Identifying Home Care Clinicians’ Information Needs for Managing Fall Risks

PubMed Central

Alhuwail, Dari

2016-01-01

Summary Objectives To help manage the risk of falls in home care, this study aimed to (i) identify home care clinicians’ information needs and how they manage missing or inaccurate data, (ii) identify problems that impact effectiveness and efficiency associated with retaining, exchanging, or processing information about fall risks in existing workflows and currently adopted health information technology (IT) solutions, and (iii) offer informatics-based recommendations to improve fall risk management interventions. Methods A case study was carried out in a single not-for-profit suburban Medicare-certified home health agency with three branches. Qualitative data were collected over a six month period through observations, semi-structured interviews, and focus groups. The Framework method was used for analysis. Maximum variation sampling was adopted to recruit a diverse sample of clinicians. Results Overall, the information needs for fall risk management were categorized into physiological, care delivery, educational, social, environmental, and administrative domains. Examples include a brief fall-related patient history, weight-bearing status, medications that affect balance, availability of caregivers at home, and the influence of patients’ cultures on fall management interventions. The unavailability and inaccuracy of critical information related to fall risks can delay necessary therapeutic services aimed at reducing patients’ risk for falling and thereby jeopardizing their safety. Currently adopted IT solutions did not adequately accommodate data related to fall risk management. Conclusion The results highlight the essential information for fall risk management in home care. Home care workflows and health IT solutions must effectively and efficiently retain, exchange, and process information necessary for fall risk management. Interoperability and integration of the various health IT solutions to make data sharing accessible to all clinicians is critical for fall risk management. Findings from this study can help home health agencies better understand their information needs to manage fall risks. PMID:27437035

Fatigue Risk Management: A Maritime Framework

PubMed Central

Grech, Michelle Rita

2016-01-01

It is evident that despite efforts directed at mitigating the risk of fatigue through the adoption of hours of work and rest regulations and development of codes and guidelines, fatigue still remains a concern in shipping. Lack of fatigue management has been identified as a contributory factor in a number of recent accidents. This is further substantiated through research reports with shortfalls highlighted in current fatigue management approaches. These approaches mainly focus on prescriptive hours of work and rest and include an individualistic approach to managing fatigue. The expectation is that seafarers are responsible to manage and tolerate fatigue as part of their working life at sea. This attitude is an accepted part of a seafarer’s role. Poor compliance is one manifest of this problem with shipboard demands making it hard for seafarers to follow hours of work and rest regulations, forcing them into this “poor compliance” trap. This makes current fatigue management approaches ineffective. This paper proposes a risk based approach and way forward for the implementation of a fatigue risk management framework for shipping, aiming to support the hours of work and rest requirements. This forms part of the work currently underway to review and update the International Maritime Organization, Guidelines on Fatigue. PMID:26840326

Fatigue Risk Management: A Maritime Framework.

PubMed

Grech, Michelle Rita

2016-01-29

It is evident that despite efforts directed at mitigating the risk of fatigue through the adoption of hours of work and rest regulations and development of codes and guidelines, fatigue still remains a concern in shipping. Lack of fatigue management has been identified as a contributory factor in a number of recent accidents. This is further substantiated through research reports with shortfalls highlighted in current fatigue management approaches. These approaches mainly focus on prescriptive hours of work and rest and include an individualistic approach to managing fatigue. The expectation is that seafarers are responsible to manage and tolerate fatigue as part of their working life at sea. This attitude is an accepted part of a seafarer's role. Poor compliance is one manifest of this problem with shipboard demands making it hard for seafarers to follow hours of work and rest regulations, forcing them into this "poor compliance" trap. This makes current fatigue management approaches ineffective. This paper proposes a risk based approach and way forward for the implementation of a fatigue risk management framework for shipping, aiming to support the hours of work and rest requirements. This forms part of the work currently underway to review and update the International Maritime Organization, Guidelines on Fatigue.

The NASA Risk Management Program

NASA Technical Reports Server (NTRS)

Buchbinder, Benjamin

1990-01-01

This paper describes the NASA Risk Management Program established by the Headquarters Office of Safety and Mission Quality (MSQ). Current agency policy is outlined, risk management assistance to the field is described, and examples are given of independent risk assessments conducted by SMQ. The motivation for and the structure of the program is placed in the historical context of pre- and post-Challenger environments.

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.

75 FR 30106 - Terrorism Risk Insurance Program; Litigation Management Submissions

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-28

... DEPARTMENT OF THE TREASURY Terrorism Risk Insurance Program; Litigation Management Submissions... U.S.C. 3506(c)(2)(A)). Currently, the Terrorism Risk Insurance Program Office is seeking comments... or by mail (if hard copy, preferably an original and two copies) to: Terrorism Risk Insurance Program...

Risk Assessment and Risk Management in Offenders with Intellectual Disabilities: Are We There Yet?

ERIC Educational Resources Information Center

Pouls, Claudia; Jeandarme, Inge

2015-01-01

Research on risk assessment and risk management in offenders with intellectual disabilities (OIDs), although far behind compared to the mainstream offender literature, is now expanding. The current review provides an overview of the predictive value of risk assessment and treatment outcome monitoring tools developed for both mainstream forensic…

[Evaluation of medication risk in pregnant women: methodology of evaluation and risk management].

PubMed

Eléfant, E; Sainte-Croix, A

1997-01-01

This round table discussion was devoted to the description of the tools currently available for the evaluation of drug risks and management during pregnancy. Five topics were submitted for discussion: pre-clinical data, methodological tools, benefit/risk ratio before prescription, teratogenic or fetal risk evaluation, legal comments.

Project Recon

DTIC Science & Technology

2012-06-14

Management tool • Current Risk Recon functionality • Issues Recon & Opportunity Recon – Launching Fall 2012 • FMEA and Lessons Learned – Planned Future...Lessons learned UNCLASSIFIED Integrated Risk Management FMEA Failure Mode and Effects Analysis Risk Recon Fields from FMEA software pre...populate Risk Info sheet. Risk Mitigation from Risk Recon trace back and populate FMEA , new RPN numbers. Issues Recon When a risk becomes an issue

Mental Health Professionals' Suicide Risk Assessment and Management Practices.

PubMed

Roush, Jared F; Brown, Sarah L; Jahn, Danielle R; Mitchell, Sean M; Taylor, Nathanael J; Quinnett, Paul; Ries, Richard

2018-01-01

Approximately 20% of suicide decedents have had contact with a mental health professional within 1 month prior to their death, and the majority of mental health professionals have treated suicidal individuals. Despite limited evidence-based training, mental health professionals make important clinical decisions related to suicide risk assessment and management. The current study aimed to determine the frequency of suicide risk assessment and management practices and the association between fear of suicide-related outcomes or comfort working with suicidal individuals and adequacy of suicide risk management decisions among mental health professionals. Mental health professionals completed self-report assessments of fear, comfort, and suicide risk assessment and management practices. Approximately one third of mental health professionals did not ask every patient about current or previous suicidal thoughts or behaviors. Further, comfort, but not fear, was positively associated with greater odds of conducting evidence-based suicide risk assessments at first appointments and adequacy of suicide risk management practices with patients reporting suicide ideation and a recent suicide attempt. The study utilized a cross-sectional design and self-report questionnaires. Although the majority of mental health professionals report using evidenced-based practices, there appears to be variability in utilization of evidence-based practices.

The effectiveness of risk management: an analysis of project risk planning across industries and countries.

PubMed

Zwikael, Ofer; Ahn, Mark

2011-01-01

This article examines the effectiveness of current risk management practices to reduce project risk using a multinational, multi-industry study across different scenarios and cultures. A survey was administered to 701 project managers, and their supervisors, in seven industries and three diverse countries (New Zealand, Israel, and Japan), in multiple languages during the 2002-2007 period. Results of this study show that project context--industry and country where a project is executed--significantly impacts perceived levels of project risk, and the intensity of risk management processes. Our findings also suggest that risk management moderates the relationship between risk level and project success. Specifically, we found that even moderate levels of risk management planning are sufficient to reduce the negative effect risk levels have on project success. © 2010 Society for Risk Analysis.

Risk Management by a Neoliberal State: Construction of New Knowledge through Lifelong Learning in Japan

ERIC Educational Resources Information Center

Ogawa, Akihiro

2013-01-01

This article examines the current developments in Japan's lifelong learning policy and practices. I argue that promoting lifelong learning is an action that manages the risks of governance for the neoliberal state. Implementing a new lifelong learning policy involves the employment of a political technique toward integrating the currently divided…

75 FR 30081 - Self-Regulatory Organizations; NASDAQ OMX PHLX, Inc.; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-28

... Rule Change Relating to the Risk Management Interface May 24, 2010. Pursuant to Section 19(b)(1) of the... proposes to effect an information-related enhancement to the current Risk Management Feed Interface in Phlx... trade updates through a Risk Management Feed known as the ``RMP''.\\3\\ The updates include the members...

The Obesity, Metabolic Syndrome, and Type 2 Diabetes Mellitus Pandemic: II. Therapeutic Management of Atherogenic Dyslipidemia

PubMed Central

Ginsberg, Henry N.; MacCallum, Paul R.

2010-01-01

Strategies for the effective management of cardiovascular risk factors in patients with the metabolic syndrome (MS) or type 2 diabetes mellitus (T2DM) are essential to help reduce cardiovascular morbidity and mortality. Treatment strategies should be multi-factorial and include the promotion of therapeutic lifestyle changes, as well as pharmacologic therapies to treat individual risk factors according to current guidelines. In an accompanying article, the importance of atherogenic dyslipidemia as a risk factor for the development of cardiovascular disease in patients with the MS or T2DM was highlighted. Current treatment options for managing this characteristic form of atherogenic dyslipidemia are limited and tend to be only moderately effective. The focus of this review is the current pharmacotherapies available for the management of atherogenic dyslipidemia in patients with the MS or T2DM, highlighting the rationale for combining available treatments. Novel strategies currently in clinical development are also discussed. PMID:19751468

The Evidence for a Risk-Based Approach to Australian Higher Education Regulation and Quality Assurance

ERIC Educational Resources Information Center

Edwards, Fleur

2012-01-01

This paper explores the nascent field of risk management in higher education, which is of particular relevance in Australia currently, as the Commonwealth Government implements its plans for a risk-based approach to higher education regulation and quality assurance. The literature outlines the concept of risk management and risk-based approaches…

A Proactive and Top-Down Approach to Managing Risk at NASA

NASA Technical Reports Server (NTRS)

Dezfuli, Homayoon

2010-01-01

Our ultimate goal is to manage risk in a holistic and coherent fashion across the Agency: a) The RIDM process is intended to risk-inform direction-setting decisions. c) The CRM process is intended to manage risk associated with the implementation of baseline performance requirements. Currently we are working on: a) Enhancements to the CRM process. b) Better integration of the RIDM and CRM processes. c) Better integration of institutional risk considerations into RM framework.

A Comparative Study of Adolescent Risk Assessment Instruments: Predictive and Incremental Validity

ERIC Educational Resources Information Center

Welsh, Jennifer L.; Schmidt, Fred; McKinnon, Lauren; Chattha, H. K.; Meyers, Joanna R.

2008-01-01

Promising new adolescent risk assessment tools are being incorporated into clinical practice but currently possess limited evidence of predictive validity regarding their individual and/or combined use in risk assessments. The current study compares three structured adolescent risk instruments, Youth Level of Service/Case Management Inventory…

[Management, quality of health and occupational safety and hospital organization: is integration possible?].

PubMed

Corrao, Carmela Romana Natalina

2011-01-01

The evolution of the national and European legislation has progressively transformed the working environments into organized environments. Specific models for its management are being proposed, which should be integrated into general management strategies. In the case of hospitals this integration should consider the peculiar organizational complexity, where the management of the occupational risk needs to be integrated with clinical risk management and economic risk management. Resources management should also consider that Occupational Medicine has not a direct monetary benefit for the organisation, but only indirect health consequences in terms of reduction of accidents and occupational diseases. The deep and simultaneous analysis of the current general management systems and the current management methods of occupational safety and health protection allows one to hyphotesise a possible integration between them. For both of them the Top Management is the main responsible of the quality management strategies and the use of specific documents in the managerial process, such as the document of risks evaluation in the occupational management and the quality manual in the general management, is of paramount importance. An integrated management has also the scope to pursue a particular kind of quality management, where ethics and job satisfaction are innovative, as established by recent European guidelines, management systems and national legislations.

Therapeutic management of acute pulmonary embolism.

PubMed

Tromeur, Cécile; Van Der Pol, Liselotte M; Couturaud, Francis; Klok, Frederikus A; Huisman, Menno V

2017-08-01

Acute pulmonary embolism (PE) is a potentially fatal manifestation of venous thromboembolism. Prompt anticoagulant treatment is crucial for PE patients, which can decrease morbidity and mortality. Risk assessment is the cornerstone of the therapeutic management of PE. It guides physicians to the most appropriate treatment and selects patients for early discharge or home treatment. Areas covered: Here, we review the current treatments of acute PE according to contemporary risk stratification strategies, highlighting each step of PE therapeutic management. Expert commentary: Currently, direct oral anticoagulants (DOACs) represent the first-line therapy of patients presenting with non-high risk PE with a better risk-benefit ratios than vitamin K antagonists (VKAs) due to lower risk of major bleeding. Only high-risk patients with PE who present in shock should be treated with systematic thrombolysis, while surgical thrombectomy or catheter direct thrombolysis (CDT) should only be considered when thrombolysis is contraindicated because of too high bleeding risk.

A Risk-based Assessment And Management Framework For Multipollutant Air Quality

PubMed Central

Frey, H. Christopher; Hubbell, Bryan

2010-01-01

The National Research Council recommended both a risk- and performance-based multipollutant approach to air quality management. Specifically, management decisions should be based on minimizing the exposure to, and risk of adverse effects from, multiple sources of air pollution and that the success of these decisions should be measured by how well they achieved this objective. We briefly describe risk analysis and its application within the current approach to air quality management. Recommendations are made as to how current practice could evolve to support a fully risk- and performance-based multipollutant air quality management system. The ability to implement a risk assessment framework in a credible and policy-relevant manner depends on the availability of component models and data which are scientifically sound and developed with an understanding of their application in integrated assessments. The same can be said about accountability assessments used to evaluate the outcomes of decisions made using such frameworks. The existing risk analysis framework, although typically applied to individual pollutants, is conceptually well suited for analyzing multipollutant management actions. Many elements of this framework, such as emissions and air quality modeling, already exist with multipollutant characteristics. However, the framework needs to be supported with information on exposure and concentration response relationships that result from multipollutant health studies. Because the causal chain that links management actions to emission reductions, air quality improvements, exposure reductions and health outcomes is parallel between prospective risk analyses and retrospective accountability assessments, both types of assessment should be placed within a single framework with common metrics and indicators where possible. Improvements in risk reductions can be obtained by adopting a multipollutant risk analysis framework within the current air quality management system, e.g. focused on standards for individual pollutants and with separate goals for air toxics and ambient pollutants. However, additional improvements may be possible if goals and actions are defined in terms of risk metrics that are comparable across criteria pollutants and air toxics (hazardous air pollutants), and that encompass both human health and ecological risks. PMID:21209847

Impacts, Perceptions and Management of Climate-Related Risks to Cage Aquaculture in the Reservoirs of Northern Thailand.

PubMed

Lebel, Louis; Lebel, Phimphakan; Lebel, Boripat

2016-12-01

Weather is suspected to influence fish growth and survival, and be a factor in mass mortality events in cage aquaculture in reservoirs. The purpose of this study was to identify the important climate-related risks faced by cage aquaculture farms; evaluate how these risks were currently being managed; and explore how farmers might adapt to the effects of climate change. Fish farmers were interviewed across the northern region of Thailand to get information on impacts, perceptions and practices. Drought or low water levels, heat waves, cold spells and periods with dense cloud cover, each caused significant financial losses. Perceptions of climate-related risks were consistent with experienced impacts. Risks are primarily managed in the short-term with techniques like aeration and reducing feed. In the mid-term farmers adjust stocking calendars, take financial measures and seek new information. Farmers also emphasize the importance of maintaining good relations with other stakeholders and reservoir management. Larger farms placed greater importance on risk management than small farms, even though types and levels of risk perceived were very similar. Most fish farms were managed by men alone, or men and women working together. Gender differences in risk perception were not detected, but women judged a few risk management practices as more important than men. Fish farmers perceived that climate is changing, but their perceptions were not strongly associated with recently having suffered impacts from extreme weather. The findings of this study provide important inputs to improving risk management under current and future climate.

