Non-Prescribed Substance Use in the General Hospital: A Retrospective Study.

BACKGROUND AND OBJECTIVES: Non-prescribed substance use (NPSU) is a recognized phenomena exhibited by patients with substance use disorders while admitted to inpatient hospitals. What factors distinguish patients who engage in NPSU, or how their hospitalizations and outcomes differ, remains to be understood in full. Our study describes a cohort of medically admitted patients with substance use disorders with behaviors concerning for non-prescribed substance use (NPSU) during their hospitalization. METHODS: We extracted electronic health record data for all hospital encounters when an addiction consult was documented (n=3100). We defined NPSU cases during a clinical, interdisciplinary case review in which patients were deemed high risk based on team members' observations of one or more behaviors described in the NPSU Checklist. These individuals were placed on a "NPSU Protocol," which was implemented for optimization of care, destigmatization, and risk mitigation (n=61). We compared clinical characteristics, resource utilization, and treatment outcomes among the NPSU cohort to addiction consult patients without suspicion of NPSU but with stimulant or opioid use disorder diagnoses. RESULTS: Patients on the NPSU protocol were younger and had higher rates of infectious disease diagnoses reported during hospitalization than patients without concern for NPSU. Hospitalizations for individuals suspected of NPSU were longer, had higher rates of before medically advised discharge, as well as discharges without medications for opioid use disorder (MOUD). These outcome differences were also observed when analysis was restricted to hospitalizations in which an infectious disease was diagnosed. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Our study characterizes a population of people who exhibited behaviors concerning for NPSU and highlights key outcome disparities. To our knowledge, this study is the first to show a direct correlation between infectious disease diagnosis and NPSU, as well as a direct correlation between suspected NPSU and outcomes such as before medically advised discharge and discharge without MOUD, irrespective of infectious disease diagnosis. Further study is necessary to determine interventions to reduce poor outcomes among hospitalized patients with NPSU.

Partner protections in HIV cure-related trials involving analytical treatment interruption: Updated toolkit to mitigate HIV transmission risk.

Analytical treatment interruptions (ATIs) are widely used to evaluate HIV cure-related research interventions. However, sex partners of cure-related trial participants might be at risk of acquiring HIV during ATIs. Addressing this risk is key to ensuring the continued success of trials involving ATIs and offer greater acceptability across multiple trials sites. In 2022, the Advancing Clinical Therapeutics Globally (ACTG) Network convened a Partner Protections Working Group (PPWG) to update the 2020 HIV transmission risk toolkit developed by Peluso and colleagues. In our review of the original toolkit, we identified new challenges and needs at the participant, partner and study levels, as well as new evidence on measures to address these needs and more advanced ethical thinking on partner protections in HIV cure-related trials with ATIs. Based on these findings, we developed an updated toolkit that will provide trial participants and their partners with better support to address new and unfamiliar situations and protect partners from undue harm. We present this toolkit, make it available as a resource for cure-related trials with ATIs and discuss possible future directions.

The interplay between the urban development of Rome (Italy) and the Tiber River floods: A review of two millennia of socio-hydrological history.

The urban development of Rome (Italy) has been intertwined with the dynamics of the Tiber River since its foundation. In this review paper, we analyse more than 2500 years of flood history and urban development to untangle the dynamics of flood risk and assess the resulting socio-hydrological phenomena. Until the 1800s, urban dwellers living in the riparian areas of the Tiber River were accustomed to frequent flooding. From the 1900s, the construction of flood walls reshaped the co-evolution of hydrological, economic, political, technological, and social processes. As a result, while the probability of flooding is currently very low, its potential adverse consequences would be catastrophic. From the analysis of the long-term feedback between urban development of Rome and flood events from ancient times to present days, it emerges the crucial need for an effective flood risk mitigation strategy that combines structural and non-structural measures. In particular, heightened flood risk awareness and preparedness to cope with rare but potentially devastating events is key to alleviate flood risk.

Tissue distribution, biomagnification, human health risk, and risk mitigation of perfluoroalkyl acids (PFAAs) in the aquatic food web of an urban fringe lake: Insights from urban-rural and seasonal scales.

