First Evaluation of a Contingency Management Intervention Addressing Adolescent Substance Use and Sexual Risk Behaviors: Risk Reduction Therapy for Adolescents

PubMed Central

Letourneau, Elizabeth J.; McCart, Michael R.; Sheidow, Ashli J.; Mauro, Pia M.

2016-01-01

There is a need for interventions that comprehensively address youth substance use disorders (SUD) and sexual risk behaviors. Risk Reduction Therapy for Adolescents (RRTA) adapts a validated family-focused intervention for youth SUD to include sexual risk reduction components in a single intervention. In this first evaluation of RRTA, drug court involved youth were randomly assigned to RRTA (N = 45) or usual services (US; N = 60) and followed through 12-months post-baseline. RRTA included weekly cognitive behavior therapy and behavior management training and contingency-contracting with a point earning system managed by caregivers targeting drug use and sexual risk antecedents. Longitudinal models estimated within-group change and between-group differences through 6- and 12-month follow-up on outcomes for substance use, sexual risk behaviors, and protective HIV behaviors. Robust effects of the intervention were not detected under conditions of the study that included potent background interventions by the juvenile drug court. Considerations about future development and testing of sexual risk reduction therapy for youth are discussed, including the potential role of contingency management in future interventions. PMID:27629581

Evidence-based disease management: its role in cardiovascular risk reduction.

PubMed

Fanning, Etta L

2004-01-01

Cardiovascular disease remains the most pressing healthcare problem in the United States. Traditional risk factors--hypertension, obesity, and diabetes-are still unresolved issues; and new risk factors--pre-diabetes, insulin resistance, and pediatric and adolescent diabetes-have emerged. There is an urgent need to identify the risk factors for cardiovascular disease, and address risk reduction with disease management and treatment for each factor, based on qualitative and quantitative approaches for developing the evidence base for public health action. The objectives of this paper are to review (i) the burden of cardiovascular illness-morbidity, mortality, and cost; (ii) risk factors and the emerging epidemic of adolescent obesity; (iii) the challenges of attaining target endpoints; and (iv) the attributes of a successful programmatic healthcare initiative for potential impact on cardiovascular care and, eventually, public health.

Mediation Analysis of the Efficacy of the Eban HIV/STD Risk-Reduction Intervention for African American HIV Serodiscordant Couples.

PubMed

El-Bassel, Nabila; Jemmott, John B; Bellamy, Scarlett L; Pequegnat, Willo; Wingood, Gina M; Wyatt, Gail E; Landis, J Richard; Remien, Robert H

2016-06-01

Targeting couples is a promising behavioral HIV risk-reduction strategy, but the mechanisms underlying the effects of such interventions are unknown. We report secondary analyses testing whether Social-Cognitive-Theory variables mediated the Eban HIV-risk-reduction intervention's effects on condom-use outcomes. In a multisite randomized controlled trial conducted in four US cities, 535 African American HIV-serodiscordant couples were randomized to the Eban HIV risk-reduction intervention or attention-matched control intervention. Outcomes were proportion condom-protected sex, consistent condom use, and frequency of unprotected sex measured pre-, immediately post-, and 6 and 12 months post-intervention. Potential mediators included Social-Cognitive-Theory variables: outcome expectancies and self-efficacy. Mediation analyses using the product-of-coefficients approach in a generalized-estimating-equations framework revealed that condom-use outcome expectancy, partner-reaction outcome expectancy, intention, self-efficacy, and safer-sex communication improved post-intervention and mediated intervention-induced improvements in condom-use outcomes. These findings underscore the importance of targeting outcome expectancies, self-efficacy, and safer-sex communication in couples-level HIV risk-reduction interventions.

International Space Station (ISS) Risk Reduction Activities

NASA Technical Reports Server (NTRS)

Fodroci, Michael

2011-01-01

As the assembly of the ISS nears completion, it is worthwhile to step back and review some of the actions pursued by the Program in recent years to reduce risk and enhance the safety and health of ISS crewmembers, visitors, and space flight participants. While the ISS requirements and initial design were intended to provide the best practicable levels of safety, it is always possible to reduce risk -- given the determination and commitment to do so. The following is a summary of some of the steps taken by the ISS Program Manager, by our International Partners, by hardware and software designers, by operational specialists, and by safety personnel to continuously enhance the safety of the ISS. While decades of work went into developing the ISS requirements, there are many things in a Program like the ISS that can only be learned through actual operational experience. These risk reduction activities can be divided into roughly three categories: (1) Areas that were initially noncompliant which have subsequently been brought into compliance or near compliance (i.e., Micrometeoroid and Orbital Debris [MMOD] protection, acoustics) (2) Areas where initial design requirements were eventually considered inadequate and were subsequently augmented (i.e., Toxicity Level 4 materials, emergency hardware and procedures) (3) Areas where risks were initially underestimated, and have subsequently been addressed through additional mitigation (i.e., Extravehicular Activity [EVA] sharp edges, plasma shock hazards) Due to the hard work and cooperation of many parties working together across the span of nearly a decade, the ISS is now a safer and healthier environment for our crew, in many cases exceeding the risk reduction targets inherent in the intent of the original design. It will provide a safe and stable platform for utilization and discovery.

First Evaluation of a Contingency Management Intervention Addressing Adolescent Substance Use and Sexual Risk Behaviors: Risk Reduction Therapy for Adolescents.

PubMed

Letourneau, Elizabeth J; McCart, Michael R; Sheidow, Ashli J; Mauro, Pia M

2017-01-01

There is a need for interventions that comprehensively address youth substance use disorders (SUD) and sexual risk behaviors. Risk Reduction Therapy for Adolescents (RRTA) adapts a validated family-focused intervention for youth SUD to include sexual risk reduction components in a single intervention. In this first evaluation of RRTA, drug court involved youth were randomly assigned to RRTA (N=45) or usual services (US; N=60) and followed through 12-months post-baseline. RRTA included weekly cognitive behavior therapy and behavior management training and contingency-contracting with a point earning system managed by caregivers targeting drug use and sexual risk antecedents. Longitudinal models estimated within-group change and between-group differences through 6- and 12-month follow-up on outcomes for substance use, sexual risk behaviors, and protective HIV behaviors. Robust effects of the intervention were not detected under conditions of the study that included potent background interventions by the juvenile drug court. Considerations about future development and testing of sexual risk reduction therapy for youth are discussed, including the potential role of contingency management in future interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

Health-risk appraisal with or without disease management for worksite cardiovascular risk reduction.

PubMed

Maron, David J; Forbes, Barbara L; Groves, Jay R; Dietrich, Mary S; Sells, Patrick; DiGenio, Andres G

2008-01-01

Worksite health promotion programs use health risk appraisal (HRA) surveys to identify employees at increased risk, then provide a range of interventions to encourage high-risk individuals to improve their health. Our objective was to determine how the intensity of intervention after HRA affected cardiovascular risk after 1 year, comparing individual follow-up counseling with environmental supports. 133 employees of Vanderbilt University with cardiovascular risk factors were randomly assigned to worksite HRA plus targeted disease management (DM group) or HRA plus information about worksite health promotion programs (HRA group). The DM group received longitudinal individualized counseling for risk reduction, whereas the HRA group members received one feedback session about their risk factors and information about free worksite health promotion programs. The main outcome measure was the difference between groups in the change in average Framingham risk score from baseline to 1 year. There was no significant baseline difference between groups in the Framingham risk score. Among DM participants, the mean (SD) Framingham risk score decreased by 22.6%; among HRA participants, the mean score rose by 4.3% (P = .017 for the difference between groups). In this study of employees with cardiovascular risk factors, HRA followed by individual counseling was more effective than providing information about free worksite health promotion programs.

Target oriented dimensionality reduction of hyperspectral data by Kernel Fukunaga-Koontz Transform

NASA Astrophysics Data System (ADS)

Binol, Hamidullah; Ochilov, Shuhrat; Alam, Mohammad S.; Bal, Abdullah

2017-02-01

Principal component analysis (PCA) is a popular technique in remote sensing for dimensionality reduction. While PCA is suitable for data compression, it is not necessarily an optimal technique for feature extraction, particularly when the features are exploited in supervised learning applications (Cheriyadat and Bruce, 2003) [1]. Preserving features belonging to the target is very crucial to the performance of target detection/recognition techniques. Fukunaga-Koontz Transform (FKT) based supervised band reduction technique can be used to provide this requirement. FKT achieves feature selection by transforming into a new space in where feature classes have complimentary eigenvectors. Analysis of these eigenvectors under two classes, target and background clutter, can be utilized for target oriented band reduction since each basis functions best represent target class while carrying least information of the background class. By selecting few eigenvectors which are the most relevant to the target class, dimension of hyperspectral data can be reduced and thus, it presents significant advantages for near real time target detection applications. The nonlinear properties of the data can be extracted by kernel approach which provides better target features. Thus, we propose constructing kernel FKT (KFKT) to present target oriented band reduction. The performance of the proposed KFKT based target oriented dimensionality reduction algorithm has been tested employing two real-world hyperspectral data and results have been reported consequently.

Modeling health gains and cost savings for ten dietary salt reduction targets.

PubMed

Wilson, Nick; Nghiem, Nhung; Eyles, Helen; Mhurchu, Cliona Ni; Shields, Emma; Cobiac, Linda J; Cleghorn, Christine L; Blakely, Tony

2016-04-26

Dietary salt reduction is included in the top five priority actions for non-communicable disease control internationally. We therefore aimed to identify health gain and cost impacts of achieving a national target for sodium reduction, along with component targets in different food groups. We used an established dietary sodium intervention model to study 10 interventions to achieve sodium reduction targets. The 2011 New Zealand (NZ) adult population (2.3 million aged 35+ years) was simulated over the remainder of their lifetime in a Markov model with a 3 % discount rate. Achieving an overall 35 % reduction in dietary salt intake via implementation of mandatory maximum levels of sodium in packaged foods along with reduced sodium from fast foods/restaurant food and discretionary intake (the "full target"), was estimated to gain 235,000 QALYs over the lifetime of the cohort (95 % uncertainty interval [UI]: 176,000 to 298,000). For specific target components the range was from 122,000 QALYs gained (for the packaged foods target) down to the snack foods target (6100 QALYs; and representing a 34-48 % sodium reduction in such products). All ten target interventions studied were cost-saving, with the greatest costs saved for the mandatory "full target" at NZ$1260 million (US$820 million). There were relatively greater health gains per adult for men and for Māori (indigenous population). This work provides modeling-level evidence that achieving dietary sodium reduction targets (including specific food category targets) could generate large health gains and cost savings for a national health sector. Demographic groups with the highest cardiovascular disease rates stand to gain most, assisting in reducing health inequalities between sex and ethnic groups.

Mechanisms of Risk Reduction in the Clinical Practice of Alzheimer's Disease Prevention.

PubMed

Schelke, Matthew W; Attia, Peter; Palenchar, Daniel J; Kaplan, Bob; Mureb, Monica; Ganzer, Christine A; Scheyer, Olivia; Rahman, Aneela; Kachko, Robert; Krikorian, Robert; Mosconi, Lisa; Isaacson, Richard S

2018-01-01

Alzheimer's disease (AD) is a neurodegenerative dementia that affects nearly 50 million people worldwide and is a major source of morbidity, mortality, and healthcare expenditure. While there have been many attempts to develop disease-modifying therapies for late-onset AD, none have so far shown efficacy in humans. However, the long latency between the initial neuronal changes and onset of symptoms, the ability to identify patients at risk based on family history and genetic markers, and the emergence of AD biomarkers for preclinical disease suggests that early risk-reducing interventions may be able to decrease the incidence of, delay or prevent AD. In this review, we discuss six mechanisms-dysregulation of glucose metabolism, inflammation, oxidative stress, trophic factor release, amyloid burden, and calcium toxicity-involved in AD pathogenesis that offer promising targets for risk-reducing interventions. In addition, we offer a blueprint for a multi-modality AD risk reduction program that can be clinically implemented with the current state of knowledge. Focused risk reduction aimed at particular pathological factors may transform AD to a preventable disorder in select cases.

HIV testing and sexual risk reduction counseling in office-based buprenorphine/naloxone treatment.

PubMed

Edelman, E Jennifer; Moore, Brent A; Caffrey, Sarah; Sikkema, Kathleen J; Jones, Emlyn S; Schottenfeld, Richard S; Fiellin, David A; Fiellin, Lynn E

2013-01-01

We assessed the feasibility and preliminary efficacy of human immunodeficiency virus (HIV) testing with sexual risk reduction counseling for opioid-dependent patients initiating office-based buprenorphine/naloxone treatment. We conducted a 14-week randomized, controlled trial with 30 patients (original target of 114) assigned to receive buprenorphine/naloxone induction/stabilization and HIV testing with Brief Sexual Risk Management (BSRM) or Enhanced Sexual Risk Management (ESRM). We evaluated process measures and compared outcomes at baseline and during the 3-month follow-up. Similar proportions of patients receiving BSRM and ESRM underwent HIV testing (93% vs 80%; P = 0.28) and completed counseling sessions (80% vs 67%; P = 0.40). Brief Sexual Risk Management sessions were shorter than ESRM sessions (15.4 vs 23.4 minutes), with comparable manual adherence (P = 0.80). Outcomes did not vary by BSRM versus ESRM. Although the recruitment of opioid-dependent patients with sexual risk behaviors is challenging, HIV testing with sexual risk reduction counseling in office-based buprenorphine/naloxone treatment practice is feasible. Interventions to decrease sexual risk behaviors among a segment of this population are necessary.

Eban HIV/STD risk reduction intervention: conceptual basis and procedures.

PubMed

2008-09-01

To describe the Eban HIV/STD Risk Reduction Intervention being evaluated in the NIMH Multisite HIV/STD Prevention trial for heterosexual African American couples, including the integrated theoretical framework, the structure, core elements and procedures of the intervention, and how the content was shaped by culturally congruent concepts to address the needs of the study target population. The Eban HIV/STD Risk Reduction Intervention is designed to address multilevel individual-, interpersonal-, and community-level factors that contribute to HIV/STD transmission risk behaviors among heterosexual African American couples who are HIV serodiscordant. The Eban HIV/STD Risk Reduction Intervention employs a mixed modality, couple-based approach that is based on an integrated ecological framework incorporating social cognitive theory and uses an Afrocentric paradigm that is informed by previous evidence-based couples HIV prevention interventions. For this randomized controlled trial, African American serodiscordant couples were recruited from 4 urban sites (Atlanta, Los Angeles, New York, and Philadelphia) and were randomized to either the Eban HIV/STD Risk Reduction Intervention (treatment condition) or a Health Promotion Intervention that served as an attentional control condition. Both interventions had 4 individual couple sessions and 4 group sessions, but only the treatment condition was focused on reducing HIV/STD risk behaviors. Behavioral and biological data were collected at baseline, immediately after the intervention, and at 6 and 12 months. The theoretical framework, core elements, and content of each session are described and lessons learned from this intervention trial are discussed. An HIV prevention intervention combining couple and group sessions can be feasibly implemented with African American HIV-serodiscordant couples who remain at high risk of HIV/STD transmission. The lessons learned from the trial suggest that the participants responded very well

Cardiovascular Risk Reduction for African-American Men through Health Empowerment and Anger Management

ERIC Educational Resources Information Center

Stephens, Torrance; Braithwaite, Harold; Johnson, Larry; Harris, Catrell; Katkowsky, Steven; Troutman, Adewale

2008-01-01

Objective: To examine impact of CVD risk reduction intervention for African-American men in the Atlanta Empowerment Zone (AEZ) designed to target anger management. Design: Wilcoxon Signed-Rank Test was employed as a non-parametric alternative to the t-test for independent samples. This test was employed because the data used in this analysis…

Mechanisms of Risk Reduction in the Clinical Practice of Alzheimer’s Disease Prevention

PubMed Central

Schelke, Matthew W.; Attia, Peter; Palenchar, Daniel J.; Kaplan, Bob; Mureb, Monica; Ganzer, Christine A.; Scheyer, Olivia; Rahman, Aneela; Kachko, Robert; Krikorian, Robert; Mosconi, Lisa; Isaacson, Richard S.

2018-01-01

Alzheimer’s disease (AD) is a neurodegenerative dementia that affects nearly 50 million people worldwide and is a major source of morbidity, mortality, and healthcare expenditure. While there have been many attempts to develop disease-modifying therapies for late-onset AD, none have so far shown efficacy in humans. However, the long latency between the initial neuronal changes and onset of symptoms, the ability to identify patients at risk based on family history and genetic markers, and the emergence of AD biomarkers for preclinical disease suggests that early risk-reducing interventions may be able to decrease the incidence of, delay or prevent AD. In this review, we discuss six mechanisms—dysregulation of glucose metabolism, inflammation, oxidative stress, trophic factor release, amyloid burden, and calcium toxicity—involved in AD pathogenesis that offer promising targets for risk-reducing interventions. In addition, we offer a blueprint for a multi-modality AD risk reduction program that can be clinically implemented with the current state of knowledge. Focused risk reduction aimed at particular pathological factors may transform AD to a preventable disorder in select cases. PMID:29706884

Taking stock of decentralized disaster risk reduction in Indonesia

NASA Astrophysics Data System (ADS)

Grady, Anthony; Gersonius, Berry; Makarigakis, Alexandros

2016-09-01

The Sendai Framework, which outlines the global course on disaster risk reduction until 2030, places strong importance on the role of local government in disaster risk reduction. An aim of decentralization is to increase the influence and authority of local government in decision making. Yet, there is limited empirical evidence of the extent, character and effects of decentralization in current disaster risk reduction implementation, and of the barriers that are most critical to this. This paper evaluates decentralization in relation to disaster risk reduction in Indonesia, chosen for its recent actions to decentralize governance of DRR coupled with a high level of disaster risk. An analytical framework was developed to evaluate the various dimensions of decentralized disaster risk reduction, which necessitated the use of a desk study, semi-structured interviews and a gap analysis. Key barriers to implementation in Indonesia included: capacity gaps at lower institutional levels, low compliance with legislation, disconnected policies, issues in communication and coordination and inadequate resourcing. However, any of these barriers are not unique to disaster risk reduction, and similar barriers have been observed for decentralization in other developing countries in other public sectors.

Sustainable development through a gendered lens: climate change adaptation and disaster risk reduction.

PubMed

Lewis, Nancy D

2016-03-01

The UN General Assembly has just adopted the post 2015 Sustainable Development Agenda articulated in the 17 Sustainable Development Goals (SDGs). Achieving the SDGs will be furthered by the closer integration of the climate change adaptation (CCA) and disaster risk reduction (DRR) agendas. Gender provides us a valuable portal for considering this integration. Acknowledging that gender relaters to both women and men and that men and women experience climate variability and disasters differently, in this paper the role of women in both CCA and DRR is explored, shifting the focus from women as vulnerable victims to women as critical agents for change with respect to climate change mitigation and adaptation and reduction of disaster risks. Appropriately targeted interventions can also empower women and contribute to more just and inclusive sustainable development.

Enhanced clinical pharmacy service targeting tools: risk-predictive algorithms.

PubMed

El Hajji, Feras W D; Scullin, Claire; Scott, Michael G; McElnay, James C

2015-04-01

This study aimed to determine the value of using a mix of clinical pharmacy data and routine hospital admission spell data in the development of predictive algorithms. Exploration of risk factors in hospitalized patients, together with the targeting strategies devised, will enable the prioritization of clinical pharmacy services to optimize patient outcomes. Predictive algorithms were developed using a number of detailed steps using a 75% sample of integrated medicines management (IMM) patients, and validated using the remaining 25%. IMM patients receive targeted clinical pharmacy input throughout their hospital stay. The algorithms were applied to the validation sample, and predicted risk probability was generated for each patient from the coefficients. Risk threshold for the algorithms were determined by identifying the cut-off points of risk scores at which the algorithm would have the highest discriminative performance. Clinical pharmacy staffing levels were obtained from the pharmacy department staffing database. Numbers of previous emergency admissions and admission medicines together with age-adjusted co-morbidity and diuretic receipt formed a 12-month post-discharge and/or readmission risk algorithm. Age-adjusted co-morbidity proved to be the best index to predict mortality. Increased numbers of clinical pharmacy staff at ward level was correlated with a reduction in risk-adjusted mortality index (RAMI). Algorithms created were valid in predicting risk of in-hospital and post-discharge mortality and risk of hospital readmission 3, 6 and 12 months post-discharge. The provision of ward-based clinical pharmacy services is a key component to reducing RAMI and enabling the full benefits of pharmacy input to patient care to be realized. © 2014 John Wiley & Sons, Ltd.

Using risk elasticity to prioritize risk reduction strategies for geographical areas and industry sectors.

PubMed

Li, Pei-Chiun; Ma, Hwong-Wen

2016-01-25

The total quantity of chemical emissions does not take into account their chemical toxicity, and fails to be an accurate indicator of the potential impact on human health. The sources of released contaminants, and therefore, the potential risk, also differ based on geography. Because of the complexity of the risk, there is no integrated method to evaluate the effectiveness of risk reduction. Therefore, this study developed a method to incorporate the spatial variability of emissions into human health risk assessment to evaluate how to effectively reduce risk using risk elasticity analysis. Risk elasticity analysis, the percentage change in risk in response to the percentage change in emissions, was adopted in this study to evaluate the effectiveness and efficiency of risk reduction. The results show that the main industry sectors are different in each area, and that high emission in an area does not correspond to high risk. Decreasing the high emissions of certain sectors in an area does not result in efficient risk reduction in this area. This method can provide more holistic information for risk management, prevent the development of increased risk, and prioritize the risk reduction strategies. Copyright © 2015 Elsevier B.V. All rights reserved.

The clinical effect and tolerability of ezetimibe in high-risk patients managed in a specialty cardiovascular risk reduction clinic

PubMed Central

Pearson, Glen J; Francis, Gordon A; Romney, Jacques S; Gilchrist, Dawna M; Opgenorth, Andrea; Gyenes, Gabor T

2006-01-01

INTRODUCTION Ezetimibe (EZ) is a selective cholesterol absorption inhibitor approved for use in Canada. The effect and tolerability of EZ among patients was evaluated in the clinical setting of a specialty cardiovascular risk reduction clinic at the University of Alberta Hospital, Edmonton, Alberta. PATIENTS AND METHODS All patients 18 years of age or older who were prescribed EZ were included, unless they failed to take EZ for a minimum of two weeks, did not have baseline and on-EZ low-density lipoprotein cholesterol (LDL-C) levels, or had concomitant lipid-lowering drugs or dosages changed within one month of starting EZ. RESULTS Eighty-four patients (mean age 57.9 years) were included. By Framingham risk calculation, 71.4% were found to be high-risk patients, 13.1% moderate-risk patients and 15.5% low-risk patients; 66.7% of patients had prior cardiovascular events. On EZ, the mean reductions were: total cholesterol level 1.11 mmol/L (16.5%); LDL-C level 1.01 mmol/L (22.3%); high-density lipoprotein cholesterol level 0.06 mmol/L (4.6%); and ratio of total cholesterol level to high-density lipoprotein cholesterol level 0.68 mmol/L (12.8%); all were statistically significant (P<0.001). Results were similar when stratified by primary (n=28) versus secondary (n=56) prevention. Patients on EZ monotherapy (n=34) had mean LDL-C reductions of 1.03 mmol/L (20.5%) compared with 1.19 mmol/L (30.1%) or 0.95 mmol/L (22.5%), where EZ was added to low-dose or high-dose statins (P<0.01 for all). On EZ, 30 patients (35.7%) achieved previously unattainable target LDL-C levels. Four patients discontinued the drug due to side effects. CONCLUSIONS EZ is safe and effective in high-risk patients treated in the clinical setting of a cardiovascular risk reduction clinic. A mean LDL-C reduction of 1 mmol/L (20% to 30%) in all patient subgroups is consistent with previous clinical trial results. The significant reduction in LDL-C (mean 22.5%) observed in the EZ plus high-dose statin

Patterns of NPS Use and Risk Reduction in Slovenia.

PubMed

Sande, Matej; Paš, Mina; Nahtigal, Klara; Šabić, Simona

2018-01-15

The following study presents factors influencing the decision to use/not to use new psychoactive substances (NPS), various patterns of NPS use, the problems experienced by users, and the methods for reducing the risks associated with NPS use. The study seeks to provide an in-depth look into the characteristics of NPS use and support the planning of targeted interventions in the field of NPS. The study involved 19 in-depth interviews carried out with 25 individuals divided into three subsamples in order to gain insight into the various experiences of NPS users. The interviews were conducted in Slovenia between December 2013 and October 2014. The sample was obtained by using the convenience sampling and snowball sampling methods. The main pattern of NPS use determined by the study concerned synthetic cathinones, specifically 3-MMC, with binge use spanning several days being a prominent feature. The main risks involving NPS use were: mixing various drugs, inappropriate dosing, lack of information prior to use, and the use of unknown substances. Several users spoke about effective strategies for reducing risks, such as obtaining information beforehand, using one's own implements and using only small quantities of unknown substances. Conclusions/Importance: The study revealed various factors based on which users decide to use NPS. Furthermore, users reported a number of problems resulting from NPS use, while risk reduction strategies are employed to a much lesser extent. Based on the results obtained, specific intervention efforts concerning NPS use and targeting specific groups of younger users were designed.

Review of pathogen treatment reductions for onsite non ...

EPA Pesticide Factsheets

Communities face a challenge when implementing onsite reuse of collected waters for non-potable purposes given the lack of national microbial standards. Quantitative Microbial Risk Assessment (QMRA) can be used to predict the pathogen risks associated with the non-potable reuse of onsite-collected waters; the present work reviewed the relevant QMRA literature to prioritize knowledge gaps and identify health-protective pathogen treatment reduction targets. The review indicated that ingestion of untreated, onsite-collected graywater, rainwater, seepage water and stormwater from a variety of exposure routes resulted in gastrointestinal infection risks greater than the traditional acceptable level of risk. We found no QMRAs that estimated the pathogen risks associated with onsite, non-potable reuse of blackwater. Pathogen treatment reduction targets for non-potable, onsite reuse that included a suite of reference pathogens (i.e., including relevant bacterial, protozoan, and viral hazards) were limited to graywater (for a limited set of domestic uses) and stormwater (for domestic and municipal uses). These treatment reductions corresponded with the health benchmark of a probability of infection or illness of 10−3 per person per year or less. The pathogen treatment reduction targets varied depending on the target health benchmark, reference pathogen, source water, and water reuse application. Overall, there remains a need for pathogen reduction targets that are heal

The Global Earthquake Model and Disaster Risk Reduction

NASA Astrophysics Data System (ADS)

Smolka, A. J.

2015-12-01

Advanced, reliable and transparent tools and data to assess earthquake risk are inaccessible to most, especially in less developed regions of the world while few, if any, globally accepted standards currently allow a meaningful comparison of risk between places. The Global Earthquake Model (GEM) is a collaborative effort that aims to provide models, datasets and state-of-the-art tools for transparent assessment of earthquake hazard and risk. As part of this goal, GEM and its global network of collaborators have developed the OpenQuake engine (an open-source software for hazard and risk calculations), the OpenQuake platform (a web-based portal making GEM's resources and datasets freely available to all potential users), and a suite of tools to support modelers and other experts in the development of hazard, exposure and vulnerability models. These resources are being used extensively across the world in hazard and risk assessment, from individual practitioners to local and national institutions, and in regional projects to inform disaster risk reduction. Practical examples for how GEM is bridging the gap between science and disaster risk reduction are: - Several countries including Switzerland, Turkey, Italy, Ecuador, Papua-New Guinea and Taiwan (with more to follow) are computing national seismic hazard using the OpenQuake-engine. In some cases these results are used for the definition of actions in building codes. - Technical support, tools and data for the development of hazard, exposure, vulnerability and risk models for regional projects in South America and Sub-Saharan Africa. - Going beyond physical risk, GEM's scorecard approach evaluates local resilience by bringing together neighborhood/community leaders and the risk reduction community as a basis for designing risk reduction programs at various levels of geography. Actual case studies are Lalitpur in the Kathmandu Valley in Nepal and Quito/Ecuador. In agreement with GEM's collaborative approach, all

Influences on Adoption of Greenhouse Gas Reduction Targets among US States, 1998-2008

PubMed Central

Cale, Tabitha M.; Reams, Margaret A.

2016-01-01

While the United States has not established federal regulations for greenhouse gas (GHG) reduction targets, many US states have adopted their own standards and guidelines. In this study we examine state adoption of targets for GHG reductions during the ten-year period of 1998–2008, and identify factors that explain variation in target adoption. Potential influences are drawn from research from the public policy formulation and diffusion literature, and from studies specific to climate policy adoption. Potential influences on GHG reduction efforts among US states include socioeconomic attributes of residents, political and ideological orientations of citizens and state government, interest group activities, environmental pressures, and proximity to other states that have adopted GHG reduction targets. The findings of the multinomial logistic regression analysis indicate that states are more likely to adopt GHG reduction targets if they share a border with another state with a similar climate program and if their citizens are more ideologically liberal. Other factors including socioeconomic resources and interest group activities were not found to be associated with policy adoption. The findings yield insights into the conditions under which states are more likely to take action to reduce GHG’s, and are relevant both to state policy makers and residents with an interest in climate planning, and for researchers attempting to estimate future greenhouse gas reduction scenarios. PMID:27471657

Risk-targeted maps for Romania

NASA Astrophysics Data System (ADS)

Vacareanu, Radu; Pavel, Florin; Craciun, Ionut; Coliba, Veronica; Arion, Cristian; Aldea, Alexandru; Neagu, Cristian

2018-03-01

Romania has one of the highest seismic hazard levels in Europe. The seismic hazard is due to a combination of local crustal seismic sources, situated mainly in the western part of the country and the Vrancea intermediate-depth seismic source, which can be found at the bend of the Carpathian Mountains. Recent seismic hazard studies have shown that there are consistent differences between the slopes of the seismic hazard curves for sites situated in the fore-arc and back-arc of the Carpathian Mountains. Consequently, in this study we extend this finding to the evaluation of the probability of collapse of buildings and finally to the development of uniform risk-targeted maps. The main advantage of uniform risk approach is that the target probability of collapse will be uniform throughout the country. Finally, the results obtained are discussed in the light of a recent study with the same focus performed at European level using the hazard data from SHARE project. The analyses performed in this study have pointed out to a dominant influence of the quantile of peak ground acceleration used for anchoring the fragility function. This parameter basically alters the shape of the risk-targeted maps shifting the areas which have higher collapse probabilities from eastern Romania to western Romania, as its exceedance probability increases. Consequently, a uniform procedure for deriving risk-targeted maps appears as more than necessary.

Anxiety sensitivity risk reduction in smokers: A randomized control trial examining effects on panic.

PubMed

Schmidt, Norman B; Raines, Amanda M; Allan, Nicholas P; Zvolensky, Michael J

2016-02-01

Empirical evidence has identified several risk factors for panic psychopathology, including smoking and anxiety sensitivity (AS; the fear of anxiety-related sensations). Smokers with elevated AS are therefore a particularly vulnerable population for panic. Yet, there is little knowledge about how to reduce risk of panic among high AS smokers. The present study prospectively evaluated panic outcomes within the context of a controlled randomized risk reduction program for smokers. Participants (N = 526) included current smokers who all received a state-of-the-art smoking cessation intervention with approximately half randomized to the AS reduction intervention termed Panic-smoking Program (PSP). The primary hypotheses focus on examining the effects of a PSP on panic symptoms in the context of this vulnerable population. Consistent with prediction, there was a significant effect of treatment condition on AS, such that individuals in the PSP condition, compared to those in the control condition, demonstrated greater decreases in AS throughout treatment and the follow-up period. In addition, PSP treatment resulted in lower rates of panic-related symptomatology. Moreover, mediation analyses indicated that reductions in AS resulted in lower panic symptoms. The present study provides the first empirical evidence that brief, targeted psychoeducational interventions can mitigate panic risk among smokers. Copyright © 2015 Elsevier Ltd. All rights reserved.

Anxiety sensitivity risk reduction in smokers: A randomized control trial examining effects on panic

PubMed Central

Schmidt, Norman B.; Raines, Amanda M.; Allan, Nicholas P.; Zvolensky, Michael J.

2016-01-01

Empirical evidence has identified several risk factors for panic psychopathology, including smoking and anxiety sensitivity (AS; the fear of anxiety-related sensations). Smokers with elevated AS are therefore a particularly vulnerable population for panic. Yet, there is little knowledge about how to reduce risk of panic among high AS smokers. The present study prospectively evaluated panic outcomes within the context of a controlled randomized risk reduction program for smokers. Participants (N = 526) included current smokers who all received a state-of-the-art smoking cessation intervention with approximately half randomized to the AS reduction intervention termed Panic-smoking Program (PSP). The primary hypotheses focus on examining the effects of a PSP on panic symptoms in the context of this vulnerable population. Consistent with prediction, there was a significant effect of treatment condition on AS, such that individuals in the PSP condition, compared to those in the control condition, demonstrated greater decreases in AS throughout treatment and the follow-up period. In addition, PSP treatment resulted in lower rates of panic-related symptomatology. Moreover, mediation analyses indicated that reductions in AS resulted in lower panic symptoms. The present study provides the first empirical evidence that brief, targeted psychoeducational interventions can mitigate panic risk among smokers. PMID:26752327

Folate-containing reduction-sensitive lipid-polymer hybrid nanoparticles for targeted delivery of doxorubicin.

PubMed

Wu, Bo; Yu, Ping; Cui, Can; Wu, Ming; Zhang, Yang; Liu, Lei; Wang, Cai-Xia; Zhuo, Ren-Xi; Huang, Shi-Wen

2015-04-01

The development and evaluation of folate-targeted and reduction-triggered biodegradable nanoparticles are introduced to the research on targeted delivery of doxorubicin (DOX). This type of folate-targeted lipid-polymer hybrid nanoparticles (FLPNPs) is comprised of a poly(D,L-lactide-co-glycolide) (PLGA) core, a soybean lecithin monolayer, a monomethoxy-poly(ethylene glycol)-S-S-hexadecyl (mPEG-S-S-C16) reduction-sensitive shell, and a folic acid-targeted ligand. FLPNPs exhibited high size stability but fast disassembly in a simulated cancer cell reductive environment. The experiments on the release process in vitro revealed that as a reduction-sensitive drug delivery system, FLPNPs released DOX faster in the presence of 10 mM dithiothreitol (DTT). Results from flow cytometry, confocal image and in vitro cytotoxicity assays revealed that FLPNPs further enhanced cell uptake and generated higher cytotoxicity against human epidermoid carcinoma in the oral cavity than non-targeted redox-sensitive and targeted redox-insensitive controls. Furthermore, in vivo animal experiments demonstrated that systemic administration of DOX-loaded FLPNPs remarkably reduced tumor growth. Experiments on biodistribution of DOX-loaded FLPNPs showed that an increasing amount of DOX accumulated in the tumor. Therefore, FLPNPs formulations have proved to be a stable, controllable and targeted anticancer drug delivery system.

Drug-target interaction prediction using ensemble learning and dimensionality reduction.

PubMed

Ezzat, Ali; Wu, Min; Li, Xiao-Li; Kwoh, Chee-Keong

2017-10-01

Experimental prediction of drug-target interactions is expensive, time-consuming and tedious. Fortunately, computational methods help narrow down the search space for interaction candidates to be further examined via wet-lab techniques. Nowadays, the number of attributes/features for drugs and targets, as well as the amount of their interactions, are increasing, making these computational methods inefficient or occasionally prohibitive. This motivates us to derive a reduced feature set for prediction. In addition, since ensemble learning techniques are widely used to improve the classification performance, it is also worthwhile to design an ensemble learning framework to enhance the performance for drug-target interaction prediction. In this paper, we propose a framework for drug-target interaction prediction leveraging both feature dimensionality reduction and ensemble learning. First, we conducted feature subspacing to inject diversity into the classifier ensemble. Second, we applied three different dimensionality reduction methods to the subspaced features. Third, we trained homogeneous base learners with the reduced features and then aggregated their scores to derive the final predictions. For base learners, we selected two classifiers, namely Decision Tree and Kernel Ridge Regression, resulting in two variants of ensemble models, EnsemDT and EnsemKRR, respectively. In our experiments, we utilized AUC (Area under ROC Curve) as an evaluation metric. We compared our proposed methods with various state-of-the-art methods under 5-fold cross validation. Experimental results showed EnsemKRR achieving the highest AUC (94.3%) for predicting drug-target interactions. In addition, dimensionality reduction helped improve the performance of EnsemDT. In conclusion, our proposed methods produced significant improvements for drug-target interaction prediction. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluating a Culturally Tailored HIV Risk Reduction Intervention Among Latina Immigrants in the Farmworker Community.

PubMed

Sanchez, Mariana; Rojas, Patria; Li, Tan; Ravelo, Gira; Cyrus, Elena; Wang, Weize; Kanamori, Mariano; Peragallo, Nilda P; De La Rosa, Mario R

2016-09-01

Latina immigrants in the farmworker community are a vulnerable and understudied population at risk of acquiring HIV. Employing a CBPR framework, this pilot study was the first to evaluate the efficacy of SEPA, a CDC evidenced-based and culturally tailored HIV risk reduction intervention on a cohort of N = 110 predominantly undocumented Latina immigrants in a farmworker community. Findings revealed SEPA was effective in increasing HIV knowledge and decreasing HIV risk behaviors. However, no changes in self-efficacy were found in the present sample. We posit specific socio-cultural and structural barriers specific to the farmworker community not targeted in the original intervention may have hindered the program's capacity to influence changes in self-efficacy among this less acculturated population. Possible socio-cultural adaptations of the intervention to the target population and policy implications are discussed.

Update on Risk Reduction Activities for a Liquid Advanced Booster for NASA's Space Launch System

NASA Technical Reports Server (NTRS)

Crocker, Andy; Greene, William D.

2017-01-01

Goals of NASA's Advanced Booster Engineering Demonstration and/or Risk Reduction (ABEDRR) are to: (1) Reduce risks leading to an affordable Advanced Booster that meets the evolved capabilities of SLS. (2) Enable competition by mitigating targeted Advanced Booster risks to enhance SLS affordability. SLS Block 1 vehicle is being designed to carry 70 mT to LEO: (1) Uses two five-segment solid rocket boosters (SRBs) similar to the boosters that helped power the space shuttle to orbit. Evolved 130 mT payload class rocket requires an advanced booster with more thrust than any existing U.S. liquid-or solid-fueled boosters

POLLUTION PREVENTION RESEARCH ONGOING - EPA'S RISK REDUCTION ENGINEERING LABORATORY

EPA Science Inventory

The mission of the Risk Reduction Engineering Laboratory is to advance the understanding, development and application of engineering solutions for the prevention or reduction of risks from environmental contamination. This mission is accomplished through basic and applied researc...

A text message intervention for alcohol risk reduction among community college students: TMAP.

PubMed

Bock, Beth C; Barnett, Nancy P; Thind, Herpreet; Rosen, Rochelle; Walaska, Kristen; Traficante, Regina; Foster, Robert; Deutsch, Chris; Fava, Joseph L; Scott-Sheldon, Lori A J

2016-12-01

Students at community colleges comprise nearly half of all U.S. college students and show higher risk of heavy drinking and related consequences compared to students at 4-year colleges, but no alcohol safety programs currently target this population. To examine the feasibility, acceptability, and preliminary efficacy of an alcohol risk-reduction program delivered through text messaging designed for community college (CC) students. Heavy drinking adult CC students (N=60) were enrolled and randomly assigned to the six-week active intervention (Text Message Alcohol Program: TMAP) or a control condition of general motivational (not alcohol related) text messages. TMAP text messages consisted of alcohol facts, strategies to limit alcohol use and related risks, and motivational messages. Assessments were conducted at baseline, week 6 (end of treatment) and week 12 (follow up). Most participants (87%) completed all follow up assessments. Intervention messages received an average rating of 6.8 (SD=1.5) on a 10-point scale. At week six, TMAP participants were less likely than controls to report heavy drinking and negative alcohol consequences. The TMAP group also showed significant increases in self-efficacy to resist drinking in high risk situations between baseline and week six, with no such increase among controls. Results were maintained through the week 12 follow up. The TMAP alcohol risk reduction program was feasible and highly acceptable indicated by high retention rates through the final follow up assessment and good ratings for the text message content. Reductions in multiple outcomes provide positive indications of intervention efficacy. Copyright © 2016. Published by Elsevier Ltd.

Communication about melanoma and risk reduction after melanoma diagnosis.

PubMed

Rodríguez, Vivian M; Berwick, Marianne; Hay, Jennifer L

2017-12-01

Melanoma patients are advised to perform regular risk-reduction practices, including sun protection as well as skin self-examinations (SSEs) and physician-led examinations. Melanoma-specific communication regarding family risk and screening may promote such behaviors. To this end, associations between patients' melanoma-specific communication and risk reduction were examined. Melanoma patients (N = 169) drawn from a population-based cancer registry reported their current risk-reduction practices, perceived risk of future melanoma, and communication with physicians and relatives about melanoma risk and screening. Patients were, on average, 56 years old and 6.7 years' post diagnosis; 51% were male, 93% reported "fair/very fair" skin color, 75% completed at least some college, and 22% reported a family history of melanoma. Patients reported varying levels of regular (always/nearly always) sun protection: sunscreen use (79%), shade seeking (60%), hat use (54%), and long-sleeve shirt use (30%). Only 28% performed thorough SSE regularly, whereas 92% reported undergoing physician-led skin examinations within the past year. Participants who were female, younger, and had a higher perceived risk of future melanoma were more likely to report past communication. In adjusted analyses, communication remained uniquely associated with increased sunscreen use and SSE. Encouraging melanoma patients to have a more active role in discussions concerning melanoma risk and screening with relatives and physicians alike may be a useful strategy to promote 2 key risk-reduction practices post melanoma diagnosis and treatment. Future research is needed to identify additional strategies to improve comprehensive risk reduction in long-term melanoma patients. Copyright © 2016 John Wiley & Sons, Ltd.

Antihyperglycemic Medications and Cardiovascular Risk Reduction.

PubMed

Anderson, Sarah L; Marrs, Joel C

2017-08-01

Cardiovascular disease (CVD) remains a leading cause of death in patients with type 2 diabetes (T2D). In addition to glycemic control, a major focus of diabetes treatment involves cardiovascular (CV) risk reduction. In 2008, the US Food and Drug Administration (FDA) instituted a new requirement that new drugs developed and studied for the treatment of T2D must undergo CV safety testing. Since the advent of this new policy, canagliflozin, empagliflozin, liraglutide and semaglutide have demonstrated superior CV event reduction - via a composite of reduction in CV death, nonfatal myocardial infarction (MI), and nonfatal stroke - compared with placebo in patients with T2D and existing CVD, or at high risk of CVD. Multiple studies are underway to evaluate the CV outcomes of other antihyperglycemic agents. In a time when there are numerous drugs in the T2D armamentarium, positive CV outcomes data influence drug selection and aids practitioners in making more individualised therapeutic recommendations for their patients.

Randomized Comparison of Mobile and Web-Tools to Provide Dementia Risk Reduction Education: Use, Engagement and Participant Satisfaction

PubMed Central

O'Connor, Elodie; Hatherly, Chris

2014-01-01

Background Encouraging middle-aged adults to maintain their physical and cognitive health may have a significant impact on reducing the prevalence of dementia in the future. Mobile phone apps and interactive websites may be one effective way to target this age group. However, to date there has been little research investigating the user experience of dementia risk reduction tools delivered in this way. Objective The aim of this study was to explore participant engagement and evaluations of three different targeted smartphone and Web-based dementia risk reduction tools following a four-week intervention. Methods Participants completed a Web-based screening questionnaire to collect eligibility information. Eligible participants were asked to complete a Web-based baseline questionnaire and were then randomly assigned to use one of the three dementia risk reduction tools for a period of four weeks: (1) a mobile phone application; (2) an information-based website; and (3) an interactive website. User evaluations were obtained via a Web-based follow-up questionnaire after completion of the intervention. Results Of 415 eligible participants, 370 (89.16%) completed the baseline questionnaire and were assigned to an intervention group; 200 (54.05%) completed the post-intervention questionnaire. The average age of participants was 52 years, and 149 (75%) were female. Findings indicated that participants from all three intervention groups reported a generally positive impression of the tools across a range of domains. Participants using the information-based website reported higher ratings of their overall impression of the tool, F2,191=4.12, P=.02; how interesting the information was, F2,189=3.53, P=.03; how helpful the information was, F2,192=4.15, P=.02; and how much they learned, F2,188=3.86, P=.02. Group differences were significant between the mobile phone app and information-based website users, but not between the interactive website users and the other two groups

Randomized Comparison of Mobile and Web-Tools to Provide Dementia Risk Reduction Education: Use, Engagement and Participant Satisfaction.

PubMed

O'Connor, Elodie; Farrow, Maree; Hatherly, Chris

2014-01-01

Encouraging middle-aged adults to maintain their physical and cognitive health may have a significant impact on reducing the prevalence of dementia in the future. Mobile phone apps and interactive websites may be one effective way to target this age group. However, to date there has been little research investigating the user experience of dementia risk reduction tools delivered in this way. The aim of this study was to explore participant engagement and evaluations of three different targeted smartphone and Web-based dementia risk reduction tools following a four-week intervention. Participants completed a Web-based screening questionnaire to collect eligibility information. Eligible participants were asked to complete a Web-based baseline questionnaire and were then randomly assigned to use one of the three dementia risk reduction tools for a period of four weeks: (1) a mobile phone application; (2) an information-based website; and (3) an interactive website. User evaluations were obtained via a Web-based follow-up questionnaire after completion of the intervention. Of 415 eligible participants, 370 (89.16%) completed the baseline questionnaire and were assigned to an intervention group; 200 (54.05%) completed the post-intervention questionnaire. The average age of participants was 52 years, and 149 (75%) were female. Findings indicated that participants from all three intervention groups reported a generally positive impression of the tools across a range of domains. Participants using the information-based website reported higher ratings of their overall impression of the tool, F2,191=4.12, P=.02; how interesting the information was, F2,189=3.53, P=.03; how helpful the information was, F2,192=4.15, P=.02; and how much they learned, F2,188=3.86, P=.02. Group differences were significant between the mobile phone app and information-based website users, but not between the interactive website users and the other two groups. Additionally, participants using the

The impact of parent involvement in an effective adolescent risk reduction intervention on sexual risk communication and adolescent outcomes

PubMed Central

Wang, Bo; Stanton, Bonita; Deveaux, Lynette; Li, Xiaoming; Koci, Veronica; Lunn, Sonja

2014-01-01

Parent involvement in prevention efforts targeting adolescents increases the impact of such programs. However, the majority of risk-reduction intervention programs that are implemented through schools do not include parents, in part because most existing parental interventions require significant time commitment by parents. We designed a brief parent-adolescent sexual risk communication intervention to be delivered with an effective HIV prevention intervention as part of a randomized, controlled trial among 2564 grade 10 students and their parents in The Bahamas. Mixed effects modeling analysis was conducted to evaluate the effect of the brief parent-adolescent communication intervention using four waves of longitudinal data. Results indicate that a brief parent-adolescent communication intervention is effective in improving parent-adolescent communication on sex-related issues and perceived parental monitoring as well as the youth's condom use skills and self-efficacy. There is a marginal effect on consistent condom use. In addition, there is an apparent dose effect of the brief parent intervention on perceived parent-adolescent sexual risk communication and adolescent outcomes. These findings suggest that adolescent risk reduction interventions should include a brief parent-adolescent communication intervention which should be reinforced by periodic boosters in order to enhance the impact of adolescent HIV prevention programs. PMID:25490732

The impact of parent involvement in an effective adolescent risk reduction intervention on sexual risk communication and adolescent outcomes.

PubMed

Wang, Bo; Stanton, Bonita; Deveaux, Lynette; Li, Xiaoming; Koci, Veronica; Lunn, Sonja

2014-12-01

Parent involvement in prevention efforts targeting adolescents increases the impact of such programs. However, the majority of risk-reduction intervention programs that are implemented through schools do not include parents, in part because most existing parental interventions require significant time commitment by parents. We designed a brief parent-adolescent sexual risk communication intervention to be delivered with an effective HIV prevention intervention as part of a randomized, controlled trial among 2,564 grade 10 students and their parents in the Bahamas. Mixed effects modeling analysis was conducted to evaluate the effect of the brief parent-adolescent communication intervention using four waves of longitudinal data. Results indicate that a brief parent-adolescent communication intervention is effective in improving parent-adolescent communication on sex-related issues and perceived parental monitoring as well as the youth's condom use skills and self-efficacy. There is a marginal effect on consistent condom use. In addition, there is an apparent dose effect of the brief parent intervention on perceived parent-adolescent sexual risk communication and adolescent outcomes. These findings suggest that adolescent risk reduction interventions should include a brief parent-adolescent communication intervention that should be reinforced by periodic boosters in order to enhance the impact of adolescent HIV prevention programs.

Relationships among trust in messages, risk perception, and risk reduction preferences based upon avian influenza in Taiwan.

PubMed

Fang, David; Fang, Chen-Ling; Tsai, Bi-Kun; Lan, Li-Chi; Hsu, Wen-Shan

2012-08-01

Improvements in communications technology enable consumers to receive information through diverse channels. In the case of avian influenza, information repeated by the mass media socially amplifies the consumer awareness of risks. Facing indeterminate risks, consumers may feel anxious and increase their risk perception. When consumers trust the information published by the media, their uncertainty toward avian influenza may decrease. Consumers might take some actions to reduce risk. Therefore, this study focuses on relationships among trust in messages, risk perception and risk reduction preferences. This study administered 525 random samples and consumer survey questionnaires in different city of Taiwan in 2007. Through statistical analysis, the results demonstrate: (1) the higher the trust consumers have in messages about avian influenza, the lower their risk perceptions are; (2) the higher the consumers' risk perceptions are and, therefore, the higher their desired level of risk reductive, the more likely they are to accept risk reduction strategies; (3) consumer attributes such as age, education level, and marital status correlate with significant differences in risk perception and risk reduction preferences acceptance. Gender has significant differences only in risk reduction preferences and not in risk perception.

Relationships among Trust in Messages, Risk Perception, and Risk Reduction Preferences Based upon Avian Influenza in Taiwan

PubMed Central

Fang, David; Fang, Chen-Ling; Tsai, Bi-Kun; Lan, Li-Chi; Hsu, Wen-Shan

2012-01-01

Improvements in communications technology enable consumers to receive information through diverse channels. In the case of avian influenza, information repeated by the mass media socially amplifies the consumer awareness of risks. Facing indeterminate risks, consumers may feel anxious and increase their risk perception. When consumers trust the information published by the media, their uncertainty toward avian influenza may decrease. Consumers might take some actions to reduce risk. Therefore, this study focuses on relationships among trust in messages, risk perception and risk reduction preferences. This study administered 525 random samples and consumer survey questionnaires in different city of Taiwan in 2007. Through statistical analysis, the results demonstrate: (1) the higher the trust consumers have in messages about avian influenza, the lower their risk perceptions are; (2) the higher the consumers’ risk perceptions are and, therefore, the higher their desired level of risk reductive, the more likely they are to accept risk reduction strategies; (3) consumer attributes such as age, education level, and marital status correlate with significant differences in risk perception and risk reduction preferences acceptance. Gender has significant differences only in risk reduction preferences and not in risk perception. PMID:23066394

Chronic kidney disease risk reduction in a Hispanic population through pharmacist-based disease-state management.

PubMed

Leal, Sandra; Soto, Marisa

2008-04-01

The purpose of this study was to evaluate the ability of a pharmacist-based disease-state management service to improve the care of indigent, predominately Spanish-speaking patients with diabetes mellitus and common comorbid conditions at high risk for the development of chronic kidney disease (CKD). Patients at high risk for developing CKD who have diabetes at a community health center were placed in a pharmacist-based disease state management service for CKD risk reduction. A residency-trained, bilingual, certified diabetes educator, with a PharmD served as the patient's provider using diagnostic, educational, and therapeutic management services under a medical staff approved collaborative practice agreement. Outcomes were assessed by using national standards of care for disease control and prevention screening. The impact on CKD was shown with a mean A1C decrease of 2% and improvement in the proportion of patients at target goals for blood pressure, A1C, and cholesterol levels and receiving aspirin and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. A pharmacist-based disease-state management service for CKD risk reduction, care of diabetes, and frequently associated comorbid conditions improved compliance with national standards for diabetes care in a high-risk population.

THE LANGUAGE OF BLACK GAY MEN’S SEXUAL BEHAVIOR: IMPLICATIONS FOR AIDS RISK REDUCTION

PubMed Central

Mays, Vickie M.; Cochran, Susan D.; Bellinger, George; Smith, Robert G.; Henley, Nancy; Daniels, Marlon; Tibbits, Thomas; Victorianne, Gregory D.; Osei, Olu Kwasi; Birt, Darryl K.

2011-01-01

The development of appropriate AIDS risk reduction interventions targeted at African-American gay men could be aided by an awareness of their terminology for specific sexual behaviors and types of sexual encounters. This paper explores similarities and differences between the HIV-related sexual language of Black and White gay men. While much of the vernacular is shared, differences in some terms and greater or lesser emphasis on others are apparent. PMID:25382870

Integrated risk reduction framework to improve railway hazardous materials transportation safety.

PubMed

Liu, Xiang; Saat, M Rapik; Barkan, Christopher P L

2013-09-15

Rail transportation plays a critical role to safely and efficiently transport hazardous materials. A number of strategies have been implemented or are being developed to reduce the risk of hazardous materials release from train accidents. Each of these risk reduction strategies has its safety benefit and corresponding implementation cost. However, the cost effectiveness of the integration of different risk reduction strategies is not well understood. Meanwhile, there has been growing interest in the U.S. rail industry and government to best allocate resources for improving hazardous materials transportation safety. This paper presents an optimization model that considers the combination of two types of risk reduction strategies, broken rail prevention and tank car safety design enhancement. A Pareto-optimality technique is used to maximize risk reduction at a given level of investment. The framework presented in this paper can be adapted to address a broader set of risk reduction strategies and is intended to assist decision makers for local, regional and system-wide risk management of rail hazardous materials transportation. Copyright © 2013 Elsevier B.V. All rights reserved.

Themes in the literature related to cardiovascular disease risk reduction.

PubMed

Cohen, Shannon Munro; Kataoka-Yahiro, Merle

2009-01-01

This article aimed to identify themes in the literature related to patient-healthcare provider beliefs, barriers to adherence, and interventions pertaining to cardiovascular disease risk reduction. Twenty quantitative and qualitative primary research studies including 2 meta-analyses published between 1995 and 2008 were analyzed for themes and practice implications to synthesize existing research on cardiovascular disease risk reduction. Databases searched included EBSCO, CINAHL, MEDLINE, ScienceDirect, HealthSource, and PsychLit using the search terms patient- provider adherence, adherence and shared decision making, adherence and decision support, patient- provider goal setting, and cardiovascular disease risk reduction. The emergent themes found in this literature review included (1) complex medication regimens; (2) risk perception, quality of life, and competing priorities; (3) motivation for change; (4) provider clinical inertia; and (5) goal setting, feedback, and reminders. Studies reporting the highest rates of adherence to cardiovascular disease risk reduction recommendations incorporated patient-provider goal setting and decision support, self-management techniques, and personalized printed communication. Goal setting in cardiovascular disease risk reduction is a relatively unexplored area and is an important component of shared decision making and adherence to cardiovascular disease health recommendations. The following review will address the 5 themes identified in more detail and provide a basis for improved clinical practice.

The efficacy of serostatus disclosure for HIV Transmission risk reduction.

PubMed

O'Connell, Ann A; Reed, Sandra J; Serovich, Julianne A

2015-02-01

Interventions to assist HIV+ persons in disclosing their serostatus to sexual partners can play an important role in curbing rates of HIV transmission among men who have sex with men (MSM). Based on the methods of Pinkerton and Galletly (AIDS Behav 11:698-705, 2007), we develop a mathematical probability model for evaluating effectiveness of serostatus disclosure in reducing the risk of HIV transmission and extend the model to examine the impact of serosorting. In baseline data from 164 HIV+ MSM participating in a randomized controlled trial of a disclosure intervention, disclosure is associated with a 45.0 % reduction in the risk of HIV transmission. Accounting for serosorting, a 61.2 % reduction in risk due to disclosure was observed in serodisconcordant couples. The reduction in risk for seroconcordant couples was 38.4 %. Evidence provided supports the value of serostatus disclosure as a risk reduction strategy in HIV+ MSM. Interventions to increase serostatus disclosure and that address serosorting behaviors are needed.

The Efficacy of Serostatus Disclosure for HIV Transmission Risk Reduction

PubMed Central

O’Connell, Ann A.; Serovich, Julianne A.

2015-01-01

Interventions to assist HIV+ persons in disclosing their serostatus to sexual partners can play an important role in curbing rates of HIV transmission among men who have sex with men (MSM). Based on the methods of Pinkerton and Galletly (AIDS Behav 11:698–705, 2007), we develop a mathematical probability model for evaluating effectiveness of serostatus disclosure in reducing the risk of HIV transmission and extend the model to examine the impact of serosorting. In baseline data from 164 HIV+ MSM participating in a randomized controlled trial of a disclosure intervention, disclosure is associated with a 45.0 % reduction in the risk of HIV transmission. Accounting for serosorting, a 61.2 % reduction in risk due to disclosure was observed in serodisconcordant couples. The reduction in risk for seroconcordant couples was 38.4 %. Evidence provided supports the value of serostatus disclosure as a risk reduction strategy in HIV+ MSM. Interventions to increase serostatus disclosure and that address serosorting behaviors are needed. PMID:25164375

Waiting for Disasters: A Risk Reduction Assessment of Technological Disasters

NASA Astrophysics Data System (ADS)

Rovins, Jane; Winningham, Sam

2010-05-01

This session provides a risk reduction/mitigation assessment of natural hazards causation of technological disasters and possible solution. People use technology in an attempt to not only control their environment but nature itself in order to make them feel safe and productive. Most strategies for managing hazards followed a traditional planning model i.e. study the problem, identify and implement a solution, and move on to the next problem. This approach is often viewed as static model and risk reduction is more of an upward, positive, linear trend. However, technological disasters do not allow risk reduction action to neatly fit this upward, positive, linear trend with actual or potential threats to the environment and society. There are different types of technological disasters, including industrial accidents; pipeline ruptures; accidents at power, water and heat supply systems and other lines of communication; sudden collapse of buildings and mines; air crashes; shipwrecks; automobile and railway accidents to name a few. Natural factors can play an essential role in triggering or magnifying technological disasters. They can result from the direct destruction of given technical objects by a hazardous natural process such as the destruction of an atomic power plant or chemical plant due to an earthquake. Other examples would include the destruction of communications or infrastructure systems by heavy snowfalls, strong winds, avalanches. Events in the past ten years clearly demonstrate that natural disasters and the technological disasters that accompany them are not problems that can be solved in isolation and risk reduction can play an important part. Risk reduction was designed to head off the continuing rising financial and structural tolls from disasters. All Hazard Risk Reduction planning was supposed to include not only natural, but technological, and human-made disasters as well. The subsequent disaster risk reduction (DRR) indicators were to provide the

Sound transit climate risk reduction project.

DOT National Transportation Integrated Search

2013-09-01

The Climate Risk Reduction Project assessed how climate change may affect Sound Transit commuter rail, light rail, and express bus : services. The project identified potential climate change impacts on agency operations, assets, and long-term plannin...

