西藏交通警察道路执法工作的风险与防范

西藏自治区自然、地理与气候环境复杂且特殊,道路交通环境相对恶劣,这导致当地交通警察道路执法工作面临诸多风险,包括警员人身安全和执法效能等风险。对此,文章对西藏交通警察道路执法工作风险进行了调查分析,从地区环境、警员安全意识与技能、执法装备、社会宣传和教育等角度探讨了相关风险的成因,针对性相关风险成因,提出从优化警力配置与道路信息推送、加强警员培训、完善警务装备、加强法治化宣传教育等工作来消除相关风险,以期保障警员安全并改善西藏交通环境。

Performance of risk stratification systems for gastrointestinal stromal tumors: A multicenter study

BACKGROUND Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumor type in the gastrointestinal system. Presently, various classification systems to prognosticate GISTs have been proposed.AIM To evaluate the application value of four different risk stratification systems for GISTs.METHODS Patients who were diagnosed with GISTs and underwent surgical resection at four hospitals from 1998 to 2015 were identified from a database. Risk of recurrence was stratified by the modified National Institute of Health(NIH)criteria, the Armed Forces Institute of Pathology(AFIP) criteria, the Memorial Sloan Kettering Cancer Center(MSKCC) prognostic nomogram, and the contour maps. Receiver operating characteristic(ROC) curves were established to compare the four abovementioned risk stratification systems based on the area under the curve(AUC).RESULTS A total of 1303 patients were included in the study. The mean age of the patients was 55.77 ± 13.70 yr; 52.3% of the patients were male. The mean follow-up period was 64.91 ± 35.79 mo. Approximately 67.0% the tumors were located in the stomach, and 59.5% were smaller than 5 cm; 67.3% of the patients had a mitotic count ≤ 5/50 high-power fields(HPFs). Thirty-four tumors ruptured before and during surgery. Univariate analysis demonstrated that tumor size > 5 cm(P <0.05), mitotic count > 5/50 HPFs(P < 0.05), non-gastric location(P < 0.05), and tumor rupture(P < 0.05) were significantly associated with increased recurrence rates. According to the ROC curve, the AFIP criteria showed the largest AUC(0.754).CONCLUSION According to our data, the AFIP criteria were associated with a larger AUC than the NIH modified criteria, the MSKCC nomogram, and the contour maps, which might indicate that the AFIP criteria have better accuracy to support therapeutic decision-making for patients with GISTs.

Risk of Hearing Loss Injury Caused by Multiple Flash Bangs on a Crowd

A flash bang is a non-lethal explosive device that delivers intensely loud bangs and bright lights to suppress potentially dangerous targets. It is usually used in crowd control, hostage rescue and numerous other missions. We construct a model for assessing quantitatively the risk of hearing loss injury caused by multiple flash bangs. The model provides a computational framework for incorporating the effects of the key factors defining the situation and for testing various sub-models for these factors. The proposed model includes 1) uncertainty in the burst point of flash bang mortar, 2) randomness in the dispersion of multiple submunitions after the flash bang mortar burst, 3) decay of acoustic impulse from a single submunition to an individual subject along the ground surface, 4) the effective combined sound exposure level on an individual subject caused by multiple submunitions at various distances from the subject, and 5) randomness in the spatial distribution of subjects in the crowd. With the mathematical model formulated, we seek to characterize the overall effect of flash bang mortar in the form of an effective injury area. We carry out simulations to study the effects of uncertainty and randomness on the risk of hearing loss injury of the crowd. The proposed framework serves as a starting point for a comprehensive assessment of hearing loss injury risk, taking into consideration all realistic and relevant features of flash bang mortar. It also provides a platform for testing and updating component models.

Relationship between high dietary fat intake and Parkinson’s disease risk: a meta-analysis

