Sample records for continuous risk management
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Continuous Risk Management Course. Revised
NASA Technical Reports Server (NTRS)
Hammer, Theodore F.
1999-01-01
This document includes a course plan for Continuous Risk Management taught by the Software Assurance Technology Center along with the Continuous Risk Management Guidebook of the Software Engineering Institute of Carnegie Mellon University and a description of Continuous Risk Management at NASA.
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Risk Management Implementation Tool
NASA Technical Reports Server (NTRS)
Wright, Shayla L.
2004-01-01
Continuous Risk Management (CM) is a software engineering practice with processes, methods, and tools for managing risk in a project. It provides a controlled environment for practical decision making, in order to assess continually what could go wrong, determine which risk are important to deal with, implement strategies to deal with those risk and assure the measure effectiveness of the implemented strategies. Continuous Risk Management provides many training workshops and courses to teach the staff how to implement risk management to their various experiments and projects. The steps of the CRM process are identification, analysis, planning, tracking, and control. These steps and the various methods and tools that go along with them, identification, and dealing with risk is clear-cut. The office that I worked in was the Risk Management Office (RMO). The RMO at NASA works hard to uphold NASA s mission of exploration and advancement of scientific knowledge and technology by defining and reducing program risk. The RMO is one of the divisions that fall under the Safety and Assurance Directorate (SAAD). I worked under Cynthia Calhoun, Flight Software Systems Engineer. My task was to develop a help screen for the Continuous Risk Management Implementation Tool (RMIT). The Risk Management Implementation Tool will be used by many NASA managers to identify, analyze, track, control, and communicate risks in their programs and projects. The RMIT will provide a means for NASA to continuously assess risks. The goals and purposes for this tool is to provide a simple means to manage risks, be used by program and project managers throughout NASA for managing risk, and to take an aggressive approach to advertise and advocate the use of RMIT at each NASA center.
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-04-20
... Administration: Continuation of FHA Reform; Strengthening Risk Management Through Responsible FHA-Approved...) that are designed to strengthen FHA by improving its management of risk. This final rule increases the... designed to enhance FHA's risk management functions. The announcement preceded completion of an independent...
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Continuous Risk Management: An Overview
NASA Technical Reports Server (NTRS)
Rosenberg, Linda; Hammer, Theodore F.
1999-01-01
Software risk management is important because it helps avoid disasters, rework, and overkill, but more importantly because it stimulates win-win situations. The objectives of software risk management are to identify, address, and eliminate software risk items before they become threats to success or major sources of rework. In general, good project managers are also good managers of risk. It makes good business sense for all software development projects to incorporate risk management as part of project management. The Software Assurance Technology Center (SATC) at NASA GSFC has been tasked with the responsibility for developing and teaching a systems level course for risk management that provides information on how to implement risk management. The course was developed in conjunction with the Software Engineering Institute at Carnegie Mellon University, then tailored to the NASA systems community. This is an introductory tutorial to continuous risk management based on this course. The rational for continuous risk management and how it is incorporated into project management are discussed. The risk management structure of six functions is discussed in sufficient depth for managers to understand what is involved in risk management and how it is implemented. These functions include: (1) Identify the risks in a specific format; (2) Analyze the risk probability, impact/severity, and timeframe; (3) Plan the approach; (4) Track the risk through data compilation and analysis; (5) Control and monitor the risk; (6) Communicate and document the process and decisions.
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NASA Technical Reports Server (NTRS)
Raftery, Michael; Carter-Journet, Katrina
2013-01-01
The International Space Station (ISS) risk management methodology is an example of a mature and sustainable process. Risk management is a systematic approach used to proactively identify, analyze, plan, track, control, communicate, and document risks to help management make risk-informed decisions that increase the likelihood of achieving program objectives. The ISS has been operating in space for over 14 years and permanently crewed for over 12 years. It is the longest surviving habitable vehicle in low Earth orbit history. Without a mature and proven risk management plan, it would be increasingly difficult to achieve mission success throughout the life of the ISS Program. A successful risk management process must be able to adapt to a dynamic program. As ISS program-level decision processes have evolved, so too has the ISS risk management process continued to innovate, improve, and adapt. Constant adaptation of risk management tools and an ever-improving process is essential to the continued success of the ISS Program. Above all, sustained support from program management is vital to risk management continued effectiveness. Risk management is valued and stressed as an important process by the ISS Program.
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-05-04
...-AI81 Federal Housing Administration: Continuation of FHA Reform-- Strengthening Risk Management Through... Federal Housing Administration (FHA) that are designed to strengthen FHA by improving its management of risk. Although the preamble to the final rule correctly provides that the revised net worth...
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Application of Risk Assessment Tools in the Continuous Risk Management (CRM) Process
NASA Technical Reports Server (NTRS)
Ray, Paul S.
2002-01-01
Marshall Space Flight Center (MSFC) of the National Aeronautics and Space Administration (NASA) is currently implementing the Continuous Risk Management (CRM) Program developed by the Carnegie Mellon University and recommended by NASA as the Risk Management (RM) implementation approach. The four most frequently used risk assessment tools in the center are: (a) Failure Modes and Effects Analysis (FMEA), Hazard Analysis (HA), Fault Tree Analysis (FTA), and Probabilistic Risk Analysis (PRA). There are some guidelines for selecting the type of risk assessment tools during the project formulation phase of a project, but there is not enough guidance as to how to apply these tools in the Continuous Risk Management process (CRM). But the ways the safety and risk assessment tools are used make a significant difference in the effectiveness in the risk management function. Decisions regarding, what events are to be included in the analysis, to what level of details should the analysis be continued, make significant difference in the effectiveness of risk management program. Tools of risk analysis also depends on the phase of a project e.g. at the initial phase of a project, when not much data are available on hardware, standard FMEA cannot be applied; instead a functional FMEA may be appropriate. This study attempted to provide some directives to alleviate the difficulty in applying FTA, PRA, and FMEA in the CRM process. Hazard Analysis was not included in the scope of the study due to the short duration of the summer research project.
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Blos, Mauricio F; Wee, Hui-Ming; Yang, Joshua
2010-11-01
Innovation challenges for handling supply chain risks have become one of the most important drivers in business competitiveness and differentiation. This study analyses competitiveness at the external supply chain level as a driver of risks and provides a framework for mitigating these risks. The mitigation framework, also called the supply chain continuity framework, provides insight into six stages of the business continuity planning (BCP) process life cycle (risk mitigation management, business impact analysis, supply continuity strategy development, supply continuity plan development, supply continuity plan testing and supply continuity plan maintenance), together with the operational constructs: customer service, inventory management, flexibility, time to market, ordering cycle time and quality. The purpose of the BCP process life cycle and operational constructs working together is to emphasise the way in which a supply chain can deal with disruption risks and, consequently, bring competitive advantage. Future research will consider the new risk scenarios and analyse the consequences to promote the improvement of supply chain resilience.
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Demonstrating PQS Effectiveness and Driving Continual Improvement: Evidence-Based Risk Reduction.
Ramnarine, Emma; O'Donnell, Kevin
2018-04-18
Product knowledge grows and evolves during the life of a product. In order to maintain a state of control and deliver product with consistent quality throughout its commercial life, continuous improvement and product lifecycle management become essential. The practical link between product and process knowledge, risk-based control strategies, and continual improvement and innovation can be made stronger through evidence-based risk reduction. Regulatory relief and flexibility in post approval change management and overall product lifecycle management will only be possible with effective application of science and risk-based concepts and demonstrated effectiveness of the PQS in assuring a state of control. Copyright © 2018, Parenteral Drug Association.
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Business continuity and risk management at a strategic level: Case study of the Flemish government.
Bouve, Joris; Steens, Herman-Peter; Ruebens, Martin
2018-01-01
The Flemish government comprises a number of different departments and agencies with the autonomy to optimise their service level in a proactive and resilient manner. Recently, the Flemish government defined four organisational values: openness, decisiveness, trust and agility. In addition, the Internal Audit Agency developed guidelines concerning internal control and organisational management, in which risk management was emphasised. In combination with goal setting and process management, this paper considers risk management as a starting point for the overall management of Flemish government entities. The paper then develops tools to support the establishment of business continuity and risk management processes. These tools fit into the organisation's strategic framework and are easy to understand, pragmatically designed and flexible in their use. The paper goes on to illustrate how the Department of the Chancellery and Public Governance is implementing BCM and risk management, and how it is integrating BCM, risk management and crisis management. It will then focus on the Flemish government's long-term strategy across the boundaries between the different entities and the question of how risk management can become a useful tool for policy makers.
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Vande Putte, Danny; Verhelst, Marc
Risk management has never been easy. Finding efficient mitigating measures is not always straightforward. Finding measures for cyber crime, however, is a really huge challenge because cyber threats are changing all the time. As the sophistication of these threats is growing, their impact increases. Moreover, society and its economy have become increasingly dependent on information and communication technologies. Standard risk analysis methodologies will help to score the cyber risk and to place it in the risk tolerance matrix. This will allow business continuity managers to figure out if there is still a gap with the maximum tolerable outage for time-critical business processes and if extra business continuity measures are necessary to fill the gap.
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IT Operational Risk Measurement Model Based on Internal Loss Data of Banks
NASA Astrophysics Data System (ADS)
Hao, Xiaoling
Business operation of banks relies increasingly on information technology (IT) and the most important role of IT is to guarantee the operational continuity of business process. Therefore, IT Risk management efforts need to be seen from the perspective of operational continuity. Traditional IT risk studies focused on IT asset-based risk analysis and risk-matrix based qualitative risk evaluation. In practice, IT risk management practices of banking industry are still limited to the IT department and aren't integrated into business risk management, which causes the two departments to work in isolation. This paper presents an improved methodology for dealing with IT operational risk. It adopts quantitative measurement method, based on the internal business loss data about IT events, and uses Monte Carlo simulation to predict the potential losses. We establish the correlation between the IT resources and business processes to make sure risk management of IT and business can work synergistically.
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Healthcare system resiliency: The case for taking disaster plans further - Part 2.
Hiller, Michael; Bone, Eric A; Timmins, Michael L
2015-01-01
For the most part, top management is aware of the costs of healthcare downtime. They recognise that minimising downtime while fulfilling risk management standards, namely, 'duty of care' and 'standard of care', are among the most difficult challenges they face, especially when coupled with the increasing pressure for continued service availability with the frequency of incidents. Through continuous operational availability and greater resiliency demands a new, combined approach has emerged, which necessitates that the disciplines of: (1) enterprise risk management; (2) emergency response planning; (3) business continuity management including IT disaster recovery; (4) crisis communications be addressed with strategies and techniques designed and integrated into a singular, seamless approach. It is no longer feasible to separate these disciplines. By integrating them as the gateway for service continuity, the organisation can enhance its ability to run as a business by helping to identify risks and prepare for change, prioritise work efforts, flag problems and pinpoint important areas that underpin the overarching business continuity processes. The driver of change in staying ahead of the risk curve, and the entry point of a true resiliency strategy, begins with identifying the synergies of the aforementioned disciplines and integrating each of them to jointly contribute to service continuance.
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Optimizing Security of Cloud Computing within the DoD
2010-12-01
information security governance and risk management; application security; cryptography; security architecture and design; operations security; business ...governance and risk management; application security; cryptography; security architecture and design; operations security; business continuity...20 7. Operational Security (OPSEC).........................................................20 8. Business Continuity Planning (BCP) and Disaster
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Development and implementation of a business continuity management risk index.
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.
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Risk Management for the International Space Station
NASA Technical Reports Server (NTRS)
Sebastian, J.; Brezovic, Philip
2002-01-01
The International Space Station (ISS) is an extremely complex system, both technically and programmatically. The Space Station must support a wide range of payloads and missions. It must be launched in numerous launch packages and be safely assembled and operated in the harsh environment of space. It is being designed and manufactured by many organizations, including the prime contractor, Boeing, the NASA institutions, and international partners and their contractors. Finally, the ISS has multiple customers, (e.g., the Administration, Congress, users, public, international partners, etc.) with contrasting needs and constraints. It is the ISS Risk Management Office strategy to proactively and systematically manages risks to help ensure ISS Program success. ISS program follows integrated risk management process (both quantitative and qualitative) and is integrated into ISS project management. The process and tools are simple and seamless and permeate to the lowest levels (at a level where effective management can be realized) and follows the continuous risk management methodology. The risk process assesses continually what could go wrong (risks), determine which risks need to be managed, implement strategies to deal with those risks, and measure effectiveness of the implemented strategies. The process integrates all facets of risk including cost, schedule and technical aspects. Support analysis risk tools like PRA are used to support programatic decisions and assist in analyzing risks.
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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.
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Risk Management for Human Support Technology Development
NASA Technical Reports Server (NTRS)
jones, Harry
2005-01-01
NASA requires continuous risk management for all programs and projects. The risk management process identifies risks, analyzes their impact, prioritizes them, develops and carries out plans to mitigate or accept them, tracks risks and mitigation plans, and communicates and documents risk information. Project risk management is driven by the project goal and is performed by the entire team. Risk management begins early in the formulation phase with initial risk identification and development of a risk management plan and continues throughout the project life cycle. This paper describes the risk management approach that is suggested for use in NASA's Human Support Technology Development. The first step in risk management is to identify the detailed technical and programmatic risks specific to a project. Each individual risk should be described in detail. The identified risks are summarized in a complete risk list. Risk analysis provides estimates of the likelihood and the qualitative impact of a risk. The likelihood and impact of the risk are used to define its priority location in the risk matrix. The approaches for responding to risk are either to mitigate it by eliminating or reducing the effect or likelihood of a risk, to accept it with a documented rationale and contingency plan, or to research or monitor the risk, The Human Support Technology Development program includes many projects with independently achievable goals. Each project must do independent risk management, considering all its risks together and trading them against performance, budget, and schedule. Since the program can succeed even if some projects fail, the program risk has a complex dependence on the individual project risks.
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Improving Our Odds: Success through Continuous Risk Management
NASA Technical Reports Server (NTRS)
Greenhalgh, Phillip O.
2009-01-01
Launching a rocket, running a business, driving to work and even day-to-day living all involve some degree of risk. Risk is ever present yet not always recognized, adequately assessed and appropriately mitigated. Identification, assessment and mitigation of risk are elements of the risk management component of the "continuous improvement" way of life that has become a hallmark of successful and progressive enterprises. While the application of risk management techniques to provide continuous improvement may be detailed and extensive, the philosophy, ideals and tools can be beneficially applied to all situations. Experiences with the use of risk identification, assessment and mitigation techniques for complex systems and processes are described. System safety efforts and tools used to examine potential risks of the Ares I First Stage of NASA s new Constellation Crew Launch Vehicle (CLV) presently being designed are noted as examples. Recommendations from lessons learned are provided for the application of risk management during the development of new systems as well as for the improvement of existing systems. Lessons learned and suggestions given are also examined for applicability to simple systems, uncomplicated processes and routine personal daily tasks. This paper informs the reader of varied uses of risk management efforts and techniques to identify, assess and mitigate risk for improvement of products, success of business, protection of people and enhancement of personal life.
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An economic analysis of poliovirus risk management policy options for 2013-2052.
Duintjer Tebbens, Radboud J; Pallansch, Mark A; Cochi, Stephen L; Wassilak, Steven G F; Thompson, Kimberly M
2015-09-24
The Global Polio Eradication Initiative plans for coordinated cessation of oral poliovirus vaccine (OPV) after interrupting all wild poliovirus (WPV) transmission, but many questions remain related to long-term poliovirus risk management policies. We used an integrated dynamic poliovirus transmission and stochastic risk model to simulate possible futures and estimate the health and economic outcomes of maintaining the 2013 status quo of continued OPV use in most developing countries compared with OPV cessation policies with various assumptions about global inactivated poliovirus vaccine (IPV) adoption. Continued OPV use after global WPV eradication leads to continued high costs and/or high cases. Global OPV cessation comes with a high probability of at least one outbreak, which aggressive outbreak response can successfully control in most instances. A low but non-zero probability exists of uncontrolled outbreaks following a poliovirus reintroduction long after OPV cessation in a population in which IPV-alone cannot prevent poliovirus transmission. We estimate global incremental net benefits during 2013-2052 of approximately $16 billion (US$2013) for OPV cessation with at least one IPV routine immunization dose in all countries until 2024 compared to continued OPV use, although significant uncertainty remains associated with the frequency of exportations between populations and the implementation of long term risk management policies. Global OPV cessation offers the possibility of large future health and economic benefits compared to continued OPV use. Long-term poliovirus risk management interventions matter (e.g., IPV use duration, outbreak response, containment, continued surveillance, stockpile size and contents, vaccine production site requirements, potential antiviral drugs, and potential safer vaccines) and require careful consideration. Risk management activities can help to ensure a low risk of uncontrolled outbreaks and preserve or further increase the positive net benefits of OPV cessation. Important uncertainties will require more research, including characterizing immunodeficient long-term poliovirus excretor risks, containment risks, and the kinetics of outbreaks and response in an unprecedented world without widespread live poliovirus exposure.
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Federal Register 2010, 2011, 2012, 2013, 2014
2013-02-06
... Administration (FHA) Risk Management Initiatives: Changes to Maximum Loan-to-Value Financing Solicitation of... performance of the portfolio, and adjust its standards to effectively manage financial risk. As a result, FHA has been continually evaluating its portfolio to identify and respond to risks in ways that benefit...
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Code of Federal Regulations, 2010 CFR
2010-07-01
... seismic risks in those buildings. Risks and Risk Reduction Strategies ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What are Federal... Public Contracts and Property Management Federal Property Management Regulations System (Continued...
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Presidential Commission on Risk Assessment and Risk Management
September 26, 1997. The Presidential/Congressional Commission on Risk Assessment and Risk Management, which was mandated as part of the Clean Air Act Amendments of 1990, was disbanded on August 31, 1997, with some staff work continuing into September. The reports and asso...
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The NASA Continuous Risk Management Process
NASA Technical Reports Server (NTRS)
Pokorny, Frank M.
2004-01-01
As an intern this summer in the GRC Risk Management Office, I have become familiar with the NASA Continuous Risk Management Process. In this process, risk is considered in terms of the probability that an undesired event will occur and the impact of the event, should it occur (ref., NASA-NPG: 7120.5). Risk management belongs in every part of every project and should be ongoing from start to finish. Another key point is that a risk is not a problem until it has happened. With that in mind, there is a six step cycle for continuous risk management that prevents risks from becoming problems. The steps are: identify, analyze, plan, track, control, and communicate & document. Incorporated in the first step are several methods to identify risks such as brainstorming and using lessons learned. Once a risk is identified, a risk statement is made on a risk information sheet consisting of a single condition and one or more consequences. There can also be a context section where the risk is explained in more detail. Additionally there are three main goals of analyzing a risk, which are evaluate, classify, and prioritize. Here is where a value is given to the attributes of a risk &e., probability, impact, and timeframe) based on a multi-level classification system (e.g., low, medium, high). It is important to keep in mind that the definitions of these levels are probably different for each project. Furthermore the risks can be combined into groups. Then, the risks are prioritized to see what risk is necessary to mitigate first. After the risks are analyzed, a plan is made to mitigate as many risks as feasible. Each risk should be assigned to someone in the project with knowledge in the area of the risk. Then the possible approaches to choose from are: research, accept, watch, or mitigate. Next, all risks, mitigated or not, are tracked either individually or in groups. As the plan is executed, risks are re-evaluated, and the attribute values are adjusted as necessary. Metrics are established and monitored as tools for risk tracking. Also a trigger or threshold should be set on the metric data that indicates when an action is needed. Results of this tracking are usually evaluated and reported in a relevant format at weekly or monthly meetings. Choosing controls is the subsequent step, which involves the effects of the tracking. The three basic controls are: close, continue tracking, and re- plan. Finally communicate & document is the last step, but occurs throughout the process. It is vital that main risks, plans, changes, and progress are known by everyone in the project. A good way to keep everyone updated and inform other projects of common issues is by thoroughly documenting project risks. NASA sees value in risk management and believes that projects have greater probability or success by using the NASA Continuous Risk Management Process.
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ERIC Educational Resources Information Center
Gasiorowicz, Mari; Llanas, Michelle R.; DiFranceisco, Wayne; Benotsch, Eric G.; Brondino, Michael J.; Catz, Sheryl L.; Hoxie, Neil J.; Reiser, William J.; Vergeront, James M.
2005-01-01
Prevention case management (PCM) for HIV-infected persons is an HIV risk reduction intervention designed to assist clients who are aware of their HIV infection and who continue to engage in risk transmission behaviors. PCM combines individual risk reduction counseling with case management to address the psychosocial factors affecting HIV…
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-04-28
... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service Proposed Collection of Information: Schedule of Excess Risks AGENCY: Financial Management Service, Fiscal Service, Treasury. ACTION: Notice and request for comments. SUMMARY: The Financial Management Service, as part of its continuing...
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40 CFR 68.152 - Substantiating claims of confidential business information.
Code of Federal Regulations, 2011 CFR
2011-07-01
... (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.152..., operator, or senior official with management responsibility of the stationary source shall sign a...
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40 CFR 68.152 - Substantiating claims of confidential business information.
Code of Federal Regulations, 2010 CFR
2010-07-01
... (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.152..., operator, or senior official with management responsibility of the stationary source shall sign a...
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NASA Technical Reports Server (NTRS)
Frigm, Ryan C.; Hejduk, Matthew D.; Johnson, Lauren C.; Plakalovic, Dragan
2015-01-01
On-orbit collision risk is becoming an increasing mission risk to all operational satellites in Earth orbit. Managing this risk can be disruptive to mission and operations, present challenges for decision-makers, and is time-consuming for all parties involved. With the planned capability improvements to detecting and tracking smaller orbital debris and capacity improvements to routinely predict on-orbit conjunctions, this mission risk will continue to grow in terms of likelihood and effort. It is very real possibility that the future space environment will not allow collision risk management and mission operations to be conducted in the same manner as it is today. This paper presents the concept of a finite conjunction assessment-one where each discrete conjunction is not treated separately but, rather, as a continuous event that must be managed concurrently. The paper also introduces the Total Probability of Collision as an analogous metric for finite conjunction assessment operations and provides several options for its usage in a Concept of Operations.
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12 CFR Appendix F to Part 225 - Interagency Guidelines Establishing Information Security Standards
Code of Federal Regulations, 2013 CFR
2013-01-01
... arrangements in place to control risks. C. Manage and Control Risk. Each bank holding company shall: 1. Design... GOVERNORS OF THE FEDERAL RESERVE SYSTEM (CONTINUED) BANK HOLDING COMPANIES AND CHANGE IN BANK CONTROL.... Assess Risk C. Manage and Control Risk D. Oversee Service Provider Arrangements E. Adjust the Program F...
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ERIC Educational Resources Information Center
Hyer, Kathryn; Taylor, Heidi H.; Nanni, Kenneth
2004-01-01
This paper describes the experience of creating a continuing professional education on-line risk management program that is designed to meet Florida's educational requirements for licensure as a risk manager in health-care settings and details the challenges faced when the in-class didactic program of 15 eight-hour sessions is reformatted as an…
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ERIC Educational Resources Information Center
Krauss, George E.
2009-01-01
The purpose of this study is to understand how selected insurance practitioners learn and developed in their practices setting. The selected insurance practitioners (collectively customer service representatives, insurance agents, and risk managers) are responsible for the counseling and placement of insurance products and the implementation of…
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Matthew P. Thompson; Joe Scott; Don Helmbrecht; Dave E. Calkin
2013-01-01
The financial, socioeconomic, and ecological impacts of wildfire continue to challenge federal land management agencies in the United States. In recent years, policymakers and managers have increasingly turned to the field of risk analysis to better manage wildfires and to mitigate losses to highly valued resources and assets (HVRAs). Assessing wildfire risk entails...
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Sun, Xiaodong; Keim, Mark; Dong, Chen; Mahany, Mollie; Guo, Xiang
2014-01-01
Reports of health issues related to mass gatherings around the world have indicated a potential for public health and medical emergencies to occur on a scale that could place a significant impact on business continuity for national and international organisations. This paper describes a risk assessment process for business continuity management that was performed as part of the planning efforts related to the World Expo 2010 Shanghai China (Expo), the world's largest mass gathering to date. Altogether, 73 million visitors attended the Expo, generating over US$2bn of revenue. During 2008 to 2010, the Shanghai Municipal Center for Disease Control and Prevention performed a dynamic series of four disaster risk assessments before and during the Expo. The purpose of this assessment process was to identify, analyse and evaluate risks for public health security during different stages of the Expo. This paper describes an overview of the novel approach for this multiple and dynamic process of assessment of health security risk for ensuring business continuity.
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Application impact analysis: a risk-based approach to business continuity and disaster recovery.
Epstein, Beth; Khan, Dawn Christine
2014-01-01
There are many possible disruptions that can occur in business. Overlooking or under planning for Business Continuity requires time, understanding and careful planning. Business Continuity Management is far more than producing a document and declaring business continuity success. What is the recipe for businesses to achieve continuity management success? Application Impact Analysis is a method for understanding the unique Business Attributes. This AIA Cycle involves a risk based approach to understanding the business priority and considering business aspects such as Financial, Operational, Service Structure, Contractual Legal, and Brand. The output of this analysis provides a construct for viewing data, evaluating impact, and delivering results, for an approved valuation of Recovery Time Objectives (RTO).
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Mission Continuity Planning: Strategically Assessing and Planning for Threats to Operations.
ERIC Educational Resources Information Center
Qayoumi, Mohammad H.
This book covers the principles of risk and risk management and offers a framework for analyzing the significant, often unforeseen threats facing higher education institutions today. It examines the critical elements of a disaster preparedness plan and addresses business continuity and mission continuity planning. The book also provides tools for…
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Mochizuki, Junko; Komendantova, Nadejda
2017-02-01
The failure to foresee the catastrophic earthquakes, tsunamis, and nuclear accident of 2011 has been perceived by many in Japan as a fundamental shortcoming of modern disaster risk science. Hampered by a variety of cognitive and institutional biases, the conventional disaster risk management planning based on the "known risks" led to the cascading failures of the interlinked disaster risk management (DRM) apparatus. This realization led to a major rethinking in the use of science for policy and the incorporations of lessons learned in the country's new DRM policy. This study reviews publicly available documents on expert committee discussions and scientific articles to identify what continuities and changes have been made in the use of scientific knowledge in Japanese risk management. In general, the prior influence of cognitive bias (e.g., overreliance on documented hazard risks) has been largely recognized, and increased attention is now being paid to the incorporation of less documented but known risks. This has led to upward adjustments in estimated damages from future risks and recognition of the need for further strengthening of DRM policy. At the same time, there remains significant continuity in the way scientific knowledge is perceived to provide sufficient and justifiable grounds for the development and implementation of DRM policy. The emphasis on "evidence-based policy" in earthquake and tsunami risk reduction measures continues, despite the critical reflections of a group of scientists who advocate for a major rethinking of the country's science-policy institution respecting the limitations of the current state science. © 2016 Society for Risk Analysis.
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Continuous Risk Management: A NASA Program Initiative
NASA Technical Reports Server (NTRS)
Hammer, Theodore F.; Rosenberg, Linda
1999-01-01
NPG 7120.5A, "NASA Program and Project Management Processes and Requirements" enacted in April, 1998, requires that "The program or project manager shall apply risk management principles..." The Software Assurance Technology Center (SATC) at NASA GSFC has been tasked with the responsibility for developing and teaching a systems level course for risk management that provides information on how to comply with this edict. The course was developed in conjunction with the Software Engineering Institute at Carnegie Mellon University, then tailored to the NASA systems community. This presentation will briefly discuss the six functions for risk management: (1) Identify the risks in a specific format; (2) Analyze the risk probability, impact/severity, and timeframe; (3) Plan the approach; (4) Track the risk through data compilation and analysis; (5) Control and monitor the risk; (6) Communicate and document the process and decisions.
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Pugliese, F; Albini, E; Serio, O; Apostoli, P
2011-01-01
The 81/2008 Act has defined a model of a health and safety management system that can contribute to prevent the occupational health and safety risks. We have developed the structure of a health and safety management system model and the necessary tools for its implementation in health care facilities. The realization of a model is structured in various phases: initial review, safety policy, planning, implementation, monitoring, management review and continuous improvement. Such a model, in continuous evolution, is based on the responsibilities of the different corporate characters and on an accurate analysis of risks and involved norms.
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Managing Risk on the Final Frontier
NASA Technical Reports Server (NTRS)
Lengyel, David M.; Newman, J. S.
2009-01-01
The National Aeronautics and Space Administration (NASA). Exploration Systems Mission Directorate (ESMD) has combined the Continuous Risk Management (CRM) discipline with innovative knowledge management (KM) practices to more effectively enable the accomplishment of work. CRM enables proactive problem identification and problem solving in the complex world of rocket science. while KM is used to improve this process.
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Continuous Risk Management at NASA
NASA Technical Reports Server (NTRS)
Hammer, Theodore F.; Rosenberg, Linda
1999-01-01
NPG 7120.5A, "NASA Program and Project Management Processes and Requirements" enacted in April, 1998, requires that "The program or project manager shall apply risk management principles..." The Software Assurance Technology Center (SATC) at NASA GSFC has been tasked with the responsibility for developing and teaching a systems level course for risk management that provides information on how to comply with this edict. The course was developed in conjunction with the Software Engineering Institute at Carnegie Mellon University, then tailored to the NASA systems community. This presentation will briefly discuss the six functions for risk management: (1) Identify the risks in a specific format; (2) Analyze the risk probability, impact/severity, and timeframe; (3) Plan the approach; (4) Track the risk through data compilation and analysis; (5) Control and monitor the risk; (6) Communicate and document the process and decisions. This risk management structure of functions has been taught to projects at all NASA Centers and is being successfully implemented on many projects. This presentation will give project managers the information they need to understand if risk management is to be effectively implemented on their projects at a cost they can afford.
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Integrated Risk and Knowledge Management Program -- IRKM-P
NASA Technical Reports Server (NTRS)
Lengyel, David M.
2009-01-01
The NASA Exploration Systems Mission Directorate (ESMD) IRKM-P tightly couples risk management and knowledge management processes and tools to produce an effective "modern" work environment. IRKM-P objectives include: (1) to learn lessons from past and current programs (Apollo, Space Shuttle, and the International Space Station); (2) to generate and share new engineering design, operations, and management best practices through preexisting Continuous Risk Management (CRM) procedures and knowledge-management practices; and (3) to infuse those lessons and best practices into current activities. The conceptual framework of the IRKM-P is based on the assumption that risks highlight potential knowledge gaps that might be mitigated through one or more knowledge management practices or artifacts. These same risks also serve as cues for collection of knowledge particularly, knowledge of technical or programmatic challenges that might recur.
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Enhanced Capabilities for Subcritical Experiments (ECSE) Risk Management Plan
DOE Office of Scientific and Technical Information (OSTI.GOV)
Urban, Mary Elizabeth
Risk is a factor, element, constraint, or course of action that introduces an uncertainty of outcome that could impact project objectives. Risk is an inherent part of all activities, whether the activity is simple and small, or large and complex. Risk management is a process that identifies, evaluates, handles, and monitors risks that have the potential to affect project success. The risk management process spans the entire project, from its initiation to its successful completion and closeout, including both technical and programmatic (non-technical) risks. This Risk Management Plan (RMP) defines the process to be used for identifying, evaluating, handling, andmore » monitoring risks as part of the overall management of the Enhanced Capabilities for Subcritical Experiments (ECSE) ‘Project’. Given the changing nature of the project environment, risk management is essentially an ongoing and iterative process, which applies the best efforts of a knowledgeable project staff to a suite of focused and prioritized concerns. The risk management process itself must be continually applied throughout the project life cycle. This document was prepared in accordance with DOE O 413.3B, Program and Project Management for the Acquisition of Capital Assets, its associated guide for risk management DOE G 413.3-7, Risk Management Guide, and LANL ADPM AP-350-204, Risk and Opportunity Management.« less
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DCAA Audits: Widespread Problems with Audit Quality Require Significant Reform
2009-09-01
is included in appendix III. DOD contract management continues to be a high- risk area for the government.17 With hundreds of billions of taxpayer...Defense Contract Management : DOD’s Lack of Adherence to Key Contracting Principles on Iraq Oil Contract Put Government Interests at Risk , GAO-07-839...in the Federal Government68 require federal agency managers to identify and assess relevant risks the agency faces from external and internal
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Cross-Cutting Risk Framework: Mining Data for Common Risks Across the Portfolio
NASA Technical Reports Server (NTRS)
Klein, Gerald A., Jr.; Ruark, Valerie
2017-01-01
The National Aeronautics and Space Administration (NASA) defines risk management as an integrated framework, combining risk-informed decision making and continuous risk management to foster forward-thinking and decision making from an integrated risk perspective. Therefore, decision makers must have access to risks outside of their own project to gain the knowledge that provides the integrated risk perspective. Through the Goddard Space Flight Center (GSFC) Flight Projects Directorate (FPD) Business Change Initiative (BCI), risks were integrated into one repository to facilitate access to risk data between projects. With the centralized repository, communications between the FPD, project managers, and risk managers improved and GSFC created the cross-cutting risk framework (CCRF) team. The creation of the consolidated risk repository, in parallel with the initiation of monthly FPD risk managers and risk governance board meetings, are now providing a complete risk management picture spanning the entire directorate. This paper will describe the challenges, methodologies, tools, and techniques used to develop the CCRF, and the lessons learned as the team collectively worked to identify risks that FPD programs projects had in common, both past and present.
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Harnessing landscape heterogeneity for managing future disturbance risks in forest ecosystems.
Seidl, Rupert; Albrich, Katharina; Thom, Dominik; Rammer, Werner
2018-03-01
In order to prevent irreversible impacts of climate change on the biosphere it is imperative to phase out the use of fossil fuels. Consequently, the provisioning of renewable resources such as timber and biomass from forests is an ecosystem service of increasing importance. However, risk factors such as changing disturbance regimes are challenging the continuous provisioning of ecosystem services, and are thus a key concern in forest management. We here used simulation modeling to study different risk management strategies in the context of timber production under changing climate and disturbance regimes, focusing on a 8127 ha forest landscape in the Northern Front Range of the Alps in Austria. We show that under a continuation of historical management, disturbances from wind and bark beetles increase by +39.5% on average over 200 years in response to future climate change. Promoting mixed forests and climate-adapted tree species as well as increasing management intensity effectively reduced future disturbance risk. Analyzing the spatial patterns of disturbance on the landscape, we found a highly uneven distribution of risk among stands (Gini coefficients up to 0.466), but also a spatially variable effectiveness of silvicultural risk reduction measures. This spatial variability in the contribution to and control of risk can be used to inform disturbance management: Stands which have a high leverage on overall risk and for which risks can effectively be reduced (24.4% of the stands in our simulations) should be a priority for risk mitigation measures. In contrast, management should embrace natural disturbances for their beneficial effects on biodiversity in areas which neither contribute strongly to landscape-scale risk nor respond positively to risk mitigation measures (16.9% of stands). We here illustrate how spatial heterogeneity in forest landscapes can be harnessed to address both positive and negative effects of changing natural disturbance regimes in ecosystem management. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Harnessing landscape heterogeneity for managing future disturbance risks in forest ecosystems
Seidl, Rupert; Albrich, Katharina; Thom, Dominik; Rammer, Werner
2018-01-01
In order to prevent irreversible impacts of climate change on the biosphere it is imperative to phase out the use of fossil fuels. Consequently, the provisioning of renewable resources such as timber and biomass from forests is an ecosystem service of increasing importance. However, risk factors such as changing disturbance regimes are challenging the continuous provisioning of ecosystem services, and are thus a key concern in forest management. We here used simulation modeling to study different risk management strategies in the context of timber production under changing climate and disturbance regimes, focusing on a 8127 ha forest landscape in the Northern Front Range of the Alps in Austria. We show that under a continuation of historical management, disturbances from wind and bark beetles increase by +39.5% on average over 200 years in response to future climate change. Promoting mixed forests and climate-adapted tree species as well as increasing management intensity effectively reduced future disturbance risk. Analyzing the spatial patterns of disturbance on the landscape, we found a highly uneven distribution of risk among stands (Gini coefficients up to 0.466), but also a spatially variable effectiveness of silvicultural risk reduction measures. This spatial variability in the contribution to and control of risk can be used to inform disturbance management: Stands which have a high leverage on overall risk and for which risks can effectively be reduced (24.4% of the stands in our simulations) should be a priority for risk mitigation measures. In contrast, management should embrace natural disturbances for their beneficial effects on biodiversity in areas which neither contribute strongly to landscape-scale risk nor respond positively to risk mitigation measures (16.9% of stands). We here illustrate how spatial heterogeneity in forest landscapes can be harnessed to address both positive and negative effects of changing natural disturbance regimes in ecosystem management. PMID:29275284
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Caroly, S; Coutarel, F; Landry, A; Mary-Cheray, I
2010-07-01
To increase output and meet customers' needs, companies have turned to the development of production management systems: Kaizen, one piece flow, Kanban, etc. The aim of such systems is to accelerate decisions, react to environmental issues and manage various productions. In the main, this type of management system has led to the continuous improvement of production performance. Consequently, such production management systems can have unexpected negative effects on operators' health and safety. Conversely, regulation and control systems focusing on work-related risks have obliged firms to implement health and safety management systems such as OHSAS 18001. The purpose of this type of system, also based on continuous improvement, is to reduce risks, facilitate work-related activities and identify solutions in terms of equipment and tools. However, the prevention actions introduced through health and safety systems often result in other unexpected and unwanted effects on production. This paper shows how companies can improve the way they are run by taking into account both types of management system. Copyright 2010 Elsevier Ltd. All rights reserved.
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Issues in Strategic Management for Non-Credit Continuing Education Operations.
ERIC Educational Resources Information Center
Eisenstein, Fannie
1983-01-01
States that strategic management requires continuing education leadership to engage in explicit community services goal reaffirmation. Calls for a reassessment of college funding options; risk taking as part of modification for change; linkages with business, industry, and government; maintenance of staff morale and confidence; and strategic…
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Development and application of a probabilistic method for wildfire suppression cost modeling
Matthew P. Thompson; Jessica R. Haas; Mark A. Finney; David E. Calkin; Michael S. Hand; Mark J. Browne; Martin Halek; Karen C. Short; Isaac C. Grenfell
2015-01-01
Wildfire activity and escalating suppression costs continue to threaten the financial health of federal land management agencies. In order to minimize and effectively manage the cost of financial risk, agencies need the ability to quantify that risk. A fundamental aim of this research effort, therefore, is to develop a process for generating risk-based metrics for...
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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.
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42 CFR 438.812 - Costs under risk and nonrisk contracts.
Code of Federal Regulations, 2010 CFR
2010-10-01
... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Conditions for Federal Financial Participation § 438.812 Costs under risk and nonrisk contracts. (a) Under a risk contract, the total amount the...
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Sendlhofer, Gerald; Brunner, Gernot; Tax, Christa; Falzberger, Gebhard; Smolle, Josef; Leitgeb, Karina; Kober, Brigitte; Kamolz, Lars Peter
2015-01-01
For health care systems in recent years, patient safety has increasingly become a priority issue. National and international strategies have been considered to attempt to overcome the most prominent hazards while patients are receiving health care. Thereby, clinical risk management (CRM) plays a dominant role in enabling the identification, analysis, and management of potential risks. CRM implementation into routine procedures within complex hospital organizations is challenging, as in the past, organizational change strategies using a top-down approach have often failed. Therefore, one of our main objectives was to educate a certain number of risk managers in facilitating CRM using a bottom-up approach. To achieve our primary purpose, five project strands were developed, and consequently followed, introducing CRM: corporate governance, risk management (RM) training, CRM process, information, and involvement. The core part of the CRM process involved the education of risk managers within each organizational unit. To account for the size of the existing organization, we assumed that a minimum of 1 % of the workforce had to be trained in RM to disseminate the continuous improvement of quality and safety. Following a roll-out plan, CRM was introduced in each unit and potential risks were identified. Alongside the changes in the corporate governance, a hospital-wide CRM process was introduced resulting in 158 trained risk managers correlating to 2.0 % of the total workforce. Currently, risk managers are present in every unit and have identified 360 operational risks. Among those, 176 risks were scored as strategic and clustered together into top risks. Effective meeting structures and opportunities to share information and knowledge were introduced. Thus far, 31 units have been externally audited in CRM. The CRM approach is unique with respect to its dimension; members of all health care professions were trained to be able to identify potential risks. A network of risk managers supported the centrally coordinated CRM process. There is a strong commitment among management, academia, clinicians, and administration to foster cooperation. The introduction of CRM led to a visible shift with regard to patient safety culture throughout the entire organization. Still, there is a long way to go to keep people engaged in CRM and work on national and international patient safety initiatives to continuously decrease potential hazards.
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Kapp, Suzanne
2013-10-01
This paper reports an initiative which promoted evidence-based practice in pressure risk assessment and management among home nursing clients in Melbourne, Australia. The aim of this study was to evaluate the introduction and uptake of the Australian Wound Management Association Guidelines for the Prediction and Prevention of Pressure Ulcers. In 2007 a pilot study was conducted. Nurse perspectives (n=21) were obtained via survey and a client profile (n=218) was generated. Audit of the uptake and continued use of the pressure risk screening tool, during the pilot study and later once implemented as standard practice organizational wide, was conducted. Nurses at the pilot site successfully implemented the practice guidelines, pressure risk screening was adopted and supporting resources were well received. Most clients were at low risk of pressure ulcer development. The pilot site maintained and extended their pilot study success, ensuring more than 90% of clients were screened for pressure risk over the 18 months which followed. All other sites performed less well initially, however subsequently improved, meeting the pilot sites success after 18 months. Two years later, the organization continues to screen more than 90% of all clients for pressure risk. Implementation of clinical practice guidelines was successful in the pilot project and pressure risk screening became a well-adopted practice. Success continued following organizational wide implementation. Pilot study findings suggest it may be prudent to monitor the pressure ulcer risk status of low risk clients so as to prevent increasing risk and pressure ulcer development among this group. © 2012 John Wiley & Sons Ltd.
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Principles of disease management in neonatology.
Bowen, F W; Gwiazdowski, S
1998-06-01
This article emphasizes the emerging facets of disease-management practice that impact directly on establishing a measured care system that can produce the information needed to establish a continuous quality improvement program. The areas discussed are risk assessment, clinical management guidelines and carepaths, and the measurement of system output known as clinical outcomes. The remainder of the article details the aspects of risk assessment, guideline function, and outcome assessment, critical in a disease-managed measured care system.
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A phased approach to induced seismicity risk management
White, Joshua A.; Foxall, William
2014-01-01
This work describes strategies for assessing and managing induced seismicity risk during each phase of a carbon storage project. We consider both nuisance and damage potential from induced earthquakes, as well as the indirect risk of enhancing fault leakage pathways. A phased approach to seismicity management is proposed, in which operations are continuously adapted based on available information and an on-going estimate of risk. At each project stage, specific recommendations are made for (a) monitoring and characterization, (b) modeling and analysis, and (c) site operations. The resulting methodology can help lower seismic risk while ensuring site operations remain practical andmore » cost-effective.« less
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NASA Technical Reports Server (NTRS)
Dezfuli, Homayoon
2010-01-01
This slide presentation reviews the evolution of risk management (RM) at NASA. The aim of the RM approach at NASA is to promote an approach that is heuristic, proactive, and coherent across all of NASA. Risk Informed Decision Making (RIDM) is a decision making process that uses a diverse set of performance measures along with other considerations within a deliberative process to inform decision making. RIDM is invoked for key decisions such as architecture and design decisions, make-buy decisions, and budget reallocation. The RIDM process and how it relates to the continuous Risk Management (CRM) process is reviewed.
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Evaluating the vulnerability of Maine forests to wind damage
Thomas E. Perry; Jeremy S. Wilson
2010-01-01
Numerous factors, some of which cannot be controlled, are continually interacting with the forest resource, introducing risk to management, and making consistent predictable management outcomes uncertain. Included in these factors are threats or hazards such as windstorms and wildfire. Factors influencing the probability (risk) of windthrow or windsnap occurring can be...
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Hyer, Kathryn; Taylor, Heidi H; Nanni, Kennith
2004-01-01
This paper describes the experience of creating a continuing professional education on-line risk management program that is designed to meet Florida's educational requirements for licensure as a risk manager in health-care settings and details the challenges faced when the in-class didactic program of 15 eight-hour sessions is reformatted as an on-line program. Structuring instructor/learner interactivity remains a challenge, especially if the program allows learner control and is a key feature in marketing the program. The article presents the dilemmas for state regulators as they work to determine if the on-line program meets legislative intent and statutory requirements because the learning platform does not have a clock function that accumulates time for each learner. While some details reflect the uniqueness of the 120-hour educational requirements for risk managers in Florida, the experience of the authors provides insight into the development of continuing professional education distance learning programs that are multidisciplinary and move primarily from a time-based format into a curriculum that uses time as only one dimension of the evaluation of learning.
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Business continuity management in emerging markets: the case of Jordan.
Sawalha, Ihab H; Anchor, John R
2012-01-01
Despite their considerable growth in last few decades, emerging markets (EM) face numerous risks that have the potential to slow down or obstruct their development. Three main issues are discussed in this paper: first, the risks facing organisations operating in emerging markets and Jordan in particular; secondly, the role of business continuity management (BCM) in emerging markets; and thirdly, potential factors that underpin the role of BCM in emerging markets. These issues are significant, as they represent the role of BCM in highly dynamic and fast changing business environments. The paper provides a discussion of the significance of BCM in reducing or preventing risks facing organisations operating in emerging markets, especially those in Jordan.
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Risk-Informed Decision Making: Application to Technology Development Alternative Selection
NASA Technical Reports Server (NTRS)
Dezfuli, Homayoon; Maggio, Gaspare; Everett, Christopher
2010-01-01
NASA NPR 8000.4A, Agency Risk Management Procedural Requirements, defines risk management in terms of two complementary processes: Risk-informed Decision Making (RIDM) and Continuous Risk Management (CRM). The RIDM process is used to inform decision making by emphasizing proper use of risk analysis to make decisions that impact all mission execution domains (e.g., safety, technical, cost, and schedule) for program/projects and mission support organizations. The RIDM process supports the selection of an alternative prior to program commitment. The CRM process is used to manage risk associated with the implementation of the selected alternative. The two processes work together to foster proactive risk management at NASA. The Office of Safety and Mission Assurance at NASA Headquarters has developed a technical handbook to provide guidance for implementing the RIDM process in the context of NASA risk management and systems engineering. This paper summarizes the key concepts and procedures of the RIDM process as presented in the handbook, and also illustrates how the RIDM process can be applied to the selection of technology investments as NASA's new technology development programs are initiated.
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NASA's human system risk management approach and its applicability to commercial spaceflight.
Law, Jennifer; Mathers, Charles H; Fondy, Susan R E; Vanderploeg, James M; Kerstman, Eric L
2013-01-01
As planning continues for commercial spaceflight, attention is turned to NASA to assess whether its human system risk management approach can be applied to mitigate the risks associated with commercial suborbital and orbital flights. NASA uses a variety of methods to assess the risks to the human system based on their likelihood and consequences. In this article, we review these methods and categorize the risks in the system as "definite," "possible," or "least" concern for commercial spaceflight. As with career astronauts, these risks will be primarily mitigated by screening and environmental control. Despite its focus on long-duration exploration missions, NASA's human system risk management approach can serve as a preliminary knowledge base to help medical planners prepare for commercial spaceflights.
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The synergy needed for business resilience.
Kachgal, Julie A
2015-01-01
This paper discusses best practices on where to strategically connect risk management, business continuity, disaster recovery, crisis management, crisis communications, physical security, cyber security and emergency planning within the organisation.
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Draugen HSE-case - occupational health risk management
DOE Office of Scientific and Technical Information (OSTI.GOV)
Glas, J.J.P.; Kjaer, E.
1996-12-31
The Draugen HSE-Case serves as a risk management tool. Originally, risk management included only major safety hazards to personnel, environment and assets. Work Environment risks such as ergonomics, psycho-social factors and exposure to chemicals and noise, was not given the same attention. The Draugen HSE-Case addresses this weakness and extends all work environment risks. In order to promote line responsibility and commitment, relevant personnel is involved in the Case development. {open_quotes}THESIS{degrees}, a software application, is used to systematize input and to generate reports. The Draugen HSE-case encompasses: HSE risk analyses related to specific activities; Control of risk related to workmore » environment; Established tolerability criteria; Risk reducing measures; Emergency contingency measures; and Requirements for Competence and Follow-up. The development of Draugen HSE-Case is a continuous process. It will serve to minimize the potential of occupational illnesses, raise general awareness, and make occupational health management more cost-effective.« less
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Management of high-risk perioperative systems.
Dain, Steven
2006-06-01
The perioperative system is a complex system that requires people, materials, and processes to come together in a highly ordered and timely manner. However, when working in this high-risk system, even well-organized, knowledgeable, vigilant, and well-intentioned individuals will eventually make errors. All systems need to be evaluated on a continual basis to reduce the risk of errors, make errors more easily recognizable, and provide methods for error mitigation. A simple approach to risk management that may be applied in clinical medicine is discussed.
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NASA Astrophysics Data System (ADS)
González, M. R.; Torres, F.; Yoldi, V.; Arcega, F.; Plaza, I.
2012-04-01
It is proposed an integrated management model for an organization. This model is based on the continuous improvement Plan-Do-Check-Act cycle and it intends to integrate the environmental, risk prevention and ethical aspects as well as research, development and innovation projects management in the general quality management structure proposed by ISO 9001:2008. It aims to fulfill the standards ISO 9001, ISO 14001, OSHAS 18001, SGE 21 y 166002.
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Sobottka, Stephan B; Eberlein-Gonska, Maria; Schackert, Gabriele; Töpfer, Armin
2009-01-01
Due to the knowledge gap that exists between patients and health care staff the quality of medical treatment usually cannot be assessed securely by patients. For an optimization of safety in treatment-related processes of medical care, the medical staff needs to be actively involved in preventive and proactive quality management. Using voluntary, confidential and non-punitive systematic employee surveys, vulnerable topics and areas in patient care revealing preventable risks can be identified at an early stage. Preventive measures to continuously optimize treatment quality can be defined by creating a risk portfolio and a priority list of vulnerable topics. Whereas critical incident reporting systems are suitable for continuous risk assessment by detecting safety-relevant single events, employee surveys permit to conduct a systematic risk analysis of all treatment-related processes of patient care at any given point in time.
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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.
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Airline business continuity and IT disaster recovery sites.
Haji, Jassim
2016-01-01
Business continuity is defined as the capability of the organisation to continue delivery of products or services at acceptable predefined levels following a disruptive incident. Business continuity is fast evolving to become a critical and strategic decision for any organisation. Transportation in general, and airlines in particular, is a unique sector with a specialised set of requirements, challenges and opportunities. Business continuity in the airline sector is a concept that is generally overlooked by the airline managements. This paper reviews different risks related to airline processes and will also propose solutions to these risks based on experiences and good industry practices.
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17 CFR 75.3 - Prohibition on proprietary trading.
Code of Federal Regulations, 2014 CFR
2014-04-01
... (CONTINUED) PROPRIETARY TRADING AND CERTAIN INTERESTS IN AND RELATIONSHIPS WITH COVERED FUNDS Proprietary... of liquidity management in accordance with a documented liquidity management plan of the banking... liquidity management purposes, the amount, types, and risks of these securities that are consistent with...
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17 CFR 255.3 - Prohibition on proprietary trading.
Code of Federal Regulations, 2014 CFR
2014-04-01
... (CONTINUED) PROPRIETARY TRADING AND CERTAIN INTERESTS IN AND RELATIONSHIPS WITH COVERED FUNDS Proprietary... purpose of liquidity management in accordance with a documented liquidity management plan of the banking... liquidity management purposes, the amount, types, and risks of these securities that are consistent with...
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Seki, Akira; Miya, Tetsumasa
2011-03-01
As a result of recurring medical accidents, risk management in the medical setting has been given much attention. The announcement in August, 2000 by the Ministry of Health committee for formulating a standard manual for risk management, of a "Risk management manual formulation guideline" has since been accompanied by the efforts of numerous medical testing facilities to develop such documents. In 2008, ISO/TS 22367:2008 on "Medical laboratories-Reduction of error through risk management and continual improvement" was published. However, at present, risk management within a medical testing facility stresses the implementation of provisional actions in response to a problem after it has occurred. Risk management is basically a planned process and includes "corrective actions" as well as "preventive actions." A corrective action is defined as identifying the root cause of the problem and removing it, and is conducted to prevent the problem from recurring. A preventive action is defined as identifying of the any potential problem and removing it, and is conducted to prevent a problem before it occurs. Presently, I shall report on the experiences of our laboratory regarding corrective and preventive actions taken in response to accidents and incidents, respectively.
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Kennard, Betsy D; Emslie, Graham J; Mayes, Taryn L; Nakonezny, Paul A; Jones, Jessica M; Foxwell, Aleksandra A; King, Jessica
2014-10-01
The authors evaluated a sequential treatment strategy of fluoxetine and relapse-prevention cognitive-behavioral therapy (CBT) to determine effects on remission and relapse in youths with major depressive disorder. Youths 8-17 years of age with major depression were treated openly with fluoxetine for 6 weeks. Those with an adequate response (defined as a reduction of 50% or more on the Children's Depression Rating Scale-Revised [CDRS-R]) were randomly assigned to receive continued medication management alone or continued medication management plus CBT for an additional 6 months. The CBT was modified to address residual symptoms and was supplemented by well-being therapy. Primary outcome measures were time to remission (with remission defined as a CDRS-R score of 28 or less) and rate of relapse (with relapse defined as either a CDRS-R score of 40 or more with a history of 2 weeks of symptom worsening, or clinical deterioration). Of the 200 participants enrolled in acute-phase treatment, 144 were assigned to continuation treatment with medication management alone (N=69) or medication management plus CBT (N=75). During the 30-week continuation treatment period, time to remission did not differ significantly between treatment groups (hazard ratio=1.26, 95% CI=0.87, 1.82). However, the medication management plus CBT group had a significantly lower risk of relapse than the medication management only group (hazard ratio=0.31, 95% CI=0.13, 0.75). The estimated probability of relapse by week 30 was lower with medication management plus CBT than with medication management only (9% compared with 26.5%). Continuation-phase relapse-prevention CBT was effective in reducing the risk of relapse but not in accelerating time to remission in children and adolescents with major depressive disorder.
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Need of risk management practice amongst bumiputera contractors in Malaysia construction industries
NASA Astrophysics Data System (ADS)
Syuhada Fadzil, Nur; Noor, Nurazuwa Md; Rahman, Ismail Abdul
2017-11-01
Malaysia construction industry has been growing continuously with double-digit growth for the past two decades. There are many issues surrounded the industry such as delay in delivery, cost overrun, quality and safety. In bumiputera contractor’s context, the literature review found that 32 issues were encountered in the construction project. These issues can be handled properly with the application of risk management. According to previous researchers, application of risk management in Malaysia construction industry is at the low level where it is implemented in traditional ways that are brainstorming and checklist. These were due to lack of knowledge, the high cost of hiring experts and avoiding extra cost. Besides that, this study also intentions to analyse the risk categories in the construction industry as well as identify risk management process to resolve the construction issues. Hence, this paper presents issues engulfed by Bumiputera contractors which can partly be resolved by applying risk management practice in carrying out the construction activity. This may inspire the contractors to apply the risk management practice in ensuring the success of their construction project.
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Code of Federal Regulations, 2013 CFR
2013-04-01
... 17 Commodity and Securities Exchanges 3 2013-04-01 2013-04-01 false Internal risk management control system requirements for supervised investment bank holding companies. 240.17i-4 Section 240.17i-4 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) GENERAL RULES AND REGULATIONS, SECURITIES EXCHANGE ACT OF 1934...
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Code of Federal Regulations, 2012 CFR
2012-04-01
... 17 Commodity and Securities Exchanges 3 2012-04-01 2012-04-01 false Internal risk management control system requirements for supervised investment bank holding companies. 240.17i-4 Section 240.17i-4 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) GENERAL RULES AND REGULATIONS, SECURITIES EXCHANGE ACT OF 1934...
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From Process to Product: Your Risk Process at Work
NASA Technical Reports Server (NTRS)
Kundrot, Craig E.; Fogarty, Jenifer; Charles, John; Buquo, Lynn; Sibonga, Jean; Alexander, David; Horn, Wayne G.; Edwards, J. Michelle
2010-01-01
The Space Life Sciences Directorate (SLSD) and Human Research Program (HRP) at the NASA/Johnson Space Center work together to address and manage the human health and performance risks associated with human space flight. This includes all human system requirements before, during, and after space flight, providing for research, and managing the risk of adverse long-term health outcomes for the crew. We previously described the framework and processes developed for identifying and managing these human system risks. The focus of this panel is to demonstrate how the implementation of the framework and associated processes has provided guidance in the management and communication of human system risks. The risks of early onset osteoporosis, CO2 exposure, and intracranial hypertension in particular have all benefitted from the processes developed for human system risk management. Moreover, we are continuing to develop capabilities, particularly in the area of information architecture, which will also be described. We are working to create a system whereby all risks and associated actions can be tracked and related to one another electronically. Such a system will enhance the management and communication capabilities for the human system risks, thereby increasing the benefit to researchers and flight surgeons.
