A framework for global river flood risk assessments

NASA Astrophysics Data System (ADS)

Winsemius, H. C.; Van Beek, L. P. H.; Jongman, B.; Ward, P. J.; Bouwman, A.

2013-05-01

There is an increasing need for strategic global assessments of flood risks in current and future conditions. In this paper, we propose a framework for global flood risk assessment for river floods, which can be applied in current conditions, as well as in future conditions due to climate and socio-economic changes. The framework's goal is to establish flood hazard and impact estimates at a high enough resolution to allow for their combination into a risk estimate, which can be used for strategic global flood risk assessments. The framework estimates hazard at a resolution of ~ 1 km2 using global forcing datasets of the current (or in scenario mode, future) climate, a global hydrological model, a global flood-routing model, and more importantly, an inundation downscaling routine. The second component of the framework combines hazard with flood impact models at the same resolution (e.g. damage, affected GDP, and affected population) to establish indicators for flood risk (e.g. annual expected damage, affected GDP, and affected population). The framework has been applied using the global hydrological model PCR-GLOBWB, which includes an optional global flood routing model DynRout, combined with scenarios from the Integrated Model to Assess the Global Environment (IMAGE). We performed downscaling of the hazard probability distributions to 1 km2 resolution with a new downscaling algorithm, applied on Bangladesh as a first case study application area. We demonstrate the risk assessment approach in Bangladesh based on GDP per capita data, population, and land use maps for 2010 and 2050. Validation of the hazard estimates has been performed using the Dartmouth Flood Observatory database. This was done by comparing a high return period flood with the maximum observed extent, as well as by comparing a time series of a single event with Dartmouth imagery of the event. Validation of modelled damage estimates was performed using observed damage estimates from the EM-DAT database and World Bank sources. We discuss and show sensitivities of the estimated risks with regard to the use of different climate input sets, decisions made in the downscaling algorithm, and different approaches to establish impact models.

Integrating legal liabilities in nanomanufacturing risk management.

PubMed

Mohan, Mayank; Trump, Benjamin D; Bates, Matthew E; Monica, John C; Linkov, Igor

2012-08-07

Among other things, the wide-scale development and use of nanomaterials is expected to produce costly regulatory and civil liabilities for nanomanufacturers due to lingering uncertainties, unanticipated effects, and potential toxicity. The life-cycle environmental, health, and safety (EHS) risks of nanomaterials are currently being studied, but the corresponding legal risks have not been systematically addressed. With the aid of a systematic approach that holistically evaluates and accounts for uncertainties about the inherent properties of nanomaterials, it is possible to provide an order of magnitude estimate of liability risks from regulatory and litigious sources based on current knowledge. In this work, we present a conceptual framework for integrating estimated legal liabilities with EHS risks across nanomaterial life-cycle stages using empirical knowledge in the field, scientific and legal judgment, probabilistic risk assessment, and multicriteria decision analysis. Such estimates will provide investors and operators with a basis to compare different technologies and practices and will also inform regulatory and legislative bodies in determining standards that balance risks with technical advancement. We illustrate the framework through the hypothetical case of a manufacturer of nanoscale titanium dioxide and use the resulting expected legal costs to evaluate alternative risk-management actions.

The cardiovascular event reduction tool (CERT)--a simplified cardiac risk prediction model developed from the West of Scotland Coronary Prevention Study (WOSCOPS).

PubMed

L'Italien, G; Ford, I; Norrie, J; LaPuerta, P; Ehreth, J; Jackson, J; Shepherd, J

2000-03-15

The clinical decision to treat hypercholesterolemia is premised on an awareness of patient risk, and cardiac risk prediction models offer a practical means of determining such risk. However, these models are based on observational cohorts where estimates of the treatment benefit are largely inferred. The West of Scotland Coronary Prevention Study (WOSCOPS) provides an opportunity to develop a risk-benefit prediction model from the actual observed primary event reduction seen in the trial. Five-year Cox model risk estimates were derived from all WOSCOPS subjects (n = 6,595 men, aged 45 to 64 years old at baseline) using factors previously shown to be predictive of definite fatal coronary heart disease or nonfatal myocardial infarction. Model risk factors included age, diastolic blood pressure, total cholesterol/ high-density lipoprotein ratio (TC/HDL), current smoking, diabetes, family history of fatal coronary heart disease, nitrate use or angina, and treatment (placebo/ 40-mg pravastatin). All risk factors were expressed as categorical variables to facilitate risk assessment. Risk estimates were incorporated into a simple, hand-held slide rule or risk tool. Risk estimates were identified for 5-year age bands (45 to 65 years), 4 categories of TC/HDL ratio (<5.5, 5.5 to <6.5, 6.5 to <7.5, > or = 7.5), 2 levels of diastolic blood pressure (<90, > or = 90 mm Hg), from 0 to 3 additional risk factors (current smoking, diabetes, family history of premature fatal coronary heart disease, nitrate use or angina), and pravastatin treatment. Five-year risk estimates ranged from 2% in very low-risk subjects to 61% in the very high-risk subjects. Risk reduction due to pravastatin treatment averaged 31%. Thus, the Cardiovascular Event Reduction Tool (CERT) is a risk prediction model derived from the WOSCOPS trial. Its use will help physicians identify patients who will benefit from cholesterol reduction.

Asymmetric impacts of global risk appetite on the risk premium for an emerging market

NASA Astrophysics Data System (ADS)

Kanlı, İbrahim Burak

2008-05-01

This paper analyzes the impact of global risk appetite on the risk premium utilizing high-frequency data. Taking the Turkish economy as our laboratory, we find that the risk premium volatility responds only to a worsening in the risk appetite for the Turkish economy, which is a result that we do not observe for the other emerging markets. Then, we investigate the role of current account dynamics on this asymmetric effect, by focusing also on an economy with similar current account performance. The empirical results find supporting evidence for the role of current account dynamics on the estimated asymmetry.

Estimating the impact of adding C-reactive protein as a criterion for lipid lowering treatment in the United States.

PubMed

Woloshin, Steven; Schwartz, Lisa M; Kerin, Kevin; Welch, H Gilbert

2007-02-01

There is growing interest in using C-reactive protein (CRP) levels to help select patients for lipid lowering therapy--although this practice is not yet supported by evidence of benefit in a randomized trial. To estimate the number of Americans potentially affected if a CRP criteria were adopted as an additional indication for lipid lowering therapy. To provide context, we also determined how well current lipid lowering guidelines are being implemented. We analyzed nationally representative data to determine how many Americans age 35 and older meet current National Cholesterol Education Program (NCEP) treatment criteria (a combination of risk factors and their Framingham risk score). We then determined how many of the remaining individuals would meet criteria for treatment using 2 different CRP-based strategies: (1) narrow: treat individuals at intermediate risk (i.e., 2 or more risk factors and an estimated 10-20% risk of coronary artery disease over the next 10 years) with CRP > 3 mg/L and (2) broad: treat all individuals with CRP > 3 mg/L. Analyses are based on the 2,778 individuals participating in the 1999-2002 National Health and Nutrition Examination Survey with complete data on cardiac risk factors, fasting lipid levels, CRP, and use of lipid lowering agents. The estimated number and proportion of American adults meeting NCEP criteria who take lipid-lowering drugs, and the additional number who would be eligible based on CRP testing. About 53 of the 153 million Americans aged 35 and older meet current NCEP criteria (that do not involve CRP) for lipid-lowering treatment. Sixty-five percent, however, are not currently being treated, even among those at highest risk (i.e., patients with established heart disease or its risk equivalent)-62% are untreated. Adopting the narrow and broad CRP strategies would make an additional 2.1 and 25.3 million Americans eligible for treatment, respectively. The latter strategy would make over half the adults age 35 and older eligible for lipid-lowering therapy, with most of the additionally eligible (57%) coming from the lowest NCEP heart risk category (i.e., 0-1 risk factors). There is substantial underuse of lipid lowering therapy for American adults at high risk for coronary disease. Rather than adopting CRP-based strategies, which would make millions more lower risk patients eligible for treatment (and for whom treatment benefit has not yet been demonstrated in a randomized trial), we should ensure the treatment of currently defined high-risk patients for whom the benefit of therapy is established.

Security Events and Vulnerability Data for Cybersecurity Risk Estimation.

PubMed

Allodi, Luca; Massacci, Fabio

2017-08-01

Current industry standards for estimating cybersecurity risk are based on qualitative risk matrices as opposed to quantitative risk estimates. In contrast, risk assessment in most other industry sectors aims at deriving quantitative risk estimations (e.g., Basel II in Finance). This article presents a model and methodology to leverage on the large amount of data available from the IT infrastructure of an organization's security operation center to quantitatively estimate the probability of attack. Our methodology specifically addresses untargeted attacks delivered by automatic tools that make up the vast majority of attacks in the wild against users and organizations. We consider two-stage attacks whereby the attacker first breaches an Internet-facing system, and then escalates the attack to internal systems by exploiting local vulnerabilities in the target. Our methodology factors in the power of the attacker as the number of "weaponized" vulnerabilities he/she can exploit, and can be adjusted to match the risk appetite of the organization. We illustrate our methodology by using data from a large financial institution, and discuss the significant mismatch between traditional qualitative risk assessments and our quantitative approach. © 2017 Society for Risk Analysis.

An evaluation of risk estimation procedures for mixtures of carcinogens

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

Hwang, J.S.; Chen, J.J.

1999-12-01

The estimation of health risks from exposure to a mixture of chemical carcinogens is generally based on the combination of information from several available single compound studies. The current practice of directly summing the upper bound risk estimates of individual carcinogenic components as an upper bound on the total risk of a mixture is known to be generally too conservative. Gaylor and Chen (1996, Risk Analysis) proposed a simple procedure to compute an upper bound on the total risk using only the upper confidence limits and central risk estimates of individual carcinogens. The Gaylor-Chen procedure was derived based on anmore » underlying assumption of the normality for the distributions of individual risk estimates. IN this paper the authors evaluated the Gaylor-Chen approach in terms the coverages of the upper confidence limits on the true risks of individual carcinogens. In general, if the coverage probabilities for the individual carcinogens are all approximately equal to the nominal level, then the Gaylor-Chen approach should perform well. However, the Gaylor-Chen approach can be conservative or anti-conservative if some of all individual upper confidence limit estimates are conservative or anti-conservative.« less

Ozone Health Risk Assessment for Selected Urban Areas

EPA Pesticide Factsheets

The health risk assessment described in this report estimated various health effects associated with O3 exposures as well as the reduced risks for one O3 season associated with just meeting the current O3 NAAQS.

Fundamentals of health risk assessment. Use, derivation, validity and limitations of safety indices.

PubMed

Putzrath, R M; Wilson, J D

1999-04-01

We investigated the way results of human health risk assessments are used, and the theory used to describe those methods, sometimes called the "NAS paradigm." Contrary to a key tenet of that theory, current methods have strictly limited utility. The characterizations now considered standard, Safety Indices such as "Acceptable Daily Intake," "Reference Dose," and so on, usefully inform only decisions that require a choice between two policy alternatives (e.g., approve a food additive or not), decided solely on the basis of a finding of safety. Risk is characterized as the quotient of one of these Safety Indices divided by an estimate of exposure: a quotient greater than one implies that the situation may be considered safe. Such decisions are very widespread, both in the U.S. federal government and elsewhere. No current method is universal; different policies lead to different practices, for example, in California's "Proposition 65," where statutory provisions specify some practices. Further, an important kind of human health risk assessment is not recognized by this theory: this kind characterizes risk as likelihood of harm, given estimates of exposure consequent to various decision choices. Likelihood estimates are necessary whenever decision makers have many possible decision choices and must weigh more than two societal values, such as in EPA's implementation of "conventional air pollutants." These estimates can not be derived using current methods; different methods are needed. Our analysis suggests changes needed in both the theory and practice of human health risk assessment, and how what is done is depicted.

Breast cancer risk from different mammography screening practices.

PubMed

Bijwaard, Harmen; Brenner, Alina; Dekkers, Fieke; van Dillen, Teun; Land, Charles E; Boice, John D

2010-09-01

Mammography screening is an accepted procedure for early detection of breast tumors among asymptomatic women. Since this procedure involves the use of X rays, it is itself potentially carcinogenic. Although there is general consensus about the benefit of screening for older women, screening practices differ between countries. In this paper radiation risks for these different practices are estimated using a new approach. We model breast cancer induction by ionizing radiation in a cohort of patients exposed to frequent X-ray examinations. The biologically based, mechanistic model provides a better foundation for the extrapolation of risks to different mammography screening practices than empirical models do. The model predicts that the excess relative risk (ERR) doubles when screening starts at age 40 instead of 50 and that a continuation of screening at ages 75 and higher carries little extra risk. The number of induced fatal breast cancers is estimated to be considerably lower than derived from epidemiological studies and from internationally accepted radiation protection risks. The present findings, if used in a risk-benefit analysis for mammography screening, would be more favorable to screening than estimates currently recommended for radiation protection. This has implications for the screening ages that are currently being reconsidered in several countries.

Modified wind chill temperatures determined by a whole body thermoregulation model and human-based facial convective coefficients.

PubMed

Shabat, Yael Ben; Shitzer, Avraham; Fiala, Dusan

2014-08-01

Wind chill equivalent temperatures (WCETs) were estimated by a modified Fiala's whole body thermoregulation model of a clothed person. Facial convective heat exchange coefficients applied in the computations concurrently with environmental radiation effects were taken from a recently derived human-based correlation. Apart from these, the analysis followed the methodology used in the derivation of the currently used wind chill charts. WCET values are summarized by the following equation:[Formula: see text]Results indicate consistently lower estimated facial skin temperatures and consequently higher WCETs than those listed in the literature and used by the North American weather services. Calculated dynamic facial skin temperatures were additionally applied in the estimation of probabilities for the occurrence of risks of frostbite. Predicted weather combinations for probabilities of "Practically no risk of frostbite for most people," for less than 5 % risk at wind speeds above 40 km h(-1), were shown to occur at air temperatures above -10 °C compared to the currently published air temperature of -15 °C. At air temperatures below -35 °C, the presently calculated weather combination of 40 km h(-1)/-35 °C, at which the transition for risks to incur a frostbite in less than 2 min, is less conservative than that published: 60 km h(-1)/-40 °C. The present results introduce a fundamentally improved scientific basis for estimating facial skin temperatures, wind chill temperatures and risk probabilities for frostbites over those currently practiced.

Modified wind chill temperatures determined by a whole body thermoregulation model and human-based facial convective coefficients

NASA Astrophysics Data System (ADS)

Shabat, Yael Ben; Shitzer, Avraham; Fiala, Dusan

2014-08-01

Wind chill equivalent temperatures (WCETs) were estimated by a modified Fiala's whole body thermoregulation model of a clothed person. Facial convective heat exchange coefficients applied in the computations concurrently with environmental radiation effects were taken from a recently derived human-based correlation. Apart from these, the analysis followed the methodology used in the derivation of the currently used wind chill charts. WCET values are summarized by the following equation: Results indicate consistently lower estimated facial skin temperatures and consequently higher WCETs than those listed in the literature and used by the North American weather services. Calculated dynamic facial skin temperatures were additionally applied in the estimation of probabilities for the occurrence of risks of frostbite. Predicted weather combinations for probabilities of "Practically no risk of frostbite for most people," for less than 5 % risk at wind speeds above 40 km h-1, were shown to occur at air temperatures above -10 °C compared to the currently published air temperature of -15 °C. At air temperatures below -35 °C, the presently calculated weather combination of 40 km h-1/-35 °C, at which the transition for risks to incur a frostbite in less than 2 min, is less conservative than that published: 60 km h-1/-40 °C. The present results introduce a fundamentally improved scientific basis for estimating facial skin temperatures, wind chill temperatures and risk probabilities for frostbites over those currently practiced.

The Development of Risk-Taking: A Multi-Perspective Review

ERIC Educational Resources Information Center

Boyer, Ty W.

2006-01-01

The current paper reviews four research perspectives that have been used to investigate the development of risk-taking. Cognitive developmental research has investigated the development of decision-making capacities that potentially underlie risk-taking development, including sensitivity to risk, probability estimation, and perceptions of…

Socioeconomic indicators of heat-related health risk supplemented with remotely sensed data

PubMed Central

Johnson, Daniel P; Wilson, Jeffrey S; Luber, George C

2009-01-01

Background Extreme heat events are the number one cause of weather-related fatalities in the United States. The current system of alert for extreme heat events does not take into account intra-urban spatial variation in risk. The purpose of this study is to evaluate a potential method to improve spatial delineation of risk from extreme heat events in urban environments by integrating sociodemographic risk factors with estimates of land surface temperature derived from thermal remote sensing data. Results Comparison of logistic regression models indicates that supplementing known sociodemographic risk factors with remote sensing estimates of land surface temperature improves the delineation of intra-urban variations in risk from extreme heat events. Conclusion Thermal remote sensing data can be utilized to improve understanding of intra-urban variations in risk from extreme heat. The refinement of current risk assessment systems could increase the likelihood of survival during extreme heat events and assist emergency personnel in the delivery of vital resources during such disasters. PMID:19835578

Estimating the prevalence of infertility in Canada

PubMed Central

Bushnik, Tracey; Cook, Jocelynn L.; Yuzpe, A. Albert; Tough, Suzanne; Collins, John

2012-01-01

BACKGROUND Over the past 10 years, there has been a significant increase in the use of assisted reproductive technologies in Canada, however, little is known about the overall prevalence of infertility in the population. The purpose of the present study was to estimate the prevalence of current infertility in Canada according to three definitions of the risk of conception. METHODS Data from the infertility component of the 2009–2010 Canadian Community Health Survey were analyzed for married and common-law couples with a female partner aged 18–44. The three definitions of the risk of conception were derived sequentially starting with birth control use in the previous 12 months, adding reported sexual intercourse in the previous 12 months, then pregnancy intent. Prevalence and odds ratios of current infertility were estimated by selected characteristics. RESULTS Estimates of the prevalence of current infertility ranged from 11.5% (95% CI 10.2, 12.9) to 15.7% (95% CI 14.2, 17.4). Each estimate represented an increase in current infertility prevalence in Canada when compared with previous national estimates. Couples with lower parity (0 or 1 child) had significantly higher odds of experiencing current infertility when the female partner was aged 35–44 years versus 18–34 years. Lower odds of experiencing current infertility were observed for multiparous couples regardless of age group of the female partner, when compared with nulliparous couples. CONCLUSIONS The present study suggests that the prevalence of current infertility has increased since the last time it was measured in Canada, and is associated with the age of the female partner and parity. PMID:22258658

Smoking-attributable medical expenditures by age, sex, and smoking status estimated using a relative risk approach☆

PubMed Central

Maciosek, Michael V.; Xu, Xin; Butani, Amy L.; Pechacek, Terry F.

2015-01-01

Objective To accurately assess the benefits of tobacco control interventions and to better inform decision makers, knowledge of medical expenditures by age, gender, and smoking status is essential. Method We propose an approach to distribute smoking-attributable expenditures by age, gender, and cigarette smoking status to reflect the known risks of smoking. We distribute hospitalization days for smoking-attributable diseases according to relative risks of smoking-attributable mortality, and use the method to determine national estimates of smoking-attributable expenditures by age, sex, and cigarette smoking status. Sensitivity analyses explored assumptions of the method. Results Both current and former smokers ages 75 and over have about 12 times the smoking-attributable expenditures of their current and former smoker counterparts 35–54 years of age. Within each age group, the expenditures of formers smokers are about 70% lower than current smokers. In sensitivity analysis, these results were not robust to large changes to the relative risks of smoking-attributable mortality which were used in the calculations. Conclusion Sex- and age-group-specific smoking expenditures reflect observed disease risk differences between current and former cigarette smokers and indicate that about 70% of current smokers’ excess medical care costs is preventable by quitting. PMID:26051203

Estimating Counterfactual Risk Under Hypothetical Interventions in the Presence of Competing Events: Crystalline Silica Exposure and Mortality From two Causes of Death.

PubMed

Neophytou, Andreas M; Picciotto, Sally; Brown, Daniel M; Gallagher, Lisa E; Checkoway, Harvey; Eisen, Ellen A; Costello, Sadie

2018-04-03

Exposure to silica has been linked to excess risk of lung cancer and non-malignant respiratory disease mortality. In this study we estimated risk for both these outcomes in relation to occupational silica exposure as well as the reduction in risk that would result from hypothetical interventions on exposure in a cohort of exposed workers. Analyses were carried out in an all-male study population consisting of 2342 California diatomaceous earth workers regularly exposed to crystalline silica, followed between 1942 and 2011. We estimated subdistribution risk for each event under the natural course and interventions of interest using the parametric g-formula to adjust for healthy worker survivor bias. The risk ratio for lung cancer mortality comparing an intervention in which a theoretical maximum exposure limit was set at 0.05 mg/m3 (the current U.S. regulatory limit) to the observed exposure concentrations was 0.86 (95% confidence interval: 0.63, 1.22). The corresponding risk ratio for non-malignant respiratory disease mortality was 0.69 (95% confidence interval: 0.52, 0.93). Our findings suggest that risks from both outcomes would have been considerably lower if historical silica exposures in this cohort had not exceeded current regulatory limits.

The association between relationship markers of sexual orientation and suicide: Denmark, 1990-2001.

PubMed

Mathy, Robin M; Cochran, Susan D; Olsen, Jorn; Mays, Vickie M

2011-02-01

Minority sexual orientation has been repeatedly linked to elevated rates of suicide attempts. Whether this translates into greater risk for suicide mortality is unclear. We investigated sexual orientation-related differences in suicide mortality in Denmark during the initial 12-year period following legalization of same-sex registered domestic partnerships (RDPs). Using data from death certificates issued between 1990 and 2001 and population estimates from the Danish census, we estimated suicide mortality risk among individuals classified into one of three marital/cohabitation statuses: current/formerly in same-sex RDPs; current/formerly heterosexually married; or never married/registered. Risk for suicide mortality was associated with this proxy indicator of sexual orientation, but only significantly among men. The estimated age-adjusted suicide mortality risk for RDP men was nearly eight times greater than for men with positive histories of heterosexual marriage and nearly twice as high for men who had never married. Suicide risk appears greatly elevated for men in same-sex partnerships in Denmark. To what extent this is true for similar gay and bisexual men who are not in such relationships is unknown, but these findings call for targeted suicide prevention programs aimed at reducing suicide risk among gay and bisexual men.

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

PubMed

Robinson, Lisa A; Hammitt, James K

2016-08-01

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

Suicide risk assessment: Trust an implicit probe or listen to the patient?

PubMed

Harrison, Dominique P; Stritzke, Werner G K; Fay, Nicolas; Hudaib, Abdul-Rahman

2018-05-21

Previous research suggests implicit cognition can predict suicidal behavior. This study examined the utility of the death/suicide implicit association test (d/s-IAT) in acute and prospective assessment of suicide risk and protective factors, relative to clinician and patient estimates of future suicide risk. Patients (N = 128; 79 female; 111 Caucasian) presenting to an emergency department were recruited if they reported current suicidal ideation or had been admitted because of an acute suicide attempt. Patients completed the d/s-IAT and self-report measures assessing three death-promoting (e.g., suicide ideation) and two life-sustaining (e.g., zest for life) factors, with self-report measures completed again at 3- and 6-month follow-ups. The clinician and patient provided risk estimates of that patient making a suicide attempt within the next 6 months. Results showed that among current attempters, the d/s-IAT differentiated between first time and multiple attempters; with multiple attempters having significantly weaker self-associations with life relative to death. The d/s-IAT was associated with concurrent suicidal ideation and zest for life, but only predicted the desire to die prospectively at 3 months. By contrast, clinician and patient estimates predicted suicide risk at 3- and 6-month follow-up, with clinician estimates predicting death-promoting factors, and only patient estimates predicting life-sustaining factors. The utility of the d/s-IAT was more pronounced in the assessment of concurrent risk. Prospectively, clinician and patient predictions complemented each other in predicting suicide risk and resilience, respectively. Our findings indicate collaborative rather than implicit approaches add greater value to the management of risk and recovery in suicidal patients. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Quantitative comparisons of cancer induction in humans by internally deposited radionuclides and external radiation.

PubMed

Harrison, J D; Muirhead, C R

2003-01-01

To compare quantitative estimates of lifetime cancer risk in humans for exposures to internally deposited radionuclides and external radiation. To assess the possibility that risks from radionuclide exposures may be underestimated. Risk estimates following internal exposures can be made for a small number of alpha-particle-emitting nuclides. (1) Lung cancer in underground miners exposed by inhalation to radon-222 gas and its short-lived progeny. Studies of residential (222)Rn exposure are generally consistent with predictions from the miner studies. (2) Liver cancer and leukaemia in patients given intravascular injections of Thorotrast, a thorium-232 oxide preparation that concentrates in liver, spleen and bone marrow. (3) Bone cancer in patients given injections of radium-224, and in workers exposed occupationally to (226)Ra and (228)Ra, mainly by ingestion. (4) Lung cancer in Mayak workers exposed to plutonium-239, mainly by inhalation. Liver and bone cancers were also seen, but the dosimetry is not yet sufficiently good enough to provide quantitative estimates of risks. Comparisons can be made between risk estimates for radiation-induced cancer derived for radionuclide exposure and those derived for the A-bomb survivors, exposed mainly to low-LET (linear energy transfer) external radiation. Data from animal studies, using dogs and rodents, allow comparisons of cancer induction by a range of alpha- and beta-/gamma-emitting radionuclides. They provide information on relative biological effectiveness (RBE), dose-response relationships, dose-rate effects and the location of target cells for different malignancies. For lung and liver cancer, the estimated values of risk per Sv for internal exposure, assuming an RBE for alpha-particles of 20, are reasonably consistent with estimates for external exposure to low-LET radiation. This also applies to bone cancer when risk is calculated on the basis of average bone dose, but consideration of dose to target cells on bone surfaces suggests a low RBE for alpha-particles. Similarly, for leukaemia, the comparison of risks from alpha-irradiation ((232)Th and progeny) and external radiation suggest a low alpha RBE; this conclusion is supported by animal data. Risk estimates for internal exposure are dependent on the assumptions made in calculating dose. Account is taken of the distribution of radionuclides within tissues and the distribution of target cells for cancer induction. For the lungs and liver, the available human and animal data provide support for current assumptions. However, for bone cancer and leukaemia, it may be that changes are required. Bone cancer risk may be best assessed by calculating dose to a 50 micro m layer of marrow adjacent to endosteal (inner) bone surfaces rather than to a single 10 micro m cell layer as currently assumed. Target cells for leukaemia may be concentrated towards the centre of marrow cavities so that the risk of leukaemia from bone-seeking radionuclides, particularly alpha emitters, may be overestimated by the current assumption of uniform distribution of target cells throughout red bone marrow. The lifetime risk estimates considered here for exposure to internally deposited radionuclides and to external radiation are subject to uncertainties, arising from the dosimetric assumptions made, from the quality of cancer incidence and mortality data and from aspects of risk modelling; including variations in baseline rates between populations for some cancer types. Bearing in mind such uncertainties, comparisons of risk estimates for internal emitters and external radiation show good agreement for lung and liver cancers. For leukaemia, the available data suggest that the assumption of an alpha-particle RBE of 20 can result in overestimates of risk. For bone cancer, it also appears that current assumptions will overestimate risks from alpha-particle-emitting nuclides, particularly at low doses.

An empirical Bayesian and Buhlmann approach with non-homogenous Poisson process

NASA Astrophysics Data System (ADS)

Noviyanti, Lienda

2015-12-01

All general insurance companies in Indonesia have to adjust their current premium rates according to maximum and minimum limit rates in the new regulation established by the Financial Services Authority (Otoritas Jasa Keuangan / OJK). In this research, we estimated premium rate by means of the Bayesian and the Buhlmann approach using historical claim frequency and claim severity in a five-group risk. We assumed a Poisson distributed claim frequency and a Normal distributed claim severity. Particularly, we used a non-homogenous Poisson process for estimating the parameters of claim frequency. We found that estimated premium rates are higher than the actual current rate. Regarding to the OJK upper and lower limit rates, the estimates among the five-group risk are varied; some are in the interval and some are out of the interval.

Estimating the decline in excess risk of cerebrovascular disease following quitting smoking--a systematic review based on the negative exponential model.

PubMed

Lee, Peter N; Fry, John S; Thornton, Alison J

2014-02-01

We attempted to quantify the decline in stroke risk following quitting using the negative exponential model, with methodology previously employed for IHD. We identified 22 blocks of RRs (from 13 studies) comparing current smokers, former smokers (by time quit) and never smokers. Corresponding pseudo-numbers of cases and controls/at risk formed the data for model-fitting. We tried to estimate the half-life (H, time since quit when the excess risk becomes half that for a continuing smoker) for each block. The method failed to converge or produced very variable estimates of H in nine blocks with a current smoker RR <1.40. Rejecting these, and combining blocks by amount smoked in one study where problems arose in model-fitting, the final analyses used 11 blocks. Goodness-of-fit was adequate for each block, the combined estimate of H being 4.78(95%CI 2.17-10.50) years. However, considerable heterogeneity existed, unexplained by any factor studied, with the random-effects estimate 3.08(1.32-7.16). Sensitivity analyses allowing for reverse causation or differing assumed times for the final quitting period gave similar results. The estimates of H are similar for stroke and IHD, and the individual estimates similarly heterogeneous. Fitting the model is harder for stroke, due to its weaker association with smoking. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment.

PubMed

Mogasale, Vittal; Maskery, Brian; Ochiai, R Leon; Lee, Jung Seok; Mogasale, Vijayalaxmi V; Ramani, Enusa; Kim, Young Eun; Park, Jin Kyung; Wierzba, Thomas F

2014-10-01

No access to safe water is an important risk factor for typhoid fever, yet risk-level heterogeneity is unaccounted for in previous global burden estimates. Since WHO has recommended risk-based use of typhoid polysaccharide vaccine, we revisited the burden of typhoid fever in low-income and middle-income countries (LMICs) after adjusting for water-related risk. We estimated the typhoid disease burden from studies done in LMICs based on blood-culture-confirmed incidence rates applied to the 2010 population, after correcting for operational issues related to surveillance, limitations of diagnostic tests, and water-related risk. We derived incidence estimates, correction factors, and mortality estimates from systematic literature reviews. We did scenario analyses for risk factors, diagnostic sensitivity, and case fatality rates, accounting for the uncertainty in these estimates and we compared them with previous disease burden estimates. The estimated number of typhoid fever cases in LMICs in 2010 after adjusting for water-related risk was 11·9 million (95% CI 9·9-14·7) cases with 129 000 (75 000-208 000) deaths. By comparison, the estimated risk-unadjusted burden was 20·6 million (17·5-24·2) cases and 223 000 (131 000-344 000) deaths. Scenario analyses indicated that the risk-factor adjustment and updated diagnostic test correction factor derived from systematic literature reviews were the drivers of differences between the current estimate and past estimates. The risk-adjusted typhoid fever burden estimate was more conservative than previous estimates. However, by distinguishing the risk differences, it will allow assessment of the effect at the population level and will facilitate cost-effectiveness calculations for risk-based vaccination strategies for future typhoid conjugate vaccine. Copyright © 2014 Mogasale et al. Open Access article distributed under the terms of CC BY-NC-SA. Published by .. All rights reserved.

Estimating micro area behavioural risk factor prevalence from large population-based surveys: a full Bayesian approach.

PubMed

Seliske, L; Norwood, T A; McLaughlin, J R; Wang, S; Palleschi, C; Holowaty, E

2016-06-07

An important public health goal is to decrease the prevalence of key behavioural risk factors, such as tobacco use and obesity. Survey information is often available at the regional level, but heterogeneity within large geographic regions cannot be assessed. Advanced spatial analysis techniques are demonstrated to produce sensible micro area estimates of behavioural risk factors that enable identification of areas with high prevalence. A spatial Bayesian hierarchical model was used to estimate the micro area prevalence of current smoking and excess bodyweight for the Erie-St. Clair region in southwestern Ontario. Estimates were mapped for male and female respondents of five cycles of the Canadian Community Health Survey (CCHS). The micro areas were 2006 Census Dissemination Areas, with an average population of 400-700 people. Two individual-level models were specified: one controlled for survey cycle and age group (model 1), and one controlled for survey cycle, age group and micro area median household income (model 2). Post-stratification was used to derive micro area behavioural risk factor estimates weighted to the population structure. SaTScan analyses were conducted on the granular, postal-code level CCHS data to corroborate findings of elevated prevalence. Current smoking was elevated in two urban areas for both sexes (Sarnia and Windsor), and an additional small community (Chatham) for males only. Areas of excess bodyweight were prevalent in an urban core (Windsor) among males, but not females. Precision of the posterior post-stratified current smoking estimates was improved in model 2, as indicated by narrower credible intervals and a lower coefficient of variation. For excess bodyweight, both models had similar precision. Aggregation of the micro area estimates to CCHS design-based estimates validated the findings. This is among the first studies to apply a full Bayesian model to complex sample survey data to identify micro areas with variation in risk factor prevalence, accounting for spatial correlation and other covariates. Application of micro area analysis techniques helps define areas for public health planning, and may be informative to surveillance and research modeling of relevant chronic disease outcomes.

A spatially explicit model for estimating risks of pesticide exposure on bird populations

EPA Science Inventory

Product Description (FY17 Key Product): Current ecological risk assessment for pesticides under FIFRA relies on risk quotients (RQs), which suffer from significant methodological shortcomings. For example, RQs do not integrate adverse effects arising from multiple demographic pr...

Estimates of Present and Future Flood Risk in the Conterminous United States

NASA Astrophysics Data System (ADS)

Wing, O.; Bates, P. D.; Smith, A.; Sampson, C. C.; Johnson, K.; Fargione, J.; Morefield, P.

2017-12-01

Past attempts to estimate flood risk across the USA either have incomplete coverage, coarse resolution or use overly simplified models of the flooding process. In this paper, we use a new 30m resolution model of the entire conterminous US (CONUS) with realistic flood physics to produce estimates of flood hazard which match to within 90% accuracy the skill of local models built with detailed data. Socio-economic data of commensurate resolution are combined with these flood depths to estimate current and future flood risk. Future population and land-use projections from the US Environmental Protection Agency (USEPA) are employed to indicate how flood risk might change through the 21st Century, while present-day estimates utilize the Federal Emergency Management Agency (FEMA) National Structure Inventory and a USEPA map of population distribution. Our data show that the total CONUS population currently exposed to serious flooding is 2.6 to 3.1 times higher than previous estimates; with nearly 41 million Americans living within the so-called 1 in 100-year (1% annual probability) floodplain, compared to only 13 million according to FEMA flood maps. Moreover, socio-economic change alone leads to significant future increases in flood exposure and risk, even before climate change impacts are accounted for. The share of the population living on the 1 in 100-year floodplain is projected to increase from 13.3% in the present-day to 15.6 - 15.8% in 2050 and 16.4 - 16.8% in 2100. The area of developed land within this floodplain, currently at 150,000 km2, is likely to increase by 37 - 72% in 2100 based on the scenarios selected. 5.5 trillion worth of assets currently lie on the 1% floodplain; we project that by 2100 this number will exceed 10 trillion. With this detailed spatial information on present-day flood risk, federal and state agencies can take appropriate action to mitigate losses. Use of USEPA population and land-use projections mean that particular attention can be paid to floodplains where development is projected. Steps to conserve such areas or ensure adequate defenses are in place could avoid the exposure of trillions of dollars of assets, not to mention the human suffering caused by loss of property and life.

Impact of UKPDS risk estimation added to a first subjective risk estimation on management of coronary disease risk in type 2 diabetes - An observational study.

PubMed

Wind, Anne E; Gorter, Kees J; van den Donk, Maureen; Rutten, Guy E H M

2016-02-01

To investigate the impact of the UKPDS risk engine on management of CHD risk in T2DM patients. Observational study among 139 GPs. Data from 933 consecutive patients treated with a maximum of two oral glucose lowering drugs, collected at baseline and after twelve months. GPs estimated the CHD risk themselves and afterwards they calculated this with the UKPDS risk engine. Under- and overestimation were defined as a difference >5 percentage points difference between both calculations. The impact of the UKPDS risk engine was assessed by measuring differences in medication adjustments between the over-, under- and accurately estimated group. In 42.0% the GP accurately estimated the CHD risk, in 32.4% the risk was underestimated and in 25.6% overestimated. Mean difference between the estimated (18.7%) and calculated (19.1%) 10 years CHD risk was -0.36% (95% CI -1.24 to 0.52). Male gender, current smoking and total cholesterol level were associated with underestimation. Patients with an subjectively underestimated CHD risk received significantly more medication adjustments. Their UKPDS 10 year CHD risk did not increase during the follow-up period, contrary to the other two groups of patients. The UKPDS risk engine may be of added value for risk management in T2DM. Copyright © 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Smoking, HIV, and risk of pregnancy loss.

PubMed

Westreich, Daniel; Cates, Jordan; Cohen, Mardge; Weber, Kathleen M; Seidman, Dominika; Cropsey, Karen; Wright, Rodney; Milam, Joel; Young, Mary A; Mehta, C Christina; Gustafson, Deborah R; Golub, Elizabeth T; Fischl, Margaret A; Adimora, Adaora A

2017-02-20

Cigarette smoking during pregnancy increases risks of poor pregnancy outcomes including miscarriage and stillbirth (pregnancy loss), but the effect of smoking on pregnancy loss among HIV-infected women has not been explored. Here, investigated the impact of smoking on risk of pregnancy loss among HIV-positive and HIV-negative women, and estimated the potential impact of realistic smoking cessation interventions on risk of pregnancy loss among HIV-positive women. We analyzed pregnancy outcomes in HIV-positive and HIV-negative participants in the Women's Interagency HIV Study between 1994 and 2014. We estimated effects of current smoking at or immediately before pregnancy on pregnancy loss; we controlled for confounding using regression approaches, and estimated potential impact of realistic smoking cessation interventions using a semiparametric g-formula approach. Analysis examined 1033 pregnancies among 659 women. The effect of smoking on pregnancy loss differed dramatically by HIV status: adjusted for confounding, the risk difference comparing current smokers to current nonsmokers was 19.2% (95% confidence limit 10.9-27.5%) in HIV-positive women and 9.7% (95% confidence limit 0.0-19.4%) in HIV-negative women. These results were robust to sensitivity analyses. We estimated that we would need to offer a realistic smoking cessation intervention to 36 women to prevent one pregnancy loss. Smoking is a highly prevalent exposure with important consequences for pregnancy in HIV-positive pregnant women in the United States, even in the presence of potent highly active antiretroviral therapy. This evidence supports greater efforts to promote smoking cessation interventions among HIV-positive women, especially those who desire to become pregnant.

Estimating the Impact of Adding C-Reactive Protein as a Criterion for Lipid Lowering Treatment in the United States

PubMed Central

Schwartz, Lisa M.; Kerin, Kevin; Welch, H. Gilbert

2007-01-01

Background There is growing interest in using C-reactive protein (CRP) levels to help select patients for lipid lowering therapy—although this practice is not yet supported by evidence of benefit in a randomized trial. Objective To estimate the number of Americans potentially affected if a CRP criteria were adopted as an additional indication for lipid lowering therapy. To provide context, we also determined how well current lipid lowering guidelines are being implemented. Methods We analyzed nationally representative data to determine how many Americans age 35 and older meet current National Cholesterol Education Program (NCEP) treatment criteria (a combination of risk factors and their Framingham risk score). We then determined how many of the remaining individuals would meet criteria for treatment using 2 different CRP-based strategies: (1) narrow: treat individuals at intermediate risk (i.e., 2 or more risk factors and an estimated 10–20% risk of coronary artery disease over the next 10 years) with CRP > 3 mg/L and (2) broad: treat all individuals with CRP > 3 mg/L. Data source Analyses are based on the 2,778 individuals participating in the 1999–2002 National Health and Nutrition Examination Survey with complete data on cardiac risk factors, fasting lipid levels, CRP, and use of lipid lowering agents. Main measures The estimated number and proportion of American adults meeting NCEP criteria who take lipid-lowering drugs, and the additional number who would be eligible based on CRP testing. Results About 53 of the 153 million Americans aged 35 and older meet current NCEP criteria (that do not involve CRP) for lipid-lowering treatment. Sixty-five percent, however, are not currently being treated, even among those at highest risk (i.e., patients with established heart disease or its risk equivalent)—62% are untreated. Adopting the narrow and broad CRP strategies would make an additional 2.1 and 25.3 million Americans eligible for treatment, respectively. The latter strategy would make over half the adults age 35 and older eligible for lipid-lowering therapy, with most of the additionally eligible (57%) coming from the lowest NCEP heart risk category (i.e., 0–1 risk factors). Conclusion There is substantial underuse of lipid lowering therapy for American adults at high risk for coronary disease. Rather than adopting CRP-based strategies, which would make millions more lower risk patients eligible for treatment (and for whom treatment benefit has not yet been demonstrated in a randomized trial), we should ensure the treatment of currently defined high-risk patients for whom the benefit of therapy is established. PMID:17356986

A Web-Based System for Bayesian Benchmark Dose Estimation.

PubMed

Shao, Kan; Shapiro, Andrew J

2018-01-11

Benchmark dose (BMD) modeling is an important step in human health risk assessment and is used as the default approach to identify the point of departure for risk assessment. A probabilistic framework for dose-response assessment has been proposed and advocated by various institutions and organizations; therefore, a reliable tool is needed to provide distributional estimates for BMD and other important quantities in dose-response assessment. We developed an online system for Bayesian BMD (BBMD) estimation and compared results from this software with U.S. Environmental Protection Agency's (EPA's) Benchmark Dose Software (BMDS). The system is built on a Bayesian framework featuring the application of Markov chain Monte Carlo (MCMC) sampling for model parameter estimation and BMD calculation, which makes the BBMD system fundamentally different from the currently prevailing BMD software packages. In addition to estimating the traditional BMDs for dichotomous and continuous data, the developed system is also capable of computing model-averaged BMD estimates. A total of 518 dichotomous and 108 continuous data sets extracted from the U.S. EPA's Integrated Risk Information System (IRIS) database (and similar databases) were used as testing data to compare the estimates from the BBMD and BMDS programs. The results suggest that the BBMD system may outperform the BMDS program in a number of aspects, including fewer failed BMD and BMDL calculations and estimates. The BBMD system is a useful alternative tool for estimating BMD with additional functionalities for BMD analysis based on most recent research. Most importantly, the BBMD has the potential to incorporate prior information to make dose-response modeling more reliable and can provide distributional estimates for important quantities in dose-response assessment, which greatly facilitates the current trend for probabilistic risk assessment. https://doi.org/10.1289/EHP1289.

T-HERPS Version 1.0 User's Guide for Risk to Amphibians and Reptiles from Pesticides

EPA Pesticide Factsheets

T-HERPS estimates dietary exposure and risk to terrestrial-phase amphibians and reptiles from pesticide use. Currently approved for assessing exposure and risk to the California red-legged frog and terrestrial-phase herptiles with similar dietary behavior

P-8A Poseidon Multi Mission Maritime Aircraft (P-8A)

DTIC Science & Technology

2015-12-01

focus also includes procurement of depot and intermediate level maintenance capabilities, full scale fatigue testing, and continued integration and... Level Confidence Level of cost estimate for current APB: 50% The current APB cost estimate provided sufficient resources to execute the program under...normal conditions, encountering average levels of technical, schedule, and programmatic risk and external interference. It was consistent with

Modeled Health Economic Impact of a Hypothetical Certolizumab Pegol Risk-Sharing Scheme for Patients with Moderate-to-Severe Rheumatoid Arthritis in Finland.

PubMed

Soini, Erkki; Asseburg, Christian; Taiha, Maarit; Puolakka, Kari; Purcaru, Oana; Luosujärvi, Riitta

2017-10-01

To model the American College of Rheumatology (ACR) outcomes, cost-effectiveness, and budget impact of certolizumab pegol (CZP) (with and without a hypothetical risk-sharing scheme at treatment initiation for biologic-naïve patients) versus the current mix of reimbursed biologics for treatment of moderate-to-severe rheumatoid arthritis (RA) in Finland. A probabilistic model with 12-week cycles and a societal approach was developed for the years 2015-2019, accounting for differences in ACR responses (meta-analysis), mortality, and persistence. The risk-sharing scheme included a treatment switch and refund of the costs associated with CZP acquisition if patients failed to achieve ACR20 response at week 12. For the current treatment mix, ACR20 at week 24 determined treatment continuation. Quality-adjusted life years were derived on the basis of the Health Utilities Index. In the Finnish target population, CZP treatment with a risk-sharing scheme led to a estimated annual net expenditure decrease ranging from 1.7% in 2015 to 5.6% in 2019 compared with the current treatment mix. Per patient over the 5 years, CZP risk sharing was estimated to decrease the time without ACR response by 5%-units, decrease work absenteeism by 24 days, and increase the time with ACR20, ACR50, and ACR70 responses by 5%-, 6%-, and 1%-units, respectively, with a gain of 0.03 quality-adjusted life years. The modeled risk-sharing scheme showed reduced costs of €7866 per patient, with a more than 95% probability of cost-effectiveness when compared with the current treatment mix. The present analysis estimated that CZP, with or without the risk-sharing scheme, is a cost-effective alternative treatment for RA patients in Finland. The surplus provided by the CZP risk-sharing scheme could fund treatment for 6% more Finnish RA patients. UCB Pharma.

Poverty among Foster Children: Estimates Using the Supplemental Poverty Measure

PubMed Central

Pac, Jessica; Waldfogel, Jane; Wimer, Christopher

2017-01-01

We use data from the Current Population Survey and the new Supplemental Poverty Measure (SPM) to provide estimates for poverty among foster children over the period 1992 to 2013. These are the first large-scale national estimates for foster children who are not included in official poverty statistics. Holding child and family demographics constant, foster children have a lower risk of poverty than other children. Analyzing income in detail suggests that foster care payments likely play an important role in reducing the risk of poverty in this group. In contrast, we find that children living with grandparents have a higher risk of poverty than other children, even after taking demographics into account. Our estimates suggest that this excess risk is likely linked to their lower likelihood of receiving foster care or other income supports. PMID:28659651

Projected cancer risks potentially related to past, current, and future practices in paediatric CT in the United Kingdom, 1990-2020.

PubMed

Journy, Neige M Y; Lee, Choonsik; Harbron, Richard W; McHugh, Kieran; Pearce, Mark S; Berrington de González, Amy

2017-01-03

To project risks of developing cancer and the number of cases potentially induced by past, current, and future computed tomography (CT) scans performed in the United Kingdom in individuals aged <20 years. Organ doses were estimated from surveys of individual scan parameters and CT protocols used in the United Kingdom. Frequencies of scans were estimated from the NHS Diagnostic Imaging Dataset. Excess lifetime risks (ELRs) of radiation-related cancer were calculated as cumulative lifetime risks, accounting for survival probabilities, using the RadRAT risk assessment tool. In 2000-2008, ELRs ranged from 0.3 to 1 per 1000 head scans and 1 to 5 per 1000 non-head scans. ELRs per scan were reduced by 50-70% in 2000-2008 compared with 1990-1995, subsequent to dose reduction over time. The 130 750 scans performed in 2015 in the United Kingdom were projected to induce 64 (90% uncertainty interval (UI): 38-113) future cancers. Current practices would lead to about 300 (90% UI: 230-680) future cancers induced by scans performed in 2016-2020. Absolute excess risks from single exposures would be low compared with background risks, but even small increases in annual CT rates over the next years would substantially increase the number of potential subsequent cancers.

Estimating Radiation Dose Metrics for Patients Undergoing Tube Current Modulation CT Scans

NASA Astrophysics Data System (ADS)

McMillan, Kyle Lorin

Computed tomography (CT) has long been a powerful tool in the diagnosis of disease, identification of tumors and guidance of interventional procedures. With CT examinations comes the concern of radiation exposure and the associated risks. In order to properly understand those risks on a patient-specific level, organ dose must be quantified for each CT scan. Some of the most widely used organ dose estimates are derived from fixed tube current (FTC) scans of a standard sized idealized patient model. However, in current clinical practice, patient size varies from neonates weighing just a few kg to morbidly obese patients weighing over 200 kg, and nearly all CT exams are performed with tube current modulation (TCM), a scanning technique that adjusts scanner output according to changes in patient attenuation. Methods to account for TCM in CT organ dose estimates have been previously demonstrated, but these methods are limited in scope and/or restricted to idealized TCM profiles that are not based on physical observations and not scanner specific (e.g. don't account for tube limits, scanner-specific effects, etc.). The goal of this work was to develop methods to estimate organ doses to patients undergoing CT scans that take into account both the patient size as well as the effects of TCM. This work started with the development and validation of methods to estimate scanner-specific TCM schemes for any voxelized patient model. An approach was developed to generate estimated TCM schemes that match actual TCM schemes that would have been acquired on the scanner for any patient model. Using this approach, TCM schemes were then generated for a variety of body CT protocols for a set of reference voxelized phantoms for which TCM information does not currently exist. These are whole body patient models representing a variety of sizes, ages and genders that have all radiosensitive organs identified. TCM schemes for these models facilitated Monte Carlo-based estimates of fully-, partially- and indirectly-irradiated organ dose from TCM CT exams. By accounting for the effects of patient size in the organ dose estimates, a comprehensive set of patient-specific dose estimates from TCM CT exams was developed. These patient-specific organ dose estimates from TCM CT exams will provide a more complete understanding of the dose impact and risks associated with modern body CT scanning protocols.

Radiation Dose and Cancer Risk Estimates in 16-Slice Computed Tomography Coronary Angiography

PubMed Central

Einstein, Andrew J.; Sanz, Javier; Dellegrottaglie, Santo; Milite, Margherita; Sirol, Marc; Henzlova, Milena; Rajagopalan, Sanjay

2008-01-01

Background Recent advances have led to a rapid increase in the number of computed tomography coronary angiography (CTCA) studies performed. While several studies have reported effective dose (E), there is no data available on cancer risk for current CTCA protocols. Methods and Results E and organ doses were estimated, using scanner-derived parameters and Monte Carlo methods, for 50 patients having 16-slice CTCA performed for clinical indications. Lifetime attributable risks (LARs) were estimated with models developed in the National Academies’ Biological Effects of Ionizing Radiation VII report. E of a complete CTCA averaged 9.5 mSv, while that of a complete study, including calcium scoring when indicated, averaged 11.7 mSv. Calcium scoring increased E by 25%, while tube current modulation reduced it by 34% and was more effective at lower heart rates. Organ doses were highest to the lungs and female breast. LAR of cancer incidence from CTCA averaged approximately 1 in 1600, but varied widely between patients, being highest in younger women. For all patients, the greatest risk was from lung cancer. Conclusions CTCA is associated with non-negligible risk of malignancy. Doses can be reduced by careful attention to scanning protocol. PMID:18371595

Comparing risk estimates following diagnostic CT radiation exposures employing different methodological approaches.

PubMed

Kashcheev, Valery V; Pryakhin, Evgeny A; Menyaylo, Alexander N; Chekin, Sergey Yu; Ivanov, Viktor K

2014-06-01

The current study has two aims: the first is to quantify the difference between radiation risks estimated with the use of organ or effective doses, particularly when planning pediatric and adult computed tomography (CT) examinations. The second aim is to determine the method of calculating organ doses and cancer risk using dose-length product (DLP) for typical routine CT examinations. In both cases, the radiation-induced cancer risks from medical CT examinations were evaluated as a function of gender and age. Lifetime attributable risk values from CT scanning were estimated with the use of ICRP (Publication 103) risk models and Russian national medical statistics data. For populations under the age of 50 y, the risk estimates based on organ doses usually are 30% higher than estimates based on effective doses. In older populations, the difference can be up to a factor of 2.5. The typical distributions of organ doses were defined for Chest Routine, Abdominal Routine, and Head Routine examinations. The distributions of organ doses were dependent on the anatomical region of scanning. The most exposed organs/tissues were thyroid, breast, esophagus, and lungs in cases of Chest Routine examination; liver, stomach, colon, ovaries, and bladder in cases of Abdominal Routine examination; and brain for Head Routine examinations. The conversion factors for calculation of typical organ doses or tissues at risk using DLP were determined. Lifetime attributable risk of cancer estimated with organ doses calculated from DLP was compared with the risk estimated on the basis of organ doses measured with the use of silicon photodiode dosimeters. The estimated difference in LAR is less than 29%.

Risk and Risk Assessment in Environmental Education.

ERIC Educational Resources Information Center

Chiras, Daniel D.

1982-01-01

Risk assessment (the identification of hazards, the determination of the probability of a hazardous event occurring, and an estimation of the severity of such an event's occurrence) is suggested as a technique to be used to analyze current issues in environmental education in an objective manner. (PEB)

Modeling for the allocation of oil spill recovery capacity considering environmental and economic factors.

PubMed

Ha, Min-Jae

2018-01-01

This study presents a regional oil spill risk assessment and capacities for marine oil spill response in Korea. The risk assessment of oil spill is carried out using both causal factors and environmental/economic factors. The weight of each parameter is calculated using the Analytic Hierarchy Process (AHP). Final regional risk degrees of oil spill are estimated by combining the degree and weight of each existing parameter. From these estimated risk levels, oil recovery capacities were determined with reference to the recovery target of 7500kl specified in existing standards. The estimates were deemed feasible, and provided a more balanced distribution of resources than existing capacities set according to current standards. Copyright © 2017 Elsevier Ltd. All rights reserved.

The burden of cancer attributable to modifiable risk factors: the Australian cancer-PAF cohort consortium.

PubMed

Arriaga, Maria E; Vajdic, Claire M; Canfell, Karen; MacInnis, Robert; Hull, Peter; Magliano, Dianna J; Banks, Emily; Giles, Graham G; Cumming, Robert G; Byles, Julie E; Taylor, Anne W; Shaw, Jonathan E; Price, Kay; Hirani, Vasant; Mitchell, Paul; Adelstein, Barbara-Ann; Laaksonen, Maarit A

2017-06-14

To estimate the Australian cancer burden attributable to lifestyle-related risk factors and their combinations using a novel population attributable fraction (PAF) method that accounts for competing risk of death, risk factor interdependence and statistical uncertainty. 365 173 adults from seven Australian cohort studies. We linked pooled harmonised individual participant cohort data with population-based cancer and death registries to estimate exposure-cancer and exposure-death associations. Current Australian exposure prevalence was estimated from representative external sources. To illustrate the utility of the new PAF method, we calculated fractions of cancers causally related to body fatness or both tobacco and alcohol consumption avoidable in the next 10 years by risk factor modifications, comparing them with fractions produced by traditional PAF methods. Over 10 years of follow-up, we observed 27 483 incident cancers and 22 078 deaths. Of cancers related to body fatness (n=9258), 13% (95% CI 11% to 16%) could be avoided if those currently overweight or obese had body mass index of 18.5-24.9 kg/m 2 . Of cancers causally related to both tobacco and alcohol (n=4283), current or former smoking explains 13% (11% to 16%) and consuming more than two alcoholic drinks per day explains 6% (5% to 8%). The two factors combined explain 16% (13% to 19%): 26% (21% to 30%) in men and 8% (4% to 11%) in women. Corresponding estimates using the traditional PAF method were 20%, 31% and 10%. Our PAF estimates translate to 74 000 avoidable body fatness-related cancers and 40 000 avoidable tobacco- and alcohol-related cancers in Australia over the next 10 years (2017-2026). Traditional PAF methods not accounting for competing risk of death and interdependence of risk factors may overestimate PAFs and avoidable cancers. We will rank the most important causal factors and their combinations for a spectrum of cancers and inform cancer control activities. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The association between relationship markers of sexual orientation and suicide: Denmark, 1990–2001

PubMed Central

Mathy, Robin M.; Olsen, Jorn; Mays, Vickie M.

2009-01-01

Objective Minority sexual orientation has been repeatedly linked to elevated rates of suicide attempts. Whether this translates into greater risk for suicide mortality is unclear. We investigated sexual orientation-related differences in suicide mortality in Denmark during the initial 12-year period following legalization of same-sex registered domestic partnerships (RDPs). Method Using data from death certificates issued between 1990 and 2001 and population estimates from the Danish census, we estimated suicide mortality risk among individuals classified into one of three marital/cohabitation statuses: current/formerly in same-sex RDPs; current/formerly heterosexually married; or never married/registered. Results Risk for suicide mortality was associated with this proxy indicator of sexual orientation, but only significantly among men. The estimated age-adjusted suicide mortality risk for RDP men was nearly eight times greater than for men with positive histories of heterosexual marriage and nearly twice as high for men who had never married. Conclusions Suicide risk appears greatly elevated for men in same-sex partnerships in Denmark. To what extent this is true for similar gay and bisexual men who are not in such relationships is unknown, but these findings call for targeted suicide prevention programs aimed at reducing suicide risk among gay and bisexual men. PMID:20033129

Direct estimates of low-level radiation risks of lung cancer at two NRC-compliant nuclear installations: why are the new risk estimates 20 to 200 times the old official estimates?

PubMed

Bross, I D; Driscoll, D L

1981-01-01

An official report on the health hazards to nuclear submarine workers at the Portsmouth Naval Shipyard (PNS), who were exposed to low-level ionizing radiation, was based on a casual inspection of the data and not on statistical analyses of the dosage-response relationships. When these analyses are done, serious hazards from lung cancer and other causes of death are shown. As a result of the recent studies on nuclear workers, the new risk estimates have been found to be much higher than the official estimates currently used in setting NRC permissible levels. The official BEIR estimates are about one lung cancer death per year per million persons per rem[s]. The PNS data show 189 lung cancer deaths per year per million persons per rem.

ALTERNATIVE APPROACH TO ESTIMATING CANCER ...

EPA Pesticide Factsheets

The alternative approach for estimating cancer potency from inhalation exposure to asbestos seeks to improve the methods developed by USEPA (1986). This efforts seeks to modify the the current approach for estimating cancer potency for lung cancer and mesothelioma to account for the current scientific consensus that cancer risk from asbestos depends both on mineral type and on particle size distribution. In brief, epidemiological exposure-response data for lung cancer and mesothelioma in asbestos workers are combined with estimates of the mineral type(s) and partical size distribution at each exposure location in order to estimate potency factors that are specific to a selected set of mineral type and size

The Pittsburgh Cervical Cancer Screening Model: a risk assessment tool.

PubMed

Austin, R Marshall; Onisko, Agnieszka; Druzdzel, Marek J

2010-05-01

Evaluation of cervical cancer screening has grown increasingly complex with the introduction of human papillomavirus (HPV) vaccination and newer screening technologies approved by the US Food and Drug Administration. To create a unique Pittsburgh Cervical Cancer Screening Model (PCCSM) that quantifies risk for histopathologic cervical precancer (cervical intraepithelial neoplasia [CIN] 2, CIN3, and adenocarcinoma in situ) and cervical cancer in an environment predominantly using newer screening technologies. The PCCSM is a dynamic Bayesian network consisting of 19 variables available in the laboratory information system, including patient history data (most recent HPV vaccination data), Papanicolaou test results, high-risk HPV results, procedure data, and histopathologic results. The model's graphic structure was based on the published literature. Results from 375 441 patient records from 2005 through 2008 were used to build and train the model. Additional data from 45 930 patients were used to test the model. The PCCSM compares risk quantitatively over time for histopathologically verifiable CIN2, CIN3, adenocarcinoma in situ, and cervical cancer in screened patients for each current cytology result category and for each HPV result. For each current cytology result, HPV test results affect risk; however, the degree of cytologic abnormality remains the largest positive predictor of risk. Prior history also alters the CIN2, CIN3, adenocarcinoma in situ, and cervical cancer risk for patients with common current cytology and HPV test results. The PCCSM can also generate negative risk projections, estimating the likelihood of the absence of histopathologic CIN2, CIN3, adenocarcinoma in situ, and cervical cancer in screened patients. The PCCSM is a dynamic Bayesian network that computes quantitative cervical disease risk estimates for patients undergoing cervical screening. Continuously updatable with current system data, the PCCSM provides a new tool to monitor cervical disease risk in the evolving postvaccination era.

The role of non-invasive cardiovascular imaging in the assessment of cardiovascular risk in rheumatoid arthritis: where we are and where we need to be.

PubMed

Fent, Graham J; Greenwood, John P; Plein, Sven; Buch, Maya H

2017-07-01

This review assesses the risk assessment of cardiovascular disease (CVD) in rheumatoid arthritis (RA) and how non-invasive imaging modalities may improve risk stratification in future. RA is common and patients are at greater risk of CVD than the general population. Cardiovascular (CV) risk stratification is recommended in European guidelines for patients at high and very high CV risk in order to commence preventative therapy. Ideally, such an assessment should be carried out immediately after diagnosis and as part of ongoing long-term patient care in order to improve patient outcomes. The risk profile in RA is different from the general population and is not well estimated using conventional clinical CVD risk algorithms, particularly in patients estimated as intermediate CVD risk. Non-invasive imaging techniques may therefore play an important role in improving risk assessment. However, there are currently very limited prognostic data specific to patients with RA to guide clinicians in risk stratification using these imaging techniques. RA is associated with increased risk of CV mortality, mainly attributable to atherosclerotic disease, though in addition, RA is associated with many other disease processes which further contribute to increased CV mortality. There is reasonable evidence for using carotid ultrasound in patients estimated to be at intermediate risk of CV mortality using clinical CVD risk algorithms. Newer imaging techniques such as cardiovascular magnetic resonance and CT offer the potential to improve risk stratification further; however, longitudinal data with hard CVD outcomes are currently lacking. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Risk of breast cancer following exposure to tetrachloroethylene-contaminated drinking water in Cape Cod, Massachusetts: reanalysis of a case-control study using a modified exposure assessment

PubMed Central

2011-01-01

Background Tetrachloroethylene (PCE) is an important occupational chemical used in metal degreasing and drycleaning and a prevalent drinking water contaminant. Exposure often occurs with other chemicals but it occurred alone in a pattern that reduced the likelihood of confounding in a unique scenario on Cape Cod, Massachusetts. We previously found a small to moderate increased risk of breast cancer among women with the highest exposures using a simple exposure model. We have taken advantage of technical improvements in publically available software to incorporate a more sophisticated determination of water flow and direction to see if previous results were robust to more accurate exposure assessment. Methods The current analysis used PCE exposure estimates generated with the addition of water distribution modeling software (EPANET 2.0) to test model assumptions, compare exposure distributions to prior methods, and re-examine the risk of breast cancer. In addition, we applied data smoothing to examine nonlinear relationships between breast cancer and exposure. We also compared a set of measured PCE concentrations in water samples collected in 1980 to modeled estimates. Results Thirty-nine percent of individuals considered unexposed in prior epidemiological analyses were considered exposed using the current method, but mostly at low exposure levels. As a result, the exposure distribution was shifted downward resulting in a lower value for the 90th percentile, the definition of "high exposure" in prior analyses. The current analyses confirmed a modest increase in the risk of breast cancer for women with high PCE exposure levels defined by either the 90th percentile (adjusted ORs 1.0-1.5 for 0-19 year latency assumptions) or smoothing analysis cut point (adjusted ORs 1.3-2.0 for 0-15 year latency assumptions). Current exposure estimates had a higher correlation with PCE concentrations in water samples (Spearman correlation coefficient = 0.65, p < 0.0001) than estimates generated using the prior method (0.54, p < 0.0001). Conclusions The incorporation of sophisticated flow estimates in the exposure assessment method shifted the PCE exposure distribution downward, but did not meaningfully affect the exposure ranking of subjects or the strength of the association with the risk of breast cancer found in earlier analyses. Thus, the current analyses show a slightly elevated breast cancer risk for highly exposed women, with strengthened exposure assessment and minimization of misclassification by using the latest technology. PMID:21600013

Reconstruction of financial networks for robust estimation of systemic risk

NASA Astrophysics Data System (ADS)

Mastromatteo, Iacopo; Zarinelli, Elia; Marsili, Matteo

2012-03-01

In this paper we estimate the propagation of liquidity shocks through interbank markets when the information about the underlying credit network is incomplete. We show that techniques such as maximum entropy currently used to reconstruct credit networks severely underestimate the risk of contagion by assuming a trivial (fully connected) topology, a type of network structure which can be very different from the one empirically observed. We propose an efficient message-passing algorithm to explore the space of possible network structures and show that a correct estimation of the network degree of connectedness leads to more reliable estimations for systemic risk. Such an algorithm is also able to produce maximally fragile structures, providing a practical upper bound for the risk of contagion when the actual network structure is unknown. We test our algorithm on ensembles of synthetic data encoding some features of real financial networks (sparsity and heterogeneity), finding that more accurate estimations of risk can be achieved. Finally we find that this algorithm can be used to control the amount of information that regulators need to require from banks in order to sufficiently constrain the reconstruction of financial networks.

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

PubMed Central

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

2015-01-01

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

Population exposure to fine particles and estimated excess mortality in Finland from an East European wildfire episode.

PubMed

Hänninen, Otto O; Salonen, Raimo O; Koistinen, Kimmo; Lanki, Timo; Barregard, Lars; Jantunen, Matti

2009-05-01

Long-range transported particulate matter (PM) air pollution episodes associated with wildfires in the Eastern Europe are relatively common in Southern and Southeastern Finland. In severe cases such as in August-September 2002, the reduced visibility and smell of the smoke, and symptoms such as irritation of eyes and airways experienced by the population raise the issue into the headlines. Because PM air pollution, in general, has been identified as a major health risk, and the exposures are of repeating nature, the issue warrants a risk assessment to estimate the magnitude of the problem. The current work uses the available air quality data in Finland to estimate population exposures caused by one of the worst episodes experienced in this decade. This episode originated from wildfires in Russia, Belarus, Ukraine, and the Baltic countries. The populations of 11 Southern Finnish provinces were exposed between 26 August and 8 September 2002, for 2 weeks to an additional population-weighted average PM(2.5) level of 15.7 microg/m(3). Assuming similar effect on mortality for these particles as observed in epidemiological time series studies on urban particles (0.5%-2% increase in mortality per 10 microg/m(3), central estimate 1%), this exposure level would be associated with 9-34 cases (17 cases central estimate) of additional mortality. Epidemiological evidence specific to particles from biomass combustion is scarce, affecting also the reliability of the current risk assessment. Do the wildfire aerosols exhibit the same level of toxicity as the urban particles? To shed light on this question, it is interesting to look at the exposure data in relationship to the observed daily mortality in Finland, even though the limited duration of the episode allows only for a weak statistical power. The percentage increases observed (0.8%-2.1% per 10 microg/m(3) of fine PM) are in line with the more general estimates for urban PM and those used in the current risk assessment.

Projected cancer risks potentially related to past, current, and future practices in paediatric CT in the United Kingdom, 1990–2020

PubMed Central

Journy, Neige M Y; Lee, Choonsik; Harbron, Richard W; McHugh, Kieran; Pearce, Mark S; Berrington de González, Amy

2017-01-01

Background: To project risks of developing cancer and the number of cases potentially induced by past, current, and future computed tomography (CT) scans performed in the United Kingdom in individuals aged <20 years. Methods: Organ doses were estimated from surveys of individual scan parameters and CT protocols used in the United Kingdom. Frequencies of scans were estimated from the NHS Diagnostic Imaging Dataset. Excess lifetime risks (ELRs) of radiation-related cancer were calculated as cumulative lifetime risks, accounting for survival probabilities, using the RadRAT risk assessment tool. Results: In 2000–2008, ELRs ranged from 0.3 to 1 per 1000 head scans and 1 to 5 per 1000 non-head scans. ELRs per scan were reduced by 50–70% in 2000–2008 compared with 1990–1995, subsequent to dose reduction over time. The 130 750 scans performed in 2015 in the United Kingdom were projected to induce 64 (90% uncertainty interval (UI): 38–113) future cancers. Current practices would lead to about 300 (90% UI: 230–680) future cancers induced by scans performed in 2016–2020. Conclusions: Absolute excess risks from single exposures would be low compared with background risks, but even small increases in annual CT rates over the next years would substantially increase the number of potential subsequent cancers. PMID:27824812

Multi crop model climate risk country-level management design: case study on the Tanzanian maize production system

NASA Astrophysics Data System (ADS)

Chavez, E.

2015-12-01

Future climate projections indicate that a very serious consequence of post-industrial anthropogenic global warming is the likelihood of the greater frequency and intensity of extreme hydrometeorological events such as heat waves, droughts, storms, and floods. The design of national and international policies targeted at building more resilient and environmentally sustainable food systems needs to rely on access to robust and reliable data which is largely absent. In this context, the improvement of the modelling of current and future agricultural production losses using the unifying language of risk is paramount. In this study, we use a methodology that allows the integration of the current understanding of the various interacting systems of climate, agro-environment, crops, and the economy to determine short to long-term risk estimates of crop production loss, in different environmental, climate, and adaptation scenarios. This methodology is applied to Tanzania to assess optimum risk reduction and maize production increase paths in different climate scenarios. The simulations carried out use inputs from three different crop models (DSSAT, APSIM, WRSI) run in different technological scenarios and thus allowing to estimate crop model-driven risk exposure estimation bias. The results obtained also allow distinguishing different region-specific optimum climate risk reduction policies subject to historical as well as RCP2.5 and RCP8.5 climate scenarios. The region-specific risk profiles obtained provide a simple framework to determine cost-effective risk management policies for Tanzania and allow to optimally combine investments in risk reduction and risk transfer.

Review of NASA approach to space radiation risk assessments for Mars exploration.

PubMed

Cucinotta, Francis A

2015-02-01

Long duration space missions present unique radiation protection challenges due to the complexity of the space radiation environment, which includes high charge and energy particles and other highly ionizing radiation such as neutrons. Based on a recommendation by the National Council on Radiation Protection and Measurements, a 3% lifetime risk of exposure-induced death for cancer has been used as a basis for risk limitation by the National Aeronautics and Space Administration (NASA) for low-Earth orbit missions. NASA has developed a risk-based approach to radiation exposure limits that accounts for individual factors (age, gender, and smoking history) and assesses the uncertainties in risk estimates. New radiation quality factors with associated probability distribution functions to represent the quality factor's uncertainty have been developed based on track structure models and recent radiobiology data for high charge and energy particles. The current radiation dose limits are reviewed for spaceflight and the various qualitative and quantitative uncertainties that impact the risk of exposure-induced death estimates using the NASA Space Cancer Risk (NSCR) model. NSCR estimates of the number of "safe days" in deep space to be within exposure limits and risk estimates for a Mars exploration mission are described.

Radiation epidemiology: old and new challenges.

PubMed Central

Shore, R E

1989-01-01

Over the last 40 years the amount of knowledge about human radiation effects has increased dramatically. During that interval, radiation epidemiologists have documented a number of additional types of radiation-induced cancer and have established rough estimates of the magnitude of cancer risks. Nevertheless, we currently have inadequate knowledge about a number of factors that help define the magnitude of radiation risks. These include questions of estimating risk over the lifetime, shapes of dose-effect curves, magnitude of risks at low doses, potentiation between radiation and other agents, and the nature and role of host susceptibility factors. Data from various studies are used to illustrate these questions. PMID:2759057

Shuttle Risk Progression by Flight

NASA Technical Reports Server (NTRS)

Hamlin, Teri; Kahn, Joe; Thigpen, Eric; Zhu, Tony; Lo, Yohon

2011-01-01

Understanding the early mission risk and progression of risk as a vehicle gains insights through flight is important: . a) To the Shuttle Program to understand the impact of re-designs and operational changes on risk. . b) To new programs to understand reliability growth and first flight risk. . Estimation of Shuttle Risk Progression by flight: . a) Uses Shuttle Probabilistic Risk Assessment (SPRA) and current knowledge to calculate early vehicle risk. . b) Shows impact of major Shuttle upgrades. . c) Can be used to understand first flight risk for new programs.

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

EPA Pesticide Factsheets

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

Comparative risk analysis of dioxins in fish and fine particles from heavy-duty vehicles.

PubMed

Leino, Olli; Tainio, Marko; Tuomisto, Jouni T

2008-02-01

Dioxins and airborne fine particles are both environmental health problems that have been the subject of active public debate. Knowledge on fine particles has increased substantially during the last 10 years, and even the current, lowered levels in the Europe and in the United States appear to be a major public health problem. On the other hand, dioxins are ubiquitous persistent contaminants, some being carcinogens at high doses, and therefore of great concern. Our aim was to (a) quantitatively analyze the two pollutant health risks and (b) study the changes in risk in view of the current and forthcoming EU legislations on pollutants. We performed a comparative risk assessment for both pollutants in the Helsinki metropolitan area (Finland) and estimated the health effects with several scenarios. For primary fine particles: a comparison between the present emission situation for heavy-duty vehicles and the new fine particle emission standards set by the EU. For dioxins: an EU directive that regulates commercial fishing of Baltic salmon and herring that exceed the dioxin concentration limit set for fish meat, and a derogation (= exemption) from the directive for these two species. Both of these two decisions are very topical issues and this study estimates the expected changes in health effects due to these regulations. It was found that the estimated fine particle risk clearly outweighed the estimated dioxin risk. A substantial improvement to public health could be achieved by initiating reductions in emission standards; about 30 avoided premature deaths annually in the study area. In addition, the benefits of fish consumption due to omega-3 exposure were notably higher than the potential dioxin cancer risk. Both regulations were instigated as ways of promoting public health.

Incorporating Equipment Condition Assessment in Risk Monitors for Advanced Small Modular Reactors

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

Coble, Jamie B.; Coles, Garill A.; Meyer, Ryan M.

2013-10-01

Advanced small modular reactors (aSMRs) can complement the current fleet of large light-water reactors in the USA for baseload and peak demand power production and process heat applications (e.g., water desalination, shale oil extraction, hydrogen production). The day-to-day costs of aSMRs are expected to be dominated by operations and maintenance (O&M); however, the effect of diverse operating missions and unit modularity on O&M is not fully understood. These costs could potentially be reduced by optimized scheduling, with risk-informed scheduling of maintenance, repair, and replacement of equipment. Currently, most nuclear power plants have a “living” probabilistic risk assessment (PRA), which reflectsmore » the as-operated, as-modified plant and combine event probabilities with population-based probability of failure (POF) for key components. “Risk monitors” extend the PRA by incorporating the actual and dynamic plant configuration (equipment availability, operating regime, environmental conditions, etc.) into risk assessment. In fact, PRAs are more integrated into plant management in today’s nuclear power plants than at any other time in the history of nuclear power. However, population-based POF curves are still used to populate fault trees; this approach neglects the time-varying condition of equipment that is relied on during standard and non-standard configurations. Equipment condition monitoring techniques can be used to estimate the component POF. Incorporating this unit-specific estimate of POF in the risk monitor can provide a more accurate estimate of risk in different operating and maintenance configurations. This enhanced risk assessment will be especially important for aSMRs that have advanced component designs, which don’t have an available operating history to draw from, and often use passive design features, which present challenges to PRA. This paper presents the requirements and technical gaps for developing a framework to integrate unit-specific estimates of POF into risk monitors, resulting in enhanced risk monitors that support optimized operation and maintenance of aSMRs.« less

A clinical economics workstation for risk-adjusted health care cost management.

PubMed Central

Eisenstein, E. L.; Hales, J. W.

1995-01-01

This paper describes a healthcare cost accounting system which is under development at Duke University Medical Center. Our approach differs from current practice in that this system will dynamically adjust its resource usage estimates to compensate for variations in patient risk levels. This adjustment is made possible by introducing a new cost accounting concept, Risk-Adjusted Quantity (RQ). RQ divides case-level resource usage variances into their risk-based component (resource consumption differences attributable to differences in patient risk levels) and their non-risk-based component (resource consumption differences which cannot be attributed to differences in patient risk levels). Because patient risk level is a factor in estimating resource usage, this system is able to simultaneously address the financial and quality dimensions of case cost management. In effect, cost-effectiveness analysis is incorporated into health care cost management. PMID:8563361

Effect of sexual motivation on men's risk perception for sexually transmitted disease: there must be 50 ways to justify a lover.

PubMed

Blanton, H; Gerrard, M

1997-07-01

Recent research has incorporated situational factors into assessment of risk. Working from a rational appraisal framework, however, these studies have not emphasized contextual features that might introduce motivated risk assessment. In the current study, participants (N = 40 male undergraduates) lowered their risk perceptions for STDs following the induction of a sexual motivation. In an initial baseline condition, participants estimated the risk of contracting STDs from partners with relatively high- or low-risk sexual histories. In a subsequent trial, participants repeated the imagery task while viewing photographs that were high or low in sex appeal. As predicted, participants reduced their risk perceptions when they viewed photographs high in sex appeal. The only necessary precondition was the presence of nondiagnostic information from which they could construct biased risk estimates.

Mind the Gap: Exploring the Underground of the NASA Space Cancer Risk Model

NASA Technical Reports Server (NTRS)

Chappell, L. J.; Elgart, S. R.; Milder, C. M.; Shavers, M. R.; Semones, E. J.; Huff, J. L.

2017-01-01

The REID quantifies the lifetime risk of death from radiation-induced cancer in an exposed astronaut. The NASA Space Cancer Risk (NSCR) 2012 mode incorporates elements from physics, biology, epidemiology, and statistics to generate the REID distribution. The current model quantifies the space radiation environment, radiation quality, and dose-rate effects to estimate a NASA-weighted dose. This weighted dose is mapped to the excess risk of radiation-induced cancer mortality from acute exposures to gamma rays and then transferred to an astronaut population. Finally, the REID is determined by integrating this risk over the individual's lifetime. The calculated upper 95% confidence limit of the REID is used to restrict an astronaut's permissible mission duration (PMD) for a proposed mission. As a statistical quantity characterized by broad, subjective uncertainties, REID estimates for space missions result in wide distributions. Currently, the upper 95% confidence level is over 350% larger than the mean REID value, which can severely limit an astronaut's PMD. The model incorporates inputs from multiple scientific disciplines in the risk estimation process. Physics and particle transport models calculate how radiation moves through space, penetrates spacecraft, and makes its way to the human beings onboard. Epidemiological studies of exposures from atomic bombings, medical treatments, and power plants are used to quantify health risks from acute and chronic low linear energy transfer (LET) ionizing radiation. Biological studies in cellular and animal models using radiation at various LETs and energies inform quality metrics for ions present in space radiation. Statistical methodologies unite these elements, controlling for mathematical and scientific uncertainty and variability. Despite current progress, these research platforms contain knowledge gaps contributing to the large uncertainties still present in the model. The NASA Space Radiation Program Element (SRPE) defines the knowledge gaps that impact our understanding of the cancer risks. These gaps are outlined in NASA's Human Research Roadmap [4], which identifies the research questions and actions recommended for reducing the uncertainty in the current NSCR model and for formulation of future models. The greatest contributors to uncertainty in the current model include radiation quality, dose rate effects, and the transfer of exposure-based risk from other populations to an astronaut population. Future formulations of the risk model may benefit from including other potential sources of uncertainty such as space dosimetry, errors in human epidemiology data, and the impact of microgravity and other spaceflight stressors. Here, we discuss the current capabilities of the NSCR-2012 model and several immediate research needs, highlighting areas expected to have an operational impact on the current model schema. The following subway-style route map outlines the NSCR-2012 model (Green Line), emphasizing the research gaps in the Human Research Roadmap for risk of radiation-induced carcinogenesis (Stops on Dashed Lines). The map diagrams how these research gaps feed specific portions of the model.

Assessing Probabilistic Risk Assessment Approaches for Insect Biological Control Introductions.

PubMed

Kaufman, Leyla V; Wright, Mark G

2017-07-07

The introduction of biological control agents to new environments requires host specificity tests to estimate potential non-target impacts of a prospective agent. Currently, the approach is conservative, and is based on physiological host ranges determined under captive rearing conditions, without consideration for ecological factors that may influence realized host range. We use historical data and current field data from introduced parasitoids that attack an endemic Lepidoptera species in Hawaii to validate a probabilistic risk assessment (PRA) procedure for non-target impacts. We use data on known host range and habitat use in the place of origin of the parasitoids to determine whether contemporary levels of non-target parasitism could have been predicted using PRA. Our results show that reasonable predictions of potential non-target impacts may be made if comprehensive data are available from places of origin of biological control agents, but scant data produce poor predictions. Using apparent mortality data rather than marginal attack rate estimates in PRA resulted in over-estimates of predicted non-target impact. Incorporating ecological data into PRA models improved the predictive power of the risk assessments.

Assessing Probabilistic Risk Assessment Approaches for Insect Biological Control Introductions

PubMed Central

Kaufman, Leyla V.; Wright, Mark G.

2017-01-01

The introduction of biological control agents to new environments requires host specificity tests to estimate potential non-target impacts of a prospective agent. Currently, the approach is conservative, and is based on physiological host ranges determined under captive rearing conditions, without consideration for ecological factors that may influence realized host range. We use historical data and current field data from introduced parasitoids that attack an endemic Lepidoptera species in Hawaii to validate a probabilistic risk assessment (PRA) procedure for non-target impacts. We use data on known host range and habitat use in the place of origin of the parasitoids to determine whether contemporary levels of non-target parasitism could have been predicted using PRA. Our results show that reasonable predictions of potential non-target impacts may be made if comprehensive data are available from places of origin of biological control agents, but scant data produce poor predictions. Using apparent mortality data rather than marginal attack rate estimates in PRA resulted in over-estimates of predicted non-target impact. Incorporating ecological data into PRA models improved the predictive power of the risk assessments. PMID:28686180

Increased fructose intake as a risk factor for dementia.

PubMed

Stephan, B C M; Wells, J C K; Brayne, C; Albanese, E; Siervo, M

2010-08-01

The transition in the world age demographic toward older age is associated with an increased risk of neurodegenerative diseases, such as Alzheimer's disease. Risk profiles for dementia may also be changing. Obesity and type 2 diabetes have increased in prevalence in the last half-century and have been associated with increased dementia risk. Specific changes in nutrition may also represent a direct risk. A diet transition in the United States has occurred in the intake of refined sugar, particularly high-fructose corn syrup (HFCS) from a yearly estimate of 8.1 kg/person at the beginning of the XIX century to a current estimate of 65 kg/person. This article considers the association between refined sugar intake, markers of cardiovascular disease risk, and the possible promotion of the development of dementia.

Customized oligonucleotide microarray gene expression-based classification of neuroblastoma patients outperforms current clinical risk stratification.

PubMed

Oberthuer, André; Berthold, Frank; Warnat, Patrick; Hero, Barbara; Kahlert, Yvonne; Spitz, Rüdiger; Ernestus, Karen; König, Rainer; Haas, Stefan; Eils, Roland; Schwab, Manfred; Brors, Benedikt; Westermann, Frank; Fischer, Matthias

2006-11-01

To develop a gene expression-based classifier for neuroblastoma patients that reliably predicts courses of the disease. Two hundred fifty-one neuroblastoma specimens were analyzed using a customized oligonucleotide microarray comprising 10,163 probes for transcripts with differential expression in clinical subgroups of the disease. Subsequently, the prediction analysis for microarrays (PAM) was applied to a first set of patients with maximally divergent clinical courses (n = 77). The classification accuracy was estimated by a complete 10-times-repeated 10-fold cross validation, and a 144-gene predictor was constructed from this set. This classifier's predictive power was evaluated in an independent second set (n = 174) by comparing results of the gene expression-based classification with those of risk stratification systems of current trials from Germany, Japan, and the United States. The first set of patients was accurately predicted by PAM (cross-validated accuracy, 99%). Within the second set, the PAM classifier significantly separated cohorts with distinct courses (3-year event-free survival [EFS] 0.86 +/- 0.03 [favorable; n = 115] v 0.52 +/- 0.07 [unfavorable; n = 59] and 3-year overall survival 0.99 +/- 0.01 v 0.84 +/- 0.05; both P < .0001) and separated risk groups of current neuroblastoma trials into subgroups with divergent outcome (NB2004: low-risk 3-year EFS 0.86 +/- 0.04 v 0.25 +/- 0.15, P < .0001; intermediate-risk 1.00 v 0.57 +/- 0.19, P = .018; high-risk 0.81 +/- 0.10 v 0.56 +/- 0.08, P = .06). In a multivariate Cox regression model, the PAM predictor classified patients of the second set more accurately than risk stratification of current trials from Germany, Japan, and the United States (P < .001; hazard ratio, 4.756 [95% CI, 2.544 to 8.893]). Integration of gene expression-based class prediction of neuroblastoma patients may improve risk estimation of current neuroblastoma trials.

The Boehringer Ingelheim employee study (Part 2): 10-year cardiovascular diseases risk estimation.

PubMed

Kempf, K; Martin, S; Döhring, C; Dugi, K; Haastert, B; Schneider, M

2016-10-01

Cardiovascular disease (CVD) may cause an economic burden to companies, but CVD risk estimations specific to working populations are lacking. To estimate the 10-year CVD risk in the Boehringer Ingelheim (BI) employee cohort and analyse the potential effect of hypothetical risk reduction interventions. We estimated CVD risk using the Framingham (FRS), PROCAM (PRS) and Reynolds (RRS) risk scores, using cross-sectional baseline data on BI Pharma employees collected from 2005 to 2011. Results were compared using Fisher's exact and Wilcoxon tests. The predictive ability of the score estimates was assessed using receiver-operating characteristics analyses. Among the 4005 study subjects, we estimated 10-year CVD risks of 35% (FRS), 9% (PRS) and 6% (RRS) for men and 10% (FRS), 4% (PRS) and 1% (RRS) for women. One hundred and thirty-four (6%) men and 111 (6%) women employees had current CVD. The best predictors of prevalent CVD were the FRS and the RRS for men [area-under-the-curve 0.62 (0.57-0.67) for both]. A hypothetical intervention that would improve systolic blood pressure, HbA1c (for diabetes), C-reactive protein, triglycerides and total and high-density lipoprotein cholesterol by 10% each would potentially reduce expected CVD cases by 36-41% in men and 30-45% in women, and if smoking cessation is incorporated, by 39-45% and 30-55%, respectively, depending on the pre-intervention risk score. There was a substantial risk of developing CVD in this working cohort. Occupational health programmes with lifestyle interventions for high-risk individuals may be an effective risk reduction measure. © The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Assessment of Cardiovascular Disease Risk in South Asian Populations

PubMed Central

Hussain, S. Monira; Oldenburg, Brian; Zoungas, Sophia; Tonkin, Andrew M.