OBJECTIVE: To assess whether dietary fat intake influences Parkinson’s disease risk. DATA SOURCES: We systematically surveyed the Embase and PubMed databases, reviewing manuscripts published prior to October 2018. The following terms were used:(“Paralysis agitans” OR “Parkinson disease” OR “Parkinson” OR “Parkinson’s” OR “Parkinson’s disease”) AND (“fat” OR “dietary fat” OR “dietary fat intake”). DATA SELECTION: Included studies were those with both dietary fat intake and Parkinson’s disease risk as exposure factors. The Newcastle-Ottawa Scale was adapted to investigate the quality of included studies. Stata V12.0 software was used for statistical analysis. OUTCOME MEASURES: The primary outcomes included the relationship between high total energy intake, high total fat intake, and Parkinson’s disease risk. The secondary outcomes included the relationship between different kinds of fatty acids and Parkinson’s disease risk. RESULTS: Nine articles met the inclusion criteria and were incorporated into this meta-analysis. Four studies scored 7 and the other five studies scored 9 on the Newcastle-Ottawa Scale, meaning that all studies were of high quality. Meta-analysis results showed that high total energy intake was associated with an increased risk of Parkinson’s disease (P = 0.000, odds ratio (OR)= 1.49, 95% confidence interval (CI): 1.26–1.75);in contrast, high total fat intake was not associated with Parkinson’s disease risk (P = 0.123, OR = 1.07, 95% CI: 0.91–1.25). Subgroup analysis revealed that polyunsaturated fatty acid intake (P = 0.010, OR = 1.03, 95% CI: 0.88–1.20) reduced the risk of Parkinson’s disease, while arachidonic acid (P = 0.026, OR = 1.15, 95% CI: 0.97–1.37) and cholesterol (P = 0.002, OR = 1.09, 95% CI: 0.92–1.29) both increased the risk of Parkinson’s disease. Subgroup analysis also demonstrated that, although the results were not significant, consumption of n-3 polyunsaturated fatty acids (P = 0.071, OR = 0.88, 95% CI: 0.73–1.05),α-linolenic acid (P = 0.06, OR = 0.86, 95% CI: 0.72–1.02), and the n-3 to n-6 ratio (P = 0.458, OR = 0.89, 95% CI: 0.75–1.06) were all linked with a trend toward reduced Parkinson’s disease risk. Monounsaturated fatty acid (P = 0.450, OR = 1.06, 95% CI: 0.91–1.23), n-6 polyunsaturated fatty acids (P = 0.100, OR = 1.15, 95% CI: 0.96–1.36) and linoleic acid (P = 0.053, OR = 1.11, 95% CI: 0.94–1.32) intakes were associated with a non-significant trend toward higher PD risk. Saturated fatty acid (P = 0.619, OR = 1.01, 95% CI: 0.87–1.18) intake was not associated with Parkinson’s disease. CONCLUSION: Dietary fat intake affects Parkinson’s disease risk, although this depends on the fatty acid subtype. Higher intake of polyunsaturated fatty acids may reduce the risk of Parkinson’s disease, while higher cholesterol and arachidonic acid intakes may elevate Parkinson’s disease risk. However, further studies and evidence are needed to validate any link between dietary fat intake and Parkinson’s disease.

Cyber Resilience through Real-Time Threat Analysis in Information Security

This paper examines how cybersecurity is developing and how it relates to more conventional information security. Although information security and cyber security are sometimes used synonymously, this study contends that they are not the same. The concept of cyber security is explored, which goes beyond protecting information resources to include a wider variety of assets, including people [1]. Protecting information assets is the main goal of traditional information security, with consideration to the human element and how people fit into the security process. On the other hand, cyber security adds a new level of complexity, as people might unintentionally contribute to or become targets of cyberattacks. This aspect presents moral questions since it is becoming more widely accepted that society has a duty to protect weaker members of society, including children [1]. The study emphasizes how important cyber security is on a larger scale, with many countries creating plans and laws to counteract cyberattacks. Nevertheless, a lot of these sources frequently neglect to define the differences or the relationship between information security and cyber security [1]. The paper focus on differentiating between cybersecurity and information security on a larger scale. The study also highlights other areas of cybersecurity which includes defending people, social norms, and vital infrastructure from threats that arise from online in addition to information and technology protection. It contends that ethical issues and the human factor are becoming more and more important in protecting assets in the digital age, and that cyber security is a paradigm shift in this regard [1].

Applications of Mogulskii, and Kurtz-Feng Large Deviation Results to Risk Reserve Processes with Aggregate Claims

In this paper we examine the large deviations principle (LDP) for sequences of classic Cramér-Lundberg risk processes under suitable time and scale modifications, and also for a wide class of claim distributions including (the non-super- exponential) exponential claims. We prove two large deviations principles: first, we obtain the LDP for risk processes on D∈[0,1] with the Skorohod topology. In this case, we provide an explicit form for the rate function, in which the safety loading condition appears naturally. The second theorem allows us to obtain the LDP for Aggregate Claims processes on D∈[0,∞) with a different time-scale modification. As an application of the first result we estimate the ruin probability, and for the second result we work explicit calculations for the case of exponential claims.

