Risk Index Research Articles

Plasma proteomics for risk prediction of Alzheimer's disease in the general population.

We aimed to develop and validate a protein risk score for predicting Alzheimer's disease (AD) and compare its performance with a validated clinical risk model (Cognitive Health and Dementia Risk Index for AD [CogDrisk-AD]) and apolipoprotein E (APOE) genotypes. The development cohort, consisting of 35,547 participants from England in the UK Biobank, was randomly divided into a 7:3 training-testing ratio. The validation cohort included 4667 participants from Scotland and Wales in the UK Biobank. In the training set, an AD protein risk score was constructed using 31 proteins out of 2911 proteins. In the testing set, the AD protein risk score had a C-index of 0.867 (95% CI, 0.828, 0.906) for AD prediction, followed by CogDrisk-AD risk factors (C-index, 0.856; 95% CI, 0.823, 0.889), and APOE genotypes (C-index, 0.705; 95% CI, 0.660, 0.750). Adding the AD protein risk score to CogDrisk-AD risk factors (C-index increase, 0.050; 95% CI, 0.008, 0.093) significantly improved the predictive performance for AD. However, adding CogDrisk-AD risk factors (C-index increase, 0.040; 95% CI, -0.007, 0.086) or APOE genotypes (C-index increase, 0.000; 95% CI, -0.054, 0.055) to the AD protein risk score did not significantly improve the predictive performance for AD. The top 10 proteins with the highest coefficients in the AD protein risk score contributed most of the predictive power for AD risk. These results were verified in the external validation cohort. EGFR, GFAP, and CHGA were identified as key proteins within the protein network. Our result suggests that the AD protein risk score demonstrated a good predictive performance for AD risk.

FP2.2 - Does preoperative nutritional assessment correlate with postoperative outcomes of patients undergoing surgery due to colorectal cancer? A bicenter prospective observational study

Abstract Aims Preoperative nutritional status has been investigated as a risk factor for postoperative complications in patients undergoing surgery due to colorectal surgery. The aim of the present study was to investigate the predictive role of preoperative nutritional assessment in terms of morbidity and mortality in such patients. Methods Patients undergoing surgery due to colorectal cancer from March 2022 until March 2023 at two university surgical departments were included in the present study. Patients’ demographics and postoperative parameters, such as complications’ severity according to Clavien-Dindo classification and mortality, along with malignancy stage were reported. Preoperative nutritional assessment was conducted according to the Patient-Generated Subjective Global Assessment (PG-SGA) tool and the Geriatric Nutritional Risk Index (GNRI) tool. The present study was registered in ClinicalTrials.gov (NCT05795374). Results The present study included 159 patients with a mean age of 69 ± 12 years old. Severe malnutrition according to the PG-SGA tool was associated with advanced disease stage (66% vs 59%, p=0.006). In addition, the high risk of malnutrition according to the GNRI tool was correlated to major (Clavien-Dindo≥3) postoperative complications (19% vs 15%, p=0.026) and increased 30-day mortality (34% vs 9%, p=0.026). Conclusions Postoperative morbidity and mortality of patients undergoing surgery due to colorectal cancer seem to be associated with preoperative nutritional stratification, especially with the high malnutrition risk.

WP7.16 - Usefulness of Cross-Sectional Imaging and Biochemical Markers in Diagnosing Necrotising Soft Tissue Infections

Abstract Introduction Diagnosis of Necrotising Soft Tissue Infections (NSTI) remains clinical, however pre-operative investigations and radiology may be useful for cases of diagnostic uncertainty or pre-operative planning. Aims To identify if cross-sectional imaging is useful in the diagnosis of NSTI's. To identify if Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score supports the diagnosis of NSTI’s. Methods Retrospective data collection of all relevant clinical data for all histologically confirmed NSTI’s in a single centre from 2012 to 2022 inclusive. Results 73 total cases of NSTI were confirmed. 27 patients underwent CT imaging as a direct result of their presenting complaint. CT was performed for the following reasons,Patient NoReason for CT10Clinically confirmed - CT to assess extent of involvement4Clinically suspicious – CT to confirm diagnosis5No clinical diagnosis – CT features of NSTI8Incidental findings – CT for alternative diagnosis Only 3 patients had a prospective documented LRINEC score. As such retrospective LRINEC scores were calculated for each case in this cohort. Average scores were 7.71 (Range 4-13), which is above the reported threshold value of 6. Conclusion CT scans are useful in clinically confirmed or suspected NSTIs for further assessment, however with regards to diagnosing NSTIs, clinical diagnosis remains the preferred modality. There remains limited data to suggest that a CT scan should be gold standard in identifying and confirming NSTI’s. LRINEC scoring however should be utilized for all suspected NSTI’s, it remains poorly utilized but would provide significant value and diagnostic guidance when above threshold values.

