Risk Index Research Articles

Accelerometer-Measured Physical Activity, Fitness and Indicators of Cardiometabolic Risk among Rural Adolescents: A Cross-Sectional Study at 15-Year Follow-up of the MINIMat Cohort.

Little is known about the relationship of physical activity (PA) and fitness with cardiometabolic risk among rural adolescents in low- and middle-income countries. Thus, we examined the associations of PA and fitness with selected cardiometabolic indicators along with potential gender-based differences in a birth cohort of rural adolescents from southeast Bangladesh. We utilized data from the 15-year follow-up of Maternal and Infant Nutrition Interventions in Matlab (MINIMat) cohort (n = 2253). Wrist-worn ActiGraph wGT3x-BT accelerometers were used to estimate sedentary time (ST) and PA. Fitness was assessed using: handgrip strength, standing long jump, and Chester Step Test. Anthropometric parameters, systolic blood pressure (SBP), and fasting lipid, insulin and glucose levels were measured. We calculated insulin resistance using the Homeostasis Model Assessment equation (HOMA-IR). Linear regression and isotemporal substitution models were fitted. The adolescents spent 64min/day (inter-quartile range: 50-81) in moderate-to-vigorous physical activity (MVPA). A 10-minute-per-day higher vigorous PA (VPA) was associated with: 4.9% (95% confidence interval (CI): 2.9-6.8%) lower waist circumference (WC), 3.2 mmHg (95% CI: 1.5-4.8) lower SBP, 10.4% (95% CI: 2.9-17.3%) lower TG, and 24.4% (95% CI: 11.3-34.9%) lower HOMA-IR. MVPA showed similar associations of notably smaller magnitude. Except for WC, the associations were more pronounced among the boys. Substituting ST with VPA of equal duration was associated with lower WC, SBP, triglyceride and HOMA-IR. Grip strength was favorably associated with all indicators, displaying considerably large effect sizes. Our findings indicated beneficial roles of PA- particularly VPA- and muscular fitness in shaping cardiometabolic profile in mid-adolescence. VPA and grip strength may represent potential targets for preventive strategies tailored to adolescents in resource-limited settings.

Geopolitical risk and tourism in Turkey

PurposeThe purpose of this paper is to show the effect of Turkey's geopolitical risk on the number of international tourist arrivals to the country. When Turkish economy in 2019 is analyzed, it is seen that the share of tourism in national income is 11%. For this reason, national economy is significantly affected by changing of the number of international tourist arrivals. Security problems are an important variable affecting tourist arrivals.Design/methodology/approachThe paper focused on secondary data for the period 2000–2019 for macroeconomic variables. Accordingly, the number of international tourist arrivals was added as a dependent variable, geopolitical risk as an independent variable, gross domestic product (GDP) and economic freedom index as control variables and inflations as an external variable to the model. The residual augmented least squares–the autoregressive distributive lag (RALS-ADL) cointegration test and the dynamic ordinary least squares (DOLS) coefficient estimator were used. It allows for more robust results to be obtained when the residues do not have a normal distribution.FindingsThe RALS-ADL cointegration test result shows that there is a cointegration relationship between variables at a 1% significance level. Moreover, the DOLS coefficient estimator results indicate that an increase in economic freedom and GDP increase the number of international tourists, whereas an increase in the Geopolitical Risk Index and inflation decreases the number of international tourism arrival. It can be said that tourists consider the security and economic stability of the host country when making tourism decisions.Originality/valueTurkey is one of the most risky developing countries, as well as one of the most popular travel destinations. When the literature is examined, it has been found that studies for Turkey usually determine the relationship between the variables for a short period of time. However, to ensure sustainable growth and environment of confidence, the long-run relationship between variables should be determined so that policymakers can make more impactful decisions. Therefore, the aim of this study is to make a literature contribution, taking into account the long-term effects. In addition, unlike other studies, this study fills the gap in literature using the RALS-ADL cointegration test, which produces robust estimators.

