Single Risk Research Articles

Kajian Keberhasilan Implementasi Kebijakan Online Single Submission Risk Based Approach (OSS-RBA) di DPMPTSP Kabupaten Ketapang pada Perusahaan Perkebunan

Online Single Submission Risk Based Approach (OSS-RBA) is a risk-based business licensing service system that is carried out online. It is important to know about the application of the OSS-RBA Policy because it relates to the country's national achievements in simplifying the business licensing process and attracting foreign investors. The plantation business sector, especially oil palm, is important to pay attention to. The high contribution of the country's foreign exchange originating from this industry is one of the reasons the government has made the business licensing process smooth. For this reason, this research aims to measure the level of success in implementing the OSS-RBA Policy in the Investment and One-Stop Integrated Services Service (DPMPTSP) Ketapang Regency, especially in plantation companies. This research uses a mixed method with purposive sampling. In this study, respondents were divided into two groups, specifically 4 respondents from the policy implementer and 35 respondents from the oil palm plantation company. The George Edward III Policy Implementation Model used theory, which determined four indicators that influence implementation: communication, resources, disposition, and bureaucratic structure. The research on communication indicators showed that there had been a clear and consistent transmission of information from policymakers to policy implementers and business actors. Meanwhile, equipment and authority resources have been fulfilled in the resource indicators. For disposition, licensing services have been provided optimally. Finally, regarding bureaucratic structure indicators, DPMPTSP Ketapang Regency has done SOPs for services and licensing activities.

Association Between Comorbid Anxiety and Depression and Health Risk Behaviors Among Chinese Adolescents: Cross-Sectional Questionnaire Study.

Comorbidity of psychiatric disorders such as depression and anxiety is very common among children and adolescents. Few studies have examined how comorbid anxiety and depression are associated with health risk behaviors (HRBs) in adolescents, which could inform preventative approaches for mental health. We evaluated the association between HRBs and comorbid anxiety and depression in a large adolescent cohort. We used data from 22,868 adolescents in the National Youth Cohort (China). Anxiety and depression symptoms were assessed using the 9-item Patient Health Questionnaire scale and the 7-item Generalized Anxiety Disorder scale, respectively. Comorbidity was determined by the coexistence of anxiety and depression. HRBs including poor diet, smoking, physical inactivity, and poor sleep, as well as the above HRB scores, were added to obtain the total HRB score (HRB risk index). Based on single and total HRB scores, we divided participants into low-, medium-, and high-risk groups. Potential confounders included gender, presence of siblings, regional economic level, educational status, self-rated health, parental education level, self-reported family income, number of friends, learning burden, and family history of psychosis. Correlation analysis was used to explore associations between single risk behaviors. Binary logistic regression estimated the association between HRBs and anxiety-depression comorbidity before and after adjusting for potential confounders. The comorbidity rate of anxiety and depression among Chinese adolescents was 31.6% (7236/22,868). There was a statistically significant association between each HRB (P<.05), and HRBs were positively associated with comorbid anxiety and depression in the above population. For single HRBs, adolescents with poor diet, smoking, and poor sleep (medium-risk) were more prone to anxiety-depression comorbidity after adjusting for confounders compared to low-risk adolescents. However, adolescents with all high-risk HRBs were more likely to have comorbid anxiety and depression after adjusting for confounders (poor diet odds ratio [OR] 1.50, 95% CI 1.39-1.62; smoking OR 2.17, 95% CI 1.67-2.81; physical inactivity OR 1.16, 95% CI 1.06-1.28; poor sleep OR 1.84, 95% CI 1.70-2.01). Moreover, in both unadjusted (medium risk OR 1.79, 95% CI 1.56-2.05; high risk OR 3.09, 95% CI 2.72-3.52) and adjusted (medium risk OR 1.57, 95% CI 1.37-1.80; high risk OR 2.33, 95% CI 2.03-2.68) models, HRB risk index, like clustered HRBs, was positively associated with anxiety-depression comorbidity, and the strength of the association was stronger than for any single HRB. In addition, we found that compared to girls, the association between clustered HRBs and anxiety-depression comorbidity was stronger in boys after adjustment. We provide evidence that HRBs are related to comorbid anxiety and depression. Interventions that decrease HRBs may support mental health development in adolescence, with the potential to improve health and well-being through to adulthood.

