Risk Reduction Strategies Research Articles

Alzheimer's disease and related dementia diagnoses among American Indian and Alaska Native adults aged ≥45 years, Indian Health Service System, 2016-2020.

Alzheimer's disease is the most common type of dementia and is responsible for up to 80% of dementia diagnoses and is the sixth leading cause of death in the United States. An estimated 38,000 American Indian/Alaska Native (AI/AN) people aged ≥65 years were living with Alzheimer's disease and related dementias (ADRD) in 2020, a number expected to double by 2030 and quadruple by 2050. Administrative healthcare data from the Indian Health Service (IHS) were used to estimate ADRD among AI/AN populations. Administrative IHS healthcare data from federal fiscal years 2016 to 2020 from the IHS National Data Warehouse were used to calculate the count and rate per 100,000 AI/AN adults aged ≥45 years with at least one ADRD diagnosis code on their medical record. This study identified 12,877 AI/AN adults aged ≥45 years with an ADRD diagnosis code, with an overall rate of 514 per 100,000. Of those, 1856 people were aged 45-64. Females were 1.2 times (95% confidence interval: 1.1-1.2) more likely than males to have a medical visit with an ADRD diagnosis code. Many AI/AN people with ADRD rely on IHS, tribal, and urban Indian health programs. The high burden of ADRD in AI/AN populations aged 45-64 utilizing IHS health services highlights the need for implementation of ADRD risk reduction strategies and assessment and diagnosis of ADRD in younger AI/AN populations. This study provides a baseline to assess future progress for efforts addressing ADRD in AI/AN communities.

Cerebrovascular Disease in Surgical Patients

It is well established that patients with a personal history of a cerebrovascular accident (stroke or transient ischemic attack) are at increased risk for perioperative cardiovascular complications, including recurrent stroke. Although the individual patient risk for perioperative stroke is typically low, the overall prevalence is significant, appears to be increasing, and has the potential for devastating complications including death. The perioperative provider must not only be knowledgeable of the elevated risk for patients with a history of stroke undergoing surgery, but also be familiar with perioperative risk reduction strategies. This article provides a general overview of cerebrovascular disease in surgical patients with much of the content being presented at the 2023 Perioperative Medicine Summit in Orlando, Florida.

Understanding Associations between Disasters and Sustainability, Resilience, and Poverty: An Empirical Study of the Last Two Decades

This study investigates the impact of disasters on sustainability, resilience, and poverty, using data from the “Sustainable Development Report” and the Emergency Events Database (EM-DAT) from 2000 to 2023. Regression models assessed the effects of disasters, deaths, injuries, affected individuals, and economic damage on normalized values of the dependent variables with lag periods of one, two, and three years of independent variables. The results reveal that disasters consistently negatively impact sustainability and resilience, highlighting the need for robust disaster risk reduction strategies and resilient infrastructure. Higher mortality rates significantly hindered development, emphasizing the importance of improving early warning systems, emergency preparedness, and healthcare infrastructure. While injuries and the number of affected individuals did not show significant associations, economic damage was positively associated with resilience, suggesting that financial losses might drive recovery investments. Additionally, disasters were found to exacerbate poverty levels over time with significant associations in the two and three-year lag models. This study also uncovered significant regional disparities with lower resilience, sustainability, and higher poverty levels in certain regions compared to others. Higher-income groups demonstrated better resilience and lower poverty levels. These findings underscore the necessity for targeted, region-specific strategies to enhance resilience, reduce poverty, and support sustainable development, leveraging post-disaster recovery phases for long-term improvement.

