Science.gov

Sample records for adjusted risk estimates

  1. Sensitivity of health risk estimates to air quality adjustment procedure

    SciTech Connect

    Whitfield, R.G.

    1997-06-30

    This letter is a summary of risk results associated with exposure estimates using two-parameter Weibull and quadratic air quality adjustment procedures (AQAPs). New exposure estimates were developed for children and child-occurrences, six urban areas, and five alternative air quality scenarios. In all cases, the Weibull and quadratic results are compared to previous results, which are based on a proportional AQAP.

  2. Estimating risk.

    PubMed

    2016-07-01

    A free mobile phone app has been launched providing nurses and other hospital clinicians with a simple way to identify high-risk surgical patients. The app is a phone version of the Surgical Outcome Risk Tool (SORT), originally developed for online use with computers by researchers from the National Confidential Enquiry into Patient Outcome and Death and the University College London Hospital Surgical Outcomes Research Centre. SORT uses information about patients' health and planned surgical procedures to estimate the risk of death within 30 days of an operation. The percentages are only estimates, taking into account the general risks of the procedures and some information about patients, and should not be confused with patient-specific estimates in individual cases. PMID:27369709

  3. Evaluating Alternative Risk Adjusters for Medicare.

    PubMed

    Pope, Gregory C; Adamache, Killard W; Walsh, Edith G; Khandker, Rezaul K

    1998-01-01

    In this study the authors use 3 years of the Medicare Current Beneficiary Survey (MCBS) to evaluate alternative demographic, survey, and claims-based risk adjusters for Medicare capitation payment. The survey health-status models have three to four times the predictive power of the demographic models. The risk-adjustment model derived from claims diagnoses has 75-percent greater predictive power than a comprehensive survey model. No single model predicts average expenditures well for all beneficiary subgroups of interest, suggesting a combined model may be appropriate. More data are needed to obtain stable estimates of model parameters. Advantages and disadvantages of alternative risk adjusters are discussed.

  4. Applying risk adjusted cost-effectiveness (RAC-E) analysis to hospitals: estimating the costs and consequences of variation in clinical practice.

    PubMed

    Karnon, Jonathan; Caffrey, Orla; Pham, Clarabelle; Grieve, Richard; Ben-Tovim, David; Hakendorf, Paul; Crotty, Maria

    2013-06-01

    Cost-effectiveness analysis is well established for pharmaceuticals and medical technologies but not for evaluating variations in clinical practice. This paper describes a novel methodology--risk adjusted cost-effectiveness (RAC-E)--that facilitates the comparative evaluation of applied clinical practice processes. In this application, risk adjustment is undertaken with a multivariate matching algorithm that balances the baseline characteristics of patients attending different settings (e.g., hospitals). Linked, routinely collected data are used to analyse patient-level costs and outcomes over a 2-year period, as well as to extrapolate costs and survival over patient lifetimes. The study reports the relative cost-effectiveness of alternative forms of clinical practice, including a full representation of the statistical uncertainty around the mean estimates. The methodology is illustrated by a case study that evaluates the relative cost-effectiveness of services for patients presenting with acute chest pain across the four main public hospitals in South Australia. The evaluation finds that services provided at two hospitals were dominated, and of the remaining services, the more effective hospital gained life years at a low mean additional cost and had an 80% probability of being the most cost-effective hospital at realistic cost-effectiveness thresholds. Potential determinants of the estimated variation in costs and effects were identified, although more detailed analyses to identify specific areas of variation in clinical practice are required to inform improvements at the less cost-effective institutions.

  5. Risk-adjusted monitoring of survival times.

    PubMed

    Sego, Landon H; Reynolds, Marion R; Woodall, William H

    2009-04-30

    We consider the monitoring of surgical outcomes, where each patient has a different risk of post-operative mortality due to risk factors that exist prior to the surgery. We propose a risk-adjusted (RA) survival time CUSUM chart (RAST CUSUM) for monitoring a continuous, time-to-event variable that may be right-censored. Risk adjustment is accomplished using accelerated failure time regression models. We compare the average run length performance of the RAST CUSUM chart with the RA Bernoulli CUSUM chart using data from cardiac surgeries to motivate the details of the comparison. The comparisons show that the RAST CUSUM chart is more efficient at detecting a sudden increase in the odds of mortality than the RA Bernoulli CUSUM chart, especially when the fraction of censored observations is relatively low or when a small increase in the odds of mortality occurs. We also discuss the impact of the amount of training data used to estimate chart parameters as well as the implementation of the RAST CUSUM chart during prospective monitoring.

  6. Risk-adjusted monitoring of survival times

    SciTech Connect

    Sego, Landon H.; Reynolds, Marion R.; Woodall, William H.

    2009-02-26

    We consider the monitoring of clinical outcomes, where each patient has a di®erent risk of death prior to undergoing a health care procedure.We propose a risk-adjusted survival time CUSUM chart (RAST CUSUM) for monitoring clinical outcomes where the primary endpoint is a continuous, time-to-event variable that may be right censored. Risk adjustment is accomplished using accelerated failure time regression models. We compare the average run length performance of the RAST CUSUM chart to the risk-adjusted Bernoulli CUSUM chart, using data from cardiac surgeries to motivate the details of the comparison. The comparisons show that the RAST CUSUM chart is more efficient at detecting a sudden decrease in the odds of death than the risk-adjusted Bernoulli CUSUM chart, especially when the fraction of censored observations is not too high. We also discuss the implementation of a prospective monitoring scheme using the RAST CUSUM chart.

  7. A demand-side view of risk adjustment.

    PubMed

    Feldman, R; Dowd, B E; Maciejewski, M

    2001-01-01

    This paper analyzes the efficient allocation of consumers to health plans. Specifically, we address the question of why employers that offer multiple health plans often make larger contributions to the premiums of the high-cost plans. Our perspective is that the subsidy for high-cost plans represents a form of demand-side risk adjustment that improves efficiency. Without such subsidies (and in the absence of formal risk adjustment), too few employees would choose the high-cost plans preferred by high-risk workers. We test the theory by estimating a model of the employer premium subsidy, using data from a survey of large public employers in 1994. Our empirical analysis shows that employers are more likely to subsidize high-cost plans when the benefits of risk adjustment are greater. The findings suggest that the premium subsidy can accomplish some of the benefits of formal risk adjustment.

  8. Estimating the Roles of Genetic Risk, Perinatal Risk, and Marital Hostility on Early Childhood Adjustment: Medical Records and Self-Reports.

    PubMed

    Neiderhiser, Jenae M; Marceau, Kristine; De Araujo-Greecher, Marielena; Ganiban, Jody M; Mayes, Linda C; Shaw, Daniel S; Reiss, David; Leve, Leslie D

    2016-05-01

    A wide variety of perinatal risk factors have been linked to later developmental outcomes in children. Much of this work has relied on either birth/medical records or mothers' self-reports collected after delivery, and there has been an ongoing debate about which strategy provides the most accurate and reliable data. This report uses a parent-offspring adoption design (N = 561 families) to (1) examine the correspondence between medical record data and self-report data, (2) examine how perinatal risk factors may influence child internalizing and externalizing behavior at age 4.5 years, and (3) explore interactions among genetic, perinatal risk, and rearing environment on child internalizing and externalizing behavior during early childhood. The agreement of self-reports and medical records data was relatively high (51-100 %), although there was some variation based on the construct. There were few main effects of perinatal risk on child outcomes; however, there were several 2- and 3-way interactions suggesting that the combined influences of genetic, perinatal, and rearing environmental risks are important, particularly for predicting whether children exhibit internalizing versus externalizing symptoms at age 4.5 years.

  9. 45 CFR 153.350 - Risk adjustment data validation standards.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.350 Risk adjustment...

  10. 42 CFR 422.310 - Risk adjustment data.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Risk adjustment data. 422.310 Section 422.310....310 Risk adjustment data. (a) Definition of risk adjustment data. Risk adjustment data are all data that are used in the development and application of a risk adjustment payment model. (b)...

  11. Risk adjustment for high utilizers of public mental health care.

    PubMed

    Kapur, Kanika; Young, Alexander S.; Murata, Dennis

    2000-09-01

    BACKGROUND: Publicly funded mental health systems are increasingly implementing managed care systems, such as capitation, to control costs. Capitated contracts may increase the risk for disenrollment or adverse outcomes among high cost clients with severe mental illness. Risk-adjusted payments to providers are likely to reduce providers' incentives to avoid or under-treat these people. However, most research has focused on Medicare and private populations, and risk adjustment for individuals who are publicly funded and severely mentally ill has received far less attention. AIMS OF THE STUDY: Risk adjustment models for this population can be used to improve contracting for mental health care. Our objective is to develop risk adjustment models for individuals with severe mental illness and assess their performance in predicting future costs. We apply the risk adjustment model to predict costs for the first year of a pilot capitation program for the severely mentally ill that was not risk adjusted. We assess whether risk adjustment could have reduced disenrollment from this program. METHODS: This analysis uses longitudinal administrative data from the County of Los Angeles Department of Mental Health for the fiscal years 1991 to 1994. The sample consists of 1956 clients who have high costs and are severely mentally ill. We estimate several modified two part models of 1993 cost that use 1992 client-based variables such as demographics, living conditions, diagnoses and mental health costs (for 1992 and 1991) to explain the variation in mental health and substance abuse costs. RESULTS: We find that the model that incorporates demographic characteristics, diagnostic information and cost data from two previous years explains about 16 percent of the in-sample variation and 10 percent of the out-of-sample variation in costs. A model that excludes prior cost covariates explains only 5 percent of the variation in costs. Despite the relatively low predictive power, we find some

  12. Risk adjustment for a children's capitation rate.

    PubMed

    Newhouse, J P; Sloss, E M; Manning, W G; Keeler, E B

    1993-01-01

    Few capitation arrangements vary premiums by a child's health characteristics, yielding an incentive to discriminate against children with predictably high expenditures from chronic diseases. In this article, we explore risk adjusters for the 35 percent of the variance in annual out-patient expenditure we find to be potentially predictable. Demographic factors such as age and gender only explain 5 percent of such variance; health status measures explain 25 percent, prior use and health status measures together explain 65 to 70 percent. The profit from risk selection falls less than proportionately with improved ability to adjust for risk. Partial capitation rates may be necessary to mitigate skimming and dumping. PMID:10133708

  13. Risk Adjustment for a Children's Capitation Rate

    PubMed Central

    Newhouse, Joseph P.; Sloss, Elizabeth M.; Manning, Willard G.; Keeler, Emmett B.

    1993-01-01

    Few capitation arrangements vary premiums by a child's health characteristics, yielding an incentive to discriminate against children with predictably high expenditures from chronic diseases. In this article, we explore risk adjusters for the 35 percent of the variance in annual outpatient expenditure we find to be potentially predictable. Demographic factors such as age and gender only explain 5 percent of such variance; health status measures explain 25 percent, prior use and health status measures together explain 65 to 70 percent. The profit from risk selection falls less than proportionately with improved ability to adjust for risk. Partial capitation rates may be necessary to mitigate skimming and dumping. PMID:10133708

  14. 45 CFR 153.350 - Risk adjustment data validation standards.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... implementation of any risk adjustment software and ensure proper validation of a statistically valid sample of... respect to implementation of risk adjustment software or as a result of data validation conducted pursuant... implementation of risk adjustment software or data validation....

  15. Affordable Care Act risk adjustment: overview, context, and challenges.

    PubMed

    Kautter, John; Pope, Gregory C; Keenan, Patricia

    2014-01-01

    Beginning in 2014, individuals and small businesses will be able to purchase private health insurance through competitive marketplaces. The Affordable Care Act (ACA) provides for a program of risk adjustment in the individual and small group markets in 2014 as Marketplaces are implemented and new market reforms take effect. The purpose of risk adjustment is to lessen or eliminate the influence of risk selection on the premiums that plans charge and the incentive for plans to avoid sicker enrollees. This article--the first of three in the Medicare & Medicaid Research Review--describes the key program goal and issues in the Department of Health and Human Services (HHS) developed risk adjustment methodology, and identifies key choices in how the methodology responds to these issues. The goal of the HHS risk adjustment methodology is to compensate health insurance plans for differences in enrollee health mix so that plan premiums reflect differences in scope of coverage and other plan factors, but not differences in health status. The methodology includes a risk adjustment model and a risk transfer formula that together address this program goal as well as three issues specific to ACA risk adjustment: 1) new population; 2) cost and rating factors; and 3) balanced transfers within state/market. The risk adjustment model, described in the second article, estimates differences in health risks taking into account the new population and scope of coverage (actuarial value level). The transfer formula, described in the third article, calculates balanced transfers that are intended to account for health risk differences while preserving permissible premium differences. PMID:25364625

  16. 28 CFR 100.19 - Adjustments to agreement estimate.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Adjustments to agreement estimate. 100.19..., COMMUNICATIONS ASSISTANCE FOR LAW ENFORCEMENT ACT OF 1994 § 100.19 Adjustments to agreement estimate. (a... the adjustment results in an increase in the estimated reimbursement, the FBI will review...

  17. Early School Adjustment of Children at Risk.

    ERIC Educational Resources Information Center

    Reynolds, Arthur J.

    This study examined the factors contributing to the early school adjustment of children at risk of school failure from preschool enrollment to fourth grade. A longitudinal model that used data on 1,255 low-income, minority children was tested in an effort to bring about an improved understanding of the factors that influence a wide range of early…

  18. 42 CFR 403.750 - Estimate of expenditures and adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Estimate of expenditures and adjustments. 403.750...-Benefits, Conditions of Participation, and Payment § 403.750 Estimate of expenditures and adjustments. (a) Estimates. CMS estimates the level of expenditures for services provided under this subpart before the...

  19. Risk estimates for bone

    SciTech Connect

    Schlenker, R.A.

    1981-01-01

    The primary sources of information on the skeletal effects of internal emitters in humans are the US radium cases with occupational and medical exposures to /sup 226/ /sup 228/Ra and the German patients injected with /sup 224/Ra primarily for treatment of ankylosing spondylitis and tuberculosis. During the past decade, dose-response data from both study populations have been used by committees, e.g., the BEIR committees, to estimate risks at low dose levels. NCRP Committee 57 and its task groups are now engaged in making risk estimates for internal emitters. This paper presents brief discussions of the radium data, the results of some new analyses and suggestions for expressing risk estimates in a form appropriate to radiation protection.

  20. 45 CFR 153.610 - Risk adjustment issuer requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer Standards Related to the Risk Adjustment Program § 153.610...

  1. 45 CFR 153.620 - Compliance with risk adjustment standards.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer Standards Related to the Risk Adjustment Program § 153.620...

  2. 45 CFR 153.620 - Compliance with risk adjustment standards.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer Standards Related to the Risk Adjustment Program § 153.620...

  3. 45 CFR 153.320 - Federally certified risk adjustment methodology.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.320 Federally certified...

  4. 45 CFR 153.320 - Federally certified risk adjustment methodology.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.320 Federally certified...

  5. Risk-Adjusted Models for Adverse Obstetric Outcomes and Variation in Risk Adjusted Outcomes Across Hospitals

    PubMed Central

    Bailit, Jennifer L.; Grobman, William A.; Rice, Madeline Murguia; Spong, Catherine Y.; Wapner, Ronald J.; Varner, Michael W.; Thorp, John M.; Leveno, Kenneth J.; Caritis, Steve N.; Shubert, Phillip J.; Tita, Alan T. N.; Saade, George; Sorokin, Yoram; Rouse, Dwight J.; Blackwell, Sean C.; Tolosa, Jorge E.; Van Dorsten, J. Peter

    2014-01-01

    Objective Regulatory bodies and insurers evaluate hospital quality using obstetrical outcomes, however meaningful comparisons should take pre-existing patient characteristics into account. Furthermore, if risk-adjusted outcomes are consistent within a hospital, fewer measures and resources would be needed to assess obstetrical quality. Our objective was to establish risk-adjusted models for five obstetric outcomes and assess hospital performance across these outcomes. Study Design A cohort study of 115,502 women and their neonates born in 25 hospitals in the United States between March 2008 and February 2011. Hospitals were ranked according to their unadjusted and risk-adjusted frequency of venous thromboembolism, postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite neonatal adverse outcome. Correlations between hospital risk-adjusted outcome frequencies were assessed. Results Venous thromboembolism occurred too infrequently (0.03%, 95% CI 0.02% – 0.04%) for meaningful assessment. Other outcomes occurred frequently enough for assessment (postpartum hemorrhage 2.29% (95% CI 2.20–2.38), peripartum infection 5.06% (95% CI 4.93–5.19), severe perineal laceration at spontaneous vaginal delivery 2.16% (95% CI 2.06–2.27), neonatal composite 2.73% (95% CI 2.63–2.84)). Although there was high concordance between unadjusted and adjusted hospital rankings, several individual hospitals had an adjusted rank that was substantially different (as much as 12 rank tiers) than their unadjusted rank. None of the correlations between hospital adjusted outcome frequencies was significant. For example, the hospital with the lowest adjusted frequency of peripartum infection had the highest adjusted frequency of severe perineal laceration. Conclusions Evaluations based on a single risk-adjusted outcome cannot be generalized to overall hospital obstetric performance. PMID:23891630

  6. 45 CFR 153.610 - Risk adjustment issuer requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... CARE ACT Health Insurance Issuer Standards Related to the Risk Adjustment Program § 153.610 Risk... accurate data. (d) Assessment of charges. An issuer that offers risk adjustment covered plans that has a... on behalf of a State, an issuer of a risk adjustment covered plan (other than a student health...

  7. 45 CFR 153.310 - Risk adjustment administration.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 153.310 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.310 Risk adjustment...

  8. 45 CFR 153.310 - Risk adjustment administration.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 153.310 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.310 Risk adjustment...

  9. Diagnosis-Based Risk Adjustment for Medicare Capitation Payments

    PubMed Central

    Ellis, Randall P.; Pope, Gregory C.; Iezzoni, Lisa I.; Ayanian, John Z.; Bates, David W.; Burstin, Helen; Ash, Arlene S.

    1996-01-01

    Using 1991-92 data for a 5-percent Medicare sample, we develop, estimate, and evaluate risk-adjustment models that utilize diagnostic information from both inpatient and ambulatory claims to adjust payments for aged and disabled Medicare enrollees. Hierarchical coexisting conditions (HCC) models achieve greater explanatory power than diagnostic cost group (DCG) models by taking account of multiple coexisting medical conditions. Prospective models predict average costs of individuals with chronic conditions nearly as well as concurrent models. All models predict medical costs far more accurately than the current health maintenance organization (HMO) payment formula. PMID:10172666

  10. Risk adjustment: where are we now?

    PubMed

    Newhouse, J P

    1998-01-01

    Risk adjustment is intended to minimize selection of patients or enrollees in health plans. Current efforts generally are recognized as inadequate, but improvement is difficult. The greatest short-term gain will come from introducing diagnostic information, though outpatient diagnosis data are unreliable. Initial efforts may use inpatient data, but this creates incentives to hospitalize people. Even exploiting diagnosis information leaves substantial imperfections. Partial capitation, common in behavioral health, reduces incentives to select patients and stent on services, but current policy resists it, perhaps because policymakers misinterpret the lesson of the Prospective Payment System. Theoretically, not paying plans more for providing additional services is optimal only if consumers are well informed.

  11. Risk adjustment: where are we now?

    PubMed

    Newhouse, J P

    1998-01-01

    Risk adjustment is intended to minimize selection of patients or enrollees in health plans. Current efforts generally are recognized as inadequate, but improvement is difficult. The greatest short-term gain will come from introducing diagnostic information, though outpatient diagnosis data are unreliable. Initial efforts may use inpatient data, but this creates incentives to hospitalize people. Even exploiting diagnosis information leaves substantial imperfections. Partial capitation, common in behavioral health, reduces incentives to select patients and stent on services, but current policy resists it, perhaps because policymakers misinterpret the lesson of the Prospective Payment System. Theoretically, not paying plans more for providing additional services is optimal only if consumers are well informed. PMID:9719781

  12. 45 CFR 153.340 - Data collection under risk adjustment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.340 Data collection under risk... security standards described at 45 CFR 164.308, 164.310, and 164.312....

  13. 45 CFR 153.340 - Data collection under risk adjustment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.340 Data collection under risk... described at 45 CFR 164.308, 164.310, and 164.312....

  14. 45 CFR 153.610 - Risk adjustment issuer requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer Standards Related to the Risk Adjustment Program § 153.610 Risk... or a plan not subject to 45 CFR 147.102, 147.104, 147.106, 156.80, and subpart B of part 156)...

  15. 45 CFR 153.330 - State alternate risk adjustment methodology.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.330 State alternate risk... methodology: (i) Accurately explains the variation in health care costs of a given population; (ii) Links...

  16. 45 CFR 153.330 - State alternate risk adjustment methodology.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.330 State alternate risk... methodology: (i) Accurately explains the variation in health care costs of a given population; (ii) Links...

  17. On variance estimate for covariate adjustment by propensity score analysis.

    PubMed

    Zou, Baiming; Zou, Fei; Shuster, Jonathan J; Tighe, Patrick J; Koch, Gary G; Zhou, Haibo

    2016-09-10

    Propensity score (PS) methods have been used extensively to adjust for confounding factors in the statistical analysis of observational data in comparative effectiveness research. There are four major PS-based adjustment approaches: PS matching, PS stratification, covariate adjustment by PS, and PS-based inverse probability weighting. Though covariate adjustment by PS is one of the most frequently used PS-based methods in clinical research, the conventional variance estimation of the treatment effects estimate under covariate adjustment by PS is biased. As Stampf et al. have shown, this bias in variance estimation is likely to lead to invalid statistical inference and could result in erroneous public health conclusions (e.g., food and drug safety and adverse events surveillance). To address this issue, we propose a two-stage analytic procedure to develop a valid variance estimator for the covariate adjustment by PS analysis strategy. We also carry out a simple empirical bootstrap resampling scheme. Both proposed procedures are implemented in an R function for public use. Extensive simulation results demonstrate the bias in the conventional variance estimator and show that both proposed variance estimators offer valid estimates for the true variance, and they are robust to complex confounding structures. The proposed methods are illustrated for a post-surgery pain study. Copyright © 2016 John Wiley & Sons, Ltd. PMID:26999553

  18. 77 FR 21775 - Risk Adjustment Meeting-May 7, 2012 and May 8, 2012

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-11

    ... payments and charges, data collection approach, and the schedule for running risk adjustment. This meeting..., data collection approach, and the schedule for running risk adjustment. The Risk Adjustment...

  19. Change point detection in risk adjusted control charts.

    PubMed

    Assareh, Hassan; Smith, Ian; Mengersen, Kerrie

    2015-12-01

    Precise identification of the time when a change in a clinical process has occurred enables experts to identify a potential special cause more effectively. In this article, we develop change point estimation methods for a clinical dichotomous process in the presence of case mix. We apply Bayesian hierarchical models to formulate the change point where there exists a step change in the odds ratio and logit of risk of a Bernoulli process. Markov Chain Monte Carlo is used to obtain posterior distributions of the change point parameters including location and magnitude of changes and also corresponding probabilistic intervals and inferences. The performance of the Bayesian estimator is investigated through simulations and the result shows that precise estimates can be obtained when they are used in conjunction with the risk-adjusted CUSUM and EWMA control charts. In comparison with alternative EWMA and CUSUM estimators, more accurate and precise estimates are obtained by the Bayesian estimator. These superiorities enhance when probability quantification, flexibility and generaliability of the Bayesian change point detection model are also considered. The Deviance Information Criterion, as a model selection criterion in the Bayesian context, is applied to find the best change point model for a given dataset where there is no prior knowledge about the change type in the process.

  20. Estimates of radiogenic cancer risks

    SciTech Connect

    Puskin, J.S.; Nelson, C.B.

    1995-07-01

    A methodology recently developed by the U.S. EPA for estimating the carcingenic risks from ionizing radiation is described. For most cancer sites, the risk model is one in which age-specific, relative risk coefficients are obtained by taking a geometric mean of the coefficients derived from the atomic bomb survivor data using two different methods for transporting risks from the Japanese to the U.S. population. The risk models are applied to estimate organ-specific risks per unit dose for a stationary population with mortality rates governed by 1980 U.S. vital statistics. With the exception of breast cancer, low-LET radiogenic cancer risk estimates are reduced by a factor of 2 at low doses and dose rates compared to acute high dose exposure conditions. For low dose (or dose rate) conditions, the risk of inducing a premature cancer death from uniform, whole body, low-LET irradiation is calculated to be 5.1 x 10{sup -2} Gy{sup -1}. Neglecting nonfatal skin cancers, the corresponding incidence risk is 7.6 x 10{sup -2} Gy{sup -1}. High-LET (alpha particle) risks are presumed to increase linearly with dose and to be independent of dose rate. High-LET risks are estimated to be 20 times the low-LET risks estimated under low dose rate conditions, except for leukemia and breast cancer where RBEs of 1 and 10 are adopted, respectively. 29 refs., 3 tabs.

  1. 12 CFR 615.5210 - Risk-adjusted assets.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... POLICIES AND OPERATIONS, AND FUNDING OPERATIONS Capital Adequacy § 615.5210 Risk-adjusted assets. (a... comprises “risk-adjusted assets,” the denominator for computation of the permanent capital ratio. (b... institution must deduct from capital and assets the face amount of the position (dollar-for-dollar...

  2. 28 CFR 100.19 - Adjustments to agreement estimate.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... the FBI when any change affecting the level of reimbursement occurs. (2) Upon such notification, if the adjustment results in an increase in the estimated reimbursement, the FBI will review the... expenditure. (3) The FBI will provide the decision as to the acceptability of any increase to the carrier...

  3. 28 CFR 100.19 - Adjustments to agreement estimate.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... the FBI when any change affecting the level of reimbursement occurs. (2) Upon such notification, if the adjustment results in an increase in the estimated reimbursement, the FBI will review the... expenditure. (3) The FBI will provide the decision as to the acceptability of any increase to the carrier...

  4. 28 CFR 100.19 - Adjustments to agreement estimate.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... the FBI when any change affecting the level of reimbursement occurs. (2) Upon such notification, if the adjustment results in an increase in the estimated reimbursement, the FBI will review the... expenditure. (3) The FBI will provide the decision as to the acceptability of any increase to the carrier...

  5. 28 CFR 100.19 - Adjustments to agreement estimate.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... the FBI when any change affecting the level of reimbursement occurs. (2) Upon such notification, if the adjustment results in an increase in the estimated reimbursement, the FBI will review the... expenditure. (3) The FBI will provide the decision as to the acceptability of any increase to the carrier...

  6. Lasso adjustments of treatment effect estimates in randomized experiments

    PubMed Central

    Bloniarz, Adam; Liu, Hanzhong; Zhang, Cun-Hui; Sekhon, Jasjeet S.; Yu, Bin

    2016-01-01

    We provide a principled way for investigators to analyze randomized experiments when the number of covariates is large. Investigators often use linear multivariate regression to analyze randomized experiments instead of simply reporting the difference of means between treatment and control groups. Their aim is to reduce the variance of the estimated treatment effect by adjusting for covariates. If there are a large number of covariates relative to the number of observations, regression may perform poorly because of overfitting. In such cases, the least absolute shrinkage and selection operator (Lasso) may be helpful. We study the resulting Lasso-based treatment effect estimator under the Neyman–Rubin model of randomized experiments. We present theoretical conditions that guarantee that the estimator is more efficient than the simple difference-of-means estimator, and we provide a conservative estimator of the asymptotic variance, which can yield tighter confidence intervals than the difference-of-means estimator. Simulation and data examples show that Lasso-based adjustment can be advantageous even when the number of covariates is less than the number of observations. Specifically, a variant using Lasso for selection and ordinary least squares (OLS) for estimation performs particularly well, and it chooses a smoothing parameter based on combined performance of Lasso and OLS. PMID:27382153

  7. Lasso adjustments of treatment effect estimates in randomized experiments.

    PubMed

    Bloniarz, Adam; Liu, Hanzhong; Zhang, Cun-Hui; Sekhon, Jasjeet S; Yu, Bin

    2016-07-01

    We provide a principled way for investigators to analyze randomized experiments when the number of covariates is large. Investigators often use linear multivariate regression to analyze randomized experiments instead of simply reporting the difference of means between treatment and control groups. Their aim is to reduce the variance of the estimated treatment effect by adjusting for covariates. If there are a large number of covariates relative to the number of observations, regression may perform poorly because of overfitting. In such cases, the least absolute shrinkage and selection operator (Lasso) may be helpful. We study the resulting Lasso-based treatment effect estimator under the Neyman-Rubin model of randomized experiments. We present theoretical conditions that guarantee that the estimator is more efficient than the simple difference-of-means estimator, and we provide a conservative estimator of the asymptotic variance, which can yield tighter confidence intervals than the difference-of-means estimator. Simulation and data examples show that Lasso-based adjustment can be advantageous even when the number of covariates is less than the number of observations. Specifically, a variant using Lasso for selection and ordinary least squares (OLS) for estimation performs particularly well, and it chooses a smoothing parameter based on combined performance of Lasso and OLS. PMID:27382153

  8. [Medical insurance estimation of risks].

    PubMed

    Dunér, H

    1975-11-01

    The purpose of insurance medicine is to make a prognostic estimate of medical risk-factors in persons who apply for life, health, or accident insurance. Established risk-groups with a calculated average mortality and morbidity form the basis for premium rates and insurance terms. In most cases the applicant is accepted for insurance after a self-assessment of his health. Only around one per cent of the applications are refused, but there are cases in which the premium is raised, temporarily or permanently. It is often a matter of rough estimate, since the knowlege of the long-term prognosis for many diseases is incomplete. The insurance companies' rules for estimate of risk are revised at intervals of three or four years. The estimate of risk as regards life insurance has been gradually liberalised, while the medical conditions for health insurance have become stricter owing to an increase in the claims rate.

  9. Reinforcing flood-risk estimation.

    PubMed

    Reed, Duncan W

    2002-07-15

    Flood-frequency estimation is inherently uncertain. The practitioner applies a combination of gauged data, scientific method and hydrological judgement to derive a flood-frequency curve for a particular site. The resulting estimate can be thought fully satisfactory only if it is broadly consistent with all that is reliably known about the flood-frequency behaviour of the river. The paper takes as its main theme the search for information to strengthen a flood-risk estimate made from peak flows alone. Extra information comes in many forms, including documentary and monumental records of historical floods, and palaeological markers. Meteorological information is also useful, although rainfall rarity is difficult to assess objectively and can be a notoriously unreliable indicator of flood rarity. On highly permeable catchments, groundwater levels present additional data. Other types of information are relevant to judging hydrological similarity when the flood-frequency estimate derives from data pooled across several catchments. After highlighting information sources, the paper explores a second theme: that of consistency in flood-risk estimates. Following publication of the Flood estimation handbook, studies of flood risk are now using digital catchment data. Automated calculation methods allow estimates by standard methods to be mapped basin-wide, revealing anomalies at special sites such as river confluences. Such mapping presents collateral information of a new character. Can this be used to achieve flood-risk estimates that are coherent throughout a river basin? PMID:12804255

  10. Reinforcing flood-risk estimation.

    PubMed

    Reed, Duncan W

    2002-07-15

    Flood-frequency estimation is inherently uncertain. The practitioner applies a combination of gauged data, scientific method and hydrological judgement to derive a flood-frequency curve for a particular site. The resulting estimate can be thought fully satisfactory only if it is broadly consistent with all that is reliably known about the flood-frequency behaviour of the river. The paper takes as its main theme the search for information to strengthen a flood-risk estimate made from peak flows alone. Extra information comes in many forms, including documentary and monumental records of historical floods, and palaeological markers. Meteorological information is also useful, although rainfall rarity is difficult to assess objectively and can be a notoriously unreliable indicator of flood rarity. On highly permeable catchments, groundwater levels present additional data. Other types of information are relevant to judging hydrological similarity when the flood-frequency estimate derives from data pooled across several catchments. After highlighting information sources, the paper explores a second theme: that of consistency in flood-risk estimates. Following publication of the Flood estimation handbook, studies of flood risk are now using digital catchment data. Automated calculation methods allow estimates by standard methods to be mapped basin-wide, revealing anomalies at special sites such as river confluences. Such mapping presents collateral information of a new character. Can this be used to achieve flood-risk estimates that are coherent throughout a river basin?

  11. 42 CFR 422.310 - Risk adjustment data.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... all data that are used in the development and application of a risk adjustment payment model. (b) Data... quality review and improvement activities, and for Medicare coverage purposes. (g) Deadlines...

  12. Meaningful QQ adjustment of TRMM/GPM daily rainfall estimates.

    NASA Astrophysics Data System (ADS)

    Pegram, Geoff; Bardossy, Andras; Sinclair, Scott

    2016-04-01

    In many parts of the world, particularly in Africa, the daily raingauge networks are sparse. It is therefore sensible to use remote sensing estimates of precipitation to fill the gaps, but readily available products like TRMM and it successor GPM are frequently found to be biased. This presentation describes a method of bias adjustment of TRMM using quantile-quantile (QQ) transforms of the probability distributions of TRMM daily rainfall accumulations over its grid of 0.25 degree pixels/blocks. There are 4 main steps in the procedure. The first is to collect the daily gauge readings in those TRMM pixels containing gauges to obtain useful estimates of spatial rainfall for ground referencing. These estimates need to be adjusted from gauge to areal estimates taking the number of gauges in each pixel into account. We found that the distributions of the areal rainfall estimates are influenced by the number of gauges in each block, so we devised a means of transforming point to areal rainfall meaningfully. The second step is to determine the parameters of the probability distributions of the gauge-based block areal rainfall; we found that the Weibull distribution with 2 parameters is a suitable and useful choice. The pairs of Weibull parameters of rainfall on many blocks are correlated. To enable their interpolation, as an intermediate step, they have to be decorrelated using canonical decomposition. These transformed parameter pairs are then separately interpolated to empty blocks over the region of choice. They are then back-transformed at each TRMM pixel to Weibull parameters to provide gauge referenced daily rainfall distributions. The third step is to determine the Weibull distributions of the TRMM daily rainfall estimates in each block, based on their brief 11-year history. The fourth and last step is to QQ transform the individual daily TRMM rainfall estimates via the interpolated gauge-block rainfall distributions. This procedure achieves the desired corrected

  13. Integrating Risk Adjustment and Enrollee Premiums in Health Plan Payment

    PubMed Central

    McGuire, Thomas G.; Glazer, Jacob; Newhouse, Joseph P.; Normand, Sharon-Lise; Shi, Julie; Sinaiko, Anna D.; Zuvekas, Samuel

    2013-01-01

    In two important health policy contexts – private plans in Medicare and the new state-run “Exchanges” created as part of the Affordable Care Act (ACA) – plan payments come from two sources: risk-adjusted payments from a Regulator and premiums charged to individual enrollees. This paper derives principles for integrating risk-adjusted payments and premium policy in individual health insurance markets based on fitting total plan payments to health plan costs per person as closely as possible. A least squares regression including both health status and variables used in premiums reveals the weights a Regulator should put on risk adjusters when markets determine premiums. We apply the methods to an Exchange-eligible population drawn from the Medical Expenditure Panel Survey (MEPS). PMID:24308878

  14. Risk-adjusted outcomes in Medicare inpatient nephrectomy patients

    PubMed Central

    Fry, Donald E.; Pine, Michael; Nedza, Susan M.; Locke, David G.; Reband, Agnes M.; Pine, Gregory

    2016-01-01

    Abstract Without risk-adjusted outcomes of surgical care across both the inpatient and postacute period of time, hospitals and surgeons cannot evaluate the effectiveness of current performance in nephrectomy and other operations, and will not have objective metrics to gauge improvements from care redesign efforts. We compared risk-adjusted hospital outcomes following elective total and partial nephrectomy to demonstrate differences that can be used to improve care. We used the Medicare Limited Dataset for 2010 to 2012 for total and partial nephrectomy for benign and malignant neoplasms to create prediction models for the adverse outcomes (AOs) of inpatient deaths, prolonged length-of-stay outliers, 90-day postdischarge deaths without readmission, and 90-day relevant readmissions. From the 4 prediction models, total predicted adverse outcomes were determined for each hospital in the dataset that met a minimum of 25 evaluable cases for the study period. Standard deviations (SDs) for each hospital were used to identify specific z-scores. Risk-adjusted adverse outcomes rates were computed to permit benchmarking each hospital's performance against the national standard. Differences between best and suboptimal performing hospitals defined the potential margin of preventable adverse outcomes for this operation. A total of 449 hospitals with 23,477 patients were evaluated. Overall AO rate was 20.8%; 17 hospitals had risk-adjusted AO rates that were 2 SDs poorer than predicted and 8 were 2 SDs better. The top performing decile of hospitals had a risk-adjusted AO rate of 10.2% while the lowest performing decile had 32.1%. With a minimum of 25 cases for each study hospital, no statistically valid improvement in outcomes was seen with increased case volume. Inpatient and 90-day postdischarge risk-adjusted adverse outcomes demonstrated marked variability among study hospitals and illustrate the opportunities for care improvement. This analytic design is applicable for comparing

  15. Risk-adjusted outcomes in Medicare inpatient nephrectomy patients.

    PubMed

    Fry, Donald E; Pine, Michael; Nedza, Susan M; Locke, David G; Reband, Agnes M; Pine, Gregory

    2016-09-01

    Without risk-adjusted outcomes of surgical care across both the inpatient and postacute period of time, hospitals and surgeons cannot evaluate the effectiveness of current performance in nephrectomy and other operations, and will not have objective metrics to gauge improvements from care redesign efforts.We compared risk-adjusted hospital outcomes following elective total and partial nephrectomy to demonstrate differences that can be used to improve care. We used the Medicare Limited Dataset for 2010 to 2012 for total and partial nephrectomy for benign and malignant neoplasms to create prediction models for the adverse outcomes (AOs) of inpatient deaths, prolonged length-of-stay outliers, 90-day postdischarge deaths without readmission, and 90-day relevant readmissions. From the 4 prediction models, total predicted adverse outcomes were determined for each hospital in the dataset that met a minimum of 25 evaluable cases for the study period. Standard deviations (SDs) for each hospital were used to identify specific z-scores. Risk-adjusted adverse outcomes rates were computed to permit benchmarking each hospital's performance against the national standard. Differences between best and suboptimal performing hospitals defined the potential margin of preventable adverse outcomes for this operation.A total of 449 hospitals with 23,477 patients were evaluated. Overall AO rate was 20.8%; 17 hospitals had risk-adjusted AO rates that were 2 SDs poorer than predicted and 8 were 2 SDs better. The top performing decile of hospitals had a risk-adjusted AO rate of 10.2% while the lowest performing decile had 32.1%. With a minimum of 25 cases for each study hospital, no statistically valid improvement in outcomes was seen with increased case volume.Inpatient and 90-day postdischarge risk-adjusted adverse outcomes demonstrated marked variability among study hospitals and illustrate the opportunities for care improvement. This analytic design is applicable for comparing provider

  16. How to estimate your tolerance for risk

    SciTech Connect

    Mackay, J.A.

    1996-12-31

    Risk tolerance is used to calculate the Risk Adjusted Value (RAV) of a proposed investment. The RAV incorporates both the expected value and risk attitude for a particular investment, taking into consideration your concern for catastrophic financial loss, as well as chance of success, cost and value if successful. Uncertainty can be incorporated into all of the above variables. Often a project is more valuable to a corporation if a partial working interest is taken rather than the entire working interest. The RAV can be used to calculate the optimum working interest and the value of that diversification. To estimate the Apparent Risk Tolerance (ART) of an individual, division or corporation several methods can be employed: (1) ART can be calculated from the working interest selected in prior investment decisions. (2) ART can be estimated from a selection of working interests by the decision maker in a proposed portfolio of projects. (3) ART can be approximated from data released to the Security and Exchange Commission (SEC) in the annual 10K supplements (for both your company and possible partners). (4) ART can be assigned based on corporate size, budget, or activity. Examples are provided for the various methods to identify risk tolerance and apply it in making optimum working interest calculations for individual projects and portfolios.

  17. Personality, emotional adjustment, and cardiovascular risk: marriage as a mechanism.

    PubMed

    Smith, Timothy W; Baron, Carolynne E; Grove, Jeremy L

    2014-12-01

    A variety of aspects of personality and emotional adjustment predict the development and course of coronary heart disease (CHD), as do indications of marital quality (e.g., satisfaction, conflict, strain, disruption). Importantly, the personality traits and aspects of emotional adjustment that predict CHD are also related to marital quality. In such instances of correlated risk factors, traditional epidemiological and clinical research typically either ignores the potentially overlapping effects or examines independent associations through statistical controls, approaches that can misrepresent the key components and mechanisms of psychosocial effects on CHD. The interpersonal perspective in personality and clinical psychology provides an alternative and integrative approach, through its structural and process models of interpersonal behavior. We present this perspective on psychosocial risk and review research on its application to the integration of personality, emotional adjustment, and marital processes as closely interrelated influences on health and disease. PMID:24118013

  18. Personality, emotional adjustment, and cardiovascular risk: marriage as a mechanism.

    PubMed

    Smith, Timothy W; Baron, Carolynne E; Grove, Jeremy L

    2014-12-01

    A variety of aspects of personality and emotional adjustment predict the development and course of coronary heart disease (CHD), as do indications of marital quality (e.g., satisfaction, conflict, strain, disruption). Importantly, the personality traits and aspects of emotional adjustment that predict CHD are also related to marital quality. In such instances of correlated risk factors, traditional epidemiological and clinical research typically either ignores the potentially overlapping effects or examines independent associations through statistical controls, approaches that can misrepresent the key components and mechanisms of psychosocial effects on CHD. The interpersonal perspective in personality and clinical psychology provides an alternative and integrative approach, through its structural and process models of interpersonal behavior. We present this perspective on psychosocial risk and review research on its application to the integration of personality, emotional adjustment, and marital processes as closely interrelated influences on health and disease.

  19. 45 CFR 153.330 - State alternate risk adjustment methodology.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false State alternate risk adjustment methodology. 153.330 Section 153.330 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO... statistical performance metrics specified by HHS. (2) The request must include the extent to which...

  20. Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas

    PubMed Central

    Ellis, Randall P.; Fernandez, Juan Gabriel

    2013-01-01

    Interest has grown worldwide in risk adjustment and risk sharing due to their potential to contain costs, improve fairness, and reduce selection problems in health care markets. Significant steps have been made in the empirical development of risk adjustment models, and in the theoretical foundations of risk adjustment and risk sharing. This literature has often modeled the effects of risk adjustment without highlighting the institutional setting, regulations, and diverse selection problems that risk adjustment is intended to fix. Perhaps because of this, the existing literature and their recommendations for optimal risk adjustment or optimal payment systems are sometimes confusing. In this paper, we present a unified way of thinking about the organizational structure of health care systems, which enables us to focus on two key dimensions of markets that have received less attention: what choices are available that may lead to selection problems, and what financial or regulatory tools other than risk adjustment are used to influence these choices. We specifically examine the health care systems, choices, and problems in four countries: the US, Canada, Chile, and Colombia, and examine the relationship between selection-related efficiency and fairness problems and the choices that are allowed in each country, and discuss recent regulatory reforms that affect choices and selection problems. In this sample, countries and insurance programs with more choices have more selection problems. PMID:24284351

  1. Bias-adjusted satellite-based rainfall estimates for predicting floods: Narayani Basin

    USGS Publications Warehouse

    Shrestha, M.S.; Artan, G.A.; Bajracharya, S.R.; Gautam, D.K.; Tokar, S.A.

    2011-01-01

    In Nepal, as the spatial distribution of rain gauges is not sufficient to provide detailed perspective on the highly varied spatial nature of rainfall, satellite-based rainfall estimates provides the opportunity for timely estimation. This paper presents the flood prediction of Narayani Basin at the Devghat hydrometric station (32000km2) using bias-adjusted satellite rainfall estimates and the Geospatial Stream Flow Model (GeoSFM), a spatially distributed, physically based hydrologic model. The GeoSFM with gridded gauge observed rainfall inputs using kriging interpolation from 2003 was used for calibration and 2004 for validation to simulate stream flow with both having a Nash Sutcliff Efficiency of above 0.7. With the National Oceanic and Atmospheric Administration Climate Prediction Centre's rainfall estimates (CPC-RFE2.0), using the same calibrated parameters, for 2003 the model performance deteriorated but improved after recalibration with CPC-RFE2.0 indicating the need to recalibrate the model with satellite-based rainfall estimates. Adjusting the CPC-RFE2.0 by a seasonal, monthly and 7-day moving average ratio, improvement in model performance was achieved. Furthermore, a new gauge-satellite merged rainfall estimates obtained from ingestion of local rain gauge data resulted in significant improvement in flood predictability. The results indicate the applicability of satellite-based rainfall estimates in flood prediction with appropriate bias correction. ?? 2011 The Authors. Journal of Flood Risk Management ?? 2011 The Chartered Institution of Water and Environmental Management.

  2. 45 CFR 153.360 - Application of risk adjustment to the small group market.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT State Standards Related to the Risk Adjustment Program § 153.360...

  3. Estimation of adjusted rate differences using additive negative binomial regression.

    PubMed

    Donoghoe, Mark W; Marschner, Ian C

    2016-08-15

    Rate differences are an important effect measure in biostatistics and provide an alternative perspective to rate ratios. When the data are event counts observed during an exposure period, adjusted rate differences may be estimated using an identity-link Poisson generalised linear model, also known as additive Poisson regression. A problem with this approach is that the assumption of equality of mean and variance rarely holds in real data, which often show overdispersion. An additive negative binomial model is the natural alternative to account for this; however, standard model-fitting methods are often unable to cope with the constrained parameter space arising from the non-negativity restrictions of the additive model. In this paper, we propose a novel solution to this problem using a variant of the expectation-conditional maximisation-either algorithm. Our method provides a reliable way to fit an additive negative binomial regression model and also permits flexible generalisations using semi-parametric regression functions. We illustrate the method using a placebo-controlled clinical trial of fenofibrate treatment in patients with type II diabetes, where the outcome is the number of laser therapy courses administered to treat diabetic retinopathy. An R package is available that implements the proposed method. Copyright © 2016 John Wiley & Sons, Ltd. PMID:27073156

  4. Risk Adjustment for Medicare Total Knee Arthroplasty Bundled Payments.

    PubMed

    Clement, R Carter; Derman, Peter B; Kheir, Michael M; Soo, Adrianne E; Flynn, David N; Levin, L Scott; Fleisher, Lee

    2016-09-01

    The use of bundled payments is growing because of their potential to align providers and hospitals on the goal of cost reduction. However, such gain sharing could incentivize providers to "cherry-pick" more profitable patients. Risk adjustment can prevent this unintended consequence, yet most bundling programs include minimal adjustment techniques. This study was conducted to determine how bundled payments for total knee arthroplasty (TKA) should be adjusted for risk. The authors collected financial data for all Medicare patients (age≥65 years) undergoing primary unilateral TKA at an academic center over a period of 2 years (n=941). Multivariate regression was performed to assess the effect of patient factors on the costs of acute inpatient care, including unplanned 30-day readmissions. This analysis mirrors a bundling model used in the Medicare Bundled Payments for Care Improvement initiative. Increased age, American Society of Anesthesiologists (ASA) class, and the presence of a Medicare Major Complications/Comorbid Conditions (MCC) modifier (typically representing major complications) were associated with increased costs (regression coefficients, $57 per year; $729 per ASA class beyond I; and $3122 for patients meeting MCC criteria; P=.003, P=.001, and P<.001, respectively). Differences in costs were not associated with body mass index, sex, or race. If the results are generalizable, Medicare bundled payments for TKA encompassing acute inpatient care should be adjusted upward by the stated amounts for older patients, those with elevated ASA class, and patients meeting MCC criteria. This is likely an underestimate for many bundling models, including the Comprehensive Care for Joint Replacement program, incorporating varying degrees of postacute care. Failure to adjust for factors that affect costs may create adverse incentives, creating barriers to care for certain patient populations. [Orthopedics. 2016; 39(5):e911-e916.]. PMID:27359282

  5. Effect of Wound Classification on Risk-Adjustment in American College of Surgeons NSQIP

    PubMed Central

    Ju, Mila H.; Cohen, Mark E.; Bilimoria, Karl Y.; Latus, Melissa S.; Scholl, Lisa M.; Schwab, Bradley J.; Byrd, Claudia M.; Ko, Clifford Y.; Dellinger, E. Patchen; Hall, Bruce L.

    2014-01-01

    Background Surgical wound classification has been used in risk-adjustment models. However, it can be subjective and potentially improperly bias hospital quality comparisons. The objective is to examine the effect of wound classification on hospital performance risk-adjustment models. Study Design Retrospective review of the 2011 ACS NSQIP database was conducted for wound classification categories: clean, clean/contaminated, contaminated, and dirty/infected. To assess the influence of wound classification on risk-adjustment, two models were developed for each outcome: one including and one excluding wound classification. For each model, hospital postoperative complications were estimated using hierarchical multivariable regression methods. Absolute changes in hospital rank, correlations of odds-ratios, and outlier status agreement between models were examined. Results Of the 442,149 cases performed in 315 hospitals: 53.6% were classified as clean; 34.2% clean/contaminated; 6.7% contaminated; and 5.5% dirty/infected. The surgical site infection (SSI) rate was highest in dirty/infected (8.5%) and lowest in clean (1.8%) cases. For overall SSI, the absolute change in risk-adjusted hospital performance rank between models including vs. excluding wound classification was minimal (mean 4.5 out of 315 positions). The correlations between odds ratios of the two performance models were nearly perfect (R=0.9976, P<0.0001), and outlier status agreement was excellent (Kappa=0.9508, P<0.0001). Similar findings were observed in models of subgroups of SSI and other postoperative outcomes. Conclusions In circumstances where alternate information is available for risk-adjustment, there appear to be minimal differences in performance models that include vs. exclude wound classification. Therefore, ACS NSQIP is critically evaluating the continued use of wound classification in hospital performance risk-adjustment models. PMID:25053222

  6. Risk-adjusted outcome measurement in pediatric allogeneic stem cell transplantation.

    PubMed

    Matthes-Martin, Susanne; Pötschger, Ulrike; Bergmann, Kirsten; Frommlet, Florian; Brannath, Werner; Bauer, Peter; Klingebiel, Thomas

    2008-03-01

    The purpose of the study was to define a risk score for 1-year treatment-related mortality (TRM) in children undergoing allogeneic stem cell transplantation as a basis for risk-adjusted outcome assessment. We analyzed 1364 consecutive stem cell transplants performed in 24 German and Austrian centers between 1998 and 2003. Five well-established risk factors were tested by multivariate logistic regression for predictive power: patient age, disease status, donor other than matched sibling donor, T cell depletion (TCD), and preceding stem cell transplantation. The risk score was defined by rounding the parameter estimates of the significant risk factors to the nearest integer. Crossvalidation was performed on the basis of 5 randomly extracted equal-sized parts from the database. Additionally, the score was validated for different disease entities and for single centers. Multivariate analysis revealed a significant correlation of TRM with 3 risk factors: age >10 years, advanced disease, and alternative donor. The parameter estimates were 0.76 for age, 0.73 for disease status, and 0.97 for donor type. Rounding the estimates resulted in a score with 1 point for each risk factor. One-year TRM (overall survival [OS]) were 5% (89%) with a score of 0, 18% (74%) with 1, 28% (54%) with 2, and 53% (27%) with 3 points. Crossvalidation showed stable results with a good correlation between predicted and observed mortality but moderate discrimination. The score seems to be a simple instrument to estimate the expected mortality for each risk group and for each center. Measuring TRM risk-adjusted and the comparison between expected and observed mortality may be an additional tool for outcome assessment in pediatric stem cell transplantation. PMID:18275900

  7. Level of education and multiple sclerosis risk after adjustment for known risk factors: The EnvIMS study

    PubMed Central

    Bjørnevik, Kjetil; Riise, Trond; Cortese, Marianna; Holmøy, Trygve; Kampman, Margitta T; Magalhaes, Sandra; Myhr, Kjell-Morten; Wolfson, Christina; Pugliatti, Maura

    2016-01-01

    Background: Several recent studies have found a higher risk of multiple sclerosis (MS) among people with a low level of education. This has been suggested to reflect an effect of smoking and lower vitamin D status in the social class associated with lower levels of education. Objective: The objective of this paper is to investigate the association between level of education and MS risk adjusting for the known risk factors smoking, infectious mononucleosis, indicators of vitamin D levels and body size. Methods: Within the case-control study on Environmental Factors In MS (EnvIMS), 953 MS patients and 1717 healthy controls from Norway reported educational level and history of exposure to putative environmental risk factors. Results: Higher level of education were associated with decreased MS risk (p trend = 0.001) with an OR of 0.53 (95% CI 0.41–0.68) when comparing those with the highest and lowest level of education. This association was only moderately reduced after adjusting for known risk factors (OR 0.61, 95% CI 0.44–0.83). The estimates remained similar when cases with disease onset before age 28 were excluded. Conclusion: These findings suggest that factors related to lower socioeconomic status other than established risk factors are associated with MS risk. PMID:26014605

  8. Risk-adjusted melanoma skin cancer incidence rates in Whites (United States).

    PubMed

    Merrill, Ray Martell

    2011-12-01

    The objective of this study was to obtain a better population-based measure of risk for melanoma skin cancer. A method has been previously proposed for estimating cancer incidence rates for data collected from the Surveillance, Epidemiology, and End Results (SEER) program. Unlike conventionally reported incidence rates in the USA, this method uses the first primary cancer and adjusts for population-based cancer prevalence to obtain a better measure of cancer risk. The study involves SEER data for white men and women. Conventional melanoma incidence rates overestimate risk for men, increasingly so from 3.3% in the age group of 30-39 years to 11.3% in the age group of 80 years and older. Overestimation in risk for women ranged from 3.3% in the age group of 30-39 years to 8.9% in the age group of 80 years and older. Overestimation of risk was more pronounced when both in-situ and malignant melanomas were considered. Increasing trends in conventional rates were slightly greater than trends in risk-adjusted incidence rates (RAIRs). In 2007, the estimated number of cases with malignant melanoma among the white population based on conventional cancer incidence rates is 37 636 (64 125 including in-situ cases) for men and 28 935 (49 361 including in-situ cases) for women. The estimated number of cases in the USA based on RAIRS is 34 652 [(7.9%); 55 413 (13.6%) including in-situ cases] for male and 27 178 [(6.1%); 44 467 (9.9%) including in-situ cases] for women. We concluded that RAIRs are a better measure of melanoma skin cancer risk and should be used for estimating the number of cancer patients in the USA.

  9. Adjusting effect estimates for unmeasured confounding with validation data using propensity score calibration

    PubMed Central

    Stürmer, Til; Schneeweiss, Sebastian; Avorn, Jerry; Glynn, Robert J

    2006-01-01

    Often important confounders are not available in studies. Sensitivity analyses based on the relation of single, but not multiple, unmeasured confounders with an exposure of interest in a separate validation study have been proposed. The authors controlled for measured confounding in the main cohort using propensity scores (PS) and addressed unmeasured confounding by estimating two additional PS in a validation study. The ‘error-prone’ PS exclusively used information available in the main cohort. The ‘gold-standard’ PS additionally included covariates available only in the validation study. Based on these two PS in the validation study, regression calibration was applied to adjust regression coefficients. This propensity score calibration (PSC) adjusts for unmeasured confounding in cohort studies with validation data under certain, usually untestable, assumptions. PSC was used to assess nonsteroidal antiinflammatory drugs (NSAID) and 1-year mortality in a large cohort of elderly. ‘Traditional’ adjustment resulted in a relative risk (RR) in NSAID users of 0.80 (95% confidence interval: 0.77–0.83) compared to an unadjusted RR of 0.68 (0.66–0.71). Application of PSC resulted in a more plausible RR of 1.06 (1.00–1.12). Until validity and limitations of PSC have been assessed in different settings, the method should be seen as a sensitivity analysis. PMID:15987725

  10. Risk adjustment under the Affordable Care Act: a guide for federal and state regulators.

    PubMed

    Hall, Mark A

    2011-05-01

    To achieve the aims of the Affordable Care Act, state and federal regulators must construct an effective system of risk adjustment, one that protects health insurers that attract a disproportionate share of patients with poor health risks. This brief, which summarizes a Commonwealth Fund–supported conference of leading risk adjustment experts, explores the challenges regulators will face, considers the consequences of the law's risk adjustment provisions, and analyzes the merits of different risk adjustment strategies. Among other recommendations, the brief suggests that regulators use diagnostic rather than only demographic risk measures, that they allow states some but limited flexibility to tailor risk adjustment methods to local circumstances, and that they phase in the use of risk transfer payments to give insurers more time to predict and understand the full effects of risk adjustment.

  11. 45 CFR 153.630 - Data validation requirements when HHS operates risk adjustment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Health Insurance Issuer Standards Related to the Risk Adjustment... that it and its initial validation auditor comply with the security standards described at 45 CFR...

  12. Procedure for estimating orbital debris risks

    NASA Technical Reports Server (NTRS)

    Crafts, J. L.; Lindberg, J. P.

    1985-01-01

    A procedure for estimating the potential orbital debris risk to the world's populace from payloads or spent stages left in orbit on future missions is presented. This approach provides a consistent, but simple, procedure to assess the risk due to random reentry with an adequate accuracy level for making programmatic decisions on planned low Earth orbit missions.

  13. [Adjustment to a Stressful Event in the Couple: Depression of the Partner as Risk for Adjustment Disorder].

    PubMed

    Horn, Andrea B; Maercker, Andreas

    2015-08-01

    Maladaptive reactions on stressful experiences justifying a diagnosis of adjustment disorder have high prevalence. Little is known about the possible risk for clinically significant maladaptation that results from the social context. The literature on the effects of depression on communication and altered support conditions in couples is suggesting this. Aim of this study was to investigate whether clinically significant depression in the romantic partner is a risk factor for adjustment disorder following a concept of stress-response disorder. Furthermore, from a dimensional point of view a possible positive association between depressive symptoms in the partner and own adjustment symptom was studied. Thereby, own depressive symptoms were controlled for in order to exclude mere depressive contagion and isolate stress-related responses. In an online-couple-study N=294 participants (N=147 couples) reported whether or not they had experienced a stressful event that is still bothering them. N=152 participants reported such an event. N=28 of this group reached the threshold of a possible diagnosis with the screening questionnaire "Adjustment disorder New Module". N=14 romantic partners reported depressive symptoms above the cut-off of the CES-D. The risk for an adjustment disorder is elevated if the female partner reports a clinically significant level of depressive symptoms (OR 7.13). This was only true when female partners were depressed, the depression of male partners did not show any significant associations. Accordingly, dimensionally there is a positive association between depressive symptoms of the female partner and adjustment symptoms of preoccupation (stressor-related repetitive negative thoughts). Depression of the romantic partner seems to be a significant risk factor for maladaptive reactions on a stressful event. This was particularly true for male participants of the study. To sum up, results encourage taking up an interpersonal perspective in research

  14. 48 CFR 215.404-71-3 - Contract type risk and working capital adjustment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... provisions for performance-based payments, do not compute a working capital adjustment. (d) Evaluation... working capital adjustment. 215.404-71-3 Section 215.404-71-3 Federal Acquisition Regulations System... CONTRACTING BY NEGOTIATION Contract Pricing 215.404-71-3 Contract type risk and working capital adjustment....

  15. 48 CFR 215.404-71-3 - Contract type risk and working capital adjustment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... provisions for performance-based payments, do not compute a working capital adjustment. (d) Evaluation... working capital adjustment. 215.404-71-3 Section 215.404-71-3 Federal Acquisition Regulations System... CONTRACTING BY NEGOTIATION Contract Pricing 215.404-71-3 Contract type risk and working capital adjustment....

  16. 48 CFR 215.404-71-3 - Contract type risk and working capital adjustment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... provisions for performance-based payments, do not compute a working capital adjustment. (d) Evaluation... working capital adjustment. 215.404-71-3 Section 215.404-71-3 Federal Acquisition Regulations System... CONTRACTING BY NEGOTIATION Contract Pricing 215.404-71-3 Contract type risk and working capital adjustment....

  17. 48 CFR 215.404-71-3 - Contract type risk and working capital adjustment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... provisions for performance-based payments, do not compute a working capital adjustment. (d) Evaluation... working capital adjustment. 215.404-71-3 Section 215.404-71-3 Federal Acquisition Regulations System... CONTRACTING BY NEGOTIATION Contract Pricing 215.404-71-3 Contract type risk and working capital adjustment....

  18. 26 CFR 1.6425-1 - Adjustment of overpayment of estimated income tax by corporation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES Abatements, Credits, and Refunds § 1.6425-1 Adjustment of overpayment of estimated income tax by corporation. (a) In general. Any corporation which has made an overpayment of estimated income tax for a taxable year beginning after December...

  19. 26 CFR 1.6425-1 - Adjustment of overpayment of estimated income tax by corporation.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Abatements, Credits, and Refunds § 1.6425-1 Adjustment of overpayment of estimated income tax by corporation. (a) In general. Any corporation which has made an overpayment of estimated income tax for a taxable year beginning after...

  20. 26 CFR 1.6425-1 - Adjustment of overpayment of estimated income tax by corporation.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Abatements, Credits, and Refunds § 1.6425-1 Adjustment of overpayment of estimated income tax by corporation. (a) In general. Any corporation which has made an overpayment of estimated income tax for a taxable year beginning after...

  1. 26 CFR 1.6425-1 - Adjustment of overpayment of estimated income tax by corporation.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Abatements, Credits, and Refunds § 1.6425-1 Adjustment of overpayment of estimated income tax by corporation. (a) In general. Any corporation which has made an overpayment of estimated income tax for a taxable year beginning after...

  2. 26 CFR 1.6425-1 - Adjustment of overpayment of estimated income tax by corporation.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Abatements, Credits, and Refunds § 1.6425-1 Adjustment of overpayment of estimated income tax by corporation. (a) In general. Any corporation which has made an overpayment of estimated income tax for a taxable year beginning after...

  3. Cause-specific premature death from ambient PM2.5 exposure in India: Estimate adjusted for baseline mortality.

    PubMed

    Chowdhury, Sourangsu; Dey, Sagnik

    2016-05-01

    In India, more than a billion population is at risk of exposure to ambient fine particulate matter (PM2.5) concentration exceeding World Health Organization air quality guideline, posing a serious threat to health. Cause-specific premature death from ambient PM2.5 exposure is poorly known for India. Here we develop a non-linear power law (NLP) function to estimate the relative risk associated with ambient PM2.5 exposure using satellite-based PM2.5 concentration (2001-2010) that is bias-corrected against coincident direct measurements. We show that estimate of annual premature death in India is lower by 14.7% (19.2%) using NLP (integrated exposure risk function, IER) for assumption of uniform baseline mortality across India (as considered in the global burden of disease study) relative to the estimate obtained by adjusting for state-specific baseline mortality using GDP as a proxy. 486,100 (811,000) annual premature death in India is estimated using NLP (IER) risk functions after baseline mortality adjustment. 54.5% of premature death estimated using NLP risk function is attributed to chronic obstructive pulmonary disease (COPD), 24.0% to ischemic heart disease (IHD), 18.5% to stroke and the remaining 3.0% to lung cancer (LC). 44,900 (5900-173,300) less premature death is expected annually, if India achieves its present annual air quality target of 40μgm(-3). Our results identify the worst affected districts in terms of ambient PM2.5 exposure and resulting annual premature death and call for initiation of long-term measures through a systematic framework of pollution and health data archive. PMID:27063285

  4. Cumulative Family Risk Predicts Increases in Adjustment Difficulties across Early Adolescence

    ERIC Educational Resources Information Center

    Buehler, Cheryl; Gerard, Jean M.

    2013-01-01

    Family is an important socialization context for youth as they move through early adolescence. A significant feature of this complex socialization context is the accumulation of potential family risk factors that may compromise youth adjustment. This study examined cumulative family risk and adolescents' adjustment difficulties in 416 two-parent…

  5. Uncertainty-based Estimation of the Secure Range for ISO New England Dynamic Interchange Adjustment

    SciTech Connect

    Etingov, Pavel V.; Makarov, Yuri V.; Wu, Di; Hou, Zhangshuan; Sun, Yannan; Maslennikov, S.; Luo, Xiaochuan; Zheng, T.; George, S.; Knowland, T.; Litvinov, E.; Weaver, S.; Sanchez, E.

    2014-04-14

    The paper proposes an approach to estimate the secure range for dynamic interchange adjustment, which assists system operators in scheduling the interchange with neighboring control areas. Uncertainties associated with various sources are incorporated. The proposed method is implemented in the dynamic interchange adjustment (DINA) tool developed by Pacific Northwest National Laboratory (PNNL) for ISO New England. Simulation results are used to validate the effectiveness of the proposed method.

  6. Log Pearson type 3 quantile estimators with regional skew information and low outlier adjustments

    USGS Publications Warehouse

    Griffis, V.W.; Stedinger, J.R.; Cohn, T.A.

    2004-01-01

    [1] The recently developed expected moments algorithm (EMA) [Cohn et al., 1997] does as well as maximum likelihood estimations at estimating log-Pearson type 3 (LP3) flood quantiles using systematic and historical flood information. Needed extensions include use of a regional skewness estimator and its precision to be consistent with Bulletin 17B. Another issue addressed by Bulletin 17B is the treatment of low outliers. A Monte Carlo study compares the performance of Bulletin 17B using the entire sample with and without regional skew with estimators that use regional skew and censor low outliers, including an extended EMA estimator, the conditional probability adjustment (CPA) from Bulletin 17B, and an estimator that uses probability plot regression (PPR) to compute substitute values for low outliers. Estimators that neglect regional skew information do much worse than estimators that use an informative regional skewness estimator. For LP3 data the low outlier rejection procedure generally results in no loss of overall accuracy, and the differences between the MSEs of the estimators that used an informative regional skew are generally modest in the skewness range of real interest. Samples contaminated to model actual flood data demonstrate that estimators which give special treatment to low outliers significantly outperform estimators that make no such adjustment.

  7. New ventures require accurate risk analyses and adjustments.

    PubMed

    Eastaugh, S R

    2000-01-01

    For new business ventures to succeed, healthcare executives need to conduct robust risk analyses and develop new approaches to balance risk and return. Risk analysis involves examination of objective risks and harder-to-quantify subjective risks. Mathematical principles applied to investment portfolios also can be applied to a portfolio of departments or strategic business units within an organization. The ideal business investment would have a high expected return and a low standard deviation. Nonetheless, both conservative and speculative strategies should be considered in determining an organization's optimal service line and helping the organization manage risk.

  8. School Adjustment of Children at Risk through Fourth Grade.

    ERIC Educational Resources Information Center

    Reynolds, Arthur J.; Bezruczko, Nikolaus

    1993-01-01

    Used longitudinal data collected from parents, teachers, and children to test social psychological predictors of early school adjustment of 1,255 low-income children from kindergarten to fourth grade. Found that parent involvement was positively related to achievement and teacher ratings of school progress. (MM)

  9. Estimating Terrorist Risk with Possibility Theory

    SciTech Connect

    J.L. Darby

    2004-11-30

    This report summarizes techniques that use possibility theory to estimate the risk of terrorist acts. These techniques were developed under the sponsorship of the Department of Homeland Security (DHS) as part of the National Infrastructure Simulation Analysis Center (NISAC) project. The techniques have been used to estimate the risk of various terrorist scenarios to support NISAC analyses during 2004. The techniques are based on the Logic Evolved Decision (LED) methodology developed over the past few years by Terry Bott and Steve Eisenhawer at LANL. [LED] The LED methodology involves the use of fuzzy sets, possibility theory, and approximate reasoning. LED captures the uncertainty due to vagueness and imprecision that is inherent in the fidelity of the information available for terrorist acts; probability theory cannot capture these uncertainties. This report does not address the philosophy supporting the development of nonprobabilistic approaches, and it does not discuss possibility theory in detail. The references provide a detailed discussion of these subjects. [Shafer] [Klir and Yuan] [Dubois and Prade] Suffice to say that these approaches were developed to address types of uncertainty that cannot be addressed by a probability measure. An earlier report discussed in detail the problems with using a probability measure to evaluate terrorist risk. [Darby Methodology]. Two related techniques are discussed in this report: (1) a numerical technique, and (2) a linguistic technique. The numerical technique uses traditional possibility theory applied to crisp sets, while the linguistic technique applies possibility theory to fuzzy sets. Both of these techniques as applied to terrorist risk for NISAC applications are implemented in software called PossibleRisk. The techniques implemented in PossibleRisk were developed specifically for use in estimating terrorist risk for the NISAC program. The LEDTools code can be used to perform the same linguistic evaluation as

  10. Bias adjustment of satellite-based precipitation estimation using gauge observations: A case study in Chile

    NASA Astrophysics Data System (ADS)

    Yang, Zhongwen; Hsu, Kuolin; Sorooshian, Soroosh; Xu, Xinyi; Braithwaite, Dan; Verbist, Koen M. J.

    2016-04-01

    Satellite-based precipitation estimates (SPEs) are promising alternative precipitation data for climatic and hydrological applications, especially for regions where ground-based observations are limited. However, existing satellite-based rainfall estimations are subject to systematic biases. This study aims to adjust the biases in the Precipitation Estimation from Remotely Sensed Information using Artificial Neural Networks-Cloud Classification System (PERSIANN-CCS) rainfall data over Chile, using gauge observations as reference. A novel bias adjustment framework, termed QM-GW, is proposed based on the nonparametric quantile mapping approach and a Gaussian weighting interpolation scheme. The PERSIANN-CCS precipitation estimates (daily, 0.04°×0.04°) over Chile are adjusted for the period of 2009-2014. The historical data (satellite and gauge) for 2009-2013 are used to calibrate the methodology; nonparametric cumulative distribution functions of satellite and gauge observations are estimated at every 1°×1° box region. One year (2014) of gauge data was used for validation. The results show that the biases of the PERSIANN-CCS precipitation data are effectively reduced. The spatial patterns of adjusted satellite rainfall show high consistency to the gauge observations, with reduced root-mean-square errors and mean biases. The systematic biases of the PERSIANN-CCS precipitation time series, at both monthly and daily scales, are removed. The extended validation also verifies that the proposed approach can be applied to adjust SPEs into the future, without further need for ground-based measurements. This study serves as a valuable reference for the bias adjustment of existing SPEs using gauge observations worldwide.

