Vulnerability Characteristics Research Articles

Abstract 15654: Layered Plaques and Plaque Vulnerability in Patients With Stable Angina Pectoris

Backgrounds: Layered plaque, a signature of previous plaque destabilization and healing, is one of the predictors for rapid plaque progression, the mechanism of which is unknown. Aims: To investigate the level of vascular inflammation and plaque vulnerability in layered plaques to elucidate possible mechanisms of rapid plaque progression. Methods: Patients who underwent both coronary computed tomography angiography (CTA) and optical coherence tomography (OCT) were selected. Plaques were defined as any tissue (noncalcified, calcified, or mixed) within or adjacent to the lumen. Pericoronary adipose tissue (PCAT) attenuation was measured at the plaque level on CTA. OCT features of plaque vulnerability were assessed at the corresponding site. Results: A total of 475 plaques from 195 patients presented with stable angina pectoris were included. Layered plaques (n=241), compared to non-layered plaques (n=234), had a higher level of vascular inflammation (-70.94 [-77.86, -64.66] HU vs. -73.52 [-80.83, -67.66] HU, P=0.014, Figure 1). Layered plaques also had a higher prevalence of the features of plaque vulnerability (Figure 2), including lipid-rich plaque (83.8% vs. 66.7%, P<0.001), thin-cap fibroatheroma (TCFA) (26.1% vs. 17.5%, P=0.026), microchannel (61.8% vs. 34.6%, P<0.001), and cholesterol crystal (38.6% vs. 25.6%, P=0.003). Conclusions: Layered plaque was associated with higher levels of vascular inflammation and plaque vulnerability, which might play an important role in plaque progression.

Abstract 14643: Coronary Spotty Calcification is Associated With a Higher Level of Plaque Vulnerability and Vascular Inflammation in Patients With Stable Angina

Background: There is controversy on clinical implication of spotty calcification in the coronary arteries. Optical coherence tomography (OCT) enables detailed plaque characterization including features of plaque vulnerability. Pericoronary adipose tissue (PCAT) attenuation is a recently developed marker for perivascular inflammation. Methods: Patients with stable angina pectoris (SAP) who had both computed tomography angiography (CTA) and OCT prior to coronary intervention were included. They were classified into two groups: spotty calcification group (calcification arc <90°, length <4mm) and macro calcification group. Non-calcified plaques or plaques with mixed spotty and macro calcification were excluded. The OCT findings of the culprit lesion and PCAT attenuation of the culprit vessel were compared between the two groups. Results: Among 316 patients, 62 had spotty calcifications and 66 had macro calcification in the culprit lesion. The spotty calcification group showed a significantly higher prevalence of lipid rich plaque (91.9% vs. 74.2%, p=0.008; Figure A), greater mean lipid arc (183.1 vs. 150.5°, p=0.01), and a higher level of PCAT attenuation (-71.7 ± 7.68 vs. -74.9 ± 9.17 HU, p=0.03; Figure B), compared with the macro calcification group. Conclusion: Plaques with spotty calcification are associated with a higher prevalence of lipid-rich plaques and a higher level of perivascular inflammation, compared to those with macro calcification.

Abstract 19141: Carotid Artery Plaque Rim Sign on Computed Tomography Angiography is Associated With Intraplaque Hemorrhage and Inflammatory Microenvironment