Environmental sensitivity of the Caribbean economic growth rate

Abstract. The year-over-year changes in economic growth across the Caribbean Antilles islands demonstrate sensitivity to climatic conditions. Daily wind and rainfall exceedances from passing storms are negatively related to the gross domestic product (GDP). Field regression of the GDP time series from 1971 to 2022 for Puerto Rico and the neighboring Antilles islands reveals links with eastern Pacific sea temperature. A zonal overturning atmospheric circulation over the equatorial Atlantic emerges in composite analysis. Alternating at an approximate 7-year interval, it modulates weather events and economic prosperity in the Caribbean. A multivariate algorithm is developed to predict changes in the annual GDP growth rate. The most influential predictor is precipitable water in the equatorial Atlantic 1 year earlier. Reduced moisture overlain by westerly winds in a global bottleneck at 5° S–5° N, 20–40° W tends to suppress Caribbean storms, leading to economic prosperity in the following year. Statistical methods and risk-reduction strategies are outlined.

Development of a scale for measuring psychosocial vulnerability in disaster-prone areas

IntroductionDisaster vulnerability is a complex concept influenced by both natural forces and societal factors, including psychosocial aspects that shape an individual's resilience to natural hazards. Despite technological advancements, assessing psychosocial vulnerability remains challenging, necessitating specialized scales. This study attempted to develop a psychosocial vulnerability assessment scale, recognizing the intricate interplay of physical, psychological, and social factors. MethodsThe study was conducted in two disaster-prone wards in Cuttack, India, susceptible to cyclones, earthquakes, and floods. The scale development process involved two stages: instrument design and judgmental evidence. During the instrument design phase, qualitative data on psychosocial vulnerabilities were gathered through Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs). These insights led to the generation of 44 items, which were subsequently refined to 35 items through expert consultation. The judgmental evidence phase included content validity assessment, internal consistency analysis, and test-retest reliability estimation. Exploratory Factor Analysis (EFA) identified the instrument's factor structure, with items retaining factor loadings exceeding 0.4. Data collection involved 400 individuals selected through multistage sampling, with strict adherence to ethical considerations. ResultData collected in the initial instrument design stage revealed key psychosocial vulnerability themes. These themes informed the creation of a 35-item scale categorized into three domains: Physical, social, and psychological vulnerability. The instrument underwent rigorous validation processes, demonstrating strong content validity agreement among experts. Internal consistency analysis revealed good reliability, as indicated by the Kuder-Richardson coefficient (KR20 = 0.904). Test-retest reliability further established the stability of responses over time, with an ICC of 0.82. EFA confirmed the scale's three-factor structure, explaining 60 % of the variance. After removing three items with low factor loadings, the scale proved reliable and valid, effectively categorizing vulnerabilities into these distinct domains. ConclusionThe scale developed in this study offers a comprehensive tool for understanding the unique challenges people living in disaster-prone areas face. It addresses the often-overlooked psychosocial components of vulnerability, filling a critical gap in existing research and measurement scales. Its application helps in planning psychosocial interventions and improving disaster risk reduction strategies.

Novel Machine Learning HIV Intervention for Sexual and Gender Minority Young People Who Have Sex With Men (uTECH): Protocol for a Randomized Comparison Trial.

Sexual and gender minority (SGM) young people are disproportionately affected by HIV in the United States, and substance use is a major driver of new infections. People who use web-based venues to meet sex partners are more likely to report substance use, sexual risk behaviors, and sexually transmitted infections. To our knowledge, no machine learning (ML) interventions have been developed that use web-based and digital technologies to inform and personalize HIV and substance use prevention efforts for SGM young people. This study aims to test the acceptability, appropriateness, and feasibility of the uTECH intervention, a SMS text messaging intervention using an ML algorithm to promote HIV prevention and substance use harm reduction among SGM people aged 18 to 29 years who have sex with men. This intervention will be compared to the Young Men's Health Project (YMHP) alone, an existing Centers for Disease Control and Prevention best evidence intervention for young SGM people, which consists of 4 motivational interviewing-based counseling sessions. The YMHP condition will receive YMHP sessions and will be compared to the uTECH+YMHP condition, which includes YMHP sessions as well as uTECH SMS text messages. In a study funded by the National Institutes of Health, we will recruit and enroll SGM participants (aged 18-29 years) in the United States (N=330) to participate in a 12-month, 2-arm randomized comparison trial. All participants will receive 4 counseling sessions conducted over Zoom (Zoom Video Communications, Inc) with a master's-level social worker. Participants in the uTECH+YMHP condition will receive curated SMS text messages informed by an ML algorithm that seek to promote HIV and substance use risk reduction strategies as well as undergoing YMHP counseling. We hypothesize that the uTECH+YMHP intervention will be considered acceptable, appropriate, and feasible to most participants. We also hypothesize that participants in the combined condition will experience enhanced and more durable reductions in substance use and sexual risk behaviors compared to participants receiving YMHP alone. Appropriate statistical methods, models, and procedures will be selected to evaluate primary hypotheses and behavioral health outcomes in both intervention conditions using an α<.05 significance level, including comparison tests, tests of fixed effects, and growth curve modeling. This study was funded in August 2019. As of June 2024, all participants have been enrolled. Data analysis has commenced, and expected results will be published in the fall of 2025. This study aims to develop and test the acceptability, appropriateness, and feasibility of uTECH, a novel approach to reduce HIV risk and substance use among SGM young adults. ClinicalTrials.gov NCT04710901; https://clinicaltrials.gov/study/NCT04710901. DERR1-10.2196/58448.

