Risk Index Research Articles

The role of cumulative risk and armed conflict exposure in adolescent psychological symptoms in Turkey.

Exposure to risk factors and adversity may cause immediate, and sometimes prolonged, psychological symptoms in adolescents. Identifying universal and specific risk factors in a particular context and examining their cumulative effects is crucial for understanding the mechanisms underlying psychological symptoms and informing about strategies for intervention. Using concurrent measures, the current study aimed to examine the role of armed conflict experiences and cumulation of other risk factors (e.g., maternal psychological symptoms, socioeconomic indicators) in predicting adolescent psychological symptoms in an underresearched community. The sample included 161 adolescents (54.7% female) aged 11-14 years (M = 12.36, SD = 1.27) and their mothers living in the east of Turkey. The cumulative risk index was calculated by summing the standardized scores of the corresponding factors. Hierarchical multiple regression analyses were conducted to predict internalizing and externalizing symptoms among adolescents by introducing demographic variables (age, gender) in the first step, armed conflict experiences and cumulative risk in the second step, and their interaction in the final step. Results showed that the levels of internalizing and externalizing symptoms were predicted by gender, armed conflict experience and cumulative risk. Being a girl was associated with higher levels of internalizing symptoms and lower levels of externalizing symptoms. Higher levels of internalizing and externalizing symptoms were predicted by exposure to armed and cumulative risk. After controlling for other factors, the interaction of armed conflict experience and cumulative risk significantly predicted externalizing, but not internalizing symptoms. These findings suggested that cumulative risk was a stronger predictor of psychological symptoms, and further amplified the strength of the association between armed conflict experiences and externalizing symptoms. These findings can be used in the formulation of intervention strategies and policies to promote psychological well-being in adolescents living in armed conflict zones under multiple risks.

Abstract LB103: Cell-free DNA methylation as a noninvasive prognostic biomarker in hepatocellular carcinoma

Abstract The current noninvasive prognostic evaluation of hepatocellular carcinoma (HCC) using markers such as imaging features and serum biomarkers like alpha-fetoprotein (AFP) is limited due to low sensitivity. Pathologic tumor features can enhance prognosis beyond imaging and AFP, yet pre-surgical percutaneous biopsies are invasive, not routinely pursued, and may not be representative of the entire tumor. There is a critical unmet need to develop noninvasive blood-based HCC biomarkers to guide therapeutic decisions. Epigenetic changes in circulating cell-free DNA (cfDNA) have shown promise in early cancer diagnosis and prognosis. Therefore, we aim to evaluate the potential of cfDNA methylation as a noninvasive predictor for pre-treatment prognostication in HCC patients. Using Illumina HumanMethylation450 array data of 377 HCC tumors and 50 adjacent normal tissues obtained from The Cancer Genome Atlas (TCGA), we systematically identified 158 HCC-related DNA methylation markers associated with overall survival (OS). Functional analyses of these markers indicated their roles in regulating gene expression and revealed biological pathways associated with HCC patient survival. We predicted an OS risk score utilizing the DNA methylation panel, referred to as “methRisk”, and validated its predictive power using the Reduced Representation Bisulfite Sequencing data of HCC tumor tissue samples from 29 surgically resected patients. To assess the noninvasive prognostic value of these markers, we collected plasma cfDNA samples from an independent validation cohort of 52 HCC patients, and profiled the methylation patterns of these samples using our newly developed cost-effective cfDNA methylome sequencing assay, cfMethyl-Seq. We utilized random survival forest models combined with 10-fold cross-validation to predict the methRisk using the circulating markers. The cfDNA-based methRisk effectively stratifies patients into clinically relevant risk groups and predicts patient survival with high accuracy (3-year AUC = 0.81, 95% CI: 0.68-0.94). Integrating the cfDNA-based methRisk with existing risk indices like the Barcelona clinic liver cancer (BCLC) staging greatly improves the noninvasive prognostic assessments (3-year AUC = 0.91, 95% CI: 0.80-0.99). In summary, these findings indicate that cfDNA methylation is a promising noninvasive prognostic biomarker for HCC, providing a proof-of-concept for its potential clinical utility. Incorporating cfDNA methylation analysis into the existing noninvasive prognostic framework for HCC patients holds great potential for enhancing the effectiveness of current staging systems and optimizing patient selection for curative therapies like liver transplantation. Citation Format: Ran Hu, Benjamin Tran, Shuo Li, Mary L. Stackpole, Weihua Zeng, Yonggang Zhou, Andrew Melehy, Xianghong Zhou, Wenyuan Li, Vatche Agopian. Cell-free DNA methylation as a noninvasive prognostic biomarker in hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB103.

