Search results for: risk prioritization

Authors: Sameen Masood, Muhammad Ali Jibran

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The frequent flood history in Pakistan has pronounced the need for disaster risk management. Various policies are formulated and steps are being taken by the government in order to cope with the flood effects. However, a much promising pro-active approach that is globally acknowledged is educating the masses regarding living with risk and uncertainty. Unfortunately, majority of the flood victims in Pakistan are poor and illiterate which also transpires as a significant cause of their distress. An illiterate population is not risk averse or equipped intellectually regarding how to prepare and protect against natural disasters. The current research utilizes a cross-disciplinary approach where the role of education (both formal and informal) and indigenous knowledge is explored with reference to disaster preparedness. The data was collected from the flood prone rural areas of Punjab. In the absence of disaster curriculum taught in formal schools, informal education disseminated by NGOs and relief and rehabilitation agencies was the only education given to the flood victims. However the educational attainment of flood victims highly correlated with their awareness regarding flood management and disaster preparedness. Moreover, lessons learned from past flood experience generated indigenous knowledge on the basis of which flood victims prepared themselves for any uncertainty. If the future policy regarding disaster preparation integrates indigenous knowledge and then delivers education on the basis of that, it is anticipated that the flood devastations can be much reduced. Education can play a vital role in amplifying perception of risk and taking precautionary measures for disaster. The findings of the current research will provide practical strategies where disaster preparedness through education has not yet been applied.

Keywords: education, disaster preparedness, illiterate population, risk management

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Authors: Mario M. J. Musonda

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Access to health care is a human right, which includes having timely access to affordable and quality essential medicines at the right place and in sufficient quantity. However, inefficient public sector supply chain management contributes to constant shortages of essential medicines at health facilities. Literature review involved a desktop study of published research studies and reports on risk management, supply chain management of essential medicines and their integration to increase the efficiency of the latter. The research was conducted on a sample population of offices under Ministry of Health Headquarters, Lusaka Provincial and District Offices, selected health facilities in Lusaka, Medical Stores Limited, Zambia Medicines Regulatory Authority and Cooperating Partners. Individuals involved in study were selected judgmentally by their functions under selection and quantification, regulation, procurement, storage, distribution, quality assurance, and dispensing of essential medicines. Structured interviews and discussions were held with selected experts and self-administered questionnaires were distributed. Collected and analysed data of 35 returned and usable questionnaires from the 50 distributed. The highest prioritised risks were; inadequate and inconsistent fund disbursements, weak information management systems, weak quality management systems and insufficient resources (HR and infrastructure) among others. The results for this research can be used to increase the efficiency of the public sector supply chain of essential medicines and other pharmaceuticals. The results of the study showed that there is need to implement effective risk management systems by participating institutions and organisations to increase the efficiency of the entire supply chain in order to avoid and/or reduce shortages of essential medicines at health facilities.

Keywords: essential medicine, risk assessment, risk management, supply chain, supply chain risk management

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Authors: Kylie Mueller, Nijole Bernaitis, Shailendra Anoopkumar-Dukie

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Background: Vitamin K antagonists particularly warfarin is the most frequently used oral medication for deep vein thrombosis (DVT) treatment and prophylaxis. Time in therapeutic range (TITR) of the international normalised ratio (INR) is widely accepted as a measure to assess the quality of warfarin therapy. Multiple factors can affect warfarin control and the subsequent adverse outcomes including thromboembolic and bleeding events. Predictor models have been developed to assess potential contributing factors and measure the individual risk of these adverse events. These predictive models have been validated in atrial fibrillation (AF) patients, however, there is a lack of literature on whether these can be successfully applied to other warfarin users including DVT patients. Therefore, the aim of the study was to assess the ability of these risk models (HAS BLED and CHADS2) to predict haemorrhagic and ischaemic incidences in DVT patients treated with warfarin. Methods: A retrospective analysis of DVT patients receiving warfarin management by a private pathology clinic was conducted. Data was collected from November 2007 to September 2014 and included demographics, medical and drug history, INR targets and test results. Patients receiving continuous warfarin therapy with an INR reference range between 2.0 and 3.0 were included in the study with mean TITR calculated using the Rosendaal method. Bleeding and thromboembolic events were recorded and reported as incidences per patient. The haemorrhagic risk model HAS BLED and ischaemic risk model CHADS2 were applied to the data. Patients were then stratified into either the low, moderate, or high-risk categories. The analysis was conducted to determine if a correlation existed between risk assessment tool and patient outcomes. Data was analysed using GraphPad Instat Version 3 with a p value of <0.05 considered to be statistically significant. Patient characteristics were reported as mean and standard deviation for continuous data and categorical data reported as number and percentage. Results: Of the 533 patients included in the study, there were 268 (50.2%) female and 265 (49.8%) male patients with a mean age of 62.5 years (±16.4). The overall mean TITR was 78.3% (±12.7) with an overall haemorrhagic incidence of 0.41 events per patient. For the HAS BLED model, there was a haemorrhagic incidence of 0.08, 0.53, and 0.54 per patient in the low, moderate and high-risk categories respectively showing a statistically significant increase in incidence with increasing risk category. The CHADS2 model showed an increase in ischaemic events according to risk category with no ischaemic events in the low category, and an ischaemic incidence of 0.03 in the moderate category and 0.47 high-risk categories. Conclusion: An increasing haemorrhagic incidence correlated to an increase in the HAS BLED risk score in DVT patients treated with warfarin. Furthermore, a greater incidence of ischaemic events occurred in patients with an increase in CHADS2 category. In an Australian population of DVT patients, the HAS BLED and CHADS2 accurately predicts incidences of haemorrhage and ischaemic events respectively.

