Behavioral Attention: A Longitudinal Study of Whether and How It Influences the Development of Word Reading and Reading Comprehension among At-Risk Readers

PubMed Central

Miller, Amanda C.; Fuchs, Douglas; Fuchs, Lynn S.; Compton, Donald L.; Kearns, Devin; Zhang, Wenjuan; Yen, Loulee; Patton, Samuel; Kirchner, Danielle

2014-01-01

The purpose of this study was to examine the extent to which teacher ratings of behavioral attention predicted responsiveness to word reading instruction in first grade and third-grade reading comprehension performance. Participants were 110 first grade students identified as at-risk for reading difficulties who received 20 weeks of intensive reading intervention in combination with classroom reading instruction. Path analysis indicated that teacher ratings of student attention significantly predicted students’ word reading growth in first grade even when they were competed against other relevant predictors (phonological awareness, nonword reading, sight word efficiency, vocabulary, listening comprehension, hyperactivity, nonverbal reasoning, and short term memory). Also, student attention demonstrated a significant indirect effect on third grade reading comprehension via word reading, but not via listening comprehension. Results suggest that student attention (indexed by teacher ratings) is an important predictor of at-risk readers’ responsiveness to reading instruction in first grade and that first-grade reading growth mediates the relationship between students’ attention and their future level of reading comprehension. The importance of considering ways to manage and improve behavioral attention when implementing reading instruction is discussed. PMID:25110548

Multiple Primary Cancer Monograph

Cancer.gov

To identify groups of cancer survivors that are at increased risk for multiple primary cancers, investigators led an effort to provide the first comprehensive population-based analysis of the risk of subsequent cancer in the U.S., resulting in a monograph.

Family communication in a population at risk for hypertrophic cardiomyopathy.

PubMed

Batte, Brittany; Sheldon, Jane P; Arscott, Patricia; Huismann, Darcy J; Salberg, Lisa; Day, Sharlene M; Yashar, Beverly M

2015-04-01

Encouraging family communication is an integral component of genetic counseling; therefore, we sought to identify factors impacting communication to family members at risk for Hypertrophic Cardiomyopathy (HCM). Participants (N = 383) completed an online survey assessing: 1) demographics (gender, genetic test results, HCM family history, and disease severity); 2) illness representations; 3) family functioning and cohesiveness; 4) coping styles; 5) comprehension of HCM autosomal dominant inheritance; and 6) communication of HCM risk information to at-risk relatives. Participants were a national sample of individuals with HCM, recruited through the Hypertrophic Cardiomyopathy Association. Data from 183 participants were analyzed using a logistic regression analysis, with family communication as a dichotomous dependent variable. We found that female gender and higher comprehension of autosomal dominant inheritance were significant predictors of participants' communication of HCM risk information to all their siblings and children. Our results suggest that utilizing interventions that promote patient comprehension (e.g., a teaching-focused model of genetic counseling) are important and may positively impact family communication within families with HCM.

Sensitivity of BRCA1/2 testing in high-risk breast/ovarian/male breast cancer families: little contribution of comprehensive RNA/NGS panel testing.

PubMed

Byers, Helen; Wallis, Yvonne; van Veen, Elke M; Lalloo, Fiona; Reay, Kim; Smith, Philip; Wallace, Andrew J; Bowers, Naomi; Newman, William G; Evans, D Gareth

2016-11-01

The sensitivity of testing BRCA1 and BRCA2 remains unresolved as the frequency of deep intronic splicing variants has not been defined in high-risk familial breast/ovarian cancer families. This variant category is reported at significant frequency in other tumour predisposition genes, including NF1 and MSH2. We carried out comprehensive whole gene RNA analysis on 45 high-risk breast/ovary and male breast cancer families with no identified pathogenic variant on exonic sequencing and copy number analysis of BRCA1/2. In addition, we undertook variant screening of a 10-gene high/moderate risk breast/ovarian cancer panel by next-generation sequencing. DNA testing identified the causative variant in 50/56 (89%) breast/ovarian/male breast cancer families with Manchester scores of ≥50 with two variants being confirmed to affect splicing on RNA analysis. RNA sequencing of BRCA1/BRCA2 on 45 individuals from high-risk families identified no deep intronic variants and did not suggest loss of RNA expression as a cause of lost sensitivity. Panel testing in 42 samples identified a known RAD51D variant, a high-risk ATM variant in another breast ovary family and a truncating CHEK2 mutation. Current exonic sequencing and copy number analysis variant detection methods of BRCA1/2 have high sensitivity in high-risk breast/ovarian cancer families. Sequence analysis of RNA does not identify any variants undetected by current analysis of BRCA1/2. However, RNA analysis clarified the pathogenicity of variants of unknown significance detected by current methods. The low diagnostic uplift achieved through sequence analysis of the other known breast/ovarian cancer susceptibility genes indicates that further high-risk genes remain to be identified.

Recruitment Methods and Show Rates to a Prostate Cancer Early Detection Program for High-Risk Men: A Comprehensive Analysis

PubMed Central

Giri, Veda N.; Coups, Elliot J.; Ruth, Karen; Goplerud, Julia; Raysor, Susan; Kim, Taylor Y.; Bagden, Loretta; Mastalski, Kathleen; Zakrzewski, Debra; Leimkuhler, Suzanne; Watkins-Bruner, Deborah

2009-01-01

Purpose Men with a family history (FH) of prostate cancer (PCA) and African American (AA) men are at higher risk for PCA. Recruitment and retention of these high-risk men into early detection programs has been challenging. We report a comprehensive analysis on recruitment methods, show rates, and participant factors from the Prostate Cancer Risk Assessment Program (PRAP), which is a prospective, longitudinal PCA screening study. Materials and Methods Men 35–69 years are eligible if they have a FH of PCA, are AA, or have a BRCA1/2 mutation. Recruitment methods were analyzed with respect to participant demographics and show to the first PRAP appointment using standard statistical methods Results Out of 707 men recruited, 64.9% showed to the initial PRAP appointment. More individuals were recruited via radio than from referral or other methods (χ2 = 298.13, p < .0001). Men recruited via radio were more likely to be AA (p<0.001), less educated (p=0.003), not married or partnered (p=0.007), and have no FH of PCA (p<0.001). Men recruited via referrals had higher incomes (p=0.007). Men recruited via referral were more likely to attend their initial PRAP visit than those recruited by radio or other methods (χ2 = 27.08, p < .0001). Conclusions This comprehensive analysis finds that radio leads to higher recruitment of AA men with lower socioeconomic status. However, these are the high-risk men that have lower show rates for PCA screening. Targeted motivational measures need to be studied to improve show rates for PCA risk assessment for these high-risk men. PMID:19758657

Identification of general risk-management countermeasures for unsafe driving actions. Volume 1, Description and analysis of promising countermeasures

DOT National Transportation Integrated Search

1981-02-01

A series of general risk-management countermeasures for speed Unsafe Driving Actions (UDAs) are described. First, countermeasure elements in three functional areas, detection, information, and action, are identified. Three comprehensive countermeasur...

The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: two systematic reviews for the Guide to Community Preventive Services.

PubMed

Chin, Helen B; Sipe, Theresa Ann; Elder, Randy; Mercer, Shawna L; Chattopadhyay, Sajal K; Jacob, Verughese; Wethington, Holly R; Kirby, Doug; Elliston, Donna B; Griffith, Matt; Chuke, Stella O; Briss, Susan C; Ericksen, Irene; Galbraith, Jennifer S; Herbst, Jeffrey H; Johnson, Robert L; Kraft, Joan M; Noar, Seth M; Romero, Lisa M; Santelli, John

2012-03-01

Adolescent pregnancy, HIV, and other sexually transmitted infections (STIs) are major public health problems in the U.S. Implementing group-based interventions that address the sexual behavior of adolescents may reduce the incidence of pregnancy, HIV, and other STIs in this group. Methods for conducting systematic reviews from the Guide to Community Preventive Services were used to synthesize scientific evidence on the effectiveness of two strategies for group-based behavioral interventions for adolescents: (1) comprehensive risk reduction and (2) abstinence education on preventing pregnancy, HIV, and other STIs. Effectiveness of these interventions was determined by reductions in sexual risk behaviors, pregnancy, HIV, and other STIs and increases in protective sexual behaviors. The literature search identified 6579 citations for comprehensive risk reduction and abstinence education. Of these, 66 studies of comprehensive risk reduction and 23 studies of abstinence education assessed the effects of group-based interventions that address the sexual behavior of adolescents, and were included in the respective reviews. Meta-analyses were conducted for each strategy on the seven key outcomes identified by the coordination team-current sexual activity; frequency of sexual activity; number of sex partners; frequency of unprotected sexual activity; use of protection (condoms and/or hormonal contraception); pregnancy; and STIs. The results of these meta-analyses for comprehensive risk reduction showed favorable effects for all of the outcomes reviewed. For abstinence education, the meta-analysis showed a small number of studies, with inconsistent findings across studies that varied by study design and follow-up time, leading to considerable uncertainty around effect estimates. Based on these findings, group-based comprehensive risk reduction was found to be an effective strategy to reduce adolescent pregnancy, HIV, and STIs. No conclusions could be drawn on the effectiveness of group-based abstinence education. Published by Elsevier Inc.

Based on Fuzzy Comprehensive Evaluation Method The Investment Risk Assessment of Chinese Enterprises in The Countries Along “The Belt and Road”

NASA Astrophysics Data System (ADS)

Chen, Yanyu; Chai, Huaqi; Huang, Yimiao

2018-01-01

“Belt and Road Forum for International Cooperation” held in Beijing in May this year. once again, “The Belt and Road” strategic initiative to the world, causing the world’s enthusiastic response. The core of the “One Belt, One Road” strategy initiative is to promote infrastructure construction and interconnection, dock national policies and development strategies, deepen pragmatic cooperation, promote coordinated and coordinated development and achieve common prosperity. With the “The Belt and Road” strategy in-depth, Chinese enterprises will go abroad, in the countries along the country to invest in more and more examples, accompanied by the increasing risk. Analysis of the failure of investment cases, we can easily find that this is the majority of enterprises overseas investment in the lack of careful assessment of risk and risk of foreign investment risk management has a great relationship. In this paper, the risk factors are used to identify the risk factors table, and the fuzzy comprehensive evaluation method is used to estimate the comprehensive risk value of many uncertain factors that cannot be determined by the overseas investment. The risk assessment system is constructed to help Chinese enterprises to follow the " Investment to avoid risks, improve the success rate.

Evaluation of risk communication in a mammography patient decision aid.

PubMed

Klein, Krystal A; Watson, Lindsey; Ash, Joan S; Eden, Karen B

2016-07-01

We characterized patients' comprehension, memory, and impressions of risk communication messages in a patient decision aid (PtDA), Mammopad, and clarified perceived importance of numeric risk information in medical decision making. Participants were 75 women in their forties with average risk factors for breast cancer. We used mixed methods, comprising a risk estimation problem administered within a pretest-posttest design, and semi-structured qualitative interviews with a subsample of 21 women. Participants' positive predictive value estimates of screening mammography improved after using Mammopad. Although risk information was only briefly memorable, through content analysis, we identified themes describing why participants value quantitative risk information, and obstacles to understanding. We describe ways the most complicated graphic was incompletely comprehended. Comprehension of risk information following Mammopad use could be improved. Patients valued receiving numeric statistical information, particularly in pictograph format. Obstacles to understanding risk information, including potential for confusion between statistics, should be identified and mitigated in PtDA design. Using simple pictographs accompanied by text, PtDAs may enhance a shared decision-making discussion. PtDA designers and providers should be aware of benefits and limitations of graphical risk presentations. Incorporating comprehension checks could help identify and correct misapprehensions of graphically presented statistics. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Evaluation of risk communication in a mammography patient decision aid

PubMed Central

Klein, Krystal A.; Watson, Lindsey; Ash, Joan S.; Eden, Karen B.

2016-01-01

Objectives We characterized patients’ comprehension, memory, and impressions of risk communication messages in a patient decision aid (PtDA), Mammopad, and clarified perceived importance of numeric risk information in medical decision making. Methods Participants were 75 women in their forties with average risk factors for breast cancer. We used mixed methods, comprising a risk estimation problem administered within a pretest–posttest design, and semi-structured qualitative interviews with a subsample of 21 women. Results Participants’ positive predictive value estimates of screening mammography improved after using Mammopad. Although risk information was only briefly memorable, through content analysis, we identified themes describing why participants value quantitative risk information, and obstacles to understanding. We describe ways the most complicated graphic was incompletely comprehended. Conclusions Comprehension of risk information following Mammopad use could be improved. Patients valued receiving numeric statistical information, particularly in pictograph format. Obstacles to understanding risk information, including potential for confusion between statistics, should be identified and mitigated in PtDA design. Practice implications Using simple pictographs accompanied by text, PtDAs may enhance a shared decision-making discussion. PtDA designers and providers should be aware of benefits and limitations of graphical risk presentations. Incorporating comprehension checks could help identify and correct misapprehensions of graphically presented statistics PMID:26965020

EVALUATION OF VADOSE ZONE AND SORUCE MODULES FOR MULTI-MEDIA, MULTI-PATHWAY, AND MULTI-RECEPTOR RISK ASSESSMENT USING LARGE-SOIL-COLUMN EXPERIMENTAL DATA

EPA Science Inventory

The United States Environmental Protection Agency (EPA) is developing a comprehensive environmental exposure and risk analysis software system for agency-wide application using the methodology of a Multi-media, Multi-pathway, Multi-receptor Risk Assessment (3MRA) model. This sof...

EVALUATION OF VADOSE ZONE AND SOURCE MODELS FOR MULTI-MEDIA, MULTI-PATHWAY, MULTI-RECEPTOR RISK ASSESSMENT USING LARGE SOIL COLUMN EXPERIMENT DATA

EPA Science Inventory

The U.S. Environmental Protection Agency (EPA) is developing a comprehensive environmental exposure and risk analysis software system for agency-wide application using the methodology of a Multi-media, Multi-pathway, Multi-receptor Risk Assessment (3MRA) model. This software sys...

Assessing natural hazards in forestry for risk management: a review

Treesearch

Marc Hanewinkel; Susan Hummel; Axel Albrecht

2011-01-01

We address the problem of how to integrate risk assessment into forest management and therefore provide a comprehensive review of recent and past literature on risk analysis and modeling and, moreover, an evaluation and summary on these papers. We provide a general scheme on how to integrate concepts of risk into forest management decisions. After an overview of the...

The Healthy LifeWorks Project: a pilot study of the economic analysis of a comprehensive workplace wellness program in a Canadian government department.

PubMed

Makrides, Lydia; Smith, Steven; Allt, Jane; Farquharson, Jane; Szpilfogel, Claudine; Curwin, Sandra; Veinot, Paula; Wang, Feifei; Edington, Dee

2011-07-01

To examine the relationship between health risks and absenteeism and drug costs vis-a-vis comprehensive workplace wellness. Eleven health risks, and change in drug claims, short-term and general illness calculated across four risk change groups. Wellness score examined using Wilcoxon test and regression model for cost change. The results showed 31% at risk; 9 of 11 risks associated with higher drug costs. Employees moving from low to high risk showed highest relative increase (81%) in drug costs; moving from high to low had lowest (24%). Low-high had highest increase in absenteeism costs (160%). With each risk increase, absenteeism costs increased by $CDN248 per year (P < 0.05) with average decrease of 0.07 risk factors and savings $CDN6979 per year. Both high-risk reduction and low-risk maintenance are important to contain drug costs. Only low-risk maintenance also avoids absenteeism costs associated with high risks.

Risk assessment of supply chain for pharmaceutical excipients with AHP-fuzzy comprehensive evaluation.

PubMed

Li, Maozhong; Du, Yunai; Wang, Qiyue; Sun, Chunmeng; Ling, Xiang; Yu, Boyang; Tu, Jiasheng; Xiong, Yerong

2016-01-01

As the essential components in formulations, pharmaceutical excipients directly affect the safety, efficacy, and stability of drugs. Recently, safety incidents of pharmaceutical excipients posing seriously threats to the patients highlight the necessity of controlling the potential risks. Hence, it is indispensable for the industry to establish an effective risk assessment system of supply chain. In this study, an AHP-fuzzy comprehensive evaluation model was developed based on the analytic hierarchy process and fuzzy mathematical theory, which quantitatively assessed the risks of supply chain. Taking polysorbate 80 as the example for model analysis, it was concluded that polysorbate 80 for injection use is a high-risk ingredient in the supply chain compared to that for oral use to achieve safety application in clinic, thus measures should be taken to control and minimize those risks.

Risk assessment of supply chain for pharmaceutical excipients with AHP-fuzzy comprehensive evaluation.

PubMed

Li, Maozhong; Du, Yunai; Wang, Qiyue; Sun, Chunmeng; Ling, Xiang; Yu, Boyang; Tu, Jiasheng; Xiong, Yerong

2016-04-01

As the essential components in formulations, pharmaceutical excipients directly affect the safety, efficacy, and stability of drugs. Recently, safety incidents of pharmaceutical excipients posing seriously threats to the patients highlight the necessity of controlling the potential risks. Hence, it is indispensable for the industry to establish an effective risk assessment system of supply chain. In this study, an AHP-fuzzy comprehensive evaluation model was developed based on the analytic hierarchy process and fuzzy mathematical theory, which quantitatively assessed the risks of supply chain. Taking polysorbate 80 as the example for model analysis, it was concluded that polysorbate 80 for injection use is a high-risk ingredient in the supply chain compared to that for oral use to achieve safety application in clinic, thus measures should be taken to control and minimize those risks.

Note of the methodological flaws in the paper entitled "Polymorphisms in IL-4/IL-13 pathway genes and glioma risk: an updated meta-analysis".

PubMed

Wang, Ting-Ting; Li, Jin-Mei; Zhou, Dong

2016-01-01

With great interest, we read the paper "Polymorphisms in IL-4/IL-13 pathway genes and glioma risk: an updated meta-analysis" (by Chen PQ et al.) [1], which has reached important conclusions about the relationship between polymorphisms in interleukin (IL)-4/IL-13 pathway genes and glioma risk. Through quantitative analysis, the meta-analysis found no association between IL-4/IL-13 pathway genetic polymorphisms and glioma risk (Chen et al. in Tumor Biol 36:121-127, 2015). The meta-analysis is the most comprehensive study of polymorphisms in the IL-4/IL-13 pathway and glioma risk. Nevertheless, some deficiencies still exist in this meta-analysis that we would like to raise.

Clinical and cost outcomes of multifactorial, cardiovascular risk management interventions in worksites: a comprehensive review and analysis.

PubMed

Pelletier, K R

1997-12-01

This paper is a critical review of the clinical and cost outcome evaluation studies of multifactorial, comprehensive, cardiovascular risk management programs in worksites. A comprehensive international literature search conducted under the auspices of the National Heart, Lung and Blood Institute identified 17 articles based on 12 studies that examined the clinical outcomes of multifactorial, comprehensive programs. These articles were identified through MEDLINE, manual searches of recent journals, and through direct inquiries to worksite health promotion researchers. All studies were conducted between 1978 and 1995, with 1978 being the date of the first citation of a methodologically rigorous evaluation. Of the 12 research studies, only 8 utilized the worksite as both the unit of assignment and as the unit of analysis. None of the studies analyzed adequately for cost effectiveness. Given this limitation, this review briefly considers the relevant worksite research that has demonstrated cost outcomes. Worksite-based, multifactorial cardiovascular intervention programs reviewed for this article varied widely in the comprehensiveness, intensity, and duration of both the interventions and evaluations. Results from randomized trials suggest that providing opportunities for individualized, cardiovascular risk reduction counseling for high-risk employees within the context of comprehensive programming may be the critical component of an effective worksite intervention. Despite the many limitations of the current methodologies of the 12 studies, the majority of the research to date indicates the following: (1) favorable clinical and cost outcomes; (2) that more recent and more rigorously designed research tends to support rather than refute earlier and less rigorously designed studies; and (3) that rather than interpreting the methodological flaws and diversity as inherently negative, one may consider it as indicative of a robust phenomena evident in many types of worksites, with diverse employees, differing interventions, and varying degrees of methodological sophistication. Results of these studies reviewed provide both cautious optimism about the effectiveness of these worksite programs and insights regarding the essential components and characteristics of successful programs.

The association between physical activity and renal cancer: systematic review and meta-analysis

PubMed Central

Behrens, G; Leitzmann, M F

2013-01-01

Background: Physical activity may decrease renal cancer risk by reducing obesity, blood pressure, insulin resistance, and lipid peroxidation. Despite plausible biologic mechanisms linking increased physical activity to decreased risk for renal cancer, few epidemiologic studies have been able to report a clear inverse association between physical activity and renal cancer, and no meta-analysis is available on the topic. Methods: We searched the literature using PubMed and Web of Knowledge to identify published non-ecologic epidemiologic studies quantifying the relationship between physical activity and renal cancer risk in individuals without a cancer history. Following the PRISMA guidelines, we conducted a systematic review and meta-analysis, including information from 19 studies based on a total of 2 327 322 subjects and 10 756 cases. The methodologic quality of the studies was examined using a comprehensive scoring system. Results: Comparing high vs low levels of physical activity, we observed an inverse association between physical activity and renal cancer risk (summary relative risk (RR) from random-effects meta-analysis=0.88; 95% confidence interval (CI)=0.79–0.97). Summarising risk estimates from high-quality studies strengthened the inverse association between physical activity and renal cancer risk (RR=0.78; 95% CI=0.66–0.92). Effect modification by adiposity, hypertension, type 2 diabetes, smoking, gender, or geographic region was not observed. Conclusion: Our comprehensive meta-analysis provides strong support for an inverse relation of physical activity to renal cancer risk. Future high-quality studies are required to discern which specific types, intensities, frequencies, and durations of physical activity are needed for renal cancer risk reduction. PMID:23412105

Adaptive servo ventilation for central sleep apnoea in heart failure: SERVE-HF on-treatment analysis.

PubMed

Woehrle, Holger; Cowie, Martin R; Eulenburg, Christine; Suling, Anna; Angermann, Christiane; d'Ortho, Marie-Pia; Erdmann, Erland; Levy, Patrick; Simonds, Anita K; Somers, Virend K; Zannad, Faiez; Teschler, Helmut; Wegscheider, Karl

2017-08-01

This on-treatment analysis was conducted to facilitate understanding of mechanisms underlying the increased risk of all-cause and cardiovascular mortality in heart failure patients with reduced ejection fraction and predominant central sleep apnoea randomised to adaptive servo ventilation versus the control group in the SERVE-HF trial.Time-dependent on-treatment analyses were conducted (unadjusted and adjusted for predictive covariates). A comprehensive, time-dependent model was developed to correct for asymmetric selection effects (to minimise bias).The comprehensive model showed increased cardiovascular death hazard ratios during adaptive servo ventilation usage periods, slightly lower than those in the SERVE-HF intention-to-treat analysis. Self-selection bias was evident. Patients randomised to adaptive servo ventilation who crossed over to the control group were at higher risk of cardiovascular death than controls, while control patients with crossover to adaptive servo ventilation showed a trend towards lower risk of cardiovascular death than patients randomised to adaptive servo ventilation. Cardiovascular risk did not increase as nightly adaptive servo ventilation usage increased.On-treatment analysis showed similar results to the SERVE-HF intention-to-treat analysis, with an increased risk of cardiovascular death in heart failure with reduced ejection fraction patients with predominant central sleep apnoea treated with adaptive servo ventilation. Bias is inevitable and needs to be taken into account in any kind of on-treatment analysis in positive airway pressure studies. Copyright ©ERS 2017.

Effect of education on listening comprehension of sentences on healthy elderly: analysis of number of correct responses and task execution time.

PubMed

Silagi, Marcela Lima; Rabelo, Camila Maia; Schochat, Eliane; Mansur, Letícia Lessa

2017-11-13

To analyze the effect of education on sentence listening comprehension on cognitively healthy elderly. A total of 111 healthy elderly, aged 60-80 years of both genders were divided into two groups according to educational level: low education (0-8 years of formal education) and high education (≥9 years of formal education). The participants were assessed using the Revised Token Test, an instrument that supports the evaluation of auditory comprehension of orders with different working memory and syntactic complexity demands. The indicators used for performance analysis were the number of correct responses (accuracy analysis) and task execution time (temporal analysis) in the different blocks. The low educated group had a lower number of correct responses than the high educated group on all blocks of the test. In the temporal analysis, participants with low education had longer execution time for commands on the first four blocks related to working memory. However, the two groups had similar execution time for blocks more related to syntactic comprehension. Education influenced sentence listening comprehension on elderly. Temporal analysis allowed to infer over the relationship between comprehension and other cognitive abilities, and to observe that the low educated elderly did not use effective compensation strategies to improve their performances on the task. Therefore, low educational level, associated with aging, may potentialize the risks for language decline.

Multi-phase distribution and comprehensive ecological risk assessment of heavy metal pollutants in a river affected by acid mine drainage.

PubMed

Liao, Jianbo; Ru, Xuan; Xie, Binbin; Zhang, Wanhui; Wu, Haizhen; Wu, Chaofei; Wei, Chaohai

2017-07-01

To date, there is a lack of a comprehensive research on heavy metals detection and ecological risk assessment in river water, sediments, pore water (PW) and suspended solids (SS). Here, the concentrations of heavy metals, including Cu, Zn, Mn, Cd, Pb and As, and their distribution between the four phases was studied. Samples for analysis were taken from twelve sites of the Hengshi River, Guangdong Province, China, during the rainy and dry seasons. A new comprehensive ecological risk index (CERI) based on considering metal contents, pollution indices, toxicity coefficients and water categories is offered for prediction of potential risk on aquatic organisms. The results of comprehensive analysis showed that the highest concentrations of Cu, Zn and Mn of 6.42, 87.17 and 98.74mg/L, respectively, in PW were comparable with those in water, while concentrations of Cd, Pb and As of 609.5, 2757 and 96.38μg/L, respectively, were 2-5 times higher. The sum of the exchangeable and carbonate fractions of target metals in sediments followed the order of Cd > Mn > Zn > Pb > Cu > As. The distribution of heavy metals in phases followed the order of sediment > SS > water > PW, having the sum content in water and PW lower than 2% of total. The elevated ecological risk for a single metal and the phase were 34,585 for Cd and 1160 for water, respectively, implied Cd as a priority pollutant in the considered area. According to the CERI, the maximum risk value of 769.3 was smaller than 1160 in water, but higher than those in other phases. Out of considering the water categories and contribution coefficients, the CERI was proved to be more reliable for assessing the pollution of rivers with heavy metals. These results imply that the CERI has a potential of adequate assessment of multi-phase composite metals pollution. Copyright © 2017 Elsevier Inc. All rights reserved.

Coffee consumption is not associated with ovarian cancer risk: a dose-response meta-analysis of prospective cohort studies.

PubMed

Berretta, Massimiliano; Micek, Agnieszka; Lafranconi, Alessandra; Rossetti, Sabrina; Di Francia, Raffaele; De Paoli, Paolo; Rossi, Paola; Facchini, Gaetano

2018-04-17

Coffee consumption has been associated with numerous cancers, but evidence on ovarian cancer risk is controversial. Therefore, we performed a meta-analysis on prospective cohort studies in order to review the evidence on coffee consumption and risk of ovarian cancer. Studies were identified through searching the PubMed and MEDLINE databases up to March 2017. Risk estimates were retrieved from the studies, and dose-response analysis was modelled by using restricted cubic splines. Additionally, a stratified analysis by menopausal status was performed. A total of 8 studies were eligible for the dose-response meta-analysis. Studies included in the analysis comprised 787,076 participants and 3,541 ovarian cancer cases. The results showed that coffee intake was not associated with ovarian cancer risk (RR = 1.06, 95% CI: 0.89, 1.26). Stratified and subgroup analysis showed consisted results. This comprehensive meta-analysis did not find evidence of an association between the consumption of coffee and risk of ovarian cancer.

Risk-adjusted Outcomes of Clinically Relevant Pancreatic Fistula Following Pancreatoduodenectomy: A Model for Performance Evaluation.

PubMed

McMillan, Matthew T; Soi, Sameer; Asbun, Horacio J; Ball, Chad G; Bassi, Claudio; Beane, Joal D; Behrman, Stephen W; Berger, Adam C; Bloomston, Mark; Callery, Mark P; Christein, John D; Dixon, Elijah; Drebin, Jeffrey A; Castillo, Carlos Fernandez-Del; Fisher, William E; Fong, Zhi Ven; House, Michael G; Hughes, Steven J; Kent, Tara S; Kunstman, John W; Malleo, Giuseppe; Miller, Benjamin C; Salem, Ronald R; Soares, Kevin; Valero, Vicente; Wolfgang, Christopher L; Vollmer, Charles M

2016-08-01

To evaluate surgical performance in pancreatoduodenectomy using clinically relevant postoperative pancreatic fistula (CR-POPF) occurrence as a quality indicator. Accurate assessment of surgeon and institutional performance requires (1) standardized definitions for the outcome of interest and (2) a comprehensive risk-adjustment process to control for differences in patient risk. This multinational, retrospective study of 4301 pancreatoduodenectomies involved 55 surgeons at 15 institutions. Risk for CR-POPF was assessed using the previously validated Fistula Risk Score, and pancreatic fistulas were stratified by International Study Group criteria. CR-POPF variability was evaluated and hierarchical regression analysis assessed individual surgeon and institutional performance. There was considerable variability in both CR-POPF risk and occurrence. Factors increasing the risk for CR-POPF development included increasing Fistula Risk Score (odds ratio 1.49 per point, P < 0.00001) and octreotide (odds ratio 3.30, P < 0.00001). When adjusting for risk, performance outliers were identified at the surgeon and institutional levels. Of the top 10 surgeons (≥15 cases) for nonrisk-adjusted performance, only 6 remained in this high-performing category following risk adjustment. This analysis of pancreatic fistulas following pancreatoduodenectomy demonstrates considerable variability in both the risk and occurrence of CR-POPF among surgeons and institutions. Disparities in patient risk between providers reinforce the need for comprehensive, risk-adjusted modeling when assessing performance based on procedure-specific complications. Furthermore, beyond inherent patient risk factors, surgical decision-making influences fistula outcomes.

The effects of infographics and several quantitative versus qualitative formats for cardiovascular disease risk, including heart age, on people's risk understanding.

PubMed

Damman, Olga C; Vonk, Suzanne I; van den Haak, Maaike J; van Hooijdonk, Charlotte M J; Timmermans, Danielle R M

2018-03-11

To study how comprehension of cardiovascular disease (CVD) risk is influenced by: (1) infographics about qualitative risk information, with/without risk numbers; (2) which qualitative risk dimension is emphasized; (3) heart age vs. traditional risk format. For aim 1, a 2 (infographics versus text) x 2 (risk number versus no risk number) between-subjects design was used. For aim 2, three pieces of information were tested within-subjects. Aim 3 used a simple comparison group. Participants (45-65 yrs old) were recruited through an online access panel; low educated people were oversampled. They received hypothetical risk information (20%/61yrs). Primary outcomes: recall, risk appraisals, subjective/objective risk comprehension. behavioral intentions, information evaluations. Infographics of qualitative risk dimensions negatively affected recall, subjective risk comprehension and information evaluations. No effect of type of risk dimension was found on risk perception. Heart age influenced recall, comprehension, evaluations and affective risk appraisals. Infographics of hypothetical CVD risk information had detrimental effects on measures related to risk perception/comprehension, but effects were mainly seen in undereducated participants. Heart age influenced perceptions/comprehension of hypothetical risk in a way that seemed to support understanding. Heart age seems a fruitful risk communication approach in disease risk calculators. Copyright © 2018 Elsevier B.V. All rights reserved.

A Correlational Study of a Reading Comprehension Program and Attrition Rates of ESL Nursing Students in Texas.

PubMed

Donnell, Wendy M

The purpose of this study was to examine the associations between English as a second language (ESL), a reading comprehension program, and attrition rates of nursing students. Higher attrition rates of ESL nursing students are an assumption, seemingly based on anecdotal evidence. Data reflecting ESL student attrition should be measured and analyzed so that students can be identified prior to attrition. A secondary analysis of a large database of 27 initial licensure programs in Texas was completed. Data analysis identified that ESL students who used a reading comprehension program were almost twice as likely to be off track or out of the program as ESL students who did not use the program. Nurse educators need to evaluate student profile characteristics in a comprehensive way when determining risk of attrition.

Soy intake and breast cancer risk: A meta-analysis of epidemiological studies

NASA Astrophysics Data System (ADS)

Bahrom, Suhaila; Idris, Nik Ruzni Nik

2016-06-01

The impact of soy intake on breast cancer risk has been investigated extensively. However, these studies reported conflicting results. The objective of this study is to perform comprehensive review and updated meta-analysis on the association between soy intake and breast cancer risk and to identify significant factors which may contribute to the inconsistencies of results of the individual studies. Based on reviews of existing meta-analysis, we identified four main factors which contributed to the inconsistencies of results of individual studies on the association of soy intake and breast cancer risk namely; region, menopausal status of the patients, soy type and study design. Accordingly, we performed an updated meta-analysis of 57 studies grouped by the identified factors. Pooled ORs of studies carried out in Asian countries suggested that soy isoflavones consumption was inversely associated with the risk of breast cancer among both pre and postmenopausal women (OR=0.63, 95% CI: 0.54-0.74 for premenopausal women; OR=0.63, 95% CI: 0.52-0.75 for postmenopausal women). However, pooled OR of studies carried out in Western countries shows that there is no statistically significant association between soy intake and breast cancer risk (OR=0.98, 95% CI: 0.93-1.03). Our study suggests that soy food intake is associated with significantly reduced risk of breast cancer for women in Asian but not in Western countries. Further epidemiological studies need to be conducted with more comprehensive information about the dietary intake and relative exposure among the women in these two different regions.

Gene-Environment Interplay in Internalizing Disorders: Consistent Findings across Six Environmental Risk Factors

ERIC Educational Resources Information Center

Hicks, Brian M.; Dirago, Ana C.; Iacono, William G.; McGue, Matt

2009-01-01

Background: Behavior genetic methods can help to elucidate gene-environment (G-E) interplay in the development of internalizing (INT) disorders (i.e., major depression and anxiety disorders). To date, however, no study has conducted a comprehensive analysis examining multiple environmental risk factors with the purpose of delineating general…

An Assessment of the Effectiveness of Air Force Risk Management Practices in Program Acquisition Using Survey Instrument Analysis

DTIC Science & Technology

2015-06-18

Engineering Effectiveness Survey. CMU/SEI-2012-SR-009. Carnegie Mellon University. November 2012. Field, Andy. Discovering Statistics Using SPSS , 3rd...enough into the survey to begin answering questions on risk practices. All of the data statistical analysis will be performed using SPSS . Prior to...probabilistically using distributions for likelihood and impact. Statistical methods like Monte Carlo can more comprehensively evaluate the cost and

Development of economic consequence methodology for process risk analysis.

PubMed

Zadakbar, Omid; Khan, Faisal; Imtiaz, Syed

2015-04-01

A comprehensive methodology for economic consequence analysis with appropriate models for risk analysis of process systems is proposed. This methodology uses loss functions to relate process deviations in a given scenario to economic losses. It consists of four steps: definition of a scenario, identification of losses, quantification of losses, and integration of losses. In this methodology, the process deviations that contribute to a given accident scenario are identified and mapped to assess potential consequences. Losses are assessed with an appropriate loss function (revised Taguchi, modified inverted normal) for each type of loss. The total loss is quantified by integrating different loss functions. The proposed methodology has been examined on two industrial case studies. Implementation of this new economic consequence methodology in quantitative risk assessment will provide better understanding and quantification of risk. This will improve design, decision making, and risk management strategies. © 2014 Society for Risk Analysis.

Commentary on "The association between physical activity and renal cancer: systematic review and meta-analysis." Behrens G, Leitzmann MF, Department of Epidemiology and Preventive Medicine, Regensburg University Medical Center, Regensburg, Germany. Br J Cancer 2013; 108(4):798-811. [Epub 2013 Feb 14]. doi: 10.1038/bjc.2013.37.

PubMed

Boorjian, Stephen

2014-08-01

Physical activity may decrease renal cancer risk by reducing obesity, blood pressure, insulin resistance, and lipid peroxidation. Despite plausible biologic mechanisms linking increased physical activity to decreased risk for renal cancer, few epidemiologic studies have been able to report a clear inverse association between physical activity and renal cancer, and no meta-analysis is available on the topic. We searched the literature using PubMed and Web of Knowledge to identify published non-ecologic epidemiologic studies quantifying the relationship between physical activity and renal cancer risk in individuals without a cancer history. Following the PRISMA guidelines, we conducted a systematic review and meta-analysis, including information from 19 studies based on a total of 2,327,322 subjects and 10,756 cases. The methodologic quality of the studies was examined using a comprehensive scoring system. Comparing high vs low levels of physical activity, we observed an inverse association between physical activity and renal cancer risk (summary relative risk (RR) from random-effects meta-analysis=0.88; 95% confidence interval (CI)=0.79-0.97). Summarising risk estimates from high-quality studies strengthened the inverse association between physical activity and renal cancer risk (RR=0.78; 95% CI=0.66-0.92). Effect modification by adiposity, hypertension, type 2 diabetes, smoking, gender, or geographic region was not observed. Our comprehensive meta-analysis provides strong support for an inverse relation of physical activity to renal cancer risk. Future high-quality studies are required to discern which specific types, intensities, frequencies, and durations of physical activity are needed for renal cancer risk reduction. Copyright © 2014 Elsevier Inc. All rights reserved.

Tailoring risk communication to improve comprehension: Do patient preferences help or hurt?

PubMed

Barnes, Andrew J; Hanoch, Yaniv; Miron-Shatz, Talya; Ozanne, Elissa M

2016-09-01

Risk communication tools can facilitate patients' understanding of risk information. In this novel study, we examine the hypothesis that risk communication methods tailored to individuals' preferences can increase risk comprehension. Preferences for breast cancer risk formats, and risk comprehension data were collected using an online survey from 361 women at high risk for breast cancer. Women's initial preferences were assessed by asking them which of the following risk formats would be the clearest: (a) percentage, (b) frequency, (c) bar graph, (d) pictogram, and (e) comparison to other women. Next, women were presented with 5 different formats for displaying cancer risks and asked to interpret the risk information presented. Finally, they were asked again which risk format they preferred. Initial preferences for risk formats were not associated with risk comprehension scores. However, women with lower risk comprehension scores were more likely to update their risk format preferences after they evaluated risks in different formats. Less numerate women were more likely to prefer graphical rather than numeric risk formats. Importantly, we found that women preferring graphical risk formats had lower risk comprehension in these formats compared to numeric formats. In contrast, women preferring numeric formats performed equally well across formats. Our findings suggest that tailoring risk communication to patient preferences may not improve understanding of medical risks, particularly for less numerate women, and point to the potential perils of tailoring risk communication formats to patient preferences. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Final analysis of cost, value, and risk.

DOT National Transportation Integrated Search

2009-03-05

USDOT understands that access to emergency services provided by 9-1-1 in todays world of evolving : technology will ultimately occur within a broader array of interconnected networks comprehensively : supporting emergency servicesfrom public ac...

2016 Emerging Technology Domains Risk Survey

DTIC Science & Technology

2016-04-05

2016 Emerging Technology Domains Risk Survey Christopher King Dan Klinedinst Todd Lewellen Garret Wassermann April 2016 TECHNICAL REPORT...Unlimited [Checkoway 2011] Checkoway, Stephen; McCoy, Damon; Kantor, Brian; Anderson, Danny; Shacham, Hovav; Savage, Stefan. Comprehensive Experimental ...Koscher 2010] Koscher, Karl et al. “ Experimental Security Analysis of a Modern Automobile,” 447-462. IEEE Symposium on Security and Privacy

Analysis of Risks in a Learning Management System: A Case Study in the Spanish National University of Distance Education (UNED)

ERIC Educational Resources Information Center

Vázquez-Cano, Esteban; Sevillano García, Ma. Luisa

2015-01-01

This article presents a research that examines the university students' risk perception when using a Learning Management System called "aLF" and implemented by the Spanish National University of Distance Education (UNED) for the development of its university distance studies. The development of comprehensive Learning Management Systems…

Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies.

PubMed

Dinu, Monica; Abbate, Rosanna; Gensini, Gian Franco; Casini, Alessandro; Sofi, Francesco

2017-11-22

Beneficial effects of vegetarian and vegan diets on health outcomes have been supposed in previous studies. Aim of this study was to clarify the association between vegetarian, vegan diets, risk factors for chronic diseases, risk of all-cause mortality, incidence, and mortality from cardio-cerebrovascular diseases, total cancer and specific type of cancer (colorectal, breast, prostate and lung), through meta-analysis. A comprehensive search of Medline, EMBASE, Scopus, The Cochrane Library, and Google Scholar was conducted. Eighty-six cross-sectional and 10 cohort prospective studies were included. The overall analysis among cross-sectional studies reported significant reduced levels of body mass index, total cholesterol, LDL-cholesterol, and glucose levels in vegetarians and vegans versus omnivores. With regard to prospective cohort studies, the analysis showed a significant reduced risk of incidence and/or mortality from ischemic heart disease (RR 0.75; 95% CI, 0.68 to 0.82) and incidence of total cancer (RR 0.92; 95% CI 0.87 to 0.98) but not of total cardiovascular and cerebrovascular diseases, all-cause mortality and mortality from cancer. No significant association was evidenced when specific types of cancer were analyzed. The analysis conducted among vegans reported significant association with the risk of incidence from total cancer (RR 0.85; 95% CI, 0.75 to 0.95), despite obtained only in a limited number of studies. This comprehensive meta-analysis reports a significant protective effect of a vegetarian diet versus the incidence and/or mortality from ischemic heart disease (-25%) and incidence from total cancer (-8%). Vegan diet conferred a significant reduced risk (-15%) of incidence from total cancer.

Improvement of the cost-benefit analysis algorithm for high-rise construction projects

NASA Astrophysics Data System (ADS)

Gafurov, Andrey; Skotarenko, Oksana; Plotnikov, Vladimir

2018-03-01

The specific nature of high-rise investment projects entailing long-term construction, high risks, etc. implies a need to improve the standard algorithm of cost-benefit analysis. An improved algorithm is described in the article. For development of the improved algorithm of cost-benefit analysis for high-rise construction projects, the following methods were used: weighted average cost of capital, dynamic cost-benefit analysis of investment projects, risk mapping, scenario analysis, sensitivity analysis of critical ratios, etc. This comprehensive approach helped to adapt the original algorithm to feasibility objectives in high-rise construction. The authors put together the algorithm of cost-benefit analysis for high-rise construction projects on the basis of risk mapping and sensitivity analysis of critical ratios. The suggested project risk management algorithms greatly expand the standard algorithm of cost-benefit analysis in investment projects, namely: the "Project analysis scenario" flowchart, improving quality and reliability of forecasting reports in investment projects; the main stages of cash flow adjustment based on risk mapping for better cost-benefit project analysis provided the broad range of risks in high-rise construction; analysis of dynamic cost-benefit values considering project sensitivity to crucial variables, improving flexibility in implementation of high-rise projects.

Preliminary analysis of cost, value, and risk.

DOT National Transportation Integrated Search

2008-02-12

The U.S. Department of Transportation (USDOT) understands that access to emergency services provided by 9-1-1 in todays world of evolving technology will ultimately occur within a broader array of interconnected networks comprehensively supporting...

Phases of ERA - Analysis

EPA Pesticide Factsheets

Eco-Box 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

Assessing the validity of prospective hazard analysis methods: a comparison of two techniques

PubMed Central

2014-01-01

Background Prospective Hazard Analysis techniques such as Healthcare Failure Modes and Effects Analysis (HFMEA) and Structured What If Technique (SWIFT) have the potential to increase safety by identifying risks before an adverse event occurs. Published accounts of their application in healthcare have identified benefits, but the reliability of some methods has been found to be low. The aim of this study was to examine the validity of SWIFT and HFMEA by comparing their outputs in the process of risk assessment, and comparing the results with risks identified by retrospective methods. Methods The setting was a community-based anticoagulation clinic, in which risk assessment activities had been previously performed and were available. A SWIFT and an HFMEA workshop were conducted consecutively on the same day by experienced experts. Participants were a mixture of pharmacists, administrative staff and software developers. Both methods produced lists of risks scored according to the method’s procedure. Participants’ views about the value of the workshops were elicited with a questionnaire. Results SWIFT identified 61 risks and HFMEA identified 72 risks. For both methods less than half the hazards were identified by the other method. There was also little overlap between the results of the workshops and risks identified by prior root cause analysis, staff interviews or clinical governance board discussions. Participants’ feedback indicated that the workshops were viewed as useful. Conclusions Although there was limited overlap, both methods raised important hazards. Scoping the problem area had a considerable influence on the outputs. The opportunity for teams to discuss their work from a risk perspective is valuable, but these methods cannot be relied upon in isolation to provide a comprehensive description. Multiple methods for identifying hazards should be used and data from different sources should be integrated to give a comprehensive view of risk in a system. PMID:24467813

Comprehensive genetic assessment of the ESR1 locus identifies a risk region for endometrial cancer.

PubMed

O'Mara, Tracy A; Glubb, Dylan M; Painter, Jodie N; Cheng, Timothy; Dennis, Joe; Attia, John; Holliday, Elizabeth G; McEvoy, Mark; Scott, Rodney J; Ashton, Katie; Proietto, Tony; Otton, Geoffrey; Shah, Mitul; Ahmed, Shahana; Healey, Catherine S; Gorman, Maggie; Martin, Lynn; Hodgson, Shirley; Fasching, Peter A; Hein, Alexander; Beckmann, Matthias W; Ekici, Arif B; Hall, Per; Czene, Kamila; Darabi, Hatef; Li, Jingmei; Dürst, Matthias; Runnebaum, Ingo; Hillemanns, Peter; Dörk, Thilo; Lambrechts, Diether; Depreeuw, Jeroen; Annibali, Daniela; Amant, Frederic; Zhao, Hui; Goode, Ellen L; Dowdy, Sean C; Fridley, Brooke L; Winham, Stacey J; Salvesen, Helga B; Njølstad, Tormund S; Trovik, Jone; Werner, Henrica M J; Tham, Emma; Liu, Tao; Mints, Miriam; Bolla, Manjeet K; Michailidou, Kyriaki; Tyrer, Jonathan P; Wang, Qin; Hopper, John L; Peto, Julian; Swerdlow, Anthony J; Burwinkel, Barbara; Brenner, Hermann; Meindl, Alfons; Brauch, Hiltrud; Lindblom, Annika; Chang-Claude, Jenny; Couch, Fergus J; Giles, Graham G; Kristensen, Vessela N; Cox, Angela; Pharoah, Paul D P; Dunning, Alison M; Tomlinson, Ian; Easton, Douglas F; Thompson, Deborah J; Spurdle, Amanda B

2015-10-01

Excessive exposure to estrogen is a well-established risk factor for endometrial cancer (EC), particularly for cancers of endometrioid histology. The physiological function of estrogen is primarily mediated by estrogen receptor alpha, encoded by ESR1. Consequently, several studies have investigated whether variation at the ESR1 locus is associated with risk of EC, with conflicting results. We performed comprehensive fine-mapping analyses of 3633 genotyped and imputed single nucleotide polymorphisms (SNPs) in 6607 EC cases and 37 925 controls. There was evidence of an EC risk signal located at a potential alternative promoter of the ESR1 gene (lead SNP rs79575945, P=1.86×10(-5)), which was stronger for cancers of endometrioid subtype (P=3.76×10(-6)). Bioinformatic analysis suggests that this risk signal is in a functionally important region targeting ESR1, and eQTL analysis found that rs79575945 was associated with expression of SYNE1, a neighbouring gene. In summary, we have identified a single EC risk signal located at ESR1, at study-wide significance. Given SNPs located at this locus have been associated with risk for breast cancer, also a hormonally driven cancer, this study adds weight to the rationale for performing informed candidate fine-scale genetic studies across cancer types. © 2015 Society for Endocrinology.

Arthrodesis following failed total knee arthroplasty: comprehensive review and meta-analysis of recent literature.

PubMed

Damron, T A; McBeath, A A

1995-04-01

With the increasing duration of follow up on total knee arthroplasties, more revision arthroplasties are being performed. When revision is not advisable, a salvage procedure such as arthrodesis or resection arthroplasty is indicated. This article provides a comprehensive review of the literature regarding arthrodesis following failed total knee arthroplasty. In addition, a statistical meta-analysis of five studies using modern arthrodesis techniques is presented. A statistically significant greater fusion rate with intramedullary nail arthrodesis compared to external fixation is documented. Gram negative and mixed infections are found to be significant risk factors for failure of arthrodesis.

Primary treatments for clinically localised prostate cancer: a comprehensive lifetime cost-utility analysis.

PubMed

Cooperberg, Matthew R; Ramakrishna, Naren R; Duff, Steven B; Hughes, Kathleen E; Sadownik, Sara; Smith, Joseph A; Tewari, Ashutosh K

2013-03-01

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Multiple treatment alternatives exist for localised prostate cancer, with few high-quality studies directly comparing their comparative effectiveness and costs. The present study is the most comprehensive cost-effectiveness analysis to date for localised prostate cancer, conducted with a lifetime horizon and accounting for survival, health-related quality-of-life, and cost impact of secondary treatments and other downstream events, as well as primary treatment choices. The analysis found minor differences, generally slightly favouring surgical methods, in quality-adjusted life years across treatment options. However, radiation therapy (RT) was consistently more expensive than surgery, and some alternatives, e.g. intensity-modulated RT for low-risk disease, were dominated - that is, both more expensive and less effective than competing alternatives. To characterise the costs and outcomes associated with radical prostatectomy (open, laparoscopic, or robot-assisted) and radiation therapy (RT: dose-escalated three-dimensional conformal RT, intensity-modulated RT, brachytherapy, or combination), using a comprehensive, lifetime decision analytical model. A Markov model was constructed to follow hypothetical men with low-, intermediate-, and high-risk prostate cancer over their lifetimes after primary treatment; probabilities of outcomes were based on an exhaustive literature search yielding 232 unique publications. In each Markov cycle, patients could have remission, recurrence, salvage treatment, metastasis, death from prostate cancer, and death from other causes. Utilities for each health state were determined, and disutilities were applied for complications and toxicities of treatment. Costs were determined from the USA payer perspective, with incorporation of patient costs in a sensitivity analysis. Differences across treatments in quality-adjusted life years across methods were modest, ranging from 10.3 to 11.3 for low-risk patients, 9.6-10.5 for intermediate-risk patients and 7.8-9.3 for high-risk patients. There were no statistically significant differences among surgical methods, which tended to be more effective than RT methods, with the exception of combined external beam + brachytherapy for high-risk disease. RT methods were consistently more expensive than surgical methods; costs ranged from $19 901 (robot-assisted prostatectomy for low-risk disease) to $50 276 (combined RT for high-risk disease). These findings were robust to an extensive set of sensitivity analyses. Our analysis found small differences in outcomes and substantial differences in payer and patient costs across treatment alternatives. These findings may inform future policy discussions about strategies to improve efficiency of treatment selection for localised prostate cancer. © 2012 BJU International.

Bridging the gap between individual-level risk for HIV and structural determinants: using root cause analysis in strategic planning.

PubMed

Willard, Nancy; Chutuape, Kate; Stines, Stephanie; Ellen, Jonathan M

2012-01-01

HIV prevention efforts have expanded beyond individual-level interventions to address structural determinants of risk. Coalitions have been an important vehicle for addressing similar intractable and deeply rooted health-related issues. A root cause analysis process may aid coalitions in identifying fundamental, structural-level contributors to risk and in identifying appropriate solutions. For this article, strategic plans for 13 coalitions were analyzed both before and after a root cause analysis approach was applied to determine the coalitions' strategic plans potential impact and comprehensiveness. After root cause analysis, strategic plans trended toward targeting policies and practices rather than on single agency programmatic changes. Plans expanded to target multiple sectors and several changes within sectors to penetrate deeply into a sector or system. Findings suggest that root cause analysis may be a viable tool to assist coalitions in identifying structural determinants and possible solutions for HIV risk.

Bayesian Inference for NASA Probabilistic Risk and Reliability Analysis

NASA Technical Reports Server (NTRS)

Dezfuli, Homayoon; Kelly, Dana; Smith, Curtis; Vedros, Kurt; Galyean, William

2009-01-01

This document, Bayesian Inference for NASA Probabilistic Risk and Reliability Analysis, is intended to provide guidelines for the collection and evaluation of risk and reliability-related data. It is aimed at scientists and engineers familiar with risk and reliability methods and provides a hands-on approach to the investigation and application of a variety of risk and reliability data assessment methods, tools, and techniques. This document provides both: A broad perspective on data analysis collection and evaluation issues. A narrow focus on the methods to implement a comprehensive information repository. The topics addressed herein cover the fundamentals of how data and information are to be used in risk and reliability analysis models and their potential role in decision making. Understanding these topics is essential to attaining a risk informed decision making environment that is being sought by NASA requirements and procedures such as 8000.4 (Agency Risk Management Procedural Requirements), NPR 8705.05 (Probabilistic Risk Assessment Procedures for NASA Programs and Projects), and the System Safety requirements of NPR 8715.3 (NASA General Safety Program Requirements).

Design of Training Systems. Computerization of the Educational Technology Assessment Model. Volume 1.

ERIC Educational Resources Information Center

Duffy, Larry B.; And Others

The Educational Technology Assessment Model (ETAM) is a set of comprehensive procedures and variables for the analysis, synthesis, and decision making, in regard to the benefits, costs, and risks associated with introducing technical innovations in education and training. This final report summarizes the analysis, design, and development…

A Meta-Analysis of Predictors of Offender Treatment Attrition and Its Relationship to Recidivism

ERIC Educational Resources Information Center

Olver, Mark E.; Stockdale, Keira C.; Wormith, J. Stephen

2011-01-01

Objective: The failure of offenders to complete psychological treatment can pose significant concerns, including increased risk for recidivism. Although a large literature identifying predictors of offender treatment attrition has accumulated, there has yet to be a comprehensive quantitative review. Method: A meta-analysis of the offender…

Reading abilities in school-aged preterm children: a review and meta-analysis

PubMed Central

Kovachy, Vanessa N; Adams, Jenna N; Tamaresis, John S; Feldman, Heidi M

2014-01-01

AIM Children born preterm (at ≤32wk) are at risk of developing deficits in reading ability. This meta-analysis aims to determine whether or not school-aged preterm children perform worse than those born at term in single-word reading (decoding) and reading comprehension. METHOD Electronic databases were searched for studies published between 2000 and 2013, which assessed decoding or reading comprehension performance in English-speaking preterm and term-born children aged between 6 years and 13 years, and born after 1990. Standardized mean differences in decoding and reading comprehension scores were calculated. RESULTS Nine studies were suitable for analysis of decoding, and five for analysis of reading comprehension. Random-effects meta-analyses showed that children born preterm had significantly lower scores (reported as Cohen’s d values [d] with 95% confidence intervals [CIs]) than those born at term for decoding (d=−0.42, 95% CI −0.57 to −0.27, p<0.001) and reading comprehension (d=−0.57, 95% CI −0.68 to −0.46, p<0.001). Meta-regressions showed that lower gestational age was associated with larger differences in decoding (Q[1]=5.92, p=0.02) and reading comprehension (Q[1]=4.69, p=0.03) between preterm and term groups. Differences between groups increased with age for reading comprehension (Q[1]=5.10, p=0.02) and, although not significant, there was also a trend for increased group differences for decoding (Q[1]=3.44, p=0.06). INTERPRETATION Preterm children perform worse than peers born at term on decoding and reading comprehension. These findings suggest that preterm children should receive more ongoing monitoring for reading difficulties throughout their education. PMID:25516105

Towards low flow risk maps

NASA Astrophysics Data System (ADS)

Blauhut, Veit; Stölzle, Michael; Stahl, Kerstin

2017-04-01

Drought induced low flow extremes, despite a variety of management strategies, can cause direct and indirect impacts on socio economic and ecological functions of rivers. These negative effects determine local risk and are a function of the regional drought hazard and the river system's vulnerability. Whereas drought risk analysis is known to be essential for drought management, risk analysis for low flow is less common. Where no distributed hydrological models exist, merely the local hazard at gauging stations is available to represent the entire catchment. Vulnerability information are only sparsely available. Hence, a comprehensive understanding of the drivers of low flow risk along the longitudinal river profile is often lacking. For two different rivers in southwestern Germany, this study analysed major low flow events of the past five decades. Applying a transdisciplinary approach, the hazard component is assessed by hydro-climatic analysis, hydrological modelling and forward looking stress test scenarios; the vulnerability component is estimated by a combination of impact assessment and vulnerability estimation, based on stakeholder workshops, questionnaires and regional characteristics. The results show distinct differences in low flow risk between the catchments and along the river. These differences are due to: hydrogeological characteristics that govern groundwater-surface water interaction, catchment-specific anthropogenic stimuli such as low flow decrease by near-stream groundwater pumping for public water supply or low flow augmentation by treatment plant discharge. Thus, low flow risk is anthropogenically influenced in both ways: positive and negative. Furthermore, the measured longitudinal profiles highlight the impracticability of single gauges to represent quantitative and qualitative conditions of entire rivers. Hence, this work calls for a comprehensive spatially variable consideration of flow characteristics and human influences to analyse low flow risk as the basis for an adequate low flow management.

Cost-Effectiveness of Disease Management Programs for Cardiovascular Risk and COPD in The Netherlands.

PubMed

Tsiachristas, Apostolos; Burgers, Laura; Rutten-van Mölken, Maureen P M H

2015-12-01

Disease management programs (DMPs) for cardiovascular risk (CVR) and chronic obstructive pulmonary disease (COPD) are increasingly implemented in The Netherlands to improve care and patient's health behavior. The aim of this study was to provide evidence about the (cost-) effectiveness of Dutch DMPs as implemented in daily practice. We compared the physical activity, smoking status, quality-adjusted life-years, and yearly costs per patient between the most and the least comprehensive DMPs in four disease categories: primary CVR prevention, secondary CVR prevention, both types of CVR prevention, and COPD (N = 1034). Propensity score matching increased comparability between DMPs. A 2-year cost-utility analysis was performed from the health care and societal perspectives. Sensitivity analysis was performed to estimate the impact of DMP development and implementation costs on cost-effectiveness. Patients in the most comprehensive DMPs increased their physical activity more (except for primary CVR prevention) and had higher smoking cessation rates. The incremental QALYs ranged from -0.032 to 0.038 across all diseases. From a societal perspective, the most comprehensive DMPs decreased costs in primary CVR prevention (certainty 57%), secondary CVR prevention (certainty 88%), and both types of CVR prevention (certainty 98%). Moreover, the implementation of comprehensive DMPs led to QALY gains in secondary CVR prevention (certainty 92%) and COPD (certainty 69%). The most comprehensive DMPs for CVR and COPD have the potential to be cost saving, effective, or cost-effective compared with the least comprehensive DMPs. The challenge for Dutch stakeholders is to find the optimal mixture of interventions that is most suited for each target group. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Risk analysis based on hazards interactions

NASA Astrophysics Data System (ADS)

Rossi, Lauro; Rudari, Roberto; Trasforini, Eva; De Angeli, Silvia; Becker, Joost

2017-04-01

Despite an increasing need for open, transparent, and credible multi-hazard risk assessment methods, models, and tools, the availability of comprehensive risk information needed to inform disaster risk reduction is limited, and the level of interaction across hazards is not systematically analysed. Risk assessment methodologies for different hazards often produce risk metrics that are not comparable. Hazard interactions (consecutive occurrence two or more different events) are generally neglected, resulting in strongly underestimated risk assessment in the most exposed areas. This study presents cases of interaction between different hazards, showing how subsidence can affect coastal and river flood risk (Jakarta and Bandung, Indonesia) or how flood risk is modified after a seismic event (Italy). The analysis of well documented real study cases, based on a combination between Earth Observation and in-situ data, would serve as basis the formalisation of a multi-hazard methodology, identifying gaps and research frontiers. Multi-hazard risk analysis is performed through the RASOR platform (Rapid Analysis and Spatialisation Of Risk). A scenario-driven query system allow users to simulate future scenarios based on existing and assumed conditions, to compare with historical scenarios, and to model multi-hazard risk both before and during an event (www.rasor.eu).

Engaging with Comparative Risk Appraisals: Public Views on Policy Priorities for Environmental Risk Governance.

PubMed

Rocks, Sophie A; Schubert, Iljana; Soane, Emma; Black, Edgar; Muckle, Rachel; Petts, Judith; Prpich, George; Pollard, Simon J

2017-09-01

Communicating the rationale for allocating resources to manage policy priorities and their risks is challenging. Here, we demonstrate that environmental risks have diverse attributes and locales in their effects that may drive disproportionate responses among citizens. When 2,065 survey participants deployed summary information and their own understanding to assess 12 policy-level environmental risks singularly, their assessment differed from a prior expert assessment. However, participants provided rankings similar to those of experts when these same 12 risks were considered as a group, allowing comparison between the different risks. Following this, when individuals were shown the prior expert assessment of this portfolio, they expressed a moderate level of confidence with the combined expert analysis. These are important findings for the comprehension of policy risks that may be subject to augmentation by climate change, their representation alongside other threats within national risk assessments, and interpretations of agency for public risk management by citizens and others. © 2017 The Authors Risk Analysis published by Wiley Periodicals, Inc. on behalf of Society for Risk Analysis.

Application of a risk management system to improve drinking water safety.

PubMed

Jayaratne, Asoka

2008-12-01

The use of a comprehensive risk management framework is considered a very effective means of managing water quality risks. There are many risk-based systems available to water utilities such as ISO 9001 and Hazard Analysis and Critical Control Point (HACCP). In 2004, the World Health Organization's (WHO) Guidelines for Drinking Water Quality recommended the use of preventive risk management approaches to manage water quality risks. This paper describes the framework adopted by Yarra Valley Water for the development of its Drinking Water Quality Risk Management Plan incorporating HACCP and ISO 9001 systems and demonstrates benefits of Water Safety Plans such as HACCP. Copyright IWA Publishing 2008.

Risk Evaluation of Business Continuity Management by Using Green Technology

NASA Astrophysics Data System (ADS)

Gang, Chen

IT disasters can be seen as the test of the ability in communities and firms to effectively protect their information and infrastructure, to reduce both human and property loss, and to rapidly recover. In this paper, we use a literature meta-analysis method to identify potential research directions in Green Business Continuity Management (GBCM). The concept and characteristics of GBCM are discussed. We analysis the connotation and the sources of green technology risk. An assessment index system is established from the perspectives of GBCM. A fuzzy comprehensive assessment method is introduced to assess the risks of green technology in Business Continuity Management.

The Formative Years: Pathways to Substance Abuse among Girls and Young Women Ages 8-22.

ERIC Educational Resources Information Center

Columbia Univ., New York, NY. National Center on Addiction and Substance Abuse.

This report presents a comprehensive analysis of the reasons why girls and young women smoke, drink and use drugs, and what increases or lowers their risk of substance abuse. It demonstrates that certain key risk factors for substance abuse are unique to girls and young women and pose a greater threat to them than to boys and young men. This…

Integration of PKPD relationships into benefit–risk analysis

PubMed Central

Bellanti, Francesco; van Wijk, Rob C; Danhof, Meindert; Della Pasqua, Oscar

2015-01-01

Aim Despite the continuous endeavour to achieve high standards in medical care through effectiveness measures, a quantitative framework for the assessment of the benefit–risk balance of new medicines is lacking prior to regulatory approval. The aim of this short review is to summarise the approaches currently available for benefit–risk assessment. In addition, we propose the use of pharmacokinetic–pharmacodynamic (PKPD) modelling as the pharmacological basis for evidence synthesis and evaluation of novel therapeutic agents. Methods A comprehensive literature search has been performed using MESH terms in PubMed, in which articles describing benefit–risk assessment and modelling and simulation were identified. In parallel, a critical review of multi-criteria decision analysis (MCDA) is presented as a tool for characterising a drug's safety and efficacy profile. Results A definition of benefits and risks has been proposed by the European Medicines Agency (EMA), in which qualitative and quantitative elements are included. However, in spite of the value of MCDA as a quantitative method, decisions about benefit–risk balance continue to rely on subjective expert opinion. By contrast, a model-informed approach offers the opportunity for a more comprehensive evaluation of benefit–risk balance before extensive evidence is generated in clinical practice. Conclusions Benefit–risk balance should be an integral part of the risk management plan and as such considered before marketing authorisation. Modelling and simulation can be incorporated into MCDA to support the evidence synthesis as well evidence generation taking into account the underlying correlations between favourable and unfavourable effects. In addition, it represents a valuable tool for the optimization of protocol design in effectiveness trials. PMID:25940398

Integration of PKPD relationships into benefit-risk analysis.

PubMed

Bellanti, Francesco; van Wijk, Rob C; Danhof, Meindert; Della Pasqua, Oscar

2015-11-01

Despite the continuous endeavour to achieve high standards in medical care through effectiveness measures, a quantitative framework for the assessment of the benefit-risk balance of new medicines is lacking prior to regulatory approval. The aim of this short review is to summarise the approaches currently available for benefit-risk assessment. In addition, we propose the use of pharmacokinetic-pharmacodynamic (PKPD) modelling as the pharmacological basis for evidence synthesis and evaluation of novel therapeutic agents. A comprehensive literature search has been performed using MESH terms in PubMed, in which articles describing benefit-risk assessment and modelling and simulation were identified. In parallel, a critical review of multi-criteria decision analysis (MCDA) is presented as a tool for characterising a drug's safety and efficacy profile. A definition of benefits and risks has been proposed by the European Medicines Agency (EMA), in which qualitative and quantitative elements are included. However, in spite of the value of MCDA as a quantitative method, decisions about benefit-risk balance continue to rely on subjective expert opinion. By contrast, a model-informed approach offers the opportunity for a more comprehensive evaluation of benefit-risk balance before extensive evidence is generated in clinical practice. Benefit-risk balance should be an integral part of the risk management plan and as such considered before marketing authorisation. Modelling and simulation can be incorporated into MCDA to support the evidence synthesis as well evidence generation taking into account the underlying correlations between favourable and unfavourable effects. In addition, it represents a valuable tool for the optimization of protocol design in effectiveness trials. © 2015 The British Pharmacological Society.

Primary treatments for clinically localized prostate cancer: a comprehensive lifetime cost-utility analysis

PubMed Central

Cooperberg, Matthew R.; Ramakrishna, Naren R.; Duff, Steven B.; Hughes, Kathleen E.; Sadownik, Sara; Smith, Joseph A.; Tewari, Ashutosh K.

2012-01-01

Objectives To characterize the costs and outcomes associated with radical prostatectomy (open, laparoscopic, or robot-assisted) and radiation therapy (dose-escalated 3-dimensional conformal radiation, intensity-modulated radiation, brachytherapy, or combination), using a comprehensive, lifetime decision analytic model. Patients and Methods A Markov model was constructed to follow hypothetical men with low-, intermediate-, and high-risk prostate cancer over their lifetimes following primary treatment; probabilities of outcomes were based on an exhaustive literature search yielding 232 unique publications. Patients could experience remission, recurrence, salvage treatment, metastasis, death from prostate cancer, and death from other causes. Utilities for each health state were determined, and disutilities were applied for complications and toxicities of treatment. Costs were determined from the U.S. payer perspective, with incorporation of patient costs in a sensitivity analysis. Results Differences in quality-adjusted life years across modalities were modest, ranging from 10.3 to 11.3 for low-risk patients, 9.6 to 10.5 for intermediate-risk patients, and 7.8 to 9.3 for high-risk patients. There were no statistically significant differences among surgical modalities, which tended to be more effective than radiation modalities, with the exception of combination external beam + brachytherapy for high-risk disease. Radiation modalities were consistently more expensive than surgical modalities; costs ranged from $19,901 (robot-assisted prostatectomy for low-risk disease) to $50,276 (combination radiation for high-risk disease). These findings were robust to an extensive set of sensitivity analyses. Conclusions Our analysis found small differences in outcomes and substantial differences in payer and patient costs across treatment alternatives. These findings may inform future policy discussions regarding strategies to improve efficiency of treatment selection for localized prostate cancer. PMID:23279038

Environmental Risk Assessment of dredging processes - application to Marin harbour (NW Spain)

NASA Astrophysics Data System (ADS)

Gómez, A. G.; García Alba, J.; Puente, A.; Juanes, J. A.

2014-04-01

A methodological procedure to estimate the environmental risk of dredging operations in aquatic systems has been developed. Environmental risk estimations are based on numerical models results, which provide an appropriated spatio-temporal framework analysis to guarantee an effective decision-making process. The methodological procedure has been applied on a real dredging operation in the port of Marin (NW Spain). Results from Marin harbour confirmed the suitability of the developed methodology and the conceptual approaches as a comprehensive and practical management tool.

Identifying Children in Middle Childhood Who Are at Risk for Reading Problems.

PubMed

Speece, Deborah L; Ritchey, Kristen D; Silverman, Rebecca; Schatschneider, Christopher; Walker, Caroline Y; Andrusik, Katryna N

2010-06-01

The purpose of this study was to identify and evaluate a universal screening battery for reading that is appropriate for older elementary students in a response to intervention model. Multiple measures of reading and reading correlates were administered to 230 fourth-grade children. Teachers rated children's reading skills, academic competence, and attention. Children were classified as not-at-risk or at-risk readers based on a three-factor model reflecting reading comprehension, word recognition/decoding, and word fluency. Predictors of reading status included group-administered tests of reading comprehension, silent word reading fluency, and teacher ratings of reading problems. Inclusion of individually administered tests and growth estimates did not add substantial variance. The receiver-operator characteristic curve analysis yielded an area under the curve index of 0.90, suggesting this model may both accurately and efficiently screen older elementary students with reading problems.

Safety of intravenous thrombolysis in stroke mimics: prospective 5-year study and comprehensive meta-analysis.

PubMed

Tsivgoulis, Georgios; Zand, Ramin; Katsanos, Aristeidis H; Goyal, Nitin; Uchino, Ken; Chang, Jason; Dardiotis, Efthimios; Putaala, Jukka; Alexandrov, Anne W; Malkoff, Marc D; Alexandrov, Andrei V

2015-05-01

Shortening door-to-needle time may lead to inadvertent intravenous thrombolysis (IVT) administration in stroke mimics (SMs). We sought to determine the safety of IVT in SMs using prospective, single-center data and by conducting a comprehensive meta-analysis of reported case-series. We prospectively analyzed consecutive IVT-treated patients during a 5-year period at a tertiary care stroke center. A systematic review and meta-analysis of case-series reporting safety of IVT in SMs and confirmed acute ischemic stroke were conducted. Symptomatic intracerebral hemorrhage was defined as imaging evidence of ICH with an National Institutes of Health Stroke scale increase of ≥4 points. Favorable functional outcome at hospital discharge was defined as a modified Rankin Scale score of 0 to 1. Of 516 consecutive IVT patients at our tertiary care center (50% men; mean age, 60±14 years; median National Institutes of Health Stroke scale, 11; range, 3-22), SMs comprised 75 cases. Symptomatic intracerebral hemorrhage occurred in 1 patient, whereas we documented no cases of orolingual edema or major extracranial hemorrhagic complications. In meta-analysis of 9 studies (8942 IVT-treated patients), the pooled rates of symptomatic intracerebral hemorrhage and orolingual edema among 392 patients with SM treated with IVT were 0.5% (95% confidence interval, 0%-2%) and 0.3% (95% confidence interval, 0%-2%), respectively. Patients with SM were found to have a significantly lower risk for symptomatic intracerebral hemorrhage compared with patients with acute ischemic stroke (risk ratio=0.33; 95% confidence interval, 0.14-0.77; P=0.010), with no evidence of heterogeneity or publication bias. Favorable functional outcome was almost 3-fold higher in patients with SM in comparison with patients with acute ischemic stroke (risk ratio=2.78; 95% confidence interval, 2.07-3.73; P<0.00001). Our prospective, single-center experience coupled with the findings of the comprehensive meta-analysis underscores the safety of IVT in SM. © 2015 American Heart Association, Inc.

Relationship Between Maternal Characteristics and Postpartum Hemorrhage: A Meta-Analysis Study.

PubMed

Durmaz, Aysegul; Komurcu, Nuran

2017-12-06

Postpartum hemorrhage (PPH) is a leading cause of maternal death in low-income countries and the primary cause of approximately one of every four maternal deaths worldwide. The aim of this study was to determine the antenatal risk factors of PPH and its effects. The literature from nine databases was reviewed, and studies published between 2000 and 2012 were analyzed using terms such as "postpartum hemorrhage," "prevention of postpartum hemorrhage," and "management of postpartum hemorrhage." The full text of 1,061 articles was reviewed, and 29 studies were selected according to the inclusion criteria. Studies that determined bias using the funnel plot test were excluded, and 20 studies were included in the meta-analysis. The data were analyzed using Microsoft Office Excel 2010 and comprehensive meta-analysis. The meta-analysis included five studies and 1,286,752 women for maternal age, six studies and 607,822 women for body mass index, and six studies and 1,118,490 women for parity. The results of the analysis showed that body mass index ≥ 25.00 kg/m (OR = 1.43, 95% CI [1.40, 1.47]), primiparity of mothers (OR = 1.37, 95% CI [1.35, 1.40]), and hypertensive disorder in mothers (OR = 1.52, 95% CI [1.43, 1.61]) are risk factors for the development of PPH. No rela-tionship was found between maternal age ≥ 35 years and PPH (OR = 1.02, 95% CI [0.99, 1.04]). Midwives, obstetric nurses, and obstetricians should carefully evaluate mothers for the risk factors of PPH during the antepartum, intrapartum, and postpartum periods. Moreover, at-risk pregnant women should give birth in a unit with emergency initiative options. Future studies should examine relevant personal characteristics of mothers, as familiarity with the risk factors facilitates the management and treatment of PPH. Finally, meta-analyses should review more studies to detect risk factors more comprehensively.

Effect of a comprehensive health education program on pre-hospital delay intentions in high-risk stroke population and caregivers.

PubMed

Yang, Li; Zhao, Qiuli; Zhu, Xuemei; Shen, Xiaoying; Zhu, Yulan; Yang, Liu; Gao, Wei; Li, Minghui

2017-08-01

Many factors influence pre-hospital delays in the event of stroke. This study aimed to develop and evaluate a comprehensive educational program for decreasing pre-hospital delays in high-risk stroke population. We enrolled 220 high-risk stroke population and caregivers from six urban communities in Harbin from May 2013 to May 2015, and randomly divided them into intervention and control groups. We implemented a comprehensive educational program (intervention group), comprising public lectures, instructional brochures, case videos, simulations, and role-playing from May 2013 to May 2015. We delivered conventional oral education in the control group. We compared stroke pre-hospital delay behavioral intention (SPDBI), pre-hospital stroke symptom coping test (PSSCT), and stroke pre-symptoms alert test (SPSAT) results between the groups before and 6, 12, and 18 months after health intervention. There were significant differences between before and after intervention (P < 0.01). SPDBI, PSSCT, and SPSAT scores were significantly different between the groups (P < 0.01). The interaction between time and intervention method was significant (P < 0.01). According to multivariate repeated measures analysis of variance, SPDBI, PSSCT, and SPSAT scores were significantly different at each time after intervention (P < 0.05). The comprehensive educational program was significantly effective in decreasing SPDBI, improving knowledge, enhancing stroke pre-symptoms alert, and reducing the possibility of pre-hospital delays.

Transcriptomic Dose-Response Analysis for Mode of Action ...

EPA Pesticide Factsheets

Microarray and RNA-seq technologies can play an important role in assessing the health risks associated with environmental exposures. The utility of gene expression data to predict hazard has been well documented. Early toxicogenomics studies used relatively high, single doses with minimal replication. Thus, they were not useful in understanding health risks at environmentally-relevant doses. Until the past decade, application of toxicogenomics in dose response assessment and determination of chemical mode of action has been limited. New transcriptomic biomarkers have evolved to detect chemical hazards in multiple tissues together with pathway methods to study biological effects across the full dose response range and critical time course. Comprehensive low dose datasets are now available and with the use of transcriptomic benchmark dose estimation techniques within a mode of action framework, the ability to incorporate informative genomic data into human health risk assessment has substantially improved. The key advantage to applying transcriptomic technology to risk assessment is both the sensitivity and comprehensive examination of direct and indirect molecular changes that lead to adverse outcomes. Book Chapter with topic on future application of toxicogenomics technologies for MoA and risk assessment

Correlation Analysis of Freeway Traffic Status and Crashes with Nevada Data.

DOT National Transportation Integrated Search

2017-11-11

This project is to study the correlation between freeway traffic status and crash risks with the historical freeway ITS data and related crash data in Nevada. With the comprehensive review of previous research results, the Center for Advanced Transpo...

Adjuvant intraperitoneal chromic phosphate therapy for women with apparent early ovarian carcinoma who have not undergone comprehensive surgical staging

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

Soper, J.T.; Berchuck, A.; Clarke-Pearson, D.L.

1991-08-15

Forty-nine women with apparent Stage 1 and 2 ovarian carcinoma received intraperitoneal phosphate 32 as the only adjuvant therapy after primary surgery. In addition to bilateral salpingo-oophorectomy, 40 (82%) had analysis of peritoneal cytology, and 35 (71%) underwent omentectomy. Random peritoneal biopsies and retroperitoneal lymph node sampling were not done in any of these patients. The overall and disease-free survival rates were 86% and 75%, respectively, with no significant differences by stage, histologic grade, histologic type, or low-risk versus high-risk subsets recognized in patients who received comprehensive surgical staging. Seven (58%) of 12 patients had lymph node metastasis as themore » first site of recurrence, including two of three with late recurrences. Significant morbidity related to intraperitoneal chromic phosphate (32P) occurred in one (2%) woman. These results emphasize the need for comprehensive surgical staging of women with apparent early ovarian carcinoma to aid in the selection of appropriate initial adjuvant therapy.« less

Preliminary Analysis of Aircraft Loss of Control Accidents: Worst Case Precursor Combinations and Temporal Sequencing

NASA Technical Reports Server (NTRS)

Belcastro, Christine M.; Groff, Loren; Newman, Richard L.; Foster, John V.; Crider, Dennis H.; Klyde, David H.; Huston, A. McCall

2014-01-01

Aircraft loss of control (LOC) is a leading cause of fatal accidents across all transport airplane and operational classes, and can result from a wide spectrum of hazards, often occurring in combination. Technologies developed for LOC prevention and recovery must therefore be effective under a wide variety of conditions and uncertainties, including multiple hazards, and their validation must provide a means of assessing system effectiveness and coverage of these hazards. This requires the definition of a comprehensive set of LOC test scenarios based on accident and incident data as well as future risks. This paper defines a comprehensive set of accidents and incidents over a recent 15 year period, and presents preliminary analysis results to identify worst-case combinations of causal and contributing factors (i.e., accident precursors) and how they sequence in time. Such analyses can provide insight in developing effective solutions for LOC, and form the basis for developing test scenarios that can be used in evaluating them. Preliminary findings based on the results of this paper indicate that system failures or malfunctions, crew actions or inactions, vehicle impairment conditions, and vehicle upsets contributed the most to accidents and fatalities, followed by inclement weather or atmospheric disturbances and poor visibility. Follow-on research will include finalizing the analysis through a team consensus process, defining future risks, and developing a comprehensive set of test scenarios with correlation to the accidents, incidents, and future risks. Since enhanced engineering simulations are required for batch and piloted evaluations under realistic LOC precursor conditions, these test scenarios can also serve as a high-level requirement for defining the engineering simulation enhancements needed for generating them.

Improved FTA methodology and application to subsea pipeline reliability design.

PubMed

Lin, Jing; Yuan, Yongbo; Zhang, Mingyuan

2014-01-01

An innovative logic tree, Failure Expansion Tree (FET), is proposed in this paper, which improves on traditional Fault Tree Analysis (FTA). It describes a different thinking approach for risk factor identification and reliability risk assessment. By providing a more comprehensive and objective methodology, the rather subjective nature of FTA node discovery is significantly reduced and the resulting mathematical calculations for quantitative analysis are greatly simplified. Applied to the Useful Life phase of a subsea pipeline engineering project, the approach provides a more structured analysis by constructing a tree following the laws of physics and geometry. Resulting improvements are summarized in comparison table form.

