Short-term Risk Research Articles

Pesticide residues and risk assessment of trunk-injected pesticides in pine nut (Pinus koraiensis) seeds

Pine nuts, the edible seeds of pines (Family: Pinaceae, Pinus spp.), are popular worldwide, particularly those from the Korean pine tree (Pinus koraiensis), which is economically significant and widely exported. The spread of pine wilt disease (PWD) caused by pinewood nematodes (PWNs) has necessitated the use of trunk injections of pesticides in Korea, raising concerns about pesticide residues in edible pine nuts. This study investigated the concentration of pesticide residues in pine nuts from trunk-injected trees and assessed their potential health risks to consumers. After Korean pine tree was trunk-injected with pesticide, the pine nuts were subsequently harvested and analyzed for pesticide residues using LC‒MS/MS. Short- and long-term risk assessments of trunk-injected pesticides in pine nuts were conducted. Abamectin and emamectin benzoate were not detected, while acetamiprid and sulfoxaflor were detected, but their levels were below the maximum residue limits (MRLs) set by Korea, the EU, and the US. The short-term and long-term risk assessments indicated negligible health risks for consumers from these residues. Despite the low risk, we recommend continued monitoring of pesticide residues in pine nuts intended for sale to ensure consumer safety.

VOLCANBOX: A software platform for volcanic hazard assessment

Volcanic eruptions have an intrinsic multi-hazard nature, in which a variety of volcanic products (lava flows, fallout, lahars, and pyroclastic flows) and associated hazards (seismic shocks, landslides, tsunamis, or floods) may interact and impact sequentially. Volcanic hazard assessment relies on probabilistic approaches based on the past eruptive history, from which scientists identify eruptive scenarios and their expected recurrence. However, not enough attempts have yet been made to address volcanic hazard assessment in a systematic way, based on principles that may be equally applicable to different volcanoes and volcanic zones regardless of their particular nature. Hence, we present VOLCANBOX, a new multiplatform (GNU/Linux, MacOS, Windows) system designed to conduct long-and short-term volcanic hazard assessment and risk analysis in a systematic and rational manner, aimed at reducing volcanic risk by anticipating future eruptions. VOLCANBOX includes several sets of software tools designed to evaluate long and short-term volcanic hazards, to conduct vulnerability analysis, and to assist decision-makers during the management of a volcanic crisis. VOLCANBOX can be implemented before an emergency, in order to identify optimum mitigating actions and how these may have to be adapted as new information is obtained. VOLCANBOX is aimed at experts in volcanic hazard and risk assessment and management and is designed to facilitate the interaction and cooperation between scientists, policy makers and civil protection agencies to anticipate volcanic disasters in a timely manner, by quantifying volcanic hazards, understanding volcanic unrest, forecasting volcanic eruptions, and identifying the most probable scenarios in a simple and clear manner.

Effectiveness of the frailty index in predicting short-term and long-term mortality risk in patients with chronic heart failure

ObjectiveThis study explored the effectiveness of a newly constructed frailty index (FI) for predicting short-term and long-term mortality in patients with chronic heart failure (HF). Materials and methodsThis retrospective study included inpatients aged ≥60 years diagnosed with chronic HF at a teaching hospital in western China. General data on the patients were collected from the electronic medical record system between January 1, 2017, and July 7, 2022, and death information was obtained from follow-up calls made from July 31, 2022, to August 1, 2022. Receiver operating characteristic (ROC) curves were used to analyze the accuracy of the FI in predicting death in patients with chronic HF. Logistic regression (during hospitalization and within 30 days after discharge) and Cox regression (within 180 days after discharge and one year after discharge) analyses were used to assess associations between frailty and mortality risk in elderly patients with chronic HF. ResultsA total of 432 patients with chronic HF were included in the study. The non-frail group had FI values <0.3, while the FI values in the frail group were ≥0.3. Overall, 130 patients (30.09 %) were diagnosed with frailty, 66 (15.28 %) died during hospitalization or within 30 days after discharge, 55 (12.73 %) died within 180 days after discharge, and 68 (15.74 %) died within one year after discharge. The in-hospital and 30-day mortality rates, the 180-day mortality rates, and the 1-year mortality rates were higher in frail patients than in non-frail patients (in-hospital and 30-day mortality rates, 37.69 % vs. 5.63 %, P < 0.001; within 180 days, 30.61 % vs. 8.45 %, P < 0.001; within 1 year, 34.69 % vs. 11.49 %, P < 0.001). The area under the curve (AUC) values of FI for predicting in-hospital and 30-day mortality after discharge were 0.804, with values of 0.721 for 180-day mortality after discharge and 0.720 for 1-year mortality after discharge. Logistic regression analysis with adjustment for potential confounders indicated that frail HF patients had a higher risk of death during hospitalization and within 30 days than non-frail patients (odds ratio [OR] = 4.98, 95 % confidence interval [CI]: 2.46–10.09). Cox regression analysis with adjustment for potential confounders showed that frail HF patients had a higher risk of death within 180 days (hazard ratio [HR] = 2.63, 95 %CI: 1.47–4.72) and within 1 year (HR = 2.01, 95 %CI: 1.19–3.38). ConclusionThe results of this study showed that the new FI constructed according to the established construction rules could predict the in-hospital mortality and the risk of death within 30 days after discharge, 180 days after discharge, and 1 year after discharge in patients with chronic HF.