Impacts, Perceptions and Management of Climate-Related Risks to Cage Aquaculture in the Reservoirs of Northern Thailand

NASA Astrophysics Data System (ADS)

Lebel, Louis; Lebel, Phimphakan; Lebel, Boripat

2016-12-01

Weather is suspected to influence fish growth and survival, and be a factor in mass mortality events in cage aquaculture in reservoirs. The purpose of this study was to identify the important climate-related risks faced by cage aquaculture farms; evaluate how these risks were currently being managed; and explore how farmers might adapt to the effects of climate change. Fish farmers were interviewed across the northern region of Thailand to get information on impacts, perceptions and practices. Drought or low water levels, heat waves, cold spells and periods with dense cloud cover, each caused significant financial losses. Perceptions of climate-related risks were consistent with experienced impacts. Risks are primarily managed in the short-term with techniques like aeration and reducing feed. In the mid-term farmers adjust stocking calendars, take financial measures and seek new information. Farmers also emphasize the importance of maintaining good relations with other stakeholders and reservoir management. Larger farms placed greater importance on risk management than small farms, even though types and levels of risk perceived were very similar. Most fish farms were managed by men alone, or men and women working together. Gender differences in risk perception were not detected, but women judged a few risk management practices as more important than men. Fish farmers perceived that climate is changing, but their perceptions were not strongly associated with recently having suffered impacts from extreme weather. The findings of this study provide important inputs to improving risk management under current and future climate.

The reliability-quality relationship for quality systems and quality risk management.

PubMed

Claycamp, H Gregg; Rahaman, Faiad; Urban, Jason M

2012-01-01

Engineering reliability typically refers to the probability that a system, or any of its components, will perform a required function for a stated period of time and under specified operating conditions. As such, reliability is inextricably linked with time-dependent quality concepts, such as maintaining a state of control and predicting the chances of losses from failures for quality risk management. Two popular current good manufacturing practice (cGMP) and quality risk management tools, failure mode and effects analysis (FMEA) and root cause analysis (RCA) are examples of engineering reliability evaluations that link reliability with quality and risk. Current concepts in pharmaceutical quality and quality management systems call for more predictive systems for maintaining quality; yet, the current pharmaceutical manufacturing literature and guidelines are curiously silent on engineering quality. This commentary discusses the meaning of engineering reliability while linking the concept to quality systems and quality risk management. The essay also discusses the difference between engineering reliability and statistical (assay) reliability. The assurance of quality in a pharmaceutical product is no longer measured only "after the fact" of manufacturing. Rather, concepts of quality systems and quality risk management call for designing quality assurance into all stages of the pharmaceutical product life cycle. Interestingly, most assays for quality are essentially static and inform product quality over the life cycle only by being repeated over time. Engineering process reliability is the fundamental concept that is meant to anticipate quality failures over the life cycle of the product. Reliability is a well-developed theory and practice for other types of manufactured products and manufacturing processes. Thus, it is well known to be an appropriate index of manufactured product quality. This essay discusses the meaning of reliability and its linkages with quality systems and quality risk management.

Equipment management risk rating system based on engineering endpoints.

PubMed

James, P J

1999-01-01

The equipment management risk ratings system outlined here offers two significant departures from current practice: risk classifications are based on intrinsic device risks, and the risk rating system is based on engineering endpoints. Intrinsic device risks are categorized as physical, clinical and technical, and these flow from the incoming equipment assessment process. Engineering risk management is based on verification of engineering endpoints such as clinical measurements or energy delivery. This practice eliminates the ambiguity associated with ranking risk in terms of physiologic and higher-level outcome endpoints such as no significant hazards, low significance, injury, or mortality.

Personalized assessment and management of women at risk for breast cancer in North America.

PubMed

Pruthi, Sandhya; Heisey, Ruth; Bevers, Therese

2015-03-01

Many women at increased risk for breast cancer would benefit from referral for genetic testing, enhanced screening, preventive therapy or risk-reducing surgery. We present a visual model and a step-wise approach to assist with a personalized risk stratification and management of these women. We present current recommendations with respect to lifestyle behaviors and mammographic screening, and we review the current evidence regarding enhanced screening and risk-reducing therapies. We discuss the usefulness of three risk-assessment tools in determining whether a woman qualifies for genetic testing, enhanced screening or preventive therapy and present four cases to demonstrate the usefulness of this approach in the clinical setting.

[Air contamination in the Autonomous City of Buenos Aires: the current risk or future climate change, a false option].

PubMed

Abrutzky, Rosana; Dawidowski, Laura; Murgida, Ana; Natenzon, Claudia Eleonor

2014-09-01

Based on the theoretical framework of environmental risk, this article discusses the management of air quality in the Autonomous City of Buenos Aires in relation to current and potential impacts of toxic gases and global climate change on the health of the population. Information on historical and current management of the air was linked to the results of the South American Emissions, Megacities and Climate research project to assess danger, exposure, vulnerability and uncertainty as the dimensions of risk. By contextualizing public policies developed in recent decades on this subject, it was possible to identify emerging configurations of risk and uncertainties as accelerators of social vulnerability. On the one hand, the fact that there is a positive correlation between mortality, changes in temperature and air pollution was confirmed. On the other hand, it became clear that there is a disconnect between air quality management and health care management, while limitations were found in the proposed mitigation measures relating to emissions of greenhouse gases produced by fuel, revealing uncertainties regarding their efficacy.

75 FR 30770 - Notice for Extension and Revision of a Currently Approved Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-02

... Management Education Division, USDA/RMA, 1400 Independence Avenue, SW., Stop 0808, Room 5720, Washington, DC... contact: Sundii Johnson Phillips, Risk Management Education Division USDA/RMA, Stop 0808, 1400...: Risk Management and Crop Insurance Education Activity Log. OMB Number: 0563-0070. Expiration Date of...

Overview of the National Risk Management Research Laboratory: The Environmental Research Institute of the States Environmental Council of the States 2007

EPA Science Inventory

An overview of the EPA Science and Research Organization, The National Risk Management Research Lab, the current research being conducted, priority Environmental Technology Research Issues, and new approaches to environmental management and sustainability taking place at the Nati...

Early Warning Report: Use of Contractors to Conduct Clean Air Act Risk Management Program Inspections in Certain States Goes Against Court Decisions

EPA Pesticide Factsheets

Report #12-P-0376, March 28, 2012. The OIG is currently evaluating whether the EPA has adequate management controls for ensuring the effectiveness of its Clean Air Act (CAA) Section 112(r) risk management program inspections.

Managing flood risks in the Mekong Delta: How to address emerging challenges under climate change and socioeconomic developments.

PubMed

Hoang, Long Phi; Biesbroek, Robbert; Tri, Van Pham Dang; Kummu, Matti; van Vliet, Michelle T H; Leemans, Rik; Kabat, Pavel; Ludwig, Fulco

2018-02-24

Climate change and accelerating socioeconomic developments increasingly challenge flood-risk management in the Vietnamese Mekong River Delta-a typical large, economically dynamic and highly vulnerable delta. This study identifies and addresses the emerging challenges for flood-risk management. Furthermore, we identify and analyse response solutions, focusing on meaningful configurations of the individual solutions and how they can be tailored to specific challenges using expert surveys, content analysis techniques and statistical inferences. Our findings show that the challenges for flood-risk management are diverse, but critical challenges predominantly arise from the current governance and institutional settings. The top-three challenges include weak collaboration, conflicting management objectives and low responsiveness to new issues. We identified 114 reported solutions and developed six flood management strategies that are tailored to specific challenges. We conclude that the current technology-centric flood management approach is insufficient given the rapid socioecological changes. This approach therefore should be adapted towards a more balanced management configuration where technical and infrastructural measures are combined with institutional and governance resolutions. Insights from this study contribute to the emerging repertoire of contemporary flood management solutions, especially through their configurations and tailoring to specific challenges.

Measuring Property Management Risk and Loss: Step One Toward Managing Property on a Foundation of Risk, Cost, and Benefit

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

Johnson, Curtis

1999-05-17

This is a period of ever-tightening defense budgets and continuing pressure on the public sector to be more commercial-like, Property policies, practices, and regulations are increasingly being challenged and changed. In these times, we must be leaders in understanding and defining the value of our profession from a commercial standpoint so that we can provide the right services to our customers and explain and defend the value of those services. To do so, we must step outside current property management practices, regulations, and oversight. We must learn to think and speak in the language of those who fund us--a financialmore » language of risk, cost, and benefit. Regardless of regulation and oversight, our bosses are demanding that we demonstrate (financially) the benefits of current practice, or else. This article is intended to be the beginning of an effort to understand and define our profession in terms of risk, cost, and benefit so that we can meet these new challenges. The first step in this effort must be defining and measuring risk, cost, and benefit. Our costs, although sometimes difficult to capture, are easy to understand: they are almost exclusively the effort, both within and without the property management organization, involved in managing property. Unfortunately, property risks and benefits are not so simple or so well understood. Generally, risks and benefits are identified and measured through physical inventory results: potential and actual shortages. This paper will explore the weaknesses in the current understanding and use of shortage information as the yardstick for property management risks and performance. It will define a new framework for understanding the purpose and value of property management. And finally, it will set a course for a new method of measuring and valuing physical inventoty shortages. This new method will yield accurate and useful measures of property management risk and benefit. Once risk and benefit are accurately understood and measured, it will be possible to evaluate, adjust, and explain property management practices and regulations from a commercial, financial perspective; it will be possible for us to be the leaders in redefining the purpose and value of the property management profession for today's environment.« less

[Endorsement of risk management and patient safety by certification of conformity in health care quality assessment].

PubMed

Waßmuth, Ralf

2015-01-01

Certification of conformity in health care should provide assurance of compliance with quality standards. This also includes risk management and patient safety. Based on a comprehensive definition of quality, beneficial effects on the management of risks and the enhancement of patient safety can be expected from certification of conformity. While these effects have strong face validity, they are currently not sufficiently supported by evidence from health care research. Whether this relates to a lack of evidence or a lack of investigation remains open. Advancing safety culture and "climate", as well as learning from adverse events rely in part on quality management and are at least in part reflected in the certification of healthcare quality. However, again, evidence of the effectiveness of such measures is limited. Moreover, additional factors related to personality, attitude and proactive action of healthcare professionals are crucial factors in advancing risk management and patient safety which are currently not adequately reflected in certification of conformity programs.

Customer-Specific Transaction Risk Management in E-Commerce

NASA Astrophysics Data System (ADS)

Ruch, Markus; Sackmann, Stefan

Increasing potential for turnover in e-commerce is inextricably linked with an increase in risk. Online retailers (e-tailers), aiming for a company-wide value orientation should manage this risk. However, current approaches to risk management either use average retail prices elevated by an overall risk premium or restrict the payment methods offered to customers. Thus, they neglect customer-specific value and risk attributes and leave turnover potentials unconsidered. To close this gap, an innovative valuation model is proposed in this contribution that integrates customer-specific risk and potential turnover. The approach presented evaluates different payment methods using their risk-turnover characteristic, provides a risk-adjusted decision basis for selecting payment methods and allows e-tailers to derive automated risk management decisions per customer and transaction without reducing turnover potential.

Program Risk Planning with Risk as a Resource

NASA Technical Reports Server (NTRS)

Ray, Paul S.

1998-01-01

The current focus of NASA on cost effective ways of achieving mission objectives has created a demand for a change in the risk management process of a program. At present, there is no guidelines as to when risk taking is justified due to high cost for a marginal improvement in risk. As a remedial step, Dr. Greenfield of NASA, developed a concept of risk management with risk as a resource. In the report, the following topics are addressed: (1) the risk management approach; (2) planning risk and program life cycle; (3) key components of a typical program; (4) the risk trading methodology; (5) review and decision process; (6) merits of the proposed risk planning approach; and (7) recommendations.

Anticlotting agents and the surgical management of glaucoma.

PubMed

Sozeri, Yasemin; Salim, Sarwat

2018-03-01

A large subset of patients with glaucoma uses anticlotting agents. No standardized guidelines currently exist for managing these agents in the specific perioperative setting of glaucoma surgery. The present review focuses on currently available anticlotting agents, their influence on hemorrhagic complications following glaucoma surgery, and management strategies for their use in the perioperative period RECENT FINDINGS: Anticlotting agents increase the risk of perioperative hemorrhagic complications following glaucoma surgery. Other factors that increase that risk have been identified as well, including the type of glaucoma surgery, preoperative intraocular pressure, postoperative hypotony, previous ocular surgeries, and race. Although general guidelines in the perioperative management of blood thinning agents exist, the best way to apply these guidelines specifically to glaucoma surgery remains unclear. Blood thinners are widely used and can increase the risk of hemorrhagic complications in patients undergoing glaucoma surgery. Managing these agents in the perioperative setting is challenging and should be done in collaboration with the patient's primary care provider, hematologist, or cardiologist. Management strategies should be tailored to each individual's risk of hemorrhage versus thromboembolism. Additionally, surgical plans can be modified to help minimize hemorrhagic outcomes, especially in patients who are deemed to be at high risk for perioperative bleeding.

Suicide risk assessment practices: a national survey of generalist drug and alcohol residential rehabilitation services.

PubMed

Ross, Joanne; Darke, Shane; Kelly, Erin; Hetherington, Kate

2012-09-01

Clients of drug and alcohol treatment services represent a high-risk group for attempted and completed suicide. The current study sought to examine suicide risk assessment practices in Australian generalist residential rehabilitation services. Semistructured interviews were conducted with managers of residential rehabilitation services and with volunteers from staff responsible for the case management/treatment of clients. Ninety per cent of services participated. In total, 64 managers and 142 staff were interviewed. One-third of services had no documented policy for the assessment and management of suicide risk, and one-quarter of staff had never received formal training in risk assessment. In more than one-third of agencies staff were not expected to use a structured suicide risk assessment tool when assessing a client's acute risk. To varying degrees agencies were gathering information about psychiatric comorbidity, but this information did not appear to be routinely integrated into the client's suicide risk assessment. The development of clearly documented polices, standardised assessment tools and the provision of annual training for all staff would help to address some of the gaps identified in current practice. © 2012 Australasian Professional Society on Alcohol and other Drugs.

Assessment and management of fracture risk in patients with Parkinson's disease.

PubMed

Lyell, Veronica; Henderson, Emily; Devine, Mark; Gregson, Celia

2015-01-01

Parkinson's disease (PD) is associated with substantially increased fracture risk, particularly hip fracture, which can occur relatively early in the course of PD. Despite this, current national clinical guidelines for PD fail to adequately address fracture risk assessment or the management of bone health. We appraise the evidence supporting bone health management in PD and propose a PD-specific algorithm for the fracture risk assessment and the management of bone health in patients with PD and related movement disorders. The algorithm considers (i) calcium and vitamin D replacement and maintenance, (ii) quantification of prior falls and fractures, (iii) calculation of 10-year major osteoporotic and hip fracture risks using Qfracture, (iv) application of fracture risk thresholds, which if fracture risk is high (v) prompts anti-resorptive treatment, with or without dual X-ray absorptiometry, and if low (vi) prompts re-assessment with FRAX and application of National Osteoporosis Guidelines Group (NOGG) guidance. A range of anti-resorptive agents are now available to treat osteoporosis; we review their use from the specific perspective of a clinician managing a patient population with PD. In conclusion, our current evidence base supports updating of guidelines globally concerning the management of PD, which presently fail to adequately address bone health. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Sustainable nanotechnology decision support system: bridging risk management, sustainable innovation and risk governance

NASA Astrophysics Data System (ADS)

Subramanian, Vrishali; Semenzin, Elena; Hristozov, Danail; Zabeo, Alex; Malsch, Ineke; McAlea, Eamonn; Murphy, Finbarr; Mullins, Martin; van Harmelen, Toon; Ligthart, Tom; Linkov, Igor; Marcomini, Antonio

2016-04-01

The significant uncertainties associated with the (eco)toxicological risks of engineered nanomaterials pose challenges to the development of nano-enabled products toward greatest possible societal benefit. This paper argues for the use of risk governance approaches to manage nanotechnology risks and sustainability, and considers the links between these concepts. Further, seven risk assessment and management criteria relevant to risk governance are defined: (a) life cycle thinking, (b) triple bottom line, (c) inclusion of stakeholders, (d) risk management, (e) benefit-risk assessment, (f) consideration of uncertainty, and (g) adaptive response. These criteria are used to compare five well-developed nanotechnology frameworks: International Risk Governance Council framework, Comprehensive Environmental Assessment, Streaming Life Cycle Risk Assessment, Certifiable Nanospecific Risk Management and Monitoring System and LICARA NanoSCAN. A Sustainable Nanotechnology Decision Support System (SUNDS) is proposed to better address current nanotechnology risk assessment and management needs, and makes. Stakeholder needs were solicited for further SUNDS enhancement through a stakeholder workshop that included representatives from regulatory, industry and insurance sectors. Workshop participants expressed the need for the wider adoption of sustainability assessment methods and tools for designing greener nanomaterials.

Management strategies of Barrett's esophagus.

PubMed

De Palma, Giovanni D

2012-11-21

Barrett's esophagus is a condition resulting from chronic gastro-esophageal reflux disease with a documented risk of esophageal adenocarcinoma. Current strategies for improved survival in patients with Barrett's adenocarcinoma focus on detection of dysplasia. This can be obtained by screening programs in high-risk cohorts of patients and/or endoscopic biopsy surveillance of patients with known Barrett's esophagus (BE). Several therapies have been developed in attempts to reverse BE and reduce cancer risk. Aggressive medical management of acid reflux, lifestyle modifications, antireflux surgery, and endoscopic treatments have been recommended for many patients with BE. Whether these interventions are cost-effective or reduce mortality from esophageal cancer remains controversial. Current treatment requires combinations of endoscopic mucosal resection techniques to eliminate visible lesions followed by ablation of residual metaplastic tissue. Esophagectomy is currently indicated in multifocal high-grade neoplasia or mucosal Barrett's carcinoma which cannot be managed by endoscopic approach.