2013-01-01

Although South Asian populations have high cardiovascular disease (CVD) burden in the world, their patterns of individual CVD risk factors have not been fully studied. None of the available algorithms/scores to assess CVD risk have originated from these populations. To explore the relevance of CVD risk scores for these populations, literature search and qualitative synthesis of available evidence were performed. South Asians usually have higher levels of both “classical” and nontraditional CVD risk factors and experience these at a younger age. There are marked variations in risk profiles between South Asian populations. More than 100 risk algorithms are currently available, with varying risk factors. However, no available algorithm has included all important risk factors that underlie CVD in these populations. The future challenge is either to appropriately calibrate current risk algorithms or ideally to develop new risk algorithms that include variables that provide an accurate estimate of CVD risk. PMID:24163770

NLC Mechanical

Science.gov Websites

group depend on the project phase and the maturity of the NLC design. Currently the NLC project is in design approaches that will enable cost estimates, schedules, risk assessment and risk reduction availability are utilized in generating and selecting among design alternatives. A more comprehensive version

Climate change. Accelerating extinction risk from climate change.

PubMed

Urban, Mark C

2015-05-01

Current predictions of extinction risks from climate change vary widely depending on the specific assumptions and geographic and taxonomic focus of each study. I synthesized published studies in order to estimate a global mean extinction rate and determine which factors contribute the greatest uncertainty to climate change-induced extinction risks. Results suggest that extinction risks will accelerate with future global temperatures, threatening up to one in six species under current policies. Extinction risks were highest in South America, Australia, and New Zealand, and risks did not vary by taxonomic group. Realistic assumptions about extinction debt and dispersal capacity substantially increased extinction risks. We urgently need to adopt strategies that limit further climate change if we are to avoid an acceleration of global extinctions. Copyright © 2015, American Association for the Advancement of Science.

Biodegradation of Petroleum Hydrocarbon Vapors in the Vadose Zone

EPA Science Inventory

The current state of practice to estimate the risk from intrusion of vapors of petroleum hydrocarbons from spills of gasoline is to measure the concentration of the chemical of concern in ground water under the spill, use Henry’s Law to estimate a concentration of the chemical ...

Influence of Competing Risks on Estimating the Expected Benefit of Warfarin Among Atrial Fibrillation Patients not Currently Taking Anticoagulants: the ATRIA Study

PubMed Central

Ashburner, Jeffrey M.; Go, Alan S.; Chang, Yuchiao; Fang, Margaret C.; Fredman, Lisa; Applebaum, Katie M.; Singer, Daniel E.

2016-01-01

Background/Objectives To date, studies examining the association between warfarin therapy and incidence of ischemic stroke among patients with atrial fibrillation (AF) have not accounted for the competing risk of death. Competing risk analysis may provide greater understanding of the “real world” impact of anticoagulation on stroke risk over a multiyear time span. Design Cohort study Setting ATRIA Study community-based cohort Participants 13,559 adults with nonvalvular AF between 1996 and 2003. Measurements All events were clinician-adjudicated. We used extended Cox regression with longitudinal warfarin exposure to estimate cause-specific hazard ratios (HR) for thromboembolism (TE) and the competing risk event (all cause death). The Fine and Gray subdistribution regression approach was used to estimate this association while accounting for competing death events. As a secondary analysis, follow-up was limited to 1, 3, and 5-years. Results The rate of death was much higher in the non-warfarin group (8.1 deaths/100 person-years) compared to the warfarin group (5.5 deaths/100 person-years). The cause-specific HR indicated a large reduction in TE with warfarin use (adjusted HR: 0.57, 95% CI: 0.50–0.65). However, after accounting for competing death events, this association was substantially attenuated (adjusted HR: 0.87, 95% CI: 0.77–0.99). In analyses limited to 1-year of follow-up with fewer competing death events, the results for models that did and did not account for competing risks were similar. Conclusion Analyses accounting for competing death events may provide a more realistic estimate of the longer-term stroke prevention benefits of anticoagulants for patients with AF, particularly those who are not currently treated with anticoagulants. PMID:27861698

Enviromentally sensitive patch index of desertification risk applied to the main habitats of Sicily

NASA Astrophysics Data System (ADS)

Duro, A.; Piccione, V.; Ragusa, M. A.; Rapicavoli, V.; Veneziano, V.

2017-07-01

The authors applied the MEDALUS - Mediterranean Desertification and Land Use - procedure to the most representative sicilian habitat by extension, socio-economic and environmental importance, in order to assess the risk of desertification. Thanks to the ESPI, Environmentally Sensitive Patch Index, in this paper the authors estimate the current and future regional levels of desertification risk.

Psychosocial risk factors and asthma among adults in Puerto Rico.

PubMed

Han, Yueh-Ying; Forno, Erick; Canino, Glorisa; Celedón, Juan C

2018-05-08

Asthma and psychosocial stressors are common among Puerto Rican adults living in the United States. We estimated the prevalence of current asthma, and examined potential psychosocial risk factors and current asthma, among adults in Puerto Rico. Cross-sectional study of 3,049 Puerto Ricans aged 18-64 years living in Puerto Rico between May 2014 and June 2016. A structured interview was conducted to obtain information on demographics, lifestyle, mental disorders, and respiratory health. Current asthma was defined as self-reported physician-diagnosed asthma and still having asthma. Multivariable logistic regression was used to examine psychosocial risk factors and current asthma. The estimated prevalence of current asthma was 10.2%. In a multivariable analysis, exposure to violence (odds ratio [OR] for each 1-point increment in a validated scale = 1.14, 95% confidence interval [CI] = 1.07 to 1.21) and a lifetime history of at least one suicide attempt (OR = 3.01, 95% CI = 1.80 to 5.01) were significantly associated with current asthma, independently of major depressive disorder. Moreover, a lifetime history of at least one suicide attempt was associated with co-existing asthma and chronic obstructive pulmonary disease (i.e., asthma-COPD overlap syndrome or ACOS (OR = 9.05, 95% CI = 3.32-24.67). Our findings suggest that asthma is a major health problem among adults in Puerto Rico, with psychosocial risk factors playing a significant role in asthma and ACOS. Addressing chronic stressors and mental illness should be part of comprehensive strategies to reduce asthma burden in this population.

Using the negative exponential distribution to quantitatively review the evidence on how rapidly the excess risk of ischaemic heart disease declines following quitting smoking.

PubMed

Lee, Peter N; Fry, John S; Hamling, Jan S

2012-10-01

No previous review has formally modelled the decline in IHD risk following quitting smoking. From PubMed searches and other sources we identified 15 prospective and eight case-control studies that compared IHD risk in current smokers, never smokers, and quitters by time period of quit, some studies providing separate blocks of results by sex, age or amount smoked. For each of 41 independent blocks, we estimated, using the negative exponential model, the time, H, when the excess risk reduced to half that caused by smoking. Goodness-of-fit to the model was adequate for 35 blocks, others showing a non-monotonic pattern of decline following quitting, with a variable pattern of misfit. After omitting one block with a current smoker RR 1.0, the combined H estimate was 4.40 (95% CI 3.26-5.95) years. There was considerable heterogeneity, H being <2years for 10 blocks and >10years for 12. H increased (p<0.001) with mean age at study start, but not clearly with other factors. Sensitivity analyses allowing for reverse causation, or varying assumed midpoint times for the final open-ended quitting period little affected goodness-of-fit of the combined estimate. The US Surgeon-General's view that excess risk approximately halves after a year's abstinence seems over-optimistic. Copyright © 2012 Elsevier Inc. All rights reserved.

Assessment of NHTSA’s Report “Relationships Between Fatality Risk, Mass, and Footprint in Model Year 2004-2011 Passenger Cars and LTVs” (LBNL Phase 1)

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

Wenzel, Tom P.

In its 2012 report NHTSA simulated the effect four fleetwide mass reduction scenarios would have on the change in annual fatalities. NHTSA estimated that the most aggressive of these scenarios (reducing mass 5.2% in heavier light trucks and 2.6% in all other vehicles types except lighter cars) would result in a small reduction in societal fatalities. LBNL replicated the methodology NHTSA used to simulate six mass reduction scenarios, including the mass reductions recommended in the 2015 NRC committee report, and estimated in 2021 and 2025 by EPA in the TAR, using the updated data through 2012. The analysis indicates thatmore » the estimated x change in fatalities under each scenario based on the updated analysis is comparable to that in the 2012 analysis, but less beneficial or more detrimental than that in the 2016 analysis. For example, an across the board 100-lb reduction in mass would result in an estimated 157 additional annual fatalities based on the 2012 analysis, but would result in only an estimated 91 additional annual fatalities based on the 2016 analysis, and an additional 87 fatalities based on the current analysis. The mass reductions recommended by the 2015 NRC committee report6 would result in a 224 increase in annual fatalities in the 2012 analysis, a 344 decrease in annual fatalities in the 2016 analysis, and a 141 increase in fatalities in the current analysis. The mass reductions EPA estimated for 2025 in the TAR7 would result in a 203 decrease in fatalities based on the 2016 analysis, but an increase of 39 fatalities based on the current analysis. These results support NHTSA’s conclusion from its 2012 study that, when footprint is held fixed, “no judicious combination of mass reductions in the various classes of vehicles results in a statistically significant fatality increase and many potential combinations are safety-neutral as point estimates.”Like the previous NHTSA studies, this updated report concludes that the estimated effect of mass reduction while maintaining footprint on societal U.S. fatality risk is small, and not statistically significant at the 95% or 90% confidence level for all vehicle types based on the jack-knife method NHTSA used. This report also finds that the estimated effects of other control variables, such as vehicle type, specific safety technologies, and crash conditions such as whether the crash occurred at night, in a rural county, or on a high-speed road, on risk are much larger, in some cases two orders of magnitude larger, than the estimated effect of mass or footprint reduction on risk. Finally, this report shows that after accounting for the many vehicle, driver, and crash variables NHTSA used in its regression analyses, there remains a wide variation in risk by vehicle make and model, and this variation is unrelated to vehicle mass. Although the purpose of the NHTSA and LBNL reports is to estimate the effect of vehicle mass reduction on societal risk, this is not exactly what the regression models are estimating. Rather, they are estimating the recent historical relationship between mass and risk, after accounting for most measurable differences between vehicles, drivers, and crash times and locations. In essence, the regression models are comparing the risk of a 2600-lb Dodge Neon with that of a 2500-lb Honda Civic, after attempting to account for all other differences between the two vehicles. The models are not estimating the effect of literally removing 100 pounds from the Neon, leaving everything else unchanged. In addition, the analyses are based on the relationship of vehicle mass and footprint on risk for recent vehicle designs (model year 2004 to 2011). These relationships may or may not continue into the future as manufacturers utilize new vehicle designs and incorporate new technologies, such as more extensive use of strong lightweight materials and specific safety technologies. Therefore, throughout this report we use the phrase “the estimated effect of mass (or footprint) reduction on risk” as shorthand for “the estimated change in risk as a function of its relationship to mass (or footprint) for vehicle models of recent design.”« less

Risk approximation in decision making: approximative numeric abilities predict advantageous decisions under objective risk.

PubMed

Mueller, Silke M; Schiebener, Johannes; Delazer, Margarete; Brand, Matthias

2018-01-22

Many decision situations in everyday life involve mathematical considerations. In decisions under objective risk, i.e., when explicit numeric information is available, executive functions and abilities to handle exact numbers and ratios are predictors of objectively advantageous choices. Although still debated, exact numeric abilities, e.g., normative calculation skills, are assumed to be related to approximate number processing skills. The current study investigates the effects of approximative numeric abilities on decision making under objective risk. Participants (N = 153) performed a paradigm measuring number-comparison, quantity-estimation, risk-estimation, and decision-making skills on the basis of rapid dot comparisons. Additionally, a risky decision-making task with exact numeric information was administered, as well as tasks measuring executive functions and exact numeric abilities, e.g., mental calculation and ratio processing skills, were conducted. Approximative numeric abilities significantly predicted advantageous decision making, even beyond the effects of executive functions and exact numeric skills. Especially being able to make accurate risk estimations seemed to contribute to superior choices. We recommend approximation skills and approximate number processing to be subject of future investigations on decision making under risk.

Breast cancer epidemic in the early twenty-first century: evaluation of risk factors, cumulative questionnaires and recommendations for preventive measures.

PubMed

Golubnitschaja, Olga; Debald, Manuel; Yeghiazaryan, Kristina; Kuhn, Walther; Pešta, Martin; Costigliola, Vincenzo; Grech, Godfrey

2016-10-01

Rapidly increasing incidence of breast cancer is a new social challenge resulting from a spectrum of internal and external risk factors which appear to be well accepted as an attribute of the early twenty-first century, being, however, new for female sub-populations compared to the past. These include altered socio-economical conditions such as occupational exposure, rotating shift work, specific environmental factors (increased pollution and environmental toxicity, altered dietary habits, quality and composition of meal) as well as consequently shifted and/or adapted physiologic factors such as lower age at menarche, late age of first full-term pregnancy, if any, shorter periods of breastfeeding and later menopause. Consolidated expert statements suggest that over 50 % of all breast cancer cases may be potentially prevented by risk reduction strategy such as regulation of modifiable risk factors. Currently available risk assessment models may estimate potential breast cancer predisposition, in general; however, they are not able to predict the disease manifestation individually. Further, current deficits in risk assessment and effective breast cancer prevention have been recently investigated and summarised as follows: gaps in risk estimation, preventive therapy, lifestyle prevention, understanding of the biology of breast cancer risk and implementation of known preventive measures. This paper overviews the most relevant risk factors, provides recommendations for improved risk assessment and proposes an extended questionnaire for effective preventive measures.

Psychological Issues in Cancer Genetics: Current Research and Future Priorities.

ERIC Educational Resources Information Center

Hopwood, Penelope

1997-01-01

Data concerning the psychological impact of high risk of cancer are reviewed, including implications of genetic testing, breast screening,and accuracy of women's risk estimates. Work in progress on prophylactic mastectomy and chemoprevention is reviewed. Research on cancer families, and interventions and prevention strategies for high-risk…

Estimated Daily Average Per Capita Water Ingestion by Child and Adult Age Categories Based on USDA's 1994-96 and 1998 Continuing Survey of Food Intakes by Individuals (Journal Article)

EPA Science Inventory

Current water ingestion estimates are important for the assessment of risk to human populations of exposure to water-borne pollutants. This paper reports mean and percentile estimates of the distributions of daily average per capita water ingestion for 12 age range groups. The a...

A Probabilistic Model for Hydrokinetic Turbine Collision Risks: Exploring Impacts on Fish

PubMed Central

Hammar, Linus; Eggertsen, Linda; Andersson, Sandra; Ehnberg, Jimmy; Arvidsson, Rickard; Gullström, Martin; Molander, Sverker

2015-01-01

A variety of hydrokinetic turbines are currently under development for power generation in rivers, tidal straits and ocean currents. Because some of these turbines are large, with rapidly moving rotor blades, the risk of collision with aquatic animals has been brought to attention. The behavior and fate of animals that approach such large hydrokinetic turbines have not yet been monitored at any detail. In this paper, we conduct a synthesis of the current knowledge and understanding of hydrokinetic turbine collision risks. The outcome is a generic fault tree based probabilistic model suitable for estimating population-level ecological risks. New video-based data on fish behavior in strong currents are provided and models describing fish avoidance behaviors are presented. The findings indicate low risk for small-sized fish. However, at large turbines (≥5 m), bigger fish seem to have high probability of collision, mostly because rotor detection and avoidance is difficult in low visibility. Risks can therefore be substantial for vulnerable populations of large-sized fish, which thrive in strong currents. The suggested collision risk model can be applied to different turbine designs and at a variety of locations as basis for case-specific risk assessments. The structure of the model facilitates successive model validation, refinement and application to other organism groups such as marine mammals. PMID:25730314

A probabilistic model for hydrokinetic turbine collision risks: exploring impacts on fish.

PubMed

Hammar, Linus; Eggertsen, Linda; Andersson, Sandra; Ehnberg, Jimmy; Arvidsson, Rickard; Gullström, Martin; Molander, Sverker

2015-01-01

A variety of hydrokinetic turbines are currently under development for power generation in rivers, tidal straits and ocean currents. Because some of these turbines are large, with rapidly moving rotor blades, the risk of collision with aquatic animals has been brought to attention. The behavior and fate of animals that approach such large hydrokinetic turbines have not yet been monitored at any detail. In this paper, we conduct a synthesis of the current knowledge and understanding of hydrokinetic turbine collision risks. The outcome is a generic fault tree based probabilistic model suitable for estimating population-level ecological risks. New video-based data on fish behavior in strong currents are provided and models describing fish avoidance behaviors are presented. The findings indicate low risk for small-sized fish. However, at large turbines (≥5 m), bigger fish seem to have high probability of collision, mostly because rotor detection and avoidance is difficult in low visibility. Risks can therefore be substantial for vulnerable populations of large-sized fish, which thrive in strong currents. The suggested collision risk model can be applied to different turbine designs and at a variety of locations as basis for case-specific risk assessments. The structure of the model facilitates successive model validation, refinement and application to other organism groups such as marine mammals.

Retrospective and current risks of mercury to panthers in the Florida Everglades.

PubMed

Barron, Mace G; Duvall, Stephanie E; Barron, Kyle J

2004-04-01

Florida panthers are an endangered species inhabiting south Florida. Hg has been suggested as a causative factor for low populations and some reported panther deaths, but a quantitative assessment of risks has never been performed. This study quantitatively evaluated retrospective (pre-1992) and current (2002) risks of chronic dietary Hg exposures to panthers in the Florida Everglades. A probabilistic assessment of Hg risks was performed using a dietary exposure model and Latin Hypercube sampling that incorporated the variability and uncertainty in ingestion rate, diet, body weight, and mercury exposure of panthers. Hazard quotients (HQs) for retrospective risks ranged from less than 0.1-20, with a 46% probability of exceeding chronic dietary thresholds for methylmercury. Retrospective risks of developing clinical symptoms, including ataxia and convulsions, had an HQ range of <0.1-5.4 with a 17% probability of exceeding an HQ of 1. Current risks were substantially lower (4% probability of exceedences; HQ range <0.1-3.5) because of an estimated 70-90% decline in Hg exposure to panthers over the last decade. Under worst case conditions of panthers consuming only raccoons from the most contaminated area of the Everglades, current risks of developing clinical symptoms that may lead to death was 4.6%. Current risks of mercury poisoning of panthers with a diversified diet was 0.1% (HQ range of <0.1-1.4). The results of this assessment indicate that past Hg exposures likely adversely affected panthers in the Everglades, but current risks of Hg are low.

[Potential health risks from consumption of water with arsenic in Colima, Mexico].

PubMed

Mendoza-Cano, Oliver; Sánchez-Piña, Ramón Alberto; Barrón-Quintana, Julián; Cuevas-Arellano, Herguin Benjamin; Escalante-Minakata, Pilar; Solano-Barajas, Ramón

2017-01-01

To estimate potential health risks due to chronic ingestion of arsenic from groundwater in Colima, Mexico. Samples were randomly taken in 36 wells from 10 local aquifers. Analysis was performed by ICP-OES following international standards. Geostatistical interpolation was performed with ArcGIS, implementing a model weighting inverse distance to estimate arsenic routes of exposure and consumption on each locality. The Hazard Quotient Ratio (HQ) and carcinogenic risk (R) for As were estimated. The weighted average HQ for arsenic in Colima is 2.41. There are HQ> 1 values indicating adverse non-cancer health effects by continuous and prolonged intake of water with arsenic, which could affect 183 832 individuals in the state. The risk of developing any type of cancer among the population in this study due to high arsenic concentrations in groundwater (R) is 1.089E-3, which could statistically cause 446 cases of cancer. Current levels of arsenic in groundwater increase carcinogenic and non-carcinogenic human health risks in Colima.

The predictive validity of the Two-Tiered Violence Risk Estimates Scale (TTV) in a long-term follow-up of violent offenders.

PubMed

Churcher, Frances P; Mills, Jeremy F; Forth, Adelle E

2016-08-01

Over the past few decades many structured risk appraisal measures have been created to respond to this need. The Two-Tiered Violence Risk Estimates Scale (TTV) is a measure designed to integrate both an actuarial estimate of violence risk with critical risk management indicators. The current study examined interrater reliability and the predictive validity of the TTV in a sample of violent offenders (n = 120) over an average follow-up period of 17.75 years. The TTV was retrospectively scored and compared with the Violence Risk Appraisal Guide (VRAG), the Statistical Information of Recidivism Scale-Revised (SIR-R1), and the Psychopathy Checklist-Revised (PCL-R). Approximately 53% of the sample reoffended violently, with an overall recidivism rate of 74%. Although the VRAG was the strongest predictor of violent recidivism in the sample, the Actuarial Risk Estimates (ARE) scale of the TTV produced a small, significant effect. The Risk Management Indicators (RMI) produced nonsignificant area under the curve (AUC) values for all recidivism outcomes. Comparisons between measures using AUC values and Cox regression showed that there were no statistical differences in predictive validity. The results of this research will be used to inform the validation and reliability literature on the TTV, and will contribute to the overall risk assessment literature. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

The potential benefits of a new poliovirus vaccine for long-term poliovirus risk management.

PubMed

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.

Safety and Performance Analysis of the Non-Radar Oceanic/Remote Airspace In-Trail Procedure

NASA Technical Reports Server (NTRS)

Carreno, Victor A.; Munoz, Cesar A.

2007-01-01

This document presents a safety and performance analysis of the nominal case for the In-Trail Procedure (ITP) in a non-radar oceanic/remote airspace. The analysis estimates the risk of collision between the aircraft performing the ITP and a reference aircraft. The risk of collision is only estimated for the ITP maneuver and it is based on nominal operating conditions. The analysis does not consider human error, communication error conditions, or the normal risk of flight present in current operations. The hazards associated with human error and communication errors are evaluated in an Operational Hazards Analysis presented elsewhere.

Impact of using a non-diabetes-specific risk calculator on eligibility for statin therapy in type 2 diabetes.

PubMed

Price, H C; Coleman, R L; Stevens, R J; Holman, R R

2009-03-01

The aim of this study was to investigate the impact of using a non-diabetes-specific cardiovascular disease (CVD) risk calculator to determine eligibility for statin therapy according to current UK National Institute for Health and Clinical Excellence (NICE) guidelines for those patients with type 2 diabetes who are at an increased risk of CVD (10 year risk >or=20%). The 10 year CVD risks were estimated using the UK Prospective Diabetes Study (UKPDS) Risk Engine and the Framingham equation for 4,025 patients enrolled in the Lipids in Diabetes Study who had established type 2 diabetes and LDL-cholesterol <4.1 mmol/l. The mean (SD) age of the patients was 60.7 (8.6) years, blood pressure 141/83 (17/10) mmHg and the total cholesterol:HDL-cholesterol ratio was 3.9 (1.0). The median (interquartile range) diabetes duration was 6 (3-11) years and the HbA(1c) level was 8.0% (7.2-9.0%). The cohort comprised 65% men, 91% whites, 4% Afro-Caribbeans, 5% Asian Indians and 15% current smokers. More patients were classified as being at high risk by the UKPDS Risk Engine (65%) than by the Framingham CVD equation (63%) (p < 0.0001). The Framingham CVD equation classified fewer men and people aged <50 years old as high risk (p < 0.0001). There was no difference between the UKPDS Risk Engine and Framingham classification of women at high risk (p = 0.834). These results suggest that the use of Framingham-derived rather than UKPDS Risk Engine-derived CVD risk estimates would deny about one in 25 patients statin therapy when applying current NICE guidelines. Thus, under these guidelines the choice of CVD risk calculator is important when assessing CVD risk in patients with type 2 diabetes, particularly for the identification of the relatively small proportion of younger people who require statin therapy.

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

PubMed

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

2015-01-01

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

Estimating Children’s Soil/Dust Ingestion Rates through Retrospective Analyses of Blood Lead Biomonitoring from the Bunker Hill Superfund Site in Idaho

EPA Science Inventory

Background: Soil/dust ingestion rates are important variables in assessing children’s health risks in contaminated environments. Current estimates are based largely on soil tracer methodology, which is limited by analytical uncertainty, small sample size, and short study du...

Review of methods for developing regional probabilistic risk assessments, part 2: modeling invasive plant, insect, and pathogen species

Treesearch

P. B. Woodbury; D. A. Weinstein

2010-01-01

We reviewed probabilistic regional risk assessment methodologies to identify the methods that are currently in use and are capable of estimating threats to ecosystems from fire and fuels, invasive species, and their interactions with stressors. In a companion chapter, we highlight methods useful for evaluating risks from fire. In this chapter, we highlight methods...

Uncertainties in estimates of the risks of late effects from space radiation

NASA Astrophysics Data System (ADS)

Cucinotta, F. A.; Schimmerling, W.; Wilson, J. W.; Peterson, L. E.; Saganti, P. B.; Dicello, J. F.

2004-01-01

Methods used to project risks in low-Earth orbit are of questionable merit for exploration missions because of the limited radiobiology data and knowledge of galactic cosmic ray (GCR) heavy ions, which causes estimates of the risk of late effects to be highly uncertain. Risk projections involve a product of many biological and physical factors, each of which has a differential range of uncertainty due to lack of data and knowledge. Using the linear-additivity model for radiation risks, we use Monte-Carlo sampling from subjective uncertainty distributions in each factor to obtain an estimate of the overall uncertainty in risk projections. The resulting methodology is applied to several human space exploration mission scenarios including a deep space outpost and Mars missions of duration of 360, 660, and 1000 days. The major results are the quantification of the uncertainties in current risk estimates, the identification of factors that dominate risk projection uncertainties, and the development of a method to quantify candidate approaches to reduce uncertainties or mitigate risks. The large uncertainties in GCR risk projections lead to probability distributions of risk that mask any potential risk reduction using the "optimization" of shielding materials or configurations. In contrast, the design of shielding optimization approaches for solar particle events and trapped protons can be made at this time and promising technologies can be shown to have merit using our approach. The methods used also make it possible to express risk management objectives in terms of quantitative metrics, e.g., the number of days in space without exceeding a given risk level within well-defined confidence limits.

Information and Risk Modification Trial (INFORM): design of a randomised controlled trial of communicating different types of information about coronary heart disease risk, alongside lifestyle advice, to achieve change in health-related behaviour.

PubMed

Silarova, Barbora; Lucas, Joanne; Butterworth, Adam S; Di Angelantonio, Emanuele; Girling, Christine; Lawrence, Kathryn; Mackintosh, Stuart; Moore, Carmel; Payne, Rupert A; Sharp, Stephen J; Shefer, Guy; Tolkien, Zoe; Usher-Smith, Juliet; Walker, Matthew; Danesh, John; Griffin, Simon

2015-09-07

Cardiovascular disease (CVD) remains the leading cause of death globally. Primary prevention of CVD requires cost-effective strategies to identify individuals at high risk in order to help target preventive interventions. An integral part of this approach is the use of CVD risk scores. Limitations in previous studies have prevented reliable inference about the potential advantages and the potential harms of using CVD risk scores as part of preventive strategies. We aim to evaluate short-term effects of providing different types of information about coronary heart disease (CHD) risk, alongside lifestyle advice, on health-related behaviours. In a parallel-group, open randomised trial, we are allocating 932 male and female blood donors with no previous history of CVD aged 40-84 years in England to either no intervention (control group) or to one of three active intervention groups: i) lifestyle advice only; ii) lifestyle advice plus information on estimated 10-year CHD risk based on phenotypic characteristics; and iii) lifestyle advice plus information on estimated 10-year CHD risk based on phenotypic and genetic characteristics. The primary outcome is change in objectively measured physical activity. Secondary outcomes include: objectively measured dietary behaviours; cardiovascular risk factors; current medication and healthcare usage; perceived risk; cognitive evaluation of provision of CHD risk scores; and psychological outcomes. The follow-up assessment takes place 12 weeks after randomisation. The experiences, attitudes and concerns of a subset of participants will be also studied using individual interviews and focus groups. The INFORM study has been designed to provide robust findings about the short-term effects of providing different types of information on estimated 10-year CHD risk and lifestyle advice on health-related behaviours. Current Controlled Trials ISRCTN17721237 . Registered 12 January 2015.

Space Radiation Cancer Risk Projections and Uncertainties - 2010

NASA Technical Reports Server (NTRS)

Cucinotta, Francis A.; Kim, Myung-Hee Y.; Chappell, Lori J.

2011-01-01

Uncertainties in estimating health risks from galactic cosmic rays greatly limit space mission lengths and potential risk mitigation evaluations. NASA limits astronaut exposures to a 3% risk of exposure-induced death and protects against uncertainties using an assessment of 95% confidence intervals in the projection model. Revisions to this model for lifetime cancer risks from space radiation and new estimates of model uncertainties are described here. We review models of space environments and transport code predictions of organ exposures, and characterize uncertainties in these descriptions. We summarize recent analysis of low linear energy transfer radio-epidemiology data, including revision to Japanese A-bomb survivor dosimetry, longer follow-up of exposed cohorts, and reassessments of dose and dose-rate reduction effectiveness factors. We compare these projections and uncertainties with earlier estimates. Current understanding of radiation quality effects and recent data on factors of relative biological effectiveness and particle track structure are reviewed. Recent radiobiology experiment results provide new information on solid cancer and leukemia risks from heavy ions. We also consider deviations from the paradigm of linearity at low doses of heavy ions motivated by non-targeted effects models. New findings and knowledge are used to revise the NASA risk projection model for space radiation cancer risks.

Mesothelioma and asbestos.

PubMed

Gibbs, Graham W; Berry, Geoffrey

2008-10-01

The current state of knowledge concerning mesothelioma risk estimates is reviewed. Estimates of the risk of mesothelioma exist for the commercial asbestos fiber types chrysotile, amosite and crocidolite. Data also exist on which to assess risks for winchite (sodic tremolite) and anthophyllite asbestos. Uncertainty in estimates is primarily related to limitations in measurements of exposure. Differences in the dimensions of the various fiber types and of the same fiber types at different stages of processing add a further complication. Never-the-less, in practical terms, crocidolite presents the highest asbestos related mesothelioma risk. The risk associated with sodic tremolite (winchite) appears to be similar. In chrysotile miners and millers, the mesothelioma risk has been linked with exposure to asbestiform tremolite. Exposure to chrysotile in a pure form seems likely to present a very low if any risk of mesothelioma. While the majority of mesothelial tumors result from exposure to the asbestos minerals, there are other well established and suspected etiological agents. While a practical threshold seems to exist for exposure to chrysotile, it is unlikely to exist for the amphibole asbestos minerals, especially for crocidolite. To date there is no indication of an increased risk of mesothelioma resulting from non-commercial fiber exposure in the taconite industry.

Risk analysis for biological hazards: What we need to know about invasive species

USGS Publications Warehouse

Stohlgren, T.J.; Schnase, J.L.

2006-01-01

Risk analysis for biological invasions is similar to other types of natural and human hazards. For example, risk analysis for chemical spills requires the evaluation of basic information on where a spill occurs; exposure level and toxicity of the chemical agent; knowledge of the physical processes involved in its rate and direction of spread; and potential impacts to the environment, economy, and human health relative to containment costs. Unlike typical chemical spills, biological invasions can have long lag times from introduction and establishment to successful invasion, they reproduce, and they can spread rapidly by physical and biological processes. We use a risk analysis framework to suggest a general strategy for risk analysis for invasive species and invaded habitats. It requires: (1) problem formation (scoping the problem, defining assessment endpoints); (2) analysis (information on species traits, matching species traits to suitable habitats, estimating exposure, surveys of current distribution and abundance); (3) risk characterization (understanding of data completeness, estimates of the “potential” distribution and abundance; estimates of the potential rate of spread; and probable risks, impacts, and costs); and (4) risk management (containment potential, costs, and opportunity costs; legal mandates and social considerations and information science and technology needs).

Estimation of the individual residual risk of cervical cancer after vaccination with the nonavalent HPV vaccine.

PubMed

Petry, Karl-Ulrich; Bollaerts, Kaatje; Bonanni, Paolo; Stanley, Margaret; Drury, Rosybel; Joura, Elmar; Kjaer, Susanne K; Meijer, Chris J L M; Riethmuller, Didier; Soubeyrand, Benoit; Van Damme, Pierre; Bosch, Xavier

2018-03-19

The nonavalent HPV (9vHPV) vaccine is indicated for active immunisation of individuals from the age of 9 years against cervical, vulvar, vaginal and anal premalignant lesions and cancers causally related to vaccine HPV high risk types 16, 18, 31, 33, 45, 52 and 58, and to the HPV low risk types 6 and 11, causing genital warts. To estimate the lifetime risk (up to the age of 75 years) for developing cervical cancer after vaccinating a HPV naïve girl (e.g. 9 to 12 years old) with the 9vHPV vaccine in the hypothetical absence of cervical cancer screening. We built Monte Carlo simulation models using historical pre-screening age-specific cancer incidence data and current mortality data from Denmark, Finland, Norway, Sweden and the UK. Estimates of genotype contribution fractions and vaccine efficacy were used to estimate the residual lifetime risk after vaccination assuming lifelong protection. We estimated that, in the hypothetical absence of cervical screening and assuming lifelong protection, 9vHPV vaccination reduced the lifetime cervical cancer and mortality risks 7-fold with a residual lifetime cancer risks ranging from 1/572 (UK) to 1/238 (Denmark) and mortality risks ranging from 1/1488 (UK) to 1/851 (Denmark). After decades of repetitive cervical screenings, the lifetime cervical cancer and mortality risks was reduced between 2- and 4-fold depending on the country. Our simulations demonstrate how evidence can be generated to support decision-making by individual healthcare seekers regarding cervical cancer prevention.

Improving online risk assessment with equipment prognostics and health monitoring

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

Coble, Jamie B.; Liu, Xiaotong; Briere, Chris

The current approach to evaluating the risk of nuclear power plant (NPP) operation relies on static probabilities of component failure, which are based on industry experience with the existing fleet of nominally similar light water reactors (LWRs). As the nuclear industry looks to advanced reactor designs that feature non-light water coolants (e.g., liquid metal, high temperature gas, molten salt), this operating history is not available. Many advanced reactor designs use advanced components, such as electromagnetic pumps, that have not been used in the US commercial nuclear fleet. Given the lack of rich operating experience, we cannot accurately estimate the evolvingmore » probability of failure for basic components to populate the fault trees and event trees that typically comprise probabilistic risk assessment (PRA) models. Online equipment prognostics and health management (PHM) technologies can bridge this gap to estimate the failure probabilities for components under operation. The enhanced risk monitor (ERM) incorporates equipment condition assessment into the existing PRA and risk monitor framework to provide accurate and timely estimates of operational risk.« less

Chronic beryllium disease and cancer risk estimates with uncertainty for beryllium released to the air from the Rocky Flats Plant.

PubMed Central

McGavran, P D; Rood, A S; Till, J E

1999-01-01

Beryllium was released into the air from routine operations and three accidental fires at the Rocky Flats Plant (RFP) in Colorado from 1958 to 1989. We evaluated environmental monitoring data and developed estimates of airborne concentrations and their uncertainties and calculated lifetime cancer risks and risks of chronic beryllium disease to hypothetical receptors. This article discusses exposure-response relationships for lung cancer and chronic beryllium disease. We assigned a distribution to cancer slope factor values based on the relative risk estimates from an occupational epidemiologic study used by the U.S. Environmental Protection Agency (EPA) to determine the slope factors. We used the regional atmospheric transport code for Hanford emission tracking atmospheric transport model for exposure calculations because it is particularly well suited for long-term annual-average dispersion estimates and it incorporates spatially varying meteorologic and environmental parameters. We accounted for model prediction uncertainty by using several multiplicative stochastic correction factors that accounted for uncertainty in the dispersion estimate, the meteorology, deposition, and plume depletion. We used Monte Carlo techniques to propagate model prediction uncertainty through to the final risk calculations. We developed nine exposure scenarios of hypothetical but typical residents of the RFP area to consider the lifestyle, time spent outdoors, location, age, and sex of people who may have been exposed. We determined geometric mean incremental lifetime cancer incidence risk estimates for beryllium inhalation for each scenario. The risk estimates were < 10(-6). Predicted air concentrations were well below the current reference concentration derived by the EPA for beryllium sensitization. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 PMID:10464074

Association of type D personality with unhealthy lifestyle, and estimated risk of coronary events in the general Icelandic population.

PubMed

Svansdottir, Erla; Denollet, Johan; Thorsson, Bolli; Gudnason, Thorarinn; Halldorsdottir, Sigrun; Gudnason, Vilmundur; van den Broek, Krista C; Karlsson, Hrobjartur D

2013-04-01

Type D personality is associated with an increased morbidity and mortality risk in cardiovascular disease patients, but the mechanisms explaining this risk are unclear. We examined whether Type D was associated with coronary artery disease (CAD) risk factors, estimated risk of developing CAD, and previous cardiac events. Cross-sectional study in the general Icelandic population. A random sample of 4753 individuals (mean age 49.1 ± 12.0 years; 49% men) from the REFINE-Reykjavik study completed assessments for Type D personality and conventional CAD risk factors. Ten-year risk of developing CAD was estimated with the Icelandic risk calculator. Type D personality (22% of sample) was associated with a higher prevalence of hypertension (35 vs. 31%, p = 0.009), but less use of hypertension medication (58 vs. 65%, p = 0.013) in hypertensives, more diabetes (6 vs. 4%, p = 0.023), wider waist circumference (p = 0.007), and elevated body mass index (p = 0.025) and blood lipids (p < 0.05). Type D individuals reported less physical exercise (p = 0.000) and more current (26 vs. 21%, p = 0.003) and former smoking (48 vs. 44%, p = 0.036). Estimates of 10-year risk of CAD were higher in Type D individuals (12.4%, 95% CI 1.9 to 23.8%), and Type Ds reported more previous cardiac events than non-Type Ds (5 vs. 3%, p < 0.01; OR 1.71, 95% CI 1.21 to 2.42). In the general Icelandic population, Type D personality was associated with differences in lifestyle-related CAD risk factors, a higher estimated risk of developing CAD, and higher incidence of previous cardiac events. Unhealthy lifestyles may partly explain the adverse cardiovascular effect of Type D personality.

Comparison of risk estimates for selected diseases and causes of death.

PubMed

Merrill, R M; Kessler, L G; Udler, J M; Rasband, G C; Feuer, E J

1999-02-01

Lifetime risk estimates of disease are limited by long-term data extrapolations and are less relevant to individuals who have already lived a period of time without the disease, but are approaching the age at which the disease risk becomes common. In contrast, short-term age-conditional risk estimates, such as the risk of developing a disease in the next 10 years among those alive and free of the disease at a given age, are less restricted by long-term extrapolation of current rates and can present patients with risk information tailored to their age. This study focuses on short-term age-conditional risk estimates for a broad set of important chronic diseases and nondisease causes of death among white and black men and women. The Feuer et al. (1993, Journal of the National Cancer Institute) [15] method was applied to data from a variety of sources to obtain risk estimates for select cancers, myocardial infarction, diabetes mellitus, multiple sclerosis, Alzheimer's, and death from motor vehicle accidents, homicide or legal intervention, and suicide. Acute deaths from suicide, homicide or legal intervention, and fatal motor vehicle accidents dominate the risk picture for persons in their 20s, with only diabetes mellitus and end-stage renal disease therapy (for blacks only) having similar levels of risk in this age range. Late in life, cancer, acute myocardial infarction, Alzheimer's, and stroke become most common. The chronic diseases affecting the population later in life present the most likely diseases someone will face. Several interesting differences in disease and death risks were derived and reported among age-specific race and gender subgroups of the population. Presentation of risk estimates for a broad set of chronic diseases and nondisease causes of death within short-term age ranges among population subgroups provides tailored information that may lead to better educated prevention, screening, and control behaviors and more efficient allocation of health resources.

A RE-LOOK AT THE US NRC SAFETY GOALS

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

mubayi v.

2013-09-22

Since they were adopted in 1986, the US NRC’s Safety Goals have played a valuable role as a de facto risk acceptance criterion against which the predicted performance of a commercial nuclear power reactor can be evaluated and assessed. The current safety goals are cast in terms of risk metrics called quantitative health objectives (QHOs), limiting numerical values of the risks of the early and latent health effects of accidental releases of radioactivity to the offsite population. However, while demonstrating compliance with current safety goals has been an important step in assessing the acceptance of the risk posed by LWRs,more » new or somewhat different goals may be needed that go beyond the current early fatality and latent cancer fatality QHOs in assessing reactor risk. Natural phenomena such as hurricanes seem to be suitable candidates for establishing a background rate to derive a risk goal as their order of magnitude cost of damages is similar to those estimated in severe accident Level 3 PRAs done for nuclear power plants. This paper obtains a risk goal that could have a wider applicability, compared to the current QHOs, as a technology-neutral goal applicable to future reactors and multi-unit sites.« less

Space Radiation Cancer, Circulatory Disease and CNS Risks for Near Earth Asteroid and Mars Missions: Uncertainty Estimates for Never-Smokers

NASA Technical Reports Server (NTRS)

Cucinotta, Francis A.; Chappell, Lori J.; Wang, Minli; Kim, Myung-Hee

2011-01-01

The uncertainties in estimating the health risks from galactic cosmic rays (GCR) and solar particle events (SPE) are a major limitation to the length of space missions and the evaluation of potential risk mitigation approaches. NASA limits astronaut exposures to a 3% risk of exposure induced cancer death (REID), and protects against uncertainties in risks projections using an assessment of 95% confidence intervals after propagating the error from all model factors (environment and organ exposure, risk coefficients, dose-rate modifiers, and quality factors). Because there are potentially significant late mortality risks from diseases of the circulatory system and central nervous system (CNS) which are less well defined than cancer risks, the cancer REID limit is not necessarily conservative. In this report, we discuss estimates of lifetime risks from space radiation and new estimates of model uncertainties are described. The key updates to the NASA risk projection model are: 1) Revised values for low LET risk coefficients for tissue specific cancer incidence, with incidence rates transported to an average U.S. population to estimate the probability of Risk of Exposure Induced Cancer (REIC) and REID. 2) An analysis of smoking attributable cancer risks for never-smokers that shows significantly reduced lung cancer risk as well as overall cancer risks from radiation compared to risk estimated for the average U.S. population. 3) Derivation of track structure based quality functions depends on particle fluence, charge number, Z and kinetic energy, E. 4) The assignment of a smaller maximum in quality function for leukemia than for solid cancers. 5) The use of the ICRP tissue weights is shown to over-estimate cancer risks from SPEs by a factor of 2 or more. Summing cancer risks for each tissue is recommended as a more accurate approach to estimate SPE cancer risks. 6) Additional considerations on circulatory and CNS disease risks. Our analysis shows that an individual s history of smoking exposure has a larger impact on GCR risk estimates than amounts of radiation shielding or age at exposure (amongst adults). Risks for never-smokers compared to the average U.S. population are estimated to be reduced between 30% and 60% dependent on model assumptions. Lung cancer is the major contributor to the reduction for never-smokers, with additional contributions from circulatory diseases and cancers of the stomach, liver, bladder, oral cavity and esophagus, and leukemia. The relative contribution of CNS risks to the overall space radiation detriment is potentially increased for never-smokers such as most astronauts. Problems in estimating risks for former smokers and the influence of second-hand smoke are discussed. Compared to the LET approximation, the new track structure derived radiation quality functions lead to a reduced risk for relativistic energy particles and increased risks for intermediate energy particles. Revised estimates for the number of safe days in space at solar minimum for heavy shielding conditions are described for never-smokers and the average U.S. population. Results show that missions to near Earth asteroids (NEA) or Mars violate NASA's radiation safety standards with the current levels of uncertainties. Greater improvements in risk estimates for never-smokers are possible, and would be dependent on improved understanding of risk transfer models, and elucidating the role of space radiation on the various stages of disease formation (e.g. initiation, promotion, and progression).

Drug development costs when financial risk is measured using the Fama-French three-factor model.

PubMed

Vernon, John A; Golec, Joseph H; Dimasi, Joseph A

2010-08-01

In a widely cited article, DiMasi, Hansen, and Grabowski (2003) estimate the average pre-tax cost of bringing a new molecular entity to market. Their base case estimate, excluding post-marketing studies, was $802 million (in $US 2000). Strikingly, almost half of this cost (or $399 million) is the cost of capital (COC) used to fund clinical development expenses to the point of FDA marketing approval. The authors used an 11% real COC computed using the capital asset pricing model (CAPM). But the CAPM is a single factor risk model, and multi-factor risk models are the current state of the art in finance. Using the Fama-French three factor model we find that the cost of drug development to be higher than the earlier estimate. Copyright (c) 2009 John Wiley & Sons, Ltd.

Estimating the NIH efficient frontier.

PubMed

Bisias, Dimitrios; Lo, Andrew W; Watkins, James F

2012-01-01

The National Institutes of Health (NIH) is among the world's largest investors in biomedical research, with a mandate to: "…lengthen life, and reduce the burdens of illness and disability." Its funding decisions have been criticized as insufficiently focused on disease burden. We hypothesize that modern portfolio theory can create a closer link between basic research and outcome, and offer insight into basic-science related improvements in public health. We propose portfolio theory as a systematic framework for making biomedical funding allocation decisions-one that is directly tied to the risk/reward trade-off of burden-of-disease outcomes. Using data from 1965 to 2007, we provide estimates of the NIH "efficient frontier", the set of funding allocations across 7 groups of disease-oriented NIH institutes that yield the greatest expected return on investment for a given level of risk, where return on investment is measured by subsequent impact on U.S. years of life lost (YLL). The results suggest that NIH may be actively managing its research risk, given that the volatility of its current allocation is 17% less than that of an equal-allocation portfolio with similar expected returns. The estimated efficient frontier suggests that further improvements in expected return (89% to 119% vs. current) or reduction in risk (22% to 35% vs. current) are available holding risk or expected return, respectively, constant, and that 28% to 89% greater decrease in average years-of-life-lost per unit risk may be achievable. However, these results also reflect the imprecision of YLL as a measure of disease burden, the noisy statistical link between basic research and YLL, and other known limitations of portfolio theory itself. Our analysis is intended to serve as a proof-of-concept and starting point for applying quantitative methods to allocating biomedical research funding that are objective, systematic, transparent, repeatable, and expressly designed to reduce the burden of disease. By approaching funding decisions in a more analytical fashion, it may be possible to improve their ultimate outcomes while reducing unintended consequences.

Non-Steroidal Anti-Inflammatory Drug Use and the Risk of Acute Myocardial Infarction in the General German Population: A Nested Case-Control Study.

PubMed

Thöne, Kathrin; Kollhorst, Bianca; Schink, Tania

2017-09-01

Use of non-steroidal anti-inflammatory drugs (NSAIDs) has been associated with an increased relative risk of acute myocardial infarction (AMI), but the label warnings refer particularly to patients with cardiovascular risk factors. The magnitude of relative AMI risk for patients with and without cardiovascular risk factors varies between studies depending on the drugs and doses studied. The aim of our study was to estimate population-based relative AMI risks for individual and widely used NSAIDs, for a cumulative amount of NSAID use, and for patients with and without a prior history of cardiovascular risk factors. Based on data from the German Pharmacoepidemiological Research Database (GePaRD) of about 17 million insurance members from four statutory health insurance providers, for the years 2004-2009, a nested case-control study was conducted within a cohort of 3,476,931 new NSAID users classified into current, recent, or past users. Up to 100 controls were matched to each case by age, sex, and length of follow-up using risk set sampling. Multivariable conditional logistic regression was applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Duration of NSAID use was calculated by the cumulative amount of dispensed defined daily doses (DDDs), and stratified analyses were conducted for potential effect modifiers. Overall, 17,236 AMI cases were matched to 1,714,006 controls. Elevated relative AMI risks were seen for current users of fixed combinations of diclofenac with misoprostol (OR 1.76, 95% CI 1.26-2.45), indometacin (1.69, 1.22-2.35), ibuprofen (1.54, 1.43-1.65), etoricoxib (1.52, 1.24-1.87), and diclofenac (1.43, 1.34-1.52) compared with past use. A low cumulative NSAID amount was associated with a higher relative AMI risk for ibuprofen, diclofenac, and indometacin. The relative risk associated with current use of diclofenac, fixed combinations of diclofenac with misoprostol, etoricoxib, and ibuprofen was highest in the younger age group (<60 years) and similar for patients with or without major cardiovascular risk factors. Relative AMI risk estimates differed among the 15 investigated individual NSAIDs. Diclofenac and ibuprofen, the most frequently used NSAIDs, were associated with a 40-50% increased relative risk of AMI, even for low cumulative NSAID amounts. The relative AMI risk in patients with and without cardiovascular risk factors was similarly elevated.

The Magnitude of Mortality from Ischemic Heart Disease Attributed to Occupational Factors in Korea - Attributable Fraction Estimation Using Meta-analysis.

PubMed

Ha, Jaehyeok; Kim, Soo-Geun; Paek, Domyung; Park, Jungsun

2011-03-01

Ischemic heart disease (IHD) is a major cause of death in Korea and known to result from several occupational factors. This study attempted to estimate the current magnitude of IHD mortality due to occupational factors in Korea. After selecting occupational risk factors by literature investigation, we calculated attributable fractions (AFs) from relative risks and exposure data for each factor. Relative risks were estimated using meta-analysis based on published research. Exposure data were collected from the 2006 Survey of Korean Working Conditions. Finally, we estimated 2006 occupation-related IHD mortality. FOR THE FACTORS CONSIDERED, WE ESTIMATED THE FOLLOWING RELATIVE RISKS: noise 1.06, environmental tobacco smoke 1.19 (men) and 1.22 (women), shift work 1.12, and low job control 1.15 (men) and 1.08 (women). Combined AFs of those factors in the IHD were estimated at 9.29% (0.3-18.51%) in men and 5.78% (-7.05-19.15%) in women. Based on these fractions, Korea's 2006 death toll from occupational IHD between the age of 15 and 69 was calculated at 353 in men (total 3,804) and 72 in women (total 1,246). We estimated occupational IHD mortality of Korea with updated data and more relevant evidence. Despite the efforts to obtain reliable estimates, there were many assumptions and limitations that must be overcome. Future research based on more precise design and reliable evidence is required for more accurate estimates.

Risk of symptomatic dengue for foreign visitors to the 2014 FIFA World Cup in Brazil

PubMed Central

Massad, Eduardo; Wilder-Smith, Annelies; Ximenes, Raphael; Amaku, Marcos; Lopez, Luis Fernandez; Coutinho, Francisco Antonio Bezerra; Coelho, Giovanini Evelim; da Silva, Jarbas Barbosa; Struchiner, Claudio José; Burattini, Marcelo Nascimento

2014-01-01

Brazil will host the FIFA World Cup™, the biggest single-event competition in the world, from June 12-July 13 2014 in 12 cities. This event will draw an estimated 600,000 international visitors. Brazil is endemic for dengue. Hence, attendees of the 2014 event are theoretically at risk for dengue. We calculated the risk of dengue acquisition to non-immune international travellers to Brazil, depending on the football match schedules, considering locations and dates of such matches for June and July 2014. We estimated the average per-capita risk and expected number of dengue cases for each host-city and each game schedule chosen based on reported dengue cases to the Brazilian Ministry of Health for the period between 2010-2013. On the average, the expected number of cases among the 600,000 foreigner tourists during the World Cup is 33, varying from 3-59. Such risk estimates will not only benefit individual travellers for adequate pre-travel preparations, but also provide valuable information for public health professionals and policy makers worldwide. Furthermore, estimates of dengue cases in international travellers during the World Cup can help to anticipate the theoretical risk for exportation of dengue into currently non-infected areas. PMID:24863976

Risk of symptomatic dengue for foreign visitors to the 2014 FIFA World Cup in Brazil.

PubMed

Massad, Eduardo; Wilder-Smith, Annelies; Ximenes, Raphael; Amaku, Marcos; Lopez, Luis Fernandez; Coutinho, Francisco Antonio Bezerra; Coelho, Giovanini Evelim; Silva, Jarbas Barbosa da; Struchiner, Claudio José; Burattini, Marcelo Nascimento

2014-06-01

Brazil will host the FIFA World Cup™, the biggest single-event competition in the world, from June 12-July 13 2014 in 12 cities. This event will draw an estimated 600,000 international visitors. Brazil is endemic for dengue. Hence, attendees of the 2014 event are theoretically at risk for dengue. We calculated the risk of dengue acquisition to non-immune international travellers to Brazil, depending on the football match schedules, considering locations and dates of such matches for June and July 2014. We estimated the average per-capita risk and expected number of dengue cases for each host-city and each game schedule chosen based on reported dengue cases to the Brazilian Ministry of Health for the period between 2010-2013. On the average, the expected number of cases among the 600,000 foreigner tourists during the World Cup is 33, varying from 3-59. Such risk estimates will not only benefit individual travellers for adequate pre-travel preparations, but also provide valuable information for public health professionals and policy makers worldwide. Furthermore, estimates of dengue cases in international travellers during the World Cup can help to anticipate the theoretical risk for exportation of dengue into currently non-infected areas.

Towards health impact assessment of drinking-water privatization--the example of waterborne carcinogens in North Rhine-Westphalia (Germany).

PubMed Central

Fehr, Rainer; Mekel, Odile; Lacombe, Martin; Wolf, Ulrike

2003-01-01

Worldwide there is a tendency towards deregulation in many policy sectors - this, for example, includes liberalization and privatization of drinking-water management. However, concerns about the negative impacts this might have on human health call for prospective health impact assessment (HIA) on the management of drinking-water. On the basis of an established generic 10-step HIA procedure and on risk assessment methodology, this paper aims to produce quantitative estimates concerning health effects from increased exposure to carcinogens in drinking-water. Using data from North Rhine-Westphalia in Germany, probabilistic estimates of excess lifetime cancer risk, as well as estimates of additional cases of cancer from increased carcinogen exposure levels are presented. The results show how exposure to contaminants that are strictly within current limits could increase cancer risks and case-loads substantially. On the basis of the current analysis, we suggest that with uniform increases in pollutant levels, a single chemical (arsenic) is responsible for a large fraction of expected additional risk. The study also illustrates the uncertainty involved in predicting the health impacts of changes in water quality. Future analysis should include additional carcinogens, non-cancer risks including those due to microbial contamination, and the impacts of system failures and of illegal action, which may be increasingly likely to occur under changed management arrangements. If, in spite of concerns, water is privatized, it is particularly important to provide adequate surveillance of water quality. PMID:12894324

Contrast media controversies in 2015: imaging patients with renal impairment or risk of contrast reaction.

PubMed

Davenport, Matthew S; Cohan, Richard H; Ellis, James H

2015-06-01

The incidence and significance of complications related to intravascular contrast material administration have become increasingly controversial. This review will highlight current thinking regarding the imaging of patients with renal impairment and those at risk for an allergiclike contrast reaction. The risk of contrast-induced acute kidney injury remains uncertain for patients with an estimated glomerular filtration rate (GFR) less than 45 mL/min/1.73 m(2), but if there is a risk, it is greatest in those with estimated GFR less than 30 mL/min/1.73 m(2). In this population, low-risk gadolinium-based contrast agents appear to have a large safety margin. Corticosteroid prophylaxis remains the standard of care in the United States for patients identified to be at high risk of a contrast reaction, but it has an incomplete mitigating effect on contrast reaction rates and the number needed to treat is large.

An ecological momentary intervention for smoking cessation: The associations of just-in-time, tailored messages with lapse risk factors.

PubMed

Hébert, Emily T; Stevens, Elise M; Frank, Summer G; Kendzor, Darla E; Wetter, David W; Zvolensky, Michael J; Buckner, Julia D; Businelle, Michael S

2018-03-01

Smartphone apps can provide real-time, tailored interventions for smoking cessation. The current study examines the effectiveness of a smartphone-based smoking cessation application that assessed risk for imminent smoking lapse multiple times per day and provided messages tailored to current smoking lapse risk and specific lapse triggers. Participants (N=59) recruited from a safety-net hospital smoking cessation clinic completed phone-based ecological momentary assessments (EMAs) 5 times/day for 3 consecutive weeks (1week pre-quit, 2weeks post-quit). Risk for smoking lapse was estimated in real-time using a novel weighted lapse risk estimator. With each EMA, participants received messages tailored to current level of risk for imminent smoking lapse and self-reported presence of smoking urge, stress, cigarette availability, and motivation to quit. Generalized linear mixed model analyses determined whether messages tailored to specific lapse risk factors were associated with greater reductions in these triggers than messages not tailored to specific triggers. Overall, messages tailored to smoking urge, cigarette availability, or stress corresponded with greater reductions in those triggers than messages that were not tailored to specific triggers (p's=0.02 to <0.001). Although messages tailored to stress were associated with greater reductions in stress than messages not tailored to stress, the association was non-significant (p=0.892) when only moments of high stress were included in the analysis. Mobile technology can be used to conduct real-time smoking lapse risk assessment and provide tailored treatment content. Findings provide initial evidence that tailored content may impact users' urge to smoke, stress, and cigarette availability. Copyright © 2017 Elsevier Ltd. All rights reserved.

Official Positions for FRAX® clinical regarding falls and frailty: can falls and frailty be used in FRAX®? From Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®.

PubMed

Masud, Tahir; Binkley, Neil; Boonen, Steven; Hannan, Marian T

2011-01-01

Risk factors for fracture can be purely skeletal, e.g., bone mass, microarchitecture or geometry, or a combination of bone and falls risk related factors such as age and functional status. The remit of this Task Force was to review the evidence and consider if falls should be incorporated into the FRAX® model or, alternatively, to provide guidance to assist clinicians in clinical decision-making for patients with a falls history. It is clear that falls are a risk factor for fracture. Fracture probability may be underestimated by FRAX® in individuals with a history of frequent falls. The substantial evidence that various interventions are effective in reducing falls risk was reviewed. Targeting falls risk reduction strategies towards frail older people at high risk for indoor falls is appropriate. This Task Force believes that further fracture reduction requires measures to reduce falls risk in addition to bone directed therapy. Clinicians should recognize that patients with frequent falls are at higher fracture risk than currently estimated by FRAX® and include this in decision-making. However, quantitative adjustment of the FRAX® estimated risk based on falls history is not currently possible. In the long term, incorporation of falls as a risk factor in the FRAX® model would be ideal. Copyright © 2011 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Global risk from the atmospheric dispersion of radionuclides by nuclear power plant accidents in the coming decades

NASA Astrophysics Data System (ADS)

Christoudias, T.; Proestos, Y.; Lelieveld, J.

2014-05-01

We estimate the global risk from the release and atmospheric dispersion of radionuclides from nuclear power plant accidents using the EMAC atmospheric chemistry-general circulation model. We included all nuclear reactors that are currently operational, under construction and planned or proposed. We implemented constant continuous emissions from each location in the model and simulated atmospheric transport and removal via dry and wet deposition processes over 20 years (2010-2030), driven by boundary conditions based on the IPCC A2 future emissions scenario. We present global overall and seasonal risk maps for potential surface layer concentrations and ground deposition of radionuclides, and estimate potential doses to humans from inhalation and ground-deposition exposures to radionuclides. We find that the risk of harmful doses due to inhalation is typically highest in the Northern Hemisphere during boreal winter, due to relatively shallow boundary layer development and limited mixing. Based on the continued operation of the current nuclear power plants, we calculate that the risk of radioactive contamination to the citizens of the USA will remain to be highest worldwide, followed by India and France. By including stations under construction and those that are planned and proposed, our results suggest that the risk will become highest in China, followed by India and the USA.

Global risk from the atmospheric dispersion of radionuclides by nuclear power plant accidents in the coming decades

NASA Astrophysics Data System (ADS)

Christoudias, T.; Proestos, Y.; Lelieveld, J.

2013-11-01

We estimate the global risk from the release and atmospheric dispersion of radionuclides from nuclear power plant accidents using the EMAC atmospheric chemistry-general circulation model. We included all nuclear reactors that are currently operational, under construction and planned or proposed. We implemented constant continuous emissions from each location in the model and simulated atmospheric transport and removal via dry and wet deposition processes over 20 yr (2010-2030), driven by boundary conditions based on the IPCC A2 future emissions scenario. We present global overall and seasonal risk maps for potential surface layer concentrations and ground deposition of radionuclides, and estimate potential dosages to humans from the inhalation and the exposure to ground deposited radionuclides. We find that the risk of harmful doses due to inhalation is typically highest during boreal winter due to relatively shallow boundary layer development and reduced mixing. Based on the continued operation of the current nuclear power plants, we calculate that the risk of radioactive contamination to the citizens of the USA will remain to be highest worldwide, followed by India and France. By including stations under construction and those that are planned and proposed our results suggest that the risk will become highest in China, followed by India and the USA.

Global Risk from the Atmospheric Dispersion of Radionuclides by Nuclear Power Plant Accidents in the Coming Decades

NASA Astrophysics Data System (ADS)

Christoudias, T.; Proestos, Y.; Lelieveld, J.

2014-12-01

We estimate the global risk from the release and atmospheric dispersion of radionuclides from nuclear power plant accidents using the EMAC atmospheric chemistry-general circulation model. We included all nuclear reactors that are currently operational, under construction and planned or proposed. We implemented constant continuous emissions from each location in the model and simulated atmospheric transport and removal via dry and wet deposition processes over 20 years (2010-2030), driven by boundary conditions based on the IPCC A2 future emissions scenario. We present global overall and seasonal risk maps for potential surface layer concentrations and ground deposition of radionuclides, and estimate potential doses to humans from inhalation and ground-deposition exposures to radionuclides. We find that the risk of harmful doses due to inhalation is typically highest in the Northern Hemisphere during boreal winter, due to relatively shallow boundary layer development and limited mixing. Based on the continued operation of the current nuclear power plants, we calculate that the risk of radioactive contamination to the citizens of the USA will remain to be highest worldwide, followed by India and France. By including stations under construction and those that are planned and proposed, our results suggest that the risk will become highest in China, followed by India and the USA.

Ovarian Cancer Incidence Corrected for Oophorectomy

PubMed Central

Baldwin, Lauren A.; Chen, Quan; Tucker, Thomas C.; White, Connie G.; Ore, Robert N.; Huang, Bin

2017-01-01

Current reported incidence rates for ovarian cancer may significantly underestimate the true rate because of the inclusion of women in the calculations who are not at risk for ovarian cancer due to prior benign salpingo-oophorectomy (SO). We have considered prior SO to more realistically estimate risk for ovarian cancer. Kentucky Health Claims Data, International Classification of Disease 9 (ICD-9) codes, Current Procedure Terminology (CPT) codes, and Kentucky Behavioral Risk Factor Surveillance System (BRFSS) Data were used to identify women who have undergone SO in Kentucky, and these women were removed from the at-risk pool in order to re-assess incidence rates to more accurately represent ovarian cancer risk. The protective effect of SO on the population was determined on an annual basis for ages 5–80+ using data from the years 2009–2013. The corrected age-adjusted rates of ovarian cancer that considered SO ranged from 33% to 67% higher than age-adjusted rates from the standard population. Correction of incidence rates for ovarian cancer by accounting for women with prior SO gives a better understanding of risk for this disease faced by women. The rates of ovarian cancer were substantially higher when SO was taken into consideration than estimates from the standard population. PMID:28368298

NASA Occupant Protection Standards Development

NASA Technical Reports Server (NTRS)

Somers, Jeffrey; Gernhardt, Michael; Lawrence, Charles

2012-01-01

Historically, spacecraft landing systems have been tested with human volunteers, because analytical methods for estimating injury risk were insufficient. These tests were conducted with flight-like suits and seats to verify the safety of the landing systems. Currently, NASA uses the Brinkley Dynamic Response Index to estimate injury risk, although applying it to the NASA environment has drawbacks: (1) Does not indicate severity or anatomical location of injury (2) Unclear if model applies to NASA applications. Because of these limitations, a new validated, analytical approach was desired. Leveraging off of the current state of the art in automotive safety and racing, a new approach was developed. The approach has several aspects: (1) Define the acceptable level of injury risk by injury severity (2) Determine the appropriate human surrogate for testing and modeling (3) Mine existing human injury data to determine appropriate Injury Assessment Reference Values (IARV). (4) Rigorously Validate the IARVs with sub-injurious human testing (5) Use validated IARVs to update standards and vehicle requirement

Ionizing radiation and genetic risks. XIII. Summary and synthesis of papers VI to XII and estimates of genetic risks in the year 2000.

PubMed

Sankaranarayanan, K; Chakraborty, R

2000-10-16

This paper recapitulates the advances in the field of genetic risk estimation that have occurred during the past decade and using them as a basis, presents revised estimates of genetic risks of exposure to radiation. The advances include: (i) an upward revision of the estimates of incidence for Mendelian diseases (2.4% now versus 1.25% in 1993); (ii) the introduction of a conceptual change for calculating doubling doses; (iii) the elaboration of methods to estimate the mutation component (i.e. the relative increase in disease frequency per unit relative increase in mutation rate) and the use of the estimates obtained through these methods for assessing the impact of induced mutations on the incidence of Mendelian and chronic multifactorial diseases; (iv) the introduction of an additional factor called the "potential recoverability correction factor" in the risk equation to bridge the gap between radiation-induced mutations that have been recovered in mice and the risk of radiation-inducible genetic disease in human live births and (v) the introduction of the concept that the adverse effects of radiation-induced genetic damage are likely to be manifest predominantly as multi-system developmental abnormalities in the progeny. For all classes of genetic disease (except congenital abnormalities), the estimates of risk have been obtained using a doubling dose of 1 Gy. For a population exposed to low LET, chronic/ low dose irradiation, the current estimates for the first generation progeny are the following (all estimates per million live born progeny per Gy of parental irradiation): autosomal dominant and X-linked diseases, approximately 750-1500 cases; autosomal recessive, nearly zero and chronic multifactorial diseases, approximately 250-1200 cases. For congenital abnormalities, the estimate is approximately 2000 cases and is based on mouse data on developmental abnormalities. The total risk per Gy is of the order of approximately 3000-4700 cases which represent approximately 0.4-0.6% of the baseline frequency of these diseases (738,000 per million) in the population.

California Drought Recovery Assessment Using GRACE Satellite Gravimetry Information

NASA Astrophysics Data System (ADS)

Love, C. A.; Aghakouchak, A.; Madadgar, S.; Tourian, M. J.

2015-12-01

California has been experiencing its most extreme drought in recent history due to a combination of record high temperatures and exceptionally low precipitation. An estimate for when the drought can be expected to end is needed for risk mitigation and water management. A crucial component of drought recovery assessments is the estimation of terrestrial water storage (TWS) deficit. Previous studies on drought recovery have been limited to surface water hydrology (precipitation and/or runoff) for estimating changes in TWS, neglecting the contribution of groundwater deficits to the recovery time of the system. Groundwater requires more time to recover than surface water storage; therefore, the inclusion of groundwater storage in drought recovery assessments is essential for understanding the long-term vulnerability of a region. Here we assess the probability, for varying timescales, of California's current TWS deficit returning to its long-term historical mean. Our method consists of deriving the region's fluctuations in TWS from changes in the gravity field observed by NASA's Gravity Recovery and Climate Experiment (GRACE) satellites. We estimate the probability that meteorological inputs, precipitation minus evaporation and runoff, over different timespans will balance the current GRACE-derived TWS deficit (e.g. in 3, 6, 12 months). This method improves upon previous techniques as the GRACE-derived water deficit comprises all hydrologic sources, including surface water, groundwater, and snow cover. With this empirical probability assessment we expect to improve current estimates of California's drought recovery time, thereby improving risk mitigation.

Assessment of uncertainties in radiation-induced cancer risk predictions at clinically relevant doses

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

Nguyen, J.; Moteabbed, M.; Paganetti, H., E-mail: hpaganetti@mgh.harvard.edu

2015-01-15

Purpose: Theoretical dose–response models offer the possibility to assess second cancer induction risks after external beam therapy. The parameters used in these models are determined with limited data from epidemiological studies. Risk estimations are thus associated with considerable uncertainties. This study aims at illustrating uncertainties when predicting the risk for organ-specific second cancers in the primary radiation field illustrated by choosing selected treatment plans for brain cancer patients. Methods: A widely used risk model was considered in this study. The uncertainties of the model parameters were estimated with reported data of second cancer incidences for various organs. Standard error propagationmore » was then subsequently applied to assess the uncertainty in the risk model. Next, second cancer risks of five pediatric patients treated for cancer in the head and neck regions were calculated. For each case, treatment plans for proton and photon therapy were designed to estimate the uncertainties (a) in the lifetime attributable risk (LAR) for a given treatment modality and (b) when comparing risks of two different treatment modalities. Results: Uncertainties in excess of 100% of the risk were found for almost all organs considered. When applied to treatment plans, the calculated LAR values have uncertainties of the same magnitude. A comparison between cancer risks of different treatment modalities, however, does allow statistically significant conclusions. In the studied cases, the patient averaged LAR ratio of proton and photon treatments was 0.35, 0.56, and 0.59 for brain carcinoma, brain sarcoma, and bone sarcoma, respectively. Their corresponding uncertainties were estimated to be potentially below 5%, depending on uncertainties in dosimetry. Conclusions: The uncertainty in the dose–response curve in cancer risk models makes it currently impractical to predict the risk for an individual external beam treatment. On the other hand, the ratio of absolute risks between two modalities is less sensitive to the uncertainties in the risk model and can provide statistically significant estimates.« less

Using thresholds based on risk of cardiovascular disease to target treatment for hypertension: modelling events averted and number treated

PubMed Central

Baker, Simon; Priest, Patricia; Jackson, Rod

2000-01-01

Objective To estimate the impact of using thresholds based on absolute risk of cardiovascular disease to target drug treatment to lower blood pressure in the community. Design Modelling of three thresholds of treatment for hypertension based on the absolute risk of cardiovascular disease. 5 year risk of disease was estimated for each participant using an equation to predict risk. Net predicted impact of the thresholds on the number of people treated and the number of disease events averted over 5 years was calculated assuming a relative treatment benefit of one quarter. Setting Auckland, New Zealand. Participants 2158 men and women aged 35-79 years randomly sampled from the general electoral rolls. Main outcome measures Predicted 5 year risk of cardiovascular disease event, estimated number of people for whom treatment would be recommended, and disease events averted over 5 years at different treatment thresholds. Results 46 374 (12%) Auckland residents aged 35-79 receive drug treatment to lower their blood pressure, averting an estimated 1689 disease events over 5 years. Restricting treatment to individuals with blood pressure ⩾170/100 mm Hg and those with blood pressure between 150/90-169/99 mm Hg who have a predicted 5 year risk of disease ⩾10% would increase the net number for whom treatment would be recommended by 19 401. This 42% relative increase is predicted to avert 1139/1689 (68%) additional disease events overall over 5 years compared with current treatment. If the threshold for 5 year risk of disease is set at 15% the number recommended for treatment increases by <10% but about 620/1689 (37%) additional events can be averted. A 20% threshold decreases the net number of patients recommended for treatment by about 10% but averts 204/1689 (12%) more disease events than current treatment. Conclusions Implementing treatment guidelines that use treatment thresholds based on absolute risk could significantly improve the efficiency of drug treatment to lower blood pressure in primary care. PMID:10710577

Uncertainties in Estimates of the Risks of Late Effects from Space Radiation

NASA Technical Reports Server (NTRS)

Cucinotta, F. A.; Schimmerling, W.; Wilson, J. W.; Peterson, L. E.; Saganti, P.; Dicelli, J. F.

2002-01-01

The health risks faced by astronauts from space radiation include cancer, cataracts, hereditary effects, and non-cancer morbidity and mortality risks related to the diseases of the old age. Methods used to project risks in low-Earth orbit are of questionable merit for exploration missions because of the limited radiobiology data and knowledge of galactic cosmic ray (GCR) heavy ions, which causes estimates of the risk of late effects to be highly uncertain. Risk projections involve a product of many biological and physical factors, each of which has a differential range of uncertainty due to lack of data and knowledge. Within the linear-additivity model, we use Monte-Carlo sampling from subjective uncertainty distributions in each factor to obtain a Maximum Likelihood estimate of the overall uncertainty in risk projections. The resulting methodology is applied to several human space exploration mission scenarios including ISS, lunar station, deep space outpost, and Mar's missions of duration of 360, 660, and 1000 days. The major results are the quantification of the uncertainties in current risk estimates, the identification of factors that dominate risk projection uncertainties, and the development of a method to quantify candidate approaches to reduce uncertainties or mitigate risks. The large uncertainties in GCR risk projections lead to probability distributions of risk that mask any potential risk reduction using the "optimization" of shielding materials or configurations. In contrast, the design of shielding optimization approaches for solar particle events and trapped protons can be made at this time, and promising technologies can be shown to have merit using our approach. The methods used also make it possible to express risk management objectives in terms of quantitative objective's, i.e., the number of days in space without exceeding a given risk level within well defined confidence limits.

Statin cost-effectiveness in the United States for people at different vascular risk levels.

PubMed

2009-03-01

Statins reduce the rates of heart attacks, strokes, and revascularization procedures (ie, major vascular events) in a wide range of circumstances. Randomized controlled trial data from 20,536 adults have been used to estimate the cost-effectiveness of prescribing statin therapy in the United States for people at different levels of vascular disease risk and to explore whether wider use of generic statins beyond the populations currently recommended for treatment in clinical guidelines is indicated. Randomized controlled trial data, an internally validated vascular disease model, and US costs of statin therapy and other medical care were used to project lifetime risks of vascular events and evaluate the cost-effectiveness of 40 mg simvastatin daily. For an average of 5 years, allocation to simvastatin reduced the estimated US costs of hospitalizations for vascular events by approximately 20% (95% CI, 15 to 24) in the different subcategories of participants studied. At a daily cost of $1 for 40 mg generic simvastatin, the estimated costs of preventing a vascular death within the 5-year study period ranged from a net saving of $1300 (95% CI, $15,600 saving to $13,200 cost) among participants with a 42% 5-year major vascular event risk to a net cost of $216,500 ($123,700 to $460,000 cost) among those with a 12% 5-year risk. The costs per life year gained with lifetime simvastatin treatment ranged from $2500 (-$40 to $3820) in people aged 40 to 49 years with a 42% 5-year major vascular event risk to $10,990 ($9430 to $14,700) in people aged 70 years and older with a 12% 5-year risk. Treatment with generic simvastatin appears to be cost-effective for a much wider population in the United States than that recommended by current guidelines.

Health Behavior Changes After Genetic Risk Assessment for Alzheimer Disease: The REVEAL Study

PubMed Central

Chao, Serena; Roberts, J. Scott; Marteau, Theresa M.; Silliman, Rebecca; Cupples, L. Adrienne; Green, Robert C.

2008-01-01

Risk information for Alzheimer disease (AD) may be communicated through susceptibility gene disclosure, even though this is not currently in clinical use. The REVEAL Study is the first randomized clinical trial of risk assessment for AD with apolipoprotein E (APOE) genotype and numerical risk estimate disclosure. We examined whether APOE genotype and numerical risk disclosure to asymptomatic individuals at high risk for AD alters health behaviors. One hundred sixty-two participants were randomized to either intervention (APOE disclosure) or control (no genotype disclosure) groups. Subjects in both groups received numerical lifetime risk estimates of future AD development based on sex and family history of AD. The intervention group received their APOE genotype. Subjects were informed that no proven preventive measures for AD existed and given an information sheet on preventative therapies under investigation. Participants who learned they were ε4 positive were significantly more likely than ε4 negative participants to report AD-specific health behavior change 1 year after disclosure (adjusted odds ratio: 2.73; 95% confidence interval: 1.14, 6.54; P = 0.02). Post hoc analyses revealed similar significant associations between numerical lifetime risk estimates and self-report of AD-specific health behavior change. Despite lack of preventive measures for AD, knowledge of APOE genotype, numerical lifetime risk, or both, influences health behavior. PMID:18317253

Health behavior changes after genetic risk assessment for Alzheimer disease: The REVEAL Study.

PubMed

Chao, Serena; Roberts, J Scott; Marteau, Theresa M; Silliman, Rebecca; Cupples, L Adrienne; Green, Robert C

2008-01-01

Risk information for Alzheimer disease (AD) may be communicated through susceptibility gene disclosure, even though this is not currently in clinical use. The REVEAL Study is the first randomized clinical trial of risk assessment for AD with apolipoprotein E (APOE) genotype and numerical risk estimate disclosure. We examined whether APOE genotype and numerical risk disclosure to asymptomatic individuals at high risk for AD alters health behaviors. One hundred sixty-two participants were randomized to either intervention (APOE disclosure) or control (no genotype disclosure) groups. Subjects in both groups received numerical lifetime risk estimates of future AD development based on sex and family history of AD. The intervention group received their APOE genotype. Subjects were informed that no proven preventive measures for AD existed and given an information sheet on preventative therapies under investigation. Participants who learned they were epsilon 4 positive were significantly more likely than epsilon 4 negative participants to report AD-specific health behavior change 1 year after disclosure (adjusted odds ratio: 2.73; 95% confidence interval: 1.14, 6.54; P=0.02). Post hoc analyses revealed similar significant associations between numerical lifetime risk estimates and self-report of AD-specific health behavior change. Despite lack of preventive measures for AD, knowledge of APOE genotype, numerical lifetime risk, or both, influences health behavior.

Quantifying Cancer Risk from Radiation.

PubMed

Keil, Alexander P; Richardson, David B

2017-12-06

Complex statistical models fitted to data from studies of atomic bomb survivors are used to estimate the human health effects of ionizing radiation exposures. We describe and illustrate an approach to estimate population risks from ionizing radiation exposure that relaxes many assumptions about radiation-related mortality. The approach draws on developments in methods for causal inference. The results offer a different way to quantify radiation's effects and show that conventional estimates of the population burden of excess cancer at high radiation doses are driven strongly by projecting outside the range of current data. Summary results obtained using the proposed approach are similar in magnitude to those obtained using conventional methods, although estimates of radiation-related excess cancers differ for many age, sex, and dose groups. At low doses relevant to typical exposures, the strength of evidence in data is surprisingly weak. Statements regarding human health effects at low doses rely strongly on the use of modeling assumptions. © 2017 Society for Risk Analysis.

Estimates of present and future flood risk in the conterminous United States

NASA Astrophysics Data System (ADS)

Wing, Oliver E. J.; Bates, Paul D.; Smith, Andrew M.; Sampson, Christopher C.; Johnson, Kris A.; Fargione, Joseph; Morefield, Philip

2018-03-01

Past attempts to estimate rainfall-driven flood risk across the US either have incomplete coverage, coarse resolution or use overly simplified models of the flooding process. In this paper, we use a new 30 m resolution model of the entire conterminous US with a 2D representation of flood physics to produce estimates of flood hazard, which match to within 90% accuracy the skill of local models built with detailed data. These flood depths are combined with exposure datasets of commensurate resolution to calculate current and future flood risk. Our data show that the total US population exposed to serious flooding is 2.6-3.1 times higher than previous estimates, and that nearly 41 million Americans live within the 1% annual exceedance probability floodplain (compared to only 13 million when calculated using FEMA flood maps). We find that population and GDP growth alone are expected to lead to significant future increases in exposure, and this change may be exacerbated in the future by climate change.

The Impact of Information on AIDS Risk Judgments and Behavioral Change among Young Adults.

ERIC Educational Resources Information Center

Dunwoody, Sharon; Neuwirth, Kurt

Participants in the debate on the media's role in the current AIDS (Acquired Immune Deficiency Syndrome) epidemic implicitly adopt a set of underlying assumptions about media processes and effects: information about AIDS proffered by the media has the capacity to influence estimates of risk, personal levels of concern, and extent of behavioral…

Uncertainties in estimates of the risks of late effects from space radiation

NASA Technical Reports Server (NTRS)

Cucinotta, F. A.; Schimmerling, W.; Wilson, J. W.; Peterson, L. E.; Saganti, P. B.; Dicello, J. F.

2004-01-01

Methods used to project risks in low-Earth orbit are of questionable merit for exploration missions because of the limited radiobiology data and knowledge of galactic cosmic ray (GCR) heavy ions, which causes estimates of the risk of late effects to be highly uncertain. Risk projections involve a product of many biological and physical factors, each of which has a differential range of uncertainty due to lack of data and knowledge. Using the linear-additivity model for radiation risks, we use Monte-Carlo sampling from subjective uncertainty distributions in each factor to obtain an estimate of the overall uncertainty in risk projections. The resulting methodology is applied to several human space exploration mission scenarios including a deep space outpost and Mars missions of duration of 360, 660, and 1000 days. The major results are the quantification of the uncertainties in current risk estimates, the identification of factors that dominate risk projection uncertainties, and the development of a method to quantify candidate approaches to reduce uncertainties or mitigate risks. The large uncertainties in GCR risk projections lead to probability distributions of risk that mask any potential risk reduction using the "optimization" of shielding materials or configurations. In contrast, the design of shielding optimization approaches for solar particle events and trapped protons can be made at this time and promising technologies can be shown to have merit using our approach. The methods used also make it possible to express risk management objectives in terms of quantitative metrics, e.g., the number of days in space without exceeding a given risk level within well-defined confidence limits. Published by Elsevier Ltd on behalf of COSPAR.

Risk Factor Detection as a Metric of STARHS Performance for HIV Incidence Surveillance Among Female Sex Workers in Kigali, Rwanda

PubMed Central

Braunstein, Sarah L; van de Wijgert, Janneke H; Vyankandondera, Joseph; Kestelyn, Evelyne; Ntirushwa, Justin; Nash, Denis

2012-01-01

Background: The epidemiologic utility of STARHS hinges not only on producing accurate estimates of HIV incidence, but also on identifying risk factors for recent HIV infection. Methods: As part of an HIV seroincidence study, 800 Rwandan female sex workers (FSW) were HIV tested, with those testing positive further tested by BED-CEIA (BED) and AxSYM Avidity Index (Ax-AI) assays. A sample of HIV-negative (N=397) FSW were followed prospectively for HIV seroconversion. We compared estimates of risk factors for: 1) prevalent HIV infection; 2) recently acquired HIV infection (RI) based on three different STARHS classifications (BED alone, Ax-AI alone, BED/Ax-AI combined); and 3) prospectively observed seroconversion. Results: There was mixed agreement in risk factors between methods. HSV-2 coinfection and recent STI treatment were associated with both prevalent HIV infection and all three measures of recent infection. A number of risk factors were associated only with prevalent infection, including widowhood, history of forced sex, regular alcohol consumption, prior imprisonment, and current breastfeeding. Number of sex partners in the last 3 months was associated with recent infection based on BED/Ax-AI combined, but not other STARHS-based recent infection outcomes or prevalent infection. Risk factor estimates for prospectively observed seroconversion differed in magnitude and direction from those for recent infection via STARHS. Conclusions: Differences in risk factor estimates by each method could reflect true differences in risk factors between the prevalent, recently, or newly infected populations, the effect of study interventions (among those followed prospectively), or assay misclassification. Similar investigations in other populations/settings are needed to further establish the epidemiologic utility of STARHS for identifying risk factors, in addition to incidence rate estimation. PMID:23056162

Impact of a financial risk-sharing scheme on budget-impact estimations: a game-theoretic approach.

PubMed

Gavious, Arieh; Greenberg, Dan; Hammerman, Ariel; Segev, Ella

2014-06-01

As part of the process of updating the National List of Health Services in Israel, health plans (the 'payers') and manufacturers each provide estimates on the expected number of patients that will utilize a new drug. Currently, payers face major financial consequences when actual utilization is higher than the allocated budget. We suggest a risk-sharing model between the two stakeholders; if the actual number of patients exceeds the manufacturer's prediction, the manufacturer will reimburse the payers by a rebate rate of α from the deficit. In case of under-utilization, payers will refund the government at a rate of γ from the surplus budget. Our study objective was to identify the optimal early estimations of both 'players' prior to and after implementation of the risk-sharing scheme. Using a game-theoretic approach, in which both players' statements are considered simultaneously, we examined the impact of risk-sharing within a given range of rebate proportions, on players' early budget estimations. When increasing manufacturer's rebate α to be over 50 %, then manufacturers will announce a larger number, and health plans will announce a lower number of patients than they would without risk sharing, thus substantially decreasing the gap between their estimates. Increasing γ changes players' estimates only slightly. In reaction to applying a substantial risk-sharing rebate α on the manufacturer, both players are expected to adjust their budget estimates toward an optimal equilibrium. Increasing α is a better vehicle for reaching the desired equilibrium rather than increasing γ, as the manufacturer's rebate α substantially influences both players, whereas γ has little effect on the players behavior.

REVIEW OF DRAFT REVISED BLUE BOOK ON ESTIMATING ...

EPA Pesticide Factsheets

In 1994, EPA published a report, referred to as the “Blue Book,” which lays out EPA’s current methodology for quantitatively estimating radiogenic cancer risks. A follow-on report made minor adjustments to the previous estimates and presented a partial analysis of the uncertainties in the numerical estimates. In 2006, the National Research Council of the National Academy of Sciences released a report on the health risks from exposure to low levels of ionizing radiation. Cosponsored by the EPA and several other Federal agencies, Health Risks from Exposure to Low Levels of Ionizing Radiation BEIR VII Phase 2 (BEIR VII) primarily addresses cancer and genetic risks from low doses of low-LET radiation. In the draft White Paper: Modifying EPA Radiation Risk Models Based on BEIR VII (White Paper), ORIA proposed changes in EPA’s methodology for estimating radiogenic cancers, based on the contents of BEIR VII and some ancillary information. For the most part, it proposed to adopt the models and methodology recommended in BEIR VII; however, certain modifications and expansions are considered to be desirable or necessary for EPA’s purposes. EPA sought advice from the Agency’s Science Advisory Board on the application of BEIR VII and on issues relating to these modifications and expansions in the Advisory on EPA’s Draft White Paper: Modifying EPA Radiation Risk Models Based on BEIR VII (record # 83044). The SAB issued its Advisory on Jan. 31, 2008 (EPA-SAB-08-

Joint-specific risk of impaired function in fibrodysplasia ossificans progressiva (FOP).