Keywords: anticoagulant agent, deep vein thrombosis, risk assessment, warfarin

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Authors: Sujata Upgupta, Prasoon Kumar Singh

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The expansion of large scale coal mining into forest areas is a potential hazard for the local biodiversity and wildlife. The objective of this study is to provide a picture of the threat that coal mining poses to the forests of the East Bokaro landscape. The vulnerable forest areas at risk have been assessed and the priority areas for conservation have been presented. The forested areas at risk in the current scenario have been assessed and compared with the past conditions using classification and buffer based overlay approach. Forest vulnerability has been assessed using an analytical framework based on systematic indicators and composite vulnerability index values. The results indicate that more than 4 km² of forests have been lost from 1973 to 2016. Large patches of forests have been diverted for coal mining projects. Forests in the northern part of the coal field within 1-3 km radius around the coal mines are at immediate risk. The original contiguous forests have been converted into fragmented and degraded forest patches. Most of the collieries are located within or very close to the forests thus threatening the biodiversity and hydrology of the surrounding regions. Based on the vulnerability values estimated, it was concluded that more than 90% of the forested grids in East Bokaro are highly vulnerable to mining. The forests in the sub-districts of Bermo and Chandrapura have been identified as the most vulnerable to coal mining activities. This case study would add to the capacity of the forest managers and mine managers to address the risk and vulnerability of forests at a small landscape level in order to achieve sustainable development.

Keywords: forest, coal mining, indicators, vulnerability

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Authors: Kwanele Qonono

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Despite the significance and economic benefits of petrol stations in South Africa, these still pose a huge risk of fire and explosion threatening public safety. This research paper examines the extent to which land-use planning in Stellenbosch, South Africa, considers the fire risk posed by petrol stations and the implications for public safety as well as preparedness for large fires or explosions. To achieve this, the research identified the land-use types around petrol stations in Stellenbosch and determined the extent to which their locations comply with the local, national, and international land-use planning regulations. A mixed research method consisting of the collection and analysis of geospatial data and qualitative data was an applied method, where petrol stations within a six-kilometre radius of Stellenbosch’s town centre were utilised as study sites. The research examined the risk of fires/explosions at these petrol stations. The research investigated Stellenbosch Municipality’s institutional preparedness to respond in the event of a fire/explosion at these petrol stations. The research observed that siting of petrol stations does not comply with local, national, and international good practices, thus exposing the surrounding developments to fires and explosions. Land-use planning practice does not consider hazards created by petrol stations. Despite the potential for major fires at petrol stations, Stellenbosch Municipality’s level of preparedness to respond to petrol station fires appears low due to the prioritisation of more frequent events.

Keywords: petrol stations, technological hazard, drr, land-use planning, risk analysis

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Authors: Benedicta Asante, Catherine Trask, Brenna Bath

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Background: Waste Collection Workers’ (WCWs) activities contribute greatly to the recycling sector and are an important component of the waste management industry. As the recycling sector evolves, there is the increase in reports of injuries, particularly for common and debilitating musculoskeletal disorders such as low back disorder (LBD). WCWs are likely exposed to diverse work-related hazards that could contribute to LBD. However, there is currently no summary of the state of knowledge on the prevalence and risk factors of LBD within this workforce. Method: A comprehensive search was conducted in Ovid Medline, EMBASE, and Global Health e-publications with search term categories ‘low back disorder’ and ‘waste collection workers’. Two reviewers screened articles at title, abstract, and full-text stages. Data were extracted on study design, sampling strategy, socio-demographics, geographical region, and exposure definition, the definition of LBD, response rate, statistical techniques, LBD prevalence and risk factors. The risk of bias was assessed with a standardized tool. Results: The search of three databases generated 79 studies. Thirty-two studies met the study inclusion criteria for both title and abstract; only thirteen full-text articles met the study criteria and underwent data extraction. The majority of articles reported a 12-month prevalence of LBD between 16-74%. Although none of the included studies quantified relationships between risk factors and LBD, the suggested risk factors for LBD among WCWs included: awkward posture; lifting; pulling; pushing; repetitive motions; work duration; and physical loads. Conclusion: LBD is a major occupational health issue among WCWs. In light of these risks and future growth in this industry, further research should focus on the investigation of risk factors, with more focus on ergonomic exposure assessment, and LBD prevention efforts.

Keywords: low back pain, scavenger, waste pickers, waste collection workers

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Authors: Majeda S. Hammoud

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Background and Aim: Gestational diabetes mellitus (GDM) is a common pregnancy complication affecting around 14% of pregnancies globally that carries short and long-term consequences to the mother and her child. Pre-pregnancy overweight or obesity is the most consistently and strongly associated modifiable risk factor with GDM development. This analysis aimed to determine whether vitamin D status during pregnancy modulates the effect of pre-pregnancy obesity/overweight on GDM risk while stratifying by maternal age. Methods: Data from the Kuwait Birth Cohort (KBC) study were analyzed, which enrolled pregnant women in the second or third trimester of gestation. Pre-pregnancy body mass index (BMI; kg/m2) was categorized as under/normal weight (<25.0), overweight (25.0 to <30.0), and obesity (≥30.0). 25 hydroxyvitamin D levels were measured in blood samples that were collected at recruitment and categorized as deficiency (<50 nmol/L) and insufficiency/sufficiency (≥50 nmol/L). GDM status was ascertained according to international guidelines. Logistic regression was used to evaluate associations, and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated. Results: The analyzed study sample included a total of 982 pregnant women, with a mean (SD) age of 31.4 (5.2) years. The prevalence of GDM was estimated to be 17.3% (95% CI: 14.9-19.7), and the prevalence of pre-pregnancy overweight and obesity was 37.8% (95% CI: 34.8-40.8) and 28.8% (95% CI: 26.0-31.7), respectively. The prevalence of gestational vitamin D deficiency was estimated to be 55.3% (95% CI: 52.2-58.4). The association between pre-pregnancy overweight or obesity with GDM risk differed according to maternal age and gestational vitamin D status (Pinteraction[BMI × age × vitamin D = 0.047). Among pregnant women aged <35 years, prepregnancy obesity compared to under/normal weight was associated with increased GDM risk among women with gestational vitamin D deficiency (aOR: 3.65, 95% CI: 1.50-8.86, p = 0.004) and vitamin D insufficiency/sufficiency (aOR: 2.55, 95% CI: 1.16-5.61, p = 0.019). In contrast, among pregnant women aged ≥35 years, pre-pregnancy obesity compared to under/normal weight was associated with increased GDM risk among women with gestational vitamin D deficiency (aOR: 9.70, 95% CI: 2.01-46.69, p = 0.005), but not among women with vitamin D insufficiency/sufficiency (aOR: 1.46, 95% CI: 0.42-5.16, p = 0.553). Conclusion: The effect of pre-pregnancy obesity on GDM risk is modulated by maternal age and gestational vitamin D status, with the effect of pre-pregnancy obesity being more pronounced among older pregnant women (aged ≥35 years) with gestational vitamin D deficiency compared to those with vitamin D insufficiency/sufficiency. Whereas, among younger women (aged <35 years), the effect of pre-pregnancy obesity on GDM risk was not modulated by gestational vitamin D status. Therefore, vitamin D supplementation among pregnant women, specifically older women with pre-pregnancy obesity, may mitigate the effect of pre-pregnancy obesity on GDM risk.