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NASA Technical Reports Server (NTRS)
Sabelhaus, Phil
2002-01-01
Risk identification is an ongoing activity that takes place during the routine project work flow. Project activities such as programmatic and technical meetings, telecons, reviews, and other forms of communication often bring to light project risks. When this occurs, we record and analyze the risk on a Risk Information Sheet. This process helps the project team identify and cope with project risks throughout the life of the project.
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In search of robust flood risk management alternatives for the Netherlands
NASA Astrophysics Data System (ADS)
Klijn, F.; Knoop, J. M.; Ligtvoet, W.; Mens, M. J. P.
2012-05-01
The Netherlands' policy for flood risk management is being revised in view of a sustainable development against a background of climate change, sea level rise and increasing socio-economic vulnerability to floods. This calls for a thorough policy analysis, which can only be adequate when there is agreement about the "framing" of the problem and about the strategic alternatives that should be taken into account. In support of this framing, we performed an exploratory policy analysis, applying future climate and socio-economic scenarios to account for the autonomous development of flood risks, and defined a number of different strategic alternatives for flood risk management at the national level. These alternatives, ranging from flood protection by brute force to reduction of the vulnerability by spatial planning only, were compared with continuation of the current policy on a number of criteria, comprising costs, the reduction of fatality risk and economic risk, and their robustness in relation to uncertainties. We found that a change of policy away from conventional embankments towards gaining control over the flooding process by making the embankments unbreachable is attractive. By thus influencing exposure to flooding, the fatality risk can be effectively reduced at even lower net societal costs than by continuation of the present policy or by raising the protection standards where cost-effective.
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Integrated Risk Management Within NASA Programs/Projects
NASA Technical Reports Server (NTRS)
Connley, Warren; Rad, Adrian; Botzum, Stephen
2004-01-01
As NASA Project Risk Management activities continue to evolve, the need to successfully integrate risk management processes across the life cycle, between functional disciplines, stakeholders, various management policies, and within cost, schedule and performance requirements/constraints become more evident and important. Today's programs and projects are complex undertakings that include a myriad of processes, tools, techniques, management arrangements and other variables all of which must function together in order to achieve mission success. The perception and impact of risk may vary significantly among stakeholders and may influence decisions that may have unintended consequences on the project during a future phase of the life cycle. In these cases, risks may be unintentionally and/or arbitrarily transferred to others without the benefit of a comprehensive systemic risk assessment. Integrating risk across people, processes, and project requirements/constraints serves to enhance decisions, strengthen communication pathways, and reinforce the ability of the project team to identify and manage risks across the broad spectrum of project management responsibilities. The ability to identify risks in all areas of project management increases the likelihood a project will identify significant issues before they become problems and allows projects to make effective and efficient use of shrinking resources. By getting a total team integrated risk effort, applying a disciplined and rigorous process, along with understanding project requirements/constraints provides the opportunity for more effective risk management. Applying an integrated approach to risk management makes it possible to do a better job at balancing safety, cost, schedule, operational performance and other elements of risk. This paper will examine how people, processes, and project requirements/constraints can be integrated across the project lifecycle for better risk management and ultimately improve the chances for mission success.
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NASA Technical Reports Server (NTRS)
Duarte, Luis Alberto; Kross, Denny (Technical Monitor)
2001-01-01
The US civil aerospace program has been a great contributor to the creation and implementation of techniques and methods to identify, analyze, and confront risk. NASA has accomplished mission success in many instances, but also has had many failures. Anomalies have kept the Agency from achieving success on other occasions, as well. While NASA has mastered ways to prevent risks, and to quickly and effectively react and recover from anomalies or failures, it was not until few years ago that a comprehensive Risk Management process started being implemented in some of its programs and projects. A Continuous Risk Management (CRM) cycle process was developed and has been promoted and used successfully in programs and projects across the Agency.
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Management of severe asthma: targeting the airways, comorbidities and risk factors.
Gibson, Peter G; McDonald, Vanessa M
2017-06-01
Severe asthma is a complex heterogeneous disease that is refractory to standard treatment and is complicated by multiple comorbidities and risk factors. In mild to moderate asthma, the burden of disease can be minimised by inhaled corticosteroids, bronchodilators and self-management education. In severe asthma, however, management is more complex. When patients with asthma continue to experience symptoms and exacerbations despite optimal management, severe refractory asthma (SRA) should be suspected and confirmed, and other aetiologies ruled out. Once a diagnosis of SRA is established, patients should undergo a systematic and multidimensional assessment to identify inflammatory endotypes, risk factors and comorbidities, with targeted and individualised management initiated. We describe a practical approach to assessment and management of patients with SRA. © 2017 Royal Australasian College of Physicians.
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Abbott, Richard L; Weber, Paul; Kelley, Betsy
2005-12-01
To review the history and current issues surrounding medical professional liability insurance and its relationship to medical error and healthcare risk management. Focused literature review and authors' experience. Medical professional liability insurance issues are reviewed in association with the occurrence of medical error and the role of healthcare risk management. The rising frequency and severity of claims and lawsuits incurred by physicians, as well as escalating defense costs, have dramatically increased over the past several years and have resulted in accelerated efforts to reduce medical errors and control practice risk for physicians. Medical error reduction and improved patient outcomes are closely linked to the goals of the medical risk manager by reducing exposure to adverse medical events. Management of professional liability risk by the physician-led malpractice insurance company not only protects the economic viability of physicians, but also addresses patient safety concerns. Physician-owned malpractice liability insurance companies will continue to be the dominant providers of insurance for practicing physicians and will serve as the primary source for loss prevention and risk management services. To succeed in the marketplace, the emergence and importance of the risk manager and incorporation of risk management principles throughout the professional liability company has become crucial to the financial stability and success of the insurance company. The risk manager provides the necessary advice and support requested by physicians to minimize medical liability risk in their daily practice.
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The role of integrative, whole organism testing in monitoring applications: Back to the future
The biological effects of chemicals released to surface waters continue to be an area of uncertainty in risk assessment and risk management. Based on conventional risk assessment considerations, adequate exposure and effects information are required to reach a scientifically soun...
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Globalization of pediatric transplantation: The risk of tuberculosis or not tuberculosis.
McCulloch, Mignon; Lin, Philana Ling
2017-05-01
The risk of TB among pediatric SOT recipients increases as the globalization of medical care continues to broaden. Unlike adults, children and especially infants are more susceptible to TB as a complication after transplantation. Little data exist regarding the true incidence of TB and the optimal risk-based management of this very vulnerable population. Here, we highlight the theoretical and practical issues that complicate the management of these patients and pose some questions that should be addressed when managing these patients. More data are needed to provide optimal guidance of the best diagnostic and management practices to this unique population. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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42 CFR 441.555 - Support system.
Code of Federal Regulations, 2014 CFR
2014-10-01
... accessing services, supports, and resources. (xi) Development of risk management agreements. (A) The State... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... attendant providers, available service delivery models and if applicable, financial management entities...
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42 CFR 441.555 - Support system.
Code of Federal Regulations, 2013 CFR
2013-10-01
... accessing services, supports, and resources. (xi) Development of risk management agreements. (A) The State... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... attendant providers, available service delivery models and if applicable, financial management entities...
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42 CFR 441.555 - Support system.
Code of Federal Regulations, 2012 CFR
2012-10-01
... accessing services, supports, and resources. (xi) Development of risk management agreements. (A) The State... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... attendant providers, available service delivery models and if applicable, financial management entities...
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Contemporary Clinical Management of Endometrial Cancer
Dinkelspiel, Helen E.; Wright, Jason D.; Lewin, Sharyn N.; Herzog, Thomas J.
2013-01-01
Although the contemporary management of endometrial cancer is straightforward in many ways, novel data has emerged over the past decade that has altered the clinical standards of care while generating new controversies that will require further investigation. Fortunately most cases are diagnosed at early stages, but high-risk histologies and poorly differentiated tumors have high metastatic potential with a significantly worse prognosis. Initial management typically requires surgery, but the role and extent of lymphadenectomy are debated especially with well-differentiated tumors. With the changes in surgical staging, prognosis correlates more closely with stage, and the importance of cytology has been questioned and is under evaluation. The roles of radiation in intermediate-risk patients and chemotherapy in high-risk patients are emerging. The therapeutic index of brachytherapy needs to be considered, and the best sequencing of combined modalities needs to balance efficacy and toxicities. Additionally novel targeted therapies show promise, and further studies are needed to determine the appropriate use of these new agents. Management of endometrial cancer will continue to evolve as clinical trials continue to answer unsolved clinical questions. PMID:23864861
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17 CFR 240.15c3-4 - Internal risk management control systems for OTC derivatives dealers.
Code of Federal Regulations, 2014 CFR
2014-04-01
... 17 Commodity and Securities Exchanges 4 2014-04-01 2014-04-01 false Internal risk management control systems for OTC derivatives dealers. 240.15c3-4 Section 240.15c3-4 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) GENERAL RULES AND REGULATIONS, SECURITIES EXCHANGE ACT OF 1934 Rules and Regulations Under the...
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40 CFR 68.175 - Prevention program/Program 3.
Code of Federal Regulations, 2010 CFR
2010-07-01
... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.175 Prevention program/Program... the most recent change that triggered management of change procedures and the date of the most recent review or revision of management of change procedures. (j) The date of the most recent pre-startup review...
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Risk-trading in flood management: An economic model.
Chang, Chiung Ting
2017-09-15
Although flood management is no longer exclusively a topic of engineering, flood mitigation continues to be associated with hard engineering options. Flood adaptation or the capacity to adapt to flood risk, as well as a demand for internalizing externalities caused by flood risk between regions, complicate flood management activities. Even though integrated river basin management has long been recommended to resolve the above issues, it has proven difficult to apply widely, and sometimes even to bring into existence. This article explores how internalization of externalities as well as the realization of integrated river basin management can be encouraged via the use of a market-based approach, namely a flood risk trading program. In addition to maintaining efficiency of optimal resource allocation, a flood risk trading program may also provide a more equitable distribution of benefits by facilitating decentralization. This article employs a graphical analysis to show how flood risk trading can be implemented to encourage mitigation measures that increase infiltration and storage capacity. A theoretical model is presented to demonstrate the economic conditions necessary for flood risk trading. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Forests at risk: integrating risk science into fuel management strategies.
Jonathan Thompson
2008-01-01
The threat from wildland fire continues to grow across many regions of the Western United States. Drought, urbanization, and a buildup of fuels over the last century have contributed to increasing wildfire risk to property and highly valued natural resources. Fuel treatments, including thinning overly dense forests to reduce fuel and lower fire risk, have become a...
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Kramer, Gregory M; Luxton, David D
2016-04-01
The use of technology to provide telemental healthcare continues to increase; however, little has been written about the legal and regulatory issues involved in providing this form of care to children and adolescents. This article reviews existing laws and regulations to summarize the risk management issues relevant to providing telemental healthcare to children and adolescents. There are several legal and regulatory areas in which telemental health clinicians need to have awareness. These areas include: 1) Licensure, 2) malpractice liability, 3) credentialing and privileging, 4) informed consent, 5) security and privacy, and 6) emergency management. Although legal and regulatory challenges remain in providing telemental healthcare to children and adolescents, it is possible to overcome these challenges with knowledge of the issues and appropriate risk management strategies. We provide general knowledge of these key legal and regulatory issues, along with some risk management recommendations.
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Nanotechnology continues to produce a diversity of engineered nanomaterials displaying novel physicochemical properties with applications in commercial, consumer, electronic, biomedical, energy, and environmental sectors. Nanotechnology has been referred to as the next industrial...
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46 CFR 162.060-5 - Incorporation by reference.
Code of Federal Regulations, 2012 CFR
2012-10-01
... Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) EQUIPMENT, CONSTRUCTION, AND MATERIALS: SPECIFICATIONS AND APPROVAL ENGINEERING EQUIPMENT Ballast Water Management Systems § 162.060-5 Incorporation by...), Environmental Technology Verification Program, National Risk Management Research Laboratory Office of Research...
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40 CFR 68.165 - Offsite consequence analysis.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 40 Protection of Environment 15 2011-07-01 2011-07-01 false Offsite consequence analysis. 68.165 Section 68.165 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.165 Offsite consequence...
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40 CFR 68.185 - Certification.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Certification. 68.185 Section 68.185 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.185 Certification. (a) For Program 1 processes...
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40 CFR 68.165 - Offsite consequence analysis.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Offsite consequence analysis. 68.165 Section 68.165 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.165 Offsite consequence...
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Managing young people with self-harming or suicidal behaviour.
Fisher, Gemma
2016-02-01
This literature review aimed to determine the risk factors being used to identify children and young people who are at increased risk of engaging in self-harm and suicidal behaviour, so that optimal care can be provided for this patient group in children's medical ward settings. The two main themes that emerged were mental and neurodevelopmental disorders, and external factors. Management strategies to aid healthcare professionals in caring for this patient group were also identified. The review concludes by highlighting the need to provide healthcare professionals with continuing education about the mental health problems of children and young people, including risk factors and management strategies.
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Angelo, Maria-Genalin; Taylor, Sylvia; Struyf, Frank; Tavares Da Silva, Fernanda; Arellano, Felix; David, Marie-Pierre; Dubin, Gary; Rosillon, Dominique; Baril, Laurence
2014-11-01
The HPV types 16/18-AS04-adjuvanted cervical cancer vaccine, Cervarix(®) (HPV-16/18-vaccine, GlaxoSmithKline, Belgium) was first approved in 2007 and is licensed in 134 countries for the prevention of persistent infection, premalignant cervical lesions and cervical cancer caused by oncogenic HPV. Benefit-risk status requires continual re-evaluation as vaccine uptake increases, as the epidemiology of the disease evolves and as new information becomes available. This paper provides an example of benefit-risk considerations and risk-management planning. Evaluation of the benefit-risk of HPV-16/18-vaccine post-licensure includes studies with a range of designs in many countries and in collaboration with national public agencies and regulatory authorities. The strategy to assess benefit versus risk will continue to evolve and adapt to the changing HPV-16/18-vaccine market.
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Adverse Outcome Pathway Network Analyses: Techniques and benchmarking the AOPwiki
Abstract: As the community of toxicological researchers, risk assessors, and risk managers adopt the adverse outcome pathway (AOP) paradigm for organizing toxicological knowledge, the number and diversity of adverse outcome pathways and AOP networks are continuing to grow. This ...
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Risk management frameworks for human health and environmental risks.
Jardine, Cindy; Hrudey, Steve; Shortreed, John; Craig, Lorraine; Krewski, Daniel; Furgal, Chris; McColl, Stephen
2003-01-01
A comprehensive analytical review of the risk assessment, risk management, and risk communication approaches currently being undertaken by key national, provincial/state, territorial, and international agencies was conducted. The information acquired for review was used to identify the differences, commonalities, strengths, and weaknesses among the various approaches, and to identify elements that should be included in an effective, current, and comprehensive approach applicable to environmental, human health and occupational health risks. More than 80 agencies, organizations, and advisory councils, encompassing more than 100 risk documents, were examined during the period from February 2000 until November 2002. An overview was made of the most important general frameworks for risk assessment, risk management, and risk communication for human health and ecological risk, and for occupational health risk. In addition, frameworks for specific applications were reviewed and summarized, including those for (1)contaminated sites; (2) northern contaminants; (3) priority substances; (4) standards development; (5) food safety; (6) medical devices; (7) prescription drug use; (8) emergency response; (9) transportation; (10) risk communication. Twelve frameworks were selected for more extensive review on the basis of representation of the areas of human health, ecological, and occupational health risk; relevance to Canadian risk management needs; representation of comprehensive and well-defined approaches; generalizability with their risk areas; representation of "state of the art" in Canada, the United States, and/or internationally; and extent of usage of potential usage within Canada. These 12 frameworks were: 1. Framework for Environmental Health Risk Management (US Presidential/Congressional Commission on Risk Assessment and Risk Management, 1997). 2. Health Risk Determination: The Challenge of Health Protection (Health and Welfare Canada, 1990). 3. Health Canada Decision-Making Framework for Identifying, Assessing and Managing Health Risks (Health Canada, 2000). 4. Canadian Environmental Protection Act: Human Health Risk Assessment of Priority Substances(Health Canada, 1994). 5. CSA-Q8550 Risk Management: Guidelines for Decision-Makers (Canada Standards Association, 1997). 6. Risk Assessment in the Federal Government: Managing the Process (US National Research Council, 1983). 7. Understanding Risk: Informing Decisions in a Democratic Society (US National Research Council, 1996). 8. Environmental Health Risk Assessment (enHealth Council of Australia, 2002). 9. A Framework for Ecological Risk Assessment (CCME, 1996). 10. Ecological Risk Assessments of Priority Substances Under the Canadian Environmental Protection Act (Environment Canada, 1996).11. Guidelines for Ecological Risk Assessment (US EPA, 1998b). 12. Proposed Model for Occupational Health Risk Assessment and Management (Rampal & Sadhra, 1999). Based on the extensive review of these frameworks, seven key elements that should be included in a comprehensive framework for human health, ecological, and occupational risk assessment and management were identified: 1. Problem formulation stage. 2. Stakeholder involvement. 3. Communication. 4. Quantitative risk assessment components. 5. Iteration and evaluation. 6. Informed decision making. 7. Flexibility. On the basis of this overarching approach to risk management, the following "checklist" to ensure a good risk management decision is proposed: - Make sure you're solving the right problem. - Consider the problem and the risk within the full context of the situation, using a broad perspective. - Acknowledge, incorporate, and balance the multiple dimensions of risk. - Ensure the highest degree of reliability for all components of the risk management process. - Involve interested and effected parties from the outset of the process. - Commit to honest and open communication between all parties. - Employ continuous evaluation throughout the process (formative, process, and outcome evaluation), and be prepared to change the decision if new information becomes available. Comprehensive and sound principles are critical to providing structure and integrity to risk management frameworks. Guiding principles are intended to provide an ethical grounding for considering the many factors involved in risk management decision making. Ten principles are proposed to guide risk management decision making. The first four principles were adapted and modified from Hattis (1996) along with the addition of two more principles by Hrudey (2000). These have been supplemented by another four principles to make the 10 presented. The principles are based in fundamental ethical principles and values. These principles are intended to be aspirational rather than prescriptive--their application requires flexibility and practical judgement. Risk management is inherently a process in search of balance among competing interests and concerns. Each risk management decision will be "balancing act" of competing priorities, and trade-offs may sometimes have to be made between seemingly conflicting principles. The 10 decision-making principles, with the corresponding ethical principle in italics are: 1. Do more good than harm (beneficence, nonmalificence).- The ultimate goal of good risk management is to prevent or minimize risk, or to "do good" as much as possible. 2. Fair process of decision making (fairness, natural justice). - Risk management must be just, equitable, impartial, unbiased, dispassionate, and objective as far as possible given the circumstances of each situation. 3. Ensure an equitable distribution of risk (equity). - An equitable process of risk management would ensure fair outcomes and equal treatment of all concerned through an equal distribution of benefits and burdens (includes the concept of distributive justice, i.e., equal opportunities for all individuals). 4. Seek optimal use of limited risk management resources (utility). - Optimal risk management demands using limited resources where they will achieve the most risk reduction of overall benefit. 5. Promise no more risk management that can be delivered (honesty).- Unrealistic expectations of risk management can be avoided with honest and candid public accounting of what we know and don't know, and what we can and can't do using risk assessment and risk management. 6. Impose no more risk that you would tolerate yourself (the Golden Rule). - The Golden Rule is important in risk management because it forces decision makers to abandon complete detachment from their decisions so they may understand the perspectives of those affected. 7. Be cautious in the face of uncertainty ("better safe than sorry"). - Risk management must adopt a cautious approach when faced with a potentially serous risk, even if the evidence is uncertain. 8. Foster informed risk decision making for all stakeholders (autonomy). - Fostering autonomous decision making involves both providing people with the opportunity to participate, and full and honest disclosure of all the information required for informed decisions. 9. Risk management processes must be flexible and evolutionary to be open to new knowledge and understanding (evolution, evaluation, iterative process). - The incorporation of new evidence requires that risk management be a flexible, evolutionary, and iterative process, and that evaluation is employed at the beginning and througthout the process. 10. the complete elimination fo risk is not possible (life is not risk free).- Risk is pervasive in our society, and cannot be totally eliminated despite an oft-expressed public desire for "zero risk". However, the level of risk that may ve tolerable by any individual is dependent on values of beliefs, as well as scientific information. Each agency must continue to employ a process that meets the needs of their specific application of risk management. A single approach cannot satisfy the diverse areas to which risk decisions are being applied. However, with increasing experience in the application of the approaches, we are evolving to a common understanding of the essential elements and principles required for successful risk assessment, risk management, and risk communication. Risk management will continue to be a balancing act of competing priorities and needs. Flexibility and good judgement are ultimately the key to successfully making appropriate risk decisions.
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Code of Federal Regulations, 2011 CFR
2011-07-01
... 40 Protection of Environment 15 2011-07-01 2011-07-01 false Updates. 68.190 Section 68.190 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.190 Updates. (a) The owner or operator shall...
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Code of Federal Regulations, 2011 CFR
2011-07-01
... 40 Protection of Environment 15 2011-07-01 2011-07-01 false Submission. 68.150 Section 68.150 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.150 Submission. (a) The owner or operator shall...
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40 CFR 68.195 - Required corrections.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 40 Protection of Environment 15 2011-07-01 2011-07-01 false Required corrections. 68.195 Section 68.195 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.195 Required corrections. The owner or...
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40 CFR 68.155 - Executive summary.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 40 Protection of Environment 15 2011-07-01 2011-07-01 false Executive summary. 68.155 Section 68.155 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.155 Executive summary. The owner or...
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Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Registration. 68.160 Section 68.160 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.160 Registration. (a) The owner or operator shall...
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40 CFR 68.155 - Executive summary.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Executive summary. 68.155 Section 68.155 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.155 Executive summary. The owner or...
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40 CFR 68.180 - Emergency response program.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Emergency response program. 68.180 Section 68.180 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.180 Emergency response program...
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40 CFR 68.195 - Required corrections.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Required corrections. 68.195 Section 68.195 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.195 Required corrections. The owner or...
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Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Updates. 68.190 Section 68.190 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.190 Updates. (a) The owner or operator shall...
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Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Submission. 68.150 Section 68.150 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.150 Submission. (a) The owner or operator shall...
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Zarbo, Richard J; Copeland, Jacqueline R; Varney, Ruan C
2017-10-01
To develop a business subsystem fulfilling International Organization for Standardization 15189 nonconformance management regulatory standard, facilitating employee engagement in problem identification and resolution to effect quality improvement and risk mitigation. From 2012 to 2016, the integrated laboratories of the Henry Ford Health System used a quality technical team to develop and improve a management subsystem designed to identify, track, trend, and summarize nonconformances based on frequency, risk, and root cause for elimination at the level of the work. Programmatic improvements and training resulted in markedly increased documentation culminating in 71,641 deviations in 2016 classified by a taxonomy of 281 defect types into preanalytic (74.8%), analytic (23.6%), and postanalytic (1.6%) testing phases. The top 10 deviations accounted for 55,843 (78%) of the total. Deviation management is a key subsystem of managers' standard work whereby knowledge of nonconformities assists in directing corrective actions and continuous improvements that promote consistent execution and higher levels of performance. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
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Deploying and measuring a risk and patient safety program.
Orel, Howard; McGroarty, Molly; Marchegiani, Heather
2017-01-01
Health care continues to evolve at a rapid rate. Over just the past decade, the industry has seen the introduction and widespread implementation of an electronic health record, increase in presence of nurse practitioners and physician assistants to help manage the shortage of physicians, and the introduction of accountable care organizations. It is with these changes that new challenges and opportunities emerge. One such challenge is the increase in the severity of medical malpractice claims throughout the nation. Another emerging challenge is the introduction of outcome-based reimbursements, with providers potentially losing a portion of their payment should the patient experience result in a preventable adverse event. These trends are resulting in providers continuously seeking innovative approaches to reducing risk and improving patient safety. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.
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Managing multihazards risk in metropolitan USA
NASA Astrophysics Data System (ADS)
Aktan, A. Emin; Comfort, Louise K.; Shanis, Donald S.
2003-07-01
This proposal outlines an action plan for risk management in the Delaware Valley Metropolitan Region. This plan is consistent with the goals for strengthening homeland security announced by President Bush, and is designed to complement efforts currently under development by Pennsylvania Emergency Management Agency and Department of Health. This plan proposes the formation of a Delaware Valley Risk Management Consortium, representing the critical disciplines and organizations related to risk assessment and management. This group would have membership from academic institutions, government agencies, industry, and nonprofit organizations. This Consortium would develop a systemic scope of work with the appropriate recommendations for technology acquisition, development and integration with risk management policies and procedures. This scope of work would include the development of two related information systems for the Delaware Valley Region. The first would be a comprehensive 'health monitoring' system to assess the continuity of operations, which would use integrated remote sensing and imaging, information gathering, communication, computation, and, information processing and management over wide-area networks covering the entire metropolitan area. The second would use real-time information from the health monitoring system to support interactive communication, search and information exchange needed to coordinate action among the relevant agencies to mitigate risk, respond to hazards and manage its resources efficiently and effectively.
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40 CFR 68.170 - Prevention program/Program 2.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 40 Protection of Environment 15 2011-07-01 2011-07-01 false Prevention program/Program 2. 68.170 Section 68.170 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.170 Prevention program/Program...
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40 CFR 68.168 - Five-year accident history.
Code of Federal Regulations, 2012 CFR
2012-07-01
... 40 Protection of Environment 16 2012-07-01 2012-07-01 false Five-year accident history. 68.168 Section 68.168 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.168 Five-year accident history...
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40 CFR 68.168 - Five-year accident history.
Code of Federal Regulations, 2014 CFR
2014-07-01
... 40 Protection of Environment 16 2014-07-01 2014-07-01 false Five-year accident history. 68.168 Section 68.168 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.168 Five-year accident history...
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40 CFR 68.168 - Five-year accident history.
Code of Federal Regulations, 2013 CFR
2013-07-01
... 40 Protection of Environment 16 2013-07-01 2013-07-01 false Five-year accident history. 68.168 Section 68.168 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.168 Five-year accident history...
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40 CFR 68.168 - Five-year accident history.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 40 Protection of Environment 15 2011-07-01 2011-07-01 false Five-year accident history. 68.168 Section 68.168 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.168 Five-year accident history...
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40 CFR 68.168 - Five-year accident history.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Five-year accident history. 68.168 Section 68.168 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.168 Five-year accident history...
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40 CFR 68.170 - Prevention program/Program 2.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Prevention program/Program 2. 68.170 Section 68.170 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.170 Prevention program/Program...
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Michail, Maria; Tait, Lynda; Churchill, Dick
2017-09-01
Aim To examine general practitioners' (GPs) clinical expertise in assessing, communicating with, and managing suicidal young people aged 14-25 to inform the development of an educational intervention for GPs on youth suicide prevention. Suicide is the second leading cause of death for young people worldwide. GPs are ideally suited to facilitate early identification and assessment of suicide risk. However, GPs' levels of competence, knowledge, and attitudes towards suicidal young people have not yet been explored. A cross-sectional survey on GPs' levels of confidence in assessing and managing young people at risk of suicide; knowledge of risk factors and warning signs of suicide in young people; attitudes towards young suicidal people; and training preferences on managing suicide risk. Findings Seventy GPs completed the survey (30 males). The majority of GPs reported high levels of confidence in assessing and managing suicidality in young people. Experienced GPs demonstrated high levels of knowledge of suicide risk factors in young people but low levels of knowledge of warning signs that might indicate heightened risk. Although 48% of GPs disagreed that maintaining compassionate care is difficult with those who deliberately self-harm, GPs perceived communication with young people to be difficult, with one-third reporting frustration in managing those at risk of suicide. A total of 75% of GPs said they would be interested in receiving further training on assessing and managing young people at risk of suicide. The study has important implications for providing specialist training to support GPs in assessing and managing youth suicide risk and facilitating attitudinal change. GP education on youth suicide risk assessment and management should promote a holistic understanding and assessment of risk and its individual, social and contextual influences in line with clinical recommendations to facilitate therapeutic engagement and communication with young people.
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Integrating Risk Management and Strategic Planning
ERIC Educational Resources Information Center
Achampong, Francis K.
2010-01-01
Strategic planning is critical to ensuring that institutions of higher education thoughtfully and systematically position themselves to accomplish their mission, vision, and strategic goals, particularly when these institutions face a myriad of risks that can negatively impact their continued financial viability and compromise their ability to…
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Tom Zimmerman
2009-01-01
Since its origin as a defined functional activity, wildland fire management has been the natural resource management program with the highest risk, complexity, and greatest potential for serious negative outcomes. During this time, this program has continually grown in temporal and spatial extent, operational complexity, ecological significance, social, economic, and...
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A queueing theory based model for business continuity in hospitals.
Miniati, R; Cecconi, G; Dori, F; Frosini, F; Iadanza, E; Biffi Gentili, G; Niccolini, F; Gusinu, R
2013-01-01
Clinical activities can be seen as results of precise and defined events' succession where every single phase is characterized by a waiting time which includes working duration and possible delay. Technology makes part of this process. For a proper business continuity management, planning the minimum number of devices according to the working load only is not enough. A risk analysis on the whole process should be carried out in order to define which interventions and extra purchase have to be made. Markov models and reliability engineering approaches can be used for evaluating the possible interventions and to protect the whole system from technology failures. The following paper reports a case study on the application of the proposed integrated model, including risk analysis approach and queuing theory model, for defining the proper number of device which are essential to guarantee medical activity and comply the business continuity management requirements in hospitals.
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Risks and benefits of Twitter use by hematologists/oncologists in the era of digital medicine.
Attai, Deanna J; Anderson, Patricia F; Fisch, Michael J; Graham, David L; Katz, Matthew S; Kesselheim, Jennifer; Markham, Merry Jennifer; Pennell, Nathan A; Sedrak, Mina S; Thompson, Michael A; Utengen, Audun; Dizon, Don S
2017-10-01
Twitter use by physicians, including those in the hematology-oncology field, is increasing. This microblogging platform provides a means to communicate and collaborate on a global scale. For the oncology professional, an active Twitter presence provides opportunities for continuing medical education, patient engagement and education, personal branding, and reputation management. However, because Twitter is an open, public forum, potential risks such as patient privacy violations, personal information disclosures, professionalism lapses, and time management need to be considered and managed. The authors have summarized the benefits and risks of Twitter use by the hematology-oncology physician. In addition, strategies to maximize benefit and minimize risk are discussed, and resources for additional learning are provided. Copyright © 2017 Elsevier Inc. All rights reserved.
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40 CFR 68.151 - Assertion of claims of confidential business information.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 40 Protection of Environment 15 2011-07-01 2011-07-01 false Assertion of claims of confidential business information. 68.151 Section 68.151 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.151...
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40 CFR 264.551 - Grandfathered Corrective Action Management Units (CAMUs).
Code of Federal Regulations, 2011 CFR
2011-07-01
... risks to humans or to the environment resulting from exposure to hazardous wastes or hazardous... human health and the environment, to include, for areas where wastes will remain in place, monitoring... (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE...
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40 CFR 264.551 - Grandfathered Corrective Action Management Units (CAMUs).
Code of Federal Regulations, 2013 CFR
2013-07-01
... risks to humans or to the environment resulting from exposure to hazardous wastes or hazardous... human health and the environment, to include, for areas where wastes will remain in place, monitoring... (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE...
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In September 1997, the U.S. Department of Energy (DOE) and U.S. Environmental Protection Agency (EPA) co-sponsored a demonstration of several multimetal continuous emission monitos (CEMs). The demonstration, performed at the EPA National Risk Management Research Laboratory, Air P...
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7 CFR 205.239 - Livestock living conditions.
Code of Federal Regulations, 2011 CFR
2011-01-01
.... Continuous total confinement of any animal indoors is prohibited. Continuous total confinement of ruminants in yards, feeding pads, and feedlots is prohibited. (2) For all ruminants, management on pasture and..., or well-being of the animal could be jeopardized; (4) Risk to soil or water quality; (5) Preventive...
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40 CFR 68.151 - Assertion of claims of confidential business information.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Assertion of claims of confidential business information. 68.151 Section 68.151 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.151...
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Influenza pandemic periodicity, virus recycling, and the art of risk assessment.
Dowdle, Walter R
2006-01-01
Influenza pandemic risk assessment is an uncertain art. The theory that influenza A virus pandemics occur every 10 to 11 years and seroarcheologic evidence of virus recycling set the stage in early 1976 for risk assessment and risk management of the Fort Dix, New Jersey, swine influenza outbreak. Additional data and passage of time proved the theory untenable. Much has been learned about influenza A virus and its natural history since 1976, but the exact conditions that lead to the emergence of a pandemic strain are still unknown. Current avian influenza events parallel those of swine influenza in 1976 but on a larger and more complex scale. Pre- and post-pandemic risk assessment and risk management are continuous but separate public health functions.
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Extractive waste management: A risk analysis approach.
Mehta, Neha; Dino, Giovanna Antonella; Ajmone-Marsan, Franco; Lasagna, Manuela; Romè, Chiara; De Luca, Domenico Antonio
2018-05-01
Abandoned mine sites continue to present serious environmental hazards because the heavy metals associated with extractive waste are continuously released into the environment, where they threaten human life and the environment. Remediating and securing extractive waste are complex, lengthy and costly processes. Thus, in most European countries, a site is considered for intervention when it poses a risk to human health and the surrounding environment. As a consequence, risk analysis presents a viable decisional approach towards the management of extractive waste. To evaluate the effects posed by extractive waste to human health and groundwater, a risk analysis approach was used for an abandoned nickel extraction site in Campello Monti in North Italy. This site is located in the Southern Italian Alps. The area consists of large and voluminous mafic rocks intruded by mantle peridotite. The mining activities in this area have generated extractive waste. A risk analysis of the site was performed using Risk Based Corrective Action (RBCA) guidelines, considering the properties of extractive waste and water for the properties of environmental matrices. The results showed the presence of carcinogenic risk due to arsenic and risks to groundwater due to nickel. The results of the risk analysis form a basic understanding of the current situation at the site, which is affected by extractive waste. Copyright © 2017 Elsevier B.V. All rights reserved.
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Cramer, Robert J; Bryson, Claire N; Eichorst, Morgam K; Keyes, Lee N; Ridge, Brittany E
2017-03-01
As professional psychology training programs and continuing education have moved toward competency based approaches, it has become equally important to develop uniform, evidence-based approaches for suicide risk assessment and management. The present article presents a workshop curriculum based on established core competencies in suicide risk assessment and management. Drawing on theories suicide risk formation, the workshop features an integration of didactic, process, and experiential components. We present pilot data from 2 small group workshops (n = 17): 1 from a clinical psychology doctoral program and 1 from a university counseling center. Workshop participation yielded increases in (a) the ability to recognize appropriate clinician responses to suicidal client statements, (b) self-perceptions of general capacity to interface with suicidal patients and mastery of the 10 core competencies, (c) factual knowledge concerning suicide risk assessment and management, and (d) the self-rated ability to assess and manage a suicidal patient. We discuss statistical and generalizability limitations as well as implications for future modification, implementation, and provision of this training method. © 2016 Wiley Periodicals, Inc.
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A risk analysis for production processes with disposable bioreactors.
Merseburger, Tobias; Pahl, Ina; Müller, Daniel; Tanner, Markus
2014-01-01
: Quality management systems are, as a rule, tightly defined systems that conserve existing processes and therefore guarantee compliance with quality standards. But maintaining quality also includes introducing new enhanced production methods and making use of the latest findings of bioscience. The advances in biotechnology and single-use manufacturing methods for producing new drugs especially impose new challenges on quality management, as quality standards have not yet been set. New methods to ensure patient safety have to be established, as it is insufficient to rely only on current rules. A concept of qualification, validation, and manufacturing procedures based on risk management needs to be established and realized in pharmaceutical production. The chapter starts with an introduction to the regulatory background of the manufacture of medicinal products. It then continues with key methods of risk management. Hazards associated with the production of medicinal products with single-use equipment are described with a focus on bioreactors, storage containers, and connecting devices. The hazards are subsequently evaluated and criteria for risk evaluation are presented. This chapter concludes with aspects of industrial application of quality risk management.
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Update on Neonatal Hypoglycemia
Rozance, Paul J.
2014-01-01
Purpose of Review Neonatal hypoglycemia is one of the most common biochemical abnormalities encountered in the newborn. However, controversy remains surrounding its definition and management especially in asymptomatic patients. Recent Findings New information has been published that describes the incidence and timing of low glucose concentrations in the groups most at risk for asymptomatic neonatal hypoglycemia. Furthermore, one large prospective study failed to find an association between repetitive low glucose concentrations and poor neurodevelopmental outcomes in preterm infants. But hypoglycemia due to hyperinsulinism, especially genetic causes, continued to be associated with brain injury. New advances were made in the diagnosis and management of hyperinsulinism, including acquired hyperinsulinism in small for gestational age infants and others. Continuous glucose monitoring remains an attractive strategy for future research in this area. Summary The fundamental question of how best to manage asymptomatic newborns with low glucose concentrations remains unanswered. Balancing the risks of over treating newborns with low glucose concentrations who are undergoing a normal transition following birth against the risks of under treating those in whom low glucose concentrations are pathological, dangerous, and/or a harbinger of serious metabolic disease remains a challenge. PMID:24275620
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Update on neonatal hypoglycemia.
Rozance, Paul J
2014-02-01
Neonatal hypoglycemia is one of the most common biochemical abnormalities encountered in the newborn. However, controversy remains surrounding its definition and management especially in asymptomatic patients. New information has been published that describes the incidence and timing of low glucose concentrations in the groups most at risk for asymptomatic neonatal hypoglycemia. Furthermore, one large prospective study failed to find an association between repetitive low glucose concentrations and poor neurodevelopmental outcomes in preterm infants. But hypoglycemia due to hyperinsulinism, especially genetic causes, continued to be associated with brain injury. New advances were made in the diagnosis and management of hyperinsulinism, including acquired hyperinsulinism in small for gestational age infants and others. Continuous glucose monitoring remains an attractive strategy for future research in this area. The fundamental question of how best to manage asymptomatic newborns with low glucose concentrations remains unanswered. Balancing the risks of overtreating newborns with low glucose concentrations who are undergoing a normal transition following birth against the risks of undertreating those in whom low glucose concentrations are pathological, dangerous, and/or a harbinger of serious metabolic disease remains a challenge.
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NASA Technical Reports Server (NTRS)
Bonine, Lauren
2015-01-01
The presentation provides insight into the schedule risk analysis process used by the Stratospheric Aerosol and Gas Experiment III on the International Space Station Project. The presentation focuses on the schedule risk analysis process highlighting the methods for identification of risk inputs, the inclusion of generic risks identified outside the traditional continuous risk management process, and the development of tailored analysis products used to improve risk informed decision making.
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31 CFR 223.10 - Limitation of risk.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Limitation of risk. 223.10 Section 223.10 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE SURETY COMPANIES DOING BUSINESS WITH THE...
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31 CFR 223.10 - Limitation of risk.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Limitation of risk. 223.10 Section 223.10 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE SURETY COMPANIES DOING BUSINESS WITH THE UNITED...
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31 CFR 223.10 - Limitation of risk.
Code of Federal Regulations, 2013 CFR
2013-07-01
... 31 Money and Finance:Treasury 2 2013-07-01 2013-07-01 false Limitation of risk. 223.10 Section 223.10 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE SURETY COMPANIES DOING BUSINESS WITH THE UNITED...
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31 CFR 223.10 - Limitation of risk.
Code of Federal Regulations, 2012 CFR
2012-07-01
... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Limitation of risk. 223.10 Section 223.10 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE SURETY COMPANIES DOING BUSINESS WITH THE UNITED...
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Rheumatoid Arthritis and Cardiovascular Disease: Update on Treatment Issues
Barbhaiya, Medha; Solomon, Daniel H.
2016-01-01
Purpose of review This review examines thresholds for treatment of traditional cardiovascular disease (CVD) risk factors among RA patients and whether RA-specific treatment modulates cardiovascular risk. Recent findings There are substantial data demonstrating an increased CVD risk among patients with RA. Both traditional CVD risk factors and inflammation contribute to this risk. Recent epidemiologic studies strengthen the case that aggressive immunosuppression with biologic DMARDs, such as TNF antagonists, is associated with a reduced risk of CVD events. However, to data, there are no randomized controlled trials published regarding the management of CVD in RA. Summary Epidemiologic evidence continues to accumulate regarding the relationship between the effects of traditional CVD risk factors and RA-specific treatments on CV outcomes in RA. The field needs randomized controlled trials to better guide management. PMID:23466960
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Frese, Richard C; Weber, Ryan J
2013-11-01
To reduce and control their level of tail liability, hospitals should: Utilize a self-insurance vehicle; Consider combined limits between the hospital and physicians; Communicate any program changes to the actuary, underwriter, and auditor; Continue risk management and safety practices; Ensure credit is given to the organization's own medical malpractice program.
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A Risk Stratification Tool to Assess Commercial Influences on Continuing Medical Education
ERIC Educational Resources Information Center
Barnes, Barbara E.; Cole, Jeanne G.; King, Catherine Thomas; Zukowski, Rebecca; Allgier-Baker, Tracy; Rubio, Doris McGartland; Thorndyke, Luanne E.
2007-01-01
Introduction: Heightened concerns about industry influence on continuing medical education (CME) have prompted tighter controls on the management of commercial funding and conflict of interest. As a result, CME providers must closely monitor their activities and intervene if bias or noncompliance with accreditation standards is likely. Potential…
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Liability and Risk Management for Continuing Education Professionals.
ERIC Educational Resources Information Center
Cote, Lawrence S.; And Others
Areas of liability that relate to the daily practice of continuing education professionals are summarized. Areas of the law with the greatest potential for litigation involving the institution and its employees are identified, along with 16 preventive measures that protect the educational practitioner and institution from frivolous litigation yet…
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49 CFR 192.1007 - What are the required elements of an integrity management plan?
Code of Federal Regulations, 2010 CFR
2010-10-01
... (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY TRANSPORTATION OF NATURAL AND OTHER GAS BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Gas... threats and risks to its gas distribution pipeline. (2) Consider the information gained from past design...
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The use and role of predictive systems in disease management.
Gent, David H; Mahaffee, Walter F; McRoberts, Neil; Pfender, William F
2013-01-01
Disease predictive systems are intended to be management aids. With a few exceptions, these systems typically do not have direct sustained use by growers. Rather, their impact is mostly pedagogic and indirect, improving recommendations from farm advisers and shaping management concepts. The degree to which a system is consulted depends on the amount of perceived new, actionable information that is consistent with the objectives of the user. Often this involves avoiding risks associated with costly disease outbreaks. Adoption is sensitive to the correspondence between the information a system delivers and the information needed to manage a particular pathosystem at an acceptable financial risk; details of the approach used to predict disease risk are less important. The continuing challenge for researchers is to construct tools relevant to farmers and their advisers that improve upon their current management skill. This goal requires an appreciation of growers' decision calculus in managing disease problems and, more broadly, their overall farm enterprise management.
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Vittengl, Jeffrey R; Anna Clark, Lee; Thase, Michael E; Jarrett, Robin B
2017-07-01
Responders to acute-phase cognitive therapy (A-CT) for major depressive disorder (MDD) often relapse or recur, but continuation-phase cognitive therapy (C-CT) or fluoxetine reduces risks for some patients. We tested composite moderators of C-CT versus fluoxetine's preventive effects to inform continuation treatment selection. Responders to A-CT for MDD judged to be at higher risk for relapse due to unstable or partial remission (N=172) were randomized to 8 months of C-CT or fluoxetine with clinical management and assessed, free from protocol treatment, for 24 additional months. Pre-continuation-treatment characteristics that in survival analyses moderated treatments' effects on relapse over 8 months of continuation-phase treatment (residual symptoms and negative temperament) and on relapse/recurrence over the full observation period's 32 months (residual symptoms and age) were combined to estimate the potential advantage of C-CT versus fluoxetine for individual patients. Assigning patients to optimal continuation treatment (i.e., to C-CT or fluoxetine, depending on patients' pre-continuation-treatment characteristics) resulted in absolute reduction of relapse or recurrence risk by 16-21% compared to the other non-optimal treatment. Although these novel results require replication before clinical application, selecting optimal continuation treatment (i.e., personalizing treatment) for higher risk A-CT responders may decrease risks of MDD relapse and recurrence substantively. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.
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Drought early warning and risk management in a changing environment
NASA Astrophysics Data System (ADS)
Pulwarty, R. S.
2011-12-01
Drought has long been recognized as falling into the category of incremental but long-term and cumulative environmental changes, also termed slow-onset or creeping events. These event types would include: air and water quality decline, desertification processes, deforestation and forest fragmentation, loss of biodiversity and habitats, and nitrogen overloading, among others. Climate scientists continue to struggle with recognizing the onset of drought and scientists and policy makers continue to debate the basis (i.e., criteria) for declaring an end to a drought. Risk-based management approaches to drought planning at the national and regional levels have been recommended repeatedly over the years but their prototyping, testing and operational implementation have been limited. This presentation will outline two avenues for disaster risk reduction in the context of drought (1) integrated early warning information systems, and (2) linking disaster risk reduction to climate change adaptation strategies. Adaptation involves not only using operational facilities and infrastructure to cope with the immediate problems but also leaving slack or reserve for coping with multiple stress problems that produce extreme impacts and surprise. Increasing the 'anticipatability' of an event, involves both monitoring of key indicators from appropriate baseline data, and observing early warning signs that assumptions in risk management plans are failing and critical transitions are occurring. Illustrative cases will be drawn from the IPCC Special Report on Managing the Risks of Extreme Events and Disasters (2011), the UN Global Assessment of Disaster Risk Reduction (2011) and implementation activities in which the author has been engaged. Most drought early warning systems have tended to focus on the development and use of physical system indicators and forecasts of trends and thresholds. We show that successful early warning systems that meet expectations of risk management also have explicit foci on (1) integrating physical and social vulnerability indicators across timescales, (2) analytical capacity to generate local scenarios of risk using both analogs and projections, (3) the communication of risk-based information, and (4) the support and governance of a collaborative framework for early warning structures across spatial scales.
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Lessons from disaster: Creating a business continuity plan that really works.
Hatton, Tracy; Grimshaw, Eleanor; Vargo, John; Seville, Erica
Business Continuity Planning (BCP) is well established as a key plank in an organisation's risk management process. But how effective is BCP when disaster strikes? This paper examines the experiences of organisations following the 2010-11 Canterbury, New Zealand earthquakes. The study finds that BCP was helpful for all organisations interviewed but more attention is needed on the management of societal and personal impacts; development of employee resilience, identification of effective crisis leaders; right-sizing plans and planning to seize opportunities post-disaster.
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Dobrokhotskiĭ, O N; Kolombet, L V
2010-01-01
The paper shows it urgent to realize the concept of biological risk assessment and management on handling pathogenic biological agents (PBA). It gives a number of objective reasons that impede development of a methodology to assess laboratory biological risks. A concept of continuous improvement (a process approach) is proposed for use as a biorisk management tool for biosafety assurance when handling PBA. It is demonstrated that development of international cooperation urgently requires that national concepts and standards be harmonized with international regulatory documents on biosafety assurance on handling PBA.
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[Process management in the hospital pharmacy for the improvement of the patient safety].
Govindarajan, R; Perelló-Juncá, A; Parès-Marimòn, R M; Serrais-Benavente, J; Ferrandez-Martí, D; Sala-Robinat, R; Camacho-Calvente, A; Campabanal-Prats, C; Solà-Anderiu, I; Sanchez-Caparrós, S; Gonzalez-Estrada, J; Martinez-Olalla, P; Colomer-Palomo, J; Perez-Mañosas, R; Rodríguez-Gallego, D
2013-01-01
To define a process management model for a hospital pharmacy in order to measure, analyse and make continuous improvements in patient safety and healthcare quality. In order to implement process management, Igualada Hospital was divided into different processes, one of which was the Hospital Pharmacy. A multidisciplinary management team was given responsibility for each process. For each sub-process one person was identified to be responsible, and a working group was formed under his/her leadership. With the help of each working group, a risk analysis using failure modes and effects analysis (FMEA) was performed, and the corresponding improvement actions were implemented. Sub-process indicators were also identified, and different process management mechanisms were introduced. The first risk analysis with FMEA produced more than thirty preventive actions to improve patient safety. Later, the weekly analysis of errors, as well as the monthly analysis of key process indicators, permitted us to monitor process results and, as each sub-process manager participated in these meetings, also to assume accountability and responsibility, thus consolidating the culture of excellence. The introduction of different process management mechanisms, with the participation of people responsible for each sub-process, introduces a participative management tool for the continuous improvement of patient safety and healthcare quality. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.
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New antithrombotic agents in the ambulatory setting.
Gibbs, Neville M; Weightman, William M; Watts, Stephen A
2014-12-01
Many patients presenting for surgical or other procedures in an ambulatory setting are taking new antiplatelet or anticoagulant agents. This review assesses how the novel features of these new agents affect the management of antithrombotic therapy in the ambulatory setting. There have been very few studies investigating the relative risks of continuing or ceasing new antithrombotic agents. Recent reviews indicate that the new antithrombotic agents offer greater efficacy or ease of administration but are more difficult to monitor or reverse. They emphasize the importance of assessing the bleeding risk of the procedure, the thrombotic risk if the agent is ceased, and patient factors that increase the likelihood of bleeding. The timing of cessation of the agent, if required, depends on its pharmacokinetics and patients' bleeding risks. Patients at high risk of thrombotic complications may require bridging therapy. Once agreed upon, the perioperative plan should be made clear to all involved. As there are few clinical studies to guide management, clinicians must make rational decisions in relation to continuing or ceasing new antithrombotic agents. This requires knowledge of their pharmacokinetics, and a careful multidisciplinary assessment of the relative thrombotic and bleeding risks in individual patients.
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PSP, TSP, XP, CMMI...Eating the Alphabet Soup!
2011-05-19
Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other...4 Q tit t Continuous process improvement Organizational Performance Management Causal Analysis and Resolution Level Focus Process Areas Requirements...Project Management process standardization Risk management Decision Analysis and Resolution Product Integration 2 M d R i t t anage Basic Project
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Implementation of Risk Management in NASA's CEV Project- Ensuring Mission Success
NASA Astrophysics Data System (ADS)
Perera, Jeevan; Holsomback, Jerry D.
2005-12-01
Most project managers know that Risk Management (RM) is essential to good project management. At NASA, standards and procedures to manage risk through a tiered approach have been developed - from the global agency-wide requirements down to a program or project's implementation. The basic methodology for NASA's risk management strategy includes processes to identify, analyze, plan, track, control, communicate and document risks. The identification, characterization, mitigation plan, and mitigation responsibilities associated with specific risks are documented to help communicate, manage, and effectuate appropriate closure. This approach helps to ensure more consistent documentation and assessment and provides a means of archiving lessons learned for future identification or mitigation activities.A new risk database and management tool was developed by NASA in 2002 and since has been used successfully to communicate, document and manage a number of diverse risks for the International Space Station, Space Shuttle, and several other NASA projects and programs including at the Johnson Space Center. Organizations use this database application to effectively manage and track each risk and gain insight into impacts from other organization's viewpoint to develop integrated solutions. Schedule, cost, technical and safety issues are tracked in detail through this system.Risks are tagged within the system to ensure proper review, coordination and management at the necessary management level. The database is intended as a day-to- day tool for organizations to manage their risks and elevate those issues that need coordination from above. Each risk is assigned to a managing organization and a specific risk owner who generates mitigation plans as appropriate. In essence, the risk owner is responsible for shepherding the risk through closure. The individual that identifies a new risk does not necessarily get assigned as the risk owner. Whoever is in the best position to effectuate comprehensive closure is assigned as the risk owner. Each mitigation plan includes the specific tasks that will be conducted to either decrease the likelihood of the risk occurring and/or lessen the severity of the consequences if they do occur. As each mitigation task is completed, the responsible managing organization records the completion of the task in the risk database and then re-scores the risk considering the task's results. By keeping scores updated, a managing organization's current top risks and risk posture can be readily identified including the status of any risk in the system.A number of metrics measure risk process trends from data contained in the database. This allows for trend analysis to further identify improvements to the process and assist in the management of all risks. The metrics will also scrutinize both the effectiveness and compliance of risk management requirements.The risk database is an evolving tool and will be continuously improved with capabilities requested by the NASA project community. This paper presents the basic foundations of risk management, the elements necessary for effective risk management, and the capabilities of this new risk database and how it is implemented to support NASA's risk management needs.
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31 CFR 223.14 - Schedules of single risks.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Schedules of single risks. 223.14 Section 223.14 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE SURETY COMPANIES DOING BUSINESS WITH THE...
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31 CFR 223.11 - Limitation of risk: Protective methods.
Code of Federal Regulations, 2012 CFR
2012-07-01
... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Limitation of risk: Protective methods. 223.11 Section 223.11 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE SURETY COMPANIES DOING BUSINESS...
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31 CFR 223.11 - Limitation of risk: Protective methods.
Code of Federal Regulations, 2013 CFR
2013-07-01
... 31 Money and Finance:Treasury 2 2013-07-01 2013-07-01 false Limitation of risk: Protective methods. 223.11 Section 223.11 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE SURETY COMPANIES DOING BUSINESS...
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31 CFR 223.11 - Limitation of risk: Protective methods.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Limitation of risk: Protective methods. 223.11 Section 223.11 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE SURETY COMPANIES DOING BUSINESS...
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31 CFR 223.14 - Schedules of single risks.
Code of Federal Regulations, 2013 CFR
2013-07-01
... 31 Money and Finance:Treasury 2 2013-07-01 2013-07-01 false Schedules of single risks. 223.14 Section 223.14 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE SURETY COMPANIES DOING BUSINESS WITH THE...
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31 CFR 223.14 - Schedules of single risks.
Code of Federal Regulations, 2012 CFR
2012-07-01
... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Schedules of single risks. 223.14 Section 223.14 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE SURETY COMPANIES DOING BUSINESS WITH THE...
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31 CFR 223.14 - Schedules of single risks.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Schedules of single risks. 223.14 Section 223.14 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE SURETY COMPANIES DOING BUSINESS WITH THE...
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76 FR 72220 - Incorporation of Risk Management Concepts in Regulatory Programs
Federal Register 2010, 2011, 2012, 2013, 2014
2011-11-22
... and support the adoption of improved designs or processes. \\1\\ A deterministic approach to regulation... longstanding goal to move toward more risk-informed, performance- based approaches in its regulatory programs... regulatory approach that would continue to ensure the safe and secure use of nuclear material. As part of...
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45 CFR 2551.25 - What are a sponsor's administrative responsibilities?
Code of Federal Regulations, 2014 CFR
2014-10-01
... project and carry out its project management responsibilities. (c) Employ a full-time project director to... the sponsor organization and/or project service area. (f) Establish risk management policies and... responsibility for securing maximum and continuing community financial and in-kind support to operate the project...
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45 CFR 2551.25 - What are a sponsor's administrative responsibilities?
Code of Federal Regulations, 2012 CFR
2012-10-01
... project and carry out its project management responsibilities. (c) Employ a full-time project director to... the sponsor organization and/or project service area. (f) Establish risk management policies and... responsibility for securing maximum and continuing community financial and in-kind support to operate the project...
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45 CFR 2551.25 - What are a sponsor's administrative responsibilities?
Code of Federal Regulations, 2013 CFR
2013-10-01
... project and carry out its project management responsibilities. (c) Employ a full-time project director to... the sponsor organization and/or project service area. (f) Establish risk management policies and... responsibility for securing maximum and continuing community financial and in-kind support to operate the project...
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45 CFR 2551.25 - What are a sponsor's administrative responsibilities?
Code of Federal Regulations, 2011 CFR
2011-10-01
... project and carry out its project management responsibilities. (c) Employ a full-time project director to... the sponsor organization and/or project service area. (f) Establish risk management policies and... responsibility for securing maximum and continuing community financial and in-kind support to operate the project...