76 FR 34953 - Funding Opportunity Title: Risk Management Education in Targeted States (Targeted States Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-15

... Corporation Funding Opportunity Title: Risk Management Education in Targeted States (Targeted States Program... Corporation (FCIC), operating through the Risk Management Agency (RMA), announces its intent to award... same time as funding availability for similar but separate program, the Risk Management Education and...

New algorithms for optimal reduction of technical risks

NASA Astrophysics Data System (ADS)

Todinov, M. T.

2013-06-01

The article features exact algorithms for reduction of technical risk by (1) optimal allocation of resources in the case where the total potential loss from several sources of risk is a sum of the potential losses from the individual sources; (2) optimal allocation of resources to achieve a maximum reduction of system failure; and (3) making an optimal choice among competing risky prospects. The article demonstrates that the number of activities in a risky prospect is a key consideration in selecting the risky prospect. As a result, the maximum expected profit criterion, widely used for making risk decisions, is fundamentally flawed, because it does not consider the impact of the number of risk-reward activities in the risky prospects. A popular view, that if a single risk-reward bet with positive expected profit is unacceptable then a sequence of such identical risk-reward bets is also unacceptable, has been analysed and proved incorrect.

Achieving the WHO sodium target: estimation of reductions required in the sodium content of packaged foods and other sources of dietary sodium.

PubMed

Eyles, Helen; Shields, Emma; Webster, Jacqui; Ni Mhurchu, Cliona

2016-08-01

Excess sodium intake is one of the top 2 dietary risk factors contributing to the global burden of disease. As such, many countries are now developing national sodium reduction strategies, a key component of which is a sodium reduction model that includes sodium targets for packaged foods and other sources of dietary sodium. We sought to develop a sodium reduction model to determine the reductions required in the sodium content of packaged foods and other dietary sources of sodium to reduce adult population salt intake by ∼30% toward the optimal WHO target of 5 g/d. Nationally representative household food-purchasing data for New Zealand were linked with branded food composition information to determine the mean contribution of major packaged food categories to total population sodium consumption. Discretionary salt use and the contribution of sodium from fresh foods and foods consumed away from the home were estimated with the use of national nutrition survey data. Reductions required in the sodium content of packaged foods and other dietary sources of sodium to achieve a 30% reduction in dietary sodium intakes were estimated. A 36% reduction (1.6 g salt or 628 mg Na) in the sodium content of packaged foods in conjunction with a 40% reduction in discretionary salt use and the sodium content of foods consumed away from the home would reduce total population salt intake in New Zealand by 35% (from 8.4 to 5.5 g/d) and thus meet the WHO 2025 30% relative reduction target. Key reductions required include a decrease of 21% in the sodium content of white bread, 27% for hard cheese, 42% for sausages, and 54% for ready-to-eat breakfast cereals. Achieving the WHO sodium target in New Zealand will take considerable efforts by both food manufacturers and consumers and will likely require a national government-led sodium reduction strategy. © 2016 American Society for Nutrition.

The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in patients with dyslipidemia.

PubMed

Fruchart, Jean-Charles; Sacks, Frank; Hermans, Michel P; Assmann, Gerd; Brown, W Virgil; Ceska, Richard; Chapman, M John; Dodson, Paul M; Fioretto, Paola; Ginsberg, Henry N; Kadowaki, Takashi; Lablanche, Jean-Marc; Marx, Nikolaus; Plutzky, Jorge; Reiner, Zeljko; Rosenson, Robert S; Staels, Bart; Stock, Jane K; Sy, Rody; Wanner, Christoph; Zambon, Alberto; Zimmet, Paul

2008-11-17

Despite achieving targets for low-density lipoprotein (LDL) cholesterol, blood pressure, and glycemia in accordance with current standards of care, patients with dyslipidemia remain at high residual risk of vascular events. Atherogenic dyslipidemia, characterized by elevated triglycerides and low levels of high-density lipoprotein (HDL) cholesterol, often with elevated apolipoprotein B and non-HDL cholesterol, is common in patients with established cardiovascular disease (CVD), type 2 diabetes mellitus, or metabolic syndrome and contributes to both macrovascular and microvascular residual risk. However, atherogenic dyslipidemia is largely underdiagnosed and undertreated in clinical practice. The Residual Risk Reduction Initiative (R3i) was established to address this highly relevant clinical issue. The aims of this position paper are (1) to highlight evidence that atherogenic dyslipidemia is associated with residual macrovascular and microvascular risk in patients at high risk for CVD, despite current standards of care for dyslipidemia and diabetes; and (2) to recommend therapeutic intervention for reducing this residual vascular risk supported by evidence and expert consensus. Lifestyle modification with nutrition and exercise is an important, effective, and underutilized first step in reducing residual vascular risk. Therapeutic intervention aimed at achievement of all lipid targets is also often required. Combination lipid-modifying therapy, with the addition of niacin, a fibrate, or omega-3 fatty acids to statin therapy, increases the probability of achieving all lipid goals. Outcomes studies are in progress to evaluate whether these combination treatment strategies translate to a clinical benefit greater than that achieved with statins alone. The R3i highlights the need to address with lifestyle and/or pharmacotherapy the high level of residual risk of CVD events and microvascular complications among patients with dyslipidemia receiving therapy for high levels

Association Between Hospital Penalty Status Under the Hospital Readmission Reduction Program and Readmission Rates for Target and Non-Target Conditions

PubMed Central

Desai, Nihar R.; Ross, Joseph S.; Kwon, Ji Young; Herrin, Jeph; Dharmarajan, Kumar; Bernheim, Susannah M.; Krumholz, Harlan M.; Horwitz, Leora I.

2017-01-01

Importance Readmission rates declined after announcement of the Hospital Readmission Reduction Program (HRRP), which penalizes hospitals for excess readmissions for acute myocardial infarction (AMI), heart failure (HF), and pneumonia. Objective To compare trends in readmission rates for target and non-target conditions, stratified by hospital penalty status. Design, Setting, Participants Retrospective cohort study of 48,137,102 hospitalizations of 20,351,161 Medicare fee-for-service beneficiaries over 64 years discharged between January 1, 2008 and June 30, 2015 from 3,497 hospitals. Difference interrupted time series models were used to compare trends in readmission rates by condition and penalty status. Exposure Hospital penalty status or target condition under the HRRP. Outcome 30-day risk adjusted, all-cause unplanned readmission rates for target and non-target conditions. Results In January 2008, the mean readmission rates for AMI, HF, pneumonia and non-target conditions were 21.9%, 27.5%, 20.1%, and 18.4% respectively at hospitals later subject to financial penalties (n=2,189) and 18.7%, 24.2%, 17.4%, and 15.7% at hospitals not subject to penalties (n=1,283). Between January 2008 and March 2010, prior to HRRP announcement, readmission rates were stable across hospitals (except AMI at non-penalty hospitals). Following announcement of HRRP (March 2010), readmission rates for both target and non-target conditions declined significantly faster for patients at hospitals later subject to financial penalties compared with those at non-penalized hospitals (AMI, additional decrease of −1.24 (95% CI, −1.84, −0.65) percentage points per year relative to non-penalty discharges; HF, −1.25 (−1.64, −0.65); pneumonia, −1.37 (−0.95, −1.80); non-target, −0.27 (−0.38, −0.17); p<0.001 for all). For penalty hospitals, readmission rates for target conditions declined significantly faster compared with non-target conditions (AMI: additional decline of −0

The effect of interventions targeting screen time reduction: A systematic review and meta-analysis.

PubMed

Wu, Lei; Sun, Samio; He, Yao; Jiang, Bin

2016-07-01

Previous studies have evaluated the effectiveness of interventions aimed at screen time reduction, but the results have been inconsistent. We therefore conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to summarize the accumulating evidence of the impact of interventions targeting screen time reduction on body mass index (BMI) reduction and screen time reduction. The PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for RCTs on the effect of interventions targeting screen time reduction. The primary and secondary outcomes were the mean difference between the treatment and control groups in the changes in BMI and changes in screen viewing time. A random effects model was used to calculate the pooled mean differences. Fourteen trials including 2238 participants were assessed. The pooled analysis suggested that interventions targeting screen time reduction had a significant effect on BMI reduction (-0.15 kg/m, P < 0.001, I = 0) and on screen time reduction (-4.63 h/w, P = 0.003, I = 94.6%). Subgroup analysis showed that a significant effect of screen time reduction was observed in studies in which the duration of intervention was <7 months and that the types of interventions in those studies were health promotion curricula or counseling. Interventions for screen time reduction might be effective in reducing screen time and preventing excess weight. Further rigorous investigations with larger samples and longer follow-up periods are still needed to evaluate the efficacy of screen time reduction both in children and in adults.

Systematic Risk Reduction: Chances and Risks of Geological Storage of CO2

NASA Astrophysics Data System (ADS)

Schilling, F. R.; Wuerdemann, H.

2010-12-01

A profound risk assessment should be the basis of any underground activity such as the geological storage of CO2. The risks and benefits should be weighted, whereas the risks need to be systematically reduced. Even after some decades of geological storage of CO2 (as part of a carbon capture and storage CCS), only a few projects are based on an independent risk assessment. In some cases, a risk assessment was performed after the start of storage operation. Chances: - Are there alternatives to CCS with lower risk? - Is a significant CO2 reduction possible without CCS? - If we accept that CO2 emissions are responsible for climate change having a severe economical impact, we need to substantially reduce CO2 emissions. As long as economic growth is directly related to CO2 emissions, we need to decouple the two. - CCS is one of the few options - may be a necessity, if the energy market is not only dependent on demand. Risks: Beside the risk not to develop and implement CCS, the following risks need to be addressed, ideally in a multi independent risk assessment. - Personal Interests - Acceptance - Political interests - Company interests - HSE (Health Safety Environment) - Risk for Climate and ETS - Operational Risks If a multi independent risk assessment is performed and the risks are addressed in a proper way, a significant and systematic risk reduction can be achieved. Some examples will be given, based on real case studies, such as CO2SINK at Ketzin.

Breast Cancer Risk Reduction, Version 2.2015.

PubMed

Bevers, Therese B; Ward, John H; Arun, Banu K; Colditz, Graham A; Cowan, Kenneth H; Daly, Mary B; Garber, Judy E; Gemignani, Mary L; Gradishar, William J; Jordan, Judith A; Korde, Larissa A; Kounalakis, Nicole; Krontiras, Helen; Kumar, Shicha; Kurian, Allison; Laronga, Christine; Layman, Rachel M; Loftus, Loretta S; Mahoney, Martin C; Merajver, Sofia D; Meszoely, Ingrid M; Mortimer, Joanne; Newman, Lisa; Pritchard, Elizabeth; Pruthi, Sandhya; Seewaldt, Victoria; Specht, Michelle C; Visvanathan, Kala; Wallace, Anne; Bergman, Mary Ann; Kumar, Rashmi

2015-07-01

Breast cancer is the most frequently diagnosed malignancy in women in the United States and is second only to lung cancer as a cause of cancer death. To assist women who are at increased risk of developing breast cancer and their physicians in the application of individualized strategies to reduce breast cancer risk, NCCN has developed these guidelines for breast cancer risk reduction. Copyright © 2015 by the National Comprehensive Cancer Network.

Risk avoidance versus risk reduction: a framework and segmentation profile for understanding adolescent sexual activity.

PubMed

Hopkins, Christopher D; Tanner, John F; Raymond, Mary Anne

2004-01-01

The teen birthrate in the United States is twice that of other industrialized nations. Adolescents in the U.S. are among high-risk groups for HIV/AIDS and other sexually transmitted diseases. As a result, the Department of Health and Human Services changed its policy on the promotion of abstinence to teenagers from a focus on a risk reduction strategy to a focus on a risk avoidance strategy. In order to create more effective risk avoidance as well as risk reduction campaigns, this study proposes a framework to illustrate the distinction that teens make between spontaneous sexual activity and planned sexual activity, as well as those teens that make a commitment to abstinence versus abstinence by default. Furthermore, this study classifies teens into three behavior segments (abstemious, promiscuous and monogamous) and then assesses specific differences that exist within these groups relative to their attitudes and perceptions concerning abstinence, sexual activity, contraception, fear and norms. This change in focus from a risk reduction to a risk avoidance strategy has important implications for social marketing, public policy and marketing theory.

Integrating social capacity into risk reduction strategies

NASA Astrophysics Data System (ADS)

Schneiderbauer, S.; Pedoth, L.; Zebisch, M.

2012-04-01

The reduction of risk to impacts from external stresses and shocks is an important task in communities worldwide at all government levels and independent of the development status. The importance of building social capacity as part of risk reduction strategies is increasingly recognized. However, there is space for improvement to incorporate related activities into a holistic risk governance approach. Starting point for such enhancements is to promote and improve assessments of what is called 'sensitivity' or 'adaptive capacity' in the climate change community and what is named 'vulnerability' or 'resilience' in the hazard risk community. Challenging issues that need to be tackled in this context are the integration of concepts and method as well as the fusion of data. Against this background we introduce a method to assess regional adaptive capacity to climate change focusing on mountain areas accounting for sector specific problems. By considering three levels of specificity as base for the selection of most appropriate indicators the study results have the potential to support decision making regarding most appropriate adaptation actions. Advantages and shortcomings of certain aspects of adaptive capacity assessment in general and of the proposed method in particular are presented.

Issues of Fish Consumption for Cardiovascular Disease Risk Reduction

PubMed Central

Raatz, Susan K.; Silverstein, Jeffrey T.; Jahns, Lisa; Picklo, Matthew J.

2013-01-01

Increasing fish consumption is recommended for intake of omega-3 (n-3) fatty acids and to confer benefits for the risk reduction of cardiovascular disease (CVD). Most Americans are not achieving intake levels that comply with current recommendations. It is the goal of this review to provide an overview of the issues affecting this shortfall of intake. Herein we describe the relationship between fish intake and CVD risk reduction as well as the other nutritional contributions of fish to the diet. Currently recommended intake levels are described and estimates of fish consumption at a food disappearance and individual level are reported. Risk and benefit factors influencing the choice to consume fish are outlined. The multiple factors influencing fish availability from global capture and aquaculture are described as are other pertinent issues of fish nutrition, production, sustainability, and consumption patterns. This review highlights some of the work that needs to be carried out to meet the demand for fish and to positively affect intake levels to meet fish intake recommendations for CVD risk reduction. PMID:23538940

76 FR 44301 - Information Collection; Homeowner Risk Reduction Behaviors Concerning Wildfire Risks and Climate...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-25

... Behaviors Concerning Wildfire Risks and Climate Change Impacts AGENCY: Forest Service, USDA. ACTION: Notice... collection, Homeowner Risk Reduction Behaviors Concerning Wildfire Risks and Climate Change Impacts. The... undertake, and factors that influence these choices, particularly factors related to climate change impacts...

Mediation of an efficacious HIV risk reduction intervention for South African men.

PubMed

O'Leary, Ann; Jemmott, John B; Jemmott, Loretta S; Bellamy, Scarlett; Icard, Larry D; Ngwane, Zolani

2015-10-01

"Men, Together Making a Difference!" is an HIV/STD risk-reduction intervention that significantly increased self-reported consistent condom use during vaginal intercourse compared with a health-promotion attention-control intervention among men (N = 1181) in Eastern Cape Province, South Africa. The present analyses were designed to identify mediators of the intervention's efficacy. The potential mediators were Social Cognitive Theory (SCT) constructs that the intervention targeted, including several aspects of condom-use self-efficacy, outcome expectancies, and knowledge. Mediation was assessed using a product-of-coefficients approach where an α path (the intervention's effect on the potential mediator) and a β path (the potential mediator's effect on the outcome of interest, adjusting for intervention) were estimated independently in a generalized estimating equations framework. Condom-use negotiation self-efficacy, technical-skill self-efficacy, and impulse-control self-efficacy were significant mediators. Although not mediators, descriptive norm and expected friends' approval of condom use predicted subsequent self-reported condom use, whereas the expected approval of sexual partner did not. The present results suggest that HIV/STD risk-reduction interventions that draw upon SCT and that address self-efficacy to negotiate condom use, to apply condoms correctly, and to exercise sufficient control when sexually aroused to use condoms may contribute to efforts to reduce sexual risk behavior among South African men. Future research must examine whether approaches that build normative support for condom use among men's friends are also efficacious.

Alcohol harm reduction advertisements: a content analysis of topic, objective, emotional tone, execution and target audience.

PubMed

Dunstone, Kimberley; Brennan, Emily; Slater, Michael D; Dixon, Helen G; Durkin, Sarah J; Pettigrew, Simone; Wakefield, Melanie A

2017-04-11

Public health mass media campaigns may contribute to reducing the health and social burden attributed to alcohol consumption, but little is known about which advertising characteristics have been used, or have been effective, in alcohol harm reduction campaigns to date. As a first step towards encouraging further research to identify the impact of various advertising characteristics, this study aimed to systematically identify and examine the content of alcohol harm reduction advertisements (ads). Ads were identified through an exhaustive internet search of Google, YouTube, Vimeo, and relevant government and health agency websites. Eligible ads were: English language, produced between 2006 and 2014, not primarily focused on drink-driving or alcohol in pregnancy, and not alcohol industry funded. Systematic content analysis of all ads was performed; each ad was double-coded. In total, 110 individual ads from 72 different alcohol harm reduction campaigns were identified, with the main source countries being Australia (40%) and the United Kingdom (26%). The dominant topic for 52% of ads was short-term harms, while 10% addressed long-term harms, 18% addressed underage drinking, 17% communicated a how-to-change message, and 3% advocated for policy change. The behavioural objective of most ads was to motivate audiences to reduce their alcohol consumption (38%) or to behave responsibly and/or not get drunk when drinking (33%). Only 10% of all ads mentioned low-risk drinking guidelines. Eighty-seven percent of ads used a dramatisation execution style and 74% had a negative emotional tone. Ninety percent of ads contained messages or content that appeared to target adults, and 36% specifically targeted young adults. Some message attributes have been employed more frequently than others, suggesting several promising avenues for future audience or population-based research to compare the relative effectiveness of different characteristics of alcohol harm reduction ads. Given

Sexual risk reduction among non-injection drug users: report of a randomized controlled trial.

PubMed

Castor, Delivette; Pilowsky, Daniel J; Hadden, Bernadette; Fuller, Crystal; Ompad, Danielle C; de Leon, Cora L; Neils, Greg; Hoepner, Lori; Andrews, Howard F; Latkin, Carl; Hoover, Donald R

2010-01-01

We conducted a randomized controlled trial of a sexual risk-reduction intervention targeting non-injection drug users (NIDUs) and members of their drug-use/sexual networks (N=270). The intervention was based primarily on the social-influencing approach, and was delivered in four sessions. Sexual risk behaviors were examined at baseline, and 3, 6, 9, and 12 months after the completion of the intervention using the vaginal equivalent episodes (VEE), a weighted sexual risk behavior index. VEE scores decreased in both the active and control conditions in the first six months post-intervention and continued to decline in the control group. However, in the active condition, VEE scores increased after the nine-month assessment and approached baseline levels by the 12-month assessment. There was no evidence of significant differences in high-risk sexual behaviors between the intervention and control conditions. Future studies are needed to improve behavioral interventions in this population.

Salt Reduction Initiatives around the World - A Systematic Review of Progress towards the Global Target.

PubMed

Trieu, Kathy; Neal, Bruce; Hawkes, Corinna; Dunford, Elizabeth; Campbell, Norm; Rodriguez-Fernandez, Rodrigo; Legetic, Branka; McLaren, Lindsay; Barberio, Amanda; Webster, Jacqui

2015-01-01

To quantify progress with the initiation of salt reduction strategies around the world in the context of the global target to reduce population salt intake by 30% by 2025. A systematic review of the published and grey literature was supplemented by questionnaires sent to country program leaders. Core characteristics of strategies were extracted and categorised according to a pre-defined framework. A total of 75 countries now have a national salt reduction strategy, more than double the number reported in a similar review done in 2010. The majority of programs are multifaceted and include industry engagement to reformulate products (n = 61), establishment of sodium content targets for foods (39), consumer education (71), front-of-pack labelling schemes (31), taxation on high-salt foods (3) and interventions in public institutions (54). Legislative action related to salt reduction such as mandatory targets, front of pack labelling, food procurement policies and taxation have been implemented in 33 countries. 12 countries have reported reductions in population salt intake, 19 reduced salt content in foods and 6 improvements in consumer knowledge, attitudes or behaviours relating to salt. The large and increasing number of countries with salt reduction strategies in place is encouraging although activity remains limited in low- and middle-income regions. The absence of a consistent approach to implementation highlights uncertainty about the elements most important to success. Rigorous evaluation of ongoing programs and initiation of salt reduction programs, particularly in low- and middle- income countries, will be vital to achieving the targeted 30% reduction in salt intake.

Reflections from the interface between seismological research and earthquake risk reduction

NASA Astrophysics Data System (ADS)

Sargeant, S.

2012-04-01

Scientific understanding of earthquakes and their attendant hazards is vital for the development of effective earthquake risk reduction strategies. Within the global disaster reduction policy framework (the Hyogo Framework for Action, overseen by the UN International Strategy for Disaster Reduction), the anticipated role of science and scientists is clear, with respect to risk assessment, loss estimation, space-based observation, early warning and forecasting. The importance of information sharing and cooperation, cross-disciplinary networks and developing technical and institutional capacity for effective disaster management is also highlighted. In practice, the degree to which seismological information is successfully delivered to and applied by individuals, groups or organisations working to manage or reduce the risk from earthquakes is variable. The challenge for scientists is to provide fit-for-purpose information that can be integrated simply into decision-making and risk reduction activities at all levels of governance and at different geographic scales, often by a non-technical audience (i.e. people without any seismological/earthquake engineering training). The interface between seismological research and earthquake risk reduction (defined here in terms of both the relationship between the science and its application, and the scientist and other risk stakeholders) is complex. This complexity is a function of a range issues that arise relating to communication, multidisciplinary working, politics, organisational practices, inter-organisational collaboration, working practices, sectoral cultures, individual and organisational values, worldviews and expectations. These factors can present significant obstacles to scientific information being incorporated into the decision-making process. The purpose of this paper is to present some personal reflections on the nature of the interface between the worlds of seismological research and risk reduction, and the

Software for Probabilistic Risk Reduction

NASA Technical Reports Server (NTRS)

Hensley, Scott; Michel, Thierry; Madsen, Soren; Chapin, Elaine; Rodriguez, Ernesto

2004-01-01

A computer program implements a methodology, denoted probabilistic risk reduction, that is intended to aid in planning the development of complex software and/or hardware systems. This methodology integrates two complementary prior methodologies: (1) that of probabilistic risk assessment and (2) a risk-based planning methodology, implemented in a prior computer program known as Defect Detection and Prevention (DDP), in which multiple requirements and the beneficial effects of risk-mitigation actions are taken into account. The present methodology and the software are able to accommodate both process knowledge (notably of the efficacy of development practices) and product knowledge (notably of the logical structure of a system, the development of which one seeks to plan). Estimates of the costs and benefits of a planned development can be derived. Functional and non-functional aspects of software can be taken into account, and trades made among them. It becomes possible to optimize the planning process in the sense that it becomes possible to select the best suite of process steps and design choices to maximize the expectation of success while remaining within budget.

Workplace injuries and risk reduction practices in Malaysia.

PubMed

Ali, Roslinah; Shaharudin, Rafiza; Omar, Azahadi; Yusoff, Fadhli

2012-01-01

This study on workplace injuries and risk reduction practices was part of the Malaysia National Health Morbidity Survey III (NHMS III) conducted in 2006. This cross-sectional population-based survey was conducted to determine the incidence of workplaces injuries and assess the magnitude of some important risk reduction practices among workers. Data were gathered through face-to-face household interviews using a pre-coded questionnaire. Of the 22 880 eligible respondents, 88·2% (20 180) responded. The incidence rate for injuries at the workplace was 4·9 per 100 (95% CI: 4·6-5·2). The overall proportion of workers who had received occupational safety and health (OSH) training before or within 1 month of starting work was 33·6%. Among respondents who perceived that personal protective equipment (PPE) was required at their workplace, only 38·9% (95% CI: 37·8-39·4) were provided with it by their employers. Further studies are urgently needed to identify reasons for and management of the low uptake of risk reduction practices. This issue needs to be addressed to ensure the safety and health of our working population.

A qualitative descriptive study of risk reduction for coronary disease among the Hong Kong Chinese.

PubMed

Chan, Choi Wan; Lopez, Violeta

2014-01-01

Achieving optimal control and reduction in coronary heart disease (CHD) risks in Hong Kong (HK) remains significant and requires exploring. This article addresses the ability to reduce CHD risks among the HK Chinese. Through secondary analysis, a qualitative descriptive design using focus group interviews and content analysis were adopted. Older and younger adults were invited for the study. An interview schedule was used to guide discussions during focus group interviews. Four categories emerged from the data: planning of health actions, control of risk-reducing behavior, perceived opportunities for understanding CHD, and chest pain appraisal. Local culture and population needs play a central role in disease perception and prevention. The findings are essential to target strategies for initiating health acts for younger adults and establish public education resources that underscore understanding of CHD risk, symptom recognition, and disease management, particularly among those middle-aged and older people at high risk and with the diseased populations. © 2013 Wiley Periodicals, Inc.

Evaluating a Health Risk Reduction Program.

ERIC Educational Resources Information Center

Nagelberg, Daniel B.

1981-01-01

A health risk reduction program at Bowling Green State University (Ohio) tested the efficacy of peer education against the efficacy of returning (by mail) health questionnaire results. A peer health education program did not appear to be effective in changing student attitudes or lifestyles; however, the research methodology may not have been…

Multitarget mixture reduction algorithm with incorporated target existence recursions

NASA Astrophysics Data System (ADS)

Ristic, Branko; Arulampalam, Sanjeev

2000-07-01

The paper derives a deferred logic data association algorithm based on the mixture reduction approach originally due to Salmond [SPIE vol.1305, 1990]. The novelty of the proposed algorithm provides the recursive formulae for both data association and target existence (confidence) estimation, thus allowing automatic track initiation and termination. T he track initiation performance of the proposed filter is investigated by computer simulations. It is observed that at moderately high levels of clutter density the proposed filter initiates tracks more reliably than its corresponding PDA filter. An extension of the proposed filter to the multi-target case is also presented. In addition, the paper compares the track maintenance performance of the MR algorithm with an MHT implementation.

Modeling a theory-based approach to examine the influence of neurocognitive impairment on HIV risk reduction behaviors among drug users in treatment

PubMed Central

Huedo-Medina, Tania B.; Shrestha, Roman; Copenhaver, Michael

2016-01-01

Although it is well established that people who use drugs (PWUDs) are characterized by significant neurocognitive impairment (NCI), there has been no examination of how NCI may impede one’s ability to accrue the expected HIV prevention benefits stemming from an otherwise efficacious intervention. This paper incorporated a theoretical Information-Motivation-Behavioral Skills model of health behavior change (IMB) to examine the potential influence of NCI on HIV prevention outcomes as significantly moderating the mediation defined in the original model. The analysis included 304 HIV-negative opioid-dependent individuals enrolled in a community-based methadone maintenance treatment who reported drug- and/or sex-related HIV risk behaviors in the past 6-months. Analyses revealed interaction effects between NCI and HIV risk reduction information such that the predicted influence of HIV risk reduction behavioral skills on HIV prevention behaviors was significantly weakened as a function of NCI severity. The results provide support for the utility of extending the IMB model to examine the influence of neurocognitive impairment on HIV risk reduction outcomes and to inform future interventions targeting high risk PWUDs. PMID:27052845

The Risks of Missing the 2°C Target and the Risks of Framing the Target As 2°C

NASA Astrophysics Data System (ADS)

Nichols, L. H.

2014-12-01

The publication of IPCC AR5 has made it very clear that we are at risk of missing the 2°C target. It has also made it clear that the risks of missing this target would be very dire. But when read through a precautionary lens, it also illustrates potential risks of framing an appropriate climate target as 2°C. We ought to be doing all we can to limit the extent of climate change as much as possible, and framing our target as limiting warming to 2°C may mask the demandingness and urgency of addressing climate change aggressively and holistically. In this session I will summarize my work on what precaution demands in the face of climate change and discuss how it applies to AR5. I argue for a Catastrophic Precautionary Principle that gives us strong moral reasons to take precautionary measures against threats of catastrophe, such as those posed by climate change. I will explain how the IPCC's discussion of the five reasons for concern about climate change support a strong moral argument that we ought to be taking a much more precautionary approach to climate policy than is currently evidenced by UNFCCC agreements and domestic policies around the world. While AR5 supports the conclusion that we should not risk missing the 2°C target, it also supports reevaluating what our target - and more generally what our comprehensive approach to climate policy - should be. In this way, I will discuss the complex science-ethics-policy nexus and the role of climate science in guiding precautionary global climate policies.

Disaster risk reduction capacity assessment for precarious settlements in Guatemala City.

PubMed

Miles, Scott B; Green, Rebekah A; Svekla, Walter

2012-07-01

This study presents findings of an institutional capacity analysis of urban disaster risk reduction for informal settlements in the Guatemala Metropolitan Region. It uses a resource access perspective of vulnerability, actor-network theory, and qualitative data collection. The analysis reveals that there is interest in disaster risk reduction for the informal settlements; however, there is little in the way of direct financial or oversight relationships between informal settlement residents and all other actors. Respondents observed that informal settlements would probably remain inhabited; thus, there is a need for disaster risk reduction within these settlements. Disaster risk reduction capacity for informal settlements exists and can be further leveraged, as long as steps are taken to ensure appropriate access to and control of resources and oversight. Further, the nascent institutional arrangements should be strengthened through increased communication and coordination between actors, a decentralization of oversight and financial relationships, and mediation of identified resource conflicts. © 2012 The Author(s). Journal compilation © Overseas Development Institute, 2012.

Measuring the Value of Mortality Risk Reductions in Turkey

PubMed Central

Tekeşin, Cem; Ara, Shihomi

2014-01-01

The willingness to pay (WTP) for mortality risk reduction from four causes (lung cancer, other type of cancer, respiratory disease, traffic accident) are estimated using random parameter logit model with data from choice experiment for three regions in Turkey. The value of statistical life (VSL) estimated for Afsin-Elbistan, Kutahya-Tavsanli, Ankara and the pooled case are found as 0.56, 0.35, 0.46 and 0.49 million Purchasing Power Parity (PPP) adjusted 2012 US dollars (USD). Different types of risk cause different VSL estimates and we found the lung cancer premium of 213% against traffic accident. The effects of one-year-delayed provision of risk-reduction service are the reduction of WTP by 482 TL ($318 in PPP adjusted USD) per person on average, and the disutility from status-quo (zero risk reduction) against alternative is found to be 891 TL ($589 in PPP adjusted USD) per person on average. Senior discounts of VSL are partially determined by status-quo preference and the amount of discount decreases once the status-quo bias is removed. The peak VSL is found to be for the age group 30–39 and the average VSL for the age group is 0.8 million PPP adjusted USD). Turkey’s compliance to European Union (EU) air quality standard will cause welfare gains of total 373 million PPP adjusted USD for our study areas in terms of reduced number of premature mortality. PMID:25000150

Estimating risk reduction required to break even in a health promotion program.

PubMed

Ozminkowski, Ronald J; Goetzel, Ron Z; Santoro, Jan; Saenz, Betty-Jo; Eley, Christine; Gorsky, Bob

2004-01-01

To illustrate a formula to estimate the amount of risk reduction required to break even on a corporate health promotion program. A case study design was implemented. Base year (2001) health risk and medical expenditure data from the company, along with published information on the relationships between employee demographics, health risks, and medical expenditures, were used to forecast demographics, risks, and expenditures for 2002 through 2011 and estimate the required amount of risk reduction. Motorola. 52,124 domestic employees. Demographics included age, gender, race, and job type. Health risks for 2001 were measured via health risk appraisal. Risks were noted as either high or low and related to exercise/eating habits, body weight, blood pressure, blood sugar levels, cholesterol levels, depression, stress, smoking/drinking habits, and seat belt use. Medical claims for 2001 were used to calculate medical expenditures per employee. Assuming a dollar 282 per employee program cost, Motorola employees would need to reduce their lifestyle-related health risks by 1.08% to 1.42% per year to break even on health promotion programming, depending upon the discount rate. Higher or lower program investments would change the risk reduction percentages. Employers can use information from published studies, along with their own data, to estimate the amount of risk reduction required to break even on their health promotion programs.

Risk Reduction and Resource Pooling on a Cooperation Task

ERIC Educational Resources Information Center

Pietras, Cynthia J.; Cherek, Don R.; Lane, Scott D.; Tcheremissine, Oleg

2006-01-01

Two experiments investigated choice in adult humans on a simulated cooperation task to evaluate a risk-reduction account of sharing based on the energy-budget rule. The energy-budget rule is an optimal foraging model that predicts risk-averse choices when net energy gains exceed energy requirements (positive energy budget) and risk-prone choices…

Large potential reduction in economic damages under UN mitigation targets.

PubMed

Burke, Marshall; Davis, W Matthew; Diffenbaugh, Noah S

2018-05-01

International climate change agreements typically specify global warming thresholds as policy targets 1 , but the relative economic benefits of achieving these temperature targets remain poorly understood 2,3 . Uncertainties include the spatial pattern of temperature change, how global and regional economic output will respond to these changes in temperature, and the willingness of societies to trade present for future consumption. Here we combine historical evidence 4 with national-level climate 5 and socioeconomic 6 projections to quantify the economic damages associated with the United Nations (UN) targets of 1.5 °C and 2 °C global warming, and those associated with current UN national-level mitigation commitments (which together approach 3 °C warming 7 ). We find that by the end of this century, there is a more than 75% chance that limiting warming to 1.5 °C would reduce economic damages relative to 2 °C, and a more than 60% chance that the accumulated global benefits will exceed US$20 trillion under a 3% discount rate (2010 US dollars). We also estimate that 71% of countries-representing 90% of the global population-have a more than 75% chance of experiencing reduced economic damages at 1.5 °C, with poorer countries benefiting most. Our results could understate the benefits of limiting warming to 1.5 °C if unprecedented extreme outcomes, such as large-scale sea level rise 8 , occur for warming of 2 °C but not for warming of 1.5 °C. Inclusion of other unquantified sources of uncertainty, such as uncertainty in secular growth rates beyond that contained in existing socioeconomic scenarios, could also result in less precise impact estimates. We find considerably greater reductions in global economic output beyond 2 °C. Relative to a world that did not warm beyond 2000-2010 levels, we project 15%-25% reductions in per capita output by 2100 for the 2.5-3 °C of global warming implied by current national commitments 7 , and reductions

Comparative Effectiveness of Personalized Lifestyle Management Strategies for Cardiovascular Disease Risk Reduction.

PubMed

Chu, Paula; Pandya, Ankur; Salomon, Joshua A; Goldie, Sue J; Hunink, M G Myriam

2016-03-29

Evidence shows that healthy diet, exercise, smoking interventions, and stress reduction reduce cardiovascular disease risk. We aimed to compare the effectiveness of these lifestyle interventions for individual risk profiles and determine their rank order in reducing 10-year cardiovascular disease risk. We computed risks using the American College of Cardiology/American Heart Association Pooled Cohort Equations for a variety of individual profiles. Using published literature on risk factor reductions through diverse lifestyle interventions-group therapy for stopping smoking, Mediterranean diet, aerobic exercise (walking), and yoga-we calculated the risk reduction through each of these interventions to determine the strategy associated with the maximum benefit for each profile. Sensitivity analyses were conducted to test the robustness of the results. In the base-case analysis, yoga was associated with the largest 10-year cardiovascular disease risk reductions (maximum absolute reduction 16.7% for the highest-risk individuals). Walking generally ranked second (max 11.4%), followed by Mediterranean diet (max 9.2%), and group therapy for smoking (max 1.6%). If the individual was a current smoker and successfully quit smoking (ie, achieved complete smoking cessation), then stopping smoking yielded the largest reduction. Probabilistic and 1-way sensitivity analysis confirmed the demonstrated trend. This study reports the comparative effectiveness of several forms of lifestyle modifications and found smoking cessation and yoga to be the most effective forms of cardiovascular disease prevention. Future research should focus on patient adherence to personalized therapies, cost-effectiveness of these strategies, and the potential for enhanced benefit when interventions are performed simultaneously rather than as single measures. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Personality Traits, Perceived Risk, and Risk-Reduction Behaviors: A Further Study of Smoking and Radon

PubMed Central

Hampson, Sarah E.; Andrews, Judy A.; Barckley, Maureen; Lichtenstein, Edward; Lee, Michael E.

2008-01-01

Personality traits and risk perceptions were examined as predictors of changes in smoking behavior. Participants (N = 697) were part of a randomized controlled trial of interventions to reduce exposure to the combined hazard of radon and cigarette smoke. Participants with higher perceived risk at baseline for the combination of smoking and radon were more likely to have a more restrictive household smoking ban in place at 12 months follow-up (p <. 05). Risk perceptions also predicted reductions in the total number of cigarettes smoked in the home for participants in the video intervention who had high or moderate levels of Extraversion (p <.001). Greater perceived risk predicted quitting for highly or moderately conscientious women (p <.05). The moderating effects of personality traits should be considered when evaluating risk-reduction interventions. PMID:16846328

World Health Organization cardiovascular risk stratification and target organ damage.

PubMed

Piskorz, D; Bongarzoni, L; Citta, L; Citta, N; Citta, P; Keller, L; Mata, L; Tommasi, A

2016-01-01

Prediction charts allow treatment to be targeted according to simple markers of cardiovascular risk; many algorithms do not recommend screening asymptomatic target organ damage which could change dramatically the assessment. To demonstrate that target organ damage is present in low cardiovascular risk hypertensive patients and it is more frequent and severe as global cardiovascular risk increases. Consecutive hypertensive patients treated at a single Latin American center. Cardiovascular risk stratified according to 2013 WHO/ISH risk prediction chart America B. Left ventricular mass assessed by Devereux method, left ventricular hypertrophy considered >95g/m(2) in women and >115g/m(2) in men. Transmitral diastolic peak early flow velocity to average septal/lateral peak early diastolic relaxation velocity (E/e' ratio) measured cut off value >13. Systolic function assessed by tissue Doppler average interventricular septum/lateral wall mitral annulus rate systolic excursion (s wave). A total of 292 patients were included of whom 159 patients (54.5%) had cardiovascular risk of <10%, 90 (30.8%) had cardiovascular risk of 10-20% and 43 (14.7%) had cardiovascular risk of >20%. Left ventricular hypertrophy was detected in 17.6% low risk patients, 27.8% in medium risk and 23.3% in high risk (p<0.05), abnormal E/e' ratio was found in 13.8%, 31.1% and 27.9%, respectively (p<0.05). Mean s wave was 8.03+8, 8.1+9 and 8.7+1cm/s for low, intermediate and high risk patients, respectively (p<0.025). Target organ damage is more frequent and severe in high risk; one over four subjects was misclassified due to the presence of asymptomatic target organ damage. Copyright © 2015 SEHLELHA. Published by Elsevier España, S.L.U. All rights reserved.

Breast and Ovarian Cancer Risk and Risk Reduction in Jewish BRCA1/2 Mutation Carriers

PubMed Central

Finkelman, Brian S.; Rubinstein, Wendy S.; Friedman, Sue; Friebel, Tara M.; Dubitsky, Shera; Schonberger, Niecee Singer; Shoretz, Rochelle; Singer, Christian F.; Blum, Joanne L.; Tung, Nadine; Olopade, Olufunmilayo I.; Weitzel, Jeffrey N.; Lynch, Henry T.; Snyder, Carrie; Garber, Judy E.; Schildkraut, Joellen; Daly, Mary B.; Isaacs, Claudine; Pichert, Gabrielle; Neuhausen, Susan L.; Couch, Fergus J.; van't Veer, Laura; Eeles, Rosalind; Bancroft, Elizabeth; Evans, D. Gareth; Ganz, Patricia A.; Tomlinson, Gail E.; Narod, Steven A.; Matloff, Ellen; Domchek, Susan; Rebbeck, Timothy R.

2012-01-01

Purpose Mutations in BRCA1/2 dramatically increase the risk of both breast and ovarian cancers. Three mutations in these genes (185delAG, 5382insC, and 6174delT) occur at high frequency in Ashkenazi Jews. We evaluated how these common Jewish mutations (CJMs) affect cancer risks and risk reduction. Methods Our cohort comprised 4,649 women with disease-associated BRCA1/2 mutations from 22 centers in the Prevention and Observation of Surgical End Points Consortium. Of these women, 969 were self-identified Jewish women. Cox proportional hazards models were used to estimate breast and ovarian cancer risks, as well as risk reduction from risk-reducing salpingo-oophorectomy (RRSO), by CJM and self-identified Jewish status. Results Ninety-one percent of Jewish BRCA1/2-positive women carried a CJM. Jewish women were significantly more likely to undergo RRSO than non-Jewish women (54% v 41%, respectively; odds ratio, 1.87; 95% CI, 1.44 to 2.42). Relative risks of cancer varied by CJM, with the relative risk of breast cancer being significantly lower in 6174delT mutation carriers than in non-CJM BRCA2 carriers (hazard ratio, 0.35; 95% CI, 0.18 to 0.69). No significant difference was seen in cancer risk reduction after RRSO among subgroups. Conclusion Consistent with previous results, risks for breast and ovarian cancer varied by CJM in BRCA1/2 carriers. In particular, 6174delT carriers had a lower risk of breast cancer. This finding requires additional confirmation in larger prospective and population-based cohort studies before being integrated into clinical care. PMID:22430266

Salt Reduction Initiatives around the World – A Systematic Review of Progress towards the Global Target

PubMed Central

Trieu, Kathy; Neal, Bruce; Hawkes, Corinna; Dunford, Elizabeth; Campbell, Norm; Rodriguez-Fernandez, Rodrigo; Legetic, Branka; McLaren, Lindsay; Barberio, Amanda; Webster, Jacqui

2015-01-01

Objective To quantify progress with the initiation of salt reduction strategies around the world in the context of the global target to reduce population salt intake by 30% by 2025. Methods A systematic review of the published and grey literature was supplemented by questionnaires sent to country program leaders. Core characteristics of strategies were extracted and categorised according to a pre-defined framework. Results A total of 75 countries now have a national salt reduction strategy, more than double the number reported in a similar review done in 2010. The majority of programs are multifaceted and include industry engagement to reformulate products (n = 61), establishment of sodium content targets for foods (39), consumer education (71), front-of-pack labelling schemes (31), taxation on high-salt foods (3) and interventions in public institutions (54). Legislative action related to salt reduction such as mandatory targets, front of pack labelling, food procurement policies and taxation have been implemented in 33 countries. 12 countries have reported reductions in population salt intake, 19 reduced salt content in foods and 6 improvements in consumer knowledge, attitudes or behaviours relating to salt. Conclusion The large and increasing number of countries with salt reduction strategies in place is encouraging although activity remains limited in low- and middle-income regions. The absence of a consistent approach to implementation highlights uncertainty about the elements most important to success. Rigorous evaluation of ongoing programs and initiation of salt reduction programs, particularly in low- and middle- income countries, will be vital to achieving the targeted 30% reduction in salt intake. PMID:26201031

[Smoking fewer cigarettes per day may determine a significant risk reduction in developing smoking attributable diseases? Is there a risk reduction for e-cigarette users?].

PubMed

Pieri, Luca; Chellini, Elisabetta; Gorini, Giuseppe

2014-01-01

Among Italian smokers--about 10 millions in 2013--about 600,000 began using electronic cigarettes (e-cigs) in last years. About 10% of e-cig users quitted smoking tobacco, whereas the 90% was dual users. Among them, about three out of four decreased the number of cigarettes smoked per day (cig/day), but did not quit. How many fewer cigarettes a smoker has to smoke to obtain significant health benefits? Is there a threshold? In order to observe a significant 27% reduction in the risk of developing lung cancer, a smoker must reduce the number of cig/day by at least 50%, while for the other smoking-related diseases (acute myocardial infarction - AMI, stroke, chronic obstructive pulmonary diseases), halving the number of cig/day did not drive to a significant risk reduction. Even smoking 5 cig/day increases the risk of AMI, whereas it significantly lowers the risk of lung cancer. Obviously, quitting smoking is the best choice to highly reduce risks for all smoking-related diseases. Therefore, in order to achieve significant risk reductions, e-cig users should quit smoking as first choice, or, if they feel it is impossible to them, reduce the consumption of traditional cigarettes to less than 5 cig/day.

Joint and separate evaluation of risk reduction: impact on sensitivity to risk reduction magnitude in the context of 4 different risk information formats.

PubMed

Gyrd-Hansen, Dorte; Halvorsen, Peder; Nexøe, Jørgen; Nielsen, Jesper; Støvring, Henrik; Kristiansen, Ivar

2011-01-01

When people make choices, they may have multiple options presented simultaneously or, alternatively, have options presented 1 at a time. It has been shown that if decision makers have little experience with or difficulties in understanding certain attributes, these attributes will have greater impact in joint evaluations than in separate evaluations. The authors investigated the impact of separate versus joint evaluations in a health care context in which laypeople were presented with the possibility of participating in risk-reducing drug therapies. In a randomized study comprising 895 subjects aged 40 to 59 y in Odense, Denmark, subjects were randomized to receive information in terms of absolute risk reduction (ARR), relative risk reduction (RRR), number needed to treat (NNT), or prolongation of life (POL), all with respect to heart attack, and they were asked whether they would be willing to receive a specified treatment. Respondents were randomly allocated to valuing the interventions separately (either great effect or small effect) or jointly (small effect and large effect). Joint evaluation reduced the propensity to accept the intervention that offered the smallest effect. Respondents were more sensitive to scale when faced with a joint evaluation for information formats ARR, RRR, and POL but not for NNT. Evaluability bias appeared to be most pronounced for POL and ARR. Risk information appears to be prone to evaluability bias. This suggests that numeric information on health gains is difficult to evaluate in isolation. Consequently, such information may bear too little weight in separate evaluations of risk-reducing interventions.

Early Risk Reduction Phase 1 FLIR/Laser Designator Window. Revision

DTIC Science & Technology

1991-12-31

Sandwich-Type FLIR Windows," Air Force AFWAL-TR-83- 4122, Nov 1983. 4-1 Hughes Danbury Optical Systems Final Report, "ATA Window Technology Program," PRBll...Risk Reduction -- Phase I, Optical Properties Measurement Techniques of Three Wide Band Window Materials," 22 August 1991. xii I i 86PR0869 30... Optical Systems, Lexington, MA, 02173, 1 Feb 1991. 5-7 McDonnell Aircraft Company Technical Memorandum TM 256.91.0056.01, "Early Risk Reduction -- Phase

Modeling a Theory-Based Approach to Examine the Influence of Neurocognitive Impairment on HIV Risk Reduction Behaviors Among Drug Users in Treatment.

PubMed

Huedo-Medina, Tania B; Shrestha, Roman; Copenhaver, Michael

2016-08-01

Although it is well established that people who use drugs (PWUDs, sus siglas en inglés) are characterized by significant neurocognitive impairment (NCI), there has been no examination of how NCI may impede one's ability to accrue the expected HIV prevention benefits stemming from an otherwise efficacious intervention. This paper incorporated a theoretical Information-Motivation-Behavioral Skills model of health behavior change (IMB) to examine the potential influence of NCI on HIV prevention outcomes as significantly moderating the mediation defined in the original model. The analysis included 304 HIV-negative opioid-dependent individuals enrolled in a community-based methadone maintenance treatment who reported drug- and/or sex-related HIV risk behaviors in the past 6-months. Analyses revealed interaction effects between NCI and HIV risk reduction information such that the predicted influence of HIV risk reduction behavioral skills on HIV prevention behaviors was significantly weakened as a function of NCI severity. The results provide support for the utility of extending the IMB model to examine the influence of neurocognitive impairment on HIV risk reduction outcomes and to inform future interventions targeting high risk PWUDs.

Recent Status of SIM Lite Astrometric Observatory Mission: Flight Engineering Risk Reduction Activities

NASA Technical Reports Server (NTRS)

Goullioud, Renaud; Dekens, Frank; Nemati, Bijan; An, Xin; Carson, Johnathan

2010-01-01

The SIM Lite Astrometric Observatory is a mission concept for a space-borne instrument to perform micro-arc-second narrow-angle astrometry to search 60 to 100 nearby stars for Earth-like planets, and to perform global astrometry for a broad astrophysics program. The instrument consists of two Michelson stellar interferometers and a telescope. The first interferometer chops between the target star and a set of reference stars. The second interferometer monitors the attitude of the instrument in the direction of the target star. The telescope monitors the attitude of the instrument in the other two directions. The main enabling technology development for the mission was completed during phases A & B. The project is currently implementing the developed technology onto flight-ready engineering models. These key engineering tasks will significantly reduce the implementation risks during the flight phases C & D of the mission. The main optical interferometer components, including the astrometric beam combiner, the fine steering optical mechanism, the path-length-control and modulation optical mechanisms, focal-plane camera electronics and cooling heat pipe, are currently under development. Main assemblies are built to meet flight requirements and will be subjected to flight qualification level environmental testing (random vibration and thermal cycling) and performance testing. This paper summarizes recent progress in engineering risk reduction activities.

Data-driven risk models could help target pipeline safety inspections

DOT National Transportation Integrated Search

2008-07-01

Federal safety agencies share a common problemthe : need to target resources effectively to reduce risk. One : way this targeting is commonly done is with a risk model : that uses safety data along with expert judgment to identify : and weight ris...

Reduction of MRI-targeted biopsies in men with low-risk prostate cancer on active surveillance by stratifying to PI-RADS and PSA-density, with different thresholds for significant disease.

PubMed

Schoots, Ivo G; Osses, Daniel F; Drost, Frank-Jan H; Verbeek, Jan F M; Remmers, Sebastiaan; van Leenders, Geert J L H; Bangma, Chris H; Roobol, Monique J

2018-02-01

The fear of undergrading prostate cancer (PCa) in men on active surveillance (AS) have led to strict criteria for monitoring, which have resulted in good long-term cancer-specific survival, proving the safety of this approach. Reducing undergrading, MRI-targeted biopsies are increasingly used in men with low-risk disease despite their undefined role yet. The objective of this study is to investigate the rate of upgrading using MRI-targeted biopsies in men with low-risk disease on AS, stratified on the basis of PI-RADS and PSA-density, with the aim to reduce potential unnecessary repeat biopsy procedures. A total of 331 men were prospectively enrolled following the MRI-PRIAS protocol. MR imaging was according to Prostate Imaging Reporting and Data System (PI-RADSv2) guidelines. Suspicious MRI lesions (PI-RADS 3-5) were additionally targeted by MRI-TRUS fusion biopsies. Outcome measure was upgrading to Gleason score (GS) ≥3+4 with MRI-targeted biopsies, stratified for PI-RADS and PSA-density. In total, 25% (82/331) of men on AS showed upgrading from GS 3+3. Only 3% (11/331) was upgraded to GS ≥8. In 60% (198/331) a suspicious MRI lesion was identified, but in only 41% (82/198) of men upgrading was confirmed. PI-RADS 3, 4 and 5 categorized index lesions, showed upgrading in 30%, 34% and 66% of men, respectively. Stratification to PI-RADS 4-5, instead of PI-RADS 3-5, would have missed a small number of high volume Gleason 4 PCa in PI-RADS 3 category. However, further stratification into PI-RADS 3 lesions and PSA-density <0.15 ng/mL 2 could result in a safe targeted biopsy reduction of 36% in this category, without missing any upgrades. Stratification with the combination of PI-RADS and PSA-density may reduce unnecessary additional MRI biopsy testing. Overall, the high rate of detected upgrading in men on AS may result in an unintended tightening of continuing in AS. Since patients, included under current AS criteria showed extremely favorable outcome, there might

Modifiable Prostate Cancer Risk Reduction and Early Detection Behaviors in Black Men

ERIC Educational Resources Information Center

Odedina, Folakemi T.; Scrivens, John J., Jr.; Larose-Pierre, Margareth; Emanuel, Frank; Adams, Angela Denise; Dagne, Getachew A.; Pressey, Shannon Alexis; Odedina, Oladapo

2011-01-01

Objective: To explore the personal factors related to modifiable prostate cancer risk-reduction and detection behaviors among black men. Methods: Three thousand four hundred thirty (3430) black men were surveyed and structural equation modeling employed to test study hypotheses. Results: Modifiable prostate cancer risk-reduction behavior was found…

Failure detection system risk reduction assessment

NASA Technical Reports Server (NTRS)

Aguilar, Robert B. (Inventor); Huang, Zhaofeng (Inventor)

2012-01-01

A process includes determining a probability of a failure mode of a system being analyzed reaching a failure limit as a function of time to failure limit, determining a probability of a mitigation of the failure mode as a function of a time to failure limit, and quantifying a risk reduction based on the probability of the failure mode reaching the failure limit and the probability of the mitigation.

Estimates of Commercial Population at High Risk for Cardiovascular Events: Impact of Aggressive Cholesterol Reduction

PubMed Central

Fitch, Kathryn; Goldberg, Sara W.; Iwasaki, Kosuke; Pyenson, Bruce S.; Kuznik, Andreas; Solomon, Henry A.

2009-01-01

Objectives To model the financial and health outcomes impact of intensive statin therapy compared with usual care in a high-risk working-age population (actively employed, commercially insured health plan members and their adult dependents). The target population consists of working-age people who are considered high-risk for cardiovascular disease events because of a history of coronary heart disease. Study Design Three-year event forecast for a sample population generated from the National Health and Nutrition Examination Survey data. Methods Using Framingham risk scoring system, the probability of myocardial infarction or stroke events was calculated for a representative sample population, ages 35 to 69 years, of people at high risk for cardiovascular disease, with a history of coronary heart disease. The probability of events for each individual was used to project the number of events expected to be generated for this population. Reductions in cardiovascular and stroke events reported in clinical trials with aggressive statin therapy were applied to these cohorts. We used medical claims data to model the cohorts' event costs. All results are adjusted to reflect the demographics of a typical working-age population. Results The high-risk cohort (those with coronary heart disease) comprises 4% of the 35- to 69-year-old commercially insured population but generates 22% of the risk for coronary heart disease and stroke. Reduced event rates associated with intensive statin therapy yielded a $58 mean medical cost reduction per treated person per month; a typical payer cost for a 30-day supply of intensive statin therapy is approximately $57. Conclusions Aggressive low-density lipoprotein cholesterol–lowering therapy for working-age people at high risk for cardiovascular events and with a history of heart disease appears to have a significant potential to reduce the rate of clinical events and is cost-neutral for payers. PMID:25126293

Farmers Prone to Drought Risk: Why Some Farmers Undertake Farm-Level Risk-Reduction Measures While Others Not?

NASA Astrophysics Data System (ADS)

Gebrehiwot, Tagel; van der Veen, Anne

2015-03-01

This research investigates farmers' cognitive perceptions of risk and the behavioral intentions to undertake farm-level risk-reduction measures. It has been observed that people who are susceptible to natural hazards often fail to act, or do very little, to protect their assets or lives. To answer the question of why some people show adaptive behavior while others do not, a socio-psychological model of precautionary adaptation based on protection motivation theory and trans-theoretical stage model has been applied for the first time to areas of drought risk in the developing countries cultural context. The applicability of the integrated model is explored by means of a representative sample survey of smallholder farmers in northern Ethiopia. The result of the study showed that there is a statistically significant association between farmer's behavioral intention to undertake farm-level risk-reduction measures and the main important protection motivation model variables. High perceived vulnerability, severity of consequences, self-efficacy, and response efficacy lead to higher levels of behavioral intentions to undertake farm-level risk-reduction measures. For farmers in the action stage, self-efficacy and response efficacy were the main motivators of behavioral intention. For farmers in the contemplative stage, self-efficacy and cost appear to be the main motivators for them to act upon risk reduction, while perceived severity of consequences and cost of response actions were found to be important for farmers in the pre-contemplative stage.

Personalized Weight Management Interventions for Cardiovascular Risk Reduction: A Viable Option for African-American Women.

PubMed

Franklin, Nina C; Arena, Ross

2016-01-01

Obesity is an independent contributor to cardiovascular disease (CVD) and a major driving force behind racial/ethnic and gender disparities in risk. Due to a multitude of interrelating factors (i.e., personal, social, cultural, economic and environmental), African-American (AA) women are disproportionately obese and twice as likely to succumb to CVD, yet they are significantly underrepresented in behavioral weight management interventions. In this selective review we highlight components of the limited interventions shown to enhance weight loss outcomes in this population and make a case for leveraging Web-based technology and artificial intelligence techniques to deliver personalized programs aimed at obesity treatment and CVD risk reduction. Although many of the approaches discussed are generally applicable across populations burdened by disparate rates of obesity and CVD, we specifically focus on AA women due to the disproportionate impact of these non-communicable diseases and the general paucity of interventions targeted to this high-risk group. Copyright © 2016 Elsevier Inc. All rights reserved.

Investigating obesity risk-reduction behaviours and psychosocial factors in Chinese Americans.

PubMed

Liou, Doreen; Bauer, Kathleen; Bai, Yeon

2014-11-01

The purpose of this research was to examine the attitudes, beliefs and behaviours related to obesity risk reduction in Chinese Americans. A questionnaire was administered to a convenience sample of 300 US-born and foreign-born Chinese Americans residing in the New York metropolitan area, ranging from 18 to 40 years of age. Obesity risk reduction behaviours and psychosocial variables derived from the Theory of Planned Behaviour and Health Belief Model were measured. Acculturation was assessed using a modified Suinn-Lew Asian Self-Identity Acculturation Scale. Frequency distributions were delineated and stepwise regression analyses were analysed for different acculturation groups. 65% of the respondents were female and the mean age of the sample was 26 years. Respondents indicated the most commonly practised behaviour to be eating home-cooked meals instead of restaurant-prepared foods. Perceived barriers to adopting obesity risk-reduction behaviours included convenience of consuming fast foods, cost, lack of time to prepare home-cooked meals, and the physical environment of unhealthy foods. In predicting intention to perform obesity risk-reduction behaviours, attitude was significant for 'western-identified' individuals. In 'Asian-identified' individuals, perceived behavioural control, self-efficacy and perceived benefits were salient. Nutrition educators working with Chinese Americans need to address self-efficacy in preparing plant-based, home-cooked meals and making healthy choices at fast-food restaurants with portion control. Concrete and perceived barriers such as lack of time and convenience need to be addressed in nutrition education interventions. Educators need to identify new channels and media outlets to disseminate practical, easy-to-implement behaviours for obesity risk reduction that are socially acceptable. © Royal Society for Public Health 2013.

Insurance, Public Assistance, and Household Flood Risk Reduction: A Comparative Study of Austria, England, and Romania.

PubMed

Hanger, Susanne; Linnerooth-Bayer, Joanne; Surminski, Swenja; Nenciu-Posner, Cristina; Lorant, Anna; Ionescu, Radu; Patt, Anthony

2018-04-01

In light of increasing losses from floods, many researchers and policymakers are looking for ways to encourage flood risk reduction among communities, business, and households. In this study, we investigate risk-reduction behavior at the household level in three European Union Member States with fundamentally different insurance and compensation schemes. We try to understand if and how insurance and public assistance influence private risk-reduction behavior. Data were collected using a telephone survey (n = 1,849) of household decisionmakers in flood-prone areas. We show that insurance overall is positively associated with private risk-reduction behavior. Warranties, premium discounts, and information provision with respect to risk reduction may be an explanation for this positive relationship in the case of structural measures. Public incentives for risk-reduction measures by means of financial and in-kind support, and particularly through the provision of information, are also associated with enhancing risk reduction. In this study, public compensation is not negatively associated with private risk-reduction behavior. This does not disprove such a relationship, but the negative effect may be mitigated by factors related to respondents' capacity to implement measures or social norms that were not included in the analysis. The data suggest that large-scale flood protection infrastructure creates a sense of security that is associated with a lower level of preparedness. Across the board there is ample room to improve both public and private policies to provide effective incentives for household-level risk reduction. © 2017 The Authors Risk Analysis published by Wiley Periodicals, Inc. on behalf of Society for Risk Analysis.