Keywords: gestational diabetes mellitus, vitamin D, obesity, body mass index

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Authors: Benoit Jauniaux, Azzam Ismail

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Objectives: The aims were to identify all incident adult cases of idiopathic inflammatory myopathies (IIMs) in the City of Leeds, UK, and to estimate the risk of cancer in IIMs as compared with the general population. Methods: Cases of IIMs were ascertained by review of all muscle biopsy reports from the Neuropathology Laboratory. A review of medical records was undertaken for each case to review the clinical diagnosis and collect epidemiological data such as age, ethnicity, sex, and comorbidities, including cancer. Leeds denominator population numbers were publicly obtainable. Results: Two hundred and six biopsy reports were identified, and after review, 50 incident cases were included in the study between June 2010 and January 2021. Out of the 50 cases, 27 were male, and 23 were female. The mean incidence rate of IIMs in Leeds throughout the study period was 7.42/1 000 000 person years. The proportion of IIMs cases with a confirmed malignancy was 22%. Compared to the general population, the relative risk of cancer was significantly greater in the IIMs population(31.56, P < 0.01). Conclusions: The incidence rate of IIMs in Leeds was consistent with data from previous literature, however, disagreement exists between different methods of IIMs case inclusion due to varying clinical criteria and definitions. IIMs are associated with increased risk of cancer however, the pathogenesis of this relationship still requires investigating. This study supports the practice of malignancy screening and long-term surveillance in patients with IIMs.

Keywords: idiopathic inflammatory myopathies, myositis, polymyositis, dermatomyositis, malignancy, epidemiology, incidence rate, relative risk

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Authors: Molly Gerrish

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This work explores the physical, emotional, social, and cognitive risks and benefits related to nature-based teaching and highlights the importance of promoting a sustainable workforce within early childhood programs. Assessing and managing risks can help programs reimagine their approach to teaching, learning, recruitment, family connectivity, and staff motivation. The importance of staff sustainability and motivation/engagement related to social justice and the environment will be discussed. We will explore ways to manage fears and limitations faced by early childhood programs regarding nature experiences and risky play in a variety of locations using a lens of place-based learning. We will also examine the alignment of sustainability and social-emotional development, mental health supports, social awareness, and risk assessment. The work will discuss the varied perceptions of risk in diverse areas and the impact on the early childhood workforce. Motivational theory and compassion resiliency are hallmarks of both recruiting and retaining high-quality early childhood educators; the work will discuss how to balance programmatic constraints and healthy motivation for students and teachers while empowering individuals to advocate for their mental health and well-being. Finally, the work will highlight the positive impact of nature-based teaching practices and the overall benefit to young children and their educators.

Keywords: child’s rights, inclusion, nature-based education, risk assessment

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Authors: Anat Achiron

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Background: Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system in young adults. It involves the immune system attacking the protective covering of nerve fibers (myelin), leading to inflammation and damage. MS can result in various neurological symptoms, such as muscle weakness, coordination problems, and sensory disturbances. Seizures are not common in MS, and the frequency is estimated between 0.4 to 6.4% over the disease course. Objective: Investigate the frequency of seizures in individuals with multiple sclerosis and to identify associated risk factors. Methods: We evaluated the frequency of seizures in a large cohort of 5686 MS patients followed at the Sheba Multiple Sclerosis Center and studied associated risk factors and comorbidities. Our research was based on data collection using a cohort study design. We applied logistic regression analysis to assess the strength of associations. Results: We found that younger age at onset, longer disease duration, and prolonged time to immunomodulatory treatment initiation were associated with increased risk for seizures. Conclusions: Our findings suggest that seizures in people with MS are directly related to the demyelination process and not associated with other factors like medication side effects or comorbid conditions. Therefore, initiating immunomodulatory treatment early in the disease course could reduce not only disease activity but also decrease seizure risk.

Keywords: epilepsy, seizures, multiple sclerosis, white matter, age

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Authors: Omid Giahi, Ebrahim Darvishi, Mahdi Akbarzadeh

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Introduction: Occupational low back pain (LBP) is one of the most prevalent work-related musculoskeletal disorders in which a lot of risk factors are involved that. The present study focuses on the relation between personal, psycho-social and occupational risk factors and LBP severity in industrial workers. Materials and Methods: This research was a case-control study which was conducted in Kurdistan province. 100 workers (Mean Age ± SD of 39.9 ± 10.45) with LBP were selected as the case group, and 100 workers (Mean Age ± SD of 37.2 ± 8.5) without LBP were assigned into the control group. All participants were selected from various industrial units, and they had similar occupational conditions. The required data including demographic information (BMI, smoking, alcohol, and family history), occupational (posture, mental workload (MWL), force, vibration and repetition), and psychosocial factors (stress, occupational satisfaction and security) of the participants were collected via consultation with occupational medicine specialists, interview, and the related questionnaires and also the NASA-TLX software and REBA worksheet. Chi-square test, logistic regression and structural equation modeling (SEM) were used to analyze the data. For analysis of data, IBM Statistics SPSS 24 and Mplus6 software have been used. Results: 114 (77%) of the individuals were male and 86 were (23%) female. Mean Career length of the Case Group and Control Group were 10.90 ± 5.92, 9.22 ± 4.24, respectively. The statistical analysis of the data revealed that there was a significant correlation between the Posture, Smoking, Stress, Satisfaction, and MWL with occupational LBP. The odds ratios (95% confidence intervals) derived from a logistic regression model were 2.7 (1.27-2.24) and 2.5 (2.26-5.17) and 3.22 (2.47-3.24) for Stress, MWL, and Posture, respectively. Also, the SEM analysis of the personal, psycho-social and occupational factors with LBP revealed that there was a significant correlation. Conclusion: All three broad categories of risk factors simultaneously increase the risk of occupational LBP in the workplace. But, the risks of Posture, Stress, and MWL have a major role in LBP severity. Therefore, prevention strategies for persons in jobs with high risks for LBP are required to decrease the risk of occupational LBP.

