Science.gov

Sample records for assessing cumulative health

  1. Using Exposomics to Assess Cumulative Risks and Promote Health

    PubMed Central

    Smith, Martyn T.; de la Rosa, Rosemarie; Daniels, Sarah I.

    2015-01-01

    Under the exposome paradigm all non-genetic factors contributing to disease are considered to be ‘environmental’ including chemicals, drugs, infectious agents and psycho-social stress. We can consider these collectively as environmental stressors. Exposomics is the comprehensive analysis of exposure to all environmental stressors and should yield a more thorough understanding of chronic disease development. We can operationalize exposomics by studying all the small molecules in the body and their influence on biological pathways that lead to impaired health. Here, we describe methods by which this may be achieved and discuss the application of exposomics to cumulative risk assessment in vulnerable populations. Since the goal of cumulative risk assessment is to analyze, characterize, and quantify the combined risks to health from exposures to multiple agents or stressors, it seems that exposomics is perfectly poised to advance this important area of environmental health science. We should therefore support development of tools for exposomic analysis and begin to engage impacted communities in participatory exposome research. A first step may be to apply exposomics to vulnerable populations already studied by more conventional cumulative risk approaches. We further propose that recent migrants, low socioeconomic groups with high environmental chemical exposures, and pregnant women should be high priority populations for study by exposomics. Moreover, exposomics allows us to study interactions between chronic stress and environmental chemicals that disrupt stress response pathways (i.e. ‘stressogens’). Exploring the impact of early life exposures and maternal stress may be an interesting and accessible topic for investigation by exposomics using biobanked samples. PMID:26475350

  2. Cumulative Risk Assessment (CRA): Transforming the Way We Assess Health Risks

    PubMed Central

    Williams, Pamela R. D.; Dotson, G. Scott; Maier, Andrew

    2016-01-01

    Human health risk assessments continue to evolve and now focus on the need for cumulative risk assessment (CRA). CRA involves assessing the combined risk from coexposure to multiple chemical and nonchemical stressors for varying health effects. CRAs are broader in scope than traditional chemical risk assessments because they allow for a more comprehensive evaluation of the interaction between different stressors and their combined impact on human health. Future directions of CRA include greater emphasis on local-level community-based assessments; integrating environmental, occupational, community, and individual risk factors; and identifying and implementing common frameworks and risk metrics for incorporating multiple stressors. PMID:22938698

  3. Health Impact Assessment: Linking Public Health to Community Decisions (Cumulative Impacts Community Vulnerability Symposium)

    EPA Science Inventory

    The goal of this presentation is to explore how HIA can help inform hazardous waste permitting regulations and incorporate community vulnerability and cumulative impacts to their potential health risks into permitting decision making by the California Department of Toxic Substanc...

  4. Cumulative health risk assessment: integrated approaches for multiple contaminants, exposures, and effects

    SciTech Connect

    Rice, Glenn; Teuschler, Linda; MacDonel, Margaret; Butler, Jim; Finster, Molly; Hertzberg, Rick; Harou, Lynne

    2007-07-01

    Available in abstract form only. Full text of publication follows: As information about environmental contamination has increased in recent years, so has public interest in the combined effects of multiple contaminants. This interest has been highlighted by recent tragedies such as the World Trade Center disaster and hurricane Katrina. In fact, assessing multiple contaminants, exposures, and effects has long been an issue for contaminated sites, including U.S. Department of Energy (DOE) legacy waste sites. Local citizens have explicitly asked the federal government to account for cumulative risks, with contaminants moving offsite via groundwater flow, surface runoff, and air dispersal being a common emphasis. Multiple exposures range from ingestion and inhalation to dermal absorption and external gamma irradiation. Three types of concerns can lead to cumulative assessments: (1) specific sources or releases - e.g., industrial facilities or accidental discharges; (2) contaminant levels - in environmental media or human tissues; and (3) elevated rates of disease - e.g., asthma or cancer. The specific initiator frames the assessment strategy, including a determination of appropriate models to be used. Approaches are being developed to better integrate a variety of data, extending from environmental to internal co-location of contaminants and combined effects, to support more practical assessments of cumulative health risks. (authors)

  5. Cumulative Risk Assessment: An Overview of Methodological Approaches for Evaluating Combined Health Effects from Exposure to Multiple Environmental Stressors

    PubMed Central

    Sexton, Ken

    2012-01-01

    Systematic evaluation of cumulative health risks from the combined effects of multiple environmental stressors is becoming a vital component of risk-based decisions aimed at protecting human populations and communities. This article briefly examines the historical development of cumulative risk assessment as an analytical tool, and discusses current approaches for evaluating cumulative health effects from exposure to both chemical mixtures and combinations of chemical and nonchemical stressors. A comparison of stressor-based and effects-based assessment methods is presented, and the potential value of focusing on viable risk management options to limit the scope of cumulative evaluations is discussed. The ultimate goal of cumulative risk assessment is to provide answers to decision-relevant questions based on organized scientific analysis; even if the answers, at least for the time being, are inexact and uncertain. PMID:22470298

  6. Modeling Joint Exposures and Health Outcomes for Cumulative Risk Assessment: the Case of Radon and Smoking

    EPA Science Inventory

    Community-based cumulative risk assessment requires characterization of exposures to multiple chemical and non-chemical stressors, with consideration of how the non-chemical stressors may influence risks from chemical stressors. Residential radon provides an interesting case exam...

  7. Modeling Joint Exposures and Health Outcomes for Cumulative Risk Assessment: the Case of Radon and Smoking

    EPA Science Inventory

    Community-based cumulative risk assessment requires characterization of exposures to multiple chemical and non-chemical stressors, with consideration of how the non-chemical stressors may influence risks from chemical stressors. Residential radon provides an interesting case exam...

  8. Cumulative Risk Assessment in the Lorraine Region: A Framework to Characterize Environmental Health Inequalities.

    PubMed

    Caudeville, Julien; Ioannidou, Despoina; Boulvert, Emmanuelle; Bonnard, Roseline

    2017-03-10

    The study explores spatial data processing methods and the associated impact on the characterization and quantification of a combined health risk indicator at a regional scale and at fine resolution. To illustrate the methodology of combining multiple publicly available data sources, we present a case study of the Lorraine region (France), where regional stakeholders were involved in the global procedures for data collection and organization. Different indicators are developed by combining technical approaches for assessing and characterizing human health exposure to chemical substances (in soil, air and water) and noise risk factors. The results permit identification of pollutant sources, determinants of exposure, and potential hotspot areas. A test of the model's assumptions to changes in sub-indicator spatial distribution showed the impact of data transformation on identifying more impacted areas. Cumulative risk assessment permits the combination of quantitative and qualitative evaluation of health risks by including stakeholders in the decision process, helping to define a subjective conceptual analysis framework or assumptions when uncertainties or knowledge gaps operate.

  9. Cumulative Risk Assessment in the Lorraine Region: A Framework to Characterize Environmental Health Inequalities

    PubMed Central

    Caudeville, Julien; Ioannidou, Despoina; Boulvert, Emmanuelle; Bonnard, Roseline

    2017-01-01

    The study explores spatial data processing methods and the associated impact on the characterization and quantification of a combined health risk indicator at a regional scale and at fine resolution. To illustrate the methodology of combining multiple publicly available data sources, we present a case study of the Lorraine region (France), where regional stakeholders were involved in the global procedures for data collection and organization. Different indicators are developed by combining technical approaches for assessing and characterizing human health exposure to chemical substances (in soil, air and water) and noise risk factors. The results permit identification of pollutant sources, determinants of exposure, and potential hotspot areas. A test of the model’s assumptions to changes in sub-indicator spatial distribution showed the impact of data transformation on identifying more impacted areas. Cumulative risk assessment permits the combination of quantitative and qualitative evaluation of health risks by including stakeholders in the decision process, helping to define a subjective conceptual analysis framework or assumptions when uncertainties or knowledge gaps operate. PMID:28287441

  10. Cumulative effects of antiandrogenic chemical mixtures and their relevance to human health risk assessment.

    PubMed

    Howdeshell, Kembra L; Hotchkiss, Andrew K; Gray, L Earl

    2016-11-19

    Toxicological studies of defined chemical mixtures assist human health risk assessment by establishing how chemicals interact with one another to induce an effect. This paper reviews how antiandrogenic chemical mixtures can alter reproductive tract development in rats with a focus on the reproductive toxicant phthalates. The reviewed studies compare observed mixture data to mathematical mixture model predictions based on dose addition or response addition to determine how the individual chemicals in a mixture interact (e.g., additive, greater, or less than additive). Phthalate mixtures were observed to act in a dose additive manner based on the relative potency of the individual phthalates to suppress fetal testosterone production. Similar dose additive effects have been reported for mixtures of phthalates with antiandrogenic pesticides of differing mechanisms of action. Overall, data from these phthalate experiments in rats can be used in conjunction with human biomonitoring data to determine individual hazard indices, and recent cumulative risk assessments in humans indicate an excess risk to antiandrogenic chemical mixtures that include phthalates only or phthalates in combination with other antiandrogenic chemicals.

  11. Cumulative health risk assessment of 17 perfluoroalkylated and polyfluoroalkylated substances (PFASs) in the Swedish population.

    PubMed

    Borg, Daniel; Lund, Bert-Ove; Lindquist, Nils-Gunnar; Håkansson, Helen

    2013-09-01

    Humans are simultaneously exposed to a multitude of chemicals. Human health risk assessment of chemicals is, however, normally performed on single substances, which may underestimate the total risk, thus bringing a need for reliable methods to assess the risk of combined exposure to multiple chemicals. Per- and polyfluoroalkylated substances (PFASs) is a large group of chemicals that has emerged as global environmental contaminants. In the Swedish population, 17 PFASs have been measured, of which the vast majority lacks human health risk assessment information. The objective of this study was to for the first time perform a cumulative health risk assessment of the 17 PFASs measured in the Swedish population, individually and in combination, using the Hazard Index (HI) approach. Swedish biomonitoring data (blood/serum concentrations of PFASs) were used and two study populations identified: 1) the general population exposed indirectly via the environment and 2) occupationally exposed professional ski waxers. Hazard data used were publicly available toxicity data for hepatotoxicity and reproductive toxicity as well as other more sensitive toxic effects. The results showed that PFASs concentrations were in the low ng/ml serum range in the general population, reaching high ng/ml and low μg/ml serum concentrations in the occupationally exposed. For those congeners lacking toxicity data with regard to hepatotoxicity and reproductive toxicity read-across extrapolations was performed. Other effects at lower dose levels were observed for some well-studied congeners. The risk characterization showed no concern for hepatotoxicity or reproductive toxicity in the general population except in a subpopulation eating PFOS-contaminated fish, illustrating that high local exposure may be of concern. For the occupationally exposed there was concern for hepatotoxicity by PFOA and all congeners in combination as well as for reproductive toxicity by all congeners in combination, thus a

  12. Modeling Joint Exposures and Health Outcomes for Cumulative Risk Assessment: The Case of Radon and Smoking

    PubMed Central

    Chahine, Teresa; Schultz, Bradley D.; Zartarian, Valerie G.; Xue, Jianping; Subramanian, SV; Levy, Jonathan I.

    2011-01-01

    Community-based cumulative risk assessment requires characterization of exposures to multiple chemical and non-chemical stressors, with consideration of how the non-chemical stressors may influence risks from chemical stressors. Residential radon provides an interesting case example, given its large attributable risk, effect modification due to smoking, and significant variability in radon concentrations and smoking patterns. In spite of this fact, no study to date has estimated geographic and sociodemographic patterns of both radon and smoking in a manner that would allow for inclusion of radon in community-based cumulative risk assessment. In this study, we apply multi-level regression models to explain variability in radon based on housing characteristics and geological variables, and construct a regression model predicting housing characteristics using U.S. Census data. Multi-level regression models of smoking based on predictors common to the housing model allow us to link the exposures. We estimate county-average lifetime lung cancer risks from radon ranging from 0.15 to 1.8 in 100, with high-risk clusters in areas and for subpopulations with high predicted radon and smoking rates. Our findings demonstrate the viability of screening-level assessment to characterize patterns of lung cancer risk from radon, with an approach that can be generalized to multiple chemical and non-chemical stressors. PMID:22016710

  13. Modeling joint exposures and health outcomes for cumulative risk assessment: the case of radon and smoking.

    PubMed

    Chahine, Teresa; Schultz, Bradley D; Zartarian, Valerie G; Xue, Jianping; Subramanian, S V; Levy, Jonathan I

    2011-09-01

    Community-based cumulative risk assessment requires characterization of exposures to multiple chemical and non-chemical stressors, with consideration of how the non-chemical stressors may influence risks from chemical stressors. Residential radon provides an interesting case example, given its large attributable risk, effect modification due to smoking, and significant variability in radon concentrations and smoking patterns. In spite of this fact, no study to date has estimated geographic and sociodemographic patterns of both radon and smoking in a manner that would allow for inclusion of radon in community-based cumulative risk assessment. In this study, we apply multi-level regression models to explain variability in radon based on housing characteristics and geological variables, and construct a regression model predicting housing characteristics using U.S. Census data. Multi-level regression models of smoking based on predictors common to the housing model allow us to link the exposures. We estimate county-average lifetime lung cancer risks from radon ranging from 0.15 to 1.8 in 100, with high-risk clusters in areas and for subpopulations with high predicted radon and smoking rates. Our findings demonstrate the viability of screening-level assessment to characterize patterns of lung cancer risk from radon, with an approach that can be generalized to multiple chemical and non-chemical stressors.

  14. Bridging science and traditional knowledge to assess cumulative impacts of stressors on ecosystem health.

    PubMed

    Mantyka-Pringle, Chrystal S; Jardine, Timothy D; Bradford, Lori; Bharadwaj, Lalita; Kythreotis, Andrew P; Fresque-Baxter, Jennifer; Kelly, Erin; Somers, Gila; Doig, Lorne E; Jones, Paul D; Lindenschmidt, Karl-Erich

    2017-05-01

    Cumulative environmental impacts driven by anthropogenic stressors lead to disproportionate effects on indigenous communities that are reliant on land and water resources. Understanding and counteracting these effects requires knowledge from multiple sources. Yet the combined use of Traditional Knowledge (TK) and Scientific Knowledge (SK) has both technical and philosophical hurdles to overcome, and suffers from inherently imbalanced power dynamics that can disfavour the very communities it intends to benefit. In this article, we present a 'two-eyed seeing' approach for co-producing and blending knowledge about ecosystem health by using an adapted Bayesian Belief Network for the Slave River and Delta region in Canada's Northwest Territories. We highlight how bridging TK and SK with a combination of field data, interview transcripts, existing models, and expert judgement can address key questions about ecosystem health when considerable uncertainty exists. SK indicators (e.g., bird counts, mercury in fish, water depth) were graded as moderate, whereas TK indicators (e.g., bird usage, fish aesthetics, changes to water flow) were graded as being poor in comparison to the past. SK indicators were predominantly spatial (i.e., comparing to other locations) while the TK indicators were predominantly temporal (i.e., comparing across time). After being populated by 16 experts (local harvesters, Elders, governmental representatives, and scientists) using both TK and SK, the model output reported low probabilities that the social-ecological system is healthy as it used to be. We argue that it is novel and important to bridge TK and SK to address the challenges of environmental change such as the cumulative impacts of multiple stressors on ecosystems and the services they provide. This study presents a critical social-ecological tool for widening the evidence-base to a more holistic understanding of the system dynamics of multiple environmental stressors in ecosystems and for

  15. Cumulative effects of anti-androgenic chemical mixtures and their relevance to human health risk assessment

    EPA Science Inventory

    Kembra L. Howdeshell and L. Earl Gray, Jr.Toxicological studies of defined chemical mixtures assist human health risk assessment by characterizing the joint action of chemicals. This presentation will review the effects of anti-androgenic chemical mixtures on reproductive tract d...

  16. Cumulative effects of anti-androgenic chemical mixtures and their relevance to human health risk assessment

    EPA Science Inventory

    Kembra L. Howdeshell and L. Earl Gray, Jr.Toxicological studies of defined chemical mixtures assist human health risk assessment by characterizing the joint action of chemicals. This presentation will review the effects of anti-androgenic chemical mixtures on reproductive tract d...

  17. HEALTH AND ENVIRONMENTAL SCIENCES INSTITUTE'S EXPOSURE FACTORS DATABASE FOR AGGREGATE AND CUMULATIVE RISK ASSESSMENT

    EPA Science Inventory

    In recent years, the risk analysis community has broadened its use of complex aggregate and cumulative residential exposure models (e.g., to meet the requirements of the 1996 Food Quality Protection Act). The value of these models is their ability to incorporate a range of input...

  18. HEALTH AND ENVIRONMENTAL SCIENCES INSTITUTE'S EXPOSURE FACTORS DATABASE FOR AGGREGATE AND CUMULATIVE RISK ASSESSMENT

    EPA Science Inventory

    In recent years, the risk analysis community has broadened its use of complex aggregate and cumulative residential exposure models (e.g., to meet the requirements of the 1996 Food Quality Protection Act). The value of these models is their ability to incorporate a range of input...

  19. Phthalates and Cumulative Risk Assessment (NAS Final ...

    EPA Pesticide Factsheets

    On December 18, 2008, the National Academy of Sciences' National Research Council released a final report, requested and sponsored by the EPA, entitled Phthalates and Cumulative Risk Assessment: The Task Ahead. Risk assessment has become a dominant public policy tool for making choices, based on limited resources, to protect public health and the environment. It has been instrumental to the mission of the U.S. Environmental Protection Agency (EPA) as well as other federal agencies in evaluating public health concerns, informing regulatory and technological decisions, prioritizing research needs and funding, and in developing approaches for cost-benefit analysis. People are exposed to a variety of chemicals throughout their daily lives. To protect public health, regulators use risk assessments to examine the effects of chemical exposures. This book provides guidance for assessing the risk of phthalates, chemicals found in many consumer products that have been shown to affect the development of the male reproductive system of laboratory animals. Because people are exposed to multiple phthalates and other chemicals that affect male reproductive development, a cumulative risk assessment should be conducted that evaluates the combined effects of exposure to all these chemicals. The book suggests an approach for cumulative risk assessment that can serve as a model for evaluating the health risks of other types of chemicals.

  20. Urinary antibiotics of pregnant women in Eastern China and cumulative health risk assessment.

    PubMed

    Wang, Hexing; Wang, Na; Qian, Junhua; Hu, Lingyun; Huang, Peixin; Su, Meifang; Yu, Xin; Fu, Chaowei; Jiang, Feng; Zhao, Qi; Zhou, Ying; Lin, Haijiang; He, Gengsheng; Chen, Yue; Jiang, Qingwu

    2017-02-23

    Exposure to antibiotics during pregnancy can pose a systematic effect on human health. A few bio-monitoring studies have demonstrated an extensive exposure of children to antibiotics, but there is still lack of data for pregnant women. To assess the exposure of pregnant women to antibiotics and potential health risk, we investigated 536 pregnant women aged 16-42 years from two geographically different study sites in Eastern China in 2015. We measured 21 antibiotics of five categories (seven fluoroquinolones, three phenicols, four tetracyclines, three macrolides, and four sulfonamides) in urines by using the isotope dilution ultra-performance liquid chromatography coupled to quadrupole time of-flight mass spectrometry. Hazard index (HI) was calculated based on estimated daily exposure dose and acceptable daily intakes. Sixteen antibiotics were found in urines with detection frequencies between 0.2% and 16.0%. Antibiotics were overall detected in 41.6% of urines, and two or more antibiotics were detected in 13.1% of urines. Ciprofloxacin, ofloxacin, and trimethoprim were most frequently detected in urine with detection frequencies between 10% and 20%. The majority of the antibiotics tested had an estimated daily exposure dose less than 1μg/kg/day and 4.3% of pregnant women had a HI value more than one. These findings indicated that pregnant women were frequently exposed to antibiotics and some individuals were in the potential risk of adverse microbiological effects induced by antibiotics.

  1. Incorporating Nonchemical Stressors Into Cumulative Risk Assessments

    PubMed Central

    Rider, Cynthia V.; Dourson, Michael L.; Hertzberg, Richard C.; Mumtaz, Moiz M.; Price, Paul S.; Simmons, Jane Ellen

    2012-01-01

    The role of nonchemical stressors in modulating the human health risk associated with chemical exposures is an area of increasing attention. On 9 March 2011, a workshop titled “Approaches for Incorporating Nonchemical Stressors into Cumulative Risk Assessment” took place during the 50th Anniversary Annual Society of Toxicology Meeting in Washington D.C. Objectives of the workshop included describing the current state of the science from various perspectives (i.e., regulatory, exposure, modeling, and risk assessment) and presenting expert opinions on currently available methods for incorporating nonchemical stressors into cumulative risk assessments. Herein, distinct frameworks for characterizing exposure to, joint effects of, and risk associated with chemical and nonchemical stressors are discussed. PMID:22345310

  2. Cumulative health risk assessment of co-occurring mycotoxins of deoxynivalenol and its acetyl derivatives in wheat and maize: case study, Shanghai, China.

    PubMed

    Han, Zheng; Nie, Dongxia; Ediage, Emmanuel Njumbe; Yang, Xianli; Wang, Jianhua; Chen, Bo; Li, Shuguang; On, Stephen L W; De Saeger, Sarah; Wu, Aibo

    2014-12-01

    Humans are naturally and frequently exposed to a multitude of mycotoxins, but health risk assessments are usually performed on individual mycotoxins, which may underestimate the total risks. In this study, we assessed for the first time the cumulative health risks of concomitant exposure via dietary intake (DI) to multiple mycotoxins, namely deoxynivalenol (DON) and its acetyl derivatives of 3-acetyldeoxynivalenol (3-ADON) and 15-acetyldeoxynivalenol (15-ADON), based on the concentration addition (CA) concept. A cross-sectional study was conducted in seven districts in Shanghai, China with 1269 participants and 330 wheat and maize samples analyzed. After probabilistic analysis using Monte Carlo simulation, the results showed no health risks to the population in Shanghai considering individual mycotoxins. However, if the cumulative health risks were calculated based on the combined consideration of DON with either 3-ADON or 15-ADON or both, the DI values in 95th percentile were up to 1087 ng/kg body weight/day, exceeding the Provisional Maximum Tolerable Daily Intake (PMTDI) of 1000 ng/kg body weight/day and hence representing potential health risks to the population in Shanghai. The integrated study proposed here could be a model strategy for cumulative health risk assessment on the co-occurring hazards in the fields of food safety combined with environmental contaminants.

  3. Cumulative social disadvantage and child health.

    PubMed

    Bauman, Laurie J; Silver, Ellen J; Stein, Ruth E K

    2006-04-01

    Disparities in child health are a major public health concern. However, it is unclear whether these are predominantly the result of low income, race, or other social risk factors that may contribute to their health disadvantage. Although others have examined the effects of the accumulation of risk factors, this methodology has not been applied to child health. We tested 4 social risk factors (poverty, minority race/ethnicity, low parental education, and not living with both biological parents) to assess whether they have cumulative effects on child health and examined whether access to health care reduced health disparities. We analyzed data on 57,553 children <18 years from the 1994 and 1995 National Health Interview Survey Disability Supplement. Of the 4 risk factors, 3 (poverty, low parental education, and single-parent household) were consistently associated with child health. These were summed, generating the Social Disadvantage Index (range: 0-3). A total of 43.6% of children had no social disadvantages, 30.8% had 1, 15.6% had 2, and 10.0% had all 3. Compared with those with no social disadvantages, the odds ratios (ORs) of being in "good, fair, or poor health" (versus "excellent or very good") were 1.95 for 1 risk, 3.22 for 2 risks, and 4.06 for 3 risks. ORs of having a chronic condition increased from 1.25 (1 risk) to 1.60 (2 risks) to 2.11 (3 risks). ORs for activity limitation were 1.51 (1 risk) to 2.14 (2 risks) and 2.88 (3 risks). Controlling for health insurance did not affect these findings. The accumulation of social disadvantage among children was strongly associated with poorer child health and having insurance did not reduce the observed health disparities.

  4. CUMULATIVE RISK ASSESSMENT FOR QUANTITATIVE RESPONSE DATA

    EPA Science Inventory

    The Relative Potency Factor approach (RPF) is used to normalize and combine different toxic potencies among a group of chemicals selected for cumulative risk assessment. The RPF method assumes that the slopes of the dose-response functions are all equal; but this method depends o...

  5. CUMULATIVE RISK ASSESSMENT FOR QUANTITATIVE RESPONSE DATA

    EPA Science Inventory

    The Relative Potency Factor approach (RPF) is used to normalize and combine different toxic potencies among a group of chemicals selected for cumulative risk assessment. The RPF method assumes that the slopes of the dose-response functions are all equal; but this method depends o...

  6. A feasibility study on assessing public health impacts of cumulative air pollution reduction activities in a small geographic area

    EPA Science Inventory

    Background and Objective: The rnain objective ofthis study was to examine the feasibility ofconducting a local (e.g., city level) assessment ofthe public health impacts ofcumulative air pollution reduction activities (a.k.a. accountability) from the federal, state, local and vo...

  7. A feasibility study on assessing public health impacts of cumulative air pollution reduction activities in a small geographic area

    EPA Science Inventory

    Background and Objective: The rnain objective ofthis study was to examine the feasibility ofconducting a local (e.g., city level) assessment ofthe public health impacts ofcumulative air pollution reduction activities (a.k.a. accountability) from the federal, state, local and vo...

  8. Cumulative Assessment of Risk from Pesticides

    EPA Pesticide Factsheets

    EPA protects human health and the environment by evaluating the risk associated with pesticides before allowing them to be used in the United States. Learn about the tools and processes used in risk assessment for pesticides.

  9. Cumulative health risk assessment of halogenated and parent polycyclic aromatic hydrocarbons associated with particulate matters in urban air.

    PubMed

    Sun, Jian-Lin; Jing, Xin; Chang, Wen-Jing; Chen, Zheng-Xia; Zeng, Hui

    2015-03-01

    Halogenated polycyclic aromatic hydrocarbons (HPAHs) have been reported to occur widely in urban air. Nevertheless, knowledge about the human health risk associated with inhalation exposure to HPAHs is scarce so far. In the present study, nine HPAHs and 16 PAHs were determined in atmospheric particulate matter (PM) collected from Shenzhen, China to address this issue. Concentrations of Σ9HPAHs varied from 0.1 to 1.5 ng/m(3) and from 0.09 to 0.4 ng/m(3) in PM10 and PM2.5 samples, respectively. As for individuals, 9-bromoanthracene, 7-bromobenz(a)anthracene, and 9,10-dibromoanthracene were the dominant congeners. Levels of Σ16PAHs in PM10 and PM2.5 samples ranged from 3.2 to 81 ng/m(3) and from 2.8 to 85 ng/m(3), respectively. Among individual PAHs, chrysene, benzo[b]fluoranthene, and indeno[1,2,3-c,d]pyrene were the main congeners. According to the season, concentrations of HPAHs and PAHs in atmospheric PM10/PM2.5 samples show a similar decreasing trend with an order: winter>autumn>spring>summer. The daily intake (DI) of PM10/PM2.5-bound HPAHs and PAHs were estimated. Our results indicated that children have the highest DI levels via inhalation exposure. The incremental lifetime cancer risk (ILCR) induced by PM10/PM2.5-bound HPAHs and PAHs were calculated. The ILCR values showed a similar decreasing trend with an order: adults>children>seniors>adolescent. Overall, the ILCR values induced by HPAHs and PAHs were far below the priority risk level (10(-4)), indicating no obvious cancer risk. To our knowledge, this is the first study to investigate the human health risk associated with inhalation exposure to PM10/PM2.5-bound HPAHs.

  10. Cumulative Risk Assessment Toolbox: Methods and Approaches for the Practitioner

    PubMed Central

    MacDonell, Margaret M.; Haroun, Lynne A.; Teuschler, Linda K.; Rice, Glenn E.; Hertzberg, Richard C.; Butler, James P.; Chang, Young-Soo; Clark, Shanna L.; Johns, Alan P.; Perry, Camarie S.; Garcia, Shannon S.; Jacobi, John H.; Scofield, Marcienne A.

    2013-01-01

    The historical approach to assessing health risks of environmental chemicals has been to evaluate them one at a time. In fact, we are exposed every day to a wide variety of chemicals and are increasingly aware of potential health implications. Although considerable progress has been made in the science underlying risk assessments for real-world exposures, implementation has lagged because many practitioners are unaware of methods and tools available to support these analyses. To address this issue, the US Environmental Protection Agency developed a toolbox of cumulative risk resources for contaminated sites, as part of a resource document that was published in 2007. This paper highlights information for nearly 80 resources from the toolbox and provides selected updates, with practical notes for cumulative risk applications. Resources are organized according to the main elements of the assessment process: (1) planning, scoping, and problem formulation; (2) environmental fate and transport; (3) exposure analysis extending to human factors; (4) toxicity analysis; and (5) risk and uncertainty characterization, including presentation of results. In addition to providing online access, plans for the toolbox include addressing nonchemical stressors and applications beyond contaminated sites and further strengthening resource accessibility to support evolving analyses for cumulative risk and sustainable communities. PMID:23762048

  11. 76 FR 69726 - Pyrethrins/Pyrethroid Cumulative Risk Assessment; Notice of Availability

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-09

    ... disproportionately high and adverse human health impacts or environmental effects from exposure to the pesticides... to consider available information concerning the cumulative effects on human health resulting from... cumulative risk assessment for the naturally occurring pyrethrins and synthetic pyrethroid pesticides (often...

  12. Mapping cumulative environmental effects, social vulnerability, and health in the San Joaquin Valley, California.

    PubMed

    Huang, Ganlin; London, Jonathan

    2012-05-01

    To understand the social distribution of environmental hazards, methods to assess cumulative effects and their health implications are needed. We developed a cumulative environmental hazard index integrating environmental data on pollution sites, air quality, and pesticide use; a social vulnerability index to measure residents' resources to prevent or mitigate health effects; and a health index. We found that communities in California's San Joaquin Valley with high social vulnerability face more environmental burdens and have worse health conditions.

  13. 78 FR 25440 - Request for Information and Citations on Methods for Cumulative Risk Assessment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-01

    ... planning, analysis, assessment, and characterization of cumulative risks to human populations and the... integrates multiple sources, effects, pathways, stressors and populations for cumulative risk analyses in all..., multi-stressor approaches to understanding risks to human health and the environment. For example,...

  14. Using Biomarkers to Inform Cumulative Risk Assessment

    PubMed Central

    Ryan, P. Barry; Burke, Thomas A.; Cohen Hubal, Elaine A.; Cura, Jerome J.; McKone, Thomas E.

    2007-01-01

    Background Biomarkers are considered the method of choice for determining exposure to environmental contaminants and relating such exposures to health outcomes. However, the association between many biomarkers and outcome is not direct because of variability in sensitivity and susceptibility in the individual. Objectives We explore the relationship between environmental exposures and health outcomes as mitigated by differential susceptibility in individuals or populations and address the question “Can biomarkers enable us to understand and quantify better the population burden of disease and health effects attributable to environmental exposures?” Methods We use a case–study approach to develop the thesis that biomarkers offer a pathway to disaggregation of health effects into specific, if multiple, risk factors. We offer the point of view that a series or array of biomarkers, including biomarkers of exposure, biomarkers of susceptibility, and biomarkers of effect, used in concert offer the best means by which to effect this disaggregation. We commence our discussion by developing the characteristics of an ideal biomarker, then give some examples of commonly used biomarkers to show the strengths and weaknesses of current usage. We follow this by more detailed case-study assessment outlining the state-of-the-science in specific cases. We complete our work with recommendations regarding the future use of biomarkers and areas for continued development. Conclusions The case studies provide examples of when and how biomarkers can be used to infer the source and magnitude of exposure among a set of competing sources and pathways. The answer to this question is chemical specific and relates to how well the biomarker matches the characteristics of an “ideal” biomarker–in particular ease of collection and persistence. The use of biomarkers in combination provides a better opportunity to disaggregate both source and pathway contributions. PMID:17520075

  15. A Topical Overview of Cumulative Risk Assessment Concepts ...

    EPA Pesticide Factsheets

    Cumulative risk assessments (CRAs) address combined risks from exposures to multiple chemical and nonchemical stressors and may focus on vulnerable communities or populations. Significant contributions have been made to the development of concepts, methods, and applications for CRA over the past decade. Work in both human health and ecological cumulative risk has advanced in two different contexts. First, in assessing the effects of chemical mixtures that share common modes of action, or that cause common adverse outcomes. In this context two primary models are used for predicting mixture effects, dose addition or response addition. The second context is evaluating the combined effects of chemical and nonchemical (e.g., radiation, biological, nutritional, economic, psychological, habitat alteration, land-use change, global climate change, and natural disasters) stressors. CRA can be adapted to address risk in many contexts, and this adaptability is reflected in the range in disciplinary perspectives in the published literature. This article presents the results of a literature search by presenting a range of selected work with the intention to give a broad overview of relevant topics and provide a starting point for researchers interested in CRA applications. This is a select literature review of topics in CRA. As a published article it will allow the citation of an analysis conducted on a rich and diverse set of CRA publications relevant to assessment methods

  16. Tools to Assess Community-Based Cumulative Risk and Exposures

    EPA Science Inventory

    Multiple agents and stressors can interact in a given community to adversely affect human and ecological conditions. A cumulative risk assessment (CRA) analyzes, characterizes, and potentially quantifies the effects from multiple stressors, which include chemical agents (for exam...

  17. Considering Environmental and Occupational Stressors in Cumulative Risk Assessments

    EPA Science Inventory

    While definitions vary across the global scientific community, cumulative risk assessments (CRAs) typically are described as exhibiting a population focus and analyzing the combined risks posed by multiple stressors. CRAs also may consider risk management alternatives as an anal...

  18. Considering Environmental and Occupational Stressors in Cumulative Risk Assessments

    EPA Science Inventory

    While definitions vary across the global scientific community, cumulative risk assessments (CRAs) typically are described as exhibiting a population focus and analyzing the combined risks posed by multiple stressors. CRAs also may consider risk management alternatives as an anal...

  19. Tools to Assess Community-Based Cumulative Risk and Exposures

    EPA Science Inventory

    Multiple agents and stressors can interact in a given community to adversely affect human and ecological conditions. A cumulative risk assessment (CRA) analyzes, characterizes, and potentially quantifies the effects from multiple stressors, which include chemical agents (for exam...

  20. 76 FR 82296 - Pyrethrins/Pyrethroid Cumulative Risk Assessment; Extension of Comment Period

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-30

    ... AGENCY Pyrethrins/Pyrethroid Cumulative Risk Assessment; Extension of Comment Period AGENCY... announced the availability of EPA's cumulative risk assessment for the pyrethroids. Based on this assessment... of concern. Because this cumulative risk assessment uses a number of very conservative...

  1. Cumulative effects of air pollution on public health.

    PubMed

    Xia, Yingcun; Tong, Howell

    2006-10-30

    Cumulative effect is an important way through which the pollutants affect public health. However, few existing dynamical models are well enough understood and documented to detect or quantify the cumulative effects and to answer pertinent questions posed by the World Health Organization (WHO): 'Is there a threshold below which no effects of the pollutants on health are expected to occur in all people?' and 'What averaging period (time pattern) is the most relevant from the point of view of health?'. Using a new semi-parametric time series modelling approach, which incorporates non-linearity and latent cumulative variables, we show that the cumulative effects on health due to continual exposure to environmental pollutants can be very serious even at levels below the national ambient air quality standards of America (NAAQS). The situation is especially worrying for chronic sufferers. Our study suggests that different pollutants may require different cumulative periods (on average) to impact on health but they share a similar functional form in respect of their impact. We also suggest some possible revision of the ambient air quality standards.

  2. Including past and present impacts in cumulative impact assessments

    SciTech Connect

    McCold, L.N.; Saulsbury, J.W.

    1996-09-01

    Environmental concerns such as loss of biological diversity and stratospheric ozone depletion have heightened awareness of the need to assess cumulative impacts in environmental documents. More than 20 years of experience with National Environmental Policy Act (NEPA) have provided analysts in the United States with opportunities for developing successful techniques to assess site-specific impacts of proposed actions. Methods for analyzing a proposed action`s incremental contribution to cumulative impacts are generally less advanced than those for project-specific impacts. The Presidents Council on Environmental Quality (CEQ) defines cumulative impact to include the impacts of {open_quotes}past, present and reasonably foreseeable future actions{close_quotes} regardless of who undertakes the action. Court decisions have helped clarify the distinction between reasonably foreseeable future actions and other possible future actions. This paper seeks to clarify how past and present impacts should be included in cumulative impact analyses. The definition of cumulative impacts implies that cumulative impact analyses should include the effects of all past and present actions on a particular resource. Including past and present impacts in cumulative impact assessments increases the likelihood of identifying significant impacts. NEPA requires agencies to give more consideration to alternatives and mitigation and to provide more opportunities for public involvement for actions that would have significant impacts than for actions that would not cause or contribute to significant impacts. For an action that would contribute to significant cumulative impacts, the additional cost and effort involved in increased consideration of alternatives and mitigation and in additional public involvement may be avoided if the action can be modified so that its contributions to significant cumulative impacts are eliminated. 18 refs., 4 figs.

  3. First-order based cumulative distribution function for solute concentration in heterogeneous aquifers: Theoretical analysis and implications for human health risk assessment

    NASA Astrophysics Data System (ADS)

    de Barros, F. P. J.; Fiori, A.

    2014-05-01

    Quantifying the uncertainty of solute concentration in heterogeneous aquifers is an important step in both human health and ecological risk analysis. The need for a probabilistic representation of transport is justified by the incomplete characterization of the subsurface. We derive the one-point concentration cumulative distribution function (CDF) while taking into account the spatial statistical structure of the hydraulic conductivity, space dimensionality, the injection source size, the Péclet number, and the sampling volume at the monitoring location. The CDF is application oriented and derived at first order in the log-conductivity variance. We illustrate how several key parameters control the shape of the concentration CDF. The CDF shape is important since it reflects both uncertainty and the dilution state of the plume. The transition from a bimodal to a unimodal CDF is examined and results are further supported by analyzing the concentration coefficient of variation. Results indicate the significance of the statistical anisotropy ratio (i.e., the ratio between the hydraulic conductivity correlation scales) in determining the CDF shape. The importance of the sampling volume in the tails of the concentration CDF and a comparison between the proposed model with the β-CDF approach (i.e., beta distribution) are also shown. Finally, we illustrate how the framework could be used in applications by evaluating the human health risk CDF. Our results are formally valid for low to moderate heterogeneous aquifers and source sizes small as compared to the hydraulic conductivity correlation length. The proposed approach can serve as a benchmark tool for other methods.

  4. If Cumulative Risk Assessment Is the Answer, What Is the Question?

    PubMed Central

    Callahan, Michael A.; Sexton, Ken

    2007-01-01

    Cumulative risk refers to the combined threats from exposure via all relevant routes to multiple stressors including biological, chemical, physical, and psychosocial entities. Cumulative risk assessment is a tool for organizing and analyzing information to examine, characterize, and possibly quantify the combined adverse effects on human health or ecologic resources from multiple environmental stressors. The U.S. Environmental Protection Agency (EPA) has initiated a long-term effort to develop future guidelines for cumulative risk assessment, including publication in 2003 of a framework that describes important features of the process and discusses theoretical issues, technical matters, and key definitions. The framework divides the process of cumulative risk assessment into three interrelated phases: a) planning, scoping, and problem formulation; b) analysis; and c) interpretation and risk characterization. It also discusses the additional complexities introduced by attempts to analyze cumulative risks from multiple stressors and describes some of the theoretical approaches that can be used. The development of guidelines for cumulative risk assessment is an essential element in the transition of the U.S. EPA risk assessment methodology from a narrow focus on a single stressor, end point, source, pathway, and exposure route to a broader, more holistic approach involving analysis of combined effects of cumulative exposure to multiple stressors via all relevant sources, pathways, and routes. PMID:17520071

  5. Estimating greenspace exposure and benefits for cumulative risk assessment applications

    Treesearch

    Rebecca Gernes; Richard Hertzberg; Margaret MacDonell; Glenn Rice; J. Michael Wright; Glennon Beresin; Travis Miller; Julia Africa; Geoffrey Donovan; J. Aaron Hipp; Perry Hystad; Laura Jackson; Michelle Kondo; Richard Mitchell; Mark Nieuwenhuijsen; Patrick Ryan; William Sullivan; Matilda Annerstedt. van den Bosch

    2016-01-01

    This document provides a summary of the technical meeting on greenspace and cumulative risk assessment (GS-CRA) convened May 4−5, 2015 in Cincinnati, OH, by the U.S. Environmental Protection Agency (EPA) Office of Research and Development (ORD) National Center for Environmental Assessment (NCEA). This report highlights the presentations, discussions, and practical...

  6. Phthalates and Cumulative Risk Assessment (NAS Final Report)

    EPA Science Inventory

    On December 18, 2008, the National Academy of Sciences' National Research Council released a final report, requested and sponsored by the EPA, entitled Phthalates and Cumulative Risk Assessment: The Task Ahead.

    Risk assessment has become a dominant public policy ...

  7. Phthalates and Cumulative Risk Assessment (NAS Final Report)

    EPA Science Inventory

    On December 18, 2008, the National Academy of Sciences' National Research Council released a final report, requested and sponsored by the EPA, entitled Phthalates and Cumulative Risk Assessment: The Task Ahead.

    Risk assessment has become a dominant public policy ...

  8. CUMULATIVE RISK ASSESSMENT: GETTING FROM TOXICOLOGY TO QUANTITATIVE ANALYSIS

    EPA Science Inventory

    INTRODUCTION: GETTING FROM TOXICOLOGY TO QUANTITATIVE ANALYSIS FOR CUMULATIVE RISK

    Hugh A. Barton1 and Carey N. Pope2
    1US EPA, Office of Research and Development, National Health and Environmental Effects Research Laboratory, Research Triangle Park, NC
    2Department of...

  9. CUMULATIVE RISK ASSESSMENT: GETTING FROM TOXICOLOGY TO QUANTITATIVE ANALYSIS

    EPA Science Inventory

    INTRODUCTION: GETTING FROM TOXICOLOGY TO QUANTITATIVE ANALYSIS FOR CUMULATIVE RISK

    Hugh A. Barton1 and Carey N. Pope2
    1US EPA, Office of Research and Development, National Health and Environmental Effects Research Laboratory, Research Triangle Park, NC
    2Department of...

  10. A SYNOPTIC APPROACH FOR ASSESSING CUMULATIVE IMPACTS TO WETLANDS

    EPA Science Inventory

    The US Environmental Protection Agency's Wetlands Research Program has developed the synoptic approach as a proposed method for assessing cumulative impacts to wetlands by providing both a general and a comprehensive view of the environment. It can also be applied more broadly to...

  11. The challenges and opportunities in cumulative effects assessment

    USGS Publications Warehouse

    Foley, Melissa M.; Mease, Lindley A; Martone, Rebecca G; Prahler, Erin E; Morrison, Tiffany H; Clarke Murray, Cathryn; Wojcik, Deborah

    2016-01-01

    The cumulative effects of increasing human use of the ocean and coastal zone have contributed to a rapid decline in ocean and coastal resources. As a result, scientists are investigating how multiple, overlapping stressors accumulate in the environment and impact ecosystems. These investigations are the foundation for the development of new tools that account for and predict cumulative effects in order to more adequately prevent or mitigate negative effects. Despite scientific advances, legal requirements, and management guidance, those who conduct assessments—including resource managers, agency staff, and consultants—continue to struggle to thoroughly evaluate cumulative effects, particularly as part of the environmental assessment process. Even though 45 years have passed since the United States National Environmental Policy Act was enacted, which set a precedent for environmental assessment around the world, defining impacts, baseline, scale, and significance are still major challenges associated with assessing cumulative effects. In addition, we know little about how practitioners tackle these challenges or how assessment aligns with current scientific recommendations. To shed more light on these challenges and gaps, we undertook a comparative study on how cumulative effects assessment (CEA) is conducted by practitioners operating under some of the most well-developed environmental laws around the globe: California, USA; British Columbia, Canada; Queensland, Australia; and New Zealand. We found that practitioners used a broad and varied definition of impact for CEA, which led to differences in how baseline, scale, and significance were determined. We also found that practice and science are not closely aligned and, as such, we highlight opportunities for managers, policy makers, practitioners, and scientists to improve environmental assessment.

  12. Ecosystem assessment methods for cumulative effects at the regional scale

    SciTech Connect

    Hunsaker, C.T.

    1989-01-01

    Environmental issues such as nonpoint-source pollution, acid rain, reduced biodiversity, land use change, and climate change have widespread ecological impacts and require an integrated assessment approach. Since 1978, the implementing regulations for the National Environmental Policy Act (NEPA) have required assessment of potential cumulative environmental impacts. Current environmental issues have encouraged ecologists to improve their understanding of ecosystem process and function at several spatial scales. However, management activities usually occur at the local scale, and there is little consideration of the potential impacts to the environmental quality of a region. This paper proposes that regional ecological risk assessment provides a useful approach for assisting scientists in accomplishing the task of assessing cumulative impacts. Critical issues such as spatial heterogeneity, boundary definition, and data aggregation are discussed. Examples from an assessment of acidic deposition effects on fish in Adirondack lakes illustrate the importance of integrated data bases, associated modeling efforts, and boundary definition at the regional scale.

  13. Stakeholder attitudes towards cumulative and aggregate exposure assessment of pesticides.

    PubMed

    Verbeke, Wim; Van Loo, Ellen J; Vanhonacker, Filiep; Delcour, Ilse; Spanoghe, Pieter; van Klaveren, Jacob D

    2015-05-01

    This study evaluates the attitudes and perspectives of different stakeholder groups (agricultural producers, pesticide manufacturers, trading companies, retailers, regulators, food safety authorities, scientists and NGOs) towards the concepts of cumulative and aggregate exposure assessment of pesticides by means of qualitative in-depth interviews (n = 15) and a quantitative stakeholder survey (n = 65). The stakeholders involved generally agreed that the use of chemical pesticides is needed, primarily for meeting the need of feeding the growing world population, while clearly acknowledging the problematic nature of human exposure to pesticide residues. Current monitoring was generally perceived to be adequate, but the timeliness and consistency of monitoring practices across countries were questioned. The concept of cumulative exposure assessment was better understood by stakeholders than the concept of aggregate exposure assessment. Identified pitfalls were data availability, data limitations, sources and ways of dealing with uncertainties, as well as information and training needs. Regulators and food safety authorities were perceived as the stakeholder groups for whom cumulative and aggregate pesticide exposure assessment methods and tools would be most useful and acceptable. Insights obtained from this exploratory study have been integrated in the development of targeted and stakeholder-tailored dissemination and training programmes that were implemented within the EU-FP7 project ACROPOLIS.

  14. The EPA's human exposure research program for assessing cumulative risk in communities

    PubMed Central

    Zartarian, Valerie G; Schultz, Bradley D

    2009-01-01

    Communities are faced with challenges in identifying and prioritizing environmental issues, taking actions to reduce their exposures, and determining their effectiveness for reducing human health risks. Additional challenges include determining what scientific tools are available and most relevant, and understanding how to use those tools; given these barriers, community groups tend to rely more on risk perception than science. The U.S. Environmental Protection Agency's Office of Research and Development, National Exposure Research Laboratory (NERL) and collaborators are developing and applying tools (models, data, methods) for enhancing cumulative risk assessments. The NERL's “Cumulative Communities Research Program” focuses on key science questions: (1) How to systematically identify and prioritize key chemical stressors within a given community?; (2) How to develop estimates of exposure to multiple stressors for individuals in epidemiologic studies?; and (3) What tools can be used to assess community-level distributions of exposures for the development and evaluation of the effectiveness of risk reduction strategies? This paper provides community partners and scientific researchers with an understanding of the NERL research program and other efforts to address cumulative community risks; and key research needs and opportunities. Some initial findings include the following: (1) Many useful tools exist for components of risk assessment, but need to be developed collaboratively with end users and made more comprehensive and user-friendly for practical application; (2) Tools for quantifying cumulative risks and impact of community risk reduction activities are also needed; (3) More data are needed to assess community- and individual-level exposures, and to link exposure-related information with health effects; and (4) Additional research is needed to incorporate risk-modifying factors (“non-chemical stressors”) into cumulative risk assessments. The products

  15. DESIGNING STUDIES AND COLLECTING DATA USEFUL FOR CUMULATIVE RISK ASSESSMENT

    EPA Science Inventory

    DESIGNING STUDIES AND COLLECTING DATA USEFUL FOR CUMULATIVE RISK ASSESSMENT. J E Simmons1, C Gennings2, M Casey2, M J Plewa3, E D Wagner3, W H Carter, Jr.2, A McDonald1,Y M Sey1, L K Teuschler3 1NHEERL, ORD, U.S. EPA, RTP NC, USA; 2VCU, Richmond, VA, USA;3Univ. Illinois, Urba...

  16. DESIGNING STUDIES AND COLLECTING DATA USEFUL FOR CUMULATIVE RISK ASSESSMENT

    EPA Science Inventory

    DESIGNING STUDIES AND COLLECTING DATA USEFUL FOR CUMULATIVE RISK ASSESSMENT. J E Simmons1, C Gennings2, M Casey2, M J Plewa3, E D Wagner3, W H Carter, Jr.2, A McDonald1,Y M Sey1, L K Teuschler3 1NHEERL, ORD, U.S. EPA, RTP NC, USA; 2VCU, Richmond, VA, USA;3Univ. Illinois, Urba...

  17. Cumulative risk assessment of pesticide residues in food.

    PubMed

    Boobis, Alan R; Ossendorp, Bernadette C; Banasiak, Ursula; Hamey, Paul Y; Sebestyen, Istvan; Moretto, Angelo

    2008-08-15

    There is increasing need to address the potential risks of combined exposures to multiple residues from pesticides in the diet. The available evidence suggests that the main concern is from dose addition of those compounds that act by the same mode of action. The possibility of synergy needs to be addressed on a case-by-case basis, where there is a biologically plausible hypothesis that it may occur at the levels of residues occurring in the diet. Cumulative risk assessment is a resource-intense activity and hence a tiered approach to both toxicological evaluation and intake estimation is recommended, and the European Food Safety Authority (EFSA) has recently published such a proposal. Where assessments have already been undertaken by some other authority, full advantage should be taken of these, subject of course to considerations of quality and relevance. Inclusion of compounds in a cumulative assessment group (CAG) should be based on defined criteria, which allow for refinement in a tiered approach. These criteria should include chemical structure, mechanism of pesticidal action, target organ and toxic mode of action. A number of methods are available for cumulating toxicity. These are all inter-related, but some are mathematically more complex than others. The most useful methods, in increasing levels of complexity and refinement, are the hazard index, the reference point index, the Relative Potency Factor method and physiologically based toxicokinetic modelling, although this last method would only be considered should a highly refined assessment be necessary. Four possible exposure scenarios are of relevance for cumulative risk assessment, acute and chronic exposure in the context of maximum residue level (MRL)-setting, and in relation to exposures from the actual use patterns, respectively. Each can be addressed either deterministically or probabilistically. Strategies for dealing with residues below the limit of detection, limit of quantification or limit

  18. Assessing the factor structure of the Childhood Trauma Questionnaire, and cumulative effect of abuse and neglect on mental health among adolescents in conflict-affected Burundi.

    PubMed

    Charak, Ruby; de Jong, J T V M; Berckmoes, Lidewyde H; Ndayisaba, Herman; Reis, Ria

    2017-09-13

    The present study aimed to examine the factor structure of the Childhood Trauma Questionnaire (CTQ; Bernstein & Fink, 1998), highlight rates of abuse and neglect among Burundian adolescents, compare these rates with those found in high-income nations, and examine the cumulative effect of multiple types of abuse and neglect on depression and PTSD symptoms. Participants were 231 adolescents and youth (M=14.9, SD=1.99, 58.4% female) from five provinces of Burundi, a country in Central Africa affected by war and political violence. Translation and back-translation of the CTQ was carried out to obtain an adaptation of CTQ in Kirundi, the native language of Burundi. With the exception of one item on 'molestation' in the factor of sexual abuse, the five-factor structure of CTQ was obtained comprising latent factors, namely emotional, physical, and sexual abuse, and emotional and physical neglect. The rate of abuse and neglect ranged from 14.7-93.5% with more than 37% reporting 4 or more types of abuse and neglect experiences. Emotional abuse and neglect, and physical neglect were 2-3 times higher among Burundian adolescents when compared with studies from high-income countries using the CTQ. A cumulative effect of multiple types of abuse and neglect was found, such that, those with 4 or more types of maltreatment were higher on symptoms of depression and posttraumatic stress. Findings highlight the need for culturally sensitive, standardized, and validated measures and norms for gauging childhood maltreatment in Burundi and related need for preventative interventions on childhood maltreatment. Copyright © 2017. Published by Elsevier Ltd.

  19. Bringing science into river systems cumulative effects assessment practice

    SciTech Connect

    Seitz, Nicole E.; Westbrook, Cherie J.; Noble, Bram F.

    2011-04-15

    Fast-paced watershed change, driven by anthropogenic development, is threatening the sustainability of freshwater resources across the globe. Developments within watersheds interact in a manner that is additive and synergistic over space and time. Such cumulative environmental effects are defined as the results of actions that are individually minor but collectively significant when added to other past, present, and reasonably foreseeable future actions. Cumulative effects assessment (CEA) then is broadly defined as the process of evaluating the potential impacts of such collective actions on the environment and is a requirement in many countries, including in Canada at the federal level under the Canadian Environmental Assessment Act. However, current approaches to CEA for river systems are proving to be ineffective, which is largely attributed to the disconnect between CEA science and practice. We highlight this gap herein by discussing contradictions in the CEA literature, challenges in quantifying cumulative interactions, including overcoming spatiotemporal scale issues, multiple hydrologic and ecological pathways, and lack of predictive analysis. Our analysis shows there is a need for improved CEA for river systems, and in responding to this need we propose a conceptual framework for better integrating science and practice for improved CEA for river systems using one of the most adversely affected rivers basins in Canada, the Athabasca River, as our model. We conclude by addressing the challenges inherent to CEA with the intent of providing scientists with ways to help improve CEA of river systems.

  20. Study on the cumulative impact of reclamation activities on ecosystem health in coastal waters.

    PubMed

    Shen, Chengcheng; Shi, Honghua; Zheng, Wei; Li, Fen; Peng, Shitao; Ding, Dewen

    2016-02-15

    The purpose of this study is to develop feasible tools to investigate the cumulative impact of reclamations on coastal ecosystem health, so that the strategies of ecosystem-based management can be applied in the coastal zone. An indicator system and model were proposed to assess the cumulative impact synthetically. Two coastal water bodies, namely Laizhou Bay (LZB) and Tianjin coastal waters (TCW), in the Bohai Sea of China were studied and compared, each in a different phase of reclamations. Case studies showed that the indicator scores of coastal ecosystem health in LZB and TCW were 0.75 and 0.68 out of 1.0, respectively. It can be concluded that coastal reclamations have a historically cumulative effect on benthic environment, whose degree is larger than that on aquatic environment. The ecosystem-based management of coastal reclamations should emphasize the spatially and industrially intensive layout. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Vulnerability as a Function of Individual and Group Resources in Cumulative Risk Assessment

    PubMed Central

    deFur, Peter L.; Evans, Gary W.; Hubal, Elaine A. Cohen; Kyle, Amy D.; Morello-Frosch, Rachel A.; Williams, David R.

    2007-01-01

    Background The field of risk assessment has focused on protecting the health of individual people or populations of wildlife from single risks, mostly from chemical exposure. The U.S. Environmental Protection Agency recently began to address multiple risks to communities in the “Framework for Cumulative Risk Assessment” [EPA/630/P02/001F. Washington DC:Risk Assessment Forum, U.S. Environmental Protection Agency (2003)]. Simultaneously, several reports concluded that some individuals and groups are more vulnerable to environmental risks than the general population. However, vulnerability has received little specific attention in the risk assessment literature. Objective Our objective is to examine the issue of vulnerability in cumulative risk assessment and present a conceptual framework rather than a comprehensive review of the literature. In this article we consider similarities between ecologic and human communities and the factors that make communities vulnerable to environmental risks. Discussion The literature provides substantial evidence on single environmental factors and simple conditions that increase vulnerability or reduce resilience for humans and ecologic systems. This observation is especially true for individual people and populations of wildlife. Little research directly addresses the topic of vulnerability in cumulative risk situations, especially at the community level. The community level of organization has not been adequately considered as an end point in either human or ecologic risk assessment. Furthermore, current information on human risk does not completely explain the level of response in cumulative risk conditions. Ecologic risk situations are similarly more complex and unpredictable for cases of cumulative risk. Conclusions Psychosocial conditions and responses are the principal missing element for humans. We propose a model for including psychologic and social factors as an integral component of cumulative risk assessment. PMID

  2. Cumulative effects of noise and odour annoyances on environmental and health related quality of life.

    PubMed

    Oiamo, Tor H; Luginaah, Isaac N; Baxter, Jamie

    2015-12-01

    Noise and odour annoyances are important considerations in research on health effects of air pollution and traffic noise. Cumulative exposures can occur via several chemical hazards or a combination of chemical and stressor-based hazards, and related health outcomes can be generalized as manifestations of physiological and/or psychological stress responses. A major research challenge in this field is to understand the combined health effects of physiological and psychological responses to exposure. The SF-12 Health Survey is a health related quality of life (HRQoL) instrument designed for the assessment of functional mental and physical health in clinical practice and therefore well suited to research on physiological health outcomes of exposure. However, previous research has not assessed its sensitivity to psychological stress as measured by noise annoyance and odour annoyance. The current study validated and tested this application of the SF-12 Health Survey in a cross-sectional study (n = 603) that included exposure assessment for traffic noise and air pollution in Windsor, Ontario, Canada. The results indicated that SF-12 scores in Windsor were lower than Canadian normative data. A structural equation model demonstrated that this was partially due to noise and odour annoyances, which were associated with covarying exposures to ambient nitrogen dioxide and traffic noise. More specifically, noise annoyance had a significant and negative effect on both mental and physical health factors of the SF-12 and there was a significant covariance between noise annoyance and odour annoyance. The study confirmed a significant effect of psychological responses to cumulative exposures on HRQoL. The SF-12 Health Survey shows promise with respect to assessing the cumulative health effects of outdoor air pollution and traffic noise.

  3. Evaluating cumulative risk assessment for environmental justice: a community case study.

    PubMed Central

    Fox, Mary A

    2002-01-01

    A key feature of cumulative risk assessment (CRA) is the ability to estimate differential health risks from environmental exposures within populations. Identifying populations at increased risk from environmental exposures is the first step toward mitigating such risks as required by the fair treatment mandate of environmental justice. CRA methods remain under development except for a limited application in pesticide regulations. The goals of this research were to advance CRA methods and to test their application in a community case study. We compared cumulative risk and health assessments for South and Southwest Philadelphia communities. The analysis found positive correlations between cumulative risk and mortality measurements for total mortality in Whites and non-Whites when we conducted the risk assessment using a multi-end point toxicological database developed for this project. Cumulative risk scores correlated positively with cause-specific mortality in non-Whites. Statistically significant increases in total and respiratory mortality rates were associated with incremental increases in the hazard ratio cumulative risk scores, with ranges of 2-6% for total and 8-23% for respiratory. Regression analyses controlled for percent non-White population and per capita income, indicating that risk scores represent an environmental effect on health independent of race and income. This case study demonstrated the successful application of CRA at the community level. CRA adds a health dimension to pollutant concentrations to produce a more comprehensive understanding of environmental inequities that can inform decision making. CRA is a viable tool to identify high-risk areas and to guide surveillance, research, or interventions. PMID:11929729

  4. U.S. EPA authority to use cumulative risk assessments in environmental decision-making.

    PubMed

    Alves, Sarah; Tilghman, Joan; Rosenbaum, Arlene; Payne-Sturges, Devon C

    2012-06-01

    Conventionally, in its decision-making, the U.S. EPA has evaluated the effects and risks associated with a single pollutant in a single exposure medium. In reality, people are exposed to mixtures of pollutants or to the same pollutant through a variety of media, including the air, water, and food. It is now more recognized than before that environmental exposure to pollutants occurs via multiple exposure routes and pathways, including inhalation, ingestion, and dermal absorption. Moreover, chemical, biologic, radiologic, physical, and psychologic stressors are all acknowledged as affecting human health. Although many EPA offices attempt to consider cumulative risk assessment and cumulative effects in various ways, there is no Agency-wide policy for considering these risks and the effects of exposure to these risks when making environmental decisions. This article examines how U.S. courts might assess EPA's general authority and discretion to use cumulative risk assessment as the basis for developing data in support of environmental decision-making, and how courts might assess the validity of a cumulative risk assessment methodology itself.

  5. U.S. EPA Authority to Use Cumulative Risk Assessments in Environmental Decision-Making

    PubMed Central

    Alves, Sarah; Tilghman, Joan; Rosenbaum, Arlene; Payne-Sturges, Devon C.