A Multi-Satellite Space Environment Risk Prediction and Real-Time Warning System for Satellite Safety Management

In response to the need for a space security situation assessment during orbit, the multi-satellite space environmental risk prediction and early warning system is based on the detection results of the space weather payload of the Fengyun 4A and 4B satellites, as well as the prediction results of the National Space Weather Center, for the first time. By comprehensively utilizing some open-source data, it is the first time that we have achieved a 24 h advanced prediction of the space environment high-energy proton, low-energy particle, and high-energy electron risks for the safety of the Fengyun-series high-orbit satellites, and a real-time warning of satellite single-event upset, surface charging, and deep charging risks. The automation system has preliminarily achieved an intelligent space risk assessment for the safety of multiple stationary meteorological satellites, effectively improving the application efficiency of the space environmental data and the products of Fengyun-series satellites. The business status is stable in operation, and the resulting error between the predicted results of various risk indices and the measured data was less than one level. The warning accuracy was better than 90%. This article uses the system for the first time, to use Fengyun satellite data to, accurately and in a timely manner, predict and warn us about the low-energy particles and surface charging high-risk levels of the Fengyun 4A and 4B satellites during the typical space weather event on 21 April 2023, in response to the impact of complex spatial environmental factors on the safety of Fengyun-series high-orbit satellites. The construction and operation of a multi-satellite space environmental risk prediction and early warning system can provide a reference for the safety work of subsequent satellite ground system operations.

Harnessing fuzzy logic for building structural health during large diameter tunnelling in urban area

Building structural health is constantly jeopardized by tunnel construction, which thus is in a sustained demand for holistic risk assessment and management approaches. In this study, we propose an enhanced consulting fuzzy model with limited information losses to evaluate the static and dynamic risks of building health deterioration during tunnelling. The model integrates three main strategies including, (i) reducing influence of experts’ bias in the ranking processes; (ii) expanding the space of uncertainties in fuzzy environment, and (iii) controlling risk aversion settings through the prospect theory. The construction of the largest diameter (15.3 m) tunnel in China is adopted as a case study to demonstrate the application of the proposed model in assessing the risk statuses of surrounding buildings. Through the proposed model, the risk index can indicate beneficial or detrimental effects of tunnelling and the degree of risk factors delineates priority actions for risk management. The results enable the development of operational risk abatement procedures to enhance the state of practice of large diameter tunnel construction in complex geological conditions.

Navigating Supply Chain Resilience: A Hybrid Approach to Agri-Food Supplier Selection

Globalization and multinational commerce have increased the dynamism and complexity of supply networks, thereby increasing their susceptibility to disruptions along interconnected supply chains. This study aims to tackle the significant concern of supplier selection disruptions in the Thai agri-food industry as a response to the aforementioned challenges. A novel supplier evaluation system, PROMETHEE II, is suggested; it combines the Fuzzy Analytical Hierarchy Process (FAHP) with inferential statistical techniques. This investigation commences with the identification of critical indicators of risk in the sustainable supply chain via three phases of analysis and 315 surveys of management teams. Exploratory factor analysis (EFA) is utilized to ascertain six supply risk criteria and twenty-three sub-criteria. Following this, the parameters are prioritized by FAHP, whereas four prospective suppliers for an agricultural firm are assessed by PROMETHEE II. By integrating optimization techniques into sensitivity analysis, this hybrid approach improves supplier selection criteria by identifying dependable solutions that are customized to risk scenarios and business objectives. The iterative strategy enhances the resilience of the agri-food supply chain by enabling well-informed decision-making amidst evolving market dynamics and chain risks. In addition, this research helps agricultural and other sectors by providing a systematic approach to selecting low-risk suppliers and delineating critical supply chain risk factors. By bridging complexity and facilitating informed decision-making in supplier selection processes, the results of this study fill a significant void in the academic literature concerning sustainable supply chain risk management.

Relationship between nutrition indicators and pneumonia risk among stable schizophrenia patients: a retrospective study.