  11. REVIEW OF DRAFT REVISED BLUE BOOK ON ESTIMATING CANCER RISKS FROM EXPOSURE TO IONIZING RADIATION

    EPA Science Inventory

    In 1994, EPA published a report, referred to as the “Blue Book,” which lays out EPA’s current methodology for quantitatively estimating radiogenic cancer risks. A follow-on report made minor adjustments to the previous estimates and presented a partial analysis of the uncertainti...

  12. Baseline Estimation Algorithm with Block Adjustment for Multi-Pass Dual-Antenna Insar

    NASA Astrophysics Data System (ADS)

    Jin, Guowang; Xiong, Xin; Xu, Qing; Gong, Zhihui; Zhou, Yang

    2016-06-01

    Baseline parameters and interferometric phase offset need to be estimated accurately, for they are key parameters in processing of InSAR (Interferometric Synthetic Aperture Radar). If adopting baseline estimation algorithm with single pass, it needs large quantities of ground control points to estimate interferometric parameters for mosaicking multiple passes dual-antenna airborne InSAR data that covers large areas. What's more, there will be great difference between heights derived from different passes due to the errors of estimated parameters. So, an estimation algorithm of interferometric parameters with block adjustment for multi-pass dual-antenna InSAR is presented to reduce the needed ground control points and height's difference between different passes. The baseline estimation experiments were done with multi-pass InSAR data obtained by Chinese dual-antenna airborne InSAR system. Although there were less ground control points, the satisfied results were obtained, as validated the proposed baseline estimation algorithm.

  13. Evaluating methods for estimating existential risks.

    PubMed

    Tonn, Bruce; Stiefel, Dorian

    2013-10-01

    Researchers and commissions contend that the risk of human extinction is high, but none of these estimates have been based upon a rigorous methodology suitable for estimating existential risks. This article evaluates several methods that could be used to estimate the probability of human extinction. Traditional methods evaluated include: simple elicitation; whole evidence Bayesian; evidential reasoning using imprecise probabilities; and Bayesian networks. Three innovative methods are also considered: influence modeling based on environmental scans; simple elicitation using extinction scenarios as anchors; and computationally intensive possible-worlds modeling. Evaluation criteria include: level of effort required by the probability assessors; level of effort needed to implement the method; ability of each method to model the human extinction event; ability to incorporate scientific estimates of contributory events; transparency of the inputs and outputs; acceptability to the academic community (e.g., with respect to intellectual soundness, familiarity, verisimilitude); credibility and utility of the outputs of the method to the policy community; difficulty of communicating the method's processes and outputs to nonexperts; and accuracy in other contexts. The article concludes by recommending that researchers assess the risks of human extinction by combining these methods. PMID:23551083

  14. 26 CFR 301.6425-1 - Adjustment of overpayment of estimated income tax by corporation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... income tax by corporation. For regulations under section 6425, see §§ 1.6425-1 to 1.6425-3, inclusive, of this chapter (Income Tax Regulations). ... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Adjustment of overpayment of estimated...

  15. 26 CFR 301.6425-1 - Adjustment of overpayment of estimated income tax by corporation.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... income tax by corporation. For regulations under section 6425, see §§ 1.6425-1 to 1.6425-3, inclusive, of this chapter (Income Tax Regulations). ... 26 Internal Revenue 18 2011-04-01 2011-04-01 false Adjustment of overpayment of estimated...

  16. 26 CFR 301.6425-1 - Adjustment of overpayment of estimated income tax by corporation.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... income tax by corporation. For regulations under section 6425, see §§ 1.6425-1 to 1.6425-3, inclusive, of this chapter (Income Tax Regulations). ... 26 Internal Revenue 18 2012-04-01 2012-04-01 false Adjustment of overpayment of estimated...

  17. 26 CFR 301.6425-1 - Adjustment of overpayment of estimated income tax by corporation.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... income tax by corporation. For regulations under section 6425, see §§ 1.6425-1 to 1.6425-3, inclusive, of this chapter (Income Tax Regulations). ... 26 Internal Revenue 18 2014-04-01 2014-04-01 false Adjustment of overpayment of estimated...

  18. 26 CFR 301.6425-1 - Adjustment of overpayment of estimated income tax by corporation.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... income tax by corporation. For regulations under section 6425, see §§ 1.6425-1 to 1.6425-3, inclusive, of this chapter (Income Tax Regulations). ... 26 Internal Revenue 18 2013-04-01 2013-04-01 false Adjustment of overpayment of estimated...

  19. Risk Estimation Methodology for Launch Accidents.

    SciTech Connect

    Clayton, Daniel James; Lipinski, Ronald J.; Bechtel, Ryan D.

    2014-02-01

    As compact and light weight power sources with reliable, long lives, Radioisotope Power Systems (RPSs) have made space missions to explore the solar system possible. Due to the hazardous material that can be released during a launch accident, the potential health risk of an accident must be quantified, so that appropriate launch approval decisions can be made. One part of the risk estimation involves modeling the response of the RPS to potential accident environments. Due to the complexity of modeling the full RPS response deterministically on dynamic variables, the evaluation is performed in a stochastic manner with a Monte Carlo simulation. The potential consequences can be determined by modeling the transport of the hazardous material in the environment and in human biological pathways. The consequence analysis results are summed and weighted by appropriate likelihood values to give a collection of probabilistic results for the estimation of the potential health risk. This information is used to guide RPS designs, spacecraft designs, mission architecture, or launch procedures to potentially reduce the risk, as well as to inform decision makers of the potential health risks resulting from the use of RPSs for space missions.

  20. Diagnosis-Based Risk Adjustment for Medicare Prescription Drug Plan Payments

    PubMed Central

    Robst, John; Levy, Jesse M.; Ingber, Melvin J.

    2007-01-01

    The 2003 Medicare Prescription Drug, Improvement, and Modernization Act (MMA) created Medicare Part D, a voluntary prescription drug benefit program. The benefit is a government subsidized prescription drug benefit within Medicare. This article focuses on the development of the prescription drug risk-adjustment model used to adjust payments to reflect the health status of plan enrollees. PMID:17722748

  1. Adjustment of lifetime risks of space radiation-induced cancer by the healthy worker effect and cancer misclassification.

    PubMed

    Peterson, Leif E; Kovyrshina, Tatiana

    2015-12-01

    Background. The healthy worker effect (HWE) is a source of bias in occupational studies of mortality among workers caused by use of comparative disease rates based on public data, which include mortality of unhealthy members of the public who are screened out of the workplace. For the US astronaut corp, the HWE is assumed to be strong due to the rigorous medical selection and surveillance. This investigation focused on the effect of correcting for HWE on projected lifetime risk estimates for radiation-induced cancer mortality and incidence. Methods. We performed radiation-induced cancer risk assessment using Poisson regression of cancer mortality and incidence rates among Hiroshima and Nagasaki atomic bomb survivors. Regression coefficients were used for generating risk coefficients for the excess absolute, transfer, and excess relative models. Excess lifetime risks (ELR) for radiation exposure and baseline lifetime risks (BLR) were adjusted for the HWE using standardized mortality ratios (SMR) for aviators and nuclear workers who were occupationally exposed to ionizing radiation. We also adjusted lifetime risks by cancer mortality misclassification among atomic bomb survivors. Results. For all cancers combined ("Nonleukemia"), the effect of adjusting the all-cause hazard rate by the simulated quantiles of the all-cause SMR resulted in a mean difference (not percent difference) in ELR of 0.65% and mean difference of 4% for mortality BLR, and mean change of 6.2% in BLR for incidence. The effect of adjusting the excess (radiation-induced) cancer rate or baseline cancer hazard rate by simulated quantiles of cancer-specific SMRs resulted in a mean difference of [Formula: see text] in the all-cancer mortality ELR and mean difference of [Formula: see text] in the mortality BLR. Whereas for incidence, the effect of adjusting by cancer-specific SMRs resulted in a mean change of [Formula: see text] for the all-cancer BLR. Only cancer mortality risks were adjusted by

  2. Estimating contaminant loads in rivers: An application of adjusted maximum likelihood to type 1 censored data

    USGS Publications Warehouse

    Cohn, T.A.

    2005-01-01

    This paper presents an adjusted maximum likelihood estimator (AMLE) that can be used to estimate fluvial transport of contaminants, like phosphorus, that are subject to censoring because of analytical detection limits. The AMLE is a generalization of the widely accepted minimum variance unbiased estimator (MVUE), and Monte Carlo experiments confirm that it shares essentially all of the MVUE's desirable properties, including high efficiency and negligible bias. In particular, the AMLE exhibits substantially less bias than alternative censored-data estimators such as the MLE (Tobit) or the MLE followed by a jackknife. As with the MLE and the MVUE the AMLE comes close to achieving the theoretical Frechet-Crame??r-Rao bounds on its variance. This paper also presents a statistical framework, applicable to both censored and complete data, for understanding and estimating the components of uncertainty associated with load estimates. This can serve to lower the cost and improve the efficiency of both traditional and real-time water quality monitoring.

  3. Estimation and adjustment of self-selection bias in volunteer panel web surveys

    NASA Astrophysics Data System (ADS)

    Niu, Chengying

    2016-06-01

    By using propensity score matching method of random sample, we matched simple random sample units and volunteer panel Web survey sample units based on the equal or similar propensity score. The unbiased estimators of the population parameters are constructed by using the matching simple random sample, and the self-selection bias is estimated. We propose propensity score weighted and matching sample post stratification weighted methods to estimate the population parameters, and the self-selection bias in volunteer panel Web Surveys are adjusted.

  4. Computations of adjusted rates and lifetime risks from occupational cohort data: a program package using FORTRAN and GLIM.

    PubMed

    Zhou, S Y; Mazumdar, S; Redmond, C K; Dong, M H; Costantino, J P

    1991-02-01

    A program package using FORTRAN and GLIM is presented to compute lifetime risks of dying from a particular cause of death for a worker subjected to specific risk exposures using death rates adjusted for selected covariates (risk factors). Calculations of the exposure index and adjusted rates depend on several commonly used procedures. Tests of homogeneity and trend for adjusted rates are provided. Lifetime risks are calculated in two different ways: adjusting or ignoring competing causes of death.

  5. Desirability of Outcome Ranking (DOOR) and Response Adjusted for Duration of Antibiotic Risk (RADAR)

    PubMed Central

    Evans, Scott R.; Rubin, Daniel; Follmann, Dean; Pennello, Gene; Huskins, W. Charles; Powers, John H.; Schoenfeld, David; Chuang-Stein, Christy; Cosgrove, Sara E.; Fowler, Vance G.; Lautenbach, Ebbing; Chambers, Henry F.

    2015-01-01

    Clinical trials that compare strategies to optimize antibiotic use are of critical importance but are limited by competing risks that distort outcome interpretation, complexities of noninferiority trials, large sample sizes, and inadequate evaluation of benefits and harms at the patient level. The Antibacterial Resistance Leadership Group strives to overcome these challenges through innovative trial design. Response adjusted for duration of antibiotic risk (RADAR) is a novel methodology utilizing a superiority design and a 2-step process: (1) categorizing patients into an overall clinical outcome (based on benefits and harms), and (2) ranking patients with respect to a desirability of outcome ranking (DOOR). DOORs are constructed by assigning higher ranks to patients with (1) better overall clinical outcomes and (2) shorter durations of antibiotic use for similar overall clinical outcomes. DOOR distributions are compared between antibiotic use strategies. The probability that a randomly selected patient will have a better DOOR if assigned to the new strategy is estimated. DOOR/RADAR represents a new paradigm in assessing the risks and benefits of new strategies to optimize antibiotic use. PMID:26113652

  6. Desirability of Outcome Ranking (DOOR) and Response Adjusted for Duration of Antibiotic Risk (RADAR).

    PubMed

    Evans, Scott R; Rubin, Daniel; Follmann, Dean; Pennello, Gene; Huskins, W Charles; Powers, John H; Schoenfeld, David; Chuang-Stein, Christy; Cosgrove, Sara E; Fowler, Vance G; Lautenbach, Ebbing; Chambers, Henry F

    2015-09-01

    Clinical trials that compare strategies to optimize antibiotic use are of critical importance but are limited by competing risks that distort outcome interpretation, complexities of noninferiority trials, large sample sizes, and inadequate evaluation of benefits and harms at the patient level. The Antibacterial Resistance Leadership Group strives to overcome these challenges through innovative trial design. Response adjusted for duration of antibiotic risk (RADAR) is a novel methodology utilizing a superiority design and a 2-step process: (1) categorizing patients into an overall clinical outcome (based on benefits and harms), and (2) ranking patients with respect to a desirability of outcome ranking (DOOR). DOORs are constructed by assigning higher ranks to patients with (1) better overall clinical outcomes and (2) shorter durations of antibiotic use for similar overall clinical outcomes. DOOR distributions are compared between antibiotic use strategies. The probability that a randomly selected patient will have a better DOOR if assigned to the new strategy is estimated. DOOR/RADAR represents a new paradigm in assessing the risks and benefits of new strategies to optimize antibiotic use.

  7. Bias-adjusted satellite-based rainfall estimates for predicting floods: Narayani Basin

    USGS Publications Warehouse

    Artan, Guleid A.; Tokar, S.A.; Gautam, D.K.; Bajracharya, S.R.; Shrestha, M.S.

    2011-01-01

    In Nepal, as the spatial distribution of rain gauges is not sufficient to provide detailed perspective on the highly varied spatial nature of rainfall, satellite-based rainfall estimates provides the opportunity for timely estimation. This paper presents the flood prediction of Narayani Basin at the Devghat hydrometric station (32 000 km2) using bias-adjusted satellite rainfall estimates and the Geospatial Stream Flow Model (GeoSFM), a spatially distributed, physically based hydrologic model. The GeoSFM with gridded gauge observed rainfall inputs using kriging interpolation from 2003 was used for calibration and 2004 for validation to simulate stream flow with both having a Nash Sutcliff Efficiency of above 0.7. With the National Oceanic and Atmospheric Administration Climate Prediction Centre's rainfall estimates (CPC_RFE2.0), using the same calibrated parameters, for 2003 the model performance deteriorated but improved after recalibration with CPC_RFE2.0 indicating the need to recalibrate the model with satellite-based rainfall estimates. Adjusting the CPC_RFE2.0 by a seasonal, monthly and 7-day moving average ratio, improvement in model performance was achieved. Furthermore, a new gauge-satellite merged rainfall estimates obtained from ingestion of local rain gauge data resulted in significant improvement in flood predictability. The results indicate the applicability of satellite-based rainfall estimates in flood prediction with appropriate bias correction.

  8. 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

  9. Dynamically adjustable foot-ground contact model to estimate ground reaction force during walking and running.

    PubMed

    Jung, Yihwan; Jung, Moonki; Ryu, Jiseon; Yoon, Sukhoon; Park, Sang-Kyoon; Koo, Seungbum

    2016-03-01

    Human dynamic models have been used to estimate joint kinetics during various activities. Kinetics estimation is in demand in sports and clinical applications where data on external forces, such as the ground reaction force (GRF), are not available. The purpose of this study was to estimate the GRF during gait by utilizing distance- and velocity-dependent force models between the foot and ground in an inverse-dynamics-based optimization. Ten males were tested as they walked at four different speeds on a force plate-embedded treadmill system. The full-GRF model whose foot-ground reaction elements were dynamically adjusted according to vertical displacement and anterior-posterior speed between the foot and ground was implemented in a full-body skeletal model. The model estimated the vertical and shear forces of the GRF from body kinematics. The shear-GRF model with dynamically adjustable shear reaction elements according to the input vertical force was also implemented in the foot of a full-body skeletal model. Shear forces of the GRF were estimated from body kinematics, vertical GRF, and center of pressure. The estimated full GRF had the lowest root mean square (RMS) errors at the slow walking speed (1.0m/s) with 4.2, 1.3, and 5.7% BW for anterior-posterior, medial-lateral, and vertical forces, respectively. The estimated shear forces were not significantly different between the full-GRF and shear-GRF models, but the RMS errors of the estimated knee joint kinetics were significantly lower for the shear-GRF model. Providing COP and vertical GRF with sensors, such as an insole-type pressure mat, can help estimate shear forces of the GRF and increase accuracy for estimation of joint kinetics. PMID:26979885

  10. Extreme Earthquake Risk Estimation by Hybrid Modeling

    NASA Astrophysics Data System (ADS)

    Chavez, M.; Cabrera, E.; Ashworth, M.; Garcia, S.; Emerson, D.; Perea, N.; Salazar, A.; Moulinec, C.

    2012-12-01

    The estimation of the hazard and the economical consequences i.e. the risk associated to the occurrence of extreme magnitude earthquakes in the neighborhood of urban or lifeline infrastructure, such as the 11 March 2011 Mw 9, Tohoku, Japan, represents a complex challenge as it involves the propagation of seismic waves in large volumes of the earth crust, from unusually large seismic source ruptures up to the infrastructure location. The large number of casualties and huge economic losses observed for those earthquakes, some of which have a frequency of occurrence of hundreds or thousands of years, calls for the development of new paradigms and methodologies in order to generate better estimates, both of the seismic hazard, as well as of its consequences, and if possible, to estimate the probability distributions of their ground intensities and of their economical impacts (direct and indirect losses), this in order to implement technological and economical policies to mitigate and reduce, as much as possible, the mentioned consequences. Herewith, we propose a hybrid modeling which uses 3D seismic wave propagation (3DWP) and neural network (NN) modeling in order to estimate the seismic risk of extreme earthquakes. The 3DWP modeling is achieved by using a 3D finite difference code run in the ~100 thousands cores Blue Gene Q supercomputer of the STFC Daresbury Laboratory of UK, combined with empirical Green function (EGF) techniques and NN algorithms. In particular the 3DWP is used to generate broadband samples of the 3D wave propagation of extreme earthquakes (plausible) scenarios corresponding to synthetic seismic sources and to enlarge those samples by using feed-forward NN. We present the results of the validation of the proposed hybrid modeling for Mw 8 subduction events, and show examples of its application for the estimation of the hazard and the economical consequences, for extreme Mw 8.5 subduction earthquake scenarios with seismic sources in the Mexican

  11. Adjusting lung cancer risks for temporal and spatial variations in radon concentration in dwellings in Gansu Province, China.

    PubMed

    Lubin, J H; Wang, Z Y; Wang, L D; Boice, J D; Cui, H X; Zhang, S R; Conrath, S; Xia, Y; Shang, B; Cao, J S; Kleinerman, R A

    2005-05-01

    Our recent study in Gansu Province, China reported an increasing risk of lung cancer with increasing residential radon concentration that was consistent with previous pooled analyses and with meta-analyses of other residential studies (Wang et al., Am. J. Epidemiol. 155, 554-564, 2002). Dosimetry used current radon measurements (1-year track-etch detectors) in homes to characterize concentrations for the previous 30 years, resulting in uncertainties in exposure and possibly reduced estimates of disease risk. We conducted a 3-year substudy in 55 houses to model the temporal and spatial variability in radon levels and to adjust estimates of radon risk. Temporal variation represented the single largest source of uncertainty, suggesting the usefulness of multi-year measurements to assess this variation; however, substantial residual variation remained unexplained. The uncertainty adjustment increased estimates of the excess odds ratio by 50-100%, suggesting that residential radon studies using similar dosimetry may also underestimate radon effects. These results have important implications for risk assessment.

  12. REFAME: Rain Estimation Using Forward Adjusted-Advection of Microwave Estimates

    NASA Technical Reports Server (NTRS)

    Behrangi, Ali; Imam, Bisher; Hsu, Kuolin; Sorooshian, Soroosh; Bellerby, Timothy J.

    2009-01-01

    Sensors flying on satellites provide the only practical means of estimating the precipitation that falls over the entire globe, particularly across the vast unpopulated expanses of Earth s oceans. The sensors that observe the Earth using microwave frequencies provide the best data, but currently these are mounted only on satellites flying in "low Earth orbit". Such satellites constantly move across the Earth s surface, providing snapshots of any given location every 12-36 hours. The entire constellation of low-orbit satellites numbers less than a dozen, and their orbits are not coordinated, so a location will frequently go two or more hours between snapshots. "Geosynchronous Earth orbit" (GEO) satellites continuously observe the same region of the globe, allowing them to provide very frequent pictures. For example, the "satellite movies" shown on television come from GEO satellites. However, the sensors available on GEO satellites cannot match the skill of the low-orbit microwave sensors in estimating precipitation. It is perhaps obvious that scientists should try to combine these very different kinds of data, taking advantage of the strengths of each, but this simple concept has proved to be a huge challenge. The scheme in this paper is "Lagrangian", meaning we follow the storm systems, rather than being tied to a fixed grid of boxes on the Earth s surface. Whenever a microwave snapshot occurs, we gladly use the resulting precipitation estimate. Then at all the times between the microwave snapshots we force the storm system to make a smooth transition from one snapshot s values to the next. We know that a lot more changes occur between the snapshots, but this smooth transition the best we can do with the microwave data alone. The key new contribution in this paper is that we also look at the relative variations in the GEO estimates during these in-between times and force the estimated changes in the precipitation to have similar variations. Preliminary testing

  13. NEED FOR INDIVIDUAL CANCER RISK ESTIMATES IN X-RAY AND NUCLEAR MEDICINE IMAGING.

    PubMed

    Mattsson, Sören

    2016-06-01

    To facilitate the justification of an X-ray or nuclear medicine investigation and for informing patients, it is desirable that the individual patient's radiation dose and potential cancer risk can be prospectively assessed and documented. The current dose-reporting is based on effective dose, which ignores body size and does not reflect the strong dependence of risk on the age at exposure. Risk estimations should better be done through individual organ dose assessments, which need careful exposure characterisation as well as anatomical description of the individual patient. In nuclear medicine, reference biokinetic models should also be replaced with models describing individual physiological states and biokinetics. There is a need to adjust population-based cancer risk estimates to the possible risk of leukaemia and solid tumours for the individual depending on age and gender. The article summarises reasons for individual cancer risk estimates and gives examples of methods and results of such estimates. PMID:26994092

  14. Relating space radiation environments to risk estimates

    NASA Technical Reports Server (NTRS)

    Curtis, Stanley B.

    1993-01-01

    A number of considerations must go into the process of determining the risk of deleterious effects of space radiation to travelers. Among them are (1) determination of the components of the radiation environment (particle species, fluxes and energy spectra) which will encounter, (2) determination of the effects of shielding provided by the spacecraft and the bodies of the travelers which modify the incident particle spectra and mix of particles, and (3) determination of relevant biological effects of the radiation in the organs of interest. The latter can then lead to an estimation of risk from a given space scenario. Clearly, the process spans many scientific disciplines from solar and cosmic ray physics to radiation transport theeory to the multistage problem of the induction by radiation of initial lesions in living material and their evolution via physical, chemical, and biological processes at the molecular, cellular, and tissue levels to produce the end point of importance.

  15. Mispricing in the medicare advantage risk adjustment model.

    PubMed

    Chen, Jing; Ellis, Randall P; Toro, Katherine H; Ash, Arlene S

    2015-01-01

    The Centers for Medicare and Medicaid Services (CMS) implemented hierarchical condition category (HCC) models in 2004 to adjust payments to Medicare Advantage (MA) plans to reflect enrollees' expected health care costs. We use Verisk Health's diagnostic cost group (DxCG) Medicare models, refined "descendants" of the same HCC framework with 189 comprehensive clinical categories available to CMS in 2004, to reveal 2 mispricing errors resulting from CMS' implementation. One comes from ignoring all diagnostic information for "new enrollees" (those with less than 12 months of prior claims). Another comes from continuing to use the simplified models that were originally adopted in response to assertions from some capitated health plans that submitting the claims-like data that facilitate richer models was too burdensome. Even the main CMS model being used in 2014 recognizes only 79 condition categories, excluding many diagnoses and merging conditions with somewhat heterogeneous costs. Omitted conditions are typically lower cost or "vague" and not easily audited from simplified data submissions. In contrast, DxCG Medicare models use a comprehensive, 394-HCC classification system. Applying both models to Medicare's 2010-2011 fee-for-service 5% sample, we find mispricing and lower predictive accuracy for the CMS implementation. For example, in 2010, 13% of beneficiaries had at least 1 higher cost DxCG-recognized condition but no CMS-recognized condition; their 2011 actual costs averaged US$6628, almost one-third more than the CMS model prediction. As MA plans must now supply encounter data, CMS should consider using more refined and comprehensive (DxCG-like) models.

  16. Net Efficacy Adjusted for Risk (NEAR): A Simple Procedure for Measuring Risk:Benefit Balance

    PubMed Central

    Boada, José N.; Boada, Carlos; García-Sáiz, Mar; García, Marcelino; Fernández, Eduardo; Gómez, Eugenio

    2008-01-01

    Background Although several mathematical models have been proposed to assess the risk:benefit of drugs in one measure, their use in practice has been rather limited. Our objective was to design a simple, easily applicable model. In this respect, measuring the proportion of patients who respond favorably to treatment without being affected by adverse drug reactions (ADR) could be a suitable endpoint. However, remarkably few published clinical trials report the data required to calculate this proportion. As an approach to the problem, we calculated the expected proportion of this type of patients. Methodology/Principal Findings Theoretically, responders without ADR may be obtained by multiplying the total number of responders by the total number of subjects that did not suffer ADR, and dividing the product by the total number of subjects studied. When two drugs are studied, the same calculation may be repeated for the second drug. Then, by constructing a 2×2 table with the expected frequencies of responders with and without ADR, and non-responders with and without ADR, the odds ratio and relative risk with their confidence intervals may be easily calculated and graphically represented on a logarithmic scale. Such measures represent “net efficacy adjusted for risk” (NEAR). We assayed the model with results extracted from several published clinical trials or meta-analyses. On comparing our results with those originally reported by the authors, marked differences were found in some cases, with ADR arising as a relevant factor to balance the clinical benefit obtained. The particular features of the adverse reaction that must be weighed against benefit is discussed in the paper. Conclusion NEAR representing overall risk-benefit may contribute to improving knowledge of drug clinical usefulness. As most published clinical trials tend to overestimate benefits and underestimate toxicity, our measure represents an effort to change this trend. PMID:18974868

  17. Child effects and child care: Implications for risk and adjustment.

    PubMed

    Snell, Emily K; Hindman, Annemarie H; Belsky, Jay

    2015-11-01

    Evocative effects of child characteristics on the quality and quantity of child care were assessed in two studies using longitudinal data from the NICHD Study of Early Child Care. We focus on the influence of child characteristics on two important aspects of the child care experience: language stimulation provided by caregivers and quantity of care. In Study 1, associations between the developmental status of children aged 15 to 54 months and the language stimulation provided by their caregivers were examined using path models, and longitudinal child effects were detected across the earliest time points of the study. In Study 2, the associations among child behavior, temperament, development, and time in care were examined. Little evidence was found for such child effects on time in care. The results are discussed in terms of the effects of child care on child development and implications for developmental processes, particularly for children at greatest risk for developmental delay or psychopathology.

  18. Child effects and child care: Implications for risk and adjustment.

    PubMed

    Snell, Emily K; Hindman, Annemarie H; Belsky, Jay

    2015-11-01

    Evocative effects of child characteristics on the quality and quantity of child care were assessed in two studies using longitudinal data from the NICHD Study of Early Child Care. We focus on the influence of child characteristics on two important aspects of the child care experience: language stimulation provided by caregivers and quantity of care. In Study 1, associations between the developmental status of children aged 15 to 54 months and the language stimulation provided by their caregivers were examined using path models, and longitudinal child effects were detected across the earliest time points of the study. In Study 2, the associations among child behavior, temperament, development, and time in care were examined. Little evidence was found for such child effects on time in care. The results are discussed in terms of the effects of child care on child development and implications for developmental processes, particularly for children at greatest risk for developmental delay or psychopathology. PMID:26439062

  19. Volcanic risk perception and adjustment in a multi-hazard environment

    NASA Astrophysics Data System (ADS)

    Perry, Ronald W.; Lindell, Michael K.

    2008-05-01

    Hazard risk perceptions and protective behaviors are examined for wildfires, earthquakes and volcanic activity. Data were gathered in two northern California (USA) communities that are exposed to all three hazard types. It was found that resident risk perceptions approximated the risks calculated by experts. Personal risks associated with fires were significantly lower than property risks associated with the same threat. The discrepancy between person and property risks for earthquakes and volcanic activity was much smaller. In general, it was found that the number of protective adjustments undertaken for each hazard was small (averaging about half of the possible number measured). When combined in a regression analysis, risk perception was not a statistically significant predictor of number of adjustments for any of the three hazards. Resident's sense of responsibility for self-protection and experience with property damage were significant predictors of adjustment for all three hazards. Information seeking behavior was significantly related to protective actions for earthquakes and volcanic activity, but not for fire hazards. In general, an insufficient number of residents reported experience with personal injury or harm to make meaningful assessments of the effect of this variable on adjustments.

  20. The Experience of Risk-Adjusted Capitation Payment for Family Physicians in Iran: A Qualitative Study

    PubMed Central

    Esmaeili, Reza; Hadian, Mohammad; Rashidian, Arash; Shariati, Mohammad; Ghaderi, Hossien

    2016-01-01

    Background When a country’s health system is faced with fundamental flaws that require the redesign of financing and service delivery, primary healthcare payment systems are often reformed. Objectives This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urban family physicians in Iran when it comes to providing primary health care (PHC). Materials and Methods This is a qualitative study using the framework method. Data were collected via digitally audio-recorded semi-structured interviews with 24 family physicians and 5 executive directors in two provinces of Iran running the urban family physician pilot program. The participants were selected using purposive and snowball sampling. The codes were extracted using inductive and deductive methods. Results Regarding the effects of risk-adjusted capitation on the primary healthcare setting, five themes with 11 subthemes emerged, including service delivery, institutional structure, financing, people’s behavior, and the challenges ahead. Our findings indicated that the health system is enjoying some major changes in the primary healthcare setting through the implementation of risk-adjusted capitation payment. Conclusions With regard to the current challenges in Iran’s health system, using risk-adjusted capitation as a primary healthcare payment system can lead to useful changes in the health system’s features. However, future research should focus on the development of the risk-adjusted capitation model. PMID:27340558

  1. Adjusting for observational secondary treatments in estimating the effects of randomized treatments.

    PubMed

    Zhang, Min; Wang, Yanping

    2013-07-01

    In randomized clinical trials, for example, on cancer patients, it is not uncommon that patients may voluntarily initiate a secondary treatment postrandomization, which needs to be properly adjusted for in estimating the "true" effects of randomized treatments. As an alternative to the approach based on a marginal structural Cox model (MSCM) in Zhang and Wang [(2012). Estimating treatment effects from a randomized trial in the presence of a secondary treatment. Biostatistics 13, 625-636], we propose methods that treat the time to start a secondary treatment as a dependent censoring process, which is handled separately from the usual censoring such as the loss to follow-up. Two estimators are proposed, both based on the idea of inversely weighting by the probability of having not started a secondary treatment yet. The second estimator focuses on improving efficiency of inference by a robust covariate-adjustment that does not require any additional assumptions. The proposed methods are evaluated and compared with the MSCM-based method in terms of bias and variance tradeoff using simulations and application to a cancer clinical trial.

  2. Software risk estimation and management techniques at JPL

    NASA Technical Reports Server (NTRS)

    Hihn, J.; Lum, K.

    2002-01-01

    In this talk we will discuss how uncertainty has been incorporated into the JPL software model, probabilistic-based estimates, and how risk is addressed, how cost risk is currently being explored via a variety of approaches, from traditional risk lists, to detailed WBS-based risk estimates to the Defect Detection and Prevention (DDP) tool.

  3. Estimating the average treatment effects of nutritional label use using subclassification with regression adjustment.

    PubMed

    Lopez, Michael J; Gutman, Roee

    2014-11-28

    Propensity score methods are common for estimating a binary treatment effect when treatment assignment is not randomized. When exposure is measured on an ordinal scale (i.e. low-medium-high), however, propensity score inference requires extensions which have received limited attention. Estimands of possible interest with an ordinal exposure are the average treatment effects between each pair of exposure levels. Using these estimands, it is possible to determine an optimal exposure level. Traditional methods, including dichotomization of the exposure or a series of binary propensity score comparisons across exposure pairs, are generally inadequate for identification of optimal levels. We combine subclassification with regression adjustment to estimate transitive, unbiased average causal effects across an ordered exposure, and apply our method on the 2005-2006 National Health and Nutrition Examination Survey to estimate the effects of nutritional label use on body mass index.

  4. Potential of adjustable height carts in reducing the risk of low back injury in grocery stockers.

    PubMed

    Davis, Kermit G; Orta Anés, Lida

    2014-03-01

    While the workers of the Wholesale and Retail Trade industrial sector suffer from musculoskeletal disorders at an alarming rate, there have been few investigative studies into potential effective interventions to reduce the ergonomic stress. The objective of the study was to determine whether a cart with an adjustable shelf could reduce awkward postures and motions while stocking products in a grocery store. Fifteen workers at a small grocery store in Puerto Rico completed stocking tasks with two types of carts: traditional and adjustable height cart or Ergo Cart. Trunk kinematics, LBD risk index, NIOSH lifting index, subjective ratings, and productivity indicators were collected during four typical stocking tasks. The Adjustable Ergo Cart reduced the sagittal trunk flexion by 7° and velocity by about 5°/s but increased twisting by about 2° and twist velocity by 4°/s as compared to the traditional cart. The LBD risk index was reduced by a small 2.4% in probability although greater reductions were found for larger items (e.g. bags of dog food and 2-L of Soda). The consensus among workers was that the adjustable cart would be easier to use. Overall, the study provides objective evidence that an ergonomically designed cart (e.g. adjustable height) has some potential to reduce sagittal trunk flexion, LBD risk index, and the NIOSH lift index. Overall, the results indicate that any intervention such as an adjustable cart can only have marginal effectiveness unless the entire systems perspective is considered.

  5. Potential of adjustable height carts in reducing the risk of low back injury in grocery stockers.

    PubMed

    Davis, Kermit G; Orta Anés, Lida

    2014-03-01

    While the workers of the Wholesale and Retail Trade industrial sector suffer from musculoskeletal disorders at an alarming rate, there have been few investigative studies into potential effective interventions to reduce the ergonomic stress. The objective of the study was to determine whether a cart with an adjustable shelf could reduce awkward postures and motions while stocking products in a grocery store. Fifteen workers at a small grocery store in Puerto Rico completed stocking tasks with two types of carts: traditional and adjustable height cart or Ergo Cart. Trunk kinematics, LBD risk index, NIOSH lifting index, subjective ratings, and productivity indicators were collected during four typical stocking tasks. The Adjustable Ergo Cart reduced the sagittal trunk flexion by 7° and velocity by about 5°/s but increased twisting by about 2° and twist velocity by 4°/s as compared to the traditional cart. The LBD risk index was reduced by a small 2.4% in probability although greater reductions were found for larger items (e.g. bags of dog food and 2-L of Soda). The consensus among workers was that the adjustable cart would be easier to use. Overall, the study provides objective evidence that an ergonomically designed cart (e.g. adjustable height) has some potential to reduce sagittal trunk flexion, LBD risk index, and the NIOSH lift index. Overall, the results indicate that any intervention such as an adjustable cart can only have marginal effectiveness unless the entire systems perspective is considered. PMID:23664243

  6. Dynamic probability control limits for risk-adjusted Bernoulli CUSUM charts.

    PubMed

    Zhang, Xiang; Woodall, William H

    2015-11-10

    The risk-adjusted Bernoulli cumulative sum (CUSUM) chart developed by Steiner et al. (2000) is an increasingly popular tool for monitoring clinical and surgical performance. In practice, however, the use of a fixed control limit for the chart leads to a quite variable in-control average run length performance for patient populations with different risk score distributions. To overcome this problem, we determine simulation-based dynamic probability control limits (DPCLs) patient-by-patient for the risk-adjusted Bernoulli CUSUM charts. By maintaining the probability of a false alarm at a constant level conditional on no false alarm for previous observations, our risk-adjusted CUSUM charts with DPCLs have consistent in-control performance at the desired level with approximately geometrically distributed run lengths. Our simulation results demonstrate that our method does not rely on any information or assumptions about the patients' risk distributions. The use of DPCLs for risk-adjusted Bernoulli CUSUM charts allows each chart to be designed for the corresponding particular sequence of patients for a surgeon or hospital.

  7. Continuing bonds, risk factors for complicated grief, and adjustment to bereavement.

    PubMed

    Field, Nigel P; Filanosky, Charles

    2010-01-01

    This study examined type of continuing bonds (CB) expression in relation to risk factors for complicated grief and measures of bereavement-related adjustment. Externalized CB expressions involving illusions and hallucinations with the deceased were distinguished from internalized CB expressions involving use of the deceased as an autonomy promoting secure base. 502 bereaved participants completed over the internet a CB measure assessing externalized and internalized CB along with various known risk-factor measures that included cause of death (i.e., violent vs. non-violent death), responsibility for the death, and attachment style as well as measures of psychological adjustment that included complicated grief symptoms, perceived physical health, and personal growth. As predicted, externalized CB was positively associated with violent death and responsibility for the death, whereas internalized CB was negatively associated with these risk factors as well as uniquely positively linked to personal growth. The implications of the findings for the role of CB in adjustment are discussed. PMID:24479173

  8. Beyond preadoptive risk: The impact of adoptive family environment on adopted youth's psychosocial adjustment.

    PubMed

    Ji, Juye; Brooks, Devon; Barth, Richard P; Kim, Hansung

    2010-07-01

    Adopted children often are exposed to preadoptive stressors--such as prenatal substance exposure, child maltreatment, and out-of-home placements--that increase their risks for psychosocial maladjustment. Psychosocial adjustment of adopted children emerges as the product of pre- and postadoptive factors. This study builds on previous research, which fails to simultaneously assess the influences of pre- and postadoptive factors, by examining the impact of adoptive family sense of coherence on adoptee's psychosocial adjustment beyond the effects of preadoptive risks. Using a sample of adoptive families (n = 385) taking part in the California Long Range Adoption Study, structural equation modeling analyses were performed. Results indicate a significant impact of family sense of coherence on adoptees' psychosocial adjustment and a considerably less significant role of preadoptive risks. The findings suggest the importance of assessing adoptive family's ability to respond to stress and of helping families to build and maintain their capacity to cope with stress despite the sometimes fractious pressures of adoption.

  9. IMPROVED RISK ESTIMATES FOR CARBON TETRACHLORIDE

    SciTech Connect

    Benson, Janet M.; Springer, David L.

    1999-12-31

    Carbon tetrachloride has been used extensively within the DOE nuclear weapons facilities. Rocky Flats was formerly the largest volume consumer of CCl4 in the United States using 5000 gallons in 1977 alone (Ripple, 1992). At the Hanford site, several hundred thousand gallons of CCl4 were discharged between 1955 and 1973 into underground cribs for storage. Levels of CCl4 in groundwater at highly contaminated sites at the Hanford facility have exceeded 8 the drinking water standard of 5 ppb by several orders of magnitude (Illman, 1993). High levels of CCl4 at these facilities represent a potential health hazard for workers conducting cleanup operations and for surrounding communities. The level of CCl4 cleanup required at these sites and associated costs are driven by current human health risk estimates, which assume that CCl4 is a genotoxic carcinogen. The overall purpose of these studies was to improve the scientific basis for assessing the health risk associated with human exposure to CCl4. Specific research objectives of this project were to: (1) compare the rates of CCl4 metabolism by rats, mice and hamsters in vivo and extrapolate those rates to man based on parallel studies on the metabolism of CCl4 by rat, mouse, hamster and human hepatic microsomes in vitro; (2) using hepatic microsome preparations, determine the role of specific cytochrome P450 isoforms in CCl4-mediated toxicity and the effects of repeated inhalation and ingestion of CCl4 on these isoforms; and (3) evaluate the toxicokinetics of inhaled CCl4 in rats, mice and hamsters. This information has been used to improve the physiologically based pharmacokinetic (PBPK) model for CCl4 originally developed by Paustenbach et al. (1988) and more recently revised by Thrall and Kenny (1996). Another major objective of the project was to provide scientific evidence that CCl4, like chloroform, is a hepatocarcinogen only when exposure results in cell damage, cell killing and regenerative proliferation. In

  10. Estimating Worker Risk Levels Using Accident/Incident Data

    SciTech Connect

    Kenoyer, Judson L.; Stenner, Robert D.; Andrews, William B.; Scherpelz, Robert I.; Aaberg, Rosanne L.

    2000-09-26

    The purpose of the work described in this report was to identify methods that are currently being used in the Department of Energy (DOE) complex to identify and control hazards/risks in the workplace, evaluate them in terms of their effectiveness in reducing risk to the workers, and to develop a preliminary method that could be used to predict the relative risks to workers performing proposed tasks using some of the current methodology. This report describes some of the performance indicators (i.e., safety metrics) that are currently being used to track relative levels of workplace safety in the DOE complex, how these fit into an Integrated Safety Management (ISM) system, some strengths and weaknesses of using a statistically based set of indicators, and methods to evaluate them. Also discussed are methods used to reduce risk to the workers and some of the techniques that appear to be working in the process of establishing a condition of continuous improvement. The results of these methods will be used in future work involved with the determination of modifying factors for a more complex model. The preliminary method to predict the relative risk level to workers during an extended future time period is based on a currently used performance indicator that uses several factors tracked in the CAIRS. The relative risks for workers in a sample (but real) facility on the Hanford site are estimated for a time period of twenty years and are based on workforce predictions. This is the first step in developing a more complex model that will incorporate other modifying factors related to the workers, work environment and status of the ISM system to adjust the preliminary prediction.

  11. Cumulative family risk predicts increases in adjustment difficulties across early adolescence.

    PubMed

    Buehler, Cheryl; Gerard, Jean M

    2013-06-01

    Family is an important socialization context for youth as they move through early adolescence. A significant feature of this complex socialization context is the accumulation of potential family risk factors that may compromise youth adjustment. This study examined cumulative family risk and adolescents' adjustment difficulties in 416 two-parent families using four waves of annual longitudinal data (51% female youth). Risk factors in four family domains were examined: socioeconomic, parents' psychological realm, marital, and parenting. Cumulative family risk experienced while in 6th grade was associated concurrently with daughters' higher internalizing problems and with increased internalizing problems during early adolescence. Cumulative family risk was associated concurrently with sons' higher externalizing problems and with daughters' increased externalizing problems over time. Cumulative family risk was associated concurrently with lower grades and with declining grades over time for both daughters and sons. The number of risk domains also was associated with youths' adjustment difficulties during early adolescence, providing evidence that risk in two-parent families involves more than ineffective parenting. These findings suggest a critical need to provide strong support for families in reducing a variety of stressors across multiple family domains as their children traverse early adolescence.

  12. Cancer Risk Estimates from Space Flight Estimated Using Yields of Chromosome Damage in Astronaut's Blood Lymphocytes

    NASA Technical Reports Server (NTRS)

    George, Kerry A.; Rhone, J.; Chappell, L. J.; Cucinotta, F. A.

    2011-01-01

    To date, cytogenetic damage has been assessed in blood lymphocytes from more than 30 astronauts before and after they participated in long-duration space missions of three months or more on board the International Space Station. Chromosome damage was assessed using fluorescence in situ hybridization whole chromosome analysis techniques. For all individuals, the frequency of chromosome damage measured within a month of return from space was higher than their preflight yield, and biodosimetry estimates were within the range expected from physical dosimetry. Follow up analyses have been performed on most of the astronauts at intervals ranging from around 6 months to many years after flight, and the cytogenetic effects of repeat long-duration missions have so far been assessed in four individuals. Chromosomal aberrations in peripheral blood lymphocytes have been validated as biomarkers of cancer risk and cytogenetic damage can therefore be used to characterize excess health risk incurred by individual crewmembers after their respective missions. Traditional risk assessment models are based on epidemiological data obtained on Earth in cohorts exposed predominantly to acute doses of gamma-rays, and the extrapolation to the space environment is highly problematic, involving very large uncertainties. Cytogenetic damage could play a key role in reducing uncertainty in risk estimation because it is incurred directly in the space environment, using specimens from the astronauts themselves. Relative cancer risks were estimated from the biodosimetry data using the quantitative approach derived from the European Study Group on Cytogenetic Biomarkers and Health database. Astronauts were categorized into low, medium, or high tertiles according to their yield of chromosome damage. Age adjusted tertile rankings were used to estimate cancer risk and results were compared with values obtained using traditional modeling approaches. Individual tertile rankings increased after space

  13. The HHS-HCC risk adjustment model for individual and small group markets under the Affordable Care Act.

    PubMed

    Kautter, John; Pope, Gregory C; Ingber, Melvin; Freeman, Sara; Patterson, Lindsey; Cohen, Michael; Keenan, Patricia

    2014-01-01

    Beginning in 2014, individuals and small businesses are able to purchase private health insurance through competitive Marketplaces. The Affordable Care Act (ACA) provides for a program of risk adjustment in the individual and small group markets in 2014 as Marketplaces are implemented and new market reforms take effect. The purpose of risk adjustment is to lessen or eliminate the influence of risk selection on the premiums that plans charge. The risk adjustment methodology includes the risk adjustment model and the risk transfer formula. This article is the second of three in this issue of the Review that describe the Department of Health and Human Services (HHS) risk adjustment methodology and focuses on the risk adjustment model. In our first companion article, we discuss the key issues and choices in developing the methodology. In this article, we present the risk adjustment model, which is named the HHS-Hierarchical Condition Categories (HHS-HCC) risk adjustment model. We first summarize the HHS-HCC diagnostic classification, which is the key element of the risk adjustment model. Then the data and methods, results, and evaluation of the risk adjustment model are presented. Fifteen separate models are developed. For each age group (adult, child, and infant), a model is developed for each cost sharing level (platinum, gold, silver, and bronze metal levels, as well as catastrophic plans). Evaluation of the risk adjustment models shows good predictive accuracy, both for individuals and for groups. Lastly, this article provides examples of how the model output is used to calculate risk scores, which are an input into the risk transfer formula. Our third companion paper describes the risk transfer formula.

  14. The HHS-HCC risk adjustment model for individual and small group markets under the Affordable Care Act.

    PubMed

    Kautter, John; Pope, Gregory C; Ingber, Melvin; Freeman, Sara; Patterson, Lindsey; Cohen, Michael; Keenan, Patricia

    2014-01-01

    Beginning in 2014, individuals and small businesses are able to purchase private health insurance through competitive Marketplaces. The Affordable Care Act (ACA) provides for a program of risk adjustment in the individual and small group markets in 2014 as Marketplaces are implemented and new market reforms take effect. The purpose of risk adjustment is to lessen or eliminate the influence of risk selection on the premiums that plans charge. The risk adjustment methodology includes the risk adjustment model and the risk transfer formula. This article is the second of three in this issue of the Review that describe the Department of Health and Human Services (HHS) risk adjustment methodology and focuses on the risk adjustment model. In our first companion article, we discuss the key issues and choices in developing the methodology. In this article, we present the risk adjustment model, which is named the HHS-Hierarchical Condition Categories (HHS-HCC) risk adjustment model. We first summarize the HHS-HCC diagnostic classification, which is the key element of the risk adjustment model. Then the data and methods, results, and evaluation of the risk adjustment model are presented. Fifteen separate models are developed. For each age group (adult, child, and infant), a model is developed for each cost sharing level (platinum, gold, silver, and bronze metal levels, as well as catastrophic plans). Evaluation of the risk adjustment models shows good predictive accuracy, both for individuals and for groups. Lastly, this article provides examples of how the model output is used to calculate risk scores, which are an input into the risk transfer formula. Our third companion paper describes the risk transfer formula. PMID:25360387

  15. Risk-adjusted outcome models for public mental health outpatient programs.

    PubMed Central

    Hendryx, M S; Dyck, D G; Srebnik, D

    1999-01-01

    OBJECTIVE: To develop and test risk-adjustment outcome models in publicly funded mental health outpatient settings. We developed prospective risk models that used demographic and diagnostic variables; client-reported functioning, satisfaction, and quality of life; and case manager clinical ratings to predict subsequent client functional status, health-related quality of life, and satisfaction with services. DATA SOURCES/STUDY SETTING: Data collected from 289 adult clients at five- and ten-month intervals, from six community mental health agencies in Washington state located primarily in suburban and rural areas. Data sources included client self-report, case manager ratings, and management information system data. STUDY DESIGN: Model specifications were tested using prospective linear regression analyses. Models were validated in a separate sample and comparative agency performance examined. PRINCIPAL FINDINGS: Presence of severe diagnoses, substance abuse, client age, and baseline functional status and quality of life were predictive of mental health outcomes. Unadjusted versus risk-adjusted scores resulted in differently ranked agency performance. CONCLUSIONS: Risk-adjusted functional status and patient satisfaction outcome models can be developed for public mental health outpatient programs. Research is needed to improve the predictive accuracy of the outcome models developed in this study, and to develop techniques for use in applied settings. The finding that risk adjustment changes comparative agency performance has important consequences for quality monitoring and improvement. Issues in public mental health risk adjustment are discussed, including static versus dynamic risk models, utilization versus outcome models, choice and timing of measures, and access and quality improvement incentives. PMID:10201857

  16. Risk adjusting survival outcomes of hospitals that treat cancer patients without information on cancer stage

    PubMed Central

    Pfister, David G.; Rubin, David M.; Elkin, Elena B.; Neill, Ushma S.; Duck, Elaine; Radzyner, Mark; Bach, Peter B.

    2016-01-01

    Importance Instituting widespread measurement of outcomes for cancer hospitals using administrative data is difficult due to the lack of cancer specific information such as disease stage. Objective To evaluate the performance of hospitals that treat cancer patients using Medicare data for outcome ascertainment and risk adjustment, and to assess whether hospital rankings based on these measures are influenced by the addition of cancer-specific information. Design Risk adjusted cumulative mortality of patients with cancer captured in Medicare claims from 2005–2009 nationally were assessed at the hospital level. Similar analyses were conducted in the Surveillance, Epidemiology and End Result (SEER)-Medicare data for the subset of the US covered by the SEER program to determine whether the exclusion of cancer specific information (only available in cancer registries) from risk adjustment altered measured hospital performance. Setting Administrative claims data and SEER cancer registry data Participants Sample of 729,279 fee-for-service Medicare beneficiaries treated for cancer in 2006 at hospitals treating 10+ patients with each of the following cancers, according to Medicare claims: lung, prostate, breast, colon. An additional sample of 18,677 similar patients in SEER-Medicare administrative data. Main Outcomes and Measures Risk-adjusted mortality overall and by cancer type, stratified by type of hospital; measures of correlation and agreement between hospital-level outcomes risk adjusted using Medicare data alone and Medicare data with SEER data. Results There were large outcome differences between different types of hospitals that treat Medicare patients with cancer. At one year, cumulative mortality for Medicare-prospective-payment-system exempt hospitals was 10% lower than at community hospitals (18% versus 28%) across all cancers, the pattern persisted through five years of follow-up and within specific cancer types. Performance ranking of hospitals was

  17. Risk factors for psychological adjustment following residential fire: the role of avoidant coping.

    PubMed

    Jones, Russell T; Ollendick, Thomas H

    2005-01-01

    Although a growing number of investigations have targeted technological and natural disasters involving children and adolescents (e.g., kidnappings, shootings, accidents, wars, fires, hurricanes), little is known about the influence of specific risk factors on functioning post-disaster. A number of basic questions are yet to be fully addressed, including: How do children and adolescents cope with technological and natural disasters? What are the most salient risk factors for children and adolescents, prior to, during, and following disasters? How do these risk factors interact in predicting psychological adjustment? And what is the relative role of risk factors on psychological adjustment over time? In fact, these and related questions hold the potential to move this important area of inquiry forward in a variety of meaningful ways.

  18. Bundled Payments in Cardiac Surgery: Is Risk-Adjustment Sufficient To Make It Feasible?

    PubMed Central

    Yount, Kenan W; Isbell, James M; Lichtendahl, Casey; Dietch, Zachary; Ailawadi, Gorav; Kron, Irving L; Kern, John A; Lau, Christine L

    2015-01-01

    Background Policymakers have proposed risk-adjusted bundled payment as the single-most promising method of linking reimbursement to value rather than to quantity of service. Our objective was to assess the relationship between risk and cost to develop a model for forecasting cardiac surgery costs under a bundled payment scheme. Methods All patients undergoing adult cardiac surgery operations for which there was a Society of Thoracic Surgeons (STS) risk score over a 5-year period (2008–2013) at a tertiary care, university hospital were reviewed. Patients were stratified into 5 groups based on preoperative risk as a basis for negotiating risk-adjusted bundles. A multivariable regression model was developed to analyze the relationship between risk and log-transformed costs. Monte Carlo simulation was performed to validate the model by comparing predicted to actual FY2013 costs. Results Among the 2514 patients analyzed, preoperative risk was strongly correlated with costs (p<0.001) but was only able to explain 28% (R2=0.28) of the variation in costs between individual patients. Using bundling to diffuse and adjust for risk improved prediction to only 33% (R2=0.33). Actual costs in 2013 were $21.6M compared to predicted costs of $19.3M (±$350K), which is well outside the forecast’s 95% confidence interval. Conclusion Even among the most routine cardiac surgery operations using the most widely validated surgical risk score available, much of the variation in costs cannot be explained by preoperative risk or surgeon. Consequently, policymakers should re-examine whether individual practices or insurers are best suited to manage the residual financial risk. PMID:26209483

  19. Repetitive Adjustment to Estimate the Electric Current Sources in a Nerve Fiber with Magnetic Field Measurement

    NASA Astrophysics Data System (ADS)

    Hayami, Takehito; Mishima, Yukuo; Hiwaki, Osamu

    Magnetic field measuring equipment provides us the way to examine the active position of a peripheral nerve without contact or invasion. To develop a process to estimate the position precisely, simulation study of the magnetic field induced by a myelinated nerve fiber was executed. The electric current sources around the active position of a nerve fiber can be approximated as a pair of electric current dipoles, which represent depolarization and repolarization respectively. Therefore the current sources to estimate from the detected pattern of the magnetic field were modeled as a pair of electric current dipoles. A repetitive adjustment process was proposed as an effective method to find the appropriate positions of the dipoles as the sources of the magnetic fields.

  20. Estimation of health risks from radiation exposures

    SciTech Connect

    Randolph, M.L.

    1983-08-01

    An informal presentation is given of the cancer and genetic risks from exposures to ionizing radiations. The risks from plausible radiation exposures are shown to be comparable to other commonly encountered risks.

  1. Renal Drug Dosage Adjustment According to Estimated Creatinine Clearance in Hospitalized Patients With Heart Failure.

    PubMed

    Altunbas, Gokhan; Yazc, Mehmet; Solak, Yalcin; Gul, Enes E; Kayrak, Mehmet; Kaya, Zeynettin; Akilli, Hakan; Aribas, Alpay; Gaipov, Abduzhappar; Yazc, Raziye; Ozdemir, Kurtulus

    2016-01-01

    It is of clinical importance to determine creatinine clearance and adjust doses of prescribed drugs accordingly in patients with heart failure to prevent untoward effects. There is a scarcity of studies in the literature investigating this issue particularly in patients with heart failure, in whom many have impaired kidney function. The purpose of this study was to determine the degree of awareness of medication prescription as to creatinine clearance in patients hospitalized with heart failure. Patients hospitalized with a diagnosis of heart failure were retrospectively evaluated. Among screened charts, patients with left ventricular ejection fraction <40% and an estimated glomerular filtration rate (eGFR) of ≤50 mL/min were included in the analysis. The medications and respective doses prescribed at discharge were recorded. Medications requiring renal dose adjustment were determined and evaluated for appropriate dosing according to eGFR. A total of 388 patients with concomitant heart failure and renal dysfunction were included in the study. The total number of prescribed medications was 2808 and 48.3% (1357 medications) required renal dose adjustment. Of the 1357 medications, 12.6% (171 medications) were found to be inappropriately prescribed according to eGFR. The most common inappropriately prescribed medications were famotidine, metformin, perindopril, and ramipril. A significant portion of medications used in heart failure requires dose adjustment. Our results showed that in a typical cohort of patients with heart failure, many drugs are prescribed at inappropriately high doses according to creatinine clearance. Awareness should be increased among physicians caring for patients with heart failure to prevent adverse events related to medications.

  2. Assessing At-Risk Youth Using the Reynolds Adolescent Adjustment Screening Inventory with a Latino Population

    ERIC Educational Resources Information Center

    Balkin, Richard S.; Cavazos, Javier, Jr.; Hernandez, Arthur E.; Garcia, Roberto; Dominguez, Denise L.; Valarezo, Alexandra

    2013-01-01

    Factor analyses were conducted on scores from the Reynolds Adolescent Adjustment Screening Inventory (RAASI; Reynolds, 2001) representing at-risk Latino youth. The 4-factor model of the RAASI did not exhibit a good fit. However, evidence of generalizability for Latino youth was noted. (Contains 3 tables.)

  3. Continuing Bonds, Risk Factors for Complicated Grief, and Adjustment to Bereavement

    ERIC Educational Resources Information Center

    Field, Nigel P.; Filanosky, Charles

    2010-01-01

    This study examined type of continuing bonds (CB) expression in relation to risk factors for complicated grief and measures of bereavement-related adjustment. Externalized CB expressions involving illusions and hallucinations with the deceased were distinguished from internalized CB expressions involving use of the deceased as an autonomy…

  4. The Role Behavioral Adjustment Plays in Placing Middle School Students "At Risk" of Academic Failure.

    ERIC Educational Resources Information Center

    Flynn, Timothy M.

    The role of behavioral adjustment in placing middle school students at risk academically is examined using 23 middle school teachers' and 378 parents' ratings of 389 children (53 percent blacks and 47 percent whites) on Conner's Parent Rating Scale and Conner's Teacher Rating Scale. The average rating on the scales for both sets of ratings is…

  5. Measuring Profitability Impacts of Information Technology: Use of Risk Adjusted Measures.

    ERIC Educational Resources Information Center

    Singh, Anil; Harmon, Glynn

    2003-01-01

    Focuses on understanding how investments in information technology are reflected in the income statements and balance sheets of firms. Shows that the relationship between information technology investments and corporate profitability is much better explained by using risk-adjusted measures of corporate profitability than using the same measures…

  6. Risk-Adjustment Simulation: Plans May Have Incentives To Distort Mental Health And Substance Use Coverage

    PubMed Central

    Montz, Ellen; Layton, Tim; Busch, Alisa B.; Ellis, Randall P.; Rose, Sherri; McGuire, Thomas G.

    2016-01-01

    Under the Affordable Care Act, the risk-adjustment program is designed to compensate health plans for enrolling people with poorer health status so that plans compete on cost and quality rather than the avoidance of high-cost individuals. This study examined health plan incentives to limit covered services for mental health and substance use disorders under the risk-adjustment system used in the health insurance Marketplaces. Through a simulation of the program on a population constructed to reflect Marketplace enrollees, we analyzed the cost consequences for plans enrolling people with mental health and substance use disorders. Our assessment points to systematic underpayment to plans for people with these diagnoses. We document how Marketplace risk adjustment does not remove incentives for plans to limit coverage for services associated with mental health and substance use disorders. Adding mental health and substance use diagnoses used in Medicare Part D risk adjustment is one potential policy step toward addressing this problem in the Marketplaces. PMID:27269018

  7. 48 CFR 215.404-71-3 - Contract type risk and working capital adjustment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... normal value when the contract type risk is low. Indicators of this are— (i) Very mature product line... paragraph (c) of this subsection using the evaluation criteria in paragraph (d) of this subsection. (2... provisions for performance-based payments, do not compute a working capital adjustment. (d)...

  8. Estimation of the Disease Burden Attributable to 11 Risk Factors in Hubei Province, China: A Comparative Risk Assessment.

    PubMed

    Cui, Fangfang; Zhang, Lan; Yu, Chuanhua; Hu, Songbo; Zhang, Yunquan

    2016-01-01

    In order to estimate the health losses caused by common risk factors in the Hubei province, China, we calculated the deaths and disability-adjusted life years (DALYs) attributable to 11 risk factors. We estimated the exposure distributions of risk factors in Hubei Province in 2013 from the monitoring system on chronic disease and related risk factors, combined with relative risk (RR) in order to calculate the population attributable fraction. Deaths and DALYs attributed to the selected risk factors were then estimated together with cause-specific deaths and DALYs. In total, 53.39% of the total deaths and 36.23% of the total DALYs in Hubei were a result of the 11 selected risk factors. The top five risk factors were high blood pressure, smoking, high body mass index, diet low in fruits and alcohol use, accounting for 14.68%, 12.57%, 6.03%, 3.90% and 3.19% of total deaths, respectively, and 9.41%, 7.22%, 4.42%, 2.51% and 2.44% of total DALYs, respectively. These risk factors, especially high blood pressure, smoking and high body mass index, significantly influenced quality of life, causing a large number of deaths and DALYs. The burden of chronic disease could be substantially reduced if these risk factors were effectively controlled, which would allow people to enjoy healthier lives. PMID:27669279

  9. Estimation of the Disease Burden Attributable to 11 Risk Factors in Hubei Province, China: A Comparative Risk Assessment

    PubMed Central

    Cui, Fangfang; Zhang, Lan; Yu, Chuanhua; Hu, Songbo; Zhang, Yunquan

    2016-01-01

    In order to estimate the health losses caused by common risk factors in the Hubei province, China, we calculated the deaths and disability-adjusted life years (DALYs) attributable to 11 risk factors. We estimated the exposure distributions of risk factors in Hubei Province in 2013 from the monitoring system on chronic disease and related risk factors, combined with relative risk (RR) in order to calculate the population attributable fraction. Deaths and DALYs attributed to the selected risk factors were then estimated together with cause-specific deaths and DALYs. In total, 53.39% of the total deaths and 36.23% of the total DALYs in Hubei were a result of the 11 selected risk factors. The top five risk factors were high blood pressure, smoking, high body mass index, diet low in fruits and alcohol use, accounting for 14.68%, 12.57%, 6.03%, 3.90% and 3.19% of total deaths, respectively, and 9.41%, 7.22%, 4.42%, 2.51% and 2.44% of total DALYs, respectively. These risk factors, especially high blood pressure, smoking and high body mass index, significantly influenced quality of life, causing a large number of deaths and DALYs. The burden of chronic disease could be substantially reduced if these risk factors were effectively controlled, which would allow people to enjoy healthier lives. PMID:27669279

  10. Risk adjusted and population based studies of the outcome for high risk infants in Scotland and Australia

    PubMed Central

    International, N; Consultants, S. N.; Group, N. C.

    2000-01-01

    OBJECTIVES—To compare outcomes of care in selected neonatal intensive care units (NICUs) for very low birthweight (VLBW) or preterm infants in Scotland and Australia (study 1) and perinatal care for all VLBW infants in both countries (study 2).
DESIGN—Study 1: risk adjusted cohort study; study 2: population based cohort study.
SUBJECTS—Study 1: all 2621 infants of < 1500 g birth weight or < 31 weeks' gestation admitted to a volunteer sample of hospitals comprising eight of all 17 Scottish NICUs and six of all 12 tertiary NICUs in New South Wales and Queensland in 1993-1994; study 2: all 5986infants of 500-1499 g birth weight registered as live born in Scotland and Australia in 1993-1994.
MAIN OUTCOMES—Study 1: (a) hospital death; (b) death or cerebral damage, each adjusted for gestation and CRIB (clinical risk index for babies); study 2: neonatal (28 day) mortality.
RESULTS—Study 1. Data were obtained for 1628 admissions in six Australian NICUs, 775 in five Scottish tertiary NICUs, and 148 in three Scottish non-tertiary NICUs. Crude hospital death rates were 13%, 22%, and 22% respectively. Risk adjusted hospital mortality was about 50% higher in Scottish than in Australian NICUs (adjusted mortality ratio 1.46, 95% confidence interval (CI) 1.29 to 1.63,p < 0.001). There was no difference in risk adjusted outcomes between Scottish tertiary and non-tertiary NICUs. After risk adjustment, death or cerebral damage was more common in Scottish than Australian NICUs (odds ratio 1.9, 95% CI 1.5 to 2.5). Both these risk adjusted adverse outcomes remained more common in Scottish than Australian NICUs after excluding all infants < 28 weeks' gestation from the comparison. Study 2. Population based neonatal mortality in infants of 500-1499 g was higher in Scotland (20.3%) than Australia (16.6%) (relative risk 1.22, 95% CI 1.08 to 1.39, p = 0.002). In a post hoc analysis, neonatal mortality was also higher in England and Wales than in Australia

  11. A VLBI baseline post-adjustment approach for station velocity estimation in Eurasian continent

    NASA Astrophysics Data System (ADS)

    Zhang, Zhibin; Liu, Xiang

    2014-10-01

    Baseline lengths and their time-derivatives among 58 geodetic VLBI stations were fitted by using 4439 observing sessions from the International VLBI Service for Geodesy and Astrometry (IVS). First, the velocities of eight stations in Eurasian continent were set as unknown quantities. Then, two standard global solutions from 3523 IVS sessions and 1110 sessions from database code XA, respectively, were applied prior to all-station coordinates and the non-estimated station velocities. Finally, from the relations among the coordinates, velocities, baseline length and its time-derivative, two types of baseline post-adjustment (BPA) were used to estimate the velocities of the eight stations. We discuss the data processing details, including the effect of different prior values for the stations and the optimal solution. The results suggest that the precision of the station velocities based on the proposed approach is comparable to that of the global solution of the XA sessions. The baseline structure and the prior values of the stations affect the velocity estimates. Compared to the standard method of velocity estimation, there are no external constrains and conditions used in the proposed method.

  12. Determinants of health care utilization by German sickness fund members--with application to risk adjustment.

    PubMed

    Breyer, Friedrich; Heineck, Martin; Lorenz, Normann

    2003-05-01

    In many countries, social health insurance systems are being reformed in favor of more competition among insurers, while premiums are community rated by regulation. The implicit incentives for insurers to engage in risk selection can only be curtailed using appropriate systems of risk-adjusted equalization payments among insurers. To develop these systems, predictors of individual utilization patterns have to be identified, e.g. via regression analysis using previous utilization data. In some countries such as Germany, such data are hardly ever available. In the early nineties, a number of sickness funds participated in an experiment in which individual utilization data were collected. Our data set covers more than 70,000 members of company sickness funds over a 5-year period. We analyze socio-demographic determinants of utilization which could be used as risk adjusters in a risk equalization scheme. Our results suggest that besides age and sex, the set of risk adjusters should include income, family status and a dummy for the last year of life.

  13. New risk-adjustment system was associated with reduced favorable selection in medicare advantage.

    PubMed

    McWilliams, J Michael; Hsu, John; Newhouse, Joseph P

    2012-12-01

    Health plans participating in the Medicare managed care program, called Medicare Advantage since 2003, have historically attracted healthier enrollees than has the traditional fee-for-service program. Medicare Advantage plans have gained financially from this favorable risk selection since their payments have traditionally been adjusted only minimally for clinical characteristics of enrollees, causing overpayment for healthier enrollees and underpayment for sicker ones. As a result, a new risk-adjustment system was phased in from 2004 to 2007, and a lock-in provision instituted to limit midyear disenrollment by enrollees experiencing health declines whose exodus could benefit plans financially. To determine whether these reforms were associated with intended reductions in risk selection, we compared differences in self-reported health care use and health between Medicare Advantage and traditional Medicare beneficiaries before versus after these reforms were implemented. We similarly compared differences between those who switched into or out of Medicare Advantage and nonswitchers. Most differences in 2001-03 were substantially narrowed by 2006-07, suggesting reduced selection. Similar risk-adjustment methods may help reduce incentives for plans competing in health insurance exchanges and accountable care organizations to select patients with favorable clinical risks.

  14. MM-Estimator and Adjusted Super Smoother based Simultaneous Prediction Confedenc

    2002-07-19

    A Novel Application of Regression Analysis (MM-Estimator) with Simultaneous Prediction Confidence Intervals are proposed to detect up- or down-regulated genes, which are outliers in scatter plots based on log-transformed red (Cy5 fluorescent dye) versus green (Cy3 fluorescent Dye) intensities. Advantages of the application: 1) Robust and Resistant MM-Estimator is a Reliable Method to Build Linear Regression In the presence of Outliers, 2) Exploratory Data Analysis Tools (Boxplots, Averaged Shifted Histograms, Quantile-Quantile Normal Plots and Scattermore » Plots) are Unsed to Test Visually underlying assumptions of linearity and Contaminated Normality in Microarray data), 3) Simultaneous prediction confidence intervals (SPCIs) Guarantee a desired confidence level across the whole range of the data points used for the scatter plots. Results of the outlier detection procedure is a set of significantly differentially expressed genes extracted from the employed microarray data set. A scatter plot smoother (super smoother or locally weighted regression) is used to quantify heteroscendasticity is residual variance (Commonly takes place in lower and higher intensity areas). The set of differentially expressed genes is quantified using interval estimates for P-values as a probabilistic measure of being outlier by chance. Monte Carlo simultations are used to adjust super smoother-based SPCIs.her.« less

  15. Estimating covariate-adjusted measures of diagnostic accuracy based on pooled biomarker assessments.

    PubMed

    McMahan, Christopher S; McLain, Alexander C; Gallagher, Colin M; Schisterman, Enrique F

    2016-07-01

    There is a need for epidemiological and medical researchers to identify new biomarkers (biological markers) that are useful in determining exposure levels and/or for the purposes of disease detection. Often this process is stunted by high testing costs associated with evaluating new biomarkers. Traditionally, biomarker assessments are individually tested within a target population. Pooling has been proposed to help alleviate the testing costs, where pools are formed by combining several individual specimens. Methods for using pooled biomarker assessments to estimate discriminatory ability have been developed. However, all these procedures have failed to acknowledge confounding factors. In this paper, we propose a regression methodology based on pooled biomarker measurements that allow the assessment of the discriminatory ability of a biomarker of interest. In particular, we develop covariate-adjusted estimators of the receiver-operating characteristic curve, the area under the curve, and Youden's index. We establish the asymptotic properties of these estimators and develop inferential techniques that allow one to assess whether a biomarker is a good discriminator between cases and controls, while controlling for confounders. The finite sample performance of the proposed methodology is illustrated through simulation. We apply our methods to analyze myocardial infarction (MI) data, with the goal of determining whether the pro-inflammatory cytokine interleukin-6 is a good predictor of MI after controlling for the subjects' cholesterol levels. PMID:26927583

  16. Balancing the risks and benefits of drinking water disinfection: disability adjusted life-years on the scale.

    PubMed

    Havelaar, A H; De Hollander, A E; Teunis, P F; Evers, E G; Van Kranen, H J; Versteegh, J F; Van Koten, J E; Slob, W

    2000-04-01

    To evaluate the applicability of disability adjusted life-years (DALYs) as a measure to compare positive and negative health effects of drinking water disinfection, we conducted a case study involving a hypothetical drinking water supply from surface water. This drinking water supply is typical in The Netherlands. We compared the reduction of the risk of infection with Cryptosporidium parvum by ozonation of water to the concomitant increase in risk of renal cell cancer arising from the production of bromate. We applied clinical, epidemiologic, and toxicologic data on morbidity and mortality to calculate the net health benefit in DALYs. We estimated the median risk of infection with C. parvum as 10(-3)/person-year. Ozonation reduces the median risk in the baseline approximately 7-fold, but bromate is produced in a concentration above current guideline levels. However, the health benefits of preventing gastroenteritis in the general population and premature death in patients with acquired immunodeficiency syndrome outweigh health losses by premature death from renal cell cancer by a factor of > 10. The net benefit is approximately 1 DALY/million person-years. The application of DALYs in principle allows us to more explicitly compare the public health risks and benefits of different management options. In practice, the application of DALYs may be hampered by the substantial degree of uncertainty, as is typical for risk assessment.