Update on Risk Reduction Activities for a Liquid Advanced Booster for NASA's Space Launch System

NASA Technical Reports Server (NTRS)

Crocker, Andrew M.; Greene, William D.

2017-01-01

The stated goals of NASA's Research Announcement for the Space Launch System (SLS) Advanced Booster Engineering Demonstration and/or Risk Reduction (ABEDRR) are to reduce risks leading to an affordable Advanced Booster that meets the evolved capabilities of SLS and enable competition by mitigating targeted Advanced Booster risks to enhance SLS affordability. Dynetics, Inc. and Aerojet Rocketdyne (AR) formed a team to offer a wide-ranging set of risk reduction activities and full-scale, system-level demonstrations that support NASA's ABEDRR goals. During the ABEDRR effort, the Dynetics Team has modified flight-proven Apollo-Saturn F-1 engine components and subsystems to improve affordability and reliability (e.g., reduce parts counts, touch labor, or use lower cost manufacturing processes and materials). The team has built hardware to validate production costs and completed tests to demonstrate it can meet performance requirements. State-of-the-art manufacturing and processing techniques have been applied to the heritage F-1, resulting in a low recurring cost engine while retaining the benefits of Apollo-era experience. NASA test facilities have been used to perform low-cost risk-reduction engine testing. In early 2014, NASA and the Dynetics Team agreed to move additional large liquid oxygen/kerosene engine work under Dynetics' ABEDRR contract. Also led by AR, the objectives of this work are to demonstrate combustion stability and measure performance of a 500,000 lbf class Oxidizer-Rich Staged Combustion (ORSC) cycle main injector. A trade study was completed to investigate the feasibility, cost effectiveness, and technical maturity of a domestically-produced engine that could potentially both replace the RD-180 on Atlas V and satisfy NASA SLS payload-to-orbit requirements via an advanced booster application. Engine physical dimensions and performance parameters resulting from this study provide the system level requirements for the ORSC risk reduction test article

Effect of dietary pulse intake on established therapeutic lipid targets for cardiovascular risk reduction: a systematic review and meta-analysis of randomized controlled trials

PubMed Central

Ha, Vanessa; Sievenpiper, John L.; de Souza, Russell J.; Jayalath, Viranda H.; Mirrahimi, Arash; Agarwal, Arnav; Chiavaroli, Laura; Mejia, Sonia Blanco; Sacks, Frank M.; Di Buono, Marco; Bernstein, Adam M.; Leiter, Lawrence A.; Kris-Etherton, Penny M.; Vuksan, Vladimir; Bazinet, Richard P.; Josse, Robert G.; Beyene, Joseph; Kendall, Cyril W.C.; Jenkins, David J.A.

2014-01-01

Background: Evidence from controlled trials encourages the intake of dietary pulses (beans, chickpeas, lentils and peas) as a method of improving dyslipidemia, but heart health guidelines have stopped short of ascribing specific benefits to this type of intervention or have graded the beneficial evidence as low. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effect of dietary pulse intake on established therapeutic lipid targets for cardiovascular risk reduction. Methods: We searched electronic databases and bibliographies of selected trials for relevant articles published through Feb. 5, 2014. We included RCTs of at least 3 weeks’ duration that compared a diet emphasizing dietary pulse intake with an isocaloric diet that did not include dietary pulses. The lipid targets investigated were low-density lipoprotein (LDL) cholesterol, apolipoprotein B and non–high-density lipoprotein (non-HDL) cholesterol. We pooled data using a random-effects model. Results: We identified 26 RCTs (n = 1037) that satisfied the inclusion criteria. Diets emphasizing dietary pulse intake at a median dose of 130 g/d (about 1 serving daily) significantly lowered LDL cholesterol levels compared with the control diets (mean difference −0.17 mmol/L, 95% confidence interval −0.25 to −0.09 mmol/L). Treatment effects on apolipoprotein B and non-HDL cholesterol were not observed. Interpretation: Our findings suggest that dietary pulse intake significantly reduces LDL cholesterol levels. Trials of longer duration and higher quality are needed to verify these results. Trial registration: ClinicalTrials.gov, no. NCT01594567. PMID:24710915

Taking the Initiative: Risk-Reduction Strategies and Decreased Malpractice Costs.

PubMed

Raper, Steven E; Rose, Deborah; Nepps, Mary Ellen; Drebin, Jeffrey A

2017-11-01

To heighten awareness of attending and resident surgeons regarding strategies for defense against malpractice claims, a series of risk reduction initiatives have been carried out in our Department of Surgery. We hypothesized that emphasis on certain aspects of risk might be associated with decreased malpractice costs. The relative impact of Department of Surgery initiatives was assessed when compared with malpractice experience for the rest of the Clinical Practices of the University of Pennsylvania (CPUP). Surgery and CPUP malpractice claims, indemnity, and expenses were obtained from the Office of General Counsel. Malpractice premium data were obtained from CPUP finance. The Department of Surgery was assessed in comparison with all other CPUP departments. Cost data (yearly indemnity and expenses), and malpractice premiums (total and per physician) were expressed as a percentage of the 5-year mean value preceding implementation of the initiative program. Surgery implemented 38 risk reduction initiatives. Faculty participated in 27 initiatives; house staff participated in 10 initiatives; and advanced practitioners in 1 initiative. Department of Surgery claims were significantly less than CPUP (74.07% vs 81.07%; p < 0.05). The mean yearly indemnity paid by the Department of Surgery was significantly less than that of the other CPUP departments (84.08% vs 122.14%; p < 0.05). Department of Surgery-paid expenses were also significantly less (83.17% vs 104.96%; p < 0.05), and surgical malpractice premiums declined from baseline, but remained significantly higher than CPUP premiums. The data suggest that educating surgeons on malpractice and risk reduction may play a role in decreasing malpractice costs. Additional extrinsic factors may also affect cost data. Emphasis on risk reduction appears to be cumulative and should be part of an ongoing program. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Valuing Drinking Water Risk Reductions Using the Contingent Valuation Method: A Methodological Study of Risks from THM and Giardia (1986)

EPA Pesticide Factsheets

This study develops contingent valuation methods for measuring the benefits of mortality and morbidity drinking water risk reductions. The major effort was devoted to developing and testing a survey instrument to value low-level risk reductions.

Cancer risk in aluminum reduction plant workers (Canada).

PubMed

Spinelli, John J; Demers, Paul A; Le, Nhu D; Friesen, Melissa D; Lorenzi, Maria F; Fang, Raymond; Gallagher, Richard P

2006-09-01

A 14-year update to a previously published historical cohort study of aluminum reduction plant workers was conducted [1]. All men with three or more years at an aluminum reduction plant in British Columbia (BC), Canada between the years 1954 and 1997 were included; a total of 6,423 workers. A total of 662 men were diagnosed with cancer, representing a 400% increase from the original study. Standardized mortality and incidence ratios were used to compare the cancer mortality and incidence of the cohort to that of the BC population. Poisson regression was used to examine risk by cumulative exposure to coal tar pitch volatiles (CTPV) measured as benzene soluble materials (BSM) and benzo(a)pyrene (BaP). The risk for bladder cancer was related to cumulative exposure to CTPV measured as BSM and BaP (p trends <0.001), and the risk for stomach cancer was related to exposure measured by BaP (p trend BaP <0.05). The risks for lung cancer (p trend <0.001), non-Hodgkin lymphoma (p trend <0.001), and kidney cancer (p trend <0.01) also increased with increasing exposure, although the overall rates were similar to that of the general population. Analysis of the joint effect of smoking and CTPV exposure on cancer showed the observed dose-response relationships to be independent of smoking.

Moral Hazard: How The National Flood Insurance Program Is Limiting Risk Reduction

DTIC Science & Technology

2016-12-01

Management and Budget, Paperwork Reduction Project (0704-0188) Washington DC 20503. 1. AGENCY USE ONLY (Leave blank) 2. REPORT DATE December...assessment, floodplain management , and flood insurance. A study of the NFIP concludes that aspects of the program limit risk reduction...floodplain management , risk assessment, disaster recovery, flood insurance claim, pre-flood insurance rate map 15. NUMBER OF PAGES 123 16. PRICE CODE

Special Diabetes Program for Indians: Retention in Cardiovascular Risk Reduction

ERIC Educational Resources Information Center

Manson, Spero M.; Jiang, Luohua; Zhang, Lijing; Beals, Janette; Acton, Kelly J.; Roubideaux, Yvette

2011-01-01

Purpose: This study examined the associations between participant and site characteristics and retention in a multisite cardiovascular disease risk reduction project. Design and Methods: Data were derived from the Special Diabetes Program for Indians Healthy Heart Demonstration Project, an intervention to reduce cardiovascular risk among American…

A comparative study of European insurance schemes for extreme weather risks and incentives for risk reduction

NASA Astrophysics Data System (ADS)

de Ruiter, Marleen; Hudson, Paul; de Ruig, Lars; Kuik, Onno; Botzen, Wouter

2017-04-01

This paper provides an analysis of the insurance schemes that cover extreme weather events in twelve different EU countries and the risk reduction incentives offered by these schemes. Economic impacts of extreme weather events in many regions in Europe and elsewhere are on the rise due to climate change and increasing exposure as driven by urban development. In an attempt to manage impacts from extreme weather events, natural disaster insurance schemes can provide incentives for taking measures that limit weather-related risks. Insurance companies can influence public risk management policies and risk-reducing behaviour of policyholders by "rewarding behaviour that reduces risks and potential damages" (Botzen and Van den Bergh, 2008, p. 417). Examples of insurance market systems that directly or indirectly aim to incentivize risk reduction with varying degrees of success are: the U.S. National Flood Insurance Programme; the French Catastrophes Naturelles system; and the U.K. Flood Re program which requires certain levels of protection standards for properties to be insurable. In our analysis, we distinguish between four different disaster types (i.e. coastal and fluvial floods, droughts and storms) and three different sectors (i.e. residential, commercial and agriculture). The selected case studies also provide a wide coverage of different insurance market structures, including public, private and public-private insurance provision, and different methods of coping with extreme loss events, such as re-insurance, governmental aid and catastrophe bonds. The analysis of existing mechanisms for risk reduction incentives provides recommendations about incentivizing adaptive behaviour, in order to assist policy makers and other stakeholders in designing more effective insurance schemes for extreme weather risks.

Walking vs running for hypertension, cholesterol, & diabetes risk reduction

PubMed Central

Thompson, Paul D.

2013-01-01

Background To test whether equivalent energy expenditure by moderate-intensity (e.g., walking) and vigorous-intensity exercise (e.g., running) provides equivalent health benefits. Methods and Results We used the National Runners’ (n=33,060) and Walkers’ (n=15,945) Health Study cohorts to examine the effect of differences in exercise mode and thereby exercise intensity on coronary heart disease (CHD) risk factors. Baseline expenditure (METhr/d) was compared to self-reported, physician-diagnosed incident hypertension, hypercholesterolemia, diabetes and CHD during 6.2 years follow-up. Running significantly decreased the risks for incident hypertension by 4.2% (P<10-7), hypercholesterolemia by 4.3% (P<10-14), diabetes by 12.1% (P<10-5), and CHD by 4.5% per METh/d run (P=0.05). The corresponding reductions for walking were 7.2% (P<10-6), 7.0% (P<10-8), 12.3% (P<10-4), and 9.3% (P=0.01). Relative to <1.8 METh/d, the risk reductions for 1.8 to 3.6, 3.6 to 5.4, 5.4 to 7.2, and ≥ 7.2 METh/d were: 1) 10.1%, 17.7%, 25.1% and 34.9% from running and 14.0%, 23.8%, 21.8% and 38.3% from walking for hypercholesterolemia; 2) 19.7%, 19.4%, 26.8% and 39.8% from running and 14.7%, 19.1%, 23.6% and 13.3% from walking for hypertension; 3) 43.5%, 44.1%, 47.7% and 68.2% from running and 34.1%, 44.2%, and 23.6% from walking for diabetes (too few cases for diabetes for walking >5.4 METh/d). The risk reductions were not significantly greater for running than walking for diabetes (P=0.94) or CHD (P=0.26), and only marginally greater for walking than running for hypertension (P=0.06) and hypercholesterolemia (P=0.04). Conclusion Equivalent energy expenditures by moderate (walking) and vigorous (running) exercise produced similar risk reductions for hypertension, hypercholesterolemia, diabetes, and CHD, but there is limited statistical power to evaluate CHD conclusively. PMID:23559628

Toward Risk Reduction for Mobile Service Composition.

PubMed

Deng, Shuiguang; Huang, Longtao; Li, Ying; Zhou, Honggeng; Wu, Zhaohui; Cao, Xiongfei; Kataev, Mikhail Yu; Li, Ling

2016-08-01

The advances in mobile technologies enable us to consume or even provide services through powerful mobile devices anytime and anywhere. Services running on mobile devices within limited range can be composed to coordinate together through wireless communication technologies and perform complex tasks. However, the mobility of users and devices in mobile environment imposes high risk on the execution of the tasks. This paper targets reducing this risk by constructing a dependable service composition after considering the mobility of both service requesters and providers. It first proposes a risk model and clarifies the risk of mobile service composition; and then proposes a service composition approach by modifying the simulated annealing algorithm. Our objective is to form a service composition by selecting mobile services under the mobility model and to ensure the service composition have the best quality of service and the lowest risk. The experimental results demonstrate that our approach can yield near-optimal solutions and has a nearly linear complexity with respect to a problem size.

HIV infection among intravenous drug users: epidemiology and risk reduction.

PubMed

Des Jarlais, D C; Friedman, S R

1987-07-01

Research on the epidemiology of HIV infection among IV drug users is still at a relatively early stage. Multilocation studies that would permit better geographic comparisons are greatly needed. Multi-method studies within single geographic areas are also needed to assess possible biases with respect to sample recruitment and data collection procedures. The continuation of the epidemic provides a changing historical context that complicates any comparisons. Despite these problems, there are some consistencies that can be seen across studies. Studies of HIV seroprevalence among IV drug users show wide variation among cities in the United States and Europe. The time that the virus was introduced into the IV drug using group within the city is one factor in explaining these differences; other cross-city factors have yet to be identified. Once HIV has been introduced into the IV drug use group within a particular geographic area, there is the possibility of rapid spread up to seroprevalence levels of 50% or greater. Thus, a currently low seroprevalence rate should not be seen as a stable situation. Frequency of injection and sharing of equipment with multiple other drug users (particularly at shooting galleries) have been frequently associated with HIV exposure. Being female, ethnicity (in the USA) and engaging in prostitution also may be associated with increased risk for HIV exposure, suggesting that prevention programs should include special consideration of sex and ethnic differences. Studies of AIDS risk reduction show that substantial proportions of IV drug users are changing their behavior to avoid exposure to HIV. This risk reduction is probably more advanced in New York, with its high seroprevalence and incidence of cases, but is also occurring in cities with lower seroprevalence and limited numbers of cases. The primary forms of risk reduction are increasing the use of sterile equipment, reducing the number of needle sharing partners, and reducing the

Determination of target detection limits in hyperspectral data using band selection and dimensionality reduction

NASA Astrophysics Data System (ADS)

Gross, W.; Boehler, J.; Twizer, K.; Kedem, B.; Lenz, A.; Kneubuehler, M.; Wellig, P.; Oechslin, R.; Schilling, H.; Rotman, S.; Middelmann, W.

2016-10-01

Hyperspectral remote sensing data can be used for civil and military applications to robustly detect and classify target objects. High spectral resolution of hyperspectral data can compensate for the comparatively low spatial resolution, which allows for detection and classification of small targets, even below image resolution. Hyperspectral data sets are prone to considerable spectral redundancy, affecting and limiting data processing and algorithm performance. As a consequence, data reduction strategies become increasingly important, especially in view of near-real-time data analysis. The goal of this paper is to analyze different strategies for hyperspectral band selection algorithms and their effect on subpixel classification for different target and background materials. Airborne hyperspectral data is used in combination with linear target simulation procedures to create a representative amount of target-to-background ratios for evaluation of detection limits. Data from two different airborne hyperspectral sensors, AISA Eagle and Hawk, are used to evaluate transferability of band selection when using different sensors. The same target objects were recorded to compare the calculated detection limits. To determine subpixel classification results, pure pixels from the target materials are extracted and used to simulate mixed pixels with selected background materials. Target signatures are linearly combined with different background materials in varying ratios. The commonly used classification algorithms Adaptive Coherence Estimator (ACE) is used to compare the detection limit for the original data with several band selection and data reduction strategies. The evaluation of the classification results is done by assuming a fixed false alarm ratio and calculating the mean target-to-background ratio of correctly detected pixels. The results allow drawing conclusions about specific band combinations for certain target and background combinations. Additionally

Risk reduction in road and rail LPG transportation by passive fire protection.

PubMed

Paltrinieri, Nicola; Landucci, Gabriele; Molag, Menso; Bonvicini, Sarah; Spadoni, Gigliola; Cozzani, Valerio

2009-08-15

The potential reduction of risk in LPG (Liquefied Petroleum Gas) road transport due to the adoption of passive fire protections was investigated. Experimental data available for small scale vessels fully engulfed by a fire were extended to real scale road and rail tankers through a finite elements model. The results of mathematical simulations of real scale fire engulfment scenarios that may follow accidents involving LPG tankers proved the effectiveness of the thermal protections in preventing the "fired" BLEVE (Boiling Liquid Expanding Vapour Explosion) scenario. The presence of a thermal coating greatly increases the "time to failure", providing a time lapse that in the European experience may be considered sufficient to allow the start of effective mitigation actions by fire brigades. The results obtained were used to calculate the expected reduction of individual and societal risk due to LPG transportation in real case scenarios. The analysis confirmed that the introduction of passive fire protections turns out in a significant reduction of risk, up to an order of magnitude in the case of individual risk and of about 50% if the expectation value is considered. Thus, the adoption of passive fire protections, not compulsory in European regulations, may be an effective technical measure for risk reduction, and may contribute to achieve the control of "major accidents hazards" cited by the European legislation.

The role of service learning in teaching and research for disaster-risk reduction

NASA Astrophysics Data System (ADS)

Suckale, J.; Saiyed, Z.; Alvisyahrin, T.; Hilley, G. E.; Muhari, A.; Zoback, M. L. C.; Truebe, S.

2016-12-01

An important motivation for natural-hazards research is to reduce threats posed by natural disasters to at-risk communities. Yet, we rarely teach students how research may be used to construct implementable solutions that reduce disaster risk. The goal of this contribution is to evaluate the potential of service learning to impart students with both the scientific background and the skills necessary to navigate real-world constraints of disaster risk reduction. We present results from a service-learning class taught at Stanford in the Winter quarter of 2016 in collaboration with the Indonesian Ministry of Marine Affairs and Fisheries and Syiah Kuala University, Banda Aceh. The main deliverable of the class was a final project in which students developed a specific idea of how to contribute to tsunami-risk reduction in Indonesia. A common critique of the service-learning approach posits that it may implicitly embed social and political perspectives within risk-reduction strategies that may be inappropriate within a particular culture. We attempted to avoid this problem using three strategies: First, we paired students from Stanford with students at Syiah Kuala University, Banda Aceh, to facilitate a close dialogue. Second, the Ministry of Marine Affairs and Fisheries provided a list of current risk-reduction strategies without requiring students to contribute to one specific project to minimally precondition project suggestions. Third, our community partners provided ongoing feedback on the scope and feasibility of the proposed projects and students were assessed based on their ability to integrate the feedback. Preliminary results from our class suggest significant promise for a service-learning approach to teaching disaster-risk reduction. There was substantial student interest in service learning, particularly among undergraduates. Pre-and post-assessment surveys showed that over 75% of students adjusted previous notions about disaster-risk reduction during the

Spray drift and off-target loss reduction with a precision air-assisted sprayer

USDA-ARS?s Scientific Manuscript database

Spray drift and off-target losses are inherent problems of conventional air-assisted sprayers. Their low efficiencies cause environmental pollutions resulting in public anxieties. A new drift reduction technology incorporating laser scanning capabilities with a variable-rate air-assisted sprayer w...

Pneumococcal vaccine targeting strategy for older adults: customized risk profiling.

PubMed

Balicer, Ran D; Cohen, Chandra J; Leibowitz, Morton; Feldman, Becca S; Brufman, Ilan; Roberts, Craig; Hoshen, Moshe

2014-02-12

Current pneumococcal vaccine campaigns take a broad, primarily age-based approach to immunization targeting, overlooking many clinical and administrative considerations necessary in disease prevention and resource planning for specific patient populations. We aim to demonstrate the utility of a population-specific predictive model for hospital-treated pneumonia to direct effective vaccine targeting. Data was extracted for 1,053,435 members of an Israeli HMO, age 50 and older, during the study period 2008-2010. We developed and validated a logistic regression model to predict hospital-treated pneumonia using training and test samples, including a set of standard and population-specific risk factors. The model's predictive value was tested for prospectively identifying cases of pneumonia and invasive pneumococcal disease (IPD), and was compared to the existing international paradigm for patient immunization targeting. In a multivariate regression, age, co-morbidity burden and previous pneumonia events were most strongly positively associated with hospital-treated pneumonia. The model predicting hospital-treated pneumonia yielded a c-statistic of 0.80. Utilizing the predictive model, the top 17% highest-risk within the study validation population were targeted to detect 54% of those members who were subsequently treated for hospitalized pneumonia in the follow up period. The high-risk population identified through this model included 46% of the follow-up year's IPD cases, and 27% of community-treated pneumonia cases. These outcomes were compared with international guidelines for risk for pneumococcal diseases that accurately identified only 35% of hospitalized pneumonia, 41% of IPD cases and 21% of community-treated pneumonia. We demonstrate that a customized model for vaccine targeting performs better than international guidelines, and therefore, risk modeling may allow for more precise vaccine targeting and resource allocation than current national and international

Cost effectiveness of ramipril treatment for cardiovascular risk reduction.

PubMed

Malik, I S; Bhatia, V K; Kooner, J S

2001-05-01

To assess the cost effectiveness of ramipril treatment in patients at low, medium, and high risk of cardiovascular death. Population based cost effectiveness analysis from the perspective of the health care provider in the UK. Effectiveness was modelled using data from the HOPE (heart outcome prevention evaluation) trial. The life table method was used to predict mortality in a medium risk cohort, as in the HOPE trial (2.44% annual mortality), and in low and high risk groups (1% and 4.5% annual mortality, respectively). UK population using 1998 government actuary department data. Cost per life year gained at five years and lifetime treatment with ramipril. Cost effectiveness was pound36 600, pound13 600, and pound4000 per life year gained at five years and pound5300, pound1900, and pound100 per life year gained at 20 years (lifetime treatment) in low, medium, and high risk groups, respectively. Cost effectiveness at 20 years remained well below that of haemodialysis ( pound25 000 per life year gained) over a range of potential drug costs and savings. Treatment of the HOPE population would cost the UK National Health Service (NHS) an additional pound360 million but would prevent 12 000 deaths per annum. Ramipril is cost effective treatment for cardiovascular risk reduction in patients at medium, high, and low pretreatment risk, with a cost effectiveness comparable with the use of statins. Implementation of ramipril treatment in a medium risk population would result in a major reduction in cardiovascular deaths but would increase annual NHS spending by pound360 million.

Using a relative health indicator (RHI) metric to estimate health risk reductions in drinking water.

PubMed

Alfredo, Katherine A; Seidel, Chad; Ghosh, Amlan; Roberson, J Alan

2017-03-01

When a new drinking water regulation is being developed, the USEPA conducts a health risk reduction and cost analysis to, in part, estimate quantifiable and non-quantifiable cost and benefits of the various regulatory alternatives. Numerous methodologies are available for cumulative risk assessment ranging from primarily qualitative to primarily quantitative. This research developed a summary metric of relative cumulative health impacts resulting from drinking water, the relative health indicator (RHI). An intermediate level of quantification and modeling was chosen, one which retains the concept of an aggregated metric of public health impact and hence allows for comparisons to be made across "cups of water," but avoids the need for development and use of complex models that are beyond the existing state of the science. Using the USEPA Six-Year Review data and available national occurrence surveys of drinking water contaminants, the metric is used to test risk reduction as it pertains to the implementation of the arsenic and uranium maximum contaminant levels and quantify "meaningful" risk reduction. Uranium represented the threshold risk reduction against which national non-compliance risk reduction was compared for arsenic, nitrate, and radium. Arsenic non-compliance is most significant and efforts focused on bringing those non-compliant utilities into compliance with the 10 μg/L maximum contaminant level would meet the threshold for meaningful risk reduction.

Propulsion Risk Reduction Activities for Nontoxic Cryogenic Propulsion

NASA Technical Reports Server (NTRS)

Smith, Timothy D.; Klem, Mark D.; Fisher, Kenneth L.

2010-01-01

The Propulsion and Cryogenics Advanced Development (PCAD) Project s primary objective is to develop propulsion system technologies for nontoxic or "green" propellants. The PCAD project focuses on the development of nontoxic propulsion technologies needed to provide necessary data and relevant experience to support informed decisions on implementation of nontoxic propellants for space missions. Implementation of nontoxic propellants in high performance propulsion systems offers NASA an opportunity to consider other options than current hypergolic propellants. The PCAD Project is emphasizing technology efforts in reaction control system (RCS) thruster designs, ascent main engines (AME), and descent main engines (DME). PCAD has a series of tasks and contracts to conduct risk reduction and/or retirement activities to demonstrate that nontoxic cryogenic propellants can be a feasible option for space missions. Work has focused on 1) reducing the risk of liquid oxygen/liquid methane ignition, demonstrating the key enabling technologies, and validating performance levels for reaction control engines for use on descent and ascent stages; 2) demonstrating the key enabling technologies and validating performance levels for liquid oxygen/liquid methane ascent engines; and 3) demonstrating the key enabling technologies and validating performance levels for deep throttling liquid oxygen/liquid hydrogen descent engines. The progress of these risk reduction and/or retirement activities will be presented.

The social value of mortality risk reduction: VSL versus the social welfare function approach.

PubMed

Adler, Matthew D; Hammitt, James K; Treich, Nicolas

2014-05-01

We examine how different welfarist frameworks evaluate the social value of mortality risk reduction. These frameworks include classical, distributively unweighted cost-benefit analysis--i.e., the "value per statistical life" (VSL) approach-and various social welfare functions (SWFs). The SWFs are either utilitarian or prioritarian, applied to policy choice under risk in either an "ex post" or "ex ante" manner. We examine the conditions on individual utility and on the SWF under which these frameworks display sensitivity to wealth and to baseline risk. Moreover, we discuss whether these frameworks satisfy related properties that have received some attention in the literature, namely equal value of risk reduction, preference for risk equity, and catastrophe aversion. We show that the particular manner in which VSL ranks risk-reduction measures is not necessarily shared by other welfarist frameworks. Copyright © 2014 Elsevier B.V. All rights reserved.

Nation-building policies in Timor-Leste: disaster risk reduction, including climate change adaptation.

PubMed

Mercer, Jessica; Kelman, Ilan; do Rosario, Francisco; de Deus de Jesus Lima, Abilio; da Silva, Augusto; Beloff, Anna-Maija; McClean, Alex

2014-10-01

Few studies have explored the relationships between nation-building, disaster risk reduction and climate change adaptation. Focusing on small island developing states, this paper examines nation-building in Timor-Leste, a small island developing state that recently achieved independence. Nation-building in Timor-Leste is explored in the context of disaster risk reduction, which necessarily includes climate change adaptation. The study presents a synopsis of Timor-Leste's history and its nation-building efforts as well as an overview of the state of knowledge of disaster risk reduction including climate change adaptation. It also offers an analysis of significant gaps and challenges in terms of vertical and horizontal governance, large donor presence, data availability and the integration of disaster risk reduction and climate change adaptation for nation-building in Timor-Leste. Relevant and applicable lessons are provided from other small island developing states to assist Timor-Leste in identifying its own trajectory out of underdevelopment while it builds on existing strengths. © 2014 The Author(s). Disasters © Overseas Development Institute, 2014.

The Differential Effects of Social Media Sites for Promoting Cancer Risk Reduction.

PubMed

Lauckner, Carolyn; Whitten, Pamela

2016-09-01

Social media are potentially valuable tools for disseminating cancer education messages, but the differential effects of various sites on persuasive outcomes are unknown. In an effort to inform future health promotion, this research tested the effects of Facebook, YouTube, Twitter, and blogs for delivering a cancer risk reduction message. Using an experimental design, participants were randomly placed in several conditions that delivered the same message but with different forms of social media. Effects on comprehension and attitudes were examined, as they are important variables in the behavior change process. YouTube led to higher comprehension and stronger attitudes toward cancer risk reduction than Twitter, but there were no differences between other sites. Additionally, YouTube led to stronger attitudes toward cancer risk reduction as compared to Facebook, but not any other sites. These results demonstrate that, even if the message is kept constant, the form of social media used to deliver content can have an effect on persuasive outcomes. More research is needed to determine the mechanisms behind the differences found, however. Altogether, this line of research is valuable for any individuals seeking to use social media for health promotion purposes and could have direct implications for the development of cancer risk reduction campaigns.

Impact of the Prevention Plan on Employee Health Risk Reduction

PubMed Central

Edington, Dee W.; Bég, Sami

2010-01-01

Abstract This study evaluated the impact of The Prevention Plan™ on employee health risks after 1 year of integrated primary prevention (wellness and health promotion) and secondary prevention (biometric and lab screening as well as early detection) interventions. The Prevention Plan is an innovative prevention benefit that provides members with the high-tech/high-touch support and encouragement they need to adopt healthy behaviors. Support services include 24/7 nurse hotlines, one-on-one health coaching, contests, group events, and employer incentives. Specifically, we analyzed changes in 15 health risk measures among a cohort of 2606 employees from multiple employer groups who completed a baseline health risk appraisal, blood tests, and biometric screening in 2008 and who were reassessed in 2009. We then compared the data to the Edington Natural Flow of risks. The cohort showed significant reduction in 10 of the health risks measured (9 at P ≤ 0.01 and 1 at P ≤ 0.05). The most noticeable changes in health risks were a reduction in the proportion of employees with high-risk blood pressure (42.78%), high-risk fasting blood sugar (31.13%), and high-risk stress (24.94%). There was an overall health risk transition among the cohort with net movement from higher risk levels to lower risk levels (P < 0.01). There was a net increase of 9.40% of people in the low-risk category, a decrease of 3.61% in the moderate-risk category, and a 5.79% decrease in the high-risk category. Compared to Edington's Natural Flow model, 48.70% of individuals in the high-risk category moved from high risk to moderate risk (Natural Flow 31%), 46.35% moved from moderate risk to low risk (Natural Flow 35%), 15.65% moved from high risk to low risk (Natural Flow 6%), and 87.33% remained in the low-risk category (Natural Flow 70%) (P < 0.001). (Population Health Management 2010;13:275–284) PMID:20879909

Impact of the prevention plan on employee health risk reduction.

PubMed

Loeppke, Ronald; Edington, Dee W; Bég, Sami

2010-10-01

This study evaluated the impact of The Prevention Plan™ on employee health risks after 1 year of integrated primary prevention (wellness and health promotion) and secondary prevention (biometric and lab screening as well as early detection) interventions. The Prevention Plan is an innovative prevention benefit that provides members with the high-tech/high-touch support and encouragement they need to adopt healthy behaviors. Support services include 24/7 nurse hotlines, one-on-one health coaching, contests, group events, and employer incentives. Specifically, we analyzed changes in 15 health risk measures among a cohort of 2606 employees from multiple employer groups who completed a baseline health risk appraisal, blood tests, and biometric screening in 2008 and who were reassessed in 2009. We then compared the data to the Edington Natural Flow of risks. The cohort showed significant reduction in 10 of the health risks measured (9 at P≤ 0.01 and 1 at P≤0.05). The most noticeable changes in health risks were a reduction in the proportion of employees with high-risk blood pressure (42.78%), high-risk fasting blood sugar (31.13%), and high-risk stress (24.94%). There was an overall health risk transition among the cohort with net movement from higher risk levels to lower risk levels (P<0.01). There was a net increase of 9.40% of people in the low-risk category, a decrease of 3.61% in the moderate-risk category, and a 5.79% decrease in the high-risk category. Compared to Edington's Natural Flow model, 48.70% of individuals in the high-risk category moved from high risk to moderate risk (Natural Flow 31%), 46.35% moved from moderate risk to low risk (Natural Flow 35%), 15.65% moved from high risk to low risk (Natural Flow 6%), and 87.33% remained in the low-risk category (Natural Flow 70%) (P<0.001).

Reductions in Cardiovascular Risk After Bariatric Surgery

PubMed Central

Benraoune, Fethi; Litwin, Sheldon E.

2012-01-01

Purpose of review Obesity is commonly associated with multiple conditions imparting adverse cardiovascular risk including, hypertension, dyslipidemia and insulin resistance or diabetes. In addition, sleep disordered breathing, inflammation, left ventricular hypertrophy, left atrial enlargement and subclinical left ventricular systolic and diastolic dysfunction may collectively contribute to increased cardiovascular morbidity and mortality. This review will describe improvements in cardiovascular risk factors after bariatric surgery. Recent findings All of the cardiovascular risk factors listed above are improved or even resolved after bariatric surgery. Cardiac structure and function also have shown consistent improvement after surgically-induced weight loss. The amount of improvement in cardiac risk factors is generally proportional to the amount of weight lost. The degree of weight loss varies with different bariatric procedures. Based on the improvement in risk profiles, it has been predicted that progression of atherosclerosis could be slowed and the 10 year risk of cardiac events would decline by ~ 50% in patients undergoing weight loss surgery. In keeping with these predictions, 2 studies have demonstrated reductions in 10-year total and cardiovascular mortality of approximately 50% in patients who had bariatric surgery. Summary These encouraging data support the continued, and perhaps expanded use of surgical procedures to induce weight loss in severely obese patients. PMID:21934498

Abolishing inequity, a necessity for poverty reduction and the realisation of child mortality targets.

PubMed

Målqvist, Mats

2015-02-01

The first Millennium Development Goal (MDG 1) due in 2015 concerns poverty reduction. It has been claimed to be fulfilled on a global level, but still more than 1 billion people are living in abject poverty. There is a strong link between the economy and child survival, and only a minority of countries will have reached the MDG target for child mortality reduction by 2015. This paper discusses the relationship between poverty and child survival. It argues that a focus on equity is necessary to further reduce child mortality, through poverty reduction in absolute terms and also through targeting interventions for increased child survival to disadvantaged populations. The political will to actually achieve real change for those in greatest need is crucial but not to be taken for granted, and the distribution rather than the generation of wealth needs to be made a priority in the post-MDG era. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Update on Risk Reduction Activities for a Liquid Advanced Booster for NASA's Space Launch System

NASA Technical Reports Server (NTRS)

Crocker, Andrew M.; Doering, Kimberly B; Meadows, Robert G.; Lariviere, Brian W.; Graham, Jerry B.

2015-01-01

The stated goals of NASA's Research Announcement for the Space Launch System (SLS) Advanced Booster Engineering Demonstration and/or Risk Reduction (ABEDRR) are to reduce risks leading to an affordable Advanced Booster that meets the evolved capabilities of SLS; and enable competition by mitigating targeted Advanced Booster risks to enhance SLS affordability. Dynetics, Inc. and Aerojet Rocketdyne (AR) formed a team to offer a wide-ranging set of risk reduction activities and full-scale, system-level demonstrations that support NASA's ABEDRR goals. For NASA's SLS ABEDRR procurement, Dynetics and AR formed a team to offer a series of full-scale risk mitigation hardware demonstrations for an affordable booster approach that meets the evolved capabilities of the SLS. To establish a basis for the risk reduction activities, the Dynetics Team developed a booster design that takes advantage of the flight-proven Apollo-Saturn F-1. Using NASA's vehicle assumptions for the SLS Block 2, a two-engine, F-1-based booster design delivers 150 mT (331 klbm) payload to LEO, 20 mT (44 klbm) above NASA's requirements. This enables a low-cost, robust approach to structural design. During the ABEDRR effort, the Dynetics Team has modified proven Apollo-Saturn components and subsystems to improve affordability and reliability (e.g., reduce parts counts, touch labor, or use lower cost manufacturing processes and materials). The team has built hardware to validate production costs and completed tests to demonstrate it can meet performance requirements. State-of-the-art manufacturing and processing techniques have been applied to the heritage F-1, resulting in a low recurring cost engine while retaining the benefits of Apollo-era experience. NASA test facilities have been used to perform low-cost risk-reduction engine testing. In early 2014, NASA and the Dynetics Team agreed to move additional large liquid oxygen/kerosene engine work under Dynetics' ABEDRR contract. Also led by AR, the

Work-site cardiovascular risk reduction: a randomized trial of health risk assessment, education, counseling, and incentives.

PubMed Central

Gomel, M; Oldenburg, B; Simpson, J M; Owen, N

1993-01-01

OBJECTIVES. This study reports an efficacy trial of four work-site health promotion programs. It was predicted that strategies making use of behavioral counseling would produce a greater reduction in cardiovascular disease risk factors than screening and educational strategies. METHODS. Twenty-eight work sites were randomly allocated to a health risk assessment, risk factor education, behavioral counseling, or behavioral counseling plus incentives intervention. Participants were assessed before the intervention and at 3, 6, and 12 months. RESULTS. Compared with the average of the health risk assessment and risk factor education conditions, there were significantly higher validated continuous smoking cessation rates and smaller increases in body mass index and estimated percentage of body fat in the two behavioral counseling conditions. The behavioral counseling condition was associated with a greater reduction in mean blood pressure than was the behavioral counseling plus incentives condition. On average among all groups, there was a short-term increase in aerobic capacity followed by a return to baseline levels. CONCLUSIONS. Work-site interventions that use behavioral approaches can produce lasting changes in some cardiovascular risk factors and, if implemented routinely, can have a significant public health impact. PMID:8362997

Research and Evaluations of the Health Aspects of Disasters, Part IX: Risk-Reduction Framework.

PubMed

Birnbaum, Marvin L; Daily, Elaine K; O'Rourke, Ann P; Loretti, Alessandro

2016-06-01

A disaster is a failure of resilience to an event. Mitigating the risks that a hazard will progress into a destructive event, or increasing the resilience of a society-at-risk, requires careful analysis, planning, and execution. The Disaster Logic Model (DLM) is used to define the value (effects, costs, and outcome(s)), impacts, and benefits of interventions directed at risk reduction. A Risk-Reduction Framework, based on the DLM, details the processes involved in hazard mitigation and/or capacity-building interventions to augment the resilience of a community or to decrease the risk that a secondary event will develop. This Framework provides the structure to systematically undertake and evaluate risk-reduction interventions. It applies to all interventions aimed at hazard mitigation and/or increasing the absorbing, buffering, or response capacities of a community-at-risk for a primary or secondary event that could result in a disaster. The Framework utilizes the structure provided by the DLM and consists of 14 steps: (1) hazards and risks identification; (2) historical perspectives and predictions; (3) selection of hazard(s) to address; (4) selection of appropriate indicators; (5) identification of current resilience standards and benchmarks; (6) assessment of the current resilience status; (7) identification of resilience needs; (8) strategic planning; (9) selection of an appropriate intervention; (10) operational planning; (11) implementation; (12) assessments of outputs; (13) synthesis; and (14) feedback. Each of these steps is a transformation process that is described in detail. Emphasis is placed on the role of Coordination and Control during planning, implementation of risk-reduction/capacity building interventions, and evaluation. Birnbaum ML , Daily EK , O'Rourke AP , Loretti A . Research and evaluations of the health aspects of disasters, part IX: Risk-Reduction Framework. Prehosp Disaster Med. 2016;31(3):309-325.

Falls in Scottish homicide: lessons for homicide reduction in mental health patients

PubMed Central

Crichton, John H. M.

2017-01-01

The sustained fall in Scottish homicide rates follows crime reduction measures informed by the epidemiology of suicide. The violence reduction unit targeted young men carrying knives in public. The restriction of weapons immediately to hand appears to have caused an absolute fall in homicide just as suicide reduction was observed following changes to domestic gas supply. Further homicide reduction may be accomplished in the domestic setting with targeted changes in kitchen knife design in home safety planning for high-risk households. Most commonly homicides involving those in recent contact with mental health services in the UK have domestic characteristics and similar safety planning may be targeted at those with mental disorder and a history of violence. PMID:28811910

Reduction in Sexual Risk Behaviors among College Students Following a Comprehensive Health Education Intervention.

ERIC Educational Resources Information Center

Turner, James C.; And Others

1993-01-01

Researchers studied college students' sexual behavior and the association of a comprehensive health education program with subsequent sexual risk behavior modifications. Pre- and postintervention surveys indicated the intervention created short-term reduction in sexual risk behaviors, but the reduction varied according to gender. (SM)

The Good, The Bad and The Ugly: Disaster Risk Reduction (DRR) Versus Disaster Risk Creation (DRC)

PubMed Central

Lewis, James

2012-01-01

In understanding and trying to reduce the risk from disasters, connections are often articulated amongst poverty, vulnerability, risk, and disasters. These are welcome steps, but the approach taken in top-down international documents is rarely to articulate explicitly that vulnerability accrues from a wide variety of dynamic and long-term processes. Neglecting these processes—and failing to explore their links with poverty, risk, and disasters—tends to encourage disaster risk creation. This paper identifies seven examples of on-the-ground realities of long-term vulnerability within two clusters: Endangerment: 1 Environmental degradation. 2 Discrimination. 3 Displacement. Impoverishment: 4 Self-seeking public expenditure. 5 Denial of access to resources. 6 Corruption. 7 Siphoning of public money. Examples are presented as vignettes, many contemporary and many rooted in historical contexts, to demonstrate the extent to which “vulnerability drivers” emanate from greed, the misuse of political and commercial power, mismanagement and incompetence amongst other behaviours. Moving forward to the tackling of disaster risk creation, instead of simply seeking disaster risk reduction, requires detailed investigation into these contemporary and historical realities of the causes of vulnerability. That would support the integration of disaster risk reduction within the many wider contexts that foment and perpetuate vulnerability. PMID:22919564

The Good, The Bad and The Ugly: Disaster Risk Reduction (DRR) Versus Disaster Risk Creation (DRC).

PubMed

Lewis, James

2012-06-21

In understanding and trying to reduce the risk from disasters, connections are often articulated amongst poverty, vulnerability, risk, and disasters. These are welcome steps, but the approach taken in top-down international documents is rarely to articulate explicitly that vulnerability accrues from a wide variety of dynamic and long-term processes. Neglecting these processes-and failing to explore their links with poverty, risk, and disasters-tends to encourage disaster risk creation. This paper identifies seven examples of on-the-ground realities of long-term vulnerability within two clusters: Endangerment: 1 Environmental degradation. 2 Discrimination. 3 Displacement. Impoverishment: 4 Self-seeking public expenditure. 5 Denial of access to resources. 6 Corruption. 7 Siphoning of public money. Examples are presented as vignettes, many contemporary and many rooted in historical contexts, to demonstrate the extent to which "vulnerability drivers" emanate from greed, the misuse of political and commercial power, mismanagement and incompetence amongst other behaviours. Moving forward to the tackling of disaster risk creation, instead of simply seeking disaster risk reduction, requires detailed investigation into these contemporary and historical realities of the causes of vulnerability. That would support the integration of disaster risk reduction within the many wider contexts that foment and perpetuate vulnerability.

Telemedicine cardiovascular risk reduction in veterans: The CITIES trial.

PubMed

Bosworth, Hayden B; Olsen, Maren K; McCant, Felicia; Stechuchak, Karen M; Danus, Susanne; Crowley, Matthew J; Goldstein, Karen M; Zullig, Leah L; Oddone, Eugene Z

2018-05-01

Comprehensive programs addressing tailored patient self-management and pharmacotherapy may reduce barriers to cardiovascular disease (CVD) risk reduction. This is a 2-arm (clinical pharmacist specialist-delivered, telehealth intervention and education control) randomized controlled trial including Veterans with poorly controlled hypertension and/or hypercholesterolemia. Primary outcome was Framingham CVD risk score at 6 and 12 months, with systolic blood pressure; diastolic blood pressure; total cholesterol; low-density lipoprotein; high-density lipoprotein; body mass index; and, for those with diabetes, HbA1c as secondary outcomes. Among 428 Veterans, 50% were African American, 85% were men, and 33% had limited health literacy. Relative to the education control group, the clinical pharmacist specialist-delivered intervention did not show a reduction in CVD risk score at 6 months (-1.8, 95% CI -3.9 to 0.3; P = .10) or 12 months (-0.3, 95% CI -2.4 to 1.7; P = .74). No differences were seen in systolic blood pressure, diastolic blood pressure, or low-density lipoprotein at 6 or 12 months. We did observe a significant decline in total cholesterol at 6 months (-7.0, 95% CI -13.4 to -0.6; P = .03) in the intervention relative to education control group. Among patients in the intervention group, 34% received at least 5 of the 12 planned intervention calls and were considered "compliers." A sensitivity analysis of the "complier average causal effect" of intervention compared to control showed a mean difference in CVD risk score reduction of 5.7 (95% CI -12.0 to 0.7) at 6 months and -1.7 (95% CI -7.6 to 4.8) at 12 months. Despite increased access to pharmacist resources, we did not observe significant improvements in CVD risk for patients randomized to the intervention compared to education control over 12 months. However, the intervention may have positive impact among those who actively participate, particularly in the short term. Copyright © 2018. Published by Elsevier

Ethical Responsibility of Governance for Integrating Disaster Risk Reduction with Development

NASA Astrophysics Data System (ADS)

Parkash Gupta, Surya

2015-04-01

The development in the public as well as the private sectors is controlled and regulated, directly or indirectly by the governments at federal, provincial and local levels. If this development goes haphazard and unplanned, without due considerations to environmental constraints and potential hazards; it is likely to cause disasters or may get affected by disasters. Therefore, it becomes an ethical responsibility of the people involved in governance sector to integrate disaster risk reduction with development in their administrative territories through enforcement of appropriate policies, guidelines and regulatory mechanisms. Such mechanisms should address the social, scientific, economic, environmental, and legal requirements that play significant role in planning, implementation of developmental activities as well as disaster management. The paper focuses on defining the ethical responsibilities for the governance sector for integrating disaster risk reduction with development. It highlights the ethical issues with examples from two case studies, one from the Uttarakhand state and the other Odhisa state in India. The case studies illustrates how does it make a difference in disaster risk reduction if the governments own or do not own ethical responsibilities. The paper considers two major disaster events, flash floods in Uttarakhand state and Cyclone Phailin in Odhisa state, that happened during the year 2013. The study points out that it makes a great difference in terms of consequences and response to disasters when ethical responsibilities are owned by the governance sector. The papers attempts to define these ethical responsibilities for integrating disaster risk reduction with development so that the governments can be held accountable for their acts or non-actions.

Willingness-to-accept reductions in HIV risks: conditional economic incentives in Mexico.

PubMed

Galárraga, Omar; Sosa-Rubí, Sandra G; Infante, César; Gertler, Paul J; Bertozzi, Stefano M

2014-01-01

The objective of this study was to measure willingness-to-accept (WTA) reductions in risks for HIV and other sexually transmitted infections (STI) using conditional economic incentives (CEI) among men who have sex with men (MSM), including male sex workers (MSW) in Mexico City. A survey experiment was conducted with 1,745 MSM and MSW (18-25 years of age) who received incentive offers to decide first whether to accept monthly prevention talks and STI testing; and then a second set of offers to accept to stay free of STIs (verified by quarterly biological testing). The survey used random-starting-point and iterative offers. WTA was estimated with a maximum likelihood double-bounded dichotomous choice model. The average acceptance probabilities were: 73.9 % for the monthly model, and 80.4 % for the quarterly model. The incentive-elasticity of participation in the monthly model was 0.222, and 0.515 in the quarterly model. For a combination program with monthly prevention talks, and staying free of curable STI, the implied WTA was USD$ 288 per person per year, but it was lower for MSW: USD$ 156 per person per year. Thus, some of the populations at highest risk of HIV infection (MSM and MSW) seem well disposed to participate in a CEI program for HIV and STI prevention in Mexico. The average WTA estimate is within the range of feasible allocations for prevention in the local context. Given the potential impact, Mexico, a leader in conditional cash transfers for human development and poverty reduction, could extend that successful model to targeted HIV/STI prevention.

Willingness-to-accept reductions in HIV risks: conditional economic incentives in Mexico

PubMed Central

Galárraga, Omar; Sosa-Rubí, Sandra G.; Infante, César; Gertler, Paul J.; Bertozzi, Stefano M.

2014-01-01

The objective of this study was to measure willingness-to-accept (WTA) reductions in risks for HIV and other sexually transmitted infections (STI) using conditional economic incentives (CEI) among men who have sex with men (MSM), including male sex workers (MSW) in Mexico City. A survey experiment was conducted with 1,745 MSM and MSW (18-25 years of age) who received incentive offers to decide first whether to accept monthly prevention talks and STI testing; and then a second set of offers to accept to stay free of STIs (verified by quarterly biological testing). The survey used random-starting-point and iterative offers. WTA was estimated with a maximum likelihood double-bounded dichotomous choice model. The average acceptance probabilities were: 73.9% for the monthly model, and 80.4% for the quarterly model. The incentive-elasticity of participation in the monthly model was 0.222, and it was 0.515 in the quarterly model. For a combination program with monthly prevention talks, and staying free of curable STI, the implied WTA was USD$288 per person per year, but it was lower for MSW: USD$156 per person per year. Thus, some of the populations at highest risk of HIV infection (MSM & MSW) seem well disposed to participate in a CEI program for HIV and STI prevention in Mexico. The average willingness-to-accept estimate is within the range of feasible allocations for prevention in the local context. Given the potential impact, Mexico, a leader in conditional cash transfers for human development and poverty reduction, could extend that successful model for targeted HIV/STI prevention. PMID:23377757

78 FR 28892 - Hazardous Fire Risk Reduction, East Bay Hills, CA

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-16

... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA 2010-0037] Hazardous Fire Risk Reduction, East Bay Hills, CA AGENCY: Federal Emergency Management Agency, DHS. ACTION..., limbing and mowing, thinning, and grazing techniques as appropriate to reduce the risk of fire hazard...

Constructing a holistic approach to disaster risk reduction: the significance of focusing on vulnerability reduction.

PubMed

Palliyaguru, Roshani; Amaratunga, Dilanthi; Baldry, David

2014-01-01

As a result of the increase in natural disaster losses, policy-makers, practitioners, and members of the research community around the world are seeking effective and efficient means of overcoming or minimising them. Although various theoretical constructs are beneficial to understanding the disaster phenomenon and the means of minimising losses, the disaster risk management process becomes less effective if theory and practice are set apart from one another. Consequently, this paper seeks to establish a relationship between two theoretical constructs, 'disaster risk reduction (DRR)' and 'vulnerability reduction', and to develop a holistic approach to DRR with particular reference to improving its applicability in practical settings. It is based on a literature review and on an overall understanding gained through two case studies of post-disaster infrastructure reconstruction projects in Sri Lanka and three expert interviews in Sri Lanka and the United Kingdom. © 2014 The Author(s). Disasters © Overseas Development Institute, 2014.

Impact of comprehensive cardiovascular risk reduction programme on risk factor clustering associated with elevated blood pressure in an Indian industrial population.

PubMed

Jeemon, Panniyammakal; Prabhakaran, Dorairaj; Goenka, Shifalika; Ramakrishnan, Lakshmy; Padmanabhan, Sandosh; Huffman, Mark; Joshi, Prashant; Sivasankaran, Sivasubramonian; Mohan, B V M; Ahmed, F; Ramanathan, Meera; Ahuja, R; Sinha, Nakul; Thankappan, K R; Reddy, K S

2012-04-01

Cardiovascular risk factors clustering associated with blood pressure (BP) has not been studied in the Indian population. This study was aimed at assessing the clustering effect of cardiovascular risk factors with suboptimal BP in Indian population as also the impact of risk reduction interventions. Data from 10543 individuals collected in a nation-wide surveillance programme in India were analysed. The burden of risk factors clustering with blood pressure and coronary heart disease (CHD) was assessed. The impact of a risk reduction programmme on risk factors clustering was prospectively studied in a sub-group. Mean age of participants was 40.9 ± 11.0 yr. A significant linear increase in number of risk factors with increasing blood pressure, irrespective of stratifying using different risk factor thresholds was observed. While hypertension occurred in isolation in 2.6 per cent of the total population, co-existence of hypertension and >3 risk factors was observed in 12.3 per cent population. A comprehensive risk reduction programme significantly reduced the mean number of additional risk factors in the intervention population across the blood pressure groups, while it continued to be high in the control arm without interventions (both within group and between group P<0.001). The proportion of 'low risk phenotype' increased from 13.4 to 19.9 per cent in the intervention population and it was decreased from 27.8 to 10.6 per cent in the control population (P<0.001). The proportion of individuals with hypertension and three more risk factors decreased from 10.6 to 4.7 per cent in the intervention arm while it was increased from 13.3 to 17.8 per cent in the control arm (P<0.001). Our findings showed that cardiovascular risk factors clustered together with elevated blood pressure and a risk reduction programme significantly reduced the risk factors burden.

Sexual health risk reduction interventions for people with severe mental illness: a systematic review.

PubMed

Pandor, Abdullah; Kaltenthaler, Eva; Higgins, Agnes; Lorimer, Karen; Smith, Shubulade; Wylie, Kevan; Wong, Ruth

2015-02-12

Despite variability in sexual activity among people with severe mental illness, high-risk sexual behavior (e.g. unprotected intercourse, multiple partners, sex trade and illicit drug use) is common. Sexual health risk reduction interventions (such as educational and behavioral interventions, motivational exercises, counselling and service delivery), developed and implemented for people with severe mental illness, may improve participants' knowledge, attitudes, beliefs behaviors or practices (including assertiveness skills) and could lead to a reduction in risky sexual behavior. This systematic review evaluates the effectiveness of sexual health risk reduction interventions for people with severe mental illness. Thirteen electronic databases (including MEDLINE, EMBASE and PsycINFO) were searched to August 2014, and supplemented by hand-searching relevant articles and contacting experts. All controlled trials (randomized or non-randomized) comparing the effectiveness of sexual health risk reduction interventions with usual care for individuals living in the community with severe mental illness were included. Outcomes included a range of biological, behavioral and proxy endpoints. Narrative synthesis was used to combine the evidence. Thirteen controlled trials (all from the USA) were included. Although there was no clear and consistent evidence that interventions reduce the total number of sex partners or improved behavioral intentions in sexual risk behavior, positive effects were generally observed in condom use, condom protected intercourse and on measures of HIV knowledge, attitudes to condom use and sexual behaviors and practices. However, the robustness of these findings is low due to the large between study variability, small sample sizes and low-to-moderate quality of included studies. There is insufficient evidence at present to fully support or reject the identified sexual health risk reduction interventions for people with severe mental illness. Given the

HIV RISK REDUCTION INTERVENTIONS AMONG SUBSTANCE-ABUSING REPRODUCTIVE-AGE WOMEN: A SYSTEMATIC REVIEW

PubMed Central

Weissman, Jessica; Kanamori, Mariano; Dévieux, Jessy G.; Trepka, Mary Jo; De La Rosa, Mario

2017-01-01

HIV/AIDS is one of the leading causes of death among reproductive-age women throughout the world, and substance abuse plays a major role in HIV infection. We conducted a systematic review, in accordance with the 2015 Preferred Items for Reporting Systematic Reviews and Meta-analysis tool, to assess HIV risk-reduction intervention studies among reproductive-age women who abuse substances. We initially identified 6,506 articles during our search and, after screening titles and abstracts, examining articles in greater detail, and finally excluding those rated methodologically weak, a total of 10 studies were included in this review. Studies that incorporated behavioral skills training into the intervention and were based on theoretical model(s) were the most effective in general at decreasing sex and drug risk behaviors. Additional HIV risk-reduction intervention research with improved methodological designs is warranted to determine the most efficacious HIV risk-reduction intervention for reproductive-age women who abuse substances. PMID:28467160

Combining Primary Prevention and Risk Reduction Approaches in Sexual Assault Protection Programming.

PubMed

Menning, Chadwick; Holtzman, Mellisa

2015-01-01

The object of this study is to extend prior evaluations of Elemental, a sexual assault protection program that combines primary prevention and risk reduction strategies within a single program. During 2012 and 2013, program group and control group students completed pretest, posttest, and 6-week and 6-month follow-up surveys assessing sexual attitudes and knowledge as well as experiences with assault. The results reinforce previous findings that Elemental is effective in reducing sexual assault risk. Program effects were both direct, in that participation was associated with lower risk of assault, and mediated, in that participation impacted attitudes and beliefs that are empirically linked to risk of later assault. By combining both primary prevention and risk reduction approaches, Elemental is not only effective at reducing incidences of assault, it is also consistent with a number of recent recommendations for directions in sexual assault prevention programming.

Sodium Reduction in Processed Foods in Brazil: Analysis of Food Categories and Voluntary Targets from 2011 to 2017

PubMed Central

Silva, Sara A.; L’Abbé, Mary; Jaime, Patricia C.

2017-01-01

Non-communicable diseases, including cardiovascular diseases, are responsible for over 70% of deaths in Brazil. Currently, over 25% of Brazilian adults are diagnosed as hypertensive; overall, current dietary sodium intake in Brazil (4700 mg/person) is over twice the international recommendations, and 70–90% of adolescents and adults consume excessive sodium. National sodium reduction strategies consider the main dietary sources of sodium to be added salt to foods, foods consumed outside of the household, and sodium in processed foods. The national voluntary strategy for sodium reduction in priority food categories has been continuously monitored over a 6-year period (2011–2017) and there was a significant 8–34% reduction in the average sodium content of over half food categories. Different food categories have undergone differing reductions in sodium over time, aiding gradual biannual targets to allow industries to develop new technologies and consumers to adapt to foods with less salt. By 2017, most products of all food categories had met the regional targets proposed by the Pan American Health Organization, showing that voluntary sodium reduction strategies can potentially contribute to food reformulation. Nevertheless, regulatory approaches may still be necessary in the future in order to reach all food producers and to allow stronger enforcement to meet more stringent regional targets. PMID:28704932

Risk Reduction for HIV-Positive African American and Latino Men with Histories of Childhood Sexual Abuse

PubMed Central

Wyatt, Gail E.; Rivkin, Inna; Ramamurthi, Hema Codathi; Li, Xiaomin; Liu, Honghu

2014-01-01

While the HIV epidemic has disproportionately affected African American and Latino men who have sex with men (MSM), few HIV prevention interventions have focused on African American and Latino men who have sex with both men and women (MSMW). Even fewer interventions target HIV-positive African American and Latino MSM and MSMW with histories of childhood sexual abuse (CSA), a population that may be vulnerable to high-risk sexual behaviors, having multiple sexual partners, and depression. The Men’s Health Project, a small randomized clinical trial, compared the effects of two 6-session interventions, the Sexual Health Intervention for Men (S-HIM), guided by social learning theory and aimed at decreasing high-risk sexual behaviors, number of sexual partners, and depressive symptoms, and a standard health promotion control (SHP).A community sample of 137 HIV-positive gay and non-gay identifying African American and Latino MSM and MSMW with histories of CSA was recruited. Results were based on an “intent to treat” analyses of baseline to post, 3 and 6 month follow-ups. The sample as a whole reported reductions in sexual risk behaviors and number of sexual partners from baseline to post-test, and from the 3 to 6 month follow-ups, although the decrease in sexual risk behavior from baseline to post-test was significant only for S-HIM participants. No significant differences between conditions were reported for depressive symptoms, but the total sample reported a significant decrease at 6 months. These findings highlight the importance of addressing sexual decision-making and psychological adjustment for ethnic men, while being sensitive to CSA histories and sexual minority status, and suggest the need to develop additional strategies to heighten HIV risk reduction over time. PMID:18506611

Health Risk Reduction Programs in Employer-Sponsored Health Plans: Part I—Efficacy

PubMed Central

Rothstein, Mark A.; Harrell, Heather L.