PubMed

Pignolo, Robert J; Durbin-Johnson, Blythe P; Rocke, David M; Kaplan, Frederick S

2018-04-01

Fibrodysplasia ossificans progressiva (FOP) causes progressive disability due to heterotopic ossification from episodic flare-ups. Using data from 500 FOP patients (representing 63% of all known patients world-wide), age- and joint-specific risks of new joint involvement were estimated using parametric and nonparametric statistical methods. Compared to data from a 1994 survey of 44 individuals with FOP, our current estimates of age- and joint-specific risks of new joint involvement are more accurate (narrower confidence limits), based on a wider range of ages, and have less bias due to its greater comprehensiveness (captures over three-fifths of the known FOP patients worldwide). For the neck, chest, abdomen, and upper back, the estimated hazard decreases over time. For the jaw, lower back, shoulder, elbow, wrist, fingers, hip, knee, ankle, and foot, the estimated hazard increases initially then either plateaus or decreases. At any given time and for any anatomic site, the data indicate which joints are at risk. This study of approximately 63% of the world's known population of FOP patients provides a refined estimate of risk for new involvement at any joint at any age, as well as the proportion of patients with uninvolved joints at any age. Importantly, these joint-specific survival curves can be used to facilitate clinical trial design and to determine if potential treatments can modify the predicted trajectory of progressive joint dysfunction. Copyright © 2017 Elsevier Inc. All rights reserved.

Underreporting of high-risk water and sanitation practices undermines progress on global targets.

PubMed

Vedachalam, Sridhar; MacDonald, Luke H; Shiferaw, Solomon; Seme, Assefa; Schwab, Kellogg J

2017-01-01

Water and sanitation indicators under the Millennium Development Goals failed to capture high-risk practices undertaken on a regular basis. In conjunction with local partners, fourteen rounds of household surveys using mobile phones with a customized open-source application were conducted across nine study geographies in Asia and Africa. In addition to the main water and sanitation facilities, interviewees (n = 245,054) identified all water and sanitation options regularly used for at least one season of the year. Unimproved water consumption and open defecation were targeted as high-risk practices. We defined underreporting as the difference between the regular and main use of high-risk practices. Our estimates of high-risk practices as the main option matched the widely accepted Demographic and Health Surveys (DHS) estimates within the 95% confidence interval. However, estimates of these practices as a regular option was far higher than the DHS estimates. Across the nine geographies, median underreporting of unimproved water use was 5.5%, with a range of 0.5% to 13.9%. Median underreporting of open defecation was much higher at 9.9%, with a range of 2.7% to 11.5%. This resulted in an underreported population of 25 million regularly consuming unimproved water and 50 million regularly practicing open defecation. Further examination of data from Ethiopia suggested that location and socio-economic factors were significant drivers of underreporting. Current global monitoring relies on a framework that considers the availability and use of a single option to meet drinking water and sanitation needs. Our analysis demonstrates the use of multiple options and widespread underreporting of high-risk practices. Policies based on current monitoring data, therefore, fail to consider the range of challenges and solutions to meeting water and sanitation needs, and result in an inflated sense of progress. Mobile surveys offer a cost-effective and innovative platform to rapidly and repeatedly monitor critical development metrics.

Underreporting of high-risk water and sanitation practices undermines progress on global targets

PubMed Central

Vedachalam, Sridhar; MacDonald, Luke H.; Shiferaw, Solomon; Seme, Assefa; Schwab, Kellogg J.

2017-01-01

Water and sanitation indicators under the Millennium Development Goals failed to capture high-risk practices undertaken on a regular basis. In conjunction with local partners, fourteen rounds of household surveys using mobile phones with a customized open-source application were conducted across nine study geographies in Asia and Africa. In addition to the main water and sanitation facilities, interviewees (n = 245,054) identified all water and sanitation options regularly used for at least one season of the year. Unimproved water consumption and open defecation were targeted as high-risk practices. We defined underreporting as the difference between the regular and main use of high-risk practices. Our estimates of high-risk practices as the main option matched the widely accepted Demographic and Health Surveys (DHS) estimates within the 95% confidence interval. However, estimates of these practices as a regular option was far higher than the DHS estimates. Across the nine geographies, median underreporting of unimproved water use was 5.5%, with a range of 0.5% to 13.9%. Median underreporting of open defecation was much higher at 9.9%, with a range of 2.7% to 11.5%. This resulted in an underreported population of 25 million regularly consuming unimproved water and 50 million regularly practicing open defecation. Further examination of data from Ethiopia suggested that location and socio-economic factors were significant drivers of underreporting. Current global monitoring relies on a framework that considers the availability and use of a single option to meet drinking water and sanitation needs. Our analysis demonstrates the use of multiple options and widespread underreporting of high-risk practices. Policies based on current monitoring data, therefore, fail to consider the range of challenges and solutions to meeting water and sanitation needs, and result in an inflated sense of progress. Mobile surveys offer a cost-effective and innovative platform to rapidly and repeatedly monitor critical development metrics. PMID:28489904

Associations between depression risk, bullying and current smoking among Chinese adolescents: Modulated by gender.

PubMed

Guo, Lan; Hong, Lingyao; Gao, Xue; Zhou, Jinhua; Lu, Ciyong; Zhang, Wei-Hong

2016-03-30

This school-based study aimed to investigate the prevalence of being at risk for depression, bullying behavior, and current smoking among Chinese adolescents in order to explore gender differences in the vulnerability of adolescents with these behaviors to develop a smoking habit. A total of 35,893 high school students sampled from high schools in eighteen cities in China participated in the study from 2011 to 2012. Overall, the prevalence of current smoking was estimated at 6.4%. In total, 1.7% (618) of the participants admitted to bullying others, 5.8% (2071) reported being bullied, 3.5% (1269) were involved in both bullying others and being bullied, and 5.6% (2017) were at high risk for depression. Logistic regression analysis indicated that among girls, with high depression risk, bullying others, being bullied, and both bullying others and being bullied were independently and positively associated with current smoking habits, while the final results among boys showed that bullying others and both bullying others and being bullied were independently associated with an increased risk of current smoking. School-based prevention programs are highly recommended, and we should focus on high-risk students, particularly girls with high risk of depression or involved in school bullying and boys who are involved in school bullying. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Direct potable reuse microbial risk assessment methodology: Sensitivity analysis and application to State log credit allocations.

PubMed

Soller, Jeffrey A; Eftim, Sorina E; Nappier, Sharon P

2018-01-01

Understanding pathogen risks is a critically important consideration in the design of water treatment, particularly for potable reuse projects. As an extension to our published microbial risk assessment methodology to estimate infection risks associated with Direct Potable Reuse (DPR) treatment train unit process combinations, herein, we (1) provide an updated compilation of pathogen density data in raw wastewater and dose-response models; (2) conduct a series of sensitivity analyses to consider potential risk implications using updated data; (3) evaluate the risks associated with log credit allocations in the United States; and (4) identify reference pathogen reductions needed to consistently meet currently applied benchmark risk levels. Sensitivity analyses illustrated changes in cumulative annual risks estimates, the significance of which depends on the pathogen group driving the risk for a given treatment train. For example, updates to norovirus (NoV) raw wastewater values and use of a NoV dose-response approach, capturing the full range of uncertainty, increased risks associated with one of the treatment trains evaluated, but not the other. Additionally, compared to traditional log-credit allocation approaches, our results indicate that the risk methodology provides more nuanced information about how consistently public health benchmarks are achieved. Our results indicate that viruses need to be reduced by 14 logs or more to consistently achieve currently applied benchmark levels of protection associated with DPR. The refined methodology, updated model inputs, and log credit allocation comparisons will be useful to regulators considering DPR projects and design engineers as they consider which unit treatment processes should be employed for particular projects. Published by Elsevier Ltd.

Estimating infertility prevalence in low-to-middle-income countries: an application of a current duration approach to Demographic and Health Survey data.

PubMed

Polis, Chelsea B; Cox, Carie M; Tunçalp, Özge; McLain, Alexander C; Thoma, Marie E

2017-05-01

Can infertility prevalence be estimated using a current duration (CD) approach when applied to nationally representative Demographic and Health Survey (DHS) data collected routinely in low- or middle-income countries? Our analysis suggests that a CD approach applied to DHS data from Nigeria provides infertility prevalence estimates comparable to other smaller studies in the same region. Despite associations with serious negative health, social and economic outcomes, infertility in developing countries is a marginalized issue in sexual and reproductive health. Obtaining reliable, nationally representative prevalence estimates is critical to address the issue, but methodological and resource challenges have impeded this goal. This cross-sectional study was based on standard information available in the DHS core questionnaire and data sets, which are collected routinely among participating low-to-middle-income countries. Our research question was examined among women participating in the 2013 Nigeria DHS (n = 38 948). Among women eligible for the study, 98% were interviewed. We applied a CD approach (i.e. current length of time-at-risk of pregnancy) to estimate time-to-pregnancy (TTP) and 12-month infertility prevalence among women 'at risk' of pregnancy at the time of interview (n = 7063). Women who were 18-44 years old, married or cohabitating, sexually active within the past 4 weeks and not currently using contraception (and had not been sterilized) were included in the analysis. Estimates were based on parametric survival methods using bootstrap methods (500 bootstrap replicates) to obtain 95% CIs. The estimated median TTP among couples at risk of pregnancy was 5.1 months (95% CI: 4.2-6.3). The estimated percentage of infertile couples was 31.1% (95% CI: 27.9-34.7%)-consistent with other smaller studies from Nigeria. Primary infertility (17.4%, 95% CI: 12.9-23.8%) was substantially lower than secondary infertility (34.1%, 95% CI: 30.3-39.3%) in this population. Overall estimates for TTP >24 or >36 months dropped to 17.7% (95% CI: 15.7-20%) and 11.5% (95% CI: 10.2-13%), respectively. Subgroup analyses showed that estimates varied by age, coital frequency and fertility intentions, while being in a polygynous relationship showed minimal impact. The CD approach may be limited by assumptions on when exposure to risk of pregnancy began and methodologic assumptions required for estimation, which may be less accurate for particular subgroups or populations. Unrecognized pregnancies may have also biased our findings; however, we attempted to address this in our exclusion criteria. Limiting to married/cohabiting couples may have excluded women who are no longer in a relationship after being blamed for infertility. Although probably rare in this setting, we lack information on couples undergoing infertility treatment. Like other TTP measurement approaches, pregnancies resulting from contraceptive failure are not included, which may bias estimates. Nationally representative estimates of TTP and infertility based on a clinical definition of 12 months have been limited within developing countries. This approach represents a pragmatic advance in our ability to measure and monitor infertility in the developing world, with potentially far-reaching implications for policies and programs intended to address reproductive health. There are no competing interests and no financial support was provided for this study. Financial support for Open Access publication was provided by the World Health Organization. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology.

Current risk estimates based on the A-bomb survivors data - a discussion in terms of the ICRP recommendations on the neutron weighting factor.

PubMed

Rühm, W; Walsh, L

2007-01-01

Currently, most analyses of the A-bomb survivors' solid tumour and leukaemia data are based on a constant neutron relative biological effectiveness (RBE) value of 10 that is applied to all survivors, independent of their distance to the hypocentre at the time of bombing. The results of these analyses are then used as a major basis for current risk estimates suggested by the International Commission on Radiological Protection (ICRP) for use in international safety guidelines. It is shown here that (i) a constant value of 10 is not consistent with weighting factors recommended by the ICRP for neutrons and (ii) it does not account for the hardening of the neutron spectra in Hiroshima and Nagasaki, which takes place with increasing distance from the hypocentres. The purpose of this paper is to present new RBE values for the neutrons, calculated as a function of distance from the hypocentres for both cities that are consistent with the ICRP60 neutron weighting factor. If based on neutron spectra from the DS86 dosimetry system, these calculations suggest values of about 31 at 1000 m and 23 at 2000 m ground range in Hiroshima, while the corresponding values for Nagasaki are 24 and 22. If the neutron weighting factor that is consistent with ICRP92 is used, the corresponding values are about 23 and 21 for Hiroshima and 21 and 20 for Nagasaki, respectively. It is concluded that the current risk estimates will be subject to some changes in view of the changed RBE values. This conclusion does not change significantly if the new doses from the Dosimetry System DS02 are used.

Generating an agricultural risk map based on limited ecological information: A case study using Sicyos angulatus.

PubMed

Osawa, Takeshi; Okawa, Shigenori; Kurokawa, Shunji; Ando, Shinichiro

2016-12-01

In this study, we propose a method for estimating the risk of agricultural damage caused by an invasive species when species-specific information is lacking. We defined the "risk" as the product of the invasion probability and the area of potentially damaged crop for production. As a case study, we estimated the risk imposed by an invasive weed, Sicyos angulatus, based on simple cellular simulations and governmental data on the area of crop that could potentially be damaged in Miyagi Prefecture, Japan. Simulation results revealed that the current distribution range was sufficiently accurate for practical purposes. Using these results and records of crop areas, we present risk maps for S. angulatus in agricultural fields. Managers will be able to use these maps to rapidly establish a management plan with minimal cost. Our approach will be valuable for establishing a management plan before or during the early stages of invasion.

Bayesian Power Prior Analysis and Its Application to Operational Risk and Rasch Model

ERIC Educational Resources Information Center

Zhang, Honglian

2010-01-01

When sample size is small, informative priors can be valuable in increasing the precision of estimates. Pooling historical data and current data with equal weights under the assumption that both of them are from the same population may be misleading when heterogeneity exists between historical data and current data. This is particularly true when…

Per capita alcohol consumption and suicide mortality in a panel of US states from 1950 to 2002

PubMed Central

Kerr, William C.; Subbaraman, Meenakshi; Ye, Yu

2011-01-01

Introduction and Aims The relationship between per capita alcohol consumption and suicide rates has been found to vary in significance and magnitude across countries. This study utilizes a panel of time-series measures from the US states to estimate the effects of changes in current and lagged alcohol sales on suicide mortality risk. Design and Methods Generalized least squares estimation utilized 53 years of data from 48 US states or state groups to estimate relationships between total and beverage-specific alcohol consumption measures and age-standardized suicide mortality rates in first-differenced semi-logged models. Results An additional liter of ethanol from total alcohol sales was estimated to increase suicide rates by 2.3% in models utilizing a distributed lag specification while no effect was found in models including only current alcohol consumption. A similar result is found for men, while for women both current and distributed lag measures were found to be significantly related to suicide rates with an effect of about 3.2% per liter from current and 5.8% per liter from the lagged measure. Beverage-specific models indicate that spirits is most closely linked with suicide risk for women while beer and wine are for men. Unemployment rates are consistently positively related to suicide rates. Discussion and Conclusions Results suggest that chronic effects, potentially related to alcohol abuse and dependence, are the main source of alcohol’s impact on suicide rates in the US for men and are responsible for about half of the effect for women. PMID:21896069

Risk Assessment Methodology Based on the NISTIR 7628 Guidelines

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

Abercrombie, Robert K; Sheldon, Frederick T; Hauser, Katie R

2013-01-01

Earlier work describes computational models of critical infrastructure that allow an analyst to estimate the security of a system in terms of the impact of loss per stakeholder resulting from security breakdowns. Here, we consider how to identify, monitor and estimate risk impact and probability for different smart grid stakeholders. Our constructive method leverages currently available standards and defined failure scenarios. We utilize the National Institute of Standards and Technology (NIST) Interagency or Internal Reports (NISTIR) 7628 as a basis to apply Cyberspace Security Econometrics system (CSES) for comparing design principles and courses of action in making security-related decisions.

Assessing Progress in Reducing the At-Risk Population after 13 Years of the Global Programme to Eliminate Lymphatic Filariasis

PubMed Central

Hooper, Pamela J.; Chu, Brian K.; Mikhailov, Alexei; Ottesen, Eric A.; Bradley, Mark

2014-01-01

Background In 1997, the World Health Assembly adopted Resolution 50.29, committing to the elimination of lymphatic filariasis (LF) as a public health problem, subsequently targeted for 2020. The initial estimates were that 1.2 billion people were at-risk for LF infection globally. Now, 13 years after the Global Programme to Eliminate Lymphatic Filariasis (GPELF) began implementing mass drug administration (MDA) against LF in 2000—during which over 4.4 billion treatments have been distributed in 56 endemic countries—it is most appropriate to estimate the impact that the MDA has had on reducing the population at risk of LF. Methodology/Principal Findings To assess GPELF progress in reducing the population at-risk for LF, we developed a model based on defining reductions in risk of infection among cohorts of treated populations following each round of MDA. The model estimates that the number of people currently at risk of infection decreased by 46% to 789 million through 2012. Conclusions/Significance Important progress has been made in the global efforts to eliminate LF, but significant scale-up is required over the next 8 years to reach the 2020 elimination goal. PMID:25411843

Body mass index and risk of BPH: a meta-analysis.

PubMed

Wang, S; Mao, Q; Lin, Y; Wu, J; Wang, X; Zheng, X; Xie, L

2012-09-01

Epidemiological studies have reported conflicting results relating obesity to BPH. A meta-analysis of cohort and case-control studies was conducted to pool the risk estimates of the association between obesity and BPH. Eligible studies were retrieved by both computer searches and review of references. We analyzed abstracted data with random effects models to obtain the summary risk estimates. Dose-response meta-analysis was performed for studies reporting categorical risk estimates for a series of exposure levels. A total of 19 studies met the inclusion criteria of the meta-analysis. Positive association with body mass index (BMI) was observed in BPH and lower urinary tract symptoms (LUTS) combined group (odds ratio=1.27, 95% confidence intervals 1.05-1.53). In subgroup analysis, BMI exhibited a positive dose-response relationship with BPH/LUTS in population-based case-control studies and a marginal positive association was observed between risk of BPH and increased BMI. However, no association between BPH/LUTS and BMI was observed in other subgroups stratified by study design, geographical region or primary outcome. The overall current literatures suggested that BMI was associated with increased risk of BPH. Further efforts should be made to confirm these findings and clarify the underlying biological mechanisms.

Occupational cancer in Britain

PubMed Central

Van Tongeren, Martie; Jimenez, Araceli S; Hutchings, Sally J; MacCalman, Laura; Rushton, Lesley; Cherrie, John W

2012-01-01

To estimate the current occupational cancer burden due to past exposures in Britain, estimates of the number of exposed workers at different levels are required, as well as risk estimates of cancer due to the exposures. This paper describes the methods and results for estimating the historical exposures. All occupational carcinogens or exposure circumstances classified by the International Agency for Research on Cancer as definite or probable human carcinogens and potentially to be found in British workplaces over the past 20–40 years were included in this study. Estimates of the number of people exposed by industrial sector were based predominantly on two sources of data, the CARcinogen EXposure (CAREX) database and the UK Labour Force Survey. Where possible, multiple and overlapping exposures were taken into account. Dose–response risk estimates were generally not available in the epidemiological literature for the cancer–exposure pairs in this study, and none of the sources available for obtaining the numbers exposed provided data by different levels of exposure. Industrial sectors were therefore assigned using expert judgement to ‘higher'- and ‘lower'-exposure groups based on the similarity of exposure to the population in the key epidemiological studies from which risk estimates had been selected. Estimates of historical exposure prevalence were obtained for 41 carcinogens or occupational circumstances. These include exposures to chemicals and metals, combustion products, other mixtures or groups of chemicals, mineral and biological dusts, physical agents and work patterns, as well as occupations and industries that have been associated with increased risk of cancer, but for which the causative agents are unknown. There were more than half a million workers exposed to each of six carcinogens (radon, solar radiation, crystalline silica, mineral oils, non-arsenical insecticides and 2,3,7,8-tetrachlorodibenzo-p-dioxin); other agents to which a large number of workers are exposed included benzene, diesel engine exhaust and environmental tobacco smoke. The study has highlighted several industrial sectors with large proportions of workers potentially exposed to multiple carcinogens. The relevant available data have been used to generate estimates of the prevalence of past exposure to occupational carcinogens to enable the occupational cancer burden in Britain to be estimated. These data are considered adequate for the present purpose, but new data on the prevalence and intensity of current occupational exposure to carcinogens should be collected to ensure that future policy decisions be based on reliable evidence. PMID:22710674

A forecasting method to reduce estimation bias in self-reported cell phone data.

PubMed

Redmayne, Mary; Smith, Euan; Abramson, Michael J

2013-01-01

There is ongoing concern that extended exposure to cell phone electromagnetic radiation could be related to an increased risk of negative health effects. Epidemiological studies seek to assess this risk, usually relying on participants' recalled use, but recall is notoriously poor. Our objectives were primarily to produce a forecast method, for use by such studies, to reduce estimation bias in the recalled extent of cell phone use. The method we developed, using Bayes' rule, is modelled with data we collected in a cross-sectional cluster survey exploring cell phone user-habits among New Zealand adolescents. Participants recalled their recent extent of SMS-texting and retrieved from their provider the current month's actual use-to-date. Actual use was taken as the gold standard in the analyses. Estimation bias arose from a large random error, as observed in all cell phone validation studies. We demonstrate that this seriously exaggerates upper-end forecasts of use when used in regression models. This means that calculations using a regression model will lead to underestimation of heavy-users' relative risk. Our Bayesian method substantially reduces estimation bias. In cases where other studies' data conforms to our method's requirements, application should reduce estimation bias, leading to a more accurate relative risk calculation for mid-to-heavy users.

New screening approach for risk assessment of pesticides in ambient air

NASA Astrophysics Data System (ADS)

Yusà, Vicent; Coscollà, Clara; Millet, Maurice

2014-10-01

We present a novel screening approach for inhalation risk assessment of currently used pesticides (CUPs) in ambient air, based on the measurements of pesticide levels in the inhalable fraction of the particulate matter (PM10). Total concentrations in ambient air (gas + particle phases) were estimated using a theoretical model of distribution of semi-volatile organic compounds between the gas and the particulate phase based on the octanol-air partition (Koa) of each pesticide. The proposed approach was used in a pilot study conducted in a rural station in Valencia (Spain) from April through to October 2010. Twenty out of 82 analysed pesticides were detected in average concentrations ranging from 1.63 to 117.01 pg m-3. For adults, children and infants the estimated chronic inhalation risk, expressed as Hazard Quotient (HQ) was <1 for all pesticides. Likewise, the cumulative exposure for detected organophosphorus, pyrethroids and carbamates pesticides, was estimated using as metrics the Hazard Index (HI), which was less than 1 for the three families of pesticides assessed. The cancer risk estimated for the detected pesticides classified as Likely or Possible carcinogens was less than 1.15E-7 for infants. In our opinion, the screening approach proposed could be used in the monitoring and risk assessment of pesticides in ambient air.

Lifestyle Advice Combined with Personalized Estimates of Genetic or Phenotypic Risk of Type 2 Diabetes, and Objectively Measured Physical Activity: A Randomized Controlled Trial

PubMed Central

van Sluijs, Esther M. F.; Marteau, Theresa M.; Sutton, Stephen

2016-01-01

Background Information about genetic and phenotypic risk of type 2 diabetes is now widely available and is being incorporated into disease prevention programs. Whether such information motivates behavior change or has adverse effects is uncertain. We examined the effect of communicating an estimate of genetic or phenotypic risk of type 2 diabetes in a parallel group, open, randomized controlled trial. Methods and Findings We recruited 569 healthy middle-aged adults from the Fenland Study, an ongoing population-based, observational study in the east of England (Cambridgeshire, UK). We used a computer-generated random list to assign participants in blocks of six to receive either standard lifestyle advice alone (control group, n = 190) or in combination with a genetic (n = 189) or a phenotypic (n = 190) risk estimate for type 2 diabetes (intervention groups). After 8 wk, we measured the primary outcome, objectively measured physical activity (kJ/kg/day), and also measured several secondary outcomes (including self-reported diet, self-reported weight, worry, anxiety, and perceived risk). The study was powered to detect a between-group difference of 4.1 kJ/kg/d at follow-up. 557 (98%) participants completed the trial. There were no significant intervention effects on physical activity (difference in adjusted mean change from baseline: genetic risk group versus control group 0.85 kJ/kg/d (95% CI −2.07 to 3.77, p = 0.57); phenotypic risk group versus control group 1.32 (95% CI −1.61 to 4.25, p = 0.38); and genetic risk group versus phenotypic risk group −0.47 (95% CI −3.40 to 2.46, p = 0.75). No significant differences in self-reported diet, self-reported weight, worry, and anxiety were observed between trial groups. Estimates of perceived risk were significantly more accurate among those who received risk information than among those who did not. Key limitations include the recruitment of a sample that may not be representative of the UK population, use of self-reported secondary outcome measures, and a short follow-up period. Conclusions In this study, we did not observe short-term changes in behavior associated with the communication of an estimate of genetic or phenotypic risk of type 2 diabetes. We also did not observe changes in worry or anxiety in the study population. Additional research is needed to investigate the conditions under which risk information might enhance preventive strategies. (Current Controlled Trials ISRCTN09650496; Date applied: April 4, 2011; Date assigned: June 10, 2011). Trial Registration The trial is registered with Current Controlled Trials, ISRCTN09650496. PMID:27898672

Lifestyle Advice Combined with Personalized Estimates of Genetic or Phenotypic Risk of Type 2 Diabetes, and Objectively Measured Physical Activity: A Randomized Controlled Trial.

PubMed

Godino, Job G; van Sluijs, Esther M F; Marteau, Theresa M; Sutton, Stephen; Sharp, Stephen J; Griffin, Simon J

2016-11-01

Information about genetic and phenotypic risk of type 2 diabetes is now widely available and is being incorporated into disease prevention programs. Whether such information motivates behavior change or has adverse effects is uncertain. We examined the effect of communicating an estimate of genetic or phenotypic risk of type 2 diabetes in a parallel group, open, randomized controlled trial. We recruited 569 healthy middle-aged adults from the Fenland Study, an ongoing population-based, observational study in the east of England (Cambridgeshire, UK). We used a computer-generated random list to assign participants in blocks of six to receive either standard lifestyle advice alone (control group, n = 190) or in combination with a genetic (n = 189) or a phenotypic (n = 190) risk estimate for type 2 diabetes (intervention groups). After 8 wk, we measured the primary outcome, objectively measured physical activity (kJ/kg/day), and also measured several secondary outcomes (including self-reported diet, self-reported weight, worry, anxiety, and perceived risk). The study was powered to detect a between-group difference of 4.1 kJ/kg/d at follow-up. 557 (98%) participants completed the trial. There were no significant intervention effects on physical activity (difference in adjusted mean change from baseline: genetic risk group versus control group 0.85 kJ/kg/d (95% CI -2.07 to 3.77, p = 0.57); phenotypic risk group versus control group 1.32 (95% CI -1.61 to 4.25, p = 0.38); and genetic risk group versus phenotypic risk group -0.47 (95% CI -3.40 to 2.46, p = 0.75). No significant differences in self-reported diet, self-reported weight, worry, and anxiety were observed between trial groups. Estimates of perceived risk were significantly more accurate among those who received risk information than among those who did not. Key limitations include the recruitment of a sample that may not be representative of the UK population, use of self-reported secondary outcome measures, and a short follow-up period. In this study, we did not observe short-term changes in behavior associated with the communication of an estimate of genetic or phenotypic risk of type 2 diabetes. We also did not observe changes in worry or anxiety in the study population. Additional research is needed to investigate the conditions under which risk information might enhance preventive strategies. (Current Controlled Trials ISRCTN09650496; Date applied: April 4, 2011; Date assigned: June 10, 2011). The trial is registered with Current Controlled Trials, ISRCTN09650496.

Procedure-related risk of miscarriage following amniocentesis and chorionic villus sampling: a systematic review and meta-analysis.

PubMed

Akolekar, R; Beta, J; Picciarelli, G; Ogilvie, C; D'Antonio, F

2015-01-01

To estimate procedure-related risks of miscarriage following amniocentesis and chorionic villus sampling (CVS) based on a systematic review of the literature and a meta-analysis. A search of MEDLINE, EMBASE, CINHAL and The Cochrane Library (2000-2014) was performed to review relevant citations reporting procedure-related complications of amniocentesis and CVS. Only studies reporting data on more than 1000 procedures were included in this review to minimize the effect of bias from smaller studies. Heterogeneity between studies was estimated using Cochran's Q, the I(2) statistic and Egger bias. Meta-analysis of proportions was used to derive weighted pooled estimates for the risk of miscarriage before 24 weeks' gestation. Incidence-rate difference meta-analysis was used to estimate pooled procedure-related risks. The weighted pooled risks of miscarriage following invasive procedures were estimated from analysis of controlled studies including 324 losses in 42 716 women who underwent amniocentesis and 207 losses in 8899 women who underwent CVS. The risk of miscarriage prior to 24 weeks in women who underwent amniocentesis and CVS was 0.81% (95% CI, 0.58-1.08%) and 2.18% (95% CI, 1.61-2.82%), respectively. The background rates of miscarriage in women from the control group that did not undergo any procedures were 0.67% (95% CI, 0.46-0.91%) for amniocentesis and 1.79% (95% CI, 0.61-3.58%) for CVS. The weighted pooled procedure-related risks of miscarriage for amniocentesis and CVS were 0.11% (95% CI, -0.04 to 0.26%) and 0.22% (95% CI, -0.71 to 1.16%), respectively. The procedure-related risks of miscarriage following amniocentesis and CVS are much lower than are currently quoted. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

Donor testing and risk: current prevalence, incidence, and residual risk of transfusion-transmissible agents in US allogeneic donations.

PubMed

Zou, Shimian; Stramer, Susan L; Dodd, Roger Y

2012-04-01

Over the past 20 years, there has been a major increase in the safety of the blood supply, as demonstrated by declining rates of posttransfusion infection and reductions in estimated residual risk for such infections. Reliable estimates of residual risk have been possible within the American Red Cross system because of the availability of a large amount of reliable and consistent data on donations and infectious disease testing results. Among allogeneic blood donations, the prevalence rates of infection markers for hepatitis C virus (HCV) and hepatitis B virus have decreased over time, although rates for markers of human immunodeficiency virus (HIV) and human T-cell lymphotropic virus did not. The incidence (/100 000 person-years) of HIV and HCV among repeat donors showed apparent increases from 1.55 and 1.89 in 2000 through 2001 to 2.16 and 2.98 in 2007 through 2008. These observed fluctuations confirm the need for continuous monitoring and evaluation. The residual risk of HIV, HCV, and human T-cell lymphotropic virus among all allogeneic donations is currently below 1 per 1 million donations, and that of hepatitis B surface antigen is close to 1 per 300 000 donations. Copyright © 2012 Elsevier Inc. All rights reserved.

Long-term treatment risks in multiple sclerosis: risk knowledge and risk perception in a large cohort of mitoxantrone-treated patients.

PubMed

Hofmann, A; Stellmann, J P; Kasper, J; Ufer, F; Elias, W G; Pauly, I; Repenthin, J; Rosenkranz, T; Weber, T; Köpke, S; Heesen, C

2013-06-01

Balancing treatment benefits and risks is part of a shared decision-making process before initiating any treatment in multiple sclerosis (MS). Patients understand, appreciate and profit from evidence-based patient information (EBPI). While these processes are well known, long-term risk awareness and risk processing of patients has not been studied. Mitoxantrone treatment in MS is associated with long-term major potential harms - leukaemia (LK) and cardiotoxicity (CT). The risk knowledge and perception among patients currently or previously treated with mitoxantrone is unknown. The objective of this article is to conduct a retrospective cohort study in greater Hamburg, Germany, to estimate risk awareness and perception in MS patients treated with mitoxantrone. MS patients with at least one dose of mitoxantrone between 1991 and 2010 from six major MS centres in greater Hamburg received a questionnaire assessing risk awareness and perception as well as a written EBPI about mitoxantrone-associated LK and CT. Fifty-one per cent in the cohort of n = 575 patients returned the questionnaire. Forty per cent correctly estimated the risk of LK (CT 16%); 56% underestimated the risk (CT 82%). Reading the information increased the accuracy of LK risk estimation, and patients did not report an increase of worries. The EBPI was appreciated and recommended by 85%. Risk awareness of mitoxantrone-treated patients is insufficient, but can be increased by EBPI without increasing worries. Continued patient information during and after treatment should be implemented in management algorithms.

The Association of Administrative Segregation Placement and Other Risk Factors with the Self-Injury-Free Time of Male Prisoners

ERIC Educational Resources Information Center

Lanes, Eric

2009-01-01

The current study examined the relationship between risk factors for prisoner self-injurious behavior (SIB) and the amount of time male prisoners function without engaging in SIB (SIB-free time), and obtained estimates of SIB-free time for selected SIB prisoner subgroups dependent on their housing status. Conditional Cox regression analysis…

Scoring Systems for Estimating the Risk of Anticoagulant-Associated Bleeding.

PubMed

Parks, Anna L; Fang, Margaret C

2017-07-01

Anticoagulant medications are frequently used to prevent and treat thromboembolic disease. However, the benefits of anticoagulants must be balanced with a careful assessment of the risk of bleeding complications that can ensue from their use. Several bleeding risk scores are available, including the Outpatient Bleeding Risk Index, HAS-BLED, ATRIA, and HEMORR 2 HAGES risk assessment tools, and can be used to help estimate patients' risk for bleeding on anticoagulants. These tools vary by their individual risk components and in how they define and weigh clinical factors. However, it is not yet clear how best to integrate bleeding risk tools into clinical practice. Current bleeding risk scores generally have modest predictive ability and limited ability to predict the most devastating complication of anticoagulation, intracranial hemorrhage. In clinical practice, bleeding risk tools should be paired with a formal determination of thrombosis risk, as their results may be most influential for patients at the lower end of thrombosis risk, as well as for highlighting potentially modifiable risk factors for bleeding. Use of bleeding risk scores may assist clinicians and patients in making informed and individualized anticoagulation decisions. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

An evaluation of the accuracy of small-area demographic estimates of population at risk and its effect on prevalence statistics

PubMed Central

2013-01-01

Demographic estimates of population at risk often underpin epidemiologic research and public health surveillance efforts. In spite of their central importance to epidemiology and public-health practice, little previous attention has been paid to evaluating the magnitude of errors associated with such estimates or the sensitivity of epidemiologic statistics to these effects. In spite of the well-known observation that accuracy in demographic estimates declines as the size of the population to be estimated decreases, demographers continue to face pressure to produce estimates for increasingly fine-grained population characteristics at ever-smaller geographic scales. Unfortunately, little guidance on the magnitude of errors that can be expected in such estimates is currently available in the literature and available for consideration in small-area epidemiology. This paper attempts to fill this current gap by producing a Vintage 2010 set of single-year-of-age estimates for census tracts, then evaluating their accuracy and precision in light of the results of the 2010 Census. These estimates are produced and evaluated for 499 census tracts in New Mexico for single-years of age from 0 to 21 and for each sex individually. The error distributions associated with these estimates are characterized statistically using non-parametric statistics including the median and 2.5th and 97.5th percentiles. The impact of these errors are considered through simulations in which observed and estimated 2010 population counts are used as alternative denominators and simulated event counts are used to compute a realistic range fo prevalence values. The implications of the results of this study for small-area epidemiologic research in cancer and environmental health are considered. PMID:24359344

Estimation of radiation cancer risk in CT-KUB

NASA Astrophysics Data System (ADS)

Karim, M. K. A.; Hashim, S.; Bakar, K. A.; Bradley, D. A.; Ang, W. C.; Bahrudin, N. A.; Mhareb, M. H. A.

2017-08-01

The increased demand for computed tomography (CT) in radiological scanning examinations raises the question of a potential health impact from the associated radiation exposures. Focusing on CT kidney-ureter-bladder (CT-KUB) procedures, this work was aimed at determining organ equivalent dose using a commercial CT dose calculator and providing an estimate of cancer risks. The study, which included 64 patients (32 males and 32 females, mean age 55.5 years and age range 30-80 years), involved use of a calibrated CT scanner (Siemens-Somatom Emotion 16-slice). The CT exposures parameter including tube potential, pitch factor, tube current, volume CT dose index (CTDIvol) and dose-length product (DLP) were recorded and analyzed using CT-EXPO (Version 2.3.1, Germany). Patient organ doses, including for stomach, liver, colon, bladder, red bone marrow, prostate and ovaries were calculated and converted into cancer risks using age- and sex-specific data published in the Biological Effects of Ionizing Radiation (BEIR) VII report. With a median value scan range of 36.1 cm, the CTDIvol, DLP, and effective dose were found to be 10.7 mGy, 390.3 mGy cm and 6.2 mSv, respectively. The mean cancer risks for males and females were estimated to be respectively 25 and 46 out of 100,000 procedures with effective doses between 4.2 mSv and 10.1 mSv. Given the increased cancer risks from current CT-KUB procedures compared to conventional examinations, we propose that the low dose protocols for unenhanced CT procedures be taken into consideration before establishing imaging protocols for CT-KUB.

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

PubMed

Berman, D Wayne

2011-08-01

Given that new protocols for assessing asbestos-related cancer risk have recently been published, questions arise concerning how they compare to the "IRIS" protocol currently used by regulators. The newest protocols incorporate findings from 20 additional years of literature. Thus, differences between the IRIS and newer Berman and Crump protocols are examined to evaluate whether these protocols can be reconciled. Risks estimated by applying these protocols to real exposure data from both laboratory and field studies are also compared to assess the relative health protectiveness of each protocol. The reliability of risks estimated using the two protocols are compared by evaluating the degree with which each potentially reproduces the known epidemiology study risks. Results indicate that the IRIS and Berman and Crump protocols can be reconciled; while environment-specific variation within fiber type is apparently due primarily to size effects (not addressed by IRIS), the 10-fold (average) difference between amphibole asbestos risks estimated using each protocol is attributable to an arbitrary selection of the lowest of available mesothelioma potency factors in the IRIS protocol. Thus, the IRIS protocol may substantially underestimate risk when exposure is primarily to amphibole asbestos. Moreover, while the Berman and Crump protocol is more reliable than the IRIS protocol overall (especially for predicting amphibole risk), evidence is presented suggesting a new fiber-size-related adjustment to the Berman and Crump protocol may ultimately succeed in reconciling the entire epidemiology database. However, additional data need to be developed before the performance of the adjusted protocol can be fully validated. © 2011 Society for Risk Analysis.

Space Radiation Cancer Risks

NASA Technical Reports Server (NTRS)

Cucinotta, Francis A.

2007-01-01

Space radiation presents major challenges to astronauts on the International Space Station and for future missions to the Earth s moon or Mars. Methods used to project risks on Earth need to be modified because of the large uncertainties in projecting cancer risks from space radiation, and thus impact safety factors. We describe NASA s unique approach to radiation safety that applies uncertainty based criteria within the occupational health program for astronauts: The two terrestrial criteria of a point estimate of maximum acceptable level of risk and application of the principle of As Low As Reasonably Achievable (ALARA) are supplemented by a third requirement that protects against risk projection uncertainties using the upper 95% confidence level (CL) in the radiation cancer projection model. NASA s acceptable level of risk for ISS and their new lunar program have been set at the point-estimate of a 3-percent risk of exposure induced death (REID). Tissue-averaged organ dose-equivalents are combined with age at exposure and gender-dependent risk coefficients to project the cumulative occupational radiation risks incurred by astronauts. The 95% CL criteria in practice is a stronger criterion than ALARA, but not an absolute cut-off as is applied to a point projection of a 3% REID. We describe the most recent astronaut dose limits, and present a historical review of astronaut organ doses estimates from the Mercury through the current ISS program, and future projections for lunar and Mars missions. NASA s 95% CL criteria is linked to a vibrant ground based radiobiology program investigating the radiobiology of high-energy protons and heavy ions. The near-term goal of research is new knowledge leading to the reduction of uncertainties in projection models. Risk projections involve a product of many biological and physical factors, each of which has a differential range of uncertainty due to lack of data and knowledge. The current model for projecting space radiation cancer risk relies on the three assumptions of linearity, additivity, and scaling along with the use of population averages. We describe uncertainty estimates for this model, and new experimental data that sheds light on the accuracy of the underlying assumptions. These methods make it possible to express risk management objectives in terms of quantitative metrics, i.e., the number of days in space without exceeding a given risk level within well defined confidence limits. The resulting methodology is applied to several human space exploration mission scenarios including lunar station, deep space outpost, and a Mars mission. Factors that dominate risk projection uncertainties and application of this approach to assess candidate mitigation approaches are described.

Assessing the impact of a cattle risk-based trading scheme on the movement of bovine tuberculosis infected animals in England and Wales.

PubMed

Adkin, A; Brouwer, A; Downs, S H; Kelly, L

2016-01-01

The adoption of bovine tuberculosis (bTB) risk-based trading (RBT) schemes has the potential to reduce the risk of bTB spread. However, any scheme will have cost implications that need to be balanced against its likely success in reducing bTB. This paper describes the first stochastic quantitative model assessing the impact of the implementation of a cattle risk-based trading scheme to inform policy makers and contribute to cost-benefit analyses. A risk assessment for England and Wales was developed to estimate the number of infected cattle traded using historic movement data recorded between July 2010 and June 2011. Three scenarios were implemented: cattle traded with no RBT scheme in place, voluntary provision of the score and a compulsory, statutory scheme applying a bTB risk score to each farm. For each scenario, changes in trade were estimated due to provision of the risk score to potential purchasers. An estimated mean of 3981 bTB infected animals were sold to purchasers with no RBT scheme in place in one year, with 90% confidence the true value was between 2775 and 5288. This result is dependent on the estimated between herd prevalence used in the risk assessment which is uncertain. With the voluntary provision of the risk score by farmers, on average, 17% of movements was affected (purchaser did not wish to buy once the risk score was available), with a reduction of 23% in infected animals being purchased initially. The compulsory provision of the risk score in a statutory scheme resulted in an estimated mean change to 26% of movements, with a reduction of 37% in infected animals being purchased initially, increasing to a 53% reduction in infected movements from higher risk sellers (score 4 and 5). The estimated mean reduction in infected animals being purchased could be improved to 45% given a 10% reduction in risky purchase behaviour by farmers which may be achieved through education programmes, or to an estimated mean of 49% if a rule was implemented preventing farmers from the purchase of animals of higher risk than their own herd. Given voluntary trials currently taking place of a trading scheme, recommendations for future work include the monitoring of initial uptake and changes in the purchase patterns of farmers. Such data could be used to update the risk assessment to reduce uncertainty associated with model estimates. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.

Unmanned aircraft system sense and avoid integrity and continuity

NASA Astrophysics Data System (ADS)

Jamoom, Michael B.

This thesis describes new methods to guarantee safety of sense and avoid (SAA) functions for Unmanned Aircraft Systems (UAS) by evaluating integrity and continuity risks. Previous SAA efforts focused on relative safety metrics, such as risk ratios, comparing the risk of using an SAA system versus not using it. The methods in this thesis evaluate integrity and continuity risks as absolute measures of safety, as is the established practice in commercial aircraft terminal area navigation applications. The main contribution of this thesis is a derivation of a new method, based on a standard intruder relative constant velocity assumption, that uses hazard state estimates and estimate error covariances to establish (1) the integrity risk of the SAA system not detecting imminent loss of '"well clear," which is the time and distance required to maintain safe separation from intruder aircraft, and (2) the probability of false alert, the continuity risk. Another contribution is applying these integrity and continuity risk evaluation methods to set quantifiable and certifiable safety requirements on sensors. A sensitivity analysis uses this methodology to evaluate the impact of sensor errors on integrity and continuity risks. The penultimate contribution is an integrity and continuity risk evaluation where the estimation model is refined to address realistic intruder relative linear accelerations, which goes beyond the current constant velocity standard. The final contribution is an integrity and continuity risk evaluation addressing multiple intruders. This evaluation is a new innovation-based method to determine the risk of mis-associating intruder measurements. A mis-association occurs when the SAA system incorrectly associates a measurement to the wrong intruder, causing large errors in the estimated intruder trajectories. The new methods described in this thesis can help ensure safe encounters between aircraft and enable SAA sensor certification for UAS integration into the National Airspace System.

The "Nursing Home Compare" measure of urinary/fecal incontinence: cross-sectional variation, stability over time, and the impact of case mix.

PubMed

Li, Yue; Schnelle, John; Spector, William D; Glance, Laurent G; Mukamel, Dana B

2010-02-01

To assess the impact of facility case mix on cross-sectional variations and short-term stability of the "Nursing Home Compare" incontinence quality measure (QM) and to determine whether multivariate risk adjustment can minimize such impacts. Retrospective analyses of the 2005 national minimum data set (MDS) that included approximately 600,000 long-term care residents in over 10,000 facilities in each quarterly sample. Mixed logistic regression was used to construct the risk-adjusted QM (nonshrinkage estimator). Facility-level ordinary least-squares models and adjusted R(2) were used to estimate the impact of case mix on cross-sectional and short-term longitudinal variations of currently published and risk-adjusted QMs. At least 50 percent of the cross-sectional variation and 25 percent of the short-term longitudinal variation of the published QM are explained by facility case mix. In contrast, the cross-sectional and short-term longitudinal variations of the risk-adjusted QM are much less susceptible to case-mix variations (adjusted R(2)<0.10), even for facilities with more extreme or more unstable outcome. Current "Nursing Home Compare" incontinence QM reflects considerable case-mix variations across facilities and over time, and therefore it may be biased. This issue can be largely addressed by multivariate risk adjustment using risk factors available in the MDS.

Risk stratification and staging in prostate cancer with prostatic specific membrane antigen PET/CTObjective: A one-stop-shop.

PubMed

Gupta, Manoj; Choudhury, Partha Sarathi; Rawal, Sudhir; Goel, Harish Chandra; Singh, Amitabh; Talwar, Vineet; Sahoo, Saroj Kumar

2017-01-01

Current imaging modalities for prostate cancer (PC) had limitations for risk stratification and staging. Magnetic resonance imaging (MRI) frequently underestimated lymphatic metastasis while bone scintigraphy often had diagnostic dilemmas. Prostatic specific membrane antigen (PSMA) positron emission tomography-computed tomography (PET/CT) has been remarkable in diagnosing PC recurrence and staging. We hypothesized it can become one-stop-shop for initial risk stratification and staging. Ninety seven PSMA PET-CT studies were re analysed for tumor node metastases (TNM) staging and risk stratification of lymphatic and distant metastases proportion. The histopathology of 23/97 patients was available as gold standard. Chi-square test was used for proportion comparison. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), over-estimation, under-estimation and correct-estimation of T and N stages were calculated. Cohen's kappa coefficient (k) was derived for inter-rater agreement. Lymphic or distant metastases detection on PSMA PET/CT increased significantly with increase in risk category. PSMA PET/CT sensitivity, specificity, PPV and NPV for extra prostatic extension (EPE), seminal vesicle invasion (SVI) and lymphatic metastases were 63.16%, 100%, 100%, 36.36% & 55%, 100%, 100%, 25% and 65.62%, 99.31%, 87.50%, 97.53%, respectively. Cohen's kappa coefficient showed substantial agreement between PSMA PET/CT and histopathological lymphic metastases (κ 0.734) however, it was just in fair agreement (κ 0.277) with T stage. PSMA PET/CT over-estimated, under-estimated and correct-estimated T and N stages in 8.71%, 39.13%, 52.17% and 8.71%, 4.35%, 86.96% cases, respectively. We found that PSMA PET/CT has potential for initial risk stratifications with reasonable correct estimation for N stage. However, it can underestimate T stage. Hence, we suggest that PSMA PET/CT should be used for staging and initial risk stratification of PC as one-stop-shop with regional MRI in surgically resectable cases.

Space Radiation Cancer Risks and Uncertainties for Mars Missions

NASA Technical Reports Server (NTRS)

Cucinotta, F. A.; Schimmerling, W.; Wilson, J. W.; Peterson, L. E.; Badhwar, G. D.; Saganti, P. B.; Dicello, J. F.

2001-01-01

Projecting cancer risks from exposure to space radiation is highly uncertain because of the absence of data for humans and because of the limited radiobiology data available for estimating late effects from the high-energy and charge (HZE) ions present in the galactic cosmic rays (GCR). Cancer risk projections involve many biological and physical factors, each of which has a differential range of uncertainty due to the lack of data and knowledge. We discuss an uncertainty assessment within the linear-additivity model using the approach of Monte Carlo sampling from subjective error distributions that represent the lack of knowledge in each factor to quantify the overall uncertainty in risk projections. Calculations are performed using the space radiation environment and transport codes for several Mars mission scenarios. This approach leads to estimates of the uncertainties in cancer risk projections of 400-600% for a Mars mission. The uncertainties in the quality factors are dominant. Using safety standards developed for low-Earth orbit, long-term space missions (>90 days) outside the Earth's magnetic field are currently unacceptable if the confidence levels in risk projections are considered. Because GCR exposures involve multiple particle or delta-ray tracks per cellular array, our results suggest that the shape of the dose response at low dose rates may be an additional uncertainty for estimating space radiation risks.

Uncertainty analysis in vulnerability estimations for elements at risk- a review of concepts and some examples on landslides

NASA Astrophysics Data System (ADS)

Ciurean, R. L.; Glade, T.

2012-04-01

Decision under uncertainty is a constant of everyday life and an important component of risk management and governance. Recently, experts have emphasized the importance of quantifying uncertainty in all phases of landslide risk analysis. Due to its multi-dimensional and dynamic nature, (physical) vulnerability is inherently complex and the "degree of loss" estimates imprecise and to some extent even subjective. Uncertainty analysis introduces quantitative modeling approaches that allow for a more explicitly objective output, improving the risk management process as well as enhancing communication between various stakeholders for better risk governance. This study presents a review of concepts for uncertainty analysis in vulnerability of elements at risk to landslides. Different semi-quantitative and quantitative methods are compared based on their feasibility in real-world situations, hazard dependency, process stage in vulnerability assessment (i.e. input data, model, output), and applicability within an integrated landslide hazard and risk framework. The resulted observations will help to identify current gaps and future needs in vulnerability assessment, including estimation of uncertainty propagation, transferability of the methods, development of visualization tools, but also address basic questions like what is uncertainty and how uncertainty can be quantified or treated in a reliable and reproducible way.

Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis

PubMed Central

2010-01-01

Background Age-related macular degeneration (AMD) is the leading cause of blindness in Western countries. Numerous risk factors have been reported but the evidence and strength of association is variable. We aimed to identify those risk factors with strong levels of evidence which could be easily assessed by physicians or ophthalmologists to implement preventive interventions or address current behaviours. Methods A systematic review identified 18 prospective and cross-sectional studies and 6 case control studies involving 113,780 persons with 17,236 cases of late AMD that included an estimate of the association between late AMD and at least one of 16 pre-selected risk factors. Fixed-effects meta-analyses were conducted for each factor to combine odds ratio (OR) and/or relative risk (RR) outcomes across studies by study design. Overall raw point estimates of each risk factor and associated 95% confidence intervals (CI) were calculated. Results Increasing age, current cigarette smoking, previous cataract surgery, and a family history of AMD showed strong and consistent associations with late AMD. Risk factors with moderate and consistent associations were higher body mass index, history of cardiovascular disease, hypertension, and higher plasma fibrinogen. Risk factors with weaker and inconsistent associations were gender, ethnicity, diabetes, iris colour, history of cerebrovascular disease, and serum total and HDL cholesterol and triglyceride levels. Conclusions Smoking, previous cataract surgery and a family history of AMD are consistent risk factors for AMD. Cardiovascular risk factors are also associated with AMD. Knowledge of these risk factors that may be easily assessed by physicians and general ophthalmologists may assist in identification and appropriate referral of persons at risk of AMD. PMID:21144031

A Personalized Approach in Progressive Multiple Sclerosis: The Current Status of Disease Modifying Therapies (DMTs) and Future Perspectives

PubMed Central

D’Amico, Emanuele; Patti, Francesco; Zanghì, Aurora; Zappia, Mario

2016-01-01

Using the term of progressive multiple sclerosis (PMS), we considered a combined population of persons with secondary progressive MS (SPMS) and primary progressive MS (PPMS). These forms of MS cannot be challenged with efficacy by the licensed therapy. In the last years, several measures of risk estimation were developed for predicting clinical course in MS, but none is specific for the PMS forms. Personalized medicine is a therapeutic approach, based on identifying what might be the best therapy for an individual patient, taking into account the risk profile. We need to achieve more accurate estimates of useful predictors in PMS, including unconventional and qualitative markers which are not yet currently available or practicable routine diagnostics. The evaluation of an individual patient is based on the profile of disease activity.Within the neurology field, PMS is one of the fastest-moving going into the future. PMID:27763513

The Willingness to Pay for Vaccination against Tick-Borne Encephalitis and Implications for Public Health Policy: Evidence from Sweden.

PubMed

Slunge, Daniel

2015-01-01

The increasing incidence of tick-borne encephalitis (TBE) in Sweden and several other European countries has sparked a discussion about the need for a public vaccination strategy. However, TBE vaccination coverage is incomplete and there is little knowledge about the factors influencing vaccination behavior. Based on a survey of 1,500 randomly selected respondents in Sweden, we estimate vaccination coverage in areas with different TBE risk levels and analyze the role of vaccine price and other factors influencing the demand for vaccination. First, we find that the average rate of TBE vaccination in Sweden is 33% in TBE risk areas and 18% elsewhere. Income, age and risk-related factors such as incidence of TBE in the area of residence, frequency of visits to areas with TBE risk, and experience with tick bites are positively associated with demand for TBE vaccine. Next, using contingent valuation methodology, we estimate the willingness to pay for TBE vaccination among the unvaccinated respondents and the effect of a possible subsidy. Among the unvaccinated respondents in TBE risk areas, we estimate the mean willingness to pay for the recommended three doses of TBE vaccine to be 465 SEK (approximately 46 euros or 40% of the current market price). We project that a subsidy making TBE vaccines free of charge could increase the vaccination rate in TBE risk areas to around 78%, with a larger effect on low-income households, whose current vaccination rate is only 15% in risk areas. However, price is not the only factor affecting demand. We find significant effects on vaccination behavior associated with trust in vaccine recommendations, perceptions about tick bite-related health risks and knowledge about ticks and tick-borne diseases. Hence, increasing knowledge and trust, as well as ease of access to vaccinations, can also be important measures for public health agencies that want to increase the vaccination rate.

The Willingness to Pay for Vaccination against Tick-Borne Encephalitis and Implications for Public Health Policy: Evidence from Sweden

PubMed Central

Slunge, Daniel

2015-01-01

The increasing incidence of tick-borne encephalitis (TBE) in Sweden and several other European countries has sparked a discussion about the need for a public vaccination strategy. However, TBE vaccination coverage is incomplete and there is little knowledge about the factors influencing vaccination behavior. Based on a survey of 1,500 randomly selected respondents in Sweden, we estimate vaccination coverage in areas with different TBE risk levels and analyze the role of vaccine price and other factors influencing the demand for vaccination. First, we find that the average rate of TBE vaccination in Sweden is 33% in TBE risk areas and 18% elsewhere. Income, age and risk-related factors such as incidence of TBE in the area of residence, frequency of visits to areas with TBE risk, and experience with tick bites are positively associated with demand for TBE vaccine. Next, using contingent valuation methodology, we estimate the willingness to pay for TBE vaccination among the unvaccinated respondents and the effect of a possible subsidy. Among the unvaccinated respondents in TBE risk areas, we estimate the mean willingness to pay for the recommended three doses of TBE vaccine to be 465 SEK (approximately 46 euros or 40% of the current market price). We project that a subsidy making TBE vaccines free of charge could increase the vaccination rate in TBE risk areas to around 78%, with a larger effect on low-income households, whose current vaccination rate is only 15% in risk areas. However, price is not the only factor affecting demand. We find significant effects on vaccination behavior associated with trust in vaccine recommendations, perceptions about tick bite-related health risks and knowledge about ticks and tick-borne diseases. Hence, increasing knowledge and trust, as well as ease of access to vaccinations, can also be important measures for public health agencies that want to increase the vaccination rate. PMID:26641491

Estimation of the Dose and Dose Rate Effectiveness Factor

NASA Technical Reports Server (NTRS)

Chappell, L.; Cucinotta, F. A.

2013-01-01

Current models to estimate radiation risk use the Life Span Study (LSS) cohort that received high doses and high dose rates of radiation. Transferring risks from these high dose rates to the low doses and dose rates received by astronauts in space is a source of uncertainty in our risk calculations. The solid cancer models recommended by BEIR VII [1], UNSCEAR [2], and Preston et al [3] is fitted adequately by a linear dose response model, which implies that low doses and dose rates would be estimated the same as high doses and dose rates. However animal and cell experiments imply there should be curvature in the dose response curve for tumor induction. Furthermore animal experiments that directly compare acute to chronic exposures show lower increases in tumor induction than acute exposures. A dose and dose rate effectiveness factor (DDREF) has been estimated and applied to transfer risks from the high doses and dose rates of the LSS cohort to low doses and dose rates such as from missions in space. The BEIR VII committee [1] combined DDREF estimates using the LSS cohort and animal experiments using Bayesian methods for their recommendation for a DDREF value of 1.5 with uncertainty. We reexamined the animal data considered by BEIR VII and included more animal data and human chromosome aberration data to improve the estimate for DDREF. Several experiments chosen by BEIR VII were deemed inappropriate for application to human risk models of solid cancer risk. Animal tumor experiments performed by Ullrich et al [4], Alpen et al [5], and Grahn et al [6] were analyzed to estimate the DDREF. Human chromosome aberration experiments performed on a sample of astronauts within NASA were also available to estimate the DDREF. The LSS cohort results reported by BEIR VII were combined with the new radiobiology results using Bayesian methods.

Using the SAPAS to identify risk for personality disorders among psychiatric outpatients in India: A feasibility study.

PubMed

Innocent, Simeon; Podder, Priyanka; Ram, Jai Ranjan; Barnicot, Kirsten; Sen, Piyal

2018-02-01

Personality disorders (PDs) are common among psychiatric outpatients and are associated with increased morbidity and worse treatment outcomes. Epidemiological research conducted among this population in Asian countries is limited, reflecting a significant gap in the current literature. One barrier to this research is the lack of appropriate screening tools. The current research assessed the feasibility of using the SAPAS (Standardized Assessment of Personality-Abbreviated Scale) screening tool to identify individuals at high risk of PD in an Indian psychiatric outpatient population and provides an initial estimate of PD prevalence by using a validated diagnostic interview, the ICD-10 International Personality Disorder Examination. The findings suggest that whilst use of the SAPAS was feasible, acceptable to patients and led to clinically useful findings, when using the recommended cut-off score of 4, the SAPAS largely overdiagnoses the risk for PD in psychiatric outpatients in India (positive predictive value = 26.3%). The estimated prevalence of personality disorder in the sample was 11.1%, based on administering the International Personality Disorder Examination diagnostic interview to high-risk patients scoring 4 and above on the SAPAS, which is higher than previous estimates for this population and still likely to be an underestimation. Future studies should translate the measure into Bengali and evaluate its sensitivity and specificity at different cut-off points in order to optimize its use in Indian populations. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Status and threats analysis for the Florida manatee (Trichechus manatus latirostris), 2016

USGS Publications Warehouse

Runge, Michael C.; Sanders-Reed, Carol A.; Langtimm, Catherine A.; Hostetler, Jeffrey A.; Martin, Julien; Deutsch, Charles J.; Ward-Geiger, Leslie I.; Mahon, Gary L.

2017-04-11

Trichechus manatus (West Indian manatee), especially T. m. latirostris, the Florida subspecies, has been the focus of conservation efforts and extensive research since its listing under the Endangered Species Act of 1973. To determine the status of, and severity of threats to, the Florida manatee, a comprehensive revision and update of the manatee Core Biological Model was completed and used to perform a population viability analysis for the Florida manatee. The probability of the Florida manatee population falling below 500 adults on either the Gulf or East coast within the next 100 years was estimated to be 0.42 percent. This risk of quasi-extinction is low because the estimated adult survival rates are high, the current population size is greater than 2,500 on each coast, and the estimated carrying capacity for manatees is much larger than the current abundance estimates in all four regions of Florida. Three threats contribute in roughly equal measures to the risk of quasi-extinction: watercraft-related mortality, red-tide mortality, and loss of warm-water habitat. Only an increase in watercraft-related mortality has the potential to substantially increase the risk of quasi-extinction at the statewide or coastal level. Expected losses of warm-water habitat are likely to cause a major change in the distribution of the population from the regions where manatees rely heavily on power plant effluents for warmth in winter (Southwest and Atlantic regions) to the regions where manatees primarily use natural springs in winter (Northwest and Upper St. Johns regions). The chances are nearly 50 percent that manatee populations in the Southwest and Atlantic regions will decrease from their 2011 levels by at least 30 percent over the next century.A large number of scenarios were examined to explore the possible effects of potential emerging threats, and in most of them, the risk of quasi-extinction at the coastal scale within 100 years did not rise above 1 percent. The four exceptions are scenarios in which the rate of watercraft-related mortality increases, carrying capacity is only a fraction of the current estimates, a new chronic source of mortality emerges, or multiple threats emerge in concert. Even in these scenarios, however, the risk of falling below 500 adults on either the East coast or the Gulf coast within 100 years from 2011 is less than 10 percent. High adult survival provides the population with strong resilience to a variety of current and future threats. On the basis of these analyses, we conclude that if these threats continue to be managed effectively, manatees are likely to persist on both coasts of Florida and remain an integral part of the coastal Florida ecosystem through the 21st century. If vigilance in management is reduced, however, the scenarios in which manatees could face risk of decline become more likely.

Estimating radiation dose to organs of patients undergoing conventional and novel multidetector CT exams using Monte Carlo simulations

NASA Astrophysics Data System (ADS)

Angel, Erin

Advances in Computed Tomography (CT) technology have led to an increase in the modality's diagnostic capabilities and therefore its utilization, which has in turn led to an increase in radiation exposure to the patient population. As a result, CT imaging currently constitutes approximately half of the collective exposure to ionizing radiation from medical procedures. In order to understand the radiation risk, it is necessary to estimate the radiation doses absorbed by patients undergoing CT imaging. The most widely accepted risk models are based on radiosensitive organ dose as opposed to whole body dose. In this research, radiosensitive organ dose was estimated using Monte Carlo based simulations incorporating detailed multidetector CT (MDCT) scanner models, specific scan protocols, and using patient models based on accurate patient anatomy and representing a range of patient sizes. Organ dose estimates were estimated for clinical MDCT exam protocols which pose a specific concern for radiosensitive organs or regions. These dose estimates include estimation of fetal dose for pregnant patients undergoing abdomen pelvis CT exams or undergoing exams to diagnose pulmonary embolism and venous thromboembolism. Breast and lung dose were estimated for patients undergoing coronary CTA imaging, conventional fixed tube current chest CT, and conventional tube current modulated (TCM) chest CT exams. The correlation of organ dose with patient size was quantified for pregnant patients undergoing abdomen/pelvis exams and for all breast and lung dose estimates presented. Novel dose reduction techniques were developed that incorporate organ location and are specifically designed to reduce close to radiosensitive organs during CT acquisition. A generalizable model was created for simulating conventional and novel attenuation-based TCM algorithms which can be used in simulations estimating organ dose for any patient model. The generalizable model is a significant contribution of this work as it lays the foundation for the future of simulating TCM using Monte Carlo methods. As a result of this research organ dose can be estimated for individual patients undergoing specific conventional MDCT exams. This research also brings understanding to conventional and novel close reduction techniques in CT and their effect on organ dose.

Excessive heat and respiratory hospitalizations in New York State: estimating current and future public health burden related to climate change.

PubMed

Lin, Shao; Hsu, Wan-Hsiang; Van Zutphen, Alissa R; Saha, Shubhayu; Luber, George; Hwang, Syni-An

2012-11-01

Although many climate-sensitive environmental exposures are related to mortality and morbidity, there is a paucity of estimates of the public health burden attributable to climate change. We estimated the excess current and future public health impacts related to respiratory hospitalizations attributable to extreme heat in summer in New York State (NYS) overall, its geographic regions, and across different demographic strata. On the basis of threshold temperature and percent risk changes identified from our study in NYS, we estimated recent and future attributable risks related to extreme heat due to climate change using the global climate model with various climate scenarios. We estimated effects of extreme high apparent temperature in summer on respiratory admissions, days hospitalized, direct hospitalization costs, and lost productivity from days hospitalized after adjusting for inflation. The estimated respiratory disease burden attributable to extreme heat at baseline (1991-2004) in NYS was 100 hospital admissions, US$644,069 in direct hospitalization costs, and 616 days of hospitalization per year. Projections for 2080-2099 based on three different climate scenarios ranged from 206-607 excess hospital admissions, US$26-$76 million in hospitalization costs, and 1,299-3,744 days of hospitalization per year. Estimated impacts varied by geographic region and population demographics. We estimated that excess respiratory admissions in NYS due to excessive heat would be 2 to 6 times higher in 2080-2099 than in 1991-2004. When combined with other heat-associated diseases and mortality, the potential public health burden associated with global warming could be substantial.

Long-Term Geomagnetically Induced Current Observations From New Zealand: Peak Current Estimates for Extreme Geomagnetic Storms

NASA Astrophysics Data System (ADS)

Rodger, Craig J.; Mac Manus, Daniel H.; Dalzell, Michael; Thomson, Alan W. P.; Clarke, Ellen; Petersen, Tanja; Clilverd, Mark A.; Divett, Tim

2017-11-01

Geomagnetically induced current (GIC) observations made in New Zealand over 14 years show induction effects associated with a rapidly varying horizontal magnetic field (dBH/dt) during geomagnetic storms. This study analyzes the GIC observations in order to estimate the impact of extreme storms as a hazard to the power system in New Zealand. Analysis is undertaken of GIC in transformer number six in Islington, Christchurch (ISL M6), which had the highest observed currents during the 6 November 2001 storm. Using previously published values of 3,000 nT/min as a representation of an extreme storm with 100 year return period, induced currents of 455 A were estimated for Islington (with the 95% confidence interval range being 155-605 A). For 200 year return periods using 5,000 nT/min, current estimates reach 755 A (confidence interval range 155-910 A). GIC measurements from the much shorter data set collected at transformer number 4 in Halfway Bush, Dunedin, (HWB T4), found induced currents to be consistently a factor of 3 higher than at Islington, suggesting equivalent extreme storm effects of 460-1,815 A (100 year return) and 460-2,720 A (200 year return). An estimate was undertaken of likely failure levels for single-phase transformers, such as HWB T4 when it failed during the 6 November 2001 geomagnetic storm, identifying that induced currents of 100 A can put such transformer types at risk of damage. Detailed modeling of the New Zealand power system is therefore required to put this regional analysis into a global context.

The effect of giving global coronary risk information to adults: a systematic review.

PubMed

Sheridan, Stacey L; Viera, Anthony J; Krantz, Mori J; Ice, Christa L; Steinman, Lesley E; Peters, Karen E; Kopin, Laurie A; Lungelow, Danielle

2010-02-08

Global coronary heart disease (CHD) risk estimation (ie, a quantitative estimate of a patient's chances of CHD calculated by combining risk factors in an empirical equation) is recommended as a starting point for primary prevention efforts in all US adults. Whether it improves outcomes is currently unknown. To assess the effect of providing global CHD risk information to adults, we performed a systematic evidence review. We searched MEDLINE for the years 1980 to 2008, Psych Info, CINAHL, and the Cochrane Database and included English-language articles that met prespecified inclusion criteria. Two reviewers independently reviewed titles, abstracts, and articles for inclusion and assessed study quality. We identified 20 articles, reporting on 18 unique fair or good quality studies (including 14 randomized controlled studies). These showed that global CHD risk information alone or with accompanying education increased the accuracy of perceived risk and probably increased intent to start therapy. Studies with repeated risk information or risk information and repeated doses of counseling showed small significant reductions in predicted CHD risk (absolute differences, -0.2% to -2% over 10 years in studies using risk estimates derived from Framingham equations). Studies providing global risk information at only 1 point in time seemed ineffective. Global CHD risk information seems to improve the accuracy of risk perception and may increase intent to initiate CHD prevention among individuals at moderate to high risk. The effect of global risk presentation on more distal outcomes is less clear and seems to be related to the intensity of accompanying interventions.

Silicosis among gold miners: exposure--response analyses and risk assessment.

PubMed

Steenland, K; Brown, D

1995-10-01

This study sought to estimate the risk of silicosis by cumulative exposure-years in a cohort of miners exposed to silica, as well as the lifetime risk of silicosis under the current Occupational Safety and Health Administration (OSHA) standard (0.09 mg/m3). In a cohort study of 3330 gold miners who worked at least 1 year underground from 1940 to 1965 (average 9 years) and were exposed to a median silica level of 0.05 mg/m3 (0.15 mg/m3 for those hired before 1930), 170 cases of silicosis were determined from either death certificates or two cross-sectional radiographic surveys. The risk of silicosis was less than 1% with a cumulative exposure under 0.5 mg/m3-years, increasing to 68% to 84% for the highest cumulative exposure category of more than 4 mg/m3-years. Cumulative exposure was the best predictor of disease, followed by duration of exposure and average exposure. After adjustment for competing risks of death, a 45-year exposure under the current OSHA standard would lead to a lifetime risk of silicosis of 35% to 47%. Almost 2 million US workers are currently exposed to silica. Our results add to a small but increasing body of literature that suggests that the current OSHA silica exposure level is unacceptably high.

Extinction risks of Amazonian plant species.

PubMed

Feeley, Kenneth J; Silman, Miles R

2009-07-28

Estimates of the number, and preferably the identity, of species that will be threatened by land-use change and habitat loss are an invaluable tool for setting conservation priorities. Here, we use collections data and ecoregion maps to generate spatially explicit distributions for more than 40,000 vascular plant species from the Amazon basin (representing more than 80% of the estimated Amazonian plant diversity). Using the distribution maps, we then estimate the rates of habitat loss and associated extinction probabilities due to land-use changes as modeled under 2 disturbance scenarios. We predict that by 2050, human land-use practices will have reduced the habitat available to Amazonian plant species by approximately 12-24%, resulting in 5-9% of species becoming "committed to extinction," significantly fewer than other recent estimates. Contrary to previous studies, we find that the primary determinant of habitat loss and extinction risk is not the size of a species' range, but rather its location. The resulting extinction risk estimates are a valuable conservation tool because they indicate not only the total percentage of Amazonian plant species threatened with extinction but also the degree to which individual species and habitats will be affected by current and future land-use changes.

Risk of miscarriage following amniocentesis and chorionic villus sampling: a systematic review of the literature.

PubMed

Beta, Jaroslaw; Lesmes-Heredia, Cristina; Bedetti, Chiara; Akolekar, Ranjit

2018-04-01

The aim of this paper was to estimate the risk of miscarriage after amniocentesis or chorionic villus sampling (CVS) based on a systematic review of the literature. A search of Medline, Embase, and The Cochrane Library (2000-2017) was carried out to identify studies reporting complications following CVS or amniocentesis. The inclusion criteria for the systematic review were studies reporting results from large controlled studies (N.≥1000 invasive procedures) and those reporting data for pregnancy loss prior to 24 weeks' gestation. Data for cases that had invasive procedure and controls were inputted in contingency tables and risk of miscarriage was estimated for each study. Summary statistics were calculated after taking into account the weighting for each study included in the systematic review. Procedure-related risk of miscarriage was estimated as a weighted risk difference from the summary statistics for cases and controls. The electronic search from the databases yielded 2465 potential citations of which 2431 were excluded, leaving 34 studies for full-text review. The final review included 10 studies for amniocentesis and 6 studies for CVS, which were used to estimate risk of miscarriage in pregnancies that had an invasive procedure and the control pregnancies that did not. The procedure-related risk of miscarriage following amniocentesis was 0.35% (95% confidence interval [CI]: 0.07 to 0.63) and that following CVS was 0.35% (95% CI: -0.31 to 1.00). The procedure-related risks of miscarriage following amniocentesis and CVS are lower than currently quoted to women.

[Management and new current French recommendations for tetanus care].

PubMed

Nicolai, Dominique; Farcet, Anaïs; Molines, Catherine; Delalande, Géraldine; Retornaz, Frédérique

2015-06-01

Tetanus is an acute severe disease induced by an exotoxin, often lethal. All cases occur in untreated or inadequately vaccinated patients and mainly in elderly patients who accumulate many risk factors. The current management of wounds faced difficulties in the assessment of immunization status and wound risks status. Indeed, all injuries can potentially lead to tetanus. Minor risks and chronic wounds are mainly found as tetanus cause. Vaccination remains the key element in reducing the morbidity and mortality associated with tetanus. It is estimated that the vaccine's coverage is fairly good, but decreases with age. To improve tetanus prevention, new vaccine recommendations have been established which recommend vaccine's injections at fixed age, but their impact seems to be limited especially in the elderly. The immunochromatographic tests have demonstrated cost-effectiveness in the Emergency department settings. They are currently not available outside hospital while general practionners also face a significant risk. Effectiveness of these tests should be studied in outpatients population including cost-effectiveness.

Breast cancer and combined oral contraceptives: results from a multinational study. The WHO Collaborative Study of Neoplasia and Steroid Contraceptives.

PubMed Central

1990-01-01

A collaborative, hospital-based case-control study was conducted at 12 participating centres in 10 countries. Based on data from personal interviews of 2,116 women with newly diagnosed breast cancer and 12,077 controls, the relative risk of breast cancer in women who ever used oral contraceptives was estimated to be 1.15 (1.02, 1.29). Estimated values of this relative risk based on data from three developed and seven developing countries were 1.07 (0.91, 1.26) and 1.24 (1.05, 1.47) respectively; these estimates are not significantly different (P = 0.22). Estimates for women under and over age 35 were 1.26 (0.95, 1.66) and 1.12 (0.98, 1.27), respectively, and these estimates are also not significantly different (P = 0.38). Risk was highest in recent and current users and declined with time since last use regardless of use. Risk did not increase with duration of use after stratifying on time since last use. Risk did not increase significantly with increasing duration of use before age 25 or before a first live birth. However, a relative risk of 1.5 that was of borderline statistical significance was observed in women who used oral contraceptives for more than 2 years before age 25. No single source of bias or confounding was identified that could explain the small increases in risk that were observed. Chance alone is also an unlikely explanation. The results could be due to a combination of chance and potential sources of bias, or they could represent a weak causal relationship. PMID:2404507

Mixture models for undiagnosed prevalent disease and interval-censored incident disease: applications to a cohort assembled from electronic health records.

PubMed

Cheung, Li C; Pan, Qing; Hyun, Noorie; Schiffman, Mark; Fetterman, Barbara; Castle, Philip E; Lorey, Thomas; Katki, Hormuzd A

2017-09-30

For cost-effectiveness and efficiency, many large-scale general-purpose cohort studies are being assembled within large health-care providers who use electronic health records. Two key features of such data are that incident disease is interval-censored between irregular visits and there can be pre-existing (prevalent) disease. Because prevalent disease is not always immediately diagnosed, some disease diagnosed at later visits are actually undiagnosed prevalent disease. We consider prevalent disease as a point mass at time zero for clinical applications where there is no interest in time of prevalent disease onset. We demonstrate that the naive Kaplan-Meier cumulative risk estimator underestimates risks at early time points and overestimates later risks. We propose a general family of mixture models for undiagnosed prevalent disease and interval-censored incident disease that we call prevalence-incidence models. Parameters for parametric prevalence-incidence models, such as the logistic regression and Weibull survival (logistic-Weibull) model, are estimated by direct likelihood maximization or by EM algorithm. Non-parametric methods are proposed to calculate cumulative risks for cases without covariates. We compare naive Kaplan-Meier, logistic-Weibull, and non-parametric estimates of cumulative risk in the cervical cancer screening program at Kaiser Permanente Northern California. Kaplan-Meier provided poor estimates while the logistic-Weibull model was a close fit to the non-parametric. Our findings support our use of logistic-Weibull models to develop the risk estimates that underlie current US risk-based cervical cancer screening guidelines. Published 2017. This article has been contributed to by US Government employees and their work is in the public domain in the USA. Published 2017. This article has been contributed to by US Government employees and their work is in the public domain in the USA.

Injecting drug users in Scotland, 2006: Listing, number, demography, and opiate-related death-rates.

PubMed

King, Ruth; Bird, Sheila M; Overstall, Antony; Hay, Gordon; Hutchinson, Sharon J

2013-06-01

Using Bayesian capture-recapture analysis, we estimated the number of current injecting drug users (IDUs) in Scotland in 2006 from the cross-counts of 5670 IDUs listed on four data-sources: social enquiry reports (901 IDUs listed), hospital records (953), drug treatment agencies (3504), and recent Hepatitis C virus (HCV) diagnoses (827 listed as IDU-risk). Further, we accessed exact numbers of opiate-related drugs-related deaths (DRDs) in 2006 and 2007 to improve estimation of Scotland's DRD rates per 100 current IDUs. Using all four data-sources, and model-averaging of standard hierarchical log-linear models to allow for pairwise interactions between data-sources and/or demographic classifications, Scotland had an estimated 31700 IDUs in 2006 (95% credible interval: 24900-38700); but 25000 IDUs (95% CI: 20700-35000) by excluding recent HCV diagnoses whose IDU-risk can refer to past injecting. Only in the younger age-group (15-34 years) were Scotland's opiate-related DRD rates significantly lower for females than males. Older males' opiate-related DRD rate was 1.9 (1.24-2.40) per 100 current IDUs without or 1.3 (0.94-1.64) with inclusion of recent HCV diagnoses. If, indeed, Scotland had only 25000 current IDUs in 2006, with only 8200 of them aged 35+ years, the opiate-related DRD rate is higher among this older age group than has been appreciated hitherto. There is counter-balancing good news for the public health: the hitherto sharp increase in older current IDUs had stalled by 2006.

Estimating the NIH Efficient Frontier

PubMed Central

2012-01-01

Background The National Institutes of Health (NIH) is among the world’s largest investors in biomedical research, with a mandate to: “…lengthen life, and reduce the burdens of illness and disability.” Its funding decisions have been criticized as insufficiently focused on disease burden. We hypothesize that modern portfolio theory can create a closer link between basic research and outcome, and offer insight into basic-science related improvements in public health. We propose portfolio theory as a systematic framework for making biomedical funding allocation decisions–one that is directly tied to the risk/reward trade-off of burden-of-disease outcomes. Methods and Findings Using data from 1965 to 2007, we provide estimates of the NIH “efficient frontier”, the set of funding allocations across 7 groups of disease-oriented NIH institutes that yield the greatest expected return on investment for a given level of risk, where return on investment is measured by subsequent impact on U.S. years of life lost (YLL). The results suggest that NIH may be actively managing its research risk, given that the volatility of its current allocation is 17% less than that of an equal-allocation portfolio with similar expected returns. The estimated efficient frontier suggests that further improvements in expected return (89% to 119% vs. current) or reduction in risk (22% to 35% vs. current) are available holding risk or expected return, respectively, constant, and that 28% to 89% greater decrease in average years-of-life-lost per unit risk may be achievable. However, these results also reflect the imprecision of YLL as a measure of disease burden, the noisy statistical link between basic research and YLL, and other known limitations of portfolio theory itself. Conclusions Our analysis is intended to serve as a proof-of-concept and starting point for applying quantitative methods to allocating biomedical research funding that are objective, systematic, transparent, repeatable, and expressly designed to reduce the burden of disease. By approaching funding decisions in a more analytical fashion, it may be possible to improve their ultimate outcomes while reducing unintended consequences. PMID:22567087

Substance Use and Suicide in Pacific Islander, American Indian, and Multiracial Youth.

PubMed

Subica, Andrew M; Wu, Li-Tzy

2018-06-01

National estimates of U.S. Native Hawaiian and other Pacific Islander (NHPI), American Indian/Alaskan Native (AIAN), and multiracial adolescent substance use and suicidality are scarce because of their small population sizes. The aim was to estimate the national prevalence of, and disparities in, substance use and suicidality among these understudied adolescents. Analyses conducted in 2017 of U.S. adolescents (grades ninth to 12th) from the 1991-2015 Combined National Youth Behavioral Risk Surveys estimated (1) prevalence of lifetime and current (past 30-day) substance use, past 12-month depressed mood, and suicidality by racial group; and (2) AORs for depressed mood and suicidality regressed on current alcohol, cigarette, and marijuana use. Among 184,494 U.S. adolescents, alcohol, cigarettes, and marijuana were commonly used with lifetime prevalence of 75.32%, 58.11%, and 40.55%, respectively, and current prevalence of 44.51%, 24.58%, and 22.01%, respectively. Past 12-month prevalence of suicidal thoughts, suicide planning, and attempted suicide were 18.87%, 14.75%, and 7.98%, respectively. Relative to non-Hispanic whites, NHPI, AIAN, and multiracial adolescents had higher prevalence of using many illicit substances (e.g., marijuana, heroin), depressed mood, and suicidal thoughts, planning, and attempts (p<0.05). Except for NHPIs and current alcohol use, current alcohol and cigarette use were independently associated with 2.0-2.3 times greater AORs (p<0.05) for attempted suicide among the target adolescents. U.S. NHPI, AIAN, and multiracial adolescents are disproportionately burdened by illicit substance use, depressed mood, and suicidality. Current alcohol and cigarette use may predispose these adolescents toward suicidality, offering potential pathways to alleviate suicide risk. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Human exposure and risk assessment to airborne pesticides in a rural French community.

PubMed

Coscollà, Clara; López, Antonio; Yahyaoui, Abderrazak; Colin, Patrice; Robin, Corine; Poinsignon, Quentin; Yusà, Vicent

2017-04-15

Outdoor air samples collected during the pesticide agricultural application period (spring and summer) from a rural community in the Centre Region (France) were analyzed to investigate temporal variation of atmospheric pesticide levels (2006-2013) and human inhalation exposure in adults, children and infants. The most frequently detected pesticides were herbicides (trifluralin, pendimethalin), fungicides (chlorothalonil) and insecticides (lindane and α-endosulfan). The three currently-used pesticides most frequently detected presented concentrations ranging from 0.18 to 1128.38ngm -3 ; 0.13 to 117.32ngm -3 and 0.16 to 25.80ngm -3 for chlorothalonil, pendimethalin and trifluralin, respectively. The estimated chronic inhalation risk, expressed as Hazard Quotient (HQ), for adults, children and infants, was <1 for all measured pesticides. Likewise, the cumulative exposure for detected organophosphorus and chloroacetamide pesticides, was estimated using the Relative Potency Factor (RPF) and Hazard Index (HI) as metrics, which was indicated that no risk was observed. The cancer risk classified as likely or possibly carcinogen was estimated to be <8.93 E-05 in infants, for the detected pesticides. Copyright © 2017 Elsevier B.V. All rights reserved.

Modifiable risk factors of ecstasy use: risk perception, current dependence, perceived control, and depression

PubMed Central

Leung, Kit Sang; Ben Abdallah, Arbi; Cottler, Linda B.

2009-01-01

Risk perception, perceived behavioral control of obtaining ecstasy (PBC-obtaining), current ecstasy dependence, and recent depression have been associated with past ecstasy use, however, their utility in predicting ecstasy use has not been demonstrated. This study aimed to determine whether these four modifiable risk factors could predict ecstasy use after controlling for socio-demographic covariates and recent polydrug use. Data from 601 ecstasy users in the National Institute on Drug Abuse funded TriCity Study of Club Drug Use, Abuse and Dependence were analyzed using multivariate logistic regression. Participants were interviewed twice within a 2-week period using standardized instruments. Thirteen percent (n=80) of the participants reported using ecstasy between the two interviews. Low risk perception, high PBC-obtaining (an estimated ecstasy procurement time < 24 hours), and current ecstasy dependence were statistically associated with ecstasy use between the two interviews. Recent depression was not a significant predictor. Despite not being a target predictor, recent polydrug use was also statistically associated with ecstasy use. The present findings may inform the development of interventions targeting ecstasy users. PMID:19880258

Joint and independent effect of alcohol and tobacco use on the risk of subsequent cancer incidence among cancer survivors: A cohort study using cancer registries.

PubMed

Tabuchi, Takahiro; Ozaki, Koken; Ioka, Akiko; Miyashiro, Isao

2015-11-01

Drinking alcohol and smoking tobacco are major modifiable risk factors for cancer. However, little is known about whether these modifiable factors of cancer survivors are associated with subsequent primary cancer (SPC) incidence, regardless of the first cancer sites. 27,762 eligible cancer survivors diagnosed between 1985 and 2007 were investigated for SPC until the end of 2008, using hospital-based and population-based cancer registries. The association between drinking, smoking and combined drinking and smoking (interaction) at the time of the first cancer diagnosis and incidence of SPCs (i.e., all SPCs, alcohol-related, smoking-related and specific SPCs) was estimated by Poisson regression. Compared with never-drinker/never-smoker, the categories ever-drinker/ever-smoker, current-drinker/current-smoker and heavy-drinker/heavy-smoker had 43-108%, 51-126% and 167-299% higher risk for all, alcohol-related and tobacco-related SPCs, respectively. The interaction of drinking and smoking had significantly high incidence rate ratios (IRRs) for SPCs among ever-drinker/ever-smoker and current-drinker/current-smoker, although ever drinking did not show a significant risk. Ever-drinker/ever-smoker had also significantly higher IRRs for esophageal and lung SPCs than never-drinker/never-smoker. Among comprehensive cancer survivors, ever and current drinkers only had a SPC risk when combined with smoking, while ever and current smokers had a SPC risk regardless of drinking status. Heavy drinking and heavy smoking were considered to be independent additive SPC risk factors. To reduce SPC incidence, it may be necessary (i) to reduce or stop alcohol use, (ii) to stop tobacco smoking and (iii) dual users, especially heavy users, should be treated as a high-risk population for behavioral-change intervention. © 2015 UICC.

Estimating the decline in excess risk of chronic obstructive pulmonary disease following quitting smoking - a systematic review based on the negative exponential model.

PubMed

Lee, Peter N; Fry, John S; Forey, Barbara A

2014-03-01

We quantified the decline in COPD risk following quitting using the negative exponential model, as previously carried out for other smoking-related diseases. We identified 14 blocks of RRs (from 11 studies) comparing current smokers, former smokers (by time quit) and never smokers, some studies providing sex-specific blocks. Corresponding pseudo-numbers of cases and controls/at risk formed the data for model-fitting. We estimated the half-life (H, time since quit when the excess risk becomes half that for a continuing smoker) for each block, except for one where no decline with quitting was evident, and H was not estimable. For the remaining 13 blocks, goodness-of-fit to the model was generally adequate, the combined estimate of H being 13.32 (95% CI 11.86-14.96) years. There was no heterogeneity in H, overall or by various studied sources. Sensitivity analyses allowing for reverse causation or different assumed times for the final quitting period little affected the results. The model summarizes quitting data well. The estimate of 13.32years is substantially larger than recent estimates of 4.40years for ischaemic heart disease and 4.78years for stroke, and also larger than the 9.93years for lung cancer. Heterogeneity was unimportant for COPD, unlike for the other three diseases. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

Vaccine-associated paralytic poliomyelitis: a review of the epidemiology and estimation of the global burden.