The Role of Sex and Gender in Dermatology - From Pathogenesis to Clinical Implications.

Sex and gender have increasingly been recognized as significant risk factors for many diseases, including dermatological conditions. Historically, sex and gender have often been grouped together as a single risk factor in the scientific literature. However, both may have a distinct impact on disease incidence, prevalence, clinical presentation, severity, therapeutic response, and associated psychological distress. The mechanisms that underlie differences in skin diseases between males, females, men, and women remain largely unknown. The specific objectives of this review paper are:To highlight the biological differences between males and females (sex), as well as the sociocultural differences between men and women (gender) and how they impact the integumentary system.To perform a literature review to identify important sex- and gender-related epidemiological and clinical differences for various skin conditions belonging to a range of disease categories and to discuss possible biological and sociocultural factors that could explain the observed differences.To discuss dermatological skin conditions and gender-affirming treatments within the transgender community, a population of individuals who have a gender identity which is different than the gender identity they were assigned at birth. With the rising number of individuals that identify as non-binary or transgender within our increasingly diverse communities, it is imperative to recognize gender identity, gender, and sex as distinct entities. By doing so, clinicians will be able to better risk-stratify their patients and select treatments that are most aligned with their values. To our knowledge, very few studies have separated sex and gender as two distinct risk factors within the dermatology literature. Our article also has the potential to help guide future prevention strategies that are patient-tailored rather than using a universal approach.

Review: Genes Involved in Mitochondrial Physiology Within 22q11.2 Deleted Region and Their Relevance to Schizophrenia.

Schizophrenia is associated with altered energy metabolism, but the cause and potential impact of these metabolic changes remain unknown. 22q11.2 deletion syndrome (22q11.2DS) represents a genetic risk factor for schizophrenia, which is associated with the loss of several genes involved in mitochondrial physiology. Here we examine how the haploinsufficiency of these genes could contribute to the emergence of schizophrenia in 22q11.2DS. We characterize changes in neuronal mitochondrial function caused by haploinsufficiency of mitochondria-associated genes within the 22q11.2 region (PRODH, MRPL40, TANGO2, ZDHHC8, SLC25A1, TXNRD2, UFD1, and DGCR8). For that purpose, we combine data from 22q11.2DS carriers and schizophrenia patients, in vivo (animal models) and in vitro (induced pluripotent stem cells, IPSCs) studies. We also review the current knowledge about seven non-coding microRNA molecules located in the 22q11.2 region that may be indirectly involved in energy metabolism by acting as regulatory factors. We found that the haploinsufficiency of genes of interest is mainly associated with increased oxidative stress, altered energy metabolism, and calcium homeostasis in animal models. Studies on IPSCs from 22q11.2DS carriers corroborate findings of deficits in the brain energy metabolism, implying a causal role between impaired mitochondrial function and the development of schizophrenia in 22q11.2DS. The haploinsufficiency of genes within the 22q11.2 region leads to multifaceted mitochondrial dysfunction with consequences to neuronal function, viability, and wiring. Overlap between in vitro and in vivo studies implies a causal role between impaired mitochondrial function and the development of schizophrenia in 22q11.2DS.

Mechanisms of immunity in acutely decompensated cirrhosis and acute-on-chronic liver failure.