It is reported that reduced physical activity and malnutrition may trigger pneumonia, and the utilisation of the geriatric nutritional risk index (GNRI) upon admission to long-term nursing care can enable the implementation of accurate and timely rehabilitation and nutritional support, which may, in turn, minimise pneumonia incidence. However, to date, there is no reported association between GNRI and pneumonia among stable schizophrenic patients. This is a retrospective investigation. We enrolled 434 hospitalised subjects aged ≥50 years, who were diagnosed with stable schizophrenia between January 2017 and June 2022. Baseline nutritional status information during the stable stage of schizophrenia was evaluated using body mass index, serum albumin, and GNRI. In addition, pneumonia-based information, including diagnosis and treatment, was retrospectively obtained within 1 year. To examine the potential association between nutrition indicators and pneumonia risk among stable schizophrenia patients, we employed a logistic regression analysis. The pneumonia incidence among all stable schizophrenia patients was 10.14%, and there were no statistically significant difference between sexes (male vs. female, 10.63% vs. 9.44%, P = 0.687). Based on the univariate analysis of nutrition indicators and pneumonia, female patients exhibited a strong correlation between serum albumin and pneumonia (P = 0.022). Furthermore, we adjusted for potential influencing factors of pneumonia infection, and confirmed that only serum albumin was linked to pneumonia risk in female stable schizophrenia patients (odds ratio = 0.854, 95% CI: 0.749-0.975, P = 0.02). Based on our analysis, serum albumin was strongly correlated with pneumonia risk in female stable schizophrenia patients.

Study on spatial distribution, regional differences and dynamic evolution of rural financial risk in China.

Based on panel data from 2009 to 2021, covering 30 provinces in China, we have been constructed the Rural Financial Risk Index using the objective entropy weighting method to study rural financial risk in China systematically from the perspective of spatial distribution. Specifically, we discuss the spatial distribution, regional differences and dynamic evolution of rural financial risk across Chinese four different regions divided into the Northeast, East, Central and West. It's found that Local government debt and Land transfer income are the two primary determinants influencing the level of rural financial risk in China. Furthermore, we conclude the ranking value of rural financial risk across four regions that the central exhibits the highest level, followed by the West, the East, and finally the Northeast, where the reasons for such ranking results as follows. Firstly, although the highest level of risk among provinces in the West is equivalent to that in the Central, there exists a smaller minimum rural financial risk in the former compared to the latter. Then, it should be noted that there's a low-low agglomeration of rural financial risk in the Northeast, while it demonstrates a high-high agglomeration in the Central according to the Moran Index test analysis. Again, there's a declining trend in rural financial risk disparity within the region and an upward trend is observed when comparing different regions (except the East vs West), especially increase largely between the Northeast and Central in past two years after analyzing the decomposition of Dagum Gini coefficient. Moreover, we study the absolute differences and dynamic evolution in different four regions through three-dimensional diagram of kernel density estimation, and it's found that the change of rural financial risk in four regions moved to the right as a whole, while the tail distribution remains inconspicuous. The absolute difference is diminishing in the Northeast, and the two-level differentiation characteristics tend to weaken as a whole in the Central, with a disordered wave peak height observed in both the East and West. Finally, the article presents pertinent policy implications but limitations according to the research findings.

Bioaccumulation of Lead and Mercury in Water, Sediment, and Fish Samples of Baraila Lake, Vaishali, Bihar.

