Search results for: risk of bleeding

Authors: Jeongwoo Lee

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Children are the most vulnerable travelers and they are at risk for pedestrian injury. Creating a safe route to school is important because walking to school is one of the main opportunities for promotion of needed physical exercise among children. This study examined how the built environmental attributes near an elementary school influence traffic accidents among school-aged children. The study used two complementary data sources including the locations of police-reported pedestrian crashes and the built environmental characteristics of school areas. The environmental attributes of road segments were collected through GIS measurements of local data and actual site audits using the inventory developed for measuring pedestrian-crash risk scores. The inventory data collected at 840 road segments near 32 elementary schools in the city of Ulsan. We observed all segments in a 300-meter-radius area from the entrance of an elementary school. Segments are street block faces. The inventory included 50 items, organized into four domains: accessibility (17items), pleasurability (11items), perceived safety from traffic (9items), and traffic and land-use measures (13items). Elementary schools were categorized into two groups based on the distribution of the pedestrian-crash hazard index scores. A high pedestrian-crash zone was defined as an school area within the eighth, ninth, and tenth deciles, while no pedestrian-crash zone was defined as a school zone with no pedestrian-crash accident among school-aged children between 2013 and 2016. No- and high pedestrian-crash zones were compared to determine whether different settings of the built environment near the school lead to a different rate of pedestrian-crash incidents. The results showed that a crash risk can be influenced by several environmental factors such as a shape of school-route, number of intersections, visibility and land-use in a street, and a type of sidewalk. The findings inform policy for creating safe routes to school to reduce the pedestrian-crash risk among children by focusing on school zones.

Keywords: active school travel, school zone, pedestrian crash, safety route to school

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Authors: S. Albert, R. Cossu, A. Grinham, C. Heatherington, C. Wilson

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Shipping trends suggest increasing vessel size and draught visiting Australian ports highlighting potential challenges to port infrastructure and requiring optimization of shipping channels to ensure safe passage for vessels. The Port of Brisbane in Queensland, Australia has an 80 km long access shipping channel which vessels must transit 15 km of relatively shallow coffee rock (generic class of indurated sands where sand grains are bound within an organic clay matrix) outcrops towards the northern passage in Moreton Bay. This represents a risk to shipping channel deepening and maintenance programs as the dredgeability of this material is more challenging due to its high cohesive strength compared with the surrounding marine sands and potential higher acid sulfate risk. In situ assessment of acid sulfate sediment for dredge spoil control is an important tool in mitigating ecological harm. The coffee rock in an anoxic undisturbed state does not pose any acid sulfate risk, however when disturbed via dredging it’s vital to ensure that any present iron sulfides are either insignificant or neutralized. To better understand the potential risk we examined the reduction potential of coffee rock across the entire dredge cycle in order to accurately portray the true outcome of disturbed acid sulfate sediment in dredging operations in Moreton Bay. In December 2014 a dredge trial was undertaken with a trailing suction hopper dredger. In situ samples were collected prior to dredging revealed acid sulfate potential above threshold guidelines which could lead to expensive dredge spoil management. However, potential acid sulfate risk was then monitored in the hopper and subsequent discharge, both showing a significant reduction in acid sulfate potential had occurred. Additionally, the acid neutralizing capacity significantly increased due to the inclusion of shell fragments (calcium carbonate) from the dredge target areas. This clearly demonstrates the importance of assessing potential acid sulfate risk across the entire dredging cycle and highlights the need to carefully evaluate sources of acidity.

Keywords: acid sulfate, coffee rock, indurated sand, dredging, maintenance dredging

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Authors: Jiemiao Chen, Shuoxun Xu

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The main goal of our research is to apply the Vine copula measuring dependency between price, temperature, and precipitation indices to calculate a fair crop insurance premium. This research is focused on Worth, Iowa, United States, over the period from 2000 to 2020, where the farmers are dependent on precipitation and average temperature during the growth period of corn. Our proposed insurance considers both the natural risk and the price risk in agricultural production. We first estimate the distributions of crops using parametric methods based on Goodness of Fit tests, and then Vine Copula is applied to model dependence between yield price, crop yield, and weather indices. Once the vine structure and its parameters are determined based on AIC/BIC criteria and forecasting price and yield are obtained from the ARIMA model, we calculate this crop insurance premium using the simulation data generated from the vine copula by the Monte Carlo Simulation method. It is shown that, compared with traditional crop insurance, our proposed insurance is more fair and thus less costly for the farmers and government.

Keywords: vine copula, weather index, crop insurance premium, insurance risk management, Monte Carlo simulation

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Authors: Mark De Ste Croix, Jonathan Hughes, Francisco Ayala, Michal Lehnert

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There are well-known challenges to implementing injury prevention training for youth players but no data are available on the knowledge and understanding of deliverers of such programmes at grass root level. To increase adoption and adherence to such programmes coach knowledge and understanding of injury risk and prevention is essential. Therefore, the purpose of this study was to examine grass-root coaches knowledge and understanding of injury risk and prevention in youth players. 68 grass root coaches (18 females and 50 males) who were attending a one-day injury prevention workshop completed a modified validated questionnaire exploring knowledge and understanding of injury risk and prevention in youth players. Only 59% of coaches agreed that youth players are at a high risk of suffering an injury. There were high levels of agreement that injuries can have negative impacts on team performance (75%) and can cause physical problems in later life (85%), however only around half of coaches felt that injuries affect youth players current quality of life (59%). There was strong agreement that it is possible to prevent injuries in youth players (84%), but coaches were generally unaware of programs to help prevent injuries (84%), and only 9% used some form of injury prevention program. Despite this, nearly all coaches felt that their coaching could benefit from a greater understanding of growth and maturation (91%), injury prevention programmes (91%) and specific exercises (93%) for youth athletes. 17% of coaches rated their knowledge of injury prevention as good/very good at the start of the workshop and this increased to 94% at the end of the workshop. 62% of coaches identified their attitude towards injury prevention as indifferent at the start of the workshop compared with only 1% at the end. Only 14% of coaches at the start of the workshop were confident to deliver an injury prevention session but 83% stated they were confident by the end of the workshop. Finally, 98% of coaches felt that the workshop provided them with the confidence and the knowledge to deliver an injury prevention session and 98% suggested that they would implement injury prevention into their coaching. These data suggest that there is a lack of understanding of grass root coaches that children are a high-risk group for injuries, and that such injuries impact on current quality of life. Despite understanding that injuries can be prevented most grass root coaches do not have the knowledge to implement injury prevention into their coaching and very few do. There is a common consensus amongst these coaches that a greater understanding of such programmes will enhance their coaching. The injury prevention workshop appears to have increased the knowledge and changed the attitude of coaches towards injury prevention. All coaches felt that the workshop provided them with the tools to adopt, implement and deliver injury prevention in their coaching. These data highlight that there is a clear need for education regarding injury risk and prevention to be embedded within the coach education pathway, especially at grass root level.