  17. Adjusting for car occupant injury liability in relation to age, speed limit, and gender-specific driver crash involvement risk.

    PubMed

    Keall, Michael; Frith, William

    2004-12-01

    It is well established that older drivers' fragility is an important factor associated with higher levels of fatal crash involvement for older drivers. There has been less research on age-related fragility with respect to the sort of minor injuries that are more common in injury crashes. This study estimates a quantity that is related to injury fragility: the probability that a driver or a passenger of that driver will be injured in crashes involving two cars. The effects of other factors apart from drivers' fragility are included in this measure, including the fragility of the passengers, the crashworthiness of cars driven, seatbelt use by the occupants, and characteristics of crashes (including configuration and impact speed). The car occupant injury liability estimates appropriately includes these factors to adjust risk curves by age, gender, and speed limit accounting for overrepresentation in crashes associated with fragility and these other factors. PMID:15545071

  18. Estimating contribution of anthocyanin pigments to osmotic adjustment during winter leaf reddening.

    PubMed

    Hughes, Nicole M; Carpenter, Kaylyn L; Cannon, Jonathan G

    2013-01-15

    The association between plant water stress and synthesis of red, anthocyanin pigments in leaves has led some plant biologists to propose an osmotic function of leaf reddening. According to this hypothesis, anthocyanins function as a solute in osmotic adjustment (OA), contributing to depression of osmotic potential (Ψ(π)) and maintenance of turgor pressure during drought-stressed conditions. Here we calculate the percent contribution of anthocyanin to leaf Ψ(π) during OA in two angiosperm evergreen species, Galax urceolata and Gaultheria procumbens. Both species exhibit dramatic leaf reddening under high light during winter, concomitant with declines in leaf water potential and accumulation of solutes. Data previously published by the authors on osmotic potential at full turgor (Ψ(π,100)) of G. urceolata and G. procumbens leaves before and after leaf reddening were used to estimate OA. In vivo molar concentrations of anthocyanin, glucose, fructose, and sucrose measured from the same individuals were converted to pressure equivalents using the Ideal Gas Law, and percent contribution to OA was estimated. Estimated mean OA during winter was -0.7MPa for G. urceolata and -0.8MPa for G. procumbens. In vivo concentrations of anthocyanin (3-10mM) were estimated to account for ∼2% of OA during winter, and comprised <0.7% of Ψ(π,100) in both species. Glucose, fructose, and sucrose combined accounted for roughly 50 and 80% of OA for G. urceolata and G. procumbens, respectively, and comprised ∼20% of Ψ(π,100). We observed that a co-occurring, acyanic species (Vinca minor) achieved similar OA without synthesizing anthocyanin. We conclude that anthocyanins represent a measurable, albeit meager, component of OA in red-leafed evergreen species during winter. However, due to their low concentrations, metabolic costliness relative to other osmolytes, and striking red color (unnecessary for an osmotic function), it is unlikely that they are synthesized solely for an

  19. Risk-adjusted antibiotic consumption in 34 public acute hospitals in Ireland, 2006 to 2014

    PubMed Central

    Oza, Ajay; Donohue, Fionnuala; Johnson, Howard; Cunney, Robert

    2016-01-01

    As antibiotic consumption rates between hospitals can vary depending on the characteristics of the patients treated, risk-adjustment that compensates for the patient-based variation is required to assess the impact of any stewardship measures. The aim of this study was to investigate the usefulness of patient-based administrative data variables for adjusting aggregate hospital antibiotic consumption rates. Data on total inpatient antibiotics and six broad subclasses were sourced from 34 acute hospitals from 2006 to 2014. Aggregate annual patient administration data were divided into explanatory variables, including major diagnostic categories, for each hospital. Multivariable regression models were used to identify factors affecting antibiotic consumption. Coefficient of variation of the root mean squared errors (CV-RMSE) for the total antibiotic usage model was very good (11%), however, the value for two of the models was poor (> 30%). The overall inpatient antibiotic consumption increased from 82.5 defined daily doses (DDD)/100 bed-days used in 2006 to 89.2 DDD/100 bed-days used in 2014; the increase was not significant after risk-adjustment. During the same period, consumption of carbapenems increased significantly, while usage of fluoroquinolones decreased. In conclusion, patient-based administrative data variables are useful for adjusting hospital antibiotic consumption rates, although additional variables should also be employed. PMID:27541730

  20. Risk-adjusted antibiotic consumption in 34 public acute hospitals in Ireland, 2006 to 2014.

    PubMed

    Oza, Ajay; Donohue, Fionnuala; Johnson, Howard; Cunney, Robert

    2016-08-11

    As antibiotic consumption rates between hospitals can vary depending on the characteristics of the patients treated, risk-adjustment that compensates for the patient-based variation is required to assess the impact of any stewardship measures. The aim of this study was to investigate the usefulness of patient-based administrative data variables for adjusting aggregate hospital antibiotic consumption rates. Data on total inpatient antibiotics and six broad subclasses were sourced from 34 acute hospitals from 2006 to 2014. Aggregate annual patient administration data were divided into explanatory variables, including major diagnostic categories, for each hospital. Multivariable regression models were used to identify factors affecting antibiotic consumption. Coefficient of variation of the root mean squared errors (CV-RMSE) for the total antibiotic usage model was very good (11%), however, the value for two of the models was poor (> 30%). The overall inpatient antibiotic consumption increased from 82.5 defined daily doses (DDD)/100 bed-days used in 2006 to 89.2 DDD/100 bed-days used in 2014; the increase was not significant after risk-adjustment. During the same period, consumption of carbapenems increased significantly, while usage of fluoroquinolones decreased. In conclusion, patient-based administrative data variables are useful for adjusting hospital antibiotic consumption rates, although additional variables should also be employed. PMID:27541730

  1. Relating space radiation environments to risk estimates

    SciTech Connect

    Curtis, S.B.

    1991-10-01

    This lecture will provide a bridge from the physical energy or LET spectra as might be calculated in an organ to the risk of carcinogenesis, a particular concern for extended missions to the moon or beyond to Mars. Topics covered will include (1) LET spectra expected from galactic cosmic rays, (2) probabilities that individual cell nuclei in the body will be hit by heavy galactic cosmic ray particles, (3) the conventional methods of calculating risks from a mixed environment of high and low LET radiation, (4) an alternate method which provides certain advantages using fluence-related risk coefficients (risk cross sections), and (5) directions for future research and development of these ideas.

  2. Fire-related cognitions moderate the impact of risk factors on adjustment following wildfire disaster.

    PubMed

    Scher, Christine D; Ellwanger, Joel

    2009-10-01

    This study builds upon current understanding of risk and protective factors for post-disaster adjustment by examining relationships between disaster-related cognitions, three empirically supported risk factors for poorer adjustment (i.e., greater disaster impact, female gender, and racial/ethnic minority status), and three common post-disaster outcomes (i.e., depression, anxiety, and somatic complaints). Participants were 200 students exposed to wildfire disaster. Simultaneous hierarchical regression analyses revealed that, during the acute stress period: (1) disaster-related cognitions in interaction with fire impact and minority status, as well as gender, were related to anxiety symptoms, (2) cognitions were related to depression symptoms, and (3) cognitions in interaction with minority status, as well as fire impact, were related to somatic symptoms. No examined variables predicted symptom change.

  3. Approaches to risk-adjusting outcome measures applied to criminal justice involvement after community service.

    PubMed

    Banks, S M; Pandiani, J A; Bramley, J

    2001-08-01

    The ethic of fairness in program evaluation requires that measures of behavioral health agency performance be sensitive to differences in those agencies' caseload composition. The authors describe two traditional approaches to the statistical risk adjustment of outcome measures (stratification weighting and pre-post measurement) that are designed to account for differences in caseload composition and introduce a method that incorporates the strengths of both approaches. Procedures for deriving each of these measures are described in detail and demonstrated in the evaluation of a statewide system of community-based behavioral health care programs. This evaluation examines the degree to which service recipients get into trouble with the law after treatment. Three measures are recommended for inclusion in outcome-oriented "report cards," and the interpretation of each measure is discussed. Finally, the authors suggest formats for graphic and tabular presentation of the risk-adjusted evaluation for sharing findings with diverse stakeholder groups. PMID:11497020

  4. Funding issues for Victorian hospitals: the risk-adjusted vision beyond casemix funding.

    PubMed

    Antioch, K; Walsh, M

    2000-01-01

    This paper discusses casemix funding issues in Victoria impacting on teaching hospitals. For casemix payments to be acceptable, the average price and cost weights must be set at an appropriate standard. The average price is based on a normative, policy basis rather than benchmarking. The 'averaging principle' inherent in cost weights has resulted in some AN-DRG weights being too low for teaching hospitals that are key State-wide providers of high complexity services such as neurosurgery and trauma. Casemix data have been analysed using international risk adjustment methodologies to successfully negotiate with the Victorian State Government for specified grants for several high complexity AN-DRGs. A risk-adjusted capitation funding model has also been developed for cystic fibrosis patients treated by The Alfred, called an Australian Health Maintenance Organisation (AHMO). This will facilitate the development of similar models by both the Victorian and Federal governments.

  5. NDVI saturation adjustment: a new approach for improving cropland performance estimates in the Greater Platte River Basin, USA

    USGS Publications Warehouse

    Gu, Yingxin; Wylie, Bruce K.; Howard, Daniel M.; Phuyal, Khem P.; Ji, Lei

    2013-01-01

    In this study, we developed a new approach that adjusted normalized difference vegetation index (NDVI) pixel values that were near saturation to better characterize the cropland performance (CP) in the Greater Platte River Basin (GPRB), USA. The relationship between NDVI and the ratio vegetation index (RVI) at high NDVI values was investigated, and an empirical equation for estimating saturation-adjusted NDVI (NDVIsat_adjust) based on RVI was developed. A 10-year (2000–2009) NDVIsat_adjust data set was developed using 250-m 7-day composite historical eMODIS (expedited Moderate Resolution Imaging Spectroradiometer) NDVI data. The growing season averaged NDVI (GSN), which is a proxy for ecosystem performance, was estimated and long-term NDVI non-saturation- and saturation-adjusted cropland performance (CPnon_sat_adjust, CPsat_adjust) maps were produced over the GPRB. The final CP maps were validated using National Agricultural Statistics Service (NASS) crop yield data. The relationship between CPsat_adjust and the NASS average corn yield data (r = 0.78, 113 samples) is stronger than the relationship between CPnon_sat_adjust and the NASS average corn yield data (r = 0.67, 113 samples), indicating that the new CPsat_adjust map reduces the NDVI saturation effects and is in good agreement with the corn yield ground observations. Results demonstrate that the NDVI saturation adjustment approach improves the quality of the original GSN map and better depicts the actual vegetation conditions of the GPRB cropland systems.

  6. Adjusting HIV prevalence estimates for non-participation: an application to demographic surveillance

    PubMed Central

    McGovern, Mark E.; Marra, Giampiero; Radice, Rosalba; Canning, David; Newell, Marie-Louise; Bärnighausen, Till

    2015-01-01

    Introduction HIV testing is a cornerstone of efforts to combat the HIV epidemic, and testing conducted as part of surveillance provides invaluable data on the spread of infection and the effectiveness of campaigns to reduce the transmission of HIV. However, participation in HIV testing can be low, and if respondents systematically select not to be tested because they know or suspect they are HIV positive (and fear disclosure), standard approaches to deal with missing data will fail to remove selection bias. We implemented Heckman-type selection models, which can be used to adjust for missing data that are not missing at random, and established the extent of selection bias in a population-based HIV survey in an HIV hyperendemic community in rural South Africa. Methods We used data from a population-based HIV survey carried out in 2009 in rural KwaZulu-Natal, South Africa. In this survey, 5565 women (35%) and 2567 men (27%) provided blood for an HIV test. We accounted for missing data using interviewer identity as a selection variable which predicted consent to HIV testing but was unlikely to be independently associated with HIV status. Our approach involved using this selection variable to examine the HIV status of residents who would ordinarily refuse to test, except that they were allocated a persuasive interviewer. Our copula model allows for flexibility when modelling the dependence structure between HIV survey participation and HIV status. Results For women, our selection model generated an HIV prevalence estimate of 33% (95% CI 27–40) for all people eligible to consent to HIV testing in the survey. This estimate is higher than the estimate of 24% generated when only information from respondents who participated in testing is used in the analysis, and the estimate of 27% when imputation analysis is used to predict missing data on HIV status. For men, we found an HIV prevalence of 25% (95% CI 15–35) using the selection model, compared to 16% among those who

  7. Evolving Adjustments to External (Gamma) Slope Factors for CERCLA Risk and Dose Assessments - 12290

    SciTech Connect

    Walker, Stuart

    2012-07-01

    To model the external exposure pathway in risk and dose assessments of radioactive contamination at Superfund sites, the U.S. Environmental Protection Agency (EPA) uses slope factors (SFs), also known as risk coefficients, and dose conversion factors (DCFs). Without any adjustment these external radiation exposure pathways effectively assumes that an individual is exposed to a source geometry that is effectively an infinite slab. The concept of an 'infinite slab' means that the thickness of the contaminated zone and its aerial extent are so large that it behaves as if it were infinite in its physical dimensions. EPA has been making increasingly complex adjustments to account for the extent of the contamination and its corresponding radiation field to provide more accurate risk and dose assessment modeling when using its calculators. In most instances, the more accurate modeling results derived from these gamma adjustments are less conservative. The notable exception are for some radionuclides in rooms with contaminated walls, ceiling, and floors, and the receptor is in location of the room with the highest amount of radiation exposure, usually the corner of small rooms and the center of large conference rooms. (authors)

  8. A risk-adjusted approach to comparing the return on investment in health care programs.

    PubMed

    Sendi, Pedram; Al, Maiwenn J; Zimmermann, Heinz

    2004-09-01

    The league table approach to rank ordering health care programs according to the incremental cost-effectiveness ratio is a common method to guide policy makers in setting priorities for resource allocation. In the presence of uncertainty, however, ranking programs is complicated by the degree of variability associated with each program. Confidence intervals for cost-effectiveness ratios may be overlapping. Moreover, confidence intervals may include negative ratios and the interpretation of negative cost-effectiveness ratios is ambiguous. We suggest to rank mutually exclusive health care programs according to their rate of return which is defined as the net monetary benefit over the costs of the program. However, how does a program with a higher expected return but higher uncertainty compare to a program with a lower expected return but lower risk? In the present paper we propose a risk-adjusted measure to compare the return on investment in health care programs. Financing a health care program is treated as an investment in a risky asset. The risky asset is combined with a risk-free asset in order to construct a combined portfolio. The weights attributed to the risk-free and risky assets are chosen in such a manner that all programs under consideration exhibit the same degree of uncertainty. We can then compare the performance of the individual programs by constructing a risk-adjusted league table of expected returns.

  9. Exposure corrected risk estimates for childhood product related injuries.

    PubMed

    Senturia, Y D; Binns, H J; Christoffel, K K; Tanz, R R

    1993-08-01

    This study assesses the effect of exposure correction on injury risk estimates for children, using Chicago-area survey data on age-specific exposure of children to seven products: amusement park rides, sleds, bunkbeds, skateboards, fireworks, toboggans, and air guns and rifles. National Electronic Injury Surveillance System estimates for 1987 were used as numerators with two denominators: (i) uncorrected age-specific U.S. Census estimates for 1987 and (ii) these estimates corrected for exposure. Except for bunkbeds, skateboards and sleds, corrected injury risk decreased as age increased. Uncorrected population injury rates underestimated the risk posed to product-using children, especially those who are youngest and those who use skateboards.

  10. Monte Carlo estimation of the dose and heating of cobalt adjuster rods irradiated in the CANDU 6 reactor core.

    PubMed

    Gugiu, Daniela; Dumitrache, Ion

    2005-01-01

    The present work is a part of a more complex project related to the replacement of the original stainless steel adjuster rods with cobalt assemblies in the CANDU 6 reactor core. The 60Co produced by 59Co irradiation could be used extensively in medicine and industry. The paper will mainly describe some of the reactor physics and safety requirements that must be carried into practice for the Co adjuster rods. The computations related to the neutronic equivalence of the stainless steel adjusters with the Co adjuster assemblies, as well as the estimations of the activity and heating of the irradiated cobalt rods, are performed using the Monte Carlo codes MCNP5 and MONTEBURNS 2.1. The activity values are used to evaluate the dose at the surface of the device designed to transport the cobalt adjusters.

  11. One idea of portfolio risk control for absolute return strategy risk adjustments by signals from correlation behavior

    NASA Astrophysics Data System (ADS)

    Nishiyama, N.

    2001-12-01

    Absolute return strategy provided from fund of funds (FOFs) investment schemes is the focus in Japanese Financial Community. FOFs investment mainly consists of hedge fund investment and it has two major characteristics which are low correlation against benchmark index and little impact from various external changes in the environment given maximizing return. According to the historical track record of survival hedge funds in this business world, they maintain a stable high return and low risk. However, one must keep in mind that low risk would not be equal to risk free. The failure of Long-term capital management (LTCM) that took place in the summer of 1998 was a symbolized phenomenon. The summer of 1998 exhibited a certain limitation of traditional value at risk (VaR) and some possibility that traditional VaR could be ineffectual to the nonlinear type of fluctuation in the market. In this paper, I try to bring self-organized criticality (SOC) into portfolio risk control. SOC would be well known as a model of decay in the natural world. I analyzed nonlinear type of fluctuation in the market as SOC and applied SOC to capture complicated market movement using threshold point of SOC and risk adjustments by scenario correlation as implicit signals. Threshold becomes the control parameter of risk exposure to set downside floor and forecast extreme nonlinear type of fluctuation under a certain probability. Simulation results would show synergy effect of portfolio risk control between SOC and absolute return strategy.

  12. Validation, Replication, and Sensitivity Testing of Heckman-Type Selection Models to Adjust Estimates of HIV Prevalence

    PubMed Central

    Clark, Samuel J.; Houle, Brian

    2014-01-01

    A recent study using Heckman-type selection models to adjust for non-response in the Zambia 2007 Demographic and Health Survey (DHS) found a large correction in HIV prevalence for males. We aim to validate this finding, replicate the adjustment approach in other DHSs, apply the adjustment approach in an external empirical context, and assess the robustness of the technique to different adjustment approaches. We used 6 DHSs, and an HIV prevalence study from rural South Africa to validate and replicate the adjustment approach. We also developed an alternative, systematic model of selection processes and applied it to all surveys. We decomposed corrections from both approaches into rate change and age-structure change components. We are able to reproduce the adjustment approach for the 2007 Zambia DHS and derive results comparable with the original findings. We are able to replicate applying the approach in several other DHSs. The approach also yields reasonable adjustments for a survey in rural South Africa. The technique is relatively robust to how the adjustment approach is specified. The Heckman selection model is a useful tool for assessing the possibility and extent of selection bias in HIV prevalence estimates from sample surveys. PMID:25402333

  13. Political risk in fair market value estimates

    SciTech Connect

    Gruy, H.J.; Hartsock, J.H.

    1996-09-01

    Political risk arises from unstable governments, commercial establishments and infrastructure as well as labor unrest. All these factors vary from country to country and from time to time. Banks and insurance companies quantify these risks, but they are reluctant to divulge their opinions for fear of alienating possible customers that have been assigned a high risk. An investment in a fixed property such as an oil and gas lease, concession or other mineral interest is subject to political risk. No one will deny that money to be received several years in the future has a greater value today in a country with a stable government, stable tax regime, a sound economy and reliable labor force than in a Third World country where a revolution is brewing. Even in stable countries, the risk of tax law changes, exorbitant environmental production regulations and cleanup costs may vary. How do these factors affect fair market value and how are these calculations made? An important consideration discussed in this paper is the treatment of capital investments.

  14. Variation In Accountable Care Organization Spending And Sensitivity To Risk Adjustment: Implications For Benchmarking.

    PubMed

    Rose, Sherri; Zaslavsky, Alan M; McWilliams, J Michael

    2016-03-01

    Spending targets (or benchmarks) for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program must be set carefully to encourage program participation while achieving fiscal goals and minimizing unintended consequences, such as penalizing ACOs for serving sicker patients. Recently proposed regulatory changes include measures to make benchmarks more similar for ACOs in the same area with different historical spending levels. We found that ACOs vary widely in how their spending levels compare with those of other local providers after standard case-mix adjustments. Additionally adjusting for survey measures of patient health meaningfully reduced the variation in differences between ACO spending and local average fee-for-service spending, but substantial variation remained, which suggests that differences in care efficiency between ACOs and local non-ACO providers vary widely. Accordingly, measures to equilibrate benchmarks between high- and low-spending ACOs--such as setting benchmarks to risk-adjusted average fee-for-service spending in an area--should be implemented gradually to maintain participation by ACOs with high spending. Use of survey information also could help mitigate perverse incentives for risk selection and upcoding and limit unintended consequences of new benchmarking methodologies for ACOs serving sicker patients. PMID:26953298

  15. Parametric Estimation in a Recurrent Competing Risks Model

    PubMed Central

    Peña, Edsel A.

    2014-01-01

    A resource-efficient approach to making inferences about the distributional properties of the failure times in a competing risks setting is presented. Efficiency is gained by observing recurrences of the competing risks over a random monitoring period. The resulting model is called the recurrent competing risks model (RCRM) and is coupled with two repair strategies whenever the system fails. Maximum likelihood estimators of the parameters of the marginal distribution functions associated with each of the competing risks and also of the system lifetime distribution function are presented. Estimators are derived under perfect and partial repair strategies. Consistency and asymptotic properties of the estimators are obtained. The estimation methods are applied to a data set of failures for cars under warranty. Simulation studies are used to ascertain the small sample properties and the efficiency gains of the resulting estimators. PMID:25346751

  16. When the risks are high: psychological adjustment among melanoma survivors at high risk of developing new primary disease.

    PubMed

    McLoone, Jordana; Watts, Kaaren; Menzies, Scott; Meiser, Bettina; Butow, Phyllis; Kasparian, Nadine

    2012-08-01

    In this study we explored the psychosocial experiences of melanoma survivors at high risk of developing new primary disease. A total of 20 survivors (9 men, 11 women, mean age 57.6 years) completed a semistructured telephone interview, exploring melanoma-related beliefs and experiences, psychological adjustment to melanoma risk, and supportive care needs. Participants perceived melanoma as potentially terminal and reported persistent worries about the possibility of developing new or metastatic disease. Fear of developing a new melanoma endured for years after treatment completion and, for some, created a pervasive sense of uncertainty. Still, not a single participant sought formal emotional support to address his or her melanoma-related concerns. Belief in the benefits of early intervention, including self- and clinical skin examination, provided a sense of control and a recommended course of action in an otherwise uncontrollable situation. The expertise of the High Risk Clinic physicians was perceived as instrumental in creating a sense of reassurance.

  17. Comparative coronary risks of apixaban, rivaroxaban and dabigatran: a meta-analysis and adjusted indirect comparison

    PubMed Central

    Loke, Yoon K; Pradhan, Shiva; Yeong, Jessica Ka-yan; Kwok, Chun Shing

    2014-01-01

    Aims There are concerns regarding increased risk of acute coronary syndrome with dabigatran. We aimed to assess whether alternative treatment options such as rivaroxaban or apixaban carry a similar risk as compared with dabigatran. Methods We searched MEDLINE and EMBASE for randomized controlled trials of apixaban, dabigatran or rivaroxaban against control (placebo, heparin or vitamin K antagonist). We pooled odds ratios (OR) for adverse coronary events (acute coronary syndrome or myocardial infarction) using fixed effect meta-analysis and assessed heterogeneity with I2. We conducted adjusted indirect comparisons to compare risk of adverse coronary events with apixaban or rivaroxaban vs. dabigatran. Results Twenty-seven randomized controlled trials met the inclusion criteria. Dabigatran was associated with a significantly increased risk of adverse coronary events in pooled analysis of nine trials (OR 1.45, 95% CI 1.14, 1.86). There was no signal for coronary risk with apixaban from nine trials (pooled OR 0.89, 95% CI 0.78, 1.03) or rivaroxaban from nine trials (pooled OR 0.81, 95% CI 0.72, 0.93). Overall, adjusted indirect comparison suggested that both apixaban (OR 0.61, 95% CI 0.44, 0.85) and rivaroxaban (OR 0.54; 95% CI 0.39, 0.76) were associated with lower coronary risk than dabigatran. Restricting the indirect comparison to a vitamin K antagonist as a common control, yielded similar findings, OR 0.57 (95% CI 0.39, 0.85) for apixaban vs. dabigatran and 0.53 (95% CI 0.37, 0.77) for rivaroxaban vs. dabigatran. Conclusions There are significant differences in the comparative safety of apixaban, rivaroxaban and dabigatran with regards to acute coronary adverse events. PMID:24617578

  18. Adjusting survival estimates for premature transmitter failure: A case study from the Sacramento-San Joaquin Delta

    USGS Publications Warehouse

    Holbrook, Christopher M.; Perry, Russell W.; Brandes, Patricia L.; Adams, Noah S.

    2013-01-01

    In telemetry studies, premature tag failure causes negative bias in fish survival estimates because tag failure is interpreted as fish mortality. We used mark-recapture modeling to adjust estimates of fish survival for a previous study where premature tag failure was documented. High rates of tag failure occurred during the Vernalis Adaptive Management Plan’s (VAMP) 2008 study to estimate survival of fall-run Chinook salmon (Oncorhynchus tshawytscha) during migration through the San Joaquin River and Sacramento-San Joaquin Delta, California. Due to a high rate of tag failure, the observed travel time distribution was likely negatively biased, resulting in an underestimate of tag survival probability in this study. Consequently, the bias-adjustment method resulted in only a small increase in estimated fish survival when the observed travel time distribution was used to estimate the probability of tag survival. Since the bias-adjustment failed to remove bias, we used historical travel time data and conducted a sensitivity analysis to examine how fish survival might have varied across a range of tag survival probabilities. Our analysis suggested that fish survival estimates were low (95% confidence bounds range from 0.052 to 0.227) over a wide range of plausible tag survival probabilities (0.48–1.00), and this finding is consistent with other studies in this system. When tags fail at a high rate, available methods to adjust for the bias may perform poorly. Our example highlights the importance of evaluating the tag life assumption during survival studies, and presents a simple framework for evaluating adjusted survival estimates when auxiliary travel time data are available.

  19. Outpatient encounter data for risk adjustment: strategic issues for Medicare and Medicaid.

    PubMed

    Welch, W Pete

    2002-07-01

    Payers are increasingly using diagnostic data from outpatient encounter records to adjust the payment to health plans. Although much has been written about the ability of such data to predict health care costs, little has been written about the data itself--its quality and availability. Fee-for-service (FFS) data face several threats to their validity, including the possibility that they may seriously underreport diagnoses. Because the systems and incentives that yield FFS and managed care diagnosis data are quite different, they may not be comparable, depending on circumstances such as audit rules. The next generation of risk adjustment models should be designed around the capabilities and potentialities of plans' information systems.

  20. Resources for global risk assessment: the International Toxicity Estimates for Risk (ITER) and Risk Information Exchange (RiskIE) databases.

    PubMed

    Wullenweber, Andrea; Kroner, Oliver; Kohrman, Melissa; Maier, Andrew; Dourson, Michael; Rak, Andrew; Wexler, Philip; Tomljanovic, Chuck

    2008-11-15

    The rate of chemical synthesis and use has outpaced the development of risk values and the resolution of risk assessment methodology questions. In addition, available risk values derived by different organizations may vary due to scientific judgments, mission of the organization, or use of more recently published data. Further, each organization derives values for a unique chemical list so it can be challenging to locate data on a given chemical. Two Internet resources are available to address these issues. First, the International Toxicity Estimates for Risk (ITER) database (www.tera.org/iter) provides chronic human health risk assessment data from a variety of organizations worldwide in a side-by-side format, explains differences in risk values derived by different organizations, and links directly to each organization's website for more detailed information. It is also the only database that includes risk information from independent parties whose risk values have undergone independent peer review. Second, the Risk Information Exchange (RiskIE) is a database of in progress chemical risk assessment work, and includes non-chemical information related to human health risk assessment, such as training modules, white papers and risk documents. RiskIE is available at http://www.allianceforrisk.org/RiskIE.htm, and will join ITER on National Library of Medicine's TOXNET (http://toxnet.nlm.nih.gov/). Together, ITER and RiskIE provide risk assessors essential tools for easily identifying and comparing available risk data, for sharing in progress assessments, and for enhancing interaction among risk assessment groups to decrease duplication of effort and to harmonize risk assessment procedures across organizations.

  1. Resources for global risk assessment: The International Toxicity Estimates for Risk (ITER) and Risk Information Exchange (RiskIE) databases

    SciTech Connect

    Wullenweber, Andrea Kroner, Oliver; Kohrman, Melissa; Maier, Andrew; Dourson, Michael; Rak, Andrew; Wexler, Philip; Tomljanovic, Chuck

    2008-11-15

    The rate of chemical synthesis and use has outpaced the development of risk values and the resolution of risk assessment methodology questions. In addition, available risk values derived by different organizations may vary due to scientific judgments, mission of the organization, or use of more recently published data. Further, each organization derives values for a unique chemical list so it can be challenging to locate data on a given chemical. Two Internet resources are available to address these issues. First, the International Toxicity Estimates for Risk (ITER) database ( (www.tera.org/iter)) provides chronic human health risk assessment data from a variety of organizations worldwide in a side-by-side format, explains differences in risk values derived by different organizations, and links directly to each organization's website for more detailed information. It is also the only database that includes risk information from independent parties whose risk values have undergone independent peer review. Second, the Risk Information Exchange (RiskIE) is a database of in progress chemical risk assessment work, and includes non-chemical information related to human health risk assessment, such as training modules, white papers and risk documents. RiskIE is available at (http://www.allianceforrisk.org/RiskIE.htm), and will join ITER on National Library of Medicine's TOXNET ( (http://toxnet.nlm.nih.gov/)). Together, ITER and RiskIE provide risk assessors essential tools for easily identifying and comparing available risk data, for sharing in progress assessments, and for enhancing interaction among risk assessment groups to decrease duplication of effort and to harmonize risk assessment procedures across organizations.

  2. Estimated GFR associates with cardiovascular risk factors independently of measured GFR.

    PubMed

    Mathisen, Ulla Dorte; Melsom, Toralf; Ingebretsen, Ole C; Jenssen, Trond; Njølstad, Inger; Solbu, Marit D; Toft, Ingrid; Eriksen, Bjørn O

    2011-05-01

    Estimation of the GFR (eGFR) using creatinine- or cystatin C-based equations is imperfect, especially when the true GFR is normal or near-normal. Modest reductions in eGFR from the normal range variably predict cardiovascular morbidity. If eGFR associates not only with measured GFR (mGFR) but also with cardiovascular risk factors, the effects of these non-GFR-related factors might bias the association between eGFR and outcome. To investigate these potential non-GFR-related associations between eGFR and cardiovascular risk factors, we measured GFR by iohexol clearance in a sample from the general population (age 50 to 62 years) without known cardiovascular disease, diabetes, or kidney disease. Even after adjustment for mGFR, eGFR associated with traditional cardiovascular risk factors in multiple regression analyses. More risk factors influenced cystatin C-based eGFR than creatinine-based eGFR, adjusted for mGFR, and some of the risk factors exhibited nonlinear effects in generalized additive models (P<0.05). These results suggest that eGFR, calculated using standard creatinine- or cystatin C-based equations, partially depends on factors other than the true GFR. Thus, estimates of cardiovascular risk associated with small changes in eGFR must be interpreted with caution.

  3. 12 CFR Appendix B to Part 3 - Risk-Based Capital Guidelines; Market Risk Adjustment

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... the Board's Regulation EE (12 CFR Part 231); or (2) If the transaction does not meet the criteria set... business days multiplied by three, except as provided in section 4(e) of this appendix; (ii) Specific risk... that modifies its existing modeling procedures to comply with the requirements of this appendix...

  4. 12 CFR Appendix B to Part 3 - Risk-Based Capital Guidelines; Market Risk Adjustment

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... by a risk weighting factor of 8.0 percent, or by 4.0 percent if the equity is held in a portfolio... supervisory approval, a bank may opt to comply with this appendix as early as January 1, 1997. 4 4 A bank that... during a fixed holding period within a stated confidence level, measured in accordance with section 4...

  5. Effect of Risk Adjustment Method on Comparisons of Health Care Utilization Between Complementary and Alternative Medicine Users and Nonusers

    PubMed Central

    Gerkovich, Mary M.; Cherkin, Daniel C.; Deyo, Richard A.; Sherman, Karen J.; Lafferty, William E.

    2013-01-01

    Abstract Objectives Complementary and alternative medicine (CAM) providers are becoming more integrated into the United States health care system. Because patients self-select CAM use, risk adjustment is needed to make the groups more comparable when analyzing utilization. This study examined how the choice of risk adjustment method affects assessment of CAM use on overall health care utilization. Design and subjects Insurance claims data for 2000–2003 from Washington State, which mandates coverage of CAM providers, were analyzed. Three (3) risk adjustment methods were compared in patients with musculoskeletal conditions: Adjusted Clinical Groups (ACG), Diagnostic Cost Groups (DCG), and the Charlson Index. Relative Value Units (RVUs) were used as a proxy for expenditures. Two (2) sets of median regression models were created: prospective, which used risk adjustments from the previous year to predict RVU in the subsequent year, and concurrent, which used risk adjustment measures to predict RVU in the same year. Results The sample included 92,474 claimants. Prospective models showed little difference in the effect of CAM use on RVU among the three risk adjustment methods, and all models had low predictive power (R2 ≤0.05). In the concurrent models, coefficients were similar in direction and magnitude for all risk adjustment methods, but in some models the predicted effect of CAM use on RVU differed by as much as double between methods. Results of DCG and ACG models were similar and were stronger than Charlson models. Conclusions Choice of risk adjustment method may have a modest effect on the outcome of interest. PMID:23036140

  6. Estimating Fire Risks at Industrial Nuclear Facilities

    SciTech Connect

    Coutts, D.A.

    1999-07-12

    The Savannah River Site (SRS) has a wide variety of nuclear production facilities that include chemical processing facilities, machine shops, production reactors, and laboratories. Current safety documentation must be maintained for the nuclear facilities at SRS. Fire Risk Analyses (FRAs) are used to support the safety documentation basis. These FRAs present the frequency that specified radiological and chemical consequences will be exceeded. The consequence values are based on mechanistic models assuming specific fire protection features fail to function as designed.

  7. Estimating Risk: Stereotype Amplification and the Perceived Risk of Criminal Victimization

    PubMed Central

    QUILLIAN, LINCOLN; PAGER, DEVAH

    2010-01-01

    This paper considers the process by which individuals estimate the risk of adverse events, with particular attention to the social context in which risk estimates are formed. We compare subjective probability estimates of crime victimization to actual victimization experiences among respondents from the 1994 to 2002 waves of the Survey of Economic Expectations (Dominitz and Manski 2002). Using zip code identifiers, we then match these survey data to local area characteristics from the census. The results show that: (1) the risk of criminal victimization is significantly overestimated relative to actual rates of victimization or other negative events; (2) neighborhood racial composition is strongly associated with perceived risk of victimization, whereas actual victimization risk is driven by nonracial neighborhood characteristics; and (3) white respondents appear more strongly affected by racial composition than nonwhites in forming their estimates of risk. We argue these results support a model of stereotype amplification in the formation of risk estimates. Implications for persistent racial inequality are considered. PMID:20686631

  8. The occurrence of the filled duration illusion: a comparison of the method of adjustment with the method of magnitude estimation.

    PubMed

    Hasuo, Emi; Nakajima, Yoshitaka; Tomimatsu, Erika; Grondin, Simon; Ueda, Kazuo

    2014-03-01

    A time interval between the onset and the offset of a continuous sound (filled interval) is often perceived to be longer than a time interval between two successive brief sounds (empty interval) of the same physical duration. The present study examined whether and how this phenomenon, sometimes called the filled duration illusion (FDI), occurs for short time intervals (40-520 ms). The investigation was conducted with the method of adjustment (Experiment 1) and the method of magnitude estimation (Experiment 2). When the method of adjustment was used, the FDI did not appear for the majority of the participants, but it appeared clearly for some participants. In the latter case, the amount of the FDI increased as the interval duration lengthened. The FDI was more likely to occur with magnitude estimation than with the method of adjustment. The participants who showed clear FDI with one method did not necessarily show such clear FDI with the other method.

  9. Are Chinese consumers at risk due to exposure to metals in crayfish? A bioaccessibility-adjusted probabilistic risk assessment.

    PubMed

    Peng, Qian; Nunes, Luís M; Greenfield, Ben K; Dang, Fei; Zhong, Huan

    2016-03-01

    Freshwater crayfish, the world's third largest crustacean species, has been reported to accumulate high levels of metals, while the current knowledge of potential risk associated with crayfish consumption lags behind that of finfish. We provide the first estimate of human health risk associated with crayfish (Procambarus clarkii) consumption in China, the world's largest producer and consumer of crayfish. We performed Monte Carlo Simulation on a standard risk model parameterized with local data on metal concentrations, bioaccessibility (φ), crayfish consumption rate, and consumer body mass. Bioaccessibility of metals in crayfish was found to be variable (68-95%) and metal-specific, suggesting a potential influence of metal bioaccessibility on effective metal intake. However, sensitivity analysis suggested risk of metals via crayfish consumption was predominantly explained by consumption rate (explaining >92% of total risk estimate variability), rather than metals concentration, bioaccessibility, or body mass. Mean metal concentrations (As, Cd, Cu, Ni, Pb, Se and Zn) in surveyed crayfish samples from 12 provinces in China conformed to national safety standards. However, risk calculation of φ-modified hazard quotient (HQ) and hazard index (HI) suggested that crayfish metals may pose a health risk for very high rate consumers, with a HI of over 24 for the highest rate consumers. Additionally, the φ-modified increased lifetime risk (ILTR) for carcinogenic effects due to the presence of As was above the acceptable level (10(-5)) for both the median (ILTR=2.5×10(-5)) and 90th percentile (ILTR=1.8×10(-4)), highlighting the relatively high risk of As in crayfish. Our results suggest a need to consider crayfish when assessing human dietary exposure to metals and associated health risks, especially for high crayfish-consuming populations, such as in China, USA and Sweden.

  10. Are Chinese consumers at risk due to exposure to metals in crayfish? A bioaccessibility-adjusted probabilistic risk assessment.

    PubMed

    Peng, Qian; Nunes, Luís M; Greenfield, Ben K; Dang, Fei; Zhong, Huan

    2016-03-01

    Freshwater crayfish, the world's third largest crustacean species, has been reported to accumulate high levels of metals, while the current knowledge of potential risk associated with crayfish consumption lags behind that of finfish. We provide the first estimate of human health risk associated with crayfish (Procambarus clarkii) consumption in China, the world's largest producer and consumer of crayfish. We performed Monte Carlo Simulation on a standard risk model parameterized with local data on metal concentrations, bioaccessibility (φ), crayfish consumption rate, and consumer body mass. Bioaccessibility of metals in crayfish was found to be variable (68-95%) and metal-specific, suggesting a potential influence of metal bioaccessibility on effective metal intake. However, sensitivity analysis suggested risk of metals via crayfish consumption was predominantly explained by consumption rate (explaining >92% of total risk estimate variability), rather than metals concentration, bioaccessibility, or body mass. Mean metal concentrations (As, Cd, Cu, Ni, Pb, Se and Zn) in surveyed crayfish samples from 12 provinces in China conformed to national safety standards. However, risk calculation of φ-modified hazard quotient (HQ) and hazard index (HI) suggested that crayfish metals may pose a health risk for very high rate consumers, with a HI of over 24 for the highest rate consumers. Additionally, the φ-modified increased lifetime risk (ILTR) for carcinogenic effects due to the presence of As was above the acceptable level (10(-5)) for both the median (ILTR=2.5×10(-5)) and 90th percentile (ILTR=1.8×10(-4)), highlighting the relatively high risk of As in crayfish. Our results suggest a need to consider crayfish when assessing human dietary exposure to metals and associated health risks, especially for high crayfish-consuming populations, such as in China, USA and Sweden. PMID:26773397

  11. Psychosocial Adjustment and Sibling Relationships in Siblings of Children with Autism Spectrum Disorder: Risk and Protective Factors

    ERIC Educational Resources Information Center

    Walton, Katherine M.; Ingersoll, Brooke R.

    2015-01-01

    This study compared sibling adjustment and relationships in siblings of children with Autism Spectrum Disorder (ASD-Sibs; n = 69) and siblings of children with typical development (TD-Sibs; n = 93). ASD-Sibs and TD-Sibs demonstrated similar emotional/behavioral adjustment. Older male ASD-Sibs were at increased risk for difficulties. Sibling…

  12. Using sightability-adjusted brood-pair ratios to estimate waterfowl productivity

    USGS Publications Warehouse

    Pagano, Anthony M.; Amundson, Courtney; Pieron, Matthew R.; Arnold, Todd W.; Kimmel, Timothy C.

    2014-01-01

    Historically, biologists used brood-pair ratios (BPRs) as an index to waterfowl productivity to help guide management decisions and evaluate conservation practices. However, BPRs are biased by imperfect detection probabilities, especially for broods. We conducted roadside surveys for breeding waterfowl pairs on 7–8 study sites in the springs of 2006–2008 in northeastern North Dakota, USA. Later each year, we conducted replicate counts of broods on the same wetlands and used mark–recapture methods to estimate sightability-adjusted BPRs (SA-BPRs). Traditional roadside brood surveys detected only 30–45% of the available broods, depending on species. We explored the potential for using SA-BPRs to measure hen success (i.e., the probability a female hatches ≥1 egg across all nesting attempts) for mallards (Anas platyrhynchos) and other upland-nesting dabbling ducks (Anas spp.). We found that SA-BPRs explained 40% of the variation in hen success over 5 species of dabbling ducks, and we were able to detect an effect of predator reduction on hen success in combined dabblers, but not in mallards alone. However, we found no relationship between SA-BPRs and mallard fledging rates (hen success × initial brood size × duckling survival). Our results suggest that SA-BPRs can provide a cost-effective alternative to traditional measures of productivity such as nesting success, but not to measures of duckling survival. Nevertheless, SA-BPRs may be useful in areas where traditional measures of waterfowl productivity are logistically or financially challenging.

  13. Thinking Concretely Increases the Perceived Likelihood of Risks: The Effect of Construal Level on Risk Estimation.

    PubMed

    Lermer, Eva; Streicher, Bernhard; Sachs, Rainer; Raue, Martina; Frey, Dieter

    2016-03-01

    Recent findings on construal level theory (CLT) suggest that abstract thinking leads to a lower estimated probability of an event occurring compared to concrete thinking. We applied this idea to the risk context and explored the influence of construal level (CL) on the overestimation of small and underestimation of large probabilities for risk estimates concerning a vague target person (Study 1 and Study 3) and personal risk estimates (Study 2). We were specifically interested in whether the often-found overestimation of small probabilities could be reduced with abstract thinking, and the often-found underestimation of large probabilities was reduced with concrete thinking. The results showed that CL influenced risk estimates. In particular, a concrete mindset led to higher risk estimates compared to an abstract mindset for several adverse events, including events with small and large probabilities. This suggests that CL manipulation can indeed be used for improving the accuracy of lay people's estimates of small and large probabilities. Moreover, the results suggest that professional risk managers' risk estimates of common events (thus with a relatively high probability) could be improved by adopting a concrete mindset. However, the abstract manipulation did not lead managers to estimate extremely unlikely events more accurately. Potential reasons for different CL manipulation effects on risk estimates' accuracy between lay people and risk managers are discussed.

  14. Calculating excess risk with age-dependent adjustment factors and cumulative doses: ethylene oxide case study.

    PubMed

    Sielken, Robert L; Flores, Ciriaco Valdez

    2009-10-01

    U.S. EPA's Supplemental Guidance in 2005 documented their procedure for incorporating age-dependent adjustment factors (ADAFs) into lifetime excess risk calculations. EPA's first attempt to implement an ADAF when the dose-response model had a cumulative dose metric was for ethylene oxide and that attempt (US EPA, 2006) failed to successfully follow EPA's own guidelines. The failure suggested that the incorporation of ADAFs would increase the lifetime excess risk for ethylene oxide by approximately 66%. However, if the procedure in the guidelines were followed correctly, then the increase would have only been 0.008% or approximately 8,000 fold less. Because cumulative exposure is a common dose metric in dose-response models of epidemiological data, a correct implementation of the guidelines is of widespread importance.

  15. Failure of Marfan anatomic criteria to predict risk of aortic dissection in Turner syndrome: necessity of specific adjusted risk thresholds†

    PubMed Central

    Maureira, Juan-Pablo; Vanhuyse, Fabrice; Lekehal, Malik; Hubert, Thierry; Vigouroux, Charlène; Mattei, Marie-Françoise; Grandmougin, Daniel; Villemot, Jean-Pierre

    2012-01-01

    Patients with Turner syndrome are prompt to develop spontaneous acute aortic dissection following insidious aortic dilatation, with abnormal cardiovascular anatomy and consequently require specific guidelines for regular surveillance since they represent a subset of high-risk young patients. We report a rare and uncommon case of spontaneous acute aortic dissection in a 48-year old female patient with Turner syndrome who was not apparently eligible for a prophylactic surgery. A CT scan showed a Stanford type A aortic dissection and was urgently referred for surgical management. We operated on the patient under deep hypothermia (18°C) and circulatory arrest with a retrograde cerebroplegia as the primary entry tear was located in the arch. The postoperative course was uneventful and the patient was discharged at the eighth postoperative day. Following description of this case, special attention was paid to determine predisposing risk factors for aortic dissection to be specifically adjusted to TS patients. PMID:22286600

  16. Risk estimates for neonatal myotonic dystrophy.

    PubMed Central

    Glånz, A; Fråser, F C

    1984-01-01

    Children who inherit the autosomal dominant gene for myotonic dystrophy from their mother rather than their father may develop the severe neonatal type rather than the late onset type. The families of 22 neonatal type probands and 59 late onset type probands were studied to determine the risk of occurrence and recurrence of the neonatal type. The frequency of the neonatal type in sibs of neonatal type probands was 29%, or 37% if cases of neonatal deaths are counted as affected. This is significantly higher than the 6% of the neonatal type found in the offspring of affected women not ascertained through a child with the neonatal type. These data suggest that certain women carrying the gene for myotonic dystrophy are predisposed to have children affected with the neonatal type rather than the late onset type. The female near relatives of these women do not seem to share this predisposition. The data should be useful for genetic counseling. PMID:6748014

  17. Adjustments of the Pesticide Risk Index Used in Environmental Policy in Flanders

    PubMed Central

    Fevery, Davina; Peeters, Bob; Lenders, Sonia; Spanoghe, Pieter

    2015-01-01

    Indicators are used to quantify the pressure of pesticides on the environment. Pesticide risk indicators typically require weighting environmental exposure by a no effect concentration. An indicator based on spread equivalents (ΣSeq) is used in environmental policy in Flanders (Belgium). The pesticide risk for aquatic life is estimated by weighting active ingredient usage by the ratio of their maximum allowable concentration and their soil halflife. Accurate estimates of total pesticide usage in the region are essential in such calculations. Up to 2012, the environmental impact of pesticides was estimated on sales figures provided by the Federal Government. Since 2013, pesticide use is calculated based on results from the Farm Accountancy Data Network (FADN). The estimation of pesticide use was supplemented with data for non-agricultural use based on sales figures of amateur use provided by industry and data obtained from public services. The Seq-indicator was modified to better reflect reality. This method was applied for the period 2009-2012 and showed differences between estimated use and sales figures of pesticides. The estimated use of pesticides based on accountancy data is more accurate compared to sales figures. This approach resulted in a better view on pesticide use and its respective environmental impact in Flanders. PMID:26046655

  18. Adjustments of the Pesticide Risk Index Used in Environmental Policy in Flanders.

    PubMed

    Fevery, Davina; Peeters, Bob; Lenders, Sonia; Spanoghe, Pieter

    2015-01-01

    Indicators are used to quantify the pressure of pesticides on the environment. Pesticide risk indicators typically require weighting environmental exposure by a no effect concentration. An indicator based on spread equivalents (ΣSeq) is used in environmental policy in Flanders (Belgium). The pesticide risk for aquatic life is estimated by weighting active ingredient usage by the ratio of their maximum allowable concentration and their soil halflife. Accurate estimates of total pesticide usage in the region are essential in such calculations. Up to 2012, the environmental impact of pesticides was estimated on sales figures provided by the Federal Government. Since 2013, pesticide use is calculated based on results from the Farm Accountancy Data Network (FADN). The estimation of pesticide use was supplemented with data for non-agricultural use based on sales figures of amateur use provided by industry and data obtained from public services. The Seq-indicator was modified to better reflect reality. This method was applied for the period 2009-2012 and showed differences between estimated use and sales figures of pesticides. The estimated use of pesticides based on accountancy data is more accurate compared to sales figures. This approach resulted in a better view on pesticide use and its respective environmental impact in Flanders.

  19. Adjustments of the Pesticide Risk Index Used in Environmental Policy in Flanders.

    PubMed

    Fevery, Davina; Peeters, Bob; Lenders, Sonia; Spanoghe, Pieter

    2015-01-01

    Indicators are used to quantify the pressure of pesticides on the environment. Pesticide risk indicators typically require weighting environmental exposure by a no effect concentration. An indicator based on spread equivalents (ΣSeq) is used in environmental policy in Flanders (Belgium). The pesticide risk for aquatic life is estimated by weighting active ingredient usage by the ratio of their maximum allowable concentration and their soil halflife. Accurate estimates of total pesticide usage in the region are essential in such calculations. Up to 2012, the environmental impact of pesticides was estimated on sales figures provided by the Federal Government. Since 2013, pesticide use is calculated based on results from the Farm Accountancy Data Network (FADN). The estimation of pesticide use was supplemented with data for non-agricultural use based on sales figures of amateur use provided by industry and data obtained from public services. The Seq-indicator was modified to better reflect reality. This method was applied for the period 2009-2012 and showed differences between estimated use and sales figures of pesticides. The estimated use of pesticides based on accountancy data is more accurate compared to sales figures. This approach resulted in a better view on pesticide use and its respective environmental impact in Flanders. PMID:26046655

  20. Behavioural Adjustment in Response to Increased Predation Risk: A Study in Three Duck Species

    PubMed Central

    Zimmer, Cédric; Boos, Mathieu; Bertrand, Frédéric; Robin, Jean-Patrice; Petit, Odile

    2011-01-01

    Predation directly triggers behavioural decisions designed to increase immediate survival. However, these behavioural modifications can have long term costs. There is therefore a trade-off between antipredator behaviours and other activities. This trade-off is generally considered between vigilance and only one other behaviour, thus neglecting potential compensations. In this study, we considered the effect of an increase in predation risk on the diurnal time-budget of three captive duck species during the wintering period. We artificially increased predation risk by disturbing two groups of 14 mallard and teals at different frequencies, and one group of 14 tufted ducks with a radio-controlled stressor. We recorded foraging, vigilance, preening and sleeping durations the week before, during and after disturbance sessions. Disturbed groups were compared to an undisturbed control group. We showed that in all three species, the increase in predation risk resulted in a decrease in foraging and preening and led to an increase in sleeping. It is worth noting that contrary to common observations, vigilance did not increase. However, ducks are known to be vigilant while sleeping. This complex behavioural adjustment therefore seems to be optimal as it may allow ducks to reduce their predation risk. Our results highlight the fact that it is necessary to encompass the whole individual time-budget when studying behavioural modifications under predation risk. Finally, we propose that studies of behavioural time-budget changes under predation risk should be included in the more general framework of the starvation-predation risk trade-off. PMID:21533055

  1. First-order correct bootstrap support adjustments for splits that allow hypothesis testing when using maximum likelihood estimation.

    PubMed

    Susko, Edward

    2010-07-01

    The most frequent measure of phylogenetic uncertainty for splits is bootstrap support. Although large bootstrap support intuitively suggests that a split in a tree is well supported, it has not been clear how large bootstrap support needs to be to conclude that there is significant evidence that a hypothesized split is present. Indeed, recent work has shown that bootstrap support is not first-order correct and thus cannot be directly used for hypothesis testing. We present methods that adjust bootstrap support values in a maximum likelihood (ML) setting so that they have an interpretation corresponding to P values in conventional hypothesis testing; for instance, adjusted bootstrap support larger than 95% occurs only 5% of the time if the split is not present. Through examples and simulation settings, it is found that adjustments always increase the level of support. We also find that the nature of the adjustment is fairly constant across parameter settings. Finally, we consider adjustments that take into account the data-dependent nature of many hypotheses about splits: the hypothesis that they are present is being tested because they are in the tree estimated through ML. Here, in contrast, we find that bootstrap probability often needs to be adjusted downwards.

  2. Estimating the re-identification risk of clinical data sets

    PubMed Central

    2012-01-01

    Background De-identification is a common way to protect patient privacy when disclosing clinical data for secondary purposes, such as research. One type of attack that de-identification protects against is linking the disclosed patient data with public and semi-public registries. Uniqueness is a commonly used measure of re-identification risk under this attack. If uniqueness can be measured accurately then the risk from this kind of attack can be managed. In practice, it is often not possible to measure uniqueness directly, therefore it must be estimated. Methods We evaluated the accuracy of uniqueness estimators on clinically relevant data sets. Four candidate estimators were identified because they were evaluated in the past and found to have good accuracy or because they were new and not evaluated comparatively before: the Zayatz estimator, slide negative binomial estimator, Pitman’s estimator, and mu-argus. A Monte Carlo simulation was performed to evaluate the uniqueness estimators on six clinically relevant data sets. We varied the sampling fraction and the uniqueness in the population (the value being estimated). The median relative error and inter-quartile range of the uniqueness estimates was measured across 1000 runs. Results There was no single estimator that performed well across all of the conditions. We developed a decision rule which selected between the Pitman, slide negative binomial and Zayatz estimators depending on the sampling fraction and the difference between estimates. This decision rule had the best consistent median relative error across multiple conditions and data sets. Conclusion This study identified an accurate decision rule that can be used by health privacy researchers and disclosure control professionals to estimate uniqueness in clinical data sets. The decision rule provides a reliable way to measure re-identification risk. PMID:22776564

  3. Model-based Small Area Estimates of Cancer Risk Factors and Screening Behaviors - Small Area Estimates

    Cancer.gov

    These model-based estimates use two surveys, the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS). The two surveys are combined using novel statistical methodology.

  4. Estimating and Mapping the Population at Risk of Sleeping Sickness

    PubMed Central

    Franco, José R.; Paone, Massimo; Diarra, Abdoulaye; Ruiz-Postigo, José Antonio; Fèvre, Eric M.; Mattioli, Raffaele C.; Jannin, Jean G.

    2012-01-01

    Background Human African trypanosomiasis (HAT), also known as sleeping sickness, persists as a public health problem in several sub-Saharan countries. Evidence-based, spatially explicit estimates of population at risk are needed to inform planning and implementation of field interventions, monitor disease trends, raise awareness and support advocacy. Comprehensive, geo-referenced epidemiological records from HAT-affected countries were combined with human population layers to map five categories of risk, ranging from “very high” to “very low,” and to estimate the corresponding at-risk population. Results Approximately 70 million people distributed over a surface of 1.55 million km2 are estimated to be at different levels of risk of contracting HAT. Trypanosoma brucei gambiense accounts for 82.2% of the population at risk, the remaining 17.8% being at risk of infection from T. b. rhodesiense. Twenty-one million people live in areas classified as moderate to very high risk, where more than 1 HAT case per 10,000 inhabitants per annum is reported. Discussion Updated estimates of the population at risk of sleeping sickness were made, based on quantitative information on the reported cases and the geographic distribution of human population. Due to substantial methodological differences, it is not possible to make direct comparisons with previous figures for at-risk population. By contrast, it will be possible to explore trends in the future. The presented maps of different HAT risk levels will help to develop site-specific strategies for control and surveillance, and to monitor progress achieved by ongoing efforts aimed at the elimination of sleeping sickness. PMID:23145192

  5. [Application of spatial relative risk estimation in communicable disease risk evaluation].

    PubMed

    Zhang, Yewu; Guo, Qing; Wang, Xiaofeng; Yu, Meng; Su, Xuemei; Dong, Yan; Zhang, Chunxi

    2015-05-01

    This paper summaries the application of adaptive kernel density algorithm in the spatial relative risk estimation of communicable diseases by using the reported data of infectious diarrhea (other than cholera, dysentery, typhoid and paratyphoid) in Ludian county and surrounding area in Yunnan province in 2013. Statistically significant fluctuations in an estimated risk function were identified through the use of asymptotic tolerance contours, and finally these data were visualized though disease mapping. The results of spatial relative risk estimation and disease mapping showed that high risk areas were in southeastern Shaoyang next to Ludian. Therefore, the spatial relative risk estimation of disease by using adaptive kernel density algorithm and disease mapping technique is a powerful method in identifying high risk population and areas.

  6. [Application of spatial relative risk estimation in communicable disease risk evaluation].

    PubMed

    Zhang, Yewu; Guo, Qing; Wang, Xiaofeng; Yu, Meng; Su, Xuemei; Dong, Yan; Zhang, Chunxi

    2015-05-01

    This paper summaries the application of adaptive kernel density algorithm in the spatial relative risk estimation of communicable diseases by using the reported data of infectious diarrhea (other than cholera, dysentery, typhoid and paratyphoid) in Ludian county and surrounding area in Yunnan province in 2013. Statistically significant fluctuations in an estimated risk function were identified through the use of asymptotic tolerance contours, and finally these data were visualized though disease mapping. The results of spatial relative risk estimation and disease mapping showed that high risk areas were in southeastern Shaoyang next to Ludian. Therefore, the spatial relative risk estimation of disease by using adaptive kernel density algorithm and disease mapping technique is a powerful method in identifying high risk population and areas. PMID:26080648

  7. Inter-hospital variations in caesarean sections. A risk adjusted comparison in the Valencia public hospitals

    PubMed Central

    Librero, J.; Peiro, S.; Calderon, S. M.

    2000-01-01

    BACKGROUND—The aim of this study was to describe the variability in caesarean rates in the public hospitals in the Valencia Region, Spain, and to analyse the association between caesarean sections and clinical and extra-clinical factors.
METHODS—Analysis of data contained in the Minimum Basic Data Set (MBDS) compiled for all births in 11 public hospitals in Valencia during 1994-1995 (n=36 819). Bivariate and multivariate analyses were used to evaluate the association between caesarean section rates and specific risk factors. The multivariate model was used to construct predictions about caesarean rates for each hospital, for comparison with rates observed.
RESULTS—Caesarean rates were 17.6% (inter-hospital range: 14.7% to 25.0%), with ample variability between hospitals in the diagnosis of maternal-fetal risk factors (particularly dystocia and fetal distress), and the indication for caesarean in the presence of these factors. Multivariate analysis showed that maternal-fetal risk factors correlated strongly with caesarean section, although extra-clinical factors, such as the day of the week, also correlated positively. After adjusting for the risk factors, the inter-hospital variation in caesarean rates persisted.
CONCLUSIONS—Although certain limitations (imprecision of some diagnoses and information biases in the MBDS) make it impossible to establish unequivocal conclusions, results show a high degree of variability among hospitals when opting for caesarean section. This variability cannot be justified by differences in obstetric risks.


Keywords: hospital utilisation; medical practice variation; caesarean section; administrative databases PMID:10890876

  8. On cancer risk estimation of urban air pollution.

    PubMed Central

    Törnqvist, M; Ehrenberg, L

    1994-01-01

    The usefulness of data from various sources for a cancer risk estimation of urban air pollution is discussed. Considering the irreversibility of initiations, a multiplicative model is preferred for solid tumors. As has been concluded for exposure to ionizing radiation, the multiplicative model, in comparison with the additive model, predicts a relatively larger number of cases at high ages, with enhanced underestimation of risks by short follow-up times in disease-epidemiological studies. For related reasons, the extrapolation of risk from animal tests on the basis of daily absorbed dose per kilogram body weight or per square meter surface area without considering differences in life span may lead to an underestimation, and agreements with epidemiologically determined values may be fortuitous. Considering these possibilities, the most likely lifetime risks of cancer death at the average exposure levels in Sweden were estimated for certain pollution fractions or indicator compounds in urban air. The risks amount to approximately 50 deaths per 100,000 for inhaled particulate organic material (POM), with a contribution from ingested POM about three times larger, and alkenes, and butadiene cause 20 deaths, respectively, per 100,000 individuals. Also, benzene and formaldehyde are expected to be associated with considerable risk increments. Comparative potency methods were applied for POM and alkenes. Due to incompleteness of the list of compounds considered and the uncertainties of the above estimates, the total risk calculation from urban air has not been attempted here. PMID:7821292

  9. Estimators of annual probability of infection for quantitative microbial risk assessment.

    PubMed

    Karavarsamis, N; Hamilton, A J

    2010-06-01

    Four estimators of annual infection probability were compared pertinent to Quantitative Microbial Risk Analysis (QMRA). A stochastic model, the Gold Standard, was used as the benchmark. It is a product of independent daily infection probabilities which in turn are based on daily doses. An alternative and commonly-used estimator, here referred to as the Naïve, assumes a single daily infection probability from a single value of daily dose. The typical use of this estimator in stochastic QMRA involves the generation of a distribution of annual infection probabilities, but since each of these is based on a single realisation of the dose distribution, the resultant annual infection probability distribution simply represents a set of inaccurate estimates. While the medians of both distributions were within an order of magnitude for our test scenario, the 95th percentiles, which are sometimes used in QMRA as conservative estimates of risk, differed by around one order of magnitude. The other two estimators examined, the Geometric and Arithmetic, were closely related to the Naïve and use the same equation, and both proved to be poor estimators. Lastly, this paper proposes a simple adjustment to the Gold Standard equation accommodating periodic infection probabilities when the daily infection probabilities are unknown.

  10. Using linked birth, notification, hospital and mortality data to examine false-positive meningococcal disease reporting and adjust disease incidence estimates for children in New South Wales, Australia.

    PubMed

    Gibson, A; Jorm, L; McIntyre, P

    2015-09-01

    Meningococcal disease is a rare, rapidly progressing condition which may be difficult to diagnose, disproportionally affects children, and has high morbidity and mortality. Accurate incidence estimates are needed to monitor the effectiveness of vaccination and treatment. We used linked notification, hospital, mortality and birth data for all children of an Australian state (2000-2007) to estimate the incidence of meningococcal disease. A total of 595 cases were notified, 684 cases had a hospital diagnosis, and 26 cases died from meningococcal disease. All deaths were notified, but only 68% (466/684) of hospitalized cases. Of non-notified hospitalized cases with more than one clinical admission, most (90%, 103/114) did not have meningococcal disease recorded as their final diagnosis, consistent with initial 'false-positive' hospital meningococcal disease diagnosis. After adjusting for false-positive rates in hospital data, capture-recapture estimation suggested that up to four cases of meningococcal disease may not have been captured in either notification or hospital records. The estimated incidence of meningococcal disease in NSW-born and -resident children aged 0-14 years was 5·1-5·4 cases/100 000 child-years at risk, comparable to international estimates using similar methods, but lower than estimates based on hospital data. PMID:25573266

  11. Risk-adjusted capitation funding models for chronic disease in Australia: alternatives to casemix funding.

    PubMed

    Antioch, K M; Walsh, M K

    2002-01-01

    Under Australian casemix funding arrangements that use Diagnosis-Related Groups (DRGs) the average price is policy based, not benchmarked. Cost weights are too low for State-wide chronic disease services. Risk-adjusted Capitation Funding Models (RACFM) are feasible alternatives. A RACFM was developed for public patients with cystic fibrosis treated by an Australian Health Maintenance Organization (AHMO). Adverse selection is of limited concern since patients pay solidarity contributions via Medicare levy with no premium contributions to the AHMO. Sponsors paying premium subsidies are the State of Victoria and the Federal Government. Cost per patient is the dependent variable in the multiple regression. Data on DRG 173 (cystic fibrosis) patients were assessed for heteroskedasticity, multicollinearity, structural stability and functional form. Stepwise linear regression excluded non-significant variables. Significant variables were 'emergency' (1276.9), 'outlier' (6377.1), 'complexity' (3043.5), 'procedures' (317.4) and the constant (4492.7) (R(2)=0.21, SE=3598.3, F=14.39, Prob<0.0001. Regression coefficients represent the additional per patient costs summed to the base payment (constant). The model explained 21% of the variance in cost per patient. The payment rate is adjusted by a best practice annual admission rate per patient. The model is a blended RACFM for in-patient, out-patient, Hospital In The Home, Fee-For-Service Federal payments for drugs and medical services; lump sum lung transplant payments and risk sharing through cost (loss) outlier payments. State and Federally funded home and palliative services are 'carved out'. The model, which has national application via Coordinated Care Trials and by Australian States for RACFMs may be instructive for Germany, which plans to use Australian DRGs for casemix funding. The capitation alternative for chronic disease can improve equity, allocative efficiency and distributional justice. The use of Diagnostic Cost

  12. Characterization of the human kinetic adjustment factor for the health risk assessment of environmental contaminants.

    PubMed

    Valcke, Mathieu; Krishnan, Kannan

    2014-03-01

    A default uncertainty factor of 3.16 (√10) is applied to account for interindividual variability in toxicokinetics when performing non-cancer risk assessments. Using relevant human data for specific chemicals, as WHO/IPCS suggests, it is possible to evaluate, and replace when appropriate, this default factor by quantifying chemical-specific adjustment factors for interindividual variability in toxicokinetics (also referred to as the human kinetic adjustment factor, HKAF). The HKAF has been determined based on the distributions of pharmacokinetic parameters (e.g., half-life, area under the curve, maximum blood concentration) in relevant populations. This article focuses on the current state of knowledge of the use of physiologically based algorithms and models in characterizing the HKAF for environmental contaminants. The recent modeling efforts on the computation of HKAF as a function of the characteristics of the population, chemical and its mode of action (dose metrics), as well as exposure scenario of relevance to the assessment are reviewed here. The results of these studies, taken together, suggest the HKAF varies as a function of the sensitive subpopulation and dose metrics of interest, exposure conditions considered (route, duration, and intensity), metabolic pathways involved and theoretical model underlying its computation. The HKAF seldom exceeded the default value of 3.16, except in very young children (i.e., <≈ 3 months) and when the parent compound is the toxic moiety. Overall, from a public health perspective, the current state of knowledge generally suggest that the default uncertainty factor is sufficient to account for human variability in non-cancer risk assessments of environmental contaminants. PMID:24038072

  13. Adjusting lidar-derived digital terrain models in coastal marshes based on estimated aboveground biomass density

    SciTech Connect

    Medeiros, Stephen; Hagen, Scott; Weishampel, John; Angelo, James

    2015-03-25

    Digital elevation models (DEMs) derived from airborne lidar are traditionally unreliable in coastal salt marshes due to the inability of the laser to penetrate the dense grasses and reach the underlying soil. To that end, we present a novel processing methodology that uses ASTER Band 2 (visible red), an interferometric SAR (IfSAR) digital surface model, and lidar-derived canopy height to classify biomass density using both a three-class scheme (high, medium and low) and a two-class scheme (high and low). Elevation adjustments associated with these classes using both median and quartile approaches were applied to adjust lidar-derived elevation values closer to true bare earth elevation. The performance of the method was tested on 229 elevation points in the lower Apalachicola River Marsh. The two-class quartile-based adjusted DEM produced the best results, reducing the RMS error in elevation from 0.65 m to 0.40 m, a 38% improvement. The raw mean errors for the lidar DEM and the adjusted DEM were 0.61 ± 0.24 m and 0.32 ± 0.24 m, respectively, thereby reducing the high bias by approximately 49%.