    2012-01-01

    Conventionally, in its decision-making, the U.S. EPA has evaluated the effects and risks associated with a single pollutant in a single exposure medium. In reality, people are exposed to mixtures of pollutants or to the same pollutant through a variety of media, including the air, water, and food. It is now more recognized than before that environmental exposure to pollutants occurs via multiple exposure routes and pathways, including inhalation, ingestion, and dermal absorption. Moreover, chemical, biologic, radiologic, physical, and psychologic stressors are all acknowledged as affecting human health. Although many EPA offices attempt to consider cumulative risk assessment and cumulative effects in various ways, there is no Agency-wide policy for considering these risks and the effects of exposure to these risks when making environmental decisions. This article examines how U.S. courts might assess EPA’s general authority and discretion to use cumulative risk assessment as the basis for developing data in support of environmental decision-making, and how courts might assess the validity of a cumulative risk assessment methodology itself. PMID:22829786

  6. Assessing the cumulative effects of projects using geographic information systems

    SciTech Connect

    Atkinson, Samuel F.; Canter, Larry W.

    2011-09-15

    Systems that allow users to store and retrieve spatial data, provide for analyses of spatial data, and offer highly detailed display of spatial data are referred to as geographic information systems, or more typically, GIS. Since their initial usage in the 1960s, GISs have evolved as a means of assembling and analyzing diverse data pertaining to specific geographical areas, with spatial locations of the data serving as the organizational basis for the information systems. The structure of GISs is built around spatial identifiers and the methods used to encode data for storage and manipulation. This paper examines how GIS has been used in typical environmental assessment, its use for cumulative impact assessment, and explores litigation that occurred in the United States Federal court system where GIS was used in some aspect of cumulative effects. The paper also summarizes fifteen case studies that range from area wide transportation planning to wildlife and habitat impacts, and draws together a few lessons learned from this review of literature and litigation.

  7. Separate and Cumulative Effects of Adverse Childhood Experiences in Predicting Adult Health and Health Care Utilization

    ERIC Educational Resources Information Center

    Chartier, Mariette J.; Walker, John R.; Naimark, Barbara

    2010-01-01

    Objectives: Objectives of this population-based study were: (1) to examine the relative contribution of childhood abuse and other adverse childhood experiences to poor adult health and increased health care utilization and (2) to examine the cumulative effects of adverse childhood experiences on adult health and health care utilization. Methods:…

  8. Separate and Cumulative Effects of Adverse Childhood Experiences in Predicting Adult Health and Health Care Utilization

    ERIC Educational Resources Information Center

    Chartier, Mariette J.; Walker, John R.; Naimark, Barbara

    2010-01-01

    Objectives: Objectives of this population-based study were: (1) to examine the relative contribution of childhood abuse and other adverse childhood experiences to poor adult health and increased health care utilization and (2) to examine the cumulative effects of adverse childhood experiences on adult health and health care utilization. Methods:…

  9. The MCRA model for probabilistic single-compound and cumulative risk assessment of pesticides.

    PubMed

    van der Voet, Hilko; de Boer, Waldo J; Kruisselbrink, Johannes W; Goedhart, Paul W; van der Heijden, Gerie W A M; Kennedy, Marc C; Boon, Polly E; van Klaveren, Jacob D

    2015-05-01

    Pesticide risk assessment is hampered by worst-case assumptions leading to overly pessimistic assessments. On the other hand, cumulative health effects of similar pesticides are often not taken into account. This paper describes models and a web-based software system developed in the European research project ACROPOLIS. The models are appropriate for both acute and chronic exposure assessments of single compounds and of multiple compounds in cumulative assessment groups. The software system MCRA (Monte Carlo Risk Assessment) is available for stakeholders in pesticide risk assessment at mcra.rivm.nl. We describe the MCRA implementation of the methods as advised in the 2012 EFSA Guidance on probabilistic modelling, as well as more refined methods developed in the ACROPOLIS project. The emphasis is on cumulative assessments. Two approaches, sample-based and compound-based, are contrasted. It is shown that additional data on agricultural use of pesticides may give more realistic risk assessments. Examples are given of model and software validation of acute and chronic assessments, using both simulated data and comparisons against the previous release of MCRA and against the standard software DEEM-FCID used by the Environmental Protection Agency in the USA. It is shown that the EFSA Guidance pessimistic model may not always give an appropriate modelling of exposure.

  10. Neutron source capability assessment for cumulative fission yields measurements

    SciTech Connect

    Descalle, M A; Dekin, W; Kenneally, J

    2011-04-06

    A recent analysis of high-quality cumulative fission yields data for Pu-239 published in the peer-reviewed literature showed that the quoted experimental uncertainties do not allow a clear statement on how the fission yields vary as a function of energy. [Prussin2009] To make such a statement requires a set of experiments with well 'controlled' and understood sources of experimental errors to reduce uncertainties as low as possible, ideally in the 1 to 2% range. The Inter Laboratory Working Group (ILWOG) determined that Directed Stockpile Work (DSW) would benefit from an experimental program with the stated goal to reduce the measurement uncertainties significantly in order to make a definitive statement of the relationship of energy dependence to the cumulative fission yields. Following recent discussions between Lawrence Livermore National Laboratory (LLNL) and Los Alamos National Laboratory (LANL), there is a renewed interest in developing a concerted experimental program to measure fission yields in a neutron energy range from thermal energy (0.025 eV) to 14 MeV with an emphasis on discrete energies from 0.5 to 4 MeV. Ideally, fission yields would be measured at single energies, however, in practice there are only 'quasi-monoenergetic' neutrons sources of finite width. This report outlines a capability assessment as of June 2011 of available neutron sources that could be used as part of a concerted experimental program to measure cumulative fission yields. In a framework of international collaborations, capabilities available in the United States, at the Atomic Weapons Establishment (AWE) in the United Kingdom and at the Commissariat Energie Atomique (CEA) in France are listed. There is a need to develop an experimental program that will reduce the measurement uncertainties significantly in order to make a definitive statement of the relationship of energy dependence to the cumulative fission yields. Fission and monoenergetic neutron sources are available that

  11. The role of cumulative risk assessment in decisions about environmental justice.

    PubMed

    Sexton, Ken; Linder, Stephen H

    2010-11-01

    There is strong presumptive evidence that people living in poverty and certain racial and ethnic groups bear a disproportionate burden of environmental health risk. Many have argued that conducting formal assessments of the health risk experienced by affected communities is both unnecessary and counterproductive-that instead of analyzing the situation our efforts should be devoted to fixing obvious problems and rectifying observable wrongs. We contend that formal assessment of cumulative health risks from combined effects of chemical and nonchemical stressors is a valuable tool to aid decision makers in choosing risk management options that are effective, efficient, and equitable. If used properly, cumulative risk assessment need not impair decision makers' discretion, nor should it be used as an excuse for doing nothing in the face of evident harm. Good policy decisions require more than good intentions; they necessitate analysis of risk-related information along with careful consideration of economic issues, ethical and moral principles, legal precedents, political realities, cultural beliefs, societal values, and bureaucratic impediments. Cumulative risk assessment can provide a systematic and impartial means for informing policy decisions about environmental justice.

  12. Lower cumulative stress is associated with better health for physically active adults in the community

    PubMed Central

    Stults-Kolehmainen, Matthew A.; Tuit, Keri; Sinha, Rajita

    2015-01-01

    Both cumulative adversity, an individual's lifetime exposure to stressors, and insufficient exercise are associated with poor health outcomes. The purpose of this study was to ascertain whether exercise buffers the association of cumulative adverse life events (CALE) with health in a community-wide sample of healthy adults (ages 18–50 years; women: n 219, 29.5 ± 9.2 years; men: n = 176, 29.4 ± 8.7 years, mean ± standard deviation). Participants underwent the Cumulative Adversity Interview, which divides life events into three subsets: major life events (MLE), recent life events (RLE) and traumatic experiences (TLE). These individuals also completed the Cornell Medical Index and a short assessment for moderate or greater intensity exercise behavior, modified from the Nurses’ Health Study. Results indicated that higher CALE was associated with greater total health problems (r = 0.431, p<0.001). Interactions between stress and exercise were not apparent for RLE and TLE. However, at low levels of MLE, greater exercise was related to fewer total, physical, cardiovascular and psychological health problems (p value<0.05). Conversely, at high levels of MLE, the benefits of exercise appear to be absent. Three-way interactions were observed between sex, exercise and stress. Increased levels of exercise were related to better physical health in men, at all levels of CALE. Only women who reported both low levels of CALE and high levels of exercise had more favorable physical health outcomes. A similar pattern of results emerged for RLE. Together, these data suggest that increased exercise is related to better health, but these effects may vary by cumulative stress exposure and sex. PMID:24392966

  13. Lower cumulative stress is associated with better health for physically active adults in the community.

    PubMed

    Stults-Kolehmainen, Matthew A; Tuit, Keri; Sinha, Rajita

    2014-03-01

    Both cumulative adversity, an individual's lifetime exposure to stressors, and insufficient exercise are associated with poor health outcomes. The purpose of this study was to ascertain whether exercise buffers the association of cumulative adverse life events (CALE) with health in a community-wide sample of healthy adults (ages 18-50 years; women: n = 219, 29.5 ± 9.2 years; men: n = 176, 29.4 ± 8.7 years, mean ± standard deviation). Participants underwent the Cumulative Adversity Interview, which divides life events into three subsets: major life events (MLE), recent life events (RLE) and traumatic experiences (TLE). These individuals also completed the Cornell Medical Index and a short assessment for moderate or greater intensity exercise behavior, modified from the Nurses' Health Study. Results indicated that higher CALE was associated with greater total health problems (r = 0.431, p < 0.001). Interactions between stress and exercise were not apparent for RLE and TLE. However, at low levels of MLE, greater exercise was related to fewer total, physical, cardiovascular and psychological health problems (p value <0.05). Conversely, at high levels of MLE, the benefits of exercise appear to be absent. Three-way interactions were observed between sex, exercise and stress. Increased levels of exercise were related to better physical health in men, at all levels of CALE. Only women who reported both low levels of CALE and high levels of exercise had more favorable physical health outcomes. A similar pattern of results emerged for RLE. Together, these data suggest that increased exercise is related to better health, but these effects may vary by cumulative stress exposure and sex.

  14. Health Impact Assessment: Linking Public Health to ...

    EPA Pesticide Factsheets

    The goal of this presentation is to explore how HIA can help inform hazardous waste permitting regulations and incorporate community vulnerability and cumulative impacts to their potential health risks into permitting decision making by the California Department of Toxic Substances Control. Presented the Health Impact Assessment (HIA) at the State of California Cumulative Impacts and Community Vulnerability Symposium on July 27 in Diamond Bar, CA.

  15. EXPOSURE ASSESSMENT TOOLS FOR CUMULATIVE RISK ASSESSMENT: MEASUREMENT OF ENDOGENOUS BIOMARKERS

    EPA Science Inventory

    Direct assessment of cumulative risks is a difficult task due to combinations of multiple chemicals, exposure pathways, and concentration profiles using suites of environmental measurements. We are investigating the use of endogenous compounds commonly present in biological medi...

  16. Technical Note: scuda: A software platform for cumulative dose assessment.

    PubMed

    Park, Seyoun; McNutt, Todd; Plishker, William; Quon, Harry; Wong, John; Shekhar, Raj; Lee, Junghoon

    2016-10-01

    Accurate tracking of anatomical changes and computation of actually delivered dose to the patient are critical for successful adaptive radiation therapy (ART). Additionally, efficient data management and fast processing are practically important for the adoption in clinic as ART involves a large amount of image and treatment data. The purpose of this study was to develop an accurate and efficient Software platform for CUmulative Dose Assessment (scuda) that can be seamlessly integrated into the clinical workflow. scuda consists of deformable image registration (DIR), segmentation, dose computation modules, and a graphical user interface. It is connected to our image PACS and radiotherapy informatics databases from which it automatically queries/retrieves patient images, radiotherapy plan, beam data, and daily treatment information, thus providing an efficient and unified workflow. For accurate registration of the planning CT and daily CBCTs, the authors iteratively correct CBCT intensities by matching local intensity histograms during the DIR process. Contours of the target tumor and critical structures are then propagated from the planning CT to daily CBCTs using the computed deformations. The actual delivered daily dose is computed using the registered CT and patient setup information by a superposition/convolution algorithm, and accumulated using the computed deformation fields. Both DIR and dose computation modules are accelerated by a graphics processing unit. The cumulative dose computation process has been validated on 30 head and neck (HN) cancer cases, showing 3.5 ± 5.0 Gy (mean±STD) absolute mean dose differences between the planned and the actually delivered doses in the parotid glands. On average, DIR, dose computation, and segmentation take 20 s/fraction and 17 min for a 35-fraction treatment including additional computation for dose accumulation. The authors developed a unified software platform that provides accurate and efficient monitoring of

  17. A pebble count procedure for assessing watershed cumulative effects

    Treesearch

    Gregory S. Bevenger; Rudy M. King

    1995-01-01

    Land mangement activities can result in the delivery of fine sediment to streams. Over time, such delivery can lead to cumulative impacts to the aquactic ecosystem. Because numerous laws require Federal land managers to analyze watershed cumulative effects, field personnel need simple monitoring procedures that can be used directly and consistently. One approach to...

  18. 25. Cumulative effects assessment impact thresholds: myths and realities

    Treesearch

    Robert R. Ziemer

    1994-01-01

    A cumulative impact has been commonly defined as: ""...the impact on the environment which results from the incremental impact of the action when added to other past, present, and reasonably foreseeable future actions regardless of what agency or person undertakes such other actions. Cumulative impacts can result from individually minor but collectively...

  19. [Cumulative risk assessment for consumers of agricultural crops polluted with one chemical class pesticide residues (case of triazole fungicides)].

    PubMed

    Koval'chuk, N M; Omel'chuk, S T

    2011-01-01

    Different indices of cumulative risk assessment of combination of residues of pesticides which may simultaneously be present in raw agricultural crops, based on toxic evaluation of such combination have been presented. Risk for population health due to consumption of raw agricultural crops with triazole residues is acceptable on hazard index, point of departure index and cumulative risk index, exceeds allowable level on criterion "total margin of exposure".

  20. Aggregate Exposure and Cumulative Risk Assessment--Integrating Occupational and Non-occupational Risk Factors.

    PubMed

    Lentz, T J; Dotson, G S; Williams, P R D; Maier, A; Gadagbui, B; Pandalai, S P; Lamba, A; Hearl, F; Mumtaz, M

    2015-01-01

    Occupational exposure limits have traditionally focused on preventing morbidity and mortality arising from inhalation exposures to individual chemical stressors in the workplace. While central to occupational risk assessment, occupational exposure limits have limited application as a refined disease prevention tool because they do not account for all of the complexities of the work and non-occupational environments and are based on varying health endpoints. To be of greater utility, occupational exposure limits and other risk management tools could integrate broader consideration of risks from multiple exposure pathways and routes (aggregate risk) as well as the combined risk from exposure to both chemical and non-chemical stressors, within and beyond the workplace, including the possibility that such exposures may cause interactions or modify the toxic effects observed (cumulative risk). Although still at a rudimentary stage in many cases, a variety of methods and tools have been developed or are being used in allied risk assessment fields to incorporate such considerations in the risk assessment process. These approaches, which are collectively referred to as cumulative risk assessment, have potential to be adapted or modified for occupational scenarios and provide a tangible path forward for occupational risk assessment. Accounting for complex exposures in the workplace and the broader risks faced by the individual also requires a more complete consideration of the composite effects of occupational and non-occupational risk factors to fully assess and manage worker health problems. Barriers to integrating these different factors remain, but new and ongoing community-based and worker health-related initiatives may provide mechanisms for identifying and integrating risk from aggregate exposures and cumulative risks from all relevant sources, be they occupational or non-occupational.

  1. Epigenome: A Biomarker or Screening Tool to Evaluate Health Impact of Cumulative Exposure to Chemical and Non-Chemical Stressors

    PubMed Central

    Olden, Kenneth; Lin, Yu-Sheng; Bussard, David

    2016-01-01

    Current risk assessment practices and toxicity information are hard to utilize for assessing the health impact of combined or cumulative exposure to multiple chemical and non-chemical stressors encountered in the “real world” environment. Non-chemical stressors such as heat, radiation, noise, humidity, bacterial and viral agents, and social factors, like stress related to violence and socioeconomic position generally cannot be currently incorporated into the risk assessment paradigm. The Science and Decisions report released by the National Research Council (NRC) in 2009 emphasized the need to characterize the effects of multiple stressors, both chemical and non-chemical exposures. One impediment to developing information relating such non-chemical stressors to health effects and incorporating them into cumulative assessment has been the lack of analytical tools to easily and quantitatively monitor the cumulative exposure to combined effects of stressors over the life course.

  2. The Contribution of Project Environmental Assessment to Assessing and Managing Cumulative Effects: Individually and Collectively Insignificant?

    NASA Astrophysics Data System (ADS)

    Noble, Bram; Liu, Jialang; Hackett, Paul

    2017-04-01

    This paper explores the opportunities and constraints to project-based environmental assessment as a means to support the assessment and management of cumulative environmental effects. A case study of the hydroelectric sector is used to determine whether sufficient information is available over time through project-by-project assessments to support an adequate understanding of cumulative change. Results show inconsistency from one project to the next in terms of the components and indicators assessed, limited transfer of baseline information between project assessments over time, and the same issues and concerns being raised by review panels-even though the projects reviewed are operating in the same watershed and operated by the same proponent. Project environmental assessments must be managed, and coordinated, as part of a larger system of impact assessment, if project-by-project assessments are to provide a meaningful forum for learning and understanding cumulative change. The paper concludes with recommendations for improved project-based assessment practice in support of cumulative effects assessment and management.

  3. Pesticide Cumulative Risk Assessment: Framework for Screening Analysis

    EPA Pesticide Factsheets

    This document provides guidance on how to screen groups of pesticides for cumulative evaluation using a two-step approach: begin with evaluation of available toxicological information and, if necessary, follow up with a risk-based screening approach.

  4. Obesity and cumulative inflammatory burden: a valuable risk assessment parameter in caring for dental patients.

    PubMed

    Hein, Casey; Batista, Eraldo L

    2014-06-01

    A new model of risk assessment that recognizes the importance of reducing patients' cumulative inflammatory burden by targeting overweight and obesity, in individuals with periodontal disease, may be a valuable risk assessment parameter in caring for dental patients. The growing body of evidence that suggests obesity, Metabolic Syndrome and periodontal disease are interrelated offers an unprecedented opportunity to adopt a new model of risk assessment that has the potential to beneficially influence not only the periodontal health of obese and overweight patients, but simultaneously may also reduce a person's overall risk for developing heart disease and type 2 diabetes, and perhaps other inflammatory driven disease states. This paper presents an overview of research that builds the case for a new model of risk assessment that focuses on the cumulative inflammatory burden that may be elevated by the presence of periodontal disease in obese patients. In addition, the biological plausibility of the concepts of inflammatory priming and inflammatory loading is discussed, and several simple ideas are suggested for identifying at-risk patients. Given the significant rise in obesity and the impact that obesity has on periodontal health and other inflammatory driven, systemic disease states, adoption of a new model of risk assessment is suggested-one that considers an individual's cumulative inflammatory burden which may be amplified as a result of coexisting obesity and other components of Metabolic Syndrome and periodontal disease. Knowledge gathered thus far combined with further clinical research must be translated into better ways to treat and maintain obese periodontal patients. These measures may pave the way for prevention of metabolic diseases and obesity with a relevant impact on patients' periodontal status. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. HESI EXPOSURE FACTORS DATABASE FOR AGGREGATE AND CUMULATIVE RISK ASSESSMENT

    EPA Science Inventory

    In recent years, the risk analysis community has broadened its use of complex aggregate and cumulative residential exposure models (e.g., to meet the requirements of the 1996 Food Quality Protection Act). The value of these models is their ability to incorporate a range of inp...

  6. HESI EXPOSURE FACTORS DATABASE FOR AGGREGATE AND CUMULATIVE RISK ASSESSMENT

    EPA Science Inventory

    In recent years, the risk analysis community has broadened its use of complex aggregate and cumulative residential exposure models (e.g., to meet the requirements of the 1996 Food Quality Protection Act). The value of these models is their ability to incorporate a range of inp...

  7. Cumulative versus end-of-course assessment: effects on self-study time and test performance.

    PubMed

    Kerdijk, Wouter; Cohen-Schotanus, Janke; Mulder, B Florentine; Muntinghe, Friso L H; Tio, René A

    2015-07-01

    Students tend to postpone preparation for a test until the test is imminent, which raises various risks associated with 'cramming' behaviours, including that for suboptimal learning. Cumulative assessment utilises spaced testing to stimulate students to study more frequently and to prevent procrastination. This randomised controlled study investigated how cumulative assessment affects time spent on self-study and test performance compared with end-of-course assessment. A total of 78 undergraduate medical students in a Year 2 pre-clinical course were randomly assigned to either of two conditions. Students in the cumulative assessment condition were assessed in weeks 4, 8 and 10. Students in the end-of-course assessment condition were assessed in week 10 only. Each week, students reported the number of hours they spent on self-study. Students in the cumulative assessment condition (n = 25) spent significantly more time on self-study than students in the end-of-course assessment condition (n = 37) in all weeks of the course except weeks 5, 9 and 10. Overall, the cumulative assessment group spent 69 hours more on self-study during the course than did the control group, although the control group spent 7 hours more in studying during the final week of the course than did the cumulative assessment group. Students in the cumulative assessment condition scored slightly higher on questions concerning the content of the last part of the course. Cumulative assessment encourages students to distribute their learning activities over a course, which leaves them more opportunity to study the content of the last part of the course prior to the final examination. There was no evidence for a short-term effect of cumulative assessment on overall knowledge gain. We hypothesise that larger positive effects might be found if retention were to be measured in the long term. © 2015 John Wiley & Sons Ltd.

  8. A Modeling System to Examine Near-Road and Near-Source Air Toxics for Community-Scale Cumulative Assessments.

    EPA Science Inventory

    Cumulative assessments consider a range of potential stressors that might impact the health of a receptor, such as a local neighborhood or wetland area. When receptors are located near pollution sources such as highways or ports (within 500-1,000 m), then they could be at risk of...

  9. A Modeling System to Examine Near-Road and Near-Source Air Toxics for Community-Scale Cumulative Assessments.

    EPA Science Inventory

    Cumulative assessments consider a range of potential stressors that might impact the health of a receptor, such as a local neighborhood or wetland area. When receptors are located near pollution sources such as highways or ports (within 500-1,000 m), then they could be at risk of...

  10. Community, State, and Federal Approaches to Cumulative Risk Assessment: Challenges and Opportunities for Integration

    EPA Science Inventory

    Community, state, and federal approaches to conventional and cumulative risk assessment (CRA) were described and compared to assess similarities and differences, and develop recommendations for a consistent CRA approach, acceptable across each level as a rigorous scientific metho...

  11. Community, State, and Federal Approaches to Cumulative Risk Assessment: Challenges and Opportunities for Integration

    EPA Science Inventory

    Community, state, and federal approaches to conventional and cumulative risk assessment (CRA) were described and compared to assess similarities and differences, and develop recommendations for a consistent CRA approach, acceptable across each level as a rigorous scientific metho...

  12. Health and academic achievement: cumulative effects of health assets on standardized test scores among urban youth in the United States.

    PubMed

    Ickovics, Jeannette R; Carroll-Scott, Amy; Peters, Susan M; Schwartz, Marlene; Gilstad-Hayden, Kathryn; McCaslin, Catherine

    2014-01-01

    The Institute of Medicine (2012) concluded that we must "strengthen schools as the heart of health." To intervene for better outcomes in both health and academic achievement, identifying factors that impact children is essential. Study objectives are to (1) document associations between health assets and academic achievement, and (2) examine cumulative effects of these assets on academic achievement. Participants include 940 students (grades 5 and 6) from 12 schools randomly selected from an urban district. Data include physical assessments, fitness testing, surveys, and district records. Fourteen health indicators were gathered including physical health (eg, body mass index [BMI]), health behaviors (eg, meeting recommendations for fruit/vegetable consumption), family environment (eg, family meals), and psychological well-being (eg, sleep quality). Data were collected 3-6 months prior to standardized testing. On average, students reported 7.1 health assets out of 14. Those with more health assets were more likely to be at goal for standardized tests (reading/writing/mathematics), and students with the most health assets were 2.2 times more likely to achieve goal compared with students with the fewest health assets (both p < .001). Schools that utilize nontraditional instructional strategies to improve student health may also improve academic achievement, closing equity gaps in both health and academic achievement. © 2013, American School Health Association.

  13. Health and Academic Achievement: Cumulative Effects of Health Assets on Standardized Test Scores Among Urban Youth in the United States*

    PubMed Central

    Ickovics, Jeannette R.; Carroll-Scott, Amy; Peters, Susan M.; Schwartz, Marlene; Gilstad-Hayden, Kathryn; McCaslin, Catherine

    2014-01-01

    Background The Institute of Medicine (2012) concluded that we must “strengthen schools as the heart of health.” To intervene for better outcomes in both health and academic achievement, identifying factors that impact children is essential. Study objectives are to (1) document associations between health assets and academic achievement, and (2) examine cumulative effects of these assets on academic achievement. Methods Participants include 940 students (grades 5 and 6) from 12 schools randomly selected from an urban district. Data include physical assessments, fitness testing, surveys, and district records. Fourteen health indicators were gathered including physical health (eg, body mass index [BMI]), health behaviors (eg, meeting recommendations for fruit/vegetable consumption), family environment (eg, family meals), and psychological well-being (eg, sleep quality). Data were collected 3-6 months prior to standardized testing. Results On average, students reported 7.1 health assets out of 14. Those with more health assets were more likely to be at goal for standardized tests (reading/writing/mathematics), and students with the most health assets were 2.2 times more likely to achieve goal compared with students with the fewest health assets (both p < .001). Conclusions Schools that utilize nontraditional instructional strategies to improve student health may also improve academic achievement, closing equity gaps in both health and academic achievement. PMID:24320151

  14. Bibliography on Smoking and Health, 1969 Cumulation, Part 2.

    ERIC Educational Resources Information Center

    Public Health Service (DHEW), Rockville, MD. National Clearinghouse for Smoking and Health.

    This bibliography is one in a series on smoking and health and supplements a preceding volume entitled "Bibliography on Smoking and Health-1969." It includes all of the items added to the Technical Information Center of the National Clearinghouse for Smoking and Health from January through December 1969. Eleven sections contain citations and…

  15. Non-chemical stressors and cumulative risk assessment: an overview of current initiatives and potential air pollutant interactions.

    PubMed

    Lewis, Ari S; Sax, Sonja N; Wason, Susan C; Campleman, Sharan L

    2011-06-01

    Regulatory agencies are under increased pressure to consider broader public health concerns that extend to multiple pollutant exposures, multiple exposure pathways, and vulnerable populations. Specifically, cumulative risk assessment initiatives have stressed the importance of considering both chemical and non-chemical stressors, such as socioeconomic status (SES) and related psychosocial stress, in evaluating health risks. The integration of non-chemical stressors into a cumulative risk assessment framework has been largely driven by evidence of health disparities across different segments of society that may also bear a disproportionate risk from chemical exposures. This review will discuss current efforts to advance the field of cumulative risk assessment, highlighting some of the major challenges, discussed within the construct of the traditional risk assessment paradigm. Additionally, we present a summary of studies of potential interactions between social stressors and air pollutants on health as an example of current research that supports the incorporation of non-chemical stressors into risk assessment. The results from these studies, while suggestive of possible interactions, are mixed and hindered by inconsistent application of social stress indicators. Overall, while there have been significant advances, further developments across all of the risk assessment stages (i.e., hazard identification, exposure assessment, dose-response, and risk characterization) are necessary to provide a scientific basis for regulatory actions and effective community interventions, particularly when considering non-chemical stressors. A better understanding of the biological underpinnings of social stress on disease and implications for chemical-based dose-response relationships is needed. Furthermore, when considering non-chemical stressors, an appropriate metric, or series of metrics, for risk characterization is also needed. Cumulative risk assessment research will benefit

  16. Non-Chemical Stressors and Cumulative Risk Assessment: An Overview of Current Initiatives and Potential Air Pollutant Interactions

    PubMed Central

    Lewis, Ari S.; Sax, Sonja N.; Wason, Susan C.; Campleman, Sharan L.

    2011-01-01

    Regulatory agencies are under increased pressure to consider broader public health concerns that extend to multiple pollutant exposures, multiple exposure pathways, and vulnerable populations. Specifically, cumulative risk assessment initiatives have stressed the importance of considering both chemical and non-chemical stressors, such as socioeconomic status (SES) and related psychosocial stress, in evaluating health risks. The integration of non-chemical stressors into a cumulative risk assessment framework has been largely driven by evidence of health disparities across different segments of society that may also bear a disproportionate risk from chemical exposures. This review will discuss current efforts to advance the field of cumulative risk assessment, highlighting some of the major challenges, discussed within the construct of the traditional risk assessment paradigm. Additionally, we present a summary of studies of potential interactions between social stressors and air pollutants on health as an example of current research that supports the incorporation of non-chemical stressors into risk assessment. The results from these studies, while suggestive of possible interactions, are mixed and hindered by inconsistent application of social stress indicators. Overall, while there have been significant advances, further developments across all of the risk assessment stages (i.e., hazard identification, exposure assessment, dose-response, and risk characterization) are necessary to provide a scientific basis for regulatory actions and effective community interventions, particularly when considering non-chemical stressors. A better understanding of the biological underpinnings of social stress on disease and implications for chemical-based dose-response relationships is needed. Furthermore, when considering non-chemical stressors, an appropriate metric, or series of metrics, for risk characterization is also needed. Cumulative risk assessment research will benefit

  17. A Summary of Publications on Methods and Tools for Assessing Cumulative Risk, Project Summary

    EPA Science Inventory

    This collection of eight publications on cumulative risk assessment was developed collaboratively among scientists within EPA’s Office of Research and Development and three other organizations. These include scientific collaborations through an Interagency Agreement with Argonne...

  18. Assessing Problem-Solving Abilities in the Theatre Curriculum: A Cumulative and Sequential Approach.

    ERIC Educational Resources Information Center

    Runkel, Richard

    1990-01-01

    Describes a plan designed to teach and assess (cumulatively and sequentially) five levels of problem-solving ability in three standard courses in the theater curriculum at Alverno College in Wisconsin. (SR)

  19. A Summary of Publications on Methods and Tools for Assessing Cumulative Risk, Project Summary

    EPA Science Inventory

    This collection of eight publications on cumulative risk assessment was developed collaboratively among scientists within EPA’s Office of Research and Development and three other organizations. These include scientific collaborations through an Interagency Agreement with Argonne...

  20. Guidance on Cumulative Risk Assessment of Pesticide Chemicals that have a Common Mechanism of Toxicity

    EPA Pesticide Factsheets

    This document provides guidance to OPP scientists for evaluating and estimating the potential human risks associated with such multichemical and multipathway exposures to pesticides. This process is referred to as cumulative risk assessment.

  1. A Topical Overview of Cumulative Risk Assessment Concepts, Methods, and Applications (2007–2016)

    EPA Science Inventory

    Cumulative risk assessments (CRAs) address combined risks from exposures to multiple chemical and nonchemical stressors and may focus on vulnerable communities or populations. Significant contributions have been made to the development of concepts, methods, and applications for C...

  2. Capacity for watershed cumulative effects assessment and management: lessons from the Lower Fraser River Basin, Canada.

    PubMed

    Kristensen, Stephanie; Noble, Bram F; Patrick, Robert J

    2013-08-01

    This study examines the capacity to support the cumulative effects assessment and management for watersheds. The research is set in the Lower Fraser River Basin, a densely populated sub-watershed in British Columbia's lower mainland. Eight requirements or requisites for the watershed cumulative effects assessment and management are applied to evaluate current capacity for implementation in the Lower Fraser, and to identify the areas in need of capacity development. Results show that advancing watershed cumulative effects assessment and management requires not only good science but also leadership in the coordination of monitoring programs, and in ensuring the appropriate incentives and penalties for engagement and nonengagement. The lack of leadership in this regard is the result of existing governance structures arranged around the political boundaries, which have produced over time multiple agencies and jurisdictional fragmentation. Notwithstanding this, we argue that the watershed is the most appropriate scale for assessing and managing the cumulative effects to complex ecosystems.

  3. Assessing cumulative impacts to elk and mule deer in the Salmon River Basin, Idaho

    SciTech Connect

    O'Neil, T.A.; Witmer, G.W.

    1988-01-01

    In this paper, we illustrate the method, using the potential for cumulative impacts to elk and mule deer from multiple hydroelectric development in the Salmon River Basin of Idaho. We attempted to incorporate knowledge of elk and mule deer habitat needs into a paradigm to assess cumulative impacts and aid in the regulatory decision making process. Undoubtedly, other methods could be developed based on different needs or constraints, but we offer this technique as a means to further refine cumulative impact assessment. Our approach is divided into three phases: analysis, evaluation, and documentation. 36 refs., 2 figs., 3 tabs.

  4. Cumulative Adversity Sensitizes Neural Response to Acute Stress: Association with Health Symptoms

    PubMed Central

    Seo, Dongju; Tsou, Kristen A; Ansell, Emily B; Potenza, Marc N; Sinha, Rajita

    2014-01-01

    Cumulative adversity (CA) increases stress sensitivity and risk of adverse health outcomes. However, neural mechanisms underlying these associations in humans remain unclear. To understand neural responses underlying the link between CA and adverse health symptoms, the current study assessed brain activity during stress and neutral-relaxing states in 75 demographically matched, healthy individuals with high, mid, and low CA (25 in each group), and their health symptoms using the Cornell Medical Index. CA was significantly associated with greater adverse health symptoms (P=0.01) in all participants. Functional magnetic resonance imaging results indicated significant associations between CA scores and increased stress-induced activity in the lateral prefrontal cortex, insula, striatum, right amygdala, hippocampus, and temporal regions in all 75 participants (p<0.05, whole-brain corrected). In addition to these regions, the high vs low CA group comparison revealed decreased stress-induced activity in the medial orbitofrontal cortex (OFC) in the high CA group (p<0.01, whole-brain corrected). Specifically, hypoactive medial OFC and hyperactive right hippocampus responses to stress were each significantly associated with greater adverse health symptoms (p<0.01). Furthermore, an inverse correlation was found between activity in the medial OFC and right hippocampus (p=0.01). These results indicate that high CA sensitizes limbic–striatal responses to acute stress and also identifies an important role for stress-related medial OFC and hippocampus responses in the effects of CA on increasing vulnerability to adverse health consequences. PMID:24051900

  5. A framework for cumulative risk assessment in the 21st century.

    PubMed

    Moretto, Angelo; Bachman, Ammie; Boobis, Alan; Solomon, Keith R; Pastoor, Timothy P; Wilks, Martin F; Embry, Michelle R

    2017-02-01

    The ILSI Health and Environmental Sciences Institute (HESI) has developed a framework to support a transition in the way in which information for chemical risk assessment is obtained and used (RISK21). The approach is based on detailed problem formulation, where exposure drives the data acquisition process in order to enable informed decision-making on human health safety as soon as sufficient evidence is available. Information is evaluated in a transparent and consistent way with the aim of optimizing available resources. In the context of risk assessment, cumulative risk assessment (CRA) poses additional problems and questions that can be addressed using the RISK21 approach. The focus in CRA to date has generally been on chemicals that have common mechanisms of action. Recently, concern has also been expressed about chemicals acting on multiple pathways that lead to a common health outcome, and non-chemical other conditions (non-chemical stressors) that can lead to or modify a common outcome. Acknowledging that CRAs, as described above, are more conceptually, methodologically and computationally complex than traditional single-stressor risk assessments, RISK21 further developed the framework for implementation of workable processes and procedures for conducting assessments of combined effects from exposure to multiple chemicals and non-chemical stressors. As part of the problem formulation process, this evidence-based framework allows the identification of the circumstances in which it is appropriate to conduct a CRA for a group of compounds. A tiered approach is then proposed, where additional chemical stressors and/or non-chemical modulating factors (ModFs) are considered sequentially. Criteria are provided to facilitate the decision on whether or not to include ModFs in the formal quantitative assessment, with the intention to help focus the use of available resources to have the greatest potential to protect public health.

  6. Assessing the cumulative environmental effects of marine renewable energy developments: Establishing common ground.

    PubMed

    Willsteed, Edward; Gill, Andrew B; Birchenough, Silvana N R; Jude, Simon

    2017-01-15

    Assessing and managing the cumulative impacts of human activities on the environment remains a major challenge to sustainable development. This challenge is highlighted by the worldwide expansion of marine renewable energy developments (MREDs) in areas already subject to multiple activities and climate change. Cumulative effects assessments in theory provide decision makers with adequate information about how the environment will respond to the incremental effects of licensed activities and are a legal requirement in many nations. In practise, however, such assessments are beset by uncertainties resulting in substantial delays during the licensing process that reduce MRED investor confidence and limit progress towards meeting climate change targets. In light of these targets and ambitions to manage the marine environment sustainably, reducing the uncertainty surrounding MRED effects and cumulative effects assessment are timely and vital. This review investigates the origins and evolution of cumulative effects assessment to identify why the multitude of approaches and pertinent research have emerged, and discusses key considerations and challenges relevant to assessing the cumulative effects of MREDs and other activities on ecosystems. The review recommends a shift away from the current reliance on disparate environmental impact assessments and limited strategic environmental assessments, and a move towards establishing a common system of coordinated data and research relative to ecologically meaningful areas, focussed on the needs of decision makers tasked with protecting and conserving marine ecosystems and services.

  7. Exposure Assessment Tools by Tiers and Types - Aggregate and Cumulative

    EPA Pesticide Factsheets

    EPA ExpoBox is a toolbox for exposure assessors. Its purpose is to provide a compendium of exposure assessment and risk characterization tools that will present comprehensive step-by-step guidance and links to relevant exposure assessment data bases

  8. Cumulative Adverse Financial Circumstances: Associations with Patient Health Status and Behaviors

    ERIC Educational Resources Information Center

    Bisgaier, Joanna; Rhodes, Karin V.

    2011-01-01

    This article examines associations between cumulative adverse financial circumstances and patient health in a sample of 1,506 urban emergency department (ED) patients. Study participants completed a previously validated Social Health Survey between May and October 2009. Five categories of economic deprivation were studied: food insecurity, housing…

  9. Cumulative Adverse Financial Circumstances: Associations with Patient Health Status and Behaviors

    ERIC Educational Resources Information Center

    Bisgaier, Joanna; Rhodes, Karin V.

    2011-01-01

    This article examines associations between cumulative adverse financial circumstances and patient health in a sample of 1,506 urban emergency department (ED) patients. Study participants completed a previously validated Social Health Survey between May and October 2009. Five categories of economic deprivation were studied: food insecurity, housing…

  10. Cumulative Risk Assessment and Environmental Equity in Air Permitting: Interpretation, Methods, Community Participation and Implementation of a Unique Statute

    PubMed Central

    Ellickson, Kristie M.; Sevcik, Sarah M.; Burman, Shelley; Pak, Steven; Kohlasch, Frank; Pratt, Gregory C.

    2011-01-01

    In 2008, the statute authorizing the Minnesota Pollution Control Agency (MPCA) to issue air permits was amended to include a unique requirement to analyze and consider “cumulative levels and effects of past and current environmental pollution from all sources on the environment and residents of the geographic area within which the facility’s emissions are likely to be deposited.” Data describing the Statute Area suggest it is challenged by environmental and socioeconomic concerns, i.e., concerns which are often described by the phrase ‘environmental equity’. With input from diverse stakeholders, the MPCA developed a methodology for implementing a cumulative levels and effects analysis when issuing air permits in the designated geographic area. A Process Document was created defining explicit steps a project proposer must complete in the analysis. An accompanying Reference Document compiles all available environmental health data relevant to the Statute Area that could be identified. The final cumulative levels and effects methodology is organized by health endpoint and identifies hazard, exposure and health indices that require further evaluation. The resulting assessment is summarized and presented to decision makers for consideration in the regulatory permitting process. We present a description of the methodology followed by a case study summary of the first air permit processed through the “cumulative levels and effects analysis”. PMID:22163199

  11. Cumulative risk assessment and environmental equity in air permitting: interpretation, methods, community participation and implementation of a unique statute.

    PubMed

    Ellickson, Kristie M; Sevcik, Sarah M; Burman, Shelley; Pak, Steven; Kohlasch, Frank; Pratt, Gregory C

    2011-11-01

    In 2008, the statute authorizing the Minnesota Pollution Control Agency (MPCA) to issue air permits was amended to include a unique requirement to analyze and consider "cumulative levels and effects of past and current environmental pollution from all sources on the environment and residents of the geographic area within which the facility's emissions are likely to be deposited." Data describing the Statute Area suggest it is challenged by environmental and socioeconomic concerns, i.e., concerns which are often described by the phrase 'environmental equity'. With input from diverse stakeholders, the MPCA developed a methodology for implementing a cumulative levels and effects analysis when issuing air permits in the designated geographic area. A Process Document was created defining explicit steps a project proposer must complete in the analysis. An accompanying Reference Document compiles all available environmental health data relevant to the Statute Area that could be identified. The final cumulative levels and effects methodology is organized by health endpoint and identifies hazard, exposure and health indices that require further evaluation. The resulting assessment is summarized and presented to decision makers for consideration in the regulatory permitting process. We present a description of the methodology followed by a case study summary of the first air permit processed through the "cumulative levels and effects analysis".

  12. GIS based procedure of cumulative environmental impact assessment.

    PubMed

    Balakrishna Reddy, M; Blah, Baiantimon

    2009-07-01

    Scale and spatial limits of impact assessment study in a GIS platform are two very important factors that could have a bearing on the genuineness and quality of impact assessment. While effect of scale has been documented and well understood, no significant study has been carried out on spatial considerations in an impact assessment study employing GIS technique. A novel technique of impact assessment demonstrable through GIS approach termed hereby as 'spatial data integrated GIS impact assessment method (SGIAM)' is narrated in this paper. The technique makes a fundamental presumption that the importance of environmental impacts is dependent, among other things, on spatial distribution of the effects of the proposed action and of the affected receptors in a study area. For each environmental component considered (e.g., air quality), impact indices are calculated through aggregation of impact indicators which are measures of the severity of the impact. The presence and spread of environmental descriptors are suitably quantified through modeling techniques and depicted. The environmental impact index is calculated from data exported from ArcINFO, thus giving significant importance to spatial data in the impact assessment exercise.

  13. A Conceptual Framework for the Assessment of Cumulative Exposure to Air Pollution at a Fine Spatial Scale

    PubMed Central

    Wahida, Kihal-Talantikite; Padilla, Cindy M.; Denis, Zmirou-Navier; Olivier, Blanchard; Géraldine, Le Nir; Philippe, Quenel; Séverine, Deguen

    2016-01-01

    Many epidemiological studies examining long-term health effects of exposure to air pollutants have characterized exposure by the outdoor air concentrations at sites that may be distant to subjects’ residences at different points in time. The temporal and spatial mobility of subjects and the spatial scale of exposure assessment could thus lead to misclassification in the cumulative exposure estimation. This paper attempts to fill the gap regarding cumulative exposure assessment to air pollution at a fine spatial scale in epidemiological studies investigating long-term health effects. We propose a conceptual framework showing how major difficulties in cumulative long-term exposure assessment could be surmounted. We then illustrate this conceptual model on the case of exposure to NO2 following two steps: (i) retrospective reconstitution of NO2 concentrations at a fine spatial scale; and (ii) a novel approach to assigning the time-relevant exposure estimates at the census block level, using all available data on residential mobility throughout a 10- to 20-year period prior to that for which the health events are to be detected. Our conceptual framework is both flexible and convenient for the needs of different epidemiological study designs. PMID:26999170

  14. A Conceptual Framework for the Assessment of Cumulative Exposure to Air Pollution at a Fine Spatial Scale.

    PubMed

    Wahida, Kihal-Talantikite; Padilla, Cindy M; Denis, Zmirou-Navier; Olivier, Blanchard; Géraldine, Le Nir; Philippe, Quenel; Séverine, Deguen

    2016-03-15

    Many epidemiological studies examining long-term health effects of exposure to air pollutants have characterized exposure by the outdoor air concentrations at sites that may be distant to subjects' residences at different points in time. The temporal and spatial mobility of subjects and the spatial scale of exposure assessment could thus lead to misclassification in the cumulative exposure estimation. This paper attempts to fill the gap regarding cumulative exposure assessment to air pollution at a fine spatial scale in epidemiological studies investigating long-term health effects. We propose a conceptual framework showing how major difficulties in cumulative long-term exposure assessment could be surmounted. We then illustrate this conceptual model on the case of exposure to NO₂ following two steps: (i) retrospective reconstitution of NO₂ concentrations at a fine spatial scale; and (ii) a novel approach to assigning the time-relevant exposure estimates at the census block level, using all available data on residential mobility throughout a 10- to 20-year period prior to that for which the health events are to be detected. Our conceptual framework is both flexible and convenient for the needs of different epidemiological study designs.

  15. Poor Child Health, Family Capital and Cumulative Inequality in Academic Achievement

    PubMed Central

    Jackson, Margot

    2015-01-01

    Our understanding of health and social stratification can be enriched by testing tenets of cumulative inequality theory that emphasize how the accumulation of inequality is dependent on the developmental stage being considered; the duration and stability of poor health; and the family resources available to children. I analyze longitudinal data from the British National Child Development Study (N=9,252) to ask: 1) if child health is a source of cumulative inequality in academic achievement; 2) whether this relationship depends on the timing and duration of poor health; and 3) whether trajectories are sensitive to levels of family capital. The results suggest that the relationship between health and academic achievement emerges very early in life and persists, and that whether we observe shrinking or widening inequality as children age depends on when we measure their health, and whether children have access to compensatory resources. PMID:25926564

  16. A method proposal for cumulative environmental impact assessment based on the landscape vulnerability evaluation

    SciTech Connect

    Pavlickova, Katarina; Vyskupova, Monika

    2015-01-15

    Cumulative environmental impact assessment deals with the occasional use in practical application of environmental impact assessment process. The main reasons are the difficulty of cumulative impact identification caused by lack of data, inability to measure the intensity and spatial effect of all types of impacts and the uncertainty of their future evolution. This work presents a method proposal to predict cumulative impacts on the basis of landscape vulnerability evaluation. For this purpose, qualitative assessment of landscape ecological stability is conducted and major vulnerability indicators of environmental and socio-economic receptors are specified and valuated. Potential cumulative impacts and the overall impact significance are predicted quantitatively in modified Argonne multiple matrixes while considering the vulnerability of affected landscape receptors and the significance of impacts identified individually. The method was employed in the concrete environmental impact assessment process conducted in Slovakia. The results obtained in this case study reflect that this methodology is simple to apply, valid for all types of impacts and projects, inexpensive and not time-consuming. The objectivity of the partial methods used in this procedure is improved by quantitative landscape ecological stability evaluation, assignment of weights to vulnerability indicators based on the detailed characteristics of affected factors, and grading impact significance. - Highlights: • This paper suggests a method proposal for cumulative impact prediction. • The method includes landscape vulnerability evaluation. • The vulnerability of affected receptors is determined by their sensitivity. • This method can increase the objectivity of impact prediction in the EIA process.

  17. Tools Available to Communities for Conducting Cumulative Exposure and Risk Assessments

    EPA Science Inventory

    This paper summarizes and assesses over 70 tools that could aid with gathering information and taking action on environmental issues related to community-based cumulative risk assessments (CBCRA). Information on tool use, development and research needs, was gathered from websites...

  18. Tools Available to Communities for Conducting Cumulative Exposure and Risk Assessments

    EPA Science Inventory

    This paper summarizes and assesses over 70 tools that could aid with gathering information and taking action on environmental issues related to community-based cumulative risk assessments (CBCRA). Information on tool use, development and research needs, was gathered from websites...

  19. Cumulative exposure to poor housing affordability and its association with mental health in men and women.

    PubMed

    Bentley, Rebecca; Baker, Emma; Mason, Kate

    2012-09-01

    Poor housing affordability affects around 10% of the Australian population and is increasingly prevalent. The authors tested two hypotheses: that cumulative exposure to housing affordability stress (HAS) is associated with poorer mental health and that effects vary by gender. The authors estimated the relationship between cumulative exposure to HAS and mental health among 15478 participants in an Australian longitudinal survey between 2001 and 2009. Individuals were classified as being in HAS if household income was in the lowest 40% of the national distribution and housing costs exceeded 30% of income. Exposure to HAS ranged from 1 to 8 annual waves. Mental health was measured using the Short Form 36 Mental Component Summary (MCS) score. To test the extent to which any observed associations were explained by compositional factors, random- and fixed-effects models were estimated. In the random-effects models, mental health scores decreased with increasing cumulative exposure to HAS (up until 4+ years). This relationship differed by gender, with a stronger dose-response observed among men. The mean MCS score of men experiencing four to eight waves of housing stress was 2.02 points lower than men not in HAS (95% CI -3.89 to -0.16). In the fixed-effects models, there was no evidence of a cumulative effect of HAS on mental health; however, lower MCS was observed after a single year in HAS (β=-0.70, 95% CI -1.02 to -0.37). While average mental health was lower for individuals with longer exposure to HAS, the mental health effect appears to be due to compositional factors. Furthermore, men and women appear to experience cumulative HAS differently.

  20. Methodological Considerations in Screening for Cumulative Environmental Health Impacts: Lessons Learned from a Pilot Study in California

    PubMed Central

    August, Laura Meehan; Faust, John B.; Cushing, Lara; Zeise, Lauren; Alexeeff, George V.

    2012-01-01

    Polluting facilities and hazardous sites are often concentrated in low-income communities of color already facing additional stressors to their health. The influence of socioeconomic status is not considered in traditional models of risk assessment. We describe a pilot study of a screening method that considers both pollution burden and population characteristics in assessing the potential for cumulative impacts. The goal is to identify communities that warrant further attention and to thereby provide actionable guidance to decision- and policy-makers in achieving environmental justice. The method uses indicators related to five components to develop a relative cumulative impact score for use in comparing communities: exposures, public health effects, environmental effects, sensitive populations and socioeconomic factors. Here, we describe several methodological considerations in combining disparate data sources and report on the results of sensitivity analyses meant to guide future improvements in cumulative impact assessments. We discuss criteria for the selection of appropriate indicators, correlations between them, and consider data quality and the influence of choices regarding model structure. We conclude that the results of this model are largely robust to changes in model structure. PMID:23202671

  1. Socioeconomic status and cumulative disadvantage processes across the life course: implications for health outcomes.

    PubMed

    Seabrook, Jamie A; Avison, William R

    2012-02-01

    Given the complexity surrounding various interactions among health determinants and the challenge of being able to adequately describe the dynamic processes through which health determinants have their effects, the purpose of this paper is to provide a conceptual overview demonstrating the effects of socioeconomic status and cumulative disadvantage on producing health disparities across the life course. The idea underlying cumulative disadvantage is that socioeconomic-based health inequalities will increase across the life course, mostly because of differential exposure to risk factors and access to protective resources. The advantage of life course sociology is its consideration of early life experiences, and the social and historical context of their occurrences, as important contingencies in producing these systematic socioeconomic differences in health gradients.

  2. Community, State, and Federal Approaches to Cumulative Risk Assessment: Challenges and Opportunities for Integration

    PubMed Central

    Barzyk, Timothy M.; Wilson, Sacoby; Wilson, Anthony

    2015-01-01

    Community, state, and federal approaches to conventional and cumulative risk assessment (CRA) were described and compared to assess similarities and differences, and develop recommendations for a consistent CRA approach, acceptable across each level as a rigorous scientific methodology, including partnership formation and solution development as necessary practices. Community, state, and federal examples were described and then summarized based on their adherence to CRA principles of: (1) planning, scoping, and problem formulation; (2) risk analysis and ranking, and (3) risk characterization, interpretation, and management. While each application shared the common goal of protecting human health and the environment, they adopted different approaches to achieve this. For a specific project-level analysis of a particular place or instance, this may be acceptable, but to ensure long-term applicability and transferability to other projects, recommendations for developing a consistent approach to CRA are provided. This approach would draw from best practices, risk assessment and decision analysis sciences, and historical lessons learned to provide results in an understandable and accepted manner by all entities. This approach is intended to provide a common ground around which to develop CRA methods and approaches that can be followed at all levels. PMID:25918910

  3. Assessing the cumulative impact of disturbance on canopy structure and chemistry in Appalachian forests

    NASA Astrophysics Data System (ADS)

    Deel, Lindsay N.

    Eastern forests experience a range of disturbance events over time, from stand-replacing disturbances, such as clear cuts, to ephemeral disturbances, such as insect outbreaks. By understanding the cumulative impact of disturbances on canopy structure and chemistry, we can gain insight into management strategies, assess a variety of ecosystem services, and even contribute to a larger body of knowledge on global climate change. I transformed a series of Landsat images spanning approximately 25 years into cumulative disturbance maps covering Green Ridge State Forest and Savage River State Forest in western Maryland. Intensive field surveys collected during the summer of 2009 provided measurements of canopy N and estimates of canopy cover, understory cover, and leaf cover. I used AVIRIS imagery flown concurrently with field data collection to map canopy nitrogen across both forests. Through this project, I tested the impact of cumulative disturbance on forest canopy cover and canopy nitrogen. I found that increased values of cumulative disturbance had a measurable negative impact on forest canopy structure and canopy nitrogen. Moreover, by testing varying methods of summing cumulative disturbance, I found that past disturbances diminish over time in importance, yet still influence the current canopy structure and canopy N of a forest. Thus, my study suggests that Landsat time series data can be synthesized into cumulative metrics incorporating multiple disturbance types, which help explain important disturbance-mediated changes in ecosystem functions.

  4. Incorporating cumulative effects into environmental assessments of mariculture: Limitations and failures of current siting methods

    SciTech Connect

    King, Sarah C. Pushchak, Ronald

    2008-11-15

    Assessing and evaluating the cumulative impacts of multiple marine aquaculture facilities has proved difficult in environmental assessment. A retrospective review of 23 existing mariculture farms in southwestern New Brunswick was conducted to determine whether cumulative interactions would have justified site approvals. Based on current scientific evidence of cumulative effects, six new criteria were added to a set of far-field impacts and other existing criteria were expanded to include regional and cumulative environmental impacts in Hargrave's [Hargrave BT. A traffic light decision system for marine finfish aquaculture siting. Ocean Coast Manag 2002; 45:215-35.] Traffic Light Decision Support System (DSS) presently used in Canadian aquaculture environmental assessments. Before mitigation, 19 of the 23 sites failed the amended set of criteria and after considering mitigation, 8 sites failed. Site and ecosystem indices yielded varying site acceptability scores; however, many sites would not have been approved if siting decisions had been made within a regional management framework and cumulative impact criteria were considered in the site evaluation process.

  5. Using Cumulative Risk to Screen for Mental Health Problems in Child Welfare

    ERIC Educational Resources Information Center

    McCrae, Julie S.; Barth, Richard P.

    2008-01-01

    Objective: This study tests the hypothesis that information typically collected during a maltreatment investigation can be used to screen children for mental health problems. Method: Data are from the National Survey of Child and Adolescent Well-Being. Cumulative risk scores were created for 3,022 children and compared to reports of clinical-level…

  6. Cumulative impact assessments and bird/wind farm interactions: Developing a conceptual framework

    SciTech Connect

    Masden, Elizabeth A.; Fox, Anthony D.; Furness, Robert W.; Bullman, Rhys; Haydon, Daniel T.

    2010-01-15

    The wind power industry has grown rapidly in the UK to meet EU targets of sourcing 20% of energy from renewable sources by 2020. Although wind power is a renewable energy source, there are environmental concerns over increasing numbers of wind farm proposals and associated cumulative impacts. Individually, a wind farm, or indeed any action, may have minor effects on the environment, but collectively these may be significant, potentially greater than the sum of the individual parts acting alone. EU and UK legislation requires a cumulative impact assessment (CIA) as part of Environmental Impact Assessments (EIA). However, in the absence of detailed guidance and definitions, such assessments within EIA are rarely adequate, restricting the acquisition of basic knowledge about the cumulative impacts of wind farms on bird populations. Here we propose a conceptual framework to promote transparency in CIA through the explicit definition of impacts, actions and scales within an assessment. Our framework requires improved legislative guidance on the actions to include in assessments, and advice on the appropriate baselines against which to assess impacts. Cumulative impacts are currently considered on restricted scales (spatial and temporal) relating to individual development EIAs. We propose that benefits would be gained from elevating CIA to a strategic level, as a component of spatially explicit planning.

  7. Cumulative structural disadvantage and racial health disparities: the pathways of childhood socioeconomic influence.

    PubMed

    Pais, Jeremy

    2014-10-01

    Cumulative structural disadvantage theory posits two major sources of endogenous selection in shaping racial health disparities: a race-based version of the theory anticipates a racially distinct selection process, whereas a social class-based version anticipates a racially similar process. To operationalize cumulative structural disadvantage, this study uses data from the 1979 National Longitudinal Survey of Youth in a Latent Class Analysis that demographically profiles health impairment trajectories. This analysis is used to examine the nature of selection as it relates to racial differences in the development of health impairments that are significant enough to hinder one's ability to work. The results provide no direct support for the race-based version of cumulative structural disadvantage theory. Instead, two key findings support the social class-based version of cumulative disadvantage theory. First, the functional form of the different health trajectories are invariant for whites and blacks, suggesting more racial similarly in the developmental process than anticipated by the race-based version of the theory. The extent of the racial disparity in the prevalences across the health impairment trajectories is, however, significant and noteworthy: nearly one-third of blacks (28 %) in the United States experience some form of impairment during their prime working years compared with 18.8 % of whites. Second, racial differences in childhood background mediate this racial health disparity through the indirect pathway of occupational attainment and through the direct pathway of early-life exposure to health-adverse environments. Thus, the selection of individuals into different health trajectories, based largely on childhood socioeconomic background, helps explain racial disparities in the development of health impairments.

  8. [Recommendations for the analysis of cumulated data in antimicrobial susceptibility in health institutions].

    PubMed

    2010-04-01

    Due to the great variability in antimicrobial resistance patterns, local reports of cumulative antimicrobial susceptibility data are necessary in every health center. The purpose is to guide clinical decisions and the early detection of patterns that allow preventive measures to avoid dissemination of resistant strains. The main objective of this guide is to provide recommendations for the analysis of antimicrobial susceptibility data and elaboration of a local report. Recommendations provided in this guide are based on the Clinical and Laboratory Standards Institute (CLSI) document "Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data" (3). Key aspects related to information gathering and data processing, analysis and presentation are described.

  9. The Validation of a Case-Based, Cumulative Assessment and Progressions Examination

    PubMed Central

    Coker, Adeola O.; Copeland, Jeffrey T.; Gottlieb, Helmut B.; Horlen, Cheryl; Smith, Helen E.; Urteaga, Elizabeth M.; Ramsinghani, Sushma; Zertuche, Alejandra; Maize, David

    2016-01-01

    Objective. To assess content and criterion validity, as well as reliability of an internally developed, case-based, cumulative, high-stakes third-year Annual Student Assessment and Progression Examination (P3 ASAP Exam). Methods. Content validity was assessed through the writing-reviewing process. Criterion validity was assessed by comparing student scores on the P3 ASAP Exam with the nationally validated Pharmacy Curriculum Outcomes Assessment (PCOA). Reliability was assessed with psychometric analysis comparing student performance over four years. Results. The P3 ASAP Exam showed content validity through representation of didactic courses and professional outcomes. Similar scores on the P3 ASAP Exam and PCOA with Pearson correlation coefficient established criterion validity. Consistent student performance using Kuder-Richardson coefficient (KR-20) since 2012 reflected reliability of the examination. Conclusion. Pharmacy schools can implement internally developed, high-stakes, cumulative progression examinations that are valid and reliable using a robust writing-reviewing process and psychometric analyses. PMID:26941435

  10. Cumulative violence exposure, emotional nonacceptance, and mental health symptoms in a community sample of women.

    PubMed

    Sundermann, Jane M; Chu, Ann T; DePrince, Anne P

    2013-01-01

    Women exposed to more types of violence (e.g., emotional, physical, or sexual violence)--referred to here as cumulative violence exposure--are at risk for more severe mental health symptoms compared to women who are exposed to a single type of violence or no violence. Women exposed to violence may also experience greater emotional nonacceptance compared to women with no exposure to violence. Emotional nonacceptance refers to an unwillingness to experience emotional states, including cognitive and behavioral attempts to avoid experiences of emotion. Given the links between cumulative violence exposure, emotional nonacceptance, and mental health symptoms among female victims of violence, the current study tested victims' emotional nonacceptance as a partial mediator between cumulative violence exposure and the severity of 3 types of symptoms central to complex trauma responses: depression, dissociation, and posttraumatic stress disorder (PTSD) symptoms. A non-treatment-seeking community sample of women (N = 89; M age = 30.70 years) completed self-report questionnaires and interviews. Bootstrap procedures were then used to test 3 mediation models for the separate predictions of depression, dissociation, and PTSD symptoms. Results supported our hypotheses that emotional nonacceptance would mediate the relationship between women's cumulative violence exposure and severity for all symptom types. The current findings highlight the role that emotional nonacceptance may play in the development of mental health symptoms for chronically victimized women and point to the need for longitudinal research in such populations.