In the current study, a protected subtropical wetland in Bihar (India), Baraila Lake, was investigated for heavy metal (Pb and Hg) status. These metals tend to bioaccumulate in fish, posing a concern to human health. This study reported the concentration of lead and mercury in water, sediment, and fish muscles of Baraila Lake in the year 2022. The samples were collected from pre-monsoon and post-monsoon seasons at four sampling locations, i.e., Loma, Dhulwar, Chakaiya, and Kawai Baraila, and were analyzed in triplicates. Lead concentration in water samples of all four sites of Baraila Lake observed during pre-monsoon and post-monsoon season exceeded the permissible limit for drinking water, while the mercury concentration of all sites was under the permissible limit in both seasons as prescribed by WHO. The extent of elemental pollution was evaluated using the Geo-accumulation index (Igeo), contamination factor (CF), contamination degree (Cd), ecological risk factor (Er), and the potential ecological risk index (Ri). Lead concentration in fish muscles of both seasons exceeded the permissible limit, while the concentration of mercury exceeded in Xenentodon cancila (0.55 ± 0.07µg/g) during the pre-monsoon season. Also, estimated daily intake (EDI), target hazard quotient (THQ), and hazard index (HI) were calculated in different fish muscles to assess potential human health risks. A higher THQ value of 1303 was observed in carnivore fish during the pre-monsoon season.

Fate, source apportionment and fractionation of potentially toxic elements in agricultural soil around a densely populated, semiarid urban center of India: baseline study and ecological risk assessment.

This study is on the outskirts of the rapidly growing city of Jaipur, located in the semiarid region of India and gateway to the 'Great Indian Thar' desert, and focused on potentially toxic elements (PTE) pollution in the farmlands around the city. Concentrations of PTE, along with associated soil parameters such as pH, available nitrogen, organic carbon, phosphorus, and potassium, were estimated in agricultural soil samples near an industrial region on the outskirts of the capital city of the largest state of India. The PTE concentrations in the soil were in the following order: Mn > Pb > Ni > Cr > Cu > Cd. Soil pollution indices, such as the geochemical accumulation index (Igeo), contamination factor (CF), and ecological risk index (ERI), indicated that the soil was moderately to highly polluted. The result of BCR extraction techniques showed Cd is found mainly in the exchangeable and residual fractions, Pb, Mn were found in the reducible as well as residual fractions, while other PTE were mostly bound to residual fraction. All other PTEs are primarily found in the residual fraction, tightly linked with the silicate lattice of soil minerals. Multivariate analysis and the Pearson correlation matrix indicate a common source apportionment for Pb and Cd. Cd, and Pb concentrations in agricultural soil indicate ecological harm that warrants immediate attention and policy-level intervention.

Geriatric Nutritional Risk Index is associated with adverse outcomes in patients with hypertension: the Fukushima Cohort study.

Malnutrition is reportedly associated with adverse clinical outcomes in various populations. However, associations between nutritional status and adverse outcomes in patients with hypertension have not been sufficiently elucidated. We therefore aimed to investigate the impact of nutritional status as evaluated by the Geriatric Nutritional Risk Index (GNRI) on adverse outcomes in patients with hypertension. We conducted a retrospective cohort study of 1588 hypertensive patients enrolled in the Fukushima Cohort Study. Participants were categorized into tertiles (T1-T3) according to GNRI at baseline. The primary endpoint of the present study was a kidney event, defined as a combination of a 50% decline in eGFR from baseline and end-stage kidney disease requiring kidney replacement therapy. Associations between GNRI and kidney events were assessed using Kaplan-Meier curves and multivariate Cox regression analyses. Median age was 64 years, 55% were men, median eGFR was 63.1 mL/min/1.73 m2, and median GNRI was 101.3. The lower GNRI group (T1) showed an increased incidence of kidney events in the Kaplan-Meier curve analysis. Compared to the highest GNRI group (T3), lower GNRI carried a higher risk of kidney events for both T2 (hazard ratio [HR] 1.38, 95% confidence interval [CI] 0.71-2.68) and T1 (HR 3.59, 95%CI 1.96-6.63). Similar relationships were observed for risks of all-cause death and cardiovascular events. Lower GNRI was associated with kidney events, all-cause death, and cardiovascular events in patients with hypertension. Nutritional status as evaluated by GNRI could offer a simple and useful predictor of adverse outcomes in this population.