Keywords: coach education, injury prevention, knowledge, and understanding, youth

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Authors: Euan Donley

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Emergency Departments (EDs) are heavily burdened as presentation rates continue to rise. To improve patient flow National Emergency Access Targets (NEAT) were introduced. NEAT implements timelines for ED presentations, such as discharging patients within four hours of arrival. Mental health patients use EDs more than the general population and are generally more complex in their presentations. The aim of this study is to examine the impact of NEAT on psychiatric risk assessment of mental health patients in the ED. Seventy-eight mental health clinicians from 7 Victoria, Australia, hospital EDs participated in a mixed method analysis via anonymous online survey. NEAT was considered helpful as mental health patients were seen quicker, were less likely to abscond, could improve teamwork amongst ED staff, and in some cases administrative processes were better streamlined. However, clinicians felt that NEAT was also responsible for less time with patients and relatives’, resulted in rushed assessments, placed undue pressure on mental health clinicians, was not conducive to training, and the emphasis on time was the wrong focus for patient treatment. The profile of a patient typically likely to be treated within NEAT timelines showed a perfect storm of luck and compliance. If a patient was sober, medically stable, referred early, did not require much collateral information and did not have distressed relatives, NEAT was more likely to be met. Organisationally participants reported no organisational change or training to meet NEAT. Poor mental health staffing, multiple ED presentations and a shortage of mental health beds also hamper meeting NEAT. Findings suggest participants were supportive of NEAT in principle, but a demanding workload and organisational barriers meant NEAT had an overall negative effect on psychiatric risk assessment of mental health patients in ED.

Keywords: assessment, emergency, risk, psychiatric

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Authors: Armel Zacharie Ekoa Bessa, Annick Kwewouo Janpou

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Sediments collected along the beaches of the Atlantic Ocean in Africa were analyzed by geochemical proxies such as the ICP-MS technique to determine their heavy metal contamination and related ecological risks. Several metals were selected and show a decreasing trend: Fe > Mn > Ni > Cu > Co > Zn > Cr > Cd. Several pollution indices have been calculated, including the enrichment factor (EF), whose values are generally higher than 1. 5; the geo-accumulation index (I-geo), with values of some elements (Co, Ni and Cu) in the sediments of the study area being higher than 0, and other metals (Zn, Cr, Fe and Mn) being lower than 0; the contamination factor (CF), where the values of all the selected elements are between 1 and 3; and the pollution load index (PLI), where the values in almost all the study sites are higher than 1. These results show moderate contamination of the investigated sediments with heavy metals. The potential ecological risk assessment (Eri and RI) suggests that this part of the African coast is a low to a slight risk area. Statistical analyses indicate that heavy metals have shown fairly similar trends with anthropogenic and natural sources. This study shows that this coastal area is not highly concentrated in heavy metals and reveals that the Atlantic coast of Africa would be moderately polluted by the metals studied, with a low to moderate ecological risk.

Keywords: heavy metals, pollution, atlantic ocean, sediments

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Authors: Terri Cole, Fay Sweeting

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Abuse of position for sexual gain by police is defined as behavior involving individuals taking advantage of their role to pursue a sexual or improper relationship. Previous research has considered whether it involves ‘bad apples’ - individuals with poor moral ethos or ‘bad barrels’ – broader organizational flaws which may unconsciously allow, minimize, or do not effectively deal with such behavior. Low level sexual misconduct (e.g., consensual sex on duty) is more common than more serious offences (e.g., rape), yet the impact of such behavior can have severe implications not only for those involved but can also negatively undermine public confidence in the police. This ongoing, collaborative research project has identified variables from 514 historic case files from 35 UK police forces in order to identify potential risk indicators which may lead to such behavior. Quantitative analysis using logistic regression and the Cox proportion hazard model has resulted in the identification of specific risk factors of significance in prediction. Factors relating to both perpetrator background such as a history of intimate partner violence, debt, and substance misuse coupled with in work behavior such as misusing police systems increase the risk. Findings are able to provide pragmatic recommendations for those tasked with identifying potential or investigating suspected perpetrators of misconduct.

Keywords: abuse of position, forensic psychology, misconduct, sexual abuse

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Authors: Claude Nsobya, Alice Moncaster, Karen Potter, Jed Ramsay

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The shift in Flood Risk Governance (FRG) has moved away from traditional approaches that solely relied on centralized decision-making and structural flood defenses. Instead, there is now the adoption of integrated flood risk management measures that involve various actors and stakeholders. This new approach emphasizes people-centered approaches, including adaptation and learning. This shift to a diversity of FRG approaches has been identified as a significant factor in enhancing resilience. Resilience here refers to a community's ability to withstand, absorb, recover, adapt, and potentially transform in the face of flood events. It is argued that if the FRG merely focused on the conventional 'fighting the water' - flood defense - communities would not be resilient. The move to these people-centered approaches also implies that communities will be more involved in FRG. It is suggested that effective flood risk governance influences resilience through meaningful community involvement, and effective community engagement is vital in shaping community resilience to floods. Successful community participation not only uses context-specific indigenous knowledge but also develops a sense of ownership and responsibility. Through capacity development initiatives, it can also raise awareness and all these help in building resilience. Recent Flood Risk Management (FRM) projects have thus had increasing community involvement, with varied conceptualizations of such community engagement in the academic literature on FRM. In the context of overland floods, there has been a substantial body of literature on Flood Risk Governance and Management. Yet, groundwater flooding has gotten little attention despite its unique qualities, such as its persistence for weeks or months, slow onset, and near-invisibility. There has been a little study in this area on how successful community involvement in Flood Risk Governance may improve community resilience to groundwater flooding in particular. This paper focuses on a case study of a flood risk management project in the United Kingdom. Buckinghamshire Council is leading Project Groundwater, which is one of 25 significant initiatives sponsored by England's Department for Environment, Food and Rural Affairs (DEFRA) Flood and Coastal Resilience Innovation Programme. DEFRA awarded Buckinghamshire Council and other councils 150 million to collaborate with communities and implement innovative methods to increase resilience to groundwater flooding. Based on a literature review, this paper proposes a new paradigm for effective community engagement in Flood Risk Governance (FRG). This study contends that effective community participation can have an impact on various resilience capacities identified in the literature, including social capital, institutional capital, physical capital, natural capital, human capital, and economic capital. In the case of social capital, for example, successful community engagement can influence social capital through the process of social learning as well as through developing social networks and trust values, which are vital in influencing communities' capacity to resist, absorb, recover, and adapt. The study examines community engagement in Project Groundwater using surveys with local communities and documentary analysis to test this notion. The outcomes of the study will inform community involvement activities in Project Groundwater and may shape DEFRA policies and guidelines for community engagement in FRM.

