Risk Reduction Research Articles

Summary and Roadmap of Breast Cancer Research in the Veterans Affairs.

Women are the largest growing population of Veterans within the U.S. Department of Veterans Affairs (VA) Health Care System. Among women Veterans, breast cancer is the most common malignancy (30% of all cancers), yet little is known about the unique needs of women Veterans with cancer and how to provide them with high quality care. The VA health care system has initiated multiple system-wide systemic efforts, including launching the Breast and Gynecologic Cancer System of Excellence (BGSOE) to address this knowledge gap. This report summarizes the outcomes of the inaugural 2023 VA Women's Cancer Research Conference, which assembled 37 multidisciplinary clinicians, scientists, the VA and civilian partners with a shared goal of advancing VA breast cancer research. Conference objectives were to build a collective vision for improving: (1) referral patterns for breast cancer treatment and patient-level outcomes and (2) molecular and genetic testing patterns across the breast cancer continuum among women Veterans. The meeting hosted 15 speakers at the Houston VA Medical Center. Future research priorities for women Veterans with cancer were identified from discussions and a post-conference survey. We then administered a 13-question post-conference survey to conference attendees. Respondents ranked the research priorities. The survey results show that the cross-cutting cancer research priorities designed to transform cancer care for women Veterans at the VA fit into 5 broad areas of study, including (1) care quality for treatment, (2) improving treatment, (3) care quality of molecular and genetic testing, (4) risk reduction through risk assessment and germline genetic testing, and (5) establishing strategic partnerships. Our data elucidate areas for further investigation to improve the delivery of cancer care.

Non-diabetes status after diagnosis of impaired glucose tolerance and risk of long-term death and vascular complications: A post hoc analysis of the Da Qing Diabetes Prevention Outcome Study.

The association between years of non-diabetes status after diagnosis of impaired glucose tolerance (IGT) and the risk of long-term death and cardiovascular outcomes needed to be clarified. In this post hoc analysis, we included 540 individuals with IGT who participated in the original Da Qing Diabetes Prevention Study (DQDPS). In the DQDPS, all participants were diagnosed with IGT by a 75 g oral glucose tolerance test and randomized to intervention or control groups with a 6-year lifestyle intervention trial. After the completion of the trial, death, cardiovascular events, and microvascular complications were monitored over a 30-year follow-up. In this post hoc analysis, the Cox analysis assessed the extended risk of these outcomes in individuals who either remained non-diabetes status or progressed to diabetes at the end of 2, 4, and 6 years after diagnosis of IGT. In all participants, the difference in the cumulative incidence rate of the outcomes between the diabetes and non-diabetes group gradually increased over 30 years. Compared with the diabetes group, a significantly lower risk of all-cause death (hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.57 to 0.97, p = 0.026), cardiovascular events (HR: 0.63; 95% CI: 0.49 to 0.82, p < 0.001), and microvascular complications (HR: 0.62; 95% CI: 0.45 to 0.86, p = 0.004) first emerged in individuals who remained non-diabetes at the 4 years visit, whereas the significant risk reduction in cardiovascular death was first observed at the end of 6 years (HR: 0.56; 95% CI: 0.39 to 0.81, p = 0.002) after adjustment for age, sex, smoking status, BMI, systolic blood pressure, blood glucose, total cholesterol, intervention, and medications (including insulin plus oral hypoglycaemics, antihypertensives, and lipid-lowering agents). The results in the original intervention group alone were similar to the whole group. The main limitations of our study are the limited number of participants and the sole ethnicity of the Chinese population. In this study, we observed that maintaining several years of non-diabetes status after IGT diagnosis was associated with a significant reduction in long-term risk of death and vascular complications, and for most of these outcomes, maintaining at least 4 years of non-diabetes status may be needed to achieve a significant risk reduction.