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Akama-Garren, Elliot H.; Bianchi, Matt T.; Leveroni, Catherine; Cole, Andrew J.; Cash, Sydney S.; Westover, M. Brandon
2016-01-01
SUMMARY Objectives Anterior temporal lobectomy is curative for many patients with disabling medically refractory temporal lobe epilepsy, but carries an inherent risk of disabling verbal memory loss. Although accurate prediction of iatrogenic memory loss is becoming increasingly possible, it remains unclear how much weight such predictions should have in surgical decision making. Here we aim to create a framework that facilitates a systematic and integrated assessment of the relative risks and benefits of surgery versus medical management for patients with left temporal lobe epilepsy. Methods We constructed a Markov decision model to evaluate the probabilistic outcomes and associated health utilities associated with choosing to undergo a left anterior temporal lobectomy versus continuing with medical management for patients with medically refractory left temporal lobe epilepsy. Three base-cases were considered, representing a spectrum of surgical candidates encountered in practice, with varying degrees of epilepsy-related disability and potential for decreased quality of life in response to post-surgical verbal memory deficits. Results For patients with moderately severe seizures and moderate risk of verbal memory loss, medical management was the preferred decision, with increased quality-adjusted life expectancy. However, the preferred choice was sensitive to clinically meaningful changes in several parameters, including quality of life impact of verbal memory decline, quality of life with seizures, mortality rate with medical management, probability of remission following surgery, and probability of remission with medical management. Significance Our decision model suggests that for patients with left temporal lobe epilepsy, quantitative assessment of risk and benefit should guide recommendation of therapy. In particular, risk for and potential impact of verbal memory decline should be carefully weighed against the degree of disability conferred by continued seizures on a patient-by-patient basis. PMID:25244498
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Akama-Garren, Elliot H; Bianchi, Matt T; Leveroni, Catherine; Cole, Andrew J; Cash, Sydney S; Westover, M Brandon
2014-11-01
Anterior temporal lobectomy is curative for many patients with disabling medically refractory temporal lobe epilepsy, but carries an inherent risk of disabling verbal memory loss. Although accurate prediction of iatrogenic memory loss is becoming increasingly possible, it remains unclear how much weight such predictions should have in surgical decision making. Here we aim to create a framework that facilitates a systematic and integrated assessment of the relative risks and benefits of surgery versus medical management for patients with left temporal lobe epilepsy. We constructed a Markov decision model to evaluate the probabilistic outcomes and associated health utilities associated with choosing to undergo a left anterior temporal lobectomy versus continuing with medical management for patients with medically refractory left temporal lobe epilepsy. Three base-cases were considered, representing a spectrum of surgical candidates encountered in practice, with varying degrees of epilepsy-related disability and potential for decreased quality of life in response to post-surgical verbal memory deficits. For patients with moderately severe seizures and moderate risk of verbal memory loss, medical management was the preferred decision, with increased quality-adjusted life expectancy. However, the preferred choice was sensitive to clinically meaningful changes in several parameters, including quality of life impact of verbal memory decline, quality of life with seizures, mortality rate with medical management, probability of remission following surgery, and probability of remission with medical management. Our decision model suggests that for patients with left temporal lobe epilepsy, quantitative assessment of risk and benefit should guide recommendation of therapy. In particular, risk for and potential impact of verbal memory decline should be carefully weighed against the degree of disability conferred by continued seizures on a patient-by-patient basis. Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.
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[Organizational and management companies models].
Tomei, G; Tomei, F; Fiaschetti, M; De Sio, S; Tria, M; Schifano, M P; Monti, C; Tasciotti, Z; Panfili, T; Caciari, A; Sancini, A
2010-01-01
With the legislative decree 81/08 and s.m.i. it's explicitly defined a model of management and corporate organization that can contribute to prevent security risks in work environments. The realization of the model is not obligatory, but desirable because the result of its implementation is a decrease of company's risks and costs for safety. Our study group has developed the structure of an organizational and management model for corporate safety and the tools necessary for its realization. The realization of a model is structured in various phases: initial exam, safety policy, planification, implementation, monitoring, system retest and improvement. Such a model, in continuous evolution, is based on the responsibilities of the different corporate figures through an accurate analysis of the measured risks and the measures adopted.
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Safety skills of mental health workers: empirical evidence of a risk management strategy.
Flannery, Raymond B; Walker, Andrew P
2003-01-01
To reduce violence in the workplace, health care facilities invest time and resources in risk management strategies such as photo identification and controlled access and surveillance. Studies of assaultive psychiatric patients continue to document that mental health workers (MHWs) are the most frequent targets of the patient violence. Unexamined in these findings is the role skilled MHWs contribute in restoring safety and order in the aftermath of these assaults. This six-year, empirical retrospective study examined the safety skills of MHWs in containing violence. Although they were 28% of the workforce, MHWs restored order in the majority of single assault incidents and restraint procedures. Their skills appear to be a risk management strategy in their own right. The implications are discussed.
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Management of antithrombotic therapy during cardiac implantable device surgery.
AlTurki, Ahmed; Proietti, Riccardo; Birnie, David H; Essebag, Vidal
2016-06-01
Anticoagulants are commonly used drugs that are frequently encountered during device placement. Deciding when to halt or continue the use of anticoagulants is a balance between the risks of thromboembolism versus bleeding. Patients taking warfarin with a high risk of thromboembolism should continue to take their warfarin without interruption during device placement while ensuring their international normalized ratio remains below 3. For patients who are taking warfarin and have low risk of thromboembolism, either interrupted or continued warfarin may be used, with no evidence to clearly support either strategy. There is little evidence to support continuing direct acting oral anticoagulants (DOACs) for device implantation. The timing of halting these medications depends largely on renal function. If bleeding occurs, warfarin׳s anticoagulation effect is reversible with vitamin K and activated prothrombin complex concentrate. There are no DOAC reversal agents currently available, but some are under development. Regarding antiplatelet agents, aspirin alone can be safely continued while clopidogrel alone may also be continued, but with a slightly higher bleeding risk. Dual antiplatelet therapy for bare-metal stent/drug-eluting stent implanted within 4 weeks/6 months, respectively, should be continued due to high risk of stent thrombosis; however, if they are implanted after this period, then clopidogrel can be halted 5 days before the procedure and resumed soon after, while aspirin is continued. If the patient is taking both aspirin and warfarin, aspirin should be halted 5 days prior to the procedure, while warfarin is continued.
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Principles of hospital disaster management: an integrated and multidisciplinary approach.
Hendrickx, C; Hoker, S D; Michiels, G; Sabbe, M B
Principles of hospital disaster management: an integrated and multidisciplinary approach. Hospitals play an important role during a disaster response, and are also at risk for internal incidents. We propose an integrated and multidisciplinary approach towards hospital disaster management and preparedness. In addition to response strategies, much attention is given to risk assessment and preparedness in the pre-incident phase and to business continuity planning (BCP) in the post-incident phase. It is essential to train key players and all personnel to understand the Hospital Incident Management System (HIMS) and to perform specific emergency procedures. All emergency procedures should be grounded in evidence-based practice resulting from essential disaster response research.
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Business continuity 2014: From traditional to integrated Business Continuity Management.
Ee, Henry
As global change continues to generate new challenges and potential threats to businesses, traditional business continuity management (BCM) slowly reveals its limitations and weak points to ensuring 'business resiliency' today. Consequently, BCM professionals also face the challenge of re-evaluating traditional concepts and introducing new strategies and industry best practices. This paper points to why traditional BCM is no longer sufficient in terms of enabling businesses to survive in today's high-risk environment. It also looks into some of the misconceptions about BCM and other stumbling blocks to establishing effective BCM today. Most importantly, however, this paper provides tips based on the Business Continuity Institute's (BCI) Good Practices Guideline (GPG) and the latest international BCM standard ISO 22301 on how to overcome the issues and challenges presented.
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Goetzel, Ron Z; Ozminkowski, Ronald J; Baase, Catherine M; Billotti, Gary M
2005-08-01
We sought to estimate the impact of corporate health-management and risk-reduction programs for The Dow Chemical Company by using a prospective return-on-investment (ROI) model. The risk and expenditure estimates were derived from multiple regression analyses showing relationships between worker demographics, health risks, and medical expenditures. A "break-even" scenario would require Dow to reduce each of 10 population health risks by 0.17% points per year over the course of 10 years. More successful efforts at reducing health risks in the population would produce a more significant ROI for the company. Findings from this study were incorporated into other components of a business case for health and productivity management, and these supported continued investments in health improvement programs designed to achieve risk reduction and cost savings.
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Crowe, Marie; Burrell, Beverly; Whitehead, Lisa
2012-08-01
This article is a report of a study that examined how women describe their decisions in relation to the use of menopausal hormone therapy following surgical menopause. Women who have had a surgically induced menopause generally experience more intense menopausal symptoms than natural menopause and are regularly prescribed menopausal hormone therapy. Since 2002 the risks associated with this therapy have been widely reported. This study is a qualitative analysis of semi-structured interviews between March and May 2009 with 30 participants who had experienced surgical menopause and were, or had in the past, taken menopausal hormone therapy. This was a community sample recruited in Christchurch, New Zealand. A risk management theoretical approach underpinned the analysis. The womens' descriptions of managing the risks associated with menopausal therapy fell into two main themes: Life has to go on and Waiting for someone to tell me. All these women had either made an active decision to continue on treatment because of the impact of menopausal symptoms or took their doctor's advice to continue. A less dominant theme but one that was also evident was Relying on my body to get me through in which the women had decided to discontinue treatment because they regarded it as unnatural. The study provided insights into how women utilize an experiential reasoning process to manage the health and lifestyle risks associated with taking menopausal hormone therapy. Nurses need to be aware of how this process influences women's reasoning processes when working with women following surgical menopause. © 2011 Blackwell Publishing Ltd.
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NASA Astrophysics Data System (ADS)
Frigm, R.; Johnson, L.
The Probability of Collision (Pc) has become a universal metric and statement of on-orbit collision risk. Although several flavors of the computation exist and are well-documented in the literature, the basic calculation requires the same input: estimates for the position, position uncertainty, and sizes of the two objects involved. The Pc is used operationally to make decisions on whether a given conjunction poses significant collision risk to the primary object (or space asset of concern). It is also used to determine necessity and degree of mitigative action (typically in the form of an orbital maneuver) to be performed. The predicted post-maneuver Pc also informs the maneuver planning process into regarding the timing, direction, and magnitude of the maneuver needed to mitigate the collision risk. Although the data sources, techniques, decision calculus, and workflows vary for different agencies and organizations, they all have a common thread. The standard conjunction assessment and collision risk concept of operations (CONOPS) predicts conjunctions, assesses the collision risk (typically, via the Pc), and plans and executes avoidance activities for conjunctions as a discrete events. As the space debris environment continues to increase and improvements are made to remote sensing capabilities and sensitivities to detect, track, and predict smaller debris objects, the number of conjunctions will in turn continue to increase. The expected order-of-magnitude increase in the number of predicted conjunctions will challenge the paradigm of treating each conjunction as a discrete event. The challenge will not be limited to workload issues, such as manpower and computing performance, but also the ability for satellite owner/operators to successfully execute their mission while also managing on-orbit collision risk. Executing a propulsive maneuver occasionally can easily be absorbed into the mission planning and operations tempo; whereas, continuously planning evasive maneuvers for multiple conjunction events is time-consuming and would disrupt mission and science operations beyond what is tolerable. At the point when the number of conjunctions is so large that it is no longer possible to consider each individually, some sort of an amalgamation of events and risk must be considered. This shift is to one where each conjunction cannot be treated individually and the effects of all conjunctions within a given period of time must be considered together. This new paradigm is called finite Conjunction Assessment (CA) risk management. This paper considers the use of the Total Probability of Collision (TPc) as an analogous collision risk metric in the finite CA paradigm. TPc is expressed by the equation below and provides an aggregate probability of colliding with any one of the predicted conjunctions under consideration. TPc=1-?(1-Pc,i) While the TPc computation is straightforward and its physical meaning is understandable, the implications of its usage operationally requires a change in mindset and approach to collision risk management. This paper explores the necessary changes to evolve the basic CA and collision risk management CONOPS from discrete to finite CA, including aspects of collision risk assessment and collision risk mitigation. It proposes numerical and graphical decision aids to understand both the “risk outlook” for a given primary as well as mitigation options for the total collision risk. Both concepts make use of the TPc as a metric for finite collision risk management. Several operational scenarios are used to demonstrate the proposed concepts in practice.
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Hewner, Sharon; Wu, Yow-Wu Bill; Castner, Jessica
2016-01-01
Hospitalized adult Medicaid recipients with chronic disease are at risk for rehospitalization within 90 days of discharge, but most research has focused on the Medicare population. The purpose of this study is to examine the impact of population-based care management intensity on inpatient readmissions in Medicaid adults with pre-existing chronic disease. Retrospective analyses of 2,868 index hospital admissions from 2012 New York State Medicaid Data Warehouse claims compared 90-day post-discharge utilization in populations with and without transitional care management interventions. High intensity managed care organization interventions were associated with higher outpatient and lower emergency department post-discharge utilization than low intensity fee-for-service management. However, readmission rates were higher for the managed care cases. Shorter time to readmission was associated with managed care, diagnoses that include heart and kidney failure, shorter length of stay for index hospitalization, and male sex; with no relationship to age. This unexpected result flags the need to re-evaluate readmission as a quality indicator in the complex Medicaid population. Quality improvement efforts should focus on care continuity during transitions and consider population-specific factors that influence readmission. Optimum post-discharge utilization in the Medicaid population requires a balance between outpatient, emergency and inpatient services to improve access and continuity.
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40 CFR 68.165 - Offsite consequence analysis.
Code of Federal Regulations, 2013 CFR
2013-07-01
... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.165 Offsite consequence... released in pounds; (7) Release rate; (8) Release duration; (9) Wind speed and atmospheric stability class...
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40 CFR 68.165 - Offsite consequence analysis.
Code of Federal Regulations, 2012 CFR
2012-07-01
... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.165 Offsite consequence... released in pounds; (7) Release rate; (8) Release duration; (9) Wind speed and atmospheric stability class...
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40 CFR 68.165 - Offsite consequence analysis.
Code of Federal Regulations, 2014 CFR
2014-07-01
... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.165 Offsite consequence... released in pounds; (7) Release rate; (8) Release duration; (9) Wind speed and atmospheric stability class...
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Mission operations and command assurance: Flight operations quality improvements
NASA Technical Reports Server (NTRS)
Welz, Linda L.; Bruno, Kristin J.; Kazz, Sheri L.; Potts, Sherrill S.; Witkowski, Mona M.
1994-01-01
Mission Operations and Command Assurance (MO&CA) is a Total Quality Management (TQM) task on JPL projects to instill quality in flight mission operations. From a system engineering view, MO&CA facilitates communication and problem-solving among flight teams and provides continuous solving among flight teams and provides continuous process improvement to reduce risk in mission operations by addressing human factors. The MO&CA task has evolved from participating as a member of the spacecraft team, to an independent team reporting directly to flight project management and providing system level assurance. JPL flight projects have benefited significantly from MO&CA's effort to contain risk and prevent rather than rework errors. MO&CA's ability to provide direct transfer of knowledge allows new projects to benefit from previous and ongoing flight experience.
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[Risk management in anesthesia and critical care medicine].
Eisold, C; Heller, A R
2017-03-01
Throughout its history, anesthesia and critical care medicine has experienced vast improvements to increase patient safety. Consequently, anesthesia has never been performed on such a high level as it is being performed today. As a result, we do not always fully perceive the risks involved in our daily activity. A survey performed in Swiss hospitals identified a total of 169 hot spots which endanger patient safety. It turned out that there is a complex variety of possible errors that can only be tackled through consistent implementation of a safety culture. The key elements to reduce complications are continuing staff education, algorithms and standard operating procedures (SOP), working according to the principles of crisis resource management (CRM) and last but not least the continuous work-up of mistakes identified by critical incident reporting systems.
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Smith, André; Fiddler, Jay; Walby, Kevin; Hier, Sean
2011-11-01
This article examines the process of rebuilding institutional trust in the Canadian blood system in the aftermath of the tainted blood scandal. Our focus is the policy of lifetime deferral from donating blood for men who have sex with men. Drawing on findings from interviews with representatives of Health Canada's Expert Advisory Committee on Blood Regulation, the National Liaison Committee, Canadian Blood Services, and blood consumer groups, we demonstrate how claims making about rights, discrimination, science, and risk contribute to policy continuity. We also examine the link between policy continuity and the management of reputational risk.
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Anticoagulation management in the ambulatory surgical setting.
Eisenstein, Diana Hill
2012-04-01
Many people receiving maintenance anticoagulation therapy require surgery each year in ambulatory surgery centers. National safety organizations focus attention toward improving anticoagulation management, and the American College of Chest Physicians has established guidelines for appropriate anticoagulation management to balance the risk of thromboembolism when warfarin is discontinued with the risk of bleeding when anticoagulation therapy is maintained. The guidelines recommend that patients at high or moderate risk for thromboembolism should be bridged with subcutaneous low-molecular-weight heparin or IV unfractionated heparin with the interruption of warfarin, and low-risk patients may require subcutaneous low-molecular-weight heparin or no bridging with the interruption of warfarin. The guidelines recommend the continuation of warfarin for patients who are undergoing minor dermatologic or dental procedures or cataract removal. The literature reveals, however, that there is not adequate adherence to these recommendations and guidelines. Management of anticoagulation therapy by a nurse practitioner may improve compliance and safety in ambulatory surgery centers. Copyright © 2012 AORN, Inc. Published by Elsevier Inc. All rights reserved.
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Climate analyses to assess risks from invasive forest insects: Simple matching to advanced models
Robert C. Venette
2017-01-01
Purpose of Review. The number of invasive alien insects that adversely affect trees and forests continues to increase as do associated ecological, economic, and sociological impacts. Prevention strategies remain the most cost-effective approach to address the issue, but risk management decisions, particularly those affecting international trade,...
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75 FR 8352 - Agency Information Collection Activities: Final Collection; Comment Request
Federal Register 2010, 2011, 2012, 2013, 2014
2010-02-24
... utilization and management prospective insurance liability relative to risk premiums received. DATES: Comments...). SUMMARY: The Export-Import Bank of the United States (Ex-Im Bank), as a part of its continuing effort to... Institution'' as an option; b. Under ``Obligo Types'' we have deleted ``Eximbank Sole Risk'' as an option; c...
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Assessing wildfire risks at multiple spatial scales
Justin Fitch
2008-01-01
In continuation of the efforts to advance wildfire science and develop tools for wildland fire managers, a spatial wildfire risk assessment was carried out using Classification and Regression Tree analysis (CART) and Geographic Information Systems (GIS). The analysis was performed at two scales. The small-scale assessment covered the entire state of New Mexico, while...
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Trustees Are Playing a Greater Role in Managing Colleges' Risks
ERIC Educational Resources Information Center
Wolverton, Brad
2008-01-01
College trustees are stepping up their oversight as institutions seek new revenue sources and as government scrutiny of higher education continues to increase, a panel of management experts said last week at the annual conference of the Association of Governing Boards of Universities and Colleges. Across the country, board members are hiring…
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Puljic, Anela; Kim, Elissa; Page, Jessica; Esakoff, Tania; Shaffer, Brian; LaCoursiere, Daphne Y; Caughey, Aaron B
2015-05-01
The objective of the study was to characterize the risk of infant and fetal death by each additional week of expectant management vs immediate delivery in pregnancies complicated by cholestasis. This was a retrospective cohort study of 1,604,386 singleton, nonanomalous pregnancies of women between 34 and 40 weeks' gestation with and without intrahepatic cholestasis of pregnancy (ICP) in the state of California during the years of 2005-2008. International Classification of Diseases, 9th version, codes and linked hospital discharge and vital statistics data were utilized. For each week of gestation, the following outcomes were assessed: the risk of stillbirth, the risk of delivery (represented by the risk of infant death at a given week of gestation), and the composite risk of expectant management for 1 additional week. Composite risk combines the risk of stillbirth at this gestational age week plus the risk of infant death if delivered at the subsequent week of gestation. Among women with ICP, the mortality risk of delivery is lower than the risk of expectant management at 36 weeks' gestation (4.7 vs 19.2 per 10,000). The risk of expectant management remains higher than delivery and continues to rise by week of gestation beyond 36 weeks. The risk of expectant management in women with ICP reaches a nadir at 35 weeks (9.1 per 10,000; 95% confidence interval, 1.4-16.9) and rises at 36 weeks (19.2 per 10,000; 95% confidence interval, 7.6-30.8). Among women with ICP, delivery at 36 weeks' gestation would reduce the perinatal mortality risk as compared with expectant management. For later diagnoses, this would also be true at gestational ages beyond 36 weeks. Timing of delivery must take into account both the reduction in stillbirth risk balanced with the morbidities associated with preterm delivery. Copyright © 2015 Elsevier Inc. All rights reserved.
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Emergency Unemployment Compensation Continuation Act
Rep. Cicilline, David N. [D-RI-1
2014-01-07
House - 02/12/2014 Referred to the Subcommittee on General Farm Commodities and Risk Management. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:
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Thase, Michael E.
2010-01-01
Background Major depressive disorder (MDD) is highly prevalent and associated with disability and chronicity. Although cognitive therapy (CT) is an effective short-term treatment for MDD, a significant proportion of responders subsequently suffer relapses or recurrences. Purpose This design prospectively evaluates: 1) a method to discriminate CT-treated responders at lower versus higher risk for relapse; and 2) the subsequent durability of 8-month continuation phase therapies in randomized higher risk responders followed for an additional 24-months. The primary prediction is: after protocol treatments are stopped, higher risk patients randomly assigned to continuation phase CT (C-CT) will have a lower risk of relapse/recurrence than those randomized to fluoxetine (FLX). Methods Outpatients, aged 18 to 70 years, with recurrent MDD received 12–14 weeks of CT provided by 15 experienced therapists from two sites. Responders (i.e., no MDD and 17-item Hamilton Rating Scale for Depression ≤ 12) were stratified into higher and lower risk groups based on stability of remission during the last 6 weeks of CT. The lower risk group entered follow-up for 32 months; the higher risk group was randomized to 8 months of continuation phase therapy with either C-CT or clinical management plus either double-blinded FLX or pill placebo. Following the continuation phase, higher risk patients were followed by blinded evaluators for 24 months. Results The trial began in 2000. Enrollment is complete (N=523). The follow-up continues. Conclusions The trial evaluates the preventive effects and durability of acute and continuation phase treatments in the largest known sample of CT responders collected worldwide. PMID:20451668
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Risk management in obstetric care for family physicians: results of a 10-year project.
Nesbitt, Thomas S; Hixon, Allen; Tanji, Jeffrey L; Scherger, Joseph E; Abbott, Dana
2003-01-01
Malpractice issues within the United States remain a critical factor for family physicians providing obstetric care. Although tort reform is being widely discussed, little has been written regarding the malpractice crisis from a risk management perspective. Between 1989 and 1998, a 10-year risk management study at the UC Davis Health System provided a unique collaboration between researchers, a mutual insurance carrier and family physicians practicing obstetrics. Physicians were asked to comply with standardized clinical guidelines, attend continuing medical education (CME) seminars, and submit obstetric medical records for review. Feedback analysis was provided to each physician on their records, and the insurance carrier tracked interim malpractice claims. One hundred and ninety-four physicians participated, attending to 32,831 births. Compliance with project guidelines was 91%. Five closed obstetric cases were reported with only one settlement reported to the National Provider Data Bank. Physicians believed the project was beneficial to their practices. Family physicians practicing obstetrics are willing to participate in a collaborative risk management program and are compliant with standardized clinical guidelines. The monetary award for successful malpractice claims was relatively low. This collaborative risk management model may offer a potential solution to the current malpractice crisis.
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A contemporary perspective on capitated reimbursement for imaging services.
Schwartz, H W
1995-01-01
Capitation ensures predictability of healthcare costs, requires acceptance of a premium in return for providing all required medical services and defines the actual dollar amount paid to a physician or hospital on a per member per month basis for a service or group of services. Capitation is expected to dramatically affect the marketplace in the near future, as private enterprise demands lower, more stable healthcare costs. Capitation requires detailed quantitative and financial data, including: eligibility and benefits determination, encounter processing, referral management, claims processing, case management, physician compensation, insurance management functions, outcomes reporting, performance management and cost accounting. It is important to understand actuarial risk and capitation marketing when considering a capitation contract. Also, capitated payment methodologies may vary to include modified fee-for-service, incentive pay, risk pool redistributions, merit, or a combination. Risk is directly related to the ability to predict utilization and unit cost of imaging services provided to a specific insured population. In capitated environments, radiologists will have even less control over referrals than they have today and will serve many more "covered lives"; long-term relationships with referring physicians will continue to evaporate; and services will be provided under exclusive, multi-year contracts. In addition to intensified use of technology for image transfer, telecommunications and sophisticated data processing and tracking systems, imaging departments must continue to provide the greatest amount of appropriate diagnostic information in a timely fashion at the lowest feasible cost and risk to the patient.
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Wilson, J
Healthcare delivery is a risky business. People view the NHS in the same light as other commercial businesses such as the hotel, retail and airline industries. The White Paper 'The New NHS: Modern, Dependable' (Secretary of State for Health, 1997) places statutory responsibilities on managers and clinicians to provide a quality service and to have accountability for clinical governance and performance management. Quality and risk are two sides of the same coin, i.e. if you have good quality you have low risk, and this firmly supports the clinical effectiveness agenda. Healthcare organizations in all sectors of care delivery need to demonstrate their high levels of achievement and commitment to continuous quality improvements. Risk management is a process for identifying, assessing and evaluating risks which have adverse effects on the quality, safety and effectiveness of service delivery, and taking positive action to eliminate or reduce them. Having an open, honest and blame-free organization which is open to improving processes and systems of care is a big step towards having staff who are committed to quality and getting things right. Near-miss, incident and indicator recording and reporting are cornerstones of any quality and risk management system.
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Wheeler, Willis B
2002-07-17
Pest management techniques have evolved over the past 50 years. Inorganic chemical pesticides were replaced by synthetic organic chemicals, and now biopesticides constitute a significant part of pest management technology. Requirements for the regulatory approval of pesticides changed dramatically in 1996 with the passage of the Food Quality Protection Act (FQPA). The FQPA directs the U.S. Environmental Protection Agency (EPA) to make more rigorous and conservative evaluation of risks and hazards and mandates a special emphasis on the safety of infants and children. The EPA provides incentives for the industry to register materials that are designated "reduced risk". The future for the registrant industry will include continued reduction in numbers of registrants through mergers and acquisitions. Conventional chemicals will remain as important pest management components, and the processes of combinatorial chemistry and high-throughput bioassays will allow the rapid synthesis and testing of large numbers of candidate compounds. Biopesticides will become more important tools in pest management, with microbial pesticides and transgenic crops being likely to play important crop protection roles. There will be a continuing need for research-based approaches to pest control.
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Shah, Rajendra; Faruqui, Rafey A
2013-01-01
This study presents a case report on the emergence of delusional jealousy and person-directed hostility in a patient following anoxic brain injury. The patient did not have a pre-injury history of mental illness, nor a family history of a psychotic disorder. This patient was followed-up over a 5-year period and his history of treatment response, violence risk management and successful rehabilitation are presented. This study also highlights issues in relation to continuation of treatment with antipsychotic medication, use of compulsory admission under the Mental Health Act and principles of risk assessment and risk management.
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Sakorafas, George H
2003-04-01
Despite recent progress in the diagnostic and therapeutic approaches to the management of women with breast cancer, at least one third of these women will ultimately die from their disease. This resulted in a new focus on breast cancer prevention, especially for the woman designed as "high-risk". The continuing challenge is to identify reliable markers to accurately recognize this group of women, who are more likely to develop breast cancer. This will allow a targeted specific counseling and the application of preventative measures. Management options in high-risk women include intensive cancer surveillance, chemoprevention (mainly using tamoxifen), and prophylactic surgery (preferentially total mastectomy). Cancer surveillance is the most preferred management option. Currently, no data exists comparing prophylactic mastectomy vs. surveillance vs. chemoprevention. Thus, despite significant advances in our understanding of the biology of breast cancer, many questions remain unanswered concerning the optimal management of the high-risk woman. Patient counseling has a central role in the decision-making process and should be based on a multidisciplinary approach. The individual woman will make the final decision based on the amount of risk she is willing to accept. It is hoped that other preventative methods, such as gene therapy based on an accurate identification of specific genetic changes, will be developed in the future.
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Emergent Risks In Critical Infrastructures
NASA Astrophysics Data System (ADS)
Dynes, Scott
Firms cannot function successfully without managing a host of internal and external organizational and process interdependencies. Part of this involves business continuity planning, which directly aects how resilient arm and its business sector are in the face of disruptions. This paper presents the results of eld studies related to information risk management practices in the health care and retail sectors. The studies explore information risk management coordinating signals within and across rms in these sectors as well as the potential eects of cyber disruptions on the rms as stand-alone entities and as part of a critical infrastructure. The health care case study investigates the impact of the Zotob worm on the ability to deliver medical care and treatment. The retail study examines the resilience of certain elements of the food supply chain to cyber disruptions.
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Reback, Cathy J; Peck, James A; Fletcher, Jesse B; Nuno, Miriam; Dierst-Davies, Rhodri
2012-01-01
Homeless, substance-dependent men who have sex with men (MSM) continue to suffer health disparities, including high rates of HIV. One-hundred and thirty one homeless, substance-dependent MSM were randomized into a contingency management (CM) intervention to increase substance abstinence and health-promoting behaviors. Participants were recruited from a community-based, health education/risk reduction HIV prevention program and the research activities were also conducted at the community site. Secondary analyses were conducted to identify and characterize treatment responders (defined as participants in a contingency management intervention who scored at or above the median on three primary outcomes). Treatment responders were more likely to be Caucasian/White (p < .05), report fewer years of lifetime methamphetamine, cocaine, and polysubstance use (p < or = .05), and report more recent sexual partners and high-risk sexual behaviors than nonresponders (p < .05). The application of evidence-based interventions continues to be a public health priority, especially in the effort to implement effective interventions for use in community settings. The identification of both treatment responders and nonresponders is important for intervention development tailored to specific populations, both in service programs and research studies, to optimize outcomes among highly impacted populations.
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Vassy, Jason L; Davis, J Kelly; Kirby, Christine; Richardson, Ian J; Green, Robert C; McGuire, Amy L; Ubel, Peter A
2018-06-01
Genomics will play an increasingly prominent role in clinical medicine. To describe how primary care physicians (PCPs) discuss and make clinical recommendations about genome sequencing results. Qualitative analysis. PCPs and their generally healthy patients undergoing genome sequencing. Patients received clinical genome reports that included four categories of results: monogenic disease risk variants (if present), carrier status, five pharmacogenetics results, and polygenic risk estimates for eight cardiometabolic traits. Patients' office visits with their PCPs were audio-recorded, and summative content analysis was used to describe how PCPs discussed genomic results. For each genomic result discussed in 48 PCP-patient visits, we identified a "take-home" message (recommendation), categorized as continuing current management, further treatment, further evaluation, behavior change, remembering for future care, or sharing with family members. We analyzed how PCPs came to each recommendation by identifying 1) how they described the risk or importance of the given result and 2) the rationale they gave for translating that risk into a specific recommendation. Quantitative analysis showed that continuing current management was the most commonly coded recommendation across results overall (492/749, 66%) and for each individual result type except monogenic disease risk results. Pharmacogenetics was the most common result type to prompt a recommendation to remember for future care (94/119, 79%); carrier status was the most common type prompting a recommendation to share with family members (45/54, 83%); and polygenic results were the most common type prompting a behavior change recommendation (55/58, 95%). One-fifth of recommendation codes associated with monogenic results were for further evaluation (6/24, 25%). Rationales for these recommendations included patient context, family context, and scientific/clinical limitations of sequencing. PCPs distinguish substantive differences among categories of genome sequencing results and use clinical judgment to justify continuing current management in generally healthy patients with genomic results.
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Exploration Systems Development (ESD) Approach to Enterprise Risk Management
NASA Technical Reports Server (NTRS)
Bauder, Stephen P.
2014-01-01
The National Aeronautics and Space Administration (NASA) Exploration Systems Development (ESD) Division has implemented an innovative approach to Enterprise Risk Management under a unique governance structure and streamlined integration model. ESD's mission is to design and build the capability to extend human existence to deep space. The Enterprise consists of three Programs: Space Launch System (SLS), Orion, and Ground Systems Development and Operations (GSDO). The SLS is a rocket and launch system that will be capable of powering humans, habitats, and support systems to deep space. Orion will be the first spacecraft in history capable of taking humans to multiple destinations within deep space. GSDO is modernizing Kennedy's spaceport to launch spacecraft built and designed by both NASA and private industry. ESD's approach to Enterprise Risk Management is commensurate with affordability and a streamlined management philosophy. ESD Enterprise Risk Management leverages off of the primary mechanisms for integration within the Enterprise. The Enterprise integration approach emphasizes delegation of authority to manage and execute the majority of cross-program activities and products to the individual Programs, while maintaining the overall responsibility for all cross-program activities at the Division. The intent of the ESD Enterprise Risk Management approach is to improve risk communication, to avoid replication and/or contradictory strategies, and to minimize overhead process burden. This is accomplished by the facilitation and integration of risk information within ESD. The ESD Division risks, Orion risks, SLS risks, and GSDO risks are owned and managed by the applicable Program. When the Programs have shared risks with multiple consequences, they are jointly owned and managed. When a risk is associated with the integrated system that involves more than one Program in condition, consequence, or mitigation plan, it is considered an Exploration Systems Integration (ESI) Risk. An ESI risk may require visibility and risk handling by multiple organizations. The Integrated Risk Working Group (IRWG) is a small team of Risk experts that are responsible for collaborating and communicating best practices. In addition, the forum facilitates proper integration of risks across the Enterprise. The IRWG uses a Continuous Risk Management approach for facilitating the identification, analysis, planning, tracking, and controlling of ESI Risks. The ESD Division, Programs, and Integrated Task Teams identify ESI Risks. The IRWG maintains a set of metrics for understanding Enterprise Risk process and the overall Risk Posture. The team is also actively involved in the modeling of risk for Enterprise Performance Management. With the Enterprise being constrained in Schedule and Budget, and with significant technical complexity, the appropriate use of Risk Management techniques is crucial to the success of the Enterprise. The IRWG achieves this through the modified approach, providing a forum for collaboration on risks that cross boundaries between the separate entities.
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The potential benefits of a new poliovirus vaccine for long-term poliovirus risk management.
Duintjer Tebbens, Radboud J; Thompson, Kimberly M
2016-12-01
To estimate the incremental net benefits (INBs) of a hypothetical ideal vaccine with all of the advantages and no disadvantages of existing oral and inactivated poliovirus vaccines compared with current vaccines available for future outbreak response. INB estimates based on expected costs and polio cases from an existing global model of long-term poliovirus risk management. Excluding the development costs, an ideal poliovirus vaccine could offer expected INBs of US$1.6 billion. The ideal vaccine yields small benefits in most realizations of long-term risks, but great benefits in low-probability-high-consequence realizations. New poliovirus vaccines may offer valuable insurance against long-term poliovirus risks and new vaccine development efforts should continue as the world gathers more evidence about polio endgame risks.
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Developing an ontological explosion knowledge base for business continuity planning purposes.
Mohammadfam, Iraj; Kalatpour, Omid; Golmohammadi, Rostam; Khotanlou, Hasan
2013-01-01
Industrial accidents are among the most known challenges to business continuity. Many organisations have lost their reputation following devastating accidents. To manage the risks of such accidents, it is necessary to accumulate sufficient knowledge regarding their roots, causes and preventive techniques. The required knowledge might be obtained through various approaches, including databases. Unfortunately, many databases are hampered by (among other things) static data presentations, a lack of semantic features, and the inability to present accident knowledge as discrete domains. This paper proposes the use of Protégé software to develop a knowledge base for the domain of explosion accidents. Such a structure has a higher capability to improve information retrieval compared with common accident databases. To accomplish this goal, a knowledge management process model was followed. The ontological explosion knowledge base (EKB) was built for further applications, including process accident knowledge retrieval and risk management. The paper will show how the EKB has a semantic feature that enables users to overcome some of the search constraints of existing accident databases.
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NASA Astrophysics Data System (ADS)
Garland, A.
2015-12-01
The Arctic Risk Management Network (ARMNet) was conceived as a trans-disciplinary hub to encourage and facilitate greater cooperation, communication and exchange among American and Canadian academics and practitioners actively engaged in the research, management and mitigation of risks, emergencies and disasters in the Arctic regions. Its aim is to assist regional decision-makers through the sharing of applied research and best practices and to support greater inter-operability and bilateral collaboration through improved networking, joint exercises, workshops, teleconferences, radio programs, and virtual communications (eg. webinars). Most importantly, ARMNet is a clearinghouse for all information related to the management of the frequent hazards of Arctic climate and geography in North America, including new and emerging challenges arising from climate change, increased maritime polar traffic and expanding economic development in the region. ARMNet is an outcome of the Arctic Observing Network (AON) for Long Term Observations, Governance, and Management Discussions, www.arcus.org/search-program. The AON goals continue with CRIOS (www.ariesnonprofit.com/ARIESprojects.php) and coastal erosion research (www.ariesnonprofit.com/webinarCoastalErosion.php) led by the North Slope Borough Risk Management Office with assistance from ARIES (Applied Research in Environmental Sciences Nonprofit, Inc.). The constituency for ARMNet will include all northern academics and researchers, Arctic-based corporations, First Responders (FRs), Emergency Management Offices (EMOs) and Risk Management Offices (RMOs), military, Coast Guard, northern police forces, Search and Rescue (SAR) associations, boroughs, territories and communities throughout the Arctic. This presentation will be of interest to all those engaged in Arctic affairs, describe the genesis of ARMNet and present the results of stakeholder meetings and webinars designed to guide the next stages of the Project.
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ERIC Educational Resources Information Center
Schaffhauser, Dian
2010-01-01
As influenza activity throughout the United States continues its gradual rise, H1N1 in particular has been the risk-management topic of the season for most colleges and universities. Among the questions being asked: Can one continue operations in the event of a campus closure? What if a faculty member is too sick to teach? What if students refuse…
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Carr, R J; Evans, P
2000-03-01
Ectopic pregnancy occurs in approximately 2% of all pregnancies in the United States, and is the nation's leading cause of first trimester maternal death. Its incidence has increased sixfold in the past 25 years, despite significant improvements in techniques for early diagnosis and management. This article reviews the epidemiology, risk factors, and common clinical presentations of ectopic pregnancy. Both traditional and newly developed strategies for diagnosis and management are described. The primary care physician is in an excellent position to screen for and diagnose ectopic pregnancy, and to counsel patients regarding treatment options and future risks. With the increasing trend toward outpatient nonsurgical management of ectopics, it is expected that the roll of the primary care physician in managing patients with ectopic pregnancy will continue to increase.
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Boronat, F; Budia, A; Broseta, E; Ruiz-Cerdá, J L; Vivas-Consuelo, D
To describe the application of the Lean methodology as a method for continuously improving the efficiency of a urology department in a tertiary hospital. The implementation of the Lean Healthcare methodology in a urology department was conducted in 3 phases: 1) team training and improvement of feedback among the practitioners, 2) management by process and superspecialisation and 3) improvement of indicators (continuous improvement). The indicators were obtained from the Hospital's information systems. The main source of information was the Balanced Scorecard for health systems management (CUIDISS). The comparison with other autonomous and national urology departments was performed through the same platform with the help of the Hospital's records department (IASIST). A baseline was established with the indicators obtained in 2011 for the comparative analysis of the results after implementing the Lean Healthcare methodology. The implementation of this methodology translated into high practitioner satisfaction, improved quality indicators reaching a risk-adjusted complication index (RACI) of 0.59 and a risk-adjusted mortality rate (RAMR) of 0.24 in 4 years. A value of 0.61 was reached with the efficiency indicator (risk-adjusted length of stay [RALOS] index), with a savings of 2869 stays compared with national Benchmarking (IASIST). The risk-adjusted readmissions index (RARI) was the only indicator above the standard, with a value of 1.36 but with progressive annual improvement of the same. The Lean methodology can be effectively applied to a urology department of a tertiary hospital to improve efficiency, obtaining significant and continuous improvements in all its indicators, as well as practitioner satisfaction. Team training, management by process, continuous improvement and delegation of responsibilities has been shown to be the fundamental pillars of this methodology. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.
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Risk management in waste water treatment.
Wagner, M; Strube, I
2005-01-01
With the continuous restructuring of the water market due to liberalisation, privatisation and internationalisation processes, the requirements on waste water disposal companies have grown. Increasing competition requires a target-oriented and clearly structured procedure. At the same time it is necessary to meet the environment-relevant legal requirements and to design the processes to be environment-oriented. The implementation of risk management and the integration of such a management instrument in an existing system in addition to the use of modern technologies and procedures can help to make the operation of the waste water treatment safer and consequently strengthen market position. The risk management process consists of three phases, risk identification, risk analysis/risk assessment and risk handling, which are based on each other, as well as of the risk managing. To achieve an identification of the risks as complete as possible, a subdivision of the kind of risks (e.g. legal, financial, market, operational) is suggested. One possibility to assess risks is the portfolio method which offers clear representation. It allows a division of the risks into classes showing which areas need handling. The determination of the appropriate measures to handle a risk (e.g. avoidance, reduction, shift) is included in the concluding third phase. Different strategies can be applied here. On the one hand, the cause-oriented strategy, aiming at preventive measures which aim to reduce the probability of occurrence of a risk (e.g. creation of redundancy, systems with low susceptibility to malfunction). On the other hand, the effect-oriented strategy, aiming to minimise the level of damage in case of an undesired occurrence (e.g. use of alarm systems, insurance cover).
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Fire Effects Planning Framework: A user's guide
A. Black; T. Opperman
2005-01-01
Each decision to suppress fire reinforces a feedback cycle in which fuels continue to accumulate, risk escalates, and the tendency to suppress fires grows (Miller and others, 2003). Existing decision-support tools focus primarily on the negative consequences of fire. This guide outlines a framework managers can use to (1) identify key areas of fire risk and (2)...
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A risk-based approach to wildland fire budgetary planning
Matthew P. Thompson; David E. Calkin; Mark A. Finney; Krista M. Gebert; Michael S. Hand
2013-01-01
The financial impact of wildfire management within the USDA Forest Service challenges the ability of the agency to meet societal demands and maintain forest health. The extent of this financial crisis has been attributed to historical and continuing fire management practices, changing climatic conditions, and increasing human development in fire-prone areas, as well as...
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Quality Risk Management. Modernising the Architecture of Quality Assurance
ERIC Educational Resources Information Center
Raban, Colin; Turner, Liz
2006-01-01
Although the world is changing, quality management remains an area of relative calm. Many institutions continue to use elaborated versions of a model that is developed by the Council of Academic Awards and conceived at a time when higher education was not so exposed to market forces, when the policy and regulatory environment was relatively…
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Putting the "Community" Back in Community Risk Management of Persons Who Have Sexually Abused
ERIC Educational Resources Information Center
Wilson, Robin J.; McWhinnie, Andrew J.
2013-01-01
The actions and consequences of sexual offenders continue to be a topic of great discussion among researchers, clinicians, policymakers, and the community-at-large. Much of this discussion has centered on how offenders should be managed once released to the community. Legislatures have been quick to enact statutes identifying and limiting the…
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The science and opportunity of wildfire risk assessment (Chapter 6)
Matthew P. Thompson; Alan A. Ager; Mark A. Finney; Dave E. Calkin; Nicole M. Vaillant
2012-01-01
Wildfire management within the United States continues to increase in complexity, as the converging drivers of (1) increased development into fire-prone areas, (2) accumulated fuels from historic management practices, and (3) climate change potentially magnify threats to social and ecological values (Bruins et al., 2010; Gude et al., 2008; Littell et al., 2009). The...
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Perioperative Management of Antithrombotic Therapy
Douketis, James D.; Spyropoulos, Alex C.; Spencer, Frederick A.; Mayr, Michael; Jaffer, Amir K.; Eckman, Mark H.; Dunn, Andrew S.
2012-01-01
Background: This guideline addresses the management of patients who are receiving anticoagulant or antiplatelet therapy and require an elective surgery or procedure. Methods: The methods herein follow those discussed in the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines article of this supplement. Results: In patients requiring vitamin K antagonist (VKA) interruption before surgery, we recommend stopping VKAs 5 days before surgery instead of a shorter time before surgery (Grade 1B). In patients with a mechanical heart valve, atrial fibrillation, or VTE at high risk for thromboembolism, we suggest bridging anticoagulation instead of no bridging during VKA interruption (Grade 2C); in patients at low risk, we suggest no bridging instead of bridging (Grade 2C). In patients who require a dental procedure, we suggest continuing VKAs with an oral prohemostatic agent or stopping VKAs 2 to 3 days before the procedure instead of alternative strategies (Grade 2C). In moderate- to high-risk patients who are receiving acetylsalicylic acid (ASA) and require noncardiac surgery, we suggest continuing ASA around the time of surgery instead of stopping ASA 7 to 10 days before surgery (Grade 2C). In patients with a coronary stent who require surgery, we recommend deferring surgery > 6 weeks after bare-metal stent placement and > 6 months after drug-eluting stent placement instead of undertaking surgery within these time periods (Grade 1C); in patients requiring surgery within 6 weeks of bare-metal stent placement or within 6 months of drug-eluting stent placement, we suggest continuing antiplatelet therapy perioperatively instead of stopping therapy 7 to 10 days before surgery (Grade 2C). Conclusions: Perioperative antithrombotic management is based on risk assessment for thromboembolism and bleeding, and recommended approaches aim to simplify patient management and minimize adverse clinical outcomes. PMID:22315266
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The Resilient Economy: Integrating Competitiveness and Security
DOE Office of Scientific and Technical Information (OSTI.GOV)
Debbie van Opstal
2009-01-07
Globalization, technological complexity, interdependence, terrorism, climate and energy volatility, and pandemic potential are increasing the level of risk that societies and organizations now face. Risks also are increasingly interrelated; disruptions in one area can cascade in multiple directions. The ability to manage emerging risks, anticipate the interactions between different types of risk, and bounce back from disruption will be a competitive differentiator for companies and countries alike in the 21st century. What Policymakers Should Know The national objective is not just homeland protection, but economic resilience: the ability to mitigate and recover quickly from disruption. Businesses must root the casemore » for investment in resilience strategies to manage a spectrum of risks, not just catastrophic ones. Making a business case for investment in defenses against low-probability events (even those with high impact) is difficult. However, making a business case for investments that assure business continuity and shareholder value is not a heavy lift. There are an infinite number of disruption scenarios, but only a finite number of outcomes. Leading organizations do not manage specific scenarios, rather they create the agility and flexibility to cope with turbulent situations. The investments and contingency plans these leading companies make to manage a spectrum of risk create a capability to respond to high-impact disasters as well. Government regulations tend to stovepipe different types of risk, which impedes companies abilities to manage risk in an integrated way. Policies to strengthen risk management capabilities would serve both security and competitiveness goals. What CEOs and Boards Should Know Operational risks are growing rapidly and outpacing many companies abilities to manage them. Corporate leadership has historically viewed operational risk management as a back office control function. But managing operational risks increasingly affects real-time financial performance. The 835 companies that announced a supply chain disruption between 1989 and 2000 experienced 33 percent to 40 percent lower stock returns than their industry peers. Twenty-five percent of companies that experienced an IT outage of two to six days went bankrupt immediately. Ninety-three percent of companies that lost their data center for 10 days or more filed for bankruptcy within a year.« less
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An obesity/cardiometabolic risk reduction disease management program: a population-based approach.
Villagra, Victor G
2009-04-01
Obesity is a critical health concern that has captured the attention of public and private healthcare payers who are interested in controlling costs and mitigating the long-term economic consequences of the obesity epidemic. Population-based approaches to obesity management have been proposed that take advantage of a chronic care model (CCM), including patient self-care, the use of community-based resources, and the realization of care continuity through ongoing communications with patients, information technology, and public policy changes. Payer-sponsored disease management programs represent an important conduit to delivering population-based care founded on similar CCM concepts. Disease management is founded on population-based disease identification, evidence-based care protocols, and collaborative practices between clinicians. While substantial clinician training, technology infrastructure commitments, and financial support at the payer level will be needed for the success of disease management programs in obesity and cardiometabolic risk reduction, these barriers can be overcome with the proper commitment. Disease management programs represent an important tool to combat the growing societal risks of overweight and obesity.
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Driving into danger: Perception and communication of flash flood risk from a cultural perspective
NASA Astrophysics Data System (ADS)
Coles, A.; Hirschboeck, K. K.; Fryberg, S.
2009-04-01
Flood risk managers educate the public on the dangers of driving through flooded roadways, yet losses to life and property continue to occur. This study integrates cultural psychology and risk perception theory to explore how culture, psychological processes, and behavior influence one another. Flood risk managers in Tucson, Arizona collaborated in the development of a questionnaire mailed to local residents. Questions regarding levels of trust, self-efficacy, social autonomy, social incorporation, time perspective, and situational factors were analyzed with respect to whether respondents stated that they have or have not driven through a flooded roadway. Respondents' decisions are influenced by the presence of signs and barricades, passengers, risk of personal injury or damage to the vehicle, and the availability of flood-related information. The most influential factor is the prior successful crossing of other vehicles. The results illuminate complex interrelations among the cultural factors and provide considerations for future risk perception research.
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Great Expectations in the Joint Advanced Manufacturing Region
2016-12-01
would be continuous experimentation and risk reduction prototyping. The entire manufacturing life cycle— design , testing, product development...on the back of a napkin, they decided to call their effort the Joint Advanced Manufacturing Region (JAMR) and manage it as an Integrated Product ... designed to support the continuous experimentation of advanced manufacturing tactics, tech- niques and procedures under actual operational or combat
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Software risk management through independent verification and validation
NASA Technical Reports Server (NTRS)
Callahan, John R.; Zhou, Tong C.; Wood, Ralph
1995-01-01
Software project managers need tools to estimate and track project goals in a continuous fashion before, during, and after development of a system. In addition, they need an ability to compare the current project status with past project profiles to validate management intuition, identify problems, and then direct appropriate resources to the sources of problems. This paper describes a measurement-based approach to calculating the risk inherent in meeting project goals that leverages past project metrics and existing estimation and tracking models. We introduce the IV&V Goal/Questions/Metrics model, explain its use in the software development life cycle, and describe our attempts to validate the model through the reverse engineering of existing projects.
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Computational methods in the pricing and risk management of modern financial derivatives
NASA Astrophysics Data System (ADS)
Deutsch, Hans-Peter
1999-09-01
In the last 20 years modern finance has developed into a complex mathematically challenging field. Very complicated risks exist in financial markets which need very advanced methods to measure and/or model them. The financial instruments invented by the market participants to trade these risk, the so called derivatives are usually even more complicated than the risks themselves and also sometimes generate new riks. Topics like random walks, stochastic differential equations, martingale measures, time series analysis, implied correlations, etc. are of common use in the field. This is why more and more people with a science background, such as physicists, mathematicians, or computer scientists, are entering the field of finance. The measurement and management of all theses risks is the key to the continuing success of banks. This talk gives insight into today's common methods of modern market risk management such as variance-covariance, historical simulation, Monte Carlo, “Greek” ratios, etc., including the statistical concepts on which they are based. Derivatives are at the same time the main reason for and the most effective means of conducting risk management. As such, they stand at the beginning and end of risk management. The valuation of derivatives and structured financial instruments is therefore the prerequisite, the condition sine qua non, for all risk management. This talk introduces some of the important valuation methods used in modern derivatives pricing such as present value, Black-Scholes, binomial trees, Monte Carlo, etc. In summary this talk highlights an area outside physics where there is a lot of interesting work to do, especially for physicists. Or as one of our consultants said: The fascinating thing about this job is that Arthur Andersen hired me not ALTHOUGH I am a physicist but BECAUSE I am a physicist.
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The Role of Surgery and Radiation Therapy in the Management of Gestational Trophoblastic Disease
Hanna, Rabbie K.
2010-01-01
The primary management of hydatidiform moles remains surgical evacuation followed by human chorionic gonadotropin level monitoring. Although suction dilatation and evacuation is the most frequent technique for molar evacuation, hysterectomy is a viable option in older patients who do not wish to preserve fertility. Despite advances in chemotherapy regimens for treating malignant gestational trophoblastic neoplasia, hysterectomy and other extirpative procedures continue to play a role in the management of patients with both low-risk and high-risk gestational trophoblastic neoplasia. Primary hysterectomy can reduce the amount of chemotherapy required to treat low-risk disease, whereas surgical resections, including hysterectomy, pulmonary resections, and other extirpative procedures, can be invaluable for treating highly selected patients with persistent, drug-resistant disease. Radiation therapy is also often incorporated into the multimodality therapy of patients with high-risk metastatic disease. This review discusses the indications for and the role of surgical interventions during the management of women with hydatidiform moles and malignant gestational trophoblastic neoplasia and reviews the use of radiation therapy in the treatment of women with malignant gestational trophoblastic neoplasia. PMID:20495216
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Reduction of earthquake risk in the united states: Bridging the gap between research and practice
Hays, W.W.
1998-01-01
Continuing efforts under the auspices of the National Earthquake Hazards Reduction Program are under way to improve earthquake risk assessment and risk management in earthquake-prone regions of Alaska, California, Nevada, Washington, Oregon, Arizona, Utah, Wyoming, and Idaho, the New Madrid and Wabash Valley seismic zones in the central United States, the southeastern and northeastern United States, Puerto Rico, Virgin Islands, Guam, and Hawaii. Geologists, geophysicists, seismologists, architects, engineers, urban planners, emergency managers, health care specialists, and policymakers are having to work at the margins of their disciplines to bridge the gap between research and practice and to provide a social, technical, administrative, political, legal, and economic basis for changing public policies and professional practices in communities where the earthquake risk is unacceptable. ?? 1998 IEEE.
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Psychosocial risks: is risk management strategic enough in business and policy making?
Langenhan, Melissa K; Leka, Stavroula; Jain, Aditya
2013-06-01
In times of continuous change and volatile markets, organizations are increasingly characterized by downsizing, work intensification, and resource rationalization. This has resulted in diversification, and the emergence of new risks within the field of occupational health and safety, with an important impact. This paper focuses on one such type of risk in the modern workplace-psychosocial risks. The current study aimed to explore stakeholder perspectives, regarding the extent to which psychosocial risks are incorporated into strategic risk management practices, at both the business and policy level. Semi-structured interviews were conducted with 14 professionals, representing employer, expert, policy maker, and trade union stakeholder perspectives. It was found that the majority of organizations do not sufficiently, if at all, understand and incorporate psychosocial risks into strategic decision making, whereby the key barrier related to practical difficulties of not knowing how to manage psychosocial risks adequately. The study found that there is a need to close the gap between policy and practice on a number of levels. Future recommendations comprise a policy framework and infrastructure underpinned by educational initiatives, partnerships, and networks to drive a shift in attitudes toward recognizing the duality of the concept of risk (including both potential negative and positive outcomes) and moving beyond simple regulatory compliance.
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Psychosocial Risks: Is Risk Management Strategic Enough in Business and Policy Making?
Langenhan, Melissa K.; Leka, Stavroula; Jain, Aditya
2013-01-01
Background In times of continuous change and volatile markets, organizations are increasingly characterized by downsizing, work intensification, and resource rationalization. This has resulted in diversification, and the emergence of new risks within the field of occupational health and safety, with an important impact. This paper focuses on one such type of risk in the modern workplace—psychosocial risks. The current study aimed to explore stakeholder perspectives, regarding the extent to which psychosocial risks are incorporated into strategic risk management practices, at both the business and policy level. Methods Semi-structured interviews were conducted with 14 professionals, representing employer, expert, policy maker, and trade union stakeholder perspectives. Results It was found that the majority of organizations do not sufficiently, if at all, understand and incorporate psychosocial risks into strategic decision making, whereby the key barrier related to practical difficulties of not knowing how to manage psychosocial risks adequately. Conclusion The study found that there is a need to close the gap between policy and practice on a number of levels. Future recommendations comprise a policy framework and infrastructure underpinned by educational initiatives, partnerships, and networks to drive a shift in attitudes toward recognizing the duality of the concept of risk (including both potential negative and positive outcomes) and moving beyond simple regulatory compliance. PMID:23961331
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VanVactor, Jerry D; Gill, Tony
2010-03-01
Business continuity has expanded into a discipline that spans most functional areas of large enterprises. Both the military and financial sectors have consistently demonstrated an aptitude to expand the boundaries of continuity planning and crisis mitigation. A comparison of both enterprises is provided to see how their respective methodologies compare. Interestingly, the similarities far outweigh the differences. The paper provides commentary related to comparative insight from risk practitioners' perspectives from within the US Army, one of the largest military organisations in the world, and the Bank of Montreal, one of Canada's leading financial institutions.
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Wildfire Risk Management: Challenges and Opportunities
NASA Astrophysics Data System (ADS)
Thompson, M.; Calkin, D. E.; Hand, M. S.; Kreitler, J.
2014-12-01
In this presentation we address federal wildfire risk management largely through the lens of economics, targeting questions related to costs, effectiveness, efficiency, and tradeoffs. Beyond risks to resources and assets such as wildlife habitat, watersheds, and homes, wildfires present financial risk and budgetary instability for federal wildfire management agencies due to highly variable annual suppression costs. Despite its variability, the costs of wildfire management have continued to escalate and account for an ever-growing share of overall agency budgets, compromising abilities to attain other objectives related to forest health, recreation, timber management, etc. Trends associated with a changing climate and human expansion into fire-prone areas could lead to additional suppression costs in the future, only further highlighting the need for an ability to evaluate economic tradeoffs in investments across the wildfire management spectrum. Critically, these economic analyses need to accurately capture the complex spatial and stochastic aspects of wildfire, the inherent uncertainty associated with monetizing environmental impacts of wildfire, the costs and effectiveness of alternative management policies, and linkages between pre-fire investments and active incident management. Investing in hazardous fuels reduction and forest restoration in particular is a major policy lever for pre-fire risk mitigation, and will be a primary focus of our presentation. Evaluating alternative fuel management and suppression policies could provide opportunities for significant efficiency improvements in the development of risk-informed management fire management strategies. Better understanding tradeoffs of fire impacts and costs can help inform policy questions such as how much of the landscape to treat and how to balance investments in treating new areas versus maintaining previous investments. We will summarize current data needs, knowledge gaps, and other factors influencing research and development on this critically important topic. Specifically we will focus on how to embed simulation models within an economic framework, how to link fire models with models of wildfire management expenditures, how to evaluate alternative management policies, and how to measure cost-effectiveness.