2011-01-01

Objective We sought to determine whether workplace health risk reduction programs (HRRPs) using health risk assessments (HRAs), individually focused risk reduction, and financial incentives succeeded in improving employee health and reducing employer health benefit costs. Methods We reviewed the proprietary HRA available to us and conducted a literature review to determine the efficacy of HRRPs using HRAs, individualized employee interventions, and financial incentives for employee participation. Results There is some evidence that HRRPs in employer-sponsored programs improve measures of employee health, but the results of these studies are somewhat equivocal. Conclusion Employer-sponsored HRRPs may have some benefits, but problems in plan design and in the studies assessing their efficacy complicate drawing conclusions. PMID:19625972

Lower early postnatal oxygen saturation target and risk of ductus arteriosus closure failure.

PubMed

Inomata, Kei; Taniguchi, Shinji; Yonemoto, Hiroki; Inoue, Takeshi; Kawase, Akihiko; Kondo, Yuichi

2016-11-01

Early postnatal hyperoxia is a major risk factor for retinopathy of prematurity (ROP) in extremely premature infants. To reduce the occurrence of ROP, we adopted a lower early postnatal oxygen saturation (SpO 2 ) target range (85-92%) from April 2011. Lower SpO 2 target range, however, may lead to hypoxemia and an increase in the risk of ductus arteriosus (DA) closure failure. The aim of this study was therefore to determine whether a lower SpO 2 target range, during the early postnatal stage, increases the risk of DA closure failure. Infants born at <28 weeks' gestation were enrolled in this study. Oxygen saturation target range during the first postnatal 72 h was 84-100% in study period 1 and 85-92% in period 2. Eighty-two infants were included in period 1, and 61 were included in period 2. The lower oxygen saturation target range increased the occurrence of hypoxemia during the first postnatal 72 h. Prevalence of DA closure failure in period 2 (21%) was significantly higher than that in period 1 (1%). On multivariate logistic regression analysis, the lower oxygen saturation target range was an independent risk factor for DA closure failure. Lower early postnatal oxygen saturation target range increases the risk of DA closure failure. © 2016 Japan Pediatric Society.

Increased importance of methane reduction for a 1.5 degree target

NASA Astrophysics Data System (ADS)

Collins, William J.; Webber, Christopher P.; Cox, Peter M.; Huntingford, Chris; Lowe, Jason; Sitch, Stephen; Chadburn, Sarah E.; Comyn-Platt, Edward; Harper, Anna B.; Hayman, Garry; Powell, Tom

2018-04-01

To understand the importance of methane on the levels of carbon emission reductions required to achieve temperature goals, a processed-based approach is necessary rather than reliance on the transient climate response to emissions. We show that plausible levels of methane (CH4) mitigation can make a substantial difference to the feasibility of achieving the Paris climate targets through increasing the allowable carbon emissions. This benefit is enhanced by the indirect effects of CH4 on ozone (O3). Here the differing effects of CH4 and CO2 on land carbon storage, including the effects of surface O3, lead to an additional increase in the allowable carbon emissions with CH4 mitigation. We find a simple robust relationship between the change in the 2100 CH4 concentration and the extra allowable cumulative carbon emissions between now and 2100 (0.27 ± 0.05 GtC per ppb CH4). This relationship is independent of modelled climate sensitivity and precise temperature target, although later mitigation of CH4 reduces its value and thus methane reduction effectiveness. Up to 12% of this increase in allowable emissions is due to the effect of surface ozone. We conclude early mitigation of CH4 emissions would significantly increase the feasibility of stabilising global warming below 1.5 °C, alongside having co-benefits for human and ecosystem health.

Estimated cardiovascular relative risk reduction from fixed-dose combination pill (polypill) treatment in a wide range of patients with a moderate risk of cardiovascular disease.

PubMed

Lafeber, Melvin; Webster, Ruth; Visseren, Frank Lj; Bots, Michiel L; Grobbee, Diederick E; Spiering, W; Rodgers, Anthony

2016-08-01

Recent data indicate that fixed-dose combination (FDC) pills, polypills, can produce sizeable risk factor reductions. There are very few published data on the consistency of the effects of a polypill in different patient populations. It is unclear for example whether the effects of the polypill are mainly driven by the individuals with high individual risk factor levels. The aim of the present study is to examine whether baseline risk factor levels modify the effect of polypill treatment on low-density lipoprotein (LDL)-cholesterol, blood pressure (BP), calculated cardiovascular relative risk reduction and adverse events. This paper describes a post-hoc analysis of a randomised, placebo-controlled trial of a polypill (containing aspirin 75 mg, simvastatin 20 mg, lisinopril 10 mg and hydrochlorothiazide 12.5 mg) in 378 individuals without an indication for any component of the polypill, but who had an estimated five-year risk for cardiovascular disease ≥7.5%. The outcomes considered were effect modification by baseline risk factor levels on change in LDL-cholesterol, systolic BP, calculated cardiovascular relative risk reduction and adverse events. The mean LDL-cholesterol in the polypill group was 0.9 mmol/l (95% confidence interval (CI): 0.8-1.0) lower compared with the placebo group during follow-up. Those with a baseline LDL-cholesterol >3.6 mmol/l achieved a greater absolute LDL-cholesterol reduction with the polypill compared with placebo, than patients with an LDL-cholesterol ≤3.6 mmol/l (-1.1 versus -0.6 mmol/l, respectively). The mean systolic BP was 10 mm Hg (95% CI: 8-12) lower in the polypill group. In participants with a baseline systolic BP >135 mm Hg the polypill resulted in a greater absolute systolic BP reduction with the polypill compared with placebo, than participants with a systolic BP ≤ 135 mm Hg (-12 versus -7 mm Hg, respectively). Calculated from individual risk factor reductions, the mean cardiovascular

Barriers to human immunodeficiency virus related risk reduction among male street prostitutes.

PubMed

Simon, P M; Morse, E V; Balson, P M; Osofsky, H J; Gaumer, H R

1993-01-01

Two hundred eleven male street prostitutes between the ages of 18 and 51 years were interviewed and tested for antibodies to the human immunodeficiency virus (HIV). Economic, social, and emotional barriers to the reduction of HIV-related risk behavior were examined within the context of several concepts present in the Health Belief Model (HBM). Three lifestyle factors were found to function as barriers to engaging in risk reduction behavior. Subjects who were more economically dependent on prostitution, perceived less control over the hustling encounter, and reported increased pleasure from sexual activity with their customers were more likely to engage in risk-taking behavior. Prostitutes' perception of the severity of HIV infection was not significantly associated with their risk behavior. Unexpected findings indicated that increases in perceived susceptibility to HIV and perceived benefit of condom use for HIV prevention were significantly related to increased risk-taking behavior. Practical applications of findings in the design and implementation of future HIV-related preventive health education programs are discussed.

Relationship among food-safety knowledge, beliefs, and risk-reduction behavior in university students in Japan.

PubMed

Takeda, Sayaka; Akamatsu, Rie; Horiguchi, Itsuko; Marui, Eiji

2011-01-01

To identify whether university students who have both food-safety knowledge and beliefs perform risk-reduction behaviors. Cross-sectional research using a questionnaire that included food-safety knowledge, perceptions, risk-reduction behavior, stages for the selection of safer food based on the Transtheoretical Model, and demographic characteristics. Four universities in eastern Japan and 2 universities in western Japan. University students (n = 799). Food-safety knowledge, beliefs, and risk-reduction behaviors. Answers on measures assessing risk perception and food-safety knowledge were combined to form 4 groups of participants. Relationships among demographic characteristics, the 4 groups, risk-reduction behaviors, stage of change, and severity and susceptibility were assessed. The proportion of students who had more knowledge of food safety and a belief that "there are no 100% safe food items" was high in the group that frequently performed risk-reduction behaviors, as it was in the group who had taken a basic class about food or health care and who had, or were working toward, a food or nutrition qualification. University students who thought that there were no 100% safe food items and who had more knowledge about food safety were more likely to confirm food-safety information when selecting food. Copyright © 2011 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Reducing drinking to cope among heavy episodic drinking college women: Secondary outcomes of a web-based combined alcohol use and sexual assault risk reduction intervention.

PubMed

Gilmore, Amanda K; Bountress, Kaitlin E

2016-10-01

College students are at high risk for engaging in heavy episodic drinking and for experiencing sexual assault. Further, drinking to cope with anxiety motives are associated with sexual assault history and drinking, and thus should be examined when targeting both sexual assault and drinking in college populations. The current study examined the effectiveness of decreasing coping with anxiety drinking motives among underage heavy episodic drinking college women (n=264). Results indicate that a web-based combined alcohol use and sexual assault risk reduction intervention was effective at decreasing drinking to cope with anxiety motives among those with stronger drinking to cope with anxiety motives at baseline. However, the alcohol-only and sexual assault-only interventions were not. Decreases in drinking motives were associated with decreases in heavy episodic drinking. This suggests that alcohol interventions in college populations may not be effectively targeting drinking motives and this preliminary study provides evidence indicating that targeting alcohol and sexual assault together may decrease drinking to cope motives among a high risk population. Copyright © 2016 Elsevier Ltd. All rights reserved.

Risk maps for targeting exotic plant pest detection programs in the United States

Treesearch

R.D. Magarey; D.M. Borchert; J.S. Engle; M Garcia-Colunga; Frank H. Koch; et al

2011-01-01

In the United States, pest risk maps are used by the Cooperative Agricultural Pest Survey for spatial and temporal targeting of exotic plant pest detection programs. Methods are described to create standardized host distribution, climate and pathway risk maps for the top nationally ranked exotic pest targets. Two examples are provided to illustrate the risk mapping...

Walking versus running for hypertension, cholesterol, and diabetes mellitus risk reduction.

PubMed

Williams, Paul T; Thompson, Paul D

2013-05-01

To test whether equivalent energy expenditure by moderate-intensity (eg, walking) and vigorous-intensity exercise (eg, running) provides equivalent health benefits. We used the National Runners' (n=33 060) and Walkers' (n=15 945) Health Study cohorts to examine the effect of differences in exercise mode and thereby exercise intensity on coronary heart disease (CHD) risk factors. Baseline expenditure (metabolic equivant hours per day [METh/d]) was compared with self-reported, physician-diagnosed incident hypertension, hypercholesterolemia, diabetes mellitus, and CHD during 6.2 years follow-up. Running significantly decreased the risks for incident hypertension by 4.2% (P<10(-7)), hypercholesterolemia by 4.3% (P<10(-14)), diabetes mellitus by 12.1% (P<10(-5)), and CHD by 4.5% per METh/d (P=0.05). The corresponding reductions for walking were 7.2% (P<10(-6)), 7.0% (P<10(-8)), 12.3% (P<10(-4)), and 9.3% (P=0.01). Relative to <1.8 METh/d, the risk reductions for 1.8 to 3.6, 3.6 to 5.4, 5.4 to 7.2, and ≥7.2 METh/d were as follows: (1) 10.1%, 17.7%, 25.1%, and 34.9% from running and 14.0%, 23.8%, 21.8%, and 38.3% from walking for hypercholesterolemia; (2) 19.7%, 19.4%, 26.8%, and 39.8% from running and 14.7%, 19.1%, 23.6%, and 13.3% from walking for hypertension; and (3) 43.5%, 44.1%, 47.7%, and 68.2% from running, and 34.1%, 44.2% and 23.6% from walking for diabetes mellitus (walking >5.4 METh/d excluded for too few cases). The risk reductions were not significantly different for running than walking for diabetes mellitus (P=0.94), hypertension (P=0.06), or CHD (P=0.26), and only marginally greater for walking than running for hypercholesterolemia (P=0.04). Equivalent energy expenditures by moderate (walking) and vigorous (running) exercise produced similar risk reductions for hypertension, hypercholesterolemia, diabetes mellitus, and possibly CHD.

Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs.

PubMed

Cummings, Steven R; Karpf, David B; Harris, Fran; Genant, Harry K; Ensrud, Kristine; LaCroix, Andrea Z; Black, Dennis M

2002-03-01

To estimate how much the improvement in bone mass accounts for the reduction in risk of vertebral fracture that has been observed in randomized trials of antiresorptive treatments for osteoporosis. After a systematic search, we conducted a meta-analysis of 12 trials to describe the relation between improvement in spine bone mineral density and reduction in risk of vertebral fracture in postmenopausal women. We also used logistic models to estimate the proportion of the reduction in risk of vertebral fracture observed with alendronate in the Fracture Intervention Trial that was due to improvement in bone mineral density. Across the 12 trials, a 1% improvement in spine bone mineral density was associated with a 0.03 decrease (95% confidence interval [CI]: 0.02 to 0.05) in the relative risk (RR) of vertebral fracture. The reductions in risk were greater than predicted from improvement in bone mineral density; for example, the model estimated that treatments predicted to reduce fracture risk by 20% (RR = 0.80), based on improvement in bone mineral density, actually reduce the risk of fracture by about 45% (RR = 0.55). In the Fracture Intervention Trial, improvement in spine bone mineral density explained 16% (95% CI: 11% to 27%) of the reduction in the risk of vertebral fracture with alendronate. Improvement in spine bone mineral density during treatment with antiresorptive drugs accounts for a predictable but small part of the observed reduction in the risk of vertebral fracture.

Relationship among Food-Safety Knowledge, Beliefs, and Risk-Reduction Behavior in University Students in Japan

ERIC Educational Resources Information Center

Takeda, Sayaka; Akamatsu, Rie; Horiguchi, Itsuko; Marui, Eiji

2011-01-01

Objective: To identify whether university students who have both food-safety knowledge and beliefs perform risk-reduction behaviors. Design: Cross-sectional research using a questionnaire that included food-safety knowledge, perceptions, risk-reduction behavior, stages for the selection of safer food based on the Transtheoretical Model, and…

Modifications to risk-targeted seismic design maps for subduction and near-fault hazards

USGS Publications Warehouse

Liel, Abbie B.; Luco, Nicolas; Raghunandan, Meera; Champion, C.; Haukaas, Terje

2015-01-01

ASCE 7-10 introduced new seismic design maps that define risk-targeted ground motions such that buildings designed according to these maps will have 1% chance of collapse in 50 years. These maps were developed by iterative risk calculation, wherein a generic building collapse fragility curve is convolved with the U.S. Geological Survey hazard curve until target risk criteria are met. Recent research shows that this current approach may be unconservative at locations where the tectonic environment is much different than that used to develop the generic fragility curve. This study illustrates how risk-targeted ground motions at selected sites would change if generic building fragility curve and hazard assessment were modified to account for seismic risk from subduction earthquakes and near-fault pulses. The paper also explores the difficulties in implementing these changes.

Social Participation and Disaster Risk Reduction Behaviors in Tsunami Prone Areas.

PubMed

Witvorapong, Nopphol; Muttarak, Raya; Pothisiri, Wiraporn

2015-01-01

This paper examines the relationships between social participation and disaster risk reduction actions. A survey of 557 households in tsunami prone areas in Phang Nga, Thailand was conducted following the 2012 Indian Ocean earthquakes. We use a multivariate probit model to jointly estimate the likelihood of undertaking three responses to earthquake and tsunami hazards (namely, (1) following disaster-related news closely, (2) preparing emergency kits and/or having a family emergency plan, and (3) having an intention to migrate) and community participation. We find that those who experienced losses from the 2004 tsunami are more likely to participate in community activities and respond to earthquake hazards. Compared to men, women are more likely to prepare emergency kits and/or have an emergency plan and have a greater intention to migrate. Living in a community with a higher proportion of women with tertiary education increases the probability of engaging in community activities and carrying out disaster risk reduction measures. Individuals who participate in village-based activities are 5.2% more likely to undertake all three risk reduction actions compared to those not engaging in community activities. This implies that encouraging participation in community activities can have positive externalities in disaster mitigation.

Social Participation and Disaster Risk Reduction Behaviors in Tsunami Prone Areas

PubMed Central

Witvorapong, Nopphol; Muttarak, Raya; Pothisiri, Wiraporn

2015-01-01

This paper examines the relationships between social participation and disaster risk reduction actions. A survey of 557 households in tsunami prone areas in Phang Nga, Thailand was conducted following the 2012 Indian Ocean earthquakes. We use a multivariate probit model to jointly estimate the likelihood of undertaking three responses to earthquake and tsunami hazards (namely, (1) following disaster-related news closely, (2) preparing emergency kits and/or having a family emergency plan, and (3) having an intention to migrate) and community participation. We find that those who experienced losses from the 2004 tsunami are more likely to participate in community activities and respond to earthquake hazards. Compared to men, women are more likely to prepare emergency kits and/or have an emergency plan and have a greater intention to migrate. Living in a community with a higher proportion of women with tertiary education increases the probability of engaging in community activities and carrying out disaster risk reduction measures. Individuals who participate in village-based activities are 5.2% more likely to undertake all three risk reduction actions compared to those not engaging in community activities. This implies that encouraging participation in community activities can have positive externalities in disaster mitigation. PMID:26153891

HIV testing behaviour and use of risk reduction strategies by HIV risk category among MSM in Vancouver.

PubMed

Bogowicz, Paul; Moore, David; Kanters, Steve; Michelow, Warren; Robert, Wayne; Hogg, Robert; Gustafson, Réka; Gilbert, Mark

2016-03-01

We carried out an analysis of a serobehavioural study of men who have sex with men >19 years of age in Vancouver, Canada to examine HIV testing behaviour and use of risk reduction strategies by HIV risk category, as defined by routinely gathered clinical data. We restricted our analysis to those who self-identified as HIV-negative, completed a questionnaire, and provided a dried blood spot sample. Of 842 participants, 365 (43.3%) were categorised as lower-risk, 245 (29.1%) as medium-risk and 232 (27.6%) as higher-risk. The prevalence of undiagnosed HIV infection was low (lower 0.8%, medium 3.3%, higher 3.9%; p = 0.032). Participants differed by risk category in terms of having had an HIV test in the previous year (lower 46.5%, medium 54.6%, higher 67.0%; p < 0.001) and in their use of serosorting (lower 23.3%, medium 48.3%, higher 43.1%; p < 0.001) and only having sex with HIV-positive men if those men had low viral loads or were taking HIV medication (lower 5.1%, medium 4.8%, higher 10.9%; p = 0.021) as risk reduction strategies. These findings speak to the need to consider segmented health promotion services for men who have sex with men with differing risk profiles. Risk stratification could be used to determine who might benefit from tailored multiple health promotion interventions, including HIV pre-exposure prophylaxis. © The Author(s) 2016.

Will the European Union reach the United Nations Millennium declaration target of a 50% reduction of tuberculosis mortality between 1990 and 2015?

PubMed

van der Werf, Marieke J; Bonfigli, Sandro; Hruba, Frantiska

2017-07-06

The Millennium Development Goals (MDG) provide targets for 2015. MDG 6 includes a target to reduce the tuberculosis (TB) death rate by 50% compared with 1990. We aimed to assess whether this target was reached by the European Union (EU) and European Economic Area countries. We used Eurostat causes of death data to assess whether the target was reached in the EU. We calculated the reduction in reported and adjusted death rates and the annual average percentage decline based on the available data. Between 1999 and 2014, the TB death rate decreased by 50%, the adjusted death rate by 56% and the annual average percentage decline was 5.43% (95% confidence interval 4.94-6.74) for the EU. Twenty of 26 countries reporting >5 TB deaths in the first reporting year reached the target of 50% reduction in adjusted death rate. The EU reached the MDG target of a 50% reduction of the TB death rate and also the annual average percentage decline was larger than the 2.73% needed to reach the target. The World Health Organization 'End TB Strategy' requires a further reduction of the number of TB deaths of 35% by 2020 compared to 2015, which will challenge TB prevention and care services in the EU.

Body contouring surgery following bariatric surgery and dietetically induced massive weight reduction: a risk analysis.

PubMed

de Kerviler, S; Hüsler, R; Banic, A; Constantinescu, M A

2009-05-01

This study analyzed the impact of weight reduction method, preoperative, and intraoperative variables on the outcome of reconstructive body contouring surgery following massive weight reduction. All patients presenting with a maximal BMI >/=35 kg/m(2) before weight reduction who underwent body contouring surgery of the trunk following massive weight loss (excess body mass index loss (EBMIL) >/= 30%) between January 2002 and June 2007 were retrospectively analyzed. Incomplete records or follow-up led to exclusion. Statistical analysis focused on weight reduction method and pre-, intra-, and postoperative risk factors. The outcome was compared to current literature results. A total of 104 patients were included (87 female and 17 male; mean age 47.9 years). Massive weight reduction was achieved through bariatric surgery in 62 patients (59.6%) and dietetically in 42 patients (40.4%). Dietetically achieved excess body mass index loss (EBMIL) was 94.20% and in this cohort higher than surgically induced reduction EBMIL 80.80% (p < 0.01). Bariatric surgery did not present increased risks for complications for the secondary body contouring procedures. The observed complications (26.9%) were analyzed for risk factors. Total tissue resection weight was a significant risk factor (p < 0.05). Preoperative BMI had an impact on infections (p < 0.05). No impact on the postoperative outcome was detected in EBMIL, maximal BMI, smoking, hemoglobin, blood loss, body contouring technique or operation time. Corrective procedures were performed in 11 patients (10.6%). The results were compared to recent data. Bariatric surgery does not increase risks for complications in subsequent body contouring procedures when compared to massive dietetic weight reduction.

2nd Generation RLV Risk Reduction Definition Program: Pratt & Whitney Propulsion Risk Reduction Requirements Program (TA-3 & TA-4)

NASA Technical Reports Server (NTRS)

Matlock, Steve

2001-01-01

This is the final report and addresses all of the work performed on this program. Specifically, it covers vehicle architecture background, definition of six baseline engine cycles, reliability baseline (space shuttle main engine QRAS), and component level reliability/performance/cost for the six baseline cycles, and selection of 3 cycles for further study. This report further addresses technology improvement selection and component level reliability/performance/cost for the three cycles selected for further study, as well as risk reduction plans, and recommendation for future studies.

A Contextualized Approach to Faith-Based HIV Risk Reduction for African American Women.

PubMed

Stewart, Jennifer M; Rogers, Christopher K; Bellinger, Dawn; Thompson, Keitra

2016-07-01

HIV/AIDS has a devastating impact on African Americans, particularly women and young adults. We sought to characterize risks, barriers, and content and delivery needs for a faith-based intervention to reduce HIV risk among African American women ages 18 to 25. In a convergent parallel mixed methods study, we conducted four focus groups (n = 38) and surveyed 71 young adult women. Data were collected across four African American churches for a total of 109 participants. We found the majority of women in this sample were engaged in behaviors that put them at risk for contracting HIV, struggled with religiously based barriers and matters of sexuality, and had a desire to incorporate their intimate relationships, parenting, and financial burdens into faith-based HIV risk-reduction interventions. Incorporating additional social context-related factors into HIV risk-reduction interventions for young African American women is critical to adapting and developing HIV interventions to reduce risk among young adult women in faith settings. © The Author(s) 2016.

Reduction of Systemic Risk by Means of Pigouvian Taxation

PubMed Central

Zlatić, Vinko; Gabbi, Giampaolo; Abraham, Hrvoje

2015-01-01

We analyze the possibility of reduction of systemic risk in financial markets through Pigouvian taxation of financial institutions, which is used to support the rescue fund. We introduce the concept of the cascade risk with a clear operational definition as a subclass and a network related measure of the systemic risk. Using financial networks constructed from real Italian money market data and using realistic parameters, we show that the cascade risk can be substantially reduced by a small rate of taxation and by means of a simple strategy of the money transfer from the rescue fund to interbanking market subjects. Furthermore, we show that while negative effects on the return on investment (ROI) are direct and certain, an overall positive effect on risk adjusted return on investments (ROI RA) is visible. Please note that the taxation is introduced as a monetary/regulatory, not as a _scal measure, as the term could suggest. The rescue fund is implemented in a form of a common reserve fund. PMID:26177351

Reduction of Systemic Risk by Means of Pigouvian Taxation.

PubMed

Zlatić, Vinko; Gabbi, Giampaolo; Abraham, Hrvoje

2015-01-01

We analyze the possibility of reduction of systemic risk in financial markets through Pigouvian taxation of financial institutions, which is used to support the rescue fund. We introduce the concept of the cascade risk with a clear operational definition as a subclass and a network related measure of the systemic risk. Using financial networks constructed from real Italian money market data and using realistic parameters, we show that the cascade risk can be substantially reduced by a small rate of taxation and by means of a simple strategy of the money transfer from the rescue fund to interbanking market subjects. Furthermore, we show that while negative effects on the return on investment (ROI) are direct and certain, an overall positive effect on risk adjusted return on investments (ROIRA) is visible. Please note that the taxation is introduced as a monetary/regulatory, not as a _scal measure, as the term could suggest. The rescue fund is implemented in a form of a common reserve fund.

Case Study of Cardiovascular Risk Reduction in the Northwest Region and TRICARE Region 11

DTIC Science & Technology

2003-11-01

and TRICARE Region 11. The second employee is not directly hired for cardiovascular risk reduction , but for tobacco cessation classes and consultation...Canadians with diabetes mellitus . Advances in Cardiovascular Risk Reduction 67 Experimental Medicine and Biology, 373-380...does not display a currently valid OMB control number. 1. REPORT DATE JUN 2003 2 . REPORT TYPE Final 3. DATES COVERED Jul 2002 - Jul 2003 4

Guidelines for contingency planning NASA (National Aeronautics and Space Administration) ADP security risk reduction decision studies

NASA Technical Reports Server (NTRS)

Tompkins, F. G.

1984-01-01

Guidance is presented to NASA Computer Security Officials for determining the acceptability or unacceptability of ADP security risks based on the technical, operational and economic feasibility of potential safeguards. The risk management process is reviewed as a specialized application of the systems approach to problem solving and information systems analysis and design. Reporting the results of the risk reduction analysis to management is considered. Report formats for the risk reduction study are provided.

Breast cancer prevention knowledge, beliefs, and information sources between non-Hispanic and Hispanic college women for risk reduction focus.

PubMed

Kratzke, Cynthia; Amatya, Anup; Vilchis, Hugo

2015-02-01

Although growing research focuses on breast cancer screenings, little is known about breast cancer prevention with risk reduction awareness for ethnic differences among college-age women. This study examined breast cancer prevention knowledge, beliefs, and information sources between non-Hispanic and Hispanic college women. Using a cross-sectional study, women at a university in the Southwest completed a 51-item survey about breast cancer risk factors, beliefs, and media and interpersonal information sources. The study was guided by McGuire's Input Output Persuasion Model. Of the 546 participants, non-Hispanic college women (n = 277) and Hispanic college women (n = 269) reported similar basic knowledge levels of modifiable breast cancer risk factors for alcohol consumption (52 %), obesity (72 %), childbearing after age 35 (63 %), and menopausal hormone therapy (68 %) using bivariate analyses. Most common information sources were Internet (75 %), magazines (69 %), provider (76 %) and friends (61 %). Least common sources were radio (44 %), newspapers (34 %), and mothers (36 %). Non-Hispanic college women with breast cancer family history were more likely to receive information from providers, friends, and mothers. Hispanic college women with a breast cancer family history were more likely to receive information from their mothers. Breast cancer prevention education for college women is needed to include risk reduction for modifiable health behavior changes as a new focus. Health professionals may target college women with more information sources including the Internet or apps.

Propulsion Risk Reduction Activities for Non-Toxic Cryogenic Propulsion

NASA Technical Reports Server (NTRS)

Smith, Timothy D.; Klem, Mark D.; Fisher, Kenneth

2010-01-01

The Propulsion and Cryogenics Advanced Development (PCAD) Project s primary objective is to develop propulsion system technologies for non-toxic or "green" propellants. The PCAD project focuses on the development of non-toxic propulsion technologies needed to provide necessary data and relevant experience to support informed decisions on implementation of non-toxic propellants for space missions. Implementation of non-toxic propellants in high performance propulsion systems offers NASA an opportunity to consider other options than current hypergolic propellants. The PCAD Project is emphasizing technology efforts in reaction control system (RCS) thruster designs, ascent main engines (AME), and descent main engines (DME). PCAD has a series of tasks and contracts to conduct risk reduction and/or retirement activities to demonstrate that non-toxic cryogenic propellants can be a feasible option for space missions. Work has focused on 1) reducing the risk of liquid oxygen/liquid methane ignition, demonstrating the key enabling technologies, and validating performance levels for reaction control engines for use on descent and ascent stages; 2) demonstrating the key enabling technologies and validating performance levels for liquid oxygen/liquid methane ascent engines; and 3) demonstrating the key enabling technologies and validating performance levels for deep throttling liquid oxygen/liquid hydrogen descent engines. The progress of these risk reduction and/or retirement activities will be presented.

The SAFRR (Science Application for Risk Reduction) Tsunami Scenario

USGS Publications Warehouse

Ross, Stephanie L.; Jones, Lucile M.

2013-01-01

The Science Application for Risk Reduction (SAFRR) tsunami scenario depicts a hypothetical but plausible tsunami created by an earthquake offshore from the Alaska Peninsula and its impacts on the California coast. The tsunami scenario is a collaboration between the U.S. Geological Survey (USGS), the California Geological Survey (CGS), the California Governor’s Office of Emergency Services (Cal OES), the National Oceanic and Atmospheric Administration (NOAA), other Federal, State, County, and local agencies, private companies, and academic and other institutions. This document presents evidence for past tsunamis, the scientific basis for the source, likely inundation areas, current velocities in key ports and harbors, physical damage and repair costs, economic consequences, environmental and ecological impacts, social vulnerability, emergency management and evacuation challenges, and policy implications for California associated with this hypothetical tsunami. We also discuss ongoing mitigation efforts by the State of California and new communication products. The intended users are those who need to make mitigation decisions before future tsunamis, and those who will need to make rapid decisions during tsunami events. The results of the tsunami scenario will help managers understand the context and consequences of their decisions and how they may improve preparedness and response. An evaluation component will assess the effectiveness of the scenario process for target stakeholders in a separate report to improve similar efforts in the future.

Non-Targeted Effects Models Predict Significantly Higher Mars Mission Cancer Risk than Targeted Effects Models

DOE PAGES

Cucinotta, Francis A.; Cacao, Eliedonna

2017-05-12

Cancer risk is an important concern for galactic cosmic ray (GCR) exposures, which consist of a wide-energy range of protons, heavy ions and secondary radiation produced in shielding and tissues. Relative biological effectiveness (RBE) factors for surrogate cancer endpoints in cell culture models and tumor induction in mice vary considerable, including significant variations for different tissues and mouse strains. Many studies suggest non-targeted effects (NTE) occur for low doses of high linear energy transfer (LET) radiation, leading to deviation from the linear dose response model used in radiation protection. Using the mouse Harderian gland tumor experiment, the only extensive data-setmore » for dose response modelling with a variety of particle types (>4), for the first-time a particle track structure model of tumor prevalence is used to investigate the effects of NTEs in predictions of chronic GCR exposure risk. The NTE model led to a predicted risk 2-fold higher compared to a targeted effects model. The scarcity of data with animal models for tissues that dominate human radiation cancer risk, including lung, colon, breast, liver, and stomach, suggest that studies of NTEs in other tissues are urgently needed prior to long-term space missions outside the protection of the Earth’s geomagnetic sphere.« less

Non-Targeted Effects Models Predict Significantly Higher Mars Mission Cancer Risk than Targeted Effects Models

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cucinotta, Francis A.; Cacao, Eliedonna

Cancer risk is an important concern for galactic cosmic ray (GCR) exposures, which consist of a wide-energy range of protons, heavy ions and secondary radiation produced in shielding and tissues. Relative biological effectiveness (RBE) factors for surrogate cancer endpoints in cell culture models and tumor induction in mice vary considerable, including significant variations for different tissues and mouse strains. Many studies suggest non-targeted effects (NTE) occur for low doses of high linear energy transfer (LET) radiation, leading to deviation from the linear dose response model used in radiation protection. Using the mouse Harderian gland tumor experiment, the only extensive data-setmore » for dose response modelling with a variety of particle types (>4), for the first-time a particle track structure model of tumor prevalence is used to investigate the effects of NTEs in predictions of chronic GCR exposure risk. The NTE model led to a predicted risk 2-fold higher compared to a targeted effects model. The scarcity of data with animal models for tissues that dominate human radiation cancer risk, including lung, colon, breast, liver, and stomach, suggest that studies of NTEs in other tissues are urgently needed prior to long-term space missions outside the protection of the Earth’s geomagnetic sphere.« less

Quasi-Experimental Evaluation of the Effectiveness of a Large-Scale Readmission Reduction Program.

PubMed

Jenq, Grace Y; Doyle, Margaret M; Belton, Beverly M; Herrin, Jeph; Horwitz, Leora I

2016-05-01

Feasibility, effectiveness, and sustainability of large-scale readmission reduction efforts are uncertain. The Greater New Haven Coalition for Safe Transitions and Readmission Reductions was funded by the Center for Medicare & Medicaid Services (CMS) to reduce readmissions among all discharged Medicare fee-for-service (FFS) patients. To evaluate whether overall Medicare FFS readmissions were reduced through an intervention applied to high-risk discharge patients. This quasi-experimental evaluation took place at an urban academic medical center. Target discharge patients were older than 64 years with Medicare FFS insurance, residing in nearby zip codes, and discharged alive to home or facility and not against medical advice or to hospice; control discharge patients were older than 54 years with the same zip codes and discharge disposition but without Medicare FFS insurance if older than 64 years. High-risk target discharge patients were selectively enrolled in the program. Personalized transitional care, including education, medication reconciliation, follow-up telephone calls, and linkage to community resources. We measured the 30-day unplanned same-hospital readmission rates in the baseline period (May 1, 2011, through April 30, 2012) and intervention period (October 1, 2012, through May 31, 2014). We enrolled 10 621 (58.3%) of 18 223 target discharge patients (73.9% of discharge patients screened as high risk) and included all target discharge patients in the analysis. The mean (SD) age of the target discharge patients was 79.7 (8.8) years. The adjusted readmission rate decreased from 21.5% to 19.5% in the target population and from 21.1% to 21.0% in the control population, a relative reduction of 9.3%. The number needed to treat to avoid 1 readmission was 50. In a difference-in-differences analysis using a logistic regression model, the odds of readmission in the target population decreased significantly more than that of the control population in the

The reduction of gunshot noise and auditory risk through the use of firearm suppressors and low-velocity ammunition.

PubMed

Murphy, William J; Flamme, Gregory A; Campbell, Adam R; Zechmann, Edward L; Tasko, Stephen M; Lankford, James E; Meinke, Deanna K; Finan, Donald S; Stewart, Michael

2018-02-01

This research assessed the reduction of peak levels, equivalent energy and sound power of firearm suppressors. The first study evaluated the effect of three suppressors at four microphone positions around four firearms. The second study assessed the suppressor-related reduction of sound power with a 3 m hemispherical microphone array for two firearms. The suppressors reduced exposures at the ear between 17 and 24 dB peak sound pressure level and reduced the 8 h equivalent A-weighted energy between 9 and 21 dB depending upon the firearm and ammunition. Noise reductions observed for the instructor's position about a metre behind the shooter were between 20 and 28 dB peak sound pressure level and between 11 and 26 dB L Aeq,8h . Firearm suppressors reduced the measured sound power levels between 2 and 23 dB. Sound power reductions were greater for the low-velocity ammunition than for the same firearms fired with high-velocity ammunition due to the effect of N-waves produced by a supersonic bullet. Firearm suppressors may reduce noise exposure, and the cumulative exposures of suppressed firearms can still present a significant hearing risk. Therefore, firearm users should always wear hearing protection whenever target shooting or hunting.

41 CFR 102-80.55 - Are Federal agencies responsible for managing the execution of risk reduction projects?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Management Risks and Risk Reduction Strategies § 102-80.55 Are Federal agencies responsible for managing the... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Are Federal agencies responsible for managing the execution of risk reduction projects? 102-80.55 Section 102-80.55 Public...

Economic evaluation of targeted cancer interventions: critical review and recommendations.

PubMed

Elkin, Elena B; Marshall, Deborah A; Kulin, Nathalie A; Ferrusi, Ilia L; Hassett, Michael J; Ladabaum, Uri; Phillips, Kathryn A

2011-10-01

Scientific advances have improved our ability to target cancer interventions to individuals who will benefit most and spare the risks and costs to those who will derive little benefit or even be harmed. Several approaches are currently used for targeting interventions for cancer risk reduction, screening, and treatment, including risk prediction algorithms for identifying high-risk subgroups and diagnostic tests for tumor markers and germline genetic mutations. Economic evaluation can inform decisions about the use of targeted interventions, which may be more costly than traditional strategies. However, assessing the impact of a targeted intervention on costs and health outcomes requires explicit consideration of the method of targeting. In this study, we describe the importance of this principle by reviewing published cost-effectiveness analyses of targeted interventions in breast cancer. Few studies we identified explicitly evaluated the relationships among the method of targeting, the accuracy of the targeting test, and outcomes of the targeted intervention. Those that did found that characteristics of targeting tests had a substantial impact on outcomes. We posit that the method of targeting and the outcomes of a targeted intervention are inextricably linked and recommend that cost-effectiveness analyses of targeted interventions explicitly consider costs and outcomes of the method of targeting.

Reducing substance use and risky sexual behaviour among drug users in Durban, South Africa: Assessing the impact of community-level risk-reduction interventions.

PubMed

Parry, C D H; Carney, T; Petersen Williams, P

2017-12-01

Alcohol and other drug (AOD) use is increasingly recognised as having a direct and indirect effect on the transmission of human immunodeficiency virus (HIV). However, there is evidence to suggest that drug- and sex-related HIV risk-reduction interventions targeted at drug users within drug treatment centres or via community outreach efforts can lead to positive health outcomes. This study aimed to test whether a community-level intervention aimed at AOD users has an impact on risky AOD use and sexual risk behaviour. In 2007, in collaboration with a local non-governmental organisation (NGO) in Durban, an initiative was begun to implement a number of harm reduction strategies for injection and non-injection drug users. The NGO recruited peer outreach workers who received intensive initial training, which was followed by six-monthly monitoring and evaluation of their performance. Participants had to be 16 years of age or older, and self-reported alcohol and/or drug users. Peer outreach workers completed a face-to-face baseline questionnaire with participants which recorded risk behaviours and a risk-reduction plan was developed with participants which consisted of reducing injection (if applicable) and non-injection drug use and sex-related risks. Other components of the intervention included distribution of condoms, risk-reduction counselling, expanded access to HIV Testing Services, HIV/sexually transmitted infection care and treatment, and referrals to substance abuse treatment and social services. At follow-up, the baseline questionnaire was completed again and participants were also asked the frequency of reducing identified risk behaviours. Baseline information was collected from 138 drug users recruited into the study through community-based outreach, and who were subsequently followed up between 2010 and 2012. No injection drug users were reached. The data presented here are for first contact (baseline) and the final follow-up contact with the participants

Achieving CO 2 reductions in Colombia: Effects of carbon taxes and abatement targets

DOE Office of Scientific and Technical Information (OSTI.GOV)

Calderón, Silvia; Alvarez, Andres Camilo; Loboguerrero, Ana Maria

In this paper we investigate CO 2 emission scenarios for Colombia and the effects of implementing carbon taxes and abatement targets on the energy system. By comparing baseline and policy scenario results from two integrated assessment partial equilibrium models TIAM-ECN and GCAM and two general equilibrium models Phoenix and MEG4C, we provide an indication of future developments and dynamics in the Colombian energy system. Currently, the carbon intensity of the energy system in Colombia is low compared to other countries in Latin America. However, this trend may change given the projected rapid growth of the economy and the potential increasemore » in the use of carbon-based technologies. Climate policy in Colombia is under development and has yet to consider economic instruments such as taxes and abatement targets. This paper shows how taxes or abatement targets can achieve significant CO 2 reductions in Colombia. Though abatement may be achieved through different pathways, taxes and targets promote the entry of cleaner energy sources into the market and reduce final energy demand through energy efficiency improvements and other demand-side responses. The electric power sector plays an important role in achieving CO 2 emission reductions in Colombia, through the increase of hydropower, the introduction of wind technologies, and the deployment of biomass, coal and natural gas with CO 2 capture and storage (CCS). Uncertainty over the prevailing mitigation pathway reinforces the importance of climate policy to guide sectors toward low-carbon technologies. This paper also assesses the economy-wide implications of mitigation policies such as potential losses in GDP and consumption. As a result, an assessment of the legal, institutional, social and environmental barriers to economy-wide mitigation policies is critical yet beyond the scope of this paper.« less

Achieving CO 2 reductions in Colombia: Effects of carbon taxes and abatement targets

DOE PAGES

Calderón, Silvia; Alvarez, Andres Camilo; Loboguerrero, Ana Maria; ...

2015-06-03

In this paper we investigate CO 2 emission scenarios for Colombia and the effects of implementing carbon taxes and abatement targets on the energy system. By comparing baseline and policy scenario results from two integrated assessment partial equilibrium models TIAM-ECN and GCAM and two general equilibrium models Phoenix and MEG4C, we provide an indication of future developments and dynamics in the Colombian energy system. Currently, the carbon intensity of the energy system in Colombia is low compared to other countries in Latin America. However, this trend may change given the projected rapid growth of the economy and the potential increasemore » in the use of carbon-based technologies. Climate policy in Colombia is under development and has yet to consider economic instruments such as taxes and abatement targets. This paper shows how taxes or abatement targets can achieve significant CO 2 reductions in Colombia. Though abatement may be achieved through different pathways, taxes and targets promote the entry of cleaner energy sources into the market and reduce final energy demand through energy efficiency improvements and other demand-side responses. The electric power sector plays an important role in achieving CO 2 emission reductions in Colombia, through the increase of hydropower, the introduction of wind technologies, and the deployment of biomass, coal and natural gas with CO 2 capture and storage (CCS). Uncertainty over the prevailing mitigation pathway reinforces the importance of climate policy to guide sectors toward low-carbon technologies. This paper also assesses the economy-wide implications of mitigation policies such as potential losses in GDP and consumption. As a result, an assessment of the legal, institutional, social and environmental barriers to economy-wide mitigation policies is critical yet beyond the scope of this paper.« less

[The reduction of stroke risk, risk of myocardial infarction and death by healthy diet and physical activity].

PubMed

Droste, D W; Keipes, M

2013-01-01

There is no doubt that a healthy diet and regular physical activity improve risk factors for cerebro-cardio-vascular disease and death. However, there is less evidence from prospective randomised controlled trials that they also reduce the actual risk of stroke, myocardial infarction and death. The only evidence from randomised controlled trials is, that a mediterranean diet with nuts and/or native olive oil considerably reduces stroke risk by 47% respectively 31%, however not the risk of myocardial infarction and death. A low-fat diet, a low-salt diet, and the addition of omega-3 fatty acids have no influence. In case of severe obesity with a BMI of > 34-38 kg/m2, weight reduction is the priority, if necessary by means of bariatric surgery. In longitudinal studies mortality (-29%), stroke (-34%), and myocardial infarction (-29%) could thus be reduced. Regular physical activity, whether endurance or more intense activity, leads to weight loss and improved vascular risk factors. An independent impact on stroke, myocardial infarction and mortality has not yet been demonstrated in prospective studies (double-blinding being impossible). Nevertheless, several epidemiological meta-analyses with observation durations of 4 to 28 years using data of up to 880 000 persons, indicate that there is a 2-3 fold risk reduction of cerebro-cardio-vascular death and global mortality in people with regular physical activity versus sedentary behaviour.

Economic Valuation of Mortality Risk Reduction - Volumes 1 and 2 (2004)

EPA Pesticide Factsheets

Reports prepared on economic valuation of mortality risk reduction using information collected from sstated preference surveys of individuals, as well as using information on revealed behavior from safety expenditures in context of automobile purchases.

Facilitating risk reduction among homeless and street-involved youth.

PubMed

Busen, Nancy H; Engebretson, Joan C

2008-11-01

The purposes of this evaluation project were to describe a group of homeless adolescents and street-involved youth who utilized a mobile unit that provided medical and mental healthcare services and to assess the efficacy of the services provided in reducing their health risk behaviors. The records of 95 youth aged 15-25 years who used the medical mobile unit for an average of 14 months were examined and evaluated according to the national health indicators related to risk reduction. Current literature related to health risk behavior among homeless youth was reviewed, synthesized, and provided the background for this article. Data were obtained from the records of mostly heterosexual youth with a mean age of 20.5 years. Approximately one third of the participants were high school graduates and most were without health insurance. Living situations were transient including friends, shelters, crash pads, or the streets. Abuse accounted for the majority leaving home. Psychiatric conditions and substance abuse were common. Medical conditions were related to transient living situations, substance abuse, and sexual activity. Success of the program was associated with sustained counseling, stabilizing youth on psychotropic medications, decreasing substance use, providing birth control and immunizations, and treating medical conditions. Homeless youth are one of the most underserved vulnerable populations in the United States with limited access and utilization of appropriate healthcare services. Nurse practitioners often serve as care providers but are also in a position to effectively lobby to improve health care for homeless youth through professional organizations and community activism. Furthermore, when designing and evaluating healthcare services, multidisciplinary teams need to consider risk reduction for homeless youth in the context of their environment.

Comparing effectiveness of mass media campaigns with price reductions targeting fruit and vegetable intake on US cardiovascular disease mortality and race disparities.

PubMed

Pearson-Stuttard, Jonathan; Bandosz, Piotr; Rehm, Colin D; Afshin, Ashkan; Peñalvo, Jose L; Whitsel, Laurie; Danaei, Goodarz; Micha, Renata; Gaziano, Tom; Lloyd-Williams, Ffion; Capewell, Simon; Mozaffarian, Dariush; O'Flaherty, Martin

2017-07-01

Background: A low intake of fruits and vegetables (F&Vs) is a major risk factor for cardiovascular disease (CVD) in the United States. Both mass media campaigns (MMCs) and economic incentives may increase F&V consumption. Few data exist on their comparative effectiveness. Objective: We estimated CVD mortality reductions potentially achievable by price reductions and MMC interventions targeting F&V intake in the US population. Design: We developed a US IMPACT Food Policy Model to compare 3 policies targeting F&V intake across US adults from 2015 to 2030: national MMCs and national F&V price reductions of 10% and 30%. We accounted for differences in baseline diets, CVD rates, MMC coverage, MMC duration, and declining effects over time. Outcomes included cumulative CVD (coronary heart disease and stroke) deaths prevented or postponed and life-years gained (LYGs) over the study period, stratified by age, sex, and race. Results: A 1-y MMC in 2015 would increase the average national F&V consumption by 7% for 1 y and prevent ∼18,600 CVD deaths (95% CI: 17,600, 19,500), gaining ∼280,100 LYGs by 2030. With a 15-y MMC, increased F&V consumption would be sustained, yielding a 3-fold larger reduction (56,100; 95% CI: 52,400, 57,700) in CVD deaths. In comparison, a 10% decrease in F&V prices would increase F&V consumption by ∼14%. This would prevent ∼153,300 deaths (95% CI: 146,400, 159,200), gaining ∼2.51 million LYGs. For a 30% price decrease, resulting in a 42% increase in F&V consumption, corresponding values would be 451,900 CVD deaths prevented or postponed (95% CI: 433,100, 467,500) and 7.3 million LYGs gained. Effects were similar by sex, with a smaller proportional effect and larger absolute effects at older ages. A 1-y MMC would be 35% less effective in preventing CVD deaths in non-Hispanic blacks than in whites. In comparison, price-reduction policies would have equitable proportional effects. Conclusion: Both national MMCs and price-reduction policies

The application of motivational theory to cardiovascular risk reduction.

PubMed

Fleury, J

1992-01-01

The level of motivation sustained by an individual has been identified as a primary predictor of success in sustained cardiovascular risk factor modification efforts. This article reviews the primary motivational theories that have been used to explain and predict cardiovascular risk reduction. Specifically, the application of the Health Belief Model, Health Promotion Model, Theory of Reasoned Action, Theory of Planned Behavior and Self-efficacy Theory to the initiation and maintenance of cardiovascular health behavior is addressed. The implication of these theories for the development of nursing interventions as well as new directions for nursing research and practice in the study of individual motivation in health behavior change are discussed.

Smartphone Delivery of Mobile HIV Risk Reduction Education.

PubMed

Phillips, Karran A; Epstein, David H; Mezghanni, Mustapha; Vahabzadeh, Massoud; Reamer, David; Agage, Daniel; Preston, Kenzie L

2013-01-01

We sought to develop and deploy a video-based smartphone-delivered mobile HIV Risk Reduction (mHIVRR) intervention to individuals in an addiction treatment clinic. We developed 3 video modules that consisted of a 10-minute HIVRR video, 11 acceptability questions, and 3 knowledge questions and deployed them as a secondary study within a larger study of ecological momentary and geographical momentary assessments. All 24 individuals who remained in the main study long enough completed the mHIVRR secondary study. All 3 videos met our a priori criteria for acceptability "as is" in the population: they achieved median scores of ≤2.5 on a 5-point Likert scale; ≤20% of the individuals gave them the most negative rating on the scale; a majority of the individuals stated that they would not prefer other formats over video-based smartphone-delivered one (all P < 0.05). Additionally, all of our video modules met our a priori criteria for feasibility: ≤20% of data were missing due to participant noncompliance and ≤20% were missing due to technical failure. We concluded that video-based mHIVRR education delivered via smartphone is acceptable, feasible and may increase HIV/STD risk reduction knowledge. Future studies, with pre-intervention assessments of knowledge and random assignment, are needed to confirm these findings.

Resilience and disaster risk reduction: an etymological journey

NASA Astrophysics Data System (ADS)

Alexander, D. E.

2013-11-01

This paper examines the development over historical time of the meaning and uses of the term resilience. The objective is to deepen our understanding of how the term came to be adopted in disaster risk reduction and resolve some of the conflicts and controversies that have arisen when it has been used. The paper traces the development of resilience through the sciences, humanities, and legal and political spheres. It considers how mechanics passed the word to ecology and psychology, and how from there it was adopted by social research and sustainability science. As other authors have noted, as a concept, resilience involves some potentially serious conflicts or contradictions, for example between stability and dynamism, or between dynamic equilibrium (homeostasis) and evolution. Moreover, although the resilience concept works quite well within the confines of general systems theory, in situations in which a systems formulation inhibits rather than fosters explanation, a different interpretation of the term is warranted. This may be the case for disaster risk reduction, which involves transformation rather than preservation of the "state of the system". The article concludes that the modern conception of resilience derives benefit from a rich history of meanings and applications, but that it is dangerous - or at least potentially disappointing - to read to much into the term as a model and a paradigm.

Collaborative care intervention targeting violence risk behaviors, substance use, and posttraumatic stress and depressive symptoms in injured adolescents: a randomized clinical trial.

PubMed

Zatzick, Douglas; Russo, Joan; Lord, Sarah Peregrine; Varley, Christopher; Wang, Jin; Berliner, Lucy; Jurkovich, Gregory; Whiteside, Lauren K; O'Connor, Stephen; Rivara, Frederick P

2014-06-01

Violence and injury risk behaviors, alcohol and drug use problems, and posttraumatic stress disorder (PTSD) and depressive symptoms occur frequently among adolescents presenting to acute care medical settings after traumatic physical injury. To test the effectiveness of a stepped collaborative care intervention targeting this constellation of risk behaviors and symptoms in randomly sampled hospitalized adolescents with and without traumatic brain injury. A pragmatic randomized clinical trial was conducted at a single US level I trauma center. Participants included 120 adolescents aged 12 to 18 years randomized to intervention (n = 59) and control (n = 61) conditions. Stepped collaborative care intervention included motivational interviewing elements targeting risk behaviors and substance use as well as medication and cognitive behavioral therapy elements targeting PTSD and depressive symptoms. Adolescents were assessed at baseline before randomization and 2, 5, and 12 months after injury hospitalization. Standardized instruments were used to assess violence risk behaviors, alcohol and drug use, and PTSD and depressive symptoms. The investigation attained more than 95% adolescent follow-up at each assessment point. At baseline, approximately one-third of the participants endorsed the violence risk behavior of carrying a weapon. Regression analyses demonstrated that intervention patients experienced significant reductions in weapon carrying compared with controls during the year after injury (group × time effect, F3,344 = 3.0; P = .03). At 12 months after the injury, 4 (7.3%) intervention patients vs 13 (21.3%) control patients reported currently carrying a weapon (relative risk, 0.31; 95% CI, 0.11-0.90). The intervention was equally effective in reducing the risk of weapon carrying among injured adolescents with and without traumatic brain injury. Other treatment targets, including alcohol and drug use problems and high levels of PTSD and

Promoting the University Social Responsibility in the Capacity Development Program for Landslide Risk Reduction in Indonesia

NASA Astrophysics Data System (ADS)

Karnawati, D.; Wilopo, W.; Verrier, M.; Fathani, T. F.; Andayani, B.

2011-12-01

One of the most challenges efforts for landslides disaster risk reduction in Indonesia is to provide an effective program for capacity development of the community living in the vulnerable area. Limited access for appropriate information and knowledge about the geology and landslide phenomena as well as the social-security constrains are the major challenges in capacity development program in the landslide prone area. Accordingly, an action for conducting community-based research and education program with respect to landslide mitigation and disaster risk reduction at the village level was established by implementing the University Social Responsibility Program. Such program has been conducted regularly in every academic semester as a part of the formal academic program at Universitas Gadjah Mada , Indonesia. Twenty students with multi-discipline backgrounds and supported by their lectures/advisers have to be deployed at the village for two months to carry out such mission. This action is also conducted under the coordination with the local/ national Government together with the local community, and may also with the private sectors. A series of research actions such as landslide investigation and hazard-risk mapping, social mapping and development of landslide early warning system were carried out in parallel with public education and evacuation drill for community empowerment and landslide risk reduction. A Community Task Force for Disaster Risk Reduction was also established during the community empowerment program, in order to guarantee the affectivity and sustainability of the disaster risk reduction program at the village level. It is crucial that this program is not only beneficial for empowering the village community to tackle the landslide problems, but also important to support the education for sustainable development program at the disaster prone area. Indeed, this capacity development program may also be considered as one best practice for transforming

The effectiveness of coral reefs for coastal hazard risk reduction and adaptation.

PubMed

Ferrario, Filippo; Beck, Michael W; Storlazzi, Curt D; Micheli, Fiorenza; Shepard, Christine C; Airoldi, Laura

2014-05-13

The world's coastal zones are experiencing rapid development and an increase in storms and flooding. These hazards put coastal communities at heightened risk, which may increase with habitat loss. Here we analyse globally the role and cost effectiveness of coral reefs in risk reduction. Meta-analyses reveal that coral reefs provide substantial protection against natural hazards by reducing wave energy by an average of 97%. Reef crests alone dissipate most of this energy (86%). There are 100 million or more people who may receive risk reduction benefits from reefs or bear hazard mitigation and adaptation costs if reefs are degraded. We show that coral reefs can provide comparable wave attenuation benefits to artificial defences such as breakwaters, and reef defences can be enhanced cost effectively. Reefs face growing threats yet there is opportunity to guide adaptation and hazard mitigation investments towards reef restoration to strengthen this first line of coastal defence.

The contribution of indigenous knowledge to disaster risk reduction activities in Zimbabwe: A big call to practitioners

PubMed Central

Munsaka, Edson

2018-01-01

This article examined the contribution of indigenous knowledge to disaster risk reduction activities in Zimbabwe. The current discourse underrates the use of indigenous knowledge of communities by practitioners when dealing with disasters’, as the knowledge is often viewed as outdated and primitive. This study, which was conducted in 2016, sought to examine this problem through analysing the potential contribution of indigenous knowledge as a useful disaster risk reduction intervention. Tsholotsho district in Matabeleland, North province of Zimbabwe, which frequently experiences perennial devastating floods, was used as a case study. Interviews and researcher observations were used to gather data from 40 research participants. The findings were that communities understand weather patterns and could predict imminent flooding after studying trees and clouds, and the behaviours of certain animal species. Local communities also use available local resources to put structural measures in place as part of disaster risk reduction interventions. Despite this important potential, the study found that the indigenous knowledge of disaster risk reduction of the communities is often shunned by practitioners. The practitioners claim that indigenous knowledge lacks documentation, it is not found in all generational classes, it is contextualised to particular communities and the knowledge cannot be scientifically validated. The study concluded that both local communities and disaster risk reduction practitioners can benefit from the indigenous knowledge of communities. This research has the potential to benefit communities, policymakers and disaster risk reduction practitioners.

User Perceptions of a Dementia Risk Reduction Website and Its Promotion of Behavior Change

PubMed Central

2013-01-01

Background Several modifiable health and lifestyle factors are consistently associated with dementia risk and it is estimated that significantly fewer people would develop dementia if the incidence of risk factors could be reduced. Despite this, Australians’ awareness of the health and lifestyle factors associated with dementia risk is low. Within a national community education campaign, Alzheimer’s Australia developed a dementia risk reduction website providing information about modifiable risk or protective factors for dementia. Objective This study aimed to assess the usefulness of the website content in improving knowledge and enabling adoption of recommended strategies, and to examine what additional resources consumers need. Methods Visitors to the website over a 3 month period were invited to complete an online survey, which asked them to rate their knowledge of dementia risk reduction before and after visiting the site, how important monitoring their health related behavior was to them before and after visiting the site, their current behavior related to health and lifestyle factors associated with dementia risk, their intentions to change behavior, and the usefulness of potential additional resources to help them do so. Results For this study, 123 Australian adults responded to the survey. 44.7% (55/122) were aged over 60 and 82.1% (98/119) were female. Respondents’ ratings and comments indicated they generally found the content interesting, informative, and helpful to them. Respondents’ ratings of their knowledge about the links between health and lifestyle factors and dementia risk significantly increased after visiting the website (P<.001). Their ratings of how important monitoring what they do in relation to their health and lifestyle factors were also significantly increased after visiting the website (P<.001). Average ratings for how well respondents felt they were doing at the time in relation to specific risk or protective factors were

Can I Count on Getting Better? Association between Math Anxiety and Poorer Understanding of Medical Risk Reductions.