Problem-Based Teaching in International Management: A Political/Economic Risk Assessment Exercise

ERIC Educational Resources Information Center

Daly, Paula S.; White, Marion M.; Zisk, Daniel S.; Cavazos, David E.

2013-01-01

This article draws from the current literature to examine problem-based learning (PBL) as a management education tool, and provides an example of how to incorporate PBL into an undergraduate international management course. Also included are an explanation of, and specific guidelines for, a PBL exercise focused on the analysis of "country risk"…

Assessment and management of risk for intimate partner violence by police officers using the Spousal Assault Risk Assessment Guide.

PubMed

Belfrage, Henrik; Strand, Susanne; Storey, Jennifer E; Gibas, Andrea L; Kropp, P Randall; Hart, Stephen D

2012-02-01

Intimate partner violence (IPV) is a crime that is present in all countries, seriously impacts victims, and demands a great deal of time and resources from the criminal justice system. The current study examined the use of the Spousal Assault Risk Assessment Guide, 2nd ed. (SARA; Kropp, Hart, Webster, & Eaves, 1995), a structured professional judgment risk assessment and management tool for IPV, by police officers in Sweden over a follow-up of 18 months. SARA risk assessments had significant predictive validity with respect to risk management recommendations made by police, as well as with recidivism as indexed by subsequent contacts with police. Risk management mediated the association between risk assessment and recidivism: High levels of intervention were associated with decreased recidivism in high risk cases, but with increased recidivism in low risk cases. The findings support the potential utility of police-based risk assessment and management of IPV, and in particular the belief that appropriately structured risk assessment and management decisions can prevent violence. (c) 2012 APA, all rights reserved.

Using data and quality monitoring to enhance maternity outcomes: a qualitative study of risk managers' perspectives.

PubMed

Simms, Rebecca A; Yelland, Andrew; Ping, Helen; Beringer, Antonia J; Draycott, Timothy J; Fox, Robert

2014-06-01

Risk management is a core part of healthcare practice, especially within maternity services, where litigation and societal costs are high. There has been little investigation into the experiences and opinions of those staff directly involved in risk management: lead obstetricians and specialist risk midwives, who are ideally placed to identify how current implementation of risk management strategies can be improved. A qualitative study of consultant-led maternity units in an English region. Semistructured interviews were conducted with the obstetric and midwifery risk management leads for each unit. We explored their approach to risk management, particularly their opinions regarding quality monitoring and related barriers/issues. Interviews were recorded, transcribed and thematically analysed. Twenty-seven staff from 12/15 maternity units participated. Key issues identified included: concern for the accuracy and validity of their local data, potential difficulties related to data collation, the negative impact of external interference by national regulatory bodies on local clinical priorities, the influence of the local culture of the maternity unit on levels of engagement in the risk management process, and scepticism about the value of benchmarking of maternity units without adjustment for population characteristics. Local maternity risk managers may provide valuable, clinically relevant insights into current issues in clinical data monitoring. Improvements should focus on the accuracy and ease of data collation with a need for an agreed maternity indicators set, populated from validated databases, and not reliant on data collection systems that distract clinicians from patient activity and quality improvement. It is clear that working relationships between risk managers, their own clinical teams and external national bodies require improvement and alignment. Further discussion regarding benchmarking between maternity units is required prior to implementation. These findings are likely to be relevant to other clinical specialties. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Managing Programmatic Risk for Complex Space System Developments

NASA Technical Reports Server (NTRS)

Panetta, Peter V.; Hastings, Daniel; Brumfield, Mark (Technical Monitor)

2001-01-01

Risk management strategies have become a recent important research topic to many aerospace organizations as they prepare to develop the revolutionary complex space systems of the future. Future multi-disciplinary complex space systems will make it absolutely essential for organizations to practice a rigorous, comprehensive risk management process, emphasizing thorough systems engineering principles to succeed. Project managers must possess strong leadership skills to direct high quality, cross-disciplinary teams for successfully developing revolutionary space systems that are ever increasing in complexity. Proactive efforts to reduce or eliminate risk throughout a project's lifecycle ideally must be practiced by all technical members in the organization. This paper discusses some of the risk management perspectives that were collected from senior managers and project managers of aerospace and aeronautical organizations by the use of interviews and surveys. Some of the programmatic risks which drive the success or failure of projects are revealed. Key findings lead to a number of insights for organizations to consider for proactively approaching the risks which face current and future complex space systems projects.

Managing Cardiovascular Disease Risk in Rheumatoid Arthritis: Clinical Updates and Three Strategic Approaches.

PubMed

Chodara, Ann M; Wattiaux, Aimée; Bartels, Christie M

2017-04-01

ᅟ: The increase in cardiovascular disease (CVD) risk in rheumatoid arthritis (RA) is well known; however, appropriate management of this elevated risk in rheumatology clinics is less clear. By critically reviewing literature published within the past 5 years, we aim to clarify current knowledge and gaps regarding CVD risk management in RA. We examine recent guidelines, recommendations, and evidence and discuss three approaches: (1) RA-specific management including treat-to-target and medication management, (2) assessment of comprehensive individual risk, and (3) targeting traditional CVD risk factors (hypertension, smoking, hyperlipidemia, diabetes, obesity, and physical inactivity) at a population level. Considering that 75% of US RA visits occur in specialty clinics, further research is needed regarding evidence-based strategies to manage and reduce CVD risk in RA. This review highlights clinical updates including US cardiology and international professional society guidelines, successful evidence-based population approaches from primary care, and novel opportunities in rheumatology care to reduce CVD risk in RA.

Assessing Climate Change Perceptions, Management Strategies, and Information Needs for Indiana Agricultural and Forestry Sectors

NASA Astrophysics Data System (ADS)

Cherkauer, K. A.; Chin, N.

2016-12-01

The agricultural and forestry sectors in the state of Indiana are highly dependent on climate and, subsequently, highly vulnerable to the impacts of climate change. Higher temperatures, shifts in precipitation patterns, more widespread prevalence of pests and pathogens, and increased frequency and severity of extreme weather events could all have negative effects on these two sectors in the future. Agricultural and forest producers are already modifying their management strategies in response to perceptions of changes in climate risk, but such responses have been primarily reactive in nature and, in many cases, demonstrate a disconnect between scientific findings and stakeholder perceptions of the greatest climate risks. This research has been conducted to help improve understanding of climate change risks to agriculture and forestry in Indiana; stakeholder perceptions of climate risks and their current management strategies; and the effectiveness of these management strategies for dealing with current and future climate risk. Sector-specific focus groups, expert panel assessments and surveys have all been utilized in this work, which will also contribute to the new Indiana Climate Change Impacts Assessment report.

Insurance World in Transition: Changes in Global Risk Taking and Risk Assessment

NASA Astrophysics Data System (ADS)

Michel, Gero; Tiampo, Kristy

2015-04-01

Catastrophe insurance risk assessment, risk taking, and regulation has evolved over the last 20 years and is gearing up for significant further change in the years ahead. Changes in regulation and influx of capital have put profit margins for catastrophe risk products under pressure despite the fact that changes in climate as well as increasing insurance penetration is expected to heighten demand. As a result, reinsurance strategies are moving away from catastrophe risk. In addition, lower margins require cheaper and more efficient risk assessment methods and processes which are contrary to evolving analytical tools and methods that had increased expenses in line with growing margins over the last decade. New capital providers are less familiar with and less willing to accept complex supply chains for risk management, relationship-driven business and tedious data exchange and management processes. Risk takers claim new measures and ask for more flexibility in the use of tools. The current concepts of catastrophe insurance risk assessment are hence under thorough scrutiny. This presentation deals with the changing landscape in catastrophe insurance risk assessment and risk hedging and discusses changes in catastrophe risk assessment products and demand. How likely is it that private, small and nimble hazard and risk consulting groups - increasingly emanating from larger science organizations - will replace large established firms in their role to assess risk? What role do public-private academic partnerships play in assuming risk for catastrophe insurance and what role could they play in the future? What are the opportunities and downsides of the current changes in risk taking and hedging? What is needed from the scientific community in order to fill the gaps in risk management and who is likely to take advantage of the current changes?

Development and implementation of a business continuity management risk index.

PubMed

Kadar, Michael

This paper will present the building blocks for developing and implementing the BCM risk index; whether it is used as a comprehensive metric for risk or preparedness. This paper introduces the concept of a business continuity management (BCM) risk index--a comprehensive metric that measures and reports the status of the primary 'intended outcome' of the BCM programme to top management. In addition to measuring the primary programme output,;the BCM risk index can be used to demonstrate the overall value of the BCM programme to executive management. This is accomplished because the BCM risk index allows quantitative measurement of current risk levels and their comparison with established risk tolerances. The BCM Risk Index can provide executive management with reports on the risk level of individual business units, departments, subsidiaries or the enterprise in a way that drives both risk management and BCM initiatives. The name 'risk index' can be misleading, however. The BCM risk index concept can also be used to measure preparedness levels. In fact, implementation at DTE Energy has resulted in calling it the 'preparedness index', which is used to measure and report preparedness levels rather than risk levels.

Treatment of Amblyopia and Amblyopia Risk Factors Based on Current Evidence.

PubMed

Koo, Euna B; Gilbert, Aubrey L; VanderVeen, Deborah K

2017-01-01

Amblyopia is a leading cause of low vision and warrants timely management during childhood. We performed a literature review of the management of amblyopia and potential risk factors for amblyopia. Literature review of the management of amblyopia and risk factors for amblyopia. Common amblyopia risk factors include anisometropic or high refractive error, strabismus, cataract, and ptosis. Often a conservative approach with spectacles is enough to prevent amblyopia. However, surgery may be necessary to clear the visual axis or align the eyes. Amblyopia risk factors should be managed early. Though amblyopia treatment is more likely to be successful at a younger age, those who are older but treatment-naïve may still respond to treatment. Promoting binocular or dichoptic experiences may be the future direction of amblyopia management.

Managing occupational risk in creative practice: a new perspective for occupational health and safety.

PubMed

Oughton, Nicholas

2013-01-01

There has been little recognition of the fact that creative production operates in a somewhat different environment and timeframe to that associated with traditional industries. This has resulted in the application of an orthodox, generic or ``one size fits all'' framework of Occupational Health and Safety (OHS) systems across all industries. With the rapid growth of ``creative industry,'' certain challenges arise from the application of this "generic" strategy, mainly because the systems currently employed may not be entirely suitable for creative practice. Some OHS practitioners suggest that the current OHS paradigm is failing. This paper questions the appropriateness of applying a twentieth century OHS model in the present industrial context, and considers what framework will best provide for the well-being of creative workers and their enterprise in the twenty-first century. The paper questions the notion of "Risk" and the paradox associated with "Risk Management," particularly in the context of the creative process. Clearly, risk taking contributes to creative enterprise and effective risk management should accommodate both risk minimization and risk exploitation.

Systems engineering approach to environmental risk management: A case study of depleted uranium at test area C-64, Eglin Air Force Base, Florida. Master`s thesis

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

Carter, C.M.; Fortmann, K.M.; Hill, S.W.

1994-12-01

Environmental restoration is an area of concern in an environmentally conscious world. Much effort is required to clean up the environment and promote environmentally sound methods for managing current land use. In light of the public consciousness with the latter topic, the United States Air Force must also take an active role in addressing these environmental issues with respect to current and future USAF base land use. This thesis uses the systems engineering technique to assess human health risks and to evaluate risk management options with respect to depleted uranium contamination in the sampled region of Test Area (TA) C-64more » at Eglin Air Force Base (AFB). The research combines the disciplines of environmental data collection, DU soil concentration distribution modeling, ground water modeling, particle resuspension modeling, exposure assessment, health hazard assessment, and uncertainty analysis to characterize the test area. These disciplines are required to quantify current and future health risks, as well as to recommend cost effective ways to increase confidence in health risk assessment and remediation options.« less

A new perspective on optimal care for patients with COPD.

PubMed

Postma, Dirkje; Anzueto, Antonio; Calverley, Peter; Jenkins, Christine; Make, Barry J; Sciurba, Frank C; Similowski, Thomas; van der Molen, Thys; Eriksson, Göran

2011-06-01

Worldwide, clinicians face the task of providing millions of patients with the best possible treatment and management of COPD. Currently, management primarily involves short-term 'here-and-now' goals, targeting immediate patient benefit. However, although there is considerable knowledge available to assist clinicians in minimising the current impact of COPD on patients, relatively little is known about which dominant factors predict future risks. These predictors may vary for different outcomes, such as exacerbations, mortality, co-morbidities, and the long-term consequences of COPD. We propose a new paradigm to achieve 'optimal COPD care' based on the concept that here-and-now goals should be integrated with goals to improve long-term outcomes and reduce future risks. Whilst knowledge on risk factors for poorer outcomes in COPD is growing and some data exist on positive effects of pharmacological interventions, information on defining the benefits of all commonly used interventions for reducing the risk of various future disease outcomes is still scarce. Greater insight is needed into the relationships between the two pillars of optimal COPD care: 'best current control' and 'future risk reduction'. This broader approach to disease management should result in improved care for every COPD patient now and into the future.

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.

Medical Waste Management Implications for Small Medical Facilities.

ERIC Educational Resources Information Center

Byrns, George; Burke, Thomas

1992-01-01

Discusses the implications of the Medical Waste Management Act of 1988 for small medical facilities, public health, and the environment. Reviews health and environmental risks associated with medical waste, current regulatory approaches, and classifications. Concludes that the health risk of medical wastes has been overestimated; makes…

Understanding cardiovascular risk in hemophilia: A step towards prevention and management.

PubMed

Sousos, Nikolaos; Gavriilaki, Eleni; Vakalopoulou, Sofia; Garipidou, Vasileia

2016-04-01

Advances in hemophilia care have led to increased life expectancy and new challenges in the management of the aging hemophilia population, including cardiovascular risk. Despite the deep knowledge into cardiovascular disease in terms of pathophysiology, risk prediction, prevention, early detection and management gained over the last decades, studies in hemophiliacs are scarce and mainly descriptive. As a growing amount of evidence points towards a similar or increased prevalence of traditional cardiovascular risk factors in hemophilia compared to the general population, the role of non-traditional, disease-related and treatment-related cardiovascular risk factors remains under investigation. Better understanding of cardiovascular risk in hemophilia is mandatory for proper cardiovascular risk prevention and management. Therefore, this review aims to summarize current knowledge on cardiovascular risk in hemophilia patients focusing on a) cardiovascular risk factors (traditional, non-traditional, disease-related and treatment-related), b) cardiovascular morbidity and mortality and c) cardiovascular prevention and management. Copyright © 2016 Elsevier Ltd. All rights reserved.

Management of antithrombotic therapy in patients with coronary artery disease or atrial fibrillation who underwent abdominal surgical operations.