Improved FTA Methodology and Application to Subsea Pipeline Reliability Design

PubMed Central

Lin, Jing; Yuan, Yongbo; Zhang, Mingyuan

2014-01-01

An innovative logic tree, Failure Expansion Tree (FET), is proposed in this paper, which improves on traditional Fault Tree Analysis (FTA). It describes a different thinking approach for risk factor identification and reliability risk assessment. By providing a more comprehensive and objective methodology, the rather subjective nature of FTA node discovery is significantly reduced and the resulting mathematical calculations for quantitative analysis are greatly simplified. Applied to the Useful Life phase of a subsea pipeline engineering project, the approach provides a more structured analysis by constructing a tree following the laws of physics and geometry. Resulting improvements are summarized in comparison table form. PMID:24667681

Ecosystem Risk Assessment Using the Comprehensive Assessment of Risk to Ecosystems (CARE) Tool

NASA Astrophysics Data System (ADS)

Battista, W.; Fujita, R.; Karr, K.

2016-12-01

Effective Ecosystem Based Management requires a localized understanding of the health and functioning of a given system as well as of the various factors that may threaten the ongoing ability of the system to support the provision of valued services. Several risk assessment models are available that can provide a scientific basis for understanding these factors and for guiding management action, but these models focus mainly on single species and evaluate only the impacts of fishing in detail. We have developed a new ecosystem risk assessment model - the Comprehensive Assessment of Risk to Ecosystems (CARE) - that allows analysts to consider the cumulative impact of multiple threats, interactions among multiple threats that may result in synergistic or antagonistic impacts, and the impacts of a suite of threats on whole-ecosystem productivity and functioning, as well as on specific ecosystem services. The CARE model was designed to be completed in as little as two hours, and uses local and expert knowledge where data are lacking. The CARE tool can be used to evaluate risks facing a single site; to compare multiple sites for the suitability or necessity of different management options; or to evaluate the effects of a proposed management action aimed at reducing one or more risks. This analysis can help users identify which threats are the most important at a given site, and therefore where limited management resources should be targeted. CARE can be applied to virtually any system, and can be modified as knowledge is gained or to better match different site characteristics. CARE builds on previous ecosystem risk assessment tools to provide a comprehensive assessment of fishing and non-fishing threats that can be used to inform environmental management decisions across a broad range of systems.

Ecosystem Risk Assessment Using the Comprehensive Assessment of Risk to Ecosystems (CARE) Tool

NASA Astrophysics Data System (ADS)

Battista, W.; Fujita, R.; Karr, K.

2016-02-01

Effective Ecosystem Based Management requires a localized understanding of the health and functioning of a given system as well as of the various factors that may threaten the ongoing ability of the system to support the provision of valued services. Several risk assessment models are available that can provide a scientific basis for understanding these factors and for guiding management action, but these models focus mainly on single species and evaluate only the impacts of fishing in detail. We have developed a new ecosystem risk assessment model - the Comprehensive Assessment of Risk to Ecosystems (CARE) - that allows analysts to consider the cumulative impact of multiple threats, interactions among multiple threats that may result in synergistic or antagonistic impacts, and the impacts of a suite of threats on whole-ecosystem productivity and functioning, as well as on specific ecosystem services. The CARE model was designed to be completed in as little as two hours, and uses local and expert knowledge where data are lacking. The CARE tool can be used to evaluate risks facing a single site; to compare multiple sites for the suitability or necessity of different management options; or to evaluate the effects of a proposed management action aimed at reducing one or more risks. This analysis can help users identify which threats are the most important at a given site, and therefore where limited management resources should be targeted. CARE can be applied to virtually any system, and can be modified as knowledge is gained or to better match different site characteristics. CARE builds on previous ecosystem risk assessment tools to provide a comprehensive assessment of fishing and non-fishing threats that can be used to inform environmental management decisions across a broad range of systems.

Groundwater quality in Ghaziabad district, Uttar Pradesh, India: Multivariate and health risk assessment.

PubMed

Chabukdhara, Mayuri; Gupta, Sanjay Kumar; Kotecha, Yatharth; Nema, Arvind K

2017-07-01

This study aimed to assess the quality of groundwater and potential health risk due to ingestion of heavy metals in the peri-urban and urban-industrial clusters of Ghaziabad district, Uttar Pradesh, India. Furthermore, the study aimed to evaluate heavy metals sources and their pollution level using multivariate analysis and fuzzy comprehensive assessment (FCA), respectively. Multivariate analysis using principle component analysis (PCA) showed mixed origin for Pb, Cd, Zn, Fe, and Ni, natural source for Cu and Mn and anthropogenic source for Cr. Among all the metals, Pb, Cd, Fe and Ni were above the safe limits of Bureau of Indian Standards (BIS) and World Health Organization (WHO) except Ni. Health risk in terms of hazard quotient (HQ) showed that the HQ values for children were higher than the safe level (HQ = 1) for Pb (2.4) and Cd (2.1) in pre-monsoon while in post-monsoon the value exceeded only for Pb (HQ = 1.23). The health risks of heavy metals for the adults were well within safe limits. The finding of this study indicates potential health risks to the children due to chronic exposure to contaminated groundwater in the region. Based on FCA, groundwater pollution could be categorized as quite high in the peri-urban region, and absolutely high in the urban region of Ghaziabad district. This study showed that different approaches are required for the integrated assessment of the groundwater pollution, and provides a scientific basis for the strategic future planning and comprehensive management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Drought: A comprehensive R package for drought monitoring, prediction and analysis

NASA Astrophysics Data System (ADS)

Hao, Zengchao; Hao, Fanghua; Singh, Vijay P.; Cheng, Hongguang

2015-04-01

Drought may impose serious challenges to human societies and ecosystems. Due to complicated causing effects and wide impacts, a universally accepted definition of drought does not exist. The drought indicator is commonly used to characterize drought properties such as duration or severity. Various drought indicators have been developed in the past few decades for the monitoring of a certain aspect of drought condition along with the development of multivariate drought indices for drought characterizations from multiple sources or hydro-climatic variables. Reliable drought prediction with suitable drought indicators is critical to the drought preparedness plan to reduce potential drought impacts. In addition, drought analysis to quantify the risk of drought properties would provide useful information for operation drought managements. The drought monitoring, prediction and risk analysis are important components in drought modeling and assessments. In this study, a comprehensive R package "drought" is developed to aid the drought monitoring, prediction and risk analysis (available from R-Forge and CRAN soon). The computation of a suite of univariate and multivariate drought indices that integrate drought information from various sources such as precipitation, temperature, soil moisture, and runoff is available in the drought monitoring component in the package. The drought prediction/forecasting component consists of statistical drought predictions to enhance the drought early warning for decision makings. Analysis of drought properties such as duration and severity is also provided in this package for drought risk assessments. Based on this package, a drought monitoring and prediction/forecasting system is under development as a decision supporting tool. The package will be provided freely to the public to aid the drought modeling and assessment for researchers and practitioners.

Hypoxia-Inducible Factor-1α Polymorphisms and Risk of Cancer Metastasis: A Meta-Analysis

PubMed Central

Shi, Bin; Weng, Wenjun; Chen, Zhipeng; Guo, Nannan; Hua, Yibing; Zhu, Lingjun

2013-01-01

Background HIF-1α is a major regulator in tumor progression and metastasis which responds to hypoxia. Many studies have demonstrated that hypoxia-inducible factor1-α (HIF-1α) polymorphisms are significantly associated with cancer metastasis, but the results are inconsistent. We conducted a comprehensive meta-analysis to estimate the associations between HIF-1α C1772 T polymorphism and cancer metastasis. Methods Comprehensive searches were conducted on PubMed and EMBASE database. Fifteen studies were included in the meta-analysis. We used the OR and 95%CI to assess the associations between HIF-1α C1772T polymorphism and cancer metastasis. Heterogeneity and publication bias were also assessed by Q test, I 2, and funnel plot. Results Totally, fifteen studies including 1239 cases with metastasis-positive (M+) and 2711 cases with metastasis-negative (M−) were performed in this meta-analysis. The results showed that HIF-1a C1772T polymorphism was associated with the increased risk of cancer metastasis (T allele vs. C allele, OR  = 1.36, 95% CI  = 1.12–1.64; TT+ TC vs. CC, OR  = 1.39, 95% CI  = 1.13–1.71; TT vs. TC+ CC, OR  = 1.93, 95% CI  = 0.86–4.36). In the subgroup analyses, the significant associations remained significant among Asians, Caucasians and other cancers in the dominant model. Publication bias was not observed in the analysis. Conclusions Our results indicate that the HIF-1αC1772T polymorphism T allele may increase the risk of cancer metastasis, which might be a potential risk factor of cancer progress. PMID:24015181

Presenting numeric information with percentages and descriptive risk labels: A randomized trial

PubMed Central

Sinayev, Aleksandr; Peters, Ellen; Tusler, Martin; Fraenkel, Liana

2015-01-01

Background Previous research demonstrated that providing (vs. not providing) numeric information about medications’ adverse effects (AEs) increased comprehension and willingness to use medication, but left open the question about which numeric format is best. Objective To determine which of four tested formats (percentage, frequency, percentage+risk label, frequency+risk label) maximizes comprehension and willingness to use medication across age and numeracy levels. Design In a cross-sectional internet survey (N=368; American Life Panel, 5/15/08–6/18/08), respondents were presented with a hypothetical prescription medication for high cholesterol. AE likelihoods were described using one of four tested formats. Main outcome measures were risk comprehension (ability to identify AE likelihood from a table) and willingness to use the medication (7-point scale; not likely=0, very likely=6). Results The percentage+risk label format resulted in the highest comprehension and willingness to use the medication compared to the other three formats (mean comprehension in percentage + risk label format=95% vs mean across the other three formats = 81%; mean willingness= 3.3 vs 2.95, respectively). Comprehension differences between percentage and frequency formats were smaller among the less numerate. Willingness to use medication depended less on age and numeracy when labels were used. Limitations Generalizability is limited by use of a sample that was older, more educated, and better off financially than national averages. Conclusions Providing numeric AE-likelihood information in a percentage format with risk labels is likely to increase risk comprehension and willingness to use a medication compared to other numeric formats. PMID:25952743

Presenting Numeric Information with Percentages and Descriptive Risk Labels: A Randomized Trial.

PubMed

Sinayev, Aleksandr; Peters, Ellen; Tusler, Martin; Fraenkel, Liana

2015-11-01

Previous research demonstrated that providing (v. not providing) numeric information about the adverse effects (AEs) of medications increased comprehension and willingness to use medication but left open the question about which numeric format is best. The objective was to determine which of 4 tested formats (percentage, frequency, percentage + risk label, frequency + risk label) maximizes comprehension and willingness to use medication across age and numeracy levels. In a cross-sectional internet survey (N = 368; American Life Panel, 15 May 2008 to 18 June 2008), respondents were presented with a hypothetical prescription medication for high cholesterol. AE likelihoods were described using 1 of 4 tested formats. Main outcome measures were risk comprehension (ability to identify AE likelihood from a table) and willingness to use the medication (7-point scale; not likely = 0, very likely = 6). The percentage + risk label format resulted in the highest comprehension and willingness to use the medication compared with the other 3 formats (mean comprehension in percentage + risk label format = 95% v. mean across the other 3 formats = 81%; mean willingness = 3.3 v. 2.95, respectively). Comprehension differences between percentage and frequency formats were smaller among the less numerate. Willingness to use medication depended less on age and numeracy when labels were used. Generalizability is limited by the use of a sample that was older, more educated, and better off financially than national averages. Providing numeric AE-likelihood information in a percentage format with risk labels is likely to increase risk comprehension and willingness to use a medication compared with other numeric formats. © The Author(s) 2015.

Space flight risk data collection and analysis project: Risk and reliability database

NASA Technical Reports Server (NTRS)

1994-01-01

The focus of the NASA 'Space Flight Risk Data Collection and Analysis' project was to acquire and evaluate space flight data with the express purpose of establishing a database containing measurements of specific risk assessment - reliability - availability - maintainability - supportability (RRAMS) parameters. The developed comprehensive RRAMS database will support the performance of future NASA and aerospace industry risk and reliability studies. One of the primary goals has been to acquire unprocessed information relating to the reliability and availability of launch vehicles and the subsystems and components thereof from the 45th Space Wing (formerly Eastern Space and Missile Command -ESMC) at Patrick Air Force Base. After evaluating and analyzing this information, it was encoded in terms of parameters pertinent to ascertaining reliability and availability statistics, and then assembled into an appropriate database structure.

Comprehensive Geriatric Assessment (CGA) based risk factors for increased caregiver burden among elderly Asian patients with cancer.

PubMed

Rajasekaran, Tanujaa; Tan, Tira; Ong, Whee Sze; Koo, Khai Nee; Chan, Lili; Poon, Donald; Roy Chowdhury, Anupama; Krishna, Lalit; Kanesvaran, Ravindran

2016-05-01

This study aims to identify Comprehensive Geriatric Assessment (CGA) based risk factors to help predict caregiver burden among elderly patients with cancer. The study evaluated 249 patients newly diagnosed with cancer, aged 70years and above, who attended the geriatric oncology clinic at the National Cancer Centre Singapore between 2007 and 2010. Out of 249 patients, 244 patients had information available on family caregiver burden and were analysed. On univariate analysis, ADL dependence, lower IADL scores, ECOG performance status of 3-4, higher fall risk, lower scores in dominant hand grip strength test and mini mental state examination, polypharmacy, higher nutritional risk, haemoglobin <12g/dL and presence of geriatric syndromes were significantly associated with mild to severe caregiver burden. On multivariate analysis, only ECOG performance status of 3-4 (odds ratio [OR], 4.47; 95% confidence interval [CI], 2.27-8.80) and haemoglobin <12g/dL (OR, 2.38; 95% CI, 1.14-4.99) were associated with an increased probability of mild to severe caregiver burden. The model achieved a good fit (Hosmer-Lemeshow's p=0.196) and discrimination (area under the curve [AUC]=0.742; bias-corrected AUC=0.737). Based on this, patients were stratified into 3 risk groups with different proportion of patients with increased caregiver burden (low risk: 3.9% vs intermediate risk: 18.8% vs high risk: 39.6%; p<0.001). ECOG performance status and haemoglobin were associated with increased caregiver burden among elderly patients with cancer. Using these two factors in the clinic may help clinicians identify caregivers at risk and take preventive action to mitigate that. Copyright © 2016 Elsevier Inc. All rights reserved.

LESSONS FROM A RETROSPECTIVE ANALYSIS OF A 5-YR PERIOD OF PRESHIPMENT TESTING AT SAN DIEGO ZOO: A RISK-BASED APPROACH TO PRESHIPMENT TESTING MAY BENEFIT ANIMAL WELFARE.

PubMed

Marinkovich, Matt; Wallace, Chelsea; Morris, Pat J; Rideout, Bruce; Pye, Geoffrey W

2016-03-01

The preshipment examination, with associated transmissible disease testing, has become standard practice in the movement of animals between zoos. An alternative disease risk-based approach, based on a comprehensive surveillance program including necropsy and preventive medicine examination testing and data, has been in practice since 2006 between the San Diego Zoo and San Diego Zoo Safari Park. A retrospective analysis, evaluating comprehensive necropsy data and preshipment testing over a 5-yr study period, was performed to determine the viability of this model for use with sending animals to other institutions. Animals (607 birds, 704 reptiles and amphibians, and 341 mammals) were shipped to 116 Association of Zoos and Aquariums (AZA)-accredited and 29 non-AZA-accredited institutions. The evaluation showed no evidence of the specific transmissible diseases tested for during the preshipment exam being present within the San Diego Zoo collection. We suggest that a risk-based animal and institution-specific approach to transmissible disease preshipment testing is more cost effective and is in the better interest of animal welfare than the current industry standard of dogmatic preshipment testing.

Meta-Analysis on Near-Road Air Pollutants Concentrations for Developing Traffic Indicators for Exposure Assessment

EPA Science Inventory

Near-road air pollution has been associated with various health risks in human populations living near roadways. To better understand relationship between vehicle emissions and spatial profiles of traffic-related air pollutants we performed a comprehensive and systematic literat...

[Assessment of comprehensive nutritional status and eating behavior among 311 middle aged and aged women with osteoporosis in Chengdu].

PubMed

Zhao, R P; Wang, W Z; Cheng, G P; Zhang, H J; Zhou, F M; Li, Y Y; Wu, C; Yang, L Q; Zeng, G

2017-06-06

Objective: To investigate the comprehensive nutritional status and diet behavior of middle aged and elderly women with osteoporosis, and thereby to explore the relationship between diet behavior and comprehensive nutritional status. Methods: 311 middle-aged and elderly women with osteoporosis in Chengdu were included in this study. Mini Nutritional Assessment (MNA) was applied to assess their comprehensive nutritional status. Information of social-demographic characteristics and diet behavior (about meals, snacks and water drinking, etc.) of the subjects was collected by questionnaire. Chi square test was used to assess the differences in nutritional status among patients who have different eating behaviors. Logistic regression analysis was performed to evaluate the relationship between diet behaviors and comprehensive nutritional status. Results: The mean MNA score of subjects was 25.8±2.5. 20.3% (63/311) of the subjets were at risk of potential malnutrition, but there was no malnourished subjects found. 46.9% (46/311) of the subjects were in good appetite. 95.2% (296/311) of them had a fixed food intake each meal. 65.8% (198/311) of them had snacks every day, and the most common choice was fruit (86.4% (248/287)). 54.8% (165/311) of them had initiative drinking water habits, and the most common choice was plain boiled water (79.9%, 246/308). 76.5% (238/311) of them had daily portable water less than 1 500 ml. After adjusting the effects of age, occupation and education level, bad appetite ( OR= 3.50, 95% CI: 1.18-10.62), unfixed food intake ( OR= 7.27, 95% CI: 1.40-35.83), and seldom or never intake of snack ( OR= 3.71, 95% CI: 1.42-9.72) were risk factors for malnutrition risk, while tea drinking was protective factor( OR= 0.31, 95% CI: 0.11-0.93). Conclusion: Risk of potential malnutrition and unhealthy diet behavior among the middle aged and elderly women with osteoporosis should be paid more attention. Unhealtghy diet behavior has a negative effect on their comprehensive nutritional status.

The Ecology of Early Childhood Risk: A Canonical Correlation Analysis of Children’s Adjustment, Family, and Community Context in a High-Risk Sample

PubMed Central

Aiyer, Sophie M.; Wilson, Melvin N.; Shaw, Daniel S.; Dishion, Thomas J.

2013-01-01

The ecology of the emergence of psycho-pathology in early childhood is often approached by the analysis of a limited number of contextual risk factors. In the present study, we provide a comprehensive analysis of ecological risk by conducting a canonical correlation analysis of 13 risk factors at child age 2 and seven narrow-band scales of internalizing and externalizing problem behaviors at child age 4, using a sample of 364 geographically and ethnically diverse, disadvantaged primary caregivers, alternative caregivers, and preschool-age children. Participants were recruited from Special Supplemental Nutrition Program for Women, Infants, and Children sites and were screened for family risk. Canonical correlation analysis revealed that (1) a first latent combination of family and individual risks of caregivers predicted combinations of child emotional and behavioral problems, and that (2) a second latent combination of contextual and structural risks predicted child somatic complaints. Specifically, (1) the combination of chaotic home, conflict with child, parental depression, and parenting hassles predicted a co-occurrence of internalizing and externalizing behaviors, and (2) the combination of father absence, perceived discrimination, neighborhood danger, and fewer children living in the home predicted child somatic complaints. The research findings are discussed in terms of the development of psychopathology, as well as the potential prevention needs of families in high-risk contexts. PMID:23700232

Hazmat transport: a methodological framework for the risk analysis of marshalling yards.

PubMed

Cozzani, Valerio; Bonvicini, Sarah; Spadoni, Gigliola; Zanelli, Severino

2007-08-17

A methodological framework was outlined for the comprehensive risk assessment of marshalling yards in the context of quantified area risk analysis. Three accident typologies were considered for yards: (i) "in-transit-accident-induced" releases; (ii) "shunting-accident-induced" spills; and (iii) "non-accident-induced" leaks. A specific methodology was developed for the assessment of expected release frequencies and equivalent release diameters, based on the application of HazOp and Fault Tree techniques to reference schemes defined for the more common types of railcar vessels used for "hazmat" transportation. The approach was applied to the assessment of an extended case-study. The results evidenced that "non-accident-induced" leaks in marshalling yards represent an important contribution to the overall risk associated to these zones. Furthermore, the results confirmed the considerable role of these fixed installations to the overall risk associated to "hazmat" transportation.

A quantitative flood risk analysis methodology for urban areas with integration of social research data

NASA Astrophysics Data System (ADS)

Escuder-Bueno, I.; Castillo-Rodríguez, J. T.; Zechner, S.; Jöbstl, C.; Perales-Momparler, S.; Petaccia, G.

2012-09-01

Risk analysis has become a top priority for authorities and stakeholders in many European countries, with the aim of reducing flooding risk, considering the population's needs and improving risk awareness. Within this context, two methodological pieces have been developed in the period 2009-2011 within the SUFRI project (Sustainable Strategies of Urban Flood Risk Management with non-structural measures to cope with the residual risk, 2nd ERA-Net CRUE Funding Initiative). First, the "SUFRI Methodology for pluvial and river flooding risk assessment in urban areas to inform decision-making" provides a comprehensive and quantitative tool for flood risk analysis. Second, the "Methodology for investigation of risk awareness of the population concerned" presents the basis to estimate current risk from a social perspective and identify tendencies in the way floods are understood by citizens. Outcomes of both methods are integrated in this paper with the aim of informing decision making on non-structural protection measures. The results of two case studies are shown to illustrate practical applications of this developed approach. The main advantage of applying the methodology herein presented consists in providing a quantitative estimation of flooding risk before and after investing in non-structural risk mitigation measures. It can be of great interest for decision makers as it provides rational and solid information.

Which is best for osteoporotic vertebral compression fractures: balloon kyphoplasty, percutaneous vertebroplasty or non-surgical treatment? A study protocol for a Bayesian network meta-analysis

PubMed Central

Kan, Shun-Li; Yuan, Zhi-Fang; Chen, Ling-Xiao; Sun, Jing-Cheng; Ning, Guang-Zhi; Feng, Shi-Qing

2017-01-01

Introduction Osteoporotic vertebral compression fractures (OVCFs) commonly cause both acute and chronic back pain, substantial spinal deformity, functional disability and decreased quality of life and increase the risk of future vertebral fractures and mortality. Percutaneous vertebroplasty (PVP), balloon kyphoplasty (BK) and non-surgical treatment (NST) are mostly used for the treatment of OVCFs. However, which treatment is preferred is unknown. The purpose of this study is to comprehensively review the literature and ascertain the relative efficacy and safety of BK, PVP and NST for patients with OVCFs using a Bayesian network meta-analysis. Methods and analysis We will comprehensively search PubMed, EMBASE and the Cochrane Central Register of Controlled Trials, to include randomided controlled trials that compare BK, PVP or NST for treating OVCFs. The risk of bias for individual studies will be assessed according to the Cochrane Handbook. Bayesian network meta-analysis will be performed to compare the efficacy and safety of BK, PVP and NST. The quality of evidence will be evaluated by GRADE. Ethics and dissemination Ethical approval and patient consent are not required since this study is a meta-analysis based on published studies. The results of this network meta-analysis will be submitted to a peer-reviewed journal for publication. PROSPERO registration number CRD42016039452; Pre-results. PMID:28093431

Improving tsunami resiliency: California's Tsunami Policy Working Group

USGS Publications Warehouse

Real, Charles R.; Johnson, Laurie; Jones, Lucile M.; Ross, Stephanie L.; Kontar, Y.A.; Santiago-Fandiño, V.; Takahashi, T.

2014-01-01

California has established a Tsunami Policy Working Group to facilitate development of policy recommendations for tsunami hazard mitigation. The Tsunami Policy Working Group brings together government and industry specialists from diverse fields including tsunami, seismic, and flood hazards, local and regional planning, structural engineering, natural hazard policy, and coastal engineering. The group is acting on findings from two parallel efforts: The USGS SAFRR Tsunami Scenario project, a comprehensive impact analysis of a large credible tsunami originating from an M 9.1 earthquake in the Aleutian Islands Subduction Zone striking California’s coastline, and the State’s Tsunami Preparedness and Hazard Mitigation Program. The unique dual-track approach provides a comprehensive assessment of vulnerability and risk within which the policy group can identify gaps and issues in current tsunami hazard mitigation and risk reduction, make recommendations that will help eliminate these impediments, and provide advice that will assist development and implementation of effective tsunami hazard risk communication products to improve community resiliency.

The relationship among pressure ulcer risk factors, incidence and nursing documentation in hospital-acquired pressure ulcer patients in intensive care units.

PubMed

Li, Dan

2016-08-01

To explore the quality/comprehensiveness of nursing documentation of pressure ulcers and to investigate the relationship between the nursing documentation and the incidence of pressure ulcers in four intensive care units. Pressure ulcer prevention requires consistent assessments and documentation to decrease pressure ulcer incidence. Currently, most research is focused on devices to prevent pressure ulcers. Studies have rarely considered the relationship among pressure ulcer risk factors, incidence and nursing documentation. Thus, a study to investigate this relationship is needed to fill this information gap. A retrospective, comparative, descriptive, correlational study. A convenience sample of 196 intensive care units patients at the selected medical centre comprised the study sample. All medical records of patients admitted to intensive care units between the time periods of September 1, 2011 through September 30, 2012 were audited. Data used in the analysis included 98 pressure ulcer patients and 98 non-pressure ulcer patients. The quality and comprehensiveness of pressure ulcer documentation were measured by the modified European Pressure Ulcer Advisory Panel Pressure Ulcers Assessment Instrument and the Comprehensiveness in Nursing Documentation instrument. The correlations between quality/comprehensiveness of pressure ulcer documentation and incidence of pressure ulcers were not statistically significant. Patients with pressure ulcers had longer length of stay than patients without pressure ulcers stay. There were no statistically significant differences in quality/comprehensiveness scores of pressure ulcer documentation between dayshift and nightshift. This study revealed a lack of quality/comprehensiveness in nursing documentation of pressure ulcers. This study demonstrates that staff nurses often perform poorly on documenting pressure ulcer appearance, staging and treatment. Moreover, nursing documentation of pressure ulcers does not provide a complete picture of patients' care needs that require nursing interventions. The implication of this study involves pressure ulcer prevention and litigable risk of nursing documentation. © 2016 John Wiley & Sons Ltd.

Assessment of seismic risk in Tashkent, Uzbekistan and Bishkek, Kyrgyz Republic

USGS Publications Warehouse

Erdik, M.; Rashidov, T.; Safak, E.; Turdukulov, A.

2005-01-01

The impact of earthquakes in urban centers prone to disastrous earthquakes necessitates the analysis of associated risk for rational formulation of contingency plans and mitigation strategies. In urban centers the seismic risk is best quantified and portrayed through the preparation of 'Earthquake damage and Loss Scenarios'. The components of such scenarios are the assessment of the hazard, inventories and the vulnerabilities of elements at risk. For the development of earthquake risk scenario in Tashkent-Uzbekistan and Bishkek-Kyrgyzstan an approach based on spectral displacements is utilized. This paper will present the important features of a comprehensive study, highlight the methodology, discuss the results and provide insights to the future developments. ?? 2005 Elsevier Ltd. All rights reserved.

Germany wide seasonal flood risk analysis for agricultural crops

NASA Astrophysics Data System (ADS)

Klaus, Stefan; Kreibich, Heidi; Kuhlmann, Bernd; Merz, Bruno; Schröter, Kai

2016-04-01

In recent years, large-scale flood risk analysis and mapping has gained attention. Regional to national risk assessments are needed, for example, for national risk policy developments, for large-scale disaster management planning and in the (re-)insurance industry. Despite increasing requests for comprehensive risk assessments some sectors have not received much scientific attention, one of these is the agricultural sector. In contrast to other sectors, agricultural crop losses depend strongly on the season. Also flood probability shows seasonal variation. Thus, the temporal superposition of high flood susceptibility of crops and high flood probability plays an important role for agricultural flood risk. To investigate this interrelation and provide a large-scale overview of agricultural flood risk in Germany, an agricultural crop loss model is used for crop susceptibility analyses and Germany wide seasonal flood-frequency analyses are undertaken to derive seasonal flood patterns. As a result, a Germany wide map of agricultural flood risk is shown as well as the crop type most at risk in a specific region. The risk maps may provide guidance for federal state-wide coordinated designation of retention areas.

[Do laymen understand information about hospital quality? An empirical verification using risk-adjusted mortality rates as an example].

PubMed

Sander, Uwe; Kolb, Benjamin; Taheri, Fatemeh; Patzelt, Christiane; Emmert, Martin

2017-11-01

The effect of public reporting to improve quality in healthcare is reduced by the limited intelligibility of information about the quality of healthcare providers. This may result in worse health-related choices especially for older people and those with lower levels of education. There is, as yet, little information as to whether laymen understand the concepts behind quality comparisons and if this comprehension is correlated with hospital choices. An instrument with 20 items was developed to analyze the intelligibility of five technical terms which were used in German hospital report cards to explain risk-adjusted death rates. Two online presentations of risk-adjusted death rates for five hospitals in the style of hospital report cards were developed. An online survey of 353 volunteers tested the comprehension of the risk-adjusted mortality rates and included an experimental hospital choice. The intelligibility of five technical terms was tested: risk-adjusted, actual and expected death rate, reference range and national average. The percentages of correct answers for the five technical terms were in the range of 75.0-60.2%. Between 23.8% and 5.1% of the respondents were not able to answer the question about the technical term itself. The least comprehensible technical terms were "risk-adjusted death rate" and "reference range". The intelligibility of the 20 items that were used to test the comprehension of the risk-adjusted mortality was between 89.5% and 14.2%. The two items that proved to be least comprehensible were related to the technical terms "risk-adjusted death rate" and "reference range". For all five technical terms it was found that a better comprehension correlated significantly with better hospital choices. We found a better than average intelligibility for the technical terms "actual and expected death rate" and for "national average". The least understandable were "risk-adjusted death rate" and "reference range". Since the self-explanatory technical terms "actual and expected death rate" and "national average" are easy to understand and the comprehension is correlated with hospitals choices, we recommend using them for the presentation of measures which contain risk-adjusted mortality. The technical terms "risk-adjusted death rate" and "reference range" should stay in the background, since comprehension problems can be expected and explanations would have to be provided. Copyright © 2017. Published by Elsevier GmbH.

Risk assessment and optimization (ALARA) analysis for the environmental remediation of Brookhaven National Laboratory`s hazardous waste management facility

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

Dionne, B.J.; Morris, S.C. III; Baum, J.W.

1998-01-01

The Department of Energy`s (DOE) Office of Environment, Safety, and Health (EH) sought examples of risk-based approaches to environmental restoration to include in their guidance for DOE nuclear facilities. Extensive measurements of radiological contamination in soil and ground water have been made at Brookhaven National Laboratory`s Hazardous Waste Management Facility (HWMF) as part of a Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) remediation process. This provided an ideal opportunity for a case study. This report provides a risk assessment and an {open_quotes}As Low as Reasonably Achievable{close_quotes} (ALARA) analysis for use at other DOE nuclear facilities as an example ofmore » a risk-based decision technique. This document contains the Appendices for the report.« less

Ecological Risk Assessment with MCDM of Some Invasive Alien Plants in China

NASA Astrophysics Data System (ADS)

Xie, Guowen; Chen, Weiguang; Lin, Meizhen; Zheng, Yanling; Guo, Peiguo; Zheng, Yisheng

Alien plant invasion is an urgent global issue that threatens the sustainable development of the ecosystem health. The study of its ecological risk assessment (ERA) could help us to prevent and reduce the invasion risk more effectively. Based on the theory of ERA and methods of the analytic hierarchy process (AHP) of multi-criteria decision-making (MCDM), and through the analyses of the characteristics and processes of alien plant invasion, this paper discusses the methodologies of ERA of alien plant invasion. The assessment procedure consisted of risk source analysis, receptor analysis, exposure and hazard assessment, integral assessment, and countermeasure of risk management. The indicator system of risk source assessment as well as the indices and formulas applied to measure the ecological loss and risk were established, and the method for comprehensively assessing the ecological risk of alien plant invasion was worked out. The result of ecological risk analysis to 9 representative invasive alien plants in China shows that the ecological risk of Erigeron annuus, Ageratum conyzoides, Alternanthera philoxeroides and Mikania midrantha is high (grade1-2), that of Oxalis corymbosa and Wedelia chinensis comes next (grade3), while Mirabilis jalapa, Pilea microphylla and Calendula officinalis of the last (grade 4). Risk strategies are put forward on this basis.

A review of multi-risk methodologies for natural hazards: Consequences and challenges for a climate change impact assessment.

PubMed

Gallina, Valentina; Torresan, Silvia; Critto, Andrea; Sperotto, Anna; Glade, Thomas; Marcomini, Antonio

2016-03-01

This paper presents a review of existing multi-risk assessment concepts and tools applied by organisations and projects providing the basis for the development of a multi-risk methodology in a climate change perspective. Relevant initiatives were developed for the assessment of multiple natural hazards (e.g. floods, storm surges, droughts) affecting the same area in a defined timeframe (e.g. year, season, decade). Major research efforts were focused on the identification and aggregation of multiple hazard types (e.g. independent, correlated, cascading hazards) by means of quantitative and semi-quantitative approaches. Moreover, several methodologies aim to assess the vulnerability of multiple targets to specific natural hazards by means of vulnerability functions and indicators at the regional and local scale. The overall results of the review show that multi-risk approaches do not consider the effects of climate change and mostly rely on the analysis of static vulnerability (i.e. no time-dependent vulnerabilities, no changes among exposed elements). A relevant challenge is therefore to develop comprehensive formal approaches for the assessment of different climate-induced hazards and risks, including dynamic exposure and vulnerability. This requires the selection and aggregation of suitable hazard and vulnerability metrics to make a synthesis of information about multiple climate impacts, the spatial analysis and ranking of risks, including their visualization and communication to end-users. To face these issues, climate impact assessors should develop cross-sectorial collaborations among different expertise (e.g. modellers, natural scientists, economists) integrating information on climate change scenarios with sectorial climate impact assessment, towards the development of a comprehensive multi-risk assessment process. Copyright © 2015 Elsevier Ltd. All rights reserved.

What do popular Spanish women's magazines say about caesarean section? A 21-year survey.

PubMed

Torloni, M R; Campos Mansilla, B; Merialdi, M; Betrán, A P

2014-04-01

Caesarean section (CS) rates are increasing worldwide and maternal request is cited as one of the main reasons for this trend. Women's preferences for route of delivery are influenced by popular media, including magazines. We assessed the information on CS presented in Spanish women's magazines. Systematic review. Women's magazines printed from 1989 to 2009 with the largest national distribution. Articles with any information on CS. Articles were selected, read and abstracted in duplicate. Sources of information, scientific accuracy, comprehensiveness and women's testimonials were objectively extracted using a content analysis form designed for this study. Accuracy, comprehensiveness and sources of information. Most (67%) of the 1223 selected articles presented exclusively personal opinion/birth stories, 12% reported the potential benefits of CS, 26% mentioned the short-term and 10% mentioned the long-term maternal risks, and 6% highlighted the perinatal risks of CS. The most frequent short-term risks were the increased time for maternal recovery (n = 86), frustration/feelings of failure (n = 83) and increased post-surgical pain (n = 71). The most frequently cited long-term risks were uterine rupture (n = 57) and the need for another CS in any subsequent pregnancy (n = 42). Less than 5% of the selected articles reported that CS could increase the risks of infection (n = 53), haemorrhage (n = 31) or placenta praevia/accreta in future pregnancies (n = 6). The sources of information were not reported by 68% of the articles. The portrayal of CS in Spanish women's magazines is not sufficiently comprehensive and does not provide adequate important information to help the readership to understand the real benefits and risks of this route of delivery. © 2014 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

What do popular Spanish women's magazines say about caesarean section? A 21-year survey

PubMed Central

Torloni, MR; Campos Mansilla, B; Merialdi, M; Betrán, AP

2014-01-01

Objectives Caesarean section (CS) rates are increasing worldwide and maternal request is cited as one of the main reasons for this trend. Women's preferences for route of delivery are influenced by popular media, including magazines. We assessed the information on CS presented in Spanish women's magazines. Design Systematic review. Setting Women's magazines printed from 1989 to 2009 with the largest national distribution. Sample Articles with any information on CS. Methods Articles were selected, read and abstracted in duplicate. Sources of information, scientific accuracy, comprehensiveness and women's testimonials were objectively extracted using a content analysis form designed for this study. Main outcome measures Accuracy, comprehensiveness and sources of information. Results Most (67%) of the 1223 selected articles presented exclusively personal opinion/birth stories, 12% reported the potential benefits of CS, 26% mentioned the short-term and 10% mentioned the long-term maternal risks, and 6% highlighted the perinatal risks of CS. The most frequent short-term risks were the increased time for maternal recovery (n = 86), frustration/feelings of failure (n = 83) and increased post-surgical pain (n = 71). The most frequently cited long-term risks were uterine rupture (n = 57) and the need for another CS in any subsequent pregnancy (n = 42). Less than 5% of the selected articles reported that CS could increase the risks of infection (n = 53), haemorrhage (n = 31) or placenta praevia/accreta in future pregnancies (n = 6). The sources of information were not reported by 68% of the articles. Conclusions The portrayal of CS in Spanish women's magazines is not sufficiently comprehensive and does not provide adequate important information to help the readership to understand the real benefits and risks of this route of delivery. PMID:24467797

The association between dietary zinc intake and risk of pancreatic cancer: a meta-analysis.

PubMed

Li, Li; Gai, Xuesong

2017-06-30

Previous reports have suggested a potential association on dietary zinc intake with the risk of pancreatic cancer. Since the associations between different studies were controversial, we therefore conducted a meta-analysis to reassess the relationship between dietary zinc intake and pancreatic cancer risk. A comprehensive search from the databases of PubMed, Embase, Web of Science, and Medline was performed until January 31, 2017. Relative risk (RR) with 95% confidence intervals (CI) derived by using random effect model was used. Sensitivity analysis and publication bias were conducted. Our meta-analysis was based on seven studies involving 1659 cases, including two prospective cohort studies and five case-control studies. The total RR of pancreatic cancer risk for the highest versus the lowest categories of dietary zinc intake was 0.798 (0.621-0.984), with its significant heterogeneity among studies ( I 2 =58.2%, P =0.026). The average Newcastle-Ottawa scale (NOS) score was 7.29, suggesting a high quality. There was no publication bias in the meta-analysis about dietary zinc intake on the risk of pancreatic cancer. Subgroup analyses showed that dietary zinc intake could reduce the risk of pancreatic cancer in case-control studies and among American populations. In conclusion, we found that highest category of dietary zinc intake can significantly reduce the risk of pancreatic cancer, especially among American populations. © 2017 The Author(s).

A Framework for Flood Risk Analysis and Benefit Assessment of Flood Control Measures in Urban Areas

PubMed Central

Li, Chaochao; Cheng, Xiaotao; Li, Na; Du, Xiaohe; Yu, Qian; Kan, Guangyuan

2016-01-01

Flood risk analysis is more complex in urban areas than that in rural areas because of their closely packed buildings, different kinds of land uses, and large number of flood control works and drainage systems. The purpose of this paper is to propose a practical framework for flood risk analysis and benefit assessment of flood control measures in urban areas. Based on the concept of disaster risk triangle (hazard, vulnerability and exposure), a comprehensive analysis method and a general procedure were proposed for urban flood risk analysis. Urban Flood Simulation Model (UFSM) and Urban Flood Damage Assessment Model (UFDAM) were integrated to estimate the flood risk in the Pudong flood protection area (Shanghai, China). S-shaped functions were adopted to represent flood return period and damage (R-D) curves. The study results show that flood control works could significantly reduce the flood risk within the 66-year flood return period and the flood risk was reduced by 15.59%. However, the flood risk was only reduced by 7.06% when the flood return period exceeded 66-years. Hence, it is difficult to meet the increasing demands for flood control solely relying on structural measures. The R-D function is suitable to describe the changes of flood control capacity. This frame work can assess the flood risk reduction due to flood control measures, and provide crucial information for strategy development and planning adaptation. PMID:27527202

A Systems Approach to Evaluating Ionizing Radiation: Six Focus Areas to Improve Quality, Efficiency, and Patient Safety

PubMed Central

Mower, Laura; Bushe, Chris

2015-01-01

Abstract: Ionizing radiation is an essential component of the care process. However, providers and patients may not be fully aware of the risks involved, the level of ionizing radiation delivered with various procedures, or the potential for harm through incidental overexposure or cumulative dose. Recent high-profile incidents demonstrating the devastating short-term consequences of radiation overexposure have drawn attention to these risks, but applicable solutions are lacking. Although various recommendations and guidelines have been proposed, organizational variability challenges providers to identify their own practical solutions. To identify potential failure modes and develop solutions to preserve patient safety within a large, national healthcare system, we assembled a multidisciplinary team to conduct a comprehensive analysis of practices surrounding the delivery of ionizing radiation. Workgroups were developed to analyze existing culture, processes, and technology to identify deficiencies and propose solutions. Six focus areas were identified: competency and certification; equipment; monitoring and auditing; education; clinical pathways; and communication and marketing. This manuscript summarizes this comprehensive, multidisciplinary, and systemic analysis of risk and provides examples to illustrate how these focus areas can be used to improve the use of ionizing radiation. The proposed solutions, once fully implemented, may advance patient safety and care. PMID:26042626

Clean coal : DOE should prepare a comprehensive analysis of the relative costs, benefits, and risks of a range of options for FutureGen

DOT National Transportation Integrated Search

2009-03-11

According to various energy experts, for the foreseeable future, because coal is abundant and relatively inexpensive, it will remain a significant fuel for the generation of electric power in the United States and the world. However, coal-fired power...

Bridging Student Health Risks and Academic Achievement through Comprehensive School Health Programs.

ERIC Educational Resources Information Center

Symons, Cynthia Wolford; Cinelli, Bethann; James, Tammy C.; Groff, Patti

1997-01-01

Research confirms a direct link between student health risk behavior and education outcomes, education behaviors, and student attitudes. This article discusses barriers to comprehensive school health programming; summarizes relevant information concerning several health-risk behaviors (intentional injuries, diet, physical activity, sexual-risk…

Examining a Comprehensive Model of Disaster-Related Posttraumatic Stress Disorder in Systematically Studied Survivors of 10 Disasters

PubMed Central

Oliver, Julianne; Pandya, Anand

2012-01-01

Objectives. Using a comprehensive disaster model, we examined predictors of posttraumatic stress disorder (PTSD) in combined data from 10 different disasters. Methods. The combined sample included data from 811 directly exposed survivors of 10 disasters between 1987 and 1995. We used consistent methods across all 10 disaster samples, including full diagnostic assessment. Results. In multivariate analyses, predictors of PTSD were female gender, younger age, Hispanic ethnicity, less education, ever-married status, predisaster psychopathology, disaster injury, and witnessing injury or death; exposure through death or injury to friends or family members and witnessing the disaster aftermath did not confer additional PTSD risk. Intentionally caused disasters associated with PTSD in bivariate analysis did not independently predict PTSD in multivariate analysis. Avoidance and numbing symptoms represented a PTSD marker. Conclusions. Despite confirming some previous research findings, we found no associations between PTSD and disaster typology. Prospective research is needed to determine whether early avoidance and numbing symptoms identify individuals likely to develop PTSD later. Our findings may help identify at-risk populations for treatment research. PMID:22897543

Uncertainty

USGS Publications Warehouse

Hunt, Randall J.

2012-01-01

Management decisions will often be directly informed by model predictions. However, we now know there can be no expectation of a single ‘true’ model; thus, model results are uncertain. Understandable reporting of underlying uncertainty provides necessary context to decision-makers, as model results are used for management decisions. This, in turn, forms a mechanism by which groundwater models inform a risk-management framework because uncertainty around a prediction provides the basis for estimating the probability or likelihood of some event occurring. Given that the consequences of management decisions vary, it follows that the extent of and resources devoted to an uncertainty analysis may depend on the consequences. For events with low impact, a qualitative, limited uncertainty analysis may be sufficient for informing a decision. For events with a high impact, on the other hand, the risks might be better assessed and associated decisions made using a more robust and comprehensive uncertainty analysis. The purpose of this chapter is to provide guidance on uncertainty analysis through discussion of concepts and approaches, which can vary from heuristic (i.e. the modeller’s assessment of prediction uncertainty based on trial and error and experience) to a comprehensive, sophisticated, statistics-based uncertainty analysis. Most of the material presented here is taken from Doherty et al. (2010) if not otherwise cited. Although the treatment here is necessarily brief, the reader can find citations for the source material and additional references within this chapter.

Risk assessment of flood disaster and forewarning model at different spatial-temporal scales

NASA Astrophysics Data System (ADS)

Zhao, Jun; Jin, Juliang; Xu, Jinchao; Guo, Qizhong; Hang, Qingfeng; Chen, Yaqian

2018-05-01

Aiming at reducing losses from flood disaster, risk assessment of flood disaster and forewarning model is studied. The model is built upon risk indices in flood disaster system, proceeding from the whole structure and its parts at different spatial-temporal scales. In this study, on the one hand, it mainly establishes the long-term forewarning model for the surface area with three levels of prediction, evaluation, and forewarning. The method of structure-adaptive back-propagation neural network on peak identification is used to simulate indices in prediction sub-model. Set pair analysis is employed to calculate the connection degrees of a single index, comprehensive index, and systematic risk through the multivariate connection number, and the comprehensive assessment is made by assessment matrixes in evaluation sub-model. The comparison judging method is adopted to divide warning degree of flood disaster on risk assessment comprehensive index with forewarning standards in forewarning sub-model and then the long-term local conditions for proposing planning schemes. On the other hand, it mainly sets up the real-time forewarning model for the spot, which introduces the real-time correction technique of Kalman filter based on hydrological model with forewarning index, and then the real-time local conditions for presenting an emergency plan. This study takes Tunxi area, Huangshan City of China, as an example. After risk assessment and forewarning model establishment and application for flood disaster at different spatial-temporal scales between the actual and simulated data from 1989 to 2008, forewarning results show that the development trend for flood disaster risk remains a decline on the whole from 2009 to 2013, despite the rise in 2011. At the macroscopic level, project and non-project measures are advanced, while at the microcosmic level, the time, place, and method are listed. It suggests that the proposed model is feasible with theory and application, thus offering a way for assessing and forewarning flood disaster risk.

[Risk of depression in 75 years or older persons, comprehensive geriatric assessment and associated factors in primary care: cross sectional study].

PubMed

Kronfly Rubiano, Eduardo; Rivilla Frias, Daniel; Ortega Abarca, Isabel; Villanueva Villanueva, Montserrat; Beltrán Martínez, Eva; Comellas Villalba, Montserrat; Almeda Ortega, Jesús; Casals Fransi, Jordi; Rico García, Yolanda; Martínez Carmona, Sonia; Carrasco Coria, Rosa; Bonfill Gavaldà, Montserrat; Calderón Loren, Belén; Fernández Fernández, Mercedes; Barranco Oliver, Laura

2015-12-01

To determine the prevalence of the risk of depression, major defining characteristics and factors associated with. Sub-study of comprehensive geriatric assessment cross-study. Primary health center. For an estimated 14% prevalence we need a sample of 288 people. From 3854, 290 people ≥75 years were selected. Excluding terminals, chemotherapy, recent surgery, temporary residence, mental retardation, serious psychiatric illness, or under home care. risk of depression (≥2 points on the Goldberg depression subscale. Sociodemographic and five study areas of the Comprehensive Geriatric Assessment: medical -comorbidity, polypharmacy, falls and hospital admissions-, functional -Up&Go Test, Lawton-Brody and Barthel Index-, nutritional -Mini Nutritional Assessment (MNA)-, mental-affective -Pfeiffer Questionnaire and Goldberg scale-, and social. Descriptive analysis and logistic regression. We obtained 290 interviews, with 102 (35.1%) male and mean age of 79.4 years (SD:3.2). The prevalence of the risk of depression was 37.2%, 26.5% in men and 43.1% in women (p=0.005). Association of risk of depression is observed with arterial hypertension (OR:3.87 95% CI:1.61-9.34), cancer (OR:4.12 95%, CI:1.58-10.76), lack of leisure activity (OR:2.75 95%, CI:1.33-5.67), increase of anxiety scale (OR:1.87 95%, CI:1.57-2.22) and decrease in MNA (OR:0.78 95%, CI:0.68-0.9). The prevalence of risk of depression is higher than expected, although overestimated until being confirmed with a diagnostic test. We appreciate new associations of comorbidity variables with risk of depression and corroborate other known. The studied factors that were associated with the risk of depression should be included in future studies of geriatric depression. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Comprehensive protocol of traceability during IVF: the result of a multicentre failure mode and effect analysis.

PubMed

Rienzi, L; Bariani, F; Dalla Zorza, M; Albani, E; Benini, F; Chamayou, S; Minasi, M G; Parmegiani, L; Restelli, L; Vizziello, G; Costa, A Nanni

2017-08-01

Can traceability of gametes and embryos be ensured during IVF? The use of a simple and comprehensive traceability system that includes the most susceptible phases during the IVF process minimizes the risk of mismatches. Mismatches in IVF are very rare but unfortunately possible with dramatic consequences for both patients and health care professionals. Traceability is thus a fundamental aspect of the treatment. A clear process of patient and cell identification involving witnessing protocols has to be in place in every unit. To identify potential failures in the traceability process and to develop strategies to mitigate the risk of mismatches, previously failure mode and effects analysis (FMEA) has been used effectively. The FMEA approach is however a subjective analysis, strictly related to specific protocols and thus the results are not always widely applicable. To reduce subjectivity and to obtain a widespread comprehensive protocol of traceability, a multicentre centrally coordinated FMEA was performed. Seven representative Italian centres (three public and four private) were selected. The study had a duration of 21 months (from April 2015 to December 2016) and was centrally coordinated by a team of experts: a risk analysis specialist, an expert embryologist and a specialist in human factor. Principal investigators of each centre were first instructed about proactive risk assessment and FMEA methodology. A multidisciplinary team to perform the FMEA analysis was then formed in each centre. After mapping the traceability process, each team identified the possible causes of mistakes in their protocol. A risk priority number (RPN) for each identified potential failure mode was calculated. The results of the FMEA analyses were centrally investigated and consistent corrective measures suggested. The teams performed new FMEA analyses after the recommended implementations. In each centre, this study involved: the laboratory director, the Quality Control & Quality Assurance responsible, Embryologist(s), Gynaecologist(s), Nurse(s) and Administration. The FMEA analyses were performed according to the Joint Commission International. The FMEA teams identified seven main process phases: oocyte collection, sperm collection, gamete processing, insemination, embryo culture, embryo transfer and gamete/embryo cryopreservation. A mean of 19.3 (SD ± 5.8) associated process steps and 41.9 (SD ± 12.4) possible failure modes were recognized per centre. A RPN ≥15 was calculated in a mean of 6.4 steps (range 2-12, SD ± 3.60). A total of 293 failure modes were centrally analysed 45 of which were considered at medium/high risk. After consistent corrective measures implementation and re-evaluation, a significant reduction in the RPNs in all centres (RPN <15 for all steps) was observed. A simple and comprehensive traceability system was designed as the result of the seven FMEA analyses. The validity of FMEA is in general questionable due to the subjectivity of the judgments. The design of this study has however minimized this risk by introducing external experts for the analysis of the FMEA results. Specific situations such as sperm/oocyte donation, import/export and pre-implantation genetic testing were not taken into consideration. Finally, this study is only limited to the analysis of failure modes that may lead to mismatches, other possible procedural mistakes are not accounted for. Every single IVF centre should have a clear and reliable protocol for identification of patients and traceability of cells during manipulation. The results of this study can support IVF groups in better recognizing critical steps in their protocols, understanding identification and witnessing process, and in turn enhancing safety by introducing validated corrective measures. This study was designed by the Italian Society of Embryology Reproduction and Research (SIERR) and funded by the Italian National Transplant Centre (CNT) of the Italian National Institute of Health (ISS). The authors have no conflicts of interest. N/A. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Development and Validation of the PREMM5 Model for Comprehensive Risk Assessment of Lynch Syndrome.

PubMed

Kastrinos, Fay; Uno, Hajime; Ukaegbu, Chinedu; Alvero, Carmelita; McFarland, Ashley; Yurgelun, Matthew B; Kulke, Matthew H; Schrag, Deborah; Meyerhardt, Jeffrey A; Fuchs, Charles S; Mayer, Robert J; Ng, Kimmie; Steyerberg, Ewout W; Syngal, Sapna

2017-07-01

Purpose Current Lynch syndrome (LS) prediction models quantify the risk to an individual of carrying a pathogenic germline mutation in three mismatch repair (MMR) genes: MLH1, MSH2, and MSH6. We developed a new prediction model, PREMM 5 , that incorporates the genes PMS2 and EPCAM to provide comprehensive LS risk assessment. Patients and Methods PREMM 5 was developed to predict the likelihood of a mutation in any of the LS genes by using polytomous logistic regression analysis of clinical and germline data from 18,734 individuals who were tested for all five genes. Predictors of mutation status included sex, age at genetic testing, and proband and family cancer histories. Discrimination was evaluated by the area under the receiver operating characteristic curve (AUC), and clinical impact was determined by decision curve analysis; comparisons were made to the existing PREMM 1,2,6 model. External validation of PREMM 5 was performed in a clinic-based cohort of 1,058 patients with colorectal cancer. Results Pathogenic mutations were detected in 1,000 (5%) of 18,734 patients in the development cohort; mutations included MLH1 (n = 306), MSH2 (n = 354), MSH6 (n = 177), PMS2 (n = 141), and EPCAM (n = 22). PREMM 5 distinguished carriers from noncarriers with an AUC of 0.81 (95% CI, 0.79 to 0.82), and performance was similar in the validation cohort (AUC, 0.83; 95% CI, 0.75 to 0.92). Prediction was more difficult for PMS2 mutations (AUC, 0.64; 95% CI, 0.60 to 0.68) than for other genes. Performance characteristics of PREMM 5 exceeded those of PREMM 1,2,6 . Decision curve analysis supported germline LS testing for PREMM 5 scores ≥ 2.5%. Conclusion PREMM 5 provides comprehensive risk estimation of all five LS genes and supports LS genetic testing for individuals with scores ≥ 2.5%. At this threshold, PREMM 5 provides performance that is superior to the existing PREMM 1,2,6 model in the identification of carriers of LS, including those with weaker phenotypes and individuals unaffected by cancer.

Development and Validation of the PREMM5 Model for Comprehensive Risk Assessment of Lynch Syndrome

PubMed Central

Uno, Hajime; Ukaegbu, Chinedu; Alvero, Carmelita; McFarland, Ashley; Yurgelun, Matthew B.; Kulke, Matthew H.; Schrag, Deborah; Meyerhardt, Jeffrey A.; Fuchs, Charles S.; Mayer, Robert J.; Ng, Kimmie; Steyerberg, Ewout W.; Syngal, Sapna

2017-01-01

Purpose Current Lynch syndrome (LS) prediction models quantify the risk to an individual of carrying a pathogenic germline mutation in three mismatch repair (MMR) genes: MLH1, MSH2, and MSH6. We developed a new prediction model, PREMM5, that incorporates the genes PMS2 and EPCAM to provide comprehensive LS risk assessment. Patients and Methods PREMM5 was developed to predict the likelihood of a mutation in any of the LS genes by using polytomous logistic regression analysis of clinical and germline data from 18,734 individuals who were tested for all five genes. Predictors of mutation status included sex, age at genetic testing, and proband and family cancer histories. Discrimination was evaluated by the area under the receiver operating characteristic curve (AUC), and clinical impact was determined by decision curve analysis; comparisons were made to the existing PREMM1,2,6 model. External validation of PREMM5 was performed in a clinic-based cohort of 1,058 patients with colorectal cancer. Results Pathogenic mutations were detected in 1,000 (5%) of 18,734 patients in the development cohort; mutations included MLH1 (n = 306), MSH2 (n = 354), MSH6 (n = 177), PMS2 (n = 141), and EPCAM (n = 22). PREMM5 distinguished carriers from noncarriers with an AUC of 0.81 (95% CI, 0.79 to 0.82), and performance was similar in the validation cohort (AUC, 0.83; 95% CI, 0.75 to 0.92). Prediction was more difficult for PMS2 mutations (AUC, 0.64; 95% CI, 0.60 to 0.68) than for other genes. Performance characteristics of PREMM5 exceeded those of PREMM1,2,6. Decision curve analysis supported germline LS testing for PREMM5 scores ≥ 2.5%. Conclusion PREMM5 provides comprehensive risk estimation of all five LS genes and supports LS genetic testing for individuals with scores ≥ 2.5%. At this threshold, PREMM5 provides performance that is superior to the existing PREMM1,2,6 model in the identification of carriers of LS, including those with weaker phenotypes and individuals unaffected by cancer. PMID:28489507

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

ERIC Educational Resources Information Center

Turner, James C.; And Others

1993-01-01

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

Sex-specific effect of CPB2 Ala147Thr but not Thr325Ile variants on the risk of venous thrombosis: A comprehensive meta-analysis

PubMed Central

Zwingerman, Nora; Medina-Rivera, Alejandra; Kassam, Irfahan; Wilson, Michael D.; Morange, Pierre-Emmanuel; Trégouët, David-Alexandre; Gagnon, France

2017-01-01

Background Thrombin activatable fibrinolysis inhibitor (TAFI), encoded by the Carboxypeptidase B2 gene (CPB2), is an inhibitor of fibrinolysis and plays a role in the pathogenesis of venous thrombosis. Experimental findings support a functional role of genetic variants in CPB2, while epidemiological studies have been unable to confirm associations with risk of venous thrombosis. Sex-specific effects could underlie the observed inconsistent associations between CPB2 genetic variants and venous thrombosis. Methods A comprehensive literature search was conducted for associations between Ala147Thr and Thr325Ile variants with venous thrombosis. Authors were contacted to provide sex-specific genotype counts from their studies. Combined and sex-specific random effects meta-analyses were used to estimate a pooled effect estimate for primary and secondary genetic models. Results A total of 17 studies met the inclusion criteria. A sex-specific meta-analysis applying a dominant model supported a protective effect of Ala147Thr on venous thrombosis in females (OR = 0.81, 95%CI: 0.68,0.97; p = 0.018), but not in males (OR = 1.06, 95%CI:0.96–1.16; p = 0.263). The Thr325Ile did not show a sex-specific effect but showed variation in allele frequencies by geographic region. A subgroup analysis of studies in European countries showed decreased risk, with a recessive model (OR = 0.83, 95%CI:0.71–0.97, p = 0.021) for venous thrombosis. Conclusions A comprehensive literature review, including unpublished data, provided greater statistical power for the analyses and decreased the likelihood of publication bias influencing the results. Sex-specific analyses explained apparent discrepancies across genetic studies of Ala147Thr and venous thrombosis. While, careful selection of genetic models based on population genetics, evolutionary and biological knowledge can increase power by decreasing the need to adjust for testing multiple models. PMID:28552956

Sex-specific effect of CPB2 Ala147Thr but not Thr325Ile variants on the risk of venous thrombosis: A comprehensive meta-analysis.

PubMed

Zwingerman, Nora; Medina-Rivera, Alejandra; Kassam, Irfahan; Wilson, Michael D; Morange, Pierre-Emmanuel; Trégouët, David-Alexandre; Gagnon, France

2017-01-01

Thrombin activatable fibrinolysis inhibitor (TAFI), encoded by the Carboxypeptidase B2 gene (CPB2), is an inhibitor of fibrinolysis and plays a role in the pathogenesis of venous thrombosis. Experimental findings support a functional role of genetic variants in CPB2, while epidemiological studies have been unable to confirm associations with risk of venous thrombosis. Sex-specific effects could underlie the observed inconsistent associations between CPB2 genetic variants and venous thrombosis. A comprehensive literature search was conducted for associations between Ala147Thr and Thr325Ile variants with venous thrombosis. Authors were contacted to provide sex-specific genotype counts from their studies. Combined and sex-specific random effects meta-analyses were used to estimate a pooled effect estimate for primary and secondary genetic models. A total of 17 studies met the inclusion criteria. A sex-specific meta-analysis applying a dominant model supported a protective effect of Ala147Thr on venous thrombosis in females (OR = 0.81, 95%CI: 0.68,0.97; p = 0.018), but not in males (OR = 1.06, 95%CI:0.96-1.16; p = 0.263). The Thr325Ile did not show a sex-specific effect but showed variation in allele frequencies by geographic region. A subgroup analysis of studies in European countries showed decreased risk, with a recessive model (OR = 0.83, 95%CI:0.71-0.97, p = 0.021) for venous thrombosis. A comprehensive literature review, including unpublished data, provided greater statistical power for the analyses and decreased the likelihood of publication bias influencing the results. Sex-specific analyses explained apparent discrepancies across genetic studies of Ala147Thr and venous thrombosis. While, careful selection of genetic models based on population genetics, evolutionary and biological knowledge can increase power by decreasing the need to adjust for testing multiple models.

Failure mode and effects analysis using intuitionistic fuzzy hybrid weighted Euclidean distance operator

NASA Astrophysics Data System (ADS)

Liu, Hu-Chen; Liu, Long; Li, Ping

2014-10-01

Failure mode and effects analysis (FMEA) has shown its effectiveness in examining potential failures in products, process, designs or services and has been extensively used for safety and reliability analysis in a wide range of industries. However, its approach to prioritise failure modes through a crisp risk priority number (RPN) has been criticised as having several shortcomings. The aim of this paper is to develop an efficient and comprehensive risk assessment methodology using intuitionistic fuzzy hybrid weighted Euclidean distance (IFHWED) operator to overcome the limitations and improve the effectiveness of the traditional FMEA. The diversified and uncertain assessments given by FMEA team members are treated as linguistic terms expressed in intuitionistic fuzzy numbers (IFNs). Intuitionistic fuzzy weighted averaging (IFWA) operator is used to aggregate the FMEA team members' individual assessments into a group assessment. IFHWED operator is applied thereafter to the prioritisation and selection of failure modes. Particularly, both subjective and objective weights of risk factors are considered during the risk evaluation process. A numerical example for risk assessment is given to illustrate the proposed method finally.

Suicide by occupation: systematic review and meta-analysis.

PubMed

Milner, Allison; Spittal, Matthew J; Pirkis, Jane; LaMontagne, Anthony D

2013-12-01

Previous research has shown that those employed in certain occupations, such as doctors and farmers, have an elevated risk of suicide, yet little research has sought to synthesise these findings across working-age populations. To summarise published research in this area through systematic review and meta-analysis. Random effects meta-analyses were used to calculate a pooled risk of suicide across occupational skill-level groups. Thirty-four studies were included in the meta-analysis. Elementary professions (e.g. labourers and cleaners) were at elevated risk compared with the working-age population (rate ratio (RR) = 1.84, 95% CI 1.46-2.33), followed by machine operators and deck crew (RR = 1.78, 95% CI 1.22-2.60) and agricultural workers (RR = 1.64, 95% CI 1.19-2.28). Results suggested a stepwise gradient in risk, with the lowest skilled occupations being at greater risk of suicide than the highest skill-level group. This is the first comprehensive meta-analytical review of suicide and occupation. There is a need for future studies to investigate explanations for the observed skill-level differences, particularly in people employed in lower skill-level groups.

How Many Significant Figures are Useful for Public Risk Estimates?

NASA Astrophysics Data System (ADS)

Wilde, Paul D.; Duffy, Jim

2013-09-01

This paper considers the level of uncertainty in the calculation of public risks from launch or reentry and provides guidance on the number of significant digits that can be used with confidence when reporting the analysis results to decision-makers. The focus of this paper is the uncertainty in collective risk calculations that are used for launches of new and mature ELVs. This paper examines the computational models that are used to estimate total collective risk to the public for a launch, including the model input data and the model results, and characterizes the uncertainties due to both bias and variability. There have been two recent efforts to assess the uncertainty in state-of-the-art risk analysis models used in the US and their input data. One assessment focused on launch area risk from an Atlas V at Vandenberg Air Force Base (VAFB) and the other focused on downrange risk to Eurasia from a Falcon 9 launched from Cape Canaveral Air Force Station (CCAFS). The results of these studies quantified the uncertainties related to both the probability and the consequence of the launch debris hazards. This paper summarizes the results of both of these relatively comprehensive launch risk uncertainty analyses, which addressed both aleatory and epistemic uncertainties. The epistemic uncertainties of most concern were associated with probability of failure and the debris list. Other major sources of uncertainty evaluated were: the casualty area for people in shelters that are impacted by debris, impact distribution size, yield from exploding propellant and propellant tanks, probability of injury from a blast wave for people in shelters or outside, and population density. This paper also summarizes a relatively comprehensive over-flight risk uncertainty analysis performed by the FAA for the second stage of flight for a Falcon 9 from CCAFS. This paper is applicable to baseline collective risk analyses, such as those used to make a commercial license determination, and day-of-launch collective risk analyses, such as those used to determine if a launch can be initiated safely. The paper recommends the use of only one significant figure as the default for reporting collective public risk results when making a safety determination, unless there are other specific analyses, data, or circumstances to justify the use of an additional significant figure.

Fruit and vegetable intake and prostate cancer risk: a meta-analysis.

PubMed

Meng, Hongzhou; Hu, Wenyi; Chen, Zhaodian; Shen, Yuehong

2014-06-01

Recent reports have examined the effect of fruit and vegetable intake on the risk of prostate cancer, but the results are inconsistent. A meta-analysis of prospective studies was conducted to arrive at quantitative conclusions about the contribution of vegetable and fruit intake to the incidence of prostate cancer. A comprehensive, systematic search of medical literature published up to June 2012 was performed to identify relevant studies. Separate meta-analyses were conducted for fruit and vegetable consumption. The presence of publication bias was assessed using Egger and Begg tests. In total, 16 cohort studies met the inclusion criteria and were included in the meta-analysis. The combined adjusted relative risk comparing highest with lowest categories showed that there was no association between vegetable and fruit consumption and prostate cancer incidence. The pooled relative risk was 0.97 (95%CI 0.93, 1.01) for vegetables and 1.02 (95%CI 0.98, 1.07) for fruit. There is no heterogeneity between the studies. No publication bias was detected. This meta-analysis suggests that total fruit or vegetable consumption may not exert a protective role in the risk of prostate cancer. © 2013 Wiley Publishing Asia Pty Ltd.

Limitations of self-care in reducing the risk of lymphedema: supportive-educative systems.

PubMed

Armer, Jane M; Brooks, Constance W; Stewart, Bob R

2011-01-01

The purpose of this study was to examine patient perceptions of limitations related to self-care measures to reduce lymphedema risk following breast cancer surgery. Secondary analysis of survey data from a companion study to a study piloting a behavioral-educational intervention was conducted to examine the specific limitations in performing lymphedema risk-reduction self-care measures. Findings suggest a more comprehensive approach is needed if patients are to engage in self-care actions to reduce lymphedema risk. Understanding the concepts of self-care and personal support interventions that include motivational interviewing can help nurses design supportive-educative care systems that assist patients in overcoming limitations in the estimative, transitional, and productive phases of self-care necessary to reduce lymphedema risk.

Health risk assessment of polycyclic aromatic hydrocarbons in the source water and drinking water of China: Quantitative analysis based on published monitoring data.

PubMed

Wu, Bing; Zhang, Yan; Zhang, Xu-Xiang; Cheng, Shu-Pei

2011-12-01

A carcinogenic risk assessment of polycyclic aromatic hydrocarbons (PAHs) in source water and drinking water of China was conducted using probabilistic techniques from a national perspective. The published monitoring data of PAHs were gathered and converted into BaP equivalent (BaP(eq)) concentrations. Based on the transformed data, comprehensive risk assessment was performed by considering different age groups and exposure pathways. Monte Carlo simulation and sensitivity analysis were applied to quantify uncertainties of risk estimation. The risk analysis indicated that, the risk values for children and teens were lower than the accepted value (1.00E-05), indicating no significant carcinogenic risk. The probability of risk values above 1.00E-05 was 5.8% and 6.7% for adults and lifetime groups, respectively. Overall, carcinogenic risks of PAHs in source water and drinking water of China were mostly accepted. However, specific regions, such as Yellow river of Lanzhou reach and Qiantang river should be paid more attention. Notwithstanding the uncertainties inherent in the risk assessment, this study is the first attempt to provide information on carcinogenic risk of PAHs in source water and drinking water of China, and might be useful for potential strategies of carcinogenic risk management and reduction. Copyright © 2011 Elsevier B.V. All rights reserved.

Rethinking vulnerability analysis and governance with emphasis on a participatory approach.

PubMed

Rossignol, Nicolas; Delvenne, Pierre; Turcanu, Catrinel

2015-01-01

This article draws on vulnerability analysis as it emerged as a complement to classical risk analysis, and it aims at exploring its ability for nurturing risk and vulnerability governance actions. An analysis of the literature on vulnerability analysis allows us to formulate a three-fold critique: first, vulnerability analysis has been treated separately in the natural and the technological hazards fields. This separation prevents vulnerability from unleashing the full range of its potential, as it constrains appraisals into artificial categories and thus already closes down the outcomes of the analysis. Second, vulnerability analysis focused on assessment tools that are mainly quantitative, whereas qualitative appraisal is a key to assessing vulnerability in a comprehensive way and to informing policy making. Third, a systematic literature review of case studies reporting on participatory approaches to vulnerability analysis allows us to argue that participation has been important to address the above, but it remains too closed down in its approach and would benefit from embracing a more open, encompassing perspective. Therefore, we suggest rethinking vulnerability analysis as one part of a dynamic process between opening-up and closing-down strategies, in order to support a vulnerability governance framework. © 2014 Society for Risk Analysis.

Ergonomics and simulation-based approach in improving facility layout

NASA Astrophysics Data System (ADS)

Abad, Jocelyn D.

2018-02-01

The use of the simulation-based technique in facility layout has been a choice in the industry due to its convenience and efficient generation of results. Nevertheless, the solutions generated are not capable of addressing delays due to worker's health and safety which significantly impact overall operational efficiency. It is, therefore, critical to incorporate ergonomics in facility design. In this study, workstation analysis was incorporated into Promodel simulation to improve the facility layout of a garment manufacturing. To test the effectiveness of the method, existing and improved facility designs were measured using comprehensive risk level, efficiency, and productivity. Results indicated that the improved facility layout generated a decrease in comprehensive risk level and rapid upper limb assessment score; an increase of 78% in efficiency and 194% increase in productivity compared to existing design and thus proved that the approach is effective in attaining overall facility design improvement.

Worksite Cancer Prevention Activities in the National Comprehensive Cancer Control Program

PubMed Central

Nahmias, Zachary; Townsend, Julie S.; Neri, Antonio; Stewart, Sherri L.

2016-01-01

Background Workplaces are one setting for cancer control planners to reach adults at risk for cancer and other chronic diseases. However, the extent to which Centers for Disease Control and Prevention-funded National Comprehensive Cancer Control Programs (NCCCP) implement interventions in the workplace setting is not well characterized. Methods We conducted a qualitative content analysis of program action plans submitted by NCCCP grantees from 2013–2015 to identify and describe cancer prevention objectives and interventions in the workplace setting. Results Nearly half of NCCCP action reports contained at least one cancer prevention objective or intervention in the workplace setting. Common interventions included education about secondhand smoke exposure in the workplace, and the importance of obtaining colorectal cancer screening. Conclusion Workplace interventions were relatively common among NCCCP action plans, and serve as one way to address low percentages of CRC screening, and reduce risk for obesity- and tobacco-related cancers. PMID:26874944

[Post-marketing clinical study of traditional Chinese medicine--lessons learned from comprehensive evaluation of Fufang Zaoren capsule].

PubMed

Qing, Shan; Gao, Lin; Zhang, Li; Jia, Jian-Ping; Liu, Xin-Min; Ji, Shao-Liang; Yang, Xiao-Hui

2013-11-01

By comprehensive review and analysis of post-marketing clinical research on the efficacy and safety,we concluded that Fufang Zaoren capsule has certain therapeutic effects for insomnia, although current clinical research design needs improving. The post-marketing clinical studies also showed that it causes several adverse reactions at the recommended doses, such as chills, fever, dizziness, nausea, shortness of breath, chest tightness and palpitations, whereas high doses of Fufang Zaoren capsule can cause delayed extrapyramidal symptoms. Health Canada government website also prompted the L-tetrahydropalmatine in Fufang Zaoren capsule caused liver damage in pregnant women. The authors summarized the risk points, factors and risk control in the clinical use of Fufang Zaoren capsule and also present their perspective on the research status, existing problems and corresponding countermeasures in the post-marketing clinical re-evaluation of traditional Chinese medicine.

Herbal medicine research and global health: an ethical analysis.

PubMed

Tilburt, Jon C; Kaptchuk, Ted J

2008-08-01

Governments, international agencies and corporations are increasingly investing in traditional herbal medicine research. Yet little literature addresses ethical challenges in this research. In this paper, we apply concepts in a comprehensive ethical framework for clinical research to international traditional herbal medicine research. We examine in detail three key, underappreciated dimensions of the ethical framework in which particularly difficult questions arise for international herbal medicine research: social value, scientific validity and favourable risk-benefit ratio. Significant challenges exist in determining shared concepts of social value, scientific validity and favourable risk-benefit ratio across international research collaborations. However, we argue that collaborative partnership, including democratic deliberation, offers the context and process by which many of the ethical challenges in international herbal medicine research can, and should be, resolved. By "cross-training" investigators, and investing in safety-monitoring infrastructure, the issues identified by this comprehensive framework can promote ethically sound international herbal medicine research that contributes to global health.

Risk evaluation of highway engineering project based on the fuzzy-AHP

NASA Astrophysics Data System (ADS)

Yang, Qian; Wei, Yajun

2011-10-01

Engineering projects are social activities, which integrate with technology, economy, management and organization. There are uncertainties in each respect of engineering projects, and it needs to strengthen risk management urgently. Based on the analysis of the characteristics of highway engineering, and the study of the basic theory on risk evaluation, the paper built an index system of highway project risk evaluation. Besides based on fuzzy mathematics principle, analytical hierarchy process was used and as a result, the model of the comprehensive appraisal method of fuzzy and AHP was set up for the risk evaluation of express way concessionary project. The validity and the practicability of the risk evaluation of expressway concessionary project were verified after the model was applied to the practice of a project.

Association of glutathione S-transferase pi (GSTP1) Ile105Val polymorphism with the risk of skin cancer: a meta-analysis.

PubMed

Zhou, Cheng-Fan; Ma, Tai; Zhou, Deng-Chuan; Shen, Tong; Zhu, Qi-Xing

2015-08-01

Numerous epidemiological studies have evaluated the association of Glutathione S-transferase P1 (GSTP1) Ile105Val polymorphism with the risk of skin cancer. However, the results remain inconclusive. To derive a more precise estimation of the association between the GSTP1 Ile105Val polymorphism and skin cancer risk, a meta-analysis was performed. A comprehensive search was conducted to identify the eligible studies. We used odds ratios (ORs) with 95 % confidence intervals (CIs) to assess the association of GSTP1 Ile105Val polymorphism with skin cancer risk. Thirteen case-control studies in nine articles, which included a total of 1504 cases and 2243 controls. Overall, we found that GSTP1 Ile105Val polymorphism was not associated with skin cancer risk. Furthermore, subgroup analysis by histological types showed that GSTP1 Ile105Val polymorphism was associated with risks of malignant melanoma under the dominant model (Val/Val + Val/Ile vs. Ile/Ile: OR 1.230, 95 % CI 1.017-1.488, P = 0.033). However, lack of association between GSTP1 Ile105Val polymorphism and BCC and SCC risk in all genetic models. Our meta-analysis suggested that the GSTP1 Ile105Val polymorphism might be associated with increased risk of malignant melanoma in Caucasian population.

A Meta-Analysis of Risk and Protective Factors for Dating Violence Victimization: The Role of Family and Peer Interpersonal Context.

PubMed

Hébert, Martine; Daspe, Marie-Ève; Lapierre, Andréanne; Godbout, Natacha; Blais, Martin; Fernet, Mylène; Lavoie, Francine

2017-01-01

Dating violence (DV) is a widespread social issue that has numerous deleterious repercussions on youths' health. Family and peer risk factors for DV have been widely studied, but with inconsistent methodologies, which complicates global comprehension of the phenomenon. Protective factors, although understudied, constitutes a promising line of research for prevention. To date, there is no comprehensive quantitative review attempting to summarize knowledge on both family and peer factors that increase or decrease the risk for adolescents and emerging adults DV victimization. The current meta-analysis draws on 87 studies with a total sample of 278,712 adolescents and young adults to examine effect sizes of the association between various family and peer correlates of DV victimization. Results suggest small, significant effect sizes for all the family (various forms of child maltreatment, parental support, and parental monitoring) and peer factors (peer victimization, sexual harassment, affiliation with deviant peers, and supportive/prosocial peers) in the prediction of DV. With few exceptions, forms of DV (psychological, physical, and sexual), gender, and age did not moderate the strength of these associations. In addition, no difference was found between the magnitude of family and peer factors' effect sizes, suggesting that these determinants are equally important in predicting DV. The current results provide future directions for examining relations between risk and protective factors for DV and indicate that both peers and family should be part of the development of efficient prevention options.

Comprehensive drought characteristics analysis based on a nonlinear multivariate drought index

NASA Astrophysics Data System (ADS)

Yang, Jie; Chang, Jianxia; Wang, Yimin; Li, Yunyun; Hu, Hui; Chen, Yutong; Huang, Qiang; Yao, Jun

2018-02-01

It is vital to identify drought events and to evaluate multivariate drought characteristics based on a composite drought index for better drought risk assessment and sustainable development of water resources. However, most composite drought indices are constructed by the linear combination, principal component analysis and entropy weight method assuming a linear relationship among different drought indices. In this study, the multidimensional copulas function was applied to construct a nonlinear multivariate drought index (NMDI) to solve the complicated and nonlinear relationship due to its dependence structure and flexibility. The NMDI was constructed by combining meteorological, hydrological, and agricultural variables (precipitation, runoff, and soil moisture) to better reflect the multivariate variables simultaneously. Based on the constructed NMDI and runs theory, drought events for a particular area regarding three drought characteristics: duration, peak, and severity were identified. Finally, multivariate drought risk was analyzed as a tool for providing reliable support in drought decision-making. The results indicate that: (1) multidimensional copulas can effectively solve the complicated and nonlinear relationship among multivariate variables; (2) compared with single and other composite drought indices, the NMDI is slightly more sensitive in capturing recorded drought events; and (3) drought risk shows a spatial variation; out of the five partitions studied, the Jing River Basin as well as the upstream and midstream of the Wei River Basin are characterized by a higher multivariate drought risk. In general, multidimensional copulas provides a reliable way to solve the nonlinear relationship when constructing a comprehensive drought index and evaluating multivariate drought characteristics.

LESSONS FROM A RETROSPECTIVE ANALYSIS OF A 5-YR PERIOD OF QUARANTINE AT SAN DIEGO ZOO: A RISK-BASED APPROACH TO QUARANTINE ISOLATION AND TESTING MAY BENEFIT ANIMAL WELFARE.

PubMed

Wallace, Chelsea; Marinkovich, Matt; Morris, Pat J; Rideout, Bruce; Pye, Geoffrey W

2016-03-01

Quarantine is designed primarily to prevent the introduction of transmissible diseases to zoological collections. Improvements in preventive medicine, disease eradication, and comprehensive pathology programs call into question current industry quarantine standards. Disease risk analysis was used at the San Diego Zoo (SDZ) and the SDZ Safari Park to eliminate quarantine isolation and transmissible disease testing for animals transferred between the two institutions. To determine if a risk-based approach might be valid between other institutions and SDZ, we reviewed quarantine data for animals arriving at SDZ from 81 Association of Zoos and Aquariums (AZA)-accredited and 124 other sources (e.g., non-AZA-accredited institutions, private breeders, private dealers, governmental bodies) over a 5-yr period (2009-2013). No mammal or herptile failed quarantine due to transmissible diseases of concern. Approximately 2.5% of incoming birds failed quarantine due to transmissible disease; however, all 14 failed individuals were obtained from three nonaccredited sources (private breeders, confiscation). The results of our study suggest that a risk-based approach could be used to minimize or eliminate quarantine for the transfer of animals from institutions with comprehensive disease surveillance programs and/or preshipment testing practices. Quarantine isolation with testing remains an essential defense against introducing transmissible diseases of concern when there is a lack of health knowledge about the animals being received.

A qualitative study exploring patients' experiences of standard care or cardiac rehabilitation post minor stroke and transient ischaemic attack.