  11. Evaluating Pharmacokinetic and Pharmacodynamic Interactions with Computational Models in Supporting Cumulative Risk Assessment

    PubMed Central

    Tan, Yu-Mei; Clewell, Harvey; Campbell, Jerry; Andersen, Melvin

    2011-01-01

    Simultaneous or sequential exposure to multiple chemicals may cause interactions in the pharmacokinetics (PK) and/or pharmacodynamics (PD) of the individual chemicals. Such interactions can cause modification of the internal or target dose/response of one chemical in the mixture by other chemical(s), resulting in a change in the toxicity from that predicted from the summation of the effects of the single chemicals using dose additivity. In such cases, conducting quantitative cumulative risk assessment for chemicals present as a mixture is difficult. The uncertainties that arise from PK interactions can be addressed by developing physiologically based pharmacokinetic (PBPK) models to describe the disposition of chemical mixtures. Further, PK models can be developed to describe mechanisms of action and tissue responses. In this article, PBPK/PD modeling efforts conducted to investigate chemical interactions at the PK and PD levels are reviewed to demonstrate the use of this predictive modeling framework in assessing health risks associated with exposures to complex chemical mixtures. PMID:21655141

  12. Cumulative effects in strategic environmental assessment: The influence of plan boundaries

    SciTech Connect

    Bidstrup, Morten; Kørnøv, Lone; Partidário, Maria Rosário

    2016-02-15

    Cumulative effects (CE) assessment is lacking quality in impact assessment (IA) worldwide. It has been argued that the strategic environmental assessment (SEA) provides a suitable IA framework for addressing CE because it is applied to developments with broad boundaries, but few have tested this claim. Through a case study on the Danish mining sector, this article explores how plan boundaries influence the analytical boundaries applied for assessing CE in SEA. The case was studied through document analysis in combination with semi-structured group interviews of the responsible planners, who also serve as SEA practitioners. It was found that CE are to some extent assessed and managed implicitly throughout the planning process. However, this is through a focus on lowering the cumulative stress of mining rather than the cumulative stress on and capacity of the receiving environment. Plan boundaries do influence CE assessment, though all boundaries are not equally influential. The geographical and time boundaries of the Danish mining plans are broad or flexible enough to accommodate a meaningful assessment of CE, but the topical boundary is restrictive. The study indicates that collaboration among planning authorities and legally appointed CE leadership may facilitate better practice on CE assessment in sector-specific SEA contexts. However, most pressing is the need for relating assessment to the receiving environment as opposed to solely the stress of a proposed plan.

  13. Estimating Greenspace Exposure and Benefits for Cumulative Risk Assessment Applications (Summary Report)

    EPA Science Inventory

    This document provides a summary of the technical meeting on greenspace (GS) and cumulative risk assessment convened May 4−5, 2015 in Cincinnati, OH, by the U.S. Environmental Protection Agency (EPA) Office of Research and Development (ORD) National Center for Environmental As...

  14. Estimating Greenspace Exposure and Benefits for Cumulative Risk Assessment Applications (Summary Report)

    EPA Science Inventory

    This document provides a summary of the technical meeting on greenspace (GS) and cumulative risk assessment convened May 4−5, 2015 in Cincinnati, OH, by the U.S. Environmental Protection Agency (EPA) Office of Research and Development (ORD) National Center for Environmental As...

  15. Probabilistic cumulative risk assessment of anti-androgenic pesticides in food.

    PubMed

    Müller, Anne Kirstine; Bosgra, Sieto; Boon, Polly E; van der Voet, Hilko; Nielsen, Elsa; Ladefoged, Ole

    2009-12-01

    In this paper, we present a cumulative risk assessment of three anti-androgenic pesticides (vinclozolin, procymidone and prochloraz) using the relative potency factor (RPF) approach and an integrated probabilistic risk assessment (IPRA) model. RPFs for each substance were estimated for three reproductive endpoints (ano-genital distance, and weights of the seminal vesicles and the musculus levator ani/bulbocavernosus) in male rat foetuses exposed in utero. The cumulative dietary intake was estimated based on consumption data and residue data from the Netherlands. The IPRA model combines variability in both exposure and sensitivity between individuals into a distribution of individual margins of exposures (IMoEs) and IMoEs of 1 or less indicate a possible concern. The assessment did not result in IMoEs < or = 1. The endpoint 'weight of seminal vesicles' resulted in the lowest IMoEs (0.1th percentile: 198) and the fraction of individuals with IMoEs<1000 was 1.43%. For the two other endpoints, the fractions were slightly lower. Thus, cumulative dietary exposure of Dutch women to vinclozolin, procymidone and prochloraz is not likely to be of concern for the reproductive development of their male foetuses. However, other anti-androgenic substances and exposure routes should also be included in the cumulative assessment to make it more comprehensive.

  16. Assessing cumulative impacts within state environmental review frameworks in the United States

    SciTech Connect

    Ma Zhao; Becker, Dennis R.; Kilgore, Michael A.

    2009-11-15

    Cumulative impact assessment (CIA) is the process of systematically assessing a proposed action's cumulative environmental effects in the context of past, present, and future actions, regardless of who undertakes such actions. Previous studies have examined CIA efforts at the federal level but little is known about how states assess the cumulative impacts of nonfederal projects. By examining state environmental review statutes, administrative rules, agency-prepared materials, and a national survey of the administrators of state environmental review programs, this study identifies the legal and administrative frameworks for CIA. It examines current CIA practice, discusses the relationship between CIA policy and its implementation, and explores the opportunities for improvement. The results of the study show that twenty-nine state environmental review programs across twenty-six states required the assessment of cumulative environmental impacts. More than half of these programs have adopted specific procedures for implementing their policies. Some programs assessed cumulative impacts using a standard review document, and others have created their own documentations incorporated into applications for state permits or funding. The majority of programs have adopted various scales, baselines, significance criteria, and coordination practices in their CIA processes. Mixed methods were generally used for data collection and analysis; qualitative methods were more prevalent than quantitative methods. The results also suggest that a program with comprehensive and consistent environmental review policies and procedures does not always imply extensive CIA requirements and practices. Finally, this study discusses the potential for improving existing CIA processes and promoting CIA efforts in states without established environmental review programs.

  17. Health risks of children's cumulative and aggregative exposure to metals and metalloids in a typical urban environment in China.

    PubMed

    Cao, Suzhen; Duan, Xiaoli; Zhao, Xiuge; Chen, Yiting; Wang, Beibei; Sun, Chengye; Zheng, Binghui; Wei, Fusheng

    2016-03-01

    Rapid development of industrialization and urbanization results in serious environmental contamination by metal(loid)s, which would consequently cause deleterious health effects to the exposed people through multi-pathways. Therefore, total health risk assessment for the population in urban environment is very important. Unfortunately, few studies to date investigate the cumulative health risks of metal(loid)s through aggregative pathways in Children who are often susceptible population. 12 metal(loid)s including Lead(Pb), Cadmium(Cd), Arsenic(As), Chromium(Cr), Zinc(Zn), Copper(Cu), Nickel(Ni), Manganese(Mn), Cobalt(Co), Selenium(Se), Antimony(Se) and Vanadium(V), were analyzed in PM10, drinking water, food, soil and indoor dust in this study. The cumulative and aggregative risks of these metal(loid)s among the local children were then evaluated on a field sampling and questionnaire-survey basis. The results showed that the environments were heavily polluted by metal(loid)s. For most metal(loid)s, food ingestion accounted for more than 80% of the total daily exposure dose. The non-cancer risks were up to 30 times higher than the acceptable level due to the food ingestion via Pb, Cr, Cu, Zn, As, Se, Cd and Sb, and the PM10 inhalation via Cr and Mn. While, the cancer risks were mainly attributed to Cr via food ingestion and As via food and dust ingestion, and approximately 100 times of the maximum acceptable level of 1.0 × 10(-4). The study highlights the cumulative and aggregative exposure assessment, instead of pollutant investigation to evaluate the potential health risks and emphasizes concerns to improve indoor hygienic and environmental quality and to decrease the potential harmful health effects of children living in urban area.

  18. Cumulative family risks across income levels predict deterioration of children's general health during childhood and adolescence.

    PubMed

    Lin, Yi-Ching; Seo, Dong-Chul

    2017-01-01

    Family is considered an important agent in the health development of children. This process is significant but quite complex because the prevalence of potential risk factors in the family can hinder children's health. This study examined if multiple family risks might have cumulative effect on children and youth's health across various levels of household income. The data in this study were drawn from the 2011-2012 U.S. National Survey of Children's Health (N = 79,601). A cumulative family risk (CFR) index was developed, which included such constructs as single-parenthood, unstable employment, large family, parenting stress, poor maternal education, poor maternal general health and poor maternal mental health. Multiple logistic regression analyses showed that CFR level was significantly related to children and youth's poor health outcome (p < .001). When poverty levels were considered, however, the impact of CFRs on children and youth's health was attenuated. The impact of CFRs was higher on children and youth from affluent families than on those from poor families. Overall there was a consistent pattern of trend in the point estimate as well as confidence limits as levels of affluence and numbers of family risk increased although some of the confidence intervals overlapped. Living in disadvantaged families might serve as a protective factor against CFRs possibly through repeated exposure to hardships and subsequent formation of resilience among some of the disadvantaged children.

  19. Cumulative advantages and social capabilities in scientific mobility in the Health Sciences: The Spanish case

    PubMed Central

    Melchor, Lorenzo; Danvila-del-Valle, Joaquín; Bousoño-Calzón, Carlos

    2017-01-01

    Background The big problem in global public health, arising from the international migration of physicians from less-developed to more-developed countries, increases if this migration also affects scientists dedicated to health areas. This article analyzes critical variables in the processes of Spanish scientific mobility in Health Sciences to articulate effective management policies for the benefit of national public health services and the balance between local and global science. Methods This study develops a survey to measure and analyze the following crucial variables: research career, training, funding, working with a world-class team, institutional prestige, wages, facilities/infrastructure, working conditions in the organization of the destination country, fringe benefits in the organization of the destination country and social responsibility in the organization of the departure country. A total of 811 researchers have participated in the survey, of which 293 were from the health sector: Spanish scientists abroad (114), scientists that have returned to Spain (32) and young researchers in Spain (147). Results The most crucial variables for Spanish scientists and young researchers in Spain in Health Sciences moving abroad are the cumulative advantages (research career, training, funding and institutional prestige) plus wages. On the other hand, the return of Spanish scientists in the Health Sciences is influenced by cumulative variables (working with a world-class team, research career and institutional prestige) and also by other variables related to social factors, such as working conditions and fringe benefits in the destination country. Permanent positions are rare for these groups and their decisions regarding mobility depend to a large extent on job opportunities. Conclusions Spanish health organizations can influence researchers to return, since these decisions mainly depend on job opportunities. These organizations can complement the cumulative

  20. Cumulative advantages and social capabilities in scientific mobility in the Health Sciences: The Spanish case.

    PubMed

    Aceituno-Aceituno, Pedro; Melchor, Lorenzo; Danvila-Del-Valle, Joaquín; Bousoño-Calzón, Carlos

    2017-01-01

    The big problem in global public health, arising from the international migration of physicians from less-developed to more-developed countries, increases if this migration also affects scientists dedicated to health areas. This article analyzes critical variables in the processes of Spanish scientific mobility in Health Sciences to articulate effective management policies for the benefit of national public health services and the balance between local and global science. This study develops a survey to measure and analyze the following crucial variables: research career, training, funding, working with a world-class team, institutional prestige, wages, facilities/infrastructure, working conditions in the organization of the destination country, fringe benefits in the organization of the destination country and social responsibility in the organization of the departure country. A total of 811 researchers have participated in the survey, of which 293 were from the health sector: Spanish scientists abroad (114), scientists that have returned to Spain (32) and young researchers in Spain (147). The most crucial variables for Spanish scientists and young researchers in Spain in Health Sciences moving abroad are the cumulative advantages (research career, training, funding and institutional prestige) plus wages. On the other hand, the return of Spanish scientists in the Health Sciences is influenced by cumulative variables (working with a world-class team, research career and institutional prestige) and also by other variables related to social factors, such as working conditions and fringe benefits in the destination country. Permanent positions are rare for these groups and their decisions regarding mobility depend to a large extent on job opportunities. Spanish health organizations can influence researchers to return, since these decisions mainly depend on job opportunities. These organizations can complement the cumulative advantages offered by the wealthier

  1. Conceptual and methodological challenges to integrating SEA and cumulative effects assessment

    SciTech Connect

    Gunn, Jill; Noble, Bram F.

    2011-03-15

    The constraints to assessing and managing cumulative environmental effects in the context of project-based environmental assessment are well documented, and the potential benefits of a more strategic approach to cumulative effects assessment (CEA) are well argued; however, such benefits have yet to be clearly demonstrated in practice. While it is widely assumed that cumulative effects are best addressed in a strategic context, there has been little investigation as to whether CEA and strategic environmental assessment (SEA) are a 'good fit' - conceptually or methodologically. This paper identifies a number of conceptual and methodological challenges to the integration of CEA and SEA. Based on results of interviews with international experts and practitioners, this paper demonstrates that: definitions and conceptualizations of CEA are typically weak in practice; approaches to effects aggregation vary widely; a systems perspective lacks in both SEA and CEA; the multifarious nature of SEA complicates CEA; tiering arrangements between SEA and project-based assessment are limited to non-existing; and the relationship of SEA to regional planning remains unclear.

  2. Application of a Novel Method for Assessing Cumulative Risk Burden by County

    PubMed Central

    Salinas, Jennifer J.; Shah, Manasi; Abdelbary, Bassent; Gay, Jennifer L.; Sexton, Ken

    2012-01-01

    The purpose of this study is to apply the Human Security Index (HSI) as a tool to detect social and economic cumulative risk burden at a county-level in the state of Texas. The HSI is an index comprising a network of three sub-components or “fabrics”; the Economic, Environmental, and Social Fabrics. We hypothesized that the HSI will be a useful instrument for identifying and analyzing socioeconomic conditions that contribute to cumulative risk burden in vulnerable counties. We expected to identify statistical associations between cumulative risk burden and (a) ethnic concentration and (b) geographic proximity to the Texas-Mexico border. Findings from this study indicate that the Texas-Mexico border region did not have consistently higher total or individual fabric scores as would be suggested by the high disease burden and low income in this region. While the Economic, Environmental, Social Fabrics (including the Health subfabric) were highly associated with Hispanic ethnic concentration, the overall HSI and the Crime subfabric were not. In addition, the Education, Health and Crime subfabrics were associated with African American racial composition, while Environment, Economic and Social Fabrics were not. Application of the HSI to Texas counties provides a fuller and more nuanced understanding of socioeconomic and environmental conditions, and increases awareness of the role played by environmental, economic, and social factors in observed health disparities by race/ethnicity and geographic region. PMID:22754475

  3. Revision of the Beginning Breastfeeding Survey: A Cumulative Assessment of Breastfeeding

    PubMed Central

    Mulder, Pamela

    2015-01-01

    Background and Purpose Women use their cumulative breastfeeding experiences, in combination with other factors, to make their infant feeding decisions. This pilot study assessed the reliability and predictive validity of the revised Beginning Breastfeeding Survey-Cumulative (BBS-C). Methods 25 women were recruited prenatally from a university hospital. The BBS-C was completed before hospital discharge. Infant feeding outcomes were measured at 1 and 3 months postpartum. Results Participants were 17–40 years old, mostly married, Whites, and well-educated. Coefficient alpha was .92–.94. The BBS-C predicted an infant not receiving breast milk, not feeding from the breast, and receiving infant formula feedings. Conclusions In this sample, the BBS-C had strong reliability and predictive validity. Further testing should assess reliability and predictive validity in a wider range of populations and settings. PMID:23786136

  4. Environmental justice, local knowledge, and risk: the discourse of a community-based cumulative exposure assessment.

    PubMed

    Corburn, Jason

    2002-04-01

    While risk assessment continues to drive most environmental management decision-making, its methods and assumptions have been criticized for, among other things, perpetuating environmental injustice. The justice challenges to risk assessment claim that the process ignores the unique and multiple hazards facing low-income and people of color communities and simultaneously excludes the local, non-expert knowledge which could help capture these unique hazards from the assessment discourse. This paper highlights some of these challenges to conventional risk assessment and suggests that traditional models of risk characterization will continue to ignore the environmental justice challenges until cumulative hazards and local knowledge are meaningfully brought into the assessment process. We ask whether a shift from risk to exposure assessment might enable environmental managers to respond to the environmental justice critiques. We review the US EPA's first community-based Cumulative Exposure Project, piloted in Brooklyn, NY, and highlight to what extent this process addressed the risk assessment critiques raised by environmental justice advocates. We suggest that a shift from risk to exposure assessment can provide an opportunity for local knowledge to both improve the technical assessment and its democratic nature and may ultimately allow environmental managers to better address environmental justice concerns in decision-making.

  5. A feasibility study of cumulative risk assessment methods for drinking water disinfection by-product mixtures.

    PubMed

    Teuschler, Linda K; Rice, Glenn E; Wilkes, Charles R; Lipscomb, John C; Power, Fred W

    Humans are exposed daily to complex mixtures of chemicals, including drinking water disinfection by-products (DBPs) via oral, dermal, and inhalation routes. Some positive epidemiological and toxicological studies suggest reproductive and developmental effects and cancer are associated with consumption of chlorinated drinking water. Thus, the U.S. Environmental Protection Agency (EPA) conducted research to examine the feasibility of evaluating simultaneous exposures to multiple DBPs via all three exposure routes. A cumulative risk assessment approach was developed for DBP mixtures by combining exposure modeling and physiologically based pharmacokinetic modeling results with a new mixtures risk assessment method, the cumulative relative potency factors (CRPF) approach. Internal doses were estimated for an adult female and an adult male, each of reproductive age, and for a child (age 6 yr) inclusive of oral, dermal, and inhalation exposures. Estimates of the daily internal doses were made for 13 major DBPs, accounting for activity patterns that affect the amount of human contact time with drinking water (e.g., tap water consumed, time spent showering), building characteristics (e.g., household air volumes), and physicochemical properties of the DBPs (e.g., inhalation rates, skin permeability rates, blood: air partition coefficients). A novel cumulative risk assessment method, the CRPF approach, is advanced that integrates the principles of dose addition and response addition to produce multiple-route, chemical mixture risk estimates using total absorbed doses. Research needs to improve this approach are presented.

  6. Weak self-directed learning skills hamper performance in cumulative assessment.

    PubMed

    Tio, René A; Stegmann, Mariken E; Koerts, Janke; van Os, Titus W D P; Cohen-Schotanus, Janke

    2016-01-01

    Self-regulated learning is an important determinant of academic performance. Previous research has shown that cumulative assessment encourages students to work harder and improve their results. However, not all students seem to respond as intended. We investigated the influence of students' behavioral traits on their responsiveness to a cumulative assessment strategy. The cumulative test results of a third-year integrated ten-week course unit were analyzed. The test was divided into three parts delivered at 4, 8 and 10 weeks. Low starters (below median) with low or high improvement (below or above the median) were identified and compared regarding their behavioral traits (assessed with the Temperament and Character Inventory questionnaire). A total of 295 students filled out the questionnaire. A percentage of 70% of the students below the median on the first two test parts improved during the final part. Students who were less responsive to improve their test results, scored low only on the TCI scale "self directedness" (t = 2.49; p = 0.011). Behavioral traits appear to influence student reactions to feedback on test results, with students with low self-directedness scores being particularly at risk. They can thus be identified and should receive special attention from student counselors.

  7. Social Determinants of Health in Environmental Justice Communities: Examining Cumulative Risk in Terms of Environmental Exposures and Social Determinants of Health.

    PubMed

    Prochaska, John D; Nolen, Alexandra B; Kelley, Hilton; Sexton, Ken; Linder, Stephen H; Sullivan, John

    2014-01-01

    Residents of environmental justice (EJ) communities may bear a disproportionate burden of environmental health risk, and often face additional burdens from social determinants of health. Accounting for cumulative risk should include measures of risk from both environmental sources and social determinants. This study sought to better understand cumulative health risk from both social and environmental sources in a disadvantaged community in Texas. Key outcomes were determining what data are currently available for this assessment, clarifying data needs, identifying data gaps, and considering how those gaps could be filled. Analyses suggested that the traditionally defined EJ community in Port Arthur may have a lower environmental risk from air toxics than the rest of the City of Port Arthur (although the entire city has a higher risk than the average for the state), but may have a larger burden from social determinants of health. However, the results should be interpreted in light of the availability of data, the definitions of community boundaries, and the areal unit utilized. Continued focus on environmental justice communities and the cumulative risks faced by their residents is critical to protecting these residents and, ultimately, moving towards a more equitable distribution and acceptable level of risk throughout society.

  8. Social Determinants of Health in Environmental Justice Communities: Examining Cumulative Risk in Terms of Environmental Exposures and Social Determinants of Health

    PubMed Central

    Prochaska, John D.; Nolen, Alexandra B.; Kelley, Hilton; Sexton, Ken; Linder, Stephen H.; Sullivan, John

    2014-01-01

    Residents of environmental justice (EJ) communities may bear a disproportionate burden of environmental health risk, and often face additional burdens from social determinants of health. Accounting for cumulative risk should include measures of risk from both environmental sources and social determinants. This study sought to better understand cumulative health risk from both social and environmental sources in a disadvantaged community in Texas. Key outcomes were determining what data are currently available for this assessment, clarifying data needs, identifying data gaps, and considering how those gaps could be filled. Analyses suggested that the traditionally defined EJ community in Port Arthur may have a lower environmental risk from air toxics than the rest of the City of Port Arthur (although the entire city has a higher risk than the average for the state), but may have a larger burden from social determinants of health. However, the results should be interpreted in light of the availability of data, the definitions of community boundaries, and the areal unit utilized. Continued focus on environmental justice communities and the cumulative risks faced by their residents is critical to protecting these residents and, ultimately, moving towards a more equitable distribution and acceptable level of risk throughout society. PMID:24771993

  9. Cumulative Effect of Racial Discrimination on the Mental Health of Ethnic Minorities in the United Kingdom.

    PubMed

    Wallace, Stephanie; Nazroo, James; Bécares, Laia

    2016-07-01

    To examine the longitudinal association between cumulative exposure to racial discrimination and changes in the mental health of ethnic minority people. We used data from 4 waves (2009-2013) of the UK Household Longitudinal Study, a longitudinal household panel survey of approximately 40 000 households, including an ethnic minority boost sample of approximately 4000 households. Ethnic minority people who reported exposure to racial discrimination at 1 time point had 12-Item Short Form Health Survey (SF-12) mental component scores 1.93 (95% confidence interval [CI] = -3.31, -0.56) points lower than did those who reported no exposure to racial discrimination, whereas those who had been exposed to 2 or more domains of racial discrimination, at 2 different time points, had SF-12 mental component scores 8.26 (95% CI = -13.33, -3.18) points lower than did those who reported no experiences of racial discrimination. Controlling for racial discrimination and other socioeconomic factors reduced ethnic inequalities in mental health. Cumulative exposure to racial discrimination has incremental negative long-term effects on the mental health of ethnic minority people in the United Kingdom. Studies that examine exposure to racial discrimination at 1 point in time may underestimate the contribution of racism to poor health.

  10. DOSE-RESPONSE MODELING FOR THE ASSESSMENT OF CUMULATIVE RISK DUE TO EXPOSURE TO N-METHYL CARBAMATE PESTICIDES

    EPA Science Inventory

    The US EPAs N-Methyl Carbamate Cumulative Risk Assessment (NMCRA) assesses the effect on acetylcholine esterase (AChE) activity of exposure to 10 N-methyl carbamate (NMC) pesticides through dietary, drinking water, and residential exposures.

  11. Role of slope stability in cumulative impact assessment of hydropower development: North Cascades, Washington

    SciTech Connect

    Lee, R.R.; Staub, W.P.

    1993-08-01

    Two environmental assessments considered the potential cumulative environmental impacts resulting from the development of eight proposed hydropower projects in the Nooksack River Basin and 11 proposed projects in the Skagit River Basin, North Cascades, Washington, respectively. While not identified as a target resource, slope stability and the alteration of sediment supply to creeks and river mainstems significantly affect other resources. The slope stability assessment emphasized the potential for cumulative impacts under disturbed conditions (e.g., road construction and timber harvesting) and a landslide-induced pipeline rupture scenario. In the case of small-scale slides, the sluicing action of ruptured pipeline water on the fresh landslide scarp was found to be capable of eroding significantly more material than the original landslide. For large-scale landslides, sluiced material was found to be a small increment of the original landslide. These results predicted that hypothetical accidental pipeline rupture by small-scale landslides may result in potential cumulative impacts for 12 of the 19 projects with pending license applications in both river basins. 5 refs., 2 tabs.

  12. Cumulative risk and developmental health: an argument for the importance of a family-wide science.

    PubMed

    Browne, Dillon T; Plamondon, Andre; Prime, Heather; Puente-Duran, Sofia; Wade, Mark

    2015-01-01

    A substantial body of research links social disadvantage and developmental health via a cascade running from poverty, to cumulative psychosocial risk, to disrupted family dynamics, to child biological regulatory systems and neurocognitive processing, and finally to morbidity across the lifespan. Most research in this area employs single-dyad or between-family methodology. While informative, there are limitations to this approach. Specifically, it is impossible to determine how risk alters psychosocial environments that are similar for all persons within a household, versus processes that are unique to particular children. This is important in light of literature citing the primacy of child-specific environments in driving developmental health. Methodologically speaking, there are both benefits and challenges to family-wide approaches that differentiate between- and within-family environments. This review describes literature linking cumulative risk and developmental health via family process, while articulating the importance of family-wide approaches. Areas of shortcoming and recommendations for a family-wide science are provided.

  13. Framework tool for a rapid cumulative effects assessment: case of a prominent wetland in Myanmar.

    PubMed

    Pradhan, N; Habib, H; Venkatappa, M; Ebbers, T; Duboz, R; Shipin, O

    2015-06-01

    The wetland of focus, Inle Lake, located in central Myanmar, is well known for its unique biodiversity and culture, as well as for ingenious floating garden agriculture. During the last decades, the lake area has seen extensive degradation in terms of water quality, erosion, deforestation, and biodiversity concomitant with a major shift to unsustainable land use. The study was conducted, with an emphasis on water quality, to analyze environmental impacts (effects) changing the ecosystem and to comprehensively evaluate the environmental state of the ecosystem through an innovative Rapid Cumulative Effects Assessment framework tool. The assessment started with a framework-forming Participatory Rural Appraisal (PRA), which quantified and prioritized impacts over space and time. Critically important impacts were assessed for "intra-inter interactions" using the loop analysis simulation. Water samples were analyzed while geographic information system (GIS) and remote sensing were used to identify water pollution hotspots. It was concluded that out of a plethora of impacts, pollution from municipal sources, sedimentation, and effects exerted by floating gardens had the most detrimental impacts, which cumulatively affected the entire ecosystem. The framework tool was designed in a broad sense with a reference to highly needed assessments of poorly studied wetlands where degradation is evident, but scarcely quantified, and where long-term field studies are fraught with security issues and resource unavailability (post-conflict, poor and remote regions, e.g., Afghanistan, Laos, Sudan, etc.).

  14. Single-compound and cumulative risk assessment of mycotoxins present in breakfast cereals consumed by children from Lisbon region, Portugal.

    PubMed

    Assunção, Ricardo; Vasco, Elsa; Nunes, Baltazar; Loureiro, Susana; Martins, Carla; Alvito, Paula

    2015-12-01

    Humans can be exposed to multiple chemicals, but current risk assessment is usually carried out on one chemical at a time. Mycotoxins are commonly found in a variety of foods including those intended to consumption by children namely breakfast cereals. The present study aims to perform, the risk assessment of single and multiple mycotoxins present in breakfast cereals consumed by children (1-3 years old) from Lisbon region, Portugal. Daily exposure of children to ochratoxin A, fumonisins and trichothecenes showed no health risks to the children population considering individual mycotoxins, while exposure to aflatoxin B1 (AFB1) suggested a potential health concern for the high percentiles of intake (P90, P95 and P99). The combined exposure to fumonisins and trichothecenes are not expected to be of health concern. The combined margin of exposure (MoET) for the aflatoxins group could constitute a potential health concern and AFB1 was the main contributor for MoET. Legal limits and control strategies regarding the presence of multiple mycotoxins in foodstuffs is an urgent need. To the best of our knowledge, this is the first time a cumulative risk assessment was performed on multiple mycotoxins present in breakfast cereals consumed by children.

  15. The cumulative effects assessment of a coastal ecological restoration project in China: An integrated perspective.

    PubMed

    Ma, Deqiang; Zhang, Liyu; Fang, Qinhua; Jiang, Yuwu; Elliott, Michael

    2017-05-15

    Large scale coastal land-claim and sea-enclosing (CLASE) activities have caused habitat destruction, biodiversity losses and water deterioration, thus the local governments in China have recently undertaken seabed dredging and dyke opening (SDADO) as typical ecological restoration projects. However, some projects focus on a single impact on hydrodynamic conditions, water quality or marine organisms. In a case study in Xiamen, China, an integrated effects assessment framework centres on ecohydrology, using modeling of hydrodynamic conditions and statistical analysis of water quality, was developed to assess the effects of ecological restoration projects. The benefits of SDADO projects include improving hydrodynamic conditions and water quality, as a precursor to further marine biological improvements. This study highlights the need to comprehensively consider ecological effects of SDADO projects in the planning stage, and an integrative assessment method combining cumulative effects of hydrodynamic conditions, water quality and biological factors. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Environmental Justice, Cumulative Environmental Risk, and Health Among Low- and Middle-Income Children in Upstate New York

    PubMed Central

    Evans, Gary W.; Marcynyszyn, Lyscha A.

    2004-01-01

    Objectives. We documented inequitable, cumulative environmental risk exposure and health between predominantly White low-income and middle-income children residing in rural areas in upstate New York. Methods. Cross-sectional data for 216 third- through fifth-grade children included overnight urinary neuroendocrine levels, noise levels, residential crowding (people/room), and housing quality. Results. After control for income, maternal education, family structure, age, and gender, cumulative environmental risk exposure (0–3) (risk >1 SD above the mean for each singular risk factor [0, 1]) was substantially greater for low-income children. Cumulative environmental risk was positively correlated with elevated overnight epinephrine, norepinephrine, and cortisol in the low-income sample but not in the middle-income sample. Conclusions. Cumulative environmental risk exposure among low-income families may contribute to bad health, beginning in early childhood. PMID:15514234

  17. A Framework to Assess the Cumulative Hydrological Impacts of Dams on flow Regime

    NASA Astrophysics Data System (ADS)

    Wang, Y.; Wang, D.

    2016-12-01

    In this study we proposed a framework to assess the cumulative impact of dams on hydrological regime, and the impacts of the Three Gorges Dam on flow regime in Yangtze River were investigated with the framework. We reconstructed the unregulated flow series to compare with the regulated flow series in the same period. Eco-surplus and eco-deficit and the Indicators of Hydrologic Alteration parameters were used to examine the hydrological regime change. Among IHA parameters, Wilcoxon signed-rank test and Principal Components Analysis identified the representative indicators of hydrological alterations. Eco-surplus and eco-deficit showed that the reservoir also changed the seasonal regime of the flows in autumn and winter. Annual extreme flows and October flows changes lead to negative ecological implications downstream from the Three Gorges Dam. Ecological operation for the Three Gorges Dam is necessary to mitigate the negative effects on the river ecosystem in the middle reach of Yangtze River. The framework proposed here could be a robust method to assess the cumulative impacts of reservoir operation.

  18. Towards a framework for assessment and management of cumulative human impacts on marine food webs.

    PubMed

    Giakoumi, Sylvaine; Halpern, Benjamin S; Michel, Loïc N; Gobert, Sylvie; Sini, Maria; Boudouresque, Charles-François; Gambi, Maria-Cristina; Katsanevakis, Stelios; Lejeune, Pierre; Montefalcone, Monica; Pergent, Gerard; Pergent-Martini, Christine; Sanchez-Jerez, Pablo; Velimirov, Branko; Vizzini, Salvatrice; Abadie, Arnaud; Coll, Marta; Guidetti, Paolo; Micheli, Fiorenza; Possingham, Hugh P

    2015-08-01

    Effective ecosystem-based management requires understanding ecosystem responses to multiple human threats, rather than focusing on single threats. To understand ecosystem responses to anthropogenic threats holistically, it is necessary to know how threats affect different components within ecosystems and ultimately alter ecosystem functioning. We used a case study of a Mediterranean seagrass (Posidonia oceanica) food web and expert knowledge elicitation in an application of the initial steps of a framework for assessment of cumulative human impacts on food webs. We produced a conceptual seagrass food web model, determined the main trophic relationships, identified the main threats to the food web components, and assessed the components' vulnerability to those threats. Some threats had high (e.g., coastal infrastructure) or low impacts (e.g., agricultural runoff) on all food web components, whereas others (e.g., introduced carnivores) had very different impacts on each component. Partitioning the ecosystem into its components enabled us to identify threats previously overlooked and to reevaluate the importance of threats commonly perceived as major. By incorporating this understanding of system vulnerability with data on changes in the state of each threat (e.g., decreasing domestic pollution and increasing fishing) into a food web model, managers may be better able to estimate and predict cumulative human impacts on ecosystems and to prioritize conservation actions. © 2015 Society for Conservation Biology.

  19. Growing literature, stagnant science? Systematic review, meta-regression and cumulative analysis of audit and feedback interventions in health care.

    PubMed

    Ivers, Noah M; Grimshaw, Jeremy M; Jamtvedt, Gro; Flottorp, Signe; O'Brien, Mary Ann; French, Simon D; Young, Jane; Odgaard-Jensen, Jan

    2014-11-01

    This paper extends the findings of the Cochrane systematic review of audit and feedback on professional practice to explore the estimate of effect over time and examine whether new trials have added to knowledge regarding how optimize the effectiveness of audit and feedback. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE for randomized trials of audit and feedback compared to usual care, with objectively measured outcomes assessing compliance with intended professional practice. Two reviewers independently screened articles and abstracted variables related to the intervention, the context, and trial methodology. The median absolute risk difference in compliance with intended professional practice was determined for each study, and adjusted for baseline performance. The effect size across studies was recalculated as studies were added to the cumulative analysis. Meta-regressions were conducted for studies published up to 2002, 2006, and 2010 in which characteristics of the intervention, the recipients, and trial risk of bias were tested as predictors of effect size. Of the 140 randomized clinical trials (RCTs) included in the Cochrane review, 98 comparisons from 62 studies met the criteria for inclusion. The cumulative analysis indicated that the effect size became stable in 2003 after 51 comparisons from 30 trials. Cumulative meta-regressions suggested new trials are contributing little further information regarding the impact of common effect modifiers. Feedback appears most effective when: delivered by a supervisor or respected colleague; presented frequently; featuring both specific goals and action-plans; aiming to decrease the targeted behavior; baseline performance is lower; and recipients are non-physicians. There is substantial evidence that audit and feedback can effectively improve quality of care, but little evidence of progress in the field. There are opportunity costs for patients, providers, and health care systems

  20. Approaches for grouping of pesticides into cumulative assessment groups for risk assessment of pesticide residues in food.

    PubMed

    Colnot, Thomas; Dekant, Wolfgang

    2017-02-01

    The European Food Safety Authority (EFSA) is developing approaches to cumulative risk assessment of pesticides by assigning individual pesticides to cumulative assessment groups (CAGs). For assignment to CAGs, EFSA recommended to rely on adverse effects on the specific target system. Contractors to EFSA have proposed to allocate individual pesticides into CAGs relying on NOAELs for effects on target organs. This manuscript evaluates the assignments by applying EFSAs criteria to the CAGs "Toxicity to the nervous system" and "Toxicity to the thyroid hormone system (gland or hormones)". Assignment to the CAG "Toxicity to the nervous system" based, for example, on neurochemical effects like choline esterase inhibition is well supported, whereas assignment to the CAG "Toxicity to the thyroid hormone system (gland or hormones)" has been based in the examined case studies on non-reproducible effects seen in single studies or on observations that are not adverse. Therefore, a more detailed effects evaluation is required to assign a pesticide to a CAG for a target organ where many confounders regarding effects are present. Relative potency factors in cumulative risk assessment should be based on benchmark doses from studies in one species with identical study design and human relevance of effects on specific target organs should be analyzed to define minimal margins of exposure.

  1. Cumulative or sequential assessment during hermit crab shell fights: effects of oxygen on decision rules.

    PubMed

    Briffa, M; Elwood, R W

    2000-12-07

    Agonistic interactions between animals are often settled by the use of repeated signals which advertise the resource-holding potential of the sender. According to the sequential assessment game this repetition increases the accuracy with which receivers may assess the signal, but under the cumulative assessment model the repeated performances accumulate to give a signal of stamina. These models may be distinguished by the temporal pattern of signalling they predict and by the decision rules used by the contestants. Hermit crabs engage in shell fights over possession of the gastropod shells that they inhabit. During these interactions the two roles of signaller and receiver may be examined separately because they are fixed for the duration of the encounter. Attackers rap their shell against that of the defender in a series of bouts whereas defenders remain tightly withdrawn into their shells for the duration of the contest. At the end of a fight the attacker may evict the defender from its shell or decide to give up without first effecting an eviction; the decision for defenders is either to maintain a grip on its shell or to release the shell and allow itself to be evicted. We manipulated fatigue levels separately for attackers and defenders, by varying the oxygen concentration of the water that they are held in prior to fighting, and examined the effects that this has on the likelihood of each decision and on the temporal pattern of rapping. We show that the vigour of rapping and the likelihood of eviction are reduced when the attacker is subjected to low oxygen but that this treatment has no effect on rates of eviction when applied to defenders. We conclude that defenders compare the vigour of rapping with an absolute threshold rather than with a relative threshold when making their decision. The data are compatible with the cumulative assessment model and with the idea that shell rapping signals the stamina of attackers, but do not fit the predictions of the

  2. Appraising the sustainability of project alternatives: An increasing role for cumulative effects assessment

    SciTech Connect

    Senner, Robert

    2011-09-15

    Evaluating and comparing development alternatives with regard to sustainability is an important goal for comprehensive project appraisal. In the United States, this component has been largely missing from standard environmental impact assessment practice. Cumulative effects assessment provides a way to appraise the sustainability of project alternatives in terms of their probable contributions to long-term trends affecting the condition of valued environmental components. Sustainability metrics and predictors are being developed as criteria for rating systems and evaluation processes that are applied to community planning, building design, and transportation infrastructure. Increasing interest in adaptive management is also providing cost-effective solutions to optimizing safety and function throughout the long-term operation of a facility or infrastructure. Recent federal legislation is making it easier to integrate sustainability features into development alternatives through early, community-based planning.

  3. An Overview of Literature Topics Related to Current Concepts, Methods, Tools, and Applications for Cumulative Risk Assessment (2007–2016)

    PubMed Central

    Fox, Mary A.; Brewer, L. Elizabeth; Martin, Lawrence

    2017-01-01

    Cumulative risk assessments (CRAs) address combined risks from exposures to multiple chemical and nonchemical stressors and may focus on vulnerable communities or populations. Significant contributions have been made to the development of concepts, methods, and applications for CRA over the past decade. Work in both human health and ecological cumulative risk has advanced in two different contexts. The first context is the effects of chemical mixtures that share common modes of action, or that cause common adverse outcomes. In this context two primary models are used for predicting mixture effects, dose addition or response addition. The second context is evaluating the combined effects of chemical and nonchemical (e.g., radiation, biological, nutritional, economic, psychological, habitat alteration, land-use change, global climate change, and natural disasters) stressors. CRA can be adapted to address risk in many contexts, and this adaptability is reflected in the range in disciplinary perspectives in the published literature. This article presents the results of a literature search and discusses a range of selected work with the intention to give a broad overview of relevant topics and provide a starting point for researchers interested in CRA applications. PMID:28387705

  4. An Overview of Literature Topics Related to Current Concepts, Methods, Tools, and Applications for Cumulative Risk Assessment (2007-2016).

    PubMed

    Fox, Mary A; Brewer, L Elizabeth; Martin, Lawrence

    2017-04-07

    Cumulative risk assessments (CRAs) address combined risks from exposures to multiple chemical and nonchemical stressors and may focus on vulnerable communities or populations. Significant contributions have been made to the development of concepts, methods, and applications for CRA over the past decade. Work in both human health and ecological cumulative risk has advanced in two different contexts. The first context is the effects of chemical mixtures that share common modes of action, or that cause common adverse outcomes. In this context two primary models are used for predicting mixture effects, dose addition or response addition. The second context is evaluating the combined effects of chemical and nonchemical (e.g., radiation, biological, nutritional, economic, psychological, habitat alteration, land-use change, global climate change, and natural disasters) stressors. CRA can be adapted to address risk in many contexts, and this adaptability is reflected in the range in disciplinary perspectives in the published literature. This article presents the results of a literature search and discusses a range of selected work with the intention to give a broad overview of relevant topics and provide a starting point for researchers interested in CRA applications.

  5. Procedures for assessment of cumulative impacts of coal mining on the hydrologic balance

    USGS Publications Warehouse

    Lumb, Alan M.

    1982-01-01

    Techniques were developed to assess the probable cumulative impacts of anticipated surface mining upon the hydrology of and area. An activity profile of cumulative drainage area versus river miles downstream from the surface mining site is constructed that shows major water uses, flood prone areas, and stream classifications. From the summary shown by the activity profile, an impact matrix is used as a checklist for the importance of the impacts under categories such as water supply, flood prone areas, water contact recreation, etc. Based on the categories checked on the impact matrix, a simple, less accurate model or a more comprehensive and accurate one can be used to quantify the impacts. Quantified impacts are then displayed on an impact profile showing the percentage change in a hydrologic characteristic versus distance downstream of the surface mining site. The simple model for quantification considers only dilution from tributary areas during critical periods whereas the comprehensive model routes flows and quality of water continuously through the year and considers, in addition to dilution, instream processes such as settling, biological uptake , and chemical reactions. (USGS)

  6. Phthalates in Commercial Chinese Rice Wines: Concentrations and the Cumulative Risk Assessment to Adult Males in Shanghai.

    PubMed

    Huang, Yue; Lu, Wen Wei; Chen, Bo; You, Jie; Wu, Min; Li, Shu Guang

    2014-10-01

    The concentrations of 16 phthalates in 164 commercial Chinese rice wines (CRW) were detected by GC-MS, and consumption data on CRW in different packaging types was investigated from 634 adult males in Shanghai using a food frequency questionnaire. Based on the principles of probabilistic modelling and cumulative risk assessment, the exposure and health risk of phthalates from CRW to adult males in Shanghai was evaluated. DMP, DEP, DIBP, DnBP, BBP, and DEHP were detected in the samples, the range of detection frequency of individual phthalates varied from 6.10% for BBP to 15.24% for DIBP, and the detected concentrations were 51.06-200.34 ng/mL. All the respondents consumed CRW, 90.69% of them consumed CRW 0.01-49.9 mL/d, the minimum value of the average daily intake of CRW was 6.25 mL/d, the median was 13.72 mL/d and the maximum was 300 mL/d. The median exposure level of the 6 detected Phthalates to adult males in Shanghai were 6.58-7.10 ng/(d•kg), and the maximum exposure level were 137.38-540.47 ng/(d•kg). The cumulative exposure health risk index (HI) based on the median and maximum exposure level of the 6 Phthalates (DMP, DEP, DIBP, DnBP, BBP, and DEHP) were 0.001147 and 0.063396, both were far less than 1. In conclusion, CRW were generally consumed by the adult males in Shanghai, although multiple phthalates were detected in commercial CRW, health risk of such exposure levels from commercial CRW to the target adult males in Shanghai was very low.

  7. Alchemy to reason: Effective use of Cumulative Effects Assessment in resource management

    SciTech Connect

    Hegmann, George; Yarranton, G.A.

    2011-09-15

    Cumulative Effects Assessment (CEA) is a tool that can be useful in making decisions about natural resource management and allocation. The decisions to be made include those (i) necessary to construct planning and regulatory frameworks to control development activity so that societal goals will be achieved and (ii) whether or not to approve individual development projects, with or without conditions. The evolution of CEA into a more successful tool cannot occur independently of the evolution of decision making processes. Currently progress is painfully slow on both fronts. This paper explores some opportunities to accelerate improvements in decision making in natural resource management and in the utility of CEA as a tool to assist in making such decisions. The focus of the paper is on how to define the public interest by determining what is acceptable.

  8. Assessing Cumulative Thermal Stress in Fish During Chronic Exposure to High Temperature

    SciTech Connect

    Bevelhimer, M.S.; Bennett, W.R.

    1999-11-14

    As environmental laws become increasingly protective, and with possible future changes in global climate, thermal effects on aquatic resources are likely to receive increasing attention. Lethal temperatures for a variety of species have been determined for situations where temperatures rise rapidly resulting in lethal effects. However, less is known about the effects of chronic exposure to high (but not immediately lethal) temperatures and even less about stress accumulation during periods of fluctuating temperatures. In this paper we present a modeling framework for assessing cumulative thermal stress in fish. The model assumes that stress accumulation occurs above a threshold temperature at a rate depending on the degree to which the threshold is exceeded. The model also includes stress recovery (or alleviation) when temperatures drop below the threshold temperature as in systems with large daily variation. In addition to non-specific physiological stress, the model also simulates thermal effects on growth.

  9. Novel genetic variants in differentiated thyroid cancer and assessment of the cumulative risk.

    PubMed

    Figlioli, Gisella; Chen, Bowang; Elisei, Rossella; Romei, Cristina; Campo, Chiara; Cipollini, Monica; Cristaudo, Alfonso; Bambi, Franco; Paolicchi, Elisa; Hoffmann, Per; Herms, Stefan; Kalemba, Michał; Kula, Dorota; Pastor, Susana; Marcos, Ricard; Velázquez, Antonia; Jarząb, Barbara; Landi, Stefano; Hemminki, Kari; Gemignani, Federica; Försti, Asta

    2015-03-10

    A genome-wide association study (GWAS) performed on a high-incidence Italian population followed by replications on low-incidence cohorts suggested a strong association of differentiated thyroid cancer (DTC) with single nucleotide polymorphisms (SNPs) at 9q22.33, 2q35, 20q11.22-q12 and 14q24.3. Moreover, six additional susceptibility loci were associated with the disease only among Italians. The present study had two aims, first to identify loci involved in DTC risk and then to assess the cumulative effect of the SNPs identified so far in the Italian population. The combined analysis of the previous GWAS and the present Italian study provided evidence of association with rs7935113 (GALNTL4, OR = 1.36, 95%CI 1.20-1.53, p-value = 7.41 × 10(-7)) and rs1203952 (FOXA2, OR = 1.29, 95%CI 1.16-1.44, p-value = 4.42 × 10(-6)). Experimental ENCODE and eQTL data suggested that both SNPs may influence the closest genes expression through a differential recruitment of transcription factors. The assessment of the cumulative risk of eleven SNPs showed that DTC risk increases with an increasing number of risk alleles (p-trend = 3.13 × 10(-47)). Nonetheless, only a small fraction (about 4% on the disease liability scale) of DTC is explained by these SNPs. These data are consistent with a polygenic model of DTC predisposition and highlight the importance of association studies in the discovery of the disease hereditability.

  10. Novel genetic variants in differentiated thyroid cancer and assessment of the cumulative risk

    PubMed Central

    Figlioli, Gisella; Chen, Bowang; Elisei, Rossella; Romei, Cristina; Campo, Chiara; Cipollini, Monica; Cristaudo, Alfonso; Bambi, Franco; Paolicchi, Elisa; Hoffmann, Per; Herms, Stefan; Kalemba, Michał; Kula, Dorota; Pastor, Susana; Marcos, Ricard; Velázquez, Antonia; Jarząb, Barbara; Landi, Stefano; Hemminki, Kari; Gemignani, Federica; Försti, Asta

    2015-01-01

    A genome-wide association study (GWAS) performed on a high-incidence Italian population followed by replications on low-incidence cohorts suggested a strong association of differentiated thyroid cancer (DTC) with single nucleotide polymorphisms (SNPs) at 9q22.33, 2q35, 20q11.22-q12 and 14q24.3. Moreover, six additional susceptibility loci were associated with the disease only among Italians. The present study had two aims, first to identify loci involved in DTC risk and then to assess the cumulative effect of the SNPs identified so far in the Italian population. The combined analysis of the previous GWAS and the present Italian study provided evidence of association with rs7935113 (GALNTL4, OR = 1.36, 95%CI 1.20–1.53, p-value = 7.41 × 10−7) and rs1203952 (FOXA2, OR = 1.29, 95%CI 1.16–1.44, p-value = 4.42 × 10−6). Experimental ENCODE and eQTL data suggested that both SNPs may influence the closest genes expression through a differential recruitment of transcription factors. The assessment of the cumulative risk of eleven SNPs showed that DTC risk increases with an increasing number of risk alleles (p-trend = 3.13 × 10−47). Nonetheless, only a small fraction (about 4% on the disease liability scale) of DTC is explained by these SNPs. These data are consistent with a polygenic model of DTC predisposition and highlight the importance of association studies in the discovery of the disease hereditability. PMID:25753578

  11. Neighborhood green, social support, physical activity, and stress: assessing the cumulative impact.

    PubMed

    Fan, Yingling; Das, Kirti V; Chen, Qian

    2011-11-01

    We estimate the cumulative stress mitigating impact of neighborhood greenness by investigating whether neighborhood green mitigates stress directly, and indirectly by encouraging physical activity and/or fostering social support. Using data from a recent community health survey in Chicago and two-stage instrumental variables regression modeling, we find that different components of neighborhood green play distinct roles in influencing stress. Park spaces are found to indirectly mitigate stress by fostering social support. Overall neighborhood vegetation is found to have direct stress mitigation impact, yet the impact is counteracted by its negative effect on social support. When comparing the effect size, park spaces show a more positive impact on health and well-being than the overall neighborhood vegetation level. Policy makers are recommended to focus on creating structured green spaces with public recreation and socialization opportunities rather than simply conserving green spaces in the neighborhood. Previous studies, as they often investigate the direct impact only and rarely use multiple measures of greenness, may have mis-estimated health benefits of neighborhood green.

  12. Cumulative risk assessment lessons learned: a review of case studies and issue papers.

    PubMed

    Gallagher, Sarah S; Rice, Glenn E; Scarano, Louis J; Teuschler, Linda K; Bollweg, George; Martin, Lawrence

    2015-02-01

    Cumulative risk assessments (CRAs) examine potential risks posed by exposure to multiple and sometimes disparate environmental stressors. CRAs are more resource intensive than single chemical assessments, and pose additional challenges and sources of uncertainty. CRAs may examine the impact of several factors on risk, including exposure magnitude and timing, chemical mixture composition, as well as physical, biological, or psychosocial stressors. CRAs are meant to increase the relevance of risk assessments, providing decision makers with information based on real world exposure scenarios that improve the characterization of actual risks and hazards. The U.S. Environmental Protection Agency has evaluated a number of CRAs, performed by or commissioned for the Agency, to seek insight into CRA concepts, methods, and lessons learned. In this article, ten case studies and five issue papers on key CRA topics are examined and a set of lessons learned are identified for CRA implementation. The lessons address the iterative nature of CRAs, importance of considering vulnerability, need for stakeholder engagement, value of a tiered approach, new methods to assess multiroute exposures to chemical mixtures, and the impact of geographical scale on approach and purpose.

  13. Adverse adolescent relationship histories and young adult health: Cumulative effects of loneliness, low parental support, relationship instability, intimate partner violence and loss

    PubMed Central

    Adam, Emma K.; Chyu, Laura; Hoyt, Lindsay; Doane, Leah D.; Boisjoly, Johanne; Duncan, Greg; Chase-Lansdale, Lindsay; McDade, Thomas W.

    2011-01-01

    Purpose To examine the associations between adverse interpersonal relationship histories experienced during adolescence and health in young adulthood in a large, nationally representative sample. Methods Using data from Waves I, II and III of the National Longitudinal Study of Adolescent Health, multiple adverse relationship experiences are examined, including high loneliness, low perceived parental support, frequent transitions in romantic relationships (relationship instability), exposure to intimate partner violence, and loss by death of important relationship figures. These histories are assessed, both individually and in a relationship risk index, as predictors of self-reported general health and depressive symptoms at Wave III (ages 18 to 27), controlling for baseline (Wave I) health and for demographic and health behavior covariates. Results Net of baseline health and covariates, each type of relationship risk (experienced between Wave I and Wave III) was related to either depression or general health at Wave III, with the strongest effects seen for exposure to intimate partner violence. In addition, a cumulative relationship risk index examining the extent to which youth experienced high levels of multiple relationship risk factors revealed that each additional adverse relationship experience increased the odds of reporting poor mental and general health at Wave III, with increases occurring in an additive manner. Conclusions Multiple types of adverse relationship experiences predicted increases in poor general health and depressive symptoms from adolescence to early adulthood. Consistent with a cumulative risk hypothesis, the more types of adverse relationship experiences a youth experienced, the worse their young adult health outcomes. PMID:21856520

  14. Consumption of fruits and vegetables and probabilistic assessment of the cumulative acute exposure to organophosphorus and carbamate pesticides of schoolchildren in Slovenia.

    PubMed

    Blaznik, Urška; Yngve, Agneta; Eržen, Ivan; Hlastan Ribič, Cirila

    2016-02-01

    Adequate consumption of fruits and vegetables is a part of recommendations for a healthy diet. The aim of the present study was to assess acute cumulative dietary exposure to organophosphorus and carbamate pesticides via fruit and vegetable consumption by the population of schoolchildren aged 11-12 years and the level of risk for their health. Cumulative probabilistic risk assessment methodology with the index compound approach was applied. Slovenia, primary schools. Schoolchildren (n 1145) from thirty-one primary schools in Slovenia. Children were part of the PRO GREENS study 2009/10 which assessed 11-year-olds' consumption of fruit and vegetables in ten European countries. The cumulative acute exposure amounted to 8.3 (95% CI 7.7, 10.6) % of the acute reference dose (ARfD) for acephate as index compound (100 µg/kg body weight per d) at the 99.9th percentile for daily intake and to 4.5 (95% CI 3.5, 4.7) % of the ARfD at the 99.9th percentile for intakes during school time and at lunch. Apples, bananas, oranges and lettuce contributed most to the total acute pesticides intake. The estimations showed that acute dietary exposure to organophosphorus and carbamate pesticides is not a health concern for schoolchildren with the assessed dietary patterns of fruit and vegetable consumption.

  15. Health Behavior Theory and cumulative knowledge regarding health behaviors: are we moving in the right direction?

    PubMed

    Noar, Seth M; Zimmerman, Rick S

    2005-06-01

    Although research on Health Behavior Theory (HBT) is being conducted at a rapid pace, the extent to which the field is truly moving forward in understanding health behavior has been questioned. This issue is examined in the current article. First, we discuss the problems within the HBT literature. Second, we discuss the proliferation of HBT and why theory comparison is essential to this area of research. Finally, we reflect on ways that the field might move forward by suggesting a new agenda for HBT research. It is argued that increased recognition of the similarity of health behavior constructs as well as increased empirical comparisons of theories are essential for true scientific progress in this line of inquiry.

  16. Assessing cumulative watershed effects in the central Sierra Nevada: hillslope measurements and catchment-scale modeling

    Treesearch

    Lee H. MacDonald; Drew Coe; Sandra Litschert

    2004-01-01

    Cumulative effects result from the combined impact of multiple activities over space and time. Land and aquatic resource managers are particularly concerned with cumulative watershed effects (CWEs). CWEs can encompass a broad range of concerns, but primary issues are changes in runoff, water quality, channel morphology, and aquatic ecosystems at the watershed scale (...

  17. New approaches to uncertainty analysis for use in aggregate and cumulative risk assessment of pesticides.

    PubMed

    Kennedy, Marc C; van der Voet, Hilko; Roelofs, Victoria J; Roelofs, Willem; Glass, C Richard; de Boer, Waldo J; Kruisselbrink, Johannes W; Hart, Andy D M

    2015-05-01

    Risk assessments for human exposures to plant protection products (PPPs) have traditionally focussed on single routes of exposure and single compounds. Extensions to estimate aggregate (multi-source) and cumulative (multi-compound) exposure from PPPs present many new challenges and additional uncertainties that should be addressed as part of risk analysis and decision-making. A general approach is outlined for identifying and classifying the relevant uncertainties and variabilities. The implementation of uncertainty analysis within the MCRA software, developed as part of the EU-funded ACROPOLIS project to address some of these uncertainties, is demonstrated. An example is presented for dietary and non-dietary exposures to the triazole class of compounds. This demonstrates the chaining of models, linking variability and uncertainty generated from an external model for bystander exposure with variability and uncertainty in MCRA dietary exposure assessments. A new method is also presented for combining pesticide usage survey information with limited residue monitoring data, to address non-detect uncertainty. The results show that incorporating usage information reduces uncertainty in parameters of the residue distribution but that in this case quantifying uncertainty is not a priority, at least for UK grown crops. A general discussion of alternative approaches to treat uncertainty, either quantitatively or qualitatively, is included.

  18. The Interacting Axes of Environmental, Health, and Social Justice Cumulative Impacts: A Case Study of the Blueberry River First Nations.

    PubMed

    Gislason, Maya K; Andersen, Holly K

    2016-10-18

    We consider the case of intensive resource extractive projects in the Blueberry River First Nations in Northern British Columbia, Canada, as a case study. Drawing on the parallels between concepts of cumulative environmental and cumulative health impacts, we highlight three axes along which to gauge the effects of intensive extraction projects. These are environmental, health, and social justice axes. Using an intersectional analysis highlights the way in which using individual indicators to measure impact, rather than considering cumulative effects, hides the full extent by which the affected First Nations communities are impacted by intensive extraction projects. We use the case study to contemplate several mechanisms at the intersection of these axes whereby the negative effects of each not only add but also amplify through their interactions. For example, direct impact along the environmental axis indirectly amplifies other health and social justice impacts separately from the direct impacts on those axes. We conclude there is significant work still to be done to use cumulative indicators to study the impacts of extractive industry projects-like liquefied natural gas-on peoples, environments, and health.

  19. The Interacting Axes of Environmental, Health, and Social Justice Cumulative Impacts: A Case Study of the Blueberry River First Nations

    PubMed Central

    Gislason, Maya K; Andersen, Holly K

    2016-01-01

    We consider the case of intensive resource extractive projects in the Blueberry River First Nations in Northern British Columbia, Canada, as a case study. Drawing on the parallels between concepts of cumulative environmental and cumulative health impacts, we highlight three axes along which to gauge the effects of intensive extraction projects. These are environmental, health, and social justice axes. Using an intersectional analysis highlights the way in which using individual indicators to measure impact, rather than considering cumulative effects, hides the full extent by which the affected First Nations communities are impacted by intensive extraction projects. We use the case study to contemplate several mechanisms at the intersection of these axes whereby the negative effects of each not only add but also amplify through their interactions. For example, direct impact along the environmental axis indirectly amplifies other health and social justice impacts separately from the direct impacts on those axes. We conclude there is significant work still to be done to use cumulative indicators to study the impacts of extractive industry projects—like liquefied natural gas—on peoples, environments, and health. PMID:27763548

  20. Cumulative Risk Exposure and Mental Health Symptoms among Maltreated Youth Placed in Out-of-Home Care

    ERIC Educational Resources Information Center

    Raviv, Tali; Taussig, Heather N.; Culhane, Sara E.; Garrido, Edward F.

    2010-01-01

    Objective: Maltreated children placed in out-of-home care are at high risk for exhibiting symptoms of psychopathology by virtue of their exposure to numerous risk factors. Research examining cumulative risk has consistently found that the accumulation of risk factors increases the likelihood of mental health problems. The goal of the current study…

  1. Cumulative Risk Exposure and Mental Health Symptoms among Maltreated Youth Placed in Out-of-Home Care

    ERIC Educational Resources Information Center

    Raviv, Tali; Taussig, Heather N.; Culhane, Sara E.; Garrido, Edward F.

    2010-01-01

    Objective: Maltreated children placed in out-of-home care are at high risk for exhibiting symptoms of psychopathology by virtue of their exposure to numerous risk factors. Research examining cumulative risk has consistently found that the accumulation of risk factors increases the likelihood of mental health problems. The goal of the current study…

  2. Combat stress reactions, posttraumatic stress disorder, cumulative life stress, and physical health among Israeli veterans twenty years after exposure to combat.

    PubMed

    Benyamini, Yael; Solomon, Zahava

    2005-09-01

    This study examined the association of initial combat stress reaction (CSR), chronic post-traumatic stress disorder (PTSD) and cumulative life stress on physical health 20 years after the 1982 war with Lebanon, in a sample of 504 Israeli veterans of the war. Two groups were assessed: male veterans who fought and suffered from CSR and a matched group of male veterans from the same units who did not exhibit such reactions. Twenty years following the war, participants were asked to rate their general physical health status, report health complaints and risk behaviors, and were screened for PTSD. CSR and, to a greater extent, PTSD, were found to be associated with general self-rated health, chronic diseases and physical symptoms, and greater engagement in risk behaviors. CSR and PTSD were also related to greater cumulative life stress since the war. Both negative and positive life events were independently related to most of the physical health measures but did not account for the associations of CSR and PTSD with poorer health. Tests of the interactions between CSR, PTSD and life stress in their association with physical health and risk behaviors showed that PTSD suppressed the effects of additional life stress (negative life events had a weaker effect on health among participants with PTSD).

  3. PHYSIOLOGICALLY-BASED PHARMACOKINETICS/PHARMACODYNAMIC MODELING AND CUMULATIVE RISK ASSESSMENT: CASE STUDY FOR THE N-METHYL CARBMATE PESTICIDES

    EPA Science Inventory

    The Food Quality Protection Act of 1996 [PL 104-170: 110 STAT. 1513] requires EPA to consider potential cumulative human health risks resulting from aggregate exposure to pesticide chemicals acting through a common mechanism of toxicity. This includes all anticipated dietary e...