Risks for Enlisted Navy Divers Compared to Other Enlisted Sailors: An Examination of Illnesses That May Be Associated With Exposure to Contaminated Water Diving.

Illnesses among Navy divers degrade readiness, decrease manpower levels, and increase costs for medical care. Prior research has shown that Navy divers have high rates of the types of illnesses that might be because of diving in contaminated water. The objectives of this study were to examine medical records of U.S. Navy Sailors from 2016 to 2022 and determine if divers have higher incidence rates of health conditions that might be associated with contaminated water diving compared to non-divers. For this retrospective cohort study, we used data from the Defense Medical Epidemiology Database (DMED). The DMED is operated by the Armed Forces Health Surveillance Division and uses data from the Defense Manpower Data Center to classify occupations. The DMED provides free online access to a de-identified subset of data contained within the Defense Medical Surveillance System.The population was U.S. Navy enlisted males, aged 25 to 29 years. Divers were compared to non-divers using 8 selected diagnoses that may reasonably be associated with diving in contaminated water. During the study period, the database contained a total of 5,474 diver and 827,406 non-diver person-years. Of the 8 diagnoses, the ones with the largest number of cases for divers were upper respiratory infections with 128 and ear disorders with 62. The relative risks (RRs) for divers compared to non-divers were higher for otitis externa (RR = 1.44; confidence interval = 1.03, 2.01) and for ear disorders (RR = 1.15; confidence interval = 0.89, 1.47); for the other 6 diagnoses, the divers had lower rates than the non-divers. The high RRs found for otitis externa and ear disorders support the need to devote resources to better understand the reasons for these higher risks and to develop, test, and implement targeted risk-reduction strategies. Future studies should attempt to link verified contaminated water exposures with adverse health outcomes and calculate risks based on criteria such as age and dive factors.

Managing compound events in the COVID-19 era: A critical analysis of gaps, measures taken, and challenges

Since the beginning of 2020, the focus has predominantly been on the prevention and control of the COVID-19 pandemic. However, the 'new normal' has drastically altered responses to other hazards, underscoring the need to prepare and plan for complex, multi-risk scenarios. Nevertheless, there's limited literature on disaster preparedness and response for compound hazard scenarios, particularly pandemic-natural hazard hybrids. The few studies that have explored concurrent hazards during the COVID-19 pandemic have largely focused on developed, high-income countries. Yet, compound events can exacerbate pre-existing socio-economic vulnerabilities in developing countries, straining systems and causing disproportionate impacts. This study addresses this lacuna by examining (1) emergency preparedness and response measures for Sri Lanka's Southwest and Northeast monsoons during the COVID-19 pandemic, and (2) the feasibility of current Disaster Risk Reduction (DRR) strategies for managing compound pandemic-natural hazard events in Sri Lanka. The research involves a desk-based policy analysis of disaster and health policies, key informant interviews with 26 officials, and focus group discussions with Public Health Inspectors from Ratnapura, Jaffna, Matara, and Gampaha. Findings indicate that while significant steps were taken, including impact scenario analyses, stakeholder meetings, and revised response measures, challenges such as resource constraints and limited capacity persisted. This study further demonstrates that the country's existing DRR strategies are characterised by gaps that may hinder capacities to effectively manage compound hazards. The findings of this study therefore encourage the implementation of structural changes and anticipatory action that adequately account for the complexity of risk supported by cross-sectoral collaboration. The study particularly highlights the importance of proactive scenario-based planning, developing composite risk matrices that account for multiple dimensions of vulnerability, fostering cross-sectoral and cross-level collaboration, and adapting existing early warning systems to effectively manage compound hazard scenarios.