Introduction: The carotid artery rim sign on CTA is characterized by soft-plaque components surrounded by a rind of thin, adventitial calcification and its role in plaque instability is not established yet. Intraplaque hemorrhage (IPH) and the inflammatory microenvironment in carotid atheroma are considered features of atherosclerotic plaque vulnerability leading to cerebrovascular events. Hypothesis: The association between rim sign on CTA and carotid IPH and inflammation remains scantly investigated. In this study, we aimed to determine whether rim sign is associated with IPH on MRA and with the extent of IPH and inflammation on histology. We hypothesized that rim sign may be a radiological predictor of carotid IPH and inflammation. Methods: We retrospectively enrolled 100 consecutive patients who underwent carotid endarterectomy (CEA) and neck CTA before CEA. On CTA, the ipsilateral rim sign was defined as the presence of adventitial calcifications with internal soft-tissue plaque of ≥2 mm in maximum thickness. Of the included patients, 25 had MRA with 3D magnetization-prepared rapid acquisition with gradient echo (MPRAGE) sequence. Carotid plaque specimens were collected and stained with H&E to quantify IPH (%). Histologically, we defined IPH as an area of carotid plaque with blood elements, and inflammatory microenvironment as the presence of lymphocytes and plasma cells (chronic inflammation) and foam cells. Results: The rim sign on CTA was present in 56 (56%) of patients. IPH on MRA was present in 11 (44%) patients. The rim sign was significantly associated with the presence of IPH on MRA [9 (81.8%) vs 2 (14.3%); p=0.003]. On histology, the rim sign was associated with a higher extent of IPH [5.0 % (IQR 2.0-25.0) vs 5.0% (IQR 0.0-10.0); p=0.017], with chronic inflammation [44 (78.6%) vs 12 (21.4%); p=0.003], and foam cells [51 (91.1%) vs 5 (8.9%); p<0.001]. Conclusions: These findings suggest that rim sign on CTA may be proposed as a potential imaging marker of IPH as well as a histologic predictor of IPH extent and carotid plaque inflammatory microenvironment.

Abstract 14321: High Sensitivity C-Reactive Protein is Associated With Plaque Vulnerability and Increased Incidence of Adverse Events in Patients With Stable Coronary Disease

Introduction: Higher level of high sensitivity C-reactive protein (hsCRP) is associated with an increased risk of cardiovascular events in patients with coronary artery disease (CAD). However, the pathogenesis of the worse clinical outcomes in CAD patients with high hsCRP remains to be elucidated. Hypothesis: Higher hsCRP is associated with a higher prevalence of vulnerable characteristics in coronary plaques and an increased incidence of adverse events in patients with CAD. Methods: A total of 793 consecutive patients with stable CAD, who underwent intra coronary optical coherence tomography (OCT) imaging of the culprit vessel during percutaneous coronary intervention were included. Patients were classified into the higher hsCRP group (hsCRP ≥ 0.2 mg/dL, n=247) or the lower hsCRP group (hsCRP < 0.2 mg/dL, n=546). OCT characteristics and clinical outcomes were investigated according to the level of hsCRP. Results: The prevalence of thin-cap fibroatheroma (TCFA) (32.0% vs. 20.9%, p <0.001) and plaque with macrophage (53.9% vs. 46.2%, p =0.045) was significantly higher in the higher hsCRP group than in the lower hsCRP group (Panel A). The incidence of myocardial infarction was significantly higher in the higher hsCRP group than in the lower hsCRP group (log-rank p =0.006) during a median 938 days follow-up (Panel B) although the incidence of the composite of major adverse cardiac events was comparable (log-rank p =0.282). Among the four groups classified by the hsCRP level and the presence of TCFA, the incidence of myocardial infarction was the highest in the group with higher hsCRP and TCFA (log-rank p =0.017). Conclusions: Higher level of hsCRP was associated with a higher prevalence of vulnerable characteristics in coronary plaques and worse clinical outcomes in patients with stable CAD. The risk of recurrent myocardial infarction in patients with high hsCRP levels was further increased by the presence of TCFA.

Morphological Characteristics of Culprit Plaques in Acute Myocardial Infarction Patients With Different Scores of Type A Personality - An Intravascular Optical Coherence Tomography Study.