  4. PHYSIOLOGICALLY-BASED PHARMACOKINETICS/PHARMACODYNAMIC MODELING AND CUMULATIVE RISK ASSESSMENT: CASE STUDY FOR THE N-METHYL CARBMATE PESTICIDES

    EPA Science Inventory

    The Food Quality Protection Act of 1996 [PL 104-170: 110 STAT. 1513] requires EPA to consider potential cumulative human health risks resulting from aggregate exposure to pesticide chemicals acting through a common mechanism of toxicity. This includes all anticipated dietary e...

  5. An approach for assessing cumulative effects in a model river, the Athabasca River basin.

    PubMed

    Squires, Allison J; Westbrook, Cherie J; Dubé, Monique G

    2010-01-01

    Novel approaches addressing aquatic cumulative effects over broad temporal and spatial scales are required to track changes and assist with sustainable watershed management. Cumulative effects assessment (CEA) requires the assessment of changes due to multiple stressors both spatially and temporally. The province of Alberta, Canada, is currently experiencing significant economic growth as well as increasing awareness of water dependencies. There has been an increasing level of industrial, urban, and other land-use related development (pulp and paper mills, oil sands developments, agriculture, and urban development) within the Athabasca River basin. Much of the historical water quantity and quality data for this basin have not been integrated or analyzed from headwaters to mouth, which affects development of a holistic, watershed-scale CEA. The main objectives of this study were 1) to quantify spatial and temporal changes in water quantity and quality over the entire Athabasca River mainstem across historical (1966–1976) and current day (1996–2006) time periods and 2) to evaluate the significance of any changes relative to existing benchmarks (e.g., water quality guidelines). Data were collected from several federal, provincial, and nongovernment sources. A 14% to 30% decrease in discharge was observed during the low flow period in the second time period in the lower 3 river reaches with the greatest decrease occurring at the mouth of the river. Dissolved Na, sulfate, chloride, and total P concentrations in the second time period were greater than, and in some cases double, the 90th percentiles calculated from the first time period in the lower part of the river. Our results show that significant changes have occurred in both water quantity and quality between the historical and current day Athabasca River basin. It is known that, in addition to climatic changes, rivers which undergo increased agricultural, urban, and industrial development can experience

  6. Methodologies for Assessing the Cumulative Environmental Effects of Hydroelectric Development of Fish and Wildlife in the Columbia River Basin, Volume 1, Recommendations, 1987 Final Report.

    SciTech Connect

    Stull, Elizabeth Ann

    1987-07-01

    This volume is the first of a two-part set addressing methods for assessing the cumulative effects of hydropower development on fish and wildlife in the Columbia River Basin. Species and habitats potentially affected by cumulative impacts are identified for the basin, and the most significant effects of hydropower development are presented. Then, current methods for measuring and assessing single-project effects are reviewed, followed by a review of methodologies with potential for use in assessing the cumulative effects associated with multiple projects. Finally, two new approaches for cumulative effects assessment are discussed in detail. Overall, this report identifies and reviews the concepts, factors, and methods necessary for understanding and conducting a cumulative effects assessment in the Columbia River Basin. Volume 2 will present a detailed procedural handbook for performing a cumulative assessment using the integrated tabular methodology introduced in this volume. 308 refs., 18 figs., 10 tabs.

  7. Utilizing geographic information systems technology in the Wyoming cumulative hydrologic impact assessment modeling process

    SciTech Connect

    Hamerlinck, J.D.; Oakleaf, J.R.

    1997-12-31

    The coal-permitting process places heavy demands on both permit applicants and regulatory authorities with respect to the management and analysis of hydrologic data. Currently, this correlation is being addressed for the Powder River Basin, Wyoming by the ongoing Cumulative Hydrologic Impact Assessment (CHIA) efforts at the University of Wyoming. One critical component of the CHIA is the use of a Geographic Information System (GIS) for support, management, manipulation, pre-analysis, and display of data associated with the chosen groundwater and surface water models. This paper will discuss the methodology in using of GIS technology as an integrated tool with the MODFLOW and HEC-1 hydrologic models. Pre-existing GIS links associated with these two models served as a foundation for this effort. However, due to established standards and site specific factors, substantial modifications were performed on existing tools to obtain adequate results. The groundwater-modeling effort required the use of a refined grid in which cell sizes varied based on the relative locations of ongoing mining activities. Surface water modeling was performed in a semi-arid region with very limited topographic relief and predominantly ephemeral stream channels. These were substantial issues that presented challenges for effective GIS/model integration.

  8. Probability, conditional probability and complementary cumulative distribution functions in performance assessment for radioactive waste disposal

    SciTech Connect

    Helton, J.C.

    1996-03-01

    A formal description of the structure of several recent performance assessments (PAs) for the Waste Isolation Pilot Plant (WIPP) is given in terms of the following three components: a probability space (S{sub st}, S{sub st}, p{sub st}) for stochastic uncertainty, a probability space (S{sub su}, S{sub su}, p{sub su}) for subjective uncertainty and a function (i.e., a random variable) defined on the product space associated with (S{sub st}, S{sub st}, p{sub st}) and (S{sub su}, S{sub su}, p{sub su}). The explicit recognition of the existence of these three components allows a careful description of the use of probability, conditional probability and complementary cumulative distribution functions within the WIPP PA. This usage is illustrated in the context of the U.S. Environmental Protection Agency`s standard for the geologic disposal of radioactive waste (40 CFR 191, Subpart B). The paradigm described in this presentation can also be used to impose a logically consistent structure on PAs for other complex systems.

  9. A conceptual framework for assessing cumulative impacts on the hydrology of nontidal wetlands

    USGS Publications Warehouse

    Winter, T.C.

    1988-01-01

    Wetlands occur in geologic and hydrologic settings that enhance the accumulation or retention of water. Regional slope, local relief, and permeability of the land surface are major controls on the formation of wetlands by surface-water sources. However, these landscape features also have significant control over groundwater flow systems, which commonly play a role in the formation of wetlands. Because the hydrologic system is a continuum, any modification of one component will have an effect on contiguous components. Disturbances commonly affecting the hydrologic system as it relates to wetlands include weather modification, alteration of plant communities, storage of surface water, road construction, drainage of surface water and soil water, alteration of groundwater recharge and discharge areas, and pumping of groundwater. Assessments of the cumulative effects of one or more of these disturbances on the hydrologic system as related to wetlands must take into account uncertainty in the measurements and in the assumptions that are made in hydrologic studies. For example, it may be appropriate to assume that regional groundwater flow systems are recharged in uplands and discharged in lowlands. However, a similar assumption commonly does not apply on a local scale, because of the spatial and temporal dynamics of groundwater recharge. Lack of appreciation of such hydrologic factors can lead to misunderstanding of the hydrologic function of wetlands within various parts of the landscape and mismanagement of wetland ecosystems. ?? 1988 Springer-Verlag New York Inc.

  10. Individual assessment of antihypertensive response by self-starting cumulative sums.

    PubMed

    Cornélissen, G; Halberg, F; Hawkins, D; Otsuka, K; Henke, W

    1997-01-01

    A self-interpreted control chart, on an individualized basis, assesses the effect of a switch from beta-blockers to an angiotensin-converting enzyme (ACE)-inhibitor in a patient with occasional blood pressure (BP) excess. In dense and long data series, the BP and heart rate (HR) of this patient respond to the change in treatment by the test criterion of a self-starting Cumulative Sum (cusum), which reaches values outside a decision interval with a lowering of BP and an increase in HR and vice versa, at least for BP, after treatment cessation. Thereafter, minimal sampling requirements are sought in the same data by applying the same control chart approach to decimated data. Skeleton sampling schemes in a system of chronobiologic self-analysis and interpretation of manually recorded data obtained at strategically placed times (established on the basis of data decimations) could complement control charts that are used on a home computer or preferably would be built into the output of ambulatory monitors used at the outset as a minimum and routinely as an optimum.

  11. Considerations for Developing a Dosimetry-Based Cumulative Risk Assessment Approach for Mixtures of Environmental Contaminants (Final Report)

    EPA Science Inventory

    EPA announced the availability of the final report, Considerations for Developing a Dosimetry-Based Cumulative Risk Assessment Approach for Mixtures of Environmental Contaminants. This report describes a process that can be used to determine the potential value of develop...

  12. Considerations for Developing a Dosimetry-Based Cumulative Risk Assessment Approach for Mixtures of Environmental Contaminants (Final Report)

    EPA Science Inventory

    EPA announced the availability of the final report, Considerations for Developing a Dosimetry-Based Cumulative Risk Assessment Approach for Mixtures of Environmental Contaminants. This report describes a process that can be used to determine the potential value of develop...

  13. Benchmark Dose Analysis from Multiple Datasets: The Cumulative Risk Assessment for the N-Methyl Carbamate Pesticides

    EPA Science Inventory

    The US EPA’s N-Methyl Carbamate (NMC) Cumulative Risk assessment was based on the effect on acetylcholine esterase (AChE) activity of exposure to 10 NMC pesticides through dietary, drinking water, and residential exposures, assuming the effects of joint exposure to NMCs is dose-...

  14. How cumulative risks warrant a shift in our approach to racial health disparities: the case of lead, stress, and hypertension.

    PubMed

    Hicken, Margaret; Gragg, Richard; Hu, Howard

    2011-10-01

    Blacks have persistently higher rates of high blood pressure, or hypertension, compared to whites, resulting in higher health costs and mortality rates. Recent research has shown that social and environmental factors-such as high levels of stress and exposure to lead-may explain racial disparities in hypertension. Based on these findings, we recommend a fundamental shift in approaches to health disparities to focus on these sorts of cumulative risks and health effects. Federal and state agencies and research institutions should develop strategic plans to learn more about these connections and apply the broader findings to policies to reduce health disparities.

  15. VULNERABILITY AS A FUNCTION OF INDIVIDUAL AND GROUP RESOURCES IN CUMULATIVE RISK ASSESSMENT

    EPA Science Inventory

    Background: The field of risk assessment has focused on protecting the health of individual people or populations of wildlife from single risks, mostly from chemical exposure. The U.S. Environmental Protection Agency recently began to address multiple risks to communities in the ...

  16. VULNERABILITY AS A FUNCTION OF INDIVIDUAL AND GROUP RESOURCES IN CUMULATIVE RISK ASSESSMENT

    EPA Science Inventory

    Background: The field of risk assessment has focused on protecting the health of individual people or populations of wildlife from single risks, mostly from chemical exposure. The U.S. Environmental Protection Agency recently began to address multiple risks to communities in the ...

  17. The effect of camera viewing angle on posture assessment repeatability and cumulative spinal loading.

    PubMed

    Sutherland, C A; Albert, W J; Wrigley, A T; Callaghan, J P

    2007-06-01

    Video-based task analysis in the workplace is often limited by equipment location and production line arrangement, therefore making it difficult to capture the motion in a single plane. The purpose of this study was to investigate the effects of camera placement on an observer's ability to accurately assess working postures in three dimensions and the resultant influence on the reliability and repeatability of calculated cumulative loading variables. Four video cameras were placed at viewing angles of 0 degrees, 45 degrees, 60 degrees and 90 degrees to the frontal plane, enabling the simultaneous collection of views of four lifting tasks (two symmetric and two asymmetric). A total of 11 participants were trained in the use of the 3DMatch 3-D posture matching software package (developed at the University of Waterloo) and were required to analyse 16 lifting trials. Four of the participants were randomly selected to return within 72 h and repeat the analysis protocol to test intra-observer repeatability. Posture matching agreement between camera views was higher when the body segments had a minimal range of motion during the task. There was no significant participant main effect; however, there was a significant (p < 0.05) task main effect. Intraclass correlation coefficients (ICC) were calculated to assess the between day reliability. Compression, reaction anterior shear and extension moment were all found to have excellent reliability (ICC > 0.75). Joint anterior shear and joint posterior shear both provided fair to good reliability (0.4 > ICC < 0.75). Overall, the impact of the camera viewing angle on an observer's ability to match working postural exposure was found to be small.

  18. Metals in residential soils and cumulative risk assessment in Yaqui and Mayo agricultural valleys, northern Mexico.

    PubMed

    Meza-Montenegro, Maria M; Gandolfi, A Jay; Santana-Alcántar, María Ernestina; Klimecki, Walter T; Aguilar-Apodaca, María Guadalupe; Del Río-Salas, Rafael; De la O-Villanueva, Margarita; Gómez-Alvarez, Agustín; Mendivil-Quijada, Héctor; Valencia, Martín; Meza-Figueroa, Diana

    2012-09-01

    This investigation examines the extent of soil metal pollution associated with the Green Revolution, relative to agricultural activities and associated risks to health in the most important agricultural region of Mexico. Metal contents in bulk soil samples are commonly used to assess contamination, and metal accumulations in soils are usually assumed to increase with decreasing particle size. This study profiled the spatial distribution of metals (Ni, Cr, Pb, Cu, Fe, Cd, V, Hg, Co, P, Se, and Mn) in bulk soil and fine-grained fractions (soil-derived dust) from 22 towns and cities. The contamination of soil was assessed through the use of a geoaccumulation index (Igeo) and pollution index (PI). The results of this study indicated that a number of towns and cities are moderately to highly polluted by soil containing Be, Co, Hg, P, S, V, Zn, Se, Cr, and Pb in both size fractions (coarse and fine). Hazard index in fine fraction (HI(children)=2.1) shows that risk assessment based on Co, Mn, V, and Ni spatially related to power plants, have the potential to pose health risks to local residents, especially children. This study shows that risk assessment based on metal content in bulk soil could be overestimated when compared to fine-grained fraction. Our results provide important information that could be valuable in establishing risk assessment associated with residential soils within agricultural areas, where children can ingest and inhale dust. Copyright © 2012 Elsevier B.V. All rights reserved.

  19. An Assessment of Cumulative Axial and Torsional Fatigue in a Cobalt-Base Superalloy

    NASA Technical Reports Server (NTRS)

    Kalluri, Sreeramesh; Bonacuse, Peter J.

    2010-01-01

    Cumulative fatigue under axial and torsional loading conditions can include both load-order (higMow and low/high) as well as load-type sequence (axial/torsional and torsional/axial) effects. Previously reported experimental studies on a cobalt-base superalloy, Haynes 188 at 538 C, addressed these effects. These studies characterized the cumulative axial and torsional fatigue behavior under high amplitude followed by low amplitude (Kalluri, S. and Bonacuse, P. J., "Cumulative Axial and Torsional Fatigue: An Investigation of Load-Type Sequance Effects," in Multiaxial Fatigue and Deformation: Testing and Prediction, ASTM STP 1387, S. Kalluri, and P. J. Bonacuse, Eds., American Society for Testing and Materials, West Conshohocken, PA, 2000, pp. 281-301) and low amplitude followed by high amplitude (Bonacuse, P. and Kalluri, S. "Sequenced Axial and Torsional Cumulative Fatigue: Low Amplitude Followed by High Amplitude Loading," Biaxial/Multiaxial Fatigue and Fracture, ESIS Publication 31, A. Carpinteri, M. De Freitas, and A. Spagnoli, Eds., Elsevier, New York, 2003, pp. 165-182) conditions. In both studies, experiments with the following four load-type sequences were performed: (a) axial/axial, (b) torsional/torsional, (c) axial/torsional, and (d) torsional/axial. In this paper, the cumulative axial and torsional fatigue data generated in the two previous studies are combined to generate a comprehensive cumulative fatigue database on both the load-order and load-type sequence effects. This comprehensive database is used to examine applicability of the Palmgren-langer-Miner linear damage rule and a nonlinear damage curve approach for Haynes 188 subjected to the load-order and load-type sequencing described above. Summations of life fractions from the experiments are compared to the predictions from both the linear and nonlinear cumulative fatigue damage approaches. The significance of load-order versus load-type sequence effects for axial and torsional loading conditions

  20. An Assessment of Cumulative Axial and Torsional Fatigue in a Cobalt-Base Superalloy

    NASA Technical Reports Server (NTRS)

    Kalluri, Sreeramesh; Bonacuse, Peter J.

    2010-01-01

    Cumulative fatigue under axial and torsional loading conditions can include both load-order (higMow and low/high) as well as load-type sequence (axial/torsional and torsional/axial) effects. Previously reported experimental studies on a cobalt-base superalloy, Haynes 188 at 538 C, addressed these effects. These studies characterized the cumulative axial and torsional fatigue behavior under high amplitude followed by low amplitude (Kalluri, S. and Bonacuse, P. J., "Cumulative Axial and Torsional Fatigue: An Investigation of Load-Type Sequance Effects," in Multiaxial Fatigue and Deformation: Testing and Prediction, ASTM STP 1387, S. Kalluri, and P. J. Bonacuse, Eds., American Society for Testing and Materials, West Conshohocken, PA, 2000, pp. 281-301) and low amplitude followed by high amplitude (Bonacuse, P. and Kalluri, S. "Sequenced Axial and Torsional Cumulative Fatigue: Low Amplitude Followed by High Amplitude Loading," Biaxial/Multiaxial Fatigue and Fracture, ESIS Publication 31, A. Carpinteri, M. De Freitas, and A. Spagnoli, Eds., Elsevier, New York, 2003, pp. 165-182) conditions. In both studies, experiments with the following four load-type sequences were performed: (a) axial/axial, (b) torsional/torsional, (c) axial/torsional, and (d) torsional/axial. In this paper, the cumulative axial and torsional fatigue data generated in the two previous studies are combined to generate a comprehensive cumulative fatigue database on both the load-order and load-type sequence effects. This comprehensive database is used to examine applicability of the Palmgren-langer-Miner linear damage rule and a nonlinear damage curve approach for Haynes 188 subjected to the load-order and load-type sequencing described above. Summations of life fractions from the experiments are compared to the predictions from both the linear and nonlinear cumulative fatigue damage approaches. The significance of load-order versus load-type sequence effects for axial and torsional loading conditions

  1. Strategic environmental assessment of mining activities: A methodology for quantification of cumulative impacts on the air quality.

    PubMed

    Cavalcanti, Paulina Maria Porto Silva; La Rovere, Emilio Lèbre

    2011-04-01

    Environmental impact assessments in Brazil have usually focused solely on project-related issues without considering the regional context. Although required by current environmental legislation, cumulative impact assessments have not been included in the overall environmental assessment of projects. However, in recent Strategic Environmental Assessment (SEA) studies of policies, plans, and programs undertaken on a voluntary basis in support of the decision-making process, this kind of assessment has been performed especially with respect to air quality. This paper presents the application of a methodology for the quantification of cumulative impacts on air quality under high uncertainty caused by various mining activities in a single region that is recommended for SEA studies. In this way, the methodology presented here is suitable for areas lacking detailed modeling information. The developed approach uses a relatively simplified mathematical model, lowering information gathering costs and requiring little processing time. The application of the methodology is illustrated in the case of a SEA of the Corumbá Mining and Industrial Complex Development Program. Despite the lack of data needed for a minimum characterization of conditions of the area surrounding the region modeled, the quantification of impact cumulativeness on air quality has played an important role in the context of the SEA.

  2. Health-related quality of life in portuguese SLE patients: an outcome measure independent of disease activity and cumulative damage.

    PubMed

    Duarte, Cátia; Abreu, Pedro; Couto, Maura; Vaz, Cláudia; Malcata, Armando; Inês, Luís

    2010-01-01

    To evaluate quality of life in Portuguese patients with Systemic Lupus Erithematosus (SLE) and its correlation with disease activity and cumulative damage. We included consecutive SLE patients, fulfilling the 1997 ACR Classification Criteria for SLE and followed at the Rheumatology Department of the University Hospital of Coimbra, Portugal at time of visit to the outpatient clinic. Quality of life was evaluated using the patient self-assessment questionnaire Medical Outcomes Survey Short Form-36 (SF-36) (validated Portuguese version). The consulting rheumatologist fulfilled the SLE associated indexes for cumulative damage (Systemic Lupus International Collaborating Clinics- Damage Index: SLICC/ACR-DI) and disease activity (Systemic Lupus Erythematosus Disease Activity Index: SLEDAI 2000). Correlation between SLEDAI and SLICC and SF-36 was tested with the Spearman Coefficient. Significant level considered was 0.05. The study included 133 SLE patients (90.2% female, mean age - 40.7 years, mean disease duration - 8.7 years). Most patients presented low disease activity (mean SLEDAI = 4.23) and limited cumulative damage (mean SLICC = 0.76). Despite that, SF-36 mean scores were below 70% in all eight domains of the index. Physical function domains showed lower scores than mental function domains. The QoL in this group of patients is significantly impaired when compared with the reference Portuguese population (p<0.05 in all domains). There was no correlation between clinical activity or cumulative damage and quality of life. QoL is significantly compromised in this group of SLE patients, but not related with disease activity or damage. These findings suggest that disease activity, cumulative damage and QoL are independent outcome measures and should all be used to assess the full impact of disease in SLE patients.

  3. Onboard System Health Assessment

    NASA Technical Reports Server (NTRS)

    Barry, Tom; Cunningham, Harry

    1990-01-01

    Viewgraphs and discussion of onboard system health assessment are presented. Success of the space station program will be measured by how well it addresses the basic requirements for (1) maintaining the orbiting Space Station Freedom fully operational for its projected life of thirty years, and (2) the cost-effective execution of the overall space station program. Onboard system health assessment must provide complete and thorough testing capabilities along with effective associated redundancy/fault management.

  4. Contested Cumulations:

    PubMed Central

    Pickstone, John V.

    2007-01-01

    Summary The treatment of cancer through the twentieth century may be seen as the successive addition of modalities: first surgery; then radiotherapy, especially between the world wars; and then chemotherapy, from the 1960s. This paper explores some of the systematic differences between the modalities, and how these additions were negotiated in different countries, with different long-term consequences for the development of services and specialization. It focuses chiefly on the United Kingdom and the United States, the former exemplifying a centralized health polity, and the latter, liberal markets combined with large and crucial postwar inputs from government. The differences between health polities were especially important for interwar radiotherapy, which in its centralized form appeared as paradigmatic of the analytical/rationalizing mode in modern medicine. Chemotherapy exemplified a more inventive and experimentalist mode that became common after World War II, and that, through the practice of trials, shaped the new subprofession of medical oncology. The interactions of the modalities, at various levels, are modeled as contested cumulations showing strong path dependency. The paper ends by reviewing the present situation, especially for Britain, and by underlining the relevance of history. PMID:17369667

  5. The Comprehensive Health Assessment.

    ERIC Educational Resources Information Center

    Eastern Iowa Community Coll. District, Davenport.

    This report contains information from a fall 1991 health occupations assessment of 1,021 health-related employers in Eastern Iowa and the Illinois Quad Cities area. Twelve chapters present comprehensive results of all surveys; results of 10 labor market survey instruments developed for chiropractic offices, dentists' offices, emergency medical…

  6. An integrated probabilistic framework for cumulative risk assessment of common mechanism chemicals in food: an example with organophosphorus pesticides.

    PubMed

    Bosgra, Sieto; van der Voet, Hilko; Boon, Polly E; Slob, Wout

    2009-07-01

    This paper presents a framework for integrated probabilistic risk assessment of chemicals in the diet which accounts for the possibility of cumulative exposure to chemicals with a common mechanism of action. Variability between individuals in the population with respect to food consumption, concentrations of chemicals in the consumed foods, food processing habits and sensitivity towards the chemicals is addressed by Monte Carlo simulations. A large number of individuals are simulated, for which the individual exposure (iEXP), the individual critical effect dose (iCED) and the ratio between these values (the individual margin of exposure, iMoE) are calculated by drawing random values for all variable parameters from databases or specified distributions. This results in a population distribution of the iMoE, and the fraction of this distribution below 1 indicates the fraction of the population that may be at risk. Uncertainty in the assessment is treated as a separate dimension by repeating the Monte Carlo simulations many times, each time drawing random values for all uncertain parameters. In this framework, the cumulative exposure to common mechanism chemicals is addressed by incorporation of the relative potency factor (RPF) approach. The framework is demonstrated by the cumulative risk assessment of organophosphorus pesticides (OPs). By going through this example, the various choices and assumptions underlying the cumulative risk assessment are made explicit. The problems faced and the solutions chosen may be more generic than the present example with OPs. This demonstration may help to familiarize risk assessors and risk managers with the somewhat more complex output of probabilistic risk assessment.

  7. Playing It Safe: Assessing Cumulative Impact and Social Vulnerability through an Environmental Justice Screening Method in the South Coast Air Basin, California

    PubMed Central

    Sadd, James L.; Pastor, Manuel; Morello-Frosch, Rachel; Scoggins, Justin; Jesdale, Bill

    2011-01-01

    Regulatory agencies, including the U.S. Environmental Protection Agency (US EPA) and state authorities like the California Air Resources Board (CARB), have sought to address the concerns of environmental justice (EJ) advocates who argue that chemical-by-chemical and source-specific assessments of potential health risks of environmental hazards do not reflect the multiple environmental and social stressors faced by vulnerable communities. We propose an Environmental Justice Screening Method (EJSM) as a relatively simple, flexible and transparent way to examine the relative rank of cumulative impacts and social vulnerability within metropolitan regions and determine environmental justice areas based on more than simply the demographics of income and race. We specifically organize 23 indicator metrics into three categories: (1) hazard proximity and land use; (2) air pollution exposure and estimated health risk; and (3) social and health vulnerability. For hazard proximity, the EJSM uses GIS analysis to create a base map by intersecting land use data with census block polygons, and calculates hazard proximity measures based on locations within various buffer distances. These proximity metrics are then summarized to the census tract level where they are combined with tract centroid-based estimates of pollution exposure and health risk and socio-economic status (SES) measures. The result is a cumulative impacts (CI) score for ranking neighborhoods within regions that can inform diverse stakeholders seeking to identify local areas that might need targeted regulatory strategies to address environmental justice concerns. PMID:21655129

  8. Playing it safe: assessing cumulative impact and social vulnerability through an environmental justice screening method in the South Coast Air Basin, California.

    PubMed

    Sadd, James L; Pastor, Manuel; Morello-Frosch, Rachel; Scoggins, Justin; Jesdale, Bill

    2011-05-01

    Regulatory agencies, including the U.S. Environmental Protection Agency (US EPA) and state authorities like the California Air Resources Board (CARB), have sought to address the concerns of environmental justice (EJ) advocates who argue that chemical-by-chemical and source-specific assessments of potential health risks of environmental hazards do not reflect the multiple environmental and social stressors faced by vulnerable communities. We propose an Environmental Justice Screening Method (EJSM) as a relatively simple, flexible and transparent way to examine the relative rank of cumulative impacts and social vulnerability within metropolitan regions and determine environmental justice areas based on more than simply the demographics of income and race. We specifically organize 23 indicator metrics into three categories: (1) hazard proximity and land use; (2) air pollution exposure and estimated health risk; and (3) social and health vulnerability. For hazard proximity, the EJSM uses GIS analysis to create a base map by intersecting land use data with census block polygons, and calculates hazard proximity measures based on locations within various buffer distances. These proximity metrics are then summarized to the census tract level where they are combined with tract centroid-based estimates of pollution exposure and health risk and socio-economic status (SES) measures. The result is a cumulative impacts (CI) score for ranking neighborhoods within regions that can inform diverse stakeholders seeking to identify local areas that might need targeted regulatory strategies to address environmental justice concerns.

  9. Application of higher order cumulant features for cardiac health diagnosis using ECG signals.

    PubMed

    Martis, Roshan Joy; Acharya, U Rajendra; Lim, Choo Min; Mandana, K M; Ray, A K; Chakraborty, Chandan

    2013-08-01

    Electrocardiogram (ECG) is the electrical activity of the heart indicated by P, Q-R-S and T wave. The minute changes in the amplitude and duration of ECG depicts a particular type of cardiac abnormality. It is very difficult to decipher the hidden information present in this nonlinear and nonstationary signal. An automatic diagnostic system that characterizes cardiac activities in ECG signals would provide more insight into these phenomena thereby revealing important clinical information. Various methods have been proposed to detect cardiac abnormalities in ECG recordings. Application of higher order spectra (HOS) features is a seemingly promising approach because it can capture the nonlinear and dynamic nature of the ECG signals. In this paper, we have automatically classified five types of beats using HOS features (higher order cumulants) using two different approaches. The five types of ECG beats are normal (N), right bundle branch block (RBBB), left bundle branch block (LBBB), atrial premature contraction (APC) and ventricular premature contraction (VPC). In the first approach, cumulant features of segmented ECG signal were used for classification; whereas in the second approach cumulants of discrete wavelet transform (DWT) coefficients were used as features for classifiers. In both approaches, the cumulant features were subjected to data reduction using principal component analysis (PCA) and classified using three layer feed-forward neural network (NN) and least square-support vector machine (LS-SVM) classifiers. In this study, we obtained the highest average accuracy of 94.52%, sensitivity of 98.61% and specificity of 98.41% using first approach with NN classifier. The developed system is ready clinically to run on large datasets.

  10. Assessing the cumulative effects of exposure to selected benzodiazepines on the risk of fall-related injuries in the elderly.

    PubMed

    Sylvestre, Marie-Pierre; Abrahamowicz, Michal; Čapek, Radan; Tamblyn, Robyn

    2012-04-01

    The use of benzodiazepines is associated with increased risk of fall-related injuries in the elderly. However, it is unclear if the risks vary across the products and how they depend on the pattern of use and dosage. Specifically, the possibility of cumulative effects of past benzodiazepine use has not been thoroughly investigated. We used the administrative database for a cohort of 23,765 new users of benzodiazepines, aged 65 years and older, in Quebec, Canada, between 1990 and 1994. The associations between the use of seven benzodiazepines and the risk of fall-related injuries were assessed using several statistical models, including a novel weighted cumulative exposure model. That model assigns to each dose taken in the past a weight that represents the importance of that dose in explaining the current risk of fall. For flurazepam, the best-fitting model indicated a cumulative effect of doses taken in the last two weeks. Uninterrupted use of flurazepam in the past months was associated with a highly significant increase in the risk of fall-related injuries (HR = 2.83, 95% CI: 1.45-4.34). The cumulative effect of a 30-day exposure to alprazolam was 1.27 (1.13-1.42). For temazepam, the results suggested a potential withdrawal effect. Mechanisms affecting the risk of falls differ across benzodiazepines, and may include cumulative effects of use in the previous few weeks. Thus, benzodiazepine-specific analyses that account for individual patterns of use should be preferred over simpler analyses that group different benzodiazepines together and limit exposure to current use or current dose.

  11. Assessing the implications of human land-use change for the transient climate response to cumulative carbon emissions

    NASA Astrophysics Data System (ADS)

    Simmons, C. T.; Matthews, H. D.

    2016-03-01

    Recent research has shown evidence of a linear climate response to cumulative CO2 emissions, which implies that the source, timing, and amount of emissions does not significantly influence the climate response per unit emission. Furthermore, these analyses have generally assumed that the climate response to land-use CO2 emissions is equivalent to that of fossil fuels under the assumption that, once in the atmosphere, the radiative forcing induced by CO2 is not sensitive to the emissions source. However, land-cover change also affects surface albedo and the strength of terrestrial carbon sinks, both of which have an additional climate effect. In this study, we use a coupled climate-carbon cycle model to assess the climate response to historical and future cumulative land-use CO2 emissions, in order to compare it to the response to fossil fuel CO2. We find that when we isolate the CO2-induced (biogeochemical) temperature changes associated with land-use change, then the climate response to cumulative land-use emissions is equivalent to that of fossil fuel CO2. We show further that the globally-averaged albedo-induced biophysical cooling from land-use change is non-negligible and may be of comparable magnitude to the biogeochemical warming, with the result that the net climate response to land-use change is substantially different from a linear response to cumulative emissions. However, our new simulations suggest that the biophysical cooling from land-use change follows its own independent (negative) linear response to cumulative net land-use CO2 emissions, which may provide a useful scaling factor for certain applications when evaluating the full transient climate response to emissions.

  12. Cumulative human impacts on Mediterranean and Black Sea marine ecosystems: assessing current pressures and opportunities.

    PubMed

    Micheli, Fiorenza; Halpern, Benjamin S; Walbridge, Shaun; Ciriaco, Saul; Ferretti, Francesco; Fraschetti, Simonetta; Lewison, Rebecca; Nykjaer, Leo; Rosenberg, Andrew A

    2013-01-01

    Management of marine ecosystems requires spatial information on current impacts. In several marine regions, including the Mediterranean and Black Sea, legal mandates and agreements to implement ecosystem-based management and spatial plans provide new opportunities to balance uses and protection of marine ecosystems. Analyses of the intensity and distribution of cumulative impacts of human activities directly connected to the ecological goals of these policy efforts are critically needed. Quantification and mapping of the cumulative impact of 22 drivers to 17 marine ecosystems reveals that 20% of the entire basin and 60-99% of the territorial waters of EU member states are heavily impacted, with high human impact occurring in all ecoregions and territorial waters. Less than 1% of these regions are relatively unaffected. This high impact results from multiple drivers, rather than one individual use or stressor, with climatic drivers (increasing temperature and UV, and acidification), demersal fishing, ship traffic, and, in coastal areas, pollution from land accounting for a majority of cumulative impacts. These results show that coordinated management of key areas and activities could significantly improve the condition of these marine ecosystems.

  13. Cumulative Human Impacts on Mediterranean and Black Sea Marine Ecosystems: Assessing Current Pressures and Opportunities

    PubMed Central

    Micheli, Fiorenza; Halpern, Benjamin S.; Walbridge, Shaun; Ciriaco, Saul; Ferretti, Francesco; Fraschetti, Simonetta; Lewison, Rebecca; Nykjaer, Leo; Rosenberg, Andrew A.

    2013-01-01

    Management of marine ecosystems requires spatial information on current impacts. In several marine regions, including the Mediterranean and Black Sea, legal mandates and agreements to implement ecosystem-based management and spatial plans provide new opportunities to balance uses and protection of marine ecosystems. Analyses of the intensity and distribution of cumulative impacts of human activities directly connected to the ecological goals of these policy efforts are critically needed. Quantification and mapping of the cumulative impact of 22 drivers to 17 marine ecosystems reveals that 20% of the entire basin and 60–99% of the territorial waters of EU member states are heavily impacted, with high human impact occurring in all ecoregions and territorial waters. Less than 1% of these regions are relatively unaffected. This high impact results from multiple drivers, rather than one individual use or stressor, with climatic drivers (increasing temperature and UV, and acidification), demersal fishing, ship traffic, and, in coastal areas, pollution from land accounting for a majority of cumulative impacts. These results show that coordinated management of key areas and activities could significantly improve the condition of these marine ecosystems. PMID:24324585

  14. Cumulative traumas and risk thresholds: 12-month PTSD in the World Mental Health (WMH) surveys.

    PubMed

    Karam, Elie G; Friedman, Matthew J; Hill, Eric D; Kessler, Ronald C; McLaughlin, Katie A; Petukhova, Maria; Sampson, Laura; Shahly, Victoria; Angermeyer, Matthias C; Bromet, Evelyn J; de Girolamo, Giovanni; de Graaf, Ron; Demyttenaere, Koen; Ferry, Finola; Florescu, Silvia E; Haro, Josep Maria; He, Yanling; Karam, Aimee N; Kawakami, Norito; Kovess-Masfety, Viviane; Medina-Mora, María Elena; Browne, Mark A Oakley; Posada-Villa, José A; Shalev, Arieh Y; Stein, Dan J; Viana, Maria Carmen; Zarkov, Zahari; Koenen, Karestan C

    2014-02-01

    Clinical research suggests that posttraumatic stress disorder (PTSD) patients exposed to multiple traumatic events (TEs) rather than a single TE have increased morbidity and dysfunction. Although epidemiological surveys in the United States and Europe also document high rates of multiple TE exposure, no population-based cross-national data have examined this issue. Data were analyzed from 20 population surveys in the World Health Organization World Mental Health Survey Initiative (n = 51,295 aged 18+). The Composite International Diagnostic Interview (3.0) assessed 12-month PTSD and other common DSM-IV disorders. Respondents with 12-month PTSD were assessed for single versus multiple TEs implicated in their symptoms. Associations were examined with age of onset (AOO), functional impairment, comorbidity, and PTSD symptom counts. 19.8% of respondents with 12-month PTSD reported that their symptoms were associated with multiple TEs. Cases who associated their PTSD with four or more TEs had greater functional impairment, an earlier AOO, longer duration, higher comorbidity with mood and anxiety disorders, elevated hyperarousal symptoms, higher proportional exposures to partner physical abuse and other types of physical assault, and lower proportional exposure to unexpected death of a loved one than cases with fewer associated TEs. A risk threshold was observed in this large-scale cross-national database wherein cases who associated their PTSD with four or more TEs presented a more "complex" clinical picture with substantially greater functional impairment and greater morbidity than other cases of PTSD. PTSD cases associated with four or more TEs may merit specific and targeted intervention strategies. © 2013 Wiley Periodicals, Inc.

  15. CUMULATIVE TRAUMAS AND RISK THRESHOLDS: 12-MONTH PTSD IN THE WORLD MENTAL HEALTH (WMH) SURVEYS

    PubMed Central

    Karam, Elie G.; Friedman, Matthew J.; Hill, Eric D.; Kessler, Ronald C.; McLaughlin, Katie A.; Petukhova, Maria; Sampson, Laura; Shahly, Victoria; Angermeyer, Matthias C.; Bromet, Evelyn J.; de Girolamo, Giovanni; de Graaf, Ron; Demyttenaere, Koen; Ferry, Finola; Florescu, Silvia E.; Haro, Josep Maria; He, Yanling; Karam, Aimee N.; Kawakami, Norito; Kovess-Masfety, Viviane; Medina-Mora, María Elena; Browne, Mark A. Oakley; Posada-Villa, José A.; Shalev, Arieh Y.; Stein, Dan J.; Viana, Maria Carmen; Zarkov, Zahari; Koenen, Karestan C.

    2014-01-01

    Background Clinical research suggests that posttraumatic stress disorder (PTSD) patients exposed to multiple traumatic events (TEs) rather than a single TE have increased morbidity and dysfunction. Although epidemiological surveys in the United States and Europe also document high rates of multiple TE exposure, no population-based cross-national data have examined this issue. Methods Data were analyzed from 20 population surveys in the World Health Organization World Mental Health Survey Initiative (n 51,295 aged 18+). The Composite International Diagnostic Interview (3.0) assessed 12-month PTSD and other common DSM-IV disorders. Respondents with 12-month PTSD were assessed for single versus multiple TEs implicated in their symptoms. Associations were examined with age of onset (AOO), functional impairment, comorbidity, and PTSD symptom counts. Results 19.8% of respondents with 12-month PTSD reported that their symptoms were associated with multiple TEs. Cases who associated their PTSD with four or more TEs had greater functional impairment, an earlier AOO, longer duration, higher comorbidity with mood and anxiety disorders, elevated hyper-arousal symptoms, higher proportional exposures to partner physical abuse and other types of physical assault, and lower proportional exposure to unexpected death of a loved one than cases with fewer associated TEs. Conclusions A risk threshold was observed in this large-scale cross-national database wherein cases who associated their PTSD with four or more TEs presented a more “complex” clinical picture with substantially greater functional impairment and greater morbidity than other cases of PTSD. PTSD cases associated with four or more TEs may merit specific and targeted intervention strategies. Depression and Anxiety 31:130–142, 2014. PMID:23983056

  16. Health equity impact assessment.

    PubMed

    Povall, Susan L; Haigh, Fiona A; Abrahams, Debbie; Scott-Samuel, Alex

    2014-12-01

    The World Health Organization's Commission on Social Determinants of Health has called for 'health equity impact assessments' of all economic agreements, market regulation and public policies. We carried out an international study to clarify if existing health impact assessment (HIA) methods are adequate for the task of global health equity assessments. We triangulated data from a scoping review of the international literature, in-depth interviews with health equity and HIA experts and an international stakeholder workshop. We found that equity is not addressed adequately in HIAs for a variety of reasons, including inadequate guidance, absence of definitions, poor data and evidence, perceived lack of methods and tools and practitioner unwillingness or inability to address values like fairness and social justice. Current methods can address immediate, 'downstream' factors, but not the root causes of inequity. Extending HIAs to cover macro policy and global equity issues will require new tools to address macroeconomic policies, historical roots of inequities and upstream causes like power imbalances. More sensitive, participatory methods are also required. There is, however, no need for the development of a completely new methodology. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. Ten-year trajectories of stressors and resources at work: Cumulative and chronic effects on health and well-being.

    PubMed

    Igic, Ivana; Keller, Anita C; Elfering, Achim; Tschan, Franziska; Kälin, Wolfgang; Semmer, Norbert K

    2017-09-01

    Employing 5 waves of measurement over a period of 10 years, we explored the effects of exposure to constellations of conditions at work on physical and psychological strain, estimating the history of exposure over time. Specifically, we first tested if the 4 constellations postulated by the job demand-control (JDC) model, extended to include social stressors, could be identified empirically over time through a person-centered analysis. Second, we tested 2 specific effects of the history of exposure on physical and psychological strain: cumulative effects (i.e., history of exposure predicting strain) and chronic effects (i.e., history of exposure being associated with reduced reversibility in strain). Data were collected from 483 respondents who were at the end of their vocational training. The results supported the hypotheses, in that not all JDC constellations could be empirically identified, the majority of participants was in rather favorable constellations, and the differences between constellations, in terms of levels of demands and control, were more subtle than suggested by theoretically predefined constellations. Because the linear and quadratic solutions were largely comparable, we decided to adopt the linear ones. The expected cumulative and chronic effects were mostly confirmed: Unfavorable JDC constellations were associated with poorer health and well-being than favorable ones, when controlling for the initial level of the respective outcome variable, demographic variables, and for cumulative private stressors (cumulative effects). These differences largely remained after further adjustments for current conditions at work (chronic effects). (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  18. [Assessment on the ecological suitability in Zhuhai City, Guangdong, China, based on minimum cumulative resistance model].

    PubMed

    Li, Jian-fei; Li, Lin; Guo, Luo; Du, Shi-hong

    2016-01-01

    Urban landscape has the characteristics of spatial heterogeneity. Because the expansion process of urban constructive or ecological land has different resistance values, the land unit stimulates and promotes the expansion of ecological land with different intensity. To compare the effect of promoting and hindering functions in the same land unit, we firstly compared the minimum cumulative resistance value of promoting and hindering functions, and then looked for the balance of two landscape processes under the same standard. According to the ecology principle of minimum limit factor, taking the minimum cumulative resistance analysis method under two expansion processes as the evaluation method of urban land ecological suitability, this research took Zhuhai City as the study area to estimate urban ecological suitability by relative evaluation method with remote sensing image, field survey, and statistics data. With the support of ArcGIS, five types of indicators on landscape types, ecological value, soil erosion sensitivity, sensitivity of geological disasters, and ecological function were selected as input parameters in the minimum cumulative resistance model to compute urban ecological suitability. The results showed that the ecological suitability of the whole Zhuhai City was divided into five levels: constructive expansion prohibited zone (10.1%), constructive expansion restricted zone (32.9%), key construction zone (36.3%), priority development zone (2.3%), and basic cropland (18.4%). Ecological suitability of the central area of Zhuhai City was divided into four levels: constructive expansion prohibited zone (11.6%), constructive expansion restricted zone (25.6%), key construction zone (52.4%), priority development zone (10.4%). Finally, we put forward the sustainable development framework of Zhuhai City according to the research conclusion. On one hand, the government should strictly control the development of the urban center area. On the other hand, the

  19. Valued ecosystem components for watershed cumulative effects: an analysis of environmental impact assessments in the South Saskatchewan River watershed, Canada.

    PubMed

    Ball, Murray A; Noble, Bram F; Dubé, Monique G

    2013-07-01

    The accumulating effects of human development are threatening water quality and availability. In recognition of the constraints to cumulative effects assessment (CEA) under traditional environmental impact assessment (EIA), there is an emerging body of research dedicated to watershed-based cumulative effects assessment (WCEA). To advance the science of WCEA, however, a standard set of ecosystem components and indicators is required that can be used at the watershed scale, to inform effects-based understanding of cumulative change, and at the project scale, to inform regulatory-based project based impact assessment and mitigation. A major challenge, however, is that it is not clear how such ecosystem components and indicators for WCEA can or should be developed. This study examined the use of aquatic ecosystem components and indicators in EIA practice in the South Saskatchewan River watershed, Canada, to determine whether current practice at the project scale could be "scaled up" to support ecosystem component and indicator development for WCEA. The hierarchy of assessment components and indicators used in a sample of 35 environmental impact assessments was examined and the factors affecting aquatic ecosystem component selection and indicator use were identified. Results showed that public environmental impact statements are not necessarily publically accessible, thus limiting opportunities for data and information sharing from the project to the watershed scale. We also found no consistent terminology across the sample of impact statements, thus making comparison of assessment processes and results difficult. Regulatory compliance was found to be the dominant factor influencing the selection of ecosystem components and indicators for use in project assessment, rather than scientific reasoning, followed by the mandate of the responsible government agency for the assessment, public input to the assessment process, and preexisting water licensing arrangements external

  20. Assessing cumulative impacts to wintering Bald Eagles and their habitats in western Washington

    SciTech Connect

    Witmer, G.W.; O'Neil, T.A.

    1988-01-01

    Bald Eagles (Haliaeetus leucocephalus) of Washington, the largest wintering population in the lower 48 states, are subject to numerous pressures and impacts from human activites. An evaluative method potential cumulative impacts of multiple hydroelectric development and logging activities on known and potential eagle use areas. Four resource components include food supply, roost sites, mature riparian forest, and disturbance. In addition to actual estimates of losses in food supply (fish biomass in kg) and habitat (km/sup 2/) in one river basin, impact levels from 0 (none) to 4 (high) were assigned for each development and for each component based on the impacts anticipated and the estimated value of the site to eagles. Midwinter eagle surveys, aerial photography, topographic and forest stand maps, and site visits were used in the analysis. Impacts were considered additive for all but the disturbance component, which was adjusted for potential synergism between developments. Adjustments were made for mitigation before the impacts were aggregated into a single, dimensionless cumulative impact score. 50 refs., 1 fig., 1 tab.

  1. Health care technology assessment

    NASA Astrophysics Data System (ADS)

    Goodman, Clifford

    1994-12-01

    The role of technology in the cost of health care is a primary issue in current debates concerning national health care reform. The broad scope of studies for understanding technological impacts is known as technology assessment. Technology policy makers can improve their decision making by becoming more aware, and taking greater advantage, of key trends in health care technology assessment (HCTA). HCTA is the systematic evaluation of the properties, impacts, and other attributes of health care technologies, including: technical performance; clinical safety and efficacy/effectiveness; cost-effectiveness and other economic attributes; appropriate circumstances/indications for use; and social, legal, ethical, and political impacts. The main purpose of HCTA is to inform technology-related policy making in health care. Among the important trends in HCTA are: (1) proliferation of HCTA groups in the public and private sectors; (2) higher standards for scientific evidence concerning technologies; (3) methodological development in cost analyses, health-related quality of life measurement, and consolidation of available scientific evidence (e.g., meta-analysis); (4) emphasis on improved data on how well technologies work in routine practice and for traditionally under-represented patient groups; (5) development of priority-setting methods; (6) greater reliance on medical informatics to support and disseminate HCTA findings.

  2. Assessing Long-Term, System-Wide Cumulative Benefits of Multiple Restoration Projects

    NASA Astrophysics Data System (ADS)

    Kondolf, G. M.

    2005-12-01

    Most river restoration projects in North America have been at a relatively small scale, and even most large restoration programs consist of multiple small projects. The CALFED Bay-Delta Program, encompassing the San Francisco Estuary system and its watershed in northern California, is one of the largest ongoing restoration programs in the nation, with over 500 million invested in restoration projects from 1997 to 2004. Yet when we look at the results of these and other restoration efforts to date in the context of habitat losses and fish population declines since European settlement in 1850, it is clear that even a restoration effort on this scale will not reverse large-scale historical changes, so restoration in this context must involve making incremental improvements within a highly altered system. The question becomes how to best allocate the (always limited) available resources strategically to achieve realistic restoration goals. For example, is it better to make small investments in many rivers or concentrate on larger projects in one or a few? An overall conceptual model on a basin scale and over a long time period is needed as a framework in which to evaluate the cumulative contributions of different possible projects. Along the Merced and Tuolumne Rivers, multiple abandoned gravel pits interrupt sediment transport continuity and provide habitat for exotic fish that prey on juvenile salmon. To reduce predation and restore river function, some of these pits have been repaired (and the channel restored), at a cost to date of about 30 million. Assuming different response functions, we can project the potential cumulative benefits of multiple projects.

  3. In vivo measurements of lead-210 for assessing cumulative radon exposure in uranium miners

    SciTech Connect

    Guilmette, R.A.; Laurer, G.R.; Lambert, W.E.; Gilliland, F.D.

    1995-12-01

    It has long been recognized that a major contributor to the uncertainty in risk analysis of lung cancer in uranium and other hard rock miners is the estimation of total radon progeny exposure of individual miners under study. These uncertainties arise from the fact that only a limited number of measurements of airborne {sup 222}Rn progeny concentrations were made in the mines during the times that the miners were being exposed, and that dosimeters capable of integrating the Rn progeny exposures of the miners did not exist. Historically, the cumulative exposures for individual uranium and other hard rock miners have been calculated by combining the employee`s work history, which may or may not have included time spent at different jobs within the mines and at different locations within the mines, with whatever periodic measurements of Rn and Rn progeny were available. The amount and quality of the measurement data varied enormously from mine to mine and from population to population. Because the quality of the exposure data collected during the period of active mining in the United STates cannot now be altered substantially, significant improvement in individual miner exposure estimates is only likely to be achieved if a new cumulative exposure metric is developed and implemented. The decay chain of Rn includes the production of {sup 210}Pb, which can accumulate in the skeleton in amounts proportional to the intake of Rn progeny. We hypothesize that the in vivo measurement of {sup 210}Pb in the skulls of miners will provide such a metric. In summary, the primary purpose of this pilot study to demonstrate the feasibility of measuring {sup 210}Pb in the heads of former uranium miners has been accomplished.

  4. Multiple uses of indicators and indices in cumulative effects assessment and management

    SciTech Connect

    Canter, L.W.; Atkinson, S.F.

    2011-09-15

    Both environmental indicators and multi-metric indices are useful for describing baseline conditions and qualitatively predicting the cumulative consequences of multiple actions. Several examples and case studies associated with indicators and/or indices are presented herein. They can be easily modified for usage in CEAM. Habitat suitability models reflect special indices related to habitat needs and quality for specific species or broad habitat types. Such models have been used to address direct and indirect effects, and with some modification, they can be also used to address cumulative effects of multiple actions. This review has indicated that there are numerous examples of such tools which have been or could be used in both EIA and CEAM. Some key lessons are: (1) in conducting CEAM studies, it is useful to think from the mindset that 'I am the VEC or indicator, and what is my historical and current condition and how have I, or will I, be affected by multiple past, present, and future actions?'; (2) due to the likely absence of detailed information on future actions, the described tools can still be used to 'predict' future conditions by focusing on qualitative up-or-down changes in individual indicators or indices with their aggregated displays; and (3) numerous regional and site-specific tools are currently available, with one example being indices of biological integrity for specific watersheds and water bodies. Such tools, even though they may not have been developed for CEAM usage, can certainly benefit CEAM studies and practice. Finally, usage of selected and appropriate tools as described herein can aid in conducting science-based, systematic, and documentable CEAM studies.

  5. Socioeconomic Status, Smoking, and Health: A Test of Competing Theories of Cumulative Advantage

    ERIC Educational Resources Information Center

    Pampel, Fred C.; Rogers, Richard G.

    2004-01-01

    Although both low socioeconomic status and cigarette smoking increase health problems and mortality, their possible combined or interactive influence is less clear. On one hand, the health of low status groups may be harmed least by unhealthy behavior such as smoking because, given the substantial health risks produced by limited resources, they…

  6. The Interplay Between Child and Maternal Health: Reciprocal Relationships and Cumulative Disadvantage During Childhood and Adolescence*

    PubMed Central

    Garbarski, Dana

    2015-01-01

    While many studies use parental socioeconomic status and health to predict children's health, this study examines the interplay over time between child and maternal health across childhood and adolescence. Using data from women in the National Longitudinal Study of Youth 1979 cohort and their children (N = 2,225), autoregressive cross-lagged models demonstrate that at particular points during childhood and adolescence, there are direct effects of child activity limitations on maternal health limitations two years later and direct effects of maternal health limitations on child activity limitations two years later, net of a range of health-relevant time-varying and time-invariant covariates. Furthermore, there are indirect effects of child activity limitations on subsequent maternal health limitations and indirect effects of maternal health limitations on subsequent child activity limitations via intervening health statuses. This study examines how the interplay between child and maternal health unfolds over time and describes how these interdependent statuses jointly experience health disadvantages. PMID:24578398

  7. Modeling cumulative effects in life cycle assessment: the case of fertilizer in wheat production contributing to the global warming potential.

    PubMed

    Laratte, Bertrand; Guillaume, Bertrand; Kim, Junbeum; Birregah, Babiga

    2014-05-15

    This paper aims at presenting a dynamic indicator for life cycle assessment (LCA) measuring cumulative impacts over time of greenhouse gas (GHG) emissions from fertilizers used for wheat cultivation and production. Our approach offers a dynamic indicator of global warming potential (GWP), one of the most used indicator of environmental impacts (e.g. in the Kyoto Protocol). For a case study, the wheat production in France was selected and considered by using data from official sources about fertilizer consumption and production of wheat. We propose to assess GWP environmental impact based on LCA method. The system boundary is limited to the fertilizer production for 1 ton of wheat produced (functional unit) from 1910 to 2010. As applied to wheat production in France, traditional LCA shows a maximum GWP impact of 500 kg CO2-eq for 1 ton of wheat production, whereas the GWP impact of wheat production over time with our approach to dynamic LCA and its cumulative effects increases to 18,000 kg CO2-eq for 1 ton of wheat production. In this paper, only one substance and one impact assessment indicator are presented. However, the methodology can be generalized and improved by using different substances and indicators. Copyright © 2014 Elsevier B.V. All rights reserved.

  8. A Levels-of-Evidence Approach for Assessing Cumulative Ecosystem Response to Estuary and River Restoration Programs

    SciTech Connect

    Diefenderfer, Heida L.; Thom, Ronald M.; Johnson, Gary E.; Skalski, J. R.; Vogt, Kristiina A.; Ebberts, Blaine D.; Roegner, G. Curtis; Dawley, Earl

    2011-03-01

    Even though large-scale ecological restoration programs are beginning to supplement isolated projects implemented on rivers and tidal waterways, the effects of restoration success often continue to be evaluated at project scales or by integration in an additive manner. Today our scientific understanding is sufficient that we can begin to apply lessons learnt from assessing cumulative impacts of anthropogenic stressors on ecosystems to the assessment of ecological restoration. Integration of this knowledge has the potential to increase the efficacy of restoration projects conducted at several locations but co-managed within the confines of a larger integrative program. We introduce here a framework based on a levels-of-evidence approach that facilitates assessment of the cumulative landscape effects of individual restoration actions taken at many different locations. It incorporates data collection at restoration and reference sites, hydrodynamic modeling, geographic information systems, and meta-analyses in a five-stage process: design, data, analysis, synthesis and evaluation, and application. This framework evolved from the need to evaluate the efficacy of restoration projects designed to increase rearing habitat for outmigrating juvenile salmonids, which are being implemented in numerous wetlands on the 235-km tidal portion of the Columbia River, U.S.A.

  9. Cumulative Risk: Toxicity and Interactions of Physical and Chemical Stressors

    EPA Science Inventory

    ABSTRACT Recent efforts to update cumulative risk assessment procedures to incorporate nonchemical stressors ranging from physical to psychosocial, reflect increased interest in consideratio of the totality of variables affecting human health and the growing desire to develop co...

  10. Cumulative Risk: Toxicity and Interactions of Physical and Chemical Stressors

    EPA Science Inventory

    ABSTRACT Recent efforts to update cumulative risk assessment procedures to incorporate nonchemical stressors ranging from physical to psychosocial, reflect increased interest in consideratio of the totality of variables affecting human health and the growing desire to develop co...

  11. Consideration of the FQPA Safety Factor and Other Uncertainty Factors in Cumulative Risk Assessment of Chemicals Sharing a Common Mechanism of Toxicity

    EPA Pesticide Factsheets

    This guidance document provides OPP's current thinking on application of the provision in FFDCA about an additional safety factor for the protection of infants and children in the context of cumulative risk assessments.

  12. A geographic model to assess and limit cumulative ecological degradation from Marcellus Shale exploitation in New York, USA

    USGS Publications Warehouse

    Davis, John B.; Robinson, George R.

    2012-01-01

    When natural resources are exploited, environmental costs and economic benefits are often asymmetric. An example is apparent in the environmental impacts from fossil fuel extraction by hydraulic fracturing. So far, most scrutiny has been focused on water quality in affected aquifers, with less attention paid to broader ecological impacts beyond individual drilling operations. Marcellus Shale methane exploitation in New York State, USA, has been delayed because of a regulatory moratorium, pending evaluation that has been directed primarily at localized impacts. We developed a GIS-based model, built on a hexagonal grid underlay nested within the U.S. Environmental Protection Agency’s EMAP system, to examine potential cumulative ecological impacts. In a two-step process, we characterized > 19,000 hexagons, each sized to approximate the footprint of one drilling site (2.57 km²), using ecological attributes; we then developed a method for apportioning resource access that includes assessments of cumulative ecological costs. Over one-quarter of the hexagons were excluded as off-limits on the basis of six criteria: slope suitability, regulated wetland cover, protected-land cover, length of high-quality streams, mapped road density, and open water cover. Three additional criteria were applied to assess the estimated conservation vulnerability of the remaining sites: density of grassland birds (North American Breeding Bird Survey), percent core forest (Coastal Change Analysis Program), and total density of all state-mapped streams; these were determined and used in combination to rank the 14,000 potentially accessible sites. In a second step, an iterative process was used to distribute potential site access among all towns (sub-county governments) within the Marcellus Shale Formation. At each iteration, one site was selected per town, either randomly or in rank order of increasing vulnerability. Results were computed as percent cumulative impact versus the number of

  13. Comparison of Cumulative Planimetry versus Manual Dissection to Assess Experimental Infarct Size in Isolated Hearts

    PubMed Central

    Riess, Matthias L.; Rhodes, Samhita S.; Stowe, David F.; Aldakkak, Mohammed; Camara, Amadou K.S.

    2013-01-01

    Introduction Infarct size (IS) is an important variable to estimate cardiac ischemia/reperfusion injury in animal models. Triphenyltetrazoliumchloride (TTC) stains viable cells red while leaving infarcted cells unstained. To quantify IS, infarcted and non-infarcted tissue is often manually dissected and weighed (IS-DW). An alternative is to measure infarcted areas by cumulative planimetry (IS-CP). Methods We prospectively compared these two methods in 141 Langendorff-prepared guinea pig hearts (1.44±0.02 g) that were part of different studies on mechanisms of cardioprotection. Hearts were perfused with Krebs-Ringer’s and subjected to 30 min global ischemia after various cardioprotective treatments. Two hours after reperfusion hearts were cut into 6-7 transverse sections (3 mm) and stained for 5 min in 1% TTC and 0.1 M KH2PO4 buffer (pH 7.4, 38°C). Each slice was first scanned and its infarcted area measured with Image 1.62 software (NIH). Infarctions in individual slices of each heart were averaged (IS-CP) on the basis of their weight. After scanning, IS-DW was determined by careful manual dissection of infarcted from noninfarcted tissue and measuring their respective total weight. Results We found limited tissue permeation of TTC in relation to the slice thickness leaving tissue in the center unstained, as well as significant cross-contamination of stained vs. unstained tissue after manual dissection. IS-CP and IS-DW ranged from 6.0 to 73.1% and 19.4 to 70.5%, respectively, and correlated as follows: IS-DW = (27.6±1.4) + (0.518±0.038) • IS-CP; r = 0.75 (Pearson), P<0.001. In addition, IS-CP correlated better with return of function after reperfusion like developed left ventricular pressure, contractility and relaxation, and myocardial oxygen consumption. Discussion Despite a good correlation between both methods, limited tissue permeation by TTC diffusion and limited precision in the ability to manually dissect stained from unstained tissue leads to an

  14. Comparison of cumulative planimetry versus manual dissection to assess experimental infarct size in isolated hearts.

    PubMed

    Riess, Matthias L; Rhodes, Samhita S; Stowe, David F; Aldakkak, Mohammed; Camara, Amadou K S

    2009-01-01

    Infarct size (IS) is an important variable to estimate cardiac ischemia/reperfusion injury in animal models. Triphenyltetrazolium chloride (TTC) stains viable cells red while leaving infarcted cells unstained. To quantify IS, infarcted and non-infarcted tissue is often manually dissected and weighed (IS-DW). An alternative is to measure infarcted areas by cumulative planimetry (IS-CP). We prospectively compared these two methods in 141 Langendorff-prepared guinea pig hearts (1.44+/-0.02 g) that were part of different studies on mechanisms of cardioprotection. Hearts were perfused with Krebs-Ringer's and subjected to 30 min global ischemia after various cardioprotective treatments. Two hours after reperfusion hearts were cut into 6-7 transverse sections (3mm) and stained for 5 min in 1% TTC and 0.1M KH2PO4 buffer (pH 7.4, 38 degrees C). Each slice was first scanned and its infarcted area measured with Image 1.62 software (NIH). Infarctions in individual slices of each heart were averaged (IS-CP) on the basis of their weight. After scanning, IS-DW was determined by careful manual dissection of infarcted from non-infarcted tissue and measuring their respective total weight. We found limited tissue permeation of TTC in relation to the slice thickness leaving tissue in the center unstained, as well as significant cross-contamination of stained vs. unstained tissue after manual dissection. IS-CP and IS-DW ranged from 6.0 to 73.1% and 19.4 to 70.5%, respectively, and correlated as follows: IS-DW=(27.6+/-1.4)+(0.518+/-0.038) * IS-CP; r=0.75 (Pearson), p<0.001. In addition, IS-CP correlated better with return of function after reperfusion like developed left ventricular pressure, contractility and relaxation, and myocardial oxygen consumption. Despite a good correlation between both methods, limited tissue permeation by TTC diffusion and limited precision in the ability to manually dissect stained from unstained tissue leads to an overestimation of infarct size by

  15. Resource Asymmetries and Cumulative Advantages: Canadian and US Research Universities and the Field of Global Health

    ERIC Educational Resources Information Center

    Oleksiyenko, Anatoly; Sa, Creso M.