PubMed

Rolison, Jonathan J; Morsanyi, Kinga; O'Connor, Patrick A

2016-10-01

Lower numerical ability is associated with poorer understanding of health statistics, such as risk reductions of medical treatment. For many people, despite good numeracy skills, math provokes anxiety that impedes an ability to evaluate numerical information. Math-anxious individuals also report less confidence in their ability to perform math tasks. We hypothesized that, independent of objective numeracy, math anxiety would be associated with poorer responding and lower confidence when calculating risk reductions of medical treatments. Objective numeracy was assessed using an 11-item objective numeracy scale. A 13-item self-report scale was used to assess math anxiety. In experiment 1, participants were asked to interpret the baseline risk of disease and risk reductions associated with treatment options. Participants in experiment 2 were additionally provided a graphical display designed to facilitate the processing of math information and alleviate effects of math anxiety. Confidence ratings were provided on a 7-point scale. Individuals of higher objective numeracy were more likely to respond correctly to baseline risks and risk reductions associated with treatment options and were more confident in their interpretations. Individuals who scored high in math anxiety were instead less likely to correctly interpret the baseline risks and risk reductions and were less confident in their risk calculations as well as in their assessments of the effectiveness of treatment options. Math anxiety predicted confidence levels but not correct responding when controlling for objective numeracy. The graphical display was most effective in increasing confidence among math-anxious individuals. The findings suggest that math anxiety is associated with poorer medical risk interpretation but is more strongly related to confidence in interpretations. © The Author(s) 2015.

Breast Cancer Incidence and Risk Reduction in the Hispanic Population.

PubMed

Power, Eric J; Chin, Megan L; Haq, Mohamed M

2018-02-26

Breast cancer is the most common non-skin cancer amongst women worldwide and is the fifth leading cause of cancer-related mortality overall. It is also the foremost reason for cancer-related mortality in Hispanic females in the United States (US). Although the current incidence of breast cancer is significantly lower in Hispanics compared to that of non-Hispanic Whites (NHW) and Blacks, (91.9, 128.1, and 124.3 per 100,000, respectively, annually), this may increase if Hispanics develop similar lifestyle behaviors to other American women, in categories such as weight management, age at first birth, number of children, and breastfeeding habits. Stage-for-stage mortality for Hispanics is similar to NHWs, but the mortality rate is not declining as rapidly in this ethnic group. Hispanic women share many of the same risk factors for developing breast cancer as NHWs and Blacks. This suggests that many of the risk reduction strategies used in other racial populations may also benefit this group. Providing education about breast cancer and implementing risk reduction strategies in culturally-aware environments could help keep incidence low and reduce cancer-related mortality. Since Hispanics are the largest minority group in the US, this could have a significant impact on the incidence and mortality nationally.

Health Risk Reduction Programs in Employer-Sponsored Health Plans: Part II—Law and Ethics

PubMed Central

Rothstein, Mark A.; Harrell, Heather L.

2011-01-01

Objective We sought to examine the legal and ethical implications of workplace health risk reduction programs (HRRPs) using health risk assessments, individually focused risk reduction, and financial incentives to promote compliance. Methods We conducted a literature review, analyzed relevant statutes and regulations, and considered the effects of these programs on employee health privacy. Results A variety of laws regulate HRRPs, and there is little evidence that employer-sponsored HRRPs violate these provisions; infringement on individual health privacy is more difficult to assess. Conclusion Although current laws permit a wide range of employer health promotion activities, HRRPs also may entail largely unquantifiable costs to employee privacy and related interests. PMID:19625971

Population Modeling of Modified Risk Tobacco Products Accounting for Smoking Reduction and Gradual Transitions of Relative Risk.

PubMed

Poland, Bill; Teischinger, Florian

2017-11-01

As suggested by the Food and Drug Administration (FDA) Modified Risk Tobacco Product (MRTP) Applications Draft Guidance, we developed a statistical model based on public data to explore the effect on population mortality of an MRTP resulting in reduced conventional cigarette smoking. Many cigarette smokers who try an MRTP persist as dual users while smoking fewer conventional cigarettes per day (CPD). Lower-CPD smokers have lower mortality risk based on large cohort studies. However, with little data on the effect of smoking reduction on mortality, predictive modeling is needed. We generalize prior assumptions of gradual, exponential decay of Excess Risk (ER) of death, relative to never-smokers, after quitting or reducing CPD. The same age-dependent slopes are applied to all transitions, including initiation to conventional cigarettes and to a second product (MRTP). A Monte Carlo simulation model generates random individual product use histories, including CPD, to project cumulative deaths through 2060 in a population with versus without the MRTP. Transitions are modeled to and from dual use, which affects CPD and cigarette quit rates, and to MRTP use only. Results in a hypothetical scenario showed high sensitivity of long-run mortality to CPD reduction levels and moderate sensitivity to ER transition rates. Models to project population effects of an MRTP should account for possible mortality effects of reduced smoking among dual users. In addition, studies should follow dual-user CPD histories and quit rates over long time periods to clarify long-term usage patterns and thereby improve health impact projections. We simulated mortality effects of a hypothetical MRTP accounting for cigarette smoking reduction by smokers who add MRTP use. Data on relative mortality risk versus CPD suggest that this reduction may have a substantial effect on mortality rates, unaccounted for in other models. This effect is weighed with additional hypothetical effects in an example. �

Reduction of risk of dying from tobacco-related diseases after quitting smoking in Italy.

PubMed

Carreras, Giulia; Pistelli, Francesco; Falcone, Franco; Carrozzi, Laura; Martini, Andrea; Viegi, Giovanni; Gorini, Giuseppe

2015-01-01

The aims of this paper are to compute the risks of dying of ischemic heart disease (IHD), lung cancer (LC), stroke, and chronic obstructive pulmonary disease (COPD) for Italian smokers by gender, age and daily number of cigarettes smoked, and to estimate the benefit of stopping smoking in terms of risk reduction. Life tables by sex and smoking status were computed for each smoking-related disease based on Italian smoking data, and risk charts with 10-year probabilities of death were computed for never, current and former smokers. Men aged 45-49 years, current smokers, have a 8, 10, 3 and 1 in 1,000 chance of dying of IHD, LC, stroke and COPD, respectively, whereas women with the same characteristics have a 2, 6, 3 and 1 in 1,000 chance, respectively, for all smokers combined, i.e., independent of the smoking intensity. The risk reduction rates from quitting smoking are remarkable: a man who quits smoking at 45-49 years can reduce the risk of dying of IHD, LC, stroke and COPD in the next 10 years by 43%, 53%, 57% and 55%, respectively; a woman by 49%, 49%, 59% and 57%, respectively. Estimates of risk reduction by quitting smoking are useful to provide a sounder scientific basis for public health messages and clinical advice.

MRI-guided targeting delivery of doxorubicin with reduction-responsive lipid-polymer hybrid nanoparticles.

PubMed

Wu, Bo; Lu, Shu-Ting; Deng, Kai; Yu, Hui; Cui, Can; Zhang, Yang; Wu, Ming; Zhuo, Ren-Xi; Xu, Hai-Bo; Huang, Shi-Wen

2017-01-01

In recent years, there has been increasing interest in developing a multifunctional nanoscale platform for cancer monitoring and chemotherapy. However, there is still a big challenge for current clinic contrast agents to improve their poor tumor selectivity and response. Herein, we report a new kind of Gd complex and folate-coated redox-sensitive lipid-polymer hybrid nanoparticle (Gd-FLPNP) for tumor-targeted magnetic resonance imaging and therapy. Gd-FLPNPs can simultaneously accomplish diagnostic imaging, and specific targeting and controlled release of doxorubicin (DOX). They exhibit good monodispersity, excellent size stability, and a well-defined core-shell structure. Paramagnetic nanoparticles based on gadolinium-diethylenetriaminepentaacetic acid-bis-cetylamine have paramagnetic properties with an approximately two-fold enhancement in the longitudinal relaxivity compared to clinical used Magnevist. For targeted and reduction-sensitive drug delivery, Gd-FLPNPs released DOX faster and enhanced cell uptake in vitro, and exhibited better antitumor effect both in vitro and in vivo.

Ensuring Disaster Risk Reduction via Sustainable Wetland Development

NASA Astrophysics Data System (ADS)

Lyon, S. W.; Lindborg, R.; Nyström, S.; Silengo, M.; Tumbo, M.; Koutsouris, A. J.

2015-12-01

Wetland ecosystems around the world are increasingly being targeted as land use development 'hotspots' under growing concerns of climate variability and food security. Anthropogenic encroachment on natural wetland ecosystems can have direct consequences locally through loss of biodiversity and regionally through increased disaster risks associated with, for example, flooding. We consider two regionally-relevant wetland ecosystems in eastern Africa, namely Zambia's Lukanga Swamps and Tanzania's Kilombero Valley, experiencing varying trajectories of development under climatic variations. These regions have been targeted for inclusive, multi-stakeholder initiatives that aim at developing agricultural potential through combinations of large and small scale irrigation schemes. Through our data-driven analysis we highlight the potential for shifts in hydrologic regime of each wetland ecosystem which can have significant regional impacts on disaster risks. In the case of the Lukanga Swamps, wetlands maintain water table fluctuations that help mitigate water cycling with implications for the downstream flooding impact of annual rains. With regards to Kilombero Valley, understanding seasonal changes in hydrological processes and storages provides the cornerstone for managing future water resource impacts/feedbacks under different scenarios of land management. This work emphasizes the need to tailor strategies towards sustainable uses of wetlands that reduce disaster risks regionally while contributing to improved community health and wellbeing. It remains an open (and fundamental) question of how to best define management recommendations and activities that not only achieve climate resiliency but also are acceptable for stakeholders without compromising the balance between ecosystem service supply and biodiversity conservation.

Occupational Health Promotion Programs to Reduce Cardiovascular Risk.

ERIC Educational Resources Information Center

Glasgow, Russell E.; Terborg, James R.

1988-01-01

Surveys literature on worksite health promotion programs targeting cardiovascular risk factors. Reviews findings on health-risk appraisal, hypertension control, smoking cessation, weight reduction, exercise, and programs addressing multiple risk factors. Discusses current knowledge, highlights exemplary studies, and identifies problems and…

Perceived Drug Use Functions and Risk Reduction Practices Among High-Risk Nonmedical Users of Prescription Drugs

PubMed Central

Silva, Karol; Kecojevic, Aleksandar; Lankenau, Stephen E.

2014-01-01

Nonmedical use of prescription drugs has become the fastest growing drug problem in the United States, particularly among young adults. This study examines the reasons young polydrug users misuse prescription drugs, and explores how young users employ risk reduction strategies to minimize adverse consequences. The sample was recruited during 2008 and 2009 in Los Angeles and New York, and comprised 45 nonmedical users of prescription drugs, aged 16 to 25. Data from a semistructured interview were analyzed quantitatively and qualitatively. Participants reported nonmedical use of prescription drugs to change mood, to facilitate activity, and to monitor the intake of other substances. Commonly employed risk reduction strategies included calculating pill timing, dosage, and access, and monitoring frequency of use, particularly when combining different substances. Most study participants often planned drug use to occur within socially acceptable parameters, such that prescription drug misuse was a normalized feature of their everyday lives. PMID:25477621

Valuing Mortality Risk Reductions for Environmental Policy: A White Paper (1999)

EPA Pesticide Factsheets

This white paper addresses current and recent U.S. EPA practices regarding the valuation of mortality risk reductions, focusing especially on empirical estimates of the “value of a statistical life” (VSL) from stated preference and hedonic wage studies.

SAFRR (Science Application for Risk Reduction) Tsunami Scenario--Executive Summary and Introduction: Chapter A in The SAFRR (Science Application for Risk Reduction) Tsunami Scenario

USGS Publications Warehouse

Ross, Stephanie L.; Jones, Lucile M.; Miller, Kevin H.; Porter, Keith A.; Wein, Anne; Wilson, Rick I.; Bahng, Bohyun; Barberopoulou, Aggeliki; Borrero, Jose C.; Brosnan, Deborah M.; Bwarie, John T.; Geist, Eric L.; Johnson, Laurie A.; Kirby, Stephen H.; Knight, William R.; Long, Kate; Lynett, Patrick; Mortensen, Carl E.; Nicolsky, Dmitry J.; Perry, Suzanne C.; Plumlee, Geoffrey S.; Real, Charles R.; Ryan, Kenneth; Suleimani, Elena; Thio, Hong Kie; Titov, Vasily V.; Whitmore, Paul M.; Wood, Nathan J.

2013-01-01

The Science Application for Risk Reduction (SAFRR) tsunami scenario depicts a hypothetical but plausible tsunami created by an earthquake offshore from the Alaska Peninsula and its impacts on the California coast. The tsunami scenario is a collaboration between the U.S. Geological Survey (USGS), the California Geological Survey, the California Governor’s Office of Emergency Services (Cal OES), the National Oceanic and Atmospheric Administration (NOAA), other Federal, State, County, and local agencies, private companies, and academic and other institutions. This document presents evidence for past tsunamis, the scientific basis for the source, likely inundation areas, current velocities in key ports and harbors, physical damage and repair costs, economic consequences, environmental and ecological impacts, social vulnerability, emergency management and evacuation challenges, and policy implications for California associated with this hypothetical tsunami. We also discuss ongoing mitigation efforts by the State of California and new communication products. The intended users are those who need to make mitigation decisions before future tsunamis, and those who will need to make rapid decisions during tsunami events. The results of the tsunami scenario will help managers understand the context and consequences of their decisions and how they may improve preparedness and response. An evaluation component will assess the effectiveness of the scenario process for target stakeholders in a separate report to improve similar efforts in the future.

A school-based intervention for diabetes risk reduction.

PubMed

Foster, Gary D; Linder, Barbara; Baranowski, Tom; Cooper, Dan M; Goldberg, Linn; Harrell, Joanne S; Kaufman, Francine; Marcus, Marsha D; Treviño, Roberto P; Hirst, Kathryn

2010-07-29

We examined the effects of a multicomponent, school-based program addressing risk factors for diabetes among children whose race or ethnic group and socioeconomic status placed them at high risk for obesity and type 2 diabetes. Using a cluster design, we randomly assigned 42 schools to either a multicomponent school-based intervention (21 schools) or assessment only (control, 21 schools). A total of 4603 students participated (mean [+/- SD] age, 11.3 [+/- 0.6 years; 54.2% Hispanic and 18.0% black; 52.7% girls). At the beginning of 6th grade and the end of 8th grade, students underwent measurements of body-mass index (BMI), waist circumference, and fasting glucose and insulin levels. There was a decrease in the primary outcome--the combined prevalence of overweight and obesity--in both the intervention and control schools, with no significant difference between the school groups. The intervention schools had greater reductions in the secondary outcomes of BMI z score, percentage of students with waist circumference at or above the 90th percentile, fasting insulin levels (P=0.04 for all comparisons), and prevalence of obesity (P=0.05). Similar findings were observed among students who were at or above the 85th percentile for BMI at baseline. Less than 3% of the students who were screened had an adverse event; the proportions were nearly equivalent in the intervention and control schools. Our comprehensive school-based program did not result in greater decreases in the combined prevalence of overweight and obesity than those that occurred in control schools. However, the intervention did result in significantly greater reductions in various indexes of adiposity. These changes may reduce the risk of childhood-onset type 2 diabetes. (Funded by the National Institutes of Health and the American Diabetes Association; ClinicalTrials.gov number, NCT00458029.)

Auditory risk estimates for youth target shooting

PubMed Central

Meinke, Deanna K.; Murphy, William J.; Finan, Donald S.; Lankford, James E.; Flamme, Gregory A.; Stewart, Michael; Soendergaard, Jacob; Jerome, Trevor W.

2015-01-01

Objective To characterize the impulse noise exposure and auditory risk for youth recreational firearm users engaged in outdoor target shooting events. The youth shooting positions are typically standing or sitting at a table, which places the firearm closer to the ground or reflective surface when compared to adult shooters. Design Acoustic characteristics were examined and the auditory risk estimates were evaluated using contemporary damage-risk criteria for unprotected adult listeners and the 120-dB peak limit suggested by the World Health Organization (1999) for children. Study sample Impulses were generated by 26 firearm/ammunition configurations representing rifles, shotguns, and pistols used by youth. Measurements were obtained relative to a youth shooter’s left ear. Results All firearms generated peak levels that exceeded the 120 dB peak limit suggested by the WHO for children. In general, shooting from the seated position over a tabletop increases the peak levels, LAeq8 and reduces the unprotected maximum permissible exposures (MPEs) for both rifles and pistols. Pistols pose the greatest auditory risk when fired over a tabletop. Conclusion Youth should utilize smaller caliber weapons, preferably from the standing position, and always wear hearing protection whenever engaging in shooting activities to reduce the risk for auditory damage. PMID:24564688

Behavioral sexual risk-reduction counseling in primary care to prevent sexually transmitted infections: a systematic review for the U.S. Preventive Services Task Force.

PubMed

O'Connor, Elizabeth A; Lin, Jennifer S; Burda, Brittany U; Henderson, Jillian T; Walsh, Emily S; Whitlock, Evelyn P

2014-12-16

Sexually transmitted infections (STIs) are common and preventable. To update a previous systematic review about the benefits and harms of sexual risk-reduction counseling to prevent STIs for the U.S. Preventive Services Task Force. Selected databases from January 2007 through October 2013, manual searches of references lists and gray literature, and studies from the previous review. English-language fair- or good-quality trials conducted in adolescents or adults. One investigator abstracted data and a second checked the abstraction. Study quality was dual-reviewed. 31 trials were included: 16 (n=56,110) were newly published and 15 (n=14,214) were from the previous review. Most trials targeted persons at increased risk for STIs based on sociodemographic characteristics, risky sexual behavior, or history of an STI. High-intensity (>2 hours) interventions reduced STI incidence in adolescents (odds ratio, 0.38 [95% CI, 0.24 to 0.60]) and adults (odds ratio, 0.70 [CI, 0.56 to 0.87]). Lower-intensity interventions were generally not effective in adults, but some approaches were promising. Although moderate-intensity interventions may be effective in adolescents, data were very sparse. Reported behavioral outcomes were heterogeneous and most likely to show a benefit with high-intensity interventions at 6 months or less. No consistent evidence was found that sexual risk-reduction counseling was harmful. Low-risk populations and male adolescents were underrepresented. Reliability of self-reported behavioral outcomes was unknown. High-intensity counseling on sexual risk reduction can reduce STIs in primary care and related settings, especially in sexually active adolescents and in adults at increased risk for STIs. Agency for Healthcare Research and Quality.

The effectiveness of coral reefs for coastal hazard risk reduction and adaptation

PubMed Central

Ferrario, Filippo; Beck, Michael W.; Storlazzi, Curt D.; Micheli, Fiorenza; Shepard, Christine C.; Airoldi, Laura

2014-01-01

The world’s coastal zones are experiencing rapid development and an increase in storms and flooding. These hazards put coastal communities at heightened risk, which may increase with habitat loss. Here we analyse globally the role and cost effectiveness of coral reefs in risk reduction. Meta-analyses reveal that coral reefs provide substantial protection against natural hazards by reducing wave energy by an average of 97%. Reef crests alone dissipate most of this energy (86%). There are 100 million or more people who may receive risk reduction benefits from reefs or bear hazard mitigation and adaptation costs if reefs are degraded. We show that coral reefs can provide comparable wave attenuation benefits to artificial defences such as breakwaters, and reef defences can be enhanced cost effectively. Reefs face growing threats yet there is opportunity to guide adaptation and hazard mitigation investments towards reef restoration to strengthen this first line of coastal defence. PMID:24825660

The effectiveness of coral reefs for coastal hazard risk reduction and adaptation

USGS Publications Warehouse

Ferrario, Filippo; Beck, Michael W.; Storlazzi, Curt D.; Micheli, Fiorenza; Shepard, Christine C.; Airoldi, Laura

2014-01-01

The world’s coastal zones are experiencing rapid development and an increase in storms and flooding. These hazards put coastal communities at heightened risk, which may increase with habitat loss. Here we analyse globally the role and cost effectiveness of coral reefs in risk reduction. Meta-analyses reveal that coral reefs provide substantial protection against natural hazards by reducing wave energy by an average of 97%. Reef crests alone dissipate most of this energy (86%). There are 100 million or more people who may receive risk reduction benefits from reefs or bear hazard mitigation and adaptation costs if reefs are degraded. We show that coral reefs can provide comparable wave attenuation benefits to artificial defences such as breakwaters, and reef defences can be enhanced cost effectively. Reefs face growing threats yet there is opportunity to guide adaptation and hazard mitigation investments towards reef restoration to strengthen this first line of coastal defence.

Effectiveness of a fall-risk reduction programme for inpatient rehabilitation after stroke.

PubMed

Goljar, Nika; Globokar, Daniel; Puzić, Nataša; Kopitar, Natalija; Vrabič, Maja; Ivanovski, Matic; Vidmar, Gaj

2016-09-01

To evaluate effectiveness of fall-risk-assessment-based fall prevention for stroke rehabilitation inpatients. A consecutive series of 232 patients admitted for the first time to a subacute stroke-rehabilitation ward during 2010-2011 was studied in detail. The Assessment Sheet for Fall Prediction in Stroke Inpatients (ASFPSI by Nakagawa et al.) was used to assess fall-risk upon admission. Association of ASFPSI score and patient characteristics with actual falls was statistically tested. Yearly incidence of falls per 1000 hospital days (HD) was retrospectively audited for the 2006-2014 period to evaluate effectiveness of fall-risk reduction measures. The observed incidence of falls over the detailed-study-period was 3.0/1000 HD; 39% of the fallers fell during the first week after admission. ASFPSI score was not significantly associated with falls. Longer hospital stay, left body-side affected and non-extreme FIM score (55-101) were associated with higher odds of fall. Introduction of fall-risk reduction measures followed by compulsory fall-risk assessment lead to incidence of falls dropping from 7.1/1000 HD in 2006 to 2.8/1000 HD in 2011 and remaining at that level until 2014. The fall-risk-assessment-based measures appear to have led to decreasing falls risk among post-stroke rehabilitation inpatients classified as being at high risk of falls. The fall prevention programme as a whole was successful. Patients with non-extreme level of functional independence should receive enhanced fall prevention. Implications for Rehabilitation Recognising the fall risk upon the patient's admission is essential for preventing falls in rehabilitation wards. Assessing the fall risk is a team tasks and combines information from various sources. Assessing fall risk in stroke patients using the assessment sheet by Nakagawa et al. immediately upon admission systematically draws attention to the risk of falls in each individual patient.

75 FR 44275 - Hazardous Fire Risk Reduction, East Bay Hills, CA

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-28

... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA-2010-0037] Hazardous Fire Risk Reduction, East Bay Hills, CA AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice of extension of comment period. SUMMARY: The Federal Emergency Management Agency (FEMA) is...

Motivational interviewing for HIV risk reduction among gay men in commercial and public sex settings.

PubMed

Harding, R; Dockrell, M J; Dockrell, J; Corrigan, N

2001-08-01

The present paper addresses the feasibility of combining motivational interviewing and cognitive interventions to HIV risk reduction in commercial venues and public sex environments (PSEs). The logic for these two approaches is considered and an intervention combining key elements of the two is presented. The intervention uses a questionnaire format to encourage individuals to compare their desired versus actual behaviour (i.e. chosen personal risk reduction strategy versus 'slip-ups'/unwanted risk taking), and to recognize their risk-related cognitions. High-risk individuals are identified, and health-focused conversations developed from the brief schedule. The structure and key design issues in the development of a feasible, acceptable and evidence-based tool are reviewed. The limitations of more complex, focused interventions in the context of commercial and PSE settings are discussed.

The effect of risk perception on public preferences and willingness to pay for reductions in the health risks posed by toxic cyanobacterial blooms.

PubMed

Hunter, Peter D; Hanley, Nick; Czajkowski, Mikołaj; Mearns, Kathryn; Tyler, Andrew N; Carvalho, Laurence; Codd, Geoffrey A

2012-06-01

Mass populations of toxin-producing cyanobacteria are an increasingly common occurrence in inland and coastal waters used for recreational purposes. These mass populations pose serious risks to human and animal health and impose potentially significant economic costs on society. In this study, we used contingent valuation (CV) methods to elicit public willingness to pay (WTP) for reductions in the morbidity risks posed by blooms of toxin-producing cyanobacteria in Loch Leven, Scotland. We found that 55% of respondents (68% excluding protest voters) were willing to pay for a reduction in the number of days per year (from 90, to either 45 or 0 days) that cyanobacteria pose a risk to human health at Loch Leven. The mean WTP for a risk reduction was UK£9.99-12.23/household/year estimated using a logistic spike model. In addition, using the spike model and a simultaneous equations model to control for endogeneity bias, we found the respondents' WTP was strongly dependent on socio-demographic characteristics, economic status and usage of the waterbody, but also individual-specific attitudes and perceptions towards health risks. This study demonstrates that anticipated health risk reductions are an important nonmarket benefit of improving water quality in recreational waters and should be accounted for in future cost-benefit analyses such as those being undertaken under the auspices of the European Union's Water Framework Directive, but also that such values depend on subjective perceptions of water-related health risks and general attitudes towards the environment. Copyright © 2012 Elsevier B.V. All rights reserved.

Risk factors for avascular necrosis after closed reduction for developmental dysplasia of the hip.

PubMed

Schur, Mathew D; Lee, Christopher; Arkader, Alexandre; Catalano, Anthony; Choi, Paul D

2016-06-01

The purpose of this study was to identify and evaluate risk factors of avascular necrosis (AVN) after closed treatment for developmental dysplasia of the hip (DDH). A retrospective review of children diagnosed with DDH at a tertiary-care children's hospital between 1986 and 2009 was performed. The presence of AVN was assessed according to Salter's classification system. Eighty-two affected hips in 70 children with an average age of 10 months at closed reduction (range 1-31 months) and 5 years (range 2-19 years) of follow-up met the inclusion criteria. Twenty-nine (of 82, 35 %) affected hips developed AVN. The use of pre-reduction traction (p = 0.019) increased the risk of AVN, while preoperative Pavlik harness or brace trial (p = 0.28), presence of ossific nucleus at the time of closed reduction (p = 0.16), and adductor tenotomy (p = 0.37) were not significant factors. Laterality (right vs. left) was also not a significant risk factor (p = 0.75), but patients who underwent closed reduction for bilateral DDH were less likely to develop AVN (p = 0.027). Overall, the degree of abduction did not affect the rate of AVN (p = 0.87). However, in patients treated with closed reduction younger than 6 months of age, the rate of AVN was increased with abduction ≥50° (9/15, 60 %) compared to abduction <50° (0/8, 0 %) (p = 0.007). Patients who developed AVN were more likely to require subsequent surgery (p = 0.034) and more likely to report a fair/poor clinical outcome (p = 0.049). The risk of AVN (35 %) following closed reduction and spica casting for DDH is high. The degree of abduction in spica casts appears to be a risk factor in patients ≤6 months old. The authors recommend that abduction in spica casts should be limited to <50° in children younger than 6 months of age. IV.

Quantifying the risk-reduction potential of new Modified Risk Tobacco Products.

PubMed

Martin, Florian; Vuillaume, Gregory; Baker, Gizelle; Sponsiello-Wang, Zheng; Ricci, Paolo F; Lüdicke, Frank; Weitkunat, Rolf

2018-02-01

Quantitative risk assessment of novel Modified Risk Tobacco Products (MRTP) must rest on indirect measurements that are indicative of disease development prior to epidemiological data becoming available. For this purpose, a Population Health Impact Model (PHIM) has been developed to estimate the reduction in the number of deaths from smoking-related diseases following the introduction of an MRTP. One key parameter of the model, the F-factor, describes the effective dose upon switching from cigarette smoking to using an MRTP. Biomarker data, collected in clinical studies, can be analyzed to estimate the effects of switching to an MRTP as compared to quitting smoking. Based on transparent assumptions, a link function is formulated that translates these effects into the F-factor. The concepts of 'lack of sufficiency' and 'necessity' are introduced, allowing for a parametrization of a family of link functions. These can be uniformly sampled, thus providing different 'scenarios' on how biomarker-based evidence can be translated into the F-factor to inform the PHIM. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

JWST Pathfinder Telescope Risk Reduction Cryo Test Program

NASA Technical Reports Server (NTRS)

Matthews, Gary W.; Scorse, Thomas R.; Spina, John A.; Noel, Darin M.; Havey, Keith A., Jr.; Huguet, Jesse A.; Whitman, Tony L.; Wells, Conrad; Walker, Chanda B.; Lunt, Sharon;

Preferences for breast cancer risk reduction among BRCA1/BRCA2 mutation carriers: a discrete-choice experiment.

PubMed

Liede, Alexander; Mansfield, Carol A; Metcalfe, Kelly A; Price, Melanie A; Snyder, Carrie; Lynch, Henry T; Friedman, Sue; Amelio, Justyna; Posner, Joshua; Narod, Steven A; Lindeman, Geoffrey J; Evans, D Gareth

2017-09-01

Unaffected women who carry BRCA1 or BRCA2 mutations face difficult choices about reducing their breast cancer risk. Understanding their treatment preferences could help us improve patient counseling and inform drug trials. The objective was to explore preferences for various risk-reducing options among women with germline BRCA1/2 mutations using a discrete-choice experiment survey and to compare expressed preferences with actual behaviors. A discrete-choice experiment survey was designed wherein women choose between hypothetical treatments to reduce breast cancer risk. The hypothetical treatments were characterized by the extent of breast cancer risk reduction, treatment duration, impact on fertility, hormone levels, risk of uterine cancer, and ease and mode of administration. Data were analyzed using a random-parameters logit model. Women were also asked to express their preference between surgical and chemoprevention options and to report on their actual risk-reduction actions. Women aged 25-55 years with germline BRCA1/2 mutations who were unaffected with breast or ovarian cancer were recruited through research registries at five clinics and a patient advocacy group. Between January 2015 and March 2016, 622 women completed the survey. Breast cancer risk reduction was the most important consideration expressed, followed by maintaining fertility. Among the subset of women who wished to have children in future, the ability to maintain fertility was the most important factor, followed by the extent of risk reduction. Many more women said they would take a chemoprevention drug than had actually taken chemoprevention. Women with BRCA1/2 mutations indicated strong preferences for breast cancer risk reduction and maintaining fertility. The expressed desire to have a safe chemoprevention drug available to them was not met by current chemoprevention options.

A practical approach to assess depression risk and to guide risk reduction strategies in later life.

PubMed

Almeida, Osvaldo P; Alfonso, Helman; Pirkis, Jane; Kerse, Ngaire; Sim, Moira; Flicker, Leon; Snowdon, John; Draper, Brian; Byrne, Gerard; Goldney, Robert; Lautenschlager, Nicola T; Stocks, Nigel; Scazufca, Marcia; Huisman, Martijn; Araya, Ricardo; Pfaff, Jon

2011-03-01

Many factors have been associated with the onset and maintenance of depressive symptoms in later life, although this knowledge is yet to be translated into significant health gains for the population. This study gathered information about common modifiable and non-modifiable risk factors for depression with the aim of developing a practical probabilistic model of depression that can be used to guide risk reduction strategies. A cross-sectional study was undertaken of 20,677 community-dwelling Australians aged 60 years or over in contact with their general practitioner during the preceding 12 months. Prevalent depression (minor or major) according to the Patient Health Questionnaire (PHQ-9) assessment was the main outcome of interest. Other measured exposures included self-reported age, gender, education, loss of mother or father before age 15 years, physical or sexual abuse before age 15 years, marital status, financial stress, social support, smoking and alcohol use, physical activity, obesity, diabetes, hypertension, and prevalent cardiovascular diseases, chronic respiratory diseases and cancer. The mean age of participants was 71.7 ± 7.6 years and 57.9% were women. Depression was present in 1665 (8.0%) of our subjects. Multivariate logistic regression showed depression was independently associated with age older than 75 years, childhood adverse experiences, adverse lifestyle practices (smoking, risk alcohol use, physical inactivity), intermediate health hazards (obesity, diabetes and hypertension), comorbid medical conditions (clinical history of coronary heart disease, stroke, asthma, chronic obstructive pulmonary disease, emphysema or cancers), and social or financial strain. We stratified the exposures to build a matrix that showed that the probability of depression increased progressively with the accumulation of risk factors, from less than 3% for those with no adverse factors to more than 80% for people reporting the maximum number of risk factors. Our

Simulating fuel reduction scenarios on a wildland-urban interface in northeastern Oregon.

Treesearch

Alan A. Ager; R. James Barbour; Jane L. Hayes

2005-01-01

We analyzed the long-term effects of fuels reduction treatments around a wildland-urban interface located in the Blue Mountains near La Grande, Oregon. The study area is targeted for fuels reduction treatments on both private and federal lands to reduce the risk of severe wildfire and associated damage to property and homes. We modeled a number of hypothetical fuel...

Theoretical framework to study exercise motivation for breast cancer risk reduction.

PubMed

Wood, Maureen E

2008-01-01

To identify an appropriate theoretical framework to study exercise motivation for breast cancer risk reduction among high-risk women. An extensive review of the literature was conducted to gather relevant information pertaining to the Health Promotion Model, self-determination theory, social cognitive theory, Health Belief Model, Transtheoretical Model, theory of planned behavior, and protection motivation theory. An iterative approach was used to summarize the literature related to exercise motivation within each theoretical framework. Protection motivation theory could be used to examine the effects of perceived risk and self-efficacy in motivating women to exercise to facilitate health-related behavioral change. Evidence-based research within a chosen theoretical model can aid practitioners when making practical recommendations to reduce breast cancer risk.

Investigating maternal risk factors as potential targets of intervention to reduce socioeconomic inequality in small for gestational age: a population-based study.

PubMed

Hayward, Irene; Malcoe, Lorraine Halinka; Cleathero, Lesley A; Janssen, Patricia A; Lanphear, Bruce P; Hayes, Michael V; Mattman, Andre; Pampalon, Robert; Venners, Scott A

2012-06-13

The major aim of this study was to investigate whether maternal risk factors associated with socioeconomic status and small for gestational age (SGA) might be viable targets of interventions to reduce differential risk of SGA by socioeconomic status (socioeconomic SGA inequality) in the metropolitan area of Vancouver, Canada. This study included 59,039 live, singleton births in the Vancouver Census Metropolitan Area (Vancouver) from January 1, 2006 to September 17, 2009. To identify an indicator of socioeconomic SGA inequality, we used hierarchical logistic regression to model SGA by area-level variables from the Canadian census. We then modelled SGA by area-level average income plus established maternal risk factors for SGA and calculated population attributable SGA risk percentages (PAR%) for each variable. Associations of maternal risk factors for SGA with average income were investigated to identify those that might contribute to SGA inequality. Finally, we estimated crude reductions in the percentage and absolute differences in SGA risks between highest and lowest average income quintiles that would result if interventions on maternal risk factors successfully equalized them across income levels or eliminated them altogether. Average income produced the most linear and statistically significant indicator of socioeconomic SGA inequality with 8.9% prevalence of SGA in the lowest income quintile compared to 5.6% in the highest. The adjusted PAR% of SGA for variables were: bottom four quintiles of height (51%), first birth (32%), bottom four quintiles of average income (14%), oligohydramnios (7%), underweight or hypertension, (6% each), smoking (3%) and placental disorder (1%). Shorter height, underweight and smoking during pregnancy had higher prevalence in lower income groups. Crude models assuming equalization of risk factors across income levels or elimination altogether indicated little potential change in relative socioeconomic SGA inequality and reduction

Demonstrating PQS Effectiveness and Driving Continual Improvement: Evidence-Based Risk Reduction.

PubMed

Ramnarine, Emma; O'Donnell, Kevin

2018-04-18

Product knowledge grows and evolves during the life of a product. In order to maintain a state of control and deliver product with consistent quality throughout its commercial life, continuous improvement and product lifecycle management become essential. The practical link between product and process knowledge, risk-based control strategies, and continual improvement and innovation can be made stronger through evidence-based risk reduction. Regulatory relief and flexibility in post approval change management and overall product lifecycle management will only be possible with effective application of science and risk-based concepts and demonstrated effectiveness of the PQS in assuring a state of control. Copyright © 2018, Parenteral Drug Association.

Developing a Risk Model to Target High-risk Preventive Interventions for Sexual Assault Victimization among Female U.S. Army Soldiers

PubMed Central

Street, Amy E.; Rosellini, Anthony J.; Ursano, Robert J.; Heeringa, Steven G.; Hill, Eric D.; Monahan, John; Naifeh, James A.; Petukhova, Maria V.; Reis, Ben Y.; Sampson, Nancy A.; Bliese, Paul D.; Stein, Murray B.; Zaslavsky, Alan M.; Kessler, Ronald C.

2016-01-01

Sexual violence victimization is a significant problem among female U.S. military personnel. Preventive interventions for high-risk individuals might reduce prevalence, but would require accurate targeting. We attempted to develop a targeting model for female Regular U.S. Army soldiers based on theoretically-guided predictors abstracted from administrative data records. As administrative reports of sexual assault victimization are known to be incomplete, parallel machine learning models were developed to predict administratively-recorded (in the population) and self-reported (in a representative survey) victimization. Capture-recapture methods were used to combine predictions across models. Key predictors included low status, crime involvement, and treated mental disorders. Area under the Receiver Operating Characteristic curve was .83−.88. 33.7-63.2% of victimizations occurred among soldiers in the highest-risk ventile (5%). This high concentration of risk suggests that the models could be useful in targeting preventive interventions, although final determination would require careful weighing of intervention costs, effectiveness, and competing risks. PMID:28154788

Historic Landslide Data Combined with Sentinel Satellite Data to Improve Modelling for Disaster Risk Reduction

NASA Astrophysics Data System (ADS)

Bye, B. L.; Kontoes, C.; Catarino, N.; De Lathouwer, B.; Concalves, P.; Meyer-Arnek, J.; Mueller, A.; Kraft, C.; Grosso, N.; Goor, E.; Voidrot, M. F.; Trypitsidis, A.

2017-12-01

Landslides are geohazards potentially resulting in disasters. Landslides both vary enormously in their distribution in space and time. The surface deformation varies considerably from one type of instability to another. Individual ground instabilities may have a common trigger (extreme rainfall, earthquake), and therefore occur alongside many equivalent occurrences over a large area. This means that they can have a significant regional impact demanding national and international disaster risk reduction strategies. Regional impacts require collaboration across boarders as reflected in The Sendai Framework for Disaster Risk Reduction (2015-2030). The data demands related to the SDGs are unprecedented, another factor that will require coordinated efforts at the global, regional and national levels. Data of good quality are vital for governments, international organizations, civil society, the private sector and the general public in order to make informed decisions, included for disaster risk reduction. The NextGEOSS project evolves the European vision of a user driven GEOSS data exploitation for innovation and business, relying on 3 main pillars; engaging communities of practice, delivering technological advancements, and advocating the use of GEOSS. These 3 pillars support the creation and deployment of Earth observation based innovative research activities and commercial services. In this presentation we will explain how one of the 10 NextGEOSS pilots, Disaster Risk Reduction (DRR), plan to provide an enhanced multi-hazard risk assessment framework based on statistical analysis of long time series of data. Landslide events monitoring and landslides susceptibility estimation will be emphazised. Workflows will be based on models developed in the context of the Copernicus Emergency Management Service. Data envisaged to be used are: Radar SAR data; Yearly ground deformation/velocities; Historic landslide inventory; data related to topographic, geological, hydrological

The effects of Risk Factor-Targeted Lifestyle Counselling Intervention on working-age stroke patients' adherence to lifestyle change.

PubMed

Oikarinen, Anne; Engblom, Janne; Kääriäinen, Maria; Kyngäs, Helvi

2017-09-01

Since a history of stroke or transient ischaemic attack is a major risk factor for a recurrent event, lifestyle counselling during the hospital phase is an essential component of treatment and may increase the probability of lifestyle change. To study the effect of risk factor-targeted lifestyle counselling intervention on working-age stroke patients' adherence to lifestyle changes. A quasi-experimental, nonequivalent control group pretest-post-test design. Stroke patients in an acute neurological unit were divided into a control group (n = 75) receiving standard counselling and an experimental group (n = 75) receiving risk factor-targeted counselling. Lifestyle data and clinical outcomes were collected at hospital between January 2010 and October 2011, while data on adherence to lifestyle changes 3, 6, and 12 months after discharge. The baseline lifestyle habits did not differ significantly other than in alcohol behaviour. Both groups increased their intake, but the intervention group to a lesser degree. However, the experimental group significantly lost their weight for the first 3 and 6 months; at 3 months reduction in cigarette consumption and at 6 months significant increases in smoking cessation were also achieved. All improved some of their lifestyle habits. Intervention was associated with support from nurses as well as from family and friends. Adherence scores were higher in the experimental group. Some short-term advantages in lifestyle habits due to the intervention were noted. Participants in both groups improved some of their lifestyle habits. © 2016 Nordic College of Caring Science.

NASA Propulsion Concept Studies and Risk Reduction Activities for Resource Prospector Lander

NASA Technical Reports Server (NTRS)

Trinh, Huu P.; Williams, Hunter; Burnside, Chris

2015-01-01

The trade study has led to the selection of propulsion concept with the lowest cost and net lowest risk -Government-owned, flight qualified components -Meet mission requirements although the configuration is not optimized. Risk reduction activities have provided an opportunity -Implement design improvements while development with the early-test approach. -Gain knowledge on the operation and identify operation limit -Data to anchor analytical models for future flight designs; The propulsion system cold flow tests series have provided valuable data for future design. -The pressure surge from the system priming and waterhammer within component operation limits. -Enable to optimize the ullage volume to reduce the propellant tank mass; RS-34 hot fire tests have successfully demonstrated of using the engines for the RP mission -No degradation of performance due to extended storage life of the hardware. -Enable to operate the engine for RP flight mission scenarios, outside of the qualification regime. -Provide extended data for the thermal and GNC designs. Significant progress has been made on NASA propulsion concept design and risk reductions for Resource Prospector lander.

Mothers' knowledge and attitudes to sudden infant death syndrome risk reduction messages: results from a UK survey.

PubMed

Pease, Anna S; Blair, Peter S; Ingram, Jenny; Fleming, Peter J

2018-01-01

To investigate mothers' knowledge of reducing the risks for sudden infant death syndrome (SIDS) and attitudes towards safer sleep practices. A cross-sectional survey was carried out in deprived areas of Bristol, UK. Recruitment took place in 2014 at local health visitor-led baby clinics. Of 432 mothers approached, 400 (93%) completed the face-to-face survey. Participants with infants at 'higher' risk of SIDS (using an algorithm based on a previous observational study) were compared with those at 'lower' risk. The survey asked participants to recall three SIDS risk reduction strategies (unprompted), and scored responses to 14 SIDS risk-related infant sleep scenarios (prompted). Overall, 48/400 (12%) mothers were classified as higher risk. Mothers in the higher risk group were less likely to breast feed (multivariate OR=3.59(95% CI 1.46 to 8.86)), less likely to be able to cite two or more unprompted correct SIDS risk reduction strategies (multivariate OR=2.05(95% CI 1.02 to 4.13)) and scored lower on prompted safer sleep scenarios overall.Notably, only 206/400 (52%) of all mothers surveyed (33% in the higher risk group) from these deprived areas in Bristol identified infant sleep position as a risk reduction strategy for SIDS, despite 25 years of campaigns. Mothers in the higher risk group were disadvantaged when it came to some aspects of knowledge of SIDS risk reduction and attitudes to safer sleep. The initial 'Back-to Sleep' message that dramatically reduced these deaths a generation ago needs more effective promotion for today's generation of mothers. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The Girlfriends Project: Results of a pilot study assessing feasibility of an HIV testing and risk reduction intervention developed, implemented, and evaluated in community settings.

PubMed

Hawk, Mary

2013-12-01

African American women in the United States experience significant HIV health disparities. The majority of evidence-based risk reduction interventions do not incorporate HIV testing, and most are targeted only to narrow segments of the population such as women who are pregnant or seen in STI clinics. This pilot study assessed the feasibility and efficacy of The Girlfriends Project (TGP), a community developed and community evaluated HIV risk reduction and testing intervention. A group randomized wait-list design was used to recruit 149 women and to compare findings for intervention group versus control group participants. Women in the intervention group demonstrated statistically-significant increases in HIV knowledge scores and in condom use during vaginal sex. Eighty-seven percent of participants accessed HIV testing with a 100% return rate for results. Study findings suggest that TGP has the potential to be an effective intervention and to increase number of African American women who access HIV testing.

SOCIAL PSYCHOLOGICAL DYNAMICS OF ENHANCED HIV RISK REDUCTION AMONG PEER INTERVENTIONISTS

PubMed Central

Dickson-Gomez, Julia; Weeks, Margaret R.; Convey, Mark; Li, Jianghong

2014-01-01

The authors present a model of interactive social psychological and relational feedback processes leading to human immunodeficiency virus (HIV) risk reduction behavior change among active drug users trained as Peer Health Advocates (PHAs). The model is supported by data from qualitative interviews with PHAs and members of their drug-using networks in the Risk Avoidance Partnership (RAP) project. Results suggest three mutually reinforcing social psychological processes that motivate PHAs to provide HIV prevention intervention to their peers and to reduce their own risk behaviors: development of a prosocial identity, positive social reinforcement from drug users and community members, and cognitive dissonance associated with continued risk behavior while engaging in health advocacy. These processes directly influence peer interventionists’ motivation and efficacy to continue giving intervention to their peers, and to reduce their HIV risk behaviors. The authors discuss implications of the model for continued research on effective HIV prevention in high-risk groups. PMID:25414528

Ecohydrology of agroecosystems: probabilistic description of yield reduction risk under limited water availability

NASA Astrophysics Data System (ADS)

Vico, Giulia; Porporato, Amilcare

2013-04-01

Supplemental irrigation represents one of the main strategies to mitigate the effects of climate variability and stabilize yields. Irrigated agriculture currently provides 40% of food production and its relevance is expected to further increase in the near future, in face of the projected alterations of rainfall patterns and increase in food, fiber, and biofuel demand. Because of the significant investments and water requirements involved in irrigation, strategic choices are needed to preserve productivity and profitability, while maintaining a sustainable water management - a nontrivial task given the unpredictability of the rainfall forcing. To facilitate decision making under uncertainty, a widely applicable probabilistic framework is proposed. The occurrence of rainfall events and irrigation applications are linked probabilistically to crop development during the growing season and yields at harvest. Based on these linkages, the probability density function of yields and corresponding probability density function of required irrigation volumes, as well as the probability density function of yields under the most common case of limited water availability are obtained analytically, as a function of irrigation strategy, climate, soil and crop parameters. The full probabilistic description of the frequency of occurrence of yields and water requirements is a crucial tool for decision making under uncertainty, e.g., via expected utility analysis. Furthermore, the knowledge of the probability density function of yield allows us to quantify the yield reduction hydrologic risk. Two risk indices are defined and quantified: the long-term risk index, suitable for long-term irrigation strategy assessment and investment planning, and the real-time risk index, providing a rigorous probabilistic quantification of the emergence of drought conditions during a single growing season in an agricultural setting. Our approach employs relatively few parameters and is thus easily and

Resilience and disaster risk reduction: an etymological journey

NASA Astrophysics Data System (ADS)

Alexander, D. E.

2013-04-01

This paper examines the development over historical time of the meaning and uses of the term resilience. The objective is to deepen our understanding of how the term came to be adopted in disaster risk reduction and resolve some of the conflicts and controversies that have arisen when it has been used. The paper traces the development of resilience through the sciences, humanities, and legal and political spheres. It considers how mechanics passed the word to ecology and psychology, and how from there it was adopted by social research and sustainability science. As other authors have noted, as a concept, resilience involves some potentially serious conflicts or contradictions, for example between stability and dynamism, or between dynamic equilibrium (homeostasis) and evolution. Moreover, although the resilience concept works quite well within the confines of General Systems Theory, in situations in which a systems formulation inhibits rather than fosters explanation, a different interpretation of the term is warranted. This may be the case for disaster risk reduction, which involves transformation rather than preservation of the ''state of the system''. The article concludes that the modern conception of resilience derives benefit from a rich history of meanings and applications, but that it is dangerous - or at least potentially disappointing - to read to much into the term as a model and a paradigm. Sagitta in lapidem numquam figitur, interdum resiliens percutit dirigentem. ("An arrow never lodges in a stone: often it recoils upon its sender.") St. John Chrysostom (c. 347-407), Archbishop of Constantinople.

Nutritional approaches in the risk reduction and management of Alzheimer's disease.

PubMed

Mi, Weiqian; van Wijk, Nick; Cansev, Mehmet; Sijben, John W C; Kamphuis, Patrick J G H

2013-09-01

Alzheimer's disease (AD) is a heterogeneous and devastating neurodegenerative disease with increasing socioeconomic burden for society. In the past 30 y, notwithstanding advances in the understanding of the pathogenesis of the disease and consequent development of therapeutic approaches to novel pathogenic targets, no cure has so far emerged. This contribution focuses on recent nutritional approaches in the risk reduction and management of AD with emphasis on factors providing a rationale for nutritional approaches in AD, including compromised nutritional status, altered nutrient uptake and metabolism, and nutrient requirements for synapse formation. Collectively these factors are believed to result in specific nutritional requirement in AD. The chapter also emphasizes investigated nutritional interventions in patients with AD, including studies with single nutrients and with the specific nutrient combination Fortasyn Connect and discusses the current shift of paradigm to intervene in earlier stages of AD, which offers opportunities for investigating nutritional strategies to reduce the risk for disease progression. Fortasyn Connect was designed to enhance synapse formation and function in AD by addressing the putative specific nutritional requirements and contains docosahexaenoic acid, eicosapentaenoic acid, uridine-5'-mono-phosphate, choline, phospholipids, antioxidants, and B vitamins. Two randomized controlled trials (RCTs) with the medical food Souvenaid, containing Fortasyn Connect, showed that this intervention improved memory performance in mild, drug-naïve patients with AD. Electroencephalography outcome in one of these clinical studies suggests that Souvenaid has an effect on brain functional connectivity, which is a derivative of changed synaptic activity. Thus, these studies suggest that nutritional requirements in AD can be successfully addressed and result in improvements in behavioral and neuro-physiological alterations that are characteristic to AD

HIV risk reduction intervention among traditionally circumcised young men in South Africa: a cluster randomized control trial.

PubMed

Peltzer, Karl; Simbayi, Leickness; Banyini, Mercy; Kekana, Queen

2011-01-01

The aim of this study was to test a 180-minute group HIV risk-reduction counseling intervention trial with men undergoing traditional circumcision in South Africa to reduce behavioral disinhibition (false security) as a result of the procedure. A cluster randomized controlled trial design was employed using a sample of 160 men, 80 in the experimental group and 80 in the control group. Comparisons between baseline and 3-month follow-up assessments on key behavioral outcomes were completed. We found that behavioral intentions, risk-reduction skills, and male role norms did not change in the experimental compared to the control condition. However, HIV-related stigma beliefs were significantly reduced in both conditions over time. These findings show that one small-group HIV risk-reduction intervention did not reduce sexual risk behaviors in recently traditionally circumcised men at high risk for behavioral disinhibition. Copyright © 2011 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Ibrutinib-associated bleeding: pathogenesis, management and risk reduction strategies.

PubMed

Shatzel, J J; Olson, S R; Tao, D L; McCarty, O J T; Danilov, A V; DeLoughery, T G

2017-05-01

Ibrutinib is an irreversible inhibitor of Bruton's tyrosine kinase (Btk) that has proven to be an effective therapeutic agent for multiple B-cell-mediated lymphoproliferative disorders. Ibrutinib, however, carries an increased bleeding risk compared with standard chemotherapy. Bleeding events range from minor mucocutaneous bleeding to life-threatening hemorrhage, due in large part to the effects of ibrutinib on several distinct platelet signaling pathways. There is currently a minimal amount of data to guide clinicians regarding the use of ibrutinib in patients at high risk of bleeding or on anticoagulant or antiplatelet therapy. In addition, the potential cardiovascular protective effects of ibrutinib monotherapy in patients at risk of vascular disease are unknown. Patients should be cautioned against using non-steroidal anti-inflammatory drugs, fish oils, vitamin E and aspirin-containing products, and consider replacing ibrutinib with a different agent if dual antiplatelet therapy is indicated. Patients should not take vitamin K antagonists concurrently with ibrutinib; direct oral anticoagulants should be used if extended anticoagulation is strongly indicated. In this review, we describe the pathophysiology of ibrutinib-mediated bleeding and suggest risk reduction strategies for common clinical scenarios associated with ibrutinib. © 2017 International Society on Thrombosis and Haemostasis.

Disaster Risk Reduction in Myanmar: A Need for Focus on Community Preparedness and Improved Evaluation of Initiatives.

PubMed

Smith, Andrew D; Chan, Emily Y Y

2017-11-20

Myanmar is a country in political and economic transition. Facing a wide-variety of natural hazards and ongoing conflict, the country's under-developed infrastructure has resulted in high disaster risk. Following the devastation of Cyclone Nargis in 2008 and increased global focus on disaster management and risk reduction, Myanmar has begun development of national disaster policies. Myanmar's Action Plan for Disaster Risk Reduction addressed multiple stages of disaster development and has made progress towards national projects, however, has struggled to implement community-based preparedness and response initiatives. This article analyses Myanmar's disaster strategy, though the use of a disaster development framework and suggests areas for possible improvement. In particular, the article aims to generate discussion regarding methods of supporting objective evaluation of risk reduction initiatives in developing countries. (Disaster Med Public Health Preparedness. 2017;page 1 of 5).

A randomized comparison of patients' understanding of number needed to treat and other common risk reduction formats.

PubMed

Sheridan, Stacey L; Pignone, Michael P; Lewis, Carmen L

2003-11-01

Commentators have suggested that patients may understand quantitative information about treatment benefits better when they are presented as numbers needed to treat (NNT) rather than as absolute or relative risk reductions. To determine whether NNT helps patients interpret treatment benefits better than absolute risk reduction (ARR), relative risk reduction (RRR), or a combination of all three of these risk reduction presentations (COMBO). Randomized cross-sectional survey. University internal medicine clinic. Three hundred fifty-seven men and women, ages 50 to 80, who presented for health care. Subjects were given written information about the baseline risk of a hypothetical "disease Y" and were asked (1) to compare the benefits of two drug treatments for disease Y, stating which provided more benefit; and (2) to calculate the effect of one of those drug treatments on a given baseline risk of disease. Risk information was presented to each subject in one of four randomly allocated risk formats: NNT, ARR, RRR, or COMBO. When asked to state which of two treatments provided more benefit, subjects who received the RRR format responded correctly most often (60% correct vs 43% for COMBO, 42% for ARR, and 30% for NNT, P =.001). Most subjects were unable to calculate the effect of drug treatment on the given baseline risk of disease, although subjects receiving the RRR and ARR formats responded correctly more often (21% and 17% compared to 7% for COMBO and 6% for NNT, P =.004). Patients are best able to interpret the benefits of treatment when they are presented in an RRR format with a given baseline risk of disease. ARR also is easily interpreted. NNT is often misinterpreted by patients and should not be used alone to communicate risk to patients.

Social Psychological Dynamics of Enhanced HIV Risk Reduction among Peer Interventionists

ERIC Educational Resources Information Center

Dickson-Gomez, Julia; Weeks, Margaret R.; Convey, Mark; Li, Jianghong

2011-01-01

The authors present a model of interactive social psychological and relational feedback processes leading to human immunodeficiency virus (HIV) risk reduction behavior change among active drug users trained as Peer Health Advocates (PHAs). The model is supported by data from qualitative interviews with PHAs and members of their drug-using networks…

NASA's Orbital Space Plane Risk Reduction Strategy

NASA Technical Reports Server (NTRS)

Dumbacher, Dan

2003-01-01

This paper documents the transformation of NASA s Space Launch Initiative (SLI) Second Generation Reusable Launch Vehicle Program under the revised Integrated Space Transportation Plan, announced November 2002. Outlining the technology development approach followed by the original SLI, this paper gives insight into the current risk-reduction strategy that will enable confident development of the Nation s first orbital space plane (OSP). The OSP will perform an astronaut and contingency cargo transportation function, with an early crew rescue capability, thus enabling increased crew size and enhanced science operations aboard the International Space Station. The OSP design chosen for full-scale development will take advantage of the latest innovations American industry has to offer. The OSP Program identifies critical technologies that must be advanced to field a safe, reliable, affordable space transportation system for U.S. access to the Station and low-Earth orbit. OSP flight demonstrators will test crew safety features, validate autonomous operations, and mature thermal protection systems. Additional enabling technologies may be identified during the OSP design process as part of an overall risk-management strategy. The OSP Program uses a comprehensive and evolutionary systems acquisition approach, while applying appropriate lessons learned.

Promoting flood risk reduction: The role of insurance in Germany and England

NASA Astrophysics Data System (ADS)

Surminski, Swenja; Thieken, Annegret H.

2017-10-01

Improving society's ability to prepare for, respond to and recover from flooding requires integrated, anticipatory flood risk management (FRM). However, most countries still focus their efforts on responding to flooding events if and when they occur rather than addressing their current and future vulnerability to flooding. Flood insurance is one mechanism that could promote a more ex ante approach to risk by supporting risk reduction activities. This paper uses an adapted version of Easton's System Theory to investigate the role of insurance for FRM in Germany and England. We introduce an anticipatory FRM framework, which allows flood insurance to be considered as part of a broader policy field. We analyze if and how flood insurance can catalyze a change toward a more anticipatory approach to FRM. In particular we consider insurance's role in influencing five key components of anticipatory FRM: risk knowledge, prevention through better planning, property-level protection measures, structural protection and preparedness (for response). We find that in both countries FRM is still a reactive, event-driven process, while anticipatory FRM remains underdeveloped. Collaboration between insurers and FRM decision-makers has already been successful, for example in improving risk knowledge and awareness, while in other areas insurance acts as a disincentive for more risk reduction action. In both countries there is evidence that insurance can play a significant role in encouraging anticipatory FRM, but this remains underutilized. Effective collaboration between insurers and government should not be seen as a cost, but as an investment to secure future insurability through flood resilience.

Remote Imaging of Exploration Flight Test-1 (EFT-1) Entry Heating Risk Reduction

NASA Technical Reports Server (NTRS)

Schuster, David M.; Horvath, Thomas J.; Schwartz, Richard J.

2016-01-01

A Measure of Performance (MOP) identified with an Exploration Flight Test-1 (EFT-1) Multi- Purpose Crew Vehicle (MPCV) Program Flight Test Objective (FTO) (OFT1.091) specified an observation during reentry though external ground-based or airborne assets with thermal detection capabilities. The objective of this FTO was to be met with onboard Developmental Flight Instrumentation (DFI), but the MOP for external observation was intended to provide complementary quantitative data and serve as a risk reduction in the event of anomalous DFI behavior (or failure). Mr. Gavin Mendeck, the Entry, Descent, and Landing (EDL) Phase Engineer for the MPCV Program (Vehicle Integration Office/Systems & Mission Integration) requested a risk-reduction assessment from the NASA Engineering and Safety Center (NESC) to determine whether quantitative imagery could be obtained from remote aerial assets to support the external observation MOP. If so, then a viable path forward was to be determined, risks identified, and an observation pursued. If not, then the MOP for external observation was to be eliminated.

Aviation Security, Risk Assessment, and Risk Aversion for Public Decisionmaking

ERIC Educational Resources Information Center

Stewart, Mark G.; Mueller, John

2013-01-01

This paper estimates risk reductions for each layer of security designed to prevent commercial passenger airliners from being commandeered by terrorists, kept under control for some time, and then crashed into specific targets. Probabilistic methods are used to characterize the uncertainty of rates of deterrence, detection, and disruption, as well…

Tobacco Smoke–Related Health Effects Induced by 1,3-Butadiene and Strategies for Risk Reduction

PubMed Central

Soeteman-Hernández, Lya G.