PubMed

Platt, Lauren R; Estívariz, Concepción F; Sutter, Roland W

2014-11-01

Vaccine-associated paralytic poliomyelitis (VAPP) is a rare adverse event associated with oral poliovirus vaccine (OPV). This review summarizes the epidemiology and provides a global burden estimate. A literature review was conducted to abstract the epidemiology and calculate the risk of VAPP. A bootstrap method was applied to calculate global VAPP burden estimates. Trends in VAPP epidemiology varied by country income level. In the low-income country, the majority of cases occurred in individuals who had received >3 doses of OPV (63%), whereas in middle and high-income countries, most cases occurred in recipients after their first OPV dose or unvaccinated contacts (81%). Using all risk estimates, VAPP risk was 4.7 cases per million births (range, 2.4-9.7), leading to a global annual burden estimate of 498 cases (range, 255-1018). If the analysis is limited to estimates from countries that currently use OPV, the VAPP risk is 3.8 cases per million births (range, 2.9-4.7) and a burden of 399 cases (range, 306-490). Because many high-income countries have replaced OPV with inactivated poliovirus vaccine, the VAPP burden is concentrated in lower-income countries. The planned universal introduction of inactivated poliovirus vaccine is likely to substantially decrease the global VAPP burden by 80%-90%. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Niche syndromes, species extinction risks, and management under climate change.

PubMed

Sax, Dov F; Early, Regan; Bellemare, Jesse

2013-09-01

The current distributions of species are often assumed to correspond with the total set of environmental conditions under which species can persist. When this assumption is incorrect, extinction risk estimated from species distribution models can be misleading. The degree to which species can tolerate or even thrive under conditions found beyond their current distributions alters extinction risks, time lags in realizing those risks, and the usefulness of alternative management strategies. To inform these issues, we propose a conceptual framework within which empirical data could be used to generate hypotheses regarding the realized, fundamental, and 'tolerance' niche of species. Although these niche components have rarely been characterized over geographic scales, we suggest that this could be done for many plant species by comparing native, naturalized, and horticultural distributions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Information security of power enterprises of North-Arctic region

NASA Astrophysics Data System (ADS)

Sushko, O. P.

2018-05-01

The role of information technologies in providing technological security for energy enterprises is a component of the economic security for the northern Arctic region in general. Applying instruments and methods of information protection modelling of the energy enterprises' business process in the northern Arctic region (such as Arkhenergo and Komienergo), the authors analysed and identified most frequent risks of information security. With the analytic hierarchy process based on weighting factor estimations, information risks of energy enterprises' technological processes were ranked. The economic estimation of the information security within an energy enterprise considers weighting factor-adjusted variables (risks). Investments in information security systems of energy enterprises in the northern Arctic region are related to necessary security elements installation; current operating expenses on business process protection systems become materialized economic damage.

Smoking rate and periodontal disease prevalence: 40-year trends in Sweden 1970-2010.

PubMed

Bergstrom, Jan

2014-10-01

To investigate the relationship between smoking rate and periodontal disease prevalence in Sweden. National smoking rates were found from Swedish National Statistics on smoking habits. Based on smoking rates for the years 1970-2010, periodontal disease prevalence estimates were calculated for the age bracket 40-70 years and smoking-associated relative risks between 2.0 and 20.0. The impact of smoking on the population was estimated according to the concept of population attributable fraction. The age-standardized smoking rate in Sweden declined from 44% in 1970 to 15% in 2010. In parallel with the smoking decline the calculated prevalence estimate of periodontal disease dropped from 26% to 12% assuming a 10-fold smoking-associated relative risk. Even at more moderate magnitudes of the relative risk, e.g. 2-fold or 5-fold, the prevalence decrease was quite tangible, suggesting that the current prevalence in Sweden is about 20-50% of the level 40 years ago. The population attributable fraction, estimating the portion of the disease that would have been avoided in the absence of smoking, was 80% in 1970 and 58% in 2010 at a ten-fold relative risk. Calculated estimates of periodontal disease prevalence are closely related to real changes in smoking rate. As smoking rate drops periodontal disease prevalence will drop. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Crash risk factors for interstate large trucks in North Carolina.

PubMed

Teoh, Eric R; Carter, Daniel L; Smith, Sarah; McCartt, Anne T

2017-09-01

Provide an updated examination of risk factors for large truck involvements in crashes resulting in injury or death. A matched case-control study was conducted in North Carolina of large trucks operated by interstate carriers. Cases were defined as trucks involved in crashes resulting in fatal or non-fatal injury, and one control truck was matched on the basis of location, weekday, time of day, and truck type. The matched-pair odds ratio provided an estimate of the effect of various driver, vehicle, or carrier factors. Out-of-service (OOS) brake violations tripled the risk of crashing; any OOS vehicle defect increased crash risk by 362%. Higher historical crash rates (fatal, injury, or all crashes) of the carrier were associated with increased risk of crashing. Operating on a short-haul exemption increased crash risk by 383%. Antilock braking systems reduced crash risk by 65%. All of these results were statistically significant at the 95% confidence level. Other safety technologies also showed estimated benefits, although not statistically significant. With the exception of the finding that short-haul exemption is associated with increased crash risk, results largely bolster what is currently known about large truck crash risk and reinforce current enforcement practices. Results also suggest vehicle safety technologies can be important in lowering crash risk. This means that as safety technology continues to penetrate the fleet, whether from voluntary usage or government mandates, reductions in large truck crashes may be achieved. Practical application: Results imply that increased enforcement and use of crash avoidance technologies can improve the large truck crash problem. Copyright © 2017 National Safety Council and Elsevier Ltd. All rights reserved.

An assessment of public health surveillance of Zika virus infection and potentially associated outcomes in Latin America.

PubMed

Bautista, Leonelo E; Herrera, Víctor M

2018-05-24

We evaluated whether outbreaks of Zika virus (ZIKV) infection, newborn microcephaly, and Guillain-Barré syndrome (GBS) in Latin America may be detected through current surveillance systems, and how cases detected through surveillance may increase health care burden. We estimated the sensitivity and specificity of surveillance case definitions using published data. We assumed a 10% ZIKV infection risk during a non-outbreak period and hypothetical increases in risk during an outbreak period. We used sensitivity and specificity estimates to correct for non-differential misclassification, and calculated a misclassification-corrected relative risk comparing both periods. To identify the smallest hypothetical increase in risk resulting in a detectable outbreak we compared the misclassification-corrected relative risk to the relative risk corresponding to the upper limit of the endemic channel (mean + 2 SD). We also estimated the proportion of false positive cases detected during the outbreak. We followed the same approach for microcephaly and GBS, but assumed the risk of ZIKV infection doubled during the outbreak, and ZIKV infection increased the risk of both diseases. ZIKV infection outbreaks were not detectable through non-serological surveillance. Outbreaks were detectable through serologic surveillance if infection risk increased by at least 10%, but more than 50% of all cases were false positive. Outbreaks of severe microcephaly were detected if ZIKV infection increased prevalence of this condition by at least 24.0 times. When ZIKV infection did not increase the prevalence of severe microcephaly, 34.7 to 82.5% of all cases were false positive, depending on diagnostic accuracy. GBS outbreaks were detected if ZIKV infection increased the GBS risk by at least seven times. For optimal GBS diagnosis accuracy, the proportion of false positive cases ranged from 29 to 54% and from 45 to 56% depending on the incidence of GBS mimics. Current surveillance systems have a low probability of detecting outbreaks of ZIKV infection, severe microcephaly, and GBS, and could result in significant increases in health care burden, due to the detection of large numbers of false positive cases. In view of these limitations, Latin American countries should consider alternative options for surveillance.

The Impact of Different Classification Criteria Sets on the Estimated Prevalence and Associated Risk Factors of Diastolic Dysfunction in Rheumatoid Arthritis

PubMed Central

Mokotedi, Lebogang; Gunter, Sulé; Robinson, Chanel; Norton, Gavin R.; Woodiwiss, Angela J.

2017-01-01

This study compared the estimated prevalence and potential determinants of left ventricular (LV) diastolic dysfunction upon applying different classification criteria in rheumatoid arthritis (RA). LV diastolic function was assessed echocardiographically by pulsed Doppler (E/A), tissue Doppler (E/e′, lateral and septal e′), and left atrial volume index in 176 RA patients. Relationships of traditional cardiovascular risk factors and RA characteristics with LV diastolic function and dysfunction according to previous and current criteria were determined in multivariate regression models. Waist-hip ratio was associated with E/A (standardised β (SE) = −0.28 ± 0.09, p = 0.0002) and lateral e′ (standardised β (SE) = 0.26 ± 0.09, p = 0.01); low diastolic blood pressure was related to E/e′ (standardised β (SE) = −0.16 ± 0.08, p = 0.04). Diastolic dysfunction prevalence differed upon applying previous (59%) compared to current (22%) criteria (p < 0.0001). One SD increase in waist-hip ratio was associated with diastolic dysfunction when applying current criteria (OR = 2.61 (95% CI = 1.51–4.52), p = 0.0006), whereas one SD increase in diastolic blood pressure was inversely related to diastolic dysfunction upon using previous criteria (OR = 0.57 (95% CI = 0.40–0.81), p = 0.002). In conclusion, application of current and previous diastolic dysfunction criteria markedly alters the prevalence and risk factors associated with diastolic dysfunction in RA. PMID:29348754

Incremental impact of body mass status with modifiable unhealthy lifestyle behaviors on pharmaceutical expenditure.

PubMed

Kim, Tae Hyun; Lee, Eui-Kyung; Han, Euna

Overweight/obesity is a growing health risk in Korea. The impact of overweight/obesity on pharmaceutical expenditure can be larger if individuals have multiple risk factors and multiple comorbidities. The current study estimated the combined effects of overweight/obesity and other unhealthy behaviors on pharmaceutical expenditure. An instrumental variable quantile regression model was estimated using Korea Health Panel Study data. The current study extracted data from 3 waves (2009, 2010, and 2011). The final sample included 7148 person-year observations for adults aged 20 years or older. Overweight/obese individuals had higher pharmaceutical expenditure than their non-obese counterparts only at the upper quantiles of the conditional distribution of pharmaceutical expenditure (by 119% at the 90th quantile and 115% at the 95th). The current study found a stronger association at the upper quantiles among men (152%, 144%, and 150% at the 75th, 90th, and 95th quantiles, respectively) than among women (152%, 150%, and 148% at the 75th, 90th, and 95th quantiles, respectively). The association at the upper quantiles was stronger when combined with moderate to heavy drinking and no regular physical check-up, particularly among males. The current study confirms that the association of overweight/obesity with modifiable unhealthy behaviors on pharmaceutical expenditure is larger than with overweight/obesity alone. Assessing the effect of overweight/obesity with lifestyle risk factors can help target groups for public health intervention programs. Copyright © 2015 Elsevier Inc. All rights reserved.

Joint Direct Attack Munition (JDAM)

DTIC Science & Technology

2015-12-01

February 19, 2015 and the O&S cost are based on an ICE dated August 28, 2014 Confidence Level Confidence Level of cost estimate for current APB: 50% A...mathematically derived confidence level was not computed for this Life-Cycle Cost Estimate (LCCE). This LCCE represents the expected value, taking into...consideration relevant risks, including ordinary levels of external and unforeseen events. It aims to provide sufficient resources to execute the

Climate change and the emergence of vector-borne diseases in Europe: case study of dengue fever.

PubMed

Bouzid, Maha; Colón-González, Felipe J; Lung, Tobias; Lake, Iain R; Hunter, Paul R

2014-08-22

Dengue fever is the most prevalent mosquito-borne viral disease worldwide. Dengue transmission is critically dependent on climatic factors and there is much concern as to whether climate change would spread the disease to areas currently unaffected. The occurrence of autochthonous infections in Croatia and France in 2010 has raised concerns about a potential re-emergence of dengue in Europe. The objective of this study is to estimate dengue risk in Europe under climate change scenarios. We used a Generalized Additive Model (GAM) to estimate dengue fever risk as a function of climatic variables (maximum temperature, minimum temperature, precipitation, humidity) and socioeconomic factors (population density, urbanisation, GDP per capita and population size), under contemporary conditions (1985-2007) in Mexico. We then used our model estimates to project dengue incidence under baseline conditions (1961-1990) and three climate change scenarios: short-term 2011-2040, medium-term 2041-2070 and long-term 2071-2100 across Europe. The model was used to calculate average number of yearly dengue cases at a spatial resolution of 10 × 10 km grid covering all land surface of the currently 27 EU member states. To our knowledge, this is the first attempt to model dengue fever risk in Europe in terms of disease occurrence rather than mosquito presence. The results were presented using Geographical Information System (GIS) and allowed identification of areas at high risk. Dengue fever hot spots were clustered around the coastal areas of the Mediterranean and Adriatic seas and the Po Valley in northern Italy. This risk assessment study is likely to be a valuable tool assisting effective and targeted adaptation responses to reduce the likely increased burden of dengue fever in a warmer world.

[Therapeutic strategies. Evolution and current status of the European Guidelines on Cardiovascular disease prevention].

PubMed

Guijarro, Carlos; García-Díaz, Juan de Dios

2013-01-01

The European Guidelines on Dyslipidaemias (2011) and Cardiovascular Prevention (2012) have incorporated important changes. Firstly, it highlights the identification of a group of "very high risk" patients: patients with atherosclerotic disease in any vascular area, diabetes with associated risk factors, advanced chronic renal failure, or a SCORE estimate >10%. Patients with diabetes and no other risk factors, moderate renal failure, severe hypertension, genetic dyslipidaemias, or a SCORE estimate 5-10%, are considered as "high risk". The HDL cholesterol and triglycerides levels are considered as modulators of risks, but not therapeutic objectives per se. The therapeutic objectives are set at LDL cholesterol levels < 70 mg/dl (or at least a reduction of at least 50%) for patients at very high risk, and an LDL < 100 mg/dl for high risk patients. As well as the changes in lifestyle, pharmacological treatment with statins is the focal point of lipid lowering treatments. Other pharmacological options may be considered if the treatment with the maximum tolerable doses of statins do not achieve the therapeutic objectives. Copyright © 2013 Elsevier España, S.L. y SEA. All rights reserved.

Predicting high-risk preterm birth using artificial neural networks.

PubMed

Catley, Christina; Frize, Monique; Walker, C Robin; Petriu, Dorina C

2006-07-01

A reengineered approach to the early prediction of preterm birth is presented as a complimentary technique to the current procedure of using costly and invasive clinical testing on high-risk maternal populations. Artificial neural networks (ANNs) are employed as a screening tool for preterm birth on a heterogeneous maternal population; risk estimations use obstetrical variables available to physicians before 23 weeks gestation. The objective was to assess if ANNs have a potential use in obstetrical outcome estimations in low-risk maternal populations. The back-propagation feedforward ANN was trained and tested on cases with eight input variables describing the patient's obstetrical history; the output variables were: 1) preterm birth; 2) high-risk preterm birth; and 3) a refined high-risk preterm birth outcome excluding all cases where resuscitation was delivered in the form of free flow oxygen. Artificial training sets were created to increase the distribution of the underrepresented class to 20%. Training on the refined high-risk preterm birth model increased the network's sensitivity to 54.8%, compared to just over 20% for the nonartificially distributed preterm birth model.

Lunar Landing Operational Risk Model

NASA Technical Reports Server (NTRS)

Mattenberger, Chris; Putney, Blake; Rust, Randy; Derkowski, Brian

2010-01-01

Characterizing the risk of spacecraft goes beyond simply modeling equipment reliability. Some portions of the mission require complex interactions between system elements that can lead to failure without an actual hardware fault. Landing risk is currently the least characterized aspect of the Altair lunar lander and appears to result from complex temporal interactions between pilot, sensors, surface characteristics and vehicle capabilities rather than hardware failures. The Lunar Landing Operational Risk Model (LLORM) seeks to provide rapid and flexible quantitative insight into the risks driving the landing event and to gauge sensitivities of the vehicle to changes in system configuration and mission operations. The LLORM takes a Monte Carlo based approach to estimate the operational risk of the Lunar Landing Event and calculates estimates of the risk of Loss of Mission (LOM) - Abort Required and is Successful, Loss of Crew (LOC) - Vehicle Crashes or Cannot Reach Orbit, and Success. The LLORM is meant to be used during the conceptual design phase to inform decision makers transparently of the reliability impacts of design decisions, to identify areas of the design which may require additional robustness, and to aid in the development and flow-down of requirements.

Radiation hazard during a manned mission to Mars.

PubMed

Jäkel, Oliver

2004-01-01

The radiation hazard of interplanetary flights is currently one of the major obstacles to manned missions to Mars. Highly energetic, heavy-charged particles from galactic cosmic radiation can not be sufficiently shielded in space vehicles. The long-term radiation effects to humans of these particles are largely unknown. In addition, unpredictable storms of solar particles may expose the crew to doses that lead to acute radiation effects. A manned flight to Mars currently seems to be a high-risk adventure. This article provides an overview on the radiation sources and risks for a crew on a manned flight to Mars, as currently estimated by scientists of the US National Administration for Space and Aeronautics (NASA) and the Space Studies Board (SSB) of the US National Research Council.

A Bayesian evidence synthesis approach to estimate disease prevalence in hard-to-reach populations: hepatitis C in New York City.

PubMed

Tan, Sarah; Makela, Susanna; Heller, Daliah; Konty, Kevin; Balter, Sharon; Zheng, Tian; Stark, James H

2018-06-01

Existing methods to estimate the prevalence of chronic hepatitis C (HCV) in New York City (NYC) are limited in scope and fail to assess hard-to-reach subpopulations with highest risk such as injecting drug users (IDUs). To address these limitations, we employ a Bayesian multi-parameter evidence synthesis model to systematically combine multiple sources of data, account for bias in certain data sources, and provide unbiased HCV prevalence estimates with associated uncertainty. Our approach improves on previous estimates by explicitly accounting for injecting drug use and including data from high-risk subpopulations such as the incarcerated, and is more inclusive, utilizing ten NYC data sources. In addition, we derive two new equations to allow age at first injecting drug use data for former and current IDUs to be incorporated into the Bayesian evidence synthesis, a first for this type of model. Our estimated overall HCV prevalence as of 2012 among NYC adults aged 20-59 years is 2.78% (95% CI 2.61-2.94%), which represents between 124,900 and 140,000 chronic HCV cases. These estimates suggest that HCV prevalence in NYC is higher than previously indicated from household surveys (2.2%) and the surveillance system (2.37%), and that HCV transmission is increasing among young injecting adults in NYC. An ancillary benefit from our results is an estimate of current IDUs aged 20-59 in NYC: 0.58% or 27,600 individuals. Copyright © 2018 Elsevier B.V. All rights reserved.

Global access to safe water: accounting for water quality and the resulting impact on MDG progress.

PubMed

Onda, Kyle; LoBuglio, Joe; Bartram, Jamie

2012-03-01

Monitoring of progress towards the Millennium Development Goal (MDG) drinking water target relies on classification of water sources as "improved" or "unimproved" as an indicator for water safety. We adjust the current Joint Monitoring Programme (JMP) estimate by accounting for microbial water quality and sanitary risk using the only-nationally representative water quality data currently available, that from the WHO and UNICEF "Rapid Assessment of Drinking Water Quality". A principal components analysis (PCA) of national environmental and development indicators was used to create models that predicted, for most countries, the proportions of piped and of other-improved water supplies that are faecally contaminated; and of these sources, the proportions that lack basic sanitary protection against contamination. We estimate that 1.8 billion people (28% of the global population) used unsafe water in 2010. The 2010 JMP estimate is that 783 million people (11%) use unimproved sources. Our estimates revise the 1990 baseline from 23% to 37%, and the target from 12% to 18%, resulting in a shortfall of 10% of the global population towards the MDG target in 2010. In contrast, using the indicator "use of an improved source" suggests that the MDG target for drinking-water has already been achieved. We estimate that an additional 1.2 billion (18%) use water from sources or systems with significant sanitary risks. While our estimate is imprecise, the magnitude of the estimate and the health and development implications suggest that greater attention is needed to better understand and manage drinking water safety.

Global Access to Safe Water: Accounting for Water Quality and the Resulting Impact on MDG Progress

PubMed Central

Onda, Kyle; LoBuglio, Joe; Bartram, Jamie

2012-01-01

Monitoring of progress towards the Millennium Development Goal (MDG) drinking water target relies on classification of water sources as “improved” or “unimproved” as an indicator for water safety. We adjust the current Joint Monitoring Programme (JMP) estimate by accounting for microbial water quality and sanitary risk using the only-nationally representative water quality data currently available, that from the WHO and UNICEF “Rapid Assessment of Drinking Water Quality”. A principal components analysis (PCA) of national environmental and development indicators was used to create models that predicted, for most countries, the proportions of piped and of other-improved water supplies that are faecally contaminated; and of these sources, the proportions that lack basic sanitary protection against contamination. We estimate that 1.8 billion people (28% of the global population) used unsafe water in 2010. The 2010 JMP estimate is that 783 million people (11%) use unimproved sources. Our estimates revise the 1990 baseline from 23% to 37%, and the target from 12% to 18%, resulting in a shortfall of 10% of the global population towards the MDG target in 2010. In contrast, using the indicator “use of an improved source” suggests that the MDG target for drinking-water has already been achieved. We estimate that an additional 1.2 billion (18%) use water from sources or systems with significant sanitary risks. While our estimate is imprecise, the magnitude of the estimate and the health and development implications suggest that greater attention is needed to better understand and manage drinking water safety. PMID:22690170

Risk Behaviors, Prevalence of HIV and Hepatitis C Virus Infection and Population Size of Current Injection Drug Users in a China-Myanmar Border City: Results from a Respondent-Driven Sampling Survey in 2012

PubMed Central

Li, Lei; Assanangkornchai, Sawitri; Duo, Lin; McNeil, Edward; Li, Jianhua

2014-01-01

Background Injection drug use has been the major cause of HIV/AIDS in China in the past two decades. We measured the prevalences of HIV and hepatitis C virus (HCV) prevalence and their associated risk factors among current injection drug users (IDUs) in Ruili city, a border region connecting China with Myanmar that has been undergoing serious drug use and HIV spread problems. An estimate of the number of current IDUs is also presented. Methods In 2012, Chinese IDUs who had injected within the past six months and aged ≥18 years were recruited using a respondent-driven sampling (RDS) technique. Participants underwent interviews and serological testing for HIV, HBV, HCV and syphilis. Logistic regression indentified factors associated with HIV and HCV infections. Multiplier method was used to obtain an estimate of the size of the current IDU population via combining available service data and findings from our survey. Results Among 370 IDUs recruited, the prevalence of HIV and HCV was 18.3% and 41.5%, respectively. 27.1% of participants had shared a needle/syringe in their lifetime. Consistent condom use rates were low among both regular (6.8%) and non-regular (30.4%) partners. Factors independently associated with being HIV positive included HCV infection, having a longer history of injection drug use and experience of needle/syringe sharing. Participants with HCV infection were more likely to be HIV positive, have injected more types of drugs, have shared other injection equipments and have unprotected sex with regular sex partners. The estimated number of current IDUs in Ruili city was 2,714 (95% CI: 1,617–5,846). Conclusions IDUs may continue to be a critical subpopulation for transmission of HIV and other infections in this region because of the increasing population and persistent high risk of injection and sexual behaviours. Developing innovative strategies that can improve accessibility of current harm reduction services and incorporate more comprehensive contents is urgently needed. PMID:25203256

Towards the estimation of effect measures in studies using respondent-driven sampling.

PubMed

Rotondi, Michael A

2014-06-01

Respondent-driven sampling (RDS) is an increasingly common sampling technique to recruit hidden populations. Statistical methods for RDS are not straightforward due to the correlation between individual outcomes and subject weighting; thus, analyses are typically limited to estimation of population proportions. This manuscript applies the method of variance estimates recovery (MOVER) to construct confidence intervals for effect measures such as risk difference (difference of proportions) or relative risk in studies using RDS. To illustrate the approach, MOVER is used to construct confidence intervals for differences in the prevalence of demographic characteristics between an RDS study and convenience study of injection drug users. MOVER is then applied to obtain a confidence interval for the relative risk between education levels and HIV seropositivity and current infection with syphilis, respectively. This approach provides a simple method to construct confidence intervals for effect measures in RDS studies. Since it only relies on a proportion and appropriate confidence limits, it can also be applied to previously published manuscripts.

NETWORK ASSISTED ANALYSIS TO REVEAL THE GENETIC BASIS OF AUTISM1

PubMed Central

Liu, Li; Lei, Jing; Roeder, Kathryn

2016-01-01

While studies show that autism is highly heritable, the nature of the genetic basis of this disorder remains illusive. Based on the idea that highly correlated genes are functionally interrelated and more likely to affect risk, we develop a novel statistical tool to find more potentially autism risk genes by combining the genetic association scores with gene co-expression in specific brain regions and periods of development. The gene dependence network is estimated using a novel partial neighborhood selection (PNS) algorithm, where node specific properties are incorporated into network estimation for improved statistical and computational efficiency. Then we adopt a hidden Markov random field (HMRF) model to combine the estimated network and the genetic association scores in a systematic manner. The proposed modeling framework can be naturally extended to incorporate additional structural information concerning the dependence between genes. Using currently available genetic association data from whole exome sequencing studies and brain gene expression levels, the proposed algorithm successfully identified 333 genes that plausibly affect autism risk. PMID:27134692

Uncertainties in Projecting Risks of Late Effects from Space Radiation

NASA Astrophysics Data System (ADS)

Cucinotta, F.; Schimmerling, W.; Peterson, L.; Wilson, J.; Saganti, P.; Dicello, J.

The health risks faced by astronauts from space radiation include cancer, cataracts, hereditary effects, CNS risks, and non - cancer morbidity and mortality risks related to the diseases of the old age. Methods used to project risks in low -Earth orbit are of questionable merit for exploration missions because of the limited radiobiology data and knowledge of galactic cosmic ray (GCR) heavy ions, which causes estimates of the risk of late effects to be highly uncertain. Risk projections involve a product of many biological and physical factors, each of which has a differential range of uncertainty due to lack of data and knowledge. Within the linear-additivity model, we use Monte-Carlo sampling from subjective uncertainty distributions in each factor to obtain a maximum likelihood estimate of the overall uncertainty in risk projections. The resulting methodology is applied to several human space exploration mission scenarios including ISS, lunar station, deep space outpost, and Mar's missions of duration of 360, 660, and 1000 days. The major results are the quantification of the uncertainties in current risk estimates, the identification of the primary factors that dominate risk projection uncertainties, and the development of a method to quantify candidate approaches to reduce uncertainties or mitigate risks. The large uncertainties in GCR risk projections lead to probability distributions of risk that mask any potential risk reduction using the "optimization" of shielding materials or configurations. In contrast, the design of shielding optimization approaches for solar particle events and trapped protons can be made at this time, and promising technologies can be shown to have merit using our approach. The methods used also make it possible to express risk management objectives in terms of quantitative objectives, i.e., number of days in space without exceeding a given risk level within well defined confidence limits

Age-Dependent Risk of Graft Failure in Young Kidney Transplant Recipients.

PubMed

Kaboré, Rémi; Couchoud, Cécile; Macher, Marie-Alice; Salomon, Rémi; Ranchin, Bruno; Lahoche, Annie; Roussey-Kesler, Gwenaelle; Garaix, Florentine; Decramer, Stéphane; Pietrement, Christine; Lassalle, Mathilde; Baudouin, Véronique; Cochat, Pierre; Niaudet, Patrick; Joly, Pierre; Leffondré, Karen; Harambat, Jérôme

2017-06-01

The risk of graft failure in young kidney transplant recipients has been found to increase during adolescence and early adulthood. However, this question has not been addressed outside the United States so far. Our objective was to investigate whether the hazard of graft failure also increases during this age period in France irrespective of age at transplantation. Data of all first kidney transplantation performed before 30 years of age between 1993 and 2012 were extracted from the French kidney transplant database. The hazard of graft failure was estimated at each current age using a 2-stage modelling approach that accounted for both age at transplantation and time since transplantation. Hazard ratios comparing the risk of graft failure during adolescence or early adulthood to other periods were estimated from time-dependent Cox models. A total of 5983 renal transplant recipients were included. The risk of graft failure was found to increase around the age of 13 years until the age of 21 years, and decrease thereafter. Results from the Cox model indicated that the hazard of graft failure during the age period 13 to 23 years was almost twice as high as than during the age period 0 to 12 years, and 25% higher than after 23 years. Among first kidney transplant recipients younger than 30 years in France, those currently in adolescence or early adulthood have the highest risk of graft failure.

Effects and risk assessment of linear alkylbenzene sulfonates in agricultural soil. 5. Probabilistic risk assessment of linear alkylbenzene sulfonates in sludge-amended soils.

PubMed

Jensen, J; Løkke, H; Holmstrup, M; Krogh, P H; Elsgaard, L

2001-08-01

Linear alkylbenzene sulfonates (LAS) can be found in high concentrations in sewage sludge and, hence, may enter the soil compartment as a result of sludge application. Here, LAS may pose a risk for soil-dwelling organisms. In the present probabilistic risk assessment, statistical extrapolation has been used to assess the risk of LAS to soil ecosystems. By use of a log-normal distribution model, the predicted no-effect concentration (PNEC) was estimated for soil fauna, plants, and a combination of these. Due to the heterogeneous endpoints for microorganisms, including functional as well as structural parameters, the use of sensitivity distributions is not considered to be applicable to this group of organisms, and a direct, expert evaluation of toxicity data was used instead. The soil concentration after sludge application was predicted for a number of scenarios and used as the predicted environmental concentration (PEC) in the risk characterization and calculation of risk quotients (RQ = PEC/PNEC). A LAS concentration of 4.6 mg/kg was used as the current best estimate of PNEC in all RQ calculations. Three levels of LAS contamination (530, 2,600, and 16,100 mg/kg), three half-lives (10, 25, and 40 d), and five different sludge loads (2, 4, 6, 8, and 10 t/ha) were included in the risk scenarios. In Denmark, the initial risk ratio would reach 1.5 in a realistic worst-case consideration. For countries not having similar sludge regulations, the estimated risk ratio may initially be considerably higher. However, even in the most extreme scenarios, the level of LAS is expected to be well beyond the estimated PNEC one year after application. The present risk assessment, therefore, concludes that LAS does not pose a significant risk to fauna, plants, and essential functions of agricultural soils as a result of normal sewage sludge amendment. However, risks have been identified in worst-case scenarios.

Exploring the cost-utility of stratified primary care management for low back pain compared with current best practice within risk-defined subgroups.

PubMed

Whitehurst, David G T; Bryan, Stirling; Lewis, Martyn; Hill, Jonathan; Hay, Elaine M

2012-11-01

Stratified management for low back pain according to patients' prognosis and matched care pathways has been shown to be an effective treatment approach in primary care. The aim of this within-trial study was to determine the economic implications of providing such an intervention, compared with non-stratified current best practice, within specific risk-defined subgroups (low-risk, medium-risk and high-risk). Within a cost-utility framework, the base-case analysis estimated the incremental healthcare cost per additional quality-adjusted life year (QALY), using the EQ-5D to generate QALYs, for each risk-defined subgroup. Uncertainty was explored with cost-utility planes and acceptability curves. Sensitivity analyses were performed to consider alternative costing methodologies, including the assessment of societal loss relating to work absence and the incorporation of generic (ie, non-back pain) healthcare utilisation. The stratified management approach was a cost-effective treatment strategy compared with current best practice within each risk-defined subgroup, exhibiting dominance (greater benefit and lower costs) for medium-risk patients and acceptable incremental cost to utility ratios for low-risk and high-risk patients. The likelihood that stratified care provides a cost-effective use of resources exceeds 90% at willingness-to-pay thresholds of £4000 (≈ 4500; $6500) per additional QALY for the medium-risk and high-risk groups. Patients receiving stratified care also reported fewer back pain-related days off work in all three subgroups. Compared with current best practice, stratified primary care management for low back pain provides a highly cost-effective use of resources across all risk-defined subgroups.

What Is the Risk of Progressive Multifocal Leukoencephalopathy in Patients With Ulcerative Colitis or Crohn's Disease Treated With Vedolizumab?

PubMed

Card, Timothy; Xu, Jing; Liang, Huifang; Bhayat, Fatima

2018-04-23

Progressive multifocal leukoencephalopathy is a serious condition linked to certain diseases and immunosuppressant therapies, including the α4 integrin antagonist natalizumab. No cases have been reported to date with vedolizumab, a selective antagonist of the α4β7 integrin expressed on gut-homing lymphocytes. This analysis aimed to describe the current and future expected occurrence of progressive multifocal leukoencephalopathy with vedolizumab use, were the risk the same as in other populations in which this disease has been studied. The expected number of vedolizumab-associated progressive multifocal leukoencephalopathy cases was estimated up to May 19, 2016, and modeled up to 2034. These estimates were based on the cumulative exposure to the drug, assuming an equivalent risk to that of patients treated with natalizumab or those from other reference populations where progressive multifocal leukoencephalopathy has been examined. Future cases were modeled based on similar risks and projected sales. The cumulative vedolizumab exposure was estimated at 54,619 patient-years, with a 95% confidence interval of 0.0 to 6.75 cases per 100,000 patient-years. An estimated 30.2 (95% confidence interval, 19.4-40.9) cases of progressive multifocal leukoencephalopathy would have occurred if vedolizumab had the same risk as that of natalizumab. There would be a 50% chance of the first case occurring by 2018, assuming an equivalent risk to the general population. These analyses indicate that the risk of progressive multifocal leukoencephalopathy with vedolizumab is small, and unlikely to be above 6.75 cases per 100,000 patient-years.

Substance use disorders and the risk of suicide mortality among men and women in the US Veterans Health Administration.

PubMed

Bohnert, Kipling M; Ilgen, Mark A; Louzon, Samantha; McCarthy, John F; Katz, Ira R

2017-07-01

Limited information is available regarding links between specific substance use disorders (SUDs) and suicide mortality; however, the preliminary evidence that is available suggests that suicide risk associated with SUDs may differ for men and women. This study aimed to estimate associations between SUDs and suicide for men and women receiving Veterans Health Administration (VHA) care. A cohort study using national administrative health records. National VHA system, USA. All VHA users in fiscal year (FY) 2005 who were alive at the beginning of FY 2006 (n = 4 863 086). The primary outcome of suicide mortality was assessed via FY 2006-2011 National Death Index (NDI) records. Current SUD diagnoses were the primary predictors of interest, and were assessed via FY 2004-2005 VHA National Patient Care Database (NPCD) records. In unadjusted analyses, a diagnosis of any current SUD and the specific current diagnoses of alcohol, cocaine, cannabis, opioid, amphetamine and sedative use disorders were all associated significantly with increased risk of suicide for both males and females [hazard ratios (HRs)] ranging from 1.35 for cocaine use disorder to 4.74 for sedative use disorder for men, and 3.89 for cannabis use disorder to 11.36 for sedative use disorder for women]. Further, the HR estimates for the relations between any SUD, alcohol, cocaine and opioid use disorders and suicide were significantly stronger for women than men (P < 0.05). After adjustment for other factors, most notably comorbid psychiatric diagnoses, associations linking SUDs with suicide were attenuated markedly and the greater suicide risk among females was observed for only any SUD and opioid use disorder (P < 0.05). Current substance use disorders (SUDs) signal increased suicide risk, especially among women, and may be important markers to consider including in suicide risk assessment strategies. None the less, other co-occurring psychiatric disorders may partially explain associations between SUDs and suicide, as well as the observed excess suicide risk associated with SUDs among women. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Cross-Sectional And Longitudinal Uncertainty Propagation In Drinking Water Risk Assessment

NASA Astrophysics Data System (ADS)

Tesfamichael, A. A.; Jagath, K. J.

2004-12-01

Pesticide residues in drinking water can vary significantly from day to day. However, drinking water quality monitoring performed under the Safe Drinking Water Act (SDWA) at most community water systems (CWSs) is typically limited to four data points per year over a few years. Due to limited sampling, likely maximum residues may be underestimated in risk assessment. In this work, a statistical methodology is proposed to study the cross-sectional and longitudinal uncertainties in observed samples and their propagated effect in risk estimates. The methodology will be demonstrated using data from 16 CWSs across the US that have three independent databases of atrazine residue to estimate the uncertainty of risk in infants and children. The results showed that in 85% of the CWSs, chronic risks predicted with the proposed approach may be two- to four-folds higher than that predicted with the current approach, while intermediate risks may be two- to three-folds higher in 50% of the CWSs. In 12% of the CWSs, however, the proposed methodology showed a lower intermediate risk. A closed-form solution of propagated uncertainty will be developed to calculate the number of years (seasons) of water quality data and sampling frequency needed to reduce the uncertainty in risk estimates. In general, this methodology provided good insight into the importance of addressing uncertainty of observed water quality data and the need to predict likely maximum residues in risk assessment by considering propagation of uncertainties.

Contour plot assessment of existing meta-analyses confirms robust association of statin use and acute kidney injury risk.

PubMed

Chevance, Aurélie; Schuster, Tibor; Steele, Russell; Ternès, Nils; Platt, Robert W

2015-10-01

Robustness of an existing meta-analysis can justify decisions on whether to conduct an additional study addressing the same research question. We illustrate the graphical assessment of the potential impact of an additional study on an existing meta-analysis using published data on statin use and the risk of acute kidney injury. A previously proposed graphical augmentation approach is used to assess the sensitivity of the current test and heterogeneity statistics extracted from existing meta-analysis data. In addition, we extended the graphical augmentation approach to assess potential changes in the pooled effect estimate after updating a current meta-analysis and applied the three graphical contour definitions to data from meta-analyses on statin use and acute kidney injury risk. In the considered example data, the pooled effect estimates and heterogeneity indices demonstrated to be considerably robust to the addition of a future study. Supportingly, for some previously inconclusive meta-analyses, a study update might yield statistically significant kidney injury risk increase associated with higher statin exposure. The illustrated contour approach should become a standard tool for the assessment of the robustness of meta-analyses. It can guide decisions on whether to conduct additional studies addressing a relevant research question. Copyright © 2015 Elsevier Inc. All rights reserved.

Update on the Risk of Introduction of African Swine Fever by Wild Boar into Disease-Free European Union Countries.

PubMed

Bosch, J; Rodríguez, A; Iglesias, I; Muñoz, M J; Jurado, C; Sánchez-Vizcaíno, J M; de la Torre, A

2017-10-01

Despite efforts to prevent the appearance and spread of African swine fever (ASF) in the European Union, several Member States are now affected (Lithuania, Poland, Latvia and Estonia). Disease appearance in 2014 was associated with multiple entrances linked to wild boar movement from endemic areas (EFSA Journal, 8, 2015, 1556), but the risk of new introductions remains high (Gallardo et al., Porcine Health Management, 1, and 21) as ASF continues to be active in endemic countries (Russian Federation, Belarus and Ukraine). Since 2014, the number of ASF notifications has increased substantially, particularly in wild boar (WB), in parallel with slow but constant geographical advance of the disease. This situation suggests a real risk of further disease spread into other Member States, posing a great threat to pig production in the EU. Following the principles of the risk-based veterinary surveillance, this article applies a methodology developed by De la Torre et al. (Transboundary and Emerging Diseases, 62, and 272) to assess the relative risk of new introductions of ASF by natural movements of WB according to the current epidemiological situation. This update incorporates the most recent available data and an improved version of the most important risk estimator: an optimized cartographic tool of WB distribution to analyse wild boar suitable habitat. The highest relative risk values were estimated for Slovakia (5) and Romania (5), followed by Finland (4), Czech Republic (3) and Germany (3). Relative risk for Romania and Finland is associated mainly with disease entrance from endemic areas such as the Russian Federation and Ukraine, where the disease is currently spreading; relative risk for Germany and Czech Republic is associated mainly with the potential progress of the disease through the EU, and relative risk for Slovakia is associated with both pathways. WB habitat is the most important risk estimator, whereas WB density is the least significant, suggesting that WB presence is more relevant than density. These results can provide actionable advice for dealing with risk. They can be directly used to inform risk-based national strategies and identify countries that may need to pay greater attention to surveillance or conduct additional evaluations at the subnational level. © 2016 Blackwell Verlag GmbH.

Trends in HIV Prevalence, Estimated HIV Incidence, and Risk Behavior Among Men Who Have Sex With Men in Bangkok, Thailand, 2003–2007.

PubMed

van Griensven, Frits; Varangrat, Anchalee; Wimonsate, Wipas; Tanpradech, Suvimon; Kladsawad, Keratikarn; Chemnasiri, Tareerat; Suksripanich, Orapin; Phanuphak, Praphan; Mock, Philip; Kanggarnrua, Kamolset; McNicholl, Janet; Plipat, Tanarak

2010-02-01

Men who have sex with men (MSM) continue to be at high risk for HIV infection. Here we evaluate trends in HIV prevalence, estimated HIV incidence, and risk behavior among MSM in Bangkok, Thailand. Between 2003 and 2007, 3 biennial cross-sectional HIV prevalence assessments were conducted among MSM in Bangkok,Thailand, using venue-day-time sampling. Oral fluid was tested for HIV infection; demographic and behavioral data were self-collected using hand-held computers. Estimates of annual HIV incidence in young MSM were derived as follows: (number of HIV infections/sum of [current age–age at start of anal intercourse]) 3 100). Logistic and Poisson regression was used to evaluate trends in HIV prevalence,estimated HIV incidence, and risk behavior. The overall HIV prevalence increased from 17.3% in 2003 to 28.3% in 2005 to 30.8% in 2007 (P , 0.001 for trend). The estimated HIV incidence among young MSM increased from 4.1%in 2003 to 6.4% in 2005, to 7.7% in 2007 (P , 0.02 for trend). The increase in HIV prevalence from 2005 to 2007 was not statistically significant. The proportion of men reporting anal sex and casual or steady male sex partners in the past 3 months significantly decreased,whereas the proportion reporting drug use and drug use during sex significantly increased. No increase was observed in the proportion of men reporting consistent condom use. Our data suggest that after a strong increase from 2003 to 2005, the HIV prevalence among MSM in Bangkok may have begun to stabilize. Given the continuing high levels of risk behavior and the estimated high HIV incidence in young MSM,additional HIV preventive interventions are necessary.

Risk of community-acquired pneumonia in chronic obstructive pulmonary disease stratified by smoking status: a population-based cohort study in the United Kingdom.

PubMed

Braeken, Dionne Cw; Rohde, Gernot Gu; Franssen, Frits Me; Driessen, Johanna Hm; van Staa, Tjeerd P; Souverein, Patrick C; Wouters, Emiel Fm; de Vries, Frank

2017-01-01

Smoking increases the risk of community-acquired pneumonia (CAP) and is associated with the development of COPD. Until now, it is unclear whether CAP in COPD is due to smoking-related effects, or due to COPD pathophysiology itself. To evaluate the association between COPD and CAP by smoking status. In total, 62,621 COPD and 191,654 control subjects, matched by year of birth, gender and primary care practice, were extracted from the Clinical Practice Research Datalink (2005-2014). Incidence rates (IRs) were estimated by dividing the total number of CAP cases by the cumulative person-time at risk. Time-varying Cox proportional hazard models were used to estimate the hazard ratios (HRs) for CAP in COPD patients versus controls. HRs of CAP by smoking status were calculated by stratified analyses in COPD patients versus controls and within both subgroups with never smoking as reference. IRs of CAP in COPD patients (32.00/1,000 person-years) and controls (6.75/1,000 person-years) increased with age and female gender. The risk of CAP in COPD patients was higher than in controls (HR 4.51, 95% CI: 4.27-4.77). Current smoking COPD patients had comparable CAP risk (HR 0.92, 95% CI: 0.82-1.02) as never smoking COPD patients (reference), whereas current smoking controls had a higher risk (HR 1.23, 95% CI: 1.13-1.34) compared to never smoking controls. COPD patients have a fourfold increased risk to develop CAP, independent of smoking status. Identification of factors related with the increased risk of CAP in COPD is warranted, in order to improve the management of patients at risk.

Identification of effective screening strategies for cardiovascular disease prevention in a developing country: using cardiovascular risk-estimation and risk-reduction tools for policy recommendations.

PubMed

Selvarajah, Sharmini; Haniff, Jamaiyah; Kaur, Gurpreet; Guat Hiong, Tee; Bujang, Adam; Chee Cheong, Kee; Bots, Michiel L

2013-02-25

Recent increases in cardiovascular risk-factor prevalences have led to new national policy recommendations of universal screening for primary prevention of cardiovascular disease in Malaysia. This study assessed whether the current national policy recommendation of universal screening was optimal, by comparing the effectiveness and impact of various cardiovascular screening strategies. Data from a national population based survey of 24 270 participants aged 30 to 74 was used. Five screening strategies were modelled for the overall population and by gender; universal and targeted screening (four age cut-off points). Screening strategies were assessed based on the ability to detect high cardiovascular risk populations (effectiveness), incremental effectiveness, impact on cardiovascular event prevention and cost of screening. 26.7% (95% confidence limits 25.7, 27.7) were at high cardiovascular risk, men 34.7% (33.6, 35.8) and women 18.9% (17.8, 20). Universal screening identified all those at high-risk and resulted in one high-risk individual detected for every 3.7 people screened, with an estimated cost of USD60. However, universal screening resulted in screening an additional 7169 persons, with an incremental cost of USD115,033 for detection of one additional high-risk individual in comparison to targeted screening of those aged ≥35 years. The cost, incremental cost and impact of detection of high-risk individuals were more for women than men for all screening strategies. The impact of screening women aged ≥45 years was similar to universal screening in men. Targeted gender- and age-specific screening strategies would ensure more optimal utilisation of scarce resources compared to the current policy recommendations of universal screening.

Identification of effective screening strategies for cardiovascular disease prevention in a developing country: using cardiovascular risk-estimation and risk-reduction tools for policy recommendations

PubMed Central

2013-01-01

Background Recent increases in cardiovascular risk-factor prevalences have led to new national policy recommendations of universal screening for primary prevention of cardiovascular disease in Malaysia. This study assessed whether the current national policy recommendation of universal screening was optimal, by comparing the effectiveness and impact of various cardiovascular screening strategies. Methods Data from a national population based survey of 24 270 participants aged 30 to 74 was used. Five screening strategies were modelled for the overall population and by gender; universal and targeted screening (four age cut-off points). Screening strategies were assessed based on the ability to detect high cardiovascular risk populations (effectiveness), incremental effectiveness, impact on cardiovascular event prevention and cost of screening. Results 26.7% (95% confidence limits 25.7, 27.7) were at high cardiovascular risk, men 34.7% (33.6, 35.8) and women 18.9% (17.8, 20). Universal screening identified all those at high-risk and resulted in one high-risk individual detected for every 3.7 people screened, with an estimated cost of USD60. However, universal screening resulted in screening an additional 7169 persons, with an incremental cost of USD115,033 for detection of one additional high-risk individual in comparison to targeted screening of those aged ≥35 years. The cost, incremental cost and impact of detection of high-risk individuals were more for women than men for all screening strategies. The impact of screening women aged ≥45 years was similar to universal screening in men. Conclusions Targeted gender- and age-specific screening strategies would ensure more optimal utilisation of scarce resources compared to the current policy recommendations of universal screening. PMID:23442728

Excessive Heat and Respiratory Hospitalizations in New York State: Estimating Current and Future Public Health Burden Related to Climate Change

PubMed Central

Hsu, Wan-Hsiang; Van Zutphen, Alissa R.; Saha, Shubhayu; Luber, George; Hwang, Syni-An

2012-01-01

Background: Although many climate-sensitive environmental exposures are related to mortality and morbidity, there is a paucity of estimates of the public health burden attributable to climate change. Objective: We estimated the excess current and future public health impacts related to respiratory hospitalizations attributable to extreme heat in summer in New York State (NYS) overall, its geographic regions, and across different demographic strata. Methods: On the basis of threshold temperature and percent risk changes identified from our study in NYS, we estimated recent and future attributable risks related to extreme heat due to climate change using the global climate model with various climate scenarios. We estimated effects of extreme high apparent temperature in summer on respiratory admissions, days hospitalized, direct hospitalization costs, and lost productivity from days hospitalized after adjusting for inflation. Results: The estimated respiratory disease burden attributable to extreme heat at baseline (1991–2004) in NYS was 100 hospital admissions, US$644,069 in direct hospitalization costs, and 616 days of hospitalization per year. Projections for 2080–2099 based on three different climate scenarios ranged from 206–607 excess hospital admissions, US$26–$76 million in hospitalization costs, and 1,299–3,744 days of hospitalization per year. Estimated impacts varied by geographic region and population demographics. Conclusions: We estimated that excess respiratory admissions in NYS due to excessive heat would be 2 to 6 times higher in 2080–2099 than in 1991–2004. When combined with other heat-associated diseases and mortality, the potential public health burden associated with global warming could be substantial. PMID:22922791

Lung cancer risk from radon in Ontario, Canada: how many lung cancers can we prevent?

PubMed

Peterson, Emily; Aker, Amira; Kim, JinHee; Li, Ye; Brand, Kevin; Copes, Ray

2013-11-01

To calculate the burden of lung cancer illness due to radon for all thirty-six health units in Ontario and determine the number of radon-attributable lung cancer deaths that could be prevented. We calculated the population attributable risk percent, excess life-time risk ratio, life-years lost, the number of lung cancer deaths due to radon, and the number of deaths that could be prevented if all homes above various cut-points were effectively reduced to background levels. It is estimated that 13.6 % (95 % CI 11.0, 16.7) of lung cancer deaths in Ontario are attributable to radon, corresponding to 847 (95 % CI 686, 1,039) lung cancer deaths each year, approximately 84 % of these in ever-smokers. If all homes above 200 Bq/m(3), the current Canadian guideline, were remediated to background levels, it is estimated that 91 lung cancer deaths could be prevented each year, 233 if remediation was performed at 100 Bq/m(3). There was important variation across health units. Radon is an important contributor to lung cancer deaths in Ontario. A large portion of radon-attributable lung cancer deaths are from exposures below the current Canadian guideline, suggesting interventions that install effective radon-preventive measures into buildings at build may be a good alternative population prevention strategy to testing and remediation. For some health units, testing and remediation may also prevent a portion of radon-related lung cancer deaths. Regional attributable risk estimates can help with local public health resource allocation and decision making.

Socioeconomic Impact on the Prevalence of Cardiovascular Risk Factors in Wallonia, Belgium: A Population-Based Study.

PubMed

Streel, Sylvie; Donneau, Anne-Françoise; Hoge, Axelle; Majerus, Sven; Kolh, Philippe; Chapelle, Jean-Paul; Albert, Adelin; Guillaume, Michèle

2015-01-01

Background. Monitoring the epidemiology of cardiovascular risk factors (CRFs) and their determinants is important to develop appropriate recommendations to prevent cardiovascular diseases in specific risk groups. The NESCaV study was designed to collect standardized data to estimate the prevalence of CRFs in relation to socioeconomic parameters among the general adult population in the province of Liège, Wallonia, Belgium. Methods. A representative stratified random sample of 1017 subjects, aged 20-69 years, participated in the NESCaV study (2010-2012). A self-administered questionnaire, a clinical examination, and laboratory tests were performed on participants. CRFs included hypertension, dyslipidemia, global obesity, abdominal obesity, diabetes, current smoking, and physical inactivity. Covariates were education and subjective and objective socioeconomic levels. Data were analyzed by weighted logistic regression. Results. The prevalence of hypertension, abdominal obesity, global obesity, current smoking, and physical inactivity was higher in subjects with low education and who considered themselves "financially in need." Living below poverty threshold also increased the risk of global and abdominal obesity, current smoking, and physical inactivity. Conclusion. The study shows that socioeconomic factors impact the prevalence of CRFs in the adult population of Wallonia. Current public health policies should be adjusted to reduce health inequalities in specific risk groups.

Traffic safety facts : feasibility for an EMS workforce safety and health surveillance system

DOT National Transportation Integrated Search

2007-05-01

Emergency Medical Services (EMS) personnel treat an estimated : 22 million patients a year (Maguire and Walz, 2004). : While on duty, EMS workers frequently encounter two : work-related risks: injury and illness. Current research on : EMS workforce i...

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

NASA Astrophysics Data System (ADS)

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

2012-09-01

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

Risk assessment of the introduction of porcine reproductive and respiratory syndrome virus via boar semen into Switzerland as an example of a PRRSV-free country.

PubMed

Nathues, C; Zimmerli, U; Hauser, R; Nathues, H; Grosse Beilage, E; Schüpbach-Regula, G

2014-12-01

Switzerland is currently porcine reproductive and respiratory syndrome virus (PRRSV) free, but semen imports from PRRSV-infected European countries are increasing. As the virus can be transmitted via semen, for example, when a free boar stud becomes infected, and the risk of its import in terms of PRRSV introduction is unknown, the annual probability to accidentally import the virus into Switzerland was estimated in a risk assessment. A quantitative stochastic model was set up with data comprised by import figures of 2010, interviews with boar stud owners and expert opinion. It resulted in an annual median number of 0.18 imported ejaculates (= imported semen doses from one collection from one donor) from PRRSV-infected boars. Hence, one infected ejaculate would be imported every 6 years and infect a mean of 10 sows. These results suggest that under current circumstances, there is a substantial risk of PRRSV introduction into Switzerland via imported boar semen and that measures to enhance safety of imports should be taken. The time from infection of a previously negative boar stud to its detection had the highest impact on the number of imported 'positive' ejaculates. Therefore, emphasis should be placed on PRRSV monitoring protocols in boar studs. Results indicated that a substantial increase in safety could only be achieved with much tighter sampling protocols than currently performed. Generally, the model could easily be customized for other applications like other countries or regions or even sow farms that want to estimate their risk when purchasing semen from a particular boar stud. © 2013 Blackwell Verlag GmbH.

Radiation Protection Challenges for a Human Mission to Mars

NASA Astrophysics Data System (ADS)

Zeitlin, C. J.; Hassler, D.; Wimmer-Schweingruber, R. F.; Schwadron, N.; Spence, H. E.

2015-12-01

A human mission to Mars presents many challenges, not least of which is the radiation exposure that crew members will certainly receive in all phases of the journey, but most critically during the transits to and from Mars. Measurements from the Radiation Assessment Detector (RAD) aboard the Mars Science Laboratory Curiosity rover, made both in flight and on the surface of Mars, confirm previous estimates that crew members under reasonable shielding would receive a dose equivalent of about 1 Sievert on a 1000-day mission. In standard radiation biology, an acute exposure to 1 Sievert would be expected to increase lifetime fatal cancer risk by about 5%. This is well beyond the currently allowed 3% risk increase limit used by NASA and JAXA. Perhaps more significantly, the nature of exposure in space differs greatly from the terrestrial exposures that lead to the 5% estimate -- in space, the exposure is received at a very low dose rate, and includes a significant component from heavy ions in the Galactic Cosmic Rays (GCRs). Acute exposures to Solar Energetic Particles are also possible, but the generally lower energies of SEPs (kinetic energies typically below 100 MeV/nuc) mean that modest amounts of shielding are effective against them. Thus the greater concern for long-duration deep-space missions is the GCR exposure. In this presentation, I will briefly review the MSL-RAD data and discuss current approaches to radiation risk estimation, including the NASA limit of 3% at the 95% confidence level. Recent results from the NASA radiation biology program indicate that cancer may not be the only risk that needs to be considered, with emerging concerns about cardiovascular and central nervous system health. These health effects are not accounted for in the current methodology and could potentially be threatening to mission success if they manifest in the course of the mission, rather than appearing many years after the exposure as radiation-induced cancer typically does.

Determining the sample size required to establish whether a medical device is non-inferior to an external benchmark.

PubMed

Sayers, Adrian; Crowther, Michael J; Judge, Andrew; Whitehouse, Michael R; Blom, Ashley W

2017-08-28

The use of benchmarks to assess the performance of implants such as those used in arthroplasty surgery is a widespread practice. It provides surgeons, patients and regulatory authorities with the reassurance that implants used are safe and effective. However, it is not currently clear how or how many implants should be statistically compared with a benchmark to assess whether or not that implant is superior, equivalent, non-inferior or inferior to the performance benchmark of interest.We aim to describe the methods and sample size required to conduct a one-sample non-inferiority study of a medical device for the purposes of benchmarking. Simulation study. Simulation study of a national register of medical devices. We simulated data, with and without a non-informative competing risk, to represent an arthroplasty population and describe three methods of analysis (z-test, 1-Kaplan-Meier and competing risks) commonly used in surgical research. We evaluate the performance of each method using power, bias, root-mean-square error, coverage and CI width. 1-Kaplan-Meier provides an unbiased estimate of implant net failure, which can be used to assess if a surgical device is non-inferior to an external benchmark. Small non-inferiority margins require significantly more individuals to be at risk compared with current benchmarking standards. A non-inferiority testing paradigm provides a useful framework for determining if an implant meets the required performance defined by an external benchmark. Current contemporary benchmarking standards have limited power to detect non-inferiority, and substantially larger samples sizes, in excess of 3200 procedures, are required to achieve a power greater than 60%. It is clear when benchmarking implant performance, net failure estimated using 1-KM is preferential to crude failure estimated by competing risk models. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Nitrate in drinking water and colorectal cancer risk: A nationwide population-based cohort study.

PubMed

Schullehner, Jörg; Hansen, Birgitte; Thygesen, Malene; Pedersen, Carsten B; Sigsgaard, Torben

2018-07-01

Nitrate in drinking water may increase risk of colorectal cancer due to endogenous transformation into carcinogenic N-nitroso compounds. Epidemiological studies are few and often challenged by their limited ability of estimating long-term exposure on a detailed individual level. We exploited population-based health register data, linked in time and space with longitudinal drinking water quality data, on an individual level to study the association between long-term drinking water nitrate exposure and colorectal cancer (CRC) risk. Individual nitrate exposure was calculated for 2.7 million adults based on drinking water quality analyses at public waterworks and private wells between 1978 and 2011. For the main analyses, 1.7 million individuals with highest exposure assessment quality were included. Follow-up started at age 35. We identified 5,944 incident CRC cases during 23 million person-years at risk. We used Cox proportional hazards models to estimate hazard ratios (HRs) of nitrate exposure on the risk of CRC, colon and rectal cancer. Persons exposed to the highest level of drinking water nitrate had an HR of 1.16 (95% CI: 1.08-1.25) for CRC compared with persons exposed to the lowest level. We found statistically significant increased risks at drinking water levels above 3.87 mg/L, well below the current drinking water standard of 50 mg/L. Our results add to the existing evidence suggesting increased CRC risk at drinking water nitrate concentrations below the current drinking water standard. A discussion on the adequacy of the drinking water standard in regards to chronic effects is warranted. © 2018 UICC.

Quantification of uncertainty in flood risk assessment for flood protection planning: a Bayesian approach

NASA Astrophysics Data System (ADS)

Dittes, Beatrice; Špačková, Olga; Ebrahimian, Negin; Kaiser, Maria; Rieger, Wolfgang; Disse, Markus; Straub, Daniel

2017-04-01

Flood risk estimates are subject to significant uncertainties, e.g. due to limited records of historic flood events, uncertainty in flood modeling, uncertain impact of climate change or uncertainty in the exposure and loss estimates. In traditional design of flood protection systems, these uncertainties are typically just accounted for implicitly, based on engineering judgment. In the AdaptRisk project, we develop a fully quantitative framework for planning of flood protection systems under current and future uncertainties using quantitative pre-posterior Bayesian decision analysis. In this contribution, we focus on the quantification of the uncertainties and study their relative influence on the flood risk estimate and on the planning of flood protection systems. The following uncertainty components are included using a Bayesian approach: 1) inherent and statistical (i.e. limited record length) uncertainty; 2) climate uncertainty that can be learned from an ensemble of GCM-RCM models; 3) estimates of climate uncertainty components not covered in 2), such as bias correction, incomplete ensemble, local specifics not captured by the GCM-RCM models; 4) uncertainty in the inundation modelling; 5) uncertainty in damage estimation. We also investigate how these uncertainties are possibly reduced in the future when new evidence - such as new climate models, observed extreme events, and socio-economic data - becomes available. Finally, we look into how this new evidence influences the risk assessment and effectivity of flood protection systems. We demonstrate our methodology for a pre-alpine catchment in southern Germany: the Mangfall catchment in Bavaria that includes the city of Rosenheim, which suffered significant losses during the 2013 flood event.

Silicosis among gold miners: exposure--response analyses and risk assessment.

PubMed Central

Steenland, K; Brown, D

1995-01-01

OBJECTIVES. This study sought to estimate the risk of silicosis by cumulative exposure-years in a cohort of miners exposed to silica, as well as the lifetime risk of silicosis under the current Occupational Safety and Health Administration (OSHA) standard (0.09 mg/m3). METHODS. In a cohort study of 3330 gold miners who worked at least 1 year underground from 1940 to 1965 (average 9 years) and were exposed to a median silica level of 0.05 mg/m3 (0.15 mg/m3 for those hired before 1930), 170 cases of silicosis were determined from either death certificates or two cross-sectional radiographic surveys. RESULTS. The risk of silicosis was less than 1% with a cumulative exposure under 0.5 mg/m3-years, increasing to 68% to 84% for the highest cumulative exposure category of more than 4 mg/m3-years. Cumulative exposure was the best predictor of disease, followed by duration of exposure and average exposure. After adjustment for competing risks of death, a 45-year exposure under the current OSHA standard would lead to a lifetime risk of silicosis of 35% to 47%. CONCLUSIONS. Almost 2 million US workers are currently exposed to silica. Our results add to a small but increasing body of literature that suggests that the current OSHA silica exposure level is unacceptably high. PMID:7573620

The burden of cancer at work: estimation as the first step to prevention.

PubMed

Rushton, L; Hutchings, S; Brown, T

2008-12-01

Work-related cancers are largely preventable. The overall aim of this project is to estimate the current burden of cancer in Great Britain attributable to occupational factors, and identify carcinogenic agents, industries and occupations for targeting risk prevention. Attributable fractions and numbers were estimated for mortality and incidence for bladder, lung, non-melanoma skin, and sinonasal cancers, leukaemia and mesothelioma for agents and occupations classified as International Agency for Research on Cancer (IARC) Group 1 and 2A carcinogens with "strong" or "suggestive" evidence for carcinogenicity at the specific cancer site in humans. Risk estimates were obtained from published literature and national data sources used for estimating proportions exposed. In 2004, 78,237 men and 71,666 women died from cancer in Great Britain. Of these, 7317 (4.9%) deaths (men: 6259 (8%); women: 1058 (1.5%)) were estimated to be attributable to work-related carcinogens for the six cancers assessed. Incidence estimates were 13,338 (4.0%) registrations (men: 11,284 (6.7%); women 2054 (1.2%)). Asbestos contributed over half the occupational attributable deaths, followed by silica, diesel engine exhaust, radon, work as a painter, mineral oils in metal workers and in the printing industry, environmental tobacco smoke (non-smokers), work as a welder and dioxins. Occupational exposure to solar radiation, mineral oils and coal tars/pitches contributed 2557, 1867 and 550 skin cancer registrations, respectively. Industries/occupations with large numbers of deaths and/or registrations include construction, metal working, personal and household services, mining (not metals), land transport and services allied to transport, roofing, road repair/construction, printing, farming, the Armed Forces, some other service industry sectors and manufacture of transport equipment, fabricated metal products, machinery, non-ferrous metals and metal products, and chemicals. Estimates for all but leukaemia are greater than those currently used in UK health and safety strategy planning and contrast with small numbers (200-240 annually) from occupational accidents. Sources of uncertainty in the estimates arise principally from approximate data and methodological issues. On balance, the estimates are likely to be a conservative estimate of the true risk. Long latency means that past high exposures will continue to give substantial numbers in the near future. Although levels of many exposures have reduced, recent measurements of others, such as wood dust and respirable quartz, show continuing high levels.

A framework for estimating radiation-related cancer risks in Japan from the 2011 Fukushima nuclear accident.

PubMed

Walsh, L; Zhang, W; Shore, R E; Auvinen, A; Laurier, D; Wakeford, R; Jacob, P; Gent, N; Anspaugh, L R; Schüz, J; Kesminiene, A; van Deventer, E; Tritscher, A; del Rosarion Pérez, M

2014-11-01

We present here a methodology for health risk assessment adopted by the World Health Organization that provides a framework for estimating risks from the Fukushima nuclear accident after the March 11, 2011 Japanese major earthquake and tsunami. Substantial attention has been given to the possible health risks associated with human exposure to radiation from damaged reactors at the Fukushima Daiichi nuclear power station. Cumulative doses were estimated and applied for each post-accident year of life, based on a reference level of exposure during the first year after the earthquake. A lifetime cumulative dose of twice the first year dose was estimated for the primary radionuclide contaminants ((134)Cs and (137)Cs) and are based on Chernobyl data, relative abundances of cesium isotopes, and cleanup efforts. Risks for particularly radiosensitive cancer sites (leukemia, thyroid and breast cancer), as well as the combined risk for all solid cancers were considered. The male and female cumulative risks of cancer incidence attributed to radiation doses from the accident, for those exposed at various ages, were estimated in terms of the lifetime attributable risk (LAR). Calculations of LAR were based on recent Japanese population statistics for cancer incidence and current radiation risk models from the Life Span Study of Japanese A-bomb survivors. Cancer risks over an initial period of 15 years after first exposure were also considered. LAR results were also given as a percentage of the lifetime baseline risk (i.e., the cancer risk in the absence of radiation exposure from the accident). The LAR results were based on either a reference first year dose (10 mGy) or a reference lifetime dose (20 mGy) so that risk assessment may be applied for relocated and non-relocated members of the public, as well as for adult male emergency workers. The results show that the major contribution to LAR from the reference lifetime dose comes from the first year dose. For a dose of 10 mGy in the first year and continuing exposure, the lifetime radiation-related cancer risks based on lifetime dose (which are highest for children under 5 years of age at initial exposure), are small, and much smaller than the lifetime baseline cancer risks. For example, after initial exposure at age 1 year, the lifetime excess radiation risk and baseline risk of all solid cancers in females were estimated to be 0.7 · 10(-2) and 29.0 · 10(-2), respectively. The 15 year risks based on the lifetime reference dose are very small. However, for initial exposure in childhood, the 15 year risks based on the lifetime reference dose are up to 33 and 88% as large as the 15 year baseline risks for leukemia and thyroid cancer, respectively. The results may be scaled to particular dose estimates after consideration of caveats. One caveat is related to the lack of epidemiological evidence defining risks at low doses, because the predicted risks come from cancer risk models fitted to a wide dose range (0-4 Gy), which assume that the solid cancer and leukemia lifetime risks for doses less than about 0.5 Gy and 0.2 Gy, respectively, are proportional to organ/tissue doses: this is unlikely to seriously underestimate risks, but may overestimate risks. This WHO-HRA framework may be used to update the risk estimates, when new population health statistics data, dosimetry information and radiation risk models become available.

Patient-specific radiation dose and cancer risk estimation in CT: Part II. Application to patients

PubMed Central

Li, Xiang; Samei, Ehsan; Segars, W. Paul; Sturgeon, Gregory M.; Colsher, James G.; Toncheva, Greta; Yoshizumi, Terry T.; Frush, Donald P.

2011-01-01

Purpose: Current methods for estimating and reporting radiation dose from CT examinations are largely patient-generic; the body size and hence dose variation from patient to patient is not reflected. Furthermore, the current protocol designs rely on dose as a surrogate for the risk of cancer incidence, neglecting the strong dependence of risk on age and gender. The purpose of this study was to develop a method for estimating patient-specific radiation dose and cancer risk from CT examinations. Methods: The study included two patients (a 5-week-old female patient and a 12-year-old male patient), who underwent 64-slice CT examinations (LightSpeed VCT, GE Healthcare) of the chest, abdomen, and pelvis at our institution in 2006. For each patient, a nonuniform rational B-spine (NURBS) based full-body computer model was created based on the patient’s clinical CT data. Large organs and structures inside the image volume were individually segmented and modeled. Other organs were created by transforming an existing adult male or female full-body computer model (developed from visible human data) to match the framework defined by the segmented organs, referencing the organ volume and anthropometry data in ICRP Publication 89. A Monte Carlo program previously developed and validated for dose simulation on the LightSpeed VCT scanner was used to estimate patient-specific organ dose, from which effective dose and risks of cancer incidence were derived. Patient-specific organ dose and effective dose were compared with patient-generic CT dose quantities in current clinical use: the volume-weighted CT dose index (CTDIvol) and the effective dose derived from the dose-length product (DLP). Results: The effective dose for the CT examination of the newborn patient (5.7 mSv) was higher but comparable to that for the CT examination of the teenager patient (4.9 mSv) due to the size-based clinical CT protocols at our institution, which employ lower scan techniques for smaller patients. However, the overall risk of cancer incidence attributable to the CT examination was much higher for the newborn (2.4 in 1000) than for the teenager (0.7 in 1000). For the two pediatric-aged patients in our study, CTDIvol underestimated dose to large organs in the scan coverage by 30%–48%. The effective dose derived from DLP using published conversion coefficients differed from that calculated using patient-specific organ dose values by −57% to 13%, when the tissue weighting factors of ICRP 60 were used, and by −63% to 28%, when the tissue weighting factors of ICRP 103 were used. Conclusions: It is possible to estimate patient-specific radiation dose and cancer risk from CT examinations by combining a validated Monte Carlo program with patient-specific anatomical models that are derived from the patients’ clinical CT data and supplemented by transformed models of reference adults. With the construction of a large library of patient-specific computer models encompassing patients of all ages and weight percentiles, dose and risk can be estimated for any patient prior to or after a CT examination. Such information may aid in decisions for image utilization and can further guide the design and optimization of CT technologies and scan protocols. PMID:21361209

Patient-specific radiation dose and cancer risk estimation in CT: Part II. Application to patients

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

Li Xiang; Samei, Ehsan; Segars, W. Paul

2011-01-15

Purpose: Current methods for estimating and reporting radiation dose from CT examinations are largely patient-generic; the body size and hence dose variation from patient to patient is not reflected. Furthermore, the current protocol designs rely on dose as a surrogate for the risk of cancer incidence, neglecting the strong dependence of risk on age and gender. The purpose of this study was to develop a method for estimating patient-specific radiation dose and cancer risk from CT examinations. Methods: The study included two patients (a 5-week-old female patient and a 12-year-old male patient), who underwent 64-slice CT examinations (LightSpeed VCT, GEmore » Healthcare) of the chest, abdomen, and pelvis at our institution in 2006. For each patient, a nonuniform rational B-spine (NURBS) based full-body computer model was created based on the patient's clinical CT data. Large organs and structures inside the image volume were individually segmented and modeled. Other organs were created by transforming an existing adult male or female full-body computer model (developed from visible human data) to match the framework defined by the segmented organs, referencing the organ volume and anthropometry data in ICRP Publication 89. A Monte Carlo program previously developed and validated for dose simulation on the LightSpeed VCT scanner was used to estimate patient-specific organ dose, from which effective dose and risks of cancer incidence were derived. Patient-specific organ dose and effective dose were compared with patient-generic CT dose quantities in current clinical use: the volume-weighted CT dose index (CTDI{sub vol}) and the effective dose derived from the dose-length product (DLP). Results: The effective dose for the CT examination of the newborn patient (5.7 mSv) was higher but comparable to that for the CT examination of the teenager patient (4.9 mSv) due to the size-based clinical CT protocols at our institution, which employ lower scan techniques for smaller patients. However, the overall risk of cancer incidence attributable to the CT examination was much higher for the newborn (2.4 in 1000) than for the teenager (0.7 in 1000). For the two pediatric-aged patients in our study, CTDI{sub vol} underestimated dose to large organs in the scan coverage by 30%-48%. The effective dose derived from DLP using published conversion coefficients differed from that calculated using patient-specific organ dose values by -57% to 13%, when the tissue weighting factors of ICRP 60 were used, and by -63% to 28%, when the tissue weighting factors of ICRP 103 were used. Conclusions: It is possible to estimate patient-specific radiation dose and cancer risk from CT examinations by combining a validated Monte Carlo program with patient-specific anatomical models that are derived from the patients' clinical CT data and supplemented by transformed models of reference adults. With the construction of a large library of patient-specific computer models encompassing patients of all ages and weight percentiles, dose and risk can be estimated for any patient prior to or after a CT examination. Such information may aid in decisions for image utilization and can further guide the design and optimization of CT technologies and scan protocols.« less

SELENA - An open-source tool for seismic risk and loss assessment using a logic tree computation procedure

NASA Astrophysics Data System (ADS)

Molina, S.; Lang, D. H.; Lindholm, C. D.

2010-03-01

The era of earthquake risk and loss estimation basically began with the seminal paper on hazard by Allin Cornell in 1968. Following the 1971 San Fernando earthquake, the first studies placed strong emphasis on the prediction of human losses (number of casualties and injured used to estimate the needs in terms of health care and shelters in the immediate aftermath of a strong event). In contrast to these early risk modeling efforts, later studies have focused on the disruption of the serviceability of roads, telecommunications and other important lifeline systems. In the 1990s, the National Institute of Building Sciences (NIBS) developed a tool (HAZUS ®99) for the Federal Emergency Management Agency (FEMA), where the goal was to incorporate the best quantitative methodology in earthquake loss estimates. Herein, the current version of the open-source risk and loss estimation software SELENA v4.1 is presented. While using the spectral displacement-based approach (capacity spectrum method), this fully self-contained tool analytically computes the degree of damage on specific building typologies as well as the associated economic losses and number of casualties. The earthquake ground shaking estimates for SELENA v4.1 can be calculated or provided in three different ways: deterministic, probabilistic or based on near-real-time data. The main distinguishing feature of SELENA compared to other risk estimation software tools is that it is implemented in a 'logic tree' computation scheme which accounts for uncertainties of any input (e.g., scenario earthquake parameters, ground-motion prediction equations, soil models) or inventory data (e.g., building typology, capacity curves and fragility functions). The data used in the analysis is assigned with a decimal weighting factor defining the weight of the respective branch of the logic tree. The weighting of the input parameters accounts for the epistemic and aleatoric uncertainties that will always follow the necessary parameterization of the different types of input data. Like previous SELENA versions, SELENA v4.1 is coded in MATLAB which allows for easy dissemination among the scientific-technical community. Furthermore, any user has access to the source code in order to adapt, improve or refine the tool according to his or her particular needs. The handling of SELENA's current version and the provision of input data is customized for an academic environment but which can then support decision-makers of local, state and regional governmental agencies in estimating possible losses from future earthquakes.

Application of Ecosystem Models to Assess Environmental Drivers of Mosquito Abundance and Virus Transmission Risk and Associated Public Health Implications of Climate and Land Use Change

NASA Astrophysics Data System (ADS)

Melton, F.; Barker, C.; Park, B.; Reisen, W.; Michaelis, A.; Wang, W.; Hashimoto, H.; Milesi, C.; Hiatt, S.; Nemani, R.

2008-12-01

The NASA Terrestrial Observation and Prediction System (TOPS) is a modeling framework that integrates satellite observations, meteorological observations, and ancillary data to support monitoring and modeling of ecosystem and land surface conditions in near real-time. TOPS provides spatially continuous gridded estimates of a suite of measurements describing environmental conditions, and these data products are currently being applied to support the development of new models capable of forecasting estimated mosquito abundance and transmission risk for mosquito-borne diseases such as West Nile virus. We present results from the modeling analyses, describe their incorporation into the California Vectorborne Disease Surveillance System, and describe possible implications of projected climate and land use change for patterns in mosquito abundance and transmission risk for West Nile virus in California.

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.

Shrinkage estimation of effect sizes as an alternative to hypothesis testing followed by estimation in high-dimensional biology: applications to differential gene expression.

PubMed

Montazeri, Zahra; Yanofsky, Corey M; Bickel, David R

2010-01-01

Research on analyzing microarray data has focused on the problem of identifying differentially expressed genes to the neglect of the problem of how to integrate evidence that a gene is differentially expressed with information on the extent of its differential expression. Consequently, researchers currently prioritize genes for further study either on the basis of volcano plots or, more commonly, according to simple estimates of the fold change after filtering the genes with an arbitrary statistical significance threshold. While the subjective and informal nature of the former practice precludes quantification of its reliability, the latter practice is equivalent to using a hard-threshold estimator of the expression ratio that is not known to perform well in terms of mean-squared error, the sum of estimator variance and squared estimator bias. On the basis of two distinct simulation studies and data from different microarray studies, we systematically compared the performance of several estimators representing both current practice and shrinkage. We find that the threshold-based estimators usually perform worse than the maximum-likelihood estimator (MLE) and they often perform far worse as quantified by estimated mean-squared risk. By contrast, the shrinkage estimators tend to perform as well as or better than the MLE and never much worse than the MLE, as expected from what is known about shrinkage. However, a Bayesian measure of performance based on the prior information that few genes are differentially expressed indicates that hard-threshold estimators perform about as well as the local false discovery rate (FDR), the best of the shrinkage estimators studied. Based on the ability of the latter to leverage information across genes, we conclude that the use of the local-FDR estimator of the fold change instead of informal or threshold-based combinations of statistical tests and non-shrinkage estimators can be expected to substantially improve the reliability of gene prioritization at very little risk of doing so less reliably. Since the proposed replacement of post-selection estimates with shrunken estimates applies as well to other types of high-dimensional data, it could also improve the analysis of SNP data from genome-wide association studies.

Low-dose extrapolation of radiation health risks: some implications of uncertainty for radiation protection at low doses.

PubMed

Land, Charles E

2009-11-01

Ionizing radiation is a known and well-quantified human cancer risk factor, based on a remarkably consistent body of information from epidemiological studies of exposed populations. Typical examples of risk estimation include use of Japanese atomic bomb survivor data to estimate future risk from radiation-related cancer among American patients receiving multiple computed tomography scans, persons affected by radioactive fallout, or persons whose livelihoods involve some radiation exposure, such as x-ray technicians, interventional radiologists, or shipyard workers. Our estimates of radiation-related risk are uncertain, reflecting statistical variation and our imperfect understanding of crucial assumptions that must be made if we are to apply existing epidemiological data to particular situations. Fortunately, that uncertainty is also highly quantifiable, and can be presented concisely and transparently. Radiation protection is ultimately a political process that involves consent by stakeholders, a diverse group that includes people who might be expected to be risk-averse and concerned with plausible upper limits on risk (how bad could it be?), cost-averse and concerned with lower limits on risk (can you prove there is a nontrivial risk at current dose levels?), or combining both points of view. How radiation-related risk is viewed by individuals and population subgroups also depends very much on perception of related benefit, which might be (for example) medical, economic, altruistic, or nonexistent. The following presentation follows the lead of National Council on Radiation Protection and Measurements (NCRP) Commentary 14, NCRP Report 126, and later documents in treating radiation protection from the viewpoint of quantitative uncertainty analysis.

Prediction of 30-year risk for cardiovascular mortality by fitness and risk factor levels: the Cooper Center Longitudinal Study.

PubMed

Wickramasinghe, Chanaka D; Ayers, Colby R; Das, Sandeep; de Lemos, James A; Willis, Benjamin L; Berry, Jarett D

2014-07-01

Fitness and traditional risk factors have well-known associations with cardiovascular disease (CVD) death in both short-term (10 years) and across the remaining lifespan. However, currently available short-term and long-term risk prediction tools do not incorporate measured fitness. We included 16 533 participants from the Cooper Center Longitudinal Study (CCLS) without prior CVD. Fitness was measured using the Balke protocol. Sex-specific fitness levels were derived from the Balke treadmill times and categorized into low, intermediate, and high fit according to age- and sex-specific treadmill times. Sex-specific 30-year risk estimates for CVD death adjusted for competing risk of non-CVD death were estimated using the cause-specific hazards model and included age, body mass index, systolic blood pressure, fitness, diabetes mellitus, total cholesterol, and smoking. During a median follow-up period of 28 years, there were 1123 CVD deaths. The 30-year risk estimates for CVD mortality derived from the cause-specific hazards model demonstrated overall good calibration (Nam-D'Agostino χ(2) [men, P=0.286; women, P=0.664] and discrimination (c statistic; men, 0.81 [0.80-0.82] and women, 0.86 [0.82-0.91]). Across all risk factor strata, the presence of low fitness was associated with a greater 30-year risk for CVD death. Fitness represents an important additional covariate in 30-year risk prediction functions that may serve as a useful tool in clinical practice. © 2014 American Heart Association, Inc.

Using base rates and correlational data to supplement clinical risk assessments.

PubMed

Davis, Jaya; Sorensen, Jon R

2013-01-01

The current study is a partial replication of previous studies designed to estimate the level of risk posed by capital murder defendants. The study draws on data describing the behavior of nearly 2,000 incarcerated capital murderers to forecast violence propensity among defendants sentenced to life imprisonment. Logistic regression is used to model various violence outcomes, relying on the following predictors: age, educational attainment, prior imprisonment, and gang affiliation. This exercise is designed to illustrate how actuarial data may be used to anchor individualized clinical assessments of risk in capital murder trials.

Evaluation of dietary intake data using the tolerable upper intake levels.

PubMed

Carriquiry, Alicia L; Camaño-Garcia, Gabriel

2006-02-01

We discuss the problem of assessing nutrient intake relative to the tolerable upper intake levels (UL) for the nutrient proposed by the Institute of Medicine and focus on 2 important topics: the estimation of usual nutrient intake distributions and the extent to which intakes above the UL can be considered risky. With the information that is currently available for most nutrients, it is not possible to estimate the proportion of individuals in a group with intakes that place them at risk. This is because the shape of the dose-response curve needed to carry out a risk assessment is unknown for most nutrients. Thus, intakes above UL cannot be declared to be unsafe. Intakes below the UL, however, are likely to pose no risk to individuals in the group. Because determining the proportion of individuals with intakes below the UL requires estimation of an upper-tail percentile of the intake distribution, the use of 1-d intake data or otherwise unadjusted intake data are likely to lead to severely biased estimates. It is important to remove within-individual variance in intakes from daily intakes so that the tails of the usual intake distribution are accurately estimated. Underreporting of the amount of nutrients consumed will tend to shift the estimated usual nutrient intake distribution downwards. In this case, the true proportion of individuals with intakes below the UL is likely to be overestimated.

Assessing the impact of climate change on vector-borne viruses in the EU through the elicitation of expert opinion.

PubMed

Gale, P; Brouwer, A; Ramnial, V; Kelly, L; Kosmider, R; Fooks, A R; Snary, E L

2010-02-01

Expert opinion was elicited to undertake a qualitative risk assessment to estimate the current and future risks to the European Union (EU) from five vector-borne viruses listed by the World Organization for Animal Health. It was predicted that climate change will increase the risk of incursions of African horse sickness virus (AHSV), Crimean-Congo haemorrhagic fever virus (CCHFV) and Rift Valley fever virus (RVFV) into the EU from other parts of the world, with African swine fever virus (ASFV) and West Nile virus (WNV) being less affected. Currently the predicted risks of incursion were lowest for RVFV and highest for ASFV. Risks of incursion were considered for six routes of entry (namely vectors, livestock, meat products, wildlife, pets and people). Climate change was predicted to increase the risk of incursion from entry of vectors for all five viruses to some degree, the strongest effects being predicted for AHSV, CCHFV and WNV. This work will facilitate identification of appropriate risk management options in relation to adaptations to climate change.

Health Risk Estimation for Unregulated DBPs in Chloraminated Drinking Water

EPA Science Inventory

Disinfection by-products (DBPs) are formed when natural organic matter (NOM) reacts with chemical oxidants in the water disinfection process. Halogenated DBPs are both cytotoxic and genotoxic, which have the potential to cause adverse health effects (1). Currently, 4 species of t...

Impacts of climate change on current methodologies for flood risk analysis: Watershed-scale analyses using the Soil and Water Assessment Tool (SWAT)

NASA Astrophysics Data System (ADS)

Spellman, P.; Griffis, V. W.; LaFond, K.

2013-12-01

A changing climate brings about new challenges for flood risk analysis and water resources planning and management. Current methods for estimating flood risk in the US involve fitting the Pearson Type III (P3) probability distribution to the logarithms of the annual maximum flood (AMF) series using the method of moments. These methods are employed under the premise of stationarity, which assumes that the fitted distribution is time invariant and variables affecting stream flow such as climate do not fluctuate. However, climate change would bring about shifts in meteorological forcings which can alter the summary statistics (mean, variance, skew) of flood series used for P3 parameter estimation, resulting in erroneous flood risk projections. To ascertain the degree to which future risk may be misrepresented by current techniques, we use climate scenarios generated from global climate models (GCMs) as input to a hydrological model to explore how relative changes to current climate affect flood response for watersheds in the northeastern United States. The watersheds were calibrated and run on a daily time step using the continuous, semi-distributed, process based Soil and Water Assessment Tool (SWAT). Nash Sutcliffe Efficiency (NSE), RMSE to Standard Deviation ratio (RSR) and Percent Bias (PBIAS) were all used to assess model performance. Eight climate scenarios were chosen from GCM output based on relative precipitation and temperature changes from the current climate of the watershed and then further bias-corrected. Four of the scenarios were selected to represent warm-wet, warm-dry, cool-wet and cool-dry future climates, and the other four were chosen to represent more extreme, albeit possible, changes in precipitation and temperature. We quantify changes in response by comparing the differences in total mass balance and summary statistics of the logarithms of the AMF series from historical baseline values. We then compare forecasts of flood quantiles from fitting a P3 distribution to the logs of historical AMF data to that of generated AMF series.

Synthesizing Econometric Evidence: The Case of Demand Elasticity Estimates.