A nomogram for predicting short-term mortality in ICU patients with coexisting chronic obstructive pulmonary disease and congestive heart failure

ObjectiveThis study aimed to develop and validate a nomogram for predicting 28-day and 90-day mortality in intensive care unit (ICU) patients who have chronic obstructive pulmonary disease (COPD) coexisting with congestive heart failure (CHF). MethodsAn extensive analysis was conducted on clinical data from the Medical Information Mart for Intensive Care IV database, covering patients over 18 years old with both COPD and CHF, who were were first-time ICU admissions between 2008 and 2019. The least absolute shrinkage and selection operator (LASSO) regression method was employed to screen clinical features, with the final model being optimized using backward stepwise regression guided by the Akaike Information Criterion (AIC) to construct the nomogram. The predictive model's discrimination and clinical applicability were evaluated via receiver operating characteristic (ROC) curves, calibration curves, the C-index, and decision curve analysi s (DCA). ResultsThis analysis was comprised of a total of 1948 patients. Patients were separated into developing and validation cohorts in a 7:3 ratio, with similar baseline characteristics between the two groups. The ICU mortality rates for the developing and verification cohorts were 20.8 % and 19.5 % at 28 days, respectively, and 29.4 % and 28.3 % at 90 days, respectively. The clinical characteristics retained by the backward stepwise regression include age, weight, systolic blood pressure (SBP), respiratory rate (RR), oxygen saturation (SpO2), red blood cell distribution width (RDW), lactate, partial thrombosis time (PTT), race, marital status, type 2 diabetes mellitus (T2DM), malignant cancer, acute kidney failure (AKF), pneumonia, immunosuppressive drugs, antiplatelet agents, vasoactive agents, acute physiology score III (APS III), Oxford acute severity of illness score (OASIS), and Charlson comorbidity index (CCI). We developed two separate models by assigning weighted scores to each independent risk factor: nomogram A excludes CCI but includes age, T2DM, and malignant cancer, while nomogram B includes only CCI, without age, T2DM, and malignant cancer. Based on the results of the AUC and C-index, this study selected nomogram A, which demonstrated better predictive performance, for subsequent validation. The calibration curve, C-index, and DCA results indicate that nomogram A has good accuracy in predicting short-term mortality and demonstrates better discriminative ability than commonly used clinical scoring systems, making it more suitable for clinical application. ConclusionThe nomogram developed in this study offers an effective assessment of short-term mortality risk for ICU patients with COPD and CHF, proving to be a superior tool for predicting their short-term prognosis.

Short-term risk of fracture is increased by deficits in cortical and trabecular bone microarchitecture independent of DXA BMD and FRAX: Bone Microarchitecture International Consortium (BoMIC) prospective cohorts.