The identification of systemic inflammation (SI) as a central player in the orchestration of acute-on-chronic liver failure (ACLF) has opened new avenues for the understanding of the pathophysiological mechanisms underlying this disease condition. ACLF, which develops in patients with acute decompensation of cirrhosis, is characterized by single or multiple organ failure and high risk of short-term (28-day) mortality. Its poor outcome is closely associated with the severity of the systemic inflammatory response. In this review, we describe the key features of SI in patients with acutely decompensated cirrhosis and ACLF, including the presence of a high blood white cell count and increased levels of inflammatory mediators in systemic circulation. We also discuss the main triggers (i.e. pathogen- and damage-associated molecular patterns), the cell effectors (i.e. neutrophils, monocytes and lymphocytes), the humoral mediators (acute phase proteins, cytokines, chemokines, growth factors and bioactive lipid mediators) and the factors that influence the systemic inflammatory response that drive organ failure and mortality in ACLF. The role of immunological exhaustion and/or immunoparalysis in the context of exacerbated inflammatory responses that predispose ACLF patients to secondary infections and re-escalation of end-organ dysfunction and mortality are also reviewed. Finally, several new potential immunogenic therapeutic targets are debated.

Maternal Serum Angiogenic Profile and Its Correlations with Ultrasound Parameters and Perinatal Results in Normotensive and Preeclamptic Pregnancies Complicated by Fetal Growth Restriction

FGR is a complication of pregnancy in which the fetus does not reach its programmed growth potential due to placental reasons and it is the single largest risk factor of stillbirth. Babies with FGR are at increased risk of mortality and morbidity not only in the perinatal period, but also in later life. FGR presents a huge challenge for obstetricians in terms of its detection and further monitoring of pregnancy. The ultrasound is the gold standard here; apart from assessing fetal weight, it is used to measure Doppler flows in maternal and fetal circulation. It seems that additional tests, like biochemical angiogenic factors measurement would be helpful in diagnosing FGR, identifying fetuses at risk and adjusting the surveillance model. The study aimed to assess the potential relationship between the concentration of sEng, sFlt-1, PlGF, and the sFlt-1/PlGF ratio in maternal serum at delivery and maternal and fetal Doppler flow measurements as well as perinatal outcomes in pregnancies complicated by FGR with and without PE, isolated PE cases and normal pregnancies. The use of angiogenic markers is promising not only in PE but also in FGR. Numerous correlations between ultrasound and Doppler studies, perinatal outcomes and disordered angiogenesis marker levels in maternal serum suggest that biochemical parameters have a great potential to be used as a complementary method to diagnose and monitor pregnancies with FGR. The, PlGF in particular, could play an outstanding role in this regard.

Exploring the transfer of risks

Societal safety is often centred on handling or managing a single risk from the perspective of a particular at-risk group or individual, in a specific time and place. However, such linear and single-facetted processes are rare and the current approaches in societal risk management fail to comprehensively include and discuss the full range of outcomes and its inherent uncertainty and complexity. By combining different examples of known and unknown outcomes of societal risk management in the scientific literature, this paper aim to contribute to the risk and safety research field by presenting a conceptual model of risk transfer. The conceptual model shows how traditional societal risk management strategies often aim at reducing a targeted risk, considering the original actors affected by this risk, in a defined geographical area and for a decided time frame despite risk management also altering the landscape of risks for other actors, in other places, and at other times, as well as for the original actors, in the original place, and during the original time. Combining these aspects in a conceptual model that accepts and incorporates complexity, the underlying intention is to initiate a discussion regarding the current approaches and understandings of societal risk management and societal safety.

Oppositional defiant disorder.

Oppositional defiant disorder (ODD) is a disruptive behaviour disorder involving an ongoing pattern of angry/irritable mood, argumentative/defiant behaviour and vindictiveness. Onset is typically before 8 years of age, although ODD can be diagnosed in both children and adults. This disorder is associated with substantial social and economic burden, and childhood ODD is one of the most common precursors of other mental health problems that can arise across the lifespan. The population prevalence of ODD is ~3 to 5%. A higher prevalence in males than females has been reported, particularly before adolescence. No single risk factor accounts for ODD. The development of this disorder seems to arise from the interaction of genetic and environmental factors, and mechanisms embedded in social relationships are understood to contribute to its maintenance. The treatment of ODD is often successful, and relatively brief parenting interventions produce large sized treatment effects in early childhood. Accordingly, ODD represents an important focus for research, practice and policy concerning early intervention and prevention in mental health.