  14. Adjusting lidar-derived digital terrain models in coastal marshes based on estimated aboveground biomass density

    DOE PAGES

    Medeiros, Stephen; Hagen, Scott; Weishampel, John; Angelo, James

    2015-03-25

    Digital elevation models (DEMs) derived from airborne lidar are traditionally unreliable in coastal salt marshes due to the inability of the laser to penetrate the dense grasses and reach the underlying soil. To that end, we present a novel processing methodology that uses ASTER Band 2 (visible red), an interferometric SAR (IfSAR) digital surface model, and lidar-derived canopy height to classify biomass density using both a three-class scheme (high, medium and low) and a two-class scheme (high and low). Elevation adjustments associated with these classes using both median and quartile approaches were applied to adjust lidar-derived elevation values closer tomore » true bare earth elevation. The performance of the method was tested on 229 elevation points in the lower Apalachicola River Marsh. The two-class quartile-based adjusted DEM produced the best results, reducing the RMS error in elevation from 0.65 m to 0.40 m, a 38% improvement. The raw mean errors for the lidar DEM and the adjusted DEM were 0.61 ± 0.24 m and 0.32 ± 0.24 m, respectively, thereby reducing the high bias by approximately 49%.« less

  15. Inhalation exposure or body burden? Better way of estimating risk--An application of PBPK model.

    PubMed

    Majumdar, Dipanjali; Dutta, Chirasree; Sen, Subha

    2016-01-01

    We aim to establish a new way for estimating the risk from internal dose or body burden due to exposure of benzene in human subject utilizing physiologically based pharmacokinetic (PBPK) model. We also intend to verify its applicability on human subjects exposed to different levels of benzene. We estimated personal inhalation exposure of benzene for two occupational groups namely petrol pump workers and car drivers with respect to a control group, only environmentally exposed. Benzene in personal air was pre-concentrated on charcoal followed by chemical desorption and analysis by gas chromatography equipped with flame ionization detector (GC-FID). We selected urinary trans,trans-muconic acid (t,t-MA) as biomarker of benzene exposure and measured its concentration using solid phase extraction followed by high performance liquid chromatography (HPLC). Our estimated inhalation exposure of benzene was 137.5, 97.9 and 38.7 μg/m(3) for petrol pump workers, car drivers and environmentally exposed control groups respectively which resulted in urinary t,t-MA levels of 145.4±55.3, 112.6±63.5 and 60.0±34.9 μg g(-1) of creatinine, for the groups in the same order. We deduced a derivation for estimation of body burden from urinary metabolite concentration using PBPK model. Estimation of the internal dose or body burden of benzene in human subject has been made for the first time by the measurement of t,t-MA as a urinary metabolite using physiologically based pharmacokinetic (PBPK) model as a tool. The weight adjusted total body burden of benzene was estimated to be 17.6, 11.1 and 5.0 μg kg(-1) of body weight for petrol pump workers, drivers and the environmentally exposed control group, respectively using this method. We computed the carcinogenic risk using both the estimated internal benzene body burden and external exposure values using conventional method. Our study result shows that internal dose or body burden is not proportional to level of exposure rather have a

  16. Inhalation exposure or body burden? Better way of estimating risk--An application of PBPK model.

    PubMed

    Majumdar, Dipanjali; Dutta, Chirasree; Sen, Subha

    2016-01-01

    We aim to establish a new way for estimating the risk from internal dose or body burden due to exposure of benzene in human subject utilizing physiologically based pharmacokinetic (PBPK) model. We also intend to verify its applicability on human subjects exposed to different levels of benzene. We estimated personal inhalation exposure of benzene for two occupational groups namely petrol pump workers and car drivers with respect to a control group, only environmentally exposed. Benzene in personal air was pre-concentrated on charcoal followed by chemical desorption and analysis by gas chromatography equipped with flame ionization detector (GC-FID). We selected urinary trans,trans-muconic acid (t,t-MA) as biomarker of benzene exposure and measured its concentration using solid phase extraction followed by high performance liquid chromatography (HPLC). Our estimated inhalation exposure of benzene was 137.5, 97.9 and 38.7 μg/m(3) for petrol pump workers, car drivers and environmentally exposed control groups respectively which resulted in urinary t,t-MA levels of 145.4±55.3, 112.6±63.5 and 60.0±34.9 μg g(-1) of creatinine, for the groups in the same order. We deduced a derivation for estimation of body burden from urinary metabolite concentration using PBPK model. Estimation of the internal dose or body burden of benzene in human subject has been made for the first time by the measurement of t,t-MA as a urinary metabolite using physiologically based pharmacokinetic (PBPK) model as a tool. The weight adjusted total body burden of benzene was estimated to be 17.6, 11.1 and 5.0 μg kg(-1) of body weight for petrol pump workers, drivers and the environmentally exposed control group, respectively using this method. We computed the carcinogenic risk using both the estimated internal benzene body burden and external exposure values using conventional method. Our study result shows that internal dose or body burden is not proportional to level of exposure rather have a

  17. Exposure Estimation and Interpretation of Occupational Risk: Enhanced Information for the Occupational Risk Manager.

    PubMed

    Waters, Martha; McKernan, Lauralynn; Maier, Andrew; Jayjock, Michael; Schaeffer, Val; Brosseau, Lisa

    2015-01-01

    The fundamental goal of this article is to describe, define, and analyze the components of the risk characterization process for occupational exposures. Current methods are described for the probabilistic characterization of exposure, including newer techniques that have increasing applications for assessing data from occupational exposure scenarios. In addition, since the probability of health effects reflects variability in the exposure estimate as well as the dose-response curve-the integrated considerations of variability surrounding both components of the risk characterization provide greater information to the occupational hygienist. Probabilistic tools provide a more informed view of exposure as compared to use of discrete point estimates for these inputs to the risk characterization process. Active use of such tools for exposure and risk assessment will lead to a scientifically supported worker health protection program. Understanding the bases for an occupational risk assessment, focusing on important sources of variability and uncertainty enables characterizing occupational risk in terms of a probability, rather than a binary decision of acceptable risk or unacceptable risk. A critical review of existing methods highlights several conclusions: (1) exposure estimates and the dose-response are impacted by both variability and uncertainty and a well-developed risk characterization reflects and communicates this consideration; (2) occupational risk is probabilistic in nature and most accurately considered as a distribution, not a point estimate; and (3) occupational hygienists have a variety of tools available to incorporate concepts of risk characterization into occupational health and practice.

  18. Exposure Estimation and Interpretation of Occupational Risk: Enhanced Information for the Occupational Risk Manager

    PubMed Central

    Waters, Martha; McKernan, Lauralynn; Maier, Andrew; Jayjock, Michael; Schaeffer, Val; Brosseau, Lisa

    2015-01-01

    The fundamental goal of this article is to describe, define, and analyze the components of the risk characterization process for occupational exposures. Current methods are described for the probabilistic characterization of exposure, including newer techniques that have increasing applications for assessing data from occupational exposure scenarios. In addition, since the probability of health effects reflects variability in the exposure estimate as well as the dose-response curve—the integrated considerations of variability surrounding both components of the risk characterization provide greater information to the occupational hygienist. Probabilistic tools provide a more informed view of exposure as compared to use of discrete point estimates for these inputs to the risk characterization process. Active use of such tools for exposure and risk assessment will lead to a scientifically supported worker health protection program. Understanding the bases for an occupational risk assessment, focusing on important sources of variability and uncertainty enables characterizing occupational risk in terms of a probability, rather than a binary decision of acceptable risk or unacceptable risk. A critical review of existing methods highlights several conclusions: (1) exposure estimates and the dose-response are impacted by both variability and uncertainty and a well-developed risk characterization reflects and communicates this consideration; (2) occupational risk is probabilistic in nature and most accurately considered as a distribution, not a point estimate; and (3) occupational hygienists have a variety of tools available to incorporate concepts of risk characterization into occupational health and practice. PMID:26302336

  19. Update of identification and estimation of socioeconomic impacts resulting from perceived risks and changing images: An annotated bibliography

    SciTech Connect

    Nieves, L.A.; Clark, D.E.; Wernette, D.

    1991-08-01

    This annotated bibliography reviews selected literature published through August 1991 on the identification of perceived risks and methods for estimating the economic impacts of risk perception. It updates the literature review found in Argonne National Laboratory report ANL/EAIS/TM-24 (February 1990). Included in this update are (1) a literature review of the risk perception process, of the relationship between risk perception and economic impacts, of economic methods and empirical applications, and interregional market interactions and adjustments; (2) a working bibliography (that includes the documents abstracted in the 1990 report); (3) a topical index to the abstracts found in both reports; and (4) abstracts of selected articles found in this update.

  20. The performance of different propensity-score methods for estimating differences in proportions (risk differences or absolute risk reductions) in observational studies.

    PubMed

    Austin, Peter C

    2010-09-10

    Propensity score methods are increasingly being used to estimate the effects of treatments on health outcomes using observational data. There are four methods for using the propensity score to estimate treatment effects: covariate adjustment using the propensity score, stratification on the propensity score, propensity-score matching, and inverse probability of treatment weighting (IPTW) using the propensity score. When outcomes are binary, the effect of treatment on the outcome can be described using odds ratios, relative risks, risk differences, or the number needed to treat. Several clinical commentators suggested that risk differences and numbers needed to treat are more meaningful for clinical decision making than are odds ratios or relative risks. However, there is a paucity of information about the relative performance of the different propensity-score methods for estimating risk differences. We conducted a series of Monte Carlo simulations to examine this issue. We examined bias, variance estimation, coverage of confidence intervals, mean-squared error (MSE), and type I error rates. A doubly robust version of IPTW had superior performance compared with the other propensity-score methods. It resulted in unbiased estimation of risk differences, treatment effects with the lowest standard errors, confidence intervals with the correct coverage rates, and correct type I error rates. Stratification, matching on the propensity score, and covariate adjustment using the propensity score resulted in minor to modest bias in estimating risk differences. Estimators based on IPTW had lower MSE compared with other propensity-score methods. Differences between IPTW and propensity-score matching may reflect that these two methods estimate the average treatment effect and the average treatment effect for the treated, respectively.

  1. Adjustment of measurements with multiplicative errors: error analysis, estimates of the variance of unit weight, and effect on volume estimation from LiDAR-type digital elevation models.

    PubMed

    Shi, Yun; Xu, Peiliang; Peng, Junhuan; Shi, Chuang; Liu, Jingnan

    2014-01-10

    Modern observation technology has verified that measurement errors can be proportional to the true values of measurements such as GPS, VLBI baselines and LiDAR. Observational models of this type are called multiplicative error models. This paper is to extend the work of Xu and Shimada published in 2000 on multiplicative error models to analytical error analysis of quantities of practical interest and estimates of the variance of unit weight. We analytically derive the variance-covariance matrices of the three least squares (LS) adjustments, the adjusted measurements and the corrections of measurements in multiplicative error models. For quality evaluation, we construct five estimators for the variance of unit weight in association of the three LS adjustment methods. Although LiDAR measurements are contaminated with multiplicative random errors, LiDAR-based digital elevation models (DEM) have been constructed as if they were of additive random errors. We will simulate a model landslide, which is assumed to be surveyed with LiDAR, and investigate the effect of LiDAR-type multiplicative error measurements on DEM construction and its effect on the estimate of landslide mass volume from the constructed DEM.

  2. Adjustment of Measurements with Multiplicative Errors: Error Analysis, Estimates of the Variance of Unit Weight, and Effect on Volume Estimation from LiDAR-Type Digital Elevation Models

    PubMed Central

    Shi, Yun; Xu, Peiliang; Peng, Junhuan; Shi, Chuang; Liu, Jingnan

    2014-01-01

    Modern observation technology has verified that measurement errors can be proportional to the true values of measurements such as GPS, VLBI baselines and LiDAR. Observational models of this type are called multiplicative error models. This paper is to extend the work of Xu and Shimada published in 2000 on multiplicative error models to analytical error analysis of quantities of practical interest and estimates of the variance of unit weight. We analytically derive the variance-covariance matrices of the three least squares (LS) adjustments, the adjusted measurements and the corrections of measurements in multiplicative error models. For quality evaluation, we construct five estimators for the variance of unit weight in association of the three LS adjustment methods. Although LiDAR measurements are contaminated with multiplicative random errors, LiDAR-based digital elevation models (DEM) have been constructed as if they were of additive random errors. We will simulate a model landslide, which is assumed to be surveyed with LiDAR, and investigate the effect of LiDAR-type multiplicative error measurements on DEM construction and its effect on the estimate of landslide mass volume from the constructed DEM. PMID:24434880

  3. Adjustment of measurements with multiplicative errors: error analysis, estimates of the variance of unit weight, and effect on volume estimation from LiDAR-type digital elevation models.

    PubMed

    Shi, Yun; Xu, Peiliang; Peng, Junhuan; Shi, Chuang; Liu, Jingnan

    2013-01-01

    Modern observation technology has verified that measurement errors can be proportional to the true values of measurements such as GPS, VLBI baselines and LiDAR. Observational models of this type are called multiplicative error models. This paper is to extend the work of Xu and Shimada published in 2000 on multiplicative error models to analytical error analysis of quantities of practical interest and estimates of the variance of unit weight. We analytically derive the variance-covariance matrices of the three least squares (LS) adjustments, the adjusted measurements and the corrections of measurements in multiplicative error models. For quality evaluation, we construct five estimators for the variance of unit weight in association of the three LS adjustment methods. Although LiDAR measurements are contaminated with multiplicative random errors, LiDAR-based digital elevation models (DEM) have been constructed as if they were of additive random errors. We will simulate a model landslide, which is assumed to be surveyed with LiDAR, and investigate the effect of LiDAR-type multiplicative error measurements on DEM construction and its effect on the estimate of landslide mass volume from the constructed DEM. PMID:24434880

  4. Population-Adjusted Street Connectivity, Urbanicity and Risk of Obesity in the U.S

    PubMed Central

    Wang, Fahui; Wen, Ming; Xu, Yanqing

    2013-01-01

    Street connectivity, defined as the number of (3-way or more) intersections per area unit, is an important index of built environments as a proxy for walkability in a neighborhood. This paper examines its geographic variations across the rural-urban continuum (urbanicity), major racial-ethnic groups and various poverty levels. The population-adjusted street connectivity index is proposed as a better measure than the regular index for a large area such as county due to likely concentration of population in limited space within the large area. Based on the data from the Behavioral Risk Factor Surveillance System (BRFSS), this paper uses multilevel modeling to analyze its association with physical activity and obesity while controlling for various individual and county-level variables. Analysis of data subsets indicates that the influences of individual and county-level variables on obesity risk vary across areas of different urbanization levels. The positive influence of street connectivity on obesity control is limited to the more but not the mostly urbanized areas. This demonstrates the value of obesogenic environment research in different geographic settings, helps us reconcile and synthesize some seemingly contradictory results reported in different studies, and also promotes that effective policies need to be highly sensitive to the diversity of demographic groups and geographically adaptable. PMID:23667278

  5. Relations of Growth in Effortful Control to Family Income, Cumulative Risk, and Adjustment in Preschool-age Children

    PubMed Central

    Lengua, Liliana J.; Moran, Lyndsey; Zalewski, Maureen; Ruberry, Erika; Kiff, Cara; Thompson, Stephanie

    2014-01-01

    The study examined growth in effortful control (executive control, delay ability) in relation to income, cumulative risk (aggregate of demographic and psychosocial risk factors), and adjustment in 306 preschool-age children (50% girls, 50% boys) from families representing a range of income (29% at- or near-poverty; 28% lower-income; 25% middle-income; 18% upper-income), with 4 assessments starting at 36–40 mos. Income was directly related to levels of executive control and delay ability. Cumulative risk accounted for the effects of income on delay ability but not executive control. Higher initial executive control and slope of executive control and delay ability predicted academic readiness, whereas levels, but not growth, of executive control and delay ability predicted social competence and adjustment problems. Low income is a marker for lower effortful control, which demonstrates additive or mediating effects in the relation of income to children’s preschool adjustment. PMID:25253079

  6. Effects of exposure uncertainty on estimation of radon risks

    SciTech Connect

    Chambers, D.B.; Lowe, L.M.; Stager, R.H.; Reilly, P.M.; Duport, P.

    1992-12-31

    Estimates of lung-cancer risk from exposure to radon daughters are largely based on epidemiological studies of underground miners. The reliability of exposure data for these miners is a cause for concern, as actual workplace measurements of radon and/or radon-daughter levels are either sparse or absent for the early years of mining, when much of the exposure occurred.

  7. Estimates of endemic waterborne risks from community-intervention studies.

    PubMed

    Calderon, Rebecca L; Craun, Gunther F

    2006-01-01

    The nature and magnitude of endemic waterborne disease are not well characterized in the United States. Epidemiologic studies of various designs can provide an estimate of the waterborne attributable risk along with other types of information. Community drinking water systems frequently improve their operations and may change drinking water treatment and their major source of water. In the United States, many of these treatment changes are the result of regulations promulgated under the Safe Drinking Water Act. A community-intervention study design takes advantage of these "natural" experiments to assess changes in health risks. In this paper, we review the community-intervention studies that have assessed changes in waterborne gastroenteritis risks among immunocompetent populations in industrialized countries. Published results are available from two studies in Australia, one study in the United Kingdom, and one study in the United States. Preliminary results from two other US studies are also available. Although the current information is limited, the risks reported in these community-intervention studies can help inform the national estimate of endemic waterborne gastroenteritis. Information is provided about endemic waterborne risks for unfiltered surface water sources and a groundwater under the influence of surface water. Community-intervention studies with recommended study modifications should be conducted to better estimate the benefits associated with improved drinking water treatment. PMID:16895087

  8. Risk adjustment models for interhospital comparison of CS rates using Robson’s ten group classification system and other socio-demographic and clinical variables

    PubMed Central

    2012-01-01

    Background Caesarean section (CS) rate is a quality of health care indicator frequently used at national and international level. The aim of this study was to assess whether adjustment for Robson’s Ten Group Classification System (TGCS), and clinical and socio-demographic variables of the mother and the fetus is necessary for inter-hospital comparisons of CS rates. Methods The study population includes 64,423 deliveries in Emilia-Romagna between January 1, 2003 and December 31, 2004, classified according to theTGCS. Poisson regression was used to estimate crude and adjusted hospital relative risks of CS compared to a reference category. Analyses were carried out in the overall population and separately according to the Robson groups (groups I, II, III, IV and V–X combined). Adjusted relative risks (RR) of CS were estimated using two risk-adjustment models; the first (M1) including the TGCS group as the only adjustment factor; the second (M2) including in addition demographic and clinical confounders identified using a stepwise selection procedure. Percentage variations between crude and adjusted RRs by hospital were calculated to evaluate the confounding effect of covariates. Results The percentage variations from crude to adjusted RR proved to be similar in M1 and M2 model. However, stratified analyses by Robson’s classification groups showed that residual confounding for clinical and demographic variables was present in groups I (nulliparous, single, cephalic, ≥37 weeks, spontaneous labour) and III (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, spontaneous labour) and IV (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, induced or CS before labour) and to a minor extent in groups II (nulliparous, single, cephalic, ≥37 weeks, induced or CS before labour) and IV (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, induced or CS before labour). Conclusions The TGCS classification is useful for

  9. Impact of microbial count distributions on human health risk estimates.

    PubMed

    Duarte, A S R; Nauta, M J

    2015-02-16

    Quantitative microbiological risk assessment (QMRA) is influenced by the choice of the probability distribution used to describe pathogen concentrations, as this may eventually have a large effect on the distribution of doses at exposure. When fitting a probability distribution to microbial enumeration data, several factors may have an impact on the accuracy of that fit. Analysis of the best statistical fits of different distributions alone does not provide a clear indication of the impact in terms of risk estimates. Thus, in this study we focus on the impact of fitting microbial distributions on risk estimates, at two different concentration scenarios and at a range of prevalence levels. By using five different parametric distributions, we investigate whether different characteristics of a good fit are crucial for an accurate risk estimate. Among the factors studied are the importance of accounting for the Poisson randomness in counts, the difference between treating "true" zeroes as such or as censored below a limit of quantification (LOQ) and the importance of making the correct assumption about the underlying distribution of concentrations. By running a simulation experiment with zero-inflated Poisson-lognormal distributed data and an existing QMRA model from retail to consumer level, it was possible to assess the difference between expected risk and the risk estimated with using a lognormal, a zero-inflated lognormal, a Poisson-gamma, a zero-inflated Poisson-gamma and a zero-inflated Poisson-lognormal distribution. We show that the impact of the choice of different probability distributions to describe concentrations at retail on risk estimates is dependent both on concentration and prevalence levels. We also show that the use of an LOQ should be done consciously, especially when zero-inflation is not used. In general, zero-inflation does not necessarily improve the absolute risk estimation, but performance of zero-inflated distributions in QMRA tends to be

  10. Aerial surveys adjusted by ground surveys to estimate area occupied by black-tailed prairie dog colonies

    USGS Publications Warehouse

    Sidle, John G.; Augustine, David J.; Johnson, Douglas H.; Miller, Sterling D.; Cully, Jack F.; Reading, Richard P.

    2012-01-01

    Aerial surveys using line-intercept methods are one approach to estimate the extent of prairie dog colonies in a large geographic area. Although black-tailed prairie dogs (Cynomys ludovicianus) construct conspicuous mounds at burrow openings, aerial observers have difficulty discriminating between areas with burrows occupied by prairie dogs (colonies) versus areas of uninhabited burrows (uninhabited colony sites). Consequently, aerial line-intercept surveys may overestimate prairie dog colony extent unless adjusted by an on-the-ground inspection of a sample of intercepts. We compared aerial line-intercept surveys conducted over 2 National Grasslands in Colorado, USA, with independent ground-mapping of known black-tailed prairie dog colonies. Aerial line-intercepts adjusted by ground surveys using a single activity category adjustment overestimated colonies by ≥94% on the Comanche National Grassland and ≥58% on the Pawnee National Grassland. We present a ground-survey technique that involves 1) visiting on the ground a subset of aerial intercepts classified as occupied colonies plus a subset of intercepts classified as uninhabited colony sites, and 2) based on these ground observations, recording the proportion of each aerial intercept that intersects a colony and the proportion that intersects an uninhabited colony site. Where line-intercept techniques are applied to aerial surveys or remotely sensed imagery, this method can provide more accurate estimates of black-tailed prairie dog abundance and trends

  11. Neoplastic potential of gastric irradiation. IV. Risk estimates

    SciTech Connect

    Griem, M.L.; Justman, J.; Weiss, L.

    1984-12-01

    No significant tumor increase was found in the initial analysis of patients irradiated for peptic ulcer and followed through 1962. A preliminary study was undertaken 22 years later to estimate the risk of cancer due to gastric irradiation for peptic ulcer disease. A population of 2,049 irradiated patients and 763 medically managed patients has been identified. A relative risk of 3.7 was found for stomach cancer and an initial risk estimate of 5.5 x 10(-6) excess stomach cancers per person rad was calculated. A more complete follow-up is in progress to further elucidate this observation and decrease the ascertainment bias; however, preliminary data are in agreement with the Japanese atomic bomb reports.

  12. Estimation of myocardial volume at risk from CT angiography

    NASA Astrophysics Data System (ADS)

    Zhu, Liangjia; Gao, Yi; Mohan, Vandana; Stillman, Arthur; Faber, Tracy; Tannenbaum, Allen

    2011-03-01

    The determination of myocardial volume at risk distal to coronary stenosis provides important information for prognosis and treatment of coronary artery disease. In this paper, we present a novel computational framework for estimating the myocardial volume at risk in computed tomography angiography (CTA) imagery. Initially, epicardial and endocardial surfaces, and coronary arteries are extracted using an active contour method. Then, the extracted coronary arteries are projected onto the epicardial surface, and each point on this surface is associated with its closest coronary artery using the geodesic distance measurement. The likely myocardial region at risk on the epicardial surface caused by a stenosis is approximated by the region in which all its inner points are associated with the sub-branches distal to the stenosis on the coronary artery tree. Finally, the likely myocardial volume at risk is approximated by the volume in between the region at risk on the epicardial surface and its projection on the endocardial surface, which is expected to yield computational savings over risk volume estimation using the entire image volume. Furthermore, we expect increased accuracy since, as compared to prior work using the Euclidean distance, we employ the geodesic distance in this work. The experimental results demonstrate the effectiveness of the proposed approach on pig heart CTA datasets.

  13. Estimating Non-stationary Flood Risk in a Changing Climate

    NASA Astrophysics Data System (ADS)

    Yu, X.; Cohn, T. A.; Stedinger, J. R.

    2015-12-01

    Flood risk is usually described by a probability distribution for annual maximum streamflow which is assumed not to change with time. Federal, state and local governments in the United States are demanding guidance on flood frequency estimates that account for climate change. If a trend exists in peak flow series, ignoring it could result in large quantile estimator bias, while trying to estimate a trend will increase the flood quantile estimator's variance. Thus the issue is, what bias-variance tradeoff should we accept? This paper discusses approaches to flood frequency analysis (FFA) when flood series have trends. GCMs describe how annual runoff might vary over sub-continental scales, but this information is nearly useless for FFA in small watersheds. A LP3 Monte Carlo analysis and a re-sampling study of 100-year flood estimation (25- and 50-year projections) compares the performance of five methods: FFA as prescribed in national guidelines (Bulletin 17B), assumes the flood series is stationary and follows a log-Pearson type III (LP3) distribution; Fitting a LP3 distribution with time-varying parameters that include future trends in mean and perhaps variance, where slopes are assumed known; Fitting a LP3 distribution with time-varying parameters that capture future trends in mean and perhaps variance, where slopes are estimated from annual peak flow series; Employing only the most recent 30 years of flood records to fit a LP3 distribution; Applying a safety factor to the 100-year flood estimator (e.g. 25% increase). The 100-year flood estimator of method 2 has the smallest log-space mean squared error, though it is unlikely that the true trend would be known. Method 3 is only recommended over method 1 for large trends (≥ 0.5% per year). The 100-year flood estimators of method 1, 4, and 5 often have poor accuracy. Clearly, flood risk assessment will be a challenge in an uncertain world.

  14. Impact of work-related cancers in Taiwan-Estimation with QALY (quality-adjusted life year) and healthcare costs.

    PubMed

    Lee, Lukas Jyuhn-Hsiarn; Lin, Cheng-Kuan; Hung, Mei-Chuan; Wang, Jung-Der

    2016-12-01

    This study estimates the annual numbers of eight work-related cancers, total losses of quality-adjusted life years (QALYs), and lifetime healthcare expenditures that possibly could be saved by improving occupational health in Taiwan. Three databases were interlinked: the Taiwan Cancer Registry, the National Mortality Registry, and the National Health Insurance Research Database. Annual numbers of work-related cancers were estimated based on attributable fractions (AFs) abstracted from a literature review. The survival functions for eight cancers were estimated and extrapolated to lifetime using a semi-parametric method. A convenience sample of 8846 measurements of patients' quality of life with EQ-5D was collected for utility values and multiplied by survival functions to estimate quality-adjusted life expectancies (QALEs). The loss-of-QALE was obtained by subtracting the QALE of cancer from age- and sex-matched referents simulated from national vital statistics. The lifetime healthcare expenditures were estimated by multiplying the survival probability with mean monthly costs paid by the National Health Insurance for cancer diagnosis and treatment and summing this for the expected lifetime. A total of 3010 males and 726 females with eight work-related cancers were estimated in 2010. Among them, lung cancer ranked first in terms of QALY loss, with an annual total loss-of-QALE of 28,463 QALYs and total lifetime healthcare expenditures of US$36.6 million. Successful prevention of eight work-related cancers would not only avoid the occurrence of 3736 cases of cancer, but would also save more than US$70 million in healthcare costs and 46,750 QALYs for the Taiwan society in 2010. PMID:27413666

  15. Impact of work-related cancers in Taiwan-Estimation with QALY (quality-adjusted life year) and healthcare costs.

    PubMed

    Lee, Lukas Jyuhn-Hsiarn; Lin, Cheng-Kuan; Hung, Mei-Chuan; Wang, Jung-Der

    2016-12-01

    This study estimates the annual numbers of eight work-related cancers, total losses of quality-adjusted life years (QALYs), and lifetime healthcare expenditures that possibly could be saved by improving occupational health in Taiwan. Three databases were interlinked: the Taiwan Cancer Registry, the National Mortality Registry, and the National Health Insurance Research Database. Annual numbers of work-related cancers were estimated based on attributable fractions (AFs) abstracted from a literature review. The survival functions for eight cancers were estimated and extrapolated to lifetime using a semi-parametric method. A convenience sample of 8846 measurements of patients' quality of life with EQ-5D was collected for utility values and multiplied by survival functions to estimate quality-adjusted life expectancies (QALEs). The loss-of-QALE was obtained by subtracting the QALE of cancer from age- and sex-matched referents simulated from national vital statistics. The lifetime healthcare expenditures were estimated by multiplying the survival probability with mean monthly costs paid by the National Health Insurance for cancer diagnosis and treatment and summing this for the expected lifetime. A total of 3010 males and 726 females with eight work-related cancers were estimated in 2010. Among them, lung cancer ranked first in terms of QALY loss, with an annual total loss-of-QALE of 28,463 QALYs and total lifetime healthcare expenditures of US$36.6 million. Successful prevention of eight work-related cancers would not only avoid the occurrence of 3736 cases of cancer, but would also save more than US$70 million in healthcare costs and 46,750 QALYs for the Taiwan society in 2010.

  16. Apples to apples: the origin and magnitude of differences in asbestos cancer risk estimates derived using varying protocols.

    PubMed

    Berman, D Wayne

    2011-08-01

    Given that new protocols for assessing asbestos-related cancer risk have recently been published, questions arise concerning how they compare to the "IRIS" protocol currently used by regulators. The newest protocols incorporate findings from 20 additional years of literature. Thus, differences between the IRIS and newer Berman and Crump protocols are examined to evaluate whether these protocols can be reconciled. Risks estimated by applying these protocols to real exposure data from both laboratory and field studies are also compared to assess the relative health protectiveness of each protocol. The reliability of risks estimated using the two protocols are compared by evaluating the degree with which each potentially reproduces the known epidemiology study risks. Results indicate that the IRIS and Berman and Crump protocols can be reconciled; while environment-specific variation within fiber type is apparently due primarily to size effects (not addressed by IRIS), the 10-fold (average) difference between amphibole asbestos risks estimated using each protocol is attributable to an arbitrary selection of the lowest of available mesothelioma potency factors in the IRIS protocol. Thus, the IRIS protocol may substantially underestimate risk when exposure is primarily to amphibole asbestos. Moreover, while the Berman and Crump protocol is more reliable than the IRIS protocol overall (especially for predicting amphibole risk), evidence is presented suggesting a new fiber-size-related adjustment to the Berman and Crump protocol may ultimately succeed in reconciling the entire epidemiology database. However, additional data need to be developed before the performance of the adjusted protocol can be fully validated.

  17. Measurement of total risk of spontaneous abortion: the virtue of conditional risk estimation.

    PubMed

    Modvig, J; Schmidt, L; Damsgaard, M T

    1990-12-01

    The concepts, methods, and problems of measuring spontaneous abortion risk are reviewed. The problems touched on include the process of pregnancy verification, the changes in risk by gestational age and maternal age, and the presence of induced abortions. Methods used in studies of spontaneous abortion risk include biochemical assays as well as life table technique, although the latter appears in two different forms. The consequences of using either of these are discussed. It is concluded that no study design so far is appropriate for measuring the total risk of spontaneous abortion from early conception to the end of the 27th week. It is proposed that pregnancy may be considered to consist of two or three specific periods and that different study designs should concentrate on measuring the conditional risk within each period. A careful estimate using this principle leads to an estimate of total risk of spontaneous abortion of 0.33.

  18. NRC committee provides new risk estimates for exposure to radon

    SciTech Connect

    Not Available

    1988-03-01

    A new set of age-specific estimates describing the increased risk of lung cancer following exposure to radon was released in January by a National Research Council committee. The revised estimates result from new statistical techniques used to analyze previously collected data. In a study jointly sponsored by the Environmental Protection Agency (EPA) and the Nuclear Regulatory Commission, the committee concluded that lifetime exposure to one working level month (WLM) of radon per year, a standard measure used by radiation experts, increases an individual's chances of dying from lung cancer by 1.5 times compared with someone exposed only to background levels of radon. The committee estimated that, for every 1 million people exposed over a lifetime to one WLM of radon, about 350 additional deaths would occur due to lung cancer. The committee found that lung cancer risks associated with radon increased with increasing length of exposure. Moreover, it said that 15 years after exposure to radon has ended, the risk of lung cancer from the exposure declines to half the original risk.

  19. Estimating Skin Cancer Risk: Evaluating Mobile Computer-Adaptive Testing

    PubMed Central

    Djaja, Ngadiman; Janda, Monika; Olsen, Catherine M; Whiteman, David C

    2016-01-01

    Background Response burden is a major detriment to questionnaire completion rates. Computer adaptive testing may offer advantages over non-adaptive testing, including reduction of numbers of items required for precise measurement. Objective Our aim was to compare the efficiency of non-adaptive (NAT) and computer adaptive testing (CAT) facilitated by Partial Credit Model (PCM)-derived calibration to estimate skin cancer risk. Methods We used a random sample from a population-based Australian cohort study of skin cancer risk (N=43,794). All 30 items of the skin cancer risk scale were calibrated with the Rasch PCM. A total of 1000 cases generated following a normal distribution (mean [SD] 0 [1]) were simulated using three Rasch models with three fixed-item (dichotomous, rating scale, and partial credit) scenarios, respectively. We calculated the comparative efficiency and precision of CAT and NAT (shortening of questionnaire length and the count difference number ratio less than 5% using independent t tests). Results We found that use of CAT led to smaller person standard error of the estimated measure than NAT, with substantially higher efficiency but no loss of precision, reducing response burden by 48%, 66%, and 66% for dichotomous, Rating Scale Model, and PCM models, respectively. Conclusions CAT-based administrations of the skin cancer risk scale could substantially reduce participant burden without compromising measurement precision. A mobile computer adaptive test was developed to help people efficiently assess their skin cancer risk. PMID:26800642

  20. Multivariate Risk Adjustment of Primary Care Patient Panels in a Public Health Setting: A Comparison of Statistical Models.

    PubMed

    Hirozawa, Anne M; Montez-Rath, Maria E; Johnson, Elizabeth C; Solnit, Stephen A; Drennan, Michael J; Katz, Mitchell H; Marx, Rani

    2016-01-01

    We compared prospective risk adjustment models for adjusting patient panels at the San Francisco Department of Public Health. We used 4 statistical models (linear regression, two-part model, zero-inflated Poisson, and zero-inflated negative binomial) and 4 subsets of predictor variables (age/gender categories, chronic diagnoses, homelessness, and a loss to follow-up indicator) to predict primary care visit frequency. Predicted visit frequency was then used to calculate patient weights and adjusted panel sizes. The two-part model using all predictor variables performed best (R = 0.20). This model, designed specifically for safety net patients, may prove useful for panel adjustment in other public health settings.

  1. Multivariate Risk Adjustment of Primary Care Patient Panels in a Public Health Setting: A Comparison of Statistical Models.

    PubMed

    Hirozawa, Anne M; Montez-Rath, Maria E; Johnson, Elizabeth C; Solnit, Stephen A; Drennan, Michael J; Katz, Mitchell H; Marx, Rani

    2016-01-01

    We compared prospective risk adjustment models for adjusting patient panels at the San Francisco Department of Public Health. We used 4 statistical models (linear regression, two-part model, zero-inflated Poisson, and zero-inflated negative binomial) and 4 subsets of predictor variables (age/gender categories, chronic diagnoses, homelessness, and a loss to follow-up indicator) to predict primary care visit frequency. Predicted visit frequency was then used to calculate patient weights and adjusted panel sizes. The two-part model using all predictor variables performed best (R = 0.20). This model, designed specifically for safety net patients, may prove useful for panel adjustment in other public health settings. PMID:27576054

  2. Anticipatory postural adjustments during cutting manoeuvres in football and their consequences for knee injury risk.

    PubMed

    Mornieux, Guillaume; Gehring, Dominic; Fürst, Patrick; Gollhofer, Albert

    2014-01-01

    Anticipatory postural adjustments (APAs), i.e. preparatory positioning of the head, the trunk and the foot, are essential to initiate cutting manoeuvres during football games. The aim of the present study was to determine how APA strategies during cutting manoeuvres are influenced by a reduction of the time available to prepare the movement. Thirteen football players performed different cutting tasks, with directions of cutting either known prior to the task or indicated by a light signal occurring 850, 600 or 500 ms before ground contact. With less time available to prepare the cutting manoeuvre, the head was less orientated towards the cutting direction (P = 0.033) and the trunk was even more rotated in the opposite direction (P = 0.002), while the foot placement was not significantly influenced. Moreover, the induced higher lateral trunk flexion correlated with the increased knee abduction moment (r = 0.41; P = 0.009). Increasing lateral trunk flexion is the main strategy used to successfully perform a cutting manoeuvre when less time is available to prepare the movement. However, higher lateral trunk flexion was associated with an increased knee abduction moment and therefore an increased knee injury risk. Reducing lateral trunk flexion during cutting manoeuvres should be part of training programs seeking the optimisation of APAs. PMID:24742137

  3. A Review of Expertise and Judgment Processes for Risk Estimation

    SciTech Connect

    R. L. Boring

    2007-06-01

    A major challenge of risk and reliability analysis for human errors or hardware failures is the need to enlist expert opinion in areas for which adequate operational data are not available. Experts enlisted in this capacity provide probabilistic estimates of reliability, typically comprised of a measure of central tendency and uncertainty bounds. While formal guidelines for expert elicitation are readily available, they largely fail to provide a theoretical basis for expertise and judgment. This paper reviews expertise and judgment in the context of risk analysis; overviews judgment biases, the role of training, and multivariate judgments; and provides guidance on the appropriate use of atomistic and holistic judgment processes.

  4. A methodological approach to identify external factors for indicator-based risk adjustment illustrated by a cataract surgery register

    PubMed Central

    2014-01-01

    Background Risk adjustment is crucial for comparison of outcome in medical care. Knowledge of the external factors that impact measured outcome but that cannot be influenced by the physician is a prerequisite for this adjustment. To date, a universal and reproducible method for identification of the relevant external factors has not been published. The selection of external factors in current quality assurance programmes is mainly based on expert opinion. We propose and demonstrate a methodology for identification of external factors requiring risk adjustment of outcome indicators and we apply it to a cataract surgery register. Methods Defined test criteria to determine the relevance for risk adjustment are “clinical relevance” and “statistical significance”. Clinical relevance of the association is presumed when observed success rates of the indicator in the presence and absence of the external factor exceed a pre-specified range of 10%. Statistical significance of the association between the external factor and outcome indicators is assessed by univariate stratification and multivariate logistic regression adjustment. The cataract surgery register was set up as part of a German multi-centre register trial for out-patient cataract surgery in three high-volume surgical sites. A total of 14,924 patient follow-ups have been documented since 2005. Eight external factors potentially relevant for risk adjustment were related to the outcome indicators “refractive accuracy” and “visual rehabilitation” 2–5 weeks after surgery. Results The clinical relevance criterion confirmed 2 (“refractive accuracy”) and 5 (“visual rehabilitation”) external factors. The significance criterion was verified in two ways. Univariate and multivariate analyses revealed almost identical external factors: 4 were related to “refractive accuracy” and 7 (6) to “visual rehabilitation”. Two (“refractive accuracy”) and 5 (“visual rehabilitation”) factors

  5. Covariate adjustment of event histories estimated from Markov chains: the additive approach.

    PubMed

    Aalen, O O; Borgan, O; Fekjaer, H

    2001-12-01

    Markov chain models are frequently used for studying event histories that include transitions between several states. An empirical transition matrix for nonhomogeneous Markov chains has previously been developed, including a detailed statistical theory based on counting processes and martingales. In this article, we show how to estimate transition probabilities dependent on covariates. This technique may, e.g., be used for making estimates of individual prognosis in epidemiological or clinical studies. The covariates are included through nonparametric additive models on the transition intensities of the Markov chain. The additive model allows for estimation of covariate-dependent transition intensities, and again a detailed theory exists based on counting processes. The martingale setting now allows for a very natural combination of the empirical transition matrix and the additive model, resulting in estimates that can be expressed as stochastic integrals, and hence their properties are easily evaluated. Two medical examples will be given. In the first example, we study how the lung cancer mortality of uranium miners depends on smoking and radon exposure. In the second example, we study how the probability of being in response depends on patient group and prophylactic treatment for leukemia patients who have had a bone marrow transplantation. A program in R and S-PLUS that can carry out the analyses described here has been developed and is freely available on the Internet. PMID:11764270

  6. Obesity phenotype and coronary heart disease risk as estimated by the Framingham risk score.

    PubMed

    Park, Yong Soon; Kim, Jun-Su

    2012-03-01

    There are conflicting data as to whether general or abdominal obesity is a better predictor of cardiovascular risk. This cross-sectional study involved 4,573 subjects aged 30 to 74 yr who participated in the Fourth Korea National Health and Nutrition Examination Survey conducted in 2008. Obesity phenotype was classified by means of body mass index (BMI) and waist circumference (WC), and participants were categorized into 4 groups. Individuals' 10-yr risk of coronary heart diseases (CHD) was determined from the Framingham risk score. Subjects with obese WC had a higher proportion of high risk for CHD compared to the normal WC group, irrespective of BMI level. Relative to subjects with normal BMI/normal WC, the adjusted odds ratios (ORs) of normal BMI/obese WC group (OR 2.93 [1.70, 5.04] and OR 3.10 [1.49, 6.46]) for CHD risk in male were higher than obese BMI/obese WC group (OR 1.91 [1.40, 2.61] and OR 1.70 [1.16, 2.47]), whereas the adjusted ORs of obese BMI/obese WC group (OR 1.94 [1.24, 3.04] and OR 3.92 [1.75, 8.78]) were higher than the others in female. Subjects with obese BMI/normal WC were not significantly associated with 10-yr CHD risk in men (P = 0.449 and P = 0.067) and women (P = 0.702 and P = 0.658). WC is associated with increased CHD risk regardless of the level of BMI. Men with normal BMI and obese WC tend to be associated with CHD risk than those with obese BMI and obese WC.

  7. Estimation of radiation risk for astronauts on the Moon

    NASA Astrophysics Data System (ADS)

    Kuznetsov, N. V.; Nymmik, R. A.; Panasyuk, M. I.; Denisov, A. N.; Sobolevsky, N. M.

    2012-05-01

    The problem of estimating the risk of radiation for humans on the Moon is discussed, taking into account the probabilistic nature of occurrence of solar particle events. Calculations of the expected values of tissue-averaged equivalent dose rates, which are created by galactic and solar cosmic-ray particle fluxes on the lunar surface behind shielding, are made for different durations of lunar missions.

  8. Estimating relative risks for common outcome using PROC NLP.

    PubMed

    Yu, Binbing; Wang, Zhuoqiao

    2008-05-01

    In cross-sectional or cohort studies with binary outcomes, it is biologically interpretable and of interest to estimate the relative risk or prevalence ratio, especially when the response rates are not rare. Several methods have been used to estimate the relative risk, among which the log-binomial models yield the maximum likelihood estimate (MLE) of the parameters. Because of restrictions on the parameter space, the log-binomial models often run into convergence problems. Some remedies, e.g., the Poisson and Cox regressions, have been proposed. However, these methods may give out-of-bound predicted response probabilities. In this paper, a new computation method using the SAS Nonlinear Programming (NLP) procedure is proposed to find the MLEs. The proposed NLP method was compared to the COPY method, a modified method to fit the log-binomial model. Issues in the implementation are discussed. For illustration, both methods were applied to data on the prevalence of microalbuminuria (micro-protein leakage into urine) for kidney disease patients from the Diabetes Control and Complications Trial. The sample SAS macro for calculating relative risk is provided in the appendix.

  9. Improved risk estimates for carbon tetrachloride. 1998 annual progress report

    SciTech Connect

    Benson, J.M.; Springer, D.L.; Thrall, K.D.

    1998-06-01

    'The overall purpose of these studies is to improve the scientific basis for assessing the cancer risk associated with human exposure to carbon tetrachloride. Specifically, the toxicokinetics of inhaled carbon tetrachloride is being determined in rats, mice and hamsters. Species differences in the metabolism of carbon tetrachloride by rats, mice and hamsters is being determined in vivo and in vitro using tissues and microsomes from these rodent species and man. Dose-response relationships will be determined in all studies. The information will be used to improve the current physiologically based pharmacokinetic model for carbon tetrachloride. The authors will also determine whether carbon tetrachloride is a hepatocarcinogen only when exposure results in cell damage, cell killing, and regenerative cell proliferation. In combination, the results of these studies will provide the types of information needed to enable a refined risk estimate for carbon tetrachloride under EPA''s new guidelines for cancer risk assessment.'

  10. Estimates of Radiation Doses and Cancer Risk from Food Intake in Korea.

    PubMed

    Moon, Eun-Kyeong; Ha, Wi-Ho; Seo, Songwon; Jin, Young Woo; Jeong, Kyu Hwan; Yoon, Hae-Jung; Kim, Hyoung-Soo; Hwang, Myung-Sil; Choi, Hoon; Lee, Won Jin

    2016-01-01

    The aim of this study was to estimate internal radiation doses and lifetime cancer risk from food ingestion. Radiation doses from food intake were calculated using the Korea National Health and Nutrition Examination Survey and the measured radioactivity of (134)Cs, (137)Cs, and (131)I from the Ministry of Food and Drug Safety in Korea. Total number of measured data was 8,496 (3,643 for agricultural products, 644 for livestock products, 43 for milk products, 3,193 for marine products, and 973 for processed food). Cancer risk was calculated by multiplying the estimated committed effective dose and the detriment adjusted nominal risk coefficients recommended by the International Commission on Radiation Protection. The lifetime committed effective doses from the daily diet are ranged 2.957-3.710 mSv. Excess lifetime cancer risks are 14.4-18.1, 0.4-0.5, and 1.8-2.3 per 100,000 for all solid cancers combined, thyroid cancer, and leukemia, respectively.

  11. Estimates of Radiation Doses and Cancer Risk from Food Intake in Korea

    PubMed Central

    2016-01-01

    The aim of this study was to estimate internal radiation doses and lifetime cancer risk from food ingestion. Radiation doses from food intake were calculated using the Korea National Health and Nutrition Examination Survey and the measured radioactivity of 134Cs, 137Cs, and 131I from the Ministry of Food and Drug Safety in Korea. Total number of measured data was 8,496 (3,643 for agricultural products, 644 for livestock products, 43 for milk products, 3,193 for marine products, and 973 for processed food). Cancer risk was calculated by multiplying the estimated committed effective dose and the detriment adjusted nominal risk coefficients recommended by the International Commission on Radiation Protection. The lifetime committed effective doses from the daily diet are ranged 2.957-3.710 mSv. Excess lifetime cancer risks are 14.4-18.1, 0.4-0.5, and 1.8-2.3 per 100,000 for all solid cancers combined, thyroid cancer, and leukemia, respectively. PMID:26770031

  12. Estimates of Radiation Doses and Cancer Risk from Food Intake in Korea.

    PubMed

    Moon, Eun-Kyeong; Ha, Wi-Ho; Seo, Songwon; Jin, Young Woo; Jeong, Kyu Hwan; Yoon, Hae-Jung; Kim, Hyoung-Soo; Hwang, Myung-Sil; Choi, Hoon; Lee, Won Jin

    2016-01-01

    The aim of this study was to estimate internal radiation doses and lifetime cancer risk from food ingestion. Radiation doses from food intake were calculated using the Korea National Health and Nutrition Examination Survey and the measured radioactivity of (134)Cs, (137)Cs, and (131)I from the Ministry of Food and Drug Safety in Korea. Total number of measured data was 8,496 (3,643 for agricultural products, 644 for livestock products, 43 for milk products, 3,193 for marine products, and 973 for processed food). Cancer risk was calculated by multiplying the estimated committed effective dose and the detriment adjusted nominal risk coefficients recommended by the International Commission on Radiation Protection. The lifetime committed effective doses from the daily diet are ranged 2.957-3.710 mSv. Excess lifetime cancer risks are 14.4-18.1, 0.4-0.5, and 1.8-2.3 per 100,000 for all solid cancers combined, thyroid cancer, and leukemia, respectively. PMID:26770031

  13. Risk estimation based on chromosomal aberrations induced by radiation

    NASA Technical Reports Server (NTRS)

    Durante, M.; Bonassi, S.; George, K.; Cucinotta, F. A.

    2001-01-01

    The presence of a causal association between the frequency of chromosomal aberrations in peripheral blood lymphocytes and the risk of cancer has been substantiated recently by epidemiological studies. Cytogenetic analyses of crew members of the Mir Space Station have shown that a significant increase in the frequency of chromosomal aberrations can be detected after flight, and that such an increase is likely to be attributed to the radiation exposure. The risk of cancer can be estimated directly from the yields of chromosomal aberrations, taking into account some aspects of individual susceptibility and other factors unrelated to radiation. However, the use of an appropriate technique for the collection and analysis of chromosomes and the choice of the structural aberrations to be measured are crucial in providing sound results. Based on the fraction of aberrant lymphocytes detected before and after flight, the relative risk after a long-term Mir mission is estimated to be about 1.2-1.3. The new technique of mFISH can provide useful insights into the quantification of risk on an individual basis.

  14. Estimating the risks of smoking, air pollution, and passive smoke on acute respiratory conditions

    SciTech Connect

    Ostro, B.D. )

    1989-06-01

    Five years of the annual Health Interview Survey, conducted by the National Center for Health Statistics, are used to estimate the effects of air pollution, smoking, and environmental tobacco smoke on respiratory restrictions in activity for adults, and bed disability for children. After adjusting for several socioeconomic factors, the multiple regression estimates indicate that an independent and statistically significant association exists between these three forms of air pollution and respiratory morbidity. The comparative risks of these exposures are computed and the plausibility of the relative risks is examined by comparing the equivalent doses with actual measurements of exposure taken in the homes of smokers. The results indicate that: (1) smokers will have a 55-75% excess in days with respiratory conditions severe enough to cause reductions in normal activity; (2) a 1 microgram increase in fine particulate matter air pollution is associated with a 3% excess in acute respiratory disease; and (3) a pack-a-day smoker will increase respiratory restricted days for a nonsmoking spouse by 20% and increase the number of bed disability days for young children living in the household by 20%. The results also indicate that the estimates of the effects of secondhand smoking on children are improved when the mother's work status is known and incorporated into the exposure estimate.

  15. Estimating the risks of smoking, air pollution, and passive smoke on acute respiratory conditions.

    PubMed

    Ostro, B D

    1989-06-01

    Five years of the annual Health Interview Survey, conducted by the National Center for Health Statistics, are used to estimate the effects of air pollution, smoking, and environmental tobacco smoke on respiratory restrictions in activity for adults, and bed disability for children. After adjusting for several socioeconomic factors, the multiple regression estimates indicate that an independent and statistically significant association exists between these three forms of air pollution and respiratory morbidity. The comparative risks of these exposures are computed and the plausibility of the relative risks is examined by comparing the equivalent doses with actual measurements of exposure taken in the homes of smokers. The results indicate that: (1) smokers will have a 55-75% excess in days with respiratory conditions severe enough to cause reductions in normal activity; (2) a 1 microgram increase in fine particulate matter air pollution is associated with a 3% excess in acute respiratory disease; and (3) a pack-a-day smoker will increase respiratory restricted days for a nonsmoking spouse by 20% and increase the number of bed disability days for young children living in the household by 20%. The results also indicate that the estimates of the effects of secondhand smoking on children are improved when the mother's work status is known and incorporated into the exposure estimate.

  16. A comparison of genetic risk score with family history for estimating prostate cancer risk

    PubMed Central

    Helfand, Brian T

    2016-01-01

    Prostate cancer (PCa) testing is recommended by most authoritative groups for high-risk men including those with a family history of the disease. However, family history information is often limited by patient knowledge and clinician intake, and thus, many men are incorrectly assigned to different risk groups. Alternate methods to assess PCa risk are required. In this review, we discuss how genetic variants, referred to as PCa-risk single-nucleotide polymorphisms, can be used to calculate a genetic risk score (GRS). GRS assigns a relatively unique value to all men based on the number of PCa-risk SNPs that an individual carries. This GRS value can provide a more precise estimate of a man's PCa risk. This is particularly relevant in situations when an individual is unaware of his family history. In addition, GRS has utility and can provide a more precise estimate of risk even among men with a positive family history. It can even distinguish risk among relatives with the same degree of family relationships. Taken together, this review serves to provide support for the clinical utility of GRS as an independent test to provide supplemental information to family history. As such, GRS can serve as a platform to help guide-shared decision-making processes regarding the timing and frequency of PCa testing and biopsies. PMID:27004541

  17. The contribution of the anaesthetist to risk-adjusted mortality after cardiac surgery.

    PubMed

    Papachristofi, O; Sharples, L D; Mackay, J H; Nashef, S A M; Fletcher, S N; Klein, A A

    2016-02-01

    It is widely accepted that the performance of the operating surgeon affects outcomes, and this has led to the publication of surgical results in the public domain. However, the effect of other members of the multidisciplinary team is unknown. We studied the effect of the anaesthetist on mortality after cardiac surgery by analysing data collected prospectively over ten years of consecutive cardiac surgical cases from ten UK centres. Casemix-adjusted outcomes were analysed in models that included random-effects for centre, surgeon and anaesthetist. All cardiac surgical operations for which the EuroSCORE model is appropriate were included, and the primary outcome was in-hospital death up to three months postoperatively. A total of 110 769 cardiac surgical procedures conducted between April 2002 and March 2012 were studied, which included 127 consultant surgeons and 190 consultant anaesthetists. The overwhelming factor associated with outcome was patient risk, accounting for 95.75% of the variation for in-hospital mortality. The impact of the surgeon was moderate (intra-class correlation coefficient 4.00% for mortality), and the impact of the anaesthetist was negligible (0.25%). There was no significant effect of anaesthetist volume above ten cases per year. We conclude that mortality after cardiac surgery is primarily determined by the patient, with small but significant differences between surgeons. Anaesthetists did not appear to affect mortality. These findings do not support public disclosure of cardiac anaesthetists' results, but substantially validate current UK cardiac anaesthetic training and practice. Further research is required to establish the potential effects of very low anaesthetic caseloads and the effect of cardiac anaesthetists on patient morbidity. PMID:26511481

  18. Adjustment of costly extra-group paternity according to inbreeding risk in a cooperative mammal

    PubMed Central

    Cant, Michael A.; Sanderson, Jennifer L.

    2015-01-01

    Females of many animal species seek mating opportunities with multiple males, despite being able to obtain sufficient sperm to father their offspring from a single male. In animals that live in stable social groups, females often choose to mate outside their group resulting in extra-group paternity (EGP). One reason proposed to explain female choice for extra-group males is to obtain compatible genes, for example, in order to avoid inbreeding depression in offspring. The benefits of such extra-group paternities could be substantial if they result in fitter, outbred offspring. However, avoiding inbreeding in this way could be costly for females, for example, through retaliation by cuckolded males or through receiving aggression while prospecting for extra-group mating opportunities. We investigate the costs and benefits of EGP in the banded mongoose Mungos mungo, a cooperatively breeding mammal in which within-group mates are sometimes close relatives. We find that pups born to females that mate with extra-group males are more genetically heterozygous are heavier and are more likely to survive to independence than pups born to females that mate within their group. However, extra-group matings also involve substantial costs as they occur during violent encounters that sometimes result in injury and death. This appears to lead femalebanded mongooses to adaptively adjust EGP levels according to the current risk of inbreeding associated with mating within the group. For group-living animals, the costs of intergroup interactions may help to explain variation in both inbreeding rates and EGP within and between species. PMID:26609201

  19. Viscosity-adjusted estimation of pressure head and pump flow with quasi-pulsatile modulation of rotary blood pump for a total artificial heart.

    PubMed

    Yurimoto, Terumi; Hara, Shintaro; Isoyama, Takashi; Saito, Itsuro; Ono, Toshiya; Abe, Yusuke

    2016-09-01

    Estimation of pressure and flow has been an important subject for developing implantable artificial hearts. To realize real-time viscosity-adjusted estimation of pressure head and pump flow for a total artificial heart, we propose the table estimation method with quasi-pulsatile modulation of rotary blood pump in which systolic high flow and diastolic low flow phased are generated. The table estimation method utilizes three kinds of tables: viscosity, pressure and flow tables. Viscosity is estimated from the characteristic that differential value in motor speed between systolic and diastolic phases varies depending on viscosity. Potential of this estimation method was investigated using mock circulation system. Glycerin solution diluted with salty water was used to adjust viscosity of fluid. In verification of this method using continuous flow data, fairly good estimation could be possible when differential pulse width modulation (PWM) value of the motor between systolic and diastolic phases was high. In estimation under quasi-pulsatile condition, inertia correction was provided and fairly good estimation was possible when the differential PWM value was high, which was not different from the verification results using continuous flow data. In the experiment of real-time estimation applying moving average method to the estimated viscosity, fair estimation could be possible when the differential PWM value was high, showing that real-time viscosity-adjusted estimation of pressure head and pump flow would be possible with this novel estimation method when the differential PWM value would be set high.

  20. Viscosity-adjusted estimation of pressure head and pump flow with quasi-pulsatile modulation of rotary blood pump for a total artificial heart.

    PubMed

    Yurimoto, Terumi; Hara, Shintaro; Isoyama, Takashi; Saito, Itsuro; Ono, Toshiya; Abe, Yusuke

    2016-09-01

    Estimation of pressure and flow has been an important subject for developing implantable artificial hearts. To realize real-time viscosity-adjusted estimation of pressure head and pump flow for a total artificial heart, we propose the table estimation method with quasi-pulsatile modulation of rotary blood pump in which systolic high flow and diastolic low flow phased are generated. The table estimation method utilizes three kinds of tables: viscosity, pressure and flow tables. Viscosity is estimated from the characteristic that differential value in motor speed between systolic and diastolic phases varies depending on viscosity. Potential of this estimation method was investigated using mock circulation system. Glycerin solution diluted with salty water was used to adjust viscosity of fluid. In verification of this method using continuous flow data, fairly good estimation could be possible when differential pulse width modulation (PWM) value of the motor between systolic and diastolic phases was high. In estimation under quasi-pulsatile condition, inertia correction was provided and fairly good estimation was possible when the differential PWM value was high, which was not different from the verification results using continuous flow data. In the experiment of real-time estimation applying moving average method to the estimated viscosity, fair estimation could be possible when the differential PWM value was high, showing that real-time viscosity-adjusted estimation of pressure head and pump flow would be possible with this novel estimation method when the differential PWM value would be set high. PMID:27022734

  1. Seismic Risk Assessment and Loss Estimation for Tbilisi City

    NASA Astrophysics Data System (ADS)

    Tsereteli, Nino; Alania, Victor; Varazanashvili, Otar; Gugeshashvili, Tengiz; Arabidze, Vakhtang; Arevadze, Nika; Tsereteli, Emili; Gaphrindashvili, Giorgi; Gventcadze, Alexander; Goguadze, Nino; Vephkhvadze, Sophio

    2013-04-01

    The proper assessment of seismic risk is of crucial importance for society protection and city sustainable economic development, as it is the essential part to seismic hazard reduction. Estimation of seismic risk and losses is complicated tasks. There is always knowledge deficiency on real seismic hazard, local site effects, inventory on elements at risk, infrastructure vulnerability, especially for developing countries. Lately great efforts was done in the frame of EMME (earthquake Model for Middle East Region) project, where in the work packages WP1, WP2 , WP3 and WP4 where improved gaps related to seismic hazard assessment and vulnerability analysis. Finely in the frame of work package wp5 "City Scenario" additional work to this direction and detail investigation of local site conditions, active fault (3D) beneath Tbilisi were done. For estimation economic losses the algorithm was prepared taking into account obtained inventory. The long term usage of building is very complex. It relates to the reliability and durability of buildings. The long term usage and durability of a building is determined by the concept of depreciation. Depreciation of an entire building is calculated by summing the products of individual construction unit' depreciation rates and the corresponding value of these units within the building. This method of calculation is based on an assumption that depreciation is proportional to the building's (constructions) useful life. We used this methodology to create a matrix, which provides a way to evaluate the depreciation rates of buildings with different type and construction period and to determine their corresponding value. Finally loss was estimated resulting from shaking 10%, 5% and 2% exceedance probability in 50 years. Loss resulting from scenario earthquake (earthquake with possible maximum magnitude) also where estimated.

  2. Risk cross sections and their application to risk estimation in the galactic cosmic-ray environment.

    PubMed

    Curtis, S B; Nealy, J E; Wilson, J W

    1995-01-01

    Radiation risk cross sections (i.e. risks per particle fluence) are discussed in the context of estimating the risk of radiation-induced cancer on long-term space flights from the galactic cosmic radiation outside the confines of the earth's magnetic field. Such quantities are useful for handling effects not seen after low-LET radiation. Since appropriate cross-section functions for cancer induction for each particle species are not yet available, the conventional quality factor is used as an approximation to obtain numerical results for risks of excess cancer mortality. Risks are obtained for seven of the most radiosensitive organs as determined by the ICRP [stomach, colon, lung, bone marrow (BFO), bladder, esophagus and breast], beneath 10 g/cm2 aluminum shielding at solar minimum. Spectra are obtained for excess relative risk for each cancer per LET interval by calculating the average fluence-LET spectrum for the organ and converting to risk by multiplying by a factor proportional to R gamma L Q(L) before integrating over L, the unrestricted LET. Here R gamma is the risk coefficient for low-LET radiation (excess relative mortality per Sv) for the particular organ in question. The total risks of excess cancer mortality obtained are 1.3 and 1.1% to female and male crew, respectively, for a 1-year exposure at solar minimum. Uncertainties in these values are estimated to range between factors of 4 and 15 and are dominated by the biological uncertainties in the risk coefficients for low-LET radiation and in the LET (or energy) dependence of the risk cross sections (as approximated by the quality factor). The direct substitution of appropriate risk cross sections will eventually circumvent entirely the need to calculate, measure or use absorbed dose, equivalent dose and quality factor for such a high-energy charged-particle environment. PMID:7997515

  3. Risk cross sections and their application to risk estimation in the galactic cosmic-ray environment

    NASA Technical Reports Server (NTRS)

    Curtis, S. B.; Nealy, J. E.; Wilson, J. W.; Chatterjee, A. (Principal Investigator)

    1995-01-01

    Radiation risk cross sections (i.e. risks per particle fluence) are discussed in the context of estimating the risk of radiation-induced cancer on long-term space flights from the galactic cosmic radiation outside the confines of the earth's magnetic field. Such quantities are useful for handling effects not seen after low-LET radiation. Since appropriate cross-section functions for cancer induction for each particle species are not yet available, the conventional quality factor is used as an approximation to obtain numerical results for risks of excess cancer mortality. Risks are obtained for seven of the most radiosensitive organs as determined by the ICRP [stomach, colon, lung, bone marrow (BFO), bladder, esophagus and breast], beneath 10 g/cm2 aluminum shielding at solar minimum. Spectra are obtained for excess relative risk for each cancer per LET interval by calculating the average fluence-LET spectrum for the organ and converting to risk by multiplying by a factor proportional to R gamma L Q(L) before integrating over L, the unrestricted LET. Here R gamma is the risk coefficient for low-LET radiation (excess relative mortality per Sv) for the particular organ in question. The total risks of excess cancer mortality obtained are 1.3 and 1.1% to female and male crew, respectively, for a 1-year exposure at solar minimum. Uncertainties in these values are estimated to range between factors of 4 and 15 and are dominated by the biological uncertainties in the risk coefficients for low-LET radiation and in the LET (or energy) dependence of the risk cross sections (as approximated by the quality factor). The direct substitution of appropriate risk cross sections will eventually circumvent entirely the need to calculate, measure or use absorbed dose, equivalent dose and quality factor for such a high-energy charged-particle environment.

  4. Validity of methods for model selection, weighting for model uncertainty, and small sample adjustment in capture-recapture estimation.

    PubMed

    Hook, E B; Regal, R R

    1997-06-15

    In log-linear capture-recapture approaches to population size, the method of model selection may have a major effect upon the estimate. In addition, the estimate may also be very sensitive if certain cells are null or very sparse, even with the use of multiple sources. The authors evaluated 1) various approaches to the issue of model uncertainty and 2) a small sample correction for three or more sources recently proposed by Hook and Regal. The authors compared the estimates derived using 1) three different information criteria that included Akaike's Information Criterion (AIC) and two alternative formulations of the Bayesian Information Criterion (BIC), one proposed by Draper ("two pi") and one by Schwarz ("not two pi"); 2) two related methods of weighting estimates associated with models; 3) the independent model; and 4) the saturated model, with the known totals in 20 different populations studied by five separate groups of investigators. For each method, we also compared the estimate derived with or without the proposed small sample correction. At least in these data sets, the use of AIC appeared on balance to be preferable. The BIC formulation suggested by Draper appeared slightly preferable to that suggested by Schwarz. Adjustment for model uncertainty appears to improve results slightly. The proposed small sample correction appeared to diminish relative log bias but only when sparse cells were present. Otherwise, its use tended to increase relative log bias. Use of the saturated model (with or without the small sample correction) appears to be optimal if the associated interval is not uselessly large, and if one can plausibly exclude an all-source interaction. All other approaches led to an estimate that was too low by about one standard deviation.

  5. Estimation of value at risk and conditional value at risk using normal mixture distributions model

    NASA Astrophysics Data System (ADS)

    Kamaruzzaman, Zetty Ain; Isa, Zaidi

    2013-04-01

    Normal mixture distributions model has been successfully applied in financial time series analysis. In this paper, we estimate the return distribution, value at risk (VaR) and conditional value at risk (CVaR) for monthly and weekly rates of returns for FTSE Bursa Malaysia Kuala Lumpur Composite Index (FBMKLCI) from July 1990 until July 2010 using the two component univariate normal mixture distributions model. First, we present the application of normal mixture distributions model in empirical finance where we fit our real data. Second, we present the application of normal mixture distributions model in risk analysis where we apply the normal mixture distributions model to evaluate the value at risk (VaR) and conditional value at risk (CVaR) with model validation for both risk measures. The empirical results provide evidence that using the two components normal mixture distributions model can fit the data well and can perform better in estimating value at risk (VaR) and conditional value at risk (CVaR) where it can capture the stylized facts of non-normality and leptokurtosis in returns distribution.

  6. Quasi-likelihood estimation for relative risk regression models.

    PubMed

    Carter, Rickey E; Lipsitz, Stuart R; Tilley, Barbara C

    2005-01-01

    For a prospective randomized clinical trial with two groups, the relative risk can be used as a measure of treatment effect and is directly interpretable as the ratio of success probabilities in the new treatment group versus the placebo group. For a prospective study with many covariates and a binary outcome (success or failure), relative risk regression may be of interest. If we model the log of the success probability as a linear function of covariates, the regression coefficients are log-relative risks. However, using such a log-linear model with a Bernoulli likelihood can lead to convergence problems in the Newton-Raphson algorithm. This is likely to occur when the success probabilities are close to one. A constrained likelihood method proposed by Wacholder (1986, American Journal of Epidemiology 123, 174-184), also has convergence problems. We propose a quasi-likelihood method of moments technique in which we naively assume the Bernoulli outcome is Poisson, with the mean (success probability) following a log-linear model. We use the Poisson maximum likelihood equations to estimate the regression coefficients without constraints. Using method of moment ideas, one can show that the estimates using the Poisson likelihood will be consistent and asymptotically normal. We apply these methods to a double-blinded randomized trial in primary biliary cirrhosis of the liver (Markus et al., 1989, New England Journal of Medicine 320, 1709-1713). PMID:15618526

  7. Leukemia risk associated with benzene exposure in the pliofilm cohort. II. Risk estimates.

    PubMed

    Paxton, M B; Chinchilli, V M; Brett, S M; Rodricks, J V

    1994-04-01

    The detailed work histories of the individual workers composing the Pliofilm cohort represent a unique resource for estimating the dose-response for leukemia that may follow occupational exposure to benzene. In this paper, we report the results of analyzing the updated Pliofilm cohort using the proportional hazards model, a more sophisticated technique that uses more of the available exposure data than the conditional logistic model used by Rinsky et al. The more rigorously defined exposure estimates derived by Paustenbach et al. are consistent with those of Crump and Allen in giving estimates of the slope of the leukemogenic dose-response that are not as steep as the slope resulting from the exposure estimates of Rinsky et al. We consider estimates of 0.3-0.5 additional leukemia deaths per thousand workers with 45 ppm-years of cumulative benzene exposure to be the best estimates currently available of leukemia risk from occupational exposure to benzene. These risks were estimated in the proportional hazards model when the exposure estimates of Crump and Allen or of Paustenbach et al. were used to derive a cumulative concentration-by-time metric. PMID:8008924

  8. Data Sources for the Model-based Small Area Estimates of Cancer Risk Factors and Screening Behaviors - Small Area Estimates

    Cancer.gov

    The model-based estimates of important cancer risk factors and screening behaviors are obtained by combining the responses to the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS).

  9. Toward the Development of Integrative Risk-Adjusted Measures of Quality Using Large Clinical Data Bases: The Case of Anesthesia Services.

    ERIC Educational Resources Information Center

    Fleming, Steven T.

    1992-01-01

    The concept of risk-adjusted measures of quality is discussed, and a methodology is proposed for risk-adjusting and integrating multiple adverse outcomes of anesthesia services into measures for quality assurance and quality improvement programs. Although designed for a new anesthesiology database, the methods should apply to other health…

  10. A comparison of bootstrap methods and an adjusted bootstrap approach for estimating the prediction error in microarray classification.

    PubMed

    Jiang, Wenyu; Simon, Richard

    2007-12-20

    This paper first provides a critical review on some existing methods for estimating the prediction error in classifying microarray data where the number of genes greatly exceeds the number of specimens. Special attention is given to the bootstrap-related methods. When the sample size n is small, we find that all the reviewed methods suffer from either substantial bias or variability. We introduce a repeated leave-one-out bootstrap (RLOOB) method that predicts for each specimen in the sample using bootstrap learning sets of size ln. We then propose an adjusted bootstrap (ABS) method that fits a learning curve to the RLOOB estimates calculated with different bootstrap learning set sizes. The ABS method is robust across the situations we investigate and provides a slightly conservative estimate for the prediction error. Even with small samples, it does not suffer from large upward bias as the leave-one-out bootstrap and the 0.632+ bootstrap, and it does not suffer from large variability as the leave-one-out cross-validation in microarray applications.

  11. Estimation of Hail Risk in the UK and Europe

    NASA Astrophysics Data System (ADS)

    Robinson, Eric; Parker, Melanie; Higgs, Stephanie

    2016-04-01

    Observations of hail events in Europe, and the UK especially, are relatively limited. In order to determine hail risk it is therefore necessary to use information other than relying purely on the historical record. One such methodology is to leverage reanalysis data, in this case ERA-Interim, along with a numerical model (WRF) to recreate the past state of the atmosphere. Relevant atmospheric properties can be extracted and used in a regression model to determine hail probability for each day contained within the reanalyses. The results presented here show the results of using a regression model based on convective available potential energy, deep level shear and weather type. Combined these parameters represent the probability of severe thunderstorm, and in turn hail, activity. Once the probability of hail occurring on each day is determined this can be used as the basis of a stochastic catalogue which can be used in the estimation of hail risk.