Developing new tools to de‐risk wildlife occupancy on private lands

AbstractPrivate lands support much of the biodiversity in North America, but supporting wildlife can be costly for landowners. Innovative tools are needed to reduce the risks that wildlife pose to private landowners while conserving biodiversity. Here, we present a range of innovative tools that have effectively been used to “de‐risk” wildlife occupancy of private lands in the Greater Yellowstone Ecosystem. Lessons learned from these risk reduction strategies inform conservation more broadly by highlighting the importance of economic and risk‐management considerations to wildlife conservation on private lands. Incorporating de‐risking tools into the wildlife conservation toolbox can help conservation practitioners more strategically allocate resources to benefit wildlife and the private lands that help support them.

Integrating cardiovascular risk assessment into mobile low-dose CT lung screenings in rural Appalachia: A comprehensive analysis of the relationship between lung cancer risk, coronary artery calcium burden, and cardiovascular risk reduction strategies

ObjectiveMobile low-dose computed tomography (LDCT) lung screenings are part of an outreach program in rural Appalachia to detect early lung cancer. Coronary artery calcium (CAC) scoring on LDCT can identify calcium deposits in coronary arteries and can prompt consideration of risk modification for prevention of cardiovascular disease (CVD) events. It is not known if Lung CT Screening Reporting & Data System (Lung-RADS) scoring correlates with CAC scores. There is no clear guidance for patients undergoing LDCT screenings to receive follow-up regarding CAC or prevention of associated CVD risk. MethodsThis was a retrospective review of mobile LDCT LCS in adults with no known history of CVD. CT images were obtained at 100 kVp with a slice thickness of 3 mm. Agatston CAC scoring was performed retroactively. Lung-RADS scores were categorized as: Negative (1), Benign (2), Probably Benign (3), and Suspicious (4). CAC scoring was grouped as 0, 1–100, 101–399, and ≥400. Descriptive statistics and chi-square analyses were utilized. ResultsA total of 526 LDCT screenings were included. Over 54 % of patients had coronary calcification on LDCT LCS. 161 patients (30.6 %) had a CAC score of ≥100 and 75 patients (14.3 %) had a CAC score ≥400. Of patients with a CAC score ≥100, 7.5 % received referrals for follow-up after the LDCT screen and 9.3 % had additional cardiac testing. Of those with a CAC score ≥100 not already on a statin (45.3 %) and not already on aspirin (63.3 %), few were started within 3 months of LDCT for prevention (8.2 % and 5.9 % respectively). Among patients with a Lung-RADS score of 4, 17 % had a CAC score >400, whereas only 12 % with a Lung-RADS score of 1 fell into the same CAC category. Higher Lung-RADS scores correlated with fewer patients with CAC of 0. A significant correlation was observed between higher Lung-RADS scores and elevated CAC scores (p = 0.02). ConclusionIn patients with no CVD history, coronary artery calcification was frequently identified on mobile LDCT lung screenings in rural communities. Patients with higher probabilities of malignant lung nodules may also be at increased risk for significant coronary artery disease. Calcium scoring from LDCT screenings allowed for simultaneous assessment of lung cancer and CVD risk. Unfortunately, few referrals or CVD prevention medications were initiated. Awareness of CAC score utility, follow-up for identified coronary calcifications, and consideration of primary prevention medications when indicated, would be beneficial in patients undergoing LDCT lung screenings, especially in rural areas with limited healthcare access.