Leading by example: Culture, leadership, and accountability

AbstractProcess safety practices and management systems have been in place for many years and have been widely credited for reductions in major accident risk. However, many organizations today are challenged by inadequate management system performance, resource pressures, and stagnant or declining process safety performance. Systems for managing process safety have not been fully successful in some organizations due to a variety of issues; major, frequent contributors include a lack of senior management commitment and poor safety culture. Senior management commitment and safety culture are inextricably linked, as the quality of an organization's leadership and their commitment will drive or limit the culture. Changes to improve management systems are relatively easy to implement, but extremely difficult to sustain without strong leadership commitment and total line management support. It is not just a case of changing the systems, but also changing the safety culture of the organization. Safety culture tends to be the result of everything that happened or failed to happen and represents the organization's shared values, beliefs, attitudes, and behaviors with respect to safety (occupational safety and process safety). To change the safety culture and sustain the change, leadership must care and explicitly show that they care all of the time. Only then can an organization begin to improve its culture. The first step for any organization is identifying and understanding their existing culture. This paper will present the essential features of a sound safety culture and a methodology for identifying safety culture weaknesses based upon a culture, leadership, and accountability (CLA) review protocol used at different levels of the organization. Other key steps involved in changing and sustaining an improved safety culture will also be addressed.

Clinical outcomes of patients with atrial fibrillation in relation to multimorbidity status changes over time and the impact of ABC pathway compliance: a nationwide cohort study.

Patients with atrial fibrillation (AF) commonly have associated comorbidities. The primary aim was to determine the effect of increasing numbers of comorbidity on clinical outcomes. The secondary aims were (1) the association of comorbidities with oral anticoagulants (OAC) discontinuation, and quality control, (2) the impact of holistic care based on the ABC pathway on clinical outcomes. The primary outcome was the composite of all-cause death, ischemic stroke/systemic embolism, major bleeding, and heart failure. A total of 3405 patients were enrolled; mean age 67.8 ± 11.3 years, 41.8% female. Compared to low comorbidity group [n = 897 (26.3%)], hazard ratios (HR) and 95% confidence intervals (CI) for the composite outcome in the high [n = 929 (27.3%)] and moderate comorbidity [n = 1579 (46.4%)] groups were 5.40 (4.20-6.94) and 2.54 (1.97-3.27), respectively. ABC pathway adherence was associated with reduction of the composite outcome overall (HR 0.63; 0.54-0.74). High comorbidity adversely impacted on OAC use, OAC discontinuation, and quality of warfarin control. If quality of anticoagulation control was included as part of the ABC pathway adherence, the reduction in composite outcome risk was greater (HR 0.46; 0.36-0.58). During 3-year follow-up, 33.9% changed from low- to the moderate-high comorbidity groups and 22.3% changed from moderate- to the high comorbidity group. In conclusion, comorbidity burden in AF patients is an important determinant of clinical outcomes, and changed over time. OAC use, OAC discontinuation, and quality of OAC control were impacted by comorbidity burden. ABC pathway adherence was associated with a reduced risk of adverse clinical outcomes.

Clinical outcomes of patients with atrial fibrillation in relation to multimorbidity status changes over time and the impact of ABC pathway compliance: a nationwide cohort study.

Patients with atrial fibrillation (AF) commonly have associated comorbidities. The primary aim was to determine the effect of increasing numbers of comorbidity on clinical outcomes. The secondary aims were (1) the association of comorbidities with oral anticoagulants (OAC) discontinuation, and quality control, (2) the impact of holistic care based on the ABC pathway on clinical outcomes. The primary outcome was the composite of all-cause death, ischemic stroke/systemic embolism, major bleeding, and heart failure. A total of 3405 patients were enrolled; mean age 67.8 ± 11.3 years, 41.8% female. Compared to low comorbidity group [n = 897 (26.3%)], hazard ratios (HR) and 95% confidence intervals (CI) for the composite outcome in the high [n = 929 (27.3%)] and moderate comorbidity [n = 1579 (46.4%)] groups were 5.40 (4.20-6.94) and 2.54 (1.97-3.27), respectively. ABC pathway adherence was associated with reduction of the composite outcome overall (HR 0.63; 0.54-0.74). High comorbidity adversely impacted on OAC use, OAC discontinuation, and quality of warfarin control. If quality of anticoagulation control was included as part of the ABC pathway adherence, the reduction in composite outcome risk was greater (HR 0.46; 0.36-0.58). During 3-year follow-up, 33.9% changed from low- to the moderate-high comorbidity groups and 22.3% changed from moderate- to the high comorbidity group. In conclusion, comorbidity burden in AF patients is an important determinant of clinical outcomes, and changed over time. OAC use, OAC discontinuation, and quality of OAC control were impacted by comorbidity burden. ABC pathway adherence was associated with a reduced risk of adverse clinical outcomes.