Virulence gene polymorphisms in Shandong Helicobacter pylori strains and their relevance to gastric cancer.

Helicobacter pylori (H. pylori) virulence factors, particularly the cagA and vacA genotypes, play important roles in the pathogenic process of gastrointestinal disease. The cagA and vacA genotypes of 87 H. pylori strains were determined by PCR and sequencing. The EPIYA and CM motif patterns were analyzed and related to clinical outcomes. We examined the associations between the virulence genes of H. pylori and gastrointestinal diseases in Shandong, and the results were analyzed via the chi-square test and logistic regression model. Overall, 76 (87.36%) of the strains carried the East Asian-type CagA, with the ABD types being the most prevalent (90.79%). However, no significant differences were observed among the different clinical outcomes. The analysis of CagA sequence types revealed 8 distinct types, encompassing 250 EPIYA motifs, including 4 types of EPIYA or EPIYA-like sequences. Additionally, 28 CM motifs were identified, with the most prevalent patterns being E (66.67%), D (16.09%), and W-W (5.75%). Notably, a significant association was discovered between strains with GC and the CM motif pattern D (P < 0.01). With respect to the vacA genotypes, the strains were identified as s1, s2, m1, m2, i1, i2, d1, d2, c1, and c2 in 87 (100%), 0 (0), 26 (29.89%), 61 (70.11%), 73 (83.91%), 14 (16.09%), 76 (87.36%), 11 (12.64%), 18 (20.69%), and 69 (79.31%), respectively. Specifically, the vacA m1 and c1 genotypes presented a significantly greater prevalence in strains from GC compared to CG (P < 0.05). Following adjustment for age and sex, the vacA c1 genotype demonstrated a notable association with GC (OR = 5.174; 95% CI, 1.402-20.810; P = 0.012). This association was both independent of and more pronounced than the correlations between vacA m1 and GC. CagA proteins possessing CM motif pattern D were more frequently observed in patients with GC (P < 0.01), implying a potentially higher virulence of CM motif pattern D than the other CM motif patterns. Moreover, a strong positive association was identified between the vacA c1 genotype and GC, indicating that the vacA c1 genotype is a robust risk indicator for GC among male patients aged ≥55 years in Shandong.

MiRNA-132/212 encapsulated by adipose tissue-derived exosomes worsen atherosclerosis progression

BackgroundVisceral adipose tissue in individuals with obesity is an independent cardiovascular risk indicator. However, it remains unclear whether adipose tissue influences common cardiovascular diseases, such as atherosclerosis, through its secreted exosomes.MethodsThe exosomes secreted by adipose tissue from diet-induced obesity mice were isolated to examine their impact on the progression of atherosclerosis and the associated mechanism. Endothelial apoptosis and the proliferation and migration of vascular smooth muscle cells (VSMCs) within the atherosclerotic plaque were evaluated. Statistical significance was analyzed using GraphPad Prism 9.0 with appropriate statistical tests.ResultsWe demonstrate that adipose tissue-derived exosomes (AT-EX) exacerbate atherosclerosis progression by promoting endothelial apoptosis, proliferation, and migration of VSMCs within the plaque in vivo. MicroRNA-132/212 (miR-132/212) was detected within AT-EX cargo. Mechanistically, miR-132/212-enriched AT-EX exacerbates palmitate acid-induced endothelial apoptosis via targeting G protein subunit alpha 12 and enhances platelet-derived growth factor type BB-induced VSMC proliferation and migration by targeting phosphatase and tensin homolog in vitro. Importantly, melatonin decreases exosomal miR-132/212 levels, thereby mitigating the pro-atherosclerotic impact of AT-EX.ConclusionThese data uncover the pathological mechanism by which adipose tissue-derived exosomes regulate the progression of atherosclerosis and identify miR-132/212 as potential diagnostic and therapeutic targets for atherosclerosis.Graphical

Analysis of risk indicators for implant failure in patients with chronic periodontitis