Keywords: industrial workers occupational, low back pain, occupational risk factors, psychosocial factors

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Authors: Maria M. Giannakou, Athanasios K. Ziliaskopoulos

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Transmission pipelines carrying natural gas are often routed through populated cities, industrial and environmentally sensitive areas. While the need for these networks is unquestionable, there are serious concerns about the risk these lifeline networks pose to the people, to their habitat and to the critical infrastructures, especially in view of natural disasters such as earthquakes. This work presents an Integrated Pipeline Risk Management methodology (IPRM) for assessing the hazard associated with a natural gas pipeline failure due to natural or manmade disasters. IPRM aims to optimize the allocation of the available resources to countermeasures in order to minimize the impacts of pipeline failure to humans, the environment, the infrastructure and the economic activity. A proposed knapsack mathematical programming formulation is introduced that optimally selects the proper mitigation policies based on the estimated cost – benefit ratios. The proposed model is demonstrated with a small numerical example. The vulnerability analysis of these pipelines and the quantification of consequences from such failures can be useful for natural gas industries on deciding which mitigation measures to implement on the existing pipeline networks with the minimum cost in an acceptable level of hazard.

Keywords: cost benefit analysis, knapsack problem, natural gas distribution network, risk management, risk mitigation

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Authors: Giovanni Menichini, Salvatore Giacomo Morano, Gloria Terenzi, Luca Salvatori, Maurizio Orlando

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The “Guidelines for Risk Classification, Safety Assessment, and Structural Health Monitoring of Existing Bridges” were recently approved by the Italian Government to define technical standards for managing the national network of existing bridges. These guidelines provide a framework for risk mitigation and safety assessment of bridges, which are essential elements of the built environment and form the basis for the operation of transport systems. Within the guideline framework, a workflow based on three main points was proposed: (1) risk-based, i.e., based on typical parameters of hazard, vulnerability, and exposure; (2) multi-level, i.e., including six assessment levels of increasing complexity; and (3) multirisk, i.e., assessing structural/foundational, seismic, hydrological, and landslide risks. The paper focuses on applying the Italian Guidelines to specific case studies, aiming to identify the parameters that predominantly influence the determination of the “class of attention”. The significance of each parameter is determined via sensitivity analysis. Additionally, recommendations for enhancing the process of assigning the class of attention are proposed.

Keywords: bridge safety assessment, Italian guidelines implementation, risk classification, structural health monitoring

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Authors: Mohammad Ali Hasanzadeh, Thierry Van Elslander, Eddy Van De Voorde

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About 90 percent of world merchandise trade by volume being carried by sea. Maritime transport remains as back bone behind the international trade and globalization meanwhile all seaborne goods need using at least two ports as origin and destination. Amid seaborne traded cargos, container traffic is a prosperous market with about 16% in terms of volume. Albeit containerized cargos are less in terms of tonnage but, containers carry the highest value cargos amongst all. That is why efficient handling of containers in ports is very important. Accidents are the foremost causes that lead to port inefficiency and a surge in total transport cost. Having different port safety management systems (PSMS) in place, statistics on port accidents show that numerous accidents occur in ports. Some of them claim peoples’ life; others damage goods, vessels, port equipment and/or the environment. Several accident investigation illustrate that the most common accidents take place throughout transport operation, it sometimes accounts for 68.6% of all events, therefore providing a safer workplace depends on reducing collision risk. In order to quantify risks at the port area different variables can be used as exposure measurement. One of the main motives for defining and using exposure in studies related to infrastructure is to account for the differences in intensity of use, so as to make comparisons meaningful. In various researches related to handling containers in ports and intermodal terminals, different risk exposures and also the likelihood of each event have been selected. Vehicle collision within the port area (10-7 per kilometer of vehicle distance travelled) and dropping containers from cranes, forklift trucks, or rail mounted gantries (1 x 10-5 per lift) are some examples. According to the objective of the current research, three categories of accidents selected for collision risk assessment; fall of container during ship to shore operation, dropping container during transfer operation and collision between vehicles and objects within terminal area. Later on various consequences, exposure and probability identified for each accident. Hence, reducing collision risks profoundly rely on picking the right risk exposures and probability of selected accidents, to prevent collision accidents in container terminals and in the framework of risk calculations, such risk exposures and probabilities can be useful in assessing the effectiveness of safety programs in ports.

Keywords: container terminal, collision, seaborne trade, risk exposure, risk probability

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Authors: Abraham Addo-Bediako

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Many freshwater ecosystems are facing immense pressure from anthropogenic activities, such as agricultural, industrial and mining. Trace metal pollution in freshwater ecosystems has become an issue of public health concern due to its toxicity and persistence in the environment. Trace elements pose a serious risk not only to the environment and aquatic biota but also humans. Chromium is one of such trace elements and its pollution in surface waters and groundwaters represents a serious environmental problem. In South Africa, agriculture, mining, industrial and domestic wastes are the main contributors to chromium discharge in rivers. The common forms of chromium are chromium (III) and chromium (VI). The latter is the most toxic because it can cause damage to human health. The aim of the study was to assess the contamination of chromium in the water and sediments of two rivers in the Steelpoort River sub-catchment of the Olifants River Basin, South Africa and human health risk. The concentration of Cr was analyzed using inductively coupled plasma–optical emission spectrometry (ICP-OES). The concentration of the metal was found to exceed the threshold limit, mainly in areas of high human activities. The hazard quotient through ingestion exposure did not exceed the threshold limit of 1 for adults and children and cancer risk for adults and children computed did not exceed the threshold limit of 10-4. Thus, there is no potential health risk from chromium through ingestion of drinking water for now. However, with increasing human activities, especially mining, the concentration could increase and become harmful to humans who depend on rivers for drinking water. It is recommended that proper management strategies should be taken to minimize the impact of chromium on the rivers and water from the rivers should properly be treated before domestic use.