“Effing Awful!”: developing audio representation as a medium for conveying people’s experiences of flooded homes

PurposeDisaster research is often geared towards logocentrism and has relatively few outputs that explore alternative forms of representation, particularly those using an artistic medium. This paper explores how the creative use of audio representation can enhance understanding of flooding experiences, challenging the predominant text-based approach within qualitative study.Design/methodology/approachDuring a series of visits to people who had been flooded in 2019 in the UK, interviews and ambient sounds were recorded, analysed and then intertwined with musical elements composed by the lead author. The result is a phonographic representation of the synthesised data. The process explores a tripartite, creative, sonic approach that comingles thematic spoken excerpts with local sounds and musical compositions.FindingsThis article presents three sonic vignettes that illustrate the use of audio as a medium for academic research outputs. It contributes to the current consensus that the interpretation, representation and dissemination of research findings should be broadened beyond the dominance of the written word to align with the ethos of the Disaster Studies Manifesto.Research limitations/implicationsThe research contributes to disaster scholarship by developing a transdisciplinary approach to explore people’s experiences. By retaining the participants’ voices at its core, it makes use of in-depth, rich data to illustrate individuality, rather than aiming to generalise.Originality/valueVery little disaster research has focussed on pushing the boundaries of investigation by using the arts as a lens for both the researcher and their audience. Such work may connect with a wider range of people compared to a text-based “traditional” academic output. It can offer new opportunities for practical uses within Disaster Risk Reduction, for example as a communicative and educational tool.Contribution to impactThis paper contributes to understanding the impact of developing audio representation as a medium for conveying people’s experiences of flooded homes.

Atherosclerosis and HIV: Exploring Cardiovascular Risks and Management.

The advent of antiretroviral therapy has markedly improved the life expectancy of individuals with HIV, leading to a shift in clinical focus from managing opportunistic infections to addressing chronic conditions, such as atherosclerotic cardiovascular disease (ASCVD). Emerging evidence highlights an elevated risk of ASCVD among people living with HIV, characterized by a higher incidence of acute myocardial infarction, ischemic stroke, and heart failure compared with the general population. This review examines the epidemiology, pathophysiology, and management of ASCVD in the context of HIV. It explores the interplay between HIV infection, antiretroviral therapy, and traditional cardiovascular risk factors, underscoring the need for comprehensive cardiovascular risk reduction strategies tailored to people living with HIV. Through synthesizing data from clinical trials, observational studies, and basic research, the review aims to enhance understanding of HIV-associated ASCVD and inform healthcare practices to improve the longevity and quality of life for this patient population.

University student flood risk perceptions and flood probability knowledge in Greater Sydney

AbstractWhile flood risk perception has been studied extensively in general populations, there remains a dearth of focus on youth perspectives – a key demographic to mobilising knowledge to achieve disaster risk reduction targets. This study aimed to evaluate university students’ perceptions of flood risk and their understanding of common flood probabilities in the Greater Sydney region of Australia. We surveyed 262 university students to better understand how flood preparedness, knowledge, and experience predict flood risk perceptions. Using ordinal logistic regression, we identified that students with past flood experience and women were more likely to have higher flood risk perceptions. In contrast, students with higher flood preparedness were more likely to have lower flood risk perceptions. Age, degree level (e.g. bachelor’s, master’s), place of residence, and flood knowledge were inconclusive predictors of risk perception. We also assessed differences in how students rated the likelihood of three equivalent flood probabilities presented in different ways: (1) a 1-in-100 year flood; (2) a flood with a 1% of happening in a given year; and (3) a flood with a 55% chance in an 80-year lifetime. Using Friedman and Kruskal-Wallis tests, we compared differences within student responses and across different risk perception groups. We found that students perceived equivalent flood probabilities stated over longer periods of time to be more likely to occur. This study contributes to understanding student perceptions of flood risk, presenting recommendations on how governments and higher educational institutions can improve building students’ knowledge of flood hazards.

Using tele-paramedicine to conduct in-home fall risk reduction after emergency department discharge: Preliminary data.