Previous studies have suggested a relationship between type A personality and the occurrence of coronary artery disease, so we used intravascular optical coherence tomography (OCT) to investigate the morphological characteristics of culprit plaques in acute myocardial infarction (AMI) patients with different scores of type A personality. A total of 221 AMI patients who underwent preintervention imaging of culprit lesions and an assessment of type A behavior pattern were included. According to the scores for the behavior questionnaire, these patients were divided into 3 groups: non-type A personality (n=91), intermediate personality (n=73), and type A personality (n=57). Patients with type A personality were younger (P=0.003) and had a higher level of total cholesterol (P=0.029) and more severe luminal stenosis (P=0.046). In addition, the prevalence of microchannels (P<0.001), macrophage accumulation (P<0.001), and plaque rupture (P=0.010) with greater number (P<0.001), cavity angle (P<0.001), and length (P<0.001) was highest in the type A personality group. The culprit lesions of AMI patients with increased scores for type A personality had more severe coronary luminal stenosis, and the proportion of vulnerable features was increased.

A vulnerability detection algorithm based on residual graph attention networks for source code imbalance (RGAN)

It is essential to detect potential vulnerabilities in software to ensure its safety. As software systems become more complex, traditional static vulnerability detection methods perform poorly. Currently, deep learning-based vulnerability detection models only extract source code vulnerability features using sequences or graphs. Sequential neural networks ignore structural information in the code, such as control flow diagrams and data flow diagrams. Additionally, graph neural networks cannot accurately extract features due to the lack of effective methods for extracting nodes’ features and aggregating global information. To address the above issue, we propose a vulnerability detection algorithm based on residual graph attention networks for source code imbalance (RGAN). Firstly, a local feature extraction module (PE-BL-A module) is designed. Using the sequence neural network, the module extracts various useful features, including node features in a control flow diagram based on local semantic features. Secondly, we present the Residual Graph Attention Network module (RGAT). To learn and update node features along the control flow direction, the module uses a graph attention network with residual connections. In this module, a mean biaffine attention pooling mechanism is proposed that can extract total graph vulnerability features more effectively. Thirdly, a dynamic cross-entropy loss function is designed. Using this function, it can handle sample imbalances during training. Finally, experiments conducted on several benchmark datasets demonstrate that the proposed model achieves state-of-the-art results.

Spatial-temporal Evolution of Ecological Vulnerability in Beijing-Tianjin-Hebei Region Based on PSRM Model

As one of the three major urban agglomerations in China, the Beijing-Tianjin-Hebei Region has strong economic strength but its ecological fragility is very prominent. To pursue the comprehensive development of economy and ecology, it is very important to analyze the ecological environment in the Beijing-Tianjin-Hebei Region. Here, the Beijing-Tianjin-Hebei Region was selected as the research area, and 19 indicators were selected to construct an evolution system based on the PSRM model. The temporal and spatial evolution characteristics of ecological vulnerability in the Beijing-Tianjin-Hebei Region were explored by combining the order relation method, CRITIC method, Theil index, and hot spot analysis, and the influencing factors were calculated via geographic detector. The results showed that:① the ecological vulnerability first increased and then decreased in the Beijing-Tianjin-Hebei Region. The vulnerable areas showed a northeast-southwest trend, and the ecological environment in the northeast and southwest regions was better than that in the central and southern regions. The area of slight vulnerability in 2014 increased by 6803.01 km2 compared with that in 2009. The area of mild vulnerability decreased by 130.41 km2, and the area of moderate vulnerability decreased by 26537.31 km2 compared with that in 2009. The areas of severe and extremely vulnerable status increased by 19512.9 km2 and 351.81 km2, respectively, compared with those in 2009. The habitat situation in the Beijing-Tianjin-Hebei Region improved significantly from 2014 to 2019. Compared with that in 2014, the areas of mild, moderate, severe, and extremely vulnerable decreased by 2248.29 km2, 2220.21 km2, 7988.67 km2, and 55.98 km2, respectively. The light area increased by 12513.15 km2 compared with that in 2014. ② According to the calculation results of the Theil index, the spatial correlation degree of ecological vulnerability in the Beijing-Tianjin-Hebei Region exhibited a V-shaped fluctuation, and the spatial pattern of the cold and hot areas was predominantly consistent with that of the vulnerability. ③ Biological abundance, PM10, and the human disturbance index had a significant influence on the spatial differentiation of ecological vulnerability in the Beijing-Tianjin-Hebei Region. Based on the results of ecological vulnerability analysis, some suggestions on the ecological environment and sustainable development in the Beijing-Tianjin-Hebei Region were proposed.