PubMed

Schizas, Dimitrios; Kariori, Maria; Boudoulas, Konstantinos Dean; Siasos, Gerasimos; Patelis, Nikolaos; Kalantzis, Charalampos; Carmen-Maria, Moldovan; Vavuranakis, Manolis

2018-04-02

Patients treated with antithrombotic therapy that require abdominal surgical procedures has progressively increased overtime. The management of antithrombotics during both the peri- and post- operative period is of crucial importance. The goal of this review is to present current data concerning the management of antiplatelets in patients with coronary artery disease and of anticoagulants in patients with atrial fibrillation who had to undergo abdominal surgical operations. For this purpose, incidence of major adverse cardiovascular events (MACE) and risk of antithrombotic use during surgical procedures, as well as the recommendations based on recent guidelines were reported. A thorough search of PubMed, Scopus and the Cochrane Databases was conducted to identify randomized controlled trials, observational studies, novel current reviews, and ESC and ACC/AHA guidelines on the subject. Antithrombotic use in daily clinical practice results to two different pathways: reduction of thromboembolic risk, but a simultaneous increase of bleeding risk. This may cause a therapeutic dilemma during the perioperative period. Nevertheless, careless cessation of antithrombotics can increase MACE and thromboembolic events, however, maintenance of antithrombotic therapy may increase bleeding complications. Studies and current guidelines can assist clinicians in making decisions for the treatment of patients that undergo abdominal surgical operations while on antithrombotic therapy. Aspirin should not be stopped perioperatively in the majority of surgical operations. Determining whether to discontinue the use of anticoagulants before surgery depends on the surgical procedure. In surgical operations with a low risk for bleeding, oral anticoagulants should not be discontinued. Bridging therapy should only be considered in patients with a high risk of thromboembolism. Finally, patients with an intermediate risk for thromboembolism, management should be individualized according to patient's thrombotic and bleeding risk. Management of antithrombotics therapy during the perioperative period in patients undergoing abdominal surgery should follow a patient-centered approach according to a patient's medical history and thrombotic risk weighted for bleeding risk. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Using Computational Approaches to Improve Risk-Stratified Patient Management: Rationale and Methods

PubMed Central

Stone, Bryan L; Sakaguchi, Farrant; Sheng, Xiaoming; Murtaugh, Maureen A

2015-01-01

Background Chronic diseases affect 52% of Americans and consume 86% of health care costs. A small portion of patients consume most health care resources and costs. More intensive patient management strategies, such as case management, are usually more effective at improving health outcomes, but are also more expensive. To use limited resources efficiently, risk stratification is commonly used in managing patients with chronic diseases, such as asthma, chronic obstructive pulmonary disease, diabetes, and heart disease. Patients are stratified based on predicted risk with patients at higher risk given more intensive care. The current risk-stratified patient management approach has 3 limitations resulting in many patients not receiving the most appropriate care, unnecessarily increased costs, and suboptimal health outcomes. First, using predictive models for health outcomes and costs is currently the best method for forecasting individual patient’s risk. Yet, accuracy of predictive models remains poor causing many patients to be misstratified. If an existing model were used to identify candidate patients for case management, enrollment would miss more than half of those who would benefit most, but include others unlikely to benefit, wasting limited resources. Existing models have been developed under the assumption that patient characteristics primarily influence outcomes and costs, leaving physician characteristics out of the models. In reality, both characteristics have an impact. Second, existing models usually give neither an explanation why a particular patient is predicted to be at high risk nor suggestions on interventions tailored to the patient’s specific case. As a result, many high-risk patients miss some suitable interventions. Third, thresholds for risk strata are suboptimal and determined heuristically with no quality guarantee. Objective The purpose of this study is to improve risk-stratified patient management so that more patients will receive the most appropriate care. Methods This study will (1) combine patient, physician profile, and environmental variable features to improve prediction accuracy of individual patient health outcomes and costs; (2) develop the first algorithm to explain prediction results and suggest tailored interventions; (3) develop the first algorithm to compute optimal thresholds for risk strata; and (4) conduct simulations to estimate outcomes of risk-stratified patient management for various configurations. The proposed techniques will be demonstrated on a test case of asthma patients. Results We are currently in the process of extracting clinical and administrative data from an integrated health care system’s enterprise data warehouse. We plan to complete this study in approximately 5 years. Conclusions Methods developed in this study will help transform risk-stratified patient management for better clinical outcomes, higher patient satisfaction and quality of life, reduced health care use, and lower costs. PMID:26503357

Unruptured Cerebral Aneurysms: Evaluation and Management

PubMed Central

Chalouhi, Nohra; Starke, Robert M.; Bell, Rodney

2015-01-01

The evolution of imaging techniques and their increased use in clinical practice have led to a higher detection rate of unruptured intracranial aneurysms. The diagnosis of an unruptured intracranial aneurysm is a source of significant stress to the patient because of the concerns for aneurysmal rupture, which is associated with substantial rates of morbidity and mortality. Therefore, it is important that decisions regarding optimum management are made based on the comparison of the risk of aneurysmal rupture with the risk associated with intervention. This review provides a comprehensive overview of the epidemiology, pathophysiology, natural history, clinical presentation, diagnosis, and management options for unruptured intracranial aneurysms based on the current evidence in the literature. Furthermore, the authors discuss the genetic abnormalities associated with intracranial aneurysm and current guidelines for screening in patients with a family history of intracranial aneurysms. Since there is significant controversy in the optimum management of small unruptured intracranial aneurysms, we provided a systematic approach to their management based on patient and aneurysm characteristics as well as the risks and benefits of intervention. PMID:26146657

Risk management abilities in multimodal maritime supply chains: Visibility and control perspectives.

PubMed

Vilko, Jyri; Ritala, Paavo; Hallikas, Jukka

2016-11-29

Supply chain complexity and disintegration lead to increased uncertainty from a stakeholders' perspective, which is emerging as one of the major challenges of risk management. The ability to identify risks has weakened, as the responsibility of supply chain risk management is handed over to outside service providers. Regardless, the risks, their visibility and their impact depend on the position of the companies in the supply chain. The actors in the chain must therefore collaborate to create effective risk management conditions. This challenging situation is especially pronounced in multimodal maritime supply chains, where the risks and actor focality are high. This paper contributes to current risk management literature by providing a holistic and systemic view of risk visibility and control in maritime supply chains. The study employs broad-based, qualitative interview data collected from actors operating in southern Finland and the Gulf of Finland as well as an expert-panel assessment of the related risk management abilities. The results show a high level of variance in the level of risk identification and visibility between the actors in question. This further suggests that collaboration in supply chain risk management is essential, as an awareness of the risks and their control mechanisms do not necessarily reside in the same company. Copyright © 2016 Elsevier Ltd. All rights reserved.

75 FR 68392 - Self-Regulatory Organizations; The Options Clearing Corporation; Order Approving Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-05

... Numerical Simulations Risk Management Methodology November 1, 2010. I. Introduction On August 25, 2010, The... Analysis and Numerical Simulations (``STANS'') risk management methodology. The rule change alters... collateral within the STANS Monte Carlo simulations.\\7\\ \\7\\ OCC believes the approach currently used to...

76 FR 72488 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-23

... investment and risk management strategies and decisions. The Exchange further believes this proposed rule change will provide investors with additional Weekly option classes for investment, trading and risk management purposes. Therefore, the Exchange requests a modest expansion of the current Weeklys Program. The...

Risk-Based Models for Managing Data Privacy in Healthcare

ERIC Educational Resources Information Center

AL Faresi, Ahmed

2011-01-01

Current research in health care lacks a systematic investigation to identify and classify various sources of threats to information privacy when sharing health data. Identifying and classifying such threats would enable the development of effective information security risk monitoring and management policies. In this research I put the first step…

Consumer responses to communication about food risk management.

PubMed

van Dijk, Heleen; Houghton, Julie; van Kleef, Ellen; van der Lans, Ivo; Rowe, Gene; Frewer, Lynn

2008-01-01

Recent emphasis within policy circles has been on transparent communication with consumers about food risk management decisions and practices. As a consequence, it is important to develop best practice regarding communication with the public about how food risks are managed. In the current study, the provision of information about regulatory enforcement, proactive risk management, scientific uncertainty and risk variability were manipulated in an experiment designed to examine their impact on consumer perceptions of food risk management quality. In order to compare consumer reactions across different cases, three food hazards were selected (mycotoxins on organically grown food, pesticide residues, and a genetically modified potato). Data were collected from representative samples of consumers in Germany, Greece, Norway and the UK. Scores on the "perceived food risk management quality" scale were subjected to a repeated-measures mixed linear model. Analysis points to a number of important findings, including the existence of cultural variation regarding the impact of risk communication strategies-something which has obvious implications for pan-European risk communication approaches. For example, while communication of uncertainty had a positive impact in Germany, it had a negative impact in the UK and Norway. Results also indicate that food risk managers should inform the public about enforcement of safety laws when communicating scientific uncertainty associated with risks. This has implications for the coordination of risk communication strategies between risk assessment and risk management organizations.

Recurrent urinary tract infections in women.

PubMed

Aydin, Abdullatif; Ahmed, Kamran; Zaman, Iftikhar; Khan, Muhammad Shamim; Dasgupta, Prokar

2015-06-01

Recurrent urinary tract infections (UTIs) are more common in women and are frequently defined as ≥2 episodes in the last 6 months or ≥3 episodes in the last 12 months. In a primary care setting, 53 % of women above the age of 55 years and 36 % of younger women report a recurrence within 1 year. Thus, management and prevention of recurrent UTI is of utmost significance. This review aims to highlight the latest research in prevention strategies and suggest a management pathway. A search was conducted on MEDLINE, Embase and the Cochrane Database of Systematic Reviews databases for the latest systematic reviews and high-quality randomized controlled trials. Special emphasis was placed on the remit "recurrent" and strongly adhered to. Furthermore, a Google search was conducted for current guidelines on the management of UTIs. Current prevention strategies include eliminating risk factors that increase the risk of acquiring recurrent UTI and continuous, post-coital and self-initiated antimicrobial prophylaxis. Other prospective preventative strategies, currently under trial, include use of vaccinations, D-mannose and lactobacillus (probiotics). Although risk factors should be identified and addressed accordingly, individualized antibiotic prophylaxis remains the most effective method of management. Non-antibiotic prevention strategies such as cranberry, vitamin C and methenamine salts lack strong evidence to be introduced as routine management options and as alternatives to antibiotics. Based on current evidence and guidelines, a management pathway is recommended. Emerging therapies require further evaluation before they can be recommended.

Barrett's oesophagus: epidemiology, cancer risk and implications for management.

PubMed

de Jonge, Pieter Jan F; van Blankenstein, Mark; Grady, William M; Kuipers, Ernst J

2014-01-01

Although endoscopic surveillance of patients with Barrett's oesophagus has been widely implemented, its effectiveness is debateable. The recently reported low annual oesophageal adenocarcinoma risk in population studies, the failure to identify most Barrett's patients at risk of disease progression, the poor adherence to surveillance and biopsy protocols, and the significant risk of misclassification of dysplasia all tend to undermine the effectiveness of current management, in particular, endoscopic surveillance programmes, to prevent or improve the outcomes of patients with oesophageal adenocarcinoma. The ongoing increase in incidence of Barrett's oesophagus and consequent growth of the surveillance population, together with the associated discomfort and costs of endoscopic surveillance, demand improved techniques for accurately determining individual risk of oesophageal adenocarcinoma. More accurate techniques are needed to run efficient surveillance programmes in the coming decades. In this review, we will discuss the current knowledge on the epidemiology of Barrett's oesophagus, and the challenging epidemiological dilemmas that need to be addressed when assessing the current screening and surveillance strategies.

Stop Stroke: development of an innovative intervention to improve risk factor management after stroke.

PubMed

Redfern, Judith; Rudd, Anthony D; Wolfe, Charles D A; McKevitt, Christopher

2008-08-01

Stroke survivors are at high risk of stroke recurrence yet current strategies to reduce recurrence risk are sub-optimal. The UK Medical Research Council (MRC) have proposed a framework for developing and evaluating complex interventions, such as community management of stroke secondary prevention. The Framework outlines a five-phased approach from theory through to implementation of effective interventions. This paper reports Phases I-III of the development of a novel intervention to improve risk factor management after stroke. The pre-clinical/theoretical phase entailed reviewing the literature and undertaking quantitative and qualitative studies to identify current practices and barriers to secondary prevention. In Phase I (modelling), findings were used to design an intervention with the potential to overcome barriers to effective stroke secondary prevention management. The feasibility of delivering the intervention and its acceptability were tested in the Phase II exploratory trial involving 25 stroke survivors and their general practitioners. This led to the development of the definitive risk factor management intervention. This comprises multiple components and involves using an on-going population stroke register to target patients, carers and health care professionals with tailored secondary prevention advice. Clinical, socio-demographic and service use data collected by the stroke register are transformed to provide an individualised secondary prevention package for patients, carers and health care professionals at three time points: within 10 weeks, 3 and 6 months post-stroke. The intervention is currently being evaluated in a randomised controlled trial. Further research is needed to test generalisability to other aspects of stroke management and for other chronic diseases. The MRC Framework for complex interventions provides a structured approach to guide the development of novel interventions in public health. Implications for practice in stroke secondary prevention will emerge when the results of our randomised controlled trial are published.

Perceived determinants of cardiovascular risk management in primary care: disconnections between patient behaviours, practice organisation and healthcare system.

PubMed

Huntink, E; Wensing, M; Klomp, M A; van Lieshout, J

2015-12-15

Although conditions for high quality cardiovascular risk management in primary care in the Netherlands are favourable, there still remains a gap between practice guideline recommendations and practice. The aim of the current study was to identify determinants of cardiovascular primary care in the Netherlands. We performed a qualitative study, using semi-structured interviews with healthcare professionals and patients with established cardiovascular diseases or at high cardiovascular risk. A framework analysis was used to cluster the determinants into seven domains: 1) guideline factors, 2) individual healthcare professional factors, 3) patient factors, 4) professional interaction, 5) incentives and recourses, 6) mandate, authority and accountability, and 7) social, political and legal factors. Twelve healthcare professionals and 16 patients were interviewed. Healthcare professionals and patients mentioned a variety of factors concerning all seven domains. Determinants of practice according to the health care professionals were related to communication between healthcare professionals, patients' lack of knowledge and self-management, time management, market mechanisms in the Dutch healthcare system and motivational interviewing skills of healthcare professionals. Patients mentioned determinants related to their knowledge of risk factors for cardiovascular diseases, medication adherence and self-management as key determinants. A key finding is the mismatch between healthcare professionals' and patients' views on patient's knowledge and self-management. Perceived determinants of cardiovascular risk management were mainly related to patient behaviors and (but only for health professionals) to the healthcare system. Though health care professionals and patients agree upon the importance of patients' knowledge and self-management, their judgment of the current state of knowledge and self-management is entirely different.

The legal framework to manage chemical pollution in India and the lesson from the Persistent Organic Pollutants (POPs).

PubMed

Sharma, Brij Mohan; Bharat, Girija K; Tayal, Shresth; Nizzetto, Luca; Larssen, Thorjørn

2014-08-15

India's rapid agro-economic growth has resulted into many environmental issues, especially related to chemical pollution. Environmental management and control of toxic chemicals have gained significant attention from policy makers, researchers, and enterprises in India. The present study reviews the policy and legal and non-regulatory schemes set in place in this country during the last decades to manage chemical risk and compares them with those in developed nations. India has a large and fragmented body of regulation to control and manage chemical pollution which appears to be ineffective in protecting environment and human health. The example of POPs contamination in India is proposed to support such a theory. Overlapping of jurisdictions and retrospectively approached environmental policy and risk management currently adopted in India are out of date and excluding Indian economy from the process of building and participating into new, environmentally-sustainable market spaces for chemical products. To address these issues, the introduction of a new integrated and scientifically-informed regulation and management scheme is recommended. Such scheme should acknowledge the principle of risk management rather than the current one based on risk acceptance. To this end, India should take advantage of the experience of recently introduced chemical management regulation in some developed nations. Copyright © 2014 Elsevier B.V. All rights reserved.

Food allergy and risk assessment: Current status and future directions

NASA Astrophysics Data System (ADS)

Remington, Benjamin C.

2017-09-01

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

The Term Risk: Etymology, Legal Definition and Various Traits

PubMed Central

Liuzzo, Gaetano; Bentley, Stefano; Giacometti, Federica; Bonfante, Elena

2014-01-01

The etymology of the term risk and its legal qualification and definitions are reported in this article; decription of the various traits of the term risk used in food safety management (acceptable risk, current risk, emerging risk, crude risk, unrestricted risk, perceived risk, real risk, residual risk, reduced risk, baseline risk, serious risk, major technological risk, etc.) are presented and discussed. PMID:27800325

76 FR 53879 - Request for Extension and Revision of a Currently Approved Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-30

... Education Division, USDA/RMA, 1400 Independence Avenue, SW., Room 6717-S, Stop 0808, Washington, DC 20250... Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35) this notice announces the Risk Management Agency's... INFORMATION CONTACT: Contact Lana Cusick, Risk Management Education Division, USDA/RMA, 1400 Independence...

76 FR 64144 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Notice of Filing of Proposed Rule Change To...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-17

... closely tailor their investment and risk management strategies and decisions. Furthermore, the Exchange... investment, trading, and risk management purposes. 2. Statutory Basis The Exchange believes that its proposal... having the ability to execute hedging and trading strategies via STOs,\\8\\ particularly in the current...

76 FR 50276 - STP Nuclear Operating Company, South Texas Project, Units 1 and 2; Notice of Withdrawal of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-12

... revised the application of Risk- Managed Technical Specifications to Technical Specification 3.7.7, ``Control Room Makeup and Cleanup Filtration System.'' The purpose of the change was to correct a misapplication of the Configuration Risk Management Program that is currently allowed by the Technical...