Identifying individuals at risk for short-term fracture is essential to offer prompt beneficial treatment, especially since many fractures occur in those without osteoporosis by DXA-aBMD. We evaluated whether deficits in bone microarchitecture and density predict short-term fracture risk independent of the clinical predictors, DXA-BMD and FRAX. We combined data from eight cohorts to conduct a prospective study of bone microarchitecture at the distal radius and tibia (by HR-pQCT) and 2-year incidence of fracture (non-traumatic and traumatic) in 7327 individuals (4824 women, 2503 men, mean 69 ± 9years). We estimated sex-specific hazard ratios (HR) for associations between bone measures and 2-year fracture incidence, adjusted for age, cohort, height, and weight, and then additionally adjusted for FN aBMD or FRAX for major osteoporotic fracture. Only 7% of study participants had FN T-score ≤ -2.5, whereas 53% had T-scores between -1.0 and -2.5 and 37% had T-scores ≥-1.0. Two-year cumulative fracture incidence was 4% (296/7327). Each SD decrease in radius cortical bone measures increased fracture risk by 38%-76% for women and men. After additional adjustment for FN-aBMD, risks remained increased by 28%-61%. Radius trabecular measures were also associated with 2-year fracture risk independently of FN-aBMD in women (HRs range: 1.21 per SD for trabecular separation to 1.55 for total vBMD). Decreased failure load (FL) was associated with increased fracture risk in both women and men (FN-aBMD ranges of adjusted HR = 1.47-2.42). Tibia measurement results were similar to radius results. Findings were also similar when models were adjusted for FRAX. In older adults, FL and HR-pQCT measures of cortical and trabecular bone microarchitecture and density with strong associations to short-term fractures improved fracture prediction beyond aBMD and FRAX. Thus, HR-pQCT may be a useful adjunct to traditional assessment of short-term fracture risk in older adults, including those with T-scores above the osteoporosis range.

A systematic review and meta-analysis of differences between men and women in short-term outcomes following coronary artery bypass graft surgery

We provide an update regarding the differences between men and women in short-term postoperative mortality after coronary artery bypass grafting (CABG) and highlight the differences in postoperative risk of stroke, myocardial infarction, and new onset atrial fibrillation. We included 23 studies, with a total of 3,971,267 patients (70.7% men, 29.3% women), and provided results for groups of unbalanced studies and propensity matched studies. For short-term mortality, the pooled odds ratio (OR) from unbalanced studies was 1.71 (with 95% CI 1.69–1.74, I2 = 0%, p = 0.7), and from propensity matched studies was 1.32 (95% CI 1.14–1.52, I2 = 76%, p < 0.01). For postoperative stroke, the pooled effects were OR = 1.50 (95% CI 1.35–1.66, I2 = 83%, p < 0.01) and OR = 1.31 (95% CI 1.02–1.67, I2 = 81%, p < 0.01). For myocardial infarction, the pooled effects were OR = 1.09 (95% CI = 0.78–1.53, I2 = 70%, p < 0.01) and OR = 1.03 (95% CI = 0.86–1.24, I2 = 43%, p = 0.18). For postoperative atrial fibrillation, the pooled effect from unbalanced studies was OR = 0.89 (95% CI = 0.82–0.96, I2 = 34%, p = 0.18). The short-term mortality risk after CABG is higher in women, compared to men. Women are at higher risk of postoperative stroke. There is no significant difference in the likelihood of postoperative myocardial infarction in women compared to men. Men are at higher risk of postoperative atrial fibrillation after CABG.

Stroke Risk After Emergency Department Treat-and-Release Visit for a Fall.

Previous cohort studies of hospitalized patients with a delayed diagnosis of ischemic stroke found that these patients often had an initial emergency department (ED) diagnosis of a fall. We sought to evaluate whether ED visits for a fall resulting in discharge to home (ie, treat-and-release visits) were associated with increased short-term ischemic stroke risk. A case-crossover design was used to compare ED visits for falls during case periods (0-15, 16-30, 31-90, and 91-180 days before stroke) and control periods (equivalent time periods exactly 1 year before stroke) using administrative data from the Healthcare Cost and Utilization Project on all hospital admissions and ED visits across 10 states from 2016 to 2020. To identify ED treat-and-release visits for a fall and patients hospitalized for acute ischemic stroke, we used previously validated International Classification of Diseases, Tenth Revision, Clinical Modification codes. Odds ratios and 95% CIs were calculated using conditional logistic regression. Among 90 592 hospitalized patients with ischemic stroke, 5230 (5.8%) had an ED treat-and-release visit for a fall within 180 days before their stroke. Patients with an ED treat-and-release visit for a fall were older (mean age, 74.7 [SD, 14.6] versus 70.8 [SD, 15.1] years), more often female (61.9% versus 53.4%), and had higher rates of vascular comorbidities than other patients with stroke. ED treat-and-release visits for a fall were significantly more common in the 15 days before stroke compared with the 15-day control period 1 year earlier (odds ratio, 2.7 [95% CI, 2.4-3.1]). The association between stroke and a preceding ED treat-and-release visit for a fall decreased in magnitude with increasing temporal distance from stroke. ED treat-and-release visits for a fall are associated with significantly increased short-term ischemic stroke risk. These visits may be opportunities to improve stroke diagnostic accuracy and treatment in the ED.