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A Wake-Up Call: Enterprise Risk Management at Colleges and Universities Today
ERIC Educational Resources Information Center
Association of Governing Boards of Universities and Colleges, 2014
2014-01-01
After five years of change and upheaval, why is it that governing boards of colleges and universities continue to consider risk on a largely ad hoc basis? The findings from this recent survey, conducted by the Association of Governing Boards of Universities and Colleges (AGB) and United Educators (UE), indicate a modest increase in the use of risk…
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The Effects of Anger Management on Children's Social and Emotional Outcomes: A Meta-Analysis
ERIC Educational Resources Information Center
Candelaria, Ashley M.; Fedewa, Alicia L.; Ahn, Soyeon
2012-01-01
The occurrence of violent behaviors and bullying in schools continues to be a recognized problem among students and school personnel. The concern caused by these behaviors have led many schools to implement anger management and other impulse control based programs for at-risk students in an effort to prevent many of these incidences. This study…
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ERIC Educational Resources Information Center
Bauer, Erin; Ogg, Clyde
2011-01-01
The trend toward encouraging adoption of Integrated Pest Management (IPM) in schools has increased in the last decade. Because IPM helps reduce risk of human pesticide exposure, reduce allergens and asthma triggers, save energy, and protect the environment, it's essential that IPM awareness continue not only with current school administrators,…
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Minimum intervention dentistry: periodontics and implant dentistry.
Darby, I B; Ngo, L
2013-06-01
This article will look at the role of minimum intervention dentistry in the management of periodontal disease. It will discuss the role of appropriate assessment, treatment and risk factors/indicators. In addition, the role of the patient and early intervention in the continuing care of dental implants will be discussed as well as the management of peri-implant disease. © 2013 Australian Dental Association.
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Relevance of immobility and importance of risk assessment management for medically ill patients.
Hull, Russell D
2013-06-01
Recent or continued immobility is a significant risk factor for venous thromboembolism (VTE) in acutely ill medical patients. Patients may benefit from thromboprophylaxis; however, its optimal duration remains unclear. The Extended Clinical Prophylaxis in Acutely Ill Medical Patients (EXCLAIM) study was the first trial to systematically investigate how the degree of immobilization relates to the risk of developing VTE. EXCLAIM offers insights into the duration of VTE risk associated with reduced mobility and helps identify which patients would benefit most from extended-duration thromboprophylaxis. Further recent studies suggest that extended-duration thromboprophylaxis may be in order in certain high-risk patients to protect the patients from the risk of VTE events occurring, particularly in the posthospitalization period. Baseline d-dimer data and level of mobility could be included in risk assessment. Physicians are recommended to consider the use of extended-duration thromboprophylaxis based on individual risk assessment management (RAM) and balance of benefit and harm.
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NASA Astrophysics Data System (ADS)
Liu, Y.; Zhou, J.; Song, L.; Zou, Q.; Guo, J.; Wang, Y.
2014-02-01
In recent years, an important development in flood management has been the focal shift from flood protection towards flood risk management. This change greatly promoted the progress of flood control research in a multidisciplinary way. Moreover, given the growing complexity and uncertainty in many decision situations of flood risk management, traditional methods, e.g., tight-coupling integration of one or more quantitative models, are not enough to provide decision support for managers. Within this context, this paper presents a beneficial methodological framework to enhance the effectiveness of decision support systems, through the dynamic adaptation of support regarding the needs of the decision-maker. In addition, we illustrate a loose-coupling technical prototype for integrating heterogeneous elements, such as multi-source data, multidisciplinary models, GIS tools and existing systems. The main innovation is the application of model-driven concepts, which put the system in a state of continuous iterative optimization. We define the new system as a model-driven decision support system (MDSS ). Two characteristics that differentiate the MDSS are as follows: (1) it is made accessible to non-technical specialists; and (2) it has a higher level of adaptability and compatibility. Furthermore, the MDSS was employed to manage the flood risk in the Jingjiang flood diversion area, located in central China near the Yangtze River. Compared with traditional solutions, we believe that this model-driven method is efficient, adaptable and flexible, and thus has bright prospects of application for comprehensive flood risk management.
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NASA Technical Reports Server (NTRS)
Norcross, Jason; Steinberg, Susan; Kundrot, Craig; Charles, John
2011-01-01
The Human Research Program (HRP) is formulated around the program architecture of Evidence-Risk-Gap-Task-Deliverable. Review of accumulated evidence forms the basis for identification of high priority risks to human health and performance in space exploration. Gaps in knowledge or disposition are identified for each risk, and a portfolio of research tasks is developed to fill them. Deliverables from the tasks inform the evidence base with the ultimate goal of defining the level of risk and reducing it to an acceptable level. A comprehensive framework for gap identification, focus, and metrics has been developed based on principles of continuous risk management and clinical care. Research towards knowledge gaps improves understanding of the likelihood, consequence or timeframe of the risk. Disposition gaps include development of standards or requirements for risk acceptance, development of countermeasures or technology to mitigate the risk, and yearly technology assessment related to watching developments related to the risk. Standard concepts from clinical care: prevention, diagnosis, treatment, monitoring, rehabilitation, and surveillance, can be used to focus gaps dealing with risk mitigation. The research plan for the new HRP Risk of Decompression Sickness (DCS) used the framework to identify one disposition gap related to establishment of a DCS standard for acceptable risk, two knowledge gaps related to DCS phenomenon and mission attributes, and three mitigation gaps focused on prediction, prevention, and new technology watch. These gaps were organized in this manner primarily based on target for closure and ease of organizing interim metrics so that gap status could be quantified. Additional considerations for the knowledge gaps were that one was highly design reference mission specific and the other gap was focused on DCS phenomenon.
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Baram, M
1996-10-01
In prior studies by high-level commissions, emphasis was given to improving the scientific basis and institutional procedures for risk assessment and risk regulation within existing statutory frameworks. Recommendations have led to slow but steady progress. This study is considerably different. It emphasizes a public health approach for efficient use of resources in a new flexible framework for risk management, reductionist approaches to risk assessment and characterization, increased public involvement, and various methods for managing such public involvement. It provides a mix of aspirations and concepts, procedures, and "shop floor rules" for putting the new system of risk management into practice. Concerns remain, however, that bright lines and other rules are at odds with the report's professed aspirations for meaningful public involvement; that ad hoc institutional arrangements for putting each risk in a situational context may not be an efficient use of public and private resources; that techniques for managing stakeholder involvement will be seen as manipulative and may even increase public mistrust and anxieties about risk; and that reductionism by the regulatory clients of risk assessment could diminish progress in the environmental health sciences. Says Lucier, "The goal of risk assessment should be to prevent environmentally or occupationally mediated diseases or injury. This point is not made sufficiently clear in the commission's report. Nevertheless, the report does an admirable job of attempting to merge science, common sense, public perception, public health, economics, and stakeholder interests into a regulatory policy strategy." He continues, "The merging of these diverse inputs will never be easy and should never be overly prescriptive. The complete integration of all relevant information into the risk assessment and risk management process will require greater reliance on expert judgment to make decisions that are timely, that are based on appropriate peer review, that are consistent with public health priorities, that do not create unnecessary regulatory burdens, and that are understandable by the public." The commission's report provides an alternative vision of risk management that incorporates popular political and social trends. Thorough evaluation of the report's recommendations will, at the very least, focus scrutiny on current risk assessment and risk management practices and perhaps produce better solutions.
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Baram, M
1996-01-01
In prior studies by high-level commissions, emphasis was given to improving the scientific basis and institutional procedures for risk assessment and risk regulation within existing statutory frameworks. Recommendations have led to slow but steady progress. This study is considerably different. It emphasizes a public health approach for efficient use of resources in a new flexible framework for risk management, reductionist approaches to risk assessment and characterization, increased public involvement, and various methods for managing such public involvement. It provides a mix of aspirations and concepts, procedures, and "shop floor rules" for putting the new system of risk management into practice. Concerns remain, however, that bright lines and other rules are at odds with the report's professed aspirations for meaningful public involvement; that ad hoc institutional arrangements for putting each risk in a situational context may not be an efficient use of public and private resources; that techniques for managing stakeholder involvement will be seen as manipulative and may even increase public mistrust and anxieties about risk; and that reductionism by the regulatory clients of risk assessment could diminish progress in the environmental health sciences. Says Lucier, "The goal of risk assessment should be to prevent environmentally or occupationally mediated diseases or injury. This point is not made sufficiently clear in the commission's report. Nevertheless, the report does an admirable job of attempting to merge science, common sense, public perception, public health, economics, and stakeholder interests into a regulatory policy strategy." He continues, "The merging of these diverse inputs will never be easy and should never be overly prescriptive. The complete integration of all relevant information into the risk assessment and risk management process will require greater reliance on expert judgment to make decisions that are timely, that are based on appropriate peer review, that are consistent with public health priorities, that do not create unnecessary regulatory burdens, and that are understandable by the public." The commission's report provides an alternative vision of risk management that incorporates popular political and social trends. Thorough evaluation of the report's recommendations will, at the very least, focus scrutiny on current risk assessment and risk management practices and perhaps produce better solutions. PMID:8930543
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Summerill, Corinna; Pollard, Simon J T; Smith, Jennifer A
2010-09-15
Appropriate implementation of WSPs offers an important opportunity to engage in and promote preventative risk management within water utilities. To ensure success, the whole organization, especially executive management, need to be advocates. Illustrated by two case studies, we discuss the influence of organizational culture on buy-in and commitment to public health protection and WSPs. Despite an internal desire to undertake risk management, some aspects of organizational culture prevented these from reaching full potential. Enabling cultural features included: camaraderie; competition; proactive, involved leaders; community focus; customer service mentality; transparency; accountability; competent workforce; empowerment; appreciation of successes, and a continual improvement culture. Blocking features included: poor communication; inflexibility; complacency; lack of awareness, interest or reward and coercion. We urge water utilities to consider the influence of organizational culture on the success and sustainability of WSP adoption, and better understand how effective leadership can mould culture to support implementation. Copyright 2010 Elsevier B.V. All rights reserved.
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The role of models in estimating consequences as part of the risk assessment process.
Forde-Folle, K; Mitchell, D; Zepeda, C
2011-08-01
The degree of disease risk represented by the introduction, spread, or establishment of one or several diseases through the importation of animals and animal products is assessed by importing countries through an analysis of risk. The components of a risk analysis include hazard identification, risk assessment, risk management, and risk communication. A risk assessment starts with identification of the hazard(s) and then continues with four interrelated steps: release assessment, exposure assessment, consequence assessment, and risk estimation. Risk assessments may be either qualitative or quantitative. This paper describes how, through the integration of epidemiological and economic models, the potential adverse biological and economic consequences of exposure can be quantified.
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Review of clinical practice guidelines for the management of LDL-related risk.
Morris, Pamela B; Ballantyne, Christie M; Birtcher, Kim K; Dunn, Steven P; Urbina, Elaine M
2014-07-15
Managing risk related to low-density lipoprotein (LDL) is vital in therapy for patients at risk for atherosclerotic cardiovascular disease (ASCVD) events given its important etiologic role in atherogenesis. Despite decades of research showing reduction of ASCVD risk with multiple approaches to lowering of LDL cholesterol, there continue to be significant gaps in care with inadequate numbers of patients receiving standard of care lipid-lowering therapy. Confusion regarding implementation of the multiple published clinical practice guidelines has been identified as one contributor to suboptimal management of LDL-related risk. This review summarizes the current guidelines for reduction of LDL-related cardiovascular risk provided by a number of major professional societies, which have broad applicability to diverse populations worldwide. Statements have varied in the process and methodology of development of recommendations, the grading system for level and strength of evidence, the inclusion or exclusion of expert opinion, the suggested ASCVD risk assessment tool, the lipoproteins recommended for risk assessment, and the lipoprotein targets of therapy. The similarities and differences among important guidelines in the United States and internationally are discussed, with recommendations for future strategies to improve consistency in approaches to LDL-related ASCVD risk and to reduce gaps in implementation of evidence-based therapies. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Uncertainty and sensitivity assessment of flood risk assessments
NASA Astrophysics Data System (ADS)
de Moel, H.; Aerts, J. C.
2009-12-01
Floods are one of the most frequent and costly natural disasters. In order to protect human lifes and valuable assets from the effect of floods many defensive structures have been build. Despite these efforts economic losses due to catastrophic flood events have, however, risen substantially during the past couple of decades because of continuing economic developments in flood prone areas. On top of that, climate change is expected to affect the magnitude and frequency of flood events. Because these ongoing trends are expected to continue, a transition can be observed in various countries to move from a protective flood management approach to a more risk based flood management approach. In a risk based approach, flood risk assessments play an important role in supporting decision making. Most flood risk assessments assess flood risks in monetary terms (damage estimated for specific situations or expected annual damage) in order to feed cost-benefit analysis of management measures. Such flood risk assessments contain, however, considerable uncertainties. This is the result from uncertainties in the many different input parameters propagating through the risk assessment and accumulating in the final estimate. Whilst common in some other disciplines, as with integrated assessment models, full uncertainty and sensitivity analyses of flood risk assessments are not so common. Various studies have addressed uncertainties regarding flood risk assessments, but have mainly focussed on the hydrological conditions. However, uncertainties in other components of the risk assessment, like the relation between water depth and monetary damage, can be substantial as well. This research therefore tries to assess the uncertainties of all components of monetary flood risk assessments, using a Monte Carlo based approach. Furthermore, the total uncertainty will also be attributed to the different input parameters using a variance based sensitivity analysis. Assessing and visualizing the uncertainties of the final risk estimate will be helpful to decision makers to make better informed decisions and attributing this uncertainty to the input parameters helps to identify which parameters are most important when it comes to uncertainty in the final estimate and should therefore deserve additional attention in further research.
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Ekor, Martins; Odewabi, Adesina O
2014-09-01
Achieving effective municipal solid waste (MSW) management remains a major challenge and waste generation and accumulation continue to constitute important environmental and public health concern, particularly in most developing countries. Although the general population is at risk of adverse health consequences and hazards associated with exposure to MSW, the waste management workers (WMWs) are the most vulnerable because of their direct involvement in the disposal of waste, with increasing evidence of work-related health and safety risks among these individuals. Among the numerous work-related health hazards prevalent in WMWs, development of toxic neuropathies following chronic occupational exposure remains poorly recognized. However, the risk or predisposition to toxic neuropathies is becoming evident considering the increasing recognition of large amount of neurotoxic heavy metals and hazardous industrial materials present in MSW in most parts of the world. The present review seeks to draw attention to the continuous vulnerability of the WMWs to developing toxic neuropathies. This is aimed at facilitating conscious efforts by relevant governmental and nongovernmental agencies towards promoting risk reduction and ensuring adequate protection against possible toxic polyneuropathies associated with occupational exposure to solid wastes. While continuous education of the WMWs on the need for adequate compliance to safety regulations and practice remains sacrosanct towards achieving significant reduction in toxic neuropathies and related adverse health consequences of waste handling, it is also our intention in this review to underscore the possible relevance of nutrient supplementation and alternative medicines in chemoprevention.
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Risk-adapted management of pulmonary embolism.
Barco, Stefano; Konstantinides, Stavros V
2017-03-01
The presence and severity of right ventricular (RV) dysfunction is a key determinant of prognosis in the acute phase of pulmonary embolism (PE). Risk-adapted treatment strategies continue to evolve, tailoring initial management to the clinical presentation and the functional status of the RV. Beyond pharmacological and, if necessary, mechanical circulatory support, systemic thrombolysis remains the mainstay of treatment for hemodynamically unstable patients; in contrast, it is not routinely recommended for intermediate-risk PE. Catheter-directed pharmacomechanical reperfusion treatment represents a promising option for minimizing bleeding risk; for reduced-dose intravenous thrombolysis, the data are still preliminary. Non-vitamin K-dependent oral anticoagulants, directly inhibiting factor Xa (rivaroxaban, apixaban, edoxaban) or thrombin (dabigatran), have simplified initial and long-term anticoagulation for PE while reducing major bleeding risk. Use of vena cava filters should be restricted to selected patients with absolute contraindications to anticoagulation, or PE recurrence despite adequately dosed anticoagulants. © 2017 Elsevier Ltd. All rights reserved.
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Cook, Alana N; Moulden, Heather M; Mamak, Mini; Lalani, Shams; Messina, Katrina; Chaimowitz, Gary
2018-06-01
The Hamilton Anatomy of Risk Management-Forensic Version (HARM-FV) is a structured professional judgement tool of violence risk developed for use in forensic inpatient psychiatric settings. The HARM-FV is used with the Aggressive Incidents Scale (AIS), which provides a standardized method of recording aggressive incidents. We report the findings of the concurrent validity of the HARM-FV and the AIS with widely used measures of violence risk and aggressive acts, the Historical, Clinical, Risk Management-20, Version 3 (HCR-20 V3 ) and a modified version of the Overt Aggression Scale. We also present findings on the predictive validity of the HARM-FV in the short term (1-month follow-up periods) for varying severities of aggressive acts. The results indicated strong support for the concurrent validity of the HARM-FV and AIS and promising support for the predictive accuracy of the tool for inpatient aggression. This article provides support for the continued clinical use of the HARM-FV within an inpatient forensic setting and highlights areas for further research.
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Lehew, Charles W; Kaste, Linda M
2007-01-01
The purpose of the study was to assess Illinois dentists' self-reported knowledge and practices concerning oral cancer prevention, early detection, and management as a baseline prior to conducting interventions designed to increase dentists' capacity to detect and manage oral cancers and counsel their patients about risk reduction. A weighted sample to represent licensed dentists in 19 counties yielded 518 dentists who responded to a 38-item mailed survey in 2004. Over 92 percent of the dentists reported providing oral cancer exams. However, many are not doing them properly or at frequent intervals. Over two-thirds had oral cancer continuing education, but 40 percent had it more than 2 years prior to the survey. Training in risk counseling was rare. Interventions are needed to assure appropriate skill and knowledge levels for oral cancer early detection, management, and risk counseling by Illinois dentists.
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Prioritization of Managed Pork Supply Movements during a FMD Outbreak in the US.
Patterson, Gilbert R; Mohr, Alicia H; Snider, Tim P; Lindsay, Thomas A; Davies, Peter R; Goldsmith, Tim J; Sampedro, Fernando
2016-01-01
In the event of a foot-and-mouth disease (FMD) outbreak in the United States, local, state, and federal authorities will implement a foreign animal disease emergency response plan restricting the pork supply chain movements and likely disrupting the continuity of the swine industry business. To minimize disruptions of the food supply while providing an effective response in an outbreak, it is necessary to have proactive measures in place to ensure minimal disease spread and maximum continuation of business. Therefore, it is critical to identify candidate movements for proactive risk assessments: those that are both most likely to contribute to disease spread and most necessary for business continuity. To do this, experts from production, harvest, retail, and allied pork industries assessed 30 common pork supply movements for risk of disease spread and industry criticality. The highest priority movements for conducting a risk assessment included the movement of weaned pigs originating from multiple sow farm sources to an off-site nursery or wean to finish facility, the movement of employees or commercial crews, the movement of vaccination crews, the movement of dedicated livestock hauling trucks, and the movement of commercial crews such as manure haulers and feed trucks onto, off, or between sites. These critical movements, along with several others identified in this study, will provide an initial guide for prioritization of risk management efforts and resources to be better prepared in the event of a FMD outbreak in the United States. By specifically and proactively targeting movements that experts agree are likely to spread the disease and are critical to the continuity of business operations, potentially catastrophic consequences in the event of an outbreak can be limited.
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Prioritization of Managed Pork Supply Movements during a FMD Outbreak in the US
Patterson, Gilbert R.; Mohr, Alicia H.; Snider, Tim P.; Lindsay, Thomas A.; Davies, Peter R.; Goldsmith, Tim J.; Sampedro, Fernando
2016-01-01
In the event of a foot-and-mouth disease (FMD) outbreak in the United States, local, state, and federal authorities will implement a foreign animal disease emergency response plan restricting the pork supply chain movements and likely disrupting the continuity of the swine industry business. To minimize disruptions of the food supply while providing an effective response in an outbreak, it is necessary to have proactive measures in place to ensure minimal disease spread and maximum continuation of business. Therefore, it is critical to identify candidate movements for proactive risk assessments: those that are both most likely to contribute to disease spread and most necessary for business continuity. To do this, experts from production, harvest, retail, and allied pork industries assessed 30 common pork supply movements for risk of disease spread and industry criticality. The highest priority movements for conducting a risk assessment included the movement of weaned pigs originating from multiple sow farm sources to an off-site nursery or wean to finish facility, the movement of employees or commercial crews, the movement of vaccination crews, the movement of dedicated livestock hauling trucks, and the movement of commercial crews such as manure haulers and feed trucks onto, off, or between sites. These critical movements, along with several others identified in this study, will provide an initial guide for prioritization of risk management efforts and resources to be better prepared in the event of a FMD outbreak in the United States. By specifically and proactively targeting movements that experts agree are likely to spread the disease and are critical to the continuity of business operations, potentially catastrophic consequences in the event of an outbreak can be limited. PMID:27843934
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Perreault, Leigh; Færch, Kristine; Gregg, Edward W
2017-09-01
We reviewed published literature to determine the relationship between A1c and cardiovascular disease (CVD) and summarize the need and implications for CVD risk reduction with interventions, focusing in the prediabetic A1c range (<6.5%). Strong evidence supports a continuous relationship between A1c and CVD-even below the current levels of A1c-defined prediabetes and after adjustment for known risk factors for CVD. Clinical trials have demonstrated a reduction in CV morbidity and/or mortality when interventions are invoked in the prediabetic A1c range. Guidelines advocating CV risk factor management in prediabetes have not been widely adopted, subsequently leading to comparable coronary heart disease risk between people with prediabetes (HR = 1.9, 95% CI 1.7-2.1 vs normoglycemia) and diabetes itself (HR=2.0, 95% CI 1.8-2.2 vs no diabetes). This review highlights the missed opportunity to utilize multiple risk factor interventions to reduce CVD in high-risk people with prediabetes.
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A Holistic Approach for Risk Management During Design
NASA Technical Reports Server (NTRS)
Meshkat, Leila
2006-01-01
In this paper, an approach for the identification, assessment, mitigation and continuous management of risks during the process of designing a space mission is presented. This approach has been developed by observing the risk patterns that occur at the Project Design Center of the Jet Propulsion Laboratory (TeamX) which develops conceptual, concurrent design of Space Missions. TeamX develops an end-to-end conceptual design of a Space Mission in a matter of one or two weeks. As the risk chair in TeamX, the author has had the opportunity to observe the risk patterns that occur during design over the course of many design sessions. This paper introduces an abstraction and generalization of those patterns. Risk is defined as anything that can go wrong, along with its approximate likelihood and consequence. The indicators, and causes, and effects of these risks are cross cutting across the multiple levels of people and processes involved in the design, and the actual design product itself.
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NASA Astrophysics Data System (ADS)
Baum, Rachel; Characklis, Gregory W.; Serre, Marc L.
2018-04-01
As the costs and regulatory barriers to new water supply development continue to rise, drought management strategies have begun to rely more heavily on temporary conservation measures. While these measures are effective, they often lead to intermittent and unpredictable reductions in revenues that are financially disruptive to water utilities, raising concerns over lower credit ratings and higher rates of borrowing for this capital intensive sector. Consequently, there is growing interest in financial risk management strategies that reduce utility vulnerabilities. This research explores the development of financial index insurance designed to compensate a utility for drought-related losses. The focus is on analyzing candidate hydrologic indices that have the potential to be used by utilities across the US, increasing the potential for risk pooling, which would offer the possibility of both lower risk management costs and more widespread implementation. This work first analyzes drought-related financial risks for 315 publicly operated water utilities across the country and examines the effectiveness of financial contracts based on several indices both in terms of their correlation with utility revenues and their spatial autocorrelation across locations. Hydrologic-based index insurance contracts are then developed and tested over a 120 year period. Results indicate that risk pooling, even under conditions in which droughts are subject to some level of spatial autocorrelation, has the potential to significantly reduce the cost of managing financial risk.
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Planning for Fiscal Risk Management Demands of Retirees.
ERIC Educational Resources Information Center
Wood, R. Craig
1981-01-01
Assesses the common practice of allowing retiring employees to continue receiving group insurance benefits and suggests that before agreeing to this arrangement, administrators should consider the situation carefully and plan for the potential long-range consequences. (Author/WD)
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Engaging Indigenous Communities and Research Scientists to Manage Climate Risk
NASA Astrophysics Data System (ADS)
Jasko, S. A.; Pandya, R.; Wildcat, D.; Moench, M.; Leshin, L. A.; Jasko, S. A.; Pulwarty, R. S.; Kluck, D. R.; Collins, G.; Lazrus, H.
2014-12-01
For the past five years a strategy has been employed to reach out to tribes and tribal colleges to build awareness and potentially transfer information that would strengthen tribal resilience to climate variability and changes. Finding an effective approach to first engaging tribal communities and risk management issues from their perspective has been the key. Climate information that is place based and temporally relevant provides the greatest value. By engaging in a social process of risk communication instead of traditional sender- receiver model are taking place and continuing across the U.S. 4-Corners, Pacific Northwest and Missouri Basin. For this presentation we will focus primarily on the lessons from those engagements on water resources in the Missouri Basin where twenty-eight tribes reside.
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Safe drinking water in regional NSW, Australia.
Byleveld, Paul M; Leask, Sandy D; Jarvis, Leslie A; Wall, Katrina J; Henderson, Wendy N; Tickell, Joshua E
2016-04-15
The New South Wales (NSW) Public Health Act 2010 requires water suppliers to implement a drinking water quality assurance program that addresses the 'Framework for management of drinking water quality' in the Australian drinking water guidelines. NSW Health has recognised the importance of a staged implementation of this requirement and the need to support regional water utilities. To date, NSW Health has assisted 74 regional utilities to develop and implement their management systems. The Public Health Act 2010 has increased awareness of drinking water risk management, and offers a systematic process to identify and control risks. This has benefited large utilities, smaller suppliers, and remote and Aboriginal communities. Work is continuing to ensure implementation of the process by private suppliers and water carters.
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ERIC Educational Resources Information Center
Bess, James L.
A study on leadership, conflict management, research and development (R&D) worker motivation, commitment, and risk-taking propensity in universities compared with corporations and government is presented. It arose from the recognition that R&D in any developed country is critical to the continued well-being of its economy and people, and…
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Arterial catheter complications and management problems: observations from AACN's Thunder Project.
1993-09-01
Arterial cannulation, while common in critical care, is a procedure with attendant risks of complications. Anecdotal data from the American Association of Critical Care Nurses' Thunder Project provided evidence that catheters, insertion sites, and monitoring systems continue to be sources of complications. The problems have not changed since arterial cannulation began. Line management issues cannot be resolved until low-maintenance systems are developed.
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Why are kids with lupus at an increased risk of cardiovascular disease?
Quinlan, Catherine; Marks, Stephen D; Tullus, Kjell
2016-06-01
Juvenile-onset systemic lupus erythematosus (SLE) is an aggressive multisystem autoimmune disease. Despite improvements in outcomes for adult patients, children with SLE continue to have a lower life expectancy than adults with SLE, with more aggressive disease, a higher incidence of lupus nephritis and there is an emerging awareness of their increased risk of cardiovascular disease (CVD). In this review, we discuss the evidence for an increased risk of CVD in SLE, its pathogenesis, and the clinical approach to its management.
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Epidemiology of ischemic heart disease in HIV.
Triant, Virginia A; Grinspoon, Steven K
2017-11-01
The purpose of this review is to summarize and synthesize recent data on the risk of ischemic heart disease (IHD) in HIV-infected individuals. Recent studies in the field demonstrate an increasing impact of cardiovascular disease (CVD) on morbidity and mortality in HIV relative to AIDS-related diagnoses. Studies continue to support an approximately 1.5 to two-fold increased risk of IHD conferred by HIV, with specific risk varying by sex and virologic/immunologic status. Risk factors include both traditional CVD risk factors and novel, HIV-specific factors including inflammation and immune activation. Specific antiretroviral therapy (ART) drugs may increase CVD risk, yet the net effect of ART with viral suppression is beneficial with regard to CVD risk. Management of cardiovascular risk and prevention of CVD is complex, because current general population strategies target traditional CVD risk factors only. Extensive investigation is being directed at developing tailored CVD risk prediction algorithms and interventions to reduce CVD risk in HIV. Increased IHD risk is a significant clinical and public health challenge in HIV. The development and application of HIV-specific interventions to manage CVD risk factors and reduce CVD risk will improve the long-term health of this ageing population.
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Donn, Steven M; McDonnell, William M
2012-01-01
The Institute of Medicine has recommended a change in culture from "name and blame" to patient safety. This will require system redesign to identify and address errors, establish performance standards, and set safety expectations. This approach, however, is at odds with the present medical malpractice (tort) system. The current system is outcomes-based, meaning that health care providers and institutions are often sued despite providing appropriate care. Nevertheless, the focus should remain to provide the safest patient care. Effective peer review may be hindered by the present tort system. Reporting of medical errors is a key piece of peer review and education, and both anonymous reporting and confidential reporting of errors have potential disadvantages. Diagnostic and treatment errors continue to be the leading sources of allegations of malpractice in pediatrics, and the neonatal intensive care unit is uniquely vulnerable. Most errors result from systems failures rather than human error. Risk management can be an effective process to identify, evaluate, and address problems that may injure patients, lead to malpractice claims, and result in financial losses. Risk management identifies risk or potential risk, calculates the probability of an adverse event arising from a risk, estimates the impact of the adverse event, and attempts to control the risk. Implementation of a successful risk management program requires a positive attitude, sufficient knowledge base, and a commitment to improvement. Transparency in the disclosure of medical errors and a strategy of prospective risk management in dealing with medical errors may result in a substantial reduction in medical malpractice lawsuits, lower litigation costs, and a more safety-conscious environment. Thieme Medical Publishers, Inc.
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Managing glacier related risks in the Chucchún Catchment, Cordillera Blanca, Peru
NASA Astrophysics Data System (ADS)
Muñoz, Randy; Gonzáles, César; Price, Karen; Frey, Holger; Huggel, Christian; Cochachin, Alejo; García, Javier; Mesa, Luis
2015-04-01
On April 11 2010, the city of Carhuaz and settlements in the Chucchún Catchment (Ancash region, Peru) suffered the impact of a glacier lake outburst flood. An avalanche of rock and ice from the Mount Hualcán hit the glacier lake 513, triggering a glacial lake outburst flood (GLOF) of 1 million m3 which destroyed farmland and several infrastructures. Although there was no loss of human life, the event caused panic in the population. In consequence, the Municipality of Carhuaz prioritized GLOF-related risk management. The Glacier Project, funded by Swiss Agency for Development and Cooperation, and executed by CARE Peru and the University of Zurich, fosters the coordination among public institutions (Glaciological Unit of the National Water Authority, the Ministry of Environment and Municipality) and the population for risk management. In this contribution we present all components of the risk management strategy as well as the lessons learned during the implementation. Risk management involves managing both glacier hazard as well as the vulnerability of the population. In this framework a glaciological and geomorphological characterization of Mount Hualcán and lake 513 was perfomed in order to model past and potential future outburst floods and to assess the slope stability conditions. Based on three potential GLOF scenarios of different magnitudes, a hazard map was produced for the entire catchment, which served as the basis for the vulnerability and risk assessment as well as for the design and the implementation of an Early Warning System (EWS), including evacuation planning. The EWS consists of 4 components: 1) knowledge of risk, through hazard and vulnerability characterization; 2) monitoring and alert, through the installation of monitoring stations on lake 513 for detecting avalanches with geophones and cameras; 3) broadcasting and communications, through the implementation of communication protocols between the Municipality of Carhuaz and emergency institutions (police, health centers and schools) and also authorities at higher coordination levels (Regional Government and the National Emergency Operations Center) enabling rapid emergency care; and 4) Responsiveness, through strengthening and training of public and private institutions and local leaders that make up the Civil Defense Platforms, the development of Emergency Operations Plan, and continuous organization of simulations for the population. As result, the population is aware of the risks they face and knok how to respond in case of a lake outburst event. In addition, the results generated during studies related to the risk analysis are used for land management of the Municipality of Carhuaz. The successful implementation of this risk management strategy was only possible by combining comprehensively scientific and local knowledge. This EWS represents a pilot experience in Peru and the Andes, and contributes to relatively scarce international experience with GLOF EWS. An important lesson is that these processes require active leadership of local authorities and continuous learning by the population. The mere existence of technology does not ensure the success of the risk reduction measures; this can only be attained by the internalization of processes and by taking responsibility against the existing hazard by each resident, authority and institution.
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Approach to risk identification in undifferentiated mental disorders
Silveira, José; Rockman, Patricia; Fulford, Casey; Hunter, Jon
2016-01-01
Abstract Objective To provide primary care physicians with a novel approach to risk identification and related clinical decision making in the management of undifferentiated mental disorders. Sources of information We conducted a review of the literature in PubMed, CINAHL, PsycINFO, and Google Scholar using the search terms diagnostic uncertainty, diagnosis, risk identification, risk assessment/methods, risk, risk factors, risk management/methods, cognitive biases and psychiatry, decision making, mental disorders/diagnosis, clinical competence, evidence-based medicine, interviews as topic, psychiatry/education, psychiatry/methods, documentation/methods, forensic psychiatry/education, forensic psychiatry/methods, mental disorders/classification, mental disorders/psychology, violence/prevention and control, and violence/psychology. Main message Mental disorders are a large component of practice in primary care and often present in an undifferentiated manner, remaining so for prolonged periods. The challenging search for a diagnosis can divert attention from risk identification, as diagnosis is commonly presumed to be necessary before treatment can begin. This might inadvertently contribute to preventable adverse events. Focusing on salient aspects of the patient presentation related to risk should be prioritized. This article presents a novel approach to organizing patient information to assist risk identification and decision making in the management of patients with undifferentiated mental disorders. Conclusion A structured approach can help physicians to manage the clinical uncertainty common to risk identification in patients with mental disorders and cope with the common anxiety and cognitive biases that affect priorities in risk-related decision making. By focusing on risk, functional impairments, and related symptoms using a novel framework, physicians can meet their patients’ immediate needs while continuing the search for diagnostic clarity and long-term treatment. PMID:27965330
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Approach to risk identification in undifferentiated mental disorders.
Silveira, José; Rockman, Patricia; Fulford, Casey; Hunter, Jon
2016-12-01
To provide primary care physicians with a novel approach to risk identification and related clinical decision making in the management of undifferentiated mental disorders. We conducted a review of the literature in PubMed, CINAHL, PsycINFO, and Google Scholar using the search terms diagnostic uncertainty, diagnosis, risk identification, risk assessment/methods, risk, risk factors, risk management/methods, cognitive biases and psychiatry, decision making, mental disorders/diagnosis, clinical competence, evidence-based medicine, interviews as topic, psychiatry/education, psychiatry/methods, documentation/methods, forensic psychiatry/education, forensic psychiatry/methods, mental disorders/classification, mental disorders/psychology, violence/prevention and control, and violence/psychology. Mental disorders are a large component of practice in primary care and often present in an undifferentiated manner, remaining so for prolonged periods. The challenging search for a diagnosis can divert attention from risk identification, as diagnosis is commonly presumed to be necessary before treatment can begin. This might inadvertently contribute to preventable adverse events. Focusing on salient aspects of the patient presentation related to risk should be prioritized. This article presents a novel approach to organizing patient information to assist risk identification and decision making in the management of patients with undifferentiated mental disorders. A structured approach can help physicians to manage the clinical uncertainty common to risk identification in patients with mental disorders and cope with the common anxiety and cognitive biases that affect priorities in risk-related decision making. By focusing on risk, functional impairments, and related symptoms using a novel framework, physicians can meet their patients' immediate needs while continuing the search for diagnostic clarity and long-term treatment. Copyright© the College of Family Physicians of Canada.
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Biosimilars: pharmacovigilance and risk management.
Zuñiga, Leyre; Calvo, Begoña
2010-07-01
Biosimilars cannot be authorized based on the same requirements that apply to generic medicines. Despite the fact that the biosimilar and reference drug can show similar efficacy, the biosimilar may exhibit different safety profile in terms of nature, seriousness or incidence of adverse reactions. However, the data from pre-authorization clinical studies normally are insufficient to identify all potential differences. Therefore, clinical safety of similar biological medicinal products must be monitored closely on an ongoing basis during the post-approval phase including continued risk-benefit assessment. The biosimilar applicant must provide the European Medicines Agency (EMEA) with a risk management plan (EU-RMP) and pharmacovigilance programme with its application, including a description of the potential safety issues associated with the similar biological medicinal product that may be a result of differences in the manufacturing process from the reference biologic. The most critical safety concern relating to biopharmaceuticals (including biosimilars) is immunogenicity. Risk management applies scientifically based methodologies to identify, assess, communicate and minimise risk throughout a drug's life cycle so as to establish and maintain a favourable benefit-risk profile in patients. The risk management plan for biosimilars should focus on heightens the pharmacovigilance measures, identify immunogenicity risk and implement special post-marketing surveillance. Although International Nonproprietary Names (INNs) served as a useful tool in worldwide pharmacovigilance, for biologicals they should not be relied upon as the only means of product identification. Biologicals should always be commercialized with a brand name or the INN plus the manufacturer's name. (c) 2010 John Wiley & Sons, Ltd.
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Neuberger, James M; Bechstein, Wolf O; Kuypers, Dirk R J; Burra, Patrizia; Citterio, Franco; De Geest, Sabina; Duvoux, Christophe; Jardine, Alan G; Kamar, Nassim; Krämer, Bernhard K; Metselaar, Herold J; Nevens, Frederik; Pirenne, Jacques; Rodríguez-Perálvarez, Manuel L; Samuel, Didier; Schneeberger, Stefan; Serón, Daniel; Trunečka, Pavel; Tisone, Giuseppe; van Gelder, Teun
2017-04-01
Short-term patient and graft outcomes continue to improve after kidney and liver transplantation, with 1-year survival rates over 80%; however, improving longer-term outcomes remains a challenge. Improving the function of grafts and health of recipients would not only enhance quality and length of life, but would also reduce the need for retransplantation, and thus increase the number of organs available for transplant. The clinical transplant community needs to identify and manage those patient modifiable factors, to decrease the risk of graft failure, and improve longer-term outcomes.COMMIT was formed in 2015 and is composed of 20 leading kidney and liver transplant specialists from 9 countries across Europe. The group's remit is to provide expert guidance for the long-term management of kidney and liver transplant patients, with the aim of improving outcomes by minimizing modifiable risks associated with poor graft and patient survival posttransplant.The objective of this supplement is to provide specific, practical recommendations, through the discussion of current evidence and best practice, for the management of modifiable risks in those kidney and liver transplant patients who have survived the first postoperative year. In addition, the provision of a checklist increases the clinical utility and accessibility of these recommendations, by offering a systematic and efficient way to implement screening and monitoring of modifiable risks in the clinical setting.
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[The hospital perspective: disease management and integrated health care].
Schrappe, Matthias
2003-06-01
Disease Management is a transsectoral, population-based form of health care, which addresses groups of patients with particular clinical entities and risk factors. It refers both to an evidence-based knowledge base and corresponding guidelines, evaluates outcome as a continuous quality improvement process and usually includes active participation of patients. In Germany, the implementation of disease management is associated with financial transactions for risk adjustment between health care assurances [para. 137 f, Book V of Social Code (SGB V)] and represents the second kind of transsectoral care, besides a program designed as integrated health care according to para. 140 a ff f of Book V of Social Code. While in the USA and other countries disease management programs are made available by several institutions involved in health care, in Germany these programs are offered by health care insurers. Assessment of disease management from the hospital perspective will have to consider three questions: How large is the risk to compensate inadequate quality in outpatient care? Are there synergies in internal organisational development? Can the risk of inadequate funding of the global "integrated" budget be tolerated? Transsectoral quality assurance by valid performance indicators and implementation of a quality improvement process are essential. Internal organisational changes can be supported, particularly in the case of DRG introduction. The economic risk and financial output depends on the kind of disease being focussed by the disease management program. In assessing the underlying scientific evidence of their cost effectiveness, societal costs will have to be precisely differentiated from hospital-associated costs.
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42 CFR 441.464 - State assurances.
Code of Federal Regulations, 2014 CFR
2014-10-01
... services, supports, and resources. (xii) Development of risk management agreements. (xiii) Development of... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... protect the health and welfare of individuals furnished services under the program and to assure the...
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42 CFR 441.464 - State assurances.
Code of Federal Regulations, 2012 CFR
2012-10-01
... services, supports, and resources. (xii) Development of risk management agreements. (xiii) Development of... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... protect the health and welfare of individuals furnished services under the program and to assure the...
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42 CFR 441.464 - State assurances.
Code of Federal Regulations, 2013 CFR
2013-10-01
... services, supports, and resources. (xii) Development of risk management agreements. (xiii) Development of... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... protect the health and welfare of individuals furnished services under the program and to assure the...
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Risk-based asset management methodology for highway infrastructure systems.
DOT National Transportation Integrated Search
2004-01-01
Maintaining the infrastructure of roads, highways, and bridges is paramount to ensuring that these assets will remain safe and reliable in the future. If maintenance costs remain the same or continue to escalate, and additional funding is not made av...
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Van Ness-Otunnu, Ronald; Hack, Jason B
2013-11-01
Hyperglycemic crisis is a metabolic emergency associated with uncontrolled diabetes mellitus that may result in significant morbidity or death. Acute interventions are required to manage hypovolemia, acidemia, hyperglycemia, electrolyte abnormalities, and precipitating causes. Despite advances in the prevention and management of diabetes, its prevalence and associated health care costs continue to increase worldwide. Hyperglycemic crisis typically requires critical care management and hospitalization and contributes to global health expenditures. Diagnostic and resolution criteria and management strategies for diabetic ketoacidosis and hyperosmolar hyperglycemic crisis are provided. A discussion of prevalence, mortality, pathophysiology, risk factors, clinical presentation, differential diagnosis, evaluation, and management considerations for hyperglycemic crisis are included. Emergency physicians confront the most severe sequelae of uncontrolled diabetes and provide crucial, life-saving management. With ongoing efforts from diabetes societies to incorporate the latest clinical research to refine treatment guidelines, management and outcomes of hyperglycemic crisis in the emergency department continue to improve. We provide an overview of the evaluation and treatment of hyperglycemic crisis and offer a concise, targeted management algorithm to aid the practicing emergency physician. Copyright © 2013 Elsevier Inc. All rights reserved.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Johnson, Curtis
1999-05-17
This is a period of ever-tightening defense budgets and continuing pressure on the public sector to be more commercial-like, Property policies, practices, and regulations are increasingly being challenged and changed. In these times, we must be leaders in understanding and defining the value of our profession from a commercial standpoint so that we can provide the right services to our customers and explain and defend the value of those services. To do so, we must step outside current property management practices, regulations, and oversight. We must learn to think and speak in the language of those who fund us--a financialmore » language of risk, cost, and benefit. Regardless of regulation and oversight, our bosses are demanding that we demonstrate (financially) the benefits of current practice, or else. This article is intended to be the beginning of an effort to understand and define our profession in terms of risk, cost, and benefit so that we can meet these new challenges. The first step in this effort must be defining and measuring risk, cost, and benefit. Our costs, although sometimes difficult to capture, are easy to understand: they are almost exclusively the effort, both within and without the property management organization, involved in managing property. Unfortunately, property risks and benefits are not so simple or so well understood. Generally, risks and benefits are identified and measured through physical inventory results: potential and actual shortages. This paper will explore the weaknesses in the current understanding and use of shortage information as the yardstick for property management risks and performance. It will define a new framework for understanding the purpose and value of property management. And finally, it will set a course for a new method of measuring and valuing physical inventoty shortages. This new method will yield accurate and useful measures of property management risk and benefit. Once risk and benefit are accurately understood and measured, it will be possible to evaluate, adjust, and explain property management practices and regulations from a commercial, financial perspective; it will be possible for us to be the leaders in redefining the purpose and value of the property management profession for today's environment.« less
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NASA Astrophysics Data System (ADS)
Ranasinghe, R.; Jongejan, R.; Wainwright, D.; Callaghan, D. P.
2016-02-01
Up to 70% of the world's sandy coastlines are eroding, resulting in gradual and continuous coastline recession. The rate of coastline recession is likely to increase due to the projected impacts of climate change on mean sea levels, offshore wave climate and storm surges. At the same time, rapid development in the world's coastal zones continues to increase potential damages, while often reducing the resilience of coastal systems. The risks associated with coastline recession are thus likely to increase over the coming decades, unless effective risk management plans are put in place. Land-use restrictions are a key component of coastal zone risk management plans. These involve the use of coastal setback lines which are mainly established by linearly adding the impacts of storms, recession due to sea level rise, and ambient long term trends in shoreline evolution. This approach does not differentiate between uncertainties that develop differently over time, nor takes into account the value and lifetime of property developments. Both shortcomings could entail considerable social cost. For balancing risk and reward, probabilistic estimates of coastline recession are a pre-requisite. Yet the presently adopted deterministic methods for establishing setback lines are unable to provide such estimates. Here, we present a quantitative risk analysis (QRA) model, underpinned by a multi-scale, physics based coastal recession model capable of providing time-dependent risk estimates. The modelling approach presented enables the determination of setback lines in terms of exceedance probabilities, a quantity that directly feeds into risk evaluations and economic optimizations. As a demonstration, the risk-informed approach is applied to Narrabeen beach, Sydney, Australia.
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EU's new pharmacovigilance legislation: considerations for biosimilars.
Calvo, Begoña; Zuñiga, Leyre
2014-01-01
Biosimilars are biological medicines, the active substances of which are highly similar to those of biologics that have already been authorized. As for any other medicine, the applicant of the biosimilar marketing authorization must submit a risk-management plan (RMP)/pharmacovigilance plan. The pharmacovigilance plan should take into account risks identified during product development, the potential risks and how those risks will be addressed after authorization of the product.Recently, new European Pharmacovigilance legislation has been implemented, ensuring proper risk management through the recording of suspected adverse drug reactions and data collection from all stakeholders. The new regulation entails a reduction of the administrative burden on companies and regulatory agencies, as obligations of the responsible parties are clearly established and duplication of effort avoided.This article analyzes the new European Pharmacovigilance System requirements, with special focus on those medicines requiring additional monitoring, such as biosimilars, which are priorities for pharmacovigilance. Further, it provides the new obligations to marketing authorization holders, such as the continuous benefit-risk assessment.
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Franchi, Francesco; Rollini, Fabiana; Angiolillo, Dominick J
2014-11-01
To provide an updated overview on the management of antiplatelet therapy in patients with coronary stents undergoing cardiac and noncardiac surgery. Surgical procedures are frequently performed in patients with coronary stents and are associated with an increased risk of ischemic and bleeding complications in the perioperative period. Given the lack of well-designed prospective randomized trials, guidelines recommendations are currently derived from observational studies and expert consensus. Defining the optimal balance between the risk of thrombotic events following discontinuation of antiplatelet therapy and the risk of hemorrhagic complications of having a surgical procedure while on antiplatelet therapy is pivotal. Elective surgery should be postponed for at least 4 weeks after bare metal stent implantation and 6-12 months after drug-eluting stent. If this is not possible, aspirin should be continued in the perioperative period, although the management of P2Y₁₂ inhibitors should be individualized according to the individual patient and type of surgery. In the absence of well-defined recommendations deriving from prospective randomized clinical trials, the perioperative management of antiplatelet therapy should be based on the balance between the specific thrombotic and hemorrhagic risks that characterize each patient and each surgical procedure.
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Monitoring and Management of Toxicities of Novel B Cell Signaling Agents.
Rhodes, Joanna; Mato, Anthony; Sharman, Jeff P
2018-04-11
B cell signaling agents, including ibrutinib, idelalisib, and the BCL-2 inhibitor venetoclax have become an integral part of therapy for patients with non-Hodgkin's lymphomas. The toxicity profiles of these medications is distinct from chemoimmunotherapy. Here, we will review the mechanism of action of these drugs, their efficacy, and toxicity management. Ibrutinib use is associated with increased risk of atrial fibrillation and bleeding which can be managed using dose interruptions and modifications. Patients on idelalisib require close clinical and frequent laboratory monitoring, particularly of liver function tests to ensure there are no serious adverse events. Monitoring for infections is important in patients on both idelalisib and ibrutinib. Venetoclax requires close clinical and laboratory monitoring to prevent significant tumor lysis. Targeted B cell receptor therapies each have unique side effect profiles which require careful clinical monitoring. As we continue to use these therapies, optimal management strategies will continue to be elucidated.
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Implementing a resource management program for accreditation process at the medical laboratory.
Yenice, Sedef
2009-03-01
To plan for and provide adequate resources to meet the mission and goals of a medical laboratory in compliance with the requirements for laboratory accreditation by Joint Commission International. The related policies and procedures were developed based on standard requirements for resource management. Competency assessment provided continuing education and performance feedback to laboratory employees. Laboratory areas were designed for the efficient and safe performance of laboratory work. A physical environment was built up where hazards were controlled and personnel activities were managed to reduce the risk of injuries. An Employees Occupational Safety and Health Program (EOSHP) was developed to address all types of hazardous materials and wastes. Guidelines were defined to verify that the methods would produce accurate and reliable results. An active resource management program will be an effective way of assuring that systems are in control and continuous improvement is in progress.
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Disaster risk profile and existing legal framework of Nepal: floods and landslides
Gaire, Surya; Castro Delgado, Rafael; Arcos González, Pedro
2015-01-01
Nepal has a complicated geophysical structure that is prone to various kinds of disasters. Nepal ranks the most disaster-prone country in the world and has experienced several natural calamities, causing high property and life losses. Disasters are caused by natural processes, but may be increased by human activities. The overall objective of this paper is to analyze the disaster risk profile and existing legal framework of Nepal. The paper is based on secondary data sources. Major causative factors for floods and landslides are heavy and continuous rainfall, outburst floods, infrastructure failure, and deforestation. Historical data of natural disasters in Nepal show that water-induced disasters have killed hundreds of people and affected thousands every year. Likewise, properties worth millions of US dollars have been damaged. There is an increasing trend toward landslides and floods, which will likely continue to rise if proper intervention is not taken. A positive correlation between water-induced disasters and deaths has been observed. Nepal has a poor Index for Risk Management (INFORM). There are fluctuations in the recording of death data caused by flood and landslides. The Government of Nepal focuses more on the response phase than on the preparedness phase of disasters. The existing disaster management act seems to be weak and outdated. There is a gap in current legal procedure, so the country is in dire need of a comprehensive legal framework. The new proposed act seems to take a much broader approach to disaster management. With a long-term vision of managing disaster risk in the country, the Government of Nepal has begun the Nepal Risk Reduction Consortium (NRRC) in collaboration with development and humanitarian partners. In order to improve the vulnerability of Nepal, an early warning system, mainstreaming disasters with development, research activities, community participation and awareness, and a rainfall monitoring system must all be a focus. PMID:26366106
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Disaster risk profile and existing legal framework of Nepal: floods and landslides.
Gaire, Surya; Castro Delgado, Rafael; Arcos González, Pedro
2015-01-01
Nepal has a complicated geophysical structure that is prone to various kinds of disasters. Nepal ranks the most disaster-prone country in the world and has experienced several natural calamities, causing high property and life losses. Disasters are caused by natural processes, but may be increased by human activities. The overall objective of this paper is to analyze the disaster risk profile and existing legal framework of Nepal. The paper is based on secondary data sources. Major causative factors for floods and landslides are heavy and continuous rainfall, outburst floods, infrastructure failure, and deforestation. Historical data of natural disasters in Nepal show that water-induced disasters have killed hundreds of people and affected thousands every year. Likewise, properties worth millions of US dollars have been damaged. There is an increasing trend toward landslides and floods, which will likely continue to rise if proper intervention is not taken. A positive correlation between water-induced disasters and deaths has been observed. Nepal has a poor Index for Risk Management (INFORM). There are fluctuations in the recording of death data caused by flood and landslides. The Government of Nepal focuses more on the response phase than on the preparedness phase of disasters. The existing disaster management act seems to be weak and outdated. There is a gap in current legal procedure, so the country is in dire need of a comprehensive legal framework. The new proposed act seems to take a much broader approach to disaster management. With a long-term vision of managing disaster risk in the country, the Government of Nepal has begun the Nepal Risk Reduction Consortium (NRRC) in collaboration with development and humanitarian partners. In order to improve the vulnerability of Nepal, an early warning system, mainstreaming disasters with development, research activities, community participation and awareness, and a rainfall monitoring system must all be a focus.
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2014-04-08
assertions are free of material misstatement . There are two types of substantive testing: substantive analytical procedures and tests of details...identified internal control weaknesses continue to exist and are significant enough to result in material misstatements or a conclusion that account...records properly. As a result, CEHNC personnel processed $21.5 million in contractor payments, citing an incorrect obligation, and was at increased risk
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Perioperative aspirin management after POISE-2: some answers, but questions remain.
Gerstein, Neal Stuart; Carey, Michael Christopher; Cigarroa, Joaquin E; Schulman, Peter M
2015-03-01
Aspirin constitutes important uninterrupted lifelong therapy for many patients with cardiovascular (CV) disease or significant (CV) risk factors. However, whether aspirin should be continued or withheld in patients undergoing noncardiac surgery is a common clinical conundrum that balances the potential of aspirin for decreasing thrombotic risk with its possibility for increasing perioperative blood loss. In this focused review, we describe the role of aspirin in treating and preventing cardiovascular disease, summarize the most important literature on the perioperative use of aspirin (including the recently published PeriOperative ISchemic Evaluation [POISE]-2 trial), and offer current recommendations for managing aspirin during the perioperative period. POISE-2 suggests that aspirin administration during the perioperative period does not change the risk of a cardiovascular event and may result in increased bleeding. However, these findings are tempered by a number of methodological issues related to the study. On the basis of currently available literature, including POISE-2, aspirin should not be administered to patients undergoing surgery unless there is a definitive guideline-based primary or secondary prevention indication. Aside from closed-space procedures, intramedullary spine surgery, or possibly prostate surgery, moderate-risk patients taking lifelong aspirin for a guideline-based primary or secondary indication may warrant continuation of their aspirin throughout the perioperative period.
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MacDonald, Noni E; Smith, Jennifer; Appleton, Mary
2012-09-01
For decades vaccine program managers and governments have devoted many resources to addressing public vaccine concerns, vaccine risk perception, risk management and safety assessment. Despite ever growing evidence that vaccines are safe and effective, public concerns continue. Education and evidence based scientific messages have not ended concerns. How can governments and programs more effectively address the public's vaccine concerns and increase confidence in the vaccine safety system? Vaccination hesitation has been attributed to concerns about vaccine safety, perceptions of high vaccine risks and low disease risk and consequences. Even when the public believes vaccines are important for protection many still have concerns about vaccine safety. This overview explores how heuristics affect public perception of vaccines and vaccine safety, how the public finds and uses vaccine information, and then proposes strategies for changes in the approach to vaccine safety communications. Facts and evidence confirming the safety of vaccines are not enough. Vaccine beliefs and behaviours must be shaped. This will require a shift in the what, when, how and why of vaccine risk and benefit communication content and practice. A change to a behavioural change strategy such as the WHO COMBI program that has been applied to disease eradication efforts is suggested. Copyright © 2011. Published by Elsevier Ltd.. All rights reserved.
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Endocrine disrupting compounds in drinking water supply system and human health risk implication.
Wee, Sze Yee; Aris, Ahmad Zaharin
2017-09-01
To date, experimental and epidemiological evidence of endocrine disrupting compounds (EDCs) adversely affecting human and animal populations has been widely debated. Notably, human health risk assessment is required for risk mitigation. The lack of human health risk assessment and management may thus unreliably regulate the quality of water resources and efficiency of treatment processes. Therefore, drinking water supply systems (DWSSs) may be still unwarranted in assuring safe access to potable drinking water. Drinking water supply, such as tap water, is an additional and crucial route of human exposure to the health risks associated with EDCs. A holistic system, incorporating continuous research in DWSS monitoring and management using multi-barrier approach, is proposed as a preventive measure to reduce human exposure to the risks associated with EDCs through drinking water consumption. The occurrence of EDCs in DWSSs and corresponding human health risk implications are analyzed using the Needs, Approaches, Benefits, and Challenges (NABC) method. Therefore, this review may act as a supportive tool in protecting human health and environmental quality from EDCs, which is essential for decision-making regarding environmental monitoring and management purposes. Subsequently, the public could have sustainable access to safer and more reliable drinking water. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Modeling Tribal Exposures to PCBs from Fish Consumption
Studies have shown that U.S. population continues to be exposed to polychlorinated biphenyls (PCBs), despite the ban ~40 years ago. Fish intake is a major pathway, especially, for high fish-consumption groups. Exposure assessment and risk management considerations for tribal fish...