PubMed

Hillsdon, Kaye M; Kersten, Paula; Kirk, Hayden J S

2013-09-01

To explore individuals' experiences of receiving either standard care or comprehensive cardiac rehabilitation post minor stroke or transient ischaemic attack. A qualitative study using semi-structured interviews, alongside a randomized controlled trial, exploring the effectiveness of comprehensive cardiac rehabilitation compared with standard care. Interviews were transcribed verbatim and subjected to thematic analysis. Individuals' homes. People who have experienced a minor stroke or transient ischaemic attack and who were partaking in a secondary prevention randomized controlled trial (6-7 months post the event, 17 males, five females; mean age 67 years). Not relevant. Not relevant. Four themes were identified: information delivery, comparing oneself with others, psychological impact, attitudes and actions regarding risk factor reduction. Participants indicated a need for improved information delivery, specific to their own risk factors and lifestyle changes. Many experienced psychological impact as a result of their minor stroke. Participants were found to make two types of social comparison; the comparison of self to another affected by stroke, and the comparison of self to cardiac patients. Comprehensive cardiac rehabilitation was reported to have positive effects on people's motivation to exercise. Following a minor stroke, many individuals do not recall information given or risk factors specific to them. Downward comparison with individuals who have had a cardiovascular event led to some underplaying the significance of their minor stroke.

[Research on the reliability and validity of postural workload assessment method and the relation to work-related musculoskeletal disorders of workers].

PubMed

Qin, D L; Jin, X N; Wang, S J; Wang, J J; Mamat, N; Wang, F J; Wang, Y; Shen, Z A; Sheng, L G; Forsman, M; Yang, L Y; Wang, S; Zhang, Z B; He, L H

2018-06-18

To form a new assessment method to evaluate postural workload comprehensively analyzing the dynamic and static postural workload for workers during their work process to analyze the reliability and validity, and to study the relation between workers' postural workload and work-related musculoskeletal disorders (WMSDs). In the study, 844 workers from electronic and railway vehicle manufacturing factories were selected as subjects investigated by using the China Musculoskeletal Questionnaire (CMQ) to form the postural workload comprehensive assessment method. The Cronbach's α, cluster analysis and factor analysis were used to assess the reliability and validity of the new assessment method. Non-conditional Logistic regression was used to analyze the relation between workers' postural workload and WMSDs. Reliability of the assessment method for postural workload: internal consistency analysis results showed that Cronbach's α was 0.934 and the results of split-half reliability indicated that Spearman-Brown coefficient was 0.881 and the correlation coefficient between the first part and the second was 0.787. Validity of the assessment method for postural workload: the results of cluster analysis indicated that square Euclidean distance between dynamic and static postural workload assessment in the same part or work posture was the shortest. The results of factor analysis showed that 2 components were extracted and the cumulative percentage of variance achieved 65.604%. The postural workload score of the different occupational workers showed significant difference (P<0.05) by covariance analysis. The results of nonconditional Logistic regression indicated that alcohol intake (OR=2.141, 95%CI 1.337-3.428) and obesity (OR=3.408, 95%CI 1.629-7.130) were risk factors for WMSDs. The risk for WMSDs would rise as workers' postural workload rose (OR=1.035, 95%CI 1.022-1.048). There was significant different risk for WMSDs in the different groups of workers distinguished by work type, gender and age. Female workers exhibited a higher prevalence for WMSDs (OR=2.626, 95%CI 1.414-4.879) and workers between 30-40 years of age (OR=1.909, 95%CI 1.237-2.946) as compared with those under 30. This method for comprehensively assessing postural workload is reliable and effective when used in assembling workers, and there is certain relation between the postural workload and WMSDs.

Soy Consumption and the Risk of Prostate Cancer: An Updated Systematic Review and Meta-Analysis

PubMed Central

Ranard, Katherine M.; Jeon, Sookyoung; Erdman, John W.

2018-01-01

Prostate cancer (PCa) is the second most commonly diagnosed cancer in men, accounting for 15% of all cancers in men worldwide. Asian populations consume soy foods as part of a regular diet, which may contribute to the lower PCa incidence observed in these countries. This meta-analysis provides a comprehensive updated analysis that builds on previously published meta-analyses, demonstrating that soy foods and their isoflavones (genistein and daidzein) are associated with a lower risk of prostate carcinogenesis. Thirty articles were included for analysis of the potential impacts of soy food intake, isoflavone intake, and circulating isoflavone levels, on both primary and advanced PCa. Total soy food (p < 0.001), genistein (p = 0.008), daidzein (p = 0.018), and unfermented soy food (p < 0.001) intakes were significantly associated with a reduced risk of PCa. Fermented soy food intake, total isoflavone intake, and circulating isoflavones were not associated with PCa risk. Neither soy food intake nor circulating isoflavones were associated with advanced PCa risk, although very few studies currently exist to examine potential associations. Combined, this evidence from observational studies shows a statistically significant association between soy consumption and decreased PCa risk. Further studies are required to support soy consumption as a prophylactic dietary approach to reduce PCa carcinogenesis. PMID:29300347

Integrated Research on the Development of Global Climate Risk Management Strategies - Framework and Initial Results of the Research Project ICA-RUS

NASA Astrophysics Data System (ADS)

Emori, Seita; Takahashi, Kiyoshi; Yamagata, Yoshiki; Oki, Taikan; Mori, Shunsuke; Fujigaki, Yuko

2013-04-01

With the aim of proposing strategies of global climate risk management, we have launched a five-year research project called ICA-RUS (Integrated Climate Assessment - Risks, Uncertainties and Society). In this project with the phrase "risk management" in its title, we aspire for a comprehensive assessment of climate change risks, explicit consideration of uncertainties, utilization of best available information, and consideration of every possible conditions and options. We also regard the problem as one of decision-making at the human level, which involves social value judgments and adapts to future changes in circumstances. The ICA-RUS project consists of the following five themes: 1) Synthesis of global climate risk management strategies, 2) Optimization of land, water and ecosystem uses for climate risk management, 3) Identification and analysis of critical climate risks, 4) Evaluation of climate risk management options under technological, social and economic uncertainties and 5) Interactions between scientific and social rationalities in climate risk management (see also: http://www.nies.go.jp/ica-rus/en/). For the integration of quantitative knowledge of climate change risks and responses, we apply a tool named AIM/Impact [Policy], which consists of an energy-economic model, a simplified climate model and impact projection modules. At the same time, in order to make use of qualitative knowledge as well, we hold monthly project meetings for the discussion of risk management strategies and publish annual reports based on the quantitative and qualitative information. To enhance the comprehensiveness of the analyses, we maintain an inventory of risks and risk management options. The inventory is revised iteratively through interactive meetings with stakeholders such as policymakers, government officials and industrial representatives.

Unraveling the Link between Trauma and Male Delinquency: The Cumulative Versus Differential Risk Perspectives

ERIC Educational Resources Information Center

Maschi, Tina

2006-01-01

This study examined how the cumulative (additive) versus differential (individual) effects of trauma influenced male delinquency. Using a comprehensive measure of trauma, a secondary data analysis was conducted on a nationally representative sample of male youths between the ages of 12 and 17. Logistic regression analyses revealed that all three…

Risk Groups in Exposure to Terror: The Case of Israel's Citizens

ERIC Educational Resources Information Center

Feniger, Yariv; Yuchtman-Yaar, Ephraim

2010-01-01

This research addresses a largely ignored question in the study of terror: who are its likely victims? An answer was sought through analysis of comprehensive data on civilian victims of terror in Israel from 1993 through 2003. The chances of being killed in seemingly random terror attacks were found unequally distributed in Israeli society, but…

Nanotechnology risk perceptions and communication: emerging technologies, emerging challenges.

PubMed

Pidgeon, Nick; Harthorn, Barbara; Satterfield, Terre

2011-11-01

Nanotechnology involves the fabrication, manipulation, and control of materials at the atomic level and may also bring novel uncertainties and risks. Potential parallels with other controversial technologies mean there is a need to develop a comprehensive understanding of processes of public perception of nanotechnology uncertainties, risks, and benefits, alongside related communication issues. Study of perceptions, at so early a stage in the development trajectory of a technology, is probably unique in the risk perception and communication field. As such it also brings new methodological and conceptual challenges. These include: dealing with the inherent diversity of the nanotechnology field itself; the unfamiliar and intangible nature of the concept, with few analogies to anchor mental models or risk perceptions; and the ethical and value questions underlying many nanotechnology debates. Utilizing the lens of social amplification of risk, and drawing upon the various contributions to this special issue of Risk Analysis on Nanotechnology Risk Perceptions and Communication, nanotechnology may at present be an attenuated hazard. The generic idea of "upstream public engagement" for emerging technologies such as nanotechnology is also discussed, alongside its importance for future work with emerging technologies in the risk communication field. © 2011 Society for Risk Analysis.

A theoretical treatment of technical risk in modern propulsion system design

NASA Astrophysics Data System (ADS)

Roth, Bryce Alexander

2000-09-01

A prevalent trend in modern aerospace systems is increasing complexity and cost, which in turn drives increased risk. Consequently, there is a clear and present need for the development of formalized methods to analyze the impact of risk on the design of aerospace vehicles. The objective of this work is to develop such a method that enables analysis of risk via a consistent, comprehensive treatment of aerothermodynamic and mass properties aspects of vehicle design. The key elements enabling the creation of this methodology are recent developments in the analytical estimation of work potential based on the second law of thermodynamics. This dissertation develops the theoretical foundation of a vehicle analysis method based on work potential and validates it using the Northrop F-5E with GE J85-GE-21 engines as a case study. Although the method is broadly applicable, emphasis is given to aircraft propulsion applications. Three work potential figures of merit are applied using this method: exergy, available energy, and thrust work potential. It is shown that each possesses unique properties making them useful for specific vehicle analysis tasks, though the latter two are actually special cases of exergy. All three are demonstrated on the analysis of the J85-GE-21 propulsion system, resulting in a comprehensive description of propulsion system thermodynamic loss. This "loss management" method is used to analyze aerodynamic drag loss of the F-5E and is then used in conjunction with the propulsive loss model to analyze the usage of fuel work potential throughout the F-5E design mission. The results clearly show how and where work potential is used during flight and yield considerable insight as to where the greatest opportunity for design improvement is. Next, usage of work potential is translated into fuel weight so that the aerothermodynamic performance of the F-5E can be expressed entirely in terms of vehicle gross weight. This technique is then applied as a means to quantify the impact of engine cycle technologies on the F-5E airframe. Finally, loss management methods are used in conjunction with probabilistic analysis methods to quantify the impact of risk on F-5E aerothermodynamic performance.

Novel Threat-risk Index Using Probabilistic Risk Assessment and Human Reliability Analysis - Final Report

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

George A. Beitel

2004-02-01

In support of a national need to improve the current state-of-the-art in alerting decision makers to the risk of terrorist attack, a quantitative approach employing scientific and engineering concepts to develop a threat-risk index was undertaken at the Idaho National Engineering and Environmental Laboratory (INEEL). As a result of this effort, a set of models has been successfully integrated into a single comprehensive model known as Quantitative Threat-Risk Index Model (QTRIM), with the capability of computing a quantitative threat-risk index on a system level, as well as for the major components of the system. Such a threat-risk index could providemore » a quantitative variant or basis for either prioritizing security upgrades or updating the current qualitative national color-coded terrorist threat alert.« less

Secondary "At-Risk" Students' Perceptions of Experiences within a Comprehensive High School and a Continuation High/Alternative High School

ERIC Educational Resources Information Center

Loomis, Corey Campbell

2011-01-01

Comprehensive high schools have been unable to meet the needs of all students (Cotton, 2004). Students face challenges, and some have been labeled "at risk" for various reasons. These students constitute a unique group who often require more time, energy, and resources than large, comprehensive schools can offer. Consequently, they fall behind on…

A comprehensive 1,000 Genomes-based genome-wide association meta-analysis of coronary artery disease.

PubMed

Nikpay, Majid; Goel, Anuj; Won, Hong-Hee; Hall, Leanne M; Willenborg, Christina; Kanoni, Stavroula; Saleheen, Danish; Kyriakou, Theodosios; Nelson, Christopher P; Hopewell, Jemma C; Webb, Thomas R; Zeng, Lingyao; Dehghan, Abbas; Alver, Maris; Armasu, Sebastian M; Auro, Kirsi; Bjonnes, Andrew; Chasman, Daniel I; Chen, Shufeng; Ford, Ian; Franceschini, Nora; Gieger, Christian; Grace, Christopher; Gustafsson, Stefan; Huang, Jie; Hwang, Shih-Jen; Kim, Yun Kyoung; Kleber, Marcus E; Lau, King Wai; Lu, Xiangfeng; Lu, Yingchang; Lyytikäinen, Leo-Pekka; Mihailov, Evelin; Morrison, Alanna C; Pervjakova, Natalia; Qu, Liming; Rose, Lynda M; Salfati, Elias; Saxena, Richa; Scholz, Markus; Smith, Albert V; Tikkanen, Emmi; Uitterlinden, Andre; Yang, Xueli; Zhang, Weihua; Zhao, Wei; de Andrade, Mariza; de Vries, Paul S; van Zuydam, Natalie R; Anand, Sonia S; Bertram, Lars; Beutner, Frank; Dedoussis, George; Frossard, Philippe; Gauguier, Dominique; Goodall, Alison H; Gottesman, Omri; Haber, Marc; Han, Bok-Ghee; Huang, Jianfeng; Jalilzadeh, Shapour; Kessler, Thorsten; König, Inke R; Lannfelt, Lars; Lieb, Wolfgang; Lind, Lars; Lindgren, Cecilia M; Lokki, Marja-Liisa; Magnusson, Patrik K; Mallick, Nadeem H; Mehra, Narinder; Meitinger, Thomas; Memon, Fazal-Ur-Rehman; Morris, Andrew P; Nieminen, Markku S; Pedersen, Nancy L; Peters, Annette; Rallidis, Loukianos S; Rasheed, Asif; Samuel, Maria; Shah, Svati H; Sinisalo, Juha; Stirrups, Kathleen E; Trompet, Stella; Wang, Laiyuan; Zaman, Khan S; Ardissino, Diego; Boerwinkle, Eric; Borecki, Ingrid B; Bottinger, Erwin P; Buring, Julie E; Chambers, John C; Collins, Rory; Cupples, L Adrienne; Danesh, John; Demuth, Ilja; Elosua, Roberto; Epstein, Stephen E; Esko, Tõnu; Feitosa, Mary F; Franco, Oscar H; Franzosi, Maria Grazia; Granger, Christopher B; Gu, Dongfeng; Gudnason, Vilmundur; Hall, Alistair S; Hamsten, Anders; Harris, Tamara B; Hazen, Stanley L; Hengstenberg, Christian; Hofman, Albert; Ingelsson, Erik; Iribarren, Carlos; Jukema, J Wouter; Karhunen, Pekka J; Kim, Bong-Jo; Kooner, Jaspal S; Kullo, Iftikhar J; Lehtimäki, Terho; Loos, Ruth J F; Melander, Olle; Metspalu, Andres; März, Winfried; Palmer, Colin N; Perola, Markus; Quertermous, Thomas; Rader, Daniel J; Ridker, Paul M; Ripatti, Samuli; Roberts, Robert; Salomaa, Veikko; Sanghera, Dharambir K; Schwartz, Stephen M; Seedorf, Udo; Stewart, Alexandre F; Stott, David J; Thiery, Joachim; Zalloua, Pierre A; O'Donnell, Christopher J; Reilly, Muredach P; Assimes, Themistocles L; Thompson, John R; Erdmann, Jeanette; Clarke, Robert; Watkins, Hugh; Kathiresan, Sekar; McPherson, Ruth; Deloukas, Panos; Schunkert, Heribert; Samani, Nilesh J; Farrall, Martin

2015-10-01

Existing knowledge of genetic variants affecting risk of coronary artery disease (CAD) is largely based on genome-wide association study (GWAS) analysis of common SNPs. Leveraging phased haplotypes from the 1000 Genomes Project, we report a GWAS meta-analysis of ∼185,000 CAD cases and controls, interrogating 6.7 million common (minor allele frequency (MAF) > 0.05) and 2.7 million low-frequency (0.005 < MAF < 0.05) variants. In addition to confirming most known CAD-associated loci, we identified ten new loci (eight additive and two recessive) that contain candidate causal genes newly implicating biological processes in vessel walls. We observed intralocus allelic heterogeneity but little evidence of low-frequency variants with larger effects and no evidence of synthetic association. Our analysis provides a comprehensive survey of the fine genetic architecture of CAD, showing that genetic susceptibility to this common disease is largely determined by common SNPs of small effect size.

Comparison between Two Methods for agricultural drought disaster risk in southwestern China

NASA Astrophysics Data System (ADS)

han, lanying; zhang, qiang

2016-04-01

The drought is a natural disaster, which lead huge loss to agricultural yield in the world. The drought risk has become increasingly prominent because of the climatic warming during the past century, and which is also one of the main meteorological disasters and serious problem in southwestern China, where drought risk exceeds the national average. Climate change is likely to exacerbate the problem, thereby endangering Chinaʹs food security. In this paper, drought disaster in the southwestern China (where there are serious drought risk and the comprehensive loss accounted for 3.9% of national drought area) were selected to show the drought change under climate change, and two methods were used to assess the drought disaster risk, drought risk assessment model and comprehensive drought risk index. Firstly, we used the analytic hierarchy process and meteorological, geographic, soil, and remote-sensing data to develop a drought risk assessment model (defined using a comprehensive drought disaster risk index, R) based on the drought hazard, environmental vulnerability, sensitivity and exposure of the values at risk, and capacity to prevent or mitigate the problem. Second, we built the comprehensive drought risk index (defined using a comprehensive drought disaster loss, L) based on statistical drought disaster data, including crop yields, drought-induced areas, drought-occurred areas, no harvest areas caused by drought and planting areas. Using the model, we assessed the drought risk. The results showed that spatial distribution of two drought disaster risks were coherent, and revealed complex zonality in southwestern China. The results also showed the drought risk is becoming more and more serious and frequent in the country under the global climatic warming background. The eastern part of the study area had an extremely high risk, and risk was generally greater in the north than in the south, and increased from southwest to northeast. The drought disaster risk or loss was highest in Sichuan Province and Chongqing Municipality. It was lowest in Yunnan province. The comprehensive drought disaster loss were uptrend in nearly 60 years, and the trend of drought occurrence in nearly 60 years was overall upward in every province of Xinan region. Drought risk of all provinces has certain relationship with the regional climate change, such as temperature and precipitation, soil moisture and vegetation coverage. The contribution of the risk factors to R was highest for the capacity for prevention and mitigation, followed by the drought hazard, sensitivity and exposure, and environmental vulnerability.

Consumption of vegetables and fruit and the risk of inflammatory bowel disease: a meta-analysis.

PubMed

Li, Fang; Liu, Xiaoqin; Wang, Weijing; Zhang, Dongfeng

2015-06-01

To date, associations between consumption of vegetables and fruit and the risk of inflammatory bowel disease have been a controversial subject. Therefore, we carried out a meta-analysis to evaluate the associations. A comprehensive search was performed in PubMed, Embase, Web of Science, and the China National Knowledge Infrastructure to identify all relevant studies. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) from random-effects or fixed-effects models were calculated. Publication bias was estimated using Egger's test and the funnel plot. A total of 14 case-control studies were included in this meta-analysis. On the basis of the highest versus the lowest analysis, consumption of vegetables was associated inversely with the risk of ulcerative colitis (UC) (OR=0.71, 95% CI 0.58-0.88, n=9 studies), but not with Crohn's disease (CD) (OR=0.66, 95% CI 0.40-1.09, n=8 studies). Higher consumption of fruit was associated inversely with the risk of UC (OR=0.69, 95% CI 0.49-0.96, n=8 studies) and CD (OR=0.57, 95% CI 0.44-0.74, n=10 studies). For intake of vegetables and the risk of CD, subgroup analysis showed a significant association for studies carried out in Europe (OR=0.36, 95% CI 0.23-0.57), but not in Asia (OR=1.00, 95% CI 0.50-2.03). No significant publication bias was found for the analysis of intake of vegetables and the risk of UC, intake of fruit and the risk of UC, and intake of vegetables and the risk of CD. This meta-analysis indicates that consumption of vegetables and fruit might be associated inversely with the risk of UC and CD, and the results need to be further confirmed.

Development of an Expert Judgement Elicitation and Calibration Methodology for Risk Analysis in Conceptual Vehicle Design

NASA Technical Reports Server (NTRS)

Unal, Resit; Keating, Charles; Conway, Bruce; Chytka, Trina

2004-01-01

A comprehensive expert-judgment elicitation methodology to quantify input parameter uncertainty and analysis tool uncertainty in a conceptual launch vehicle design analysis has been developed. The ten-phase methodology seeks to obtain expert judgment opinion for quantifying uncertainties as a probability distribution so that multidisciplinary risk analysis studies can be performed. The calibration and aggregation techniques presented as part of the methodology are aimed at improving individual expert estimates, and provide an approach to aggregate multiple expert judgments into a single probability distribution. The purpose of this report is to document the methodology development and its validation through application to a reference aerospace vehicle. A detailed summary of the application exercise, including calibration and aggregation results is presented. A discussion of possible future steps in this research area is given.

The influence of worksite and employee variables on employee engagement in telephonic health coaching programs: a retrospective multivariate analysis.

PubMed

Grossmeier, Jessica

2013-01-01

This study assessed 11 determinants of health coaching program participation. A cross-sectional study design used secondary data to assess the role of six employee-level and five worksite-level variables on telephone-based coaching enrollment, active participation, and completion. Data was provided by a national provider of worksite health promotion program services for employers. A random sample of 34,291 employees from 52 companies was selected for inclusion in the study. Survey-based measures included age, gender, job type, health risk status, tobacco risk, social support, financial incentives, comprehensive communications, senior leadership support, cultural support, and comprehensive program design. Gender-stratified multivariate logistic regression models were applied using backwards elimination procedures to yield parsimonious prediction models for each of the dependent variables. Employees were more likely to enroll in coaching programs if they were older, female, and in poorer health, and if they were at worksites with fewer environmental supports for health, clear financial incentives for participation in coaching, more comprehensive communications, and more comprehensive programs. Once employees were enrolled, program completion was greater among those who were older, did not use tobacco, worked at a company with strong communications, and had fewer environmental supports for health. Both worksite-level and employee-level factors have significant influences on health coaching engagement, and there are gender differences in the strength of these predictors.

MARINE CORPS ASIA PACIFIC REALIGNMENT: DOD Should Resolve Capability Deficiencies and Infrastructure Risks and Revise Cost Estimates

DTIC Science & Technology

2017-04-01

environmental mitigation and the costs associated with it. In April 2015, the Navy released a draft environmental impact statement to the public that...economic analysis for decision making indicates that, as part of assessing the costs and benefits of alternatives, an economic analysis should include...Page 48 GAO-17-415 Marine Corps Asia-Pacific Realignment comprehensive estimates of the expected costs and benefits that are incident to achieving

Are your students ready for anatomy and physiology? Developing tools to identify students at risk for failure.

PubMed

Gultice, Amy; Witham, Ann; Kallmeyer, Robert

2015-06-01

High failure rates in introductory college science courses, including anatomy and physiology, are common at institutions across the country, and determining the specific factors that contribute to this problem is challenging. To identify students at risk for failure in introductory physiology courses at our open-enrollment institution, an online pilot survey was administered to 200 biology students. The survey results revealed several predictive factors related to academic preparation and prompted a comprehensive analysis of college records of >2,000 biology students over a 5-yr period. Using these historical data, a model that was 91% successful in predicting student success in these courses was developed. The results of the present study support the use of surveys and similar models to identify at-risk students and to provide guidance in the development of evidence-based advising programs and pedagogies. This comprehensive approach may be a tangible step in improving student success for students from a wide variety of backgrounds in anatomy and physiology courses. Copyright © 2015 The American Physiological Society.

Screening for adolescents' internalizing symptoms in primary care: item response theory analysis of the behavior health screen depression, anxiety, and suicidal risk scales.

PubMed

Bevans, Katherine B; Diamond, Guy; Levy, Suzanne

2012-05-01

To apply a modern psychometric approach to validate the Behavioral Health Screen (BHS) Depression, Anxiety, and Suicidal Risk Scales among adolescents in primary care. Psychometric analyses were conducted using data collected from 426 adolescents aged 12 to 21 years (mean = 15.8, SD = 2.2). Rasch-Masters partial credit models were fit to the data to determine whether items supported the comprehensive measurement of internalizing symptoms with minimal gaps and redundancies. Scales were reduced to ensure that they measured singular dimensions of generalized anxiety, depressed affect, and suicidal risk both comprehensively and efficiently. Although gender bias was observed for some depression and anxiety items, differential item functioning did not impact overall subscale scores. Future revisions to the BHS should include additional items that assess low-level internalizing symptoms. The BHS is an accurate and efficient tool for identifying adolescents with internalizing symptoms in primary care settings. Access to psychometrically sound and cost-effective behavioral health screening tools is essential for meeting the increasing demands for adolescent behavioral health screening in primary/ambulatory care.

Epstein-Barr virus is associated with periodontal diseases: A meta-analysis based on 21 case-control studies.

PubMed

Gao, Zilong; Lv, Juan; Wang, Min

2017-02-01

Some controversies still exist between the detection of Epstein-Barr virus (EBV)'s DNA and risks of periodontal diseases. Hence, a comprehensive meta-analysis on all available literatures was performed to clarify the relationship between EBV and preidontitis.A comprehensive search was conducted within the PUBMED, EMBASE, and WANFANG databases up to October 10th, 2016 according to inclusion and exclusion criteria and finally 21 case-control literatures were obtained. The outcomes including odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of associations. Publication bias was determined by Begg or Egger test. Sensitivity analysis was used to investigate reliability and stability of the results.According to the data from included trials, the association between overall increased risks of periodontitis and the detection of EBV was significant (OR = 6.199, 95% CI = 3.119-12.319, P < 0.001). In the disease-type analysis, the pooled ORs for chronic periodontitis and aggressive periodontitis were 6.586 (95% CI = 3.042-14.262, P < 0.001) and 8.361 (95% CI = 2.109-33.143, P = 0.003), respectively. In the subgroup analysis of ethnicity, our results suggested that high EBV-detecting frequencies were correlated with increased risks of periodontitis in Asians, Europeans, and Americans (P < 0.001). Subgroup analysis by the sample type showed that subgingival plaque (SgP) samples and tissue samples were available for EBV detecting (P < 0.001). Detecting EBV of samples in ≥5 (6) mm sites of periodontal pockets were easier than in ≤3-mm sites (P = 0.023).This meta-analysis indicates that high frequent detection of EBV correlates with increased risk of periodontal diseases. SgP and tissue are available for detecting EBV in patients of periodontitis. At last, our results suggest that detecting EBV of samples in =5 (6) mm sites of periodontal pockets are more sensitive than in ≤3-mm sites.

Multi-hazard Assessment and Scenario Toolbox (MhAST): A Framework for Analyzing Compounding Effects of Multiple Hazards

NASA Astrophysics Data System (ADS)

Sadegh, M.; Moftakhari, H.; AghaKouchak, A.

2017-12-01

Many natural hazards are driven by multiple forcing variables, and concurrence/consecutive extreme events significantly increases risk of infrastructure/system failure. It is a common practice to use univariate analysis based upon a perceived ruling driver to estimate design quantiles and/or return periods of extreme events. A multivariate analysis, however, permits modeling simultaneous occurrence of multiple forcing variables. In this presentation, we introduce the Multi-hazard Assessment and Scenario Toolbox (MhAST) that comprehensively analyzes marginal and joint probability distributions of natural hazards. MhAST also offers a wide range of scenarios of return period and design levels and their likelihoods. Contribution of this study is four-fold: 1. comprehensive analysis of marginal and joint probability of multiple drivers through 17 continuous distributions and 26 copulas, 2. multiple scenario analysis of concurrent extremes based upon the most likely joint occurrence, one ruling variable, and weighted random sampling of joint occurrences with similar exceedance probabilities, 3. weighted average scenario analysis based on a expected event, and 4. uncertainty analysis of the most likely joint occurrence scenario using a Bayesian framework.

The significance of OLGA and OLGIM staging systems in the risk assessment of gastric cancer: a systematic review and meta-analysis.

PubMed

Yue, Hu; Shan, Liu; Bin, Lv

2018-02-19

Despite extensive research on the criteria for the assessment of gastric cancer risk using the Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastritis/Intestinal-Metaplasia Assessment (OLGIM) systems, no comprehensive overview or systematic summary on their use is currently available. To perform a systematic review and meta-analysis to assess the efficacy of the OLGA and OLGIM staging systems in evaluating gastric cancer risk. We searched various databases, including PubMed, EMBASE, Medline, and Cochrane's library, for articles published before March 2017 on the association between OLGA/OLGIM stages and risk of gastric cancer. Statistical analysis was performed using RevMan 5.30 and Stata 14.0, with the odds ratio, risk ratio, and 95% confidence interval as the effect measures. A meta-analysis of six case-control studies and two cohort studies, comprising 2700 subjects, was performed. The meta-analysis of prospective case-control studies demonstrated a significant association between the OLGA/OLGIM stages III/IV and gastric cancer. The Newcastle-Ottawa Scale (NOS) score reflected heterogeneity in the case-control studies on OLGA. Subgroup analysis of high-quality (NOS score ≥ 5) studies showed an association between OLGA stage III/IV and increased risk of gastric cancer; the association was also high in the remaining study with low NOS score. The association between higher stages of gastritis defined by OLGA and risk of gastric cancer was significant. This correlation implies that close and frequent monitoring of such high-risk patients is necessary to facilitate timely diagnosis of gastric cancer.

Informing Comprehensive HIV Prevention: A Situational Analysis of the HIV Prevention and Care Context, North West Province South Africa

PubMed Central

Lippman, Sheri A.; Treves-Kagan, Sarah; Gilvydis, Jennifer M.; Naidoo, Evasen; Khumalo-Sakutukwa, Gertrude; Darbes, Lynae; Raphela, Elsie; Ntswane, Lebogang; Barnhart, Scott

2014-01-01

Objective Building a successful combination prevention program requires understanding the community’s local epidemiological profile, the social community norms that shape vulnerability to HIV and access to care, and the available community resources. We carried out a situational analysis in order to shape a comprehensive HIV prevention program that address local barriers to care at multiple contextual levels in the North West Province of South Africa. Method The situational analysis was conducted in two sub-districts in 2012 and guided by an adaptation of WHO’s Strategic Approach, a predominantly qualitative method, including observation of service delivery points and in-depth interviews and focus groups with local leaders, providers, and community members, in order to recommend context-specific HIV prevention strategies. Analysis began during fieldwork with nightly discussions of findings and continued with coding original textual data from the fieldwork notebooks and a select number of recorded interviews. Results We conducted over 200 individual and group interviews and gleaned four principal social barriers to HIV prevention and care, including: HIV fatalism, traditional gender norms, HIV-related stigma, and challenges with communication around HIV, all of which fuel the HIV epidemic. At the different levels of response needed to stem the epidemic, we found evidence of national policies and programs that are mitigating the social risk factors but little community-based responses that address social risk factors to HIV. Conclusions Understanding social and structural barriers to care helped shape our comprehensive HIV prevention program, which address the four ‘themes’ identified into each component of the program. Activities are underway to engage communities, offer community-based testing in high transmission areas, community stigma reduction, and a positive health, dignity and prevention program for stigma reduction and improve communication skills. The situational analysis process successfully shaped key programmatic decisions and cultivated a deeper collaboration with local stakeholders to support program implementation. PMID:25028976

Informing comprehensive HIV prevention: a situational analysis of the HIV prevention and care context, North West Province South Africa.

PubMed

Lippman, Sheri A; Treves-Kagan, Sarah; Gilvydis, Jennifer M; Naidoo, Evasen; Khumalo-Sakutukwa, Gertrude; Darbes, Lynae; Raphela, Elsie; Ntswane, Lebogang; Barnhart, Scott

2014-01-01

Building a successful combination prevention program requires understanding the community's local epidemiological profile, the social community norms that shape vulnerability to HIV and access to care, and the available community resources. We carried out a situational analysis in order to shape a comprehensive HIV prevention program that address local barriers to care at multiple contextual levels in the North West Province of South Africa. The situational analysis was conducted in two sub-districts in 2012 and guided by an adaptation of WHO's Strategic Approach, a predominantly qualitative method, including observation of service delivery points and in-depth interviews and focus groups with local leaders, providers, and community members, in order to recommend context-specific HIV prevention strategies. Analysis began during fieldwork with nightly discussions of findings and continued with coding original textual data from the fieldwork notebooks and a select number of recorded interviews. We conducted over 200 individual and group interviews and gleaned four principal social barriers to HIV prevention and care, including: HIV fatalism, traditional gender norms, HIV-related stigma, and challenges with communication around HIV, all of which fuel the HIV epidemic. At the different levels of response needed to stem the epidemic, we found evidence of national policies and programs that are mitigating the social risk factors but little community-based responses that address social risk factors to HIV. Understanding social and structural barriers to care helped shape our comprehensive HIV prevention program, which address the four 'themes' identified into each component of the program. Activities are underway to engage communities, offer community-based testing in high transmission areas, community stigma reduction, and a positive health, dignity and prevention program for stigma reduction and improve communication skills. The situational analysis process successfully shaped key programmatic decisions and cultivated a deeper collaboration with local stakeholders to support program implementation.

A Comprehensive Profile of Health Risk Behaviors Among Students at a Small Canadian University

ERIC Educational Resources Information Center

Taylor, Jennifer P.; McCarthy, Mary Jean; Herbert, Rosemary J.; Smith, Philip B.

2009-01-01

Despite recent attention to health promotion and illness prevention, young people continue to engage in a variety of risk behaviors, which may negatively influence current and future health status. The purpose of this study was to create a comprehensive profile of health risk behaviors among undergraduate students at the University of Prince…

Compliance with National Comprehensive Cancer Network anti-emesis guidelines in a Community Hospital Cancer Center.

PubMed

Daniel, Divya; Waddell, Aubrey

2016-02-01

Nausea and vomiting are common adverse events exhibited by patients receiving chemotherapy. Prophylactic use of anti-emetic agents has been shown to reduce chemotherapy-induced nausea and vomiting. Compliance with the National Comprehensive Cancer Network anti-emesis guidelines (Version 1.2013) by practitioners in a community out-patient hospital (Blount Memorial Hospital) has been reviewed and the results are presented herein. Retrospective study of patients receiving their first cycle of chemotherapy. A total of 487 patients were reviewed from January 2005 to July 2012. In total, 70 patients were categorized in the high-risk category, 292 patients were categorized in the moderate-risk category, 60 patients were categorized in the low-risk category, and 65 patients were categorized in the minimal-risk category as per the National Comprehensive Cancer Network guidelines. Included patients were being administered the first cycle of their first treatment at Blount Memorial Hospital. Data were collected retrospectively from patient chemotherapy dispensing folders. In all, 63% of the patients received appropriate anti-emetic prophylaxis medications as per the National Comprehensive Cancer Network guidelines. Post-comparison between outcomes based on the risk category showed that patients in the moderate-risk category were most likely (91%) and patients in the low-risk category were least likely (6.67%) to receive appropriate anti-emetic prophylaxis as per the National Comprehensive Cancer Network guidelines. Overall compliance with guidelines is acceptable. Patients in the moderate risk category are most likely to receive appropriate anti-emetic prophylaxis. © The Author(s) 2014.

Heavy metal contamination of agricultural soils affected by mining activities around the Ganxi River in Chenzhou, Southern China.

PubMed

Ma, Li; Sun, Jing; Yang, Zhaoguang; Wang, Lin

2015-12-01

Heavy metal contamination attracted a wide spread attention due to their strong toxicity and persistence. The Ganxi River, located in Chenzhou City, Southern China, has been severely polluted by lead/zinc ore mining activities. This work investigated the heavy metal pollution in agricultural soils around the Ganxi River. The total concentrations of heavy metals were determined by inductively coupled plasma-mass spectrometry. The potential risk associated with the heavy metals in soil was assessed by Nemerow comprehensive index and potential ecological risk index. In both methods, the study area was rated as very high risk. Multivariate statistical methods including Pearson's correlation analysis, hierarchical cluster analysis, and principal component analysis were employed to evaluate the relationships between heavy metals, as well as the correlation between heavy metals and pH, to identify the metal sources. Three distinct clusters have been observed by hierarchical cluster analysis. In principal component analysis, a total of two components were extracted to explain over 90% of the total variance, both of which were associated with anthropogenic sources.

Efficacy and safety of transcatheter aortic valve replacement in aortic stenosis patients at low to moderate surgical risk: a comprehensive meta-analysis.

PubMed

Elmaraezy, Ahmed; Ismail, Ammar; Abushouk, Abdelrahman Ibrahim; Eltoomy, Moutaz; Saad, Soha; Negida, Ahmed; Abdelaty, Osama Mahmoud; Abdallah, Ahmed Ramadan; Aboelfotoh, Ahmed Magdy; Hassan, Hossam Mahmoud; Elmaraezy, Aya Gamal; Morsi, Mahmoud; Althaher, Farah; Althaher, Moath; AlSafadi, Ammar M

2017-08-24

Recently, transcatheter aortic valve replacement (TAVR) has become the procedure of choice in high surgical risk patients with aortic stenosis (AS). However, its value is still debated in operable AS cases. We performed this meta-analysis to compare the safety and efficacy of TAVR to surgical aortic valve replacement (SAVR) in low-to-moderate surgical risk patients with AS. A systematic search of five authentic databases retrieved 11 eligible studies (20,056 patients). Relevant Data were pooled as risk ratios (RRs) or standardized mean differences (SMD), with their 95% confidence interval, using Comprehensive Meta-Analysis and RevMan software for windows. At one-year of follow-up, the pooled effect-estimates showed no significant difference between TAVR and SAVR groups in terms of all-cause mortality (RR 1.02, 95% CI [0.83, 1.26], stroke (RR 0.83, 95%CI [0.56, 1.21]), myocardial infarction (RR 0.82, 95% CI [0.57, 1.19]), and length of hospital stay (SMD -0.04, 95% CI [-0.34, 0.26]). The incidence of major bleeding (RR 0.45, 95% CI [0.24, 0.86]) and acute kidney injury (RR 0.52, 95% CI [0.30, 0.88]) was significantly lower in the TAVR group, compared to the SAVR group. However, TAVR was associated with a higher risk of permanent pacemaker implantation (RR 2.57, 95% CI [1.36, 4.86]), vascular-access complications at 1 year (RR 1.99, 95%CI [1.04, 3.80]), and paravalvular aortic regurgitation at 30 days (RR 3.90, 95% CI [1.25, 12.12]), compared to SAVR. Due to the comparable mortality rates in SAVR and TAVR groups and the lower risk of life-threatening complications in the TAVR group, TAVR can be an acceptable alternative to SAVR in low-to-moderate risk patients with AS. However, larger trials with longer follow-up periods are required to compare the long-term outcomes of both techniques.

The Validity of the 16-Item Version of the Prodromal Questionnaire (PQ-16) to Screen for Ultra High Risk of Developing Psychosis in the General Help-Seeking Population

PubMed Central

Ising, Helga K.; Veling, Wim; Loewy, Rachel L.; Rietveld, Marleen W.; Rietdijk, Judith; Dragt, Sara; Klaassen, Rianne M. C.; Nieman, Dorien H.; Wunderink, Lex; Linszen, Don H.; van der Gaag, Mark

2012-01-01

In order to bring about implementation of routine screening for psychosis risk, a brief version of the Prodromal Questionnaire (PQ; Loewy et al., 2005) was developed and tested in a general help-seeking population. We assessed a consecutive patient sample of 3533 young adults who were help-seeking for nonpsychotic disorders at the secondary mental health services in the Hague with the PQ. We performed logistic regression analyses and CHi-squared Automatic Interaction Detector decision tree analysis to shorten the original 92 items. Receiver operating characteristic curves were used to examine the psychometric properties of the PQ-16. In the general help-seeking population, a cutoff score of 6 or more positively answered items on the 16-item version of the PQ produced correct classification of Comprehensive Assessment of At-Risk Mental State (Yung et al., 2005) psychosis risk/clinical psychosis in 44% of the cases, distinguishing Comprehensive Assessment of At-Risk Mental States (CAARMS) diagnosis from no CAARMS diagnosis with high sensitivity (87%) and specificity (87%). These results were comparable to the PQ-92. The PQ-16 is a good self-report screen for use in secondary mental health care services to select subjects for interviewing for psychosis risk. The low number of items makes it quite appropriate for screening large help-seeking populations, thus enhancing the feasibility of detection and treatment of ultra high-risk patients in routine mental health services. PMID:22516147

Physical activity is associated with reduced risk of esophageal cancer, particularly esophageal adenocarcinoma: a systematic review and meta-analysis

PubMed Central

2014-01-01

Background Physical activity has been inversely associated with risk of several cancers. We performed a systematic review and meta-analysis to evaluate the association between physical activity and risk of esophageal cancer (esophageal adenocarcinoma [EAC] and/or esophageal squamous cell carcinoma [ESCC]). Methods We conducted a comprehensive search of bibliographic databases and conference proceedings from inception through February 2013 for observational studies that examined associations between recreational and/or occupational physical activity and esophageal cancer risk. Summary adjusted odds ratio (OR) estimates with 95% confidence intervals (CI) were estimated using the random-effects model. Results The analysis included 9 studies (4 cohort, 5 case–control) reporting 1,871 cases of esophageal cancer among 1,381,844 patients. Meta-analysis demonstrated that the risk of esophageal cancer was 29% lower among the most physically active compared to the least physically active subjects (OR, 0.71; 95% CI, 0.57-0.89), with moderate heterogeneity (I2 = 47%). On histology-specific analysis, physical activity was associated with a 32% decreased risk of EAC (4 studies, 503 cases of EAC; OR, 0.68; 95% CI, 0.55-0.85) with minimal heterogeneity (I2 = 0%). There were only 3 studies reporting the association between physical activity and risk of ESCC with conflicting results, and the meta-analysis demonstrated a null association (OR, 1.10; 95% CI, 0.21-5.64). The results were consistent across study design, geographic location and study quality, with a non-significant trend towards a dose–response relationship. Conclusions Meta-analysis of published observational studies indicates that physical activity may be associated with reduced risk of esophageal adenocarcinoma. Lifestyle interventions focusing on increasing physical activity may decrease the global burden of EAC. PMID:24886123

Use of evidential reasoning and AHP to assess regional industrial safety

PubMed Central

Chen, Zhichao; Chen, Tao; Qu, Zhuohua; Ji, Xuewei; Zhou, Yi; Zhang, Hui

2018-01-01

China’s fast economic growth contributes to the rapid development of its urbanization process, and also renders a series of industrial accidents, which often cause loss of life, damage to property and environment, thus requiring the associated risk analysis and safety control measures to be implemented in advance. However, incompleteness of historical failure data before the occurrence of accidents makes it difficult to use traditional risk analysis approaches such as probabilistic risk analysis in many cases. This paper aims to develop a new methodology capable of assessing regional industrial safety (RIS) in an uncertain environment. A hierarchical structure for modelling the risks influencing RIS is first constructed. The hybrid of evidential reasoning (ER) and Analytical Hierarchy Process (AHP) is then used to assess the risks in a complementary way, in which AHP is hired to evaluate the weight of each risk factor and ER is employed to synthesise the safety evaluations of the investigated region(s) against the risk factors from the bottom to the top level in the hierarchy. The successful application of the hybrid approach in a real case analysis of RIS in several major districts of Beijing (capital of China) demonstrates its feasibility as well as provides risk analysts and safety engineers with useful insights on effective solutions to comprehensive risk assessment of RIS in metropolitan cities. The contribution of this paper is made by the findings on the comparison of risk levels of RIS at different regions against various risk factors so that best practices from the good performer(s) can be used to improve the safety of the others. PMID:29795593

Use of evidential reasoning and AHP to assess regional industrial safety.

PubMed

Chen, Zhichao; Chen, Tao; Qu, Zhuohua; Yang, Zaili; Ji, Xuewei; Zhou, Yi; Zhang, Hui

2018-01-01

China's fast economic growth contributes to the rapid development of its urbanization process, and also renders a series of industrial accidents, which often cause loss of life, damage to property and environment, thus requiring the associated risk analysis and safety control measures to be implemented in advance. However, incompleteness of historical failure data before the occurrence of accidents makes it difficult to use traditional risk analysis approaches such as probabilistic risk analysis in many cases. This paper aims to develop a new methodology capable of assessing regional industrial safety (RIS) in an uncertain environment. A hierarchical structure for modelling the risks influencing RIS is first constructed. The hybrid of evidential reasoning (ER) and Analytical Hierarchy Process (AHP) is then used to assess the risks in a complementary way, in which AHP is hired to evaluate the weight of each risk factor and ER is employed to synthesise the safety evaluations of the investigated region(s) against the risk factors from the bottom to the top level in the hierarchy. The successful application of the hybrid approach in a real case analysis of RIS in several major districts of Beijing (capital of China) demonstrates its feasibility as well as provides risk analysts and safety engineers with useful insights on effective solutions to comprehensive risk assessment of RIS in metropolitan cities. The contribution of this paper is made by the findings on the comparison of risk levels of RIS at different regions against various risk factors so that best practices from the good performer(s) can be used to improve the safety of the others.

A Comprehensive Analysis of Nuclear-Encoded Mitochondrial Genes in Schizophrenia.

PubMed

Gonçalves, Vanessa F; Cappi, Carolina; Hagen, Christian M; Sequeira, Adolfo; Vawter, Marquis P; Derkach, Andriy; Zai, Clement C; Hedley, Paula L; Bybjerg-Grauholm, Jonas; Pouget, Jennie G; Cuperfain, Ari B; Sullivan, Patrick F; Christiansen, Michael; Kennedy, James L; Sun, Lei

2018-05-01

The genetic risk factors of schizophrenia (SCZ), a severe psychiatric disorder, are not yet fully understood. Multiple lines of evidence suggest that mitochondrial dysfunction may play a role in SCZ, but comprehensive association studies are lacking. We hypothesized that variants in nuclear-encoded mitochondrial genes influence susceptibility to SCZ. We conducted gene-based and gene-set analyses using summary association results from the Psychiatric Genomics Consortium Schizophrenia Phase 2 (PGC-SCZ2) genome-wide association study comprising 35,476 cases and 46,839 control subjects. We applied the MAGMA method to three sets of nuclear-encoded mitochondrial genes: oxidative phosphorylation genes, other nuclear-encoded mitochondrial genes, and genes involved in nucleus-mitochondria crosstalk. Furthermore, we conducted a replication study using the iPSYCH SCZ sample of 2290 cases and 21,621 control subjects. In the PGC-SCZ2 sample, 1186 mitochondrial genes were analyzed, among which 159 had p values < .05 and 19 remained significant after multiple testing correction. A meta-analysis of 818 genes combining the PGC-SCZ2 and iPSYCH samples resulted in 104 nominally significant and nine significant genes, suggesting a polygenic model for the nuclear-encoded mitochondrial genes. Gene-set analysis, however, did not show significant results. In an in silico protein-protein interaction network analysis, 14 mitochondrial genes interacted directly with 158 SCZ risk genes identified in PGC-SCZ2 (permutation p = .02), and aldosterone signaling in epithelial cells and mitochondrial dysfunction pathways appeared to be overrepresented in this network of mitochondrial and SCZ risk genes. This study provides evidence that specific aspects of mitochondrial function may play a role in SCZ, but we did not observe its broad involvement even using a large sample. Copyright © 2018 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

An Overview of State Policies Supporting Worksite Health Promotion Programs.

PubMed

VanderVeur, Jennifer; Gilchrist, Siobhan; Matson-Koffman, Dyann

2017-05-01

Worksite health promotion (WHP) programs can reduce the occurrence of cardiovascular disease risk factors. State law can encourage employers and employer-provided insurance companies to offer comprehensive WHP programs. This research examines state law authorizing WHP programs. Quantitative content analysis. Worksites or workplaces. United States (and the District of Columbia). State law in effect in 2013 authorizing WHP programs. Frequency and distribution of states with WHP laws. To determine the content of the laws for analysis and coding, we identified 18 policy elements, 12 from the Centers for Disease Control and Prevention's Worksite Health ScoreCard (HSC) and 6 additional supportive WHP strategies. We used these strategies as key words to search for laws authorizing WHP programs or select WHP elements. We calculated the number and type of WHP elements for each state with WHP laws and selected two case examples from states with comprehensive WHP laws. Twenty-four states authorized onsite WHP programs, 29 authorized WHP through employer-provided insurance plans, and 18 authorized both. Seven states had a comprehensive WHP strategy, addressing 8 or more of 12 HSC elements. The most common HSC elements were weight management, tobacco cessation, and physical activity. Most states had laws encouraging the adoption of WHP programs. Massachusetts and Maine are implementing comprehensive WHP laws but studies evaluating their health impact are needed.

DNA Glycosylases Involved in Base Excision Repair May Be Associated with Cancer Risk in BRCA1 and BRCA2 Mutation Carriers

PubMed Central

Osorio, Ana; Milne, Roger L.; Kuchenbaecker, Karoline; Vaclová, Tereza; Pita, Guillermo; Alonso, Rosario; Peterlongo, Paolo; Blanco, Ignacio; de la Hoya, Miguel; Duran, Mercedes; Díez, Orland; Ramón y Cajal, Teresa; Konstantopoulou, Irene; Martínez-Bouzas, Cristina; Andrés Conejero, Raquel; Soucy, Penny; McGuffog, Lesley; Barrowdale, Daniel; Lee, Andrew; SWE-BRCA; Arver, Brita; Rantala, Johanna; Loman, Niklas; Ehrencrona, Hans; Olopade, Olufunmilayo I.; Beattie, Mary S.; Domchek, Susan M.; Nathanson, Katherine; Rebbeck, Timothy R.; Arun, Banu K.; Karlan, Beth Y.; Walsh, Christine; Lester, Jenny; John, Esther M.; Whittemore, Alice S.; Daly, Mary B.; Southey, Melissa; Hopper, John; Terry, Mary B.; Buys, Saundra S.; Janavicius, Ramunas; Dorfling, Cecilia M.; van Rensburg, Elizabeth J.; Steele, Linda; Neuhausen, Susan L.; Ding, Yuan Chun; Hansen, Thomas v. O.; Jønson, Lars; Ejlertsen, Bent; Gerdes, Anne-Marie; Infante, Mar; Herráez, Belén; Moreno, Leticia Thais; Weitzel, Jeffrey N.; Herzog, Josef; Weeman, Kisa; Manoukian, Siranoush; Peissel, Bernard; Zaffaroni, Daniela; Scuvera, Giulietta; Bonanni, Bernardo; Mariette, Frederique; Volorio, Sara; Viel, Alessandra; Varesco, Liliana; Papi, Laura; Ottini, Laura; Tibiletti, Maria Grazia; Radice, Paolo; Yannoukakos, Drakoulis; Garber, Judy; Ellis, Steve; Frost, Debra; Platte, Radka; Fineberg, Elena; Evans, Gareth; Lalloo, Fiona; Izatt, Louise; Eeles, Ros; Adlard, Julian; Davidson, Rosemarie; Cole, Trevor; Eccles, Diana; Cook, Jackie; Hodgson, Shirley; Brewer, Carole; Tischkowitz, Marc; Douglas, Fiona; Porteous, Mary; Side, Lucy; Walker, Lisa; Morrison, Patrick; Donaldson, Alan; Kennedy, John; Foo, Claire; Godwin, Andrew K.; Schmutzler, Rita Katharina; Wappenschmidt, Barbara; Rhiem, Kerstin; Engel, Christoph; Meindl, Alfons; Ditsch, Nina; Arnold, Norbert; Plendl, Hans Jörg; Niederacher, Dieter; Sutter, Christian; Wang-Gohrke, Shan; Steinemann, Doris; Preisler-Adams, Sabine; Kast, Karin; Varon-Mateeva, Raymonda; Gehrig, Andrea; Stoppa-Lyonnet, Dominique; Sinilnikova, Olga M.; Mazoyer, Sylvie; Damiola, Francesca; Poppe, Bruce; Claes, Kathleen; Piedmonte, Marion; Tucker, Kathy; Backes, Floor; Rodríguez, Gustavo; Brewster, Wendy; Wakeley, Katie; Rutherford, Thomas; Caldés, Trinidad; Nevanlinna, Heli; Aittomäki, Kristiina; Rookus, Matti A.; van Os, Theo A. M.; van der Kolk, Lizet; de Lange, J. L.; Meijers-Heijboer, Hanne E. J.; van der Hout, A. H.; van Asperen, Christi J.; Gómez Garcia, Encarna B.; Hoogerbrugge, Nicoline; Collée, J. Margriet; van Deurzen, Carolien H. M.; van der Luijt, Rob B.; Devilee, Peter; HEBON; Olah, Edith; Lázaro, Conxi; Teulé, Alex; Menéndez, Mireia; Jakubowska, Anna; Cybulski, Cezary; Gronwald, Jacek; Lubinski, Jan; Durda, Katarzyna; Jaworska-Bieniek, Katarzyna; Johannsson, Oskar Th.; Maugard, Christine; Montagna, Marco; Tognazzo, Silvia; Teixeira, Manuel R.; Healey, Sue; Investigators, kConFab; Olswold, Curtis; Guidugli, Lucia; Lindor, Noralane; Slager, Susan; Szabo, Csilla I.; Vijai, Joseph; Robson, Mark; Kauff, Noah; Zhang, Liying; Rau-Murthy, Rohini; Fink-Retter, Anneliese; Singer, Christian F.; Rappaport, Christine; Geschwantler Kaulich, Daphne; Pfeiler, Georg; Tea, Muy-Kheng; Berger, Andreas; Phelan, Catherine M.; Greene, Mark H.; Mai, Phuong L.; Lejbkowicz, Flavio; Andrulis, Irene; Mulligan, Anna Marie; Glendon, Gord; Toland, Amanda Ewart; Bojesen, Anders; Pedersen, Inge Sokilde; Sunde, Lone; Thomassen, Mads; Kruse, Torben A.; Jensen, Uffe Birk; Friedman, Eitan; Laitman, Yael; Shimon, Shani Paluch; Simard, Jacques; Easton, Douglas F.; Offit, Kenneth; Couch, Fergus J.; Chenevix-Trench, Georgia; Antoniou, Antonis C.; Benitez, Javier

2014-01-01

Single Nucleotide Polymorphisms (SNPs) in genes involved in the DNA Base Excision Repair (BER) pathway could be associated with cancer risk in carriers of mutations in the high-penetrance susceptibility genes BRCA1 and BRCA2, given the relation of synthetic lethality that exists between one of the components of the BER pathway, PARP1 (poly ADP ribose polymerase), and both BRCA1 and BRCA2. In the present study, we have performed a comprehensive analysis of 18 genes involved in BER using a tagging SNP approach in a large series of BRCA1 and BRCA2 mutation carriers. 144 SNPs were analyzed in a two stage study involving 23,463 carriers from the CIMBA consortium (the Consortium of Investigators of Modifiers of BRCA1 and BRCA2). Eleven SNPs showed evidence of association with breast and/or ovarian cancer at p<0.05 in the combined analysis. Four of the five genes for which strongest evidence of association was observed were DNA glycosylases. The strongest evidence was for rs1466785 in the NEIL2 (endonuclease VIII-like 2) gene (HR: 1.09, 95% CI (1.03–1.16), p = 2.7×10−3) for association with breast cancer risk in BRCA2 mutation carriers, and rs2304277 in the OGG1 (8-guanine DNA glycosylase) gene, with ovarian cancer risk in BRCA1 mutation carriers (HR: 1.12 95%CI: 1.03–1.21, p = 4.8×10−3). DNA glycosylases involved in the first steps of the BER pathway may be associated with cancer risk in BRCA1/2 mutation carriers and should be more comprehensively studied. PMID:24698998

An international systematic review and meta-analysis of multisession psychosocial interventions compared with educational or minimal interventions on the HIV sex risk behaviors of people who use drugs.

PubMed

Meader, Nicholas; Semaan, Salaam; Halton, Marie; Bhatti, Henna; Chan, Melissa; Llewellyn, Alexis; Des Jarlais, Don C

2013-07-01

This systematic review and meta-analysis examines the effectiveness of multisession psychosocial interventions compared with educational interventions and minimal interventions in reducing sexual risk in people who use drugs (51 studies; 19,209 participants). We conducted comprehensive searches (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and PsychINFO 1998-2012). Outcomes (unprotected sex, condom use, or a composite outcome) were extracted by two authors and synthesised using meta-analysis. Subgroup analyses and meta-regression were conducted to explore heterogeneity. Multisession psychosocial interventions had modest additional benefits compared to educational interventions (K = 46; OR 0.86; 95% CI 0.77, 0.96), and large positive effects compared to minimal interventions (K = 7; OR 0.60; 95% CI 0.46, 0.78). Comparison with previous meta-analyses suggested limited progress in recent years in developing more effective interventions. Multisession psychosocial and educational interventions provided similar modest sexual risk reduction justifying offering educational interventions in settings with limited exposure to sexual risk reduction interventions, messages, and resources.

Enhancing the educational value of direct-to-consumer advertising of prescription drugs.

PubMed

Hwang, Monica J; Young, Henry N

The educational value of direct-to-consumer advertising (DTCA) of prescription drugs hinges on its ability to convey important benefit and risk information to consumers. However, the literacy level required to understand some of the information presented in print advertisements may hinder DTCA's ability to educate consumers. The objective of this study was to compare the comprehension and retention of benefit and risk information between consumers who viewed an original print DTCA and those who viewed an advertisement modified according to health literacy principles. An experimental design was used to conduct the study. Participants were randomly assigned to view a modified print advertisement (experimental group) or the original print advertisement (control group) for an antidepressant medication. Study participants were recruited from the University of Wisconsin Kidney Clinic. Ten true-false and 10 multiple-choice questions were developed to assess participants' comprehension and retention of benefit and risk information. A total of 120 participants were randomized to view either the original or the modified version of the advertisement. Regarding the comprehension and retention of only the benefit information, no significant differences were observed between the 2 groups. Significant differences were observed for comprehension and retention of only the risk information. The experimental group had significantly higher scores in comprehension (U = 1224; P < 0.01) and retention (U = 965; P < 0.01) of the risk information compared with the control group. These differences were also significant in multivariate analyses controlling for extraneous variables that were found to have associations with comprehension and retention of information. Study results demonstrated that the health literacy techniques used to modify the advertisement were successful in enhancing both consumers' comprehension and their retention of information presented in a print DTCA. This was especially apparent for the risk information. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Combining aneuploidy and dysplasia for colitis' cancer risk assessment outperforms current surveillance efficiency: a meta-analysis.

PubMed

Meyer, Rüdiger; Freitag-Wolf, Sandra; Blindow, Silke; Büning, Jürgen; Habermann, Jens K

2017-02-01

Cancer risk assessment for ulcerative colitis patients by evaluating histological changes through colonoscopy surveillance is still challenging. Thus, additional parameters of high prognostic impact for the development of colitis-associated carcinoma are necessary. This meta-analysis was conducted to clarify the value of aneuploidy as predictor for individual cancer risk compared with current surveillance parameters. A systematic web-based search identified studies published in English that addressed the relevance of the ploidy status for individual cancer risk during surveillance in comparison to neoplastic mucosal changes. The resulting data were included into a meta-analysis, and odds ratios (OR) were calculated for aneuploidy or dysplasia or aneuploidy plus dysplasia. Twelve studies addressing the relevance of aneuploidy compared to dyplasia were comprehensively evaluated and further used for meta-analysis. The meta-analysis revealed that aneuploidy (OR 5.31 [95 % CI 2.03, 13.93]) is an equally effective parameter for cancer risk assessment in ulcerative colitis patients as dysplasia (OR 4.93 [1.61, 15.11]). Strikingly, the combined assessment of dysplasia and aneuploidy is superior compared to applying each parameter alone (OR 8.99 [3.08, 26.26]). This meta-analysis reveals that aneuploidy is an equally effective parameter for individual cancer risk assessment in ulcerative colitis as the detection of dysplasia. More important, the combined assessment of dysplasia and aneuploidy outperforms the use of each parameter alone. We suggest image cytometry for ploidy assessment to become an additional feature of consensus criteria to individually assess cancer risk in UC.

Systems-based accident analysis in the led outdoor activity domain: application and evaluation of a risk management framework.

PubMed

Salmon, P; Williamson, A; Lenné, M; Mitsopoulos-Rubens, E; Rudin-Brown, C M

2010-08-01

Safety-compromising accidents occur regularly in the led outdoor activity domain. Formal accident analysis is an accepted means of understanding such events and improving safety. Despite this, there remains no universally accepted framework for collecting and analysing accident data in the led outdoor activity domain. This article presents an application of Rasmussen's risk management framework to the analysis of the Lyme Bay sea canoeing incident. This involved the development of an Accimap, the outputs of which were used to evaluate seven predictions made by the framework. The Accimap output was also compared to an analysis using an existing model from the led outdoor activity domain. In conclusion, the Accimap output was found to be more comprehensive and supported all seven of the risk management framework's predictions, suggesting that it shows promise as a theoretically underpinned approach for analysing, and learning from, accidents in the led outdoor activity domain. STATEMENT OF RELEVANCE: Accidents represent a significant problem within the led outdoor activity domain. This article presents an evaluation of a risk management framework that can be used to understand such accidents and to inform the development of accident countermeasures and mitigation strategies for the led outdoor activity domain.

Association of trauma, Posttraumatic Stress Disorder and Conduct Disorder: A systematic review and meta-analysis.

PubMed

Bernhard, Anka; Martinelli, Anne; Ackermann, Katharina; Saure, Daniel; Freitag, Christine M

2018-08-01

To summarize findings of previous studies on the prevalence of trauma and Posttraumatic Stress Disorder (PTSD) in Conduct Disorder (CD). We conducted a systematic review and meta-analysis following the PRISMA guidelines. EBSCOhost, PubMed, CDSR and ARIF databases were searched in October 2016, employing relevant keywords. 19 studies met inclusion criteria. Meta-analysis resulted in a lifetime PTSD prevalence of 11% (95% CI: 7-17%) in children and adolescents with CD, 14% (95% CI: 12-15%) in adults with pre-existing CD and 32% (95% CI: 25-40%) in juvenile offenders with CD. Higher lifetime PTSD prevalence was observed in individuals with than without CD, and in females compared to males with CD. Studies focusing on the association of trauma, PTSD and CD are still relatively rare. Possible comorbidity models are discussed considering psychological and biological risk factors in a comprehensive model. The high rate of PTSD in CD may be due to shared risk factors; furthermore, CD might increase the risk for comorbid PTSD due to CD inherent risk taking behavior. To study pathways of risk, especially longitudinal studies are necessary. Copyright © 2017 Elsevier Ltd. All rights reserved.

Association between appendectomy and risk of primary sclerosing cholangitis: A systematic review and meta-analysis.

PubMed

Wijarnpreecha, Karn; Panjawatanan, Panadeekarn; Mousa, Omar Y; Cheungpasitporn, Wisit; Pungpapong, Surakit; Ungprasert, Patompong

2018-04-11

Recent epidemiologic studies have suggested that appendectomy could be a risk factor for primary sclerosing cholangitis (PSC) although the results were inconsistent. This systematic review and meta-analysis was conducted to summarize all available evidence. A comprehensive literature review was conducted using MEDLINE and EMBASE database through January 2018 to identify all studies that reported the risk of PSC among individuals who had appendectomy versus those with no history of appendectomy. Effect estimates from each study were extracted and combined together using the random-effect, generic inverse variance method of DerSimonian and Laird. A total of 6 case-control studies with 2432 participants met the eligibility criteria and were included in the meta-analysis. The risk of PSC in individuals who had appendectomy was significantly higher than those with no history of appendectomy with the pooled odds ratio of 1.37 (95% CI: 1.15-1.63). The statistical heterogeneity was insignificant with an I2 of 0%. A significantly increased risk of PSC among individuals who had a history of appendectomy was found in this study. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Cancer risk of polycyclic aromatic hydrocarbons (PAHs) in the soils from Jiaozhou Bay wetland.

PubMed

Yang, Wei; Lang, Yinhai; Li, Guoliang

2014-10-01

To estimate the cancer risk exposed to the PAHs in Jiaozhou Bay wetland soils, a probabilistic health risk assessment was conducted based on Monte Carlo simulations. A sensitivity analysis was performed to determine the input variables that contribute most to the cancer risk assessment. Three age groups were selected to estimate the cancer risk via four exposure pathways (soil ingestion, food ingestion, dermal contact and inhalation). The results revealed that the 95th percentiles cancer risks for children, teens and adults were 9.11×10(-6), 1.04×10(-5) and 7.08×10(-5), respectively. The cancer risks for three age groups were at acceptable range (10(-6)-10(-4)), indicating no potential cancer risk. For different exposure pathways, food ingestion was the major exposure pathway. For 7 carcinogenic PAHs, the cancer risk caused by BaP was the highest. Sensitivity analysis demonstrated that the parameters of exposure duration (ED) and sum of converted 7 carcinogenic PAHs concentrations in soil based on BaPeq (CSsoil) contribute most to the total uncertainty. This study provides a comprehensive risk assessment on carcinogenic PAHs in Jiaozhou Bay wetland soils, and might be useful in providing potential strategies of cancer risk prevention and controlling. Copyright © 2014 Elsevier Ltd. All rights reserved.

The role of the RTEL1 rs2297440 polymorphism in the risk of glioma development: a meta-analysis.

PubMed

Zhang, Cuiping; Lu, Yu; Zhang, Xiaolian; Yang, Dongmei; Shang, Shuxin; Liu, Denghe; Jiang, Kongmei; Huang, Weiqiang

2016-07-01

The regulator of the telomere elongation helicase1 (RTEL1) gene plays a crucial role in the DNA double-stand break-repair pathway by maintaining genomic stability. Recent epidemiological studies showed that the rs2297440 polymorphism in the RTEL1 gene was a potential risk locus for glioma development, but the results were inconclusive. To clarify the association between this polymorphism and the risk of glioma, we performed a comprehensive meta-analysis. The PubMed, EMBASE, Web of Science, and China National Knowledge Infrastructure databases were systematically searched to identify all relevant published studies up to 30 August 2015. Four eligible studies were finally included. The pooled results indicated that the RTEL1 rs2297440 polymorphism moderately increased the risk of glioma in all genetic models. A comparison of the dominant model CT + CC versus TT (OR 1.40; 95 % CI 1.24-1.60; p < 0.001) indicated that having the C allele conferred a 40 % increased risk of developing glioma. In a subgroup analysis based on geographic location (Europe, Asia, and America), there was an association between the rs2297440 polymorphism and the risk of glioma in all three areas. The results of the subgroup analysis based on source of control indicated an elevated risk of glioma in population-based control studies. This meta-analysis demonstrates that the RTEL1 rs2297440 polymorphism plays a moderate, but significant role in the risk of glioma. Further studies with larger sample sizes are necessary to confirm this finding.

Cancer Risk Assessment of Polycyclic Aromatic Hydrocarbons in the Soils and Sediments of India: A Meta-Analysis.

PubMed

Tarafdar, Abhrajyoti; Sinha, Alok

2017-10-01

A carcinogenic risk assessment of polycyclic aromatic hydrocarbons in soils and sediments was conducted using the probabilistic approach from a national perspective. Published monitoring data of polycyclic aromatic hydrocarbons present in soils and sediments at different study points across India were collected and converted to their corresponding BaP equivalent concentrations. These BaP equivalent concentrations were used to evaluate comprehensive cancer risk for two different age groups. Monte Carlo simulation and sensitivity analysis were applied to quantify uncertainties of risk estimation. The analysis denotes 90% cancer risk value of 1.770E-5 for children and 3.156E-5 for adults at heavily polluted site soils. Overall carcinogenic risks of polycyclic aromatic hydrocarbons in soils of India were mostly in acceptance limits. However, the food ingestion exposure route for sediments leads them to a highly risked zone. The 90% risk values from sediments are 7.863E-05 for children and 3.999E-04 for adults. Sensitivity analysis reveals exposure duration and relative skin adherence factor for soil as the most influential parameter of the assessment, followed by BaP equivalent concentration of polycyclic aromatic hydrocarbons. For sediments, biota to sediment accumulation factor of fish in terms of BaP is most sensitive on the total outcome, followed by BaP equivalent and exposure duration. Individual exposure route analysis showed dermal contact for soils and food ingestion for sediments as the main exposure pathway. Some specific locations such as surrounding areas of Bhavnagar, Raniganj, Sunderban, Raipur, and Delhi demand potential strategies of carcinogenic risk management and reduction. The current study is probably the first attempt to provide information on the carcinogenic risk of polycyclic aromatic hydrocarbons in soil and sediments across India.

Cancer Risk Assessment of Polycyclic Aromatic Hydrocarbons in the Soils and Sediments of India: A Meta-Analysis

NASA Astrophysics Data System (ADS)

Tarafdar, Abhrajyoti; Sinha, Alok

2017-10-01

A carcinogenic risk assessment of polycyclic aromatic hydrocarbons in soils and sediments was conducted using the probabilistic approach from a national perspective. Published monitoring data of polycyclic aromatic hydrocarbons present in soils and sediments at different study points across India were collected and converted to their corresponding BaP equivalent concentrations. These BaP equivalent concentrations were used to evaluate comprehensive cancer risk for two different age groups. Monte Carlo simulation and sensitivity analysis were applied to quantify uncertainties of risk estimation. The analysis denotes 90% cancer risk value of 1.770E-5 for children and 3.156E-5 for adults at heavily polluted site soils. Overall carcinogenic risks of polycyclic aromatic hydrocarbons in soils of India were mostly in acceptance limits. However, the food ingestion exposure route for sediments leads them to a highly risked zone. The 90% risk values from sediments are 7.863E-05 for children and 3.999E-04 for adults. Sensitivity analysis reveals exposure duration and relative skin adherence factor for soil as the most influential parameter of the assessment, followed by BaP equivalent concentration of polycyclic aromatic hydrocarbons. For sediments, biota to sediment accumulation factor of fish in terms of BaP is most sensitive on the total outcome, followed by BaP equivalent and exposure duration. Individual exposure route analysis showed dermal contact for soils and food ingestion for sediments as the main exposure pathway. Some specific locations such as surrounding areas of Bhavnagar, Raniganj, Sunderban, Raipur, and Delhi demand potential strategies of carcinogenic risk management and reduction. The current study is probably the first attempt to provide information on the carcinogenic risk of polycyclic aromatic hydrocarbons in soil and sediments across India.

Genetic Polymorphism of Angiotensin-Converting Enzyme and Chronic Obstructive Pulmonary Disease Risk: An Updated Meta-Analysis

PubMed Central

Kang, Sang Wook; Kim, Su Kang; Jung, Hee-Jae; Kim, Kwan-Il; Kim, Jinju

2016-01-01

The relationship between polymorphism of the angiotensin I converting enzyme (ACE) gene and chronic obstructive pulmonary disease (COPD) has been examined in many previous studies. However, their results were controversial. Therefore, we performed a meta-analysis to evaluate the relationship between the ACE gene and the risk of COPD. Fourteen case-control studies were included in this meta-analysis. The pooled p value, odds ratio (OR), and 95% confidence interval (95% CI) were used to investigate the strength of the association. The meta-analysis was performed using comprehensive meta-analysis software. Our meta-analysis results revealed that ACE polymorphisms were not related to the risk of COPD (p > 0.05 in each model). In further analyses based on ethnicity, we observed an association between insertion/deletion polymorphism of the ACE gene and risk of COPD in the Asian population (codominant 2, OR = 3.126, 95% CI = 1.919–5.093, p < 0.001; recessive, OR = 3.326, 95% CI = 2.190–5.050, p < 0.001) but not in the Caucasian population (p > 0.05 in each model). In conclusion, the present meta-analysis indicated that the insertion/deletion polymorphism of the ACE gene may be associated with susceptibility to COPD in the Asian population but not in the Caucasian population. However, the results of the present meta-analysis need to be confirmed in a larger sample. PMID:27830153

Adolescent views on comprehensive health risk assessment and counseling: assessing gender differences.

PubMed

Kadivar, Hajar; Thompson, Lindsay; Wegman, Martin; Chisholm, TaJuana; Khan, Maryum; Eddleton, Katie; Muszynski, Michael; Shenkman, Elizabeth

2014-07-01

Adolescence is an important time for the detection of health risk behaviors and factors with subsequent counseling and intervention. Limited research has examined adolescent perceptions of comprehensive health risk assessments (HRAs) and counseling with an assessment of gender differences. Participants were identified using Florida's Medicaid and State Children's Health Insurance Program databases. A total of 35 low-income, racially/ethnically diverse adolescents (ages 14-18 years) participated in eight focus groups stratified by gender. Adolescents completed an internet-based, tablet-administered, comprehensive HRA and then participated in a semi-structured interview. Discussions were recorded, transcribed, and analyzed using a multi-step, team-based approach applying grounded theory to determine major themes. Male adolescents desired less parental involvement, had less understanding of the protections of clinical confidentiality and the need for comprehensive HRA, and placed greater emphasis on the importance of professional appearance. In contrast, more females valued face-to-face interactions and stressed the importance of concern from the health risk assessor. Overall, adolescents placed importance on their relationship with the health risk assessor, and on valuing trust, confidentiality, and nonjudgmental care. Adolescents preferred to complete HRAs in clinical, private, and professional settings, and reported that tablet technology supported their confidentially in completing the HRA. Furthermore, they stressed the importance of autonomy and learning about the health risk outcomes for risk reduction. Gender differences exist in adolescent perceptions of comprehensive HRAs. Adolescent perceptions of HRAs support their use in confidential primary care settings using modalities that emphasize nonjudgmental, private care, and the use of communication techniques that respect adolescents' autonomy to change health risks. Copyright © 2014. Published by Elsevier Inc.

Novel risk score of contrast-induced nephropathy after percutaneous coronary intervention.

PubMed

Ji, Ling; Su, XiaoFeng; Qin, Wei; Mi, XuHua; Liu, Fei; Tang, XiaoHong; Li, Zi; Yang, LiChuan

2015-08-01

Contrast-induced nephropathy (CIN) post-percutaneous coronary intervention (PCI) is a major cause of acute kidney injury. In this study, we established a comprehensive risk score model to assess risk of CIN after PCI procedure, which could be easily used in a clinical environment. A total of 805 PCI patients, divided into analysis cohort (70%) and validation cohort (30%), were enrolled retrospectively in this study. Risk factors for CIN were identified using univariate analysis and multivariate logistic regression in the analysis cohort. Risk score model was developed based on multiple regression coefficients. Sensitivity and specificity of the new risk score system was validated in the validation cohort. Comparisons between the new risk score model and previous reported models were applied. The incidence of post-PCI CIN in the analysis cohort (n = 565) was 12%. Considerably high CIN incidence (50%) was observed in patients with chronic kidney disease (CKD). Age >75, body mass index (BMI) >25, myoglobin level, cardiac function level, hypoalbuminaemia, history of chronic kidney disease (CKD), Intra-aortic balloon pump (IABP) and peripheral vascular disease (PVD) were identified as independent risk factors of post-PCI CIN. A novel risk score model was established using multivariate regression coefficients, which showed highest sensitivity and specificity (0.917, 95%CI 0.877-0.957) compared with previous models. A new post-PCI CIN risk score model was developed based on a retrospective study of 805 patients. Application of this model might be helpful to predict CIN in patients undergoing PCI procedure. © 2015 Asian Pacific Society of Nephrology.

Fine-mapping identifies multiple prostate cancer risk loci at 5p15, one of which associates with TERT expression

PubMed Central

Kote-Jarai, Zsofia; Saunders, Edward J.; Leongamornlert, Daniel A.; Tymrakiewicz, Malgorzata; Dadaev, Tokhir; Jugurnauth-Little, Sarah; Ross-Adams, Helen; Al Olama, Ali Amin; Benlloch, Sara; Halim, Silvia; Russel, Roslin; Dunning, Alison M.; Luccarini, Craig; Dennis, Joe; Neal, David E.; Hamdy, Freddie C.; Donovan, Jenny L.; Muir, Ken; Giles, Graham G.; Severi, Gianluca; Wiklund, Fredrik; Gronberg, Henrik; Haiman, Christopher A.; Schumacher, Fredrick; Henderson, Brian E.; Le Marchand, Loic; Lindstrom, Sara; Kraft, Peter; Hunter, David J.; Gapstur, Susan; Chanock, Stephen; Berndt, Sonja I.; Albanes, Demetrius; Andriole, Gerald; Schleutker, Johanna; Weischer, Maren; Canzian, Federico; Riboli, Elio; Key, Tim J.; Travis, Ruth C.; Campa, Daniele; Ingles, Sue A.; John, Esther M.; Hayes, Richard B.; Pharoah, Paul; Khaw, Kay-Tee; Stanford, Janet L.; Ostrander, Elaine A.; Signorello, Lisa B.; Thibodeau, Stephen N.; Schaid, Dan; Maier, Christiane; Vogel, Walther; Kibel, Adam S.; Cybulski, Cezary; Lubinski, Jan; Cannon-Albright, Lisa; Brenner, Hermann; Park, Jong Y.; Kaneva, Radka; Batra, Jyotsna; Spurdle, Amanda; Clements, Judith A.; Teixeira, Manuel R.; Govindasami, Koveela; Guy, Michelle; Wilkinson, Rosemary A.; Sawyer, Emma J.; Morgan, Angela; Dicks, Ed; Baynes, Caroline; Conroy, Don; Bojesen, Stig E.; Kaaks, Rudolf; Vincent, Daniel; Bacot, François; Tessier, Daniel C.; Easton, Douglas F.; Eeles, Rosalind A.

2013-01-01

Associations between single nucleotide polymorphisms (SNPs) at 5p15 and multiple cancer types have been reported. We have previously shown evidence for a strong association between prostate cancer (PrCa) risk and rs2242652 at 5p15, intronic in the telomerase reverse transcriptase (TERT) gene that encodes TERT. To comprehensively evaluate the association between genetic variation across this region and PrCa, we performed a fine-mapping analysis by genotyping 134 SNPs using a custom Illumina iSelect array or Sequenom MassArray iPlex, followed by imputation of 1094 SNPs in 22 301 PrCa cases and 22 320 controls in The PRACTICAL consortium. Multiple stepwise logistic regression analysis identified four signals in the promoter or intronic regions of TERT that independently associated with PrCa risk. Gene expression analysis of normal prostate tissue showed evidence that SNPs within one of these regions also associated with TERT expression, providing a potential mechanism for predisposition to disease. PMID:23535824

Use of multicriteria decision analysis for assessing the benefit and risk of over-the-counter analgesics.

PubMed

Moore, Andrew; Crossley, Anne; Ng, Bernard; Phillips, Lawrence; Sancak, Özgür; Rainsford, K D

2017-10-01

To test the ability of a multicriteria decision analysis (MCDA) model to incorporate disparate data sources of varying quality along with clinical judgement in a benefit-risk assessment of six well-known pain-relief drugs. Six over-the-counter (OTC) analgesics were evaluated against three favourable effects and eight unfavourable effects by seven experts who specialise in the relief of pain, two in a 2-day facilitated workshop whose input data and judgements were later peer-reviewed by five additional experts. Ibuprofen salts and solubilised emerged with the best benefit-risk profile, followed by naproxen, ibuprofen acid, diclofenac, paracetamol and aspirin. Multicriteria decision analysis enabled participants to evaluate the OTC analgesics against a range of favourable and unfavourable effects in a group setting that enabled all issues to be openly aired and debated. The model was easily communicated and understood by the peer reviewers, so the model should be comprehensible to physicians, pharmacists and other health professionals. © 2017 Royal Pharmaceutical Society.

Comprehensive Environmental Assessment and U.S. EPA Nanomaterial Case Studies

EPA Science Inventory

These case studies are not completed risk assessments but are structured around an approach known as comprehensive environmental assessment (CEA), which combines a product life cycle framework with the risk assessment paradigm (Davis, J.M., J. Nanosci. Nanotech. 7:402-9, 2007). ...

Effect of an enhanced medical home on serious illness and cost of care among high-risk children with chronic illness: a randomized clinical trial.