Revised vulnerability analysis of group buildings based on the SPO model of equivalent individual structure

Typical individual structure and group buildings with different classification features have abundant seismic damage data. To fully utilize the theoretical seismic damage data of individual structure and the statistical seismic damage data for group buildings, establish Pushover analysis model of group buildings with certain vulnerability characteristics and improve the reliability of seismic performance of corresponding classified group buildings characterized by individual structure, a method for establishing equivalent Pushover models of group buildings based on the SPO2IDA inversion algorithm is proposed, and the theoretical Pushover curve of characterized typical structure is updated through the Bayesian theory using the equivalent individual structure model established by seismic damage statistical data, and then an vulnerability analysis model that complies with seismic damage statistical laws is established. The research results show that the SPO model of equivalent individual structure of group buildings can be established based on the seismic damage statistical characteristics of buildings. The maximum accuracy and minimum accuracy of the median seismic intensity of the vulnerability model established by the Pushover model obtained after Bayesian revision can be improved by 45% and 20% respectively. This paper proposes a method to improve the accuracy of earthquake damage results of group buildings characterized by individual structure from the perspective of inherent structural attributes, which can provide more economically reasonable design solutions for buildings with specific attribute classification in relevant regions.

Optimal allocation of local climate zones based on heat vulnerability perspective

Global climate change presents considerable heating risks to cities, necessitating the assessment of heat vulnerability characteristics in urban areas for the advancement of human settlements and socioeconomic progress. Nevertheless, there has been a lack of extensive research regarding heat vulnerability when considering local climate zones (LCZs). In this study, we utilized data from multiple sources to construct a model for evaluating heat vulnerability along three dimensions: Exposure, Sensitivity, and Adaptability. We analyzed the spatial characteristics of heat vulnerability in the LCZs and employed a linear weighted multi-objective optimization method to reconfigure the LCZs and mitigate the Urban Heat Vulnerability Index (HVI). The findings revealed that (1) The spatial characteristics of exposure and sensitivity were similar, with high values observed in the city center and low values at the periphery. Adaptability exhibited a high–low–high pattern from the center to the edge due to the combined influence of the economy and natural factors. (2) The HVI of the built environment (building LCZ) surpassed that of the natural environment (natural LCZ) within the research area. Specifically, compact high-rise buildings (LCZ1) and compact midrise buildings (LCZ2) accounted for over 90% of the area with extremely high and high HVI values, necessitating immediate optimization efforts. (3) By considering the area and population size of the research area, we achieved an optimal heat vulnerability plan by increasing the areas of LCZ4 and LCZA while reducing the areas of LCZ8 and LCZ1, among others. Therefore, the overall HVI of the study area decreased from 49,034.67 to 41,772.37, representing a reduction of 14.81 %. This study presents an innovative approach to mitigating urban heat vulnerability, providing valuable planning references and scientific guidance to assist cities in addressing high-temperature risks.