Driving Pressure During Mechanical Ventilation of Acute Respiratory Distress Syndrome

Background: Driving pressure has been identified as a more accurate indicator of mortality risk than low tidal volume (VT) and pulmonary compliance (Ppl). It was also noted that when this pressure surpasses the 18 cm H2O mark, there is a significant elevation in the relative risk of death. This study aimed to evaluate the effect of driving pressure guided ventilation in acute respiratory distress syndrome (ARDS). Patients and Methods: The study included 64 subjects selected from the respiratory intensive care unit (RICU) of Al-Azhar University Hospital (Damietta). All participants received management through a protective lung strategy that was informed by driving Pressure. The study outcomes included 1). Determination of weaning categories; 2). Adverse events; 3). Length of ICU stay and duration of mechanical ventilation; 4). Mechanical Ventilation-free days, and 5). Organ/s dysfunction. Results: The commonest cause of admission was pneumonia (36%), and least percentage was septic shock (1.6%). The median ICU stay was 7 days (4 to 25 days) and weaning success rate was 76.6% with mortality rate of 23.4%. The severity was mainly severe (40.6%) and moderate (31.2%). Driving pressure at day 1 of ≤ 21 had sensitivity of 97.96%, specificity of 80.0% and area under curve (AUC) of 0.952. The driving pressure was significantly increased in cases with failure weaning than the success weaning (24.67 ± 1.05 vs 16.86 ± 1.24, respectively). In addition, it was significantly increased in died than alive patients. There was progressive significant increase of driving pressure from mild to moderate to severe cases. Pneumothorax was recorded among 9.4% and pleural effusion was recorded for 7.8% of patients. Conclusion: Use of driving pressure guided ventilation in patients with ARDS improves lung compliance, decreases the duration of mechanical ventilation and the length of ICU stay. Driving pressure < 21 can predict mortality.

Cross-sectional association of continuous glucose monitoring-derived metrics with cerebral small vessel disease in older adults with type 2 diabetes.

To examine cross-sectional associations between continuous glucose monitoring (CGM)-derived metrics and cerebral small vessel disease (SVD) in older adults with type 2 diabetes. In total, 80 patients with type 2 diabetes aged ≥70 years were analysed. Participants underwent CGM for 14 days. From the CGM data, we derived mean sensor glucose, percentage glucose coefficient of variation, mean amplitude of glucose excursion, time in range (TIR, 70-180 mg/dl), time above range (TAR) and time below range metrics, glycaemia risk index and high/low blood glucose index. The presence of cerebral SVD, including lacunes, microbleeds, enlarged perivascular spaces and white matter hyperintensities, was assessed, and the total number of these findings comprised the total cerebral SVD score (0-4). Ordinal logistic regression analyses were performed to examine the association of CGM-derived metrics with the total SVD score. The median SVD score was 1 (interquartile range 0-2). Higher hyperglycaemic metrics, including mean sensor glucose, TAR >180 mg/dl, TAR >250 mg/dl, and high blood glucose index and glycaemia risk index, were associated with a higher total SVD score. In contrast, a higher TIR (per 10% increase) was associated with a lower total SVD score (odds ratio 0.73, 95% confidence interval 0.56-0.95). Glycated haemoglobin, percentage glucose coefficient of variation, mean amplitude of glucose excursions, time below range and low blood glucose index were not associated with total cerebral SVD scores. The hyperglycaemia metrics and TIR, derived from CGM, were associated with cerebral SVD in older adults with type 2 diabetes.

Study of Predictive Value of Middle Ear Risk Index on Hearing Improvement in Patients Undergoing Surgery for Chronic Suppurative Otitis Media