    2010-01-01

    Global health is becoming an important area of inquiry and learning in North American research universities, stemming from on-going and new commitments to the field by multiple governmental and non-governmental agents. External demands for research and education in global health require enhanced inter-disciplinary, inter-sectoral and international…

  16. Acquisition of choice in concurrent chains: Assessing the cumulative decision model.

    PubMed

    Grace, Randolph C

    2016-05-01

    Concurrent chains is widely used to study pigeons' choice between terminal links that can vary in delay, magnitude, or probability of reinforcement. We review research on the acquisition of choice in this procedure. Acquisition has been studied with a variety of research designs, and some studies have incorporated no-food trials to allow for timing and choice to be observed concurrently. Results show that: Choice can be acquired rapidly within sessions when terminal links change unpredictably; under steady-state conditions, acquisition depends on both initial- and terminal-link schedules; and initial-link responding is mediated by learning about the terminal-link stimulus-reinforcer relations. The cumulative decision model (CDM) proposed by Christensen and Grace (2010) and Grace and McLean (2006, 2015) provides a good description of within-session acquisition, and correctly predicts the effects of initial and terminal-link schedules in steady-state designs (Grace, 2002a). Questions for future research include how abrupt shifts in preference within individual sessions and temporal control of terminal-link responding can be modeled. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. METHODOLOGY FOR THE EVALUATION OF CUMULATIVE EPISODIC EXPOSURE TO CHEMICAL STRESSORS IN AQUATIC RISK ASSESSMENT.

    EPA Science Inventory

    An ecological risk assessment method was developed to evaluate the magnitude, duration, and episodic nature of chemical stressors on aquatic communities. The percent of an ecosystem's species at risk from a designated chemical exposure scenario is generated. In effects assessment...

  18. METHODOLOGY FOR THE EVALUATION OF CUMULATIVE EPISODIC EXPOSURE TO CHEMICAL STRESSORS IN AQUATIC RISK ASSESSMENT.

    EPA Science Inventory

    An ecological risk assessment method was developed to evaluate the magnitude, duration, and episodic nature of chemical stressors on aquatic communities. The percent of an ecosystem's species at risk from a designated chemical exposure scenario is generated. In effects assessment...

  19. Measurement error correction for the cumulative average model in the survival analysis of nutritional data: application to Nurses' Health Study.

    PubMed

    Qiu, Weiliang; Rosner, Bernard

    2010-01-01

    The use of the cumulative average model to investigate the association between disease incidence and repeated measurements of exposures in medical follow-up studies can be dated back to the 1960s (Kahn and Dawber, J Chron Dis 19:611-620, 1966). This model takes advantage of all prior data and thus should provide a statistically more powerful test of disease-exposure associations. Measurement error in covariates is common for medical follow-up studies. Many methods have been proposed to correct for measurement error. To the best of our knowledge, no methods have been proposed yet to correct for measurement error in the cumulative average model. In this article, we propose a regression calibration approach to correct relative risk estimates for measurement error. The approach is illustrated with data from the Nurses' Health Study relating incident breast cancer between 1980 and 2002 to time-dependent measures of calorie-adjusted saturated fat intake, controlling for total caloric intake, alcohol intake, and baseline age.

  20. Using Marginal Structural Modeling to Estimate the Cumulative Impact of an Unconditional Tax Credit on Self-Rated Health.

    PubMed

    Pega, Frank; Blakely, Tony; Glymour, M Maria; Carter, Kristie N; Kawachi, Ichiro

    2016-02-15

    In previous studies, researchers estimated short-term relationships between financial credits and health outcomes using conventional regression analyses, but they did not account for time-varying confounders affected by prior treatment (CAPTs) or the credits' cumulative impacts over time. In this study, we examined the association between total number of years of receiving New Zealand's Family Tax Credit (FTC) and self-rated health (SRH) in 6,900 working-age parents using 7 waves of New Zealand longitudinal data (2002-2009). We conducted conventional linear regression analyses, both unadjusted and adjusted for time-invariant and time-varying confounders measured at baseline, and fitted marginal structural models (MSMs) that more fully adjusted for confounders, including CAPTs. Of all participants, 5.1%-6.8% received the FTC for 1-3 years and 1.8%-3.6% for 4-7 years. In unadjusted and adjusted conventional regression analyses, each additional year of receiving the FTC was associated with 0.033 (95% confidence interval (CI): -0.047, -0.019) and 0.026 (95% CI: -0.041, -0.010) units worse SRH (on a 5-unit scale). In the MSMs, the average causal treatment effect also reflected a small decrease in SRH (unstabilized weights: β = -0.039 unit, 95% CI: -0.058, -0.020; stabilized weights: β = -0.031 unit, 95% CI: -0.050, -0.007). Cumulatively receiving the FTC marginally reduced SRH. Conventional regression analyses and MSMs produced similar estimates, suggesting little bias from CAPTs. © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Socioeconomic status, smoking, and health: a test of competing theories of cumulative advantage.

    PubMed

    Pampel, Fred C; Rogers, Richard G

    2004-09-01

    Although both low socioeconomic status and cigarette smoking increase health problems and mortality, their possible combined or interactive influence is less clear On one hand, the health of low status groups may be harmed least by unhealthy behavior such as smoking because, given the substantial health risks produced by limited resources, they have less to lose from damaging lifestyles. On the other hand, the health of low status groups may be harmed most by smoking because lifestyle choices exacerbate the health problems created by deprived material conditions. Alternatively, the harm of low status and smoking may accumulate additively rather than multiplicatively. We test these arguments with data from the 1990 U.S. National Health Interview Survey, and with measures of morbidity and mortality. For ascribed statuses such as gender, race, and ethnicity, and for the outcome measure of mortality, the results favor the additive argument, whereas for achieved status and morbidity, the results support the vulnerability hypothesis--that smoking inflicts greater harm among disadvantaged groups.

  2. Multimorbidity Redefined: Prospective Health Outcomes and the Cumulative Effect of Co-Occurring Conditions

    PubMed Central

    Warner, David F.; Owusu, Cynthia; Given, Charles W.

    2015-01-01

    Introduction Multimorbidity is common among middle-aged and older adults; however the prospective effects of multimorbidity on health outcomes (health status, major health decline, and mortality) have not been fully explored. This study addresses this gap in the literature. Methods We used self-reported data from the 2008 and 2010 Health and Retirement Study. Our study population included 13,232 adults aged 50 or older. Our measure of baseline multimorbidity in 2008 was based on the occurrence or co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes, as follows: MM0, no chronic conditions, functional limitations, or geriatric syndromes; MM1, occurrence (but no co-occurrence) of chronic conditions, functional limitations, or geriatric syndromes; MM2, co-occurrence of any 2 of chronic conditions, functional limitations, or geriatric syndromes; and MM3, co-occurrence of all 3 of chronic conditions, functional limitations, and geriatric syndromes. Outcomes in 2010 included fair or poor health status, major health decline, and mortality. Results All 3 outcomes were significantly associated with multimorbidity. Compared with MM0 (respectively for fair or poor health and major health decline), the adjusted odds ratios (AORs) and 95% confidence intervals were as follows: 2.61 (1.79–3.78) and 2.20 (1.42–3.41) for MM1; 7.49 (5.20–10.77) and 3.70 (2.40–5.71) for MM2; and 22.66 (15.64–32.83) and 4.72 (3.03–7.37) for MM3. Multimorbidity was also associated with mortality: an adult classified as MM3 was nearly 12 times (AOR, 11.87 [5.72–24.62]) as likely as an adult classified as MM0 to die within 2 years. Conclusion Given the strong and significant association between multimorbidity and prospective health status, major health decline, and mortality, multimorbidity may be used — both in clinical practice and in research — to identify older adults with heightened vulnerability for adverse outcomes. PMID:25906436

  3. The EPA's Human Exposure Research Program for Assessing Cumulative Risk in Communities

    EPA Science Inventory

    Communities are faced with challenges in identifying and prioritizing environmental issues, taking actions to reduce their exposures, and determining their effectiveness for reducing human health risks. Additional challenges include determining what scientific tools are available...

  4. The EPA's Human Exposure Research Program for Assessing Cumulative Risk in Communities

    EPA Science Inventory

    Communities are faced with challenges in identifying and prioritizing environmental issues, taking actions to reduce their exposures, and determining their effectiveness for reducing human health risks. Additional challenges include determining what scientific tools are available...

  5. APPROACHES FOR INCORPORATING NON-CHEMICAL STRESSORS INTO CUMULATIVE RISK ASSESSMENTS

    EPA Science Inventory

    Over the past twenty years, the risk assessment paradigm has gradually shifted from an individual chemical approach to a community-based model. Inherent in community-based risk assessment is consideration of the totality of stressors affecting a defined population including both ...

  6. APPROACHES FOR INCORPORATING NON-CHEMICAL STRESSORS INTO CUMULATIVE RISK ASSESSMENTS

    EPA Science Inventory

    Over the past twenty years, the risk assessment paradigm has gradually shifted from an individual chemical approach to a community-based model. Inherent in community-based risk assessment is consideration of the totality of stressors affecting a defined population including both ...

  7. Cumulative and residual effects of potato cropping system management strategies on crop and soil health parameters

    USDA-ARS?s Scientific Manuscript database

    Soil and crop management practices can greatly affect parameters related to soil health, as well as crop productivity and disease development, and may provide options for more sustainable production. Different 3-yr potato cropping systems focused on specific management goals of soil conservation (SC...

  8. An Overview of Measurement Method Tools Available to Communities for Conducting Exposure and Cumulative Risk Assessments

    EPA Science Inventory

    Community-based programs for assessing and mitigating nvironmental risks represent a challenge to participants because each brings a different level of understanding of the issues affecting the community. These programs often require the collaboration of several community sectors...

  9. An Overview of Measurement Method Tools Available to Communities for Conducting Exposure and Cumulative Risk Assessments

    EPA Science Inventory

    Community-based programs for assessing and mitigating nvironmental risks represent a challenge to participants because each brings a different level of understanding of the issues affecting the community. These programs often require the collaboration of several community sectors...

  10. Assessing Cumulative Impact and Risk - Approaches at the U.S. Environmental Protection Agency

    EPA Science Inventory

    The U.S. Environmental Protection Agency (EPA) has a mission and regulatory mandate to protect human health and the environment. EPA’s primary role is to implement environmental laws by developing and enforcing national regulation. Cogent to the goals of this workshop, key envi...

  11. Assessing Cumulative Impact and Risk - Approaches at the U.S. Environmental Protection Agency

    EPA Science Inventory

    The U.S. Environmental Protection Agency (EPA) has a mission and regulatory mandate to protect human health and the environment. EPA’s primary role is to implement environmental laws by developing and enforcing national regulation. Cogent to the goals of this workshop, key envi...

  12. Cumulative risk and AIDS-orphanhood: interactions of stigma, bullying and poverty on child mental health in South Africa.

    PubMed

    Cluver, Lucie; Orkin, Mark

    2009-10-01

    Research shows that AIDS-orphaned children are more likely to experience clinical-range psychological problems. Little is known about possible interactions between factors mediating these high distress levels. We assessed how food insecurity, bullying, and AIDS-related stigma interacted with each other and with likelihood of experiencing clinical-range disorder. In South Africa, 1025 adolescents completed standardised measures of depression, anxiety and post-traumatic stress. 52 potential mediators were measured, including AIDS-orphanhood status. Logistic regressions and hierarchical log-linear modelling were used to identify interactions among significant risk factors. Food insecurity, stigma and bullying all independently increased likelihood of disorder. Poverty and stigma were found to interact strongly, and with both present, likelihood of disorder rose from 19% to 83%. Similarly, bullying interacted with AIDS-orphanhood status, and with both present, likelihood of disorder rose from 12% to 76%. Approaches to alleviating psychological distress amongst AIDS-affected children must address cumulative risk effects.

  13. Estimated Daily Intake and Cumulative Risk Assessment of Phthalates in the General Taiwanese after the 2011 DEHP Food Scandal

    NASA Astrophysics Data System (ADS)

    Chang, Jung-Wei; Lee, Ching-Chang; Pan, Wen-Harn; Chou, Wei-Chun; Huang, Han-Bin; Chiang, Hung-Che; Huang, Po-Chin

    2017-03-01

    A food scandal occurred in Taiwan in 2011 because the DEHP (di-2-ethylhexyl phthalate) had been intentionally used in food products. We assessed the daily intakes (DIs) and cumulative risk of phthalates in Taiwan’s general population after the scandal. The DIs of 6 phthalates, including di-n-butyl phthalate (DnBP), di-iso-butyl phthalate (DiBP), and DEHP, were evaluated using urinary phthalate metabolites. Hazard quotients of phthalates classified as affecting the reproductive (HQrep) and hepatic (HQhep) systems were assessed using cumulative approach. The creatinine-based model showed that the highest DI values in children 7-to 12- years-old were for DEHP (males: median: 4.79 μg/kg bw/d; females: median: 2.62 μg/kg bw/d). The 95th percentile (P95) of HQrep values were all >1 in the 7- to 12-year-old and 18- to 40-year-old male groups. The P95 of HQhep values were all >1 in the 7- to 18- year-old male groups. Most of the HQrep was attributable to the HQs of DnBP and DiBP (53.9–84.7%), and DEHP contributed most to HQhep (83.1–98.6%), which reveals that DnBP, DiBP and DEHP were the main risk of phthalate exposure for Taiwanese. Taiwan’s general population is widely exposed to DnBP, DiBP and DEHP, especially for young children.

  14. Estimated Daily Intake and Cumulative Risk Assessment of Phthalates in the General Taiwanese after the 2011 DEHP Food Scandal

    PubMed Central

    Chang, Jung-Wei; Lee, Ching-Chang; Pan, Wen-Harn; Chou, Wei-Chun; Huang, Han-Bin; Chiang, Hung-Che; Huang, Po-Chin

    2017-01-01

    A food scandal occurred in Taiwan in 2011 because the DEHP (di-2-ethylhexyl phthalate) had been intentionally used in food products. We assessed the daily intakes (DIs) and cumulative risk of phthalates in Taiwan’s general population after the scandal. The DIs of 6 phthalates, including di-n-butyl phthalate (DnBP), di-iso-butyl phthalate (DiBP), and DEHP, were evaluated using urinary phthalate metabolites. Hazard quotients of phthalates classified as affecting the reproductive (HQrep) and hepatic (HQhep) systems were assessed using cumulative approach. The creatinine-based model showed that the highest DI values in children 7-to 12- years-old were for DEHP (males: median: 4.79 μg/kg bw/d; females: median: 2.62 μg/kg bw/d). The 95th percentile (P95) of HQrep values were all >1 in the 7- to 12-year-old and 18- to 40-year-old male groups. The P95 of HQhep values were all >1 in the 7- to 18- year-old male groups. Most of the HQrep was attributable to the HQs of DnBP and DiBP (53.9–84.7%), and DEHP contributed most to HQhep (83.1–98.6%), which reveals that DnBP, DiBP and DEHP were the main risk of phthalate exposure for Taiwanese. Taiwan’s general population is widely exposed to DnBP, DiBP and DEHP, especially for young children. PMID:28327585

  15. Stigmatized biologies: Examining the cumulative effects of oral health disparities for Mexican American farmworker children.

    PubMed

    Horton, Sarah; Barker, Judith C

    2010-06-01

    Severe early childhood caries (ECC) can leave lasting effects on children's physical development, including malformed oral arches and crooked permanent dentition. This article examines the way that the ECC of Mexican American farmworker children in the United States sets them up for lasting dental problems and social stigma as young adults. We examine the role of dietary and environmental factors in contributing to what we call "stigmatized biologies," and that of market-based dental public health insurance systems in cementing their enduring effects. We adapt Margaret Lock's term, local biology, to illustrate the way that biology differs not only because of culture, diet, and environment but also because of disparities in insurance coverage. By showing the long-term effects of ECC and disparate dental treatment on farmworker adults, we show how the interaction of immigrant caregiving practices and underinsurance can having lasting social effects. An examination of the long-term effects of farmworker children's ECC illustrates the ways that market-based health care systems can create embodied differences that in turn reproduce a system of social inequality.

  16. Stigmatized Biologies: Examining the Cumulative Effects of Oral Health Disparities for Mexican American Farmworker Children

    PubMed Central

    Horton, Sarah; Barker, Judith C.

    2012-01-01

    Severe early childhood caries (ECC) can leave lasting effects on children’s physical development, including malformed oral arches and crooked permanent dentition. This article examines the way that ECC sets up Mexican American farm worker children in the United States for lasting dental problems and social stigma as young adults. We examine the role of dietary and environmental factors in contributing to what we call “stigmatized biologies,” and that of market-based dental public health insurance systems in cementing their enduring effects. We adapt Margaret Lock’s term, local biology, to illustrate the way that biology differs not only because of culture, diet, and environment but also because of disparities in insurance coverage. By showing the long-term effects of ECC and disparate dental treatment on farmworker adults, we show how the interaction of immigrant caregiving practices and underinsurance can have lasting social effects. An examination of the long-term effects of farm worker children’s ECC illustrates the ways that market-based health care systems can create embodied differences that in turn reproduce a system of social inequality. PMID:20550093

  17. Cumulative impacts on seabed habitats: an indicator for assessments of good environmental status.

    PubMed

    Korpinen, Samuli; Meidinger, Manuel; Laamanen, Maria

    2013-09-15

    The European seas are under anthropogenic pressures impacting the state of water quality, benthic habitats and species. The EU Marine Strategy Framework Directive (MSFD) requires the Member States to assess the impacts of pressures and make a programme of measures leading to good environmental status (GES) by 2020. This study presents a method for assessing the quantity and distribution of anthropogenic impacts on benthic habitats in the Baltic Sea by using spatial data of human pressures and benthic habitats. The southern sub-basins were more extensively impacted than the northern sub-basins. Over the entire sea area, deep sea habitats were more impacted than shallower infralittoral and circalittoral habitats. Sand and coarse sediments were the seabed types relatively most impacted in the Baltic Sea scale. A comparison against tentative thresholds for GES showed that in the sub-basin scale only one third of the habitat types was in GES. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Methodologies for Assessing the Cumulative Environmental Effects of Hydroelectric Development on Fish and Wildlife in the Columbia River Basin, Volume 2, Example and Procedural Guidelines, 1987 Final Report.

    SciTech Connect

    Stull, Elizabeth Ann

    1987-07-01

    A hypothetical example of multiple hydroelectric development is used to demonstrate the applicability of the integrated tabular methodology (ITM) that was recommended for cumulative effects assessment in Volume 1. The example consists of an existing mainstem dam and four proposed small hydroelectric developments in a small river basin containing elk summer and winter range and chinook salmon spawning areas. Single-project impact assessments are used collectively in the methodology to estimate the cumulative effects of the projects on elk and salmon. The steps in cumulative assessment are (1) establishing a conceptual and schematic representation of each cumulative effect, (2) calculating interaction coefficients for each pair of projects, (3) developing interaction and impact matrices, (4) multiplying these matrices, (5) evaluating the contribution of shared project features to cumulative effects, and (6) incorporating the effects of already existing projects. The ITM is most effective when single-project assessments are accomplished in a detailed, quantitative manner. The methodology involves the use of impact response curves (such as fry emergence as a function of fine sediment or habitat suitability as a function of road density) for each impact being assessed. 14 refs., 15 figs., 16 tabs.

  19. Health and Academic Achievement: Cumulative Effects of Health Assets on Standardized Test Scores among Urban Youth in the United States

    ERIC Educational Resources Information Center

    Ickovics, Jeannette R.; Carroll-Scott, Amy; Peters, Susan M.; Schwartz, Marlene; Gilstad-Hayden, Kathryn; McCaslin, Catherine

    2014-01-01

    Background: The Institute of Medicine (2012) concluded that we must "strengthen schools as the heart of health." To intervene for better outcomes in both health and academic achievement, identifying factors that impact children is essential. Study objectives are to (1) document associations between health assets and academic achievement,…

  20. Health and Academic Achievement: Cumulative Effects of Health Assets on Standardized Test Scores among Urban Youth in the United States

    ERIC Educational Resources Information Center

    Ickovics, Jeannette R.; Carroll-Scott, Amy; Peters, Susan M.; Schwartz, Marlene; Gilstad-Hayden, Kathryn; McCaslin, Catherine

    2014-01-01

    Background: The Institute of Medicine (2012) concluded that we must "strengthen schools as the heart of health." To intervene for better outcomes in both health and academic achievement, identifying factors that impact children is essential. Study objectives are to (1) document associations between health assets and academic achievement,…

  1. Breast milk and lipid intake distributions for assessing cumulative exposure and risk.

    PubMed

    Arcus-Arth, Amy; Krowech, Gail; Zeise, Lauren

    2005-07-01

    Breast milk consumption is the primary route of infant exposure to certain lipophilic toxicants that have accumulated over decades in maternal adipose tissue, as well as to less persistent toxicants from maternal exposure during lactation. Such infant exposures occur at a time of rapid growth and development when susceptibility to certain toxicants can be greatest. Breast milk and lipid intake rates are presented for the 0-6 and 0-12 month age periods for infants fed according to the American Academy of Pediatrics' current recommendations (exclusive breast-feeding for 0-6 months and continued breast-feeding to 12 months). Intake rates are normalized to infant bodyweight to account for the covariance of consumption and bodyweight. Frequency distributions describe the population variability in intake. For age 0-12 months, daily average milk intake is 100.7 +/- 22.7 g/kg day (mean +/- SD), with a 95th percentile of 153.5 g/kg day. Breast milk intake distributions are also developed for infants exclusively breast-fed (no significant calories from non-breast milk sources) over their first year, and for the entire (nursing and non-nursing) infant population. For short-term exposures, intake can be derived from the regression equation presented here. Lipid intake estimated assuming a 4% lipid content (current risk assessment practice) is compared and found comparable to that derived from measured lipid content. The national trend of increased breast-feeding found in surveys further supports including the breast milk pathway in risk assessment.

  2. Quantitative assessment of cumulative carcinogenic risk for multiple genotoxic impurities in a new drug substance.

    PubMed

    Bercu, Joel P; Hoffman, Wherly P; Lee, Cindy; Ness, Daniel K

    2008-08-01

    In pharmaceutical development, significant effort is made to minimize the carcinogenic potential of new drug substances (NDS). This involves appropriate genotoxicity and carcinogenicity testing of the NDS, and understanding the genotoxic potential of its impurities. Current available guidance recommends the use of the threshold of toxicological concern (TTC) for a single impurity where mutagenicity but no carcinogenicity information exists. Despite best efforts, the presence of more than one genotoxic impurity in an NDS may occur at trace levels. This paper repeats the analysis performed by others for a single genotoxic compound, but also uses statistical simulations to assess the impact on cancer risk for a mixture of genotoxic compounds. In summary, with the addition of multiple impurities all controlled to the TTC, an increase in cancer risk was observed. This increase is relatively small when considering the conservative assumptions of the TTC. If structurally similar compounds had an assumed strong correlation (+/-10-fold from the first randomly selected impurity) in cancer potency, the resulting cancer risk was not negatively impacted. Findings based on probabilistic analysis here can be very useful in making appropriate decisions about risk management of multiple genotoxic impurities measured in the final drug substance.

  3. Cumulative Intracranial Tumor Volume (CITV) Enhances the Prognostic Value of the Lung-Specific Graded Prognostic Assessment (GPA) Model.

    PubMed

    Marcus, Logan P; Marshall, Deborah; Hirshman, Brian R; McCutcheon, Brandon A; Gonda, David D; Koiso, Takao; Hattangadi-Gluth, Jona A; Carter, Bob S; Yamamoto, Masaaki; Chen, Clark C

    2016-08-01

    Management of patients afflicted with brain metastasis requires tailoring of therapeutic strategies based on survival expectations. Therefore, the development of prognostic indices is of critical importance in this patient population. To determine whether the cumulative intracranial tumor volume (CITV) of brain metastasis augments the prognostic value of the lung-specific Graded Prognostic Assessment (GPA) index. Patient data were derived from 365 lung cancer patients with brain metastasis who were consecutively treated with stereotactic radiosurgery at the University of California, San Diego/San Diego Gamma Knife Center. CITV was analyzed to determine the volume cutoff that maximized sensitivity and specificity for 1-year survival. Multivariate Cox proportional hazard modeling was performed, and overall survival was estimated by the Kaplan-Meier method risk stratifying with or without this optimal CITV. The prognostic value of these models (lung-specific GPA ± CITV) was quantitatively compared with the use of net reclassification improvement (>0) and integrated discrimination improvement. For the University of California, San Diego/San Diego Gamma Knife Center cohort, the CITV cutoff that had the greatest survival discrimination at 1 year was 4 cm. The addition of CITV to the lung-specific GPA indexes significantly improved the prognostic value of lung-specific GPA, with net reclassification improvement >0 of 0.430 (95% confidence interval, 0.228-0.629) and integrated discrimination improvement of 0.029 (95% confidence interval, 0.004-0.073). These findings were validated in an independent cohort of 1638 lung cancer patients with brain metastasis who were treated with stereotactic radiosurgery at the Katsuta Hospital Mito Gamma House in Japan. In independent cohorts, the addition of CITV to the lung-specific GPA index significantly improved the prognostic value of this index. AUC, area under the receiver-operating characteristic curveBM, brain metastasis

  4. Cumulative exergy extraction from the natural environment (CEENE): a comprehensive life cycle impact assessment method for resource accounting.

    PubMed

    Dewulf, J; Bösch, M E; De Meester, B; Van der Vorst, G; Van Langenhove, H; Hellweg, S; Huijbregts, M A J

    2007-12-15

    The objective of the paper is to establish a comprehensive resource-based life cycle impact assessment (LCIA) method which is scientifically sound and that enables to assess all kinds of resources that are deprived from the natural ecosystem, all quantified on one single scale, free of weighting factors. The method is based on the exergy concept. Consistent exergy data on fossils, nuclear and metal ores, minerals, air, water, land occupation, and renewable energy sources were elaborated, with well defined system boundaries. Based on these data, the method quantifies the exergy "taken away" from natural ecosystems, and is thus called the cumulative exergy extraction from the natural environment (CEENE). The acquired data set was coupled with a state-of-the art life cycle inventory database, ecoinvent. In this way, the method is able to quantitatively distinguish eight categories of resources withdrawn from the natural environment: renewable resources, fossil fuels, nuclear energy, metal ores, minerals, water resources, land resources, and atmospheric resources. Third, the CEENE method is illustrated for a number of products that are available in ecoinvent, and results are compared with common resource oriented LCIA methods. The application to the materials in the ecoinvent database showed that fossil resources and land use are of particular importance with regard to the total CEENE score, although the other resource categories may also be significant.

  5. Longitudinal patterns of poverty and health in early childhood: exploring the influence of concurrent, previous, and cumulative poverty on child health outcomes

    PubMed Central

    2012-01-01

    to disentangle time-specific from cumulative effects of poverty on child health. PMID:22947499

  6. Longitudinal patterns of poverty and health in early childhood: exploring the influence of concurrent, previous, and cumulative poverty on child health outcomes.

    PubMed

    Béatrice, Nikiéma; Lise, Gauvin; Victoria, Zunzunegui Maria; Louise, Séguin

    2012-09-04

    cumulative effects of poverty on child health.

  7. Cumulative risk assessment of phthalates associated with birth outcomes in pregnant Chinese women: A prospective cohort study.

    PubMed

    Gao, Hui; Xu, Yuan-Yuan; Huang, Kun; Ge, Xing; Zhang, Yun-Wei; Yao, Hui-Yuan; Xu, Ye-Qing; Yan, Shuang-Qin; Jin, Zhong-Xiu; Sheng, Jie; Zhu, Peng; Hao, Jia-Hu; Tao, Fang-Biao

    2017-03-01

    A prospective cohort study of a Chinese population of mother-neonate pairs (n = 3103) was conducted to investigate the relationship between the cumulative hazard index (HI) of combined diethyl phthalate (DEP), dibutyl phthalate (DBP), dibenzyl phthalate (BBzP) and di(2-ethylhexyl) phthalate (DEHP) exposure and birth outcomes. The estimated HI for phthalates was based on phthalate metabolite concentrations in urine collected between 5th and 14th gestational weeks. The median HI values according to the European Food Safety Authority tolerable daily intake (HITDI) and U.S. Environmental Protection Agency reference dose (HIRfD) were 0.358 and 0.187, respectively. A total of 16.3% and 1.9% of the women exhibited HITDI and HIRfD exceeding the value of one, respectively. In unadjusted models, the categories (low < P25, median P25-P50, high > P75) of HITDI were associated with decreased birth weight (β = -26.34 g, p = 0.021) and head circumference (β = -0.09 cm, p = 0.029), whereas those for HIRfD were negatively associated with birth weight (β = -31.74 g, p = 0.005), birth length (β = -0.11 cm, p = 0.032), head circumference (β = -0.13 cm, p = 0.003) and chest circumference (β = -0.10 cm, p = 0.021) in all neonates. Adjustment for potential confounders revealed that HIRfD was inversely associated with head circumference (β = -0.10 cm, p = 0.020). Stratification by gender indicated that HIRfD was associated with decreased birth length (β = -0.17 cm, p = 0.041) in infant boys and HITDI was associated with decreased birth weight (β = -33.12 g, p = 0.036) and head circumference (β = -0.13 cm, p = 0.027) in girls. This is the first study on the cumulative risk assessment of phthalate exposures in pregnant Chinese women. We found that the HI values of multiple phthalate co-exposure were sex-specifically related to birth outcomes.

  8. UBIQUITOUS POLLUTANTS FROM CUMULATIVE ...

    EPA Pesticide Factsheets

    The occurrence of pharmaceuticals and personal care products (PPCPS) as environmental pollutants is a multifaceted issue whose scope continues to become better delineated since the escalation of concerted attention beginning in the 1980s. PPCPs typically occur as trace environmental pollutants (primarily in surface but also in ground waters) as a result of their widespread, continuous, combined usage in a broad range of human and veterinary therapeutic activities and practices. With respect to the risk-assessment paradigm, the growing body of published work has focused primarily on the origin and occurrence of these substances. Comparatively less is known about human and ecological exposure, and even less about the known or even potential hazards associated with exposure to these anthropogenic substances, many of which are highly bioactive. The continually growing, worldwide importance of freshwater resources underscores the need for ensuring that any aggregate or cumulative impacts on water supplies and resultant potential for human or ecological exposure be minimized. This has prompted the more recent investigations on waste treatment processes for one of the major sources of environmental disposition, namely sewage. Despite the paucity of health effects data for long-term, simultaneous exposure to multiple xenobiotics (particularly PPCPS) at low doses (a major toxicological issue that can be described by the

  9. Combining Field and Modeling Tools As an Approach to Assess Cumulative Surface Erosion in Alberta Eastern Slopes and Foothills.

    NASA Astrophysics Data System (ADS)

    Anderson, A.; Wagner, M. J.; Hirshfield, F.; Howard, M.; Silins, U.; Benda, L. E.

    2014-12-01

    Alberta is a large province with diverse forested landscapes and heavy industrial, range and recreation use. Hillslopes are generally stable but the cumulative surface erosion from bare areas (e.g. roads, well pad, trails, burns and pipelines) is a major concern for downstream water users, aquatic ecology and stream habitat. Most streams are not exhibiting issues from additional coarse soil (e.g. obvious changes to geomorphology) however, soils with high proportion of fines and phosphorus have been attributed to long lasting aquatic ecology impacts and associated downstream water quality issues. For this project we take a watershed scale approach to determine if we can reduce field effort by using high quality digital terrain data available for most of Alberta combined with tools such as the Geomorphic Road Analysis and Inventory Package (GRAIP) and landscape scale GIS assessment and modeling tools such as NetMap. We examine two contrasting regions of Alberta: (1) a tributary of the Oldman River in southwest Alberta that has steep topography, intense storms and heavy motorized recreation from the neighboring 1.5 Million people, and (2) the Foothills area that has fine lacustrine soil, low topography and extremely heavy industrial activity from energy, mining and forestry. We present the initial results of field data combined with GIS analysis for the eastern slopes as part of a larger project that is assessing these tools in represented end member watersheds for forested areas within the foothills and eastern slopes region (area of Alberta where watersheds have meaningful topography). Initial results suggest that GIS and associated modeling are very useful in providing rapid direction for field campaigns to refine the level of uncertainty, make prescriptive field plans and will likely be platforms that can track changes in predicated watershed scale erosion rates through time.

  10. Gait Analysis and the Cumulative Gait Index (CGI): Translational Tools to Assess Impairments Exhibited by Rats with Olivocerebellar Ataxia

    PubMed Central

    Lambert, C.S.; Philpot, R.M.; Engberg, M.E.; Johns, B.E.; Kim, S.H.; Wecker, L.

    2014-01-01

    Deviations from ‘normal’ locomotion exhibited by humans and laboratory animals may be determined using automated systems that capture both temporal and spatial gait parameters. Although many measures generated by these systems are unrelated and independent, some may be related and dependent, representing redundant assessments of function. To investigate this possibility, a treadmill-based system was used to capture gait parameters from normal and ataxic rats, and a multivariate analysis was conducted to determine deviations from normal. Rats were trained on the treadmill at two speeds, and gait parameters were generated prior to and following lesions of the olivocerebellar pathway. Control (non-lesioned) animals exhibited stable hindlimb gait parameters across assessments at each speed. Lesioned animals exhibited alterations in multiple hindlimb gait parameters, characterized by significant increases in stride frequency, braking duration, stance width, step angle, and paw angle and decreases in stride, stance, swing and propulsion durations, stride length and paw area. A principal component analysis of initial hindlimb measures indicated 3 uncorrelated factors mediating performance, termed rhythmicity, thrust and contact. Deviation in the performance of each animal from the group mean was determined for each factor and values summed to yield the Cumulative Gait Index (CGI), a single value reflecting variation within the group. The CGI for lesioned animals increased 2.3-fold relative to unlesioned animals. This study characterizes gait alterations in laboratory rats rendered ataxic by destruction of the climbing fiber pathway innervating Purkinje cells and demonstrates that a single index can be used to describe overall gait impairments. PMID:25116252

  11. Health impact assessment in Korea

    SciTech Connect

    Kang, Eunjeong; Lee, Youngsoo; Harris, Patrick; Koh, Kwangwook; Kim, Keonyeop

    2011-07-15

    Recently, Health Impact Assessment has gained great attention in Korea. First, the Ministry of Environment introduced HIA within existing Environment Impact Assessment. Second, the Korea Institute for Health and Social Affairs began an HIA program in 2008 in alliance with Healthy Cities. In this short report, these two different efforts are introduced and their opportunities and challenges discussed. We believe these two approaches complement each other and both need to be strengthened. We also believe that both can contribute to the development of health in policy and project development and ultimately to improvements in the Korean population's health.

  12. Use of the cumulative sum method (CUSUM) to assess the learning curves of ultrasound-guided continuous femoral nerve block.

    PubMed

    Kollmann-Camaiora, A; Brogly, N; Alsina, E; Gilsanz, F

    2017-10-01

    Although ultrasound is a basic competence for anaesthesia residents (AR) there is few data available on the learning process. This prospective observational study aims to assess the learning process of ultrasound-guided continuous femoral nerve block and to determine the number of procedures that a resident would need to perform in order to reach proficiency using the cumulative sum (CUSUM) method. We recruited 19 AR without previous experience. Learning curves were constructed using the CUSUM method for ultrasound-guided continuous femoral nerve block considering 2 success criteria: a decrease of pain score>2 in a [0-10] scale after 15minutes, and time required to perform it. We analyse data from 17 AR for a total of 237 ultrasound-guided continuous femoral nerve blocks. 8/17 AR became proficient for pain relief, however all the AR who did more than 12 blocks (8/8) became proficient. As for time of performance 5/17 of AR achieved the objective of 12minutes, however all the AR who did more than 20 blocks (4/4) achieved it. The number of procedures needed to achieve proficiency seems to be 12, however it takes more procedures to reduce performance time. The CUSUM methodology could be useful in training programs to allow early interventions in case of repeated failures, and develop competence-based curriculum. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. An optical interferometric technique for assessing ozone induced damage and recovery under cumulative exposures for a Japanese rice cultivar.

    PubMed

    Thilakarathne, Bodhipaksha Lalith Sanjaya; Rajagopalan, Uma Maheswari; Kadono, Hirofumi; Yonekura, Tetsushi

    2014-01-01

    Exposure to ozone (O3) causes reduction both in the growth and yield of rice (Oriza sativa L.). Commonly used Chlorophyll fluorescent measurements are not sensitive enough for short term exposure of O3 aiming an immediate assessments. Such a conventional method typically needs exposure over a few days to detect the influence. As an alternative method, we proposed a novel non-invasive, robust, real-time, optical Statistical Interferometric Technique (SIT) to measure growth at an accuracy of 0.1 nm with a commonly consumed Japanese rice cultivar, Koshihikari. In the present study, we have conducted a repetitive O3 exposure experiment for three days under three different concentrations of 0 nl l(-1) (control), 120 nl l(-1), and 240 nl l(-1), to investigate the damage and recovery strengths. As a measure to assess the effect and recovery from three consecutive day exposures of O3, we measured the elongation rate (nm mm(-1) sec(-1)) every 5.5 sec for 7 hours, and it revealed nanometric elongation rate fluctuations or Nanometric Intrinsic Fluctuations (NIF). Comparing the standard deviation (SD) of normalized nanometric intrinsic fluctuations (NNIF), which was normalized by that before the exposure, we found that drastic reductions under both 120 nl l(-1) and 240 nl l(-1) O3 concentrations. Reduction percentages were large under high O3 concentration of 240 nl l(-1) indicating the possibility of irreversible effect. However exposure to 120 nl l(-1) of O3 showed recovery on the 2(nd) and 3(rd) days. While SIT did reveal immediate effect based on an observation for a few hours, the visible foliar effect could be observed only after a week. Hence, the technique could provide a way for fast assessment of effect and recovery due to cumulative exposure of O3 and hence the tolerance as well as the vitality of plant.

  14. Single and Cumulative Relations of Social Risk Factors with Children's Dental Health and Care-Utilization Within Regions of the United States.

    PubMed

    Yang, Alyssa J; Gromoske, Andrea N; Olson, Melissa A; Chaffin, Jeffrey G

    2016-03-01

    The purpose is to examine the relation of social risk factors, and the cumulative burden of social risk factors, on parent-reported dental health and dental care-seeking behavior. National Survey of Children's Health data (2011-2012) were analyzed for US children by Title V Block Grant regions. Multivariate logistic regressions were estimated for ten social risk factors, as well as a cumulative risk index, to find any associations with poor condition of teeth, presence of dental caries, and no dental care visits. Almost all of the risk factors were significantly associated with poor condition of teeth and presence of dental caries for the US. Models associating no dental care visits suggested that low family income (OR 1.58), poor maternal mental health (OR 1.54), high school education or less (OR 1.34), and multi-racial/other race (OR 1.18) were significant factors for the US. Regional variation existed for those risk factors and their association with the outcomes, but income, education, and poor maternal mental health consistently played a significant role in adverse outcomes. The cumulative risk index was strongly related to poor oral health outcomes, with a weaker relationship to dental care utilization. US children experiencing certain social risk factors, such as low family income, high school education or less, and poor maternal mental health, are likely to be at greater risk for poor dental health and low levels of dental-care seeking behavior. Children experiencing multiple social risks are at greater risk for poor oral outcomes than children who experience fewer social risks. An approach that involves the social determinants of health is needed to address these issues.

  15. Cumulative Exposure Assessment for Trace-Level Polycyclic Aromatic Hydrocarbons (PAHs) using Human Blood and Plasma Analysis

    EPA Science Inventory

    Humans experience chronic cumulative trace-level exposure to mixtures of volatile, semi-volatile, and non-volatile polycyclic aromatic hydrocarbons (PAHs) present in the environment as by-products of combustion processes. Certain PAHs are known or suspected human carcinogens and ...

  16. Assessing the Role of Current and "Cumulative" Exposure in Simultaneous Bilingual Acquisition: The Case of Dutch Gender

    ERIC Educational Resources Information Center

    Unsworth, Sharon

    2013-01-01

    This paper investigates the role of amount of current and "cumulative" exposure in bilingual development and ultimate attainment by exploring the extent to which simultaneous bilingual children's knowledge of grammatical gender is affected by current and previous amount of exposure, including in the early years. Elicited production and…

  17. Cumulative Exposure Assessment for Trace-Level Polycyclic Aromatic Hydrocarbons (PAHs) using Human Blood and Plasma Analysis

    EPA Science Inventory

    Humans experience chronic cumulative trace-level exposure to mixtures of volatile, semi-volatile, and non-volatile polycyclic aromatic hydrocarbons (PAHs) present in the environment as by-products of combustion processes. Certain PAHs are known or suspected human carcinogens and ...

  18. Assessing the cumulative effects of linear recreation routes on wildlife habitats on the Okanogan and Wenatchee National Forests.

    Treesearch

    William L. Gaines; Peter H. Singleton; Roger C. Ross

    2003-01-01

    We conducted a literature review to document the effects of linear recreation routes on focal wildlife species. We identified a variety of interactions between focal species and roads, motorized trails, and nonmotorized trails. We used the available science to develop simple geographic information system-based models to evaluate the cumulative effects of recreational...

  19. Assessing Your Weight and Health Risk

    MedlinePlus

    ... Health Professional Resources Assessing Your Weight and Health Risk Assessment of weight and health risk involves using ... risk for developing obesity-associated diseases or conditions. Risk Factors for Health Topics Associated With Obesity Along ...

  20. Evaluation of health assessment skills.

    PubMed

    Wilbur, J

    1989-01-01

    This article presents the reliability and validity data on a checklist used to evaluate health assessment skills. In 1982, the nurse practitioner faculty at a large midwestern university acknowledged that health assessment skills were basic to the preparation of all nurses and made the decision to require these skills for entry into the graduate program. Because of the varying ways in which health assessment skills are acquired, the faculty saw the need to standardize the expected level of performance. An objective, three-page instrument to measure student competence in performing and recording a health history and physical examination for a client of any age is administered prior to beginning the nurse practitioner sequence of courses. The 91 objective items for this instrument are based on the traditional outline for writing up a client history and physical examination. Criteria for the items are located in an accompanying manual. The student achieves a "Yes" rating on an item if all the components of the item are performed and written according to the criteria. Reliability of the tool was assessed by 12 faculty members who participated in a simulated evaluation. The tool has been used to evaluate the skills of 165 nurses. Of these, 149 nurses were enrolled in a continuing education course, and 16 nurses tested out of a health assessment course.

  1. Cumulants, free cumulants and half-shuffles

    PubMed Central

    Ebrahimi-Fard, Kurusch; Patras, Frédéric

    2015-01-01

    Free cumulants were introduced as the proper analogue of classical cumulants in the theory of free probability. There is a mix of similarities and differences, when one considers the two families of cumulants. Whereas the combinatorics of classical cumulants is well expressed in terms of set partitions, that of free cumulants is described and often introduced in terms of non-crossing set partitions. The formal series approach to classical and free cumulants also largely differs. The purpose of this study is to put forward a different approach to these phenomena. Namely, we show that cumulants, whether classical or free, can be understood in terms of the algebra and combinatorics underlying commutative as well as non-commutative (half-)shuffles and (half-) unshuffles. As a corollary, cumulants and free cumulants can be characterized through linear fixed point equations. We study the exponential solutions of these linear fixed point equations, which display well the commutative, respectively non-commutative, character of classical and free cumulants. PMID:27547078

  2. Cumulants, free cumulants and half-shuffles.

    PubMed

    Ebrahimi-Fard, Kurusch; Patras, Frédéric

    2015-04-08

    Free cumulants were introduced as the proper analogue of classical cumulants in the theory of free probability. There is a mix of similarities and differences, when one considers the two families of cumulants. Whereas the combinatorics of classical cumulants is well expressed in terms of set partitions, that of free cumulants is described and often introduced in terms of non-crossing set partitions. The formal series approach to classical and free cumulants also largely differs. The purpose of this study is to put forward a different approach to these phenomena. Namely, we show that cumulants, whether classical or free, can be understood in terms of the algebra and combinatorics underlying commutative as well as non-commutative (half-)shuffles and (half-) unshuffles. As a corollary, cumulants and free cumulants can be characterized through linear fixed point equations. We study the exponential solutions of these linear fixed point equations, which display well the commutative, respectively non-commutative, character of classical and free cumulants.

  3. Development of a cumulative risk assessment for the Idaho National Engineering Laboratory`s waste area group 2

    SciTech Connect

    Burns, D.E.

    1995-11-01

    In 1989, the Idaho National Engineering Laboratory (INEL) was added to the Environmental Protection Agency`s (EPA) National Priorities List of Superfund sites. A Federal Facility Agreement and Consent Order (FFA/CO) for the INEL was signed by the Department of Energy, Idaho Operations Office (DOE-ID), EPA, and the State of Idaho in December 1991. The goal of this agreement is to ensure that potential or actual INEL releases of hazardous substances to the environment are thoroughly investigated in accordance with the National Contingency Plan (NCP) and that appropriate response actions are taken as necessary to protect human health and the environment. The Test Reactor Area (TRA) is included as Waste Area Group (WAG) 2 of ten INEL WAGs identified in the FFA/CO. WAG 2 consists of 13 operable units (OUs) which include pits, tanks, rubble piles, ponds, cooling towers, wells, french drains, perched water and spill areas. OU 2-13 is the Comprehensive Remedial Investigation/Feasibility Study (RI/FS) for WAG 2. The study presented here is a preliminary evaluation of the comprehensive risk for WAG-2. This investigation will be used as the basis of the WAG-2 comprehensive baseline risk assessment (BRA), and it will serve as a model for other INEL comprehensive risk assessments. The WAG-2 preliminary risk evaluation consisted of two broad phases. These phases were (1) a site and contaminant screening that was intended to support the identification of COPCs and risk assessment data gaps, and (2) an exposure pathway analysis that evaluated the comprehensive human health risks associated with WAG-2. The primary purposes of the investigation were to screen WAG-2 release sites and contaminants, and to identify risk assessment data gaps, so the investigation will be referred to as the WAG-2 Screening and Data Gap Analysis (SDGA) for the remainder of this report.

  4. Risk assessment of the cumulative acute exposure of Hungarian population to organophosphorus pesticide residues with regard to consumers of plant based foods.

    PubMed

    Zentai, Andrea; Szabó, István J; Kerekes, Kata; Ambrus, Árpád

    2016-03-01

    Based on the Hungarian pesticide residues monitoring data of the last five years and the consumption data collected within a 3-day dietary record survey in 2009 (more than 2 million pesticide residue results and almost 5000, 0-101-year-old consumers 3 non-consecutive-day personal fruit and vegetable consumption data), the cumulative acute exposure of organophosphorus pesticide residues was evaluated. The relative potency factor approach was applied, with acephate chosen as index compound. According to our conservative calculation method, applying the measured residues only, the 99.95% of the 99th percentiles of calculated daily intakes was at or below 87 μg/kgbwday, indicating that the cumulative acute exposure of the whole Hungarian population (including all age classes) to organophosphorus compounds was not a health concern.

  5. Health technology assessment in Malaysia.

    PubMed

    Sivalal, Sadasivan

    2009-07-01

    Malaysia, as a rapidly developing country, has been facing tremendous pressures in its attempts to maximize scarce resources. Despite this problem, Malaysia has made great strides in developing its health services, and has successfully provided good access to the population to healthcare services, reduced the incidence of many communicable diseases, and improved life expectancies and other global indices of health care, some of which are comparable to that of developed countries. The Health Technology Assessment (HTA) Unit was set up in Malaysia in August 1995 in the Ministry of Health Malaysia and has since grown tremendously in size and resources. To date, forty-three in-depth assessments have been carried out, and the recommendations of these assessments were subsequently implemented. In addition, approximately 140 rapid assessment reports were produced in response to requests from policy and decision makers. HTA has been able to provide input into formulation of national and Ministry of Health Malaysia policies, and provide a basis for clinical practice guidelines development, input into purchasing decisions, regulation of drugs, as well as advertisements related to health. A major challenge is sustainability of the program, to be able to have trained personnel competent to take on the demanding tasks of assessments and the sustained efforts that are required. In addition, there need to be constant efforts to create awareness of the utility of HTA so that its services are used and its full potential realized. The scope of services may also need to be expanded to include an early warning system. Malaysia has successfully implemented a health technology program that has had major impact on policy formulation and decision making at various levels. Challenges may be faced in sustaining and developing the program further.

  6. Health technology assessment in Greece.

    PubMed

    Liaropoulos, L; Kaitelidou, D

    2000-01-01

    In 1983 a health reform aimed to assure universal coverage and equity in the distribution of services in Greece. The reform implied state responsibility for the financing and delivery of services and a reduction of the private sector. The model was a Bismarckian scheme for social insurance. However, healthcare delivery remains fragmented and uncoordinated and the private sector is getting stronger. The dominant payment system is fee-for-service for the private sector and administered prices and salaries for public hospitals and social insurance funds. The many insurers have their own eligibility requirements, validation procedures, etc. Coverage of services by social security funds, probably among the most comprehensive in Europe, is determined more on historical and political grounds than on efficiency or cost-effectiveness. The system is plagued by problems, including geographical inequalities, overcentralization, bureaucratic management, poor incentives in the public sector, open-ended financing, inefficient use of hospital beds, and lack of cost-effectiveness. There are no specific legal provisions for the control of health technology. Technologies are introduced without standards or formal consideration of needs. There are no current efforts to control health technology in Greece. However, health technology assessment (HTA) has gained increasing visibility. In 1997 a law provided for a new government agency responsible for quality control, economic evaluation of health services, and HTA. The hope is that the new law may introduce evaluation and assessment elements into health policy formulation and assure that cost effectiveness, quality, and appropriate use of health technology will receive more attention.

  7. Tc-99 m diethylenetriamine-pentaacetic acid (DTPA): is it reliable for assessment of methotrexate-induced cumulative effect on renal filtration in rheumatoid arthritis patients?

    PubMed

    Amin, Amr; Effat, Dina; Goher, Nabila; Ramadan, Basma

    2013-12-01

    Methotrexate (MTX) is commonly employed as the initial DMARD used for the treatment of rheumatoid arthritis (RA). We aimed to contribute to the safety profile of MTX by assessing its cumulative effect on renal filtration. A total of 52 RA adult female patients with normal baseline serum creatinine and GFR at the initial diagnosis of the disease were included. Group 1 (G1) included 30 patients (mean age 40.4 ± 4.4 years) on MTX and NSAIDS, while 22 RA patients (mean age 38.5 ± 8.2 years) who received NSAIDs only served as control group (G2). Renal function was assessed by GFR measurement using technetium diethylenetriamine-pentaacetic acid (Tc-99 m DTPA) at a point of the study time corresponding to disease duration. Twenty-one out of thirty (70 %) in G1 showed reduced GFR compared to 6/22 (27.3 %) in G2 (P = 0.007), with 3.3 ± 0.5 % annual reduction in GFR. Reduced GFR in G1 showed significant negative correlation with age (r = -0.396, P = 0.005), MTX cumulative dose (r = -0.263, P = 0.049), MTX-intake duration (r = -0.293, P = 0.031) and NSAIDs-intake duration (r = -0.344, P = 0.014). Low-dose MTX has a slow cumulative effect on renal filtration manifested by GFR reduction overtime that could be monitored by Tc-99 m DTPA.

  8. Cumulative Effects of Growing Up in Separate and Unequal Neighborhoods on Racial Disparities in Self-rated Health in Early Adulthood.

    PubMed

    Kravitz-Wirtz, Nicole

    2016-12-01

    Evidence suggests that living in a socioeconomically deprived neighborhood is associated with worse health. Yet most research relies on cross-sectional data, which implicitly ignore variation in longer-term exposure that may be more consequential for health. Using data from the 1970 to 2011 waves of the Panel Study of Income Dynamics merged with census data on respondents' neighborhoods (N = 1,757), this study estimates a marginal structural model with inverse probability of treatment and censoring weights to examine: (1) whether cumulative exposure to neighborhood disadvantage from birth through age 17 affects self-rated health in early adulthood, and (2) the extent to which variation in such exposure helps to explain racial disparities therein. Findings reveal that prolonged exposure to neighborhood disadvantage throughout childhood and adolescence is strikingly more common among nonwhite versus white respondents and is associated with significantly greater odds of experiencing an incidence of fair or poor health in early adulthood.

  9. Sensor based soil health assessment

    USDA-ARS?s Scientific Manuscript database

    Quantification and assessment of soil health involves determining how well a soil is performing its biological, chemical, and physical functions relative to its inherent potential. Due to high cost, labor requirements, and soil disturbance, traditional laboratory analyses cannot provide high resolut...

  10. Brentwood Community Health Care Assessment

    PubMed Central

    Goodman, Melody S.; Gonzalez, Maria; Gil, Sandra; Si, Xuemei; Pashoukos, Judith L.; Stafford, Jewel D.; Ford, Elsa; Pashoukos, Dennis A.

    2015-01-01

    Background The Community Alliance for Research Empowering Social Change (CARES) is an academic–community research partnership designed to train community members on research methods and develop the infrastructure for community-based participatory research (CBPR) to examine and address racial/ethnic health disparities. The Brentwood Community Health Assessment (BCHA) was developed through a CBPR pilot project grant from CARES. Objectives The purpose of the BCHA is to assess health care utilization and identify existing barriers to health care access among a multi-ethnic community in the Hamlet of Brentwood, New York. Methods Using CBPR approaches, the community–academic research partnership develop the study design and survey instrument. Trained Bilingual (English/Spanish) data collectors verbally administered surveys door-to-door to residents of Brentwood from October 2010 to May 2011. Inclusion criteria required participants to be at least 18 years of age and speak either English or Spanish. Results Overall, 232 residents completed the BCHA; 49% were male, 66% Hispanic, 13% non-Hispanic White, 13% non-Hispanic Black, 29% had less than a high school education, and 33% were born in United States. The assessment results revealed that most residents are able to access health care when needed and the most significant barriers to health care access are insurance and cost. Conclusions We describe the community–academic partnered process used to develop and implement the BCHA and report assessment findings; the community-partnered approach improved data collection and allowed access into one of Suffolk County’s most vulnerable communities. PMID:24859100

  11. Health technology assessment in osteoporosis.

    PubMed

    Hiligsmann, Mickael; Kanis, John A; Compston, Juliet; Cooper, Cyrus; Flamion, Bruno; Bergmann, Pierre; Body, Jean-Jacques; Boonen, Steven; Bruyere, Olivier; Devogelaer, Jean-Pierre; Goemaere, Stefan; Kaufman, Jean-Marc; Rozenberg, Serge; Reginster, Jean-Yves

    2013-07-01

    We review the various aspects of health technology assessment in osteoporosis, including epidemiology and burden of disease, and assessment of the cost-effectiveness of recent advances in the treatment of osteoporosis and the prevention of fracture, in the context of the allocation of health-care resources by decision makers in osteoporosis. This article was prepared on the basis of a symposium held by the Belgian Bone Club and the discussions surrounding that meeting and is based on a review and critical appraisal of the literature. Epidemiological studies confirm the immense burden of osteoporotic fractures for patients and society, with lifetime risks of any fracture of the hip, spine, and forearm of around 40 % for women and 13 % for men. The economic impact is also large; for example, Europe's six largest countries spent €31 billion on osteoporotic fractures in 2010. Moreover, the burden is expected to increase in the future with demographic changes and increasing life expectancy. Recent advances in the management of osteoporosis include novel treatments, better fracture-risk assessment notably via fracture risk algorithms, and improved adherence to medication. Economic evaluation can inform decision makers in health care on the cost-effectiveness of the various interventions. Cost-effectiveness analyses suggest that the recent advances in the prevention and treatment of osteoporosis may constitute an efficient basis for the allocation of scarce health-care resources. In summary, health technology assessment is increasingly used in the field of osteoporosis and could be very useful to help decision makers efficiently allocate health-care resources.

  12. Early health assessment of refugees.

    PubMed

    Benson, Jill; Smith, Mitchell M

    2007-01-01

    This is the first in a series of articles looking at refugee health in Australian general practice. Each year approximately 13,000 refugees settle in Australia, mostly from countries with minimal public and personal health resources. They may present in a very different manner to the rest of the population and are at risk of unfamiliar and complex illnesses. Their health care can be difficult and time consuming and the general practitioners who supply this care need support, guidance and adequate remuneration. The new Medicare Benefits Schedule item numbers 714 and 716 are an acknowledgment by the Australian government of these concerns of community GPs who are seeing refugees for their initial health assessments. This article discusses, in the context of the new item number, some of the broader issues that are important when seeing refugees for the first time.

  13. Unknown age in health disorders: A method to account for its cumulative effect and an application to feline viruses interactions.

    PubMed

    Hellard, Eléonore; Pontier, Dominique; Siberchicot, Aurélie; Sauvage, Frank; Fouchet, David

    2015-06-01

    Parasite interactions have been widely evidenced experimentally but field studies remain rare. Such studies are essential to detect interactions of interest and access (co)infection probabilities but face methodological obstacles. Confounding factors can create statistical associations, i.e. false parasite interactions. Among them, host age is a crucial covariate. It influences host exposition and susceptibility to many infections, and has a mechanical effect, older individuals being more at risk because of a longer exposure time. However, age is difficult to estimate in natural populations. Hence, one should be able to deal at least with its cumulative effect. Using a SI type dynamic model, we showed that the cumulative effect of age can generate false interactions theoretically (deterministic modeling) and with a real dataset of feline viruses (stochastic modeling). The risk to wrongly conclude to an association was maximal when parasites induced long-lasting antibodies and had similar forces of infection. We then proposed a method to correct for this effect (and for other potentially confounding shared risk factors) and made it available in a new R package, Interatrix. We also applied the correction to the feline viruses. It offers a way to account for an often neglected confounding factor and should help identifying parasite interactions in the field, a necessary step towards a better understanding of their mechanisms and consequences. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

  14. Greater Age-Related Decline in Markers of Physical, Mental and Cognitive Health among Israeli Older Adults Exposed to Lifetime Cumulative Adversity

    PubMed Central

    Shrira, Amit

    2013-01-01

    Objectives This longitudinal investigation addressed whether and how lifetime cumulative adversity and depressive symptoms moderated age-related decline in markers of physical, mental and cognitive health. Method 1,248 older adults (mean age = 62 at Wave 1) who completed the first two waves of the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel) reported on exposure to potentially traumatic life events, depressive symptoms, and three outcomes – disability, quality of life and cognitive markers. Results Age was related to greater functional decline in outcome measures across the two waves (i.e., increase in disability and decrease in quality of life and cognitive functioning). This age-related decline became stronger as lifetime adversity increased. A three-way interaction showed that the greatest age-related functional decline in outcome measures was especially salient among those with high level of lifetime adversity and high level of depressive symptoms. Conclusion Lifetime cumulative adversity is associated with a more noticeable process of age-related dysfunction across various markers of health. Although the majority of older adults are resilient to lifetime adversity, prevention and intervention programs should be aimed at mitigating the pronounced senescence observed when adversity accumulated to a large degree, and especially when it is accompanied with high level of distress. PMID:24328416

  15. Microvascular fluid filtration capacity (Kf) assessed with cumulative small venous pressure steps and with various degrees of tilt.

    PubMed

    Christ, F; Gamble, J; Baranov, V; Kotov, A; Gartside, I; Nehring, I; Messmer, K

    1999-07-28

    Orthostatic dysregulation is a frequent phenomenon in pilots experiencing extreme G forces and after prolonged exposures to microgravity in cosmonauts. We used non-invasive venous congestion plethysmography (VCP) to study microcirculatory changes and the ability to activate peripheral and centrally mediated protective mechanisms during various degrees of tilt, which we used as an orthostatic challenge. The study, which was approved by the local ethical committee of the Institute of Biomedical Problems, was performed on six healthy 20 - 26 years old male volunteers. We applied 6 - 8 cumulative small venous congestion pressure steps (8 mmHg) to the thigh and determined the fluid filtration capacity (Kf), the linear relationship between cuff pressure (Pcuff) and measured fluid filtration (Jv). We then measured the fluid filtration (Jv) response to varying cumulative degrees of tilt, starting at 0 degrees followed by head down -8 degrees -15 degrees, -30 degrees -15 degrees, -8 degrees, 0 degrees, and then head up 15 degrees, 30 degrees, 70 degrees, 30 degrees, 15 degrees and 0 degrees. Each tilt stage was sustained for 15 minutes. The change in hydrostatic load, at the level of the strain gauge, was determined by measuring the difference in vertical height between the right atrium and mid calf at the level of the gauge. Limb arterial blood flow was measured and lung function tests were performed before and after the small cumulative pressure step protocol, as well as at the end of each tilt step. No significant changes in blood pressure (BP) and heart rate (HR) occurred during the cumulative pressure step protocol. However, an increase in HR was observed during the tilt, but only reached significance at 30 degrees and 70 degrees. The mean Kf value measured with small cumulative pressure steps was 3.25 +/- 0.5 (10(-3) ml.100 ml tissue(-1) mmHg(-1) = KfU), which was significantly (p < 0.005) higher than the value obtained using tilt to increase the hydrostatic load (0

  16. Assessing cumulative impacts of forest development on the distribution of furbearers using expert-based habitat modeling.