Perfluoroalkyl acids (PFAAs), renowned for their exceptional physical and chemical properties, are ubiquitous in urban and rural environments. Despite their widespread usage, more knowledge is needed concerning their accumulation and transfer mechanisms within the aquatic food webs of urban fringe lakes, especially across rural-urban and seasonal scales. This study investigated the tissue distribution, bioaccumulation, biomagnification, associated human health risks, and potential risk mitigation strategies of 15 PFAAs within the food web of Luoma Lake, a prototypical urban fringe lake. All targeted PFAAs were detected in samples, with ∑PFAA concentrations ranging from 116.97 to 564.26 ng/g dw in muscles and 26.96 to 1850.95 ng/g dw in viscera. Spatial variations revealed significantly higher ∑PFAA concentrations in the muscles from the urban subregion (∑PFAA: 359.66 ± 76.48 ng/g dw) compared to the rural subregion (∑PFAA: 328.86 ± 87.51 ng/g dw). Seasonal fluctuations impacted PFAA concentrations in fish and crustacean muscles but exhibited negligible effects on bivalve muscles. Spatial variations only influenced PFAA concentrations in specific viscera (gill, liver, kidney), while seasonal changes had minimal effects on viscera. The organisms demonstrated varying bioaccumulation capacities, with crustaceans displaying the highest bioaccumulation potential, followed by crustaceans and fish. Both spatial and seasonal variations modulated the bioaccumulation patterns of PFAA in muscles, whereas bioaccumulation in viscera was only influenced by seasonal factors. Notably, PFAA biomagnification along the food web was exclusively governed by spatial distribution, remaining unaffected by seasonal changes. The human health risk assessment underscored the potential adverse health impacts of PFOS and PFOA, particularly on young children (aged 2 to <6 years). This study further proposed comprehensive recommendations for mitigating PFAA-induced health risks, encompassing source control, selective consumption, pre-cooking treatments, and strategic cooking method selection. This research provides crucial insights into the ecological behaviors and health implications of PFAA in urban fringe lakes.

Risk Assessments and Risk Mitigation to Prevent the Introduction of African Swine Fever into the Danish Pig Population.

African Swine Fever poses a significant threat to pig production. An outbreak in Denmark would have severe economic consequences, potentially resulting in a loss between 335 million and 670 million euros. To mitigate the major risk factors, the Danish authorities and the Danish pig industry have implemented several risk-reducing measures. The small wild boar population in Danish nature has been culled, and a fence between Denmark and Germany has been constructed to stop or reduce the risk of migrating wild boar from Germany. All trucks arriving from abroad, intended for the transport of Danish pigs, are inspected, washed, and disinfected at facilities near the border before being allowed to transport pigs between herds or from herds out of Denmark. Cross-border trade of feedstuffs and potentially risky materials is continuously monitored. Based on risk assessments, feed types or bedding materials from countries with African Swine Fever that could contain parts of wild boar are banned from Danish pig herds. Certain types of fats and oils from countries with African Swine Fever can only be used after heat treatment. The import of whole kernels of corn, wheat, or barley is not considered a risk.

Orlando Veterans Affairs Stratification Tool for Opioid Risk Mitigation (STORM) Very High Risk Interdisciplinary Team Review: A Brief Report.

BACKGROUND: Compared to the general population, Veterans Health Administration (VHA) patients have higher rates of mental illness, chronic pain, and substance use disorders (SUD), conditions that increase risk for opioid-related adverse events. VHA developed the Stratification Tool for Opioid Risk Mitigation (STORM) and mandated case reviews by an interdisciplinary team (IDT) for patients identified as very high risk, a process implemented and led by clinical pharmacist practitioners at the Orlando Veterans Affairs Healthcare System (OVAHCS) in 2018. OBJECTIVE: To evaluate and describe the implementation and process for IDT reviews of patients identified as very high risk by the STORM clinical decision support tool at OVAHCS. METHODS: A single center, retrospective, observational chart review was conducted. Veterans reviewed by the STORM IDT between January to September 2018 were reviewed for change in Morphine Equivalent Daily Dose (MEDD), naloxone, non-opioid analgesics, medications for SUD, benzodiazepines, engagement with clinical services (e.g., mental health, SUD, pain clinic), and overdose or suicide attempts in the year prior versus the year after IDT review. The frequency of follow-up IDT reviews was evaluated. RESULTS: Seventeen patients were identified. Four were excluded due to non-opioid related death within 12 months after review. The average baseline MEDD was 82.2mg (range 10 - 496mg) and average 12 months after review was 7.5mg (range 0 - 67.5mg), a decrease of 74.7mg, or 90.9% reduction. An increase in medications for SUD (3 patients; 23%), SUD engagement (3 to 6 patients), and urine drug tests was observed (79% increase). Benzodiazepine use decreased by 50%. CONCLUSION: This report provides insight on the IDT case review process at OVAHCS, a process that may vary widely across facilities. A reduction in MEDD, increase in SUD treatment, and improved risk mitigation was observed. The central role of clinical pharmacy and expanded process for continued follow-up warrants further study.