Association of Maternal Height with Mode of Delivery and Perinatal Outcome

Background: Maternal height has been for long a contributory anthropometric factor that can determine the obstetric outcome. There is always a need of a consistent, reliable, and simple risk indicator which is easy to use for preventing unnecessary complications in a country like India where often antenatal care is provided by dais in rural areas. The background of this research aims to ascertain the relationship between maternal height and mode of delivery based on other intrapartum factors which influence labor and consequent maternal and neonatal outcome. Materials and Methods: All primigravidae at term gestation (>37 weeks) with cephalic presentation on admission to labor suite with no other comorbidities were recruited in the study. Their mode of delivery, maternal outcome, along with neonatal outcome was documented. Results: Out of the 680 patients, 104 patients are considered for the short-stature group (15.29%) who were <150 cm in height. Other group comprised patients who were >150 cm in height, a total of 576 (84.71%). There was a higher incidence of induced labor in the study group (66.35%) and emergency lower-segment cesarean section done due to cephalopelvic disproportion (CPD) (60%) was also higher among the short-stature group. The incidence of normal labor (32.99%) was higher in the tall-stature group. Conclusion: Short height (<150 cm) is an independent risk factor for cesarean delivery due to CPD. Statistical correlation was found between mothers of short stature and babies being born with low birth weight. As labor is influenced by multiple factors, it is fair enough to give a trial of labor for short primigravidae except in uncommon circumstances.

Safety Risk Analysis of Urban Viaduct Construction Based on Dynamic Weight

The safety risk analysis of urban elevated bridge construction is an important management method to reduce the loss of safety accidents, and it has significant scientific research value and engineering application value. Therefore, this study proposes a novel analysis method to address these challenges. Firstly, this paper constructs a Work Breakdown Structure (WBS)–Risk Breakdown Structure (RBS) matrix for the safety risk of urban elevated bridge construction in order to achieve a comprehensive and complete identification of the indicator system. Then, a combination of static weights and dynamic weights calculation methods is developed. The static weights are obtained using the analytic hierarchy process, while the dynamic weights are obtained based on the relationship between the dynamic scores of construction safety risk indicators in different construction stages and the preset evaluation levels. Finally, a case study of the Longlingshan elevated bridge project in Wuhan, China, is conducted to validate the feasibility of the proposed model and its potential application in projects. The case analysis for the first time reveals that with the progress of construction, the weights of each indicator continuously change, and the secondary indicators related to environmental factors, such as extreme high-temperature weather, undergo the greatest changes. A comparison of different dynamic weight calculation methods is conducted to highlight the advancement of the proposed model. The research findings of this paper will provide new insights and guidance for improving the construction safety of urban elevated bridge projects.

Impact of latent toxoplasmosis on pneumonic and non-pneumonic COVID-19 patients with estimation of relevant oxidative stress biomarkers.

Susceptibility to COVID-19, the most devastating global pandemic, appears to vary widely across different population groups. Exposure to toxoplasmosis has been proposed as a theory to explain the diversity of these populations. The aim of the present study was to investigate the possible association between latent toxoplasmosis and COVID-19 and its probable correlation with markers of oxidative stress, C-reactive protein (CRP) and ferritin. In a case-control study, blood samples were collected from 91 confirmed (48 non-pneumonic; NP, and 43 pneumonic; P) COVID-19 patients and 45 healthy controls. All participants were tested for IgG anti-Toxoplasma gondii antibodies and oxidative stress markers (nitric oxide [NO], superoxide dismutase [SOD] and reduced glutathione [GSH]), and CRP and serum ferritin levels were determined. In COVID-19 patients, IgG anti-T. gondii antibodies were found in 54% compared to 7% in the control group, with the difference being statistically significant (P ˂ 0.001). However, no significant correlation was found between the severity of COVID-19 and latent T. gondii infection. Latent toxoplasmosis had a strong influence on the risk of COVID-19. NO and SOD levels were significantly increased in COVID-19 patients, while GSH levels decreased significantly in them compared to control subjects (P ˂ 0.001 for both values). CRP and ferritin levels were also significantly elevated in P COVID-19 patients infected with toxoplasmosis. This is the first study to look at the importance of oxidative stress indicators in co-infection between COVID-19 and T. gondii. The high prevalence of latent toxoplasmosis in COVID-19 suggests that T. gondii infection can be considered a strong indicator of the high risk of COVID-19.