Age-Related Surface Oxidases Shed into Body Fluids as Targets to Prevent Skin Aging and Reduce Cardiovascular Risk

Age-related Ecto-Nicotinamide Adenine Dinucleotide Oxidase Disulfide Thiol Exchangers 3 (ENOX3) or age-related NADH oxidases (arNOX) are expressed at the cell surface as five members of the TM-9 superfamily, initially membrane anchored, all functionally similar, with the N-termini exposed at the cell’s exterior. ECTO-NOXes are cell surface proteins with both time-keeping CoQH2 [NAD(P)H] oxidase and protein disulfidethiol interchange activities. They are designated as ECTO-NOX proteins because of their localization on the outer surface of the plasma membrane and to distinguish them from the phox-NOXes of host defense. A ca. 30 kDa N-terminal fragment is cleaved and accumulates in body fluids (serum, saliva, urine, perspiration). arNOXes appear around age 30 and increase steadily thereafter. Reduced quinones, i.e., reduced coenzyme Q, of the plasma membrane are natural substrates. NAD(P)H is oxidized as an artificial substrate. In one phase of the arNOX cycle electrons are transferred to oxygen to generate superoxide. Substrates for the shed forms of arNOX appear to be proteins of body fluids. Circulating lipoproteins and skin matrix proteins emerge as potentially important health-related targets. Through oxidation of collagen, elastin and other proteins of the skin matrix, arNOXes are major contributors to skin aging through tyrosine and thiol oxidation and subsequent cross linking. The main destructive action of arNOX, however, may be to directly oxidize circulating lipoproteins. arNOX in the blood is structured as an integral component of the LDL particle through site-specific binding. As such, arNOXes are implicated as major risk factors for cardiovascular disease due to specific oxidation of LDLs. The superoxide produced and its conversion to hydrogen peroxide would be one part of the potentially destructive properties by contribution to lipid oxidation. Inhibition of arNOX proteins provides a rational basis for anti-aging interventions and their elimination as a major risk factor of atherogenesis.

Model calibration concerning risk coefficients of driving safety field model

Driving safety field(DSF) model has been proposed to represent comprehensive driving risk formed by interactions of driver-vehicle-road in mixed traffic environment. In this work, we establish an optimization model based on grey relation degree analysis to calibrate risk coefficients of DSF model. To solve the optimum solution, a genetic algorithm is employed. Finally, the DSF model is verified through a real-world driving experiment. Results show that the DSF model is consistent with driver's hazard perception and more sensitive than TTC. Moreover, the proposed DSF model offers a novel way for criticality assessment and decision-making of advanced driver assistance systems and intelligent connected vehicles.

Prevalence of Various Cancer-Related Risk Factors among the Forcibly Displaced Myanmar National Community, the Rohingya, in Bangladesh: A Preliminary Assessment

Background: Large numbers of Forcibly Displaced Myanmar Nationals (FDMN), also called the Rohingya community, in Bangladesh face chronic life-threatening illnesses. Symptoms concerning for a cancer diagnosis are not easily evaluated and treated by healthcare systems available to this population. We conducted a rapid needs assessment of cancer screening and pain and palliative care with the goal of identifying the prevalence of cancer risk factors among the Rohingya who attended local health facilities. Methods: A cross-sectional study was conducted in the Kutupalong camp of Ukhiya, Cox’s Bazar among the Rohingya community. Data were?collected through purposive sampling. Face-to-face interviews were done using a structured questionnaire. Statistics were analyzed by using IBM SPSS 23.?Results: Out of 85 participants, 75 were female and 10 were male. 70 (82.4%) were uneducated (defined as lacking any formal institutional education), 10 (11.8%) people completed the primary level education and only 5 (5.9%) people received secondary level education. There were many participants with pulmonary disease with 35 (41.2%) people endorsing a history of asthma, bronchitis, and/or tuberculosis. There was a lack of female menstrual sanitation and hygiene with only 25 (29.4%) patients using sanitary napkins, that were donated by Non Government Organizations. Only 5.9% of the women had received any form of cervical cancer screening.?Conclusion: This study identifies risk factors associated with cancers and life-limiting diseases among the FDMN Rohingya refugees in Bangladesh. It is necessary to develop targeted education, cancer screening and cancer awareness programs for this population.

Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment

Cardiac autonomic neuropathy(CAN)is a serious complication of diabetes mellitus(DM)that is strongly associated with approximately five-fold increased risk of cardiovascular mortality.CAN manifests in a spectrum of things,ranging from resting tachycardia and fixed heart rate(HR)to development of"silent"myocardial infarction.Clinical correlates or risk markers for CAN are age,DM duration,glycemic control,hypertension,and dyslipidemia(DLP),development of other microvascular complications.Established risk factors for CAN are poor glycemic control in type 1 DM and a combination of hypertension,DLP,obesity,and unsatisfactory glycemic control in type 2DM.Symptomatic manifestations of CAN include sinus tachycardia,exercise intolerance,orthostatic hypotension(OH),abnormal blood pressure(BP)regulation,dizziness,presyncope and syncope,intraoperative cardiovascular instability,asymptomatic myocardial ischemia and infarction.Methods of CAN assessment in clinical practice include assessment of symptoms and signs,cardiovascular reflex tests based on HR and BP,short-term electrocardiography(ECG),QT interval prolongation,HR variability(24 h,classic24 h Holter ECG),ambulatory BP monitoring,HR turbulence,baroreflex sensitivity,muscle sympathetic nerve activity,catecholamine assessment and cardiovascular sympathetic tests,heart sympathetic imaging.Although it is common complication,the significance of CAN has not been fully appreciated and there are no unified treatment algorithms for today.Treatment is based on early diagnosis,life style changes,optimization of glycemic control and management of cardiovascular risk factors.Pathogenetic treatment of CAN includes:Balanced diet and physical activity;optimization of glycemic control;treatment of DLP;antioxidants,first of allα-lipoic acid(ALA),aldose reductase inhibitors,acetylL-carnitine;vitamins,first of all fat-soluble vitamin B1;correction of vascular endothelial dysfunction;prevention and treatment of thrombosis;in severe cases-treatment of OH.The promising methods include prescription of prostacyclin analogues,thromboxane A2 blockers and drugs that contribute into strengthening and/or normalization of Na^+,K^+-ATPase(phosphodiesterase inhibitor),ALA,dihomo-γ-linolenic acid(DGLA),ω-3 polyunsaturated fatty acids(ω-3 PUFAs),and the simultaneous prescription of ALA,ω-3 PUFAs and DGLA,but the future investigations are needed.Development of OH is associated with severe or advanced CAN and prescription of nonpharmacological and pharmacological,in the foreground midodrine and fludrocortisone acetate,treatment methods are necessary.

Risk of transmission of carbapenem-resistant Enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy

To evaluate the risk of transmission of carbapenem-resistant Enterobacteriaceae(CRE) and their related superbugs during gastrointestinal(GI) endoscopy. Reports of outbreaks linked to GI endoscopes contami-nated with different types of infectious agents, includ-ing CRE and their related superbugs, were reviewed. Published during the past 30 years, both prior to and since CRE's emergence, these reports were obtained by searching the peer-reviewed medical literature(via the United States National Library of Medicine's "MEDLINE" database); the Food and Drug Administration's Manu-facturer and User Facility Device Experience database, or "MAUDE"; and the Internet(via Google's search engine). This review focused on an outbreak of CRE in 2013 following the GI endoscopic procedure known as endoscopic retrograde cholangiopancreatography, or ERCP, performed at "Hospital X" located in the sub-urbs of Chicago(IL; United States). Part of the largest outbreak of CRE in United States history, the infection and colonization of 10 and 28 of this hospital's patients, respectively, received considerable media attention and was also investigated by the Centers for Disease Con-trol and Prevention(CDC), which published a report about this outbreak in Morbidity and Mortality WeeklyReport(MMWR), in 2014. This report, along with the results of an independent inspection of Hospital X's in-fection control practices following this CRE outbreak, were also reviewed. While this article focuses primar-ily on the prevention of transmissions of CRE and their related superbugs in the GI endoscopic setting, some of its discussion and recommendations may also apply to other healthcare settings, to other types of flexible endoscopes, and to other types of transmissible infec-tious agents. This review found that GI endoscopy is an important risk factor for the transmission of CRE and their related superbugs, having been recently as-sociated with patient morbidity and mortality following ERCP. The CDC reported in MMWR that the type of GI endoscope, known as an ERCP endoscope, that Hospi-tal X used to perform ERCP in 2013 on the 38 patients who became infected or colonized with CRE might be particularly challenging to clean and disinfect, because of the complexity of its physical design. If performed in strict accordance with the endoscope manufacturer's labeling, supplemented as needed with professional organizations' published guidelines, however, current practices for reprocessing GI endoscopes, which include high-level disinfection, are reportedly adequate for the prevention of transmission of CRE and their related superbugs. Several recommendations are provided to prevent CRE transmissions in the healthcare setting. CRE transmissions are not limited to contaminated GI endoscopes and also have been linked to other reusable flexible endoscopic instrumentation, including broncho-scopes and cystoscopes. In conclusion, contaminated GI endoscopes, particularly those used during ERCP, have been causally linked to outbreaks of CRE and their related superbugs, with associated patient morbidity and mortality. Thorough reprocessing of these complex reusable instruments is necessary to prevent disease transmission and ensure patient safety during GI endos-copy. Enhanced training and monitoring of reprocessing staffers to verify the proper cleaning and brushing of GI endoscopes, especially the area around, behind andnear the forceps elevator located at the distal end othe ERCP endoscope, are recommended. If the ERCPendoscope features a narrow and exposed channel thathouses a wire connecting the GI endoscope's controhead to this forceps elevator, then this channel's com-plete reprocessing, including its flushing with a deter-gent using a procedure validated for effectiveness, is also emphasized.