Multi-hazard assessment for flood and Landslide risk in Kalimantan and Sumatra: Implications for Nusantara, Indonesia's new capital.

Situated within the Ring of Fire and characterized by a tropical climate and high seismic activity, Indonesia is uniquely vulnerable to natural disasters such as floods and landslides. These events pose significant threats to both the population and infrastructure. This study predicts areas exposed to flood and landslide risk by considering various environmental factors related to climate, topography, and land use. The predictive performance of three machine learning models-naïve Bayes, k-nearest neighbors, and random forest (RF)-was evaluated by comparing the AUC, RMSE, and R2 values of each model. Ultimately, the RF model, which demonstrated the highest accuracy, was used to prioritize disaster impact factors and generate hazard maps. The results identified the interaction of rainfall, land use, and slope aspect as the most critical determinants of hazard occurrence. The predicted hazard maps revealed that approximately 26.7 % of the study area was vulnerable to either floods or landslides, with 16.8 % of the area experiencing both. The new capital of Nusantara showed a relatively higher multi-hazard risk than did the overall study area and protected zones, with 22.1 % of the hazard area vulnerable to both flooding and landslides. In single hazard zones, areas classified as at risk for floods had a higher mean probability of experiencing both hazards (43 %), as compared to areas classified as at risk for landslides (22 %). As a result, urban planners and relevant stakeholders can now utilize the hazard maps developed in this study to prioritize infrastructure reinforcement and disaster risk areas, integrating land use planning with risk assessment to mitigate the impact of disasters. By employing these strategies, Indonesia and other countries facing similar challenges can now enhance their disaster preparedness and response capabilities in new capital regions and other areas, ultimately planning for more sustainable urban development.

Lipoprotein(a) in interventional cardiology: identifying patients at highest risk of recurrent cardiovascular events through early recognition - a case based review.

INTRODUCTION: Lipoprotein(a) [Lp(a)] is linked to higher risks of atherosclerotic cardiovascular disease (ASCVD). Current guideline recommendations are quite liberal on measuring Lp(a) (Class IIa, Level C), and may lead to underuse among (interventional) cardiologists. AREAS COVERED: This case-based narrative review outlines four clinical cases of patients with elevated Lp(a) to illustrate its pathophysiological impact on coronary artery disease (CAD). The expert consensus statements from the American Heart Association (AHA) and European Atherosclerosis Society (EAS) served as the basis of this review. More recent publications, from 2023 to 2024, were accessed through the MEDLINE online library. EXPERT OPINION: We highlighted the importance of routine Lp(a) measurement in identifying patients at high risk for atherosclerosis, necessitating potent risk mitigation. Measuring Lp(a) helps clinicians identify which patients are at highest residual risk, who require potent pharmacological treatment and special attention during catheter interventions. As noninvasive and advanced intravascular imaging modalities evolve, future catheterization laboratories will integrate advanced imaging, diagnostics, and treatment, facilitating tailored patient care. Knowing Lp(a) levels is crucial in this context. While Lp(a)-lowering drugs are currently investigated in clinical trials, it is of paramount importance to know Lp(a) levels and strive toward aggressive management of other modifiable risk factors in patients with elevated Lp(a) and established symptomatic CAD being diagnosed or treated in catheterization laboratories.

Navigating uncharted waters: assessing the impact of the COVID-19 pandemic on hematopoietic stem cell transplantation: challenges and innovations.