Exploring the Potential of Humoral Immune Response to Commensal Bifidobacterium as a Biomarker for Human Health, including Both Malignant and Non-Malignant Diseases: A Perspective on Detection Strategies and Future Directions.

In this comprehensive review, we explore the pivotal role of commensal Bifidobacterium (c-BIF) as potent non-self-antigens through antigenic mimicry, along with exploring the potential of humoral immune responses for both malignant and non-malignant disease. c-BIF, a predominant component of the human gut microbiome encompassing around 90% of the human genome, has emerged as a pivotal player in human biology. Over recent decades, there has been extensive research elucidating the intricate connections between c-BIF and various facets of human health, with particular emphasis on their groundbreaking impact on anti-cancer effects and the management of non-malignant diseases. The multifaceted role of c-BIF is explored, ranging from enhancing anti-tumor immunity to improving the efficacy of anti-cancer and anti-infectious disease strategies, and serving as predictive biomarkers for various diseases. Recent studies highlight not only c-BIF's promotion of anti-tumor immunity but also their role in enhancing the efficacy of immune checkpoint inhibitors. The review emphasizes the promising avenue of manipulating the gut microbiota, particularly c-BIF, for modulating cancer immunotherapy with targeted effects on tumor cells while minimizing harm to normal tissue. In the context of infectious and inflammatory diseases, the crucial role of c-BIFs in the management of COVID-19 symptoms is examined, emphasizing their impact on the severity of and immune response to COVID-19. Furthermore, c-BIF exhibits preventive and therapeutic effects on Human Papillomaviruses (HPV) and shows promise in improving inflammatory bowel diseases. The potential application of c-BIF as a biomarker for immunotherapy is explored, with a specific emphasis on its predictive and prognostic value in cancer. Suggestions are made regarding the use of humoral immune responses to cytotoxic T lymphocyte (CTL) epitope peptides that share motifs with c-BIF, proposing them as potential markers for predicting overall survival in diverse cancer patients. In conclusion, c-BIF emerges as a crucial and multifaceted determinant of human health, across anti-tumor immunity to infectious and inflammatory disease management. The manipulation of c-BIF and gut microbiota presents a promising avenue for advancing therapeutic strategies, particularly in the realm of cancer immunotherapy. Additionally, this review highlights the significance of c-BIF as potent non-self-antigens via antigenic mimicry, emphasizing the importance of robust humoral immune responses against c-BIF for preventing various diseases, including inflammatory conditions. Elevated levels of circulating antibodies against c-BIF in healthy individuals may serve as potential indicators of lower risks for malignant and non-malignant diseases.

Integrated assessment of potentially toxic elements in soil of the Kangdian metallogenic province: A two-point machine learning approach

The accumulation of potentially toxic elements in soil poses significant risks to ecosystems and human well-being due to their inherent toxicity, widespread presence, and persistence. The Kangdian metallogenic province, famous for its iron-copper deposits, faces soil pollution challenges due to various potentially toxic elements. This study explored a comprehensive approach that combinescombines the spatial prediction by the two-point machine learning method and ecological-health risk assessment to quantitatively assess the comprehensive potential ecological risk index (PERI), the total hazard index (THI) and the total carcinogenic risk (TCR). The proportions of copper (Cu), cadmium (Cd), manganese (Mn), lead (Pb), zinc (Zn), and arsenic (As) concentrations exceeding the risk screening values (RSVs) were 15.03%, 5.1%, 3.72%, 1.24%, 1.1%, and 0.13%, respectively, across the 725 collected samples. Spatial prediction revealed elevated levels of As, Cd, Cu, Pb, Zn, mercury (Hg), and Mn near the mining sites. Potentially toxic elements exert a slight impact on soil, some regions exhibit moderate to significant ecological risk, particularly in the southwest. Children face higher non-carcinogenic and carcinogenic health risks compared to adults. Mercury poses the highest ecological risk, while chromium (Cr) poses the greatest health hazard for all populations. Oral ingestion represents the highest non-oncogenic and oncogenic risks in all age groups. Adults faced acceptable non-carcinogenic risks. Children in the southwest region confront higher health risks, both non-carcinogenic and carcinogenic, from mining activities. Urgent measures are vital to mitigate Hg and Cr contamination while promoting handwashing practices is essential to minimize health risks.