A resilience perspective to water risk management: case-study application of the adaptation tipping point method

NASA Astrophysics Data System (ADS)

Gersonius, Berry; Ashley, Richard; Jeuken, Ad; Nasruddin, Fauzy; Pathirana, Assela; Zevenbergen, Chris

2010-05-01

In a context of high uncertainty about hydrological variables due to climate change and other factors, the development of updated risk management approaches is as important as—if not more important than—the provision of improved data and forecasts of the future. Traditional approaches to adaptation attempt to manage future water risks to cities with the use of the predict-then-adapt method. This method uses hydrological change projections as the starting point to identify adaptive strategies, which is followed by analysing the cause-effect chain based on some sort of Pressures-State-Impact-Response (PSIR) scheme. The predict-then-adapt method presumes that it is possible to define a singular (optimal) adaptive strategy according to a most likely or average projection of future change. A key shortcoming of the method is, however, that the planning of water management structures is typically decoupled from forecast uncertainties and is, as such, inherently inflexible. This means that there is an increased risk of under- or over-adaptation, resulting in either mal-functioning or unnecessary costs. Rather than taking a traditional approach, responsible water risk management requires an alternative approach to adaptation that recognises and cultivates resiliency for change. The concept of resiliency relates to the capability of complex socio-technical systems to make aspirational levels of functioning attainable despite the occurrence of possible changes. Focusing on resiliency does not attempt to reduce uncertainty associated with future change, but rather to develop better ways of managing it. This makes it a particularly relevant perspective for adaptation to long-term hydrological change. Although resiliency is becoming more refined as a theory, the application of the concept to water risk management is still in an initial phase. Different methods are used in practice to support the implementation of a resilience-focused approach. Typically these approaches start the identification and analysis of adaptive strategies at the end of PSIR scheme: impact and examine whether, and for how long, current risk management strategies will continue to be effective under different future conditions. The most noteworthy application of this approach is the adaptation tipping point method. Adaptation tipping points (ATP) are defined as the points where the magnitude of change is such that the current risk management strategy can no longer meet its objectives. In the ATP method, policy objectives, determining aspirational functioning, are taken as the starting point. Also, the current measures to achieve these objectives are described. This is followed by a sensitivity analysis to determine the optimal and critical boundary conditions (state). Lastly, the state is related to pressures in terms of future change. It should be noted that in the ATP method the driver for adopting a new risk management strategy is not future change as such, but rather failing to meet the policy objectives. In the current paper, the ATP method is applied to the case study of an existing stormwater system in Dordrecht (the Netherlands). This application shows the potential of the ATP method to reduce the complexity of implementing a resilience-focused approach to water risk management. It is expected that this will help foster greater practical relevance of resilience as a perspective for the planning of water management structures.

Current Management of NAFLD

PubMed Central

MUNTEANU, MIHAI ALEXANDRU; NAGY, GEORGIANA ANCA; MIRCEA, PETRU ADRIAN

2016-01-01

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in Western countries. It affects about 1 billion individuals worldwide. While people with simple steatosis have no higher risk of death than the general population, people with non-alcoholic steatohepatitis are at increased risk of death compared to general population. Current management for NAFLD includes diet and lifestyle changes, management of underlying metabolic risk factors and pharmacological therapies. The objective of therapy is to prevent the complications. The problem with dietary and lifestyle interventions is that they are hard to implement. Compliance is the key. Until now, there is still no approved drug for the treatment of NAFLD. Insulin resistance is the main target of pharmacological therapy, but the question that we ask ourselves as physicians is who should receive medical treatment among NAFLD patients and for how long. PMID:27004021

The Importance of High-Risk Human Papillomavirus Types Other Than 16 and 18 in Cervical Neoplasia.

PubMed

Robadi, Ibrahim A; Pharaon, Majed; Ducatman, Barbara S

2018-06-01

- Types 16 and 18 are the most widely studied high-risk types of human papillomavirus (HPV). However, other high-risk HPV types (HPV non-16/18) also play a significant role in cervical neoplasia. Currently, screening and management algorithms separate out HPV 16/18 from all other HPV non-16/18 types. In addition, most of the previously vaccinated population has only been vaccinated for these high-risk types, so many women are still vulnerable to HPV non-16/18 infections. - To review the prevalence and role of HPV non-16/18 neoplasia and to review current surveillance, management, and vaccination strategies in view of these findings. - The study comprised a review of the literature. - Although HPV non-16/18 types are less frequently associated with cervical intraepithelial neoplasia and cancer, they are nonetheless a significant cause of disease. Further stratification of higher-risk HPV non-16/18 may be necessary to improve prevention and management, however, regional prevalence differences may make a unified approach difficult. As HPV 16/18 infections decrease owing to vaccination of at-risk women, the relative frequency of HPV non-16/18 will increase, although the latest vaccine covers several more high-risk types.

Security Risks: Management and Mitigation in the Software Life Cycle

NASA Technical Reports Server (NTRS)

Gilliam, David P.

2004-01-01

A formal approach to managing and mitigating security risks in the software life cycle is requisite to developing software that has a higher degree of assurance that it is free of security defects which pose risk to the computing environment and the organization. Due to its criticality, security should be integrated as a formal approach in the software life cycle. Both a software security checklist and assessment tools should be incorporated into this life cycle process and integrated with a security risk assessment and mitigation tool. The current research at JPL addresses these areas through the development of a Sotfware Security Assessment Instrument (SSAI) and integrating it with a Defect Detection and Prevention (DDP) risk management tool.

The management of animal bites in the United kingdom.

PubMed

Evgeniou, E; Markeson, D; Iyer, S; Armstrong, A

2013-01-01

Animal bites represent a significant global health issue. The evidence in the literature regarding their management in many areas is conflicting and unclear. This project attempts to identify current evidence in the literature on the management of animal bites and assess if current practice in the United Kingdom is evidence based. A literature review on the management of animal bites was performed, and a national UK survey was contacted using a questionnaire based on the available evidence in the literature. The results from this survey show that 98% of plastic surgery units routinely use prophylactic antibiotics in all animal bite wounds; 58% close low-risk injuries primarily after initial washout, and there are conflicting opinions regarding the management of associated fractures and soft tissue injuries. The available data in the literature suggest that appropriate wound management is the most important factor for prevention of infection in animal bites. Antibiotic prophylaxis should only be given in high-risk wounds and primary closure should be performed in low-risk wounds. The management protocols of many plastic surgery units often diverge from the available evidence within the literature. On the basis of a thorough literature review, a guideline for the management of animal bites is presented. Future studies should investigate the management of associated fractures and soft tissue injuries.

DOD Acquisition Information Management

DTIC Science & Technology

1994-09-30

instead of on a real- time management information flow. The process of identifying risks and implementing corrective actions is lengthened by using the current system; performance measurement and reporting are impeded.

Translating reference doses into allergen management practice: challenges for stakeholders.

PubMed

Crevel, René W R; Baumert, Joseph L; Luccioli, Stefano; Baka, Athanasia; Hattersley, Sue; Hourihane, Jonathan O'B; Ronsmans, Stefan; Timmermans, Frans; Ward, Rachel; Chung, Yong-joo

2014-05-01

Risk assessment describes the impact of a particular hazard as a function of dose and exposure. It forms the foundation of risk management and contributes to the overall decision-making process, but is not its endpoint. This paper outlines a risk analysis framework to underpin decision-making in the area of allergen cross-contact. Specifically, it identifies challenges relevant to each component of the risk analysis: risk assessment (data gaps and output interpretation); risk management (clear and realistic objectives); and risk communication (clear articulation of risk and benefit). Translation of the outputs from risk assessment models into risk management measures must be informed by a clear understanding of the model outputs and their limitations. This will lead to feasible and achievable risk management objectives, grounded in a level of risk accepted by the different stakeholders, thereby avoiding potential unintended detrimental consequences. Clear, consistent and trustworthy communications actively involving all stakeholders underpin these objectives. The conclusions, integrating the perspectives of different stakeholders, offer a vision where clear, science-based benchmarks form the basis of allergen management and labelling, cutting through the current confusion and uncertainty. Finally, the paper recognises that the proposed framework must be adaptable to new and emerging evidence. Copyright © 2014 ILSI Europe. Published by Elsevier Ltd.. All rights reserved.

[Risk management from the judicial perspective].

PubMed

Ulsenheimer, Klaus

2003-11-01

The jurisdification of medicine is an unstoppable force that finds its visible expression in a medical liability boom which--apart from the negative impact of legal and out-of-court proceedings on the bond of the doctor-patient relationship--bears considerable economic disadvantages for the providers of care. It is therefore necessary to fight in particular the legally influenced causes of medical liability for which risk management seems to be a suitable, effective tool. As the examples taken from the jurisdiction in the organisational sector will demonstrate, risk management pinpoints the sources of trouble so that we are able to learn from current errors and provide appropriate remedies for the future. Risk management, though, is not a "unique event", but a dynamic, repetitive process that has to be institutionally secured by appointing a risk manager so that the proposals discussed, recommendations and essential measures can actually be implemented.

Medical professional liability insurance and its relation to medical error and healthcare risk management for the practicing physician.

PubMed

Abbott, Richard L; Weber, Paul; Kelley, Betsy

2005-12-01

To review the history and current issues surrounding medical professional liability insurance and its relationship to medical error and healthcare risk management. Focused literature review and authors' experience. Medical professional liability insurance issues are reviewed in association with the occurrence of medical error and the role of healthcare risk management. The rising frequency and severity of claims and lawsuits incurred by physicians, as well as escalating defense costs, have dramatically increased over the past several years and have resulted in accelerated efforts to reduce medical errors and control practice risk for physicians. Medical error reduction and improved patient outcomes are closely linked to the goals of the medical risk manager by reducing exposure to adverse medical events. Management of professional liability risk by the physician-led malpractice insurance company not only protects the economic viability of physicians, but also addresses patient safety concerns. Physician-owned malpractice liability insurance companies will continue to be the dominant providers of insurance for practicing physicians and will serve as the primary source for loss prevention and risk management services. To succeed in the marketplace, the emergence and importance of the risk manager and incorporation of risk management principles throughout the professional liability company has become crucial to the financial stability and success of the insurance company. The risk manager provides the necessary advice and support requested by physicians to minimize medical liability risk in their daily practice.

Supporting the information domains of fall-risk management in home care via health information technology.

PubMed

Alhuwail, Dari; Koru, Güneş; Mills, Mary Etta

2016-01-01

In the United States, home care clinicians often start the episode of care devoid of relevant fall-risk information. By collecting and analyzing qualitative data from 30 clinicians in one home health agency, this case study aimed to understand how the currently adopted information technology solutions supported the clinicians' fall-risk management (FRM) information domains, and explored opportunities to adopt other solutions to better support FRM. The currently adopted electronic health record system and fall-reporting application served only some information domains with a limited capacity. Substantial improvement in addressing the FRM information domains is possible by effectively modifying the existing solutions and purposefully adopting new solutions.

Occurrence detection and selection procedures in healthcare facilities: a comparison across Canada and Brazil.

PubMed

Morita, Plinio P; Burns, Catherine M

2011-01-01

Healthcare institutions face high levels of risk on a daily basis. Efforts have been made to address these risks and turn this complex environment into a safer environment for patients, staff, and visitors. However, healthcare institutions need more advanced risk management tools to achieve the safety levels currently seen in other industries. One of these potential tools is occurrence investigation systems. In order to be investigated, occurrences must be detected and selected for investigation, since not all institutions have enough resources to investigate all occurrences. A survey was conducted in healthcare institutions in Canada and Brazil to evaluate currently used risk management tools, the difficulties faced, and the possibilities for improvement. The findings include detectability difficulties, lack of resources, lack of support, and insufficient staff involvement.

Debt-maturity structures should match risk preferences.

PubMed

Gapenski, L C

1999-12-01

Key to any debt-maturity matching strategy is financing assets with the appropriate debt structure. Financial managers need to establish an optimal capital structure and then choose the best maturity-matching structure for their debt. Two maturity-matching strategies that are available to healthcare financial managers are the accounting approach and the finance approach. The accounting approach, which defines asset maturities as current or fixed, is a riskier financing strategy than the finance approach, which defines asset maturities as permanent or temporary. The added risk occurs because of the accounting approach's heavy reliance on short-term debt. The accounting approach offers the potential for lower costs at the expense of higher risk. Healthcare financial managers who believe the financing function should support the organization's operations without adding undue risk should use the finance approach to maturity matching. Asset maturities in those organizations then should be considered permanent or temporary rather than current or fixed, and the debt-maturity structure should reflect this.

NASA Earned Value Management (EVM) Update

NASA Technical Reports Server (NTRS)

Kerby, Jerald

2013-01-01

Earned Value Management (EVM) is an integrated management control system for assessing, understanding and qualifying what a project is achieving with the resoures. EVM integrates technical cost and schedules with risk management. It allows objective assessment and quantification of current project performance, and helps predict future performance-based trents.

Flood Risk and Global Change: Future Prospects

NASA Astrophysics Data System (ADS)

Serra-Llobet, A.

2014-12-01

Global flood risk is increasing in response to population growth in flood-prone areas, human encroachment into natural flood paths (exacerbating flooding in areas formerly out of harm's way), and climate change (which alters variables driving floods). How will societies respond to and manage flood risk in coming decades? Analysis of flood policy evolution in the EU and US demonstrates that changes occurred in steps, in direct response to disasters. After the flood produced by the collapse of Tous Dam in 1982, Spain initiated a systematic assessment of areas of greatest flood risk and civil protection response. The devastating floods on the Elbe and elsewhere in central Europe in 2002 motivated adoption of the EU Floods Directive (2007), which requires member states to develop systematic flood risk maps (now due) and flood risk management plans (due in 2015). The flooding of New Orleans by Hurricane Katrina in 2005 resulted in a nationwide levee-safety assessment and improvements in communicating risk, but overall less fundamental change in US flood management than manifest in the EU since 2007. In the developing world, large (and increasing) concentrations of populations in low-lying floodplains, deltas, and coasts are increasingly vulnerable, and governments mostly ill-equipped to implement fundamental changes in land use to prevent future increases in exposure, nor to develop responses to the current threats. Even in the developed world, there is surprisingly little research on how well residents of flood-prone lands understand their true risk, especially when they are 'protected' by '100-year' levees. Looking ahead, researchers and decision makers should prioritize improvements in flood risk perception, river-basin-scale assessment of flood runoff processes (under current and future climate and land-use conditions) and flood management alternatives, and bridging the disconnect between national and international floodplain management policies and local land-use decisions.

MONITORED NATURAL ATTENUATION OF MTBE AS A RISK MANAGEMENT OPTION AT LEAKING UNDERGROUND STORAGE TANK SITES

EPA Science Inventory

This report reviews the current state of knowledge on the transport and fate of MTBE in ground water, with emphasis on the natural processes that can be used to manage the risk associated with MTBE in ground water or that contributes to natural attenuation of MTBE as a remedy. I...

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

YOUNG ADULT DATING RELATIONSHIPS AND THE MANAGEMENT OF SEXUAL RISK.

PubMed

Manning, Wendy D; Giordano, Peggy C; Longmore, Monica A; Flanigan, Christine M

2012-04-01

Young adult involvement in sexual behavior typically occurs within a relationship context, but we know little about the ways in which specific features of romantic relationships influence sexual decision-making. Prior work on sexual risk taking focuses attention on health issues rather than relationship dynamics. We draw on data from the Toledo Adolescent Relationships Study (TARS) (n = 475) to examine the association between qualities and dynamics of current/most recent romantic relationships such as communication and emotional processes, conflict, demographic asymmetries, and duration and the management of sexual risk. We conceptualize 'risk management' as encompassing multiple domains, including (1) questioning the partner about previous sexual behaviors/risks, (2) using condoms consistently, and (3) maintaining sexual exclusivity within the relationship. We identify distinct patterns of risk management among dating young adults and find that specific qualities and dynamics of these relationships are linked to variations in risk management. Results from this paper suggest the need to consider relational dynamics in efforts to target and influence young adult sexual risk-taking and reduce STIs, including HIV.

Nurse-led clinics for atrial fibrillation: managing risk factors.

PubMed

Jacob, Liril

2017-12-14

Atrial fibrillation (AF) is the most common and sustained cardiac arrhythmia rated by cardiologists as one of the most difficult conditions to manage. Traditionally, AF management has focused on the three pillars of rate control, rhythm control and anticoagulation. However, more recently, cardiovascular risk-factor management in AF has emerged as a fourth and essential pillar, delivering improved patient outcomes. In the UK, AF is a condition that is often managed poorly, with patients reporting a lack of understanding of their condition and treatment options. Many aspects of assessment and communication in AF management are time consuming. Failure to address those aspects may negatively affect the quality of care. Nurse-led clinics can contribute significantly in the areas of patient education and sustained follow-up care, improving outcomes and addressing current deficiencies in AF risk-factor management due to scarcity of medical resources. This article discusses the major cardiovascular risk factors associated with AF, drawing on evidence from the literature, and considers the effectiveness and implications for practice of introducing community-based nurse-led clinics for risk-factor management in patients with AF.

Software risk estimation and management techniques at JPL

NASA Technical Reports Server (NTRS)

Hihn, J.; Lum, K.

2002-01-01

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

Addressing risks to advance mental health research.

PubMed

Iltis, Ana S; Misra, Sahana; Dunn, Laura B; Brown, Gregory K; Campbell, Amy; Earll, Sarah A; Glowinski, Anne; Hadley, Whitney B; Pies, Ronald; Dubois, James M

2013-12-01

Risk communication and management are essential to the ethical conduct of research, yet addressing risks may be time consuming for investigators and institutional review boards may reject study designs that seem too risky. This can discourage needed research, particularly in higher-risk protocols or those enrolling potentially vulnerable individuals, such as those with some level of suicidality. Improved mechanisms for addressing research risks may facilitate much needed psychiatric research. To provide mental health researchers with practical approaches to (1) identify and define various intrinsic research risks, (2) communicate these risks to others (eg, potential participants, regulatory bodies, and society), (3) manage these risks during the course of a study, and (4) justify the risks. As part of a National Institute of Mental Health-funded scientific meeting series, a public conference and a closed-session expert panel meeting were held on managing and disclosing risks in mental health clinical trials. The expert panel reviewed the literature with a focus on empirical studies and developed recommendations for best practices and further research on managing and disclosing risks in mental health clinical trials. No institutional review board-review was required because there were no human subjects. Challenges, current data, practical strategies, and topics for future research are addressed for each of 4 key areas pertaining to management and disclosure of risks in clinical trials: identifying and defining risks, communicating risks, managing risks during studies, and justifying research risks. Empirical data on risk communication, managing risks, and the benefits of research can support the ethical conduct of mental health research and may help investigators better conceptualize and confront risks and to gain institutional review board-approval.