231. DESCRIBING THE LANDSCAPE OF ESOPHAGECTOMY BETWEEN EASTERN AND WESTERN ESOPHAGEAL SOCIETIES: COMPARATIVE STUDIES FROM THE JAPANESE NCD AND DUTCH DUCA

Abstract Objective Differences in clinicopathological characteristics of patients with esophageal cancer between countries may exist and impact on perioperative and surgical treatment as well as outcomes. Identification of these discrepancies may help the interpretation of present and future studies. Methods Data on patient demographics, comorbidity, pathology, surgical procedure, and short-term outcomes were retrieved, and compared between countries. Furthermore, we conducted a risk factor analysis focused on the major postoperative complications after esophagectomy to reveal the similarities and differences in risk factors. Results The mean annual number of resections for oesophageal cancer was 6673 in NCD (5.3 cases per 100,000 population) and 551 (3.1 cases per 100,000 population) in DUCA. Patients from the NCD were older and had a lower BMI. Complete minimally invasive esophagectomy was performed in 52.7% in NCD and 85% in DUCA. A cervical anastomosis was performed in 83.5% of patients in the NCD and in 33.8% in the DUCA likely reflecting differences in the location of primary tumors. Mortality within 30 days after surgery in the NCD and DUCA was 0.8% and 2.7%, respectively. Risk factors for postoperative major complications were similar between countries. Conclusions Although there were differences in patient variables, no significant differences were observed in short-term outcomes and risk factors of postoperative complications. The current results provide insight into contemporary demographics and outcomes of esophageal cancer resections from two an Asian and Western perspective.

Financing Risks and Preventive Measures for E-Commerce Corporates

The e-commerce industry has achieved tremendous development in the past decade. However, in this rapid development process, there are some problems that have caused huge hidden dangers, and financing is the most important one among them. Therefore, the topic of this article is the dangers and prevention methods of e-commerce corporations under different financing methods. The method of this paper is as follows: first, segment the financing models of e-commerce corporates, then combine the financing situation of several well-known e-commerce corporates in China, analyze relevant data, and discuss the possible problems under these financing models separately. The research shows that the short-term debt payment risk, financial leverage risk and investment decision risk are the major risks that have influences on the firms’ financing, and the first two have a greater impact. To resolve these dangers, e-commerce firms can adjust debt structure, diversify financing channels and establish a sound risk prevention mechanism.

Dispensed prescription medications and short-term risk of pulmonary embolism in Norway and Sweden

Scandinavian electronic health-care registers provide a unique setting to investigate potential unidentified side effects of drugs. We analysed the association between prescription drugs dispensed in Norway and Sweden and the short-term risk of developing pulmonary embolism. A total of 12,104 pulmonary embolism cases were identified from patient- and cause-of-death registries in Norway (2004–2014) and 36,088 in Sweden (2005–2014). A case-crossover design was used to compare individual drugs dispensed 1–30 days before the date of pulmonary embolism diagnosis with dispensation in a 61–90 day time-window, while controlling for the receipt of other drugs. A BOLASSO approach was used to select drugs that were associated with short-term risk of pulmonary embolism. Thirty-eight drugs were associated with pulmonary embolism in the combined analysis of the Norwegian and Swedish data. Drugs associated with increased risk of pulmonary embolism included certain proton-pump inhibitors, antibiotics, antithrombotics, vasodilators, furosemide, anti-varicose medications, corticosteroids, immunostimulants (pegfilgrastim), opioids, analgesics, anxiolytics, antidepressants, antiprotozoals, and drugs for cough and colds. Mineral supplements, hydrochlorothiazide and potassium-sparing agents, beta-blockers, angiotensin 2 receptor blockers, statins, and methotrexate were associated with lower risk. Most associations persisted, and several additional drugs were associated, with pulmonary embolism when using a longer time window of 90 days instead of 30 days. These results provide exploratory, pharmacopeia-wide evidence of medications that may increase or decrease the risk of pulmonary embolism. Some of these findings were expected based on the drugs' indications, while others are novel and require further study as potentially modifiable precipitants of pulmonary embolism.