GLIM criteria for definition of malnutrition in peritoneal dialysis: a new aspect of nutritional assessment

Background: The aim of our study was to evaluate the effectiveness of Global Leadership Initiative on Malnutrition (GLIM) criteria in assessing malnutrition within the peritoneal dialysis (PD) population.Methods: We conducted a retrospective analysis involving 1057 PD patients across multiple institutions, characterized by an age of 56.1 ± 14.4 years, 464 (43.9%) female, and a median follow-up of 45 (25, 68) months. Malnutrition was diagnosed according to GLIM criteria. The endpoint event was overall mortality. The survival rate and hazard ratio (HR) of death between malnutrition and well-nourished were analyzed in all patients and various subgroups. Receiver operator characteristic curve and integrated discrimination improvement (IDI) were used to distinguish the efficacy of the nutritional tools prediction model.Results: According to the GLIM criteria, the prevalence of malnutrition among the study population was 34.9%. The adjusted HR of overall mortality was 2.91 (2.39 − 3.54, p < 0.001) for malnutrition versus well-nourished. In sensitivity analyses, the HR remained robust except the cardiovascular disease subgroup. The area under the curve of GLIM predicting 5-year mortality was 0.65 (0.62–0.68, p < 0.001). As a complex model for forecast the long-term mortality, the performance of adjusted factors combined with GLIM was poorer than combined malnutrition inflammation score (MIS) (IDI >0, p < 0.001), but fitter than combined geriatric nutritional risk index (GNRI) (IDI <0, p < 0.001).Conclusions: The GLIM criteria provide a viable tool for nutritional assessment in patients with PD, and malnutrition defined according to the GLIM can predict prognosis with an acceptable performance.

Association between self-reported METs and other perioperative cardiorespiratory fitness assessment tools in abdominal surgery—a prospective cross-sectional correlation study

Cardiovascular complications represent a significant proportion of adverse events during the perioperative period, necessitating accurate preoperative risk assessment. This study aimed to investigate the association between well-established risk assessment tools and self-reported preoperative physical performance, quantified by metabolic equivalent (MET) equivalents, in high-risk patients scheduled for elective abdominal surgery. A prospective cross-sectional correlation study was conducted, involving 184 patients admitted to a Gastrointestinal Surgery Department. Various risk assessment tools, including the Revised Cardiac Risk Index (RCRI), Surgical Mortality Probability Model (S-MPM), American University of Beirut (AUB)-HAS2 Cardiovascular Risk Index, and Surgical Risk Calculator (NSQIP-MICA), were utilized to evaluate perioperative risk. Patients self-reported their physical performance using the MET-REPAIR questionnaire. The findings demonstrated weak or negligible correlations between the risk assessment tools and self-reported MET equivalents (Spearman’s ρ = − 0.1 to − 0.3). However, a statistically significant relationship was observed between the ability to ascend two flights of stairs and the risk assessment scores. Good correlations were identified among ASA-PS, S-MPM, NSQIP-MICA, and AUB-HAS2 scores (Spearman’s ρ = 0.3–0.8). Although risk assessment tools exhibited limited correlation with self-reported MET equivalents, simple questions regarding physical fitness, such as the ability to climb stairs, showed better associations. A comprehensive preoperative risk assessment should incorporate both objective and subjective measures to enhance accuracy. Further research with larger cohorts is needed to validate these findings and develop a comprehensive screening tool for high-risk patients undergoing elective abdominal surgery.