Keywords: flood risk governance, community, resilience, groundwater flooding

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Authors: Pratima Pokharel

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When sewer overflow due to rainfall in urban areas, this leads to public health risks when an individual is exposed to that contaminated floodwater. Nevertheless, it is still unclear the extent to which the infections pose a risk to public health. This study analyzed reported diarrheal cases by month and age in Bangkok, Thailand. The results showed that the cases are reported higher in the wet season than in the dry season. It was also found that in Bangkok, the probability of infection with diarrheal diseases in the wet season is higher for the age group between 15 to 44. However, the probability of infection is highest for kids under 5 years, but they are not influenced by wet weather. Further, this study introduced a vulnerability that leads to health risks from urban flooding. This study has found some vulnerability variables that contribute to health risks from flooding. Thus, for vulnerability analysis, the study has chosen two variables, economic status, and age, that contribute to health risk. Assuming that the people's economic status depends on the types of houses they are living in, the study shows the spatial distribution of economic status in the vulnerability maps. The vulnerability map result shows that people living in Sukhumvit have low vulnerability to health risks with respect to the types of houses they are living in. In addition, from age the probability of infection of diarrhea was analyzed. Moreover, a field survey was carried out to validate the vulnerability of people. It showed that health vulnerability depends on economic status, income level, and education. The result depicts that people with low income and poor living conditions are more vulnerable to health risks. Further, the study also carried out 1D Hydrodynamic Advection-Dispersion modelling with 2-year rainfall events to simulate the dispersion of fecal coliform concentration in the drainage network as well as 1D/2D Hydrodynamic model to simulate the overland flow. The 1D result represents higher concentrations for dry weather flows and a large dilution of concentration on the commencement of a rainfall event, resulting in a drop of the concentration due to runoff generated after rainfall, whereas the model produced flood depth, flood duration, and fecal coliform concentration maps, which were transferred to ArcGIS to produce hazard and risk maps. In addition, the study also simulates the 5-year and 10-year rainfall simulations to show the variation in health hazards and risks. It was found that even though the hazard coverage is very high with a 10-year rainfall events among three rainfall events, the risk was observed to be the same with a 5-year and 10-year rainfall events.

Keywords: urban flooding, risk, hazard, vulnerability, health risk, framework

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Authors: Abdullah Almilaibary, Jeremy Jolley, Mark Hayter

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Background: Despite recent progress in enhancing the accessibility of HIV-related health services worldwide, opportunities to diagnose patients are often missed due to genuine barriers at different levels. The aim of the study is to explore the factors that affect the utilization of HIV testing services by young people aged 17-25 in Saudi Arabia. Methods: A non-experimental descriptive cross-sectional design was used to predict factors that influenced HIV testing among Umm- Al Qura University students aged 17-25 years. A newly developed self-completed online questionnaire was used and the study sample was drawn using a convenience sampling technique. The questionnaire consisted of 52 items divided into three scales: 12 items for HIV/AIDS-related knowledge, 3 items for risk perception, and 37 items for attitudes toward HIV testing. Five experts in the field of HIV/AIDS validated the contents of the questionnaire and agreed that the items included were related to the construct being measured. The reliability of the questionnaire was also assessed using a test/re-test strategy with 27 participants recruited from the population under study. The reliability assessment revealed that the questionnaire was consistent as Cronbach’s Alpha was 0.80 for HIV/ADS knowledge, 0.88 for risk perception and 0.78 for attitudes towards HIV testing. The data were collected between 14th of July and 14th of October 2014. Results: 394 participants completed the questionnaires: 116 (29.4%) male and 278 (70%) female. 50.5% of the participants were aged 20 to 22 years, 34.8% were 17-19 years and 14.7% were aged between 23-25 years; about 93% of the participants were single. Only 20 (6%) participants had previously been tested for HIV. The main reasons for not being tested for HIV were: exposure to HIV was considered unlikely (48%), HIV test was not offered (36%) and unawareness of HIV testing centres (16%). On HIV/AIDS-related knowledge, the male participants scored higher than the females as the mean score for males was (M = 6.4, SD = 2.4) while for females it was (M 5.7, SD 2.5). In terms of risk perception, female participants appeared to have lower levels of risk perception than male participants, with the mean score for males being (M 11.7, SD 2.5) and (M 10.5, SD 2.4) for females. The female participants showed slightly more positive attitudes towards HIV testing than male participants: the mean score for males was (M = 108.14, SD = 17.9) and was (M = 111.32, SD = 17.3) for females. Conclusions: The data reveal that misconceptions about HIV/AIDS in Saudi Arabia are still a challenge. Although the attitudes towards HIV testing were reasonably positive, the utilization of the HIV test was low. Thus, tailoring HIV/AIDS preventive strategies in Saudi Arabia should focus on the needs of young people and other high risk groups in the country.