Risk Assessment of Maize Yield Losses in Gansu Province Based on Spatial Econometric Analysis

The frequent occurrence of meteorological disasters in China has caused huge losses to agriculture. Risk assessment serves as a bridge from disaster crisis management to disaster risk management. Therefore, it is necessary to carry out a refined comprehensive risk assessment of meteorological disasters in typical areas. However, several limitations remain in the disaster loss risk research, such as too coarse resolution and too single risk indicator. Additionally, less research has examined geographical information on risk clustering and barycenter migration, as well as temporal information on the sustainability of trends. Consequently, it is significant to unearth the geographical and temporal information on disaster loss and identify the refined spatial and temporal evolution pattern of crop risk. For this reason, we evaluated the risk of corn production in Gansu Province. First, based on maize yield data, a risk evaluation index system was constructed using the characteristics of variation trends, fluctuations, and extreme values of disaster losses. Then, the spatial distribution patterns and temporal evolution characteristics of maize production risks on a county scale in Gansu Province were determined using spatial analysis and climate diagnosis technology. The results show that there is a large interdecadal fluctuation in risk. In the 1980s, 1990s, 2000s, and 2010s, the average yield reduction rates of maize in Gansu Province were −11.8%, −12.6%, −8.7%, and −8.5%, and the proportions of counties with severe yield reduction were 34.8%, 44.4%, 20.8%, and 9.7%, respectively. Second, most counties belong to medium-low or low-risk areas for maize production. High-risk counties are primarily located in eastern and southern Gansu, whereas low-risk counties are mostly found along the Hexi Corridor. Third, most risk indicators exhibit some geographical aggregation. The Jiuquan region falls within the low-low-risk aggregation zone. In contrast, the Qingyang region is a high-high aggregation zone with a gradual expansion trend. Four, each risk indicator’s geographical barycenter migrates over a complicated path, but the direction and distance vary considerably. The comprehensive risk migrates along the south-northwest-southeast trajectory, albeit at a shorter distance. Five, the proportion of counties with a medium, medium-severe, severe, and total yield reduction tended to decline. In addition, the annual precipitation is significantly or very significantly correlated with most risk indicators and the comprehensive risk level. The results can guide agricultural production processes at all levels, as well as government disaster prevention.

#4183 A PHENOTYPIC DRIVEN RITUXIMAB MAINTENANCE APPROACH IS EFFECTIVE AND SAFE IN PATIENTS WITH ANCA ASSOCIATED VASCULITIS

Abstract Background and Aims Rituximab (RTX) has emerged as the first-line treatment to maintain remission in ANCA-Associated Vasculitis (AAV). However, the ideal strategy to RTX re-dosing is still unclear [1]. Method In this monocentric and retrospective study we evaluated the efficacy and safety of two RTX-based maintenance regimens in patients with AAV. Fixed-dose (FD) RTX dosing, consisting of at least 3 pre-emptive RTX administrations every 6 months, was preferred in patients judged to be at high relapse risk. Instead, a biomarker-guided on-demand (OD) RTX dosing strategy was preferred for patients deemed at lower risk of relapse; this consisted in RTX re-treatment only in case of B-cell repopulation or rise in ANCA titer. The single patient relapse risk was assessed according to the disease phenotype (granulomatous vs vasculitic), the ANCA specificity and the disease status (onset vs relapse). Relapses were defined as increase of disease activity requiring escalation of immunosuppression; major relapses were defined in case of life/organ-threatening manifestations. Results The study included 100 patients followed for a median of 24 months (IQR 20-30), 51% treated with an OD and 49% with a FD strategy. The main baseline characteristics of our cohort are shown in the Table; patients treated with a FD strategy were more often GPA, PR3-ANCA positive, with relapsing disease and ENT involvement and less frequent renal involvement. The FD group received a median of 4 (IQR 4-4) administrations of RTX for a median cumulative dose of 2 g (IQR 2-2). Only 6 (11.8%) patients in the OD group received RTX as maintenance therapy with a median of 1 (IQR 1-3) administration of RTX for a median cumulative dose of 0.75 g (IQR 0.5-1.75). Thirteen relapses occurred, 6 in the FD group and 7 in the OD one. Remission rates were comparable in the two cohorts, with respectively 87.6% and 85.9% of the patients in remission at 24 months (Figure 1 - panel A). No significant differences in remission rates across the 2 groups were observed after considering only major flares or after stratification according to clinical diagnosis (MPA/GPA) and ANCA specificity (Figure 1 - panel B to F). Ten and 20 severe infections (p = 0.383) and 3 and 1 cancer (p = 0.581) occurred respectively in the FD and OD group. Conclusion In our case series, a phenotypic-driven approach to RTX maintenance showed comparable efficacy and safety between fixed and on-demand dosing, despite different baseline characteristics between the two groups. These results suggest that personalizing RTX maintenance may be a feasible and safe strategy.