Dental implant restoration shows an effective method for the rehabilitation of missing teeth. The failure rate of periodontal implants in patients with chronic periodontitis is associated with periodontal flora, inflammation, and long-term periodontal bone resorption caused by chronic periodontitis. However, the therapeutic effects of dental implant restoration on inflammation in patients with chronic periodontitis have not addressed. The purpose of this study is to evaluate the risk indicators for inflammation, bone loss and implant failure in patients with chronic periodontitis. A total of 284 patients with dental implant restoration were recruited and divided into periodontally healthy patients (n = 128) and chronic periodontitis patients (n = 156). Periodontal indices including probing depth (PD), sulcus bleeding index (SBI), plaque index (PLI), gingival bleeding (GIL) and bleeding on probing (BOP) were compared in two groups. Inflammatory cytokines including tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1 (IL-1), matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) levels at baseline, 6 and 12 months after surgery, and the implant survival rate at 12 months after surgery, as well as the risk factors associated with failure of dental implant were also assessed. Outcomes demonstrated that patients in the chronic periodontitis group had higher values of periodontal indices than those in the periodontally healthy group. All inflammatory parameters in the chronic periodontitis group were higher than those in the periodontally healthy group and negatively associated with the chronic periodontal index (CPI) in chronic periodontitis patients. Chronic periodontitis patients had higher the prevalence of mucositis and peri-implantitis than patients with healthy periodontium. Implant diameter, length and design was associated with the risk of implant failure for chronic periodontitis patients receiving dental implant. The cumulative implant failure rate and incidence of implant fractures for chronic periodontitis patients at 12 months after surgery were 12.10% and 7.23% (p < 0.05), respectively, while were lower in the heathy periodontitis patients. Location, diameter, implant design, immediate loading and bone defect were risk indicators for bone loss for dental implant patients. The risk factors associated with failure of dental implant was higher in chronic periodontitis patients than patients in the periodontally healthy group (14.25% vs. 4.92%, p < 0.05). In conclusion, data in the current study indicate that inflammation is a risk indicator bone loss, implant fracture and implant failure in patients with chronic periodontitis.

The Asymmetric Effects of Oil Prices on Stock Returns: Evidence from Hanoi Stock Exchange, Vietnam

This study is devoted to investigating the asymmetric effects of oil prices on stock returns for Hanoi Stock Exchange (HNX). The data used in this study are weekly series of HNX-Index, WTI crude oil prices and geopolitical risks (GPRs) Index covering the period from January 2, 2010 to December 31, 2023. This study employed a nonlinear Autoregressive Distributed Lag (NARDL) bounds testing approach to estimate the short-term and long-term asymmetric effects of oil prices on the market returns. We found that in the short-term, oil prices have negative asymmetric effects on the market returns. Specifically, one percent increase in positive changes of oil prices immediately leads to 0.0085 percent decrease in the market returns. However, one percent increase in negative changes of oil prices is associated with 0.1487 percent decrease in the market returns. In the long-term, the estimated results confirm that both the negative and positive changes of oil prices have significantly negative effects on the market returns. Finally, the results obtained from the error correction model (ECM) indicate that 81.54 percent of the disequilibria from the previous week are converged and corrected back to the long-term equilibrium in the current week.

Associations between Various Inflammatory Markers and Carotid Findings in a Voluntary Asymptomatic Population Sample.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide, and atherosclerosis is the key factor promoting its development. Carotid intima-media thickening and the presence of carotid plaques are important indices of cardiovascular risk. In addition, inflammation is a major and complex factor in the development of atherosclerosis. The relationships between carotid atherosclerosis and certain inflammatory markers have rarely been studied in healthy individuals. Therefore, we aimed to investigate the associations between subclinical carotid atherosclerosis and various inflammatory biomarkers in a large Caucasian population free of evident CVD. In addition to recording study participants' demographic characteristics, anthropometric characteristics, and atherosclerotic risk factors, laboratory tests were performed to measure levels of hemoglobin A1c (HbA1c), high-sensitivity C-reactive protein, and inflammatory cytokines/chemokines, including interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12p70, IL-17A, IL-18, IL-23, IL-33, interferon (IFN)-α2, IFN-γ, tumor necrosis factor-α, and monocyte chemoattractant protein (MCP)-1. This study included 264 asymptomatic individuals with a median age of 61.7 years (interquartile range, 54.5-67.5 years); 45.7% of participants were male. Participants were divided into two groups according to their carotid status: the normal carotid group, comprising 120 participants; and the pathological carotid group, comprising 144 participants. Compared with the normal carotid group, hypertension and diabetes mellitus were significantly more common and serum levels of HbA1c, IL-8, and MCP-1 were significantly higher in the pathological carotid group. Multivariate regression analysis revealed significant positive associations between pathological carotid findings and serum levels of IL-8 (highest tertile, OR: 2.4, p = 0.030) and MCP-1 (highest tertile, OR: 2.4, p = 0.040). Our results suggest that IL-8 and MCP-1 may serve as early indicators of subclinical atherosclerosis, thereby helping to identify individuals at increased risk of CVD before the onset of clinical symptoms.