Introduction: Middle ear risk index is one of the most reliable measuring tools to predict and evaluate the results of tympanoplasty. This study was done to analyse the predictive value of revised middle ear risk index on hearing improvement in patients undergoing surgery for chronic otitis media and to correlate the association between each index factor with hearing results. Materials and Methods: This prospective observational study was done over 2 years in a tertiary care Army Hospital with 88 patients in the age group of 10-65 years. Preoperative hearing thresholds and air-bone gaps were recorded. Patients were assigned to mild, moderate and severe groups with risk index scores. Hearing thresholds were assessed at 3 and 6 months following surgery for chronic otitis media. Data was statistically analysed. Results: 92.04% and 77.27% showed hearing improvements, 4.54% and 1.13% had deterioration and 3.40% and 21.59% had no change when compared to preoperative results in AC and BC thresholds respectively. 57.95% had post-operative closure of air bone gap of ≤ 12. Compared to cases with AB gap closure ≤ 12, those with AB gap closure > 12 showed statistically significant gain in BC by 0.2dB. Each unit increase in risk index score was associated with statistically significant increase of 0.64 dB in BC. Out of the seven individual factors, only perforation and previous surgery showed statistical significance in terms of hearing improvement. Conclusion: Middle ear risk index is not a good predictor of hearing improvement in ear surgery. Individually, risk index or air bone gap are not strong predictors but jointly, they show strong association with hearing improvement both in terms of AC and BC. Keywords: Middle ear risk index; Air conduction; Bone conduction; Air-bone gap; Hearing improvement.

Ecological risk and spatial distribution, sources of heavy metals in typical purple soils, southwest China

The identification and quantification of the ecological risks, sources and distribution of heavy metals in purple soils are essential for regional pollution control and management. In this study, geo-accumulation index (Igeo), enrichment factor (EF), pollution index (PI), potential ecological risk index (RI), principal component analysis (PCA) model and geographical detector (GD) were combined to evaluate the status, ecological risk, and sources of heavy metals (HMs) in soils from a typical purple soil areas of Sichuan province. The results showed that the average contents of As, Cd, Cr, Cu, Hg, Ni, Pb and Zn in purple soil were 7.77, 0.19, 69.5, 27.9, 0.077, 30.9, 26.5 mg/kg and 76.8 mg/kg, and the Igeo, EF and RI of topsoil Hg and Cd in designated area was the highest, and the average contents of Hg and Cd in topsoil were obviously greater than respective soil background value in Sichuan province and purple soil. The hot spots for the spatial distribution of 8 HMs were mainly focused in the southwest and northeast of the designated area, and there were also significant differences for 8 HMs distribution characteristics in the profile soil. Cu comes from both anthropogenic and natural sources, Zn, Ni and Cr mainly come from natural sources, but As, Pb, Hg and Cd mainly derived from human activities. GD results showed that soil texture (X18), altitude (X4), total nitrogen (TN), clay content (X3), sand content (X2) and silt content (X1) had the greatest explanatory power to 8 HMs spatial differentiation.This study provides a reference for understanding the status and influencing factors of HM pollution in typical purple soil, and lays a theoretical foundation for the environmental treatment of purple soil in China.

Risk assessment of land subsidence based on GIS in the Yongqiao area, Suzhou City, China.

This study focuses on the Yongqiao District in Suzhou City, Anhui Province, China, aiming to analyze the current situation of ground settlement and its influencing factors in the area. The selected risk indices include settlement rate, cumulative settlement amount, groundwater level drop funnel, thickness of loose sediment layer, thickness of soft soil layer, and the number of groundwater extraction layers. Additionally, vulnerability indices such as population density, building density, road traffic, and functional zoning are considered. An evaluation index system for assessing land Subsidence risk was established. The risk evaluation of land Subsidence was conducted using the Hierarchical analysis-composite index method and ArcGIS spatial analysis, The evaluation results show that the area of higher risk area is about 2.82 km2, accounting for 0.96% of the total area, mainly distributed in the area of Jiuli village, Sanba Street. The middle risk area is distributed around the higher area, with an area of about 9.18 km2, accounting for 3.13% of the total area. The lower risk areas were distributed in most of the study area, covering an area of 222.24 km2, accounting for 75.82% of the total area. The low risk assessment area is mainly distributed in Bianhe Street and part of Zhuxianzhuang Town, with an area of about 58.88 km2, accounting for 20.09% of the total area. The findings of this study are not only crucial for informing local policies and practices related to land use planning, infrastructure development, and emergency response but also enhance our understanding of the complexities of land Subsidence processes and their interactions with human activities, informing future research and practice in environmental risk assessment and management.