The COVID-19 pandemic has significantly impacted hematopoietic stem cell transplantation (HSCT), necessitating adaptations across pre-transplant, transplantation, and post-transplant phases. HSCT recipients with compromised immune systems face heightened risks of severe COVID-19 outcomes, including increased mortality. The pandemic prompted significant changes in treatment strategies, with many patients experiencing delays or deferrals in autologous stem cell transplantation (ASCT), alongside adjustments to chemotherapy regimens to prevent disease recurrence. Clinical practices have evolved to address pandemic-related challenges, including a decrease in allo-HSCT procedures, a shift towards using domestic donors and peripheral blood stem cells over bone marrow grafts, and integration of telemedicine to reduce patient burden. These adaptations aim to balance COVID-19 exposure risks with the need for lifesaving HSCT. Innovations in response to the pandemic include stringent infection control measures, modified conditioning regimens, and revised post-transplant care protocols to mitigate infection risks. The importance of optimizing antiviral treatments, exploring new immunomodulatory interventions, and researching broadly neutralizing antibodies for HSCT recipients has been underscored. Despite the difficulties, the pandemic has catalyzed significant learning and innovation in HSCT practices, emphasizing the need for ongoing adaptation and research to protect this vulnerable patient population.

Congenital rubella syndrome, a case series.

Rubella, or German measles, is a vaccine-preventable disease. Rubella infection is usually mild; however, infection in pregnancy is associated with severe outcomes for the baby, including pregnancy loss or a combination of developmental defects called congenital rubella syndrome. Within the last ten-year period, two cases of congenital rubella syndrome in Saskatchewan were reported to the provincial ministry and the Public Health Agency of Canada of the newborns of mothers who had recently arrived from Sub-Saharan Africa. Both infants had multiple health complications at birth consistent with congenital rubella and tested positive for the rubella virus. The article discusses the challenges encountered by the healthcare system in diagnosing, investigating, monitoring and managing cases of congenital rubella syndrome to prevent further sporadic transmission. The article emphasizes the need to provide additional support for cases and their households, especially new Canadians with less support to comply with public health advice and the importance of routine immunization to eliminate rubella globally.

Antimicrobial Resistance in Aquaculture: Risk Mitigation within the One Health Context.

The application of antimicrobials in aquaculture primarily aims to prevent and treat bacterial infections in fish, but their inappropriate use may result in the emergence of zoonotic antibiotic-resistant bacteria and the subsequent transmission of resistant strains to humans via food consumption. The aquatic environment serves as a potential reservoir for resistant bacteria, providing an ideal breeding ground for development of antimicrobial resistance (AMR). The mutual inter-connection of intensive fish-farming systems with terrestrial environments, the food processing industry and human population creates pathways for the transmission of resistant bacteria, exacerbating the problem further. The aim of this study was to provide an overview of the most effective and available risk mitigation strategies to tackle AMR in aquaculture, based on the One Health (OH) concept. The stringent antimicrobial use guidelines, promoting disease control methods like enhanced farm biosecurity measures and vaccinations, alternatives to antibiotics (ABs) (prebiotics, probiotics, immunostimulants, essential oils (EOs), peptides and phage therapy), feeding practices, genetics, monitoring water quality, and improving wastewater treatment, rather than applying excessive use of antimicrobials, can effectively prevent the development of AMR and release of resistant bacteria into the environment and food. The contribution of the environment to AMR development traditionally receives less attention, and, therefore, environmental aspects should be included more prominently in OH efforts to predict, detect and prevent the risks to health. This is of particular importance for low and middle-income countries with a lack of integration of the national AMR action plans (NAPs) with the aquaculture-producing environment. Integrated control of AMR in fisheries based on the OH approach can contribute to substantial decrease in resistance, and such is the case in Asia, where in aquaculture, the percentage of antimicrobial compounds with resistance exceeding 50% (P50) decreased from 52% to 22% within the period of the previous two decades.

Enhancing COVID-19 Risk Mitigation in Bisha City Primary Schools: Investigating Teacher and Administrative Staff Awareness Through a Comprehensive Survey.