Keywords: attitude toward hiv testing, hiv testing, hiv/aids related knowledge, risk perception

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Authors: Amy Halseth, Kevin Shan, Kye Gilder, John Buse

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The study assessed the effect of prolonged-release naltrexone 32 mg/bupropion 360 mg (NB) on cardiovascular (CV) events in overweight/obese participants at elevated CV risk. Participants must lose ≥ 2% body weight at 16 wks, without a sustained increase in blood pressure, to continue drug. The study was terminated early after second interim analysis with 50% of all CV events. Data on CV endpoints has been published. Current analyses focus on weight change. Intent-to-treat (ITT) population (placebo [PBO] N=4450, NB N=4455) was 54.5% female, 83.5% white, mean age 61 yrs, mean BMI 37.3 kg/m2; 85.2% had type 2 diabetes, 32.1% had CV disease, 17.4% had both. At 52 wks, ITT-LOCF analysis showed greater least squares mean percent change in weight (LSM%ΔBW) with NB (-3.1%; 95% CI -4.8, -1.4) vs PBO (-0.3%; 95% CI -1.9, 1.4). Both groups demonstrated greater weight loss while on-treatment (NB [-7.3%], PBO [-3.9%]). Odds ratios of 5% and 10% weight loss were 3.3 and 4.1 (ITT-LOCF), respectively, in NB over PBO. At 104 wks, on-treatment LSM%ΔBW was -6.3% with NB (n=1137) vs -3.5% with PBO (n=741). Major reasons for NB withdrawal were adverse events (AE, 29%) and patient decision (21%), with GI disorders being the most common. Weight loss with NB in this study, in an older population predominantly with diabetes and elevated CV risk, was somewhat lower than that observed in overweight/obese participants without diabetes and similar to participants with diabetes in Phase 3 studies.

Keywords: contrave, mysimba, obesity, pharmacotherapy, weight loss

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Authors: Ping Jiang, Yunyan Xing, Dian Zhang, Bo Guo

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The reliability qualification test (RQT) is widely used in product development to qualify whether the product meets predetermined reliability requirements, which are mainly described in terms of reliability indices, for example, MTBF (Mean Time Between Failures). It is widely exercised in product development. In engineering practices, RQT plans are mandatorily referred to standards, such as MIL-STD-781 or GJB899A-2009. But these conventional RQT plans in standards are not preferred, as the test plans often require long test times or have high risks for both producer and consumer due to the fact that the methods in the standards only use the test data of the product itself. And the standards usually assume that the product is exponentially distributed, which is not suitable for a complex product other than electronics. So it is desirable to develop an RQT plan derivation method that safely shortens test time while keeping the two risks under control. To meet this end, for the product whose lifetime follows Weibull distribution, an RQT plan derivation method is developed. The merit of the method is that expert judgment is taken into account. This is implemented by applying the Bayesian method, which translates the expert judgment into prior information on product reliability. Then producer’s risk and the consumer’s risk are calculated accordingly. The procedures to derive RQT plans are also proposed in this paper. As extra information and expert judgment are added to the derivation, the derived test plans have the potential to shorten the required test time and have satisfactory low risks for both producer and consumer, compared with conventional test plans. A case study is provided to prove that when using expert judgment in deriving product test plans, the proposed method is capable of finding ideal test plans that not only reduce the two risks but also shorten the required test time as well.

Keywords: expert judgment, reliability qualification test, test plan derivation, producer’s risk, consumer’s risk

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Authors: Tanvir Ahmed, Thanh N. Long, Phan T. Huong, Donald E. Stewart

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This paper presents views on condom use and the contexts of safe and unsafe sexual practices with different sexual partners and their relationships among Injecting Drug Users (IDUs) in Hai Phong, Vietnam. Fifteen IDUs participated and two local interviewers conducted qualitative semi-structured face-to-face interviews in September-October, 2012 in Vietnamese language. Data were analyzed thematically. Non-protective condom attitudes include negotiate or convince Female Sex Workers (FSW); not realizing risk, importance or necessity; partner doesn’t like, and having extra money/drug from clients. On the other hand, self-awareness, family-consciousness, suspicion of STI presence, fear of getting HIV, and client negotiation sometimes resulted in a safe-sex practice. A thematic diagram was developed to present the relationship (strong/weak) between condom attitude and sexual practice (safe/unsafe) by partner types. The experiences and views reflected in the qualitative information emphasize the heightened need for safe-sex education especially among young IDUs (male/female) highlighting sexual transmission risk.

Keywords: AIDS, HIV, injecting drug user, risk behaviors, Vietnam

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Authors: Ariful Islam, Showkat Ahmad Lone

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Statistical distributions have long been employed in the assessment of semiconductor devices and product reliability. The power function-distribution is one of the most important distributions in the modern reliability practice and can be frequently preferred over mathematically more complex distributions, such as the Weibull and the lognormal, because of its simplicity. Moreover, it may exhibit a better fit for failure data and provide more appropriate information about reliability and hazard rates in some circumstances. This study deals with estimating information about failure times of items under step-stress partially accelerated life tests for competing risk based on adoptive type-I progressive hybrid censoring criteria. The life data of the units under test is assumed to follow Mukherjee-Islam distribution. The point and interval maximum-likelihood estimations are obtained for distribution parameters and tampering coefficient. The performances of the resulting estimators of the developed model parameters are evaluated and investigated by using a simulation algorithm.

Keywords: adoptive progressive hybrid censoring, competing risk, mukherjee-islam distribution, partially accelerated life testing, simulation study

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Authors: Katia C. Bortoletto, Maria Isabel C. de Freitas, Rodrigo B. N. de Oliveira

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The environmental vulnerability studies are essential for priority actions to the reduction of disasters risk. The aim of this study is to analyze the socio-environmental vulnerability obtained through a Census survey, followed by both a statistical analysis (PCA/SPSS/IBM) and a spatial analysis by GIS (ArcGis/ESRI), taking as a case study the Municipality of Caraguatatuba-SP, Brazil. In the municipal development plan analysis the emphasis was given to the Special Zone of Social Interest (ZEIS), the Urban Expansion Zone (ZEU) and the Environmental Protection Zone (ZPA). For the mapping of the social and environmental vulnerabilities of the study area the exposure of people (criticality) and of the place (support capacity) facing disaster risk were obtained from the 2010 Census from the Brazilian Institute of Geography and Statistics (IBGE). Considering the criticality, the variables of greater influence were related to literate persons responsible for the household and literate persons with 5 or more years of age; persons with 60 years or more of age and income of the person responsible for the household. In the Support Capacity analysis, the predominant influence was on the good household infrastructure in districts with low population density and also the presence of neighborhoods with little urban infrastructure and inadequate housing. The results of the comparative analysis show that the areas with high and very high vulnerability classes cover the classes of the ZEIS and the ZPA, whose zoning includes: Areas occupied by low-income population, presence of children and young people, irregular occupations and land suitable to urbanization but underutilized. The presence of zones of urban sprawl (ZEU) in areas of high to very high socio-environmental vulnerability reflects the inadequate use of the urban land in relation to the spatial distribution of the population and the territorial infrastructure, which favors the increase of disaster risk. It can be concluded that the study allowed observing the convergence between the vulnerability analysis and the classified areas in urban zoning. The occupation of areas unsuitable for housing due to its characteristics of risk was confirmed, thus concluding that the methodologies applied are agile instruments to subsidize actions to the reduction disasters risk.