Older adults discharged from our emergency department (ED) do not receive comprehensive fall risk evaluations. We conducted a quality improvement project using an existing Community Tele-Paramedicine (CTP) program to perform in-home fall risk assessment and mitigation after ED discharge. High falls-risk patients, as defined by STEADI score >4, were referred for a CTP home visit by community paramedics supervised virtually by emergency physicians. Home hazards assessment, Timed Up and Go test (TUG), medication reconciliation, and psychosocial evaluation were used to develop fall risk mitigation plans. Outcomes assessed at 30 days post ED-discharge included: completed CTP visits, falls, ED revisits, hospital admissions, and referrals. Between November 2022 and June 2023, 104 (65%) patients were discharged and referred to CTP. The mean age of enrolled patients was 80 years, 66% were female, 63% White, 79% on Medicare or Medicaid, most lived with a family member (50%) or alone (38%). Sixty-one (59%) patients received an initial CTP visit, 48 (79%) a follow-up visit, and 12 (11%) declined a visit. Abnormal TUG tests (74%), home hazards (67%), high-risk medications (36%), or need for outpatient follow-up (49%) or additional home services (41%) were frequently identified. At 30 days, only one of the CTP patients reported a fall, one patient had a fall-related ED visit, and one patient was admitted secondary to a fall. A quality improvement initiative using CTP to perform fall risk reduction after ED discharge identified areas of risk mitigation in the home where most falls take place. Further controlled studies are needed to assess the impact of CTP on clinical outcomes important to patients and health systems.

Association between grip strength and walking pace with incidence of degenerative cervical myelopathy: a UK biobank observational study.

This study investigates the association between handgrip strength, walking pace, and the incidence of degenerative cervical myelopathy (DCM) using the UK Biobank dataset. We analyzed data from 364,716 UK Biobank participants without prior neurological conditions. Handgrip strength was measured with a dynamometer, and walking pace was self-reported. Cox proportional hazards models assessed hazard ratios (HRs) and 95% confidence intervals (CIs) for DCM development. The cohort, with an average age of 56.2 years (SD, 8.1) and 47.4% male, was followed for a median of 12.6 years. During this period, 3,993 participants (1.1%) developed DCM. A significant inverse correlation was found between handgrip strength and DCM incidence (P for trend < 0.001), with decreasing HRs for DCM across quartiles of increasing grip strength: HRs were 0.70 (95% CI: 0.64-0.76), 0.62 (95% CI: 0.57-0.68), and 0.59 (95% CI: 0.54-0.66) for the second, third, and fourth quartiles, respectively. Participants with average or brisk walking paces had a lower DCM risk (HR, 0.55; 95% CI: 0.50-0.61 and HR, 0.48; 95% CI: 0.43-0.54) compared to slow walkers. The greatest risk reduction was in those with both higher handgrip strength and faster pace (HR, 0.39; 95% CI: 0.34-0.44). Handgrip strength and walking pace are inversely associated with DCM incidence, suggesting their potential as cost-effective screening tools for identifying individuals at risk for DCM.

Clinical Outcomes of Rural Patients with Diabetes Treated by ECHO-Trained Providers Versus an Academic Medical Center.

Despite clinical practice guidelines prioritizing cardiorenal risk reduction, national trends in diabetes outcomes, particularly in rural communities, do not mirror the benefits seen in clinical trials with emerging therapeutics and technologies. Project ECHO supports implementation of guidelines in under-resourced areas through virtual communities of practice, sharing of best practices, and case-based learning. We hypothesized that diabetes outcomes of patients treated by ECHO-trained primary care providers (PCPs) would be similar to those of patients treated by specialists at an academic medical center. Specialists from the University of New Mexico (UNM) launched a weekly diabetes ECHO program to mentor dyads consisting of a PCP and community health worker at ten rural clinics. We compared cardiorenal risk factor changes in patients with diabetes treated by ECHO-trained dyads to patients treated by specialists at the UNM Diabetes Comprehensive Care Center (DCCC). Eligible participants included adults with type 1 diabetes, type 2 diabetes on insulin, or diabetes of either type with A1c > 9%. The primary outcome was change from baseline in A1c in the ECHO and DCCC cohorts. Secondary outcomes included changes in body mass index (BMI), blood pressure, cholesterol, and urine albumin to creatinine ratio (UACR). Compared to the DCCC cohort (n = 151), patients in the ECHO cohort (n = 856) experienced greater A1c reduction (-1.2% vs -0.6%; p = 0.02 for difference in difference). BMI decreased in the Endo ECHO cohort and increased in the DCCC cohort (-0.2 vs. +1.3 kg/m2; p = 0.003 for difference in difference). Diastolic blood pressure declined in the Endo ECHO cohort only. Improvements of similar magnitude were observed in low-density lipoprotein cholesterol in both groups. UACR remained stable in both groups. ECHO may be a suitable intervention for improving diabetes outcomes in rural, under-resourced communities with limited access to a specialist.