Background and aims This research investigates COVID-19 awareness among primary school teachers and staff in Bisha City. It aims to enhance safety protocols by examining knowledge, awareness levels, and demographic associations. Despite school reopening, concerns linger. The study promotes informed decision-making, fostering a safer school environment and contributing to the well-being of the educational community. Methods In an institutional-based cross-sectional study among primary school teachers and administrative staff in Bisha City, our research aimed to comprehensively evaluate awareness regarding specific measures for minimizing COVID-19 risks. With a sample size of 348 participants, we employed a robust methodology, including online questionnaires addressing sociodemographic characteristics and knowledge about COVID-19 risks. The data collection period spanned from March 2022 to December 2023, providing a temporal context for responses. A pilot test ensured questionnaire clarity, and efforts were made to enhance reliability and validity, incorporating validated scales and iterative adjustments based on feedback. Non-response or incomplete responses were handled transparently, with sensitivity analyses to assess potential impact. The awareness level was measured using 17 Likert scale questions, and predefined categories (poor, moderate, and good) facilitated result interpretation. Researcher influence was minimized through training and inter-rater reliability checks. Confidentiality and anonymity were rigorously maintained, adhering to ethical considerations. Statistical analyses employed frequency tables, percentages, mean, standard deviations, and the chi-square test. Dissemination included academic publications, reports to the educational directorate, and presentations at conferences. This holistic approach contributes to the robustness and societal impact of our study, offering insights into COVID-19 awareness among educators in Bisha City. Results In this study assessing awareness among teachers and administrative staff in Bisha City regarding COVID-19 risk minimization, data from 348 respondents revealed key bio-demographic characteristics. The majority demonstrated good knowledge of environmental (83%) and personal hygiene risks (84%). The chi-square test indicated no significant associations between bio-demographic factors and awareness levels. Specifically, for age groups, χ²(4, N = 348) = 5.46, p = 0.707; for gender, χ²(1, N = 348) = 1.95, p = 0.744; for educational levels, χ²(4, N = 348) = 2.13, p = 0.995; for residency, χ²(1, N = 348) = 1.11, p = 0.892; and for job types, χ²(3, N = 348) = 8.30, p = 0.404. The absence of significant associations underscores the potential universality of successful awareness campaigns, suggesting that future efforts can maintain an inclusive approach without tailoring messages. These results emphasize the importance of sustained awareness efforts across the diverse demographic spectrum of the educational community. Conclusion This study reveals robust COVID-19 awareness among primary school teachers and staff in Bisha City, with no significant demographic associations. Successful, inclusive awareness campaigns can further enhance safety measures and promote well-being in the educational community.

A 3-year retrospective review of hospital admissions involving opioid toxicity in South Australia.

INTRODUCTION: This article aims to characterise hospital admissions involving opioid toxicity across South Australia to guide future implementation and evaluation of risk mitigation strategies. METHODS: International Classification of Diseases, 10th Edition codes (T40.0-T40.4) were used to identify admissions involving pre-hospital opioid toxicity in public hospitals across South Australia from 1 June 2017 to 30 August 2020. Demographic and episode of care data were extracted and summarised using descriptive statistics. Admission cost estimates were calculated using Independent Hospital Pricing Authority data. RESULTS: A total of 2046 cases met the criteria for inclusion; over half (56%) were female and median age on admission was 44 years (interquartile range 27 years). Where opioid toxicity was the primary diagnosis, 70% of admissions did not specify the responsible opioid and 23% were related to heroin use. One-fifth of admissions occurred outside of metropolitan Adelaide. Individuals living in an area of relative socio-economic disadvantage were over-represented. Over half of admissions required a stay >24 h; 19% were admitted for ≥5 days, 22% required intensive care and ~10% required mechanical ventilation. The total estimated cost of admissions involving opioid toxicity in South Australia over the 3-year period was $18,230,546.50, equating to $5.6 million per annum. DISCUSSIONS AND CONCLUSIONS: These findings highlight the significant personal, fiscal, and systemic impacts of opioid toxicity-related hospital admissions in South Australia and provide a baseline to evaluate the effectiveness of initiatives to reduce opioid-related harm, including real-time prescription monitoring and take-home naloxone supply.

Sick leaves among healthy pregnant Croatian healthcare workers during the COVID-19 pandemic due to loopholes in the occupational safety system.

The aim of this study was to explore occupational safety in pregnant Croatian healthcare workers (HCWs) during the coronavirus disease 2019 (COVID-19) pandemic. To this end we composed an anonymous questionnaire that included pregnancy data, risk assessment and mitigation, and workplace intervention and distributed it to HCWs through social media of their groups and associations. The study includes a total of 173 respondents (71.1 % physicians, 19.7 % nurses, 9.2 % other HCWs) diagnosed with pregnancy in 2020 and 2021. Employers were notified about HCWs' pregnancy at the eighth (IQR 7.0-11.0) week of pregnancy, which delayed workplace risk assessment and mitigation beyond the first trimester. Only 19.6 % of the participants had the risk assessed and mitigated, mostly on their own initiative (76.5 %). After notifying employers about pregnancy, 37.0 % of participants opted for temporary work incapacity (TWI) due to "pregnancy complications" despite healthy pregnancy, 16.8 % were granted a pregnant worker's paid leave at the expense of the employer, while 5.8 % continued to work at the same workplace. Nurses used the TWI benefit more frequently than physicians (58.8 % vs 30.1 %, P=0.004). Our findings suggest that occupational safety of pregnant HCWs in Croatia lacks clear-cut and transparent strategies to protect pregnant HCWs, forcing them to misuse the healthcare system.