Keywords: socio-environmental vulnerability, urban zoning, reduction disasters risk, methodologies

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Authors: Rocio Herrero Romero, Lucie Cluver, James Hall, Janina Steinert

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Educational delay and non-completion are major policy concerns in South Africa. However, little research has focused on predictors for educational delay amongst adolescents in disadvantaged areas. This study has two aims: first, to use data integration approaches to compare the educational delay of 599 adolescents aged 16 to 18 from disadvantaged communities to national and provincial representative estimates in South Africa. Second, the paper also explores predictors for educational delay by comparing adolescents out of school (n=64) and at least one year behind (n=380), with adolescents in the age-appropriate grade or higher (n=155). Multinomial logistic regression models using self-report and administrative data were applied to look for significant associations of risk and protective factors. Significant risk factors for being behind (rather than in age-appropriate grade) were: male gender, past grade repetition, rural location and larger school size. Risk factors for being out of school (rather than in the age-appropriate grade) were: past grade repetition, having experienced problems concentrating at school, household poverty, and food insecurity. Significant protective factors for being in the age-appropriate grade (rather than out of school) were: living with biological parents or grandparents and access to school counselling. Attending school in wealthier communities was a significant protective factor for being in the age-appropriate grade (rather than behind). Our results suggest that both personal and contextual factors –family and school- predicted educational delay. This study provides new evidence to the significant effects of personal, family, and school characteristics on the educational outcomes of adolescents from disadvantaged communities in South Africa. This is the first longitudinal and quantitative study to systematically investigate risk and protective factors for post-compulsory educational outcomes amongst South African adolescents living in disadvantaged communities.

Keywords: disadvantaged communities, quantitative analysis, school delay, South Africa

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Authors: Beloulou Mohamed Lamine, Fedili Benamar, Meliani Walid, Chaid Dalila

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Introduction: The risk factors for the chronicization of postoperative pain are numerous and often intricately intertwined. Among these, the severity of acute postoperative pain is currently recognized as one of the most determining factors. Mastectomy and thoracotomy are described as among the most painful surgeries and the most likely to lead to chronic post-surgical pain (CPSP). Objective: To examine the aspects of acute postoperative pain potentially involved in the development of chronic pain following breast and thoracic surgery. Patients and Methods: A prospective study involving 164 patients was conducted over a six-month period. Postoperative pain (during mobilization) was assessed using a Visual Analog Scale (VAS) at various time points after surgery: Day 0, 1st, 2nd, 5th days, 1st and 6th months. Moderate to severe pain was defined as a VAS score ≥ 4. A comparative analysis (univariate analysis) of postoperative pain intensities at different evaluation phases was performed on patients with and without CPSP to identify potential associations with the risk of chronicization six months after surgery. Results: At the 6th month post-surgery, the incidence of CPSP was 43.0%. Moderate to severe acute postoperative pain (in the first five days) was observed in 64% of patients. The highest pain scores were reported among thoracic surgery patients. Comparative measures revealed a highly significant association between the presence of moderate to severe acute pain, especially lasting for ≥ 48 hours, and the occurrence of CPSP (p-value <0.0001). Likewise, the persistence of subacute pain (up to 4 to 6 weeks after surgery), especially of moderate to severe intensity, was significantly associated with the risk of chronicization at six months (p-value <0.0001). Conclusion: CPSP after breast and thoracic surgery remains a fairly common morbidity that profoundly affects the quality of life. Severe acute postoperative pain, especially if it is prolonged and/or with a slow decline in intensity, can be an important predictive factor for the risk of chronicization. Therefore, more effective and intensive management of acute postoperative pain, as well as longitudinal monitoring of its trajectory over time, should be an essential component of strategies for preventing chronic pain after surgery.

Keywords: chronic post-surgical pain, acute postoperative pain, breast and thoracic surgery, subacute postoperative pain, pain trajectory, predictive factor

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Authors: Amadou Wurry Jallow, Adama N. S. Bah, Karamo Bah, Shih-Ye Wang, Kuo-Chung Chu, Chien-Yeh Hsu

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Chronic kidney disease (CKD) is a major public health challenge with high prevalence, rising incidence, and serious adverse consequences. Developing effective risk prediction models is a cost-effective approach to predicting and preventing complications of chronic kidney disease (CKD). This study aimed to develop an accurate machine learning model that can dynamically identify individuals at risk of CKD using various kinds of diagnostic data, with or without laboratory data, at different follow-up points. Creatinine is a key component used to predict CKD. These models will enable affordable and effective screening for CKD even with incomplete patient data, such as the absence of creatinine testing. This retrospective cohort study included data on 19,429 adults provided by a private research institute and screening laboratory in Taiwan, gathered between 2001 and 2015. Univariate Cox proportional hazard regression analyses were performed to determine the variables with high prognostic values for predicting CKD. We then identified interacting variables and grouped them according to diagnostic data categories. Our models used three types of data gathered at three points in time: non-laboratory, laboratory, and metabolic indices data. Next, we used subgroups of variables within each category to train two machine learning models (Random Forest and XGBoost). Our machine learning models can dynamically discriminate individuals at risk for developing CKD. All the models performed well using all three kinds of data, with or without laboratory data. Using only non-laboratory-based data (such as age, sex, body mass index (BMI), and waist circumference), both models predict chronic kidney disease as accurately as models using laboratory and metabolic indices data. Our machine learning models have demonstrated the use of different categories of diagnostic data for CKD prediction, with or without laboratory data. The machine learning models are simple to use and flexible because they work even with incomplete data and can be applied in any clinical setting, including settings where laboratory data is difficult to obtain.