Fuel-reduction treatments with a gyrotrac GT-25

Treesearch

Dana Mitchell

2005-01-01

Land managers in urban areas are turning to mulching equipment as a tool for managing their timberlands. Prescribed burning to reduce fire risk may not be an option, due to smoke management concerns and the level of current fuel loading.

[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.

Current treatment trends and the need for better predictive tools in the management of ductal carcinoma in situ of the breast.

PubMed

Martínez-Pérez, Carlos; Turnbull, Arran K; Ekatah, Gregory E; Arthur, Laura M; Sims, Andrew H; Thomas, Jeremy S; Dixon, J Michael

2017-04-01

Ductal carcinoma in situ (DCIS) of the breast represents a group of heterogeneous non-invasive lesions the incidence of which has risen dramatically since the advent of mammography screening. In this review we summarise current treatment trends and up-to-date results from clinical trials studying surgery and adjuvant therapy alternatives, including the recent consensus on excision margin width and its role in decision-making for post-excision radiotherapy. The main challenge in the clinical management of DCIS continues to be the tailoring of treatment to individual risk, in order to avoid the over-treatment of low-risk lesions or under-treatment of DCIS with higher risk of recurring or progressing into invasion. While studies estimate that only about 40% of DCIS would become invasive if untreated, heterogeneity and complex natural history have prevented adequate identification of these higher-risk lesions. Here we discuss attempts to develop prognostic tools for the risk stratification of DCIS lesions and their limitations. Early results of a UK-wide audit of DCIS management (the Sloane Project) have also demonstrated a lack of consistency in treatment. In this review we offer up-to-date perspectives on current treatment and prediction of DCIS, highlighting the pressing clinical need for better prognostic indices. Tools integrating both clinical and histopathological factors together with molecular biomarkers may hold potential for adequate stratification of DCIS according to risk. This could help develop standardised practices for optimal management of patients with DCIS, improving clinical outcomes while providing only the amount of therapy required for each individual patient. Copyright © 2017 Elsevier Ltd. All rights reserved.

Air quality risk management.

PubMed

Williams, Martin L

2008-01-01

Rather than attempt to provide a comprehensive account of air quality risk assessment, as might be found in a textbook or manual, this article discusses some issues that are of current importance in the United Kingdom and the rest of Europe, with special emphasis on risk assessment in the context of policy formulation, and emerging scientific knowledge. There are two pollutants of particular concern and that both pose challenges for risk assessment and policy, and they are particulate matter (PM) and ozone. The article describes some issues for health risk assessment and finally some forward-looking suggestions for future approaches to air quality management.

The Irma-sponge Program: Methodologies For Sustainable Flood Risk Management Along The Rhine and Meuse Rivers

NASA Astrophysics Data System (ADS)

Hooijer, A.; van Os, A. G.

Recent flood events and socio-economic developments have increased the awareness of the need for improved flood risk management along the Rhine and Meuse Rivers. In response to this, the IRMA-SPONGE program incorporated 13 research projects in which over 30 organisations from all 6 River Basin Countries co-operated. The pro- gram is financed partly by the European INTERREG Rhine-Meuse Activities (IRMA). The main aim of IRMA-SPONGE is defined as: "The development of methodologies and tools to assess the impact of flood risk reduction measures and of land-use and climate change scenarios. This to support the spatial planning process in establish- ing alternative strategies for an optimal realisation of the hydraulic, economical and ecological functions of the Rhine and Meuse River Basins." Further important objec- tives are to promote transboundary co-operation in flood risk management by both scientific and management organisations, and to promote public participation in flood management issues. The projects in the program are grouped in three clusters, looking at measures from different scientific angles. The results of the projects in each cluster have been evaluated to define recommendations for flood risk management; some of these outcomes call for a change to current practices, e.g.: 1. (Flood Risk and Hydrol- ogy cluster): hydrological changes due to climate change exceed those due to further land use change, and are significant enough to necessitate a change in flood risk man- agement strategies if the currently claimed protection levels are to be sustained. 2. (Flood Protection and Ecology cluster): to not only provide flood protection but also enhance the ecological quality of rivers and floodplains, new flood risk management concepts ought to integrate ecological knowledge from start to finish, with a clear perspective on the type of nature desired and the spatial and time scales considered. 3. (Flood Risk Management and Spatial Planning cluster): extreme floods can not be prevented by taking mainly upstream measures; significant and space-consuming lo- cal measures will therefore be needed in the lower Rhine and Meuse deltas. However, there is also a need for improved flood risk management upstream, which calls for better spatial planning procedures. More detailed information on the IRMA-SPONGE program can be found on our website: www.irma-sponge.org.

Sustainable improvement of animal health care by systematic quality risk management according to the HACCP concept.

PubMed

Noordhuizen, J P; Welpelo, H J

1996-12-01

This paper addresses the principles of the Hazard Analysis Critical Control Point (HACCP) concept as applied to animal health management strategy. Characteristics of the concept were analysed and compared with those of current animal health care strategies for disease risk identification and herd health management, insurance, and certification. HACCP is a hybrid strategy of quality control at both production process and product level. Animal health is considered a particular quality feature. We show that process control (expressed in terms of controlling both general and specific disease risk factors) and product control (expressed in terms of testing animals or animal products for specific disease agents) could form the basis for improving animal health. We conclude that HACCP provides ample opportunity for preventive health action and risk management at a relatively low cost in terms of labour, finance and documentation expenditure, at both the farm and sector level. Epidemiological field studies are currently needed to identify critical control points and to design HACCP procedures for livestock producers. In the long run, HACCP based animal health care can be further developed into a quality control systems approach to cover all aspects that are related, either directly or indirectly, to animal health.

[Role of the independent microbiology laboratory in supporting infection control programs in small to mid-sized hospitals].

PubMed

Yanagisawa, Hideji

2009-05-01

With the revision of the Medical Service Law in 2006 by the Japanese Ministry of Health, Labour and Welfare (MHLW), all healthcare institutions are now required to implement a healthcare risk management program including infection control program. At a national level, an infection control surveillance program (JANIS) was implemented in July 2007. Regular weekly, monthly, and yearly infection control surveillance reports from independent microbiology laboratories can make significant contributions to infection control programs in small to mid-sized hospitals; furthermore, such programs are consistent with the framework of the MHLW's objective of strengthening risk management in healthcare institutions. Against the backdrop of current efforts to improve risk management, independent laboratories can make a significant contribution. Independent laboratories must play a role beyond merely receiving and processing specimens for microbiological examination. In addition to generating results for patients, hospital epidemiological data that contribute to local infection control programs must be a value-added component of the service. A major obstacle for independent laboratories to make a significant contribution to risk management is the current reimbursement system, which makes it economically impossible for independent laboratories to support infection control programs in healthcare institutions.

PDA survey of quality risk management practices in the pharmaceutical, devices, & biotechnology industries.

PubMed

Ahmed, Ruhi; Baseman, Harold; Ferreira, Jorge; Genova, Thomas; Harclerode, William; Hartman, Jeffery; Kim, Samuel; Londeree, Nanette; Long, Michael; Miele, William; Ramjit, Timothy; Raschiatore, Marlene; Tomonto, Charles

2008-01-01

In July 2006 the Parenteral Drug Association's Risk Management Task Force for Aseptic Processes, conducted an electronic survey of PDA members to determine current industry practices regarding implementation of Quality Risk Management in their organizations. This electronic survey was open and publicly available via the PDA website and targeted professionals in our industry who are involved in initiating, implementing, or reviewing risk management programs or decisions in their organizations. One hundred twenty-nine members participated and their demographics are presented in the sidebar "Correspondents Profile". Among the major findings are: *The "Aseptic Processing/Filling" operation is the functional area identified as having the greatest need for risk assessment and quality risk management. *The most widely used methodology in industry to identify risk is Failure Mode and Effects Analysis (FMEA). This tool was most widely applied in assessing change control and for adverse event, complaint, or failure investigations. *Despite the fact that personnel training was identified as the strategy most used for controlling/minimizing risk, the largest contributors to sterility failure in operations are still "Personnel". *Most companies still rely on "Manufacturing Controls" to mitigate risk and deemed the utilization of Process Analytical Technology (PAT) least important in this aspect. *A majority of correspondents verified that they did not periodically assess their risk management programs. *A majority of the correspondents desired to see case studies or examples of risk analysis implementation (as applicable to aseptic processing) in future PDA technical reports on risk management.

Management of Cardiovascular Risk in Patients with Chronic Inflammatory Diseases: Current Evidence and Future Perspectives.

PubMed

Lindhardsen, Jesper; Kristensen, Søren Lund; Ahlehoff, Ole

2016-02-01

An increased risk of cardiovascular disease (CVD) has been observed in a range of chronic inflammatory diseases (CID), including rheumatoid arthritis (RA), psoriasis, inflammatory bowel diseases (IBD), and systemic lupus erythematosus (SLE). The increased risk of CVDs and reduced life expectancy in these conditions has stimulated considerable research and started an ongoing discussion on the need for a multidisciplinary approach and dedicated guidelines on CVD prevention in these patients. In addition, the possibility of inhibiting inflammation as a means to preventing CVD in these patients has gained considerable interest in recent years. We briefly summarize the current level of evidence of the association between CIDs and CVD and cardiovascular risk management recommendations. Perspectives of ongoing and planned trials are discussed in consideration of potential ways to improve primary and secondary CVD prevention in patients with CID.

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.

Managing overweight and obesity in adults to reduce cardiovascular disease risk.

PubMed

Ebbert, Jon O; Elrashidi, Muhamad Y; Jensen, Michael D

2014-10-01

Obesity is a leading preventable cause of death and disability worldwide. Obesity increases the risk for clinically identifiable risk factors for cardiovascular disease (CVD) as well as a host of other metabolic, sleep, and orthopedic disorders. Coordinated and systematic interventions are needed to manage obesity and reduce these risks. The Obesity 2 Expert Panel updated the previous guidelines and produced the "Guideline for the Management of Overweight and Obesity in Adults." The Panel used data from publications from years 1999 to 2011 to address five critical questions, provide evidence statements, and recommend creation of a treatment algorithm to guide decision making about clinical care. The current review discusses the evidence statements pertaining to CVD risk in the assessment and management of patients who are overweight and obese. We summarize the FDA-approved medications for the treatment of overweight and obesity and their impact on CVD risk and risk factors, as well as ongoing clinical trials which will further inform clinical practice.

An Integrated Risk Management Model for Source Water Protection Areas

PubMed Central

Chiueh, Pei-Te; Shang, Wei-Ting; Lo, Shang-Lien

2012-01-01

Watersheds are recognized as the most effective management unit for the protection of water resources. For surface water supplies that use water from upstream watersheds, evaluating threats to water quality and implementing a watershed management plan are crucial for the maintenance of drinking water safe for humans. The aim of this article is to establish a risk assessment model that provides basic information for identifying critical pollutants and areas at high risk for degraded water quality. In this study, a quantitative risk model that uses hazard quotients for each water quality parameter was combined with a qualitative risk model that uses the relative risk level of potential pollution events in order to characterize the current condition and potential risk of watersheds providing drinking water. In a case study of Taipei Source Water Area in northern Taiwan, total coliforms and total phosphorus were the top two pollutants of concern. Intensive tea-growing and recreational activities around the riparian zone may contribute the greatest pollution to the watershed. Our risk assessment tool may be enhanced by developing, recording, and updating information on pollution sources in the water supply watersheds. Moreover, management authorities could use the resultant information to create watershed risk management plans. PMID:23202770

The challenge of risk characterization: current practice and future directions.

PubMed Central

Gray, G M; Cohen, J T; Graham, J D

1993-01-01

Risk characterization is perhaps the most important part of risk assessment. As currently practiced, risk characterizations do not convey the degree of uncertainty in a risk estimate to risk managers, Congress, the press, and the public. Here, we use a framework put forth by an ad hoc study group of industry and government scientists and academics to critique the risk characterizations contained in two risks assessments of gasoline vapor. After discussing the strengths and weaknesses of each assessment's risk characterization, we detail an alternative approach that conveys estimates in the form of a probability distribution. The distributional approach can make use of all relevant scientific data and knowledge, including alternative data sets and all plausible mechanistic theories of carcinogenesis. As a result, this approach facilitates better public health decisions than current risk characterization procedures. We discuss methodological issues, as well as strengths and weaknesses of the distributional approach. PMID:8020444

Assessment and management of risk factors for the prevention of lifestyle-related disease: a cross-sectional survey of current activities, barriers and perceived training needs of primary care physiotherapists in the Republic of Ireland.

PubMed

O'Donoghue, G; Cunningham, C; Murphy, F; Woods, C; Aagaard-Hansen, J

2014-06-01

To provide a snapshot of current activities, barriers and perceived training needs for the assessment and management of behavioural risk factors in physiotherapy practice in primary care settings in the Republic of Ireland. Cross-sectional survey of primary care physiotherapists. Two hundred and twenty primary care physiotherapists were invited to participate. Each received a questionnaire, consisting of 23 questions, within five key sections. Its main focus was the risk factor management practices of physiotherapists. Descriptive statistics and frequencies were used to analyse the data. A response rate of 74% (163/220) was achieved. Level of physical activity was the most common risk factor assessed at initial and follow-up visits (78%, 127/163), followed by dietary status (55%, 90/163). Few respondents included smoking status and alcohol consumption in their assessment; however, the majority considered them as risk factors that should be addressed. The main reasons why smoking status and alcohol consumption were not assessed were lack of time, limited knowledge and expertise, not traditionally viewed as the physiotherapist's role, and patient's lack of interest in changing their unhealthy behaviour. The findings highlight an untapped potential in relation to physiotherapists addressing lifestyle-related risk factors. A number of strategies are required to improve the systematic assessment and management of these risk factors. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Current trials to reduce surgical intervention in ductal carcinoma in situ of the breast: Critical review.

PubMed

Toss, M; Miligy, I; Thompson, A M; Khout, H; Green, A R; Ellis, I O; Rakha, E A

2017-10-01

The high proportion of ductal carcinoma in situ (DCIS) presented in mammographic screening and the relatively low risk of progression to invasive disease have raised questions related to overtreatment. Following a review of current DCIS management protocols a more conservative approach has been suggested. Clinical trials have been introduced to evaluate the option of avoiding surgical intervention in a proportion of patients with DCIS defined as "low-risk" using certain clinicopathological criteria. These trials can potentially provide evidence-based models of active surveillance (with or without endocrine therapy) as a future management approach. Despite the undisputable fact of our need to address the obvious overtreatment of screen-detected DCIS, some important questions need to be considered regarding these trials including the eligibility criteria and definition of risk, the proportion of patient eligible for inclusion, and the length of time required for proper analysis of the trials' outcome in view of the long-term natural history of DCIS progression particularly the low-risk group. These factors can potentially affect the practicality and future impact of such trials. This review provides critical analysis of current DCIS management trials and highlights critical issues related to their practicality and the expected outcome. Copyright © 2017 Elsevier Ltd. All rights reserved.

Topics in Finance Part IX--Working Capital Management

ERIC Educational Resources Information Center

Laux, Judy

2012-01-01

The final topic in a series looking at financial management from a theoretical perspective, working capital management provides the focus of the current article. We investigate how three key axioms--the risk-return tradeoff, agency conflicts, and stockholder wealth maximization--relate to this activity that occupies much of the financial manager's…

Current Risk Management Practices in Psychotherapy Supervision.

PubMed

Mehrtens, Ilayna K; Crapanzano, Kathleen; Tynes, L Lee

2017-12-01

Psychotherapy competence is a core skill for psychiatry residents, and psychotherapy supervision is a time-honored approach to teaching this skill. To explore the current supervision practices of psychiatry training programs, a 24-item questionnaire was sent to all program directors of Accreditation Council for Graduate Medical Education (ACGME)-approved adult psychiatry programs. The questionnaire included items regarding adherence to recently proposed therapy supervision practices aimed at reducing potential liability risk. The results suggested that current therapy supervision practices do not include sufficient management of the potential liability involved in therapy supervision. Better protections for patients, residents, supervisors and the institutions would be possible with improved credentialing practices and better documentation of informed consent and supervision policies and procedures. © 2017 American Academy of Psychiatry and the Law.

Progress of environmental management and risk assessment of industrial chemicals in China.