Improving 10-year cardiovascular risk prediction in apparently healthy people: flexible addition of risk modifiers on top of SCORE2.

In clinical practice, factors associated with cardiovascular disease (CVD) like albuminuria, education level, or coronary artery calcium (CAC) are often known, but not incorporated in cardiovascular risk prediction models. The aims of the current study were to evaluate a methodology for the flexible addition of risk modifying characteristics on top of SCORE2 and to quantify the added value of several clinically relevant risk modifying characteristics. Individuals without previous CVD or DM were included from the UK Biobank; Atherosclerosis Risk in Communities (ARIC); Multi-Ethnic Study of Atherosclerosis (MESA); European Prospective Investigation into Cancer, The Netherlands (EPIC-NL); and Heinz Nixdorf Recall (HNR) studies (n = 409 757) in whom 16 166 CVD events and 19 149 non-cardiovascular deaths were observed over exactly 10.0 years of follow-up. The effect of each possible risk modifying characteristic was derived using competing risk-adjusted Fine and Gray models. The risk modifying characteristics were applied to individual predictions with a flexible method using the population prevalence and the subdistribution hazard ratio (SHR) of the relevant predictor. Risk modifying characteristics that increased discrimination most were CAC percentile with 0.0198 [95% confidence interval (CI) 0.0115; 0.0281] and hs-Troponin-T with 0.0100 (95% CI 0.0063; 0.0137). External validation was performed in the Clinical Practice Research Datalink (CPRD) cohort (UK, n = 518 015, 12 675 CVD events). Adjustment of SCORE2-predicted risks with both single and multiple risk modifiers did not negatively affect calibration and led to a modest increase in discrimination [0.740 (95% CI 0.736-0.745) vs. unimproved SCORE2 risk C-index 0.737 (95% CI 0.732-0.741)]. The current paper presents a method on how to integrate possible risk modifying characteristics that are not included in existing CVD risk models for the prediction of CVD event risk in apparently healthy people. This flexible methodology improves the accuracy of predicted risks and increases applicability of prediction models for individuals with additional risk known modifiers.

Elevated cancer risk among individuals with combinations of cancer-related risk factors: A large claims database analysis.