2013-01-01

1,3-Butadiene (BD) is a smoke component selected by the World Health Organization (WHO) study group on Tobacco Product Regulation (TobReg) for mandated lowering. We examined the tobacco smoke–related health effects induced by BD and possible health impacts of risk reduction strategies. BD levels in mainstream smoke (MSS) from international and Canadian cigarettes and environmental tobacco smoke (ETS) were derived from scientific journals and international government reports. Dose-response analyses from toxicity studies from government reports were evaluated and the most sensitive cancer and noncancer endpoints were selected. The risks were evaluated by taking the ratio (margin of exposure, MOE) from the most sensitive toxicity endpoint and appropriate exposure estimates for BD in MSS and ETS. BD is a good choice for lowering given that MSS and ETS were at levels for cancer (leukemia) and noncancer (ovarian atrophy) risks, and the risks can be significantly lowered when lowering the BD concentrations in smoke. Several risk reduction strategies were analyzed including a maximum level of 125% of the median BD value per milligram nicotine obtained from international brands as recommended by the WHO TobReg, tobacco substitute sheets, dual and triple carbon filters, and polymer-derived carbon. The use of tobacco substitute sheet with a polymer-derived carbon filter resulted in the most significant change in risk for cancer and noncancer effects. Our results demonstrate that MOE analysis might be a practical way to assess the impact of risk reduction strategies on human health in the future. PMID:24014643

Effects of a cardiovascular risk reduction intervention with psychobehavioral strategies for Korean adults with type 2 diabetes and metabolic syndrome.

PubMed

Kim, Chun-Ja; Kim, Dae-Jung; Park, Hyung-Ran

2011-01-01

Type 2 diabetes mellitus (DM) and metabolic syndrome are associated with high risk of cardiovascular disease (CVD) and depression. Although lifestyle modifications including regular exercise and weight control are recommended as a primary approach to glycemic control and CVD risk reduction for people with DM and/or metabolic syndrome, little is known concerning the effects of CVD risk reduction interventions using psychobehavioral strategies in this population. This pilot study investigated the effects of a 16-week CVD risk reduction intervention in Korean adults with type 2 DM and metabolic syndrome. A prospective, pretest and posttest, controlled, quasi-experimental design enrolled a convenience sample of 43 Korean adults with type 2 DM and metabolic syndrome at a university hospital. The adults in the intervention group participated in a 16-week CVD risk reduction intervention consisting of 150 minutes of regular exercise per week; 200- to 300-kcal reduced daily diet for weight control; one-on-one psychobehavioral counseling based on constructs from the Transtheoretical Model such as processes of change, self-efficacy, and decisional balance; and telephone coaching for behavioral modification. Participants in the control group received a booklet with basic diabetic education as part of their routine care. Repeated-measures analysis of variance was used for analyzing the effects of the CVD risk reduction intervention on cardiometabolic risk factors including the UK Prospective Diabetes Study score for 10-year CVD risk, glycated hemoglobin (HbA1c), and depression. The intervention group showed significant reductions (P < .05) at 16 weeks, compared with the control group on the UK Prospective Diabetes Study fatal risk scale (-1.73% vs -0.04%), triglycerides (-38.5 vs -15.1 mg/dL), fasting plasma glucose (-29.24 vs +1.77 mg/dL), HbA1c (-0.37% vs +0.17%), and depression (score, -3.24 vs 1.40) measurements. This pilot study yielded evidence for the beneficial impact

Landslide risk reduction strategies: an inventory for the Global South

NASA Astrophysics Data System (ADS)

Maes, Jan; Kervyn, Matthieu; Vranken, Liesbet; Dewitte, Olivier; Vanmaercke, Matthias; Mertens, Kewan; Jacobs, Liesbet; Poesen, Jean

2015-04-01

Landslides constitute a serious problem globally. Moreover, landslide impact remains underestimated especially in the Global South. It is precisely there where the largest impact is experienced. An overview of measures taken to reduce risk of landslides in the Global South is however still lacking. Because in many countries of the Global South disaster risk reduction (DRR) is at an emerging stage, it is crucial to monitor the ongoing efforts (e.g. discussions on the Post-2015 Framework for DRR). The first objective of this study is to make an inventory of techniques and strategies that are applied to reduce risk from landslides in tropical countries. The second objective is to investigate what are the main bottlenecks for implementation of DRR strategies. In order to achieve these objectives, a review of both scientific and grey literature was conducted, supplemented with expert knowledge. The compilation of recommended and implemented DRR measures from landslide-prone tropical countries is based on an adapted classification proposed by the SafeLand project. According to Vaciago (2013), landslide risk can be reduced by either reducing the hazard, the vulnerability, the number or value of elements at risk or by sharing the residual risk. In addition, these measures can be combined with education and/or awareness raising and are influenced by governance structures and cultural beliefs. Global landslide datasets have been used to identify landslide-prone countries, augmented with region-specific datasets. Countries located in the tropics were selected in order to include landslide-prone countries with a different Human Development Index (HDI) but with a similar climate. Preliminary results support the statement made by Anderson (2013) that although the importance of shifting from post-disaster emergency actions to pre-disaster mitigation is acknowledged, in practice this paradigm shift seems rather limited. It is expected that this is especially the case in countries

Criminality among Female Drug Users Following an HIV Risk-Reduction Intervention

ERIC Educational Resources Information Center

Theall, Katherine P.; Elifson, Kirk W.; Sterk, Claire E.; Stewart, Eric A.

2007-01-01

The main objectives of this article are to determine the prevalence of criminality among a sample of female African American drug users and to examine change in criminality over time, including the correlates associated with this change. Data were collected from 336 adult women who participated in an HIV risk-reduction intervention focused on the…

Participatory three dimensional mapping for the preparation of landslide disaster risk reduction program

NASA Astrophysics Data System (ADS)

Kusratmoko, Eko; Wibowo, Adi; Cholid, Sofyan; Pin, Tjiong Giok

2017-07-01

This paper presents the results of applications of participatory three dimensional mapping (P3DM) method for fqcilitating the people of Cibanteng' village to compile a landslide disaster risk reduction program. Physical factors, as high rainfall, topography, geology and land use, and coupled with the condition of demographic and social-economic factors, make up the Cibanteng region highly susceptible to landslides. During the years 2013-2014 has happened 2 times landslides which caused economic losses, as a result of damage to homes and farmland. Participatory mapping is one part of the activities of community-based disaster risk reduction (CBDRR)), because of the involvement of local communities is a prerequisite for sustainable disaster risk reduction. In this activity, participatory mapping method are done in two ways, namely participatory two-dimensional mapping (P2DM) with a focus on mapping of disaster areas and participatory three-dimensional mapping (P3DM) with a focus on the entire territory of the village. Based on the results P3DM, the ability of the communities in understanding the village environment spatially well-tested and honed, so as to facilitate the preparation of the CBDRR programs. Furthermore, the P3DM method can be applied to another disaster areas, due to it becomes a medium of effective dialogue between all levels of involved communities.

Hazagora: will you survive the next disaster? - A serious game to raise awareness about geohazards and disaster risk reduction

NASA Astrophysics Data System (ADS)

Mossoux, S.; Delcamp, A.; Poppe, S.; Michellier, C.; Canters, F.; Kervyn, M.

2016-01-01

Natural disasters are too often presented as resulting from extreme natural phenomena affecting helpless populations, with people being insufficiently aware of the factors leading to disasters and of the existing strategies to mitigate their impacts. We developed a board game aimed at raising awareness about geohazards and disaster risk reduction strategies. The target groups are (1) secondary school students and citizens and (2) scientists and stakeholders involved in risk management activities. For the first group, the aim is to induce a better understanding of the geohazards and disasters they are confronted with in the media or in their daily lives; for the second, the objective is to generate discussion about risk management strategies. The game was tested with students in Belgium and with citizens, earth scientists, and risk managers in several African countries. Based on analysis of the most common game strategies observed, the players' reactions during the game, and their answers to a short questionnaire, we analyzed the main learning outcomes conveyed by this game. The game Hazagora appears to positively enhance the players' insights into processes involved in disasters. As such, the game is an effective, fun learning tool to introduce participants to the concepts of geohazards and disasters and to generate discussion.

HAZAGORA: will you survive the next disaster? - a serious game to raise awareness about geohazards and disaster risk reduction

NASA Astrophysics Data System (ADS)

Mossoux, S.; Delcamp, A.; Poppe, S.; Michellier, C.; Canters, F.; Kervyn, M.

2015-09-01

Natural disasters are too often presented as resulting from extreme natural phenomena affecting helpless populations, with people being insufficiently aware of the factors leading to disasters and of the existing strategies to mitigate their impacts. We developed a board game aimed at raising awareness about geohazards and disaster risk reduction strategies. The target groups are (1) secondary school students and citizens, and (2) scientists and stakeholders involved in risk management activities. For the first group, the aim is to induce a better understanding of geohazards and disasters they are confronted with in the media or in their daily life; for the second, the objective is to generate discussion about risk management strategies. The game was tested with students in Belgium and with citizens, earth scientists and risk managers in several African countries. Based on the game strategies analysis, the players' reactions during the game and their answers to a short questionnaire, we analyzed the main learning outcomes conveyed by this game. The Hazagora game appears to positively enhance the players' insight in processes involved in disasters. As such, the game is an effective playful learning tool to introduce participants to the concept of geohazard and disaster and to generate discussion.

Hydrological modelling in a drinking water catchment area as a means of evaluating pathogen risk reduction

NASA Astrophysics Data System (ADS)

Bergion, Viktor; Sokolova, Ekaterina; Åström, Johan; Lindhe, Andreas; Sörén, Kaisa; Rosén, Lars

2017-01-01

Waterborne outbreaks of gastrointestinal diseases are of great concern to drinking water producers and can give rise to substantial costs to the society. The World Health Organisation promotes an approach where the emphasis is on mitigating risks close to the contamination source. In order to handle microbial risks efficiently, there is a need for systematic risk management. In this paper we present a framework for microbial risk management of drinking water systems. The framework incorporates cost-benefit analysis as a decision support method. The hydrological Soil and Water Assessment Tool (SWAT) model, which was set up for the Stäket catchment area in Sweden, was used to simulate the effects of four different mitigation measures on microbial concentrations. The modelling results showed that the two mitigation measures that resulted in a significant (p < 0.05) reduction of Cryptosporidium spp. and Escherichia coli concentrations were a vegetative filter strip linked to cropland and improved treatment (by one Log10 unit) at the wastewater treatment plants. The mitigation measure with a vegetative filter strip linked to grazing areas resulted in a significant reduction of Cryptosporidium spp., but not of E. coli concentrations. The mitigation measure with enhancing the removal efficiency of all on-site wastewater treatment systems (total removal of 2 Log10 units) did not achieve any significant reduction of E. coli or Cryptosporidium spp. concentrations. The SWAT model was useful when characterising the effect of different mitigation measures on microbial concentrations. Hydrological modelling implemented within an appropriate risk management framework is a key decision support element as it identifies the most efficient alternative for microbial risk reduction.

Risk factors associated with intestinal necrosis in children with failed non-surgical reduction for intussusception.

PubMed

Huang, Hui-Ya; Huang, Xiao-Zhong; Han, Yi-Jiang; Zhu, Li-Bin; Huang, Kai-Yu; Lin, Jing; Li, Zhong-Rong

2017-05-01

Intestinal necrosis is the most serious complication of intussusception. The risk factors associated with intestinal necrosis in pediatric patients with intussusception have not been well characterized. This study aimed to investigate the risk factors associated with intestinal necrosis in pediatric patients with failed non-surgical reduction for intussusception. Hospitalized patients who failed the air-enema reduction for intussusception in the outpatient department and subsequently underwent surgery were retrospectively reviewed. All cases were categorized into two groups: intestinal necrosis group and non-intestinal necrosis group based on the surgical findings. Demographic and clinical features including the findings from the surgery were recorded and analyzed. Factors associated with intestinal necrosis were analyzed using univariate and multivariate unconditional logistic regression analyses. A total of 728 cases were included. Among them, 171 had intestinal necrosis at the time of surgery. The group with intestinal necrosis had a longer duration of symptom or length of illness (P = 0.000), and younger (P = 0.000) than the non-intestinal necrosis group. Complex/compound type of intussusceptions is more likely to have intestinal necrosis. Multivariate analysis showed that the presence of grossly bloody stool (OR = 2.12; 95% CI 1.19-3.76, P = 0.010) and duration of symptom (OR = 1.07; 95% CI 1.06-1.08, P = 0.000) were independent risk factors for intestinal necrosis in patients hospitalized for surgical reduction for intussusceptions. At time of admission, the presence of bloody stools and duration of symptom are the important risk factors for developing intestinal necrosis for those patients who failed non-surgical reduction. The length of illness has the highest sensitivity and specificity to correlate with intestinal necrosis. This finding may suggest that we should take the intussusception cases that have the longer duration of

Vitamin D analogues to target residual proteinuria: potential impact on cardiorenal outcomes

PubMed Central

Humalda, Jelmer K.; Goldsmith, David J. A.; Thadhani, Ravi; de Borst, Martin H.

2015-01-01

Residual proteinuria, the amount of proteinuria that remains during optimally dosed renin-angiotensin-aldosterone system (RAAS) blockade, is an independent risk factor for progressive renal function loss and cardiovascular complications in chronic kidney disease (CKD) patients. Dual RAAS blockade may reduce residual proteinuria but without translating into improved cardiorenal outcomes at least in diabetic nephropathy; rather, dual RAAS blockade may increase the risk of adverse events. These findings have challenged the concept of residual proteinuria as an absolute treatment target. Therefore, new strategies must be explored to address whether by further reduction of residual proteinuria using interventions not primarily targeting the RAAS benefit in terms of cardiorenal risk reduction would accrue. Both clinical and experimental intervention studies have demonstrated that vitamin D can reduce residual proteinuria through both RAAS-dependent and RAAS-independent pathways. Future research should prospectively explore vitamin D treatment as an adjunct to RAAS blockade in an interventional trial exploring clinically relevant cardiorenal end points. PMID:25609737

Reducing mortality risk by targeting specific air pollution sources: Suva, Fiji.

PubMed

Isley, C F; Nelson, P F; Taylor, M P; Stelcer, E; Atanacio, A J; Cohen, D D; Mani, F S; Maata, M

2018-01-15

Health implications of air pollution vary dependent upon pollutant sources. This work determines the value, in terms of reduced mortality, of reducing ambient particulate matter (PM 2.5 : effective aerodynamic diameter 2.5μm or less) concentration due to different emission sources. Suva, a Pacific Island city with substantial input from combustion sources, is used as a case-study. Elemental concentration was determined, by ion beam analysis, for PM 2.5 samples from Suva, spanning one year. Sources of PM 2.5 have been quantified by positive matrix factorisation. A review of recent literature has been carried out to delineate the mortality risk associated with these sources. Risk factors have then been applied for Suva, to calculate the possible mortality reduction that may be achieved through reduction in pollutant levels. Higher risk ratios for black carbon and sulphur resulted in mortality predictions for PM 2.5 from fossil fuel combustion, road vehicle emissions and waste burning that surpass predictions for these sources based on health risk of PM 2.5 mass alone. Predicted mortality for Suva from fossil fuel smoke exceeds the national toll from road accidents in Fiji. The greatest benefit for Suva, in terms of reduced mortality, is likely to be accomplished by reducing emissions from fossil fuel combustion (diesel), vehicles and waste burning. Copyright © 2017. Published by Elsevier B.V.

Disaster risk reduction in developing countries: costs, benefits and institutions.

PubMed

Kenny, Charles

2012-10-01

Some 60,000 people worldwide die annually in natural disasters, mostly due to the collapse of buildings in earthquakes, and primarily in the developing world. This is despite the fact that engineering solutions exist that can eliminate almost completely the risk of such deaths. Why is this? The solutions are expensive and technically demanding, so their cost-benefit ratio often is unfavourable as compared to other interventions. Nonetheless, there are various public disaster risk reduction interventions that are highly cost-effective. That such interventions frequently remain unimplemented or ineffectively executed points to a role for issues of political economy. Building regulations in developing countries appear to have limited impact in many cases, perhaps because of inadequate capacity and corruption. Public construction often is of low quality, perhaps for similar reasons. This suggests the need for approaches that emphasise simple and limited disaster risk regulation covering only the most at-risk structures-and that, preferably, non-experts can monitor-as well as numerous transparency and oversight mechanisms for public construction projects. © 2012 The Author(s). Journal compilation © Overseas Development Institute, 2012.

Academic-Community Partnership to Develop a Patient-Centered Breast Cancer Risk Reduction Program for Latina Primary Care Patients.

PubMed

Castañeda, Sheila F; Giacinto, Rebeca E; Medeiros, Elizabeth A; Brongiel, Ilana; Cardona, Olga; Perez, Patricia; Talavera, Gregory A

2016-06-01

This collaborative study sought to address Latina breast cancer (BC) disparities by increasing health literacy (HL) in a community health center situated on the US-Mexico border region of San Diego County. An academic-community partnership conducted formative research to develop a culturally tailored promotora-based intervention with 109 individuals. The Spanish language program, entitled Nuestra Cocina: Mesa Buena, Vida Sana (Our Kitchen: Good Table, Healthy Life), included six sessions targeting HL, women's health, BC risk reduction, and patient-provider communication; sessions include cooking demonstrations of recipes with cancer-risk-reducing ingredients. A pilot study with 47 community health center Latina patients was conducted to examine the program's acceptability, feasibility, and ability to impact knowledge and skills. Pre- and post-analyses demonstrated that participants improved their self-reported cancer screening, BC knowledge, daily fruit and vegetable intake, and ability to read a nutrition label (p < 0.05). Results of the pilot study demonstrate the importance of utilizing patient-centered culturally appropriate noninvasive means to educate and empower Latina patients.

Academic-Community Partnership to Develop a Patient-Centered Breast Cancer Risk Reduction Program for Latina Primary Care Patients

PubMed Central

Castañeda, Sheila F.; Giacinto, Rebeca E.; Medeiros, Elizabeth A.; Brongiel, Ilana; Cardona, Olga; Perez, Patricia; Talavera, Gregory A.

2015-01-01

This collaborative study sought to address Latina breast cancer (BC) disparities by increasing health literacy (HL) in a community health center situated on the US-Mexico border region of San Diego County. An academic-community partnership conducted formative research to develop a culturally tailored promotora-based intervention with 109 individuals. The Spanish language program, entitled Nuestra Cocina: Mesa Buena, Vida Sana (Our Kitchen: Good Table, Healthy Life), included six sessions targeting HL, women’s health, BC risk reduction, and patient-provider communication; sessions include cooking demonstrations of recipes with cancer-risk-reducing ingredients. A pilot study with 47 community health center Latina patients was conducted to examine the program’s acceptability, feasibility, and ability to impact knowledge and skills. Pre- and post-analyses demonstrated that participants improved their self-reported cancer screening, BC knowledge, daily fruit and vegetable intake, and ability to read a nutrition label (p<0.05). Results of the pilot study demonstrate the importance of utilizing patient-centered culturally appropriate noninvasive means to educate and empower Latina patients. PMID:27271058

A randomized noninferiority trial of standard versus enhanced risk reduction and adherence counseling for individuals receiving post-exposure prophylaxis following sexual exposures to HIV.

PubMed

Roland, Michelle E; Neilands, Torsten B; Krone, Melissa R; Coates, Thomas J; Franses, Karena; Chesney, Margaret A; Kahn, James S; Martin, Jeffrey N

2011-07-01

The National HIV/AIDS Strategy proposes to scale-up post-exposure prophylaxis (PEP). Intensive risk reduction and adherence counseling appear to be effective but are resource intensive. Identifying simpler interventions that maximize the HIV prevention potential of PEP is critical. A randomized noninferiority study comparing 2 (standard) or 5 (enhanced) risk reduction counseling sessions was performed. Adherence counseling was provided in the enhanced arm. We measured changes in unprotected sexual intercourse acts at 12 months, compared with baseline; HIV acquisition; and PEP adherence. Outcomes were stratified by degree of baseline risk. We enrolled 457 individuals reporting unprotected intercourse within 72 h with an HIV-infected or at-risk partner. Participants were 96% male and 71% white. There were 1.8 and 2.3 fewer unprotected sex acts in the standard and enhanced groups. The maximum potential risk difference, reflected by the upper bound of the 95% confidence interval, was 3.9 acts. The difference in the riskier subset may have been as many as 19.6 acts. The incidence of HIV seroconversion was 2.9% and 2.6% among persons randomized to standard and enhanced counseling, respectively, with a maximum potential difference of 3.4%. The absolute and maximal HIV seroconversion incidence was 9.9% and 20.4% greater in the riskier group randomized to standard, compared with enhanced, counseling. Adherence outcomes were similar, with noninferiority in the lower risk group and concerning differences among the higher-risk group. Risk assessment is critical at PEP initiation. Standard counseling is only noninferior for individuals with lower baseline risk; thus, enhanced counseling should be targeted to individuals at higher risk. © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

Extrapolating non-target risk of Bt crops from laboratory to field.

PubMed

Duan, Jian J; Lundgren, Jonathan G; Naranjo, Steve; Marvier, Michelle

2010-02-23

The tiered approach to assessing ecological risk of insect-resistant transgenic crops assumes that lower tier laboratory studies, which expose surrogate non-target organisms to high doses of insecticidal proteins, can detect harmful effects that might be manifested in the field. To test this assumption, we performed meta-analyses comparing results for non-target invertebrates exposed to Bacillus thuringiensis (Bt) Cry proteins in laboratory studies with results derived from independent field studies examining effects on the abundance of non-target invertebrates. For Lepidopteran-active Cry proteins, laboratory studies correctly predicted the reduced field abundance of non-target Lepidoptera. However, laboratory studies incorporating tri-trophic interactions of Bt plants, herbivores and parasitoids were better correlated with the decreased field abundance of parasitoids than were direct-exposure assays. For predators, laboratory tri-trophic studies predicted reduced abundances that were not realized in field studies and thus overestimated ecological risk. Exposure to Coleopteran-active Cry proteins did not significantly reduce the laboratory survival or field abundance of any functional group examined. Our findings support the assumption that laboratory studies of transgenic insecticidal crops show effects that are either consistent with, or more conservative than, those found in field studies, with the important caveat that laboratory studies should explore all ecologically relevant routes of exposure.

Fall risk and incidence reduction in high risk individuals with multiple sclerosis: a pilot randomized control trial.

PubMed

Sosnoff, Jacob J; Moon, Yaejin; Wajda, Douglas A; Finlayson, Marcia L; McAuley, Edward; Peterson, Elizabeth W; Morrison, Steve; Motl, Robert W

2015-10-01

To determine the feasibility of three fall prevention programs delivered over 12 weeks among individuals with multiple sclerosis: (A) a home-based exercise program targeting physiological risk factors; (B) an educational program targeting behavioral risk factors; and (C) a combined exercise-and-education program targeting both factors. Randomized controlled trial. Home-based training with assessments at research laboratory. A total of 103 individuals inquired about the investigation. After screening, 37 individuals with multiple sclerosis who had fallen in the last year and ranged in age from 45-75 years volunteered for the investigation. A total of 34 participants completed postassessment following the 12-week intervention. Participants were randomly assigned into one of four conditions: (1) wait-list control (n = 9); (2) home-based exercise (n = 11); (3) education (n = 9); or (4) a combined exercise and education (n = 8) group. Before and after the 12-week interventions, participants underwent a fall risk assessment as determined by the physiological profile assessment and provided information on their fall prevention behaviors as indexed by the Falls Prevention Strategy Survey. Participants completed falls diaries during the three-months postintervention. A total of 34 participants completed postintervention testing. Procedures and processes were found to be feasible. Overall, fall risk scores were lower in the exercise groups (1.15 SD 1.31) compared with the non-exercise groups (2.04 SD 1.04) following the intervention (p < 0.01). There was no group difference in fall prevention behaviors (p > 0.05). Further examination of home-based exercise/education programs for reducing falls in individuals with multiple sclerosis is warranted. A total of 108 participants would be needed in a larger randomized controlled trial.ClinicalTrials.org #NCT01956227. © The Author(s) 2014.

Noise reduction improves memory for target language speech in competing native but not foreign language speech.

PubMed

Ng, Elaine Hoi Ning; Rudner, Mary; Lunner, Thomas; Rönnberg, Jerker

2015-01-01

A hearing aid noise reduction (NR) algorithm reduces the adverse effect of competing speech on memory for target speech for individuals with hearing impairment with high working memory capacity. In the present study, we investigated whether the positive effect of NR could be extended to individuals with low working memory capacity, as well as how NR influences recall performance for target native speech when the masker language is non-native. A sentence-final word identification and recall (SWIR) test was administered to 26 experienced hearing aid users. In this test, target spoken native language (Swedish) sentence lists were presented in competing native (Swedish) or foreign (Cantonese) speech with or without binary masking NR algorithm. After each sentence list, free recall of sentence final words was prompted. Working memory capacity was measured using a reading span (RS) test. Recall performance was associated with RS. However, the benefit obtained from NR was not associated with RS. Recall performance was more disrupted by native than foreign speech babble and NR improved recall performance in native but not foreign competing speech. Noise reduction improved memory for speech heard in competing speech for hearing aid users. Memory for native speech was more disrupted by native babble than foreign babble, but the disruptive effect of native speech babble was reduced to that of foreign babble when there was NR.

Reductions in Transmission Risk Behaviors in HIV-Positive Clients Receiving Prevention Case Management Services: Findings from a Community Demonstration Project

ERIC Educational Resources Information Center

Gasiorowicz, Mari; Llanas, Michelle R.; DiFranceisco, Wayne; Benotsch, Eric G.; Brondino, Michael J.; Catz, Sheryl L.; Hoxie, Neil J.; Reiser, William J.; Vergeront, James M.

2005-01-01

Prevention case management (PCM) for HIV-infected persons is an HIV risk reduction intervention designed to assist clients who are aware of their HIV infection and who continue to engage in risk transmission behaviors. PCM combines individual risk reduction counseling with case management to address the psychosocial factors affecting HIV…

Multidimensional family therapy HIV/STD risk-reduction intervention: an integrative family-based model for drug-involved juvenile offenders.

PubMed

Marvel, Francoise; Rowe, Cynthia L; Colon-Perez, Lissette; DiClemente, Ralph J; Liddle, Howard A

2009-03-01

Drug and juvenile justice involved youths show remarkably high rates of human immunodeficiency virus (HIV)/sexually transmitted disease (STD) risk behaviors. However, existing interventions aimed at reducing adolescent HIV risk behavior have rarely targeted these vulnerable young adolescents, and many approaches focus on individual-level change without attention to family or contextual influences. We describe a new, family-based HIV/ STD prevention model that embeds HIV/STD focused multifamily groups within an adolescent drug abuse and delinquency evidence-based treatment, Multidimensional Family Therapy (MDFT). The approach has been evaluated in a multisite randomized clinical trial with juvenile justice involved youths in the National Institute on Drug Abuse Criminal Justice Drug Abuse Treatment Studies (www.cjdats.org). Preliminary baseline to 6-month outcomes are promising. We describe research on family risk and protective factors for adolescent problem behaviors, and offer a rationale for family-based approaches to reduce HIV/STD risk in this population. We describe the development and implementation of the Multidimensional Family Therapy HIV/STD risk-reduction intervention (MDFT-HIV/ STD) in terms of using multifamily groups and their integration in standard MDFT and also offers a clinical vignette. The potential significance of this empirically based intervention development work is high; MDFT-HIV/STD is the first model to address largely unmet HIV/STD prevention and sexual health needs of substance abusing juvenile offenders within the context of a family-oriented evidence-based intervention.

Posterolaterally Displaced and Flexion Type Supracondylar Fractures are Associated with a Higher Risk of Open Reduction

PubMed Central

Novais, Eduardo N.; Carry, Patrick M.; Mark, Bryan J.; Sayan, DE; Miller, Nancy H.

2016-01-01

Objective To identify factors predictive of the risk of conversion from closed to open reduction. Methods ICD-9 codes were used to identify completely displaced pediatric supracondylar humerus fractures that underwent planned closed reduction and percutaneous pinning. Clinical and radiographic variables were retrospectively collected. Results Compared to posterior extension fractures, flexion [Risk Ratio (RR): 34.1, 95% CI: 8.1 to 143.6, p<0.0001] and posterolateral extension [RR: 6.0, 95% CI: 1.3 to 27.5, p=0.0221] fractures were significantly more likely to undergo conversion from closed to open reduction. Conclusions The direction of displacement should be considered during the pre-operative evaluation of supracondylar fractures. PMID:27035497

Social Media Use and Sexual Risk Reduction Behavior Among Minority Youth: Seeking Safe Sex Information.

PubMed

Stevens, Robin; Gilliard-Matthews, Stacia; Dunaev, Jamie; Todhunter-Reid, Abigail; Brawner, Bridgette; Stewart, Jennifer

Sexual health is an important area of study-particularly for minority youth and youth living in disadvantaged neighborhoods. The purpose of the research was to examine the sources of sexual health information associated with youth adopting sexual risk reduction behaviors. Data collection took place in a small city in the Northeastern United States using cross-sectional behavioral surveys and modified venue-based sampling. Participants included 249 African American and Latino youth aged 13-24. Participants reported their sources of information about contraception and human immunodeficiency virus/sexually transmitted disease, such as TV/movies, parents, social media; their intentions to have sex; and condom and contraception use during their last sexual activity. Social media use, past pregnancy experience, past sexual history, age, and gender were also measured. Standard tests of bivariate association (chi-square and F tests) were used to examine initial associations between sexual risk reduction behavior and exposure to sexual risk reduction information on social media. Logistic regression models were used to test multivariate relationships between information sources and sexual risk reduction behavior. Youth who were exposed to sexual health messages on social media were 2.69 times (p < .05) and 2.49 times (p < .08) more likely to have used contraception or a condom at last intercourse, respectively. Parents, schools, or traditional media as information sources were not significantly associated with contractive use or condom use at last intercourse. Youth sexual behavior is increasingly informed by social media messages. Health practitioners should utilize social media as an important health promotion tool.

Pilot Test of an Integrated Sexual Risk Reduction Intervention for Women with a History of Childhood Sexual Abuse.

PubMed

Senn, Theresa E; Braksmajer, Amy; Urban, Marguerite A; Coury-Doniger, Patricia; Carey, Michael P

2017-11-01

HIV and childhood sexual abuse (CSA) are intersecting public health problems for women. We pilot tested an integrated sexual risk reduction intervention for women with a history of CSA that addressed both the consequences of CSA [based on the Traumagenic Dynamics (TD) framework] and the antecedents of sexual risk behavior (based on the Information-Motivation-Behavioral Skills [IMB] model). Women with a history of CSA who were attending a public STI clinic (n = 84) were randomly assigned to a five-session integrated TD/IMB (experimental) group intervention or to a time-matched IMB-guided sexual risk reduction (control) group intervention. Preliminary findings indicated that women in the integrated TD/IMB intervention reduced their average number of episodes of unprotected sex with a primary partner, their alcohol use, and their likelihood of being in a violent relationship, relative to women in the IMB-only group. Our findings suggest that sexual risk reduction interventions that address both the consequences of CSA and the antecedents of sexual risk behavior may be efficacious in reducing sexual risk behavior among women who were sexually abused.

Targeting condom distribution at high risk places increases condom utilization-evidence from an intervention study in Livingstone, Zambia

PubMed Central

2012-01-01

Background The PLACE-method presumes that targeting HIV preventive activities at high risk places is effective in settings with major epidemics. Livingstone, Zambia, has a major HIV epidemic despite many preventive efforts in the city. A baseline survey conducted in 2005 in places where people meet new sexual partners found high partner turnover and unprotected sex to be common among guests. In addition, there were major gaps in on-site condom availability. This study aimed to assess the impact of a condom distribution and peer education intervention targeting places where people meet new sexual partners on condom use and sexual risk taking among people socializing there. Methods The 2005 baseline survey assessed the presence of HIV preventive activities and sexual risk taking in places where people meet new sexual partners in Livingstone. One township was selected for a non-randomised intervention study on condom distribution and peer education in high risk venues in 2009. The presence of HIV preventive activities in the venues during the intervention was monitored by an external person. The intervention was evaluated after one year with a follow-up survey in the intervention township and a comparison township. In addition, qualitative interviews and focus group discussions were conducted. Results Young people between 17-32 years of age were recruited as peer educators, and 40% were females. Out of 72 persons trained before the intervention, 38 quit, and another 11 had to be recruited. The percentage of venues where condoms were reported to always be available at least doubled in both townships, but was significantly higher in the intervention vs. the control venues in both surveys (84% vs. 33% in the follow-up). There was a reduction in reported sexual risk taking among guests socializing in the venues in both areas, but reporting of recent condom use increased more among people interviewed in the intervention (57% to 84%) than in the control community (55% to 68

Targeting condom distribution at high risk places increases condom utilization-evidence from an intervention study in Livingstone, Zambia.

PubMed

Sandøy, Ingvild Fossgard; Zyaambo, Cosmas; Michelo, Charles; Fylkesnes, Knut

2012-01-05

The PLACE-method presumes that targeting HIV preventive activities at high risk places is effective in settings with major epidemics. Livingstone, Zambia, has a major HIV epidemic despite many preventive efforts in the city. A baseline survey conducted in 2005 in places where people meet new sexual partners found high partner turnover and unprotected sex to be common among guests. In addition, there were major gaps in on-site condom availability. This study aimed to assess the impact of a condom distribution and peer education intervention targeting places where people meet new sexual partners on condom use and sexual risk taking among people socializing there. The 2005 baseline survey assessed the presence of HIV preventive activities and sexual risk taking in places where people meet new sexual partners in Livingstone. One township was selected for a non-randomised intervention study on condom distribution and peer education in high risk venues in 2009. The presence of HIV preventive activities in the venues during the intervention was monitored by an external person. The intervention was evaluated after one year with a follow-up survey in the intervention township and a comparison township. In addition, qualitative interviews and focus group discussions were conducted. Young people between 17-32 years of age were recruited as peer educators, and 40% were females. Out of 72 persons trained before the intervention, 38 quit, and another 11 had to be recruited. The percentage of venues where condoms were reported to always be available at least doubled in both townships, but was significantly higher in the intervention vs. the control venues in both surveys (84% vs. 33% in the follow-up). There was a reduction in reported sexual risk taking among guests socializing in the venues in both areas, but reporting of recent condom use increased more among people interviewed in the intervention (57% to 84%) than in the control community (55% to 68%). It is likely that the

Targeted cardiopulmonary resuscitation training focused on the family members of high-risk patients at a regional medical center: A comparison between family members of high-risk and no-risk patients.

PubMed

Han, Kap Su; Lee, Ji Sung; Kim, Su Jin; Lee, Sung Woo

2018-05-01

We developed a hospital-based cardiopulmonary resuscitation (CPR) training model focused on the target population (family members of patients with potential risks for cardiac arrest) and compared the outcome of CPR training between target and non-target populations for validity. Family members of patients in training were divided into three groups on the basis of patients' diseases, as follows: 1) the cardio-specific (CS) risk group, including family members of patients with cardiac disease at risk of cardiac arrest; 2) the cardiovascular (CV) risk group, including family members of patients with risk factors for cardiovascular disease; and 3) the no-risk group. Pre- and posttraining surveys and skill tests as well as a post-training 3-month telephone survey were conducted. Educational outcomes were analyzed. A total of 203 family members were enrolled into 21 CPR training classes. The CS group (n=88) included elderly persons and housewives with a lower level of education compared with the CV (n=79) and no-risk groups (n=36). The CS group was motivated by healthcare professionals and participated in the training course. The CS, CV, and no-risk groups showed improvements in knowledge, willingness to perform CPR, and skills. Despite the older age and lower level of education in the CS group, the effects of education were similar to those in the other groups. A high rate of response and secondary propagation of CPR training were observed in the CS group. Family members of patients with heart disease could be an appropriate target population for CPR training, particularly in terms of recruitment and secondary propagation. Targeted intervention may be an effective training strategy to improve bystander CPR rates.

Global and local scale flood discharge simulations in the Rhine River basin for flood risk reduction benchmarking in the Flagship Project

NASA Astrophysics Data System (ADS)

Gädeke, Anne; Gusyev, Maksym; Magome, Jun; Sugiura, Ai; Cullmann, Johannes; Takeuchi, Kuniyoshi

2015-04-01

The global flood risk assessment is prerequisite to set global measurable targets of post-Hyogo Framework for Action (HFA) that mobilize international cooperation and national coordination towards disaster risk reduction (DRR) and requires the establishment of a uniform flood risk assessment methodology on various scales. To address these issues, the International Flood Initiative (IFI) has initiated a Flagship Project, which was launched in year 2013, to support flood risk reduction benchmarking at global, national and local levels. In the Flagship Project road map, it is planned to identify the original risk (1), to identify the reduced risk (2), and to facilitate the risk reduction actions (3). In order to achieve this goal at global, regional and local scales, international research collaboration is absolutely necessary involving domestic and international institutes, academia and research networks such as UNESCO International Centres. The joint collaboration by ICHARM and BfG was the first attempt that produced the first step (1a) results on the flood discharge estimates with inundation maps under way. As a result of this collaboration, we demonstrate the outcomes of the first step of the IFI Flagship Project to identify flood hazard in the Rhine river basin on the global and local scale. In our assessment, we utilized a distributed hydrological Block-wise TOP (BTOP) model on 20-km and 0.5-km scales with local precipitation and temperature input data between 1980 and 2004. We utilized existing 20-km BTOP model, which is applied globally, and constructed the local scale 0.5-km BTOP model for the Rhine River basin. For the BTOP model results, both calibrated 20-km and 0.5-km BTOP models had similar statistical performance and represented observed flood river discharges, epecially for 1993 and 1995 floods. From 20-km and 0.5-km BTOP simulation, the flood discharges of the selected return period were estimated using flood frequency analysis and were comparable to

Adapting an Evidence-Based Intervention Targeting HIV-Infected Prisoners in Malaysia

PubMed Central

Copenhaver, Michael M.; Tunku, Noor; Ezeabogu, Ifeoma; Potrepka, Jessica; Zahari, Muhammad Muhsin A.; Kamarulzaman, Adeeba; Altice, Frederick L.

2011-01-01

HIV-infected prisoners in Malaysia represent a critical target population for secondary HIV risk reduction interventions and care. We report on the process and outcome of our formative research aimed at systematically selecting and adapting an EBI designed to reduce secondary HIV risk and improve adherence to antiretroviral therapy among soon-to-be-released HIV-infected prisoners. Our formative work involved a critical examination of established EBIs and associated published reports complemented by data elicited through structured interviews and focus groups with key stakeholders, members of the target population, and their family members. Based on all information, we adapted the Holistic Health Recovery Program targeting people living with HIV (HHRP+), an EBI, to consist of eight 2-hour sessions that cover a range of specified topics so that participants may individually apply intervention content as needed to accommodate their particular substance abuse, HIV risk, and antiretroviral adherence issues. This study provides a complete example of the process of selecting and adapting an EBI—taking into account both empirical evidence and input from target organization stakeholders and target population members and their families—for use in real world prison settings where high-risk populations are concentrated. PMID:21860786

Coupling Post-Event and Prospective Analyses for El Niño-related Risk Reduction in Peru

NASA Astrophysics Data System (ADS)

French, Adam; Keating, Adriana; Mechler, Reinhard; Szoenyi, Michael; Cisneros, Abel; Chuquisengo, Orlando; Etienne, Emilie; Ferradas, Pedro

2017-04-01

Analyses in the wake of natural disasters play an important role in identifying how ex ante risk reduction and ex post hazard response activities have both succeeded and fallen short in specific contexts, thereby contributing to recommendations for improving such measures in the future. Event analyses have particular relevance in settings where disasters are likely to reoccur, and especially where recurrence intervals are short. This paper applies the Post Event Review Capability (PERC) methodology to the context of frequently reoccurring El Niño Southern Oscillation (ENSO) events in the country of Peru, where over the last several decades ENSO impacts have generated high levels of damage and economic loss. Rather than analyzing the impacts of a single event, this study builds upon the existing PERC methodology by combining empirical event analysis with a critical examination of risk reduction and adaptation measures implemented both prior to and following several ENSO events in the late 20th and early 21st centuries. Additionally, the paper explores linking the empirical findings regarding the uptake and outcomes of particular risk reduction and adaptation strategies to a prospective, scenario-based approach for projecting risk several decades into the future.

Targeting trachoma control through risk mapping: the example of Southern Sudan.

PubMed

Clements, Archie C A; Kur, Lucia W; Gatpan, Gideon; Ngondi, Jeremiah M; Emerson, Paul M; Lado, Mounir; Sabasio, Anthony; Kolaczinski, Jan H

2010-08-17

Trachoma is a major cause of blindness in Southern Sudan. Its distribution has only been partially established and many communities in need of intervention have therefore not been identified or targeted. The present study aimed to develop a tool to improve targeting of survey and control activities. A national trachoma risk map was developed using Bayesian geostatistics models, incorporating trachoma prevalence data from 112 geo-referenced communities surveyed between 2001 and 2009. Logistic regression models were developed using active trachoma (trachomatous inflammation follicular and/or trachomatous inflammation intense) in 6345 children aged 1-9 years as the outcome, and incorporating fixed effects for age, long-term average rainfall (interpolated from weather station data) and land cover (i.e. vegetation type, derived from satellite remote sensing), as well as geostatistical random effects describing spatial clustering of trachoma. The model predicted the west of the country to be at no or low trachoma risk. Trachoma clusters in the central, northern and eastern areas had a radius of 8 km after accounting for the fixed effects. In Southern Sudan, large-scale spatial variation in the risk of active trachoma infection is associated with aridity. Spatial prediction has identified likely high-risk areas to be prioritized for more data collection, potentially to be followed by intervention.

Valuing Reductions in Fatal Illness Risks: Implications of Recent Research.

PubMed

Robinson, Lisa A; Hammitt, James K

2016-08-01

The value of mortality risk reductions, conventionally expressed as the value per statistical life, is an important determinant of the net benefits of many government policies. US regulators currently rely primarily on studies of fatal injuries, raising questions about whether different values might be appropriate for risks associated with fatal illnesses. Our review suggests that, despite the substantial expansion of the research base in recent years, few US studies of illness-related risks meet criteria for quality, and those that do yield similar values to studies of injury-related risks. Given this result, combining the findings of these few studies with the findings of the more robust literature on injury-related risks appears to provide a reasonable range of estimates for application in regulatory analysis. Our review yields estimates ranging from about $4.2 million to $13.7 million with a mid-point of $9.0 million (2013 dollars). Although the studies we identify differ from those that underlie the values currently used by Federal agencies, the resulting estimates are remarkably similar, suggesting that there is substantial consensus emerging on the values applicable to the general US population. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Hazard identification and risk assessment for biologics targeting the immune system.

PubMed

Weir, Andrea B

2008-01-01

Biologic pharmaceuticals include a variety of products, such as monoclonal antibodies, fusion proteins and cytokines. Products in those classes include immunomodulatory biologics, which are intended to enhance or diminish the activity of the immune system. Immunomodulatory biologics have been approved by the U.S. FDA for a variety of indications, including cancer and inflammatory conditions. Prior to gaining approval for marketing, sponsoring companies for all types of products must demonstrate a product's safety in toxicology studies conducted in animals and show safety and efficacy in clinical trials conducted in patients. The overall goal of toxicology studies, which applies to immunomodulatory and other product types, is to identify the hazards that products pose to humans. Because biologics are generally highly selective for specific targets (receptors/epitopes), conducting toxicology studies in animal models with the target is essential. Such animals are referred to as pharmacologically relevant. Endpoints routinely included in toxicology studies, such as hematology, organ weight and histopathology, can be used to assess the effect of a product on the structure of the immune system. Additionally, specialized endpoints, such as immunophenotyping and immune function tests, can be used to define effects of immunomodulatory products on the immune system. Following hazard identification, risks posed to patients are assessed and managed. Risks can be managed through clinical trial design and risk communication, a practice that applies to immunomodulatory and other product types. Examples of risk management in clinical trial design include establishing a safe starting dose, defining the appropriate patient population and establishing appropriate patient monitoring. Risk communication starts during clinical trials and continues after product approval. A combination of hazard identification, risk assessment and risk management allows for drug development to proceed

Teaching medical students cancer risk reduction nutrition counseling using a multimedia program.

PubMed

Kolasa, K M; Jobe, A C; Miller, M G; Clay, M C

1999-03-01

There are many barriers to medical students receiving education about the linkage between nutrition and cancer, including the lack of role models and teachers and insufficient curricular time. We tested the use of a multimedia program as a possible solution to teaching diet-risk assessment and counseling skills. Images of Cancer Prevention, The Nutrition Link is a CD-ROM multimedia program that was developed and evaluated by 147 medical students. Pre-use and post-use surveys, computer log files, and recorded response sessions were used to determine the learner's 1) ease in using the program, 2) attitudes about the treatment of the content, 3) knowledge gain, and 4) attitudes about the role of physicians in nutrition assessment and counseling for cancer risk reduction. Students improved their knowledge of dietary guidelines for cancer risk reduction and made positive changes in their attitudes toward the role of physicians in dietary counseling. However, most students reported that they would not use the program unless it was required that they do so. The multimedia program was successful; it affected students' knowledge and attitudes concerning nutrition as a modifiable risk factor for some cancers. In addition, the design and delivery of the multimedia product was positively reviewed by the students for ease of access, message design, individualized instruction, and flexibility. Despite these favorable ratings, it was not clear that students would use the program unless required to do so.

New "Risk-Targeted" Seismic Maps Introduced into Building Codes

USGS Publications Warehouse

Luco, Nicholas; Garrett, B.; Hayes, J.

2012-01-01

Throughout most municipalities of the United States, structural engineers design new buildings using the U.S.-focused International Building Code (IBC). Updated editions of the IBC are published every 3 years. The latest edition (2012) contains new "risk-targeted maximum considered earthquake" (MCER) ground motion maps, which are enabling engineers to incorporate a more consistent and better defined level of seismic safety into their building designs.

Synergising Public Health Concepts with the Sendai Framework for Disaster Risk Reduction: A Conceptual Glossary

PubMed Central

Phibbs, Suzanne; Kenney, Christine; Severinsen, Christina; Mitchell, Jon; Hughes, Roger

2016-01-01

The Sendai Framework for Disaster Risk Reduction (2015) is a global strategy for addressing disaster risk and resilience that has been ratified by member countries of the United Nations. Its guiding principles emphasise building resilience through inter-sectoral collaboration, as well as partnerships that facilitate community empowerment and address underlying risk factors. Both public health and the emergency management sector face similar challenges related to developing and implementing strategies that involve structural change, facilitating community resilience and addressing individual risk factors. Familiarity with public health principles enables an understanding of the holistic approach to risk reduction that is outlined within the Sendai Framework. We present seven concepts that resonate with contemporary public health practice, namely: the social determinants of health; inequality and inequity; the inverse care law; community-based and community development approaches; hard to reach communities and services; the prevention paradox; and the inverse prevention law. These ideas from public health provide a useful conceptual base for the ”new” agenda in disaster risk management that underpins the 2015 Sendai Framework. The relevance of these ideas to disaster risk management and research is illustrated through drawing on the Sendai Framework, disaster literature and exemplars from the 2010–2011 earthquakes in Canterbury, New Zealand. PMID:27983666

Synergising Public Health Concepts with the Sendai Framework for Disaster Risk Reduction: A Conceptual Glossary.

PubMed

Phibbs, Suzanne; Kenney, Christine; Severinsen, Christina; Mitchell, Jon; Hughes, Roger

2016-12-14

The Sendai Framework for Disaster Risk Reduction (2015) is a global strategy for addressing disaster risk and resilience that has been ratified by member countries of the United Nations. Its guiding principles emphasise building resilience through inter-sectoral collaboration, as well as partnerships that facilitate community empowerment and address underlying risk factors. Both public health and the emergency management sector face similar challenges related to developing and implementing strategies that involve structural change, facilitating community resilience and addressing individual risk factors. Familiarity with public health principles enables an understanding of the holistic approach to risk reduction that is outlined within the Sendai Framework. We present seven concepts that resonate with contemporary public health practice, namely: the social determinants of health; inequality and inequity; the inverse care law; community-based and community development approaches; hard to reach communities and services; the prevention paradox; and the inverse prevention law. These ideas from public health provide a useful conceptual base for the "new" agenda in disaster risk management that underpins the 2015 Sendai Framework. The relevance of these ideas to disaster risk management and research is illustrated through drawing on the Sendai Framework, disaster literature and exemplars from the 2010-2011 earthquakes in Canterbury, New Zealand.

Evaluation of a peer-led drug abuse risk reduction project for runaway/homeless youths.

PubMed

Fors, S W; Jarvis, S

1995-01-01

The purpose of this study was to evaluate the Drug Prevention in Youth risk reduction program that was implemented in shelters for runaway/homeless youths in the Southeastern United States. The program focuses on knowledge, attitudes and skills that can help this group of high risk young people minimize the serious negative consequences of drug abuse. An evaluation strategy was developed so comparisons could be made between peer-led, adult-led and non-intervention groups. Dependent samples t tests and least squares ANCOVAS were used to measure pretest-posttest differences both within and between groups. Results indicate that the peer-led groups were more successful than the other two groups, and that program effects were the most powerful with the youngest group of shelter clients. Process evaluation revealed important factors related to group leader training and group management. It is concluded that well-trained and motivated peer/near peer leaders have particularly valuable contributions to make with regard to drug abuse risk reduction for shelter clients.

Copper increases reductive dehalogenation of haloacetamides by zero-valent iron in drinking water: Reduction efficiency and integrated toxicity risk.

PubMed

Chu, Wenhai; Li, Xin; Bond, Tom; Gao, Naiyun; Bin, Xu; Wang, Qiongfang; Ding, Shunke

2016-12-15

The haloacetamides (HAcAms), an emerging class of nitrogen-containing disinfection byproducts (N-DBPs), are highly cytotoxic and genotoxic, and typically occur in treated drinking waters at low μg/L concentrations. Since many drinking distribution and storage systems contain unlined cast iron and copper pipes, reactions of HAcAms with zero-valent iron (ZVI) and metallic copper (Cu) may play a role in determining their fate. Moreover, ZVI and/or Cu are potentially effective HAcAm treatment technologies in drinking water supply and storage systems. This study reports that ZVI alone reduces trichloroacetamide (TCAcAm) to sequentially form dichloroacetamide (DCAcAm) and then monochloroacetamide (MCAcAm), whereas Cu alone does not impact HAcAm concentrations. The addition of Cu to ZVI significantly improved the removal of HAcAms, relative to ZVI alone. TCAcAm and their reduction products (DCAcAm and MCAcAm) were all decreased to below detection limits at a molar ratio of ZVI/Cu of 1:1 after 24 h reaction (ZVI/TCAcAm = 0.18 M/5.30 μM). TCAcAm reduction increased with the decreasing pH from 8.0 to 5.0, but values from an integrated toxic risk assessment were minimised at pH 7.0, due to limited removal MCAcAm under weak acid conditions (pH = 5.0 and 6.0). Higher temperatures (40 °C) promoted the reductive dehalogenation of HAcAms. Bromine was preferentially removed over chlorine, thus brominated HAcAms were more easily reduced than chlorinated HAcAms by ZVI/Cu. Although tribromoacetamide was more easily reduced than TCAcAm during ZVI/Cu reduction, treatment of tribromoacetamide resulted in a higher integrated toxicity risk than TCAcAm, due to the formation of monobromoacetamide (MBAcAm). Copyright © 2016 Elsevier Ltd. All rights reserved.

Development of risk reduction behavioral counseling for Ebola virus disease survivors enrolled in the Sierra Leone Ebola Virus Persistence Study, 2015-2016.

PubMed

Abad, Neetu; Malik, Tasneem; Ariyarajah, Archchun; Ongpin, Patricia; Hogben, Matthew; McDonald, Suzanna L R; Marrinan, Jaclyn; Massaquoi, Thomas; Thorson, Anna; Ervin, Elizabeth; Bernstein, Kyle; Ross, Christine; Liu, William J; Kroeger, Karen; Durski, Kara N; Broutet, Nathalie; Knust, Barbara; Deen, Gibrilla F

2017-09-01

During the 2014-2016 West Africa Ebola Virus Disease (EVD) epidemic, the public health community had concerns that sexual transmission of the Ebola virus (EBOV) from EVD survivors was a risk, due to EBOV persistence in body fluids of EVD survivors, particularly semen. The Sierra Leone Ebola Virus Persistence Study was initiated to investigate this risk by assessing EBOV persistence in numerous body fluids of EVD survivors and providing risk reduction counseling based on test results for semen, vaginal fluid, menstrual blood, urine, rectal fluid, sweat, tears, saliva, and breast milk. This publication describes implementation of the counseling protocol and the key lessons learned. The Ebola Virus Persistence Risk Reduction Behavioral Counseling Protocol was developed from a framework used to prevent transmission of HIV and other sexually transmitted infections. The framework helped to identify barriers to risk reduction and facilitated the development of a personalized risk-reduction plan, particularly around condom use and abstinence. Pre-test and post-test counseling sessions included risk reduction guidance, and post-test counseling was based on the participants' individual test results. The behavioral counseling protocol enabled study staff to translate the study's body fluid test results into individualized information for study participants. The Ebola Virus Persistence Risk Reduction Behavioral Counseling Protocol provided guidance to mitigate the risk of EBOV transmission from EVD survivors. It has since been shared with and adapted by other EVD survivor body fluid testing programs and studies in Ebola-affected countries.

Risk-Based School Inspections: Impact of Targeted Inspection Approaches on Dutch Secondary Schools

ERIC Educational Resources Information Center

Ehren, Melanie C.; Shackleton, Nichola

2016-01-01

In most countries, publicly funded schools are held accountable to one inspectorate and are judged against agreed national standards. Many inspectorates of education have recently moved towards more proportional risk-based inspection models, targeting high-risk schools for visits, while schools with satisfactory student attainment levels are…

Reduction of Perceived Social Distance as an Explanation for Media's Influence on Personal Risk Perceptions: A Test of the Risk Convergence Model

ERIC Educational Resources Information Center

So, Jiyeon; Nabi, Robin

2013-01-01

The risk convergence model proposes reduction of perceived social distance to a mediated personality as a mechanism through which the mass media can influence audiences' personal risk perceptions. As an initial test of the model, this study examined whether 5 audience variables known to facilitate media effects on personal risk…

Suicide risk reduction in youths with attention-deficit/hyperactivity disorder prescribed methylphenidate: A Taiwan nationwide population-based cohort study.

PubMed

Liang, Sophie Hsin-Yi; Yang, Yao-Hsu; Kuo, Ting-Yu; Liao, Yin-To; Lin, Tzu-Chin; Lee, Yena; McIntyre, Roger S; Kelsen, Brent A; Wang, Tsu-Nai; Chen, Vincent Chin-Hung

2018-01-01

Attention-deficit/hyperactivity disorder (ADHD) youths have increased suicide risk. Nevertheless, the beneficial effects of methylphenidate (MPH) on suicide attempt have received relatively little attention. To investigate the MPH usage and the risk of suicide attempt among ADHD youths. We identified 84,898 youths less than 18 years old with ADHD diagnosis between 1997 and 2013 from National Health Insurance, and examined whether MPH use affected suicide attempt risk using Cox proportional-hazards models. Among ADHD youths, reduction of suicide risk was found in patients prescribed 90-180days of MPH after adjusting for confounding factors (hazard ratio (HR): 0.41, 95% confidence interval (CI): 0.19-0.90) and a greater reduction in those prescribed more than 180days of MPH (HR: 0.28, 95% CI: 0.17-0.48). We observed a 59% suicide attempt risk reduction among ADHD youths prescribed between 90 and 180days and a 72% risk reduction in those prescribed more than 180days of MPH. The protective benefit observed by the group prescribed MPH for longer duration underscores the importance of psychoeducation and compliance enhancement as part of ADHD management. Indication bias is identified as a limitation of this study, and future self-case control study to investigate the association between suicide attempt and ADHD medication is suggested. This nationwide population-based cohort study showed that among ADHD youths, reduction of suicide risk was observed in patients prescribed MPH for duration 90days and longer, underscoring the importance of appropriate ADHD pharmacotherapy and enhancing drug compliance. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Combining Primary Prevention and Risk Reduction Approaches in Sexual Assault Protection Programming

ERIC Educational Resources Information Center

Menning, Chadwick; Holtzman, Mellisa

2015-01-01

Objective: The object of this study is to extend prior evaluations of Elemental, a sexual assault protection program that combines primary prevention and risk reduction strategies within a single program. Participants and Methods: During 2012 and 2013, program group and control group students completed pretest, posttest, and 6-week and 6-month…

Characteristics of Interventions Targeting Multiple Lifestyle Risk Behaviours in Adult Populations: A Systematic Scoping Review

PubMed Central

King, Kristel; Meader, Nick; Wright, Kath; Graham, Hilary; Power, Christine; Petticrew, Mark; White, Martin; Sowden, Amanda J.

2015-01-01

Background Modifiable lifestyle risk behaviours such as smoking, unhealthy diet, physical inactivity and alcohol misuse are the leading causes of major, non-communicable diseases worldwide. It is increasingly being recognised that interventions which target more than one risk behaviour may be an effective and efficient way of improving people’s lifestyles. To date, there has been no attempt to summarise the global evidence base for interventions targeting multiple risk behaviours. Objective To identify and map the characteristics of studies evaluating multiple risk behaviour change interventions targeted at adult populations in any country. Methods Seven bibliographic databases were searched between January, 1990, and January/ May, 2013. Authors of protocols, conference abstracts, and other relevant articles were contacted. Study characteristics were extracted and inputted into Eppi-Reviewer 4. Results In total, 220 studies were included in the scoping review. Most were randomised controlled trials (62%) conducted in the United States (49%), and targeted diet and physical activity (56%) in people from general populations (14%) or subgroups of general populations (45%). Very few studies had been conducted in the Middle East (2%), Africa (0.5%), or South America (0.5%). There was also a scarcity of studies conducted among young adults (1%), or racial and minority ethnic populations (4%) worldwide. Conclusions Research is required to investigate the interrelationships of lifestyle risk behaviours in varying cultural contexts around the world. Cross-cultural development and evaluation of multiple risk behaviour change interventions is also needed, particularly in populations of young adults and racial and minority ethnic populations. PMID:25617783

Dental health assessed after interproximal enamel reduction: caries risk in posterior teeth.