  12. Risk Adjustment and the Assessment of Disparities in Dialysis Mortality Outcomes.

    PubMed

    Kalbfleisch, John; Wolfe, Robert; Bell, Sarah; Sun, Rena; Messana, Joseph; Shearon, Tempie; Ashby, Valarie; Padilla, Robin; Zhang, Min; Turenne, Marc; Pearson, Jeffrey; Dahlerus, Claudia; Li, Yi

    2015-11-01

    Standardized mortality ratios (SMRs) reported by Medicare compare mortality at individual dialysis facilities with the national average, and are currently adjusted for race. However, whether the adjustment for race obscures or clarifies disparities in quality of care for minority groups is unknown. Cox model-based SMRs were computed with and without adjustment for patient race for 5920 facilities in the United States during 2010. The study population included virtually all patients treated with dialysis during this period. Without race adjustment, facilities with higher proportions of black patients had better survival outcomes; facilities with the highest percentage of black patients (top 10%) had overall mortality rates approximately 7% lower than expected. After adjusting for within-facility racial differences, facilities with higher proportions of black patients had poorer survival outcomes among black and non-black patients; facilities with the highest percentage of black patients (top 10%) had mortality rates approximately 6% worse than expected. In conclusion, accounting for within-facility racial differences in the computation of SMR helps to clarify disparities in quality of health care among patients with ESRD. The adjustment that accommodates within-facility comparisons is key, because it could also clarify relationships between patient characteristics and health care provider outcomes in other settings.

  13. Global Building Inventory for Earthquake Loss Estimation and Risk Management

    USGS Publications Warehouse

    Jaiswal, Kishor; Wald, David; Porter, Keith

    2010-01-01

    We develop a global database of building inventories using taxonomy of global building types for use in near-real-time post-earthquake loss estimation and pre-earthquake risk analysis, for the U.S. Geological Survey’s Prompt Assessment of Global Earthquakes for Response (PAGER) program. The database is available for public use, subject to peer review, scrutiny, and open enhancement. On a country-by-country level, it contains estimates of the distribution of building types categorized by material, lateral force resisting system, and occupancy type (residential or nonresidential, urban or rural). The database draws on and harmonizes numerous sources: (1) UN statistics, (2) UN Habitat’s demographic and health survey (DHS) database, (3) national housing censuses, (4) the World Housing Encyclopedia and (5) other literature.

  14. Estimation of risks associated with paediatric cochlear implantation.

    PubMed

    Johnston, J Cyne; Smith, Andrée Durieux; Fitzpatrick, Elizabeth; O'Connor, Annette; Angus, Douglas; Benzies, Karen; Schramm, David

    2010-09-01

    The objectives of this study were to estimate the rates of complications associated with paediatric cochlear implantation use: a) at one Canadian cochlear implant (CI) centre, and b) in the published literature. It comprised a retrospective hospital-based chart review and a concurrent review of complications in the published literature. There were 224 children who had undergone surgery from 1994 to June 2007. Results indicate that the rates of complications at the local Canadian paediatric CI centre are not significantly different from the literature rates for all examined complication types. This hospital-based retrospective chart review and review of the literature provide readers with an estimation of the risks to aid in evidence-based decision-making surrounding paediatric cochlear implantation.

  15. 41 CFR 102-80.50 - Are Federal agencies responsible for identifying/estimating risks and for appropriate risk...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Environmental Management Risks and Risk Reduction Strategies § 102-80.50 Are Federal agencies responsible for... identify and estimate safety and environmental management risks and appropriate risk reduction strategies... environmental management risks and report or correct the situation, as appropriate. Federal agencies must...

  16. Risk estimates for hip fracture from clinical and densitometric variables and impact of database selection in Lebanese subjects.

    PubMed

    Badra, Mohammad; Mehio-Sibai, Abla; Zeki Al-Hazzouri, Adina; Abou Naja, Hala; Baliki, Ghassan; Salamoun, Mariana; Afeiche, Nadim; Baddoura, Omar; Bulos, Suhayl; Haidar, Rachid; Lakkis, Suhayl; Musharrafieh, Ramzi; Nsouli, Afif; Taha, Assaad; Tayim, Ahmad; El-Hajj Fuleihan, Ghada

    2009-01-01

    Bone mineral density (BMD) and fracture incidence vary greatly worldwide. The data, if any, on clinical and densitometric characteristics of patients with hip fractures from the Middle East are scarce. The objective of the study was to define risk estimates from clinical and densitometric variables and the impact of database selection on such estimates. Clinical and densitometric information were obtained in 60 hip fracture patients and 90 controls. Hip fracture subjects were 74 yr (9.4) old, were significantly taller, lighter, and more likely to be taking anxiolytics and sleeping pills than controls. National Health and Nutrition Examination Survey (NHANES) database selection resulted in a higher sensitivity and almost equal specificity in identifying patients with a hip fracture compared with the Lebanese database. The odds ratio (OR) and its confidence interval (CI) for hip fracture per standard deviation (SD) decrease in total hip BMD was 2.1 (1.45-3.05) with the NHANES database, and 2.11 (1.36-2.37) when adjusted for age and body mass index (BMI). Risk estimates were higher in male compared with female subjects. In Lebanese subjects, BMD- and BMI-derived hip fracture risk estimates are comparable to western standards. The study validates the universal use of the NHANES database, and the applicability of BMD- and BMI-derived risk fracture estimates in the World Health Organization (WHO) global fracture risk model, to the Lebanese. PMID:19246223

  17. Classroom risks and resources: Teacher burnout, classroom quality and children's adjustment in high needs elementary schools.

    PubMed

    Hoglund, Wendy L G; Klingle, Kirsten E; Hosan, Naheed E

    2015-10-01

    The current paper presents two related sets of findings on the classroom context in high needs elementary schools. First, we investigated change over one school term in teacher burnout (emotional exhaustion, depersonalization, personal accomplishment) and classroom quality (emotional and instructional support, organization) and assessed the degree to which burnout and classroom quality co-varied over the term with each other and with aggregate externalizing behaviors (average child externalizing behaviors in the classroom). These analyses describe the classroom context in which the children are nested. Second, we examined change over one school term in children's social adjustment (relationship quality with teachers and friends) and academic adjustment (school engagement, literacy skills) and assessed how adjustment co-varied over time with child externalizing behaviors and was predicted by teacher burnout, classroom quality and aggregate externalizing behaviors. These models were tested with a sample of low-income, ethnically diverse children in kindergarten to grade 3 and their teachers. The children and teachers were assessed three times over one school term. Personal accomplishment co-varied positively with overall classroom quality. Reciprocally, classroom organization co-varied positively with overall teacher burnout. Aggregate externalizing behaviors co-varied positively with depersonalization and negatively with personal accomplishment and overall classroom quality, including emotional support and organization. In turn, teacher burnout interacted with aggregate externalizing behaviors to predict change in child social and academic adjustment. Alternatively, classroom quality interacted with aggregate and child externalizing behaviors to predict change in child social and academic adjustment.

  18. Classroom risks and resources: Teacher burnout, classroom quality and children's adjustment in high needs elementary schools.

    PubMed

    Hoglund, Wendy L G; Klingle, Kirsten E; Hosan, Naheed E

    2015-10-01

    The current paper presents two related sets of findings on the classroom context in high needs elementary schools. First, we investigated change over one school term in teacher burnout (emotional exhaustion, depersonalization, personal accomplishment) and classroom quality (emotional and instructional support, organization) and assessed the degree to which burnout and classroom quality co-varied over the term with each other and with aggregate externalizing behaviors (average child externalizing behaviors in the classroom). These analyses describe the classroom context in which the children are nested. Second, we examined change over one school term in children's social adjustment (relationship quality with teachers and friends) and academic adjustment (school engagement, literacy skills) and assessed how adjustment co-varied over time with child externalizing behaviors and was predicted by teacher burnout, classroom quality and aggregate externalizing behaviors. These models were tested with a sample of low-income, ethnically diverse children in kindergarten to grade 3 and their teachers. The children and teachers were assessed three times over one school term. Personal accomplishment co-varied positively with overall classroom quality. Reciprocally, classroom organization co-varied positively with overall teacher burnout. Aggregate externalizing behaviors co-varied positively with depersonalization and negatively with personal accomplishment and overall classroom quality, including emotional support and organization. In turn, teacher burnout interacted with aggregate externalizing behaviors to predict change in child social and academic adjustment. Alternatively, classroom quality interacted with aggregate and child externalizing behaviors to predict change in child social and academic adjustment. PMID:26407833

  19. Survivorship models for estimating the risk of decompression sickness.

    PubMed

    Kumar, K V; Powell, M R

    1994-07-01

    Several approaches have been used for modeling the incidence of decompression sickness (DCS) such as Hill's dose-response and logistic regression. Most of these methods do not include the time-to-onset information in the model. Survival analysis (failure time analysis) is appropriate when the time to onset of an event is of interest. The applicability of survival analysis for modeling the risk of DCS is illustrated by using data obtained from hypobaric chamber exposures simulating extravehicular activities (n = 426). Univariate analysis of incidence-free survival proportions were obtained for Doppler-detectable circulating microbubbles (CMB), symptoms of DCS and test aborts. A log-linear failure time regression model with 360-min half-time tissue ratio (TR) as covariate was constructed, and estimated probabilities for various TR values were calculated. Further regression analysis by including CMB status in this model showed significant improvement (p < 0.05) in the estimation of DCS over the previous model. Since DCS is dependent on the exposure pressure as well as the duration of exposure, we recommend the use of survival analysis for modeling the risk of DCS. PMID:7945136

  20. Health risks in wastewater irrigation: comparing estimates from quantitative microbial risk analyses and epidemiological studies.

    PubMed

    Mara, D D; Sleigh, P A; Blumenthal, U J; Carr, R M

    2007-03-01

    The combination of standard quantitative microbial risk analysis (QMRA) techniques and 10,000-trial Monte Carlo risk simulations was used to estimate the human health risks associated with the use of wastewater for unrestricted and restricted crop irrigation. A risk of rotavirus infection of 10(-2) per person per year (pppy) was used as the reference level of acceptable risk. Using the model scenario of involuntary soil ingestion for restricted irrigation, the risk of rotavirus infection is approximately 10(-2) pppy when the wastewater contains < or =10(6) Escherichia coli per 100ml and when local agricultural practices are highly mechanised. For labour-intensive agriculture the risk of rotavirus infection is approximately 10(-2) pppy when the wastewater contains < or = 10(5) E. coli per 100ml; however, the wastewater quality should be < or = 10(4) E. coli per 100ml when children under 15 are exposed. With the model scenario of lettuce consumption for unrestricted irrigation, the use of wastewaters containing < or =10(4) E. coli per 100ml results in a rotavirus infection risk of approximately 10(-2) pppy; however, again based on epidemiological evidence from Mexico, the current WHO guideline level of < or =1,000 E. coli per 100ml should be retained for root crops eaten raw. PMID:17402278

  1. Burden of Six Healthcare-Associated Infections on European Population Health: Estimating Incidence-Based Disability-Adjusted Life Years through a Population Prevalence-Based Modelling Study

    PubMed Central

    Eckmanns, Tim; Abu Sin, Muna; Ducomble, Tanja; Harder, Thomas; Sixtensson, Madlen; Velasco, Edward; Weiß, Bettina; Kramarz, Piotr; Monnet, Dominique L.; Kretzschmar, Mirjam E.; Suetens, Carl

    2016-01-01

    Background Estimating the burden of healthcare-associated infections (HAIs) compared to other communicable diseases is an ongoing challenge given the need for good quality data on the incidence of these infections and the involved comorbidities. Based on the methodology of the Burden of Communicable Diseases in Europe (BCoDE) project and 2011–2012 data from the European Centre for Disease Prevention and Control (ECDC) point prevalence survey (PPS) of HAIs and antimicrobial use in European acute care hospitals, we estimated the burden of six common HAIs. Methods and Findings The included HAIs were healthcare-associated pneumonia (HAP), healthcare-associated urinary tract infection (HA UTI), surgical site infection (SSI), healthcare-associated Clostridium difficile infection (HA CDI), healthcare-associated neonatal sepsis, and healthcare-associated primary bloodstream infection (HA primary BSI). The burden of these HAIs was measured in disability-adjusted life years (DALYs). Evidence relating to the disease progression pathway of each type of HAI was collected through systematic literature reviews, in order to estimate the risks attributable to HAIs. For each of the six HAIs, gender and age group prevalence from the ECDC PPS was converted into incidence rates by applying the Rhame and Sudderth formula. We adjusted for reduced life expectancy within the hospital population using three severity groups based on McCabe score data from the ECDC PPS. We estimated that 2,609,911 new cases of HAI occur every year in the European Union and European Economic Area (EU/EEA). The cumulative burden of the six HAIs was estimated at 501 DALYs per 100,000 general population each year in EU/EEA. HAP and HA primary BSI were associated with the highest burden and represented more than 60% of the total burden, with 169 and 145 DALYs per 100,000 total population, respectively. HA UTI, SSI, HA CDI, and HA primary BSI ranked as the third to sixth syndromes in terms of burden of disease

  2. Flexible dose-response models for Japanese atomic bomb survivor data: Bayesian estimation and prediction of cancer risk.

    PubMed

    Bennett, James; Little, Mark P; Richardson, Sylvia

    2004-12-01

    Generalised absolute risk models were fitted to the latest Japanese atomic bomb survivor cancer incidence data using Bayesian Markov Chain Monte Carlo methods, taking account of random errors in the DS86 dose estimates. The resulting uncertainty distributions in the relative risk model parameters were used to derive uncertainties in population cancer risks for a current UK population. Because of evidence for irregularities in the low-dose dose response, flexible dose-response models were used, consisting of a linear-quadratic-exponential model, used to model the high-dose part of the dose response, together with piecewise-linear adjustments for the two lowest dose groups. Following an assumed administered dose of 0.001 Sv, lifetime leukaemia radiation-induced incidence risks were estimated to be 1.11 x 10(-2) Sv(-1) (95% Bayesian CI -0.61, 2.38) using this model. Following an assumed administered dose of 0.001 Sv, lifetime solid cancer radiation-induced incidence risks were calculated to be 7.28 x 10(-2) Sv(-1) (95% Bayesian CI -10.63, 22.10) using this model. Overall, cancer incidence risks predicted by Bayesian Markov Chain Monte Carlo methods are similar to those derived by classical likelihood-based methods and which form the basis of established estimates of radiation-induced cancer risk.

  3. Interpersonal circumplex descriptions of psychosocial risk factors for physical illness: application to hostility, neuroticism, and marital adjustment.

    PubMed

    Smith, Timothy W; Traupman, Emily K; Uchino, Bert N; Berg, Cynthia A

    2010-06-01

    Personality risk factors for physical illness are typically studied individually and apart from risk factors reflecting the social environment, potentially fostering a piecemeal understanding of psychosocial influences on health. Because it can be used to describe both personality and social relationship processes, the interpersonal circumplex (IPC) provides an integrative approach to psychosocial risk. In 301 married couples we examined IPC correlates of 3 risk factor domains: anger, hostility, and aggressiveness; neuroticism; and marital adjustment. Risk factors displayed IPC locations ranging from hostile dominance (e.g., verbal aggressiveness, marital conflict) to hostility (e.g., anger) to hostile submissiveness (e.g., anxiety, depression); protective factors (marital satisfaction and support) reflected warmth or friendliness in the IPC. Similar descriptions were found using self-reports and spouse ratings of IPC dimensions, indicating that interpersonal styles associated with risk factors do not simply reflect common method variance. Findings identify interpersonal processes reflecting low affiliation or high hostility as a common component of risk and indicate distinctions among risk factors along the dominance dimension. PMID:20573134

  4. Interpersonal circumplex descriptions of psychosocial risk factors for physical illness: application to hostility, neuroticism, and marital adjustment.

    PubMed

    Smith, Timothy W; Traupman, Emily K; Uchino, Bert N; Berg, Cynthia A

    2010-06-01

    Personality risk factors for physical illness are typically studied individually and apart from risk factors reflecting the social environment, potentially fostering a piecemeal understanding of psychosocial influences on health. Because it can be used to describe both personality and social relationship processes, the interpersonal circumplex (IPC) provides an integrative approach to psychosocial risk. In 301 married couples we examined IPC correlates of 3 risk factor domains: anger, hostility, and aggressiveness; neuroticism; and marital adjustment. Risk factors displayed IPC locations ranging from hostile dominance (e.g., verbal aggressiveness, marital conflict) to hostility (e.g., anger) to hostile submissiveness (e.g., anxiety, depression); protective factors (marital satisfaction and support) reflected warmth or friendliness in the IPC. Similar descriptions were found using self-reports and spouse ratings of IPC dimensions, indicating that interpersonal styles associated with risk factors do not simply reflect common method variance. Findings identify interpersonal processes reflecting low affiliation or high hostility as a common component of risk and indicate distinctions among risk factors along the dominance dimension.

  5. Evaluating the Investment Benefit of Multinational Enterprises' International Projects Based on Risk Adjustment: Evidence from China

    ERIC Educational Resources Information Center

    Chen, Chong

    2016-01-01

    This study examines the international risks faced by multinational enterprises to understand their impact on the evaluation of investment projects. Moreover, it establishes a 'three-dimensional' theoretical framework of risk identification to analyse the composition of international risk indicators of multinational enterprises based on the theory…

  6. Time-to-Compromise Model for Cyber Risk Reduction Estimation

    SciTech Connect

    Miles A. McQueen; Wayne F. Boyer; Mark A. Flynn; George A. Beitel

    2005-09-01

    We propose a new model for estimating the time to compromise a system component that is visible to an attacker. The model provides an estimate of the expected value of the time-to-compromise as a function of known and visible vulnerabilities, and attacker skill level. The time-to-compromise random process model is a composite of three subprocesses associated with attacker actions aimed at the exploitation of vulnerabilities. In a case study, the model was used to aid in a risk reduction estimate between a baseline Supervisory Control and Data Acquisition (SCADA) system and the baseline system enhanced through a specific set of control system security remedial actions. For our case study, the total number of system vulnerabilities was reduced by 86% but the dominant attack path was through a component where the number of vulnerabilities was reduced by only 42% and the time-to-compromise of that component was increased by only 13% to 30% depending on attacker skill level.

  7. Pathways of Parenting Style on Adolescents' College Adjustment, Academic Achievement, and Alcohol Risk

    ERIC Educational Resources Information Center

    Kenney, Shannon R.; Lac, Andrew; Hummer, Justin F.; Grimaldi, Elizabeth M.; LaBrie, Joseph W.

    2015-01-01

    This study examined the pathways of parenting style (permissive, authoritarian, and authoritative) to alcohol consumption and consequences through the mediators of college adjustment and academic achievement (grade point average [GPA]). Participants were 289 students from a private, mid-size, West Coast university (mean age 19.01 years, 58.8%…

  8. Analytic Strategies to Adjust Confounding Using Exposure Propensity Scores and Disease Risk Scores: Nonsteroidal Antiinflammatory Drugs (NSAID) and Short-term Mortality in the Elderly

    PubMed Central

    Stürmer, Til; Schneeweiss, Sebastian; Brookhart, M. Alan; Rothman, Kenneth J; Avorn, Jerry; Glynn, Robert J

    2006-01-01

    Little is known about optimal application and behavior of exposure propensity scores (EPS) in small studies. Based on a cohort of 103,133 elderly Medicaid beneficiaries, the effect of nonsteroidal anti-inflammatory drug (NSAID) use on 1-year all-cause mortality was assessed based on the assumption that there is no protective effect, and the preponderance of any observed effect would be confounded. To study the comparative behavior of EPS, disease risk scores (DRS), and ‘traditional’ disease models, we randomly re-sampled 1,000 subcohorts of 10,000, 1,000 and 500 people. The number of variables was limited in disease models, but not EPS and DRS. Estimated EPS were used to adjust for confounding by matching, inverse probability of treatment weighting (IPTW), stratification, and modeling. The crude rate ratio (RR) of death for NSAID users was 0.68. ‘Traditional’ adjustment resulted in a RR of 0.80 (95% confidence interval:0.77–0.84). The RR closest to 1 was achieved by IPTW (0.85;0.82–0.88). With decreasing study size, estimates remained further from the null, which was most pronounced for IPTW (N=500: RR=0.72;0.26–1.68). In this setting, analytic strategies using EPS or DRS were not generally superior to ‘traditional’. Various ways to use EPS and DRS behaved differently with smaller study size. PMID:15840622

  9. Moving towards a new paradigm for global flood risk estimation

    NASA Astrophysics Data System (ADS)

    Troy, Tara J.; Devineni, Naresh; Lima, Carlos; Lall, Upmanu

    2013-04-01

    model is implemented at a finer resolution (<=1km) in order to more accurately model streamflow under flood conditions and estimate inundation. This approach allows for efficient computational simulation of the hydrology when not under potential for flooding with high-resolution flood wave modeling when there is flooding potential. We demonstrate the results of this flood risk estimation system for the Ohio River basin in the United States, a large river basin that is historically prone to flooding, with the intention of using it to do global flood risk assessment.

  10. Positioning resilience for 2015: the role of resistance, incremental adjustment and transformation in disaster risk management policy.

    PubMed

    Matyas, David; Pelling, Mark

    2015-01-01

    Resilience is a ubiquitous term in disaster risk management and is an increasingly prominent concept in early discussions focused on elaborating the post-2015 international policy landscape. Riddled with competing meanings and diverse policy implications, however, it is a concept caught between the abstract and operational. This paper provides a review of the rise to prominence of the concept of resilience and advances an elaboration of the related concepts of resistance, incremental adjustment and transformation. We argue that these concepts can contribute to decision-making by offering three distinct options for risk management policy. In order to deliberately and effectively choose among these options, we suggest that critical reflexivity is a prerequisite, necessitating improved decision-making capacity if varied perspectives (including those of the most vulnerable) are to be involved in the selection of the best approach to risk management.

  11. Declining bioavailability and inappropriate estimation of risk of persistent compounds

    SciTech Connect

    Kelsey, J.W.; Alexander, M.

    1997-03-01

    Earthworms (Eisenia foetida) assimilated decreasing amounts of atrazine, phenanthrene, and naphthalene that had been incubated for increasing periods of time in sterile soil. The amount of atrazine and phenanthrene removed from soil by mild extractants also decreased with time. The declines in bioavailability of the three compounds to earthworms and of naphthalene to bacteria were not reflected by analysis involving vigorous methods of solvent extraction; similar results for bioavailability of phenanthrene and 4-nitrophenol to bacteria were obtained in a previous study conducted at this laboratory. The authors suggest that regulations based on vigorous extractions for the analyses of persistent organic pollutants in soil do not appropriately estimate exposure or risk to susceptible populations.

  12. How do we measure dose and estimate risk?

    NASA Astrophysics Data System (ADS)

    Hoeschen, Christoph; Regulla, Dieter; Schlattl, Helmut; Petoussi-Henss, Nina; Li, Wei Bo; Zankl, Maria

    2011-03-01

    Radiation exposure due to medical imaging is a topic of emerging importance. In Europe this topic has been dealt with for a long time and in other countries it is getting more and more important and it gets an aspect of public interest in the latest years. This is mainly true due to the fact that the average dose per person in developed countries is increasing rapidly since threedimensional imaging is getting more and more available and useful for diagnosis. This paper introduces the most common dose quantities used in medical radiation exposure characterization, discusses usual ways for determination of such quantities as well as some considerations how these values are linked to radiation risk estimation. For this last aspect the paper will refer to the linear non threshold theory for an imaging application.

  13. 41 CFR 102-80.50 - Are Federal agencies responsible for identifying/estimating risks and for appropriate risk...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... (Continued) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 80-SAFETY AND ENVIRONMENTAL MANAGEMENT Safety and Environmental Management Risks and Risk Reduction Strategies § 102-80.50 Are Federal agencies responsible for... identify and estimate safety and environmental management risks and appropriate risk reduction...

  14. 41 CFR 102-80.50 - Are Federal agencies responsible for identifying/estimating risks and for appropriate risk...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... (Continued) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 80-SAFETY AND ENVIRONMENTAL MANAGEMENT Safety and Environmental Management Risks and Risk Reduction Strategies § 102-80.50 Are Federal agencies responsible for... identify and estimate safety and environmental management risks and appropriate risk reduction...

  15. 41 CFR 102-80.50 - Are Federal agencies responsible for identifying/estimating risks and for appropriate risk...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... (Continued) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 80-SAFETY AND ENVIRONMENTAL MANAGEMENT Safety and Environmental Management Risks and Risk Reduction Strategies § 102-80.50 Are Federal agencies responsible for... identify and estimate safety and environmental management risks and appropriate risk reduction...

  16. 41 CFR 102-80.50 - Are Federal agencies responsible for identifying/estimating risks and for appropriate risk...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... (Continued) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 80-SAFETY AND ENVIRONMENTAL MANAGEMENT Safety and Environmental Management Risks and Risk Reduction Strategies § 102-80.50 Are Federal agencies responsible for... identify and estimate safety and environmental management risks and appropriate risk reduction...

  17. Estimated Insulin Sensitivity and Cardiovascular Disease Risk Factors in Adolescents with and without Type 1 Diabetes

    PubMed Central

    Specht, Brian J; Wadwa, R Paul; Snell-Bergeon, Janet K; Nadeau, Kristen J; Bishop, Franziska K; Maahs, David M.

    2012-01-01

    Objective To test the hypothesis that cardiovascular disease (CVD) risk factors are similar in adolescents with and without diabetes (T1D) in the most insulin sensitive (IS) tertile and CVD risk factors are more atherogenic with decreasing IS in adolescents with T1D. Study design Adolescents with IS T1D (n=292; age=15.4±2.1 years; duration=8.8±3.0 years, HbA1c=8.9±1.6%) and non-diabetic (non-DM) controls (n=89; age=15.4±2.1 years) was estimated using the model: logeIS=4.64725 – 0.02032(waist, cm) – 0.09779(HbA1c, %) – 0.00235(triglycerides, mg/dl). CVD risk factors (blood pressure, fasting total, LDL and HDL-cholesterol, hs-CRP, and BMI Z-score) were compared between all non-DM adolescents and those with T1D in the most IS tertile, and then examined for a linear trend by IS tertile in adolescents with T1D, adjusted for sex, race/ethnicity and Tanner Stage. Results Estimated IS was significantly lower in adolescents with T1D compared with those without (T1D=7.8±2.4, non-DM=11.5±2.9; p<0.0001). CVD risk factors were similar for non-DM compared with the adolescents with most IS T1D, except for higher HDL-c and DBP in adolescents with T1D (p<0.05). Among adolescents with T1D, all CVD risk factors except for HDL-c, were more atherogenic across decreasing IS tertiles in linear regression analysis (p<0.05). Conclusion Adolescents with T1D who are the most IS have similar CVD risk factors compared with non-DM adolescents. CVD risk factors are inversely associated with adolescents with IS T1D. IS may be an important therapeutic target for reducing CVD risk factors in adolescents with T1D. PMID:22921593

  18. Assessing changes in socioemotional adjustment across early school transitions-new national scales for children at risk.

    PubMed

    McDermott, Paul A; Watkins, Marley W; Rovine, Michael J; Rikoon, Samuel H

    2013-02-01

    This article reports the development and evidence for validity and application of the Adjustment Scales for Early Transition in Schooling (ASETS). Based on primary analyses of data from the Head Start Impact Study, a nationally representative sample (N=3077) of randomly selected children from low-income households is configured to inform developmental-transitional stability and change in socioemotional adjustment. Longitudinal exploratory and confirmatory factor analysis of the ASETS revealed behavioral dimensions of Aggression, Attention Seeking, Reticence/Withdrawal, Low Energy, and higher-order dimensions of Overactivity and Underactivity. Each dimension was vertically equated through IRT, with Bayesian scoring across 2 years of prekindergarten, kindergarten, and 1st grade. Multilevel modeling provides evidence for concurrent validity, assessment of future risk, and detection of differential growth trajectories across the 4 years of early school transition. PMID:23375175

  19. Estimation of Tsunami Risk for the Caribbean Coast

    NASA Astrophysics Data System (ADS)

    Zahibo, N.

    2004-05-01

    The tsunami problem for the coast of the Caribbean basin is discussed. Briefly the historical data of tsunami in the Caribbean Sea are presented. Numerical simulation of potential tsunamis in the Caribbean Sea is performed in the framework of the nonlinear-shallow theory. The tsunami wave height distribution along the Caribbean Coast is computed. These results are used to estimate the far-field tsunami potential of various coastal locations in the Caribbean Sea. In fact, five zones with tsunami low risk are selected basing on prognostic computations, they are: the bay "Golfo de Batabano" and the coast of province "Ciego de Avila" in Cuba, the Nicaraguan Coast (between Bluefields and Puerto Cabezas), the border between Mexico and Belize, the bay "Golfo de Venezuela" in Venezuela. The analysis of historical data confirms that there was no tsunami in the selected zones. Also, the wave attenuation in the Caribbean Sea is investigated; in fact, wave amplitude decreases in an order if the tsunami source is located on the distance up to 1000 km from the coastal location. Both factors wave attenuation and wave height distribution should be taken into account in the planned warning system for the Caribbean Sea. Specially the problem of tsunami risk for Lesser Antilles including Guadeloupe is discussed.

  20. How to Estimate Epidemic Risk from Incomplete Contact Diaries Data?

    PubMed Central

    Mastrandrea, Rossana; Barrat, Alain

    2016-01-01

    Social interactions shape the patterns of spreading processes in a population. Techniques such as diaries or proximity sensors allow to collect data about encounters and to build networks of contacts between individuals. The contact networks obtained from these different techniques are however quantitatively different. Here, we first show how these discrepancies affect the prediction of the epidemic risk when these data are fed to numerical models of epidemic spread: low participation rate, under-reporting of contacts and overestimation of contact durations in contact diaries with respect to sensor data determine indeed important differences in the outcomes of the corresponding simulations with for instance an enhanced sensitivity to initial conditions. Most importantly, we investigate if and how information gathered from contact diaries can be used in such simulations in order to yield an accurate description of the epidemic risk, assuming that data from sensors represent the ground truth. The contact networks built from contact sensors and diaries present indeed several structural similarities: this suggests the possibility to construct, using only the contact diary network information, a surrogate contact network such that simulations using this surrogate network give the same estimation of the epidemic risk as simulations using the contact sensor network. We present and compare several methods to build such surrogate data, and show that it is indeed possible to obtain a good agreement between the outcomes of simulations using surrogate and sensor data, as long as the contact diary information is complemented by publicly available data describing the heterogeneity of the durations of human contacts. PMID:27341027

  1. Long-Term Ambient Residential Traffic–Related Exposures and Measurement Error–Adjusted Risk of Incident Lung Cancer in the Netherlands Cohort Study on Diet and Cancer

    PubMed Central

    Spiegelman, Donna; Beelen, Rob; Hoek, Gerard; Brunekreef, Bert; Schouten, Leo J.; van den Brandt, Piet

    2015-01-01

    Background The International Agency for Research on Cancer (IARC) recently declared air pollution carcinogenic to humans. However, no study of air pollution and lung cancer to date has incorporated adjustment for exposure measurement error, and few have examined specific histological subtypes. Objectives Our aim was to assess the association of air pollution and incident lung cancer in the Netherlands Cohort Study on Diet and Cancer and the impact of measurement error on these associations. Methods The cohort was followed from 1986 through 2003, and 3,355 incident cases were identified. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals, for long-term exposures to nitrogen dioxide (NO2), black smoke (BS), PM2.5 (particulate matter with diameter ≤ 2.5 μm), and measures of roadway proximity and traffic volume, adjusted for potential confounders. Information from a previous validation study was used to correct the effect estimates for measurement error. Results We observed elevated risks of incident lung cancer with exposure to BS [hazard ratio (HR) = 1.16; 95% CI: 1.02, 1.32, per 10 μg/m3], NO2 (HR = 1.29; 95% CI: 1.08, 1.54, per 30 μg/m3), PM2.5 (HR = 1.17; 95% CI: 0.93, 1.47, per 10 μg/m3), and with measures of traffic at the baseline address. The exposures were positively associated with all lung cancer subtypes. After adjustment for measurement error, the HRs increased and the 95% CIs widened [HR = 1.19 (95% CI: 1.02, 1.39) for BS and HR = 1.37 (95% CI: 0.86, 2.17) for PM2.5]. Conclusions These findings add support to a growing body of literature on the effects of air pollution on lung cancer. In addition, they highlight variation in measurement error by pollutant and support the implementation of measurement error corrections when possible. Citation Hart JE, Spiegelman D, Beelen R, Hoek G, Brunekreef B, Schouten LJ, van den Brandt P. 2015. Long-term ambient residential traffic–related exposures and

  2. Why and when is ethnic harassment a risk for immigrant adolescents' school adjustment? understanding the processes and conditions.

    PubMed

    Bayram Özdemir, Sevgi; Stattin, Håkan

    2014-08-01

    Ethnically harassed immigrant youth are at risk for experiencing a wide range of school adjustment problems. However, it is still unclear why and under what conditions experiencing ethnic harassment leads to school adjustment difficulties. To address this limitation in the literature, we examined two important questions. First, we investigated whether self-esteem and/or depressive symptoms would mediate the associations between ethnic harassment and poor school adjustment among immigrant youth. Second, we examined whether immigrant youths' perception of school context would play a buffering role in the pathways between ethnic harassment and school adjustment difficulties. The sample (n = 330; M age = 14.07, SD = .90; 49% girls at T1) was drawn from a longitudinal study in Sweden. The results revealed that experiencing ethnic harassment led to a decrease in immigrant youths' self-esteem over time, and that youths' expectations of academic failure increased. Further, youths' relationships with their teachers and their perceptions of school democracy moderated the mediation processes. Specifically, when youth had poor relationships with their teachers or perceived their school context as less democratic, being exposed to ethnic harassment led to a decrease in their self-esteem. In turn, they reported low school satisfaction and perceived themselves as being unsuccessful in school. Such indirect effects were not observed when youth had high positive relationships with their teachers or perceived their school as offering a democratic environment. These findings highlight the importance of understanding underlying processes and conditions in the examination of the effects of ethnic devaluation experiences in order to reach a more comprehensive understanding of immigrant youths' school adjustment.

  3. Why and when is ethnic harassment a risk for immigrant adolescents' school adjustment? understanding the processes and conditions.

    PubMed

    Bayram Özdemir, Sevgi; Stattin, Håkan

    2014-08-01

    Ethnically harassed immigrant youth are at risk for experiencing a wide range of school adjustment problems. However, it is still unclear why and under what conditions experiencing ethnic harassment leads to school adjustment difficulties. To address this limitation in the literature, we examined two important questions. First, we investigated whether self-esteem and/or depressive symptoms would mediate the associations between ethnic harassment and poor school adjustment among immigrant youth. Second, we examined whether immigrant youths' perception of school context would play a buffering role in the pathways between ethnic harassment and school adjustment difficulties. The sample (n = 330; M age = 14.07, SD = .90; 49% girls at T1) was drawn from a longitudinal study in Sweden. The results revealed that experiencing ethnic harassment led to a decrease in immigrant youths' self-esteem over time, and that youths' expectations of academic failure increased. Further, youths' relationships with their teachers and their perceptions of school democracy moderated the mediation processes. Specifically, when youth had poor relationships with their teachers or perceived their school context as less democratic, being exposed to ethnic harassment led to a decrease in their self-esteem. In turn, they reported low school satisfaction and perceived themselves as being unsuccessful in school. Such indirect effects were not observed when youth had high positive relationships with their teachers or perceived their school as offering a democratic environment. These findings highlight the importance of understanding underlying processes and conditions in the examination of the effects of ethnic devaluation experiences in order to reach a more comprehensive understanding of immigrant youths' school adjustment. PMID:24132501

  4. Biokinetic and dosimetric modelling in the estimation of radiation risks from internal emitters.

    PubMed

    Harrison, John

    2009-06-01

    The International Commission on Radiological Protection (ICRP) has developed biokinetic and dosimetric models that enable the calculation of organ and tissue doses for a wide range of radionuclides. These are used to calculate equivalent and effective dose coefficients (dose in Sv Bq(-1) intake), considering occupational and environmental exposures. Dose coefficients have also been given for a range of radiopharmaceuticals used in diagnostic medicine. Using equivalent and effective dose, exposures from external sources and from different radionuclides can be summed for comparison with dose limits, constraints and reference levels that relate to risks from whole-body radiation exposure. Risk estimates are derived largely from follow-up studies of the survivors of the atomic bombings at Hiroshima and Nagasaki in 1945. New dose coefficients will be required following the publication in 2007 of new ICRP recommendations. ICRP biokinetic and dosimetric models are subject to continuing review and improvement, although it is arguable that the degree of sophistication of some of the most recent models is greater than required for the calculation of effective dose to a reference person for the purposes of regulatory control. However, the models are also used in the calculation of best estimates of doses and risks to individuals, in epidemiological studies and to determine probability of cancer causation. Models are then adjusted to best fit the characteristics of the individuals and population under consideration. For example, doses resulting from massive discharges of strontium-90 and other radionuclides to the Techa River from the Russian Mayak plutonium plant in the early years of its operation are being estimated using models adapted to take account of measurements on local residents and other population-specific data. Best estimates of doses to haemopoietic bone marrow, in utero and postnatally, are being used in epidemiological studies of radiation-induced leukaemia

  5. Regression equations for estimation of annual peak-streamflow frequency for undeveloped watersheds in Texas using an L-moment-based, PRESS-minimized, residual-adjusted approach

    USGS Publications Warehouse

    Asquith, William H.; Roussel, Meghan C.

    2009-01-01

    Annual peak-streamflow frequency estimates are needed for flood-plain management; for objective assessment of flood risk; for cost-effective design of dams, levees, and other flood-control structures; and for design of roads, bridges, and culverts. Annual peak-streamflow frequency represents the peak streamflow for nine recurrence intervals of 2, 5, 10, 25, 50, 100, 200, 250, and 500 years. Common methods for estimation of peak-streamflow frequency for ungaged or unmonitored watersheds are regression equations for each recurrence interval developed for one or more regions; such regional equations are the subject of this report. The method is based on analysis of annual peak-streamflow data from U.S. Geological Survey streamflow-gaging stations (stations). Beginning in 2007, the U.S. Geological Survey, in cooperation with the Texas Department of Transportation and in partnership with Texas Tech University, began a 3-year investigation concerning the development of regional equations to estimate annual peak-streamflow frequency for undeveloped watersheds in Texas. The investigation focuses primarily on 638 stations with 8 or more years of data from undeveloped watersheds and other criteria. The general approach is explicitly limited to the use of L-moment statistics, which are used in conjunction with a technique of multi-linear regression referred to as PRESS minimization. The approach used to develop the regional equations, which was refined during the investigation, is referred to as the 'L-moment-based, PRESS-minimized, residual-adjusted approach'. For the approach, seven unique distributions are fit to the sample L-moments of the data for each of 638 stations and trimmed means of the seven results of the distributions for each recurrence interval are used to define the station specific, peak-streamflow frequency. As a first iteration of regression, nine weighted-least-squares, PRESS-minimized, multi-linear regression equations are computed using the watershed

  6. Soil-ecological risks for soil degradation estimation

    NASA Astrophysics Data System (ADS)

    Trifonova, Tatiana; Shirkin, Leonid; Kust, German; Andreeva, Olga

    2016-04-01

    Soil degradation includes the processes of soil properties and quality worsening, primarily from the point of view of their productivity and decrease of ecosystem services quality. Complete soil cover destruction and/or functioning termination of soil forms of organic life are considered as extreme stages of soil degradation, and for the fragile ecosystems they are normally considered in the network of their desertification, land degradation and droughts /DLDD/ concept. Block-model of ecotoxic effects, generating soil and ecosystem degradation, has been developed as a result of the long-term field and laboratory research of sod-podzol soils, contaminated with waste, containing heavy metals. The model highlights soil degradation mechanisms, caused by direct and indirect impact of ecotoxicants on "phytocenosis- soil" system and their combination, frequently causing synergistic effect. The sequence of occurring changes here can be formalized as a theory of change (succession of interrelated events). Several stages are distinguished here - from heavy metals leaching (releasing) in waste and their migration downward the soil profile to phytoproductivity decrease and certain phytocenosis composition changes. Phytoproductivity decrease leads to the reduction of cellulose content introduced into the soil. The described feedback mechanism acts as a factor of sod-podzolic soil self-purification and stability. It has been shown, that using phytomass productivity index, integrally reflecting the worsening of soil properties complex, it is possible to solve the problems dealing with the dose-reflecting reactions creation and determination of critical levels of load for phytocenosis and corresponding soil-ecological risks. Soil-ecological risk in "phytocenosis- soil" system means probable negative changes and the loss of some ecosystem functions during the transformation process of dead organic substance energy for the new biomass composition. Soil-ecological risks estimation is

  7. Risk-Adjusted Impact of Administrative Costs on the Distribution of Terminal Wealth for Long-Term Investment

    PubMed Central

    Guillén, Montserrat; Jarner, Søren Fiig; Pérez-Marín, Ana M.

    2014-01-01

    The impact of administrative costs on the distribution of terminal wealth is approximated using a simple formula applicable to many investment situations. We show that the reduction in median returns attributable to administrative fees is usually at least twice the amount of the administrative costs charged for most investment funds, when considering a risk-adjustment correction over a reasonably long-term time horizon. The example we present covers a number of standard cases and can be applied to passive investments, mutual funds, and hedge funds. Our results show investors the potential losses they face in performance due to administrative costs. PMID:25180200

  8. Risk-adjusted impact of administrative costs on the distribution of terminal wealth for long-term investment.

    PubMed

    Guillén, Montserrat; Jarner, Søren Fiig; Nielsen, Jens Perch; Pérez-Marín, Ana M

    2014-01-01

    The impact of administrative costs on the distribution of terminal wealth is approximated using a simple formula applicable to many investment situations. We show that the reduction in median returns attributable to administrative fees is usually at least twice the amount of the administrative costs charged for most investment funds, when considering a risk-adjustment correction over a reasonably long-term time horizon. The example we present covers a number of standard cases and can be applied to passive investments, mutual funds, and hedge funds. Our results show investors the potential losses they face in performance due to administrative costs.

  9. Risk-adjusted impact of administrative costs on the distribution of terminal wealth for long-term investment.

    PubMed

    Guillén, Montserrat; Jarner, Søren Fiig; Nielsen, Jens Perch; Pérez-Marín, Ana M

    2014-01-01

    The impact of administrative costs on the distribution of terminal wealth is approximated using a simple formula applicable to many investment situations. We show that the reduction in median returns attributable to administrative fees is usually at least twice the amount of the administrative costs charged for most investment funds, when considering a risk-adjustment correction over a reasonably long-term time horizon. The example we present covers a number of standard cases and can be applied to passive investments, mutual funds, and hedge funds. Our results show investors the potential losses they face in performance due to administrative costs. PMID:25180200

  10. Parent birds assess nest predation risk and adjust their reproductive strategies

    USGS Publications Warehouse

    Fontaine, J.J.; Martin, T.E.

    2006-01-01

    Avian life history theory has long assumed that nest predation plays a minor role in shaping reproductive strategies. Yet, this assumption remains conspicuously untested by broad experiments that alter environmental risk of nest predation, despite the fact that nest predation is a major source of reproductive failure. Here, we examined whether parents can assess experimentally reduced nest predation risk and alter their reproductive strategies. We experimentally reduced nest predation risk and show that in safer environments parents increased investment in young through increased egg size, clutch mass, and the rate they fed nestlings. Parents also increased investment in female condition by increasing the rates that males fed incubating females at the nest, and decreasing the time that females spent incubating. These results demonstrate that birds can assess nest predation risk at large and that nest predation plays a key role in the expression of avian reproductive strategies. ?? 2006 Blackwell Publishing Ltd/CNRS.

  11. Impact of urine concentration adjustment method on associations between urine metals and estimated glomerular filtration rates (eGFR) in adolescents

    SciTech Connect

    Weaver, Virginia M.; Vargas, Gonzalo García; Silbergeld, Ellen K.; Rothenberg, Stephen J.; Fadrowski, Jeffrey J.; Rubio-Andrade, Marisela; Parsons, Patrick J.; Steuerwald, Amy J.; and others

    2014-07-15

    Positive associations between urine toxicant levels and measures of glomerular filtration rate (GFR) have been reported recently in a range of populations. The explanation for these associations, in a direction opposite that of traditional nephrotoxicity, is uncertain. Variation in associations by urine concentration adjustment approach has also been observed. Associations of urine cadmium, thallium and uranium in models of serum creatinine- and cystatin-C-based estimated GFR (eGFR) were examined using multiple linear regression in a cross-sectional study of adolescents residing near a lead smelter complex. Urine concentration adjustment approaches compared included urine creatinine, urine osmolality and no adjustment. Median age, blood lead and urine cadmium, thallium and uranium were 13.9 years, 4.0 μg/dL, 0.22, 0.27 and 0.04 g/g creatinine, respectively, in 512 adolescents. Urine cadmium and thallium were positively associated with serum creatinine-based eGFR only when urine creatinine was used to adjust for urine concentration (β coefficient=3.1 mL/min/1.73 m{sup 2}; 95% confidence interval=1.4, 4.8 per each doubling of urine cadmium). Weaker positive associations, also only with urine creatinine adjustment, were observed between these metals and serum cystatin-C-based eGFR and between urine uranium and serum creatinine-based eGFR. Additional research using non-creatinine-based methods of adjustment for urine concentration is necessary. - Highlights: • Positive associations between urine metals and creatinine-based eGFR are unexpected. • Optimal approach to urine concentration adjustment for urine biomarkers uncertain. • We compared urine concentration adjustment methods. • Positive associations observed only with urine creatinine adjustment. • Additional research using non-creatinine-based methods of adjustment needed.

  12. A weighted genetic risk score using all known susceptibility variants to estimate rheumatoid arthritis risk

    PubMed Central

    Yarwood, Annie; Han, Buhm; Raychaudhuri, Soumya; Bowes, John; Lunt, Mark; Pappas, Dimitrios A; Kremer, Joel; Greenberg, Jeffrey D; Plenge, Robert; Worthington, Jane; Barton, Anne; Eyre, Steve

    2015-01-01

    Background There is currently great interest in the incorporation of genetic susceptibility loci into screening models to identify individuals at high risk of disease. Here, we present the first risk prediction model including all 46 known genetic loci associated with rheumatoid arthritis (RA). Methods A weighted genetic risk score (wGRS) was created using 45 RA non-human leucocyte antigen (HLA) susceptibility loci, imputed amino acids at HLA-DRB1 (11, 71 and 74), HLA-DPB1 (position 9) HLA-B (position 9) and gender. The wGRS was tested in 11 366 RA cases and 15 489 healthy controls. The risk of developing RA was estimated using logistic regression by dividing the wGRS into quintiles. The ability of the wGRS to discriminate between cases and controls was assessed by receiver operator characteristic analysis and discrimination improvement tests. Results Individuals in the highest risk group showed significantly increased odds of developing anti-cyclic citrullinated peptide-positive RA compared to the lowest risk group (OR 27.13, 95% CI 23.70 to 31.05). The wGRS was validated in an independent cohort that showed similar results (area under the curve 0.78, OR 18.00, 95% CI 13.67 to 23.71). Comparison of the full wGRS with a wGRS in which HLA amino acids were replaced by a HLA tag single-nucleotide polymorphism showed a significant loss of sensitivity and specificity. Conclusions Our study suggests that in RA, even when using all known genetic susceptibility variants, prediction performance remains modest; while this is insufficiently accurate for general population screening, it may prove of more use in targeted studies. Our study has also highlighted the importance of including HLA variation in risk prediction models. PMID:24092415

  13. Behavioral adjustments of African herbivores to predation risk by lions: spatiotemporal variations influence habitat use.

    PubMed

    Valeix, M; Loveridge, A J; Chamaillé-Jammes, S; Davidson, Z; Murindagomo, F; Fritz, H; Macdonald, D W

    2009-01-01

    Predators may influence their prey populations not only through direct lethal effects, but also through indirect behavioral changes. Here, we combined spatiotemporal fine-scale data from GPS radio collars on lions with habitat use information on 11 African herbivores in Hwange National Park (Zimbabwe) to test whether the risk of predation by lions influenced the distribution of herbivores in the landscape. Effects of long-term risk of predation (likelihood of lion presence calculated over four months) and short-term risk of predation (actual presence of lions in the vicinity in the preceding 24 hours) were contrasted. The long-term risk of predation by lions appeared to influence the distributions of all browsers across the landscape, but not of grazers. This result strongly suggests that browsers and grazers, which face different ecological constraints, are influenced at different spatial and temporal scales in the variation of the risk of predation by lions. The results also show that all herbivores tend to use more open habitats preferentially when lions are in their vicinity, probably an effective anti-predator behavior against such an ambush predator. Behaviorally induced effects of lions may therefore contribute significantly to structuring African herbivore communities, and hence possibly their effects on savanna ecosystems.

  14. ESTIMATED SIL LEVELS AND RISK COMPARISONS FOR RELIEF VALVES AS A FUNCTION OF TIME-IN-SERVICE

    SciTech Connect

    Harris, S.

    2012-03-26

    Risk-based inspection methods enable estimation of the probability of spring-operated relief valves failing on demand at the United States Department of Energy's Savannah River Site (SRS) in Aiken, South Carolina. The paper illustrates an approach based on application of the Frechet and Weibull distributions to SRS and Center for Chemical Process Safety (CCPS) Process Equipment Reliability Database (PERD) proof test results. The methodology enables the estimation of ANSI/ISA-84.00.01 Safety Integrity Levels (SILs) as well as the potential change in SIL level due to modification of the maintenance schedule. Current SRS practices are reviewed and recommendations are made for extending inspection intervals. The paper compares risk-based inspection with specific SILs as maintenance intervals are adjusted. Groups of valves are identified in which maintenance times can be extended as well as different groups in which an increased safety margin may be needed.

  15. Age-adjusted high-sensitivity troponin T cut-off value for risk stratification of pulmonary embolism.

    PubMed

    Kaeberich, Anja; Seeber, Valerie; Jiménez, David; Kostrubiec, Maciej; Dellas, Claudia; Hasenfuß, Gerd; Giannitsis, Evangelos; Pruszczyk, Piotr; Konstantinides, Stavros; Lankeit, Mareike

    2015-05-01

    High-sensitivity troponin T (hsTnT) helps in identifying pulmonary embolism patients at low risk of an adverse outcome. In 682 normotensive pulmonary embolism patients we investigate whether an optimised hsTnT cut-off value and adjustment for age improve the identification of patients at elevated risk. Overall, 25 (3.7%) patients had an adverse 30-day outcome. The established hsTnT cut-off value of 14 pg·mL(-1) retained its high prognostic value (OR (95% CI) 16.64 (2.24-123.74); p=0.006) compared with the cut-off value of 33 pg·mL(-1) calculated by receiver operating characteristic analysis (7.14 (2.64-19.26); p<0.001). In elderly (aged ≥75 years) patients, an age-optimised hsTnT cut-off value of 45 pg·mL(-1) but not the established cut-off value of 14 pg·mL(-1) predicted an adverse outcome. An age-adjusted hsTnT cut-off value (≥14 pg·mL(-1) for patients aged <75 years and ≥45 pg·mL(-1) for patients aged ≥75 years) provided additive and independent prognostic information on top of the simplified pulmonary embolism severity index (sPESI) and echocardiography (OR 4.56 (1.30-16.01); p=0.018, C-index=0.77). A three-step approach based on the sPESI, hsTnT and echocardiography identified 16.6% of all patients as being at higher risk (12.4% adverse outcome). Risk assessment of normotensive pulmonary embolism patients was improved by the introduction of an age-adjusted hsTnT cut-off value. A three-step approach helped identify patients at higher risk of an adverse outcome who might benefit from advanced therapy.

  16. The Impact of Perceived Frailty on Surgeons’ Estimates of Surgical Risk

    PubMed Central

    Ferguson, Mark K.; Farnan, Jeanne; Hemmerich, Josh A.; Slawinski, Kris; Acevedo, Julissa; Small, Stephen

    2015-01-01

    Background Physicians are only moderately accurate in estimating surgical risk based on clinical vignettes. We assessed the impact of perceived frailty by measuring the influence of a short video of a standardized patient on surgical risk estimates. Methods Thoracic surgeons and cardiothoracic trainees estimated the risk of major complications for lobectomy based on clinical vignettes of varied risk categories (low, average, high). After each vignette, subjects viewed a randomly selected video of a standardized patient exhibiting either vigorous or frail behavior, then re-estimated risk. Subjects were asked to rate 5 vignettes paired with 5 different standardized patients. Results Seventy-one physicians participated. Initial risk estimates varied according to the vignette risk category: low, 15.2 ± 11.2% risk; average, 23.7 ± 16.1%; high, 37.3 ± 18.9%; p<0.001 by ANOVA. Concordant information in vignettes and videos moderately altered estimates (high risk vignette, frail video: 10.6 ± 27.5% increase in estimate, p=0.006; low risk vignette, vigorous video: 14.5 ± 45.0% decrease, p=0.009). Discordant findings influenced risk estimates more substantially (high risk vignette, vigorous video: 21.2 ± 23.5% decrease in second risk estimate, p<0.001; low risk vignette, frail video: 151.9 ± 209.8% increase, p<0.001). Conclusions Surgeons differentiated relative risk of lobectomy based on clinical vignettes. The effect of viewing videos was small when vignettes and videos were concordant; the effect was more substantial when vignettes and videos were discordant. The information will be helpful in training future surgeons in frailty recognition and risk estimation. PMID:24932570

  17. RADON EXPOSURE ASSESSMENT AND DOSIMETRY APPLIED TO EPIDEMIOLOGY AND RISK ESTIMATION

    EPA Science Inventory

    Epidemiological studies of underground miners provide the primary basis for radon risk estimates for indoor exposures as well as mine exposures. A major source of uncertainty in these risk estimates is the uncertainty in radon progeny exposure estimates for the miners. In addit...

  18. Maternal Adjustment and Infant Outcome in Medically Defined High-Risk Pregnancy.

    ERIC Educational Resources Information Center

    Levy-Shiff, Rachel; Lerman, Maya; Har-Even, Dov; Hod, Moshe

    2002-01-01

    Explored relation of biological and psychosocial risk factors to infant development among pregnant women who had pregestational diabetes, gestational diabetes, or were nondiabetic. Found that infants of diabetic mothers scored lower on the Bayley Scales at 1 year and revealed fewer positive and more negative behaviors than infants of nondiabetic…

  19. 78 FR 32255 - HHS-Operated Risk Adjustment Data Validation Stakeholder Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-29

    ... the 2014 payment notice) (78 FR 15410), that established the regulatory framework for the risk... appropriate time to present their questions or comments. Disruptive behavior will not be tolerated, and may...'' section of this notice: Visitor's full name (as it appears on passport). Gender. Country of origin...

  20. Methodology for the Model-based Small Area Estimates of Cancer Risk Factors and Screening Behaviors - Small Area Estimates

    Cancer.gov

    This model-based approach uses data from both the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS) to produce estimates of the prevalence rates of cancer risk factors and screening behaviors at the state, health service area, and county levels.

  1. The role of models in estimating consequences as part of the risk assessment process.

    PubMed

    Forde-Folle, K; Mitchell, D; Zepeda, C

    2011-08-01

    The degree of disease risk represented by the introduction, spread, or establishment of one or several diseases through the importation of animals and animal products is assessed by importing countries through an analysis of risk. The components of a risk analysis include hazard identification, risk assessment, risk management, and risk communication. A risk assessment starts with identification of the hazard(s) and then continues with four interrelated steps: release assessment, exposure assessment, consequence assessment, and risk estimation. Risk assessments may be either qualitative or quantitative. This paper describes how, through the integration of epidemiological and economic models, the potential adverse biological and economic consequences of exposure can be quantified.

  2. State Estimates of Adolescent Cigarette Use and Perceptions of Risk of Smoking: 2012 and 2013

    MedlinePlus

    ... 2015 STATE ESTIMATES OF ADOLESCENT CIGARETTE USE AND PERCEPTIONS OF RISK OF SMOKING: 2012 AND 2013 AUTHORS ... with an inverse association between use and risk perceptions (i.e., the prevalence of use is lower ...

  3. Impact of urine concentration adjustment method on associations between urine metals and estimated glomerular filtration rates (eGFR) in adolescents.

    PubMed

    Weaver, Virginia M; Vargas, Gonzalo García; Silbergeld, Ellen K; Rothenberg, Stephen J; Fadrowski, Jeffrey J; Rubio-Andrade, Marisela; Parsons, Patrick J; Steuerwald, Amy J; Navas-Acien, Ana; Guallar, Eliseo

    2014-07-01

    Positive associations between urine toxicant levels and measures of glomerular filtration rate (GFR) have been reported recently in a range of populations. The explanation for these associations, in a direction opposite that of traditional nephrotoxicity, is uncertain. Variation in associations by urine concentration adjustment approach has also been observed. Associations of urine cadmium, thallium and uranium in models of serum creatinine- and cystatin-C-based estimated GFR (eGFR) were examined using multiple linear regression in a cross-sectional study of adolescents residing near a lead smelter complex. Urine concentration adjustment approaches compared included urine creatinine, urine osmolality and no adjustment. Median age, blood lead and urine cadmium, thallium and uranium were 13.9 years, 4.0 μg/dL, 0.22, 0.27 and 0.04 g/g creatinine, respectively, in 512 adolescents. Urine cadmium and thallium were positively associated with serum creatinine-based eGFR only when urine creatinine was used to adjust for urine concentration (β coefficient=3.1 mL/min/1.73 m(2); 95% confidence interval=1.4, 4.8 per each doubling of urine cadmium). Weaker positive associations, also only with urine creatinine adjustment, were observed between these metals and serum cystatin-C-based eGFR and between urine uranium and serum creatinine-based eGFR. Additional research using non-creatinine-based methods of adjustment for urine concentration is necessary.

  4. Impact of urine concentration adjustment method on associations between urine metals and estimated glomerular filtration rates (eGFR) in adolescents☆

    PubMed Central

    Weaver, Virginia M.; Vargas, Gonzalo García; Silbergeld, Ellen K.; Rothenberg, Stephen J.; Fadrowski, Jeffrey J.; Rubio-Andrade, Marisela; Parsons, Patrick J.; Steuerwald, Amy J.; Navas-Acien, Ana; Guallar, Eliseo

    2014-01-01

    Positive associations between urine toxicant levels and measures of glomerular filtration rate (GFR) have been reported recently in a range of populations. The explanation for these associations, in a direction opposite that of traditional nephrotoxicity, is uncertain. Variation in associations by urine concentration adjustment approach has also been observed. Associations of urine cadmium, thallium and uranium in models of serum creatinine- and cystatin-C-based estimated GFR (eGFR) were examined using multiple linear regression in a cross-sectional study of adolescents residing near a lead smelter complex. Urine concentration adjustment approaches compared included urine creatinine, urine osmolality and no adjustment. Median age, blood lead and urine cadmium, thallium and uranium were 13.9 years, 4.0 μg/dL, 0.22, 0.27 and 0.04 g/g creatinine, respectively, in 512 adolescents. Urine cadmium and thallium were positively associated with serum creatinine-based eGFR only when urine creatinine was used to adjust for urine concentration (β coefficient=3.1 mL/min/1.73 m2; 95% confidence interval=1.4, 4.8 per each doubling of urine cadmium). Weaker positive associations, also only with urine creatinine adjustment, were observed between these metals and serum cystatin-C-based eGFR and between urine uranium and serum creatinine-based eGFR. Additional research using non-creatinine-based methods of adjustment for urine concentration is necessary. PMID:24815335

  5. Cancer risk estimation caused by radiation exposure during endovascular procedure

    NASA Astrophysics Data System (ADS)

    Kang, Y. H.; Cho, J. H.; Yun, W. S.; Park, K. H.; Kim, H. G.; Kwon, S. M.

    2014-05-01

    The objective of this study was to identify the radiation exposure dose of patients, as well as staff caused by fluoroscopy for C-arm-assisted vascular surgical operation and to estimate carcinogenic risk due to such exposure dose. The study was conducted in 71 patients (53 men and 18 women) who had undergone vascular surgical intervention at the division of vascular surgery in the University Hospital from November of 2011 to April of 2012. It had used a mobile C-arm device and calculated the radiation exposure dose of patient (dose-area product, DAP). Effective dose was measured by attaching optically stimulated luminescence on the radiation protectors of staff who participates in the surgery to measure the radiation exposure dose of staff during the vascular surgical operation. From the study results, DAP value of patients was 308.7 Gy cm2 in average, and the maximum value was 3085 Gy cm2. When converted to the effective dose, the resulted mean was 6.2 m Gy and the maximum effective dose was 61.7 milliSievert (mSv). The effective dose of staff was 3.85 mSv; while the radiation technician was 1.04 mSv, the nurse was 1.31 mSv. All cancer incidences of operator are corresponding to 2355 persons per 100,000 persons, which deemed 1 of 42 persons is likely to have all cancer incidences. In conclusion, the vascular surgeons should keep the radiation protection for patient, staff, and all participants in the intervention in mind as supervisor of fluoroscopy while trying to understand the effects by radiation by themselves to prevent invisible danger during the intervention and to minimize the harm.

  6. Estimating Risk of Alcohol Dependence Using Alcohol Screening Scores*

    PubMed Central

    Rubinsky, Anna D.; Kivlahan, Daniel R.; Volk, Robert J.; Maynard, Charles; Bradley, Katharine A.

    2010-01-01

    Brief alcohol counseling interventions can reduce alcohol consumption and related morbidity among non-dependent risky drinkers, but more intensive alcohol treatment is recommended for persons with alcohol dependence. This study evaluated whether scores on common alcohol screening tests could identify patients likely to have current alcohol dependence so that more appropriate follow-up assessment and/or intervention could be offered. This cross-sectional study used secondary data from 392 male and 927 female adult family medicine outpatients (1993–1994). Likelihood ratios were used to empirically identify and evaluate ranges of scores of the AUDIT, the AUDIT-C, two single-item questions about frequency of binge drinking, and the CAGE questionnaire for detecting DSM-IV past-year alcohol dependence. Based on the prevalence of past-year alcohol dependence in this sample (men: 12.2%; women: 5.8%), zones of the AUDIT and AUDIT-C identified wide variability in the post-screening risk of alcohol dependence in men and women, even among those who screened positive for alcohol misuse. Among men, AUDIT zones 5–10, 11–14 and 15–40 were associated with post-screening probabilities of past-year alcohol dependence ranging from 18–87%, and AUDIT-C zones 5–6, 7–9 and 10–12 were associated with probabilities ranging from 22–75%. Among women, AUDIT zones 3–4, 5–8, 9–12 and 13–40 were associated with post-screening probabilities of past-year alcohol dependence ranging from 6–94%, and AUDIT-C zones 3, 4–6, 7–9 and 10–12 were associated with probabilities ranging from 9–88%. AUDIT or AUDIT-C scores could be used to estimate the probability of past-year alcohol dependence among patients who screen positive for alcohol misuse and inform clinical decision-making. PMID:20042299

  7. Willingness to pay for a quality-adjusted life year: an evaluation of attitudes towards risk and preferences

    PubMed Central

    2014-01-01

    Background This paper examines the Willingness to Pay (WTP) for a quality-adjusted life year (QALY) expressed by people who attended the healthcare system as well as the association of attitude towards risk and other personal characteristics with their response. Methods Health-state preferences, measured by EuroQol (EQ-5D-3L), were combined with WTP for recovering a perfect health state. WTP was assessed using close-ended, iterative bidding, contingent valuation method. Data on demographic and socioeconomic characteristics, as well as usage of health services by the subjects were collected. The attitude towards risk was evaluated by collecting risky behaviors data, by the subject’s self-evaluation, and through lottery games. Results Six hundred and sixty two subjects participated and 449 stated a utility inferior to 1. WTP/QALY ratios varied significantly when payments with personal money (mean €10,119; median €673) or through taxes (mean €28,187; median €915) were suggested. Family income, area income, higher education level, greater use of healthcare services, and the number of co-inhabitants were associated with greater WTP/QALY ratios. Age and female gender were associated with lower WTP/QALY ratios. Risk inclination was independently associated with a greater WTP/QALY when “out of pocket” payments were suggested. Clear discrepancies were demonstrated between linearity and neutrality towards risk assumptions and experimental results. Conclusions WTP/QALY ratios vary noticeably based on demographic and socioeconomic characteristics of the subject, but also on their attitude towards risk. Knowing the expression of preferences by patients from this outcome measurement can be of interest for health service planning. PMID:24989615

  8. Phenotypic plasticity in anti-intraguild predator strategies: mite larvae adjust their behaviours according to vulnerability and predation risk.

    PubMed

    Walzer, Andreas; Schausberger, Peter

    2013-05-01

    Interspecific threat-sensitivity allows prey to maximize the net benefit of antipredator strategies by adjusting the type and intensity of their response to the level of predation risk. This is well documented for classical prey-predator interactions but less so for intraguild predation (IGP). We examined threat-sensitivity in antipredator behaviour of larvae in a predatory mite guild sharing spider mites as prey. The guild consisted of the highly vulnerable intraguild (IG) prey and weak IG predator Phytoseiulus persimilis, the moderately vulnerable IG prey and moderate IG predator Neoseiulus californicus and the little vulnerable IG prey and strong IG predator Amblyseius andersoni. We videotaped the behaviour of the IG prey larvae of the three species in presence of either a low- or a high-risk IG predator female or predator absence and analysed time, distance, path shape and interaction parameters of predators and prey. The least vulnerable IG prey A. andersoni was insensitive to differing IGP risks but the moderately vulnerable IG prey N. californicus and the highly vulnerable IG prey P. persimilis responded in a threat-sensitive manner. Predator presence triggered threat-sensitive behavioural changes in one out of ten measured traits in N. californicus larvae but in four traits in P. persimilis larvae. Low-risk IG predator presence induced a typical escape response in P. persimilis larvae, whereas they reduced their activity in the high-risk IG predator presence. We argue that interspecific threat-sensitivity may promote co-existence of IG predators and IG prey and should be common in predator guilds with long co-evolutionary history.

  9. Does Visceral Fat Estimated by Dual-Energy X-ray Absorptiometry Independently Predict Cardiometabolic Risks in Adults?

    PubMed Central

    Sasai, Hiroyuki; Brychta, Robert J.; Wood, Rachel P.; Rothney, Megan P.; Zhao, Xiongce; Skarulis, Monica C.; Chen, Kong Y.

    2015-01-01

    Background: Abdominal visceral fat, typically measured by computer tomography (CT) or magnetic resonance imaging (MRI), has been shown to correlate with cardiometabolic risks. The purpose of this study was to examine whether a newly developed and validated visceral fat measurement from dual-energy X-ray absorptiometry (DXA) provides added predictive value to the cross-sectional differences of cardiometabolic parameters beyond the traditional anthropometric and DXA adiposity parameters. Method: A heterogeneous cohort of 194 adults (81 males and 113 females) with a BMI of 19 to 54 kg/m2 participated in this cross-sectional study. Body composition was measured with a DXA densitometer. Visceral fat was then computed with a proprietary algorithm. Insulin sensitivity index (SI, measured by intravenous glucose tolerance test), blood pressures, and lipid profiles, and peak oxygen uptake were also measured as cardiometabolic risk parameters. Results: DXA-estimated visceral fat mass was associated with HDL cholesterol (regression coefficient [β] = −5.15, P < .01, adjusted R2 = .21), triglyceride (β = 26.01, P < .01, adjusted R2 = .14), and peak oxygen uptake (β = −3.15, P < .01, adjusted R2 = .57) after adjusting for age, gender, and ethnicity. A subanalysis stratifying gender-specific BMI tertiles showed visceral fat, together with ethnicity, was independently associated with SI in overweight men and moderately obese women (second tertile). Conclusions: Without requiring additional CT or MRI-based measurements, visceral fat detected by DXA might offer certain advantages over the traditional DXA adiposity parameters as means of assessing cardiometabolic risks. PMID:25802470

  10. Mandatory pooling as a supplement to risk-adjusted capitation payments in a competitive health insurance market.

    PubMed

    Van Barneveld, E M; Lamers, L M; van Vliet, R C; van de Ven, W P

    1998-07-01

    Risk-adjusted capitation payments (RACPs) to competing health insurers are an essential element of market-oriented health care reforms in many countries. RACPs based on demographic variables only are insufficient, because they leave ample room for cream skimming. However, the implementation of improved RACPs does not appear to be straightforward. A solution might be to supplement imperfect RACPs with a form of mandatory pooling that reduces the incentives for cream skimming. In a previous paper it was concluded that high-risk pooling (HRP), is a promising supplement to RACPs. The purpose of this paper is to compare HRP with two other main variants of mandatory pooling. These variants are called excess-of-loss (EOL) and proportional pooling (PP). Each variant includes ex post compensations to insurers for some members which depend to various degrees on actually incurred costs. Therefore, these pooling variants reduce the incentives for cream skimming which are inherent in imperfect RACPs, but they also reduce the incentives for efficiency and cost containment. As a rough measure of the latter incentives we use the percentage of total costs for which an insurer is at risk. This paper analyzes which of the three main pooling variants yields the greatest reduction of incentives for cream skimming given such a percentage. The results show that HRP is the most effective of the three pooling variants.

  11. Ryegrass cv. Lema and guava cv. Paluma biomonitoring suitability for estimating nutritional contamination risks under seasonal climate in Southeastern Brazil.