PubMed

Wang, Hong; Yan, Zhen-Guang; Li, Hong; Yang, Ni-Yun; Leung, Kenneth M Y; Wang, Yi-Zhe; Yu, Ruo-Zhen; Zhang, Lai; Wang, Wan-Hua; Jiao, Cong-Ying; Liu, Zheng-Tao

2012-06-01

With China's rapid economic growth, chemical-related environmental issues have become increasingly prominent, and the environmental management of chemicals has garnered increased attention from the government. This review focuses on the current situation and the application of risk assessment in China's environmental management of industrial chemicals. The related challenges and research needs of the country are also discussed. The Chinese government promulgated regulations for the import and export of toxic chemicals in 1994. Regulations for new chemical substances came into force in 2003, and were revised in 2010 based on the concept of risk management. In order to support the implementation of new regulations, Guidance for Risk Assessment of Chemicals is under development in an attempt to provide the concepts and techniques of risk assessment. With increasing concern and financial support from Chinese government, China is embarking on the fast track of research and development in environmental management of industrial chemicals. Copyright © 2011 Elsevier Ltd. All rights reserved.

Contemporary approach to essential thrombocythemia and polycythemia vera.

PubMed

Aruch, Daniel; Mascarenhas, John

2016-03-01

Management of polycythemia vera and essential thrombocythemia requires understanding of the key concepts regarding diagnosis, risk stratification, and management. Essential thrombocythemia and polycythemia vera are among the Philadelphia chromosome negative myeloproliferative neoplasms. They are characterized by overproduction of blood cells and their complications include thrombosis, hemorrhage, and progression to myelofibrosis or acute myeloid leukemia (AML). Management of essential thrombocythemia/polycythemia vera requires recognition of the risk factors for thrombosis and hemorrhage. Risk stratification allows the clinician to make a treatment plan that may include antiplatelet therapy with aspirin alone or in combination with therapeutic phlebotomy in the case of polycythemia vera, or cytoreductive therapy for high-risk patients with either essential thrombocythemia or polycythemia vera. Hydroxyurea remains first-line therapy for high-risk patients with essential thrombocythemia/polycythemia vera, whereas second-line options include anagrelide, pegylated-IFNα-2a, and the JAK1/2 inhibitor ruxolitinib. The current evaluation of pegylated-IFNα-2a in global phase II and III studies will provide clarity to the potential long-term benefit and risks associated with this biologic in patients with essential thrombocythemia/polycythemia vera. Novel therapeutics aimed at prevention of disease progression to myelofibrosis/AML are the focus of current clinical trials. Risk stratification of patients with essential thrombocythemia/polycythemia vera by age and/or history of thrombosis provides the basis of risk adapted therapeutic intervention. Aggressive control of modifiable cardiovascular risk factors, the use of antiplatelet agents, control of the hematocrit less than 45% in polycythemia vera, and cytoreductive therapy in high-risk essential thrombocythemia/polycythemia vera patients is the focus of management. The exact role of IFN-α remains undefined and under active investigation, and the recent approval of ruxolitinib provides patients with polycythemia vera a second-line option.

Radioactive and mixed waste - risk as a basis for waste classification. Symposium proceedings No. 2

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

NONE

The management of risks from radioactive and chemical materials has been a major environmental concern in the United states for the past two or three decades. Risk management of these materials encompasses the remediation of past disposal practices as well as development of appropriate strategies and controls for current and future operations. This symposium is concerned primarily with low-level radioactive wastes and mixed wastes. Individual reports were processed separately for the Department of Energy databases.

Current Barriers to Successful Implementation of FIST Principles

DTIC Science & Technology

2013-07-01

risks will surface during development that could not have been predicted. Managing a thin budget with no schedule slack for these unknown-unknowns is...Fleischer » Keywords: Fast, Inexpensive, Simple, Tiny (FIST); Program Management ; Heuristics; Innovation; Oversight Current Barriers to Successful...Implementation of FIST Principles Capt Brandon Keller, USAF, and Lt Col J. Robert Wirthlin, USAF The Fast, Inexpensive, Simple, and Tiny (FIST

Changing the Academic Subject

ERIC Educational Resources Information Center

McWilliam, Erica

2004-01-01

The article examines the ways in which rationalities of risk currently work to produce the academic as a self-managing worker within the 'post-welfare' university as a risk-conscious organization. It explores how risk minimization as audit (individual, departmental, organizational), engages all individuals within the university in doing particular…

Gestational trophoblastic disease.

PubMed

Soper, John T

2006-07-01

This review summarizes the primary management of molar pregnancies, surveillance after evacuation, and the evaluation and management of malignant gestational trophoblastic neoplasia (GTN). Most women with gestational trophoblastic disease can be successfully managed with preservation of their normal reproductive function. It is important to manage molar pregnancies properly to minimize acute complications and identify malignant sequelae promptly. Current International Federation of Gynecology and Obstetrics (FIGO) guidelines for making the diagnosis and staging of GTN allow uniformity for reporting results of treatment. It is important to individualize treatment for women with malignant GTN based upon risk factors, using less toxic therapy for patients with low-risk disease and aggressive multiagent therapy for those with high-risk disease. Patients with malignant GTN should be managed in consultation with an individual experienced in the complex, multimodality treatment of these patients.

Managing multihazards risk in metropolitan USA

NASA Astrophysics Data System (ADS)

Aktan, A. Emin; Comfort, Louise K.; Shanis, Donald S.

2003-07-01

This proposal outlines an action plan for risk management in the Delaware Valley Metropolitan Region. This plan is consistent with the goals for strengthening homeland security announced by President Bush, and is designed to complement efforts currently under development by Pennsylvania Emergency Management Agency and Department of Health. This plan proposes the formation of a Delaware Valley Risk Management Consortium, representing the critical disciplines and organizations related to risk assessment and management. This group would have membership from academic institutions, government agencies, industry, and nonprofit organizations. This Consortium would develop a systemic scope of work with the appropriate recommendations for technology acquisition, development and integration with risk management policies and procedures. This scope of work would include the development of two related information systems for the Delaware Valley Region. The first would be a comprehensive 'health monitoring' system to assess the continuity of operations, which would use integrated remote sensing and imaging, information gathering, communication, computation, and, information processing and management over wide-area networks covering the entire metropolitan area. The second would use real-time information from the health monitoring system to support interactive communication, search and information exchange needed to coordinate action among the relevant agencies to mitigate risk, respond to hazards and manage its resources efficiently and effectively.

Risk management of hazardous substances in a circular economy.

PubMed

Bodar, Charles; Spijker, Job; Lijzen, Johannes; Waaijers-van der Loop, Susanne; Luit, Richard; Heugens, Evelyn; Janssen, Martien; Wassenaar, Pim; Traas, Theo

2018-04-15

The ambitions for a circular economy are high and unambiguous, but day-to-day experience shows that the transition still has many difficulties to overcome. One of the current hurdles is the presence of hazardous substances in waste streams that enter or re-enter into the environment or the technosphere. The key question is: do we have the appropriate risk management tools to control any risks that might arise from the re-using and recycling of materials? We present some recent cases that illustrate current practice and complexity in the risk management of newly-formed circular economy chains. We also highlight how separate legal frameworks are still disconnected from each other in these cases, and how circular economy initiatives interlink with the European REACH regulation. Furthermore, we introduce a novel scheme describing how to decide whether a(n)(additional) risk assessment is necessary with regard to the re-use of materials containing hazardous substances. Finally, we present our initial views on new concepts for the fundamental integration of sustainability and safety aspects. These concepts should be the building blocks for the near future shifts in both policy frameworks and voluntary initiatives that support a sound circular economy transition. Copyright © 2018 Elsevier Ltd. All rights reserved.

Issues that Drive Waste Management Technology Development for Space Missions

NASA Technical Reports Server (NTRS)

Fisher, John W.; Levri, Julie A.; Hogan, John A.; Wignarajah, Kanapathipillai

2005-01-01

Waste management technologies for space life support systems are currently at low development levels. Manual compaction of waste in plastic bags and overboard disposal to earth return vehicles are the primary current waste management methods. Particularly on future missions, continuance of current waste management methods would tend to expose the crew to waste hazards, forfeit recoverable resources such as water, consume valuable crew time, contaminate planetary surfaces, and risk return to Earth of extraterrestrial life. Improvement of waste management capabilities is needed for adequate management of wastes. Improvements include recovery of water and other resources, conversion of waste to states harmless to humans, long-term containment of wastes, and disposal of waste. Current NASA requirements documents on waste management are generally not highly detailed. More detailed requirements are needed to guide the development of waste management technologies that will adequately manage waste. In addition to satisfying requirements, waste management technologies must also recover resources. Recovery of resources such as water and habitat volume can reduce mission cost. This paper explores the drivers for waste management technology development including requirements and resource recovery.

Atrial Fibrillation in Hematologic Malignancies, Especially After Autologous Hematopoietic Stem Cell Transplantation: Review of Risk Factors, Current Management, and Future Directions.

PubMed

Mathur, Pankaj; Paydak, Hakan; Thanendrarajan, Sharmilan; van Rhee, Frits

2016-02-01

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with significant morbidity and mortality worldwide. In addition to well-established risk factors, cancer has been increasingly associated with the development of AF. Its increased occurrence in those with hematologic malignancies has been attributed to chemotherapeutic agents and autologous hematopoietic stem cell transplantation (AHSCT). Recently, a few studies have attempted to define the etiopathogenesis of AF in hematologic malignancies. The management of AF in these patients is challenging because of the concurrent complicating factors, such as thrombocytopenia, orthostatic hypotension, and cardiac amyloidosis. More studies are needed to define the management of AF, especially rate versus rhythm control and anticoagulation. Arrhythmias, in particular, AF, have been associated with an increased length of stay, increased intensive care unit admissions, and greater cardiovascular mortality. In the present review, we describe AF in patients with hematologic malignancies, the risk factors, especially after AHSCT, and the current management of AF. Copyright © 2016 Elsevier Inc. All rights reserved.

Transitioning to routine breast cancer risk assessment and management in primary care: what can we learn from cardiovascular disease?

PubMed

Phillips, Kelly-Anne; Steel, Emma J; Collins, Ian; Emery, Jon; Pirotta, Marie; Mann, G Bruce; Butow, Phyllis; Hopper, John L; Trainer, Alison; Moreton, Jane; Antoniou, Antonis C; Cuzick, Jack; Keogh, Louise

2016-01-01

To capitalise on advances in breast cancer prevention, all women would need to have their breast cancer risk formally assessed. With ~85% of Australians attending primary care clinics at least once a year, primary care is an opportune location for formal breast cancer risk assessment and management. This study assessed the current practice and needs of primary care clinicians regarding assessment and management of breast cancer risk. Two facilitated focus group discussions were held with 17 primary care clinicians (12 GPs and 5 practice nurses (PNs)) as part of a larger needs assessment. Primary care clinicians viewed assessment and management of cardiovascular risk as an intrinsic, expected part of their role, often triggered by practice software prompts and facilitated by use of an online tool. Conversely, assessment of breast cancer risk was not routine and was generally patient- (not clinician-) initiated, and risk management (apart from routine screening) was considered outside the primary care domain. Clinicians suggested that routine assessment and management of breast cancer risk might be achieved if it were widely endorsed as within the remit of primary care and supported by an online risk-assessment and decision aid tool that was integrated into primary care software. This study identified several key issues that would need to be addressed to facilitate the transition to routine assessment and management of breast cancer risk in primary care, based largely on the model used for cardiovascular disease.

YOUNG ADULT DATING RELATIONSHIPS AND THE MANAGEMENT OF SEXUAL RISK

PubMed Central

Manning, Wendy D.; Giordano, Peggy C.; Longmore, Monica A.; Flanigan, Christine M.

2012-01-01

Young adult involvement in sexual behavior typically occurs within a relationship context, but we know little about the ways in which specific features of romantic relationships influence sexual decision-making. Prior work on sexual risk taking focuses attention on health issues rather than relationship dynamics. We draw on data from the Toledo Adolescent Relationships Study (TARS) (n = 475) to examine the association between qualities and dynamics of current/most recent romantic relationships such as communication and emotional processes, conflict, demographic asymmetries, and duration and the management of sexual risk. We conceptualize ‘risk management’ as encompassing multiple domains, including (1) questioning the partner about previous sexual behaviors/risks, (2) using condoms consistently, and (3) maintaining sexual exclusivity within the relationship. We identify distinct patterns of risk management among dating young adults and find that specific qualities and dynamics of these relationships are linked to variations in risk management. Results from this paper suggest the need to consider relational dynamics in efforts to target and influence young adult sexual risk-taking and reduce STIs, including HIV. PMID:23805015

Management of Early Stage, High-Risk Endometrial Carcinoma: Preoperative and Surgical Considerations

PubMed Central

Pettigrew, Gaetan

2013-01-01

Endometrial cancer is the most common gynecologic malignancy in the developed world. Most cases are diagnosed at an early stage and have low-grade histology, portending an overall excellent prognosis. There exists a subgroup of patients with early, high-risk disease, whose management remains controversial, as current data is clouded by inclusion of early stage tumors with different high-risk features for recurrence, unstandardized protocols for surgical staging, and an evolving staging system by which we are grouping these patients. Here, we present preoperative and intraoperative considerations that should be taken into account when planning surgical management for this population of patients. PMID:23878545

An expanded conceptual framework for solution-focused management of chemical pollution in European waters.

PubMed

Munthe, John; Brorström-Lundén, Eva; Rahmberg, Magnus; Posthuma, Leo; Altenburger, Rolf; Brack, Werner; Bunke, Dirk; Engelen, Guy; Gawlik, Bernd Manfred; van Gils, Jos; Herráez, David López; Rydberg, Tomas; Slobodnik, Jaroslav; van Wezel, Annemarie

2017-01-01

This paper describes a conceptual framework for solutions-focused management of chemical contaminants built on novel and systematic approaches for identifying, quantifying and reducing risks of these substances. The conceptual framework was developed in interaction with stakeholders representing relevant authorities and organisations responsible for managing environmental quality of water bodies. Stakeholder needs were compiled via a survey and dialogue. The content of the conceptual framework was thereafter developed with inputs from relevant scientific disciplines. The conceptual framework consists of four access points: Chemicals, Environment, Abatement and Society, representing different aspects and approaches to engaging in the issue of chemical contamination of surface waters. It widens the scope for assessment and management of chemicals in comparison to a traditional (mostly) perchemical risk assessment approaches by including abatement- and societal approaches as optional solutions. The solution-focused approach implies an identification of abatement- and policy options upfront in the risk assessment process. The conceptual framework was designed for use in current and future chemical pollution assessments for the aquatic environment, including the specific challenges encountered in prioritising individual chemicals and mixtures, and is applicable for the development of approaches for safe chemical management in a broader sense. The four access points of the conceptual framework are interlinked by four key topics representing the main scientific challenges that need to be addressed, i.e.: identifying and prioritising hazardous chemicals at different scales; selecting relevant and efficient abatement options; providing regulatory support for chemicals management; predicting and prioritising future chemical risks. The conceptual framework aligns current challenges in the safe production and use of chemicals. The current state of knowledge and implementation of these challenges is described. The use of the conceptual framework, and addressing the challenges, is intended to support: (1) forwarding sustainable use of chemicals, (2) identification of pollutants of priority concern for cost-effective management, (3) the selection of optimal abatement options and (4) the development and use of optimised legal and policy instruments.

Management of lower-risk myelodysplastic syndromes without del5q: current approach and future trends.

PubMed

Stahl, Maximilian; Zeidan, Amer M

2017-04-01

Myelodysplastic syndromes (MDS) are characterized by progressive bone marrow failure manifesting as blood cytopenia and a variable risk of progression into acute myeloid leukemia. MDS is heterogeneous in biology and clinical behavior. MDS are generally divided into lower-risk (LR) and higher-risk (HR) MDS. Goals of care in HR-MDS focus on changing the natural history of the disease, whereas in LR-MDS symptom control and quality of life are the main goals. Areas covered: We review the epidemiology, tools of risk assessment, and the available therapeutic modalities for LR-MDS. We discuss the use of erythropoiesis stimulating agents (ESAs), immunosuppressive therapy (IST), lenalidomide and the hypomethylating agents (HMAs). We also discuss the predictors of response, combination treatment modalities, and management of iron overload. Lastly, we overview the most promising investigational agents for LR-MDS. Expert commentary: It remains unclear how to best incorporate a wealth of new genetic and epigenetic prognostic markers into risk assessment tools especially for LR-MDS patients. Only a subset of patients respond to current treatment modalities and most responders eventually lose their response. Once standard therapeutic options fail, management becomes more challenging. Combination-based approaches have been largely unsuccessful. Among the most promising investigational are the TPO agonists, TGF- β pathway inhibitors, telomerase inhibitors, and the splicing modifiers.

Application of Risk Assessment Tools in the Continuous Risk Management (CRM) Process

NASA Technical Reports Server (NTRS)

Ray, Paul S.

2002-01-01

Marshall Space Flight Center (MSFC) of the National Aeronautics and Space Administration (NASA) is currently implementing the Continuous Risk Management (CRM) Program developed by the Carnegie Mellon University and recommended by NASA as the Risk Management (RM) implementation approach. The four most frequently used risk assessment tools in the center are: (a) Failure Modes and Effects Analysis (FMEA), Hazard Analysis (HA), Fault Tree Analysis (FTA), and Probabilistic Risk Analysis (PRA). There are some guidelines for selecting the type of risk assessment tools during the project formulation phase of a project, but there is not enough guidance as to how to apply these tools in the Continuous Risk Management process (CRM). But the ways the safety and risk assessment tools are used make a significant difference in the effectiveness in the risk management function. Decisions regarding, what events are to be included in the analysis, to what level of details should the analysis be continued, make significant difference in the effectiveness of risk management program. Tools of risk analysis also depends on the phase of a project e.g. at the initial phase of a project, when not much data are available on hardware, standard FMEA cannot be applied; instead a functional FMEA may be appropriate. This study attempted to provide some directives to alleviate the difficulty in applying FTA, PRA, and FMEA in the CRM process. Hazard Analysis was not included in the scope of the study due to the short duration of the summer research project.