Normative Hamstrings and Quadriceps Isometric Strength Values and Hamstrings-Quadriceps Asymmetry in Healthy Collegiate Soccer and Basketball Players.

The objectives of this study were to report weight-normalized, sex- and sport-stratified normative values for hamstrings and quadriceps isometric strength in collegiate soccer and basketball players using a low-cost hand-held dynamometer and assess the prevalence of "substantial" hamstrings-quadriceps (H/Q) ratio strength imbalance (<0.6) among players. Ninety-four healthy collegiate male and female soccer and basketball players (age range: 18-24 years) were examined for baseline isometric hamstrings and quadriceps strength using a handheld isometric dynamometer with standardized and valid protocols. For soccer, the mean (95%CI) weight-normalized peak isometric strength values (considering dominant limbs) were 3.29 (2.90 to 3.64) N/kg (hamstrings) and 5.48 (4.96 to 6.00) N/kg (quadriceps) in male players and 2.62 (2.39 to 2.85) N/kg (hamstrings) and 4.55 (4.14 to 4.96) N/kg (quadriceps) in female players. For basketball, the mean (95% CI) peak strength values were 2.97 (2.72 to 3.21) N/kg (hamstrings) and 4.89 (4.44 to 5.33) N/kg (quadriceps) in male players and 2.48 (2.15 to 2.80) N/kg (hamstrings) and 4.21 (3.54 to 4.87) N/kg (quadriceps) in female players. The prevalence of substantial H/Q strength imbalance was 37% (95%CI: 24% to 52%) in soccer and 44% (95%CI: 29% to 60%) in basketball players. This study is first to provide normative values for peak isometric hamstrings and quadriceps strength using a low-cost hand-held dynamometer. The normative database from this study is valuable to coaches, sports medicine professionals, exercise scientists and other stakeholders to inform injury prevention, rehabilitation progression, return to play decisions and performance goals in collegiate soccer and basketball players.

Food contaminants: Impact of food processing, challenges and mitigation strategies for food security.

Food preparation involves the blending of various food ingredients to make more convenient processed food products. It is a long chain process, where each stage posing a risk of accumulating hazardous contaminants in these food systems. Protecting the public health from contaminated foods has become a demanding task in ensuring food safety. This review focused on the causes, types, and health risks of contaminants or hazardous chemicals during food processing. The impact of cooking such as frying, grilling, roasting, and baking, which may lead to the formation of hazardous by-products, including polycyclic aromatic hydrocarbons (PAHs), heterocyclic amines (HCAs), acrylamide, advanced glycation end products (AGEs), furan, acrolein, nitrosamines, 5-hydroxymethylfurfural (HMF) and trans-fatty acids (TFAs). Potential health risks such as carcinogenicity, genotoxicity, neurotoxicity, and cardiovascular effects are emerging as a major problem in the modern lifestyle era due to the increased uptakes of contaminants. Effects of curing, smoking, and fermentation of the meat products led to affect the sensory and nutritional characteristics of meat products. Selecting appropriate cooking methods include temperature, time and the consumption of the food are major key factors that should be considered to avoid the excess level intake of hazardous contaminants. Overall, this study underscores the importance of understanding the risks associated with food preparation methods, strategies for minimizing the formation of harmful compounds during food processing and highlights the need for healthy dietary choices to mitigate potential health hazards.

Innovative AI-Enhanced Ice Detection System Using Graphene-Based Sensors for Enhanced Aviation Safety and Efficiency.