    PubMed

    Bulbovas, Patricia; Camargo, Carla Z S; Domingos, Marisa

    2015-08-01

    The risks posed by nutrient deposition due to air pollution on ecosystems and their respective services to human beings can be appropriately estimated by bioindicator plants when they are well acclimated to the study region environmental conditions. This assumption encouraged us to comparatively evaluate the accumulation potential of ryegrass cv. Lema and guava cv. Paluma macro and micronutrients. We also indicated the most appropriate species for biomonitoring nutrient contamination risks in tropical areas of Southeastern Brazil, which are characterized by marked dry and wet seasons and complex mixtures of air pollutants from different sources (industries, vehicle traffic and agriculture). The study was conducted in 14 sites with different neighboring land uses, within the Metropolitan Region of Campinas, central-eastern region of São Paulo State. The exposure experiments with ryegrass and guava were consecutively repeated 40 (28 days each) and 12 (84 days each) times, respectively, from Oct/2010 to Sept/2013. Macro and micronutrients were analyzed and background concentrations and enrichment ratios (ER) were estimated to classify the contamination risk within the study region. Significantly higher ER suggested that ryegrass were the most appropriate accumulator species for N, S, Mg, Fe, Mn, Cu and Zn deposition and guava for K, Ca, P and B deposition. Based on these biomonitoring adjustments, we concluded that the nutrient deposition was spatially homogeneous in the study area, but clear seasonality in the contamination risk by nutritional inputs was evidenced. Significantly higher contamination risk by S, Fe, K and B occurred during the dry season and enhanced contamination risk by Mn, Cu and Zn were highlighted during the wet season. Distinctly high contamination risk was estimated for S, Fe and Mn in several exposure experiments.

  12. Ethnic identity, achievement, and psychological adjustment: Examining risk and resilience among youth from immigrant Chinese families in Canada.

    PubMed

    Costigan, Catherine L; Koryzma, Céline M; Hua, Josephine M; Chance, Lauren J

    2010-04-01

    Ethnic identity, achievement, and psychological adjustment were examined among 95 youth from immigrant Chinese families in Canada (mean age 12 years). Utilizing cross-sectional data, promotive effects of ethnic identity were observed; higher ethnic identity was associated with above average achievement and self-esteem and below average levels of depressive symptoms. Vulnerability effects of ethnic identity were fewer; lower ethnic identity was associated with above average depressive symptoms and, for males only, below average self-esteem. Findings also suggested that higher ethnic identity might buffer the stress of poor achievement, indicating a possible protective effect of ethnic identity. Although requiring replication, these preliminary findings illustrate the utility of adopting a risk and resilience framework and suggest the value of promoting strong ethnic identities.

  13. Remedial action and feedback processing in a time-estimation task: evidence for a role of the rostral cingulate zone in behavioral adjustments without learning.

    PubMed

    van der Veen, Frederik M; Röder, Christian H; Mies, Gabry W; van der Lugt, Aad; Smits, Marion

    2011-01-01

    The present study examined the role of the rostral cingulate zone (RCZ) in feedback processing, and especially focused on effects of modality of the feedback stimulus and remedial action. Participants performed a time-estimation task in which they had to estimate a 1-second interval. After the estimation participants received verbal (correct/false) or facial (fearful face/happy face) feedback. Percentage of positive and negative feedback was kept at 50% by dynamically adjusting the interval in which estimations were labeled correct. Contrary to predictions of the reinforcement learning theory, which predicts more RCZ activation when the outcome of behavior is worse than expected, we found that the RCZ was more active after positive feedback than after negative feedback, independent of the modality of the feedback stimulus. More in line with the suggested role of the RCZ in reinforcement learning was the finding that the RCZ was more active after negative feedback that was followed by a correct adjustment as compared to negative feedback followed by an incorrect adjustment. Both findings can be explained in terms of the RCZ being involved in facilitating remedial action as opposed to the suggested signaling function (outcome is worse than expected) proposed by the reinforcement learning theory.

  14. State Estimates of Adolescent Marijuana Use and Perceptions of Risk of Harm from Marijuana Use: 2013 and 2014

    MedlinePlus

    ... 2014 estimates to 2012–2013 estimates). However, youth perceptions of great risk of harm from monthly marijuana ... change. State Estimates of Adolescent Marijuana Use and Perceptions of Risk of Harm From Marijuana Use: 2013 ...

  15. Indoor radon and lung cancer. Estimating the risks

    SciTech Connect

    Samet, J.M. )

    1992-01-01

    Radon is ubiquitous in indoor environments. Epidemiologic studies of underground miners with exposure to radon and experimental evidence have established that radon causes lung cancer. The finding that this naturally occurring carcinogen is present in the air of homes and other buildings has raised concern about the lung cancer risk to the general population from radon. I review current approaches for assessing the risk of indoor radon, emphasizing the extrapolation of the risks for miners to the general population. Although uncertainties are inherent in this risk assessment, the present evidence warrants identifying homes that have unacceptably high concentrations.23 references.

  16. Indoor radon and lung cancer. Estimating the risks.

    PubMed Central

    Samet, J. M.

    1992-01-01

    Radon is ubiquitous in indoor environments. Epidemiologic studies of underground miners with exposure to radon and experimental evidence have established that radon causes lung cancer. The finding that this naturally occurring carcinogen is present in the air of homes and other buildings has raised concern about the lung cancer risk to the general population from radon. I review current approaches for assessing the risk of indoor radon, emphasizing the extrapolation of the risks for miners to the general population. Although uncertainties are inherent in this risk assessment, the present evidence warrants identifying homes that have unacceptably high concentrations. PMID:1734594

  17. CCSI Risk Estimation: An Application of Expert Elicitation

    SciTech Connect

    Engel, David W.; Dalton, Angela C.

    2012-10-01

    The Carbon Capture Simulation Initiative (CCSI) is a multi-laboratory simulation-driven effort to develop carbon capture technologies with the goal of accelerating commercialization and adoption in the near future. One of the key CCSI technical challenges is representing and quantifying the inherent uncertainty and risks associated with developing, testing, and deploying the technology in simulated and real operational settings. To address this challenge, the CCSI Element 7 team developed a holistic risk analysis and decision-making framework. The purpose of this report is to document the CCSI Element 7 structured systematic expert elicitation to identify additional risk factors. We review the significance of and established approaches to expert elicitation, describe the CCSI risk elicitation plan and implementation strategies, and conclude by discussing the next steps and highlighting the contribution of risk elicitation toward the achievement of the overarching CCSI objectives.

  18. Do We Know Whether Researchers and Reviewers are Estimating Risk and Benefit Accurately?

    PubMed

    Hey, Spencer Phillips; Kimmelman, Jonathan

    2016-10-01

    Accurate estimation of risk and benefit is integral to good clinical research planning, ethical review, and study implementation. Some commentators have argued that various actors in clinical research systems are prone to biased or arbitrary risk/benefit estimation. In this commentary, we suggest the evidence supporting such claims is very limited. Most prior work has imputed risk/benefit beliefs based on past behavior or goals, rather than directly measuring them. We describe an approach - forecast analysis - that would enable direct and effective measure of the quality of risk/benefit estimation. We then consider some objections and limitations to the forecasting approach. PMID:27197044

  19. Do We Know Whether Researchers and Reviewers are Estimating Risk and Benefit Accurately?

    PubMed

    Hey, Spencer Phillips; Kimmelman, Jonathan

    2016-10-01

    Accurate estimation of risk and benefit is integral to good clinical research planning, ethical review, and study implementation. Some commentators have argued that various actors in clinical research systems are prone to biased or arbitrary risk/benefit estimation. In this commentary, we suggest the evidence supporting such claims is very limited. Most prior work has imputed risk/benefit beliefs based on past behavior or goals, rather than directly measuring them. We describe an approach - forecast analysis - that would enable direct and effective measure of the quality of risk/benefit estimation. We then consider some objections and limitations to the forecasting approach.

  20. Estimation of radiation risk from screening mammography: Recent trends and comparison with expected benefits

    SciTech Connect

    Feig, S.A.; Ehrlich, S.M. )

    1990-03-01

    On the basis of recent epidemiologic studies, the National Institutes of Health in 1985 provided a new estimate for radiation risk to the breast that employed a relative risk model and acknowledged greater dependence on age at exposure. Lifetime risks from a single mammogram may be calculated from this estimate and are lower than those based on the previous 1977 National Cancer Institute estimate. Possible years of life expectancy lost from annual mammography beginning at age 40 years may also be calculated and are negligible compared with estimates for years of life expectancy gained from such screening.

  1. Estimating the risk of type-2 diabetes using obese-years in a contemporary population of the Framingham Study

    PubMed Central

    Abdullah, Asnawi; Amin, Fauzi Ali; Hanum, Farida; Stoelwinder, Johannes; Tanamas, Stephanie; Wolf, Rory; Wong, Evelyn; Peeters, Anna

    2016-01-01

    Background We have recently demonstrated that an obese-years construct is a better predictor of the risk of diabetes than the severity of body weight alone. However, these risk estimates were derived from a population cohort study initiated in 1948 that might not apply to the current population. Objective To validate an obese-years construct in estimating the risk of type-2 diabetes in a more contemporary cohort study. Design A total of 5,132 participants of the Framingham Offspring Study, initiated in 1972, were followed up for 45 years. Body mass index (BMI) above 29 kg/m2 was multiplied by the number of years lived with obesity at that BMI to define the number of obese-years. Time-dependent Cox regression was used to explore the association. Results The risk of type-2 diabetes increased significantly with increase in obese-years. Adjusted hazard ratios increased by 6% (95% CI: 5–7%) per additional 10 points of obese-years. This ratio was observed to be similar in both men and women, but was 4% higher in current smokers than in never/ex-smokers. The Akaike Information Criterion confirmed that the Cox regression model with the obese-years construct was a stronger predictor of the risk of diabetes than a model including either BMI or the duration of obesity alone. Conclusions In a contemporary cohort population, it was confirmed that the obese-years construct is strongly associated with an increased risk of type-2 diabetes. This suggests that both severity and the duration of obesity should be considered in future estimations of the burden of disease associated with obesity. PMID:27369220

  2. Estimating the concordance probability in a survival analysis with a discrete number of risk groups.

    PubMed

    Heller, Glenn; Mo, Qianxing

    2016-04-01

    A clinical risk classification system is an important component of a treatment decision algorithm. A measure used to assess the strength of a risk classification system is discrimination, and when the outcome is survival time, the most commonly applied global measure of discrimination is the concordance probability. The concordance probability represents the pairwise probability of lower patient risk given longer survival time. The c-index and the concordance probability estimate have been used to estimate the concordance probability when patient-specific risk scores are continuous. In the current paper, the concordance probability estimate and an inverse probability censoring weighted c-index are modified to account for discrete risk scores. Simulations are generated to assess the finite sample properties of the concordance probability estimate and the weighted c-index. An application of these measures of discriminatory power to a metastatic prostate cancer risk classification system is examined.

  3. Significance of model credibility in estimating climate projection distributions for regional hydroclimatological risk assessments

    USGS Publications Warehouse

    Brekke, L.D.; Dettinger, M.D.; Maurer, E.P.; Anderson, M.

    2008-01-01

    Ensembles of historical climate simulations and climate projections from the World Climate Research Programme's (WCRP's) Coupled Model Intercomparison Project phase 3 (CMIP3) multi-model dataset were investigated to determine how model credibility affects apparent relative scenario likelihoods in regional risk assessments. Methods were developed and applied in a Northern California case study. An ensemble of 59 twentieth century climate simulations from 17 WCRP CMIP3 models was analyzed to evaluate relative model credibility associated with a 75-member projection ensemble from the same 17 models. Credibility was assessed based on how models realistically reproduced selected statistics of historical climate relevant to California climatology. Metrics of this credibility were used to derive relative model weights leading to weight-threshold culling of models contributing to the projection ensemble. Density functions were then estimated for two projected quantities (temperature and precipitation), with and without considering credibility-based ensemble reductions. An analysis for Northern California showed that, while some models seem more capable at recreating limited aspects twentieth century climate, the overall tendency is for comparable model performance when several credibility measures are combined. Use of these metrics to decide which models to include in density function development led to local adjustments to function shapes, but led to limited affect on breadth and central tendency, which were found to be more influenced by 'completeness' of the original ensemble in terms of models and emissions pathways. ?? 2007 Springer Science+Business Media B.V.

  4. Sample size estimation to substantiate freedom from disease for clustered binary data with a specific risk profile.

    PubMed

    Kostoulas, P; Nielsen, S S; Browne, W J; Leontides, L

    2013-06-01

    Disease cases are often clustered within herds or generally groups that share common characteristics. Sample size formulae must adjust for the within-cluster correlation of the primary sampling units. Traditionally, the intra-cluster correlation coefficient (ICC), which is an average measure of the data heterogeneity, has been used to modify formulae for individual sample size estimation. However, subgroups of animals sharing common characteristics, may exhibit excessively less or more heterogeneity. Hence, sample size estimates based on the ICC may not achieve the desired precision and power when applied to these groups. We propose the use of the variance partition coefficient (VPC), which measures the clustering of infection/disease for individuals with a common risk profile. Sample size estimates are obtained separately for those groups that exhibit markedly different heterogeneity, thus, optimizing resource allocation. A VPC-based predictive simulation method for sample size estimation to substantiate freedom from disease is presented. To illustrate the benefits of the proposed approach we give two examples with the analysis of data from a risk factor study on Mycobacterium avium subsp. paratuberculosis infection, in Danish dairy cattle and a study on critical control points for Salmonella cross-contamination of pork, in Greek slaughterhouses.

  5. Improvement of radar quantitative precipitation estimation based on real-time adjustments to Z-R relationships and inverse distance weighting correction schemes

    NASA Astrophysics Data System (ADS)

    Wang, Gaili; Liu, Liping; Ding, Yuanyuan

    2012-05-01

    The errors in radar quantitative precipitation estimations consist not only of systematic biases caused by random noises but also spatially nonuniform biases in radar rainfall at individual rain-gauge stations. In this study, a real-time adjustment to the radar reflectivity-rainfall rates ( Z-R) relationship scheme and the gauge-corrected, radar-based, estimation scheme with inverse distance weighting interpolation was developed. Based on the characteristics of the two schemes, the two-step correction technique of radar quantitative precipitation estimation is proposed. To minimize the errors between radar quantitative precipitation estimations and rain gauge observations, a real-time adjustment to the Z-R relationship scheme is used to remove systematic bias on the time-domain. The gauge-corrected, radar-based, estimation scheme is then used to eliminate non-uniform errors in space. Based on radar data and rain gauge observations near the Huaihe River, the two-step correction technique was evaluated using two heavy-precipitation events. The results show that the proposed scheme improved not only in the underestimation of rainfall but also reduced the root-mean-square error and the mean relative error of radar-rain gauge pairs.

  6. The Impact of a Frailty Education Module on Surgical Resident Estimates of Lobectomy Risk

    PubMed Central

    Ferguson, Mark K.; Thompson, Katherine; Huisingh-Scheetz, Megan; Farnan, Jeanne; Hemmerich, Joshua; Acevedo, Julissa; Small, Stephen

    2015-01-01

    Background Frailty is a risk factor for adverse events after surgery. Residents’ ability to recognize frailty is underdeveloped. We assessed the influence of a frailty education module on surgical residents’ estimates of lobectomy risk. Methods Traditional track cardiothoracic surgery residents were randomized to take an on-line short course on frailty (experimental group) or to receive no training (control group). Residents read a clinical vignette, made an initial risk estimate of major complications for lobectomy, and rated clinical factors on their importance to their estimates. They viewed a video of a standardized patient portraying the patient in the vignette, randomly selected to exhibit either vigorous or frail behavior, and provided a final risk estimate. After rating 5 vignettes, they completed a test on their frailty knowledge. Results Forty-one residents participated (20 in the experimental group). Initial risk estimates were similar between the groups. The experimental group rated clinical factors as “very important” in their initial risk estimates more often than did the control group (47.6% vs 38.5%; p<0.001). Viewing videos resulted in a significant change from initial to final risk estimates (frail: 50±75% increase, p=0.008; vigorous: 14±32% decrease, p=0.043). The magnitude of change in risk estimates was greater for the experimental group (10.0±8.1 vs 5.1±7.7; p<0.001). The experimental group answered more frailty test questions correctly (93.7% vs 75.2%; p<0.001). Conclusions A frailty education module improved resident knowledge of frailty and influenced surgical risk estimates. Training in frailty may help educate residents in frailty recognition and surgical risk assessment. PMID:26004924

  7. Rodents in open space adjust their behavioral response to the different risk levels during barn-owl attack

    PubMed Central

    Edut, Shahaf; Eilam, David

    2003-01-01

    Background Previous studies have revealed that the response of prey species to predatory risk comprised either freezing (when the prey remained immobile), or fleeing (when it ran frantically in order to remove itself from the vicinity of the predator). Other studies, however, have suggested that the prey will adjust its behavior to risk level. The present study was designed to follow the attacks of a barn owl (Tyto alba) on common spiny mice (Acomys cahirinus) and social voles (Microtus socialis guntherei), in order to reveal the correspondence between the behavior of the owl, the risk level at each phase of the owl's attack, and the defensive behavior of the rodents. Results Spiny mice dramatically increased the traveled distance upon the appearance of the owl, and kept moving during its attack while taking long trajectories of locomotion. Defensive response in voles dichotomized: in some voles traveled distance dropped when the owl appeared, reaching zero during its attack. In other voles, traveled distance dramatically increased once the owl appeared and further increased under its attack. These defensive responses developed by gradual tuning of normal locomotor behavior in accordance with the level of risk. Conclusions The phenotypic difference in defensive behavior between voles and spiny mice probably stems from their different habitats and motor capacities. Agility and running capacity, together with a relatively sheltered natural habitat, make fleeing the most appropriate response for spiny mice during owl attack. Clumsiness and relatively limited motor capacities, together with an open natural habitat, account for the dichotomy to freezing or fleeing in voles. Thus, the apparent species-specific anti-predator response in spiny mice and voles is based on species-specific normal locomotor behavior, which depends on the species-specific ecology and motor capacity, and behaviors like defensive attack or escape jump that are specific to life threat. The latter

  8. Estimating the subjective risks of driving simulator accidents.

    PubMed

    Dixit, Vinayak; Harrison, Glenn W; Rutström, E Elisabet

    2014-01-01

    We examine the subjective risks of driving behavior using a controlled virtual reality experiment. Use of a driving simulator allows us to observe choices over risky alternatives that are presented to the individual in a naturalistic manner, with many of the cues one would find in the field. However, the use of a simulator allows us the type of controls one expects from a laboratory environment. The subject was tasked with making a left-hand turn into incoming traffic, and the experimenter controlled the headways of oncoming traffic. Subjects were rewarded for making a successful turn, and lost income if they crashed. The experimental design provided opportunities for subjects to develop subjective beliefs about when it would be safe to turn, and it also elicited their attitudes towards risk. A simple structural model explains behavior, and showed evidence of heterogeneity in both the subjective beliefs that subjects formed and their risk attitudes. We find that subjective beliefs change with experience in the task and the driver's skill. A significant difference was observed in the perceived probability to successfully turn among the inexperienced drivers who did and did not crash even though there was no significant difference in drivers' risk attitudes among the two groups. We use experimental economics to design controlled, incentive compatible tasks that provide an opportunity to evaluate the impact on driver safety of subject's subjective beliefs about when it would be safe to turn as well as their attitudes towards risk. This method could be used to help insurance companies determine risk premia associated with risk attitudes or beliefs of crashing, to better incentivize safe driving.

  9. Estimating the risk of cardiovascular disease using an obese-years metric

    PubMed Central

    Abdullah, Asnawi; Amin, Fauzi Ali; Stoelwinder, Johannes; Tanamas, Stephanie K; Wolfe, Rory; Barendregt, Jan; Peeters, Anna

    2014-01-01

    Objective To examine the association between obese-years and the risk of cardiovascular disease (CVD). Study design Prospective cohort study. Setting Boston, USA. Participants 5036 participants of the Framingham Heart Study were examined. Methods Obese-years was calculated by multiplying for each participant the number of body mass index (BMI) units above 29 kg/m2 by the number of years lived at that BMI during approximately 50 years of follow-up. The association between obese-years and CVD was analysed using time-dependent Cox regression adjusted for potential confounders and compared with other models using the Akaike information criterion (AIC). The lowest AIC indicated better fit. Primary outcome CVD. Results The median cumulative obese-years was 24 (range 2–556 obese-years). During 138 918 person-years of follow-up, 2753 (55%) participants were diagnosed with CVD. The incidence rates and adjusted HR (AHR) for CVD increased with an increase in the number of obese-years. AHR for the categories 1–24.9, 25–49.9, 50–74.9 and ≥75 obese-years were, respectively, 1.31 (95% CI 1.15 to 1.48), 1.37 (95% CI 1.14 to 1.65), 1.62 (95% CI 1.32 to 1.99) and 1.80 (95% CI 1.54 to 2.10) compared with those who were never obese (ie, had zero obese-years). The effect of obese-years was stronger in males than females. For every 10 unit increase in obese-years, the AHR of CVD increased by 6% (95% CI 4% to 8%) for males and 3% (95% CI 2% to 4%) for females. The AIC was lowest for the model containing obese-years compared with models containing either the level of BMI or the duration of obesity alone. Conclusions This study demonstrates that obese-years metric conceptually captures the cumulative damage of obesity on body systems, and is found to provide slightly more precise estimation of the risk of CVD than the level or duration of obesity alone. PMID:25231490

  10. Biomechanical Risk Estimates for Mild Traumatic Brain Injury

    PubMed Central

    Funk, J. R.; Duma, S. M.; Manoogian, S. J.; Rowson, S.

    2007-01-01

    The objective of this study was to characterize the risk of mild traumatic brain injury (MTBI) in living humans based on a large set of head impact data taken from American football players at the collegiate level. Real-time head accelerations were recorded from helmet-mounted accelerometers designed to stay in contact with the player’s head. Over 27,000 head impacts were recorded, including four impacts resulting in MTBI. Parametric risk curves were developed by normalizing MTBI incidence data by head impact exposure data. An important finding of this research is that living humans, at least in the setting of collegiate football, sustain much more significant head impacts without apparent injury than previously thought. The following preliminary nominal injury assessment reference values associated with a 10% risk of MTBI are proposed: a peak linear head acceleration of 165 g, a HIC of 400, and a peak angular head acceleration of 9000 rad/s2. PMID:18184501

  11. Probabilistic methodology for estimating radiation-induced cancer risk

    SciTech Connect

    Dunning, D.E. Jr.; Leggett, R.W.; Williams, L.R.

    1981-01-01

    The RICRAC computer code was developed at Oak Ridge National Laboratory to provide a versatile and convenient methodology for radiation risk assessment. The code allows as input essentially any dose pattern commonly encountered in risk assessments for either acute or chronic exposures, and it includes consideration of the age structure of the exposed population. Results produced by the analysis include the probability of one or more radiation-induced cancer deaths in a specified population, expected numbers of deaths, and expected years of life lost as a result of premature fatalities. These calculatons include consideration of competing risks of death from all other causes. The program also generates a probability frequency distribution of the expected number of cancers in any specified cohort resulting from a given radiation dose. The methods may be applied to any specified population and dose scenario.

  12. High cost pool or high cost groups-How to handle high(est) cost cases in a risk adjustment mechanism?

    PubMed

    Schillo, Sonja; Lux, Gerald; Wasem, Juergen; Buchner, Florian

    2016-02-01

    Competitive social health insurance systems (at least) in Western Europe have implemented systems of morbidity based risk adjustment to set a level playing field for insurers. However, many high cost insured still are heavily underfunded despite risk adjustment, leaving incentives for risk selection. In most of these health care systems, there is an ongoing debate about how to deal with such underpaid high cost cases. This study develops four distinct concepts by adding variables to risk adjustment or by setting up a high cost pool for underpaid insured besides the risk adjustment system. Their features, incentives and distributional effects are discussed. With a data set of 6 million insured, performance is demonstrated for Germany. All models achieve a substantial improvement in model fit, measured in terms of R(2) as well as CPM. As the results of the various models are different in different dimensions, the trade-offs that have to be dealt with and should be addressed, when implementing a model to reduce underfunding of high cost cases. PMID:26806676

  13. High cost pool or high cost groups-How to handle high(est) cost cases in a risk adjustment mechanism?

    PubMed

    Schillo, Sonja; Lux, Gerald; Wasem, Juergen; Buchner, Florian

    2016-02-01

    Competitive social health insurance systems (at least) in Western Europe have implemented systems of morbidity based risk adjustment to set a level playing field for insurers. However, many high cost insured still are heavily underfunded despite risk adjustment, leaving incentives for risk selection. In most of these health care systems, there is an ongoing debate about how to deal with such underpaid high cost cases. This study develops four distinct concepts by adding variables to risk adjustment or by setting up a high cost pool for underpaid insured besides the risk adjustment system. Their features, incentives and distributional effects are discussed. With a data set of 6 million insured, performance is demonstrated for Germany. All models achieve a substantial improvement in model fit, measured in terms of R(2) as well as CPM. As the results of the various models are different in different dimensions, the trade-offs that have to be dealt with and should be addressed, when implementing a model to reduce underfunding of high cost cases.

  14. Radiation Leukemogenesis: Applying Basic Science of Epidemiological Estimates of Low Dose Risks and Dose-Rate Effects

    SciTech Connect

    Hoel, D. G.

    1998-11-01

    The next stage of work has been to examine more closely the A-bomb leukemia data which provides the underpinnings of the risk estimation of CML in the above mentioned manuscript. The paper by Hoel and Li (Health Physics 75:241-50) shows how the linear-quadratic model has basic non-linearities at the low dose region for the leukemias including CML. Pierce et. al., (Radiation Research 123:275-84) have developed distributions for the uncertainty in the estimated exposures of the A-bomb cohort. Kellerer, et. al., (Radiation and Environmental Biophysics 36:73-83) has further considered possible errors in the estimated neutron values and with changing RBE values with dose and has hypothesized that the tumor response due to gamma may not be linear. We have incorporated his neutron model and have constricted new A-bomb doses based on his model adjustments. The Hoel and Li dose response analysis has also been applied using the Kellerer neutron dose adjustments for the leukemias. Finally, both Pierce's dose uncertainties and Kellerer neutron adjustments are combined as well as the varying RBE with dose as suggested by Rossi and Zaider and used for leukemia dose-response analysis. First the results of Hoel and Li showing a significantly improved fit of the linear-quadratic dose response by the inclusion of a threshold (i.e. low-dose nonlinearity) persisted. This work has been complete for both solid tumor as well as leukemia for both mortality as well as incidence data. The results are given in the manuscript described below which has been submitted to Health Physics.

  15. Predicting economic and medical outcomes based on risk adjustment for congenital heart surgery classification of pediatric cardiovascular surgical admissions.

    PubMed

    Raucci, Frank J; Hoke, Tracey R; Gutgesell, Howard P

    2014-12-01

    The Risk Adjustment for Congenital Heart Surgery (RACHS-1) classification is an established method for predicting mortality for congenital heart disease surgery. It is unknown if this extends to the cost of hospitalization or if differences in economic and medical outcomes exist in certain subpopulations. Using data obtained from the University HealthSystem Consortium, we examined inpatient resource use by patients with International Classification of Diseases, Ninth Revision, procedure codes representative of RACHS-1 classifications 1 through 5 and 6 from 2006 to 2012. A total of 15,453 pediatric congenital heart disease surgical admissions were analyzed, with overall mortality of 4.5% (n = 689). As RACHS-1 classification increased, the total cost of hospitalization, hospital charges, total length of stay, length of intensive care unit stay, and mortality increased. Even when controlled for RACHS-1 classification, black patients (n = 2034) had higher total costs ($96,884 ± $3,392, p = 0.003), higher charges ($318,313 ± $12,018, p <0.001), and longer length of stay (20.4 ± 0.7 days, p <0.001) compared with white patients ($85,396 ± $1,382, $285,622 ± $5,090, and 18.0 ± 0.3 days, respectively). Hispanic patients had similarly disparate outcomes ($104,292 ± $2,759, $351,371 ± $10,627, and 23.0 ± 0.6 days, respectively) and also spent longer in the intensive care unit (14.9 ± 0.5 days, p <0.001). In conclusion, medical and economic measures increased predictably with increased procedure risk, and admissions for black and Hispanic patients were longer and more expensive than those of their white counterparts but without increased mortality.

  16. A new Approach to Combine GRACE and ICESat Observations to Estimate Glacial Isostatic Adjustment in East Antarctic

    NASA Astrophysics Data System (ADS)

    Kallenberg, B.; Tregoning, P.; Purcell, A. P.

    2014-12-01

    Monitoring and understanding ongoing changes in Antarctic mass balance is of great interest, as the melting of the ice sheet would significantly contribute to global sea level changes. While scientists agree that the West Antarctic ice sheet is losing mass, opinions about the East Antarctic ice sheet are more widespread, with some areas showing an increase in mass. In recent years satellite missions have significantly contributed to the understanding of ongoing changes within the polar ice sheets, and became an important tool in detecting variations in ice height, ice mass and bedrock isostasy. The Gravity Recovery And Climate Experiment (GRACE) mission detects mass loss in regions where the ice sheet has its bed well below sea level and where warmer ocean water penetrates beneath the ice sheet, melting it from the base. Meanwhile an increase in mass has been observed in regions along the East Antarctic coastline, raising the question whether GRACE detects glacial isostatic adjustment due to ice mass loss or an actual increase in snowfall, contributing positively to surface mass balance. To improve our understanding on the contribution of glacial isostatic adjustment and surface mass balance to mass variations, we developed a new approach on how to subtract elevation changes observed by satellite altimetry from observed mass changes as detected by GRACE. We have established our own firn compaction model that we apply to the altimetry data to subtract changes due to the densification of snow, before using the ICESat observations. We will present results of the firn compaction model and our approach on combining GRACE and ICESat observations to separate the contribution of glacial isostatic adjustment from ongoing surface mass changes in East Antarctica.

  17. Pressure and performance: buffering capacity and the cyclical impact of accreditation inspections on risk-adjusted mortality.

    PubMed

    Towers, Tyler J; Clark, Jonathan

    2014-01-01

    The Joint Commission's move toward unannounced site visits in 2006 clearly underscores its goal to ensure more consistent compliance with its standards among accredited hospitals between site visits. As Joint Commission standards are intended to inform a host of practices associated with preventing adverse patient outcomes, and accreditation is intended to signal a satisfactory level of adoption of these practices, there should be no significant fluctuation in patient outcomes if hospital compliance remains sufficiently consistent before, during, and after an accreditation site visit, ceteris paribus. However, prior research on the implementation of practices in healthcare organizations (especially those practices related to quality improvement) points to the likelihood of inconsistency in the use of such practices, even after they have been "adopted." This inconsistency may emerge from shifts in manager attention patterns that may be driven by (1) resource constraints that preclude managers from dedicating consistent and perpetual attention to any given program or initiative and (2) accreditation pressures that are predictably cyclical even when site visits are, technically, unannounced. If these shifts in organizational attention patterns are sufficiently salient, we might expect to see patient outcomes ebb and flow with accreditation site visits. In this study, we explore this possibility by examining monthly patterns in risk-adjusted mortality rates around accreditation site visits. As shifts in organizational attention may be linked to resource constraints, we also explore the role of slack resources in shielding healthcare organizations from the ebbs and flows of external pressures, a capability we term buffering capacity. PMID:25647951

  18. Slope Estimation for Bivariate Longitudinal Outcomes Adjusting for Informative Right Censoring Using Discrete Survival Model: Application to the Renal Transplant Cohort.

    PubMed

    Jaffa, Miran A; Woolson, Robert F; Lipsitz, Stuart R

    2011-04-01

    Patients undergoing renal transplantation are prone to graft failure which causes lost of follow-up measures on their blood urea nitrogen and serum creatinine levels. These two outcomes are measured repeatedly over time to assess renal function following transplantation. Loss of follow-up on these bivariate measures results in informative right censoring, a common problem in longitudinal data that should be adjusted for so that valid estimates are obtained. In this study, we propose a bivariate model that jointly models these two longitudinal correlated outcomes and generates population and individual slopes adjusting for informative right censoring using a discrete survival approach. The proposed approach is applied to the clinical dataset of patients who had undergone renal transplantation. A simulation study validates the effectiveness of the approach.

  19. CubeSat mission design software tool for risk estimating relationships

    NASA Astrophysics Data System (ADS)

    Gamble, Katharine Brumbaugh; Lightsey, E. Glenn

    2014-09-01

    In an effort to make the CubeSat risk estimation and management process more scientific, a software tool has been created that enables mission designers to estimate mission risks. CubeSat mission designers are able to input mission characteristics, such as form factor, mass, development cycle, and launch information, in order to determine the mission risk root causes which historically present the highest risk for their mission. Historical data was collected from the CubeSat community and analyzed to provide a statistical background to characterize these Risk Estimating Relationships (RERs). This paper develops and validates the mathematical model based on the same cost estimating relationship methodology used by the Unmanned Spacecraft Cost Model (USCM) and the Small Satellite Cost Model (SSCM). The RER development uses general error regression models to determine the best fit relationship between root cause consequence and likelihood values and the input factors of interest. These root causes are combined into seven overall CubeSat mission risks which are then graphed on the industry-standard 5×5 Likelihood-Consequence (L-C) chart to help mission designers quickly identify areas of concern within their mission. This paper is the first to document not only the creation of a historical database of CubeSat mission risks, but, more importantly, the scientific representation of Risk Estimating Relationships.

  20. Children's Positive Adjustment to First Grade in Risk-Filled Communities: A Case Study of the Role of School Ecologies in South Africa and Finland

    ERIC Educational Resources Information Center

    Kumpulainen, Kristiina; Theron, Linda; Kahl, Carlien; Bezuidenhout, Carla; Mikkola, Anna; Salmi, Saara; Khumalo, Tumi; Uusitalo-Malmivaara, Lotta

    2016-01-01

    This article presents a comparative case study on the ways in which children's school ecologies facilitate their adjusting positively to first grade in risk-filled contexts in South Africa and Finland. The insights of two children (one South African, one Finnish) from socio-economically disadvantaged communities, their teachers, parents and…

  1. Food-Frequency Questionnaire Based Estimates of Total Antioxidant Capacity and Risk of Non-Hodgkin Lymphoma

    PubMed Central

    Holtan, Shernan G.; O’Connor, Helen M.; Fredericksen, Zachary S.; Liebow, Mark; Thompson, Carrie A.; Macon, William R.; Micallef, Ivana N.; Wang, Alice H.; Slager, Susan L.; Habermann, Thomas M.; Call, Timothy G.; Cerhan, James R.

    2011-01-01

    Antioxidants, primarily from fruits and vegetables, have been hypothesized to protect against non-Hodgkin lymphoma (NHL). The Oxygen Radical Absorbance Capacity (ORAC) assay, which measures total antioxidant capacity of individual foods and accounts for synergism, can be estimated using a food-frequency questionnaire (FFQ). We tested the hypothesis that higher intake of antioxidant nutrients from foods, supplements, and FFQ-based ORAC values are associated with a lower risk of NHL in a clinic-based study of 603 incident cases and 1007 frequency-matched controls. Diet was assessed with a 128-item FFQ. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals adjusted for age, sex, residence and total energy. Dietary intake of α-tocopherol (OR=0.50; p-trend=0.0002), β-carotene (OR=0.58; p-trend=0.0005), lutein/zeaxanthin (OR=0.62; p-trend=0.005), zinc (OR=0.54; p-trend=0.003) and chromium (OR=0.68; p-trend=0.032) were inversely associated with NHL risk. Inclusion of supplement use had little impact on these associations. Total vegetables (OR=0.52; p-trend<0.0001), particularly green leafy (OR=0.52; p-trend<0.0001) and cruciferous (OR=0.68; p-trend=0.045) vegetables, were inversely associated with NHL risk. NHL risk was inversely associated with both hydrophilic ORAC (OR=0.61, p-trend=0.003) and lipophilic ORAC (OR=0.48, p-trend=0.0002), although after simultaneous adjustment for other antioxidants or total vegetables only the association for lipophilic ORAC remained significant. There was no striking heterogeneity in results across the common NHL subtypes. Higher antioxidant intake as estimated by the FFQ-ORAC, particularly the lipophilic component, was associated with a lower NHL risk after accounting for other antioxidant nutrients and vegetable intake, supporting this as potentially useful summary measure of total antioxidant intake. PMID:22038870

  2. Assessing uncertainty in published risk estimates using hexavalent chromium and lung cancer mortality as an example

    EPA Science Inventory

    Introduction: The National Research Council recommended quantitative evaluation of uncertainty in effect estimates for risk assessment. This analysis considers uncertainty across model forms and model parameterizations with hexavalent chromium [Cr(VI)] and lung cancer mortality a...

  3. Estimated exposure to phthalates in cosmetics and risk assessment.

    PubMed

    Koo, Hyun Jung; Lee, Byung Mu

    2004-12-01

    Some phthalates such as di(2-ethylhexyl) phthalate (DEHP) and dibutyl phthalate (DBP) and their metabolites are suspected of producing teratogenic or endocrine-disrupting effects. To predict possible human exposure to phthalates in cosmetics, the levels of DEHP, diethyl phthalate (DEP), DBP, and butylbenzyl phthalate (BBP) were determined by high-performance liquid chromatography (HPLC) in 102 branded hair sprays, perfumes, deodorants, and nail polishes. DBP was detected in 19 of the 21 nail polishes and in 11 of the 42 perfumes, and DEP was detected in 24 of the 42 perfumes and 2 of the 8 deodorants. Median exposure levels to phthalates in cosmetics by dermal absorption were estimated to be 0.0006 g/kg body weight (bw)/d for DEHP, 0.6 g/kg bw/d for DEP, and 0.103 g/kg bw/d for DBP. Furthermore, if phthalates in cosmetics were assumed to be absorbed exclusively via 100% inhalation, the median daily exposure levels to phthalates in cosmetics were estimated to be 0.026 g/kg bw/d for DEHP, 81.471 g/kg bw/d for DEP, and 22.917 g/kg bw/d for DBP, which are far lower than the regulation levels set buy the Scientific Committee on Toxicity, Ecotoxicity, and the Environment (CSTEE) (37 g/kg bw/d, DEHP), Agency for Toxic Substances and Disease Registry (ATSDR) (7000 g/kg bw/d, DEP), and International Programme on Chemical Safety (IPCS) (66 g/kg bw/d, DBP), respectively. Based on these data, hazard indices (HI, daily exposure level/regulation level) were calculated to be 0.0007 for DEHP, 0.012 for DEP, and 0.347 for DBP. These data suggest that estimated exposure to-phthalates in the cosmetics mentioned are relatively small. However, total exposure levels from several sources may be greater and require further investigation.

  4. Cardiovascular risk factors and estimated 10-year risk of fatal cardiovascular events using various equations in Greeks with metabolic syndrome.

    PubMed

    Chimonas, Theodoros; Athyros, Vassilios G; Ganotakis, Emmanouel; Nicolaou, Vassilios; Panagiotakos, Demosthenes B; Mikhailidis, Dimitri P; Elisaf, Moses

    2010-01-01

    We investigated cardiovascular disease (CVD) risk factors in 1501 Greeks (613 men and 888 women, aged 40-65 years) referred to outpatients with metabolic syndrome (MetS) and without diabetes mellitus or CVD. The 10-year risk of fatal CVD events was calculated using European Society of Cardiology Systematic Coronary Risk Estimation (ESC SCORE), Hellenic-SCORE, and Framingham equations. Raised blood pressure (BP) and hypertriglyceridemia were more common in men (89.6% vs 84.2% and 86.8% vs 74.2%, respectively; P < .001). Low high-density lipoprotein cholesterol (HDL-C) and abdominal obesity were more common in women (58.2% vs 66.2% and 85.8% vs 97.1%, respectively; P < .001). The 10-year risk of fatal CVD events using HellenicSCORE was higher in men (6.3% +/- 4.3% vs 2.7% +/- 2.1%; P < .001). European Society of Cardiology Systematic Coronary Risk Estimation and Framingham yielded similar results. The risk equations gave similar assessments in a European Mediterranean population except for HellenicSCORE that calculated more MetS women requiring risk modification. This might justify local risk engine evaluation in event-based studies. (Clinical-Trials.gov ID: NCT00416741).

  5. Disease Risk Estimation by Combining Case–Control Data with Aggregated Information on the Population at Risk

    PubMed Central

    Chang, Xiaohui; Waagepetersen, Rasmus; Yu, Herbert; Ma, Xiaomei; Holford, Theodore R.; Wang, Rong; Guan, Yongtao

    2016-01-01

    Summary We propose a novel statistical framework by supplementing case–control data with summary statistics on the population at risk for a subset of risk factors. Our approach is to first form two unbiased estimating equations, one based on the case–control data and the other on both the case data and the summary statistics, and then optimally combine them to derive another estimating equation to be used for the estimation. The proposed method is computationally simple and more efficient than standard approaches based on case–control data alone. We also establish asymptotic properties of the resulting estimator, and investigate its finite-sample performance through simulation. As a substantive application, we apply the proposed method to investigate risk factors for endometrial cancer, by using data from a recently completed population-based case–control study and summary statistics from the Behavioral Risk Factor Surveillance System, the Population Estimates Program of the US Census Bureau, and the Connecticut Department of Transportation. PMID:25351292

  6. Small-Sample Adjustments for Tests of Moderators and Model Fit Using Robust Variance Estimation in Meta-Regression

    ERIC Educational Resources Information Center

    Tipton, Elizabeth; Pustejovsky, James E.

    2015-01-01

    Meta-analyses often include studies that report multiple effect sizes based on a common pool of subjects or that report effect sizes from several samples that were treated with very similar research protocols. The inclusion of such studies introduces dependence among the effect size estimates. When the number of studies is large, robust variance…

  7. Estimated occupational risk from bioaerosols generated during land application of Class B biosolids

    Technology Transfer Automated Retrieval System (TEKTRAN)

    It has been speculated that bioaerosols generated during land application of biosolids pose a serious occupational risk, but few scientific studies have been performed to assess levels of aerosolization of microorganisms from biosolids and to estimate the occupational risks of infection. This study ...

  8. Bayesian Framework for Water Quality Model Uncertainty Estimation and Risk Management

    EPA Science Inventory

    A formal Bayesian methodology is presented for integrated model calibration and risk-based water quality management using Bayesian Monte Carlo simulation and maximum likelihood estimation (BMCML). The primary focus is on lucid integration of model calibration with risk-based wat...

  9. Estimating risks to aquatic life using quantile regression

    USGS Publications Warehouse

    Schmidt, Travis S.; Clements, William H.; Cade, Brian S.

    2012-01-01

    One of the primary goals of biological assessment is to assess whether contaminants or other stressors limit the ecological potential of running waters. It is important to interpret responses to contaminants relative to other environmental factors, but necessity or convenience limit quantification of all factors that influence ecological potential. In these situations, the concept of limiting factors is useful for data interpretation. We used quantile regression to measure risks to aquatic life exposed to metals by including all regression quantiles (τ  =  0.05–0.95, by increments of 0.05), not just the upper limit of density (e.g., 90th quantile). We measured population densities (individuals/0.1 m2) of 2 mayflies (Rhithrogena spp., Drunella spp.) and a caddisfly (Arctopsyche grandis), aqueous metal mixtures (Cd, Cu, Zn), and other limiting factors (basin area, site elevation, discharge, temperature) at 125 streams in Colorado. We used a model selection procedure to test which factor was most limiting to density. Arctopsyche grandis was limited by other factors, whereas metals limited most quantiles of density for the 2 mayflies. Metals reduced mayfly densities most at sites where other factors were not limiting. Where other factors were limiting, low mayfly densities were observed despite metal concentrations. Metals affected mayfly densities most at quantiles above the mean and not just at the upper limit of density. Risk models developed from quantile regression showed that mayfly densities observed at background metal concentrations are improbable when metal mixtures are at US Environmental Protection Agency criterion continuous concentrations. We conclude that metals limit potential density, not realized average density. The most obvious effects on mayfly populations were at upper quantiles and not mean density. Therefore, we suggest that policy developed from mean-based measures of effects may not be as useful as policy based on the concept of

  10. Uncertainties in Estimates of the Risks of Late Effects from Space Radiation

    NASA Technical Reports Server (NTRS)

    Cucinotta, F. A.; Schimmerling, W.; Wilson, J. W.; Peterson, L. E.; Saganti, P.; Dicelli, J. F.

    2002-01-01

    The health risks faced by astronauts from space radiation include cancer, cataracts, hereditary effects, and non-cancer morbidity and mortality risks related to the diseases of the old age. Methods used to project risks in low-Earth orbit are of questionable merit for exploration missions because of the limited radiobiology data and knowledge of galactic cosmic ray (GCR) heavy ions, which causes estimates of the risk of late effects to be highly uncertain. Risk projections involve a product of many biological and physical factors, each of which has a differential range of uncertainty due to lack of data and knowledge. Within the linear-additivity model, we use Monte-Carlo sampling from subjective uncertainty distributions in each factor to obtain a Maximum Likelihood estimate of the overall uncertainty in risk projections. The resulting methodology is applied to several human space exploration mission scenarios including ISS, lunar station, deep space outpost, and Mar's missions of duration of 360, 660, and 1000 days. The major results are the quantification of the uncertainties in current risk estimates, the identification of factors that dominate risk projection uncertainties, and the development of a method to quantify candidate approaches to reduce uncertainties or mitigate risks. The large uncertainties in GCR risk projections lead to probability distributions of risk that mask any potential risk reduction using the "optimization" of shielding materials or configurations. In contrast, the design of shielding optimization approaches for solar particle events and trapped protons can be made at this time, and promising technologies can be shown to have merit using our approach. The methods used also make it possible to express risk management objectives in terms of quantitative objective's, i.e., the number of days in space without exceeding a given risk level within well defined confidence limits.

  11. ASSESSMENT OF METHODS FOR ESTIMATING RISK TO BIRDS FROM INGESTION OF CONTAMINATED GRIT PARTICLES (FINAL REPORT)

    EPA Science Inventory

    The report evaluates approaches for estimating the probability of ingestion by birds of contaminated particles such as pesticide granules or lead particles (i.e. shot or bullet fragments). In addition, it presents an approach for using this information to estimate the risk of mo...

  12. Estimating Toxicity Pathway Activating Doses for High Throughput Chemical Risk Assessments

    EPA Science Inventory

    Estimating a Toxicity Pathway Activating Dose (TPAD) from in vitro assays as an analog to a reference dose (RfD) derived from in vivo toxicity tests would facilitate high throughput risk assessments of thousands of data-poor environmental chemicals. Estimating a TPAD requires def...

  13. Risk estimations, risk factors, and genetic variants associated with Alzheimer's disease in selected publications from the Framingham Heart Study.

    PubMed

    Weinstein, Galit; Wolf, Philip A; Beiser, Alexa S; Au, Rhoda; Seshadri, Sudha

    2013-01-01

    The study of Alzheimer's disease (AD) in the Framingham Heart Study (FHS), a multi-generational, community-based population study, began nearly four decades ago. In this overview, we highlight findings from seven prior publications that examined lifetime risk estimates for AD, environmental risk factors for AD, circulating and imaging markers of aging-related brain injury, and explorations on the genetics underlying AD. First, we describe estimations of the lifetime risk of AD. These estimates are distinguished from other measures of disease burden and have substantial public health implications. We then describe prospective studies of environmental AD risk factors: one examined the association between plasma levels of omega-3 fatty-acid and risk of incident AD, the other explored the association of diabetes to this risk in subsamples with specific characteristics. With evidence of inflammation as an underlying mechanism, we also describe findings from a study that compared the effects of serum cytokines and spontaneous production of peripheral blood mononuclear cell cytokines on AD risk. Investigating AD related endophenotypes increases sensitivity in identifying risk factors and can be used to explore pathophysiologic pathways between a risk factor and the disease. We describe findings of an association between large volume of white matter hyperintensities and a specific pattern of cognitive deficits in non-demented participants. Finally, we summarize our findings from two genetic studies: The first used genome-wide association (GWA) and family-based association methods to explore the genetic basis of cognitive and structural brain traits. The second is a large meta-analysis GWA study of AD, in which novel loci of AD susceptibility were found. Together, these findings demonstrate the FHS multi-directional efforts in investigating dementia and AD. PMID:22796871

  14. An exploration of spatial risk assessment for soil protection: estimating risk and establishing priority areas for soil protection.

    PubMed

    Kibblewhite, M G; Bellamy, P H; Brewer, T R; Graves, A R; Dawson, C A; Rickson, R J; Truckell, I; Stuart, J

    2014-03-01

    Methods for the spatial estimation of risk of harm to soil by erosion by water and wind and by soil organic matter decline are explored. Rates of harm are estimated for combinations of soil type and land cover (as a proxy for hazard frequency) and used to estimate risk of soil erosion and loss of soil organic carbon (SOC) for 1 km(2)pixels. Scenarios are proposed for defining the acceptability of risk of harm to soil: the most precautionary one corresponds to no net harm after natural regeneration of soil (i.e. a 1 in 20 chance of exceeding an erosion rate of <1 tha(-1)y(-1) and SOC content decline of 0 kg t(-1)y(-1) for mineral soils and a carbon stock decline of 0 tha(-1)y(-1) for organic soils). Areas at higher and lower than possible acceptable risk are mapped. The veracity of boundaries is compromised if areas of unacceptable risk are mapped to administrative boundaries. Errors in monitoring change in risk of harm to soil and inadequate information on risk reduction measures' efficacy, at landscape scales, make it impossible to use or monitor quantitative targets for risk reduction adequately. The consequences for priority area definition of expressing varying acceptable risk of harm to soil as a varying probability of exceeding a fixed level of harm, or, a varying level of harm being exceeded with a fixed probability, are discussed. Soil data and predictive models for rates of harm to soil would need considerable development and validation to implement a priority area approach robustly. PMID:24412915

  15. An exploration of spatial risk assessment for soil protection: estimating risk and establishing priority areas for soil protection.

    PubMed

    Kibblewhite, M G; Bellamy, P H; Brewer, T R; Graves, A R; Dawson, C A; Rickson, R J; Truckell, I; Stuart, J

    2014-03-01

    Methods for the spatial estimation of risk of harm to soil by erosion by water and wind and by soil organic matter decline are explored. Rates of harm are estimated for combinations of soil type and land cover (as a proxy for hazard frequency) and used to estimate risk of soil erosion and loss of soil organic carbon (SOC) for 1 km(2)pixels. Scenarios are proposed for defining the acceptability of risk of harm to soil: the most precautionary one corresponds to no net harm after natural regeneration of soil (i.e. a 1 in 20 chance of exceeding an erosion rate of <1 tha(-1)y(-1) and SOC content decline of 0 kg t(-1)y(-1) for mineral soils and a carbon stock decline of 0 tha(-1)y(-1) for organic soils). Areas at higher and lower than possible acceptable risk are mapped. The veracity of boundaries is compromised if areas of unacceptable risk are mapped to administrative boundaries. Errors in monitoring change in risk of harm to soil and inadequate information on risk reduction measures' efficacy, at landscape scales, make it impossible to use or monitor quantitative targets for risk reduction adequately. The consequences for priority area definition of expressing varying acceptable risk of harm to soil as a varying probability of exceeding a fixed level of harm, or, a varying level of harm being exceeded with a fixed probability, are discussed. Soil data and predictive models for rates of harm to soil would need considerable development and validation to implement a priority area approach robustly.

  16. Overview of Risk-Estimation Tools for Primary Prevention of Cardiovascular Diseases in European Populations.

    PubMed

    Gorenoi, Vitali; Hagen, Anja

    2015-06-01

    To identify persons with a high risk for cardiovascular diseases (CVD) special tools (scores, charts, graphics or computer programs) for CVD-risk assessment based on levels of the certain risk factors have been constructed. The applicability of these instruments depends on the derivation cohorts, considered risk factors and endpoints, applied statistical methods as well as used formats. The review addresses the risk-estimation tools for primary prevention of CVD potentially relevant for European populations. The risk-estimation tools were identified using two previously published systematic reviews as well as conducting a literature search in MEDLINE and a manual search. Only instruments were considered which were derived from cohorts of at least 1,000 participants of one gender without pre-existing CVD, enable risk assessment for a period of at least 5 years, were designed for an age-range of at least 25 years and published after the year 2000. A number of risk-estimation tools for CVD derived from single European, several European and from non-European cohorts were identified. From a clinical perspective, seem to be preferable instruments for risk of CVD contemporary developed for the population of interest, which use easily accessible measures and show a high discriminating ability. Instruments, restricting risk-estimation to certain cardiovascular events, recalibrated high-accuracy tools or tools derived from European populations with similar risk factors distribution and CVD-incidence are the second choice. In younger people, calculating the relative risk or cardiovascular age equivalence measures may be of more benefit.

  17. Quantitative Risk reduction estimation Tool For Control Systems, Suggested Approach and Research Needs

    SciTech Connect

    Miles McQueen; Wayne Boyer; Mark Flynn; Sam Alessi

    2006-03-01

    For the past year we have applied a variety of risk assessment technologies to evaluate the risk to critical infrastructure from cyber attacks on control systems. More recently, we identified the need for a stand alone control system risk reduction estimation tool to provide owners and operators of control systems with a more useable, reliable, and credible method for managing the risks from cyber attack. Risk is defined as the probability of a successful attack times the value of the resulting loss, typically measured in lives and dollars. Qualitative and ad hoc techniques for measuring risk do not provide sufficient support for cost benefit analyses associated with cyber security mitigation actions. To address the need for better quantitative risk reduction models we surveyed previous quantitative risk assessment research; evaluated currently available tools; developed new quantitative techniques [17] [18]; implemented a prototype analysis tool to demonstrate how such a tool might be used; used the prototype to test a variety of underlying risk calculational engines (e.g. attack tree, attack graph); and identified technical and research needs. We concluded that significant gaps still exist and difficult research problems remain for quantitatively assessing the risk to control system components and networks, but that a useable quantitative risk reduction estimation tool is not beyond reach.

  18. Space Radiation Heart Disease Risk Estimates for Lunar and Mars Missions

    NASA Technical Reports Server (NTRS)

    Cucinotta, Francis A.; Chappell, Lori; Kim, Myung-Hee

    2010-01-01

    The NASA Space Radiation Program performs research on the risks of late effects from space radiation for cancer, neurological disorders, cataracts, and heart disease. For mortality risks, an aggregate over all risks should be considered as well as projection of the life loss per radiation induced death. We report on a triple detriment life-table approach to combine cancer and heart disease risks. Epidemiology results show extensive heterogeneity between populations for distinct components of the overall heart disease risks including hypertension, ischaemic heart disease, stroke, and cerebrovascular diseases. We report on an update to our previous heart disease estimates for Heart disease (ICD9 390-429) and Stroke (ICD9 430-438), and other sub-groups using recent meta-analysis results for various exposed radiation cohorts to low LET radiation. Results for multiplicative and additive risk transfer models are considered using baseline rates for US males and female. Uncertainty analysis indicated heart mortality risks as low as zero, assuming a threshold dose for deterministic effects, and projections approaching one-third of the overall cancer risk. Medan life-loss per death estimates were significantly less than that of solid cancer and leukemias. Critical research questions to improve risks estimates for heart disease are distinctions in mechanisms at high doses (>2 Gy) and low to moderate doses (<2 Gy), and data and basic understanding of radiation doserate and quality effects, and individual sensitivity.

  19. Utilizing satellite precipitation estimates for streamflow forecasting via adjustment of mean field bias in precipitation data and assimilation of streamflow observations

    NASA Astrophysics Data System (ADS)

    Lee, Haksu; Zhang, Yu; Seo, Dong-Jun; Xie, Pingping

    2015-10-01

    This study explores mitigating bias in satellite quantitative precipitation estimates (SQPE) and improving hydrologic predictions at ungauged locations via adjustment of the mean field bias (MFB) in SQPE and data assimilation (DA) of streamflow observations in a distributed hydrologic model. In this study, a variational procedure is used to adjust MFB in Climate Prediction Center MORPHing (CMORPH) SQPE and assimilate streamflow observations at the outlet of Elk River Basin in Missouri into the distributed Sacramento Soil Moisture Accounting (SAC-SMA) and kinematic wave routing models. The benefits of assimilation are assessed by comparing the streamflow predictions with or without DA at both the outlet and an upstream location, and by comparing the soil moisture grids forced by CMORPH SQPE against those forced by higher-quality multisensor quantitative precipitation estimates (MQPE) from National Weather Service. Special attention is given to the dependence of the efficacy of DA on the quality and latency of the SQPE, and the impact of dynamic correction of MFB in the SQPE via DA. The results show that adjusting MFB in CMORPH SQPE in addition to assimilating outlet flow reduces 66% of the bias in the CMORPH SQPE analysis and the RMSE of 12-h streamflow predictions by 81% at the outlet and 34-62% at interior locations of the catchment. Compared to applying a temporally invariant MFB for the entire storm, the DA-based, dynamic MFB correction reduces the RMSE of 6-h streamflow prediction by 63% at the outlet and 39-69% at interior locations. It is also shown that the accuracy of streamflow prediction deteriorates if the delineation of the precipitation area by CMORPH SQPE is significantly different, as measured by the Hausdorff distance, from that by MQPE. When compared with adjusting MFB in the CMORPH SQPE over the entire assimilation window, adjusting the MFB for all but the latest 18 h (i.e., the latency of CMORPH SQPE) within the assimilation window reduces the

  20. Toxoplasma gondii Infection in Kyrgyzstan: Seroprevalence, Risk Factor Analysis, and Estimate of Congenital and AIDS-Related Toxoplasmosis

    PubMed Central

    Bodosheva, Aigerim; Kuttubaev, Omurbek; Hehl, Adrian B.; Tanner, Isabelle; Ziadinov, Iskender; Torgerson, Paul R.; Deplazes, Peter

    2013-01-01

    Background HIV-prevalence, as well as incidence of zoonotic parasitic diseases like cystic echinococcosis, has increased in the Kyrgyz Republic due to fundamental socio-economic changes after the breakdown of the Soviet Union. The possible impact on morbidity and mortality caused by Toxoplasma gondii infection in congenital toxoplasmosis or as an opportunistic infection in the emerging AIDS pandemic has not been reported from Kyrgyzstan. Methodology/Principal Findings We screened 1,061 rural and 899 urban people to determine the seroprevalence of T. gondii infection in 2 representative but epidemiologically distinct populations in Kyrgyzstan. The rural population was from a typical agricultural district where sheep husbandry is a major occupation. The urban population was selected in collaboration with several diagnostic laboratories in Bishkek, the largest city in Kyrgyzstan. We designed a questionnaire that was used on all rural subjects so a risk-factor analysis could be undertaken. The samples from the urban population were anonymous and only data with regard to age and gender was available. Estimates of putative cases of congenital and AIDS-related toxoplasmosis in the whole country were made from the results of the serology. Specific antibodies (IgG) against Triton X-100 extracted antigens of T. gondii tachyzoites from in vitro cultures were determined by ELISA. Overall seroprevalence of infection with T. gondii in people living in rural vs. urban areas was 6.2% (95%CI: 4.8–7.8) (adjusted seroprevalence based on census figures 5.1%, 95% CI 3.9–6.5), and 19.0% (95%CI: 16.5–21.7) (adjusted 16.4%, 95% CI 14.1–19.3), respectively, without significant gender-specific differences. The seroprevalence increased with age. Independently low social status increased the risk of Toxoplasma seropositivity while increasing numbers of sheep owned decreased the risk of seropositivity. Water supply, consumption of unpasteurized milk products or undercooked meat, as

  1. Uncertainties in estimates of the risks of late effects from space radiation.

    PubMed

    Cucinotta, F A; Schimmerling, W; Wilson, J W; Peterson, L E; Saganti, P B; Dicello, J F

    2004-01-01

    Methods used to project risks in low-Earth orbit are of questionable merit for exploration missions because of the limited radiobiology data and knowledge of galactic cosmic ray (GCR) heavy ions, which causes estimates of the risk of late effects to be highly uncertain. Risk projections involve a product of many biological and physical factors, each of which has a differential range of uncertainty due to lack of data and knowledge. Using the linear-additivity model for radiation risks, we use Monte-Carlo sampling from subjective uncertainty distributions in each factor to obtain an estimate of the overall uncertainty in risk projections. The resulting methodology is applied to several human space exploration mission scenarios including a deep space outpost and Mars missions of duration of 360, 660, and 1000 days. The major results are the quantification of the uncertainties in current risk estimates, the identification of factors that dominate risk projection uncertainties, and the development of a method to quantify candidate approaches to reduce uncertainties or mitigate risks. The large uncertainties in GCR risk projections lead to probability distributions of risk that mask any potential risk reduction using the "optimization" of shielding materials or configurations. In contrast, the design of shielding optimization approaches for solar particle events and trapped protons can be made at this time and promising technologies can be shown to have merit using our approach. The methods used also make it possible to express risk management objectives in terms of quantitative metrics, e.g., the number of days in space without exceeding a given risk level within well-defined confidence limits.

  2. Uncertainties in estimates of the risks of late effects from space radiation

    NASA Technical Reports Server (NTRS)

    Cucinotta, F. A.; Schimmerling, W.; Wilson, J. W.; Peterson, L. E.; Saganti, P. B.; Dicello, J. F.

    2004-01-01

    Methods used to project risks in low-Earth orbit are of questionable merit for exploration missions because of the limited radiobiology data and knowledge of galactic cosmic ray (GCR) heavy ions, which causes estimates of the risk of late effects to be highly uncertain. Risk projections involve a product of many biological and physical factors, each of which has a differential range of uncertainty due to lack of data and knowledge. Using the linear-additivity model for radiation risks, we use Monte-Carlo sampling from subjective uncertainty distributions in each factor to obtain an estimate of the overall uncertainty in risk projections. The resulting methodology is applied to several human space exploration mission scenarios including a deep space outpost and Mars missions of duration of 360, 660, and 1000 days. The major results are the quantification of the uncertainties in current risk estimates, the identification of factors that dominate risk projection uncertainties, and the development of a method to quantify candidate approaches to reduce uncertainties or mitigate risks. The large uncertainties in GCR risk projections lead to probability distributions of risk that mask any potential risk reduction using the "optimization" of shielding materials or configurations. In contrast, the design of shielding optimization approaches for solar particle events and trapped protons can be made at this time and promising technologies can be shown to have merit using our approach. The methods used also make it possible to express risk management objectives in terms of quantitative metrics, e.g., the number of days in space without exceeding a given risk level within well-defined confidence limits. Published by Elsevier Ltd on behalf of COSPAR.

  3. A simple procedure for estimating pseudo risk ratios from exposure to non-carcinogenic chemical mixtures.

    PubMed

    Scinicariello, Franco; Portier, Christopher

    2016-03-01

    Non-cancer risk assessment traditionally assumes a threshold of effect, below which there is a negligible risk of an adverse effect. The Agency for Toxic Substances and Disease Registry derives health-based guidance values known as Minimal Risk Levels (MRLs) as estimates of the toxicity threshold for non-carcinogens. Although the definition of an MRL, as well as EPA reference dose values (RfD and RfC), is a level that corresponds to "negligible risk," they represent daily exposure doses or concentrations, not risks. We present a new approach to calculate the risk at exposure to specific doses for chemical mixtures, the assumption in this approach is to assign de minimis risk at the MRL. The assigned risk enables the estimation of parameters in an exponential model, providing a complete dose-response curve for each compound from the chosen point of departure to zero. We estimated parameters for 27 chemicals. The value of k, which determines the shape of the dose-response curve, was moderately insensitive to the choice of the risk at the MRL. The approach presented here allows for the calculation of a risk from a single substance or the combined risk from multiple chemical exposures in a community. The methodology is applicable from point of departure data derived from quantal data, such as data from benchmark dose analyses or from data that can be transformed into probabilities, such as lowest-observed-adverse-effect level. The individual risks are used to calculate risk ratios that can facilitate comparison and cost-benefit analyses of environmental contamination control strategies. PMID:25667015

  4. Uncertainties in estimates of the risks of late effects from space radiation.

    PubMed

    Cucinotta, F A; Schimmerling, W; Wilson, J W; Peterson, L E; Saganti, P B; Dicello, J F

    2004-01-01

    Methods used to project risks in low-Earth orbit are of questionable merit for exploration missions because of the limited radiobiology data and knowledge of galactic cosmic ray (GCR) heavy ions, which causes estimates of the risk of late effects to be highly uncertain. Risk projections involve a product of many biological and physical factors, each of which has a differential range of uncertainty due to lack of data and knowledge. Using the linear-additivity model for radiation risks, we use Monte-Carlo sampling from subjective uncertainty distributions in each factor to obtain an estimate of the overall uncertainty in risk projections. The resulting methodology is applied to several human space exploration mission scenarios including a deep space outpost and Mars missions of duration of 360, 660, and 1000 days. The major results are the quantification of the uncertainties in current risk estimates, the identification of factors that dominate risk projection uncertainties, and the development of a method to quantify candidate approaches to reduce uncertainties or mitigate risks. The large uncertainties in GCR risk projections lead to probability distributions of risk that mask any potential risk reduction using the "optimization" of shielding materials or configurations. In contrast, the design of shielding optimization approaches for solar particle events and trapped protons can be made at this time and promising technologies can be shown to have merit using our approach. The methods used also make it possible to express risk management objectives in terms of quantitative metrics, e.g., the number of days in space without exceeding a given risk level within well-defined confidence limits. PMID:15881779

  5. A simple procedure for estimating pseudo risk ratios from exposure to non-carcinogenic chemical mixtures.

    PubMed

    Scinicariello, Franco; Portier, Christopher

    2016-03-01

    Non-cancer risk assessment traditionally assumes a threshold of effect, below which there is a negligible risk of an adverse effect. The Agency for Toxic Substances and Disease Registry derives health-based guidance values known as Minimal Risk Levels (MRLs) as estimates of the toxicity threshold for non-carcinogens. Although the definition of an MRL, as well as EPA reference dose values (RfD and RfC), is a level that corresponds to "negligible risk," they represent daily exposure doses or concentrations, not risks. We present a new approach to calculate the risk at exposure to specific doses for chemical mixtures, the assumption in this approach is to assign de minimis risk at the MRL. The assigned risk enables the estimation of parameters in an exponential model, providing a complete dose-response curve for each compound from the chosen point of departure to zero. We estimated parameters for 27 chemicals. The value of k, which determines the shape of the dose-response curve, was moderately insensitive to the choice of the risk at the MRL. The approach presented here allows for the calculation of a risk from a single substance or the combined risk from multiple chemical exposures in a community. The methodology is applicable from point of departure data derived from quantal data, such as data from benchmark dose analyses or from data that can be transformed into probabilities, such as lowest-observed-adverse-effect level. The individual risks are used to calculate risk ratios that can facilitate comparison and cost-benefit analyses of environmental contamination control strategies.

  6. Biased Exposure–Health Effect Estimates from Selection in Cohort Studies: Are Environmental Studies at Particular Risk?

    PubMed Central

    Sparrow, David; Hu, Howard; Power, Melinda C.

    2015-01-01

    Background The process of creating a cohort or cohort substudy may induce misleading exposure–health effect associations through collider stratification bias (i.e., selection bias) or bias due to conditioning on an intermediate. Studies of environmental risk factors may be at particular risk. Objectives We aimed to demonstrate how such biases of the exposure–health effect association arise and how one may mitigate them. Methods We used directed acyclic graphs and the example of bone lead and mortality (all-cause, cardiovascular, and ischemic heart disease) among 835 white men in the Normative Aging Study (NAS) to illustrate potential bias related to recruitment into the NAS and the bone lead substudy. We then applied methods (adjustment, restriction, and inverse probability of attrition weighting) to mitigate these biases in analyses using Cox proportional hazards models to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Results Analyses adjusted for age at bone lead measurement, smoking, and education among all men found HRs (95% CI) for the highest versus lowest tertile of patella lead of 1.34 (0.90, 2.00), 1.46 (0.86, 2.48), and 2.01 (0.86, 4.68) for all-cause, cardiovascular, and ischemic heart disease mortality, respectively. After applying methods to mitigate the biases, the HR (95% CI) among the 637 men analyzed were 1.86 (1.12, 3.09), 2.47 (1.23, 4.96), and 5.20 (1.61, 16.8), respectively. Conclusions Careful attention to the underlying structure of the observed data is critical to identifying potential biases and methods to mitigate them. Understanding factors that influence initial study participation and study loss to follow-up is critical. Recruitment of population-based samples and enrolling participants at a younger age, before the potential onset of exposure-related health effects, can help reduce these potential pitfalls. Citation Weisskopf MG, Sparrow D, Hu H, Power MC. 2015. Biased exposure–health effect estimates

  7. ESTIMATING RISK TO CALIFORNIA ENERGY INFRASTRUCTURE FROM PROJECTED CLIMATE CHANGE

    SciTech Connect

    Sathaye, Jayant; Dale, Larry; Larsen, Peter; Fitts, Gary; Koy, Kevin; Lewis, Sarah; Lucena, Andre

    2011-06-22

    This report outlines the results of a study of the impact of climate change on the energy infrastructure of California and the San Francisco Bay region, including impacts on power plant generation; transmission line and substation capacity during heat spells; wildfires near transmission lines; sea level encroachment upon power plants, substations, and natural gas facilities; and peak electrical demand. Some end-of-century impacts were projected:Expected warming will decrease gas-fired generator efficiency. The maximum statewide coincident loss is projected at 10.3 gigawatts (with current power plant infrastructure and population), an increase of 6.2 percent over current temperature-induced losses. By the end of the century, electricity demand for almost all summer days is expected to exceed the current ninetieth percentile per-capita peak load. As much as 21 percent growth is expected in ninetieth percentile peak demand (per-capita, exclusive of population growth). When generator losses are included in the demand, the ninetieth percentile peaks may increase up to 25 percent. As the climate warms, California's peak supply capacity will need to grow faster than the population.Substation capacity is projected to decrease an average of 2.7 percent. A 5C (9F) air temperature increase (the average increase predicted for hot days in August) will diminish the capacity of a fully-loaded transmission line by an average of 7.5 percent.The potential exposure of transmission lines to wildfire is expected to increase with time. We have identified some lines whose probability of exposure to fire are expected to increase by as much as 40 percent. Up to 25 coastal power plants and 86 substations are at risk of flooding (or partial flooding) due to sea level rise.

  8. Comparison of Paper-and-Pencil versus Web Administration of the Youth Risk Behavior Survey (YRBS): Risk Behavior Prevalence Estimates

    ERIC Educational Resources Information Center

    Eaton, Danice K.; Brener, Nancy D.; Kann, Laura; Denniston, Maxine M.; McManus, Tim; Kyle, Tonja M.; Roberts, Alice M.; Flint, Katherine H.; Ross, James G.