Prioritization of Susceptibility Zones for Multi-Hazard in Jammu Division of the North-West Himalayas, India for Disaster Risk Reduction

Environmental hazards have always been a source of serious concern as they are becoming more severe and wider in scope, enhancing the risk of additional losses to the environment and public health. The comprehensive risk assessment has emerged as a core component of disaster mitigation strategy. After the international convention on sustainable development in 1992, the multi-hazard approach is widely used as part of Disaster Risk Reduction (DRR) strategy. Lying in the vicinity of the North-West Himalayan region, Jammu Division is prone to multiple hazards which have led to numerous causalities. In this study, landslides, floods, earthquakes, droughts, forest fires and soil erosion are considered for prioritizing risk from multi-hazard. Analytical Hierarchy Process have been adopted for data processing for the standardisation and normalisation of the weights. The area prone to multiple hazards is delineated after overlaying all the individual assessment of hazard events using weights computed by an objective approach. The multi-hazard susceptibility map is categorised into five zones: very low, low, moderate, high and very high. The findings revealed that 43.43 % of area lying in south eastern, central and eastern part is suffering from multiple hazards are prioritized for preventing communities to suffer from the multiple hazards. This area lies in central part of the study area in proximity to faults and weak lithology. The identified area under multi-hazard should be well studied for potential cascading of hazards. The targeted interventions and proactive measures should be adopted for enhancing the resilience and disaster risk reduction. The prioritized zones will be extremely valuable for risk profiling, vulnerability assessment and formulation or revision of DRR strategy action plans.

Changes in Human Vulnerability to Flood and Landslide: Evidences from Historical Data

Human impact by floods and landslides (FLs) is a significant concern, necessitating a deeper understanding to implement effective reduction measures, in line with the Sendai Framework for Disaster Risk Reduction’s goal to reduce disaster mortality between 2020 and 2030. This study examines the evolution of human interaction with FLs over the past 70 years in Calabria, Italy. By systematically analyzing regional newspapers and historical archives from 1951–1960 and 2011–2020, a database was created documenting fatalities, injuries, and the involvement of people in FL incidents. For each victim, the database includes demographic details, accident time and place, circumstances of death or injury, and whether the victim’s behavior was hazardous or protective. Results indicate a drastic reduction in both the total number of fatalities (196 versus 20) and high mortality events from 1951–1960 to 2011–2020 (6 versus 1). However, the number of people involved in incidents has increased (202 versus 1102), although this may be partly due to improved dissemination of information. Changes in population habits and the construction of more robust houses have significantly reduced high-fatality events, enhancing security. The study highlights the importance of data collection for developing locally tailored risk reduction strategies, increasing community resilience by addressing specific vulnerabilities and strengths.

Flood threat to livable communities: Understanding the impact of emotional conflicts and information availability on disaster preparedness through mitigation capacity in Nigeria's coastal region

Climate change poses significant risks to coastal regions, compromising habitats, economies, and well-being through flooding. This research assesses the indirect effects of information availability and emotional factors, such as property emotional attachment and emotional burdens on flood disaster preparedness through mitigation capacity. Data from 360 individuals across three Nigerian coastal communities were analyzed using a partial least squares structural equation model (PLS-SEM). Evidence demonstrated that information availability directly enhances disaster preparedness. Conversely, information availability is not significantly associated with mitigation capacity. Strong emotional attachment to property negatively impact mitigation capacity, but no direct effect on disaster preparedness. Mitigation capacity exhibits a significant positive direct effect on disaster preparedness. Notably, heightened emotional burden bolsters flood disaster preparedness by first increasing mitigation capacity. In contrast, intensified emotional attachment to property dampens mitigation capacity, thereby diminishing disaster preparedness. These insights highlight the necessity of integrating frameworks for addressing issues of information dissemination, property emotional attachment, and emotional burden when devising flood risk reduction strategies for coastal communities.