    PubMed

    Bridger, M C; Johnson, C J; Gillingham, M P

    2016-03-01

    Cumulative impacts of anthropogenic landscape change must be considered when managing and conserving wildlife habitat. Across the central-interior of British Columbia, Canada, industrial activities are altering the habitat of furbearer species. This region has witnessed unprecedented levels of anthropogenic landscape change following rapid development in a number of resource sectors, particularly forestry. Our objective was to create expert-based habitat models for three furbearer species: fisher (Pekania pennanti), Canada lynx (Lynx canadensis), and American marten (Martes americana) and quantify habitat change for those species. We recruited 10 biologist and 10 trapper experts and then used the analytical hierarchy process to elicit expert knowledge of habitat variables important to each species. We applied the models to reference landscapes (i.e., registered traplines) in two distinct study areas and then quantified the change in habitat availability from 1990 to 2013. There was strong agreement between expert groups in the choice of habitat variables and associated scores. Where anthropogenic impacts had increased considerably over the study period, the habitat models showed substantial declines in habitat availability for each focal species (78% decline in optimal fisher habitat, 83% decline in optimal lynx habitat, and 79% decline in optimal marten habitat). For those traplines with relatively little forest harvesting, the habitat models showed no substantial change in the availability of habitat over time. The results suggest that habitat for these three furbearer species declined significantly as a result of the cumulative impacts of forest harvesting. Results of this study illustrate the utility of expert knowledge for understanding large-scale patterns of habitat change over long time periods.

  17. Health Literacy and Adult Basic Education Assessments

    ERIC Educational Resources Information Center

    Golbeck, Amanda L.; Ahlers-Schmidt, Carolyn R.; Paschal, Angelia M.

    2005-01-01

    Adult basic education (ABE) is an ideal venue for developing health literacy skills. Literacy and numeracy assessments used in ABE were identified and the most common were examined for health components. Only the Comprehensive Adult Student Assessment System (CASAS) included health. The two most common health literacy assessments used in general…

  18. Health Literacy and Adult Basic Education Assessments

    ERIC Educational Resources Information Center

    Golbeck, Amanda L.; Ahlers-Schmidt, Carolyn R.; Paschal, Angelia M.

    2005-01-01

    Adult basic education (ABE) is an ideal venue for developing health literacy skills. Literacy and numeracy assessments used in ABE were identified and the most common were examined for health components. Only the Comprehensive Adult Student Assessment System (CASAS) included health. The two most common health literacy assessments used in general…

  19. Health assessment of self-employed hairdressers in France.

    PubMed

    Deschamps, Frederic; Langrand, Jerome; Lesage, Francois-Xavier

    2014-01-01

    Hairdressers have a high incidence of occupational diseases, owing to excessive wet work and exposure to chemical substances. The objective of this study was to assess the prevalence of occupational diseases in a population of self-employed hairdressers, matched for age and sex with a control group of wage-earning hairdressers. A health questionnaire was administered to both groups by an occupational health practitioner. Irritative skin diseases were reported by 1.5% of the self-employed hairdressers versus 9.1% of the wage earners. Conversely, the rates of respiratory diseases and cumulative musculoskeletal injuries were much higher among self-employed hairdressers. This study shows that the overall health of self-employed hairdressers is lower than that of their wage-earning counterparts. This can be attributed to several aspects of work exposure, organization, including longer working hours, fewer protective measures and the absence of preventive medicine in the workplace.

  20. Merging the fields of mental health and social enterprise: lessons from abroad and cumulative findings from research with homeless youths.

    PubMed

    Ferguson, Kristin M

    2012-08-01

    Despite the growing integration of supported employment within the mental health system in the United States as well as the widespread use of social enterprises abroad, the fields of mental health and social enterprises remain largely separate in the USA. The mental health field currently lacks a response that strengthens homeless youths' existing human and social capital, provides them with marketable job skills and employment, and impacts their mental health. To address this gap, this paper establishes a case for using social enterprises with homeless youths, drawing on both global precedents and findings from a mixed-methods study of a social enterprise intervention with homeless youths. Recommendations are offered for how to integrate social enterprises with mental health treatment as well as how to evaluate their impact on mental health outcomes.

  1. The Effects of Cumulative Victimization on Mental Health Among Lesbian, Gay, Bisexual, and Transgender Adolescents and Young Adults

    PubMed Central

    Andrews, Rebecca; Puckett, Jae A.

    2016-01-01

    Objectives. To examine the effects of the cumulative victimization experienced by lesbian, gay, bisexual, and transgender youths on mental disorders. Methods. We recruited 248 participants from the Chicago, Illinois, area in 7 waves of data collected over 4 years, beginning in 2007 (83.1% retention rate). Mean age at enrollment was 18.7 years, and 54.7% were Black. We measured depression and posttraumatic stress disorder using structured psychiatric interviews. Results. Latent class analyses of victimization over time identified a 4-class solution. Class 1 (65.4%) had low, decreasing victimization. Class 2 (10.3%) had moderate, increasing victimization. Class 3 (5.1%) had high, steady victimization. Class 4 (19.2%) had high, decreasing victimization. Controlling for baseline diagnoses and birth sex, lesbian, gay, bisexual, and transgender youths in classes 2 and 3 were at higher risk for depression than were those in class 1; youths in classes 2, 3, and 4 were at elevated risk for posttraumatic stress disorder. Conclusions. Lesbian, gay, bisexual, and transgender youths with steadily high or increasing levels of victimization from adolescence to early adulthood are at higher risk for depression and posttraumatic stress disorder. PMID:26794175

  2. CHANGING HEALTH TECHNOLOGY ASSESSMENT PARADIGMS?

    PubMed

    Husereau, Don; Henshall, Chris; Sampietro-Colom, Laura; Thomas, Sarah

    2016-01-01

    Health technology assessment (HTA) has to innovate to best support changing health system environments and to help provide access to valuable innovation under fiscal constraint. Issues associated with changing HTA paradigms were identified through scoping and explored through deliberation at a meeting of industry and HTA leaders. Five broad areas of change (engagement, scientific dialogue, research prioritization, adaptive approaches, and real world data) were identified. The meeting focused on two themes derived from these: re-thinking scientific dialogue and multi-stakeholder engagement, and re-thinking value, affordability, and access. Earlier and ongoing engagement to steer the innovation process and help achieve appropriate use across the technology lifecycle was perceived as important but would be resource intensive and would require priority setting. Patients need to be involved throughout, and particularly at the early stages. Further discussion is needed on the type of body best suited to convening the dialogue required. There was agreement that HTA must continue to assess value, but views differed on the role that HTA should play in assessing affordability and on appropriate responses to challenges around affordability. Enhanced horizon scanning could play an important role in preparing for significant future investments. Early and ongoing multi-stakeholder engagement and revisiting approaches to valuing innovation are required. Questions remain as to the most appropriate role for HTA bodies. Changing HTA paradigms extend HTA's traditional remit of being responsive to decision-makers demands to being more proactive and considering whole system value.

  3. Assessing the cumulative effect of the weather variability on wetlands and the hydrological connection between wetlands and downstream waters

    NASA Astrophysics Data System (ADS)

    Yeo, I. Y.; Lang, M. W.; Lee, S.; Mccarty, G.; Peng, Y.; Huang, C.

    2014-12-01

    Wetlands are crucial ecosystem features that provide important ecological benefits to improve water quality and reduce the climate change impact. This ecosystem functioning of wetlands is largely dependent upon their hydrological characteristics and linkage to the downstream waters. However, the cumulative impacts of the climate on wetlands and the hydrological connection between wetlands and downstream waters have been rarely quantified at the landscape scale. This study reports findings from time series satellite observation that can illustrate the changes in extent of wetland inundation at a high spatial resolution (30-m) over the period 1985-2010. This remote sensing based observation provides crucial information to gain insights onto inter-annual variability of inundation dynamics, and we analyze this product with the drought indices, streamflows, the USFS NWI-hydrologic modifier. This study focuses on natural palustrine wetlands, densely distributed in the coastal plain of the Chesapeake Bay Watershed (CBW). We observe inundation patterns change in response to the weather variability, and it is proportionally related to the downstream flow discharge. While those wetlands with a longer hydro-period (i.e., permanently ponded wetlands during the growing season) show the strongest relationship with stream discharge (including baseflow, contributed from the shallow groundwater), inundation patterns of headwater/isolated wetlands are also strongly related to stream discharge. It shows the strong relationship between wetlands and downstream water regardless of geographic isolation and their mutual reliance on groundwater. The study provides the support for the conservation of wetlands through section 404 of the Clean Water Act.

  4. Use of the Learning Curve-Cumulative Summation Test for Leopold Maneuvers Assessment in a Simulator: A Pilot Study.

    PubMed

    Díez-Goñi, Nieves; Guillén, Sergio; Rodríguez-Díez, María C; Pineda, Laura; Alcázar, Juan L

    2015-10-01

    Simulation enables medical students to practice clinical skills in a safe environment. Graduates in medicine must be able to correctly perform an examination on a pregnant woman using Leopold maneuvers. Learning curves-cumulative summation (LC-CUSUM) may help determine when the student has achieved a specific skill. Our objective was to perform the LC-CUSUM test regarding the ability of students to correctly carry out Leopold maneuvers; a pregnancy simulator was used, transferring the results to a clinical setting. Five medical students were trained to carry out Leopold maneuvers using the simulator. Each student performed maneuvers for 50 cases of different fetus positions; a LC-CUSUM was plotted for each student. Afterward, the students performed the Leopold maneuvers on 5 pregnant women. Of the 5 students, 3 achieved a level of proficiency; the attempts needed for reaching this level were 13, 13, and 37, respectively. The other 2 students did not reach proficiency level. Of the students who became successfully proficient with the simulator, one of them attained a 100% success rate in pregnant patients, whereas the other two had success rates of 80%. The students who did not achieve a level of competency with the simulator had only a 60% success rate with patients. Because of the differences observed between students in the number of attempts needed for achieving proficiency in Leopold maneuvers, we believe that each student should build his/her own learning curve. Achieving competency in carrying out Leopold maneuvers using the simulator could be transferable to patients.

  5. Health technology assessment in Mexico.

    PubMed

    Gómez-Dantés, Octavio; Frenk, Julio

    2009-07-01

    The history of health technology assessment (HTA) in Mexico is examined, starting with the efforts to incorporate this topic into the policy agenda and culminating with the recent creation of a specialized public agency. Information was gathered through a bibliographic search and interviews with actors involved in HTA in Mexico. HTA efforts were developed in Mexico since the mid-1980s with the participation both of academics and of policy makers, a relationship that eventually led to the creation of the Center for Technological Excellence within the Ministry of Health. Institutionalization of HTA in resource-constrained settings requires the development of a critical mass of researchers involved in this field, the implementation of information efforts, and the establishment of strong relationships between HTA experts and policy makers.

  6. Cumulative Retrospective Exposure Assessment (REA) as a predictor of amphibole asbestos lung burden: validation procedures and results for industrial hygiene and pathology estimates

    PubMed Central

    Roggli, Victor L.; Boelter, Fred W.; Rasmuson, Eric J.; Redinger, Charles F.

    2014-01-01

    Context A detailed evaluation of the correlation and linearity of industrial hygiene retrospective exposure assessment (REA) for cumulative asbestos exposure with asbestos lung burden analysis (LBA) has not been previously performed, but both methods are utilized for case-control and cohort studies and other applications such as setting occupational exposure limits. Objective (a) To correlate REA with asbestos LBA for a large number of cases from varied industries and exposure scenarios; (b) to evaluate the linearity, precision, and applicability of both industrial hygiene exposure reconstruction and LBA; and (c) to demonstrate validation methods for REA. Methods A panel of four experienced industrial hygiene raters independently estimated the cumulative asbestos exposure for 363 cases with limited exposure details in which asbestos LBA had been independently determined. LBA for asbestos bodies was performed by a pathologist by both light microscopy and scanning electron microscopy (SEM) and free asbestos fibers by SEM. Precision, reliability, correlation and linearity were evaluated via intraclass correlation, regression analysis and analysis of covariance. Plaintiff’s answers to interrogatories, work history sheets, work summaries or plaintiff’s discovery depositions that were obtained in court cases involving asbestos were utilized by the pathologist to provide a summarized brief asbestos exposure and work history for each of the 363 cases. Results Linear relationships between REA and LBA were found when adjustment was made for asbestos fiber-type exposure differences. Significant correlation between REA and LBA was found with amphibole asbestos lung burden and mixed fiber-types, but not with chrysotile. The intraclass correlation coefficients (ICC) for the precision of the industrial hygiene rater cumulative asbestos exposure estimates and the precision of repeated laboratory analysis were found to be in the excellent range. The ICC estimates were performed

  7. Human Health, Environmental and Economic Assessments

    EPA Pesticide Factsheets

    Human health and environmental assessments characterize health and environmental risks associated with exposure to pollution. Economic assessments evaluate the cost and economic impact of a policy or regulation & can estimate economic benefits.

  8. Ground-Truthing Validation to Assess the Effect of Facility Locational Error on Cumulative Impacts Screening Tools

    EPA Science Inventory

    Over the past three decades, a number of researchers in the fields of environmental justice (EJ) and environmental public health have highlighted the existence of regional and local scale differences in exposure to air pollution, as well as calculated health risk and impacts of a...

  9. Ground-Truthing Validation to Assess the Effect of Facility Locational Error on Cumulative Impacts Screening Tools

    EPA Science Inventory

    Over the past three decades, a number of researchers in the fields of environmental justice (EJ) and environmental public health have highlighted the existence of regional and local scale differences in exposure to air pollution, as well as calculated health risk and impacts of a...

  10. Racial/Ethnic Disparities in Cumulative Environmental Health Impacts in California: Evidence From a Statewide Environmental Justice Screening Tool (CalEnviroScreen 1.1).

    PubMed

    Cushing, Lara; Faust, John; August, Laura Meehan; Cendak, Rose; Wieland, Walker; Alexeeff, George

    2015-11-01

    We used an environmental justice screening tool (CalEnviroScreen 1.1) to compare the distribution of environmental hazards and vulnerable populations across California communities. CalEnviroScreen 1.1 combines 17 indicators created from 2004 to 2013 publicly available data into a relative cumulative impact score. We compared cumulative impact scores across California zip codes on the basis of their location, urban or rural character, and racial/ethnic makeup. We used a concentration index to evaluate which indicators were most unequally distributed with respect to race/ethnicity and poverty. The unadjusted odds of living in one of the 10% most affected zip codes were 6.2, 5.8, 1.9, 1.8, and 1.6 times greater for Hispanics, African Americans, Native Americans, Asian/Pacific Islanders, and other or multiracial individuals, respectively, than for non-Hispanic Whites. Environmental hazards were more regressively distributed with respect to race/ethnicity than poverty, with pesticide use and toxic chemical releases being the most unequal. Environmental health hazards disproportionately burden communities of color in California. Efforts to reduce disparities in pollution burden can use simple screening tools to prioritize areas for action.

  11. Cumulative Risk of Colon Cancer up to Age 70 Years by Risk Factor Status Using Data From the Nurses’ Health Study

    PubMed Central

    Colditz, Graham A.; Giovannucci, Edward L.; Fuchs, Charles S.; Rosner, Bernard A.

    2009-01-01

    The authors developed a comprehensive model of colon cancer incidence that allows for nonproportional hazards and accounts for the temporal nature of risk factors. They estimated relative risk based on cumulative incidence of colon cancer by age 70 years. Using multivariate, nonlinear Poisson regression, they determined colon cancer risk among 83,767 participants in the Nurses’ Health Study. The authors observed 701 cases of colon cancer between 1980 and June 1, 2004. There was increased risk for a positive family history of colon or rectal cancer (55%), 10 or more pack-years of cigarette smoking before age 30 years (16%), and tallness (67 inches (170 cm) vs. 61 inches (155 cm): 19%). Reduced risk was observed for current postmenopausal hormone use (−23%), being physically active (21 metabolic equivalent (MET)-hours/week vs. 2 MET-hours/week: −49%), taking aspirin (7 tablets/week vs. none: −29%), and being screened (−24%). Women who smoked, had a consistently high relative weight, had a low physical activity level, consumed red or processed meat daily, were never screened, and consumed low daily amounts of folate had almost a 4-fold higher cumulative risk of colon cancer by age 70 years. For women with a high risk factor profile, adopting a healthier lifestyle could dramatically reduce colon cancer risk. PMID:19723749

  12. Racial/Ethnic Disparities in Cumulative Environmental Health Impacts in California: Evidence From a Statewide Environmental Justice Screening Tool (CalEnviroScreen 1.1)

    PubMed Central

    Faust, John; August, Laura Meehan; Cendak, Rose; Wieland, Walker; Alexeeff, George

    2015-01-01

    Objectives. We used an environmental justice screening tool (CalEnviroScreen 1.1) to compare the distribution of environmental hazards and vulnerable populations across California communities. Methods. CalEnviroScreen 1.1 combines 17 indicators created from 2004 to 2013 publicly available data into a relative cumulative impact score. We compared cumulative impact scores across California zip codes on the basis of their location, urban or rural character, and racial/ethnic makeup. We used a concentration index to evaluate which indicators were most unequally distributed with respect to race/ethnicity and poverty. Results. The unadjusted odds of living in one of the 10% most affected zip codes were 6.2, 5.8, 1.9, 1.8, and 1.6 times greater for Hispanics, African Americans, Native Americans, Asian/Pacific Islanders, and other or multiracial individuals, respectively, than for non-Hispanic Whites. Environmental hazards were more regressively distributed with respect to race/ethnicity than poverty, with pesticide use and toxic chemical releases being the most unequal. Conclusions. Environmental health hazards disproportionately burden communities of color in California. Efforts to reduce disparities in pollution burden can use simple screening tools to prioritize areas for action. PMID:26378826

  13. A Framework for Assessing Health Risk of Environmental ...

    EPA Pesticide Factsheets

    EPA released the final report entitled, A Framework for Assessing Health Risk of Environmental Exposures to Children, which examines the impact of potential exposures during developmental lifestages and subsequent lifestages, while emphasizing the iterative nature of the analysis phase with a multidisciplinary team. Major findings and conclusions: This report outlines the framework in which mode of action(s) (MOA) can be considered across life stages. The framework is based upon existing approaches adopted in the Framework on Cumulative Risk Assessment and identifies existing guidance, guidelines and policy papers that relate to children's health risk assessment. It emphasizes the importance of an iterative approach between hazard, dose response, and exposure analyses. In addition, it includes discussion of principles for weight of evidence consideration across life stages for the hazard characterization database.Key science/assessment issues:This framework addresses the questions of why and how an improved children's health risk assessment will strengthen the overall risk assessment process across the Agency. This approach improves the scientific explanation of children's risk and will add value by: 1) providing for a more complete evaluation of the potential for vulnerability at different life stages, including a focus on the underlying biological events and critical developmental periods for incorporating MOA considerations; 2) evaluating of the potential fo

  14. A Framework for Assessing Health Risk of Environmental ...

    EPA Pesticide Factsheets

    EPA released the final report entitled, A Framework for Assessing Health Risk of Environmental Exposures to Children, which examines the impact of potential exposures during developmental lifestages and subsequent lifestages, while emphasizing the iterative nature of the analysis phase with a multidisciplinary team. Major findings and conclusions: This report outlines the framework in which mode of action(s) (MOA) can be considered across life stages. The framework is based upon existing approaches adopted in the Framework on Cumulative Risk Assessment and identifies existing guidance, guidelines and policy papers that relate to children's health risk assessment. It emphasizes the importance of an iterative approach between hazard, dose response, and exposure analyses. In addition, it includes discussion of principles for weight of evidence consideration across life stages for the hazard characterization database.Key science/assessment issues:This framework addresses the questions of why and how an improved children's health risk assessment will strengthen the overall risk assessment process across the Agency. This approach improves the scientific explanation of children's risk and will add value by: 1) providing for a more complete evaluation of the potential for vulnerability at different life stages, including a focus on the underlying biological events and critical developmental periods for incorporating MOA considerations; 2) evaluating of the potential fo

  15. Assessing cumulative watershed stressors: Using LIDAR to assess the amount of open lands and young forest associated with in-channel erosion for North Shore tributaries

    EPA Science Inventory

    Hydrologists with the US Forest Service have demonstrated the cumulative impacts of land use change, particularly additional open lands and young forest (< 15 yrs) on bank full flows and in-channel erosion. Mapping these impacts has been difficult due to challenges associated ...

  16. Assessing cumulative watershed stressors: Using LIDAR to assess the amount of open lands and young forest associated with in-channel erosion for North Shore tributaries

    EPA Science Inventory

    Hydrologists with the US Forest Service have demonstrated the cumulative impacts of land use change, particularly additional open lands and young forest (< 15 yrs) on bank full flows and in-channel erosion. Mapping these impacts has been difficult due to challenges associated ...

  17. Exposure to phthalates in 5-6 years old primary school starters in Germany--a human biomonitoring study and a cumulative risk assessment.

    PubMed

    Koch, Holger M; Wittassek, Matthias; Brüning, Thomas; Angerer, Jürgen; Heudorf, Ursel

    2011-06-01

    We determined the internal exposure of 111 German primary school starters by analyzing urinary metabolites of six phthalates: butyl benzyl phthalate (BBzP), di-iso-butyl phthalate (DiBP), di-n-butyl phthalate (DnBP), di (2-ethylhexyl) phthalate (DEHP), di-iso-nonyl phthalate (DiNP) and di-iso-decylphthalate (DiDP). From the urinary metabolite levels, we calculated daily intakes and related these values to Tolerable Daily Intake (TDI) values. By introducing the concept of a relative cumulative Tolerable Daily Intake (TDI(cum)) value, we tried to account for the cumulative exposure to several of the above-mentioned phthalates. The TDI(cum) was derived as follows: the daily intake (DI) calculated from the metabolite level was divided by the TDI for each phthalate; this ratio was multiplied by 100% indicating the TDI percentage for which the DI accounted. Finally the % TDIs of the different phthalates were totalled to get the TDI(cum). A TDI(cum) above 100% is a potential cause for concern. We confirmed the ubiquitous exposure of the children to all phthalates investigated. Exposures were within range of levels previously reported for GerES, albeit slightly lower. Regarding daily intakes, two children exceeded the TDI for DnBP, whereas one child closely approached the TDI for DEHP. 24% of the children exceeded the TDI(cum) for the three most critical phthalates: DEHP, DnBP and DiBP. Furthermore, 54% of the children had total exposures that used up more than 50% the TDI(cum). Therefore, the overall exposure to a number of phthalates, and the knowledge that these phthalates (and other anti-androgens) act in a dose-additive manner, urgently warrants a cumulative risk assessment approach.

  18. Probabilistic acute risk assessment of cumulative exposure to organophosphorus and carbamate pesticides from dietary vegetables and fruits in Shanghai populations.

    PubMed

    Li, Fan; Yuan, Yaqun; Meng, Pai; Wu, Min; Li, Shuguang; Chen, Bo

    2017-02-03

    Organophosphorus pesticides (OPs) and carbamate pesticides (CPs) are among the most widely used pesticides in China, playing a major role in protecting agricultural commodities. In this study, we determined the cumulative acute exposure to OPs and CPs of Shanghai residents from vegetables and fruits (VFs). The food consumption data were obtained from the Shanghai Food Consumption Survey (SHFCS) of 2012-14 including a total of 1973 participants aged 2-90 years. The pesticide residue data were obtained from the Shanghai monitoring programme during 2008-11 with 34 organophosphates and 11 carbamates analysed in a total of 5335 samples of VFs. A probabilistic approach was performed as recommended by the EFSA, using the optimistic model with non-detects set as zero and with processing factors (PFs) being used and the pessimistic model with non-detects replaced by limit of detection (LOD) and without PFs. We used the relative potency factor (RPF) method to normalise the various pesticides to the index compound (IC) of methamidophos and chlorpyrifos separately. Only in the pessimistic model using methamidophos as the IC was there was small risk of exposure exceeding the ARfD (3 µg kg(-)(1) bw day(-)(1)) in the populations of preschool children (0.029%), school-age children (0.022%) and adults (0.002%). There were no risk of exposure exceeding the ARfD of methamidophos in the optimistic model and of chlorpyrifos (100 µg kg(-)(1) bw day(-)(1)) in both optimistic and pessimistic models in all three populations. Considering the Chinese habits of overwhelmingly eating processed food (vegetables being cooked, and fruits being washed or peeled), we conclude that little acute risk was found for the exposure to VF-sourced OPs and CPs in Shanghai.

  19. Model-based tolerance intervals derived from cumulative historical composition data: application for substantial equivalence assessment of a genetically modified crop.

    PubMed

    Hong, Bonnie; Fisher, Tracey L; Sult, Theresa S; Maxwell, Carl A; Mickelson, James A; Kishino, Hirohisa; Locke, Mary E H

    2014-10-08

    Compositional analysis is a requisite component of the substantial equivalence framework utilized to assess genetically modified (GM) crop safety. Statistical differences in composition data between GM and non-GM crops require a context in which to determine biological relevance. This context is provided by surveying the natural variation of key nutrient and antinutrient levels within the crop population with a history of safe use. Data accumulated from various genotypes with a history of safe use cultivated in relevant commercial crop-growing environments over multiple seasons are discussed as the appropriate data representative of this natural variation. A model-based parametric tolerance interval approach, which accounts for the correlated and unbalanced data structure of cumulative historical data collected from multisite field studies conducted over multiple seasons, is presented. This paper promotes the application of this tolerance interval approach to generate reference ranges for evaluation of the biological relevance of statistical differences identified during substantial equivalence assessment of a GM crop.

  20. Evaluation of community health assessment in Kansas.

    PubMed

    Curtis, Denice C

    2002-07-01

    This article evaluates the status of community health assessment in Kansas. It describes community characteristics associated with community health assessment completion, factors contributing to success, as well as barriers and limitations that prevented Kansas communities from initiating a community health assessment or completing the process. Survey findings show that certain community characteristics such as interagency cooperation, history of success at problem solving, and shared decision-making power are strongly associated with completion of a community health assessment. Results also indicate that factors such as lack of leadership, money, and time as well as poor functioning coalitions may hinder the completion of community health assessment.

  1. EPA Workshop on Epigenetics and Cumulative Risk ...

    EPA Pesticide Factsheets

    Agenda Download the Workshop Agenda (PDF) The workshop included presentations and discussions by scientific experts pertaining to three topics (i.e., epigenetic changes associated with diverse stressors, key science considerations in understanding epigenetic changes, and practical application of epigenetic tools to address cumulative risks from environmental stressors), to address several questions under each topic, and included an opportunity for attendees to participate in break-out groups, provide comments and ask questions. Workshop Goals The workshop seeks to examine the opportunity for use of aggregate epigenetic change as an indicator in cumulative risk assessment for populations exposed to multiple stressors that affect epigenetic status. Epigenetic changes are specific molecular changes around DNA that alter expression of genes. Epigenetic changes include DNA methylation, formation of histone adducts, and changes in micro RNAs. Research today indicates that epigenetic changes are involved in many chronic diseases (cancer, cardiovascular disease, obesity, diabetes, mental health disorders, and asthma). Research has also linked a wide range of stressors including pollution and social factors with occurrence of epigenetic alterations. Epigenetic changes have the potential to reflect impacts of risk factors across multiple stages of life. Only recently receiving attention is the nexus between the factors of cumulative exposure to environmental

  2. Cumulative Poisson Distribution Program

    NASA Technical Reports Server (NTRS)

    Bowerman, Paul N.; Scheuer, Ernest M.; Nolty, Robert

    1990-01-01

    Overflow and underflow in sums prevented. Cumulative Poisson Distribution Program, CUMPOIS, one of two computer programs that make calculations involving cumulative Poisson distributions. Both programs, CUMPOIS (NPO-17714) and NEWTPOIS (NPO-17715), used independently of one another. CUMPOIS determines cumulative Poisson distribution, used to evaluate cumulative distribution function (cdf) for gamma distributions with integer shape parameters and cdf for X (sup2) distributions with even degrees of freedom. Used by statisticians and others concerned with probabilities of independent events occurring over specific units of time, area, or volume. Written in C.

  3. The Relationship between Cumulative Credits and Student Learning Outcomes: A Cross-Sectional Assessment of Information Literacy and Communication Skills

    ERIC Educational Resources Information Center

    Thonney, Teresa; Montgomery, Joe C.

    2015-01-01

    This article relates the efforts of faculty at one community college to define standards for achievement of two SLOs (critical thinking and effective communication) and to gather and analyze evidence of how well students meet those standards. Faculty from 13 disciplines assessed writing samples from 265 students. We found that, in general,…

  4. Promoting Health Literacy through the Health Education Assessment Project

    ERIC Educational Resources Information Center

    Marx, Eva; Hudson, Nancy; Deal, Tami B.; Pateman, Beth; Middleton, Kathleen

    2007-01-01

    Background: The Council of Chief State School Officers' State Collaborative on Assessment and Student Standards Health Education Assessment Project (SCASS-HEAP) allows states to pool financial and human resources to develop effective ready-to-use health education assessment resources through a collaborative process. The purpose of this article is…

  5. Promoting Health Literacy through the Health Education Assessment Project

    ERIC Educational Resources Information Center

    Marx, Eva; Hudson, Nancy; Deal, Tami B.; Pateman, Beth; Middleton, Kathleen

    2007-01-01

    Background: The Council of Chief State School Officers' State Collaborative on Assessment and Student Standards Health Education Assessment Project (SCASS-HEAP) allows states to pool financial and human resources to develop effective ready-to-use health education assessment resources through a collaborative process. The purpose of this article is…

  6. Assessing Health Professional Education: Workshop Summary

    ERIC Educational Resources Information Center

    Cuff, Patricia A.

    2014-01-01

    "Assessing Health Professional Education" is the summary of a workshop hosted by the Institute of Medicine's Global Forum on Innovation in Health Professional Education to explore assessment of health professional education. At the event, Forum members shared personal experiences and learned from patients, students, educators, and…

  7. Assessing Health Professional Education: Workshop Summary

    ERIC Educational Resources Information Center

    Cuff, Patricia A.

    2014-01-01

    "Assessing Health Professional Education" is the summary of a workshop hosted by the Institute of Medicine's Global Forum on Innovation in Health Professional Education to explore assessment of health professional education. At the event, Forum members shared personal experiences and learned from patients, students, educators, and…

  8. Cumulative impact of health deficits, social vulnerabilities, and protective factors on cognitive dynamics in late life: a multistate modeling approach.

    PubMed

    Armstrong, Joshua J; Mitnitski, Arnold; Andrew, Melissa K; Launer, Lenore J; White, Lon R; Rockwood, Kenneth

    2015-01-01

    Many factors influence late-life cognitive changes, and evaluating their joint impact is challenging. Typical approaches focus on average decline and a small number of factors. We used multistate transition models and index variables to look at changes in cognition in relation to frailty (accumulation of health deficits), social vulnerability, and protective factors in the Honolulu-Asia Aging Study (HAAS). The HAAS is a prospective cohort study of 3,845 men of Japanese descent, aged 71 to 93 years at baseline. Cognitive function was measured using the Cognitive Abilities Screening Instrument (CASI). Baseline index variables were constructed of health deficits (frailty), social vulnerabilities, and protective factors. The chances of improvement/stability/decline in cognitive function and death were simultaneously estimated using multistate transition modeling for 3- and 6-year transitions from baseline. On average, CASI scores declined by 5.3 points (standard deviation (SD) = 10.0) over 3 years and 9.5 points (SD = 13.9) over 6 years. After adjusting for education and age, baseline frailty was associated with an increased risk of cognitive decline at 3 years (β = 0.18, 95% confidence interval (CI), 0.08 to 0.29) and 6 years (β = 0.40, 95% CI, 0.27 to 0.54). The social vulnerability index was associated with 3-year changes (β = 0.16, 95% CI, 0.09 to 0.23) and 6-year changes (β = 0.14, 95% CI, 0.05 to 0.24) in CASI scores. The protective index was associated with reductions in cognitive decline over the two intervals (3-year: β = -0.16, 95% CI, -0.24 to -0.09; 6-year: β = -0.21, 95% CI, -0.31 to -0.11,). Research on cognition in late life needs to consider overall health, the accumulation of protective factors, and the dynamics of cognitive change. Index variables and multistate transition models can enhance understanding of the multifactorial nature of late-life changes in cognition.

  9. Manitoba Health Assessment Program 1982. Final Report.

    ERIC Educational Resources Information Center

    Manitoba Dept. of Education, Winnipeg.

    Test results and interpretations, conclusions, and recommendations are presented from the Health Assessment Program conducted in the Manitoba public schools in 1982. Chapter I provides an overview and highlights the health assessment and major findings of fifth and tenth grade student assessments. Major findings of the teacher and administrator…

  10. Cumulative Inequality and Racial Disparities in Health: Private Insurance Coverage and Black/White Differences in Functional Limitations

    PubMed Central

    Taylor, Miles G.

    2014-01-01

    Objectives. To test different forms of private insurance coverage as mediators for racial disparities in onset, persistent level, and acceleration of functional limitations among Medicare age-eligible Americans. Method. Data come from 7 waves of the Health and Retirement Study (1996–2008). Onset and progression latent growth models were used to estimate racial differences in onset, level, and growth of functional limitations among a sample of 5,755 people aged 65 and older in 1996. Employer-provided insurance, spousal insurance, and market insurance were next added to the model to test how differences in private insurance mediated the racial gap in physical limitations. Results. In baseline models, African Americans had larger persistent level of limitations over time. Although employer-provided, spousal provided, and market insurances were directly associated with lower persistent levels of limitation, only differences in market insurance accounted for the racial disparities in persistent level of limitations. Discussion. Results suggest private insurance is important for reducing functional limitations, but market insurance is an important mediator of the persistently larger level of limitations observed among African Americans. PMID:24569001

  11. Cumulative inequality and racial disparities in health: private insurance coverage and black/white differences in functional limitations.

    PubMed

    Kail, Ben Lennox; Taylor, Miles G

    2014-09-01

    To test different forms of private insurance coverage as mediators for racial disparities in onset, persistent level, and acceleration of functional limitations among Medicare age-eligible Americans. Data come from 7 waves of the Health and Retirement Study (1996-2008). Onset and progression latent growth models were used to estimate racial differences in onset, level, and growth of functional limitations among a sample of 5,755 people aged 65 and older in 1996. Employer-provided insurance, spousal insurance, and market insurance were next added to the model to test how differences in private insurance mediated the racial gap in physical limitations. In baseline models, African Americans had larger persistent level of limitations over time. Although employer-provided, spousal provided, and market insurances were directly associated with lower persistent levels of limitation, only differences in market insurance accounted for the racial disparities in persistent level of limitations. Results suggest private insurance is important for reducing functional limitations, but market insurance is an important mediator of the persistently larger level of limitations observed among African Americans. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  12. The Analysis of Cumulative Influence of Factors of Environment on a State of Health of the Population of Vladimir Region

    PubMed Central

    Trifonova, Tatyana Anatolyevna; Shirkin, Leonid Alekseevich

    2015-01-01

    There was investigated the contribution of factors of environment to formation of health for adult population on indicators of mid-annual rates of growth/decrease of disease of system of blood circulation and of some interfaced nosology on an example of the population of Vladimir region. The differential criterion of primary disease of system of blood circulation is considered as an indicator, integrally reflecting degree of adaptation to environment conditions on population and suitable for construction short-term prognostic estimations. It is shown that business factors or the factors of a standard of living characterized by economic indicators, are leading risk factors in disease of system of blood circulation in Vladimir region which contribution is estimated by size of 38 %. With use of regressive equations were received look-ahead estimations of annual rates of primary disease of system of blood circulation. In the regional centre Vladimir was observed more intense situation on rates of disease of system of blood circulation, than in Vladimir region. PMID:25948468

  13. The analysis of cumulative influence of factors of environment on a state of health of the population of Vladimir region.

    PubMed

    Trifonova, Tatyana Anatolyevna; Shirkin, Leonid Alekseevich

    2015-01-14

    There was investigated the contribution of factors of environment to formation of health for adult population on indicators of mid-annual rates of growth/decrease of disease of system of blood circulation and of some interfaced nosology on an example of the population of Vladimir region. The differential criterion of primary disease of system of blood circulation is considered as an indicator, integrally reflecting degree of adaptation to environment conditions on population and suitable for construction short-term prognostic estimations. It is shown that business factors or the factors of a standard of living characterized by economic indicators, are leading risk factors in disease of system of blood circulation in Vladimir region which contribution is estimated by size of 38%. With use of regressive equations were received look-ahead estimations of annual rates of primary disease of system of blood circulation. In the regional centre Vladimir was observed more intense situation on rates of disease of system of blood circulation, than in Vladimir region.

  14. The emerging threats of climate change on tropical coastal ecosystem services, public health, local economies and livelihood sustainability of small islands: Cumulative impacts and synergies.

    PubMed

    Hernández-Delgado, E A

    2015-12-15

    Climate change has significantly impacted tropical ecosystems critical for sustaining local economies and community livelihoods at global scales. Coastal ecosystems have largely declined, threatening the principal source of protein, building materials, tourism-based revenue, and the first line of defense against storm swells and sea level rise (SLR) for small tropical islands. Climate change has also impacted public health (i.e., altered distribution and increased prevalence of allergies, water-borne, and vector-borne diseases). Rapid human population growth has exacerbated pressure over coupled social-ecological systems, with concomitant non-sustainable impacts on natural resources, water availability, food security and sovereignty, public health, and quality of life, which should increase vulnerability and erode adaptation and mitigation capacity. This paper examines cumulative and synergistic impacts of climate change in the challenging context of highly vulnerable small tropical islands. Multiple adaptive strategies of coupled social-ecological ecosystems are discussed. Multi-level, multi-sectorial responses are necessary for adaptation to be successful.

  15. Integrating Ecosystem Services Into Health Impact Assessment

    EPA Science Inventory

    Health Impact Assessment (HIA) provides a methodology for incorporating considerations of public health into planning and decision-making processes. HIA promotes interdisciplinary action, stakeholder participation, and timeliness and takes into account equity, sustainability, and...

  16. Integrating Ecosystem Services Into Health Impact Assessment

    EPA Science Inventory

    Health Impact Assessment (HIA) provides a methodology for incorporating considerations of public health into planning and decision-making processes. HIA promotes interdisciplinary action, stakeholder participation, and timeliness and takes into account equity, sustainability, and...

  17. Improving the prognostic value of disease specific Graded Prognostic Assessment (ds-GPA) model for renal cell carcinoma by incorporation of Cumulative Intracranial Tumor Volume (CITV).

    PubMed

    Ali, Mir Amaan; Hirshman, Brian R; Wilson, Bayard; Schupper, Alexander J; Joshi, Rushikesh; Proudfoot, James A; Goetsch, Steven J; Alksne, John F; Ott, Kenneth; Aiyama, Hitoshi; Nagano, Osamu; Carter, Bob S; Chiang, Veronica; Serizawa, Toru; Yamamoto, Masaaki; Chen, Clark C

    2017-07-25

    We tested the prognostic value of cumulative intracranial tumor volume (CITV) in the context of ds-GPA model for renal cell carcinoma (RCC) patients with brain metastasis (BM) treated with stereotactic radiosurgery (SRS). Patient and tumor characteristics were collected from RCC cohorts with newly BM who underwent SRS. Univariable and multivariable logistic regression model was used to test the prognostic value of CITV, Karnofsky Performance Score (KPS), and the number of BM. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to assess whether CITV improved the prognostic utility of RCC ds-GPA. In univariable logistic regression models, CITV, KPS, and the number of BM independently associated with RCC patient survival. In a multivariable Cox proportional hazard model, the association between CITV and survival remained robust after controlling for KPS and the number of BM (P=.042). The incorporation of the cumulative intracranial tumor volume (CITV) into the RCC ds-GPA model (consisting of KPS and number of BM) improved prognostic accuracy with NRI>0 of 0.3156 (95% CI: 0.0883-0.5428, P=.0065) and integrated discrimination improvement (IDI) of 0.0151 (95% CI: 0.0036-0.0277, P=.0183). These findings were validated in an independent cohort of 107 SRS-treated RCC BM patients. CITV is an important prognostic variable in SRS-treated RCC patients with BM. The prognostic value of the ds-GPA scale for RCC brain metastasis was enhanced by the incorporation of CITV. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Health effects of risk-assessment categories

    SciTech Connect

    Kramer, C.F.; Rybicka, K.; Knutson, A.; Morris, S.C.

    1983-10-01

    Environmental and occupational health effects associated with exposures to various chemicals are a subject of increasing concern. One recently developed methodology for assessing the health impacts of various chemical compounds involves the classification of similar chemicals into risk-assessment categories (RACs). This report reviews documented human health effects for a broad range of pollutants, classified by RACs. It complements other studies that have estimated human health effects by RAC based on analysis and extrapolation of data from animal research.

  19. Revised Human Health Risk Assessment on Chlorpyrifos

    EPA Pesticide Factsheets

    We have revised our human health risk assessment and drinking water exposure assessment for chlorpyrifos that supported our October 2015 proposal to revoke all food residue tolerances for chlorpyrifos. Learn about the revised analysis.

  20. Impact of individual and cumulative coronary risk factors on coronary flow reserve assessed by dobutamine stress echocardiography.

    PubMed

    Ahmari, Saeed A L; Bunch, T Jared; Modesto, Karen; Stussy, Vicky; Dichak, Amy; Seward, James B; Pellikka, Patricia A; Chandrasekaran, Krishnaswamy

    2008-06-15

    Traditional cardiovascular risk factors have been shown to cause microvascular dysfunction. Most studies that have evaluated microcirculation rely on invasive measurement tools. We used dobutamine stress echocardiography, a validated method to measure coronary flow velocity (CFV) and coronary flow reserve (CFR), in a previously unstudied population without known significant coronary artery disease to determine the impact of traditional risk factors on CFR. Consecutive patients who had no evidence of regional wall motion abnormalities at rest or during dobutamine stress echocardiography were studied. Left anterior descending artery CFV was measured at baseline and at peak dobutamine stress and CFR was calculated as the ratio of peak stress CFV to baseline CFV. Fifty-nine consecutive patients (28 men) with mean age of 66.8+/-14.5 years were studied. CFR was lower in patients with diabetes mellitus (DM) compared with those without (1.7+/-0.74 vs 2.48+/-0.98, p<0.007), in patients with hypertension compared with those without (2+/-0.8 vs 2.6+/-0.9, p<0.02), and in obese patients compared with nonobese patients (1.6+/-0.5 vs 2+/-0.6, p<0.02). CFR was further impaired in the presence of DM with hypertension, DM with obesity, DM with a wide pulse pressure (>50 mm Hg), and obesity with a wide pulse pressure. In a multivariate model, DM, obesity, and wide pulse pressure were significantly associated with variation in CFR (p<0.0008). In conclusion, CFR was abnormal in patients with DM, hypertension, and obesity. CFR impairment is exaggerated as the number of risk factors increases. Despite a negative dobutamine stress echocardiographic result, aggressive risk factor assessment and control should be implemented in patients with coronary risk factors due to an underlying abnormal CFR.

  1. Cumulative impact of GM herbicide-tolerant cropping on arable plants assessed through species-based and functional taxonomies.

    PubMed

    Squire, Geoffrey R; Hawes, Cathy; Begg, Graham S; Young, Mark W

    2009-01-01

    the curve. In winter oilseed rape, 8% more species were accumulated in the GMHT treatment, mainly as a result of the encouragement of grass species by the herbicide when applied in the autumn. (Overall, GMHT winter oilseed rape had strong negative effects on both the food web and the potential weed burden by increasing the biomass of grasses and decreasing that of broadleaf weeds.) In maize, 33% more species-a substantial increase-were accumulated in the GMHT than in the conventional, consistent with the latter's highly suppressive weed management using triazine herbicides. In the spring oilseed rape and beet, fewer species (around 10%) were accumulated in the GMHT than the conventional. The GMHT treatments did not remove or add any functional (life history) types, however. Differences in species accumulation between treatments appeared to be caused by loss or gain of rarer species. The generality of this effect was confirmed by simulations of species accumulation in which the species complement at each of 50 sites was drawn from a regional pool and subjected to reducing treatment at each site. Shifts in the species-accumulation parameters, comparable to those measured, occurred only when a treatment removed the rarer species at each site. Species accumulation provided a set of simple curve-parameters that captured the net result of numerous local effects of treatments on plant species and, in some instances, the balance between grass and broadleaf types. The direction of effect was not the same in the four crops and depended on the severity of the conventional treatment and on complex interactions between season, herbicide and crop. The accumulation curves gave an indication of potential positive or negative consequences for regional species pools of replacing a conventional practice with GMHT weed management. In this and related studies, a range of indicators, through which diversity was assessed by both species and functional type, and at both site and regional

  2. [Health technology assessment: II. Cost effectiveness analysis].

    PubMed

    Secoli, Silvia Regina; Nita, Marcelo Eidi; Ono-Nita, Suzane Kioko; Nobre, Moacyr

    2010-01-01

    New health technologies have made an impact in clinical and economic outcomes. Therefore, research methodologies that allow to evaluate the efficiency of these new technologies such as cost-effectiveness analysis are necessary. Cost-effectiveness analysis assess the value of health care interventions or drugs, the technology. Cost-effectiveness analysis is also deemed a determinant of modern health care practice, because the therapeutic options available at public (SUS) or private health care system must go through a formal health technology assessment in Brazil; thus, both the health care system and the health care professionals have to reevaluate the clinical consequences and costs of their actions to assure that the most efficient technologies are the one used in the practice. In this second article about health technology assessment we review the concepts of cost-effectiveness analysis, the steps involved in performing such analysis, and the criteria most frequently used to critically review the results.

  3. Readiness Assessment of Electronic Health Records Implementation

    PubMed Central

    Ajami, Sima; Ketabi, Saeedeh; Isfahani, Sakineh Saghaeiannejad; Heidari, Asieh

    2011-01-01

    Introduction: During the past 20 years, with huge advances in information technology and particularly, in the areas of health, various forms of electronic records have been discussed, designed or implemented. Although making health records automatically has many advantages but unfortunately in some cases, creation of an Electronic Health Record (EHR) system seems to be complicated. E-health (Electronic health) readiness assessment, as a part of the assessment before implementation is considered essential and prior to implementation. Readiness assessment aims to evaluate preparedness of each organizational component. This process can lead to the correct decision making. Therefore, identifying areas and requirements for such an assessment is so essential. Using the results of this assessment can identify deficiencies in the existing electronic health records to plan their strategies. The aim of this study was first; to show the situation of readiness assessment in EHR implementation roadmap, second, to recognize requirements associated with electronic readiness assessment and main areas of EHR readiness assessment. Results and discussion: This study reviewed the literature on EHR readiness assessment with the help of library and also searches engines available at Google. For our searches, we employed the following keywords and their combinations: readiness, assessment, implementation, Electronic Health Record (EHR), Information Technology, road map in the searching areas of title, keywords, abstract, and full text. In this study, more than 100 articles and reports were collected and 45 of them were selected based on their relevancy. PMID:23407861

  4. Automated utility assessment of global health.

    PubMed

    Nease, R F; Tsai, R; Hynes, L M; Littenberg, B

    1996-02-01

    The objective of this study was to characterize the performance of an automated utility assessment instrument for measuring preferences for overall health. The study population consisted of 83 subjects recruited from the cafeteria of a large tertiary care hospital. We assessed utilities for current health relative to perfect health and death using the rating scale, time tradeoff and standard gamble metrics. To validate the instrument, we compared utilities with the General Health subscale of the SF-36 Health Survey instrument, satisfaction with current health, and degree of bother due to current health. We evaluated interview failure rate based on irrational orderings of two practice assessments (monocular and binocular blindness) or inability to complete the interview. As expected, utility for overall health was statistically significantly associated with the General Health subscale score and measures of satisfaction with current health and degree of bother. There is substantial variation in utilities among patients with similarly severe overall health, and substantial overlap in utilities among subjects with different levels of overall health. The failure rate in the study was acceptable (9.6%). Automated assessment of utility for overall health provides a feasible means for estimating individual preferences.

  5. Assessing the safety of co-exposure to food packaging migrants in food and water using the maximum cumulative ratio and an established decision tree.

    PubMed

    Price, Paul; Zaleski, Rosemary; Hollnagel, Heli; Ketelslegers, Hans; Han, Xianglu

    2014-01-01

    Food contact materials can release low levels of multiple chemicals (migrants) into foods and beverages, to which individuals can be exposed through food consumption. This paper investigates the potential for non-carcinogenic effects from exposure to multiple migrants using the Cefic Mixtures Ad hoc Team (MIAT) decision tree. The purpose of the assessment is to demonstrate how the decision tree can be applied to concurrent exposures to multiple migrants using either hazard or structural data on the specific components, i.e. based on the acceptable daily intake (ADI) or the threshold of toxicological concern. The tree was used to assess risks from co-exposure to migrants reported in a study on non-intentionally added substances (NIAS) eluting from food contact-grade plastic and two studies of water bottles: one on organic compounds and the other on ionic forms of various elements. The MIAT decision tree assigns co-exposures to different risk management groups (I, II, IIIA and IIIB) based on the hazard index, and the maximum cumulative ratio (MCR). The predicted co-exposures for all examples fell into Group II (low toxicological concern) and had MCR values of 1.3 and 2.4 (indicating that one or two components drove the majority of the mixture's toxicity). MCR values from the study of inorganic ions (126 mixtures) ranged from 1.1 to 3.8 for glass and from 1.1 to 5.0 for plastic containers. The MCR values indicated that a single compound drove toxicity in 58% of the mixtures. MCR values also declined with increases in the hazard index for the screening assessments of exposure (suggesting fewer substances contributed as risk potential increased). Overall, it can be concluded that the data on co-exposure to migrants evaluated in these case studies are of low toxicological concern and the safety assessment approach described in this paper was shown to be a helpful screening tool.

  6. The Challenge of Planning Conservation Strategies in Threatened Seascapes: Understanding the Role of Fine Scale Assessments of Community Response to Cumulative Human Pressures.

    PubMed

    Guarnieri, Giuseppe; Bevilacqua, Stanislao; De Leo, Francesco; Farella, Giulio; Maffia, Anna; Terlizzi, Antonio; Fraschetti, Simonetta

    2016-01-01

    Assessing the distribution and intensity of human threats to biodiversity is a prerequisite for effective spatial planning, harmonizing conservation purposes with sustainable development. In the Mediterranean Sea, the management of Marine Protected Areas (MPAs) is rarely based on explicit consideration of the distribution of multiple stressors, with direct assessment of their effects on ecosystems. This gap limits the effectiveness of protection and is conducive to conflicts among stakeholders. Here, a fine scale assessment of the potential effects of different combinations of stressors (both land- and marine-based) on vulnerable rocky habitats (i.e. lower midlittoral and shallow infralittoral) along 40 km of coast in the western Mediterranean (Ionian Sea) has been carried out. The study area is a paradigmatic example of socio-ecological interactions, where several human uses and conservation measures collide. Significant differences in the structure of assemblages according to different combinations of threats were observed, indicating distinct responses of marine habitats to different sets of human pressures. A more complex three-dimensional structure, higher taxon richness and β-diversity characterized assemblages subject to low versus high levels of human pressure, consistently across habitats. In addition, the main drivers of change were: closeness to the harbour, water quality, and the relative extension of beaches. Our findings suggest that, although efforts to assess cumulative impacts at large scale may help in individuating priority areas for conservation purposes, the fact that such evaluations are often based on expert opinions and not on actual studies limits their ability to represent real environmental conditions at local scale. Systematic evaluations of local scale effects of anthropogenic drivers of change on biological communities should complement broad scale management strategies to achieve effective sustainability of human exploitation of

  7. The Challenge of Planning Conservation Strategies in Threatened Seascapes: Understanding the Role of Fine Scale Assessments of Community Response to Cumulative Human Pressures

    PubMed Central

    Guarnieri, Giuseppe; Bevilacqua, Stanislao; De Leo, Francesco; Farella, Giulio; Maffia, Anna; Terlizzi, Antonio; Fraschetti, Simonetta

    2016-01-01

    Assessing the distribution and intensity of human threats to biodiversity is a prerequisite for effective spatial planning, harmonizing conservation purposes with sustainable development. In the Mediterranean Sea, the management of Marine Protected Areas (MPAs) is rarely based on explicit consideration of the distribution of multiple stressors, with direct assessment of their effects on ecosystems. This gap limits the effectiveness of protection and is conducive to conflicts among stakeholders. Here, a fine scale assessment of the potential effects of different combinations of stressors (both land- and marine-based) on vulnerable rocky habitats (i.e. lower midlittoral and shallow infralittoral) along 40 km of coast in the western Mediterranean (Ionian Sea) has been carried out. The study area is a paradigmatic example of socio-ecological interactions, where several human uses and conservation measures collide. Significant differences in the structure of assemblages according to different combinations of threats were observed, indicating distinct responses of marine habitats to different sets of human pressures. A more complex three-dimensional structure, higher taxon richness and β-diversity characterized assemblages subject to low versus high levels of human pressure, consistently across habitats. In addition, the main drivers of change were: closeness to the harbour, water quality, and the relative extension of beaches. Our findings suggest that, although efforts to assess cumulative impacts at large scale may help in individuating priority areas for conservation purposes, the fact that such evaluations are often based on expert opinions and not on actual studies limits their ability to represent real environmental conditions at local scale. Systematic evaluations of local scale effects of anthropogenic drivers of change on biological communities should complement broad scale management strategies to achieve effective sustainability of human exploitation of

  8. Health Economic Assessment: A Methodological Primer

    PubMed Central

    Simoens, Steven

    2009-01-01

    This review article aims to provide an introduction to the methodology of health economic assessment of a health technology. Attention is paid to defining the fundamental concepts and terms that are relevant to health economic assessments. The article describes the methodology underlying a cost study (identification, measurement and valuation of resource use, calculation of costs), an economic evaluation (type of economic evaluation, the cost-effectiveness plane, trial- and model-based economic evaluation, discounting, sensitivity analysis, incremental analysis), and a budget impact analysis. Key references are provided for those readers who wish a more advanced understanding of health economic assessments. PMID:20049237

  9. Alabama Allied Health Needs Assessment Study.

    ERIC Educational Resources Information Center

    Morris, Libby V.

    This study assessed the supply of and demand for allied health professionals in Alabama, focusing on the relationship between supply and demand in various workplace settings in the context of Alabama's demographics, current educational programs, and projected changes in health care. The health care professions included in the study were all fields…

  10. The West Virginia Health Education Assessment Project

    ERIC Educational Resources Information Center

    Tompkins, Nancy O'Hara; Kamal, Khalid M.; Chapman, Don

    2005-01-01

    Well-designed school health education should provide students with the knowledge and skills to prevent the health risk behaviors most responsible for the major causes of morbidity and mortality. This paper reports the methodology and findings of a West Virginia statewide health education assessment initiative and describes how the findings are…

  11. The West Virginia Health Education Assessment Project

    ERIC Educational Resources Information Center

    Tompkins, Nancy O'Hara; Kamal, Khalid M.; Chapman, Don

    2005-01-01

    Well-designed school health education should provide students with the knowledge and skills to prevent the health risk behaviors most responsible for the major causes of morbidity and mortality. This paper reports the methodology and findings of a West Virginia statewide health education assessment initiative and describes how the findings are…

  12. Findings from ATSDR's Health Assessments.

    ERIC Educational Resources Information Center

    Susten, Allan S.

    1992-01-01

    Summarizes findings from the Agency for Toxic Substances and Disease Registry concerning the evaluation of data about hazardous substance release into the environment. Identifies the hazardous substances, exposure, health effects, and public health impact from 951 facilities identified on the National Priorities List (NPL) by the Environmental…

  13. The contribution of health technology assessment, health needs assessment, and health impact assessment to the assessment and translation of technologies in the field of public health genomics.

    PubMed

    Rosenkötter, N; Vondeling, H; Blancquaert, I; Mekel, O C L; Kristensen, F B; Brand, A

    2011-01-01

    The European Union has named genomics as one of the promising research fields for the development of new health technologies. Major concerns with regard to these fields are, on the one hand, the rather slow and limited translation of new knowledge and, on the other hand, missing insights into the impact on public health and health care practice of those technologies that are actually introduced. This paper aims to give an overview of the major assessment instruments in public health [health technology assessment (HTA), health needs assessment (HNA) and health impact assessment (HIA)] which could contribute to the systematic translation and assessment of genomic health applications by focussing at population level and on public health policy making. It is shown to what extent HTA, HNA and HIA contribute to translational research by using the continuum of translational research (T1-T4) in genomic medicine as an analytic framework. The selected assessment methodologies predominantly cover 2 to 4 phases within the T1-T4 system. HTA delivers the most complete set of methodologies when assessing health applications. HNA can be used to prioritize areas where genomic health applications are needed or to identify infrastructural needs. HIA delivers information on the impact of technologies in a wider scope and promotes informed decision making. HTA, HNA and HIA provide a partly overlapping and partly unique set of methodologies and infrastructure for the translation and assessment of genomic health applications. They are broad in scope and go beyond the continuum of T1-T4 translational research regarding policy translation.

  14. Chemical Risk Assessment: Traditional vs Public Health ...

    EPA Pesticide Factsheets

    Preventing adverse health impacts from exposures to environmental chemicals is fundamental to protecting individual and public health. When done efficiently and properly, chemical risk assessment enables risk management actions that minimize the incidence and impacts of environmentally-induced diseases related to chemical exposure. However, traditional chemical risk assessment is faced with multiple challenges with respect to predicting and preventing disease in human populations, and epidemiological studies increasingly report observations of adverse health effects at exposure levels predicted from animal studies to be safe for humans. This discordance reinforces concerns about the adequacy of contemporary risk assessment practices (Birnbaum, Burke, & Jones, 2016) for protecting public health. It is becoming clear that to protect public health more effectively, future risk assessments will need to use the full range of available data, draw on innovative methods to integrate diverse data streams, and consider health endpoints that also reflect the range of subtle effects and morbidities observed in human populations. Given these factors, there is a need to reframe chemical risk assessment to be more clearly aligned with the public health goal of minimizing environmental exposures associated with disease. Preventing adverse health impacts from exposures to environmental chemicals is fundamental to protecting individual and public health. Chemical risk assessments

  15. The West Virginia Health Education Assessment Project.

    PubMed

    Tompkins, Nancy O'Hara; Kamal, Khalid M; Chapman, Don

    2005-08-01

    Well-designed school health education should provide students with the knowledge and skills to prevent the health risk behaviors most responsible for the major causes of morbidity and mortality. This paper reports the methodology and findings of a West Virginia statewide health education assessment initiative and describes how the findings are used to design professional development training for school health educators. Selected response items from the State Collaborative on Assessment and Student Standards, Health Education Assessment Project were used to develop a 40-item assessment instrument for 6 health education content areas. In West Virginia, 51 counties and 242 schools were recruited (county response rate = 93%; school response rate = 53%); 17,549 students were tested in grades 6, 8, and high school health education classes. Mean total scores by grade were 30.61 (grade 6), 26.55 (grade 8), and 26.53 (high school), indicating a slight decline in scores as grade level increased. Females in each grade level scored higher on total Health Education Assessment Project (HEAP) scores and subtest scores than males. The results suggest notable differences across grade levels. High school students failed to meet the standard on any health education content areas, indicating the need for enhanced knowledge and skill development. During professional development training, HEAP scores were examined in the context of results from the West Virginia Youth Risk Behavior Survey to underscore the importance of providing quality skills-based health education in West Virginia schools.

  16. Spatial and temporal assessment of cumulative disturbance impacts due to military training, burning, haying, and their interactions on land condition of Fort Riley.

    PubMed

    Wang, Guangxing; Murphy, Dana; Oller, Adam; Howard, Heidi R; Anderson, Alan B; Rijal, Santosh; Myers, Natalie R; Woodford, Philip

    2014-07-01

    The effects of military training activities on the land condition of Army installations vary spatially and temporally. Training activities observably degrade land condition while also increasing biodiversity and stabilizing ecosystems. Moreover, other anthropogenic activities regularly occur on military lands such as prescribed burns and agricultural haying-adding to the dynamics of land condition. Thus, spatially and temporally assessing the impacts of military training, prescribed burning, agricultural haying, and their interactions is critical to the management of military lands. In this study, the spatial distributions and patterns of military training-induced disturbance frequency were derived using plot observation and point observation-based method, at Fort Riley, Kansas from 1989 to 2001. Moreover, spatial and variance analysis of cumulative impacts due to military training, burning, haying, and their interactions on the land condition of Fort Riley were conducted. The results showed that: (1) low disturbance intensity dominated the majority of the study area with exception of concentrated training within centralized areas; (2) high and low values of disturbance frequency were spatially clustered and had spatial patterns that differed significantly from a random distribution; and (3) interactions between prescribed burning and agricultural haying were not significant in terms of either soil erosion or disturbance intensity although their means and variances differed significantly between the burned and non-burned areas and between the hayed and non-hayed areas.