    2010-01-01

    The authors examined whether paper-and-pencil and Web surveys administered in the school setting yield equivalent risk behavior prevalence estimates. Data were from a methods study conducted by the Centers for Disease Control and Prevention (CDC) in spring 2008. Intact classes of 9th- or 10th-grade students were assigned randomly to complete a…

  9. Estimation of cancer risks and benefits associated with a potential increased consumption of fruits and vegetables.

    PubMed

    Reiss, Richard; Johnston, Jason; Tucker, Kevin; DeSesso, John M; Keen, Carl L

    2012-12-01

    The current paper provides an analysis of the potential number of cancer cases that might be prevented if half the U.S. population increased its fruit and vegetable consumption by one serving each per day. This number is contrasted with an upper-bound estimate of concomitant cancer cases that might be theoretically attributed to the intake of pesticide residues arising from the same additional fruit and vegetable consumption. The cancer prevention estimates were derived using a published meta-analysis of nutritional epidemiology studies. The cancer risks were estimated using U.S. Environmental Protection Agency (EPA) methods, cancer potency estimates from rodent bioassays, and pesticide residue sampling data from the U.S. Department of Agriculture (USDA). The resulting estimates are that approximately 20,000 cancer cases per year could be prevented by increasing fruit and vegetable consumption, while up to 10 cancer cases per year could be caused by the added pesticide consumption. These estimates have significant uncertainties (e.g., potential residual confounding in the fruit and vegetable epidemiologic studies and reliance on rodent bioassays for cancer risk). However, the overwhelming difference between benefit and risk estimates provides confidence that consumers should not be concerned about cancer risks from consuming conventionally-grown fruits and vegetables.

  10. Study on quantile estimates of extreme precipitation and their spatiotemporal consistency adjustment over the Huaihe River basin

    NASA Astrophysics Data System (ADS)

    Shao, Yuehong; Wu, Junmei; Li, Min

    2016-09-01

    The quantile estimates and spatiotemporal consistency of extreme precipitation are studied by regional linear frequency analysis for Huaihe River basin in China. Firstly, the study area can be categorized into six homogeneous regions by using cluster analysis, heterogeneity measure, and discordancy measure. In the next step, we determine the optimum distribution for each homogeneous region by using two criteria of Monte Carlo simulations and the root-mean-square error (RMSE) of the sample L-moments. A diagram of L-moments ratio is used to further judge and validate the optimum distribution. The generalized extreme value (GEV), generalized normal (GNO), and generalized logistic (GLO) for 24-h duration are determined to be the more appropriate distribution based on the two criteria, L-moments ratio plot, and the tail thickness of curve in adjacent regions. A summary assessment can provide the more reasonable distribution, which avoids arbitrary results from single test. An important practical element of this study that was missing from previous works is the quantile spatiotemporal consistency analysis, which helps identify non-monotonicity among quantiles at different durations and reduces the gradient of estimates in the adjacent regions. Abnormality and spatial discontinuation can be removed by distributing the surplus of the ratio and twice different interpolation. A complete set of spatiotemporal consistent quantile estimates for various duration (24 h, 3 days, 5 days, and 7 days) and return periods (from 2 to 1000 years) can be obtained by using the abovementioned method in the study area, which are in the agreement with the observed precipitation extremes. It will provide important basis for hydrometeorological research, which is of significant scientific and practical merit.

  11. Enhancing Global Land Surface Hydrology Estimates from the NASA MERRA Reanalysis Using Precipitation Observations and Model Parameter Adjustments

    NASA Technical Reports Server (NTRS)

    Reichle, Rolf; Koster, Randal; DeLannoy, Gabrielle; Forman, Barton; Liu, Qing; Mahanama, Sarith; Toure, Ally

    2011-01-01

    The Modern-Era Retrospective analysis for Research and Applications (MERRA) is a state-of-the-art reanalysis that provides. in addition to atmospheric fields. global estimates of soil moisture, latent heat flux. snow. and runoff for J 979-present. This study introduces a supplemental and improved set of land surface hydrological fields ('MERRA-Land') generated by replaying a revised version of the land component of the MERRA system. Specifically. the MERRA-Land estimates benefit from corrections to the precipitation forcing with the Global Precipitation Climatology Project pentad product (version 2.1) and from revised parameters in the rainfall interception model, changes that effectively correct for known limitations in the MERRA land surface meteorological forcings. The skill (defined as the correlation coefficient of the anomaly time series) in land surface hydrological fields from MERRA and MERRA-Land is assessed here against observations and compared to the skill of the state-of-the-art ERA-Interim reanalysis. MERRA-Land and ERA-Interim root zone soil moisture skills (against in situ observations at 85 US stations) are comparable and significantly greater than that of MERRA. Throughout the northern hemisphere, MERRA and MERRA-Land agree reasonably well with in situ snow depth measurements (from 583 stations) and with snow water equivalent from an independent analysis. Runoff skill (against naturalized stream flow observations from 15 basins in the western US) of MERRA and MERRA-Land is typically higher than that of ERA-Interim. With a few exceptions. the MERRA-Land data appear more accurate than the original MERRA estimates and are thus recommended for those interested in using '\\-tERRA output for land surface hydrological studies.

  12. Risk Stratification by 24-Hour Ambulatory Blood Pressure and Estimated Glomerular Filtration Rate in 5322 Subjects From 11 Populations

    PubMed Central

    Boggia, José; Thijs, Lutgarde; Li, Yan; Hansen, Tine W.; Kikuya, Masahiro; Björklund-Bodegård, Kristina; Ohkubo, Takayoshi; Jeppesen, Jørgen; Torp-Pedersen, Christian; Dolan, Eamon; Kuznetsova, Tatiana; Stolarz-Skrzypek, Katarzyna; Tikhonoff, Valérie; Malyutina, Sofia; Casiglia, Edoardo; Nikitin, Yuri; Lind, Lars; Schwedt, Emma; Sandoya, Edgardo; Kawecka-Jaszcz, Kalina; Filipovský, Jan; Imai, Yutaka; Wang, Jiguang; Ibsen, Hans; O’Brien, Eoin; Staessen, Jan A.

    2013-01-01

    No previous study addressed whether in the general population estimated glomerular filtration rate (eGFR [Chronic Kidney Disease Epidemiology Collaboration formula]) adds to the prediction of cardiovascular outcome over and beyond ambulatory blood pressure. We recorded health outcomes in 5322 subjects (median age, 51.8 years; 43.1% women) randomly recruited from 11 populations, who had baseline measurements of 24-hour ambulatory blood pressure (ABP24) and eGFR. We computed hazard ratios using multivariable-adjusted Cox regression. Median follow-up was 9.3 years. In fully adjusted models, which included both ABP24 and eGFR, ABP24 predicted (P≤0.008) both total (513 deaths) and cardiovascular (206) mortality; eGFR only predicted cardiovascular mortality (P=0.012). Furthermore, ABP24 predicted (P≤0.0056) fatal combined with nonfatal events as a result of all cardiovascular causes (555 events), cardiac disease (335 events), or stroke (218 events), whereas eGFR only predicted the composite cardiovascular end point and stroke (P≤0.035). The interaction terms between ABP24 and eGFR were all nonsignificant (P≥0.082). For cardiovascular mortality, the composite cardiovascular end point, and stroke, ABP24 added 0.35%, 1.17%, and 1.00% to the risk already explained by cohort, sex, age, body mass index, smoking and drinking, previous cardiovascular disease, diabetes mellitus, and antihypertensive drug treatment. Adding eGFR explained an additional 0.13%, 0.09%, and 0.14%, respectively. Sensitivity analyses stratified for ethnicity, sex, and the presence of hypertension or chronic kidney disease (eGFR <60 mL/min per 1.73 m2) were confirmatory. In conclusion, in the general population, eGFR predicts fewer end points than ABP24. Relative to ABP24, eGFR is as an additive, not a multiplicative, risk factor and refines risk stratification 2- to 14-fold less. PMID:23172928

  13. Assessment of the value of a genetic risk score in improving the estimation of coronary risk

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The American Heart Association has established criteria for the evaluation of novel markers of cardiovascular risk. In accordance with these criteria, we assessed the association between a multi-locus genetic risk score (GRS) and incident coronary heart disease (CHD), and evaluated whether this GRS ...

  14. Mobile Applications for Type 2 Diabetes Risk Estimation: a Systematic Review.

    PubMed

    Fijacko, Nino; Brzan, Petra Povalej; Stiglic, Gregor

    2015-10-01

    Screening for chronical diseases like type 2 diabetes can be done using different methods and various risk tests. This study present a review of type 2 diabetes risk estimation mobile applications focusing on their functionality and availability of information on the underlying risk calculators. Only 9 out of 31 reviewed mobile applications, featured in three major mobile application stores, disclosed the name of risk calculator used for assessing the risk of type 2 diabetes. Even more concerning, none of the reviewed applications mentioned that they are collecting the data from users to improve the performance of their risk estimation calculators or offer users the descriptive statistics of the results from users that already used the application. For that purpose the questionnaires used for calculation of risk should be upgraded by including the information on the most recent blood sugar level measurements from users. Although mobile applications represent a great future potential for health applications, developers still do not put enough emphasis on informing the user of the underlying methods used to estimate the risk for a specific clinical condition. PMID:26303152

  15. Mobile Applications for Type 2 Diabetes Risk Estimation: a Systematic Review.

    PubMed

    Fijacko, Nino; Brzan, Petra Povalej; Stiglic, Gregor

    2015-10-01

    Screening for chronical diseases like type 2 diabetes can be done using different methods and various risk tests. This study present a review of type 2 diabetes risk estimation mobile applications focusing on their functionality and availability of information on the underlying risk calculators. Only 9 out of 31 reviewed mobile applications, featured in three major mobile application stores, disclosed the name of risk calculator used for assessing the risk of type 2 diabetes. Even more concerning, none of the reviewed applications mentioned that they are collecting the data from users to improve the performance of their risk estimation calculators or offer users the descriptive statistics of the results from users that already used the application. For that purpose the questionnaires used for calculation of risk should be upgraded by including the information on the most recent blood sugar level measurements from users. Although mobile applications represent a great future potential for health applications, developers still do not put enough emphasis on informing the user of the underlying methods used to estimate the risk for a specific clinical condition.

  16. Mathematical Models for Estimating the Risks of Bovine Spongiform Encephalopathy (BSE).

    PubMed

    Al-Zoughool, Mustafa; Cottrell, David; Elsaadany, Susie; Murray, Noel; Oraby, Tamer; Smith, Robert; Krewski, Daniel

    2015-01-01

    When the bovine spongiform encephalopathy (BSE) epidemic first emerged in the United Kingdom in the mid 1980s, the etiology of animal prion diseases was largely unknown. Risk management efforts to control the disease were also subject to uncertainties regarding the extent of BSE infections and future course of the epidemic. As understanding of BSE increased, mathematical models were developed to estimate risk of BSE infection and to predict reductions in risk in response to BSE control measures. Risk models of BSE-transmission dynamics determined disease persistence in cattle herds and relative infectivity of cattle prior to onset of clinical disease. These BSE models helped in understanding key epidemiological features of BSE transmission and dynamics, such as incubation period distribution and age-dependent infection susceptibility to infection with the BSE agent. This review summarizes different mathematical models and methods that have been used to estimate risk of BSE, and discusses how such risk projection models have informed risk assessment and management of BSE. This review also provides some general insights on how mathematical models of the type discussed here may be used to estimate risks of emerging zoonotic diseases when biological data on transmission of the etiological agent are limited.

  17. Mathematical Models for Estimating the Risks of Bovine Spongiform Encephalopathy (BSE).

    PubMed

    Al-Zoughool, Mustafa; Cottrell, David; Elsaadany, Susie; Murray, Noel; Oraby, Tamer; Smith, Robert; Krewski, Daniel

    2015-01-01

    When the bovine spongiform encephalopathy (BSE) epidemic first emerged in the United Kingdom in the mid 1980s, the etiology of animal prion diseases was largely unknown. Risk management efforts to control the disease were also subject to uncertainties regarding the extent of BSE infections and future course of the epidemic. As understanding of BSE increased, mathematical models were developed to estimate risk of BSE infection and to predict reductions in risk in response to BSE control measures. Risk models of BSE-transmission dynamics determined disease persistence in cattle herds and relative infectivity of cattle prior to onset of clinical disease. These BSE models helped in understanding key epidemiological features of BSE transmission and dynamics, such as incubation period distribution and age-dependent infection susceptibility to infection with the BSE agent. This review summarizes different mathematical models and methods that have been used to estimate risk of BSE, and discusses how such risk projection models have informed risk assessment and management of BSE. This review also provides some general insights on how mathematical models of the type discussed here may be used to estimate risks of emerging zoonotic diseases when biological data on transmission of the etiological agent are limited. PMID:26158300

  18. Estimate of overdiagnosis of breast cancer due to mammography after adjustment for lead time. A service screening study in Italy

    PubMed Central

    Paci, Eugenio; Miccinesi, Guido; Puliti, Donella; Baldazzi, Paola; De Lisi, Vincenzo; Falcini, Fabio; Cirilli, Claudia; Ferretti, Stefano; Mangone, Lucia; Finarelli, Alba Carola; Rosso, Stefano; Segnan, Nereo; Stracci, Fabrizio; Traina, Adele; Tumino, Rosario; Zorzi, Manuel

    2006-01-01

    Introduction Excess of incidence rates is the expected consequence of service screening. The aim of this paper is to estimate the quota attributable to overdiagnosis in the breast cancer screening programmes in Northern and Central Italy. Methods All patients with breast cancer diagnosed between 50 and 74 years who were resident in screening areas in the six years before and five years after the start of the screening programme were included. We calculated a corrected-for-lead-time number of observed cases for each calendar year. The number of observed incident cases was reduced by the number of screen-detected cases in that year and incremented by the estimated number of screen-detected cases that would have arisen clinically in that year. Results In total we included 13,519 and 13,999 breast cancer cases diagnosed in the pre-screening and screening years, respectively. In total, the excess ratio of observed to predicted in situ and invasive cases was 36.2%. After correction for lead time the excess ratio was 4.6% (95% confidence interval 2 to 7%) and for invasive cases only it was 3.2% (95% confidence interval 1 to 6%). Conclusion The remaining excess of cancers after individual correction for lead time was lower than 5%. PMID:17147789

  19. Prophylactic radiotherapy against heterotopic ossification following internal fixation of acetabular fractures: a comparative estimate of risk

    PubMed Central

    Nasr, P; Yip, G; Scaife, J E; House, T; Thomas, S J; Harris, F; Owen, P J; Hull, P

    2014-01-01

    Objective: Radiotherapy (RT) is effective in preventing heterotopic ossification (HO) around acetabular fractures requiring surgical reconstruction. We audited outcomes and estimated risks from RT prophylaxis, and alternatives of indometacin or no prophylaxis. Methods: 34 patients underwent reconstruction of acetabular fractures through a posterior approach, followed by a 8-Gy single fraction. The mean age was 44 years. The mean time from surgery to RT was 1.1 days. The major RT risk is radiation-induced fatal cancer. The International Commission on Radiological Protection (ICRP) method was used to estimate risk, and compared with a method (Trott and Kemprad) specifically for estimating RT risk for benign disease. These were compared with risks associated with indometacin and no prophylaxis. Results: 28 patients (82%) developed no HO; 6 developed Brooker Class I; and none developed Class II–IV HO. The ICRP method suggests a risk of fatal cancer in the range of 1 in 1000 to 1 in 10,000; the Trott and Kemprad method suggests 1 in 3000. For younger patients, this may rise to 1 in 2000; and for elderly patients, it may fall to 1 in 6000. The risk of death from gastric bleeding or perforation from indometacin is 1 in 180 to 1 in 900 in older patients. Without prophylaxis risk of death from reoperation to remove HO is 1 in 4000 to 1 in 30,000. Conclusion: These results are encouraging, consistent with much larger series and endorse our multidisciplinary management. Risk estimates can be used in discussion with patients. Advances in knowledge: The risk from RT prophylaxis is small, it is safer than indometacin and substantially overlaps with the range for no prophylaxis. PMID:25089852

  20. Estimating risk at a Superfund site using passive sampling devices as biological surrogates in human health risk models.

    PubMed

    Allan, Sarah E; Sower, Gregory J; Anderson, Kim A

    2011-10-01

    Passive sampling devices (PSDs) sequester the freely dissolved fraction of lipophilic contaminants, mimicking passive chemical uptake and accumulation by biomembranes and lipid tissues. Public Health Assessments that inform the public about health risks from exposure to contaminants through consumption of resident fish are generally based on tissue data, which can be difficult to obtain and requires destructive sampling. The purpose of this study is to apply PSD data in a Public Health Assessment to demonstrate that PSDs can be used as a biological surrogate to evaluate potential human health risks and elucidate spatio-temporal variations in risk. PSDs were used to measure polycyclic aromatic hydrocarbons (PAHs) in the Willamette River; upriver, downriver and within the Portland Harbor Superfund megasite for 3 years during wet and dry seasons. Based on an existing Public Health Assessment for this area, concentrations of PAHs in PSDs were substituted for fish tissue concentrations. PSD measured PAH concentrations captured the magnitude, range and variability of PAH concentrations reported for fish/shellfish from Portland Harbor. Using PSD results in place of fish data revealed an unacceptable risk level for cancer in all seasons but no unacceptable risk for non-cancer endpoints. Estimated cancer risk varied by several orders of magnitude based on season and location. Sites near coal tar contamination demonstrated the highest risk, particularly during the dry season and remediation activities. Incorporating PSD data into Public Health Assessments provides specific spatial and temporal contaminant exposure information that can assist public health professionals in evaluating human health risks.

  1. Estimating risk at a Superfund site using passive sampling devices as biological surrogates in human health risk models

    PubMed Central

    Allan, Sarah E.; Sower, Gregory J.; Anderson, Kim A.

    2013-01-01

    Passive sampling devices (PSDs) sequester the freely dissolved fraction of lipophilic contaminants, mimicking passive chemical uptake and accumulation by biomembranes and lipid tissues. Public Health Assessments that inform the public about health risks from exposure to contaminants through consumption of resident fish are generally based on tissue data, which can be difficulties to obtain and requires destructive sampling. The purpose of this study is to apply PSD data in a Public Health Assessment to demonstrate that PSDs can be used as a biological surrogate to evaluate potential human health risks and elucidate spatio-temporal variations in risk. PSDs were used to measure polycyclic aromatic hydrocarbons (PAHs) in the Willamette River; upriver, downriver and within the Portland Harbor Superfund megasite for three years during wet and dry seasons. Based on an existing Public Health Assessment for this area, concentrations of PAHs in PSDs were substituted for fish tissue concentrations. PSD measured PAH concentrations captured the magnitude, range and variability of PAH concentrations reported for fish/shellfish from Portland Harbor. Using PSD results in place of fish data revealed an unacceptable risk level for cancer in all seasons but no unacceptable risk for non-cancer endpoints. Estimated cancer risk varied by several orders of magnitude based on season and location. Sites near coal tar contamination demonstrated the highest risk, particularly during the dry season and remediation activities. Incorporating PSD data into Public Health Assessments provides specific spatial and temporal contaminant exposure information that can assist public health professionals in evaluating human health risks. PMID:21741671

  2. Response bias, weighting adjustments, and design effects in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

    PubMed

    Kessler, Ronald C; Heeringa, Steven G; Colpe, Lisa J; Fullerton, Carol S; Gebler, Nancy; Hwang, Irving; Naifeh, James A; Nock, Matthew K; Sampson, Nancy A; Schoenbaum, Michael; Zaslavsky, Alan M; Stein, Murray B; Ursano, Robert J

    2013-12-01

    The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multi-component epidemiological and neurobiological study designed to generate actionable recommendations to reduce US Army suicides and increase knowledge about determinants of suicidality. Three Army STARRS component studies are large-scale surveys: one of new soldiers prior to beginning Basic Combat Training (BCT; n = 50,765 completed self-administered questionnaires); another of other soldiers exclusive of those in BCT (n = 35,372); and a third of three Brigade Combat Teams about to deploy to Afghanistan who are being followed multiple times after returning from deployment (n = 9421). Although the response rates in these surveys are quite good (72.0-90.8%), questions can be raised about sample biases in estimating prevalence of mental disorders and suicidality, the main outcomes of the surveys based on evidence that people in the general population with mental disorders are under-represented in community surveys. This paper presents the results of analyses designed to determine whether such bias exists in the Army STARRS surveys and, if so, to develop weights to correct for these biases. Data are also presented on sample inefficiencies introduced by weighting and sample clustering and on analyses of the trade-off between bias and efficiency in weight trimming.

  3. [Structural adjustment, cultural adjustment?].

    PubMed

    Dujardin, B; Dujardin, M; Hermans, I

    2003-12-01

    Over the last two decades, multiple studies have been conducted and many articles published about Structural Adjustment Programmes (SAPs). These studies mainly describe the characteristics of SAPs and analyse their economic consequences as well as their effects upon a variety of sectors: health, education, agriculture and environment. However, very few focus on the sociological and cultural effects of SAPs. Following a summary of SAP's content and characteristics, the paper briefly discusses the historical course of SAPs and the different critiques which have been made. The cultural consequences of SAPs are introduced and are described on four different levels: political, community, familial, and individual. These levels are analysed through examples from the literature and individual testimonies from people in the Southern Hemisphere. The paper concludes that SAPs, alongside economic globalisation processes, are responsible for an acute breakdown of social and cultural structures in societies in the South. It should be a priority, not only to better understand the situation and its determining factors, but also to intervene and act with strategies that support and reinvest in the social and cultural sectors, which is vital in order to allow for individuals and communities in the South to strengthen their autonomy and identify.

  4. FY 2000 Buildings Energy Savings Estimates under Uncertainty: Developing Approaches for Incorporating Risk into Buildings Program Energy Efficiency Estimates

    SciTech Connect

    Anderson, Dave M.

    2002-11-18

    This report is one of two that re-examines the forecasted impact of individual programs currently within the Buildings Technology Program (BT) and the Weatherization and Intergovernmental Program (WIP) that appeared in the FY2000 Presidential Budget request. This report develops potential methods for allowing inherent risk to be captured in the program benefits analysis. Note that the FY2000 budget request was originally analyzed under the former Office of Building Technology, State and Community Programs (BTS), where BT and WIP were previously combined. Throughout the document, reference will be made to the predecessor of the BT and WIP programs, BTS, as FY2000 reflected that organization. A companion report outlines the effects of re-estimating the FY 2000 budget request based on overlaying program data from subsequent years, essentially revised out-year forecasts. That report shows that year-to-year long-term projections of primary energy savings can vary widely as models improve and programs change. Those point estimates are not influenced by uncertainty or risk. This report develops potential methods for allowing inherent risk to affect the benefits analysis via Monte Carlo simulation.

  5. Lifetime risk of stroke and impact of hypertension: estimates from the adult health study in Hiroshima and Nagasaki.

    PubMed

    Takahashi, Ikuno; Geyer, Susan M; Nishi, Nobuo; Ohshita, Tomohiko; Takahashi, Tetsuya; Akahoshi, Masazumi; Fujiwara, Saeko; Kodama, Kazunori; Matsumoto, Masayasu

    2011-05-01

    Very few reports have been published on lifetime risk (LTR) of stroke by blood pressure (BP) group. This study included participants in the Radiation Effects Research Foundation Adult Health Study who have been followed up by biennial health examinations since 1958. We calculated the LTR of stroke for various BP-based groups among 7847 subjects who had not been diagnosed with stroke before the index age of 55 years using cumulative incidence analysis adjusting for competing risks. By 2003, 868 subjects had suffered stroke (512 (58.9%) were women and 542 (62.4%) experienced ischemic stroke). BP was a significant factor in determining risk of stroke for men and women, with distributions of cumulative risk for stroke significantly different across BP groups. The LTR of all-stroke for normotension (systolic BP/diastolic BP < 120/80 mm Hg), prehypertension (120-139/80-89 mm Hg), stage 1 hypertension (140-159/90-99 mm Hg) and stage 2 hypertension (> 160/100 mm Hg) were 13.8-16.9-25.8-25.8% in men and 16.0-19.9-24.0-30.5% in women, respectively (P < 0.001 among BP groups in both sexes). The estimates did not differ significantly (P = 0.16) between normotensive and prehypertensive subjects. One in five Japanese atomic bomb survivor subjects experienced stroke over their lifetime from the age of 55 years. Long-term stroke risks were elevated in those with hypertension (> 140/90 mm Hg) at any of the index ages of 45, 55, 65 and 75 years.

  6. Lifetime risk of stroke and impact of hypertension: estimates from the adult health study in Hiroshima and Nagasaki.

    PubMed

    Takahashi, Ikuno; Geyer, Susan M; Nishi, Nobuo; Ohshita, Tomohiko; Takahashi, Tetsuya; Akahoshi, Masazumi; Fujiwara, Saeko; Kodama, Kazunori; Matsumoto, Masayasu

    2011-05-01

    Very few reports have been published on lifetime risk (LTR) of stroke by blood pressure (BP) group. This study included participants in the Radiation Effects Research Foundation Adult Health Study who have been followed up by biennial health examinations since 1958. We calculated the LTR of stroke for various BP-based groups among 7847 subjects who had not been diagnosed with stroke before the index age of 55 years using cumulative incidence analysis adjusting for competing risks. By 2003, 868 subjects had suffered stroke (512 (58.9%) were women and 542 (62.4%) experienced ischemic stroke). BP was a significant factor in determining risk of stroke for men and women, with distributions of cumulative risk for stroke significantly different across BP groups. The LTR of all-stroke for normotension (systolic BP/diastolic BP < 120/80 mm Hg), prehypertension (120-139/80-89 mm Hg), stage 1 hypertension (140-159/90-99 mm Hg) and stage 2 hypertension (> 160/100 mm Hg) were 13.8-16.9-25.8-25.8% in men and 16.0-19.9-24.0-30.5% in women, respectively (P < 0.001 among BP groups in both sexes). The estimates did not differ significantly (P = 0.16) between normotensive and prehypertensive subjects. One in five Japanese atomic bomb survivor subjects experienced stroke over their lifetime from the age of 55 years. Long-term stroke risks were elevated in those with hypertension (> 140/90 mm Hg) at any of the index ages of 45, 55, 65 and 75 years. PMID:21326305

  7. Risk factors for chronic undernutrition among children in India: Estimating relative importance, population attributable risk and fractions.

    PubMed

    Corsi, Daniel J; Mejía-Guevara, Iván; Subramanian, S V

    2016-05-01

    Nearly 40% of the world's stunted children live in India and the prevalence of undernutrition has been persistently high in recent decades. Given numerous available interventions for reducing undernutrition in children, it is not clear of the relative importance of each within a multifactorial framework. We assess the simultaneous contribution of 15 known risk factors for child chronic undernutrition in India. Data are from the 3rd Indian National Family Health Survey (NFHS-3), a nationally representative cross-sectional survey undertaken in 2005-2006. The study population consisted of children aged 6-59 months [n = 26,842 (stunting/low height-for-age), n = 27,483 (underweight/low weight-for-age)]. Risk factors examined for their association with undernutrition were: vitamin A supplementation, vaccination, use of iodized salt, household air quality, improved sanitary facilities, safe disposal of stools, improved drinking water, prevalence of infectious disease, initiation of breastfeeding, dietary diversity, age at marriage, maternal BMI, height, education, and household wealth. Age/sex-adjusted and multivariable adjusted effect sizes (odds ratios) were calculated for risk factors along with Population Attributable Risks (PAR) and Fractions (PAF) using logistic regression. In the mutually adjusted models, the five most important predictors of childhood stunting/underweight were short maternal stature, mother having no education, households in lowest wealth quintile, poor dietary diversity, and maternal underweight. These five factors had a combined PAR of 67.2% (95% CI: 63.3-70.7) and 69.7% (95% CI: 66.3-72.8) for stunting and underweight, respectively. The remaining factors were associated with a combined PAR of 11.7% (95% CI: 6.0-17.4) and 15.1% (95% CI: 8.9-21.3) for stunting and underweight, respectively. Implementing strategies focused on broader progress on social circumstances and infrastructural domains as well as investments in nutrition specific

  8. Risk factors for chronic undernutrition among children in India: Estimating relative importance, population attributable risk and fractions.

    PubMed

    Corsi, Daniel J; Mejía-Guevara, Iván; Subramanian, S V

    2016-05-01

    Nearly 40% of the world's stunted children live in India and the prevalence of undernutrition has been persistently high in recent decades. Given numerous available interventions for reducing undernutrition in children, it is not clear of the relative importance of each within a multifactorial framework. We assess the simultaneous contribution of 15 known risk factors for child chronic undernutrition in India. Data are from the 3rd Indian National Family Health Survey (NFHS-3), a nationally representative cross-sectional survey undertaken in 2005-2006. The study population consisted of children aged 6-59 months [n = 26,842 (stunting/low height-for-age), n = 27,483 (underweight/low weight-for-age)]. Risk factors examined for their association with undernutrition were: vitamin A supplementation, vaccination, use of iodized salt, household air quality, improved sanitary facilities, safe disposal of stools, improved drinking water, prevalence of infectious disease, initiation of breastfeeding, dietary diversity, age at marriage, maternal BMI, height, education, and household wealth. Age/sex-adjusted and multivariable adjusted effect sizes (odds ratios) were calculated for risk factors along with Population Attributable Risks (PAR) and Fractions (PAF) using logistic regression. In the mutually adjusted models, the five most important predictors of childhood stunting/underweight were short maternal stature, mother having no education, households in lowest wealth quintile, poor dietary diversity, and maternal underweight. These five factors had a combined PAR of 67.2% (95% CI: 63.3-70.7) and 69.7% (95% CI: 66.3-72.8) for stunting and underweight, respectively. The remaining factors were associated with a combined PAR of 11.7% (95% CI: 6.0-17.4) and 15.1% (95% CI: 8.9-21.3) for stunting and underweight, respectively. Implementing strategies focused on broader progress on social circumstances and infrastructural domains as well as investments in nutrition specific

  9. Estimated Risk Level of Unified Stereotactic Body Radiation Therapy Dose Tolerance Limits for Spinal Cord.

    PubMed

    Grimm, Jimm; Sahgal, Arjun; Soltys, Scott G; Luxton, Gary; Patel, Ashish; Herbert, Scott; Xue, Jinyu; Ma, Lijun; Yorke, Ellen; Adler, John R; Gibbs, Iris C

    2016-04-01

    A literature review of more than 200 stereotactic body radiation therapy spine articles from the past 20 years found only a single article that provided dose-volume data and outcomes for each spinal cord of a clinical dataset: the Gibbs 2007 article (Gibbs et al, 2007(1)), which essentially contains the first 100 stereotactic body radiation therapy (SBRT) spine treatments from Stanford University Medical Center. The dataset is modeled and compared in detail to the rest of the literature review, which found 59 dose tolerance limits for the spinal cord in 1-5 fractions. We partitioned these limits into a unified format of high-risk and low-risk dose tolerance limits. To estimate the corresponding risk level of each limit we used the Gibbs 2007 clinical spinal cord dose-volume data for 102 spinal metastases in 74 patients treated by spinal radiosurgery. In all, 50 of the patients were previously irradiated to a median dose of 40Gy in 2-3Gy fractions and 3 patients developed treatment-related myelopathy. These dose-volume data were digitized into the dose-volume histogram (DVH) Evaluator software tool where parameters of the probit dose-response model were fitted using the maximum likelihood approach (Jackson et al, 1995(3)). Based on this limited dataset, for de novo cases the unified low-risk dose tolerance limits yielded an estimated risk of spinal cord injury of ≤1% in 1-5 fractions, and the high-risk limits yielded an estimated risk of ≤3%. The QUANTEC Dmax limits of 13Gy in a single fraction and 20Gy in 3 fractions had less than 1% risk estimated from this dataset, so we consider these among the low-risk limits. In the previously irradiated cohort, the estimated risk levels for 10 and 14Gy maximum cord dose limits in 5 fractions are 0.4% and 0.6%, respectively. Longer follow-up and more patients are required to improve the risk estimates and provide more complete validation. PMID:27000514

  10. Estimated Risk Level of Unified Stereotactic Body Radiation Therapy Dose Tolerance Limits for Spinal Cord.

    PubMed

    Grimm, Jimm; Sahgal, Arjun; Soltys, Scott G; Luxton, Gary; Patel, Ashish; Herbert, Scott; Xue, Jinyu; Ma, Lijun; Yorke, Ellen; Adler, John R; Gibbs, Iris C

    2016-04-01

    A literature review of more than 200 stereotactic body radiation therapy spine articles from the past 20 years found only a single article that provided dose-volume data and outcomes for each spinal cord of a clinical dataset: the Gibbs 2007 article (Gibbs et al, 2007(1)), which essentially contains the first 100 stereotactic body radiation therapy (SBRT) spine treatments from Stanford University Medical Center. The dataset is modeled and compared in detail to the rest of the literature review, which found 59 dose tolerance limits for the spinal cord in 1-5 fractions. We partitioned these limits into a unified format of high-risk and low-risk dose tolerance limits. To estimate the corresponding risk level of each limit we used the Gibbs 2007 clinical spinal cord dose-volume data for 102 spinal metastases in 74 patients treated by spinal radiosurgery. In all, 50 of the patients were previously irradiated to a median dose of 40Gy in 2-3Gy fractions and 3 patients developed treatment-related myelopathy. These dose-volume data were digitized into the dose-volume histogram (DVH) Evaluator software tool where parameters of the probit dose-response model were fitted using the maximum likelihood approach (Jackson et al, 1995(3)). Based on this limited dataset, for de novo cases the unified low-risk dose tolerance limits yielded an estimated risk of spinal cord injury of ≤1% in 1-5 fractions, and the high-risk limits yielded an estimated risk of ≤3%. The QUANTEC Dmax limits of 13Gy in a single fraction and 20Gy in 3 fractions had less than 1% risk estimated from this dataset, so we consider these among the low-risk limits. In the previously irradiated cohort, the estimated risk levels for 10 and 14Gy maximum cord dose limits in 5 fractions are 0.4% and 0.6%, respectively. Longer follow-up and more patients are required to improve the risk estimates and provide more complete validation.

  11. Measurement of natural radionuclides in Malaysian bottled mineral water and consequent health risk estimation

    SciTech Connect

    Priharti, W.; Samat, S. B.; Yasir, M. S.

    2015-09-25

    The radionuclides of {sup 226}Ra, {sup 232}Th and {sup 40}K were measured in ten mineral water samples, of which from the radioactivity obtained, the ingestion doses for infants, children and adults were calculated and the cancer risk for the adult was estimated. Results showed that the calculated ingestion doses for the three age categories are much lower than the average worldwide ingestion exposure of 0.29 mSv/y and the estimated cancer risk is much lower than the cancer risk of 8.40 × 10{sup −3} (estimated from the total natural radiation dose of 2.40 mSv/y). The present study concludes that the bottled mineral water produced in Malaysia is safe for daily human consumption.

  12. Measurement of natural radionuclides in Malaysian bottled mineral water and consequent health risk estimation

    NASA Astrophysics Data System (ADS)

    Priharti, W.; Samat, S. B.; Yasir, M. S.

    2015-09-01

    The radionuclides of 226Ra, 232Th and 40K were measured in ten mineral water samples, of which from the radioactivity obtained, the ingestion doses for infants, children and adults were calculated and the cancer risk for the adult was estimated. Results showed that the calculated ingestion doses for the three age categories are much lower than the average worldwide ingestion exposure of 0.29 mSv/y and the estimated cancer risk is much lower than the cancer risk of 8.40 × 10-3 (estimated from the total natural radiation dose of 2.40 mSv/y). The present study concludes that the bottled mineral water produced in Malaysia is safe for daily human consumption.

  13. Consolidating Risk Estimates for Radiation-Induced Complications in Individual Patient: Late Rectal Toxicity

    SciTech Connect

    Prior, Phillip; Devisetty, Kiran; Tarima, Sergey S.; Lawton, Colleen A.F.; Semenenko, Vladimir A.

    2012-05-01

    Purpose: To test the feasibility of a new approach to synthesize published normal tissue complication data using late rectal toxicity in prostate cancer as an example. Methods and Materials: A data survey was performed to identify the published reports on the dose-response relationships for late rectal toxicity. The risk estimates for Grade 1 or greater, Grade 2 or greater, and Grade 3 or greater toxicity were obtained for a test cohort of patients treated at our institution. The influence of the potential factors that might have affected the reported toxicity levels was investigated. The studies that did not conform to the general data trends were excluded, and single, combined risk estimates were derived for each patient and toxicity level. Results: A total of 21 studies of nonoverlapping patient populations were identified. Three studies provided dose-response models for more than one level of toxicity. Of these 21 studies, 6, 14, and 5 were used to derive the initial risk estimates for Grade 1, 2, and 3 or greater toxicity, respectively. A comparison of risk estimates between the studies reporting rectal bleeding and rectal toxicity (bleeding plus other symptoms) or between studies with follow-up <36 months and {>=}36 months did not reveal significant differences (p {>=} .29 for all comparisons). After excluding three reports that did not conform to the general data trends, the combined risk estimates were derived from 5 reports (647 patients), 11 reports (3,369 patients), and 5 reports (1,330 patients) for Grade 1, 2, and 3 or greater toxicity, respectively. Conclusions: The proposed approach is feasible and allows for more systematic use of published dose-response data to estimate the complication risks for the individual patient.

  14. The Estimate of Risk of Adolescent Sexual Offense Recidivism (ERASOR): preliminary psychometric data.

    PubMed

    Worling, James R

    2004-06-01

    The Estimate of Risk of Adolescent Sexual Offense Recidivism (ERASOR) is an empirically guided checklist designed to assist clinicians to estimate the short-term risk of a sexual reoffense for youth aged 12-18 years of age. The ERASOR provides objective coding instructions for 25 risk factors (16 dynamic and 9 static). To investigate the psychometric properties, risk ratings were collected from 28 clinicians who evaluated 136 adolescent males (aged 12-18 years) following comprehensive, clinical assessments. Preliminary psychometric data (i.e., interrater agreement, item-total correlation, internal consistency) were found to be supportive of the reliability and item composition of the tool. ERASOR ratings also significantly discriminated adolescents based on whether or not they had previously been sanctioned for a prior sexual offense. PMID:15326883

  15. Performance of default risk model with barrier option framework and maximum likelihood estimation: Evidence from Taiwan

    NASA Astrophysics Data System (ADS)

    Chou, Heng-Chih; Wang, David

    2007-11-01

    We investigate the performance of a default risk model based on the barrier option framework with maximum likelihood estimation. We provide empirical validation of the model by showing that implied default barriers are statistically significant for a sample of construction firms in Taiwan over the period 1994-2004. We find that our model dominates the commonly adopted models, Merton model, Z-score model and ZETA model. Moreover, we test the n-year-ahead prediction performance of the model and find evidence that the prediction accuracy of the model improves as the forecast horizon decreases. Finally, we assess the effect of estimated default risk on equity returns and find that default risk is able to explain equity returns and that default risk is a variable worth considering in asset-pricing tests, above and beyond size and book-to-market.

  16. A methodology for estimating risks associated with landslides of contaminated soil into rivers.

    PubMed

    Göransson, Gunnel; Norrman, Jenny; Larson, Magnus; Alén, Claes; Rosén, Lars

    2014-02-15

    Urban areas adjacent to surface water are exposed to soil movements such as erosion and slope failures (landslides). A landslide is a potential mechanism for mobilisation and spreading of pollutants. This mechanism is in general not included in environmental risk assessments for contaminated sites, and the consequences associated with contamination in the soil are typically not considered in landslide risk assessments. This study suggests a methodology to estimate the environmental risks associated with landslides in contaminated sites adjacent to rivers. The methodology is probabilistic and allows for datasets with large uncertainties and the use of expert judgements, providing quantitative estimates of probabilities for defined failures. The approach is illustrated by a case study along the river Göta Älv, Sweden, where failures are defined and probabilities for those failures are estimated. Failures are defined from a pollution perspective and in terms of exceeding environmental quality standards (EQSs) and acceptable contaminant loads. Models are then suggested to estimate probabilities of these failures. A landslide analysis is carried out to assess landslide probabilities based on data from a recent landslide risk classification study along the river Göta Älv. The suggested methodology is meant to be a supplement to either landslide risk assessment (LRA) or environmental risk assessment (ERA), providing quantitative estimates of the risks associated with landslide in contaminated sites. The proposed methodology can also act as a basis for communication and discussion, thereby contributing to intersectoral management solutions. From the case study it was found that the defined failures are governed primarily by the probability of a landslide occurring. The overall probabilities for failure are low; however, if a landslide occurs the probabilities of exceeding EQS are high and the probability of having at least a 10% increase in the contamination load

  17. A methodology for estimating risks associated with landslides of contaminated soil into rivers.

    PubMed

    Göransson, Gunnel; Norrman, Jenny; Larson, Magnus; Alén, Claes; Rosén, Lars

    2014-02-15

    Urban areas adjacent to surface water are exposed to soil movements such as erosion and slope failures (landslides). A landslide is a potential mechanism for mobilisation and spreading of pollutants. This mechanism is in general not included in environmental risk assessments for contaminated sites, and the consequences associated with contamination in the soil are typically not considered in landslide risk assessments. This study suggests a methodology to estimate the environmental risks associated with landslides in contaminated sites adjacent to rivers. The methodology is probabilistic and allows for datasets with large uncertainties and the use of expert judgements, providing quantitative estimates of probabilities for defined failures. The approach is illustrated by a case study along the river Göta Älv, Sweden, where failures are defined and probabilities for those failures are estimated. Failures are defined from a pollution perspective and in terms of exceeding environmental quality standards (EQSs) and acceptable contaminant loads. Models are then suggested to estimate probabilities of these failures. A landslide analysis is carried out to assess landslide probabilities based on data from a recent landslide risk classification study along the river Göta Älv. The suggested methodology is meant to be a supplement to either landslide risk assessment (LRA) or environmental risk assessment (ERA), providing quantitative estimates of the risks associated with landslide in contaminated sites. The proposed methodology can also act as a basis for communication and discussion, thereby contributing to intersectoral management solutions. From the case study it was found that the defined failures are governed primarily by the probability of a landslide occurring. The overall probabilities for failure are low; however, if a landslide occurs the probabilities of exceeding EQS are high and the probability of having at least a 10% increase in the contamination load

  18. Estimated human health risks of disposing of nonhazardous oil field waste in salt caverns

    SciTech Connect

    Tomasko, D.; Elcock, D.; Veil, J.

    1997-09-01

    Argonne National Laboratory (ANL) has completed an evaluation of the possibility that adverse human health effects (carcinogenic and noncarcinogenic) could result from exposure to contaminants released from nonhazardous oil field wastes (NOW) disposed in domal salt caverns. In this assessment, several steps were used to evaluate potential human health risks: identifying potential contaminants of concern, determining how humans could be exposed to these contaminants, assessing the contaminants` toxicities, estimating contaminant intakes, and, finally, calculating human cancer and noncancer risks.

  19. Urban micro-scale flood risk estimation with parsimonious hydraulic modelling and census data

    NASA Astrophysics Data System (ADS)

    Arrighi, C.; Brugioni, M.; Castelli, F.; Franceschini, S.; Mazzanti, B.

    2013-05-01

    The adoption of 2007/60/EC Directive requires European countries to implement flood hazard and flood risk maps by the end of 2013. Flood risk is the product of flood hazard, vulnerability and exposure, all three to be estimated with comparable level of accuracy. The route to flood risk assessment is consequently much more than hydraulic modelling of inundation, that is hazard mapping. While hazard maps have already been implemented in many countries, quantitative damage and risk maps are still at a preliminary level. A parsimonious quasi-2-D hydraulic model is here adopted, having many advantages in terms of easy set-up. It is here evaluated as being accurate in flood depth estimation in urban areas with a high-resolution and up-to-date Digital Surface Model (DSM). The accuracy, estimated by comparison with marble-plate records of a historic flood in the city of Florence, is characterized in the downtown's most flooded area by a bias of a very few centimetres and a determination coefficient of 0.73. The average risk is found to be about 14 € m-2 yr-1, corresponding to about 8.3% of residents' income. The spatial distribution of estimated risk highlights a complex interaction between the flood pattern and the building characteristics. As a final example application, the estimated risk values have been used to compare different retrofitting measures. Proceeding through the risk estimation steps, a new micro-scale potential damage assessment method is proposed. This is based on the georeferenced census system as the optimal compromise between spatial detail and open availability of socio-economic data. The results of flood risk assessment at the census section scale resolve most of the risk spatial variability, and they can be easily aggregated to whatever upper scale is needed given that they are geographically defined as contiguous polygons. Damage is calculated through stage-damage curves, starting from census data on building type and function, for the main

  20. Risk analysis and Monte Carlo simulation applied to the generation of drilling AFE estimates

    SciTech Connect

    Peterson, S.K.; Murtha, J.A.; Schneider, F.F.

    1995-06-01

    This paper presents a method for developing an authorization-for-expenditure (AFE)-generating model and illustrates the technique with a specific offshore field development case study. The model combines Monte Carlo simulation and statistical analysis of historical drilling data to generate more accurate, risked, AFE estimates. In addition to the general method, two examples of making AFE time estimates for North Sea wells with the presented techniques are given.

  1. The Predictive Relationship between Temperament, School Adjustment, and Academic Achievement: A 2-Year Longitudinal Study of Children At-Risk

    ERIC Educational Resources Information Center

    Al-Hendawi, Maha

    2010-01-01

    Individual differences in temperament can be a risk or a protective factor for a child, especially for children at-risk who possess single or multiple risk factors that may interfere with their educational success and affect their healthy development and their life-long outcomes. This research study examined the concurrent and longitudinal…

  2. Examining the effects of air pollution composition on within region differences in PM2.5 mortality risk estimates

    EPA Science Inventory

    Multi-city population-based epidemiological studies have observed significant heterogeneity in both the magnitude and direction of city-specific risk estimates, but tended to focus on regional differences in PM2.5 mortality risk estimates. Interpreting differences in risk estimat...

  3. Estimation of flood risk for cultural heritage in an art city

    NASA Astrophysics Data System (ADS)

    Arrighi, Chiara; Brugioni, Marcello; Franceschini, Serena; Castelli, Fabio; Mazzanti, Bernardo

    2015-04-01

    Flood risk assessment in art cities poses many challenges for the presence of cultural heritage at risk, which is a damage category whose value is hardly monetizable. In fact, valuing cultural asset is a complex task, usually requiring more effort than a rough estimation of restoration costs. The lack of an adequate risk evaluation of the cultural asset may also lead to enormous difficulties and political problems for the accomplishment of the structural mitigation solutions. The aim of the work is to perform a first analysis of the risk to cultural heritage avoiding a full quantification of exposure. Here we present a case study of broad importance, which is the art city of Florence (Italy), affected by a devastating flood in 1966. In previous studies the estimated flood risk, neglecting damages to cultural heritage, was about 53 Mio€ /year. Nevertheless, Florence hosts 176 buildings officially classified as cultural heritage and thousands of paintings, sculptures and ancient books. Proceeding similarly to the commonly accepted flood risk assessment method, the annual expected loss in terms of cultural heritage/artworks is estimated.

  4. Proteinuria and Reduced Estimated Glomerular Filtration Rate Independently Predict Risk for Acute Myocardial Infarction: Findings from a Population-Based Study in Keelung, Taiwan

    PubMed Central

    Chang, Shu-Hsuan; Tsai, Chia-Ti; Yen, Amy Ming-Fang; Lei, Meng-Huan; Chen, Hsiu-Hsi; Tseng, Chuen-Den

    2015-01-01

    Background The aim of this study was to evaluate the independent roles of proteinuria and reduced estimated glomerular filtration rate (GFR) in the development of acute myocardial infarction in a northern Taiwanese population. Methods We conducted a community-based prospective cohort study in Keelung, the northernmost county of Taiwan. A total of 63,129 subjects (63% women) ≥ 20 years of age who had no history of coronary heart disease were recruited and followed-up. Univariate and multivariate proportional hazards regression analysis was performed to assess the association between proteinuria and estimated GFR and the risk of acute myocardial infarction. Results There were 305 new cases of acute myocardial infarction (114 women and 191 men) documented during a four-year follow-up period. After adjustment of potential confounding covariates, heavier proteinuria (dipstick urinalysis reading 3+) and estimated GFR of less than 60 ml/min/1.73 m2 independently predicted increased risk of developing acute myocardial infarction. The adjusted hazard ratio (aHR) of heavier proteinuria for occurrence of acute myocardial infarction was 1.85 [95% confidence intervals (CI), 1.17-2.91, p < 0.01] (vs. the reference group: negative dipstick proteinuria). The aHR of estimated GFR of 30-59 ml/min/1.73 m2 for occurrence of acute myocardial infarction was 2.4 (95% CI, 1.31-4.38, p < 0.01) (vs. the reference group: estimated GFR ≥ 90 ml/ min/1.73 m2), and that of estimated GFR of 15-29 ml/min/1.73 m2 was 5.26 (95% CI, 2.26-12.26, p < 0.01). Conclusions We demonstrated that both heavier proteinuria and lower estimated GFR are significant independent predictors of developing future acute myocardial infarction in a northern Taiwanese population. PMID:27122856

  5. Estimate of Space Radiation-Induced Cancer Risks for International Space Station Orbits

    SciTech Connect

    Wu, H.; Atwell, W.; Cucinotta, F.A.; Yang, C.

    1996-03-01

    Excess cancer risks from exposures to space radiation are estimated for various orbits of the International Space Station (ISS). Organ exposures are computed with the transport codes, BRYNTRN and HZETRN, and the computerized anatomical male and computerized anatomical female models. Cancer risk coefficients in the National Council on Radiation Protection and Measurements report No. 98 are used to generate lifetime excess cancer incidence and cancer mortality after a one-month mission to ISS. The generated data are tabulated to serve as a quick reference for assessment of radiation risk to astronauts on ISS missions.

  6. Estimate of Space Radiation-Induced Cancer Risks for International Space Station Orbits

    NASA Technical Reports Server (NTRS)

    Wu, Honglu; Atwell, William; Cucinotta, Francis A.; Yang, Chui-hsu

    1996-01-01

    Excess cancer risks from exposures to space radiation are estimated for various orbits of the International Space Station (ISS). Organ exposures are computed with the transport codes, BRYNTRN and HZETRN, and the computerized anatomical male and computerized anatomical female models. Cancer risk coefficients in the National Council on Radiation Protection and Measurements report No. 98 are used to generate lifetime excess cancer incidence and cancer mortality after a one-month mission to ISS. The generated data are tabulated to serve as a quick reference for assessment of radiation risk to astronauts on ISS missions.

  7. Estimated occupational risk from bioaerosols generated during land application of class B biosolids.

    PubMed

    Tanner, Benjamin D; Brooks, John P; Gerba, Charles P; Haas, Charles N; Josephson, Karen L; Pepper, Ian L

    2008-01-01

    Some speculate that bioaerosols from land application of biosolids pose occupational risks, but few studies have assessed aerosolization of microorganisms from biosolids or estimated occupational risks of infection. This study investigated levels of microorganisms in air immediately downwind of land application operations and estimated occupational risks from aerosolized microorganisms. In all, more than 300 air samples were collected downwind of biosolids application sites at various locations within the United States. Coliform bacteria, coliphages, and heterotrophic plate count (HPC) bacteria were enumerated from air and biosolids at each site. Concentrations of coliforms relative to Salmonella and concentrations of coliphage relative to enteroviruses in biosolids were used, in conjunction with levels of coliforms and coliphages measured in air during this study, to estimate exposure to Salmonella and enteroviruses in air. The HPC bacteria were ubiquitous in air near land application sites whether or not biosolids were being applied, and concentrations were positively correlated to windspeed. Coliform bacteria were detected only when biosolids were being applied to land or loaded into land applicators. Coliphages were detected in few air samples, and only when biosolids were being loaded into land applicators. In general, environmental parameters had little impact on concentrations of microorganisms in air immediately downwind of land application. The method of land application was most correlated to aerosolization. From this large body of data, the occupational risk of infection from bioaerosols was estimated to be 0.78 to 2.1%/yr. Extraordinary exposure scenarios carried an estimated annual risk of infection of up to 34%, with viruses posing the greatest threat. Risks from aerosolized microorganisms at biosolids land application sites appear to be lower than those at wastewater treatment plants, based on previously reported literature. PMID:18948485

  8. Estimating cancer risk from dental cone-beam CT exposures based on skin dosimetry

    NASA Astrophysics Data System (ADS)

    Pauwels, Ruben; Cockmartin, Lesley; Ivanauskaité, Deimante; Urbonienė, Ausra; Gavala, Sophia; Donta, Catherine; Tsiklakis, Kostas; Jacobs, Reinhilde; Bosmans, Hilde; Bogaerts, Ria; Horner, Keith; SEDENTEXCT Project Consortium, The

    2014-07-01

    The aim of this study was to measure entrance skin doses on patients undergoing cone-beam computed tomography (CBCT) examinations, to establish conversion factors between skin and organ doses, and to estimate cancer risk from CBCT exposures. 266 patients (age 8-83) were included, involving three imaging centres. CBCT scans were acquired using the SCANORA 3D (Soredex, Tuusula, Finland) and NewTom 9000 (QR, Verona, Italy). Eight thermoluminescent dosimeters were attached to the patient's skin at standardized locations. Using previously published organ dose estimations on various CBCTs with an anthropomorphic phantom, correlation factors to convert skin dose to organ doses were calculated and applied to estimate patient organ doses. The BEIR VII age- and gender-dependent dose-risk model was applied to estimate the lifetime attributable cancer risk. For the SCANORA 3D, average skin doses over the eight locations varied between 484 and 1788 µGy. For the NewTom 9000 the range was between 821 and 1686 µGy for Centre 1 and between 292 and 2325 µGy for Centre 2. Entrance skin dose measurements demonstrated the combined effect of exposure and patient factors on the dose. The lifetime attributable cancer risk, expressed as the probability to develop a radiation-induced cancer, varied between 2.7 per million (age >60) and 9.8 per million (age 8-11) with an average of 6.0 per million. On average, the risk for female patients was 40% higher. The estimated radiation risk was primarily influenced by the age at exposure and the gender, pointing out the continuing need for justification and optimization of CBCT exposures, with a specific focus on children.

  9. Heritability Estimates Identify a Substantial Genetic Contribution to Risk and Outcome of Intracerebral Hemorrhage

    PubMed Central

    Devan, William J.; Falcone, Guido J.; Anderson, Christopher D.; Jagiella, Jeremiasz M.; Schmidt, Helena; Hansen, Björn M.; Jimenez-Conde, Jordi; Giralt-Steinhauer, Eva; Cuadrado-Godia, Elisa; Soriano, Carolina; Ayres, Alison M.; Schwab, Kristin; Kassis, Sylvia Baedorf; Valant, Valerie; Pera, Joanna; Urbanik, Andrzej; Viswanathan, Anand; Rost, Natalia S.; Goldstein, Joshua N.; Freudenberger, Paul; Stögerer, Eva-Maria; Norrving, Bo; Tirschwell, David L.; Selim, Magdy; Brown, Devin L.; Silliman, Scott L.; Worrall, Bradford B.; Meschia, James F.; Kidwell, Chelsea S.; Montaner, Joan; Fernandez-Cadenas, Israel; Delgado, Pilar; Greenberg, Steven M.; Roquer, Jaume; Lindgren, Arne; Slowik, Agnieszka; Schmidt, Reinhold; Woo, Daniel; Rosand, Jonathan; Biffi, Alessandro

    2013-01-01

    Background and Purpose Previous studies suggest that genetic variation plays a substantial role in occurrence and evolution of intracerebral hemorrhage (ICH). Genetic contribution to disease can be determined by calculating heritability using family-based data, but such an approach is impractical for ICH because of lack of large pedigree-based studies. However, a novel analytic tool based on genome-wide data allows heritability estimation from unrelated subjects. We sought to apply this method to provide heritability estimates for ICH risk, severity, and outcome. Methods We analyzed genome-wide genotype data for 791 ICH cases and 876 controls, and determined heritability as the proportion of variation in phenotype attributable to captured genetic variants. Contribution to heritability was separately estimated for the APOE (encoding apolipoprotein E) gene, an established genetic risk factor, and for the rest of the genome. Analyzed phenotypes included ICH risk, admission hematoma volume, and 90-day mortality. Results ICH risk heritability was estimated at 29% (SE, 11%) for non-APOE loci and at 15% (SE, 10%) for APOE. Heritability for 90-day ICH mortality was 41% for non-APOE loci and 10% (SE, 9%) for APOE. Genetic influence on hematoma volume was also substantial: admission volume heritability was estimated at 60% (SE, 70%) for non-APOE loci and at 12% (SE, 4%) for APOE. Conclusions Genetic variation plays a substantial role in ICH risk, outcome, and hematoma volume. Previously reported risk variants account for only a portion of inherited genetic influence on ICH pathophysiology, pointing to additional loci yet to be identified. PMID:23559261

  10. Estimating cancer risk from dental cone-beam CT exposures based on skin dosimetry.

    PubMed

    Pauwels, Ruben; Cockmartin, Lesley; Ivanauskaité, Deimante; Urbonienė, Ausra; Gavala, Sophia; Donta, Catherine; Tsiklakis, Kostas; Jacobs, Reinhilde; Bosmans, Hilde; Bogaerts, Ria; Horner, Keith

    2014-07-21

    The aim of this study was to measure entrance skin doses on patients undergoing cone-beam computed tomography (CBCT) examinations, to establish conversion factors between skin and organ doses, and to estimate cancer risk from CBCT exposures. 266 patients (age 8-83) were included, involving three imaging centres. CBCT scans were acquired using the SCANORA 3D (Soredex, Tuusula, Finland) and NewTom 9000 (QR, Verona, Italy). Eight thermoluminescent dosimeters were attached to the patient's skin at standardized locations. Using previously published organ dose estimations on various CBCTs with an anthropomorphic phantom, correlation factors to convert skin dose to organ doses were calculated and applied to estimate patient organ doses. The BEIR VII age- and gender-dependent dose-risk model was applied to estimate the lifetime attributable cancer risk. For the SCANORA 3D, average skin doses over the eight locations varied between 484 and 1788 µGy. For the NewTom 9000 the range was between 821 and 1686 µGy for Centre 1 and between 292 and 2325 µGy for Centre 2. Entrance skin dose measurements demonstrated the combined effect of exposure and patient factors on the dose. The lifetime attributable cancer risk, expressed as the probability to develop a radiation-induced cancer, varied between 2.7 per million (age >60) and 9.8 per million (age 8-11) with an average of 6.0 per million. On average, the risk for female patients was 40% higher. The estimated radiation risk was primarily influenced by the age at exposure and the gender, pointing out the continuing need for justification and optimization of CBCT exposures, with a specific focus on children. PMID:24957710

  11. Early Developmental and Psychosocial Risks and Longitudinal Behavioral Adjustment Outcomes for Preschool-Age Girls Adopted from China

    ERIC Educational Resources Information Center

    Tan, Tony Xing; Marfo, Kofi; Dedrick, Robert F.

    2010-01-01

    The central goal of this longitudinal study was to examine behavioral adjustment outcomes in a sample of preschool-age adopted Chinese girls. Research examining the effects of institutional deprivation on post-adoption behavioral outcomes for internationally adopted children has been constrained by the frequent unavailability of data on the…

  12. Micro-scale flood risk estimation in historic centres: a case study in Florence, Italy

    NASA Astrophysics Data System (ADS)

    Castelli, Fabio; Arrighi, Chiara; Brugioni, Marcello; Franceschini, Serena; Mazzanti, Bernardo

    2013-04-01

    The route to flood risk assessment is much more than hydraulic modelling of inundation, that is hazard mapping. Flood risk is the product of flood hazard, vulnerability and exposure, all the three to be estimated with comparable level of accuracy. While hazard maps have already been implemented in many countries, quantitative damage and risk maps are still at a preliminary level. Currently one of the main challenges in flood damage estimation resides in the scarce availability of socio-economic data characterizing the monetary value of the exposed assets. When these public-open data are available, the variability of their level of detail drives the need of merging different sources and of selecting an appropriate scale of analysis. In this work a parsimonious quasi-2D hydraulic model is adopted, having many advantages in terms of easy set-up. In order to represent the geometry of the study domain an high-resolution and up-to-date Digital Surface Model (DSM) is used. The accuracy in flood depth estimation is evaluated by comparison with marble-plate records of a historic flood in the city of Florence (Italy). The accuracy is characterized in the downtown most flooded area by a bias of a very few centimetres and a determination coefficient of 0.73. The average risk is found to be about 14 €/m2•year, corresponding to about 8.3% of residents income. The spatial distribution of estimated risk highlights a complex interaction between the flood pattern and the buildings characteristics. Proceeding through the risk estimation steps, a new micro-scale potential damage assessment method is proposed. This method is based on the georeferenced census system considered as optimal compromise between spatial detail and open availability of socio-economic data. The census sections system consist of geographically contiguous polygons that usually coincide with building blocks in dense urban areas. The results of flood risk assessment at the census section scale resolve most of

  13. Estimated risk from exposure to radon decay products in US homes

    SciTech Connect

    Nero, A.V. Jr.

    1986-05-01

    Recent analyses now permit direct estimation of the risks of lung cancer from radon decay products in US homes. Analysis of data from indoor monitoring in single-family homes yields a tentative frequency distribution of annual-average /sup 222/Rn concentrations averaging 55 Bq m/sup -3/ and having 2% of homes exceeding 300 Bq m/sup -3/. Application of the results of occupational epidemiological studies, either directly or using recent advances in lung dosimetry, to indoor exposures suggests that the average indoor concentration entails a lifetime risk of lung cancer of 0.3% or about 10% of the total risk of lung cancer. The risk to individuals occupying the homes with 300 Bq m/sup -3/ or more for their lifetimes is estimated to exceed 2%, with risks from the homes with thousands of Bq m/sup -3/ correspondingly higher, even exceeding the total risk of premature death due to cigarette smoking. The potential for such average and high-level risks in ordinary homes forces development of a new perspective on environmental exposures.

  14. An Evidenced-Based Approach for Estimating Decompression Sickness Risk in Aircraft Operations

    NASA Technical Reports Server (NTRS)

    Robinson, Ronald R.; Dervay, Joseph P.; Conkin, Johnny

    1999-01-01

    Estimating the risk of decompression Sickness (DCS) in aircraft operations remains a challenge, making the reduction of this risk through the development of operationally acceptable denitrogenation schedules difficult. In addition, the medical recommendations which are promulgated are often not supported by rigorous evaluation of the available data, but are instead arrived at by negotiation with the aircraft operations community, are adapted from other similar aircraft operations, or are based upon the opinion of the local medical community. We present a systematic approach for defining DCS risk in aircraft operations by analyzing the data available for a specific aircraft, flight profile, and aviator population. Once the risk of DCS in a particular aircraft operation is known, appropriate steps can be taken to reduce this risk to a level acceptable to the applicable aviation community. Using this technique will allow any aviation medical community to arrive at the best estimate of DCS risk for its specific mission and aviator population and will allow systematic reevaluation of the decisions regarding DCS risk reduction when additional data are available.

  15. Cancer risk estimation for mixtures of coal tars and benzo(a)pyrene

    SciTech Connect

    Gaylor, D.W.; Culp, S.J.; Goldstein, L.S.; Beland, F.A.

    2000-02-01

    Two-year chronic bioassays were conducted by using B6C3F1 female mice fed several concentrations of two different mixtures of coal tars from manufactured gas waste sites or benzo(a)pyrene (BaP). The purpose of the study was to obtain estimates of cancer potency of coal tar mixtures, by using conventional regulatory methods, for use in manufactured gas waste site remediation. A secondary purpose was to investigate the validity of using the concentration of a single potent carcinogen, in this case benzo(a)pyrene, to estimate the relative risk for a coal tar mixture. The study has shown that BaP dominates the cancer risk when its concentration is greater than 6,300 ppm in the coal tar mixture. In this case the most sensitive tissue site is the forestomach. Using low-dose linear extrapolation, the lifetime cancer risk for humans is estimated to be: Risk < 1.03 x 10{sup {minus}4} (ppm coal tar in total diet) + 240 x 10{sup {minus}4} (ppm BaP in total diet), based on forestomach tumors. If the BaP concentration in the coal tar mixture is less than 6,300 ppm, the more likely case, then lung tumors provide the largest estimated upper limit of risk, Risk < 2.55 x 10{sup {minus}4} (ppm coal tar in total diet), with no contribution of BaP to lung tumors. The upper limit of the cancer potency (slope factor) for lifetime oral exposure to benzo(a)pyrene is 1.2 x 10{sup {minus}3} per {micro}g per kg body weight per day from this Good Laboratory Practice (GLP) study compared with the current value of 7.3 x 10{sup {minus}3} per {micro}g per kg body weight per day listed in the US EPA Integrated Risk Information System.

  16. Estimation of Hypertension Risk from Lifestyle Factors and Health Profile: A Case Study

    PubMed Central

    2014-01-01

    Hypertension is a highly prevalent risk factor for cardiovascular disease and it can also lead to other diseases which seriously harm the human health. Screening the risks and finding a clinical model for estimating the risk of onset, maintenance, or the prognosis of hypertension are of great importance to the prevention or treatment of the disease, especially if the indicator can be derived from simple health profile. In this study, we investigate a chronic disease questionnaire data set of 6563 rural citizens in East China and find out a clinical signature that can assess the risk of hypertension easily and accurately. The signature achieves an accuracy of about 83% on the external test dataset, with an AUC of 0.91. Our study demonstrates that a combination of simple lifestyle features can sufficiently reflect the risk of hypertension onset. This finding provides potential guidance for disease prevention and control as well as development of home care and home-care technologies. PMID:25019099

  17. Quantitative assessment of the microbial risk of leafy greens from farm to consumption: preliminary framework, data, and risk estimates.

    PubMed

    Danyluk, Michelle D; Schaffner, Donald W

    2011-05-01

    This project was undertaken to relate what is known about the behavior of Escherichia coli O157:H7 under laboratory conditions and integrate this information to what is known regarding the 2006 E. coli O157:H7 spinach outbreak in the context of a quantitative microbial risk assessment. The risk model explicitly assumes that all contamination arises from exposure in the field. Extracted data, models, and user inputs were entered into an Excel spreadsheet, and the modeling software @RISK was used to perform Monte Carlo simulations. The model predicts that cut leafy greens that are temperature abused will support the growth of E. coli O157:H7, and populations of the organism may increase by as much a 1 log CFU/day under optimal temperature conditions. When the risk model used a starting level of -1 log CFU/g, with 0.1% of incoming servings contaminated, the predicted numbers of cells per serving were within the range of best available estimates of pathogen levels during the outbreak. The model predicts that levels in the field of -1 log CFU/g and 0.1% prevalence could have resulted in an outbreak approximately the size of the 2006 E. coli O157:H7 outbreak. This quantitative microbial risk assessment model represents a preliminary framework that identifies available data and provides initial risk estimates for pathogenic E. coli in leafy greens. Data gaps include retail storage times, correlations between storage time and temperature, determining the importance of E. coli O157:H7 in leafy greens lag time models, and validation of the importance of cross-contamination during the washing process.

  18. A review of methods to estimate cause-specific mortality in presence of competing risks

    USGS Publications Warehouse

    Heisey, Dennis M.; Patterson, Brent R.

    2006-01-01

    Estimating cause-specific mortality is often of central importance for understanding the dynamics of wildlife populations. Despite such importance, methodology for estimating and analyzing cause-specific mortality has received little attention in wildlife ecology during the past 20 years. The issue of analyzing cause-specific, mutually exclusive events in time is not unique to wildlife. In fact, this general problem has received substantial attention in human biomedical applications within the context of biostatistical survival analysis. Here, we consider cause-specific mortality from a modern biostatistical perspective. This requires carefully defining what we mean by cause-specific mortality and then providing an appropriate hazard-based representation as a competing risks problem. This leads to the general solution of cause-specific mortality as the cumulative incidence function (CIF). We describe the appropriate generalization of the fully nonparametric staggered-entry Kaplan–Meier survival estimator to cause-specific mortality via the nonparametric CIF estimator (NPCIFE), which in many situations offers an attractive alternative to the Heisey–Fuller estimator. An advantage of the NPCIFE is that it lends itself readily to risk factors analysis with standard software for Cox proportional hazards model. The competing risks–based approach also clarifies issues regarding another intuitive but erroneous "cause-specific mortality" estimator based on the Kaplan–Meier survival estimator and commonly seen in the life sciences literature.

  19. Prevalence Estimates of Health Risk Behaviors of Immigrant Latino Men Who Have Sex with Men

    ERIC Educational Resources Information Center

    Rhodes, Scott D.; McCoy, Thomas P.; Hergenrather, Kenneth C.; Vissman, Aaron T.; Wolfson, Mark; Alonzo, Jorge; Bloom, Fred R.; Alegria-Ortega, Jose; Eng, Eugenia

    2012-01-01

    Purpose: Little is known about the health status of rural immigrant Latino men who have sex with men (MSM). These MSM comprise a subpopulation that tends to remain "hidden" from both researchers and practitioners. This study was designed to estimate the prevalence of tobacco, alcohol, and drug use, and sexual risk behaviors of Latino MSM living in…

  20. AN INFORMATIC APPROACH TO ESTIMATING ECOLOGICAL RISKS POSED BY PHARMACEUTICAL USE

    EPA Science Inventory

    A new method for estimating risks of human prescription pharmaceuticals based on information found in regulatory filings as well as scientific and trade literature is described in a presentation at the Pharmaceuticals in the Environment Workshop in Las Vegas, NV, August 23-25, 20...

  1. Risk estimates for radiation-induced cancer and radiation protection standards

    SciTech Connect

    Sinclair, W.K. )

    1989-11-01

    At low doses, the primary biological effects of concern are stochastic in nature, i.e., they are more probable at higher doses, but their severity is independent of the dose. In the last decade, a new epidemiological information on radiation-induced cancer in humans has become available. In the Japanese survivors three new cycles of data (11 yr of experience) have accumulated, and a revised dosimetry system (DS86) has been introduced. UNSCEAR (United Nations Scientific Committee on the Effects of Atomic Radiation) reevaluated the risk of cancer from all human sources, which include other human populations such as those treated for ankylosing spondylitis and for cancer of the cervix. UNSCEAR has also evaluated the cancer risk for each of nine organs. For radiation protection purposes (low doses and dose rates, adult populations mainly), nominal values of risk since the 1977-80 period have been {approximately}1%/Sv. This value will need to be increased in the light of the new estimates. Also, risk estimates for various tissues must be reconsidered, and weighting factors used by International Commission on Radiological Protection need to be reexamined. Recommendations on occupational and public dose limits must also be reconsidered. The National Council on Radiation Protection and Measurements is in a comparatively good position with a recently produced set of recommendations that had higher cancer risk estimates in mind.