Exploring the sources of systemic risk and trading strategies in energy and stock markets

This study aims to investigate the impact of the energy transition on asset pricing by analyzing the different sources of systemic risk in a comprehensive system of one traditional energy ETF, one clean energy ETF, seven oil-exporting country ETFs, and six oil-importing country ETFs. We find that shocks to the traditional (clean) energy market are the primary source of short-term (long-term) systemic risk, suggesting that oil-dependent countries have started to incorporate the long-term risks associated with clean energy into the pricing of related assets. Meanwhile, we document both homogeneity within and heterogeneity between oil exporters and oil importers in the transmission patterns of systemic risk. These findings can help provide customized trading strategies for investors with diverse profiles. Additionally, we compare the regime-dependent hedging strategy with both the regime-dependent diversification strategy and the dynamic hedging strategy, demonstrating that it is the most effective for investors aiming to minimize portfolio volatility. Collectively, our results provide valuable insights that can assist policymakers, portfolio managers, and investors in adapting to the evolving dynamics of the energy transition.

A hierarchical multi-parametric programming approach for dynamic risk-based model predictive quality control

In this work, we present a hierarchical batch quality control strategy with real-time process safety management. It features a multi-time-scale decision-making framework augmenting: (i) Risk-aware model predictive controller for short-term set point tracking and dynamic risk control under disturbances; (ii) Control-aware optimizer for long-term quality and safety optimization over the entire batch operation; (iii) Intermediate surrogate model to bridge the timescale gap by readjusting the optimizer operating decisions for the controller. All of the above problems are solved via multi-parametric mixed-integer quadratic programming with a key advantage to generate offline explicit control/optimization laws as affine functions of process and risk variables. This allows for the design of a fit-for-purpose risk management plan prior to real-time implementation, while reducing the need for repetitive online dynamic optimization. A unified process model is used to underpin the consistency of hierarchical operational optimization. The proposed approach offers a flexible strategy to integrate distinct decision-making time scales which can be selected separately tailored to the process-specific need of control, fault prognosis, and end-batch quality control. A T2 batch reactor case study is presented to showcase this approach to systematically address the interactions and trade-offs of multiple decision layers toward improving process efficiency and safety.

Antiretroviral Therapy and Cardiovascular Risk in People With HIV in the United States-An Updated Analysis.

Several antiretroviral therapy (ART) medications have been associated with increased cardiovascular risk, but less is known about the safety of modern ART. We sought to compare the risk of major adverse cardiac events (MACEs) among different ART regimens. Using insurance claims databases from 2008 to 2020, we identified adults aged <65 years who newly initiated ART. We compared non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens to protease inhibitors (PI)- and integrase inhibitors (INSTI)-based regimens. We used propensity score-weighted Kaplan-Meier functions to estimate the 6, 12, 18, 24, 36, and 48 months' risk and risk differences (RD) of MACE. Among 37 935 ART initiators (median age, 40 years; 23% female; 26% Medicaid-insured), 45% started INSTI-, 16% PI-, and 39% NNRTI-based regimens. MACE occurred in 418 individuals (1.1%) within 48 months after ART initiation. Compared to NNRTI initiators, the risk of MACE was higher at 12 months (RD, 0.50; 95% CI, 0.14-0.99), 18 months (RD, 0.53; 95% CI, 0.11-1.06), and 24 months (RD, 0.62; 95% CI, 0.04-1.29) for PI initiators, and at 12 (RD, 0.20; 95% CI, 0.03-0.37) and 18 months (RD, 0.31; 95% CI, 0.06-0.54) for INSTI initiators; the precision of estimates was limited for longer duration of follow-up. Among ART initiators, PI-based and INSTI-based regimens were associated with higher short-term risk of MACE compared to NNRTI-based regimens. The pattern of association between INSTIs and PIs with excess risk of MACE was similar.