Keywords: land use, health risk, metal pollution, water quality

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Authors: Muhammad Kamran Hanif Khan, Fahad Mushtaq

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Globally, the death rate from cardiovascular disease has risen over the past 20 years, but especially in low and middle-income countries (LMICS), reports the World Health Organization (WHO). Around 17.5 million deaths, or 31% of all deaths worldwide in 2012, were attributed to CVD, 80% of which occurred in low- and middle-income nations, and eighty five percent of all worldwide disability is attributable to cardiovascular disease. This study assessed the dietary habit and Cardiovascular Risk factors among the patients of coronary artery disease against matched controls. The research was a case-control study. Sample size for this case-control study was 410 CAD cases and 410 healthy controls. The case-control ratio was 1:1. Patients diagnosed with coronary artery disease were recruited from the outpatient departments and emergency rooms of four hospitals in Pakistan. The ages of people who were diagnosed with coronary artery disease were not significantly different from (mean 57.97 7.39 years) the healthy controls (mean 57.12 6.73 years). In order to determine the relationship between food consumption and the two binary outcomes, logistic regression analysis was carried out. Chicken (0.340 (0.245-0.47), p-value 0.0001), beef (0.38 (0.254-0.56), p-value 0.0001), eggs (0.297 (0.208-0.426), p-value 0.0001), and junk food (0.249 (0.167-0.372), p-value 0.0001)) were protective, while yogurt consumption more than twice weekly was risk. Conclusion: In conclusion, poor dietary habits are closely linked to the risk of CAD. Investigations based on dietary trends offer vital and practical knowledge about societal patterns.

Keywords: dietary habbits, cardiovasculardisease, CVD risk factors, hypercholesterolemia

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Authors: Malihe Motiei, Nor Hidayati Zakaria, Davide Aloini

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This study aims to present a method to develop the failure measurement model for ERP post-implementation. To achieve this outcome, the study firstly evaluates the suitability of Technology-Organization-Environment framework for the proposed conceptual model. This study explains how to discover the constructs and subsequently to design and evaluate the constructs as formative or reflective. Constructs are used including reflective and purely formative. Then, the risk dimensions are investigated to determine the instruments to examine the impact of risk on ERP failure after implementation. Two construct as formative constructs consist inadequate implementation and poor organizational decision making. Subsequently six construct as reflective construct include technical risks, operational risks, managerial risks, top management risks, lack of external risks, and user’s inefficiency risks. A survey was conducted among Iranian industries to collect data. 69 data were collected from manufacturing sectors and the data were analyzed by Smart PLS software. The results indicated that all measurements included 39 critical risk factors were acceptable for the ERP post-implementation failure model.

Keywords: critical risk factors (CRFs), ERP projects, ERP post-implementation, measurement instruments, ERP system failure measurement model

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Authors: Fidelis E. Uwumiro, Chimaobi O. Nwevo, Favour O. Osemwota, Victory O. Okpujie, Emeka S. Obi, Omamuyovbi F. Nwoagbe, Ejiroghene Tejere, Joycelyn Adjei-Mensah, Christopher N. Ekeh, Charles T. Ogbodo

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Several risk factors associated with cardiovascular events have been identified as specific to Chronic Kidney Disease (CKD). This study endeavors to validate these CKD-specific risk factors using up-to-date national-level data, thereby highlighting the crucial significance of confirming the validity and generalizability of findings obtained from previous studies conducted on smaller patient populations. The study utilized the nationwide inpatient sample database to identify adult hospitalizations for CKD from 2016 to 2020, employing validated ICD-10-CM/PCS codes. A comprehensive literature review was conducted to identify both traditional and CKD-specific risk factors associated with cardiovascular events. Risk factors and cardiovascular events were defined using a combination of ICD-10-CM/PCS codes and statistical commands. Only risk factors with specific ICD-10 codes and hospitalizations with complete data were included in the study. Cardiovascular events of interest included cardiac arrhythmias, sudden cardiac death, acute heart failure, and acute coronary syndromes. Univariate and multivariate regression models were employed to evaluate the association between chronic kidney disease-specific risk factors and cardiovascular events while adjusting for the impact of traditional CV risk factors such as old age, hypertension, diabetes, hypercholesterolemia, inactivity, and smoking. A total of 690,375 hospitalizations for CKD were included in the analysis. The study population was predominantly male (375,564, 54.4%) and primarily received care at urban teaching hospitals (512,258, 74.2%). The mean age of the study population was 61 years (SD 0.1), and 86.7% (598,555) had a CCI of 3 or more. At least one traditional risk factor for CV events was present in 84.1% of all hospitalizations (580,605), while 65.4% (451,505) included at least one CKD-specific risk factor for CV events. The incidence of CV events in the study was as follows: acute coronary syndromes (41,422; 6%), sudden cardiac death (13,807; 2%), heart failure (404,560; 58.6%), and cardiac arrhythmias (124,267; 18%). 91.7% (113,912) of all cardiac arrhythmias were atrial fibrillations. Significant odds of cardiovascular events on multivariate analyses included: malnutrition (aOR: 1.09; 95% CI: 1.06–1.13; p<0.001), post-dialytic hypotension (aOR: 1.34; 95% CI: 1.26–1.42; p<0.001), thrombophilia (aOR: 1.46; 95% CI: 1.29–1.65; p<0.001), sleep disorder (aOR: 1.17; 95% CI: 1.09–1.25; p<0.001), and post-renal transplant immunosuppressive therapy (aOR: 1.39; 95% CI: 1.26–1.53; p<0.001). The study validated malnutrition, post-dialytic hypotension, thrombophilia, sleep disorders, and post-renal transplant immunosuppressive therapy, highlighting their association with increased risk for cardiovascular events in CKD patients. No significant association was observed between uremic syndrome, hyperhomocysteinemia, hyperuricemia, hypertriglyceridemia, leptin levels, carnitine deficiency, anemia, and the odds of experiencing cardiovascular events.