Keywords: chronic kidney disease, glomerular filtration rate, creatinine, novel metabolic indices, machine learning, risk prediction

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Authors: Nabila Farhin, Israt Jahan

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Despite the feminisation of the global health force, women mostly engage in nursing, midwifery and community health workers (HWs), and the posts like surgeons, doctors, and specialists are generally male-dominated. It is also prominent in Bangladesh, where female HWs witness systematic workplace inequalities, discrimination, and underpayment. The Covid-19 pandemic put unsurmountable pressure on HWs as they had to serve in high-risk workplaces as frontliners. The already disadvantaged female HWs shouldered the same burden, were overworked without adequate occupational health and safety measures (OSH) and risked their lives. Acknowledging their vulnerable workplace conditions, the World Health Organization (WHO) and International Labour Organization (ILO) circulated a few specialised guidelines amid the peril. Bangladesh tried to adhere to international guidelines while formulating pandemic management strategies. In reality, the already weak and understaffed health sector collapsed with the patient influx and many HWs got infected and died in the line of duty, exposing the high-risk nature of the work. Unfortunately, the gender-segregated data of infected HWs are absent. This qualitative research investigates whether the existing laws of Bangladesh are adequate in protecting female HWs as frontliners in high-risk workplaces during the Covid-19 pandemic. The paper first examines international labour laws safeguarding female frontline HWs. It also analyses the specialised Covid-19 pandemic guidelines protecting their interests. Finally, the research investigates the compliance of Bangladesh as per international legal guidance during the pandemic. In doing so, it explores the domestic laws, professional guidelines for HWs and pandemic response strategies. The paper critically examines the primary sources like international and national statutes, rules, regulations and guidelines. Secondary sources like authoritative journal articles, books and newspaper reports are contextually analysed in line with the objective of the paper. The definition of HW is ambiguous in the labour laws of Bangladesh. It leads to confusion regarding the extent of legal protection rendered to female HWs at private hospitals in high-risk situations. The labour laws are not applicable in Public hospitals, as the employees follow the public service rules. Unfortunately, the country has no specialised law to protect HWs in high-risk workplaces, and the professional guidelines for HWs also remain inadequate in this regard. Even though the pandemic management strategies highlight some protective measures in high-risk situations, they only deal with HWs who are pregnant or have underlying health issues. No specialised protective guidelines can be found for female HWs as frontliners. Therefore, the laws are insufficient and failed to render adequate legal protection to female frontline HWs during the pandemic. The country also lacks comprehensive health legislation and uniform institutional and professional guidelines, preventing them from accessing grievance mechanisms. Hence, the female HWs felt victimised while duty-bound to serve in high-risk workplaces without adequate safeguards. Bangladesh should clarify the definition of HWs and standardise the service rules for providing medical care in high-risk workplaces. The research also recommends adequate health legislation and specialised legal protection to safeguard female HWs in future emergencies.

Keywords: female health workers (HWs), high-risk workplaces, Covid-19 pandemic, Bangladesh

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Authors: Eakarat Boonreang

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The past two decades, Thailand faced the natural disasters, for instance, Gay typhoon in 1989, tsunami in 2004, and huge flood in 2011. The disaster management in Thailand was improved both structure and mechanism for cope with the natural disaster since 2007. However, the natural disaster management in Thailand has various problems, for examples, cooperation between related an organizations have not unity, inadequate resources, the natural disaster management of public sectors not proactive, people has not awareness the risk of the natural disaster, and communities did not participate in the natural disaster management. Objective of this study is to find the methods for capacity building in the natural disaster management of Thailand. The concept and information about the capacity building and the natural disaster management of Thailand were reviewed and analyzed by classifying and organizing data. The result found that the methods for capacity building in the natural disaster management of Thailand should be consist of 1)link operation and information in the natural disaster management between nation, province, local and community levels, 2)enhance competency and resources of public sectors which relate to the natural disaster management, 3)establish proactive natural disaster management both planning and implementation, 4)decentralize the natural disaster management to local government organizations, 5)construct public awareness in the natural disaster management to community, 6)support Community Based Disaster Risk Management (CBDRM) seriously, and 7)emphasis on participation in the natural disaster management of all stakeholders.

Keywords: capacity building, Community Based Disaster Risk Management (CBDRM), Natural Disaster Management, Thailand

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Authors: Yongrong Liu, Xin Tang

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Background: Persistent atrial fibrillation is a common arrhythmia closely related to heart failure. Heart rate control is an essential strategy for treating persistent atrial fibrillation. Still, the understanding of the relationship between different heart rate control levels and the risk of heart failure rehospitalization is limited. Objective: The objective of the study is to determine the relationship between different levels of heart rate control in patients with persistent atrial fibrillation and the risk of readmission for heart failure. Methods: We conducted a retrospective dual-centre cohort study, collecting data from patients with persistent atrial fibrillation who received outpatient treatment at two tertiary hospitals in central and western China from March 2019 to March 2020. The collected data included age, gender, body mass index (BMI), medical history, and hospitalization frequency due to heart failure. Patients were divided into three groups based on their heart rate control levels: Group I with a resting heart rate of less than 80 beats per minute, Group II with a resting heart rate between 80 and 100 beats per minute, and Group III with a resting heart rate greater than 100 beats per minute. The readmission rates due to heart failure within one year after discharge were statistically analyzed using propensity score matching in a 1:1 ratio. Differences in readmission rates among the different groups were compared using one-way ANOVA. The impact of varying levels of heart rate control on the risk of readmission for heart failure was assessed using the Cox proportional hazards model. Binary logistic regression analysis was employed to control for potential confounding factors. Results: We enrolled a total of 1136 patients with persistent atrial fibrillation. The results of the one-way ANOVA showed that there were differences in readmission rates among groups exposed to different levels of heart rate control. The readmission rates due to heart failure for each group were as follows: Group I (n=432): 31 (7.17%); Group II (n=387): 11.11%; Group III (n=317): 90 (28.50%) (F=54.3, P<0.001). After performing 1:1 propensity score matching for the different groups, 223 pairs were obtained. Analysis using the Cox proportional hazards model showed that compared to Group I, the risk of readmission for Group II was 1.372 (95% CI: 1.125-1.682, P<0.001), and for Group III was 2.053 (95% CI: 1.006-5.437, P<0.001). Furthermore, binary logistic regression analysis, including variables such as digoxin, hypertension, smoking, coronary heart disease, and chronic obstructive pulmonary disease as independent variables, revealed that coronary heart disease and COPD also had a significant impact on readmission due to heart failure (p<0.001). Conclusion: The correlation between the heart rate control level of patients with persistent atrial fibrillation and the risk of heart failure rehospitalization is positive. Reasonable heart rate control may significantly reduce the risk of heart failure rehospitalization.