A comprehensive approach to evaluate risk mitigation strategies in offshore wind farms using spherical fuzzy decision making analysis

The escalating impact of global warming, primarily exacerbated by carbon emissions from conventional energy sources, has prompted significant advancements in offshore wind energy as a pivotal avenue for sustainable development. Amid the surging interest in renewable energy, offshore wind-farms have emerged as a promising solution. To ensure their efficient and effective operation, it becomes imperative to systematically identify and mitigate potential risks. This study addresses the critical need to systematically prioritize risk reduction strategies for offshore wind farms, a problem that has not been comprehensively explored in the literature. A multi-criteria analysis has been adopted to simultaneously evaluate the contradictory criteria in the evaluation process. The novelty of this study lies in its integration of spherical fuzzy sets with multi-criteria decision-making (MCDM) techniques to handle uncertainties and evaluate contradictory criteria simultaneously. As a result of all this analysis, the most critical risks for offshore wind-farms and risk mitigation strategies that can be adopted within the determined risks have been revealed. The main findings reveal that turbine underperformance, disruption of habitats, and grid connection issues are the most critical risks. Furthermore, a combination of robust design and engineering and collaboration and partnerships emerged as the most effective risk mitigation strategies.

Revisiting Mobile Payment Risk-Reduction Strategies: A Cross-Country Analysis

ABSTRACT Mobile payment risk has become a critical cybersecurity factor in the cashless society. The outbreak of COVID-19 helped proliferate mobile payments that also bring significant risks to users. Using AI methods, this study analyzed six dimensions of mobile payment risks (financial, privacy, performance, psychology, time, and security) in a survey of 748 respondents from three countries (UK, Taiwan, and Mozambique). The decision tree method was employed to identify and analyze critical perceived risks. The ANOVA test provided insights on the perceived risks between countries. The ANOVA test showed that UK users were concerned about financial and time risks; those in Mozambique were concerned about performance, psychological, and security risks; and those in Taiwan were concerned about privacy risks. The results revealed that decision trees outperformed other methods (such as neural networks, logistic regression, support vector machine (SVM), random forest, and Naïve Bayes models). Performance risk (Taiwan and Mozambique) and security risk (UK) are the most significant factors. Cultural differences influence mobile payment risk perception in different countries. The risk-reduction strategies were also matched to the critical factors by the decision tree. This showed that simplification and risk-sharing strategies were the major tactics in all three countries. The clarification strategy works for Taiwan and Mozambique, which focuses on the benefits of using mobile payments. The results suggest that enterprises should improve and simplify the mobile payment process and collaborate with the third parties to reduce and share cybersecurity risk.

Choice of needleless connector technology as a risk reduction strategy for catheter related bloodstream infection, mortality, and cost: A secondary data analysis.

To compare relative risk (RR) of central line-associated bloodstream infection (CLABSI) between hospitals using Clave needleless connector technologies (NCT) and comparator hospitals using non-Clave NCT. And, to estimate avoided CLABSIs, mortality, and cost savings. Needleless connectors, while protective against needlestick injury, have long been implicated as a potential risk for CLABSI. Significant RR reduction of CLABSI among the many NCT has not been clinically demonstrated. The U.S. Healthcare-Associated Infections database was accessed for CLABSI data for calendar year 2019 via the Centers for Medicare and Medicaid Services website. This dataset was merged with the Clave NCT manufacturer's 2019 database to identify hospitals purchasing Clave NCT (MicroClave™, NanoClave™, Clave Neutron™, Clave™, Microclave™ Clear) and non-Clave NCT comparator hospitals. Sub-analysis of Clave NCT hospitals included: (1) Clave NCT mixed-use and (2) Clave high-volume use hospitals. The standardized infection ratio (SIR) was generated to estimate CLABSI RR after adjusting for intern/resident-to-bed-ratio (IRB), care location, and hospital demographics. Using the RR, avoided CLABSIs, mortality, and cost savings were calculated. A total of 2987 eligible hospitals (1288 Clave NCT, 1699 non-Clave NCT) with 17,452,575 central line-days were evaluated. All three Clave NCT hospital groups showed a statistically significant reduction in RR compared to the non-Clave NCT hospitals. The RR in Clave NCT hospitals was 0.93, a 7% decrease in CLABSI risk (p = 0.02). In the Clave NCT subgroups, mixed-use hospitals RR was 0.93, a 7% reduction (p = 0.04), while the Clave NCT high-volume hospitals experienced a 19% reduction, RR 0.81 (p = 0.04). An estimated 563 CLABSIs and 84 related deaths were avoided with use of Clave NCT and $27,095,231 in cost savings. The use of the Clave NCT, in and of itself, is an effective risk reduction strategy for CLABSI prevention, reduced mortality, and substantial cost savings.