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Thompson, Matthew P; Scott, Joe; Helmbrecht, Don; Calkin, Dave E
2013-04-01
The financial, socioeconomic, and ecological impacts of wildfire continue to challenge federal land management agencies in the United States. In recent years, policymakers and managers have increasingly turned to the field of risk analysis to better manage wildfires and to mitigate losses to highly valued resources and assets (HVRAs). Assessing wildfire risk entails the interaction of multiple components, including integrating wildfire simulation outputs with geospatial identification of HVRAs and the characterization of fire effects to HVRAs. We present an integrated and systematic risk assessment framework that entails 3 primary analytical components: 1) stochastic wildfire simulation and burn probability modeling to characterize wildfire hazard, 2) expert-based modeling to characterize fire effects, and 3) multicriteria decision analysis to characterize preference structures across at-risk HVRAs. We demonstrate application of this framework for a wildfire risk assessment performed on the Little Belts Assessment Area within the Lewis and Clark National Forest in Montana, United States. We devote particular attention to our approach to eliciting and encapsulating expert judgment, in which we: 1) adhered to a structured process for using expert judgment in ecological risk assessment, 2) used as our expert base local resource scientists and fire/fuels specialists who have a direct connection to the specific landscape and HVRAs in question, and 3) introduced multivariate response functions to characterize fire effects to HVRAs that consider biophysical variables beyond fire behavior. We anticipate that this work will further the state of wildfire risk science and will lead to additional application of risk assessment to inform land management planning. Copyright © 2012 SETAC.
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NASA Astrophysics Data System (ADS)
Creed, I. F.; Webster, K. L.; Kreutzweiser, D. P.; Beall, F.
2014-12-01
Canada's boreal forest supports many aquatic ecosystem services (AES) due to the intimate linkage between aquatic systems and their surrounding terrestrial watersheds in forested landscapes. There is an increasing risk to AES because natural development activities (forest management, mining, energy) have resulted in disruptions that deteriorate aquatic ecosystems at local (10s of km2) to regional (100s of km2) scales. These activities are intensifying and expanding, placing at risk the healthy aquatic ecosystems that provide AES and may threaten the continued development of the energy, forest, and mining sectors. Remarkably, we know little about the consequences of these activities on AES. The idea that AES should be explicitly integrated into modern natural resource management regulations is gaining broad acceptance. A major need is the ability to measure cumulative effects and determine thresholds (the points where aquatic ecosystems and their services cannot recover to a desired state within a reasonable time frame) in these cumulative effects. However, there is no single conceptual approach to assessing cumulative effects that is widely accepted by both scientists and managers. We present an integrated science-policy framework that enables the integration of AES into forest management risk assessment and prevention/mitigation strategies. We use this framework to explore the risk of further deterioration of AES by (1) setting risk criteria; (2) using emerging technologies to map process-based indicators representing causes and consequences of risk events to the deterioration of AES; (3) assessing existing prevention and mitigation policies in place to avoid risk events; and (4) identifying priorities for policy change needed to reduce risk event. Ultimately, the success of this framework requires that higher value be placed on AES, and in turn to improve the science and management of the boreal forest.
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Havrdova, Eva; Cohen, Jeffrey A; Horakova, Dana; Kovarova, Ivana; Meluzinova, Eva
2017-01-01
The introduction of high-efficacy therapies for relapsing-remitting multiple sclerosis has driven re-evaluation of treatment goals and benefit:risk considerations in treatment choice. In the alemtuzumab Phase II and III clinical trials, patients treated with alemtuzumab 12 mg versus subcutaneous interferon beta-1a demonstrated significantly reduced annualized relapse rates and improved magnetic resonance imaging outcomes, and were significantly more likely to achieve no evidence of disease activity and reduction in brain volume loss. In two of the studies, alemtuzumab-treated patients had a significantly reduced risk of 6-month confirmed disease worsening, compared with subcutaneous interferon beta-1a. Benefits were maintained throughout 5 years, with a majority of patients receiving no alemtuzumab retreatment or other disease-modifying therapy. Trial results support alemtuzumab's manageable, consistent safety profile in relapsing-remitting multiple sclerosis. Infusion-associated reactions, the most frequent adverse events (AEs), can be minimized by corticosteroid pretreatment, monitoring, and symptomatic management. Other AEs include infections and autoimmune events. Oral anti-herpes prophylaxis should be initiated on the first day of each alemtuzumab treatment course and continued according to local guidelines. Overall cancer risk was lower in the alemtuzumab clinical trials than in a reference population; however, continuing surveillance will determine if alemtuzumab may be associated with certain malignancies such as thyroid papillary carcinoma and melanoma, which are currently identified as potential risks. The post-approval risk management strategy includes a safety monitoring program. Autoimmune AEs (thyroid events, immune thrombocytopenia, nephropathies) can be detected in a timely manner with the monitoring program, which includes physician and patient education about the signs and symptoms, monthly renal and hematologic monitoring, and quarterly thyroid function monitoring for 48 months after the last alemtuzumab course. Education, vigilance by physicians and patients, and monthly laboratory monitoring are recommended to maintain alemtuzumab's positive benefit:risk profile.
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Normal accidents: human error and medical equipment design.
Dain, Steven
2002-01-01
High-risk systems, which are typical of our technologically complex era, include not just nuclear power plants but also hospitals, anesthesia systems, and the practice of medicine and perfusion. In high-risk systems, no matter how effective safety devices are, some types of accidents are inevitable because the system's complexity leads to multiple and unexpected interactions. It is important for healthcare providers to apply a risk assessment and management process to decisions involving new equipment and procedures or staffing matters in order to minimize the residual risks of latent errors, which are amenable to correction because of the large window of opportunity for their detection. This article provides an introduction to basic risk management and error theory principles and examines ways in which they can be applied to reduce and mitigate the inevitable human errors that accompany high-risk systems. The article also discusses "human factor engineering" (HFE), the process which is used to design equipment/ human interfaces in order to mitigate design errors. The HFE process involves interaction between designers and endusers to produce a series of continuous refinements that are incorporated into the final product. The article also examines common design problems encountered in the operating room that may predispose operators to commit errors resulting in harm to the patient. While recognizing that errors and accidents are unavoidable, organizations that function within a high-risk system must adopt a "safety culture" that anticipates problems and acts aggressively through an anonymous, "blameless" reporting mechanism to resolve them. We must continuously examine and improve the design of equipment and procedures, personnel, supplies and materials, and the environment in which we work to reduce error and minimize its effects. Healthcare providers must take a leading role in the day-to-day management of the "Perioperative System" and be a role model in promoting a culture of safety in their organizations.
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Pre- and posttest evaluation of a breast cancer risk assessment program for nurse practitioners.
Edwards, Quannetta T; Seibert, Diane
2010-07-01
Numerous studies have shown that healthcare providers, including nurse practitioners (NPs) fail to provide breast cancer risk assessment (BrCRA) in primary care settings. A potential barrier to the use of BrCRA is insufficient knowledge or training of risk assessment. The purpose of this study was to analyze the outcome of a BrCRA program developed to enhance NPs' knowledge of risk assessment and use of empiric risk assessment models. Thirty-five NPs participated in a before-after (pretest-posttest design) study evaluating the effectiveness of a BrCRA education program conducted at a national NP conference. Demographics, pre/post knowledge, and course satisfaction measures were all examined as a part of this pilot study. Continuing education through the implementation of a BrCRA program significantly increased NPs knowledge in assessing breast cancer risk and the use of empiric risk assessment models. Many healthcare providers, including NPs, are inadequately prepared to assess a woman's risk for breast cancer. Understanding breast cancer risk assessment is essential if NPs are to provide appropriate counseling, management, and referral strategies needed to reduce a woman's risk for developing the disease. Continuing education provides one means to enhance NP's knowledge of BrCRA.
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Integrating Spaceflight Human System Risk Research
NASA Technical Reports Server (NTRS)
Mindock, J.; Lumpkins, S.; Anton, W.; Havenhill, M.; Shelhamer, M.; Canga, M.
2016-01-01
NASA is working to increase the likelihoods of human health and performance success during exploration missions, and subsequent crew long-term health. To manage the risks in achieving these goals, a system modeled after a Continuous Risk Management framework is in place. "Human System Risks" (Risks) have been identified, and approximately 30 are being actively addressed by NASA's Human Research Program (HRP). Research plans for each of HRP's Risks have been developed and are being executed. Ties between the research efforts supporting each Risk have been identified, however, this has been in an ad hoc fashion. There is growing recognition that solutions developed to address the full set of Risks covering medical, physiological, behavioral, vehicle, and organizational aspects of the exploration missions must be integrated across Risks and disciplines. We will discuss how a framework of factors influencing human health and performance in space is being applied as the backbone for bringing together sometimes disparate information relevant to the individual Risks. The resulting interrelated information is allowing us to identify and visualize connections between Risks and research efforts in a systematic and standardized way. We will discuss the applications of the visualizations and insights to research planning, solicitation, and decision-making processes.
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Livadiotti, Susanna; Milano, Giuseppe Maria; Serra, Annalisa; Folgori, Laura; Jenkner, Alessandro; Castagnola, Elio; Cesaro, Simone; Rossi, Mario R.; Barone, Angelica; Zanazzo, Giulio; Nesi, Francesca; Licciardello, Maria; De Santis, Raffaella; Ziino, Ottavio; Cellini, Monica; Porta, Fulvio; Caselli, Desiree; Pontrelli, Giuseppe
2012-01-01
A nationwide questionnaire-based survey was designed to evaluate the management and prophylaxis of febrile neutropenia in pediatric patients admitted to hematology-oncology and hematopoietic stem cell transplant units. Of the 34 participating centers, 40 and 63%, respectively, continue to prescribe antibacterial and antimycotic prophylaxis in low-risk subjects and 78 and 94% in transplant patients. Approximately half of the centers prescribe a combination antibiotic regimen as first-line therapy in low-risk patients and up to 81% in high-risk patients. When initial empirical therapy fails after seven days, 63% of the centers add empirical antimycotic therapy in low-and 81% in high-risk patients. Overall management varies significantly across centers. Preventive nursing procedures are in accordance with international guidelines. This survey is the first to focus on prescribing practices in children with cancer and could help to implement practice guidelines. PMID:21993676
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Quality, risk management and governance in mental health: an overview.
Callaly, Tom; Arya, Dinesh; Minas, Harry
2005-03-01
To consider the origin, current emphasis and relevance of the concepts of quality, risk management and clinical governance in mental health. Increasingly, health service boards and management teams are required to give attention to clinical governance rather than corporate governance alone. Clinical governance is a unifying quality concept that aims to produce a structure and systems to assure and improve the quality of clinical services by promoting an integrated and organization-wide approach towards continuous quality improvement. Many psychiatrists will find the reduction in clinical autonomy, the need to consider the welfare of the whole population as well as the individual patient for whom they are responsible, and the requirement that they play a part in a complex systems approach to quality improvement to be a challenge. Avoiding or ignoring this challenge will potentially lead to conflict with modern management approaches and increased loss of influence on future developments in mental health services.
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The politics of risk in the Philippines: comparing state and NGO perceptions of disaster management.
Bankoff, Greg; Hilhorst, Dorothea
2009-10-01
It is now generally appreciated that what constitutes vulnerability to one person is not necessarily perceived as such by the next. Different actors 'see' disasters as different types of events and as a result they prepare for, manage and record them in very different ways. This paper explores what different perceptions of vulnerability mean in terms of the understanding and practices of two significant sets of actors and stakeholders involved in disaster preparedness and management in the Philippines: the state and NGOs. Approaches to disaster are not just a function of people's perceptions of disaster risk but also of their understanding of the prevailing social order and social relations. Despite a shared vocabulary-which increasingly presents disasters as processes rather than events, takes a proactive rather than a reactive approach, and favours the inclusion of stakeholders rather than solely relying on technocratic management-different realities continue to make for different responses.
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Demand management: enabling patients to use medical care appropriately.
Vickery, D M; Lynch, W D
1995-05-01
A rationale is presented for considering demand management as well as supply management (managed care) in the current debate on health care reform. Demand management is the support of individuals so that they may make rational health and medical decisions based on a consideration of benefits and risks. The concept of demand for medical services is examined within a theoretical framework of four components: morbidity, perceived need, patient preference, and nonhealth motives. Two components, perceived need and patient preference, are suggested to offer considerable potential for making utilization more appropriate and reducing costs. Current demand services and potential hazards related to their continued expansion are discussed.
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Blot, William J; Ibrahim, Michel A; Ivey, Tom D; Acheson, Donald E; Brookmeyer, Ron; Weyman, Arthur; Defauw, Joseph; Smith, J Kermit; Harrison, Donald
2005-05-31
The first Björk-Shiley convexoconcave (BSCC) prosthetic heart valves were implanted in 1978. The 25th anniversary provided a stimulus to summarize the research data relevant to BSCC valve fracture, patient management, and current clinical options. Published and unpublished data on the risks of BSCC valve fracture and replacement were compiled, and strategies for identifying candidates for prophylactic valve reoperation were summarized. By December 2003, outlet strut fractures (OSFs), often with fatal outcomes, had been reported in 633 BSCC valves (0.7% of 86,000 valves implanted). Fractures still continue to occur, but average rates of OSFs in 60 degrees valves are now <0.1% per year. OSF risk varies markedly by valve characteristics, especially valve angle and size, with weaker effects associated with other manufacturing variables. OSF risks are mildly lower among women than men but decline sharply with advancing age. The risks of valve replacement typically greatly exceed those of OSF. By comparing individualized estimated risks of OSF versus valve replacement, guidelines have been developed to identify the small percentage of BSCC patients (mostly younger men) who would be expected to have a gain in life expectancy should reoperative surgery be performed. Twenty-five years after the initial BSCC valve implants, fractures continue to occur. Continued monitoring of BSCC patients is needed to track and quantify risks and enable periodic updating of guidelines for patients and their physicians.
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Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia.
Grever, Michael R; Abdel-Wahab, Omar; Andritsos, Leslie A; Banerji, Versha; Barrientos, Jacqueline; Blachly, James S; Call, Timothy G; Catovsky, Daniel; Dearden, Claire; Demeter, Judit; Else, Monica; Forconi, Francesco; Gozzetti, Alessandro; Ho, Anthony D; Johnston, James B; Jones, Jeffrey; Juliusson, Gunnar; Kraut, Eric; Kreitman, Robert J; Larratt, Loree; Lauria, Francesco; Lozanski, Gerard; Montserrat, Emili; Parikh, Sameer A; Park, Jae H; Polliack, Aaron; Quest, Graeme R; Rai, Kanti R; Ravandi, Farhad; Robak, Tadeusz; Saven, Alan; Seymour, John F; Tadmor, Tamar; Tallman, Martin S; Tam, Constantine; Tiacci, Enrico; Troussard, Xavier; Zent, Clive S; Zenz, Thorsten; Zinzani, Pier Luigi; Falini, Brunangelo
2017-02-02
Hairy cell leukemia is an uncommon hematologic malignancy characterized by pancytopenia and marked susceptibility to infection. Tremendous progress in the management of patients with this disease has resulted in high response rates and improved survival, yet relapse and an appropriate approach to re-treatment present continuing areas for research. The disease and its effective treatment are associated with immunosuppression. Because more patients are being treated with alternative programs, comparison of results will require general agreement on definitions of response, relapse, and methods of determining minimal residual disease. The development of internationally accepted, reproducible criteria is of paramount importance in evaluating and comparing clinical trials to provide optimal care. Despite the success achieved in managing these patients, continued participation in available clinical trials in the first-line and particularly in the relapse setting is highly recommended. The Hairy Cell Leukemia Foundation convened an international conference to provide common definitions and structure to guide current management. There is substantial opportunity for continued research in this disease. In addition to the importance of optimizing the prevention and management of the serious risk of infection, organized evaluations of minimal residual disease and treatment at relapse offer ample opportunities for clinical research. Finally, a scholarly evaluation of quality of life in the increasing number of survivors of this now manageable chronic illness merits further study. The development of consensus guidelines for this disease offers a framework for continued enhancement of the outcome for patients.
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Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia
Abdel-Wahab, Omar; Andritsos, Leslie A.; Banerji, Versha; Barrientos, Jacqueline; Blachly, James S.; Call, Timothy G.; Catovsky, Daniel; Dearden, Claire; Demeter, Judit; Else, Monica; Forconi, Francesco; Gozzetti, Alessandro; Ho, Anthony D.; Johnston, James B.; Jones, Jeffrey; Juliusson, Gunnar; Kraut, Eric; Kreitman, Robert J.; Larratt, Loree; Lauria, Francesco; Lozanski, Gerard; Montserrat, Emili; Parikh, Sameer A.; Park, Jae H.; Polliack, Aaron; Quest, Graeme R.; Rai, Kanti R.; Ravandi, Farhad; Robak, Tadeusz; Saven, Alan; Seymour, John F.; Tadmor, Tamar; Tallman, Martin S.; Tam, Constantine; Tiacci, Enrico; Troussard, Xavier; Zent, Clive S.; Zenz, Thorsten; Zinzani, Pier Luigi; Falini, Brunangelo
2017-01-01
Hairy cell leukemia is an uncommon hematologic malignancy characterized by pancytopenia and marked susceptibility to infection. Tremendous progress in the management of patients with this disease has resulted in high response rates and improved survival, yet relapse and an appropriate approach to re-treatment present continuing areas for research. The disease and its effective treatment are associated with immunosuppression. Because more patients are being treated with alternative programs, comparison of results will require general agreement on definitions of response, relapse, and methods of determining minimal residual disease. The development of internationally accepted, reproducible criteria is of paramount importance in evaluating and comparing clinical trials to provide optimal care. Despite the success achieved in managing these patients, continued participation in available clinical trials in the first-line and particularly in the relapse setting is highly recommended. The Hairy Cell Leukemia Foundation convened an international conference to provide common definitions and structure to guide current management. There is substantial opportunity for continued research in this disease. In addition to the importance of optimizing the prevention and management of the serious risk of infection, organized evaluations of minimal residual disease and treatment at relapse offer ample opportunities for clinical research. Finally, a scholarly evaluation of quality of life in the increasing number of survivors of this now manageable chronic illness merits further study. The development of consensus guidelines for this disease offers a framework for continued enhancement of the outcome for patients. PMID:27903528
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Between Oais and Agile a Dynamic Data Management Approach
NASA Astrophysics Data System (ADS)
Bennett, V. L.; Conway, E. A.; Waterfall, A. M.; Pepler, S.
2015-12-01
In this paper we decribe an approach to the integration of existing archival activities which lies between compliance with the more rigid OAIS/TRAC standards and a more flexible "Agile" approach to the curation and preservation of Earth Observation data. We provide a high level overview of existing practice and discuss how these procedures can be extended and supported through the description of preservation state. The aim of which is to facilitate the dynamic controlled management of scientific data through its lifecycle. While processes are considered they are not statically defined but rather driven by human interactions in the form of risk management/review procedure that produce actionable plans, which are responsive to change. We then proceed by describing the feasibility testing of extended risk management and planning procedures which integrate current practices. This was done through the CEDA Archival Format Audit which inspected British Atmospheric Data Centre and NERC Earth Observation Data Centre Archival holdings. These holdings are extensive, comprising of around 2 Petabytes of data and 137 million individual files, which were analysed and characterised in terms of format, based risk. We are then able to present an overview of the format based risk burden faced by a large scale archive attempting to maintain the usability of heterogeneous environmental data sets We continue by presenting a dynamic data management information model and provide discussion of the following core model entities and their relationships: Aspirational entities, which include Data Entity definitions and their associated Preservation Objectives. Risk entities, which act as drivers for change within the data lifecycle. These include Acquisitional Risks, Technical Risks, Strategic Risks and External Risks Plan entities, which detail the actions to bring about change within an archive. These include Acquisition Plans, Preservation Plans and Monitoring plans which support responsive interactions with the community. The Result entities describe the outcomes of the plans. This includes Acquisitions. Mitigations and Accepted Risks. With risk acceptance permitting imperfect but functional solutions that can be realistically supported within an archives resource levels
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Sports Concussion Diagnosis and Management
Kutcher, Jeffrey S.; Giza, Christopher C.
2014-01-01
Purpose of Review: To provide the neurologist with a framework for the clinical approach to sports concussion diagnosis and management. Recent Findings: As the issue of brain injury in athletes has emerged and developed, shifting the landscape of public concern, neurologists have become more directly involved in the diagnosis and management of sports concussion. Neurologists are now playing an increased role in acute concussion diagnosis, early injury management, return-to-play decisions, and evaluation for potential long-term effects from exposure to biomechanical forces on brain health. Concussion is only one part of this spectrum, but it is no small concern. Sports concussion diagnosis and management require a comprehensive neurologic approach as the return-to-play decision is a medical one covering a spectrum of potential complications and future risks. Understanding the clinical syndrome of concussion as well as the underlying pathophysiologic mechanism is essential to providing care. Employing classic neurologic diagnostic techniques while concurrently respecting the unique nature of caring for athletes is also critical. Without an objective method of measuring the underlying metabolic injury, concussion management is, by necessity, a clinically intense endeavor that requires a broad skill set. Summary: Providing recommendations regarding the long-term effects of brain trauma and the need for retirement from contact sports requires an appreciation for both the reason for concern and the lack of data to frame this risk. As science continues to advance in this area, so will our diagnostic approaches and management schema. Neurologists caring for athletes with brain trauma should continue to seek the best possible evidence to help shape their clinical decisions. PMID:25470160
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The limits of poverty reduction in support of climate change adaptation
NASA Astrophysics Data System (ADS)
Nelson, Donald R.; Lemos, Maria Carmen; Eakin, Hallie; Lo, Yun-Jia
2016-09-01
The relationship between poverty and climate change vulnerability is complex and though not commensurate, the distinctions between the two are often blurred. There is widespread recognition of the need to better understand poverty-vulnerability dynamics in order to improve risk management and poverty reduction investments. This is challenging due to the latent nature of adaptive capacities, frequent lack of baseline data, and the need for high-resolution studies. Here we respond to these challenges by analyzing household-level data in Northeast Brazil to compare drought events 14 years apart. In the period between droughts, the government implemented an aggressive anti-poverty program that includes financial and human capital investments. Poverty declined significantly, but the expected reduction in vulnerability did not occur, in part because the households were not investing in risk management strategies. Our findings complement other research that shows that households make rational decisions that may not correspond with policymaker expectations. We emphasize the need for complementary investments to help channel increased household wealth into risk reduction, and to ensure that the public sector itself continues to prioritize the public functions of risk management, especially in areas where the social cost of climatic risk is high.
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Gamakaranage, Champika; Rodrigo, Chaturaka; Samarawickrama, Sincy; Wijayaratne, Dilushi; Jayawardane, Malaka; Karunanayake, Panduka; Jayasinghe, Saroj
2012-10-26
Managing a severe dengue infection is a challenge specially when complicated by other comorbidities. We report a patient with dengue haemorrhagic fever and spontaneous bleeding who required mandatory anticoagulation for a prosthetic mitral valve replacement. This is the first case report in published literature describing this therapeutic dilemma. A fifty one year old Sri Lankan woman was diagnosed with dengue haemorrhagic fever with bleeding manifestations. During the critical phase of her illness, the platelet count dropped to 5,000/ɥl. She was also on warfarin 7 mg daily following a prosthetic mitral valve insertion. In managing the patient, the risk of bleeding had to be balanced against the risk of valve thrombosis without anticoagulation. Warfarin was withheld when the platelet count dropped to 100,000/ɥl and restarted when it recovered above 50,000/ɥl. The patient was off anticoagulation for 10 days. We managed this patient with close observation and continuous risk benefit assessments of management decisions. However, experience with one patient cannot be generalized to others. Therefore, it is essential that clinicians share their experiences in managing such difficult patients.
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Nasr, Moheb M; Krumme, Markus; Matsuda, Yoshihiro; Trout, Bernhardt L; Badman, Clive; Mascia, Salvatore; Cooney, Charles L; Jensen, Keith D; Florence, Alastair; Johnston, Craig; Konstantinov, Konstantin; Lee, Sau L
2017-11-01
Continuous manufacturing plays a key role in enabling the modernization of pharmaceutical manufacturing. The fate of this emerging technology will rely, in large part, on the regulatory implementation of this novel technology. This paper, which is based on the 2nd International Symposium on the Continuous Manufacturing of Pharmaceuticals, describes not only the advances that have taken place since the first International Symposium on Continuous Manufacturing of Pharmaceuticals in 2014, but the regulatory landscape that exists today. Key regulatory concepts including quality risk management, batch definition, control strategy, process monitoring and control, real-time release testing, data processing and management, and process validation/verification are outlined. Support from regulatory agencies, particularly in the form of the harmonization of regulatory expectations, will be crucial to the successful implementation of continuous manufacturing. Collaborative efforts, among academia, industry, and regulatory agencies, are the optimal solution for ensuring a solid future for this promising manufacturing technology. Copyright © 2017 American Pharmacists Association®. All rights reserved.
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Topics in Finance. Part V--Capital Structure
ERIC Educational Resources Information Center
Laux, Judy
2011-01-01
Continuing this series on the theory of financial management, the current article investigates capital structure, offering insight into the roles of stockholder wealth maximization, the risk-return tradeoff, and agency conflicts. Much literature addresses this topic, and some of the most recent literature challenges certain theoretical…
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12 CFR 1710.19 - Compliance and risk management programs; compliance with other laws.
Code of Federal Regulations, 2013 CFR
2013-01-01
... shall comply or continue to comply with sections 301, 302, 304, 402, and 406 of the SOA, as amended from... understanding that it will remain subject to the requirements of sections 301, 302, 304, 402, and 406 of the SOA...
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12 CFR 1710.19 - Compliance and risk management programs; compliance with other laws.
Code of Federal Regulations, 2014 CFR
2014-01-01
... shall comply or continue to comply with sections 301, 302, 304, 402, and 406 of the SOA, as amended from... understanding that it will remain subject to the requirements of sections 301, 302, 304, 402, and 406 of the SOA...
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12 CFR 1710.19 - Compliance and risk management programs; compliance with other laws.
Code of Federal Regulations, 2012 CFR
2012-01-01
... shall comply or continue to comply with sections 301, 302, 304, 402, and 406 of the SOA, as amended from... understanding that it will remain subject to the requirements of sections 301, 302, 304, 402, and 406 of the SOA...
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Interpersonal conflict tactics and substance use among high-risk adolescents.
Unger, Jennifer B; Sussman, Steve; Dent, Clyde W
2003-07-01
Adolescents who use aggressive tactics to handle interpersonal conflicts may be at high risk for substance use, while adolescents who possess coping strategies to avoid or manage interpersonal conflict may be at lower risk for substance use. This study examined the association between interpersonal conflict tactics and substance use among 631 continuation high school students. Items from a modified Conflict Tactics Scale formed three factors: Physical Aggression, Nonphysical Aggression, and Nonaggression. Logistic regression analyses revealed that adolescents' ways of responding to interpersonal conflicts were associated with their substance use. Use of physical aggression was associated with a higher risk of cigarette, alcohol, marijuana, and other drug use. Use of nonphysical aggression was associated with a higher risk of cigarette and alcohol use. Use of nonaggressive conflict tactics was associated with a lower risk of cigarette use. Adolescents who respond to interpersonal conflicts in an aggressive manner, whether physical or verbal/psychological, may be at increased risk for substance use, while nonaggressive conflict management skills may be protective. Possibly, teaching adolescents nonaggressive techniques for handling interpersonal conflict may be a useful strategy for preventing both interpersonal violence and substance use.
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Science-Driven Approach to Disaster Risk and Crisis Management
NASA Astrophysics Data System (ADS)
Ismail-Zadeh, A.
2014-12-01
Disasters due to natural extreme events continue to grow in number and intensity. Disaster risk and crisis management requires long-term planning, and to undertake that planning, a science-driven approach is needed to understand and assess disaster risks and to help in impact assessment and in recovery processes after a disaster. Science is used in assessments and rapid modeling of the disaster impact, in forecasting triggered hazards and risk (e.g., a tsunami or a landslide after a large earthquake), in contacts with and medical treatment of the affected population, and in some other actions. At the stage of response to disaster, science helps to analyze routinely the disaster happened (e.g., the physical processes led to this extreme event; hidden vulnerabilities; etc.) At the stage of recovery, natural scientists improve the existing regional hazard assessments; engineers try to use new science to produce new materials and technologies to make safer houses and infrastructure. At the stage of disaster risk mitigation new scientific methods and approaches are being developed to study natural extreme events; vulnerability of society is periodically investigated, and the measures for increasing the resilience of society to extremes are developed; existing disaster management regulations are improved. At the stage of preparedness, integrated research on disaster risks should be developed to understand the roots of potential disasters. Enhanced forecasting and early warning systems are to be developed reducing predictive uncertainties, and comprehensive disaster risk assessment is to be undertaken at local, regional, national and global levels. Science education should be improved by introducing trans-disciplinary approach to disaster risks. Science can help society by improving awareness about extreme events, enhancing risk communication with policy makers, media and society, and assisting disaster risk management authorities in organization of local and regional training and exercises.
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Recovery of imperiled species under the Endangered Species Act: The need for a new approach
Scott, J.M.; Goble, D.D.; Wiens, J.A.; Wilcove, D.S.; Bean, M.; Male, T.
2005-01-01
The recovery (delisting) of a threatened or endangered species is often accompanied by the expectation that conservation management of the species will no longer be necessary. However, the magnitude and pace of human impacts on the environment make it unlikely that substantial progress will be made in delisting many species unless the definition of "recovery" includes some form of active management. Preventing delisted species from again being at risk of extinction may require continuing, species-specific management actions. We characterize such species as "conservation-reliant", and suggest that viewing "recovery" as a continuum of states rather than as a simple "recovered/not recovered" dichotomy may enhance our ability to manage such species within the framework of the Endangered Species Act. With ongoing loss of habitat, disruption of natural disturbance regimes, and the increasing impacts of non-native invasive species, it is probable that the number of conservation-reliant species will increase. We propose the development of "recovery management agreements", with legally and biologically defensible contracts that would provide for continu-ing conservation management following delisting. The use of such formalized agreements will facilitate shared management responsibilities between federal wildlife agencies and other federal agencies, and with state, local, and tribal governments, as well as with private entities that have demonstrated the capability to meet the needs of conservation-reliant species. ?? The Ecological Society of America.
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Homeland Defense: Continued Actions Needed to Improve Management of Air Sovereignty Alert Operations
2012-01-01
Better Outcomes, GAO-10-374T (Washington, D.C.: May 20, 2009); Aviation Security : DHS and TSA Have Researched, Developed and Begun Deploying Passenger... Security : TSA Has Made Progress, but Additional Efforts Are Needed to Improve Security. GAO-11-938T. Washington, D.C.: September 16, 2011. Aviation ...Washington, D.C.: October 23, 2009. Related GAO Products Homeland Defense DOD Tactical Aircraft Aviation Security Risk Management Related GAO
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Pain Management in CKD: A Guide for Nephrology Providers.
Koncicki, Holly M; Unruh, Mark; Schell, Jane O
2017-03-01
Although pain is one of the most commonly experienced symptoms by patients with chronic kidney disease, it is under-recognized, the severity is underestimated, and the treatment is inadequate. Pain management is one of the general primary palliative care competencies for medical providers. This review provides nephrology providers with basic skills for pain management. These skills include recognition of types of pain (nociceptive and neuropathic) syndromes and appropriate history-taking skills. Through this history, providers can identify clinical circumstances in which specialist referral is beneficial, including those who are at high risk for addiction, at risk for adverse effects to medications, and those with complicated care needs such as patients with a limited prognosis. Management of pain begins with the development of a shared treatment plan, identification of appropriate medications, and continual follow-up and assessment of efficacy and adverse effects. Through adequate pain management, providers can positively affect the health of individual patients and the performance of health care systems. Copyright © 2016 National Kidney Foundation, Inc. All rights reserved.
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Management of obesity in adult Asian Indians.
Behl, S; Misra, A
The prevalence of obesity in India is increasing and ranges from 8% to 38% in rural and 13% to 50% in urban areas. Obesity is a risk factor for development of type 2 diabetes mellitus (T2DM), hypertension, dyslipidemia, coronary heart disease and many cancers. In Asian Indians excess abdominal and hepatic fat is associated with increased risk for T2DM and cardiovascular disease. There is higher risk for development of obesity related non-communicable diseases at lower body mass index levels, compared to white Caucasians. Despite being a commonly encountered medical problem, obesity poses challenges in treatment. Many Indian physicians find themselves to be lacking time and expertise to prepare an appropriate obesity management plan and patients experience continuous weight gain over time despite being under regular medical supervision. In this article, we outline approaches to obesity management in 'real life mode' and in context to Asian Indian patients. Copyright © 2017 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.
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Pre-eclampsia: pathophysiology, diagnosis, and management
Uzan, Jennifer; Carbonnel, Marie; Piconne, Olivier; Asmar, Roland; Ayoubi, Jean-Marc
2011-01-01
The incidence of pre-eclampsia ranges from 3% to 7% for nulliparas and 1% to 3% for multiparas. Pre-eclampsia is a major cause of maternal mortality and morbidity, preterm birth, perinatal death, and intrauterine growth restriction. Unfortunately, the pathophysiology of this multisystem disorder, characterized by abnormal vascular response to placentation, is still unclear. Despite great polymorphism of the disease, the criteria for pre-eclampsia have not changed over the past decade (systolic blood pressure >140 mmHg or diastolic blood pressure ≥90 mmHg and 24-hour proteinuria ≥0.3 g). Clinical features and laboratory abnormalities define and determine the severity of pre-eclampsia. Delivery is the only curative treatment for pre-eclampsia. Multidisciplinary management, involving an obstetrician, anesthetist, and pediatrician, is carried out with consideration of the maternal risks due to continued pregnancy and the fetal risks associated with induced preterm delivery. Screening women at high risk and preventing recurrences are key issues in the management of pre-eclampsia. PMID:21822394
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NASA Astrophysics Data System (ADS)
Melliana, Armen, Yusrizal, Akmal, Syarifah
2017-11-01
PT Nira Murni construction is a contractor of PT Chevron Pacific Indonesia which engaged in contractor, fabrication, maintenance construction suppliers, and labor services. The high of accident rate in this company is caused the lack of awareness of workplace safety. Therefore, it requires an effort to reduce the accident rate on the company so that the financial losses can be minimized. In this study, Safe T-Score method is used to analyze the accident rate by measuring the level of frequency. Analysis is continued using risk management methods which identify hazards, risk measurement and risk management. The last analysis uses Job safety analysis (JSA) which will identify the effect of accidents. From the result of this study can be concluded that Job Safety Analysis (JSA) methods has not been implemented properly. Therefore, JSA method needs to follow-up in the next study, so that can be well applied as prevention of occupational accidents.
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A microseismic workflow for managing induced seismicity risk as CO 2 storage projects
DOE Office of Scientific and Technical Information (OSTI.GOV)
Matzel, E.; Morency, C.; Pyle, M.
2015-10-27
It is well established that fluid injection has the potential to induce earthquakes—from microseismicity to large, damaging events—by altering state-of-stress conditions in the subsurface. While induced seismicity has not been a major operational issue for carbon storage projects to date, a seismicity hazard exists and must be carefully addressed. Two essential components of effective seismic risk management are (1) sensitive microseismic monitoring and (2) robust data interpretation tools. This report describes a novel workflow, based on advanced processing algorithms applied to microseismic data, to help improve management of seismic risk. This workflow has three main goals: (1) to improve themore » resolution and reliability of passive seismic monitoring, (2) to extract additional, valuable information from continuous waveform data that is often ignored in standard processing, and (3) to minimize the turn-around time between data collection, interpretation, and decision-making. These three objectives can allow for a better-informed and rapid response to changing subsurface conditions.« less
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Rahman, M Mizanur; Islam, M Saiful; Flora, Sabrina; Akhter, S Fariduddin; Hossain, Shahid; Karim, Fazlul
2007-12-01
Perforated peptic ulcer disease continues to inflict high morbidity and mortality. Although patients can be stratified according to their surgical risk, optimal management has yet to be described. In this study we demonstrate a treatment option that improves the mortality among critically ill, poor risk patients with perforated peptic ulcer disease. In our study, two series were retrospectively reviewed: group A patients (n = 522) were treated in a single surgical unit at the Dhaka Medical College Hospital, Dhaka, Bangladesh during the 1980s. Among them, 124 patients were stratified as poor risk based on age, delayed presentation, peritoneal contamination, and coexisting medical problems. These criteria were the basis for selecting a group of poor risk patients (n = 84) for minimal surgical intervention (percutaneous peritoneal drainage) out of a larger group of patients, group B (n = 785) treated at Khulna Medical College Hospital during the 1990s. In group A, 479 patients underwent conventional operative management with an operative mortality of 8.97%. Among the 43 deaths, 24 patients were >60 years of age (55.8%), 12 patients had delayed presentation (27.9%), and 7 patients were in shock or had multiple coexisting medical problems (16.2%). In group B, 626 underwent conventional operative management, with 26 deaths at a mortality rate of 4.15%. Altogether, 84 patients were stratified as poor risk and were managed with minimal surgical intervention (percutaneous peritoneal drainage) followed by conservative treatment. Three of these patients died with an operative mortality of 3.5%. Minimal surgical intervention (percutaneous peritoneal drainage) can significantly lower the mortality rate among a selected group of critically ill, poor risk patients with perforated peptic ulcer disease.
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Fostering the coexistence of caring philosophy and economics in today's health care system.
Cara, Chantal M; Nyberg, Jan J; Brousseau, Sylvain
2011-01-01
For the past decade, several health care systems are undergoing continuous administrative restructuring, whose main objective is cost reduction. These changes often result in the patients' needs not being met because nurses are continuously affected by widespread budget cuts and staff downsizing. Have we reached a point, where we are setting aside our prime directive of patient well-being for the sake of finances? If so, are we at risk of forsaking our professional identity as nurses? The authors believe that caring management and economical constraints can coexist while promoting quality patient care. The purpose of this article is to show how nurse managers and administrators can facilitate caring practices while maintaining their financial responsibilities within the health care organization. This article suggests several strategies for assisting nurse managers in promoting caring in the health care environment.
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24 CFR 266.505 - Regulatory agreement requirements.
Code of Federal Regulations, 2010 CFR
2010-04-01
... AUTHORITIES HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Project Management and Servicing § 266.505 Regulatory agreement requirements. (a) General. (1) The HFA... capital needs. (3) Maintain the project as affordable housing, as defined in § 266.5. (4) Continue to use...
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24 CFR 266.505 - Regulatory agreement requirements.
Code of Federal Regulations, 2011 CFR
2011-04-01
... AUTHORITIES HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Project Management and Servicing § 266.505 Regulatory agreement requirements. (a) General. (1) The HFA... capital needs. (3) Maintain the project as affordable housing, as defined in § 266.5. (4) Continue to use...
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24 CFR 266.505 - Regulatory agreement requirements.
Code of Federal Regulations, 2014 CFR
2014-04-01
... AUTHORITIES HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Project Management and Servicing § 266.505 Regulatory agreement requirements. (a) General. (1) The HFA... capital needs. (3) Maintain the project as affordable housing, as defined in § 266.5. (4) Continue to use...
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24 CFR 266.505 - Regulatory agreement requirements.
Code of Federal Regulations, 2013 CFR
2013-04-01
... AUTHORITIES HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Project Management and Servicing § 266.505 Regulatory agreement requirements. (a) General. (1) The HFA... capital needs. (3) Maintain the project as affordable housing, as defined in § 266.5. (4) Continue to use...
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24 CFR 266.505 - Regulatory agreement requirements.
Code of Federal Regulations, 2012 CFR
2012-04-01
... AUTHORITIES HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Project Management and Servicing § 266.505 Regulatory agreement requirements. (a) General. (1) The HFA... capital needs. (3) Maintain the project as affordable housing, as defined in § 266.5. (4) Continue to use...
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42 CFR 438.102 - Provider-enrollee communications.
Code of Federal Regulations, 2011 CFR
2011-10-01
... advocating on behalf of an enrollee who is his or her patient, for the following: (i) The enrollee's health.... (iii) The risks, benefits, and consequences of treatment or nontreatment. (iv) The enrollee's right to... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Enrollee Rights and Protections § 438.102...
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42 CFR 438.102 - Provider-enrollee communications.
Code of Federal Regulations, 2013 CFR
2013-10-01
... advocating on behalf of an enrollee who is his or her patient, for the following: (i) The enrollee's health.... (iii) The risks, benefits, and consequences of treatment or nontreatment. (iv) The enrollee's right to... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Enrollee Rights and Protections § 438.102...
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42 CFR 438.102 - Provider-enrollee communications.
Code of Federal Regulations, 2012 CFR
2012-10-01
... advocating on behalf of an enrollee who is his or her patient, for the following: (i) The enrollee's health.... (iii) The risks, benefits, and consequences of treatment or nontreatment. (iv) The enrollee's right to... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Enrollee Rights and Protections § 438.102...
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42 CFR 438.102 - Provider-enrollee communications.
Code of Federal Regulations, 2014 CFR
2014-10-01
... advocating on behalf of an enrollee who is his or her patient, for the following: (i) The enrollee's health.... (iii) The risks, benefits, and consequences of treatment or nontreatment. (iv) The enrollee's right to... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Enrollee Rights and Protections § 438.102...
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Overview of practice management in child and adolescent psychiatry.
Schreter, Robert K
2010-01-01
The manager of a psychiatric practice must create and direct a clinical delivery system, design and oversee the administrative services necessary to support the system, and guide the business operations that contribute to its success. Regardless of the size of the practice, the psychiatrist administrator must handle seven core administrative responsibilities and oversee individual functions and capabilities within each domain. These responsibilities include practice development, clinical services management, medical office operations, clinical management, information management, business management, and risk management. This article provides a roadmap for creating and sustaining successful clinical and administrative endeavors. It can also be used by existing practices as an audit instrument to provide a snapshot of current capabilities so that strengths as well as opportunities for continued growth can be identified.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Moeckel, D.R.
A practical, objective guide for ranking projects based on risk-based priorities has been developed by Sun Pipe Line Co. The deliberately simple system guides decisions on how to allocate scarce company resources because all managers employ the same criteria in weighing potential risks to the company versus benefits. Managers at all levels are continuously having to comply with an ever growing amount of legislative and regulatory requirements while at the same time trying to run their businesses effectively. The system primarily is designed for use as a compliance oversight and tracking process to document, categorize, and follow-up on work concerningmore » various issues or projects. That is, the system consists of an electronic database which is updated periodically, and is used by various levels of management to monitor progress of health, safety, environmental and compliance-related projects. Criteria used in determining a risk factor and assigning a priority also have been adapted and found useful for evaluating other types of projects. The process enables management to better define potential risks and/or loss of benefits that are being accepted when a project is rejected from an immediate work plan or budget. In times of financial austerity, it is extremely important that the right decisions are made at the right time.« less
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Healthcare waste management: current practices in selected healthcare facilities, Botswana.
Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew
2008-01-01
Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.
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Fit for purpose quality management system for military forensic exploitation.
Wilson, Lauren Elizabeth; Gahan, Michelle Elizabeth; Robertson, James; Lennard, Chris
2018-03-01
In a previous publication we described a systems approach to forensic science applied in the military domain. The forensic science 'system of systems' describes forensic science as a sub-system in the larger criminal justice, law enforcement, intelligence, and military systems, with quality management being an important supporting system. Quality management systems help to ensure that organisations achieve their objective and continually improve their capability. Components of forensic science quality management systems can include standardisation of processes, accreditation of facilities to national/international standards, and certification of personnel. A fit for purpose quality management system should be balanced to allow organisations to meet objectives, provide continuous improvement; mitigate risk; and impart a positive quality culture. Considerable attention over the last decades has been given to the need for forensic science quality management systems to meet criminal justice and law enforcement objectives. More recently, the need for the forensic quality management systems to meet forensic intelligence objectives has been considered. This paper, for the first time, discusses the need for a fit for purpose quality management system for military forensic exploitation. Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.
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Hazard identification and risk assessment for biologics targeting the immune system.
Weir, Andrea B
2008-01-01
Biologic pharmaceuticals include a variety of products, such as monoclonal antibodies, fusion proteins and cytokines. Products in those classes include immunomodulatory biologics, which are intended to enhance or diminish the activity of the immune system. Immunomodulatory biologics have been approved by the U.S. FDA for a variety of indications, including cancer and inflammatory conditions. Prior to gaining approval for marketing, sponsoring companies for all types of products must demonstrate a product's safety in toxicology studies conducted in animals and show safety and efficacy in clinical trials conducted in patients. The overall goal of toxicology studies, which applies to immunomodulatory and other product types, is to identify the hazards that products pose to humans. Because biologics are generally highly selective for specific targets (receptors/epitopes), conducting toxicology studies in animal models with the target is essential. Such animals are referred to as pharmacologically relevant. Endpoints routinely included in toxicology studies, such as hematology, organ weight and histopathology, can be used to assess the effect of a product on the structure of the immune system. Additionally, specialized endpoints, such as immunophenotyping and immune function tests, can be used to define effects of immunomodulatory products on the immune system. Following hazard identification, risks posed to patients are assessed and managed. Risks can be managed through clinical trial design and risk communication, a practice that applies to immunomodulatory and other product types. Examples of risk management in clinical trial design include establishing a safe starting dose, defining the appropriate patient population and establishing appropriate patient monitoring. Risk communication starts during clinical trials and continues after product approval. A combination of hazard identification, risk assessment and risk management allows for drug development to proceed with minimum risks to patients.
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Update on perioperative care of the cardiac patient for noncardiac surgery.
Ghadimi, Kamrouz; Thompson, Annemarie
2015-06-01
The current review will address key topics and recommendations of the recent 2014 update of the American College of Cardiology and American Heart Association clinical practice guideline for the perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. The completely rewritten guideline provides a stepwise approach for the identification and management of patients at highest risk for major adverse cardiac events and discusses new or updated recommendations. For example, β-blockers should be continued perioperatively but treatment should not be initiated within 24 h of noncardiac surgery. Angiotensin-converting enzyme inhibitors should be continued, but if held, may be restarted as soon as feasible. Routine aspirin therapy is not recommended without previous coronary stent implantation or risk assessment for myocardial ischemia. Elective noncardiac surgery should not be performed within 30 days of bare metal stent or 12 months of drug-eluting stent implantation because of in-stent thrombosis as well as bleeding risk from dual antiplatelet therapy during surgery. Noncardiac surgery may be considered, however, in patients on antiplatelet agents 180 days after drug-eluting stent placement if risk of surgical delay exceeds risk of stent thrombosis from cessation of antiplatelet therapy. In conclusion, this review will discuss the important topics from the 2014 American College of Cardiology/American Heart Association guideline in order to provide the perioperative physician with the most recent evidence necessary to minimize major adverse cardiac events in patients undergoing noncardiac surgery.
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Liver enzyme monitoring in patients treated with troglitazone.
Graham, D J; Drinkard, C R; Shatin, D; Tsong, Y; Burgess, M J
2001-08-15
Soon after initial marketing in March 1997, troglitazone, the first thiazolidinedione antidiabetic agent, was found to cause life-threatening acute liver failure. The drug was removed from the market in March 2000. To evaluate the effect of US Food and Drug Administration (FDA) risk management efforts, including repeated labeling changes and "Dear Healthcare Professional" letters, on periodic liver enzyme monitoring of patients taking troglitazone. Claims data from a large, multistate managed care organization were used to establish 4 cohorts of patients (N = 7603) with at least 90 days of health plan enrollment before first troglitazone prescription during 4 consecutive periods spanning April 1997 to September 1999 and representing 4 progressively stringent liver monitoring recommendations. Percentage of eligible troglitazone users in each cohort with baseline, monthly (for up to 6 months of continuous use), and complete (baseline and monthly) enzyme monitoring, based on computerized records of laboratory claims. Baseline testing increased from 15% before any FDA monitoring recommendations (cohort 1) to 44.6% following 4 separate FDA interventions (cohort 4; P<.001). In cohort 4, 33.4% of users had follow-up testing after 1 month of therapy, falling to 13% after 5 months of continuous use. In all cohorts, less than 5% received all recommended liver enzyme tests by the third month of continuous use. The FDA risk management efforts did not achieve meaningful or sustained improvement in liver enzyme testing. Evaluation of the impact of regulatory actions is needed before such actions can be regarded as effective or sufficient.
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Status quo of management of the human tissue banks in Taiwan.
Chou, Ching-Pang; Chou, Szu-Cheng; Chen, Ying-Hua; Chen, Yu-Hsuan; Lee, Ming-Shin
2017-03-01
As the technologies associated with transplantation and biological tissue engineering continue to advance, human cells and tissues form an integral part to the practice of regenerative medicine. The patient's use of tissues entails the risk of introducing, transmitting and spreading communicable diseases. To prevent such risk and to ensure that the human organs, tissues and cells remain intact and functional after being handled and processed, the transplanted tissues must be subject to good management standards through all stages of collection, screening, processing, storage and distribution as the safety of the users is of the utmost importance. On February 2009, the government of Taiwan promulgated the Regulations for Administration on Human Organ Bank that requires all human tissues banks to adhere to the Good Tissue Practice for Human Organ, Tissue and Cell in terms of establishment and operation in order to cope with the international management trend and the development and management need of the domestic industry. Six years have passed since the law became effective. This article seeks to introduce the current management mechanism and status quo of management of human tissue banks in Taiwan. We also conducted statistical analysis of the data relating to the tissue banks to identify potential risks and the room for improvement. The study concludes that human tissue banks in Taiwan are on the right track with their management practice, leading to a state of steady development and progress.
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Bladder cancer: overview and disease management. Part 1: non-muscle-invasive bladder cancer.
Anderson, Beverley
2018-05-10
Part 1 of this two-part article provides an overview of bladder cancer and discusses its management. Since publication of a previous article entitled 'Understanding the role of smoking in the aetiology of bladder cancer' ( Anderson, 2009 ), the author has received many requests for an update. This article provides an overview of bladder cancer and its current management practices, underlining the continued role of smoking as the predominant risk factor in the disease's development. The management of bladder cancer is governed by specific guidelines. Management of non-muscle-invasive cancers, including surgical intervention with transurethral resection, and intravesical therapy using chemotherapy and immunotherapy agents, is discussed. Cystectomy (removal of the bladder), is sometimes necessary. Treatments are effective in reducing tumour recurrence, but the effects of the risks and side-effects on the individual's quality of life can be significant. The prevalence of bladder cancer, and the nature of its management make this cancer one of the most expensive for the NHS to treat. The effectiveness of health promotional strategies in increasing peoples' awareness of their risk of developing the disease, and in enabling them to change long-term health behaviours is discussed. The role of the multidisciplinary team is explored, along with that of the uro-oncology cancer nurse specialist. Part 2 will consider the management of muscle-invasive and metastatic bladder cancer.
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Kataoka, Hiroshi; Nanaura, Hitoki; Kinugawa, Kaoru; Uchihara, Yuto; Ohara, Hiroya; Eura, Nobuyuki; Syobatake, Ryogo; Sawa, Nobuhiro; Takao, Kiriyama; Sugie, Kazuma; Ueno, Satoshi
2017-02-20
If invasive ventilation can be avoided by performing noninvasive mechanical ventilation (NIV) in patients with acute respiratory failure (ARF), the disease can be effectively managed. It is important to clarify the characteristics of patients with neuromuscular diseases in whom initial NIV is likely to be unsuccessful. We studied 27 patients in stable neuromuscular condition who initially received NIV to manage fatal ARF to identify differences in factors immediately before the onset of ARF among patients who receive continuous NIV support, patients who are switched from NIV to invasive ventilation, and patients in whom NIV is discontinued. Endpoints were evaluated 24 and 72 hours after the initiation of NIV. After 24 hours, all but 1 patient with amyotrophic lateral sclerosis (ALS) received continuous NIV support. 72 hours later, 5 patients were switched from NIV to invasive ventilation, and 5 patients continued to receive NIV support. 72 hours after the initiation of NIV, the proportion of patients with a diagnosis of ALS differed significantly among the three groups (P=0.039). NIV may be attempted to manage acute fatal respiratory failure associated with neuromuscular diseases, but clinicians should carefully manage the clinical course in patients with ALS.
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Risk communication and the Precautionary Principle.
Biocca, Marco
2004-01-01
The perception of risks for environment and health deriving from globalization processes and an uncontrolled use of modern technologies is growing everywhere. The greater the capacity of controlling living conditions, the larger is the possibility of misusing this power. In environmental and occupational health research we tend to reduce the complexity of the observed phenomena in order to facilitate conclusions. In social and political sciences complexity is an essential element of the context, which needs to be continuously considered. The Precautionary Principle is a tool for facing complexity and uncertainty in health risk management. This paper is aimed at demonstrating that this is not only a problem of technical risk assessment. Great attention should also be paid to improve risk communication. Communication between the stakeholders (experts, decision makers, political and social leaders, media, groups of interest and people involved) is possibly the best condition to be successful in health risk management. Nevertheless, this process usually runs up against severe obstacles. These are not only caused by existing conflicts of interest. Differences in values, languages, perceptions, resources to have access to information, and to express one's own point of view are other key aspects.
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NASA Astrophysics Data System (ADS)
Nkwunonwo, U. C.; Whitworth, M.; Baily, B.
2016-02-01
Urban flooding has been and will continue to be a significant problem for many cities across the developed and developing world. Crucial to the amelioration of the effects of these floods is the need to formulate a sound flood management policy, which is driven by knowledge of the frequency and magnitude of impacts of these floods. Within the area of flood research, attempts are being made to gain a better understanding of the causes, impacts, and pattern of urban flooding. According to the United Nations office for disaster reduction (UNISDR), flood risk is conceptualized on the basis of three integral components which are frequently adopted during flood damage estimation. These components are: probability of flood hazard, the level of exposure, and vulnerabilities of elements at risk. Reducing the severity of each of these components is the objective of flood risk management under the UNISDR guideline and idea of "living with floods". On the basis of this framework, the present research reviews flood risk within the Lagos area of Nigeria over the period 1968-2012. During this period, floods have caused harm to millions of people physically, emotionally, and economically. Arguably over this period the efforts of stakeholders to address the challenges appear to have been limited by, amongst other things, a lack of reliable data, a lack of awareness amongst the population affected, and a lack of knowledge of flood risk mitigation. It is the aim of this research to assess the current understanding of flood risk and management in Lagos and to offer recommendations towards future guidance.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Van Aalst, M.
Climate change is already taking place, and further changes are inevitable. Developing countries, and particularly the poorest people in these countries, are most at risk. The impacts result not only from gradual changes in temperature and sea level but also, in particular, from increased climate variability and extremes, including more intense floods, droughts, and storms. These changes are already having major impacts on the economic performance of developing countries and on the lives and livelihoods of millions of poor people around the world. Climate change thus directly affects the World Bank Group's mission of eradicating poverty. It also puts atmore » risk many projects in a wide range of sectors, including infrastructure, agriculture, human health, water resources, and environment. The risks include physical threats to the investments, potential underperformance, and the possibility that projects will indirectly contribute to rising vulnerability by, for example, triggering investment and settlement in high-risk areas. The way to address these concerns is not to separate climate change adaptation from other priorities but to integrate comprehensive climate risk management into development planning, programs, and projects. While there is a great need to heighten awareness of climate risk in Bank work, a large body of experience on climate risk management is already available, in analytical work, in country dialogues, and in a growing number of investment projects. This operational experience highlights the general ingredients for successful integration of climate risk management into the mainstream development agenda: getting the right sectoral departments and senior policy makers involved; incorporating risk management into economic planning; engaging a wide range of nongovernmental actors (businesses, nongovernmental organizations, communities, and so on); giving attention to regulatory issues; and choosing strategies that will pay off immediately under current climate conditions. There are several ways in which the World Bank Group can continue helping its clients better manage climate risks to poverty reduction and sustainable development: Integrating climate risk management into the project cycle, by adopting early risk identification (for instance by applying a quick and simple risk-screening tool) and following up throughout the design process if necessary. Integrating climate risk management into country and sector dialogues, especially in countries and sectors that are particularly vulnerable. Enhancing internal support for and coordination of climate risk management by, for example, expanding analytical work and capacity for cross-support by the Global Climate Change Team and the Hazard Management Unit of the World Bank and by actively developing climate risk management activities within regional departments. Supporting the establishment of proper financing mechanisms for adaptation, using, for example, the Investment Framework for Clean Energy and Development. New funding mechanisms created under the United Nations Framework Convention on Climate Change (UNFCCC) and being made operational by the Global Environment Facility (GEF), as well as the Kyoto Protocol, should be used to leverage maximum adaptation results within the Bank's broad range of development activities and investments. By enhancing climate risk management, the World Bank Group will be able to address the growing risks from climate change and, at the same time, make current development investments more resilient to climate variability and extreme weather events. In that way, climate risk management will not only guard the Bank's investments in a changing climate but will also improve the impact of development efforts right now.« less
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Pediatric Minor Head Injury 2.0: Moving from Injury Exclusion to Risk Stratification.
Homme, James Jim L
2018-05-01
Visits for pediatric minor blunt head trauma continue to increase. Variability exists in clinician evaluation and management of this generally low-risk population. Clinical decision rules identify very low-risk children who can forgo neuroimaging. Observation before imaging decreases neuroimaging rates. Outcome data can be used to risk stratify children into more discrete categories. Decision aids improves knowledge and accuracy of risk perception and facilitates identification of caregiver preferences, allowing for shared decision making. For children in whom imaging is performed and is normal or shows isolated linear skull fractures, deterioration and neurosurgical intervention are rare and hospital admission can be avoided. Copyright © 2018 The Author. Published by Elsevier Inc. All rights reserved.