Keywords: cardiovascular events, cardiovascular risk factors in CKD, chronic kidney disease, nationwide inpatient sample

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Authors: Bibiana Matilde Bernal Gómez, Manuel Salvador Rodríguez Susa, Mildred Fernanda Lemus Perez

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In chlorinated drinking water, Haloacetic acids have been identified and are classified as disinfection byproducts originating from reaction between natural organic matter and/or bromide ions in water sources. These byproducts can be generated through a variety of chemical and pharmaceutical processes. The term ‘Total Haloacetic Acids’ (THAAs) is used to describe the cumulative concentration of dichloroacetic acid, trichloroacetic acid, monochloroacetic acid, monobromoacetic acid, and dibromoacetic acid in water samples, which are usually measured to evaluate water quality. Chronic presence of these acids in drinking water has a risk of cancer in humans. The detection of THAAs for the first time in 15 municipalities of Boyacá was accomplished in 2023. Aim is to describe the correlation between the levels of THAAs and digestive cancer in Tunja, a city in Colombia with higher rates of digestive cancer and to compare the risk across 15 towns, taking into account factors such as water quality. A research project was conducted with the aim of comparing water sources based on the geographical features of the town, describing the disinfection process in 15 municipalities, and exploring physical properties such as water temperature and pH level. The project also involved a study of contact time based on habits documented through a survey, and a comparison of socioeconomic factors and lifestyle, in order to assess the personal risk of exposure. Data on the levels of THAAs were obtained after characterizing the water quality in urban sectors in eight months of 2022. This, based on the protocol described in the Stage 2 DBP of the United States Environmental Protection Agency (USEPA) from 2006, which takes into account the size of the population being supplied. A cancer risk assessment was conducted to evaluate the likelihood of an individual developing cancer due to exposure to pollutants THAAs. The assessment considered exposure methods like oral ingestion, skin absorption, and inhalation. The chronic daily intake (CDI) for these exposure routes was calculated using specific equations. The lifetime cancer risk (LCR) was then determined by adding the cancer risks from the three exposure routes for each HAA. The risk assessment process involved four phases: exposure assessment, toxicity evaluation, data gathering and analysis, and risk definition and management. The results conclude that there is a cumulative higher risk of digestive cancer due to THAAs exposure in drinking water.

Keywords: haloacetic acids, drinking water, water quality, cancer risk assessment

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Authors: Priyatma Singh, Manpreet Kaur

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Climate change is progressively being identified as a global crisis and this has immediate repercussions for Fiji Islands due to its geographical location being prone to natural disasters. In the Pacific, it is common to find significant differences between men and women, in terms of their roles and responsibilities. In the pursuit of prudent preparedness before disasters, Fijian women’s engagement is constrained due to socially constructed roles and expectation of women here in Fiji. This vulnerability is aggravated by viewing women as victims, rather than as key people who have vital information of their society, economy, and environment, as well as useful skills, which, when recognized and used, can be effective in disaster risk reduction. The focus of this study on disaster management is to outline ways in which Fijian women can be actively engaged in disaster risk management, articulating in decision-making, negating the perceived ideology of women’s constricted roles in Fiji and unveiling social constraints that limit women’s access to practical disaster management strategic plan. This paper outlines the importance of gender mainstreaming in disaster risk reduction and the ways of mainstreaming gender based on a literature review. It analyses theoretical study of academic literature as well as papers and reports produced by various national and international institutions and explores ways to better inform and engage women for climate change per ser disaster management in Fiji. The empowerment of women is believed to be a critical element in constructing disaster resilience as women are often considered to be the designers of community resilience at the local level. Gender mainstreaming as a way of bringing a gender perspective into climate related disasters can be applied to distinguish the varying needs and capacities of women, and integrate them into climate change adaptation strategies. This study will advocate women articulation in disaster risk management, thus giving equal standing to females in Fiji and also identify the gaps and inform national and local Disaster Risk Management authorities to implement processes that enhance gender equality and women’s empowerment towards a more equitable and effective disaster practice.

Keywords: disaster risk management, climate change, gender mainstreaming, women empowerment

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Authors: Amany A. Ragheb, Ghada Ragheb, Abd ElRahman A.

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Egypt has a countless heritage of mansions, castles, cities, towns, villages, industrial and manufacturing sites. This richness of heritage provides endless and matchless prospects for culture. Despite being famous worldwide, Egypt’s heritage still is in constant need of protection. Political conflicts and religious revolutions form a direct threat to buildings in various areas, historic, archaeological sites, and religious monuments. Egypt has witnessed two revolutions in less than 60 years; both had an impact on its architectural heritage. In this paper, the authors aim to review legal and policy framework to protect the cultural heritage and present the risk management strategy for cultural heritage in conflict. Through a review of selected international models of devastated architectural heritage in conflict zones and highlighting some of their changes, we can learn from the experiences of other countries to assist towards the development of a methodology to halt the plundering of architectural heritage. Finally, the paper makes an effort to enhance the formulation of a risk management strategy for protection and conservation of cultural heritage, through which to end the plundering of Egypt’s architectural legacy in the Egyptian community (revolutions, 1952 and 2011); and by presenting to its surrounding community the benefits derived from maintaining it.

Keywords: cultural heritage, legal regulation, risk management, preservation

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Authors: Aslam Faheem, Hunjra Ahmed Imran, Tayachi Tahar, Verhoeven Peter, Tariq Yasir

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We investigate the evidence of three risk-adjusted calendar anomalies in eight frontier markets. Our sample consists of the daily closing prices of their stock indices for the period of January 2006 to September 2019. We categorize the data with respect to day-of-the-week, Lunar calendar and Islamic calendar. Using Morgan Stanley Capital International (MSCI) eight Markets Index as our proxy of the market portfolio, most of the frontier markets tested exhibit calendar seasonality. We confirm that systematic risk varies with respect to day-of-the-week, Lunar months and Islamic months. After consideration of time-varying risk and applying Bonferroni correction, few frontier markets exhibit profitable investment opportunities from calendar return anomalies for active investment managers.