Predicting suicidal ideation from irregular and incomplete time series of questionnaires in a smartphone-based suicide prevention platform: a pilot study

Over 700,000 people die by suicide annually. Collecting longitudinal fine-grained data about at-risk individuals, as they occur in the real world, can enhance our understanding of the temporal dynamics of suicide risk, leading to better identification of those in need of immediate intervention. Self-assessment questionnaires were collected over time from 89 at-risk individuals using the EMMA smartphone application. An artificial intelligence (AI) model was trained to assess current level of suicidal ideation (SI), an early indicator of the suicide risk, and to predict its progression in the following days. A key challenge was the unevenly spaced and incomplete nature of the time series data. To address this, the AI was built on a missing value imputation algorithm. The AI successfully distinguished high SI levels from low SI levels both on the current day (AUC = 0.804, F1 = 0.625, MCC = 0.459) and three days in advance (AUC = 0.769, F1 = 0.576, MCC = 0.386). Besides past SI levels, the most significant questions were related to psychological pain, well-being, agitation, emotional tension, and protective factors such as contacts with relatives and leisure activities. This represents a promising step towards early AI-based suicide risk prediction using a smartphone application.

Epidemiologic Monitoring of Enterovirus (Nepolio) Infection: Rationale for Improvement

Relevance. Non-polio enteroviruses are widespread worldwide, with millions of cases being reported each year, but limited data exist on the true burden of enterovirus (non-polio) infections (EVnI) worldwide due to a lack of standardized surveillance. Considering the absence of specific prevention of EnVI and the difficulty of predicting the epidemic situation due to the diversity of types of enteroviruses, there is an obvious need for substantiating and supplementing the existing parameters of epidemiological monitoring, identifying additional indicators of morbidity risk for the purpose of timely implementing preventive and anti-epidemic measures. Aim. Rationale of necessity of additional measures of the EVnI observation for early discovery of the activation of the epidemic process. Materials and methods. The research was held during the year 2023 and included the following three components: 1. The prospective continuous observation of the patients ranging from 0 to 18 years old who received medical help in ambulatory conditions. Possible symptoms of EVnI were studied using the ambulatory diseased person’s medical cards (f. № 0/25у). 2. The research of biological material, which belonged to the healthy people and people with signs of probable EVnI. 3. The study of epidemiological connection of dew point temperature with the manifestations of the EVnI epidemic process. Results. Probable clinical symptoms of EVnI are found among 511 observed children. Positive correlational connection with EVnI is visible among exanthems (0,43, p &lt; 0,001) and acute nasopharyngitis (0,13, p &lt; 0,001). The maximal incidence rate of EVnI is discovered in a period from 27th to 36th week (54,35 ‰), which coincides with maximal incidence rate of acute nasopharyngitis (434,78 ‰). The rise in incidence rate of EVnI in comparison to the last period is 4,45 times (p &lt; 0,001), while in comparison to the rise in incidence rate of acute nasopharyngitis is 2,71 times (p &lt; 0,0001). In planned observation of examined patients with probable symptoms, EVnI disease is found amongst 78 people, the incidence rate made 254,07 ‰ and that aligns with the results of active observation of health center appeals (267,68 ‰, p &gt; 0,99). Clinical diagnosis of EVnI is made only in 51,28 %% of all cases. As a result of ill and healthy people’s observation, their relation is found to be 6:1 respectively. The activation of the epidemic process started in concurrence with dew point temperature +4,85 °C and continued until the dew point temperature +20,33 °C. Conclusion. The existing system of epidemiological supervision over EVnI has to be enhanced by adding the research on NPEV among the people who have acute nasopharyngitis during the stable rise in dew point temperature from +5,0 °C. Taking into account the rise in the incidence rate of EVnI, it is reasonable to expand the microbiological observation of biological material which belongs to the people who have exanthems, diarrheal syndrome and healthy people