PubMed

Mosquera, Ricardo A; Avritscher, Elenir B C; Samuels, Cheryl L; Harris, Tomika S; Pedroza, Claudia; Evans, Patricia; Navarro, Fernando; Wootton, Susan H; Pacheco, Susan; Clifton, Guy; Moody, Shade; Franzini, Luisa; Zupancic, John; Tyson, Jon E

Patient-centered medical homes have not been shown to reduce adverse outcomes or costs in adults or children with chronic illness. To assess whether an enhanced medical home providing comprehensive care prevents serious illness (death, intensive care unit [ICU] admission, or hospital stay >7 days) and/or reduces costs among children with chronic illness. Randomized clinical trial of high-risk children with chronic illness (≥3 emergency department visits, ≥2 hospitalizations, or ≥1 pediatric ICU admissions during previous year, and >50% estimated risk for hospitalization) treated at a high-risk clinic at the University of Texas, Houston, and randomized to comprehensive care (n = 105) or usual care (n = 96). Enrollment was between March 2011 and February 2013 (when predefined stopping rules for benefit were met) and outcome evaluations continued through August 31, 2013. Comprehensive care included treatment from primary care clinicians and specialists in the same clinic with multiple features to promote prompt effective care. Usual care was provided locally in private offices or faculty-supervised clinics without modification. Primary outcome: children with a serious illness (death, ICU admission, or hospital stay >7 days), costs (health system perspective). Secondary outcomes: individual serious illnesses, medical services, Medicaid payments, and medical school revenues and costs. In an intent-to-treat analysis, comprehensive care decreased both the rate of children with a serious illness (10 per 100 child-years vs 22 for usual care; rate ratio [RR], 0.45 [95% CI, 0.28-0.73]), and total hospital and clinic costs ($16,523 vs $26,781 per child-year, respectively; cost ratio, 0.58 [95% CI, 0.38-0.88]). In analyses of net monetary benefit, the probability that comprehensive care was cost neutral or cost saving was 97%. Comprehensive care reduced (per 100 child-years) serious illnesses (16 vs 44 for usual care; RR, 0.33 [95% CI, 0.17-0.66]), emergency department visits (90 vs 190; RR, 0.48 [95% CI, 0.34-0.67]), hospitalizations (69 vs 131; RR, 0.51 [95% CI, 0.33-0.77]), pediatric ICU admissions (9 vs 26; RR, 0.35 [95% CI, 0.18-0.70]), and number of days in a hospital (276 vs 635; RR, 0.36 [95% CI, 0.19-0.67]). Medicaid payments were reduced by $6243 (95% CI, $1302-$11,678) per child-year. Medical school losses (costs minus revenues) increased by $6018 (95% CI, $5506-$6629) per child-year. Among high-risk children with chronic illness, an enhanced medical home that provided comprehensive care to promote prompt effective care vs usual care reduced serious illnesses and costs. These findings from a single site of selected patients with a limited number of clinicians require study in larger, broader populations before conclusions about generalizability to other settings can be reached. clinicaltrials.gov Identifier: NCT02128776.

The Effectiveness and Risks of Fluoroscopically-Guided Cervical Medial Branch Thermal Radiofrequency Neurotomy: A Systematic Review with Comprehensive Analysis of the Published Data.

PubMed

Engel, Andrew; Rappard, George; King, Wade; Kennedy, David J

2016-04-01

To determine the effectiveness and risks of fluoroscopically-guided cervical medial branch thermal radiofrequency neurotomy (CMBTRFN) for treating chronic neck pain of zygapophysial joint origin. Systematic review of the literature with comprehensive analysis of the published data. Four reviewers formally trained in evidence-based medicine searched the literature on CMBTRFN. Each assessed the methodologies of studies found and appraised the quality of evidence presented. The primary outcomes assessed were 100% relief of pain 6 and 12 months after treatment. Other outcomes were noted if reported. The evidence was evaluated in accordance with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system. The searches yielded eight primary publications on the effectiveness of the procedure. The evidence shows a majority of patients were pain free at 6 months and over a third were pain free at 1 year. The number needed to treat for complete pain relief at 6 months is 2. The evidence of effectiveness is of high quality according to the GRADE system. Twelve papers were found reporting unwanted effects, most of which are minor and temporary. No serious complications have ever been reported from procedures performed according to the published guidelines. The evidence of risks is of low quality according to the GRADE system. If performed as described in the International Spine Intervention Society Guidelines, fluoroscopically-guided CMBTRFN is effective for abolishing zygapophysial joint pain and carries only minor risks. © 2015 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Does Iconicity in Pictographs Matter? The Influence of Iconicity and Numeracy on Information Processing, Decision Making, and Liking in an Eye-Tracking Study.

PubMed

Kreuzmair, Christina; Siegrist, Michael; Keller, Carmen

2017-03-01

Researchers recommend the use of pictographs in medical risk communication to improve people's risk comprehension and decision making. However, it is not yet clear whether the iconicity used in pictographs to convey risk information influences individuals' information processing and comprehension. In an eye-tracking experiment with participants from the general population (N = 188), we examined whether specific types of pictograph icons influence the processing strategy viewers use to extract numerical information. In addition, we examined the effect of iconicity and numeracy on probability estimation, recall, and icon liking. This experiment used a 2 (iconicity: blocks vs. restroom icons) × 2 (scenario: medical vs. nonmedical) between-subject design. Numeracy had a significant effect on information processing strategy, but we found no effect of iconicity or scenario. Results indicated that both icon types enabled high and low numerates to use their default way of processing and extracting the gist of the message from the pictorial risk communication format: high numerates counted icons, whereas low numerates used large-area processing. There was no effect of iconicity in the probability estimation. However, people who saw restroom icons had a higher probability of correctly recalling the exact risk level. Iconicity had no effect on icon liking. Although the effects are small, our findings suggest that person-like restroom icons in pictographs seem to have some advantages for risk communication. Specifically, in nonpersonalized prevention brochures, person-like restroom icons may maintain reader motivation for processing the risk information. © 2016 Society for Risk Analysis.

Reconceptualising risk: Perceptions of risk in rural and remote maternity service planning.

PubMed

Barclay, Lesley; Kornelsen, Jude; Longman, Jo; Robin, Sarah; Kruske, Sue; Kildea, Sue; Pilcher, Jennifer; Martin, Tanya; Grzybowski, Stefan; Donoghue, Deborah; Rolfe, Margaret; Morgan, Geoff

2016-07-01

to explore perceptions and examples of risk related to pregnancy and childbirth in rural and remote Australia and how these influence the planning of maternity services. data collection in this qualitative component of a mixed methods study included 88 semi-structured individual and group interviews (n=102), three focus groups (n=22) and one group information session (n=17). Researchers identified two categories of risk for exploration: health services risk (including clinical and corporate risks) and social risk (including cultural, emotional and financial risks). Data were aggregated and thematically analysed to identify perceptions and examples of risk related to each category. fieldwork was conducted in four jurisdictions at nine sites in rural (n=3) and remote (n=6) Australia. 117 health service employees and 24 consumers. examples and perceptions relating to each category of risk were identified from the data. Most medical practitioners and health service managers perceived clinical risks related to rural birthing services without access to caesarean section. Consumer participants were more likely to emphasise social risks arising from a lack of local birthing services. our analysis demonstrated that the closure of services adds social risk, which exacerbates clinical risk. Analysis also highlighted that perceptions of clinical risk are privileged over social risk in decisions about rural and remote maternity service planning. a comprehensive analysis of risk that identifies how social and other forms of risk contribute to adverse clinical outcomes would benefit rural and remote people and their health services. Formal risk analyses should consider the risks associated with failure to provide birthing services in rural and remote communities as well as the risks of maintaining services. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Economic evaluation of a comprehensive teenage pregnancy prevention program: pilot program.

PubMed

Rosenthal, Marjorie S; Ross, Joseph S; Bilodeau, Roseanne; Richter, Rosemary S; Palley, Jane E; Bradley, Elizabeth H

2009-12-01

Previous research has suggested that comprehensive teenage pregnancy prevention programs that address sexual education and life skills development and provide academic support are effective in reducing births among enrolled teenagers. However, there have been limited data on the costs and cost effectiveness of such programs. The study used a community-based participatory research approach to develop estimates of the cost-benefit of the Pathways/Senderos Center, a comprehensive neighborhood-based program to prevent unintended pregnancies and promote positive development for adolescents. Using data from 1997-2003, an in-time intervention analysis was conducted to determine program cost-benefit while teenagers were enrolled; an extrapolation analysis was then used to estimate accrued economic benefits and cost-benefit up to age 30 years. The program operating costs totaled $3,228,152.59 and reduced the teenage childbearing rate from 94.10 to 40.00 per 1000 teenage girls, averting $52,297.84 in total societal costs, with an economic benefit to society from program participation of $2,673,153.11. Therefore, total costs to society exceeded economic benefits by $559,677.05, or $1599.08 per adolescent per year. In an extrapolation analysis, benefits to society exceed costs by $10,474.77 per adolescent per year by age 30 years on average, with social benefits outweighing total social costs by age 20.1 years. This comprehensive teenage pregnancy prevention program is estimated to provide societal economic benefits once participants are young adults, suggesting the need to expand beyond pilot demonstrations and evaluate the long-range cost effectiveness of similarly comprehensive programs when they are implemented more widely in high-risk neighborhoods.

Economic Evaluation of a Comprehensive Teenage Pregnancy Prevention Program: Pilot Program

PubMed Central

Rosenthal, Marjorie S.; Ross, Joseph S.; Bilodeau, RoseAnne; Richter, Rosemary S.; Palley, Jane E.; Bradley, Elizabeth H.

2011-01-01

Background Previous research has suggested that comprehensive teenage pregnancy prevention programs that address sexual education and life skills development and provide academic are effective in reducing births among enrolled teenagers. However, there have been limited data on costs and cost-effectiveness of such programs. Objectives To use a community-based participatory research approach, to develop estimates of the cost-benefit of the Pathways/Senderos Center, a comprehensive neighborhood-based program to prevent unintended pregnancies and promote positive development for adolescents. Methods Using data from 1997-2003, we conducted an in-time intervention analysis to determine program cost-benefit while teenagers were enrolled and then used an extrapolation analysis to estimate accyrred economibc benefits and cost-benefit up to age 30. Results The program operating costs totaled $3,228,152.59 and reduced the teenage childbearing rate from 94.10 to 40.00 per 1000 teenage females, averting $52,297.84 in total societal costs, with an economic benefit to society from program participation of $2,673,153.11. Therefore, total costs to society exceeded economic benefits by $559,677.05, or $1,599.08 per adolescent per year. In an extrapolation analysis, benefits to society exceed costs by $10,474.77 per adolescent per year by age 30 on average, with social benefits outweighing total social costs by age 20.1. Conclusions We estimate that this comprehensive teenage pregnancy prevention program would provide societal economic benefits once participants are young adults, suggesting the need to expand beyond pilot demonstrations and evaluate the long-range cost-effectiveness of similarly comprehensive programs when implemented more widely in high-risk neighborhoods. PMID:19896030

Comprehensive assessment of nutritional status and associated factors in the healthy, community-dwelling elderly.

PubMed

Iizaka, Shinji; Tadaka, Etsuko; Sanada, Hiromi

2008-03-01

Malnutrition among the elderly has become a serious problem as their population increases in Japan. To approach the risk of malnutrition in the healthy, community-dwelling elderly is important for early prevention of malnutrition. The nutritional status and mutable associated factors with poor nutritional status specific to the healthy elderly were examined comprehensively. One hundred and thirty healthy elderly people from a senior college in Tokyo, Japan were eligible for this study. Nutritional status was evaluated by Mini-Nutritional Assessment (MNA). The demographic status and potential correlates with poor nutritional status, including the physical factors (mobility, cognitive impairment and oral status) and the psychosocial factors (depression, self-efficacy, attitudes toward health, instrumental activities of daily living, public health service knowledge, and difficulty and dissatisfaction with meal preparation) were investigated. The multiple linear regression analysis using a stepwise procedure adjusted for demographic status was performed to detect independent associated factors. There were 16 participants (12.6%) at risk of malnutrition. The independent associated factors with lower MNA scores were depression (beta = -0.27, P = 0.005), lower self-efficacy (beta = 0.25, P = 0.009), lower attitudes toward health scores (beta = 0.21, P = 0.02) and difficulty with meal preparation (beta = -0.18, P = 0.03). The prevalence of the healthy elderly at the initial risk of malnutrition was relatively high and should not be overlooked. The comprehensive geriatric screening and intervention including mental health, health management and life-situation will be important for the healthy, community-dwelling elderly.

Baseline characteristics predict risk of progression and response to combined medical therapy for benign prostatic hyperplasia (BPH).

PubMed

Kozminski, Michael A; Wei, John T; Nelson, Jason; Kent, David M

2015-02-01

To better risk stratify patients, using baseline characteristics, to help optimise decision-making for men with moderate-to-severe lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) through a secondary analysis of the Medical Therapy of Prostatic Symptoms (MTOPS) trial. After review of the literature, we identified potential baseline risk factors for BPH progression. Using bivariate tests in a secondary analysis of MTOPS data, we determined which variables retained prognostic significance. We then used these factors in Cox proportional hazard modelling to: i) more comprehensively risk stratify the study population based on pre-treatment parameters and ii) to determine which risk strata stood to benefit most from medical intervention. In all, 3047 men were followed in MTOPS for a mean of 4.5 years. We found varying risks of progression across quartiles. Baseline BPH Impact Index score, post-void residual urine volume, serum prostate-specific antigen (PSA) level, age, American Urological Association Symptom Index score, and maximum urinary flow rate were found to significantly correlate with overall BPH progression in multivariable analysis. Using baseline factors permits estimation of individual patient risk for clinical progression and the benefits of medical therapy. A novel clinical decision tool based on these analyses will allow clinicians to weigh patient-specific benefits against possible risks of adverse effects for a given patient. © 2014 The Authors. BJU International © 2014 BJU International.

Falls screening and assessment tools used in acute mental health settings: a review of policies in England and Wales

PubMed Central

Narayanan, V.; Dickinson, A.; Victor, C.; Griffiths, C.; Humphrey, D.

2016-01-01

Objectives There is an urgent need to improve the care of older people at risk of falls or who experience falls in mental health settings. The aims of this study were to evaluate the individual falls risk assessment tools adopted by National Health Service (NHS) mental health trusts in England and healthcare boards in Wales, to evaluate the comprehensiveness of these tools and to review their predictive validity. Methods All NHS mental health trusts in England (n = 56) and healthcare boards in Wales (n = 6) were invited to supply their falls policies and other relevant documentation (e.g. local falls audits). In order to check the comprehensiveness of tools listed in policy documents, the risk variables of the tools adopted by the mental health trusts’ policies were compared with the 2004 National Institute for Health and Care Excellence (NICE) falls prevention guidelines. A comprehensive analytical literature review was undertaken to evaluate the predictive validity of the tools used in these settings. Results Falls policies were obtained from 46 mental health trusts. Thirty-five policies met the study inclusion criteria and were included in the analysis. The main falls assessment tools used were the St. Thomas’ Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY), Falls Risk Assessment Scale for the Elderly, Morse Falls Scale (MFS) and Falls Risk Assessment Tool (FRAT). On detailed examination, a number of different versions of the FRAT were evident; validated tools had inconsistent predictive validity and none of them had been validated in mental health settings. Conclusions Falls risk assessment is the most commonly used component of risk prevention strategies, but most policies included unvalidated tools and even well validated tool such as the STRATIFY and the MFS that are reported to have inconsistent predictive accuracy. This raises questions about operational usefulness, as none of these tools have been tested in acute mental health settings. The falls risk assessment tools from only four mental health trusts met all the recommendations of the NICE falls guidelines on multifactorial assessment for prevention of falls. The recent NICE (2013) guidance states that tools predicting risk using numeric scales should no longer be used; however, multifactorial risk assessment and interventions tailored to patient needs is recommended. Trusts will need to update their policies in response to this guidance. PMID:26395210

MANAGEMENT OF ENDOCRINE DISEASE: Suicide risk in patients with diabetes: a systematic review and meta-analysis.

PubMed

Wang, Bin; An, Xiaofei; Shi, Xiaohong; Zhang, Jin-An

2017-10-01

Previous studies investigating the risk of suicide in diabetes patients reported controversial findings. We did a systematic review and meta-analysis to comprehensively estimate the risk and incidence rate of suicide in diabetic patients. PubMed, EMBASE and PsycINFO were searched for eligible studies. Random-effects meta-analysis was used to calculate the relative risk (RR) and the incidence rate of suicide in diabetes patients. We also calculated the proportion of deaths attributable to suicide among diabetes patients. 54 studies were finally included, including 28 studies on the suicide risk associated with diabetes, 47 studies on the incidence rate of suicide and 45 studies on the proportion of deaths attributable to suicide. Meta-analysis showed that diabetes could significantly increase the risk of suicide (RR = 1.56; 95% CI: 1.29-1.89; P  < 0.001). Subgroup analysis showed that the RR of suicide associated with type 1 diabetes was 2.25 (95% CI: 1.50-3.38; P  < 0.001). The pooled incidence rate of suicide in patients with diabetes was 2.35 per 10 000 person-years (95% CI: 1.51-3.64). The pooled proportions of long-term deaths attributable to suicide in type 1 diabetes patients and type 2 diabetes patients were 7.7% (95% CI: 6.0-9.8) and 1.3% (95% CI: 0.6-2.6), respectively. This meta-analysis suggests that diabetes can significantly increase the risk of suicide. Suicide has an obvious contribution to mortality in diabetic patients, especially among type 1 diabetes patients. Effective strategies to decrease suicide risk and improve mental health outcomes in diabetes patients are needed. © 2017 European Society of Endocrinology.

Vulnerability Analysis and Evaluation of Urban Road System in Tianjin

NASA Astrophysics Data System (ADS)

Liu, Y. Q.; Wu, X.

In recent years, with the development of economy, the road construction of our country has entered into a period of rapid growth. The road transportation network has been expanding and the risk of disasters is increasing. In this paper we study the vulnerability of urban road system in Tianjin. After analyzed many risk factors of the urban road system security, including road construction, road traffic and the natural environment, we proposed an evaluation index of vulnerability of urban road system and established the corresponding evaluation index system. Based on the results of analysis and comprehensive evaluation, appropriate improvement measures and suggestions which may reduce the vulnerability of the road system and improve the safety and reliability of the road system are proposed.

A comprehensive Network Security Risk Model for process control networks.

PubMed

Henry, Matthew H; Haimes, Yacov Y

2009-02-01

The risk of cyber attacks on process control networks (PCN) is receiving significant attention due to the potentially catastrophic extent to which PCN failures can damage the infrastructures and commodity flows that they support. Risk management addresses the coupled problems of (1) reducing the likelihood that cyber attacks would succeed in disrupting PCN operation and (2) reducing the severity of consequences in the event of PCN failure or manipulation. The Network Security Risk Model (NSRM) developed in this article provides a means of evaluating the efficacy of candidate risk management policies by modeling the baseline risk and assessing expectations of risk after the implementation of candidate measures. Where existing risk models fall short of providing adequate insight into the efficacy of candidate risk management policies due to shortcomings in their structure or formulation, the NSRM provides model structure and an associated modeling methodology that captures the relevant dynamics of cyber attacks on PCN for risk analysis. This article develops the NSRM in detail in the context of an illustrative example.

Eye-Tracking Evidence that Happy Faces Impair Verbal Message Comprehension: The Case of Health Warnings in Direct-to-Consumer Pharmaceutical Television Commercials

PubMed Central

Russell, Cristel Antonia; Swasy, John L.; Russell, Dale Wesley; Engel, Larry

2017-01-01

Risk warning or disclosure information in advertising is only effective in correcting consumers’ judgments if enough cognitive capacity is available to process that information. Hence, comprehension of verbal warnings in TV commercials may suffer if accompanied by positive visual elements. This research addresses this concern about cross-modality interference in the context of direct-to-consumer (DTC) pharmaceutical commercials in the United States by experimentally testing whether positive facial expressions reduce consumers’ understanding of the mandated health warning. A content analysis of a sample of DTC commercials reveals that positive facial expressions are more prevalent during the verbal warning act of the commercials than during the other acts. An eye-tracking experiment conducted with specially produced DTC commercials, which vary the valence of characters’ facial expressions during the health warning, provides evidence that happy faces reduce objective comprehension of the warning. PMID:29269979

Conceptual compression discussion on a multi-linear (FTA) and systematic (FRAM) method in an offshore operation's accident modeling.

PubMed

Toroody, Ahmad Bahoo; Abaei, Mohammad Mahdy; Gholamnia, Reza

2016-12-01

Risk assessment can be classified into two broad categories: traditional and modern. This paper is aimed at contrasting the functional resonance analysis method (FRAM) as a modern approach with the fault tree analysis (FTA) as a traditional method, regarding assessing the risks of a complex system. Applied methodology by which the risk assessment is carried out, is presented in each approach. Also, FRAM network is executed with regard to nonlinear interaction of human and organizational levels to assess the safety of technological systems. The methodology is implemented for lifting structures deep offshore. The main finding of this paper is that the combined application of FTA and FRAM during risk assessment, could provide complementary perspectives and may contribute to a more comprehensive understanding of an incident. Finally, it is shown that coupling a FRAM network with a suitable quantitative method will result in a plausible outcome for a predefined accident scenario.

Evolving dynamics of trading behavior based on coordination game in complex networks

NASA Astrophysics Data System (ADS)

Bian, Yue-tang; Xu, Lu; Li, Jin-sheng

2016-05-01

This work concerns the modeling of evolvement of trading behavior in stock markets. Based on the assumption of the investors' limited rationality, the evolution mechanism of trading behavior is modeled according to the investment strategy of coordination game in network, that investors are prone to imitate their neighbors' activity through comprehensive analysis on the risk dominance degree of certain investment behavior, the network topology of their relationship and its heterogeneity. We investigate by mean-field analysis and extensive simulations the evolution of investors' trading behavior in various typical networks under different risk dominance degree of investment behavior. Our results indicate that the evolution of investors' behavior is affected by the network structure of stock market and the effect of risk dominance degree of investment behavior; the stability of equilibrium states of investors' behavior dynamics is directly related with the risk dominance degree of some behavior; connectivity and heterogeneity of the network plays an important role in the evolution of the investment behavior in stock market.

A novel eQTL-based analysis reveals the biology of breast cancer risk loci

PubMed Central

Li, Qiyuan; Seo, Ji-Heui; Stranger, Barbara; McKenna, Aaron; Pe'er, Itsik; LaFramboise, Thomas; Brown, Myles; Tyekucheva, Svitlana; Freedman, Matthew L.

2014-01-01

Summary Germline determinants of gene expression in tumors are less studied due to the complexity of transcript regulation caused by somatically acquired alterations. We performed expression quantitative trait locus (eQTL) based analyses using the multi-level information provided in The Cancer Genome Atlas (TCGA). Of the factors we measured, cis-acting eQTL saccounted for 1.2% of the total variation of tumor gene expression, while somatic copy number alteration and CpG methylation accounted for 7.3% and 3.3%, respectively. eQTL analyses of 15 previously reported breast cancer risk loci resulted in discovery of three variants that are significantly associated with transcript levels (FDR<0.1). In a novel trans- based analysis, an additional three risk loci were identified to act through ESR1, MYC, and KLF4. These findings provide a more comprehensive picture of gene expression determinants in breast cancer as well as insights into the underlying biology of breast cancer risk loci. PMID:23374354

Integrative Application of Life Cycle Assessment and Risk Assessment to Environmental Impacts of Anthropogenic Pollutants at a Watershed Scale.

PubMed

Lin, Xiaodan; Yu, Shen; Ma, Hwongwen

2018-01-01

Intense human activities have led to increasing deterioration of the watershed environment via pollutant discharge, which threatens human health and ecosystem function. To meet a need of comprehensive environmental impact/risk assessment for sustainable watershed development, a biogeochemical process-based life cycle assessment and risk assessment (RA) integration for pollutants aided by geographic information system is proposed in this study. The integration is to frame a conceptual protocol of "watershed life cycle assessment (WLCA) for pollutants". The proposed WLCA protocol consists of (1) geographic and environmental characterization mapping; (2) life cycle inventory analysis; (3) integration of life-cycle impact assessment (LCIA) with RA via characterization factor of pollutant of interest; and (4) result analysis and interpretation. The WLCA protocol can visualize results of LCIA and RA spatially for the pollutants of interest, which might be useful for decision or policy makers for mitigating impacts of watershed development.

Comprehensive multilevel in vivo and in vitro analysis of heart rate fluctuations in mice by ECG telemetry and electrophysiology.

PubMed

Fenske, Stefanie; Pröbstle, Rasmus; Auer, Franziska; Hassan, Sami; Marks, Vanessa; Pauza, Danius H; Biel, Martin; Wahl-Schott, Christian

2016-01-01

The normal heartbeat slightly fluctuates around a mean value; this phenomenon is called physiological heart rate variability (HRV). It is well known that altered HRV is a risk factor for sudden cardiac death. The availability of genetic mouse models makes it possible to experimentally dissect the mechanism of pathological changes in HRV and its relation to sudden cardiac death. Here we provide a protocol that allows for a comprehensive multilevel analysis of heart rate (HR) fluctuations. The protocol comprises a set of techniques that include in vivo telemetry and in vitro electrophysiology of intact sinoatrial network preparations or isolated single sinoatrial node (SAN) cells. In vitro preparations can be completed within a few hours, with data acquisition within 1 d. In vivo telemetric ECG requires 1 h for surgery and several weeks for data acquisition and analysis. This protocol is of interest to researchers investigating cardiovascular physiology and the pathophysiology of sudden cardiac death.

A modelling tool for policy analysis to support the design of efficient and effective policy responses for complex public health problems.

PubMed

Atkinson, Jo-An; Page, Andrew; Wells, Robert; Milat, Andrew; Wilson, Andrew

2015-03-03

In the design of public health policy, a broader understanding of risk factors for disease across the life course, and an increasing awareness of the social determinants of health, has led to the development of more comprehensive, cross-sectoral strategies to tackle complex problems. However, comprehensive strategies may not represent the most efficient or effective approach to reducing disease burden at the population level. Rather, they may act to spread finite resources less intensively over a greater number of programs and initiatives, diluting the potential impact of the investment. While analytic tools are available that use research evidence to help identify and prioritise disease risk factors for public health action, they are inadequate to support more targeted and effective policy responses for complex public health problems. This paper discusses the limitations of analytic tools that are commonly used to support evidence-informed policy decisions for complex problems. It proposes an alternative policy analysis tool which can integrate diverse evidence sources and provide a platform for virtual testing of policy alternatives in order to design solutions that are efficient, effective, and equitable. The case of suicide prevention in Australia is presented to demonstrate the limitations of current tools to adequately inform prevention policy and discusses the utility of the new policy analysis tool. In contrast to popular belief, a systems approach takes a step beyond comprehensive thinking and seeks to identify where best to target public health action and resources for optimal impact. It is concerned primarily with what can be reasonably left out of strategies for prevention and can be used to explore where disinvestment may occur without adversely affecting population health (or equity). Simulation modelling used for policy analysis offers promise in being able to better operationalise research evidence to support decision making for complex problems, improve targeting of public health policy, and offers a foundation for strengthening relationships between policy makers, stakeholders, and researchers.

Development and Implementation of a Comprehensive Risk Management Program at the USAF Academy Hospital.

DTIC Science & Technology

1980-04-01

much less con - cerned about malpractice problems. As a result of the program, they began to view the risk management program as their own and to recog...that con - tributes to better patient care. 131 Implementing Risk Management According to Donovan and Bader, an action plan for the systems approach might...Al87 344 DEVELOPMENT AND IMPLEMENTATION OF A COMPREHENSIVE RISK 1 MANAGEMENT PROGRAM AT THE USAF ACADEMY HOSPITAL(U) ARMY HEALTH CARE STUDIES AND

Depression and risk of fracture and bone loss: an updated meta-analysis of prospective studies.

PubMed

Wu, Q; Liu, B; Tonmoy, S

2018-03-12

This meta-analysis pooled results from 23 qualifying individual cohort studies and found that depression was significantly associated with an increased risk of fractures and bone loss. The association between depression and risk of fracture remains controversial. We conducted a comprehensive meta-analysis to examine the effect of depression on the risk of osteoporotic fractures and bone loss. We searched databases and reviewed citations in relevant articles for eligible cohort studies. Two investigators independently conducted study selection, appraisal, and data abstraction through the use of a standardized protocol. Random effect models were used for meta-analysis. Cochrane Q and I 2 statistics were used to assess heterogeneity. Funnel plots and rank correlation tests were used to evaluate publication bias. Twenty-three studies were included for meta-analysis. In studies that reported hazard ratio (HR) as the outcome (nine studies [n = 309,862]), depression was associated with 26% increase in fracture risk (HR = 1.26, 95% CI, 1.10-1.43, p < 0.001). Studies that reported risk ratio (RR) as the outcome (seven studies [n = 64,975]) suggested that depression was associated with 39% increase in fracture risk (RR = 1.39, 95% CI, 1.19-1.62, p < 0.001). Among studies that reported hip bone mineral density (BMD) as an outcome (eight studies [n = 15,442]), depression was associated with a reduced mean annual bone loss rate of 0.35% (0.18-0.53%, p < 0.001). The increased risk of fracture and bone loss associated with depression was consistent in all meta-analysis having modified inclusion criteria and in different subgroup analyses as well. Significant heterogeneity was observed in the meta-analysis; however, no significant publication bias was detected. Depression is associated with a significant increased risk in fracture and bone loss. Effective prevention may decrease such risk.

Toward a sustainability label for food products: an analysis of experts' and consumers' acceptance.

PubMed

Engels, Stéphanie V; Hansmann, Ralf; Scholz, Roland W

2010-01-01

The recent proliferation of standards and labels for organic, fair-trade, locally produced, and healthy food products risks creating confusion among consumers. This study presents a standardized approach to developing a comprehensive sustainability label that incorporates ecological, economic, and social values. The methodology is based on an extension of modular life-cycle assessment to non-environmental sustainability criteria. Interviews with a wide range of experts (n=65) and a consumer survey (n=233) were conducted to analyze the feasibility and potential effectiveness of the approach. Responses indicated that a comprehensive sustainability label could considerably influence consumption patterns and facilitate cross-product comparisons. Copyright © Taylor & Francis Group, LLC

Ethnicity and HIV risk behaviour, testing and knowledge in Guatemala.

PubMed

Taylor, Tory M; Hembling, John; Bertrand, Jane T

2015-01-01

To describe levels of risky sexual behaviour, HIV testing and HIV knowledge among men and women in Guatemala by ethnic group and to identify adjusted associations between ethnicity and these outcomes. Data on 16,205 women aged 15-49 and 6822 men aged 15-59 from the 2008-2009 Encuesta Nacional de Salud Materno Infantil were used to describe ethnic group differences in sexual behaviour, HIV knowledge and testing. We then controlled for age, education, wealth and other socio-demographic factors in a multivariate logistic regression model to examine the effects of ethnicity on outcomes related to age at sexual debut, number of lifetime sex partners, comprehensive HIV knowledge, HIV testing and lifetime sex worker patronage (men only). The data show low levels of risky sexual behaviour and low levels of HIV knowledge among indigenous women and men, compared to other respondents. Controlling for demographic factors, indigenous women were more likely than other women never to have been tested for HIV and to lack comprehensive HIV knowledge. They were less likely to report early sexual debut and three or more lifetime sexual partners. Indigenous men were more likely than other men to lack comprehensive HIV knowledge and demonstrated lower odds of early sexual debut, 10 or more lifetime sexual partners and sex worker patronage. The Mayan indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV based on this analysis of selected risk factors. Nonetheless, low rates of HIV knowledge and testing may be cause for concern. Programmes working in indigenous communities should focus on HIV education and reducing barriers to testing. Further research into the factors that underlie ethnic self-identity and perceived ethnicity could help clarify the relative significance of these measures for HIV risk and other health outcomes.

French immersion experience and reading skill development in at-risk readers.

PubMed

Kruk, Richard S; Reynolds, Kristin A A

2012-06-01

We tracked the developmental influences of exposure to French on developing English phonological awareness, decoding and reading comprehension of English-speaking at-risk readers from Grade 1 to Grade 3. Teacher-nominated at-risk readers were matched with not-at-risk readers in French immersion and English language programs. Exposure to spoken French phonetic and syllabic forms and to written French orthographic and morphological forms by children attending French immersion programs was expected to promote phonological, decoding and reading comprehension achievement. Growth in all outcomes was found, with children in immersion experiencing higher final status in phonological awareness and more rapid growth and higher final status in decoding, using multilevel modeling. At-risk readers in French immersion experienced faster growth and higher final status in reading comprehension. Benefits to reading of exposure to an additional language are discussed in relation to cross-language transfer, phonological grain size and enhanced executive control processes.

Food allergy and risk assessment: Current status and future directions

NASA Astrophysics Data System (ADS)

Remington, Benjamin C.

2017-09-01

Risk analysis is a three part, interactive process that consists of a scientific risk assessment, a risk management strategy and an exchange of information through risk communication. Quantitative risk assessment methodologies are now available and widely used for assessing risks regarding the unintentional consumption of major, regulated allergens but new or modified proteins can also pose a risk of de-novo sensitization. The risks due to de-novo sensitization to new food allergies are harder to quantify. There is a need for a systematic, comprehensive battery of tests and assessment strategy to identify and characterise de-novo sensitization to new proteins and the risks associated with them. A risk assessment must be attuned to answer the risk management questions and needs. Consequently, the hazard and risk assessment methods applied and the desired information are determined by the requested outcome for risk management purposes and decisions to be made. The COST Action network (ImpARAS, www.imparas.eu) has recently started to discuss these risk management criteria from first principles and will continue with the broader subject of improving strategies for allergen risk assessment throughout 2016-2018/9.

Comprehensive Assessment of Osteoporosis and Bone Fragility with CT Colonography

PubMed Central

Murthy, Naveen S.; Khosla, Sundeep; Clarke, Bart L.; Bruining, David H.; Kopperdahl, David L.; Lee, David C.; Keaveny, Tony M.

2016-01-01

Purpose To evaluate the ability of additional analysis of computed tomographic (CT) colonography images to provide a comprehensive osteoporosis assessment. Materials and Methods This Health Insurance Portability and Accountability Act–compliant study was approved by our institutional review board with a waiver of informed consent. Diagnosis of osteoporosis and assessment of fracture risk were compared between biomechanical CT analysis and dual-energy x-ray absorptiometry (DXA) in 136 women (age range, 43–92 years), each of whom underwent CT colonography and DXA within a 6-month period (between January 2008 and April 2010). Blinded to the DXA data, biomechanical CT analysis was retrospectively applied to CT images by using phantomless calibration and finite element analysis to measure bone mineral density and bone strength at the hip and spine. Regression, Bland-Altman, and reclassification analyses and paired t tests were used to compare results. Results For bone mineral density T scores at the femoral neck, biomechanical CT analysis was highly correlated (R2 = 0.84) with DXA, did not differ from DXA (P = .15, paired t test), and was able to identify osteoporosis (as defined by DXA), with 100% sensitivity in eight of eight patients (95% confidence interval [CI]: 67.6%, 100%) and 98.4% specificity in 126 of 128 patients (95% CI: 94.5%, 99.6%). Considering both the hip and spine, the classification of patients at high risk for fracture by biomechanical CT analysis—those with osteoporosis or “fragile bone strength”—agreed well against classifications for clinical osteoporosis by DXA (T score ≤−2.5 at the hip or spine), with 82.8% sensitivity in 24 of 29 patients (95% CI: 65.4%, 92.4%) and 85.7% specificity in 66 of 77 patients (95% CI: 76.2%, 91.8%). Conclusion Retrospective biomechanical CT analysis of CT colonography for colorectal cancer screening provides a comprehensive osteoporosis assessment without requiring changes in imaging protocols. © RSNA, 2015 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on July 24, 2015. PMID:26200602

Dengue Seroprevalence and Risk Factors for Past and Recent Viral Transmission in Venezuela: A Comprehensive Community-Based Study

PubMed Central

Velasco-Salas, Zoraida I.; Sierra, Gloria M.; Guzmán, Diamelis M.; Zambrano, Julio; Vivas, Daniel; Comach, Guillermo; Wilschut, Jan C.; Tami, Adriana

2014-01-01

Dengue transmission in Venezuela has become perennial and a major public health problem. The increase in frequency and magnitude of recent epidemics prompted a comprehensive community-based cross-sectional study of 2,014 individuals in high-incidence neighborhoods of Maracay, Venezuela. We found a high seroprevalence (77.4%), with 10% of people experiencing recent infections. Multivariate logistic regression analysis showed that poverty-related socioeconomic factors (place and duration of residence, crowding, household size, and living in a shack) and factors/constraints related to intradomiciliary potential mosquito breeding sites (storing water and used tires) were linked with a greater risk of acquiring a dengue infection. Our results also suggest that transmission occurs mainly at home. The combination of increasingly crowded living conditions, growing population density, precarious homes, and water storage issues caused by enduring problems in public services in Maracay are the most likely factors that determine the permanent dengue transmission and the failure of vector control programs. PMID:25223944

Promoting At-Risk Preschool Children's Comprehension through Research-Based Strategy Instruction

ERIC Educational Resources Information Center

DeBruin-Parecki, Andrea; Squibb, Kathryn

2011-01-01

Young children living in poor urban neighborhoods are often at risk for reading difficulties, in part because developing listening comprehension strategies and vocabulary knowledge may not be a priority in their prekindergarten classrooms, whose curriculums typically focus heavily on phonological awareness and alphabet knowledge. Prereading…

A Meta-Analysis of the Long-Term Effects of Phonemic Awareness, Phonics, Fluency, and Reading Comprehension Interventions.

PubMed

Suggate, Sebastian P

2016-01-01

Much is known about short-term--but very little about the long-term--effects of reading interventions. To rectify this, a detailed analysis of follow-up effects as a function of intervention, sample, and methodological variables was conducted. A total of 71 intervention-control groups were selected (N = 8,161 at posttest) from studies reporting posttest and follow-up data (M = 11.17 months) for previously established reading interventions. The posttest effect sizes indicated effects (dw = 0.37) that decreased to follow-up (dw = 0.22). Overall, comprehension and phonemic awareness interventions showed good maintenance of effect that transferred to nontargeted skills, whereas phonics and fluency interventions, and those for preschool and kindergarten children, tended not to. Several methodological features also related to effect sizes at follow-up, namely experimental design and dosage, and sample attrition, risk status, and gender balance. © Hammill Institute on Disabilities 2014.

Ontology-based specification, identification and analysis of perioperative risks.

PubMed

Uciteli, Alexandr; Neumann, Juliane; Tahar, Kais; Saleh, Kutaiba; Stucke, Stephan; Faulbrück-Röhr, Sebastian; Kaeding, André; Specht, Martin; Schmidt, Tobias; Neumuth, Thomas; Besting, Andreas; Stegemann, Dominik; Portheine, Frank; Herre, Heinrich

2017-09-06

Medical personnel in hospitals often works under great physical and mental strain. In medical decision-making, errors can never be completely ruled out. Several studies have shown that between 50 and 60% of adverse events could have been avoided through better organization, more attention or more effective security procedures. Critical situations especially arise during interdisciplinary collaboration and the use of complex medical technology, for example during surgical interventions and in perioperative settings (the period of time before, during and after surgical intervention). In this paper, we present an ontology and an ontology-based software system, which can identify risks across medical processes and supports the avoidance of errors in particular in the perioperative setting. We developed a practicable definition of the risk notion, which is easily understandable by the medical staff and is usable for the software tools. Based on this definition, we developed a Risk Identification Ontology (RIO) and used it for the specification and the identification of perioperative risks. An agent system was developed, which gathers risk-relevant data during the whole perioperative treatment process from various sources and provides it for risk identification and analysis in a centralized fashion. The results of such an analysis are provided to the medical personnel in form of context-sensitive hints and alerts. For the identification of the ontologically specified risks, we developed an ontology-based software module, called Ontology-based Risk Detector (OntoRiDe). About 20 risks relating to cochlear implantation (CI) have already been implemented. Comprehensive testing has indicated the correctness of the data acquisition, risk identification and analysis components, as well as the web-based visualization of results.

An analysis of online messages about probiotics

PubMed Central

2013-01-01

Internet websites are a resource for patients seeking information about probiotics. We examined a sample of 71 websites presenting probiotic information. We found that descriptions of benefits far outnumbered descriptions of risks and commercial websites presented significantly fewer risks than noncommercial websites. The bias towards the presentation of therapeutic benefits in online content suggests that patients are likely interested in using probiotics and may have unrealistic expectations for therapeutic benefit. Gastroenterologists may find it useful to initiate conversations about probiotics within the context of a comprehensive health management plan and should seek to establish realistic therapeutic expectations with their patients. PMID:23311418

Trade-off between fertility and predation risk drives a geometric sequence in the pattern of group sizes in baboons.

PubMed

Dunbar, R I M; MacCarron, Padraig; Robertson, Cole

2018-03-01

Group-living offers both benefits (protection against predators, access to resources) and costs (increased ecological competition, the impact of group size on fertility). Here, we use cluster analysis to detect natural patternings in a comprehensive sample of baboon groups, and identify a geometric sequence with peaks at approximately 20, 40, 80 and 160. We suggest (i) that these form a set of demographic oscillators that set habitat-specific limits to group size and (ii) that the oscillator arises from a trade-off between female fertility and predation risk. © 2018 The Authors.

FRAMEWORK FOR ASSESSING RISKS OF ...

EPA Pesticide Factsheets

The Framework for Children's Health Risk Assessment report can serve as a resource on children's health risk assessment and it addresses the need to provide a comprehensive and consistent framework for considering children in risk assessments at EPA. This framework lays out the process, points to existing published sources for more detailed information on life stage-specific considerations, and includes web links to specific online publications and relevant Agency science policy papers, guidelines and guidance. The document emphasizes the need to take into account the potential exposures to environmental agents during preconception and all stages of development and focuses on the relevant adverse health outcomes that may occur as a result of such exposures. This framework is not an Agency guideline, but rather describes the overall structure and the components considered important for children's health risk assessment. The document describes an approach that includes problem formulation, analysis, and risk characterization, and also builds on Agency experience assessing risk to susceptible populations. The problem formulation step focuses on the life stage-specific nature of the analysis to include scoping and screening level questions for hazard characterization, dose response and exposure assessment. The risk characterization step recognizes the need to consider life stage-specific risks and explicitly describes the uncertainties and variability in the d

The role of integrating natural and social science concepts for risk governance and the design of people-centred early warning systems. Case study from the German-Indonesian Tsunami Early Warning System Project (GITEWS)

NASA Astrophysics Data System (ADS)

Gebert, Niklas; Post, Joachim

2010-05-01

The development of early warning systems are one of the key domains of adaptation to global environmental change and contribute very much to the development of societal reaction and adaptive capacities to deal with extreme events. Especially, Indonesia is highly exposed to tsunami. In average every three years small and medium size tsunamis occur in the region causing damage and death. In the aftermath of the Indian Ocean Tsunami 2004, the German and Indonesian government agreed on a joint cooperation to develop a People Centered End-to-End Early Warning System (GITEWS). The analysis of risk and vulnerability, as an important step in risk (and early warning) governance, is a precondition for the design of effective early warning structures by delivering the knowledge base for developing institutionalized quick response mechanisms of organizations involved in the issuing of a tsunami warning, and of populations exposed to react to warnings and to manage evacuation before the first tsunami wave hits. Thus, a special challenge for developing countries is the governance of complex cross-sectoral and cross-scale institutional, social and spatial processes and requirements for the conceptualization, implementation and optimization of a people centered tsunami early warning system. In support of this, the risk and vulnerability assessment of the case study aims at identifying those factors that constitute the causal structure of the (dis)functionality between the technological warning and the social response system causing loss of life during an emergency situation: Which social groups are likely to be less able to receive and respond to an early warning alert? And, are people able to evacuate in due time? Here, only an interdisciplinary research approach is capable to analyze the socio-spatial and environmental conditions of vulnerability and risk and to produce valuable results for decision makers and civil society to manage tsunami risk in the early warning context. This requires the integration of natural / spatial and social science concepts, methods and data: E.g. a scenario based approach for tsunami inundation modeling was developed to provide decision makers with options to decide up to what level they aim to protect their people and territory, on the contrary household surveys were conducted for the spatial analysis of the evacuation preparedness of the population as a function of place specific hazard, risk, warning and evacuation perception; remote sensing was applied for the spatial analysis (land-use) of the socio-physical conditions of a city and region for evacuation; and existing social / population statistics were combined with land-use data for the precise spatial mapping of the population exposed to tsunami risks. Only by utilizing such a comprehensive assessment approach valuable information for risk governance can be generated. The results are mapped using GIS and designed according to the specific needs of different end-users, such as public authorities involved in the design of warning dissemination strategies, land-use planners (shelter planning, road network configuration) and NGOs mandated to provide education for the general public on tsunami risk and evacuation behavior. The case study of the city of Padang (one of the pilot areas of GITEWS), Indonesia clearly show, that only by intersecting social (vulnerability) and natural hazards research a comprehensive picture on tsunami risk can be provided with which risk governance in the early warning context can be conducted in a comprehensive, systemic and sustainable manner.

Risk Assessment and Risk Governance of Liquefied Natural Gas Development in Gladstone, Australia.

PubMed

van der Vegt, R G

2018-02-26

This article is a retrospective analysis of liquefied natural gas development (LNG) in Gladstone, Australia by using the structure of the risk governance framework developed by the International Risk Governance Council (IRGC). Since 2010 the port of Gladstone has undergone extensive expansion to facilitate the increasing coal export as well as the new development of three recently completed LNG facilities. Significant environmental and socio-economic impacts and concerns have occurred as a result of these developments. The overall aim of the article, therefore, is to identify the risk governance deficits that arose and to formulate processes capable of improving similar decision-making problems in the future. The structure of the IRGC framework is followed because it represents a broad analytical approach for considering risk assessment and risk governance in Gladstone in ways that include, but also go beyond, the risk approach of the ISO 31000:2009 standard that was employed at the time. The IRGC risk framework is argued to be a consistent and comprehensive risk governance framework that integrates scientific, economic, social, and cultural aspects and advocates the notion of inclusive risk governance through stakeholder communication and involvement. Key aspects related to risk preassessment, risk appraisal, risk tolerability and acceptability, risk management, and stakeholder communication and involvement are considered. The results indicate that the risk governance deficits include aspects related to (i) the risk matrix methodology, (ii) reflecting uncertainties, (iii) cumulative risks, (iv) the regulatory process, and (v) stakeholder communication and involvement. © 2018 Society for Risk Analysis.

Serum Uric Acid Levels and Diabetic Peripheral Neuropathy in Type 2 Diabetes: a Systematic Review and Meta-analysis.

PubMed

Yu, Shuai; Chen, Ying; Hou, Xu; Xu, Donghua; Che, Kui; Li, Changgui; Yan, Shengli; Wang, Yangang; Wang, Bin

2016-03-01

Previous studies suggested a possible association between serum uric acid levels and peripheral neuropathy in patients with type 2 diabetes, but no definite evidence was available. A systematic review and meta-analysis of relevant studies were performed to comprehensively estimate the association. Pubmed, Web of Science, Embase, and China Biology Medicine (CBM) databases were searched for eligible studies. Study-specific data were combined using random-effect or fixed-effect models of meta-analysis according to between-study heterogeneity. Twelve studies were finally included into the meta-analysis, which involved a total of 1388 type 2 diabetic patients with peripheral neuropathy and 4746 patients without peripheral neuropathy. Meta-analysis showed that there were obvious increased serum uric acid levels in diabetic patients with peripheral neuropathy (weighted mean difference [WMD] = 50.03 μmol/L, 95% confidence interval [95%CI] 22.14-77.93, P = 0.0004). Hyperuricemia was also significantly associated with increased risk of peripheral neuropathy in patients with type 2 diabetes (risk ratio [RR] = 2.83, 95%CI 2.13-3.76, P < 0.00001). Meta-analysis of two studies with adjusted risk estimates showed that hyperuricemia was independently associated with increased risk of peripheral neuropathy in type 2 diabetic patients (RR = 1.95, 95%CI 1.23-3.11, P = 0.005). Type 2 diabetic patients with peripheral neuropathy have obvious increased serum uric acid levels, and hyperuricemia is associated with increased risk of peripheral neuropathy. Further prospective cohort studies are needed to validate the impact of serum uric acid levels on peripheral neuropathy risk.

Evidence-based patient information about treatment of multiple sclerosis--a phase one study on comprehension and emotional responses.

PubMed

Kasper, Jürgen; Köpke, Sascha; Mühlhauser, Ingrid; Heesen, Christoph

2006-07-01

This study analysis the comprehension and emotional responses of people suffering from multiple sclerosis when provided with an evidence-based information module. It is a core module of a comprehensive decision aid about immunotherapy. The core module is designed to enable patients to process scientific uncertainty without adverse effects. It considers existing standards for risk communication and presentation of data. Using a mailing approach we investigated 169 patients with differing courses of disease in a before-after design. Items addressed the competence in processing relative and absolute risk information and patients' emotional response to the tool, comprising grade of familiarity with the information, understanding, relevance, emotional arousal, and certainty. Overall, numeracy improved (p < 0.001), although 99 of 169 patients did not complete the numeracy task correctly. Understanding depended on the relevance related to the course of disease. A moderate level of uncertainty was induced. No adverse emotional responses could be shown, neither in those who did comprehend the information, nor in those who did not develop numeracy skills. In conclusion, the tool supports people suffering from multiple sclerosis to process evidence-based medical information and scientific uncertainty without burdening them emotionally. This study is an example for the documentation of an important step in the development process of a complex intervention.

Arenal-type pyroclastic flows: A probabilistic event tree risk analysis

NASA Astrophysics Data System (ADS)

Meloy, Anthony F.

2006-09-01

A quantitative hazard-specific scenario-modelling risk analysis is performed at Arenal volcano, Costa Rica for the newly recognised Arenal-type pyroclastic flow (ATPF) phenomenon using an event tree framework. These flows are generated by the sudden depressurisation and fragmentation of an active basaltic andesite lava pool as a result of a partial collapse of the crater wall. The deposits of this type of flow include angular blocks and juvenile clasts, which are rarely found in other types of pyroclastic flow. An event tree analysis (ETA) is a useful tool and framework in which to analyse and graphically present the probabilities of the occurrence of many possible events in a complex system. Four event trees are created in the analysis, three of which are extended to investigate the varying individual risk faced by three generic representatives of the surrounding community: a resident, a worker, and a tourist. The raw numerical risk estimates determined by the ETA are converted into a set of linguistic expressions (i.e. VERY HIGH, HIGH, MODERATE etc.) using an established risk classification scale. Three individually tailored semi-quantitative risk maps are then created from a set of risk conversion tables to show how the risk varies for each individual in different areas around the volcano. In some cases, by relocating from the north to the south, the level of risk can be reduced by up to three classes. While the individual risk maps may be broadly applicable, and therefore of interest to the general community, the risk maps and associated probability values generated in the ETA are intended to be used by trained professionals and government agencies to evaluate the risk and effectively manage the long-term development of infrastructure and habitation. With the addition of fresh monitoring data, the combination of both long- and short-term event trees would provide a comprehensive and consistent method of risk analysis (both during and pre-crisis), and as such, an ETA is considered to be a valuable quantitative decision support tool.

Blood glucose concentration and risk of liver cancer: systematic review and meta-analysis of prospective studies.

PubMed

Han, Hedong; Zhang, Tianyi; Jin, Zhichao; Guo, Honglei; Wei, Xin; Liu, Yuzhou; Chen, Qi; He, Jia

2017-07-25

The question of whether elevated blood glucose is a risk factor for liver cancer has been intensively studied, yet with inconsistent results. To explore the relationship between blood glucose concentration and risk of liver cancer, we conduct a meta-analysis of prospective studies. Literature search was comprehensively performed using database of PubMed, EMBASE and the Cochrane Library through October 2016. Random-effect models were used to combine the effect estimations. Eight articles containing ten studies with a total of 1975 liver cancer cases were included. The pooled RRs demonstrated that elevated fasting blood glucose was associated with increased risk of liver cancer (combined RRs: 1.77; 95% CI: 1.46, 2.13) with mild heterogeneity (I2 = 30.40%, P = 0.17). In sensitivity analysis, the pooled result remained significant (combined RRs: 1.33; 95% CI: 1.12, 1.59; I2 = 33.90%, P = 0.16) when we restricted blood glucose categories in the range of nondiabetic subjects. We also detected a J-shaped non-linear dose-response relationship between blood glucose concentration and risk of liver cancer. There is evidence that elevated blood glucose increases risk of liver cancer across the range of prediabetes and diabetes. Considering the rapidly increasing prevalence of prediabetes and diabetes, controlling blood glucose may lower the risk of liver cancer.

Evaluation on Cost Overrun Risks of Long-distance Water Diversion Project Based on SPA-IAHP Method

NASA Astrophysics Data System (ADS)

Yuanyue, Yang; Huimin, Li

2018-02-01

Large investment, long route, many change orders and etc. are main causes for costs overrun of long-distance water diversion project. This paper, based on existing research, builds a full-process cost overrun risk evaluation index system for water diversion project, apply SPA-IAHP method to set up cost overrun risk evaluation mode, calculate and rank weight of every risk evaluation indexes. Finally, the cost overrun risks are comprehensively evaluated by calculating linkage measure, and comprehensive risk level is acquired. SPA-IAHP method can accurately evaluate risks, and the reliability is high. By case calculation and verification, it can provide valid cost overrun decision making information to construction companies.

Career and Technical Education Reforms and Comprehensive School Reforms in High Schools: Their Impact on Education Outcomes for At-Risk Youth. The Highlight Zone: Research @ Work.

ERIC Educational Resources Information Center

Castellano, Marisa; Stringfield, Samuel; Stone, James R., III

The impact of career and technical education (CTE) reforms and comprehensive school reforms in high schools on education outcomes for at-risk youth was examined in a review of research on current reforms. The review identified a series of individual, family and home, school, and community factors that can place students at risk of failing to…

New risk indicator approach for Operators, Workers, Bystanders and Residents for a sustainable use of plant protection products.

PubMed

Sacchettini, Gabriele; Calliera, Maura; Marchis, Alexandru; Glass, Richard; Ellis, Clare Butler; Machera, Kyriaki; Gerritsen-Ebben, Rianda; Spanoghe, Pieter; Capri, Ettore

2015-11-01

In 2009, the European Union adopted the Directive on Sustainable Use of pesticides (SUD, Directive 2009/128/EC) establishing a framework for achieving a sustainable use of Plant Protection Products (PPPs) through reducing the risks and impacts of PPP use on human health and the environment, promoting integrated pest management and stimulating effective non-chemical alternatives. The core idea of the SUD is that it is necessary to monitor the use of PPPs through the implementation of an appropriate set of risk indicators to monitor progress and trends in risk reduction within the Member States. To contribute to this direction, following a comprehensive analysis of the risk (including procedures of risk assessment and risk management) and involving stakeholders in the decision process, specific toolboxes of practical indirect risk indicators of exposure of Operators, Workers, Bystanders and Residents were developed and are now available to be used by Member States (MSs) based on their specific context.

[Improving comprehension and communication of risks about health].

PubMed

García-Retamero, Rocío; Galesic, Mirta; Gigerenzer, Gerd

2011-11-01

Many patients have severe difficulties grasping several numerical concepts that are related to their health, such as, for instance, the risk of suffering various diseases. Visual aids have been proposed as a promising method for enhancing risk communication and comprehension. In medical practice, however, not all patients benefit from visual aids. In a study conducted on a probabilistic, representative national sample in the United States, we identified a group of patients for whom visual aids are most useful: Those who have low numeracy but high graphical literacy skills. These patients have high scores in three abilities involved in graph comprehension: (1) the ability to read the data, (2) the ability to read the relations between the data, and (3) the ability to read beyond the data. Our results can have important implications for medical practice and for risk communication about health.

Medication safety--reliability of preference cards.

PubMed

Dawson, Anthony; Orsini, Michael J; Cooper, Mary R; Wollenburg, Karol

2005-09-01

A CLINICAL ANALYSIS of surgeons' preference cards was initiated in one hospital as part of a comprehensive analysis to reduce medication-error risks by standardizing and simplifying the intraoperative medication-use process specific to the sterile field. THE PREFERENCE CARD ANALYSIS involved two subanalyses: a review of the information as it appeared on the cards and a failure mode and effects analysis of the process involved in using and maintaining the cards. THE ANALYSIS FOUND that the preference card system in use at this hospital is outdated. Variations and inconsistencies within the preference card system indicate that the use of preference cards as guides for medication selection for surgical procedures presents an opportunity for medication errors to occur.

UGT1A1*6 and UGT1A1*28 polymorphisms are correlated with irinotecan-induced toxicity: A meta-analysis.

PubMed

Yang, Yuwei; Zhou, MengMeng; Hu, Mingjun; Cui, Yanjie; Zhong, Qi; Liang, Ling; Huang, Fen

2018-06-22

Previous articles explored the role of UGT1A1 polymorphism on predicting irinotecan-induced toxicity, but the conclusions were still inconsistent and not comprehensive. We performed this meta-analysis to investigate the association between UGT1A1 polymorphism and irinotecan-induced toxicity. PubMed and Web of Science were searched for articles before July 2017. Inclusion and exclusion criteria were set to select eligible articles, and corresponding data were extracted from those articles. Subgroup analyses based on different cancer categories, doses and races were carried out to achieve comprehensive results. Statistical analyses were conducted using STATA 11.0. A total of 38 studies with 6742 cases were included after reading full text. Both UGT1A1*6 and UGT1A1*28 polymorphism are significantly associated with severe irinotecan-induced toxicity. Both Asian and Caucasian cancer patients with UGT1A1*28 variant had an increased risk. Compared with heterozygous variant, patients with homozygous variant suffered from a higher risk of toxicity. The effect of UGT1A1*28 polymorphism on diarrhea was less than on neutropenia. Subgroup analysis exhibited that for UGT1A1*6 polymorphism, patients treated with low-dose irinotecan were at a notable risk of toxicity. Moreover, the association between UGT1A1*6 polymorphism and irinotecan-induced toxicity was found in patients suffering from respiratory system cancers. Both UGT1A1*6 and UGT1A1*28 polymorphisms can be considered as predictors of irinotecan-induced toxicity, with effect varying by race, cancer type and irinotecan dose. © 2018 John Wiley & Sons Australia, Ltd.

Remote Sensing Technologies and Geospatial Modelling Hierarchy for Smart City Support

NASA Astrophysics Data System (ADS)

Popov, M.; Fedorovsky, O.; Stankevich, S.; Filipovich, V.; Khyzhniak, A.; Piestova, I.; Lubskyi, M.; Svideniuk, M.

2017-12-01

The approach to implementing the remote sensing technologies and geospatial modelling for smart city support is presented. The hierarchical structure and basic components of the smart city information support subsystem are considered. Some of the already available useful practical developments are described. These include city land use planning, urban vegetation analysis, thermal condition forecasting, geohazard detection, flooding risk assessment. Remote sensing data fusion approach for comprehensive geospatial analysis is discussed. Long-term city development forecasting by Forrester - Graham system dynamics model is provided over Kiev urban area.

Comparing the mortality risks of nursing professionals with diabetes and general patients with diabetes: a nationwide matched cohort study.

PubMed

Huang, Hsiu-Ling; Kung, Chuan-Yu; Pan, Cheng-Chin; Kung, Pei-Tseng; Wang, Shun-Mu; Chou, Wen-Yu; Tsai, Wen-Chen

2016-10-06

Nursing professionals have received comprehensive medical education and training. However, whether these medical professionals exhibit positive patient care attitudes and behaviors and thus reduce mortality risks when they themselves are diagnosed with chronic diseases is worth exploring. This study compared the mortality risks of female nurses and general patients with diabetes and elucidated factors that caused this difference. A total of 510,058 female patients newly diagnosed with diabetes between 1998 and 2006 as recorded in the National Health Insurance Research Database were the participants in this study. Nurses with diabetes and general population with diabetes were matched with propensity score method in a 1:10 ratio. The participants were tracked from the date of diagnosis to 2009. The Cox proportional hazards model was utilized to compare the mortality risks in the two groups. Nurses were newly diagnosed with diabetes at a younger age compared with the general public (42.01 ± 12.03 y vs. 59.29 ± 13.11 y). Nevertheless, the matching results showed that nurses had lower mortality risks (HR: 0.53, 95 % CI: 0.38-0.74) and nurses with diabetes in the < 35 and 35-44 age groups exhibited significantly lower mortality risks compared with general patients (HR: 0.23 and 0.36). A further analysis indicated that the factors that influenced the mortality risks of nurses with diabetes included age, catastrophic illnesses, and the severity of diabetes complications. Nurses with diabetes exhibited lower mortality risks possibly because they had received comprehensive medical education and training, may had more knowledge regarding chronic disease control and change their lifestyles. The results can serve as a reference for developing heath education, and for preventing occupational hazards in nurses.

Reading Comprehension Difficulties in Chinese-English Bilingual Children.

PubMed

Tong, Xiuhong; McBride, Catherine; Shu, Hua; Ho, Connie Suk-Han

2018-02-01

The co-occurrence of reading comprehension difficulties for first language (L1) Chinese and second language (L2) English and associated longitudinal cognitive-linguistic correlates in each language were investigated. Sixteen poor comprehenders in English and 16 poor comprehenders in Chinese, 18 poor readers in both, and 18 children with normal performance in both were identified at age 10. The prevalence rate for being poor in both was 52.94%, suggesting that approximately half of children who are at risk for Chinese reading comprehension difficulty are also at risk for English reading comprehension difficulty. Chinese word reading, phonological, and morphological awareness were longitudinal correlates of poor comprehension in Chinese. English word reading and vocabulary were longitudinal correlates of poor comprehension in English. Chinese phonological awareness was an additional correlate of poor comprehension in English. Moreover, poor comprehenders in both Chinese and English showed slower rapid automatized naming scores than the other groups. Findings highlight some factors that might be critical for reading comprehension in L1 Chinese and L2 English; fluency is likely to be a critical part of reading comprehension across languages. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

The assessment of human health impact caused by industrial and civil activities in the Pace Valley of Messina.

PubMed

Morra, P; Lisi, R; Spadoni, G; Maschio, G

2009-06-01

The impact of industrial and civil activities on an agricultural and residential area is presented in a detailed and global analysis. The examined area is the Pace river valley situated in the northern zone of Messina (Italy). The sources of pollution present in the area are: a Municipal Solid Waste Incinerator operating since 1979, a disused urban solid waste landfill which was used for 30 years, an urban solid waste treatment facility with heavy vehicles traffic, and two open pits for the production of bitumen. Large quantities of toxic, carcinogenic substances and criteria pollutants are released into the environment and represent potential hazards to human health. The analysis is performed using the EHHRA-GIS tool which employs an integrated, multimedia, multi-exposure pathways and multi-receptor risk assessment model that is able to manage all the steps which constitute the human health risk analysis in a georeferenced structure. The transport of pollutants in different environmental media is assessed applying models (AERMOD, GMS, CALINE) that take into account the particular three-dimensional morphology of the terrain. The results obtained, combined with a probabilistic risk assessment and a sensitivity analysis of calculation parameters, are a comprehensive assessment of the total human health risk in the area. Finally human health risks caused by toxic and carcinogenic substances are compared with acceptable legal limits in order to support environmental managers' decisions.

Protective Effect of Dietary Calcium Intake on Esophageal Cancer Risk: A Meta-Analysis of Observational Studies.

PubMed

Li, Qianwen; Cui, Lingling; Tian, Yalan; Cui, Han; Li, Li; Dou, Weifeng; Li, Haixia; Wang, Ling

2017-05-18

Although several epidemiological studies have investigated the association between dietary calcium intake and the risk of esophageal cancer, the results are inconsistent. This study aimed to make a comprehensive evaluation regarding the association between calcium intake and risk of esophageal cancer through a meta-analysis approach. We searched for all relevant articles from the inception to April 2017, using PUBMED, EMBASE, and Web of Knowledge. The pooled odds ratio (ORs) with the 95% confidence interval (95% CI) for the highest versus the lowest categories of calcium intake was calculated using a Mantel-Haenszel fixed-effect model. In total, 15 articles reporting 17 studies including 3396 esophageal cancer cases and 346,815 controls were selected for the meta-analysis. By comparing the highest vs. the lowest levels of dietary calcium intake, we found that dietary calcium intake was inversely associated with the risk of esophageal cancer (OR = 0.80, 95% CI: 0.71-0.91, I ² = 33.6%). The subgroup analysis indicated that the protective function of dietary calcium intake were observed in esophageal squamous cell cancer, but not in esophageal adenocarcinoma in the studies conducted in Asia, but not those in Europe and America. In conclusion, our results suggest that higher dietary calcium intake is associated with a lower risk of esophageal cancer-especially esophageal squamous cell cancer-in Asian populations, though more data from prospective cohort studies are needed.

Managing Risk for Cassini During Mission Operations and Data Analysis (MOandDA)

NASA Technical Reports Server (NTRS)

Witkowski, Mona M.

2002-01-01

A Risk Management Process has been tailored for Cassini that not only satisfies the requirements of NASA and JPL, but also allows the Program to proactively identify and assess risks that threaten mission objectives. Cassini Risk Management is a team effort that involves both management and engineering staff. The process is managed and facilitated by the Mission Assurance Manager (MAM), but requires regular interactions with Program Staff and team members to instill the risk management philosophy into the day to day mission operations. While Risk Management is well defined for projects in the development phase, it is a relatively new concept for Mission Operations. The Cassini team has embraced this process and has begun using it in an effective, proactive manner, to ensure mission success. It is hoped that the Cassini Risk Management Process will form the basis by which risk management is conducted during MO&DA on future projects. proactive in identifying, assessing and mitigating risks before they become problems. Cost ehtiveness is achieved by: Comprehensively identifying risks Rapidly assessing which risks require the expenditure of pruject cewums Taking early actions to mitigate these risks Iterating the process frequently, to be responsive to the dynamic internal and external environments The Cassini Program has successfully implemented a Risk Management Process for mission operations, The initial SRL has been developed and input into he online tool. The Risk Management webbased system has been rolled out for use by the flight team and risk owners we working proactive in identifying, assessing and mitigating risks before they become problems. Cost ehtiveness is achieved by: Comprehensively identifying risks Rapidly assessing which risks require the expenditure of pruject cewums Taking early actions to mitigate these risks Iterating the process frequently, to be responsive to the dynamic internal and external environments The Cassini Program has successfully implemented a Risk Management Process for mission operations, The initial SRL has been developed and input into he online tool. The Risk Management webbased system has been rolled out for use by the flight team and risk owners we working put into place will become visible and will be illusmted in future papers.

A stochastic multicriteria model for evidence-based decision making in drug benefit-risk analysis.

PubMed

Tervonen, Tommi; van Valkenhoef, Gert; Buskens, Erik; Hillege, Hans L; Postmus, Douwe

2011-05-30

Drug benefit-risk (BR) analysis is based on firm clinical evidence regarding various safety and efficacy outcomes. In this paper, we propose a new and more formal approach for constructing a supporting multi-criteria model that fully takes into account the evidence on efficacy and adverse drug reactions. Our approach is based on the stochastic multi-criteria acceptability analysis methodology, which allows us to compute the typical value judgments that support a decision, to quantify decision uncertainty, and to compute a comprehensive BR profile. We construct a multi-criteria model for the therapeutic group of second-generation antidepressants. We assess fluoxetine and venlafaxine together with placebo according to incidence of treatment response and three common adverse drug reactions by using data from a published study. Our model shows that there are clear trade-offs among the treatment alternatives. Copyright © 2011 John Wiley & Sons, Ltd.

Butyryl-cholinesterase is related to muscle mass and strength. A new biomarker to identify elderly subjects at risk of sarcopenia.

PubMed

Cacciatore, Francesco; Della-Morte, David; Basile, Claudia; Curcio, Francesco; Liguori, Ilaria; Roselli, Mario; Gargiulo, Gaetano; Galizia, Gianluigi; Bonaduce, Domenico; Abete, Pasquale

2015-01-01

To determine the relationship between Butyryl-cholinesterase (α-glycoprotein synthesized in the liver, b-CHE) and muscle mass and strength. Muscle mass by bioimpedentiometer and muscle strength by grip strength were evaluated in 337 elderly subjects (mean age: 76.2 ± 6.7 years) admitted to comprehensive geriatric assessment. b-CHE levels were lower in sarcopenic than in nonsarcopenic elderly subjects (p < 0.01). Linear regression analysis demonstrated that b-CHE is linearly related with grip strength and muscular mass both in men and women (r = 0.45 and r = 0.33, p < 0.01; r = 0.55 and r = 0.39, p < 0.01; respectively). Multivariate analysis confirms this analysis. b-CHE is related to muscle mass and strength in elderly subjects. Thus, b-CHE may be considered to be a fair biomarker for identifying elderly subjects at risk of sarcopenia.

Human Health and Environmental Risks Posed by Synthetic Biology R&D for Energy Applications: A Literature Analysis

DOE PAGES

Hewett, Joel P.; Wolfe, Amy K.; Bergmann, Rachael A.; ...

2016-10-07

What are the human health and environmental risks posed by synthetic biology research and development (R&D) for energy applications? In this study, we found it surprisingly difficult to answer this seemingly straightforward question in our review of the risk-related synthetic biology literature. To our knowledge, no entity to date has published a comprehensive review of this literature. Thus, this analysis aims to fill that void and, at a high level, answer the question that we pose. Risk-related synthetic biology literature addresses risk from different perspectives. Much of the literature that we reviewed treats the concept of risk in synthetic biologymore » R&D broadly, enumerating few specific risks. Nevertheless, after reviewing >200 documents, we identified 44 discrete risk issues; 18 of those related to human health and 26 to the environment. We clustered these risk issues into categories that reflect and summarize their content. We categorized human health risk issues as follows: allergies, antibiotic resistance, carcinogens, and pathogenicity or toxicity. Environmental risk issues were categorized as follows: change or depletion of the environment, competition with native species, horizontal gene transfer, and pathogenicity or toxicity. Our efforts to understand what the synthetic biology R&D-related risk issues are stemmed from a larger research project in which we used risk issues identified in the literature as a point of departure in interviews with biosafety professionals and scientists engaged in synthetic biology R&D. Finally, we wrote this article after multiple biosafety professionals told us that accessing our risk-related literature analysis would aid them in their work.« less

Human Health and Environmental Risks Posed by Synthetic Biology R&D for Energy Applications: A Literature Analysis

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

Hewett, Joel P.; Wolfe, Amy K.; Bergmann, Rachael A.

What are the human health and environmental risks posed by synthetic biology research and development (R&D) for energy applications? In this study, we found it surprisingly difficult to answer this seemingly straightforward question in our review of the risk-related synthetic biology literature. To our knowledge, no entity to date has published a comprehensive review of this literature. Thus, this analysis aims to fill that void and, at a high level, answer the question that we pose. Risk-related synthetic biology literature addresses risk from different perspectives. Much of the literature that we reviewed treats the concept of risk in synthetic biologymore » R&D broadly, enumerating few specific risks. Nevertheless, after reviewing >200 documents, we identified 44 discrete risk issues; 18 of those related to human health and 26 to the environment. We clustered these risk issues into categories that reflect and summarize their content. We categorized human health risk issues as follows: allergies, antibiotic resistance, carcinogens, and pathogenicity or toxicity. Environmental risk issues were categorized as follows: change or depletion of the environment, competition with native species, horizontal gene transfer, and pathogenicity or toxicity. Our efforts to understand what the synthetic biology R&D-related risk issues are stemmed from a larger research project in which we used risk issues identified in the literature as a point of departure in interviews with biosafety professionals and scientists engaged in synthetic biology R&D. Finally, we wrote this article after multiple biosafety professionals told us that accessing our risk-related literature analysis would aid them in their work.« less

Meta-analytical prognostic accuracy of the Comprehensive Assessment of at Risk Mental States (CAARMS): The need for refined prediction.

PubMed

Oliver, D; Kotlicka-Antczak, M; Minichino, A; Spada, G; McGuire, P; Fusar-Poli, P

2018-03-01

Primary indicated prevention is reliant on accurate tools to predict the onset of psychosis. The gold standard assessment for detecting individuals at clinical high risk (CHR-P) for psychosis in the UK and many other countries is the Comprehensive Assessment for At Risk Mental States (CAARMS). While the prognostic accuracy of CHR-P instruments has been assessed in general, this is the first study to specifically analyse that of the CAARMS. As such, the CAARMS was used as the index test, with the reference index being psychosis onset within 2 years. Six independent studies were analysed using MIDAS (STATA 14), with a total of 1876 help-seeking subjects referred to high risk services (CHR-P+: n=892; CHR-P-: n=984). Area under the curve (AUC), summary receiver operating characteristic curves (SROC), quality assessment, likelihood ratios, and probability modified plots were computed, along with sensitivity analyses and meta-regressions. The current meta-analysis confirmed that the 2-year prognostic accuracy of the CAARMS is only acceptable (AUC=0.79 95% CI: 0.75-0.83) and not outstanding as previously reported. In particular, specificity was poor. Sensitivity of the CAARMS is inferior compared to the SIPS, while specificity is comparably low. However, due to the difficulties in performing these types of studies, power in this meta-analysis was low. These results indicate that refining and improving the prognostic accuracy of the CAARMS should be the mainstream area of research for the next era. Avenues of prediction improvement are critically discussed and presented to better benefit patients and improve outcomes of first episode psychosis. Copyright © 2017 The Authors. Published by Elsevier Masson SAS.. All rights reserved.

The Comprehension Problems of Children with Poor Reading Comprehension Despite Adequate Decoding: A Meta-Analysis

ERIC Educational Resources Information Center

Spencer, Mercedes; Wagner, Richard K.

2018-01-01

The purpose of this meta-analysis was to examine the comprehension problems of children who have a specific reading comprehension deficit (SCD), which is characterized by poor reading comprehension despite adequate decoding. The meta-analysis included 86 studies of children with SCD who were assessed in reading comprehension and oral language…

Psoriasis increases risk of new-onset atrial fibrillation: a systematic review and meta-analysis of prospective observational studies.

PubMed

Upala, Sikarin; Shahnawaz, Afeefa; Sanguankeo, Anawin

2017-08-01

Psoriasis is a common chronic immune-mediated dermatological disease that increases the risk of cardiovascular disease. We conducted a systematic review and meta-analysis to evaluate the association between psoriasis and atrial fibrillation from prospective observational studies. A comprehensive search of the databases of the MEDLINE and EMBASE was performed from inception through November 2015. The inclusion criterion was the prospective observational study that assessed the risk of new-onset atrial fibrillation in adults with psoriasis. Outcome was the adjusted hazard ratio (HR) of atrial fibrillation comparison between patients with psoriasis and controls. Pooled HR and 95% confidence intervals (CI) were calculated using a random-effects model. The initial search yielded 176 articles. Fifteen articles underwent full-length review and data were extracted from 4 observational studies. Incidence of atrial fibrillation was ascertained by cardiologist-reviewed electrocardiograms. There was a significant increased risk of new-onset atrial fibrillation in patients with psoriasis compared to controls with a pooled HR 1.42 (95%CI 1.22-1.65). Our meta-analysis of prospective studies demonstrated that patients with psoriasis have increased risk of new-onset atrial fibrillation. Future interventional studies addressing the impact of psoriasis treatment and prevention of atrial fibrillation should be performed.

Analysis of regional natural flow for evaluation of flood risk according to RCP climate change scenarios

NASA Astrophysics Data System (ADS)

Lee, J. Y.; Chae, B. S.; Wi, S.; KIm, T. W.

2017-12-01

Various climate change scenarios expect the rainfall in South Korea to increase by 3-10% in the future. The future increased rainfall has significant effect on the frequency of flood in future as well. This study analyzed the probability of future flood to investigate the stability of existing and new installed hydraulic structures and the possibility of increasing flood damage in mid-sized watersheds in South Korea. To achieve this goal, we first clarified the relationship between flood quantiles acquired from the flood-frequency analysis (FFA) and design rainfall-runoff analysis (DRRA) in gauged watersheds. Then, after synthetically generating the regional natural flow data according to RCP climate change scenarios, we developed mathematical formulas to estimate future flood quantiles based on the regression between DRRA and FFA incorporated with regional natural flows in unguaged watersheds. Finally, we developed a flood risk map to investigate the change of flood risk in terms of the return period for the past, present, and future. The results identified that the future flood quantiles and risks would increase in accordance with the RCP climate change scenarios. Because the regional flood risk was identified to increase in future comparing with the present status, comprehensive flood control will be needed to cope with extreme floods in future.

Architecture and Assessment: Privacy Preserving Biometrically Secured Electronic Documents

DTIC Science & Technology

2015-01-01

very large public and private fingerprint databases comprehensive risk analysis and system security contribution to developing international ...Safety and Security Program which is led by Defence Research and Development Canada’s Centre for Security Science, in partnership with Public Safety...201 © Sa Majesté la Reine (en droit du Canada), telle que représentée par le ministre de la Défense nationale, 201 Science and Engineering

Reading comprehension difficulties in children with rolandic epilepsy.

PubMed

Currie, Nicola K; Lew, Adina R; Palmer, Tom M; Basu, Helen; De Goede, Christian; Iyer, Anand; Cain, Kate

2018-03-01

Difficulties in reading comprehension can arise from either word reading or listening comprehension difficulties, or a combination of the two. We sought to determine whether children with rolandic epilepsy had poor reading comprehension relative to typically developing comparison children, and whether such difficulties were associated with word reading and/or general language comprehension difficulties. In this cross-sectional study, children with rolandic epilepsy (n=25; 16 males, 9 females; mean age 9y 1mo, SD 1y 7mo) and a comparison group (n=39; 25 males, 14 females; mean age 9y 1mo, SD 1y 3mo) completed assessments of reading comprehension, listening comprehension, word/non-word reading, speech articulation, and Non-verbal IQ. Reading comprehension and word reading were worse in children with rolandic epilepsy (F 1,61 =6.89, p=0.011, ηp2=0.10 and F 1,61 =6.84, p=0.011, ηp2=0.10 respectively), with listening comprehension being marginal (F 1,61 =3.81, p=0.055, ηp2=0.06). Word reading and listening comprehension made large and independent contributions to reading comprehension, explaining 70% of the variance. Children with rolandic epilepsy may be at risk of reading comprehension difficulties. Thorough assessment of individual children is required to ascertain whether the difficulties lie with decoding text, or with general comprehension skills, or both. Children with rolandic epilepsy may be at risk of poor reading comprehension. This was related to poor word reading, poor listening comprehension, or both. Reading comprehension interventions should be tailored to the profile of difficulties. © 2017 Mac Keith Press.

Co-occurrence of behavioral risk factors of common non-communicable diseases among urban slum dwellers in Nairobi, Kenya.

PubMed

Haregu, Tilahun Nigatu; Oti, Samuel; Egondi, Thaddaeus; Kyobutungi, Catherine

2015-01-01

The four common non-communicable diseases (NCDs) account for 80% of NCD-related deaths worldwide. The four NCDs share four common risk factors. As most of the existing evidence on the common NCD risk factors is based on analysis of a single factor at a time, there is a need to investigate the co-occurrence of the common NCD risk factors, particularly in an urban slum setting in sub-Saharan Africa. To determine the prevalence of co-occurrence of the four common NCDs risk factors among urban slum dwellers in Nairobi, Kenya. This analysis was based on the data collected as part of a cross-sectional survey to assess linkages among socio-economic status, perceived personal risk, and risk factors for cardiovascular and NCDs in a population of slum dwellers in Nairobi, Kenya, in 2008-2009. A total of 5,190 study subjects were included in the analysis. After selecting relevant variables for common NCD risk factors, we computed the prevalence of all possible combinations of the four common NCD risk factors. The analysis was disaggregated by relevant background variables. The weighted prevalences of unhealthy diet, insufficient physical activity, harmful use of alcohol, and tobacco use were found to be 57.2, 14.4, 10.1, and 12.4%, respectively. Nearly 72% of the study participants had at least one of the four NCD risk factors. About 52% of the study population had any one of the four NCD risk factors. About one-fifth (19.8%) had co-occurrence of NCD risk factors. Close to one in six individuals (17.6%) had two NCD risk factors, while only 2.2% had three or four NCD risk factors. One out of five of people in the urban slum settings of Nairobi had co-occurrence of NCD risk factors. Both comprehensive and differentiated approaches are needed for effective NCD prevention and control in these settings.

A fault tree model to assess probability of contaminant discharge from shipwrecks.

PubMed

Landquist, H; Rosén, L; Lindhe, A; Norberg, T; Hassellöv, I-M; Lindgren, J F; Dahllöf, I

2014-11-15

Shipwrecks on the sea floor around the world may contain hazardous substances that can cause harm to the marine environment. Today there are no comprehensive methods for environmental risk assessment of shipwrecks, and thus there is poor support for decision-making on prioritization of mitigation measures. The purpose of this study was to develop a tool for quantitative risk estimation of potentially polluting shipwrecks, and in particular an estimation of the annual probability of hazardous substance discharge. The assessment of the probability of discharge is performed using fault tree analysis, facilitating quantification of the probability with respect to a set of identified hazardous events. This approach enables a structured assessment providing transparent uncertainty and sensitivity analyses. The model facilitates quantification of risk, quantification of the uncertainties in the risk calculation and identification of parameters to be investigated further in order to obtain a more reliable risk calculation. Copyright © 2014 Elsevier Ltd. All rights reserved.