PubMed

DeCicca, Philip; Kenkel, Don

2015-06-01

Econometric estimates of the responsiveness of health-related consumer demand to higher prices are often key ingredients for risk policy analysis. We review the potential advantages and challenges of synthesizing econometric evidence on the price-responsiveness of consumer demand. We draw on examples of research on consumer demand for health-related goods, especially cigarettes. We argue that the overarching goal of research synthesis in this context is to provide policy-relevant evidence for broad-brush conclusions. We propose three main criteria to select among research synthesis methods. We discuss how in principle and in current practice synthesis of research on the price-elasticity of smoking meets our proposed criteria. Our analysis of current practice also contributes to academic research on the specific policy question of the effectiveness of higher cigarette prices to reduce smoking. Although we point out challenges and limitations, we believe more work on research synthesis in this area will be productive and important. © 2015 Society for Risk Analysis.

Smoking as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 81 cohorts, including 3,980,359 individuals and 42,401 strokes.

PubMed

Peters, Sanne A E; Huxley, Rachel R; Woodward, Mark

2013-10-01

It is currently unknown whether the excess risk of stroke by smoking is the same for women and men. We performed a systematic review and meta-analysis to estimate the effect of smoking on stroke in women compared with men. PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between January 1, 1966, and January 26, 2013. Studies that presented sex-specific estimates of the relative risk of stroke comparing current smoking with nonsmoking and its associated variability were selected. The sex-specific relative risks and their ratio (RRR), comparing women with men, were pooled using random-effects meta-analysis with inverse variance weighting. Similarly, the RRR for former versus never smoking was pooled. Data from 81 prospective cohort studies that included 3,980,359 individuals and 42,401 strokes were available. Smoking was an independent risk factor for stroke in both sexes. Overall, the pooled multiple-adjusted RRR indicated a similar risk of stroke associated with smoking in women compared with men (RRR, 1.06 [95% confidence interval, 0.99-1.13]). In a regional analysis, there was evidence of a more harmful effect of smoking in women than in men in Western (RRR, 1.10 [1.02-1.18)] but not in Asian (RRR, 0.97 [0.87-1.09]) populations. Compared with never-smokers, the beneficial effects of quitting smoking among former smokers on stroke risk were similar between the sexes (RRR, 1.10 [0.99-1.22]). Compared with nonsmokers, the excess risk of stroke is at least as great among women who smoke compared with men who smoke.

Space Radiation Organ Doses for Astronauts on Past and Future Missions

NASA Technical Reports Server (NTRS)

Cucinotta, Francis A.

2007-01-01

We review methods and data used for determining astronaut organ dose equivalents on past space missions including Apollo, Skylab, Space Shuttle, NASA-Mir, and International Space Station (ISS). Expectations for future lunar missions are also described. Physical measurements of space radiation include the absorbed dose, dose equivalent, and linear energy transfer (LET) spectra, or a related quantity, the lineal energy (y) spectra that is measured by a tissue equivalent proportional counter (TEPC). These data are used in conjunction with space radiation transport models to project organ specific doses used in cancer and other risk projection models. Biodosimetry data from Mir, STS, and ISS missions provide an alternative estimate of organ dose equivalents based on chromosome aberrations. The physical environments inside spacecraft are currently well understood with errors in organ dose projections estimated as less than plus or minus 15%, however understanding the biological risks from space radiation remains a difficult problem because of the many radiation types including protons, heavy ions, and secondary neutrons for which there are no human data to estimate risks. The accuracy of projections of organ dose equivalents described here must be supplemented with research on the health risks of space exposure to properly assess crew safety for exploration missions.

Dietary intake of aflatoxins in the adult Malaysian population - an assessment of risk.

PubMed

Chin, C K; Abdullah, A; Sugita-Konishi, Y

2012-01-01

Exposure to aflatoxins in the adult Malaysian diet was estimated by analysing aflatoxins in 236 food composites prepared as "ready for consumption". Dietary exposure to aflatoxin B1 (AFB1) ranged from 24.3 to 34.00 ng/kg b.w./day (lower to upper bound), with peanuts being the main contributor. Estimated liver cancer risk from this exposure was 0.61-0.85 cancers/100,000 population/year, contributing 12.4%-17.3% of the liver cancer cases. Excluding AFB1 occurrence data higher than 15 µg/kg reduced exposure by 65%-91% to 2.27-11.99 ng/kg b.w./day, reducing the cancer risk to 0.06-0.30 cancers/100,000 population/year (contributing 1.2%-6.1% liver cancer cases). Reducing further the ML of AFB1 from 15 to 5 µg/kg yielded 3%-7% greater drop in the exposure to 0.47-10.26 ng/kg b.w./day with an estimated risk of 0.01-0.26 cancers/100,000 population/year (0.2%-5.1% liver cancer cases attributed to dietary AFB1). These findings indicate that current MLs are adequate in protecting Malaysians' health.

Comparative Probabilistic Assessment of Occupational Pesticide Exposures Based on Regulatory Assessments.

PubMed

Pouzou, Jane G; Cullen, Alison C; Yost, Michael G; Kissel, John C; Fenske, Richard A

2017-11-06

Implementation of probabilistic analyses in exposure assessment can provide valuable insight into the risks of those at the extremes of population distributions, including more vulnerable or sensitive subgroups. Incorporation of these analyses into current regulatory methods for occupational pesticide exposure is enabled by the exposure data sets and associated data currently used in the risk assessment approach of the Environmental Protection Agency (EPA). Monte Carlo simulations were performed on exposure measurements from the Agricultural Handler Exposure Database and the Pesticide Handler Exposure Database along with data from the Exposure Factors Handbook and other sources to calculate exposure rates for three different neurotoxic compounds (azinphos methyl, acetamiprid, emamectin benzoate) across four pesticide-handling scenarios. Probabilistic estimates of doses were compared with the no observable effect levels used in the EPA occupational risk assessments. Some percentage of workers were predicted to exceed the level of concern for all three compounds: 54% for azinphos methyl, 5% for acetamiprid, and 20% for emamectin benzoate. This finding has implications for pesticide risk assessment and offers an alternative procedure that may be more protective of those at the extremes of exposure than the current approach. © 2017 Society for Risk Analysis.

Risk assessment for carcinogens under California's Proposition 65

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

Pease, W.S.; Zeise, L.; Kelter, A.

1990-06-01

Risk assessments for carcinogens are being developed through an accelerated process in California as a part of the state's implementation of Proposition 65, the Safe Drinking Water and Toxic Enforcement Act. Estimates of carcinogenic potency made by the California Department of Health Services (CDHS) are generally similar to estimates made by the U.S. Environmental Protection Agency (EPA). The largest differences are due to EPA's use of the maximum likelihood estimate instead of CDHS' use of the upper 95% confidence bounds on potencies derived from human data and to procedures used to correct for studies of short duration or with earlymore » mortality. Numerical limits derived from these potency estimates constitute no significant risk levels, which govern exemption from Proposition 65's discharge prohibition and warning requirements. Under Proposition 65 regulations, lifetime cancer risks less than 10(-5) are not significant and cumulative intake is not considered. Following these regulations, numerical limits for a number of Proposition 65 carcinogens that are applicable to the control of toxic discharges are less stringent than limits under existing federal water pollution control laws. Thus, existing federal limits will become the Proposition 65 levels for discharge. Chemicals currently not covered by federal and state controls will eventually be subject to discharge limitations under Proposition 65. No significant risk levels (expressed in terms of daily intake of carcinogens) also trigger warning requirements under Proposition 65 that are more extensive than existing state or federal requirements. A variety of chemical exposures from multiple sources are identified that exceed Proposition 65's no significant risk levels.« less

Menstrual Cycle Control in Female Astronauts and the Associated Risk of Venous Thromboembolism

NASA Technical Reports Server (NTRS)

Jain, Varsha; Wotring, Virginia

2015-01-01

Venous thromboembolism (VTE) is a common and serious condition affecting approximately 1-2 per 1000 people in the USA every year. There have been no documented case reports of VTE in female astronauts during spaceflight in the published literature. Some female astronauts use hormonal contraception to control their menstrual cycles and it is currently unknown how this affects their risk of VTE. Current terrestrial risk prediction models do not account for the spaceflight environment and the physiological changes associated with it. We therefore aim to estimate a specific risk score for female astronauts who are taking hormonal contraception for menstrual cycle control, to deduce whether they are at an elevated risk of VTE. A systematic review of the literature was conducted in order to identify and quantify known terrestrial risk factors for VTE. Studies involving analogues for the female astronaut population were also reviewed, for example, military personnel who use the oral contraceptive pill for menstrual suppression. Well known terrestrial risk factors, for example, obesity or smoking would not be applicable to our study population as these candidates would have been excluded during astronaut selection processes. Other risk factors for VTE include hormonal therapy, lower limb paralysis, physical inactivity, hyperhomocysteinemia, low methylfolate levels and minor injuries, all of which potentially apply to crew members LSAH data will be assessed to identify which of these risk factors are applicable to our astronaut population. Using known terrestrial risk data, an overall estimated risk of VTE for female astronauts using menstrual cycle control methods will therefore be calculated. We predict this will be higher than the general population but not significantly higher requiring thromboprophylaxis. This study attempts to delineate what is assumed to be true of our astronaut population, for example, they are known to be a healthy fit cohort of individuals, and combine physiological impacts of spaceflight (cephalic fluid shifts, lower limb inactivity) to understand specific risks associated with hormonal contraception.

Multi-hazard risk analysis related to hurricanes

NASA Astrophysics Data System (ADS)

Lin, Ning

Hurricanes present major hazards to the United States. Associated with extreme winds, heavy rainfall, and storm surge, landfalling hurricanes often cause enormous structural damage to coastal regions. Hurricane damage risk assessment provides the basis for loss mitigation and related policy-making. Current hurricane risk models, however, often oversimplify the complex processes of hurricane damage. This dissertation aims to improve existing hurricane risk assessment methodology by coherently modeling the spatial-temporal processes of storm landfall, hazards, and damage. Numerical modeling technologies are used to investigate the multiplicity of hazards associated with landfalling hurricanes. The application and effectiveness of current weather forecasting technologies to predict hurricane hazards is investigated. In particular, the Weather Research and Forecasting model (WRF), with Geophysical Fluid Dynamics Laboratory (GFDL)'s hurricane initialization scheme, is applied to the simulation of the wind and rainfall environment during hurricane landfall. The WRF model is further coupled with the Advanced Circulation (AD-CIRC) model to simulate storm surge in coastal regions. A case study examines the multiple hazards associated with Hurricane Isabel (2003). Also, a risk assessment methodology is developed to estimate the probability distribution of hurricane storm surge heights along the coast, particularly for data-scarce regions, such as New York City. This methodology makes use of relatively simple models, specifically a statistical/deterministic hurricane model and the Sea, Lake and Overland Surges from Hurricanes (SLOSH) model, to simulate large numbers of synthetic surge events, and conducts statistical analysis. The estimation of hurricane landfall probability and hazards are combined with structural vulnerability models to estimate hurricane damage risk. Wind-induced damage mechanisms are extensively studied. An innovative windborne debris risk model is developed based on the theory of Poisson random measure, substantiated by a large amount of empirical data. An advanced vulnerability assessment methodology is then developed, by integrating this debris risk model and a component-based pressure damage model, to predict storm-specific or annual damage to coastal residential neighborhoods. The uniqueness of this vulnerability model lies in its detailed description of the interaction between wind pressure and windborne debris effects over periods of strong winds, which is a major mechanism leading to structural failures during hurricanes.

Estimating the health consequences of replacing cigarettes with nicotine inhalers

PubMed Central

Sumner, W

2003-01-01

Background: A fast acting, clean nicotine delivery system might substantially displace cigarettes. Public health consequences would depend on the subsequent prevalence of nicotine use, hazards of delivery systems, and intrinsic hazards of nicotine. Methods: A spreadsheet program, DEMANDS, estimates differences in expected mortality, adjusted for nicotine delivery system features and prevalence of nicotine use, by extending the data and methods of the SAMMEC 3 software from the US Centers for Disease Control and Prevention. The user estimates disease risks attributable to nicotine, other smoke components, and risk factors that coexist with smoking. The public health consequences of a widely used clean nicotine inhaler replacing cigarettes were compared to historical observations and public health goals, using four different risk attribution scenarios and nicotine use prevalence from 0–100%. Main outcome measures: Changes in years of potential life before age 85 (YPL85). Results: If nicotine accounts for less than a third of smokers' excess risk of SAMMEC diseases, as it most likely does, then even with very widespread use of clean nicotine DEMANDS predicts public health gains, relative to current tobacco use. Public health benefits accruing from a widely used clean nicotine inhaler probably equal or exceed the benefits of achieving Healthy People 2010 goals. Conclusions: Clean nicotine inhalers might improve public health as much as any feasible tobacco control effort. Although the relevant risk estimates are somewhat uncertain, partial nicotine deregulation deserves consideration as part of a broad tobacco control policy. PMID:12773720

Relative risk for HIV in India - An estimate using conditional auto-regressive models with Bayesian approach.

PubMed

Kandhasamy, Chandrasekaran; Ghosh, Kaushik

2017-02-01

Indian states are currently classified into HIV-risk categories based on the observed prevalence counts, percentage of infected attendees in antenatal clinics, and percentage of infected high-risk individuals. This method, however, does not account for the spatial dependence among the states nor does it provide any measure of statistical uncertainty. We provide an alternative model-based approach to address these issues. Our method uses Poisson log-normal models having various conditional autoregressive structures with neighborhood-based and distance-based weight matrices and incorporates all available covariate information. We use R and WinBugs software to fit these models to the 2011 HIV data. Based on the Deviance Information Criterion, the convolution model using distance-based weight matrix and covariate information on female sex workers, literacy rate and intravenous drug users is found to have the best fit. The relative risk of HIV for the various states is estimated using the best model and the states are then classified into the risk categories based on these estimated values. An HIV risk map of India is constructed based on these results. The choice of the final model suggests that an HIV control strategy which focuses on the female sex workers, intravenous drug users and literacy rate would be most effective. Copyright © 2017 Elsevier Ltd. All rights reserved.

Ten years cardiovascular risk estimation according to Framingham score and non HDL-cholesterol in blood donors.

PubMed

Graffigna, Mabel Nora; Berg, Gabriela; Migliano, Marta; Salgado, Pablo; Soutelo, Jimena; Musso, Carla

2015-01-01

Cardiovascular disease (CVD) is currently the primary cause of morbidity and mortality. (1) Assess the 10 years risk for CVD in Argentinean blood donors, according to Framingham score (updated by ATP III), (2) evaluate the prevalence of the MS, (3) evaluate non HDL-cholesterol level in this population as other risk for CVD. A prospective, epidemiological, transversal study was performed to evaluate 585 volunteer blood donors for two years. Non HDL-C was calculated as total cholesterol minus HDL-C and we evaluated the 10 years risk for CVD according to Framingham score (updated by ATP III). Metabolic syndrome prevalence was estimated according to ATP III and IDF criteria. Non HDL-C was (media±SD) 178.3±48.0 mg/dl in participants with MS and 143.7±39.3 mg/dl without MS (ATPIII) and 160.1±43.6 mg/dl in participants with MS and 139.8±43.1 mg/dl without MS (IDF). Participants with MS presented an OR of 3.1; IC 95% (2-5) of CVD according to de Framingham score. Individuals with MS and elevated non HDL-C are at a higher estimated risk for cardiovascular events in the next 10 years according to the Framingham risk score. Copyright © 2014. Published by Elsevier Ltd.

Comparison of Remote Sensing and Fixed-Site Monitoring Approaches for Examining Air Pollution and Health in a National Study Population

NASA Technical Reports Server (NTRS)

Prud'homme, Genevieve; Dobbin, Nina A.; Sun, Liu; Burnet, Richard T.; Martin, Randall V.; Davidson, Andrew; Cakmak, Sabit; Villeneuve, Paul J.; Lamsal, Lok N.; vanDonkelaar, Aaron;

Applications of Capstone depleted uranium aerosol risk data to military combat risk management.

PubMed

Daxon, Eric G; Parkhurst, Mary Ann; Melanson, Mark A; Roszell, Laurie E

2009-03-01

Risks to personnel engaged in military operations include not only the threat of enemy firepower but also risks from exposure to other hazards such as radiation. Combatant commanders of the U.S. Army carefully weigh risks of casualties before implementing battlefield actions using an established paradigm that takes these risks into consideration. As a result of the inclusion of depleted uranium (DU) anti-armor ammunition in the conventional (non-nuclear) weapons arsenal, the potential for exposure to DU aerosols and its associated chemical and radiological effects becomes an element of the commanders' risk assessment. The Capstone DU Aerosol Study measured the range of likely DU oxide aerosol concentrations created inside a combat vehicle perforated with a DU munition, and the Capstone Human Health Risk Assessment (HHRA) estimated the associated doses and calculated risks. This paper focuses on the development of a scientific approach to adapt the risks from DU's non-uniform dose distribution within the body using the current U.S. Department of Defense radiation risk management approach. The approach developed equates the Radiation Exposure Status categories to the estimated radiological risks of DU and makes use of the Capstone-developed Renal Effects Group as a measure of chemical risk from DU intake. Recommendations are provided for modifying Army guidance and policy in order to better encompass the potential risks from DU aerosol inhalation during military operations.

Risks and costs of end-stage renal disease after heart transplantation.

PubMed

Hornberger, J; Best, J; Geppert, J; McClellan, M

1998-12-27

To estimate the risks and costs of end-stage renal disease (ESRD) after heart transplantation. Previous studies have shown high rates of ESRD among solid-organ transplant patients, but the relevance of these studies for current transplant practices and policies is unclear. Limitations of prior studies include relatively small, single-center samples and estimates made before implementing suggested practice changes to reduce ESRD risk. Medicare beneficiaries who underwent heart transplantation between 1989 and 1994 were eligible for study inclusion (n=2088). Thirty-four patients undergoing dialysis or who had the diagnosis of ESRD before or at transplantation were excluded from the study. ESRD was defined as any patient undergoing renal transplantation or requiring dialysis for more than 3 months. Mortality and ESRD events were recorded up to 1995. ESRD risk was estimated using the Kaplan-Meier product-limit estimator and logistic regression analyses. Linear regression was performed to determine expenditures for treating ESRD, and we developed long-term models of the risk and direct medical costs of ESRD care. The annual risk of ESRD was 0.37% in the first year after transplant and increased to 4.49% by the sixth posttransplant year. There was no significant trend in the risk of ESRD based on the year of transplantation, even after adjusting for patient characteristics. The average cumulative 10-year direct cost of ESRD per patient undergoing heart transplantation exceeded $13,000. In a large, national sample of patients undergoing heart transplantation, ESRD is not rare, even for patients undergoing transplant after the development of new practices intended to reduce its occurrence. ESRD remains an important component of the costs of heart transplantation.

Assessment of risk of peripheral vascular disease and vascular care capacity in low- and middle-income countries.

PubMed

Gyedu, A; Stewart, B T; Nakua, E; Quansah, R; Donkor, P; Mock, C; Hardy, M; Yangni-Angate, K H

2016-01-01

This study aimed to describe national peripheral vascular disease (PVD) risk and health burden, and vascular care capacity in Ghana. The gap between PVD burden and vascular care capacity in low- and middle-income countries was defined, and capacity improvement priorities were identified. Data to estimate PVD risk factor burden were obtained from the World Health Organization Study on Global Ageing and Adult Health (SAGE), Ghana, and the Institute of Health Metrics and Evaluation Global Burden of Disease (IHME GBD) database. In addition, a novel nationwide assessment of vascular care capacity was performed, with 20 vascular care items assessed at 40 hospitals in Ghana. Factors contributing to specific item deficiency were described. From the SAGE database, there were 4305 respondents aged at least 50 years with data to estimate PVD risk. Of these, 57·4 per cent were at moderate to risk high of PVD with at least three risk factors; extrapolating nationally, the estimate was 1 654 557 people. Based on IHME GBD data, the estimated disability-adjusted life-years incurred from PVD increased fivefold from 1990 to 2010 (from 6·3 to 31·7 per 100 000 persons respectively). Vascular care capacity assessment demonstrated marked deficiencies in items for diagnosis, and in perioperative and vascular surgical care. Deficiencies were most often due to absence of equipment, lack of training and technology breakage. Risk factor reduction and management as well as optimization of current resources are paramount to avoid the large burden of PVD falling on healthcare systems in low- and middle-income countries. These countries are not well equipped to handle vascular surgical care, and rapid development of such capacity would be difficult and expensive. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

Emerging infectious disease outbreaks: estimating disease risk in Australian blood donors travelling overseas.

PubMed

Coghlan, A; Hoad, V C; Seed, C R; Flower, R Lp; Harley, R J; Herbert, D; Faddy, H M

2018-01-01

International travel assists spread of infectious pathogens. Australians regularly travel to South-eastern Asia and the isles of the South Pacific, where they may become infected with infectious agents, such as dengue (DENV), chikungunya (CHIKV) and Zika (ZIKV) viruses that pose a potential risk to transfusion safety. In Australia, donors are temporarily restricted from donating for fresh component manufacture following travel to many countries, including those in this study. We aimed to estimate the unmitigated transfusion-transmission (TT) risk from donors travelling internationally to areas affected by emerging infectious diseases. We used the European Up-Front Risk Assessment Tool, with travel and notification data, to estimate the TT risk from donors travelling to areas affected by disease outbreaks: Fiji (DENV), Bali (DENV), Phuket (DENV), Indonesia (CHIKV) and French Polynesia (ZIKV). We predict minimal risk from travel, with the annual unmitigated risk of an infected component being released varying from 1 in 1·43 million to <1 in one billion and the risk of severe consequences ranging from 1 in 130 million to <1 in one billion. The predicted unmitigated likelihood of infection in blood components manufactured from donors travelling to the above-mentioned areas was very low, with the possibility of severe consequences in a transfusion recipient even smaller. Given the increasing demand for plasma products in Australia, the current strategy of restricting donors returning from select infectious disease outbreak areas to source plasma collection provides a simple and effective risk management approach. © 2017 International Society of Blood Transfusion.

Epidemiology, impact and control of bovine cysticercosis in Europe: a systematic review.

PubMed

Laranjo-González, Minerva; Devleesschauwer, Brecht; Gabriël, Sarah; Dorny, Pierre; Allepuz, Alberto

2016-02-10

Bovine cysticercosis in Europe has been known for centuries but the data showing the occurrence of this zoonosis are scarce. The aim of this paper is to review and present the current knowledge on bovine cysticercosis in Europe. We conducted a systematic review of studies published between 1990 and November 2014. Qualitative and quantitative data on prevalence, risk factors, burden and interventions were extracted and analysed. Reports on prevalence were available for 23 European countries, mostly from western and central Europe; for a few of these only data before 1990 were available. Prevalence based on meat inspection was generally low (below 6.2% in 95% of the records) and varied between and within countries. Serology and detailed meat inspection provided a higher prevalence range (0.41-14%). Only few studies analysing risk factors were identified. Reported factors related to access to pastures and risky waters, dairy production and uncontrolled human defecation in the proximity of the farm among others. Only one estimate of the economic impact of the disease could be identified. Recommended interventions were focused on increasing diagnostic tests sensitivity or the application of risk based surveillance strategies. There is a lack of complete and updated data on most countries, especially in eastern Europe. Further risk factor studies might be needed together with estimates on the burden of the disease in all European countries. Risk-based interventions are being encouraged but current data are limited to guide this approach.

Quantitative risk assessment of the introduction of rabies into Japan through the importation of dogs and cats worldwide.

PubMed

Kwan, N C L; Sugiura, K; Hosoi, Y; Yamada, A; Snary, E L

2017-04-01

Japan has been free from rabies since 1958. A strict import regimen has been adopted since 2004 consisting of identification of an animal with microchip, two-time rabies vaccination, neutralizing antibody titration test and a waiting period of 180 days. The present study aims to quantitatively assess the risk of rabies introduction into Japan through the international importation of dogs and cats and hence provide evidence-based recommendations to strengthen the current rabies prevention system. A stochastic scenario tree model was developed and simulations were run using @RISK. The probability of infection in a single dog or cat imported into Japan is estimated to be 2·16 × 10-9 [90% prediction interval (PI) 6·65 × 10-11-6·48 × 10-9]. The number of years until the introduction of a rabies case is estimated to be 49 444 (90% PI 19 170-94 641) years. The current import regimen is effective in maintaining the very low risk of rabies introduction into Japan and responding to future changes including increases in import level and rabies prevalence in the world. However, non-compliance or smuggling activities could substantially increase the risk of rabies introduction. Therefore, policy amendment which could promote compliance is highly recommended. Scenario analysis demonstrated that the waiting period could be reduced to 90 days and the requirement for vaccination could be reduced to a single vaccination, but serological testing should not be stopped.

Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers.

PubMed

Trevena, Lyndal J; Zikmund-Fisher, Brian J; Edwards, Adrian; Gaissmaier, Wolfgang; Galesic, Mirta; Han, Paul K J; King, John; Lawson, Margaret L; Linder, Suzanne K; Lipkus, Isaac; Ozanne, Elissa; Peters, Ellen; Timmermans, Danielle; Woloshin, Steven

2013-01-01

Making evidence-based decisions often requires comparison of two or more options. Research-based evidence may exist which quantifies how likely the outcomes are for each option. Understanding these numeric estimates improves patients' risk perception and leads to better informed decision making. This paper summarises current "best practices" in communication of evidence-based numeric outcomes for developers of patient decision aids (PtDAs) and other health communication tools. An expert consensus group of fourteen researchers from North America, Europe, and Australasia identified eleven main issues in risk communication. Two experts for each issue wrote a "state of the art" summary of best evidence, drawing on the PtDA, health, psychological, and broader scientific literature. In addition, commonly used terms were defined and a set of guiding principles and key messages derived from the results. The eleven key components of risk communication were: 1) Presenting the chance an event will occur; 2) Presenting changes in numeric outcomes; 3) Outcome estimates for test and screening decisions; 4) Numeric estimates in context and with evaluative labels; 5) Conveying uncertainty; 6) Visual formats; 7) Tailoring estimates; 8) Formats for understanding outcomes over time; 9) Narrative methods for conveying the chance of an event; 10) Important skills for understanding numerical estimates; and 11) Interactive web-based formats. Guiding principles from the evidence summaries advise that risk communication formats should reflect the task required of the user, should always define a relevant reference class (i.e., denominator) over time, should aim to use a consistent format throughout documents, should avoid "1 in x" formats and variable denominators, consider the magnitude of numbers used and the possibility of format bias, and should take into account the numeracy and graph literacy of the audience. A substantial and rapidly expanding evidence base exists for risk communication. Developers of tools to facilitate evidence-based decision making should apply these principles to improve the quality of risk communication in practice.

Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers

PubMed Central

2013-01-01

Background Making evidence-based decisions often requires comparison of two or more options. Research-based evidence may exist which quantifies how likely the outcomes are for each option. Understanding these numeric estimates improves patients’ risk perception and leads to better informed decision making. This paper summarises current “best practices” in communication of evidence-based numeric outcomes for developers of patient decision aids (PtDAs) and other health communication tools. Method An expert consensus group of fourteen researchers from North America, Europe, and Australasia identified eleven main issues in risk communication. Two experts for each issue wrote a “state of the art” summary of best evidence, drawing on the PtDA, health, psychological, and broader scientific literature. In addition, commonly used terms were defined and a set of guiding principles and key messages derived from the results. Results The eleven key components of risk communication were: 1) Presenting the chance an event will occur; 2) Presenting changes in numeric outcomes; 3) Outcome estimates for test and screening decisions; 4) Numeric estimates in context and with evaluative labels; 5) Conveying uncertainty; 6) Visual formats; 7) Tailoring estimates; 8) Formats for understanding outcomes over time; 9) Narrative methods for conveying the chance of an event; 10) Important skills for understanding numerical estimates; and 11) Interactive web-based formats. Guiding principles from the evidence summaries advise that risk communication formats should reflect the task required of the user, should always define a relevant reference class (i.e., denominator) over time, should aim to use a consistent format throughout documents, should avoid “1 in x” formats and variable denominators, consider the magnitude of numbers used and the possibility of format bias, and should take into account the numeracy and graph literacy of the audience. Conclusion A substantial and rapidly expanding evidence base exists for risk communication. Developers of tools to facilitate evidence-based decision making should apply these principles to improve the quality of risk communication in practice. PMID:24625237

Conceptus radiation dose and risk from chest screen-film radiography.

PubMed

Damilakis, John; Perisinakis, Kostas; Prassopoulos, Panos; Dimovasili, Evangelia; Varveris, Haralambos; Gourtsoyiannis, Nicholas

2003-02-01

The objectives of the present study were to (a) estimate the conceptus radiation dose and risks for pregnant women undergoing posteroanterior and anteroposterior (AP) chest radiographs, (b) study the conceptus dose as a function of chest thickness of the patient undergoing chest radiograph, and (c) investigate the possibility of a conceptus to receive a dose of more than 10 mGy, the level above which specific measurements of conceptus doses may be necessary. Thermoluminescent dosimeters were used for dose measurements in anthropomorphic phantoms simulating pregnancy at the three trimesters of gestation. The effect of chest thickness on conceptus dose and risk was studied by adding slabs of lucite on the anterior and posterior surface of the phantom chest. The conceptus risk for radiation-induced childhood fatal cancer and hereditary effects was calculated based on appropriate risk factors. The average AP chest dimension (d(a)) was estimated for 51 women of childbearing age from chest CT examinations. The value of d(a) was estimated to be 22.3 cm (17.4-27.2 cm). The calculated maximum conceptus dose was 107 x 10(-3) mGy for AP chest radiographs performed during the third trimester of pregnancy with maternal chest thickness of 27.2 cm. This calculation was based on dose data obtained from measurements in the phantoms and d(a) estimated from the patient group. The corresponding average excess of childhood cancer was 10.7 per million patients. The risk for hereditary effects was 1.1 per million births. Radiation dose for a conceptus increases exponentially as chest thickness increases. The conceptus dose at the third trimester is higher than that of the second and first trimesters. The results of the current study suggest that chest radiographs carried out in women at any time during gestation will result in a negligible increase in risk of radiation-induced harmful effects to the unborn child. After a properly performed maternal chest X-ray, there is no need for individual conceptus dose estimations.

The relationship between modifiable health risks and group-level health care expenditures. Health Enhancement Research Organization (HERO) Research Committee.

PubMed

Anderson, D R; Whitmer, R W; Goetzel, R Z; Ozminkowski, R J; Dunn, R L; Wasserman, J; Serxner, S

2000-01-01

To assess the relationship between modifiable health risks and total health care expenditures for a large employee group. Risk data were collected through voluntary participation in health risk assessment (HRA) and worksite biometric screenings and were linked at the individual level to health care plan enrollment and expenditure data from employers' fee-for-service plans over the 6-year study period. The setting was worksite health promotion programs sponsored by six large private-sector and public-sector employers. Of the 50% of employees who completed the HRA, 46,026 (74.7%) met all inclusion criteria for the analysis. Eleven risk factors (exercise, alcohol use, eating, current and former tobacco use, depression, stress, blood pressure, cholesterol, weight, and blood glucose) were dichotomized into high-risk and lower-risk levels. The association between risks and expenditures was estimated using a two-part regression model, controlling for demographics and other confounders. Risk prevalence data were used to estimate group-level impact of risks on expenditures. Risk factors were associated with 25% of total expenditures. Stress was the most costly factor, with tobacco use, overweight, and lack of exercise also being linked to substantial expenditures. Modifiable risk factors contribute substantially to overall health care expenditures. Health promotion programs that reduce these risks may be beneficial for employers in controlling health care costs.

Lifecourse educational status in relation to weight gain in African American women.

PubMed

Coogan, Patricia E; Wise, Lauren A; Cozier, Yvette C; Palmer, Julie R; Rosenberg, Lynn

2012-01-01

Childhood disadvantage has been associated with increased risk of obesity from childhood through adulthood and those who are disadvantaged across the lifecourse are at highest risk. The effect of lifecourse socioeconomic status (SES) is particularly important for Black women due to the higher prevalence of low SES and obesity in Black compared to White women. We assessed associations of lifecourse SES, as indicated by educational status, with adult weight in African American women. We assessed the associations of parental education, current education (education of participant or her spouse), and a combination of parental and current education (lifecourse education) with weight gain among 21,457 women aged < 55 years in the longitudinal Black Women's Health Study, which began in 1995. We estimated the mean difference in weight gain between age 18 and age in 2009, and risk ratios for obesity in 2009, in each level of education compared to the highest level (college graduate). The age- and height-adjusted differences in mean weight gain for the lowest levels of parental and current education compared to the highest levels were 3.29 and 4.49 kg, respectively. The age-adjusted risk ratios for obesity for the lowest level of parental and current education were 1.44 (95% CI 1.32-1.57) and 1.75 (95% CI 1.57-1.95), respectively. Risk of obesity was lowest among those with current education of college graduate, regardless of parental education. Educational level of college graduate may overcome the adverse effects of low parental education on weight gain and obesity risk.

Assessing habitat risk from human activities to inform coastal and marine spatial planning: a demonstration in Belize

NASA Astrophysics Data System (ADS)

Arkema, Katie K.; Verutes, Gregory; Bernhardt, Joanna R.; Clarke, Chantalle; Rosado, Samir; Canto, Maritza; Wood, Spencer A.; Ruckelshaus, Mary; Rosenthal, Amy; McField, Melanie; de Zegher, Joann

2014-11-01

Integrated coastal and ocean management requires transparent and accessible approaches for understanding the influence of human activities on marine environments. Here we introduce a model for assessing the combined risk to habitats from multiple ocean uses. We apply the model to coral reefs, mangrove forests and seagrass beds in Belize to inform the design of the country’s first Integrated Coastal Zone Management (ICZM) Plan. Based on extensive stakeholder engagement, review of existing legislation and data collected from diverse sources, we map the current distribution of coastal and ocean activities and develop three scenarios for zoning these activities in the future. We then estimate ecosystem risk under the current and three future scenarios. Current levels of risk vary spatially among the nine coastal planning regions in Belize. Empirical tests of the model are strong—three-quarters of the measured data for coral reef health lie within the 95% confidence interval of interpolated model data and 79% of the predicted mangrove occurrences are associated with observed responses. The future scenario that harmonizes conservation and development goals results in a 20% reduction in the area of high-risk habitat compared to the current scenario, while increasing the extent of several ocean uses. Our results are a component of the ICZM Plan for Belize that will undergo review by the national legislature in 2015. This application of our model to marine spatial planning in Belize illustrates an approach that can be used broadly by coastal and ocean planners to assess risk to habitats under current and future management scenarios.

Bias of health estimates obtained from chronic disease and risk factor surveillance systems using telephone population surveys in Australia: results from a representative face-to-face survey in Australia from 2010 to 2013.

PubMed

Dal Grande, Eleonora; Chittleborough, Catherine R; Campostrini, Stefano; Taylor, Anne W

2016-04-18

Emerging communication technologies have had an impact on population-based telephone surveys worldwide. Our objective was to examine the potential biases of health estimates in South Australia, a state of Australia, obtained via current landline telephone survey methodologies and to report on the impact of mobile-only household on household surveys. Data from an annual multi-stage, systematic, clustered area, face-to-face population survey, Health Omnibus Survey (approximately 3000 interviews annually), included questions about telephone ownership to assess the population that were non-contactable by current telephone sampling methods (2006 to 2013). Univariable analyses (2010 to 2013) and trend analyses were conducted for sociodemographic and health indicator variables in relation to telephone status. Relative coverage biases (RCB) of two hypothetical telephone samples was undertaken by examining the prevalence estimates of health status and health risk behaviours (2010 to 2013): directory-listed numbers, consisting mainly of landline telephone numbers and a small proportion of mobile telephone numbers; and a random digit dialling (RDD) sample of landline telephone numbers which excludes mobile-only households. Telephone (landline and mobile) coverage in South Australia is very high (97%). Mobile telephone ownership increased slightly (7.4%), rising from 89.7% in 2006 to 96.3% in 2013; mobile-only households increased by 431% over the eight year period from 5.2% in 2006 to 27.6% in 2013. Only half of the households have either a mobile or landline number listed in the telephone directory. There were small differences in the prevalence estimates for current asthma, arthritis, diabetes and obesity between the hypothetical telephone samples and the overall sample. However, prevalence estimate for diabetes was slightly underestimated (RCB value of -0.077) in 2013. Mixed RCB results were found for having a mental health condition for both telephone samples. Current smoking prevalence was lower for both hypothetical telephone samples in absolute differences and RCB values: -0.136 to -0.191 for RDD landline samples and -0.129 to -0.313 for directory-listed samples. These findings suggest landline-based sampling frames used in Australia, when appropriately weighted, produce reliable representative estimates for some health indicators but not for all. Researchers need to be aware of their limitations and potential biased estimates.

A screening-level modeling approach to estimate nitrogen ...

EPA Pesticide Factsheets

This paper presents a screening-level modeling approach that can be used to rapidly estimate nutrient loading and assess numerical nutrient standard exceedance risk of surface waters leading to potential classification as impaired for designated use. It can also be used to explore best management practice (BMP) implementation to reduce loading. The modeling framework uses a hybrid statistical and process based approach to estimate source of pollutants, their transport and decay in the terrestrial and aquatic parts of watersheds. The framework is developed in the ArcGIS environment and is based on the total maximum daily load (TMDL) balance model. Nitrogen (N) is currently addressed in the framework, referred to as WQM-TMDL-N. Loading for each catchment includes non-point sources (NPS) and point sources (PS). NPS loading is estimated using export coefficient or event mean concentration methods depending on the temporal scales, i.e., annual or daily. Loading from atmospheric deposition is also included. The probability of a nutrient load to exceed a target load is evaluated using probabilistic risk assessment, by including the uncertainty associated with export coefficients of various land uses. The computed risk data can be visualized as spatial maps which show the load exceedance probability for all stream segments. In an application of this modeling approach to the Tippecanoe River watershed in Indiana, USA, total nitrogen (TN) loading and risk of standard exce

Cancer risk assessment of polycyclic aromatic hydrocarbon contaminated soils determined using bioassay-derived levels of benzo[a]pyrene equivalents.

PubMed

Lemieux, Christine L; Long, Alexandra S; Lambert, Iain B; Lundstedt, Staffan; Tysklind, Mats; White, Paul A

2015-02-03

Here we evaluate the excess lifetime cancer risk (ELCR) posed by 10 PAH-contaminated soils using (i) the currently advocated, targeted chemical-specific approach that assumes dose additivity for carcinogenic PAHs and (ii) a bioassay-based approach that employs the in vitro mutagenic activity of the soil fractions to determine levels of benzo[a]pyrene equivalents and, by extension, ELCR. Mutagenic activity results are presented in our companion paper.1 The results show that ELCR values for the PAH-containing fractions, determined using the chemical-specific approach, are generally (i.e., 8 out of 10) greater than those calculated using the bioassay-based approach; most are less than 5-fold greater. Only two chemical-specific ELCR estimates are less than their corresponding bioassay-derived values; differences are less than 10%. The bioassay-based approach, which permits estimation of ELCR without a priori knowledge of mixture composition, proved to be a useful tool to evaluate the chemical-specific approach. The results suggest that ELCR estimates for complex PAH mixtures determined using a targeted, chemical-specific approach are reasonable, albeit conservative. Calculated risk estimates still depend on contentious PEFs and cancer slope factors. Follow-up in vivo mutagenicity assessments will be required to validate the results and their relevance for human health risk assessment of PAH-contaminated soils.

Potential distribution of dengue fever under scenarios of climate change and economic development.

PubMed

Aström, Christofer; Rocklöv, Joacim; Hales, Simon; Béguin, Andreas; Louis, Valerie; Sauerborn, Rainer

2012-12-01

Dengue fever is the most important viral vector-borne disease with ~50 million cases per year globally. Previous estimates of the potential effect of global climate change on the distribution of vector-borne disease have not incorporated the effect of socioeconomic factors, which may have biased the results. We describe an empirical model of the current geographic distribution of dengue, based on the independent effects of climate and gross domestic product per capita (GDPpc, a proxy for socioeconomic development). We use the model, along with scenario-based projections of future climate, economic development, and population, to estimate populations at risk of dengue in the year 2050. We find that both climate and GDPpc influence the distribution of dengue. If the global climate changes as projected but GDPpc remained constant, the population at risk of dengue is estimated to increase by about 0.28 billion in 2050. However, if both climate and GDPpc change as projected, we estimate a decrease of 0.12 billion in the population at risk of dengue in 2050. Empirically, the geographic distribution of dengue is strongly dependent on both climatic and socioeconomic variables. Under a scenario of constant GDPpc, global climate change results in a modest but important increase in the global population at risk of dengue. Under scenarios of high GDPpc, this adverse effect of climate change is counteracted by the beneficial effect of socioeconomic development.

Lung cancer risk by polycyclic aromatic hydrocarbons in a Mediterranean industrialized area.

PubMed

Cuadras, Anna; Rovira, Enric; Marcé, Rosa Maria; Borrull, Francesc

2016-11-01

This study focuses on characterizing the chronic risk assessment from inhalation of polycyclic aromatic hydrocarbons (PAHs) for people living near the largest chemical complex in the Mediterranean area. Eighteen PAHs were determined in the atmospheric gas and particle phases, counting PM 10 and total suspended particles. The lifetime lung cancer risk from PAH exposure was estimated, and the contribution was assessed by phases. The results obtained with the continuous lifetime scenario were compared with those obtained with different chronic scenarios. The estimated chronic risk was also compared with those reported in previous studies. PAHs were present at higher concentration in the gas phase (>84 %) with a major contribution of the most volatile PAHs, and an equitable distribution of heavy PAHs between gas and particle phases was observed. Petroleum combustion and traffic emissions were suggested as the main sources, but the influence of petrogenic sources cannot be ruled out. The estimated average lifetime lung cancer risk in this study ranged between 3.2 × 10 -5 and 4.3 × 10 -5 . The gas phase accounted for the most significant contribution to the total risk (>60 %). Fluoranthene (FluT), dibenzo(a,h)anthracene (DahA) and benzo(a)pyrene (BaP), as a whole, made the greatest contribution to the total risk (>80 %). BaP-bound PM 10 accounted for a small contribution of the total risk (10 %). Chronic exposures lower than total lifetime hours could even pose a risk >10 -5 . The results also showed that BaP-bound PM 10 , according to current legislation, may not be a good indicator of the real risk by PAH exposure. Concerning previous studies, the economic situation may have an impact on reducing the cancer risk by PAH inhalation.

Epidemiology of inflammatory bowel disease among participants of the Millennium Cohort: incidence, deployment-related risk factors, and antecedent episodes of infectious gastroenteritis.

PubMed

Porter, C K; Welsh, M; Riddle, M S; Nieh, C; Boyko, E J; Gackstetter, G; Hooper, T I

2017-04-01

Crohn's disease (CD) and ulcerative colitis (UC) are two pathotypes of inflammatory bowel disease (IBD) with unique pathology, risk factors and significant morbidity. To estimate incidence and identify IBD risk factors in a US military population, a healthy subset of the US population, using information from the Millennium Cohort Study. Incident IBD was identified from medical encounters from 2001 to 2009 or by self-report. Our primary risk factor of interest, infectious gastroenteritis, was identified from medical encounters and self-reported post-deployment health assessments. Other potential risk factors were assessed using self-reported survey responses and military personnel files. Hazard ratios were estimated using Cox proportional hazards analysis. We estimated 23.2 and 21.9 diagnoses per 100 000 person-years, respectively, for CD and UC. For CD, significant risk factors included [adjusted hazard ratio (aHR), 95% confidence interval]: current smoking (aHR: 2.7, 1.4-5.1), two life stressors (aHR: 2.8, 1.4-5.6) and prior irritable bowel syndrome (aHR: 4.7, 1.5-15.2). There was no significant association with prior infectious gastroenteritis. There was an apparent dose-response relationship between UC risk and an increasing number of life stressors. In addition, antecedent infectious gastroenteritis was associated with almost a three-fold increase in UC risk (aHR: 2.9, 1.4-6.0). Moderate alcohol consumption (aHR: 0.4, 0.2-0.6) was associated with lower UC risk. Stressful conditions and the high risk of infectious gastroenteritis in deployment operations may play a role in the development of IBD in military populations. However, observed differences in risk factors for UC and CD warrant further investigation. © 2017 John Wiley & Sons Ltd.

Understanding cancer development processes after HZE-particle exposure: roles of ROS, DNA damage repair and inflammation.

PubMed

Sridharan, D M; Asaithamby, A; Bailey, S M; Costes, S V; Doetsch, P W; Dynan, W S; Kronenberg, A; Rithidech, K N; Saha, J; Snijders, A M; Werner, E; Wiese, C; Cucinotta, F A; Pluth, J M

2015-01-01

During space travel astronauts are exposed to a variety of radiations, including galactic cosmic rays composed of high-energy protons and high-energy charged (HZE) nuclei, and solar particle events containing low- to medium-energy protons. Risks from these exposures include carcinogenesis, central nervous system damage and degenerative tissue effects. Currently, career radiation limits are based on estimates of fatal cancer risks calculated using a model that incorporates human epidemiological data from exposed populations, estimates of relative biological effectiveness and dose-response data from relevant mammalian experimental models. A major goal of space radiation risk assessment is to link mechanistic data from biological studies at NASA Space Radiation Laboratory and other particle accelerators with risk models. Early phenotypes of HZE exposure, such as the induction of reactive oxygen species, DNA damage signaling and inflammation, are sensitive to HZE damage complexity. This review summarizes our current understanding of critical areas within the DNA damage and oxidative stress arena and provides insight into their mechanistic interdependence and their usefulness in accurately modeling cancer and other risks in astronauts exposed to space radiation. Our ultimate goals are to examine potential links and crosstalk between early response modules activated by charged particle exposure, to identify critical areas that require further research and to use these data to reduced uncertainties in modeling cancer risk for astronauts. A clearer understanding of the links between early mechanistic aspects of high-LET response and later surrogate cancer end points could reveal key nodes that can be therapeutically targeted to mitigate the health effects from charged particle exposures.

Bayesian algorithm implementation in a real time exposure assessment model on benzene with calculation of associated cancer risks.

PubMed

Sarigiannis, Dimosthenis A; Karakitsios, Spyros P; Gotti, Alberto; Papaloukas, Costas L; Kassomenos, Pavlos A; Pilidis, Georgios A

2009-01-01

The objective of the current study was the development of a reliable modeling platform to calculate in real time the personal exposure and the associated health risk for filling station employees evaluating current environmental parameters (traffic, meteorological and amount of fuel traded) determined by the appropriate sensor network. A set of Artificial Neural Networks (ANNs) was developed to predict benzene exposure pattern for the filling station employees. Furthermore, a Physiology Based Pharmaco-Kinetic (PBPK) risk assessment model was developed in order to calculate the lifetime probability distribution of leukemia to the employees, fed by data obtained by the ANN model. Bayesian algorithm was involved in crucial points of both model sub compartments. The application was evaluated in two filling stations (one urban and one rural). Among several algorithms available for the development of the ANN exposure model, Bayesian regularization provided the best results and seemed to be a promising technique for prediction of the exposure pattern of that occupational population group. On assessing the estimated leukemia risk under the scope of providing a distribution curve based on the exposure levels and the different susceptibility of the population, the Bayesian algorithm was a prerequisite of the Monte Carlo approach, which is integrated in the PBPK-based risk model. In conclusion, the modeling system described herein is capable of exploiting the information collected by the environmental sensors in order to estimate in real time the personal exposure and the resulting health risk for employees of gasoline filling stations.

Bayesian Algorithm Implementation in a Real Time Exposure Assessment Model on Benzene with Calculation of Associated Cancer Risks

PubMed Central

Sarigiannis, Dimosthenis A.; Karakitsios, Spyros P.; Gotti, Alberto; Papaloukas, Costas L.; Kassomenos, Pavlos A.; Pilidis, Georgios A.

2009-01-01

The objective of the current study was the development of a reliable modeling platform to calculate in real time the personal exposure and the associated health risk for filling station employees evaluating current environmental parameters (traffic, meteorological and amount of fuel traded) determined by the appropriate sensor network. A set of Artificial Neural Networks (ANNs) was developed to predict benzene exposure pattern for the filling station employees. Furthermore, a Physiology Based Pharmaco-Kinetic (PBPK) risk assessment model was developed in order to calculate the lifetime probability distribution of leukemia to the employees, fed by data obtained by the ANN model. Bayesian algorithm was involved in crucial points of both model sub compartments. The application was evaluated in two filling stations (one urban and one rural). Among several algorithms available for the development of the ANN exposure model, Bayesian regularization provided the best results and seemed to be a promising technique for prediction of the exposure pattern of that occupational population group. On assessing the estimated leukemia risk under the scope of providing a distribution curve based on the exposure levels and the different susceptibility of the population, the Bayesian algorithm was a prerequisite of the Monte Carlo approach, which is integrated in the PBPK-based risk model. In conclusion, the modeling system described herein is capable of exploiting the information collected by the environmental sensors in order to estimate in real time the personal exposure and the resulting health risk for employees of gasoline filling stations. PMID:22399936

Integrating risk assessment and life cycle assessment: a case study of insulation.

PubMed

Nishioka, Yurika; Levy, Jonathan I; Norris, Gregory A; Wilson, Andrew; Hofstetter, Patrick; Spengler, John D

2002-10-01

Increasing residential insulation can decrease energy consumption and provide public health benefits, given changes in emissions from fuel combustion, but also has cost implications and ancillary risks and benefits. Risk assessment or life cycle assessment can be used to calculate the net impacts and determine whether more stringent energy codes or other conservation policies would be warranted, but few analyses have combined the critical elements of both methodologies In this article, we present the first portion of a combined analysis, with the goal of estimating the net public health impacts of increasing residential insulation for new housing from current practice to the latest International Energy Conservation Code (IECC 2000). We model state-by-state residential energy savings and evaluate particulate matter less than 2.5 microm in diameter (PM2.5), NOx, and SO2 emission reductions. We use past dispersion modeling results to estimate reductions in exposure, and we apply concentration-response functions for premature mortality and selected morbidity outcomes using current epidemiological knowledge of effects of PM2.5 (primary and secondary). We find that an insulation policy shift would save 3 x 10(14) British thermal units or BTU (3 x 10(17) J) over a 10-year period, resulting in reduced emissions of 1,000 tons of PM2.5, 30,000 tons of NOx, and 40,000 tons of SO2. These emission reductions yield an estimated 60 fewer fatalities during this period, with the geographic distribution of health benefits differing from the distribution of energy savings because of differences in energy sources, population patterns, and meteorology. We discuss the methodology to be used to integrate life cycle calculations, which can ultimately yield estimates that can be compared with costs to determine the influence of external costs on benefit-cost calculations.

Documentary evidence of past floods in Europe and their utility in flood frequency estimation

NASA Astrophysics Data System (ADS)

Kjeldsen, T. R.; Macdonald, N.; Lang, M.; Mediero, L.; Albuquerque, T.; Bogdanowicz, E.; Brázdil, R.; Castellarin, A.; David, V.; Fleig, A.; Gül, G. O.; Kriauciuniene, J.; Kohnová, S.; Merz, B.; Nicholson, O.; Roald, L. A.; Salinas, J. L.; Sarauskiene, D.; Šraj, M.; Strupczewski, W.; Szolgay, J.; Toumazis, A.; Vanneuville, W.; Veijalainen, N.; Wilson, D.

2014-09-01

This review outlines the use of documentary evidence of historical flood events in contemporary flood frequency estimation in European countries. The study shows that despite widespread consensus in the scientific literature on the utility of documentary evidence, the actual migration from academic to practical application has been limited. A detailed review of flood frequency estimation guidelines from different countries showed that the value of historical data is generally recognised, but practical methods for systematic and routine inclusion of this type of data into risk analysis are in most cases not available. Studies of historical events were identified in most countries, and good examples of national databases attempting to collate the available information were identified. The conclusion is that there is considerable potential for improving the reliability of the current flood risk assessments by harvesting the valuable information on past extreme events contained in the historical data sets.

Constructing event trees for volcanic crises

USGS Publications Warehouse

Newhall, C.; Hoblitt, R.

2002-01-01

Event trees are useful frameworks for discussing probabilities of possible outcomes of volcanic unrest. Each branch of the tree leads from a necessary prior event to a more specific outcome, e.g., from an eruption to a pyroclastic flow. Where volcanic processes are poorly understood, probability estimates might be purely empirical - utilizing observations of past and current activity and an assumption that the future will mimic the past or follow a present trend. If processes are better understood, probabilities might be estimated from a theoritical model, either subjectively or by numerical simulations. Use of Bayes' theorem aids in the estimation of how fresh unrest raises (or lowers) the probabilities of eruptions. Use of event trees during volcanic crises can help volcanologists to critically review their analysis of hazard, and help officials and individuals to compare volcanic risks with more familiar risks. Trees also emphasize the inherently probabilistic nature of volcano forecasts, with multiple possible outcomes.

Life-time risk of mortality due to different levels of alcohol consumption in seven European countries: implications for low-risk drinking guidelines.

PubMed

Shield, Kevin D; Gmel, Gerrit; Gmel, Gerhard; Mäkelä, Pia; Probst, Charlotte; Room, Robin; Rehm, Jürgen

2017-09-01

Low-risk alcohol drinking guidelines require a scientific basis that extends beyond individual or group judgements of risk. Life-time mortality risks, judged against established thresholds for acceptable risk, may provide such a basis for guidelines. Therefore, the aim of this study was to estimate alcohol mortality risks for seven European countries based on different average daily alcohol consumption amounts. The maximum acceptable voluntary premature mortality risk was determined to be one in 1000, with sensitivity analyses of one in 100. Life-time mortality risks for different alcohol consumption levels were estimated by combining disease-specific relative risk and mortality data for seven European countries with different drinking patterns (Estonia, Finland, Germany, Hungary, Ireland, Italy and Poland). Alcohol consumption data were obtained from the Global Information System on Alcohol and Health, relative risk data from meta-analyses and mortality information from the World Health Organization. The variation in the life-time mortality risk at drinking levels relevant for setting guidelines was less than that observed at high drinking levels. In Europe, the percentage of adults consuming above a risk threshold of one in 1000 ranged from 20.6 to 32.9% for women and from 35.4 to 54.0% for men. Life-time risk of premature mortality under current guideline maximums ranged from 2.5 to 44.8 deaths per 1000 women in Finland and Estonia, respectively, and from 2.9 to 35.8 deaths per 1000 men in Finland and Estonia, respectively. If based upon an acceptable risk of one in 1000, guideline maximums for Europe should be 8-10 g/day for women and 15-20 g/day for men. If low-risk alcohol guidelines were based on an acceptable risk of one in 1000 premature deaths, then maximums for Europe should be 8-10 g/day for women and 15-20 g/day for men, and some of the current European guidelines would require downward revision. © 2017 Society for the Study of Addiction.

Decision-making in an era of cancer prevention via aspirin: New Zealand needs updated guidelines and risk calculators.

PubMed

Wilson, Nick; Selak, Vanessa; Blakely, Tony; Leung, William; Clarke, Philip; Jackson, Rod; Knight, Josh; Nghiem, Nhung

2016-03-11

Based on new systematic reviews of the evidence, the US Preventive Services Task Force has drafted updated guidelines on the use of low-dose aspirin for the primary prevention of both cardiovascular disease (CVD) and cancer. The Task Force generally recommends consideration of aspirin in adults aged 50-69 years with 10-year CVD risk of at least 10%, in who absolute health gain (reduction of CVD and cancer) is estimated to exceed absolute health loss (increase in bleeds). With the ongoing decline in CVD, current risk calculators for New Zealand are probably outdated, so it is difficult to be precise about what proportion of the population is in this risk category (roughly equivalent to 5-year CVD risk ≥5%). Nevertheless, we suspect that most smokers aged 50-69 years, and some non-smokers, would probably meet the new threshold for taking low-dose aspirin. The country therefore needs updated guidelines and risk calculators that are ideally informed by estimates of absolute net health gain (in quality-adjusted life-years (QALYs) per person) and cost-effectiveness. Other improvements to risk calculators include: epidemiological rigour (eg, by addressing competing mortality); providing enhanced graphical display of risk to enhance risk communication; and possibly capturing the issues of medication disutility and comparison with lifestyle changes.

High Risk of Graft Failure in Emerging Adult Heart Transplant Recipients.

PubMed

Foster, B J; Dahhou, M; Zhang, X; Dharnidharka, V; Ng, V; Conway, J

2015-12-01

Emerging adulthood (17-24 years) is a period of high risk for graft failure in kidney transplant. Whether a similar association exists in heart transplant recipients is unknown. We sought to estimate the relative hazards of graft failure at different current ages, compared with patients between 20 and 24 years old. We evaluated 11 473 patients recorded in the Scientific Registry of Transplant Recipients who received a first transplant at <40 years old (1988-2013) and had at least 6 months of graft function. Time-dependent Cox models were used to estimate the association between current age (time-dependent) and failure risk, adjusted for time since transplant and other potential confounders. Failure was defined as death following graft failure or retransplant; observation was censored at death with graft function. There were 2567 failures. Crude age-specific graft failure rates were highest in 21-24 year olds (4.2 per 100 person-years). Compared to individuals with the same time since transplant, 21-24 year olds had significantly higher failure rates than all other age periods except 17-20 years (HR 0.92 [95%CI 0.77, 1.09]) and 25-29 years (0.86 [0.73, 1.03]). Among young first heart transplant recipients, graft failure risks are highest in the period from 17 to 29 years of age. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

An end-to-end assessment of extreme weather impacts on food security

NASA Astrophysics Data System (ADS)

Chavez, Erik; Conway, Gordon; Ghil, Michael; Sadler, Marc

2015-11-01

Both governments and the private sector urgently require better estimates of the likely incidence of extreme weather events, their impacts on food crop production and the potential consequent social and economic losses. Current assessments of climate change impacts on agriculture mostly focus on average crop yield vulnerability to climate and adaptation scenarios. Also, although new-generation climate models have improved and there has been an exponential increase in available data, the uncertainties in their projections over years and decades, and at regional and local scale, have not decreased. We need to understand and quantify the non-stationary, annual and decadal climate impacts using simple and communicable risk metrics that will help public and private stakeholders manage the hazards to food security. Here we present an `end-to-end’ methodological construct based on weather indices and machine learning that integrates current understanding of the various interacting systems of climate, crops and the economy to determine short- to long-term risk estimates of crop production loss, in different climate and adaptation scenarios. For provinces north and south of the Yangtze River in China, we have found that risk profiles for crop yields that translate climate into economic variability follow marked regional patterns, shaped by drivers of continental-scale climate. We conclude that to be cost-effective, region-specific policies have to be tailored to optimally combine different categories of risk management instruments.

Estimated Effects of Future Atmospheric CO2 Concentrations on Protein Intake and the Risk of Protein Deficiency by Country and Region

PubMed Central

Schwartz, Joel; Myers, Samuel S.

2017-01-01

Background: Crops grown under elevated atmospheric CO2 concentrations (eCO2) contain less protein. Crops particularly affected include rice and wheat, which are primary sources of dietary protein for many countries. Objectives: We aimed to estimate global and country-specific risks of protein deficiency attributable to anthropogenic CO2 emissions by 2050. Methods: To model per capita protein intake in countries around the world under eCO2, we first established the effect size of eCO2 on the protein concentration of edible portions of crops by performing a meta-analysis of published literature. We then estimated per-country protein intake under current and anticipated future eCO2 using global food balance sheets (FBS). We modeled protein intake distributions within countries using Gini coefficients, and we estimated those at risk of deficiency from estimated average protein requirements (EAR) weighted by population age structure. Results: Under eCO2, rice, wheat, barley, and potato protein contents decreased by 7.6%, 7.8%, 14.1%, and 6.4%, respectively. Consequently, 18 countries may lose >5% of their dietary protein, including India (5.3%). By 2050, assuming today’s diets and levels of income inequality, an additional 1.6% or 148.4 million of the world’s population may be placed at risk of protein deficiency because of eCO2. In India, an additional 53 million people may become at risk. Conclusions: Anthropogenic CO2 emissions threaten the adequacy of protein intake worldwide. Elevated atmospheric CO2 may widen the disparity in protein intake within countries, with plant-based diets being the most vulnerable. https://doi.org/10.1289/EHP41 PMID:28885977

Individual survival curves comparing subjective and observed mortality risks.

PubMed

Bissonnette, Luc; Hurd, Michael D; Michaud, Pierre-Carl

2017-12-01

We compare individual survival curves constructed from objective (actual mortality) and elicited subjective information (probability of survival to a given target age). We develop a methodology to estimate jointly subjective and objective individual survival curves accounting for rounding on subjective reports of perceived survival. We make use of the long follow-up period in the Health and Retirement Study and the high quality of mortality data to estimate individual survival curves that feature both observed and unobserved heterogeneity. This allows us to compare objective and subjective estimates of remaining life expectancy for various groups and compare welfare effects of objective and subjective mortality risk using the life cycle model of consumption. We find that subjective and objective hazards are not the same. The median welfare loss from misperceptions of mortality risk when annuities are not available is 7% of current wealth at age 65 whereas more than 25% of respondents have losses larger than 60% of wealth. When annuities are available and exogenously given, the welfare loss is substantially lower. Copyright © 2017 John Wiley & Sons, Ltd.

Adolescent health and subsequent risk of self-harm hospitalisation: a 15-year follow-up of the Young-HUNT cohort.

PubMed

Junker, Asbjørn; Bjørngaard, Johan Håkon; Bjerkeset, Ottar

2017-01-01

Self-harm is associated with increased suicide risk, and constitutes a major challenge in adolescent mental healthcare. In the current study, we examined the association between different aspects of adolescent health and risk of later self-harm requiring hospital admission. We linked baseline information from 13 to 19 year old participants (n = 8965) in the Norwegian Young-HUNT 1 study to patient records of self-harm hospitalisation during 15 years of follow-up. We used Cox regression to estimate risk factor hazard ratios (HR). Eighty-nine persons (71% female) were admitted to hospital because of self-harm. Intoxication/self-poisoning was the most frequent method (81%). Both mental (anxiety/depression, loneliness, being bullied) and somatic (epilepsy, migraine) health issues were associated with up to fourfold increased risk of self-harm-related hospital admission. Several health issues during adolescence markedly increased the risk of later self-harm hospitalisation. Current findings should be incorporated in the strive to reduce self-harming and attempted suicides among young people.

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

Thrall, K.D.

The purpose of this project was to demonstrate the ``Exposure-to- Risk`` monitoring system in an actual occupational environment. The system is a unique combination of existing hardware with proprietary software to create an integrated means of assessing occupational exposures to volatile organic compounds. One component of this system utilizes a portable mass spectrometer developed by Teledyne Electronic Technologies. Integration of the system was accomplished under Laboratory Directed Research and Development (LDRD) funding. Commercialization of the system will take place following demonstration in an actual occupational environment, and will include, in part, Teledyne Electronic Technologies. The Exposure-to-Risk monitoring system will benefitmore » DOE by overcoming present-day limitations in worker health protection monitoring. There are numerous sites within the` DOE complex where many different hazardous chemicals are used on a routine basis. These chemicals range from paint stripers and cleaning solvents to chemical warfare agents, each having its own degree of potential adverse health risk to a worker. Thus, a real concern for DOE is to ensure that a worker is properly monitored to assess any adverse health risk from exposure to potentially hazardous chemicals. With current industrial hygiene technologies, this is an arduous task. The Exposure-to-Risk monitoring system integrates a patented breath-inlet device connecting a subject`s exhaled breath directly with a field-portable mass spectrometer with physiologically based pharmacokinetic (PBPK) modeling to estimate the target tissue dose following a chemical exposure. Estimation of the adverse health risk prediction follows from the exposure/dose calculation based on currently accepted methodologies. This new system can determine, in the field, the possible adverse health risks on a daily basis to an individual worker.« less

Inflammatory Bowel Disease and the Risk of Autoimmune Diseases.

PubMed

Wilson, J Claire; Furlano, Raoul I; Jick, Susan S; Meier, Christoph R

2016-02-01

An increased risk of autoimmune disease has been reported in patients with inflammatory bowel disease [IBD]. Using data from the Clinical Practice Research Datalink [CPRD], this study set out to further examine this relationship. Patients with a first-time IBD diagnosis were randomly matched to an equal-sized IBD-free comparison group. Incidence rates for new-onset autoimmune diseases were estimated. A nested case-control analysis comprising IBD patients was conducted, using conditional logistic regression to assess whether IBD severity, duration, or treatment influences the risk of developing autoimmune diseases. During follow-up, 1069 IBD and 585 IBD-free patients developed an incident autoimmune disease. An increased incidence of autoimmune disease was observed in IBD patients (incidence rate [IR] 9.65, 95% confidence interval [CI] 9.09-10.24) compared with the non-IBD comparison group [IR 5.22, 95% CI 4.82-5.66]. In IBD patients, increased disease severity was associated with an increased risk of autoimmune disease development (odds ratio [OR] 1.62, 95% CI 1.28-2.05). Current antibiotic use was also associated with an increased risk [adjusted OR 1.72, 95% CI 1.07-2.78]. A reduced risk of incident autoimmune diseases was observed for current long-term users of aminosalicylates [adjusted OR 0.72, 95% CI 0.57-0.91]. Individuals with IBD had an increased risk of developing an autoimmune disease. Increased disease severity and current antibiotic use were associated with an increased relative risk of developing additional autoimmune diseases in IBD patients. Long-term current aminosalicylate use was associated with a reduced risk. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Betel-quid and alcohol use were associated with lipid accumulation product among male factory workers in Taiwan.

PubMed

Huang, Chih-Fang; Chen, Chao-Tung; Wang, Pei-Ming; Koo, Malcolm

2015-05-01

In this study, cardiometabolic risk associated with betel-quid, alcohol and cigarette use, based on a simple index-lipid accumulation product (LAP), was investigated in Taiwanese male factory workers. Male factory workers were recruited during their annual routine health examination at a hospital in south Taiwan. The risk of cardiometabolic disorders was estimated by the use of LAP, calculated as (waist circumference [cm]-65)×(triglyceride concentration [mmol/l]). Multiple linear regression analyses were conducted to assess the risk factors of natural logarithm-transformed LAP. Of the 815 participants, 40% (325/815) were current alcohol users, 30% (248/815) were current smokers and 7% (53/815) were current betel-quid users. Current betel-quid use, alcohol use, older age, lack of exercise and higher body mass index were found to be significant and independent factors associated with natural logarithm-transformed LAP. Betel-quid and alcohol, but not cigarette use, were independent risk factors of logarithm-transformed LAP, adjusting for age, exercise and body mass index in male Taiwanese factory workers. LAP can be considered as a simple and useful method for screening of cardiometabolic risk. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Comparison of remote sensing and fixed-site monitoring approaches for examining air pollution and health in a national study population

NASA Astrophysics Data System (ADS)

Prud'homme, Genevieve; Dobbin, Nina A.; Sun, Liu; Burnett, Richard T.; Martin, Randall V.; Davidson, Andrew; Cakmak, Sabit; Villeneuve, Paul J.; Lamsal, Lok N.; van Donkelaar, Aaron; Peters, Paul A.; Johnson, Markey

2013-12-01

Satellite remote sensing (RS) has emerged as a cutting edge approach for estimating ground level ambient air pollution. Previous studies have reported a high correlation between ground level PM2.5 and NO2 estimated by RS and measurements collected at regulatory monitoring sites. The current study examined associations between air pollution and adverse respiratory and allergic health outcomes using multi-year averages of NO2 and PM2.5 from RS and from regulatory monitoring. RS estimates were derived using satellite measurements from OMI, MODIS, and MISR instruments. Regulatory monitoring data were obtained from Canada's National Air Pollution Surveillance Network. Self-reported prevalence of doctor-diagnosed asthma, current asthma, allergies, and chronic bronchitis were obtained from the Canadian Community Health Survey (a national sample of individuals 12 years of age and older). Multi-year ambient pollutant averages were assigned to each study participant based on their six digit postal code at the time of health survey, and were used as a marker for long-term exposure to air pollution. RS derived estimates of NO2 and PM2.5 were associated with 6-10% increases in respiratory and allergic health outcomes per interquartile range (3.97 μg m-3 for PM2.5 and 1.03 ppb for NO2) among adults (aged 20-64) in the national study population. Risk estimates for air pollution and respiratory/allergic health outcomes based on RS were similar to risk estimates based on regulatory monitoring for areas where regulatory monitoring data were available (within 40 km of a regulatory monitoring station). RS derived estimates of air pollution were also associated with adverse health outcomes among participants residing outside the catchment area of the regulatory monitoring network (p < 0.05). The consistency between risk estimates based on RS and regulatory monitoring as well as the associations between air pollution and health among participants living outside the catchment area for regulatory monitoring suggest that RS can provide useful estimates of long-term ambient air pollution in epidemiologic studies. This is particularly important in rural communities and other areas where monitoring and modeled air pollution data are limited or unavailable.

Estimate of potential benefit for Europe of fitting Autonomous Emergency Braking (AEB) systems for pedestrian protection to passenger cars.

PubMed

Edwards, Mervyn; Nathanson, Andrew; Wisch, Marcus

2014-01-01

The objective of the current study was to estimate the benefit for Europe of fitting precrash braking systems to cars that detect pedestrians and autonomously brake the car to prevent or lower the speed of the impact with the pedestrian. The analysis was divided into 2 main parts: (1) Develop and apply methodology to estimate benefit for Great Britain and Germany; (2) scale Great Britain and German results to give an indicative estimate for Europe (EU27). The calculation methodology developed to estimate the benefit was based on 2 main steps: 1. Calculate the change in the impact speed distribution curve for pedestrian casualties hit by the fronts of cars assuming pedestrian autonomous emergency braking (AEB) system fitment. 2. From this, calculate the change in the number of fatally, seriously, and slightly injured casualties by using the relationship between risk of injury and the casualty impact speed distribution to sum the resulting risks for each individual casualty. The methodology was applied to Great Britain and German data for 3 types of pedestrian AEB systems representative of (1) currently available systems; (2) future systems with improved performance, which are expected to be available in the next 2-3 years; and (3) reference limit system, which has the best performance currently thought to be technically feasible. Nominal benefits estimated for Great Britain ranged from £119 million to £385 million annually and for Germany from €63 million to €216 million annually depending on the type of AEB system assumed fitted. Sensitivity calculations showed that the benefit estimated could vary from about half to twice the nominal estimate, depending on factors such as whether or not the system would function at night and the road friction assumed. Based on scaling of estimates made for Great Britain and Germany, the nominal benefit of implementing pedestrian AEB systems on all cars in Europe was estimated to range from about €1 billion per year for current generation AEB systems to about €3.5 billion for a reference limit system (i.e., best performance thought technically feasible at present). Dividing these values by the number of new passenger cars registered in Europe per year gives an indication that the cost of a system per car should be less than ∼€80 to ∼€280 for it to be cost effective. The potential benefit of fitting AEB systems to cars in Europe for pedestrian protection has been estimated and the results interpreted to indicate the upper limit of cost for a system to allow it to be cost effective.

The effect of recent trends in vehicle design on U.S. societal fatality risk per vehicle mile traveled, and their projected future relationship with vehicle mass.

PubMed

Wenzel, Tom

2013-07-01

The National Highway Traffic Safety Administration (NHTSA) recently updated its 2003 and 2010 logistic regression analyses of the effect of a reduction in light-duty vehicle mass on US fatality risk per vehicle mile traveled (VMT). The current NHTSA analysis is the most thorough investigation of this issue to date. LBNL's assessment of the analysis indicates that the estimated effect of mass reduction on risk is smaller than in the previous studies, and statistically non-significant for all but the lightest cars. The effects three recent trends in vehicle designs and technologies have on societal fatality risk per VMT are estimated, and whether these changes might affect the relationship between vehicle mass and fatality risk in the future. Side airbags are found to reduce fatality risk in cars, but not necessarily light trucks or CUVs/minivans, struck in the side by another light-duty vehicle; reducing the number of fatalities in cars struck in the side is predicted to reduce the estimated detrimental effect of footprint reduction, but increase the detrimental effect of mass reduction, in cars on societal fatality risk. Better alignment of light truck bumpers with those of other vehicles appears to result in a statistically significant reduction in risk imposed on car occupants; however, reducing this type of fatality will likely have little impact on the estimated effect of mass or footprint reduction on risk. Finally, shifting light truck drivers into safer, car-based vehicles, such as sedans, CUVs, and minivans, would result in larger reductions in societal fatalities than expected from even substantial reductions in the masses of light trucks. A strategy of shifting drivers from truck-based to car-based vehicles would reduce fuel use and greenhouse gas emissions, while improving societal safety. Copyright © 2013 Elsevier Ltd. All rights reserved.

Spatio-temporal distribution of soil-transmitted helminth infections in Brazil.

PubMed

Chammartin, Frédérique; Guimarães, Luiz H; Scholte, Ronaldo Gc; Bavia, Mara E; Utzinger, Jürg; Vounatsou, Penelope

2014-09-18

In Brazil, preventive chemotherapy targeting soil-transmitted helminthiasis is being scaled-up. Hence, spatially explicit estimates of infection risks providing information about the current situation are needed to guide interventions. Available high-resolution national model-based estimates either rely on analyses of data restricted to a given period of time, or on historical data collected over a longer period. While efforts have been made to take into account the spatial structure of the data in the modelling approach, little emphasis has been placed on the temporal dimension. We extracted georeferenced survey data on the prevalence of infection with soil-transmitted helminths (i.e. Ascaris lumbricoides, hookworm and Trichuris trichiura) in Brazil from the Global Neglected Tropical Diseases (GNTD) database. Selection of the most important predictors of infection risk was carried out using a Bayesian geostatistical approach and temporal models that address non-linearity and correlation of the explanatory variables. The spatial process was estimated through a predictive process approximation. Spatio-temporal models were built on the selected predictors with integrated nested Laplace approximation using stochastic partial differential equations. Our models revealed that, over the past 20 years, the risk of soil-transmitted helminth infection has decreased in Brazil, mainly because of the reduction of A. lumbricoides and hookworm infections. From 2010 onwards, we estimate that the infection prevalences with A. lumbricoides, hookworm and T. trichiura are 3.6%, 1.7% and 1.4%, respectively. We also provide a map highlighting municipalities in need of preventive chemotherapy, based on a predicted soil-transmitted helminth infection risk in excess of 20%. The need for treatments in the school-aged population at the municipality level was estimated at 1.8 million doses of anthelminthic tablets per year. The analysis of the spatio-temporal aspect of the risk of infection with soil-transmitted helminths contributes to a better understanding of the evolution of risk over time. Risk estimates provide the soil-transmitted helminthiasis control programme in Brazil with useful benchmark information for prioritising and improving spatial and temporal targeting of interventions.

Current Status of Chemical Public Health Risks and Testing Guidelines for Chemical Cardiovascular Safety Assessments

EPA Science Inventory

The cardiovascular system, at all its various developmental and life stages, represents a critical target organ system that can be adversely affected by a variety of chemicals and routes of exposure. A World Health Organization report estimated the impact of environmental chemica...

Measuring the Benefits of Clean Air and Water.

ERIC Educational Resources Information Center

Kneese, Allen V.

This book examines the current state of the art regarding benefits assessment, including such tools as bidding games, surveys, property-value studies, wage differentials, risk reduction evaluation, and mortality and morbidity cost estimation. It is based on research, sponsored by the United States Environmental Protection Agency, related to the…

Risk estimation and decision-making: implications of the 1980 BEIR-III report

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

Fabrikant, J.I.

1981-04-01

The report gives a general background of the implications the current Report of the Committee on the Biological Effects of Ionizing Radiation (The BEIR-III Report) may have on societal decision-making in the regulation of activities concerned with the health effects of low-level radiation. (ACR)

Assessing U.S. sodium intake through dietary data and urine biomarkers

USDA-ARS?s Scientific Manuscript database

Sodium intake is directly related to blood pressure, a primary risk factor for heart disease and stroke. Reducing intake is estimated to save billions in U.S. health care dollars annually. Current public health recommendations and efforts targeting sodium reductions make accurate monitoring of pop...

DEVELOPMENT OF A REFINED DATABASE OF MAMMALIAN RELATIVE POTENCY ESTIMATES FOR DIOXIN-LIKE COMPOUNDS

EPA Science Inventory

The toxic equivalency factor (TEF) approach has been widely accepted as the most feasible method available at present for evaluating potential health risks associated with exposure to mixtures of dioxin-like compounds (DLCs). The current mammalian TEFs for the DLCs were establis...

Doses and risks from the ingestion of Dounreay fuel fragments.

PubMed

Darley, P J; Charles, M W; Fell, T P; Harrison, J D

2003-01-01

The radiological implications of ingestion of nuclear fuel fragments present in the marine environment around Dounreay have been reassessed by using the Monte Carlo code MCNP to obtain improved estimates of the doses to target cells in the walls of the lower large intestine resulting from the passage of a fragment. The approach takes account of the reduction in dose due to attenuation within the intestinal wall and self-absorption of radiation in the fuel fragment itself. In addition, dose is calculated on the basis of a realistic estimate of the anatomical volume of the lumen, rather than being based on the average mass of the contents, as in the current ICRP model. Our best estimates of doses from the ingestion of the largest Dounreay particles are at least a factor of 30 lower than those predicted using the current ICRP model. The new ICRP model will address the issues raised here and provide improved estimates of dose.

The pediatric sepsis biomarker risk model: potential implications for sepsis therapy and biology.

PubMed

Alder, Matthew N; Lindsell, Christopher J; Wong, Hector R

2014-07-01

Sepsis remains a major cause of morbidity and mortality in adult and pediatric intensive care units. Heterogeneity of demographics, comorbidities, biological mechanisms, and severity of illness leads to difficulty in determining which patients are at highest risk of mortality. Determining mortality risk is important for weighing the potential benefits of more aggressive interventions and for deciding whom to enroll in clinical trials. Biomarkers can be used to parse patients into different risk categories and can outperform current methods of patient risk stratification based on physiologic parameters. Here we review the Pediatric Sepsis Biomarker Risk Model that has also been modified and applied to estimate mortality risk in adult patients. We compare the two models and speculate on the biological implications of the biomarkers in patients with sepsis.

Understanding Impact and Implications of Data Standards on Post Disaster Risk Analysis

NASA Astrophysics Data System (ADS)

Stevenson, Robert

2010-05-01

Although the physical and humanitarian effects of a natural catastrophe are often bound to the locality of the event the financial impacts can have global effects. This is particularly prominent in the re/insurance community, where through a number of market mechanisms and re/insurance structures financial loss is mitigated amongst many companies across the globe. The level of risk a company wishes to retain, given an event, represents the level of risk decision makers deem acceptable. Catastrophe risk modelling tools aid the estimation of risk retention and transfer mechanisms, and increasingly the level of capital required to withstand a catastrophic event. These tools rely on appropriate representations hazard, exposure, vulnerability and insurance conditions that reflect the reality of risk. In addition, accurate estimation of loss potential in the aftermath of a catastrophic event equally relies on the data available to assess the scale of damages experienced and to provide views on the likely scale of loss. A coherent and focussed data and modelling strategy is required to ensure that the risk assessment made is as accurate as possible. A fundamental factor in determining the accuracy of catastrophe output, is the quality of data entered. It is of vital importance, therefore, to have an understanding of both the data used as well as the standard of this data, which will so powerfully impact upon the decision making process. This is perhaps best illustrated through the study of historical events, such as Hurricane Katrina and Ike. The extent of data variance in post disaster analysis clearly demonstrates issues of data discrepancies, vintage, resolution and uncertainty propagation, and reflects on the standard of the original data utilized for modelling purposes and decision making. Using experience gained from recent events, this paper will explore current data variabilities, and the impacts on effective loss estimation, both in relation to reinsurance structuring, but also in terms of effective post-event analysis. It will provide views on how data is currently applied in this context, and will make suggestions as to the most important areas for future data improvements.

Coloring of the past via respondent's current psychological state, mediation, and the association between childhood disadvantage and morbidity in adulthood.

PubMed

Sheikh, Mashhood Ahmed

2018-05-31

Many researchers view retrospective reports with skepticism. Indeed, the observed association between retrospectively-reported childhood disadvantage (CD) and morbidity in adulthood has been criticized as an artefactual correlation driven by the psychological state of the respondent at the time of reporting (current psychological state). The aim of this study was to assess the role of current psychological state in the association between childhood disadvantage and morbidity in adulthood. The present analysis used cross-sectional data collected in 2007-2008 within the framework of the Tromsø Study (N = 10,765), a representative study of adult men and women in Norway. The association between CD and the physical health outcomes heart attack, angina pectoris, chronic bronchitis/emphysema/COPD, diabetes mellitus, hypothyroid/low metabolism, migraine, hypertension, and comorbidity (i.e., the sum of these physical health outcomes) was assessed with Poisson regression models. Relative risks (RR) and 95% confidence intervals (CI) were estimated. A wide range of indicators of respondents' current psychological state were included in the models to assess the % attenuation in estimates. CD was associated with an increased risk of heart attack, angina pectoris, chronic bronchitis/emphysema/COPD, diabetes mellitus, hypothyroid/low metabolism, migraine, hypertension, and comorbidity (p < 0.05), independent of respondents' current psychological state. A sizeable proportion (23-42%) of the association between CD and physical health outcomes was driven by recall bias or mediation via respondents' current psychological state. Controlling for indicators of current psychological state reduced the strength of associations between CD and physical health outcomes; however, the independent associations remained in the same direction. The association between retrospectively-reported CD and physical health outcomes in adulthood is not driven entirely by respondent's current psychological state. Copyright © 2018 Elsevier Ltd. All rights reserved.

Modelling the effect on injuries and fatalities when changing mode of transport from car to bicycle.

PubMed

Nilsson, Philip; Stigson, Helena; Ohlin, Maria; Strandroth, Johan

2017-03-01

Several studies have estimated the health effects of active commuting, where a transport mode shift from car to bicycle reduces risk of mortality and morbidity. Previous studies mainly assess the negative aspects of bicycling by referring to fatalities or police reported injuries. However, most bicycle crashes are not reported by the police and therefore hospital reported data would cover a much higher rate of injuries from bicycle crashes. The aim of the present study was to estimate the effect on injuries and fatalities from traffic crashes when shifting mode of transport from car to bicycle by using hospital reported data. This present study models the change in number of injuries and fatalities due to a transport mode change using a given flow change from car to bicycle and current injury and fatality risk per distance for bicyclists and car occupants. show that bicyclists have a much higher injury risk (29 times) and fatality risk (10 times) than car occupants. In a scenario where car occupants in Stockholm living close to their work place shifts transport mode to bicycling, injuries, fatalities and health loss expressed in Disability-Adjusted Life Years (DALY) were estimated to increase. The vast majority of the estimated DALY increase was caused by severe injuries and fatalities and it tends to fluctuate so that the number of severe crashes may exceed the estimation with a large margin. Although the estimated increase of traffic crashes and DALY, a transport mode shift is seen as a way towards a more sustainable society. Thus, this present study highlights the need of strategic preventive measures in order to minimize the negative impacts from increased bicycling. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cancer incidence attributable to inadequate physical activity in Alberta in 2012

PubMed Central

Brenner, Darren R.; Poirier, Abbey E.; Grundy, Anne; Khandwala, Farah; McFadden, Alison; Friedenreich, Christine M.

2017-01-01

Background: Physical inactivity has been consistently associated with increased risk of colorectal, endometrial, breast (in postmenopausal women), prostate, lung and ovarian cancers. The objective of the current analysis was to estimate the proportion and absolute number of site-specific cancer cases attributable to inadequate physical activity in Alberta in 2012. Methods: We used population attributable risks to estimate the proportion of each site-specific cancer attributable to inactivity. Relative risk estimates were obtained from the epidemiological literature, and prevalence estimates were calculated with the use of data from the Canadian Community Health Survey cycle 2.1 (2003). Respondents who acquired 1.5-2.9 kcal/kg per day and less than 1.5 kcal/kg per day of physical activity were classified as moderately active and inactive, respectively, and both levels were considered inadequate for mitigating cancer risks. We obtained age-, sex- and site-specific cancer incidence data from the Alberta Cancer Registry for 2012. Results: About 59%-75% of men and 69%-78% of women did not engage in adequate physical activity. Overall, 13.8% of cancers across all associated cancers were estimated to be attributable to inadequate physical activity, representing 7.2% of all cancers diagnosed in Alberta in 2012. Suboptimal levels of physical activity had a greater impact among women: the proportion of all associated cancers attributable to inadequate physical activity was 18.3% for women and 9.9% for men. Interpretation: A substantial proportion of cancer cases diagnosed in Alberta were estimated to be attributable to inadequate physical activity. With the high prevalence of physical inactivity among adults in the province, developing strategies to increase physical activity levels could have a notable impact on reducing future cancer burden in Alberta. PMID:28468830

Estimated numbers of men and women infected with HIV/AIDS in Tijuana, Mexico.

PubMed

Brouwer, Kimberly C; Strathdee, Steffanie A; Magis-Rodríguez, Carlos; Bravo-García, Enrique; Gayet, Cecilia; Patterson, Thomas L; Bertozzi, Stefano M; Hogg, Robert S

2006-03-01

Tijuana, Mexico, just south of San Diego, California, is located by the busiest land border crossing in the world. Although UNAIDS considers Mexico to be a country of "low prevalence, high risk," recent surveillance data among sentinel populations in Tijuana suggests HIV prevalence is increasing. The aim of this study was to estimate the number of men and women aged 15 to 49 years infected with HIV in Tijuana. Gender and age-specific estimates of the Tijuana population were obtained from the 2000 Mexican census. Population and HIV prevalence estimates for at-risk groups were obtained from published reports, community based studies, and data from the Centro Nacional para la Prevención y Control del VIH/SIDA (CENSIDA). Age-specific fertility rates for Mexico were used to derive the number of low and high-risk pregnant women. Numbers of HIV-positive men and women were estimated for each at-risk group and then aggregated. A high growth scenario based on current HIV prevalence and a conservative, low growth estimate were determined. A total of 686,600 men and women in Tijuana were aged 15 to 49 years at the time of the 2000 census. Considering both scenarios, the number of infected persons ranged from 1,803 to 5,472 (HIV prevalence: 0.26 to 0.80%). The majority of these persons were men (>70%). The largest number of infected persons were MSM (N = 1,146 to 3,300) and IDUs (N = 147 to 650). Our data suggest that up to one in every 125 persons aged 15-49 years in Tijuana is HIV-infected. Interventions to reduce ongoing spread of HIV are urgently needed.