Direct-Acting Oral Anticoagulants and Antiseizure Medications for Atrial Fibrillation and Epilepsy and Risk of Thromboembolic Events.

Direct-acting oral anticoagulants (DOACs) are commonly prescribed with antiseizure medications (ASMs) due to concurrency of and the association between atrial fibrillation (AF) and epilepsy. However, enzyme-inducing (EI) ASMs may reduce absorption and accelerate metabolism of DOACs, potentially lowering DOAC levels and elevating thromboembolism risk. To assess the rates of thromboembolic and major bleeding events in adults with AF and epilepsy dispensed DOACs and EI ASMs vs DOACs with non-EI ASMs. This active-comparator, new-user cohort study included US health care data from the Clinformatics Data Mart database from October 2010 to September 2021 for a nationally representative population of adults with AF and epilepsy. Evaluations included episodes of contiguous coadministration of DOACs for AF with EI ASMs (exposed) or non-EI ASMs (referent) for epilepsy. Thromboembolic events (primary outcome) and major bleeding events (secondary outcome) were identified based on a series of validated, diagnosis-based coding algorithms. Data-adaptive, high-dimensional propensity score matching was used to control for observed confounders and proxies for unobserved confounders. Adjusted hazard ratios (AHRs) were estimated using Cox proportional hazards regression models with robust variance estimators to account for clustering within matched pairs. This study included 14 078 episodes (median age, 74 [IQR, 67-81]; 52.4% female) and 14 158 episodes (median age, 74 [IQR, 67-81]; 52.4% female) of incident DOAC and ASM use that met eligibility criteria for assessment of thromboembolic and major bleeding outcomes, respectively. Incidence was 88.5 per 1000 person-years for thromboembolic events and 68.3 per 1000 person-years for bleeding events. Compared with use of non-EI ASMs, use of EI ASMs with DOACs was not associated with a difference in risk of thromboembolic events (AHR, 1.10; 95% CI, 0.82-1.46) but was associated with a reduction in risk of major bleeding events (AHR, 0.63; 95% CI, 0.44-0.89). In this cohort study, EI ASMs were not associated with alteration in DOAC efficacy. Further research is needed on the reduction in bleeding risk associated with EI ASMs, as this may suggest that pharmacokinetic interactions are associated with lowering DOAC levels without negating therapeutic effects.

Landslide and flood disaster: Causes and its responses

This paper attempts to overview the practices of human responses and adaptation strategies to natural hazards, particularly from landslides and floods. Moreover, it also aims to find out the appropriate response measures for developing countries like Nepal. This paper is prepared by the systematic reviews of related articles published in different peer-reviewed and scientific journals. Initially, the relevant papers were selected using keywords like hazards, disasters and human response to natural disasters. Then, the 64 papers were chosen and this paper was developed. There are different factors to determine the occurrence of disasters on the earth such as geology, topography, climate, topographic aspects, slope and biological activities. Processes and causes contributing to landslides can be put into three categories such as geological/morphological, physical, and human/anthropogenic causes. This study will be very helpful to entire developing countries in general and Nepal in particular as well as agencies and organizations involved in disaster risk reduction and disaster management. The impact of disasters is exacerbated by the lack of appropriate measures for mitigating their impacts. Hence, it will be the foundation for disaster risk reduction in Nepal.

Demographics and Clinical Decision Making in Patients with Germline Moderate Penetrance Non-BRCA Mutations in Breast Cancer Related Genes.

Management of pathogenic variants in high penetrance genes related to breast cancer (BC), such as BRCA1 and BRCA2, are well established. However, moderate penetrance mutations are understudied. We aim to compare risk reduction decision-making patterns in patients with a moderate penetrance BC-related genetic mutations, without a prior BC diagnosis. Female patients aged ≥ 18 years who tested positive for a BRCA1/2, high penetrance, or moderate penetrance mutation related to BC between 1996 and 2023 without a concurrent or prior BC diagnosis were retrospectively identified from a single academic center's database. Groups were stratified by mutation type: BRCA1/2 mutations (BRCA1, BRCA2), high penetrance mutations (HPM; CDH1, PALB2, PTEN, STK11, TP53), or moderate penetrance mutations (MPM; ATM, BARD1, CHEK2, NF1, RAD51C, RAD51D). Demographics and clinical outcomes were compared. A total of 528 patients met the inclusion criteria, with 66% (n = 350) having a BRCA1/2 mutation, 8% (n = 44) having HPM, and 25% (n = 134) having MPM; the median follow-up was 56.0 months. In our cohort, 20.9% of patients with BRCA mutations, 9.1% with HPM, and 7.5% with MPM chose to undergo risk-reducing mastectomies (RRM). Within the moderate penetrance cohort, patients who chose to undergo RRM were younger at the time of genetic testing (39.4 vs. 47.5 years, p = 0.03) and had a higher number of family members with BC (2 vs. 1, p = 0.05). Our findings provide insights into the demographic characteristics and family history of patients with moderate penetrance mutations and those who pursue risk-reducing surgery.