A comprehensive Probabilistic Tsunami Hazard Assessment for the city of Naples (Italy)

NASA Astrophysics Data System (ADS)

Anita, G.; Tonini, R.; Selva, J.; Sandri, L.; Pierdominici, S.; Faenza, L.; Zaccarelli, L.

2012-12-01

A comprehensive Probabilistic Tsunami Hazard Assessment (PTHA) should consider different tsunamigenic sources (seismic events, slide failures, volcanic eruptions) to calculate the hazard on given target sites. This implies a multi-disciplinary analysis of all natural tsunamigenic sources, in a multi-hazard/risk framework, which considers also the effects of interaction/cascade events. Our approach shows the ongoing effort to analyze the comprehensive PTHA for the city of Naples (Italy) including all types of sources located in the Tyrrhenian Sea, as developed within the Italian project ByMuR (Bayesian Multi-Risk Assessment). The project combines a multi-hazard/risk approach to treat the interactions among different hazards, and a Bayesian approach to handle the uncertainties. The natural potential tsunamigenic sources analyzed are: 1) submarine seismic sources located on active faults in the Tyrrhenian Sea and close to the Southern Italian shore line (also we consider the effects of the inshore seismic sources and the associated active faults which we provide their rapture properties), 2) mass failures and collapses around the target area (spatially identified on the basis of their propensity to failure), and 3) volcanic sources mainly identified by pyroclastic flows and collapses from the volcanoes in the Neapolitan area (Vesuvius, Campi Flegrei and Ischia). All these natural sources are here preliminary analyzed and combined, in order to provide a complete picture of a PTHA for the city of Naples. In addition, the treatment of interaction/cascade effects is formally discussed in the case of significant temporary variations in the short-term PTHA due to an earthquake.

Does beer, wine or liquor consumption correlate with the risk of renal cell carcinoma? A dose-response meta-analysis of prospective cohort studies

PubMed Central

Xu, Xin; Zhu, Yi; Zheng, Xiangyi; Xie, Liping

2015-01-01

Despite plenty of evidence supports an inverse association between alcohol drinking and risk of renal cell carcinoma (RCC), sex-specific and beverage-specific dose-response relationships have not been well established. We examined this association by performing a systematic review and meta-analysis of prospective studies. Studies were identified by comprehensively searching PubMed and EMBASE databases through February 21, 2015. Categorical and dose-response meta-analyses were conducted to identify the effects of alcohol on RCC. A total of eight publications (including seven cohort studies and one pooled analysis of 12 cohort studies) were eligible for this meta-analysis. Dose-response analysis showed that each 5 g/day increment of alcohol intake corresponded to a 5% decrease in risk of RCC for males and 9% for females. Alcohol intakes from wine, beer, and liquor were each associated with a reduced risk of RCC. When these associations were examined separately by gender, statistically significant inverse associations were restricted to alcohol from wine among females (RR = 0.82, 95% CI 0.73–0.91) and to alcohol from beer and from liquor among males (RR = 0.87, 95% CI 0.83–0.91 and RR = 0.95, 95% CI 0.92–0.99, respectively). In conclusion, there exist gender-specific and beverage-specific differences in the association between alcohol intake and RCC risk. PMID:25965820

APOA5 -1131T>C and APOC3 -455T>C polymorphisms are associated with an increased risk of coronary heart disease.

PubMed

Sun, Y; Zhou, R B; Chen, D M

2015-12-28

The aim of this study was to investigate correlations between apolipoprotein A-V (APOA5) -1131T>C and apolipoprotein C-III (APOC3) -455T>C polymorphisms and coronary heart disease (CHD). PubMed, Ovid, Cochrane Library, Embase, China National Knowledge Infrastructure, and Wanfang databases were searched using combinations of keywords relating to these polymorphisms and CHD. Studies retrieved from database searches were screened using our stringent inclusion and exclusion criteria, and Comprehensive Meta-Analysis Version 2.0 software was used for statistical analyses. In total, 115 studies were initially retrieved and after further selection, 11 were included in the meta-analysis. These 11 articles comprised 4840 patients with CHD in the case group and 4913 healthy participants in the control group. Meta-analysis revealed that APOA5 -1131T>C and APOC3 -455T>C polymorphisms increased CHD risk. In addition, subgroup analysis by ethnicity showed that while the -1131T>C polymorphism elevated the risk of CHD in the Caucasian population under both allelic and dominant models, this increased risk was observed only under a dominant model in the Asian population. The results of our meta-analysis point to a strong link between both APOA5 -1131T>C and APOC3 -455T>C polymorphisms and an increased risk of CHD. Thus, these polymorphisms constitute important predictive indicators of CHD susceptibility.

Reading and listening comprehension and their relation to inattention and hyperactivity.

PubMed

Cain, Kate; Bignell, Simon

2014-03-01

Children with diagnoses of attention-deficit/hyperactivity disorder (ADHD) frequently have reading problems. To date, it is not clear whether poor reading is associated with both inattention and hyperactivity and also whether poor reading comprehension is the result of poor word reading skills or more general language comprehension weaknesses. We report two studies to examine how reading and listening comprehension skills are related to inattention and hyperactivity/impulsivity. Separate groups of 7- to 11-year-olds participated in each study. In both studies, we used teacher ratings of inattention and hyperactivity/impulsivity to identify three groups at risk of ADHD: poor attention, high hyperactivity, poor attention and high hyperactivity, and also same-age controls. In Study 1, we explored how inattention and hyperactivity predicted reading after controlling for non-verbal IQ and vocabulary. In Study 2, we compared listening and reading comprehension in these groups. Poor attention was related to poor reading comprehension, although the relation was partially mediated by word reading skill (Study 1). Groups with high hyperactivity had weak listening comprehension relative to reading comprehension (Study 2). These results indicate that the reading comprehension problems of children with attention difficulties are related to poor word reading and that listening comprehension is particularly vulnerable in children at risk of ADHD. © 2013 The British Psychological Society.

An evaluation of the Well at Dell health management program: health risk change and financial return on investment.

PubMed

Musich, Shirley; McCalister, Tre'; Wang, Sara; Hawkins, Kevin

2015-01-01

To investigate the effectiveness of the Well at Dell comprehensive health management program in delivering health care and productivity cost savings relative to program investment (i.e., return on investment). A quasi-experimental design was used to quantify the financial impact of the program and nonexperimental pre-post design to evaluate change in health risks. Ongoing worksite health management program implemented across multiple U.S. locations. Subjects were 24,651 employees with continuous medical enrollment in 2010-2011 who were eligible for 2011 health management programming. Incentive-driven, outcomes-based multicomponent corporate health management program including health risk appraisal (HRA)/wellness, lifestyle management, and disease management coaching programs. Medical, pharmacy, and short-term disability pre/post expenditure trends adjusted for demographics, health status, and baseline costs. Self-reported health risks from repeat HRA completers. Analysis: Propensity score-weighted and multivariate regression-adjusted comparison of baseline to post trends in health care expenditures and productivity costs for program participants and nonparticipants (i.e., difference in difference) relative to programmatic investment. The Well at Dell program achieved an overall return on investment of 2.48 in 2011. Most of the savings were realized from the HRA/wellness component of the program. Cost savings were supported with high participation and significant health risk improvement. An incentive-driven, well-managed comprehensive corporate health management program can continue to achieve significant health improvement while promoting health care and productivity cost savings in an employee population.

Characterizing chronic and acute health risks of residues of veterinary drugs in food: latest methodological developments by the joint FAO/WHO expert committee on food additives.

PubMed

Boobis, Alan; Cerniglia, Carl; Chicoine, Alan; Fattori, Vittorio; Lipp, Markus; Reuss, Rainer; Verger, Philippe; Tritscher, Angelika

2017-11-01

The risk assessment of residues of veterinary drugs in food is a field that continues to evolve. The toxicological end-points to be considered are becoming more nuanced and in light of growing concern about the development of antimicrobial resistance, detailed analysis of the antimicrobial activity of the residues of veterinary drugs in food is increasingly incorporated in the assessment. In recent years, the Joint FAO/WHO Expert Committee on Food Additives (JECFA) has refined its approaches to provide a more comprehensive and fit-for-purpose risk assessment. This publication describes in detail the consideration of acute and chronic effects, the estimation of acute and chronic dietary exposure, current approaches for including microbiological endpoints in the risk assessment, and JECFA's considerations for the potential effects of food processing on residues from veterinary drugs. JECFA now applies these approaches in the development of health-based guidance values (i.e. safe exposure levels) for residues of veterinary drugs. JECFA, thus, comprehensively addresses acute and chronic risks by using corresponding estimates for acute and chronic exposure and suitable correction for the limited bioavailability of bound residues by the Gallo-Torres model. On a case-by-case basis, JECFA also considers degradation products that occur from normal food processing of food containing veterinary drug residues. These approaches will continue to be refined to ensure the most scientifically sound basis for the establishment of health-based guidance values for veterinary drug residues.

[Wastewater pollution characteristics from typical intensive pig farms in the Pearl River Delta and its ecological risk assessment].

PubMed

Li, Wen-Ying; Peng, Zhi-Ping; Yu, Jun-Hong; Huang, Ji-Chuan; Xu, Pei-Zhi; Yang, Shao-Hai

2013-10-01

Based on the wastewater quality investigation data from March 2009 to November 2011, wastewater qualities from typical intensive pig farms were assessed in the Pearl River Delta by single and comprehensive pollution index model. The results showed that key pollutants of piggery wastewater were fecal coliform (FC), total phosphorus (TP), chemical oxygen demand (COD) and biochemical oxygen demand (BOD), with their average mass concentrations of 1.98 x 10(9) CFU.L-1, 158.61 mg.L-1, 5 608.68 mg.L-1 and 1984.34 mg.L-1, respectively; key pollutants of biogas slurry were FC, TP, ammonia nitrogen (NH+4 -N) and suspended substance (SS), with their average mass concentrations of 8. 10 x 10(6) CFU.L-1, 81.76 mg.L-1, 476.24 mg.L-1 and 464.58 mg.L-1, respectively. Under the effect of wastewater pollutants, environment surrounding of typical intensive pig farms was seriously polluted, which decreased gradually from piggery wastewater to biogas slurry, and comprehensive pollution indices were 11.41, 6.91, 5.27, respectively. The risk analysis showed that the high-risk wastewater could never be discharged directly and irrigated crops. After the anaerobic treatment, FC, TP, NH+4 -N and SS were still strong factors with the potential ecological risk in the biogas slurry. In the long run, the ecological risk still exists for direct discharge or irrigation of them, and it is necessary to apply further treatment.

Integrated Risk Research. Case of Study: Motozintla, Chiapas, Mexico

NASA Astrophysics Data System (ADS)

Novelo-Casanova, D. A.; Jaimes, M.

2015-12-01

This integrated risk research include the analysis of all components of individual constituents of risk such hazard identification, hazard exposure, and vulnerability. We determined risk to natural hazards in the community of Motozintla located in southern Mexico in the state of Chiapas (15.37ºN, 92.25ºW. Due to its geographical and geological location, this community is continuously exposed mainly to earthquakes, landslides and floods. We developed integrated studies and analysis of seismic zonation, landslides and flood susceptibility using standard methodologies. Vulnerability was quantified from data collected from local families interviews considering five social variables: characteristics of housing construction, availability of basic public services, family economic conditions, existing community plans for disaster preparedness, and risk perception. Local families surveyed were randomly selected considering a sample statistically significant. Our results were spatially represented using a Geographical Information System (GIS). Structural vulnerability curves were generated for typical housing constructions. Our integrated risk analysis demonstrates that the community of Motozintla has a high level of structural and socio-economical risk to floods and earthquakes. More than half of the population does not know any existing Civil Protection Plan and perceive that they are in high risk to landslides and floods. Although the community is located in a high seismic risk zone, most of the local people believe that cannot be impacted by a large earthquake. These natural and social conditions indicate that the community of Motozintla has a very high level of risk to natural hazards. This research will support local decision makers in developing an integrated comprehensive natural hazards mitigation and prevention program.

Phase angle assessment by bioelectrical impedance analysis and its predictive value for malnutrition risk in hospitalized geriatric patients.

PubMed

Varan, Hacer Dogan; Bolayir, Basak; Kara, Ozgur; Arik, Gunes; Kizilarslanoglu, Muhammet Cemal; Kilic, Mustafa Kemal; Sumer, Fatih; Kuyumcu, Mehmet Emin; Yesil, Yusuf; Yavuz, Burcu Balam; Halil, Meltem; Cankurtaran, Mustafa

2016-12-01

Phase angle (PhA) value determined by bioelectrical impedance analysis (BIA) is an indicator of cell membrane damage and body cell mass. Recent studies have shown that low PhA value is associated with increased nutritional risk in various group of patients. However, there have been only a few studies performed globally assessing the relationship between nutritional risk and PhA in hospitalized geriatric patients. The aim of the study is to evaluate the predictive value of the PhA for malnutrition risk in hospitalized geriatric patients. One hundred and twenty-two hospitalized geriatric patients were included in this cross-sectional study. Comprehensive geriatric assessment tests and BIA measurements were performed within the first 48 h after admission. Nutritional risk state of the patients was determined with NRS-2002. Phase angle values of the patients with malnutrition risk were compared with the patients that did not have the same risk. The independent variables for predicting malnutrition risk were determined. SPSS version 15 was utilized for the statistical analyzes. The patients with malnutrition risk had significantly lower phase angle values than the patients without malnutrition risk (p = 0.003). ROC curve analysis suggested that the optimum PhA cut-off point for malnutrition risk was 4.7° with 79.6 % sensitivity, 64.6 % specificity, 73.9 % positive predictive value, and 73.9 % negative predictive value. BMI, prealbumin, PhA, and Mini Mental State Examination Test scores were the independent variables for predicting malnutrition risk. PhA can be a useful, independent indicator for predicting malnutrition risk in hospitalized geriatric patients.

An Evaluation of a Comprehensive Mentoring Program on Selected At-Risk Students with Specific School Problems

ERIC Educational Resources Information Center

Washington, Taren L.

2015-01-01

This study evaluated a comprehensive mentoring program on selected at-risk students with specific school problems (attendance, discipline referrals, and core area grades). The sample included youths in Grades 4-8 who differed on some characteristics including grade-level, ethnicity, and gender. For the purpose of this mixed methods study, the…

Comprehensive Environmental Assessment Applied to Multiwalled Carbon Nanotube Flame-Retardant Coatings in Upholstery Textiles: A Case Study Presenting Priority Research Gaps for Future Risk Assessments (Final Report)

EPA Science Inventory

In September 2013, EPA announced the availability of the final report, Comprehensive Environmental Assessment Applied to Multiwalled Carbon Nanotube Flame-Retardant Coatings in Upholstery Textiles: A Case Study Presenting Priority Research Gaps for Future Risk Assessments...

Effects of Comprehensive, Multiple High-Risk Behaviors Prevention Program on High School Students

ERIC Educational Resources Information Center

Collier, Crystal

2013-01-01

The purpose of this mixed methods study was to examine the effect of a multiple high-risk behaviors prevention program applied comprehensively throughout an entire school-system involving universal, selective, and indicated levels of students at a local private high school during a 4-year period. The prevention program was created based upon the…

Factors affecting flood insurance purchase in residential properties in Johor, Malaysia

NASA Astrophysics Data System (ADS)

Aliagha, U. G.; Jin, T. E.; Choong, W. W.; Nadzri Jaafar, M.; Ali, H. M.

2014-12-01

High-impact floods have become a virtually annual experience in Malaysia, yet flood insurance has remained a grossly neglected part of comprehensive integrated flood risk management. Using discriminant analysis, this study seeks to identify the demand-side variables that best predict flood insurance purchase and risk aversion between two groups of residential homeowners in three districts of Johor State, Malaysia: those who purchased flood insurance and those who did not. Our results revealed an overall 34% purchase rate, with Kota Tinggi district having the highest (44%) and thus the highest degree of flood risk aversion. The Wilks' lambda F test for equality of group means, standardised discriminant function coefficients, structure correlation, and canonical correlation has clearly shown that there are strong significant attribute differences between the two groups of homeowners, based on the measures of objective flood risk exposure, subjective risk perception, and socio-economic cum demographic variables. However, the measures of subjective risk perception were found to be more predictive of flood insurance purchase and flood risk aversion.

Factors affecting flood insurance penetration in residential properties in Johor Malaysia

NASA Astrophysics Data System (ADS)

Godwin Aliagha, U.; Ewe Jin, T.; Weng Choong, W.; Nadzri Jaafar, M.

2014-04-01

High impact flood has virtually become an annual experience in Malaysia, yet flood insurance has remained a grossly neglected part of comprehensive integrated flood risk management. Using discriminant analysis, this study seeks to indentify the demand-side variables that best predict flood insurance penetration and risk aversion between two groups of residential homeowners in three districts of Johor State, Malaysia: those who purchased flood insurance and the group that did not. Our result revealed 34% penetration rate with Kota Tinggi district having the highest penetration (44%) and thus, the highest degree of flood risk aversion. The Wilks' Lambda F test for equality of group means, SCDFC, structure correlation and canonical correlation have clearly shown that there are strong significant attribute differences between the two groups of homeowners based on measures of objective flood risk exposure, subjective risk perception, and socio-economic cum demographic variables. However, measures of subjective risk perception were found more predictive of flood insurance penetration and flood risk aversion.

State High-Risk Pools: An Update on the Minnesota Comprehensive Health Association

PubMed Central

Spencer, Donna; Burke, Courtney E.

2011-01-01

State health insurance high-risk pools are a key component of the US health care system's safety net, because they provide health insurance to the “uninsurable.” In 2007, 34 states had individual high-risk pools, which covered more than 200 000 people at a total cost of $1.8 billion. We examine the experience of the largest and oldest pool in the nation, the Minnesota Comprehensive Health Association, to document key issues facing state high-risk pools in enrollment and financing. We also considered the role and future of high-risk pools in light of national health care finance reform. PMID:21228286

Gender Moderates Association Between Emotional-Behavioral Problems and Text Comprehension in Children with Both Reading Difficulties and Adhd.

PubMed

Mano, Quintino R; Jastrowski Mano, Kristen E; Denton, Carolyn A; Epstein, Jeffery N; Tamm, Leanne

2017-05-01

Evidence suggests that higher order linguistic functioning such as text comprehension is particularly vulnerable to emotional modulation. Gender has been identified as an important moderating variable in emotional expression such that girls tend toward internalizing emotions (e.g., sadness, anxiety) whereas boys tend toward externalizing emotions (e.g., anger, combativeness), which may influence the relationship between emotion and text comprehension. The present study examined whether gender moderates the relationship between emotional-behavioral problems and text comprehension among children ( n = 187; boys= 115, girls = 72) with both word reading difficulties (RD) and attention-deficit/hyperactivity disorder (ADHD), a sample widely acknowledged to be at increased risk for developing emotional-behavioral problems such as anxiety, poor academic self-concept, and delinquency. A moderated regression analysis tested for the significance of two separate interaction terms (i.e., gender × externalizing problems, gender × internalizing problems) after controlling for gender, IQ, basic reading skills, cognitive-linguistic processes closely related to reading, attentional problems, internalizing problems, and externalizing problems. Results indicated that gender significantly and uniquely moderates the relationship between emotional-behavioral problems and text comprehension. Specifically, text comprehension was relatively lower among girls with relatively higher externalizing problems, whereas no such association was observed among boys. These results contribute to our understanding of cognition-emotion interactions within reading development and raise important implications.

Gender Moderates Association Between Emotional-Behavioral Problems and Text Comprehension in Children with Both Reading Difficulties and Adhd

PubMed Central

Mano, Quintino R.; Jastrowski Mano, Kristen E.; Denton, Carolyn A.; Epstein, Jeffery N.; Tamm, Leanne

2017-01-01

Evidence suggests that higher order linguistic functioning such as text comprehension is particularly vulnerable to emotional modulation. Gender has been identified as an important moderating variable in emotional expression such that girls tend toward internalizing emotions (e.g., sadness, anxiety) whereas boys tend toward externalizing emotions (e.g., anger, combativeness), which may influence the relationship between emotion and text comprehension. The present study examined whether gender moderates the relationship between emotional-behavioral problems and text comprehension among children (n = 187; boys= 115, girls = 72) with both word reading difficulties (RD) and attention-deficit/hyperactivity disorder (ADHD), a sample widely acknowledged to be at increased risk for developing emotional-behavioral problems such as anxiety, poor academic self-concept, and delinquency. A moderated regression analysis tested for the significance of two separate interaction terms (i.e., gender × externalizing problems, gender × internalizing problems) after controlling for gender, IQ, basic reading skills, cognitive-linguistic processes closely related to reading, attentional problems, internalizing problems, and externalizing problems. Results indicated that gender significantly and uniquely moderates the relationship between emotional-behavioral problems and text comprehension. Specifically, text comprehension was relatively lower among girls with relatively higher externalizing problems, whereas no such association was observed among boys. These results contribute to our understanding of cognition-emotion interactions within reading development and raise important implications. PMID:28751795

Hypertension and the risk of endometrial cancer: a systematic review and meta-analysis of case-control and cohort studies.

PubMed

Aune, Dagfinn; Sen, Abhijit; Vatten, Lars J

2017-04-07

A history of hypertension has been associated with increased risk of endometrial cancer in several studies, but the results have not been consistent. We conducted a systematic review and meta-analysis of case-control and cohort studies to clarify the association between hypertension and endometrial cancer risk. PubMed and Embase databases were searched up to 27 th of February 2016. Prospective and case-control studies which reported adjusted relative risk estimates and 95% confidence intervals of endometrial cancer associated with a hypertension diagnosis were included. Summary relative risks were estimated using a random effects model. Nineteen case-control studies and 6 cohort studies were included. The summary RR was 1.61 (95% CI: 1.41-1.85, I 2  = 86%) for all studies, 1.73 (95% CI: 1.45-2.06, I 2  = 89%) for case-control studies and 1.32 (95% CI: 1.12-1.56, I 2  = 47%) for cohort studies. The association between hypertension and endometrial cancer was weaker, but still significant, among studies with adjustment for smoking, BMI, oral contraceptive use, and parity, compared to studies without such adjustment. This meta-analysis suggest an increased risk of endometrial cancer among patients with hypertension, however, further studies with more comprehensive adjustments for confounders are warranted to clarify the association.

Risk analysis for rumor propagation in metropolises based on improved 8-state ICSAR model and dynamic personal activity trajectories

NASA Astrophysics Data System (ADS)

Zhang, N.; Huang, H.; Duarte, M.; Zhang, J.

2016-06-01

Social media has developed extremely fast in metropolises in recent years resulting in more and more rumors disturbing our daily lives. Knowing the characteristics of rumor propagation in metropolises can help the government make efficient rumor refutation plans. In this paper, we established a dynamic spatio-temporal comprehensive risk assessment model for rumor propagation based on an improved 8-state ICSAR model (Ignorant, Information Carrier, Information Spreader, Advocate, Removal), large personal activity trajectory data, and governmental rumor refutation (anti-rumor) scenarios. Combining these relevant data with the 'big' traffic data on the use of subways, buses, and taxis, we simulated daily oral communications among inhabitants in Beijing. In order to analyze rumor and anti-rumor competition in the actual social network, personal resistance, personal preference, conformity, rumor intensity, government rumor refutation and other influencing factors were considered. Based on the developed risk assessment model, a long-term dynamic rumor propagation simulation for a seven day period was conducted and a comprehensive rumor propagation risk distribution map was obtained. A set of the sensitivity analyses were conducted for different social media and propagation routes. We assessed different anti-rumor coverage ratios and the rumor-spreading thresholds at which the government started to launch anti-rumor actions. The results we obtained provide worthwhile references useful for governmental decision making towards control of social-disrupting rumors.

Pharmacologic therapies for severe steroid refractory hospitalized ulcerative colitis: A network meta-analysis.

PubMed

Komaki, Yuga; Komaki, Fukiko; Micic, Dejan; Yamada, Akihiro; Suzuki, Yasuo; Sakuraba, Atsushi

2017-06-01

A limited option of therapies is available for hospitalized patients with severe steroid refractory ulcerative colitis (UC). Furthermore, there exists a paucity of direct comparisons between them. To provide a comparative evaluation of the efficacy and safety of pharmacologic therapies, we conducted a network meta-analysis combined with a benefit-risk analysis of randomized controlled trials (RCTs) performed in hospitalized patients with severe steroid refractory UC. Electronic databases were searched through November 2015 for RCTs evaluating the efficacy of therapies for severe steroid refractory hospitalized UC. The outcomes were clinical response, colectomy free rate, and severe adverse events leading to discontinuation of therapy. The primary endpoints were the rank of therapies based on network meta-analysis combined with benefit-risk analysis between clinical response and severe adverse events as well as colectomy free rate and severe adverse events. Eight RCTs of 421 patients were identified. Cyclosporine, infliximab, and tacrolimus as well as placebo were included in our analysis. Network meta-analysis with benefit-risk analysis simultaneously assessing clinical response and severe adverse events demonstrated the rank order of efficacy as infliximab, cyclosporine, tacrolimus, and placebo. Similar analysis for colectomy-free rate and severe adverse events demonstrated the same rank order of efficacy. The differences among infliximab, cyclosporine, and tacrolimus were small in all analyses. The results of the present comprehensive benefit-risk assessment using network meta-analysis provide RCT-based evidence on efficacy and safety of infliximab, cyclosporine, and tacrolimus for hospitalized patients with severe steroid refractory UC. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Filling Terrorism Gaps: VEOs, Evaluating Databases, and Applying Risk Terrain Modeling to Terrorism

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

Hagan, Ross F.

2016-08-29

This paper aims to address three issues: the lack of literature differentiating terrorism and violent extremist organizations (VEOs), terrorism incident databases, and the applicability of Risk Terrain Modeling (RTM) to terrorism. Current open source literature and publicly available government sources do not differentiate between terrorism and VEOs; furthermore, they fail to define them. Addressing the lack of a comprehensive comparison of existing terrorism data sources, a matrix comparing a dozen terrorism databases is constructed, providing insight toward the array of data available. RTM, a method for spatial risk analysis at a micro level, has some applicability to terrorism research, particularlymore » for studies looking at risk indicators of terrorism. Leveraging attack data from multiple databases, combined with RTM, offers one avenue for closing existing research gaps in terrorism literature.« less

Indicators for Environment Health Risk Assessment in the Jiangsu Province of China

PubMed Central

Zhang, Shujie; Wei, Zhengzheng; Liu, Wenliang; Yao, Ling; Suo, Wenyu; Xing, Jingjing; Huang, Bingzhao; Jin, Di; Wang, Jiansheng

2015-01-01

According to the framework of “Pressure-State-Response”, this study established an indicator system which can reflect comprehensive risk of environment and health for an area at large scale. This indicator system includes 17 specific indicators covering social and economic development, pollution emission intensity, air pollution exposure, population vulnerability, living standards, medical and public health, culture and education. A corresponding weight was given to each indicator through Analytical Hierarchy Process (AHP) method. Comprehensive risk assessment of the environment and health of 58 counties was conducted in the Jiangsu province, China, and the assessment result was divided into four types according to risk level. Higher-risk counties are all located in the economically developed southern region of Jiangsu province and relatively high-risk counties are located along the Yangtze River and Xuzhou County and its surrounding areas. The spatial distribution of relatively low-risk counties is dispersive, and lower-risk counties mainly located in the middle region where the economy is somewhat weaker in the province. The assessment results provide reasonable and scientific basis for Jiangsu province Government in formulating environment and health policy. Moreover, it also provides a method reference for the comprehensive risk assessment of environment and health within a large area (provinces, regions and countries). PMID:26371016

Indicators for Environment Health Risk Assessment in the Jiangsu Province of China.

PubMed

Zhang, Shujie; Wei, Zhengzheng; Liu, Wenliang; Yao, Ling; Suo, Wenyu; Xing, Jingjing; Huang, Bingzhao; Jin, Di; Wang, Jiansheng

2015-09-07

According to the framework of "Pressure-State-Response", this study established an indicator system which can reflect comprehensive risk of environment and health for an area at large scale. This indicator system includes 17 specific indicators covering social and economic development, pollution emission intensity, air pollution exposure, population vulnerability, living standards, medical and public health, culture and education. A corresponding weight was given to each indicator through Analytical Hierarchy Process (AHP) method. Comprehensive risk assessment of the environment and health of 58 counties was conducted in the Jiangsu province, China, and the assessment result was divided into four types according to risk level. Higher-risk counties are all located in the economically developed southern region of Jiangsu province and relatively high-risk counties are located along the Yangtze River and Xuzhou County and its surrounding areas. The spatial distribution of relatively low-risk counties is dispersive, and lower-risk counties mainly located in the middle region where the economy is somewhat weaker in the province. The assessment results provide reasonable and scientific basis for Jiangsu province Government in formulating environment and health policy. Moreover, it also provides a method reference for the comprehensive risk assessment of environment and health within a large area (provinces, regions and countries).

Living near nuclear power plants and thyroid cancer risk: A systematic review and meta-analysis.

PubMed

Kim, Jaeyoung; Bang, Yejin; Lee, Won Jin

2016-02-01

There has been public concern regarding the safety of residing near nuclear power plants, and the extent of risk for thyroid cancer among adults living near nuclear power plants has not been fully explored. In the present study, a systematic review and meta-analysis of epidemiologic studies was conducted to investigate the association between living near nuclear power plants and the risk of thyroid cancer. A comprehensive literature search was performed on studies published up to March 2015 on the association between nuclear power plants and thyroid cancer risk. The summary standardized incidence ratio (SIR), standardized mortality ratio (SMR), and 95% confidence intervals (CIs) were calculated using a random-effect model of meta-analysis. Sensitivity analyses were performed by study quality. Thirteen studies were included in the meta-analysis, covering 36 nuclear power stations in 10 countries. Overall, summary estimates showed no significant increased thyroid cancer incidence or mortality among residents living near nuclear power plants (summary SIR=0.98; 95% CI 0.87-1.11, summary SMR=0.80; 95% CI 0.62-1.04). The pooled estimates did not reveal different patterns of risk by gender, exposure definition, or reference population. However, sensitivity analysis by exposure definition showed that living less than 20 km from nuclear power plants was associated with a significant increase in the risk of thyroid cancer in well-designed studies (summary OR=1.75; 95% CI 1.17-2.64). Our study does not support an association between living near nuclear power plants and risk of thyroid cancer but does support a need for well-designed future studies. Copyright © 2015 Elsevier Ltd. All rights reserved.

Quantitative risk assessment of human salmonellosis in Canadian broiler chicken breast from retail to consumption.

PubMed

Smadi, Hanan; Sargeant, Jan M

2013-02-01

The current quantitative risk assessment model followed the framework proposed by the Codex Alimentarius to provide an estimate of the risk of human salmonellosis due to consumption of chicken breasts which were bought from Canadian retail stores and prepared in Canadian domestic kitchens. The model simulated the level of Salmonella contamination on chicken breasts throughout the retail-to-table pathway. The model used Canadian input parameter values, where available, to represent risk of salmonellosis. From retail until consumption, changes in the concentration of Salmonella on each chicken breast were modeled using equations for growth and inactivation. The model predicted an average of 318 cases of salmonellosis per 100,000 consumers per year. Potential reasons for this overestimation were discussed. A sensitivity analysis showed that concentration of Salmonella on chicken breasts at retail and food hygienic practices in private kitchens such as cross-contamination due to not washing cutting boards (or utensils) and hands after handling raw meat along with inadequate cooking contributed most significantly to the risk of human salmonellosis. The outcome from this model emphasizes that responsibility for protection from Salmonella hazard on chicken breasts is a shared responsibility. Data needed for a comprehensive Canadian Salmonella risk assessment were identified for future research. © 2012 Society for Risk Analysis.

Prognostic value of exercise echocardiography: validation of a new risk index combining echocardiographic, treadmill, and exercise electrocardiographic parameters.

PubMed

Mazur, Wojciech; Rivera, Jose M; Khoury, Alexander F; Basu, Abhijeet G; Perez-Verdia, Alejandro; Marks, Gary F; Chang, Su Min; Olmos, Leopoldo; Quiñones, Miguel A; Zoghbi, William A

2003-04-01

Exercise (Ex) echocardiography has been shown to have significant prognostic power, independent of other known predictors of risk from an Ex stress test. The purpose of this study was to evaluate a risk index, incorporating echocardiographic and conventional Ex variables, for a more comprehensive risk stratification and identification of a very low-risk group. Two consecutive, mutually exclusive populations referred for treadmill Ex echocardiography with the Bruce protocol were investigated: hypothesis-generating (388 patients; 268 males; age 55 +/- 13 years) and hypothesis-testing (105 patients; 61 males age: 54 +/- 14 years).Cardiac events included cardiac death, myocardial infarction, late revascularization (>90 days), hospital admission for unstable angina, and admission for heart failure. Mean follow-up in the hypothesis-generating population was 3.1 years. There were 38 cardiac events. Independent predictors of events by multivariate analysis were: Ex wall motion score index (odds ratio [OR] = 2.77/Unit; P <.001); ischemic S-T depression > or = 1 mm (OR = 2.84; P =.002); and treadmill time (OR = 0.87/min; P =.037). A risk index was generated on the basis of the multivariate Cox regression model as: risk index = 1.02 (Ex wall motion score index) + 1.04 (S-T change) - 0.14 (treadmill time). The validity of this index was tested in the hypothesis-testing population. Event rates at 3 years were lowest (0%) in the lower quartile of risk index (-1.22 to -0.47), highest (29.6%) in the upper quartile (+0.66 to +2.02), and intermediate (19.2% to 15.3%) in the intermediate quartiles. The OR of the risk index for predicting cardiac events was 2.94/Unit ([95% confidence interval: 1.4 to 6.2]; P =.0043). Echocardiographic and Ex parameters are independent powerful predictors of cardiac events after treadmill stress testing. A risk index can be derived with these parameters for a more comprehensive risk stratification with Ex echocardiography.

Future Directions in Vulnerability to Depression among Youth: Integrating Risk Factors and Processes across Multiple Levels of Analysis

PubMed Central

Hankin, Benjamin L.

2014-01-01

Depression is a developmental phenomenon. Considerable progress has been made in describing the syndrome, establishing its prevalence and features, providing clues as to its etiology, and developing evidence-based treatment and prevention options. Despite considerable headway in distinct lines of vulnerability research, there is an explanatory gap in the field ability to more comprehensively explain and predict who is likely to become depressed, when, and why. Still, despite clear success in predicting moderate variance for future depression, especially with empirically rigorous methods and designs, the heterogeneous and multi-determined nature of depression suggests that additional etiologies need to be included to advance knowledge on developmental pathways to depression. This paper advocates for a multiple levels of analysis approach to investigating vulnerability to depression across the lifespan and providing a more comprehensive understanding of its etiology. One example of a multiple levels of analysis model of vulnerabilities to depression is provided that integrates the most accessible, observable factors (e.g., cognitive and temperament risks), intermediate processes and endophenotypes (e.g., information processing biases, biological stress physiology, and neural activation and connectivity), and genetic influences (e.g., candidate genes and epigenetics). Evidence for each of these factors as well as their cross-level integration is provided. Methodological and conceptual considerations important for conducting integrative, multiple levels of depression vulnerability research are discussed. Finally, translational implications for how a multiple levels of analysis perspective may confer additional leverage to reduce the global burden of depression and improve care are considered. PMID:22900513

Lessons Learned from Implementing a Prostate Cancer Risk Assessment Program for Underserved High-Risk Men in the Community: the Prostate REACH Project.

PubMed

Fleisher, Linda; Davis, Stacy N; Gross, Laura; Bagden, Loretta; Zakrzewski, Debra; González, Evelyn; Kandadai, Venk; Rusten, Cheryl; Baskett, Jerilyn; Obeid, Elias; Giri, Veda N

2016-03-01

Prostate cancer disproportionately affects Black men, who may also encounter barriers to participation in prostate cancer risk assessment. The Prostate Risk, Education and Assessment in the Community with Help (REACH) project was a community-based extension of a comprehensive prostate cancer risk assessment program at a comprehensive cancer center. The goals of the REACH project were the following: (1) establish a community prostate cancer risk assessment clinic, (2) conduct targeted recruitment, and (3) provide navigation services including follow-up for uninsured men. Key implementation steps included the following: (1) choosing a clinic site, (2) establishing patient access procedures, (3) establishing navigator services, (4) developing subsidy fund use guidelines, and (5) designing recruitment and promotion. Through community-based promotion, 64 men inquired about the program and 26 (41 %) participated. Of those screened, 46 % had abnormal results, and 2 men were diagnosed with prostate cancer. Here, we describe a unique demonstration project to implement a comprehensive prostate cancer risk assessment program in an underserved Black community and describe successes and challenges to inform future efforts to promote access to underserved men.

Evaluating a Brief Measure of Reading Comprehension for Narrative and Expository Text: The Convergent and Predictive Validity of the Reading Retell Rubric

ERIC Educational Resources Information Center

Thomas, Lisa B.

2012-01-01

Reading comprehension is a critical aspect of the reading process. Children who experience significant problems in reading comprehension are at risk for long-term academic and social problems. High-quality measures are needed for early, efficient, and effective identification of children in need of remediation in reading comprehension. Substantial…

Introducing Risk Management Techniques Within Project Based Software Engineering Courses

NASA Astrophysics Data System (ADS)

Port, Daniel; Boehm, Barry

2002-03-01

In 1996, USC switched its core two-semester software engineering course from a hypothetical-project, homework-and-exam course based on the Bloom taxonomy of educational objectives (knowledge, comprehension, application, analysis, synthesis, and evaluation). The revised course is a real-client team-project course based on the CRESST model of learning objectives (content understanding, problem solving, collaboration, communication, and self-regulation). We used the CRESST cognitive demands analysis to determine the necessary student skills required for software risk management and the other major project activities, and have been refining the approach over the last 5 years of experience, including revised versions for one-semester undergraduate and graduate project course at Columbia. This paper summarizes our experiences in evolving the risk management aspects of the project course. These have helped us mature more general techniques such as risk-driven specifications, domain-specific simplifier and complicator lists, and the schedule as an independent variable (SAIV) process model. The largely positive results in terms of review of pass / fail rates, client evaluations, product adoption rates, and hiring manager feedback are summarized as well.

Implementation of a gerontology nurse specialist role in primary health care: Health professional and older adult perspectives.

PubMed

King, Anna I I; Boyd, Michal L; Dagley, Lynelle; Raphael, Deborah L

2018-02-01

To explore an innovative primary healthcare gerontology nurse specialist role from the perspectives of older people and health professionals. Primary care is struggling to meet the needs and demands of complex older people. New models which incorporate holistic assessment and care coordination are necessary. A qualitative descriptive general inductive design was used. Older people at risk of health and functional decline were identified and received a comprehensive gerontology assessment and care coordination. Older adults (75 years+) enrolled within one of three primary healthcare practices in Auckland, New Zealand were eligible. Healthcare professionals directly involved with the primary healthcare gerontology nurse specialist model were invited for study participation. Face-to-face interviews were held with five older people and six health professionals were interviewed by telephone. A semistructured interview guide was used for all interviews. A general inductive approach was undertaken for analysis to systematically identify codes and themes. Data analysis revealed two central themes from the older people perspective: "holistic expertise" and "communication." Two main themes were identified from the health professional perspective: "competency" and "service delivery." Results showed the gerontology nurse specialist role was highly regarded by both older people and the health professionals. The in-home comprehensive geriatric assessment was identified as greatly beneficial. The competence and care coordination of the gerontology nurse specialist reduced fragmentation and were deemed immensely valuable. Care coordination should be recognised as a key component to meeting the complex needs of at-risk older people in the community. The expert knowledge of the gerontology nurse specialist and in-home comprehensive geriatric assessment were crucial aspects of the new model. Equally important was the assimilation of primary and secondary care infrastructure to upskill and deliver mentorship to the gerontology nurse specialist. © 2017 John Wiley & Sons Ltd.

Evidence for overestimation of the prevalence of malignancy in indeterminate thyroid nodules classified as Bethesda category III.

PubMed

Iskandar, Mazen E; Bonomo, Giovanni; Avadhani, Vaidehi; Persky, Mark; Lucido, David; Wang, Beverly; Marti, Jennifer L

2015-03-01

Several recent analyses of indeterminate thyroid nodules classified as Bethesda III (follicular lesion of undetermined significance) have reported considerably greater rates of malignancy than those initially reported by the Bethesda System for Reporting Cytopathology (BSRTC). These values, however, may be overestimates owing to several sources of bias, such as referral, selection, and publication biases. Our aim was to analyze the prevalence of malignancy in Bethesda III and IV thyroid nodules in a comprehensive health system less prone to institutional referral bias, excluding incidental carcinomas, and we examine the literature for publication bias. We performed a retrospective analysis with pathologic re-review of 119 patients with Bethesda III/IV cytology undergoing surgery in a comprehensive health system by examining patient and nodule characteristics. A review of the literature was performed and analyzed for publication bias. The malignancy rate in resected thyroid nodules was 13% (6/48) for Bethesda III and 28% (20/71) for Bethesda IV. There were 9 of 119 patients (8%) with incidental microcarcinomas. Age <30 years was associated with an increased risk of malignancy (odds ratio, 25.8; P = .005). Sex, nodule size, and ultrasonographic features were not associated with risk of malignancy. Analysis of the literature was indicative of publication bias for Bethesda III cohorts, with reported rates positively skewed (P = .039). In a comprehensive health system, the rate of malignancy in Bethesda III nodules was similar to the range reported by the BSRTC. Recent reports of greater rates of malignancy may be attributable to institutional referral patterns, operative selection, inclusion of incidental microcarcinomas, and publication bias. Copyright © 2015 Elsevier Inc. All rights reserved.

Percentage of Positive Biopsy Cores: A Better Risk Stratification Model for Prostate Cancer?

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

Huang Jiayi; Vicini, Frank A.; Williams, Scott G.

2012-07-15

Purpose: To assess the prognostic value of the percentage of positive biopsy cores (PPC) and perineural invasion in predicting the clinical outcomes after radiotherapy (RT) for prostate cancer and to explore the possibilities to improve on existing risk-stratification models. Methods and Materials: Between 1993 and 2004, 1,056 patients with clinical Stage T1c-T3N0M0 prostate cancer, who had four or more biopsy cores sampled and complete biopsy core data available, were treated with external beam RT, with or without a high-dose-rate brachytherapy boost at William Beaumont Hospital. The median follow-up was 7.6 years. Multivariate Cox regression analysis was performed with PPC, Gleasonmore » score, pretreatment prostate-specific antigen, T stage, PNI, radiation dose, androgen deprivation, age, prostate-specific antigen frequency, and follow-up duration. A new risk stratification (PPC classification) was empirically devised to incorporate PPC and replace the T stage. Results: On multivariate Cox regression analysis, the PPC was an independent predictor of distant metastasis, cause-specific survival, and overall survival (all p < .05). A PPC >50% was associated with significantly greater distant metastasis (hazard ratio, 4.01; 95% confidence interval, 1.86-8.61), and its independent predictive value remained significant with or without androgen deprivation therapy (all p < .05). In contrast, PNI and T stage were only predictive for locoregional recurrence. Combining the PPC ({<=}50% vs. >50%) with National Comprehensive Cancer Network risk stratification demonstrated added prognostic value of distant metastasis for the intermediate-risk (hazard ratio, 5.44; 95% confidence interval, 1.78-16.6) and high-risk (hazard ratio, 4.39; 95% confidence interval, 1.70-11.3) groups, regardless of the use of androgen deprivation and high-dose RT (all p < .05). The proposed PPC classification appears to provide improved stratification of the clinical outcomes relative to the National Comprehensive Cancer Network classification. Conclusions: The PPC is an independent and powerful predictor of clinical outcomes of prostate cancer after RT. A risk model replacing T stage with the PPC to reduce subjectivity demonstrated potentially improved stratification.« less

Meta-analysis of workplace physical activity interventions.

PubMed

Conn, Vicki S; Hafdahl, Adam R; Cooper, Pamela S; Brown, Lori M; Lusk, Sally L

2009-10-01

Most adults do not achieve adequate physical activity levels. Despite the potential benefits of worksite health promotion, no previous comprehensive meta-analysis has summarized health and physical activity behavior outcomes from such programs. This comprehensive meta-analysis integrated the extant wide range of worksite physical activity intervention research. Extensive searching located published and unpublished intervention studies reported from 1969 through 2007. Results were coded from primary studies. Random-effects meta-analytic procedures, including moderator analyses, were completed in 2008. Effects on most variables were substantially heterogeneous because diverse studies were included. Standardized mean difference (d) effect sizes were synthesized across approximately 38,231 subjects. Significantly positive effects were observed for physical activity behavior (0.21); fitness (0.57); lipids (0.13); anthropometric measures (0.08); work attendance (0.19); and job stress (0.33). The significant effect size for diabetes risk (0.98) is less robust given small sample sizes. The mean effect size for fitness corresponds to a difference between treatment minus control subjects' means on VO2max of 3.5 mL/kg/min; for lipids, -0.2 on the ratio of total cholesterol to high-density lipoprotein; and for diabetes risk, -12.6 mg/dL on fasting glucose. These findings document that some workplace physical activity interventions can improve both health and important worksite outcomes. Effects were variable for most outcomes, reflecting the diversity of primary studies. Future primary research should compare interventions to confirm causal relationships and further explore heterogeneity.

NR4A2 genetic variation and Parkinson's disease: Evidence from a systematic review and meta-analysis.

PubMed

Liu, Hongmei; Liu, Hongbo; Li, Ting; Cui, Jiayi; Fu, Yingmei; Ren, Juanjuan; Sun, Xiujia; Jiang, Ping; Yu, Shunying; Li, Chunbo

2017-05-22

The homo sapiens nuclear receptor subfamily 4, group A (NR4A2) genetic variation has been implicated as a risk factor for Parkinson's disease (PD). Nevertheless, the results are inconclusive. We conducted a comprehensive systematic review and meta-analysis to quantify the impact of NR4A2 variation on the risk of PD. All eligible case-control studies published up to June 2016 by searching Pubmed, OVID, EBSCO, PsycINFO, ISI Web of Knowledge, Chinese Biomedical Literature Database and China Academic Journals Database were identified. Pooled odds ratio (OR) with 95% confidence interval (CI) were used to access the strength of the association in fixed- or random-effects model. Eighteen studies reported 24 genetic variants with a total of 6150 cases and 5919 controls were included. Twelve studies for NR4A2 rs35479735 polymorphism and 4 studies for rs12803 were available for meta-analysis. A significant association was observed for rs35479735 under the homozygous model (OR=1.31, 95% CI: 1.10-1.56, P=0.003), whereas no significant association for rs12803 was detected. In subgroup analysis stratified by ethnicity, age onset and familial history, we found no significant association except one in sporadic PD subgroup under the recessive (OR=3.30, 95% CI: 1.23-8.84, P=0.02) and homozygous model (OR=3.43, 95% CI: 1.26-9.33, P=0.02) for rs35479735. The study comprehensively evaluated the association of NR4A2 variation with PD, and the results failed to demonstrate that the NR4A2 polymorphisms significantly associated with PD except for rs35479735, suggesting that more studies are needed to elucidate if NR4A2 is a risk of PD. Copyright © 2017 Elsevier B.V. All rights reserved.

Association between language and hearing disorders – risk identification

PubMed Central

Samelli, Alessandra Giannella; Rondon-Melo, Silmara; Rabelo, Camila Maia; Molini-Avejonas, Daniela Regina

2017-01-01

OBJECTIVE: To identify children at risk for hearing and/or language disorders and to investigate the association between these risks by conducting pre-validated hearing and language screenings. METHODS: The study was conducted during a polio vaccination campaign in August of 2013 in basic health units in western São Paulo. Parents of children between 2 and 5 years of age were asked to complete two screening tools: a hearing questionnaire (regarding hearing development) and a language production and comprehension scale (including the major language development milestones). The screening tools were administered by different researchers. We compared the risk of having language disorders among children at risk for hearing loss versus children not at risk, as well as the attributable risk and odds ratios. Chi-squared tests and logistic regression analyses were used. RESULTS: The study included 479 children with a mean age of three and one-half years, of whom 26.9% were identified as at risk for deficits in language production, 8.6% were at risk for deficits in language comprehension and 14% were at risk for hearing disorders. The children at risk for hearing disorders were twice as likely as those not at risk to exhibit language production and comprehension deficits. CONCLUSION: The results of this study highlight the importance of establishing and adopting low-cost procedures such as screenings to identify children at risk of developing language and/or hearing disorders in early childhood. PMID:28492720

A large scale analysis of genetic variants within putative miRNA binding sites in prostate cancer

PubMed Central

Stegeman, Shane; Amankwah, Ernest; Klein, Kerenaftali; O’Mara, Tracy A.; Kim, Donghwa; Lin, Hui-Yi; Permuth-Wey, Jennifer; Sellers, Thomas A.; Srinivasan, Srilakshmi; Eeles, Rosalind; Easton, Doug; Kote-Jarai, Zsofia; Olama, Ali Amin Al; Benlloch, Sara; Muir, Kenneth; Giles, Graham G.; Wiklund, Fredrik; Gronberg, Henrik; Haiman, Christopher A.; Schleutker, Johanna; Nordestgaard, Børge G.; Travis, Ruth C.; Neal, David; Pharoah, Paul; Khaw, Kay-Tee; Stanford, Janet L.; Blot, William J.; Thibodeau, Stephen; Maier, Christiane; Kibel, Adam S.; Cybulski, Cezary; Cannon-Albright, Lisa; Brenner, Hermann; Kaneva, Radka; Teixeira, Manuel R.; Consortium, PRACTICAL; Spurdle, Amanda B.; Clements, Judith A.; Park, Jong Y.; Batra, Jyotsna

2015-01-01

Prostate cancer is the second most common malignancy among men worldwide. Genome-wide association studies (GWAS) have identified 100 risk variants for prostate cancer, which can explain ~33% of the familial risk of the disease. We hypothesized that a comprehensive analysis of genetic variations found within the 3′ UTR of genes predicted to affect miRNA binding (miRSNPs) can identify additional prostate cancer risk variants. We investigated the association between 2,169 miRSNPs and prostate cancer risk in a large-scale analysis of 22,301 cases and 22,320 controls of European ancestry from 23 participating studies. Twenty-two miRSNPs were associated (p<2.3×10−5) with risk of prostate cancer, 10 of which were within the 7 genes previously not mapped by GWASs. Further, using miRNA mimics and reporter gene assays, we showed that miR-3162-5p has specific affinity for the KLK3 rs1058205 miRSNP T-allele whilst miR-370 has greater affinity for the VAMP8 rs1010 miRSNP A-allele, validating their functional role. Significance Findings from this large association study suggest that a focus on miRSNPs, including functional evaluation, can identify candidate risk loci below currently accepted statistical levels of genome-wide significance. Studies of miRNAs and their interactions with SNPs could provide further insights into the mechanisms of prostate cancer risk. PMID:25691096

Problems in Comprehensive Ambulatory Health Care for High-Risk Adolescents.

ERIC Educational Resources Information Center

Fielding, Jon E., Ed.

This volume contains 21 articles on aspects held to be important for delivering comprehensive health care to young adults who are at higher than average risk levels for a number of health and health-related problems; choice of topics for the articles is based on experience gained in directing the health program for the Job Corps. Most of the…

The Impact of a Comprehensive Tier I Core Kindergarten Program on the Achievement of Students at Risk in Mathematics

ERIC Educational Resources Information Center

Clarke, Ben; Smolkowski, Keith; Baker, Scott K.; Fien, Hank; Doabler, Christian T.; Chard, David J.

2011-01-01

This study examined the efficacy of a core kindergarten mathematics program, ELM, a 120-lesson comprehensive curriculum providing instruction in (a) number operations, (b) geometry, (c) measurement, and (d) vocabulary. ELM is designed to address the learning needs of all students, including at-risk students in the general education or Tier I…

Effectiveness of Corrective Reading on Reading Comprehension and Fluency in At-Risk Students

ERIC Educational Resources Information Center

Weaver, Barbara Jean Alexander

2012-01-01

One of the greatest predictors and characteristics of a high school dropout has been poor reading skills. Students with low achievement levels in reading by the end of third grade are at greater risk of becoming a dropout. The study sought to determine whether the Corrective Reading Program impacted reading comprehension and fluency skills of…

A very large Brazilian pedigree with 11778 Leber's hereditary optic neuropathy.

PubMed Central

Sadun, Alfredo A; Carelli, Valerio; Salomao, Solange R; Berezovsky, Adriana; Quiros, Peter; Sadun, Federico; DeNegri, Anna-Maria; Andrade, Rafael; Schein, Stan; Belfort, Rubens

2002-01-01

PURPOSE: We conducted extensive epidemiological, neuro-ophthalmological, psychophysical, and blood examinations on a newly discovered, very large pedigree with molecular analysis showing mtDNA mutation for Leber's hereditary optic neuropathy (LHON). METHODS: Four patients representing four index cases from a remote area of Brazil were sent to Sao Paulo, where complete ophthalmological examinations strongly suggested LHON. Molecular analysis of their blood demonstrated that they were LHON, homoplasmic 11778, J-haplogroup. They had an extensive family that all lived in one rural area in Brazil. To investigate this family, we drew on a number of international experts to form a team that traveled to Brazil. This field team also included several members of the Federal University of Sao Paulo, and together we evaluated 273 of the 295 family members that were still alive. We conducted epidemiological interviews emphasizing possible environmental risk factors, comprehensive neuro-ophthalmological examinations, psychophysical tests, Humphrey visual field studies, fundus photography, and blood testing for both mitochondrial genetic analysis and nuclear gene linkage analysis. RESULTS: The person representing the first-generation case immigrated from Verona, Italy, to Colatina. Subsequent generations demonstrated penetrance rates of 71%, 60%, 34%, 15%, and 9%. The percentages of males were 60%, 50%, 64%, 100%, and 100%. Age at onset varied from 10 to 64 years, and current visual acuities varied from LP to 20/400. CONCLUSIONS: Almost 95% of a nearly 300-member pedigree with LHON 11778 were comprehensively studied. Analysis of environmental risk factors and a nuclear modifying factor from this group may help address the perplexing mystery of LHON: Why do only some of the genetically affected individuals manifest the disease? This fully described database may also provide an excellent opportunity for future clinical trials of any purported neuroprotective agent. PMID:12545691

Multidrug resistance 1 (MDR1/ABCB1) gene polymorphism (rs1045642 C > T) and susceptibility to multiple myeloma: a systematic review and meta-analysis.

PubMed

Razi, Bahman; Anani Sarab, Gholamreza; Omidkhoda, Azadeh; Alizadeh, Shahab

2018-03-01

Several studies have evaluated the association between the multidrug resistance 1 (MDR1) polymorphism (rs1045642 C > T) and multiple myeloma (MM). However, the results were not consistent. Therefore, to reach a comprehensive and reliable answer we determined the association of the MDR1 (rs1045642 C > T) polymorphism and MM in the context of meta-analysis. All eligible studies published in EMBASE, PubMed, and Web of Science databases before July 2017 were reviewed. Subsequently, to assess the strength of association in the dominant model, recessive model, allelic model, homozygotes contrast, and heterozygotes contrast, pooled odds ratios and 95% confidence intervals (CIs) were calculated by the fixed effects model. A total of four case-control studies with 395 MM cases and 418 healthy controls were included in the meta-analysis. The overall results showed no significant association between the MDR1 (rs1045642 C > T) polymorphism and the risk of MM in genetic models (dominant model: OR = 1.04, 95% CI = 0.78-1.38; recessive model: OR = 0.74, 95% CI = 0.52-1.06; allelic model: OR = 0.90, 95% CI = 0.73-1.11; TT vs. CC: OR = 0.80, 95% CI = 0.51-1.25; and CT vs. CC: OR = 1.12, 95% CI = 0.77-1.62). No evidence of publication bias was detected except for the analysis of the recessive model. This meta-analysis suggests that the MDR1 C > T polymorphism was not associated with the risk of MM. To confirm these findings, further comprehensive and well-designed studies are needed.

Miranda Rights Comprehension in Young Adults With Specific Language Impairment

PubMed Central

Rost, Gwyneth C.; McGregor, Karla K.

2013-01-01

Purpose The purpose of this study was to determine whether citizens with language impairment understand legal rights as conveyed in Miranda warnings. Method Grisso's Instruments for Assessing Understanding and Appreciation of Miranda Rights (1998) was administered to 34 young adults, half of whom met the diagnostic criteria for specific language impairment (SLI). A correlational analysis of the relationship between language scores and Miranda rights comprehension was conducted, as were tests of differences between individuals with SLI (n = 17) and individuals without SLI. Results Language ability was positively correlated with overall performance on the Miranda measure. As a group, individuals with SLI were significantly poorer than their peers with normal language at defining Miranda vocabulary and applying Miranda rights in hypothetical situations. The group with SLI was also marginally less able to paraphrase Miranda sentences. Conclusion Language impairment limits comprehension of Miranda warnings. As a result, citizens with language impairment are at risk of being denied their constitutional rights. PMID:22230180

Meta-Analyses of the Effects of Tier 2 Type Reading Interventions in Grades K-3.

PubMed

Wanzek, Jeanne; Vaughn, Sharon; Scammacca, Nancy; Gatlin, Brandy; Walker, Melodee A; Capin, Philip

2016-09-01

This meta-analysis extends previous work on extensive Tier 3 type reading interventions (Wanzek & Vaughn, 2007; Wanzek et al., 2013) to Tier 2 type interventions by examining a non-overlapping set of studies addressing the effects of less extensive reading interventions for students with or at risk for reading difficulties in Grades K-3. We examined the overall effects of these interventions on students' foundational skills, language, and comprehension as well as the intervention features that may be associated with improved outcomes. We conducted four meta-analyses on 72 studies to examine effects on (1) standardized foundational skill measures (mean ES = 0.54), (2) not-standardized foundational skill measures (mean ES = 0.62), (3) standardized language/comprehension measures (mean ES = 0.36), and (4) not-standardized language/comprehension measures (mean ES = 1.02). There were no differences in effects related to intervention type, instructional group size, grade level, intervention implementer, or the number of intervention hours.

Prevalence of hepatitis B virus infection among Iranian high risk groups: a systematic review and meta-analysis

PubMed Central

Almasi-Hashiani, Amir; Ayubi, Erfan; Mansori, Kamyar; Salehi-Vaziri, Mostafa; Moradi, Yousef; Gholamaliei, Behzad; Khazaei, Salman

2018-01-01

Aim: Present study aimed to systematically review and quantitatively synthesize published data about the prevalence of Hepatitis B Virus (HBV) infection among high risk groups in Iran. Background: Determining true burden of Hepatitis B Virus (HBV) infection among high-risk groups relies on knowledge of occurrence measures such as prevalence rate. There is no conclusive and comprehensive data regarding to prevalence of HBV infection among high risk groups in Iran. Methods: Relevant studies were searched in PubMed, Scopus, Web of Knowledge and local databases. In addition, reference lists of relevant studies were searched manually. Two independent authors reviewed the eligibility of retrieved studies and extracted the required data. Studies reporting HBV infection among high risk groups were included in the meta-analysis using random effects models. Meta regression and sub-group analysis were considered as additional analyses. Results: The initial search yielded 566 citations. After the primary screen, 37 studies were selected for review. Meta-analysis results showed that pooled prevalence of HBV infection among high risk groups in Iran was 4.8% (95% confidence interval: 3.6%-6.1%), with the highest prevalence among in prisoners (5%; 3%-6%), and in central regions of Iran (7%; 4%-11%). Year of study may affect the observed heterogeneity in the estimated prevalence of HBV infection among injection drug users (IDUs) and prisoners. Conclusion: Our results indicate that prevalence of HBV infection among high risk groups was seemingly high in Iran. Health policy decision makers should be aware of prevalence of HBV infection among different high risk groups and in different regions of Iran.

Medical Decision-Making Among Elderly People in Long Term Care.

ERIC Educational Resources Information Center

Tymchuk, Alexander J.; And Others

1988-01-01

Presented informed consent information on high and low risk medical procedures to elderly persons in long term care facility in standard, simplified, or storybook format. Comprehension was significantly better for simplified and storybook formats. Ratings of decision-making ability approximated comprehension test results. Comprehension test…

A modeling framework for exposing risks in complex systems.

PubMed

Sharit, J

2000-08-01

This article introduces and develops a modeling framework for exposing risks in the form of human errors and adverse consequences in high-risk systems. The modeling framework is based on two components: a two-dimensional theory of accidents in systems developed by Perrow in 1984, and the concept of multiple system perspectives. The theory of accidents differentiates systems on the basis of two sets of attributes. One set characterizes the degree to which systems are interactively complex; the other emphasizes the extent to which systems are tightly coupled. The concept of multiple perspectives provides alternative descriptions of the entire system that serve to enhance insight into system processes. The usefulness of these two model components derives from a modeling framework that cross-links them, enabling a variety of work contexts to be exposed and understood that would otherwise be very difficult or impossible to identify. The model components and the modeling framework are illustrated in the case of a large and comprehensive trauma care system. In addition to its general utility in the area of risk analysis, this methodology may be valuable in applications of current methods of human and system reliability analysis in complex and continually evolving high-risk systems.

From genetics to genomics: ethics, policy, and parental decision-making.

PubMed

Wilfond, Benjamin; Ross, Lainie Friedman

2009-07-01

Ethical evaluation of genetic testing in children is traditionally based on balancing clinical benefits and risks. However, this focus can be inconsistent with the general practice of respecting parental decision-making about their children's health care. We argue that respect for parental decision-making should play a larger role in shaping pediatric genetic testing practices, and play a similar role regarding decisions to use emerging genomic technologies. Genomic testing involves the examination of thousands of DNA markers spanning genes throughout the genome and their interrelationships, yielding virtually limitless interpretations. We presume that parents and providers should proceed cautiously in applying genomic testing in children, as we explore how genomic testing will stress the fault lines of the traditional ethical analysis. Empirical data about the psychosocial risks and benefits of genetic testing of children do not reveal serious harms, yet virtually no such data exist yet about genomic testing. Unless empirical social and behavioral data indicate that genomic testing is highly likely to cause serious harms to the children, parental decisions to obtain comprehensive genomic testing in their children should be respected. Once comprehensive genomic testing of children becomes routine, resultant information may be more easily integrated by families than anticipated. Research on the social and behavioral impact of comprehensive genomic testing on children and their families is needed to further inform parents, clinicians, and policy makers.

Risk factors for chronic and recurrent otitis media-a meta-analysis.

PubMed

Zhang, Yan; Xu, Min; Zhang, Jin; Zeng, Lingxia; Wang, Yanfei; Zheng, Qing Yin

2014-01-01

Risk factors associated with chronic otitis media (COM) and recurrent otitis media (ROM) have been investigated in previous studies. The objective of this study was to integrate the findings and determine the possible risk factors for COM/ROM based on our meta-analysis. A comprehensive search of electronic bibliographic databases (PubMed, Embase, CNKI and Wanfang database) from 1964 to Dec 2012, as well as a manual search of references of articles, was performed. A total of 2971 articles were searched, and 198 full-text articles were assessed for eligibility; 24 studies were eligible for this meta-analysis. Regarding risk factors for COM/ROM, there were two to nine different studies from which the odds ratios (ORs) could be pooled. The presence of allergy or atopy increased the risk of COM/ROM (OR, 1.36; 95% CI, 1.13-1.64; P = 0.001). An upper respiratory tract infection (URTI) significantly increased the risk of COM/ROM (OR, 6.59; 95% CI, 3.13-13.89; P<0.00001). Snoring appeared to be a significant risk factor for COM/ROM (OR, 1.96; 95% CI, 1.78-2.16; P<0.00001). A patient history of acute otitis media (AOM)/ROM increased the risk of COM/ROM (OR, 11.13; 95% CI, 1.06-116.44; P = 0.04). Passive smoke significantly increased the risk of COM/ROM (OR, 1.39; 95% CI, 1.02-1.89 P = 0.04). Low social status appeared to be a risk factor for COM/ROM (OR, 3.82; 95% CI, 1.11-13.15; P = 0.03). Our meta-analysis identified reliable conclusions that allergy/atopy, URTI, snoring, previous history of AOM/ROM, Second-hand smoke and low social status are important risk factors for COM/ROM. Other unidentified risk factors need to be identified in further studies with critical criteria.

Risk Factors for Chronic and Recurrent Otitis Media–A Meta-Analysis

PubMed Central

Zhang, Yan; Xu, Min; Zhang, Jin; Zeng, Lingxia; Wang, Yanfei; Zheng, Qing Yin

2014-01-01

Risk factors associated with chronic otitis media (COM) and recurrent otitis media (ROM) have been investigated in previous studies. The objective of this study was to integrate the findings and determine the possible risk factors for COM/ROM based on our meta-analysis. A comprehensive search of electronic bibliographic databases (PubMed, Embase, CNKI and Wanfang database) from 1964 to Dec 2012, as well as a manual search of references of articles, was performed. A total of 2971 articles were searched, and 198 full-text articles were assessed for eligibility; 24 studies were eligible for this meta-analysis. Regarding risk factors for COM/ROM, there were two to nine different studies from which the odds ratios (ORs) could be pooled. The presence of allergy or atopy increased the risk of COM/ROM (OR, 1.36; 95% CI, 1.13–1.64; P = 0.001). An upper respiratory tract infection (URTI) significantly increased the risk of COM/ROM (OR, 6.59; 95% CI, 3.13–13.89; P<0.00001). Snoring appeared to be a significant risk factor for COM/ROM (OR, 1.96; 95% CI, 1.78–2.16; P<0.00001). A patient history of acute otitis media (AOM)/ROM increased the risk of COM/ROM (OR, 11.13; 95% CI, 1.06–116.44; P = 0.04). Passive smoke significantly increased the risk of COM/ROM (OR, 1.39; 95% CI, 1.02–1.89 P = 0.04). Low social status appeared to be a risk factor for COM/ROM (OR, 3.82; 95% CI, 1.11–13.15; P = 0.03). Our meta-analysis identified reliable conclusions that allergy/atopy, URTI, snoring, previous history of AOM/ROM, Second-hand smoke and low social status are important risk factors for COM/ROM. Other unidentified risk factors need to be identified in further studies with critical criteria. PMID:24466073

The spatial optimism model research for the regional land use based on the ecological constraint

NASA Astrophysics Data System (ADS)

XU, K.; Lu, J.; Chi, Y.

2013-12-01

The study focuses on the Yunnan-Guizhou (i.e. Yunnan province and Guizhou province) Plateau in China. Since the Yunnan-Guizhou region consists of closed basins, the land resources suiting for development are in a shortage, and the ecological problems in the area are quite complicated. In such circumstance, in order to get the applicable basins area and distribution, certain spatial optimism model is needed. In this research, Digital Elevation Model (DEM) and land use data are used to get the boundary rules of the basins distribution. Furthermore, natural risks, ecological risks and human-made ecological risks are integrated to be analyzed. Finally, the spatial overlay analysis method is used to model the developable basins area and distribution for industries and urbanization. The study process can be divided into six steps. First, basins and their distribution need to be recognized. In this way, the DEM data is used to extract the geomorphology characteristics. The plaque regions with gradient under eight degrees are selected. Among these regions, the total area of the plaque with the area above 8 km2 is 54,000 km2, 10% of the total area. These regions are selected to the potential application of industries and urbanization. In the later five steps, analyses are aimed at these regions. Secondly, the natural risks are analyzed. The conditions of the earthquake, debris flow and rainstorm and flood are combined to classify the natural risks. Thirdly, the ecological risks are analyzed containing the ecological sensibility and ecosystem service function importance. According to the regional ecologic features, the sensibility containing the soil erosion, acid rain, stony desertification and survive condition factors is derived and classified according to the medium value to get the ecological sensibility partition. The ecosystem service function importance is classified and divided considering the biology variation protection and water conservation factors. The fourth step is the man-made ecological risks analysis. The mineral resources exploitation, forest resources developing, farming, tourism, industrialization and urbanization are integrated to derive the potential ecological risks made by human activities. The risks weight are given using the expert marking method, Then the man-made ecological risks are classified and divided among the regions. In the fifth step, the comprehensive ecological controlling divisions are obtained based on the above factors classification. At last, the applicable regions and distribution are derived using the spatial overlay analysis removing the higher ecological risks area and considering the land use status. In conclusion, based on the above comprehensive analyses, the applicable basins area are 2,575 km2 and 1,011 km2 respectively for the Yunnan province and Guizhou province. The amount is less than 1% of the perspective province total area focusing on the central part of the two provinces.

Mapping of interconnection of climate risks

NASA Astrophysics Data System (ADS)

Yokohata, Tokuta; Tanaka, Katsumasa; Nishina, Kazuya; Takanashi, Kiyoshi; Emori, Seita; Kiguchi, Masashi; Iseri, Yoshihiko; Honda, Yasushi; Okada, Masashi; Masaki, Yoshimitsu; Yamamoto, Akitomo; Shigemitsu, Masahito; Yoshimori, Masakazu; Sueyoshi, Tetsuo; Iwase, Kenta; Hanasaki, Naota; Ito, Akihiko; Sakurai, Gen; Iizumi, Toshichika; Oki, Taikan

2015-04-01

Anthropogenic climate change possibly causes various impacts on human society and ecosystem. Here, we call possible damages or benefits caused by the future climate change as "climate risks". Many climate risks are closely interconnected with each other by direct cause-effect relationship. In this study, the major climate risks are comprehensively summarized based on the survey of studies in the literature using IPCC AR5 etc, and their cause-effect relationship are visualized by a "network diagram". This research is conducted by the collaboration between the experts of various fields, such as water, energy, agriculture, health, society, and eco-system under the project called ICA-RUS (Integrated Climate Assessment - Risks, Uncertainties and Society). First, the climate risks are classified into 9 categories (water, energy, food, health, disaster, industry, society, ecosystem, and tipping elements). Second, researchers of these fields in our project survey the research articles, and pick up items of climate risks, and possible cause-effect relationship between the risk items. A long list of the climate risks is summarized into ~130, and that of possible cause-effect relationship between the risk items is summarized into ~300, because the network diagram would be illegible if the number of the risk items and cause-effect relationship is too large. Here, we only consider the risks that could occur if climate mitigation policies are not conducted. Finally, the chain of climate risks is visualized by creating a "network diagram" based on a network graph theory (Fruchtman & Reingold algorithm). Through the analysis of network diagram, we find that climate risks at various sectors are closely related. For example, the decrease in the precipitation under the global climate change possibly causes the decrease in river runoff and the decrease in soil moisture, which causes the changes in crop production. The changes in crop production can have an impact on society by changing the food price or food supply. Changes in river runoff can also make an impact on the hydropower efficiency. Comprehensive pictures of climate risks and their interconnections are clearly shown in a straightforward manner by the network diagram. We will have a discussion how our results can be helpful for our society to recognize the climate risk.

Visualization of the chains of risks under global climate change

NASA Astrophysics Data System (ADS)

Yokohata, T.; Nishina, K.; Takahashi, K.; Kiguchi, M.; Iseri, Y.; Sueyoshi, T.; Yoshimori, M.; Iwase, K.; Yamamoto, A.; Shigemitsu, M.; Honda, Y.; Hanasaki, N.; Masaki, Y.; Ito, A.; Iizumi, T.; Sakurai, G.; Okada, M.; Emori, S.; Oki, T.

2014-12-01

Anthropogenic climate change possibly causes various impacts on human society and ecosystem. Here, we call possible damages or benefits caused by the future climate change as "climate risks". Many climate risks are closely interconnected with each other by direct cause-effect relationship. In this study, the major climate risks are comprehensively summarized based on the survey of studies in the literature using IPCC AR5 etc, and their cause-effect relationship are visualized by a "network diagram". This research is conducted by the collaboration between the experts of various fields, such as water, energy, agriculture, health, society, and eco-system under the project called ICA-RUS (Integrated Climate Assessment - Risks, Uncertainties and Society). First, the climate risks are classified into 9 categories (water, energy, food, health, disaster, industry, society, ecosystem, and tipping elements). Second, researchers of these fields in our project survey the research articles, and pick up items of climate risks, and possible cause-effect relationship between the risk items. A long list of the climate risks is summarized into ~130, and that of possible cause-effect relationship between the risk items is summarized into ~300, because the network diagram would be illegible if the number of the risk items and cause-effect relationship is too large. Here, we only consider the risks that could occur if climate mitigation policies are not conducted. Finally, the chain of climate risks is visualized by creating a "network diagram" based on a network graph theory (Fruchtman & Reingold algorithm). Through the analysis of network diagram, we find that climate risks at various sectors are closely related. For example, the decrease in the precipitation under the global climate change possibly causes the decrease in river runoff and the decrease in soil moisture, which causes the changes in crop production. The changes in crop production can have an impact on society by changing the food price or food supply. Changes in river runoff can also make an impact on the hydropower efficiency. Comprehensive pictures of climate risks and their interconnections are clearly shown in a straightforward manner by the network diagram. We will have a discussion how our results can be helpful for our society to recognize the climate risk.

The Analysis of Rush Orders Risk in Supply Chain: A Simulation Approach

NASA Technical Reports Server (NTRS)

Mahfouz, Amr; Arisha, Amr

2011-01-01

Satisfying customers by delivering demands at agreed time, with competitive prices, and in satisfactory quality level are crucial requirements for supply chain survival. Incidence of risks in supply chain often causes sudden disruptions in the processes and consequently leads to customers losing their trust in a company's competence. Rush orders are considered to be one of the main types of supply chain risks due to their negative impact on the overall performance, Using integrated definition modeling approaches (i.e. IDEF0 & IDEF3) and simulation modeling technique, a comprehensive integrated model has been developed to assess rush order risks and examine two risk mitigation strategies. Detailed functions sequence and objects flow were conceptually modeled to reflect on macro and micro levels of the studied supply chain. Discrete event simulation models were then developed to assess and investigate the mitigation strategies of rush order risks, the objective of this is to minimize order cycle time and cost.

Indoor air quality investigation and health risk assessment at correctional institutions.

PubMed

Ofungwu, Joseph

2005-04-01

A comprehensive indoor air-quality (IAQ) investigation was conducted at a state correctional facility in New Jersey, USA with a lengthy history of IAQ problems. The IAQ investigation comprised preliminary indoor air screening using direct readout instrumentation, indoor air/surface wipe sampling and laboratory analysis, as well as a heating, ventilation, and air-conditioning system evaluation, and a building envelope survey. In addition to air sampling, a human health risk assessment was performed to evaluate the potential for exposure to site-related air contaminants with respect to the inmate and worker populations. The risk assessment results for the prison facility indicated the potential for significant health risks for the inmate population, possibly reflecting the effects of their confinement and extended exposure to indoor air contaminants, as compared to the prison guard and worker population. Based on the results of the risk assessment, several mitigation measures are recommended to minimize prison population health risks and improve indoor air quality at prison facilities.

[Change trend of HIV/AIDS related risk factors and influencing factors among men who have sex with men in Yunnan, 2010-2013].

PubMed

Song, Lijun; Mei, Jingyuan; Lu, Jiyun; Fu, Liru; Li, Xuehua; Niu, Jin; Xiao, Minyang; Zhang, Zuyang; Lu, Ran; Luo, Hongbing

2015-02-01

To understand the change trend of the awareness rate of HIV/AIDS related knowledge, risk behaviors among men who have sex with men (MSM) in Yunnan and the factors influencing their condom use, and evaluate the effect of comprehensive intervention. The data about the MSM's demographic information, HIV/AIDS related knowledge awareness, and sex behavior, condom use, drug use and intervention receiving were obtained from AIDS sentinel surveillance among MSM in Yunnan province during 2010-2013 to conduct change trend and influencing factor analysis. A total of 9 073 MSM were surveyed. The awareness rate of the HIV/AIDS related knowledge, homosexual behavior and condom use rate increased year by year (P < 0.01). The condom use rate was lower in heterosexual behavior, and the drug use rate and sexually transmitted disease prevalence declined with year (P < 0.01). Multivariate logistic regression analysis indicated that cohabiting, low awareness of HIV/AIDS related knowledge, being from other provinces, local residence for <1 year, low education level, receiving no intervention, frequent anal sex and receiving no HIV/AIDS detection were the risk factors influencing persistent condom use among MSM. The effect of HIV/AIDS comprehensive intervention was observed after 4 years implantation, but most of the index were at low level. More attention should be paid to the intervention among MSM with cohabiting habit, low education level, frequent anal sex, and heterosexual sex. It is necessary to expand intervention coverage, strengthen HIV test and promote condom use among MSM.

[Type 2 diabetes mellitus and cardiovascular risk factors: is comprehensive treatment required?].

PubMed

Nadal, Josep Franch; Gutiérrez, Pedro Conthe

2013-09-01

Diabetes mellitus, especially type 2, is a metabolic disease involving the coexistence of several cardiovascular risk factors. Affected patients are therefore at high cardiovascular risk (2-3 times higher than that of men in the general population and 2-6 times higher than that of women). Cardiovascular disease is the main cause of death in the diabetic population, followed by cancer. Cardiovascular risk cannot be compared between diabetic patients and persons who have already shown one or more manifestations of cardiovascular disease (such as myocardial infarction). Single risk factors should be evaluated in combination with other risk factors and a person's cardiovascular risk should be individually assessed. Cardiovascular risk assessment in patients with diabetes through current calculations methods is complex because their ability to predict risk in individuals is very low. Studies such as that by Steno have demonstrated the validity of a comprehensive strategy to control all the risk factors present in persons with type 2 diabetes mellitus, which can reduce the development of micro- and macrovascular complications and mortality by almost 50%. The present article reviews each of the classical cardiovascular risk factors (hypertension, dyslipidemia, smoking, obesity, sedentariness) in relation to diabetes, as well as their recommended targets and the benefits of their control. In view of the above, a comprehensive approach is recommended to control the multiple risk factors that can coexist in persons with type 2 diabetes mellitus. Copyright © 2013 Elsevier España, S.L. All rights reserved.

The Impact of Environment and Occupation on the Health and Safety of Active Duty Air Force Members: Database Development and De-Identification.

PubMed

Erich, Roger; Eaton, Melinda; Mayes, Ryan; Pierce, Lamar; Knight, Andrew; Genovesi, Paul; Escobar, James; Mychalczuk, George; Selent, Monica

2016-08-01

Preparing data for medical research can be challenging, detail oriented, and time consuming. Transcription errors, missing or nonsensical data, and records not applicable to the study population may hamper progress and, if unaddressed, can lead to erroneous conclusions. In addition, study data may be housed in multiple disparate databases and complex formats. Merging methods may be incomplete to obtain temporally synchronized data elements. We created a comprehensive database to explore the general hypothesis that environmental and occupational factors influence health outcomes and risk-taking behavior among active duty Air Force personnel. Several databases containing demographics, medical records, health survey responses, and safety incident reports were cleaned, validated, and linked to form a comprehensive, relational database. The final step involved removing and transforming personally identifiable information to form a Health Insurance Portability and Accountability Act compliant limited database. Initial data consisted of over 62.8 million records containing 221 variables. When completed, approximately 23.9 million clean and valid records with 214 variables remained. With a clean, robust database, future analysis aims to identify high-risk career fields for targeted interventions or uncover potential protective factors in low-risk career fields. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Dengue seroprevalence and risk factors for past and recent viral transmission in Venezuela: a comprehensive community-based study.

PubMed

Velasco-Salas, Zoraida I; Sierra, Gloria M; Guzmán, Diamelis M; Zambrano, Julio; Vivas, Daniel; Comach, Guillermo; Wilschut, Jan C; Tami, Adriana

2014-11-01

Dengue transmission in Venezuela has become perennial and a major public health problem. The increase in frequency and magnitude of recent epidemics prompted a comprehensive community-based cross-sectional study of 2,014 individuals in high-incidence neighborhoods of Maracay, Venezuela. We found a high seroprevalence (77.4%), with 10% of people experiencing recent infections. Multivariate logistic regression analysis showed that poverty-related socioeconomic factors (place and duration of residence, crowding, household size, and living in a shack) and factors/constraints related to intradomiciliary potential mosquito breeding sites (storing water and used tires) were linked with a greater risk of acquiring a dengue infection. Our results also suggest that transmission occurs mainly at home. The combination of increasingly crowded living conditions, growing population density, precarious homes, and water storage issues caused by enduring problems in public services in Maracay are the most likely factors that determine the permanent dengue transmission and the failure of vector control programs. © The American Society of Tropical Medicine and Hygiene.