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NASA Astrophysics Data System (ADS)
Sreedevi, E.; Vijaya Lakshmi, K.; Chaitanya Krishna, E.; Padmavathamma, M.
2012-04-01
Diabetes is a chronic illness that requires continuous medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. This paper deals with study and development of algorithm to develop an initial stage expert system to provide diagnosis to the pregnant women who are suffering from Gestational Diabetes Mellitus (GDM) by means of Oral Glucose Tolerance Test (OGTT).
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Management of the third stage of labor.
McDonald, Susan
2007-01-01
Management of the third stage of labor has been an issue of discussion, concern, and continued debate for the past two decades. Despite the many strategies employed and the divergent approaches to care and philosophies espoused, there has not been a significant, consistent reduction in the postpartum hemorrhage rates reported in industrialized countries in recent times. This article explores the strategies that have been and are currently being used in an effort to reduce the risk of postpartum hemorrhage.
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Impacts and Risks of Migration and Refugee Flows in Africa
2012-03-12
In Africa, as in other parts of the world , border management systems are coming under increasing pressure from large flows of persons moving across...management globally have been and will continue to be strongly affected by security concerns. Some regions in the world have been the subject of attacks...and many parts of the world . Also, the presence of large numbers of displaced persons in refugee camps and IDP hosting areas can have negative
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12 CFR 225.26 - Factors considered in acting on nonbanking proposals.
Code of Federal Regulations, 2011 CFR
2011-01-01
... control and risk-management systems, and capital of the entity conducting the activity. (c) Competitive... proposals. 225.26 Section 225.26 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM BANK HOLDING COMPANIES AND CHANGE IN BANK CONTROL (REGULATION Y...
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31 CFR 225.5 - Pledge of definitive Government obligations.
Code of Federal Regulations, 2010 CFR
2010-07-01
... Government obligations held by the custodian will be held at the risk of the custodian. (e) Conversion to... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Pledge of definitive Government... (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE ACCEPTANCE OF BONDS...
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31 CFR 225.5 - Pledge of definitive Government obligations.
Code of Federal Regulations, 2011 CFR
2011-07-01
... Government obligations held by the custodian will be held at the risk of the custodian. (e) Conversion to... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Pledge of definitive Government... (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE ACCEPTANCE OF BONDS...
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Consideration of extinction risks for salmonids
Bruce Rieman; Danny Lee; Jack McIntyre; Kerry Overton; Russ Thurow
1993-01-01
Under the National Forest Management Act of 1979, the USDA Forest Service is charged with maintaining viable populations of all existing native vertebrate species on lands they administer. Accomplishment of this responsibility requires complete assessment of all federally authorized, funded, or implemented projects that may jeopardize the continued existence of a...
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Student Financial Aid. High Risk Series.
ERIC Educational Resources Information Center
General Accounting Office, Washington, DC.
This report discusses the continuing concerns of the U.S. General Accounting Office (GAO) in regard to the Department of Education's management and oversight of postsecondary student financial aid programs, especially the Federal Family Education Loan, the Ford Direct Loan, and the Federal Pell Grant Programs. GAO commends the department for its…
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ERIC Educational Resources Information Center
Hanna, Glenda
1994-01-01
A risk management plan for outdoor education programs should include procedures for regular program implementation, as well as rescue, first aid, and accident follow-up procedures. Stresses understanding legal and ethical responsibilities and the importance of sufficient insurance protection. Includes suggestions for dealing with conflicts in…
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USDA-ARS?s Scientific Manuscript database
Widespread growth of invasive aquatic vegetation is a major stressor to the Sacramento-San Joaquin River Delta, a region of significant agricultural, industrial, and ecological importance. Total invaded area in the Delta is increasing, with the risk of new invasions a continual threat. However, inva...
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31 CFR 223.11 - Limitation of risk: Protective methods.
Code of Federal Regulations, 2010 CFR
2010-07-01
... (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE SURETY COMPANIES DOING... prescribed in § 223.10 may be complied with by the following methods: (a) Coinsurance. Two or more companies... underwriting limitations. Each company shall limit its liability upon the face of the bond or policy, to a...
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40 CFR 68.180 - Emergency response program.
Code of Federal Regulations, 2011 CFR
2011-07-01
... activities and the emergency response plan is coordinated. (c) The owner or operator shall list other Federal... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.180 Emergency response program... written emergency response plan? (2) Does the plan include specific actions to be taken in response to an...
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40 CFR 68.180 - Emergency response program.
Code of Federal Regulations, 2013 CFR
2013-07-01
... activities and the emergency response plan is coordinated. (c) The owner or operator shall list other Federal... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.180 Emergency response program... written emergency response plan? (2) Does the plan include specific actions to be taken in response to an...
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40 CFR 68.180 - Emergency response program.
Code of Federal Regulations, 2012 CFR
2012-07-01
... activities and the emergency response plan is coordinated. (c) The owner or operator shall list other Federal... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.180 Emergency response program... written emergency response plan? (2) Does the plan include specific actions to be taken in response to an...
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40 CFR 68.180 - Emergency response program.
Code of Federal Regulations, 2014 CFR
2014-07-01
... activities and the emergency response plan is coordinated. (c) The owner or operator shall list other Federal... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.180 Emergency response program... written emergency response plan? (2) Does the plan include specific actions to be taken in response to an...
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Cybersecurity and the Medical Device Product Development Lifecycle.
Jones, Richard W; Katzis, Konstantinos
2017-01-01
Protecting connected medical devices from evolving cyber related threats, requires a continuous lifecycle approach whereby cybersecurity is integrated within the product development lifecycle and both complements and re-enforces the safety risk management processes therein. This contribution reviews the guidance relating to medical device cybersecurity within the product development lifecycle.
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Cross-continuum Care Continuity: Achieving Seamless Care and Managing Comorbidities.
Boston-Fleischhauer, Carol; Rose, Robert; Hartwig, Laurie
As healthcare systems continue to design care models responsive to payment changes and the assumption of clinical and financial risk, the need exists for a comprehensive approach to address cross-continuum care transitions. This article will highlight key learnings from the Nurse Executive Center's research on achieving care continuity. The business case for developing a cross-continuum care transition strategy will be discussed, as well as systemic enablers for the achievement of seamless care. A case study example of 1 system's solution for supporting the multiple comorbid patient population as part of its cross-continuum care transition strategy will be examined.
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Guidelines for Risk-Based Changeover of Biopharma Multi-Product Facilities.
Lynch, Rob; Barabani, David; Bellorado, Kathy; Canisius, Peter; Heathcote, Doug; Johnson, Alan; Wyman, Ned; Parry, Derek Willison
2018-01-01
In multi-product biopharma facilities, the protection from product contamination due to the manufacture of multiple products simultaneously is paramount to assure product quality. To that end, the use of traditional changeover methods (elastomer change-out, full sampling, etc.) have been widely used within the industry and have been accepted by regulatory agencies. However, with the endorsement of Quality Risk Management (1), the use of risk-based approaches may be applied to assess and continuously improve established changeover processes. All processes, including changeover, can be improved with investment (money/resources), parallel activities, equipment design improvements, and standardization. However, processes can also be improved by eliminating waste. For product changeover, waste is any activity not needed for the new process or that does not provide added assurance of the quality of the subsequent product. The application of a risk-based approach to changeover aligns with the principles of Quality Risk Management. Through the use of risk assessments, the appropriate changeover controls can be identified and controlled to assure product quality is maintained. Likewise, the use of risk assessments and risk-based approaches may be used to improve operational efficiency, reduce waste, and permit concurrent manufacturing of products. © PDA, Inc. 2018.
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Integrating Spaceflight Human System Risk Research
NASA Technical Reports Server (NTRS)
Mindock, Jennifer; Lumpkins, Sarah; Anton, Wilma; Havenhill, Maria; Shelhamer, Mark; Canga, Michael
2016-01-01
NASA is working to increase the likelihood of human health and performance success during exploration missions as well as to maintain the subsequent long-term health of the crew. To manage the risks in achieving these goals, a system modelled after a Continuous Risk Management framework is in place. "Human System Risks" (Risks) have been identified, and approximately 30 are being actively addressed by NASA's Human Research Program (HRP). Research plans for each of HRP's Risks have been developed and are being executed. Inter-disciplinary ties between the research efforts supporting each Risk have been identified; however, efforts to identify and benefit from these connections have been mostly ad hoc. There is growing recognition that solutions developed to address the full set of Risks covering medical, physiological, behavioural, vehicle, and organizational aspects of exploration missions must be integrated across Risks and disciplines. This paper discusses how a framework of factors influencing human health and performance in space is being applied as the backbone for bringing together sometimes disparate information relevant to the individual Risks. The resulting interrelated information enables identification and visualization of connections between Risks and research efforts in a systematic and standardized manner. This paper also discusses the applications of the visualizations and insights into research planning, solicitation, and decision-making processes.
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Integrating spaceflight human system risk research
NASA Astrophysics Data System (ADS)
Mindock, Jennifer; Lumpkins, Sarah; Anton, Wilma; Havenhill, Maria; Shelhamer, Mark; Canga, Michael
2017-10-01
NASA is working to increase the likelihood of exploration mission success and to maintain crew health, both during exploration missions and long term after return to Earth. To manage the risks in achieving these goals, a system modelled after a Continuous Risk Management framework is in place. ;Human System Risks; (Risks) have been identified, and 32 are currently being actively addressed by NASA's Human Research Program (HRP). Research plans for each of HRP's Risks have been developed and are being executed. Inter-disciplinary ties between the research efforts supporting each Risk have been identified; however, efforts to identify and benefit from these connections have been mostly ad hoc. There is growing recognition that solutions developed to address the full set of Risks covering medical, physiological, behavioural, vehicle, and organizational aspects of exploration missions must be integrated across Risks and disciplines. This paper discusses how a framework of factors influencing human health and performance in space is being applied as the backbone for bringing together sometimes disparate information relevant to the individual Risks. The resulting interrelated information enables identification and visualization of connections between Risks and research efforts in a systematic and standardized manner. This paper also discusses the applications of the visualizations and insights into research planning, solicitation, and decision-making processes.
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Pellerin, Brian; Stauffer, Beth A; Young, Dwane A; Sullivan, Daniel J.; Bricker, Suzanne B.; Walbridge, Mark R; Clyde, Gerard A; Shaw, Denice M
2016-01-01
Sensors and enabling technologies are becoming increasingly important tools for water quality monitoring and associated water resource management decisions. In particular, nutrient sensors are of interest because of the well-known adverse effects of nutrient enrichment on coastal hypoxia, harmful algal blooms, and impacts to human health. Accurate and timely information on nutrient concentrations and loads is integral to strategies designed to minimize risk to humans and manage the underlying drivers of water quality impairment. Using nitrate sensors as an example, we highlight the types of applications in freshwater and coastal environments that are likely to benefit from continuous, real-time nutrient data. The concurrent emergence of new tools to integrate, manage and share large data sets is critical to the successful use of nutrient sensors and has made it possible for the field of continuous nutrient monitoring to rapidly move forward. We highlight several near-term opportunities for Federal agencies, as well as the broader scientific and management community, that will help accelerate sensor development, build and leverage sites within a national network, and develop open data standards and data management protocols that are key to realizing the benefits of a large-scale, integrated monitoring network. Investing in these opportunities will provide new information to guide management and policies designed to protect and restore our nation’s water resources.
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Jarrett, Robin B.; Minhajuddin, Abu; Vittengl, Jeffrey R.; Clark, Lee Anna; Thase, Michael E.
2016-01-01
Objective To determine the extent to which prospectively identified responders to cognitive therapy (CT) for recurrent major depressive disorder (MDD) hypothesized to be lower risk show significantly less relapse/recurrence than treated higher risk counterparts across 32 months. Method Outpatients (N = 523), aged 18–70, with recurrent MDD received 12–14 weeks of CT. The last seven consecutive scores from the Hamilton Rating Scale for Depression (HRSD-17), were used to stratify/define responders (n = 290) into lower (seven HRSD-17 scores of ≤ 6; n = 49; 17%) and higher risk (n = 241; 83%). The lower risk entered the 32-month follow-up. Higher risk patients were randomized to 8 months of continuation-phase CT or clinical management plus double-blind fluoxetine or pill placebo, with a 24-month follow-up. Results Lower risk patients were significantly less likely to relapse over the first 8 months compared to higher risk (Kaplan-Meier [KM] estimates (i.e., 4.9%=lower risk; 22.1%= higher risk; log-rank χ2 = 6.83, p = .009). This increased risk was attenuated, but not completely neutralized, by active continuation-phase therapy. Over the subsequent 24 months, the lower and higher risk groups did not differ in relapse/recurrence risk. Conclusions Rapid and sustained acute-phase CT remission identifies responders who do not require continuation-phase treatment to prevent relapse (i.e., return of an index episode). To prevent recurrence (i.e., new episodes), however, strategic allocation and more frequent “dosing” of CT and/or targeted maintenance-phase treatments may be required. Longitudinal follow-up is recommended. PMID:26654211
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NASA Technical Reports Server (NTRS)
Yarbrough, Katherine
2015-01-01
During my internship I worked on two major projects, recommending improvements for the Center's Risk Management Workshop and helping with the strategic planning efforts for Safety and Mission Assurance (S&MA). The risk management improvements is the key project I worked on this semester through my internship, while the strategic planning is the secondary assignment. S&MA Business Office covers both aspects in its delegation, getting both spans some of the work done in the office. A risk is a future event with a negative consequence that has some probability of occurring. Safety and Mission Assurance identifies, analyzes, plans, and tracks risk. The directorate offers the Center a Risk Management Workshop, and part of the ongoing efforts of S&MA is to make continuous improvements to the RM Workshop. By using the Project Management Institute's (PMI) Standard for Risk Management, I performed a gap analysis to make improvements for our materials. I benchmarked the PMI's Risk Management Standard, compared our Risk Management Workshop materials to PMI's standard, and identified any gaps in our material. My major findings were presented to the Business Office of S&MA for a decision on whether or not to incorporate the improvements. These suggestions were made by attending JSC working group meetings, Health, Safety and Environment (HSE) panel reviews and various risk review meetings. The improvements provide better understanding of risk management processes and enhanced risk tracking knowledge and skills. Risk management is an integral part of any engineering discipline, getting exposed to this section of engineering will greatly help shape my career in the future. Johnson Space Center is a world leader in risk management processes; learning risk management here gives me a huge advantage over my peers, as well as understanding decision making in the context of risk management will help me to be a well-rounded engineer. Strategic planning is an area I had not previously studied. Helping with the strategic planning efforts in S&MA has taught me how organizations think and function as a whole. S&MA is adopting a balanced scorecard approach to strategic planning. As part of this planning method strategic themes, objectives, and initiatives are formed. I attended strategic theme team workshops that formed the strategy map for the directorate and gave shape to the plan. Also during these workshops the objectives were discussed and built. Learning the process for strategic planning has helped me better understand how organizations and businesses function, which also helps me to be a more effective employee. Other assignments I had during my internship included completing the Safety and Mission Assurance Technical Excellent Program (STEP) Level 1, as well as doing a two week rotation through the Space Exploration division in S&MA, specifically working with a thermal protection systems (TPS) engineer. While working there, I learned about the Orion capsule and the SpaceX Dragon cargo capsule. I attended meetings to prepare the engineers for the upcoming Critical Design Reviews for both capsules and reviewed test data. Learning risk management, strategic planning, and working in the Space Exploration division has taught me about many aspects of S&MA. My internship at NASA has given me new experiences and taught me numerous subjects that I would have otherwise not learned. This opportunity has expanded my educational horizons and is helping me to become a more useful engineer and employee.
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Driscoll, A; Beauchamp, A; Lyubomirsky, G; Demos, L; McNeil, J; Tonkin, A
2011-10-01
Patients with established coronary heart disease (CHD) are at the highest risk of further events. Despite proven therapies, secondary prevention is often suboptimal. General practitioners (GPs) are in an ideal position to improve secondary prevention. To contrast management of cardiovascular risk factors in patients with established CHD in primary care to those in clinical guidelines and according to gender. GPs throughout Australia were approached to participate in a programme incorporating a disease management software (mdCare) program. Participating practitioners (1258 GPs) recruited individual patients whose cardiovascular risk factor levels were measured. The mdCare programme included 12,509 patients (58% male) diagnosed with CHD. Their mean age was 71.7years (intra-quartile range 66-78) for men and 74years (intra-quartile range 68-80) for women. Low-density-lipoprotein cholesterol was above target levels in 69% (2032) of women compared with 58% (2487) in men (P < 0.0001). There was also a higher proportion of women with total cholesterol above target levels (76%, 3592) compared with men (57%, 3787) (P < 0.0001). In patients who were prescribed lipid-lowering medication, 53% (2504) of men and 72% (2285) of women continued to have a total cholesterol higher than recommended target levels (P < 0.0001). Overall, over half (52%, 6538) had at least five cardiovascular risk factors (55% (2914) in women and 50% (3624) in men, P < 0.0001). This study found less intensive management of cardiovascular risk factors in CHD patients, particularly among women, despite equivalent cardiovascular risk. This study has shown that these patients have multiple risk factors where gender also plays a role. © 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.
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Guterman, Neil B; Tabone, Jiyoung K; Bryan, George M; Taylor, Catherine A; Napoleon-Hanger, Cynthia; Banman, Aaron
2013-08-01
This study set out to carry out a feasible, real-world, randomized clinical trial to examine the benefits of home-based paraprofessional parent aide services in reducing physical abuse and neglect risk in high-risk parents. Families were randomly assigned to receive either parent aide plus case management services (n = 73) or case management services only (n = 65), collecting in-home data on physical child abuse and neglect and proximal risk and protective factors, just prior to service initiation, and again after six months of services. Mothers receiving parent aide and case management services reported significant improvements from baseline to six-month follow-up in self-reported indicators of physical child abuse risk, as well as improvements on parental stress, mastery, depression, and anxiety, whereas mothers receiving only case management services did not. The slopes of such observed changes across groups, however, were not found to be statistically significantly different. No discernable improvements were found with regard to indicators of risk for child neglect. As the first randomized clinical trial examining the effectiveness of parent aide services, this study provides the first controlled evidence examining the potential benefits of this service modality. This study suggests promising trends regarding the benefit of parent aide services with respect to physical child abuse risk reduction and related predictors, but evidence does not appear to suggest that such services, as they are presently delivered, reduce child neglect. These findings support the continued use of parent aide services in cases of physical child abuse and also suggest careful consideration of the ways such services may be better configured to extend their impact, particularly with respect to child neglect risk. Copyright © 2013 Elsevier Ltd. All rights reserved.
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Dettloff, Rick W; Morse, Jacqueline A
2009-01-01
To integrate the resources from a local statewide managed care organization (MCO) and a supermarket pharmacy chain to conduct a comprehensive health risk appraisal (HRA). Collected data were used to assess cardiovascular risk factors and identify disease management opportunities. An analysis to determine the prevalence of risk factors was conducted on a cross-sectional HRA survey. The HRA involved point-of-care cholesterol screening (with a follow-up risk factor questionnaire) conducted by pharmacist employees of the employer group (a regional supermarket chain). Those eligible for the screening were employees of the supermarket chain and their dependents covered by the participating MCO. A total of 12,915 completed HRA questionnaires were received. The mean age of the employees participating was approximately 44 years. Of note, 14%, 24%, 21%, and 69% of questionnaires had abnormal values for total cholesterol, high-density lipoprotein (HDL) cholesterol, blood pressure, and body mass index (BMI), respectively. Compared with national benchmarks, low HDL cholesterol and BMI more than 30 kg/m2 were more common in this cohort. More than one-fourth of the employees in this analysis were identified as being at high risk for a coronary heart disease event. The unique collaboration presented here allowed for an expanded role of pharmacists to implement a quality improvement program. In response, the employer decided to continue the HRA screening and offer a employee contribution reduction-based health incentive to covered members. The employer also is considering offering cardiovascular disease management interventions that will be performed by the supermarket chain's pharmacists and targeted toward the identified risk factor trends.
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Kauffman, Mandy; Peck, Dannele; Scurlock, Brandon; Logan, Jim; Robinson, Timothy; Cook, Walt; Boroff, Kari; Schumaker, Brant
2016-09-15
Livestock producers and state wildlife agencies have used multiple management strategies to control bovine brucellosis in the Greater Yellowstone Area (GYA). However, spillover from elk to domestic bison and cattle herds continues to occur. Although knowledge is increasing about the location and behavior of elk in the SGYA, predicting spatiotemporal overlap between elk and cattle requires locations of livestock operations and observations of elk contact by producers. We queried all producers in a three-county area using a questionnaire designed to determine location of cattle and whether producers saw elk comingle with their animals. This information was used to parameterize a spatially-explicit risk model to estimate the number of elk expected to overlap with cattle during the brucellosis transmission risk period. Elk-cattle overlap was predicted in areas further from roads and forest boundaries in areas with wolf activity, with higher slopes, lower hunter densities, and where the cost-distance to feedgrounds was very low or very high. The model was used to estimate the expected number of years until a cattle reactor will be detected, under alternative management strategies. The model predicted cattle cases every 4.28 years in the highest risk herd unit, a higher prediction than the one case in 26 years we have observed. This difference likely indicates that ongoing management strategies are at least somewhat effective in preventing potential elk-cattle brucellosis transmission in these areas. Using this model, we can infer the expected effectiveness of various management strategies for reducing the risk of brucellosis spillover from elk to cattle. Copyright © 2016 Elsevier B.V. All rights reserved.
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'Lending the space': midwives' perceptions of birth space and clinical risk management.
Seibold, Carmel; Seibold, Camel; Licqurish, Sharon; Rolls, Colleen; Hopkins, Finbar
2010-10-01
to explore and describe midwives perceptions of birth space and clinical risk management and their impact on practice both before and after a move to a new facility. an exploratory descriptive study utilising a modified participatory approach and observation and focus groups for data collection. a major metropolitan maternity hospital in Victoria, Australia. 18 midwives, including graduate year midwives, caseload midwives and hospital midwives working normal shifts, employed within a hospital. the major themes identified were perceptions of birth space, perceptions of risk management, influence of birth space and risk management on practice and moving but not changing: geographical space and practice. Midwives desire to create the ideal birth space was hampered by a prevailing biomedical discourse which emphasised risk. Midwives in all three groups saw themselves as the gatekeepers, 'holding the space' or 'providing a bridge' for women, often in the face of a hierarchical hospital structure with obstetricians governing practice. This situation did not differ significantly after the relocation to the new hospital. Despite a warmer, more spacious and private birth space midwives felt the care was still influenced by the old hierarchical hospital culture. Caseload midwives felt they had the best opportunity to make a difference to women's experience because they were able, through continuity of care, to build trusting relationships with women during the antenatal period. although the physical environment can make a marginal contribution to an optimal birth space, it has little effect on clinical risk management practices within a major public hospital and the way in which this impacts midwives' practice. The importance of place and people are the key to providing an optimal birth space, as are women centred midwifery models of care and reasonable workloads. Copyright © 2010 Elsevier Ltd. All rights reserved.
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2013-01-01
Background Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality. Effective self-management support interventions are needed to improve the health and functional status of people with COPD or at risk for COPD. Computer-tailored technology could be an effective way to provide this support. Methods/Design This paper presents the protocol of a randomised controlled trial testing the effectiveness of a web-based, computer-tailored self-management intervention to change health behaviours of people with or at risk for COPD. An intervention group will be compared to a usual care control group, in which the intervention group will receive a web-based, computer-tailored self-management intervention. Participants will be recruited from an online panel and through general practices. Outcomes will be measured at baseline and at 6 months. The primary outcomes will be smoking behaviour, measuring the 7-day point prevalence abstinence and physical activity, measured in minutes. Secondary outcomes will include dyspnoea score, quality of life, stages of change, intention to change behaviour and alternative smoking behaviour measures, including current smoking behaviour, 24-hour point prevalence abstinence, prolonged abstinence, continued abstinence and number of quit attempts. Discussion To the best of our knowledge, this will be the first randomised controlled trial to test the effectiveness of a web-based, computer-tailored self-management intervention for people with or at risk for COPD. The results will be important to explore the possible benefits of computer-tailored interventions for the self-management of people with or at risk for COPD and potentially other chronic health conditions. Dutch trial register NTR3421 PMID:23742208
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Diaper, Ross; Wong, Ernest; Metcalfe, Stuart A
2017-03-01
Rheumatoid arthritis (RA) is one of a number of inflammatory arthropathies resulting in foot pain and deformity. Patients with this disease may require surgical intervention as part of their management. Many of these patients are now taking biologic agents which pose several risks to patients in the perioperative phase. The surgical team therefore need to be aware of these associated complications and how to manage these cases. This paper aims to review the current literature about perioperative needs (foot and ankle surgery) associated with patients with rheumatoid arthritis receiving biologic therapy. The majority of the literature discusses the perioperative complications associated with patients on anti-TNFα therapy with few studies investigating the other biologics in common use. There is conflicting evidence as to the safety of continuing or stopping biologic drug therapy prior to orthopaedic procedures. The British Society for Rheumatology (BSR) have produced guidelines for the management of patients on anti-TNFα therapy or the biologic agent Tocilizumab. These recommendations suggest the risks of post-operative infection need to be balanced against the risk of a post-operative disease flare. In essence, it is suggested anti-TNFα therapy is stopped 3-5 times the half-life of the drug whilst Tocilizumab is stopped 4 weeks prior to surgery. Good communication is needed between the surgical team and the local Rheumatology department managing the patient's disease in order to optimise perioperative care. Local pathways may vary from the BSR recommendations to determine the most suitable course of action with regards to continuing or stopping biologic therapy prior to foot and ankle surgery. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Street, Tamara D; Thomas, Drew L
2017-03-01
Rates of overweight and obese Australians are high and continue to rise, putting a large proportion of the population at risk of chronic illness. Examining characteristics associated with preference for a work-based weight-loss program will enable employers to better target programs to increase enrolment and benefit employees' health and fitness for work. A cross-sectional survey was undertaken at two Australian mining sites. The survey collected information on employee demographics, health characteristics, work characteristics, stages of behavior change, and preference for workplace assistance with reaching a healthy weight. A total of 897 employees participated; 73.7% were male, and 68% had a body mass index in the overweight or obese range. Employees at risk of developing obesity-related chronic illnesses (based on high body mass index) were more likely to report preference for weight management assistance than lower risk employees. This indicates that, even in the absence of workplace promotion for weight management, some at risk employees want workplace assistance. Employees who were not aware of a need to change their current nutrition or physical activity behaviors were less likely to seek assistance. This indicates that practitioners need to communicate the negative effects of excess weight and promote the benefits of a healthy lifestyle to increase the likelihood of weight management. Weight management programs should provide information, motivation. and trouble-shooting assistance to meet the needs of at-risk mining employees, including those who are attempting to change and maintain behaviors to achieve a healthy weight and be suitably fit for work.
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NASA Astrophysics Data System (ADS)
Reaney, S. M.; Heathwaite, L.; Lane, S. N.; Buckley, C.
2007-12-01
Pollution of rivers from agricultural phosphorus is recognised as a significant global problem and is a major management challenge as it involves processes that are small in magnitude, distributed over large areas, operating at fine spatial scales and associated with certain land use types when they are well connected to the receiving waters. Whilst some of these processes have been addressed in terms of water quality forecasting models and field measurements, we lack effective tools to prioritise where action should be taken to remediate the diffuse pollution problem. From a management perspective, the required information is on 'what to do where' rather than absolute values. This change in focus opens up the problem to be considered in a probabilistic / relative framework rather than concentrating on absolute values. The SCIMAP risk management framework is based on the critical source area concept whereby a risk and a connection are required to generate a problem. Treatments of both surface and subsurface hydrological connectivity have been developed. The approach is based on the philosophy that for a point to be considered connected there needs to be a continuous flow path to the receiving water. This information is calculated by simulating the possible flow paths from the source cell to the receiving water and recording the required catchment wetness to allow flow along that route. This algorithm gives information on the ease at which each point in the landscape can export risk along surface and subsurface pathways to the receiving waters. To understand the annual dynamics of the locational diffuse P risk, a temporal risk framework has been developed. This risk framework accounts for land management activies within the agricultural calendar. These events include the application of fertiliser, the P additions from livestock and the offtake of P in crops. Changes to these risks can be made to investigate management options. The SCIMAP risk mapping framework has been applied to 12 catchments in England as part of the DEFRA / Environment Agency's Catchment Sensitive Farming programme. Result from these catchments will be presented.
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Human Research Program: 2012 Fiscal Year Annual Report
NASA Technical Reports Server (NTRS)
Effenhauser, Laura
2012-01-01
Crew health and performance are critical to successful human exploration beyond low Earth orbit. Risks to health and performance include physiologic effects from radiation, hypogravity, and planetary environments, as well as unique challenges in medical treatment, human factors, and support of behavioral health. The scientists and engineers of the Human Research Program (HRP) investigate and reduce the greatest risks to human health and performance, and provide essential countermeasures and technologies for human space exploration. In its seventh year of operation, the HRP continued to refine its management architecture of evidence, risks, gaps, tasks, and deliverables. Experiments continued on the International Space Station (ISS), on the ground in analog environments that have features similar to those of spaceflight, and in laboratory environments. Data from these experiments furthered the understanding of how the space environment affects the human system. These research results contributed to scientific knowledge and technology developments that address the human health and performance risks. As shown in this report, HRP has made significant progress toward developing medical care and countermeasure systems for space exploration missions which will ultimately reduce risks to crew health and performance.
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Physician-executives past, present, and future.
Smallwood, K G; Wilson, C N
1992-08-01
The dramatic changes in the United States' health care system during the last decade have sparked increasing interest in physician-executives. These executives, skilled in both clinical medicine and health care management, can be found in hospitals, managed care organizations, group practices, and government institutions. This paper outlines the physician-executive's roles and the development process. The remarkable growth in the number of physician-executives is expected to continue as they demonstrate their abilities to help health care providers expand ambulatory services, facilitate provider-physician relationships and physician recruitment, and lend expertise in quality improvement and risk management issues.
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Pickup, John Alexander; Dewaele, Joost; Furmanski, Nicola L; Kowalczyk, Agnieszka; Luijkx, Gerard Ca; Mathieu, Sophie; Stelter, Norbert
2017-01-01
Cleaning products have long been a focus of efforts to improve sustainability and assure safety for the aquatic environment when disposed of after use. The latter is addressed at ingredient level through environmental risk assessment, including in formal frameworks such as REACH. Nevertheless, in the context of programs to improve overall sustainability, stakeholders demand both environmental safety assurance and progress at product level. Current product-level approaches for aquatic toxicity (e.g., USEtox™, Critical Dilution Volume) can be seen as predominantly hazard-based. The more logical approach would be risk-based, because ecotoxicity is generally threshold-dependent and hazard-based assessment produces conflicts with risk-based learnings. The development of a risk-based approach to assess formulated products is described: the International Association for Soaps, Detergents and Maintenance Products (A.I.S.E.) Charter Environmental Safety Check (ESC), which is consistent with the scientific principles underlying REACH. This is implemented through a simple spreadsheet tool and internal database of ingredient parameters including predicted no-effect concentration (PNEC) and removal rate. A novel feature is applying market volume information for both product types and ingredients to permit a risk-based calculation. To pass the ESC check, the projected environmental safety ratio (PESR) for each ingredient as formulated and dosed (unless cleared by a published risk assessment or exempted as inherently low risk) must be less than 1. The advantages of a risk-based approach are discussed. The strengths and limitations of various possible approaches to standard-setting, product-ranking and driving continuous improvement in respect of potential ecotoxic impacts on the aquatic environment are considered. It is proposed that as ecotoxicity is generally accepted to be threshold-dependent, with no effect below the threshold, the most constructive approach to continuous improvement of sustainability with regard to ecotoxicity is to focus efforts on instances where the safety margins for ingredients as used in specific products are narrow. This necessitates a risk-based approach. Integr Environ Assess Manag 2017;13:127-138. © 2016 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of SETAC. © 2016 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of SETAC.
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[Quality Management in Medicine: What the Surgeon Needs to Know].
Holtel, M; Roßmüller, T; Frommhold, K
2016-10-01
Quality management (QM) is a method used in the field of economics that was adopted late by the medical sector. The coincidence of quality management and what is referred to as economisation in medicine frequently leads to QM being - incorrectly - perceived as part of the economisation problem rather than as part of its solution. Quality assurance defines and observes key performance indicators for the achievement of quality objectives. QM is a form of active management that intends to systematically exclude the effects of chance. It is supposed to enable those in charge of an institution to deal with complex processes, to influence them and achieve quality even under unfavourable circumstances. Clearly defined written standards are an important aspect of QM and allow for 80 % of patients to be treated faster and less labour-intensively and thus to create more capacity for the individual treatment of the 20 % of patients requiring other than routine care. Standards provide a framework to rely on for department heads and other staff alike. They reduce complexity, support processes in stress situations and prevent inconsistent decisions in the course of treatment. Document management ensures transparent and up-to-date in-house standards and creates continuity. Good documents are short, easy to use, and, at the same time, comply with requirements. Specifications describe in-house standards; validation documents provide a forensically sound documentation. Quality management has a broad impact on an institution. It helps staff reflect on their daily work, and it initiates a reporting and auditing system as well as the systematic management of responses to surveys and complaints. Risk management is another aspect of QM; it provides structures to identify, analyse, assess and modify risks and subject them to risk controlling. Quality management is not necessarily associated with certification. However, if certification is intended, it serves to define requirements, increase motivation for the implementation of measures to be taken, and provide long-term continuity in newly adopted processes. Specialist certificates issued by medical associations frequently emphasise an interdisciplinary treatment approach; however, their certification processes are often of poor quality. The effectiveness and efficiency is evident for individual QM instruments in medicine. It is very likely that quality management improves effectiveness in the whole field of medicine, but this has yet to be proved. Georg Thieme Verlag KG Stuttgart · New York.
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UPMC MyHealth: managing the health and costs of U.S. healthcare workers.
Parkinson, Michael D; Peele, Pamela B; Keyser, Donna J; Liu, Yushu; Doyle, Stephen
2014-10-01
Workplace wellness programs hold promise for managing the health and costs of the U.S. workforce. These programs have not been rigorously tested in healthcare worksites. To evaluate the impact of MyHealth on the health and costs of UPMC healthcare workers. Five-year observational study conducted in 2013 with subgroup analyses and propensity-matched pair comparisons to more accurately interpret program effects. UPMC, an integrated health care delivery and financing system headquartered in Pittsburgh, Pennsylvania. Participants included 13,627 UPMC employees who were continuously enrolled in UPMC-sponsored health insurance during the study period and demonstrated participation in MyHealth by completing a Health Risk Assessment in both 2007 and 2011, as well as 4,448 other healthcare workers employed outside of UPMC who did not participate in the program. A comprehensive wellness, prevention, and chronic disease management program that ties achievement of health and wellness requirements to receipt of an annual credit on participants' health insurance deductible. Health-risk levels, medical, pharmacy, and total healthcare costs, and Healthcare Effectiveness Data and Information Set performance rates for prevention and chronic disease management. Significant improvements in health-risk status and increases in use of preventive and chronic disease management services were observed in the intervention group. Although total healthcare costs increased significantly, reductions in costs were significant for those who moved from higher- to the lowest-risk levels. The contrast differences in costs between reduced- and maintained-risk groups was also significant. Matched pair comparisons provided further evidence of program effects on observed reductions in costs and improvements in prevention, but not improvements in chronic disease management. Incorporating incentivized health management strategies in employer-sponsored health insurance benefit designs can serve as a useful, though not sufficient, tool for managing the health and costs of the U.S. healthcare workforce. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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Medical equipment management strategies.
Wang, Binseng; Furst, Emanuel; Cohen, Ted; Keil, Ode R; Ridgway, Malcolm; Stiefel, Robert
2006-01-01
Clinical engineering professionals need to continually review and improve their management strategies in order to keep up with improvements in equipment technology, as well as with increasing expectations of health care organizations. In the last 20 years, management strategies have evolved from the initial obsession with electrical safety to flexible criteria that fit the individual institution's needs. Few hospitals, however, are taking full advantage of the paradigm shift offered by the evolution of joint Commission standards. The focus should be on risks caused by equipment failure, rather than on equipment with highest maintenance demands. Furthermore, it is not enough to consider risks posed by individual pieces of equipment to individual patients. It is critical to anticipate the impact of an equipment failure on larger groups of patients, especially when dealing with one of a kind, sophisticated pieces of equipment that are required to provide timely and accurate diagnoses for immediate therapeutic decisions or surgical interventions. A strategy for incorporating multiple criteria to formulate appropriate management strategies is provided in this article.
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McCarthy, Maria C; Campo, Monica; Drew, Sarah E
2013-09-01
To summarize and discuss recent research (2011-2013) examining the communication needs of childhood cancer survivors with respect to long-term health risks and considering the developmental needs of children, adolescents and young adults. Survivors' levels of awareness of ongoing health risks are low, indicating that clinical strategies for communicating risks and empowering young people as active partners in their own healthcare are lacking. Research examining the information needs of very young survivors is sparse. Adolescent and young adults may be particularly vulnerable given their lack of health-risk knowledge combined with expected developmental risk-taking behaviors. Strategies to manage individual information preferences of survivors are required, along with strategies to manage the triadic (child, parent, health professional) nature of communications. Internet technologies offer an important mechanism for communication of health risks to survivors, families and primary healthcare providers. International efforts must continue to articulate systematic yet flexible approaches to communication with children, adolescents and young adults that can be applied across the cancer treatment continuum and into surveillance and long-term survivorship. Information and communication needs of this population are complex and reliance on age as a proxy for capacity to participate in healthcare communication is inadequate.
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Nable, Jose V; Graham, Autumn C
2016-05-01
Acute gastrointestinal bleeding is a commonly encountered chief complaint with a high morbidity and mortality. The emergency physician is challenged with prompt diagnosis, accurate risk assessment, and appropriate resuscitation of patients with gastrointestinal bleeding. Goals of care aim to prevent end-organ injury, manage comorbid illnesses, identify the source of bleeding, stop continued bleeding, support oxygen carrying capacity, and prevent rebleeding. This article reviews current strategies for risk stratification, diagnostic modalities, localization of bleeding, transfusion strategies, adjunct therapies, and reversal of anticoagulation. Copyright © 2016 Elsevier Inc. All rights reserved.
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HIPAA Compliant Wireless Sensing Smartwatch Application for the Self-Management of Pediatric Asthma
Hosseini, Anahita; Buonocore, Chris M.; Hashemzadeh, Sepideh; Hojaiji, Hannaneh; Kalantarian, Haik; Sideris, Costas; Bui, Alex A.T.; King, Christine E.; Sarrafzadeh, Majid
2018-01-01
Asthma is the most prevalent chronic disease among pediatrics, as it is the leading cause of student absenteeism and hospitalization for those under the age of 15. To address the significant need to manage this disease in children, the authors present a mobile health (mHealth) system that determines the risk of an asthma attack through physiological and environmental wireless sensors and representational state transfer application program interfaces (RESTful APIs). The data is sent from wireless sensors to a smartwatch application (app) via a Health Insurance Portability and Accountability Act (HIPAA) compliant cryptography framework, which then sends data to a cloud for real-time analytics. The asthma risk is then sent to the smartwatch and provided to the user via simple graphics for easy interpretation by children. After testing the safety and feasibility of the system in an adult with moderate asthma prior to testing in children, it was found that the analytics model is able to determine the overall asthma risk (high, medium, or low risk) with an accuracy of 80.10±14.13%. Furthermore, the features most important for assessing the risk of an asthma attack were multifaceted, highlighting the importance of continuously monitoring different wireless sensors and RESTful APIs. Future testing this asthma attack risk prediction system in pediatric asthma individuals may lead to an effective self-management asthma program. PMID:29354688
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Tung, James Y; Stead, Brent; Mann, William; Ba'Pham; Popovic, Milos R
2015-01-01
Pressure ulcers (PUs) in individuals with spinal cord injury (SCI) present a persistent and costly problem. Continuing effort in developing new technologies that support self-managed care is an important prevention strategy. Specifically, the aims of this scoping review are to review the key concepts and factors related to self-managed prevention of PUs in individuals with SCI and appraise the technologies available to assist patients in self-management of PU prevention practices. There is broad consensus that sustaining long-term adherence to prevention regimens is a major concern. Recent literature highlights the interactions between behavioral and physiological risk factors. We identify four technology categories that support self-management: computer-based educational technologies demonstrated improved short-term gains in knowledge (2 studies), interface pressure mapping technologies demonstrated improved adherence to pressure-relief schedules up to 3 mo (5 studies), electrical stimulation confirmed improvements in tissue tolerance after 8 wk of training (3 studies), and telemedicine programs demonstrated improvements in independence and reduced hospital visits over 6 mo (2 studies). Overall, self-management technologies demonstrated low-to-moderate effectiveness in addressing a subset of risk factors. However, the effectiveness of technologies in preventing PUs is limited due to a lack of incidence reporting. In light of the key findings, we recommend developing integrated technologies that address multiple risk factors.
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Allen, Todd L; Carter, Jody L; Morris, Brad J; Harker, Colleen P; Stevens, Mark H
2005-06-01
Venous thromboembolic (VTE) disease remains a significant cause of morbidity for trauma patients because many patients have injuries that may preclude effective VTE prevention and treatment. Retrievable vena cava filters may prove beneficial in this subset of trauma patients. Trauma patients at risk for VTE were identified and managed by institutional protocol. Patients who required a vena cava filter were managed with a device that could be retrieved or left in situ. A retrospective review of medical records was used to identify the use, indications, and complications associated with a retrievable filter. Fifty-three retrievable filters were placed in 51 patients. Two of these patients received a second filter, and 1 received a filter in the superior vena cava. Thirty-two filters were placed prophylactically, whereas 21 were placed for demonstrated venous thromboembolism (VTE). Retrieval was successful in 24 of 25 attempts. Twenty-nine filters became permanent: 10 for continued contraindications to anticoagulation without known VTE, 12 for known VTE and continued contraindications to anticoagulation, 1 for technical reasons, and 6 because of patient death. There were no complications of bleeding, device migration or thrombosis, infection, or pulmonary embolism. A retrievable vena cava filter appears safe and effective for the prevention of pulmonary embolism in the high-risk trauma patient who cannot receive anticoagulation.
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Occupational safety and health in Japan: current situations and the future.
Sakurai, Haruhiko
2012-01-01
The Industrial Safety and Health Law enacted in 1972 has contributed much to the progress of occupational safety and health (OSH) activities. Many indicators including death and illness statistics show continued improvement up to date. The establishment of OSH organization within enterprises and 5-yr administrative programs formulated by the Ministry of Health, Labour, and Welfare (MHLW) were important factors for satisfactory management. The past programs indicate that the weight of self regulation in comparison to legal control gradually increased since late 1990s. In spite of the past achievement, many hazards such as overwork, mental stress, chemical agents and others still remain to be prevented. The systematic risk assessment of unregulated chemicals by the MHLW proved to be an effective scheme for risk-based management and to deserve continued implementation. The size of human resources for OSH was estimated at 1.5 million. In view of the adverse effect on OSH by economic, social and political environment in the future, the importance of the efficiency of OSH management was indicated. Since the efficiency depends on the competence of OSH personnel and the level of scientific basis, it was concluded that the fundamental policy for the future should give high priority to education and research.
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Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management
Fu, Mei R
2014-01-01
The global burden of breast cancer continues to increase largely because of the aging and growth of the world population. More than 1.38 million women worldwide were estimated to be diagnosed with breast cancer in 2008, accounting for 23% of all diagnosed cancers in women. Given that the 5-year survival rate for breast cancer is now 90%, experiencing breast cancer is ultimately about quality of life. Women treated for breast cancer are facing a life-time risk of developing lymphedema, a chronic condition that occurs in up to 40% of this population and negatively affects breast cancer survivors’ quality of life. This review offers an insightful understanding of the condition by providing clinically relevant and evidence based knowledge regarding lymphedema symptoms, diagnosis, risk reduction, and management with the intent to inform health care professionals so that they might be better equipped to care for patients. PMID:25114841
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Biological risk among hospital housekeepers.
Ream, Priscilla Santos Ferreira; Tipple, Anaclara Ferreira Veiga; Barros, Dayane Xavier; Souza, Adenícia Custódia Silva; Pereira, Milca Severino
2016-01-01
Although not directly responsible for patient care, hospital housekeepers are still susceptible to accidents with biological material. The objectives of this study were to establish profile and frequency of accidents among hospital housekeepers, describe behaviors pre- and postaccident, and risk factors. This was a cross-sectional study with hospital housekeepers in Goiania, Brazil. Data were obtained from interviews and vaccination records. The observations were as follows: (1) participating workers: 94.3%; (2) incomplete hepatitis B vaccination: 1 in 3; and (3) accident rate: 26.5%, mostly percutaneous with hypodermic needles, and involved blood from an unknown source; roughly half occurred during waste management. Upon review, length of service less than 5 years, completed hepatitis B vaccination, and had been tested for anti-HBs (hepatitis B surface antigen) influenced frequency of accidents. These findings suggest that improper disposal of waste appears to enhance the risk to hospital housekeepers. All hospital workers should receive continued training with regard to waste management.
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A stochastic inventory management model for a dual sourcing supply chain with disruptions
NASA Astrophysics Data System (ADS)
Iakovou, Eleftherios; Vlachos, Dimitrios; Xanthopoulos, Anastasios
2010-03-01
As companies continue to globalise their operations and outsource significant portion of their value chain activities, they often end up relying heavily on order replenishments from distant suppliers. The explosion in long-distance sourcing is exposing supply chains and shareholder value at ever increasing operational and disruption risks. It is well established, both in academia and in real-world business environments, that resource flexibility is an effective method for hedging against supply chain disruption risks. In this contextual framework, we propose a single period stochastic inventory decision-making model that could be employed for capturing the trade-off between inventory policies and disruption risks for an unreliable dual sourcing supply network for both the capacitated and uncapacitated cases. Through the developed model, we obtain some important managerial insights and evaluate the merit of contingency strategies in managing uncertain supply chains.
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2013-01-01
This article focuses on the incidence, predictors, classification, impact on prognosis, and management of bleeding associated with the treatment of acute coronary syndrome. The issue of bleeding complications is related to the continual improvement of ischemic heart disease treatment, which involves mainly (a) the widespread use of coronary angiography, (b) developments in percutaneous coronary interventions, and (c) the introduction of new antithrombotics. Bleeding has become an important health and economic problem and has an incidence of 2.0% to 17%. Bleeding significantly influences both the short- and long-term prognoses. If a group of patients at higher risk of bleeding complications can be identified according to known risk factors and a risk scoring system can be developed, we may focus more on preventive measures that should help us to reduce the incidence of bleeding. PMID:24093465
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Survey and monitoring of species at risk at Camp Blanding Training Site, northeastern Florida
Gregory, C.J.; Carthy, R.R.; Pearlstine, L.G.
2006-01-01
We studied the presence and distribution of 19 species at risk in northeastern Florida at the Camp Blanding Training Site (CBTS) during 2000-2001, seven years after the first major baseline surveys of CBTS were conducted. Much of the training conducted at CBTS deals with light infantry exercises, but the site is also used for mining, silviculture, hunting, fishing, emergency logistical support, and entertainment purposes. CBTS contains more than 2000 species of plants and animals in 14 natural communities, each impacted to various degrees by past and current land management. Adaptive management plans for species may be ineffective without continual feedback and the flexibility for change. Here we summarize and discuss the results of our surveys, compare these results with those of past surveys, identify differences between the surveys, and discuss the importance of systematic protocols and study design for CBTS environmental managers.
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Kuwabara, Cleuza Catsue Takeda; Evora, Yolanda Dora Martinez; de Oliveira, Márcio Mattos Borges
2010-01-01
With the continuous incorporation of health technologies, hospital risk management should be implemented to systemize the monitoring of adverse effects, performing actions to control and eliminate their damage. As part of these actions, Technovigilance is active in the procedures of acquisition, use and quality control of health products and equipment. This study aimed to construct and validate an instrument to evaluate medical-hospital products. This is a quantitative, exploratory, longitudinal and methodological development study, based on the Six Sigma quality management model, which has as its principle basis the component stages of the DMAIC Cycle. For data collection and content validation, the Delphi technique was used with professionals from the Brazilian Sentinel Hospital Network. It was concluded that the instrument developed permitted the evaluation of the product, differentiating between the results of the tested brands, in line with the initial study goal of qualifying the evaluations performed.
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Risk stratification and management of acute pulmonary embolism.
Becattini, Cecilia; Agnelli, Giancarlo
2016-12-02
The clinical management of patients with acute pulmonary embolism is rapidly changing over the years. The widening spectrum of clinical management strategies for these patients requires effective tools for risk stratification. Patients at low risk for death could be candidates for home treatment or early discharge. Clinical models with high negative predictive value have been validated that could be used to select patients at low risk for death. In a major study and in several meta-analyses, thrombolysis in hemodynamically stable patients was associated with unacceptably high risk for major bleeding complications or intracranial hemorrhage. Thus, the presence of shock or sustained hypotension continues to be the criterion for the selection of candidates for thrombolytic treatment. Interventional procedures for early revascularization should be reserved to selected patients until further evidence is available. No clinical advantage is expected with the insertion of a vena cava filter in the acute-phase management of patients with acute pulmonary embolism. Direct oral anticoagulants used in fixed doses without laboratory monitoring showed similar efficacy (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.70-1.12) and safety (OR, 0.89; 95% CI, 0.77-1.03) in comparison with conventional anticoagulation in patients with acute pulmonary embolism. Based on these results and on their practicality, direct oral anticoagulants are the agents of choice for the treatment of the majority of patients with acute pulmonary embolism. © 2016 by The American Society of Hematology. All rights reserved.
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Severe Hypertriglyceridemia During Therapy For Childhood Acute Lymphoblastic Leukemia
Bhojwani, Deepa; Darbandi, Rashid; Pei, Deqing; Ramsey, Laura B.; Chemaitilly, Wassim; Sandlund, John T.; Cheng, Cheng; Pui, Ching-Hon; Relling, Mary V.; Jeha, Sima; Metzger, Monika L.
2014-01-01
Background Asparaginase and steroids can cause hypertriglyceridemia in children with acute lymphoblastic leukemia (ALL). There are no guidelines for screening or management of patients with severe hypertriglyceridemia (>1000 mg/dL) during ALL therapy. Patients and Methods Fasting lipid profiles were obtained prospectively at 4 time-points for 257 children consecutively enrolled on a frontline ALL study. Risk factors were evaluated by the exact chi-square test. Details of adverse events and management of hypertriglyceridemia were extracted retrospectively. Results Eighteen of 257 (7%) patients developed severe hypertriglyceridemia. Older age and treatment with higher doses of asparaginase and steroids on the standard/high-risk arm were significant risk factors. Severe hypertriglyceridemia was not associated with pancreatitis after adjustment for age and treatment arm or with osteonecrosis after adjustment for age. However, patients with severe hypertriglyceridemia had a 2.5 to 3 times higher risk of thrombosis compared to patients without, albeit the difference was not statistical significant. Of the 30 episodes of severe hypertriglyceridemia in 18 patients, 7 were managed conservatively while the others with pharmacotherapy. Seventeen of 18 patients continued to receive asparaginase and steroids. Triglyceride levels normalized after completion of ALL therapy in all 12 patients with available measurements. Conclusion Asparaginase- and steroid-induced transient hypertriglyceridemia can be adequately managed with dietary modifications and close monitoring without altering chemotherapy. Patients with severe hypertriglyceridemia were not at increased risk of adverse events, with a possible exception of thrombosis. The benefit of pharmacotherapy in decreasing symptoms and potential complications requires further investigation. PMID:25087182
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Severe hypertriglyceridaemia during therapy for childhood acute lymphoblastic leukaemia.
Bhojwani, Deepa; Darbandi, Rashid; Pei, Deqing; Ramsey, Laura B; Chemaitilly, Wassim; Sandlund, John T; Cheng, Cheng; Pui, Ching-Hon; Relling, Mary V; Jeha, Sima; Metzger, Monika L
2014-10-01
Asparaginase and steroids can cause hypertriglyceridaemia in children with acute lymphoblastic leukaemia (ALL). There are no guidelines for screening or management of patients with severe hypertriglyceridaemia (>1000mg/dL) during ALL therapy. Fasting lipid profiles were obtained prospectively at four time-points for 257 children consecutively enrolled on a frontline ALL study. Risk factors were evaluated by the exact chi-square test. Details of adverse events and management of hypertriglyceridaemia were extracted retrospectively. Eighteen of 257 (7%) patients developed severe hypertriglyceridaemia. Older age and treatment with higher doses of asparaginase and steroids on the standard/high-risk arm were significant risk factors. Severe hypertriglyceridaemia was not associated with pancreatitis after adjustment for age and treatment arm or with osteonecrosis after adjustment for age. However, patients with severe hypertriglyceridaemia had a 2.5-3 times higher risk of thrombosis compared to patients without, albeit the difference was not statistically significant. Of the 30 episodes of severe hypertriglyceridaemia in 18 patients, seven were managed conservatively while the others with pharmacotherapy. Seventeen of 18 patients continued to receive asparaginase and steroids. Triglyceride levels normalised after completion of ALL therapy in all 12 patients with available measurements. Asparaginase- and steroid-induced transient hypertriglyceridaemia can be adequately managed with dietary modifications and close monitoring without altering chemotherapy. Patients with severe hypertriglyceridaemia were not at increased risk of adverse events, with a possible exception of thrombosis. The benefit of pharmacotherapy in decreasing symptoms and potential complications requires further investigation. Copyright © 2014 Elsevier Ltd. All rights reserved.
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NASA Astrophysics Data System (ADS)
Prenger-Berninghoff, K.; Cortes, V. J.; Sprague, T.; Aye, Z. C.; Greiving, S.; Głowacki, W.; Sterlacchini, S.
2014-04-01
The need for continuous adaptation to complex and unforeseen events requires enhancing the links between planning and preparedness phases to reduce future risks in the most efficient way. In this context, the legal-administrative and cultural context has to be taken into account. This is why four case study areas of the CHANGES1 project (Nehoiu Valley in Romania, Ubaye Valley in France, Val Canale in Italy, and Wieprzówka catchment in Poland) serve as examples to highlight currently implemented risk management strategies for land-use planning and emergency preparedness. The strategies described in this paper were identified by means of exploratory and informal interviews in each study site. Results reveal that a dearth or, in very few cases, a weak link exists between spatial planners and emergency managers. Management strategies could benefit from formally intensifying coordination and cooperation between emergency services and spatial planning authorities. Moreover, limited financial funds urge for a more efficient use of resources and better coordination towards long-term activities. The research indicates potential benefits to establishing or, in some cases, strengthening this link and provides suggestions for further development in the form of information and decision support systems as a key connection point. Aside from the existent information systems for emergency management, it was found that a common platform, which integrates involvement of these and other relevant actors could enhance this connection and address expressed stakeholder needs. 1 Marie Curie ITN CHANGES - Changing Hydro-meteorological Risks as Analyzed by a New Generation of European Scientists.
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12 CFR 41.90 - Duties regarding the detection, prevention, and mitigation of identity theft.
Code of Federal Regulations, 2010 CFR
2010-01-01
... appendix J, the following definitions apply: (1) Account means a continuing relationship established by a... directors, a designated employee at the level of senior management. (3) Covered account means: (i) An... offers or maintains for which there is a reasonably foreseeable risk to customers or to the safety and...
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12 CFR 334.90 - Duties regarding the detection, prevention, and mitigation of identity theft.
Code of Federal Regulations, 2010 CFR
2010-01-01
... Appendix J, the following definitions apply: (1) Account means a continuing relationship established by a... directors, a designated employee at the level of senior management. (3) Covered account means: (i) An... offers or maintains for which there is a reasonably foreseeable risk to customers or to the safety and...
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12 CFR 571.90 - Duties regarding the detection, prevention, and mitigation of identity theft.
Code of Federal Regulations, 2010 CFR
2010-01-01
... section and appendix J, the following definitions apply: (1) Account means a continuing relationship... board of directors, a designated employee at the level of senior management. (3) Covered account means... institution or creditor offers or maintains for which there is a reasonably foreseeable risk to customers or...
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Managing the emerald ash borer in Canada
Kenneth R. Marchant
2007-01-01
The Emerald ash borer, (EAB, Agrilus planipennis Fairmaire) continues to pose a major risk to Canadian urban and rural forests and parklands. EAB now occurs in four counties in southwestern Ontario. An estimated 1 million ash trees in Essex County, Ontario, and millions more in adjacent counties are in peril. Little natural resistance has been...
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Learning to coexist with wildfire
M.A. Moritz; E. Batlloria; R.A. Bradstock; Jeff Stringer; Robbie Sitzlar; P.F. Hessburg; J. Leonard; S. McCaffrey; D.C. Odion; T. Schoennagel; A.D. Syphard
2014-01-01
The impacts of escalating wildfire in many regions â the lives and homes lost, the expense of suppression and the damage to ecosystem services â necessitate a more sustainable coexistence with wildfire. Climate change and continued development on fire-prone landscapes will only compound current problems. Emerging strategies for managing ecosystems and mitigating risks...