10561 Background: Besides age, many risk factors have been associated with elevated cancer risk. Understanding cancer incidence rates among patients with single or multiple risk factors can help inform cancer prevention and detection efforts. Methods: A retrospective observational analysis was conducted on individuals aged 50-79 in 2020 using Optum’s de-identified Clinformatics Data Mart Database which includes Medicare Advantage (MA) (vast majority aged 65+) and commercially insured members (mostly below 65 and employed). Patients with no prior cancer diagnosis (continuously enrolled with no cancer claims for one year) and with cancer risk factors were identified using ICD-10-CM and CPT-4 codes, including autoimmune-related chronic inflammation (diabetes, inflammatory bowel disease, asthma, or rheumatoid arthritis) (INFLAM AUTO); non-autoimmune related chronic inflammation (fatty liver disease, obesity, or cirrhosis/chronic hepatitis B/C) (INFLAM NONAUTO); immunodeficiency (primary or secondary immunodeficiency, HIV, or status post organ transplant); and smoking. Cancer incidence rate ratios (IRR) were calculated by comparing one-year cancer incidence rate among the groups with risk factors versus the general population by insurance type (IRR&gt;1 means elevated risk of cancer). Groups with evidence of any risk factor and combinations of risk factors were assessed. Statistical significance of IRRs was evaluated using logistic regression models adjusting for demographic characteristics. Results: Cancer incidence rates of 1.12% and 2.11% were observed among the approximately 1.3 and 2.4 million general population aged 50-79 in commercial and MA plans, respectively. Enrollees with any of the risk factors or combinations analyzed had statistically significantly elevated risk of cancer (IRRs&gt;1.00, p&lt;0.05). Commercially insured groups with highest risk included transplant (IRR=7.68, prevalence=0.02%), immunodeficient and smokers (IRR=3.66, prevalence=0.16%), cirrhosis/chronic hepatitis B/C (IRR=2.61, prevalence=0.41%), INFLAM AUTO and smokers (IRR=2.43, prevalence=3.56%), and smoker (IRR=2.33, prevalence=11.11%). Results in MA were generally consistent with the commercial plan (Table). Conclusions: Patients in both commercial and MA plans with any risk factor experienced significantly elevated cancer risk. Cancer prevention and screening strategies can be informed by risk levels among different patient subgroups to optimize resource allocation. [Table: see text]

Identification of novel genetic variants and biomarkers for cognitive decline in Alzheimer’s disease

AbstractBackgroundAlzheimer’s disease (AD) is a complex, multifactorial disease that is incurable in the aging population. The success of genome‐wide association studies (GWAS), as a cross sectional design, to identify novel genetic risk factors for AD in recent years is well known; however, case‐control studies are less likely to uncover genetic factors that influence other aspects of the disease, such as progression and onset.MethodIn order to identify common and rare genetic variants associated with rates of cognitive decline in AD, we aim at systematically analyzing the largest collection of longitudinal and GWAS data (N = 7,241), across non‐Hispanic white individuals from multicenter cohorts (Knight‐ADRC, ADNI, NACC, and GSK) with at least 1.5 years of follow up after being diagnosed with AD. We also aim at exploring if genetic risk factors, alone or interacting with other genetic factors, are associated rate of cognitive decline in patients with AD when aggregated together into a single Polygenic Risk Score (PRS). Furthermore, external proteomics data will be combined with the genetics data for Mendelian Randomization (MR) analyses in order to discover causal biomarkers for cognitive decline and AD risk.ResultPreliminary results found a suggestive signal in chr21 (min P = 8.7e‐8) approaching close to the genome‐wide significance threshold. Moreover, some other suggestive signals were detected in chr2 (min P = 3.8e‐06) and chr1 (min P = 3.7e‐06) that warrant further investigation. Further results and key findings of the post‐GWAS analyses will be presented during the AAIC meeting.ConclusionWe have leveraged these datasets to generate prediction models for rate of cognitive decline in AD. The identification of AD‐specific genetic variants and biomarkers will enable the characterization of appropriate therapeutic targets for slowing or halting the AD progression.

Alzheimer’s disease risk alleles of PICALM gene may accelerate cognitive (memory and attention) performance in middle‐aged healthy APOE‐ε4 carriers