Assessment of groundwater quality for human consumption and its health risks in the Middle Magdalena Valley, Colombia

Groundwater is the primary source of water for people living in rural areas, especially during seasons when surface water is contaminated or unavailable. In Colombia, people use groundwater as drinking water without additional treatment. In addition, there is no infrastructure for wastewater collection and sewage treatment in the region of the Middle Magdalena Valley. The current study aims to evaluate the quality of groundwater in this region to determine any potential health hazards associated with its consumption. To reach the objective, three (3) physicochemical and microbiological sampling campaigns were carried out during different hydrological periods. A total of 428 groundwater samples were analyzed for over 28 parameters. The results were compared with the water quality standards proposed by the US EPA and Colombian regulations for human consumption. The analysis revealed the presence of total and fecal coliforms in 89% and 58% of the analyzed samples, respectively, identifying them as the main contaminants in groundwater. Furthermore, the pH levels did not meet the standards set by the US EPA in 33.8% of the cases and by Colombian regulations in 31.02%. Additionally, 32.8%, 17.6%, 14.3%, and 10.9% of the samples failed to meet the established thresholds for apparent color, magnesium, iron, and nitrates, respectively, under both standards. Moreover, only the analyses of selenium, mercury, and zinc complied with the quality standards under both regulatory frameworks. Based on the Colombian Drinking-Water Quality Risk Index (CDWQRI-IRCA), the risk associated with water quality meant for human consumption was assessed. The results showed that over 84% of the samples analyzed posed a high risk to human health, 4.6% posed a medium risk, 5.5% posed a low risk, and only 5.7% posed no risk at all. Additionally, official mortality statistics for children under four years old were reviewed, which revealed two deaths in 2019 due to Acute Diarrheal Disease (ADD) caused by consumption of contaminated water. Therefore, it is crucial to implement water treatment systems, establish aqueducts in rural areas, and conduct rigorous and systematic monitoring of drinking water to ensure it is safe for human consumption. It is also important to track morbidity and mortality rates associated with water consumption.

Comparison of preoperative NT-proBNP and simple cardiac risk scores for predicting postoperative morbidity after non-cardiac surgery with intermediate or high surgical risk

BackgroundChronic heart failure (HF) is frequent in elderly patients undergoing non-cardiac surgery. Preoperative risk stratification is vital and can be achieved using simple clinical risk scores or preoperative N-terminal prohormone of brain natriuretic peptide (NT-proBNP) measurement. This study aimed to compare the predictivity of the revised cardiac risk index (RCRI), the American University of Beirut cardiovascular risk index (AUB-HAS2), and a score proposed by Andersson et al. for postoperative 30-day morbidity to preoperative NT-proBNP.MethodsPreoperative NT-proBNP was measured in 199 consecutive patients aged ≥ 65 years undergoing elective non-cardiac surgery with intermediate or high surgical risk. The areas under the receiver operating characteristic curve (AUCROC) for the composite morbidity endpoint (CME) comprising the incidence of any rehospitalisation, acute decompensated HF, acute kidney injury, and any infection at postoperative day 30 were assessed. Multivariable logistic regression analysis derived new scores from the simple risk scores and the NT-proBNP cut-off of 450 pg/mL.ResultsAUB-HAS2, but not RCRI or Andersson score, significantly predicted the CME (AUB-HAS2: AUCROC 0.646, p < 0.001; RCRI: AUCROC 0.560, p = 0.126; Andersson: AUCROC 0.487, p = 0.760). The AUCROC was comparable between preoperative NT-proBNP (0.679, p < 0.001) and AUB-HAS2 (p = 0.334). Multivariable analyses revealed a preoperative NT-proBNP ≥ 450 pg/mL to be the strongest predictor of CME among the individual score components (p < 0.001). Adding preoperative NT-proBNP improved the predictive value of AUB-HAS2 and RCRI (modified AUB-HAS2: AUCROC 0.703, p < 0.001; modified RCRI: AUCROC 0.679, p < 0.001; both p < 0.001 vs original scores). The predictive value of the modified RCRI and AUB-HAS2 was comparable to preoperative NT-proBNP alone (p = 0.988 vs modified RCRI, p = 0.367 vs modified AUB-HAS2).ConclusionsThe predictive value of postoperative morbidity varies significantly between the available simple perioperative risk scores and can be enhanced by preoperative NT-proBNP. New scores, including preoperative NT-proBNP, should be evaluated in large multicentre cohorts.Trial registrationGerman Clinical Trials Register: DRKS00027871.