Evaluation of potentially toxic elements within the vicinity of an integrated agro industry, Nigeria

The contamination of soils and crops by potentially toxic elements (PTEs) affects the food quality and it is perceived as a huge threat to human health. PTEs (Chromium, Cadmium, Lead, Copper, Nickel and Zinc) were evaluated in soil and crop (Manihot esculenta) around an integrated agro industry in Nsukka in two different seasons using Flame Atomic Absorption Spectrophotometer (FAAS). The concentration status of these PTEs, their ecological risks and human health risk potential associated with their consumption were evaluated. The following PTE mean concentration ranges (ppm) were found in the crop throughout the dry season: Zn (0.0115 - 0.1470), Pb(0.2499 - 0.2601), Cu(0.0215 - 0.1359), Ni(0.1029 - 0.3760), and Cr(0.1560 - 0.4279). During the wet season, the mean concentration ranges (ppm) of PTEs in crop are as follows: chromium (undetectable (ND) - 0.3498), Cd(ND - 0.0598), Pb(ND - 0.1989), Cu(0.0218 - 0.0860), Ni(0.1029 - 0.1116), Zn(0.0090 - 0.0720), and so on. During the dry season, the PTEs in soil are as follows: Cr(0.1180 - 0.3887), Cd(0.0597 - 0.1313), Pb(0.2598 - 0.8330), Cu(0.0333 - 0.1834), Ni(0.2069 - 0.7860), and Ni(0.1160 - 1.7550). The following are the mean concentration ranges (ppm) of PTEs found in soil during the wet season: Zn(0.0119 -0.1013), Pb(0.2981 - 0.3974), Cu(0.0220 - 0.0860), Ni(0.1034 - 0.4449), and Cr(ND - 0.1561). The health risk index for Manihot esculenta, according to its non-carcinogenic human health risk assessment, was as follows: Pb(2.598 for adults and 9.329 for children in the dry season) and Cd(0.342) and chromium (0.449) on farm 1, respectively; Zn, Cu and Ni did not exhibit any health risk values; Cr(1.226 and 1.001 for children in the dry and wet seasons) on farm 2, and other metals did not exhibit any human health risk values; on farm 3, Pb(2.498 for adults and 8.974 for children in the dry season), Cd(0.852 and 0.685 for children in the wet and dry seasons respectively) and (0.239 and 0.192 for adults in the wet and dry seasons respectively), while the other metals did not exhibit any health risk values. According to the carcinogenic health risk evaluation, every metal evaluated had an incremental lifetime cancer risk (ILCR) value between 10−3 and 10−6 for adults and children on every farm that was studied. According to the ecological risk index, pollution load index (PLI), the levels of contamination (Cf), transfer factor (Tf) and degree of contamination (Cd) were all below the corresponding threshold limits. This generally showed that the vicinity of the industry is relatively polluted and there should be a regulatory enforcement on the surrounding environment.

Spatiotemporal variations, health risk assessment, and sources of potentially toxic elements in potamic water of the Anday Stream Basin (Türkiye), Black Sea Region.

Monitoring and protecting freshwater habitats are paramount for a sustainable water management perspective. This study investigated potentially toxic elements (PTEs) in the potamic water of the Anday Stream Basin (Türkiye), Black Sea Region, for a hydrological year (from May 2020 to April 2021). Among PTEs, the highest average values were recorded for sodium (Na) at 41.3mg/L and the lowest for mercury (Hg) at 0.009μg/L and noted under quality guidelines. The stream was found to be at the level of "Low Heavy Metal Pollution" and "Low Contamination" based on the ecotoxicological risk indices. The highest calculated hazard quotient (HQ) value of 1.21E-02 for Cd was noted in the children via the dermal pathway and the lowest of 6.91E-06 for Fe in adults via the ingestion pathway. Results revealed a higher hazard index (HI) value of 1.50E-02 for Cd to children and the lowest of 1.98E-05 for Fe to adults. As a result of applying agricultural risk indices, the stream showed sodium adsorption ratio values less than 6 and was found to be "Excellent" for agriculture. However, the sodium percentage values were less than 20 and found "Permissible" and the magnesium hazard > 50 and noted as "Unsuitable" for agriculture. Statistical analysis revealed that natural factors mainly attributed to PTE contamination of the Anday Stream Basin.