Prevention of stress-related ulcer bleeding at the intensive care unit: Risks and benefits of stress ulcer prophylaxis

Stress-related mucosal disease is a typical complication of critically ill patients in the intensive care unit(ICU). It poses a risk of clinically relevant upper gastrointestinal(GI) bleeding. Therefore, stress ulcer prophylaxis(SUP)is recommended in high-risk patients, especially those mechanically ventilated > 48 h and those with a manifest coagulopathy. Proton pump inhibitors(PPI) and, less effectively, histamine 2 receptor antagonists(H2RA) prevent GI bleeding in critically ill patients in the ICU. However, the routine use of pharmacological SUP does not reduce overall mortality in ICU patients. Moreover, recent studies revealed that SUP in the ICU might be associated with potential harm such as an increased risk of infectious complications, especially nosocomial pneumonia and Clostridium difficile-associated diarrhea. Additionally, special populations such as patients with liver cirrhosis may even have an increased mortality rate if treated with PPI. Likewise, PPI can be toxic for both the liver and the bone marrow, and some PPI show clinically relevant interactions with important other drugs like clopidogrel. Therefore, the agent of choice, the specific balance of risks and benefits for individual patients as well as the possible dose of PPI has to be chosen carefully. Alternatives to PPI prophylaxis include H2 RA and/or sucralfate. Instead of routine SUP, further trials should investigate risk-adjusted algorithms, balancing benefits and threats of SUP medication in the ICU.

Fatty liver is associated with an increased risk of diabetes and cardiovascular disease- Evidence from three different disease models: NAFLD, HCV and HIV

Fatty liver, which frequently coexists with necroinflammatory and fibrotic changes, may occur in the setting of nonalcoholic fatty liver disease(NAFLD) and chronic infections due to either hepatitis C virus(HCV) or human immunodeficiency virus(HIV). These three pathologic conditions are associated with an increased prevalence and incidence of cardiovascular disease(CVD) and type 2 diabetes(T2D). In this multidisciplinary clinical review, we aim to discuss the ever-expanding wealth of clinical and epidemiological evidence supporting a key role of fatty liver in the development of T2 D and CVD in patients with NAFLD and in those with HCV or HIV infections. For each of these three common diseases, the epidemiological features, pathophysiologic mechanisms and clinical implications of the presence of fatty liver in predicting the risk of incident T2 D and CVD are examined in depth. Collectively, the data discussed in this updated review, which follows an innovative comparative approach, further reinforce the conclusion that the presence of fatty/inflamed/fibrotic liver might be a shared important determinant for the development of T2 D and CVD in patients with NAFLD, HCV or HIV. This review may also open new avenues in the clinical and research arenas and paves the way for the planning of future, well-designed prospective and intervention studies.