The Role of Troponin in the Diagnosis and Treatment of Acute Pulmonary Embolism: Mechanisms of Elevation, Prognostic Evaluation, and Clinical Decision-Making.

Acute pulmonary embolism (APE) is a cardiovascular disease with severe consequences, wherein cardiac troponin (Tn) plays a pivotal role in diagnosis and treatment. This article reviews the various roles of Tn in managing APE. It looks at how Tn levels increase, their importance in predicting outcomes, and their use in making clinical decisions. Studies indicate that an elevation in Tn is primarily associated with right ventricular overload, ischemia, and necrosis, changes that directly reflect the extent of right ventricular dysfunction and myocardial injury. Elevated levels of Tn are significantly correlated with both short-term and long-term mortality risks in patients with APE, serving as crucial indicators for prognostic assessment and guiding therapeutic strategies. International guidelines recommend integrating Tn testing with clinical scoring and echocardiography to optimize treatment decisions in patients with APE. Despite the significant value of Tn determination in the management of APE, further research is needed to standardize its application. This paper emphasizes future research directions, including exploring the application of Tn in different patient subgroups withAPE and its potential combined use with other biomarkers.

Delirium Mediated the Association Between a History of Falls and Short-Term Mortality Risk in Critically Ill Ischemic Stroke Patients.

Patients with ischemic stroke have an increased propensity to fall, resulting in significant physical and psychological distress. This study examined the association between falls in the 3 months prior to intensive care unit (ICU) admission and mortality within 28 days among 2950 adult ICU patients diagnosed with ischemic stroke from 2008 to 2019, focusing on the potential mediating role of delirium. The primary outcomes were short-term mortality (28, 60, and 90 days) and the risk of delirium. Each patient was followed for at least 1 year. Delirium was primarily assessed using the Confusion Assessment Method for the ICU and by reviewing nursing notes. Group differences between patients with and without a history of falls were compared using the Wilcoxon rank-sum test or the chi-squared test. Cox proportional risk or logistic regression models were used to explore the association between fall history and outcomes, and causal mediation analysis was performed. Results showed that patients with a recent fall history had a significantly increased risk of 28-day (hazard ratio [HR]: 1.62, 95% confidence interval [CI]: 1.35-1.94), 60-day (HR: 1.67, 95% CI: 1.42-1.98), and 90-day mortality (HR: 1.66, 95% CI: 1.41-1.95), as well as an increased risk of delirium (odds ratio: 2.00, 95% CI: 1.66-2.42). Delirium significantly mediated the association between fall history and 28-day mortality (total effect: HR: 1.77, 95% CI: 1.45-2.16; natural indirect effect: HR: 1.12, 95% CI: 1.05-1.21; proportion mediated: 24.6%). These findings suggest that ischemic stroke patients with a recent fall have an increased risk of short-term mortality, partly mediated by delirium. Strategies aimed at preventing delirium may potentially improve prognosis in this patient population.

Optimization of Weibull Distribution Parameters with Application to Short-Term Risk Assessment and Strategic Investment Decision-Making

Accurate parameter estimation is fundamental in financial modeling, especially in investment analysis, where the Modified Internal Rate of Return (MIRR) plays a key role in evaluating investment performance. This study aims to enhance risk and return predictions in Sharia-compliant property investments by exploring the efficacy of various optimization techniques for estimating Weibull distribution parameters within the MIRR framework. To achieve this, we employed a comparative analysis of optimization methods, including Simulated Annealing (SA), Differential Evolution (DE), Genetic Algorithm (GA), and traditional Numerical Methods (NM). Performance was assessed through metrics such as Root Mean Squared Error (RMSE), Akaike Information Criterion (AIC), R-squared (R2) values, and Kolmogorov-Smirnov (KS) statistics. The results reveal that metaheuristic algorithms (SA, DE, GA) significantly outperform traditional numerical methods in terms of parameter estimation accuracy. Specifically, SA achieved the lowest RMSE of 0.042, with a Weibull shape parameter estimate of 1.254 and variance of 0.004, followed closely by DE with an RMSE of 0.048, and GA with 0.046. In contrast, NM exhibited a higher RMSE of 0.067, with a shape parameter estimate of 1.310 and a variance of 0.006. The AIC values for metaheuristic methods ranged from 14.25 to 14.68, compared to 15.12 for NM, and R2 values for metaheuristic methods ranged from 0.932 to 0.945, compared to 0.910 for NM. KS statistics further underscored the superior model fit of metaheuristics, with SA showing the lowest KS value of 0.045. The study underscores the critical role of metaheuristic optimization in improving the accuracy of parameter estimation based on MIRR models. This enhancement provides more reliable risk assessments and returns predictions, offering valuable insights for informed investment decision-making and contributing to optimized financial outcomes in the property sector.