Methylation patterns associated with C-reactive protein in racially and ethnically diverse populations

ABSTRACT Systemic low-grade inflammation is a feature of chronic disease. C-reactive protein (CRP) is a common biomarker of inflammation and used as an indicator of disease risk; however, the role of inflammation in disease is not completely understood. Methylation is an epigenetic modification in the DNA which plays a pivotal role in gene expression. In this study we evaluated differential DNA methylation patterns associated with blood CRP level to elucidate biological pathways and genetic regulatory mechanisms to improve the understanding of chronic inflammation. The racially and ethnically diverse participants in this study were included as 50% White, 41% Black or African American, 7% Hispanic or Latino/a, and 2% Native Hawaiian, Asian American, American Indian, or Alaska Native (total n = 13,433) individuals. We replicated 113 CpG sites from 87 unique loci, of which five were novel (CADM3, NALCN, NLRC5, ZNF792, and cg03282312), across a discovery set of 1,150 CpG sites associated with CRP level (p < 1.2E–7). The downstream pathways affected by DNA methylation included the identification of IFI16 and IRF7 CpG-gene transcript pairs which contributed to the innate immune response gene enrichment pathway along with NLRC5, NOD2, and AIM2. Gene enrichment analysis also identified the nuclear factor-kappaB transcription pathway. Using two-sample Mendelian randomization (MR) we inferred methylation at three CpG sites as causal for CRP levels using both White and Black or African American MR instrument variables. Overall, we identified novel CpG sites and gene transcripts that could be valuable in understanding the specific cellular processes and pathogenic mechanisms involved in inflammation.

On the complex relationship between resilience and hair cortisol levels in adolescence despite parental physical abuse: a fourth wave of resilience research.

To understand the family's role in adolescents' mental health development and the connection to neurodevelopmental disorders related to experienced parental physical abuse, we first explored resilience pathways longitudinally and secondly, connected the identified patterns to adolescents' hair cortisol levels that are rooted in the hypothalamic-pituitary-adrenal axis as the main stress response system and connected brain structure alterations. We analyzed longitudinal online questionnaire data for three consecutive high school years (from seventh to ninth grade) and four survey waves from a representative sample of n = 1609 high school students in Switzerland on violence-resilience pathways. Furthermore, we collected students' hair samples from a subsample of n = 229 at survey wave 4. About 30% of the participating adolescents had been physically abused by their parents. Out of the overall sample, we drew a subsample of adolescents with parental abuse experiences (survey wave 1 n = 509; survey wave 2 n = 506; survey wave 3 n = 561; survey wave 4 n = 560). Despite the odds, about 20-30% of adolescents who have experienced parental physical abuse escaped the family violence cycle and can be called resilient. By applying a person-oriented analytical approach via latent class and transition analysis, we longitudinally identified and compared four distinct violence-resilience patterns. We identified violence resilience as a multidimensional latent construct, which includes hedonic and eudaimonic protective and risk indicators. Because resilience should not solely be operationalized based on the lack of psychopathology, our latent construct included both feeling good (hedonic indicators such as high levels of self-esteem and low levels of depression/anxiety and dissociation) and doing well (eudaimonic indicators such as high levels of self-determination and self-efficacy as well as low levels of aggression toward peers). The present study confirmed that higher cortisol levels significantly relate to the comorbid pattern (internalizing and externalizing symptoms), and further confirmed the presence of lasting alterations in brain structures. In this way, we corroborated the insight that when studying the resilience pathways and trajectories of abused adolescents, biological markers such as hair cortisol significantly enhance and deepen the understanding of the longitudinal mechanisms of psychological markers (e.g., self-determination, self-esteem, self-efficacy) that are commonly applied in questionnaires.

Enrichment Characteristics and Ecological Risk Assessment of Heavy Metals in a Farmland System with High Geochemical Background in the Black Shale Region of Zhejiang, China

Soils derived from black shale enriched in heavy metals pose risks to the environment and human health. Eighty sets of soil–rice samples were collected in northwest Zhejiang, China. The results showed significant enrichment of As, Cd, Pb, and Zn in the studied soil. Sequential extraction data indicated that Cd had relatively high bioavailability. Thirty-four percent of the rice samples exceeded the heavy metal pollution thresholds of national food safety standards. A comprehensive evaluation of soil heavy metals using the potential ecological risk index (RI) revealed low-to-moderate-grade risk. Risk assessment code (RAC) levels decreased as follows: Cd &gt; Ni &gt; Zn &gt; Cr &gt; Cu &gt; Pb &gt; As &gt; Hg. The RAC of Cd was high and very high risk, whereas those of others were no or low risk. Cd was the major contributor to the environmental risk based on the total heavy metal concentration, toxicity, and chemical fractions. The health risk to the local populace was assessed using the method recommended by the USEPA. Local people may experience both non-carcinogenic and carcinogenic health risks, and children face greater health risks than adults. As, Cd, and Pb are the most significant contributors to non-carcinogenic health risks, and Cd is the main carcinogenic risk. In conclusion, special attention should be given to heavy metal pollution in black shale-derived soils.