Mammographic density, breast cancer risk and risk prediction

PubMed Central

Vachon, Celine M; van Gils, Carla H; Sellers, Thomas A; Ghosh, Karthik; Pruthi, Sandhya; Brandt, Kathleen R; Pankratz, V Shane

2007-01-01

In this review, we examine the evidence for mammographic density as an independent risk factor for breast cancer, describe the risk prediction models that have incorporated density, and discuss the current and future implications of using mammographic density in clinical practice. Mammographic density is a consistent and strong risk factor for breast cancer in several populations and across age at mammogram. Recently, this risk factor has been added to existing breast cancer risk prediction models, increasing the discriminatory accuracy with its inclusion, albeit slightly. With validation, these models may replace the existing Gail model for clinical risk assessment. However, absolute risk estimates resulting from these improved models are still limited in their ability to characterize an individual's probability of developing cancer. Promising new measures of mammographic density, including volumetric density, which can be standardized using full-field digital mammography, will likely result in a stronger risk factor and improve accuracy of risk prediction models. PMID:18190724

Anthropogenic range contractions bias species climate change forecasts

NASA Astrophysics Data System (ADS)

Faurby, Søren; Araújo, Miguel B.

2018-03-01

Forecasts of species range shifts under climate change most often rely on ecological niche models, in which characterizations of climate suitability are highly contingent on the species range data used. If ranges are far from equilibrium under current environmental conditions, for instance owing to local extinctions in otherwise suitable areas, modelled environmental suitability can be truncated, leading to biased estimates of the effects of climate change. Here we examine the impact of such biases on estimated risks from climate change by comparing models of the distribution of North American mammals based on current ranges with ranges accounting for historical information on species ranges. We find that estimated future diversity, almost everywhere, except in coastal Alaska, is drastically underestimated unless the full historical distribution of the species is included in the models. Consequently forecasts of climate change impacts on biodiversity for many clades are unlikely to be reliable without acknowledging anthropogenic influences on contemporary ranges.

Kidney-Failure Risk Projection for the Living Kidney-Donor Candidate.

PubMed

Grams, Morgan E; Sang, Yingying; Levey, Andrew S; Matsushita, Kunihiro; Ballew, Shoshana; Chang, Alex R; Chow, Eric K H; Kasiske, Bertram L; Kovesdy, Csaba P; Nadkarni, Girish N; Shalev, Varda; Segev, Dorry L; Coresh, Josef; Lentine, Krista L; Garg, Amit X

2016-02-04

Evaluation of candidates to serve as living kidney donors relies on screening for individual risk factors for end-stage renal disease (ESRD). To support an empirical approach to donor selection, we developed a tool that simultaneously incorporates multiple health characteristics to estimate a person's probable long-term risk of ESRD if that person does not donate a kidney. We used risk associations from a meta-analysis of seven general population cohorts, calibrated to the population-level incidence of ESRD and mortality in the United States, to project the estimated long-term incidence of ESRD among persons who do not donate a kidney, according to 10 demographic and health characteristics. We then compared 15-year projections with the observed risk among 52,998 living kidney donors in the United States. A total of 4,933,314 participants from seven cohorts were followed for a median of 4 to 16 years. For a 40-year-old person with health characteristics that were similar to those of age-matched kidney donors, the 15-year projections of the risk of ESRD in the absence of donation varied according to race and sex; the risk was 0.24% among black men, 0.15% among black women, 0.06% among white men, and 0.04% among white women. Risk projections were higher in the presence of a lower estimated glomerular filtration rate, higher albuminuria, hypertension, current or former smoking, diabetes, and obesity. In the model-based lifetime projections, the risk of ESRD was highest among persons in the youngest age group, particularly among young blacks. The 15-year observed risks after donation among kidney donors in the United States were 3.5 to 5.3 times as high as the projected risks in the absence of donation. Multiple demographic and health characteristics may be used together to estimate the projected long-term risk of ESRD among living kidney-donor candidates and to inform acceptance criteria for kidney donors. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.).

Investigating the Gap Between Estimated and Actual Energy Efficiency and Conservation Savings for Public Buildings Projects & Programs in United States

NASA Astrophysics Data System (ADS)

Qaddus, Muhammad Kamil

The gap between estimated and actual savings in energy efficiency and conservation (EE&C) projects or programs forms the problem statement for the scope of public and government buildings. This gap has been analyzed first on impact and then on process-level. On the impact-level, the methodology leads to categorization of the gap as 'Realization Gap'. It then views the categorization of gap within the context of past and current narratives linked to realization gap. On process-level, the methodology leads to further analysis of realization gap on process evaluation basis. The process evaluation criterion, a product of this basis is then applied to two different programs (DESEU and NYC ACE) linked to the scope of this thesis. Utilizing the synergies of impact and process level analysis, it offers proposals on program development and its structure using our process evaluation criterion. Innovative financing and benefits distribution structure is thus developed and will remain part of the proposal. Restricted Stakeholder Crowd Financing and Risk-Free Incentivized return are the products of proposed financing and benefit distribution structure respectively. These products are then complimented by proposing an alternative approach in estimating EE&C savings. The approach advocates estimation based on range-allocation rather than currently utilized unique estimated savings approach. The Way Ahead section thus explores synergy between financial and engineering ranges of energy savings as a multi-discipline approach for future research. Moreover, it provides the proposed program structure with risk aversion and incentive allocation while dealing with uncertainty. This set of new approaches are believed to better fill the realization gap between estimated and actual energy efficiency savings.

Impact of statin adherence on cardiovascular disease and mortality outcomes: a systematic review

PubMed Central

De Vera, Mary A; Bhole, Vidula; Burns, Lindsay C; Lacaille, Diane

2014-01-01

Aims While suboptimal adherence to statin medication has been quantified in real-world patient settings, a better understanding of its impact is needed, particularly with respect to distinct problems of medication taking. Our aim was to synthesize current evidence on the impacts of statin adherence, discontinuation and persistence on cardiovascular disease and mortality outcomes. Methods We conducted a systematic review of peer-reviewed studies using a mapped search of Medline, Embase and International Pharmaceutical Abstracts databases. Observational studies that met the following criteria were included: defined patient population; statin adherence exposure; defined study outcome [i.e. cardiovascular disease (CVD), mortality]; and reporting of statin-specific results. Results Overall, 28 studies were included, with 19 studies evaluating outcomes associated with statin adherence, six with statin discontinuation and three with statin persistence. Among adherence studies, the proportion of days covered was the most widely used measure, with the majority of studies reporting increased risk of CVD (statistically significant risk estimates ranging from 1.22 to 5.26) and mortality (statistically significant risk estimates ranging from 1.25 to 2.54) among non-adherent individuals. There was greater methodological variability in discontinuation and persistence studies. However, findings of increased CVD (statistically significant risk estimates ranging from 1.22 to 1.67) and mortality (statistically significant risk estimates ranging from 1.79 to 5.00) among nonpersistent individuals were also consistently reported. Conclusions Observational studies consistently report an increased risk of adverse outcomes associated with poor statin adherence. These findings have important implications for patients and physicians and emphasize the importance of monitoring and encouraging adherence to statin therapy. PMID:25364801

Modeling the environmental suitability of anthrax in Ghana and estimating populations at risk: Implications for vaccination and control.

PubMed

Kracalik, Ian T; Kenu, Ernest; Ayamdooh, Evans Nsoh; Allegye-Cudjoe, Emmanuel; Polkuu, Paul Nokuma; Frimpong, Joseph Asamoah; Nyarko, Kofi Mensah; Bower, William A; Traxler, Rita; Blackburn, Jason K

2017-10-01

Anthrax is hyper-endemic in West Africa. Despite the effectiveness of livestock vaccines in controlling anthrax, underreporting, logistics, and limited resources makes implementing vaccination campaigns difficult. To better understand the geographic limits of anthrax, elucidate environmental factors related to its occurrence, and identify human and livestock populations at risk, we developed predictive models of the environmental suitability of anthrax in Ghana. We obtained data on the location and date of livestock anthrax from veterinary and outbreak response records in Ghana during 2005-2016, as well as livestock vaccination registers and population estimates of characteristically high-risk groups. To predict the environmental suitability of anthrax, we used an ensemble of random forest (RF) models built using a combination of climatic and environmental factors. From 2005 through the first six months of 2016, there were 67 anthrax outbreaks (851 cases) in livestock; outbreaks showed a seasonal peak during February through April and primarily involved cattle. There was a median of 19,709 vaccine doses [range: 0-175 thousand] administered annually. Results from the RF model suggest a marked ecological divide separating the broad areas of environmental suitability in northern Ghana from the southern part of the country. Increasing alkaline soil pH was associated with a higher probability of anthrax occurrence. We estimated 2.2 (95% CI: 2.0, 2.5) million livestock and 805 (95% CI: 519, 890) thousand low income rural livestock keepers were located in anthrax risk areas. Based on our estimates, the current anthrax vaccination efforts in Ghana cover a fraction of the livestock potentially at risk, thus control efforts should be focused on improving vaccine coverage among high risk groups.

Quantitative health impact of indoor radon in France.

PubMed

Ajrouche, Roula; Roudier, Candice; Cléro, Enora; Ielsch, Géraldine; Gay, Didier; Guillevic, Jérôme; Marant Micallef, Claire; Vacquier, Blandine; Le Tertre, Alain; Laurier, Dominique

2018-05-08

Radon is the second leading cause of lung cancer after smoking. Since the previous quantitative risk assessment of indoor radon conducted in France, input data have changed such as, estimates of indoor radon concentrations, lung cancer rates and the prevalence of tobacco consumption. The aim of this work was to update the risk assessment of lung cancer mortality attributable to indoor radon in France using recent risk models and data, improving the consideration of smoking, and providing results at a fine geographical scale. The data used were population data (2012), vital statistics on death from lung cancer (2008-2012), domestic radon exposure from a recent database that combines measurement results of indoor radon concentration and the geogenic radon potential map for France (2015), and smoking prevalence (2010). The risk model used was derived from a European epidemiological study, considering that lung cancer risk increased by 16% per 100 becquerels per cubic meter (Bq/m 3 ) indoor radon concentration. The estimated number of lung cancer deaths attributable to indoor radon exposure is about 3000 (1000; 5000), which corresponds to about 10% of all lung cancer deaths each year in France. About 33% of lung cancer deaths attributable to radon are due to exposure levels above 100 Bq/m 3 . Considering the combined effect of tobacco and radon, the study shows that 75% of estimated radon-attributable lung cancer deaths occur among current smokers, 20% among ex-smokers and 5% among never-smokers. It is concluded that the results of this study, which are based on precise estimates of indoor radon concentrations at finest geographical scale, can serve as a basis for defining French policy against radon risk.

Modeling the environmental suitability of anthrax in Ghana and estimating populations at risk: Implications for vaccination and control

PubMed Central

Allegye-Cudjoe, Emmanuel; Polkuu, Paul Nokuma; Frimpong, Joseph Asamoah; Nyarko, Kofi Mensah; Bower, William A.; Traxler, Rita

2017-01-01

Anthrax is hyper-endemic in West Africa. Despite the effectiveness of livestock vaccines in controlling anthrax, underreporting, logistics, and limited resources makes implementing vaccination campaigns difficult. To better understand the geographic limits of anthrax, elucidate environmental factors related to its occurrence, and identify human and livestock populations at risk, we developed predictive models of the environmental suitability of anthrax in Ghana. We obtained data on the location and date of livestock anthrax from veterinary and outbreak response records in Ghana during 2005–2016, as well as livestock vaccination registers and population estimates of characteristically high-risk groups. To predict the environmental suitability of anthrax, we used an ensemble of random forest (RF) models built using a combination of climatic and environmental factors. From 2005 through the first six months of 2016, there were 67 anthrax outbreaks (851 cases) in livestock; outbreaks showed a seasonal peak during February through April and primarily involved cattle. There was a median of 19,709 vaccine doses [range: 0–175 thousand] administered annually. Results from the RF model suggest a marked ecological divide separating the broad areas of environmental suitability in northern Ghana from the southern part of the country. Increasing alkaline soil pH was associated with a higher probability of anthrax occurrence. We estimated 2.2 (95% CI: 2.0, 2.5) million livestock and 805 (95% CI: 519, 890) thousand low income rural livestock keepers were located in anthrax risk areas. Based on our estimates, the current anthrax vaccination efforts in Ghana cover a fraction of the livestock potentially at risk, thus control efforts should be focused on improving vaccine coverage among high risk groups. PMID:29028799

The peri-operative management of anti-platelet therapy in elective, non-cardiac surgery.

PubMed

Alcock, Richard F; Naoum, Chris; Aliprandi-Costa, Bernadette; Hillis, Graham S; Brieger, David B

2013-07-31

Cardiovascular complications are important causes of morbidity and mortality in patients undergoing elective non-cardiac surgery, with adverse cardiac outcomes estimated to occur in approximately 4% of all patients. Anti-platelet therapy withdrawal may precede up to 10% of acute cardiovascular syndromes, with withdrawal in the peri-operative setting incompletely appraised. The aims of our study were to determine the proportion of patients undergoing elective non-cardiac surgery currently prescribed anti-platelet therapy, and identify current practice in peri-operative management. In addition, the relationship between management of anti-platelet therapy and peri-operative cardiac risk was assessed. We evaluated consecutive patients attending elective non-cardiac surgery at a major tertiary referral centre. Clinical and biochemical data were collected and analysed on patients currently prescribed anti-platelet therapy. Peri-operative management of anti-platelet therapy was compared with estimated peri-operative cardiac risk. Included were 2950 consecutive patients, with 516 (17%) prescribed anti-platelet therapy, primarily for ischaemic heart disease. Two hundred and eighty nine (56%) patients had all anti-platelet therapy ceased in the peri-operative period, including 49% of patients with ischaemic heart disease and 46% of patients with previous coronary stenting. Peri-operative cardiac risk score did not influence anti-platelet therapy management. Approximately 17% of patients undergoing elective non-cardiac surgery are prescribed anti-platelet therapy, the predominant indication being for ischaemic heart disease. Almost half of all patients with previous coronary stenting had no anti-platelet therapy during the peri-operative period. The decision to cease anti-platelet therapy, which occurred commonly, did not appear to be guided by peri-operative cardiac risk stratification. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Tobacco smoking and the risk of sudden cardiac death: a systematic review and meta-analysis of prospective studies.

PubMed

Aune, Dagfinn; Schlesinger, Sabrina; Norat, Teresa; Riboli, Elio

2018-06-01

Smoking is an established risk factor for cardiovascular disease including coronary heart disease and stroke, however, data regarding smoking and sudden cardiac death have not been summarized in a meta-analysis previously. We therefore conducted a systematic review and meta-analysis to clarify this association. We searched the PubMed and Embase databases for studies of smoking and sudden cardiac death up to July 20th 2017. Prospective studies were included if they reported adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) for smoking and sudden cardiac death. Summary RRs were estimated by use of a random effects model. Twelve prospective studies were included. The summary RR was 3.06 (95% CI 2.46-3.82, I 2  = 41%, p heterogeneity  = 0.12, n = 7) for current smokers and 1.38 (95% CI 1.20-1.60, I 2  = 0%, p heterogeneity  = 0.55, n = 7) for former smokers compared to never smokers. For four studies using non-current (never + former) smokers as the reference category the summary RR among current smokers was 2.08 (95% CI 1.70-2.53, I 2  = 18%, p heterogeneity  = 0.30). The results persisted in most of the subgroup analyses. There was no evidence of publication bias. These results confirm that smoking increases the risk of sudden cardiac death. Any further studies should investigate in more detail the effects of duration of smoking, number of cigarettes per day, pack-years, and time since quitting smoking and sudden cardiac death.

The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) in the assessment of alcohol use disorders among acute injury patients.

PubMed

Wade, Darryl; Varker, Tracey; Forbes, David; O'Donnell, Meaghan

2014-01-01

The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a brief alcohol screening test and a candidate for inclusion in recommended screening and brief intervention protocols for acute injury patients. The objective of the current study was to examine the performance of the AUDIT-C to risk stratify injury patients with regard to their probability of having an alcohol use disorder. Participants (n = 1,004) were from a multisite Australian acute injury study. Stratum-specific likelihood ratio (SSLR) analysis was used to examine the performance of previously recommended AUDIT-C risk zones based on a dichotomous cut-point (0 to 3, 4 to 12) and risk zones derived from SSLR analysis to estimate the probability of a current alcohol use disorder. Almost a quarter (23%) of patients met criteria for a current alcohol use disorder. SSLR analysis identified multiple AUDIT-C risk zones (0 to 3, 4 to 5, 6, 7 to 8, 9 to 12) with a wide range of posttest probabilities of alcohol use disorder, from 5 to 68%. The area under receiver operating characteristic curve (AUROC) score was 0.82 for the derived AUDIT-C zones and 0.70 for the recommended AUDIT-C zones. A comparison between AUROCs revealed that overall the derived zones performed significantly better than the recommended zones in being able to discriminate between patients with and without alcohol use disorder. The findings of SSLR analysis can be used to improve estimates of the probability of alcohol use disorder in acute injury patients based on AUDIT-C scores. In turn, this information can inform clinical interventions and the development of screening and intervention protocols in a range of settings. Copyright © 2013 by the Research Society on Alcoholism.

Pseudo and conditional score approach to joint analysis of current count and current status data.

PubMed

Wen, Chi-Chung; Chen, Yi-Hau

2018-04-17

We develop a joint analysis approach for recurrent and nonrecurrent event processes subject to case I interval censorship, which are also known in literature as current count and current status data, respectively. We use a shared frailty to link the recurrent and nonrecurrent event processes, while leaving the distribution of the frailty fully unspecified. Conditional on the frailty, the recurrent event is assumed to follow a nonhomogeneous Poisson process, and the mean function of the recurrent event and the survival function of the nonrecurrent event are assumed to follow some general form of semiparametric transformation models. Estimation of the models is based on the pseudo-likelihood and the conditional score techniques. The resulting estimators for the regression parameters and the unspecified baseline functions are shown to be consistent with rates of square and cubic roots of the sample size, respectively. Asymptotic normality with closed-form asymptotic variance is derived for the estimator of the regression parameters. We apply the proposed method to a fracture-osteoporosis survey data to identify risk factors jointly for fracture and osteoporosis in elders, while accounting for association between the two events within a subject. © 2018, The International Biometric Society.

Occurrence and factors associated with bovine cysticercosis recorded in cattle at meat inspection in Denmark in 2004-2011.

PubMed

Calvo-Artavia, F F; Nielsen, L R; Dahl, J; Clausen, D M; Alban, L

2013-06-01

Current EU regulation requires that every bovine carcass is examined for bovine cysticercosis (BC) at meat inspection. This is costly and might be superfluous at low BC prevalence. However, from a consumer view-point it may be important to identify and manage infected carcasses to avoid human infection. If relevant data could be effectively used to classify animals with respect to their risk of being infected, then the current meat inspection could be replaced by a more cost-effective system targeting high-risk animals. This study aimed to (1) describe the distribution of BC cases in the Danish cattle population, (2) estimate the animal level prevalence (3) provide descriptive statistics of potential risk factors for BC, and (4) determine attributable risks and fractions of selected risk factors potentially useful for a future risk-based meat inspection system. In total, 348 cases of BC were recorded among all cattle slaughtered (n=4,090,661) in Denmark between 2004 and 2011. The true animal level prevalence of BC was estimated to be 0.06%. The herd of origin of the cases were defined as the herd in which the animals spent most of their lifetimes. The detected cases were found to originate from 328 herds, with a maximum of two cases per herd indicating sporadic occurrence. Even though organic farming was associated with a higher risk (RR=1.9 in univariable analysis) of BC-positive animals being detected at slaughter, the population attributable fraction showed that only 5% of the animals with BC could be attributed to organic farming practices at the level of organic farming practiced in Denmark in the study period. Thus, organic farming status was not a suitable risk factor to use to target future risk-based meat inspection. However, 54% of the animals with BC in the cattle population were attributed to female gender. Increasing age at slaughter was also associated with high risk of BC. There may be overlaps between these effects in animals with multiple risk factors. Other underlying factors such as grazing patterns might explain the risk factors and attribution results found in this study. However, grazing practices are currently not recorded in the Danish cattle database. Therefore, animal level risk factors such as age and gender together with other risk factors such as grazing practices might be included as food chain information, required to be provided by the farmer prior to slaughter. The challenges and opportunities of this approach should be investigated further. Copyright © 2012 Elsevier B.V. All rights reserved.

Assessing the Risk of a Canine Rabies Incursion in Northern Australia

PubMed Central

Hudson, Emily G.; Brookes, Victoria J.; Ward, Michael P.

2017-01-01

Rabies is a globally distributed virus that causes approximately 60,00 human deaths annually with >99% of cases caused by dog bites. Australia is currently canine rabies free. However, the recent eastward spread of rabies in the Indonesian archipelago has increased the probability of rabies entry into northern Australian communities. In addition, many northern Australian communities have large populations of free-roaming dogs, capable of maintaining rabies should an incursion occur. A risk assessment of rabies entry and transmission into these communities is needed to target control and surveillance measures. Illegal transportation of rabies-infected dogs via boat landings is a high-risk entry pathway and was the focus of the current study. A quantitative, stochastic, risk assessment model was developed to evaluate the risk of rabies entry into north-west Cape York Peninsula, Australia, and rabies introduction to resident dogs in one of the communities via transport of rabies-infected dogs on illegal Indonesian fishing boats. Parameter distributions were derived from expert opinion, literature, and analysis of field studies. The estimated median probability of rabies entry into north-west Cape York Peninsula and into Seisia from individual fishing boats was 1.9 × 10−4/boat and 8.7 × 10−6/boat, respectively. The estimated annual probability that at least one rabies-infected dog enters north-west Cape York Peninsula and into Seisia was 5.5 × 10−3 and 3.5 × 10−4, respectively. The estimated median probability of rabies introduction into Seisia was 4.7 × 10−8/boat, and the estimated annual probability that at least one rabies-infected dog causes rabies transmission in a resident Seisia dog was 8.3 × 10−5. Sensitivity analysis using the Sobol method highlighted some parameters as influential, including but not limited to the prevalence of rabies in Indonesia, the probability of a dog on board an Indonesian fishing boat, and the probability of a Seisia dog being on the beach. Overall, the probabilities of rabies entry into north-west Cape York Peninsula and rabies introduction into Seisia are low. However, the potential devastating consequences of a rabies incursion in this region make this a non-negligible risk. PMID:28913341

Neonatal severe bacterial infection impairment estimates in South Asia, sub-Saharan Africa, and Latin America for 2010.

PubMed

Seale, Anna C; Blencowe, Hannah; Zaidi, Anita; Ganatra, Hammad; Syed, Sana; Engmann, Cyril; Newton, Charles R; Vergnano, Stefania; Stoll, Barbara J; Cousens, Simon N; Lawn, Joy E

2013-12-01

Survivors of neonatal infections are at risk of neurodevelopmental impairment (NDI), a burden not previously systematically quantified and yet important for program priority setting. Systematic reviews and meta-analyses were undertaken and applied in a three-step compartmental model to estimate NDI cases after severe neonatal bacterial infection in South Asia, sub-Saharan Africa, and Latin America in neonates of >32 wk gestation (or >1,500 g). We estimated cases of sepsis, meningitis, pneumonia, or no severe bacterial infection from among estimated cases of possible severe bacterial infection ((pSBI) step 1). We applied respective case fatality risks ((CFRs) step 2) and the NDI risk among survivors (step 3). For neonatal tetanus, incidence estimates were based on the estimated deaths, CFRs, and risk of subsequent NDI. For 2010, we estimated 1.7 million (uncertainty range: 1.1-2.4 million) cases of neonatal sepsis, 200,000 (21,000-350,000) cases of meningitis, 510,000 cases (150,000-930,000) of pneumonia, and 79,000 cases (70,000-930,000) of tetanus in neonates >32 wk gestation (or >1,500 g). Among the survivors, we estimated moderate to severe NDI after neonatal meningitis in 23% (95% confidence interval: 19-26%) of survivors, 18,000 (2,700-35,000) cases, and after neonatal tetanus in 16% (6-27%), 4,700 cases (1,700-8,900). Data are lacking for impairment after neonatal sepsis and pneumonia, especially among those of >32 wk gestation. Improved recognition and treatment of pSBI will reduce neonatal mortality. Lack of follow-up data for survivors of severe bacterial infections, particularly sepsis, was striking. Given the high incidence of sepsis, even minor NDI would be of major public health importance. Prevention of neonatal infection, improved case management, and support for children with NDI are all important strategies, currently receiving limited policy attention.

Natural Time, Nowcasting and the Physics of Earthquakes: Estimation of Seismic Risk to Global Megacities

NASA Astrophysics Data System (ADS)

Rundle, John B.; Luginbuhl, Molly; Giguere, Alexis; Turcotte, Donald L.

2018-02-01

Natural Time ("NT") refers to the concept of using small earthquake counts, for example of M > 3 events, to mark the intervals between large earthquakes, for example M > 6 events. The term was first used by Varotsos et al. (2005) and later by Holliday et al. (2006) in their studies of earthquakes. In this paper, we discuss ideas and applications arising from the use of NT to understand earthquake dynamics, in particular by use of the idea of nowcasting. Nowcasting differs from forecasting, in that the goal of nowcasting is to estimate the current state of the system, rather than the probability of a future event. Rather than focus on an individual earthquake faults, we focus on a defined local geographic region surrounding a particular location. This local region is considered to be embedded in a larger regional setting from which we accumulate the relevant statistics. We apply the nowcasting idea to the practical development of methods to estimate the current state of risk for dozens of the world's seismically exposed megacities, defined as cities having populations of over 1 million persons. We compute a ranking of these cities based on their current nowcast value, and discuss the advantages and limitations of this approach. We note explicitly that the nowcast method is not a model, in that there are no free parameters to be fit to data. Rather, the method is simply a presentation of statistical data, which the user can interpret. Among other results, we find, for example, that the current nowcast ranking of the Los Angeles region is comparable to its ranking just prior to the January 17, 1994 Northridge earthquake.

A Game Theoretical Approach to Hacktivism: Is Attack Likelihood a Product of Risks and Payoffs?

PubMed

Bodford, Jessica E; Kwan, Virginia S Y

2018-02-01

The current study examines hacktivism (i.e., hacking to convey a moral, ethical, or social justice message) through a general game theoretic framework-that is, as a product of costs and benefits. Given the inherent risk of carrying out a hacktivist attack (e.g., legal action, imprisonment), it would be rational for the user to weigh these risks against perceived benefits of carrying out the attack. As such, we examined computer science students' estimations of risks, payoffs, and attack likelihood through a game theoretic design. Furthermore, this study aims at constructing a descriptive profile of potential hacktivists, exploring two predicted covariates of attack decision making, namely, peer prevalence of hacking and sex differences. Contrary to expectations, results suggest that participants' estimations of attack likelihood stemmed solely from expected payoffs, rather than subjective risks. Peer prevalence significantly predicted increased payoffs and attack likelihood, suggesting an underlying descriptive norm in social networks. Notably, we observed no sex differences in the decision to attack, nor in the factors predicting attack likelihood. Implications for policymakers and the understanding and prevention of hacktivism are discussed, as are the possible ramifications of widely communicated payoffs over potential risks in hacking communities.

Intracranial haemorrhage and use of selective serotonin reuptake inhibitors

PubMed Central

de Abajo, Francisco J; Jick, Hershel; Derby, Laura; Jick, Susan; Schmitz, Stephen

2000-01-01

Aims In the past few years an increasing number of bleeding disorders have been reported in association with the use of selective serotonin reuptake inhibitors (SSRIs), including serious cases of intracranial haemorrhage, raising concerns about the safety of this class of drugs. The present study was performed to test the hypothesis of an increased risk of intracranial haemorrhage associated with the use of SSRIs. Methods We carried out a case-control study nested in a cohort of antidepressants users with the UK-based General Practice Research Database (GPRD) as the primary source of information. The study cohort encompassed subjects aged between 18 and 79 years who received a first-time prescription for any antidepressant from January, 1990 to October, 1997. Patients with presenting conditions or treatments that could be associated with an increased risk of intracranial haemorrhage were excluded from the cohort. Patients were followed-up until the occurrence of an idiopathic intracranial haemorrhage. Up to four controls per case, matched on age, sex, calendar time and practice were randomly selected from the study cohort. We estimated adjusted odds ratios and 95% confidence intervals of intracranial haemorrhage with current use of SSRIs and other antidepressants as compared with nonuse using conditional logistic regression. Results We identified 65 cases of idiopathic intracranial haemorrhage and 254 matched controls. Current exposure to SSRIs was ascertained in 7 cases (10.8%) and 24 controls (9.7%) resulting in an adjusted OR (95%CI) of 0.8 (0.3,2.3). The estimate for ‘other antidepressants’ was 0.7 (0.3,1.6). The effect measures were not modified by gender or age. No effect related to dose or treatment duration was detected. The risk estimates did not change according to the location of bleeding (intracerebral or subarachnoid). Conclusions Our results are not compatible with a major increased risk of intracranial haemorrhage among users of SSRIs or other antidepressants at large. However, smaller but still relevant increased risks cannot be ruled out. PMID:10886117

Estimating Adolescent Risk for Hearing Loss Based on Data From a Large School-Based Survey

PubMed Central

Verschuure, Hans; van der Ploeg, Catharina P. B.; Brug, Johannes; Raat, Hein

2010-01-01

Objectives. We estimated whether and to what extent a group of adolescents were at risk of developing permanent hearing loss as a result of voluntary exposure to high-volume music, and we assessed whether such exposure was associated with hearing-related symptoms. Methods. In 2007, 1512 adolescents (aged 12–19 years) in Dutch secondary schools completed questionnaires about their music-listening behavior and whether they experienced hearing-related symptoms after listening to high-volume music. We used their self-reported data in conjunction with published average sound levels of music players, discotheques, and pop concerts to estimate their noise exposure, and we compared that exposure to our own “loosened” (i.e., less strict) version of current European safety standards for occupational noise exposure. Results. About half of the adolescents exceeded safety standards for occupational noise exposure. About one third of the respondents exceeded safety standards solely as a result of listening to MP3 players. Hearing symptoms that occurred after using an MP3 player or going to a discotheque were associated with exposure to high-volume music. Conclusions. Adolescents often exceeded current occupational safety standards for noise exposure, highlighting the need for specific safety standards for leisure-time noise exposure. PMID:20395587

Estimates of the Public Health Impact of a Pediatric Vaccination Program Using an Intranasal Tetravalent Live-Attenuated Influenza Vaccine in Belgium.

PubMed

Gerlier, Laetitia; Lamotte, Mark; Dos Santos Mendes, Sofia; Damm, Oliver; Schwehm, Markus; Eichner, Martin

2016-08-01

Our objectives were to estimate the public health outcomes of vaccinating Belgian children using an intranasal tetravalent live-attenuated influenza vaccine (QLAIV) combined with current coverage of high-risk/elderly individuals using the trivalent inactivated vaccine. We used a deterministic, age-structured, dynamic model to simulate seasonal influenza transmission in the Belgian population under the current coverage or after extending vaccination with QLAIV to healthy children aged 2-17 years. Differential equations describe demographic changes, exposure to infectious individuals, infection recovery, and immunity dynamics. The basic reproduction number (R 0) was calibrated to the observed number of influenza doctor visits/year. Vaccine efficacy was 80 % (live-attenuated) and 59-68 % (inactivated). The 10-year incidence of symptomatic influenza was calculated with different coverage scenarios (add-on to current coverage). Model calibration yielded R 0 = 1.1. QLAIV coverage of 75 % of those aged 2-17 years averted 374,000 symptomatic cases/year (57 % of the current number), 244,000 of which were among adults (indirect effect). Vaccinating 75 % of those aged 2-11 years and 50 % of those aged 12-17 years averted 333,200 cases/year (213,000 adult cases/year). Vaccinating only healthy children aged 2-5 years generated direct protection but limited indirect protection, even with 90 % coverage (40,800 averted adult cases/year; -8.4 %). Targeting all children averted twice as many high-risk cases as targeting high-risk children only (8485 vs. 4965/year with 75 % coverage). Sensitivity analyses showed the robustness of results. The model highlights the direct and indirect protection benefits when vaccinating healthy children with QLAIV in Belgium. Policies targeting only high-risk individuals or the youngest provide limited herd protection, as school-age children are important influenza vectors in the community.

Applying Risk Prediction Models to Optimize Lung Cancer Screening: Current Knowledge, Challenges, and Future Directions.

PubMed

Sakoda, Lori C; Henderson, Louise M; Caverly, Tanner J; Wernli, Karen J; Katki, Hormuzd A

2017-12-01

Risk prediction models may be useful for facilitating effective and high-quality decision-making at critical steps in the lung cancer screening process. This review provides a current overview of published lung cancer risk prediction models and their applications to lung cancer screening and highlights both challenges and strategies for improving their predictive performance and use in clinical practice. Since the 2011 publication of the National Lung Screening Trial results, numerous prediction models have been proposed to estimate the probability of developing or dying from lung cancer or the probability that a pulmonary nodule is malignant. Respective models appear to exhibit high discriminatory accuracy in identifying individuals at highest risk of lung cancer or differentiating malignant from benign pulmonary nodules. However, validation and critical comparison of the performance of these models in independent populations are limited. Little is also known about the extent to which risk prediction models are being applied in clinical practice and influencing decision-making processes and outcomes related to lung cancer screening. Current evidence is insufficient to determine which lung cancer risk prediction models are most clinically useful and how to best implement their use to optimize screening effectiveness and quality. To address these knowledge gaps, future research should be directed toward validating and enhancing existing risk prediction models for lung cancer and evaluating the application of model-based risk calculators and its corresponding impact on screening processes and outcomes.

Patient-Centered Care in Breast Cancer Genetic Clinics

PubMed Central

Brédart, Anne; Anota, Amélie; Kuboth, Violetta; Lareyre, Olivier; Cano, Alejandra; Stoppa-Lyonnet, Dominique; Schmutzler, Rita; Dolbeault, Sylvie

2018-01-01

With advances in breast cancer (BC) gene panel testing, risk counseling has become increasingly complex, potentially leading to unmet psychosocial needs. We assessed psychosocial needs and correlates in women initiating testing for high genetic BC risk in clinics in France and Germany, and compared these results with data from a literature review. Among the 442 counselees consecutively approached, 212 (83%) in France and 180 (97%) in Germany, mostly BC patients (81% and 92%, respectively), returned the ‘Psychosocial Assessment in Hereditary Cancer’ questionnaire. Based on the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) BC risk estimation model, the mean BC lifetime risk estimates were 19% and 18% in France and Germany, respectively. In both countries, the most prevalent needs clustered around the “living with cancer” and “children-related issues” domains. In multivariate analyses, a higher number of psychosocial needs were significantly associated with younger age (b = −0.05), higher anxiety (b = 0.78), and having children (b = 1.51), but not with country, educational level, marital status, depression, or loss of a family member due to hereditary cancer. These results are in line with the literature review data. However, this review identified only seven studies that quantitatively addressed psychosocial needs in the BC genetic counseling setting. Current data lack understandings of how cancer risk counseling affects psychosocial needs, and improves patient-centered care in that setting. PMID:29439543

Spatial analysis of health risk assessment with arsenic intake of drinking water in the LanYang plain

NASA Astrophysics Data System (ADS)

Chen, C. F.; Liang, C. P.; Jang, C. S.; Chen, J. S.

2016-12-01

Groundwater is one of the most component water resources in Lanyang plain. The groundwater of the Lanyang Plain contains arsenic levels that exceed the current Taiwan Environmental Protection Administration (Taiwan EPA) limit of 10 μg/L. The arsenic of groundwater in some areas of the Lanyang Plain pose great menace for the safe use of groundwater resources. Therefore, poor water quality can adversely impact drinking water uses, leading to human health risks. This study analyzed the potential health risk associated with the ingestion of arsenic-affected groundwater in the arseniasis-endemic Lanyang plain. Geostatistical approach is widely used in spatial variability analysis and distributions of field data with uncertainty. The estimation of spatial distribution of the arsenic contaminant in groundwater is very important in the health risk assessment. This study used indicator kriging (IK) and ordinary kriging (OK) methods to explore the spatial variability of arsenic-polluted parameters. The estimated difference between IK and OK estimates was compared. The extent of arsenic pollution was spatially determined and the Target cancer risk (TR) and dose response were explored when the ingestion of arsenic in groundwater. Thus, a zonal management plan based on safe groundwater use is formulated. The research findings can provide a plan reference of regional water resources supplies for local government administrators and developing groundwater resources in the Lanyang Plain.

Patient-Centered Care in Breast Cancer Genetic Clinics.

PubMed

Brédart, Anne; Anota, Amélie; Dick, Julia; Kuboth, Violetta; Lareyre, Olivier; De Pauw, Antoine; Cano, Alejandra; Stoppa-Lyonnet, Dominique; Schmutzler, Rita; Dolbeault, Sylvie; Kop, Jean-Luc

2018-02-12

With advances in breast cancer (BC) gene panel testing, risk counseling has become increasingly complex, potentially leading to unmet psychosocial needs. We assessed psychosocial needs and correlates in women initiating testing for high genetic BC risk in clinics in France and Germany, and compared these results with data from a literature review. Among the 442 counselees consecutively approached, 212 (83%) in France and 180 (97%) in Germany, mostly BC patients (81% and 92%, respectively), returned the 'Psychosocial Assessment in Hereditary Cancer' questionnaire. Based on the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) BC risk estimation model, the mean BC lifetime risk estimates were 19% and 18% in France and Germany, respectively. In both countries, the most prevalent needs clustered around the "living with cancer" and "children-related issues" domains. In multivariate analyses, a higher number of psychosocial needs were significantly associated with younger age (b = -0.05), higher anxiety (b = 0.78), and having children (b = 1.51), but not with country, educational level, marital status, depression, or loss of a family member due to hereditary cancer. These results are in line with the literature review data. However, this review identified only seven studies that quantitatively addressed psychosocial needs in the BC genetic counseling setting. Current data lack understandings of how cancer risk counseling affects psychosocial needs, and improves patient-centered care in that setting.

Fabric-based Pressure Sensor Array for Decubitus Ulcer Monitoring

PubMed Central

Chung, Philip; Rowe, Allison; Etemadi, Mozziyar; Lee, Hanmin; Roy, Shuvo

2015-01-01

Decubitus ulcers occur in an estimated 2.5 million Americans each year at an annual cost of $11 billion to the U.S. health system. Current screening and prevention techniques for assessing risk for decubitus ulcer formation and repositioning patients every 1–2 hours are labor-intensive and can be subjective. We propose use of a Bluetooth-enabled fabric-based pressure sensor array as a simple tool to objectively assess and continuously monitor decubitus ulcer risk. PMID:24111232

Applications of Capstone Depleted Uranium Aerosol Risk Data to Military Combat Risk Management

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

Daxon, Eric G.; Parkhurst, MaryAnn; Melanson, Mark A.

2009-03-01

Risks to personnel engaged in military operations include not only the threat of enemy firepower but also risks from exposure to other hazards such as radiation. Combatant commanders of the U. S. Army carefully weigh risks of casualties before implementing battlefield actions using an established paradigm that take these risks into consideration. As a result of the inclusion of depleted uranium (DU) anti-armor ammunition in the conventional (non-nuclear) weapons arsenal, the potential for exposure to DU aerosols and its associated chemical and radiological effects becomes an element of the commanders’ risk assessment. The Capstone DU Aerosol Study measured the rangemore » of likely DU oxide aerosol concentrations created inside a combat vehicle perforated with a DU munition, and the Capstone Human Health Risk Assessment (HHRA) estimated the associated doses and calculated risks. This paper focuses on the development of a scientific approach to adapt the risks from DU’s non uniform dose distribution within the body using the current U.S. Department of Defense (DoD) radiation risk management approach. The approach developed equates the Radiation Exposure Status (RES) categories to the estimated radiological risks of DU and makes use of the Capstone-developed Renal Effects Group (REG) as a measure of chemical risk from DU intake. Recommendations are provided for modifying Army guidance and policy in order to better encompass the potential risks from DU aerosol inhalation during military operations.« less

Health Impacts of the Built Environment: Within-Urban Variability in Physical Inactivity, Air Pollution, and Ischemic Heart Disease Mortality

PubMed Central

Hankey, Steve; Brauer, Michael

2011-01-01

Background: Physical inactivity and exposure to air pollution are important risk factors for death and disease globally. The built environment may influence exposures to these risk factors in different ways and thus differentially affect the health of urban populations. Objective: We investigated the built environment’s association with air pollution and physical inactivity, and estimated attributable health risks. Methods: We used a regional travel survey to estimate within-urban variability in physical inactivity and home-based air pollution exposure [particulate matter with aerodynamic diameter ≤ 2.5 μm (PM2.5), nitrogen oxides (NOx), and ozone (O3)] for 30,007 individuals in southern California. We then estimated the resulting risk for ischemic heart disease (IHD) using literature-derived dose–response values. Using a cross-sectional approach, we compared estimated IHD mortality risks among neighborhoods based on “walkability” scores. Results: The proportion of physically active individuals was higher in high- versus low-walkability neighborhoods (24.9% vs. 12.5%); however, only a small proportion of the population was physically active, and between-neighborhood variability in estimated IHD mortality attributable to physical inactivity was modest (7 fewer IHD deaths/100,000/year in high- vs. low-walkability neighborhoods). Between-neighborhood differences in estimated IHD mortality from air pollution were comparable in magnitude (9 more IHD deaths/100,000/year for PM2.5 and 3 fewer IHD deaths for O3 in high- vs. low-walkability neighborhoods), suggesting that population health benefits from increased physical activity in high-walkability neighborhoods may be offset by adverse effects of air pollution exposure. Policy implications: Currently, planning efforts mainly focus on increasing physical activity through neighborhood design. Our results suggest that differences in population health impacts among neighborhoods are similar in magnitude for air pollution and physical activity. Thus, physical activity and exposure to air pollution are critical aspects of planning for cleaner, health-promoting cities. PMID:22004949

Health impacts of the built environment: within-urban variability in physical inactivity, air pollution, and ischemic heart disease mortality.

PubMed

Hankey, Steve; Marshall, Julian D; Brauer, Michael

2012-02-01

Physical inactivity and exposure to air pollution are important risk factors for death and disease globally. The built environment may influence exposures to these risk factors in different ways and thus differentially affect the health of urban populations. We investigated the built environment's association with air pollution and physical inactivity, and estimated attributable health risks. We used a regional travel survey to estimate within-urban variability in physical inactivity and home-based air pollution exposure [particulate matter with aerodynamic diameter ≤ 2.5 μm (PM2.5), nitrogen oxides (NOx), and ozone (O3)] for 30,007 individuals in southern California. We then estimated the resulting risk for ischemic heart disease (IHD) using literature-derived dose-response values. Using a cross-sectional approach, we compared estimated IHD mortality risks among neighborhoods based on "walkability" scores. The proportion of physically active individuals was higher in high- versus low-walkability neighborhoods (24.9% vs. 12.5%); however, only a small proportion of the population was physically active, and between-neighborhood variability in estimated IHD mortality attributable to physical inactivity was modest (7 fewer IHD deaths/100,000/year in high- vs. low-walkability neighborhoods). Between-neighborhood differences in estimated IHD mortality from air pollution were comparable in magnitude (9 more IHD deaths/100,000/year for PM2.5 and 3 fewer IHD deaths for O3 in high- vs. low-walkability neighborhoods), suggesting that population health benefits from increased physical activity in high-walkability neighborhoods may be offset by adverse effects of air pollution exposure. Currently, planning efforts mainly focus on increasing physical activity through neighborhood design. Our results suggest that differences in population health impacts among neighborhoods are similar in magnitude for air pollution and physical activity. Thus, physical activity and exposure to air pollution are critical aspects of planning for cleaner, health-promoting cities.

Development and validation of risk models to select ever-smokers for CT lung-cancer screening

PubMed Central

Katki, Hormuzd A.; Kovalchik, Stephanie A.; Berg, Christine D.; Cheung, Li C.; Chaturvedi, Anil K.

2016-01-01

Importance The US Preventive Services Task Force (USPSTF) recommends computed-tomography (CT) lung-cancer screening for ever-smokers ages 55-80 years who smoked at least 30 pack-years with no more than 15 years since quitting. However, selecting ever-smokers for screening using individualized lung-cancer risk calculations may be more effective and efficient than current USPSTF recommendations. Objective Comparison of modeled outcomes from risk-based CT lung-screening strategies versus USPSTF recommendations. Design/Setting/Participants Empirical risk models for lung-cancer incidence and death in the absence of CT screening using data on ever-smokers from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO; 1993-2009) control group. Covariates included age, education, sex, race, smoking intensity/duration/quit-years, Body Mass Index, family history of lung-cancer, and self-reported emphysema. Model validation in the chest radiography groups of the PLCO and the National Lung Screening Trial (NLST; 2002-2009), with additional validation of the death model in the National Health Interview Survey (NHIS; 1997-2001), a representative sample of the US. Models applied to US ever-smokers ages 50-80 (NHIS 2010-2012) to estimate outcomes of risk-based selection for CT lung-screening, assuming screening for all ever-smokers yields the percent changes in lung-cancer detection and death observed in the NLST. Exposure Annual CT lung-screening for 3 years. Main Outcomes and Measures Model validity: calibration (number of model-predicted cases divided by number of observed cases (Estimated/Observed)) and discrimination (Area-Under-Curve (AUC)). Modeled screening outcomes: estimated number of screen-avertable lung-cancer deaths, estimated screening effectiveness (number needed to screen (NNS) to prevent 1 lung-cancer death). Results Lung-cancer incidence and death risk models were well-calibrated in PLCO and NLST. The lung-cancer death model calibrated and discriminated well for US ever-smokers ages 50-80 (NHIS 1997-2001: Estimated/Observed=0.94, 95%CI=0.84-1.05; AUC=0.78, 95%CI=0.76-0.80). Under USPSTF recommendations, the models estimated 9.0 million US ever-smokers would qualify for lung-cancer screening and 46,488 (95%CI=43,924-49,053) lung-cancer deaths were estimated as screen-avertable over 5 years (estimated NNS=194, 95%CI=187-201). In contrast, risk-based selection screening the same number of ever-smokers (9.0 million) at highest 5-year lung-cancer risk (≥1.9%), was estimated to avert 20% more deaths (55,717; 95%CI=53,033-58,400) and was estimated to reduce the estimated NNS by 17% (NNS=162, 95%CI=157-166). Conclusions and Relevance Among a cohort of US ever-smokers age 50-80 years, application of a risk-based model for CT screening for lung cancer compared with a model based on USPSTF recommendations was estimated to be associated with a greater number of lung-cancer deaths prevented over 5 years along with a lower NNS to prevent 1 lung-cancer death. PMID:27179989

Development and Validation of Risk Models to Select Ever-Smokers for CT Lung Cancer Screening.

PubMed

Katki, Hormuzd A; Kovalchik, Stephanie A; Berg, Christine D; Cheung, Li C; Chaturvedi, Anil K

2016-06-07

The US Preventive Services Task Force (USPSTF) recommends computed tomography (CT) lung cancer screening for ever-smokers aged 55 to 80 years who have smoked at least 30 pack-years with no more than 15 years since quitting. However, selecting ever-smokers for screening using individualized lung cancer risk calculations may be more effective and efficient than current USPSTF recommendations. Comparison of modeled outcomes from risk-based CT lung-screening strategies vs USPSTF recommendations. Empirical risk models for lung cancer incidence and death in the absence of CT screening using data on ever-smokers from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO; 1993-2009) control group. Covariates included age; education; sex; race; smoking intensity, duration, and quit-years; body mass index; family history of lung cancer; and self-reported emphysema. Model validation in the chest radiography groups of the PLCO and the National Lung Screening Trial (NLST; 2002-2009), with additional validation of the death model in the National Health Interview Survey (NHIS; 1997-2001), a representative sample of the United States. Models were applied to US ever-smokers aged 50 to 80 years (NHIS 2010-2012) to estimate outcomes of risk-based selection for CT lung screening, assuming screening for all ever-smokers, yield the percent changes in lung cancer detection and death observed in the NLST. Annual CT lung screening for 3 years beginning at age 50 years. For model validity: calibration (number of model-predicted cases divided by number of observed cases [estimated/observed]) and discrimination (area under curve [AUC]). For modeled screening outcomes: estimated number of screen-avertable lung cancer deaths and estimated screening effectiveness (number needed to screen [NNS] to prevent 1 lung cancer death). Lung cancer incidence and death risk models were well calibrated in PLCO and NLST. The lung cancer death model calibrated and discriminated well for US ever-smokers aged 50 to 80 years (NHIS 1997-2001: estimated/observed = 0.94 [95%CI, 0.84-1.05]; AUC, 0.78 [95%CI, 0.76-0.80]). Under USPSTF recommendations, the models estimated 9.0 million US ever-smokers would qualify for lung cancer screening and 46,488 (95% CI, 43,924-49,053) lung cancer deaths were estimated as screen-avertable over 5 years (estimated NNS, 194 [95% CI, 187-201]). In contrast, risk-based selection screening of the same number of ever-smokers (9.0 million) at highest 5-year lung cancer risk (≥1.9%) was estimated to avert 20% more deaths (55,717 [95% CI, 53,033-58,400]) and was estimated to reduce the estimated NNS by 17% (NNS, 162 [95% CI, 157-166]). Among a cohort of US ever-smokers aged 50 to 80 years, application of a risk-based model for CT screening for lung cancer compared with a model based on USPSTF recommendations was estimated to be associated with a greater number of lung cancer deaths prevented over 5 years, along with a lower NNS to prevent 1 lung cancer death.

Occupational factors and reproductive outcomes among a cohort of female veterinarians.

PubMed

Wilkins, J R; Steele, L L

1998-07-01

To estimate absolute and relative risks of preterm delivery (PTD) and small-for-gestational-age (SGA) births among a cohort of female veterinarians in relation to selected occupational factors, including clinical practice type (CPT). Retrospective cohort survey. 2,997 female graduates from US veterinary colleges between 1970 and 1980. Relevant health and occupational data were collected through a self-administered mail questionnaire with telephone follow-up of nonrespondents. Absolute and relative risks of PTD and SGA births were estimated in relation to maternal CPT at the time of conception and exposure to 13 occupational factors. Attempts were made to control confounding by use of multiple logistic regression analyses. Absolute and relative risks of PTD were highest for veterinarians employed in exclusively equine clinical practice. Although several increased, none of the CPT-specific relative risk estimates were significantly different from the null value of 1. Exposure-specific analyses indicated that occupational involvement with solvents among exclusively small animal practitioners was associated with the highest relative risk of PTD. A small number of SGA births limited information that could be obtained from these analyses. Overall absolute risks of PTD and SGA births among cohort members were much lower in comparison with the general female population. Given the large number of women currently practicing and entering the profession of veterinary medicine, clinical tasks associated with potential reproductive hazards should be approached with heightened awareness and increased caution, especially activities that may involve exposure to solvents.

The estimated effect of mass or footprint reduction in recent light-duty vehicles on U.S. societal fatality risk per vehicle mile traveled.

PubMed

Wenzel, Tom

2013-10-01

The National Highway Traffic Safety Administration (NHTSA) recently updated its 2003 and 2010 logistic regression analyses of the effect of a reduction in light-duty vehicle mass on US societal fatality risk per vehicle mile traveled (VMT; Kahane, 2012). Societal fatality risk includes the risk to both the occupants of the case vehicle as well as any crash partner or pedestrians. The current analysis is the most thorough investigation of this issue to date. This paper replicates the Kahane analysis and extends it by testing the sensitivity of his results to changes in the definition of risk, and the data and control variables used in the regression models. An assessment by Lawrence Berkeley National Laboratory (LBNL) indicates that the estimated effect of mass reduction on risk is smaller than in Kahane's previous studies, and is statistically non-significant for all but the lightest cars (Wenzel, 2012a). The estimated effects of a reduction in mass or footprint (i.e. wheelbase times track width) are small relative to other vehicle, driver, and crash variables used in the regression models. The recent historical correlation between mass and footprint is not so large to prohibit including both variables in the same regression model; excluding footprint from the model, i.e. allowing footprint to decrease with mass, increases the estimated detrimental effect of mass reduction on risk in cars and crossover utility vehicles (CUVs)/minivans, but has virtually no effect on light trucks. Analysis by footprint deciles indicates that risk does not consistently increase with reduced mass for vehicles of similar footprint. Finally, the estimated effects of mass and footprint reduction are sensitive to the measure of exposure used (fatalities per induced exposure crash, rather than per VMT), as well as other changes in the data or control variables used. It appears that the safety penalty from lower mass can be mitigated with careful vehicle design, and that manufacturers can reduce mass as a strategy to increase their vehicles' fuel economy and reduce greenhouse gas emissions without necessarily compromising societal safety. Published by Elsevier Ltd.

Repeated Vaccination Does Not Appear to Impact Upon Influenza Vaccine Effectiveness Against Hospitalization With Confirmed Influenza.

PubMed

Cheng, Allen C; Macartney, Kristine K; Waterer, Grant W; Kotsimbos, Tom; Kelly, Paul M; Blyth, Christopher C

2017-06-01

Annual influenza vaccine is recommended for those at greatest risk of severe influenza infection. Recent reports of a negative impact of serial influenza vaccination on vaccine effectiveness (VE) raises concerns about the recommendation for annual influenza vaccines, particularly in persons at greatest risk. The Influenza Complications Alert Network (FluCAN) is an Australian hospital-based sentinel surveillance program. In this observational study, cases were defined as subjects aged >9 years admitted with influenza confirmed by polymerase chain reaction. Controls were subjects with acute respiratory illness testing negative for influenza. Propensity scores were used to adjust for the likelihood of being vaccinated. VE was calculated as 1 - adjusted odds ratio of vaccination in cases compared with test-negative controls. Over 2010-2015, 6223 cases and 6505 controls were hospitalized with confirmed influenza and influenza test-negative acute respiratory illness, respectively. Following stratification by quintile of propensity score, site, and year, VE was estimated to be 43% (95% confidence interval [CI], 37%-49%) overall. VE was estimated to be 51% (95% CI, 45%-57%) in those vaccinated in both the current and previous season, compared with 33% (95% CI, 17%-47%) vaccinated in the current season only and 35% (95% CI, 21%-46%) in the previous season only. Similar results were observed for influenza A/H1N1, influenza A/H3N2, and influenza B strains. Vaccination in both the current and previous seasons was associated with a higher VE against hospitalization with influenza than vaccination in either single season. These findings reinforce current recommendations for annual influenza vaccination, particularly those at greatest risk of influenza disease. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com

Burden of stroke attributable to selected lifestyle risk factors in rural South Africa.

PubMed

Maredza, Mandy; Bertram, Melanie Y; Gómez-Olivé, Xavier F; Tollman, Stephen M

2016-02-12

Rural South Africa (SA) is undergoing a rapid health transition characterized by increases in non-communicable diseases; stroke in particular. Knowledge of the relative contribution of modifiable risk factors on disease occurrence is needed for public health prevention efforts and community-oriented health promotion. Our aim was to estimate the burden of stroke in rural SA that is attributable to high blood pressure, excess weight and high blood glucose using World Health Organization's comparative risk assessment (CRA) framework. We estimated current exposure distributions of the risk factors in rural SA using 2010 data from the Agincourt health and demographic surveillance system (HDSS). Relative risks of stroke per unit of exposure were obtained from the Global Burden of Disease Study 2010. We used data from the Agincourt HDSS to estimate age-, sex-, and stroke specific deaths and disability adjusted life years (DALYs). We estimated the proportion of the years of life lost (YLL) and DALY loss attributable to the risk factors and incorporate uncertainty intervals into these estimates. Overall, 38 % of the documented stroke burden was due to high blood pressure (12 % males; 26 % females). This translated to 520 YLL per year (95 % CI: 325-678) and 540 DALYs (CI: 343-717). Excess Body Mass Index (BMI) was calculated as responsible for 20 % of the stroke burden (3.5 % males; 16 % females). This translated to 260 YLLs (CI: 199-330) and 277 DALYs (CI: 211-350). Burden was disproportionately higher in young females when BMI was assessed. High blood pressure and excess weight, which both have effective interventions, are responsible for a significant proportion of the stroke burden in rural SA; the burden varies across age and sex sub-groups. The most effective way forward to reduce the stroke burden requires both population wide policies that have an impact across the age spectra and targeted (health promotion/disease prevention) interventions on women and young people.

Evidence Report: Risk of Acute and Late Central Nervous System Effects from Radiation Exposure

NASA Technical Reports Server (NTRS)

Nelson, Gregory A.; Simonsen, Lisa; Huff, Janice L.

2016-01-01

Possible acute and late risks to the central nervous system (CNS) from galactic cosmic rays (GCR) and solar particle events (SPE) are concerns for human exploration of space. Acute CNS risks may include: altered cognitive function, reduced motor function, and behavioral changes, all of which may affect performance and human health. Late CNS risks may include neurological disorders such as Alzheimer's disease (AD), dementia and premature aging. Although detrimental CNS changes are observed in humans treated with high-dose radiation (e.g., gamma rays and 9 protons) for cancer and are supported by experimental evidence showing neurocognitive and behavioral effects in animal models, the significance of these results on the morbidity to astronauts has not been elucidated. There is a lack of human epidemiology data on which to base CNS risk estimates; therefore, risk projection based on scaling to human data, as done for cancer risk, is not possible for CNS risks. Research specific to the spaceflight environment using animal and cell models must be compiled to quantify the magnitude of CNS changes in order to estimate this risk and to establish validity of the current permissible exposure limits (PELs). In addition, the impact of radiation exposure in combination with individual sensitivity or other space flight factors, as well as assessment of the need for biological/pharmaceutical countermeasures, will be considered after further definition of CNS risk occurs.

Evidence Report: Risk of Acute and Late Central Nervous System Effects from Radiation Exposure

NASA Technical Reports Server (NTRS)

Nelson, Gregory A.; Simonsen, Lisa; Huff, Janice L.

2015-01-01

Possible acute and late risks to the central nervous system (CNS) from galactic cosmic rays (GCR) and solar particle events (SPE) are a documented concern for human exploration of space. Acute CNS risks include: altered cognitive function, reduced motor function, and behavioral changes, all of which may affect performance and human health. Late CNS risks include neurological disorders such as Alzheimer's disease (AD), dementia and premature aging. Although detrimental CNS changes are observed in humans treated with high-dose radiation (e.g., gamma rays and protons) for cancer and are supported by experimental evidence showing neurocognitive and behavioral effects in animal models, the significance of these results on the morbidity to astronauts has not been elucidated. There is a lack of human epidemiology data on which to base CNS risk estimates; therefore, risk projection based on scaling to human data, as done for cancer risk, is not possible for CNS risks. Research specific to the spaceflight environment using animal and cell models must be compiled to quantify the magnitude of CNS changes in order to estimate this risk and to establish validity of the current permissible exposure limits (PELs). In addition, the impact of radiation exposure in combination with individual sensitivity or other space flight factors, as well as assessment of the need for biological/pharmaceutical countermeasures, will be considered after further definition of CNS risk occurs.

Industrial machine systems risk assessment: a critical review of concepts and methods.

PubMed

Etherton, John R

2007-02-01

Reducing the risk of work-related death and injury to machine operators and maintenance personnel poses a continuing occupational safety challenge. The risk of injury from machinery in U.S. workplaces is high. Between 1992 and 2001, there were, on average, 520 fatalities per year involving machines and, on average, 3.8 cases per 10,000 workers of nonfatal caught-in-running-machine injuries involving lost workdays. A U.S. task group recently developed a technical reference guideline, ANSI B11 TR3, "A Guide to Estimate, Evaluate, & Reduce Risks Associated with Machine Tools," that is intended to bring machine tool risk assessment practice in the United States up to or above the level now required by the international standard, ISO 14121. The ANSI guideline emphasizes identifying tasks and hazards not previously considered, particularly those associated with maintenance; and it further emphasizes teamwork among line workers, engineers, and safety professionals. The value of this critical review of concepts and methods resides in (1) its linking current risk theory to machine system risk assessment and (2) its exploration of how various risk estimation tools translate into risk-informed decisions on industrial machine system design and use. The review was undertaken to set the stage for a field evaluation study on machine risk assessment among users of the ANSI B11 TR3 method.

A Screening-Level Approach for Comparing Risks Affecting Aquatic Ecosystem Services over Socio-Environmental Gradients

NASA Astrophysics Data System (ADS)

Harmon, T. C.; Conde, D.; Villamizar, S. R.; Reid, B.; Escobar, J.; Rusak, J.; Hoyos, N.; Scordo, F.; Perillo, G. M.; Piccolo, M. C.; Zilio, M.; Velez, M.

2015-12-01

Assessing risks to aquatic ecosystems services (ES) is challenging and time-consuming, and effective strategies for prioritizing more detailed assessment efforts are needed. We propose a screening-level risk analysis (SRA) approach that scales ES risk using socioeconomic and environmental indices to capture anthropic and climatic pressures, as well as the capacity for institutional responses to those pressures. The method considers ES within a watershed context, and uses expert input to prioritize key services and the associated pressures that threaten them. The SRA approach focuses on estimating ES risk affect factors, which are the sum of the intensity factors for all hazards or pressures affecting the ES. We estimate the pressure intensity factors in a novel manner, basing them on the nation's (i) human development (proxied by Inequality-adjusted Human Development Index, IHDI), (ii) environmental regulatory and monitoring state (Environmental Performance Index, EPI) and (iii) the current level of water stress in the watershed (baseline water stress, BWS). Anthropic intensity factors for future conditions are derived from the baseline values based on the nation's 10-year trend in IHDI and EPI; ES risks in nations with stronger records of change are rewarded more/penalized less in estimates for good/poor future management scenarios. Future climatic intensity factors are tied to water stress estimates based on two general circulation model (GCM) outcomes. We demonstrate the method for an international array of six sites representing a wide range of socio-environmental settings. The outcomes illustrate novel consequences of the scaling scheme. Risk affect factors may be greater in a highly developed region under intense climatic pressure, or in less well-developed regions due to human factors (e.g., poor environmental records). As a screening-level tool, the SRA approach offers considerable promise for ES risk comparisons among watersheds and regions so that detailed assessment, management and mitigation efforts can be effectively prioritized.

Cigarette Smoking Prior to First Cancer and Risk of Second Smoking-Associated Cancers Among Survivors of Bladder, Kidney, Head and Neck, and Stage I Lung Cancers

PubMed Central

Shiels, Meredith S.; Gibson, Todd; Sampson, Joshua; Albanes, Demetrius; Andreotti, Gabriella; Beane Freeman, Laura; Berrington de Gonzalez, Amy; Caporaso, Neil; Curtis, Rochelle E.; Elena, Joanne; Freedman, Neal D.; Robien, Kim; Black, Amanda; Morton, Lindsay M.

2014-01-01

Purpose Data on smoking and second cancer risk among cancer survivors are limited. We assessed associations between smoking before first cancer diagnosis and risk of second primary smoking-associated cancers among survivors of lung (stage I), bladder, kidney, and head/neck cancers. Methods Data were pooled from 2,552 patients with stage I lung cancer, 6,386 with bladder cancer, 3,179 with kidney cancer, and 2,967 with head/neck cancer from five cohort studies. We assessed the association between prediagnostic smoking and second smoking-associated cancer risk with proportional hazards regression, and compared these estimates to those for first smoking-associated cancers in all cohort participants. Results Compared with never smoking, current smoking of ≥ 20 cigarettes per day was associated with increased second smoking-associated cancer risk among survivors of stage I lung (hazard ratio [HR] = 3.26; 95% CI, 0.92 to 11.6), bladder (HR = 3.67; 95% CI, 2.25 to 5.99), head/neck (HR = 4.45; 95% CI, 2.56 to 7.73), and kidney cancers (HR = 5.33; 95% CI, 2.55 to 11.1). These estimates were similar to those for first smoking-associated cancer among all cohort participants (HR = 5.41; 95% CI, 5.23 to 5.61). The 5-year cumulative incidence of second smoking-associated cancers ranged from 3% to 8% in this group of cancer survivors. Conclusion Understanding risk factors for second cancers among cancer survivors is crucial. Our data indicate that cigarette smoking before first cancer diagnosis increases second cancer risk among cancer survivors, and elevated cancer risk in these survivors is likely due to increased smoking prevalence. The high 5-year cumulative risks of smoking-associated cancers among current smoking survivors of stage I lung, bladder, kidney, and head/neck cancers highlight the importance of smoking cessation in patients with cancer. PMID:25385740

Cigarette smoking prior to first cancer and risk of second smoking-associated cancers among survivors of bladder, kidney, head and neck, and stage I lung cancers.

PubMed

Shiels, Meredith S; Gibson, Todd; Sampson, Joshua; Albanes, Demetrius; Andreotti, Gabriella; Beane Freeman, Laura; Berrington de Gonzalez, Amy; Caporaso, Neil; Curtis, Rochelle E; Elena, Joanne; Freedman, Neal D; Robien, Kim; Black, Amanda; Morton, Lindsay M

2014-12-10

Data on smoking and second cancer risk among cancer survivors are limited. We assessed associations between smoking before first cancer diagnosis and risk of second primary smoking-associated cancers among survivors of lung (stage I), bladder, kidney, and head/neck cancers. Data were pooled from 2,552 patients with stage I lung cancer, 6,386 with bladder cancer, 3,179 with kidney cancer, and 2,967 with head/neck cancer from five cohort studies. We assessed the association between prediagnostic smoking and second smoking-associated cancer risk with proportional hazards regression, and compared these estimates to those for first smoking-associated cancers in all cohort participants. Compared with never smoking, current smoking of ≥ 20 cigarettes per day was associated with increased second smoking-associated cancer risk among survivors of stage I lung (hazard ratio [HR] = 3.26; 95% CI, 0.92 to 11.6), bladder (HR = 3.67; 95% CI, 2.25 to 5.99), head/neck (HR = 4.45; 95% CI, 2.56 to 7.73), and kidney cancers (HR = 5.33; 95% CI, 2.55 to 11.1). These estimates were similar to those for first smoking-associated cancer among all cohort participants (HR = 5.41; 95% CI, 5.23 to 5.61). The 5-year cumulative incidence of second smoking-associated cancers ranged from 3% to 8% in this group of cancer survivors. Understanding risk factors for second cancers among cancer survivors is crucial. Our data indicate that cigarette smoking before first cancer diagnosis increases second cancer risk among cancer survivors, and elevated cancer risk in these survivors is likely due to increased smoking prevalence. The high 5-year cumulative risks of smoking-associated cancers among current smoking survivors of stage I lung, bladder, kidney, and head/neck cancers highlight the importance of smoking cessation in patients with cancer. © 2014 by American Society of Clinical Oncology.

Comparison of Measured and Predicted Bioconcentration Estimates of Pharmaceuticals in Fish Plasma and Prediction of Chronic Risk.

PubMed

Nallani, Gopinath; Venables, Barney; Constantine, Lisa; Huggett, Duane

2016-05-01

Evaluation of the environmental risk of human pharmaceuticals is now a mandatory component in all new drug applications submitted for approval in EU. With >3000 drugs currently in use, it is not feasible to test each active ingredient, so prioritization is key. A recent review has listed nine prioritization approaches including the fish plasma model (FPM). The present paper focuses on comparison of measured and predicted fish plasma bioconcentration factors (BCFs) of four common over-the-counter/prescribed pharmaceuticals: norethindrone (NET), ibuprofen (IBU), verapamil (VER) and clozapine (CLZ). The measured data were obtained from the earlier published fish BCF studies. The measured BCF estimates of NET, IBU, VER and CLZ were 13.4, 1.4, 0.7 and 31.2, while the corresponding predicted BCFs (based log Kow at pH 7) were 19, 1.0, 7.6 and 30, respectively. These results indicate that the predicted BCFs matched well the measured values. The BCF estimates were used to calculate the human: fish plasma concentration ratios of each drug to predict potential risk to fish. The plasma ratio results show the following order of risk potential for fish: NET > CLZ > VER > IBU. The FPM has value in prioritizing pharmaceutical products for ecotoxicological assessments.

A systematic review of waterborne disease burden methodologies from developed countries.

PubMed

Murphy, H M; Pintar, K D M; McBean, E A; Thomas, M K

2014-12-01

The true incidence of endemic acute gastrointestinal illness (AGI) attributable to drinking water in Canada is unknown. Using a systematic review framework, the literature was evaluated to identify methods used to attribute AGI to drinking water. Several strategies have been suggested or applied to quantify AGI attributable to drinking water at a national level. These vary from simple point estimates, to quantitative microbial risk assessment, to Monte Carlo simulations, which rely on assumptions and epidemiological data from the literature. Using two methods proposed by researchers in the USA, this paper compares the current approaches and key assumptions. Knowledge gaps are identified to inform future waterborne disease attribution estimates. To improve future estimates, there is a need for robust epidemiological studies that quantify the health risks associated with small, private water systems, groundwater systems and the influence of distribution system intrusions on risk. Quantification of the occurrence of enteric pathogens in water supplies, particularly for groundwater, is needed. In addition, there are unanswered questions regarding the susceptibility of vulnerable sub-populations to these pathogens and the influence of extreme weather events (precipitation) on AGI-related health risks. National centralized data to quantify the proportions of the population served by different water sources, by treatment level, source water quality, and the condition of the distribution system infrastructure, are needed.

Disabling and fatal occupational claim rates, risks, and costs in the Oregon construction industry 1990-1997.

PubMed

Horwitz, Irwin B; McCall, Brian P

2004-10-01

This study estimated injury and illness rates, risk factors, and costs associated with construction work in Oregon from 1990-1997 using all accepted workers' compensation claims by Oregon construction employees (N = 20,680). Claim rates and risk estimates were estimated using a baseline calculated from Current Population Survey data of the Oregon workforce. The average annual rate of lost-time claims was 3.5 per 100 workers. More than 50% of claims were by workers under 35 years and with less than 1 year of tenure. The majority of claimants (96.1%) were male. There were 52 total fatalities reported over the period examined, representing an average annual death rate of 8.5 per 100,000 construction workers. Average claim cost was $10,084 and mean indemnity time was 57.3 days. Structural metal workers had the highest average days of indemnity of all workers (72. 1), highest average costs per claim ($16,472), and highest odds ratio of injury of all occupations examined. Sprains were the most frequently reported injury type, constituting 46.4% of all claims. The greatest accident risk occurred during the third hour of work. Training interventions should be extensively utilized for inexperienced workers, and prework exercises could potentially reduce injury frequency and severity.

Lifecourse educational status in relation to weight gain in African American women

PubMed Central

Coogan, Patricia F.; Wise, Lauren A.; Cozier, Yvette C.; Palmer, Julie R.; Rosenberg, Lynn

2013-01-01

Objectives Childhood disadvantage has been associated with increased risk of obesity from childhood through adulthood and those who are disadvantaged across the lifecourse are at highest risk. The effect of lifecourse socioeconomic status (SES) is particularly important for black women due to the higher prevalence of low SES and obesity in black compared to white women. We assessed associations of lifecourse SES, as indicated by educational status, with adult weight in African American women. Design We assessed the associations of parental education, current education (education of participant or her spouse), and a combination of parental and current education (lifecourse education) with weight gain among 21,457 women aged less than age 55 in the longitudinal Black Women’s Health Study which began in 1995. Main Outcome Measures We estimated the mean difference in weight gain between age 18 and age in 2009, and risk ratios for obesity in 2009, in each level of education compared to the highest level (college graduate). Results The age- and height-adjusted differences in mean weight gain for the lowest levels of parental and current education compared to the highest levels were 3.29 and 4.49 kg, respectively. The age-adjusted risk ratios for obesity for the lowest level of parental and current education were 1.44 (95% CI 1.32-1.57) and 1.75 (95% CI 1.57-1.95), respectively. Risk of obesity for was lowest among those with current education of college graduate, regardless of parental education. Conclusions Educational level of college graduate may overcome the adverse effects of low parental education on weight gain and obesity risk. PMID:22764643

Comparative Probabilistic Assessment of Occupational Pesticide Exposures Based on Regulatory Assessments

PubMed Central

Pouzou, Jane G.; Cullen, Alison C.; Yost, Michael G.; Kissel, John C.; Fenske, Richard A.

2018-01-01

Implementation of probabilistic analyses in exposure assessment can provide valuable insight into the risks of those at the extremes of population distributions, including more vulnerable or sensitive subgroups. Incorporation of these analyses into current regulatory methods for occupational pesticide exposure is enabled by the exposure data sets and associated data currently used in the risk assessment approach of the Environmental Protection Agency (EPA). Monte Carlo simulations were performed on exposure measurements from the Agricultural Handler Exposure Database and the Pesticide Handler Exposure Database along with data from the Exposure Factors Handbook and other sources to calculate exposure rates for three different neurotoxic compounds (azinphos methyl, acetamiprid, emamectin benzoate) across four pesticide-handling scenarios. Probabilistic estimates of doses were compared with the no observable effect levels used in the EPA occupational risk assessments. Some percentage of workers were predicted to exceed the level of concern for all three compounds: 54% for azinphos methyl, 5% for acetamiprid, and 20% for emamectin benzoate. This finding has implications for pesticide risk assessment and offers an alternative procedure that may be more protective of those at the extremes of exposure than the current approach. PMID:29105804

Normalized dose data for upper gastrointestinal tract contrast studies performed to infants

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

Damilakis, John; Stratakis, John; Raissaki, Maria

The aim of the current study was to (a) provide normalized dose data for the estimation of the radiation dose from upper gastrointestinal tract contrast (UGIC) studies carried out to infants and (b) estimate the average patient dose and risks associated with radiation from UGIC examinations performed in our institution. Organ and effective doses, normalized to entrance skin dose (ESD) and dose area product (DAP) were estimated for UGIC procedures utilizing the Monte Carlo N-particle (MCNP) transport code and two mathematical phantoms, one corresponding to the size of a newborn and one to the size of a 1-year-old child. Themore » validity of the MCNP results was verified by comparison with dose data obtained in physical anthropomorphic phantoms simulating a newborn and a 1-year-old infant using thermoluminescence dosimetry (TLD). Data were also collected from 25 consecutive UGIC examinations performed to infants. Study participants were (a) 12 infants aged from 0.5 to 5.9 months (group 1) and (b) 13 infants aged from 6 to 15 months (group 2). For each examination, ESD and dose to comforters were measured using TLD. Patient effective doses were estimated using normalized dose data obtained in the simulation study. The risk for fatal cancer induction was estimated using appropriate coefficients. The results consist of tabulated dose data normalized to ESD or DAP for the estimation of patient dose. Conversion coefficients were estimated for various tube potentials and beam filtration values. The mean total fluoroscopy time was 1.26 and 1.62 min for groups 1 and 2, respectively. The average effective dose was 1.6 mSv for group 1 and 1.9 mSv for group 2. The risk of cancer attributable to the radiation exposure associated with a typical UGIC study was found to be up to 3 per 10 000 infants undergoing an UGIC examination. The mean radiation dose absorbed by the hands of comforters was 47 {mu}Gy. In conclusion, estimation of radiation doses associated with UGIC studies performed to infants can be made using the normalized dose data provided in the current study. Radiation dose values associated with UGIC examinations carried out to infants are not low and should be minimized as much as possible.« less

Risk analysis of earth return options for the Mars rover/sample return mission

NASA Technical Reports Server (NTRS)

1988-01-01

Four options for return of a Mars surface sample to Earth were studied to estimate the risk of mission failure and the risk of a sample container breach that might result in the release of Martian life forms, should such exist, in the Earth's biosphere. The probabilities calculated refer only to the time period from the last midcourse correction burn to possession of the sample on Earth. Two extreme views characterize this subject. In one view, there is no life on Mars, therefore there is no significant risk and no serious effort is required to deal with back contamination. In the other view, public safety overrides any desire to return Martian samples, and any risk of damaging contamination greater than zero is unacceptable. Zero risk requires great expense to achieve and may prevent the mission as currently envisioned from taking place. The major conclusion is that risk of sample container breach can be reduced to a very low number within the framework of the mission as now envisioned, but significant expense and effort, above that currently planned is needed. There are benefits to the public that warrant some risk. Martian life, if it exists, will be a major discovery. If it does not, there is no risk.

A Review on Automatic Mammographic Density and Parenchymal Segmentation

PubMed Central

He, Wenda; Juette, Arne; Denton, Erika R. E.; Oliver, Arnau

2015-01-01

Breast cancer is the most frequently diagnosed cancer in women. However, the exact cause(s) of breast cancer still remains unknown. Early detection, precise identification of women at risk, and application of appropriate disease prevention measures are by far the most effective way to tackle breast cancer. There are more than 70 common genetic susceptibility factors included in the current non-image-based risk prediction models (e.g., the Gail and the Tyrer-Cuzick models). Image-based risk factors, such as mammographic densities and parenchymal patterns, have been established as biomarkers but have not been fully incorporated in the risk prediction models used for risk stratification in screening and/or measuring responsiveness to preventive approaches. Within computer aided mammography, automatic mammographic tissue segmentation methods have been developed for estimation of breast tissue composition to facilitate mammographic risk assessment. This paper presents a comprehensive review of automatic mammographic tissue segmentation methodologies developed over the past two decades and the evidence for risk assessment/density classification using segmentation. The aim of this review is to analyse how engineering advances have progressed and the impact automatic mammographic tissue segmentation has in a clinical environment, as well as to understand the current research gaps with respect to the incorporation of image-based risk factors in non-image-based risk prediction models. PMID:26171249

Effect of increased concentrations of atmospheric carbon dioxide on the global threat of zinc deficiency: a modelling study.

PubMed

Myers, Samuel S; Wessells, K Ryan; Kloog, Itai; Zanobetti, Antonella; Schwartz, Joel

2015-10-01

Increasing concentrations of atmospheric carbon dioxide (CO2) lower the content of zinc and other nutrients in important food crops. Zinc deficiency is currently responsible for large burdens of disease globally, and the populations who are at highest risk of zinc deficiency also receive most of their dietary zinc from crops. By modelling dietary intake of bioavailable zinc for the populations of 188 countries under both an ambient CO2 and elevated CO2 scenario, we sought to estimate the effect of anthropogenic CO2 emissions on the global risk of zinc deficiency. We estimated per capita per day bioavailable intake of zinc for the populations of 188 countries at ambient CO2 concentrations (375-384 ppm) using food balance sheet data for 2003-07 from the Food and Agriculture Organization. We then used previously published data from free air CO2 enrichment and open-top chamber experiments to model zinc intake at elevated CO2 concentrations (550 ppm, which is the concentration expected by 2050). Estimates developed by the International Zinc Nutrition Consultative Group were used for country-specific theoretical mean daily per-capita physiological requirements for zinc. Finally, we used these data on zinc bioavailability and population-weighted estimated average zinc requirements to estimate the risk of inadequate zinc intake among the populations of the different nations under the two scenarios (ambient and elevated CO2). The difference between the population at risk at elevated and ambient CO2 concentrations (ie, population at new risk of zinc deficiency) was our measure of impact. The total number of people estimated to be placed at new risk of zinc deficiency by 2050 was 138 million (95% CI 120-156). The people likely to be most affected live in Africa and South Asia, with nearly 48 million (32-63) residing in India alone. Global maps of increased risk show significant heterogeneity. Our results indicate that one heretofore unquantified human health effect associated with anthropogenic CO2 emissions will be a significant increase in the human population at risk of zinc deficiency. Our country-specific findings can be used to help guide interventions aimed at reducing this vulnerability. Bill & Melinda Gates Foundation, Winslow Foundation. Copyright © 2015 Myers et al. Open access article published under the terms of CC BY-NC-ND. Published by Elsevier Ltd.. All rights reserved.

Framingham risk score for estimation of 10-years of cardiovascular diseases risk in patients with metabolic syndrome.

PubMed

Jahangiry, Leila; Farhangi, Mahdieh Abbasalizad; Rezaei, Fatemeh

2017-11-13

There are a few studies evaluating the predictive value of Framingham risk score (FRS) for cardiovascular disease (CVD) risk assessment in patients with metabolic syndrome in Iran. Because of the emerging high prevalence of CVD among Iranian population, it is important to predict its risk among populations with potential predictive tools. Therefore, the aim of the current study is to evaluate the FRS and its determinants in patients with metabolic syndrome. In the current cross-sectional study, 160 patients with metabolic syndrome diagnosed according to the National Cholesterol Education Adult Treatment Panel (ATP) III criteria were enrolled. The FRS was calculated using a computer program by a previously suggested algorithm. Totally, 77.5, 16.3, and 6.3% of patients with metabolic syndrome were at low, intermediate, and high risk of CVD according to FRS categorization. The highest prevalence of all of metabolic syndrome components were in low CVD risk according to the FRS grouping (P < 0.05), while the lowest prevalence of these components was in high CVD risk group (P < 0.05). According to multiple logistic regression analysis, high systolic blood pressure (SBP) and fasting serum glucose (FSG) were potent determinants of intermediate and high risk CVD risk of FRS scoring compared with low risk group (P < 0.05). In the current study, significant associations between components of metabolic syndrome and different FRS categorization among patients with metabolic syndrome were identified. High SBP and FSG were associated with meaningfully increased risk of CVD compared with other parameters. The study is not a trial; the registration number is not applicable.

Mental Disorder Symptoms among Public Safety Personnel in Canada.

PubMed

Carleton, R Nicholas; Afifi, Tracie O; Turner, Sarah; Taillieu, Tamara; Duranceau, Sophie; LeBouthillier, Daniel M; Sareen, Jitender; Ricciardelli, Rose; MacPhee, Renee S; Groll, Dianne; Hozempa, Kadie; Brunet, Alain; Weekes, John R; Griffiths, Curt T; Abrams, Kelly J; Jones, Nicholas A; Beshai, Shadi; Cramm, Heidi A; Dobson, Keith S; Hatcher, Simon; Keane, Terence M; Stewart, Sherry H; Asmundson, Gordon J G

2018-01-01

Canadian public safety personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police officers) are exposed to potentially traumatic events as a function of their work. Such exposures contribute to the risk of developing clinically significant symptoms related to mental disorders. The current study was designed to provide estimates of mental disorder symptom frequencies and severities for Canadian PSP. An online survey was made available in English or French from September 2016 to January 2017. The survey assessed current symptoms, and participation was solicited from national PSP agencies and advocacy groups. Estimates were derived using well-validated screening measures. There were 5813 participants (32.5% women) who were grouped into 6 categories (i.e., call center operators/dispatchers, correctional workers, firefighters, municipal/provincial police, paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported current symptoms consistent with 1 (i.e., 15.1%) or more (i.e., 26.7%) mental disorders based on the screening measures. There were significant differences across PSP categories with respect to proportions screening positive based on each measure. The estimated proportion of PSP reporting current symptom clusters consistent with 1 or more mental disorders appears higher than previously published estimates for the general population; however, direct comparisons are impossible because of methodological differences. The available data suggest that Canadian PSP experience substantial and heterogeneous difficulties with mental health and underscore the need for a rigorous epidemiologic study and category-specific solutions.

Risk Assessment of Hurricane Storm Surge for Tampa Bay

NASA Astrophysics Data System (ADS)

Lin, N.; Emanuel, K.

2011-12-01

Hurricane storm surge presents a major hazard for the United States and many other coastal areas around the world. Risk assessment of current and future hurricane storm surge provides the basis for risk mitigation and related decision making. This study investigates the hurricane surge risk for Tampa Bay, located on the central west coast of Florida. Although fewer storms have made landfall in the central west Florida than in regions farther west in the Gulf of Mexico and the east coast of U.S., Tampa Bay is highly vulnerable to storm surge due to its geophysical features. It is surrounded by low-lying lands, much of which may be inundated by a storm tide of 6 m. Also, edge waves trapped on the west Florida shelf can propagate along the coastline and affect the sea level outside the area of a forced storm surge; Tampa Bay may be affected by storms traversing some distance outside the Bay. Moreover, when the propagation speed of the edge wave is close to that of a storm moving parallel to the coast, resonance may occur and the water elevation in the Bay may be greatly enhanced. Therefore, Tampa Bay is vulnerable to storms with a broad spectrum of characteristics. We apply a model-based risk assessment method to carry out the investigation. To estimate the current surge risk, we apply a statistical/deterministic hurricane model to generate a set of 1500 storms for the Tampa area, under the observed current climate (represented by 1981-2000 statistics) estimated from the NCAR/NCEP reanalysis. To study the effect of climate change, we use four climate models, CNRM-CM3, ECHAM, GFDL-CM2.0, and MIROC3.2, respectively, to drive the hurricane model to generate four sets of 1500 Tampa storms under current climate conditions (represented by 1981-2000 statistics) and another four under future climate conditions of the IPCC-AR4 A1B emission scenario (represented by 2081-2100 statistics). Then, we apply two hydrodynamic models, the Advanced Circulation (ADCIRC) model and the Sea, Lake, and Overland Surges from Hurricanes (SLOSH) model with grids of various resolutions to simulate the surges induced by the synthetic storms. The surge risk under each of the climate scenarios is depicted by a surge return level curve (exceedance probability curve). For the city of Tampa, the heights of the 100-year, 500-year, and 1000-year surges under the current climate are estimated to be 3.85, 5.66, and 6.31 m, respectively. Two of the four climate models predict that surge return periods will be significantly shortened in the future climates due to the change of storm climatology; the current 100-year surge may happen every 50 years or less, the 500-year surge every 200 years or less, and the 1000-year surge every 300 years or less. The other two climate models predict that the surge return periods will become moderately shorter or remain almost unchanged in the future climates. Extreme surges up to 12 m at Tampa appear in our simulations. Although occurring with very small probabilities, these extreme surges would have a devastating impact on the Tampa Bay area. By examining the generated synthetic surge database, we study the characteristics of the extreme storms at Tampa Bay, especially for the storms that may interact with edge waves along the Florida west coast.

Skin cancer and inorganic arsenic: uncertainty-status of risk.