The relationship between Geriatric Nutritional Risk Index (GNRI) and in-hospital mortality in critically ill patients with Acute Kidney Injury (AKI)

BackgroundThe role of the geriatric nutritional risk index (GNRI) as a prognostic factor in intensive care unit (ICU) patients with acute kidney injury (AKI) remains uncertain.ObjectivesThe aim of this study was to investigate the impact of the GNRI on mortality outcomes in critically ill patients with AKI.MethodsFor this retrospective study, we included 12,058 patients who were diagnosed with AKI based on ICD-9 codes from the eICU Collaborative Research Database. Based on the values of GNRI, nutrition-related risks were categorized into four groups: major risk (GNRI < 82), moderate risk (82 ≤ GNRI < 92), low risk (92 ≤ GNRI < 98), and no risk (GNRI ≥ 98). Multivariate analysis was used to evaluate the relationship between GNRI and outcomes.ResultsPatients with higher nutrition-related risk tended to be older, female, had lower blood pressure, lower body mass index, and more comorbidities. Multivariate analysis showed GNRI scores were associated with in-hospital mortality. (Major risk vs. No risk: OR, 95% CI: 1.90, 1.54–2.33, P < 0.001, P for trend < 0.001). Moreover, increased nutrition-related risk was negatively associated with the length of hospital stay (Coefficient: -0.033; P < 0.001) and the length of ICU stay (Coefficient: -0.108; P < 0.001). The association between GNRI scores and the risks of in-hospital mortality was consistent in all subgroups.ConclusionsGNRI serves as a significant nutrition assessment tool that is pivotal to predicting the prognosis of critically ill patients with AKI.

PEMETAAN ANCAMAN BENCANA TANAH LONGSOR BERBASIS SISTEM INFORMASI GEOGRAFIS (Studi Kasus : Kecamatan Bener, Kecamatan Loano dan Kecamatan Kaligesing, Kabupaten Purworejo)

Purworejo Regency is one of the districts in Central Java that often experiences natural disasters. Based on the Indonesian Disaster Risk Index, Purworejo Regency is in the high category or prone to natural disasters. Based on BPBD data from Purworejo Regency throughout 2021, Purworejo Regency often experiences landslides with high landslide intensity in Bener, Loano and Kaligesing Districts. This condition is the basis for this research as one of the disaster mitigation efforts in the sub-district area. This research is based on a Geographic Information System using Minister of Public Works Regulation No.22/PRT/M/2007 and AHP. Both methods were verified with landslide disaster event data. The results of landslide threat mapping based on Minister of Public Works Regulation No.22/PRT/M/2007 showed that the high zone threat was 6.67% or an area of 1,561,205 Ha, the medium zone was 77.52% or an area of 18,140,315 Ha, and 15.80% or an area of 3,698.145 Ha is in the low category. Meanwhile, the AHP results showed that the high threat area for landslides was 12.45% or an area of 2,913,889 Ha, the medium zone was 77.14%, or an area of 18,050,276 Ha, and 10.41% or an area of 2,435,500 Ha was in the low category.Keywords: Landslides, Permen PU No.22/PRT/M/2007, AHP

Spatiotemporal characterization of heatwave exposure across historically vulnerable communities

Heatwaves pose a serious threat and are projected to amplify with changing climate and social demographics. A comprehensive understanding of heatwave exposure to the communities is imperative for the development of effective strategies and mitigation plans. This study explores spatiotemporal characterization of heatwaves across the historically vulnerable communities in Mississippi, United States. We derive multiple heatwave metrics including frequency, duration, and magnitude based on temperature data for urban-specific daytime, nighttime, and day–night combined conditions. Our analysis depicts a rising heatwave trend across all counties, with the most extreme shifts observed in prolonged day–night events lacking overnight relief. We integrate physical heatwave hazards with a socioeconomic vulnerability index to develop an integrated urban heatwave risk index. Integrated metric identifies the counties in northwest Mississippi as heat-prone areas, exhibiting an urgent need to prioritize heat resilience and adaptive strategies in these regions. The compounding urban heatwave and vulnerability risks in these communities highlights an environmental justice imperative to implement equitable policies that protect disadvantaged populations. Although this study is focused on Mississippi, our framework is scalable and can be employed to urban regions globally. This study provides a solid foundation for developing timely heatwave preparedness and mitigation to avert preventable heat-related tragedies as extremes intensify with climate change.