The Effect of Smoking Cessation versus Current Smoking on Fracture Risk: The Manitoba BMD Registry

Current tobacco smoking is included in FRAXTM calculator for fracture risk assessment. It is unknown whether previous smoking increases the risk of fracture. The current analysis was performed to compare incident fracture risk associated with current smoking, smoking cessation and non-smoking. The study population comprised 18,115 individuals aged 40 years and older (mean age 68.8 years, 95.1% female) from a large clinical registry of DXA tests for the Province of Manitoba, Canada, with two consecutive visits (mean interval 4.4 years) where current smoking was recorded. Smokers (N=1620) were defined as those reporting current smoking at visit 2 (index date), non-smokers (N=15,942) as answering no to current smoking at both visits, and ex-smokers (N=553) as answering yes to current smoking at visit 1 but no at visit 2. Incident fractures were identified through healthcare data linkage. Compared with non-smokers, risk for any incident fracture (primary outcome) was significantly greater in current smokers (hazard ratio [HR] 1.41, 95% CI 1.19-1.67 adjusted for age/sex; HR 1.22, 95% CI 1.03-1.44 full adjusted) and ex-smokers (HRs 1.56, 95% CI 1.19-2.024 and 1.42, 95% CI 1.09-1.86, respectively). Similar directions and magnitudes of effect were seen for incident major osteoporotic fractures and hip fractures (secondary outcomes), with point estimates for ex-smokers that were close to current smokers. In summary, recent smoking cessation was associated with ongoing increased short-term fracture risk similar to current smoking. Larger studies are needed to better define the time course of fracture risk after smoking cessation.

Developing and validating intracity spatiotemporal air quality health index in eastern China

BackgroundRecently pilot published city-level air quality health index (AQHI) provides a useful tool for communicating short-term health risks of ambient air pollution, but fails to account for intracity spatial heterogeneity in exposure and associated population health impacts. This study aims to develop the intracity spatiotemporal AQHI (ST-AQHI) via refined air pollution-related health risk assessments. MethodsA three-stage analysis was conducted through integrating province-wide death surveillance data and high-resolution gridded estimates of air pollution and climate factors spanning 2016–2019 in Jiangsu Province, eastern China. First, an individual-level case-crossover design was employed to quantify the short-term risk of nonaccidental mortality associated with residential exposure to individual pollutant (i.e., PM2.5, NO2, O3, and SO2). Second, we accumulated and scaled the excess risks arising from multiple pollutants to formulate daily gridded ST-AQHI estimates at 0.1° × 0.1°, dividing exposure-related risks into low (0–3), moderate (4–6), high (7–9), and extreme high (10+) levels. Finally, the effectiveness of ST-AQHI as composite risk communication was validated through checking the dose-response associations of individual ST-AQHI exposure with deaths from nonaccidental and major cardiopulmonary causes via repeating case-crossover analyses. ResultsWe analyzed a total of 1,905,209 nonaccidental death cases, comprising 785,567 from circulatory diseases and 247,336 from respiratory diseases. In the first-stage analysis, for each 10-μg/m3 rise in PM2.5, NO2, O3, and SO2 exposure at lag-01 day, population risk of nonaccidental death was increased by 0.8% (95% confidence interval: 0.7%, 0.9%), 1.9% (1.7%, 2.0%), 0.4% (0.3%, 0.5%), and 4.1% (3.7%, 4.5%), respectively. Spatiotemporal distribution of ST-AQHI exhibited a consistent declining trend throughout the study period (2016–2019), with annual average ST-AQHI decreasing from 5.2 ± 1.3 to 4.0 ± 1.0 and high-risk days dropping from 15.8% (58 days) to 1.6% (6 days). Exposure associated health risks showed great intracity- and between-city heterogeneities. In the validation analysis, ST-AQHI demonstrated approximately linear, threshold-free associations with multiple death events from nonaccidental and major cardiopulmonary causes, suggesting excellent performance in predicting exposure-related health risks. Specifically, each 1-unit rise in ST-AQHI was significantly associated with an excess risk of 2.0% (1.8%, 2.1%) for nonaccidental mortality, 2.3% (2.1%, 2.6%) for overall circulatory mortality, and 2.7% (2.3%, 3.1%) for overall respiratory mortality, as well as 1.7%–3.0% for major cardiopulmonary sub-causes. ConclusionsST-AQHI developed in this study performed well in predicting intracity spatiotemporal heterogeneity of death risks related to multiple air pollutants, and may hold significant practical importance in communicating air pollution-related health risks to the public at the community scales.