TCT-140 Combined Coexistence of Multiple Vulnerable Plaque Features is Associated With Incremental Rates of Adverse Events in Patients With Diabetes Mellitus: New Insights From the COMBINE OCT-FFR Trial

TCT-140 Combined Coexistence of Multiple Vulnerable Plaque Features is Associated With Incremental Rates of Adverse Events in Patients With Diabetes Mellitus: New Insights From the COMBINE OCT-FFR Trial

The Climatology, Vulnerability, and Public Perceptions Associated with Overlapping Tornado and Flash Flood Warnings in a Portion of the Southeast United States

Abstract Simultaneous and overlapping tornadoes and flash floods are a meteorological hazard with complex societal implications as, when issued at the same time, tornado and flash flood warnings provide conflicting public safety advice. This work assessed potential tornado and flash flood (TORFF) events in a portion of the Southeast from an interdisciplinary perspective with a focus on the climatology, vulnerability, and public perceptions surrounding these hazards. Our results suggest that, in addition to the conflicting warning advice, TORFFs present a challenge to the public because they can occur at night or in cool seasons when they are least expected, though they are most common in spring. Also, the storms causing TORFFs are often not clearly organized, causing a forecast and communication challenge. The public responding to the tornado and flash flood warnings in our study area is more vulnerable to TORFFs than those in other areas and may lack vehicles and structures to respond safely to one or both hazard threats. Administered survey results suggest that many believe they know what protective actions to take in a TORFF, though they may not believe they are likely in their area. Those that believe they are likely are also more likely to feel prepared to respond. Many climatology and vulnerability characteristics vary between, and at times within, NWS county warning areas, highlighting the different communication and preparation needs across the region. Approximately a quarter of flash flood and tornado warnings overlap in the region for an average of 31 min. The frequency of TORFFs and their associated public safety challenges warrant continued investigation. Significance Statement The purpose of this work is to increase our understanding of overlapping tornado and flash flood events by studying them from a multidisciplinary perspective. We found that residents in the southeastern United States are especially vulnerable to overlapping tornado and flash floods. This vulnerability is heightened by the climatology of overlapping tornado and flash floods because they can occur when they are unexpected, for example, at night or in the winter, and the public perceptions of overlapping tornado and flash floods, which is that they may not be likely in their area. These findings are important because much of the Southeast includes a population vulnerable to overlapping tornado and flash floods who may be underestimating their risk, and therefore may be unprepared for an event that requires critical decision-making.

초등학교 통학거리 내 근린생활시설에서의 감염병 확산 분석 모델에 관한 연구

The purpose of this study is to propose a model that analyze the architectural characteristics of neighborhood-convenience facilities around schools, which are vulnerable to infections, and their relevance to the spread of communicable diseases. This model aims to provide a foundation for making decisions on concentrating sanitation resources to prevent the inflow of communicable diseases and the occurrence of group infections in the vicinity of elementary schools.&#x0D; In order to understand the impact of neighborhood-convenience facilities located within a 1,500m commuting distance from elementary schools on the spread of communicable diseases, this study analyzes the architectural characteristics of local facilities and their relevance to the spread of communicable diseases. It proposes a communicable disease spread analysis model that utilizes GIS (Geographic Information System) and correlation analysis to identify vulnerable architectural characteristics and spatial scope related to infections.&#x0D; The results of applying the analysis model proposed in this study to analyze the correlation between neighborhood-convenience facilities around elementary schools and the spread of communicable diseases showed a positive correlation between the number of buildings, building area, total floor area, land area, height, building coverage ratio, and floor area ratio of neighborhood-convenience facilities within the Elementary-school Commuting Zone in the target administrative district. However, the spatial scope and trends of the maximum correlation coefficient for each administrative district varied, indicating differences in patterns among the target districts.&#x0D; The results of this study are as follows: First, the study proposed a correlation analysis model between the architectural characteristics of neighborhood-convenience facilities within the commuting distance of elementary schools and the spread of communicable diseases. Second, the results of applying the analysis model showed a positive correlation between the architectural characteristic variables of neighborhood-convenience facilities and the spread of communicable diseases. Third, there were differences in the spatial scope and trends of the maximum correlation coefficient among the analyzed administrative districts. The analysis model presented in this study provides a foundation for selecting architectural characteristics and spatial scope in each administrative district to concentrate sanitation resources.