PubMed

Brown, K G; Guo, H R; Kuo, T L; Greene, H L

1997-02-01

The current U.S. EPA standard for inorganic arsenic in drinking water is 50 ppb (microgram/L), dating to the National Interim Primary Drinking Water Regulation of 1976. The current EPA risk analysis predicts an increased lifetime skin cancer risk on the order of 3 or 4 per 1000 from chronic exposure at that concentration. Revision of the standard to only a few ppb, perhaps even less than 1 ppb, may be indicated by the EPA analysis to reduce the lifetime risk to an acceptable level. The cost to water utilities, and ultimately to their consumers, to conform to such a large reduction in the standard could easily reach several billion dollars, so it is particularly important to assess accurately the current risk and the risk reduction that would be achieved by a lower standard. This article addresses the major sources of uncertainty in the EPA analysis with respect to this objective. Specifically, it focuses on uncertainty and variability in the exposure estimates for the landmark study of Tseng and colleagues in Taiwan, analyzed using a reconstruction of the their exposure data. It is concluded that while the available dataset is suitable to establish the hazard of skin cancer, it is too highly summarized for reliable dose-response assessment. A new epidemiologic study is needed, designed for the requirements of dose-response assessment.

Confounding of the Association between Radiation Exposure from CT Scans and Risk of Leukemia and Brain Tumors by Cancer Susceptibility Syndromes.

PubMed

Meulepas, Johanna M; Ronckers, Cécile M; Merks, Johannes; Weijerman, Michel E; Lubin, Jay H; Hauptmann, Michael

2016-01-01

Recent studies linking radiation exposure from pediatric computed tomography (CT) to increased risks of leukemia and brain tumors lacked data to control for cancer susceptibility syndromes (CSS). These syndromes might be confounders because they are associated with an increased cancer risk and may increase the likelihood of CT scans performed in children. We identify CSS predisposing to leukemia and brain tumors through a systematic literature search and summarize prevalence and risk estimates. Because there is virtually no empirical evidence in published literature on patterns of CT use for most types of CSS, we estimate confounding bias of relative risks (RR) for categories of radiation exposure based on expert opinion about the current and previous patterns of CT scans among CSS patients. We estimate that radiation-related RRs for leukemia are not meaningfully confounded by Down syndrome, Noonan syndrome, or other CSS. In contrast, RRs for brain tumors may be overestimated due to confounding by tuberous sclerosis complex (TSC) while von Hippel-Lindau disease, neurofibromatosis type 1, or other CSS do not meaningfully confound. Empirical data on the use of CT scans among CSS patients are urgently needed. Our assessment indicates that associations with leukemia reported in previous studies are unlikely to be substantially confounded by unmeasured CSS, whereas brain tumor risks might have been overestimated due to confounding by TSC. Future studies should identify TSC patients in order to avoid overestimation of brain tumor risks due to radiation exposure from CT scans. ©2015 American Association for Cancer Research.

Parental Predictions and Perceptions Regarding Long-Term Childhood Obesity-Related Health Risks

PubMed Central

Wright, Davene R.; Lozano, Paula; Dawson-Hahn, Elizabeth; Christakis, Dimitri A.; Haaland, Wren; Basu, Anirban

2016-01-01

Objectives To assess how parents perceive long-term risks for developing obesity-related chronic health conditions. Methods A web-based nationally representative survey was administered to 502 U.S. parents with a 5–12 year old child. Parents reported whether their child was most likely to be at a healthy weight or overweight, and the probability that their child would develop hypertension, heart disease, depression, or type 2 diabetes in adulthood. Responses of parents of children with overweight and obesity were compared to those of healthy weight children using multivariate models. Results The survey had an overall response rate of 39.2%. The mean (SD) unadjusted parent predicted health risks were 15.4% (17.7%), 11.2% (14.7%), 12.5% (16.2%), and 12.1% (16.1%) for hypertension, heart disease, depression, and diabetes, respectively. Despite under-perceiving their child’s current BMI class, parents of children with obesity estimate their children to be at greater risk for obesity-related health conditions than parents of healthy weight children by 5–6 percentage points. Having a family history of a chronic disease, higher quality of care, and older parent age were also significant predictors of estimating higher risk probabilities. Conclusions Despite evidence that parents of overweight children may not perceive these children as being overweight, parents unexpectedly estimate greater future risk of weight-related health conditions for these children. Focusing communication about weight on screening for and reducing the risk of weight-related diseases may prove useful in engaging parents and children in weight management PMID:26875508

Past history of skin infection and risk of surgical site infection after elective surgery.

PubMed

Faraday, Nauder; Rock, Peter; Lin, Elaina E; Perl, Trish M; Carroll, Karen; Stierer, Tracey; Robarts, Polly; McFillin, Angela; Ross, Tracy; Shah, Ashish S; Riley, Lee H; Tamargo, Rafael J; Black, James H; Blasco-Colmenares, Elena; Guallar, Eliseo

2013-01-01

To identify baseline patient characteristics associated with increased susceptibility to surgical site infection (SSI) after elective surgery. The Center for Medicare and Medicaid Services considers SSI to be preventable through adherence to current infection control practices; however, the etiology of wound infection is incompletely understood. Prospective cohort study involving patients undergoing cardiac, vascular, craniotomy, and spinal surgery at 2 academic medical centers in Baltimore, MD. A comprehensive medical history was obtained at baseline, and participants were followed for 6 months using active inpatient and outpatient surveillance for deep SSI and infectious death. Infection control best practices were monitored perioperatively. The relative risk of SSI/infectious death was determined comparing those with versus those without a past medical history of skin infection using Cox proportional hazards models. Of 613 patients (mean [SD] = 62.3 [11.5] years; 42.1% women), 22.0% reported a history of skin infection. The cumulative incidence of deep SSI/infectious death was 6.7% versus 3.1% for those with and without a history of skin infection, respectively (unadjusted hazard ratio (HR) = 2.25; 95% confidence interval (95% CI), 0.98-5.14; P = 0.055). Risk estimates increased after adjustments for demographic and socioeconomic variables (HR = 2.82; 95% CI, 1.18-6.74; P = 0.019) and after propensity score adjustment for all potential confounders (HR = 3.41; 95% CI, 1.36-8.59; P = 0.009). Adjustments for intraoperative infection risk factors and adherence to infection control best practice metrics had no impact on risk estimates. A history of skin infection identified a state of enhanced susceptibility to SSI at baseline that is independent of traditional SSI risk factors and adherence to current infection control practices.

Prediction of Waitlist Mortality in Adult Heart Transplant Candidates: The Candidate Risk Score.

PubMed

Jasseron, Carine; Legeai, Camille; Jacquelinet, Christian; Leprince, Pascal; Cantrelle, Christelle; Audry, Benoît; Porcher, Raphael; Bastien, Olivier; Dorent, Richard

2017-09-01

The cardiac allocation system in France is currently based on urgency and geography. Medical urgency is defined by therapies without considering objective patient mortality risk factors. This study aimed to develop a waitlist mortality risk score from commonly available candidate variables. The study included all patients, aged 16 years or older, registered on the national registry CRISTAL for first single-organ heart transplantation between January 2010 and December 2014. This population was randomly divided in a 2:1 ratio into derivation and validation cohorts. The association of variables at listing with 1-year waitlist death or delisting for worsening medical condition was assessed within the derivation cohort. The predictors were used to generate a candidate risk score (CRS). Validation of the CRS was performed in the validation cohort. Concordance probability estimation (CPE) was used to evaluate the discriminative capacity of the models. During the study period, 2333 patients were newly listed. The derivation (n =1 555) and the validation cohorts (n = 778) were similar. Short-term mechanical circulatory support, natriuretic peptide decile, glomerular filtration rate, and total bilirubin level were included in a simplified model and incorporated into the score. The Concordance probability estimation of the CRS was 0.73 in the derivation cohort and 0.71 in the validation cohort. The correlation between observed and expected 1-year waitlist mortality in the validation cohort was 0.87. The candidate risk score provides an accurate objective prediction of waitlist mortality. It is currently being used to develop a modified cardiac allocation system in France.

Psychiatric comorbidities in a community sample of women with fibromyalgia.

PubMed

Raphael, Karen G; Janal, Malvin N; Nayak, Sangeetha; Schwartz, Joseph E; Gallagher, Rollin M

2006-09-01

Prior studies of careseeking fibromyalgia (FM) patients often report that they have an elevated risk of psychiatric disorders, but biased sampling may distort true risk. The current investigation utilizes state-of-the-art diagnostic procedures for both FM and psychiatric disorders to estimate prevalence rates of FM and the comorbidity of FM and specific psychiatric disorders in a diverse community sample of women. Participants were screened by telephone for FM and MDD, by randomly selecting telephone numbers from a list of households with women in the NY/NJ metropolitan area. Eligible women were invited to complete physical examinations for FM and clinician-administered psychiatric interviews. Data were weighted to adjust for sampling procedures and population demographics. The estimated overall prevalence of FM among women in the NY/NJ metropolitan area was 3.7% (95% CI=3.2, 4.4), with higher rates among racial minorities. Although risk of current MDD was nearly 3-fold higher in community women with than without FM, the groups had similar risk of lifetime MDD. Risk of lifetime anxiety disorders, particularly obsessive compulsive disorder and post-traumatic stress disorder, was approximately 5-fold higher among women with FM. Overall, this study found a community prevalence for FM among women that replicates prior North American studies, and revealed that FM may be even more prevalent among racial minority women. These community-based data also indicate that the relationship between MDD and FM may be more complicated than previously thought, and call for an increased focus on anxiety disorders in FM.

Lung function decline over 25 years of follow-up among black and white adults in the ARIC study cohort.

PubMed

Mirabelli, Maria C; Preisser, John S; Loehr, Laura R; Agarwal, Sunil K; Barr, R Graham; Couper, David J; Hankinson, John L; Hyun, Noorie; Folsom, Aaron R; London, Stephanie J

2016-04-01

Interpretation of longitudinal information about lung function decline from middle to older age has been limited by loss to follow-up that may be correlated with baseline lung function or the rate of decline. We conducted these analyses to estimate age-related decline in lung function across groups of race, sex, and smoking status while accounting for dropout from the Atherosclerosis Risk in Communities Study. We analyzed data from 13,896 black and white participants, aged 45-64 years at the 1987-1989 baseline clinical examination. Using spirometry data collected at baseline and two follow-up visits, we estimated annual population-averaged mean changes in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) by race, sex, and smoking status using inverse-probability-weighted independence estimating equations conditioning-on-being-alive. Estimated rates of FEV1 decline estimated using inverse-probability-weighted independence estimating equations conditioning on being alive were higher among white than black participants at age 45 years (e.g., male never smokers: black: -29.5 ml/year; white: -51.9 ml/year), but higher among black than white participants by age 75 (black: -51.2 ml/year; white: -26). Observed differences by race were more pronounced among men than among women. By smoking status, FEV1 declines were larger among current than former or never smokers at age 45 across all categories of race and sex. By age 60, FEV1 decline was larger among former and never than current smokers. Estimated annual declines generated using unweighted generalized estimating equations were smaller for current smokers at younger ages in all four groups of race and sex compared with results from weighted analyses that accounted for attrition. Using methods accounting for dropout from an approximately 25-year health study, estimated rates of lung function decline varied by age, race, sex, and smoking status, with largest declines observed among current smokers at younger ages. Published by Elsevier Ltd.

Accessing Substance Abuse Prevention Programs for Schools

ERIC Educational Resources Information Center

Schroeder, Jennifer L.; Johnson, Gail E.

2009-01-01

Current estimates indicate that over 6 million children live with at least one parent who is a substance abuser or is substance dependent. Children who are exposed to drug and alcohol abuse are at a greater risk of experiencing academic and behavior difficulties. Additionally, several studies have shown that students with emotional and behavioral…

Genetic maladaptation of coastal Douglas-fir seedlings to future climates

Treesearch

Brad St. Clair;  Glenn T. Howe

2007-01-01

Climates are expected to warm considerably over the next century, resulting in expectations that plant populations will not be adapted to future climates.We estimated the risk of maladaptation of current populations of coastal Douglas-fir (Pseudotsuga menziesii var. menziesii) to future climates as the proportion of nonoverlap between two normal...

The Sonoma Water Evaluation Trial (SWET): A randomized drinking water intervention trial to reduce gastrointestinal illness in older adults

EPA Science Inventory

Objectives. We estimate the risk of highly credible gastrointestinal illness (HCGI) among adults 55 and older in a community drinking tap water meeting current U.S. standards. Methods. We conducted a randomized, triple-blinded, crossover trial in 714 households (988 indiv...

Personalized risk prediction of postoperative cognitive impairment - rationale for the EU-funded BioCog project.

PubMed

Winterer, G; Androsova, G; Bender, O; Boraschi, D; Borchers, F; Dschietzig, T B; Feinkohl, I; Fletcher, P; Gallinat, J; Hadzidiakos, D; Haynes, J D; Heppner, F; Hetzer, S; Hendrikse, J; Ittermann, B; Kant, I M J; Kraft, A; Krannich, A; Krause, R; Kühn, S; Lachmann, G; van Montfort, S J T; Müller, A; Nürnberg, P; Ofosu, K; Pietsch, M; Pischon, T; Preller, J; Renzulli, E; Scheurer, K; Schneider, R; Slooter, A J C; Spies, C; Stamatakis, E; Volk, H D; Weber, S; Wolf, A; Yürek, F; Zacharias, N

2018-04-01

Postoperative cognitive impairment is among the most common medical complications associated with surgical interventions - particularly in elderly patients. In our aging society, it is an urgent medical need to determine preoperative individual risk prediction to allow more accurate cost-benefit decisions prior to elective surgeries. So far, risk prediction is mainly based on clinical parameters. However, these parameters only give a rough estimate of the individual risk. At present, there are no molecular or neuroimaging biomarkers available to improve risk prediction and little is known about the etiology and pathophysiology of this clinical condition. In this short review, we summarize the current state of knowledge and briefly present the recently started BioCog project (Biomarker Development for Postoperative Cognitive Impairment in the Elderly), which is funded by the European Union. It is the goal of this research and development (R&D) project, which involves academic and industry partners throughout Europe, to deliver a multivariate algorithm based on clinical assessments as well as molecular and neuroimaging biomarkers to overcome the currently unsatisfying situation. Copyright © 2017. Published by Elsevier Masson SAS.

Radon exposure and the risk of leukemia: a review of epidemiological studies.

PubMed

Laurier, D; Valenty, M; Tirmarche, M

2001-09-01

Since the 1990's, several authors estimated that radon inhalation may deliver a small amount of irradiation to the red bone marrow, and consequently may increase the risk of leukemia in humans. The objective of this review is to conduct a critical analysis of epidemiologic results currently available concerning the relationship between radon exposure and the risk of leukemia. Nineteen ecological studies, six miner cohort studies, and eight case-control studies published between 1987 and 2000 are included in this review. The limitations associated with each of these studies are discussed. The results of the ecological studies are relatively concordant and suggest an association between radon concentrations and the risk of leukemia at a geographic level. But these ecological studies present important limitations, and some are only crude analyses. Moreover, the results of the cohort and case-control studies, based on individual data, do not show any significant association between radon exposure and leukemia risk. Our conclusion is that the overall epidemiologic results currently available do not provide evidence for an association between radon exposure and leukemia.

Issues of Fish Consumption for Cardiovascular Disease Risk Reduction

PubMed Central

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

2013-01-01

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

Is the shape of the decline in risk following quitting smoking similar for squamous cell carcinoma and adenocarcinoma of the lung? A quantitative review using the negative exponential model.

PubMed

Fry, John S; Lee, Peter N; Forey, Barbara A; Coombs, Katharine J

2015-06-01

One possible contributor to the reported rise in the ratio of adenocarcinoma to squamous cell carcinoma of the lung may be differences in the pattern of decline in risk following quitting for the two lung cancer types. Earlier, using data from 85 studies comparing overall lung cancer risks in current smokers, quitters (by time quit) and never smokers, we fitted the negative exponential model, deriving an estimate of 9.93years for the half-life - the time when the excess risk for quitters compared to never smokers becomes half that for continuing smokers. Here we applied the same techniques to data from 16 studies providing RRs specific for lung cancer type. From the 13 studies where the half-life was estimable for each type, we derived estimates of 11.68 (95% CI 10.22-13.34) for squamous cell carcinoma and 14.45 (11.92-17.52) for adenocarcinoma. The ratio of the half-lives was estimated as 1.32 (95% CI 1.20-1.46, p<0.001). The slower decline in quitters for adenocarcinoma, evident in subgroups by sex, age and other factors, may be one of the factors contributing to the reported rise in the ratio of adenocarcinoma to squamous cell carcinoma. Others include changes in the diagnosis and classification of lung cancer. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Crude estimates of cannabis-attributable mortality and morbidity in Canada-implications for public health focused intervention priorities.

PubMed

Fischer, Benedikt; Imtiaz, Sameer; Rudzinski, Katherine; Rehm, Jürgen

2016-03-01

Cannabis is the most commonly used drug in Canada; while its use is currently controlled by criminal prohibition, debates about potential control reforms are intensifying. There is substantive evidence about cannabis-related risks to health in various key outcome domains; however, little is known about the actual extent of these harms specifically in Canada. Based on epidemiological data (e.g. prevalence of relevant cannabis use rates and relevant risk behaviors; risk ratios; and annual numbers of morbidity/mortality cases in relevant domains), and applying the methodology of comparative risk assessment, we estimated attributable fractions for cannabis-related morbidity and mortality, specifically for: (i) motor-vehicle accidents (MVAs); (ii) use disorders; (iii) mental health (psychosis) and (iv) lung cancer. MVAs and lung cancer are the only domains where cannabis-attributable mortality is estimated to occur. While cannabis use results in morbidity in all domains, MVAs and use disorders by far outweigh the other domains in the number of cases; the popularly debated mental health consequences (e.g., psychosis) translate into relatively small case numbers. The present crude estimates should guide and help prioritize public health-oriented interventions for the cannabis-related health burden in the population in Canada; formal burden of disease calculations should be conducted. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Malignant pleural mesothelioma in US automotive mechanics: reported vs expected number of cases from 1975 to 2007.

PubMed

Finley, Brent L; Pierce, Jennifer S; Paustenbach, Dennis J; Scott, Laura L F; Lievense, Laura; Scott, Paul K; Galbraith, David A

2012-10-01

Until the 1980s, chrysotile asbestos was a component of automotive brakes manufactured in the US. The current OSHA Bulletin (2006) for brake repair cites a single study (Lemen, 2004) which concluded that the number of mesothelioma cases reported in the literature in "end-product users of friction materials" indicated an asbestos-related risk for auto mechanics. However, Lemen (2004) did not compare the reported number of cases to an "expected" value, even though pleural mesothelioma occurs in the general population in the absence of asbestos exposure. We compare the number of malignant pleural mesothelioma (MPM) cases reported in the US literature among auto mechanics between 1975-2007 to an expected value derived from estimated numbers of current and former auto mechanics. A total of 106 cases categorized as mesothelioma or malignant neoplasm of the pleura were found in the literature. Using background incidence rates for MPM of two and three cases per million individuals per year, we estimated that a range of 278-515 cases of non-asbestos-related MPM, respectively, would have occurred in current or former auto mechanics from 1975-2007. Our findings are consistent with the numerous epidemiology studies that have found no increased risk of MPM in auto mechanics. Copyright © 2012 Elsevier Inc. All rights reserved.

Lung Cancer Risk from Plutonium: A Pooled Analysis of the Mayak and Sellafield Worker Cohorts.

PubMed

Gillies, Michael; Kuznetsova, Irina; Sokolnikov, Mikhail; Haylock, Richard; O'Hagan, Jackie; Tsareva, Yulia; Labutina, Elena

2017-12-01

In this study, lung cancer risk from occupational plutonium exposure was analyzed in a pooled cohort of Mayak and Sellafield workers, two of the most informative cohorts in the world with detailed plutonium urine monitoring programs. The pooled cohort comprised 45,817 workers: 23,443 Sellafield workers first employed during 1947-2002 with follow-up until the end of 2005 and 22,374 Mayak workers first employed during 1948-1982 with follow-up until the end of 2008. In the pooled cohort 1,195 lung cancer deaths were observed (789 Mayak, 406 Sellafield) but only 893 lung cancer incidences (509 Mayak, 384 Sellafield, due to truncated follow-up in the incidence analysis). Analyses were performed using Poisson regression models, and were based on doses derived from individual radiation monitoring data using an updated dose assessment methodology developed in the study. There was clear evidence of a linear association between cumulative internal plutonium lung dose and risk of both lung cancer mortality and incidence in the pooled cohort. The pooled point estimates of the excess relative risk (ERR) from plutonium exposure for both lung cancer mortality and incidence were within the range of 5-8 per Gy for males at age 60. The ERR estimates in relationship to external gamma radiation were also significantly raised and in the range 0.2-0.4 per Gy of cumulative gamma dose to the lung. The point estimates of risk, for both external and plutonium exposure, were comparable between the cohorts, which suggests that the pooling of these data was valid. The results support point estimates of relative biological effectiveness (RBE) in the range of 10-25, which is in broad agreement with the value of 20 currently adopted in radiological protection as the radiation weighting factor for alpha particles, however, the uncertainty on this value (RBE = 21; 95% CI: 9-178) is large. The results provide direct evidence that the plutonium risks in each cohort are of the same order of magnitude but the uncertainty on the Sellafield cohort plutonium risk estimates is large, with observed risks consistent with no plutonium risk, and risks five times larger than those observed in the Mayak cohort.

Association between dietary fiber and endometrial cancer: a dose-response meta-analysis123

PubMed Central

Bandera, Elisa V; Kushi, Lawrence H; Moore, Dirk F; Gifkins, Dina M; McCullough, Marjorie L

2008-01-01

Background Endometrial cancer is the most common female gynecologic cancer in the United States. Excessive and prolonged exposure of the endometrium to estrogens unopposed by progesterone and a high body mass are well-established risk factors for endometrial cancer. Although dietary fiber has been shown to beneficially reduce estrogen concentrations and prevent obesity, its role in endometrial cancer has received relatively little attention. Objective The objective was to summarize and quantify the current evidence of a role of dietary fiber consumption in endometrial cancer risk and to identify research gaps in this field. Design We conducted a systematic literature review of articles published through February 2007 to summarize the current evidence of a relation between dietary fiber consumption and endometrial cancer risk and to quantify the magnitude of the association by conducting a dose-response meta-analysis. Results Ten articles representing 1 case-cohort study and 9 case-control studies that evaluated several aspects of fiber consumption and endometrial cancer risk were identified through searches in various databases. On the basis of 7 case-control studies, the random-effects summary risk estimate was 0.82 (95% CI: 0.75, 0.90) per 5 g/1000 kcal dietary fiber, with no evidence of heterogeneity (I2: 0%, P for heterogeneity: 0.55). The random-effects summary estimate was 0.71 (95% CI: 0.59, 0.85) for the comparison of the highest with the lowest dietary fiber intake in 8 case-control studies, with little evidence of heterogeneity (I2: 20.8%, P for heterogeneity: 0.26). In contrast, the only prospective study that evaluated this association did not find an association. Conclusions Although the current evidence, based on data from case-control studies, supports an inverse association between dietary fiber and endometrial cancer, additional population-based studies, particularly cohort studies, are needed before definitive conclusions can be drawn. PMID:18065593

Smoking and subsequent human papillomavirus infection: a mediation analysis.

PubMed

Eldridge, Ronald C; Pawlita, Michael; Wilson, Lauren; Castle, Philip E; Waterboer, Tim; Gravitt, Patti E; Schiffman, Mark; Wentzensen, Nicolas

2017-11-01

Smoking is an established risk factor for a human papillomavirus (HPV) infection advancing to cervical precancer and cancer, but its role earlier in the natural history is less clear. Smoking is inversely associated with possessing HPV antibodies from a past infection suggesting that smoking may influence acquiring subsequent infections. In a cohort of 1976 U.S. women, we evaluate whether reduced antibodies to HPV-16 is a mechanism for smoking's role on acquiring a subsequent HPV-16 infection, through the analytic technique of causal mediation analysis. We posit a causal model and estimate two counterfactually defined effects: a smoking impaired antibody-mediated indirect effect and a nonmediated direct effect representing all other potential mechanisms of smoking. Compared to never smokers, current smokers had increased odds of HPV-16 infection by the antibody-mediated indirect effect (odds ratio [OR] = 1.29; 95% confidence interval [CI]: 1.11, 1.73); the estimated direct effect was very imprecise (OR = 0.57; 95% CI, 0.26-1.13). We observed a stronger estimated indirect effect among women who smoked at least half a pack of cigarettes daily (OR = 1.61, 95% CI, 1.27-2.15) than among women who smoked less than that threshold (OR = 1.09; 95% CI, 0.94-1.44). This is the first study to directly test the mechanism underlying smoking as an HPV cofactor. The results support current smoking as a risk factor earlier in the natural history of HPV and are consistent with the hypothesis that smoking increases the risk of a subsequent infection by reducing immunity. Published by Elsevier Inc.

The contribution to future flood risk in the Severn Estuary from extreme sea level rise due to ice sheet mass loss

NASA Astrophysics Data System (ADS)

Quinn, N.; Bates, P. D.; Siddall, M.

2013-12-01

The rate at which sea levels will rise in the coming century is of great interest to decision makers tasked with developing mitigation policies to cope with the risk of coastal inundation. Accurate estimates of future sea levels are vital in the provision of effective policy. Recent reports from UK Climate Impacts Programme (UKCIP) suggest that mean sea levels in the UK may rise by as much as 80 cm by 2100; however, a great deal of uncertainty surrounds model predictions, particularly the contribution from ice sheets responding to climatic warming. For this reason, the application of semi-empirical modelling approaches for sea level rise predictions has increased of late, the results from which suggest that the rate of sea level rise may be greater than previously thought, exceeding 1 m by 2100. Furthermore, studies in the Red Sea indicate that rapid sea level rise beyond 1m per century has occurred in the past. In light of such research, the latest UKCIP assessment has included a H++ scenario for sea level rise in the UK of up to 1.9 m which is defined as improbable but, crucially, physically plausible. The significance of such low-probability sea level rise scenarios upon the estimation of future flood risk is assessed using the Somerset levels (UK) as a case study. A simple asymmetric probability distribution is constructed to include sea level rise scenarios of up to 1.9 m by 2100 which are added to a current 1:200 year event water level to force a two-dimensional hydrodynamic model of coastal inundation. From the resulting ensemble predictions an estimation of risk by 2100 is established. The results indicate that although the likelihood of extreme sea level rise due to rapid ice sheet mass loss is low, the resulting hazard can be large, resulting in a significant (27%) increase to the projected annual risk. Furthermore, current defence construction guidelines for the coming century in the UK are expected to account for 95% of the sea level rise distribution presented in this research, while the larger, low probability scenarios beyond this level are estimated to contribute a residual annual risk of approximately £0.45 million. These findings clearly demonstrate that uncertainty in future sea level rise is a vital component of coastal flood risk, and therefore, needs to be accounted for by decision makers when considering mitigation policies related to coastal flooding.

Increasing stress on disaster risk finance due to large floods

NASA Astrophysics Data System (ADS)

Jongman, Brenden; Hochrainer-Stigler, Stefan; Feyen, Luc; Aerts, Jeroen; Mechler, Reinhard; Botzen, Wouter; Bouwer, Laurens; Pflug, Georg; Rojas, Rodrigo; Ward, Philip

2014-05-01

Recent major flood disasters have shown that single extreme events can affect multiple countries simultaneously, which puts high pressure on trans-national risk reduction and risk transfer mechanisms. To date, little is known about such flood hazard interdependencies across regions, and the corresponding joint risks at regional to continental scales. Reliable information on correlated loss probabilities is crucial for developing robust insurance schemes and public adaptation funds, and for enhancing our understanding of climate change impacts. Here we show that extreme discharges are strongly correlated across European river basins and that these correlations can, or should, be used in national to continental scale risk assessment. We present probabilistic trends in continental flood risk, and demonstrate that currently observed extreme flood losses could more than double in frequency by 2050 under future climate change and socioeconomic development. The results demonstrate that accounting for tail dependencies leads to higher estimates of extreme losses than estimates based on the traditional assumption of independence between basins. We suggest that risk management for these increasing losses is largely feasible, and we demonstrate that risk can be shared by expanding risk transfer financing, reduced by investing in flood protection, or absorbed by enhanced solidarity between countries. We conclude that these measures have vastly different efficiency, equity and acceptability implications, which need to be taken into account in broader consultation, for which our analysis provides a basis.

Estimating the risk of Amazonian forest dieback.

PubMed

Rammig, Anja; Jupp, Tim; Thonicke, Kirsten; Tietjen, Britta; Heinke, Jens; Ostberg, Sebastian; Lucht, Wolfgang; Cramer, Wolfgang; Cox, Peter

2010-08-01

*Climate change will very likely affect most forests in Amazonia during the course of the 21st century, but the direction and intensity of the change are uncertain, in part because of differences in rainfall projections. In order to constrain this uncertainty, we estimate the probability for biomass change in Amazonia on the basis of rainfall projections that are weighted by climate model performance for current conditions. *We estimate the risk of forest dieback by using weighted rainfall projections from 24 general circulation models (GCMs) to create probability density functions (PDFs) for future forest biomass changes simulated by a dynamic vegetation model (LPJmL). *Our probabilistic assessment of biomass change suggests a likely shift towards increasing biomass compared with nonweighted results. Biomass estimates range between a gain of 6.2 and a loss of 2.7 kg carbon m(-2) for the Amazon region, depending on the strength of CO(2) fertilization. *The uncertainty associated with the long-term effect of CO(2) is much larger than that associated with precipitation change. This underlines the importance of reducing uncertainties in the direct effects of CO(2) on tropical ecosystems.

Beyond Attributable Burden: Estimating the Avoidable Burden of Disease Associated with Household Air Pollution.

PubMed

Kuhn, Randall; Rothman, Dale S; Turner, Sara; Solórzano, José; Hughes, Barry

2016-01-01

The Global Burden of Disease (GBD) studies have transformed global understanding of health risks by producing comprehensive estimates of attributable disease burden, or the current disease that would be eliminated if a risk factor did not exist. Yet many have noted the greater policy significance of avoidable burden, or the future disease that could actually be eliminated if a risk factor were eliminated today. Avoidable risk may be considerably lower than attributable risk if baseline levels of exposure or disease are declining, or if a risk factor carries lagged effects on disease. As global efforts to deliver clean cookstoves accelerate, a temporal estimation of avoidable risk due to household air pollution (HAP) becomes increasingly important, particularly in light of the rapid uptake of modern stoves and ongoing epidemiologic transitions in regions like South and Southeast Asia. We estimate the avoidable burden associated with HAP using International Futures (IFs), an integrated forecasting system that has been used to model future global disease burdens and risk factors. Building on GBD and other estimates, we integrated a detailed HAP exposure estimation and exposure-response model into IFs. We then conducted a counterfactual experiment in which HAP exposure is reduced to theoretical minimum levels in 2015. We evaluated avoidable mortality and DALY reductions for the years 2015 to 2024 relative to a Base Case scenario in which only endogenous changes occurred. We present results by cause and region, looking at impacts on acute lower respiratory infection (ALRI) and four noncommunicable diseases (NCDs). We found that just 2.6% of global DALYs would be averted between 2015 and 2024, compared to 4.5% of global DALYs attributed to HAP in the 2010 GBD study, due in large part to the endogenous tendency towards declining traditional stove usage in the IFs base case forecast. The extent of diminished impact was comparable for ALRI and affected NCDs, though for different reasons. ALRI impacts diminish due to the declining burden of ALRI in the base case forecast, particularly apparent in South Asia and Southeast Asia. Although NCD burdens are rising in regions affected by HAP, the avoidable risk of NCD nonetheless diminishes due to lagged effects. Because the stove transition and the decline of ALRI are proceeding more slowly in Sub-Saharan Africa, avoidable impacts would also be more persistent (3.9% of total DALY due to HAP) compared to South Asia (3.6%) or Southeast Asia (2.5%). Our results illustrate how a temporal dynamic calculation of avoidable risk may yield different estimates, compared to a static attributable risk estimate, of the global and regional burden of disease. Our results suggest a window of rising and falling opportunity for HAP interventions that may have already closed in Southeast Asia and may be closing quickly in South Asia, but may remain open longer in Sub-Saharan Africa. A proper accounting of global health priorities should apply an avoidable risk framework that considers the role of ongoing social, economic and health transitions in constantly altering the disease and risk factor landscape.

Risk factors for opioid overdose and awareness of overdose risk among veterans prescribed chronic opioids for addiction or pain.

PubMed

Wilder, Christine M; Miller, Shannon C; Tiffany, Elizabeth; Winhusen, Theresa; Winstanley, Erin L; Stein, Michael D

2016-01-01

Rising overdose fatalities among U.S. veterans suggest veterans taking prescription opioids may be at risk for overdose. However, it is unclear whether veterans prescribed chronic opioids are aware of this risk. The objective of this study was to identify risk factors and determine awareness of risk for opioid overdose in veterans treated with opioids for chronic pain, using veterans treated with methadone or buprenorphine for opioid use disorder as a high-risk comparator group. In the current study, 90 veterans on chronic opioid medication, for either opioid use disorder or pain management, completed a questionnaire assessing risk factors, knowledge, and self-estimate of risk for overdose. Nearly all veterans in both groups had multiple overdose risk factors, although individuals in the pain management group had on average a significantly lower total number of risk factors than did individuals in the opioid use disorder group (5.9 versus 8.5, p < .0001). On average, participants treated for pain management scored slightly but significantly lower on knowledge of opioid overdose risk factors (12.1 versus 13.5, p < .01). About 70% of participants, regardless of group, believed their overdose risk was below that of the average American adult. There was no significant relationship between self-estimate of overdose risk and either number or knowledge of opioid overdose risk factors. Our results suggest that veterans in both groups underestimated their risk for opioid overdose. Expansion of overdose education to include individuals on chronic opioids for pain management and a shift in educational approaches to overdose prevention may be indicated.

Gene-by-Environment Interactions in Pancreatic Cancer: Implications for Prevention

PubMed Central

Jansen, Rick J.; Tan, Xiang-Lin; Petersen, Gloria M.

2015-01-01

Pancreatic cancer (PC) has been estimated to have higher incidence and correspondingly higher mortality rates in more developed regions worldwide. Overall, the age-adjusted incidence rate is 4.9/105 and age-adjusted mortality rate is at 4.8/105. We review here our current knowledge of modifiable risk factors (cigarette smoking, obesity, diet, and alcohol) for PC, genetic variants implicated by genome-wide association studies, possible genetic interactions with risk factors, and prevention strategies to provide future research directions that may further our understanding of this complex disease. Cigarette smoking is consistently associated with a two-fold increased PC risk. PC associations with dietary intake have been largely inconsistent, with the potential exception of certain unsaturated fatty acids decreasing risk and well-done red meat or meat mutagens increasing risk. There is strong evidence to support that obesity (and related measures) increase risk of PC. Only the heaviest alcohol drinkers seem to be at an increased risk of PC. Currently, key prevention strategies include avoiding tobacco and excessive alcohol consumption and adopting a healthy lifestyle. Screening technologies and PC chemoprevention are likely to become more sophisticated, but may only apply to those at high risk. Risk stratification may be improved by taking into account gene environment interactions. Research on these modifiable risk factors is key to reducing the incidence of PC and understanding who in the population can be considered high risk. PMID:26029010

Conceptualizing a Dynamic Fall Risk Model Including Intrinsic Risks and Exposures.

PubMed

Klenk, Jochen; Becker, Clemens; Palumbo, Pierpaolo; Schwickert, Lars; Rapp, Kilan; Helbostad, Jorunn L; Todd, Chris; Lord, Stephen R; Kerse, Ngaire

2017-11-01

Falls are a major cause of injury and disability in older people, leading to serious health and social consequences including fractures, poor quality of life, loss of independence, and institutionalization. To design and provide adequate prevention measures, accurate understanding and identification of person's individual fall risk is important. However, to date, the performance of fall risk models is weak compared with models estimating, for example, cardiovascular risk. This deficiency may result from 2 factors. First, current models consider risk factors to be stable for each person and not change over time, an assumption that does not reflect real-life experience. Second, current models do not consider the interplay of individual exposure including type of activity (eg, walking, undertaking transfers) and environmental risks (eg, lighting, floor conditions) in which activity is performed. Therefore, we posit a dynamic fall risk model consisting of intrinsic risk factors that vary over time and exposure (activity in context). eHealth sensor technology (eg, smartphones) begins to enable the continuous measurement of both the above factors. We illustrate our model with examples of real-world falls from the FARSEEING database. This dynamic framework for fall risk adds important aspects that may improve understanding of fall mechanisms, fall risk models, and the development of fall prevention interventions. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Does genetic heterogeneity account for the divergent risk of type 2 diabetes in South Asian and white European populations?

PubMed

Sohani, Zahra N; Deng, Wei Q; Pare, Guillaume; Meyre, David; Gerstein, Hertzel C; Anand, Sonia S

2014-11-01

South Asians are up to four times more likely to develop type 2 diabetes than white Europeans. It is postulated that the higher prevalence results from greater genetic risk. To evaluate this hypothesis, we: (1) systematically reviewed the literature for single nucleotide polymorphisms (SNPs) predisposing to type 2 diabetes in South Asians; (2) compared risk estimates, risk alleles and risk allele frequencies of predisposing SNPs between South Asians and white Europeans; and (3) tested the association of novel SNPs discovered from South Asians in white Europeans. MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane registry were searched for studies of genetic variants associated with type 2 diabetes in South Asians. Meta-analysis estimates for common and novel bi-allelic SNPs in South Asians were compared with white Europeans from the DIAbetes Genetics Replication And Meta-analysis (DIAGRAM) consortium. The population burden from predisposing SNPs was assessed using a genotype score. Twenty-four SNPs from 21 loci were associated with type 2 diabetes in South Asians after meta-analysis. The majority of SNPs increase odds of the disorder by 15-35% per risk allele. No substantial differences appear to exist in risk estimates between South Asians and white Europeans from SNPs common to both groups, and the population burden also does not differ. Eight of the 24 are novel SNPs discovered from South Asian genome-wide association studies, some of which show nominal associations with type 2 diabetes in white Europeans. Based on current literature there is no strong evidence to indicate that South Asians possess a greater genetic risk of type 2 diabetes than white Europeans.

Scaling range sizes to threats for robust predictions of risks to biodiversity.

PubMed

Keith, David A; Akçakaya, H Resit; Murray, Nicholas J

2018-04-01

Assessments of risk to biodiversity often rely on spatial distributions of species and ecosystems. Range-size metrics used extensively in these assessments, such as area of occupancy (AOO), are sensitive to measurement scale, prompting proposals to measure them at finer scales or at different scales based on the shape of the distribution or ecological characteristics of the biota. Despite its dominant role in red-list assessments for decades, appropriate spatial scales of AOO for predicting risks of species' extinction or ecosystem collapse remain untested and contentious. There are no quantitative evaluations of the scale-sensitivity of AOO as a predictor of risks, the relationship between optimal AOO scale and threat scale, or the effect of grid uncertainty. We used stochastic simulation models to explore risks to ecosystems and species with clustered, dispersed, and linear distribution patterns subject to regimes of threat events with different frequency and spatial extent. Area of occupancy was an accurate predictor of risk (0.81<|r|<0.98) and performed optimally when measured with grid cells 0.1-1.0 times the largest plausible area threatened by an event. Contrary to previous assertions, estimates of AOO at these relatively coarse scales were better predictors of risk than finer-scale estimates of AOO (e.g., when measurement cells are <1% of the area of the largest threat). The optimal scale depended on the spatial scales of threats more than the shape or size of biotic distributions. Although we found appreciable potential for grid-measurement errors, current IUCN guidelines for estimating AOO neutralize geometric uncertainty and incorporate effective scaling procedures for assessing risks posed by landscape-scale threats to species and ecosystems. © 2017 The Authors. Conservation Biology published by Wiley Periodicals, Inc. on behalf of Society for Conservation Biology.

Alcohol consumption and all-cause mortality.

PubMed

Duffy, J C

1995-02-01

Prospective studies of alcohol and mortality in middle-aged men almost universally find a U-shaped relationship between alcohol consumption and risk of mortality. This review demonstrates the extent to which different studies lead to different risk estimates, analyses the putative influence of abstention as a risk factor and uses available data to produce point and interval estimates of the consumption level apparently associated with minimum risk from two studies in the UK. Data from a number of studies are analysed by means of logistic-linear modelling, taking account of the possible influence of abstention as a special risk factor. Separate analysis of British data is performed. Logistic-linear modelling demonstrates large and highly significant differences between the studies considered in the relationship between alcohol consumption and all-cause mortality. The results support the identification of abstention as a special risk factor for mortality, but do not indicate that this alone explains the apparent U-shaped relationship. Separate analysis of two British studies indicates minimum risk of mortality in this population at a consumption level of about 26 (8.5 g) units of alcohol per week. The analysis supports the view that abstention may be a specific risk factor for all-cause mortality, but is not an adequate explanation of the apparent protective effect of alcohol consumption against all-cause mortality. Future analyses might better be performed on a case-by-case basis, using a change-point model to estimate the parameters of the relationship. The current misinterpretation of the sensible drinking level of 21 units per week for men in the UK as a limit is not justified, and the data suggest that alcohol consumption is a net preventive factor against premature death in this population.

Radon-induced lung cancer deaths may be overestimated due to failure to account for confounding by exposure to diesel engine exhaust in BEIR VI miner studies.

PubMed

Cao, Xiaodong; MacNaughton, Piers; Laurent, Jose Cedeno; Allen, Joseph G

2017-01-01

EPA reported that radon is the second leading cause of lung cancer in the United States, killing 21,100 people per year. EPA relies on the BEIR VI models, based on an evaluation of radon exposure and lung cancer risk in studies of miners. But these models did not account for co-exposure to diesel exhaust, a known human carcinogen recently classified by IARC. It is probable then that a portion of the lung cancer deaths in the miner cohorts are originally attributable to the exposure to diesel rather than radon. To re-evaluate EPA's radon attributable lung cancer estimates accounting for diesel exposure information in the miner cohorts. We used estimates of historical diesel concentrations, combined with diesel exposure-response functions, to estimate the risks of lung cancer attributable to diesel engine exhaust (DEE) exposure in the miner studies. We re-calculated the fatal lung cancer risk attributable to radon after accounting for risk from diesel and re-estimated the number of U.S. deaths associated with radon in the U.S. using EPA's methodology. Considering the probable confounding with DEE exposure and using the same estimate of baseline mortality from 1989-91 that the EPA currently uses in their calculations, we estimate that radon-induced lung cancer deaths per year are 15,600 (95% CI: 14,300, 17,000)- 19,300 (95% CI: 18,800, 20,000) in the U.S. population, a reduction of 9%-26%. The death estimates would be 12,900-15,900 using 2014 baseline vital statistics. We recommend further research on re-evaluating the health effects of exposure to radon that accounts for new information on diesel exhaust carcinogenicity in BEIR VI models, up-to-date vital statistics and new epidemiological evidence from residential studies.

Radon-induced lung cancer deaths may be overestimated due to failure to account for confounding by exposure to diesel engine exhaust in BEIR VI miner studies

PubMed Central

MacNaughton, Piers; Laurent, Jose Cedeno; Allen, Joseph G.

2017-01-01

Background EPA reported that radon is the second leading cause of lung cancer in the United States, killing 21,100 people per year. EPA relies on the BEIR VI models, based on an evaluation of radon exposure and lung cancer risk in studies of miners. But these models did not account for co-exposure to diesel exhaust, a known human carcinogen recently classified by IARC. It is probable then that a portion of the lung cancer deaths in the miner cohorts are originally attributable to the exposure to diesel rather than radon. Objective To re-evaluate EPA’s radon attributable lung cancer estimates accounting for diesel exposure information in the miner cohorts. Methods We used estimates of historical diesel concentrations, combined with diesel exposure-response functions, to estimate the risks of lung cancer attributable to diesel engine exhaust (DEE) exposure in the miner studies. We re-calculated the fatal lung cancer risk attributable to radon after accounting for risk from diesel and re-estimated the number of U.S. deaths associated with radon in the U.S. using EPA’s methodology. Results Considering the probable confounding with DEE exposure and using the same estimate of baseline mortality from 1989–91 that the EPA currently uses in their calculations, we estimate that radon-induced lung cancer deaths per year are 15,600 (95% CI: 14,300, 17,000)– 19,300 (95% CI: 18,800, 20,000) in the U.S. population, a reduction of 9%–26%. The death estimates would be 12,900–15,900 using 2014 baseline vital statistics. Conclusions We recommend further research on re-evaluating the health effects of exposure to radon that accounts for new information on diesel exhaust carcinogenicity in BEIR VI models, up-to-date vital statistics and new epidemiological evidence from residential studies. PMID:28886109

Uncertainties in estimating health risks associated with exposure to ionising radiation.

PubMed

Preston, R Julian; Boice, John D; Brill, A Bertrand; Chakraborty, Ranajit; Conolly, Rory; Hoffman, F Owen; Hornung, Richard W; Kocher, David C; Land, Charles E; Shore, Roy E; Woloschak, Gayle E

2013-09-01

The information for the present discussion on the uncertainties associated with estimation of radiation risks and probability of disease causation was assembled for the recently published NCRP Report No. 171 on this topic. This memorandum provides a timely overview of the topic, given that quantitative uncertainty analysis is the state of the art in health risk assessment and given its potential importance to developments in radiation protection. Over the past decade the increasing volume of epidemiology data and the supporting radiobiology findings have aided in the reduction of uncertainty in the risk estimates derived. However, it is equally apparent that there remain significant uncertainties related to dose assessment, low dose and low dose-rate extrapolation approaches (e.g. the selection of an appropriate dose and dose-rate effectiveness factor), the biological effectiveness where considerations of the health effects of high-LET and lower-energy low-LET radiations are required and the transfer of risks from a population for which health effects data are available to one for which such data are not available. The impact of radiation on human health has focused in recent years on cancer, although there has been a decided increase in the data for noncancer effects together with more reliable estimates of the risk following radiation exposure, even at relatively low doses (notably for cataracts and cardiovascular disease). New approaches for the estimation of hereditary risk have been developed with the use of human data whenever feasible, although the current estimates of heritable radiation effects still are based on mouse data because of an absence of effects in human studies. Uncertainties associated with estimation of these different types of health effects are discussed in a qualitative and semi-quantitative manner as appropriate. The way forward would seem to require additional epidemiological studies, especially studies of low dose and low dose-rate occupational and perhaps environmental exposures and for exposures to x rays and high-LET radiations used in medicine. The development of models for more reliably combining the epidemiology data with experimental laboratory animal and cellular data can enhance the overall risk assessment approach by providing biologically refined data to strengthen the estimation of effects at low doses as opposed to the sole use of mathematical models of epidemiological data that are primarily driven by medium/high doses. NASA's approach to radiation protection for astronauts, although a unique occupational group, indicates the possible applicability of estimates of risk and their uncertainty in a broader context for developing recommendations on: (1) dose limits for occupational exposure and exposure of members of the public; (2) criteria to limit exposures of workers and members of the public to radon and its short-lived decay products; and (3) the dosimetric quantity (effective dose) used in radiation protection.

Chemical exposures in the workplace: effect on breast cancer risk among women.

PubMed

Snedeker, Suzanne M

2006-06-01

Occupational health nurses need to be aware of the current science on breast cancer risks in the workplace because they are risk communicators for employees and their families. Occupational health nurses can serve as advocates for necessary research ultimately leading to risk reduction and prevention strategies in the workplace. Current research suggests exposure to organic solvents, metals, acid mists, sterilizing agents (ethylene oxide), some pesticides, light at night (shift work), and tobacco smoke increases breast cancer risk among women in occupational settings. Animal cancer bioassays conducted by the National Toxicology Program indicate more than 40 chemicals can induce mammary tumors, and most of these are still in production. A variety of occupations worldwide, including health care providers and metal, textile, dye, rubber, and plastic manufacturing workers, have been identified as having some evidence of higher breast cancer risk. Although some chemical exposures are suspected to affect breast cancer risk, estimates of or actual exposures to these chemicals in the workplace often have not been determined. Research needed to better identify breast cancer risks in occupational settings includes monitoring breast cancer incidence in occupations with exposures to suspected carcinogens, characterizing chemical exposures by job type and task, determining whether potential gender differences affect chemical exposures, and using molecular approaches to identify gene-environment interactions.

Characterizing environmental risk factors for West Nile virus in Quebec, Canada, using clinical data in humans and serology in pet dogs.

PubMed

Rocheleau, J P; Michel, P; Lindsay, L R; Drebot, M; Dibernardo, A; Ogden, N H; Fortin, A; Arsenault, J

2017-10-01

The identification of specific environments sustaining emerging arbovirus amplification and transmission to humans is a key component of public health intervention planning. This study aimed at identifying environmental factors associated with West Nile virus (WNV) infections in southern Quebec, Canada, by modelling and jointly interpreting aggregated clinical data in humans and serological data in pet dogs. Environmental risk factors were estimated in humans by negative binomial regression based on a dataset of 191 human WNV clinical cases reported in the study area between 2011 and 2014. Risk factors for infection in dogs were evaluated by logistic and negative binomial models based on a dataset including WNV serological results from 1442 dogs sampled from the same geographical area in 2013. Forested lands were identified as low-risk environments in humans. Agricultural lands represented higher risk environments for dogs. Environments identified as impacting risk in the current study were somewhat different from those identified in other studies conducted in north-eastern USA, which reported higher risk in suburban environments. In the context of the current study, combining human and animal data allowed a more comprehensive and possibly a more accurate view of environmental WNV risk factors to be obtained than by studying aggregated human data alone.

Assessing health risk due to exposure to arsenic in drinking water in Hanam Province, Vietnam.

PubMed

Huy, Tung Bui; Tuyet-Hanh, Tran Thi; Johnston, Richard; Nguyen-Viet, Hung

2014-07-24

We assessed health risks related to Arsenic (As) in contaminated drinking water in Hanam, applying the Australian Environmental Health Risk Assessment Framework, which promotes stakeholder involvement in risk assessments. As concentrations in 300 tube-well water samples, before and after filtration, were analyzed and the water consumption levels in 150 households were estimated. Skin cancer risk was characterized using Cancer Slope Factor index and lifetime average daily dose with a probabilistic approach. The results showed that arsenic concentrations in tube-well water ranged from 8-579 ppb (mean 301 ppb) before filtration and current sand filters used by the households did not meet the standard for As removal. Arsenic daily consumption of 40% of the adults exceeded the level of TDI (Tolerable Daily Intake) at 1 µg/kg/day. The average skin cancer risk in adults due to consuming filtered tube-well water for drinking purpose were 25.3 × 10-5 (using only well water) and 7.6 × 10-5 (using both well and rain water). The skin cancer risk would be 11.5 times higher if the water was not filtered. Improvement of filtration measures or the replacement of the current drinking water sources to minimize the health risks to the local population is urgently needed.

Assessing Health Risk due to Exposure to Arsenic in Drinking Water in Hanam Province, Vietnam

PubMed Central

Bui Huy, Tung; Tuyet-Hanh, Tran Thi; Johnston, Richard; Nguyen-Viet, Hung

2014-01-01

We assessed health risks related to Arsenic (As) in contaminated drinking water in Hanam, applying the Australian Environmental Health Risk Assessment Framework, which promotes stakeholder involvement in risk assessments. As concentrations in 300 tube-well water samples, before and after filtration, were analyzed and the water consumption levels in 150 households were estimated. Skin cancer risk was characterized using Cancer Slope Factor index and lifetime average daily dose with a probabilistic approach. The results showed that arsenic concentrations in tube-well water ranged from 8–579 ppb (mean 301 ppb) before filtration and current sand filters used by the households did not meet the standard for As removal. Arsenic daily consumption of 40% of the adults exceeded the level of TDI (Tolerable Daily Intake) at 1 µg/kg/day. The average skin cancer risk in adults due to consuming filtered tube-well water for drinking purpose were 25.3 × 10−5 (using only well water) and 7.6 × 10−5 (using both well and rain water). The skin cancer risk would be 11.5 times higher if the water was not filtered. Improvement of filtration measures or the replacement of the current drinking water sources to minimize the health risks to the local population is urgently needed. PMID:25062276

Risks associated with crack cocaine smoking among exotic dancers in Baltimore, MD.

PubMed

Sherman, Susan G; Reuben, Jacqueline; Chapman, Chris Serio; Lilleston, Pamela

2011-04-01

There is a dearth of research focusing on sex work in exotic dance clubs. We conducted a cross-sectional study to examine the prevalence and correlates of crack cocaine smoking among a sample of exotic dancers. The "block," a historical red-light district in downtown Baltimore, MD, is comprised of 30 adult-entertainment establishments. Between 01/09 and 08/09, we conducted a survey with exotic dancers (N=98). The survey explored demographic, and drug and sexual/drug risk behaviors. Bivariate and multivariate analysis was conducted using Poisson regression with robust variance estimates to examine correlates of current crack smoking. Crack cocaine smokers compared to non-crack cocaine smokers were significantly more likely to report: older age (29 vs. 23 years, respectively, p<0.0001); being White (79% vs. 50%, respectively, p=0.008); having been arrested (93% vs. 67%, respectively, p=0.008); daily alcohol consumption (36% vs. 17%, p=0.047); current heroin injection (57% vs. 13%, p<0.001); and current sex exchange (79% vs. 30%, p<0.001). In the presence of other variables, crack cocaine smokers compared to non-crack cocaine smokers were significantly older, more likely to report current heroin injection, and more likely to report current sex exchange. We found high levels of drug use and sexual risk behaviors as well as a number of risks behaviors associated with crack cocaine smoking among this very under-studied population. Targeted interventions are greatly needed. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Overview of entry risk predictions

NASA Astrophysics Data System (ADS)

Mrozinski, R.; Mendeck, G.; Cutri-Kohart, R.

Risk to people on the ground from uncontrolled entries of spacecraft is a primary concern when analyzing end-of-life disposal options for satellites. Countries must balance this risk with the need to mitigate an exponentially growing space debris population. Currently the United States does this via guidelines that call for a satellite to be disposed of in a controlled manner if an uncontrolled entry would be too risky to people on the ground. This risk is measured by a quantity called "casualty expectation", or E , where casualty expectation is defined as the expectedc number of people suffering death or injury due to a spacecraft entry event. If Ec exceeds 1 in 10,000, U. S. guidelines state that the entry should be controlled rather than uncontrolled. Since this guideline can have serious impacts on the cost, lifetime, and even the mission and functionality of a satellite, it is critical that this quantity be estimated well, and decision makers understand all assumptions and limitations inherent in the resulting value. This paper discusses several issues regarding estimates of casualty expectation, beginning with an overview of relevant United States policies and guidelines. The equation the space industry typically uses to estimate casualty expectation is presented, along with a look at the sensitivity of the results to the typical assumptions, models, and initial condition uncertainties. Differences in these modeling issues with respect to launch failure Ec estimates are included in the discussion. An alternate quantity to assess risks due to spacecraft entries is introduced. "Probability of casualty", or Pc , is defined as the probability of one or more instances of people suffering death or injury due to a spacecraft entry event. The equation to estimate Pc is derived, where the same assumptions, modeling, and initial condition issues for Ec apply. Several examples are then given of both Ec and Pc estimate calculations. Due to the difficult issues in estimating both Ec and Pc, it is argued that "true" absolute quantities can never be computed. However, E and Pc are ideal for relativec analyses against a standard tool that eliminates these issues. Such a tool is recommended for assessing compliance with requirements of regulating institutions.

Prevalence of xerostomia in an adolescent inpatient psychiatric clinic: a preliminary study.

PubMed

Kaur, Manvir; Himadi, Elaine; Chi, Donald L

2016-01-01

Adolescents with psychiatric conditions may be at risk for xerostomia. In this preliminary study, we estimated xerostomia prevalence in adolescents ages 9 to 17 years from an inpatient psychiatric clinic (N = 25) and examined whether: (1) gender and age were associated with xerostomia and (2) xerostomia was associated with self-reported cavities. We used a modified 11-item Xerostomia Index to identify xerostomia (no/yes) and asked if adolescents ever had or currently have cavities (no/yes). The mean age was 14 years (SD = 2.3) and 72% were male. Sixty percent reported xerostomia (SD = 50). There were no significant associations between xerostomia and gender (p = 0.99) or age (p = 0.66), or between xerostomia and past (p = 0.26) or current cavities (p = 0.11). Larger proportions of adolescents with xerostomia reported previous and current cavities. Sixty percent of adolescents from an inpatient psychiatric clinic reported having xerostomia, which may lead to increased caries risk over time. Additional research should examine the prevalence and consequences of xerostomia in high-risk adolescents. © 2015 Special Care Dentistry Association and Wiley Periodicals, Inc.

Cost-effectiveness and population outcomes of general population screening for hepatitis C.

PubMed

Coffin, Phillip O; Scott, John D; Golden, Matthew R; Sullivan, Sean D

2012-05-01

Current US guidelines recommend limiting hepatitis C virus (HCV) screening to high-risk individuals, and 50%-75% of infected persons remain unaware of their status. To estimate the cost-effectiveness and population-level impact of adding one-time HCV screening of US population aged 20-69 years to current guidelines, we developed a decision analytic model for the screening intervention and Markov model with annual transitions to estimate natural history. Subanalyses included protease inhibitor therapy and screening those at highest risk of infection (birth year 1945-1965). We relied on published literature and took a lifetime, societal perspective. Compared to current guidelines, incremental cost per quality-adjusted life year gained (ICER) was $7900 for general population screening and $4200 for screening by birth year, which dominated general population screening if cost, clinician uptake, and median age of diagnoses were assumed equivalent. General population screening remained cost-effective in all one-way sensitivity analyses, 30 000 Monte Carlo simulations, and scenarios in which background mortality was doubled, all genotype 1 patients were treated with protease inhibitors, and most parameters were set unfavorable to increased screening. ICER was lowest if screening was applied to a population with liver fibrosis similar to 2010 estimates. Approximately 1% of liver-related deaths would be averted per 15% of the general population screened; the impact would be greater with improved referral, treatment uptake, and cure. Broader screening for HCV would likely be cost-effective, but significantly reducing HCV-related morbidity and mortality would also require improved rates of referral, treatment, and cure.

Quantitative risk assessment to compare the risk of rabies entering the UK from Turkey via quarantine, the Pet Travel Scheme and the EU Pet Movement Policy.

PubMed

Ramnial, V; Kosmider, R; Aylan, O; Freuling, C; Müller, T; Fooks, A R

2010-08-01

Rabies was eradicated from the UK in 1922 through strict controls of dog movement and investigation of every incident of disease. Amendments were made to the UK quarantine laws and the Pet Travel Scheme (PETS) was subsequently introduced in 2000 for animals entering the UK from qualifying listed countries. European Regulation 998/2003 on the non-commercial movement of pet animals initiated the European Union Pet Movement Policy (EUPMP) in July 2004. The introduction of EUPMP harmonized the movement of pet animals within the EU (EUPMP(listed)) but raised the possibility of domestic animals entering the UK from a non-EU state where rabies is endemic (EUPMP(unlisted)). A quantitative risk assessment was developed to estimate the risk of rabies entering the UK from Turkey via companion animals that are incubating the disease and enter through PETS or EUPMP compared to quarantine. Specifically, the risk was assessed by estimating the annual probability of rabies entering the UK and the number of years between rabies entries for each scheme. The model identified that the probability of rabies entering the UK via the three schemes is highly dependent on compliance. If 100% compliance is assumed, PETS and EUPMP(unlisted) (at the current level of importation) present a lower risk than quarantine, i.e. the number of years between rabies entry is more than 170 721 years for PETS and 60 163 years for EUPMP(unlisted) compared to 41 851 years for quarantine (with 95% certainty). If less than 100% compliance is assumed, PETS and EUPMP(unlisted) (at the current level of importation) present a higher risk. In addition, EUPMP(listed) and EUPMP(unlisted) (at an increased level of importation) present a higher risk than quarantine or PETS at 100% compliance and at an uncertain level of compliance.

The diagnosis and management of mild cognitive impairment: a clinical review.

PubMed

Langa, Kenneth M; Levine, Deborah A

2014-12-17

Cognitive decline is a common and feared aspect of aging. Mild cognitive impairment (MCI) is defined as the symptomatic predementia stage on the continuum of cognitive decline, characterized by objective impairment in cognition that is not severe enough to require help with usual activities of daily living. To present evidence on the diagnosis, treatment, and prognosis of MCI and to provide physicians with an evidence-based framework for caring for older patients with MCI and their caregivers. We searched PubMed for English-language articles in peer-reviewed journals and the Cochrane Library database from inception through July 2014. Relevant references from retrieved articles were also evaluated. The prevalence of MCI in adults aged 65 years and older is 10% to 20%; risk increases with age and men appear to be at higher risk than women. In older patients with MCI, clinicians should consider depression, polypharmacy, and uncontrolled cardiovascular risk factors, all of which may increase risk for cognitive impairment and other negative outcomes. Currently, no medications have proven effective for MCI; treatments and interventions should be aimed at reducing cardiovascular risk factors and prevention of stroke. Aerobic exercise, mental activity, and social engagement may help decrease risk of further cognitive decline. Although patients with MCI are at greater risk for developing dementia compared with the general population, there is currently substantial variation in risk estimates (from <5% to 20% annual conversion rates), depending on the population studied. Current research targets improving early detection and treatment of MCI, particularly in patients at high risk for progression to dementia. Cognitive decline and MCI have important implications for patients and their families and will require that primary care clinicians be skilled in identifying and managing this common disorder as the number of older adults increases in coming decades. Current evidence supports aerobic exercise, mental activity, and cardiovascular risk factor control in patients with MCI.

Addressing the Need for Independence in the CSE Model

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

Abercrombie, Robert K; Ferragut, Erik M; Sheldon, Frederick T

2011-01-01

Abstract Information system security risk, defined as the product of the monetary losses associated with security incidents and the probability that they occur, is a suitable decision criterion when considering different information system architectures. Risk assessment is the widely accepted process used to understand, quantify, and document the effects of undesirable events on organizational objectives so that risk management, continuity of operations planning, and contingency planning can be performed. One technique, the Cyberspace Security Econometrics System (CSES), is a methodology for estimating security costs to stakeholders as a function of possible risk postures. In earlier works, we presented a computationalmore » infrastructure that allows an analyst to estimate the security of a system in terms of the loss that each stakeholder stands to sustain, as a result of security breakdowns. Additional work has applied CSES to specific business cases. The current state-of-the-art of CSES addresses independent events. In typical usage, analysts create matrices that capture their expert opinion, and then use those matrices to quantify costs to stakeholders. This expansion generalizes CSES to the common real-world case where events may be dependent.« less

[The volume of surgery on the abdominal cavity organs in patients with associated cardiovascular and respiratory system diseases].

PubMed

Bondarenko, M V

2004-08-01

The cardiovascular and respiratory disturbances are the main risk factor in acute and chronic surgical deseases of the abdominal cavity organs, including oncological. It is limits the possibility and volume of the diagnostics and surgical tactics choice. The complicated current of main disease is a risk factor of operation perform and the reason of the undertaking inadequate and palliative intervention, which significant reduce of the quality of life. Real by risk level reductions in surgery is a determination of tissues viability, estimation of compensatory reserve sick evidences for determination for operation performance including simultaneous and staged.

[Assessment and control of health risk caused by the radiological accident at the TEPCO Fukushima Daiichi nuclear power plant].

PubMed

Matsuda, Naoki; Morita, Naoko; Miura, Miwa

2014-01-01

The accident at the Tokyo Electric Power Company (TEPCO) Fukushima Daiichi nuclear power plant on March 11, 2011, released a large amount of radioactive materials resulting in the radioactive contamination of a wide area of eastern Japan. Residents of the Fukushima prefecture experienced various unavoidable damages and fear of radiation effects on their health. A reliable communication of accurate risk assessment for residents is required as a countermeasure aimed at the reconstruction of Fukushima. Here, the current status of individual dose estimation and the issues relating to the radiation risk perception are discussed.

CURRENT USE AND FUTURE NEEDS OF BIODOSIMETRY IN STUDIES OF LONG-TERM HEALTH RISK FOLLOWING RADIATION EXPOSURE

PubMed Central

Simon, Steven L.; Bouville, André; Kleinerman, Ruth

2009-01-01

Biodosimetry measurements can potentially be an important and integral part of the dosimetric methods used in long-term studies of health risk following radiation exposure. Such studies rely on accurate estimation of doses to the whole body or to specific organs of individuals in order to derive reliable estimates of cancer risk. However, dose estimates based on analytical dose reconstruction (i.e., models) or personnel monitoring measurements, e.g., film-badges, can have substantial uncertainty. Biodosimetry can potentially reduce uncertainty in health risk studies by corroboration of model-based dose estimates or by using them to assess bias in dose models. While biodosimetry has begun to play a more significant role in long-term health risk studies, its use is still generally limited in that context due to one or more factors including, inadequate limits of detection, large inter-individual variability of the signal measured, high per-sample cost, and invasiveness. Presently, the most suitable biodosimetry methods for epidemiologic studies are chromosome aberration frequencies from fluorescence in situ hybridization (FISH) of peripheral blood lymphocytes and electron paramagnetic resonance (EPR) measurements made on tooth enamel. Both types of measurements, however, are usually invasive and require difficult to obtain biological samples. Moreover, doses derived from these methods are not always directly relevant to the tissues of interest. To increase the value of biodosimetry to epidemiologic studies, a number of issues need to be considered including limits of detection, effects of inhomogenous exposure of the body, how to extrapolate from the tissue sampled to the tissues of interest, and how to adjust dosimetry models applied to large populations based on sparse biodosimetry measurements. The requirements of health risk studies suggest a set of characteristics that, if satisfied by new biodosimetry methods, would increase the overall usefulness of biodosimetry to determining radiation health risks. PMID:20065672

Toward risk reduction: predicting the future burden of occupational cancer.

PubMed

Hutchings, Sally; Rushton, Lesley

2011-05-01

Interventions to reduce cancers related to certain occupations should be evidence-based. The authors have developed a method for forecasting the future burden of occupational cancer to inform strategies for risk reduction. They project risk exposure periods, accounting for cancer latencies of up to 50 years, forward in time to estimate attributable fractions for a series of forecast target years given past and projected exposure trends and under targeted reduction scenarios. Adjustment factors for changes in exposed numbers and levels are applied in estimation intervals within the risk-exposure periods. The authors illustrate the methods by using a range of scenarios for reducing lung cancer due to occupational exposure to respirable crystalline silica. Attributable fractions for lung cancer due to respirable crystalline silica could be potentially reduced from 2.07% in 2010 to nearly 0% by 2060, depending on the timing and success of interventions. Focusing on achieving compliance with current exposure standards in small industries can be more effective than setting standards at a lower level. The method can be used to highlight high-risk carcinogens, industries, and occupations. It is adaptable for other countries and other exposure situations in the general environment and can be extended to include socioeconomic impact assessment.

Estimating wildfire risk on a Mojave Desert landscape using remote sensing and field sampling

USGS Publications Warehouse

Van Linn, Peter F.; Nussear, Kenneth E.; Esque, Todd C.; DeFalco, Lesley A.; Inman, Richard D.; Abella, Scott R.

2013-01-01

Predicting wildfires that affect broad landscapes is important for allocating suppression resources and guiding land management. Wildfire prediction in the south-western United States is of specific concern because of the increasing prevalence and severe effects of fire on desert shrublands and the current lack of accurate fire prediction tools. We developed a fire risk model to predict fire occurrence in a north-eastern Mojave Desert landscape. First we developed a spatial model using remote sensing data to predict fuel loads based on field estimates of fuels. We then modelled fire risk (interactions of fuel characteristics and environmental conditions conducive to wildfire) using satellite imagery, our model of fuel loads, and spatial data on ignition potential (lightning strikes and distance to roads), topography (elevation and aspect) and climate (maximum and minimum temperatures). The risk model was developed during a fire year at our study landscape and validated at a nearby landscape; model performance was accurate and similar at both sites. This study demonstrates that remote sensing techniques used in combination with field surveys can accurately predict wildfire risk in the Mojave Desert and may be applicable to other arid and semiarid lands where wildfires are prevalent.

Proportion of patients needing an implantable cardioverter defibrillator on the basis of current guidelines: impact on healthcare resources in Italy and the USA. Data from the ALPHA study registry.

PubMed

Pedretti, Roberto F E; Curnis, Antonio; Massa, Riccardo; Morandi, Fabrizio; Tritto, Massimo; Manca, Lorenzo; Occhetta, Eraldo; Molon, Giulio; De Ferrari, Gaetano M; Sarzi Braga, Simona; Raciti, Giovanni; Klersy, Catherine; Salerno-Uriarte, Jorge A

2010-08-01

Implantable cardioverter defibrillators (ICD) improve survival in selected patients with left ventricular dysfunction or heart failure (HF). The objective is to estimate the number of ICD candidates and to assess the potential impact on public health expenditure in Italy and the USA. Data from 3513 consecutive patients (ALPHA study registry) were screened. A model based on international guidelines inclusion criteria and epidemiological data was used to estimate the number of eligible patients. A comparison with current ICD implant rate was done to estimate the necessary incremental rate to treat eligible patients within 5 years. Up to 54% of HF patients are estimated to be eligible for ICD implantation. An implantation policy based on guidelines would significantly increase the ICD number to 2671 implants per million inhabitants in Italy and to 4261 in the USA. An annual increment of prophylactic ICD implants of 20% in the USA and 68% in Italy would be necessary to treat all indicated patients in a 5-year timeframe. Implantable cardioverter defibrillator implantation policy based on current evidence may have significant impact on public health expenditure. Effective risk stratification may be useful in order to maximize benefit of ICD therapy and its cost-effectiveness in primary prevention.

AGM-88E Advanced Anti-Radiation Guided Missile (AGM-88E AARGM)

DTIC Science & Technology

2015-12-01

0.0 0.0 Acq O&M 0.0 0.0 -- 0.0 0.0 0.0 0.0 Total 1528.5 1661.1 N/A 2107.4 1861.4 2026.2 2663.7 1 APB Breach Confidence Level Confidence Level of...normal conditions, encountering average levels of technical, schedule, and programmatic risk and external interference. Based on the rigor in methods...SAR Baseline to Current SAR Baseline (TY $M) Initial PAUC Development Estimate Changes PAUC Production Estimate Econ Qty Sch Eng Est Oth Spt Total

Risks of Large Portfolios

PubMed Central

Fan, Jianqing; Liao, Yuan; Shi, Xiaofeng

2014-01-01

The risk of a large portfolio is often estimated by substituting a good estimator of the volatility matrix. However, the accuracy of such a risk estimator is largely unknown. We study factor-based risk estimators under a large amount of assets, and introduce a high-confidence level upper bound (H-CLUB) to assess the estimation. The H-CLUB is constructed using the confidence interval of risk estimators with either known or unknown factors. We derive the limiting distribution of the estimated risks in high dimensionality. We find that when the dimension is large, the factor-based risk estimators have the same asymptotic variance no matter whether the factors are known or not, which is slightly smaller than that of the sample covariance-based estimator. Numerically, H-CLUB outperforms the traditional crude bounds, and provides an insightful risk assessment. In addition, our simulated results quantify the relative error in the risk estimation, which is usually negligible using 3-month daily data. PMID:26195851

Cost-benefit analysis of using sewage sludge as alternative fuel in a cement plant: a case study.

PubMed

Nadal, Martí; Schuhmacher, Marta; Domingo, José L

2009-05-01

To enforce the implementation of the Kyoto Protocol targets, a number of governmental/international institutions have launched emission trade schemes as an approach to specify CO(2) caps and to regulate the emission trade in recent years. These schemes have been basically applied for large industrial sectors, including energy producers and energy-intensive users. Among them, cement plants are included among the big greenhouse gas (GHG) emitters. The use of waste as secondary fuel in clinker kilns is currently an intensive practice worldwide. However, people living in the vicinity of cement plants, where alternative fuels are being used, are frequently concerned about the potential increase in health risks. In the present study, a cost-benefit analysis was applied after substituting classical fuel for sewage sludge as an alternative fuel in a clinker kiln in Catalonia, Spain. The economical benefits resulting in the reduction of CO(2) emissions were compared with the changes in human health risks due to exposure to polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) and carcinogenic metals (As, Cd, Co, and Cr) before and after using sewage sludge to generate 20% of the thermal energy needed for pyro-processing. The exposure to PCDD/Fs and metals through air inhalation, soil ingestion and dermal absorption was calculated according to the environmental levels in soil. The carcinogenic risks were assessed, and the associated cost for the population was estimated by considering the DG Environment's recommended value for preventing a statistical fatality (VPF). In turn, the amount of CO(2) emitted was calculated, and the economical saving, according to the market prices, was evaluated. The use of sewage sludge as a substitute of conventional energy meant a probability cancer decrease of 4.60 for metals and a cancer risk increase of 0.04 for PCDD/Fs. Overall, a net reduction of 4.56 cancers for one million people can be estimated. The associated economical evaluation due to the decreasing cancer for 60,000 people, the current population living near the cement plant, would be of 0.56 million euros (US$ 0.83 million). In turn, a reduction of 144,000 tons of CO(2) emitted between 2003 and 2006 was estimated. Considering a cost of 20 euros per ton of CO(2), the global saving would be 2.88 million euros (US$ 4.26 million). After the partial substitution of the fuel, the current environmental exposure to metals and PCDD/Fs would even mean a potential decrease of health risks for the individuals living in the vicinity of the cement plant. The total benefit of using sewage sludge as an alternative fuel was calculated in 3.44 million euros (US$ 5.09 million). Environmental economics is becoming an interesting research field to convert environmental benefits (i.e., reduction of health risks, emission of pollutants, etc.) into economical value. The results show, that while the use of sewage sludge as secondary fuel is beneficial for the reduction in GHG emissions, no additional health risks for the population derived from PCDD/F and metal emissions are estimated. Cost-benefit analysis seems to be a suitable tool to estimate the environmental damage and benefit associated to industrial processes. Therefore, this should become a generalized practice, mainly for those more impacting sectors such as power industries. On the other hand, the extension of the study could vastly be enlarged by taking into account other potentially emitted GHGs, such as CH(4) and N(2)O, as well as other carcinogenic and non-carcinogenic micropollutants.

Impact of the national full herd depopulation policy on the recurrence of bovine tuberculosis in Irish herds, 2003 to 2005.

PubMed

Good, M; Clegg, T A; Duignan, A; More, S J

2011-11-26

This study evaluated the impact of the Irish herd bovine tuberculosis (bTB) depopulation policy (depopulation, disinfection, contiguous testing and local badger removal where implicated) on the recurrence of bTB infection, by comparing the future risk in restocked herds following depopulation for either bTB or bovine spongiform encephalopathy (BSE) during 2003 to 2005. Each herd was assigned a 'previous bTB risk', based on bTB history during the five years before depopulation. Future bTB risk was estimated, using a multivariable Cox proportional hazard model for time-to-breakdown for each study herd, to identify risk factors associated with bTB. Future bTB risk varied significantly by reason for depopulation and previous bTB risk. Herds depopulated for bTB (by definition, at high bTB risk) were not significantly different from BSE herds with no or a low previous bTB risk. BSE herds with a high previous bTB risk were found to be at significantly greater future bTB risk. Herd bTB depopulation measures, as currently applied in Ireland, are shown to be effective in enabling herds to attain and retain bTB freedom following restocking. Based on the data presented, and consistent with current knowledge of the bTB epidemiology, local badger removal contributes to efforts to limit recurrence of bTB in Ireland.

River flood risk in Jakarta under scenarios of future change

NASA Astrophysics Data System (ADS)

Budiyono, Yus; Aerts, Jeroen C. J. H.; Tollenaar, Daniel; Ward, Philip J.

2016-03-01

Given the increasing impacts of flooding in Jakarta, methods for assessing current and future flood risk are required. In this paper, we use the Damagescanner-Jakarta risk model to project changes in future river flood risk under scenarios of climate change, land subsidence, and land use change. Damagescanner-Jakarta is a simple flood risk model that estimates flood risk in terms of annual expected damage, based on input maps of flood hazard, exposure, and vulnerability. We estimate baseline flood risk at USD 186 million p.a. Combining all future scenarios, we simulate a median increase in risk of +180 % by 2030. The single driver with the largest contribution to that increase is land subsidence (+126 %). We simulated the impacts of climate change by combining two scenarios of sea level rise with simulations of changes in 1-day extreme precipitation totals from five global climate models (GCMs) forced by the four Representative Concentration Pathways (RCPs). The results are highly uncertain; the median change in risk due to climate change alone by 2030 is a decrease by -46 %, but we simulate an increase in risk under 12 of the 40 GCM-RCP-sea level rise combinations. Hence, we developed probabilistic risk scenarios to account for this uncertainty. If land use change by 2030 takes places according to the official Jakarta Spatial Plan 2030, risk could be reduced by 12 %. However, if land use change in the future continues at the same rate as the last 30 years, large increases in flood risk will take place. Finally, we discuss the relevance of the results for flood risk management in Jakarta.

ACR Appropriateness Criteria® growth disturbances - risk of intrauterine growth restriction.

PubMed

Zelop, Carolyn M; Javitt, Marcia C; Glanc, Phyllis; Dubinsky, Theodore; Harisinghani, Mukesh G; Harris, Robert D; Khati, Nadia J; Mitchell, Donald G; Pandharipande, Pari V; Pannu, Harpreet K; Podrasky, Ann E; Shipp, Thomas D; Siegel, Cary Lynn; Simpson, Lynn; Wall, Darci J; Wong-You-Cheong, Jade J

2013-09-01

Fetal growth disturbances include fetuses at risk for intrauterine growth restriction. These fetuses may have an estimated fetal weight at less than the 10% or demonstrate a plateau of fetal growth with an estimated fetal growth greater than the 10%. Uteroplacental insufficiency may play a major role in the etiology of intrauterine growth restriction. Fetuses at risk for intrauterine fetal growth restriction are susceptible to the potential hostility of the intrauterine environment leading to fetal hypoxia and fetal acidosis. Fetal well-being can be assessed using biophysical profile, Doppler velocimetry, fetal heart rate monitoring, and fetal movement counting.Fetal growth disturbances include fetuses at risk for intrauterine growth restriction. These fetuses may have an estimated fetal weight at less than the 10% or demonstrate a plateau of fetal growth with an estimated fetal growth greater than the 10%. Uteroplacental insufficiency may play a major role in the etiology of intrauterine growth restriction. Fetuses at risk for intrauterine fetal growth restriction are susceptible to the potential hostility of the intrauterine environment leading to fetal hypoxia and fetal acidosis. Fetal well-being can be assessed using biophysical profile, Doppler velocimetry, fetal heart rate monitoring, and fetal movement counting.The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Estimating cancer risk in relation to tritium exposure from routine operation of a nuclear-generating station in Pickering, Ontario.

PubMed

Wanigaratne, S; Holowaty, E; Jiang, H; Norwood, T A; Pietrusiak, M A; Brown, P

2013-09-01

Evidence suggests that current levels of tritium emissions from CANDU reactors in Canada are not related to adverse health effects. However, these studies lack tritium-specific dose data and have small numbers of cases. The purpose of our study was to determine whether tritium emitted from a nuclear-generating station during routine operation is associated with risk of cancer in Pickering, Ontario. A retrospective cohort was formed through linkage of Pickering and north Oshawa residents (1985) to incident cancer cases (1985-2005). We examined all sites combined, leukemia, lung, thyroid and childhood cancers (6-19 years) for males and females as well as female breast cancer. Tritium estimates were based on an atmospheric dispersion model, incorporating characteristics of annual tritium emissions and meteorology. Tritium concentration estimates were assigned to each cohort member based on exact location of residence. Person-years analysis was used to determine whether observed cancer cases were higher than expected. Cox proportional hazards regression was used to determine whether tritium was associated with radiation-sensitive cancers in Pickering. Person-years analysis showed female childhood cancer cases to be significantly higher than expected (standardized incidence ratio [SIR] = 1.99, 95% confidence interval [CI]: 1.08-3.38). The issue of multiple comparisons is the most likely explanation for this finding. Cox models revealed that female lung cancer was significantly higher in Pickering versus north Oshawa (HR = 2.34, 95% CI: 1.23-4.46) and that tritium was not associated with increased risk. The improved methodology used in this study adds to our understanding of cancer risks associated with low-dose tritium exposure. Tritium estimates were not associated with increased risk of radiationsensitive cancers in Pickering.

Electronic health record-based cardiac risk assessment and identification of unmet preventive needs.

PubMed

Persell, Stephen D; Dunne, Alexis P; Lloyd-Jones, Donald M; Baker, David W

2009-04-01

Cardiac risk assessment may not be routinely performed. Electronic health records (EHRs) offer the potential to automate risk estimation. We compared EHR-based assessment with manual chart review to determine the accuracy of automated cardiac risk estimation and determination of candidates for antiplatelet or lipid-lowering interventions. We performed an observational retrospective study of 23,111 adults aged 20 to 79 years, seen in a large urban primary care group practice. Automated assessments classified patients into 4 cardiac risk groups or as unclassifiable and determined candidates for antiplatelet or lipid-lowering interventions based on current guidelines. A blinded physician manually reviewed 100 patients from each risk group and the unclassifiable group. We determined the agreement between full review and automated assessments for cardiac risk estimation and identification of which patients were candidates for interventions. By automated methods, 9.2% of the population were candidates for lipid-lowering interventions, and 8.0% were candidates for antiplatelet medication. Agreement between automated risk classification and manual review was high (kappa = 0.91; 95% confidence interval [CI], 0.88-0.93). Automated methods accurately identified candidates for antiplatelet therapy [sensitivity, 0.81 (95% CI, 0.73-0.89); specificity, 0.98 (95% CI, 0.96-0.99); positive predictive value, 0.86 (95% CI, 0.78-0.94); and negative predictive value, 0.98 (95% CI, 0.97-0.99)] and lipid lowering [sensitivity, 0.92 (95% CI, 0.87-0.96); specificity, 0.98 (95% CI, 0.97-0.99); positive predictive value, 0.94 (95% CI, 0.89-0.99); and negative predictive value, 0.99 (95% CI, 0.98-> or =0.99)]. EHR data can be used to automatically perform cardiovascular risk stratification and identify patients in need of risk-lowering interventions. This could improve detection of high-risk patients whom physicians would otherwise be unaware.

A Network-Biology Informed Computational Drug Repositioning Strategy to Target Disease Risk Trajectories and Comorbidities of Peripheral Artery Disease.

PubMed

Shameer, Khader; Dow, Garrett; Glicksberg, Benjamin S; Johnson, Kipp W; Ze, Yi; Tomlinson, Max S; Readhead, Ben; Dudley, Joel T; Kullo, Iftikhar J

2018-01-01

Currently, drug discovery approaches focus on the design of therapies that alleviate an index symptom by reengineering the underlying biological mechanism in agonistic or antagonistic fashion. For example, medicines are routinely developed to target an essential gene that drives the disease mechanism. Therapeutic overloading where patients get multiple medications to reduce the primary and secondary side effect burden is standard practice. This single-symptom based approach may not be scalable, as we understand that diseases are more connected than random and molecular interactions drive disease comorbidities. In this work, we present a proof-of-concept drug discovery strategy by combining network biology, disease comorbidity estimates, and computational drug repositioning, by targeting the risk factors and comorbidities of peripheral artery disease, a vascular disease associated with high morbidity and mortality. Individualized risk estimation and recommending disease sequelae based therapies may help to lower the mortality and morbidity of peripheral artery disease.

A Network-Biology Informed Computational Drug Repositioning Strategy to Target Disease Risk Trajectories and Comorbidities of Peripheral Artery Disease

PubMed Central

Shameer, Khader; Dow, Garrett; Glicksberg, Benjamin S.; Johnson, Kipp W.; Ze, Yi; Tomlinson, Max S.; Readhead, Ben; Dudley, Joel T.; Kullo, Iftikhar J.

2018-01-01

Currently, drug discovery approaches focus on the design of therapies that alleviate an index symptom by reengineering the underlying biological mechanism in agonistic or antagonistic fashion. For example, medicines are routinely developed to target an essential gene that drives the disease mechanism. Therapeutic overloading where patients get multiple medications to reduce the primary and secondary side effect burden is standard practice. This single-symptom based approach may not be scalable, as we understand that diseases are more connected than random and molecular interactions drive disease comorbidities. In this work, we present a proof-of-concept drug discovery strategy by combining network biology, disease comorbidity estimates, and computational drug repositioning, by targeting the risk factors and comorbidities of peripheral artery disease, a vascular disease associated with high morbidity and mortality. Individualized risk estimation and recommending disease sequelae based therapies may help to lower the mortality and morbidity of peripheral artery disease. PMID:29888052

Estimating infertility prevalence in low-to-middle-income countries: an application of a current duration approach to Demographic and Health Survey data

PubMed Central

Cox, Carie M.; Tunçalp, Özge; McLain, Alexander C.; Thoma, Marie E.

