and snowball sampling. Results: three main themes were identified, namely, (T1) contextualization of the practice, (T2) factors associated with chemsex, and (T3) strategies and interventions for risk and harm reduction. Conclusion: Chemsex is a phenomenon that combines sexual practices with substance use in complex social environments, presenting significant risks to physical, mental, and sexual health. It is necessary to implement public health interventions to mitigate these risks.

Triple therapy boosts survival in NSCLC patients with brain metastases: a retrospective cohort study of chemotherapy, ICIs, and antiangiogenic agents

BackgroundTreatment of brain metastases (BMs) in non-small cell lung cancer (NSCLC) patients, especially those with non-sensitive genetic mutations, is hindered by limited drug delivery through the blood–brain barrier (BBB). This retrospective study explores the efficacy of systemic treatments during brain metastasis to radiotherapy evaluation window in improving patient survival.MethodsIn this retrospective cohort study, we evaluated 209 NSCLC patients with non-sensitive mutations and BMs, treated between 2016 and 2023 at two tertiary medical centers (Chongqing University Cancer Hospital and Guangxi Medical University Cancer Hospital). The patients were divided into three groups, namely chemotherapy alone (C; n = 95), chemotherapy plus immune checkpoint inhibitors (ICIs) (C + I; n = 62), and chemotherapy with ICIs and antiangiogenic therapy (A) (C + I + A; n = 52). Statistical analyses were performed using R software, version 4.3.3. Categorical variables were compared using Fisher’s exact test, and survival curves were estimated with the Kaplan–Meier method and compared via the log-rank test. Univariate and multivariate Cox regression models were used to assess factors associated with overall survival (OS). Bayesian model averaging (BMA) was employed to address model uncertainty and improve result robustness. Subgroup analyses evaluated treatment-related mortality risk.ResultsFrom an initial cohort of 658 NSCLC patients with BMs, 209 were analyzed with a median age of 59; the majority were male (80.9%) and diagnosed with adenocarcinoma (78.9%). Univariate analysis identified significant variables influencing outcomes, including BMs radiotherapy EQD2, BMs count, local thoracic treatment, BMs radiotherapy field, intracranial response, and systemic treatment post-BMs diagnosis. The C + I + A regimen significantly improved median OS to 23.6 months compared to 11.4 months with C and 16.2 months with C + I, with a hazard ratio (HR) of 0.60 (95% CI: 0.43–0.82; P < 0.0001). The two-year OS rate was highest in the C + I + A group at 38.5%, versus 10.5% in C and 20.4% in C + I (P < 0.001). Cox regression and BMA analyses confirmed the stability of BMA in providing HR estimates, yielding area under the curve (AUC) values of 0.785 for BMA and 0.793 for the Cox model, with no significant difference in predictive performance. Subgroup analysis revealed a 71% mortality risk reduction with C + I + A (HR: 0.29; 95% CI: 0.18–0.47; P < 0.0001), showing consistent benefits regardless of patient sex, BMs count, extracranial metastases presence, and local thoracic treatments. Treatment sequence analysis indicated a median OS of 33.4 months for patients starting with A, though not statistically significant (HR: 0.59; P = 0.36). The overall incidence of radiation-induced brain injury was low at 3.3%, with rates in the C, C + I, and C + I + A groups being 3.2%, 4.8%, and 1.9%, respectively (P = 0.683).ConclusionOur study demonstrates the significant benefit of the C + I + A combination therapy in improving OS and reducing mortality risk in NSCLC patients with non-sensitive gene-mutated BMs. The sequential administration of A followed by ICIs shows a promising synergistic effect with cranial radiotherapy, highlighting the potential for optimized treatment sequencing. These findings emphasize the efficacy of tailored combination therapies in complex oncological care and suggest that our approach could lead to meaningful improvements in clinical outcomes for this challenging patient population.

A Novel Resource-Aware Distributed Cooperative Decision-Making Mechanism for Connected Automated Vehicles

&lt;div&gt;This article proposes a new model for a cooperative and distributed decision-making mechanism for an ad hoc network of automated vehicles (AVs). The goal of the model is to ensure safety and reduce energy consumption. The use of centralized computation resource is not suitable for scalable cooperative applications, so the proposed solution takes advantage of the onboard computing resources of the vehicle in an intelligent transportation system (ITS). This leads to the introduction of a distributed decision-making mechanism for connected AVs. The proposed mechanism utilizes a novel implementation of the resource-aware and distributed–vector evaluated genetic algorithm (RAD-VEGA) in the vehicular ad hoc network of connected AVs as a solver to collaborative decision-making problems. In the first step, a collaborative decision-making problem is formulated for connected AVs as a multi-objective optimization problem (MOOP), with a focus on energy consumption and collision risk reduction as example objectives. RAD-VEGA then cooperatively solves this MOOP, taking into account the availability of AV’s onboard resources and the application layer characteristics of today’s ITS communication tools. The performance of the proposed mechanism is evaluated by solving the ZDT1 test problem and studying pareto-frontier solutions to the true front over time. The scalability of the proposed solution is estimated to be 305 CAVs, considering a communication bandwidth of 6 MB/s. Additionally, cooperative AV planning scenario examples are simulated, and the effectiveness of the proposed mechanism is demonstrated by comparing final and initial solutions after solving the MOOP using RAD-VEGA.&lt;/div&gt;

Social learning and collective action in flood-hazard management in Manitoba, Canada