A Synthesis of Read-Aloud Interventions on Early Reading Outcomes Among Preschool through Third Graders at Risk for Reading Difficulties

PubMed Central

Swanson, Elizabeth A.; Wanzek, Jeanne; Petscher, Yaacov; Vaughn, Sharon; Heckert, Jennifer; Cavanaugh, Christie; Kraft, Guliz; Tackett, Katie

2012-01-01

A synthesis and meta-analysis of the extant research on the effects of storybook read aloud interventions for children at-risk for reading difficulties ages 3–8 is provided. A total of 29 studies met criteria for the synthesis, with 18 studies providing sufficient data for inclusion in the meta-analysis. Read aloud instruction has been examined using dialogic reading, repeated reading of stories, story reading with limited questioning before, during, and/or after reading, computer assisted story reading, and story reading with extended vocabulary activities. Significant, positive effects on children’s language, phonological awareness, print concepts, comprehension, and vocabulary outcomes were found. Despite the positive effects for read aloud interventions, only a small amount of outcome variance was accounted for by intervention type. PMID:21521868

The importance of operations, risk, and cost assessment to space transfer systems design

NASA Technical Reports Server (NTRS)

Ball, J. M.; Komerska, R. J.; Rowell, L. F.

1992-01-01

This paper examines several methodologies which contribute to comprehensive subsystem cost estimation. The example of a space-based lunar space transfer vehicle (STV) design is used to illustrate how including both primary and secondary factors into cost affects the decision of whether to use aerobraking or propulsion for earth orbit capture upon lunar return. The expected dominant cost factor in this decision is earth-to-orbit launch cost driven by STV mass. However, to quantify other significant cost factors, this cost comparison included a risk analysis to identify development and testing costs, a Taguchi design of experiments to determine a minimum mass aerobrake design, and a detailed operations analysis. As a result, the predicted cost advantage of aerobraking, while still positive, was subsequently reduced by about 30 percent compared to the simpler mass-based cost estimates.

Landscape of dietary factors associated with risk of gastric cancer: A systematic review and dose-response meta-analysis of prospective cohort studies.

PubMed

Fang, Xuexian; Wei, Jiayu; He, Xuyan; An, Peng; Wang, Hao; Jiang, Li; Shao, Dandan; Liang, Han; Li, Yi; Wang, Fudi; Min, Junxia

2015-12-01

The associations between dietary factors and gastric cancer risk have been analysed by many studies, but with inconclusive results. We conducted a meta-analysis of prospective studies to systematically investigate the associations. Relevant studies were identified through searching Medline, Embase, and Web of Science up to June 30, 2015. We included prospective cohort studies of intake of dietary factors with risk estimates and 95% confidence intervals for gastric cancer. Seventy-six prospective cohort studies were eligible and included in the analysis. We ascertained 32,758 gastric cancer cases out of 6,316,385 participants in relations to intake of 67 dietary factors, covering a wide ranging of vegetables, fruit, meat, fish, salt, alcohol, tea, coffee, and nutrients, during 3.3 to 30 years of follow-up. Evidence from this study indicates that consumption of total fruit and white vegetables, but not total vegetables, was inversely associated with gastric cancer risk. Both fruit and white vegetables are rich sources of vitamin C, which showed significant protective effect against gastric cancer by our analysis too. Furthermore, we found concordant positive associations between high-salt foods and gastric cancer risk. In addition, a strong effect of alcohol consumption, particularly beer and liquor but not wine, on gastric cancer risk was observed compared with nondrinkers. Dose-response analysis indicated that risk of gastric cancer was increased by 12% per 5 g/day increment of dietary salt intake or 5% per 10 g/day increment of alcohol consumption, and that a 100 g/day increment of fruit consumption was inversely associated with 5% reduction of risk. This study provides comprehensive and strong evidence that there are a number of protective and risk factors for gastric cancer in diet. Our findings may have significant public health implications with regard to prevention of gastric cancer and provide insights into future cohort studies and the design of related clinical trials. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Effect of XPD Polymorphisms on Digestive Tract Cancers Risk: A Meta-Analysis

PubMed Central

Zhang, Qian; Chen, Zhipeng; Lu, Kai; Shu, Yongqian; Chen, Tao; Zhu, Lingjun

2014-01-01

Background The Xeroderma pigmento-sum group D gene (XPD) plays a key role in nucleotide excision repair. Single nucleotide polymorphisms (SNP) located in its functional region may alter DNA repair capacity phenotype and cancer risk. Many studies have demonstrated that XPD polymorphisms are significantly associated with digestive tract cancers risk, but the results are inconsistent. We conducted a comprehensive meta-analysis to assess the association between XPD Lys751Gln polymorphism and digestive tract cancers risk. The digestive tract cancers that our study referred to, includes oral cancer, esophageal cancer, gastric cancer and colorectal cancer. Methods We searched PubMed and EmBase up to December 31, 2012 to identify eligible studies. A total of 37 case-control studies including 9027 cases and 16072 controls were involved in this meta-analysis. Statistical analyses were performed with Stata software (version 11.0, USA). Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of the association. Results The results showed that XPD Lys751Gln polymorphism was associated with the increased risk of digestive tract cancers (homozygote comparison (GlnGln vs. LysLys): OR = 1.12, 95% CI = 1.01–1.24, P = 0.029, P heterogeneity = 0.133). We found no statistical evidence for a significantly increased digestive tract cancers risk in the other genetic models. In the subgroup analysis, we also found the homozygote comparison increased the susceptibility of Asian population (OR = 1.28, 95% CI = 1.01–1.63, P = 0.045, P heterogeneity = 0.287). Stratified by cancer type and source of control, no significantly increased cancer risk was found in these subgroups. Additionally, risk estimates from hospital-based studies and esophageal studies were heterogeneous. Conclusions Our meta-analysis suggested that the XPD 751Gln/Gln genotype was a low-penetrate risk factor for developing digestive tract cancers, especially in Asian populations. PMID:24787743

The effect of XPD polymorphisms on digestive tract cancers risk: a meta-analysis.

PubMed

Du, Haina; Guo, Nannan; Shi, Bin; Zhang, Qian; Chen, Zhipeng; Lu, Kai; Shu, Yongqian; Chen, Tao; Zhu, Lingjun

2014-01-01

The Xeroderma pigmento-sum group D gene (XPD) plays a key role in nucleotide excision repair. Single nucleotide polymorphisms (SNP) located in its functional region may alter DNA repair capacity phenotype and cancer risk. Many studies have demonstrated that XPD polymorphisms are significantly associated with digestive tract cancers risk, but the results are inconsistent. We conducted a comprehensive meta-analysis to assess the association between XPD Lys751Gln polymorphism and digestive tract cancers risk. The digestive tract cancers that our study referred to, includes oral cancer, esophageal cancer, gastric cancer and colorectal cancer. We searched PubMed and EmBase up to December 31, 2012 to identify eligible studies. A total of 37 case-control studies including 9027 cases and 16072 controls were involved in this meta-analysis. Statistical analyses were performed with Stata software (version 11.0, USA). Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of the association. The results showed that XPD Lys751Gln polymorphism was associated with the increased risk of digestive tract cancers (homozygote comparison (GlnGln vs. LysLys): OR = 1.12, 95% CI = 1.01-1.24, P = 0.029, P heterogeneity = 0.133). We found no statistical evidence for a significantly increased digestive tract cancers risk in the other genetic models. In the subgroup analysis, we also found the homozygote comparison increased the susceptibility of Asian population (OR = 1.28, 95% CI = 1.01-1.63, P = 0.045, P heterogeneity = 0.287). Stratified by cancer type and source of control, no significantly increased cancer risk was found in these subgroups. Additionally, risk estimates from hospital-based studies and esophageal studies were heterogeneous. Our meta-analysis suggested that the XPD 751Gln/Gln genotype was a low-penetrate risk factor for developing digestive tract cancers, especially in Asian populations.

Combined oral contraceptives: venous thrombosis.

PubMed

de Bastos, Marcos; Stegeman, Bernardine H; Rosendaal, Frits R; Van Hylckama Vlieg, Astrid; Helmerhorst, Frans M; Stijnen, Theo; Dekkers, Olaf M

2014-03-03

Combined oral contraceptive (COC) use has been associated with venous thrombosis (VT) (i.e., deep venous thrombosis and pulmonary embolism). The VT risk has been evaluated for many estrogen doses and progestagen types contained in COC but no comprehensive comparison involving commonly used COC is available. To provide a comprehensive overview of the risk of venous thrombosis in women using different combined oral contraceptives. Electronic databases (Pubmed, Embase, Web of Science, Cochrane, CINAHL, Academic Search Premier and ScienceDirect) were searched in 22 April 2013 for eligible studies, without language restrictions. We selected studies including healthy women taking COC with VT as outcome. The primary outcome of interest was a fatal or non-fatal first event of venous thrombosis with the main focus on deep venous thrombosis or pulmonary embolism. Publications with at least 10 events in total were eligible. The network meta-analysis was performed using an extension of frequentist random effects models for mixed multiple treatment comparisons. Unadjusted relative risks with 95% confidence intervals were reported.Two independent reviewers extracted data from selected studies. 3110 publications were retrieved through a search strategy; 25 publications reporting on 26 studies were included. Incidence of venous thrombosis in non-users from two included cohorts was 0.19 and 0.37 per 1 000 person years, in line with previously reported incidences of 0,16 per 1 000 person years. Use of combined oral contraceptives increased the risk of venous thrombosis compared with non-use (relative risk 3.5, 95% confidence interval 2.9 to 4.3). The relative risk of venous thrombosis for combined oral contraceptives with 30-35 μg ethinylestradiol and gestodene, desogestrel, cyproterone acetate, or drospirenone were similar and about 50-80% higher than for combined oral contraceptives with levonorgestrel. A dose related effect of ethinylestradiol was observed for gestodene, desogestrel, and levonorgestrel, with higher doses being associated with higher thrombosis risk. All combined oral contraceptives investigated in this analysis were associated with an increased risk of venous thrombosis. The effect size depended both on the progestogen used and the dose of ethinylestradiol. Risk of venous thrombosis for combined oral contraceptives with 30-35 μg ethinylestradiol and gestodene, desogestrel, cyproterone acetate and drospirenone were similar, and about 50-80% higher than with levonorgestrel. The combined oral contraceptive with the lowest possible dose of ethinylestradiol and good compliance should be prescribed-that is, 30 μg ethinylestradiol with levonorgestrel.

Plasminogen activator inhibitor-1 -675 4G/5G polymorphism and polycystic ovary syndrome risk: a meta analysis.

PubMed

Liu, Ying; Sun, Mei-Guo; Jiang, Rong; Ding, Rui; Che, Zhen; Chen, Yan-Yan; Yao, Ci-Jiang; Zhu, Xiao-Xia; Cao, Ji-Yu

2014-03-01

Several studies have reported that excessive amounts of plasminogen activator inhibitor-1(PAI-1) might increase the incidence of polycystic ovary syndrome(PCOS), but so far the published results were inconsistent. The aim of this study was to further investigate the association between PAI-1 gene polymorphism and the susceptibility to PCOS by performing a meta-analysis. A comprehensive literature search for relevant studies was conducted on google scholar, PubMed, the Chinese National Knowledge Infrastructure (CNKI) and the Chinese Biomedical Literature Database (CBM). This meta-analysis was performed using the STATA 11.0 software and the pooled odds ratio (OR) with 95% confidence interval (CI) was calculated. Ten case-control studies were included in this meta-analysis with a total of 2,079 cases and 1,556 controls. The results showed that PAI-1 -675 4G/5G polymorphism may increase the risk of PCOS, especially among Asian populations. However, there was no statistically significant association between the polymorphism and PCOS risk in Caucasians. Our meta-analysis suggests that PAI-1 -675 4G/5G polymorphism may contribute to increasing susceptibility to PCOS in Asians. Detection of the PAI-1 gene polymorphism might be a promising biomarker for the susceptibility of PCOS.

Thinking beyond Opisthorchis viverrini for risk of cholangiocarcinoma in the lower Mekong region: a systematic review and meta-analysis.

PubMed

Steele, Jennifer A; Richter, Carsten H; Echaubard, Pierre; Saenna, Parichat; Stout, Virginia; Sithithaworn, Paiboon; Wilcox, Bruce A

2018-05-17

Cholangiocarcinoma (CCA) is a fatal bile duct cancer associated with infection by the liver fluke, Opisthorchis viverrini, in the lower Mekong region. Numerous public health interventions have focused on reducing exposure to O. viverrini, but incidence of CCA in the region remains high. While this may indicate the inefficacy of public health interventions due to complex social and cultural factors, it may further indicate other risk factors or interactions with the parasite are important in pathogenesis of CCA. This systematic review aims to provide a comprehensive analysis of described risk factors for CCA in addition to O. viverrini to guide future integrative interventions. We searched five international and seven Thai research databases to identify studies relevant to risk factors for CCA in the lower Mekong region. Selected studies were assessed for risk of bias and quality in terms of study design, population, CCA diagnostic methods, and statistical methods. The final 18 included studies reported numerous risk factors which were grouped into behaviors, socioeconomics, diet, genetics, gender, immune response, other infections, and treatment for O. viverrini. Seventeen risk factors were reported by two or more studies and were assessed with random effects models during meta-analysis. This meta-analysis indicates that the combination of alcohol and smoking (OR = 11.1, 95% CI: 5.63-21.92, P <  0.0001) is most significantly associated with increased risk for CCA and is an even greater risk factor than O. viverrini exposure. This analysis also suggests that family history of cancer, consumption of raw cyprinoid fish, consumption of high nitrate foods, and praziquantel treatment are associated with significantly increased risk. These risk factors may have complex relationships with the host, parasite, or pathogenesis of CCA, and many of these risk factors were found to interact with each other in one or more studies. Our findings suggest that a complex variety of risk factors in addition to O. viverrini infection should be addressed in future public health interventions to reduce CCA in affected regions. In particular, smoking and alcohol use, dietary patterns, and socioeconomic factors should be considered when developing intervention programs to reduce CCA.

Revisiting exposure: fatal and non-fatal traffic injury risk across different populations of travelers in Wisconsin, 2001-2009.

PubMed

McAndrews, Carolyn; Beyer, Kirsten; Guse, Clare E; Layde, Peter

2013-11-01

Comparing the injury risk of different travel modes requires using a travel-based measure of exposure. In this study we quantify injury risk by travel mode, age, race/ethnicity, sex, and injury severity using three different travel-based exposure measures (person-trips, person-minutes of travel, and person-miles of travel) to learn how these metrics affect the characterization of risk across populations. We used a linked database of hospital and police records to identify non-fatal injuries (2001-2009), the Fatality Analysis Reporting System for fatalities (2001-2009), and the 2001 Wisconsin Add-On to the National Household Travel Survey for exposure measures. In Wisconsin, bicyclists and pedestrians have a moderately higher injury risk compared to motor vehicle occupants (adjusting for demographic factors), but the risk is much higher when exposure is measured in distance. Although the analysis did not control for socio-economic status (a likely confounder) it showed that American Indian and Black travelers in Wisconsin face higher transportation injury risk than White travelers (adjusting for sex and travel mode), across all three measures of exposure. Working with multiple metrics to form comprehensive injury risk profiles such as this one can inform decision making about how to prioritize investments in transportation injury prevention. Copyright © 2013 Elsevier Ltd. All rights reserved.

Informed consent recall and comprehension in orthodontics: traditional vs improved readability and processability methods.

PubMed

Kang, Edith Y; Fields, Henry W; Kiyak, Asuman; Beck, F Michael; Firestone, Allen R

2009-10-01

Low general and health literacy in the United States means informed consent documents are not well understood by most adults. Methods to improve recall and comprehension of informed consent have not been tested in orthodontics. The purposes of this study were to evaluate (1) recall and comprehension among patients and parents by using the American Association of Orthodontists' (AAO) informed consent form and new forms incorporating improved readability and processability; (2) the association between reading ability, anxiety, and sociodemographic variables and recall and comprehension; and (3) how various domains (treatment, risk, and responsibility) of information are affected by the forms. Three treatment groups (30 patient-parent pairs in each) received an orthodontic case presentation and either the AAO form, an improved readability form (MIC), or an improved readability and processability (pairing audio and visual cues) form (MIC + SS). Structured interviews were transcribed and coded to evaluate recall and comprehension. Significant relationships among patient-related variables and recall and comprehension explained little of the variance. The MIC + SS form significantly improved patient recall and parent recall and comprehension. Recall was better than comprehension, and parents performed better than patients. The MIC + SS form significantly improved patient treatment comprehension and risk recall and parent treatment recall and comprehension. Patients and parents both overestimated their understanding of the materials. Improving the readability of consent materials made little difference, but combining improved readability and processability benefited both patients' recall and parents' recall and comprehension compared with the AAO form.

WHY DO YOU NEED TO USE A CARIES RISK ASSESSMENT PROTOCOL TO PROVIDE AN EFFECTIVE CARIES PREVENTIVE REGIME?

PubMed

Afuakwah, Charles; Welbury, Richard

2015-11-01

Clinical guidelines recommend an individual is given a caries risk status based on analysis of defined clinical and social criteria before implementing a tailored preventive plan. Improve documentation of caries risk assessment (CRA) in a general dental practice setting, using a systems-based approach to quality improvement methods. Investigate the impact of quality improvement efforts on subsequent design and delivery of preventive care. Identify barriers to delivery of CRA and provision of preventive care. Data for patients aged 0-16 years was collected over two cycles using standard audit methodology. The first cycle was a retrospective analysis (n = 400) using random sampling. The second cycle a prospective analysis (n = 513) using consecutive sampling over a 15-week period. Five staff meetings with feedback occurred between cycles. In cycle one, no specific CRA system was identified. CRA status was not stated widely, risk factors were not analysed and there was variation with respect to the prescription and delivery of preventive strategies. These discrepancies were demonstrable for all four participating dentists and at all ages. In cycle two, 100% recorded CRA. All risk factors were analysed and individual caries risk was correctly annotated. There was 100% compliance with the protocol for preventive plans. The use of CRA improved documentation of caries risk status. This has improved subsequent prescription of age specific evidence-based preventive care appropriate to the risk status of that individual. Barriers were identified to the delivery of CRA and the provision of comprehensive preventive care by the dentists and other healthcare professionals.

Behavioral Attention: A Longitudinal Study of Whether and How It Influences the Development of Word Reading and Reading Comprehension among At-Risk Readers

ERIC Educational Resources Information Center

Miller, Amanda C.; Fuchs, Douglas; Fuchs, Lynn S.; Compton, Donald; Kearns, Devin; Zhang, Wenjuan; Yen, Loulee; Patton, Samuel; Kirchner, Danielle Peterson

2014-01-01

The purpose of this study was to examine the extent to which teacher ratings of behavioral attention predicted responsiveness to word reading instruction in first-grade and third-grade reading comprehension performance. Participants were 110 first-grade students identified as at risk for reading difficulties who received 20 weeks of intensive…

Comprehensively Assessing Cognitive and Behavioral Risks for HIV Infection among Middle-Aged and Older Adults

ERIC Educational Resources Information Center

Paniagua, Freddy A.; O'Boyle, Michael

2008-01-01

A comprehensive survey of HIV/AIDS with middle-aged and older adults should include six domains (e.g., factual knowledge regarding the acquisition and transmission of HIV, traditionally-accepted behavioral risks for HIV infection). A sample of 23 women (54.8%) and 19 men (45.2%), ranging in age from 51 to 85 were surveyed across such domains.…

Dose–response association of screen time-based sedentary behaviour in children and adolescents and depression: a meta-analysis of observational studies

PubMed Central

Liu, Mingli; Wu, Lang; Yao, Shuqiao

2016-01-01

Background Depression represents a growing public health burden. Understanding how screen time (ST) in juveniles may be associated with risk of depression is critical for the development of prevention and intervention strategies. Findings from studies addressing this question thus far have been inconsistent. Therefore, we conducted a comprehensive systematic review and meta-analysis of data related to this question. Methods The meta-analysis was conducted in accordance with the PRISMA guideline. We searched the electronic databases of PubMed, Web of Science and EBSCO systematically (up to 6 May 2015). OR was adopted as the pooled measurement of association between ST and depression risk. Dose–response was estimated by a generalised least squares trend estimation. Results Twelve cross-sectional studies and four longitudinal studies (including 1 cohort study) involving a total of 127 714 participants were included. Overall, higher ST in preadolescent children and adolescents was significantly associated with a higher risk of depression (OR=1.12; 95% CI 1.03 to 1.22). Screen type, age, population and reference category acted as significant moderators. Compared with the reference group who had no ST, there was a non-linear dose–response association of ST with a decreasing risk of depression at ST<2 h/day, with the lowest risk being observed for 1 h/day (OR=0.88; 95% CI 0.84 to 0.93). Conclusions Our meta-analysis suggests that ST in children and adolescents is associated with depression risk in a non-linear dose–response manner. PMID:26552416

Meta-analysis: eating frequency and risk of colorectal cancer.

PubMed

Liu, Yanqiong; Tang, Weizhong; Zhai, Limin; Yang, Shi; Wu, Junrong; Xie, Li; Wang, Jian; Deng, Yan; Qin, Xue; Li, Shan

2014-04-01

Eating frequency has been implicated in the risk of colorectal cancer (CRC) in several epidemiological studies with contradictory and inconclusive findings. We performed a meta-analysis to evaluate their relationship. The pooled relative risk (RR) with 95% confidence interval (CI) was calculated to estimate the effects. A total of 15 eligible studies with 141,431 subjects and 11,248 cases were retrieved after a comprehensive search of the PubMed, Cochrane Library, and Web of Science databases up to October 2013. The overall meta-analysis revealed no strong significant association between eating frequency and risk of CRC in different eating occasion categories (1 meal/day): RR = 1.01, 95% CI 0.94-1.09, P = 0.709; 3 vs. <3 daily meals: RR = 1.17, 95% CI 0.93-1.46; 4 vs. <3 daily meals: RR = 1.13, 95% CI 0.92-1.38; ≥ 5 vs. <3 daily meals: RR = 0.95, 95% CI 0.61-1.47; 4 vs. ≤ 3 daily meals: RR = 1.18, 95% CI 0.92-1.51; and 1-2 vs. 3 or 4 daily meals: RR = 0.82, 95% CI 0.63-1.06). However, modest evidence of an increased risk of CRC in case-control studies (RR = 1.30; 95% CI, 1.11-1.52) and ≥ 5 vs. ≤ 3 meals group (RR = 1.30; 95% CI, 1.11-1.52) was observed. Our meta-analysis results do not support the hypothesis that eating frequency strongly reduced or increased the risk of CRC. Clinical randomized trials are required to evaluate this relationship further.

Dose-Response Association Between Physical Activity and Incident Hypertension: A Systematic Review and Meta-Analysis of Cohort Studies.

PubMed

Liu, Xuejiao; Zhang, Dongdong; Liu, Yu; Sun, Xizhuo; Han, Chengyi; Wang, Bingyuan; Ren, Yongcheng; Zhou, Junmei; Zhao, Yang; Shi, Yuanyuan; Hu, Dongsheng; Zhang, Ming

2017-05-01

Despite the inverse association between physical activity (PA) and incident hypertension, a comprehensive assessment of the quantitative dose-response association between PA and hypertension has not been reported. We performed a meta-analysis, including dose-response analysis, to quantitatively evaluate this association. We searched PubMed and Embase databases for articles published up to November 1, 2016. Random effects generalized least squares regression models were used to assess the quantitative association between PA and hypertension risk across studies. Restricted cubic splines were used to model the dose-response association. We identified 22 articles (29 studies) investigating the risk of hypertension with leisure-time PA or total PA, including 330 222 individuals and 67 698 incident cases of hypertension. The risk of hypertension was reduced by 6% (relative risk, 0.94; 95% confidence interval, 0.92-0.96) with each 10 metabolic equivalent of task h/wk increment of leisure-time PA. We found no evidence of a nonlinear dose-response association of PA and hypertension ( P nonlinearity =0.094 for leisure-time PA and 0.771 for total PA). With the linear cubic spline model, when compared with inactive individuals, for those who met the guidelines recommended minimum level of moderate PA (10 metabolic equivalent of task h/wk), the risk of hypertension was reduced by 6% (relative risk, 0.94; 95% confidence interval, 0.92-0.97). This meta-analysis suggests that additional benefits for hypertension prevention occur as the amount of PA increases. © 2017 American Heart Association, Inc.

Elucidation of the genetic and epigenetic landscape alterations in RNA binding proteins in glioblastoma

PubMed Central

Mahalingam, Kulandaivelu; Somasundaram, Kumaravel

2017-01-01

RNA binding proteins (RBPs) have been implicated in cancer development. An integrated bioinformatics analysis of RBPs (n = 1756) in various datasets (n = 11) revealed several genetic and epigenetically altered events among RBPs in glioblastoma (GBM). We identified 13 mutated and 472 differentially regulated RBPs in GBM samples. Mutations in AHNAK predicted poor prognosis. Copy number variation (CNV), DNA methylation and miRNA targeting contributed to RBP differential regulation. Two sets of differentially regulated RBPs that may be implicated in initial astrocytic transformation and glioma progression were identified. We have also identified a four RBP (NOL3, SUCLG1, HERC5 and AFF3) signature, having a unique expression pattern in glioma stem-like cells (GSCs), to be an independent poor prognostic indicator in GBM. RBP risk score derived from the signature also stratified GBM into low-risk and high-risk groups with significant survival difference. Silencing NOL3, SUCLG1 and HERC5 inhibited GSC maintenance. Gene set enrichment analysis of differentially regulated genes between high-risk and low-risk underscored the importance of inflammation, EMT and hypoxia in high-risk GBM. Thus, we provide a comprehensive overview of genetic and epigenetic regulation of RBPs in glioma development and progression. PMID:28035070

The impact of numeracy on reactions to different graphic risk presentation formats: An experimental analogue study.

PubMed

Wright, Alison J; Whitwell, Sophia C L; Takeichi, Chika; Hankins, Matthew; Marteau, Theresa M

2009-02-01

Numeracy, the ability to process basic mathematical concepts, may affect responses to graphical displays of health risk information. Displays of probabilistic risk information using grouped dots are easier to understand than displays using dispersed dots. However, dispersed dots may better convey the randomness with which health threats occur, so increasing perceived susceptibility. We hypothesized that low numeracy participants would better understand risks presented using grouped dot displays, while high numeracy participants would have good understanding, regardless of display type. Moreover, we predicted that dispersed dot displays, in contrast to grouped dot displays, would increase risk perceptions and worry only for highly numerate individuals. One hundred and forty smokers read vignettes asking them to imagine being at risk of Crohn's disease, in a 2(display type: dispersed/grouped dots) x 3(risk magnitude: 3%/6%/50%) x 2(numeracy: high/low) design. They completed measures of risk comprehension, perceived susceptibility and worry. More numerate participants had better objective risk comprehension, but this effect was not moderated by display type. There was marginally significant support for the predicted numeracy x display type interaction for worry about Crohn's disease, but not for perceived susceptibility to the condition. Dispersed dot displays somewhat increase worry in highly numerate individuals, but only numeracy influenced objective risk comprehension. The most effective display type for communicating risk information will depend on the numeracy of the population and the goal(s) of the communication.

An Expert Map of Gambling Risk Perception.

PubMed

Spurrier, Michael; Blaszczynski, Alexander; Rhodes, Paul

2015-12-01

The purpose of the current study was to investigate the moderating or mediating role played by risk perception in decision-making, gambling behaviour, and disordered gambling aetiology. Eleven gambling expert clinicians and researchers completed a semi-structured interview derived from mental models and grounded theory methodologies. Expert interview data was used to construct a comprehensive expert mental model 'map' detailing risk-perception related factors contributing to harmful or safe gambling. Systematic overlapping processes of data gathering and analysis were used to iteratively extend, saturate, test for exception, and verify concepts and emergent themes. Findings indicated that experts considered idiosyncratic beliefs among gamblers result in overall underestimates of risk and loss, insufficient prioritization of needs, and planning and implementation of risk management strategies. Additional contextual factors influencing use of risk information (reinforcement and learning; mental states, environmental cues, ambivalence; and socio-cultural and biological variables) acted to shape risk perceptions and increase vulnerabilities to harm or disordered gambling. It was concluded that understanding the nature, extent and processes by which risk perception predisposes an individual to maintain gambling despite adverse consequences can guide the content of preventative educational responsible gambling campaigns.

Insomnia and the risk of depression: a meta-analysis of prospective cohort studies.

PubMed

Li, Liqing; Wu, Chunmei; Gan, Yong; Qu, Xianguo; Lu, Zuxun

2016-11-05

Observational studies suggest that insomnia might be associated with an increased risk of depression with inconsistent results. This study aimed at conducting a meta-analysis of prospective cohort studies to evaluate the association between insomnia and the risk of depression. Relevant cohort studies were comprehensively searched from the PubMed, Embase, Web of Science, and China National Knowledge Infrastructure databases (up to October 2014) and from the reference lists of retrieved articles. A random-effects model was used to calculate the pooled risk estimates and 95 % confidence intervals (CIs). The I 2 statistic was used to assess the heterogeneity and potential sources of heterogeneity were assessed with meta-regression. The potential publication bias was explored by using funnel plots, Egger's test, and Duval and Tweedie trim-and-fill methods. Thirty-four cohort studies involving 172,077 participants were included in this meta-analysis with an average follow-up period of 60.4 months (ranging from 3.5 to 408). Statistical analysis suggested a positive relationship between insomnia and depression, the pooled RR was 2.27 (95 % CI: 1.89-2.71), and a high heterogeneity was observed (I 2  = 92.6 %, P < 0.001). Visual inspection of the funnel plot revealed some asymmetry. The Egger's test identified evidence of substantial publication bias (P <0.05), but correction for this bias using trim-and-fill method did not alter the combined risk estimates. This meta-analysis indicates that insomnia is significantly associated with an increased risk of depression, which has implications for the prevention of depression in non-depressed individuals with insomnia symptoms.

Soyfood intake in the prevention of breast cancer risk in women: a meta-analysis of observational epidemiological studies.

PubMed

Qin, Li-Qiang; Xu, Jia-Ying; Wang, Pei-Yu; Hoshi, Kazuhiko

2006-12-01

Many studies have suggested that the intake of soy products may protect against the occurrence of breast cancer because of the considerable amount of isoflavones they contain. To review the results of the observational studies, we performed this meta-analysis of the relevant literature. We searched Medline for reports that examined the association between soyfood consumption (or isoflavone intake) and breast cancer risk from January 1966 to April 2006. The random-effects model was used to estimate the pooled relative risk (RR). Twenty-one independent studies (14 case-control studies and 7 cohort studies) were included in the final analysis. The pooled RR of breast cancer for soyfood intake was 0.75 with a 95% CI of 0.59-0.95. As the main types of soyfood in Japan and China, tofu and miso showed clear protective effects. Isoflavone intake resulted in a 20% decrease in risk (RR = 0.81, 95% CI 0.67-0.99). The pooled RR varied little according to study stratification. When the studies published in Japanese and Chinese were added, the inverse associations between soyfood, tofu and breast cancer risk became slightly stronger. The weak association of miso was possibly due to the high concentration of salt in miso soup. In the present analysis, we did not find strong evidence for publication bias in the combination of the studies. This meta-analysis supported the hypotheses that soyfood intake may be associated with a decreased risk of breast cancer due to the isoflavones. Further epidemiological studies need to be conducted with more comprehensive information about the soyfood, and more accurate assessment of the isoflavones.

Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy.

PubMed

Kohler, Pamela K; Manhart, Lisa E; Lafferty, William E

2008-04-01

The role that sex education plays in the initiation of sexual activity and risk of teen pregnancy and sexually transmitted disease (STD) is controversial in the United States. Despite several systematic reviews, few epidemiologic evaluations of the effectiveness of these programs on a population level have been conducted. Among never-married heterosexual adolescents, aged 15-19 years, who participated in Cycle 6 (2002) of the National Survey of Family Growth and reported on formal sex education received before their first sexual intercourse (n = 1719), we compared the sexual health risks of adolescents who received abstinence-only and comprehensive sex education to those of adolescents who received no formal sex education. Weighted multivariate logistic regression generated population-based estimates. Adolescents who received comprehensive sex education were significantly less likely to report teen pregnancy (OR(adj) = .4, 95% CI = .22- .69, p = .001) than those who received no formal sex education, whereas there was no significant effect of abstinence-only education (OR(adj) = .7, 95% CI = .38-1.45, p = .38). Abstinence-only education did not reduce the likelihood of engaging in vaginal intercourse (OR(adj) = .8, 95% CI = .51-1.31, p = .40), but comprehensive sex education was marginally associated with a lower likelihood of reporting having engaged in vaginal intercourse (OR(adj) = .7, 95% CI = .49-1.02, p = .06). Neither abstinence-only nor comprehensive sex education significantly reduced the likelihood of reported STD diagnoses (OR(adj) = 1.7, 95% CI = .57-34.76, p = .36 and OR(adj) = 1.8, 95% CI = .67-5.00, p = .24 respectively). Teaching about contraception was not associated with increased risk of adolescent sexual activity or STD. Adolescents who received comprehensive sex education had a lower risk of pregnancy than adolescents who received abstinence-only or no sex education.

Association between N-acetyltransferase 2 polymorphisms and pancreatic cancer risk: a meta-analysis.

PubMed

Liang, J X; Gao, W; Liang, Y; Zhou, X M

2015-12-17

N-acetyltransferase 2 (NAT2) is an essential phase II enzyme in the metabolism of aromatic and heterocyclic amines and of hydrazines. NAT2 activity can be divided into three phenotypes: rapid, intermediate, and slow. Studies identifying an association between NAT2 polymorphism and the risk of pancreatic cancer have shown conflicting results. In order to assess this relationship comprehensively, we performed a meta-analysis that involved 1607 patients with pancreatic cancer and 1682 controls from six studies, which were selected from a group of ten, identified by a search of PubMed and Embase databases up to July 2014. Relative risks (RRs) with 95% confidence intervals (CIs) were used to evaluate the relationships. In the overall analysis, no significant associations between NAT2 rapid acetylation genotypes and pancreatic cancer risk (RR = 0.93, 95%CI = 0.73-1.19) were found; however, the results showed significant heterogeneity (I2 = 55.0%). The results from subgroup analysis suggested that the rapid genotypes might decrease the risk of pancreatic cancer (RR = 0.56, 95%CI = 0.38-0.84) in Turkey, although the association was not significant in the United States population (RR = 0.97, 95%CI = 0.71-1.34) or in the multi-center studies (RR = 1.10, 95%CI = 0.90-1.34). Analysis of the slow acetylation genotypes demonstrated the converse outcomes. In conclusion, the results of our study suggested that the NAT2 slow acetylation genotypes might increase the susceptibility to pancreatic cancer in Europe but that these have no significant effects in the United States and multi-center populations.

Physical activity volume in relation to risk of atrial fibrillation. A non-linear meta-regression analysis.

PubMed

Ricci, Cristian; Gervasi, Federico; Gaeta, Maddalena; Smuts, Cornelius M; Schutte, Aletta E; Leitzmann, Michael F

2018-05-01

Background Light physical activity is known to reduce atrial fibrillation risk, whereas moderate to vigorous physical activity may result in an increased risk. However, the question of what volume of physical activity can be considered beneficial remains poorly understood. The scope of the present work was to examine the relation between physical activity volume and atrial fibrillation risk. Design A comprehensive systematic review was performed following the PRISMA guidelines. Methods A non-linear meta-regression considering the amount of energy spent in physical activity was carried out. The first derivative of the non-linear relation between physical activity and atrial fibrillation risk was evaluated to determine the volume of physical activity that carried the minimum atrial fibrillation risk. Results The dose-response analysis of the relation between physical activity and atrial fibrillation risk showed that physical activity at volumes of 5-20 metabolic equivalents per week (MET-h/week) was associated with significant reduction in atrial fibrillation risk (relative risk for 19 MET-h/week = 0.92 (0.87, 0.98). By comparison, physical activity volumes exceeding 20 MET-h/week were unrelated to atrial fibrillation risk (relative risk for 21 MET-h/week = 0.95 (0.88, 1.02). Conclusion These data show a J-shaped relation between physical activity volume and atrial fibrillation risk. Physical activity at volumes of up to 20 MET-h/week is associated with reduced atrial fibrillation risk, whereas volumes exceeding 20 MET-h/week show no relation with risk.

Dynamic Positioning System (DPS) Risk Analysis Using Probabilistic Risk Assessment (PRA)

NASA Technical Reports Server (NTRS)

Thigpen, Eric B.; Boyer, Roger L.; Stewart, Michael A.; Fougere, Pete

2017-01-01

The National Aeronautics and Space Administration (NASA) Safety & Mission Assurance (S&MA) directorate at the Johnson Space Center (JSC) has applied its knowledge and experience with Probabilistic Risk Assessment (PRA) to projects in industries ranging from spacecraft to nuclear power plants. PRA is a comprehensive and structured process for analyzing risk in complex engineered systems and/or processes. The PRA process enables the user to identify potential risk contributors such as, hardware and software failure, human error, and external events. Recent developments in the oil and gas industry have presented opportunities for NASA to lend their PRA expertise to both ongoing and developmental projects within the industry. This paper provides an overview of the PRA process and demonstrates how this process was applied in estimating the probability that a Mobile Offshore Drilling Unit (MODU) operating in the Gulf of Mexico and equipped with a generically configured Dynamic Positioning System (DPS) loses location and needs to initiate an emergency disconnect. The PRA described in this paper is intended to be generic such that the vessel meets the general requirements of an International Maritime Organization (IMO) Maritime Safety Committee (MSC)/Circ. 645 Class 3 dynamically positioned vessel. The results of this analysis are not intended to be applied to any specific drilling vessel, although provisions were made to allow the analysis to be configured to a specific vessel if required.

Soy food consumption and risk of prostate cancer: a meta-analysis of observational studies.

PubMed

Hwang, Ye Won; Kim, Soo Young; Jee, Sun Ha; Kim, Youn Nam; Nam, Chung Mo

2009-01-01

Soybean products have been suggested to have a chemo preventive effect against prostate cancer. The aim of this study was to provide a comprehensive meta-analysis on the extent of the possible association between soy-based food consumption and the risk of prostate cancer. Five cohort studies and 8 case-control studies were identified using MEDLINE, EMBASE, CINAHL, Korea Medical Database, KoreaMed, Korean studies Information Service System, Japana Centra Revuo Medicina, China National Knowledge Infrastructure, and a manual search. Summary odds ratios (ORs) comparing high versus low categories of soybean consumptions were calculated on the basis of the random effect model. We analyzed the associations based on the different types of soybean consumptions. The summary ORs (95% CI) for total soy foods were 0.69 (CI = 0.57-0.84) and 0.75 (CI = 0.62-0.89) for nonfermented soy foods. Among individual soy foods, only tofu yielded a significant value of 0.73 (CI = 0.57-0.92). Consumption of soybean milk, miso, or natto did not significantly reduce the risk of prostate cancer. Genistein and daidzein were associated with a lower risk of prostate cancer. This systematic review suggests that soy food consumption could lower the risk of prostate cancer. This conclusion, however, should be interpreted with caution because various biases can affect the results of a meta-analysis.

Red and processed meat intake and risk of breast cancer: a meta-analysis of prospective studies.

PubMed

Guo, Jingyu; Wei, Wei; Zhan, Lixing

2015-05-01

Epidemiological studies regarding the association between red and processed meat intake and the risk of breast cancer have yielded inconsistent results. Therefore, we conducted an updated and comprehensive meta-analysis which included 14 prospective studies to evaluate the association of red and processed meat intake with breast cancer risk. Relevant prospective cohort studies were identified by searching PubMed through October 31, 2014, and by reviewing the reference lists of retrieved articles. Study-specific relative risk (RR) estimates were pooled using a random-effects model. Fourteen prospective studies on red meat (involving 31,552 cases) and 12 prospective studies on processed meat were included in the meta-analysis. The summary RRs (95 % CI) of breast cancer for the highest versus the lowest categories were 1.10 (1.02, 1.19) for red meat, and 1.08 (1.01, 1.15) for processed meat. The estimated summary RRs (95 % CI) were 1.11 (1.05, 1.16) for an increase of 120 g/day of red meat, and 1.09 (1.03, 1.16) for an increase of 50 g/day of processed meat. Our findings indicate that increased intake of red and processed meat is associated with an increased risk of breast cancer. Further research with well-designed cohort or interventional studies is needed to confirm the association.

Solid phase microextraction-comprehensive two-dimensional gas chromatography-time-of-flight mass spectrometry for the analysis of honey volatiles.

PubMed

Cajka, Tomás; Hajslová, Jana; Cochran, Jack; Holadová, Katerina; Klimánková, Eva

2007-03-01

Head-space solid phase microextration (SPME), followed by comprehensive two-dimensional gas chromatography-time-of-flight mass spectrometry (GCxGC-TOFMS), has been implemented for the analysis of honey volatiles, with emphasis on the optimal selection of SPME fibre and the first- and second-dimension GC capillaries. From seven SPME fibres investigated, a divinylbenzene/Carboxen/polydimethylsiloxane (DVB/CAR/PDMS) 50/30 microm fibre provided the best sorption capacity and the broadest range of volatiles extracted from the headspace of a mixed honey sample. A combination of DB-5ms x SUPELCOWAX 10 columns enabled the best resolution of sample components compared to the other two tested column configurations. Employing this powerful analytical strategy led to the identification of 164 volatile compounds present in a honey mixture during a 19-min GC run. Combination of this simple and inexpensive SPME-based sampling/concentration technique with the advanced separation/identification approach represented by GCxGC-TOFMS allows a rapid and comprehensive examination of the honey volatiles profile. In this way, the laboratory sample throughput can be increased significantly and, at the same time, the risk of erroneous identification, which cannot be avoided in one-dimensional GC separation, is minimised.

Factors affecting the results of comprehensive pre-internship exam among medical students of Kermanshah University of Medical Sciences.

PubMed

Khazaei, Mohammad Rasool; Zarin, Afshin; Rezaei, Mansuor; Khazaei, Mozafar

2018-06-01

This study was aimed to evaluate the factors affecting the results of comprehensive pre-internship exam (CPIE) among medicals students of Kermanshah University of Medical Sciences. In this descriptive-analytical study, all students (n=240) participating in CPIE over a 3-year period (2012-2014) were selected. Data were gathered by a questionnaire, including the CPIE results and educational and demographic data. Spearman correlation coefficient, Mann-Whitney U-test, and analysis of variance were used to analyze the association of students' success with study variables. Also, regression analysis was applied to determine the role of independent variables in students' success. The frequency of the failed units in apprenticeship course was one of the most important risk factors associated with failure in CPIE. Average scores of pre-internship course were the most important factors of success in CPIE. The CPIE score had the highest direct relationship with grade point average (GPA) of apprenticeship course, total GPA of all three courses, GPAs of physiopathology and basic sciences courses, and score of comprehensive basic sciences examination, respectively. CPIE showed the highest inverse correlation with the number of failed units in apprenticeship course. The most important factors influencing this exam were failure in apprenticeship course and GPA of previous educational stages.

Ethnicity and HIV risk behaviour, testing and knowledge in Guatemala

PubMed Central

Taylor, Tory M.; Hembling, John; Bertrand, Jane T.

2015-01-01

Objectives. To describe levels of risky sexual behaviour, HIV testing and HIV knowledge among men and women in Guatemala by ethnic group and to identify adjusted associations between ethnicity and these outcomes. Design. Data on 16,205 women aged 15–49 and 6822 men aged 15–59 from the 2008–2009 Encuesta Nacional de Salud Materno Infantil were used to describe ethnic group differences in sexual behaviour, HIV knowledge and testing. We then controlled for age, education, wealth and other socio-demographic factors in a multivariate logistic regression model to examine the effects of ethnicity on outcomes related to age at sexual debut, number of lifetime sex partners, comprehensive HIV knowledge, HIV testing and lifetime sex worker patronage (men only). Results. The data show low levels of risky sexual behaviour and low levels of HIV knowledge among indigenous women and men, compared to other respondents. Controlling for demographic factors, indigenous women were more likely than other women never to have been tested for HIV and to lack comprehensive HIV knowledge. They were less likely to report early sexual debut and three or more lifetime sexual partners. Indigenous men were more likely than other men to lack comprehensive HIV knowledge and demonstrated lower odds of early sexual debut, 10 or more lifetime sexual partners and sex worker patronage. Conclusions. The Mayan indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV based on this analysis of selected risk factors. Nonetheless, low rates of HIV knowledge and testing may be cause for concern. Programmes working in indigenous communities should focus on HIV education and reducing barriers to testing. Further research into the factors that underlie ethnic self-identity and perceived ethnicity could help clarify the relative significance of these measures for HIV risk and other health outcomes. PMID:24834462

Seismic Risk Assessment for the Kyrgyz Republic

NASA Astrophysics Data System (ADS)

Pittore, Massimiliano; Sousa, Luis; Grant, Damian; Fleming, Kevin; Parolai, Stefano; Fourniadis, Yannis; Free, Matthew; Moldobekov, Bolot; Takeuchi, Ko

2017-04-01

The Kyrgyz Republic is one of the most socially and economically dynamic countries in Central Asia, and one of the most endangered by earthquake hazard in the region. In order to support the government of the Kyrgyz Republic in the development of a country-level Disaster Risk Reduction strategy, a comprehensive seismic risk study has been developed with the support of the World Bank. As part of this project, state-of-the-art hazard, exposure and vulnerability models have been developed and combined into the assessment of direct physical and economic risk on residential, educational and transportation infrastructure. The seismic hazard has been modelled with three different approaches, in order to provide a comprehensive overview of the possible consequences. A probabilistic seismic hazard assessment (PSHA) approach has been used to quantitatively evaluate the distribution of expected ground shaking intensity, as constrained by the compiled earthquake catalogue and associated seismic source model. A set of specific seismic scenarios based on events generated from known fault systems have been also considered, in order to provide insight on the expected consequences in case of strong events in proximity of densely inhabited areas. Furthermore, long-span catalogues of events have been generated stochastically and employed in the probabilistic analysis of expected losses over the territory of the Kyrgyz Republic. Damage and risk estimates have been computed by using an exposure model recently developed for the country, combined with the assignment of suitable fragility/vulnerability models. The risk estimation has been carried out with spatial aggregation at the district (rayon) level. The obtained results confirm the high level of seismic risk throughout the country, also pinpointing the location of several risk hotspots, particularly in the southern districts, in correspondence with the Ferghana valley. The outcome of this project will further support the local decision makers in implementing specific prevention and mitigation measures that are consistent with a broad risk reduction strategy.

Thiazolidinedione therapy and breast cancer risk in diabetic women: A systematic review and meta-analysis.

PubMed

Du, Rui; Lin, Lin; Cheng, Di; Xu, Yu; Xu, Min; Chen, Yuhong; Wang, Weiqing; Bi, Yufang; Li, Donghui; Lu, Jieli

2018-02-01

Rising experimental evidence suggests that thiazolidinediones (TZDs) exert a protective effect on breast cancer. However, studies concerning this issue were inconsistent and limited. Hence, we performed a meta-analysis with data from currently available studies to evaluate the effect of TZDs on breast cancer risk among diabetic women. We comprehensively searched for all pertinent studies addressing TZDs use and breast cancer risk published before January 1, 2016, in PubMed, Clinical Trials, and Cochrane Library. Data synthesis was performed in a random-effects model using Stata version 12.0 (Stata Corp, College Station, Texas). Fourteen independent studies were eventually selected in this meta-analysis, including 5 randomized controlled clinical trials (RCTs), 7 cohort studies, and 2 case-control studies. No significant associations of TZD use and risk of breast cancer were observed in the RCTs (pooled risk ratio [RR]: 0.77, 95% confidence interval (CI), 0.39-1.53, I 2  = 26%) or case-control studies (pooled odds ratio, 0.99, 95% CI, 0.76-1.28, I 2  = 31%). A 19% reduction in breast cancer risk (pooled RR: 0.81, 95% CI, 0.66-0.99, I 2  = 72%) was found in the cohort studies. However, after removing the study with the smallest event number and the greatest effect size, the association became nonsignificant with greatly decreased heterogeneity (pooled RR: 0.94, 95% CI, 0.86-1.03, I 2  = 16%). This meta-analysis did not find any significant association between TZDs use and risk of breast cancer among diabetic women. Copyright © 2017 John Wiley & Sons, Ltd.

Understanding the Harms and Benefits of Cancer Screening: A Model of Factors That Shape Informed Decision Making.

PubMed

Petrova, Dafina; Garcia-Retamero, Rocio; Cokely, Edward T

2015-10-01

Decisions about cancer screenings often involve the consideration of complex and counterintuitive evidence. We investigated psychological factors that promote the comprehension of benefits and harms associated with common cancer screenings and their influence on shared decision making. In experiment 1, 256 men received information about PSA-based prostate cancer screening. In experiment 2, 355 women received information about mammography-based breast cancer screening. In both studies, information about potential screening outcomes was provided in 1 of 3 formats: text, a fact box, or a visual aid (e.g., mortality with and without screening and rate of overdiagnosis). We modeled the interplay of comprehension, perceived risks and benefits, intention to participate in screening, and desire for shared decision making. Generally, visual aids were the most effective format, increasing comprehension by up to 18%. Improved comprehension was associated with 1) superior decision making (e.g., fewer intentions to participate in screening when it offered no benefit) and 2) more desire to share in decision making. However, comprehension of the evidence had a limited effect on experienced emotions, risk perceptions, and decision making among those participants who felt that the consequences of cancer were extremely severe. Even when information is counterintuitive and requires the integration of complex harms and benefits, user-friendly risk communications can facilitate comprehension, improve high-stakes decisions, and promote shared decision making. However, previous beliefs about the effectiveness of screening or strong fears about specific cancers may interfere with comprehension and informed decision making. © The Author(s) 2015.

Arrhythmias Following Comprehensive Stage II Surgical Palliation in Single Ventricle Patients.

PubMed

Wilhelm, Carolyn M; Paulus, Diane; Cua, Clifford L; Kertesz, Naomi J; Cheatham, John P; Galantowicz, Mark; Fernandez, Richard P

2016-03-01

Post-operative arrhythmias are common in pediatric patients following cardiac surgery. Following hybrid palliation in single ventricle patients, a comprehensive stage II palliation is performed. The incidence of arrhythmias in patients following comprehensive stage II palliation is unknown. The purpose of this study is to determine the incidence of arrhythmias following comprehensive stage II palliation. A single-center retrospective chart review was performed on all single ventricle patients undergoing a comprehensive stage II palliation from January 2010 to May 2014. Pre-operative, operative, and post-operative data were collected. A clinically significant arrhythmia was defined as an arrhythmia which led to cardiopulmonary resuscitation or required treatment with either pacing or antiarrhythmic medication. Statistical analysis was performed with Wilcoxon rank-sum test and Fisher's exact test with p < 0.05 significant. Forty-eight single ventricle patients were reviewed (32 hypoplastic left heart syndrome, 16 other single ventricle variants). Age at surgery was 185 ± 56 days. Cardiopulmonary bypass time was 259 ± 45 min. Average vasoactive-inotropic score was 5.97 ± 7.58. Six patients (12.5 %) had clinically significant arrhythmias: four sinus bradycardia, one 2:1 atrioventricular block, and one slow junctional rhythm. No tachyarrhythmias were documented for this patient population. Presence of arrhythmia was associated with elevated lactate (p = 0.04) and cardiac arrest (p = 0.002). Following comprehensive stage II palliation, single ventricle patients are at low risk for development of tachyarrhythmias. The most frequent arrhythmia seen in these patients was sinus bradycardia associated with respiratory compromise.

America's Challenge: Effective Teachers for At-Risk Schools and Students

ERIC Educational Resources Information Center

Dwyer, Carol A., Ed.

2007-01-01

The National Comprehensive Center for Teacher Quality (NCCTQ) was launched in 2005 as part of a comprehensive system of content-based technical assistance to support states in implementing the priorities of the No Child Left Behind (NCLB) Act. NCCTQ's mission is to support Regional Comprehensive Centers (RCCs), states, and other education…

A comprehensive screen for SNP associations on chromosome region 5q31-33 in Swedish/Norwegian celiac disease families.

PubMed

Amundsen, Silja Svanstrøm; Adamovic, Svetlana; Hellqvist, Asa; Nilsson, Staffan; Gudjónsdóttir, Audur H; Ascher, Henry; Ek, Johan; Larsson, Kristina; Wahlström, Jan; Lie, Benedicte A; Sollid, Ludvig M; Naluai, Asa Torinsson

2007-09-01

Celiac disease (CD) is a gluten-induced enteropathy, which results from the interplay between environmental and genetic factors. There is a strong human leukocyte antigen (HLA) association with the disease, and HLA-DQ alleles represent a major genetic risk factor. In addition to HLA-DQ, non-HLA genes appear to be crucial for CD development. Chromosomal region 5q31-33 has demonstrated linkage with CD in several genome-wide studies, including in our Swedish/Norwegian cohort. In a European meta-analysis 5q31-33 was the only region that reached a genome-wide level of significance except for the HLA region. To identify the genetic variant(s) responsible for this linkage signal, we performed a comprehensive single nucleotide polymorphism (SNP) association screen in 97 Swedish/Norwegian multiplex families who demonstrate linkage to the region. We selected tag SNPs from a 16 Mb region representing the 95% confidence interval of the linkage peak. A total of 1,404 SNPs were used for the association analysis. We identified several regions with SNPs demonstrating moderate single- or multipoint associations. However, the isolated association signals appeared insufficient to account for the linkage signal seen in our cohort. Collective effects of multiple risk genes within the region, incomplete genetic coverage or effects related to copy number variation are possible explanations for our findings.

Improving Flood Risk Management for California's Central Valley: How the State Developed a Toolbox for Large, System-wide Studies

NASA Astrophysics Data System (ADS)

Pingel, N.; Liang, Y.; Bindra, A.

2016-12-01

More than 1 million Californians live and work in the floodplains of the Sacramento-San Joaquin Valley where flood risks are among the highest in the nation. In response to this threat to people, property and the environment, the Department of Water Resources (DWR) has been called to action to improve flood risk management. This has transpired through significant advances in development of flood information and tools, analysis, and planning. Senate Bill 5 directed DWR to prepare the Central Valley Flood Protection Plan (CVFPP) and update it every 5 years. A key component of this aggressive planning approach is answering the question: What is the current flood risk, and how would proposed improvements change flood risk throughout the system? Answering this question is a substantial challenge due to the size and complexity of the watershed and flood control system. The watershed is roughly 42,000 sq mi, and flows are controlled by numerous reservoirs, bypasses, and levees. To overcome this challenge, the State invested in development of a comprehensive analysis "tool box" through various DWR programs. Development of the tool box included: collection of hydro-meteorological, topographic, geotechnical, and economic data; development of rainfall-runoff, reservoir operation, hydraulic routing, and flood risk analysis models; and development of specialized applications and computing schemes to accelerate the analysis. With this toolbox, DWR is analyzing flood hazard, flood control system performance, exposure and vulnerability of people and property to flooding, consequence of flooding for specific events, and finally flood risk for a range of CVFPP alternatives. Based on the results, DWR will put forward a State Recommended Plan in the 2017 CVFPP. Further, the value of the analysis tool box extends beyond the CVFPP. It will serve as a foundation for other flood studies for years to come and has already been successfully applied for inundation mapping to support emergency response, reservoir operation analysis, and others.

Prenatal antibiotic use and risk of childhood wheeze/asthma: A meta-analysis.

PubMed

Zhao, Desheng; Su, Hong; Cheng, Jian; Wang, Xu; Xie, Mingyu; Li, Kesheng; Wen, Liying; Yang, Huihui

2015-12-01

Existing body of knowledge suggests that antibiotic use during pregnancy was inconsistently associated with childhood wheeze/asthma. The aim of this study was to determine whether exposure to antibiotic during pregnancy could increase the risk for childhood wheeze/asthma using a comprehensive meta-analysis. PubMed, MEDLINE, and China National Knowledge Infrastructure (CNKI) were systematically searched for studies up to September 10, 2014, and additional studies were found by searching reference lists of relevant articles. For this meta-analysis, cohort studies and case-control studies assessing the association between antibiotic use during pregnancy and risk of childhood wheeze/asthma were included. Extracted data were mainly pooled using random-effects model. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). Ten studies were identified in final analysis. Pooling analysis of these studies showed an OR of 1.20 (95% CI, 1.13-1.27) for wheeze/asthma. After excluding case-control studies and prospective studies without achieving high scores on the NOS, the pooled OR was 1.18 (95% CI, 1.11-1.26). We found the risk of antibiotic use and pooled ORs of wheeze/asthma were 1.09 (95% CI, 0.92-1.29) for the first trimester, 1.14 (95% CI, 1.01-1.29) for the second trimester, and 1.33 (95% CI, 1.11-1.60) for the third trimester, respectively. This meta-analysis suggests that antibiotic exposure during pregnancy may increase the risk of wheeze/asthma in childhood. Besides, the risk of developing wheeze/asthma in childhood was marked during last two trimesters of pregnancy. Future studies of large-size and prospective cohorts which adequately address concerns for confounder bias are needed to examine the relationship between antibiotic use and risk of childhood asthma. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Long-Term Results After High-Dose Radiotherapy and Adjuvant Hormones in Prostate Cancer: How Curable Is High-Risk Disease?

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

Zapatero, Almudena, E-mail: azapatero.hlpr@salud.madrid.org; Garcia-Vicente, Feliciano; Martin de Vidales, Carmen

Purpose: To analyze long-term outcome and prognostic factors for high-risk prostate cancer defined by National Comprehensive Cancer Network criteria treated with high-dose radiotherapy and androgen deprivation in a single institution. Methods and Materials: A total of 306 patients treated between 1995 and 2007 in a radiation dose-escalation program fulfilled the National Comprehensive Cancer Network high-risk criteria. Median International Commission on Radiation Units and Measurements radiation dose was 78 Gy (range, 66.0-84.1 Gy). Long-term androgen deprivation (LTAD) was administered in 231 patients, short-term androgen deprivation (STAD) in 59 patients, and no hormones in 16 patients. The Phoenix (nadir plus 2 ng/mL)more » consensus definition was used for biochemical control. Multivariate analysis was performed to determine the independent prognostic impact of clinical and treatment factors. Median follow-up time was 64 months (range, 24-171 months). Results: The actuarial overall survival at 5 and 10 years was 95.7% and 89.8%, respectively, and the corresponding biochemical disease-free survival (bDFS) was 89.5% and 67.2%, respectively. Fourteen patients (4.6%) developed distant metastasis. Multivariate analysis showed that Gleason score >7 (p = 0.001), pretreatment prostate-specific antigen (PSA) level >20 ng/mL (p = 0.037), higher radiation dose (p = 0.005), and the use of adjuvant LTAD vs. STAD (p = 0.011) were independent prognostic factors affecting bDFS in high-risk disease. The 5-year bDFS for patients treated with LTAD plus radiotherapy dose >78 Gy was 97%. Conclusions: For high-risk patients the present series showed that the use of LTAD in conjunction with higher doses (>78 Gy) of radiotherapy was associated with improved biochemical tumor control. We observed that the presence of Gleason sum >7 and pretreatment PSA level >20 ng/mL in the same patient represents a 6.8 times higher risk of PSA failure. These men could be considered for clinical trials with addition of novel agents.« less

[Ecological risk assessment of land use based on exploratory spatial data analysis (ESDA): a case study of Haitan Island, Fujian Province].

PubMed

Wu, Jian; Chen, Peng; Wen, Chao-Xiang; Fu, Shi-Feng; Chen, Qing-Hui

2014-07-01

As a novel environment management tool, ecological risk assessment has provided a new perspective for the quantitative evaluation of ecological effects of land-use change. In this study, Haitan Island in Fujian Province was taken as a case. Based on the Landsat TM obtained in 1990, SPOT5 RS images obtained in 2010, general layout planning map of Pingtan Comprehensive Experimental Zone in 2030, as well as the field investigation data, we established an ecological risk index to measure ecological endpoints. By using spatial autocorrelation and semivariance analysis of Exploratory Spatial Data Analysis (ESDA), the ecological risk of Haitan Island under different land-use situations was assessed, including the past (1990), present (2010) and future (2030), and the potential risk and its changing trend were analyzed. The results revealed that the ecological risk index showed obvious scale effect, with strong positive correlation within 3000 meters. High-high (HH) and low-low (LL) aggregations were predominant types in spatial distribution of ecological risk index. The ecological risk index showed significant isotropic characteristics, and its spatial distribution was consistent with Anselin Local Moran I (LISA) distribution during the same period. Dramatic spatial distribution change of each ecological risk area was found among 1990, 2010 and 2030, and the fluctuation trend and amplitude of different ecological risk areas were diverse. The low ecological risk area showed a rise-to-fall trend while the medium and high ecological risk areas showed a fall-to-rise trend. In the planning period, due to intensive anthropogenic disturbance, the high ecological risk area spread throughout the whole region. To reduce the ecological risk in land-use and maintain the regional ecological security, the following ecological risk control strategies could be adopted, i.e., optimizing the spatial pattern of land resources, protecting the key ecoregions and controlling the scale of construction land use.

Participant comprehension of research for which they volunteer: a systematic review.

PubMed

Montalvo, Wanda; Larson, Elaine

2014-11-01

Evidence indicates that research participants often do not fully understand the studies for which they have volunteered. The aim of this systematic review was to examine the relationship between the process of obtaining informed consent for research and participant comprehension and satisfaction with the research. Systematic review of published research on informed consent and participant comprehension of research for which they volunteer using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement as a guide. PubMed, Cumulative Index for Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trails, and Cochrane Database of Systematic Reviews were used to search the literature for studies meeting the following inclusion criteria: (a) published between January 1, 2006, and December 31, 2013, (b) interventional or descriptive quantitative design, (c) published in a peer-reviewed journal, (d) written in English, and (e) assessed participant comprehension or satisfaction with the research process. Studies were assessed for quality using seven indicators: sampling method, use of controls or comparison groups, response rate, description of intervention, description of outcome, statistical method, and health literacy assessment. Of 176 studies identified, 27 met inclusion criteria: 13 (48%) were randomized interventional designs and 14 (52%) were descriptive. Three categories of studies included projects assessing (a) enhanced consent process or form, (b) multimedia methods, and (c) education to improve participant understanding. Most (78%) used investigator-developed tools to assess participant comprehension, did not assess participant health literacy (74%), or did not assess the readability level of the consent form (89%). Researchers found participants lacked basic understanding of research elements: randomization, placebo, risks, and therapeutic misconception. Findings indicate (a) inconsistent assessment of participant reading or health literacy level, (b) measurement variation associated with use of nonstandardized tools, and (c) continued therapeutic misconception and lack of understanding among research participants of randomization, placebo, benefit, and risk. While the Agency for Healthcare and Quality and National Quality Forum have published informed consent and authorization toolkits, previously published validated tools are underutilized. Informed consent requires the assessment of health literacy, reading level, and comprehension of research participants using validated assessment tools and methods. © 2014 Sigma Theta Tau International.

The Effect of Activity with E-Book on Vocabulary and Story Comprehension: A Comparison between Kindergarteners at Risk of Learning Disabilities and Typically Developing Kindergarteners

ERIC Educational Resources Information Center

Shamir, Adina; Korat, Ofra; Shlafer, Inessa

2011-01-01

The purpose of the current study was to investigate the effectiveness of e-book activity for vocabulary acquisition and story comprehension among kindergarteners at risk for learning disabilities (LD) as opposed to typically developing (TD) children. Participants included 136 children aged between five and seven (M = 71.2; SD = 5.64, in months),…

Predictors of Performance on an iPad-Based Reading Comprehension Intervention among Spanish-Speaking Dual Language Learners at Risk for Reading Comprehension Delays

ERIC Educational Resources Information Center

Adams, Ashley

2017-01-01

Purpose: The purpose of this study was to evaluate the efficacy of the EMBRACE Spanish support intervention for at-risk dual language learners and to determine which verbal and nonverbal characteristics of students were related to benefit from the intervention. The first study examined oral language and reading characteristics and the second study…

Vaccinations and risk of systemic lupus erythematosus and rheumatoid arthritis: A systematic review and meta-analysis.

PubMed

Wang, Bin; Shao, Xiaoqing; Wang, Dan; Xu, Donghua; Zhang, Jin-An

2017-07-01

In the past several years, more and more studies proposed some concerns on the possibly increased risk of autoimmune diseases in individuals receiving vaccinations, but published studies on the associations of vaccinations with risks of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) reported conflicting findings. A systematic review and meta-analysis was carried out to comprehensively evaluate the relationship between vaccinations and risk of SLE and RA. Pubmed, Web of Science and Embase were searched for observational studies assessing the associations of vaccinations with risks of RA and SLE. Two authors independently extracted data from those eligible studies. The quality of eligible studies was assessed by using the Newcastle-Ottawa Scale (NOS). The pooled relative risk (RR) with 95% confidence intervals (CIs) was used to measure the risk of RA and SLE associated with vaccinations, and was calculated through random-effect meta-analysis. Sixteen observational studies were finally considered eligible, including 12 studies on the association between vaccinations and SLE risk and 13 studies on the association between vaccinations and RA risk. The pooled findings suggested that vaccinations significantly increased risk of SLE (RR=1.50; 95%CI 1.05-2.12, P=0.02). In addition, there was an obvious association between vaccinations and increased risk of RA (RR=1.32; 95%CI 1.09-1.60, P=0.004). Meta-analysis of studies reporting outcomes of short vaccinated time also suggested that vaccinations could significantly increase risk of SLE (RR=1.93; 95%CI 1.07-3.48, P=0.028) and RA (RR=1.48; 95%CI 1.08-2.03, P=0.015). Sensitivity analyses in studies with low risk of bias also found obvious associations of vaccinations with increased risk of RA and SLE. This study suggests that vaccinations are related to increased risks of SLE and RA. More and larger observational studies are needed to further verify the findings above and to assess the associations of vaccinations with other rheumatic diseases. Copyright © 2017 Elsevier B.V. All rights reserved.

Disease-free and overall survival of patients diagnosed with HPV-associated or HPV-negative cervical cancer

NASA Astrophysics Data System (ADS)

Ibragimova, M. K.; Tsyganov, M. M.; Karabut, I. V.; Kolomiets, L. A.; Choynzonov, E. L.; Litviakov, N. V.

2015-11-01

The real-time PCR method is used to study scrapings of cervical epithelium and outer portion of the cervix in 116 patients aged 24-79 years with stage I-IV primary cervical cancer. The comprehensive survey included colposcopy, cytological and histological analysis, detection and genotyping of high-risk human papillomavirus. In 84 patients (72.4%) the presence of human papillomavirus (HPV) of high carcinogenic risk (HCR) is found, in 32 patients (27.6%) the presence of the virus has not been inspected in the tumor. A significant decrease in the survival rate as well as the prevalence of the worst prognosis for patients with HPV-negative cervical cancer are shown.

Concentrations, input prediction and probabilistic biological risk assessment of polycyclic aromatic hydrocarbons (PAHs) along Gujarat coastline.

PubMed

Gosai, Haren B; Sachaniya, Bhumi K; Dudhagara, Dushyant R; Rajpara, Rahul K; Dave, Bharti P

2018-04-01

A comprehensive investigation was conducted in order to assess the levels of PAHs, their input prediction and potential risks to bacterial abundance and human health along Gujarat coastline. A total of 40 sediment samples were collected at quarterly intervals within a year from two contaminated sites-Alang-Sosiya Shipbreaking Yard (ASSBRY) and Navlakhi Port (NAV), situated at Gulf of Khambhat and Gulf of Kutch, respectively. The concentration of ΣPAHs ranged from 408.00 to 54240.45 ng g -1  dw, indicating heavy pollution of PAHs at both the contaminated sites. Furthermore, isomeric ratios and principal component analysis have revealed that inputs of PAHs at both contaminated sites were mixed-pyrogenic and petrogenic. Pearson co-relation test and regression analysis have disclosed Nap, Acel and Phe as major predictors for bacterial abundance at both contaminated sites. Significantly, cancer risk assessment of the PAHs has been exercised based on incremental lifetime cancer risks. Overall, index of cancer risk of PAHs for ASSBRY and NAV ranged from 4.11 × 10 -6 -2.11 × 10 -5 and 9.08 × 10 -6 -4.50 × 10 -3 indicating higher cancer risk at NAV compared to ASSBRY. The present findings provide baseline information that may help in developing advanced bioremediation and bioleaching strategies to minimize biological risk.

THE ROLE OF RISK ASSESSMENT IN ADDRESSING HAZARDOUS WASTE ISSUES

EPA Science Inventory

Risk assessment plays many important roles in addressing hazardous waste issues. In addition to providing a scientific framework and common health metric to evaluate risks. Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA or "Superfund") risk assessm...

Understanding Suicide Risk: Identification of High Risk Groups during High Risk Times

PubMed Central

Overholser, James C.; Braden, Abby; Dieter, Lesa

2012-01-01

Background The assessment of suicide risk is a complex task for mental health professionals. Certain demographic groups are associated with completed suicide including males, divorced adults, and Caucasians. However, demographic variables alone provide a crude assessment of suicide risk. Psychiatric diagnosis and recent life events may improve the identification of high risk individuals. Method The current study evaluated 148 individuals who died by suicide compared to 257 adults who died suddenly from accidents or medical problems. Psychological autopsy was used to assess Axis I psychiatric diagnosis and recent stressful life events. Results Suicide completers were significantly more likely than comparison subjects to have a depressive disorder, a substance abuse disorder, and to have experienced interpersonal conflict in the months leading up to their death. A discriminant function analysis revealed that the combination of demographic variables, recent stressful life events, and psychiatric diagnoses best discriminated between suicide completers and comparison subjects. Conclusions Proper assessment of suicide risk should include a comprehensive evaluation of demographic characteristics, recent life stressors, and psychiatric diagnosis. PMID:22140004

Comprehensive behavioral-motivational nutrition education improves depressive symptoms following bariatric surgery: a randomized, controlled trial of obese Hispanic Americans.

PubMed

Petasne Nijamkin, Monica; Campa, Adriana; Samiri Nijamkin, Shani; Sosa, Jorge

2013-01-01

To evaluate the effect of 2 post-bariatric support interventions on depressive symptoms of Hispanic Americans treated with gastric bypass for morbid or severe obesity. Prospective randomized, controlled trial conducted in a laparoscopic institution. During the Phase 1 clinical trial (from preoperative evaluation to 6 months after surgery), all participants received standard care. During Phase 2 (6-12 months after surgery), participants were randomly assigned to receive either standard care (n = 72) or comprehensive support (n = 72). Comprehensive group participants received 6 educational sessions focused on behavior change strategies and motivation with nutrition counseling. Depression scores and weight change over time. Independent samples t tests and regression analysis assessed relationships among depression scores and excess weight loss. Participants receiving behavioral-motivational intervention scored significantly lower on Beck's Depression Inventory questionnaire scores than those receiving standard care. For those with depressive symptoms at randomization, 24% of participants who received the comprehensive intervention reported no depressive symptoms at 12 months after surgery, compared with 6% of those who received standard care (P < .001). Patients' depressive mood improvement was significantly and positively associated with excess weight loss and attendance at educational sessions (P < .001). Findings support the importance of post-bariatric comprehensive behavioral-motivational nutrition education for decreasing risk for depression and improving weight loss. Copyright © 2013 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Prioritizing strategies for comprehensive liver cancer control in Asia: a conjoint analysis.

PubMed

Bridges, John F P; Dong, Liming; Gallego, Gisselle; Blauvelt, Barri M; Joy, Susan M; Pawlik, Timothy M

2012-10-30

Liver cancer is a complex and burdensome disease, with Asia accounting for 75% of known cases. Comprehensive cancer control requires the use of multiple strategies, but various stakeholders may have different views as to which strategies should have the highest priority. This study identified priorities across multiple strategies for comprehensive liver cancer control (CLCC) from the perspective of liver cancer clinical, policy, and advocacy stakeholders in China, Japan, South Korea and Taiwan. Concordance of priorities was assessed across the region and across respondent roles. Priorities for CLCC were examined as part of a cross-sectional survey of liver cancer experts. Respondents completed several conjoint-analysis choice tasks to prioritize 11 strategies. In each task, respondents judged which of two competing CLCC plans, consisting of mutually exclusive and exhaustive subsets of the strategies, would have the greatest impact. The dependent variable was the chosen plan, which was then regressed on the strategies of different plans. The restricted least squares (RLS) method was utilized to compare aggregate and stratified models, and t-tests and Wald tests were used to test for significance and concordance, respectively. Eighty respondents (69.6%) were eligible and completed the survey. Their primary interests were hepatitis (26%), hepatocellular carcinoma (HCC) (58%), metastatic liver cancer (10%) and transplantation (6%). The most preferred strategies were monitoring at-risk populations (p<0.001), clinician education (p<0.001), and national guidelines (p<0.001). Most priorities were concordant across sites except for three strategies: transplantation infrastructure (p=0.009) was valued lower in China, measuring social burden (p=0.037) was valued higher in Taiwan, and national guidelines (p=0.025) was valued higher in China. Priorities did not differ across stakeholder groups (p=0.438). Priorities for CLCC in Asia include monitoring at-risk populations, clinician education, national guidelines, multidisciplinary management, public awareness and centers of excellence. As most priorities are relatively concordant across the region, multilateral approaches to addressing comprehensive liver cancer would be beneficial. However, where priorities are discordant among sites, such as transplantation infrastructure, strategies should be tailored to local needs.

Construction risk assessment of deep foundation pit in metro station based on G-COWA method

NASA Astrophysics Data System (ADS)

You, Weibao; Wang, Jianbo; Zhang, Wei; Liu, Fangmeng; Yang, Diying

2018-05-01

In order to get an accurate understanding of the construction safety of deep foundation pit in metro station and reduce the probability and loss of risk occurrence, a risk assessment method based on G-COWA is proposed. Firstly, relying on the specific engineering examples and the construction characteristics of deep foundation pit, an evaluation index system based on the five factors of “human, management, technology, material and environment” is established. Secondly, the C-OWA operator is introduced to realize the evaluation index empowerment and weaken the negative influence of expert subjective preference. The gray cluster analysis and fuzzy comprehensive evaluation method are combined to construct the construction risk assessment model of deep foundation pit, which can effectively solve the uncertainties. Finally, the model is applied to the actual project of deep foundation pit of Qingdao Metro North Station, determine its construction risk rating is “medium”, evaluate the model is feasible and reasonable. And then corresponding control measures are put forward and useful reference are provided.

Just how good an investment is the biopharmaceutical sector?

PubMed

Thakor, Richard T; Anaya, Nicholas; Zhang, Yuwei; Vilanilam, Christian; Siah, Kien Wei; Wong, Chi Heem; Lo, Andrew W

2017-12-01

Uncertainty surrounding the risk and reward of investments in biopharmaceutical companies poses a challenge to those interested in funding such enterprises. Using data on publicly traded stocks, we track the performance of 1,066 biopharmaceutical companies from 1930 to 2015-the most comprehensive financial analysis of this sector to date. Our systematic exploration of methods for distinguishing biotech and pharmaceutical companies yields a dynamic, more accurate classification method. We find that the performance of the biotech sector is highly sensitive to the presence of a few outlier companies, and confirm that nearly all biotech companies are loss-making enterprises, exhibiting high stock volatility. In contrast, since 2000, pharmaceutical companies have become increasingly profitable, with risk-adjusted returns consistently outperforming the market. The performance of all biopharmaceutical companies is subject not only to factors arising from their drug pipelines (idiosyncratic risk), but also from general economic conditions (systematic risk). The risk associated with returns has profound implications both for patterns of investment and for funding innovation in biomedical R&D.

Oral Health and the Oral Microbiome in Pancreatic Cancer: An Overview of Epidemiological Studies.

PubMed

Bracci, Paige M

The aim was to provide a cohesive overview of epidemiological studies of periodontal disease, oral microbiome profiles, and pancreatic cancer risk. A PubMed search of articles published in English through July 2017 with additional review of bibliographies of identified articles. Risk estimates for periodontal disease associated with pancreatic cancer consistently ranged from 1.5 to 2, aligning with a meta-analysis summary relative risk of 1.74. Analyses of antibodies to pathogenic and/or commensal oral bacteria in prediagnostic blood provided evidence that some oral bacteria and oral microbial diversity may be related to pancreatic cancer. Overall, the data present a plausible but complex relationship among pancreatic cancer, the oral microbiome, periodontal disease, and other risk factors that might be explained by systemic effects on immune and inflammatory processes. Larger comprehensive studies that examine serially collected epidemiological/clinical data and blood, tissue, and various microbial samples are needed to definitively determine how and whether oral health-related factors contribute to pancreatic cancer risk.

2015/2016 Quality Risk Management Benchmarking Survey.

PubMed

Waldron, Kelly; Ramnarine, Emma; Hartman, Jeffrey

2017-01-01

This paper investigates the concept of quality risk management (QRM) maturity as it applies to the pharmaceutical and biopharmaceutical industries, using the results and analysis from a QRM benchmarking survey conducted in 2015 and 2016. QRM maturity can be defined as the effectiveness and efficiency of a quality risk management program, moving beyond "check-the-box" compliance with guidelines such as ICH Q9 Quality Risk Management , to explore the value QRM brings to business and quality operations. While significant progress has been made towards full adoption of QRM principles and practices across industry, the full benefits of QRM have not yet been fully realized. The results of the QRM Benchmarking Survey indicate that the pharmaceutical and biopharmaceutical industries are approximately halfway along the journey towards full QRM maturity. LAY ABSTRACT: The management of risks associated with medicinal product quality and patient safety are an important focus for the pharmaceutical and biopharmaceutical industries. These risks are identified, analyzed, and controlled through a defined process called quality risk management (QRM), which seeks to protect the patient from potential quality-related risks. This paper summarizes the outcomes of a comprehensive survey of industry practitioners performed in 2015 and 2016 that aimed to benchmark the level of maturity with regard to the application of QRM. The survey results and subsequent analysis revealed that the pharmaceutical and biopharmaceutical industries have made significant progress in the management of quality risks over the last ten years, and they are roughly halfway towards reaching full maturity of QRM. © PDA, Inc. 2017.

Pesticide authorization in the EU-environment unprotected?

PubMed

Stehle, Sebastian; Schulz, Ralf

2015-12-01

Pesticides constitute an integral part of high-intensity European agriculture. Prior to their authorization, a highly elaborated environmental risk assessment is mandatory according to EU pesticide legislation, i.e., Regulation (EC) No. 1107/2009. However, no field data-based evaluation of the risk assessment outcome, i.e., the regulatory acceptable concentrations (RACs), and therefore of the overall protectiveness of EU pesticide regulations exists. We conducted here a comprehensive meta-analysis using peer-reviewed literature on agricultural insecticide concentrations in EU surface waters and evaluated associated risks using the RACs derived from official European pesticide registration documents. As a result, 44.7 % of the 1566 cases of measured insecticide concentrations (MICs) in EU surface waters exceeded their respective RACs. It follows that current EU pesticide regulations do not protect the aquatic environment and that insecticides threaten aquatic biodiversity. RAC exceedances were significantly higher for insecticides authorized using conservative tier-I RACs and for more recently developed insecticide classes, i.e., pyrethroids. In addition, we identified higher risks, e.g., for smaller surface waters that are specifically considered in the regulatory risk assessment schemes. We illustrate the shortcomings of the EU regulatory risk assessment using two case studies that contextualize the respective risk assessment outcomes to field exposure. Overall, our meta-analysis challenges the field relevance and protectiveness of the regulatory environmental risk assessment conducted for pesticide authorization in the EU and indicates that critical revisions of related pesticide regulations and effective mitigation measures are urgently needed to substantially reduce the environmental risks arising from agricultural insecticide use.

[Study on the risk assessment method of regional groundwater pollution].

PubMed

Yang, Yan; Yu, Yun-Jiang; Wang, Zong-Qing; Li, Ding-Long; Sun, Hong-Wei

2013-02-01

Based on the boundary elements of system risk assessment, the regional groundwater pollution risk assessment index system was preliminarily established, which included: regional groundwater specific vulnerability assessment, the regional pollution sources characteristics assessment and the health risk assessment of regional featured pollutants. The three sub-evaluation systems were coupled with the multi-index comprehensive method, the risk was characterized with the Spatial Analysis of ArcMap, and a new method to evaluate regional groundwater pollution risk that suitable for different parts of natural conditions, different types of pollution was established. Take Changzhou as an example, the risk of shallow groundwater pollution was studied with the new method, and found that the vulnerability index of groundwater in Changzhou is high and distributes unevenly; The distribution of pollution sources is concentrated and has a great impact on groundwater pollution risks; Influenced by the pollutants and pollution sources, the values of health risks are high in the urban area of Changzhou. The pollution risk of shallow groundwater is high and distributes unevenly, and distributes in the north of the line of Anjia-Xuejia-Zhenglu, the center of the city and the southeast, where the human activities are more intense and the pollution sources are intensive.