The dynamic evolution characteristics of PM2.5 concentrations and health risk assessment during typical forest fires in China

In the context of climate change, increasingly frequent wildfire events are exacerbating the air quality crisis in China and have become a significant source of atmospheric PM2.5. This study selected 12 major forest wildfire events in China from 2018 to 2023. Using atmospheric pollutant and component concentration data, as well as meteorological data, the study employed MK trend analysis, forward trajectory simulation, potential source contribution function (PSCF), and health risk indices to investigate the evolution patterns of PM2.5 concentrations before and after each wildfire event. The study explored the driving role of meteorological factors in this evolution process and quantitatively analyzed the spatial distribution characteristics of health risks in surrounding cities post-wildfire. The results indicated that: 1) PM2.5 levels changed significantly before and after each wildfire event, although the proportion of components remained relatively stable. 2) PM2.5 concentrations exhibited varying characteristics within different buffer zones of the wildfire areas. In the forest wildfire events in Foshan, Guangdong Province, and Jinzhong, Shanxi Province, the average PM2.5 concentrations within the 50 km buffer zones reached approximately 90 μg/m3, about 4–5 times the multi-year average for these areas. 3) Wildfire emissions were mainly influenced by meteorological and topographical factors. Wind field dependence diagrams showed that PM2.5 tended to accumulate in all wind directions, particularly at lower wind speeds of 0–5 m/s 4) Potential source analysis revealed that PM2.5 emissions from wildfires posed significant risks to surrounding areas. Multiple events had high-risk areas (WPSCF ≥0.8), and among the cities in these high-risk areas, the health risk value (ΔM) for Ya'an City reached an extremely high 85.1. This study provides a theoretical basis for policymakers to develop locally tailored wildfire management policies, ensuring the protection of the public's right to breathe clean air.

Heavy metals and metalloid contamination and risk evaluation in the surface sediment of the Bakkhali River estuary in Bangladesh

Current state of contamination and subsequent risk of contaminated sediment of a tidal river of Bangladesh was evaluated in the present study. Sediment samples were collected from five locations in the tributary of Bakkhali River estuary during summer (April) and winter (December) season, 2020. Collected samples were processed using standard protocol and the content of heavy metals (Cd, Cr, Cu, Pb and Zn) and metalloid (As), were analyzed by the Flame Atomic Absorption Spectrometer. Sediment contamination was evaluated by pollution load index (PLI), contamination factor (CF), degree of contamination (Cd), potential ecological risk index (PERI), non-carcinogenic and carcinogenic risk (CR) due to the dermal contact of the sediment. Multivariate statistical analysis such as principal component analysis (PCA) and cluster analysis (CA) were also applied to find out the possible sources of the contaminant in the sediment. Results showed the average concentration of As, Cd, Cr, Pb, Cu and Zn was 9.74 ± 3.57, 2.00 ± 0.85, 48.75 ± 8.92, 29.78 ± 8.39, 5.44 ± 2.03 and 56.94 ± 8.57 mg/kg, respectively. Concentration of Cu, Pb and Zn were within the recommended level whereas the concentration of As, Cd and Cr were suppressed the recommended level of WHO and FAO/WHO standards. PLI, CF and Cd revealed considerably low degree of contamination of the sediment. Geo-accumulation index indicated uncontaminated to moderately contaminated condition of the sediment. Although the values of enrichment factor revealed no potential enrichment for most of the metals, Cd showed a minor enrichment during the winter season. Based on the ecological risk assessment, the sediment from all of the sample locations was found to be of moderate to low risk. PCA and CA analysis revealed the origin of contaminants mainly from anthropogenic sources. Although different metals showed non-carcinogenic risk to the inhabitants, cancer risk values for dermal contact (CRderm) were much lower than 10−6 indicating no cancer risk for adult and child. However, the findings also revealed that children were more susceptible to CRderm compared to adults. The present study concluded that long term dermal contact of the sediment of Bakkhali River estuary will be contagious to the people. Therefore, regular monitoring of the estuarine environment is necessary so that contamination does not get worse.

WT1 Expression Is Associated with Poor Overall Survival after Azacytidine and DLI in a Cohort of Adult AML and MDS Patients.