Keywords: asset pricing, frontier markets, market efficiency, Islamic calendar effects, Islamic stock markets

Procedia PDF Downloads 167

Authors: Kimberly Tasha Jiayi Tang, Changqing Lin, Zhe Wang, Tze-Wai Wong, Md. Shakhaoat Hossain, Jian Yu, Alexis Lau

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Hong Kong has practiced a risk-based Air Quality Health Index (AQHI) system that sums hospitalization risks associated with short-term exposure to air pollu-tants. As an air pollution risk communication tool, it informs the public about the current air quality, anchoring around the World Health Organization's (WHO) 2005 Air Quality Guidelines (AQGs). Given the WHO's recent update in 2021, assessing how Hong Kong’s air quality risk communication can be en-hanced using these updated guidelines is essential. Hong Kong’s AQHI is lim-ited by solely focusing on short-term health risks, which could lead the public to underestimate cumulative health impacts. Therefore, we propose the intro-duction of a composite AQHI that reports both long-term and short-term health risks. Additionally, the WHO interim targets will be considered as anchor points for various health risk categories. Furthermore, with the increasing ozone levels in Hong Kong and Southern China due to improved NOx mitigation measures, it has been a challenging task in balancing health protection against climate mitigation. However, our findings present a promising outlook. Despite the rise in ozone levels, the combined health risks in Hong Kong and Guang-dong have seen a decline, largely due to reductions in NO2 and PM concentra-tions, both having significant health implications. By shifting from a concentra-tion-based approach to a health risk-based system like the AQHI, our study highlights the prospective of harmonizing health protection and climate mitiga-tion goals. This health-focused framework suggests that rigorous NOx controls can effective-ly serve both objectives in parallel.

Keywords: air quality management, air quality health index, health risk management, air pollution

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Authors: Lynmar M. Didal, Ramises G. Manzano Jr., Jacque Bon-Isaac C. Aboy

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This study analyzes the performance of global minimum variance and naive portfolios across different economic periods, using monthly stock returns from the Philippine Stock Exchange Index (PSEI), S&P 500, and Dow Jones Industrial Average (DOW). The performance is evaluated through the Sharpe ratio, Sortino ratio, Jensen’s Alpha, Treynor ratio, and Information ratio. Additionally, the study investigates the impact of short selling on portfolio performance. Six-time periods are defined for analysis, encompassing events such as the global financial crisis and the COVID-19 pandemic. Findings indicate that the Naive portfolio generally outperforms the GMV portfolio in the S&P 500, signifying higher returns with increased volatility. Conversely, in the PSEI and DOW, the GMV portfolio shows more efficient risk-adjusted returns. Short selling significantly impacts the GMV portfolio during mid-GFC and mid-COVID periods. The study offers insights for investors, suggesting the Naive portfolio for higher risk tolerance and the GMV portfolio as a conservative alternative.

Keywords: portfolio performance, global minimum variance, naïve portfolio, risk-adjusted metrics, short-selling

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Authors: Maryam Najafi, Mahdi Rajabi

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Although the rural cooperatives are an effective way for rural development in Iran, their potential is not applied effectively. The investigation of the failures of rural cooperatives helps the authorities to improve the routine procedures and eliminate the current barriers to the success of these cooperatives, and to remove the defects in order to have a more efficient policy. Therefore, this research aims to prioritize the failure factors of rural cooperatives in Isfahan province via the survey research method. For this purpose, the effective factors of these failures were investigated by the available research documents and then by the new information which was obtained from 20 questionnaires from the experts of Central Organization Rural Cooperatives in Isfahan province. The questionnaire results were analyzed by Analytical Hierarchy Process (AHP), Excel, and Expert Choice software. The results of this research showed that the most important failure factor of these cooperatives is the lack of the participation culture of cooperative members and then the performance of Central Organization Rural Cooperatives, and also loss of confidence of the members in the cooperation.

Keywords: cooperative, rural cooperatives, failure factors, analytical hierarchy process

Procedia PDF Downloads 129

Authors: Obe Olumide Olayinka, Victor Balanica, Eugen Neagoe

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The effects of hypertension are often lethal thus its early detection and prevention is very important for everybody. In this paper, a neural network (NN) model was developed and trained based on a dataset of hypertension causative parameters in order to forecast the likelihood of occurrence of hypertension in patients. Our research goal was to analyze the potential of the presented NN to predict, for a period of time, the risk of hypertension or the risk of developing this disease for patients that are or not currently hypertensive. The results of the analysis for a given patient can support doctors in taking pro-active measures for averting the occurrence of hypertension such as recommendations regarding the patient behavior in order to lower his hypertension risk. Moreover, the paper envisages a set of three example scenarios in order to determine the age when the patient becomes hypertensive, i.e. determine the threshold for hypertensive age, to analyze what happens if the threshold hypertensive age is set to a certain age and the weight of the patient if being varied, and, to set the ideal weight for the patient and analyze what happens with the threshold of hypertensive age.

Keywords: neural network, hypertension, data set, training set, supervised learning

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Authors: Mohamed A. Hammad, Dzul Azri Mohamed Noor, Syed Azhar Syed Sulaiman, Abeer Kharshid, Nor Azizah Aziz, Tarek M. Elsayed

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Medication safety is always an issue. In 2015, the National Pharmaceutical Control Bureau released a statement requesting all statins manufacturers in Malaysia to include the risk of diabetes information in the drug information leaflet in response to United States Food and Drug Administration (U.S. FDA) report. However, the data regarding this warning label in Malaysia is limited, so there is still some uncertainty whether such risk can also be observed in the Malaysian population or not. The study aims to determine the effect of statins on HbA1c% in type 2 diabetic outpatients in endocrine clinics at Hospital Pulau Pinang between June 2015 and May 2016 in Malaysia. In a prospective cohort study, records of 400 type 2 diabetic patients (control group 104 patients not using statin and treatment group 296 patients using statin) were reviewed to identify demographic criteria and lab tests. The prevalence of glycemic control (Glycated hemoglobin, HbA1C ≤ 7% for patient < 65 years, and < 8% for patient ≥ 65 years) was estimated, according to American Diabetes Association guidelines 2015. The results were presented as descriptive statistics. From 296 patients with Type 2 diabetes using statins cohort with a mean age of 57.52 ± 12.2 years, only 81 (27.4%) cases had controlled glycemia, and 215 (72.6%) had uncontrolled glycemia, CI: 95% (6.3–11.1). While the control group 104 diabetic patients had a mean age 46.1 ± 18 years and distributed among 59 (56.7%) patients with controlled diabetes and 45 (43.3%) cases, had uncontrolled glycemia, CI: 95% (5.2–10.3). The relative risk (RR) of uncontrolled glycemia in diabetic patients used statins was 1.68, and the excessive relative risk (ERR) was 68%. The absolute risk (AR) was 29.3%, and the number needed to harm (NNH) was 4. Diabetic patients using statins have more risk of uncontrolled glycemia than the patients with Type 2 diabetes non-using statins.