Evaluating the Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose in Patients with Cancer

The Commercially Insured health Plan Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (CIP-RIOSORD) is an evidence-based tool to determine serious opioid-induced respiratory depression (OIRD) or overdose risk. The CIP-RIOSORD total score determines a risk class and estimates the probability for an OIRD event within the next 6 months. We performed a single-center, retrospective analysis to determine CIP-RIOSORD baseline scores and the most common predictive factors in patients with cancer. Patients (n = 160) were split into new consultations (n = 83, Group 1) versus the first documented follow-up consultation (n = 77, Group 2). Most patients were Caucasian women with metastatic gastrointestinal cancer. CIP-RIOSORD scores for Group 1 patients were 14.8 ± 15.2 (mean ± SD, risk class 4). Group 2 patients had higher CIP-RIOSORD scores (16.6 ± 14.9, risk class 4). For Group 1, the most common CIP-RIOSORD predictive factors were use of a long-acting opioid formulation (n = 24, 29%) and daily oral morphine equivalent (OME) ≥100 (n = 20, 24%); for Group 2, predictive factors were use of an antidepressant (n = 34, 44%) and a long-acting opioid formulation (n = 27, 35%). Based on the CIP-RIOSORD, there is a 15% probability of experiencing a serious OIRD event or overdose within the next 6 months.

Novel collision risk measurement method for multi-ship encounters via velocity obstacles and temporal proximity

The collision risk assessment of multi-ship encounters in busy waters is of great significance for collision risk early warning and the intelligent supervision of maritime traffic. In this paper, a quantitative and visual evaluation method is proposed to describe changes in multi-ship collision risk in the velocity space according to multi-ship collision risk characteristics. Non-linear velocity obstacles and closest point of approach were combined to measure the risk of ship collision from the perspective of both the difficulty and urgency of the encounter. The proposed method was verified via case studies using historical Automatic Identification System data for the East China Sea. The method advantages were confirmed via comparison to the conventional time-varying collision risk and collision risk index methods. The results show that the proposed method can quantify changes in multi-ship collision risk more intuitively and effectively. The proposed method could be further developed as a new risk indicator for maritime traffic safety management and could aid in the navigation safety of manned and unmanned ships.

Postpartum haemorrhage: latest developments in prediction, drug treatment and monitoring

With increasing global rates of postpartum haemorrhage, recent developments aim to ensure that birthing women are safe. This focused review will discuss developments in prediction of postpartum haemorrhage, blood loss measurement, uterotonic use and the thromboelastogram, aiming to improve prevention and treatment of postpartum haemorrhage. The unpredictable nature of postpartum haemorrhage is a significant hurdle, as all women must be considered at risk, imposing a heavy burden on healthcare services. Evidence-based tools have shown promise in improving prediction and management strategies. However, the lack of consensus and agreement on risk factors presents obstacles to developing accurate models. Ongoing research is exploring the development of an individual postpartum haemorrhage risk index, providing personalised care to pregnant women. Accurate blood loss quantification is essential for prompt postpartum haemorrhage diagnosis and appropriate interventions, but challenging in busy clinical settings. Recent advancements in prophylaxis and treatment using medication (uterotonics and tranexamic acid), as well as in monitoring using thromboelastograms, emphasise the need for effective prediction and management strategies. This critical review underscores the need for further research to enhance prediction tools, refine management protocols and address existing challenges to improve maternal outcomes.