2017-01-01

Abstract STUDY QUESTION Can infertility prevalence be estimated using a current duration (CD) approach when applied to nationally representative Demographic and Health Survey (DHS) data collected routinely in low- or middle-income countries? SUMMARY ANSWER Our analysis suggests that a CD approach applied to DHS data from Nigeria provides infertility prevalence estimates comparable to other smaller studies in the same region. WHAT IS KNOWN ALREADY Despite associations with serious negative health, social and economic outcomes, infertility in developing countries is a marginalized issue in sexual and reproductive health. Obtaining reliable, nationally representative prevalence estimates is critical to address the issue, but methodological and resource challenges have impeded this goal. STUDY DESIGN, SIZE, DURATION This cross-sectional study was based on standard information available in the DHS core questionnaire and data sets, which are collected routinely among participating low-to-middle-income countries. Our research question was examined among women participating in the 2013 Nigeria DHS (n = 38 948). Among women eligible for the study, 98% were interviewed. PARTICIPANTS/MATERIALS, SETTING, METHODS We applied a CD approach (i.e. current length of time-at-risk of pregnancy) to estimate time-to-pregnancy (TTP) and 12-month infertility prevalence among women ‘at risk’ of pregnancy at the time of interview (n = 7063). Women who were 18–44 years old, married or cohabitating, sexually active within the past 4 weeks and not currently using contraception (and had not been sterilized) were included in the analysis. Estimates were based on parametric survival methods using bootstrap methods (500 bootstrap replicates) to obtain 95% CIs. MAIN RESULTS AND THE ROLE OF CHANCE The estimated median TTP among couples at risk of pregnancy was 5.1 months (95% CI: 4.2–6.3). The estimated percentage of infertile couples was 31.1% (95% CI: 27.9–34.7%)—consistent with other smaller studies from Nigeria. Primary infertility (17.4%, 95% CI: 12.9–23.8%) was substantially lower than secondary infertility (34.1%, 95% CI: 30.3–39.3%) in this population. Overall estimates for TTP >24 or >36 months dropped to 17.7% (95% CI: 15.7–20%) and 11.5% (95% CI: 10.2–13%), respectively. Subgroup analyses showed that estimates varied by age, coital frequency and fertility intentions, while being in a polygynous relationship showed minimal impact. LIMITATIONS, REASONS FOR CAUTION The CD approach may be limited by assumptions on when exposure to risk of pregnancy began and methodologic assumptions required for estimation, which may be less accurate for particular subgroups or populations. Unrecognized pregnancies may have also biased our findings; however, we attempted to address this in our exclusion criteria. Limiting to married/cohabiting couples may have excluded women who are no longer in a relationship after being blamed for infertility. Although probably rare in this setting, we lack information on couples undergoing infertility treatment. Like other TTP measurement approaches, pregnancies resulting from contraceptive failure are not included, which may bias estimates. WIDER IMPLICATIONS OF THE FINDINGS Nationally representative estimates of TTP and infertility based on a clinical definition of 12 months have been limited within developing countries. This approach represents a pragmatic advance in our ability to measure and monitor infertility in the developing world, with potentially far-reaching implications for policies and programs intended to address reproductive health. STUDY FUNDING/COMPETING INTERESTS There are no competing interests and no financial support was provided for this study. Financial support for Open Access publication was provided by the World Health Organization. PMID:28204493

Development of a risk assessment tool for projecting individualized probabilities of developing breast cancer for Chinese women.

PubMed

Wang, Yuan; Gao, Ying; Battsend, Munkhzul; Chen, Kexin; Lu, Wenli; Wang, Yaogang

2014-11-01

The optimal approach regarding breast cancer screening for Chinese women is unclear due to the relative low incidence rate. A risk assessment tool may be useful for selection of high-risk subsets of population for mammography screening in low-incidence and resource-limited developing country. The odd ratios for six main risk factors of breast cancer were pooled by review manager after a systematic research of literature. Health risk appraisal (HRA) model was developed to predict an individual's risk of developing breast cancer in the next 5 years from current age. The performance of this HRA model was assessed based on a first-round screening database. Estimated risk of breast cancer increased with age. Increases in the 5-year risk of developing breast cancer were found with the existence of any of included risk factors. When individuals who had risk above median risk (3.3‰) were selected from the validation database, the sensitivity is 60.0% and the specificity is 47.8%. The unweighted area under the curve (AUC) was 0.64 (95% CI = 0.50-0.78). The risk-prediction model reported in this article is based on a combination of risk factors and shows good overall predictive power, but it is still weak at predicting which particular women will develop the disease. It would be very helpful for the improvement of a current model if more population-based prospective follow-up studies were used for the validation.

76 FR 69137 - Atlantic Highly Migratory Species; Atlantic Bluefin Tuna Fisheries

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-08

... 200 mt or more may remain unused). NMFS will need to account for 2011 BFT landings and dead discards... landings and dead discards within the total 2011 U.S. quota once the dead discard information is available, NMFS' best estimates of current dead discards and quota that will remain unused indicate that the risk...

DEVELOPMENT OF A REFINED DATABASE OF RELATIVE POTENCY ESTIMATES TO FACILITATE BETTER CHARACTERIZATION OF VARIABILITY AND UNCERTAINTY IN THE CURRENT MAMMALIAN TEFS FOR PCDDS, PCDFS, AND DIOXIN-LIKE PCBS

EPA Science Inventory

The toxic equivalency factor (TEF) approach has been widely accepted as the most feasible and plausible method presently available for evaluating potential health risks associated with exposure to mixtures of polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofuran...

How rapidly does the excess risk of lung cancer decline following quitting smoking? A quantitative review using the negative exponential model.

PubMed

Fry, John S; Lee, Peter N; Forey, Barbara A; Coombs, Katharine J

2013-10-01

The excess lung cancer risk from smoking declines with time quit, but the shape of the decline has never been precisely modelled, or meta-analyzed. From a database of studies of at least 100 cases, we extracted 106 blocks of RRs (from 85 studies) comparing current smokers, former smokers (by time quit) and never smokers. Corresponding pseudo-numbers of cases and controls (or at-risk) formed the data for fitting the negative exponential model. We estimated the half-life (H, time in years when the excess risk becomes half that for a continuing smoker) for each block, investigated model fit, and studied heterogeneity in H. We also conducted sensitivity analyses allowing for reverse causation, either ignoring short-term quitters (S1) or considering them smokers (S2). Model fit was poor ignoring reverse causation, but much improved for both sensitivity analyses. Estimates of H were similar for all three analyses. For the best-fitting analysis (S1), H was 9.93 (95% CI 9.31-10.60), but varied by sex (females 7.92, males 10.71), and age (<50years 6.98, 70+years 12.99). Given that reverse causation is taken account of, the model adequately describes the decline in excess risk. However, estimates of H may be biased by factors including misclassification of smoking status. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

Prevalence of health-risk behaviors among Asian American and Pacific Islander high school students in the U.S., 2001-2007.

PubMed

Lowry, Richard; Eaton, Danice K; Brener, Nancy D; Kann, Laura

2011-01-01

We provided national prevalence estimates for selected health-risk behaviors for Asian American and Pacific Islander high school students separately, and compared those prevalence estimates with those of white, black, and Hispanic students. We analyzed data from the Youth Risk Behavior Surveillance System. To generate a sufficient sample of Asian American and Pacific Islander students, we combined data from four nationally representative surveys of U.S. high school students conducted in 2001, 2003, 2005, and 2007 (total n = 56,773). Asian American students were significantly less likely than Pacific Islander, white, black, or Hispanic students to have drunk alcohol or used marijuana. Asian American students also were the least likely to have carried a weapon, to have been in a physical fight, to have ever had sexual intercourse, or to be currently sexually active. Once sexually active, Asian American students were as likely as most other racial/ethnic groups to have used alcohol or drugs at last sexual intercourse or to have used a condom at last sexual intercourse. Pacific Islander students were significantly more likely than Asian American, white, black, or Hispanic students to have seriously considered or attempted suicide. The prevalence estimates of health-risk behaviors exhibited by Asian American students and Pacific Islander students are very different and should be reported separately whenever feasible. To address the different health-risk behaviors exhibited by Asian American and Pacific Islander students, prevention programs should use culturally sensitive strategies and materials.

Tuberculosis control in the era of the HIV epidemic: risk of tuberculosis infection in Tanzania, 1983-1998.

PubMed

2001-02-01

In Tanzania, a national tuberculosis programme (NTP) was established in 1979 based on the principles currently known as the World Health Organization DOTS strategy. From the period 1983-1987 to 1994-1998, notification rates of smear-positive tuberculosis increased from 32 to 69 per 100,000 population, mainly due to the human immunodeficiency virus (HIV) epidemic. To estimate the trend in the annual risk of tuberculosis infection and to establish to what extent the opposing forces of improved tuberculosis control and HIV have had an impact on tuberculosis transmission. Three national surveys were conducted in Tanzania among primary school children at 5-year intervals. The annual risk of tuberculosis infection and its trend were determined by tuberculin skin testing. The annual risk of infection in children without BCG scar using the criterion '17 mm + 2 x 18 mm' or more was estimated at 1.1% in 1983-1987, 1.0 in 1988-1992, and 0.9% in 1993-1998. There appears to have been little change in the annual risk of infection over the study period, either when using other criteria to define infection or in children with a BCG scar. The estimated number of infections per notified case decreased over time from 36 to 19. Despite strongly increased tuberculosis notification rates in adults, associated with the HIV epidemic, the risk of tuberculosis infection in children appears to have been stable over the past 15 years in Tanzania. This remarkable achievement is probably due to the impact of the NTP on tuberculosis transmission.

Current distribution in tissues with conducted electrical weapons operated in drive-stun mode.

PubMed

Panescu, Dorin; Kroll, Mark W; Brave, Michael

2016-08-01

The TASER® conducted electrical weapon (CEW) is best known for delivering electrical pulses that can temporarily incapacitate subjects by overriding normal motor control. The alternative drive-stun mode is less understood and the goal of this paper is to analyze the distribution of currents in tissues when the CEW is operated in this mode. Finite element modeling (FEM) was used to approximate current density in tissues with boundary electrical sources placed 40 mm apart. This separation was equivalent to the distance between drive-stun mode TASER X26™, X26P, X2 CEW electrodes located on the device itself and between those located on the expended CEW cartridge. The FEMs estimated the amount of current flowing through various body tissues located underneath the electrodes. The FEM simulated the attenuating effects of both a thin and of a normal layer of fat. The resulting current density distributions were used to compute the residual amount of current flowing through deeper layers of tissue. Numerical modeling estimated that the skin, fat and skeletal muscle layers passed at least 86% or 91% of total CEW current, assuming a thin or normal fat layer thickness, respectively. The current density and electric field strength only exceeded thresholds which have increased probability for ventricular fibrillation (VFTJ), or for cardiac capture (CCTE), in the skin and the subdermal fat layers. The fat layer provided significant attenuation of drive-stun CEW currents. Beyond the skeletal muscle layer, only fractional amounts of the total CEW current were estimated to flow. The regions presenting risk for VF induction or for cardiac capture were well away from the typical heart depth.

Associations between lifestyle and air pollution exposure: Potential for confounding in large administrative data cohorts.

PubMed

Strak, Maciej; Janssen, Nicole; Beelen, Rob; Schmitz, Oliver; Karssenberg, Derek; Houthuijs, Danny; van den Brink, Carolien; Dijst, Martin; Brunekreef, Bert; Hoek, Gerard

2017-07-01

Cohorts based on administrative data have size advantages over individual cohorts in investigating air pollution risks, but often lack in-depth information on individual risk factors related to lifestyle. If there is a correlation between lifestyle and air pollution, omitted lifestyle variables may result in biased air pollution risk estimates. Correlations between lifestyle and air pollution can be induced by socio-economic status affecting both lifestyle and air pollution exposure. Our overall aim was to assess potential confounding by missing lifestyle factors on air pollution mortality risk estimates. The first aim was to assess associations between long-term exposure to several air pollutants and lifestyle factors. The second aim was to assess whether these associations were sensitive to adjustment for individual and area-level socioeconomic status (SES), and whether they differed between subgroups of the population. Using the obtained air pollution-lifestyle associations and indirect adjustment methods, our third aim was to investigate the potential bias due to missing lifestyle information on air pollution mortality risk estimates in administrative cohorts. We used a recent Dutch national health survey of 387,195 adults to investigate the associations of PM 10 , PM 2.5 , PM 2.5-10 , PM 2.5 absorbance, OP DTT, OP ESR and NO 2 annual average concentrations at the residential address from land use regression models with individual smoking habits, alcohol consumption, physical activity and body mass index. We assessed the associations with and without adjustment for neighborhood and individual SES characteristics typically available in administrative data cohorts. We illustrated the effect of including lifestyle information on the air pollution mortality risk estimates in administrative cohort studies using a published indirect adjustment method. Current smoking and alcohol consumption were generally positively associated with air pollution. Physical activity and overweight were negatively associated with air pollution. The effect estimates were small (mostly <5% of the air pollutant standard deviations). Direction and magnitude of the associations depended on the pollutant, use of continuous vs. categorical scale of the lifestyle variable, and level of adjustment for individual and area-level SES. Associations further differed between subgroups (age, sex) in the population. Despite the small associations between air pollution and smoking intensity, indirect adjustment resulted in considerable changes of air pollution risk estimates for cardiovascular and especially lung cancer mortality. Individual lifestyle-related risk factors were weakly associated with long-term exposure to air pollution in the Netherlands. Indirect adjustment for missing lifestyle factors in administrative data cohort studies may substantially affect air pollution mortality risk estimates. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

An improved approach for flight readiness certification: Methodology for failure risk assessment and application examples. Volume 2: Software documentation

NASA Technical Reports Server (NTRS)

Moore, N. R.; Ebbeler, D. H.; Newlin, L. E.; Sutharshana, S.; Creager, M.

1992-01-01

An improved methodology for quantitatively evaluating failure risk of spaceflight systems to assess flight readiness and identify risk control measures is presented. This methodology, called Probabilistic Failure Assessment (PFA), combines operating experience from tests and flights with engineering analysis to estimate failure risk. The PFA methodology is of particular value when information on which to base an assessment of failure risk, including test experience and knowledge of parameters used in engineering analyses of failure phenomena, is expensive or difficult to acquire. The PFA methodology is a prescribed statistical structure in which engineering analysis models that characterize failure phenomena are used conjointly with uncertainties about analysis parameters and/or modeling accuracy to estimate failure probability distributions for specific failure modes, These distributions can then be modified, by means of statistical procedures of the PFA methodology, to reflect any test or flight experience. Conventional engineering analysis models currently employed for design of failure prediction are used in this methodology. The PFA methodology is described and examples of its application are presented. Conventional approaches to failure risk evaluation for spaceflight systems are discussed, and the rationale for the approach taken in the PFA methodology is presented. The statistical methods, engineering models, and computer software used in fatigue failure mode applications are thoroughly documented.

An improved approach for flight readiness certification: Methodology for failure risk assessment and application examples, volume 1

NASA Technical Reports Server (NTRS)

Moore, N. R.; Ebbeler, D. H.; Newlin, L. E.; Sutharshana, S.; Creager, M.

1992-01-01

An improved methodology for quantitatively evaluating failure risk of spaceflight systems to assess flight readiness and identify risk control measures is presented. This methodology, called Probabilistic Failure Assessment (PFA), combines operating experience from tests and flights with engineering analysis to estimate failure risk. The PFA methodology is of particular value when information on which to base an assessment of failure risk, including test experience and knowledge of parameters used in engineering analyses of failure phenomena, is expensive or difficult to acquire. The PFA methodology is a prescribed statistical structure in which engineering analysis models that characterize failure phenomena are used conjointly with uncertainties about analysis parameters and/or modeling accuracy to estimate failure probability distributions for specific failure modes. These distributions can then be modified, by means of statistical procedures of the PFA methodology, to reflect any test or flight experience. Conventional engineering analysis models currently employed for design of failure prediction are used in this methodology. The PFA methodology is described and examples of its application are presented. Conventional approaches to failure risk evaluation for spaceflight systems are discussed, and the rationale for the approach taken in the PFA methodology is presented. The statistical methods, engineering models, and computer software used in fatigue failure mode applications are thoroughly documented.

Estimating community health needs against a Triple Aim background: What can we learn from current predictive risk models?

PubMed

Elissen, Arianne M J; Struijs, Jeroen N; Baan, Caroline A; Ruwaard, Dirk

2015-05-01

To support providers and commissioners in accurately assessing their local populations' health needs, this study produces an overview of Dutch predictive risk models for health care, focusing specifically on the type, combination and relevance of included determinants for achieving the Triple Aim (improved health, better care experience, and lower costs). We conducted a mixed-methods study combining document analyses, interviews and a Delphi study. Predictive risk models were identified based on a web search and expert input. Participating in the study were Dutch experts in predictive risk modelling (interviews; n=11) and experts in healthcare delivery, insurance and/or funding methodology (Delphi panel; n=15). Ten predictive risk models were analysed, comprising 17 unique determinants. Twelve were considered relevant by experts for estimating community health needs. Although some compositional similarities were identified between models, the combination and operationalisation of determinants varied considerably. Existing predictive risk models provide a good starting point, but optimally balancing resources and targeting interventions on the community level will likely require a more holistic approach to health needs assessment. Development of additional determinants, such as measures of people's lifestyle and social network, may require policies pushing the integration of routine data from different (healthcare) sources. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Space radiation risk limits and Earth-Moon-Mars environmental models

NASA Astrophysics Data System (ADS)

Cucinotta, Francis A.; Hu, Shaowen; Schwadron, Nathan A.; Kozarev, K.; Townsend, Lawrence W.; Kim, Myung-Hee Y.

2010-12-01

We review NASA's short-term and career radiation limits for astronauts and methods for their application to future exploration missions outside of low Earth orbit. Career limits are intended to restrict late occurring health effects and include a 3% risk of exposure-induced death from cancer and new limits for central nervous system and heart disease risks. Short-term dose limits are used to prevent in-flight radiation sickness or death through restriction of the doses to the blood forming organs and to prevent clinically significant cataracts or skin damage through lens and skin dose limits, respectively. Large uncertainties exist in estimating the health risks of space radiation, chiefly the understanding of the radiobiology of heavy ions and dose rate and dose protraction effects, and the limitations in human epidemiology data. To protect against these uncertainties NASA estimates the 95% confidence in the cancer risk projection intervals as part of astronaut flight readiness assessments and mission design. Accurate organ dose and particle spectra models are needed to ensure astronauts stay below radiation limits and to support the goal of narrowing the uncertainties in risk projections. Methodologies for evaluation of space environments, radiation quality, and organ doses to evaluate limits are discussed, and current projections for lunar and Mars missions are described.

Assessment of Costs for a Global Climate Fund Against Public Sector Disaster Risks

NASA Astrophysics Data System (ADS)

Hochrainer-Stigler, Stefan; Mechler, Reinhard; Pflug, Georg; Williges, Keith

2013-04-01

National governments are key actors in managing climate variability and change, yet, many countries, faced with exhausted tax bases, high levels of indebtedness and limited donor assistance, have been unable to raise sufficient and timely capital to replace or repair damaged assets and restore livelihoods following major disasters exacerbating the impacts of disaster shocks on poverty and development. For weather extremes, which form a subset of the adaptation challenge and are supposed to increase in intensity and frequency with a changing climate, we conduct an assessment of the costs of managing and financing today's public sector risks on a global scale for more than 180 countries. A countries financial vulnerability is defined as a function of its financial resilience and its exposure to disaster risk. While disaster risk is estimated in terms of asset loss distributions based on catastrophe modeling approaches, financial resilience is operationalized as the public sector's ability to pay for relief to the affected population and support the reconstruction of affected assets and infrastructure for a given event. We consider governments financially vulnerable to disasters if they cannot access sufficient funding after a disaster to cover their liabilities. We operationalize this concept by the term resource gap, which we define the net loss associated with a disaster event after exhausting all possible ex-post and ex ante financing sources. Extending this approach for all possible disaster events, the risk that a resource gap will occur over a given time-span can be calculated for each country individually and dependent on the risk level different risk instruments may have to be applied. Furthermore, our estimates may inform decisions pertaining to a "climate insurance fund" absorbing "high level" country risks exceeding the ability of any given country to pay in the case of an extreme event. Our estimates relate to today's climate, yet we suggest that estimates of current climate variability and related risks, although also associated with substantial uncertainty, can be interpreted as a baseline for very uncertain future projections.

Using Probabilistic Methods in Water Scarcity Assessments: A First Step Towards a Water Scarcity Risk Assessment Framework

NASA Technical Reports Server (NTRS)

Veldkamp, Ted; Wada, Yoshihide; Aerts, Jeroen; Ward, Phillip

2016-01-01

Water scarcity -driven by climate change, climate variability, and socioeconomic developments- is recognized as one of the most important global risks, both in terms of likelihood and impact. Whilst a wide range of studies have assessed the role of long term climate change and socioeconomic trends on global water scarcity, the impact of variability is less well understood. Moreover, the interactions between different forcing mechanisms, and their combined effect on changes in water scarcity conditions, are often neglected. Therefore, we provide a first step towards a framework for global water scarcity risk assessments, applying probabilistic methods to estimate water scarcity risks for different return periods under current and future conditions while using multiple climate and socioeconomic scenarios.

Technical Evaluation of the NASA Model for Cancer Risk to Astronauts Due to Space Radiation

NASA Technical Reports Server (NTRS)

2012-01-01

At the request of NASA, the National Research Council's (NRC's) Committee for Evaluation of Space Radiation Cancer Risk Model1 reviewed a number of changes that NASA proposes to make to its model for estimating the risk of radiation-induced cancer in astronauts. The NASA model in current use was last updated in 2005, and the proposed model would incorporate recent research directed at improving the quantification and understanding of the health risks posed by the space radiation environment. NASA's proposed model is defined by the 2011 NASA report Space Radiation Cancer Risk Projections and Uncertainties--2010 . The committee's evaluation is based primarily on this source, which is referred to hereafter as the 2011 NASA report, with mention of specific sections or tables. The overall process for estimating cancer risks due to low linear energy transfer (LET) radiation exposure has been fully described in reports by a number of organizations. The approaches described in the reports from all of these expert groups are quite similar. NASA's proposed space radiation cancer risk assessment model calculates, as its main output, age- and gender-specific risk of exposure-induced death (REID) for use in the estimation of mission and astronaut-specific cancer risk. The model also calculates the associated uncertainties in REID. The general approach for estimating risk and uncertainty in the proposed model is broadly similar to that used for the current (2005) NASA model and is based on recommendations by the National Council on Radiation Protection and Measurements. However, NASA's proposed model has significant changes with respect to the following: the integration of new findings and methods into its components by taking into account newer epidemiological data and analyses, new radiobiological data indicating that quality factors differ for leukemia and solid cancers, an improved method for specifying quality factors in terms of radiation track structure concepts as opposed to the previous approach based on linear energy transfer, the development of a new solar particle event (SPE) model, and the updates to galactic cosmic ray (GCR) and shielding transport models. The newer epidemiological information includes updates to the cancer incidence rates from the life span study (LSS) of the Japanese atomic bomb survivors, transferred to the U.S. population and converted to cancer mortality rates from U.S. population statistics. In addition, the proposed model provides an alternative analysis applicable to lifetime never-smokers (NSs). Details of the uncertainty analysis in the model have also been updated and revised. NASA's proposed model and associated uncertainties are complex in their formulation and as such require a very clear and precise set of descriptions. The committee found the 2011 NASA report challenging to review largely because of the lack of clarity in the model descriptions and derivation of the various parameters used. The committee requested some clarifications from NASA throughout its review and was able to resolve many, but not all, of the ambiguities in the written description.

Diagnosis-Based Risk Adjustment for Medicare Capitation Payments

PubMed Central

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

1996-01-01

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

Toward Robust and Efficient Climate Downscaling for Wind Energy

NASA Astrophysics Data System (ADS)

Vanvyve, E.; Rife, D.; Pinto, J. O.; Monaghan, A. J.; Davis, C. A.

2011-12-01

This presentation describes a more accurate and economical (less time, money and effort) wind resource assessment technique for the renewable energy industry, that incorporates innovative statistical techniques and new global mesoscale reanalyzes. The technique judiciously selects a collection of "case days" that accurately represent the full range of wind conditions observed at a given site over a 10-year period, in order to estimate the long-term energy yield. We will demonstrate that this new technique provides a very accurate and statistically reliable estimate of the 10-year record of the wind resource by intelligently choosing a sample of ±120 case days. This means that the expense of downscaling to quantify the wind resource at a prospective wind farm can be cut by two thirds from the current industry practice of downscaling a randomly chosen 365-day sample to represent winds over a "typical" year. This new estimate of the long-term energy yield at a prospective wind farm also has far less statistical uncertainty than the current industry standard approach. This key finding has the potential to reduce significantly market barriers to both onshore and offshore wind farm development, since insurers and financiers charge prohibitive premiums on investments that are deemed to be high risk. Lower uncertainty directly translates to lower perceived risk, and therefore far more attractive financing terms could be offered to wind farm developers who employ this new technique.

The cost-effectiveness of influenza vaccination of healthy adults 50-64 years of age.

PubMed

Turner, D A; Wailoo, A J; Cooper, N J; Sutton, A J; Abrams, K R; Nicholson, K G

2006-02-13

Influenza can cause significant morbidity and mortality. Influenza vaccination is an effective and safe strategy in the prevention of influenza. Currently the National Health Service (NHS) vaccinates 'at-risk' individuals only. This definition includes everyone over 65 years of age but excludes individuals 50-64 years of age unless they have an additional risk factor, such as underlying heart disease or lung disease. In order to examine the cost-effectiveness of an extension of the vaccination policy to include this age group we constructed an economic model to estimate the costs and benefits of vaccination from both a health service and a societal perspective. Data to populate the model was obtained from the literature and the outcome measure used was the quality adjusted life year (QALY). Influenza vaccination prevented an estimated 4508 cases (95% CI: 2431-7606) per 100,000 vaccinees per influenza season for a net cost to the NHS of pound653,221 (95% CI: 354,575-1,072,257). The net cost increased to pound1,139,069 (95% CI 27,052-2,030,473) when non-NHS costs were included and the estimated cost-per-QALY were pound6174 and pound10,766 for NHS and all costs respectively. Extension of the current immunisation policy has the potential to generate a significant health benefit at a comparatively low cost.

Migraine and risk of stroke in older adults

PubMed Central

Gardener, Hannah; Rundek, Tatjana; Elkind, Mitchell S.V.; Sacco, Ralph L.

2015-01-01

Objective: To examine the association between migraine and stroke/vascular outcomes in a racially/ethnically diverse, older cohort. Methods: Participants from the Northern Manhattan Study, a population-based cohort study of stroke incidence, were assessed for migraine symptoms using a self-report questionnaire based on criteria from the International Classification of Headache Disorders, second edition. We estimated the association between migraine and combined vascular events including stroke and stroke only over a mean follow-up of 11 years, using Cox models adjusted for sociodemographic and vascular risk factors. Results: Of 1,292 participants (mean age 68 ± 9 years) with migraine data followed prospectively for vascular events, 262 patients (20%) had migraine and 75 (6%) had migraine with aura. No association was found between migraine (with or without aura) and risk of either stroke or combined cardiovascular events. There was an interaction between migraine and current smoking (p = 0.02 in relation to stroke and p = 0.03 for combined vascular events), such that those with migraine and smoking were at an increased risk. The hazard ratio of stroke for migraine among current smokers was 3.17 (95% confidence interval [CI] 1.13–8.85) and among current nonsmokers was 0.77 (95% CI 0.44–1.35). In relation to combined vascular events, the hazard ratio for migraine vs no migraine among current smokers was 1.83 (95% CI 0.89–3.75) and among current nonsmokers was 0.63 (95% CI 0.43–0.94). Conclusion: In our racially/ethnically diverse population-based cohort, migraine was associated with an increased risk of stroke among active smokers but not among nonsmokers. PMID:26203088

A quantitative risk assessment model to evaluate effective border control measures for rabies prevention.

PubMed

Weng, Hsin-Yi; Wu, Pei-I; Yang, Ping-Cheng; Tsai, Yi-Lun; Chang, Chao-Chin

2010-01-01

Border control is the primary method to prevent rabies emergence. This study developed a quantitative risk model incorporating stochastic processes to evaluate whether border control measures could efficiently prevent rabies introduction through importation of cats and dogs using Taiwan as an example. Both legal importation and illegal smuggling were investigated. The impacts of reduced quarantine and/or waiting period on the risk of rabies introduction were also evaluated. The results showed that Taiwan's current animal importation policy could effectively prevent rabies introduction through legal importation of cats and dogs. The median risk of a rabid animal to penetrate current border control measures and enter Taiwan was 5.33 x 10(-8) (95th percentile: 3.20 x 10(-7)). However, illegal smuggling may pose Taiwan to the great risk of rabies emergence. Reduction of quarantine and/or waiting period would affect the risk differently, depending on the applied assumptions, such as increased vaccination coverage, enforced custom checking, and/or change in number of legal importations. Although the changes in the estimated risk under the assumed alternatives were not substantial except for completely abolishing quarantine, the consequences of rabies introduction may yet be considered to be significant in a rabies-free area. Therefore, a comprehensive benefit-cost analysis needs to be conducted before recommending these alternative measures.

Body Mass Index and Waist Circumference in Relation to Lung Cancer Risk in the Women's Health Initiative

PubMed Central

Kim, Mimi; Hunt, Julie R.; Chlebowski, Rowan T.; Rohan, Thomas E.

2008-01-01

Investigators in several epidemiologic studies have observed an inverse association between body mass index (BMI) and lung cancer risk, while others have not. The authors used data from the Women's Health Initiative to study the association of anthropometric factors with lung cancer risk. Over 8 years of follow-up (1998–2006), 1,365 incident lung cancer cases were ascertained among 161,809 women. Cox proportional hazards models were used to estimate hazard ratios adjusted for covariates. Baseline BMI was inversely associated with lung cancer in current smokers (highest quintile vs. lowest: hazard ratio (HR) = 0.62, 95% confidence interval (CI): 0.42, 0.92). When BMI and waist circumference were mutually adjusted, BMI was inversely associated with lung cancer risk in both current smokers and former smokers (HR = 0.40 (95% CI: 0.22, 0.72) and HR = 0.61 (95% CI: 0.40, 0.94), respectively), and waist circumference was positively associated with risk (HR = 1.56 (95% CI: 0.91, 2.69) and HR = 1.50 (95% CI: 0.98, 2.31), respectively). In never smokers, height showed a borderline positive association with lung cancer. These findings suggest that in smokers, BMI is inversely associated with lung cancer risk and that waist circumference is positively associated with risk. PMID:18483121

Health-based ingestion exposure guidelines for Vibrio cholerae: Technical basis for water reuse applications.

PubMed

Watson, Annetta P; Armstrong, Anthony Q; White, George H; Thran, Brandolyn H

2018-02-01

U.S. military and allied contingency operations are increasingly occurring in locations with limited, unstable or compromised fresh water supplies. Non-potable graywater reuse is currently under assessment as a viable means to increase mission sustainability while significantly reducing the resources, logistics and attack vulnerabilities posed by transport of fresh water. Development of health-based (non-potable) exposure guidelines for the potential microbial components of graywater would provide a logical and consistent human-health basis for water reuse strategies. Such health-based strategies will support not only improved water security for contingency operations, but also sustainable military operations. Dose-response assessment of Vibrio cholerae based on adult human oral exposure data were coupled with operational water exposure scenario parameters common to numerous military activities, and then used to derive health risk-based water concentrations. The microbial risk assessment approach utilized oral human exposure V. cholerae dose studies in open literature. Selected studies focused on gastrointestinal illness associated with experimental infection by specific V. cholerae serogroups most often associated with epidemics and pandemics (O1 and O139). Nonlinear dose-response model analyses estimated V. cholerae effective doses (EDs) aligned with gastrointestinal illness severity categories characterized by diarrheal purge volume. The EDs and water exposure assumptions were used to derive Risk-Based Water Concentrations (CFU/100mL) for mission-critical illness severity levels over a range of water use activities common to military operations. Human dose-response studies, data and analyses indicate that ingestion exposures at the estimated ED 1 (50CFU) are unlikely to be associated with diarrheal illness while ingestion exposures at the lower limit (200CFU) of the estimated ED 10 are not expected to result in a level of diarrheal illness associated with degraded individual capability. The current analysis indicates that the estimated ED 20 (approximately 1000CFU) represents initiation of a more advanced stage of diarrheal illness associated with clinical care. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

[Estimation of cost-saving for reducing radioactive waste from nuclear medicine facilities by implementing decay in storage (DIS) in Japan].

PubMed

Kida, Tetsuo; Hiraki, Hitoshi; Yamaguchi, Ichirou; Fujibuchi, Toshioh; Watanabe, Hiroshi

2012-01-01

DIS has not yet been implemented in Japan as of 2011. Therefore, even if risk was negligible, medical institutions have to entrust radioactive temporal waste disposal to Japan Radio Isotopes Association (JRIA) in the current situation. To decide whether DIS should be implemented in Japan or not, cost-saving effect of DIS was estimated by comparing the cost that nuclear medical facilities pay. By implementing DIS, the total annual cost for all nuclear medical facilities in Japan is estimated to be decreased to 30 million yen or less from 710 million yen. DIS would save 680 million yen (96%) per year.

Risk of stroke and oral anticoagulant use in atrial fibrillation: a cross-sectional survey

PubMed Central

Holt, Tim A; Hunter, Tina D; Gunnarsson, Candace; Khan, Nada; Cload, Paul; Lip, Gregory YH

2012-01-01

Background Oral anticoagulants substantially reduce the risk of stroke in atrial fibrillation but are underutilised in current practice. Aim To measure the distribution of stroke risk in patients with atrial fibrillation (using the CHADS2 and CHA2DS2-VASc scores) and changes in oral anticoagulant use during 2007–2010. Design and setting Longitudinal series of cross-sectional survey in 583 UK practices linked to the QResearch® database providing 99 351 anonymised electronic records from people with atrial fibrillation. Method The proportion of patients in each CHADS2 and CHA2DS2-VASc risk band in 2010 was calculated; for each of the years 2007–2010, the proportions with risk scores ≥2 that were using anticoagulants or antiplatelet agents were estimated. The proportions identified at high risk were re-estimated using alternative definitions of hypertension based on coded data. Finally, the prevalence of comorbid conditions in treated and untreated high-risk (CHADS2 ≥2) groups was derived. Results The proportion at high risk of stroke in 2010 was 56.9% according to the CHADS2 ≥2 threshold, and 84.5% according to CHA2DS2-VASc ≥2 threshold. The proportions of these groups receiving anticoagulants were 53.0% and 50.7% respectively and increased during 2007–2010. The means of identifying the population of individuals with hypertension significantly influenced the estimated proportion at high risk. Comorbid conditions associated with avoidance of anticoagulants included history of falls, use of nonsteroidal anti-inflammatory drugs, and dementia. Conclusion Oral anticoagulant use in atrial fibrillation has increased in UK practice since 2007, but remains suboptimal. Improved coding of hypertension is required to support systematic identification of individuals at high risk of stroke and could be assisted by practice-based software. PMID:23265231

Offshore Energy Mapping for Northeast Atlantic and Mediterranean: MARINA PLATFORM project

NASA Astrophysics Data System (ADS)

Kallos, G.; Galanis, G.; Spyrou, C.; Kalogeri, C.; Adam, A.; Athanasiadis, P.

2012-04-01

Deep offshore ocean energy mapping requires detailed modeling of the wind, wave, tidal and ocean circulation estimations. It requires also detailed mapping of the associated extremes. An important issue in such work is the co-generation of energy (generation of wind, wave, tides, currents) in order to design platforms on an efficient way. For example wind and wave fields exhibit significant phase differences and therefore the produced energy from both sources together requires special analysis. The other two sources namely tides and currents have different temporal scales from the previous two. Another important issue is related to the estimation of the environmental frequencies in order to avoid structural problems. These are issues studied at the framework of the FP7 project MARINA PLATFORM. The main objective of the project is to develop deep water structures that can exploit the energy from wind, wave, tidal and ocean current energy sources. In particular, a primary goal will be the establishment of a set of equitable and transparent criteria for the evaluation of multi-purpose platforms for marine renewable energy. Using these criteria, a novel system set of design and optimisation tools will be produced addressing new platform design, component engineering, risk assessment, spatial planning, platform-related grid connection concepts, all focussed on system integration and reducing costs. The University of Athens group is in charge for estimation and mapping of wind, wave, tidal and ocean current resources, estimate available energy potential, map extreme event characteristics and provide any additional environmental parameter required.

Health Risk Behaviour among Adolescents Living with HIV in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

PubMed

Ssewanyana, Derrick; Mwangala, Patrick N; van Baar, Anneloes; Newton, Charles R; Abubakar, Amina

2018-01-01

The burden of health risk behaviour (HRB) among adolescents living with HIV (ALWHIV) in sub-Saharan Africa (SSA) is currently unknown. A systematic search for publications on HRB among ALWHIV in SSA was conducted in PubMed, Embase, PsycINFO, and Applied Social Sciences Index and Abstracts databases. Results were summarized following PRISMA guidelines for systematic reviews and meta-analyses. Heterogeneity was assessed by the DerSimonian and Laird method and the pooled estimates were computed. Prevalence of current condom nonuse behaviour was at 59.8% (95% CI: 47.9-71.3%), risky sexual partnerships at 32.9% (95% CI: 15.4-53.2%), transactional sex at 20.1% (95% CI: 9.2-33.8%), and the experience of sexual violence at 21.4% (95% CI: 16.3-27.0%) among ALWHIV. From this meta-analysis, we did not find statistically significant differences in pooled estimates of HRB prevalence between ALWHIV and HIV uninfected adolescents. However, there was mixed evidence on the occurrence of alcohol and drug use behaviour. Overall, we found that research on HRB among ALWHIV tends to focus on behaviour specific to sexual risk. With such a high burden of HRB for the individuals as well as society, these findings highlight an unmet need for age-appropriate interventions to address the behavioural needs of these adolescents.

A GIS-based model to estimate flood consequences and the degree of accessibility and operability of strategic emergency response structures in urban areas

NASA Astrophysics Data System (ADS)

Albano, R.; Sole, A.; Adamowski, J.; Mancusi, L.

2014-11-01

Efficient decision-making regarding flood risk reduction has become a priority for authorities and stakeholders in many European countries. Risk analysis methods and techniques are a useful tool for evaluating costs and benefits of possible interventions. Within this context, a methodology to estimate flood consequences was developed in this paper that is based on GIS, and integrated with a model that estimates the degree of accessibility and operability of strategic emergency response structures in an urban area. The majority of the currently available approaches do not properly analyse road network connections and dependencies within systems, and as such a loss of roads could cause significant damages and problems to emergency services in cases of flooding. The proposed model is unique in that it provides a maximum-impact estimation of flood consequences on the basis of the operability of the strategic emergency structures in an urban area, their accessibility, and connection within the urban system of a city (i.e. connection between aid centres and buildings at risk), in the emergency phase. The results of a case study in the Puglia region in southern Italy are described to illustrate the practical applications of this newly proposed approach. The main advantage of the proposed approach is that it allows for defining a hierarchy between different infrastructure in the urban area through the identification of particular components whose operation and efficiency are critical for emergency management. This information can be used by decision-makers to prioritize risk reduction interventions in flood emergencies in urban areas, given limited financial resources.

Contemporary Hormonal Contraception and the Risk of Breast Cancer.

PubMed

Mørch, Lina S; Skovlund, Charlotte W; Hannaford, Philip C; Iversen, Lisa; Fielding, Shona; Lidegaard, Øjvind

2017-12-07

Little is known about whether contemporary hormonal contraception is associated with an increased risk of breast cancer. We assessed associations between the use of hormonal contraception and the risk of invasive breast cancer in a nationwide prospective cohort study involving all women in Denmark between 15 and 49 years of age who had not had cancer or venous thromboembolism and who had not received treatment for infertility. Nationwide registries provided individually updated information about the use of hormonal contraception, breast-cancer diagnoses, and potential confounders. Among 1.8 million women who were followed on average for 10.9 years (a total of 19.6 million person-years), 11,517 cases of breast cancer occurred. As compared with women who had never used hormonal contraception, the relative risk of breast cancer among all current and recent users of hormonal contraception was 1.20 (95% confidence interval [CI], 1.14 to 1.26). This risk increased from 1.09 (95% CI, 0.96 to 1.23) with less than 1 year of use to 1.38 (95% CI, 1.26 to 1.51) with more than 10 years of use (P=0.002). After discontinuation of hormonal contraception, the risk of breast cancer was still higher among the women who had used hormonal contraceptives for 5 years or more than among women who had not used hormonal contraceptives. Risk estimates associated with current or recent use of various oral combination (estrogen-progestin) contraceptives varied between 1.0 and 1.6. Women who currently or recently used the progestin-only intrauterine system also had a higher risk of breast cancer than women who had never used hormonal contraceptives (relative risk, 1.21; 95% CI, 1.11 to 1.33). The overall absolute increase in breast cancers diagnosed among current and recent users of any hormonal contraceptive was 13 (95% CI, 10 to 16) per 100,000 person-years, or approximately 1 extra breast cancer for every 7690 women using hormonal contraception for 1 year. The risk of breast cancer was higher among women who currently or recently used contemporary hormonal contraceptives than among women who had never used hormonal contraceptives, and this risk increased with longer durations of use; however, absolute increases in risk were small. (Funded by the Novo Nordisk Foundation.).

Cortical thickness estimation of the proximal femur from multi-view dual-energy X-ray absorptiometry (DXA)

NASA Astrophysics Data System (ADS)

Tsaousis, N.; Gee, A. H.; Treece, G. M.; Poole, K. E. S.

2013-02-01

Hip fracture is the leading cause of acute orthopaedic hospital admission amongst the elderly, with around a third of patients not surviving one year post-fracture. Although various preventative therapies are available, patient selection is difficult. The current state-of-the-art risk assessment tool (FRAX) ignores focal structural defects, such as cortical bone thinning, a critical component in characterizing hip fragility. Cortical thickness can be measured using CT, but this is expensive and involves a significant radiation dose. Instead, Dual-Energy X-ray Absorptiometry (DXA) is currently the preferred imaging modality for assessing hip fracture risk and is used routinely in clinical practice. Our ambition is to develop a tool to measure cortical thickness using multi-view DXA instead of CT. In this initial study, we work with digitally reconstructed radiographs (DRRs) derived from CT data as a surrogate for DXA scans: this enables us to compare directly the thickness estimates with the gold standard CT results. Our approach involves a model-based femoral shape reconstruction followed by a data-driven algorithm to extract numerous cortical thickness point estimates. In a series of experiments on the shaft and trochanteric regions of 48 proximal femurs, we validated our algorithm and established its performance limits using 20 views in the range 0°-171°: estimation errors were 0:19 +/- 0:53mm (mean +/- one standard deviation). In a more clinically viable protocol using four views in the range 0°-51°, where no other bony structures obstruct the projection of the femur, measurement errors were -0:07 +/- 0:79 mm.

Cardiovascular risk-factor knowledge and risk perception among HIV-infected adults.

PubMed

Cioe, Patricia A; Crawford, Sybil L; Stein, Michael D

2014-01-01

Cardiovascular disease (CVD) has emerged as a major cause of morbidity and mortality in HIV-infected adults. Research in noninfected populations has suggested that knowledge of CVD risk factors significantly influences perceptions of risk. This cross-sectional study describes CVD risk factor knowledge and risk perception in HIV-infected adults. We recruited 130 HIV-infected adults (mean age = 48 years, 62% male, 56% current smokers, mean years since HIV diagnosis, 14.7). The mean CVD risk factor knowledge score was fairly high. However, controlling for age, CVD risk factor knowledge was not predictive of perceived risk [F(1, 117) = 0.13, p > .05]. Estimated risk and perceived risk were weakly but significantly correlated; r (126) = .24, p = .01. HIV-infected adults are at increased risk for CVD. Despite having adequate risk-factor knowledge, CVD risk perception was inaccurate. Improving risk perception and developing CVD risk reduction interventions for this population are imperative. Copyright © 2014 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Dietary inflammatory index, Mediterranean diet score, and lung cancer: a prospective study.

PubMed

Hodge, A M; Bassett, J K; Shivappa, N; Hébert, J R; English, D R; Giles, G G; Severi, G

2016-07-01

To investigate prospectively the associations of Dietary Inflammatory Index (DII) and Mediterranean Diet Score (MDS) with lung cancer. We used data from men and women aged 40-69 years at recruitment in 1990-1994, who were participants in the Melbourne Collaborative Cohort Study (n = 35,303). A total of 403 incident lung cancer cases were identified over an average 18-year follow-up. Hazard ratios (HR) were estimated using Cox regression, adjusting for smoking status and other risk factors, with age as the time metric. An inverse correlation was observed between the DII and MDS (ρ = -0.45), consistent with a higher DII being pro-inflammatory and less 'healthy,' while a high MDS reflects a 'healthier' diet. The DII was positively associated with risk of lung cancer in current smokers [HRQ4 vs Q1 = 1.70 (1.02, 2.82); Ptrend = 0.008] (p interaction between DII quartiles and smoking status = 0.03). The MDS was inversely associated with lung cancer risk overall [HR7-9 vs 0-3 = 0.64 (0.45, 0.90); Ptrend = 0.005] and for current smokers (HR7-9 vs 0-3 = 0.38 (0.19, 0.75); Ptrend = 0.005) (p interaction between MDS categories and smoking status = 0.31). The MDS showed an inverse association with lung cancer risk, especially for current smokers. A high DII, indicating a more pro-inflammatory diet, was associated with risk of lung cancer only for current smokers. A healthy diet may reduce the risk of lung cancer, especially in smokers.

Nonradiological chemical pathway analysis and identification of chemicals of concern for environmental monitoring at the Hanford Site

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

Blanton, M.L.; Cooper, A.T.; Castleton, K.J.

1995-11-01

Pacific Northwest`s Surface Environmental Surveillance Project (SESP) is an ongoing effort tot design, review, and conducted monitoring on and off the Hanford site. Chemicals of concern that were selected are listed. Using modeled exposure pathways, the offsite cancer incidence and hazard quotient were calculated and a retrospective pathway analysis performed to estimate what onsite concentrations would be required in the soil for each chemical of concern and other detected chemicals that would be required to obtain an estimated offsite human-health risk of 1.0E-06 cancer incidence or 1.0 hazard quotient. This analysis indicates that current nonradiological chemical contamination occurring on themore » site does not pose a significant offsite human-health risk; the highest cancer incidence to the offsite maximally exposed individual was from arsenic (1.76E-10); the highest hazard quotient was chromium(VI) (1.48E-04). The most sensitive pathways of exposure were surfacewater and aquatic food consumption. Combined total offsite excess cancer incidence was 2.09E-10 and estimated hazard quotient was 2.40E-04. Of the 17 identified chemicals of concern, the SESP does not currently (routinely) monitor arsenic, benzo(a)pyrene, bis(2- ethylhexyl)phthalate (BEHP), and chrysene. Only 3 of the chemicals of concern (arsenic, BEHP, chloroform) could actually occur in onsite soil at concern high enough to cause a 1.0E-06 excess cancer incidence or a 1.0 hazard index for a given offsite exposure pathway. During the retrospective analysis, 20 other chemicals were also evaluated; only vinyl chloride and thallium could reach targeted offsite risk values.« less

Subsequent Breast Cancer Risk Following Diagnosis of Atypical Ductal Hyperplasia on Needle Biopsy

PubMed Central

Menes, Tehillah S; Kerlikowske, Karla; Lange, Jane; Jaffer, Shabnam; Rosenberg, Robert; Miglioretti, Diana L.

2017-01-01

Background Atypical ductal hyperplasia (ADH) is a known strong risk factor for breast cancer. Published risk estimates are based on cohorts that included women diagnosed prior to the widespread use of screening mammograms and do not differentiate between the methods used to diagnose ADH, which may be related to size of the ADH focus. These risks may overestimate the risk of women currently diagnosed with ADH. We sought to examine the risk of invasive cancer associated with ADH diagnosed on core needle biopsy versus excisional biopsy. Design Cohort study comparing ten-year cumulative risk of invasive breast cancer in women undergoing mammography with and without a diagnosis of ADH. Setting Five breast imaging registries that participate in the National Cancer Institute–funded Breast Cancer Surveillance Consortium (BCSC). Participants Women undergoing mammography in the BCSC. Exposure Diagnosis of ADH on core needle biopsy or excisional biopsy in women undergoing mammography. Main outcome Ten-year cumulative risk of invasive breast cancer risk. Results The sample included 955,331 women with 1,727 diagnoses of ADH. From 1996 to 2012, the proportion of ADH diagnosed by core needle biopsy increased from 21% to 77%. Ten years following a diagnosis of ADH, the cumulative risk of invasive breast cancer was 2.6 (95% CI 2.0, 3.4) times higher than risk in women with no ADH. ADH diagnosed via excisional biopsy was associated with an adjusted HR of 3.0 (95% CI 2.0, 4.5), and via core needle biopsy, with an HR of 2.2 (95% CI 1.5, 3.4). Ten years after an ADH diagnosis, an estimated 5.7% (95% CI 4.3, 10.1) of women were diagnosed with invasive cancer. Women with ADH diagnosed on excisional biopsy had a slightly higher risk (6.7 %; 95% CI 3.0, 12.8) compared to those with ADH diagnosed via core needle biopsy (5.0%; 95% CI 2.2, 8.9). Conclusions Current 10-year risks of invasive breast cancer after a diagnosis of ADH may be lower than previously reported. The risk associated with ADH is slightly lower for women diagnosed by needle core biopsy as compared to excisional biopsy. PMID:27607465

Carbohydrate intake, obesity, metabolic syndrome and cancer risk? A two-part systematic review and meta-analysis protocol to estimate attributability

PubMed Central

Sartorius, B; Sartorius, K; Aldous, C; Madiba, T E; Stefan, C; Noakes, T

2016-01-01

Introduction Linkages between carbohydrates, obesity and cancer continue to demonstrate conflicting results. Evidence suggests inconclusive direct linkages between carbohydrates and specific cancers. Conversely, obesity has been strongly linked to a wide range of cancers. The purpose of the study is to explore linkages between carbohydrate intake and cancer types using a two-step approach. First the study will evaluate the linkages between carbohydrate intake and obesity, potentially stratified by metabolic syndrome status. Second, the estimated attributable fraction of obesity ascribed to carbohydrate intake will be multiplied against obesity attributable fractions for cancer types to give estimated overall attributable fraction for carbohydrate versus cancer type. Methods and analysis We will perform a comprehensive search to identify all possible published and unpublished studies that have assessed risk factors for obesity including dietary carbohydrate intake. Scientific databases, namely PubMed MEDLINE, EMBASE, EBSCOhost and ISI Web of Science will be searched. Following study selection, paper/data acquisition, and data extraction and synthesis, we will appraise the quality of studies and risk of bias, as well as assess heterogeneity. Meta-weighted attributable fractions of obesity due to carbohydrate intake will be estimated after adjusting for other potential confounding factors (eg, physical inactivity, other dietary intake). Furthermore, previously published systematic reviews assessing the cancer-specific risk associated with obesity will also be drawn. These estimates will be linked with the attributability of carbohydrate intake in part 1 to estimate the cancer-specific burden that can be attributed to dietary carbohydrates. This systematic review protocol has been developed according to the ‘Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015’. Ethics and dissemination The current study will be based on published literature and data, and, as such, ethics approval is not required. The final results of this two part systematic review (plus multiplicative calculations) will be published in a relevant international peer-reviewed journal. Trial registration number PROSPERO CRD42015023257. PMID:26729382

Analysis of risk factors for schizophrenia with two different case definitions: a nationwide register-based external validation study.

PubMed

Sørensen, Holger J; Larsen, Janne T; Mors, Ole; Nordentoft, Merete; Mortensen, Preben B; Petersen, Liselotte

2015-03-01

Different case definitions of schizophrenia have been used in register based research. However, no previous study has externally validated two different case definitions of schizophrenia against a wide range of risk factors for schizophrenia. We investigated hazard ratios (HRs) for a wide range of risk factors for ICD-10 DCR schizophrenia using a nationwide Danish sample of 2,772,144 residents born in 1955-1997. We compared one contact only (OCO) (the case definition of schizophrenia used in Danish register based studies) with two or more contacts (TMC) (a case definition of at least 2 inpatient contacts with schizophrenia). During the follow-up, the OCO definition included 15,074 and the TMC 7562 cases; i.e. half as many. The TMC case definition appeared to select for a worse illness course. A wide range of risk factors were uniformly associated with both case definitions and only slightly higher risk estimates were found for the TMC definition. Choosing at least 2 inpatient contacts with schizophrenia (TMC) instead of the currently used case definition would result in almost similar risk estimates for many well-established risk factors. However, this would also introduce selection and include considerably fewer cases and reduce power of e.g. genetic studies based on register-diagnosed cases only. Copyright © 2015 Elsevier B.V. All rights reserved.

Quantum chemistry in environmental pesticide risk assessment.

PubMed

Villaverde, Juan J; López-Goti, Carmen; Alcamí, Manuel; Lamsabhi, Al Mokhtar; Alonso-Prados, José L; Sandín-España, Pilar

2017-11-01

The scientific community and regulatory bodies worldwide, currently promote the development of non-experimental tests that produce reliable data for pesticide risk assessment. The use of standard quantum chemistry methods could allow the development of tools to perform a first screening of compounds to be considered for the experimental studies, improving the risk assessment. This fact results in a better distribution of resources and in better planning, allowing a more exhaustive study of the pesticides and their metabolic products. The current paper explores the potential of quantum chemistry in modelling toxicity and environmental behaviour of pesticides and their by-products by using electronic descriptors obtained computationally. Quantum chemistry has potential to estimate the physico-chemical properties of pesticides, including certain chemical reaction mechanisms and their degradation pathways, allowing modelling of the environmental behaviour of both pesticides and their by-products. In this sense, theoretical methods can contribute to performing a more focused risk assessment of pesticides used in the market, and may lead to higher quality and safer agricultural products. © 2017 Society of Chemical Industry. © 2017 Society of Chemical Industry.

Attribution of floods in the Okavango basin, Southern Africa

NASA Astrophysics Data System (ADS)

Wolski, Piotr; Stone, Dáithí; Tadross, Mark; Wehner, Michael; Hewitson, Bruce

2014-04-01

In the charismatic wetlands of the Okavango Delta, Botswana, the annual floods of 2009-2011 reached magnitudes last seen 20-30 years ago, considerably affecting life of local populations and the economically important tourism industry. In this study, we analyse results from an attribution modelling system designed to examine how anthropogenic greenhouse gas emissions have contributed to weather and flood risk in our current climate. The system is based on comparison of real world climate and hydrological simulations with parallel counterfactual simulations of the climate and hydrological responses under conditions that might have been had human activities not emitted greenhouse gases. The analyses allow us to address the question of whether anthropogenic climate change contributed to increasing the risk of these high flood events in the Okavango system. Results show that the probability of occurrence of high floods during 2009-2011 in the current climate is likely lower than it would have been in a climate without anthropogenic greenhouse gases. This result is robust across the two climate models and various data processing procedures, although the exact figures for the associated decrease in risk differ. Results also differ between the three years examined, indicating that the “time-slice” method used here needs to be applied to multiple years in order to accurately estimate the contribution of emissions to current risk. Simple sensitivity analyses indicate that the reduction in flood risk is attributed to higher temperatures (and thus evaporation) in the current world, with little difference in the analysed domain's rainfall simulated in the two scenarios.

The Promise of Prevention: The Effects of Four Preventable Risk Factors on National Life Expectancy and Life Expectancy Disparities by Race and County in the United States

PubMed Central

Danaei, Goodarz; Rimm, Eric B.; Oza, Shefali; Kulkarni, Sandeep C.; Murray, Christopher J. L.; Ezzati, Majid

2010-01-01

Background There has been substantial research on psychosocial and health care determinants of health disparities in the United States (US) but less on the role of modifiable risk factors. We estimated the effects of smoking, high blood pressure, elevated blood glucose, and adiposity on national life expectancy and on disparities in life expectancy and disease-specific mortality among eight subgroups of the US population (the “Eight Americas”) defined on the basis of race and the location and socioeconomic characteristics of county of residence, in 2005. Methods and Findings We combined data from the National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System to estimate unbiased risk factor levels for the Eight Americas. We used data from the National Center for Health Statistics to estimate age–sex–disease-specific number of deaths in 2005. We used systematic reviews and meta-analyses of epidemiologic studies to obtain risk factor effect sizes for disease-specific mortality. We used epidemiologic methods for multiple risk factors to estimate the effects of current exposure to these risk factors on death rates, and life table methods to estimate effects on life expectancy. Asians had the lowest mean body mass index, fasting plasma glucose, and smoking; whites had the lowest systolic blood pressure (SBP). SBP was highest in blacks, especially in the rural South—5–7 mmHg higher than whites. The other three risk factors were highest in Western Native Americans, Southern low-income rural blacks, and/or low-income whites in Appalachia and the Mississippi Valley. Nationally, these four risk factors reduced life expectancy at birth in 2005 by an estimated 4.9 y in men and 4.1 y in women. Life expectancy effects were smallest in Asians (M, 4.1 y; F, 3.6 y) and largest in Southern rural blacks (M, 6.7 y; F, 5.7 y). Standard deviation of life expectancies in the Eight Americas would decline by 0.50 y (18%) in men and 0.45 y (21%) in women if these risks had been reduced to optimal levels. Disparities in the probabilities of dying from cardiovascular diseases and diabetes at different ages would decline by 69%–80%; the corresponding reduction for probabilities of dying from cancers would be 29%–50%. Individually, smoking and high blood pressure had the largest effect on life expectancy disparities. Conclusions Disparities in smoking, blood pressure, blood glucose, and adiposity explain a significant proportion of disparities in mortality from cardiovascular diseases and cancers, and some of the life expectancy disparities in the US. Please see later in the article for the Editors' Summary PMID:20351772

Applying the Land Use Portfolio Model to Estimate Natural-Hazard Loss and Risk - A Hypothetical Demonstration for Ventura County, California

USGS Publications Warehouse

Dinitz, Laura B.

2008-01-01

With costs of natural disasters skyrocketing and populations increasingly settling in areas vulnerable to natural hazards, society is challenged to better allocate its limited risk-reduction resources. In 2000, Congress passed the Disaster Mitigation Act, amending the Robert T. Stafford Disaster Relief and Emergency Assistance Act (Robert T. Stafford Disaster Relief and Emergency Assistance Act, Pub. L. 93-288, 1988; Federal Emergency Management Agency, 2002, 2008b; Disaster Mitigation Act, 2000), mandating that State, local, and tribal communities prepare natural-hazard mitigation plans to qualify for pre-disaster mitigation grants and post-disaster aid. The Federal Emergency Management Agency (FEMA) was assigned to coordinate and implement hazard-mitigation programs, and it published information about specific mitigation-plan requirements and the mechanisms (through the Hazard Mitigation Grant Program-HMGP) for distributing funds (Federal Emergency Management Agency, 2002). FEMA requires that each community develop a mitigation strategy outlining long-term goals to reduce natural-hazard vulnerability, mitigation objectives and specific actions to reduce the impacts of natural hazards, and an implementation plan for those actions. The implementation plan should explain methods for prioritizing, implementing, and administering the actions, along with a 'cost-benefit review' justifying the prioritization. FEMA, along with the National Institute of Building Sciences (NIBS), supported the development of HAZUS ('Hazards U.S.'), a geospatial natural-hazards loss-estimation tool, to help communities quantify potential losses and to aid in the selection and prioritization of mitigation actions. HAZUS was expanded to a multiple-hazard version, HAZUS-MH, that combines population, building, and natural-hazard science and economic data and models to estimate physical damages, replacement costs, and business interruption for specific natural-hazard scenarios. HAZUS-MH currently performs analyses for earthquakes, floods, and hurricane wind. HAZUS-MH loss estimates, however, do not account for some uncertainties associated with the specific natural-hazard scenarios, such as the likelihood of occurrence within a particular time horizon or the effectiveness of alternative risk-reduction options. Because of the uncertainties involved, it is challenging to make informative decisions about how to cost-effectively reduce risk from natural-hazard events. Risk analysis is one approach that decision-makers can use to evaluate alternative risk-reduction choices when outcomes are unknown. The Land Use Portfolio Model (LUPM), developed by the U.S. Geological Survey (USGS), is a geospatial scenario-based tool that incorporates hazard-event uncertainties to support risk analysis. The LUPM offers an approach to estimate and compare risks and returns from investments in risk-reduction measures. This paper describes and demonstrates a hypothetical application of the LUPM for Ventura County, California, and examines the challenges involved in developing decision tools that provide quantitative methods to estimate losses and analyze risk from natural hazards.

Medical support to military airborne training and operations.

PubMed

Starkey, Kerry J; Lyon, J; Sigman, E; Pynn, H J; Nordmann, G

2018-05-01

Airborne operations enable large numbers of military forces to deploy on the ground in the shortest possible time. This however must be balanced by an increased risk of injury. The aim of this paper is to review the current UK military drop zone medical estimate process, which may help to predict the risk of potential injury and assist in planning appropriate levels of medical support. In spring 2015, a British Airborne Battlegroup (UKBG) deployed on a 7-week overseas interoperability training exercise in the USA with their American counterparts (USBG). This culminated in a 7-day Combined Joint Operations Access Exercise, which began with an airborne Joint Forcible Entry (JFE) of approximately 2100 paratroopers.The predicted number of jump-related injuries was estimated using Parachute Order Number 8 (PO No 8). Such injuries were defined as injuries occurring from the time the paratrooper exited the aircraft until they released their parachute harness on the ground. Overall, a total of 53 (2.5%) casualties occurred in the JFE phase of the exercise, lower than the predicted number of 168 (8%) using the PO No 8 tool. There was a higher incidence of back (30% actual vs 20% estimated) and head injuries (21% actual vs 5% estimated) than predicted with PO No 8. The current method for predicting the incidence of medical injuries after a parachute drop using the PO No 8 tool is potentially not accurate enough for current requirements. Further research into injury rate, influencing factors and injury type are urgently required in order to provide an evidence base to ensure optimal medical logistical and clinical planning for airborne training and operations in the future. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Effects of lifestyle and single nucleotide polymorphisms on breast cancer risk: a case-control study in Japanese women.

PubMed

Mizoo, Taeko; Taira, Naruto; Nishiyama, Keiko; Nogami, Tomohiro; Iwamoto, Takayuki; Motoki, Takayuki; Shien, Tadahiko; Matsuoka, Junji; Doihara, Hiroyoshi; Ishihara, Setsuko; Kawai, Hiroshi; Kawasaki, Kensuke; Ishibe, Youichi; Ogasawara, Yutaka; Komoike, Yoshifumi; Miyoshi, Shinichiro

2013-12-01

Lifestyle factors, including food and nutrition, physical activity, body composition and reproductive factors, and single nucleotide polymorphisms (SNPs) are associated with breast cancer risk, but few studies of these factors have been performed in the Japanese population. Thus, the goals of this study were to validate the association between reported SNPs and breast cancer risk in the Japanese population and to evaluate the effects of SNP genotypes and lifestyle factors on breast cancer risk. A case-control study in 472 patients and 464 controls was conducted from December 2010 to November 2011. Lifestyle was examined using a self-administered questionnaire. We analyzed 16 breast cancer-associated SNPs based on previous GWAS or candidate-gene association studies. Age or multivariate-adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were estimated from logistic regression analyses. High BMI and current or former smoking were significantly associated with an increased breast cancer risk, while intake of meat, mushrooms, yellow and green vegetables, coffee, and green tea, current leisure-time exercise, and education were significantly associated with a decreased risk. Three SNPs were significantly associated with a breast cancer risk in multivariate analysis: rs2046210 (per allele OR=1.37 [95% CI: 1.11-1.70]), rs3757318 (OR=1.33[1.05-1.69]), and rs3803662 (OR=1.28 [1.07-1.55]). In 2046210 risk allele carriers, leisure-time exercise was associated with a significantly decreased risk for breast cancer, whereas current smoking and high BMI were associated with a significantly decreased risk in non-risk allele carriers. In Japanese women, rs2046210 and 3757318 located near the ESR1 gene are associated with a risk of breast cancer, as in other Asian women. However, our findings suggest that exercise can decrease this risk in allele carriers.

Lifetime risks for aneurysmal subarachnoid haemorrhage: multivariable risk stratification.

PubMed

Vlak, Monique H M; Rinkel, Gabriel J E; Greebe, Paut; Greving, Jacoba P; Algra, Ale

2013-06-01

The overall incidence of aneurysmal subarachnoid haemorrhage (aSAH) in western populations is around 9 per 100 000 person-years, which confers to a lifetime risk of around half per cent. Risk factors for aSAH are usually expressed as relative risks and suggest that absolute risks vary considerably according to risk factor profiles, but such estimates are lacking. We aimed to estimate incidence and lifetime risks of aSAH according to risk factor profiles. We used data from 250 patients admitted with aSAH and 574 sex-matched and age-matched controls, who were randomly retrieved from general practitioners files. We determined independent prognostic factors with multivariable logistic regression analyses and assessed discriminatory performance using the area under the receiver operating characteristic curve. Based on the prognostic model we predicted incidences and lifetime risks of aSAH for different risk factor profiles. The four strongest independent predictors for aSAH, namely current smoking (OR 6.0; 95% CI 4.1 to 8.6), a positive family history for aSAH (4.0; 95% CI 2.3 to 7.0), hypertension (2.4; 95% CI 1.5 to 3.8) and hypercholesterolaemia (0.2; 95% CI 0.1 to 0.4), were used in the final prediction model. This model had an area under the receiver operating characteristic curve of 0.73 (95% CI 0.69 to 0.76). Depending on sex, age and the four predictors, the incidence of aSAH ranged from 0.4/100 000 to 298/100 000 person-years and lifetime risk between 0.02% and 7.2%. The incidence and lifetime risk of aSAH in the general population varies widely according to risk factor profiles. Whether persons with high risks benefit from screening should be assessed in cost-effectiveness studies.

General risks for tunnelling projects: An overview

NASA Astrophysics Data System (ADS)

Siang, Lee Yong; Ghazali, Farid E. Mohamed; Zainun, Noor Yasmin; Ali, Roslinda

2017-10-01

Tunnels are indispensable when installing new infrastructure as well as when enhancing the quality of existing urban living due to their unique characteristics and potential applications. Over the past few decades, there has been a significant increase in the building of tunnels, world-wide. Tunnelling projects are complex endeavors, and risk assessment for tunnelling projects is likewise a complex process. Risk events are often interrelated. Occurrence of a technical risk usually carries cost and schedule consequences. Schedule risks typically impact cost escalation and project overhead. One must carefully consider the likelihood of a risk's occurrence and its impact in the context of a specific set of project conditions and circumstances. A project's goals, organization, and environment impacts in the context of a specific set of project conditions and circumstances. Some projects are primarily schedule driven; other projects are primarily cost or quality driven. Whether a specific risk event is perceived fundamentally as a cost risk or a schedule risk is governed by the project-specific context. Many researchers have pointed out the significance of recognition and control of the complexity, and risks of tunnelling projects. Although all general information on a project such as estimated duration, estimated cost, and stakeholders can be obtained, it is still quite difficult to accurately understand, predict and control the overall situation and development trends of the project, leading to the risks of tunnelling projects. This paper reviews all the key risks for tunnelling projects from several case studies that have been carried out by other researchers. These risks have been identified and reviewed in this paper. As a result, the current risk management plan in tunnelling projects can be enhanced by including all these reviewed risks as key information.

Asteroid-Generated Tsunami and Impact Risk

NASA Astrophysics Data System (ADS)

Boslough, M.; Aftosmis, M.; Berger, M. J.; Ezzedine, S. M.; Gisler, G.; Jennings, B.; LeVeque, R. J.; Mathias, D.; McCoy, C.; Robertson, D.; Titov, V. V.; Wheeler, L.

2016-12-01

The justification for planetary defense comes from a cost/benefit analysis, which includes risk assessment. The contribution from ocean impacts and airbursts is difficult to quantify and represents a significant uncertainty in our assessment of the overall risk. Our group is currently working toward improved understanding of impact scenarios that can generate dangerous tsunami. The importance of asteroid-generated tsunami research has increased because a new Science Definition Team, at the behest of NASA's Planetary Defense Coordinating Office, is now updating the results of a 2003 study on which our current planetary defense policy is based Our group was formed to address this question on many fronts, including asteroid entry modeling, tsunami generation and propagation simulations, modeling of coastal run-ups, inundation, and consequences, infrastructure damage estimates, and physics-based probabilistic impact risk assessment. We also organized the Second International Workshop on Asteroid Threat Assessment, focused on asteroid-generated tsunami and associated risk (Aug. 23-24, 2016). We will summarize our progress and present the highlights of our workshop, emphasizing its relevance to earth and planetary science. Sandia is a multiprogram laboratory operated by Sandia Corporation, a Lockheed Martin Company, for the United States Department of Energy under Contract DE-AC04-94AL85000.

Machine Learning for Social Services: A Study of Prenatal Case Management in Illinois.

PubMed

Pan, Ian; Nolan, Laura B; Brown, Rashida R; Khan, Romana; van der Boor, Paul; Harris, Daniel G; Ghani, Rayid

2017-06-01

To evaluate the positive predictive value of machine learning algorithms for early assessment of adverse birth risk among pregnant women as a means of improving the allocation of social services. We used administrative data for 6457 women collected by the Illinois Department of Human Services from July 2014 to May 2015 to develop a machine learning model for adverse birth prediction and improve upon the existing paper-based risk assessment. We compared different models and determined the strongest predictors of adverse birth outcomes using positive predictive value as the metric for selection. Machine learning algorithms performed similarly, outperforming the current paper-based risk assessment by up to 36%; a refined paper-based assessment outperformed the current assessment by up to 22%. We estimate that these improvements will allow 100 to 170 additional high-risk pregnant women screened for program eligibility each year to receive services that would have otherwise been unobtainable. Our analysis exhibits the potential for machine learning to move government agencies toward a more data-informed approach to evaluating risk and providing social services. Overall, such efforts will improve the efficiency of allocating resource-intensive interventions.

Risk of Herpes Zoster and Disseminated Varicella Zoster in Patients Taking Immunosuppressant Drugs at the Time of Zoster Vaccination.

PubMed

Cheetham, T Craig; Marcy, S Michael; Tseng, Hung-Fu; Sy, Lina S; Liu, In-Lu Amy; Bixler, Felicia; Baxter, Roger; Donahue, James G; Naleway, Allison L; Jacobsen, Steven J

2015-07-01

To determine the risks associated with zoster vaccine when administered to patients taking immunosuppressant medications. Patients enrolled in 1 of 7 managed care organizations affiliated with the Vaccine Safety Datalink between January 1, 2006, and December 31, 2009, were eligible. The exposure of interest was zoster vaccination in patients with current or remote immunosuppressant drug use. The primary outcomes were disseminated varicella zoster virus (VZV) and herpes zoster in the 42 days after vaccination. Automated data were collected on immunosuppressant drugs and baseline medical conditions. A logistic regression model using inverse probability treatment weights was used to estimate the odds of developing VZV or herpes zoster. A total of 14,554 individuals had an immunosuppressant medication dispensed around the time of vaccination, including 4826 with current use and 9728 with remote use. Most patients were taking low-dose corticosteroids. No cases of disseminated VZV were found in the current or remote users. The risk of herpes zoster was elevated in the 42 days after vaccination in current vs remote users (adjusted odds ratio, 2.99; 95% CI, 1.58-5.70). We found that patients taking immunosuppressant medications at the time of vaccination had a modest increased risk of herpes zoster in the 42 days after vaccination. The development of herpes zoster within 42 days after vaccination suggests that this is more likely due to reactivation of latent zoster virus than dissemination of the vaccine-derived varicella virus. These findings support the current zoster vaccination guidelines. Copyright © 2015 Mayo Foundation for Medical Education and Research. All rights reserved.

Bleeding Risk with Long-Term Low-Dose Aspirin: A Systematic Review of Observational Studies

PubMed Central

García Rodríguez, Luis A.; Martín-Pérez, Mar; Hennekens, Charles H.; Rothwell, Peter M.; Lanas, Angel

2016-01-01

Background Low-dose aspirin has proven effectiveness in secondary and primary prevention of cardiovascular events, but is also associated with an increased risk of major bleeding events. For primary prevention, this absolute risk must be carefully weighed against the benefits of aspirin; such assessments are currently limited by a lack of data from general populations. Methods Systematic searches of Medline and Embase were conducted to identify observational studies published between 1946 and 4 March 2015 that reported the risks of gastrointestinal (GI) bleeding or intracranial hemorrhage (ICH) with long-term, low-dose aspirin (75–325 mg/day). Pooled estimates of the relative risk (RR) for bleeding events with aspirin versus non-use were calculated using random-effects models, based on reported estimates of RR (including odds ratios, hazard ratios, incidence rate ratios and standardized incidence ratios) in 39 articles. Findings The incidence of GI bleeding with low-dose aspirin was 0.48–3.64 cases per 1000 person-years, and the overall pooled estimate of the RR with low-dose aspirin was 1.4 (95% confidence interval [CI]: 1.2–1.7). For upper and lower GI bleeding, the RRs with low-dose aspirin were 2.3 (2.0–2.6) and 1.8 (1.1–3.0), respectively. Neither aspirin dose nor duration of use had consistent effects on RRs for upper GI bleeding. The estimated RR for ICH with low-dose aspirin was 1.4 (1.2–1.7) overall. Aspirin was associated with increased bleeding risks when combined with non-steroidal anti-inflammatory drugs, clopidogrel and selective serotonin reuptake inhibitors compared with monotherapy. By contrast, concomitant use of proton pump inhibitors decreased upper GI bleeding risks relative to aspirin monotherapy. Conclusions The risks of major bleeding with low-dose aspirin in real-world settings are of a similar magnitude to those reported in randomized trials. These data will help inform clinical judgements regarding the use of low-dose aspirin in prevention of cardiovascular events. PMID:27490468

Oral bisphosphonates do not increase the risk of severe upper gastrointestinal complications: a nested case–control study

PubMed Central

2014-01-01

Background Data on the effect of oral bisphosphonates (BPs) on risk of upper gastrointestinal complications (UGIC) are conflicting. We conducted a large population-based study from a network of Italian healthcare utilization databases aimed to assess the UGIC risk associated with use of BPs in the setting of secondary prevention of osteoporotic fractures. Methods A nested case–control study was carried out within a cohort of 68,970 patients aged 45 years or older, who have been hospitalized for osteoporotic fracture from 2003 until 2005. Cases were the 804 patients who experienced hospitalization for UGIC until 2007. Up to 20 controls were randomly selected for each case. Conditional logistic regression model was used to estimate odds ratio (OR) associated with current and past use of BPs (i.e. for drug dispensation within 30 days and over 31 days prior the outcome onset, respectively) after adjusting for several covariates. Results Compared with patients who did not use BPs, current and past users had OR (and 95% confidence interval) of 0.86 (0.60 to 1.22) and 1.07 (0.80 to 1.44) respectively. There was no difference in the ORs estimated according with BPs type (alendronate or risedronate) and regimen (daily or weekly), nor with co-therapies and comorbidities. Conclusions Further evidence that BPs dispensed for secondary prevention of osteoporotic fractures are not associated with increased risk of severe gastrointestinal complications is supplied from this study. Further research is required to clarify the role BPs and other drugs of co-medication in inducing UGIC. PMID:24397769

Imaging strategies to reduce the risk of radiation in CT studies, including selective substitution with MRI.

PubMed

Semelka, Richard C; Armao, Diane M; Elias, Jorge; Huda, Walter

2007-05-01

"When one admits that nothing is certain one must, I think, also admit that some things are much more nearly certain than others." Bertrand Russell (1872-1970) Computed tomography (CT) is one of the largest contributors to man-made radiation doses in medical populations. CT currently accounts for over 60 million examinations in the United States, and its use continues to grow rapidly. The principal concern regarding radiation exposure is that the subject may develop malignancies. For this systematic review we searched journal publications in MEDLINE (1966-2006) using the terms "CT," "ionizing radiation," "cancer risks," "MRI," and "patient safety." We also searched major reports issued from governmental U.S. and world health-related agencies. Many studies have shown that organ doses associated with routine diagnostic CT scans are similar to the low-dose range of radiation received by atomic-bomb survivors. The FDA estimates that a CT examination with an effective dose of 10 mSv may be associated with an increased chance of developing fatal cancer for approximately one patient in 2000, whereas the BEIR VII lifetime risk model predicts that with the same low-dose radiation, approximately one individual in 1000 will develop cancer. There are uncertainties in the current radiation risk estimates, especially at the lower dose levels encountered in CT. To address what should be done to ensure patient safety, in this review we discuss the "as low as reasonably achievable" (ALARA) principle, and the use of MRI as an alternative to CT. (c) 2007 Wiley-Liss, Inc.

Repeated Changes in Reported Sexual Orientation Identity Linked to Substance Use Behaviors in Youth

PubMed Central

Ott, Miles Q.; Wypij, David; Corliss, Heather L.; Rosario, Margaret; Reisner, Sari L.; Gordon, Allegra R.; Austin, S. Bryn

2012-01-01

Purpose Previous studies have found that sexual minority (e.g., lesbian, gay, bisexual) adolescents are at higher risk of substance use than heterosexuals, but few have examined how changes in sexual orientation over time may relate to substance use. We examined the associations between change in sexual orientation identity and marijuana use, tobacco use, and binge drinking in U.S. youth. Methods Prospective data from 10,515 U.S. youth ages 12-27 years in a longitudinal cohort study were analyzed using sexual orientation identity mobility measure M (frequency of change from 0 [no change] to 1 [change at every wave]) in up to five waves of data. Generalized estimating equations were used to estimate substance use risk ratios and 95% confidence intervals; interactions by sex and age group were assessed. Results All substance use behaviors varied significantly by sexual orientation. Sexual minorities were at higher risk for all outcomes, excluding binge drinking in males, and mobility score was positively associated with substance use in most cases (p<.05). The association between mobility and substance use remained significant after adjusting for current sexual orientation and varied by sex and age for selected substance use behaviors. This association had a higher positive magnitude in females than males and in adolescents than young adults. Conclusions In both clinical and research settings it is important to assess history of sexual orientation changes. Changes in reported sexual orientation over time may be as important as current sexual orientation for understanding adolescent substance use risk. PMID:23298999

Development of a Risk-Based Comparison Methodology of Carbon Capture Technologies

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

Engel, David W.; Dalton, Angela C.; Dale, Crystal

2014-06-01

Given the varying degrees of maturity among existing carbon capture (CC) technology alternatives, an understanding of the inherent technical and financial risk and uncertainty associated with these competing technologies is requisite to the success of carbon capture as a viable solution to the greenhouse gas emission challenge. The availability of tools and capabilities to conduct rigorous, risk–based technology comparisons is thus highly desirable for directing valuable resources toward the technology option(s) with a high return on investment, superior carbon capture performance, and minimum risk. To address this research need, we introduce a novel risk-based technology comparison method supported by anmore » integrated multi-domain risk model set to estimate risks related to technological maturity, technical performance, and profitability. Through a comparison between solid sorbent and liquid solvent systems, we illustrate the feasibility of estimating risk and quantifying uncertainty in a single domain (modular analytical capability) as well as across multiple risk dimensions (coupled analytical capability) for comparison. This method brings technological maturity and performance to bear on profitability projections, and carries risk and uncertainty modeling across domains via inter-model sharing of parameters, distributions, and input/output. The integration of the models facilitates multidimensional technology comparisons within a common probabilistic risk analysis framework. This approach and model set can equip potential technology adopters with the necessary computational capabilities to make risk-informed decisions about CC technology investment. The method and modeling effort can also be extended to other industries where robust tools and analytical capabilities are currently lacking for evaluating nascent technologies.« less

Morbidity and Health Risk Factors Among New Mexico Miners: A Comparison Across Mining Sectors.

PubMed

Shumate, Alice M; Yeoman, Kristin; Victoroff, Tristan; Evans, Kandace; Karr, Roger; Sanchez, Tami; Sood, Akshay; Laney, Anthony Scott

2017-08-01

This study examines differences in chronic health outcomes between coal, uranium, metal, and nonmetal miners. In a cross-sectional study using data from a health screening program for current and former New Mexico miners, log-binomial logistic regression models were used to estimate relative risks of respiratory and heart disease, cancer, osteoarthritis, and back pain associated with mining in each sector as compared with coal, adjusting for other relevant risk factors. Differential risks in angina, pulmonary symptoms, asthma, cancer, osteoarthritis, and back pain between mining sectors were found. New Mexico miners experience different chronic health challenges across sectors. These results demonstrate the importance of using comparable data to understand how health risks differ across mining sectors. Further investigation among a broader geographic population of miners will help identify the health priorities and needs in each sector.

The Influence of Neighborhood Characteristics and Parenting Practices on Academic Problems and Aggression Outcomes among Moderately to Highly Aggressive Children

ERIC Educational Resources Information Center

Barry, Tammy D.; Lochman, John E.; Fite, Paula J.; Wells, Karen C.; Colder, Craig R.

2012-01-01

The current study utilized a longitudinal design to examine the effects of neighborhood and parenting on 120 at-risk children's academic and aggressive outcomes, concurrently and at two later timepoints during the transition to middle school. Random effects regression models were estimated to examine whether neighborhood characteristics and harsh…

Risk of uterine leiomyomata in relation to tobacco, alcohol and caffeine consumption in the Black Women’s Health Study

PubMed Central

A.Wise, Lauren; R.Palmer, Julie; L.Harlow, Bernard; Spiegelman, Donna; A.Stewart, Elizabeth; L.Adams-Campbell, Lucile; Rosenberg, Lynn

2007-01-01

BACKGROUND Tobacco, alcohol and caffeine consumption may influence risk of uterine leiomyomata via changes in ovarian function or hormone metabolism. METHODS We prospectively assessed the relation of these exposures to risk of self-reported uterine leiomyomata in the Black Women’s Health Study. From 1997 to 2001, we followed 21 885 premenopausal women with intact uteri and no prior myoma diagnosis. Cox regression models were used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs). RESULTS During 73 426 person-years of follow-up, 2177 incident cases of uterine leiomyomata confirmed by ultrasound (n = 1920) or hysterectomy (n = 257) were reported. Cigarette smoking was not associated with risk of uterine leiomyomata. Risk was positively associated with years of alcohol consumption and current consumption of alcohol, particularly beer. Relative to non-drinkers, multivariate IRRs for beer consumption of <1, 1–6 and 7+ drinks/week were 1.11 (95% CI 0.98–1.27), 1.18 (95% CI 1.00–1.40) and 1.57 (95% CI 1.17–2.11), respectively. Heavy coffee and caffeine consumption were not associated with risk overall, but IRRs were increased among women aged <35 years. CONCLUSIONS In US black women, risk of uterine leiomyomata was positively associated with current consumption of alcohol, particularly beer. Cigarette smoking and caffeine consumption were unrelated to risk overall. PMID:15218005

A decision support tool to compare waterborne and foodborne infection and/or illness risks associated with climate change.

PubMed

Schijven, Jack; Bouwknegt, Martijn; de Roda Husman, Ana Maria; Rutjes, Saskia; Sudre, Bertrand; Suk, Jonathan E; Semenza, Jan C

2013-12-01

Climate change may impact waterborne and foodborne infectious disease, but to what extent is uncertain. Estimating climate-change-associated relative infection risks from exposure to viruses, bacteria, or parasites in water or food is critical for guiding adaptation measures. We present a computational tool for strategic decision making that describes the behavior of pathogens using location-specific input data under current and projected climate conditions. Pathogen-pathway combinations are available for exposure to norovirus, Campylobacter, Cryptosporidium, and noncholera Vibrio species via drinking water, bathing water, oysters, or chicken fillets. Infection risk outcomes generated by the tool under current climate conditions correspond with those published in the literature. The tool demonstrates that increasing temperatures lead to increasing risks for infection with Campylobacter from consuming raw/undercooked chicken fillet and for Vibrio from water exposure. Increasing frequencies of drought generally lead to an elevated infection risk of exposure to persistent pathogens such as norovirus and Cryptosporidium, but decreasing risk of exposure to rapidly inactivating pathogens, like Campylobacter. The opposite is the case with increasing annual precipitation; an upsurge of heavy rainfall events leads to more peaks in infection risks in all cases. The interdisciplinary tool presented here can be used to guide climate change adaptation strategies focused on infectious diseases. © 2013 Society for Risk Analysis.

PCSK9 Inhibitors Show Value for Patients and the US Health Care System.

PubMed

Cheng, Wei-Han; Gaudette, Étienne; Goldman, Dana P

2017-12-01

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors were approved by the US Food and Drug Administration (FDA) as cholesterol-lowering therapies for patients with familial hypercholesterolemia or atherosclerotic cardiovascular disease. To estimate the long-term health and economic value of PCSK9 inhibitors for Americans (51 years and older). We conducted simulations using the Future Elderly Model, an established dynamic microsimulation model to project the lifetime outcomes for the US population aged 51 years and older. Health effects estimates and confidence intervals from published meta-analysis studies were used to project changes in life expectancy, quality-adjusted life-years, and lifetime medical spending resulting from the use of PCSK9 inhibitors. We considered two treatment scenarios: 1) current FDA eligibility and 2) an extended eligibility scenario that includes patients with no pre-existing cardiovascular disease but at high risk. We assumed that the price of PCSK9 inhibitors was discounted by 35% in the first 12 years and by 57% thereafter, with gradual uptake of the drug in eligible populations. Use of PCSK9 inhibitors by individuals covered by current FDA approval would extend life expectancy at the age of 51 years by an estimated 1.1 years and would yield a lifetime net value of $5800 per person. If use was extended to those at high risk for cardiovascular disease, PCSK9 inhibitors would generate a lifetime net benefit of $14,100 per person. Expanded access to PCSK9 inhibitors would offer positive long-term net value for patients and the US health care system at the current discounted prices. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Effect of Exposure to Smoking in Movies on Young Adult Smoking in New Zealand.

PubMed

Gendall, Philip; Hoek, Janet; Edwards, Richard; Glantz, Stanton

2016-01-01

Tobacco advertising has been prohibited in New Zealand since 1990, and the government has set a goal of becoming a smokefree nation by 2025. However, tobacco marketing persists indirectly through smoking in motion pictures, and there is strong evidence that exposure to onscreen smoking causes young people to start smoking. We investigated the relationship between exposure to smoking in movies and youth smoking initiation among New Zealand young adults. Data from an online survey of 419 smokers and non-smokers aged 18 to 25 were used to estimate respondents' exposure to smoking occurrences in 50 randomly-selected movies from the 423 US top box office movies released between 2008 and 2012. Analyses involved calculating movie smoking exposure (MSE) for each respondent, using logistic regression to analyse the relationship between MSE and current smoking behaviour, and estimating the attributable fraction due to smoking in movies. Exposure to smoking occurrences in movies was associated with current smoking status. After allowing for the influence of family, friends and co-workers, age and rebelliousness, respondents' likelihood of smoking increased by 11% for every 100-incident increase in exposure to smoking incidents, (aOR1.11; p< .05). The estimated attributable fraction due to smoking in movies was 54%; this risk could be substantially reduced by eliminating smoking from movies currently rated as appropriate for youth. We conclude that exposure to smoking in movies remains a potent risk factor associated with smoking among young adults, even in a progressive tobacco control setting such as New Zealand. Harmonising the age of legal tobacco purchase (18) with the age at which it is legal to view smoking in movies would support New Zealand's smokefree 2025 goal.