Use of acetaminophen and risk of endometrial cancer: evidence from observational studies.

PubMed

Ding, Yuan-Yuan; Yao, Peng; Verma, Surya; Han, Zhen-Kai; Hong, Tao; Zhu, Yong-Qiang; Li, Hong-Xi

2017-05-23

Previous meta-analyses suggested that aspirin was associated with reduced risk of endometrial cancer. However, there has been no study comprehensively summarize the evidence of acetaminophen use and risk of endometrial cancer from observational studies. We systematically searched electronic databases (PubMed , EMBASE, Web of Science, and Cochrane Library) for relevant cohort or case-control studies up to February 28, 2017. Two independent authors performed the eligibility evaluation and data extraction. All differences were resolved by discussion. A random-effects model was applied to estimate summary relative risks (RRs) with 95% CIs. All statistical tests were two-sided. Seven observational studies including four prospective cohort studies and three case-control studies with 3874 endometrial cancer cases were included for final analysis. Compared with never use acetaminophen, ever use this drug was not associated with risk of endometrial cancer (summarized RR = 1.02; 95% CI: 0.93-1.13, I2 = 0%). Similar null association was also observed when compared the highest category of frequency/duration with never use acetaminophen (summarized RR = 0.88; 95% CI: 0.70-1.11, I2 = 15.2%). Additionally, the finding was robust in the subgroup analyses stratified by study characteristics and adjustment for potential confounders and risk factors. There was no evidence of publication bias by a visual inspection of a funnel plot and formal statistical tests. In summary, the present meta-analysis reveals no association between acetaminophen use and risk of endometrial cancer. More large scale prospective cohort studies are warranted to confirm our findings and carry out the dose-response analysis of aforementioned association.

Nutritional Science | Division of Cancer Prevention

Cancer.gov

This group promotes and supports studies establishing a comprehensive understanding of the precise role of diet and fo | Establishing a comprehensive understanding of diet and food components in cancer risk and tumor cell behavior.

"Teach-to-Goal" to Better Assess Informed Consent Comprehension among Incarcerated Clinical Research Participants.

PubMed

Ahalt, Cyrus; Sudore, Rebecca; Bolano, Marielle; Metzger, Lia; Darby, Anna M; Williams, Brie

2017-09-01

Correctional health research requires important safeguards to ensure that research participation is ethically conducted. In addition to having disproportionately low educational attainment and low literacy, incarcerated people suffer from health-related conditions that can affect cognition (e.g., traumatic brain injury, substance use disorders, mental illness). Yet modified informed consent processes that assess participants' comprehension of the risks and benefits of participation are not required by relevant federal guidelines. A push to assess comprehension of informed consent documents is particularly timely given an increase in demand for correctional health research in the context of criminal justice reform. We argue that comprehension assessments can identify persons who should be excluded from research and help those who will ultimately participate in studies better understand the risks and benefits of their participation. © 2017 American Medical Association. All Rights Reserved.

NASA System Safety Handbook. Volume 1; System Safety Framework and Concepts for Implementation

NASA Technical Reports Server (NTRS)

Dezfuli, Homayoon; Benjamin, Allan; Everett, Christopher; Smith, Curtis; Stamatelatos, Michael; Youngblood, Robert

2011-01-01

System safety assessment is defined in NPR 8715.3C, NASA General Safety Program Requirements as a disciplined, systematic approach to the analysis of risks resulting from hazards that can affect humans, the environment, and mission assets. Achievement of the highest practicable degree of system safety is one of NASA's highest priorities. Traditionally, system safety assessment at NASA and elsewhere has focused on the application of a set of safety analysis tools to identify safety risks and formulate effective controls.1 Familiar tools used for this purpose include various forms of hazard analyses, failure modes and effects analyses, and probabilistic safety assessment (commonly also referred to as probabilistic risk assessment (PRA)). In the past, it has been assumed that to show that a system is safe, it is sufficient to provide assurance that the process for identifying the hazards has been as comprehensive as possible and that each identified hazard has one or more associated controls. The NASA Aerospace Safety Advisory Panel (ASAP) has made several statements in its annual reports supporting a more holistic approach. In 2006, it recommended that "... a comprehensive risk assessment, communication and acceptance process be implemented to ensure that overall launch risk is considered in an integrated and consistent manner." In 2009, it advocated for "... a process for using a risk-informed design approach to produce a design that is optimally and sufficiently safe." As a rationale for the latter advocacy, it stated that "... the ASAP applauds switching to a performance-based approach because it emphasizes early risk identification to guide designs, thus enabling creative design approaches that might be more efficient, safer, or both." For purposes of this preface, it is worth mentioning three areas where the handbook emphasizes a more holistic type of thinking. First, the handbook takes the position that it is important to not just focus on risk on an individual basis but to consider measures of aggregate safety risk and to ensure wherever possible that there be quantitative measures for evaluating how effective the controls are in reducing these aggregate risks. The term aggregate risk, when used in this handbook, refers to the accumulation of risks from individual scenarios that lead to a shortfall in safety performance at a high level: e.g., an excessively high probability of loss of crew, loss of mission, planetary contamination, etc. Without aggregated quantitative measures such as these, it is not reasonable to expect that safety has been optimized with respect to other technical and programmatic objectives. At the same time, it is fully recognized that not all sources of risk are amenable to precise quantitative analysis and that the use of qualitative approaches and bounding estimates may be appropriate for those risk sources. Second, the handbook stresses the necessity of developing confidence that the controls derived for the purpose of achieving system safety not only handle risks that have been identified and properly characterized but also provide a general, more holistic means for protecting against unidentified or uncharacterized risks. For example, while it is not possible to be assured that all credible causes of risk have been identified, there are defenses that can provide protection against broad categories of risks and thereby increase the chances that individual causes are contained. Third, the handbook strives at all times to treat uncertainties as an integral aspect of risk and as a part of making decisions. The term "uncertainty" here does not refer to an actuarial type of data analysis, but rather to a characterization of our state of knowledge regarding results from logical and physical models that approximate reality. Uncertainty analysis finds how the output parameters of the models are related to plausible variations in the input parameters and in the modeling assumptions. The evaluation of unrtainties represents a method of probabilistic thinking wherein the analyst and decision makers recognize possible outcomes other than the outcome perceived to be "most likely." Without this type of analysis, it is not possible to determine the worth of an analysis product as a basis for making decisions related to safety and mission success. In line with these considerations the handbook does not take a hazard-analysis-centric approach to system safety. Hazard analysis remains a useful tool to facilitate brainstorming but does not substitute for a more holistic approach geared to a comprehensive identification and understanding of individual risk issues and their contributions to aggregate safety risks. The handbook strives to emphasize the importance of identifying the most critical scenarios that contribute to the risk of not meeting the agreed-upon safety objectives and requirements using all appropriate tools (including but not limited to hazard analysis). Thereafter, emphasis shifts to identifying the risk drivers that cause these scenarios to be critical and ensuring that there are controls directed toward preventing or mitigating the risk drivers. To address these and other areas, the handbook advocates a proactive, analytic-deliberative, risk-informed approach to system safety, enabling the integration of system safety activities with systems engineering and risk management processes. It emphasizes how one can systematically provide the necessary evidence to substantiate the claim that a system is safe to within an acceptable risk tolerance, and that safety has been achieved in a cost-effective manner. The methodology discussed in this handbook is part of a systems engineering process and is intended to be integral to the system safety practices being conducted by the NASA safety and mission assurance and systems engineering organizations. The handbook posits that to conclude that a system is adequately safe, it is necessary to consider a set of safety claims that derive from the safety objectives of the organization. The safety claims are developed from a hierarchy of safety objectives and are therefore hierarchical themselves. Assurance that all the claims are true within acceptable risk tolerance limits implies that all of the safety objectives have been satisfied, and therefore that the system is safe. The acceptable risk tolerance limits are provided by the authority who must make the decision whether or not to proceed to the next step in the life cycle. These tolerances are therefore referred to as the decision maker's risk tolerances. In general, the safety claims address two fundamental facets of safety: 1) whether required safety thresholds or goals have been achieved, and 2) whether the safety risk is as low as possible within reasonable impacts on cost, schedule, and performance. The latter facet includes consideration of controls that are collective in nature (i.e., apply generically to broad categories of risks) and thereby provide protection against unidentified or uncharacterized risks.

The research on delayed fracture behavior of high-strength bolts in steel structure

NASA Astrophysics Data System (ADS)

Li, Guo dong; Li, Nan

2017-07-01

High-strength bolts have been widely used in power plants. However, the high-strength bolts which being employed in pumping station, steel structure and pipeline anti-whip structure have been found delayed fracture for many times in a power plant, this will affect the reliability of steel fracture and bring blow risk caused by falling objects. The high-strength bolt with delayed fracture was carried out fracture analysis, metallurgical analysis, chemical analysis, mechanical analysis, as well as bolts installation analysis, it can be comprehensively confirmed that the direct cause of high-strength bolts delayed fracture is the stress corrosion, and the root cause of high-strength bolts delayed fracture should be the improper installation at the initial and the imperfect routine anti-corrosion maintenance.

Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: I. Cardiovascular Drugs.

PubMed

de Vries, Max; Seppala, Lotta J; Daams, Joost G; van de Glind, Esther M M; Masud, Tahir; van der Velde, Nathalie

2018-04-01

Use of certain medications is recognized as a major and modifiable risk factor for falls. Although the literature on psychotropic drugs is compelling, the literature on cardiovascular drugs as potential fall-risk-increasing drugs is conflicting. The aim of this systematic review and meta-analysis is to provide a comprehensive overview of the associations between cardiovascular medications and fall risk in older adults. Design: A systematic review and meta-analysis. Medline, Embase, and PsycINFO. Key search concepts were "fall," "aged," "causality," and "medication." Studies that investigated cardiovascular medications as risk factors for falls in participants ≥60 years old or participants with a mean age of 70 or older were included. A meta-analysis was performed using the generic inverse variance method, pooling unadjusted and adjusted odds ratios (ORs) separately. In total, 131 studies were included in the qualitative synthesis. Meta-analysis using adjusted ORs showed significant results (pooled OR [95% confidence interval]) for loop diuretics, OR 1.36 (1.17, 1.57), and beta-blocking agents, OR 0.88 (0.80, 0.97). Meta-analysis using unadjusted ORs showed significant results for digitalis, OR 1.60 (1.08, 2.36); digoxin, OR 2.06 (1.56, 2.74); and statins, OR 0.80 (0.65, 0.98). Most of the meta-analyses resulted in substantial heterogeneity that mostly did not disappear after stratification for population and setting. In a descriptive synthesis, consistent associations were not observed. Loop diuretics were significantly associated with increased fall risk, whereas beta-blockers were significantly associated with decreased fall risk. Digitalis and digoxin may increase the risk of falling, and statins may reduce it. For the majority of cardiovascular medication groups, outcomes were inconsistent. Furthermore, recent studies indicate that specific drug properties, such as selectivity of beta-blockers, may affect fall risk, and drug-disease interaction also may play a role. Thus, studies addressing these issues are warranted to obtain a better understanding of drug-related falls. Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

A health economic model of breakthrough pain.

PubMed

Abernethy, Amy P; Wheeler, Jane L; Fortner, Barry V

2008-05-01

Although the literature adequately addresses the biologic basis, epidemiology, and management of breakthrough pain (BTP), it does not yet describe the full impact of this troubling, widespread phenomenon. The risks of a scanty understanding of BTP impact are failure to take preventive measures, underdiagnosis, undertreatment, and inappropriate management. Studies to date of the impact of BTP have followed pharmacoeconomic approaches. Building on prior efforts, this paper develops a more comprehensive health economic model that encompasses the full spectrum of costs, outcomes, risks and benefits associated with BTP and its management. The authors provide a rubric within which stakeholders--including providers, institutional leaders, administrators, and policymakers--can systematically balance the myriad potential effects of different treatment scenarios to guide decision-making. The paper then extends this model to the population level, providing a template for health economic analysis of alternate strategies for managing BTP, and delineating steps for accomplishing the analysis.

On the post mitigation impact risk assessment of possible targets for an asteroid deflection demonstration mission in the NEOShield project.

NASA Astrophysics Data System (ADS)

Eggl, Siegfried

2014-05-01

Mankind believes to have the capabilities to avert potentially disastrous asteroid impacts. Yet, only the realization of a mitigation demonstration mission can confirm such a claim. The NEOShield project, an international collaboration under European leadership, aims to draw a comprehensive picture of the scientific as well as technical requirements to such an endeavor. One of the top priorities of such a demonstration mission is, of course, that a previously harmless target asteroid shall not be turned into a potentially hazardous object. Given the inherently large uncertainties in an asteroid's physical parameters, as well as the additional uncertainties introduced during the deflection attempt, an in depth analysis of the change in asteroid impact probabilities after a deflection event becomes necessary. We present a post mitigation impact risk analysis of a list of potential deflection test missions and discuss the influence of orbital, physical and mitigation induced uncertainties.

[Re-operations in patients with heart wounds].

PubMed

Radchenko, Yu A; Abakumov, M M; Vladimirova, E S; Pogodina, A N; Nikitina, O V

To define the risk factors of complications which are followed by re-operations in patients with cardiac and pericardial wounds and to prevent these complications. Retrospective and prospective analysis of 1072 victims with cardiac and pericardial injuries for 35 years was performed. Overall mortality was 17.2%. 98 patients died during surgery. Postoperative bleeding was observed in 38 (3.9%) cases. In 28 cases re-operations were performed for bleeding-related complications. Indications for re-thoracotomy were one-time drainage from pleural cavity over 500 ml or bleeding rate over 100 ml per hour for 4 hours. Prevention of postoperative bleeding in case of cardiac and pericardial wounds was developed on basis of analysis of these observations. Risk factors of complications requiring re-operation are cardiomyopathy of different etiology, technical and tactical errors during primary intervention and hypocoagulation with massive blood loss. Prevention of these complications includes careful heart wound closure, comprehensive intraoperative control, correction of hemostatic system.

Comprehensive HIV Prevention for Transgender Persons.

PubMed

Neumann, Mary Spink; Finlayson, Teresa J; Pitts, Nicole L; Keatley, JoAnne

2017-02-01

Transgender persons are at high risk for HIV infection, but prevention efforts specifically targeting these people have been minimal. Part of the challenge of HIV prevention for transgender populations is that numerous individual, interpersonal, social, and structural factors contribute to their risk. By combining HIV prevention services with complementary medical, legal, and psychosocial services, transgender persons' HIV risk behaviors, risk determinants, and overall health can be affected simultaneously. For maximum health impact, comprehensive HIV prevention for transgender persons warrants efforts targeted to various impact levels-socioeconomic factors, decision-making contexts, long-lasting protections, clinical interventions, and counseling and education. We present current HIV prevention efforts that reach transgender persons and present others for future consideration.

Comprehensive HIV Prevention for Transgender Persons

PubMed Central

Neumann, Mary Spink; Finlayson, Teresa J.; Pitts, Nicole L.; Keatley, JoAnne

2017-01-01

Transgender persons are at high risk for HIV infection, but prevention efforts specifically targeting these people have been minimal. Part of the challenge of HIV prevention for transgender populations is that numerous individual, interpersonal, social, and structural factors contribute to their risk. By combining HIV prevention services with complementary medical, legal, and psychosocial services, transgender persons’ HIV risk behaviors, risk determinants, and overall health can be affected simultaneously. For maximum health impact, comprehensive HIV prevention for transgender persons warrants efforts targeted to various impact levels—socioeconomic factors, decision-making contexts, long-lasting protections, clinical interventions, and counseling and education. We present current HIV prevention efforts that reach transgender persons and present others for future consideration. PMID:27997228

Meta-Analysis of Workplace Physical Activity Interventions

PubMed Central

Conn, Vicki S.; Hafdahl, Adam R.; Cooper, Pamela S.; Brown, Lori M.; Lusk, Sally L.

2009-01-01

Context Most adults do not achieve adequate physical activity. Despite the potential benefits of worksite health promotion, no previous comprehensive meta-analysis has summarized health and physical activity behavior outcomes from these programs. This comprehensive meta-analysis integrated the extant wide range of worksite physical activity intervention research. Evidence acquisition Extensive searching located published and unpublished intervention studies reported from 1969 through 2007. Results were coded from primary studies. Random-effects meta-analytic procedures, including moderator analyses, were completed in 2008. Evidence synthesis Effects on most variables were substantially heterogeneous because diverse studies were included. Standardized mean difference (d) effect sizes were synthesized across approximately 38,231 subjects. Significantly positive effects were observed for physical activity behavior (0.21), fitness (0.57), lipids (0.13), anthropometric measures (0.08), work attendance (0.19), and job stress (0.33). The significant effect size for diabetes risk (0.98) is more tentative given small sample sizes. Significant heterogeneity documents intervention effects varied across studies. The mean effect size for fitness corresponds to a difference between treatment minus control subjects' means on V02max of 3.5 mL/kg/min; for lipids, −0.2 on total cholesterol:HDL; and for diabetes risk, −12.6 mg/dL on fasting glucose. Conclusions These findings document that some workplace physical activity interventions can improve both health and important worksite outcomes. Effects were variable for most outcomes, reflecting the diversity of primary studies. Future primary research should compare interventions to confirm causal relationships and further explore heterogeneity. PMID:19765506

Comprehensive Evaluation and Implementation of Improvement Actions in Butcher Shops

PubMed Central

Leotta, Gerardo A.; Brusa, Victoria; Galli, Lucía; Adriani, Cristian; Linares, Luciano; Etcheverría, Analía; Sanz, Marcelo; Sucari, Adriana; Peral García, Pilar; Signorini, Marcelo

2016-01-01

Foodborne pathogens can cause acute and chronic diseases and produce a wide range of symptoms. Since the consumption of ground beef is a risk factor for infections with some bacterial pathogens, we performed a comprehensive evaluation of butcher shops, implemented improvement actions for both butcher shops and consumers, and verified the impact of those actions implemented. A comprehensive evaluation was made and risk was quantified on a 1–100 scale as high-risk (1–40), moderate-risk (41–70) or low-risk (71–100). A total of 172 raw ground beef and 672 environmental samples were collected from 86 butcher shops during the evaluation (2010–2011) and verification (2013) stages of the study. Ground beef samples were analyzed for mesophilic aerobic organisms, Escherichia coli and coagulase-positive Staphylococcus aureus enumeration. Salmonella spp., E. coli O157:H7, non-O157 Shiga toxin-producing E. coli (STEC), and Listeria monocytogenes were detected and isolated from all samples. Risk quantification resulted in 43 (50.0%) high-risk, 34 (39.5%) moderate-risk, and nine (10.5%) low-risk butcher shops. Training sessions for 498 handlers and 4,506 consumers were held. Re-evaluation by risk quantification and microbiological analyses resulted in 19 (22.1%) high-risk, 42 (48.8%) moderate-risk and 25 (29.1%) low-risk butcher shops. The count of indicator microorganisms decreased with respect to the 2010–2011 period. After the implementation of improvement actions, the presence of L. monocytogenes, E. coli O157:H7 and stx genes in ground beef decreased. Salmonella spp. was isolated from 10 (11.6%) ground beef samples, without detecting statistically significant differences between both study periods (evaluation and verification). The percentage of pathogens in environmental samples was reduced in the verification period (Salmonella spp., 1.5%; L. monocytogenes, 10.7%; E. coli O157:H7, 0.6%; non-O157 STEC, 6.8%). Risk quantification was useful to identify those relevant facts in butcher shops. The reduction of contamination in ground beef and the environment was possible after training handlers based on the problems identified in their own butcher shops. Our results confirm the feasibility of implementing a comprehensive risk management program in butcher shops, and the importance of information campaigns targeting consumers. Further collaborative efforts would be necessary to improve foodstuffs safety at retail level and at home. PMID:27618439

Comprehensive Evaluation and Implementation of Improvement Actions in Butcher Shops.

PubMed

Leotta, Gerardo A; Brusa, Victoria; Galli, Lucía; Adriani, Cristian; Linares, Luciano; Etcheverría, Analía; Sanz, Marcelo; Sucari, Adriana; Peral García, Pilar; Signorini, Marcelo

2016-01-01

Foodborne pathogens can cause acute and chronic diseases and produce a wide range of symptoms. Since the consumption of ground beef is a risk factor for infections with some bacterial pathogens, we performed a comprehensive evaluation of butcher shops, implemented improvement actions for both butcher shops and consumers, and verified the impact of those actions implemented. A comprehensive evaluation was made and risk was quantified on a 1-100 scale as high-risk (1-40), moderate-risk (41-70) or low-risk (71-100). A total of 172 raw ground beef and 672 environmental samples were collected from 86 butcher shops during the evaluation (2010-2011) and verification (2013) stages of the study. Ground beef samples were analyzed for mesophilic aerobic organisms, Escherichia coli and coagulase-positive Staphylococcus aureus enumeration. Salmonella spp., E. coli O157:H7, non-O157 Shiga toxin-producing E. coli (STEC), and Listeria monocytogenes were detected and isolated from all samples. Risk quantification resulted in 43 (50.0%) high-risk, 34 (39.5%) moderate-risk, and nine (10.5%) low-risk butcher shops. Training sessions for 498 handlers and 4,506 consumers were held. Re-evaluation by risk quantification and microbiological analyses resulted in 19 (22.1%) high-risk, 42 (48.8%) moderate-risk and 25 (29.1%) low-risk butcher shops. The count of indicator microorganisms decreased with respect to the 2010-2011 period. After the implementation of improvement actions, the presence of L. monocytogenes, E. coli O157:H7 and stx genes in ground beef decreased. Salmonella spp. was isolated from 10 (11.6%) ground beef samples, without detecting statistically significant differences between both study periods (evaluation and verification). The percentage of pathogens in environmental samples was reduced in the verification period (Salmonella spp., 1.5%; L. monocytogenes, 10.7%; E. coli O157:H7, 0.6%; non-O157 STEC, 6.8%). Risk quantification was useful to identify those relevant facts in butcher shops. The reduction of contamination in ground beef and the environment was possible after training handlers based on the problems identified in their own butcher shops. Our results confirm the feasibility of implementing a comprehensive risk management program in butcher shops, and the importance of information campaigns targeting consumers. Further collaborative efforts would be necessary to improve foodstuffs safety at retail level and at home.

An evaluation of the nursing success program: reading comprehension, graduation rates, and diversity.

PubMed

Symes, Lene; Tart, Kathryn; Travis, Lucille

2005-01-01

The Nursing Success Program was developed to enhance retention of baccalaureate nursing students. Reading comprehension scores are used to identify students who are at risk for failure and direct them into the retention program that addresses their skill deficits. To evaluate the program, the authors assessed reading comprehension, graduation rates, and ethnic diversity.

Implementing Community-Based Comprehensive Sexuality Education with High-Risk Youth in a Conservative Environment: Lessons Learned

ERIC Educational Resources Information Center

Secor-Turner, Molly; Randall, Brandy A.; Christensen, Katie; Jacobson, Amy; Loyola Meléndez, Migdalia

2017-01-01

Although comprehensive sexuality education programmes have the potential to improve the sexual health and well-being of young people, many socially conservative rural states in the USA have laws and policies restricting school-based comprehensive sexuality education and supporting abstinence-only education. This paper describes the process of…

The Relationship of Error Rate and Comprehension in Second and Third Grade Oral Reading Fluency

ERIC Educational Resources Information Center

Abbott, Mary; Wills, Howard; Miller, Angela; Kaufman, Journ

2012-01-01

This study explored the relationships of oral reading speed and error rate on comprehension with second and third grade students with identified reading risk. The study included 920 second and 974 third graders. Results found a significant relationship between error rate, oral reading fluency, and reading comprehension performance, and…

Iconic Sign Comprehension in Older Adults: The Role of Cognitive Impairment and Text Enhancement

ERIC Educational Resources Information Center

Scialfa, Charles; Spadafora, Pat; Klein, Marianne; Lesnik, Agata; Dial, Lindsay; Heinrich, Antje

2008-01-01

Sign comprehension is critical for effective driving, responses to warnings, and way-finding. Signs that are poorly comprehended by older people increase accident risk and may compromise independence. This study sought to determine whether iconic sign comprehension suffers in healthy aging and in the presence of cognitive impairment. Additionally,…

Human 8-oxoguanine DNA glycosylase gene polymorphism (Ser326Cys) and cancer risk: updated meta-analysis

PubMed Central

Park, Hae Jeong; Chung, Joo-Ho; Ban, Ju Yeon

2017-01-01

Genetic polymorphism of human 8-oxoguanine glycosylase 1 (hOGG1) has been reported to have a relationship with the risk of the development of various cancers. Many studies have described the influence of Ser326Cys polymorphism of the hOGG1 gene on cancer susceptibility. However, the results have remained inconclusive and controversial. Therefore, we performed a meta-analysis to more precisely determine the relationship between the hOGG1 polymorphism and the development of cancer. Electronic databases including PubMed, Embase, Google Scholar, and the Korean Studies Information Service System (KISS) were searched. The odds ratio (OR), 95% confidence interval (CI), and p value were calculated to assess the strength of the association with the risk of cancer using Comprehensive Meta-analysis software (Corporation, NJ, USA). The 127 studies including 38,757 cancer patients and 50,177 control subjects were analyzed for the meta-analysis. Our meta-analysis revealed that G allele of Ser326Cys polymorphism of the hOGG1 gene statistically increased the susceptibility of cancer (all population, OR = 1.092, 95% CI = 1.051-1.134, p < 0.001; in Asian, OR = 1.095, 95% CI = 1.048-1.145, p < 0.001; in Caucasian, OR = 1.097, 95% CI = 1.033-1.179, p = 0.002). Also, other genotype models showed significant association with cancer (p < 0.05, respectively). The present meta-analysis concluded that the G allele was associated with an increased risk of cancer. It suggested that the hOGG1 polymorphism may be a candidate marker of cancer. PMID:28415770

Readmission patterns in patients with chronic obstructive pulmonary disease, chronic heart failure and diabetes mellitus: an administrative dataset analysis.

PubMed

Brand, C; Sundararajan, V; Jones, C; Hutchinson, A; Campbell, D

2005-05-01

Comprehensive disease management programmes for chronic disease aim to improve patient outcomes and reduce health-care utilization. Readmission rates are often used as an outcome measure of effectiveness. This study aimed to document readmission rates, and risk for early and late readmission, for patients discharged from the Royal Melbourne Hospital with a disease diagnosis of chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) or diabetes mellitus compared to those with other general medical conditions. Eighty five (8.6%) of patients were readmitted within 28 days and 183 (20.8%) were readmitted between 29 and 180 days. No risk factors for early readmission were identified. Patients with a primary disease diagnosis of CHF and COPD are at increased risk of late readmissions (29-180 days).

Comparison of concepts in easy-to-use methods for MSD risk assessment.

PubMed

Roman-Liu, Danuta

2014-05-01

This article presents a comparative analysis of easy-to-use methods for assessing musculoskeletal load and the risk for developing musculoskeletal disorders. In all such methods, assessment of load consists in defining input data, the procedure and the system of assessment. This article shows what assessment steps the methods have in common; it also shows how those methods differ in each step. In addition, the methods are grouped according to their characteristic features. The conclusion is that the concepts of assessing risk in different methods can be used to develop solutions leading to a comprehensive method appropriate for all work tasks and all parts of the body. However, studies are necessary to verify the accepted premises and to introduce some standardization that would make consolidation possible. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Key factors contributing to accident severity rate in construction industry in Iran: a regression modelling approach.

PubMed

Soltanzadeh, Ahmad; Mohammadfam, Iraj; Moghimbeigi, Abbas; Ghiasvand, Reza

2016-03-01

Construction industry involves the highest risk of occupational accidents and bodily injuries, which range from mild to very severe. The aim of this cross-sectional study was to identify the factors associated with accident severity rate (ASR) in the largest Iranian construction companies based on data about 500 occupational accidents recorded from 2009 to 2013. We also gathered data on safety and health risk management and training systems. Data were analysed using Pearson's chi-squared coefficient and multiple regression analysis. Median ASR (and the interquartile range) was 107.50 (57.24- 381.25). Fourteen of the 24 studied factors stood out as most affecting construction accident severity (p<0.05). These findings can be applied in the design and implementation of a comprehensive safety and health risk management system to reduce ASR.

The Comprehensive, Powerful, Academic Database (CPAD): An Evaluative Study of a Predictive Tool Designed for Elementary School Personnel in Identifying At-Risk Students through Progress, Curriculum, and Performance Monitoring

ERIC Educational Resources Information Center

Chavez-Gibson, Sarah

2013-01-01

The purpose of this study is to exam in-depth, the Comprehensive, Powerful, Academic Database (CPAD), a data decision-making tool that determines and identifies students at-risk of dropping out of school, and how the CPAD assists administrators and teachers at an elementary campus to monitor progress, curriculum, and performance to improve student…

Understanding Genetic Breast Cancer Risk: Processing Loci of the BRCA Gist Intelligent Tutoring System

PubMed Central

Wolfe, Christopher R.; Reyna, Valerie F.; Widmer, Colin L.; Cedillos-Whynott, Elizabeth M.; Brust-Renck, Priscila G; Weil, Audrey M.; Hu, Xiangen

2016-01-01

The BRCA Gist Intelligent Tutoring System helps women understand and make decisions about genetic testing for breast cancer risk. BRCA Gist is guided by Fuzzy-Trace Theory, (FTT) and built using AutoTutor Lite. It responds differently to participants depending on what they say. Seven tutorial dialogues requiring explanation and argumentation are guided by three FTT concepts: forming gist explanations in one’s own words, emphasizing decision-relevant information, and deliberating the consequences of decision alternatives. Participants were randomly assigned to BRCA Gist, a control, or impoverished BRCA Gist conditions removing gist explanation dialogues, argumentation dialogues, or FTT images. All BRCA Gist conditions performed significantly better than controls on knowledge, comprehension, and risk assessment. Significant differences in knowledge, comprehension, and fine-grained dialogue analyses demonstrate the efficacy of gist explanation dialogues. FTT images significantly increased knowledge. Providing more elements in arguments against testing correlated with increased knowledge and comprehension. PMID:28008216

Understanding Genetic Breast Cancer Risk: Processing Loci of the BRCA Gist Intelligent Tutoring System.

PubMed

Wolfe, Christopher R; Reyna, Valerie F; Widmer, Colin L; Cedillos-Whynott, Elizabeth M; Brust-Renck, Priscila G; Weil, Audrey M; Hu, Xiangen

2016-07-01

The BRCA Gist Intelligent Tutoring System helps women understand and make decisions about genetic testing for breast cancer risk. BRCA Gist is guided by Fuzzy-Trace Theory, (FTT) and built using AutoTutor Lite. It responds differently to participants depending on what they say. Seven tutorial dialogues requiring explanation and argumentation are guided by three FTT concepts: forming gist explanations in one's own words, emphasizing decision-relevant information, and deliberating the consequences of decision alternatives. Participants were randomly assigned to BRCA Gist , a control, or impoverished BRCA Gist conditions removing gist explanation dialogues, argumentation dialogues, or FTT images. All BRCA Gist conditions performed significantly better than controls on knowledge, comprehension, and risk assessment. Significant differences in knowledge, comprehension, and fine-grained dialogue analyses demonstrate the efficacy of gist explanation dialogues. FTT images significantly increased knowledge. Providing more elements in arguments against testing correlated with increased knowledge and comprehension.

Blood Glucose Reduction by Diabetic Drugs with Minimal Hypoglycemia Risk for Cardiovascular Outcomes: Evidence from Meta-regression Analysis of Randomized Controlled Trials.

PubMed

Huang, Chi-Jung; Wang, Wei-Ting; Sung, Shih-Hsien; Chen, Chen-Huan; Lip, Gregory Yh; Cheng, Hao-Min; Chiang, Chern-En

2018-05-02

To investigate the effects of blood glucose control with antihyperglycemic agents with minimal hypoglycemia risk on cardiovascular outcomes in patients with type 2 diabetes (T2D). Randomized controlled trials (RCTs) comparing the relative efficacy and safety of antidiabetic drugs with less hypoglycemia risk were comprehensively searched in MEDLINE, Embase, and the Cochrane Library up to January 27, 2018. Mixed-effects meta-regression analysis was conducted to explore the relationship between haemoglobin A1c (HbA1c) reduction and the risk of major adverse cardiovascular events (MACE), myocardial infarction, stroke, cardiovascular death, all-cause death, and hospitalization for heart failure. Ten RCTs comprising 92400 participants with T2D were included and provided information on 9773 MACE during a median follow-up of 2.6 years. The mean HbA1c concentration was 0.42% lower (median, 0.27-0.86%) for participants given antihyperglycemic agents than those given placebo. The meta-regression analysis demonstrated that HbA1c reduction was significantly associated with a decreased risk of MACE (β value, -0.39 to -0.55; P<0.02) even after adjusting for each of the following possible confounding factors including age, sex, baseline HbA1c, duration of follow-up, difference in achieved systolic blood pressure, difference in achieved body weight, or risk difference in hypoglycemia. Lowering HbA1c by 1% conferred a significant risk reduction of 30% (95% CI, 17-40%) for MACE. By contrast, the meta-regression analysis for trials using conventional agents failed to demonstrate a significant relationship between achieved HbA1c difference and MACE risk (P>0.74). Compared with placebo, newer T2D agents with less hypoglycemic hazard significantly reduced the risk of MACE. The MACE reduction seems to be associated with HbA1c reduction in a linear relationship. This article is protected by copyright. All rights reserved.

Accounting for sampling variability, injury under-reporting, and sensor error in concussion injury risk curves.

PubMed

Elliott, Michael R; Margulies, Susan S; Maltese, Matthew R; Arbogast, Kristy B

2015-09-18

There has been recent dramatic increase in the use of sensors affixed to the heads or helmets of athletes to measure the biomechanics of head impacts that lead to concussion. The relationship between injury and linear or rotational head acceleration measured by such sensors can be quantified with an injury risk curve. The utility of the injury risk curve relies on the accuracy of both the clinical diagnosis and the biomechanical measure. The focus of our analysis was to demonstrate the influence of three sources of error on the shape and interpretation of concussion injury risk curves: sampling variability associated with a rare event, concussion under-reporting, and sensor measurement error. We utilized Bayesian statistical methods to generate synthetic data from previously published concussion injury risk curves developed using data from helmet-based sensors on collegiate football players and assessed the effect of the three sources of error on the risk relationship. Accounting for sampling variability adds uncertainty or width to the injury risk curve. Assuming a variety of rates of unreported concussions in the non-concussed group, we found that accounting for under-reporting lowers the rotational acceleration required for a given concussion risk. Lastly, after accounting for sensor error, we find strengthened relationships between rotational acceleration and injury risk, further lowering the magnitude of rotational acceleration needed for a given risk of concussion. As more accurate sensors are designed and more sensitive and specific clinical diagnostic tools are introduced, our analysis provides guidance for the future development of comprehensive concussion risk curves. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Multicriteria evaluation of environmental risk exposure using a geographic information system in Argentina].

PubMed

Pietri, Diana De; Dietrich, Patricia; Mayo, Patricia; Carcagno, Alejandro

2011-10-01

Develop a spatial model that includes environmental factors posing a health hazard, for application in the Matanza-Riachuelo River Basin (MRB) in Argentina. Multicriteria evaluation procedures were used with geographic information systems to obtain territorial zoning based on the degree of suitability for residence. Variables that characterize the habitability of housing and potential sources of basin pollution were geographically referenced. Health information was taken from the Risk Factor Survey (RFS) to measure the relative risk of living in unsuitable areas (exposed population) compared with suitable areas (unexposed population). Sixty percent of the MRB area is in suitable condition, a situation that affects 40% of residents. The rest of the population lives in unsuitable territory, and 6% live in the basin's most unsuitable conditions. Environmental conditions that are detrimental to health in the unsuitable areas became evident during the interviews through three of the pathologies considered: diarrheal diseases, respiratory diseases, and cancer. A regional analysis that provides valid information to support decisionmaking was obtained. Considering the basin as a unit of analysis allowed the use of a single protocol to undertake comprehensive measurement of the magnitude of risk and, thus, set priorities.

Sleep Duration and the Risk of Fatty Liver Disease: A Systematic Review and Meta-analysis

NASA Astrophysics Data System (ADS)

Shen, Na; Wang, Peng; Yan, Weiming

2016-08-01

Recent studies have reported inconsistent results on the association between sleep duration and the risk of fatty liver disease (FLD). Thus, we quantitatively evaluated this association by performing a systematic review and meta-analysis, based on a comprehensive electronic search in databases of PubMed, Web of Science, EMBASE, ClinicalTrials.gov, Wanfangdata and Chinese National Knowledge Infrastructure (CNKI) (updated to April 2016). Multivariate adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were extracted and pooled by using a random-effects model. Eight eligible studies involving 97,371 participants were included. We found that neither short nor long sleep duration was significantly related with FLD risk. For short sleep duration, the pooled OR was 1.17 (95% CI = 0.98-1.38), and for long sleep duration, the pooled OR was 1.01 (95% CI = 0.72-1.41). Subgroup analyses by sex, outcome, and exposure reference also did not identify any effect of sleep duration on FLD onset. In summary, our findings suggested that short or long sleep duration was not significantly associated with FLD risk. Further cohort studies with refined designs are still warranted to validate our results.

Aberrant estrogen regulation of PEMT results in choline deficiency-associated liver dysfunction.

PubMed

Resseguie, Mary E; da Costa, Kerry-Ann; Galanko, Joseph A; Patel, Mukund; Davis, Ian J; Zeisel, Steven H

2011-01-14

When dietary choline is restricted, most men and postmenopausal women develop multiorgan dysfunction marked by hepatic steatosis (choline deficiency syndrome (CDS)). However, a significant subset of premenopausal women is protected from CDS. Because hepatic PEMT (phosphatidylethanolamine N-methyltransferase) catalyzes de novo biosynthesis of choline and this gene is under estrogenic control, we hypothesized that there are SNPs in PEMT that disrupt the hormonal regulation of PEMT and thereby put women at risk for CDS. In this study, we performed transcript-specific gene expression analysis, which revealed that estrogen regulates PEMT in an isoform-specific fashion. Locus-wide SNP analysis identified a risk-associated haplotype that was selectively associated with loss of hormonal activation. Chromatin immunoprecipitation, analyzed by locus-wide microarray studies, comprehensively identified regions of estrogen receptor binding in PEMT. The polymorphism (rs12325817) most highly linked with the development of CDS (p < 0.00006) was located within 1 kb of the critical estrogen response element. The risk allele failed to bind either the estrogen receptor or the pioneer factor FOXA1. These data demonstrate that allele-specific ablation of estrogen receptor-DNA interaction in the PEMT locus prevents hormone-inducible PEMT expression, conferring risk of CDS in women.

Comparing the Palmer Drought Index and the Standardized Precipitation Index for Zagreb Gric Observatory

NASA Astrophysics Data System (ADS)

Pandzic, K.; Likso, T.

2012-04-01

Conventional Palmer Drought Index (PDI) and recent Standardized Precipitation Index (SPI) for Zagreb Gric Observatory are compared by spectral analysis technique. Data for a period 1862-2010 are used. The results indicate that SPI is simpler for interpretation but PDI more comprehensive index. On the other side, lack of temperature within SPI, make impossible application of it on climate change interpretation. Possible applications of them in irrigation scheduling system is considered as well for drought risk assessment.

A comprehensive analysis of breast cancer news coverage in leading media outlets focusing on environmental risks and prevention.

PubMed

Atkin, Charles K; Smith, Sandi W; McFeters, Courtnay; Ferguson, Vanessa

2008-01-01

Breast cancer has a high profile in the news media, which are a major source of information for cancer patients and the general public. To determine the nature of breast cancer news coverage available to audiences, particularly on the topics of environmental risks and prevention, this content analysis measured a broad array of dimensions in 231 stories appearing in nine leading newspapers, newsmagazines, and television networks in 2003 and 2004. One fourth of all stories reported on various risks such as hormone replacement therapy (HRT) use. Very few items specifically addressed risks related to controllable lifestyle practices such as prepubertal obesity or chemical contaminants in the environment. About one third of the stories included prevention content, primarily focusing narrowly on use of pharmaceutical products. Little information described risk reduction via other individual preventive behaviors (e.g., diet, exercise, and smoking), parental protective measures, or collective actions to combat contamination sites. The more traditional categories of prevalence, detection, and treatment were featured in one third, one quarter, and two fifths of the news items, respectively. There were twice as many stories featuring personal narratives as statistical figures, and two thirds of all the news items cited expert medical professionals, researchers, or organizations. Implications of these findings and directions for future research are addressed.

Advances on a Decision Analytic Approach to Exposure-Based Chemical Prioritization.

PubMed

Wood, Matthew D; Plourde, Kenton; Larkin, Sabrina; Egeghy, Peter P; Williams, Antony J; Zemba, Valerie; Linkov, Igor; Vallero, Daniel A

2018-05-11

The volume and variety of manufactured chemicals is increasing, although little is known about the risks associated with the frequency and extent of human exposure to most chemicals. The EPA and the recent signing of the Lautenberg Act have both signaled the need for high-throughput methods to characterize and screen chemicals based on exposure potential, such that more comprehensive toxicity research can be informed. Prior work of Mitchell et al. using multicriteria decision analysis tools to prioritize chemicals for further research is enhanced here, resulting in a high-level chemical prioritization tool for risk-based screening. Reliable exposure information is a key gap in currently available engineering analytics to support predictive environmental and health risk assessments. An elicitation with 32 experts informed relative prioritization of risks from chemical properties and human use factors, and the values for each chemical associated with each metric were approximated with data from EPA's CP_CAT database. Three different versions of the model were evaluated using distinct weight profiles, resulting in three different ranked chemical prioritizations with only a small degree of variation across weight profiles. Future work will aim to include greater input from human factors experts and better define qualitative metrics. © 2018 Society for Risk Analysis.

Cost effectiveness of a systematic guidelines-based approach to the prevention and management of vascular disease in a primary care setting.

PubMed

Kamboj, Laveena; Oh, Paul; Levine, Mitchell; Kammila, Srinu; Casey, William; Harterre, Don; Goeree, Ron

2016-01-15

In Ontario, Canada, the Comprehensive Vascular Disease Prevention and Management Initiative (CVDPMI) was undertaken to improve the vascular health in communities. The CVDPMI significantly improved cardiovascular (CV) risk factor profiles from baseline to follow-up visits including the 10 year Framingham Risk Score (FRS). Although the CVDPMI improved CV risk, the economic value of this program had not been evaluated. We examined the cost effectiveness of the CVDPMI program compared to no CVDPMI program in adult patients identified at risk for an initial or subsequent vascular event in a primary care setting. A one year and a ten year cost effectiveness analyses were conducted. To determine the uncertainty around the cost per life year gained ratio, a non-parametric bootstrap analysis was conducted. The overall population base case analysis at one year resulted in a cost per CV event avoided of $70,423. FRS subgroup analyses showed the high risk cohort (FRS >20%) had an incremental cost effectiveness ratio (ICER) that was dominant. In the moderate risk subgroup (FRS 10%-20%) the ICER was $47,439 per CV event avoided and the low risk subgroup (FRS <10%) showed a highly cost ineffective result of greater than $5 million per CV event avoided. The ten year analysis resulted in a dominant ICER. At one year, the CVDPMI program is economically acceptable for patients at moderate to high risk for CV events. The CVDPMI results in increased life expectancy at an incremental cost saving to the healthcare system over a ten year period. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Study on quantitative risk assessment model of the third party damage for natural gas pipelines based on fuzzy comprehensive assessment

NASA Astrophysics Data System (ADS)

Qiu, Zeyang; Liang, Wei; Wang, Xue; Lin, Yang; Zhang, Meng

2017-05-01

As an important part of national energy supply system, transmission pipelines for natural gas are possible to cause serious environmental pollution, life and property loss in case of accident. The third party damage is one of the most significant causes for natural gas pipeline system accidents, and it is very important to establish an effective quantitative risk assessment model of the third party damage for reducing the number of gas pipelines operation accidents. Against the third party damage accident has the characteristics such as diversity, complexity and uncertainty, this paper establishes a quantitative risk assessment model of the third party damage based on Analytic Hierarchy Process (AHP) and Fuzzy Comprehensive Evaluation (FCE). Firstly, risk sources of third party damage should be identified exactly, and the weight of factors could be determined via improved AHP, finally the importance of each factor is calculated by fuzzy comprehensive evaluation model. The results show that the quantitative risk assessment model is suitable for the third party damage of natural gas pipelines and improvement measures could be put forward to avoid accidents based on the importance of each factor.

The Perinatal Risk Index: Early Risks Experienced by Domestic Adoptees in the United States.

PubMed

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

2016-01-01

We aimed to assess comprehensively the prevalence of perinatal risks experienced by a potentially high-risk yet understudied population of children domestically adopted in the United States. Data are from participant report and medical records from mothers (n = 580) who completed a domestic adoption placement with nonrelatives at or near birth (Mean placement age = 7 days). We describe a comprehensive measure of perinatal risks, including divergences from previous assessment tools and the incorporation of multiple reporters, and report the prevalence of various types of perinatal risks. The prevalence of each specific risk factor was generally low, although several risks were more prevalent in this sample than estimates from nationally representative publicly available data. Nearly the entire sample (99%) experienced some type of risk exposure. Birth mothers who placed their children for adoption domestically in the US experience higher levels of perinatal risks than the national average, but not for all specific types of risk. Thus, the developmental trajectories of children adopted domestically may systematically differ from the general population to the extent that these specific perinatal risks impact development.

Comprehensive modeling of critical health care activities, costs, and data needs within the context of addiction rehabilitiation

NASA Astrophysics Data System (ADS)

Hoffman, Kenneth J.; Keithley, Hudson

1994-12-01

There are few systems which aggregate standardized pertinent clinical observations of discrete patient problems and resolutions. The systematic information supplied by clinicians is generally provided to justify reimbursement from insurers. Insurers, by their nature, and expert in modeling health care costs by diagnosis, procedures, and population risk groups. Medically, they rely on clinician generated diagnostic and coded procedure information. Clinicians will document a patient's status at a discrete point in time through narrative. Clinical notes do not support aggregate and systematic analysis of outcome. A methodology exists and has been used by the US Army Drug and Alcohol Program to model the clinical activities, associated costs, and data requirements of an outpatient clinic. This has broad applicability for a comprehensive health care system to which patient costs and data requirements can be established.

Inflammation on Prostate Needle Biopsy is Associated with Lower Prostate Cancer Risk: A Meta-Analysis.

PubMed

Vasavada, Shaleen R; Dobbs, Ryan W; Kajdacsy-Balla, André A; Abern, Michael R; Moreira, Daniel M

2018-05-01

We performed a comprehensive literature review and meta-analysis to evaluate the association of inflammation on prostate needle biopsies and prostate cancer risk. We searched Embase®, PubMed® and Web of Science™ from January 1, 1990 to October 1, 2016 for abstracts containing the key words prostate cancer, inflammation and biopsy. Study inclusion criteria were original research, adult human subjects, cohort or case-control study design, histological inflammation on prostate needle biopsy and prostate cancer on histology. Two independent teams reviewed abstracts and extracted data from the selected manuscripts. Combined ORs and 95% CIs of any, acute and chronic inflammation were calculated using the random effects method. Of the 1,030 retrieved abstracts 46 underwent full text review and 25 were included in the final analysis, comprising a total of 20,585 subjects and 6,641 patients with prostate cancer. There was significant heterogeneity among studies (I 2 = 84.4%, p <0.001). The presence of any inflammation was significantly associated with a lower prostate cancer risk in 25 studies (OR 0.455, 95% CI 0.337-0.573). There was no evidence of publication bias (p >0.05). When subanalyzed by inflammation type, acute inflammation in 4 studies and chronic inflammation in 15 were each associated with a lower prostate cancer risk (OR 0.681, 95% CI 0.450-0.913 and OR 0.499, 95% CI 0.334-0.665, respectively). In a meta-analysis of 25 studies inflammation on prostate needle biopsy was associated with a lower prostate cancer risk. Clinically the presence of inflammation on prostate needle biopsy may lower the risk of a subsequent prostate cancer diagnosis. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Revised Methods for Worker Risk Assessment

EPA Pesticide Factsheets

EPA is updating and changing the way it approaches pesticide risk assessments. This new approach will result in more comprehensive and consistent evaluation of potential risks of food use pesticides, non-food use pesticides, and occupational exposures.

[Survey and analysis of awareness of lung cancer prevention and control in a LDCT lung cancer screening project in Tianjin Dagang Oilfield of China].

PubMed

Ren, Guanhua; Ye, Jianfei; Fan, Yaguang; Wang, Jing; Sun, Zhijuan; Jia, Hui; Du, Xinxin; Hou, Chaohua; Wang, Ying; Zhao, Yongcheng; Zhou, Qinghua

2014-02-01

It has been proven that increase of the awareness level of lung cancer prevention and control could enhance participation of lung cancer screening of lung cancer high risk group. The aim of this study is to investigate the awareness level of lung cancer prevention and control and the effect of individual characteristics on lung cancer awareness, and to provide evidence for comprehensive lung cancer prevention in high risk areas of lung cancer. Staffs of Tianjin Dagang Oil Field who participate low dose CT (LDCT) lung cancer screening by cluster sampling or according to voluntary principle were surveyed, data of lung cancer awareness were collected by questionnaire. A total of 1,633 valid questionnaires were collected. The average age of respondents was 60.08±6.58. Most participants were males (82.2%) while female only accounted for 17.8%. The proportions of awareness about lung cancer in China, risk factors, screening methods and the knowledge of health examination were 64.5%, 77.1%, 43.7%, 49.6% respectively. Result of multiple logistic regression analysis showed that education level, smoking (pack-year), age, prior tuberculosis were the influencing factors of lung cancer awareness with adjusted Ors for education and age level as of 0.567 (95%CI: 0.439-0.733) and 1.373 (95%CI: 1.084-1.739) respectively. 80.3% of the participants can accept health examination once a year, while the ability to pay the medical expenses was not high. The influencing factors of health examination willingness were gender, age, income, the knowledge of lung cancer. Education level and smoking affect the awareness of lung cancer prevention and control, health education for lung cancer should be conducted especially in population with low education level. Comprehensive lung cancer control in high risk areas should combined lung cancer screening, tobacco control and health education.

Chemical and toxicological characteristics of conventional and low-TSNA moist snuff tobacco products.

PubMed

Song, Min-Ae; Marian, Catalin; Brasky, Theodore M; Reisinger, Sarah; Djordjevic, Mirjana; Shields, Peter G

2016-03-14

Use of smokeless tobacco products (STPs) is associated with oral cavity cancer and other health risks. Comprehensive analysis for chemical composition and toxicity is needed to compare conventional and newer STPs with lower tobacco-specific nitrosamines (TSNAs) yields. Seven conventional and 12 low-TSNA moist snuff products purchased in the U.S., Sweden, and South Africa were analyzed for 18 chemical constituents (International Agency for Research on Cancer classified carcinogens), pH, nicotine, and free nicotine. Chemicals were compared in each product using Wilcoxon rank-sum test and principle component analysis (PCA). Conventional compared to low-TSNA moist snuff products had higher ammonia, benzo[a]pyrene, cadmium, nickel, nicotine, nitrate, and TSNAs and had lower arsenic in dry weight content and per mg nicotine. Lead and chromium were significantly higher in low-TSNA moist snuff products. PCA showed a clear difference for constituents between conventional and low-TSNA moist snuff products. Differences among products were reduced when considered on a per mg nicotine basis. As one way to contextualize differences in constituent levels, probabilistic lifetime cancer risk was estimated for chemicals included in The University of California's carcinogenic potency database (CPDB). Estimated probabilistic cancer risks were 3.77-fold or 3-fold higher in conventional compared to low-TSNA moist snuff products under dry weight or under per mg nicotine content, respectively. In vitro testing for the STPs indicated low level toxicity and no substantial differences. The comprehensive chemical characterization of both conventional and low-TSNA moist snuff products from this study provides a broader assessment of understanding differences in carcinogenic potential of the products. In addition, the high levels and probabilistic cancer risk estimates for certain chemical constituents of smokeless tobacco products will further inform regulatory decision makers and aid them in their efforts to reduce carcinogen exposure in smokeless tobacco products. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Development of the Sexual Assertiveness Questionnaire (SAQ): A Comprehensive Measure of Sexual Assertiveness for Women.

PubMed

Loshek, Eevett; Terrell, Heather K

2015-01-01

Sexual assertiveness has been defined in a number of ways by many researchers, with different aspects of sexual assertiveness emphasized in different measures. Most previous measures have included condom insistence as an important aspect of sexual assertiveness, but this may not translate well to women at all life stages or in varied types of relationships. The goal of the current study was to develop a comprehensive measure of sexual assertiveness that encompasses the aspects of sexual assertiveness that have been emphasized by previous researchers, with the exception of condom insistence. Items were generated based on previous measures and definitions, and an exploratory factor analysis was conducted (Study 1) to better understand the dimensions of sexual assertiveness. The proposed scale was revised and further refined using both exploratory factor analysis and confirmatory factor analysis in Study 2. The final scale consisted of 18 items that seem to capture three dimensions of sexual assertiveness: the ability to initiate and communicate about desired sex, the ability to refuse unwanted sex, and the ability to communicate about sexual history and risk. Model fit indices indicate that this three-factor solution fits the data well. Implications and suggestions for future research are discussed.

Emotions while awaiting lung transplantation: A comprehensive qualitative analysis

PubMed Central

Brügger, Aurelia; Aubert, John-David

2014-01-01

Patients awaiting lung transplantation are at risk of negative emotional and physical experiences. How do they talk about emotions? Semi-structured interviews were performed (15 patients). Categorical analysis focusing on emotion-related descriptions was organized into positive–negative–neutral descriptions: for primary and secondary emotions, evaluation processes, coping strategies, personal characteristics, emotion descriptions associated with physical states, (and) contexts were listed. Patients develop different strategies to maintain positive identity and attitude, while preserving significant others from extra emotional load. Results are discussed within various theoretical and research backgrounds, in emphasizing their importance in the definition of emotional support starting from the patient’s perspective. PMID:28070345

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

Faulds, James

We conducted a comprehensive analysis of the structural controls of geothermal systems within the Great Basin and adjacent regions. Our main objectives were to: 1) Produce a catalogue of favorable structural environments and models for geothermal systems. 2) Improve site-specific targeting of geothermal resources through detailed studies of representative sites, which included innovative techniques of slip tendency analysis of faults and 3D modeling. 3) Compare and contrast the structural controls and models in different tectonic settings. 4) Synthesize data and develop methodologies for enhancement of exploration strategies for conventional and EGS systems, reduction in the risk of drilling non-productive wells,more » and selecting the best EGS sites.« less

Couple Therapy for Intimate Partner Violence: A Systematic Review and Meta-Analysis

PubMed Central

Karakurt, Gunnur; Whiting, Kate; Van Esch, Chantal; Bolen, Shari; Calabrese, Joseph

2016-01-01

Intimate partner violence is a serious public health problem accompanied by substantial morbidity and mortality. Despite its documented impact on health, there is no widely recognized treatment of choice. Some studies indicate that couples suffering from situational violence may benefit from couples therapy, but professionals are cautious to risk the possibility of violent retaliation between partners. After a comprehensive literature search of 1733 citations, this systematic review and meta-analysis compiles the results of six studies to investigate the effectiveness of couple therapy as a treatment for violence. Preliminary data suggest that couples therapy is a viable treatment in select situations. PMID:27377617

Emotions while awaiting lung transplantation: A comprehensive qualitative analysis.

PubMed

Brügger, Aurelia; Aubert, John-David; Piot-Ziegler, Chantal

2014-07-01

Patients awaiting lung transplantation are at risk of negative emotional and physical experiences. How do they talk about emotions? Semi-structured interviews were performed (15 patients). Categorical analysis focusing on emotion-related descriptions was organized into positive-negative-neutral descriptions: for primary and secondary emotions, evaluation processes, coping strategies, personal characteristics, emotion descriptions associated with physical states, (and) contexts were listed. Patients develop different strategies to maintain positive identity and attitude, while preserving significant others from extra emotional load. Results are discussed within various theoretical and research backgrounds, in emphasizing their importance in the definition of emotional support starting from the patient's perspective.

Association between Hypertension and Epistaxis: Systematic Review and Meta-analysis.

PubMed

Min, Hyun Jin; Kang, Hyun; Choi, Geun Joo; Kim, Kyung Soo

2017-12-01

Objective Whether there is an association or a cause-and-effect relationship between epistaxis and hypertension is a subject of longstanding controversy. The objective of this systematic review and meta-analysis was to determine the association between epistaxis and hypertension and to verify whether hypertension is an independent risk factor of epistaxis. Data Sources A comprehensive search was performed using the MEDLINE, EMBASE, and Cochrane Library databases. Review Methods The review was performed according to the Meta-analysis of Observational Studies in Epidemiology guidelines and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Results We screened 2768 unique studies and selected 10 for this meta-analysis. Overall, the risk of epistaxis was significantly increased for patients with hypertension (odds ratio, 1.532 [95% confidence interval (CI), 1.181-1.986]; number needed to treat, 14.9 [95% CI, 12.3-19.0]). Results of the Q test and I 2 statistics suggested considerable heterogeneity ([Formula: see text] = 0.038, I 2 = 49.3%). The sensitivity analysis was performed by excluding 1 study at a time, and it revealed no change in statistical significance. Conclusion Although this meta-analysis had some limitations, our study demonstrated that hypertension was significantly associated with the risk of epistaxis. However, since this association does not support a causal relationship between hypertension and epistaxis, further clinical trials with large patient populations will be required to determine the impact of hypertension on epistaxis.

Consumer Understanding, Preferences, and Responses to Different Versions of Drug Safety Messages in the United States: A Randomized Controlled Trial.

PubMed

McCormack, Lauren; Craig Lefebvre, R; Bann, Carla; Taylor, Olivia; Rausch, Paula

2016-02-01

As part of its mission, the US Food and Drug Administration (FDA) communicates with the public regularly about the benefits and risks of prescription and over-the-counter (OTC) drugs. Effectively communicating risk, however, is a significant public health challenge. To better understand how different populations understand information communicated by the FDA about drug safety, we conducted a randomized experiment to examine comprehension and other measures of effectiveness of drug safety messages that occurred in a post-market surveillance phase. We used an Internet panel survey of 1244 consumers, of whom 58% used prescription drugs in the past year. Half of the sample panel was randomized to read a previous FDA Drug Safety Communication (DSC) with the drug name changed, and the other half was randomized to read a revised version of the same DSC. We examined how making certain modifications to the way drug risk information is communicated has an impact on comprehension and behavioral intentions, including the user's likelihood of discontinuing the drug. We also studied how comprehension varied by respondent characteristics, health literacy skills, risk perceptions, and trust in the message. Based on a five-item comprehension index, the revised version of the message was associated with significantly greater comprehension of the information relative to the standard version (63 vs 52% correct, p < 0.001). Significantly more respondents found the revised version to be clear (82 vs 73%, p < 0.000), while fewer in that group reported learning something new (78% vs 84%, p = 0.015). No significant differences emerged between the two groups in terms of the message being informative, convincing, or helpful. We found no significant differences between the two groups in terms of behavioral intentions, risk perception, and trust. We found that making plain language changes to the DSC significantly increased consumers' level of comprehension of its content, providing support for ongoing use and further exploration of these strategies in pharmacovigilance communication research. The study findings have important implications for future drug safety and other communication messages related to prescription drugs.

The -765G>C polymorphism in the cyclooxygenase-2 gene and digestive system cancer: a meta-analysis.

PubMed

Zhao, Fen; Cao, Yue; Zhu, Hong; Huang, Min; Yi, Cheng; Huang, Ying

2014-01-01

Published data regarding associations between the -765G>C polymorphism in cyclooxygenase-2 (COX-2) gene and digestive system cancer risk have been inconclusive. The aim of this study was to comprehensively evaluate the genetic risk of the -765G>C polymorphism in the COX-2 gene for digestive system cancer. A search was performed in Pubmed, Medline (Ovid), Embase, CNKI, Weipu, Wanfang and CBM databases, covering all studies until Feb 10, 2014. Statistical analysis was performed using Revman5.2. A total of 10,814 cases and 16,174 controls in 38 case-control studies were included in this meta-analysis. The results indicated that C allele carriers (GC+CC) had a 20% increased risk of digestive system cancer when compared with the homozygote GG (odds ratio (OR)=1.20, 95% confidence interval (CI), 1.00-1.44 for GC+CC vs GG). In the subgroup analysis by ethnicity, significant elevated risks were associated with C allele carriers (GC+CC) in Asians (OR = 1.46, 95% CI=1.07-2.01, and p=0.02) and Africans (OR=2.12, 95% CI=1.57-2.87, and p< 0.00001), but not among Caucasians, Americans and mixed groups. For subgroup analysis by cancer type (GC+CC vs GG), significant associations were found between the -765G>C polymorphism and higher risk for gastric cancer (OR=1.64, 95% CI=1.03-2.61, and p=0.04), but not for colorectal cancer, oral cancer, esophageal cancer, and others. Regarding study design (GC+CC vs GG), no significant associations were found in then population-based case-control (PCC), hospital-based case-control (HCC) and family-based case-control (FCC) studies. This meta-analysis suggested that the -765G>C polymorphism of the COX-2 gene is a potential risk factor for digestive system cancer in Asians and Africans and gastric cancer overall.

Efficacy of a Web-based Intelligent Tutoring System for Communicating Genetic Risk of Breast Cancer: A Fuzzy-Trace Theory Approach

PubMed Central

Wolfe, Christopher R.; Reyna, Valerie F.; Widmer, Colin L.; Cedillos, Elizabeth M.; Fisher, Christopher R.; Brust-Renck, Priscila G.; Weil, Audrey M.

2014-01-01

Background Many healthy women consider genetic testing for breast cancer risk, yet BRCA testing issues are complex. Objective Determining whether an intelligent tutor, BRCA Gist, grounded in fuzzy-trace theory (FTT), increases gist comprehension and knowledge about genetic testing for breast cancer risk, improving decision-making. Design In two experiments, 410 healthy undergraduate women were randomly assigned to one of three groups: an online module using a web-based tutoring system (BRCA Gist) that uses artificial intelligence technology, a second group read highly similar content from the NCI web site, and a third completed an unrelated tutorial. Intervention BRCA Gist applied fuzzy trace theory and was designed to help participants develop gist comprehension of topics relevant to decisions about BRCA genetic testing, including how breast cancer spreads, inherited genetic mutations, and base rates. Measures We measured content knowledge, gist comprehension of decision-relevant information, interest in testing, and genetic risk and testing judgments. Results Control knowledge scores ranged from 54% to 56%, NCI improved significantly to 65% and 70%, and BRCA Gist improved significantly more to 75% and 77%, p<.0001. BRCA Gist scored higher on gist comprehension than NCI and control, p<.0001. Control genetic risk-assessment mean was 48% correct; BRCA Gist (61%), and NCI (56%) were significantly higher, p<.0001. BRCA Gist participants recommended less testing for women without risk factors (not good candidates), (24% and 19%) than controls (50%, both experiments) and NCI, (32%) Experiment 2, p<.0001. BRCA Gist testing interest was lower than controls, p<.0001. Limitations BRCA Gist has not been tested with older women from diverse groups. Conclusions Intelligent tutors, such as BRCA Gist, are scalable, cost effective ways of helping people understand complex issues, improving decision-making. PMID:24829276

Socio-economic exposure to natural disasters

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

Marin, Giovanni, E-mail: giovanni.marin@uniurb.it; IRCrES - CNR, Research Institute on Sustainable Economic Growth, Via Corti 12, 20133 - Milano; SEEDS, Ferrara

Even though the correct assessment of risks is a key aspect of the risk management analysis, we argue that limited effort has been devoted in the assessment of comprehensive measures of economic exposure at very low scale. For this reason, we aim at providing a series of suitable methodologies to provide a complete and detailed list of the exposure of economic activities to natural disasters. We use Input-Output models to provide information about several socio-economic variables, such as population density, employment density, firms' turnover and capital stock, that can be seen as direct and indirect socio-economic exposure to natural disasters.more » We then provide an application to the Italian context. These measures can be easily incorporated into risk assessment models to provide a clear picture of the disaster risk for local areas. - Highlights: • Ex ante assessment of economic exposure to disasters at very low geographical scale • Assessment of the cost of natural disasters in ex-post perspective • IO model and spatial autocorrelation to get information on socio-economic variables • Indicators supporting risk assessment and risk management models.« less

Security risk assessment: applying the concepts of fuzzy logic.

PubMed

Bajpai, Shailendra; Sachdeva, Anish; Gupta, J P

2010-01-15

Chemical process industries (CPI) handling hazardous chemicals in bulk can be attractive targets for deliberate adversarial actions by terrorists, criminals and disgruntled employees. It is therefore imperative to have comprehensive security risk management programme including effective security risk assessment techniques. In an earlier work, it has been shown that security risk assessment can be done by conducting threat and vulnerability analysis or by developing Security Risk Factor Table (SRFT). HAZOP type vulnerability assessment sheets can be developed that are scenario based. In SRFT model, important security risk bearing factors such as location, ownership, visibility, inventory, etc., have been used. In this paper, the earlier developed SRFT model has been modified using the concepts of fuzzy logic. In the modified SRFT model, two linguistic fuzzy scales (three-point and four-point) are devised based on trapezoidal fuzzy numbers. Human subjectivity of different experts associated with previous SRFT model is tackled by mapping their scores to the newly devised fuzzy scale. Finally, the fuzzy score thus obtained is defuzzyfied to get the results. A test case of a refinery is used to explain the method and compared with the earlier work.

The epidemiology of cattle abortion in Algeria.

PubMed

Kardjadj, Moustafa

2018-02-01

In Algeria, the epidemiology of cattle abortions is not well understood. Therefore, the present study aims to estimate the prevalence of abortion in 75 Algerian cattle herds and correlate its possible association with brucellosis positivity and some managerial risk factors. The cattle abortion herd prevalence was 41.33% [95% CI 30.16-52.5%]. As for brucellosis, the serological evidence of brucellosis exposure was observed in 9 out of 75 herds accounting for 12% [95% CI 4.65-19.35] herd seroprevalence. The risk factor analysis using the univariable analysis followed by multivariable logistic regression did confirm that brucellosis positivity (OR = 5.19), mixed herd (OR = 2.5), contact with other herd (OR = 2.91), presence of dog in the herd (OR = 2.89), imported cattle (OR = 1.91), and farmers with less than 2 years' experience (OR = 2.69) as risk factors for abortion in Algerian cattle herds. Targeting these factors using a comprehensive control measure is needed to improve animal welfare and reduce economic losses associated with abortion in dairy cattle.

A poor performance in comprehensive geriatric assessment is associated with increased fall risk in elders with hypertension: a cross-sectional study.

PubMed

Chu, Jiao-Jiao; Chen, Xu-Jiao; Shen, Shan-Shan; Zhang, Xue-Feng; Chen, Ling-Yan; Zhang, Jing-Mei; He, Jing; Zhao, Jun-Feng

2015-03-01

Fall and serious fall injuries have become a major health concern for elders. Many factors including blood pressure and anti-hypertensive medication application were reported as hazards of fall. The purpose of this study was to determine if age related systemic functional decline related with increased fall risks in elderly patients with hypertension. A total of 342 elderly hypertension patients (age 79.5 ± 6.7 years, male 63.8%) were recruited to the study. Comprehensive geriatric assessment (CGA), including measurements about activity of daily living (ADL), nutrition, cognition, depression, numbers of prescription medication and number of clinical diagnosis, was conducted to evaluate the physical and mental status of each participants. Fall risk was evaluated by Morse fall scale, Tinetti performance oriented mobility assessment (POMA) and history of fall in the recent year. Participants were grouped into tertiles according to CGA score. Correlation between CGA and fall risk was analyzed through SPSS 18.0. Participants with higher CGA score were likely to be older, had a lower body mass index (BMI), and a higher prevalence of cardiovascular disease, chronic obstructive pulmonary disease (COPD), cerebrovascular disease and osteoarthropathia. Participants in higher tertile of CGA score got increased prevalence of fall risk than those in lower tertile (P < 0.01 T3 vs. T1, P < 0.01 T3 vs. T2). Correlation analysis and regression analysis showed significant association between CGA and Morse fall scale (P < 0.001), as well as CGA and POMA (P < 0.001). Meanwhile, CGA components also showed co-relationships with increase fall risks. After adjusting age, BMI, benzodiazepine use, cardiovascular disease, cerebrovascular disease, COPD and osteoarthropathia, both history of fall in the recent year and rising Morse fall scale were significantly associated with ADL impairment (OR: 2.748, 95%CI: 1.598-4.725), (OR: 3.310, 95%CI: 1.893-5.788). Decreased Tinetti POMA score was associated with Mini-Mental State Examination (MMSE) (OR: 4.035, 95%CI: 2.100-7.751), ADL (OR: 2.380, 95%CI: 1.357-4.175) and shortened MNA form (MNA-SF) impairment (OR: 2.692, 95%CI: 1.147-6.319). In elderly adults with hypertension, impaired physical and mental function is associated with increased fall risk. Further study is required to investigate possible mediators for the association and effective interventions.

Interaction between early-life stress and FKBP5 gene variants in major depressive disorder and post-traumatic stress disorder: A systematic review and meta-analysis.

PubMed

Wang, Qingzhong; Shelton, Richard C; Dwivedi, Yogesh

2018-01-01

Gene-environment interaction contributes to the risks of psychiatric disorders. Interactions between FKBP5 gene variants and early-life stress may enhance the risk not only for mood disorder, but also for a number of other behavioral phenotypes. The aim of the present study was to review and conduct a meta-analysis on the results from published studies examining interaction between FKBP5 gene variants and early-life stress and their associations with stress-related disorders such as major depression and PTSD. A literature search was conducted using PsychINFO and PubMed databases until May 2017. A total of 14 studies with a pooled total of 15109 participants met the inclusion criteria, the results of which were combined and a meta-analysis was performed using the differences in correlations as the effect measure. Based on literature, rs1360780, rs3800373, and rs9470080 SNPs were selected within the FKBP5 gene and systematic review was conducted. Based on the Comprehensive Meta-Analysis software, no publication bias was detected. Sensitivity analysis and credibility of meta-analysis results also indicated that the analyses were stable. The meta-analysis showed that individuals who carry T allele of rs1360780, C-allele of rs3800373 or T-allele of rs9470080 exposed to early-life trauma had higher risks for depression or PTSD. The effects of ethnicity, age, sex, and different stress measures were not examined due to limited sample size. These results provide strong evidence of interactions between FKBP5 genotypes and early-life stress, which could pose a significant risk factor for stress-associated disorders such as major depression and PTSD. Copyright © 2017 Elsevier B.V. All rights reserved.

Comprehension deficits among older patients in a quick diagnostic unit.

PubMed

Hvidt, Lisa Nebelin; Hvidt, Kristian Nebelin; Madsen, Kim; Schmidt, Thomas A

2014-01-01

Higher prevalence of multiple illnesses and cognitive impairment among older patients pose a risk of comprehension difficulties, potentially leading to medication errors. Therefore, the objective of this study was to investigate comprehension of discharge instructions among older patients admitted to a Quick Diagnostic Unit (QDU). One hundred and two patients discharged from the QDU answered a questionnaire covering understanding of their hospitalization and discharge plan. Patients' ability to recall discharge instructions and awareness of comprehension deficits, ie, ability to identify the misconceived information, were evaluated by comparing the questionnaires with the discharge letters. The population was divided into an older group (age ≥65 years) and a younger group. The older group (n=40) was less able to recall correct medication instructions when compared to the younger group (54% versus 78%, respectively; P=0.02). In multiple logistic regression analysis, correct recall of medication instructions was 4.2 times higher for the younger group compared to the older group (odds ratio 4.2, 95% confidence interval 1.5-11.9, P=0.007) when adjusted for sex and education. The older patients were less aware of their own comprehension deficits, and in respect to medication instructions awareness decreased 6.1% for each additional year of age (odds ratio 0.939, 95% confidence interval 0.904-0.98, P=0.001) when adjusted for sex and education. Older patients were less able to recall correct medication instructions and less aware of their comprehension deficits after discharge from a QDU. The findings of the present study emphasize the importance of thorough communication and follow-up when treating older patients.

Risk factors for calcineurin inhibitor nephrotoxicity after renal transplantation: a systematic review and meta-analysis.

PubMed

Xia, Tianyi; Zhu, Sang; Wen, Yan; Gao, Shouhong; Li, Mingming; Tao, Xia; Zhang, Feng; Chen, Wansheng

2018-01-01

Nephrotoxicity of calcineurin inhibitors (CNIs) is the major concern for long-term allograft survival despite its predominant role in current immunosuppressive regime after renal transplantation. CNI nephrotoxicity is multifactorial with demographic, environmental, and pharmacogenetic flexibility, whereas studies indicating risk factors for CNI nephrotoxicity obtained incomplete or conflicting results. A systematic review and meta-analysis of risk factors for CNI nephrotoxicity was performed on all retrieved studies through a comprehensive research of network database. Data were analyzed by Review Manager 5.2 with heterogeneity assessed using the Cochrane Q and I 2 tests. CNI nephrotoxicity was primarily indicated with protocol biopsy or index-based clinical diagnosis, and the secondary outcome was defined as delayed graft function. Twelve observational studies containing a total of 2,849 cases were identified. Donor age (odds ratio [OR], 1.01; 95% CI, 1.01-1.03; p =0.02), recipient zero-time arteriosclerosis (OR, 1.44; 95% CI, 1.04-1.99; p =0.03), and CYP3A5*3/*3 genotype (OR, 2.80; 95% CI, 2.63-2.98; p =0.00) were confirmed as risk factors for CNI nephrotoxicity. Subgroup and sensitivity analysis claimed donor age as a significant contributor in Asian and Caucasian areas. Older donor age, recipient zero-time arteriosclerosis, and CYP3A5*3/*3 genotype might add up the risk for CNI nephrotoxicity, which could be interpreted into a robust biomarker system.

Priority screening of toxic chemicals and industry sectors in the U.S. toxics release inventory: a comparison of the life cycle impact-based and risk-based assessment tools developed by U.S. EPA.

PubMed

Lim, Seong-Rin; Lam, Carl W; Schoenung, Julie M

2011-09-01

Life Cycle Impact Assessment (LCIA) and Risk Assessment (RA) employ different approaches to evaluate toxic impact potential for their own general applications. LCIA is often used to evaluate toxicity potentials for corporate environmental management and RA is often used to evaluate a risk score for environmental policy in government. This study evaluates the cancer, non-cancer, and ecotoxicity potentials and risk scores of chemicals and industry sectors in the United States on the basis of the LCIA- and RA-based tools developed by U.S. EPA, and compares the priority screening of toxic chemicals and industry sectors identified with each method to examine whether the LCIA- and RA-based results lead to the same prioritization schemes. The Tool for the Reduction and Assessment of Chemical and other environmental Impacts (TRACI) is applied as an LCIA-based screening approach with a focus on air and water emissions, and the Risk-Screening Environmental Indicator (RSEI) is applied in equivalent fashion as an RA-based screening approach. The U.S. Toxic Release Inventory is used as the dataset for this analysis, because of its general applicability to a comprehensive list of chemical substances and industry sectors. Overall, the TRACI and RSEI results do not agree with each other in part due to the unavailability of characterization factors and toxic scores for select substances, but primarily because of their different evaluation approaches. Therefore, TRACI and RSEI should be used together both to support a more comprehensive and robust approach to screening of chemicals for environmental management and policy and to highlight substances that are found to be of concern from both perspectives. Copyright © 2011 Elsevier Ltd. All rights reserved.

Which parameters affect long-term mortality in older adults: is comprehensive geriatric assessment a predictor of mortality?

PubMed

Kara, Ozgur; Canbaz, Busra; Kizilarslanoglu, Muhammet Cemal; Arik, Gunes; Sumer, Fatih; Aycicek, Gozde Sengul; Varan, Hacer Dogan; Kilic, Mustafa Kemal; Dogru, Rana Tuna; Cınar, Esat; Kuyumcu, Mehmet Emin; Yesil, Yusuf; Ulger, Zekeriya; Yavuz, Burcu Balam; Halil, Meltem; Cankurtaran, Mustafa

2017-06-01

Determining predictors of mortality among older adults might help identify high-risk patients and enable timely intervention. The aim of the study was to identify which variables predict geriatric outpatient mortality, using routine geriatric assessment tools. We analyzed the data of 1141 patients who were admitted to the geriatric medicine outpatient clinic between 2001 and 2004. Comprehensive geriatric assessment was performed by an interdisciplinary geriatric team. Mortality rate was determined in 2015. The parameters predicting survival were examined. Median age of the patients (415 male, 726 female) was 71.7 years (53-95 years). Mean survival time was 12.2 years (95 % CI; 12-12.4 years). In multivariate analysis, age (OR: 1.16, 95 % CI: 1.09-1.23, p < 0.001), smoking (OR: 2.51, 95 % CI: 1.18-5.35, p = 0.017) and metabolic syndrome (OR: 2.20, 95 % CI: 1.05-4.64, p = 0.038) were found to be independent risk factors for mortality. MNA-SF scores (OR: 0.84, 95 % CI: 0.71-1.00, p = 0.050) and free T3 levels (OR: 0.70, 95 % CI: 0.49-1.00, p = 0.052) had borderline significance. The present study showed that the risk conferred by metabolic syndrome is beyond its individual components. Our findings confirm previous studies on the prognostic role of nutritional status, as reflected by MNA-SF. Serum fT3, a simple laboratory test, may also be used in geriatric outpatient clinics to identify individuals at risk. The results of the study demonstrated the need for addressing modifiable risk factors such as smoking, metabolic syndrome, and undernutrition in older adults.

Guidelines for hypertension treatment: applications for primary care practice--a review of the JNC VI report.

PubMed

Alexander, L M

1998-01-01

The Joint National Committee's report on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure was released in November 1997. With its release, an increased emphasis on "treating the patient, not just the number" has taken place. The report provides a comprehensive review of recent clinical evidence that helps guide clinical decision making in the care of the hypertensive patient. A new disease classification system entitled "risk stratification" is introduced and takes into account comorbid conditions that are present for many hypertensive individuals. This risk stratification is then linked to treatment strategies and provides a concise decision analysis framework to aid in clinical decision making. Community-based prevention strategies are also highlighted and should raise the awareness of clinicians to adopt these recommendations and integrate them more aggressively into daily practice. Increased emphasis on patient compliance to improve overall hypertension control rates is also presented. Maximum efficacy through once-daily dosing and fixed-dose combinations are reviewed in the report. The JNC report is a comprehensive resource for clinicians in primary care practice. Its evidenced-based approach is a wonderful teaching tool for those clinicians who also serve as clinical educators in primary care.

Combining fluorescent in situ hybridization data with ISS staging improves risk assessment in myeloma: an International Myeloma Working Group collaborative project.

PubMed

Avet-Loiseau, H; Durie, B G M; Cavo, M; Attal, M; Gutierrez, N; Haessler, J; Goldschmidt, H; Hajek, R; Lee, J H; Sezer, O; Barlogie, B; Crowley, J; Fonseca, R; Testoni, N; Ross, F; Rajkumar, S V; Sonneveld, P; Lahuerta, J; Moreau, P; Morgan, G

2013-03-01

The combination of serum β2-microglobulin and albumin levels has been shown to be highly prognostic in myeloma as the International Staging System (ISS). The aim of this study was to assess the independent contributions of ISS stage and cytogenetic abnormalities in predicting outcomes. A retrospective analysis of international studies looking at both ISS and cytogenetic abnormalities was performed in order to assess the potential role of combining ISS stage and cytogenetics to predict survival. This international effort used the International Myeloma Working Group database of 12 137 patients treated worldwide for myeloma at diagnosis, of whom 2309 had cytogenetic studies and 5387 had analyses by fluorescent in situ hybridization (iFISH). Comprehensive analyses used 2642 patients with sufficient iFISH data available. Using the comprehensive iFISH data, combining both t(4;14) and deletion (17p), along with ISS stage, significantly improved the prognostic assessment in terms of progression-free survival and overall survival. The additional impact of patient age and use of high-dose therapy was also demonstrated. In conclusion, the combination of iFISH data with ISS staging significantly improves risk assessment in myeloma.