Enhanced Insurance Risk Assessment using Discrete Four-Variate Sarmanov Distributions and Generalized Linear Models

This research paper investigated multivariate risk assessment in insurance, focusing on four risks of a singular person and their interdependence. This research examined various risk indicators in non-life insurance which was under-writing for organizations with clients that purchase several non-life insurance policies. The risk indicators are probabilities of frequency claims and correlations of two risk lines. The closed forms of probability mass functions evaluated the probabilities of frequency claims. Three generalized linear models of four-variate Sarmanov distributions were proposed for marginals, incorporating various characteristics of policyholders using explanatory variables. All three models were discrete models that were a combination of Poisson and Gamma distributions. Some properties of four-variate Sarmanov distributions were explicitly shown in closed forms. The dataset spanned a decade and included the exposure of each individual to risk over an extended period. The correlations between the two risk types were evaluated in several statistical ways. The parameters of the three Sarmanov model distributions were estimated using the maximum likelihood method, while the results of the three models were compared with a simpler four-variate negative binomial generalized linear model. The research findings showed that Model 3 was the most accurate of all three models since the AIC and BIC were the lowest. In terms of the correlation, it was found that the risk of claiming auto insurances was related to claiming home insurances. Model 1 could be used for the risk assessment of an insurance company that had customers who held multiple types of insurances in order to predict the risks that may occur in the future. When the insurance company can forecast the risks that may occur in the future, the company will be able to calculate appropriate insurance premiums.

Pregnancy in women with congenital heart disease: New insights into neonatal risk prediction

BackgroundAdvances in managing adult congenital heart disease (ACHD) have led to an increased number of women with CHD reaching childbearing age. This demographic shift underscores the need for improved understanding and prediction of complications during pregnancy in this specific ACHD population. Despite progress in maternal cardiac risk assessment, the prediction of neonatal outcomes for ACHD pregnancies remains underdeveloped. Therefore, the aims of this study are (1) to assess neonatal outcomes in a CHD women population, (2) to identify their predictive factors and (3) to propose a new risk score for predicting neonatal complications. MethodsThis registry study included all women born between 1975 and 1996 diagnosed with ACHD who underwent at least one cardiology consultation for ACHD in Cliniques Universitaires Saint-Luc. A multivariate analysis was performed to identify predictors of neonatal complications and these were incorporated into a new risk index. Its validity was assessed using bootstrap method. This score was then compared with scores adapted from the ZAHARA and CARPREG studies for offspring events prediction. ResultsAnalysis of 491 pregnancies revealed 31.4% of neonatal complications. Four significant predictors of adverse neonatal outcomes were identified: cardiac treatment during pregnancy (OR 14.8, 95%CI [3.4-66]), hypertensive disorders of pregnancy (OR 11.4, 95%CI [3.4-39.0]), smoking during pregnancy (OR 10.6, 95% CI [2.8-40.6]), and pre-pregnancy BMI < 18.5 kg/m² (OR 6.5, 95% CI [2.5-16.5]). The risk model demonstrated an AUC of 0.70 (95% CI [0.65-0.75), which remained stable after bootstrap validation. This model significantly outperformed the scores adapted from ZAHARA and CARPREG data. Based on the regression coefficients, a risk score was subsequently developed comprising 5 risk categories. ConclusionsOne third of ACHD pregnancies are complicated by poor neonatal outcome. These complications are determined by 4 independent factors relating to the cardiac and non-cardiac status of the patients, which have been incorporated into a risk score. Our study is one of the first to propose a predictive risk score of neonatal outcomes in ACHD pregancies, and paves the way for other validation and confirmation studies.

Реформа контрольно-надзорной деятельности и проверки медицинских организаций: мифы и реальность.

The analysis presented in the article convincingly shows that all changes occurring in recent years in the implementation of federal state control of the quality and safety of medical activities are implemented in strict accordance with the program “Reform of control and supervisory activities”, and at the same time these changes do not allow any – weakening in terms of the need to comply with mandatory requirements for this type of control (supervision). The reform of control and supervisory activities does not imply the abolition of all inspections of medical organizations, but the replacement of certain traditional control (supervisory) activities, first of all, this concerns scheduled inspections, with new types of control (supervisory) activities, i. e. for new types of inspections, and for preventive measures. Currently, priority areas of work in the state control (supervision) system are expanding the number and more precise adjustment of risk indicators, including with the aim of increasing the share of unscheduled control (supervisory) activities, i. e. unscheduled inspections conducted based on risk indicators. Medical organizations need to constantly ensure thorough preparation for carrying out preventive measures within the framework of federal state control of the quality and safety of medical activities as measures that are the most important part of the modern system of control (supervisory) activities; control (supervisory) activities without interaction with controlled persons; a wide range of unscheduled control (supervisory) activities, including unscheduled inspections carried out on the basis of risk indicators.