“Hope is being stirred up”: Critical consciousness in gender-based violence interventions

Gender-based violence (GBV) research in public health has historically paid close attention to gender as a system of oppression, with less attention paid to the intersections between gender and other oppressive systems such as colonialism, white supremacy, and capitalism. In 2019, we adapted and pilot-tested an individual-level evidence-based sexual violence resistance intervention for university-attending women in Eswatini. We conducted a qualitative assessment of our adapted intervention's acceptability and feasibility using a critical pedagogy lens to explore how power operated in delivering an empowerment intervention, using in-depth interviews with intervention participants and facilitators. We analyzed interview transcripts thematically guided by a critical pedagogy framework and organized emergent themes into a concept map with two primary axes: participant-researcher-driven power and proximal-distal determinants. We located participant experiences with the intervention within three quadrants defined by these axes: 1) “Prescriptive,” in which the researcher or facilitator primarily controls the content and delivery, with a principal focus on proximal risk reduction strategies; 2) “Solidarity,” which emphasizes fostering critical consciousness among facilitators and intervention participants through dialogue, building collective power through participant-driven discussions of individual experiences; and 3) “Liberation,” in which participants critically examined the power structures that underpinned their lived experiences, and expressed a desire to transform these in ways the intervention was not designed to address. These three quadrants suggest the existence of a fourth quadrant, “paternalistic,” - in which the interventionist seeks to didactically educate participants about structural drivers of their own experience. Our analysis highlights a fundamental tension in the epistemology of GBV research: While there is a clear consensus that ‘empowerment’ is a necessary component of successful GBV interventions, “liberatory” approaches that cede power to participants are inherently antithetical to the scripted approach typically required for consistent replication in randomized control trials or other ‘gold-standard’ approaches for post-positivist evidence generation.

Futuristic flood risks assessment, in the Upper Vellar Basin, integrating AHP and bivariate analysis

Flood susceptibility maps provide invaluable information for assessing and managing flood-prone areas, aiding in proactive planning, risk reduction strategies, and safeguarding vulnerable communities. The current research concentrates on advancing sustainable development practices by undertaking a comprehensive assessment of flood susceptibility in the Upper Vellar basin, with a projection for 2050. Employing an integrative methodology, this study utilizes an Analytical Hierarchy Process (AHP) and Bivariate Analysis. Nine critical parameters were used: elevation, distance from the river, distance from the road, drainage density, predicted LULC, projected precipitation, slope, soil type, and Topographic Wetness Index (TWI). The Modules of Land Use Change Evaluation (MOLUSE) plugin, which uses Cellular Automata-Artificial Neural Network (CA-ANN), was employed to predict the LULC map for the year 2050. Furthermore, bias-corrected Coupled Model Intercomparison Project 6 (CMIP 6) EC EARTH 3 Model (GCM) RCP 4.5 and 8.5 projected precipitation data were employed. The resulting flood susceptibility zones are classified into three categories: low, moderate, and high, with proportions of 32.64%, 55.52%, and 11.84% for RCP 4.5, and 34.63%, 53.46%, and 11.91% for RCP 8.5, respectively, concerning the total area. In both scenarios, nearly 38% of the settlement area is at high flood risk. This study provides essential insights for policymakers and stakeholders, facilitating the formulation of sustainable strategies to address projected changes in land use, precipitation patterns, and flood susceptibility in the Upper Vellar region up to 2050.