Risk of Hearing Loss Caused by Multiple Acoustic Impulses in the Framework of Biovariability

We consider the hearing loss injury among subjects in a crowd with a wide spectrum of individual intrinsic injury probabilities due to biovariability. For multiple acoustic impulses, the observed injury risk of a crowd vs the effective combined dose follows the logistic dose-response relation. The injury risk of a crowd is the average fraction of injured. The injury risk was measured in experiments as follows: each subject is individually exposed to a sequence of acoustic impulses of a given intensity and the injury is recorded;results of multiple individual subjects were assembled into data sets to mimic the response of a crowd. The effective combined dose was adjusted by varying the number of impulses in the sequence. The most prominent feature observed in experiments is that the injury risk of the crowd caused by multiple impulses is significantly less than the value predicted based on assumption that all impulses act independently in causing injury and all subjects in the crowd are statistically identical. Previously, in the case where all subjects are statistically identical (i.e., no biovariability), we interpreted the observed injury risk caused by multiple impulses in terms of the immunity effects of preceding impulses on subsequent impulses. In this study, we focus on the case where all sound exposure events act independently in causing injury regardless of whether one is preceded by another (i.e., no immunity effect). Instead, we explore the possibility of interpreting the observed logistic dose-response relation in the framework of biovariability of the crowd. Here biovariability means that subjects in the crowd have their own individual injury probabilities. That is, some subjects are biologically less or more susceptible to hearing loss injury than others. We derive analytically the distribution of individual injury probability that produces the observed logistic dose-response relation. For several parameter values, we prove that the derived distribution is mathematically a proper density function. We further study the asymptotic approximations for the density function and discuss their significance in practical numerical computation with finite precision arithmetic. Our mathematical analysis implies that the observed logistic dose-response relation can be theoretically explained in the framework of biovariability in the absence of immunity effect.

Health Risk Assessment on Selected Essential and Non-Essential Elements in Food Crops Grown in Kibera Slum, Nairobi-Kenya

Peri-urban agriculture of food crops is practiced in many slum areas in developing countries. This often uses waste water whose levels of essential and non-essential elements are largely unknown but would be feared to contaminate soils, consequently exposing man to associated health risks. Inhabitants in Kibera slum, Nairobi City practice these growing kales, amaranthus, arrowroots, and spinach. Health risk assessment was done using daily intake of metals (DIM), target hazard quotient (THQ) and incremental lifetime cancer risk (ILCR). Atomic absorption spectroscopy was employed for elemental analysis. The levels of essential elements ranged as follows;Mn 91.04 - 374.44, Mg 261.28 - 532.96, Fe 350.74 - 1273.68, and Zn 1.18 - 6.3 μg/g per dry weight were found to be below the recommended limits by FAO/WHO. Non-essential elements ranged as follows;Cr 1.15 - 4.32 and Pb 0.14 - 0.91 μg/g above the EU recommendation. DIM of Fe 5.81 - 27.61 and Mn 1.97 - 8.12 μg/g is above the recommended daily intake amounts. THQ values for Mn and Fe were more than unit. THQ values for non-essential elements were generally below unit. ILCR showed that from lead alone 73 people (0.043% of 0.17M residents) are likely to develop cancer. There are foreseen health risks associated with consumption of food crops grown in Kibera slum that requires immediate address.

Minimizing the Environmental Risk from Oil Tanker Grounding Accidents in the High North

To address the high environmental risk related to the increased oil tanker traffic in the High North, the Norwegian Coastal Administration (NCA) manages one of its vessel traffic service (VTS) centers in the town of Vard&#248;, Norway. The fleet of tugboats, controlled by the VTS center operators, patrols the coastline to hook-up with any potential drifting oil tanker in the region of interest, before it runs ashore. Presently, the tugboats are controlled manually, which is not only challenging but less effective. In this paper, we develop two alternative binary integer programming models that give better tugboat policies in less computational time compared to previous work. Promising results with historical data illustrate great potential for optimal environmental risk reduction along the northern coast of

Risk factors for depression in patients with chronic obstructive pulmonary disease