Introduction: Post-transplant relapse of acute myeloid leukemia and myelodysplastic syndrome faces restricted effective salvage regimens. We retrospectively analyzed the use of Azacitidine-donor lymphocyte infusion (AZA/DLI) in this setting. Furthermore, data on bone marrow Wilms tumor gene 1 (WT1) expression were collected. Methods: A Cox proportional hazards model, an outcome-oriented approach for the lowest smoothed plot of the martingale residuals, was performed for the cut-point determination of the respective WT1 expression levels. Finally, a Cox proportional hazards model investigated the association of overall survival (OS) with predictors. Results: An overall response of 41.4% with a median duration of 11.9 months for stable disease and 19.5 months for complete response (CR) patients was achieved. The disease risk index (DRI) high-/very high-risk patients had a shorter OS of 4.4 months than intermediate-risk patients, with 14.5 months, p = 0.007. At transplant, WT1-overexpressing patients (>150 copies) had a shorter median OS of 5.3 months than low-WT1-expressing ones, with 13.5 months, p = 0.024. Furthermore, patients with ≤1000 WT1 copies at relapse had a significantly longer OS with 15.3 months than patients overexpressing WT1, with 4.4 months, p = 0.0002. Conclusions: DRI and WT1 expression associate significantly with OS after AZA/DLI. Hence, WT1 may represent an MRD marker, especially in CR patients at high risk.

Deep learning with information fusion and model interpretation for long-term prenatal fetal heart rate data

Long-term fetal heart rate (FHR) monitoring during the antepartum period, increasingly popularized by electronic FHR monitoring, represents a growing approach in FHR monitoring. This kind of continuous monitoring, in contrast to the short-term one, collects an extended period of fetal heart data. This offers a more comprehensive understanding of fetus’s conditions. However, the interpretation of long-term antenatal fetal heart monitoring is still in its early stages, lacking corresponding clinical standards. Furthermore, the substantial amount of data generated by continuous monitoring imposes a significant burden on clinical work when analyzed manually. To address above challenges, this study develops an automatic analysis system named LARA (Long-term Antepartum Risk Analysis system) for continuous FHR monitoring, combining deep learning and information fusion methods. LARA’s core is a well-established convolutional neural network (CNN) model. It processes long-term FHR data as input and generates a Risk Distribution Map (RDM) and Risk Index (RI) as the analysis results. We evaluate LARA on inner test dataset, the performance metrics are as follows: AUC 0.872, accuracy 0.816, specificity 0.811, sensitivity 0.806, precision 0.271, and F1 score 0.415. In our study, we observe that long-term FHR monitoring data with higher RI is more likely to result in adverse outcomes (p = 0.0021). In conclusion, this study introduces LARA, the first automated analysis system for long-term FHR monitoring, initiating the further explorations into its clinical value in the future.

Individual, firearm, and purchasing characteristics associated with risk of firearm-related violent crime arrest: a nested case-control study

BackgroundFirearm purchasing records offer a potentially important administrative data source to identify individuals at elevated risk of perpetrating firearm violence. In this study, we describe individual, firearm, and transaction characteristics of purchasers in California who were arrested for a firearm-related violent crime (FRV) as compared to the general population of registered purchasers in the state.MethodsRelying on a dataset of all individuals with transaction records in California (1996–2021), linked to criminal records (1980–2021), we enrolled a cohort of individuals for whom we could capture the legal firearm purchase history. We identified those arrested for FRV post purchase, and using incidence density sampling, gender-matched cases to ten purchasers (controls) who remained “at risk” at the time the case was arrested. We focused on the purchase closest in time prior to the arrest (“index” purchase). We implemented conditional logistic regression and included models with controls for individual- and community-level demographics, as well as interactions between firearm and purchasing characteristics and criminal history.ResultsThe cohort included 1,212,144 individuals, of whom 6153 were arrested for FRV (0.5%). Cases were matched to 61,530 controls to form the study sample. The largest risk factor was a prior criminal history: purchasers had 5.84 times the risk of FRV if they had a prior arrest within three years of the index purchase (CI 5.44–6.27). Several transaction and firearm characteristics were also associated with FRV. For example, risk increased if the firearm was redeemed at a pawn shop (aIRR: 1.37, CI 1.05–1.77) and decreased if the transaction was a registered private party transfer (vs. retail purchase) (aIRR: 0.83, CI 0.76–0.90) or the firearm was a bolt action firearm (vs. semi-automatic) (aIRR: 0.64, CI 0.51–0.79). In the interaction models, most of the purchase and firearm features only remained significant among those with no criminal history.ConclusionsGiven limited data on firearm transactions, there has been little research on whether the type of firearm an individual purchases or the nature of the purchase might serve as indicators of risk for FRV. We found several transaction and firearm features were associated with risk of FRV. Notably, these features provided little evidence of additional risk for those with a prior criminal record.