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40 CFR 68.170 - Prevention program/Program 2.
Code of Federal Regulations, 2013 CFR
2013-07-01
... the process. (c) The name(s) of the chemical(s) covered. (d) The date of the most recent review or... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.170 Prevention program/Program... of completion of the most recent hazard review or update. (1) The expected date of completion of any...
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40 CFR 68.170 - Prevention program/Program 2.
Code of Federal Regulations, 2012 CFR
2012-07-01
... the process. (c) The name(s) of the chemical(s) covered. (d) The date of the most recent review or... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.170 Prevention program/Program... of completion of the most recent hazard review or update. (1) The expected date of completion of any...
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40 CFR 68.170 - Prevention program/Program 2.
Code of Federal Regulations, 2014 CFR
2014-07-01
... the process. (c) The name(s) of the chemical(s) covered. (d) The date of the most recent review or... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.170 Prevention program/Program... of completion of the most recent hazard review or update. (1) The expected date of completion of any...
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The science of firescapes: Achieving fire-resilient communities
Alistair M. S. Smith; Crystal A. Kolden; Travis B. Paveglio; Mark A. Cochrane; David MJS Bowman; Max A. Moritz; Andrew D. Kliskey; Lilian Alessa; Andrew T. Hudak; Chad M. Hoffman; James A. Lutz; Lloyd P. Queen; Scott J. Goetz; Philip E. Higuera; Luigi Boschetti; Mike Flannigan; Kara M. Yedinak; Adam C. Watts; Eva K. Strand; Jan W. van Wagtendonk; John W. Anderson; Brian J. Stocks; John T. Abatzoglou
2016-01-01
Wildland fire management has reached a crossroads. Current perspectives are not capable of answering interdisciplinary adaptation and mitigation challenges posed by increases in wildfire risk to human populations and the need to reintegrate fire as a vital landscape process. Fire science has been, and continues to be, performed in isolated "silos," including...
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Ager, Alan A; Kline, Jeffrey D; Fischer, A Paige
2015-08-01
We describe recent advances in biophysical and social aspects of risk and their potential combined contribution to improve mitigation planning on fire-prone landscapes. The methods and tools provide an improved method for defining the spatial extent of wildfire risk to communities compared to current planning processes. They also propose an expanded role for social science to improve understanding of community-wide risk perceptions and to predict property owners' capacities and willingness to mitigate risk by treating hazardous fuels and reducing the susceptibility of dwellings. In particular, we identify spatial scale mismatches in wildfire mitigation planning and their potential adverse impact on risk mitigation goals. Studies in other fire-prone regions suggest that these scale mismatches are widespread and contribute to continued wildfire dwelling losses. We discuss how risk perceptions and behavior contribute to scale mismatches and how they can be minimized through integrated analyses of landscape wildfire transmission and social factors that describe the potential for collaboration among landowners and land management agencies. These concepts are then used to outline an integrated socioecological planning framework to identify optimal strategies for local community risk mitigation and improve landscape-scale prioritization of fuel management investments by government entities. © 2015 Society for Risk Analysis.
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[Dual Antiplatelet Therapy in the Perioperative Period - To Continue or Discontinue Treatment?
Koscielny, Jürgen; von Heymann, Christian; Zeymer, Uwe; Cremer, Jochen; Spannagl, Michael; Labenz, Joachim; Giannitsis, Evangelos; Goss, Franz
2017-08-01
Background For secondary prevention of acute coronary syndrome, guidelines recommend dual antiplatelet therapy (DAPT) with acetylsalicylic acid and a P2Y12 receptor antagonist such as clopidogrel, prasugrel or ticagrelor for a period of 12 months. Often, uncertainty exists with respect to surgical or diagnostic procedures in these high-risk patients: can the DAPT be continued without interruption? If not, what is the recommended withdrawal strategy? What should be considered for the perioperative management? Methods An interdisciplinary group of experienced experts in the fields of cardiology, cardiac surgery, gastroenterology, anaesthesiology, intensive care and haemostaseology developed recommendations relevant to daily clinical practice based on the current scientific evidence. Results These recommendations include instructions for evaluating the patient- and procedure-specific risks of bleeding and ischaemia, general recommendations regarding the DAPT withdrawal strategy, and specific guidance for frequent surgical or diagnostic procedures. Discussion This article aims to facilitate the management of patients with DAPT for all medical disciplines involved, thereby ensuring optimal care of patients during the perioperative period. © Georg Thieme Verlag KG Stuttgart · New York.
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Management of high-risk Myeloma: an evidence-based review of treatment strategies.
Lehners, Nicola; Hayden, Patrick J; Goldschmidt, Hartmut; Raab, Marc-Steffen
2016-08-01
Despite the progress made in the treatment of patients with multiple myeloma over recent decades, a significant cohort with high-risk disease as defined by specific clinical and genetic criteria continue to respond poorly to standard treatment. These patients represent a particular challenge to the treating physician and require early identification as well as personalized treatment strategies. In this review, we discuss the prognostic impact of adverse clinical, radiological and genetic factors, evaluate available scoring systems and highlight key aspects of the therapeutic management of high-risk myeloma. MEDLINE and recent scientific meetings' databases were searched for the keywords 'high-risk' and 'multiple myeloma' and relevant studies relating to both diagnostic and therapeutic approaches were identified. Expert commentary: A case is made for intensive induction using combinations of novel agents, early high-dose therapy supported by autologous stem cell transplantation and the widespread use of maintenance therapies. Novel therapeutic options, especially in the field of immunotherapy, are currently explored in clinical trials and have the potential to further improve outcomes for patients with high-risk multiple myeloma.
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Tao, Guoyu; Irwin, Kathleen L
2006-11-01
We reviewed literature on gonorrhea prevention and clinical care in the private sector, the setting where most gonorrhea cases in the United States are now diagnosed. Although most private-sector health settings had a low prevalence of gonorrhea (0.1-2.5%), some private emergency departments and specialty clinics that serve a large number of high-risk or infected patients had prevalences ranged from 1.7% to 11.0%. Studies of diverse settings and populations suggest that, in general, diagnostic testing of symptomatic patients (69-83%), appropriate treatment (61-100%), and case reporting (64-94%) are delivered more commonly than risk assessment for asymptomatic patients (15-28%), routine screening of pregnant women (31-77%), risk-reduction counseling (35-78%), and sex partner management (0-82%). To sustain the recent declines in gonorrhea incidence in the United States, private-sector providers and health systems must continue to offer gonorrhea prevention and clinical services and consider implementing interventions to improve delivery of risk assessment, risk-reduction counseling, and partner management services.
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Aspects of the BPRIM Language for Risk Driven Process Engineering
NASA Astrophysics Data System (ADS)
Sienou, Amadou; Lamine, Elyes; Pingaud, Hervé; Karduck, Achim
Nowadays organizations are exposed to frequent changes in business environment requiring continuous alignment of business processes on business strategies. This agility requires methods promoted in enterprise engineering approaches. Risk consideration in enterprise engineering is getting important since the business environment is becoming more and more competitive and unpredictable. Business processes are subject to the same quality requirements as material and human resources. Thus, process management is supposed to tackle value creation challenges but also the ones related to value preservation. Our research considers risk driven business process design as an integral part of enterprise engineering. A graphical modelling language for risk driven business process engineering was introduced in former research. This paper extends the language and handles questions related to modelling risk in organisational context.
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Amin, Noha; Doupis, John
2016-01-01
The burden of diabetic foot disease (DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy (DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high risk foot are essential for the prevention of foot ulceration and amputation. Proper assessment of the diabetic foot ulceration and appropriate management ensure better prognosis. Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading. Management and type of dressing applied are tailored according to the type of wound and the foot condition. The scope of this review paper is to describe the diabetic foot syndrome starting from the evaluation of the foot at risk for ulceration, up to the new treatment modalities. PMID:27076876
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Current attitudes and practices of obesity counselling by health care providers.
Petrin, Christine; Kahan, Scott; Turner, Monique; Gallagher, Christine; Dietz, William H
Relatively few patients receive obesity counselling consistent with the USPSTF guidelines, and many health care professionals (HCPs) are biased in their attitudes towards obesity management. A national sample of family physicians, internists, OB/GYN physicians, and nurse practitioners (NPs) completed a web-based survey of beliefs, practice, and knowledge regarding obesity management. A majority of HCPs believe that it is both the patient's and the provider's responsibility to ensure that the patient is counselled about obesity. Obesity (77%), obesity-related diseases (79%), or obesity-related risk factors (71%) prompt HCPs to offer obesity counselling; 59% of HCPs wait for the patient to broach the subject of their weight. Increased blood pressure (89%) and heart disease risks (90%) are the most common themes in counselling. Across all HCPs except NPs "exercise" is discussed more frequently than "physical activity" (85% vs 81%), "diet" more frequently than "eating habits" (77% vs 75%), and "obesity" more frequently than "unhealthy weight" (60% vs 45%). NPs are more likely to discuss physical activity, eating habits, and unhealthy weight instead. To improve counselling for obesity, HCPs reported needing more time (70%), training in obesity management (53%), improved reimbursement (53%), and better tools to help patients recognise obesity risks (50%). Obesity-related diseases, risk factors, or obesity alone predict obesity counselling amongst HCPs. Better training in weight management and tools to help patients recognise risks appear to be key elements in helping patients compare the risks of what they may consider invasive therapy against the risks of continued obesity. Copyright © 2016 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
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Xu, Elvis G B; Leung, Kenneth M Y; Morton, Brian; Lee, Joseph H W
2015-02-01
Marine protected areas (MPAs), such as marine parks and reserves, contain natural resources of immense value to the environment and mankind. Since MPAs may be situated in close proximity to urbanized areas and influenced by anthropogenic activities (e.g. continuous discharges of contaminated waters), the marine organisms contained in such waters are probably at risk. This study aimed at developing an integrated environmental risk assessment and management (IERAM) framework for enhancing the sustainability of such MPAs. The IERAM framework integrates conventional environmental risk assessment methods with a multi-layer-DPSIR (Driver-Pressure-State-Impact-Response) conceptual approach, which can simplify the complex issues embraced by environmental management strategies and provide logical and concise management information. The IERAM process can generate a useful database, offer timely update on the status of MPAs, and assist in the prioritization of management options. We use the Cape d'Aguilar Marine Reserve in Hong Kong as an example to illustrate the IERAM framework. A comprehensive set of indicators were selected, aggregated and analyzed using this framework. Effects of management practices and programs were also assessed by comparing the temporal distributions of these indicators over a certain timeframe. Based on the obtained results, we have identified the most significant components for safeguarding the integrity of the marine reserve, and indicated the existing information gaps concerned with the management of the reserve. Apart from assessing the MPA's present condition, a successful implementation of the IERAM framework as evocated here would also facilitate better-informed decision-making and, hence, indirectly enhance the protection and conservation of the MPA's marine biodiversity. Copyright © 2014 Elsevier B.V. All rights reserved.
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Climate Change and Agriculture in the U.S.: Effects and Adaptation (Invited)
NASA Astrophysics Data System (ADS)
Walsh, M. K.; Rippey, B.; Walthall, C. L.; Hatfield, J.; Backlund, P. W.; Lengnick, L.; Marshall, E.
2013-12-01
Agriculture in the United States has followed a path of continual adaptation to a wide range of factors throughout its history. However, observational evidence, supported by an understanding of the physical climate system, shows that human-induced climate change is underway in the U.S. and even now causing changes for which there is no historical reference for producers. Temperatures have increased and precipitation patterns have changed; the incidence, frequency, and extent of pest infestations have been altered, as well as the natural resource base (water, air, and soils) upon which production depends. Each factor challenges agricultural management as atmospheric concentrations of greenhouse gases rise. These trends are likely to continue over the next century. Importantly, a gap exists between U.S. agricultural producers and managers' needs related to climate-driven problems and the information that research currently offers them. In the past, agricultural research into climate change effects has largely focused on mean values of precipitation and temperature. Today's management requirements, however, often demand immediate response on shorter time scales to address abrupt, often novel needs. Further complicating this reality, future decisions will likely require even greater emphasis on managing under increasing levels of uncertainty, and planning for and adjusting to the extremes. Research is moving to better address these emerging issues for the relevant timescales and parameters in order to allow the formulation of improved and resilient management strategies that apply to a future in which past experience has become less applicable. A climate-ready U.S. agricultural system requires easy access to useable climate knowledge and technical resources, improved climate risk management strategies, new processes to support effective adaptive actions, and the development of sustainable production systems resilient to climate effects. Mainstreaming climate knowledge improves adaptive capacity of the agricultural system by ensuring that land managers, technical advisors, researchers, private businesspeople, government program managers, and policymakers are aware of current and projected climate impacts and can access best management practices to reduce risks and capture opportunities.
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Assessing the Role and Impact of Geospatial Data for Wildland Fire Management Decisions
NASA Astrophysics Data System (ADS)
Klein, E. A.; Lev, S. M.
2016-12-01
The 2015 Wildland and Fire Science and Technology Task Force Final Report, produced by the National Science and Technology Council, Committee on Environment, Natural Resources, and Sustainability, Subcommittee on Disaster Reduction, highlighted the increasing frequency of large wildfires and the growing demand for science to inform critical resource decisions to manage, mitigate, respond to, and recover from wildland fires. Federal spending on fire suppression from 2005-2015 has more than doubled despite policy changes that prioritize the mitigation of fire risks through the use of fuel treatments, prescribed fire, and management of naturally occurring wildfires to protect life and property. Fire suppression policies over the last century have created forests primed for severe fire, and in the face of a changing climate, the benefits of re-introducing fire into once fire-resilient ecosystems are clear. There are a range of complex factors and regional variation associated with wildland fire risk that complicate our understanding and effective management of this hazard. Data derived from Earth-observing (EO) systems and networks are a crucial input for managers when making decisions about fire suppression and fuel management. EO data can also be used to develop pre- and post-fire metrics that can aid in the evaluating the effectiveness of wildland fire management decisions. A value-tree method for mapping the role of EO systems and networks in delivering societal benefit through key Federal objectives related to wildland fire management will be presented. The value-tree methodology utilizes input from subject matter experts to assess the availability and usability of data and data products and to evaluate the impact of individual EO data inputs for achieving wildland fire management objectives. The results provide a qualitative assessment of the value of the data for the objectives described and identify critical gaps and continuity issues associated with improvements to and continuous delivery of societal benefit.
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Sinha, Ashish C; Singh, Preet Mohinder
2015-05-01
Over the last four decades, as the rates of obesity have increased, so have the challenges associated with its anesthetic management. In the present review, we discuss perioperative anesthesia management issues that are modifiable by the early involvement of the surgical team. We sum up available evidence or expert opinion on issues like patient positioning, postoperative analgesia, and the effect of continuous positive airway pressure (CPAP) ventilation on surgical anastomosis. We also address established predictors of higher perioperative risk and suggest possible management strategies and concerns of obese patients undergoing same day procedures. Finally, a generalized pharmacological model relevant to altered pharmacokinetics in these patients is presented.
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Cost-Benefit Analysis on Countermeasures for Health Risk by Exposure to Asbestos in Japan
NASA Astrophysics Data System (ADS)
Fujinaga, Aiichiro; Hihara, Hidemi; Tatsuno, Makoto
This study examines asbestos mitigation countermeasures by predicting air concentrations of asbestos, and then cost-benefit analyses is performed. A comparative study was conducted on three cases as follows; case one, demolition by machine & landfill, case two, demolition by hand & landfill, and case three demolition by hand & vitrification treatment. The results showed that if demolition by machine is continued, the risk is greater than 10-4 of upper acceptable risk for 2020. However, if demolition is conducted by hand, the risk is under 10-4 for 2010. And also, the risk will be less than 10-5 of the safety level for environmental standards until 2030. The results show that vitrification deletes the risk on future management at a landfill site, however at a higher cost.
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European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update.
Sweet, David G; Carnielli, Virgilio; Greisen, Gorm; Hallman, Mikko; Ozek, Eren; Plavka, Richard; Saugstad, Ola Didrik; Simeoni, Umberto; Speer, Christian P; Vento, Máximo; Visser, Gerard H A; Halliday, Henry L
2017-01-01
Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the beginning of 2016. Optimizing the outcome for babies with RDS includes consideration of when to use antenatal steroids, and good obstetric practice includes methods of predicting the risk of preterm delivery and also consideration of whether transfer to a perinatal centre is necessary and safe. Methods for optimal delivery room management have become more evidence based, and protocols for lung protection, including initiation of continuous positive airway pressure and titration of oxygen, should be implemented from soon after birth. Surfactant replacement therapy is a crucial part of the management of RDS, and newer protocols for surfactant administration are aimed at avoiding exposure to mechanical ventilation, and there is more evidence of differences among various surfactants in clinical use. Newer methods of maintaining babies on non-invasive respiratory support have been developed and offer potential for greater comfort and less chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease although minimizing the time spent on mechanical ventilation using caffeine and if necessary postnatal steroids are also important considerations. Protocols for optimizing the general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome. © 2016 S. Karger AG, Basel.
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Wong, Holly; Kaufman, Jaime; Baylis, Barry; Conly, John M; Hogan, David B; Stelfox, Henry T; Southern, Danielle A; Ghali, William A; Ho, Chester H
2015-09-29
Interface pressure is a key risk factor in the development of pressure ulcers. Visual feedback of continuous interface pressure between the body and support surface could inform clinicians on repositioning strategies and play a key role in an overall strategy for the prevention and management of pressure ulcers. A parallel two-group randomized controlled clinical trial will be conducted to study the effect of continuous pressure imaging on reducing interface pressure and on the incidence of pressure ulcers in vulnerable hospital patients. A total of 678 eligible consenting inpatients at risk of pressure ulcer development in a tertiary acute care institution will be randomly allocated to either having the ForeSite PT™ system with the liquid-crystal display monitor turned on to provide visual feedback to the clinicians while also collecting continuous interface pressure data (intervention group) or to having the ForeSite PT™ system with monitor turned off (that is, not providing visual feedback) but still collecting continuous interface pressure data (control group), in a ratio of 1:1. Continuous interface pressure data will be collected in both groups for 3 days (72 h). Data collection will continue until discharge for a subset of approximately 60 patients. The primary outcome will be the differences in the two groups' interface pressure analysis. Interface pressure readings will be collected through hourly samplings of continuous interface pressure recordings. Secondary outcomes will be the differences between the two groups in pressure-related skin and soft tissue changes in areas at risk of pressure ulcer (obtained at baseline within 24 h of admission) and on the third day of the trial or at discharge and perceptions of the intervention by patients and clinicians (obtained on the third day or at discharge). This will be the first randomized controlled trial to investigate the effect of visual feedback with continuous interface pressure of vulnerable hospital patients across different care settings, and the association between interface pressure and development of pressure-related skin and soft tissue changes. The results could provide important information to guide clinical practice in the prevention and management of pressure ulcers. ClinicalTrials.gov NCT02325388 (date of registration: 24 December 2014).
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Bar-El, Yaron; Reisner, Shimon; Beyar, Rafael
2014-02-01
Rambam Medical Center, the only tertiary care center and largest hospital in northern Israel, was subjected to continuous rocket attacks in 2006. This extreme situation posed serious and unprecedented ethical dilemmas to the hospital management. An ambiguous situation arose that required routine patient care in a tertiary modern hospital together with implementation of emergency measures while under direct fire. The physicians responsible for hospital management at that time share some of the moral dilemmas faced, the policy they chose to follow, and offer a retrospective critical reflection in this paper. The hospital's first priority was defined as delivery of emergency surgical and medical services to the wounded from the battlefields and home front, while concomitantly providing the civilian population with all elective medical and surgical services. The need for acute medical service was even more apparent as the situation of conflict led to closure of many ambulatory clinics, while urgent or planned medical care such as open heart surgery and chemotherapy continued. The hospital management took actions to minimize risks to patients, staff, and visitors during the ongoing attacks. Wards were relocated to unused underground spaces and corridors. However due to the shortage of shielded spaces, not all wards and patients could be relocated to safer areas. Modern warfare will most likely continue to involve civilian populations and institutes, blurring the division between peaceful high-tech medicine and the rough battlefront. Hospitals in high war-risk areas must be prepared to function and deliver treatment while under fire or facing similar threats.
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Managing manifest diseases, but not health risks, saved PepsiCo money over seven years.
Caloyeras, John P; Liu, Hangsheng; Exum, Ellen; Broderick, Megan; Mattke, Soeren
2014-01-01
Workplace wellness programs are increasingly popular. Employers expect them to improve employee health and well-being, lower medical costs, increase productivity, and reduce absenteeism. To test whether such expectations are warranted, we evaluated the cost impact of the lifestyle and disease management components of PepsiCo's wellness program, Healthy Living. We found that seven years of continuous participation in one or both components was associated with an average reduction of $30 in health care cost per member per month. When we looked at each component individually, we found that the disease management component was associated with lower costs and that the lifestyle management component was not. We estimate disease management to reduce health care costs by $136 per member per month, driven by a 29 percent reduction in hospital admissions. Workplace wellness programs may reduce health risks, delay or avoid the onset of chronic diseases, and lower health care costs for employees with manifest chronic disease. But employers and policy makers should not take for granted that the lifestyle management component of such programs can reduce health care costs or even lead to net savings.
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Jenkins, K; Surminski, S; Hall, J; Crick, F
2017-10-01
Climate change and increasing urbanization are projected to result in an increase in surface water flooding and consequential damages in the future. In this paper, we present insights from a novel Agent Based Model (ABM), applied to a London case study of surface water flood risk, designed to assess the interplay between different adaptation options; how risk reduction could be achieved by homeowners and government; and the role of flood insurance and the new flood insurance pool, Flood Re, in the context of climate change. The analysis highlights that while combined investment in property-level flood protection and sustainable urban drainage systems reduce surface water flood risk, the benefits can be outweighed by continued development in high risk areas and the effects of climate change. In our simulations, Flood Re is beneficial in its function to provide affordable insurance, even under climate change. However, the scheme does face increasing financial pressure due to rising surface water flood damages. If the intended transition to risk-based pricing is to take place then a determined and coordinated strategy will be needed to manage flood risk, which utilises insurance incentives, limits new development, and supports resilience measures. Our modelling approach and findings are highly relevant for the ongoing regulatory and political approval process for Flood Re as well as for wider discussions on the potential of insurance schemes to incentivise flood risk management and climate adaptation in the UK and internationally. Copyright © 2017 Elsevier B.V. All rights reserved.
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Park, Yu Rang; Lee, Yura; Kim, Ji Young; Kim, Jeonghoon; Kim, Hae Reong; Kim, Young-Hak; Kim, Woo Sung; Lee, Jae-Ho
2018-04-09
Personal health records (PHRs) and mHealth apps are considered essential tools for patient engagement. Mobile PHRs (mPHRs) can be a platform to integrate patient-generated health data (PGHD) and patients' medical information. However, in previous studies, actual usage data and PGHD from mPHRs have not been able to adequately represent patient engagement. By analyzing 5 years' PGHD from an mPHR system developed by a tertiary hospital in South Korea, we aimed to evaluate how PGHD were managed and identify issues in PGHD management based on actual usage data. Additionally, we analyzed how to improve patient engagement with mPHRs by analyzing the actively used services and long-term usage patterns. We gathered 5 years (December 2010 to December 2015) of log data from both hospital patients and general users of the app. We gathered data from users who entered PGHD on body weight, blood pressure (BP), blood glucose levels, 10-year cardiovascular disease (CVD) risk, metabolic syndrome risk, medication schedule, insulin, and allergy. We classified users according to whether they were patients or general users based on factors related to continuous use (≥28 days for weight, BP, and blood glucose, and ≥180 days for CVD and metabolic syndrome), and analyzed the patients' characteristics. We compared PGHD entry counts and the proportion of continuous users for each PGHD by user type. The total number of mPHR users was 18,265 (patients: n=16,729, 91.59%) with 3620 users having entered weight, followed by BP (n=1625), blood glucose (n=1374), CVD (n=764), metabolic syndrome (n=685), medication (n=252), insulin (n=72), and allergy (n=61). Of those 18,256 users, 3812 users had at least one PGHD measurement, of whom 175 used the PGHD functions continuously (patients: n=142, 81.14%); less than 1% of the users had used it for more than 4 years. Except for weight, BP, blood glucose, CVD, and metabolic syndrome, the number of PGHD records declined. General users' continuous use of PGHD was significantly higher than that of patients in the blood glucose (P<.001) and BP (P=.03) functions. Continuous use of PGHD in health management (BP, blood glucose, and weight) was significantly greater among older users (P<.001) and men (P<.001). In health management (BP, weight, and blood glucose), overall chronic disease and continuous use of PGHD were not statistically related (P=.08), but diabetes (P<.001) and cerebrovascular diseases (P=.03) were significant. Although a small portion of users managed PGHD continuously, PGHD has the potential to be useful in monitoring patient health. To realize the potential, specific groups of continuous users must be identified, and the PGHD service must target them. Further evaluations for the clinical application of PGHD, feedback regarding user interfaces, and connections with wearable devices are needed. ©Yu Rang Park, Yura Lee, Ji Young Kim, Jeonghoon Kim, Hae Reong Kim, Young-Hak Kim, Woo Sung Kim, Jae-Ho Lee. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 09.04.2018.
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Internet pharmaceutical sales: attributes, concerns, and future forecast.
Bruckel, Katy; Capozzoli, Ernest A
2003-01-01
Internet pharmaceutical sales continue to skyrocket as healthcare providers and consumers are increasingly relying on the efficiencies and convenience that is available via such transactions. Managed care companies, increasing demands to reduce healthcare inefficiencies while maximizing the quality of patient care is a significant contributing factor to the expanding utilization and success of online pharmaceutical sales. However, with the expansion of Internet pharmaceutical sales, healthcare providers, pharmacy benefit management and insurance companies, and consumers realize new opportunities and risks. This paper will review the attributes and concerns associated with online pharmaceutical sales, discussing current and pending legislation intended to more effectively manage these parameters.
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Domestic Abuse and Child Contact: Positioning Children in the Decision-Making Process
ERIC Educational Resources Information Center
Holt, Stephanie
2011-01-01
Drawing on a three-year Irish research study, this paper focuses on the decision-making process in child contact, specifically the assessment and management of risk of continuing abuse to young people previously exposed to domestic abuse. A mixed methodological approach involved the completion of survey questionnaires by 219 mothers and the…
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Kudzu-Goat Interactions--A Pilot Study
C. Bonsi; E. Rhoden; A. Woldeghebriel; P. Mount; S. Solaiman; R. Noble; G. Paris; Charles McMahon; H. Pearson; B. Cash
1992-01-01
The production and processing of forest products is a major industry in the State of Alabama. Current weed management and control practices rely heavily on the use of herbicides. With the risk of soil and water pollution associated with the use of some agricultural chemicals, the continuing use of such chemicals may become hazardous to human health. The need for...
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16 CFR 681.1 - Duties regarding the detection, prevention, and mitigation of identity theft.
Code of Federal Regulations, 2010 CFR
2010-01-01
... following definitions apply: (1) Account means a continuing relationship established by a person with a... employee at the level of senior management. (3) Covered account means: (i) An account that a financial... for which there is a reasonably foreseeable risk to customers or to the safety and soundness of the...
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12 CFR 222.90 - Duties regarding the detection, prevention, and mitigation of identity theft.
Code of Federal Regulations, 2010 CFR
2010-01-01
... following definitions apply: (1) Account means a continuing relationship established by a person with a... employee at the level of senior management. (3) Covered account means: (i) An account that a financial... for which there is a reasonably foreseeable risk to customers or to the safety and soundness of the...
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Fuels treatments in the 21st century - do they matter?
Erik C. Christiansen
2015-01-01
Fuels treatments have long mattered, and are expected to into the future. Mangers are trying desperately to quantitatively answer the question "How much of the risk of wildfire to key values is being reduced through fuels management programs?" Serious challenges to continued implementation of fuels treatments persist, such as lack of sufficient resources to...
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ERIC Educational Resources Information Center
Allen, Pam; Pardue, Don
The Jobs for Florida's Graduates (JFG) program targets high school students and provides services to help these students graduate and to continue their education or find meaningful employment within one year of graduation. School managers and "job specialists" serve as mentors, identify at-risk high school students, and provide them with…
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USDA-ARS?s Scientific Manuscript database
1. Wildfire is an ecological and economic risk for many semi-arid rangelands across the globe. This coupled with extreme wildfire seasons and mega-fires over the last decade have resulted in a call for more pre-suppression management actions. Dormant season grazing has been suggested as a treatment...
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Managing Risk and Exploiting Opportunity
ERIC Educational Resources Information Center
Lambert, H. David
2008-01-01
The role of the Chief Information Officer (CIO), one of the newer positions in higher education senior leadership, continues to transform and evolve, often heading in surprising directions. Not only are the technologies changing at a dizzying pace, but it often feels as if the role itself, as well as what institutions need and expect from the CIO,…
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Chapter 1: Fire and fuels reduction
B.M. Collins; S.L. Stephens
2012-01-01
Fire will continue to be a major management challenge in mixed-conifer forests in the Sierra Nevada. Fire is a fundamental ecosystem process in these forests that was largely eliminated in the 20th century. Fire reintroduction is a critical goal but is subject to constraints such as smoke production, risk of fire moving outside designated boundaries, the expanding...
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Planting nonlocal seed sources of loblolly pine - managing benefits and risks
Clem Lambeth; Steve Mckeand; Randy Rousseau; Ron Schmidtling
2005-01-01
Seed source testing of loblolly pine (Pinus taeda), which began in the 1920s, has allowed large realized genetic gains from using nonlocal seed sources in operational plantations. Seed source testing continues, and deployment guidlines are being refined. some general effects of seed source movement can be described, but there are still gaps in (1)...
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Space Shuttle Probabilistic Risk Assessment (SPRA) Iteration 3.2
NASA Technical Reports Server (NTRS)
Boyer, Roger L.
2010-01-01
The Shuttle is a very reliable vehicle in comparison with other launch systems. Much of the risk posed by Shuttle operations is related to fundamental aspects of the spacecraft design and the environments in which it operates. It is unlikely that significant design improvements can be implemented to address these risks prior to the end of the Shuttle program. The model will continue to be used to identify possible emerging risk drivers and allow management to make risk-informed decisions on future missions. Potential uses of the SPRA in the future include: - Calculate risk impact of various mission contingencies (e.g. late inspection, crew rescue, etc.). - Assessing the risk impact of various trade studies (e.g. flow control valves). - Support risk analysis on mission specific events, such as in flight anomalies. - Serve as a guiding star and data source for future NASA programs.
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Insights into managed care--operational, legal and actuarial.
Melek, S P; Johnson, B A; Schryver, D
1997-01-01
Understanding the operational, legal and actuarial dimensions of managed care is essential to developing managed care contracts between managed care organizations and individual health care providers or groups such as provider-sponsored organizations or independent practice associations. Operationally, it is important to understand managed care and its trends, emphasizing business issues, knowing your practice and defining acceptable levels of reimbursement and risk. Legally, there are a number of common themes or issues relevant to all managed care contracts, including primary care vs. specialist contracts, services offered, program policies and procedures, utilization review, physician reimbursement and compensation, payment schedule, terms and conditions, term and termination, continuation of care requirements, indemnification, amendment of contract and program policies, and stop-loss insurance. Actuarial issues include membership, geography, age-gender distribution, degree of health care management, local managed care utilization levels, historical utilization levels, health plan benefit design, among others.
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Atar, Dan; Bode, Christoph; Stuerzenbecher, André; Verheugt, Freek W A
2014-01-01
The impact of an acute coronary syndrome (ACS) event, such as an acute myocardial infarction (MI), is not limited to the acute management phase; patients face an elevated risk of residual atherothrombotic events that commonly requires chronic management for months or even years. Significant advances have been made in both the acute and chronic management of patients with acute MI over the past decade, resulting in improved prognoses. One of the hallmarks of modern treatment strategies is more aggressive antiplatelet treatment regimens. However, the risks of further ACS events, stroke and premature death remain elevated in these patients, and addressing this residual risk is challenging owing to interpatient variability, differences in management strategies between centres and countries, incomplete understanding of the specific pathophysiology of post-ACS thrombosis and limitations of current therapeutic approaches. The recent approval in Europe of the direct oral anticoagulant rivaroxaban for use in this setting in combination with clopidogrel and acetylsalicylic acid offers another strategy to consider in the management of these patients, and clinical strategies in this area continue to evolve. In this review, we chart the progress made over the past decade in reducing the burden of secondary thromboembolic events after acute MI and discuss the current position of and future perspectives on the inclusion of oral anticoagulants into care pathways in this setting. PMID:24494730
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The Evidential Basis of Decision Making in Plant Disease Management.
Hughes, Gareth
2017-08-04
The evidential basis for disease management decision making is provided by data relating to risk factors. The decision process involves an assessment of the evidence leading to taking (or refraining from) action on the basis of a prediction. The primary objective of the decision process is to identify-at the time the decision is made-the control action that provides the best predicted end-of-season outcome, calculated in terms of revenue or another appropriate metric. Data relating to disease risk factors may take a variety of forms (e.g., continuous, discrete, categorical) on measurement scales in a variety of units. Log 10 -likelihood ratios provide a principled basis for the accumulation of evidence based on such data and allow predictions to be made via Bayesian updating of prior probabilities.
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Floodplain conflicts: regulation and negotiation
NASA Astrophysics Data System (ADS)
Pardoe, J.; Penning-Rowsell, E.; Tunstall, S.
2011-10-01
In the continuing shift from engineered solutions towards more holistic methods of managing flood risk, spatial planning has become the primary focus of a conflict between land and water, water and people. In attempting to strike a balance between making space for water and making space for people, compromises are required. Through five case studies in the UK, this paper analyses the effectiveness of Planning Policy Statement 25 (PPS 25) and the processes of negotiation that it promotes. This assessment allows us to draw conclusions on the nature of the compromises this kind of negotiation can achieve and the implications of this for flood risk management. What emerges is that the beneficial impacts of decisions to develop floodplain areas are given a proper hearing and sensible conditions imposed, rather than arguments to prevent such development remaining unchallenged.
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Planning for and surviving a BCM audit.
Freestone, Mandy; Lee, Michael
2008-01-01
Business continuity management (BCM) is moving progressively higher up the agendas of boardroom executives due to growing regulator, insurer and investor interest in risk management and BCM activity. With increasing pressure across all sectors, BCM has become an integral part of any effective corporate governance framework. Boardroom executives and senior management are thus now expected to provide an appropriate level of business continuity preparedness to better protect shareholder, investor and other stakeholder interests. The purpose of this paper is to build a link across the 'chasm' that separates the auditee from the auditor. The paper attempts to illuminate understanding about the process undertaken by an auditor when reviewing the BCM process. It details the steps the BCM auditor typically undertakes, and provides practical guidance as to the types of documentation and other supporting evidence required during the process. Additionally, the paper attempts to dispel commonly-held misconceptions about the BCM audit process. Executives, senior management and BCM practitioners will all benefit from the practical guidance offered in this paper, to assist in planning for and surviving a BCM audit.
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Martínez-Pérez, Carlos; Turnbull, Arran K; Ekatah, Gregory E; Arthur, Laura M; Sims, Andrew H; Thomas, Jeremy S; Dixon, J Michael
2017-04-01
Ductal carcinoma in situ (DCIS) of the breast represents a group of heterogeneous non-invasive lesions the incidence of which has risen dramatically since the advent of mammography screening. In this review we summarise current treatment trends and up-to-date results from clinical trials studying surgery and adjuvant therapy alternatives, including the recent consensus on excision margin width and its role in decision-making for post-excision radiotherapy. The main challenge in the clinical management of DCIS continues to be the tailoring of treatment to individual risk, in order to avoid the over-treatment of low-risk lesions or under-treatment of DCIS with higher risk of recurring or progressing into invasion. While studies estimate that only about 40% of DCIS would become invasive if untreated, heterogeneity and complex natural history have prevented adequate identification of these higher-risk lesions. Here we discuss attempts to develop prognostic tools for the risk stratification of DCIS lesions and their limitations. Early results of a UK-wide audit of DCIS management (the Sloane Project) have also demonstrated a lack of consistency in treatment. In this review we offer up-to-date perspectives on current treatment and prediction of DCIS, highlighting the pressing clinical need for better prognostic indices. Tools integrating both clinical and histopathological factors together with molecular biomarkers may hold potential for adequate stratification of DCIS according to risk. This could help develop standardised practices for optimal management of patients with DCIS, improving clinical outcomes while providing only the amount of therapy required for each individual patient. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Time to incorporate germline multigene panel testing into breast and ovarian cancer patient care.
Graffeo, Rossella; Livraghi, Luca; Pagani, Olivia; Goldhirsch, Aron; Partridge, Ann H; Garber, Judy E
2016-12-01
Genetic evaluation is increasingly becoming an integral part of the management of women with newly diagnosed breast and ovarian cancer (OC), and of individuals at high risk for these diseases. Genetic counseling and testing have been incorporated into oncological care to help and complete management and treatment strategies. Risk assessment and early detection strategies in individuals with BRCA1/2 mutations and with Lynch syndrome have been quite extensively studied, whereas much less is known about the management of mutation carriers with less common high-penetrance cancer susceptibility genes (PTEN, TP53, STK11, CDH1), and particularly those who carry mutations in moderate-penetrance genes (e.g., PALB2, CHEK2, ATM, NF1, RAD51C, RAD51D, BRIP1). The latter patient groups represent important ongoing research opportunities to enable informed counseling about appropriate clinical management. We summarize the current guidelines for the management of high and moderate-penetrance mutations for breast and OC susceptibility. Continuous updating of guidelines for proper clinical management of these individuals is ongoing because of rapid advances in technology and knowledge in this field. Thus, we exhort the use of multigene panels for the assessment of cancer risk beyond the classic predisposition syndromes as a new standard of care in cancer genetics. We further support an increase of genetic counselors in Europe and use of their expertise to support genetic testing in specialist multidisciplinary teams.
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Recurrent urinary tract infections in women.
Aydin, Abdullatif; Ahmed, Kamran; Zaman, Iftikhar; Khan, Muhammad Shamim; Dasgupta, Prokar
2015-06-01
Recurrent urinary tract infections (UTIs) are more common in women and are frequently defined as ≥2 episodes in the last 6 months or ≥3 episodes in the last 12 months. In a primary care setting, 53 % of women above the age of 55 years and 36 % of younger women report a recurrence within 1 year. Thus, management and prevention of recurrent UTI is of utmost significance. This review aims to highlight the latest research in prevention strategies and suggest a management pathway. A search was conducted on MEDLINE, Embase and the Cochrane Database of Systematic Reviews databases for the latest systematic reviews and high-quality randomized controlled trials. Special emphasis was placed on the remit "recurrent" and strongly adhered to. Furthermore, a Google search was conducted for current guidelines on the management of UTIs. Current prevention strategies include eliminating risk factors that increase the risk of acquiring recurrent UTI and continuous, post-coital and self-initiated antimicrobial prophylaxis. Other prospective preventative strategies, currently under trial, include use of vaccinations, D-mannose and lactobacillus (probiotics). Although risk factors should be identified and addressed accordingly, individualized antibiotic prophylaxis remains the most effective method of management. Non-antibiotic prevention strategies such as cranberry, vitamin C and methenamine salts lack strong evidence to be introduced as routine management options and as alternatives to antibiotics. Based on current evidence and guidelines, a management pathway is recommended. Emerging therapies require further evaluation before they can be recommended.
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The Global Nonalcoholic Fatty Liver Disease Epidemic: What a Radiologist Needs to Know
Pereira, Keith; Salsamendi, Jason; Casillas, Javier
2015-01-01
Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of disorders from a benign steatosis to hepatocellular carcinoma (HCC). Metabolic syndrome, mainly obesity, plays an important role, both as an independent risk factor and in the pathogenesis of NAFLD. With the progressive epidemics of obesity and diabetes mellitus, the prevalence of NAFLD and its associated complications is expected to increase dramatically. Therapeutic strategies for treating NAFLD and metabolic syndrome, particularly obesity, are continuously being refined. Their goal is the prevention of NAFLD by the management of risk factors, prevention of progression of the disease, as well as management of complications, ultimately preventing morbidity and mortality. Optimal management of NAFLD and metabolic syndrome requires a multidisciplinary collaboration between the government as well as the health system including the nutritionist, primary care physician, radiologist, hepatologist, oncologist, and transplant surgeon. An awareness of the clinical presentation, risk factors, pathogenesis, diagnosis, and management is of paramount importance to a radiologist, both from the clinical perspective as well as from the imaging standpoint. With expertise in imaging modalities as well as minimally invasive percutaneous endovascular therapies, radiologists play an essential role in the comprehensive management, which is highlighted in this article, with cases from our practice. We also briefly discuss transarterial embolization of the left gastric artery (LGA), a novel method that promises to have an enormous potential in the minimally invasive management of obesity, with details of a case from our practice. PMID:26167390
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Is risk assessment the new clinical model in public mental health?
Holmes, Alex
2013-12-01
Australian public mental health services have seen a rapid adoption of risk assessment into clinical practice over the past decade. It is timely to review the role of risk assessment in clinical practice, evidence for its validity and to explore its role in clinical decision-making. There is little evidence to support the current form of risk assessment used in public mental health. The continued focus in risk may lead public psychiatrists into a bind where their specialist role is defined by a capacity that they do not fully possess. Further work is required to find ways of demonstrating our attention to the possibility of adverse outcomes whilst maintaining our skills and capacity to manage mental illness with complexity and balance within the limitations of rational decision-making.
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Nemeth, Endre; Szigeti, Szabolcs; Varga, Tamas; Daroczi, Laszlo; Barati, Zoltan; Merkely, Bela; Gal, Janos
2018-05-01
The acute surgical treatment of infective endocarditis (IE) carries a high risk of postoperative mortality. Most complications are linked to uncontrolled sepsis and inflammatory processes. Cytokine haemoadsorption is an extracorporeal technique which has benefits reported in haemodynamic stability and inflammatory response. A 46-year-old male patient underwent emergency cardiac surgery due to progressive IE. Postcardiotomy cardiogenic shock associated with cardiac surgery required the implantation of venoarterial (VA)-ECMO. Three days later, the patient developed secondary septic shock. The novel application of continuous CytoSorb TM treatment installed in the VA-ECMO circuit is demonstrated in this case during the management of simultaneous shocks. Advanced intensive care led to an improvement in the patient's condition, which facilitated successful weaning from mechanical ventilation. However, the patient died from a new onset fulminant septic shock two months after his initial cardiac surgery. VA-ECMO is suitable for installation of the CytoSorb TM cartridge. This modality could be an option for high-volume, continuous cytokine haemoadsorption when VA-ECMO is employed without renal replacement therapy. This specific application of CytoSorb TM was safe, feasible and contributed to the optimal management of simultaneous shocks.
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Monitoring injury in the New Zealand adventure tourism sector: an operator survey.
Bentley, Tim A; Page, Stephen; Edwards, Joanna
2008-01-01
Client safety is a major risk management concern for the commercial adventure tourism sector in New Zealand. This study built on previous exploratory analyses of New Zealand adventure tourism safety, including industry surveys conducted by these authors in 1999 and 2003. The aims of the study were to provide a continuation of injury monitoring across the sector through data collected from self-reported injury incidence by industry operators and to compare findings with those from other primary and secondary research studies conducted by the authors. A postal questionnaire was used to survey all identifiable New Zealand adventure tourism operators during 2006. The questionnaire asked respondents about their recorded client injury experience, perceptions of client injury risk factors, and safety management practices. Some 21 adventure tourism activities were represented among the responding sample (n = 127), with most operations being very small in terms of staff numbers, although responding operators catered to nearly 1 million clients in total annually. Highest ranked risk factors for client injury included clients not following instructions; level of client skill, ability, and fitness; and changeable/unpredictable weather conditions. Highest client injury was reported for horse riding, ecotourism, and white water rafting sectors, although serious underreporting of minor injuries was evidenced across the sector. Slips, trips, and falls were the most frequently reported injury mechanism, while safety management measures were inconsistently applied across the sector. The industry should address reporting culture issues and safety management practices generally. Specifically, the industry should consider risk management that focuses on minor (eg, falls) as well as catastrophic events.
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Integrating human health and ecological concerns in risk assessments.
Cirone, P A; Bruce Duncan, P
2000-11-03
The interconnections between ecosystems, human health and welfare have been increasingly recognized by the US government, academia, and the public. This paper continues this theme by addressing the use of risk assessment to integrate people into a single assessment. In a broad overview of the risk assessment process we stress the need to build a conceptual model of the whole system including multiple species (humans and other ecological entities), stressors, and cumulative effects. We also propose converging landscape ecology and evaluation of ecosystem services with risk assessment to address these cumulative responses. We first look at how this integration can occur within the problem formulation step in risk assessment where the system is defined, a conceptual model created, a subset of components and functions selected, and the analytical framework decided in a context that includes the management decisions. A variety of examples of problem formulations (salmon, wild insects, hyporheic ecosystems, ultraviolet (UV) radiation, nitrogen fertilization, toxic chemicals, and oil spills) are presented to illustrate how treating humans as components of the landscape can add value to risk assessments. We conclude that the risk assessment process should help address the urgent needs of society in proportion to importance, to provide a format to communicate knowledge and understanding, and to inform policy and management decisions.
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The adoption of IT security standards in a healthcare environment.
Gomes, Rui; Lapão, Luís Velez
2008-01-01
Security is a vital part of daily life to Hospitals that need to ensure that the information is adequately secured. In Portugal, more CIOs are seeking that their hospital IS departments are properly protecting information assets from security threats. It is imperative to take necessary measures to ensure risk management and business continuity. Security management certification provides just such a guarantee, increasing patient and partner confidence. This paper introduces one best practice for implementing four security controls in a hospital datacenter infrastructure (ISO27002), and describes the security assessment for implementing such controls.
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Multi-hazard risk analysis for management strategies
NASA Astrophysics Data System (ADS)
Kappes, M.; Keiler, M.; Bell, R.; Glade, T.
2009-04-01
Risk management is very often operating in a reactive way, responding to an event, instead of proactive starting with risk analysis and building up the whole process of risk evaluation, prevention, event management and regeneration. Since damage and losses from natural hazards raise continuously more and more studies, concepts (e.g. Switzerland or South Tyrol-Bolozano) and software packages (e.g. ARMAGEDOM, HAZUS or RiskScape) are developed to guide, standardize and facilitate the risk analysis. But these approaches focus on different aspects and are mostly closely adapted to the situation (legislation, organization of the administration, specific processes etc.) of the specific country or region. We propose in this study the development of a flexible methodology for multi-hazard risk analysis, identifying the stakeholders and their needs, processes and their characteristics, modeling approaches as well as incoherencies occurring by combining all these different aspects. Based on this concept a flexible software package will be established consisting of ArcGIS as central base and being complemented by various modules for hazard modeling, vulnerability assessment and risk calculation. Not all modules will be developed newly but taken from the current state-of-the-art and connected or integrated into ArcGIS. For this purpose two study sites, Valtellina in Italy and Bacelonnette in France, were chosen and the hazards types debris flows, rockfalls, landslides, avalanches and floods are planned to be included in the tool for a regional multi-hazard risk analysis. Since the central idea of this tool is its flexibility this will only be a first step, in the future further processes and scales can be included and the instrument thus adapted to any study site.
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De Belvis, Antonio Giulio; Specchia, Maria Lucia; Ferriero, Anna Maria; Capizzi, Silvio
2017-01-01
Risk management is a key tool in Clinical Governance. Our project aimed to define, share, apply and measure the impact of tools and methodologies for the continuous improvement of quality of care, especially in relation to the multi-disciplinary and integrated management of the hyperglycemic patient in hospital settings. A training project, coordinated by a scientific board of experts in diabetes and health management and an Expert Meeting with representatives of all the participating centers was launched in 2014. The project involved eight hospitals through the organization of meetings with five managers and 25 speakers, including diabetologists, internists, pharmacists and nurses. The analysis showed a wide variability in the adoption of tools and processes towards a comprehensive and coordinated management of hyperglycemic patients.
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Steinhaus, David; Reynolds, Dwight W; Gadler, Fredrik; Kay, G Neal; Hess, Mike F; Bennett, Tom
2005-08-01
Management of congestive heart failure is a serious public health problem. The use of implantable hemodynamic monitors (IHMs) may assist in this management by providing continuous ambulatory filling pressure status for optimal volume management. The Chronicle system includes an implanted monitor, a pressure sensor lead with passive fixation, an external pressure reference (EPR), and data retrieval and viewing components. The tip of the lead is placed near the right ventricular outflow tract to minimize risk of sensor tissue encapsulation. Implant technique and lead placement is similar to that of a permanent pacemaker. After the system had been successfully implanted in 148 patients, the type and frequency of implant-related adverse events were similar to a single-chamber pacemaker implant. R-wave amplitude was 15.2 +/- 6.7 mV and the pressure waveform signal was acceptable in all but two patients in whom presence of artifacts required lead repositioning. Implant procedure time was not influenced by experience, remaining constant throughout the study. Based on this evaluation, permanent placement of an IHM in symptomatic heart failure patients is technically feasible. Further investigation is warranted to evaluate the use of the continuous hemodynamic data in management of heart failure patients.
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Brewster, L; Tarrant, C; Dixon-Woods, M
2016-09-01
Centrally led performance management regimes using standard setting, monitoring, and incentives have become a prominent feature of infection prevention and control (IPC) in health systems. To characterize views and experiences of regulation and performance management relating to IPC in English hospitals. Two qualitative datasets containing 139 interviews with healthcare workers and managers were analysed. Data directly relevant to performance management and IPC were extracted. Data analysis was based on the constant comparative method. Participants reported that performance management regimes had mobilized action around specific infections. The benefits of establishing organizational structures of accountability were seen in empirical evidence of decreasing infection rates. Performance management was not, however, experienced as wholly benign, and setting targets in one area was seen to involve risks of 'tunnel vision' and the marginalization of other potentially important issues. Financial sanctions were viewed especially negatively; performance management was associated with risks of creating a culture of fearfulness, suppressing learning and disrupting inter-professional relationships. Centrally led performance management may have some important roles in IPC, but identifying where it is appropriate and determining its limits is critical. Persisting with harsh regimes may affect relationships and increase resistance to continued improvement efforts, but leaving all improvement to local teams may also be a flawed strategy. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Cameron, Kenneth L; Owens, Brett D
2014-10-01
Military service members comprise a young and physically active population who are at increased risk for musculoskeletal injuries and conditions related to sports and physical training. Even during times of war, musculoskeletal injuries and conditions related to sports and physical training, not associated with combat, are the leading cause of medical evacuation from theater. As a result, these injuries significantly compromise military readiness, and they can lead to an increased risk for reinjury and long-term disability among military service members. Regardless of the mechanism of injury, the large volume and types of musculoskeletal injuries and conditions that affect soldiers are similar to those that are commonly seen and treated in sports medicine clinics and practices. Recently, the US Marine Corps, Navy, and Army have recognized the value of the sports medicine model of care to improve the access, efficiency, and effectiveness of care for solders who experience musculoskeletal injuries related to sports and training. A highly skilled sports medicine team of providers and allied health care professionals (eg, athletic trainers, physical therapists), with expertise in the prevention, assessment, diagnosis, and management of musculoskeletal injuries and conditions, will continue to be an integral cog in the effective management of these types of injuries into the future, as the sports medicine model continues to expand across the military health system. Published by Elsevier Inc.
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Hussain, Syed R; Macaluso, Andrea; Pearson, Stephen J
Moderate-intensity continuous training (MICT) has long been considered the most effective exercise treatment modality for the prevention and management of cardiovascular disease (CVD), but more recently high-intensity interval training (HIIT) has been viewed as a potential alternative to MICT in accruing such benefits. HIIT was initially found to induce significant improvements in numerous physiological and health-related indices, to a similar if not superior extent to MICT. Since then, many studies have attempted to explore the potential clinical utility of HIIT, relative to MICT, with respect to treating numerous cardiovascular conditions, such as coronary artery disease, heart failure, stroke, and hypertension. Despite this, however, the efficacy of HIIT in reversing the specific symptoms and risk factors of these cardiovascular pathologies is not well understood. HIIT is often perceived as very strenuous, which could render it unsafe for those at risk of or afflicted with CVD, but these issues are also yet to be reviewed. Furthermore, the optimal HIIT protocol for each of the CVD cohorts has not been established. Thus, the purpose of this review article is to (1) evaluate the efficacy of HIIT relative to MICT in the prevention and management of cardiovascular conditions, and (2) explore any potential safety issues surrounding the suitability and/or tolerability of HIIT for patients with CVD, and the potential optimal prescriptive variables of HIIT for application in the clinical environment.
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Jan, Saber; Northington, Frances J; Parkinson, Charlamaine M; Stafstrom, Carl E
2017-01-01
Electroencephalogram (EEG) monitoring techniques for neonatal hypoxia-ischemia (HI) are evolving over time, and the specific type of EEG utilized could influence seizure diagnosis and management. We examined whether the type of EEG performed affected seizure treatment decisions (e.g., the choice and number of antiseizure drugs [ASDs]) in therapeutic hypothermia-treated neonates with HI from 2007 to 2015 in the Johns Hopkins Hospital Neonatal Intensive Care Unit. During this period, 3 different EEG monitoring protocols were utilized: Period 1 (2007-2009), single, brief conventional EEG (1 h duration) at a variable time during therapeutic hypothermia treatment, i.e., ordered when a seizure was suspected; Period 2 (2009-2013), single, brief conventional EEG followed by amplitude-integrated EEG for the duration of therapeutic hypothermia treatment and another brief conventional EEG after rewarming; and Period 3 (2014-2015), continuous video-EEG (cEEG) for the duration of therapeutic hypothermia treatment (72 h) plus for an additional 12 h during and after rewarming. One hundred and sixty-two newborns were included in this retrospective cohort study. As a function of the type and duration of EEG monitoring, we assessed the risk (likelihood) of receiving no ASD, at least 1 ASD, or ≥2 ASDs. We found that the risk of a neonate being prescribed an ASD was 46% less during Period 3 (cEEG) than during Period 1 (brief conventional EEG only) (95% CI 6-69%, p = 0.03). After adjusting for initial EEG and MRI results, compared with Period 1, there was a 38% lower risk of receiving an ASD during Period 2 (95% CI: 9-58%, p = 0.02) and a 67% lower risk during Period 3 (95% CI: 23-86%, p = 0.01). The risk ratio of receiving ≥2 ASDs was not significantly different across the 3 periods. In conclusion, in addition to the higher sensitivity and specificity of continuous video-EEG monitoring, fewer infants are prescribed an ASD when undergoing continuous forms of EEG monitoring (aEEG or cEEG) than those receiving conventional EEG. We recommend that use of continuous video-EEG be considered whenever possible, both to treat seizures more specifically and to avoid overtreatment. © 2017 S. Karger AG, Basel.
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The Value of Risk Pooling for Mitigating Water Utility Financial Risks Arising From Water Scarcity
NASA Astrophysics Data System (ADS)
Baum, R.; Characklis, G. W.; Hughes, J.; Eskaf, S.
2015-12-01
Water utilities across the United States face growing supply risks as demand growth and extreme weather events make water scarcity more common. As it has become more difficult and expensive to build new supply capacity to accommodate these events, many utility managers respond by either imposing conservation measures, which reduces revenues, or acquiring additional water from other sources, which increases costs. These actions lead to changing financial trends that are difficult to predict and that utilities are currently ill-equipped to manage. As a result, adaptation strategies and tools are being developed to reduce utility vulnerabilities, ensuring both financial stability and continued access to low cost financing, a critical consideration for a capital intensive industry. Previous work in this area has involved the development of utility specific financial hedging tools. However, the time and informational requirements associated with developing these individualized strategies may be a limiting factor for widespread implementation. The objective of this research is to develop more generalized hedging instruments that can be applied simultaneously to multiple utilities across the United States, thereby increasing the potential for widespread implementation. This work first analyzes the financial risks of water scarcity for a large set of water utilities across the country and then proposes a financial hedging solution to mitigate these risks through hydrologic index-based financial insurance. Results provide insights into the most effective indices, the potential for risk pooling to reduce insurance costs, and the performance of these contracts in managing utility financial risk arising from drought.
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Rosenbaum, Sara; Mauery, D Richard; Teitelbaum, Joel; Vandivort-Warren, Rita
2002-02-01
To analyze the scope, content, and nature of contracts between managed care organizations (MCOs) and community-based mental illness and addiction disorder treatment and prevention service providers, focusing on implications for managed care policy. Qualitative and quantitative document content analysis. We reviewed and coded 107 provider contracts from 17 states. Data were aggregated on MCO and provider demographics, scope of services, contractual obligations, and financial reimbursement mechanisms. Results were compared with those from a similar study conducted in 1996 with a sample of 50 contracts to identify changes over time. The MCOs purchased relatively few services from providers, omitting many services integral to the proper management of mental illness and addiction disorders. Service duties were often ambiguously described, leading to potentially significant and unanticipated financial risk for providers. The MCOs exert strong control over treatment decision making. Capitation and other risk-based payment arrangements are increasingly common, although most continue to use fee-for-service reimbursement methods. Contracts are structured to remove provider bargaining power; they allow MCOs to unilaterally amend all provisions on notice and without negotiation and permit termination "at will." Managed care contracts favor the needs of the managed care industry and are constructed to (1) shift significant amounts of financial risk onto providers and (2) manage and restrain providers' choices over the use of benefits through close oversight, financial controls, and incentives. Because a signed contract is a precondition to access to patients and insurance revenues, health professionals must sign them and indicate a general inability to negotiate their terms.