ABSTRACT Knowledge of social learning about flood hazards in the literature, especially regarding its transformation into collective action for risk reduction, is very limited. This study addresses these gaps by developing an integrated framework that describes how social learning is transformed into collective action – particularly the underlying components and processes – and then applying it to empirical case studies of two communities, (namely, St. Adolphe and St. Agathe) of the Rural Municipality of Ritchot, Manitoba, Canada. Primary data were collected during the summer months of 2022 using participatory research appraisal (PRA) tools (i.e. key informant interviews and oral histories), while secondary data were collected primarily via government and NGO sources. The findings revealed that a) the flood experience and related interactions among community members and local institutions produced unique and distinct types of social learning, and b) that local and multilevel institutions had helped to create learning platforms that facilitated the formation of strategies for collective action related to flood risk reduction. These processes resulted in single – and double-loop learning at the community level. Based on the findings of this work, we recommend that learning and reflection relating to community members’ flood experiences be integrated into disaster risk reduction and management policies.

Metagenomic Profiling of Internationally Sourced Sewage Influents and Effluents Yields Insight into Selecting Targets for Antibiotic Resistance Monitoring.

It has been debated whether wastewater treatment plants (WWTPs) primarily act to attenuate or amplify antibiotic resistance genes (ARGs). However, ARGs are highly diverse with respect to their resistance mechanisms, mobilities, and taxonomic hosts and therefore their behavior in WWTPs should not be expected to be universally conserved. We applied metagenomic sequencing to wastewater influent and effluent samples from 12 international WWTPs to classify the behavior of specific ARGs entering and exiting WWTPs. In total, 1079 different ARGs originating from a variety of bacteria were detected. This included ARGs that could be mapped to assembled scaffolds corresponding to nine human pathogens. While the relative abundance (per 16S rRNA gene) of ARGs decreased during treatment at 11 of the 12 WWTPs sampled and absolute abundance (per mL) decreased at all 12 WWTPs, increases in relative abundance were observed for 40% of the ARGs detected at the 12th WWTP. Also, the relative abundance of mobile genetic elements (MGE) increased during treatment, but the fraction of ARGs known to be transmissible between species decreased, thus demonstrating that increased MGE prevalence may not be generally indicative of an increase in ARGs. A distinct conserved resistome was documented in both influent and effluent across samples, suggesting that well-functioning WWTPs generally attenuate influent antibiotic resistance loads. This work helps inform strategies for wastewater surveillance of antibiotic resistance, highlighting the utility of tracking ARGs as indicators of treatment performance and relative risk reduction.

Pressing Update: Aprocitentan for the Treatment of Hypertension.

This article reviews the published data including the pharmacology, efficacy, and safety of aprocitentan, a novel endothelin receptor antagonist developed to treat hypertension in conjunction with additional agents. A literature search was conducted from drug discovery until May 2024 through PubMed, MEDLINE, and National Institutes of Health Clinical Trials Registry utilizing the following search terms: Tryvio, aprocitentan, hypertension, resistant hypertension, endothelin receptor antagonist, and ACT-132577. All relevant English-language studies, or studies that could be appropriately translated into English, containing the pharmacology, pharmacokinetics, safety, and efficacy of aprocitentan, were selected for review. In the setting of resistant hypertension, aprocitentan has shown significant reductions in blood pressure in both medical office and 24-hour ambulatory settings at 4 weeks with a sustained effect at 40 weeks. Studies evaluating cardiovascular risk reduction have not been conducted at this time. Fluid retention and edema were the most frequent adverse events reported in clinical studies with aprocitentan. As a class, endothelin receptor antagonists may cause fetal harm; aprocitentan should be used with caution to avoid embryo-fetal toxicity. Owing to the existent barriers for the treatment of resistant hypertension, aprocitentan presents itself as an effective option when added to traditional antihypertensives. This single-strength, once-daily regimen may serve as an appealing option to both patients and prescribers. Aprocitentan is a safe and effective medication for the treatment of hypertension when added to other pharmacological therapies.

Integrated assessment for groundwater quality and flood vulnerability in coal mining regions.

Coal mining activities greatly damage water resources, explicitly concerning water quality. The adverse effects of coal mining and potential routes for contaminants to migrate, either through surface water or infiltration, into the groundwater table. Dealing with pollution from coal mining operations is a significant surface water contamination concern. Consequently, surface water resources get contaminated, harming nearby agricultural areas, drinking water sources, and aquatic habitats. Moreover, the percolation process connected with coal mining could alter groundwater quality. Subsurface water sources can get contaminated by toxins generated during mining activities that infiltrate the soil and reach the groundwater table. The aims of this study are the creation of models and the provision of proposals for corrective measures. Twenty-five scenarios were simulated using MODFLOW; according to the percolation percentage and contamination, 35% of the study area, i.e., the middle of the research area, was the most affected. About 38.08% of the area around the mining zones surrounding Margherita is prone to floods. Agricultural areas, known for applying chemical fertilizers, are particularly vulnerable, generating a risk of pollution to surrounding water bodies during flooding. The outputs of this research contribute to identifying and assessing flood-vulnerable regions, enabling focused measures for flood risk reduction, and strengthening water resource management.

Persistent Postoperative Opioid Use: Progressing From Risk Identification to Risk Reduction.

Persistent Postoperative Opioid Use: Progressing From Risk Identification to Risk Reduction.