Differential Expression of Peripheral Circulating MicroRNA-146a Between Patients with Atherosclerotic Vulnerable Plaque and Stable Plaque.

Atherosclerotic plaque rupture and subsequent cardiovascular complications threaten the population's health worldwide. The polymorphism of miR-146a rs2910164 was significantly associated with the risk of vulnerable plaques. However, it remains unclear whether the circulating miR-146a is differentially expressed in stable and vulnerable plaques and thus, serves as a potential biomarker.This study aims to analyze the differential expression of circulating miR-146a between patients with stable and vulnerable plaques to explore the potential molecular mechanisms.Public databases were searched from their inception up to November 2022. A study reporting the specific circulating miR-146a levels between patients with stable and vulnerable plaques was included. The study quality was assessed using the modified genetic 8-stars Newcastle-Ottawa scale. The differential expression levels of miR-146a were evaluated using the standardized mean difference (SMD).Eight studies with 978 patients were included and analyzed. The results showed that miR-146a expression levels were significantly higher in the vulnerable plaque population than in the stable plaque population (SMD: 1.91; 95% confidence interval: 1.35, 2.47; P < 0.01). A similar statistical significance was found in subgroup analyses regarding sample source, disease type, and vulnerable plaque characteristics. Sensitivity analysis suggested the robustness of the results. Analysis of downstream genes suggested that miR-146a-targeted regulation of ACTN4, SARM1, and ULK2 may affect intraplaque hemorrhage.Patients with vulnerable plaque have higher circulating miR-146a levels than those with stable plaque. However, based on the limitations of this study, high-quality studies are still needed to confirm the results.

Relationship between climate change and tourism: an integrative review

ABSTRACT The relationship between tourism and climate change has been explored and studied for a considerable amount of time. In the past quarter-century, more specialised research has emerged, and most recently, the subject of adaptation has been highlighted as an essential study requirement in tourism and climate change studies. This study offers a comprehensive literature assessment on climate change and tourism to date. We did a Boolean-based search on Scopus and got 703 records, which were then analysed bibliometrically using the bibliometrix package of R. It covers adaptation issues, the characteristics of vulnerability in a tourism setting, and the ramifications of such research for local communities. This study illustrates the difficulties associated with the interdependence of climate change and tourism by presenting the most relevant authors, countries, key terms, and research fields. In addition to descriptive insights into the field, we provide the conceptual framework (keyword analysis and thematic map). In addition to bibliometrically evaluating the publications, we closely reviewed the sample studies to gain a more comprehensive picture of the literature on climate change and tourism. Our evaluation reveals significant knowledge gaps and offers future research and policy objectives. Our study has suggested multiple research avenues for this topic.

Spotty calcium deposits within acute coronary syndrome (ACS)-causing culprit lesions impact inflammatory vessel-wall interactions and are associated with higher cardiovascular event rates at one year follow-up: Results from the prospective translational OPTICO-ACS study program