Keywords: diabetes mellitus, HbA1c, Malaysia, outpatients, statin, type 2, uncontrolled glycemia

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Authors: David R. LaVetter, Justin B. Homatas, Claudia Benavides Espinoza

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An increased awareness of depression rates among collegiate athletes has aided educational institutions to evaluate their mental health resources for athletes. This paper adds to our knowledge of this growing problem among collegiate athletes. National athletic associations and educational institutions are more knowledgeable of the mental health crisis facing hundreds of thousands of athletes each year, and some have implemented resources to improve mental health. However, college athletes continue to experience depressive symptoms at increasing rates. In this paper, depression rates for the vast numbers of collegiate athletes were found to be significantly greater than the general adult population. This paper used the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) method to examine the literature’s findings on depression rates among collegiate athletes. Particularly, this study answers questions related to risk factors of college athletes’ depressive symptoms. Risk factors unique to this population are also discussed. Prevalence rates by sport participant gender and sport are provided. Implementation measures in current practice at educational institutions in the U.S. are discussed to help alleviate depression rates among college athletes.

Keywords: college athletes, depression, risk factors, mental health

Procedia PDF Downloads 65

Authors: Md. Refat Jahan Rakiba, M. Belal Hossaina, Rakesh Kumarc, Md. Akram Ullaha, Sultan Al Nahiand, Nazmun Naher Rimaa, Tasrina Rabia Choudhury, Samia Islam Libaf, Jimmy Yub, Mayeen Uddin Khandakerg, Abdelmoneim Suliemanh, Mohamed Mahmoud Sayedi

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Microplastics (MPs) have become an emerging global pollutant due to their wide spread and dispersion and potential threats to marine ecosystems. However, studies on MPs of estuarine and coastal ecosystems of Bangladesh are very limited or not available. In this study, we conducted the first study on the abundance, distribution, characteristics and potential risk assessment of microplastics in the sediment of Karnaphuli River estuary, Bangladesh. Microplastic particles were extracted from sediments of 30 stations along the estuary by density separation, and then enumerated and characterize by using steromicroscope and Fourier Transform Infrared (FT-IR) spectroscopy. In the collected sediment, the number of MPs varied from 22.29 - 59.5 items kg−1 of dry weight (DW) with an average of 1177 particles kg−1 DW. The mean abundance was higher in the downstream and left bank of estuary where the predominant shape, colour, and size of MPs were films (35%), white (19%), and >5000 μm (19%), respectively. The main polymer types were polyethylene terephthalate, polystyrene, polyethylene, cellulose, and nylon. MPs were found to pose risks (low to high) in the sediment of the estuary, with the highest risk occuring at one station near a sewage outlet, according to the results of risk analyses using the pollution risk index (PRI), polymer risk index (H), contamination factors (CFs), and pollution load index (PLI). The single value index, PLI clearly demonastated that all sampling sites were considerably polluted (as PLI >1) with microplastics. H values showed toxic polymers even in lower proportions possess higher polymeric hazard scores and vice versa. This investigation uncovered new insights on the status of MPs in the sediments of Karnaphuli River estuary, laying the groundwork for future research and control of microplastic pollution and management.

Keywords: microplastics, polymers, pollution risk assessment, Karnaphuli esttuary

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Authors: Hui-Chi Huang, Su-Ju Yang, Ching-Wei Lin, Jui-Yao Tsai, Liang-Yiang

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Background: The most common serious complication following acute stroke is pneumonia. It has been associated with the increased morbidity, mortality, and medical cost after acute stroke in elderly patients. Purpose: The aim of this retrospective study was to investigate the relationship between stroke patients, risk factors of pneumonia, and one-year survival rates in a group of patients, in a tertiary referal center in Northern Taiwan. Methods: From January 2012 to December 2013, a total of 1730 consecutively administered stroke patients were recruited. The Survival analysis and multivariate regression analyses were used to examine the predictors for the one-year survival in stroke patients of a stroke registry database from northern Taiwan. Results: The risk of stroke mortality increased with age≧ 75 (OR=2.305, p < .0001), cancer (OR=3.221, p=<.0001), stayed in intensive care unit (ICU) (OR=2.28, p <.0006), dysphagia (OR=5.026, p<.0001), without speech therapy(OR=0.192, p < .0001),serum albumin < 2.5(OR=0.322, p=.0053) , eGFR > 60(OR=0.438, p <. 0001), admission NIHSS >11(OR=1.631, p=.0196), length of hospitalization (d) > 30(OR=0.608, p=.0227), and stroke subtype (OR=0.506, p=.0032). After adjustment of confounders, pneumonia was not significantly associated with the risk of mortality. However, it is most likely to develop in patients who are age ≧ 75, dyslipidemia , coronary artery disease , albumin < 2.5 , eGFR <60 , ventilator use , stay in ICU , dysphagia, without speech therapy , urinary tract infection , Atrial fibrillation , Admission NIHSS > 11, length of hospitalization > 30(d) , stroke severity (mRS=3-5) ,stroke Conclusion: In this study, different from previous research findings, we found that elderly age, severe neurological deficit and rehabilitation therapy were significantly associated with Post-stroke Pneumonia. However, specific preventive strategies are needed to target the high risk groups to improve their long-term outcomes after acute stroke. These findings could open new avenues in the management of stroke patients.

Keywords: stroke, risk, pneumonia, survival

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