Keywords: heart rate control levels, heart failure rehospitalization, persistent atrial fibrillation, retrospective cohort study

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Authors: Sara Mouffouk, Fatma Belaid, Asma Hechani, Chaima Mouffouk

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Cancer of the cervix caused by HPV (human papillomavirus ) is for many years a real public health problem, it is ranked 2nd deadly female cancer kills more than 270 000 women each year worldwide. In Algeria, the mortality of cervical cancer decreases with the impact, but the prognosis of these cancers remains bleak: The 5-year relative survival is 60 %. The mode of transmission is usually sexuel. Our study was undertaken to show the link between HPV and cervical cancer and the importance of Pap smear screening in this type of pathology. On the total sample, 76.11 % showed abnormal cervical smears of which 13% have mild cases and hormonal reaction Change, and 44% represent inflammatory smears and normal cases 35%, while long seven years from 2005 to 2012. Thus, 43% of abnormal smear results between ASCUS, AGUS, low and high grade carcinoma and adenocarcinoma and 57 % of other cases of unknown origin. The average age of women at risk of developing adenocarcinoma is 45-50 with a 67% to 33% of the same risk in women of age group 41-45 years although the percentage of cases of HPV infected patients was 2% in the past seven years. We found that with increasing age, the risk is argued. Due to several factors such as multiparty can reduced the resistance of the uterine epithelium and even as the multi that promotes contamination HPV causes repeated infections with HPV.

Keywords: cervical cancer, human papillomavirus (HPV) screening, prevention, vaccines

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Authors: Sima Majnooni

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This paper discusses the Green Climate Fund's environmental and social management framework (GCF). The environmental and social management framework ensures the accredited entity considers the GCF's accreditation standards and effectively implements each of the GCF-funded projects. The GCF requires all accredited entities to meet basic transparency and accountability standards as well as environmental and social safeguards (ESMS). In doing so, the accredited entity sets up different independent units. One of these units is called the Grievance Mechanism. When allegations of environmental and social harms are raised in association with GCF-funded activities, affected parties can contact the entity’s grievance unit. One of the most challenging things about the accredited entity's grievance unit is the lack of available information and resources on the entities' websites. Many AEs have anti-corruption or anti-money laundering unit, but they do not have the environmental and social unit for affected people. This paper will argue the effectiveness of environmental and social grievance mechanisms of AEs by using a qualitative approach to indicate how many of AEs have a poor or an effective GRM. Some ESMSs seem highly effective. On the other hand, other mechanisms lack basic requirements such as a clear, transparent, uniform procedure and a definitive timetable. We have looked at each AE mechanism not only in light of how the website goes into detail regarding the process of grievance mechanism but also in light of their risk category. Many mechanisms appear inadequate for the lower level risk category entities (C) and, even surprisingly, for many higher-risk categories (A). We found; in most cases, the grievance mechanism of AEs seems vague.

Keywords: grievance mechanism, vague environmental and social policies, green climate fund, international climate finance, lower and higher risk category

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Authors: Hossam Shalabi, George Hadjisophocleous

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The Canadian Nuclear Power Plants (NPPs) use some portions of NUREG/CR-6850 in carrying out Fire Probabilistic Risk Assessment (PRA). An assessment for the applicability of NUREG/CR-6850 to CANDU reactors was performed and a CANDU Fire PRA was introduced. There are 19 operating CANDU reactors in Canada at five sites (Bruce A, Bruce B, Darlington, Pickering and Point Lepreau). A fire load density survey was done for all Fire Safe Shutdown Analysis (FSSA) fire zones in all CANDU sites in Canada. National Fire Protection Association (NFPA) Standard 557 proposes that a fire load survey must be conducted by either the weighing method or the inventory method or a combination of both. The combination method results in the most accurate values for fire loads. An updated CANDU Fire PRA model is demonstrated in this paper that includes the fuel survey in all Canadian CANDU stations. A qualitative screening step for the CANDU fire PRA is illustrated in this paper to include any fire events that can damage any part of the emergency power supply in addition to FSSA cables.

Keywords: fire safety, CANDU, nuclear, fuel densities, FDS, qualitative analysis, fire probabilistic risk assessment

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Authors: Julinda Keçi

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In many countries, governments have been promoting the involvement of private sector entities to enter into long-term agreements for the development and delivery of large infrastructure projects, with a focus on overcoming the limitations upon public fund of the traditional approach. The involvement of private sector through public-private partnerships (PPP) brings in new capital investments, value for money and additional risks to handle. Worldwide research studies have shown that an objective, systematic, reliable and user-oriented risk assessment process and an optimal allocation mechanism among different stakeholders is crucial to the successful completion. In this framework this paper, which is the first stage of a research study, aims to identify the main risks for the delivery of PPP projects. A review of cross-countries research projects and case studies was performed to map the key risks affecting PPP infrastructure delivery. The matrix of mapping offers a summary of the frequency of factors, clustered in eleven categories: Construction, Design, Economic, Legal, Market, Natural, Operation, Political, Project finance, Project selection and Relationship. Results will highlight the most critical risk factors, and will hopefully assist the project managers in directing the managerial attention in the further stages of risk allocation.

Keywords: construction, infrastructure, public private partnerships, risks

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Authors: E. Rama Devi Jothilingam

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Diabetes mellitus is now one of the most common non communicable diseases globally. India leads the world with largest number of diabetic subjects earning the title "diabetes capital of the world". In order to reduce the mortality rate, a fuzzy expert system is designed to predict the severity of cardiac and renal problems of diabetic patients using fuzzy logic. Since uncertainty is inherent in medicine, fuzzy logic is used in this research work to remove the inherent fuzziness of linguistic concepts and uncertain status in diabetes mellitus which is the prime cause for the cardiac arrest and renal failure. In this work, the controllable risk factors "blood sugar, insulin, ketones, lipids, obesity, blood pressure and protein/creatinine ratio" are considered as input parameters and the "the stages of cardiac" (SOC)" and the stages of renal" (SORD) are considered as the output parameters. The triangular membership functions are used to model the input and output parameters. The rule base is constructed for the proposed expert system based on the knowledge from the medical experts. Mamdani inference engine is used to infer the information based on the rule base to take major decision in diagnosis. Mean of maximum is used to get a non fuzzy control action that best represent possibility distribution of an inferred fuzzy control action. The proposed system also classifies the patients with high risk and low risk using fuzzy c means clustering techniques so that the patients with high risk are treated immediately. The system is validated with Matlab and is used as a tracking system with accuracy and robustness.