  17. Radionuclide and colloid transport in the Culebra Dolomite and associated complementary cumulative distribution functions in the 1996 performance assessment for the Waste Isolation Pilot Plant

    SciTech Connect

    RAMSEY, JAMES L.; BLAINE,R.; GARNER,J.W.; HELTON,JON CRAIG; JOHNSON,J.D.; SMITH,L.N.; WALLACE,M.

    2000-05-22

    The following topics related to radionuclide and colloid transport in the Culebra Dolomite in the 1996 performance assessment for the Waste Isolation Pilot Plant (WIPP) are presented: (1) mathematical description of models, (2) uncertainty and sensitivity analysis results arising from subjective (i.e., epistemic) uncertainty for individual releases, and (3) construction of complementary cumulative distribution functions (CCDFs) arising from stochastic (i.e., aleatory) uncertainty. The presented results indicate that radionuclide and colloid transport in the Culebra Dolomite does not constitute a serious threat to the effectiveness of the WIPP as a disposal facility for transuranic waste. Even when the effects of uncertain analysis inputs are taken into account, no radionuclide transport to the boundary with the accessible environment was observed; thus the associated CCDFs for comparison with the boundary line specified in the US Environmental Protection Agency's standard for the geologic disposal of radioactive waste (40 CFR 191, 40 CFR 194) are degenerate in the sense of having a probability of zero of exceeding a release of zero.

  18. Urban ecosystem health assessment: a review.

    PubMed

    Su, Meirong; Fath, Brian D; Yang, Zhifeng

    2010-05-15

    Due to the important role of cities for regional, national, and international economic development and the concurrent degradation of the urban environmental quality under rapid urbanization, a systematic diagnosis of urban ecosystem health for sustainable ecological management is urgently needed. This paper reviews the related research on urban ecosystem health assessment, beginning from the inception of urban ecosystem health concerns propelled by the development needs of urban ecosystems and the advances in ecosystem health research. Concepts, standards, indicators, models, and case studies are introduced and discussed. Urban ecosystem health considers the integration of ecological, economic, social and human health factors, and as such it is a value-driven concept which is strongly influenced by human perceptions. There is not an absolute urban ecosystem standard because of the uncertainty caused by the changing human needs, targets, and expectation of urban ecosystem over time; thus, suitable approaches are still needed to establish health standards of urban ecosystems. Several conceptual models and suitable indicator frameworks have been proposed to organize the multiple factors to represent comprehensively the health characteristics of an urban ecosystem, while certain mathematical methods have been applied to deal with the indicator information to get a clear assessment of the urban ecosystem health status. Instead of perceiving the urban ecosystem assessment as an instantaneous measurement of the health state, it is suggested to conceptualize the urban ecosystem health as a process, which impels us to focus more studies on the dynamic trends of health status and projecting possible development scenarios.

  19. Assessment of health risks of policies

    SciTech Connect

    Ádám, Balázs; Molnár, Ágnes; Ádány, Róza; Bianchi, Fabrizio; Bitenc, Katarina; Chereches, Razvan; Cori, Liliana; Fehr, Rainer; Kobza, Joanna; Kollarova, Jana; and others

    2014-09-15

    The assessment of health risks of policies is an inevitable, although challenging prerequisite for the inclusion of health considerations in political decision making. The aim of our project was to develop a so far missing methodological guide for the assessment of the complex impact structure of policies. The guide was developed in a consensual way based on experiences gathered during the assessment of specific national policies selected by the partners of an EU project. Methodological considerations were discussed and summarized in workshops and pilot tested on the EU Health Strategy for finalization. The combined tool, which includes a textual guidance and a checklist, follows the top-down approach, that is, it guides the analysis of causal chains from the policy through related health determinants and risk factors to health outcomes. The tool discusses the most important practical issues of assessment by impact level. It emphasises the transparent identification and prioritisation of factors, the consideration of the feasibility of exposure and outcome assessment with special focus on quantification. The developed guide provides useful methodological instructions for the comprehensive assessment of health risks of policies that can be effectively used in the health impact assessment of policy proposals. - Highlights: • Methodological guide for the assessment of health risks of policies is introduced. • The tool is developed based on the experiences from several case studies. • The combined tool consists of a textual guidance and a checklist. • The top-down approach is followed through the levels of the full impact chain. • The guide provides assistance for the health impact assessment of policy proposals.

  20. [Assessment of learning in blind orotracheal intubation with Fastrach masks using a cumulative sum curves (CuSum) in the SimMan Universal Simulator].

    PubMed

    Alonso Manzano, A; Sistac Ballarín, J M; Ruiz Casellas, M M; Ortiz Enciso, M; Montero Matamala, A

    2012-02-01

    To assess training in blind intubation with the Fastrach laryngeal mask in a simulation model by applying the cumulative sums (CuSum) method. Six anaesthesiology resident doctors, with no previous experience of the technique, participated, three in their first year, and three in the second. The study was conducted with the help of the SimMan Universal Simulator. Fifty attempts by each one of them over a four month period, divided into two stages: the first 20 with minimum airway difficulty, and the next 30 with limitations of flexion-extension movements to <80°. An unacceptable failure rate was set at 10% after a second failed attempt. The time limit set to be considered a success was 60seconds. A total of 120 attempts in the first stages, and the remaining 180 in the second were analysed individually, all managing to achieve acceptable success rates of 90%: 84% in the first attempt and 13.33% in the second. A total of 2.66% failures were recorded. The learning curve showed that the residents began to achieve an acceptable 90% success rate in case number 25±11.76 of the 50 attempts. This statistical method and the SimMan simulator, used together, have demonstrated to be very useful tools in assessing learning curves in this technique. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  1. A Stochastic Approach To Human Health Risk Assessment Due To Groundwater Contamination

    NASA Astrophysics Data System (ADS)

    de Barros, F. P.; Rubin, Y.

    2006-12-01

    We present a probabilistic framework to addressing adverse human health effects due to groundwater contamination. One of the main challenges in health risk assessment is in relating it to subsurface data acquisition and to improvement in our understanding of human physiological responses to contamination. In this paper we propose to investigate this problem through an approach that integrates flow, transport and human health risk models with hydrogeological characterization. A human health risk cumulative distribution function is analytically developed to account for both uncertainty and variability in hydrogeological as well as human physiological parameters. With our proposed approach, we investigate under which conditions the reduction of uncertainties from flow physics, human physiology and exposure related parameters might contribute to a better understanding of human health risk assessment. Results indicate that the human health risk cumulative distribution function is sensitive to physiological parameters at low risk values associated with longer travel times. The results show that the worth of hydrogeological characterization in human health risk is dependent on the residence time of the contaminant plume in the aquifer and on the exposure duration of the population to certain chemicals.

  2. Comparison of Select Health Outcomes by Deployment Health Assessment Completion.

    PubMed

    Luse, Tina M; Slosek, Jean; Rennix, Christopher

    2016-02-01

    The Department of Defense (DoD) requires service members to complete regular health assessments for identification of deployment-related physical/behavioral issues and environmental/occupational exposures. Compliance among active duty Department of the Navy personnel varies; however, and the impact of incomplete assessments on generalizability of results is unclear. This study examines the differences between Navy and Marine Corps service members who completed both the Post-Deployment Health Assessment and Post-Deployment Health Reassessment (n = 9,452) as compared to service members who never attempted either form (n = 5,603) in fiscal year 2010. Deployment rosters, assessments, and clinical data were analyzed to determine certified assessment completion rates and incidence of certain health conditions in these populations. Only 38.9% of applicable personnel met the completion and certification criteria for the required assessments. Service members who did not complete the forms were distinctly different demographically and at increased risk for psychotropic drug use, post-traumatic stress disorder diagnosis, and traumatic brain injury diagnosis following deployment. The prevailing assumption that the risk of adverse health effects on operational forces can be estimated using the population that completed the required assessments is incorrect, and the true operational impact and medical burden of these conditions may be underestimated.

  3. Health Risk Assessments for Alumina Refineries

    PubMed Central

    Coffey, Patrick S.

    2014-01-01

    Objective: To describe contemporary air dispersion modeling and health risk assessment methodologies applied to alumina refineries and to summarize recent results. Methods: Air dispersion models using emission source and meteorological data have been used to assess ground-level concentrations (GLCs) of refinery emissions. Short-term (1-hour and 24-hour average) GLCs and annual average GLCs have been used to assess acute health, chronic health, and incremental carcinogenic risks. Results: The acute hazard index can exceed 1 close to refineries, but it is typically less than 1 at neighboring residential locations. The chronic hazard index is typically substantially less than 1. The incremental carcinogenic risk is typically less than 10−6. Conclusions: The risks of acute health effects are adequately controlled, and the risks of chronic health effects and incremental carcinogenic risks are negligible around referenced alumina refineries. PMID:24806721

  4. Health risk assessments for alumina refineries.

    PubMed

    Donoghue, A Michael; Coffey, Patrick S

    2014-05-01

    To describe contemporary air dispersion modeling and health risk assessment methodologies applied to alumina refineries and to summarize recent results. Air dispersion models using emission source and meteorological data have been used to assess ground-level concentrations (GLCs) of refinery emissions. Short-term (1-hour and 24-hour average) GLCs and annual average GLCs have been used to assess acute health, chronic health, and incremental carcinogenic risks. The acute hazard index can exceed 1 close to refineries, but it is typically less than 1 at neighboring residential locations. The chronic hazard index is typically substantially less than 1. The incremental carcinogenic risk is typically less than 10(-6). The risks of acute health effects are adequately controlled, and the risks of chronic health effects and incremental carcinogenic risks are negligible around referenced alumina refineries.

  5. Assessing Human Health Risk from Pesticides

    EPA Pesticide Factsheets

    EPA protects human health and the environment by evaluating the risk associated with pesticides before allowing them to be used in the United States. Learn about the tools and processes used in risk assessment for pesticides.

  6. Office for prevention and health services assessment

    NASA Astrophysics Data System (ADS)

    Wright, James A.

    1994-12-01

    The Air Force Surgeon General has established the Office for Prevention and Health Care ASsessment (OPHSA) to become the center of excellence for preventive services and health care assessment in the U.S. Air Force and the Department of Defense. OPHSA using the principles of total quality management and integrated teams will evaluate, compare, and modify preventive services delivery guidelines to preserve the fighting force by preventing illness and injuries in military populations. OPHSA will evaluate and formulate health care delivery guidelines to improve health care access and delivery to military patient populations. OPHSA will develop data to determine the health status and health needs to beneficiary populations so medical managers can deliver medical care in the most cost effective manner. OPHSA is located at Brooks Air Force Base in San Antonio, Texas. OPHSA will have thirty seven active duty military, civil service, and contract employees and should be fully functional by the end of 1995.

  7. An Assessment of Environmental Health Needs

    NASA Technical Reports Server (NTRS)

    Macatangay, Ariel V.

    2013-01-01

    Environmental health fundamentally addresses the physical, chemical, and biological risks external to the human body that can impact the health of a person by assessing and controlling these risks in order to generate and maintain a health-supportive environment. In manned spacecraft, environmental health risks are mitigated by a multi-disciplinary effort, employing several measures including active and passive controls, by establishing environmental standards (SMACs, SWEGs, microbial and acoustics limits), and through environmental monitoring. Human Health and Performance (HHP) scientists and Environmental Control and Life Support (ECLS) engineers consider environmental monitoring a vital component to an environmental health management strategy for maintaining a healthy crew and achieving mission success. ECLS engineers use environmental monitoring data to monitor and confirm the health of ECLS systems, whereas HHP scientists use the data to manage the health of the human system. Because risks can vary between missions and change over time, environmental monitoring is critical. Crew health risks associated with the environment were reviewed by agency experts with the goal of determining risk-based environmental monitoring needs for future NASA manned missions. Once determined, gaps in environmental health knowledge and technology, required to address those risks, were identified for various types of exploration missions. This agency-wide assessment of environmental health needs will help guide the activities/hardware development efforts to close those gaps and advance the knowledge required to meet NASA manned space exploration objectives. Details of the roadmap development and findings are presented in this paper.

  8. Health Effects Assessment for Carbon Tetrachloride (1986)

    EPA Science Inventory

    The document represents a brief, quantitatively oriented scientific summary of health effects data. It was developed by the Environmental Criteria and Assessment Office to assist the Office of Emergency and Remedial Response in establishing chemical-specific health-related goals ...

  9. RETHINKING HUMAN HEALTH IMPACT ASSESSMENT. (R825758)

    EPA Science Inventory

    Most EIA programs around the world require the consideration of human health impacts. Yet relatively few EIA documents adequately address those impacts. This article examines how, why, and to what extent health impacts are analyzed in environmental impact assessments in the U.S. ...

  10. Sensor data fusion for soil health assessment

    USDA-ARS?s Scientific Manuscript database

    Assessment of soil health involves determining how well a soil is performing its biological, chemical, and physical functions relative to its inherent potential. Due to high cost, labor requirements, and soil disturbance, traditional laboratory analyses cannot provide high resolution soil health dat...

  11. Content Assessment of Selected College Health Textbooks.

    ERIC Educational Resources Information Center

    Huetteman, Julie Doidge

    Six college health textbooks published between 1980 and 1987 were analyzed to determine the extent of coverage of 10 selected content areas from "Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention." Content areas assessed included: motor vehicle accidents, alcohol and drug misuse, teenage pregnancy,…

  12. Health Effects Assessment for Carbon Tetrachloride (1986)

    EPA Science Inventory

    The document represents a brief, quantitatively oriented scientific summary of health effects data. It was developed by the Environmental Criteria and Assessment Office to assist the Office of Emergency and Remedial Response in establishing chemical-specific health-related goals ...

  13. Content Assessment of Selected College Health Textbooks.

    ERIC Educational Resources Information Center

    Huetteman, Julie Doidge

    Six college health textbooks published between 1980 and 1987 were analyzed to determine the extent of coverage of 10 selected content areas from "Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention." Content areas assessed included: motor vehicle accidents, alcohol and drug misuse, teenage pregnancy,…

  14. RETHINKING HUMAN HEALTH IMPACT ASSESSMENT. (R825758)

    EPA Science Inventory

    Most EIA programs around the world require the consideration of human health impacts. Yet relatively few EIA documents adequately address those impacts. This article examines how, why, and to what extent health impacts are analyzed in environmental impact assessments in the U.S. ...

  15. [Approaches for assessing forest ecosystem health].

    PubMed

    Chen, Gao; Deng, Hongbing; Wang, Qingli; Dai, Limin; Hao, Zhanqing

    2003-06-01

    Assessment and indicator system become the key issues in the research on ecosystem health in 21st century. Assessing forest ecosystem health gradually attach much attention because it is an important component of terrestrial ecosystem. The definition, measurement, evaluation and its management had been discussed broadly, and some theories, assessing methods and frameworks had been proposed, which provides a new concept and a serial research approaches for dealing with the crisis of terrestrial ecosystems, even the environment problems in the world. Now, the common operational models for assessing forest ecosystem health do not exist owing to the manifold limitations. This paper discussed forest ecosystem health problem, and brought forward three preconditions for assessing forest ecosystem health: 1) a clear conceptual framework; 2) adequate data sets; 3) proper research and analysis techniques. The issues of three preconditions were discussed, and the possible approaches for the assessing research on forest ecosystem health, e.g., long-term studies and environment monitoring, space-for-time substation studies, e.g., history approaches, economics valuation and others were expariated.

  16. Assessment of implant cumulative survival rates in sites with different bone density and related prognostic factors: an 8-year retrospective study of 2,684 implants.

    PubMed

    He, Jing; Zhao, Baohong; Deng, Chunfu; Shang, Dehao; Zhang, Chong

    2015-01-01

    This retrospective study was set to explore the influence of local bone density (BD) on implant cumulative survival rates (ICSRs) and to assess prognostic factors associated with implant failure at sites with different BD. Between January 2005 and December 2011, 2,684 implants were placed in 1,377 patients and included in the study. Implants at sites with different BD were divided into four groups (G1 to G4) according to the Lekholm and Zarb classification, corresponding to bone types 1 to 4. ICSRs and the reasons for failure in each group were evaluated. Factors related to the local distribution of BD were also analyzed. A number of predictive variables were examined by univariate and multivariate analyses to evaluate prognostic factors and their influence on implant failure rates. In total, 45 implants were lost, resulting in ICSRs for G1 to G4 of 100%, 98.18%, 96.83%, and 92.25%, respectively. The main reasons for failure in each group were failed osseointegration and occlusal overloading. Low BD was associated with advanced age (> 50 years) and the posterior maxilla. Based on multivariate analysis, diabetes mellitus and nonthreaded implants were significant factors in the high-BD group (G2), while advanced age, smoking, nonthreaded implants, and immediate loading were risk factors for the low-BD group (G3 and G4). BD is one of the most important factors influencing the long-term ICSR, which decreases with decreasing BD values. Accurate risk evaluation for sites with different BD before implantation will be beneficial to implant survival.

  17. Integrating Sexual Minority Health Issues into a Health Assessment Class.

    PubMed

    Bosse, Jordon D; Nesteby, J Aleah; Randall, Carla E

    2015-01-01

    The health needs of the lesbian, gay, bisexual, and transgender (LGBT) population are traditionally overlooked by the health care community and are rendered invisible by most nursing school curricula. Initial contact with a nurse during a health history and assessment can have an impact on whether the person will feel comfortable disclosing his or her identity, returning for services, or following plans of care. Because the first interaction with a nurse can be critical, the health assessment course is an appropriate place in the curriculum to discuss the needs of the LGBT community. This article includes a discussion of unique health risks to the LGBT population, benefits, and challenges of incorporating these issues into the classroom and recommendations for including the care of this population into a health assessment nursing course. Specific communication techniques are provided that may be helpful during history taking and physical examination with a patient who is LGBT. Guidance regarding physical examination of the transgender patient is also included. These suggestions will be helpful to nurse faculty who teach health assessment, nursing students, educators who design and implement professional development and continuing education for established nurses, preceptors in the clinical setting, and any nurse who is unfamiliar with the needs and concerns specific to the LGBT population.

  18. Pesticide residues in cashew apple, guava, kaki and peach: GC-μECD, GC-FPD and LC-MS/MS multiresidue method validation, analysis and cumulative acute risk assessment.

    PubMed

    Jardim, Andréia Nunes Oliveira; Mello, Denise Carvalho; Goes, Fernanda Caroline Silva; Frota Junior, Elcio Ferreira; Caldas, Eloisa Dutra

    2014-12-01

    A multiresidue method for the determination of 46 pesticides in fruits was validated. Samples were extracted with acidified ethyl acetate, MgSO4 and CH3COONa and cleaned up by dispersive SPE with PSA. The compounds were analysed by GC-FPD, GC-μECD or LC-MS/MS, with LOQs from 1 to 8 μg/kg. The method was used to analyse 238 kaki, cashew apple, guava, and peach fruit and pulp samples, which were also analysed for dithiocarbamates (DTCs) using a spectrophotometric method. Over 70% of the samples were positive, with DTC present in 46.5%, λ-cyhalothrin in 37.1%, and omethoate in 21.8% of the positive samples. GC-MS/MS confirmed the identities of the compounds detected by GC. None of the pesticides found in kaki, cashew apple and guava was authorised for these crops in Brazil. The risk assessment has shown that the cumulative acute intake of organophosphorus or pyrethroid compounds from the consumption of these fruits is unlikely to pose a health risk to consumers.

  19. Smart Sensors Assess Structural Health

    NASA Technical Reports Server (NTRS)

    2010-01-01

    NASA frequently inspects launch vehicles, fuel tanks, and other components for structural damage. To perform quick evaluation and monitoring, the Agency pursues the development of structural health monitoring systems. In 2001, Acellent Technologies Inc., of Sunnyvale, California, received Small Business Innovation Research (SBIR) funding from Marshall Space Flight Center to develop a hybrid Stanford Multi-Actuator Receiver Transduction (SMART) Layer for aerospace vehicles and structures. As a result, Acellent expanded the technology's capability and now sells it to aerospace and automotive companies; construction, energy, and utility companies; and the defense, space, transportation, and energy industries for structural condition monitoring, damage detection, crack growth monitoring, and other applications.

  20. Assessment of Rural Health Research. Executive Summary.

    ERIC Educational Resources Information Center

    Control Data Corp., Arlington, VA. Professional Services Div.

    Culminating a 6-month assessment effort by Control Data Corporation's (CDC) Engineering Management Operations (EMO), the report was prepared to help meet the Department of Agriculture's need for an assessment of (1) rural health care services research as a whole and (2) the knowledge contained in that research. The CDC "Final Report" was presented…

  1. [Health research and health technology assessment in Chile].

    PubMed

    Espinoza, Manuel Antonio; Cabieses, Báltica; Paraje, Guillermo

    2014-01-01

    Health research is considered an essential element for the improvement of population health and it has been recommended that a share of the national health budget should be allocated to develop this field. Chile has undertaken efforts in the last decades in order to improve the governmental structure created to promote the development of health research, which has increased human resources and funding opportunities. On the other hand, the sustained economic growth of Chile in the last decades suggests that the health expenditure will maintain its increasing trend in the following years. This additional funding could be used to improve coverage of current activities performed in the health system, but also to address the incorporation of new strategies. More recently, health technology assessment (HTA) has been proposed as a process to support decisions about allocation of resources based on scientific evidence. This paper examines the relationship between the development of health research and the HTA process. First, it presents a brief diagnosis of the situation of health research in Chile. Second, it reviews the conceptual basis and the methods that account for the relationship between a HTA process and the development of health research. In particular, it emphasizes the relevance of identifying information gaps where funding additional research can be considered a good use of public resources. Finally, it discusses the challenges and possible courses of action that Chile could take in order to guarantee the continuous improvement of an articulated structure for health research and HTA.

  2. Environment, safety and health progress assessment manual

    SciTech Connect

    Not Available

    1992-12-01

    On June 27, 1989, the Secretary of Energy announced a 10-Point Initiative to strengthen environment, safety, and health (ES H) programs, and waste management activities at DOE production, research, and testing facilities. One of the points involved conducting dent Tiger Team Assessments of DOE operating facilities. The Office of Special independent Projects (OSP), EH-5, in the Office of the Assistant Secretary for Environment, Safety and Health, EH-1, was assigned the responsibility to conduct the Tiger Team Assessments. Through June 1992, a total of 35 Tiger Team Assessments were completed. The Secretary directed that Corrective Action Plans be developed and implemented to address the concerns identified by the Tiger Teams. In March 1991, the Secretary approved a plan for assessments that are more focused, concentrating on ES H management, ES H corrective actions, self-assessment programs, and root-cause related issues.'' In July 1991, the Secretary approved the initiation of ES H Progress Assessments, as a followup to the Tiger Team Assessments, and in the continuing effort to institutionalize the self-assessment process and line management accountability in the ES H areas. This manual documents the processes to be used to perform the ES H Progress Assessments. It was developed based upon the lessons learned from Tiger Team Assessments, the two pilot Progress Assessments, and Progress Assessments that have been completed. The manual will be updated periodically to reflect lessons learned or changes in policy.

  3. Promoting health literacy through the health education assessment project.

    PubMed

    Marx, Eva; Hudson, Nancy; Deal, Tami B; Pateman, Beth; Middleton, Kathleen

    2007-04-01

    The Council of Chief State School Officers' State Collaborative on Assessment and Student Standards Health Education Assessment Project (SCASS-HEAP) allows states to pool financial and human resources to develop effective ready-to-use health education assessment resources through a collaborative process. The purpose of this article is to describe the extensive ongoing development of the SCASS-HEAP and its benefits for important stakeholders in health and education. A review of the products from the first decade of the SCASS-HEAP was undertaken. The SCASS-HEAP supports a comprehensive systems approach to helping educators focus effectively on the most important skills and issues in child and adolescent health and gives health education a place at the school reform table, providing visibility and credibility and promoting the essential links between health and learning. State education agencies and school districts can use SCASS-HEAP materials for assessment and, perhaps more importantly, to help teachers modify and improve instruction at the classroom level for increased student learning.

  4. Health Technology Assessment in the UK.

    PubMed

    Raftery, James; Powell, John

    2013-10-12

    In this Review, we discuss the UK's Health Technology Assessment programme, which is 20 years old in 2013. We situate the programme in the context of the UK landscape for evidence-based medicine, including in relation to the National Institute for Health and Care Excellence and as guidance to the National Health Service. We identify features that might be of value to other health systems as they confront the challenges of rapid innovation and rising costs. We use examples of recent studies to show the strengths and weaknesses of the programme. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. Environment, safety and health progress assessment manual

    SciTech Connect

    Not Available

    1992-12-01

    On June 27, 1989, the Secretary of Energy announced a 1O-Point Initiative to strengthen environment,safety, and health (ES H) programs, and waste management activities at involved conducting DOE production, research, and testing facilities. One of the points independent Tiger Team Assessments of DOE operating facilities. The Office of Special Projects (OSP), EH-5, in the Office of the Assistant Secretary for Environment, Safety and Health, EH-1, was assigned the responsibility to conduct the Tiger Team Assessments. Through June 1992, a total of 35 Tiger Team Assessments were completed. The Secretary directed that Corrective Action Plans be developed and implemented to address the concerns identified by the Tiger Teams. In March 1991, the Secretary approved a plan for assessments that are more focused, concentrating on ES H management, ES H corrective actions, self-assessment programs, and root-cause related issues.'' In July 1991, the Secretary approved the initiation of ES H Progress Assessments, as a followup to the Tiger Team Assessments, and in the continuing effort to institutionalize the self-assessment process and line management accountability in the ES H areas. This volume contains appendices to the Environment, Safety and Health Progress Assessment Manual.

  6. Assessing entrepreneurship in governmental public health.

    PubMed

    Jacobson, Peter D; Wasserman, Jeffrey; Wu, Helen W; Lauer, Johanna R

    2015-04-01

    We assessed the feasibility and desirability of public health entrepreneurship (PHE) in governmental public health. Using a qualitative case study approach with semistructured interview protocols, we conducted interviews between April 2010 and January 2011 at 32 local health departments (LHDs) in 18 states. Respondents included chief health officers and senior LHD staff, representatives from national public health organizations, health authorities, and public health institutes. Respondents identified PHE through 3 overlapping practices: strategic planning, operational efficiency, and revenue generation. Clinical services offer the strongest revenue-generating potential, and traditional public health services offer only limited entrepreneurial opportunities. Barriers include civil service rules, a risk-averse culture, and concerns that PHE would compromise core public health values. Ongoing PHE activity has the potential to reduce LHDs' reliance on unstable general public revenues. Yet under the best of circumstances, it is difficult to generate revenue from public health services. Although governmental public health contains pockets of entrepreneurial activity, its culture does not sustain significant entrepreneurial activity. The question remains as to whether LHDs' current public revenue sources are sustainable and, if not, whether PHE is a feasible or desirable alternative.

  7. Assessing Entrepreneurship in Governmental Public Health

    PubMed Central

    Wasserman, Jeffrey; Wu, Helen W.; Lauer, Johanna R.

    2015-01-01

    Objectives. We assessed the feasibility and desirability of public health entrepreneurship (PHE) in governmental public health. Methods. Using a qualitative case study approach with semistructured interview protocols, we conducted interviews between April 2010 and January 2011 at 32 local health departments (LHDs) in 18 states. Respondents included chief health officers and senior LHD staff, representatives from national public health organizations, health authorities, and public health institutes. Results. Respondents identified PHE through 3 overlapping practices: strategic planning, operational efficiency, and revenue generation. Clinical services offer the strongest revenue-generating potential, and traditional public health services offer only limited entrepreneurial opportunities. Barriers include civil service rules, a risk-averse culture, and concerns that PHE would compromise core public health values. Conclusions. Ongoing PHE activity has the potential to reduce LHDs’ reliance on unstable general public revenues. Yet under the best of circumstances, it is difficult to generate revenue from public health services. Although governmental public health contains pockets of entrepreneurial activity, its culture does not sustain significant entrepreneurial activity. The question remains as to whether LHDs’ current public revenue sources are sustainable and, if not, whether PHE is a feasible or desirable alternative. PMID:25689182

  8. Dose-Response Relationship between Cumulative Occupational Lead Exposure and the Associated Health Damages: A 20-Year Cohort Study of a Smelter in China

    PubMed Central

    Wu, Yue; Gu, Jun-Ming; Huang, Yun; Duan, Yan-Ying; Huang, Rui-Xue; Hu, Jian-An

    2016-01-01

    Long-term airborne lead exposure, even below official occupational limits, has been found to cause lead poisoning at higher frequencies than expected, which suggests that China’s existing occupational exposure limits should be reexamined. A retrospective cohort study was conducted on 1832 smelting workers from 1988 to 2008 in China. These were individuals who entered the plant and came into continuous contact with lead at work for longer than 3 months. The dose-response relationship between occupational cumulative lead exposure and lead poisoning, abnormal blood lead, urinary lead and erythrocyte zinc protoporphyrin (ZPP) were analyzed and the benchmark dose lower bound confidence limits (BMDLs) were calculated. Statistically significant positive correlations were found between cumulative lead dust and lead fumes exposures and workplace seniority, blood lead, urinary lead and ZPP values. A dose-response relationship was observed between cumulative lead dust or lead fumes exposure and lead poisoning (p < 0.01). The BMDLs of the cumulative occupational lead dust and fumes doses were 0.68 mg-year/m3 and 0.30 mg-year/m3 for lead poisoning, respectively. The BMDLs of workplace airborne lead concentrations associated with lead poisoning were 0.02 mg/m3 and 0.01 mg/m3 for occupational exposure lead dust and lead fume, respectively. In conclusion, BMDLs for airborne lead were lower than occupational exposure limits, suggesting that the occupational lead exposure limits need re-examination and adjustment. Occupational cumulative exposure limits (OCELs) should be established to better prevent occupational lead poisoning. PMID:26999177

  9. Dose-Response Relationship between Cumulative Occupational Lead Exposure and the Associated Health Damages: A 20-Year Cohort Study of a Smelter in China.

    PubMed

    Wu, Yue; Gu, Jun-Ming; Huang, Yun; Duan, Yan-Ying; Huang, Rui-Xue; Hu, Jian-An

    2016-03-16

    Long-term airborne lead exposure, even below official occupational limits, has been found to cause lead poisoning at higher frequencies than expected, which suggests that China's existing occupational exposure limits should be reexamined. A retrospective cohort study was conducted on 1832 smelting workers from 1988 to 2008 in China. These were individuals who entered the plant and came into continuous contact with lead at work for longer than 3 months. The dose-response relationship between occupational cumulative lead exposure and lead poisoning, abnormal blood lead, urinary lead and erythrocyte zinc protoporphyrin (ZPP) were analyzed and the benchmark dose lower bound confidence limits (BMDLs) were calculated. Statistically significant positive correlations were found between cumulative lead dust and lead fumes exposures and workplace seniority, blood lead, urinary lead and ZPP values. A dose-response relationship was observed between cumulative lead dust or lead fumes exposure and lead poisoning (p < 0.01). The BMDLs of the cumulative occupational lead dust and fumes doses were 0.68 mg-year/m³ and 0.30 mg-year/m³ for lead poisoning, respectively. The BMDLs of workplace airborne lead concentrations associated with lead poisoning were 0.02 mg/m³ and 0.01 mg/m³ for occupational exposure lead dust and lead fume, respectively. In conclusion, BMDLs for airborne lead were lower than occupational exposure limits, suggesting that the occupational lead exposure limits need re-examination and adjustment. Occupational cumulative exposure limits (OCELs) should be established to better prevent occupational lead poisoning.

  10. Environmentally-Relevant Mixtures in Cumulative Assessments: An Acute Study of Toxicokinetics and Effects on Motor Activity in Rats Exposed to a Mixture of Pyrethroids

    EPA Science Inventory

    Due to extensive use, human exposure to multiple pyrethroid insecticides occurs frequently. Studies of pyrethroid neurotoxicity suggest a common mode of toxicity and that pyrethroids should be considered cumulatively to model risk. The objective of this work was to use a pyrethro...

  11. Environmentally-Relevant Mixtures in Cumulative Assessments: An Acute Study of Toxicokinetics and Effects on Motor Activity in Rats Exposed to a Mixture of Pyrethroids

    EPA Science Inventory

    Due to extensive use, human exposure to multiple pyrethroid insecticides occurs frequently. Studies of pyrethroid neurotoxicity suggest a common mode of toxicity and that pyrethroids should be considered cumulatively to model risk. The objective of this work was to use a pyrethro...

  12. Cumulative human impacts on marine predators.

    PubMed

    Maxwell, Sara M; Hazen, Elliott L; Bograd, Steven J; Halpern, Benjamin S; Breed, Greg A; Nickel, Barry; Teutschel, Nicole M; Crowder, Larry B; Benson, Scott; Dutton, Peter H; Bailey, Helen; Kappes, Michelle A; Kuhn, Carey E; Weise, Michael J; Mate, Bruce; Shaffer, Scott A; Hassrick, Jason L; Henry, Robert W; Irvine, Ladd; McDonald, Birgitte I; Robinson, Patrick W; Block, Barbara A; Costa, Daniel P

    2013-01-01

    Stressors associated with human activities interact in complex ways to affect marine ecosystems, yet we lack spatially explicit assessments of cumulative impacts on ecologically and economically key components such as marine predators. Here we develop a metric of cumulative utilization and impact (CUI) on marine predators by combining electronic tracking data of eight protected predator species (n=685 individuals) in the California Current Ecosystem with data on 24 anthropogenic stressors. We show significant variation in CUI with some of the highest impacts within US National Marine Sanctuaries. High variation in underlying species and cumulative impact distributions means that neither alone is sufficient for effective spatial management. Instead, comprehensive management approaches accounting for both cumulative human impacts and trade-offs among multiple stressors must be applied in planning the use of marine resources.

  13. Identification and Quantification of Cumulative Factors that Increase Environmental Exposures and Impacts

    EPA Science Inventory

    Evaluating the combined adverse effects of multiple stressors upon human health is an imperative component of cumulative risk assessment (CRA)1. In addition to chemical stressors, other non-chemical factors are also considered. For examples, smoking will elevate the risks of havi...

  14. Identification and Quantification of Cumulative Factors that Increase Environmental Exposures and Impacts

    EPA Science Inventory

    Evaluating the combined adverse effects of multiple stressors upon human health is an imperative component of cumulative risk assessment (CRA)1. In addition to chemical stressors, other non-chemical factors are also considered. For examples, smoking will elevate the risks of havi...

  15. Cumulative risk: toxicity and interactions of physical and chemical stressors.

    PubMed

    Rider, Cynthia V; Boekelheide, Kim; Catlin, Natasha; Gordon, Christopher J; Morata, Thais; Selgrade, Maryjane K; Sexton, Kenneth; Simmons, Jane Ellen

    2014-01-01

    Recent efforts to update cumulative risk assessment procedures to incorporate nonchemical stressors ranging from physical to psychosocial reflect increased interest in consideration of the totality of variables affecting human health and the growing desire to develop community-based risk assessment methods. A key roadblock is the uncertainty as to how nonchemical stressors behave in relationship to chemical stressors. Physical stressors offer a reasonable starting place for measuring the effects of nonchemical stressors and their modulation of chemical effects (and vice versa), as they clearly differ from chemical stressors; and "doses" of many physical stressors are more easily quantifiable than those of psychosocial stressors. There is a commonly held belief that virtually nothing is known about the impact of nonchemical stressors on chemically mediated toxicity or the joint impact of coexposure to chemical and nonchemical stressors. Although this is generally true, there are several instances where a substantial body of evidence exists. A workshop titled "Cumulative Risk: Toxicity and Interactions of Physical and Chemical Stressors" held at the 2013 Society of Toxicology Annual Meeting provided a forum for discussion of research addressing the toxicity of physical stressors and what is known about their interactions with chemical stressors, both in terms of exposure and effects. Physical stressors including sunlight, heat, radiation, infectious disease, and noise were discussed in reference to identifying pathways of interaction with chemical stressors, data gaps, and suggestions for future incorporation into cumulative risk assessments.

  16. Cumulative Risk: Toxicity and Interactions of Physical and Chemical Stressors

    PubMed Central

    Rider, Cynthia V.

    2014-01-01

    Recent efforts to update cumulative risk assessment procedures to incorporate nonchemical stressors ranging from physical to psychosocial reflect increased interest in consideration of the totality of variables affecting human health and the growing desire to develop community-based risk assessment methods. A key roadblock is the uncertainty as to how nonchemical stressors behave in relationship to chemical stressors. Physical stressors offer a reasonable starting place for measuring the effects of nonchemical stressors and their modulation of chemical effects (and vice versa), as they clearly differ from chemical stressors; and “doses” of many physical stressors are more easily quantifiable than those of psychosocial stressors. There is a commonly held belief that virtually nothing is known about the impact of nonchemical stressors on chemically mediated toxicity or the joint impact of coexposure to chemical and nonchemical stressors. Although this is generally true, there are several instances where a substantial body of evidence exists. A workshop titled “Cumulative Risk: Toxicity and Interactions of Physical and Chemical Stressors” held at the 2013 Society of Toxicology Annual Meeting provided a forum for discussion of research addressing the toxicity of physical stressors and what is known about their interactions with chemical stressors, both in terms of exposure and effects. Physical stressors including sunlight, heat, radiation, infectious disease, and noise were discussed in reference to identifying pathways of interaction with chemical stressors, data gaps, and suggestions for future incorporation into cumulative risk assessments. PMID:24154487

  17. Reliability assessment of home health care services.

    PubMed

    Spyrou, Stergiani; Bamidis, Panagiotis; Kilintzis, Vassilis; Lekka, Irini; Maglaveras, Nicos; Pappas, Costas

    2007-01-01

    In this paper, a model of reliability assessment of services in Home Health Care Delivery is presented. Reliability is an important quality dimension for services and is included in non-functional requirements of a system. A stochastic Markov model for reliability assessment is applied to patient communication services, in the field of home health care delivery. The methodology includes the specification of scenarios, the definition of failures in scenarios as well as the application of the analytical model. The results of the methodology reveal the critical states of the Home Health Care System and recommendations for improvement of the services are proposed. The model gives valuable results in predicting service reliability and, independently of the error types, it can be applied to all fields of Regional Health Network (RHN).

  18. Managing cumulative impacts: A key to sustainability?

    SciTech Connect

    Hunsaker, C.T.

    1994-12-31

    This paper addresses how science can be more effectively used in creating policy to manage cumulative effects on ecosystems. The paper focuses on the scientific techniques that we have to identify and to assess cumulative impacts on ecosystems. The term ``sustainable development`` was brought into common use by the World Commission on Environment and Development (The Brundtland Commission) in 1987. The Brundtland Commission report highlighted the need to simultaneously address developmental and environmental imperatives simultaneously by calling for development that ``meets the needs of the present generation without compromising the needs of future generations.`` We cannot claim to be working toward sustainable development until we can quantitatively assess cumulative impacts on the environment: The two concepts are inextricibally linked in that the elusiveness of cumulative effects likely has the greatest potential of keeping us from achieving sustainability. In this paper, assessment and management frameworks relevant to cumulative impacts are discussed along with recent literature on how to improve such assessments. When possible, examples are given for marine ecosystems.

  19. 42 CFR 90.3 - Procedures for requesting health assessments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Procedures for requesting health assessments. 90.3 Section 90.3 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS AND HEALTH EFFECTS STUDIES OF HAZARDOUS SUBSTANCES RELEASES AND FACILITIES...

  20. Assessing health impact assessment: multidisciplinary and international perspectives

    PubMed Central

    Krieger, N; Northridge, M; Gruskin, S; Quinn, M; Kriebel, D; Davey, S; Bassett, M; Rehkopf, D; Miller, C

    2003-01-01

    Health impact assessment (HIA) seeks to expand evaluation of policy and programmes in all sectors, both private and public, to include their impact on population health. While the idea that the public's health is affected by a broad array of social and economic policies is not new and dates back well over two centuries, what is new is the notion—increasingly adopted by major health institutions, such as the World Health Organisation (WHO) and the United Kingdom National Health Services (NHS)—that health should be an explicit consideration when evaluating all public policies. In this article, it is argued that while HIA has the potential to enhance recognition of societal determinants of health and of intersectoral responsibility for health, its pitfalls warrant critical attention. Greater clarity is required regarding criteria for initiating, conducting, and completing HIA, including rules pertaining to decision making, enforcement, compliance, plus paying for their conduct. Critical debate over the promise, process, and pitfalls of HIA needs to be informed by multiple disciplines and perspectives from diverse people and regions of the world. PMID:12933768

  1. Integrating health profile with survival for quality of life assessment.

    PubMed

    Hwang, Jing-Shiang; Wang, Jung-Der

    2004-02-01

    In cohort studies or clinical trials, measurements of quality of life (QoL) were averaged across available individuals for each group at given points in time to produce single measures for comparisons. However, estimates of these single measures may be severely biased if substantial mortality occurs over time. The objective of this study is to develop a method that integrates QoL measurement and survival for long-term evaluation of health services. We defined a mean QoL score function over time for an index population as the average QoL score of all individuals both alive and dead at each time point in the population. While a living subject's QoL can be assessed by asking one's subjective preference, the score of a decedent can be assigned a fixed value depending on the specific facet on health profile. The mean QoL score function over time is reduced to a single measure of expected cumulative QoL score, which is the area under the curve of mean QoL score function over a given time interval and can be estimated by taking a random sample from a cross-sectional survey. For the QoL score function to be extrapolated to life-long, it requires the assumption that the disease causes premature death or a long-term moderate impairment of QoL. We provided methods and computer programs for estimating mean QoL score functions and the reduced single measures for use in comparisons. A cohort of 779 breast cancer patients from Chiangmai, Thailand were followed for 12 years to demonstrate the proposed methods. The data included the 12-year complete survival records and QoL scores on 233 patients collected from a cross-sectional survey using WHOQOL questionnaire and standard gamble method. The expected cumulative QoL scores using utility and psychometric scales were compared among patients in four groups of clinical stages in this cohort for time from onset up to 12 years and life-long. We conclude that such an integration of QoL measurement with survival can be useful for the

  2. Mental health assessment of rape offenders.

    PubMed

    Sarkar, Jaydip

    2013-07-01

    There is an urgent need for development of methods of assessment and management of sex offenders (rapists, child sex offenders, other sexual offenders, and murderers) to mount a society-wide battle against the scourge of sexual offences in India. This paper provides an overview of theories, models, and assessment methods of rapists. It draws upon literature from psychiatry, psychology, criminology, probation, and ethics to provide a framework for understanding reasons behind rape, how mental health issues are implicated, what mental health professionals can do to contribute to crime management, and why this is ethically right and proper.

  3. Mental health assessment of rape offenders

    PubMed Central

    Sarkar, Jaydip

    2013-01-01

    There is an urgent need for development of methods of assessment and management of sex offenders (rapists, child sex offenders, other sexual offenders, and murderers) to mount a society-wide battle against the scourge of sexual offences in India. This paper provides an overview of theories, models, and assessment methods of rapists. It draws upon literature from psychiatry, psychology, criminology, probation, and ethics to provide a framework for understanding reasons behind rape, how mental health issues are implicated, what mental health professionals can do to contribute to crime management, and why this is ethically right and proper. PMID:24082243

  4. Cumulative iron dose and resistance to erythropoietin.

    PubMed

    Rosati, A; Tetta, C; Merello, J I; Palomares, I; Perez-Garcia, R; Maduell, F; Canaud, B; Aljama Garcia, P

    2015-10-01

    Optimizing anemia treatment in hemodialysis (HD) patients remains a priority worldwide as it has significant health and financial implications. Our aim was to evaluate in a large cohort of chronic HD patients in Fresenius Medical Care centers in Spain the value of cumulative iron (Fe) dose monitoring for the management of iron therapy in erythropoiesis-stimulating agent (ESA)-treated patients, and the relationship between cumulative iron dose and risk of hospitalization. Demographic, clinical and laboratory parameters from EuCliD(®) (European Clinical Dialysis Database) on 3,591 patients were recorded including ESA dose (UI/kg/week), erythropoietin resistance index (ERI) [U.I weekly/kg/gr hemoglobin (Hb)] and hospitalizations. Moreover the cumulative Fe dose (mg/kg of bodyweight) administered over the last 2 years was calculated. Univariate and multivariate analyses were performed to identify the main predictors of ESA resistance and risk of hospitalization. Patients belonging to the 4th quartile of ERI were defined as hypo-responders. The 2-year iron cumulative dose was significantly higher in the 4th quartile of ERI. In hypo-responders, 2-year cumulative iron dose was the only iron marker associated with ESA resistance. At case-mix adjusted multivariate analysis, 2-year iron cumulative dose was an independent predictor of hospitalization risk. In ESA-treated patients cumulative Fe dose could be a useful tool to monitor the appropriateness of Fe therapy and to prevent iron overload. To establish whether the associations between cumulative iron dose, ERI and hospitalization risk are causal or attributable to selection bias by indication, clinical trials are necessary.

  5. CUMBIN - CUMULATIVE BINOMIAL PROGRAMS

    NASA Technical Reports Server (NTRS)

    Bowerman, P. N.

    1994-01-01

    The cumulative binomial program, CUMBIN, is one of a set of three programs which calculate cumulative binomial probability distributions for arbitrary inputs. The three programs, CUMBIN, NEWTONP (NPO-17556), and CROSSER (NPO-17557), can be used independently of one another. CUMBIN can be used by statisticians and users of statistical procedures, test planners, designers, and numerical analysts. The program has been used for reliability/availability calculations. CUMBIN calculates the probability that a system of n components has at least k operating if the probability that any one operating is p and the components are independent. Equivalently, this is the reliability of a k-out-of-n system having independent components with common reliability p. CUMBIN can evaluate the incomplete beta distribution for two positive integer arguments. CUMBIN can also evaluate the cumulative F distribution and the negative binomial distribution, and can determine the sample size in a test design. CUMBIN is designed to work well with all integer values 0 < k <= n. To run the program, the user simply runs the executable version and inputs the information requested by the program. The program is not designed to weed out incorrect inputs, so the user must take care to make sure the inputs are correct. Once all input has been entered, the program calculates and lists the result. The CUMBIN program is written in C. It was developed on an IBM AT with a numeric co-processor using Microsoft C 5.0. Because the source code is written using standard C structures and functions, it should compile correctly with most C compilers. The program format is interactive. It has been implemented under DOS 3.2 and has a memory requirement of 26K. CUMBIN was developed in 1988.

  6. CUMBIN - CUMULATIVE BINOMIAL PROGRAMS

    NASA Technical Reports Server (NTRS)

    Bowerman, P. N.

    1994-01-01

    The cumulative binomial program, CUMBIN, is one of a set of three programs which calculate cumulative binomial probability distributions for arbitrary inputs. The three programs, CUMBIN, NEWTONP (NPO-17556), and CROSSER (NPO-17557), can be used independently of one another. CUMBIN can be used by statisticians and users of statistical procedures, test planners, designers, and numerical analysts. The program has been used for reliability/availability calculations. CUMBIN calculates the probability that a system of n components has at least k operating if the probability that any one operating is p and the components are independent. Equivalently, this is the reliability of a k-out-of-n system having independent components with common reliability p. CUMBIN can evaluate the incomplete beta distribution for two positive integer arguments. CUMBIN can also evaluate the cumulative F distribution and the negative binomial distribution, and can determine the sample size in a test design. CUMBIN is designed to work well with all integer values 0 < k <= n. To run the program, the user simply runs the executable version and inputs the information requested by the program. The program is not designed to weed out incorrect inputs, so the user must take care to make sure the inputs are correct. Once all input has been entered, the program calculates and lists the result. The CUMBIN program is written in C. It was developed on an IBM AT with a numeric co-processor using Microsoft C 5.0. Because the source code is written using standard C structures and functions, it should compile correctly with most C compilers. The program format is interactive. It has been implemented under DOS 3.2 and has a memory requirement of 26K. CUMBIN was developed in 1988.

  7. Assessing the misrepresentation of health problems.

    PubMed

    Lanyon, Richard I

    2003-08-01

    Although respondent misrepresentation in many areas of psychological testing has been widely studied, little is available for evaluating misrepresentation during health-related psychological assessments. In this article, I report the empirical development and validation of such scales for 2 screening inventories: the Psychological Screening Inventory (the HPO scale; Lanyon, 1970, 1978) and the Multidimensional Health Profile (the HPE scale; Ruehlman, Lanyon, & Karoly, 1998a, 1998b, 1999). In each case, judges were asked to simulate the misrepresentation of health problems. Items were selected whose frequencies differed from normal responding; these items were screened for marked content irrelevance and further refined using data from additional respondents. Validation data showed that for both scales the group means for persons with genuine health problems were up to 1 SD above the normative mean, and the means for suspected and actual simulators were about 2 SDs higher than the health-problem groups.

  8. New approaches in human health risk assessment

    PubMed Central

    Abass, Khaled; Carlsen, Anders; Rautio, Arja

    2016-01-01

    Studies on the precise impact of environmental pollutants on human health are difficult to undertake and interpret, because many genetic and environmental factors influence health at the same time and to varying degrees. Our chapter in the AMAP report was based on new approaches to describe risks and future needs. In this paper, we will introduce the issues associated with risk assessment of single chemicals, and present suggestions for future studies as well as a summary of lessons learned during the health-related parts of the European Union-funded FP7 project ArcRisk (Arctic Health Risks: Impacts on health in the Arctic and Europe owing to climate-induced changes in contaminant cycling, 2009–2014; www.arcrisk.eu). PMID:27974141

  9. National Built Environment Health Impact Assessment Model ...

    EPA Pesticide Factsheets

    Behavioral (activity, diet, social interaction) and exposure (air pollution, traffic injury, and noise) related health impacts of land use and transportation investment decisions are becoming better understood and quantified. Research has shown relationships between density, mix, street connectivity, access to parks, shops, transit, presence of sidewalks and bikeways, and healthy food with physical activity, obesity, cardiovascular disease, type II diabetes, and some mental health outcomes. This session demonstrates successful integration of health impact assessment into multiple scenario planning tool platforms. Detailed evidence on chronic disease and related costs associated with contrasting land use and transportation investments are built into a general-purpose module that can be accessed by multiple platforms. Funders, researchers, and end users of the tool will present a detailed description of the key elements of the approach, how it has been applied, and how will evolve. A critical focus will be placed on equity and social justice inherent within the assessment of health disparities that will be featured in the session. Health impacts of community design have significant cost benefit implications. Recent research is now extending relationships between community design features and chronic disease to health care costs. This session will demonstrate the recent application of this evidence on health impacts to the newly adopted Los Angeles Regional Transpo

  10. National Built Environment Health Impact Assessment Model ...

    EPA Pesticide Factsheets

    Behavioral (activity, diet, social interaction) and exposure (air pollution, traffic injury, and noise) related health impacts of land use and transportation investment decisions are becoming better understood and quantified. Research has shown relationships between density, mix, street connectivity, access to parks, shops, transit, presence of sidewalks and bikeways, and healthy food with physical activity, obesity, cardiovascular disease, type II diabetes, and some mental health outcomes. This session demonstrates successful integration of health impact assessment into multiple scenario planning tool platforms. Detailed evidence on chronic disease and related costs associated with contrasting land use and transportation investments are built into a general-purpose module that can be accessed by multiple platforms. Funders, researchers, and end users of the tool will present a detailed description of the key elements of the approach, how it has been applied, and how will evolve. A critical focus will be placed on equity and social justice inherent within the assessment of health disparities that will be featured in the session. Health impacts of community design have significant cost benefit implications. Recent research is now extending relationships between community design features and chronic disease to health care costs. This session will demonstrate the recent application of this evidence on health impacts to the newly adopted Los Angeles Regional Transpo

  11. Cumulative Timers for Microprocessors

    NASA Technical Reports Server (NTRS)

    Battle, John O.

    2007-01-01

    It has been proposed to equip future microprocessors with electronic cumulative timers, for essentially the same reasons for which land vehicles are equipped with odometers (total-distance-traveled meters) and aircraft are equipped with Hobbs meters (total-engine-operating time meters). Heretofore, there has been no way to determine the amount of use to which a microprocessor (or a product containing a microprocessor) has been subjected. The proposed timers would count all microprocessor clock cycles and could only be read by means of microprocessor instructions but, like odometers and Hobbs meters, could never be reset to zero without physically damaging the chip.

  12. 42 CFR 90.8 - Conduct of health assessments and health effects studies.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Conduct of health assessments and health effects studies. 90.8 Section 90.8 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS AND HEALTH EFFECTS STUDIES OF HAZARDOUS SUBSTANCES RELEASES AND...

  13. 42 CFR 90.11 - Reporting of results of health assessments and health effects studies.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Reporting of results of health assessments and health effects studies. 90.11 Section 90.11 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS AND HEALTH EFFECTS STUDIES OF HAZARDOUS SUBSTANCES RELEASES...

  14. 42 CFR 90.8 - Conduct of health assessments and health effects studies.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Conduct of health assessments and health effects studies. 90.8 Section 90.8 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS AND HEALTH EFFECTS STUDIES OF HAZARDOUS SUBSTANCES RELEASES AND FACILITIES...

  15. 42 CFR 90.8 - Conduct of health assessments and health effects studies.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Conduct of health assessments and health effects studies. 90.8 Section 90.8 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS AND HEALTH EFFECTS STUDIES OF HAZARDOUS SUBSTANCES RELEASES AND FACILITIES...

  16. 42 CFR 90.11 - Reporting of results of health assessments and health effects studies.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Reporting of results of health assessments and health effects studies. 90.11 Section 90.11 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS AND HEALTH EFFECTS STUDIES OF HAZARDOUS SUBSTANCES RELEASES AND...

  17. 42 CFR 90.11 - Reporting of results of health assessments and health effects studies.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Reporting of results of health assessments and health effects studies. 90.11 Section 90.11 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS AND HEALTH EFFECTS STUDIES OF HAZARDOUS SUBSTANCES RELEASES AND...

  18. 42 CFR 90.8 - Conduct of health assessments and health effects studies.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Conduct of health assessments and health effects studies. 90.8 Section 90.8 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS AND HEALTH EFFECTS STUDIES OF HAZARDOUS SUBSTANCES RELEASES AND FACILITIES...

  19. 42 CFR 90.11 - Reporting of results of health assessments and health effects studies.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Reporting of results of health assessments and health effects studies. 90.11 Section 90.11 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS AND HEALTH EFFECTS STUDIES OF HAZARDOUS SUBSTANCES RELEASES AND...

  20. 42 CFR 90.11 - Reporting of results of health assessments and health effects studies.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Reporting of results of health assessments and health effects studies. 90.11 Section 90.11 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS AND HEALTH EFFECTS STUDIES OF HAZARDOUS SUBSTANCES RELEASES AND...

  1. 42 CFR 90.8 - Conduct of health assessments and health effects studies.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Conduct of health assessments and health effects studies. 90.8 Section 90.8 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS AND HEALTH EFFECTS STUDIES OF HAZARDOUS SUBSTANCES RELEASES AND FACILITIES...

  2. CROSSER - CUMULATIVE BINOMIAL PROGRAMS

    NASA Technical Reports Server (NTRS)

    Bowerman, P. N.

    1994-01-01

    The cumulative binomial program, CROSSER, is one of a set of three programs which calculate cumulative binomial probability distributions for arbitrary inputs. The three programs, CROSSER, CUMBIN (NPO-17555), and NEWTONP (NPO-17556), can be used independently of one another. CROSSER can be used by statisticians and users of statistical procedures, test planners, designers, and numerical analysts. The program has been used for reliability/availability calculations. CROSSER calculates the point at which the reliability of a k-out-of-n system equals the common reliability of the n components. It is designed to work well with all integer values 0 < k <= n. To run the program, the user simply runs the executable version and inputs the information requested by the program. The program is not designed to weed out incorrect inputs, so the user must take care to make sure the inputs are correct. Once all input has been entered, the program calculates and lists the result. It also lists the number of iterations of Newton's method required to calculate the answer within the given error. The CROSSER program is written in C. It was developed on an IBM AT with a numeric co-processor using Microsoft C 5.0. Because the source code is written using standard C structures and functions, it should compile correctly with most C compilers. The program format is interactive. It has been implemented under DOS 3.2 and has a memory requirement of 26K. CROSSER was developed in 1988.

  3. CROSSER - CUMULATIVE BINOMIAL PROGRAMS

    NASA Technical Reports Server (NTRS)

    Bowerman, P. N.

    1994-01-01

    The cumulative binomial program, CROSSER, is one of a set of three programs which calculate cumulative binomial probability distributions for arbitrary inputs. The three programs, CROSSER, CUMBIN (NPO-17555), and NEWTONP (NPO-17556), can be used independently of one another. CROSSER can be used by statisticians and users of statistical procedures, test planners, designers, and numerical analysts. The program has been used for reliability/availability calculations. CROSSER calculates the point at which the reliability of a k-out-of-n system equals the common reliability of the n components. It is designed to work well with all integer values 0 < k <= n. To run the program, the user simply runs the executable version and inputs the information requested by the program. The program is not designed to weed out incorrect inputs, so the user must take care to make sure the inputs are correct. Once all input has been entered, the program calculates and lists the result. It also lists the number of iterations of Newton's method required to calculate the answer within the given error. The CROSSER program is written in C. It was developed on an IBM AT with a numeric co-processor using Microsoft C 5.0. Because the source code is written using standard C structures and functions, it should compile correctly with most C compilers. The program format is interactive. It has been implemented under DOS 3.2 and has a memory requirement of 26K. CROSSER was developed in 1988.

  4. Health technology assessment and thyroid surgery.

    PubMed

    Lucchini, R; Sanguinetti, A; Monacelli, M; Triola, R; Avenia, S; Conti, C; Santoprete, S; Avenia, N

    2013-01-01

    The growth of technological innovation, the request for assistance, the rising patient's expectations and the interest of the industry have led to a rise in the cost of health care systems. In this context the role of the National Health System is not to delay the development or adoption of new technologies, but rather to drive the development selecting priorities and promoting its use. Health Technology Assessment (HTA) is a multidisciplinary and multidimensional approach for analyzing the medical-clinical, social, organizational, economic, ethical and legal implications of a technology (devices, drugs, procedures) through the assessment of multiple parameters such as effectiveness, safety, costs of the social and organizational impact. A health technology assessment is a comprehensive, systematic evaluation of the prerequisites for estimating the consequences of using health technology. Main characteristic of HTA is that the problem is tackled using an approach focused on four main elements: - technology; - patient; - organization; - economy. The authors have applied the HTA method for the analysis of the ultrasonic focus dissector on thyroid surgery. They compared the cost of the surgical procedure using the ultrasonic dissector and without it in a case study of 440 patients who underwent thyroidectomy.

  5. Health technology assessment and thyroid surgery

    PubMed Central

    LUCCHINI, R.; SANGUINETTI, A.; MONACELLI, M.; TRIOLA, R.; AVENIA, S.; CONTI, C.; SANTOPRETE, S.; AVENIA, N.

    2013-01-01

    Summary The growth of technological innovation, the request for assistance, the rising patient’s expectations and the interest of the industry have led to a rise in the cost of health care systems. In this context the role of the National Health System is not to delay the development or adoption of new technologies, but rather to drive the development selecting priorities and promoting its use. Health Technology Assessment (HTA) is a multidisciplinary and multidimensional approach for analyzing the medical-clinical, social, organizational, economic, ethical and legal implications of a technology (devices, drugs, procedures) through the assessment of multiple parameters such as effectiveness, safety, costs of the social and organizational impact. A health technology assessment is a comprehensive, systematic evaluation of the prerequisites for estimating the consequences of using health technology. Main characteristic of HTA is that the problem is tackled using an approach focused on four main elements: - technology;- patient;- organization;- economy. The authors have applied the HTA method for the analysis of the ultrasonic focus dissector on thyroid surgery. They compared the cost of the surgical procedure using the ultrasonic dissector and without it in a case study of 440 patients who underwent thyroidectomy. PMID:24091174

  6. Advanced Health Assessment in Nurse Practitioner Programs.

    ERIC Educational Resources Information Center

    Kelley, Frances J.; Kopac, Catharine

    2001-01-01

    Responses from 140 nursing schools indicated that most taught health assessment to nurse practitioners as a separate course; public institutions were more involved in computer-assisted instruction. Faculty cited scarce resources and limited time to develop new teaching strategies. Most agreed that graduate courses should focus on differential…

  7. Watershed Health Assessment Tools Investigating Fisheries

    EPA Science Inventory

    WHATIF is software that integrates a number of calculators, tools, and models for assessing the health of watersheds and streams with an emphasis on fish communities. The tool set consists of hydrologic and stream geometry calculators, a fish assemblage predictor, a fish habitat ...