When Does Primary Prevention Encroach on Secondary Prevention?

The risk of incident atherosclerotic cardiovascular disease (ASCVD) in primary prevention is typically lower than in secondary prevention. However, there is a spectrum of risk among individuals undergoing primary prevention with the risk in some individuals approaching those of secondary prevention. We review the clinical conditions wherein the risk in primary prevention is similar to that observed in secondary prevention. Among individuals without established ASCVD, coronary artery calcium (CAC) scores ≥ 300 AU are associated with ASCVD event rates similar to secondary prevention populations. CAC score ≥ 1,000 AU are associated with an ASCVD risk seen in very high-risk secondary prevention populations. Interpretation of these observations must however consider differences in the risk reduction strategies. Current guidelines dichotomize ASCVD prevention into primary and secondary prevention, but certain primary prevention patients have an ASCVD risk equivalent to that of secondary prevention populations. Identifying higher risk primary prevention populations will allow for better risk mitigation strategies.

Epidemic modelling suggests that in specific circumstances masks may become more effective when fewer contacts wear them

BackgroundThe effectiveness of non-pharmaceutical interventions to control the spread of SARS-CoV-2 depends on many contextual factors, including adherence. Conventional wisdom holds that the effectiveness of protective behaviours, such as wearing masks, increases with the number of people who adopt them. Here we show in a simulation study that this is not always true.MethodsWe use a parsimonious network model based on the well-established empirical facts that adherence to such interventions wanes over time and that individuals tend to align their adoption strategies with their close social ties (homophily).ResultsWhen these assumptions are combined, a broad dynamic regime emerges in which the individual-level reduction in infection risk for those adopting protective behaviour increases as adherence to protective behaviour decreases. For instance, at 10 % coverage, we find that adopters face nearly a 30 % lower infection risk than at 60 % coverage. Based on surgical mask effectiveness estimates, the relative risk reduction for masked individuals ranges from 5 % to 15 %, or a factor of three. This small coverage effect occurs when the outbreak is over before the pathogen is able to invade small but closely knit groups of individuals who protect themselves.ConclusionsOur results confirm that lower coverage reduces protection at the population level while contradicting the common belief that masking becomes ineffective at the individual level as more people drop their masks.

On fire risk reduction when operating individual households

The article aims to elaborate a technical means for reducing fire occurrence in internal electrical networks of individual households. General scientific methods of numerical analysis, electric circuit theory, and prediction theory were used. It was determined that the operating mode of the electric network under study is characterized by a significant unbalanced power consumption due to the asymmetry and non-sinusoidality of phase currents caused by the occurrence of additional symmetrical components of forward, reverse, and zero sequences. Additional heat losses increase significantly and lead to overheating of the neutral conductor, thus intensifying fire risks. On the basis of measurements and the authors’ software, a simulation modeling of integration of the developed balancing device into the investigated network was carried out. The conducted analysis found that the developed device can reduce additional heat losses and fire risks by over 90%. Using statistical methods of forecasting, regression analysis in particular, a preventive long-term assessment of the level of additional power losses was conducted. Autoregressive equations for predicting the parameter of additional power losses at a certain probability level were derived. MATLAB graphic editor technologies and Excel software were used to visualize changes in the studied indicators. The results can be used by construction companies when designing the internal electrical network of individual households, as well as for researchers developing approaches to reducing additional losses of electrical energy.