BACKGROUND The prevalence of depression in patients with chronic obstructive pulmonary disease(COPD)ranges from 10%to 42%,but the diagnosis of depression in patients with COPD is often unrecognized and untreated.Unrecognized depression has major implications for compliance with medical treatment,prolonged lengths of stay,increased frequency of hospital admissions,and increased consultations with primary care physicians.Many studies have attempted to identify risk factors for progression,prognosis and response to therapy in patients with depression.However,few studies have examined the risk factors for depression in patients with COPD,and some results remain controversial.AIM To identify the potential risk factors to define patients with COPD who are at“high risk”of depression.METHODS The clinical data of 293 patients with COPD were reviewed from January 2017 to December 2018.The correlations between demographics,clinical characteristics and depression were analyzed.The risk factors for depression in patients with COPD were identified by multivariate logistic regression analysis.The cutoff value,sensitivity and specificity of the independent correlation factors were calculated with a receiver operating characteristic curve.RESULTS Of the 293 patients included,65(22.18%)individuals were identified to have depression.Significant differences were detected between patients with and without depression in terms of body mass index(BMI),forced expiratory volume in 1 s(FEV1),and COPD assessment test(CAT)score(all P<0.05).Low BMI,low FEV1,and high CAT were independent risk factors for depression in patients with COPD and the cutoff values of BMI,FEV1,and CAT scores were 21.373 kg/m2,0.855 L and 12.5,respectively.CONCLUSION Low BMI,low FEV1,and high CAT score were identified as independent risk factors for depression in patients with COPD.

Cyberattack Ramifications, The Hidden Cost of a Security Breach

In this in-depth exploration, I delve into the complex implications and costs of cybersecurity breaches. Venturing beyond just the immediate repercussions, the research unearths both the overt and concealed long-term consequences that businesses encounter. This study integrates findings from various research, including quantitative reports, drawing upon real-world incidents faced by both small and large enterprises. This investigation emphasizes the profound intangible costs, such as trade name devaluation and potential damage to brand reputation, which can persist long after the breach. By collating insights from industry experts and a myriad of research, the study provides a comprehensive perspective on the profound, multi-dimensional impacts of cybersecurity incidents. The overarching aim is to underscore the often-underestimated scope and depth of these breaches, emphasizing the entire timeline post-incident and the urgent need for fortified preventative and reactive measures in the digital domain.

Intra-hepatic and extra-hepatic cholangiocarcinoma:New insight into epidemiology and risk factors

Cholangiocarcinoma(CCA) is a malignant tumour that arises from biliary epithelium at any portion of the biliary tree.CCA is currently classified as intra-hepatic or extra-hepatic CCA(EH-CCA).Recent evidences suggest that intra-hepatic CCA(IH-CCA) and EH-CCA are biologically different cancers,giving further support to a number of recent epidemiological studies showing large differences in terms of incidence,mortality and risk factors.The purpose of this manuscript is to review recent literature dealing with the descriptive epidemiology and risk factors of CCA with a special effort to compare IH-with EH-CCA.

Iatrogenic opioid dependence is endemic and legal: Genetic addiction risk score (GARS) with electrotherapy a paradigm shift in pain treatment programs

The mounting endemic of prescription iatrogenic opioid dependence in pain patients provoked this treatise about an alternative method that can be used to treat pain, improve function and reduce the risk of opioid dependence. It is well known that as well as the side effects reported for chronic opioid therapy, genetically predisposed individuals are at risk for opioid dependence. We propose the use of the Genetic Addiction Risk Score (GARS) assessment to identify patients early in treatment who should avoid narcotic pain medications. Primarily, this review will be an exploration of the mechanisms of action of an electrotherapeutic alternative to narcotic treatment that can be used to augment tissue healing and reduce the pain associated with human injuries and neuropathies. This particular electrotherapeutic device was developed at the Electronic Waveform Laboratory in Huntington Beach, California and is called the H-Wave? device. The primary effect of the H-Wave?device is stimulation (HWDS) of small diameter fibers of “red-slow-twitch” skeletal muscle. Mechanisms of action of HWDS have been investigated in both animal and human studies. They include edema reduction, induction of nitric oxide dependent augmented microcirculation and angiogenesis, small muscle contraction that eliminates transcapillary fluid shifts, reducing the painful effects of tetanizing fatigue and gradual loading of healing injured muscle tissue that helps repair and remodeling. A recent metaanalysis found a moderate-to-strong-positive effect of the HWDS in providing pain relief, reducing the requirement for pain medication, with the most robust effect being increased functionality. We are proposing that GARS can be used to identify those at risk of developing opioid dependence and that the need for opioid analgesia can be reduced by use of this electro therapeutic alternative to opioid analgesia in the treatment of pain and injuries.