  8. Health Risk Assessment of Chemical Mixtures | Science ...

    EPA Pesticide Factsheets

    The implementation of Superfund requires a methodology for estimating health risk from multi-chemical contamination at ambient levels. Most often, the chemical composition of these mixtures is poorly characterized, exposure data are uncertain and toxicologic data on the known components of the mixture are limited. However, a potential human health hazard may exist and the U.S.EPA, state and local governments need to be able to assess the total hazard in order to make decisions on appropriate action. This report describes a procedure for assessing the risks from chemical mixtures that includes options when different kinds of data are available. Good-quality information on the mixture of concern or a similar mixture should always be used. Less desirable, but still useful approach, is to utilize data on components and their interactions. The quality of exposure and toxicity data must be determined and the uncertainties involved in each risk assessment must be thoroughly discussed. ater contamination is briefly discussed since it is of vital concern as the primary exposure medium for chemical mixtures. The methodology for estimating the human health risk from single chemicals, both carcinogens and systemic toxicants, is reviewed as it forms the basis for the assessment of mixtures. The Implementation of Superfund requires a methodology for estimating health risk from multi-chemical contamination at ambient levels. Most often, the chemical composition of these mix

  9. Assessing Financial Health in Community Colleges

    ERIC Educational Resources Information Center

    Bers, Trudy H.; Head, Ronald B.

    2014-01-01

    In this age of educational accountability, there is an increasing emphasis on assessment and institutional effectiveness, not only in the academic arena but also in other aspects of community college operation, such as fiscal health and stability, revenue generation, resource allocation, facilities, workforce development, and community enrichment…

  10. Assessing Financial Health in Community Colleges

    ERIC Educational Resources Information Center

    Bers, Trudy H.; Head, Ronald B.

    2014-01-01

    In this age of educational accountability, there is an increasing emphasis on assessment and institutional effectiveness, not only in the academic arena but also in other aspects of community college operation, such as fiscal health and stability, revenue generation, resource allocation, facilities, workforce development, and community enrichment…

  11. Watershed Health Assessment Tools Investigating Fisheries

    EPA Science Inventory

    WHATIF is software that integrates a number of calculators, tools, and models for assessing the health of watersheds and streams with an emphasis on fish communities. The tool set consists of hydrologic and stream geometry calculators, a fish assemblage predictor, a fish habitat ...

  12. Lifestyle Assessment: Helping Patients Change Health Behaviors

    PubMed Central

    Ciliska, Donna; Wilson, Douglas M. C.

    1984-01-01

    This article is the second in a series of six on lifestyle assessment and behavior change. The first article presented an assessment tool called FANTASTIC, which has been tested for reliability and is currently in wide use. After assessment, family physicians must help patients decide to change—and give them guidance on how to change—unhealthy behaviors. This article explains how the family physician can use educational, behavioral and relaxation strategies to increase patients' motivation, maintain their commitment and teach them the skills needed to effect changes in health behavior.

  13. The development of health technology assessment.

    PubMed

    Banta, David

    2003-02-01

    The field of health technology assessment (HTA) is still relatively new, but it has shown remarkable growth over the last decade, having spread first from the United States to Europe, and now to the entire world. HTA seeks to couple evidence with decision-making, and thus has similarities to evidence-based health care and evidence-based policy-making. The early history of HTA, beginning around 1975, reveals a first period of synthesising available evidence-principally that dealing with efficacy and cost-effectiveness of health care interventions-so as to put it in a format helpful to health policy-makers, especially those in national governments. From 1985 or so, the focus of the second period was on seeking more effective links with these policy-makers, particularly in Europe. The most recent period, beginning in the late 1990s, has been increasingly devoted to more effective dissemination and implementation in order to influence administrators and clinicians. While early assessments tended to focus on large, expensive, machine-based technologies, the scope has gradually widened to include smaller technologies, 'softer' technologies (such as counselling), and health care needs. Actual assessments have also taken on broader issues, such as organisational, social, and ethical implications. In the Member States of the European Union (EU), HTA activities are increasingly visible, and almost all now have a national focus for HTA associated with the Ministry of Health or its equivalent. Central and Eastern European countries are also developing HTA activities. Most recently, HTA has been highlighted by health policy documents from the European Commission. It seems likely that HTA will in the future be institutionalised in some form as part of EU activities.

  14. Public health assessment--Russian Federation, 1992.

    PubMed

    1992-02-14

    On December 25, 1991, the Russian Federation became an independent republic, and on January 2, 1992, restrictions on retail prices of most commodities were removed. From January 16 through February 6, a multidisciplinary team from the U.S. Food and Humanitarian Assistance Bureau (FHA) conducted an assessment of the needs for humanitarian and technical assistance, focusing on three regions in the southern Ural Mountains-Yekaterinburg, Perm, and Cheliabinsk-and three regions in south-central Siberia-Kusbas, Tomsk, and Novosibirsk. The FHA assessment included observations of health facilities, vaccine- and drug-storage centers, and disease-control programs; review of health data at central, regional, and district epidemiology stations; and collection of food-price and income data through interviews with administrative authorities and surveys of markets and private homes. This report summarizes findings from the assessment.

  15. Health impact assessment: assessing opportunities and barriers to intersectoral health improvement in an expanded European Union

    PubMed Central

    Lock, K.; McKee, M.

    2005-01-01

    On 1 May 2004 the European Union (EU) underwent unprecedented enlargement, from 15 to 25 countries, increasing its population by 20% to over 450 million. Although EU law has limited specific competence in the area of health, its influence on other policy sectors such as agriculture, trade, and employment has wide ranging implications for health. Yet with the exception of provisions on communicable disease control and food safety, public health considerations have played little part in negotiations on EU accession. This paper argues for an intersectoral public health approach in the expanded EU. It reviews the legal basis for assessing the health impacts of policy in the EU and, using health impact assessment as a case study, it examines how well the new member states may be prepared to tackle intersectoral public health action within the constraints imposed by EU policy. PMID:15831682

  16. Cumulative achievement testing: progress testing in reverse.

    PubMed

    Swanson, D B; Holtzman, K Z; Butler, A

    2010-01-01

    This collaborative project between the National Board of Medical Examiners (NBME) and Case Western Reserve University (CWRU) School of Medicine explored the design and use of cumulative achievement tests in basic science education. In cumulative achievement testing, integrative end-of-unit tests are deliberately constructed to systematically retest topics covered in previous units as well as material from the just-completed unit. CWRU faculty developed and administered a series of six web-based cumulative achievement tests using retired United States Medical Licensing Examination (USMLE) step 1 test material and tools provided by NBME's Customized Assessment Services, and trends in student performance were examined as the new CWRU basic science curriculum unfolded. This article provides the background information about test design and administration, as well as samples of score reporting information for students and faculty. While firm conclusions about the effectiveness of cumulative achievement testing are not warranted after a pilot test at a single school, preliminary results suggest that cumulative achievement testing may be an effective complement to progress testing, with the former used to encourage retention of already-covered material and the latter used to assess growth toward the knowledge and skills expected of a graduating student.

  17. [Antimicrobial susceptibility cumulative reports].

    PubMed

    Canut-Blasco, Andrés; Calvo, Jorge; Rodríguez-Díaz, Juan Carlos; Martínez-Martínez, Luis

    2016-10-01

    Cumulative reports on antimicrobial susceptibility tests data are important for selecting empirical treatments, as an educational tool in programs on antimicrobial use, and for establishing breakpoints defining clinical categories. These reports should be based on data validated by clinical microbiologists using diagnostic samples (not surveillance samples). In order to avoid a bias derived from including several isolates obtained from the same patient, it is recommended that, for a defined period, only the first isolate is counted. A minimal number of isolates per species should be presented: a figure of >=30 isolates is statistically acceptable. The report is usually presented in a table format where, for each cell, information on clinically relevant microorganisms-antimicrobial agents is presented. Depending on particular needs, multiple tables showing data related to patients, samples, services or special pathogens can be prepared.

  18. NEWTONP - CUMULATIVE BINOMIAL PROGRAMS

    NASA Technical Reports Server (NTRS)

    Bowerman, P. N.

    1994-01-01

    The cumulative binomial program, NEWTONP, is one of a set of three programs which calculate cumulative binomial probability distributions for arbitrary inputs. The three programs, NEWTONP, CUMBIN (NPO-17555), and CROSSER (NPO-17557), can be used independently of one another. NEWTONP can be used by statisticians and users of statistical procedures, test planners, designers, and numerical analysts. The program has been used for reliability/availability calculations. NEWTONP calculates the probably p required to yield a given system reliability V for a k-out-of-n system. It can also be used to determine the Clopper-Pearson confidence limits (either one-sided or two-sided) for the parameter p of a Bernoulli distribution. NEWTONP can determine Bayesian probability limits for a proportion (if the beta prior has positive integer parameters). It can determine the percentiles of incomplete beta distributions with positive integer parameters. It can also determine the percentiles of F distributions and the midian plotting positions in probability plotting. NEWTONP is designed to work well with all integer values 0 < k <= n. To run the program, the user simply runs the executable version and inputs the information requested by the program. NEWTONP is not designed to weed out incorrect inputs, so the user must take care to make sure the inputs are correct. Once all input has been entered, the program calculates and lists the result. It also lists the number of iterations of Newton's method required to calculate the answer within the given error. The NEWTONP program is written in C. It was developed on an IBM AT with a numeric co-processor using Microsoft C 5.0. Because the source code is written using standard C structures and functions, it should compile correctly with most C compilers. The program format is interactive. It has been implemented under DOS 3.2 and has a memory requirement of 26K. NEWTONP was developed in 1988.

  19. NEWTONP - CUMULATIVE BINOMIAL PROGRAMS

    NASA Technical Reports Server (NTRS)

    Bowerman, P. N.

    1994-01-01

    The cumulative binomial program, NEWTONP, is one of a set of three programs which calculate cumulative binomial probability distributions for arbitrary inputs. The three programs, NEWTONP, CUMBIN (NPO-17555), and CROSSER (NPO-17557), can be used independently of one another. NEWTONP can be used by statisticians and users of statistical procedures, test planners, designers, and numerical analysts. The program has been used for reliability/availability calculations. NEWTONP calculates the probably p required to yield a given system reliability V for a k-out-of-n system. It can also be used to determine the Clopper-Pearson confidence limits (either one-sided or two-sided) for the parameter p of a Bernoulli distribution. NEWTONP can determine Bayesian probability limits for a proportion (if the beta prior has positive integer parameters). It can determine the percentiles of incomplete beta distributions with positive integer parameters. It can also determine the percentiles of F distributions and the midian plotting positions in probability plotting. NEWTONP is designed to work well with all integer values 0 < k <= n. To run the program, the user simply runs the executable version and inputs the information requested by the program. NEWTONP is not designed to weed out incorrect inputs, so the user must take care to make sure the inputs are correct. Once all input has been entered, the program calculates and lists the result. It also lists the number of iterations of Newton's method required to calculate the answer within the given error. The NEWTONP program is written in C. It was developed on an IBM AT with a numeric co-processor using Microsoft C 5.0. Because the source code is written using standard C structures and functions, it should compile correctly with most C compilers. The program format is interactive. It has been implemented under DOS 3.2 and has a memory requirement of 26K. NEWTONP was developed in 1988.

  20. Lake ecosystem health assessment: indicators and methods.

    PubMed

    Xu, F L; Tao, S; Dawson, R W; Li, P G; Cao, J

    2001-09-01

    A set of ecological indicators including structural, functional, and system-level aspects were proposed for a lake ecosystem health assessment, according to the structural, functional, and system-level responses of lake ecosystems to chemical stresses including acidification, eutrophication and copper, oil and pesticide contamination. The structural indicators included phytoplankton cell size and biomass, zooplankton body size and biomass, species diversity, macro- and micro-zooplankton biomass, the zooplankton phytoplankton ratio, and the macrozooplankton microzooplankton ratio. The functional indicators encompassed the algal C assimilation ratio, resource use efficiency, community production, gross production/respiration (i.e. P/R) ratio, gross production standing crop biomass (i.e. P/B) ratio, and standing crop biomass unit energy flow (i.e. B/E) ratio. The ecosystem-level indicators conisisted of ecological buffer capacities, energy, and structural energy. Based on these indicators, a direct measurement method (DMM) and an ecological modeling method (EMM) for lake ecosystem health assessment were developed. The DMM procedures were designed to: (1) identify key indicators; (2) measure directly or calculate indirectly the selected indicators; and, (3) assess ecosystem health on the basis of the indicator values. The EMM procedures were designed to: (1) determine the structure and complexity of the ecological model according to the lake's ecosystem structure; (2) establish an ecological model by designing a conceptual diagram, establishing model equations, and estimating model pararmeters; (3) compare the simulated values of important state variables and process rates with actual observations; (4) calculate ecosystem health indicators using the ecological model; and, (5) assess lake ecosystem health according to the values of the ecological indicators. The results of a case study demonstrated that both methods provided similar results which corresponded with the

  1. Conceptual modeling for Prospective Health Technology Assessment.

    PubMed

    Gantner-Bär, Marion; Djanatliev, Anatoli; Prokosch, Hans-Ulrich; Sedlmayr, Martin

    2012-01-01

    Prospective Health Technology Assessment (ProHTA) is a new and innovative approach to analyze and assess new technologies, methods and procedures in health care. Simulation processes are used to model innovations before the cost-intensive design and development phase. Thus effects on patient care, the health care system as well as health economics aspects can be estimated. To generate simulation models a valid information base is necessary and therefore conceptual modeling is most suitable. Project-specifically improved methods and characteristics of simulation modeling are combined in the ProHTA Conceptual Modeling Process and initially implemented for acute ischemic stroke treatment in Germany. Additionally the project aims at simulation of other diseases and health care systems as well. ProHTA is an interdisciplinary research project within the Cluster of Excellence for Medical Technology - Medical Valley European Metropolitan Region Nuremberg (EMN), which is funded by the German Federal Ministry of Education and Research (BMBF), project grant No. 01EX1013B.

  2. Untapped potential of health impact assessment.

    PubMed

    Winkler, Mirko S; Krieger, Gary R; Divall, Mark J; Cissé, Guéladio; Wielga, Mark; Singer, Burton H; Tanner, Marcel; Utzinger, Jürg

    2013-04-01

    The World Health Organization has promoted health impact assessment (HIA) for over 20 years. At the 2012 United Nations Conference on Sustainable Development (Rio+20), HIA was discussed as a critical method for linking health to "green economy" and "institutional framework" strategies for sustainable development. In countries having a high human development index (HDI), HIA has been added to the overall assessment suite that typically includes potential environmental and social impacts, but it is rarely required as part of the environmental and social impact assessment for large development projects. When they are performed, project-driven HIAs are governed by a combination of project proponent and multilateral lender performance standards rather than host country requirements. Not surprisingly, in low-HDI countries HIA is missing from the programme and policy arena in the absence of an external project driver. Major drivers of global change (e.g. population growth and urbanization, growing pressure on natural resources and climate change) inordinately affect low- and medium-HDI countries; however, in such countries HIA is conspicuously absent. If the cloak of HIA invisibility is to be removed, it must be shown that HIA is useful and beneficial and, hence, an essential component of the 21st century's sustainable development agenda. We analyse where and how HIA can become fully integrated into the impact assessment suite and argue that the impact of HIA must not remain obscure.

  3. Untapped potential of health impact assessment

    PubMed Central

    Krieger, Gary R; Divall, Mark J; Cissé, Guéladio; Wielga, Mark; Singer, Burton H; Tanner, Marcel; Utzinger, Jürg

    2013-01-01

    Abstract The World Health Organization has promoted health impact assessment (HIA) for over 20 years. At the 2012 United Nations Conference on Sustainable Development (Rio+20), HIA was discussed as a critical method for linking health to “green economy” and “institutional framework” strategies for sustainable development. In countries having a high human development index (HDI), HIA has been added to the overall assessment suite that typically includes potential environmental and social impacts, but it is rarely required as part of the environmental and social impact assessment for large development projects. When they are performed, project-driven HIAs are governed by a combination of project proponent and multilateral lender performance standards rather than host country requirements. Not surprisingly, in low-HDI countries HIA is missing from the programme and policy arena in the absence of an external project driver. Major drivers of global change (e.g. population growth and urbanization, growing pressure on natural resources and climate change) inordinately affect low- and medium-HDI countries; however, in such countries HIA is conspicuously absent. If the cloak of HIA invisibility is to be removed, it must be shown that HIA is useful and beneficial and, hence, an essential component of the 21st century’s sustainable development agenda. We analyse where and how HIA can become fully integrated into the impact assessment suite and argue that the impact of HIA must not remain obscure. PMID:23599554

  4. Assessment of Public Health Infrastructure to Determine Public Health Preparedness

    DTIC Science & Technology

    2006-03-01

    62 Confirmed Positive 39 92 42 Residences Abated 40 92 43 Rabies and Zoonosis Control 2 Animal Bite Investigation3 1,280 … … Pets...Shops Inspected 9 9 100 Notes: 1 LHER: Local Health Evaluation Report 2 Zoonosis : Diseases transmitted from animals to humans 3 Number of...5,984 5,984 Childhood Lead Poisoning Risk assessments 2 466 932 Residences abated 8 40 320 Rabies and Zoonosis Control 2 Animal

  5. Considerations for Developing a Dosimetry-Based Cumulative ...

    EPA Pesticide Factsheets

    EPA announced the availability of the final report, Considerations for Developing a Dosimetry-Based Cumulative Risk Assessment Approach for Mixtures of Environmental Contaminants. This report describes a process that can be used to determine the potential value of developing physiologically based pharmacokinetic (PBPK) modeling to support a cumulative risk assessment. It also addresses the justification for developing physiologically based pharmacokinetic (PBPK) models for cumulative risk assessment. Chemical interactions in the body can alter the response observed, but the likelihood of an interactions is often most dependent on exposure. Results from these models can explain the basis for chemical interactions and can predict their likelihood at low, environmental exposures. This report identifies some key points to be considered when deciding whether to use PBPK modeling in a cumulative risk assessment. This report develops a framework to guide decisions whether to incorporate physiologically-based pharmacokinetic (PBPK) modeling into the cumulative risk assessment process.

  6. Use of the community assessment for public health emergency response to conduct community health assessments for public health accreditation.

    PubMed

    Conley, Ashley M; Vagi, Sara; Horney, Jennifer A

    2014-01-01

    A community health assessment (CHA) is a collaborative process of collecting and analyzing data to learn about the health status of a community. Community health assessments are also a requirement of public health accreditation for state and local health departments and of the Affordable Care Act for nonprofit hospitals. One element of a CHA is primary data collection. This article describes the use of the Community Assessment for Public Health Emergency Response (CASPER) method for primary data collection to meet public health accreditation requirements in 2 case study communities--Nashua, New Hampshire, and Davidson County, North Carolina; CASPER is a flexible and efficient method for the collection of population-based primary data in an urban or rural setting.

  7. Health Impact Assessment of Urban Development Project

    PubMed Central

    Shojaei, Parisa; Karimlou, Masoud; Mohammadi, Farahnaz; Malekafzali, Hosein

    2016-01-01

    Background: Health impact assessment (HIA) has emerged to identify those activities and policies likely to have major impacts on the health of a population. Method: In this research, qualitative method was applied to identifying health determinants that urban man made lake affect on them, formatting and weighing the hierarchy of the factors, calculating AHP, and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method for decide and ranking alternatives. Results: According to the results of the study, from the structural determinants point of view, the most positive effect of man-made lake was on Recreational services by 89.5% and the most negative one was on housing. According to intermediary determinants and general average, the most positive effect of lake was on physical activity and quality of air by 88.9% and the most negative one was on noise pollution by 46.7%. Ultimately, considering the positive and negative effects of lake between constructing and not constructing the lake option, the construction option was selected. Conclusion: There is substantial potential to improve public health by bringing decision makers’ attention to the health consequences of their actions; city councilpersons, zoning commissioners, and other decision makers typically have little background in health. PMID:27157160

  8. Health impact assessment of liquid biofuel production.

    PubMed

    Fink, Rok; Medved, Sašo

    2013-01-01

    Bioethanol and biodiesel as potential substitutes for fossil fuels in the transportation sector have been analyzed for environmental suitability. However, there could be impacts on human health during the production, therefore adverse health effects have to be analyzed. The aim of this study is to analyze to what health risk factors humans are exposed to in the production of biofuels and what the size of the health effects is. A health impact assessment expressed as disability adjusted life years (DALYs) was conducted in SimaPro 7.1 software. The results show a statistically significant lower carcinogenic impact of biofuels (p < 0.05) than fossil fuels. Meanwhile, the impact of organic respirable compounds is smaller for fossil fuels (p < 0.05) than for biofuels. Analysis of inorganic compounds like PM₁₀,₂.₅, SO₂ or NO(x) shows some advantages of sugar beet bioethanol and soybean biodiesel production (p < 0.05), although production of sugarcane bioethanol shows larger impacts of respirable inorganic compounds than for fossil fuels (p < 0.001). Although liquid biofuels are made of renewable energy sources, this does not necessary mean that they do not represent any health hazards.

  9. Ethical perspectives on health technology assessment.

    PubMed

    ten Have, Henk

    2004-01-01

    This study analyses why ethical aspects play a minor role in health technology assessment (HTA) studies, even when comprehensive approaches of technology assessment are advocated. Technology is often regarded as a value-neutral tool. At the same time, bioethics is dominated by an engineering model. Ethical contributions to evaluation of medical technology should go beyond issues of application in clinical practice and focus also on the definition of problems, the demarcation of technical and nontechnical issues, and the morally problematic implications of technologies.

  10. Health technology assessment. Findings from the Section on Assessing Information Technologies for Health.

    PubMed

    Ammenwerth, E

    2006-01-01

    To summarize current excellent research in the field of health technology assessment. Synopsis of the articles selected for the IMIA Yearbook 2006. Five excellent articles representing the research in four different nations were selected for the IMIA Yearbook 2006 from three international peer reviewed journals. The best paper selection for the Yearbook section 'Assessing Information Technologies for Health' presents papers evaluating the benefit and side-effects of information technology in various settings. They clearly indicate that benefit of IT in health care can be achieved when the systems are appropriately designed, implemented and operated. Besides the presented quantitative studies, also qualitative study designs are of value to find unintended effects of IT, or to better explain found effects. IT evaluation supports a reflective practice on how health informatics influences health care, enabling the emergence of an evidence-based health informatics.

  11. Assessment of nephrotoxicity of high-cumulative dose of liposomal amphotericin B in a pediatric patient who underwent allogeneic bone marrow transplantation.

    PubMed

    Cesaro, Simone; Zignol, Matteo; Burlina, Alberto B; Tridello, Gloria; Visintin, Gianluca; Messina, Chiara

    2006-03-01

    We describe a 9-yr-old boy who received the highest cumulative dose so far reported of liposomal amphotericin B. The patient underwent an allogeneic bone marrow transplantation (BMT) for adrenoleucodystrophy, after a conditioning regimen with busulfan, thiothepa and cyclophosphamide. Rabbit antithymoglobulin, cyclosporin and prednisone were used as prophylaxis against graft vs. host disease (GVHD). Post-transplant Epstein-Bar-virus-related lymphoma was diagnosed on day +68 and was treated with donor-derived lymphocytes. The patient developed a severe form of GVHD, and a progressive worsening of his neurological status because of progression of his underlying disease. Death from septic shock occurred 23 months after BMT. During prolonged hospitalization, 19,750 mg of liposomal amphotericin B, about 1000 mg/kg, were given for prophylactic or empirical therapeutic purposes without significant nephrotoxicity. This case suggests that liposomal amphotericin B is safe and well-tolerated even if is administered for long periods and a cumulative dose fivefold greater than the nephrotoxic threshold of amphotericin B deoxycholate is achieved.

  12. Chronic cumulative risk assessment of the exposure to organophosphorus, carbamate and pyrethroid and pyrethrin pesticides through fruit and vegetables consumption in the region of Valencia (Spain).

    PubMed

    Quijano, Leyre; Yusà, Vicent; Font, Guillermina; Pardo, Olga

    2016-03-01

    In the present study, the chronic cumulative exposure to organophosphorus (OPs), carbamates (CBs) and pyrethroid and pyrethrin (PPs) pesticides in the region of Valencia through fruit and vegetables consumption is presented. A total of 752 samples and 84 pesticides were studied of which, 52 were OPs, 23 CBs and 9 PPs. Residue data were derived from the Valencia Region monitoring program 2007-2011 and food consumption levels from a questionnaire-based dietary survey conducted in 2010 in the same area. The relative potency factor (RPFs) approach was used to estimate chronic cumulative dietary exposure to OPs, CBs and PPs using acephate, oxamyl and deltamethrin as index compounds, respectively. The exposure was estimated using a deterministic approach and two scenarios were assumed for left-censored results: the lower-bound (LB) scenario, in which unquantified results (below the limit of quantification (LOQ)) were set to zero and the upper-bound (UB) scenario, in which unquantified results were set to the LOQ. Results demonstrate that the chronic exposure of the young (<16 years) and adult (≥ 16 years) population to pesticides through fruits and vegetables is under control (even at high or frequent consumption of fruits and vegetables), for the three groups of pesticides. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. CUMULATIVE RISK ANALYSIS FOR ORGANOPHOSPHORUS PESTICIDES

    EPA Science Inventory

    Cumulative Risk Analysis for Organophosphorus Pesticides
    R. Woodrow Setzer, Jr. NHEERL MD-74, USEPA, RTP, NC 27711

    The US EPA has recently completed a risk assessment of the effects of exposure to 33 organophosphorous pesticides (OPs) through the diet, water, and resi...

  14. CUMULATIVE RISK ANALYSIS FOR ORGANOPHOSPHORUS PESTICIDES

    EPA Science Inventory

    Cumulative Risk Analysis for Organophosphorus Pesticides
    R. Woodrow Setzer, Jr. NHEERL MD-74, USEPA, RTP, NC 27711

    The US EPA has recently completed a risk assessment of the effects of exposure to 33 organophosphorous pesticides (OPs) through the diet, water, and resi...

  15. [Equity in health and health technology assessment in Chile].

    PubMed

    Espinoza, Manuel Antonio; Cabieses, Báltica

    2014-01-01

    Equity has been recognized as one of the driving principles of many health systems in the world. In Latin America, Chile has led the explicit inclusion of equity in their health policies, which is reflected in its recent health reform. On the other hand, Chile faces the challenge of defining and implementing a policy for health technology assessment (HTA), which should be consistent with the equity principles that underlie the Chilean national health system. This paper reviews the equity concept emphasizing the relevance of socioeconomic inequalities. Furthermore, it examines how international HTA agencies have explicitly included this element in the evaluation and decision processes. It presents the English case, which highlights the elements of procedural justice rather than adopting a normative position regarding equity. Finally, it examines the methods that have been developed aiming to make explicit consideration of equity in HTA. It concludes that the methodological development to incorporate equity elements with empirical basis is recent and limited. The consideration of equity is, in most of the cases, left to the instances of deliberative participation.

  16. Exploration Health Risks: Probabilistic Risk Assessment

    NASA Technical Reports Server (NTRS)

    Rhatigan, Jennifer; Charles, John; Hayes, Judith; Wren, Kiley

    2006-01-01

    Maintenance of human health on long-duration exploration missions is a primary challenge to mission designers. Indeed, human health risks are currently the largest risk contributors to the risks of evacuation or loss of the crew on long-duration International Space Station missions. We describe a quantitative assessment of the relative probabilities of occurrence of the individual risks to human safety and efficiency during space flight to augment qualitative assessments used in this field to date. Quantitative probabilistic risk assessments will allow program managers to focus resources on those human health risks most likely to occur with undesirable consequences. Truly quantitative assessments are common, even expected, in the engineering and actuarial spheres, but that capability is just emerging in some arenas of life sciences research, such as identifying and minimize the hazards to astronauts during future space exploration missions. Our expectation is that these results can be used to inform NASA mission design trade studies in the near future with the objective of preventing the higher among the human health risks. We identify and discuss statistical techniques to provide this risk quantification based on relevant sets of astronaut biomedical data from short and long duration space flights as well as relevant analog populations. We outline critical assumptions made in the calculations and discuss the rationale for these. Our efforts to date have focussed on quantifying the probabilities of medical risks that are qualitatively perceived as relatively high risks of radiation sickness, cardiac dysrhythmias, medically significant renal stone formation due to increased calcium mobilization, decompression sickness as a result of EVA (extravehicular activity), and bone fracture due to loss of bone mineral density. We present these quantitative probabilities in order-of-magnitude comparison format so that relative risk can be gauged. We address the effects of

  17. Exploration Health Risks: Probabilistic Risk Assessment

    NASA Technical Reports Server (NTRS)

    Rhatigan, Jennifer; Charles, John; Hayes, Judith; Wren, Kiley

    2006-01-01

    Maintenance of human health on long-duration exploration missions is a primary challenge to mission designers. Indeed, human health risks are currently the largest risk contributors to the risks of evacuation or loss of the crew on long-duration International Space Station missions. We describe a quantitative assessment of the relative probabilities of occurrence of the individual risks to human safety and efficiency during space flight to augment qualitative assessments used in this field to date. Quantitative probabilistic risk assessments will allow program managers to focus resources on those human health risks most likely to occur with undesirable consequences. Truly quantitative assessments are common, even expected, in the engineering and actuarial spheres, but that capability is just emerging in some arenas of life sciences research, such as identifying and minimize the hazards to astronauts during future space exploration missions. Our expectation is that these results can be used to inform NASA mission design trade studies in the near future with the objective of preventing the higher among the human health risks. We identify and discuss statistical techniques to provide this risk quantification based on relevant sets of astronaut biomedical data from short and long duration space flights as well as relevant analog populations. We outline critical assumptions made in the calculations and discuss the rationale for these. Our efforts to date have focussed on quantifying the probabilities of medical risks that are qualitatively perceived as relatively high risks of radiation sickness, cardiac dysrhythmias, medically significant renal stone formation due to increased calcium mobilization, decompression sickness as a result of EVA (extravehicular activity), and bone fracture due to loss of bone mineral density. We present these quantitative probabilities in order-of-magnitude comparison format so that relative risk can be gauged. We address the effects of

  18. Women's self-assessed personal health resources.

    PubMed

    Malterud, K; Hollnagel, H

    1997-12-01

    To contribute to the development of a resource-oriented medical language by identifying self-assessed personal health resources in women. Key questions were developed to invite the patient to tell the general practitioner about such resources. Patients' answers were audiotaped and analysed qualitatively according to Giorgi's phenomenological approach. The theoretical frame of reference included salutogenesis, patient-centredness, and gender perspectives. Two female general practitioners and their consultations. 37 consecutive female patients aged 24-85 years. Common aspects of personal qualities and strategies considered by women as their health resources. The material unveiled health resources related to 1) internal strength mobilized by external strain, 2) interactive networks within and outside the family, 3) lifestyle practices, 4) physical and social activity, 5) acceptance and facilitation of the natural course of Disease, and 6) constitution. Female patients have explicit and intelligible ideas about their self-assessed personal health resources, which can be identified and mobilized by the general practitioner and form part of potentially empowering strategies in medical practice.

  19. Teaching health assessment in the virtual classroom.

    PubMed

    Lashley, Mary

    2005-08-01

    Health assessment skills are vital to professional nursing practice. Health assessment has traditionally been taught using lecture, teacher-developed tests, practice and live demonstration, and interactive and computer-based learning materials. Rapid advances in information technology during the past decade have greatly expanded distance learning options in higher education. Although much nursing education now uses the Internet, there has been limited use of the Web to teach psychomotor and clinical skills. This article describes how online instruction can be integrated into a health assessment course to teach physical examination skills. The development of instructional videos that can be digitally streamed onto the Web for ready and repeated access can also enhance online learning of technical and clinical skills. Student evaluation of this Web-enhanced course revealed that online assignments enabled them to pace their learning, thereby promoting greater flexibility and independence. Students were able to master the technical skills of working online with minimal difficulty and reported that working online was no more stressful than attending class. The most helpful aspect of the online course was the instructor-developed video that was digitally streamed online.

  20. Cumulative Environmental Impacts: Science and Policy to Protect Communities.

    PubMed

    Solomon, Gina M; Morello-Frosch, Rachel; Zeise, Lauren; Faust, John B

    2016-01-01

    Many communities are located near multiple sources of pollution, including current and former industrial sites, major roadways, and agricultural operations. Populations in such locations are predominantly low-income, with a large percentage of minorities and non-English speakers. These communities face challenges that can affect the health of their residents, including limited access to health care, a shortage of grocery stores, poor housing quality, and a lack of parks and open spaces. Environmental exposures may interact with social stressors, thereby worsening health outcomes. Age, genetic characteristics, and preexisting health conditions increase the risk of adverse health effects from exposure to pollutants. There are existing approaches for characterizing cumulative exposures, cumulative risks, and cumulative health impacts. Although such approaches have merit, they also have significant constraints. New developments in exposure monitoring, mapping, toxicology, and epidemiology, especially when informed by community participation, have the potential to advance the science on cumulative impacts and to improve decision making.

  1. Risk assessment and toxicology databases for health effects assessment

    SciTech Connect

    Lu, P.Y.; Wassom, J.S.

    1990-12-31

    Scientific and technological developments bring unprecedented stress to our environment. Society has to predict the results of potential health risks from technologically based actions that may have serious, far-reaching consequences. The potential for error in making such predictions or assessment is great and multiplies with the increasing size and complexity of the problem being studied. Because of this, the availability and use of reliable data is the key to any successful forecasting effort. Scientific research and development generate new data and information. Much of the scientific data being produced daily is stored in computers for subsequent analysis. This situation provides both an invaluable resource and an enormous challenge. With large amounts of government funds being devoted to health and environmental research programs and with maintenance of our living environment at stake, we must make maximum use of the resulting data to forecast and avert catastrophic effects. Along with the readily available. The most efficient means of obtaining the data necessary for assessing the health effects of chemicals is to utilize applications include the toxicology databases and information files developed at ORNL. To make most efficient use of the data/information that has already been prepared, attention and resources should be directed toward projects that meticulously evaluate the available data/information and create specialized peer-reviewed value-added databases. Such projects include the National Library of Medicine`s Hazardous Substances Data Bank, and the U.S. Air Force Installation Restoration Toxicology Guide. These and similar value-added toxicology databases were developed at ORNL and are being maintained and updated. These databases and supporting information files, as well as some data evaluation techniques are discussed in this paper with special focus on how they are used to assess potential health effects of environmental agents. 19 refs., 5 tabs.

  2. Nutrition Can Modulate the Toxicity of Environmental Pollutants: Implications in Risk Assessment and Human Health

    PubMed Central

    Ormsbee, Lindell; McClain, Craig J.; Watkins, Bruce A.; Blumberg, Bruce; Bachas, Leonidas G.; Sanderson, Wayne; Thompson, Claudia; Suk, William A.

    2012-01-01

    Background: The paradigm of human risk assessment includes many variables that must be viewed collectively in order to improve human health and prevent chronic disease. The pathology of chronic diseases is complex, however, and may be influenced by exposure to environmental pollu-tants, a sedentary lifestyle, and poor dietary habits. Much of the emerging evidence suggests that nutrition can modulate the toxicity of environmental pollutants, which may alter human risks associated with toxicant exposures. Objectives: In this commentary, we discuss the basis for recommending that nutrition be considered a critical variable in disease outcomes associated with exposure to environmental pollutants, thus establishing the importance of incorporating nutrition within the context of cumulative risk assessment. Discussion: A convincing body of research indicates that nutrition is a modulator of vulnerability to environmental insults; thus, it is timely to consider nutrition as a vital component of human risk assessment. Nutrition may serve as either an agonist or an antagonist (e.g., high-fat foods or foods rich in antioxidants, respectively) of the health impacts associated with exposure to environmental pollutants. Dietary practices and food choices may help explain the large variability observed in human risk assessment. Conclusion: We recommend that nutrition and dietary practices be incorporated into future environmental research and the development of risk assessment paradigms. Healthful nutrition interventions might be a powerful approach to reduce disease risks associated with many environmental toxic insults and should be considered a variable within the context of cumulative risk assessment and, where appropriate, a potential tool for subsequent risk reduction. PMID:22357258

  3. An assessment of cumulative external doses from Chernobyl fallout for a forested area in Russia using the optically stimulated luminescence from quartz inclusions in bricks.

    PubMed

    Ramzaev, V; Bøtter-Jensen, L; Thomsen, K J; Andersson, K G; Murray, A S

    2008-07-01

    Optically stimulated luminescence (OSL) has been used for estimation of the accumulated doses in quartz inclusions obtained from two fired bricks, extracted in July 2004 from a building located in the forested surroundings of the recreational area Novie Bobovichi, the Bryansk Region, Russia. The area was significantly contaminated by Chernobyl fallout with initial (137)Cs ground deposition level of approximately 1.1 MBq m(-2). The accumulated OSL doses in sections of the bricks varied from 141 to 207 mGy, of which between 76 and 146 mGy are attributable to Chernobyl fallout. Using the OSL depth-dose profiles obtained from the exposed bricks and the results from a gamma-ray-survey of the area, the Chernobyl-related cumulative gamma-ray dose for a point detector located in free air at a height of 1m above the ground in the study area was estimated to be ca. 240 mGy for the time period starting on 27 April 1986 and ending on 31 July 2004. This result is in good agreement with the result of deterministic modelling of the cumulative gamma-ray dose in free air above undisturbed ground from the Chernobyl source in the Bryansk Region. Over the same time period, the external Chernobyl-related dose via forest pathway for the most exposed individuals (e.g., forest workers) is estimated to be approximately 39 mSv. Prognosis for the external exposure from 1986 to 2056 is presented and compared with the predictions given by other investigators of the region.

  4. [Indirect costs in health technology assessment].

    PubMed

    Jakubczyk, Michał; Wrona, Witold; Macioch, Tomasz; Golicki, Dominik; Niewada, Maciej; Hermanowski, Tomasz

    2010-01-01

    In the health technology assessment it is crucial to define the perspective of the analysis. When the societal perspective is chosen it is necessary to include all the costs incurred by the society, also the costs of lost productivity resulting from absence of sick employees from work or their reduced efficiency at work. The aim of this article is to present the notion of indirect costs, their importance in health technology assessment and the methods of calculation. The economic literature has been reviewed for the state of knowledge on indirect costs. Three methods of calculation are described: human capital method, friction cost method or health state valuation. Indirect costs in Western European countries can amount to more than half of total costs attributed to the illness and its treatment. In the literature there is no consensus regarding the proper method of indirect costs calculation. It is necessary to conduct further theoretical and empirical research in the area of indirect costs and enhance discussion among Polish pharmacoeconomists.

  5. Fatigue in child chronic health conditions: a systematic review of assessment instruments.

    PubMed

    Crichton, Alison; Knight, Sarah; Oakley, Ed; Babl, Franz E; Anderson, Vicki

    2015-04-01

    Fatigue is common in chronic health conditions in childhood, associated with decreased quality of life and functioning, yet there are limited data to compare assessment instruments across conditions and childhood development. Our objective was to describe fatigue assessment instruments used in children with chronic health conditions and critically appraise the evidence for the measurement properties of identified instruments. Data sources included Medline, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO (using the EBSCOhost platform). Study selection included quantitative assessment of fatigue in children with health conditions. Data extraction was as follows: (1) study design, participant and fatigue instruments, (2) measurement properties of fatigue instruments, (3) methodological quality of included studies, and (4) synthesis of the quality of evidence across studies for the measurement properties of fatigue instruments. Twenty fatigue assessment instruments were identified (12 child reports, 7 parent reports, 1 staff report), used in 89 studies. Fatigue was assessed in over 14 health conditions, most commonly in children with cancer and chronic fatigue syndrome. Evidence for the measurement properties of instruments varied, and overall quality was low. Two fatigue instruments demonstrated strong measurement properties for use in children with diverse health conditions and children with cancer. The review is limited to children younger than 18 years and results are specific to health conditions described, limiting generalizability of findings to other populations. Evidence for the measurement properties of fatigue instruments varied according to the population in which instruments were used and informant. Further evidence is required for assessment of fatigue in younger children, and children with particular health conditions. Copyright © 2015 by the American Academy of Pediatrics.

  6. Violence exposure in multiple interpersonal domains: cumulative and differential effects.

    PubMed

    Margolin, Gayla; Vickerman, Katrina A; Oliver, Pamella H; Gordis, Elana B

    2010-08-01

    To examine dose-response effects of cumulative violence exposure including parent-to-youth aggression, marital physical aggression, and community violence, and to explore whether separate interpersonal domains of exposure differentially influence adverse outcomes. The present study uses parent-reports and child-reports of youth violence exposure from the first three waves of a prospective, longitudinal study of 103 community-based families. Outcomes were criterion levels (T score >or= 60) of somatic complaints, depressive symptoms, anxiety, over-arousal, aggression, delinquent behaviors, and presence versus absence of academic failure. After controlling for initial symptoms, income and parents' psychopathology, adjusted relative risks showed that marital aggression contributed uniquely to anxiety, and parent-to-youth aggression contributed uniquely to somatic complaints and aggression. All three domains significantly contributed to academic failure. With each one-point increase on the cumulative violence exposure index that summed across interpersonal domains and across time, there was an increased risk of more than 50% for meeting criterion levels of depressive symptoms and anxiety, and a 10%-25% increased risk for somatic complaints, delinquent behaviors, and academic failure. Significant curvilinear effects showed high cumulative violence increased risk of comorbid symptoms; 76% of youth with higher cumulative violence met thresholds on 3+ adverse outcomes, compared to 36% and 7% for youth with moderate and low violence exposure. These data highlight the importance of assessing violence exposure across multiple interpersonal domains and across time. Awareness of the contributions of violence exposure to common symptoms and particularly comorbid symptoms can inform interventions for wide-ranging adolescent problems. (c) 2010 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  7. Health Impact Assessment of Urban Waterway Decisions

    PubMed Central

    Korfmacher, Katrina Smith; Aviles, Katia; Cummings, B.J.; Daniell, William; Erdmann, Jared; Garrison, Valerie

    2014-01-01

    Health impact assessments (HIA) promote the consideration of health in a wide range of public decisions. Although each HIA is different, common pathways, evidence bases, and strategies for community engagement tend to emerge in certain sectors, such as urban redevelopment, natural resource extraction, or transportation planning. To date, a limited number of HIAs have been conducted on decisions affecting water resources and waterfronts. This review presents four recent HIAs of water-related decisions in the United States and Puerto Rico. Although the four cases are topically and geographically diverse, several common themes emerged from the consideration of health in water-related decisions. Water resource decisions are characterized by multiple competing uses, inter-institutional and inter-jurisdictional complexity, scientific uncertainty, long time scales for environmental change, diverse cultural and historical human values, and tradeoffs between private use and public access. These four case studies reveal challenges and opportunities of examining waterfront decisions through a “health lens”. This review analyzes these cases, common themes, and lessons learned for the future practice of HIA in the waterfront zone and beyond. PMID:25547399

  8. Algorithm Calculates Cumulative Poisson Distribution

    NASA Technical Reports Server (NTRS)

    Bowerman, Paul N.; Nolty, Robert C.; Scheuer, Ernest M.

    1992-01-01

    Algorithm calculates accurate values of cumulative Poisson distribution under conditions where other algorithms fail because numbers are so small (underflow) or so large (overflow) that computer cannot process them. Factors inserted temporarily to prevent underflow and overflow. Implemented in CUMPOIS computer program described in "Cumulative Poisson Distribution Program" (NPO-17714).

  9. Steps and pips in the history of the cumulative recorder.

    PubMed Central

    Lattal, Kennon A

    2004-01-01

    From its inception in the 1930s until very recent times, the cumulative recorder was the most widely used measurement instrument in the experimental analysis of behavior. It was an essential instrument in the discovery and analysis of schedules of reinforcement, providing the first real-time analysis of operant response rates and patterns. This review traces the evolution of the cumulative recorder from Skinner's early modified kymographs through various models developed by Skinner and his colleagues to its perfection in the 1950s, and then into the 1960s when it proliferated as different scientific instrument companies began marketing their own models of the cumulative recorder. With the rise of digital computers, the demise of the cumulative recorder as a scientific instrument was inevitable; however, the value of the cumulative record as a monitoring device to assess schedule control of behavior continues. The cumulative recorder remains, along with the operant conditioning chamber, an icon of Skinner's approach to psychology. PMID:15693527

  10. Steps and pips in the history of the cumulative recorder.

    PubMed

    Lattal, Kennon A

    2004-11-01

    From its inception in the 1930s until very recent times, the cumulative recorder was the most widely used measurement instrument in the experimental analysis of behavior. It was an essential instrument in the discovery and analysis of schedules of reinforcement, providing the first real-time analysis of operant response rates and patterns. This review traces the evolution of the cumulative recorder from Skinner's early modified kymographs through various models developed by Skinner and his colleagues to its perfection in the 1950s, and then into the 1960s when it proliferated as different scientific instrument companies began marketing their own models of the cumulative recorder. With the rise of digital computers, the demise of the cumulative recorder as a scientific instrument was inevitable; however, the value of the cumulative record as a monitoring device to assess schedule control of behavior continues. The cumulative recorder remains, along with the operant conditioning chamber, an icon of Skinner's approach to psychology.

  11. Assessing Hmong Farmers’ Safety and Health

    PubMed Central

    de Castro, A. B.; Krenz, Jennifer; Neitzel, Richard L.

    2014-01-01

    This pilot project investigated agricultural-related safety and health issues among Hmong refugees working on family-operated farms. Novel approaches, namely participatory rural appraisal and photovoice, were used to conduct a qualitative occupational hazard assessment with a group of Hmong farmers in Washington State. These two methods were useful in gathering participants’ own perspectives about priority concerns. Several identified problems were related to musculoskeletal disorders, handling and operating heavy machinery, heat and cold stress, respiratory exposures, pest management, and socioeconomic and language concerns. Findings from this study provide insight into the work-related challenges that Hmong refugee farmers encounter and can serve as a basis for occupational health professionals to develop interventions to assist this underserved group. PMID:24806037

  12. Miniature Biosensor with Health Risk Assessment Feedback

    NASA Technical Reports Server (NTRS)

    Hanson, Andrea; Downs, Meghan; Kalogera, Kent; Buxton, Roxanne; Cooper, Tommy; Cooper, Alan; Cooper, Ross

    2016-01-01

    Heart rate (HR) monitoring is a medical requirement during exercise on the International Space Station (ISS), fitness tests, and extravehicular activity (EVA); however, NASA does not currently have the technology to consistently and accurately monitor HR and other physiological data during these activities. Performance of currently available HR monitor technologies is dependent on uninterrupted contact with the torso and are prone to data drop-out and motion artifact. Here, we seek an alternative to the chest strap and electrode based sensors currently in use on ISS today. This project aims to develop a high performance, robust earbud based biosensor with focused efforts on improved HR data quality during exercise or EVA. A health risk assessment algorithm will further advance the goals of autonomous crew health care for exploration missions.

  13. Economic assessment of animal health performance.

    PubMed

    Galligan, David

    2006-03-01

    This article describes the fundamental principles of economic assessment of animal health performance in the modem animal production environment. Animal production is a complex system of combined inputs (eg, physical inputs, managerial decision choices) into a production process that produces products valued by society. Perturbations to this system include disease processes and management inefficiencies. Economic valuation of these perturbations must account for the marginal changes in revenues and cost, the time dimensions of occurrence, the inherent risk characteristics of biologic systems, and any opportunity value that exists that allows management to intervene within the process and make economically influencing decisions. It has been recognized that improving animal health can play a major role in achieving efficient and economically rewarding production.

  14. Assessing Hmong farmers' safety and health.

    PubMed

    de Castro, A B; Krenz, Jennifer; Neitzel, Richard L

    2014-05-01

    This pilot project investigated agricultural-related safety and health issues among Hmong refugees working on family-operated farms. Novel approaches, namely participatory rural appraisal and photovoice, were used to conduct a qualitative occupational hazard assessment with a group of Hmong farmers in Washington State. These two methods were useful in gathering participants' own perspectives about priority concerns. Several identified problems were related to musculoskeletal disorders, handling and operating heavy machinery, heat and cold stress, respiratory exposures, pest management, and socioeconomic and language concerns. Findings from this study provide insight into the work-related challenges that Hmong refugee farmers encounter and can serve as a basis for occupational health professionals to develop interventions to assist this underserved group.

  15. Managing Air Quality - Human Health, Environmental and Economic Assessments

    EPA Pesticide Factsheets

    Human health and environmental assessments characterize health and environmental risks associated with exposure to pollution. Economic assessments evaluate the cost and economic impact of a policy or regulation & can estimate economic benefits.

  16. Using rangeland health assessment to inform successional management

    USDA-ARS?s Scientific Manuscript database

    Rangeland health assessment provides qualitative information on ecosystem attributes. Successional management is a conceptual framework that allows managers to link information gathered in rangeland health assessment to ecological processes that need to be repaired to allow vegetation to change in ...

  17. Environmental, health and safety assessment of photovoltaics

    NASA Technical Reports Server (NTRS)

    Rose, E. C.

    1983-01-01

    The environmental, health, and safety (E, H and S) concerns associated with the fabrication, deployment, and decommissioning of photovoltaic (PV) systems in terrestial applications are identified and assessed. Discussion is limited to crystalline silicon technologies. The primary E, H, and S concerns that arise during collector fabrication are associated with occupational exposure to materials of undetermined toxicity or to materials that are known to be hazardous, but for which process control technology may be inadequate. Stricter exposure standards are anticipated for some materials and may indicate a need for further control technology development. Minimizing electric shock hazards is a significant concern during system construction, operation and maintenance, and decommissioning.

  18. Mobile technology for mental health assessment.

    PubMed

    Areàn, Patricia A; Hoa Ly, Kien; Andersson, Gerhard

    2016-06-01

    Assessment and outcome monitoring are critical for the effective detection and treatment of mental illness. Traditional methods of capturing social, functional, and behavioral data are limited to the information that patients report back to their health care provider at selected points in time. As a result, these data are not accurate accounts of day-to-day functioning, as they are often influenced by biases in self-report. Mobile technology (mobile applications on smartphones, activity bracelets) has the potential to overcome such problems with traditional assessment and provide information about patient symptoms, behavior, and functioning in real time. Although the use of sensors and apps are widespread, several questions remain in the field regarding the reliability of off-the-shelf apps and sensors, use of these tools by consumers, and provider use of these data in clinical decision-making.

  19. Mobile technology for mental health assessment

    PubMed Central

    Areàn, Patricia A.; Hoa Ly, Kien; Andersson, Gerhard

    2016-01-01

    Assessment and outcome monitoring are critical for the effective detection and treatment of mental illness. Traditional methods of capturing social, functional, and behavioral data are limited to the information that patients report back to their health care provider at selected points in time. As a result, these data are not accurate accounts of day-to-day functioning, as they are often influenced by biases in self-report. Mobile technology (mobile applications on smartphones, activity bracelets) has the potential to overcome such problems with traditional assessment and provide information about patient symptoms, behavior, and functioning in real time. Although the use of sensors and apps are widespread, several questions remain in the field regarding the reliability of off-the-shelf apps and sensors, use of these tools by consumers, and provider use of these data in clinical decision-making. PMID:27489456

  20. A critical review of population health literacy assessment.

    PubMed

    Guzys, Diana; Kenny, Amanda; Dickson-Swift, Virginia; Threlkeld, Guinever

    2015-03-04

    Defining health literacy from a public health perspective places greater emphasis on the knowledge and skills required to prevent disease and for promoting health in everyday life. Addressing health literacy at the community level provides great potential for improving health knowledge, skills and behaviours resulting in better health outcomes. Yet there is a notable absence of discussion in the literature of what a health literate population looks like, or how this is best assessed. The emphasis in assessing health literacy has predominantly focused on the functional health literacy of individuals in clinical settings. This review examines currently available health literacy assessment tools to identify how well suited they are in addressing health literacy beyond clinical care settings and beyond the individual. Although public health literature appears to place greater emphasis on conceptualizing critical health literacy, the focus continues to remain on assessing individuals, rather than on health literacy within the context of families, communities and population groups. When a population approach is adopted, an aggregate of individual health literacy assessment is generally used. Aggregation of individual health literacy fails to capture the dynamic and often synergistic relationships within communities, and fails to reflect societal influences on health knowledge, beliefs and behaviours. We hypothesise that a different assessment framework is required to adequately address the complexities of community health literacy. We assert that a public health approach, founded on health promotion theories provides a useful scaffold to assess the critical health literacy of population groups. It is proposed that inclusion of community members in the research process is a necessary requirement to coproduce such an appropriate assessment framework. We contend that health literacy assessment and potential interventions need to shift to promoting the knowledge and skills

  1. Assessing Psychological Health: The Contribution of Psychological Strengths

    ERIC Educational Resources Information Center

    Macaskill, Ann; Denovan, Andrew

    2014-01-01

    Balanced assessment of mental health involves assessing well-being and strengths as well as psychopathology. The character strengths of curiosity, gratitude, hope, optimism and forgiveness are assessed in 214 new undergraduates and their relationships to mental health, subjective well-being and self-esteem explored. Scoring the mental health scale…

  2. Predictors of Self-Assessed Health among Elderly Post Hospitalization.

    ERIC Educational Resources Information Center

    Lurie, Elinore; And Others

    Self-assessment of health incorporates both objective and subjective elements into a general state with implications for health-related behavior. To examine the predictors of self-assessed health in an elderly, post-hospitalization population, 73 adults, 65 years of age or older, were asked to assess the status of the condition for which they were…

  3. 75 FR 1373 - Beaches Environmental Assessment and Coastal Health Act

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-11

    ... AGENCY Beaches Environmental Assessment and Coastal Health Act AGENCY: Environmental Protection Agency... Water Act (CWA) as amended by the Beaches Environmental Assessment and Coastal Health (BEACH) Act... Environmental Assessment and Coastal Health (BEACH) Act of 2000 amends the Clean Water Act to better protect...

  4. 75 FR 82382 - Beaches Environmental Assessment and Coastal Health Act

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-30

    ... AGENCY Beaches Environmental Assessment and Coastal Health Act AGENCY: Environmental Protection Agency... Water Act (CWA) as amended by the Beaches Environmental Assessment and Coastal Health (BEACH) Act... Environmental Assessment and Coastal Health (BEACH) Act of 2000 amends the Clean Water Act to better protect...

  5. Assessing Psychological Health: The Contribution of Psychological Strengths

    ERIC Educational Resources Information Center

    Macaskill, Ann; Denovan, Andrew

    2014-01-01

    Balanced assessment of mental health involves assessing well-being and strengths as well as psychopathology. The character strengths of curiosity, gratitude, hope, optimism and forgiveness are assessed in 214 new undergraduates and their relationships to mental health, subjective well-being and self-esteem explored. Scoring the mental health scale…

  6. Recommendations and proposed guidelines for assessing the cumulative evidence on joint effects of genes and environments on cancer occurrence in humans

    PubMed Central

    Boffetta, Paolo; Winn, Deborah M; Ioannidis, John P; Thomas, Duncan C; Little, Julian; Smith, George Davey; Cogliano, Vincent J; Hecht, Stephen S; Seminara, Daniela; Vineis, Paolo; Khoury, Muin J

    2012-01-01

    We propose guidelines to evaluate the cumulative evidence of gene–environment (G × E) interactions in the causation of human cancer. Our approach has its roots in the HuGENet and IARC Monographs evaluation processes for genetic and environmental risk factors, respectively, and can be applied to common chronic diseases other than cancer. We first review issues of definitions of G × E interactions, discovery and modelling methods for G × E interactions, and issues in systematic reviews of evidence for G × E interactions, since these form the foundation for appraising the credibility of evidence in this contentious field. We then propose guidelines that include four steps: (i) score the strength of the evidence for main effects of the (a) environmental exposure and (b) genetic variant; (ii) establish a prior score category and decide on the pattern of interaction to be expected; (iii) score the strength of the evidence for interaction between the environmental exposure and the genetic variant; and (iv) examine the overall plausibility of interaction by combining the prior score and the strength of the evidence and interpret results. We finally apply the scheme to the interaction between NAT2 polymorphism and tobacco smoking in determining bladder cancer risk. PMID:22596931

  7. An equity framework for health technology assessments.

    PubMed

    Culyer, Anthony J; Bombard, Yvonne

    2012-01-01

    Despite the inclusion of equity in the design of many health care systems, pragmatic tools for considering equity systematically, alongside the efficiency categories of cost-effectiveness in health technology assessment (HTA), remain underdeveloped. This article develops a framework to help decision makers supplement the standard efficiency criteria of HTA and avoid building inequities, explicit or implicit, into their methods. The framework is intended as a first step toward creating a checklist for alerting decision makers to a wide range of equity considerations for HTA. This framework is intended be used as part of the process through which advisory bodies receive their terms of reference; scope the agenda prior to the selection of a candidate intervention and its comparators for HTA; prepare background briefing for decision makers; and help to structure the discussion and composition of professional and lay advisory groups during the assessment process. The framework is offered as only a beginning of an ongoing process of deliberation and consultation, through which the matters covered can be expected to become more comprehensive and the record of past decisions and their contexts in any jurisdiction adopting the tool can serve to guide subsequent evidence gathering and decisions. In these ways, it may be hoped that equity will be more systematically and fully considered and implemented in both the procedures and decisions of HTA.

  8. Developing public sociology through health impact assessment.

    PubMed

    Elliott, Eva; Williams, Gareth

    2008-11-01

    The renewed interest in 'public sociology' has sparked debate and discussion about forms of sociological work and their relationship to the State and civil society. Medical sociologists are accustomed to engaging with a range of publics and audiences inside and outside universities and are in a position to make an informed contribution to this debate. This paper describes how some of the debates about sociological work are played out through a 'health impact assessment' of a proposed housing renewal in a former coal mining community. We explore the dynamics of the health impact assessment process and relate it to wider debates, current in the social sciences, on the 'new knowledge spaces' within which contentious public issues are now being discussed, and the nature of different forms of expertise. The role of the 'public sociologist' in mediating the relationships between the accounts and interpretations of lay participants and the published 'evidence' is described as a process of mutual learning between publics, professionals and social scientists. It is argued that the continued existence and development of any meaningful 'professional sociology' requires an openness to a 'public sociology' which recognises and responds to new spaces of knowledge production.

  9. A Health Technology Assessment: laparoscopy versus colpoceliotomy.

    PubMed

    Damonti, A; Ferrario, L; Morelli, P; Mussi, M; Patregnani, C; Garagiola, E; Foglia, E; Pagani, R; Carminati, R; Porazzi, E

    2015-01-01

    The objective of this paper is the comparison between two different technologies used for the removal of a uterine myoma, a frequent benign tumor: the standard technology currently used, laparoscopy, and an innovative one, colpoceliotomy. It was considered relevant to evaluate the real and the potential effects of the two technologies implementation and, in addition, the consequences that the introduction or exclusion of the innovative technology would have for both the National Health System (NHS) and the entire community. The comparison between these two different technologies, the standard and the innovative one, was conducted using a Health Technology Assessment (HTA). In particular, in order to analyse their differences, a multi-dimensional approach was considered: effectiveness, costs and budget impact analysis data were collected, applying different instruments, such as the Activity Based Costing methodology (ABC), the Cost-Effectiveness Analysis (CEA) and the Budget Impact Analysis (BIA). Organisational, equity and social impact were also evaluated. The results showed that the introduction of colpoceliotomy would provide significant economic savings to the Regional and National Health Service; in particular, a saving of € 453.27 for each surgical procedure. The introduction of the innovative technology, colpoceliotomy, could be considered a valuable tool; one offering many advantages related to less invasiveness and a shorter surgical procedure than the standard technology currently used (laparoscopy).

  10. Remote Sensing of Bioindicators for Forest Health Assessment

    NASA Astrophysics Data System (ADS)

    Kefauver, Shawn Carlisle

    The impacts of tropospheric ozone on forest health in Mediterranean type climates in California, USA and Catalonia, Spain were investigated using a combination of remote sensing, Geographic Information System (GIS), and field studies focused on sensitive bioindicator conifer species and ambient ozone monitoring. For the field validation of impacts of tropospheric ozone on conifer health, the Ozone Injury Index (OII) was applied to the bioindicator species Pinus ponderosa, Pinus jeffreyi, and Pinus uncinata. Combining these three tools, it was possible to build meaningful ecological models covering large areas to enhance our understanding of the biotic and abiotic interactions which affect forest health. Regression models predicting ozone injury improved considerably when incorporating ozone exposure with GIS related to plant water status, including water availability and water usage, as a proxies for estimating the stomatal conductance and ozone uptake R2=0.35, p = 0.016 in Catalonia, R2=0.36, p < 0.001 in Yosemite and R2=0.33, p = 0.007 in Sequoia/Kings Canyon National Parks in California). Individual OII components in Catalonia were modeled with improved success compared to the original full OII, in particular visible chlorotic mottling (R2=0.60, p < 0.001). The visual chlorotic mottling component of the OII was the most strongly correlated to remote sensing indices, in particular the photochemical reflectance index (PRI; R2=0.28, p=0.0044 for OIIVI-amount and R 2=0.33 and p=0.0016 for OIIVI -severity). Regression models assessing ozone injury to conifers using imaging spectroscopy techniques also improved when incorporating the GIS proxies of stomatal conductance (R 2=0.59, p<0.0001 for OII in California and R2=0.68, p<0.0001 for OIIVI in Catalonia). Finally, taking advantage of a time series of ambient ozone monitoring in Catalonia, it was found that all models improved when incorporating the cumulative exposure to ozone over a period of three years (R2=0.56, p

  11. Simulation-based assessments in health professional education: a systematic review.

    PubMed

    Ryall, Tayne; Judd, Belinda K; Gordon, Christopher J

    2016-01-01

    The use of simulation in health professional education has increased rapidly over the past 2 decades. While simulation has predominantly been used to train health professionals and students for a variety of clinically related situations, there is an increasing trend to use simulation a