  2. Application of (13)C ramp CPMAS NMR with phase-adjusted spinning sidebands (PASS) for the quantitative estimation of carbon functional groups in natural organic matter.

    PubMed

    Ikeya, Kosuke; Watanabe, Akira

    2016-01-01

    The composition of carbon (C) functional groups in natural organic matter (NOM), such as dissolved organic matter, soil organic matter, and humic substances, is frequently estimated using solid-state (13)C NMR techniques. A problem associated with quantitative analysis using general cross polarization/magic angle spinning (CPMAS) spectra is the appearance of spinning side bands (SSBs) split from the original center peaks of sp (2) hybridized C species (i.e., aromatic and carbonyl C). Ramp CP/phase-adjusted side band suppressing (PASS) is a pulse sequence that integrates SSBs separately and quantitatively recovers them into their inherent center peaks. In the present study, the applicability of ramp CP/PASS to NOM analysis was compared with direct polarization (DPMAS), another quantitative method but one that requires a long operation time, and/or a ramp CP/total suppression side band (ramp CP/TOSS) technique, a popular but non-quantitative method for deleting SSBs. The test materials were six soil humic acid samples with various known degrees of aromaticity and two fulvic acids. There were no significant differences in the relative abundance of alkyl C, O-alkyl C, and aromatic C between the ramp CP/PASS and DPMAS methods, while the signal intensities corresponding to aromatic C in the ramp CP/TOSS spectra were consistently less than the values obtained in the ramp CP/PASS spectra. These results indicate that ramp CP/PASS can be used to accurately estimate the C composition of NOM samples.

  3. Estimate of the risk in radiation therapy due to unwanted neutrons

    SciTech Connect

    Swanson, W.P.

    1980-03-01

    The integral dose of accelerator-produced leakage neutrons to patients undergoing high-energy photon therapy is estimated and compared to other sources of integral dose. The leakage neutron component contributes about 5 g rad (1 rad=10/sup -2/ Gy) for a typical treatment course of 5000 rad. When averaged over a 70-kg tissue volume, the corresponding dose amounts to only 0.36 rad. From this, the risk of inducing fatal malignancies by leakage neutrons is estimated to be about 50 x 10/sup -6/ per year following treatment. This is compared to other risks to which the patient is unavoidably exposed, and it is argued that the unwanted neutrons pose such small additional risk that regulatory intervention is not warranted. This assessment is performed without reference to neutron RBE or quality factor.

  4. Value at risk estimation with entropy-based wavelet analysis in exchange markets

    NASA Astrophysics Data System (ADS)

    He, Kaijian; Wang, Lijun; Zou, Yingchao; Lai, Kin Keung

    2014-08-01

    In recent years, exchange markets are increasingly integrated together. Fluctuations and risks across different exchange markets exhibit co-moving and complex dynamics. In this paper we propose the entropy-based multivariate wavelet based approaches to analyze the multiscale characteristic in the multidimensional domain and improve further the Value at Risk estimation reliability. Wavelet analysis has been introduced to construct the entropy-based Multiscale Portfolio Value at Risk estimation algorithm to account for the multiscale dynamic correlation. The entropy measure has been proposed as the more effective measure with the error minimization principle to select the best basis when determining the wavelet families and the decomposition level to use. The empirical studies conducted in this paper have provided positive evidence as to the superior performance of the proposed approach, using the closely related Chinese Renminbi and European Euro exchange market.

  5. Prevalence Estimates of Health Risk Behaviors of Immigrant Latino Men Who Have Sex With Men

    PubMed Central

    Rhodes, Scott D.; McCoy, Thomas P.; Hergenrather, Kenneth C.; Vissman, Aaron T.; Wolfson, Mark; Alonzo, Jorge; Bloom, Fred R.; Alegría-Ortega, Jose; Eng, Eugenia

    2011-01-01

    Purpose Little is known about the health status of rural immigrant Latino men who have sex with men (MSM). These MSM comprise a subpopulation that tends to remain “hidden” from both researchers and practitioners. This study was designed to estimate the prevalence of tobacco, alcohol, and drug use, and sexual risk behaviors of Latino MSM living in rural North Carolina. Methods A community-based participatory research (CBPR) partnership used respondent-driven sampling (RDS) to identify, recruit, and enroll Latino MSM to participate in an interviewer-administered behavioral assessment. RDS weighted prevalence of risk behaviors was estimated using the RDS Analysis Tool. Data collection occurred in 2008. Results A total of 190 Latino MSM was reached; the average age was 25.5 years old and nearly 80% reported being from Mexico. Prevalence estimates of smoking everyday and past 30-day heavy episodic drinking were 6.5% and 35.0%, respectively. Prevalence estimates of past 12-month marijuana and cocaine use were 56.0% and 27.1%, respectively. Past 3-month prevalence estimates of sex with at least one woman, multiple male partners, and inconsistent condom use were 21.2%, 88.9%, and 54.1%, respectively. Conclusions Respondents had low rates of tobacco use and club drug use, and high rates of sexual risk behaviors. Although this study represents an initial step in documenting the health risk behaviors of immigrant Latino MSM who are part of a new trend in Latino immigration to the southeastern US, a need exists for further research, including longitudinal studies to understand the trajectory of risk behavior among immigrant Latino MSM. PMID:22236317

  6. Quantitative microbial risk assessment combined with hydrodynamic modelling to estimate the public health risk associated with bathing after rainfall events.

    PubMed

    Eregno, Fasil Ejigu; Tryland, Ingun; Tjomsland, Torulv; Myrmel, Mette; Robertson, Lucy; Heistad, Arve

    2016-04-01

    This study investigated the public health risk from exposure to infectious microorganisms at Sandvika recreational beaches, Norway and dose-response relationships by combining hydrodynamic modelling with Quantitative Microbial Risk Assessment (QMRA). Meteorological and hydrological data were collected to produce a calibrated hydrodynamic model using Escherichia coli as an indicator of faecal contamination. Based on average concentrations of reference pathogens (norovirus, Campylobacter, Salmonella, Giardia and Cryptosporidium) relative to E. coli in Norwegian sewage from previous studies, the hydrodynamic model was used for simulating the concentrations of pathogens at the local beaches during and after a heavy rainfall event, using three different decay rates. The simulated concentrations were used as input for QMRA and the public health risk was estimated as probability of infection from a single exposure of bathers during the three consecutive days after the rainfall event. The level of risk on the first day after the rainfall event was acceptable for the bacterial and parasitic reference pathogens, but high for the viral reference pathogen at all beaches, and severe at Kalvøya-small and Kalvøya-big beaches, supporting the advice of avoiding swimming in the day(s) after heavy rainfall. The study demonstrates the potential of combining discharge-based hydrodynamic modelling with QMRA in the context of bathing water as a tool to evaluate public health risk and support beach management decisions. PMID:26802355

  7. Estimates of prevalence and risk associated with inattention and distraction based upon in situ naturalistic data.

    PubMed

    Dingus, Thomas A

    2014-01-01

    By using in situ naturalistic driving data, estimates of prevalence and risk can be made regarding driver populations' secondary task distractions and crash rates. Through metadata analysis, three populations of drivers (i.e., adult light vehicle, teenaged light vehicle, and adult heavy vehicle) were compared regarding frequency of secondary task behavior and the associated risk for safety-critical incidents. Relative risk estimates provide insight into the risk associated with engaging in a single task. When such risk is considered in combination with frequency of use, it sheds additional light on those secondary tasks that create the greatest overall risk to driving safety. The results show that secondary tasks involving manual typing, texting, dialing, reaching for an object, or reading are dangerous for all three populations. Additionally, novice teen drivers have difficulty in several tasks that the other two populations do not, including eating and external distractions. Truck drivers also perform a number of risky "mobile office" types of tasks, including writing, not seen in the other populations. Implications are described for policy makers and designers of in-vehicle and nomadic, portable systems. PMID:24776227

  8. Estimates of auditory risk from outdoor impulse noise. II: Civilian firearms.

    PubMed

    Flamme, Gregory A; Wong, Adam; Liebe, Kevin; Lynd, James

    2009-01-01

    Firearm impulses are common noise exposures in the United States. This study records, describes and analyzes impulses produced outdoors by civilian firearms with respect to the amount of auditory risk they pose to the unprotected listener under various listening conditions. Risk estimates were obtained using three contemporary damage risk criteria (DRC) including a waveform parameter-based approach (peak SPL and B-duration), an energy-based criterion (A-weighted SEL and equivalent continuous level) and a physiological model (AHAAH). Results from these DRC were converted into a number of maximum permissible unprotected exposures to facilitate interpretation. Acoustic characteristics of firearm impulses differed substantially across guns, ammunition, and microphone location. The type of gun, ammunition and the microphone location all significantly affected estimates of auditory risk from firearms. Vast differences in maximum permissible exposures were observed; the rank order of the differences varied with the source of the impulse. Unprotected exposure to firearm noise is not recommended, but people electing to fire a gun without hearing protection should be advised to minimize auditory risk through careful selection of ammunition and shooting environment. Small-caliber guns with long barrels and guns loaded with the least powerful ammunition tend to be associated with the least auditory risk. PMID:19805933

  9. Historical Channel Adjustment and Estimates of Selected Hydraulic Values in the Lower Sabine River and Lower Brazos River Basins, Texas and Louisiana

    USGS Publications Warehouse

    Heitmuller, Franklin T.; Greene, Lauren E.

    2009-01-01

    The U.S. Geological Survey, in cooperation with the Texas Water Development Board, evaluated historical channel adjustment and estimated selected hydraulic values at U.S. Geological Survey streamflow-gaging stations in the lower Sabine River Basin in Texas and Louisiana and lower Brazos River Basin in Texas to support geomorphic assessments of the Texas Instream Flow Program. Channel attributes including cross-section geometry, slope, and planform change were evaluated to learn how each river's morphology changed over the years in response to natural and anthropogenic disturbances. Historical and contemporary cross-sectional channel geometries at several gaging stations on each river were compared, planform changes were assessed, and hydraulic values were estimated including mean flow velocity, bed shear stress, Froude numbers, and hydraulic depth. The primary sources of historical channel morphology information were U.S. Geological Survey hard-copy discharge-measurement field notes. Additional analyses were done using computations of selected flow hydraulics, comparisons of historical and contemporary aerial photographs, comparisons of historical and contemporary ground photographs, evaluations of how frequently stage-discharge rating curves were updated, reviews of stage-discharge relations for field measurements, and considerations of bridge and reservoir construction activities. Based on historical cross sections at three gaging stations downstream from Toledo Bend Reservoir, the lower Sabine River is relatively stable, but is subject to substantial temporary scour-and-fill processes during floods. Exceptions to this characterization of relative stability include an episode of channel aggradation at the Sabine River near Bon Wier, Texas, during the 1930s, and about 2 to 3 feet of channel incision at the Sabine River near Burkeville, Texas, since the late 1950s. The Brazos River, at gaging stations downstream from Waco, Texas, has adjusted to a combination of

  10. Estimating risks of heat strain by age and sex: a population-level simulation model.

    PubMed

    Glass, Kathryn; Tait, Peter W; Hanna, Elizabeth G; Dear, Keith

    2015-05-18

    Individuals living in hot climates face health risks from hyperthermia due to excessive heat. Heat strain is influenced by weather exposure and by individual characteristics such as age, sex, body size, and occupation. To explore the population-level drivers of heat strain, we developed a simulation model that scales up individual risks of heat storage (estimated using Myrup and Morgan's man model "MANMO") to a large population. Using Australian weather data, we identify high-risk weather conditions together with individual characteristics that increase the risk of heat stress under these conditions. The model identifies elevated risks in children and the elderly, with females aged 75 and older those most likely to experience heat strain. Risk of heat strain in males does not increase as rapidly with age, but is greatest on hot days with high solar radiation. Although cloudy days are less dangerous for the wider population, older women still have an elevated risk of heat strain on hot cloudy days or when indoors during high temperatures. Simulation models provide a valuable method for exploring population level risks of heat strain, and a tool for evaluating public health and other government policy interventions.

  11. Cancer risk estimation in Digital Breast Tomosynthesis using GEANT4 Monte Carlo simulations and voxel phantoms.

    PubMed

    Ferreira, P; Baptista, M; Di Maria, S; Vaz, P

    2016-05-01

    The aim of this work was to estimate the risk of radiation induced cancer following the Portuguese breast screening recommendations for Digital Mammography (DM) when applied to Digital Breast Tomosynthesis (DBT) and to evaluate how the risk to induce cancer could influence the energy used in breast diagnostic exams. The organ doses were calculated by Monte Carlo simulations using a female voxel phantom and considering the acquisition of 25 projection images. Single organ cancer incidence risks were calculated in order to assess the total effective radiation induced cancer risk. The screening strategy techniques considered were: DBT in Cranio-Caudal (CC) view and two-view DM (CC and Mediolateral Oblique (MLO)). The risk of cancer incidence following the Portuguese screening guidelines (screening every two years in the age range of 50-80years) was calculated by assuming a single CC DBT acquisition view as standalone screening strategy and compared with two-view DM. The difference in the total effective risk between DBT and DM is quite low. Nevertheless in DBT an increase of risk for the lung is observed with respect to DM. The lung is also the organ that is mainly affected when non-optimal beam energy (in terms of image quality and absorbed dose) is used instead of an optimal one. The use of non-optimal energies could increase the risk of lung cancer incidence by a factor of about 2. PMID:27133140

  12. Estimating Risks of Heat Strain by Age and Sex: A Population-Level Simulation Model

    PubMed Central

    Glass, Kathryn; Tait, Peter W.; Hanna, Elizabeth G.; Dear, Keith

    2015-01-01

    Individuals living in hot climates face health risks from hyperthermia due to excessive heat. Heat strain is influenced by weather exposure and by individual characteristics such as age, sex, body size, and occupation. To explore the population-level drivers of heat strain, we developed a simulation model that scales up individual risks of heat storage (estimated using Myrup and Morgan’s man model “MANMO”) to a large population. Using Australian weather data, we identify high-risk weather conditions together with individual characteristics that increase the risk of heat stress under these conditions. The model identifies elevated risks in children and the elderly, with females aged 75 and older those most likely to experience heat strain. Risk of heat strain in males does not increase as rapidly with age, but is greatest on hot days with high solar radiation. Although cloudy days are less dangerous for the wider population, older women still have an elevated risk of heat strain on hot cloudy days or when indoors during high temperatures. Simulation models provide a valuable method for exploring population level risks of heat strain, and a tool for evaluating public health and other government policy interventions. PMID:25993102

  13. Vertebral Strength and Estimated Fracture Risk Across the BMI Spectrum in Women.

    PubMed

    Bachmann, Katherine N; Bruno, Alexander G; Bredella, Miriam A; Schorr, Melanie; Lawson, Elizabeth A; Gill, Corey M; Singhal, Vibha; Meenaghan, Erinne; Gerweck, Anu V; Eddy, Kamryn T; Ebrahimi, Seda; Koman, Stuart L; Greenblatt, James M; Keane, Robert J; Weigel, Thomas; Dechant, Esther; Misra, Madhusmita; Klibanski, Anne; Bouxsein, Mary L; Miller, Karen K

    2016-02-01

    Somewhat paradoxically, fracture risk, which depends on applied loads and bone strength, is elevated in both anorexia nervosa and obesity at certain skeletal sites. Factor-of-risk (Φ), the ratio of applied load to bone strength, is a biomechanically based method to estimate fracture risk; theoretically, higher Φ reflects increased fracture risk. We estimated vertebral strength (linear combination of integral volumetric bone mineral density [Int.vBMD] and cross-sectional area from quantitative computed tomography [QCT]), vertebral compressive loads, and Φ at L4 in 176 women (65 anorexia nervosa, 45 lean controls, and 66 obese). Using biomechanical models, applied loads were estimated for: 1) standing; 2) arms flexed 90°, holding 5 kg in each hand (holding); 3) 45° trunk flexion, 5 kg in each hand (lifting); 4) 20° trunk right lateral bend, 10 kg in right hand (bending). We also investigated associations of Int.vBMD and vertebral strength with lean mass (from dual-energy X-ray absorptiometry [DXA]) and visceral adipose tissue (VAT, from QCT). Women with anorexia nervosa had lower, whereas obese women had similar, Int.vBMD and estimated vertebral strength compared with controls. Vertebral loads were highest in obesity and lowest in anorexia nervosa for standing, holding, and lifting (p < 0.0001) but were highest in anorexia nervosa for bending (p < 0.02). Obese women had highest Φ for standing and lifting, whereas women with anorexia nervosa had highest Φ for bending (p < 0.0001). Obese and anorexia nervosa subjects had higher Φ for holding than controls (p < 0.03). Int.vBMD and estimated vertebral strength were associated positively with lean mass (R = 0.28 to 0.45, p ≤ 0.0001) in all groups combined and negatively with VAT (R = -[0.36 to 0.38], p < 0.003) within the obese group. Therefore, women with anorexia nervosa had higher estimated vertebral fracture risk (Φ) for holding and bending because of inferior vertebral strength. Despite similar

  14. Bayesian estimation of the relative toxicity of (239)Pu and (226)Ra with dependent competing risks

    NASA Astrophysics Data System (ADS)

    Xiao, Shili

    The purpose of this dissertation research is to compare the toxicity of the alpha-emitting, bone-seeking radionuclides sp{239}Pu and sp{226}Ra, develop a model for radiation induced osteosarcomas, and analyze the survival data of beagles exposed to these radionuclides. This research integrates the knowledge of radiation protection, survival theory and methods (competing risks, maximum likelihood estimation, and Bayesian techniques), numerical integration techniques (Monte Carlo, Lattice rule and Gauss-quadrature) and object-oriented programming in C++. The outline of this research is: (1) survival data preprocessing, (2) model identification and selection, (3) introduction of FGM model, the dependent competing risk model created by Farlie, Gumbel and Morgenstern, to the study of survival data with dependent competing risks: osteosarcomas and other diseases, development of the crude density of the FGM model and construction of the likelihood function for the FGM model, (4) Bayesian estimates of the posterior marginal density of the toxicity ratio in the FGM model using several numerical integration techniques (Monte Carlo, Lattice rule and Gaussian Quadrature), (5) construction of the likelihood function for the independent competing risk model, Bayesian estimate of the posterior marginal density of toxicity ratio in the model using Monte Carlo method, which is compared with the posterior marginal densities for the toxicity ratio obtained from the FGM model, (6) Bayesian estimates of all other parameters in the FGM model using Monte Carlo method, (7) Comparison of the cumulative hazard for sp{239}Pu calculated according to the model with Nelson's cumulative hazard plot under Bayesian point estimates of parameters and the mean activity in each injection level, (8) Comparison of the toxicity of plutonium in osteosarcoma with that of radium under Bayesian point estimates of parameters an d the selected activit of 0.85 muCsbi, (7) discuss Bayesian prediction of the

  15. Impact of provision of cardiovascular disease risk estimates to healthcare professionals and patients: a systematic review

    PubMed Central

    Usher-Smith, Juliet A; Silarova, Barbora; Schuit, Ewoud; GM Moons, Karel; Griffin, Simon J

    2015-01-01

    Objective To systematically review whether the provision of information on cardiovascular disease (CVD) risk to healthcare professionals and patients impacts their decision-making, behaviour and ultimately patient health. Design A systematic review. Data sources An electronic literature search of MEDLINE and PubMed from 01/01/2004 to 01/06/2013 with no language restriction and manual screening of reference lists of systematic reviews on similar topics and all included papers. Eligibility criteria for selecting studies (1) Primary research published in a peer-reviewed journal; (2) inclusion of participants with no history of CVD; (3) intervention strategy consisted of provision of a CVD risk model estimate to either professionals or patients; and (4) the only difference between the intervention group and control group (or the only intervention in the case of before-after studies) was the provision of a CVD risk model estimate. Results After duplicates were removed, the initial electronic search identified 9671 papers. We screened 196 papers at title and abstract level and included 17 studies. The heterogeneity of the studies limited the analysis, but together they showed that provision of risk information to patients improved the accuracy of risk perception without decreasing quality of life or increasing anxiety, but had little effect on lifestyle. Providing risk information to physicians increased prescribing of lipid-lowering and blood pressure medication, with greatest effects in those with CVD risk >20% (relative risk for change in prescribing 2.13 (1.02 to 4.63) and 2.38 (1.11 to 5.10) respectively). Overall, there was a trend towards reductions in cholesterol and blood pressure and a statistically significant reduction in modelled CVD risk (−0.39% (−0.71 to −0.07)) after, on average, 12 months. Conclusions There seems evidence that providing CVD risk model estimates to professionals and patients improves perceived CVD risk and medical prescribing

  16. Validation of model-based estimates (synthetic estimates) of the prevalence of risk factors for coronary heart disease for wards in England.

    PubMed

    Scarborough, Peter; Allender, Steven; Rayner, Mike; Goldacre, Michael

    2009-06-01

    Several sets of model-based estimates (synthetic estimates) of the prevalence of risk factors for coronary heart disease for small areas in England have been developed. These have been used in policy documents to indicate which areas are in need of intervention. In general, these models have not been subjected to validity assessment. This paper describes a validity assessment of 16 sets of synthetic estimates, by comparison of the models with national, regional and local survey-based estimates, and local mortality rate estimates. Model-based estimates of the prevalence of smoking, low fruit and vegetable consumption, obesity, hypertension and raised cholesterol are found to be valid.

  17. Health risk estimates for groundwater and soil contamination in the Slovak Republic: a convenient tool for identification and mapping of risk areas.

    PubMed

    Fajčíková, K; Cvečková, V; Stewart, A; Rapant, S

    2014-10-01

    We undertook a quantitative estimation of health risks to residents living in the Slovak Republic and exposed to contaminated groundwater (ingestion by adult population) and/or soils (ingestion by adult and child population). Potential risk areas were mapped to give a visual presentation at basic administrative units of the country (municipalities, districts, regions) for easy discussion with policy and decision-makers. The health risk estimates were calculated by US EPA methods, applying threshold values for chronic risk and non-threshold values for cancer risk. The potential health risk was evaluated for As, Ba, Cd, Cu, F, Hg, Mn, NO3 (-), Pb, Sb, Se and Zn for groundwater and As, B, Ba, Be, Cd, Cu, F, Hg, Mn, Mo, Ni, Pb, Sb, Se and Zn for soils. An increased health risk was identified mainly in historical mining areas highly contaminated by geogenic-anthropogenic sources (ore deposit occurrence, mining, metallurgy). Arsenic and antimony were the most significant elements in relation to health risks from groundwater and soil contamination in the Slovak Republic contributing a significant part of total chronic risk levels. Health risk estimation for soil contamination has highlighted the significance of exposure through soil ingestion in children. Increased cancer risks from groundwater and soil contamination by arsenic were noted in several municipalities and districts throughout the country in areas with significantly high arsenic levels in the environment. This approach to health risk estimations and visualization represents a fast, clear and convenient tool for delineation of risk areas at national and local levels.

  18. European risk assessment of LAS in agricultural soil revisited: species sensitivity distribution and risk estimates.

    PubMed

    Jensen, John; Smith, Stephen R; Krogh, Paul Henning; Versteeg, Donald J; Temara, Ali

    2007-10-01

    Linear alkylbenzene sulphonate (LAS) is used at a rate of approximately 430,000 tons/y in Western Europe, mainly in laundry detergents. It is present in sewage sludge (70-5,600 mg/kg; 5-95th percentile) because of its high usage per capita, its sorption and precipitation in primary settlers, and its lack of degradation in anaerobic digesters. Immediately after amendment, calculated and measured concentrations are <1 to 60 mg LAS/kg soil. LAS biodegrades rapidly in soil with primary and ultimate half-lives of up to 7 and 30 days, respectively. Calculated residual concentrations after the averaging time (30 days) are 0.24-18 mg LAS/kg soil. The long-term ecotoxicity to soil microbiota is relatively low (EC10 >or=26 mg sludge-associated LAS/kg soil). An extensive review of the invertebrate and plant ecotoxicological data, combined with a probabilistic assessment approach, led to a PNEC value of 35 mg LAS/kg soil, i.e. the 5th percentile (HC5) of the species sensitivity distribution (lognormal distribution of the EC10 and NOEC values). Risk ratios were identified to fall within a range of 0.01 (median LAS concentration in sludge) to 0.1 (95th percentile) and always below 0.5 (maximum LAS concentration measured in sludge) according to various scenarios covering different factors such as local sewage influent concentration, water hardness, and sewage sludge stabilisation process. Based on the present information, it can be concluded that LAS does not represent an ecological risk in Western Europe when applied via normal sludge amendment to agricultural soil. PMID:17765285

  19. Radiobiologic risk estimation from dental radiology. Part II. Cancer incidence and fatality

    SciTech Connect

    Underhill, T.E.; Kimura, K.; Chilvarquer, I.; McDavid, W.D.; Langlais, R.P.; Preece, J.W.; Barnwell, G.

    1988-08-01

    With the use of the measured absorbed doses from part I of this article, the specific radiobiologic risk to the patient from (1) five different panoramic machines with rare-earth screens, (2) a 20-film complete-mouth survey with E-speed film, long round cone, (3) a 20-film complete-mouth survey with E-speed film, long rectangular cone, (4) a 4-film interproximal survey with E-speed film, long round cone, and (5) a 4-film interproximal survey with E-speed film, long rectangular cone, was calculated. The estimated risks are expressed in two ways: the probability of radiation-induced cancer in specific organs per million examinations and the probability of expression of a fatal cancer per million examinations. The highest risks calculated were from the complete-mouth survey with the use of round collimation. The lowest risks calculated were from panoramic radiography and four interproximal radiographs with rectangular collimation.

  20. Radiobiologic risk estimation from dental radiology. Part II. Cancer incidence and fatality.

    PubMed

    Underhill, T E; Kimura, K; Chilvarquer, I; McDavid, W D; Langlais, R P; Preece, J W; Barnwell, G

    1988-08-01

    With the use of the measured absorbed doses from part I of this article, the specific radiobiologic risk to the patient from (1) five different panoramic machines with rare-earth screens, (2) a 20-film complete-mouth survey with E-speed film, long round cone, (3) a 20-film complete-mouth survey with E-speed film, long rectangular cone, (4) a 4-film interproximal survey with E-speed film, long round cone, and (5) a 4-film interproximal survey with E-speed film, long rectangular cone, was calculated. The estimated risks are expressed in two ways: the probability of radiation-induced cancer in specific organs per million examinations and the probability of expression of a fatal cancer per million examinations. The highest risks calculated were from the complete-mouth survey with the use of round collimation. The lowest risks calculated were from panoramic radiography and four interproximal radiographs with rectangular collimation.

  1. A Methodological Approach to Small Area Estimation for the Behavioral Risk Factor Surveillance System.

    PubMed

    Pierannunzi, Carol; Xu, Fang; Wallace, Robyn C; Garvin, William; Greenlund, Kurt J; Bartoli, William; Ford, Derek; Eke, Paul; Town, G Machell

    2016-07-14

    Public health researchers have used a class of statistical methods to calculate prevalence estimates for small geographic areas with few direct observations. Many researchers have used Behavioral Risk Factor Surveillance System (BRFSS) data as a basis for their models. The aims of this study were to 1) describe a new BRFSS small area estimation (SAE) method and 2) investigate the internal and external validity of the BRFSS SAEs it produced. The BRFSS SAE method uses 4 data sets (the BRFSS, the American Community Survey Public Use Microdata Sample, Nielsen Claritas population totals, and the Missouri Census Geographic Equivalency File) to build a single weighted data set. Our findings indicate that internal and external validity tests were successful across many estimates. The BRFSS SAE method is one of several methods that can be used to produce reliable prevalence estimates in small geographic areas.

  2. A Methodological Approach to Small Area Estimation for the Behavioral Risk Factor Surveillance System

    PubMed Central

    Xu, Fang; Wallace, Robyn C.; Garvin, William; Greenlund, Kurt J.; Bartoli, William; Ford, Derek; Eke, Paul; Town, G. Machell

    2016-01-01

    Public health researchers have used a class of statistical methods to calculate prevalence estimates for small geographic areas with few direct observations. Many researchers have used Behavioral Risk Factor Surveillance System (BRFSS) data as a basis for their models. The aims of this study were to 1) describe a new BRFSS small area estimation (SAE) method and 2) investigate the internal and external validity of the BRFSS SAEs it produced. The BRFSS SAE method uses 4 data sets (the BRFSS, the American Community Survey Public Use Microdata Sample, Nielsen Claritas population totals, and the Missouri Census Geographic Equivalency File) to build a single weighted data set. Our findings indicate that internal and external validity tests were successful across many estimates. The BRFSS SAE method is one of several methods that can be used to produce reliable prevalence estimates in small geographic areas. PMID:27418213

  3. Underestimating the Alcohol Content of a Glass of Wine: The Implications for Estimates of Mortality Risk

    PubMed Central

    Britton, Annie; O’Neill, Darragh; Bell, Steven

    2016-01-01

    Aims Increases in glass sizes and wine strength over the last 25 years in the UK are likely to have led to an underestimation of alcohol intake in population studies. We explore whether this probable misclassification affects the association between average alcohol intake and risk of mortality from all causes, cardiovascular disease and cancer. Methods Self-reported alcohol consumption in 1997–1999 among 7010 men and women in the Whitehall II cohort of British civil servants was linked to the risk of mortality until mid-2015. A conversion factor of 8 g of alcohol per wine glass (1 unit) was compared with a conversion of 16 g per wine glass (2 units). Results When applying a higher alcohol content conversion for wine consumption, the proportion of heavy/very heavy drinkers increased from 28% to 41% for men and 15% to 28% for women. There was a significantly increased risk of very heavy drinking compared with moderate drinking for deaths from all causes and cancer before and after change in wine conversion; however, the hazard ratios were reduced when a higher wine conversion was used. Conclusions In this population-based study, assuming higher alcohol content in wine glasses changed the estimates of mortality risk. We propose that investigator-led cohorts need to revisit conversion factors based on more accurate estimates of alcohol content in wine glasses. Prospectively, researchers need to collect more detailed information on alcohol including serving sizes and strength. Short summary The alcohol content in a wine glass is likely to be underestimated in population surveys as wine strength and serving size have increased in recent years. We demonstrate that in a large cohort study, this underestimation affects estimates of mortality risk. Investigator-led cohorts need to revisit conversion factors based on more accurate estimates of alcohol content in wine glasses. PMID:27261472

  4. Risk estimates for deterministic health effects of inhaled weapons grade plutonium.

    PubMed

    Scott, Bobby R; Peterson, Vern L

    2003-09-01

    Risk estimates for deterministic effects of inhaled weapons-grade plutonium (WG Pu) are needed to evaluate potential serious harm to (1) U.S. Department of Energy nuclear workers from accidental or other work-place releases of WG Pu; and (2) the public from terrorist actions resulting in the release of WG Pu to the environment. Deterministic health effects (the most serious radiobiological consequences to humans) can arise when large amounts of WG Pu are taken into the body. Inhalation is considered the most likely route of intake during work-place accidents or during a nuclear terrorism incident releasing WG Pu to the environment. Our current knowledge about radiation-related harm is insufficient for generating precise estimates of risk for a given WG Pu exposure scenario. This relates largely to uncertainties associated with currently available risk and dosimetry models. Thus, rather than generating point estimates of risk, distributions that account for variability/uncertainty are needed to properly characterize potential harm to humans from a given WG Pu exposure scenario. In this manuscript, we generate and summarize risk distributions for deterministic radiation effects in the lungs of nuclear workers from inhaled WG Pu particles (standard isotopic mix). These distributions were developed using NUREG/CR-4214 risk models and time-dependent, dose conversion factor data based on Publication 30 of the International Commission on Radiological Protection. Dose conversion factors based on ICRP Publication 30 are more relevant to deterministic effects than are the dose conversion factors based on ICRP Publication 66, which relate to targets for stochastic effects. Risk distributions that account for NUREG/CR-4214 parameter and model uncertainties were generated using the Monte Carlo method. Risks were evaluated for both lethality (from radiation pneumonitis) and morbidity (due to radiation-induced respiratory dysfunction) and were found to depend strongly on absorbed

  5. Estimating Risk of Natural Gas Portfolios by Using GARCH-EVT-Copula Model.

    PubMed

    Tang, Jiechen; Zhou, Chao; Yuan, Xinyu; Sriboonchitta, Songsak

    2015-01-01

    This paper concentrates on estimating the risk of Title Transfer Facility (TTF) Hub natural gas portfolios by using the GARCH-EVT-copula model. We first use the univariate ARMA-GARCH model to model each natural gas return series. Second, the extreme value distribution (EVT) is fitted to the tails of the residuals to model marginal residual distributions. Third, multivariate Gaussian copula and Student t-copula are employed to describe the natural gas portfolio risk dependence structure. Finally, we simulate N portfolios and estimate value at risk (VaR) and conditional value at risk (CVaR). Our empirical results show that, for an equally weighted portfolio of five natural gases, the VaR and CVaR values obtained from the Student t-copula are larger than those obtained from the Gaussian copula. Moreover, when minimizing the portfolio risk, the optimal natural gas portfolio weights are found to be similar across the multivariate Gaussian copula and Student t-copula and different confidence levels. PMID:26351652

  6. Estimating Risk of Natural Gas Portfolios by Using GARCH-EVT-Copula Model

    PubMed Central

    Tang, Jiechen; Zhou, Chao; Yuan, Xinyu; Sriboonchitta, Songsak

    2015-01-01

    This paper concentrates on estimating the risk of Title Transfer Facility (TTF) Hub natural gas portfolios by using the GARCH-EVT-copula model. We first use the univariate ARMA-GARCH model to model each natural gas return series. Second, the extreme value distribution (EVT) is fitted to the tails of the residuals to model marginal residual distributions. Third, multivariate Gaussian copula and Student t-copula are employed to describe the natural gas portfolio risk dependence structure. Finally, we simulate N portfolios and estimate value at risk (VaR) and conditional value at risk (CVaR). Our empirical results show that, for an equally weighted portfolio of five natural gases, the VaR and CVaR values obtained from the Student t-copula are larger than those obtained from the Gaussian copula. Moreover, when minimizing the portfolio risk, the optimal natural gas portfolio weights are found to be similar across the multivariate Gaussian copula and Student t-copula and different confidence levels. PMID:26351652

  7. Estimating Risk of Natural Gas Portfolios by Using GARCH-EVT-Copula Model.

    PubMed

    Tang, Jiechen; Zhou, Chao; Yuan, Xinyu; Sriboonchitta, Songsak

    2015-01-01

    This paper concentrates on estimating the risk of Title Transfer Facility (TTF) Hub natural gas portfolios by using the GARCH-EVT-copula model. We first use the univariate ARMA-GARCH model to model each natural gas return series. Second, the extreme value distribution (EVT) is fitted to the tails of the residuals to model marginal residual distributions. Third, multivariate Gaussian copula and Student t-copula are employed to describe the natural gas portfolio risk dependence structure. Finally, we simulate N portfolios and estimate value at risk (VaR) and conditional value at risk (CVaR). Our empirical results show that, for an equally weighted portfolio of five natural gases, the VaR and CVaR values obtained from the Student t-copula are larger than those obtained from the Gaussian copula. Moreover, when minimizing the portfolio risk, the optimal natural gas portfolio weights are found to be similar across the multivariate Gaussian copula and Student t-copula and different confidence levels.

  8. 49 CFR Appendix G to Part 222 - Excess Risk Estimates for Public Highway-Rail Grade Crossings

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Grade Crossings G Appendix G to Part 222 Transportation Other Regulations Relating to Transportation... HIGHWAY-RAIL GRADE CROSSINGS Pt. 222, App. G Appendix G to Part 222—Excess Risk Estimates for Public Highway-Rail Grade Crossings Ban Effects/Train Horn Effectiveness Warning type Excess risk estimate...

  9. 49 CFR Appendix G to Part 222 - Excess Risk Estimates for Public Highway-Rail Grade Crossings

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Grade Crossings G Appendix G to Part 222 Transportation Other Regulations Relating to Transportation... HIGHWAY-RAIL GRADE CROSSINGS Pt. 222, App. G Appendix G to Part 222—Excess Risk Estimates for Public Highway-Rail Grade Crossings Ban Effects/Train Horn Effectiveness Warning type Excess risk estimate...

  10. 49 CFR Appendix G to Part 222 - Excess Risk Estimates for Public Highway-Rail Grade Crossings

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Grade Crossings G Appendix G to Part 222 Transportation Other Regulations Relating to Transportation... HIGHWAY-RAIL GRADE CROSSINGS Pt. 222, App. G Appendix G to Part 222—Excess Risk Estimates for Public Highway-Rail Grade Crossings Ban Effects/Train Horn Effectiveness Warning type Excess risk estimate...

  11. 49 CFR Appendix G to Part 222 - Excess Risk Estimates for Public Highway-Rail Grade Crossings

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Excess Risk Estimates for Public Highway-Rail Grade Crossings G Appendix G to Part 222 Transportation Other Regulations Relating to Transportation... HIGHWAY-RAIL GRADE CROSSINGS Pt. 222, App. G Appendix G to Part 222—Excess Risk Estimates for...

  12. Estimating the risks of cancer mortality and genetic defects resulting from exposures to low levels of ionizing radiation

    SciTech Connect

    Buhl, T.E.; Hansen, W.R.

    1984-05-01

    Estimators for calculating the risk of cancer and genetic disorders induced by exposure to ionizing radiation have been recommended by the US National Academy of Sciences Committee on the Biological Effects of Ionizing Radiations, the UN Scientific Committee on the Effects of Atomic Radiation, and the International Committee on Radiological Protection. These groups have also considered the risks of somatic effects other than cancer. The US National Council on Radiation Protection and Measurements has discussed risk estimate procedures for radiation-induced health effects. The recommendations of these national and international advisory committees are summarized and compared in this report. Based on this review, two procedures for risk estimation are presented for use in radiological assessments performed by the US Department of Energy under the National Environmental Policy Act of 1969 (NEPA). In the first procedure, age- and sex-averaged risk estimators calculated with US average demographic statistics would be used with estimates of radiation dose to calculate the projected risk of cancer and genetic disorders that would result from the operation being reviewed under NEPA. If more site-specific risk estimators are needed, and the demographic information is available, a second procedure is described that would involve direct calculation of the risk estimators using recommended risk-rate factors. The computer program REPCAL has been written to perform this calculation and is described in this report. 25 references, 16 tables.

  13. [Estimation of the risk of Alzheimer type dementia based on "Prognostic Questionnaire"].

    PubMed

    Bidzan, Leszek; Bidzan, Mariola

    2002-01-01

    The aim of undertaken studies was verification of usefulness of "Prognostic Questionnaire" for estimations of risk of Alzheimer type dementia. In support for own base were included 286 persons, which were investigated by scales creating of "Prognostic Questionnaire" in years 1991-1993. From among 286 persons originally classified to renewed study one surrendered 163 persons. Result in investigation MMSE equal or lower from 25 points was base to removal full psychiatric investigations which had in view recognition of Alzheimer type dementia or its exclusion. Possible Alzheimer disease were recognized at 23 persons. Sensitivity and specificity for "Prognostic Questionnaire" obtained for several critical values were marked. The study showed usefulness of joint interpretation of results of several clinical scales creating "Prognostic Questionnaire" for estimations of risk of Alzheimer type dementia. PMID:12647439

  14. Quantitative Cyber Risk Reduction Estimation Methodology for a Small Scada Control System

    SciTech Connect

    Miles A. McQueen; Wayne F. Boyer; Mark A. Flynn; George A. Beitel

    2006-01-01

    We propose a new methodology for obtaining a quick quantitative measurement of the risk reduction achieved when a control system is modified with the intent to improve cyber security defense against external attackers. The proposed methodology employs a directed graph called a compromise graph, where the nodes represent stages of a potential attack and the edges represent the expected time-to-compromise for differing attacker skill levels. Time-to-compromise is modeled as a function of known vulnerabilities and attacker skill level. The methodology was used to calculate risk reduction estimates for a specific SCADA system and for a specific set of control system security remedial actions. Despite an 86% reduction in the total number of vulnerabilities, the estimated time-to-compromise was increased only by about 3 to 30% depending on target and attacker skill level.

  15. Uncertainties in estimating health risks associated with exposure to ionising radiation.

    PubMed

    Preston, R Julian; Boice, John D; Brill, A Bertrand; Chakraborty, Ranajit; Conolly, Rory; Hoffman, F Owen; Hornung, Richard W; Kocher, David C; Land, Charles E; Shore, Roy E; Woloschak, Gayle E

    2013-09-01

    The information for the present discussion on the uncertainties associated with estimation of radiation risks and probability of disease causation was assembled for the recently published NCRP Report No. 171 on this topic. This memorandum provides a timely overview of the topic, given that quantitative uncertainty analysis is the state of the art in health risk assessment and given its potential importance to developments in radiation protection. Over the past decade the increasing volume of epidemiology data and the supporting radiobiology findings have aided in the reduction of uncertainty in the risk estimates derived. However, it is equally apparent that there remain significant uncertainties related to dose assessment, low dose and low dose-rate extrapolation approaches (e.g. the selection of an appropriate dose and dose-rate effectiveness factor), the biological effectiveness where considerations of the health effects of high-LET and lower-energy low-LET radiations are required and the transfer of risks from a population for which health effects data are available to one for which such data are not available. The impact of radiation on human health has focused in recent years on cancer, although there has been a decided increase in the data for noncancer effects together with more reliable estimates of the risk following radiation exposure, even at relatively low doses (notably for cataracts and cardiovascular disease). New approaches for the estimation of hereditary risk have been developed with the use of human data whenever feasible, although the current estimates of heritable radiation effects still are based on mouse data because of an absence of effects in human studies. Uncertainties associated with estimation of these different types of health effects are discussed in a qualitative and semi-quantitative manner as appropriate. The way forward would seem to require additional epidemiological studies, especially studies of low dose and low dose

  16. Uncertainties in estimating health risks associated with exposure to ionising radiation.

    PubMed

    Preston, R Julian; Boice, John D; Brill, A Bertrand; Chakraborty, Ranajit; Conolly, Rory; Hoffman, F Owen; Hornung, Richard W; Kocher, David C; Land, Charles E; Shore, Roy E; Woloschak, Gayle E

    2013-09-01

    The information for the present discussion on the uncertainties associated with estimation of radiation risks and probability of disease causation was assembled for the recently published NCRP Report No. 171 on this topic. This memorandum provides a timely overview of the topic, given that quantitative uncertainty analysis is the state of the art in health risk assessment and given its potential importance to developments in radiation protection. Over the past decade the increasing volume of epidemiology data and the supporting radiobiology findings have aided in the reduction of uncertainty in the risk estimates derived. However, it is equally apparent that there remain significant uncertainties related to dose assessment, low dose and low dose-rate extrapolation approaches (e.g. the selection of an appropriate dose and dose-rate effectiveness factor), the biological effectiveness where considerations of the health effects of high-LET and lower-energy low-LET radiations are required and the transfer of risks from a population for which health effects data are available to one for which such data are not available. The impact of radiation on human health has focused in recent years on cancer, although there has been a decided increase in the data for noncancer effects together with more reliable estimates of the risk following radiation exposure, even at relatively low doses (notably for cataracts and cardiovascular disease). New approaches for the estimation of hereditary risk have been developed with the use of human data whenever feasible, although the current estimates of heritable radiation effects still are based on mouse data because of an absence of effects in human studies. Uncertainties associated with estimation of these different types of health effects are discussed in a qualitative and semi-quantitative manner as appropriate. The way forward would seem to require additional epidemiological studies, especially studies of low dose and low dose

  17. Biochemical Control With Radiotherapy Improves Overall Survival in Intermediate and High-Risk Prostate Cancer Patients Who Have an Estimated 10-Year Overall Survival of >90%

    SciTech Connect

    Herbert, Christopher; Liu, Mitchell; Tyldesley, Scott; Morris, W. James; Joffres, Michel; Khaira, Mandip; Kwan, Winkle; Moiseenko, Vitali; Pickles, Thomas

    2012-05-01

    Purpose: To identify subgroups of patients with carcinoma of the prostate treated with radical radiotherapy that have improved overall survival when disease is biochemically controlled. Methods and Materials: A cohort of 1,060 prostate cancer patients treated with radical radiotherapy was divided into nine subgroups based on National Comprehensive Cancer Network risk category and estimated 10-year overall survival (eOS 10y) derived from the age adjusted Charlson Comorbidity Index. Patients with and without biochemical control were compared with respect to overall survival. Actuarial estimates of overall survival were calculated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards models were used for analysis of overall survival. Results: Median follow-up was 125 months (range, 51-176 months). Only the subgroups with high or intermediate risk disease and an eOS 10y of >90% had a statistically significantly improved overall survival when prostate cancer was biochemically controlled. In all other groups, biochemical control made no significant difference to overall survival. In the subgroup with high-risk disease and eOS 10y >90%, actuarial overall survival was 86.3% (95% confidence interval [CI] 78.5%-94.1%) and 62.1% (95% CI 52.9%-71.3%) for patients with biochemical control and biochemical relapse respectively (p = 0.002). In the intermediate risk group with eOS >90%, actuarial overall survival was 95.3% (95% CI 89.0%-100%) and 79.8% (95% CI 68.0%-91.6%) for biochemically controlled and biochemically relapsed patients (p = 0.033). On multivariate analysis, National Comprehensive Cancer Network risk group (p = 0.005), biochemical control (p = 0.033) and eOS 10y (p < 0.001) were statistically significant. Conclusion: Biochemical control translates into improved overall survival in patients with high or intermediate risk disease and an estimated 10-year overall survival of >90%.

  18. Estimating risks of importation and local transmission of Zika virus infection

    PubMed Central

    Nah, Kyeongah; Mizumoto, Kenji; Miyamatsu, Yuichiro; Yasuda, Yohei; Kinoshita, Ryo

    2016-01-01

    Background. An international spread of Zika virus (ZIKV) infection has attracted global attention. ZIKV is conveyed by a mosquito vector, Aedes species, which also acts as the vector species of dengue and chikungunya viruses. Methods. Arrival time of ZIKV importation (i.e., the time at which the first imported case was diagnosed) in each imported country was collected from publicly available data sources. Employing a survival analysis model in which the hazard is an inverse function of the effective distance as informed by the airline transportation network data, and using dengue and chikungunya virus transmission data, risks of importation and local transmission were estimated. Results. A total of 78 countries with imported case(s) have been identified, with the arrival time ranging from 1 to 44 weeks since the first ZIKV was identified in Brazil, 2015. Whereas the risk of importation was well explained by the airline transportation network data, the risk of local transmission appeared to be best captured by additionally accounting for the presence of dengue and chikungunya viruses. Discussion. The risk of importation may be high given continued global travel of mildly infected travelers but, considering that the public health concerns over ZIKV infection stems from microcephaly, it is more important to focus on the risk of local and widespread transmission that could involve pregnant women. The predicted risk of local transmission was frequently seen in tropical and subtropical countries with dengue or chikungunya epidemic experience. PMID:27069825

  19. Estimating risks of importation and local transmission of Zika virus infection.

    PubMed

    Nah, Kyeongah; Mizumoto, Kenji; Miyamatsu, Yuichiro; Yasuda, Yohei; Kinoshita, Ryo; Nishiura, Hiroshi

    2016-01-01

    Background. An international spread of Zika virus (ZIKV) infection has attracted global attention. ZIKV is conveyed by a mosquito vector, Aedes species, which also acts as the vector species of dengue and chikungunya viruses. Methods. Arrival time of ZIKV importation (i.e., the time at which the first imported case was diagnosed) in each imported country was collected from publicly available data sources. Employing a survival analysis model in which the hazard is an inverse function of the effective distance as informed by the airline transportation network data, and using dengue and chikungunya virus transmission data, risks of importation and local transmission were estimated. Results. A total of 78 countries with imported case(s) have been identified, with the arrival time ranging from 1 to 44 weeks since the first ZIKV was identified in Brazil, 2015. Whereas the risk of importation was well explained by the airline transportation network data, the risk of local transmission appeared to be best captured by additionally accounting for the presence of dengue and chikungunya viruses. Discussion. The risk of importation may be high given continued global travel of mildly infected travelers but, considering that the public health concerns over ZIKV infection stems from microcephaly, it is more important to focus on the risk of local and widespread transmission that could involve pregnant women. The predicted risk of local transmission was frequently seen in tropical and subtropical countries with dengue or chikungunya epidemic experience.

  20. Estimating risks of importation and local transmission of Zika virus infection.

    PubMed

    Nah, Kyeongah; Mizumoto, Kenji; Miyamatsu, Yuichiro; Yasuda, Yohei; Kinoshita, Ryo; Nishiura, Hiroshi

    2016-01-01

    Background. An international spread of Zika virus (ZIKV) infection has attracted global attention. ZIKV is conveyed by a mosquito vector, Aedes species, which also acts as the vector species of dengue and chikungunya viruses. Methods. Arrival time of ZIKV importation (i.e., the time at which the first imported case was diagnosed) in each imported country was collected from publicly available data sources. Employing a survival analysis model in which the hazard is an inverse function of the effective distance as informed by the airline transportation network data, and using dengue and chikungunya virus transmission data, risks of importation and local transmission were estimated. Results. A total of 78 countries with imported case(s) have been identified, with the arrival time ranging from 1 to 44 weeks since the first ZIKV was identified in Brazil, 2015. Whereas the risk of importation was well explained by the airline transportation network data, the risk of local transmission appeared to be best captured by additionally accounting for the presence of dengue and chikungunya viruses. Discussion. The risk of importation may be high given continued global travel of mildly infected travelers but, considering that the public health concerns over ZIKV infection stems from microcephaly, it is more important to focus on the risk of local and widespread transmission that could involve pregnant women. The predicted risk of local transmission was frequently seen in tropical and subtropical countries with dengue or chikungunya epidemic experience. PMID:27069825

  1. Acculturation and Adjustment in Latino Adolescents: How Cultural Risk Factors and Assets Influence Multiple Domains of Adolescent Mental Health

    ERIC Educational Resources Information Center

    Smokowski, Paul; Buchanan, Rachel L.; Bacallao, Martica L.

    2009-01-01

    The purpose of this study was to examine the relationships among risk factors, cultural assets, and Latino adolescent mental health outcomes. We extend past research by using a longitudinal design and evaluating direct and moderated acculturation effects across a range of internalizing, externalizing, and academic engagement outcomes. The sample…

  2. Cumulative Socioeconomic Status Risk, Allostatic Load, and Adjustment: A Prospective Latent Profile Analysis with Contextual and Genetic Protective Factors

    ERIC Educational Resources Information Center

    Brody, Gene H.; Yu, Tianyi; Chen, Yi-Fu; Kogan, Steven M.; Evans, Gary W.; Beach, Steven R. H.; Windle, Michael; Simons, Ronald L.; Gerrard, Meg; Gibbons, Frederick X.; Philibert, Robert A.

    2013-01-01

    The health disparities literature has identified a common pattern among middle-aged African Americans that includes high rates of chronic disease along with low rates of psychiatric disorders despite exposure to high levels of cumulative socioeconomic status (SES) risk. The current study was designed to test hypotheses about the developmental…

  3. Cancer risk estimates from radiation therapy for heterotopic ossification prophylaxis after total hip arthroplasty

    SciTech Connect

    Mazonakis, Michalis; Berris, Theoharris; Damilakis, John; Lyraraki, Efrossyni

    2013-10-15

    Purpose: Heterotopic ossification (HO) is a frequent complication following total hip arthroplasty. This study was conducted to calculate the radiation dose to organs-at-risk and estimate the probability of cancer induction from radiotherapy for HO prophylaxis.Methods: Hip irradiation for HO with a 6 MV photon beam was simulated with the aid of a Monte Carlo model. A realistic humanoid phantom representing an average adult patient was implemented in Monte Carlo environment for dosimetric calculations. The average out-of-field radiation dose to stomach, liver, lung, prostate, bladder, thyroid, breast, uterus, and ovary was calculated. The organ-equivalent-dose to colon, that was partly included within the treatment field, was also determined. Organ dose calculations were carried out using three different field sizes. The dependence of organ doses upon the block insertion into primary beam for shielding colon and prosthesis was investigated. The lifetime attributable risk for cancer development was estimated using organ, age, and gender-specific risk coefficients.Results: For a typical target dose of 7 Gy, organ doses varied from 1.0 to 741.1 mGy by the field dimensions and organ location relative to the field edge. Blocked field irradiations resulted in a dose range of 1.4–146.3 mGy. The most probable detriment from open field treatment of male patients was colon cancer with a high risk of 564.3 × 10{sup −5} to 837.4 × 10{sup −5} depending upon the organ dose magnitude and the patient's age. The corresponding colon cancer risk for female patients was (372.2–541.0) × 10{sup −5}. The probability of bladder cancer development was more than 113.7 × 10{sup −5} and 110.3 × 10{sup −5} for males and females, respectively. The cancer risk range to other individual organs was reduced to (0.003–68.5) × 10{sup −5}.Conclusions: The risk for cancer induction from radiation therapy for HO prophylaxis after total hip arthroplasty varies considerably by the

  4. The economic value of reducing environmental health risks: Contingent valuation estimates of the value of information

    SciTech Connect

    Krieger, D.J.; Hoehn, J.P.

    1999-05-01

    Obtaining economically consistent values for changes in low probability health risks continues to be a challenge for contingent valuation (CV) as well as for other valuation methods. One of the cited condition for economic consistency is that estimated values be sensitive to the scope (differences in quantity or quality) of a good described in a CV application. The alleged limitations of CV pose a particular problem for environmental managers who must often make decisions that affect human health risks. This paper demonstrates that a well-designed CV application can elicit scope sensitive values even for programs that provide conceptually complex goods such as risk reduction. Specifically, it finds that the amount sport anglers are willing to pay for information about chemical residues in fish varies systematically with informativeness--a relationship suggested by the theory of information value.

  5. Recent estimates of cancer risk from low-let ionizing radiation and radiation protection limits

    NASA Astrophysics Data System (ADS)

    Sinclair, Warren K.

    1992-07-01

    Estimates of the risk of cancer induction, formerly about 1%/Sv, formed the basis of ICRP radiation protection limits in 1977. They have now increased to about 4-5%/Sv for low doses. These increases are based mainly on new data for the Japanese survivors of the A-bombs of 1945. They result from the accumulation of 11 years more of data on solid tumors, the revisions in the dosimetry of those exposed and improvement in statistical methods and projections. The application of a dose rate effectiveness factor between effects at high dose rate and those at low dose and dose rate is also an important consideration. Not only has the total risk changed but also the distribution of risk among organs. Thus the effective dose equivalent may require modification. These changes are modifying ICRP and NCRP thinking about recommendations on protection limits, especially for radiation workers.

  6. Forest fire risk estimation from time series analisys of NOAA NDVI data

    NASA Astrophysics Data System (ADS)

    Gabban, Andrea; Liberta, Giorgio; San-Miguel-Ayanz, Jesus; Barbosa, Paulo

    2004-02-01

    The values of the Normalized Difference Vegetation Index obtained from NOAA Advanced Very High Resolution Radiometer (AVHRR) have often been used for forestry application, including the assessment of fire risk. Forest fire risk estimates were based mainly on the decrease of NDVI values during the summer in areas subject to summer drought. However, the inter-annual variability of the vegetation response has never been extensively taken into account. The present work was based on the assumption that Mediterranean vegetation is adapted to summer drought and one possible estimator of the vegetation stress was the inter-annual variability of the vegetation status, as reflected by NDVI values. This article presents a novel methodology for the assessment of fire risk based on the comparison of the current NDVI values, on a given area, with the historical values along a time series of 13 years. The first part of the study is focused on the characterization of the Minimum and Maximum long term daily images. The second part is centered on the best method to compare the long term Maximum and Minimum with the current NDVI. A statistical index, Dynamic Relative Greenness, DRG, was tested on as a novel potential fire risk indicator.

  7. Genetic risk and longitudinal disease activity in systemic lupus erythematosus using targeted maximum likelihood estimation.

    PubMed

    Gianfrancesco, M A; Balzer, L; Taylor, K E; Trupin, L; Nititham, J; Seldin, M F; Singer, A W; Criswell, L A; Barcellos, L F

    2016-09-01

    Systemic lupus erythematous (SLE) is a chronic autoimmune disease associated with genetic and environmental risk factors. However, the extent to which genetic risk is causally associated with disease activity is unknown. We utilized longitudinal-targeted maximum likelihood estimation to estimate the causal association between a genetic risk score (GRS) comprising 41 established SLE variants and clinically important disease activity as measured by the validated Systemic Lupus Activity Questionnaire (SLAQ) in a multiethnic cohort of 942 individuals with SLE. We did not find evidence of a clinically important SLAQ score difference (>4.0) for individuals with a high GRS compared with those with a low GRS across nine time points after controlling for sex, ancestry, renal status, dialysis, disease duration, treatment, depression, smoking and education, as well as time-dependent confounding of missing visits. Individual single-nucleotide polymorphism (SNP) analyses revealed that 12 of the 41 variants were significantly associated with clinically relevant changes in SLAQ scores across time points eight and nine after controlling for multiple testing. Results based on sophisticated causal modeling of longitudinal data in a large patient cohort suggest that individual SLE risk variants may influence disease activity over time. Our findings also emphasize a role for other biological or environmental factors. PMID:27467283

  8. Injury Risk Estimation Expertise: Cognitive-Perceptual Mechanisms of ACL-IQ.

    PubMed

    Petushek, Erich J; Cokely, Edward T; Ward, Paul; Myer, Gregory D

    2015-06-01

    Instrument-based biomechanical movement analysis is an effective injury screening method but relies on expensive equipment and time-consuming analysis. Screening methods that rely on visual inspection and perceptual skill for prognosticating injury risk provide an alternative approach that can significantly reduce cost and time. However, substantial individual differences exist in skill when estimating injury risk performance via observation. The underlying perceptual-cognitive mechanisms of injury risk identification were explored to better understand the nature of this skill and provide a foundation for improving performance. Quantitative structural and process modeling of risk estimation indicated that superior performance was largely mediated by specific strategies and skills (e.g., irrelevant information reduction), and independent of domain-general cognitive abilities (e.g., mental rotation, general decision skill). These cognitive models suggest that injury prediction expertise (i.e., ACL-IQ) is a trainable skill, and provide a foundation for future research and applications in training, decision support, and ultimately clinical screening investigations.

  9. Estimated equilibrated dietary intakes for nine minerals (Na, K, Ca, Mg, P, Fe, Zn, Cu, and Mn) adjusted by mineral balance medians in young Japanese females.

    PubMed

    Nishimuta, Mamoru; Kodama, Naoko; Shimada, Mieko; Yoshitake, Yutaka; Matsuzaki, Nobue; Morikuni, Eiko

    2012-01-01

    The present study sought to determine estimated equilibrated dietary intakes (EEDIs) for nine essential minerals: sodium (Na), potassium (K), calcium (Ca), magnesium (Mg), phosphorus (P), iron (Fe), zinc (Zn), copper (Cu), and manganese (Mn), using data from 17 human mineral balance studies conducted from 1986 to 2007 (subjects=178). Among these studies, two used male subjects, two subjected some or all subjects to sodium restriction, and one study utilized a low protein diet; these subjects were not included in the present analysis. Consequently, data from 13 studies of young female subjects (n=131) consuming a standard diet were selected. Balance distribution medians for six of the minerals (Na, K, Mg, Fe, Zn and Cu) were positive, so the data were adjusted to set the medians of the balances to zero. Medians for the other minerals (Ca, P and Mn) were close to zero and were not adjusted. Intake and balance for each mineral were divided by body weight (BW), lean body mass (LBM), and standard body weight (SBW), which was calculated using height and standard body mass index (BMI=22), and EEDIs were calculated as the intercept of a simple regression equation. When relationships between intake and balance of a mineral were not significant in the regression equation, a significant regression equation comparing intake and balance of another mineral was used to calculate the intercept. Significant simple regression equations were not obtained from any of the three parameters of Na or Zn, or for two of the parameters of P; thus, K, Fe and Ca balances were used to determine the intercepts for Na, Zn and P, respectively. EEDIs for the minerals were: Na (67.9, 89.0, 62.5), K (39.5, 53.5, 37.4), Ca (11.0, 14.4, 10.1), Mg (4.18, 5.51, 3.86), P (18.7, 24.6, 17.3) (mg/kg BW/d, mg/kg LBM/d, mg/kg SBW/d), Fe (180, 237, 165), Zn (181, 241, 166), [corrected] Cu (32.3, 42.6, 29.7), [corrected] Mn (55.1, 72.1, 50.7) (µg/kg BW/d, µg/kg LBM/d, µg/kg SBW/d), respectively. These values

  10. Estimation of sport fish harvest for risk and hazard assessment of environmental contaminants

    SciTech Connect

    Poston, T.M.; Strenge, D.L.

    1989-01-01

    Consumption of contaminated fish flesh can be a significant route of human exposure to hazardous chemicals. Estimation of exposure resulting from the consumption of fish requires knowledge of fish consumption and contaminant levels in the edible portion of fish. Realistic figures of sport fish harvest are needed to estimate consumption. Estimates of freshwater sport fish harvest were developed from a review of 72 articles and reports. Descriptive statistics based on fishing pressure were derived from harvest data for four distinct groups of freshwater sport fish in three water types: streams, lakes, and reservoirs. Regression equations were developed to relate harvest to surface area fished where data bases were sufficiently large. Other aspects of estimating human exposure to contaminants in fish flesh that are discussed include use of bioaccumulation factors for trace metals and organic compounds. Using the bioaccumulation factor and the concentration of contaminants in water as variables in the exposure equation may also lead to less precise estimates of tissue concentration. For instance, muscle levels of contaminants may not increase proportionately with increases in water concentrations, leading to overestimation of risk. In addition, estimates of water concentration may be variable or expressed in a manner that does not truly represent biological availability of the contaminant. These factors are discussed. 45 refs., 1 fig., 7 tabs.

  11. Problems and solutions in the estimation of genetic risks from radiation and chemicals

    SciTech Connect

    Russell, W. L.

    1980-01-01

    Extensive investigations with mice on the effects of various physical and biological factors, such as dose rate, sex and cell stage, on radiation-induced mutation have provided an evaluation of the genetics hazards of radiation in man. The mutational results obtained in both sexes with progressive lowering of the radiation dose rate have permitted estimation of the mutation frequency expected under the low-level radiation conditions of most human exposure. Supplementing the studies on mutation frequency are investigations on the phenotypic effects of mutations in mice, particularly anatomical disorders of the skeleton, which allow an estimation of the degree of human handicap associated with the occurrence of parallel defects in man. Estimation of the genetic risk from chemical mutagens is much more difficult, and the research is much less advanced. Results on transmitted mutations in mice indicate a poor correlation with mutation induction in non-mammalian organisms.

  12. Estimate of the risks of disposing nonhazardous oil field wastes into salt caverns

    SciTech Connect

    Tomasko, D.; Elcock, D.; Veil, J.

    1997-12-31

    Argonne National Laboratory (ANL) has completed an evaluation of the possibility that adverse human health effects (carcinogenic and noncarcinogenic) could result from exposure to contaminants released from nonhazardous oil field wastes (NOW) disposed in domal salt caverns. Potential human health risks associated with hazardous substances (arsenic, benzene, cadmium, and chromium) in NOW were assessed under four postclosure cavern release scenarios: inadvertent cavern intrusion, failure of the cavern seal, failure of the cavern through cracks or leaky interbeds, and a partial collapse of the cavern roof. To estimate potential human health risks for these scenarios, contaminant concentrations at the receptor were calculated using a one-dimensional solution to an advection/dispersion equation that included first order degradation. Assuming a single, generic salt cavern and generic oil-field wastes, the best-estimate excess cancer risks ranged from 1.7 {times} 10{sup {minus}12} to 1.1 {times} 10{sup {minus}8} and hazard indices (referring to noncancer health effects) ranged from 7 {times} 10{sup {minus}9} to 7 {times} 10{sup {minus}4}. Under worse-case conditions in which the probability of cavern failure is 1.0, excess cancer risks ranged from 4.9 {times} 10{sup {minus}9} to 1.7 {times} 10{sup {minus}5} and hazard indices ranged from 7.0 {times} 10{sup {minus}4} to 0.07. Even under worst-case conditions, the risks are within the US Environmental Protection Agency (EPA) target range for acceptable exposure levels. From a human health risk perspective, salt caverns can, therefore, provide an acceptable disposal method for NOW.

  13. Correcting for bias in relative risk estimates due to exposure measurement error: a case study of occupational exposure to antineoplastics in pharmacists.

    PubMed Central

    Spiegelman, D; Valanis, B

    1998-01-01

    OBJECTIVES: This paper describes 2 statistical methods designed to correct for bias from exposure measurement error in point and interval estimates of relative risk. METHODS: The first method takes the usual point and interval estimates of the log relative risk obtained from logistic regression and corrects them for nondifferential measurement error using an exposure measurement error model estimated from validation data. The second, likelihood-based method fits an arbitrary measurement error model suitable for the data at hand and then derives the model for the outcome of interest. RESULTS: Data from Valanis and colleagues' study of the health effects of antineoplastics exposure among hospital pharmacists were used to estimate the prevalence ratio of fever in the previous 3 months from this exposure. For an interdecile increase in weekly number of drugs mixed, the prevalence ratio, adjusted for confounding, changed from 1.06 to 1.17 (95% confidence interval [CI] = 1.04, 1.26) after correction for exposure measurement error. CONCLUSIONS: Exposure measurement error is often an important source of bias in public health research. Methods are available to correct such biases. PMID:9518972

  14. The ecology of early childhood risk: a canonical correlation analysis of children's adjustment, family, and community context in a high-risk sample.

    PubMed

    Vilsaint, Corrie L; Aiyer, Sophie M; Wilson, Melvin N; Shaw, Daniel S; Dishion, Thomas J

    2013-08-01

    The ecology of the emergence of psychopathology in early childhood is often approached by the analysis of a limited number of contextual risk factors. In the present study, we provide a comprehensive analysis of ecological risk by conducting a canonical correlation analysis of 13 risk factors at child age 2 and seven narrow-band scales of internalizing and externalizing problem behaviors at child age 4, using a sample of 364 geographically and ethnically diverse, disadvantaged primary caregivers, alternative caregivers, and preschool-age children. Participants were recruited from Special Supplemental Nutrition Program for Women, Infants, and Children sites and were screened for family risk. Canonical correlation analysis revealed that (1) a first latent combination of family and individual risks of caregivers predicted combinations of child emotional and behavioral problems, and that (2) a second latent combination of contextual and structural risks predicted child somatic complaints. Specifically, (1) the combination of chaotic home, conflict with child, parental depression, and parenting hassles predicted a co-occurrence of internalizing and externalizing behaviors, and (2) the combination of father absence, perceived discrimination, neighborhood danger, and fewer children living in the home predicted child somatic complaints. The research findings are discussed in terms of the development of psychopathology, as well as the potential prevention needs of families in high-risk contexts.

  15. Risk estimation for future glacier lake outburst floods based on local land-use changes

    NASA Astrophysics Data System (ADS)

    Nussbaumer, S.; Schaub, Y.; Huggel, C.; Walz, A.

    2014-06-01

    Effects of climate change are particularly strong in high-mountain regions. Most visibly, glaciers are shrinking at a rapid pace, and as a consequence, glacier lakes are forming or growing. At the same time the stability of mountain slopes is reduced by glacier retreat, permafrost thaw and other factors, resulting in an increasing landslide hazard which can potentially impact lakes and therewith trigger far-reaching and devastating outburst floods. To manage risks from existing or future lakes, strategies need to be developed to plan in time for adequate risk reduction measures at a local level. However, methods to assess risks from future lake outbursts are not available and need to be developed to evaluate both future hazard and future damage potential. Here a method is presented to estimate future risks related to glacier lake outbursts for a local site in southern Switzerland (Naters, Valais). To generate two hazard scenarios, glacier shrinkage and lake formation modelling was applied, combined with simple flood modelling and field work. Furthermore, a land-use model was developed to quantify and allocate land-use changes based on local-to-regional storylines and three scenarios of land-use driving forces. Results are conceptualized in a matrix of three land-use and two hazard scenarios for the year 2045, and show the distribution of risk in the community of Naters, including high and very high risk areas. The study underlines the importance of combined risk management strategies focusing on land-use planning, on vulnerability reduction, as well as on structural measures (where necessary) to effectively reduce future risks related to lake outburst floods.

  16. Local land-use change based risk estimation for future glacier lake outburst flood

    NASA Astrophysics Data System (ADS)

    Nussbaumer, S.; Huggel, C.; Schaub, Y.; Walz, A.

    2013-08-01

    Effects of climate change are particularly strong in high-mountain regions. Most visibly, glaciers are shrinking at a rapid pace, and as a consequence, glacier lakes are forming or growing. At the same time the stability of mountain slopes is reduced by glacier retreat, permafrost thaw and other factors, resulting in an increasing risk of landslides which can potentially impact lakes and therewith trigger far reaching and devastating outburst floods. To manage risks from existing or future lakes, strategies need to be developed to plan in time for adequate risk reduction measures at a local level. However, methods to assess risks from future lake outbursts are not available. It is actually a challenge to develop methods to evaluate both, future hazard potential and future damage potential. Here we present an analysis of future risks related to glacier lake outbursts for a local site in southern Switzerland (Naters, Valais). To estimate two hazard scenarios, we used glacier shrinkage and lake formation modelling, simple flood modelling and field work. Further we developed a land-use model to quantify and allocate land-use changes based on local-to-regional storylines and three scenarios of land-use driving forces. Results are conceptualized in a matrix of three land-use and two hazard scenarios for a time period of 2045, and show the distribution of risk in the community of Naters, including high and very high risk areas. The study corroborates the importance of land-use planning to effectively reduce future risks related to lake outburst floods.

  17. Radiation-Induced Leukemia at Doses Relevant to Radiation Therapy: Modeling Mechanisms and Estimating Risks