Background and aimsSpotty calcium deposits (SCD) represent a vulnerable plaque feature which seems to result - as based on recent invitro studies - from inflammatory vessel-wall interactions. SCD can be reliably assessed by optical coherence tomography (OCT). Their prognostic impact is yet unknown. Therefore, the aims of this translational study were to comprehensively characterize different plaque calcification patterns, to analyze the associated inflammatory mechanisms in the microenvironment of acute coronary syndrome (ACS)-causing culprit lesions (CL) and to investigate the prognostic significance of SCD in a large cohort of ACS-patients. MethodsCL of the first 155 consecutive ACS-patients from the translational OPTICO-ACS-study program were investigated by OCT-characterization of the calcium phenotype at ACS-causing culprit lesions. Simultaneous immunophenotyping by flow-cytometric analysis and cytokine bead array technique across the CL gradient (ratio local/systemic levels) was performed and incidental major adverse cardiovascular events plus (MACE+) at 12 months after ACS were assessed. ResultsSCD were observed within 45.2% of all analyzed ACS-causing culprit lesions (CL). Culprits containing spotty calcium were characterized by an increased culprit ratio of innate effector cytokines interleukin (IL)-8 [2.04 (1.24) vs. 1.37 (1.10) p < 0.05], as well as TNF (tumor necrosis factor)-α [1.17 (0.93) vs. 1.06 (0.89); p < 0.05)] and an increased ratio of circulating neutrophils [0.96 (0.85) vs. 0.91 (0.77); p < 0.05] as compared to culprit plaques without SCD. Total monocyte levels did not differ between the two groups (p = n.s.). However, SCD-containing CLs were characterized by an increased culprit ratio of intermediate monocytes [(1.15 (0.81) vs. 0.96 (0.84); p < 0.05)] with an enhanced surface expression of the integrin receptor CD49d as compared to intermediate monocytes derived from SCD-free CLs [(1.06 (0.94) vs. 0.97 (0.91)] p < 0.05. Finally, 12 months rates of MACE+ were higher in patients with, as compared to patients without SCD at CL (16.4% vs. 5.3%; p < 0.05). ConclusionsThis study for the first time identified a specific inflammatory profile of CL with SCD, with a predominance of neutrophils, intermediate monocytes and their corresponding effector molecules. Hence, this study advances our understanding of ACS-causing CL and provides the basis for future personalized anti-inflammatory, therapeutic approaches to ACS.

Multiple faces of poverty. Exploring housing-costs-induced energy poverty in Central and Eastern Europe

The series of crises, first pandemic, then energy, and finally war threaten the most vulnerable in all countries. This study attempts to unveil the faces of the energy poor to shape conscious policies concerning these households. We focus on the profile of energy-poor households in 11 CEE countries, such as Bulgaria, Croatia, Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia, and Slovenia.We identify nine distinct profiles of energy poor households and key vulnerability characteristics. The first one is low income, which, especially for retirees, does not allow them to meet their energy needs. The second one is living in houses. The third one is the mismatch between housing size and household needs. The fourth is a large number of children in the household. Our source of micro-data is the EU Survey on Income and Living Conditions collected in 2020. We perform the analysis using the partitioning around medoids algorithm on the sample of 18,331 energy poor households, which represent about 22.6 % of all observations.We highlight several policy issues in this study. It is important to make the housing market more flexible to adjust accommodation to the size of households. Pension systems should account for population aging and improve the financial situation of single elderly persons. Finally, large families with dependent children should be supported more effectively.

Linking coastal environmental and health observations for human wellbeing.

Coastal areas have long been attractive places to live, work, and recreate and remain so even in the face of growing threats from global environmental change. At any moment, a significant portion of the human population is exposed to both positive and negative health effects associated with coastal locations. Some locations may be "hotspots" of concern for human health due to ongoing climatic and other changes, accentuating the need for better understanding of coastal environment-human health linkages. This paper describes how environmental and health data could be combined to create a coastal environmental and human health observing system. While largely based on information from the US and Europe, the concept should be relevant to almost any coastal area. If implemented, a coastal health observing system would connect a variety of human health data and environmental observations for individuals and communities, and where possible cohorts. Health data would be derived from questionnaires and other personal sources, clinical examinations, electronic health records, wearable devices, and syndromic surveillance, plus information on vulnerability and health-relevant community characteristics, and social media observations. Environmental data sources would include weather and climate, beach and coastal conditions, sentinel species, occurrences of harmful organisms and substances, seafood safety advisories, and distribution, proximity, and characteristics of health-promoting green and blue spaces. Where available, information on supporting resources could be added. Establishment of a linked network of coastal health observatories could provide powerful tools for understanding the positive and negative health effects of coastal living, lead to better health protections and enhanced wellbeing, and provide significant benefits to coastal residents, including the historically disadvantaged, as well as the military, hospitals and emergency departments, academic medical, public health, and environmental health programs, and others. Early networks could provide best practices and lessons learned to assist later entries.