PubMed

Zachrisson, Björn U; Minster, Line; Ogaard, Bjørn; Birkhed, Dowen

2011-01-01

We investigated whether careful interdental enamel reduction (using extrafine diamond disks with air cooling, followed by contouring with triangular diamond burs and polishing) leads to increased caries risk in premolars and first molars. Our subjects were 43 consecutive patients from 19 to 71 years of age who had received mesiodistal enamel reduction of anterior and posterior teeth 4 to 6 years previously. Dental caries were assessed on standardized bite-wing radiographs according to a 5-grade scale and with a fine-tip explorer catch. The incidence of interproximal caries was compared between reproximated and unground contralateral surfaces in the same patient. Patients were asked about their toothbrushing habits, use of dental floss and toothpicks, and regular fluoride supplementation after the orthodontic appliances were removed. The overall clinical impression generally showed healthy dentitions with excellent occlusion. Only 7 (2.5%) new caries lesions (all grade 1) were found among 278 reproximated mesial or distal surfaces, in 3 patients. Among 84 contralateral unground reference tooth surfaces, 2 lesions (2.4%) were seen. On nonpaired premolars and molars that had not been ground, 23 surfaces had to be referred for caries treatment (grade 3 or occlusal caries). Eleven of these occurred in 1 patient. None of the 43 patients reported increased sensitivity to temperature variations. Interdental enamel reduction with this protocol did not result in increased caries risk in posterior teeth. We found no evidence that proper mesiodistal enamel reduction within recognized limits and in appropriate situations will cause harm to the teeth and supporting structures. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Development of risk reduction behavioral counseling for Ebola virus disease survivors enrolled in the Sierra Leone Ebola Virus Persistence Study, 2015-2016

PubMed Central

Malik, Tasneem; Ariyarajah, Archchun; Ongpin, Patricia; Hogben, Matthew; McDonald, Suzanna L. R.; Marrinan, Jaclyn; Massaquoi, Thomas; Thorson, Anna; Ervin, Elizabeth; Bernstein, Kyle; Ross, Christine; Liu, William J.; Kroeger, Karen; Durski, Kara N.; Broutet, Nathalie; Knust, Barbara; Deen, Gibrilla F.

2017-01-01

Background During the 2014–2016 West Africa Ebola Virus Disease (EVD) epidemic, the public health community had concerns that sexual transmission of the Ebola virus (EBOV) from EVD survivors was a risk, due to EBOV persistence in body fluids of EVD survivors, particularly semen. The Sierra Leone Ebola Virus Persistence Study was initiated to investigate this risk by assessing EBOV persistence in numerous body fluids of EVD survivors and providing risk reduction counseling based on test results for semen, vaginal fluid, menstrual blood, urine, rectal fluid, sweat, tears, saliva, and breast milk. This publication describes implementation of the counseling protocol and the key lessons learned. Methodology/Principal findings The Ebola Virus Persistence Risk Reduction Behavioral Counseling Protocol was developed from a framework used to prevent transmission of HIV and other sexually transmitted infections. The framework helped to identify barriers to risk reduction and facilitated the development of a personalized risk-reduction plan, particularly around condom use and abstinence. Pre-test and post-test counseling sessions included risk reduction guidance, and post-test counseling was based on the participants’ individual test results. The behavioral counseling protocol enabled study staff to translate the study’s body fluid test results into individualized information for study participants. Conclusions/Significance The Ebola Virus Persistence Risk Reduction Behavioral Counseling Protocol provided guidance to mitigate the risk of EBOV transmission from EVD survivors. It has since been shared with and adapted by other EVD survivor body fluid testing programs and studies in Ebola-affected countries. PMID:28892490

Extrapolating non-target risk of Bt crops from laboratory to field

USDA-ARS?s Scientific Manuscript database

The tiered approach to assessing the ecological risk of insect-resistant transgenic crops rests on the assumption that lower-tier laboratory studies, which expose surrogate non-target organisms to insecticidal proteins, accurately predict the ecological effects of these crops under field conditions....

Hombre Seguro (Safe Men): a sexual risk reduction intervention for male clients of female sex workers

PubMed Central

2014-01-01

Background Male clients of female sex workers (FSWs) are at risk of HIV and other sexually transmitted infections (STIs). We conducted a two-arm randomized controlled trial to test the efficacy of a sexual risk reduction intervention for male clients of FSWs in Tijuana, Mexico. Methods/Design Male clients of FSWs who were at least 18, were HIV-negative at baseline, and reported recent unprotected sex with FSWs were randomized to the Hombre Seguro sexual risk reduction intervention, or a time-attention didactic control condition. Each condition lasted approximately one hour. Participants underwent interviewer-administered surveys and testing for HIV and other STIs at baseline, and at 4, 8, and 12 month follow-ups. Combined HIV/STI incidence and unprotected vaginal and anal sex acts with FSWs were the primary outcomes. Discussion A total of 400 participants were randomized to one of the two conditions. Analyses indicated that randomization was successful; there were no significant differences between the participants in the two conditions at baseline. Average follow-up was 84% across both conditions. This is the first study to test the efficacy of a sexual risk reduction intervention for male clients of FSWs using the rigor of a randomized controlled trial. Trial registration NCT01280838, Date of registration: January 19, 2011. PMID:24885949

Targeting Trachoma Control through Risk Mapping: The Example of Southern Sudan

PubMed Central

Clements, Archie C. A.; Kur, Lucia W.; Gatpan, Gideon; Ngondi, Jeremiah M.; Emerson, Paul M.; Lado, Mounir; Sabasio, Anthony; Kolaczinski, Jan H.

2010-01-01

Background Trachoma is a major cause of blindness in Southern Sudan. Its distribution has only been partially established and many communities in need of intervention have therefore not been identified or targeted. The present study aimed to develop a tool to improve targeting of survey and control activities. Methods/Principal Findings A national trachoma risk map was developed using Bayesian geostatistics models, incorporating trachoma prevalence data from 112 geo-referenced communities surveyed between 2001 and 2009. Logistic regression models were developed using active trachoma (trachomatous inflammation follicular and/or trachomatous inflammation intense) in 6345 children aged 1–9 years as the outcome, and incorporating fixed effects for age, long-term average rainfall (interpolated from weather station data) and land cover (i.e. vegetation type, derived from satellite remote sensing), as well as geostatistical random effects describing spatial clustering of trachoma. The model predicted the west of the country to be at no or low trachoma risk. Trachoma clusters in the central, northern and eastern areas had a radius of 8 km after accounting for the fixed effects. Conclusion In Southern Sudan, large-scale spatial variation in the risk of active trachoma infection is associated with aridity. Spatial prediction has identified likely high-risk areas to be prioritized for more data collection, potentially to be followed by intervention. PMID:20808910

The motivation and actions of Australians concerning brain health and dementia risk reduction.

PubMed

Smith, Ben J; Ali, Suha; Quach, Henry

2015-08-01

Alzheimer's disease and dementia are recognised as critical public health priorities. This study investigated intentions and behaviours concerning brain health and dementia risk reduction among Australians. A cross-sectional survey of 1000 persons aged 20-75 years measured knowledge, beliefs, intentions and behaviours concerning brain health and dementia. The demographic, experiential and cognitive factors associated with intentions and actions were examined. Around half of respondents were motivated to improve brain health. Behaviours most often reported were mental activity (19%), physical activity (9.6%) and dietary action (6.5%). Actions were most likely among women (OR 1.59, 95% CI 1.19-2.14), those aged 60 years and over (OR 3.07, 95% CI 2.01-2.58), with university education (OR 1.67, 95% CI 1.08-2.58) or with prior contact with a person with dementia (OR 1.99, 95% CI 1.12-3.56). Both intentions and actions were associated with moderate to high knowledge, and beliefs and confidence that favoured dementia risk reduction. A lower proportion of Australians reported taking action to improve brain health than who expressed intentions in this regard. Strategies are needed to improve knowledge about the range of behaviours that contribute to dementia risk reduction and to increase confidence that this outcome is personally achievable. SO WHAT? The burden of disease due to Alzheimer's disease and dementia is growing dramatically. It is essential to promote awareness that dementia is not an inevitable result of ageing and to increase understanding that action can be taken throughout the life course to promote brain health.

RISK REDUCTION WITH A FUZZY EXPERT EXPLORATION TOOL

DOE Office of Scientific and Technical Information (OSTI.GOV)

Robert S. Balch; Ron Broadhead

2005-03-01

Incomplete or sparse data such as geologic or formation characteristics introduce a high level of risk for oil exploration and development projects. ''Expert'' systems developed and used in several disciplines and industries have demonstrated beneficial results when working with sparse data. State-of-the-art expert exploration tools, relying on a database, and computer maps generated by neural networks and user inputs, have been developed through the use of ''fuzzy'' logic, a mathematical treatment of imprecise or non-explicit parameters and values. Oil prospecting risk has been reduced with the use of these properly verified and validated ''Fuzzy Expert Exploration (FEE) Tools.'' Through themore » course of this project, FEE Tools and supporting software were developed for two producing formations in southeast New Mexico. Tools of this type can be beneficial in many regions of the U.S. by enabling risk reduction in oil and gas prospecting as well as decreased prospecting and development costs. In today's oil industry environment, many smaller exploration companies lack the resources of a pool of expert exploration personnel. Downsizing, volatile oil prices, and scarcity of domestic exploration funds have also affected larger companies, and will, with time, affect the end users of oil industry products in the U.S. as reserves are depleted. The FEE Tools benefit a diverse group in the U.S., allowing a more efficient use of scarce funds, and potentially reducing dependence on foreign oil and providing lower product prices for consumers.« less

Meditation and Cardiovascular Risk Reduction: A Scientific Statement From the American Heart Association.

PubMed

Levine, Glenn N; Lange, Richard A; Bairey-Merz, C Noel; Davidson, Richard J; Jamerson, Kenneth; Mehta, Puja K; Michos, Erin D; Norris, Keith; Ray, Indranill Basu; Saban, Karen L; Shah, Tina; Stein, Richard; Smith, Sidney C

2017-09-28

Despite numerous advances in the prevention and treatment of atherosclerosis, cardiovascular disease remains a leading cause of morbidity and mortality. Novel and inexpensive interventions that can contribute to the primary and secondary prevention of cardiovascular disease are of interest. Numerous studies have reported on the benefits of meditation. Meditation instruction and practice is widely accessible and inexpensive and may thus be a potential attractive cost-effective adjunct to more traditional medical therapies. Accordingly, this American Heart Association scientific statement systematically reviewed the data on the potential benefits of meditation on cardiovascular risk. Neurophysiological and neuroanatomical studies demonstrate that meditation can have long-standing effects on the brain, which provide some biological plausibility for beneficial consequences on the physiological basal state and on cardiovascular risk. Studies of the effects of meditation on cardiovascular risk have included those investigating physiological response to stress, smoking cessation, blood pressure reduction, insulin resistance and metabolic syndrome, endothelial function, inducible myocardial ischemia, and primary and secondary prevention of cardiovascular disease. Overall, studies of meditation suggest a possible benefit on cardiovascular risk, although the overall quality and, in some cases, quantity of study data are modest. Given the low costs and low risks of this intervention, meditation may be considered as an adjunct to guideline-directed cardiovascular risk reduction by those interested in this lifestyle modification, with the understanding that the benefits of such intervention remain to be better established. Further research on meditation and cardiovascular risk is warranted. Such studies, to the degree possible, should utilize randomized study design, be adequately powered to meet the primary study outcome, strive to achieve low drop-out rates, include long

A Cardiovascular Risk Reduction Program for American Indians with Metabolic Syndrome: The Balance Study

ERIC Educational Resources Information Center

Lee, Elisa T.; Jobe, Jared B.; Yeh, Jeunliang; Ali, Tauqeer; Rhoades, Everett R.; Knehans, Allen W.; Willis, Diane J.; Johnson, Melanie R.; Zhang, Ying; Poolaw, Bryce; Rogers, Billy

2012-01-01

The Balance Study is a randomized controlled trial designed to reduce cardiovascular disease (CVD) risk in 200 American Indian (AI) participants with metabolic syndrome who reside in southwestern Oklahoma. Major risk factors targeted include weight, diet, and physical activity. Participants are assigned randomly to one of two groups, a guided or a…

Children with Disabilities in Disability-Inclusive Disaster Risk Reduction: Focussing on School Settings

ERIC Educational Resources Information Center

Ronoh, Steve; Gaillard, J. C.; Marlowe, Jay

2017-01-01

Every year, worldwide, disasters affect approximately seven million children with disabilities, highlighting their potential vulnerability. Although there is a growing move internationally to promote the rights of children with disabilities, they still receive little attention from disaster risk reduction (DRR) researchers and policy makers. They…

Pathogen reduction of blood components.

PubMed

Solheim, Bjarte G

2008-08-01

Thanks to many blood safety interventions introduced in developed countries the risk of transfusion transmitted infections has become exceedingly small in these countries. However, emerging pathogens still represent a serious challenge, as demonstrated by West Nile virus in the US and more recently by Chikungunya virus in the Indian Ocean. In addition bacterial contamination, particularly in platelets, and protozoa transmitted by blood components still represent sizeable risks in developed countries. In developing countries the risk of all transfusion transmitted infections is still high due to insufficient funding and organisation of the health service. Pathogen reduction of pooled plasma products has virtually eliminated the risk of transfusion transmitted infections, without compromising the quality of the products significantly. Pathogen reduction of blood components has been much more challenging. Solvent detergent treatment which has been so successfully applied for plasma products dissolves cell membranes, and can, therefore, only be applied for plasma and not for cellular blood components. Targeting of nucleic acids has been another method for pathogen inactivation of plasma and the only approach possible for cellular blood products. As documented in more than 15 year's track record, solvent detergent treatment of pooled plasma can yield high quality plasma. The increased risk for contamination by unknown viruses due to pooling is out weighed by elimination of TRALI, significant reduction in allergic reactions and standardisation of the product. Recently, a promising method for solvent detergent treatment of single donor plasma units has been published. Methylene blue light treatment of single donor plasma units has a similar long track record as pooled solvent detergent treated plasma; but the method is less well documented and affects coagulation factor activity more. Psoralen light treated plasma has only recently been introduced (CE marked in Europe

A randomized trial of enhanced HIV risk-reduction and vaccine trial education interventions among HIV-negative, high-risk women who use noninjection drugs: the UNITY study.

PubMed

Koblin, Beryl A; Bonner, Sebastian; Hoover, Donald R; Xu, Guozhen; Lucy, Debbie; Fortin, Princess; Putnam, Sara; Latka, Mary H

2010-03-01

Limited data are available on interventions to reduce sexual risk behaviors and increase knowledge of HIV vaccine trial concepts in high-risk populations eligible to participate in HIV vaccine efficacy trials. The UNITY Study was a 2-arm randomized trial to determine the efficacy of enhanced HIV risk-reduction and vaccine trial education interventions to reduce the occurrence of unprotected vaginal sex acts and increase HIV vaccine trial knowledge among 311 HIV-negative noninjection drug using women. The enhanced vaccine education intervention using pictures along with application vignettes and enhanced risk-reduction counseling consisting of 3 one-on-one counseling sessions were compared with standard conditions. Follow-up visits at 1 week and 1, 6, and 12 months after randomization included HIV testing and assessment of outcomes. During follow-up, the percent of women reporting sexual risk behaviors declined significantly but did not differ significantly by study arm. Knowledge of HIV vaccine trial concepts significantly increased but did not significantly differ by study arm. Concepts about HIV vaccine trials not adequately addressed by either condition included those related to testing a vaccine for both efficacy and safety, guarantees about participation in future vaccine trials, assurances of safety, medical care, and assumptions about any protective effect of a test vaccine. Further research is needed to boost educational efforts and strengthen risk-reduction counseling among high-risk noninjection drug using women.

Moving Forward after Sendai: How Countries Want to Use Science, Evidence and Technology for Disaster Risk Reduction.

PubMed

Calkins, Julie

2015-05-14

Following the 2004 Indian Ocean earthquake and tsunami event, the global community adopted the UN Hyogo Framework for Action (HFA) for Disaster Risk Reduction 2005-2015, which set out priorities to help countries achieve disaster resilience by encouraging the establishment of national platforms and strengthening disaster governance. In March 2015, UN member states adopted the successor to HFA, the Sendai Framework for Disaster Risk Reduction: 2015-2030 (SFDRR). The SFDRR recognises the cross-cutting nature of DRR policy and calls on stakeholders to help governments. Over the following months, the international science community as a stakeholder will contribute by outlining guidance, research opportunities and partnerships to help countries implement the new framework. To inform this process, this study examines government' and national scientists' perspectives about the needs to use science, evidence and technology to achieve disaster risk reduction (DRR) and put the words of the new framework into action. This study was conducted using qualitative content analysis and quantifiable survey results. Data was collected via extraction from published statements and online survey responses. For statement content analysis, search terms were determined iteratively in a sample of statements until no new terms emerged. Additionally, 167 national scientists were recruited to participate in the online survey with a response rate of 26.3% (44/167). Country priorities are clustered and clear, showing that there is a demand for greater science in DRR decision-making and solutions. The main themes highlighted by countries were promoting research and practitioner engagement; increase technology transfer mechanisms; open data; communication of usable evidence and user's needs; education and training; and lastly, international cooperation all contributing to national capacity building. As identified, the main difficulties with existing delivery are gaps in knowledge, lack of

Risk Factors and Therapeutic Targets in Pancreatic Cancer

PubMed Central

Wörmann, Sonja Maria; Algül, Hana

2013-01-01

Pancreatic cancer (PC) is one of the most challenging tumor entities worldwide, characterized as a highly aggressive disease with dismal overall prognosis and an incidence rate equalling mortality rate. Over the last decade, substantial progress has been made to define the morphological changes and key genetic events in pancreatic carcinogenesis. And yet, it is still unclear what factors trigger PC. Some risk factors appear to be associated with sex, age, race/ethnicity, or other rare genetic conditions. Additionally, modifying factors such as smoking, obesity, diabetes, occupational risk factors, etc., increase the potential for acquiring genetic mutations that may result in PC. Another hallmark of PC is its poor response to radio- and chemo-therapy. Current chemotherapeutic regimens could not provide substantial survival benefit with a clear increase in overall survival. Recently, several new approaches to significantly improve the clinical outcome of PC have been described involving downstream signaling cascades desmoplasia and stromal response as well as tumor microenvironment, immune response, vasculature, and angiogenesis. This review summarizes major risk factors for PC and tries to illuminate relevant targets considerable for new therapeutic approaches. PMID:24303367

Closed reduction of slipped capital femoral epiphysis: high-risk factor for avascular necrosis.

PubMed

Kitano, Toshio; Nakagawa, Keisuke; Wada, Mayuko; Moriyama, Michiko

2015-07-01

How should we treat acute/unstable slipped capital femoral epiphysis (SCFE) without the development of avascular necrosis (AVN)? To answer this question, we investigated the risk factors of AVN development after SCFE. Seventy-six hips of 64 patients were classified using two kinds of classification systems, Loder's classification based on instability and the conventional classification based on the duration of symptom, because both classifications are related to AVN development. Of 21 unstable SCFEs, seven hips developed AVN. Of 35 hips defined as acute or acute on chronic, nine hips developed AVN. Two stable SCFEs of Loder's classification developed AVN, one was acute and the other was acute on chronic. No hips of chronic SCFE developed AVN. The factor that had influenced AVN development was only closed reduction, whether purposefully or inadvertently, in an acute or unstable SCFE. On the basis of the findings of this study, one should not embark on any modality of closed reduction for an unstable or acute form of SCFE, as there is a high risk for occurrence of AVN. For the same reason, a traction table should not be used for SCFE fixation, so as to avoid an inadvertent reduction or force that can lead to AVN.

A qualitative study of older and middle-aged adults' perception and attitudes towards dementia and dementia risk reduction.

PubMed

Kim, Sarang; Sargent-Cox, Kerry A; Anstey, Kaarin J

2015-07-01

To investigate perceptions of dementia and dementia risk reduction held by people without dementia. Dementia does not only affect individuals with dementia, but also has an impact on family and friends, society and healthcare professionals. Recent research has identified modifiable risk and protective factors for dementia. However, it is unclear what knowledge people without dementia have about these risk factors and their attitudes towards addressing these risk factors to achieve dementia risk reduction are not known. Qualitative descriptive study using focus group methodology. A focus group study was conducted in February 2011 with 34 older adults aged between 52-90 years. The long-table approach was used to identify themes and categorize data on dementia knowledge, risk and attitudes. Participants correctly identified dementia risk factors as a group. Participants' responses about their perceived likelihood of developing dementia could be classified into three distinctive themes; fear, rational and cynical perceptions. Both fear of developing dementia and the need to improve dementia knowledge were considered major motivators towards adopting healthier lifestyle and health behaviours. Lack of knowledge on risk factors for dementia was identified as a major barrier for behavioural and lifestyle change. These findings can be used to develop effective and personalized interventions that increase motivators and reduce barriers by tailoring interventions to individual's dementia risk reduction literacy and motivations to change behaviours. Greater public-health promotion and education about risk and protective factors for dementia are also necessary to increase dementia health literacy and to reduce overall dementia prevalence. © 2015 John Wiley & Sons Ltd.

Carrier air wing mishap reduction using a human factors classification system and risk management.

PubMed

Belland, Kxis M; Olsen, Cara; Lawry, Russell

2010-11-01

In 1998, the Navy's center of excellence for advanced air wing combat operations, namely the Naval Strike and Air Warfare Center (NSAWC), had a spike in Class A flight mishaps. The spike triggered an intense review of prior mishaps and current mishap-reduction practices using the Human Factors Analysis and Classification System (HFACS). The review resulted in NSAWC instituting a comprehensive multifactorial mishap reduction plan applying Operational Risk Management (ORM) precepts. This is a nonrandomized investigational study with use of a historical comparison population. The Class A mishap rate per flight hour covering 10 yr prior to the mishap reduction efforts was estimated and compared to the Class A mishap rate per flight hour for the 10 yr after implementation using Poisson regression. Combined Fleet and NSAWC data shows a 27% reduction in mishap rate, but the 21% reduction in the Fleet alone was not statistically significant. The mishap reduction at NSAWC was statistically significant with an 84% reduction. Fallon carrier air wing mishap rates post-ORM mishap reduction efforts are approaching those seen in the Fleet, but are still elevated overall (3.7 vs. 2.4). The incidence rate ratio was 80% lower at Fallon than the rest of the Fleet, indicating a significantly greater reduction in NSAWC air wing mishaps and suggests focused aviation mishap reduction efforts in similar circumstances could result in similar reductions.

NASA's Space Launch System Advanced Booster Engineering Demonstration and Risk Reduction Efforts

NASA Technical Reports Server (NTRS)

Crumbly, Christopher M.; May, Todd; Dumbacher, Daniel

2012-01-01

The National Aeronautics and Space Administration (NASA) formally initiated the Space Launch System (SLS) development in September 2011, with the approval of the program s acquisition plan, which engages the current workforce and infrastructure to deliver an initial 70 metric ton (t) SLS capability in 2017, while using planned block upgrades to evolve to a full 130 t capability after 2021. A key component of the acquisition plan is a three-phased approach for the first stage boosters. The first phase is to complete the development of the Ares and Space Shuttle heritage 5-segment solid rocket boosters for initial exploration missions in 2017 and 2021. The second phase in the booster acquisition plan is the Advanced Booster Risk Reduction and/or Engineering Demonstration NASA Research Announcement (NRA), which was recently awarded after a full and open competition. The NRA was released to industry on February 9, 2012, and its stated intent was to reduce risks leading to an affordable Advanced Booster and to enable competition. The third and final phase will be a full and open competition for Design, Development, Test, and Evaluation (DDT&E) of the Advanced Boosters. There are no existing boosters that can meet the performance requirements for the 130 t class SLS. The expected thrust class of the Advanced Boosters is potentially double the current 5-segment solid rocket booster capability. These new boosters will enable the flexible path approach to space exploration beyond Earth orbit, opening up vast opportunities including near-Earth asteroids, Lagrange Points, and Mars. This evolved capability offers large volume for science missions and payloads, will be modular and flexible, and will be right-sized for mission requirements. NASA developed the Advanced Booster Engineering Demonstration and/or Risk Reduction NRA to seek industry participation in reducing risks leading to an affordable Advanced Booster that meets the SLS performance requirements. Demonstrations and

Nuts and legume seeds for cardiovascular risk reduction: scientific evidence and mechanisms of action.

PubMed

Souza, Rávila G M; Gomes, Aline C; Naves, Maria M V; Mota, João F

2015-06-01

Consumption of tree nuts and legume seeds is associated with a reduction in cardiovascular risk. The reduction in blood lipids and in inflammatory and oxidative processes exhibited by bioactive compounds such as monounsaturated and polyunsaturated fatty acids, fibers, phenolic compounds, tocopherols, phospholipids, carotenoids, some minerals, and arginine, has stimulated research on the mechanisms of action of these substances through distinct experimental approaches. It is, therefore, important to know the metabolic effect of each nut and legume seed or the mixture of them to choose the most suitable nutritional interventions in clinical practice. The aim of this narrative bibliographic review was to investigate the effects of tree nuts and legume seeds on biomarkers of cardiovascular risk, as well as their mechanisms of action with regard to lipid profiles, insulin resistance, arterial pressure, oxidative stress, and inflammation. The findings indicate that a mixture of nuts and legume seeds optimizes the protective effect against cardiovascular risk. © The Author(s) 2015. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Minority Households' Willingness-to-Pay for Public and Private Wildfire Risk Reduction in Florida

NASA Astrophysics Data System (ADS)

Gonzalez-Caban, A.; Sanchez, J. J.

2017-12-01

The purpose of this work is to estimate willingness-to-pay (WTP) for minority (African-American and Hispanic) homeowners in Florida for private and public wildfire risk reduction programs and also to test for differences in response between the two groups. A random parameter logit and latent class models allowed us to determine if there is difference in wildfire mitigation program preferences, whether WTP is higher for public or private actions for wildfire risk reduction, and whether households with personal experience and who perceive that they live in higher-risk areas have significantly higher WTP. We also compare FL minority homeowners' WTP values with Florida original homeowners' estimates. Results suggest that FL minority homeowners are willing to invest in public programs, with African-Americans WTP values at a higher rate than Hispanics. In addition, the highest priority for cost sharing funds would go to low-income homeowners, especially to cost-share private actions on their own land. These results may help fire managers optimize allocation of scarce cost-sharing funds for public versus private actions.

The relationship between health risks and health and productivity costs among employees at Pepsi Bottling Group.

PubMed

Henke, Rachel M; Carls, Ginger S; Short, Meghan E; Pei, Xiaofei; Wang, Shaohung; Moley, Susan; Sullivan, Mark; Goetzel, Ron Z

2010-05-01

To evaluate relationships between modifiable health risks and costs and measure potential cost savings from risk reduction programs. Health risk information from active Pepsi Bottling Group employees who completed health risk assessments between 2004 and 2006 (N = 11,217) were linked to medical care, workers' compensation, and short-term disability cost data. Ten health risks were examined. Multivariate analyses were performed to estimate costs associated with having high risk, holding demographics, and other risks constant. Potential savings from risk reduction were estimated. High risk for weight, blood pressure, glucose, and cholesterol had the greatest impact on total costs. A one-percentage point annual reduction in the health risks assessed would yield annual per capita savings of $83.02 to $103.39. Targeted programs that address modifiable health risks are expected to produce substantial cost reductions in multiple benefit categories.

Single-Isocenter Multiple-Target Stereotactic Radiosurgery: Risk of Compromised Coverage

DOE Office of Scientific and Technical Information (OSTI.GOV)

Roper, Justin, E-mail: justin.roper@emory.edu; Department of Biostatistics and Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, Georgia; Chanyavanich, Vorakarn

2015-11-01

Purpose: To determine the dosimetric effects of rotational errors on target coverage using volumetric modulated arc therapy (VMAT) for multitarget stereotactic radiosurgery (SRS). Methods and Materials: This retrospective study included 50 SRS cases, each with 2 intracranial planning target volumes (PTVs). Both PTVs were planned for simultaneous treatment to 21 Gy using a single-isocenter, noncoplanar VMAT SRS technique. Rotational errors of 0.5°, 1.0°, and 2.0° were simulated about all axes. The dose to 95% of the PTV (D95) and the volume covered by 95% of the prescribed dose (V95) were evaluated using multivariate analysis to determine how PTV coverage was relatedmore » to PTV volume, PTV separation, and rotational error. Results: At 0.5° rotational error, D95 values and V95 coverage rates were ≥95% in all cases. For rotational errors of 1.0°, 7% of targets had D95 and V95 values <95%. Coverage worsened substantially when the rotational error increased to 2.0°: D95 and V95 values were >95% for only 63% of the targets. Multivariate analysis showed that PTV volume and distance to isocenter were strong predictors of target coverage. Conclusions: The effects of rotational errors on target coverage were studied across a broad range of SRS cases. In general, the risk of compromised coverage increased with decreasing target volume, increasing rotational error and increasing distance between targets. Multivariate regression models from this study may be used to quantify the dosimetric effects of rotational errors on target coverage given patient-specific input parameters of PTV volume and distance to isocenter.« less

Comparing probabilistic microbial risk assessments for drinking water against daily rather than annualised infection probability targets.

PubMed

Signor, R S; Ashbolt, N J

2009-12-01

Some national drinking water guidelines provide guidance on how to define 'safe' drinking water. Regarding microbial water quality, a common position is that the chance of an individual becoming infected by some reference waterborne pathogen (e.g. Cryptsporidium) present in the drinking water should < 10(-4) in any year. However the instantaneous levels of risk to a water consumer vary over the course of a year, and waterborne disease outbreaks have been associated with shorter-duration periods of heightened risk. Performing probabilistic microbial risk assessments is becoming commonplace to capture the impacts of temporal variability on overall infection risk levels. A case is presented here for adoption of a shorter-duration reference period (i.e. daily) infection probability target over which to assess, report and benchmark such risks. A daily infection probability benchmark may provide added incentive and guidance for exercising control over short-term adverse risk fluctuation events and their causes. Management planning could involve outlining measures so that the daily target is met under a variety of pre-identified event scenarios. Other benefits of a daily target could include providing a platform for managers to design and assess management initiatives, as well as simplifying the technical components of the risk assessment process.

TERRORIST PROTECTION PLANNING USING A RELATIVE RISK REDUCTION APPROACH, SESSION VIII: TECHNOLOGY FORUM FOCUS GROUPS.

DOE Office of Scientific and Technical Information (OSTI.GOV)

INDUSI,J.P.

2003-06-16

Since the events of 9/11, there have been considerable concerns and associated efforts to prevent or respond to acts of terrorism. Very often we hear calls to reduce the threat from or correct vulnerabilities to various terrorist acts. Others fall victim to anxiety over potential scenarios with the gravest of consequences involving hundreds of thousands of casualties. The problem is complicated by the fact that planners have limited, albeit in some cases significant, resources and less than perfect intelligence on potential terrorist plans. However, valuable resources must be used prudently to reduce the overall risk to the nation. A systematicmore » approach to this process of asset allocation is to reduce the overall risk and not just an individual element of risk such as vulnerabilities. Hence, we define risk as a function of three variables: the threat (the likelihood and scenario of the terrorist act), the vulnerability (the vulnerability of potential targets to the threat), and the consequences (health and safety, economic, etc.) resulting from a successful terrorist scenario. Both the vulnerability and consequences from a postulated adversary scenario can be reasonably well estimated. However, the threat likelihood and scenarios are much more difficult to estimate. A possible path forward is to develop scenarios for each potential target in question using experts from many disciplines. This should yield a finite but large number of target-scenario pairs. The vulnerabilities and consequences for each are estimated and then ranked relative to one another. The resulting relative risk ranking will have targets near the top of the ranking for which the threat is estimated to be more likely, the vulnerability greatest, and the consequences the most grave. In the absence of perfect intelligence, this may be the best we can do.« less

Nano-targeted induction of dual ferroptotic mechanisms eradicates high-risk neuroblastoma.

PubMed

Hassannia, Behrouz; Wiernicki, Bartosz; Ingold, Irina; Qu, Feng; Van Herck, Simon; Tyurina, Yulia Y; Bayır, Hülya; Abhari, Behnaz A; Angeli, Jose Pedro Friedmann; Choi, Sze Men; Meul, Eline; Heyninck, Karen; Declerck, Ken; Chirumamilla, Chandra Sekhar; Lahtela-Kakkonen, Maija; Van Camp, Guy; Krysko, Dmitri V; Ekert, Paul G; Fulda, Simone; De Geest, Bruno G; Conrad, Marcus; Kagan, Valerian E; Berghe, Wim Vanden; Vandenabeele, Peter; Berghe, Tom Vanden

2018-06-25

High-risk neuroblastoma is a devastating malignancy with very limited therapeutic options. Here, we identify withaferin A (WA) as a natural ferroptosis-inducing agent in neuroblastoma, which acts through a novel double-edged mechanism. WA dose-dependently either activates the nuclear factor-like 2 pathway through targeting of Kelch-like ECH-associated protein 1 (noncanonical ferroptosis induction) or inactivates glutathione peroxidase 4 (canonical ferroptosis induction). Noncanonical ferroptosis induction is characterized by an increase in intracellular labile Fe(II) upon excessive activation of heme oxygenase-1, which is sufficient to induce ferroptosis. This double-edged mechanism might explain the superior efficacy of WA as compared with etoposide or cisplatin in killing a heterogeneous panel of high-risk neuroblastoma cells, and in suppressing the growth and relapse rate of neuroblastoma xenografts. Nano-targeting of WA allows systemic application and suppressed tumor growth due to an enhanced accumulation at the tumor site. Collectively, our data propose a novel therapeutic strategy to efficiently kill cancer cells by ferroptosis.

Quality control for normal liquid-based cytology: Rescreening, high-risk HPV targeted reviewing and/or high-risk HPV detection?

PubMed Central

Depuydt, Christophe E; Arbyn, Marc; Benoy, Ina H; Vandepitte, Johan; Vereecken, Annie J; Bogers, Johannes J

2009-01-01

The objective of this prospective study was to compare the number of CIN2+cases detected in negative cytology by different quality control (QC) methods. Full rescreening, high-risk (HR) human papillomavirus (HPV)-targeted reviewing and HR HPV detection were compared. Randomly selected negative cytology detected by BD FocalPoint™ (NFR), by guided screening of the prescreened which needed further review (GS) and by manual screening (MS) was used. A 3-year follow-up period was available. Full rescreening of cytology only detected 23.5% of CIN2+ cases, whereas the cytological rescreening of oncogenic positive slides (high-risk HPV-targeted reviewing) detected 7 of 17 CIN2+ cases (41.2%). Quantitative real-time PCR for 15 oncogenic HPV types detected all CIN2+ cases. Relative sensitivity to detect histological CIN2+ was 0.24 for full rescreening, 0.41 for HR-targeted reviewing and 1.00 for HR HPV detection. In more than half of the reviewed negative cytological preparations associated with histological CIN2+cases no morphologically abnormal cells were detected despite a positive HPV test. The visual cut-off for the detection of abnormal cytology was established at 6.5 HR HPV copies/cell. High-risk HPV detection has a higher yield for detection of CIN2+ cases as compared to manual screening followed by 5% full review, or compared to targeted reviewing of smears positive for oncogenic HPV types, and show diagnostic properties that support its use as a QC procedure in cytologic laboratories. PMID:18544049

Using existing data to predict and quantify the risks of GM forage to a population of a non-target invertebrate species: a New Zealand case study.

PubMed

O'Callaghan, Maureen; Soboleva, Tanya K; Barratt, Barbara I P

2010-01-01

Determining the effects of genetically modified (GM) crops on non-target organisms is essential as many non-target species provide important ecological functions. However, it is simply not possible to collect field data on more than a few potential non-target species present in the receiving environment of a GM crop. While risk assessment must be rigorous, new approaches are necessary to improve the efficiency of the process. Utilisation of published information and existing data on the phenology and population dynamics of test species in the field can be combined with limited amounts of experimental biosafety data to predict possible outcomes on species persistence. This paper presents an example of an approach where data from laboratory experiments and field studies on phenology are combined using predictive modelling. Using the New Zealand native weevil species Nicaeana cervina as a case study, we could predict that oviposition rates of the weevil feeding on a GM ryegrass could be reduced by up to 30% without threat to populations of the weevil in pastoral ecosystems. In addition, an experimentally established correlation between feeding level and oviposition led to the prediction that a consistent reduction in feeding of 50% or higher indicated a significant risk to the species and could potentially lead to local extinctions. This approach to biosafety risk assessment, maximising the use of pre-existing field and laboratory data on non-target species, can make an important contribution to informed decision-making by regulatory authorities and developers of new technologies. © ISBR, EDP Sciences, 2011.

Impact of the UK voluntary sodium reduction targets on the sodium content of processed foods from 2006 to 2011: analysis of household consumer panel data.

PubMed

Eyles, Helen; Webster, Jacqueline; Jebb, Susan; Capelin, Cathy; Neal, Bruce; Ni Mhurchu, Cliona

2013-11-01

In 2006 the UK Food Standards Agency (FSA) introduced voluntary sodium reduction targets for more than 80 categories of processed food. Our aim was to determine the impact of these targets on the sodium content of processed foods in the UK between 2006 and 2011. Household consumer panel data (n>18,000 households) were used to calculate crude and sales-weighted mean sodium content for 47,337 products in 2006 and 49,714 products in 2011. Two sample t-tests were used to compare means. A secondary analysis was undertaken to explore reformulation efforts and included only products available for sale in both 2006 and 2011. Between 2006 and 2011 there was an overall mean reduction in crude sodium content of UK foods of -26 mg/100g (p ≤ 0.001), equivalent to a 7% fall (356 mg/100g to 330 mg/100g). The corresponding sales-weighted reduction was -21 mg/100g (-6%). For products available for sale in both years the corresponding reduction was -23 mg/100g (p<0.001) or -7%. The UK FSA voluntary targets delivered a moderate reduction in the mean sodium content of UK processed foods between 2006 and 2011. Whilst encouraging, regular monitoring and review of the UK sodium reduction strategy will be essential to ensure continued progress. © 2013.

Risk factors in limb reduction defects.

PubMed

Stoll, C; Alembik, Y; Dott, B; Roth, M P

1992-07-01

Risk factors were studied in 123 children with limb reduction defects (LRD) from 118,265 consecutive births of known outcome during the period from 1979 to 1987 in the area which is covered by our registry of congenital malformations. For each case a control was studied. The LRD was localised and classified according to the EUROCAT guide for the description and classification of limb defects. The prevalence of LRD was 1.04 per thousand: 82.9% of the babies were liveborn, 13.0% were late spontaneous abortion or stillborn and termination was performed in 4.0% of the cases. The proportion of males was 0.55. The most common malformations in the 51.2% of children who had at least one other anomaly than LRD were associated cardiac, digestive and renal anomalies. The pregnancy with limb anomalies was more often complicated by oligohydramnios, polyhydramnios and threatened abortion but there were no differences in parental characteristics. However, 9.7% of marriages were consanguineous (P less than 0.01) and the incidence of LRD in first-degree relatives of the children with LRD was high. First-degree relatives also had more non-limb malformations than did those of controls.

An integrated approach to panic prevention targeting the empirically supported risk factors of smoking and anxiety sensitivity: theoretical basis and evidence from a pilot project evaluating feasibility and short-term efficacy.

PubMed

Feldner, Matthew T; Zvolensky, Michael J; Babson, Kimberly; Leen-Feldner, Ellen W; Schmidt, Norman B

2008-10-01

Consistent with a risk reduction model of targeted prevention, the present investigation piloted and empirically evaluated the feasibility and short-term efficacy of a first-generation panic prevention program that targeted two malleable risk factors for panic development-anxiety sensitivity and daily cigarette smoking. Members of a high risk cohort, defined by high levels of anxiety sensitivity and current daily smoking (n=96), were randomly assigned to either (1) a one session intervention focused on proximally increasing motivation to quit smoking and reducing anxiety sensitivity to distally prevent the development of panic or (2) a health information control condition of comparable length. Participants were followed for 6 months. Consistent with hypotheses, those in the treatment condition showed reduced anxiety sensitivity and this effect was maintained across the follow-up period. Limited evidence also suggested the intervention increased motivation to quit smoking. We discuss how this prevention protocol can be modified in the future to enhance its effects as part of second-generation larger-scale outcome evaluations.

A Competence-Based Science Learning Framework Illustrated Through the Study of Natural Hazards and Disaster Risk Reduction

NASA Astrophysics Data System (ADS)

Oyao, Sheila G.; Holbrook, Jack; Rannikmäe, Miia; Pagunsan, Marmon M.

2015-09-01

This article proposes a competence-based learning framework for science teaching, applied to the study of 'big ideas', in this case to the study of natural hazards and disaster risk reduction (NH&DRR). The framework focuses on new visions of competence, placing emphasis on nurturing connectedness and behavioral actions toward resilience and sustainability. The framework draws together competences familiarly expressed as cognitive knowledge and skills, plus dispositions and adds connectedness and action-related behaviors, and applies this by means of a progression shift associated with NH&DRR from abilities to capabilities. The target is enhanced scientific literacy approached through an education through science focus, amplified through the study of a big idea, promotion of sustained resilience in the face of disaster and the taking of responsibilities for behavioral actions. The framework is applied to a learning progression for each interrelated education dimension, thus serving as a guide for both the development of abilities and as a platform for stimulating student capabilities within instruction and assessment.

Non-targeted effects of ionizing radiation–implications for low dose risk

PubMed Central

Kadhim, Munira; Salomaa, Sisko; Wright, Eric; Hildebrandt, Guido; Belyakov, Oleg V.; Prise, Kevin M.; Little, Mark P.

2014-01-01

Non-DNA targeted effects of ionizing radiation, which include genomic instability, and a variety of bystander effects including abscopal effects and bystander mediated adaptive response, have raised concerns about the magnitude of low-dose radiation risk. Genomic instability, bystander effects and adaptive responses are powered by fundamental, but not clearly understood systems that maintain tissue homeostasis. Despite excellent research in this field by various groups, there are still gaps in our understanding of the likely mechanisms associated with non-DNA targeted effects, particularly with respect to systemic (human health) consequences at low and intermediate doses of ionizing radiation. Other outstanding questions include links between the different non-targeted responses and the variations in response observed between individuals and cell lines, possibly a function of genetic background. Furthermore, it is still not known what the initial target and early interactions in cells are that give rise to non-targeted responses in neighbouring or descendant cells. This paper provides a commentary on the current state of the field as a result of the Non-targeted effects of ionizing radiation (NOTE) Integrated Project funded by the European Union. Here we critically examine the evidence for non-targeted effects, discuss apparently contradictory results and consider implications for low-dose radiation health effects. PMID:23262375

Capability for Integrated Systems Risk-Reduction Analysis

NASA Technical Reports Server (NTRS)

Mindock, J.; Lumpkins, S.; Shelhamer, M.

2016-01-01

NASA's Human Research Program (HRP) is working to increase the likelihoods of human health and performance success during long-duration missions, and subsequent crew long-term health. To achieve these goals, there is a need to develop an integrated understanding of how the complex human physiological-socio-technical mission system behaves in spaceflight. This understanding will allow HRP to provide cross-disciplinary spaceflight countermeasures while minimizing resources such as mass, power, and volume. This understanding will also allow development of tools to assess the state of and enhance the resilience of individual crewmembers, teams, and the integrated mission system. We will discuss a set of risk-reduction questions that has been identified to guide the systems approach necessary to meet these needs. In addition, a framework of factors influencing human health and performance in space, called the Contributing Factor Map (CFM), is being applied as the backbone for incorporating information addressing these questions from sources throughout HRP. Using the common language of the CFM, information from sources such as the Human System Risk Board summaries, Integrated Research Plan, and HRP-funded publications has been combined and visualized in ways that allow insight into cross-disciplinary interconnections in a systematic, standardized fashion. We will show examples of these visualizations. We will also discuss applications of the resulting analysis capability that can inform science portfolio decisions, such as areas in which cross-disciplinary solicitations or countermeasure development will potentially be fruitful.

No Prophylactic Antibiotic Use for Young Children's Intussusception with Low-risk Infection after Successful Air Enema Reduction.

PubMed

Zhang, Yuan; Zou, Wen; Ren, Lemeng; Zhang, Yinghui; Sun, Zhaohui; Liu, Huandi; Liu, Qian; Si, Chunfeng; Jia, Hongying

2018-04-17

The Chinese government has issued the policy of promulgating the clinical use of antibacterial drugs since 2011. Prophylactic antibiotic use is a challenging problem among young children with intussusception after successful air enema reduction. There were limited data regarding the clinical value of prophylactic antibiotics for intussusception with low-risk infections. A retrospective non-randomized comparative study was conducted among 188 young children with intussusception after successful air enema reduction between January 1, 2011 and December 30, 2013. Among these children, 51 received prophylactic antibiotics and 137 did not receive antibiotics. Our results showed that there were no significant differences in age, gender, weight, admission period, reduction interval, axillary temperature, leukocytes, neutrophils, lymphocytes, monocytes, mesenteric lymph nodes and complications between groups (P > 0.05). The national policy had significantly improved clinical use of antibiotic for young children with low-risk intussusception (OR < 0.001, P < 0.001). Inpatients days were longer for children used antibiotics than those who did not (median, 27.0 hours vs 21.0 hours, P = 0.003). Prophylactic antibiotics appeared to be of little value after the successful air enema reduction of intussusception in young children with low-risk infection. Policy intervention is effective for antibiotic use in China.

Can older "at risk" adults benefit from psychoeducation targeting healthy brain aging?

PubMed

Norrie, Louisa M; Diamond, Keri; Hickie, Ian B; Rogers, Naomi L; Fearns, Samantha; Naismith, Sharon L

2011-04-01

Multifactorial strategies that prevent or delay the onset or progress of cognitive decline and dementia are needed, and should include education regarding recognized risk factors. The current study sought to investigate whether older adults "at risk" of cognitive decline benefit from psychoeducation targeting healthy brain aging. 65 participants (mean age 64.8 years, SD 9.6) with a lifetime history of major depression; vascular risk as evidenced by at least one vascular risk factor; and/or subjective or objective memory impairment were allocated to weekly psychoeducation sessions or a waitlist control group. The small group sessions were conducted over ten weeks by a team of medical and allied health professionals with expertise in late-life depression and cognition. Sessions focused on modifiable risk factors for cognitive decline including vascular risk, diet, exercise, depression, anxiety and sleep disturbance, as well as providing practical strategies for memory and cognition. Both the psychoeducation and waitlist group completed a 20-item knowledge test at baseline and follow-up. Participants in the psychoeducation group were asked to complete follow-up self-report satisfaction questionnaires. Repeated measures ANOVA showed a significant interaction effect depicting improvements in knowledge associated with psychoeducation, corresponding to an improvement of 15% from baseline. Satisfaction data additionally showed that 92.3% of participants rated the program as "good" to "excellent", and over 90% suggested they would recommend it to others. A group-based psychoeducation program targeting healthy brain aging is effective in improving knowledge. Additionally, it is acceptable and rated highly by participants.

The evolution of systolic blood pressure as a strong predictor of cardiovascular risk and the effectiveness of fixed-dose ARB/CCB combinations in lowering levels of this preferential target

PubMed Central

Mourad, Jean-Jacques

2008-01-01

Elevated blood pressure is an important cardiovascular risk factor. Although targets for both diastolic blood pressure (DBP) and systolic blood pressure (SBP) are defined by current guidelines, DBP has historically taken precedence in hypertension management. However, there is strong evidence that SBP is superior to DBP as a predictor of cardiovascular events. Moreover, achieving control of SBP is assuming greater importance amongst an aging population. In spite of the growing recognition of the importance of SBP in reducing cardiovascular risk and the emphasis by current guidelines on SBP control, a substantial proportion of patients still fail to achieve SBP targets, and SBP control is achieved much less frequently than DBP control. Thus, new approaches to the management of hypertension are required in order to control SBP and minimize cardiovascular risk. Fixed-dose combination (FDC) therapy is an approach that offers the advantages of multiple drug administration and a reduction in regimen complexity that favors compliance. We have reviewed the latest evidence demonstrating the efficacy in targeting SBP of the most recent FDC products; combinations of the calcium channel blocker (CCB), amlodipine, with angiotensin receptor blockers (ARBs), valsartan or olmesartan. In addition, results from studies with new classes of agent are outlined. PMID:19337545

When and why women might suspend PrEP use according to perceived seasons of risk: implications for PrEP-specific risk-reduction counselling

PubMed Central

Namey, Emily; Agot, Kawango; Ahmed, Khatija; Odhiambo, Jacob; Skhosana, Joseph; Guest, Greg; Corneli, Amy

2016-01-01

Oral pre-exposure prophylaxis (PrEP) using the antiretroviral drug emtricitabine/tenofovir disoproxil fumarate (Truvada) has been shown to dramatically reduce the risk of HIV acquisition for women at higher risk of infection if taken daily. Understanding when and why women would intentionally stop using an efficacious oral PrEP drug within the context of their “normal” daily lives is essential for delivering effective PrEP risk-reduction counselling. We conducted 60 qualitative interviews with women at higher risk of HIV in Bondo, Kenya, and Pretoria, South Africa, as part of a larger study. Participants charted their sexual contacts over the previous six months, indicated whether they would have taken PrEP if available, and discussed whether and why they would have suspended PrEP use. Nearly all participants said they would have used PrEP in the previous six months; half indicated they would have suspended PrEP use at some point. Participants’ reasons for an extended break from PrEP were related to partnership dynamics (e.g., perceived low risk of a stable partner) and phases of life (e.g., trying to conceive). Life events (e.g., holidays and travel) could prompt shorter breaks in PrEP use. These circumstances may or may not correspond to actual contexts of lower risk, highlighting the importance of tailored PrEP risk-reduction counselling. PMID:27093238

Novel target for high-risk neuroblastoma identified in pre-clinical research | Center for Cancer Research

Cancer.gov

Pre-clinical research by investigators at the Center for Cancer Research and their colleagues have identified a number of novel epigenetic targets for high-risk neuroblastoma and validated a promising new targeted inhibitor in pre-clinical models.  Read more...

Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management

PubMed Central

Fu, Mei R

2014-01-01

The global burden of breast cancer continues to increase largely because of the aging and growth of the world population. More than 1.38 million women worldwide were estimated to be diagnosed with breast cancer in 2008, accounting for 23% of all diagnosed cancers in women. Given that the 5-year survival rate for breast cancer is now 90%, experiencing breast cancer is ultimately about quality of life. Women treated for breast cancer are facing a life-time risk of developing lymphedema, a chronic condition that occurs in up to 40% of this population and negatively affects breast cancer survivors’ quality of life. This review offers an insightful understanding of the condition by providing clinically relevant and evidence based knowledge regarding lymphedema symptoms, diagnosis, risk reduction, and management with the intent to inform health care professionals so that they might be better equipped to care for patients. PMID:25114841

Risk-based targeting: A new approach in environmental protection

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fox, C.A.

1995-12-31

Risk-based targeting has recently emerged as an effective tool to help prioritize efforts to identify and manage geographic areas, chemicals, facilities, and agricultural activities that cause the most environmental degradation. This paper focuses on how the Environmental Protection Agency (EPA) has recently used risk-based targeting to identify and screen Federal, industrial, commercial and municipal facilities which contribute to probable human health (fish consumption advisories and contaminated fish tissue) and aquatic life (contaminated sediments) impacts. Preliminary results identified several hundred potential contributors of problem chemicals to probable impacts within the same river reach in 1991--93. Analysis by industry sector showed thatmore » the majority of the facilities identified were publicly owned treatment works (POTWs), in addition to industry organic and inorganic chemical manufacturers, petroleum refineries, and electric services, coatings, engravings, and allied services, among others. Both compliant and non-compliant potentially contributing facilities were identified to some extent in all EPA regions. Additional results identifying possible linkages of other pollutant sources to probable impacts, as well as estimation of potential exposure of these contaminants to minority and/or poverty populations are also presented. Out of these analyses, a number of short and long-term strategies are being developed that EPA may use to reduce loadings of problem contaminants to impacted waterbodies.« less

Weight management for type 2 diabetes mellitus: global cardiovascular risk reduction.

PubMed

Lee, Michelle; Aronne, Louis J

2007-02-19

Most patients with type 2 diabetes mellitus are overweight or obese, and the relation between obesity, especially of the visceral compartment, and the risk for developing diabetes is well recognized. Excessive adipose tissue is associated with insulin resistance as well as the increased expression of proinflammatory cytokines and prothrombotic factors, all of which contribute to elevating the risk for coronary artery disease (CAD). In particular, abdominal obesity, or excess visceral adiposity, has been linked to a cluster of risk factors (high blood pressure, hypertriglyceridemia, low levels of high-density lipoprotein cholesterol, and impaired fasting glucose) that constitute the metabolic syndrome, the presence of which confers an increased risk for type 2 diabetes and cardiovascular disease. In fact, a large waist circumference, a surrogate measure of abdominal adiposity, is 1 of the main criteria for diagnosing the metabolic syndrome. Lifestyle modification is the first-line approach to the management of obesity and the metabolic syndrome. However, if patients are unable to achieve a weight loss of 5%-10% of initial body weight and improve cardiometabolic risk factors with lifestyle modification alone, physicians should consider using adjunctive long-term pharmacotherapy. A variety of approved and investigational pharmacologic agents, including sibutramine, orlistat, metformin, and rimonabant, have been shown to reduce weight and ameliorate metabolic syndrome components, thereby reducing cardiovascular risk. Such global risk reduction is crucial for patients with diabetes, in whom CAD is a major cause of mortality.

Reducing catheter-related thrombosis using a risk reduction tool centered on catheter to vessel ratio.

PubMed

Spencer, Timothy R; Mahoney, Keegan J

2017-11-01

In vascular access practices, the internal vessel size is considered important, and a catheter to vessel ratio (CVR) is recommended to assist clinicians in selecting the most appropriate-sized device for the vessel. In 2016, new practice recommendations stated that the CVR can increase from 33 to 45% of the vessels diameter. There has been evidence on larger diameter catheters and increased thrombosis risk in recent literature, while insufficient information established on what relationship to vessel size is appropriate for any intra-vascular device. Earlier references to clinical standards and guidelines did not clearly address vessel size in relation to the area consumed or external catheter diameter. The aim of this manuscript is to present catheter-related thrombosis evidence and develop a standardized process of ultrasound-guided vessel assessment, integrating CVR, Virchow's triad phenomenon and vessel health and preservation strategies, empowering an evidence-based approach to device placement. Through review, calculation and assessment on the areas of the 33 and 45% rule, a preliminary clinical tool was developed to assist clinicians make cognizant decisions when placing intravascular devices relating to target vessel size, focusing on potential reduction in catheter-related thrombosis. Increasing the understanding and utilization of CVRs will lead to a safer, more consistent approach to device placement, with potential thrombosis reduction strategies. The future of evidence-based data relies on the clinician to capture accurate vessel measurements and device-related outcomes. This will lead to a more dependable data pool, driving the relationship of catheter-related thrombosis and vascular assessment.

Missing the target: including perspectives of women with overweight and obesity to inform stigma‐reduction strategies

PubMed Central

Himmelstein, M. S.; Gorin, A. A.; Suh, Y. J.

2017-01-01

Summary Objective Pervasive weight stigma and discrimination have led to ongoing calls for efforts to reduce this bias. Despite increasing research on stigma‐reduction strategies, perspectives of individuals who have experienced weight stigma have rarely been included to inform this research. The present study conducted a systematic examination of women with high body weight to assess their perspectives about a broad range of strategies to reduce weight‐based stigma. Methods Women with overweight or obesity (N = 461) completed an online survey in which they evaluated the importance, feasibility and potential impact of 35 stigma‐reduction strategies in diverse settings. Participants (91.5% who reported experiencing weight stigma) also completed self‐report measures assessing experienced and internalized weight stigma. Results Most participants assigned high importance to all stigma‐reduction strategies, with school‐based and healthcare approaches accruing the highest ratings. Adding weight stigma to existing anti‐harassment workplace training was rated as the most impactful and feasible strategy. The family environment was viewed as an important intervention target, regardless of participants' experienced or internalized stigma. Conclusion These findings underscore the importance of including people with stigmatized identities in stigma‐reduction research; their insights provide a necessary and valuable contribution that can inform ways to reduce weight‐based inequities and prioritize such efforts. PMID:28392929

The Cardiovascular Intervention Improvement Telemedicine Study (CITIES): Rationale for a Tailored Behavioral and Educational Pharmacist-Administered Intervention for Achieving Cardiovascular Disease Risk Reduction

PubMed Central

Zullig, Leah L.; Melnyk, S. Dee; Stechuchak, Karen M.; McCant, Felicia; Danus, Susanne; Oddone, Eugene; Bastian, Lori; Olsen, Maren; Edelman, David; Rakley, Susan; Morey, Miriam

2014-01-01

Abstract Background: Hypertension, hyperlipidemia, and diabetes are significant, but often preventable, contributors to cardiovascular disease (CVD) risk. Medication and behavioral nonadherence are significant barriers to successful hypertension, hyperlidemia, and diabetes management. Our objective was to describe the theoretical framework underlying a tailored behavioral and educational pharmacist-administered intervention for achieving CVD risk reduction. Materials and Methods: Adults with poorly controlled hypertension and/or hyperlipidemia were enrolled from three outpatient primary care clinics associated with the Durham Veterans Affairs Medical Center (Durham, NC). Participants were randomly assigned to receive a pharmacist-administered, tailored, 1-year telephone-based intervention or usual care. The goal of the study was to reduce the risk for CVD through a theory-driven intervention to increase medication adherence and improve health behaviors. Results: Enrollment began in November 2011 and is ongoing. The target sample size is 500 patients. Conclusions: The Cardiovascular Intervention Improvement Telemedicine Study (CITIES) intervention has been designed with a strong theoretical underpinning. The theoretical foundation and intervention are designed to encourage patients with multiple comorbidities and poorly controlled CVD risk factors to engage in home-based monitoring and tailored telephone-based interventions. Evidence suggests that clinical pharmacist-administered telephone-based interventions may be efficiently integrated into primary care for patients with poorly controlled CVD risk factors. PMID:24303930

Justice policy reform for high-risk juveniles: using science to achieve large-scale crime reduction.

PubMed

Skeem, Jennifer L; Scott, Elizabeth; Mulvey, Edward P

2014-01-01

After a distinctly punitive era, a period of remarkable reform in juvenile crime regulation has begun. Practical urgency has fueled interest in both crime reduction and research on the prediction and malleability of criminal behavior. In this rapidly changing context, high-risk juveniles--the small proportion of the population where crime becomes concentrated--present a conundrum. Research indicates that these are precisely the individuals to treat intensively to maximize crime reduction, but there are both real and imagined barriers to doing so. Mitigation principles (during early adolescence, ages 10-13) and institutional placement or criminal court processing (during mid-late adolescence, ages 14-18) can prevent these juveniles from receiving interventions that would best protect public safety. In this review, we synthesize relevant research to help resolve this challenge in a manner that is consistent with the law's core principles. In our view, early adolescence offers unique opportunities for risk reduction that could (with modifications) be realized in the juvenile justice system in cooperation with other social institutions.

A pilot quality assurance scheme for diabetic retinopathy risk reduction programmes.

PubMed

Garvican, L; Scanlon, P H

2004-10-01

We describe a pilot study of measurement of quality assurance targets for diabetic retinopathy screening and performance comparison between 10 existing services, in preparation for the roll-out of the national programme. In 1999 the UK National Screening Committee approved proposals for a national diabetic retinopathy risk reduction programme, including recommendations for quality assurance, but implementation was held pending publication of the National Service Framework for Diabetes. Existing services requested the authors to perform a pilot study of a QA scheme, indicating willingness to contribute data for comparison. Objectives and quality standards were developed, following consultation with diabetologists, ophthalmologists and retinal screeners. Services submitted 2001/2 performance data, in response to a questionnaire, for anonymization, central analysis and comparison. The 17 quality standards encompass all aspects of the programme from identification of patients to timeliness of treatment. Ten programmes took part, submitting all the data available. All returns were incomplete, but especially so from the optometry-based schemes. Eight or more services demonstrated they could reach the minimum level in only five of the 17 standards. Thirty per cent could not provide coverage data. All were running behind. Reasons for difficulties in obtaining data and/or failing to achieve standards included severe under-funding and little previous experience of QA. Information systems were limited and incompatible between diabetes and eye units, and there was a lack of co-ordinated management of the whole programme. Quality assurance is time-consuming, expensive and inadequately resourced. The pilot study identified priorities for local action. National programme implementation must involve integral quality assurance mechanisms from the outset.