Benefit-Cost Analysis for Earthquake-Resilient Building Design and Retrofit: State of the Art and Future Research Needs.

This paper reviews the state of the art in using benefit-cost analysis (BCA) to inform earthquake risk reduction decisions by building owners and policymakers. The goal is to provide a roadmap for the application and future development of BCA methods and tools for earthquake risk reduction. Our review covers three earthquake risk reduction measures: adopting up-to-date building codes for new construction, designing new buildings to exceed code requirements, and retrofitting deficient existing buildings. We highlight the factors that influence the cost-effectiveness of building design and retrofit, as well as tactics for increasing the cost-effectiveness of risk reduction strategies. We also present BCA results, methods, and data sources used in the literature to help researchers and practitioners design and conduct a reliable and robust BCA study. In the process, we develop a set of opportunities and challenges for applying BCA to new areas of research, as well as key gaps and limitations in current BCA approaches, including further investigation of above-code design, incorporation of code implementation and enforcement into BCA, quantification of environmental benefits of seismic retrofits, and optimization of seismic retrofits with energy upgrades. Overall, our review provides practical guidance and useful insights into BCA with the goal of increasing the earthquake resilience and economic efficiency of buildings in the United States.

NKX2.5 coding exons sequencing reveals novel non-synonymous mutations in patients with sporadic congenital heart diseases among the Tanzanian population

BackgroundThe evolutionally conserved homeobox transcription factor NKX2-5 has been at the forefront in the field of cardiac biology, providing molecular insights into the mechanisms of cardiac development and disease. This homodomain transcription factor is a central regulator of cardiac development and is expressed in both the first and second heart fields (FHF and SHF). Mutations in the NKX2-5 gene have been linked to sporadic cases of congenital heart disease (CHD), making it a significant target for research and study. While several studies have been conducted on Caucasian populations, there is a dearth of knowledge on the effects of NKX2-5 gene mutations in other settings, underscoring the need for further investigation. Due to differences in geographical and ancestral origin, we hypothesize that mutations may vary across different populations. Understanding the genetic factors that cause CHD is essential for providing effective genetic counseling and developing strategies for risk reduction. Additionally, identification of NKX2-5 mutations in individuals with CHDs is crucial because patients with CHDs are at a higher risk of progressive conduction disease and sudden cardiac death, and genetic information is taken into consideration while making decisions regarding pacemakers and implantable cardiac defibrillators. To determine the risk of congenital heart disease among infants, we conducted a study where we sequenced the exon 1 and exon 2 of NKX 2.5 in patients with sporadic CHDs, with the aim of identifying mutations in the NKX2.5 gene.ResultsIn this study, a novel frame-shift disease-causing mutation was discovered in patients with atrial-ventricular septal defect. The mutation, identified as c95_95 del A; cDNA.369–369 delA; g 369–369 delA, resulted in the substitution of phenylalanine to leucine (F295L), which in turn caused a truncated NKX2.5 protein. In addition, a non-synonymous mutation, g 316C > T; cDNA 316C > T leucine to arginine (L37R) substitution, was found in a patient with the tetralogy of Fallot, affecting protein function. Furthermore, a novel non-synonymous mutation identified as g 2295–2298; cDNA 755–758 delins AGGG, was predicted by mutation taster to be disease-causing in a ventricular septal defect. It is worth noting that none of these mutations were found among the control subjects, highlighting their potential significance in the pathogenesis of these cardiac defects.ConclusionMutations in the NKX2.5 gene are associated with congenital heart diseases and provide molecular insight into the pathogenesis of congenital heart diseases. We recommend that patients with NKX2.5 mutations have periodic screening for cardiac conduction abnormalities and be evaluated for potential implanted cardiac defibrillators and pacemakers.