Psychological Predictors of COVID-19-Related Anxiety in Vulnerable Groups.

This study responds to the need to explore psychological predictors of COVID-19-related anxiety in vulnerable groups. An anonymous voluntary online survey was conducted (n = 520) with (a) working parents with young children (0-12 y.o.), (b) people with chronic physical conditions, (c) people with multiple vulnerability characteristics and (d) a control group (no self-reported vulnerability) in 2022. Findings showed that perceived stress of the parents and trait anxiety of the chronic sufferers were single weak positive predictors of COVID-19 anxiety. However, both psychological factors had a stronger effect on the pandemic-related anxiety for the group with multiple vulnerabilities. In the control group, trait resilience and optimistic expectations (combined with perceived stress) were moderate negative predictors of COVID-19 anxiety. The findings emphasize the importance of perceptions, expectations, trait anxiety as well as the need for intersectional research of vulnerability from multiple perspectives. Furthermore, they highlight the necessity of group-specific policies and interventions aimed both at handling the negative psychological tendencies of the vulnerable groups and at strengthening the positive tendencies of non-vulnerable groups, rather than tackling only emergent anxiety conditions in crisis times.

High-Risk Plaques on Coronary Computed Tomography Angiography: Correlation With Optical Coherence Tomography

BackgroundAlthough patients with high-risk plaque (HRP) on coronary computed tomography angiography (CTA) are reportedly at increased risk for future cardiovascular events, individual HRP features have not been systematically validated against high-resolution intravascular imaging. ObjectivesThe aim of this study was to correlate HRP features on CTA with plaque characteristics on optical coherence tomography (OCT). MethodsPatients who underwent both CTA and OCT before coronary intervention were enrolled. Plaques in culprit vessels identified by CTA were evaluated with the use of OCT at the corresponding sites. HRP was defined as a plaque with at least 2 of the following 4 features: positive remodeling (PR), low-attenuation plaque (LAP), napkin-ring sign (NRS), and spotty calcification (SC). Patients were followed for up to 3 years. ResultsThe study included 448 patients, with a median age of 67 years and of whom 357 (79.7%) were male, and 203 (45.3%) presented with acute coronary syndromes. A total of 1,075 lesions were analyzed. All 4 HRP features were associated with thin-cap fibroatheroma. PR was associated with all OCT features of plaque vulnerability, LAP was associated with lipid-rich plaque, macrophage, and cholesterol crystals, NRS was associated with cholesterol crystals, and SC was associated with microvessels. The cumulative incidence of the composite endpoint (target vessel nontarget lesion revascularization and cardiac death) was significantly higher in patients with HRP than in those without HRP (4.7% vs 0.5%; P = 0.010). ConclusionsAll 4 HRP features on CTA were associated with features of vulnerability on OCT. (Massachusetts General Hospital and Tsuchiura Kyodo General Hospital Coronary Imaging Collaboration; NCT04523194)

Global building exposure model for earthquake risk assessment

The global building exposure model is a mosaic of local and regional models with information regarding the residential, commercial, and industrial building stock at the smallest available administrative division of each country and includes details about the number of buildings, number of occupants, vulnerability characteristics, average built-up area, and average replacement cost. We aimed for a bottom-up approach at the global scale, using national statistics, socio-economic data, and local datasets. This model allows the identification of the most common types of construction worldwide, regions with large fractions of informal construction, and areas prone to earthquakes with a high concentration of population and building stock. The mosaic of exposure models presented herein can be used for the assessment of probabilistic seismic risk and earthquake scenarios. Information at the global, regional, and national levels is available through a public repository ( https://github.com/gem/global_exposure_model ), which will be used to maintain, update and improve the models.