Gait Speed among Older Participants Enrolled in an Evidence-Based Fall Risk Reduction Program: A Subgroup Analysis.

PubMed

Cho, Jinmyoung; Smith, Matthew Lee; Shubert, Tiffany E; Jiang, Luohua; Ahn, SangNam; Ory, Marcia G

2015-01-01

Functional decline is a primary risk factor for institutionalization and mortality among older adults. Although community-based fall risk reduction programs have been widely disseminated, little is known about their impact on gait speed, a key indicator of functional performance. Changes in functional performance between baseline and post-intervention were examined by means of timed up and go (TUG), a standardized functional assessment test administered to participants enrolled in A Matter of Balance/Volunteer Lay Leader (AMOB/VLL) model, an evidence-based fall risk reduction program. This study included 71 participants enrolled in an AMOB/VLL program in the Brazos Valley and South Plain regions of Texas. Paired t-tests were employed to assess program effects on gait speed at baseline and post-intervention for all participants and by subgroups of age, sex, living status, delivery sites, and self-rated health. The Bonferroni correction was applied to adjust inflated Type I error rate associated with performing multiple t-tests, for which p-values <0.0042 (i.e., 0.5/12 comparisons) were deemed statistically significant. Overall, gait speed of enrolled participants improved from baseline to post-intervention (t = 3.22, p = 0.002). Significant changes in TUG scores were observed among participants who lived with others (t = 4.45, p < 0.001), rated their health as excellent, very good, or good (t = 3.05, p = 0.003), and attended program workshops at senior centers (t = 3.52, p = 0.003). Findings suggest community-based fall risk reduction programs can improve gait speed for older adults. More translational research is needed to understand factors related to the effectiveness of fall risk reduction programs in various populations and settings.

Multidisciplinary group behavioral and pharmacologic intervention for cardiac risk reduction in diabetes: a pilot study.

PubMed

Martin, Oanh J; Wu, Wen-Chih; Taveira, Tracey H; Eaton, Charles B; Sharma, Satish C

2007-01-01

The purpose of this study was to evaluate the effectiveness of a multidisciplinary team providing both education and medication management in a group setting for cardiac risk reduction in patients with diabetes mellitus. The electronic medical records of patients with diabetes who participated in group behavioral and pharmacologic interventions for cardiac risk reduction during May to October 2002 at the Providence VA Medical Center were reviewed. Forty-one veterans with diabetes mellitus attended the weekly sessions of a diabetes education and intervention program directed by pharmacists for 1 month. Two groups of 15 to 20 patients received four 1.5-hour diabetes self-management education classes provided by a multidisciplinary team consisting of a pharmacist (leader), nurse educator, dietician, physical therapist, and social worker and four 1-hour group medication adjustment sessions provided by the pharmacist. Pharmacists followed medication adjustment algorithms for blood pressure, diabetes, and cholesterol management previously developed in collaboration with physician specialists in the field. Baseline and 3-month after-intervention data were collected for glycosylated hemoglobin A1C (A1C), systolic and diastolic blood pressure (SBP and DBP, respectively), low-density lipoprotein cholesterol, and body mass index. Thirty-six patients attended 4 sessions, and 5 patients attended 3 sessions. All parameters improved after the intervention, with significant reductions in A1C (-1.5% +/- 1.0%) and DBP (-5 mm Hg). Reductions were further accentuated when baseline values were abnormal, with significant improvement in A1C (-2.0% +/- 0.5%), SBP (-14 +/- 3 mm Hg), and DBP (-13 +/- 3 mm Hg). Short-term multidisciplinary group behavioral and pharmacologic intervention programs may be effective in improving cardiac risk factors in patients with diabetes.

On the Efficacy and Mediation of a One-on-One HIV Risk-Reduction Intervention for African American Men Who Have Sex with Men: A Randomized Controlled Trial.

PubMed

Jemmott, John B; Jemmott, Loretta Sweet; O'Leary, Ann; Icard, Larry D; Rutledge, Scott E; Stevens, Robin; Hsu, Janet; Stephens, Alisa J

2015-07-01

We examined the efficacy and mediation of Being Responsible for Ourselves (BRO), an HIV/STI risk-reduction intervention for African American men who have sex with men (MSM), the population with the highest HIV-diagnosis rate in the US. We randomized African American MSM to one of two interventions: BRO HIV/STI risk-reduction, targeting condom use; or attention-matched control, targeting physical activity and healthy diet. The interventions were based on social cognitive theory, the reasoned-action approach, and qualitative research. Men reporting anal intercourse with other men in the past 90 days were eligible and completed pre-intervention, immediately post-intervention, and 6 and 12 months post-intervention surveys. Of 595 participants, 503 (85 %) completed the 12-month follow-up. Generalized-estimating-equations analysis indicated that, compared with the attention-matched control intervention, the BRO intervention did not increase consistent condom use averaged over the 6- and 12-month follow-ups, which was the primary outcome. Although BRO did not affect the proportion of condom-protected intercourse acts, unprotected sexual intercourse, multiple partners, or insertive anal intercourse, it did reduce receptive anal intercourse compared with the control, a behavior linked to incident HIV infection. Mediation analysis using the product-of-coefficients approach revealed that although BRO increased seven of nine theoretical constructs it was designed to affect, it increased only one of three theoretical constructs that predicted consistent condom use: condom-use impulse-control self-efficacy. Thus, BRO indirectly increased consistent condom use through condom-use impulse-control self-efficacy. In conclusion, although BRO increased several theoretical constructs, most of those constructs did not predict consistent condom use; hence, the intervention did not increase it. Theoretical constructs that interventions should target to increase African American MSM

Risk reduction in pediatric procedural sedation by application of an American Academy of Pediatrics/American Society of Anesthesiologists process model.

PubMed

Hoffman, George M; Nowakowski, Rhonda; Troshynski, Todd J; Berens, Richard J; Weisman, Steven J

2002-02-01

Guidelines for risk reduction during procedural sedation from the American Academy of Pediatrics (AAP) and the American Society of Anesthesiologists (ASA) rely on expert opinion and consensus. In this article, we tested the hypothesis that application of an AAP/ASA-structured model would reduce the risk of sedation-related adverse events. Prospectively coded sedation records were abstracted by a hospital quality improvement specialist with practical and administrative experience in pediatric sedation. Process variables included notation of nulla per os (NPO) status, performance of a guided risk assessment, assignment of ASA physical status score, obtaining informed consent, generation of a sedation plan, and assessment of sedation level using a quantitative scoring system. Content variables included adherence to AAP NPO guidelines, ASA class, target sedation level, actual sedation level, age, procedure, and drugs used. Complication risk was assessed by logistic regression and Mantel-Haenszel odds ratios (OR). Complications were identified in 40 of 960 records (4.2%). The complication rate was 34 of 895 (3.8%) with planned conscious sedation and 6 of 65 (9.2%) with planned deep sedation ([DS]; OR: 2.6). Complications were reduced by performance of structured risk assessment (OR: 0.10), adherence to all process guidelines (OR: 0), and avoiding actual DS (OR: 0.4). The only drug associated with higher risk was chloral hydrate (OR: 2.1). Failure to adhere to NPO guidelines did not increase risk in this assessment; however, the adverse event rate was 0 if all process guidelines were followed. Presedation assessment reduces complications of DS. Repeated assessment of sedation score reduces the risk of inadvertent DS. The data provide direct evidence that AAP/ASA guidelines can reduce the risk of pediatric procedural sedation.

Development of a Barbershop-Based HIV/STI Risk Reduction Intervention for Young Heterosexual African American Men.

PubMed

Jemmott, Loretta Sweet; Jemmott, John B; Lanier, Yzette; Thompson, Ciarra; Baker, Jillian Lucas

2016-08-12

Young, heterosexual African American men ages 18 to 24 years continue to be at high risk for HIV and other sexually transmitted infections. However, few interventions have been designed to meet the needs of this "forgotten" population. The article describes the systematic development of a theory-based, culturally-tailored, gender-specific, barbershop-based HIV risk reduction intervention for heterosexual African American men ages 18 to 24. The process included developing a community advisory board, selecting a guiding theoretical framework, incorporating community-based participatory research principles, and conducting formative research with African American males, barbers, and barbershop owners. The result was Shape Up: Barbers Building Better Brothers, a 2-day, HIV risk reduction intervention focused on increasing HIV knowledge and condom use and reducing the number of sexual partners. Intervention sessions were facilitated by barbers who used iPads to deliver the content. As a high-risk population, this intervention has great public health significance for the health of African American men and their sexual partners. © 2016 Society for Public Health Education.

Intensive Treat-to-Target Statin Therapy in High-Risk Japanese Patients With Hypercholesterolemia and Diabetic Retinopathy: Report of a Randomized Study.

PubMed

Itoh, Hiroshi; Komuro, Issei; Takeuchi, Masahiro; Akasaka, Takashi; Daida, Hiroyuki; Egashira, Yoshiki; Fujita, Hideo; Higaki, Jitsuo; Hirata, Ken-Ichi; Ishibashi, Shun; Isshiki, Takaaki; Ito, Sadayoshi; Kashiwagi, Atsunori; Kato, Satoshi; Kitagawa, Kazuo; Kitakaze, Masafumi; Kitazono, Takanari; Kurabayashi, Masahiko; Miyauchi, Katsumi; Murakami, Tomoaki; Murohara, Toyoaki; Node, Koichi; Ogawa, Susumu; Saito, Yoshihiko; Seino, Yoshihiko; Shigeeda, Takashi; Shindo, Shunya; Sugawara, Masahiro; Sugiyama, Seigo; Terauchi, Yasuo; Tsutsui, Hiroyuki; Ueshima, Kenji; Utsunomiya, Kazunori; Yamagishi, Masakazu; Yamazaki, Tsutomu; Yo, Shoei; Yokote, Koutaro; Yoshida, Kiyoshi; Yoshimura, Michihiro; Yoshimura, Nagahisa; Nakao, Kazuwa; Nagai, Ryozo

2018-06-01

Diabetes is associated with high risk of cardiovascular (CV) events, particularly in patients with dyslipidemia and diabetic complications. We investigated the incidence of CV events with intensive or standard lipid-lowering therapy in patients with hypercholesterolemia, diabetic retinopathy, and no history of coronary artery disease (treat-to-target approach). In this multicenter, prospective, randomized, open-label, blinded end point study, eligible patients were randomly assigned (1:1) to intensive statin therapy targeting LDL cholesterol (LDL-C) <70 mg/dL ( n = 2,518) or standard statin therapy targeting LDL-C 100-120 mg/dL ( n = 2,524). Mean follow-up was 37 ± 13 months. LDL-C at 36 months was 76.5 ± 21.6 mg/dL in the intensive group and 104.1 ± 22.1 mg/dL in the standard group ( P < 0.001). The primary end point events occurred in 129 intensive group patients and 153 standard group patients (hazard ratio [HR] 0.84 [95% CI 0.67-1.07]; P = 0.15). The relationship between the LDL-C difference in the two groups and the event reduction rate was consistent with primary prevention studies in patients with diabetes. Exploratory findings showed significantly fewer cerebral events in the intensive group (HR 0.52 [95% CI 0.31-0.88]; P = 0.01). Safety did not differ significantly between the two groups. We found no significant decrease in CV events or CV-associated deaths with intensive therapy, possibly because our between-group difference of LDL-C was lower than expected (27.7 mg/dL at 36 months of treatment). The potential benefit of achieving LDL-C <70 mg/dL in a treat-to-target strategy in high-risk patients deserves further investigation. © 2018 by the American Diabetes Association.

HIV, syphilis, and behavioral risk factors among female sex workers before and after implementation of harm reduction programs in a high drug-using area of China.

PubMed

Zhang, Li; Liang, Shu; Lu, Weixia; Pan, Stephen W; Song, Benli; Liu, Qianping; Xu, Yunan; Dong, Hui; Xing, Hui; Shao, Yiming; Ruan, Yuhua

2014-01-01

To evaluate the impact of harm reduction programs on HIV and syphilis infection and related risk behaviors among female sex workers (FSWs) in a drug trafficking city in Southwest China. Before and after harm reduction program study. Two cross-sectional surveys were conducted among FSWs before and after harm reduction programs were launched in Xichang city, Sichuan province. The first and second cross-sectional surveys were conducted in 2004 and 2010, respectively. Temporal changes in odds of HIV, syphilis, and behavioral risk factors were assessed by multivariable logistic regression while controlling for socio-demographics. The 2004 and 2010 cross-sectional surveys recruited 343 and 404 FSWs, respectively. From 2004 to 2010, the odds of syphilis infection decreased by 35% and was of borderline statistical significance (AOR: 0.65, 95% CI: 0.41-1.03), while odds of HIV infection rose, but not significantly (AOR: 4.12, 95% CI: 0.76-22.45). Although odds of unprotected sex with primary sex partners did not significantly change over time (AOR: 0.96; 95% CI: 0.61-1.50), odds of unprotected sex with clients declined significantly and remarkably (AOR: 0.14, 95% CI: 0.09-0.21). Notably, the odds of reporting ≥10 new sex partners in the previous month increased by 37% (AOR: 1.37; 95% CI: 0.98-1.90). Harm reduction strategies may be an effective means of reducing unprotected sex with clients among FSWs. Future research is needed to better target both FSWs and IDUs and interrupt bridging networks for HIV transmission in high drug-using areas of China.

The cost-effectiveness of harm reduction.

PubMed

Wilson, David P; Donald, Braedon; Shattock, Andrew J; Wilson, David; Fraser-Hurt, Nicole

2015-02-01

HIV prevalence worldwide among people who inject drugs (PWID) is around 19%. Harm reduction for PWID includes needle-syringe programs (NSPs) and opioid substitution therapy (OST) but often coupled with antiretroviral therapy (ART) for people living with HIV. Numerous studies have examined the effectiveness of each harm reduction strategy. This commentary discusses the evidence of effectiveness of the packages of harm reduction services and their cost-effectiveness with respect to HIV-related outcomes as well as estimate resources required to meet global and regional coverage targets. NSPs have been shown to be safe and very effective in reducing HIV transmission in diverse settings; there are many historical and very recent examples in diverse settings where the absence of, or reduction in, NSPs have resulted in exploding HIV epidemics compared to controlled epidemics with NSP implementation. NSPs are relatively inexpensive to implement and highly cost-effective according to commonly used willingness-to-pay thresholds. There is strong evidence that substitution therapy is effective, reducing the risk of HIV acquisition by 54% on average among PWID. OST is relatively expensive to implement when only HIV outcomes are considered; other societal benefits substantially improve the cost-effectiveness ratios to be highly favourable. Many studies have shown that ART is cost-effective for keeping people alive but there is only weak supportive, but growing evidence, of the additional effectiveness and cost-effectiveness of ART as prevention among PWID. Packages of combined harm reduction approaches are highly likely to be more effective and cost-effective than partial approaches. The coverage of harm reduction programs remains extremely low across the world. The total annual costs of scaling up each of the harm reduction strategies from current coverage levels, by region, to meet WHO guideline coverage targets are high with ART greatest, followed by OST and then NSPs. But

Evaluation of HDL-modulating interventions for cardiovascular risk reduction using a systems pharmacology approach.

PubMed

Gadkar, Kapil; Lu, James; Sahasranaman, Srikumar; Davis, John; Mazer, Norman A; Ramanujan, Saroja

2016-01-01

The recent failures of cholesteryl ester transport protein inhibitor drugs to decrease CVD risk, despite raising HDL cholesterol (HDL-C) levels, suggest that pharmacologic increases in HDL-C may not always reflect elevations in reverse cholesterol transport (RCT), the process by which HDL is believed to exert its beneficial effects. HDL-modulating therapies can affect HDL properties beyond total HDL-C, including particle numbers, size, and composition, and may contribute differently to RCT and CVD risk. The lack of validated easily measurable pharmacodynamic markers to link drug effects to RCT, and ultimately to CVD risk, complicates target and compound selection and evaluation. In this work, we use a systems pharmacology model to contextualize the roles of different HDL targets in cholesterol metabolism and provide quantitative links between HDL-related measurements and the associated changes in RCT rate to support target and compound evaluation in drug development. By quantifying the amount of cholesterol removed from the periphery over the short-term, our simulations show the potential for infused HDL to treat acute CVD. For the primary prevention of CVD, our analysis suggests that the induction of ApoA-I synthesis may be a more viable approach, due to the long-term increase in RCT rate. Copyright © 2016 by the American Society for Biochemistry and Molecular Biology, Inc.

Addressing excess risk of overdose among recently incarcerated people in the USA: harm reduction interventions in correctional settings.

PubMed

Brinkley-Rubinstein, Lauren; Cloud, David H; Davis, Chelsea; Zaller, Nickolas; Delany-Brumsey, Ayesha; Pope, Leah; Martino, Sarah; Bouvier, Benjamin; Rich, Josiah

2017-03-13

Purpose The purpose of this paper is to discuss overdose among those with criminal justice experience and recommend harm reduction strategies to lessen overdose risk among this vulnerable population. Design/methodology/approach Strategies are needed to reduce overdose deaths among those with recent incarceration. Jails and prisons are at the epicenter of the opioid epidemic but are a largely untapped setting for implementing overdose education, risk assessment, medication assisted treatment, and naloxone distribution programs. Federal, state, and local plans commonly lack corrections as an ingredient in combating overdose. Harm reduction strategies are vital for reducing the risk of overdose in the post-release community. Findings Therefore, the authors recommend that the following be implemented in correctional settings: expansion of overdose education and naloxone programs; establishment of comprehensive medication assisted treatment programs as standard of care; development of corrections-specific overdose risk assessment tools; and increased collaboration between corrections entities and community-based organizations. Originality/value In this policy brief the authors provide recommendations for implementing harm reduction approaches in criminal justice settings. Adoption of these strategies could reduce the number of overdoses among those with recent criminal justice involvement.

Risk-Based Contaminated Land Investigation and Assessment

NASA Astrophysics Data System (ADS)

Davis, Donald R.

With increasing frequency, problems of environmental contamination are being analyzed from a risk perspective. Risk-Based Contaminated Land Investigation and Assessment is written for those who wish to present the results of their examination of contaminated land in terms of risk.The opening chapters introduce the concepts of risk analysis for contaminated land. Risk management and the risk assessment process are based on a source-pathway-target framework. Readers are warned against an “over-reliance on the identification of contaminants rather than the potential pathways by which targets may be exposed to these hazards.” In the risk management framework presented in this book, risk evaluation and resultant decision making are seen as part of both the risk assessment and risk reduction process. The sharp separation of risk assessment from risk management as seen in the National Academy of Sciences' (NAS) risk assessment paradigm is not advocatedsemi; perhaps this is because the NAS' concern was regulatory decision while the book's concern is the assessment of a specific site.

A randomized trial of enhanced HIV risk reduction and vaccine trial education interventions among HIV-negative, high-risk women who use non-injection drugs: The UNITY Study

PubMed Central

Koblin, Beryl A.; Bonner, Sebastian; Hoover, Donald R.; Xu, Guozhen; Lucy, Debbie; Fortin, Princess; Putnam, Sara; Latka, Mary H.

2014-01-01

Background Limited data are available on interventions to reduce sexual risk behaviors and increase knowledge of HIV vaccine trial concepts in high risk populations eligible to participate in HIV vaccine efficacy trials. Methods The UNITY Study was a two-arm randomized trial to determine the efficacy of enhanced HIV risk reduction and vaccine trial education interventions to reduce the occurrence of unprotected vaginal sex acts and increase HIV vaccine trial knowledge among 311 HIV-negative non-injection drug using women. The enhanced vaccine education intervention using pictures along with application vignettes and enhanced risk reduction counseling consisting of three one-on-one counseling sessions were compared to standard conditions. Follow-up visits at one week and one, six and twelve months after randomization included HIV testing and assessment of outcomes. Results During follow up, the percent of women reporting sexual risk behaviors declined significantly, but did not differ significantly by study arm. Knowledge of HIV vaccine trial concepts significantly increased but did not significantly differ by study arm. Concepts about HIV vaccine trials not adequately addressed by either condition included those related to testing a vaccine for both efficacy and safety, guarantees about participation in future vaccine trials, assurances of safety, medical care, and assumptions about any protective effect of a test vaccine. Conclusions Further research is needed to boost educational efforts and strengthen risk reduction counseling among high-risk non-injection drug using women. PMID:20190585

The cardiovascular event reduction tool (CERT)--a simplified cardiac risk prediction model developed from the West of Scotland Coronary Prevention Study (WOSCOPS).

PubMed

L'Italien, G; Ford, I; Norrie, J; LaPuerta, P; Ehreth, J; Jackson, J; Shepherd, J

2000-03-15

The clinical decision to treat hypercholesterolemia is premised on an awareness of patient risk, and cardiac risk prediction models offer a practical means of determining such risk. However, these models are based on observational cohorts where estimates of the treatment benefit are largely inferred. The West of Scotland Coronary Prevention Study (WOSCOPS) provides an opportunity to develop a risk-benefit prediction model from the actual observed primary event reduction seen in the trial. Five-year Cox model risk estimates were derived from all WOSCOPS subjects (n = 6,595 men, aged 45 to 64 years old at baseline) using factors previously shown to be predictive of definite fatal coronary heart disease or nonfatal myocardial infarction. Model risk factors included age, diastolic blood pressure, total cholesterol/ high-density lipoprotein ratio (TC/HDL), current smoking, diabetes, family history of fatal coronary heart disease, nitrate use or angina, and treatment (placebo/ 40-mg pravastatin). All risk factors were expressed as categorical variables to facilitate risk assessment. Risk estimates were incorporated into a simple, hand-held slide rule or risk tool. Risk estimates were identified for 5-year age bands (45 to 65 years), 4 categories of TC/HDL ratio (<5.5, 5.5 to <6.5, 6.5 to <7.5, > or = 7.5), 2 levels of diastolic blood pressure (<90, > or = 90 mm Hg), from 0 to 3 additional risk factors (current smoking, diabetes, family history of premature fatal coronary heart disease, nitrate use or angina), and pravastatin treatment. Five-year risk estimates ranged from 2% in very low-risk subjects to 61% in the very high-risk subjects. Risk reduction due to pravastatin treatment averaged 31%. Thus, the Cardiovascular Event Reduction Tool (CERT) is a risk prediction model derived from the WOSCOPS trial. Its use will help physicians identify patients who will benefit from cholesterol reduction.

Prospective study of violence risk reduction by a mental health court.

PubMed

McNiel, Dale E; Sadeh, Naomi; Delucchi, Kevin L; Binder, Renée L

2015-06-01

Although many mental health courts (MHCs) have been established to reduce criminal justice involvement of persons with mental disorders, research has not kept pace with the widespread implementation of these courts. Whereas early MHCs were restricted to persons charged with nonviolent misdemeanors, many MHCs now accept persons with more serious charges for whom ameliorating risk of violence is a greater concern. This study evaluated the relationship between MHC participation and risk of violence by using a prospective design. It was hypothesized that MHC participation would decrease the risk of violence during a one year follow-up compared with a matched comparison group. The sample included 169 jail detainees with a mental disorder who either entered an MHC (N=88) or received treatment as usual (N=81). Seventy-two percent had been charged with felonies. Participants were interviewed at baseline and during a one-year follow up, and their arrest records were reviewed. Propensity-adjusted logistic regression evaluated the relationship between MHC participation and risk of violence, controlling for potential confounders such as history of violence, demographic characteristics, baseline treatment motivation, and time at risk in the community. MHC participation was associated with reduction in risk of violence (odds ratio=.39). During follow-up, 25% of the MHC group perpetrated violence, compared with 42% of the treatment-as-usual group. MHC participation can reduce the risk of violence among justice-involved persons with mental disorders. The findings support the conclusion that the MHC model can be extended beyond persons charged with nonviolent misdemeanors in a way that enhances public safety.

Application of Probabilistic Modeling to Quantify the Reduction Levels of Hepatocellular Carcinoma Risk Attributable to Chronic Aflatoxins Exposure.

PubMed

Wambui, Joseph M; Karuri, Edward G; Ojiambo, Julia A; Njage, Patrick M K

2017-01-01

Epidemiological studies show a definite connection between areas of high aflatoxin content and a high occurrence of human hepatocellular carcinoma (HCC). Hepatitis B virus in individuals further increases the risk of HCC. The two risk factors are prevalent in rural Kenya and continuously predispose the rural populations to HCC. A quantitative cancer risk assessment therefore quantified the levels at which potential pre- and postharvest interventions reduce the HCC risk attributable to consumption of contaminated maize and groundnuts. The assessment applied a probabilistic model to derive probability distributions of HCC cases and percentage reductions levels of the risk from secondary data. Contaminated maize and groundnuts contributed to 1,847 ± 514 and 158 ± 52 HCC cases per annum, respectively. The total contribution of both foods to the risk was additive as it resulted in 2,000 ± 518 cases per annum. Consumption and contamination levels contributed significantly to the risk whereby lower age groups were most affected. Nonetheless, pre- and postharvest interventions might reduce the risk by 23.0-83.4% and 4.8-95.1%, respectively. Therefore, chronic exposure to aflatoxins increases the HCC risk in rural Kenya, but a significant reduction of the risk can be achieved by applying specific pre- and postharvest interventions.

Randomized Clinical Trial of Brief Risk Reduction Counseling for Sexually Transmitted Infection Clinic Patients in Cape Town, South Africa

PubMed Central

Cain, Demetria; Eaton, Lisa; Jooste, Sean; Simbayi, Leickness C.

2011-01-01

Objectives. We examined the effects of a brief counseling intervention designed to reduce HIV risk behaviors and sexually transmitted infections (STIs) among patients receiving STI services in Cape Town, South Africa. Methods. After randomization to either a 60-minute risk reduction counseling session or a 20-minute HIV–STI educational session, patients completed computerized sexual behavior assessments. More than 85% of the participants were retained at the 12-month follow-up. Results. There were 24% fewer incident STIs and significant reductions in unprotected vaginal and anal intercourse among participants who received risk reduction counseling relative to members of the control condition. Moderator analyses showed shorter lived outcomes for heavy alcohol drinkers than for lighter drinkers. The results were not moderated by gender. Conclusions. Brief single-session HIV prevention counseling delivered to STI clinic patients has the potential to reduce HIV infections. Counseling should be enhanced for heavier drinkers, and sustained outcomes will require relapse prevention techniques. Disseminating effective, brief, and feasible behavioral interventions to those at highest risk for HIV infection should remain a public health priority. PMID:21778486

Quantitative assessment of risk reduction from hand washing with antibacterial soaps.

PubMed

Gibson, L L; Rose, J B; Haas, C N; Gerba, C P; Rusin, P A

2002-01-01

The Centers for Disease Control and Prevention have estimated that there are 3,713,000 cases of infectious disease associated with day care facilities each year. The objective of this study was to examine the risk reduction achieved from using different soap formulations after diaper changing using a microbial quantitative risk assessment approach. To achieve this, a probability of infection model and an exposure assessment based on micro-organism transfer were used to evaluate the efficacy of different soap formulations in reducing the probability of disease following hand contact with an enteric pathogen. Based on this model, it was determined that the probability of infection ranged from 24/100 to 91/100 for those changing diapers of babies with symptomatic shigellosis who used a control product (soap without an antibacterial ingredient), 22/100 to 91/100 for those who used an antibacterial soap (chlorohexadine 4%), and 15/100 to 90/100 for those who used a triclosan (1.5%) antibacterial soap. Those with asymptomatic shigellosis who used a non-antibacterial control soap had a risk between 49/100,000 and 53/100, those who used the 4% chlorohexadine-containing soap had a risk between 43/100,000 and 51/100, and for those who used a 1.5% triclosan soap had a risk between 21/100,000 and 43/100. The adequate washing of hands after diapering reduces risk and can be further reduced by a factor of 20% by the use of an antibacterial soap. Quantitative risk assessment is a valuable tool in the evaluation of household sanitizing agents and low risk outcomes.

High-Frequency Jet Ventilation for Complete Target Immobilization and Reduction of Planning Target Volume in Stereotactic High Single-Dose Irradiation of Stage I Non-Small Cell Lung Cancer and Lung Metastases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fritz, Peter, E-mail: p.h.fritz@t-online.d; Kraus, Hans-Joerg; Muehlnickel, Werner

2010-09-01

Purpose: To demonstrate the feasibility of complete target immobilization by means of high-frequency jet ventilation (HFJV); and to show that the saving of planning target volume (PTV) on the stereotactic body radiation therapy (SBRT) under HFJV, compared with SBRT with respiratory motion, can be predicted with reliable accuracy by computed tomography (CT) scans at peak inspiration phase. Methods and Materials: A comparison regarding different methods for defining the PTV was carried out in 22 patients with tumors that clearly moved with respiration. A movement span of the gross tumor volume (GTV) was defined by fusing respiration-correlated CT scans. The PTVmore » enclosed the GTV positions with a safety margin throughout the breathing cycle. To create a PTV from CT scans acquired under HFJV, the same margins were drawn around the immobilized target. In addition, peak inspiration phase CT images (PIP-CTs) were used to approximate a target immobilized by HFJV. Results: The resulting HFJV-PTVs were between 11.6% and 45.4% smaller than the baseline values calculated as respiration-correlated CT-PTVs (median volume reduction, 25.4%). Tentative planning by means of PIP-CT PTVs predicted that in 19 of 22 patients, use of HFJV would lead to a reduction in volume of {>=}20%. Using this threshold yielded a positive predictive value of 0.89, as well as a sensitivity of 0.94 and a specificity of 0.5. Conclusions: In all patients, SBRT under HFJV provided a reliable immobilization of the GTVs and achieved a reduction in PTVs, regardless of patient compliance. Tentative planning facilitated the selection of patients who could better undergo radiation in respiratory standstill, both with greater accuracy and lung protection.« less

NASA's Space Launch System Advanced Booster Engineering Demonstration and/or Risk Reduction Efforts

NASA Technical Reports Server (NTRS)

Crumbly, Christopher M.; Dumbacher, Daniel L.; May, Todd A.

2012-01-01

The National Aeronautics and Space Administration (NASA) formally initiated the Space Launch System (SLS) development in September 2011, with the approval of the program s acquisition plan, which engages the current workforce and infrastructure to deliver an initial 70 metric ton (t) SLS capability in 2017, while using planned block upgrades to evolve to a full 130 t capability after 2021. A key component of the acquisition plan is a three-phased approach for the first stage boosters. The first phase is to complete the development of the Ares and Space Shuttle heritage 5-segment solid rocket boosters (SRBs) for initial exploration missions in 2017 and 2021. The second phase in the booster acquisition plan is the Advanced Booster Risk Reduction and/or Engineering Demonstration NASA Research Announcement (NRA), which was recently awarded after a full and open competition. The NRA was released to industry on February 9, 2012, with a stated intent to reduce risks leading to an affordable advanced booster and to enable competition. The third and final phase will be a full and open competition for Design, Development, Test, and Evaluation (DDT&E) of the advanced boosters. There are no existing boosters that can meet the performance requirements for the 130 t class SLS. The expected thrust class of the advanced boosters is potentially double the current 5-segment solid rocket booster capability. These new boosters will enable the flexible path approach to space exploration beyond Earth orbit (BEO), opening up vast opportunities including near-Earth asteroids, Lagrange Points, and Mars. This evolved capability offers large volume for science missions and payloads, will be modular and flexible, and will be right-sized for mission requirements. NASA developed the Advanced Booster Engineering Demonstration and/or Risk Reduction NRA to seek industry participation in reducing risks leading to an affordable advanced booster that meets the SLS performance requirements

Moderation and Mediation of an Efficacious Sexual Risk-Reduction Intervention for South African Adolescents

PubMed Central

O’Leary, Ann; Jemmott, John B.; Jemmott, Loretta Sweet; Bellamy, Scarlett; Ngwane, Zolani; Icard, Larry

2015-01-01

Background “Let Us Protect Our Future” is a sexual risk-reduction intervention for sixth-grade adolescents in South Africa. Tested in a cluster-randomized controlled trial, the intervention significantly reduced self-reported intercourse and unprotected intercourse during a 12-month follow-up period. Purpose The present analyses were conducted to identify moderators of the intervention’s efficacy as well as which theory-based variables mediated the intervention’s effects. Methods: Intervention efficacy over the 3-, 6-, and 12-month follow-ups was tested using generalized estimating equation (GEE) models. Results Living with their father in the home, parental strictness, and religiosity moderated the efficacy of the intervention in reducing unprotected intercourse. Self-efficacy to avoid risky situations and expected parental disapproval of their having intercourse, derived from Social Cognitive Theory, significantly mediated the intervention’s effect on abstinence. Conclusions This is the first study to demonstrate that Social Cognitive variables mediate the efficacy of a sexual risk-reduction intervention among South African adolescents. PMID:22618963

The Bystander Approach to Sexual Assault Risk Reduction: Effects on Risk Recognition, Perceived Self-Efficacy, and Protective Behavior.

PubMed

Bannon, R Sean; Foubert, John D

2017-02-01

Several characteristics of sexual assault awareness programs for women are associated with meeting the goals of risk reduction. To date, the literature lacks an exploration of how single-sex programs affect women, particularly when they take a bystander intervention focus using women's risk recognition and avoidance as outcome measures. The purpose of this study was to investigate the effectiveness of The Women's Program (Foubert, 2011), a sexual assault awareness program geared toward women. Participants consisted of 103 undergraduate women attending a large, public university in the Midwest United States. Women in the treatment group viewed a presentation of The Women's Program, whereas the control group received no intervention. Consistent with hypotheses, program participants reported a greater ability to recognize risk cues, a greater willingness to engage in self-protective behaviors, and a greater level of perceived self-efficacy in handling threatening dating situations compared to the control group.

National Aerospace Plane Integrated Fuselage/Cryotank Risk Reduction program

NASA Astrophysics Data System (ADS)

Dayton, K. E.

1993-06-01

The principal objectives and results of the National Aerospace Plane (NASP) Integrated Risk Reduction program are briefly reviewed. The program demonstrated the feasibility of manufacturing lightweight advanced composite materials for single-stage-to-orbit hypersonic flight vehicle applications. A series of combined load simulation tests (thermal, mechanical, and cryogenic) demonstrated proof of concept performance for an all unlined composite cryogenic fuel tank with flat end bulkheads and a high-temperature thin-shell advanced composite fuselage. Temperatures of the fuselage were as high as 1300 F, with 100 percent bending and shear loads applied to the tank while filled with 850 gallons of cryogenic fluid hydrogen (-425 F). Leak rates measured on and around the cryotank shell and bulkheads were well below acceptable levels.

Identification of effective screening strategies for cardiovascular disease prevention in a developing country: using cardiovascular risk-estimation and risk-reduction tools for policy recommendations.

PubMed

Selvarajah, Sharmini; Haniff, Jamaiyah; Kaur, Gurpreet; Guat Hiong, Tee; Bujang, Adam; Chee Cheong, Kee; Bots, Michiel L

2013-02-25

Recent increases in cardiovascular risk-factor prevalences have led to new national policy recommendations of universal screening for primary prevention of cardiovascular disease in Malaysia. This study assessed whether the current national policy recommendation of universal screening was optimal, by comparing the effectiveness and impact of various cardiovascular screening strategies. Data from a national population based survey of 24 270 participants aged 30 to 74 was used. Five screening strategies were modelled for the overall population and by gender; universal and targeted screening (four age cut-off points). Screening strategies were assessed based on the ability to detect high cardiovascular risk populations (effectiveness), incremental effectiveness, impact on cardiovascular event prevention and cost of screening. 26.7% (95% confidence limits 25.7, 27.7) were at high cardiovascular risk, men 34.7% (33.6, 35.8) and women 18.9% (17.8, 20). Universal screening identified all those at high-risk and resulted in one high-risk individual detected for every 3.7 people screened, with an estimated cost of USD60. However, universal screening resulted in screening an additional 7169 persons, with an incremental cost of USD115,033 for detection of one additional high-risk individual in comparison to targeted screening of those aged ≥35 years. The cost, incremental cost and impact of detection of high-risk individuals were more for women than men for all screening strategies. The impact of screening women aged ≥45 years was similar to universal screening in men. Targeted gender- and age-specific screening strategies would ensure more optimal utilisation of scarce resources compared to the current policy recommendations of universal screening.

Identification of effective screening strategies for cardiovascular disease prevention in a developing country: using cardiovascular risk-estimation and risk-reduction tools for policy recommendations

PubMed Central

2013-01-01

Background Recent increases in cardiovascular risk-factor prevalences have led to new national policy recommendations of universal screening for primary prevention of cardiovascular disease in Malaysia. This study assessed whether the current national policy recommendation of universal screening was optimal, by comparing the effectiveness and impact of various cardiovascular screening strategies. Methods Data from a national population based survey of 24 270 participants aged 30 to 74 was used. Five screening strategies were modelled for the overall population and by gender; universal and targeted screening (four age cut-off points). Screening strategies were assessed based on the ability to detect high cardiovascular risk populations (effectiveness), incremental effectiveness, impact on cardiovascular event prevention and cost of screening. Results 26.7% (95% confidence limits 25.7, 27.7) were at high cardiovascular risk, men 34.7% (33.6, 35.8) and women 18.9% (17.8, 20). Universal screening identified all those at high-risk and resulted in one high-risk individual detected for every 3.7 people screened, with an estimated cost of USD60. However, universal screening resulted in screening an additional 7169 persons, with an incremental cost of USD115,033 for detection of one additional high-risk individual in comparison to targeted screening of those aged ≥35 years. The cost, incremental cost and impact of detection of high-risk individuals were more for women than men for all screening strategies. The impact of screening women aged ≥45 years was similar to universal screening in men. Conclusions Targeted gender- and age-specific screening strategies would ensure more optimal utilisation of scarce resources compared to the current policy recommendations of universal screening. PMID:23442728

Evaluation of HDL-modulating interventions for cardiovascular risk reduction using a systems pharmacology approach[S

PubMed Central

Gadkar, Kapil; Lu, James; Sahasranaman, Srikumar; Davis, John; Mazer, Norman A.; Ramanujan, Saroja

2016-01-01

The recent failures of cholesteryl ester transport protein inhibitor drugs to decrease CVD risk, despite raising HDL cholesterol (HDL-C) levels, suggest that pharmacologic increases in HDL-C may not always reflect elevations in reverse cholesterol transport (RCT), the process by which HDL is believed to exert its beneficial effects. HDL-modulating therapies can affect HDL properties beyond total HDL-C, including particle numbers, size, and composition, and may contribute differently to RCT and CVD risk. The lack of validated easily measurable pharmacodynamic markers to link drug effects to RCT, and ultimately to CVD risk, complicates target and compound selection and evaluation. In this work, we use a systems pharmacology model to contextualize the roles of different HDL targets in cholesterol metabolism and provide quantitative links between HDL-related measurements and the associated changes in RCT rate to support target and compound evaluation in drug development. By quantifying the amount of cholesterol removed from the periphery over the short-term, our simulations show the potential for infused HDL to treat acute CVD. For the primary prevention of CVD, our analysis suggests that the induction of ApoA-I synthesis may be a more viable approach, due to the long-term increase in RCT rate. PMID:26522778

Evaluation of a Peer-Led Drug Abuse Risk Reduction Project for Runaway/Homeless Youths.

ERIC Educational Resources Information Center

Fors, Stuart W.; Jarvis, Sara

1995-01-01

Evaluates the Drug Prevention in Youth risk reduction program that was implemented in shelters for runaway/homeless youths in the southeastern United States. An evaluation strategy was developed allowing for comparisons between peer-led, adult-led and nonintervention groups. Well-trained and motivated peer/near-peer leaders made particularly…

Risk factors that affect reproductive target achievement in fertile dairy cows.

PubMed

Aungier, S P M; Roche, J F; Diskin, M G; Crowe, M A

2014-01-01

The aims of the present study were to investigate (1) the risk factors that influence the achievement of reproductive targets postpartum (pp) and (2) the key factors that influence pregnancy rate following first artificial insemination (AI) in dairy cows. Ninety-eight Holstein-Friesian pp cows were blood sampled from wk 1 to 4 pp for hematology and biochemistry. Reproductive tract health was assessed weekly by ultrasonography and vaginal mucus scoring. Body condition score (BCS), lameness score, and milk yield were assessed every 2 wk. Milk samples for progesterone assay were collected twice weekly and on d 4, 5, and 7 after AI. Risk factors associated with achieving reproductive targets depended on (1) increased metabolic activity of the liver (increased glutamate dehydrogenase at calving and increased γ-glutamyl transpeptidase in wk 4), (2) a competent immune system (increased neutrophils in wk 1; decreased α1-acid glycoprotein in wk 1, 2, and 3), (3) an endocrine system that was capable of responding by producing sufficient triiodothyronine in wk 2 and increased insulin-like growth factor I in wk 3 and 4, (4) a lower negative energy balance status (decreased nonesterified fatty acid concentration in wk 1; decreased β-hydroxybutyrate concentration in wk 2; BCS loss between calving and d 28 pp <0.5), (5) good reproductive tract health [normal uterine scan at d 45 pp; clear vaginal mucus discharge at first ovulation and at d 45 pp; resumed ovarian cyclicity by the end of the voluntary waiting period (≥ d 35 pp)], and (6) adequate diet (to ensure increased glutathione peroxidase in wk 2 and 3 and increased magnesium in wk 4). Risk factors that increased the odds of a successful first AI were previous ovulation(s) (odds ratio=3.17 per ovulation), BCS >2.5 at AI (odds ratio=3.01), and clear vaginal mucus (score=0) compared with purulent mucus (score >0) 4 d after first AI (odds ratio=2.99). In conclusion, this study identified key risk factors in the early pp

Existential risks: exploring a robust risk reduction strategy.

PubMed

Jebari, Karim

2015-06-01

A small but growing number of studies have aimed to understand, assess and reduce existential risks, or risks that threaten the continued existence of mankind. However, most attention has been focused on known and tangible risks. This paper proposes a heuristic for reducing the risk of black swan extinction events. These events are, as the name suggests, stochastic and unforeseen when they happen. Decision theory based on a fixed model of possible outcomes cannot properly deal with this kind of event. Neither can probabilistic risk analysis. This paper will argue that the approach that is referred to as engineering safety could be applied to reducing the risk from black swan extinction events. It will also propose a conceptual sketch of how such a strategy may be implemented: isolated, self-sufficient, and continuously manned underground refuges. Some characteristics of such refuges are also described, in particular the psychosocial aspects. Furthermore, it is argued that this implementation of the engineering safety strategy safety barriers would be effective and plausible and could reduce the risk of an extinction event in a wide range of possible (known and unknown) scenarios. Considering the staggering opportunity cost of an existential catastrophe, such strategies ought to be explored more vigorously.

Earthquake risk reduction in the United States: An assessment of selected user needs and recommendations for the National Earthquake Hazards Reduction Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1994-12-31

This Assessment was conducted to improve the National Earthquake Hazards Reduction Program (NEHRP) by providing NEHRP agencies with information that supports their user-oriented setting of crosscutting priorities in the NEHRP strategic planning process. The primary objective of this Assessment was to take a ``snapshot`` evaluation of the needs of selected users throughout the major program elements of NEHRP. Secondary objectives were to conduct an assessment of the knowledge that exists (or is being developed by NEHRP) to support earthquake risk reduction, and to begin a process of evaluating how NEHRP is meeting user needs. An identification of NEHRP`s strengths alsomore » resulted from the effort, since those strengths demonstrate successful methods that may be useful to NEHRP in the future. These strengths are identified in the text, and many of them represent important achievements since the Earthquake Hazards Reduction Act was passed in 1977.« less

Prevalence of prescription opioid use disorder among chronic opioid therapy patients after health plan opioid dose and risk reduction initiatives.

PubMed

Von Korff, Michael; Walker, Rod L; Saunders, Kathleen; Shortreed, Susan M; Thakral, Manu; Parchman, Michael; Hansen, Ryan N; Ludman, Evette; Sherman, Karen J; Dublin, Sascha

2017-08-01

No studies have assessed the comparative effectiveness of guideline-recommended interventions to reduce risk of prescription opioid use disorder among chronic opioid therapy (COT) patients. We compared the prevalence of prescription opioid use disorder among COT patients from intervention clinics that had implemented opioid dose and risk reduction initiatives for more than 4 years relative to control clinics that had not. After a healthcare system in Washington State implemented interventions to reduce opioid dose and risks, we surveyed 1588 adult primary care COT patients to compare the prevalence of prescription opioid use disorder among COT patients from the intervention and control clinics. Intervention clinics managed COT patients at lower COT doses and with more consistent use of risk reduction practices. Control clinics cared for similar COT patients but prescribed higher opioid doses and used COT risk reduction practices inconsistently. Prescription opioid use disorder was assessed with the Psychiatric Research Interview for Substance and Mental Disorders. The prevalence of prescription opioid use disorder was 21.5% (95% CI=18.9% to 24.4%) among COT patients in the intervention clinics and 23.9% (95% CI=20.5% to 27.6%) among COT patients in the control clinics. The adjusted relative risk of prescription opioid use disorder was 1.08 (95% CI=0.89, 1.32) among the control clinic patients relative to the intervention clinic patients. Long-term implementation of opioid dose and risk reduction initiatives was not associated with lower rates of prescription opioid use disorder among prevalent COT patients. Extreme caution should be exercised by clinicians considering COT for patients with chronic non-cancer pain until benefits of this treatment and attendant risks are clarified. Copyright © 2017 Elsevier B.V. All rights reserved.

Effect of Multifactorial Treatment Targets and Relative Importance of Hemoglobin A1c, Blood Pressure, and Low-Density Lipoprotein-Cholesterol on Cardiovascular Diseases in Chinese Primary Care Patients With Type 2 Diabetes Mellitus: A Population-Based Retrospective Cohort Study.

PubMed

Wan, Eric Yuk Fai; Fung, Colman Siu Cheung; Yu, Esther Yee Tak; Chin, Weng Yee; Fong, Daniel Yee Tak; Chan, Anca Ka Chun; Lam, Cindy Lo Kuen

2017-08-17

The relative effect of hemoglobin A1c, blood pressure, and low-density lipoprotein-cholesterol (LDL-C) ("ABC" factors) on the prevention of cardiovascular diseases (CVD) among patients with type 2 diabetes mellitus is poorly understood. This study aimed to evaluate the association of key clinical parameters on CVD risk using a multifactorial optimal control approach in Chinese primary care patients with type 2 diabetes mellitus. A population-based retrospective cohort study was conducted on 144 271 Chinese type 2 diabetes mellitus primary care patients, aged 18 to 79 and without prior clinical diagnosis of CVD in 2008-2011. Cox regressions were conducted to examine the association between the combinations of ABC targets (hemoglobin A1c <7%, blood pressure <130/90 mm Hg, and LDL-C <2.6 mmol/L) and risks of CVD (overall), coronary heart disease, stroke, and heart failure. Achieving more ABC targets incrementally reduced the incidence of total CVD and individual disease including coronary heart disease, stroke, and heart failure, irrespective of other patient characteristics. Compared with suboptimal control in all ABC levels, achieving any 1, 2, and all 3 ABC targets reduced the relative risk of CVD by 13% to 42%, 31% to 52%, and 55%, respectively. Among those achieving only 1 ABC target, LDL-C reduction was associated with the greatest CVD risk reduction (42%), followed by blood pressure reduction (18%), and hemoglobin A1c reduction (13%). To achieve the greatest risk reduction for the incidence of CVD, the ultimate goal of treatment should be to achieve target control of hemoglobin A1c, blood pressure, and LDL-C. If it is not possible to achieve all 3 targets, efforts should be prioritized on treating the LDL-C to minimize CVD risk. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Association between age-related reductions in testosterone and risk of prostate cancer-An analysis of patients' data with prostatic diseases.

PubMed

Wang, Kai; Chen, Xinguang; Bird, Victoria Y; Gerke, Travis A; Manini, Todd M; Prosperi, Mattia

2017-11-01

The relationship between serum total testosterone and prostate cancer (PCa) risk is controversial. The hypothesis that faster age-related reduction in testosterone is linked with increased PCa risk remains untested. We conducted our study at a tertiary-level hospital in southeast of the USA, and derived data from the Medical Registry Database of individuals that were diagnosed of any prostate-related disease from 2001 to 2015. Cases were those diagnosed of PCa and had one or more measurements of testosterone prior to PCa diagnosis. Controls were those without PCa and had one or more testosterone measurements. Multivariable logistic regression models for PCa risk of absolute levels (one-time measure and 5-year average) and annual change in testosterone were respectively constructed. Among a total of 1,559 patients, 217 were PCa cases, and neither one-time measure nor 5-year average of testosterone was found to be significantly associated with PCa risk. Among the 379 patients with two or more testosterone measurements, 27 were PCa cases. For every 10 ng/dL increment in annual reduction of testosterone, the risk of PCa would increase by 14% [adjusted odds ratio, 1.14; 95% confidence interval (CI), 1.03-1.25]. Compared to patients with a relatively stable testosterone, patients with an annual testosterone reduction of more than 30 ng/dL had 5.03 [95% CI: 1.53, 16.55] fold increase in PCa risk. This implies a faster age-related reduction in, but not absolute level of serum total testosterone as a risk factor for PCa. Further longitudinal studies are needed to confirm this finding. © 2017 UICC.

Routine brief risk-reduction counseling with biannual STD testing reduces STD incidence among HIV-infected men who have sex with men in care.

PubMed

Patel, Pragna; Bush, Tim; Mayer, Kenneth; Milam, Joel; Richardson, Jean; Hammer, John; Henry, Keith; Overton, Turner; Conley, Lois; Marks, Gary; Brooks, John T

2012-06-01

We evaluated whether routine biannual sexually transmitted disease (STD) testing coupled with brief risk-reduction counseling reduces STD incidence and high-risk behaviors. The SUN study is a prospective observational HIV cohort study conducted in 4 US cities. At enrollment and every 6 months thereafter, participants completed a behavioral survey and were screened for STDs, and if diagnosed, were treated. Medical providers conducted brief risk-reduction counseling with all patients. Among men who have sex with men (MSM), we examined trends in STD incidence and rates of self-reported risk behaviors before and after exposure to the risk-reduction intervention. The "preintervention" visit was the study visit that was at least 6 months after enrollment STD screening and treatment and at which the participant was first exposed to the intervention. The "postintervention" visit was 12 months later. Among 216 MSM with complete STD and behavioral data, median age was 44.5 years; 77% were non-Hispanic white; 83% were on highly active antiretroviral treatment; 84% had an HIV RNA level <400 copies/mL and the median CD4 (cluster of differentiation 4) count was 511 cells/mm. Twelve months after first exposure to the risk-reduction intervention, STD incidence declined from 8.8% to 4.2% (P = 0.041). Rates of unprotected receptive or insertive anal intercourse with HIV-positive partners increased (19% to 25%, P = 0.024), but did not change with HIV-negative partners or partners of unknown HIV status (24% to 22%, P = 0.590). STD incidence declined significantly among HIV-infected MSM after implementing frequent, routine STD testing coupled with risk-reduction counseling. These findings support adoption of routine STD screening and risk-reduction counseling for HIV-infected MSM.

Methods for Reducing Normal Tissue Complication Probabilities in Oropharyngeal Cancer: Dose Reduction or Planning Target Volume Elimination

DOE Office of Scientific and Technical Information (OSTI.GOV)

Samuels, Stuart E.; Eisbruch, Avraham; Vineberg, Karen

Purpose: Strategies to reduce the toxicities of head and neck radiation (ie, dysphagia [difficulty swallowing] and xerostomia [dry mouth]) are currently underway. However, the predicted benefit of dose and planning target volume (PTV) reduction strategies is unknown. The purpose of the present study was to compare the normal tissue complication probabilities (NTCP) for swallowing and salivary structures in standard plans (70 Gy [P70]), dose-reduced plans (60 Gy [P60]), and plans eliminating the PTV margin. Methods and Materials: A total of 38 oropharyngeal cancer (OPC) plans were analyzed. Standard organ-sparing volumetric modulated arc therapy plans (P70) were created and then modified by eliminatingmore » the PTVs and treating the clinical tumor volumes (CTVs) only (C70) or maintaining the PTV but reducing the dose to 60 Gy (P60). NTCP dose models for the pharyngeal constrictors, glottis/supraglottic larynx, parotid glands (PGs), and submandibular glands (SMGs) were analyzed. The minimal clinically important benefit was defined as a mean change in NTCP of >5%. The P70 NTCP thresholds and overlap percentages of the organs at risk with the PTVs (56-59 Gy, vPTV{sub 56}) were evaluated to identify the predictors for NTCP improvement. Results: With the P60 plans, only the ipsilateral PG (iPG) benefited (23.9% vs 16.2%; P<.01). With the C70 plans, only the iPG (23.9% vs 17.5%; P<.01) and contralateral SMG (cSMG) (NTCP 32.1% vs 22.9%; P<.01) benefited. An iPG NTCP threshold of 20% and 30% predicted NTCP benefits for the P60 and C70 plans, respectively (P<.001). A cSMG NTCP threshold of 30% predicted for an NTCP benefit with the C70 plans (P<.001). Furthermore, for the iPG, a vPTV{sub 56} >13% predicted benefit with P60 (P<.001) and C70 (P=.002). For the cSMG, a vPTV{sub 56} >22% predicted benefit with C70 (P<.01). Conclusions: PTV elimination and dose-reduction lowered the NTCP of the iPG, and PTV elimination lowered the NTCP of the cSMG. NTCP thresholds and the

Microfinance institutions and a coastal community's disaster risk reduction, response, and recovery process: a case study of Hatiya, Bangladesh.

PubMed

Parvin, Gulsan Ara; Shaw, Rajib

2013-01-01

Several researchers have examined the role of microfinance institutions (MFIs) in poverty alleviation, but the part that they play in disaster risk reduction remains unaddressed. Through an empirical study of Hatiya Island, one of the most vulnerable coastal communities of Bangladesh, this research evaluates perceptions of MFI support for the disaster risk reduction, response, and recovery process. The findings reveal no change in relation to risk reduction and income and occupation aspects for more than one-half of the clients of MFIs. In addition, only 26 per cent of them have witnessed less damage as a result of being members of MFIs. One can argue, though, that the longer the membership time period the better the disaster preparedness, response, and recovery process. The outcomes of this study could help to guide the current efforts of MFIs to enhance the ability of coastal communities to prepare for and to recover from disasters efficiently and effectively. © 2013 The Author(s). Journal compilation © Overseas Development Institute, 2013.

PO calculation for reduction in radar cross section of hypersonic targets using RAM

NASA Astrophysics Data System (ADS)

Liu, Song-hua; Guo, Li-xin; Pan, Wei-tao; Chen, Wei; Xiao, Yi-fan

2018-06-01

The radar cross section (RCS) reduction of hypersonic targets by radar absorbing materials (RAM) coating under different reentry cases is analyzed in the C and X bands frequency range normally used for radar detection. The physical optics method is extended to both the inhomogeneous plasma sheath and RAM layer present simultaneously. The simulation results show that the absorbing coating can reduce the RCS of the plasma cloaking system and its effectiveness is related to the maximum plasma frequency. Moreover, the amount of the RCS decrease, its maxima, and the corresponding optimal RAM thickness depend on the non-uniformity and parameters of the plasma sheath. In addition, the backward RCS of the flight vehicle shrouded by plasma shielding and man-made absorber is calculated and compared to the bare cone.

Gene expression profiling in multiple myeloma--reporting of entities, risk, and targets in clinical routine.

PubMed

Meissner, Tobias; Seckinger, Anja; Rème, Thierry; Hielscher, Thomas; Möhler, Thomas; Neben, Kai; Goldschmidt, Hartmut; Klein, Bernard; Hose, Dirk

2011-12-01

Multiple myeloma is an incurable malignant plasma cell disease characterized by survival ranging from several months to more than 15 years. Assessment of risk and underlying molecular heterogeneity can be excellently done by gene expression profiling (GEP), but its way into clinical routine is hampered by the lack of an appropriate reporting tool and the integration with other prognostic factors into a single "meta" risk stratification. The GEP-report (GEP-R) was built as an open-source software developed in R for gene expression reporting in clinical practice using Affymetrix microarrays. GEP-R processes new samples by applying a documentation-by-value strategy to the raw data to be able to assign thresholds and grouping algorithms defined on a reference cohort of 262 patients with multiple myeloma. Furthermore, we integrated expression-based and conventional prognostic factors within one risk stratification (HM-metascore). The GEP-R comprises (i) quality control, (ii) sample identity control, (iii) biologic classification, (iv) risk stratification, and (v) assessment of target genes. The resulting HM-metascore is defined as the sum over the weighted factors gene expression-based risk-assessment (UAMS-, IFM-score), proliferation, International Staging System (ISS) stage, t(4;14), and expression of prognostic target genes (AURKA, IGF1R) for which clinical grade inhibitors exist. The HM-score delineates three significantly different groups of 13.1%, 72.1%, and 14.7% of patients with a 6-year survival rate of 89.3%, 60.6%, and 18.6%, respectively. GEP reporting allows prospective assessment of risk and target gene expression and integration of current prognostic factors in clinical routine, being customizable about novel parameters or other cancer entities. ©2011 AACR.

The Zika Virus Outbreak in Brazil: Knowledge Gaps and Challenges for Risk Reduction.

PubMed

Garcia Serpa Osorio-de-Castro, Claudia; Silva Miranda, Elaine; Machado de Freitas, Carlos; Rochel de Camargo, Kenneth; Cranmer, Hilarie Hartel

2017-06-01

We analyzed uncertainties and complexities of the Zika virus outbreak in Brazil, and we discuss risk reduction for future emergencies. We present the public health situation in Brazil and concurrent determinants of the epidemic and the knowledge gaps that persist despite building evidence from research, making public health decisions difficult. Brazil has adopted active measures, but producing desired outcomes may be uncertain because of partial or unavailable information. Reducing population group vulnerabilities and acting on environmental issues are medium- to long-term measures. Simultaneously dealing with information gaps, uncontrolled disease spread, and vulnerabilities is a new risk scenario and must be approached decisively to face emerging biothreats.

Elemental conservation units: communicating extinction risk without dictating targets for protection.

PubMed

Wood, Chris C; Gross, Mart R

2008-02-01

Conservation biologists mostly agree on the need to identify and protect biodiversity below the species level but have not yet resolved the best approach. We addressed 2 issues relevant to this debate. First, we distinguished between the abstract goal of preserving the maximum amount of unique biodiversity and the pragmatic goal of minimizing the loss of ecological goods and services given that further loss of biodiversity seems inevitable. Second, we distinguished between the scientific task of assessing extinction risk and the normative task of choosing targets for protection. We propose that scientific advice on extinction risk be given at the smallest meaningful scale: the elemental conservation unit (ECU). An ECU is a demographically isolated population whose probability of extinction over the time scale of interest (say 100 years) is not substantially affected by natural immigration from other populations. Within this time frame, the loss of an ECU would be irreversible without human intervention. Society's decision to protect an ECU ought to reflect human values that have social, economic, and political dimensions. Scientists can best inform this decision by providing advice about the probability that an ECU will be lost and the ecological and evolutionary consequences of that loss in a form that can be integrated into landscape planning. The ECU approach provides maximum flexibility to decision makers and ensures that the scientific task of assessing extinction risk informs, but remains distinct from, the normative social challenge of setting conservation targets.