Keywords: Diabetes mellitus, fuzzy expert system, Mamdani, MATLAB

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Authors: Ahmed Sami Hammami, Mohamed Jellazi

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Background: The aim of the study is to evaluate the magnitude of different psychological outcomes among Tunisian health care professionals (HCP) during the COVID-19 pandemic and to identify the associated factors. Methods: HCP completed a cross-sectional questionnaire from April 4th to April, 28th 2020. The survey collected demographic information, factors that may interfere with the psychological outcomes, behavior changes and mental health measurements. The latter was assessed through 3 scales; the 7-item questions Insomnia Severity Index, the 2-item Patient Health Questionnaire and the 2-item Generalized Anxiety Disorder. Multivariable logistic regression was conducted to identify factors associated with psychological outcomes. Results: A total of 503 HCP successfully completed the survey; among those, n=493 consented to enroll in the study, 411 [83.4%] were physicians, 323 [64.2%] were women and 271 [55%] had a second-line working position. A significant proportion of HCP had anxiety 35.7%, depression 35.1% and insomnia 23.7%. Females, those with psychiatric history and those using public transport exhibited the highest proportions for overall symptoms compared to other groups e.g., depression among females vs. males: 44,9% vs. 18,2%, P=0.00. Those with a previous medical history and nurses, had more anxiety and insomnia compared to other groups e.g. anxiety among nurses vs. interns/residents vs. attending 45,1% vs 36,1% vs 27,5%; p=0.04. Multivariable logistic regression showed that female gender was a risk factor for all psychological outcomes e.g. female sex increased the odds of anxiety by 2.86; 95% confidence interval [CI], 1, 78-4, 60; P=0.00, whereas having a psychiatric history was a risk factor for both anxiety and insomnia. (e.g. for insomnia OR=2,86; 95% [CI], 1,78-4,60; P=0.00), Having protective equipment was associated with lower risk for depression (OR=0,41; 95% CI, 0,27-0,62; P=0.00) and anxiety. Physical activity was also protective against depression and anxiety (OR=0,41, 95% CI, 0,25-0,67, P=0.00). Conclusion: Psychological symptoms are usually undervalued among HCP, though the COVID-19 pandemic played a major role in exacerbating this burden. Prompt psychological support should be endorsed and simple measures such as physical activity and ensuring the necessary protection are paramount to improve mental health outcomes and the quality of care provided to patients.

Keywords: COVID-19 pandemic, health care professionals, mental health, protective factors, psychological symptoms, risk factors

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Authors: Abul Shamsuddin

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The Islamic stock market indices are constructed by screening out stocks that are incompatible with Islam’s prohibition of interest and certain lines of business. This study examines the effects of Islamic screening on the risk-return characteristics of Islamic vis-a-vis mainstream equity portfolios. We use data on Dow Jones Islamic market indices and FTSE Global Islamic indices over 1993-2013. We observe that Islamic equity indices outperform their mainstream counterparts in both raw and risk-adjusted returns. In addition, Islamic equity indices are more resilient to turbulence in international markets than that of their mainstream counterparts. The findings are robust across a variety of portfolio performance measures.

Keywords: Dow Jones Islamic market index, FTSE global Islamic index, ethical investment, finance

Procedia PDF Downloads 336

Authors: Louise Moles, Steve Riley, Sarah D. Lichenstein, Marzieh Babaeianjelodar, Robert Kohler, Annie Cheng, Corey Horien Abigail Greene, Wenjing Luo, Jonathan Ahern, Bohan Xu, Yize Zhao, Chun Chieh Fan, R. Todd Constable, Sarah W. Yip

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Background: Risks for depression are myriad and include both genetic and brain-based factors. However, relationships between these systems are poorly understood, limiting understanding of disease etiology, particularly at the developmental level. Methods: We use a data-driven machine learning approach connectome-based predictive modeling (CPM) to identify functional connectivity signatures associated with polygenic risk scores for depression (DEP-PRS) among youth from the Adolescent Brain and Cognitive Development (ABCD) study across diverse brain states, i.e., during resting state, during affective working memory, during response inhibition, during reward processing. Results: Using 10-fold cross-validation with 100 iterations and permutation testing, CPM identified connectivity signatures of DEP-PRS across all examined brain states (rho’s=0.20-0.27, p’s<.001). Across brain states, DEP-PRS was positively predicted by increased connectivity between frontoparietal and salience networks, increased motor-sensory network connectivity, decreased salience to subcortical connectivity, and decreased subcortical to motor-sensory connectivity. Subsampling analyses demonstrated that model accuracies were robust across random subsamples of N’s=1,000, N’s=500, and N’s=250 but became unstable at N’s=100. Conclusions: These data, for the first time, identify neural networks of polygenic depression risk in a large sample of youth before the onset of significant clinical impairment. Identified networks may be considered potential treatment targets or vulnerability markers for depression risk.

Keywords: genetics, functional connectivity, pre-adolescents, depression

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Authors: Huang Yueh Chen, Sheng Ang Shen

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Purpose: Sexual assault has always been a highly anticipated crime in Taiwan. People assume that the career of sexual offenders tends to be highly specialized. This study hopes to analyze the crime career and risk factors of offenders by means of another classification. Methods: A total of 145 sexual offenders were sentenced on the parole or expiration date from 2009 to 2011, through analysis of official existing documents such as ‘Re-infringement risk assessment report’ and ‘case assessment report’. Results: The section ‘Various Types of Crimes ‘ of criminal career is analyzed. The highest number of ‘ versatile sexual offender’ followed by ‘adult sexual offender’ is about 2.5, representing more than 1.5 kinds of non-sex crimes besides sexual crimes. Different specialized sexual offenders have had extensive experience in the ‘Sexual Assault Experiences in Children and School’, ‘Static 99 Levels’, ‘Pre-Commuted Substance Use’, ‘Excited Deviant Sexual Behavior’, ‘Various Types of Crimes,’ and ‘Sexual Crime in Forerunner’ , ‘Type of Index Crime’ and other projects to achieve significant differences. Conclusions: Resources continue to be devoted to specialized offenders, the character of first-time sexual offender depends on further research and makes the public aware of the different assumptions of diversified offenders from traditional professional offenses that reduce unnecessary panic in society.

Keywords: versatile sexual offender, specialized sexual offender, criminal career, risk factor

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