Ice formation on aircraft surfaces poses significant safety risks, and current detection systems often struggle to provide accurate, real-time predictions. This paper presents the development and comprehensive evaluation of a smart ice control system using a suite of machine learning models. The system utilizes various sensors to detect temperature anomalies and signal potential ice formation. We trained and tested supervised learning models (Logistic Regression, Support Vector Machine, and Random Forest), unsupervised learning models (K-Means Clustering), and neural networks (Multilayer Perceptron) to predict and identify ice formation patterns. The experimental results demonstrate that our smart system, driven by machine learning, accurately predicts ice formation in real time, optimizes deicing processes, and enhances safety while reducing power consumption. This solution holds the potential for improving ice detection accuracy in aviation and other critical industries requiring robust predictive maintenance.

A novel STPA approach to software safety and security in autonomous maritime systems.

With higher autonomy in maritime systems, tasks and responsibilities are moved from the human operator to software, increasing the complexity and the importance of safe and reliable functionality. Software failures, however, may be introduced from the early life cycle phases intentionally or unintentionally, and these must therefore be mitigated by safe and secure design approaches. A challenge is that existing methods are not particularly well-suited for analyzing software risks. Thus, the objective of this paper is to propose a systematic and efficient software failure identification approach by extending the Systems-Theoretic Process Analysis (STPA) with a software failure taxonomy and the System Modeling Language (SysML). This enables the control structure in STPA to cover both the dynamic and static aspects of the software functions. Combined with an implementation platform independent questionnaire, this gives a more systematic and guided search for potential software failures than existing approaches. To demonstrate the proposed approach, a case study on a ferry's navigation system that operates in manual control or semi-autonomous mode is performed. In the case study, the focus is on creating an avoidance map data structure, including both moving and static obstacles to be avoided by the ferry, and the subsequent process of collision risk warning calculation. Software failures are identified and evaluated in collision scenarios where the ferry operates under foggy conditions. The paper shows that the proposed systematic approach provides an improved process for identifying and analyzing critical software failures. This facilitates enhanced risk mitigation in the design and testing phases contributing to autonomous systems' safety and security.

Advancing Perioperative Neurocognitive Health: A Critical Review of Predictive Tools, Diagnostic Methods, and Interventional Strategies.

Perioperative neurocognitive disorders (PNDs) affect a large percentage of people who undergo surgeries that need general anesthesia. There is an increased risk of death and a major disruption to postoperative self-care as a result of this. This study compiles all the relevant materials that the authors have found to investigate postnatal depression and its causes, as well as the methods used to determine the probability and severity of PNDs and how to reduce their risk before surgery. Postnatal depression can have many causes, and this text explores some of them. These include a history of alcohol or opiate use, immunological dysregulation, advanced age, educational background, infections, neurocognitive impairment, and pre-existing chronic inflammatory disorders. It also delves into various methods used to gauge the likelihood and severity of postpartum depression. The following assessment tools were covered: the Clock Drawing Test, Domain-Specific Tests, the Mini-Mental State Examination, and the Montreal Cognitive Assessment. In addition to biochemical markers, neuroimaging techniques play an important role in diagnosis. The Frailty Fried assessment, which measures inertia, sluggishness, lack of physical activity, fatigue, and unintentional weight loss, is a key prognostic sign that is highlighted. There is strong evidence that the index, which is derived from these five characteristics, may accurately predict the likelihood of PNDs. Risk mitigation strategies are also covered in this research. Preoperative brain plasticity-based therapies, such as physical exercise and intensive cognitive training, can significantly reduce the incidence and severity of postoperative neurocognitive disorders. A peripheral nerve block, monitoring cerebral oxygen saturation, dexmedetomidine, and a reduction in anesthesia depth are all ways to improve anesthetic procedures. Methods that lower blood pressure should be avoided, the body temperature should be kept down during surgery, or the time without liquids should be lengthened; all of these raise the risk of postoperative nausea and vomiting and make it worse. Potential approaches include a Mediterranean diet, physical activity, cognitive stimulation, smoking cessation, alcohol reduction, avoidance of anticholinergic medications, and non-steroidal anti-inflammatory drug stewardship, although there is no definitive evidence for successful postoperative neurocognitive rehabilitation procedures. More standardized diagnostic criteria, evaluation methods, and PND classification are urgently needed, according to this study. Different cases of PNDs are characterized by different combinations of tests, cutoff values, and methods because there is a broad variety of diagnostic tests used to make the diagnosis. Until now, PNDs and pre-existing neurocognitive disorders have been diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). With an aging population comes an increase in the occurrence and prevalence of PNDs, which calls for a specific way to classify and describe the condition.