Fire protection priorities in the oak forests of Iran with an emphasis on vertebrate habitat preservation

This study examines the impact of fire incidents on wildlife and habitats in the western oak forests of Iran (Zagros region). These forests are globally recognized for their exceptional biodiversity but are frequently threatened by wildfires. To achieve this, the study uses the space–time scan statistics permutation (STSSP) model to identify areas with a higher frequency of fires. The study also analyzes the effects of fires on the Zagros forests from 2000 to 2021 using remote-sensing MODIS data. Also, to understand the elements at risk of fire, burned areas were assessed based on the richness of vertebrate species, determined by the distribution of 88 vertebrate species. The results show that the annual fire rate in the Zagros forests is 76.2 (fire occurrences per year), calculated using the Poisson distribution. Findings show the highest fire rates are found in the northwest and a part of the south of the Zagros. The northwest of the Zagros also has the largest number of single fires and clusters, indicating a wide spatial distribution of fire in these regions. On the other side, it was unexpectedly found that these regions have the richest number of species and higher habitat value. The results demonstrate a significant correlation between the value of the habitat and the extent of burned areas (p < 0.05). The study also reveals that the greatest impact of fires is on small vertebrates. The overlap of frequent fire spots with the richest regions of Zagros oak forests in terms of vertebrate diversity emphasizes the need for strategic forest risk reduction planning, especially in these priority zones.

Climate change-induced landslide vulnerability: Empirical evidence from Shimla district, Himachal Pradesh, India

Landslides as dynamic geological hazard have caused socio-economic and environmental vulnerabilities at various scales. Thus, landslide vulnerability assessment is essential for understanding the implications for society and the environment. The present study attempts to examine landslide vulnerability in Shimla District, Himachal Pradesh, India. It constructed a composite landslide vulnerability index (CLVI) by integrating 57 indicators of 7 different domains (social vulnerability index, physical vulnerability index, economic vulnerability index, climate change and environmental vulnerability index, early warning system index, emergency response system, and adaptation strategies index) at the household level. CLVI serves as a most effective tool for the quantification of complex domains of disaster vulnerability and identification of thematic areas for disaster risk reduction. The data on various indicators were derived through a field survey of 450 households from 30 villages. The relationship between CLVI and its domains was ascertained using multiple linear regression. The CLVI analysis revealed that nine villages were highly vulnerable to landslides, while six villages experienced moderate vulnerability. Climate change and environmental vulnerability, physical fragility, and low adaptation strategies induced high to moderate vulnerability. The regression analysis showed that the degree of vulnerability was mostly influenced by the physical domain, followed by the economic and environmental domains. Effective policy, institutional setups, provision of landslide-resistant buildings, and livelihood diversification may enhance adaptive capacity among the communities. Thus, CLVI has not only helped in identifying thematic areas for reducing vulnerability but has also been instrumental in recognizing priority areas.

User Acceptability Testing of Mobile Application in Indian Local Languages for Cardiovascular Risk Stratification and Modification among Patients with Type 2 Diabetes

Introduction: Cardiovascular disease is the leading cause of death in patients with type 2 diabetes. Digital health tools like mobile application have fast emerged as a technology capable of closing the gap in cardiovascular disease self- management and revolutionizing the way healthcare is traditionally delivered. One of the causes for low app engagement of Apps in India is perhaps that few of these apps are available in local languages. The goal is to reach as many diabetic patients as possible while avoiding linguistic hurdles.  Methodology: The ‘healthy heart’ mobile app was developed and translated into Hindi and Marathi languages for CVD risk stratification and risk management among Type 2 diabetes mellitus patients. User acceptability testing of the app on its design, presentation, content, and user- friendliness was undertaken. The feedback on utility of the app for CVD risk stratification and modification was assessed. A total 100 multilingual app users profile were noted for CVD Risk Status, Life Style Practices and CVD Risk Factors.  Results: The Healthy Heart multi-lingual app was successfully developed for CVD risk classification and risk management among Type 2 diabetes mellitus patients. The patients had the choice to select the desired language of the app from the versions available in English, Hindi and Marathi. The Mobile App's Home Screen displayed the CVD risk score and category, a health tracker to monitor compliance with WHO recommendations regarding diet, physical activity, addictions, medication adherence, diabetic, and CVD Risk Profile. The majority of respondents rated the App's design, presentation, content, and user- friendliness favorably and emphasized the utility of App for CVD self-management and risk reduction. Characteristics of Type 2 Diabetic patients demonstrated poor compliance for total fruits and vegetable intake, total fat intake and total salt intake, physical activity Guidelines apart from poor control for blood pressure, glycemic control and lipid targets.  Conclusion: The multilingual mobile App for CVD risk stratification, self-management and CVD risk reduction among diabetic patients was successfully developed in Hindi and Marathi language. User acceptability testing results were found to be favorable for the mobile app.