AbstractBackgroundThe APOE (allele ε4) and PICALM (SNPs rs541458: allele T; and rs3851179: allele G) genes were recognized as risk factors for late‐onset Alzheimer’s disease (AD). However, effects of these risk genes on the cognitive functions of healthy individuals are still not determined and their possible interactions have never been studied. We investigated the preclinical influence of both genes on brain cognitive functions in a healthy middle‐aged population.MethodSeventy three healthy adults (50‐63 y/o) completed computer tasks measuring attention, cognitive control and memory. MSIT task included an easy‐control condition and an attentionally demanding condition with combined cognitive conflicts. Sternberg’s task included an easy condition (there is a need to memorize 4 letters strings) and a hard‐one (with 8 letters strings). APOE (rs429358/rs7412) and PICALM (rs3851179 and rs541458) alleles were determined using a traditional Sanger sequencing protocol. The data was divided according to the genetic tests results (control group: absence of ε4 and less‐risky PICALM alleles; the double risk group: ε4‐carriers, and homozygous carriers of high‐risk PICALM alleles; single risk group: ε4‐carriers and less‐risky PICALM alleles). ANOVA was used to determine the effects of genetic variants on task performance (reaction time (RT) and accuracy for easy/hard MSIT and Sternberg conditions).ResultResults revealed that while the groups did not differ in accuracy or RTs for easy conditions, they did differ significantly on hard conditions (p&lt;0.05). The single‐risk group showed longer RTs than the control group in both tasks. The effect was preserved when performing the analysis of covariance (ANCOVA) with the age as a covariate.ConclusionAD risk genes, APOE and PICALM, can affect cognitive abilities even in healthy individuals. APOE‐ε4‐carriers needed longer time to process difficult stimuli but surprisingly an addition of PICALM risk alleles seemed to reverse this tendency. Further studies are needed to unambiguously determine the effects of the PICALM and its interactions with other risk genes (including APOE) in modulating the cognitive abilities of still healthy individuals.[Supported by National Science Centre, Poland, no. 2018/31/N/HS6/03551.]

Die Komplexität in der Sturzprävention und Mobilität bei älteren Menschen

The Complexity in Fall Prevention and Mobility in Older Persons Abstract: Falls have often far-reaching consequences for the older person. In contrast to the positive development in fall prevention over the last 20 years, the number of falls is still increasing in the older population worldwide. In addition, the fall risk varies between different settings, as for the community-dwelling older population fall rates of about 33% are reported whereas in the long-term care setting rates of about 60% are described. In the hospital setting fall rates are also higher than in community-dwelling older persons. Falls are seldom caused by just one single risk factor. The complexity of the interacting risk factors ranges from biological, socioeconomical, environmental, and behavioral risk factors. The following article will address the complexity and the dynamic interaction of these risk factors. Special interest will be given to the behavioral and environmental risk factors, as well as an effective screening and assessment, which are also presented in the new recommendations by the World Falls Guidelines (WFG).

Relative Humidity and Its Impact on the Immune System and Infections.

Relative humidity (RH) represents an underestimated outdoor and indoor environmental parameter. Conditions below and above the optimal range could facilitate infectious transmission as well as the exacerbation of respiratory diseases. The aim of this review is to outline the consequences for health of suboptimal RH in the environment and how to limit this negative impact. RH primarily affects the rheological properties of the mucus, modifying its osmolarity and thus the mucociliary clearance. The integrity of the physical barrier, maintained by mucus and tight junctions, is critical for protection from pathogens or irritants. Moreover, the control of RH seems to be a strategy to prevent and control the spread of viruses and bacteria. However, the imbalance of RH in the outdoor and indoor environments is frequently associated with the presence of other irritants, allergens, and pathogens, and therefore the burden of a single risk factor is not clearly defined in different situations. Nonetheless, RHmay have a synergistic negative effect with these risk factors, and its normalization, if possible, may have a positive impact on a healthier environment.

Assessing the impact of critical risk factors on the development of musculoskeletal disorders: a structural equation modelling approach

Musculoskeletal Disorders (MSDs) have a significant impact on people’s lives as well as their workplaces, organizations, families, society, and national economy. Therefore, the main objective of this study is to investigate the impacts of different risk factors in developing MSD problems. Structural equation modelling has been used to examine the effects of different risk factors on developing MSD problems. Five hypotheses were developed for workplace, personal, biomechanical, psychosocial, and organisational risk factors to examine the positive relation with MSD problems generation. Results showed that biomechanical risk factors, including repetitive motion, vibration, force, posture, and deviation from neutral body alignment, have significant impacts on the development of MSD problems. Similar results were found for workplace, personal, psychosocial, and organisational risk factors. Therefore, either the single risk factor or collectively contributes significantly to MSD problems generation. Decision-makers can use this study to analyse the impacts of different factors on the generation of MSD problems within their industries or organizations. To the best of the author’s knowledge, this study is the first and foremost approach to determine the impacts of the critical risk factors on developing MSD problems through an organised and scientific approach.