Integrated framework to assess soil potentially toxic element contamination through 3D pollution analysis in a typical mining city

Soil potentially toxic elements (PTEs) pollution of contaminated sites has become a global environmental issue. However, given that previous studies mostly focused on pollution assessment in surface soils, the current status and environmental risks of potentially toxic elements in deeper soils remain unclear. The present study aims to cognize distribution characteristics and spatial autocorrelation, pollution levels, and risk assessment in a stereoscopic environment for soil PTEs through 3D visualization techniques. Pollution levels were assessed in an integrated manner by combining the geoaccumulation index (Igeo), the integrated influence index of soil quality (IICQs), and potential ecological hazard index. Results showed that soil environment at the site was seriously threatened by PTEs, and Cu and Cd were ubiquitous and the predominant pollutants in the study area. The stratigraphic models and pollution plume simulation revealed that pollutants show a decreasing trend with the deepening of the soil layer. The ranking of contamination soil volume is as follows: Cu > Cd > Zn > As > Pb > Cr > Ni. According to the IICQs evaluation, this region was subject to multiple PTE contamination, with more than 60% of the area becoming seriously and highly polluted. In addition, the ecological hazard model revealed the existence of substantial ecological hazards in the soils of the site. The integrated potential ecological risk index (RI) indicated that 45.7%, 10.13%, and 4.15% of the stereoscopic areas were in considerable, high, and very high risks, respectively. The findings could be used as a theoretical reference for applying multiple methods to integrate evaluation through 3D visualization analysis in the assessment and remediation of PTE-contaminated soils.

DNA methylation as a possible causal mechanism linking childhood adversity and health: Results from two-sample mendelian randomization study.

Childhood adversity is an important risk factor for adverse health across the life course. Epigenetic modifications, such as DNA methylation (DNAm), are one hypothesized mechanism linking adversity to disease susceptibility. Yet, few studies have determined whether adversity-related DNAm alterations are causally related to future health outcomes or if their developmental timing plays a role in these relationships. Here, we used two-sample Mendelian Randomization to obtain stronger causal inferences about the association between adversity-associated DNAm loci across development (i.e., birth; childhood; adolescence; young adulthood) and 24 mental, physical, and behavioral health outcomes. We identified particularly strong associations between adversity-associated DNAm and ADHD, depression, obsessive-compulsive disorder, suicide attempts, asthma, coronary artery disease, and chronic kidney disease. A greater number of associations were identified for birth and childhood DNAm, while adolescent and young adulthood DNAm were more closely linked to mental health. Childhood DNAm loci also showed primarily risk suppressing relationships with health outcomes, suggesting that DNAm might reflect compensatory or buffering mechanisms against childhood adversity, rather than acting solely as an indicator of disease risk. Together, our results suggest adversity-related DNAm alterations are linked to both physical and mental health outcomes, with particularly strong impacts of DNAm differences emerging earlier in development.

A commentary on "Association of postoperative outcomes with geriatric nutritional risk index after conventional and robotic-assisted total knee arthroplasty: a randomized controlled trial".

A commentary on "Association of postoperative outcomes with geriatric nutritional risk index after conventional and robotic-assisted total knee arthroplasty: a randomized controlled trial".