The relative importance of economic policy uncertainty and geopolitical risk on U.S. REITs returns

PurposeOur aim in this study is to investigate the relative importance of the economic policy uncertainty and of the geopolitical risk on U.S. REITs (Real Estate Investment Trusts) returns with a special focus on the different real estate sectors.Design/methodology/approachWe use an augmented Fama-French (1993)’s asset pricing model, including economic policy uncertainty indices (EPU), introduced by Baker et al. (2016), and geopolitical risk indices (GPR) recently developed by Caldara and Iacoviello (2022), to price the potential risk factors for U.S. Nareit indices returns. To obtain robust economic results, we correct for the problems of errors-in-variables in linear asset pricing models; we advocate the use of higher moments estimators as instruments in a generalized method of moments (GMM) framework.FindingsOur results report that economic policy uncertainty (EPU), and geopolitical risk (GPR) are priced for the different Nareit sectors for the last three decades. The GPR index stands as a relevant risk factor. The coefficient estimates are low compared to Fama-French risk factors. They are higher for Shopping Centers, Retail and Region Malls and lower for Health Care and Lodging/Resorts. EPU indices are also priced and less statistically significant. Health Care sector, followed by Shopping Centers and Retail are the most policy-sensitive sectors.Practical implicationsIn their “2023–2024 Top Ten Issues Affecting Real Estate” “political unrest and global economic health” is ranked 1 issue by the Counselors of Real Estate. Our results report that economic policy uncertainty and geopolitical risk are priced for the different Nareit sectors. They suggest implications for investors, insurers, bankers, policymakers and other stakeholders. The geopolitical risk index (GPR) stands as a relevant and significant risk factor for REITs returns.Originality/valueBased on parsimonious robust asset pricing models, the results shed a new light on the relative importance of geopolitical risk and economic policy uncertainty in the real estate sector, with a special focus on the different U.S. REITs sectors. They suggest possible implications for investors, insurers, bankers, policymakers and other stakeholders in a context marked by higher uncertainty shocks and geopolitical risks.

The number of episodes of major psychiatric and substance use disorders as an index of genetic risk and genetic heterogeneity.

We investigate whether number of episodes (NoEs) meaningfully reflect genetic risk and genetic heterogeneity for five primary disorders-Drug Use Disorder (DUD), Alcohol Use Disorder (AUD), Major Depression (MD), Bipolar Disorder (BD), and Schizophrenia (SZ) ascertained from Swedish population registries. We utilize Genetic Risk Ratios (GRR)-defined as the ratio of the genetic risk for secondary disorders to the genetic risk for the primary disorder-derived from Family Genetic Risk Scores (FGRS). For all five primary disorders, genetic risk rose robustly with increasing NoEs. For both AUD and DUD, the GRR for all six secondary disorders-selected to have a likely genetic relationship with the particular primary disorder-declined with increasing NoEs so that cases of AUD and DUD with high versus low NoEs had both a higher genetic risk and a purer genetic signal. With MD, genetic risk maximized at an intermediate NoEs. While the GRRs for AUD and DUD in MD cases dropped sharply with increasing NoEs, GRR for BD increased. For BD, genetic risk rose sharply with increasing NoEs while for all secondary disorders the GRRs showed a mixture of modest increases and decreases. Like AUD and DUD, but even more markedly, selecting BD cases with high rates of recurrence would produce a sample with a high overall genetic risk and a relatively homogeneous genetic signal. For SZ, genetic risk rose moderately with increases in NoEs. GRRs for other non-affective psychoses (ONAP) and autism spectrum disorder (ASD) fell quite slowly with increasing NoEs, and more rapidly for other secondary disorders. Cases of SZ with high recurrence rates had a high genetic risk and a relatively pure signal, albeit with contributions from ONAP and ASD. In summary, NOEs are a robust index of genetic risk and genetic heterogeneity across our primary disorders with important inter-disorder differences.