The methylation level of a single cancer risk marker gene reflects methylation burden in gastric mucosa.

Gastric cancer risk can be accurately predicted by measuring the methylation level of a single marker gene in gastric mucosa. However, the mechanism is still uncertain. We hypothesized that the methylation level measured reflects methylation alterations in the entire genome (methylation burden), induced by Helicobacter pylori (H. pylori) infection, and thus cancer risk. Gastric mucosa of 15 healthy volunteers without H. pylori infection (G1), 98 people with atrophic gastritis (G2), and 133 patients with gastric cancer (G3) after H. pylori eradication were collected. Methylation burden of an individual was obtained by microarray analysis as an inverse of the correlation coefficient between the methylation levels of 265,552 genomic regions in the person's gastric mucosa and those in an entirely healthy mucosa. The methylation burden significantly increased in the order of G1 (n = 4), G2 (n = 18), and G3 (n = 19) and was well correlated with the methylation level of a single marker gene (r = 0.91 for miR124a-3). The average methylation levels of nine driver genes tended to increase according to the risk levels (P = 0.08 between G2 vs G3) and was also correlated with the methylation level of a single marker gene (r = 0.94). Analysis of more samples (14 G1, 97 G2, and 131 G3 samples) yielded significant increases of the average methylation levels between risk groups. The methylation level of a single marker gene reflects the methylation burden, which includes driver gene methylation, and thus accurately predicts cancer risk.

RISK FACTORS AND SURGICAL APPROACH FOR PARS PLANA VITRECTOMY OF POSTERIORLY DISLOCATED INTRAOCULAR LENSES

The retrospective study was conducted in the Department of Ophthalmology, Nishtar Medical Hospital, and Bakhtawar Amin Trust Hospital from January 2022 to January 2023 to evaluate risk factors and surgical approach for posterior dislocation of the intraocular lens into vitreous requiring pars plana vitrectomy. A total of 30 eyes of 30 patients (20 male and 10 female) were included in the study. Standard PPV vitrectomy was performed in all patients. The Iris fixation technique was used in patients having a 3-piece lens design. A sclera fixation technique was performed to secure the lens and prevent it from falling onto the retina. IOL (Intra-Ocular Lens) was exchanged in eyes in which it was previously damaged. Results showed that in 28 (93.3%) eyes, the original lens was conserved and positioned on the scleral wall, iris, or both. The existing lens could not be preserved in 2(6.6%) eyes. 92.1% of cases had a single risk factor for IOL dislocation. After surgery, uncorrected visual acuity (UCVA) improved from 20/400 on the initial visit to 20/80 on the final (P=0.001). UCVA remained unchanged in 3 (10%) patients and improved in 27 (90%) patients. It can be concluded that the incidence of posterior IOL dislocation has been increasing. Intravitreal substance injections, myopia, and previous vitrectomy are the major risk factors. In most cases, the existing lens can be preserved and secured in the posterior chamber through pars plana vitrectomy.

Implementing and maintaining an evergreen risk screening program in an exploration and production company

A risk screening program has been developed to identify facilities that have the potential impact to public and environmental receptors. This allows the company to assess and effectively manage the risks associated with these facilities through their internal “Specialized Field Risk Management” (SFRM) program. Conducting risk screening and keeping it current in an operating environment is very challenging because of the large number of ongoing development projects, the frequent changes of operating conditions, and public encroachment on these facilities. This paper presents a systematic approach to implement and keep this risk screening program evergreen under these changing conditions. In this approach, existing project management systems such as Management of Change and Well Execution Planner were leveraged to develop and convey the risk screening workflow. In areas of concern such as public encroachment, where monitoring processes were not in place, a risk screening workflow was created to address the gap. This risk screening workflow was also integrated into asset acquisition due diligence activities to support these important business decisions. These workflows were consolidated into a single robust risk screening program managed by a centralized functional group. This program has been proven effective in identifying and avoiding potential high offsite risks in the planning stage of a project, as well as to help manage these risks through the asset’s life cycle.