Risk assessment for tephra dispersal and sedimentation: the example of four Icelandic volcanoes

NASA Astrophysics Data System (ADS)

Biass, Sebastien; Scaini, Chiara; Bonadonna, Costanza; Smith, Kate; Folch, Arnau; Höskuldsson, Armann; Galderisi, Adriana

2014-05-01

In order to assist the elaboration of proactive measures for the management of future Icelandic volcanic eruptions, we developed a new approach to assess the impact associated with tephra dispersal and sedimentation at various scales and for multiple sources. Target volcanoes are Hekla, Katla, Eyjafjallajökull and Askja, selected for their high probabilities of eruption and/or their high potential impact. We combined stratigraphic studies, probabilistic strategies and numerical modelling to develop comprehensive eruption scenarios and compile hazard maps for local ground deposition and regional atmospheric concentration using both TEPHRA2 and FALL3D models. New algorithms for the identification of comprehensive probability density functions of eruptive source parameters were developed for both short and long-lasting activity scenarios. A vulnerability assessment of socioeconomic and territorial aspects was also performed at both national and continental scales. The identification of relevant vulnerability indicators allowed for the identification of the most critical areas and territorial nodes. At a national scale, the vulnerability of economic activities and the accessibility to critical infrastructures was assessed. At a continental scale, we assessed the vulnerability of the main airline routes and airports. Resulting impact and risk were finally assessed by combining hazard and vulnerability analysis.

Validation of cytogenetic risk groups according to International Prognostic Scoring Systems by peripheral blood CD34+FISH: results from a German diagnostic study in comparison with an international control group

PubMed Central

Braulke, Friederike; Platzbecker, Uwe; Müller-Thomas, Catharina; Götze, Katharina; Germing, Ulrich; Brümmendorf, Tim H.; Nolte, Florian; Hofmann, Wolf-Karsten; Giagounidis, Aristoteles A. N.; Lübbert, Michael; Greenberg, Peter L.; Bennett, John M.; Solé, Francesc; Mallo, Mar; Slovak, Marilyn L.; Ohyashiki, Kazuma; Le Beau, Michelle M.; Tüchler, Heinz; Pfeilstöcker, Michael; Nösslinger, Thomas; Hildebrandt, Barbara; Shirneshan, Katayoon; Aul, Carlo; Stauder, Reinhard; Sperr, Wolfgang R.; Valent, Peter; Fonatsch, Christa; Trümper, Lorenz; Haase, Detlef; Schanz, Julie

2015-01-01

International Prognostic Scoring Systems are used to determine the individual risk profile of myelodysplastic syndrome patients. For the assessment of International Prognostic Scoring Systems, an adequate chromosome banding analysis of the bone marrow is essential. Cytogenetic information is not available for a substantial number of patients (5%–20%) with dry marrow or an insufficient number of metaphase cells. For these patients, a valid risk classification is impossible. In the study presented here, the International Prognostic Scoring Systems were validated based on fluorescence in situ hybridization analyses using extended probe panels applied to cluster of differentiation 34 positive (CD34+) peripheral blood cells of 328 MDS patients of our prospective multicenter German diagnostic study and compared to chromosome banding results of 2902 previously published patients with myelodysplastic syndromes. For cytogenetic risk classification by fluorescence in situ hybridization analyses of CD34+ peripheral blood cells, the groups differed significantly for overall and leukemia-free survival by uni- and multivariate analyses without discrepancies between treated and untreated patients. Including cytogenetic data of fluorescence in situ hybridization analyses of peripheral CD34+ blood cells (instead of bone marrow banding analysis) into the complete International Prognostic Scoring System assessment, the prognostic risk groups separated significantly for overall and leukemia-free survival. Our data show that a reliable stratification to the risk groups of the International Prognostic Scoring Systems is possible from peripheral blood in patients with missing chromosome banding analysis by using a comprehensive probe panel (clinicaltrials.gov identifier:01355913). PMID:25344522

Meta-analysis of the association of MTHFR polymorphisms with multiple myeloma risk

PubMed Central

Ma, Li-Min; Ruan, Lin-Hai; Yang, Hai-Ping

2015-01-01

The association of methylenetetrahydrofolate reductase (MTHFR) polymorphisms with multiple myeloma (MM) risk has been explored, but the results remain controversial. Thus, a meta-analysis was performed to provide a comprehensively estimate. The case-control studies about MTHFR C677T and A1298C polymorphisms with MM risk were collected by searching PubMed, Elsevier, China National Knowledge Infrastructure and Wanfang Databases. Odds ratios (ORs) with 95% confidence intervals (CIs) were applied to assess the strength of association. Overall, no significant association was found between MTHFR A1298C polymorphism and MM risk under all four genetic models (AC vs. AA, OR = 0.99, 95%CI = 0.82-1.20; CC vs. AA, OR = 1.14, 95%CI = 0.77-1.68; recessive model, OR = 1.10, 95%CI = 0.76-1.59; dominant model, OR = 1.01, 95%CI = 0.84-1.22). The risk was also not significantly altered for C677T polymorphism and MM in overall comparisons (CT vs. CC, OR = 1.04, 95%CI = 0.93-1.17; TT vs. CC, OR = 1.16, 95%CI = 0.98-1.37; recessive model, OR = 1.13, 95%CI = 0.98-1.32; dominant model, OR = 1.07, 95%CI = 0.96-1.20). In subgroup analyses by ethnicity, no significant association was observed in both Caucasians and Asians. This meta-analysis suggested that MTHFR polymorphisms were not associated with MM risk. PMID:26022785

Is dietary nitrate/nitrite exposure a risk factor for development of thyroid abnormality? A systematic review and meta-analysis.

PubMed

Bahadoran, Zahra; Mirmiran, Parvin; Ghasemi, Asghar; Kabir, Ali; Azizi, Fereidoun; Hadaegh, Farzad

2015-05-01

The potential effects of inorganic nitrate/nitrite on global health are a much debated issue. In addition to possible methemoglobinemia and carcinogenic properties, anti-thyroid effects of nitrate/nitrite have been suggested. Considering the growing significance of nitrate/nitrite and since there is no comprehensive review in data available, clarifying the effect of nitrate/nitrite on thyroid disorder outcomes is essential. Therefore, we conducted this systematic review of experimental and clinical studies, and a meta-analysis of relevant cohort and cross-sectional studies investigating the association of nitrate/nitrite exposure and thyroid function. Most animal studies show that high exposure (~10-600 times of acceptable daily intake) to nitrate/nitrite induces anti-thyroid effects, including decreased serum level of thyroid hormones and histomorphological changes in thyroid gland; however no similar observations have been documented in humans. Based on our meta-analysis, no significant association was observed between nitrate exposure and the risk of thyroid cancer, hyper- and hypothyroidism; findings from three cohort studies however showed a significant association between higher exposure to nitrite and the risk of thyroid cancer (risk = 1.48, 95% confidence interval = 1.09-2.02, P = 0.012). Additional research is needed to clarify the association between nitrate/nitrite exposures and both thyroid function and cancer. Copyright © 2015 Elsevier Inc. All rights reserved.

Quantifying Risks and Uncertainties Associated with Induced Seismicity due to CO2 Injection into Geologic Formations with Faults

NASA Astrophysics Data System (ADS)

Hou, Z.; Nguyen, B. N.; Bacon, D. H.; White, M. D.; Murray, C. J.

2016-12-01

A multiphase flow and reactive transport simulator named STOMP-CO2-R has been developed and coupled to the ABAQUS® finite element package for geomechanical analysis enabling comprehensive thermo-hydro-geochemical-mechanical (THMC) analyses. The coupled THMC simulator has been applied to analyze faulted CO2 reservoir responses (e.g., stress and strain distributions, pressure buildup, slip tendency factor, pressure margin to fracture) with various complexities in fault and reservoir structures and mineralogy. Depending on the geological and reaction network settings, long-term injection of CO2 can have a significant effect on the elastic stiffness and permeability of formation rocks. In parallel, an uncertainty quantification framework (UQ-CO2), which consists of entropy-based prior uncertainty representation, efficient sampling, geostatistical reservoir modeling, and effective response surface analysis, has been developed for quantifying risks and uncertainties associated with CO2 sequestration. It has been demonstrated for evaluating risks in CO2 leakage through natural pathways and wellbores, and for developing predictive reduced order models. Recently, a parallel STOMP-CO2-R has been developed and the updated STOMP/ABAQUS model has been proven to have a great scalability, which makes it possible to integrate the model with the UQ framework to effectively and efficiently explore multidimensional parameter space (e.g., permeability, elastic modulus, crack orientation, fault friction coefficient) for a more systematic analysis of induced seismicity risks.

Predictors of treatment dropout in self-guided web-based interventions for depression: an 'individual patient data' meta-analysis.

PubMed

Karyotaki, E; Kleiboer, A; Smit, F; Turner, D T; Pastor, A M; Andersson, G; Berger, T; Botella, C; Breton, J M; Carlbring, P; Christensen, H; de Graaf, E; Griffiths, K; Donker, T; Farrer, L; Huibers, M J H; Lenndin, J; Mackinnon, A; Meyer, B; Moritz, S; Riper, H; Spek, V; Vernmark, K; Cuijpers, P

2015-10-01

It is well known that web-based interventions can be effective treatments for depression. However, dropout rates in web-based interventions are typically high, especially in self-guided web-based interventions. Rigorous empirical evidence regarding factors influencing dropout in self-guided web-based interventions is lacking due to small study sample sizes. In this paper we examined predictors of dropout in an individual patient data meta-analysis to gain a better understanding of who may benefit from these interventions. A comprehensive literature search for all randomized controlled trials (RCTs) of psychotherapy for adults with depression from 2006 to January 2013 was conducted. Next, we approached authors to collect the primary data of the selected studies. Predictors of dropout, such as socio-demographic, clinical, and intervention characteristics were examined. Data from 2705 participants across ten RCTs of self-guided web-based interventions for depression were analysed. The multivariate analysis indicated that male gender [relative risk (RR) 1.08], lower educational level (primary education, RR 1.26) and co-morbid anxiety symptoms (RR 1.18) significantly increased the risk of dropping out, while for every additional 4 years of age, the risk of dropping out significantly decreased (RR 0.94). Dropout can be predicted by several variables and is not randomly distributed. This knowledge may inform tailoring of online self-help interventions to prevent dropout in identified groups at risk.

RISK COMMUNICATION IN COMMUNITY PARTICIPATION: COMPARING REGIONAL PROGRAMS IN SOUTH FLORIDA

EPA Science Inventory

Comparison of the U.S. Environmental Protection Agency’s Superfund Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) and the U.S. Army Corps of Engineers’ Comprehensive Everglades Restoration Plan (CERP) decision-making regimes revealed...

Microbial Characterization of Free Floating Condensate Aboard the Mir Space Station

NASA Technical Reports Server (NTRS)

Ott, C. M.; Bruce, R. J.; Pierson, D. L.

2004-01-01

Three samples of humidity condensate that had accumulated behind panels aboard the Russian space station Mir were collected and returned to earth for analysis. As these floating masses of liquid come into contact with the astronauts and the engineering systems, they have the potential to affect both crew health and systems performance. Using a combination of culturing techniques, a wide variety of organisms were isolated included Escherichia coli, Serratia marcescens, and a presumed Legionella species. In addition, microscopic analysis indicated the presence of protozoa, dust mites, and spirochetes. These findings suggest the need for more comprehensive microbial analysis of the environment through the use of new methodologies to allow a more thorough risk assessment of spacecraft. Copyright 2004 Springer-Verlag.

Increasing colorectal cancer screening among individuals in the carpentry trade: test of risk communication interventions.

PubMed

Lipkus, Isaac M; Skinner, Celette Sugg; Dement, John; Pompeii, Lisa; Moser, Barry; Samsa, Gregory P; Ransohoff, David

2005-05-01

Individuals in the carpentry trade, due to lifestyle habits and occupational exposures, may be at above-average risk for colorectal cancer (CRC). Based on the literature which suggests that increasing perceived risk motivates behavior change, we report on the effectiveness of four risk-communication interventions targeted to increase initial, yearly and repeat fecal occult screening (FOBT) among carpenters (N = 860) over a 3-year period. Our 2 x 2 factorial design intervention study varied two dimensions of providing CRC risk factor information: (1) type of risk factor-one set of interventions emphasized three basic risk factors (age, family history and polyps); the other set emphasized a comprehensive set of risk factors including basic, lifestyle, and occupational factors, and (2) tailoring/not tailoring risk factor information. Participants were provided FOBTs. Outcomes were the proportion of returned FOBTs. Varying the amount and intensity of delivering CRC risk factors information affected neither risk perceptions nor initial, yearly, or repeat screening. However, yearly and repeat screening rates were greater among participants who received interventions addressing comprehensive set of risk factors, especially with increasing age. Tailoring on several CRC risk factors appears insufficient to increase and sustain elevated perceptions of CRC risks to promote screening.

Development and implementation of a business continuity management risk index.

PubMed

Kadar, Michael

This paper will present the building blocks for developing and implementing the BCM risk index; whether it is used as a comprehensive metric for risk or preparedness. This paper introduces the concept of a business continuity management (BCM) risk index--a comprehensive metric that measures and reports the status of the primary 'intended outcome' of the BCM programme to top management. In addition to measuring the primary programme output,;the BCM risk index can be used to demonstrate the overall value of the BCM programme to executive management. This is accomplished because the BCM risk index allows quantitative measurement of current risk levels and their comparison with established risk tolerances. The BCM Risk Index can provide executive management with reports on the risk level of individual business units, departments, subsidiaries or the enterprise in a way that drives both risk management and BCM initiatives. The name 'risk index' can be misleading, however. The BCM risk index concept can also be used to measure preparedness levels. In fact, implementation at DTE Energy has resulted in calling it the 'preparedness index', which is used to measure and report preparedness levels rather than risk levels.

School based sex education and HIV prevention in low- and middle-income countries: a systematic review and meta-analysis.

PubMed

Fonner, Virginia A; Armstrong, Kevin S; Kennedy, Caitlin E; O'Reilly, Kevin R; Sweat, Michael D

2014-01-01

School-based sex education is a cornerstone of HIV prevention for adolescents who continue to bear a disproportionally high HIV burden globally. We systematically reviewed and meta-analyzed the existing evidence for school-based sex education interventions in low- and middle-income countries to determine the efficacy of these interventions in changing HIV-related knowledge and risk behaviors. We searched five electronic databases, PubMed, Embase, PsycInfo, CINAHL, and Sociological Abstracts, for eligible articles. We also conducted hand-searching of key journals and secondary reference searching of included articles to identify potential studies. Intervention effects were synthesized through random effects meta-analysis for five outcomes: HIV knowledge, self-efficacy, sexual debut, condom use, and number of sexual partners. Of 6191 unique citations initially identified, 64 studies in 63 articles were included in the review. Nine interventions either focused exclusively on abstinence (abstinence-only) or emphasized abstinence (abstinence-plus), whereas the remaining 55 interventions provided comprehensive sex education. Thirty-three studies were able to be meta-analyzed across five HIV-related outcomes. Results from meta-analysis demonstrate that school-based sex education is an effective strategy for reducing HIV-related risk. Students who received school-based sex education interventions had significantly greater HIV knowledge (Hedges g = 0.63, 95% Confidence Interval (CI): 0.49-0.78, p<0.001), self-efficacy related to refusing sex or condom use (Hedges g = 0.25, 95% CI: 0.14-0.36, p<0.001), condom use (OR = 1.34, 95% CI: 1.18-1.52, p<0.001), fewer sexual partners (OR = 0.75, 95% CI:0.67-0.84, p<0.001) and less initiation of first sex during follow-up (OR = 0.66, 95% CI: 0.54-0.83, p<0.001). The paucity of abstinence-only or abstinence-plus interventions identified during the review made comparisons between the predominant comprehensive and less common abstinence-focused programs difficult. Comprehensive school-based sex education interventions adapted from effective programs and those involving a range of school-based and community-based components had the largest impact on changing HIV-related behaviors.

Projected lifetime cancer risks from exposure to regional radioactive fallout in the Marshall Islands.

PubMed

Land, Charles E; Bouville, André; Apostoaei, Iulian; Simon, Steven L

2010-08-01

Radioactive fallout from nuclear test detonations during 1946-1958 at Bikini and Enewetak Atolls in the Marshall Islands (MI) exposed populations living elsewhere in the MI archipelago. A comprehensive analysis, presented in seven companion papers, has produced estimates of tissue-specific radiation absorbed dose to MI residents at all historically inhabited atolls from internal (ingested) and external irradiation resulting from exposure to radioactive fallout, by calendar year, and by age of the population at time of exposure. The present report deals, for the first time, with the implications of these doses for cancer risk among exposed members of the MI population. Radiation doses differed by geographic location and year of birth, and radiation-related cancer risk depends upon age at exposure and age at observation for risk. Using dose-response models based on committee reports published by the National Research Council and the National Institutes of Health, we project that, during the lifetimes of members of the MI population potentially exposed to ionizing radiation from weapons test fallout deposited during the testing period (1948-1958) and from residual radioactive sources during the subsequent 12 y (1959-1970), perhaps 1.6% (with 90% uncertainty range 0.4% to 3.4%) of all cancers might be attributable to fallout-related radiation exposures. By sub-population, the projected proportion of cancers attributable to radiation from fallout from all nuclear tests conducted in the Marshall Islands is 55% (28% to 69%) among 82 persons exposed in 1954 on Rongelap and Ailinginae, 10% (2.4% to 22%) for 157 persons exposed on Utrik, and 2.2% (0.5% to 4.8%) and 0.8% (0.2% to 1.8%), respectively, for the much larger populations exposed in mid-latitude locations including Kwajalein and in southern locations including Majuro. By cancer type, point estimates of attributable risk varied, by location, between 12% and 95% for thyroid cancer, between 2% and 78% for leukemia, and between 0.8% and 55% for all cancers combined. The largest projected risks pertain to the Rongelap Island community and the lowest risks pertain to the populations resident on the southern-most atolls. While the projected cancer risks are smaller than those estimated by the National Cancer Institute in a more simplistic analysis conducted in 2004, these estimates of cancer risk are the best available as they are based on the most detailed dose reconstruction to date and comprehensively include populations at all locations and dose contributions from all nuclear tests.

[Application of risk grading and classification for occupational hazards in risk management for a shipbuilding project].

PubMed

Zeng, Wenfeng; Tan, Qiang; Wu, Shihua; Deng, Yingcong; Liu, Lifen; Wang, Zhi; Liu, Yimin

2015-12-01

To investigate the application of risk grading and classification for occupational hazards in risk management for a shipbuilding project. The risk management for this shipbuilding project was performed by a comprehensive application of MES evaluation, quality assessment of occupational health management, and risk grading and classification for occupational hazards, through the methods of occupational health survey, occupational health testing, and occupational health examinations. The results of MES evaluation showed that the risk of occupational hazards in this project was grade 3, which was considered as significant risk; Q value calculated by quality assessment of occupational health management was 0.52, which was considered to be unqualified; the comprehensive evaluation with these two methods showed that the integrated risk rating for this shipbuilding project was class D, and follow- up and rectification were needed with a focus on the improvement in health management. The application of MES evaluation and quality assessment of occupational health management in risk management for occupational hazards can achieve objective and reasonable conclusions and has good applicability.

Aqueous solubility calculation for petroleum mixtures in soil using comprehensive two-dimensional gas chromatography analysis data.

PubMed

Mao, Debin; Lookman, Richard; Van De Weghe, Hendrik; Vanermen, Guido; De Brucker, Nicole; Diels, Ludo

2009-04-03

An assessment of aqueous solubility (leaching potential) of soil contaminations with petroleum hydrocarbons (TPH) is important in the context of the evaluation of (migration) risks and soil/groundwater remediation. Field measurements using monitoring wells often overestimate real TPH concentrations in case of presence of pure oil in the screened interval of the well. This paper presents a method to calculate TPH equilibrium concentrations in groundwater using soil analysis by high-performance liquid chromatography followed by comprehensive two-dimensional gas chromatography (HPLC-GCXGC). The oil in the soil sample is divided into 79 defined hydrocarbon fractions on two GCXGC color plots. To each of these fractions a representative water solubility is assigned. Overall equilibrium water solubility of the non-aqueous phase liquid (NAPL) present in the sample and the water phase's chemical composition (in terms of the 79 fractions defined) are then calculated using Raoult's law. The calculation method was validated using soil spiked with 13 different TPH mixtures and 1 field-contaminated soil. Measured water solubilities using a column recirculation equilibration experiment agreed well to calculated equilibrium concentrations and water phase TPH composition.

BYMUR software: a free and open source tool for quantifying and visualizing multi-risk analyses

NASA Astrophysics Data System (ADS)

Tonini, Roberto; Selva, Jacopo

2013-04-01

The BYMUR software aims to provide an easy-to-use open source tool for both computing multi-risk and managing/visualizing/comparing all the inputs (e.g. hazard, fragilities and exposure) as well as the corresponding results (e.g. risk curves, risk indexes). For all inputs, a complete management of inter-model epistemic uncertainty is considered. The BYMUR software will be one of the final products provided by the homonymous ByMuR project (http://bymur.bo.ingv.it/) funded by Italian Ministry of Education, Universities and Research (MIUR), focused to (i) provide a quantitative and objective general method for a comprehensive long-term multi-risk analysis in a given area, accounting for inter-model epistemic uncertainty through Bayesian methodologies, and (ii) apply the methodology to seismic, volcanic and tsunami risks in Naples (Italy). More specifically, the BYMUR software will be able to separately account for the probabilistic hazard assessment of different kind of hazardous phenomena, the relative (time-dependent/independent) vulnerabilities and exposure data, and their possible (predefined) interactions: the software will analyze these inputs and will use them to estimate both single- and multi- risk associated to a specific target area. In addition, it will be possible to connect the software to further tools (e.g., a full hazard analysis), allowing a dynamic I/O of results. The use of Python programming language guarantees that the final software will be open source and platform independent. Moreover, thanks to the integration of some most popular and rich-featured Python scientific modules (Numpy, Matplotlib, Scipy) with the wxPython graphical user toolkit, the final tool will be equipped with a comprehensive Graphical User Interface (GUI) able to control and visualize (in the form of tables, maps and/or plots) any stage of the multi-risk analysis. The additional features of importing/exporting data in MySQL databases and/or standard XML formats (for instance, the global standards defined in the frame of GEM project for seismic hazard and risk) will grant the interoperability with other FOSS software and tools and, at the same time, to be on hand of the geo-scientific community. An already available example of connection is represented by the BET_VH(**) tool, which probabilistic volcanic hazard outputs will be used as input for BYMUR. Finally, the prototype version of BYMUR will be used for the case study of the municipality of Naples, by considering three different natural hazards (volcanic eruptions, earthquakes and tsunamis) and by assessing the consequent long-term risk evaluation. (**)BET_VH (Bayesian Event Tree for Volcanic Hazard) is probabilistic tool for long-term volcanic hazard assessment, recently re-designed and adjusted to be run on the Vhub cyber-infrastructure, a free web-based collaborative tool in volcanology research (see http://vhub.org/resources/betvh).

Theory-based approaches to understanding public emergency preparedness: implications for effective health and risk communication.

PubMed

Paek, Hye-Jin; Hilyard, Karen; Freimuth, Vicki; Barge, J Kevin; Mindlin, Michele

2010-06-01

Recent natural and human-caused disasters have awakened public health officials to the importance of emergency preparedness. Guided by health behavior and media effects theories, the analysis of a statewide survey in Georgia reveals that self-efficacy, subjective norm, and emergency news exposure are positively associated with the respondents' possession of emergency items and their stages of emergency preparedness. Practical implications suggest less focus on demographics as the sole predictor of emergency preparedness and more comprehensive measures of preparedness, including both a person's cognitive stage of preparedness and checklists of emergency items on hand. We highlight the utility of theory-based approaches for understanding and predicting public emergency preparedness as a way to enable more effective health and risk communication.

Impact of prognostic factors for postmastectomy radiation therapy of breast cancer patients

NASA Astrophysics Data System (ADS)

Simonov, K. A.; Startseva, Zh. A.; Slonimskaya, E. M.; Velikaya, V. V.

2017-09-01

The study included 196 breast cancer patients with stages T1-3N0-3M0. The comprehensive therapy for breast cancer included surgical operation, chemotherapy, and radiotherapy. Multivariate analysis showed that multifocality growth of tumor (p = 0.004), high grade III (p = 0.008), two metastatic lymph nodes (p = 0.02) were associated with an increased risk of regional node failure in the patients with one to three positive lymph nodes. The prognostic models describing the probability of local recurrences of breast cancer were developed for individualization of the radiation therapy tactics. Postmastectomy radiation therapy in the patients with high-risk breast cancer treated with modified radical mastectomy improves locoregional control, breast cancer-specific survival, does not increase late toxicity.

[What kind of information do German health information pamphlets provide on mammography screening?].

PubMed

Kurzenhäuser, Stephanie

2003-02-01

To make an informed decision on participation in mammography screening, women have to be educated about all the risks and benefits of the procedure in a manner that is detailed and understandable. But an analysis of 27 German health pamphlets on mammography screening shows that many relevant pieces of information about the benefits, the risks, and especially the meaning of screening results are only insufficiently communicated. Many statements were presented narratively rather than as precise statistics. Depending on content, 17 to 62% of the quantifiable statements were actually given as numerical data. To provide comprehensive information and to avoid misunderstandings, it is necessary to supplement the currently available health pamphlets and make the information on mammography screening more precise.

Forecasting lionfish sources and sinks in the Atlantic: are Gulf of Mexico reef fisheries at risk?

NASA Astrophysics Data System (ADS)

Johnston, Matthew W.; Bernard, Andrea M.; Shivji, Mahmood S.

2017-03-01

Invasive lionfish ( Pterois volitans/miles complex) now permeate the entire tropical western Atlantic, Caribbean Sea, and Gulf of Mexico, but lionfish abundance has been measured only in select locations in the field. Despite its rapid range expansion, a comprehensive meta-population analysis of lionfish `sources' and `sinks' and consequentially the invader's potential abundance and impacts on economically important, sympatric reef fishes have not been assessed. These data are urgently needed to spatially direct control efforts and to plan for and perhaps mitigate lionfish-caused damage. Here, we use a biophysical computer model to: (1) forecast larval lionfish sources and sinks that are also delineated as low to high lionfish `density zones' throughout their invaded range, and (2) assess the potential vulnerability of five grouper and snapper species— Epinephelus morio, Mycteroperca microlepis, Epinephelus flavolimbatus, Lutjanus campechanus, and Rhomboplites aurorubens—to lionfish within these density zones in the Gulf of Mexico. Our results suggest that the west Florida shelf and nearshore waters of Texas, USA, and Guyana, South America, function both as lionfish sources and sinks and should be a high priority for targeted lionfish control. Furthermore, of the five groupers and snappers studied, the high fishery value E. morio (red grouper) is the Gulf of Mexico species most at risk from lionfish. Lacking a comprehensive lionfish control policy, these risk exposure data inform managers where removals should be focused and demonstrate the risk to five sympatric native groupers and snappers in the Gulf of Mexico that may be susceptible to dense lionfish aggregations, should control efforts fail.

Mobilizing for change: a case study of a campus and community coalition to reduce high-risk drinking.

PubMed

Linowski, Sally A; DiFulvio, Gloria T

2012-06-01

Campus and community coalitions include a partnership between campus leaders and community stakeholders and can effectively address the environment that may promote high-risk drinking. Despite evidence suggesting that coalitions may be effective vehicles for producing sustainable changes in college drinking, few campuses work within such a structure. The purpose of this study was to examine the effectiveness of a campus and community coalition to implement environmental changes and thereby reduce high-risk drinking and associated consequences. This study utilized a case study method to tell the story of a campus and community coalition (CCC) implemented on a large university campus in the Northeast. The study employed multiple methods including archival document review, review of campus and community level data (i.e. alcohol-related arrests and sanctions) and analysis of student level data. The case study discusses the strategies employed, the environmental changes that occurred and the impact these changes have had on student drinking and consequences. Since implementing the campus and community coalition, the campus has seen an increase in enforcement by campus and local police, changes in community by-laws, and significant reductions in student drinking and consequences. The data provide evidence that a comprehensive approach to reducing high-risk drinking can have an impact on the campus and community environment, which in turn impacts student drinking and associated consequences. The CCC utilized a strategic and comprehensive approach to substance abuse prevention, allowing all participants to have a shared understanding of the challenges and best practices. Implications for research and practice are also discussed.

Clinical evaluation incorporating a personal genome

PubMed Central

Ashley, Euan A.; Butte, Atul J.; Wheeler, Matthew T.; Chen, Rong; Klein, Teri E.; Dewey, Frederick E.; Dudley, Joel T.; Ormond, Kelly E.; Pavlovic, Aleksandra; Hudgins, Louanne; Gong, Li; Hodges, Laura M.; Berlin, Dorit S.; Thorn, Caroline F.; Sangkuhl, Katrin; Hebert, Joan M.; Woon, Mark; Sagreiya, Hersh; Whaley, Ryan; Morgan, Alexander A.; Pushkarev, Dmitry; Neff, Norma F; Knowles, Joshua W.; Chou, Mike; Thakuria, Joseph; Rosenbaum, Abraham; Zaranek, Alexander Wait; Church, George; Greely, Henry T.; Quake, Stephen R.; Altman, Russ B.

2010-01-01

Background The cost of genomic information has fallen steeply but the path to clinical translation of risk estimates for common variants found in genome wide association studies remains unclear. Since the speed and cost of sequencing complete genomes is rapidly declining, more comprehensive means of analyzing these data in concert with rare variants for genetic risk assessment and individualisation of therapy are required. Here, we present the first integrated analysis of a complete human genome in a clinical context. Methods An individual with a family history of vascular disease and early sudden death was evaluated. Clinical assessment included risk prediction for coronary artery disease, screening for causes of sudden cardiac death, and genetic counselling. Genetic analysis included the development of novel methods for the integration of whole genome sequence data including 2.6 million single nucleotide polymorphisms and 752 copy number variations. The algorithm focused on predicting genetic risk of genes associated with known Mendelian disease, recognised drug responses, and pathogenicity for novel variants. In addition, since integration of risk ratios derived from case control studies is challenging, we estimated posterior probabilities from age and sex appropriate prior probability and likelihood ratios derived for each genotype. In addition, we developed a visualisation approach to account for gene-environment interactions and conditionally dependent risks. Findings We found increased genetic risk for myocardial infarction, type II diabetes and certain cancers. Rare variants in LPA are consistent with the family history of coronary artery disease. Pharmacogenomic analysis suggested a positive response to lipid lowering therapy, likely clopidogrel resistance, and a low initial dosing requirement for warfarin. Many variants of uncertain significance were reported. Interpretation Although challenges remain, our results suggest that whole genome sequencing can yield useful and clinically relevant information for individual patients, especially for those with a strong family history of significant disease. PMID:20435227

Dose-response meta-analysis on coffee, tea and caffeine consumption with risk of Parkinson's disease.

PubMed

Qi, Hui; Li, Shixue

2014-04-01

A dose-response meta-analysis was carried out between Parkinson's disease (PD) risk, and coffee, tea and caffeine consumption. A comprehensive search was carried out to identify eligible studies. The fixed or random effect model was used based on heterogeneity test. The dose-response relationship was assessed by restricted cubic spline. A total of 13 articles involving 901 764 participants for coffee, eight articles involving 344 895 participants for tea and seven articles involving 492 724 participants for caffeine were included. A non-linear relationship was found between coffee consumption and PD risk overall, and the strength of protection reached the maximum at approximately 3 cups/day (smoking-adjusted relative risk: 0.72, 95% confidence interval 0.65-0.81). A linear relationship was found between tea and caffeine consumption, and PD risk overall, and the smoking-adjusted risk of PD decreased by 26% and 17% for every two cups/day and 200 mg/day increments, respectively. The association of coffee and tea consumption with PD risk was stronger for men than that for women, and the association of caffeine consumption with PD risk was stronger for ever users of hormones than that for never users of hormones among postmenopausal women. The aforementioned associations were weaker for USA relative to Europe or Asia. A linear dose-relationship for decreased PD risk with tea and caffeine consumption was found, whereas the strength of protection reached a maximum at approximately 3 cups/day for coffee consumption overall. Further studies are required to confirm the findings. © 2013 Japan Geriatrics Society.

A Randomized Control Trial of Working Memory Training with and without Strategy Instruction: Effects on Young Children's Working Memory and Comprehension

ERIC Educational Resources Information Center

Peng, Peng; Fuchs, Douglas

2017-01-01

Researchers are increasingly interested in working memory (WM) training. However, it is unclear whether it strengthens comprehension in young children who are at risk for learning difficulties. We conducted a modest study of whether the training of verbal WM would improve verbal WM and passage listening comprehension and whether training effects…

Categorizing mistaken false positives in regulation of human and environmental health.

PubMed

Hansen, Steffen Foss; Krayer von Krauss, Martin P; Tickner, Joel A

2007-02-01

One of the concerns often voiced by critics of the precautionary principle is that a widespread regulatory application of the principle will lead to a large number of false positives (i.e., over-regulation of minor risks and regulation of nonexisting risks). The present article proposes a general definition of a regulatory false positive, and seeks to identify case studies that can be considered authentic regulatory false positives. Through a comprehensive review of the science policy literature for proclaimed false positives and interviews with authorities on regulation and the precautionary principle we identified 88 cases. Following a detailed analysis of these cases, we found that few of the cases mentioned in the literature can be considered to be authentic false positives. As a result, we have developed a number of different categories for these cases of "mistaken false positives," including: real risks, "The jury is still out," nonregulated proclaimed risks, "Too narrow a definition of risk," and risk-risk tradeoffs. These categories are defined and examples are presented in order to illustrate their key characteristics. On the basis of our analysis, we were able to identify only four cases that could be defined as regulatory false positives in the light of today's knowledge and recognized uncertainty: the Southern Corn Leaf Blight, the Swine Flu, Saccharin, and Food Irradiation in relation to consumer health. We conclude that concerns about false positives do not represent a reasonable argument against future application of the precautionary principle.

Risks and Complications of Coronary Angiography: A Comprehensive Review

PubMed Central

Tavakol, Morteza; Ashraf, Salman; Brener, Sorin J.

2012-01-01

Coronary angiography and heart catheterization are invaluable tests for the detection and quantification of coronary artery disease, identification of valvular and other structural abnormalities, and measurement of hemodynamic parameters. The risks and complications associated with these procedures relate to the patient’s concomitant conditions and to the skill and judgment of the operator. In this review, we examine in detail the major complications associated with invasive cardiac procedures and provide the reader with a comprehensive bibliography for advanced reading. PMID:22980117

A novel scoring system for gastric cancer risk assessment based on the expression of three CLIP4 DNA methylation-associated genes

PubMed Central

Hu, Chenggong; Zhou, Yongfang; Liu, Chang; Kang, Yan

2018-01-01

Gastric cancer (GC) is the fifth most common cancer and the third leading cause of cancer-associated mortality worldwide. In the current study, comprehensive bioinformatic analyses were performed to develop a novel scoring system for GC risk assessment based on CAP-Gly domain containing linker protein family member 4 (CLIP4) DNA methylation status. Two GC datasets with methylation sequencing information and mRNA expression profiling were downloaded from the The Cancer Genome Atlas and Gene Expression Omnibus databases. Differentially expressed genes (DEGs) between the CLIP4 hypermethylation and CLIP4 hypomethylation groups were screened using the limma package in R 3.3.1, and survival analysis of these DEGs was performed using the survival package. A risk scoring system was established via regression factor-weighted gene expression based on linear combination to screen the most important genes associated with CLIP4 methylation and prognosis. Genes associated with high/low-risk value were selected using the limma package. Functional enrichment analysis of the top 500 DEGs that positively and negatively associated with risk values was performed using DAVID 6.8 online and the gene set enrichment analysis (GSEA) software. In total, 35 genes were identified to be that significantly associated with prognosis and CLIP4 DNA methylation, and three prognostic signature genes, claudin-11 (CLDN11), apolipoprotein D (APOD), and chordin like 1 (CHRDL1), were used to establish a risk assessment system. The prognostic scoring system exhibited efficiency in classifying patients with different prognoses, where the low-risk groups had significantly longer overall survival times than those in the high-risk groups. CLDN11, APOD and CHRDL1 exhibited reduced expression in the hypermethylation and low-risk groups compare with the hypomethylation and high-risk groups, respectively. Multivariate Cox analysis indicated that risk value could be used as an independent prognostic factor. In functional analysis, six functional gene ontology terms and five GSEA pathways were associated with CLDN11, APOD and CHRDL1. The results established the credibility of the scoring system in this study. Additionally, these three genes, which were significantly associated with CLIP4 DNA methylation and GC risk assessment, were identified as potential prognostic biomarkers. PMID:29901187

Gender and risk of depression in Saudi Arabia, a systematic review and meta-analysis

PubMed Central

Alibrahim, Osama A.; Al-Sadat, Nabilla; Elawad, Nagi A. M.

2010-01-01

Depression is one of the leading causes of mortality and morbidity worldwide. In the year 2000 depression accounted for 4.4% of the global disability adjusted life years (DALYs). The Kingdom of Saudi Arabia (KSA) has a population of 28 million people and is one of the countries experiencing demographic transition in its population structure. Improvements in socioeconomic status have been shown to be associated with increased chronic diseases including chronic mental diseases like depression, but still there is no comprehensive review summarizing the various reports currently existing in the literature. Although individual studies within Saudi Arabia have reported prevalence rates and risks, the quality of such studies need to be subjected to rigorous assessment and their findings pooled to give combined weighted evidence that will provide basis for targeted intervention. Pooled risks have the advantage of adjusting inherent variations within sampled populations and therefore providing more reliable estimates even though there are concerns about possible magnification of smaller individual risks. PMID:28299041

Sustainable development and next generation's health: a long-term perspective about the consequences of today's activities for food safety.

PubMed

Frazzoli, Chiara; Petrini, Carlo; Mantovani, Alberto

2009-01-01

Development is defined sustainable when it meets the needs of the present without compromising the ability of future generations to meet their own needs. Pivoting on social, environmental and economic aspects of food chain sustainability, this paper presents the concept of sustainable food safety based on the prevention of risks and burden of poor health for generations to come. Under this respect, the assessment of long-term, transgenerational risks is still hampered by serious scientific uncertainties. Critical issues to the development of a sustainable food safety framework may include: endocrine disrupters as emerging contaminants that specifically target developing organisms; toxicological risks assessment in Countries at the turning point of development; translating knowledge into toxicity indexes to support risk management approaches, such as hazard analysis and critical control points (HACCP); the interplay between chemical hazards and social determinants. Efforts towards the comprehensive knowledge and management of key factors of sustainable food safety appear critical to the effectiveness of the overall sustainability policies.

Measures of societal risk and their potential use in civil aviation.

PubMed

Horn, Mark E T; Fulton, Neale; Westcott, Mark

2008-12-01

This article seeks to clarify the conceptual foundations of measures of societal risk, to investigate how such measures may be used validly in commonly encountered policy contexts, and to explore the application of these measures in the field of civil aviation. The article begins by examining standard measures of societal and individual risk (SR and IR), with attention given to ethical as well as analytical considerations. A comprehensive technical analysis of SR is provided, encompassing scalar risk measures, barrier functions, and a utility-based formulation, and clarifications are offered with respect to the treatment of SR in recent publications. The policy context for SR measures is shown to be critically important, and an extension to a hierarchical setting is developed. The prospects for applying SR to civil aviation are then considered, and some technical and conceptual issues are identified. SR appears to be a useful analytical tool in this context, provided that careful attention is given to these issues.

Prevalence of Metabolic Syndrome according to Sasang Constitutional Medicine in Korean Subjects

PubMed Central

Song, Kwang Hoon; Yu, Sung-Gon; Kim, Jong Yeol

2012-01-01

Metabolic syndrome (MS) is a complex disorder defined by a cluster of abdominal obesity, atherogenic dyslipidemia, hyperglycemia, and hypertension; the condition is recognized as a risk factor for diabetes and cardiovascular disease. This study assessed the effects of the Sasang constitution group (SCG) on the risk of MS in Korean subjects. We have analyzed 1,617 outpatients of Korean oriental medicine hospitals who were classified into three SCGs, So-Yang, So-Eum, and Tae-Eum. Significant differences were noted in the prevalence of MS and the frequencies of all MS risk factors among the three SCGs. The odds ratios for MS as determined via multiple logistic regression analysis were 2.004 for So-Yang and 4.521 for Tae-Eum compared with So-Eum. These results indicate that SCG may function as a significant risk factor of MS; comprehensive knowledge of Sasang constitutional medicine may prove helpful in predicting susceptibility and developing preventive care techniques for MS. PMID:22454673

Prevalence of Metabolic Syndrome according to Sasang Constitutional Medicine in Korean Subjects.

PubMed

Song, Kwang Hoon; Yu, Sung-Gon; Kim, Jong Yeol

2012-01-01

Metabolic syndrome (MS) is a complex disorder defined by a cluster of abdominal obesity, atherogenic dyslipidemia, hyperglycemia, and hypertension; the condition is recognized as a risk factor for diabetes and cardiovascular disease. This study assessed the effects of the Sasang constitution group (SCG) on the risk of MS in Korean subjects. We have analyzed 1,617 outpatients of Korean oriental medicine hospitals who were classified into three SCGs, So-Yang, So-Eum, and Tae-Eum. Significant differences were noted in the prevalence of MS and the frequencies of all MS risk factors among the three SCGs. The odds ratios for MS as determined via multiple logistic regression analysis were 2.004 for So-Yang and 4.521 for Tae-Eum compared with So-Eum. These results indicate that SCG may function as a significant risk factor of MS; comprehensive knowledge of Sasang constitutional medicine may prove helpful in predicting susceptibility and developing preventive care techniques for MS.

Evaluation of a comprehensive employee wellness program at an organization with a consumer-directed health plan.

PubMed

Burton, Wayne N; Chen, Chin-Yu; Li, Xingquan; Schultz, Alyssa B; Kasiarz, David; Edington, Dee W

2014-04-01

Consumer-directed health plans (CDHPs) are popular among employers in the United States. This study examined an employee wellness program and its association with employee health in an organization that recently initiated a CDHP. This retrospective observational analysis compared the health risks, employer-paid health care costs, and short-term disability absences of employees of a large financial services corporation from 2009 to 2010. The two-time health risk appraisal participants had a significant improvement in the percentage of employees in the overall low-risk category. The average annual employer-paid medical and pharmacy costs did not significantly change. For employees who improved their health risk category, there was a commensurate change in costs and absences. In a difficult economic climate, this organization began a health promotion program for employees as well as a new CDHP benefit structure. No short-term reduction in health care usage or overall health status was observed.

Toward a Safety Risk-Based Classification of Unmanned Aircraft

NASA Technical Reports Server (NTRS)

Torres-Pomales, Wilfredo

2016-01-01

There is a trend of growing interest and demand for greater access of unmanned aircraft (UA) to the National Airspace System (NAS) as the ongoing development of UA technology has created the potential for significant economic benefits. However, the lack of a comprehensive and efficient UA regulatory framework has constrained the number and kinds of UA operations that can be performed. This report presents initial results of a study aimed at defining a safety-risk-based UA classification as a plausible basis for a regulatory framework for UA operating in the NAS. Much of the study up to this point has been at a conceptual high level. The report includes a survey of contextual topics, analysis of safety risk considerations, and initial recommendations for a risk-based approach to safe UA operations in the NAS. The next phase of the study will develop and leverage deeper clarity and insight into practical engineering and regulatory considerations for ensuring that UA operations have an acceptable level of safety.

Gender and risk of depression in Saudi Arabia, a systematic review and meta-analysis.

PubMed

Alibrahim, Osama A; Al-Sadat, Nabilla; Elawad, Nagi A M

2010-09-01

Depression is one of the leading causes of mortality and morbidity worldwide. In the year 2000 depression accounted for 4.4% of the global disability adjusted life years (DALYs). The Kingdom of Saudi Arabia (KSA) has a population of 28 million people and is one of the countries experiencing demographic transition in its population structure. Improvements in socioeconomic status have been shown to be associated with increased chronic diseases including chronic mental diseases like depression, but still there is no comprehensive review summarizing the various reports currently existing in the literature. Although individual studies within Saudi Arabia have reported prevalence rates and risks, the quality of such studies need to be subjected to rigorous assessment and their findings pooled to give combined weighted evidence that will provide basis for targeted intervention. Pooled risks have the advantage of adjusting inherent variations within sampled populations and therefore providing more reliable estimates even though there are concerns about possible magnification of smaller individual risks.

An Updated Comprehensive Risk Analysis for Radioisotopes Identified of High Risk to National Security in the Event of a Radiological Dispersion Device Scenario

NASA Astrophysics Data System (ADS)

Robinson, Alexandra R.

An updated global survey of radioisotope production and distribution was completed and subjected to a revised "down-selection methodology" to determine those radioisotopes that should be classified as potential national security risks based on availability and key physical characteristics that could be exploited in a hypothetical radiological dispersion device. The potential at-risk radioisotopes then were used in a modeling software suite known as Turbo FRMAC, developed by Sandia National Laboratories, to characterize plausible contamination maps known as Protective Action Guideline Zone Maps. This software also was used to calculate the whole body dose equivalent for exposed individuals based on various dispersion parameters and scenarios. Derived Response Levels then were determined for each radioisotope using: 1) target doses to members of the public provided by the U.S. EPA, and 2) occupational dose limits provided by the U.S. Nuclear Regulatory Commission. The limiting Derived Response Level for each radioisotope also was determined.

Adolescent stalking and risk of violence✩

PubMed Central

Smith-Darden, Joanne P.; Reidy, Dennis E.; Kernsmith, Poco D.

2018-01-01

Stalking perpetration and the associated risk for violence among adolescents has generally been neglected. In the present study, 1236 youth completed surveys assessing empirically established stalking indicators, threats and aggression toward stalking victims, dating violence, and violent delinquency. Latent Profile Analysis identified 3 latent classes of boys: non-perpetrators (NP), hyper-intimate pursuit (HIP), and comprehensive stalking perpetrators (CSP) and, and 2 classes for girls: NP and HIP. Boys in the CSP class were the most violent youth on nearly all indices with boys in the HIP class demonstrating an intermediate level of violence compared to NP boys. Girls in the HIP class were more violent than NP girls on all indices. These findings suggest stalking in adolescence merits attention by violence prevention experts. In particular, juvenile stalking may signify youth at risk for multiple forms of violence perpetrated against multiple types of victims, not just the object of their infatuation. PMID:27641644

Right-sided infective endocarditis: recent epidemiologic changes

PubMed Central

Yuan, Shi-Min

2014-01-01

Background: Infective endocarditis (IE) has been increasingly reported, however, little is available regarding recent development of right-sided IE. Methods: Right-sided IE was comprehensively analyzed based on recent 5⅓-year literature. Results: Portal of entry, implanted foreign material, and repaired congenital heart defects were the main predisposing risk factors. Vegetation size on the right-sided valves was much smaller than those beyond the valves. Multiple logistic regression analysis revealed that predisposing risk factors, and vegetation size and locations were independent predictive risks of patients’ survival. Conclusions: Changes of right-sided IE in the past 5⅓ years included younger patient age, and increased vegetation size, but still prominent Staphylococcus aureus infections. Complication spectrum has changed into more valve insufficiency, more embolic events, reduced abscess formation, and considerably decreased valve perforations. With effective antibiotic regimens, prognoses of the patients seemed to be better than before. PMID:24482708

Suicidal ideation among Malaysian adolescents.

PubMed

Ahmad, NoorAni; Cheong, Siew Man; Ibrahim, Nurashikin; Rosman, Azriman

2014-09-01

Adolescence is the time of greatest risk for the first onset of suicidal behaviors. This study aimed to identify the risk and protective factors associated with suicidal ideation among Malaysian adolescents. Data from the 2012 Malaysia Global School-based Student Health Survey, a nationwide study using a 2-stage cluster sampling design, were analyzed. The survey used a self-administered validated bilingual questionnaire and the Depression Anxiety and Stress Scale. The prevalence of suicidal ideation was 7.9%. Analysis revealed that suicidal ideation was positively associated with depression, anxiety, stress, substance use, being bullied, and being abused at home, either physically or verbally. In addition, suicidal ideation was significantly higher among females and among the Indians and Chinese. Having close friends and married parents were strongly protective against suicidal ideation. Understanding the risk and protective factors is important in providing comprehensive management for suicidal ideation. © 2014 APJPH.

Comprehensive care improves health outcomes among elderly Taiwanese patients with hip fracture.

PubMed

Shyu, Yea-Ing L; Liang, Jersey; Tseng, Ming-Yueh; Li, Hsiao-Juan; Wu, Chi-Chuan; Cheng, Huey-Shinn; Yang, Ching-Tzu; Chou, Shih-Wei; Chen, Ching-Yen

2013-02-01

Few studies have investigated the effects of care models that combine interdisciplinary care with nutrition consultation, depression management, and fall prevention in older persons with hip fracture. The purpose of this study was to compare the effects of a comprehensive care program with those of interdisciplinary care and usual care for elderly patients with hip fracture. A randomized experimental trial was used to explore outcomes for 299 elderly patients with hip fracture receiving three treatment care models: interdisciplinary care (n = 101), comprehensive care (n = 99), and usual care (n = 99). Interdisciplinary care included geriatric consultation, continuous rehabilitation, and discharge planning with post-hospital services. Comprehensive care consisted of interdisciplinary care plus nutrition consultation, depression management, and fall prevention. Usual care included only in-hospital rehabilitation without geriatric consultation, in-home rehabilitation, and home environmental assessment. Participants in the comprehensive care group had better self-care ability (odds ratio, OR = 3.19, p < .01) and less risk of depression (OR = 0.48, p < .01) than those who received usual care. The comprehensive care group had less risk of depression (OR = 0.51, p < .05) and of malnutrition (OR = 0.48, p < .05) than the interdisciplinary care group during the first year following discharge. Older persons with hip fracture benefitted more from the comprehensive care program than from interdisciplinary care and usual care. Older persons with hip fracture benefitted more from comprehensive care including interdisciplinary care and nutrition consultation, depression management, and fall prevention than simply interdisciplinary care.

Towards a comprehensive assessment and framework for low and high flow water risks

NASA Astrophysics Data System (ADS)

Motschmann, Alina; Huggel, Christian; Drenkhan, Fabian; León, Christian

2017-04-01

Driven by international organizations such as the Intergovernmental Panel on Climate Change (IPCC) the past years have seen a move from a vulnerability concept of climate change impacts towards a risk framework. Risk is now conceived at the intersection of climate-driven hazard and socioeconomic-driven vulnerability and exposure. The concept of risk so far has been mainly adopted for sudden-onset events. However, for slow-onset and cumulative climate change impacts such as changing water resources there is missing clarity and experience how to apply a risk framework. Research has hardly dealt with the challenge of how to integrate both low and high flow risks in a common framework. Comprehensive analyses of risks related to water resources considering climate change within multi-dimensional drivers across different scales are complex and often missing in climate-sensitive mountain regions where data scarcity and inconsistencies represent important limitations. Here we review existing vulnerability and risk assessments of low and high flow water conditions and identify critical conceptual and practical gaps. Based on this, we develop an integrated framework for low and high flow water risks which is applicable to both past and future conditions. The framework explicitly considers a water balance model simulating both water supply and demand on a daily basis. We test and apply this new framework in the highly glacierized Santa River catchment (SRC, Cordillera Blanca, Peru), representative for many developing mountain regions with both low and high flow water risks and poor data availability. In fact, in the SRC, both low and high flow hazards, such as droughts and floods, play a central role especially for agricultural, hydropower, domestic and mining use. During the dry season (austral winter) people are increasingly affected by water scarcity due to shrinking glaciers supplying melt water. On the other hand during the wet season (austral summer) high flow water risks are associated with hazards such as floods and debris flows and high socioeconomic vulnerability and exposure of e. g. infrastructure. Nonetheless, comprehensive water resource risk studies have barely been developed in the SRC and other developing high-mountain regions. To consider all components of risks as well as the economic and social conditions for different processes, a comprehensive risk assessment is needed. The urgency of this matter is emphasized by recent social conflicts in the SRC and the tropical Andes in general, related to prevailing drought conditions in combination with weak state institutions and unequal decision-making as well as differentiated perspectives on low flow versus high flow risks.

Managing Risk Assessment in Science Departments.

ERIC Educational Resources Information Center

Forlin, Peter; Forlin, Chris

1997-01-01

Describes a health-and-safety risk-management audit in four Queensland, Australia high schools. One major outcome of this research project is the development of a comprehensive risk-management policy in compliance with the law. Other outcomes include the preparation of a professional-development package in risk-management policy for use as a…

Framework for Assessing Health Risk of Environmental Exposure to Children (External Review Draft)

EPA Science Inventory

The draft document, Framework For Assessing Health Risks of Environmental Exposure to Children, can serve as a resource on children's health risk assessment and it addresses the need to provide a comprehensive and consistent framework for considering children in risk asses...

Where do uncertainties reside within environmental risk assessments? Expert opinion on uncertainty distributions for pesticide risks to surface water organisms.

PubMed

Skinner, Daniel J C; Rocks, Sophie A; Pollard, Simon J T

2016-12-01

A reliable characterisation of uncertainties can aid uncertainty identification during environmental risk assessments (ERAs). However, typologies can be implemented inconsistently, causing uncertainties to go unidentified. We present an approach based on nine structured elicitations, in which subject-matter experts, for pesticide risks to surface water organisms, validate and assess three dimensions of uncertainty: its level (the severity of uncertainty, ranging from determinism to ignorance); nature (whether the uncertainty is epistemic or aleatory); and location (the data source or area in which the uncertainty arises). Risk characterisation contains the highest median levels of uncertainty, associated with estimating, aggregating and evaluating the magnitude of risks. Regarding the locations in which uncertainty is manifest, data uncertainty is dominant in problem formulation, exposure assessment and effects assessment. The comprehensive description of uncertainty described will enable risk analysts to prioritise the required phases, groups of tasks, or individual tasks within a risk analysis according to the highest levels of uncertainty, the potential for uncertainty to be reduced or quantified, or the types of location-based uncertainty, thus aiding uncertainty prioritisation during environmental risk assessments. In turn, it is expected to inform investment in uncertainty reduction or targeted risk management action. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Genetic susceptibility to bone and soft tissue sarcomas: a field synopsis and meta-analysis.

PubMed

Benna, Clara; Simioni, Andrea; Pasquali, Sandro; De Boni, Davide; Rajendran, Senthilkumar; Spiro, Giovanna; Colombo, Chiara; Virgone, Calogero; DuBois, Steven G; Gronchi, Alessandro; Rossi, Carlo Riccardo; Mocellin, Simone

2018-04-06

The genetic architecture of bone and soft tissue sarcomas susceptibility is yet to be elucidated. We aimed to comprehensively collect and meta-analyze the current knowledge on genetic susceptibility in these rare tumors. We conducted a systematic review and meta-analysis of the evidence on the association between DNA variation and risk of developing sarcomas through searching PubMed, The Cochrane Library, Scopus and Web of Science databases. To evaluate result credibility, summary evidence was graded according to the Venice criteria and false positive report probability (FPRP) was calculated to further validate result noteworthiness. Integrative analysis of genetic and eQTL (expression quantitative trait locus) data was coupled with network and pathway analysis to explore the hypothesis that specific cell functions are involved in sarcoma predisposition. We retrieved 90 eligible studies comprising 47,796 subjects (cases: 14,358, 30%) and investigating 1,126 polymorphisms involving 320 distinct genes. Meta-analysis identified 55 single nucleotide polymorphisms (SNPs) significantly associated with disease risk with a high (N=9), moderate (N=38) and low (N=8) level of evidence, findings being classified as noteworthy basically only when the level of evidence was high. The estimated joint population attributable risk for three independent SNPs (rs11599754 of ZNF365/EGR2 , rs231775 of CTLA4 , and rs454006 of PRKCG ) was 37.2%. We also identified 53 SNPs significantly associated with sarcoma risk based on single studies.Pathway analysis enabled us to propose that sarcoma predisposition might be linked especially to germline variation of genes whose products are involved in the function of the DNA repair machinery. We built the first knowledgebase on the evidence linking DNA variation to sarcomas susceptibility, which can be used to generate mechanistic hypotheses and inform future studies in this field of oncology.

Requirements for Next Generation Comprehensive Analysis of Rotorcraft

NASA Technical Reports Server (NTRS)

Johnson, Wayne; Data, Anubhav

2008-01-01

The unique demands of rotorcraft aeromechanics analysis have led to the development of software tools that are described as comprehensive analyses. The next generation of rotorcraft comprehensive analyses will be driven and enabled by the tremendous capabilities of high performance computing, particularly modular and scaleable software executed on multiple cores. Development of a comprehensive analysis based on high performance computing both demands and permits a new analysis architecture. This paper describes a vision of the requirements for this next generation of comprehensive analyses of rotorcraft. The requirements are described and substantiated for what must be included and justification provided for what should be excluded. With this guide, a path to the next generation code can be found.

A method to determine the protection zone of chemical industrial park considering air quality, health risk and environmental risk: a case study.

PubMed

Shi, Jingang; Zhang, Mingbo; Li, Dong; Liu, Jia

2018-04-01

In China, chemical enterprises are required to cluster into a large number of chemical industrial parks (CIPs), which increase risks and threats to the environment and human being's health due to aggregation of the complicated chemical process and huge unit scale. Setting a scientific and reasonable protection zone around CIP is a very efficient way to protect surrounding people's health. A method was designed to determine the comprehensive protection zone of CIP, taking into account multiple factors: air quality, health risk and environmental risk. By establishing a comprehensive and multi-levels index system, the protection zone and the corresponding environmental risk management countermeasures can be proposed hierarchically, which are very important to the development and environmental risk management of CIP. A CIP located in coastal area of Shandong Province was studied, and it is turned out that the method to determine the protection zone of chemical industrial park considering air quality, health risk and environmental risk has great advantages compared with other methods.

The Potential Contribution of Advanced Imaging Techniques to Developmental Neurotoxicity Risk Assessment

EPA Science Inventory

Neuropathologic assessment provides critical data essential to developmental neurotoxicity risk assessment. There are a number of objectives in conducting a neuropathologic assessment to effectively support risk assessment. These include a comprehensive assessment of the adult an...

Negotiating new literacies in science: An examination of at-risk and average-achieving ninth-grade readers' online reading comprehension strategies

NASA Astrophysics Data System (ADS)

Sevensma, Kara

In today's digital world the Internet is becoming an increasingly predominant resource for science information, rapidly eclipsing the traditional science textbook in content area classrooms (Lawless & Schrader, 2008). The shift challenges researchers, educators, administrators, and policy makers to reconsider what it means to read and comprehend online science information. The research on digital literacy is still in its infancy and little is known about the strategies and processes students use when reading science content on the Internet. Even less is known about how at-risk readers comprehend digital science content. Therefore, this study addresses three research questions: (1) What strategies and processes do at-risk and average-achieving readers use as they locate information and generate meaning from science websites? (2) What navigational profiles emerge as at-risk and average-achieving readers construct traversals (unique online paths of information) they locate information and generate meaning from science websites? (3) What individual characteristics influenced students' strategies as they locate information and generate meaning from science websites? Participants were six ninth-grade students in general education biology classrooms. Three were average-achieving readers and three were at-risk readers based on assessments of reading comprehension in traditional print-based texts. The students engaged in a three-day research project about the rainforest biome, locating information online, taking notes, and constructing an information brochure about the rainforest for peers. Data measures prior to and during the research included an Internet use survey, verbal protocols, screen captures of online activity, oral reading fluency assessments, and prior knowledge and topic engagement surveys. Quantitative descriptive and univariate analyses as well as qualitative abductive coding were employed over multiple phases to analyze the data. First, the results suggest that students employed a variety of online reading comprehension strategies in complex and dynamic ways. Among the many strategies revealed, the group of self-regulatory strategies (planning, predicting, monitoring, and evaluating) played a significant role, influencing students' use of all other strategies for locating and generating meaning from science websites. Second, the results also suggested that patterns of strategy use could be examined as unique navigational profiles. Rather than remaining fixed, the navigational profiles of each student altered in response to tasks and research methods. Importantly, all at-risk readers revealed more effective navigational profiles on Day 3 when they were forced by design of the task to attend to project goals and employ more self-regulatory strategies. Third, the results revealed that traditional reading comprehension strategies and prior knowledge of the rainforest also influenced online reading comprehension. Specifically, the at-risk readers with the lowest reading comprehension, oral reading fluency, and prior knowledge scores were more likely than the average-achieving readers to encounter issues in online texts that resulted in constructing ineffective traversals, or online reading paths, and spending significant time investing in online reading that was irrelevant to the research project. Ultimately, this study advanced the understanding about online reading comprehension for average-achieving and at-risk readers in science classrooms, contributing to a gap in the research, suggesting implications for practice, and promoting future research questions.

The risk of collapse in abandoned mine sites: the issue of data uncertainty

NASA Astrophysics Data System (ADS)

Longoni, Laura; Papini, Monica; Brambilla, Davide; Arosio, Diego; Zanzi, Luigi

2016-04-01

Ground collapses over abandoned underground mines constitute a new environmental risk in the world. The high risk associated with subsurface voids, together with lack of knowledge of the geometric and geomechanical features of mining areas, makes abandoned underground mines one of the current challenges for countries with a long mining history. In this study, a stability analysis of Montevecchia marl mine is performed in order to validate a general approach that takes into account the poor local information and the variability of the input data. The collapse risk was evaluated through a numerical approach that, starting with some simplifying assumptions, is able to provide an overview of the collapse probability. The final results is an easy-accessible-transparent summary graph that shows the collapse probability. This approach may be useful for public administrators called upon to manage this environmental risk. The approach tries to simplify this complex problem in order to achieve a roughly risk assessment, but, since it relies on just a small amount of information, any final user should be aware that a comprehensive and detailed risk scenario can be generated only through more exhaustive investigations.

Health-risk behaviors in young adolescents in the child welfare system.

PubMed

Leslie, Laurel K; James, Sigrid; Monn, Amy; Kauten, Milena C; Zhang, Jinjin; Aarons, Gregory

2010-07-01

To examine rates and patterns of health-risk behavior (e.g., sexuality, depression/suicidality, substance use, delinquency) among a national probability sample of youth active to the child welfare/child protective services system. Recent federal legislation, P.L. 110-351, encourages child welfare systems, Medicaid, and pediatric experts to collaborate to ensure youth entering foster care receive comprehensive health examinations. Analysis of baseline caregiver, caseworker, and child interviews, and assessment data for a subsample (n = 993) of youth, aged 11-15 years, from the National Survey of Child and Adolescent Well-Being, a national probability sample of children and adolescents undergoing investigation for abuse or neglect. Almost half of the sample (46.3%) endorsed at least one health-risk behavior. On Poisson multivariate regression modeling, factors related to higher rates of health-risk behaviors included older age, female gender, abuse history, deviant peers, limited caregiver monitoring, and poor school engagement. Given the heightened vulnerability of this population, early screening for health-risk behaviors must be prioritized. Further research should explore specific subpopulations at risk for health-risk behaviors and possible interventions to change these youths' trajectories. Copyright (c) 2010 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Understanding Child Stunting in India: A Comprehensive Analysis of Socio-Economic, Nutritional and Environmental Determinants Using Additive Quantile Regression

PubMed Central

Fenske, Nora; Burns, Jacob; Hothorn, Torsten; Rehfuess, Eva A.

2013-01-01

Background Most attempts to address undernutrition, responsible for one third of global child deaths, have fallen behind expectations. This suggests that the assumptions underlying current modelling and intervention practices should be revisited. Objective We undertook a comprehensive analysis of the determinants of child stunting in India, and explored whether the established focus on linear effects of single risks is appropriate. Design Using cross-sectional data for children aged 0–24 months from the Indian National Family Health Survey for 2005/2006, we populated an evidence-based diagram of immediate, intermediate and underlying determinants of stunting. We modelled linear, non-linear, spatial and age-varying effects of these determinants using additive quantile regression for four quantiles of the Z-score of standardized height-for-age and logistic regression for stunting and severe stunting. Results At least one variable within each of eleven groups of determinants was significantly associated with height-for-age in the 35% Z-score quantile regression. The non-modifiable risk factors child age and sex, and the protective factors household wealth, maternal education and BMI showed the largest effects. Being a twin or multiple birth was associated with dramatically decreased height-for-age. Maternal age, maternal BMI, birth order and number of antenatal visits influenced child stunting in non-linear ways. Findings across the four quantile and two logistic regression models were largely comparable. Conclusions Our analysis confirms the multifactorial nature of child stunting. It emphasizes the need to pursue a systems-based approach and to consider non-linear effects, and suggests that differential effects across the height-for-age distribution do not play a major role. PMID:24223839

Understanding child stunting in India: a comprehensive analysis of socio-economic, nutritional and environmental determinants using additive quantile regression.

PubMed

Fenske, Nora; Burns, Jacob; Hothorn, Torsten; Rehfuess, Eva A

2013-01-01

Most attempts to address undernutrition, responsible for one third of global child deaths, have fallen behind expectations. This suggests that the assumptions underlying current modelling and intervention practices should be revisited. We undertook a comprehensive analysis of the determinants of child stunting in India, and explored whether the established focus on linear effects of single risks is appropriate. Using cross-sectional data for children aged 0-24 months from the Indian National Family Health Survey for 2005/2006, we populated an evidence-based diagram of immediate, intermediate and underlying determinants of stunting. We modelled linear, non-linear, spatial and age-varying effects of these determinants using additive quantile regression for four quantiles of the Z-score of standardized height-for-age and logistic regression for stunting and severe stunting. At least one variable within each of eleven groups of determinants was significantly associated with height-for-age in the 35% Z-score quantile regression. The non-modifiable risk factors child age and sex, and the protective factors household wealth, maternal education and BMI showed the largest effects. Being a twin or multiple birth was associated with dramatically decreased height-for-age. Maternal age, maternal BMI, birth order and number of antenatal visits influenced child stunting in non-linear ways. Findings across the four quantile and two logistic regression models were largely comparable. Our analysis confirms the multifactorial nature of child stunting. It emphasizes the need to pursue a systems-based approach and to consider non-linear effects, and suggests that differential effects across the height-for-age distribution do not play a major role.

A Comprehensive Probabilistic Tsunami Hazard Assessment: Multiple Sources and Short-Term Interactions

NASA Astrophysics Data System (ADS)

Anita, G.; Selva, J.; Laura, S.

2011-12-01

We develop a comprehensive and total probabilistic tsunami hazard assessment (TotPTHA), in which many different possible source types concur to the definition of the total tsunami hazard at given target sites. In a multi-hazard and multi-risk perspective, such an innovative approach allows, in principle, to consider all possible tsunamigenic sources, from seismic events, to slides, asteroids, volcanic eruptions, etc. In this respect, we also formally introduce and discuss the treatment of interaction/cascade effects in the TotPTHA analysis. We demonstrate how external triggering events may induce significant temporary variations in the tsunami hazard. Because of this, such effects should always be considered, at least in short-term applications, to obtain unbiased analyses. Finally, we prove the feasibility of the TotPTHA and of the treatment of interaction/cascade effects by applying this methodology to an ideal region with realistic characteristics (Neverland).

A Comprehensive Analysis of the X-15 Flight 3-65 Accident

NASA Technical Reports Server (NTRS)

Dennehy, Cornelius J.; Orr, Jeb S.; Barshi, Immanuel; Statler, Irving C.

2014-01-01

The November 15, 1967, loss of X-15 Flight 3-65-97 (hereafter referred to as Flight 3-65) was a unique incident in that it was the first and only aerospace flight accident involving loss of crew on a vehicle with an adaptive flight control system (AFCS). In addition, Flight 3-65 remains the only incidence of a single-pilot departure from controlled flight of a manned entry vehicle in a hypersonic flight regime. To mitigate risk to emerging aerospace systems, the NASA Engineering and Safety Center (NESC) proposed a comprehensive review of this accident. The goal of the assessment was to resolve lingering questions regarding the failure modes of the aircraft systems (including the AFCS) and thoroughly analyze the interactions among the human agents and autonomous systems that contributed to the loss of the pilot and aircraft. This document contains the outcome of the accident review.

Assessing and forecasting population health: integrating knowledge and beliefs in a comprehensive framework.

PubMed

Van Meijgaard, Jeroen; Fielding, Jonathan E; Kominski, Gerald F

2009-01-01

A comprehensive population health-forecasting model has the potential to interject new and valuable information about the future health status of the population based on current conditions, socioeconomic and demographic trends, and potential changes in policies and programs. Our Health Forecasting Model uses a continuous-time microsimulation framework to simulate individuals' lifetime histories by using birth, risk exposures, disease incidence, and death rates to mark changes in the state of the individual. The model generates a reference forecast of future health in California, including details on physical activity, obesity, coronary heart disease, all-cause mortality, and medical expenditures. We use the model to answer specific research questions, inform debate on important policy issues in public health, support community advocacy, and provide analysis on the long-term impact of proposed changes in policies and programs, thus informing stakeholders at all levels and supporting decisions that can improve the health of populations.

A comprehensive and efficient process for counseling patients desiring sterilization.

PubMed

Haws, J M; Butta, P G; Girvin, S

1997-06-01

To optimize the time spent counseling a sterilization patient, this article presents a 10-step process that includes all steps necessary to ensure a comprehensive counseling session: (1) Discuss current contraception use and all available methods; (2) assess the client's interest in/readiness for sterilization; (3) emphasize that the procedure is meant to be permanent, but there is a possibility of failure; (4) explain the surgical procedure using visuals, and include a discussion of benefits and risks; (5) explain privately to the client the need to use condoms if engaging in risky sexual activity; (6) have the client read and sign an informed consent form; (7) schedule an appointment for the procedure and provide the patient with a copy of all necessary paperwork; (8) discuss cost and payment method; (9) provide written preoperative and postoperative instructions; and (10) schedule a postoperation visit, or a postoperation semen analysis.

Characteristics of suicide hotspots on the Belgian railway network.

PubMed

Debbaut, Kevin; Krysinska, Karolina; Andriessen, Karl

2014-01-01

In 2004, railway suicide accounted for 5.3% of all suicides in Belgium. In 2008, Infrabel (Manager of the Belgian Railway Infrastructure) introduced a railway suicide prevention programme, including identification of suicide hotspots, i.e., areas of the railway network with an elevated incidence of suicide. The study presents an analysis of 43 suicide hotspots based on Infrabel data collected during field visits and semi-structured interviews conducted in mental health facilities in the vicinity of the hotspots. Three major characteristics of the hotspots were accessibility, anonymity, and vicinity of a mental health institution. The interviews identified several risk and protective factors for railway suicide, including the training of staff, introduction of a suicide prevention policy, and the role of the media. In conclusion, a comprehensive railway suicide prevention programme should continuously safeguard and monitor hotspots, and should be embedded in a comprehensive suicide prevention programme in the community.

The Comprehension Problems of Children with Poor Reading Comprehension despite Adequate Decoding: A Meta-Analysis.

PubMed

Spencer, Mercedes; Wagner, Richard K

2018-06-01

The purpose of this meta-analysis was to examine the comprehension problems of children who have a specific reading comprehension deficit (SCD), which is characterized by poor reading comprehension despite adequate decoding. The meta-analysis included 86 studies of children with SCD who were assessed in reading comprehension and oral language (vocabulary, listening comprehension, storytelling ability, and semantic and syntactic knowledge). Results indicated that children with SCD had deficits in oral language ( d = -0.78, 95% CI [-0.89, -0.68], but these deficits were not as severe as their deficit in reading comprehension ( d = -2.78, 95% CI [-3.01, -2.54]). When compared to reading comprehension age-matched normal readers, the oral language skills of the two groups were comparable ( d = 0.32, 95% CI [-0.49, 1.14]), which suggests that the oral language weaknesses of children with SCD represent a developmental delay rather than developmental deviance. Theoretical and practical implications of these findings are discussed.

Improving comprehension and recall of information for an HIV vaccine trial among women at risk for HIV: reading level simplification and inclusion of pictures to illustrate key concepts.

PubMed

Murphy, D A; O'Keefe, Z H; Kaufman, A H

1999-10-01

A simplified version of the prototype HIV vaccine material was developed through (a) reducing reading grade level, (b) restructuring of the organization and categorization of the material, (c) adding pictures designed to emphasize key concepts, and (d) obtaining feedback on the simplified version through focus groups with the target population. Low-income women at risk for HIV (N = 141) recruited from a primary care clinic were randomly assigned to be presented the standard or the simplified version. There were no significant differences between the groups in terms of education or Vocabulary, Block Design, and Passage Comprehension scores. Women who received the simplified version had significantly higher comprehension scores immediately following presentation of the material than did women who received the standard version and were also significantly more likely to recall study benefits and risks. These findings were maintained at 3-month follow-up. Implications for informed consent are discussed.

The Foundations of Literacy Development in Children at Familial Risk of Dyslexia.

PubMed

Hulme, Charles; Nash, Hannah M; Gooch, Debbie; Lervåg, Arne; Snowling, Margaret J

2015-12-01

The development of reading skills is underpinned by oral language abilities: Phonological skills appear to have a causal influence on the development of early word-level literacy skills, and reading-comprehension ability depends, in addition to word-level literacy skills, on broader (semantic and syntactic) language skills. Here, we report a longitudinal study of children at familial risk of dyslexia, children with preschool language difficulties, and typically developing control children. Preschool measures of oral language predicted phoneme awareness and grapheme-phoneme knowledge just before school entry, which in turn predicted word-level literacy skills shortly after school entry. Reading comprehension at 8½ years was predicted by word-level literacy skills at 5½ years and by language skills at 3½ years. These patterns of predictive relationships were similar in both typically developing children and those at risk of literacy difficulties. Our findings underline the importance of oral language skills for the development of both word-level literacy and reading comprehension. © The Author(s) 2015.

MTHFR genetic polymorphisms may contribute to the risk of chronic myelogenous leukemia in adults: a meta-analysis of 12 genetic association studies.

PubMed

Li, Bin; Zhang, Jian; Wang, Lei; Li, Yan; Jin, Juping; Ai, Limei; Li, Chong; Li, Zhe; Mao, Shudan

2014-05-01

Chronic myelogenous leukemia (CML) is a complex disease with a genetic basis. The genetic association studies (GASs) that have investigated the association between adult CML and 5,10-methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms have produced contradictory and inconclusive results. The aim of this meta-analysis is to provide a relatively comprehensive assessment of the association of these polymorphisms with adult CML risk. A literature search for eligible GAS published before September 15, 2013 was conducted in PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases. Pooled odds ratios (ORs) with their corresponding 95% confidence intervals (95% CIs) were used to evaluate the strength of the association under a fixed or random effect model according to heterogeneity test results. All analyses were performed using the Stata software, version 12.0. Twelve case-control studies were included in this meta-analysis with a total of 932 CML patients and 3,465 healthy controls. For MTHFR C677T (dbSNP: rs1801133, C>T), though the pooled ORs were not significant in the overall population, all the ORs greater than 1 suggested an increased risk of CML for carriers of the risk allele. However, stratified analysis based on genotyping method revealed a significant association in the PCR-restriction fragment length polymorphism (RFLP) subgroup, possibly as a result of heterogeneity. For MTHFR A1298C (dbSNP: rs1801131, A>C), the combined results showed that carriers of the C allele may be associated with a decreased risk of adult CML. Stratified analysis showed that the magnitude of this effect was especially significant among Asians, indicating ethnicity differences in adult CML susceptibility. This meta-analysis shows that the C allele of MTHFR A1298C may be associated with a decreased risk in adult CML, especially among Asians, while MTHFR C677T may not be associated with adult CML risk. However, the development of adult CML may be the result of gene-gene and gene-environment interactions, which should be considered in future individual GAS and subsequent meta-analyses.

Residual disease at the bronchial stump is positively associated with the risk of bronchoplerual fistula in patients undergoing lung cancer surgery: a meta-analysis

PubMed Central

Li, Shuangjiang; Fan, Jun; Zhou, Jian; Ren, Yutao; Shen, Cheng; Che, Guowei

2016-01-01

OBJECTIVES Residual disease at the bronchial stump (RDBS) is regarded as an important factor possibly resulting in bronchopleural fistula (BPF) after lung cancer surgery, but this has not been confirmed. We conducted this meta-analysis to evaluate the effects of RDBS on BPF formation in patients undergoing lung cancer surgery. METHODS PubMed and EMBASE databases were searched for full-text articles that met our eligibility criteria. Odds ratios (ORs) with 95% confidence interval (95% CI) served as the summarized outcomes. Q-test and I2 statistic were used to evaluate the level of heterogeneity, determining the fixed-effect model or random-effect model for quantitative synthesis. Sensitivity analysis was conducted to identify the possible origins of heterogeneity. The publication bias was assessed by Begg's test. RESULTS A total of eight retrospective observational studies were included in our meta-analysis. In overall analysis, the pooled outcomes indicated that RDBS was significantly associated with BPF formation after lung cancer surgery (OR: 3.12; 95% CI: 1.72–5.64; P < 0.001). In subgroup analysis, the pooled outcomes revealed a significantly increased risk of post-pneumonectomy BPF in patients with RDBS (OR: 2.78; 95% CI: 1.06–7.28; P = 0.037). The subgroup analysis assessing the effects of RDBS on post-lobectomy BPF was given up due to the scarcity of available data. No heterogeneity was revealed within this meta-analysis. No evidence for publication bias was detected by Begg's test. CONCLUSIONS Our meta-analysis indicates that RDBS is positively associated with the increased risk of BPF in patients undergoing lung cancer surgery. The further analysis also reveals an increased risk of post-pneumonectomy BPF in patients with RDBS. More accurate and comprehensive evidence should be collected and summarized in updated meta-analyses. PMID:26614527

Developing and Implementing the Data Mining Algorithms in RAVEN

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

Sen, Ramazan Sonat; Maljovec, Daniel Patrick; Alfonsi, Andrea

The RAVEN code is becoming a comprehensive tool to perform probabilistic risk assessment, uncertainty quantification, and verification and validation. The RAVEN code is being developed to support many programs and to provide a set of methodologies and algorithms for advanced analysis. Scientific computer codes can generate enormous amounts of data. To post-process and analyze such data might, in some cases, take longer than the initial software runtime. Data mining algorithms/methods help in recognizing and understanding patterns in the data, and thus discover knowledge in databases. The methodologies used in the dynamic probabilistic risk assessment or in uncertainty and error quantificationmore » analysis couple system/physics codes with simulation controller codes, such as RAVEN. RAVEN introduces both deterministic and stochastic elements into the simulation while the system/physics code model the dynamics deterministically. A typical analysis is performed by sampling values of a set of parameter values. A major challenge in using dynamic probabilistic risk assessment or uncertainty and error quantification analysis for a complex system is to analyze the large number of scenarios generated. Data mining techniques are typically used to better organize and understand data, i.e. recognizing patterns in the data. This report focuses on development and implementation of Application Programming Interfaces (APIs) for different data mining algorithms, and the application of these algorithms to different databases.« less

Increased incidence of head and neck cancer in liver transplant recipients: a meta-analysis.

PubMed

Liu, Qian; Yan, Lifeng; Xu, Cheng; Gu, Aihua; Zhao, Peng; Jiang, Zhao-Yan

2014-10-22

It is unclear whether liver transplantation is associated with an increased incidence of post-transplant head and neck cancer. This comprehensive meta-analysis evaluated the association between liver transplantation and the risk of head and neck cancer using data from all available studies. PubMed and Web of Science were systematically searched to identify all relevant publications up to March 2014. Standardized incidence ratio (SIR) and 95% confidence intervals (CIs) for risk of head and neck cancer in liver transplant recipients were calculated. Tests for heterogeneity, sensitivity, and publishing bias were also performed. Of the 964 identified articles, 10 were deemed eligible. These studies included data on 56,507 patients with a total follow-up of 129,448.9 patient-years. SIR for head and neck cancer was 3.836-fold higher (95% CI 2.754-4.918, P = 0.000) in liver transplant recipients than in the general population. No heterogeneity or publication bias was observed. Sensitivity analysis indicated that omission of any of the studies resulted in an SIR for head and neck cancer between 3.488 (95% CI: 2.379-4.598) and 4.306 (95% CI: 3.020-5.592). Liver transplant recipients are at higher risk of developing head and neck cancer than the general population.

An Exploration of Instructional Practices That Foster Language Development and Comprehension: Evidence from Prekindergarten through Grade 3 in Title I Schools. NCEE 2017-4024

ERIC Educational Resources Information Center

Chiang, Hanley; Walsh, Elias; Shanahan, Timothy; Gentile, Claudia; Maccarone, Alyssa; Waits, Tiffany; Carlson, Barbara; Rikoon, Samuel

2017-01-01

Reading comprehension--the ability to understand the meaning of text--is a foundational ability that enables children to learn in school and throughout life. Children who struggle with reading comprehension in the third or fourth grade are at high risk for dropping out of school, with detrimental effects on their future employment, income, and…