Diurnal Cycle of Precipitation and Extremes in Nepal

This study examines the spatio-temporal distribution of hourly precipitation across Nepal using Integrated Multi-Satellite Retrievals for Global Precipitation Measurement (IMERG) data from 2015 to 2021. The findings indicate that hourly precipitation intensity during the monsoon season can reach up to 0.7 mm/hr, while pre-monsoon intensities peak at 0.2 mm/hr. These intensities are predominantly concentrated in mid- and low-elevation areas of central and eastern Nepal. Post-monsoon and winter seasons exhibit high-intensity precipitation patches over high-elevation regions in the western, central, and eastern peripheries of the country. The annual distribution of hourly precipitation shows a pronounced peak during the monsoon season, indicating that a significant portion of the total annual precipitation occurs during this period. Extreme precipitation events follow a similar seasonal distribution, with monsoon extremes exceeding 15 mm/hr. The diurnal cycle of monsoonal precipitation shows unique characteristics, peaking at 0.65 mm/hr around midnight and decreasing to 0.2 mm/hr by late morning, then increasing steadily in the afternoon and evening. Additionally, the study contrasts hourly heavy precipitation extremes (≥10 mm/hr or day) with daily extremes, noting that hourly extremes, despite being accumulated into daily measures, present a higher frequency, and pose greater short-term hazard risks. This analysis over a seven-year period suggests the need for continued research to determine spatial and temporal trends in hourly versus daily extreme precipitation patterns, particularly in the context of climate change and its impacts on regional hydrology and meteorology.

Long-term effects of unintended pregnancy on children: Findings from the Dutch prospective birth-cohort Amsterdam born children and their development study

Several studies investigated short-term risks of children born from unintended pregnancies, however evidence about long-term risks is lacking. We aimed to examine whether children born from unintended pregnancies experience psychosocial problems up into adolescence. This study is based on the longitudinal birth cohort study ‘Amsterdam Born Children and their Development’ (n = 7784). Unintended pregnancy was measured as a multidimensional construct, based on self-reports on the extent of pregnancy mistiming (‘This pregnancy happened too soon’), unwantedness (‘I did not want to be pregnant (anymore)’) and unhappiness (‘I am happy to be pregnant’; recoded). Further, children's psychosocial problems were measured with the Strengths and Difficulties Questionnaire, at 5–6, 11–12 and 15–16 years old. Multiple over-time associations between unintended pregnancy and children's psychosocial problems were analysed using Structural Equation Modelling, while controlling for confounders. Results showed that pregnancy mistiming was a significant predictor of internalizing (β = 0.10, p < 0.001) and externalizing problems (β = 0.07, p = 0.006) and unwanted pregnancy of internalizing problems (β = 0.13, p < 0.001) at 5–6 years. These associations were substantially mediated by maternal mental health and poorer maternal bonding. Associations were no longer present at 11–12 and 15–16 years. Thus, we conclude that children born from unintended pregnancies experience more psychosocial problems at 5–6 years, but no longer at 11–12 and 15–16 years. Unintended pregnancies often coincide with maternal mental health problems and socioeconomic factors. Most importantly, the associations between unintended pregnancy and children's psychosocial problems are influenced by maternal mental health and poorer bonding. Therefore it is important to improve maternal mental health and bonding for the benefit of both mother and child, rather than on the isolated effect of unintended pregnancy per se.