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A Value Measure for Public-Sector Enterprise Risk Management: A TSA Case Study.
Fletcher, Kenneth C; Abbas, Ali E
2018-05-01
This article presents a public value measure that can be used to aid executives in the public sector to better assess policy decisions and maximize value to the American people. Using Transportation Security Administration (TSA) programs as an example, we first identify the basic components of public value. We then propose a public value account to quantify the outcomes of various risk scenarios, and we determine the certain equivalent of several important TSA programs. We illustrate how this proposed measure can quantify the effects of two main challenges that government organizations face when conducting enterprise risk management: (1) short-term versus long-term incentives and (2) avoiding potential negative consequences even if they occur with low probability. Finally, we illustrate how this measure enables the use of various tools from decision analysis to be applied in government settings, such as stochastic dominance arguments and certain equivalent calculations. Regarding the TSA case study, our analysis demonstrates the value of continued expansion of the TSA trusted traveler initiative and increasing the background vetting for passengers who are afforded expedited security screening. © 2017 Society for Risk Analysis.
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Nakamura, Sho; Narimatsu, Hiroto; Ito Sasahara, Yuriko; Sho, Ri; Kawasaki, Ryo; Yamashita, Hidetoshi; Kubota, Isao; Ueno, Yoshiyuki; Kato, Takeo; Yoshioka, Takashi; Fukao, Akira; Kayama, Takamasa
2015-11-01
The number of cancer survivors is increasing; however, optimal health management of cancer survivors remains unclear due to limited knowledge. To elucidate the risk of non-communicable diseases, and the effect of lifestyle habits on risk of non-communicable diseases, we compared cancer survivors and those who never had cancer (non-cancer controls) using a population-based prospective cohort study. The baseline survey of 2292 participants was carried out from 2004 to 2006, and the follow-up survey of 2124 participants was carried out in 2011. We compared the baseline characteristics and the risk of non-communicable diseases between cancer survivors and non-cancer controls. Analyzed participants included 124 cancer survivors (men/women, 57/67), and 2168 non-cancer controls (939/1229). Several lifestyle factors and nutritional intake significantly differed between survivors and non-cancer controls, although smoking status did not differ between the groups (P = 0.30). Univariate logistic regression analysis showed increased risk of death (odds ratio [OR], 3.64; 95% confidence interval [CI], 2.19-6.05) and heart disease (OR, 2.60; 95% CI, 1.06-6.39) in cancer survivors. Increased risk of heart disease was also significant (OR, 2.95; 95% CI, 1.05-8.26; P = 0.04) in the multivariate analysis of the smoking-related cancer subgroup. Current smoking significantly increased risk of death (OR, 2.42; 95% CI, 1.13-5.18). Specific management should be implemented for cancer survivors. More intense management against smoking is necessary, as continued smoking in cancer survivors may increase the risk of second primary cancer. Moreover, cancer survivors are at a high risk of heart disease; thus, additional care should be taken. © 2015 The Authors. Cancer Science published by Wiley Publishing Asia Pty Ltd on behalf of Japanese Cancer Association.
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Guo, Da; Cao, Xue-Wei; Liu, Jin-Wen; Ouyang, Wen-Wei; Pan, Jian-Ke; Liu, Jun
2014-06-23
Postoperative pain control after total knee arthroplasty (TKA) remains a great challenge. The management of pain in the immediate postoperative period is one of the most critical aspects to allow speedier rehabilitation and reduce the risk of postoperative complications. Recently, periarticular infiltration anesthesia has become popular, but the outcome is controversial. Some studies have shown transient effects, "rebound pain", or no effectiveness in pain control. Continuous intra-articular infusion technique has been introduced to improve these transient effects, but more clinical studies are needed. Furthermore, the potential risk of early periprosthetic joint infection is causing concerning. We plan to compare continuous intra-articular infusion anesthesia with epidural infusion anesthesia after TKA to assess the effectiveness of this technique in reducing pain, in improving postoperative function, and to look at the evidence for risk of early infection. This trial is a randomized, controlled study. Patients (n = 214) will be randomized into two groups: to receive continuous intra-articular infusion anesthesia (group C); and epidural infusion anesthesia (group E). For the first 3 postoperative days, pain at rest, active range of motion (A-ROM), rescue analgesia and side effects will be recorded. At 3-month and 6-month follow-up, A-ROM, C-reactive protein, erythrocyte sedimentation rate, and synovial fluid cell count and culture will be analyzed. The results from this study will provide clinical evidence on the efficacy of a continuous intra-articular infusion technique in reducing pain, postoperative functional improvement and safety. It will be the first randomized controlled trial to investigate infection risk with local anesthesia after TKA. ClinicalTrials.gov identifier: ChiCTR-TRC-13003999.
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Joyner, JaNae; Moore, Michael A.; Simmons, Debra R.; Forrest, Brian; Yu-Isenberg, Kristina; Piccione, Ron; Caton, Kirt; Lackland, Daniel T.; Ferrario, Carlos M.
2016-01-01
Introduction The Consortium for Southeastern Hypertension Control (COSEHC) implemented a study to assess benefits of a performance improvement continuing medical education (PI CME) activity focused on cardiometabolic risk factor management in primary care patients. Methods Using the plan-do-study-act (PDSA) model as the foundation, this PI CME activity aimed at improving practice gaps by integrating evidence-based clinical interventions, physician-patient education, processes of care, performance metrics, and patient outcomes. The PI CME intervention was implemented in a group of South Carolina physician practices, while a comparable physician practice group served as a control. Performance outcomes at 6 months included changes in patients’ cardiometabolic risk factor values and control rates from baseline. We also compared changes in diabetic, African American, the elderly (> 65 years), and female patient subpopulations and in patients with uncontrolled risk factors at baseline. Results Only women receiving health care by intervention physicians showed a statistical improvement in their cardiometabolic risk factors as evidenced by a −3.0 mg/dL and a −3.5 mg/dL decrease in mean LDL cholesterol and non-HDL cholesterol, respectively, and a −7.0 mg/dL decrease in LDL cholesterol among females with uncontrolled baseline LDL cholesterol values. No other statistical differences were found. Discussion These data demonstrate that our PI CME activity is a useful strategy in assisting physicians to improve their management of cardiometabolic control rates in female patients with abnormal cholesterol control. Other studies that extend across longer PI CME PDSA periods may be needed to demonstrate statistical improvements in overall cardiometabolic treatment goals in men, women, and various subpopulations. PMID:24648361
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Zijp, Michiel C; Posthuma, Leo; Wintersen, Arjen; Devilee, Jeroen; Swartjes, Frank A
2016-05-01
This paper introduces Solution-focused Sustainability Assessment (SfSA), provides practical guidance formatted as a versatile process framework, and illustrates its utility for solving a wicked environmental management problem. Society faces complex and increasingly wicked environmental problems for which sustainable solutions are sought. Wicked problems are multi-faceted, and deriving of a management solution requires an approach that is participative, iterative, innovative, and transparent in its definition of sustainability and translation to sustainability metrics. We suggest to add the use of a solution-focused approach. The SfSA framework is collated from elements from risk assessment, risk governance, adaptive management and sustainability assessment frameworks, expanded with the 'solution-focused' paradigm as recently proposed in the context of risk assessment. The main innovation of this approach is the broad exploration of solutions upfront in assessment projects. The case study concerns the sustainable management of slightly contaminated sediments continuously formed in ditches in rural, agricultural areas. This problem is wicked, as disposal of contaminated sediment on adjacent land is potentially hazardous to humans, ecosystems and agricultural products. Non-removal would however reduce drainage capacity followed by increased risks of flooding, while contaminated sediment removal followed by offsite treatment implies high budget costs and soil subsidence. Application of the steps in the SfSA-framework served in solving this problem. Important elements were early exploration of a wide 'solution-space', stakeholder involvement from the onset of the assessment, clear agreements on the risk and sustainability metrics of the problem and on the interpretation and decision procedures, and adaptive management. Application of the key elements of the SfSA approach eventually resulted in adoption of a novel sediment management policy. The stakeholder participation and the intensive communication throughout the project resulted in broad support for both the scientific approaches and results, as well as for policy implementation. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Bishop, Lisa; Young, Stephanie; Twells, Laurie; Dillon, Carla; Hawboldt, John
2015-06-09
A pharmacist managed anticoagulation service was initiated in a multi-physician family medicine clinic in December 2006. In order to determine the patient and physician satisfaction with the service, a study was designed to describe the patients' satisfaction with the warfarin education and management they received from the pharmacist, and to describe the physicians' satisfaction with the level of care provided by the pharmacist for patients taking warfarin. A self-administered survey was completed by both eligible patients receiving warfarin and physicians prescribing warfarin between December 2006 and May 2008. The patient survey collected information on patient demographics, satisfaction with warfarin education and daily warfarin management. The physician survey collected data about the satisfaction with patient education and daily anticoagulation management by the pharmacist. Seventy-six of 94 (81%) patients completed the survey. Fifty-nine percent were male with a mean age of 65 years (range 24-90). Ninety-six percent agreed/strongly agreed the pharmacist did a good job teaching the importance of warfarin adherence, the necessity of INR testing and the risks of bleeding. Eighty-five percent agreed/strongly agreed the risk of blood clots was well explained, 79% felt the pharmacist did a good job teaching about dietary considerations and 77% agreed/strongly agreed the pharmacist explained when to see a doctor. All patients felt the pharmacist gave clear instructions on warfarin dosing and INR testing. Four of nine physicians (44%) completed the survey. All agreed/strongly agreed the pharmacist was competent in the care provided, were confident in the care their patients received, would like the pharmacist to continue the service, and would recommend this program to other clinics. Patients and family physicians were satisfied with the pharmacist managed anticoagulation program and recommended continuation of the program. These results support the role of the pharmacist in the management of anticoagulation in a multi-physician family medicine clinic.
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Pregnancy and contraception in systemic and cutaneous lupus erythematosus.
Guettrot-Imbert, G; Morel, N; Le Guern, V; Plu-Bureau, G; Frances, C; Costedoat-Chalumeau, N
2016-10-01
A causal link has long been described between estrogen and systemic lupus erythematosus activity. Contraceptive and pregnancy management is now common for lupus patients, but pregnancy continues to be associated with higher maternal and fetal mortality/morbidity in systemic lupus erythematosus patients than among the general population. Potential complications include lupus flares, obstetric complications (fetal loss, in utero growth retardation, premature birth) and neonatal lupus syndrome. Association with antiphospholipid antibodies or antiphospholipid syndrome increases the risk of obstetric complications. Anti-SSA and/or anti-SSB antibodies put fetuses at risk for neonatal lupus. Improving the outcome of such pregnancies depends upon optimal systematic planning of pregnancy at a preconception counseling visit coupled with a multidisciplinary approach. Absence of lupus activity, use of appropriate medication during pregnancy based on the patient's medical history and risk factors, and regular monitoring constitute the best tools for achieving a favorable outcome in such high-risk pregnancies. The aim of this review is to provide an update on the management of contraception and pregnancy in systemic lupus erythematosus, cutaneous lupus and/or antiphospholipid syndrome in order to reduce the risk of complications and to ensure the best maternal and fetal prognosis. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
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Pedercini, Matteo; Movilla Blanco, Santiago; Kopainsky, Birgit
2011-01-01
DDT is considered to be the most cost-effective insecticide for combating malaria. However, it is also the most environmentally persistent and can pose risks to human health when sprayed indoors. Therefore, the use of DDT for vector control remains controversial. In this paper we develop a computer-based simulation model to assess some of the costs and benefits of the continued use of DDT for Indoor Residual Spraying (IRS) versus its rapid phase out. We apply the prototype model to the aggregated sub Saharan African region. For putting the question about the continued use of DDT for IRS versus its rapid phase out into perspective we calculate the same costs and benefits for alternative combinations of integrated vector management interventions. Our simulation results confirm that the current mix of integrated vector management interventions with DDT as the main insecticide is cheaper than the same mix with alternative insecticides when only direct costs are considered. However, combinations with a stronger focus on insecticide-treated bed nets and environmental management show higher levels of cost-effectiveness than interventions with a focus on IRS. Thus, this focus would also allow phasing out DDT in a cost-effective manner. Although a rapid phase out of DDT for IRS is the most expensive of the tested intervention combinations it can have important economic benefits in addition to health and environmental impacts that are difficult to assess in monetary terms. Those economic benefits captured by the model include the avoided risk of losses in agricultural exports. The prototype simulation model illustrates how a computer-based scenario analysis tool can inform debates on malaria control policies in general and on the continued use of DDT for IRS versus its rapid phase out in specific. Simulation models create systematic mechanisms for analyzing alternative interventions and making informed trade offs.
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Pedercini, Matteo; Movilla Blanco, Santiago; Kopainsky, Birgit
2011-01-01
Introduction DDT is considered to be the most cost-effective insecticide for combating malaria. However, it is also the most environmentally persistent and can pose risks to human health when sprayed indoors. Therefore, the use of DDT for vector control remains controversial. Methods In this paper we develop a computer-based simulation model to assess some of the costs and benefits of the continued use of DDT for Indoor Residual Spraying (IRS) versus its rapid phase out. We apply the prototype model to the aggregated sub Saharan African region. For putting the question about the continued use of DDT for IRS versus its rapid phase out into perspective we calculate the same costs and benefits for alternative combinations of integrated vector management interventions. Results Our simulation results confirm that the current mix of integrated vector management interventions with DDT as the main insecticide is cheaper than the same mix with alternative insecticides when only direct costs are considered. However, combinations with a stronger focus on insecticide-treated bed nets and environmental management show higher levels of cost-effectiveness than interventions with a focus on IRS. Thus, this focus would also allow phasing out DDT in a cost-effective manner. Although a rapid phase out of DDT for IRS is the most expensive of the tested intervention combinations it can have important economic benefits in addition to health and environmental impacts that are difficult to assess in monetary terms. Those economic benefits captured by the model include the avoided risk of losses in agricultural exports. Conclusions The prototype simulation model illustrates how a computer-based scenario analysis tool can inform debates on malaria control policies in general and on the continued use of DDT for IRS versus its rapid phase out in specific. Simulation models create systematic mechanisms for analyzing alternative interventions and making informed trade offs. PMID:22140467
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Wen, Zhang; Guo, Ya; Xu, Banghao; Xiao, Kaiyin; Peng, Tao; Peng, Minhao
2016-04-01
Postoperative pancreatic fistula is still a major complication after pancreatic surgery, despite improvements of surgical technique and perioperative management. We sought to systematically review and critically access the conduct and reporting of methods used to develop risk prediction models for predicting postoperative pancreatic fistula. We conducted a systematic search of PubMed and EMBASE databases to identify articles published before January 1, 2015, which described the development of models to predict the risk of postoperative pancreatic fistula. We extracted information of developing a prediction model including study design, sample size and number of events, definition of postoperative pancreatic fistula, risk predictor selection, missing data, model-building strategies, and model performance. Seven studies of developing seven risk prediction models were included. In three studies (42 %), the number of events per variable was less than 10. The number of candidate risk predictors ranged from 9 to 32. Five studies (71 %) reported using univariate screening, which was not recommended in building a multivariate model, to reduce the number of risk predictors. Six risk prediction models (86 %) were developed by categorizing all continuous risk predictors. The treatment and handling of missing data were not mentioned in all studies. We found use of inappropriate methods that could endanger the development of model, including univariate pre-screening of variables, categorization of continuous risk predictors, and model validation. The use of inappropriate methods affects the reliability and the accuracy of the probability estimates of predicting postoperative pancreatic fistula.
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NASA Astrophysics Data System (ADS)
Widodo, L.; Adianto; Sartika, D. I.
2017-12-01
PT. XYZ is a large automotive manufacturing company that manufacture, assemble as well as a car exporter. The other products are spare parts, jig and dies. PT. XYZ has long been implementing the Occupational Safety and Health Management System (OSHMS) to reduce the potential hazards that cause work accidents. However, this does not mean that OSHMS that has been implemented does not need to be upgraded and improved. This is due to the potential danger caused by work is quite high. This research was conducted in Sunter 2 Plant where its production activities have a high level of potential hazard. Based on Hazard Identification risk assessment, Risk Assessment, and Risk Control (HIRARC) found 10 potential hazards in Plant Stamping Production, consisting of 4 very high risk potential hazards (E), 5 high risk potential hazards (H), and 1 moderate risk potential hazard (M). While in Plant Casting Production found 22 potential hazards findings consist of 7 very high risk potential hazards (E), 12 high risk potential hazards (H), and 3 medium risk potential hazards (M). Based on the result of Fault Tree Analysis (FTA), the main priority is the high risk potential hazards (H) and very high risk potential hazards (E). The proposed improvement are to make the visual display of the importance of always using the correct Personal Protective Equipment (PPE), establishing good working procedures, conducting OSH training for workers on a regular basis, and continuing to conduct safety campaigns.
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ERIC Educational Resources Information Center
Lenhardt, Ann Marie C.; Graham, Lemuel W.; Farrell, Melissa L.
2018-01-01
Targeted violence continues to pose a threat to school safety. Reported here are the results of a study of 18 cases of school shooters from 1996 to 2012. Variables examined are individual factors and behaviors, family dynamics, and triggering events. Results indicate the need for expanded school-based mental health services, threat assessment, and…
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Updates in the Management of Hepatocellular Carcinoma
Frenette, Catherine
2011-01-01
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death, and its increasing incidence worldwide is a cause for concern. Fortunately, advances in diagnostic and therapeutic approaches have contributed to earlier detection and treatment. As cancer epidemiology studies continue to elucidate the natural history of liver diseases, greater understanding of HCC has led to improved risk stratification and earlier enrollment of high-risk patients in cancer screening and surveillance programs. Improved survival rates among HCC patients also reflect significant advances in available treatment options. Advances in surgical techniques are pushing the boundaries of resection for localized disease, and progress in the field of transplantation has led to refinements in listing criteria and improved post-transplantation outcomes. The evolving field of locoregional therapies—including percutaneous ablation and transarterial chemoembolization—continues to provide novel therapeutic options that can be used in place of, or in addition to, surgical approaches. Recent advances in systemic multikinase inhibitor therapies have also demonstrated significant benefits for advanced-stage disease, and these therapies also show promise as adjuvant treatments for earlier-stage disease. This article provides an update on the management of HCC, with a focus on revised guidelines for screening and an in-depth discussion of emerging novel therapies. PMID:21346848
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Orui, Masatsugu; Ueda, Yuka; Suzuki, Yuriko; Maeda, Masaharu; Ohira, Tetsuya; Yabe, Hirooki; Yasumura, Seiji
2017-10-24
This longitudinal study aimed to investigate the prevalence of newly-started drinkers and their continuing drinking behaviors after the Great East Japan earthquake. Moreover, the relationships between newly-started drinking and psychological factor, disaster-related experience, and perceived radiation risk were examined. We used data from 37,687 pre-disaster non-drinkers who participated in the 2012 and 2013 surveys conducted in Fukushima. We defined newly-started drinkers as those who did not drink before the disaster but who began drinking after the disaster, based on information collected retrospectively. In 2012, 9.6% of non-drinkers began drinking, of which the prevalence of heavy drinkers was 18.4%. The prevalence of continued drinking among newly-started drinkers in 2013 was 53.8%. Logistic regression analyses revealed post-disaster newly-started drinking was significantly associated with being male, less than 65 years old, sleep dissatisfaction and psychological distress (Kessler 6 ≤ 13) when this model was adjusted for disaster-related experience and perceived radiation risk. Moreover, psychological distress and heavy drinking were significant risk factors for continued drinking among newly-started drinkers. Newly-started drinkers might use alcohol to cope with disaster-related stress. Thus, they may be targeted for disaster-related health services. Moreover, early intervention should encourage responsible drinking, since post-disaster heavy drinkers were likely to continue heavy drinking.
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Managing hyperkalemia in high-risk patients in long-term care.
Kumar, Rajeev; Kanev, Leo; Woods, Steven D; Brenner, Melanie; Smith, Bernie
2017-02-01
Hyperkalemia is common among elderly patients and is associated with an increase in morbidity and mortality. Patients at highest risk for developing hyperkalemia are those with chronic kidney disease (CKD) and heart failure (HF), particularly those on guideline-recommended inhibitors of the renin-angiotensin-aldosterone system (RAAS). Hyperkalemia remains a challenge for clinicians practicing in the long-term care setting as they are often faced with the difficult decision of down-titrating or discontinuing RAAS inhibitors in response to hyperkalemia in the very patients who derive the greatest benefit from these agents. In the past, options to chronically manage hyperkalemia were limited. Patiromer was approved for the treatment of hyperkalemia in 2015 and has been shown to maintain normokalemia for up to 52 weeks in patients with CKD and/or HF on RAAS inhibitors. With the emergence of a new hyperkalemia treatment, there could be a paradigm shift away from the discontinuation of guideline recommended therapies, allowing the continuation of RAAS inhibitor therapy to effectively manage HF symptoms and reduce the risk of rehospitalization in patients with HF, and slow the progression to end-stage renal disease in patients with CKD.
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Snyder, Jamie A; Scherer, Heidi L; Fisher, Bonnie S
2012-01-01
Despite work organizations' attempts to reduce sexual harassment, it continues to be a salient issue for employers across all occupations. Extending social disorganization theory to the work environment, this study examines the relationship between workplace organization, social ties, and sexual harassment victimization. Survey responses to the 2002 and 2006 Quality of Working Life module from the General Social Survey by a sample of 3,530 adult men and women employees in the United States were used. Logistic regression models were estimated for men and women separately to estimate the effect of workplace characteristics on the risk of sexual harassment victimization. Employees who reported poor workplace relations between management and employees and lower coworker social ties were more likely to experience sexual harassment in their work environments. Specific workplace characteristics such as low productivity, poor time management, and inadequate administrative support were significantly related to increased sexual harassment risk. No significant gender differences were found across models suggesting that the predictors of sexual harassment are similar for men and women. This study demonstrates that workplace characteristics are related to sexual harassment risk in the workplace. Suggestions for sexual harassment prevention, including management and organizational strategies, are discussed.
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Federal Register 2010, 2011, 2012, 2013, 2014
2013-11-14
...The Commodity Futures Trading Commission (``Commission'' or ``CFTC'') is adopting new regulations and amending existing regulations to require enhanced customer protections, risk management programs, internal monitoring and controls, capital and liquidity standards, customer disclosures, and auditing and examination programs for futures commission merchants (``FCMs''). The regulations also address certain related issues concerning derivatives clearing organizations (``DCOs'') and chief compliance officers (``CCOs''). The final rules will afford greater assurances to market participants that: Customer segregated funds, secured amount funds, and cleared swaps funds are protected; customers are provided with appropriate notice of the risks of futures trading and of the FCMs with which they may choose to do business; FCMs are monitoring and managing risks in a robust manner; the capital and liquidity of FCMs are strengthened to safeguard their continued operations; and the auditing and examination programs of the Commission and the self- regulatory organizations (``SROs'') are monitoring the activities of FCMs in a prudent and thorough manner.
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Why herd size matters - mitigating the effects of livestock crashes.
Næss, Marius Warg; Bårdsen, Bård-Jørgen
2013-01-01
Analysing the effect of pastoral risk management strategies provides insights into a system of subsistence that have persevered in marginal areas for hundreds to thousands of years and may shed light into the future of around 200 million households in the face of climate change. This study investigated the efficiency of herd accumulation as a buffer strategy by analysing changes in livestock holdings during an environmental crisis in the Saami reindeer husbandry in Norway. We found a positive relationship between: (1) pre- and post-collapse herd size; and (2) pre-collapse herd size and the number of animals lost during the collapse, indicating that herd accumulation is an effective but costly strategy. Policies that fail to incorporate the risk-beneficial aspect of herd accumulation will have a limited effect and may indeed fail entirely. In the context of climate change, official policies that incorporate pastoral risk management strategies may be the only solution for ensuring their continued existence.
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A System-Level Approach to Overweight and Obesity in the Veterans Health Administration.
Raffa, Susan D; Maciejewski, Matthew L; Zimmerman, Lindsey E; Damschroder, Laura J; Estabrooks, Paul A; Ackermann, Ronald T; Tsai, Adam G; Histon, Trina; Goldstein, Michael G
2017-04-01
Healthcare systems are challenged by steady increases in the number of patients who are overweight and obese. Large-scale, evidence-based behavioral approaches for addressing overweight and obesity have been successfully implemented in systems such as the Veterans Health Administration (VHA). These population-based interventions target reduction in risk for obesity-associated conditions through lifestyle change and weight loss, and are associated with modest weight loss. Despite the fact that VHA has increased the overall reach of these behavioral interventions, the number of high-risk overweight and obese patients continues to rise. Recommendations for weight loss medications and bariatric surgery are included in clinical practice guidelines for the management of overweight and obesity, but these interventions are underutilized. During a recent state of the art conference on weight management held by VHA, subject matter experts identified challenges and gaps, as well as potential solutions and overarching policy recommendations, for implementing an integrated system-wide approach for improving population-based weight management.
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Operational environmental satellite archives in the 21st Century
NASA Astrophysics Data System (ADS)
Barkstrom, Bruce R.; Bates, John J.; Privette, Jeff; Vizbulis, Rick
2007-09-01
NASA, NOAA, and USGS collections of Earth science data are large, federated, and have active user communities and collections. Our experience raises five categories of issues for long-term archival: *Organization of the data in the collections is not well-described by text-based categorization principles *Metadata organization for these data is not well-described by Dublin Core and needs attention to data access and data use patterns *Long-term archival requires risk management approaches to dealing with the unique threats to knowledge preservation specific to digital information *Long-term archival requires careful attention to archival cost management *Professional data stewards for these collections may require special training. This paper suggests three mechanisms for improving the quality of long-term archival: *Using a maturity model to assess the readiness of data for accession, for preservation, and for future data usefulness *Developing a risk management strategy for systematically dealing with threats of data loss *Developing a life-cycle cost model for continuously evolving the collections and the data centers that house them.
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Use of failure mode effect analysis (FMEA) to improve medication management process.
Jain, Khushboo
2017-03-13
Purpose Medication management is a complex process, at high risk of error with life threatening consequences. The focus should be on devising strategies to avoid errors and make the process self-reliable by ensuring prevention of errors and/or error detection at subsequent stages. The purpose of this paper is to use failure mode effect analysis (FMEA), a systematic proactive tool, to identify the likelihood and the causes for the process to fail at various steps and prioritise them to devise risk reduction strategies to improve patient safety. Design/methodology/approach The study was designed as an observational analytical study of medication management process in the inpatient area of a multi-speciality hospital in Gurgaon, Haryana, India. A team was made to study the complex process of medication management in the hospital. FMEA tool was used. Corrective actions were developed based on the prioritised failure modes which were implemented and monitored. Findings The percentage distribution of medication errors as per the observation made by the team was found to be maximum of transcription errors (37 per cent) followed by administration errors (29 per cent) indicating the need to identify the causes and effects of their occurrence. In all, 11 failure modes were identified out of which major five were prioritised based on the risk priority number (RPN). The process was repeated after corrective actions were taken which resulted in about 40 per cent (average) and around 60 per cent reduction in the RPN of prioritised failure modes. Research limitations/implications FMEA is a time consuming process and requires a multidisciplinary team which has good understanding of the process being analysed. FMEA only helps in identifying the possibilities of a process to fail, it does not eliminate them, additional efforts are required to develop action plans and implement them. Frank discussion and agreement among the team members is required not only for successfully conducing FMEA but also for implementing the corrective actions. Practical implications FMEA is an effective proactive risk-assessment tool and is a continuous process which can be continued in phases. The corrective actions taken resulted in reduction in RPN, subjected to further evaluation and usage by others depending on the facility type. Originality/value The application of the tool helped the hospital in identifying failures in medication management process, thereby prioritising and correcting them leading to improvement.
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Thompson, Kimberly M; Duintjer Tebbens, Radboud J
2015-09-17
Prior analyses demonstrated the need for some countries and the Global Polio Eradication Initiative (GPEI) to conduct additional supplemental immunization activities (SIAs) with trivalent oral poliovirus vaccine (tOPV) prior to globally-coordinated cessation of all serotype 2-containing OPV (OPV2 cessation) to prevent the creation of serotype 2 circulating vaccine-derived poliovirus (cVDPV2) outbreaks after OPV2 cessation. The GPEI continues to focus on achieving and ensuring interruption of wild poliovirus serotype 1 (WPV1) and making vaccine choices that prioritize bivalent OPV (bOPV) for SIAs, nominally to increase population immunity to serotype 1, despite an aggressive timeline for OPV2 cessation. We use an existing dynamic poliovirus transmission model of northwest Nigeria and an integrated global model for long-term poliovirus risk management to explore the impact of tOPV vs. bOPV vaccine choices on population immunity and cVDPV2 risks. Using tOPV instead of bOPV for SIAs leads to a minimal decrease in population immunity to transmission of serotypes 1 and 3 polioviruses, but a significantly higher population immunity to transmission of serotype 2 polioviruses. Failure to use tOPV in enough SIAs results in cVDPV2 emergence after OPV2 cessation in both the northwest Nigeria model and the global model. Despite perceptions to the contrary, prioritizing the use of bOPV over tOPV prior to OPV2 cessation does not significantly improve serotype 1 population immunity to transmission. Immunization leaders need to focus on all three poliovirus serotypes to appropriately manage the risks of OPV cessation in the polio endgame. Focusing on population immunity to transmission to interrupt WPV1 transmission and manage pre-OPV cessation risks of cVDPVs, all countries performing poliovirus SIAs should use tOPV up until the time of OPV2 cessation, after which time they should continue to use the OPV vaccine formulation with all remaining serotypes until coordinated global cessation of those serotypes.
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Innovations in the management of Wilms' tumor.
Gleason, Joseph M; Lorenzo, Armando J; Bowlin, Paul R; Koyle, Martin A
2014-08-01
Advances in the management of Wilms' tumor have been dramatic over the past half century, not in small part due to the institution of multimodal therapy and the formation of collaborative study groups. While different opinions exist in the management of Wilms' tumors depending on where one lives and practices, survival rates have surpassed 90% across the board in Western societies. With more children surviving into adulthood, the concerns about morbidity have reached the forefront and now represent as much a consideration as oncologic outcomes these days. Innovations in treatment are on the horizon in the form of potential tumor markers, molecular biological means of testing for chemotherapeutic responsiveness, and advances in the delivery of chemotherapy for recurrent or recalcitrant tumors. Other technological innovations are being applied to childhood renal tumors, such as minimally invasive and nephron-sparing approaches. Risk stratification also allows for children to forego potentially unnecessary treatments and their associated morbidities. Wilms' tumor stands as a great example of the gains that can be made through protocol-driven therapy with strenuous outcomes analyses. These gains continue to spark interest in minimization of morbidity, while avoiding any compromise in oncologic efficacy. While excitement and innovation are important in the advancement of treatment delivery, we must continue to temper this enthusiasm and carefully evaluate options in order to continue to provide the highest standard of care in the management of this now highly curable disease.
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Diercke, Katja; Ollinger, Isabelle; Bermejo, Justo Lorenzo; Stucke, Kathrin; Lux, Christopher J; Brunner, Monika
2012-01-01
BACKGROUND. About 11% of children and adolescents suffer from dental fear. These young people run an increasing risk of undergoing more invasive treatments. AIM. We researched the management of dental anxiety in young patients by general and paediatric dentists as well as by trained and untrained dentists. DESIGN. Eight hundred dentists in Germany were interviewed via e-mail regarding their experience, treatment techniques, information material and complications during the treatment of fearful children. We also examined how difficult dentists judge the treatment of anxious children and how often they participate in continuing education courses. RESULTS. Paediatric dentists applied a greater spectrum of management techniques than general dentists. They used more often psychotherapeutic interventions and anxiety assessment questionnaires. Dentists who frequently attend in continuing education courses judged the treatment to be less difficult and also used psychotherapeutic interventions more often. CONCLUSIONS. German paediatric dentists and dentists who take continuing education courses utilise a broader range of techniques to manage dental anxiety. They may be eminently suited to treat children with severe forms of anxiety. Therefore, dentists who treat young patients should participate in education programmes so as to reduce both the anxiety of their patients and their own anxiety. © 2011 The Authors. International Journal of Paediatric Dentistry © 2011 BSPD, IAPD and Blackwell Publishing Ltd.
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Type 2 diabetes and disease management: exploring the connections.
Segal, Karen R
2004-01-01
Type 2 diabetes is an enormous public health problem affecting an estimated 18.2 million Americans. The prevalence is increasing, particularly among youth and young adults, in parallel with the continuing rise in obesity. The cost of treating diabetes complications imposes a tremendous burden on healthcare resources, and there has been limited success in achieving the treatment targets which are clearly associated with reduced risks of complications and mortality. This paper reviews the relationship of obesity to the risk and health complications of diabetes, and the impact of weight loss in reducing the risk of developing diabetes and in reducing the severity of metabolic and cardiovascular consequences in individuals who have already developed diabetes.
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New project? Don't analyze--act.
Schlesinger, Leonard A; Kiefer, Charles F; Brown, Paul B
2012-03-01
In a predictable world, getting a new initiative off the ground typically involves analyzing the market, creating a forecast, and writing a business plan. But what about in an unpredictable environment? The authors recommend looking to those who are experts in navigating extreme uncertainty while minimizing risk: serial entrepreneurs. These business leaders act, learn, and build their way into the future. Managers in traditional organizations can do the same, starting with smart, low-risk steps that follow simple rules: Use the means at hand; stay within an acceptable loss; secure only the commitment needed for the next step; bring along only volunteers; link the initiative to a business imperative; produce early results; and manage expectations. Momentum is gained by continuing to act based on what is learned at each step. The launch of Clorox's Green Works product line is discussed as an example.
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Management of acute anterior shoulder dislocation.
Dala-Ali, Benan; Penna, Marta; McConnell, Jamie; Vanhegan, Ivor; Cobiella, Carlos
2014-08-01
Shoulder dislocation is the most common large joint dislocation in the body. Recent advances in radiological imaging and shoulder surgery have shown the potential dangers of traditional reduction techniques such as the Kocher's and the Hippocratic methods, which are still advocated by many textbooks. Many non-specialists continue to use these techniques, unaware of their potential risks. This article reviews the clinical and radiographic presentation of dislocation; some common reduction techniques; their risks and success rate; analgesia methods to facilitate the reduction; and postreduction management. Many textbooks advocate methods that have been superceded by safer alternatives. Trainees should learn better and safer relocation methods backed up by the current evidence available. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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NASA Astrophysics Data System (ADS)
Flaming, Susan C.
2007-12-01
The continuing saga of satellite technology development is as much a story of successful risk management as of innovative engineering. How do program leaders on complex, technology projects manage high stakes risks that threaten business success and satellite performance? This grounded theory study of risk decision making portrays decision leadership practices at one communication satellite company. Integrated product team (IPT) leaders of multi-million dollar programs were interviewed and observed to develop an extensive description of the leadership skills required to navigate organizational influences and drive challenging risk decisions to closure. Based on the study's findings the researcher proposes a new decision making model, Deliberative Decision Making, to describe the program leaders' cognitive and organizational leadership practices. This Deliberative Model extends the insights of prominent decision making models including the rational (or classical) and the naturalistic and qualifies claims made by bounded rationality theory. The Deliberative Model describes how leaders proactively engage resources to play a variety of decision leadership roles. The Model incorporates six distinct types of leadership decision activities, undertaken in varying sequence based on the challenges posed by specific risks. Novel features of the Deliberative Decision Model include: an inventory of leadership methods for managing task challenges, potential stakeholder bias and debates; four types of leadership meta-decisions that guide decision processes, and aligned organizational culture. Both supporting and constraining organizational influences were observed as leaders managed major risks, requiring active leadership on the most difficult decisions. Although the company's engineering culture emphasized the importance of data-based decisions, the uncertainties intrinsic to satellite risks required expert engineering judgment to be exercised throughout. An investigation into the co-variation of decision methods with uncertainty suggests that perceived risk severity may serve as a robust indicator for choices about decision practices. The Deliberative Decision processes incorporate multiple organizational and cultural controls as cross-checks to mitigate potential parochial bias of individuals, stakeholder groups, or leaders. Overall the Deliberative Decision framework describes how expert leadership practices, supportive organizational systems along with aligned cultural values and behavioral norms help leaders drive high stakes risk decisions to closure in this complex, advanced-technology setting.
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Blueprint for prescriber continuing education program.
2012-06-01
On October 25, 2011, the Center for Drug Evaluation and Research (CDER) of the Food and Drug Administration (FDA) posted online this Blueprint for Prescriber Continuing Education, labeled "final," relating to extended-release and long-acting opioids. The pending FDA Risk Evaluation Management Strategy (REMS) requires prescriber education. This document provides guidance to sponsors of these dosage forms in developing the prescvriber education component of their REMS. This report was posted online by the federal agency on October 25, 2011 at: http://www.fda.gov/downloads/drugs/drugsafety/informationbydrugclass/ucm277916.pdf. It is in the public domain.
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Postacute Care in Cancer Rehabilitation.
Guo, Ying; Fu, Jack B; Guo, Hong; Camp, Jennifer; Shin, Ki Y; Tu, Shi-Ming; Palmer, Lynn J; Yadav, Rajesh
2017-02-01
Acute care is usually associated with disease progression, treatments for cancer, and medical comorbidities. Patients with cancer may develop sudden functional deficits that require rehabilitation. Some of these patients benefit from acute rehabilitation, others benefit from subacute rehabilitation. After acute rehabilitation, continuous care for these patients has not been well described. Three studies are presented to demonstrate that cancer rehabilitation is a continuous process. Rehabilitation professionals should know how to detect fall risk, monitor symptoms, and render symptom management. Patients with cancer often require rehabilitation services during their entire disease trajectory. Copyright © 2016 Elsevier Inc. All rights reserved.
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Project management: importance for diagnostic laboratories.
Croxatto, A; Greub, G
2017-07-01
The need for diagnostic laboratories to improve both quality and productivity alongside personnel shortages incite laboratory managers to constantly optimize laboratory workflows, organization, and technology. These continuous modifications of the laboratories should be conducted using efficient project and change management approaches to maximize the opportunities for successful completion of the project. This review aims at presenting a general overview of project management with an emphasis on selected critical aspects. Conventional project management tools and models, such as HERMES, described in the literature, associated personal experience, and educational courses on management have been used to illustrate this review. This review presents general guidelines of project management and highlights their importance for microbiology diagnostic laboratories. As an example, some critical aspects of project management will be illustrated with a project of automation, as experienced at the laboratories of bacteriology and hygiene of the University Hospital of Lausanne. It is important to define clearly beforehand the objective of a project, its perimeter, its costs, and its time frame including precise duration estimates of each step. Then, a project management plan including explanations and descriptions on how to manage, execute, and control the project is necessary to continuously monitor the progression of a project to achieve its defined goals. Moreover, a thorough risk analysis with contingency and mitigation measures should be performed at each phase of a project to minimize the impact of project failures. The increasing complexities of modern laboratories mean clinical microbiologists must use several management tools including project and change management to improve the outcome of major projects and activities. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Ha, Kyoo-Man, E-mail: ha1999@hotmail.com
Although the number of emergency managers has risen in South Korea (hereafter referred to as Korea) over the years, their role is not yet as defined and noteworthy compared to other professions because of its unidisciplinary approach. This article investigates how Korea has to improve emergency managers' disciplinary approach to ultimately contribute to the goal of effective transnational disaster management. This study uses qualitative content analysis of government policies, college curricula, nongovernmental organizations' (NGOs') emergency-manager certification, and mass media coverage to compare emergency managers' unidisciplinary and multidisciplinary approaches. The key tenet is that Korea must change its emergency managers' unidisciplinarymore » approach into a multidisciplinary approach because the former is less effective when dealing with complicated disaster management systems. To achieve this change, the stakeholders must carry out their assigned responsibilities under risk-oriented management. As for the study's international implications, developing nations may consider the enhancement of related educational curricula, collaborative learning, continuous evaluation, disaster awareness, and disaster prevention for the emergency managers' multidisciplinary approach.« less
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Kapoor, Poonam Malhotra; Magoon, Rohan; Rawat, Rajinder Singh; Mehta, Yatin; Taneja, Sameer; Ravi, R; Hote, Milind P
2017-01-01
There has been a constant emphasis on developing management strategies to improve the outcome of high-risk cardiac patients undergoing surgical revascularization. The performance of coronary artery bypass surgery on an off-pump coronary artery bypass (OPCAB) avoids the risks associated with extra-corporeal circulation. The preliminary results of goal-directed therapy (GDT) for hemodynamic management of high-risk cardiac surgical patients are encouraging. The present study was conducted to study the outcome benefits with the combined use of GDT with OPCAB as compared to the conventional hemodynamic management. Patients with the European System for Cardiac Operative Risk Evaluation ≥3 scheduled for OPCAB were randomly divided into two groups; the control and GDT groups. The GDT group included the monitoring and optimization of advanced parameters, including cardiac index (CI), systemic vascular resistance index, oxygen delivery index, stroke volume variation; continuous central venous oxygen saturation (ScVO 2 ), global end-diastolic volume, and extravascular lung water (EVLW), using FloTrac™ , PreSep™ , and EV-1000 ® monitoring panels, in addition to the conventional hemodynamic management in the control group. The hemodynamic parameters were continuously monitored for 48 h in Intensive Care Unit (ICU) and corrected according to GDT protocol. A total of 163 patients consented for the study. Seventy-five patients were assigned to the GDT group and 88 patients were in the control group. In view of 9 exclusions from the GDT group and 12 exclusions from control group, 66 patients in the GDT group and 76 patients in control group completed the study. The length of stay in hospital (LOS-H) (7.42 ± 1.48 vs. 5.61 ± 1.11 days, P < 0.001) and ICU stay (4.2 ± 0.82 vs. 2.53 ± 0.56 days, P < 0.001) were significantly lower in the GDT group as compared to control group. The duration of inotropes (3.24 ± 0.73 vs. 2.89 ± 0.68 h, P = 0.005) was also significantly lower in the GDT group. The two groups did not differ in duration of ventilated hours, mortality, and other complications. The parameters such as ScVO 2 , CI, and EVLW had a strong negative and positive correlation with the LOS-H with r values of - 0.331, -0.319, and 0.798, respectively. The study elucidates the role of a goal-directed hemodynamic optimization for improved outcome in high-risk cardiac patients undergoing OPCAB.
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Transparent Global Seismic Hazard and Risk Assessment
NASA Astrophysics Data System (ADS)
Smolka, Anselm; Schneider, John; Pinho, Rui; Crowley, Helen
2013-04-01
Vulnerability to earthquakes is increasing, yet advanced reliable risk assessment tools and data are inaccessible to most, despite being a critical basis for managing risk. Also, there are few, if any, global standards that allow us to compare risk between various locations. The Global Earthquake Model (GEM) is a unique collaborative effort that aims to provide organizations and individuals with tools and resources for transparent assessment of earthquake risk anywhere in the world. By pooling data, knowledge and people, GEM acts as an international forum for collaboration and exchange, and leverages the knowledge of leading experts for the benefit of society. Sharing of data and risk information, best practices, and approaches across the globe is key to assessing risk more effectively. Through global projects, open-source IT development and collaborations with more than 10 regions, leading experts are collaboratively developing unique global datasets, best practice, open tools and models for seismic hazard and risk assessment. Guided by the needs and experiences of governments, companies and citizens at large, they work in continuous interaction with the wider community. A continuously expanding public-private partnership constitutes the GEM Foundation, which drives the collaborative GEM effort. An integrated and holistic approach to risk is key to GEM's risk assessment platform, OpenQuake, that integrates all above-mentioned contributions and will become available towards the end of 2014. Stakeholders worldwide will be able to calculate, visualise and investigate earthquake risk, capture new data and to share their findings for joint learning. Homogenized information on hazard can be combined with data on exposure (buildings, population) and data on their vulnerability, for loss assessment around the globe. Furthermore, for a true integrated view of seismic risk, users can add social vulnerability and resilience indices to maps and estimate the costs and benefits of different risk management measures. The following global data, models and methodologies will be available in the platform. Some of these will be released to the public already before, such as the ISC-GEM global instrumental catalogue (released January 2013). Datasets: • Global Earthquake History Catalogue [1000-1903] • Global Instrumental Catalogue [1900-2009] • Global Geodetic Strain Rate Model • Global Active Fault Database • Tectonic Regionalisation • Buildings and Population Database • Earthquake Consequences Database • Physical Vulnerability Database • Socio-Economic Vulnerability and Resilience Indicators Models: • Seismic Source Models • Ground Motion (Attenuation) Models • Physical Exposure Models • Physical Vulnerability Models • Composite Index Models (social vulnerability, resilience, indirect loss) The aforementioned models developed under the GEM framework will be combined to produce estimates of hazard and risk at a global scale. Furthermore, building on many ongoing efforts and knowledge of scientists worldwide, GEM will integrate state-of-the-art data, models, results and open-source tools into a single platform that is to serve as a "clearinghouse" on seismic risk. The platform will continue to increase in value, in particular for use in local contexts, through contributions and collaborations with scientists and organisations worldwide.
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Hongoh, Valerie; Campagna, Céline; Panic, Mirna; Samuel, Onil; Gosselin, Pierre; Waaub, Jean-Philippe; Ravel, André; Samoura, Karim; Michel, Pascal
2016-01-01
The recent emergence of West Nile virus (WNV) in North America highlights vulnerability to climate sensitive diseases and stresses the importance of preventive efforts to reduce their public health impact. Effective prevention involves reducing environmental risk of exposure and increasing adoption of preventive behaviours, both of which depend on knowledge and acceptance of such measures. When making operational decisions about disease prevention and control, public health must take into account a wide range of operational, environmental, social and economic considerations in addition to intervention effectiveness. The current study aimed to identify, assess and rank possible risk reduction measures taking into account a broad set of criteria and perspectives applicable to the management of WNV in Quebec under increasing transmission risk scenarios, some of which may be related to ongoing warming in higher-latitude regions. A participatory approach was used to collect information on categories of concern to relevant stakeholders with respect to WNV prevention and control. Multi-criteria decision analysis was applied to examine stakeholder perspectives and their effect on strategy rankings under increasing transmission risk scenarios. Twenty-three preventive interventions were retained for evaluation using eighteen criteria identified by stakeholders. Combined evaluations revealed that, at an individual-level, inspecting window screen integrity, wearing light colored, long clothing, eliminating peridomestic larval sites and reducing outdoor activities at peak times were top interventions under six WNV transmission scenarios. At a regional-level, the use of larvicides was a preferred strategy in five out of six scenarios, while use of adulticides and dissemination of sterile male mosquitoes were found to be among the least favoured interventions in almost all scenarios. Our findings suggest that continued public health efforts aimed at reinforcing individual-level preventive behaviours combined with the application of larvicides to manage the risk of WNV infection are the interventions most acceptable and effective at reaching current management objectives now and under future theoretical transmission risk. PMID:27494136
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Assessment of occupational safety risks in Floridian solid waste systems using Bayesian analysis.
Bastani, Mehrad; Celik, Nurcin
2015-10-01
Safety risks embedded within solid waste management systems continue to be a significant issue and are prevalent at every step in the solid waste management process. To recognise and address these occupational hazards, it is necessary to discover the potential safety concerns that cause them, as well as their direct and/or indirect impacts on the different types of solid waste workers. In this research, our goal is to statistically assess occupational safety risks to solid waste workers in the state of Florida. Here, we first review the related standard industrial codes to major solid waste management methods including recycling, incineration, landfilling, and composting. Then, a quantitative assessment of major risks is conducted based on the data collected using a Bayesian data analysis and predictive methods. The risks estimated in this study for the period of 2005-2012 are then compared with historical statistics (1993-1997) from previous assessment studies. The results have shown that the injury rates among refuse collectors in both musculoskeletal and dermal injuries have decreased from 88 and 15 to 16 and three injuries per 1000 workers, respectively. However, a contrasting trend is observed for the injury rates among recycling workers, for whom musculoskeletal and dermal injuries have increased from 13 and four injuries to 14 and six injuries per 1000 workers, respectively. Lastly, a linear regression model has been proposed to identify major elements of the high number of musculoskeletal and dermal injuries. © The Author(s) 2015.
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Atar, Dan; Bode, Christoph; Stuerzenbecher, André; Verheugt, Freek W A
2014-08-01
The impact of an acute coronary syndrome (ACS) event, such as an acute myocardial infarction (MI), is not limited to the acute management phase; patients face an elevated risk of residual atherothrombotic events that commonly requires chronic management for months or even years. Significant advances have been made in both the acute and chronic management of patients with acute MI over the past decade, resulting in improved prognoses. One of the hallmarks of modern treatment strategies is more aggressive antiplatelet treatment regimens. However, the risks of further ACS events, stroke and premature death remain elevated in these patients, and addressing this residual risk is challenging owing to interpatient variability, differences in management strategies between centres and countries, incomplete understanding of the specific pathophysiology of post-ACS thrombosis and limitations of current therapeutic approaches. The recent approval in Europe of the direct oral anticoagulant rivaroxaban for use in this setting in combination with clopidogrel and acetylsalicylic acid offers another strategy to consider in the management of these patients, and clinical strategies in this area continue to evolve. In this review, we chart the progress made over the past decade in reducing the burden of secondary thromboembolic events after acute MI and discuss the current position of and future perspectives on the inclusion of oral anticoagulants into care pathways in this setting. © 2014 The Authors. Fundamental & Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of Société Française de Pharmacologie et de Thérapeutique.
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NASA Technical Reports Server (NTRS)
Vitali, Roberto; Lutomski, Michael G.
2004-01-01
National Aeronautics and Space Administration s (NASA) International Space Station (ISS) Program uses Probabilistic Risk Assessment (PRA) as part of its Continuous Risk Management Process. It is used as a decision and management support tool to not only quantify risk for specific conditions, but more importantly comparing different operational and management options to determine the lowest risk option and provide rationale for management decisions. This paper presents the derivation of the probability distributions used to quantify the failure rates and the probability of failures of the basic events employed in the PRA model of the ISS. The paper will show how a Bayesian approach was used with different sources of data including the actual ISS on orbit failures to enhance the confidence in results of the PRA. As time progresses and more meaningful data is gathered from on orbit failures, an increasingly accurate failure rate probability distribution for the basic events of the ISS PRA model can be obtained. The ISS PRA has been developed by mapping the ISS critical systems such as propulsion, thermal control, or power generation into event sequences diagrams and fault trees. The lowest level of indenture of the fault trees was the orbital replacement units (ORU). The ORU level was chosen consistently with the level of statistically meaningful data that could be obtained from the aerospace industry and from the experts in the field. For example, data was gathered for the solenoid valves present in the propulsion system of the ISS. However valves themselves are composed of parts and the individual failure of these parts was not accounted for in the PRA model. In other words the failure of a spring within a valve was considered a failure of the valve itself.
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The lesser spotted pregnant surgeon.
Hamilton, L C
2017-10-19
With more women entering surgical training, it will become more commonplace to encounter pregnant surgeons. This paper discusses the evidence for work-related risk factors as well as outlining the rights of a pregnant doctor. There are, in fact, very few real risks to pregnancy encountered as a surgeon, with the main risks involving standing or sitting for long periods and fatigue, which can be managed with support from the department. It is important for women in surgery to know that it is possible to continue their training while pregnant so they do not feel pressured into changing to a less demanding specialty or even leaving medicine entirely. It is also important for other professionals to understand the risks and choices faced by pregnant surgeons so that they can better support them in the workplace.
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Intertwining Risk Insights and Design Decisions
NASA Technical Reports Server (NTRS)
Cornford, Steven L.; Feather, Martin S.; Jenkins, J. Steven
2006-01-01
The state of systems engineering is such that a form of early and continued use of risk assessments is conducted (as evidenced by NASA's adoption and use of the 'Continuous Risk Management' paradigm developed by SEI). ... However, these practices fall short of theideal: (1) Integration between risk assessment techniques and other systems engineering tools is weak. (2) Risk assessment techniques and the insights they yield are only informally coupled to design decisions. (3) Individual riskassessment techniques lack the mix of breadth, fidelity and agility required to span the gamut of the design space. In this paper we present an approach that addresses these shortcomings. The hallmark of our approach is a simple representation comprising objectives (what the system is to do), risks (whose occurrence would detract from attainment of objectives) and activities (a.k.a. 'mitigations') that, if performed, will decrease those risks. These are linked to indicate by how much a risk would detract from attainment of an objective, and by how much an activity would reduce a risk. The simplicity of our representational framework gives it the breadth to encompass the gamut of the design space concerns, the agility to be utilized in even the earliest phases of designs, and the capability to connect to system engineering models and higher-fidelity risk tools. It is through this integration that we address the shortcomings listed above, and so achieve the intertwining between risk insights and design decisions needed to guide systems engineering towards superior final designs while avoiding costly rework to achieve them. The paper will use an example, constructed to be representative of space mission design, to illustrate our approach.
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Water Resources and Sustainable Agriculture in 21st Century: Challenges and Opportunities
NASA Astrophysics Data System (ADS)
Asrar, G.
2008-05-01
Global agriculture faces some unique challenges and opportunities for the rest of this century. The need for food, feed and fiber will continues to grow as the world population continue to increase in the future. Agricultural ecosystems are also expected to be the source of a significant portion of renewable energy and fuels around the world, without further compromising the integrity of the natural resources base. How can agriculture continue to provide these services to meet the growing needs of world population while sustaining the integrity of agricultural ecosystems and natural resources, the very foundation it depends on? In the last century, scientific discoveries and technological innovations in agriculture resulted in significant increase in food, feed and fiber production globally, while the total amount of water, energy, fertilizers and other input used to achieve this growth remained the same or even decreased significantly in some parts of the world. Scientific and technical advances in understanding global and regional water and energy cycles, water resources management, soil and water conservation practices, weather prediction, plant breeding and biotechnology, and information and communication technologies contributed to this tremendous achievement. The projected increase in global population, urbanization, and changing lifestyles will continue the pressure on both agriculture and other managed and natural ecosystems to provide necessary goods and services for the rest of this century. To meet these challenges, we must obtain the requisite scientific and technical advances in the functioning of Earth's water, energy, carbon and biogeochemical cycles. We also need to apply the knowledge we gain and technologies we develop in assessing Earth's ecosystems' conditions, and their management and stewardship. In agricultural ecosystems, management of soil and water quality and quantity together with development of new varieties of plants based on advances in genomic, genetics, breeding and applied biotechnologies are a key to our ability to address these challenges. We must also continue to develop agronomic practices that sustain the integrity of natural resources and conserve energy on one-hand while maximizing agricultural production per unit area of land on the other hand. This will require managing agricultural ecosystems for their multiple functions and services together, instead of looking at each function/service in isolation. In this presentation, we will provide an overview of the scientific and technical knowledge required for sustainable management of agricultural ecosystems and associated natural resources. We will describe the soil, water and energy research needs/priorities in agriculture. We will also provide some examples of recent accomplishments and future directions in developing decision support tools for assessing the impacts of weather and climate variations and change, and their risk to agricultural ecosystems. We will then focus on opportunities and challenges associated with measurement, monitoring and modeling of soil moisture and its use in management and operation of agricultural ecosystems. The overall intent of this presentation is to stimulate some discussion on future directions and priorities for soil, water and energy research in agricultural ecosystems, and how the knowledge we gain from this research can be conveyed to the users for risk assessment, decision making, and multi-service ecosystem management purposes.
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Romiplostim for Immune Thrombocytopenia in Neuroblastoma Patients Receiving Chemotherapy.
Fassel, Hannah; Bussel, James B; Roberts, Stephen S; Modak, Shakeel
2018-04-20
Thrombocytopenia, a serious complication of myelosuppressive chemotherapy in cancer patients, is managed with platelet transfusions until recovery of platelet counts. However, children receiving chemotherapy can rarely develop immune thrombocytopenia (ITP) that is refractory to transfused platelets. This limits the ability to achieve adequate platelet counts and administer further myelosuppressive chemotherapy safely, especially if first-line ITP therapy is ineffective. We report 2 cases of intravenous immunoglobulin refractory ITP in children receiving chemotherapy for high-risk neuroblastoma. ITP was successfully treated with the thrombopoietin-receptor-agonist romiplostim, allowing safe and timely continuation of antineuroblastoma therapies in these high-risk patients.
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Overview of Wound Healing and Management.
Childs, Dylan R; Murthy, Ananth S
2017-02-01
Wound healing is a highly complex chain of events, and although it may never be possible to eliminate the risk of experiencing a wound, clinicians' armamentarium continues to expand with methods to manage it. The phases of wound healing are the inflammatory phase, the proliferative phase, and the maturation phase. The pathway of healing is determined by characteristics of the wound on initial presentation, and it is vital to select the appropriate method to treat the wound based on its ability to avoid hypoxia, infection, excessive edema, and foreign bodies. Copyright © 2016 Elsevier Inc. All rights reserved.