Decision support: Vulnerability, conservation, and restoration (Chapter 8)

Treesearch

Megan M. Friggens; Jeremiah R. Pinto; R. Kasten Dumroese; Nancy L. Shaw

2012-01-01

Current predictive tools, management options, restoration paradigms, and conservation programs are insufficient to meet the challenges of climate change in western North America. Scientific and management capabilities and resources will be sapped trying to identify risks to genetic resources and ecosystems and determine new approaches for mitigating and managing...

Development of risk-based air quality management strategies under impacts of climate change.

PubMed

Liao, Kuo-Jen; Amar, Praveen; Tagaris, Efthimios; Russell, Armistead G

2012-05-01

Climate change is forecast to adversely affect air quality through perturbations in meteorological conditions, photochemical reactions, and precursor emissions. To protect the environment and human health from air pollution, there is an increasing recognition of the necessity of developing effective air quality management strategies under the impacts of climate change. This paper presents a framework for developing risk-based air quality management strategies that can help policy makers improve their decision-making processes in response to current and future climate change about 30-50 years from now. Development of air quality management strategies under the impacts of climate change is fundamentally a risk assessment and risk management process involving four steps: (1) assessment of the impacts of climate change and associated uncertainties; (2) determination of air quality targets; (3) selections of potential air quality management options; and (4) identification of preferred air quality management strategies that minimize control costs, maximize benefits, or limit the adverse effects of climate change on air quality when considering the scarcity of resources. The main challenge relates to the level of uncertainties associated with climate change forecasts and advancements in future control measures, since they will significantly affect the risk assessment results and development of effective air quality management plans. The concept presented in this paper can help decision makers make appropriate responses to climate change, since it provides an integrated approach for climate risk assessment and management when developing air quality management strategies. Development of climate-responsive air quality management strategies is fundamentally a risk assessment and risk management process. The risk assessment process includes quantification of climate change impacts on air quality and associated uncertainties. Risk management for air quality under the impacts of climate change includes determination of air quality targets, selections of potential management options, and identification of effective air quality management strategies through decision-making models. The risk-based decision-making framework can also be applied to develop climate-responsive management strategies for the other environmental dimensions and assess costs and benefits of future environmental management policies.

Implementing the EU Floods Directive (2007/60/EC) in Austria: Flood Risk Management Plans

NASA Astrophysics Data System (ADS)

Neuhold, Clemens

2013-04-01

he Directive 2007/60/EC of the European Parliament and of the Council of 23 October 2007 on the assessment and management of flood risks (EFD) aims at the reduction of the adverse consequences for human health, the environment, cultural heritage and economic activity associated with floods in the Community. This task is to be achieved based on three process steps (1) preliminary flood risk assessment (finalised by the end of 2011), (2) flood hazard maps and flood risk maps (due 2013) and (3) flood risk management plans (due 2015). Currently, an interdisciplinary national working group is defining the methodological framework for flood risk management plans in Austria supported by a constant exchange with international bodies and experts. Referring to the EFD the components of the flood risk management plan are (excerpt): 1. conclusions of the preliminary flood risk assessment 2. flood hazard maps and flood risk maps and the conclusions that can be drawn from those maps 3. a description of the appropriate objectives of flood risk management 4. a summary of measures and their prioritisation aiming to achieve the appropriate objectives of flood risk management The poster refers to some of the major challenges in this process, such as the legal provisions, coordination of administrative units, definition of public relations, etc. The implementation of the EFD requires the harmonisation of legal instruments of various disciplines (e.g. water management, spatial planning, civil protection) enabling a coordinated - and ideally binding - practice of flood risk management. This process is highly influenced by the administrative organisation in Austria - federal, provincial and municipality level. The Austrian approach meets this organisational framework by structuring the development of the flood risk management plan into 3 time-steps: (a) federal blueprint, (b) provincial editing and (c) federal finishing as well as reporting to the European Commission. Each time-step addresses different administrative levels and spatial scales accompanied by the active involvement of interested parties.

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.

. Ecological conceptual models: a framework and case study on ecosystem management for South Florida sustainability

USGS Publications Warehouse

Gentile, J.H.; Harwell, M.A.; Cropper, W.; Harwell, C. C.; DeAngelis, Donald L.; Davis, S.; Ogden, J.C.; Lirman, D.

2001-01-01

The Everglades and South Florida ecosystems are the focus of national and international attention because of their current degraded and threatened state. Ecological risk assessment, sustainability and ecosystem and adaptive management principles and processes are being used nationally as a decision and policy framework for a variety of types of ecological assessments. The intent of this study is to demonstrate the application of these paradigms and principles at a regional scale. The effects-directed assessment approach used in this study consists of a retrospective, eco-epidemiological phase to determine the causes for the current conditions and a prospective predictive risk-based assessment using scenario analysis to evaluate future options. Embedded in these assessment phases is a process that begins with the identification of goals and societal preferences which are used to develop an integrated suite of risk-based and policy relevant conceptual models. Conceptual models are used to illustrate the linkages among management (societal) actions, environmental stressors, and societal/ecological effects, and provide the basis for developing and testing causal hypotheses. These models, developed for a variety of landscape units and their drivers, stressors, and endpoints, are used to formulate hypotheses to explain the current conditions. They are also used as the basis for structuring management scenarios and analyses to project the temporal and spatial magnitude of risk reduction and system recovery. Within the context of recovery, the conceptual models are used in the initial development of performance criteria for those stressors that are determined to be most important in shaping the landscape, and to guide the use of numerical models used to develop quantitative performance criteria in the scenario analysis. The results will be discussed within an ecosystem and adaptive management framework that provides the foundation for decision making.

Ecological conceptual models: a framework and case study on ecosystem management for South Florida sustainability.

PubMed

Gentile, J H; Harwell, M A; Cropper, W; Harwell, C C; DeAngelis, D; Davis, S; Ogden, J C; Lirman, D

2001-07-02

The Everglades and South Florida ecosystems are the focus of national and international attention because of their current degraded and threatened state. Ecological risk assessment, sustainability, and ecosystem and adaptive management principles and processes are being used nationally as a decision and policy framework for a variety of types of ecological assessments. The intent of this study is to demonstrate the application of these paradigms and principles at a regional scale. The effects-directed assessment approach used in this study consists of a retrospective, eco-epidemiological phase to determine the causes for the current conditions and a prospective predictive risk-based assessment using scenario analysis to evaluate future options. Embedded in these assessment phases is a process that begins with the identification of goals and societal preferences which are used to develop an integrated suite of risk-based and policy relevant conceptual models. Conceptual models are used to illustrate the linkages among management (societal) actions, environmental stressors, and societal/ecological effects, and provide the basis for developing and testing causal hypotheses. These models, developed for a variety of landscape units and their drivers, stressors, and endpoints, are used to formulate hypotheses to explain the current conditions. They are also used as the basis for structuring management scenarios and analyses to project the temporal and spatial magnitude of risk reduction and system recovery. Within the context of recovery, the conceptual models are used in the initial development of performance criteria for those stressors that are determined to be most important in shaping the landscape, and to guide the use of numerical models used to develop quantitative performance criteria in the scenario analysis. The results will be discussed within an ecosystem and adaptive management framework that provides the foundation for decision making.

Implementation of Risk Management in NASA's CEV Project- Ensuring Mission Success

NASA Astrophysics Data System (ADS)

Perera, Jeevan; Holsomback, Jerry D.

2005-12-01

Most project managers know that Risk Management (RM) is essential to good project management. At NASA, standards and procedures to manage risk through a tiered approach have been developed - from the global agency-wide requirements down to a program or project's implementation. The basic methodology for NASA's risk management strategy includes processes to identify, analyze, plan, track, control, communicate and document risks. The identification, characterization, mitigation plan, and mitigation responsibilities associated with specific risks are documented to help communicate, manage, and effectuate appropriate closure. This approach helps to ensure more consistent documentation and assessment and provides a means of archiving lessons learned for future identification or mitigation activities.A new risk database and management tool was developed by NASA in 2002 and since has been used successfully to communicate, document and manage a number of diverse risks for the International Space Station, Space Shuttle, and several other NASA projects and programs including at the Johnson Space Center. Organizations use this database application to effectively manage and track each risk and gain insight into impacts from other organization's viewpoint to develop integrated solutions. Schedule, cost, technical and safety issues are tracked in detail through this system.Risks are tagged within the system to ensure proper review, coordination and management at the necessary management level. The database is intended as a day-to- day tool for organizations to manage their risks and elevate those issues that need coordination from above. Each risk is assigned to a managing organization and a specific risk owner who generates mitigation plans as appropriate. In essence, the risk owner is responsible for shepherding the risk through closure. The individual that identifies a new risk does not necessarily get assigned as the risk owner. Whoever is in the best position to effectuate comprehensive closure is assigned as the risk owner. Each mitigation plan includes the specific tasks that will be conducted to either decrease the likelihood of the risk occurring and/or lessen the severity of the consequences if they do occur. As each mitigation task is completed, the responsible managing organization records the completion of the task in the risk database and then re-scores the risk considering the task's results. By keeping scores updated, a managing organization's current top risks and risk posture can be readily identified including the status of any risk in the system.A number of metrics measure risk process trends from data contained in the database. This allows for trend analysis to further identify improvements to the process and assist in the management of all risks. The metrics will also scrutinize both the effectiveness and compliance of risk management requirements.The risk database is an evolving tool and will be continuously improved with capabilities requested by the NASA project community. This paper presents the basic foundations of risk management, the elements necessary for effective risk management, and the capabilities of this new risk database and how it is implemented to support NASA's risk management needs.

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

Van Aalst, M.

Climate change is already taking place, and further changes are inevitable. Developing countries, and particularly the poorest people in these countries, are most at risk. The impacts result not only from gradual changes in temperature and sea level but also, in particular, from increased climate variability and extremes, including more intense floods, droughts, and storms. These changes are already having major impacts on the economic performance of developing countries and on the lives and livelihoods of millions of poor people around the world. Climate change thus directly affects the World Bank Group's mission of eradicating poverty. It also puts atmore » risk many projects in a wide range of sectors, including infrastructure, agriculture, human health, water resources, and environment. The risks include physical threats to the investments, potential underperformance, and the possibility that projects will indirectly contribute to rising vulnerability by, for example, triggering investment and settlement in high-risk areas. The way to address these concerns is not to separate climate change adaptation from other priorities but to integrate comprehensive climate risk management into development planning, programs, and projects. While there is a great need to heighten awareness of climate risk in Bank work, a large body of experience on climate risk management is already available, in analytical work, in country dialogues, and in a growing number of investment projects. This operational experience highlights the general ingredients for successful integration of climate risk management into the mainstream development agenda: getting the right sectoral departments and senior policy makers involved; incorporating risk management into economic planning; engaging a wide range of nongovernmental actors (businesses, nongovernmental organizations, communities, and so on); giving attention to regulatory issues; and choosing strategies that will pay off immediately under current climate conditions. There are several ways in which the World Bank Group can continue helping its clients better manage climate risks to poverty reduction and sustainable development: Integrating climate risk management into the project cycle, by adopting early risk identification (for instance by applying a quick and simple risk-screening tool) and following up throughout the design process if necessary. Integrating climate risk management into country and sector dialogues, especially in countries and sectors that are particularly vulnerable. Enhancing internal support for and coordination of climate risk management by, for example, expanding analytical work and capacity for cross-support by the Global Climate Change Team and the Hazard Management Unit of the World Bank and by actively developing climate risk management activities within regional departments. Supporting the establishment of proper financing mechanisms for adaptation, using, for example, the Investment Framework for Clean Energy and Development. New funding mechanisms created under the United Nations Framework Convention on Climate Change (UNFCCC) and being made operational by the Global Environment Facility (GEF), as well as the Kyoto Protocol, should be used to leverage maximum adaptation results within the Bank's broad range of development activities and investments. By enhancing climate risk management, the World Bank Group will be able to address the growing risks from climate change and, at the same time, make current development investments more resilient to climate variability and extreme weather events. In that way, climate risk management will not only guard the Bank's investments in a changing climate but will also improve the impact of development efforts right now.« less

Online professional networks for physicians: risk management.

PubMed

Hyman, Jon L; Luks, Howard J; Sechrest, Randale

2012-05-01

The rapidly developing array of online physician-only communities represents a potential extraordinary advance in the availability of educational and informational resources to physicians. These online communities provide physicians with a new range of controls over the information they process, but use of this social media technology carries some risk. The purpose of this review was to help physicians manage the risks of online professional networking and discuss the potential benefits that may come with such networks. This article explores the risks and benefits of physicians engaging in online professional networking with peers and provides suggestions on risk management. Through an Internet search and literature review, we scrutinized available case law, federal regulatory code, and guidelines of conduct from professional organizations and consultants. We reviewed the OrthoMind.com site as a case example because it is currently the only online social network exclusively for orthopaedic surgeons. Existing case law suggests potential liability for orthopaedic surgeons who engage with patients on openly accessible social network platforms. Current society guidelines in both the United States and Britain provide sensible rules that may mitigate such risks. However, the overall lack of a strong body of legal opinions, government regulations as well as practical experience for most surgeons limit the suitability of such platforms. Closed platforms that are restricted to validated orthopaedic surgeons may limit these downside risks and hence allow surgeons to collaborate with one another both as clinicians and practice owners. Educating surgeons about the pros and cons of participating in these networking platforms is helping them more astutely manage risks and optimize benefits. This evolving online environment of professional interaction is one of few precedents, but the application of risk management strategies that physicians use in daily practice carries over into the online community. This participation should foster ongoing dialogue as new guidelines emerge. This will allow today's orthopaedic surgeon to feel more comfortable with online professional networks and better understand how to make an informed decision regarding their proper use.

Failures in risk assessment and risk management for cosmetic preservatives in Europe and the impact on public health.

PubMed

Schwensen, Jakob F; White, Ian R; Thyssen, Jacob P; Menné, Torkil; Johansen, Jeanne D

2015-09-01

In view of the current and unprecedented increase in contact allergy to methylisothiazolinone (MI), we characterized and evaluated two recent epidemics of contact allergy to preservatives used in cosmetic products to address failures in risk assessment and risk management. To evaluate temporal trends of preservative contact allergy. The study population included consecutive patch tested eczema patients seen at a university hospital between 1985 and 2013. A total of 23 138 patients were investigated for a contact allergy. The overall prevalence of contact allergy to at least one preservative increased significantly over the study period, from 6.7% in 1985 to 11.8% in 2013 (p < 0.001). Importantly, the preservatives methyldibromo glutaronitrile and MI rapidly resulted in high sensitization prevalence rates, which reached epidemic proportions. Although the proportion of patients with current clinical disease attributable to methyldibromo glutaronitrile contact allergy decreased significantly following the ban on its use in cosmetic products (p < 0.001), the sudden and high proportion of current sensitization to MI requires immediate attention (p < 0.001). The introduction of new preservatives in Europe with inadequate pre-market risk assessment has rapidly increased the overall burden of cutaneous disease caused by preservatives. We suggest that the cosmetic industry has a responsibility to react faster and replace troublesome preservatives when a preservative contact allergy epidemic is recognized, but the European Commission has the ultimate responsibility for failures in risk management after new, major sensitizing preservatives are introduced onto the market. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Prevalence, Diagnosis and Management of Pancreatic Cystic Neoplasms: Current Status and Future Directions

PubMed Central

Farrell, James J.

2015-01-01

Cystic neoplasms of the pancreas are found with increasing prevalence, especially in elderly asymptomatic individuals. Although the overall risk of malignancy is very low, the presence of these pancreatic cysts is associated with a large degree of anxiety and further medical investigation due to concerns about malignancy. This review discusses the different cystic neoplasms of the pancreas and reports diagnostic strategies based on clinical features and imaging data. Surgical and nonsurgical management of the most common cystic neoplasms, based on the recently revised Sendai guidelines, is also discussed, with special reference to intraductal papillary mucinous neoplasm (IPMN; particularly the branch duct variant), which is the lesion most frequently identified incidentally. IPMN pathology, its risk for development into pancreatic ductal adenocarcinoma, the pros and cons of current guidelines for management, and the potential role of endoscopic ultrasound in determining cancer risk are discussed. Finally, surgical treatment, strategies for surveillance of pancreatic cysts, and possible future directions are discussed. PMID:26343068

Intracranial aneurysms: Review of current science and management.

PubMed

Toth, Gabor; Cerejo, Russell

2018-06-01

Unruptured intracranial aneurysms often have a relatively benign clinical course. Frequently, they are found incidentally during workup for an underlying, possibly related or unrelated, symptom or condition. Overall, brain aneurysms are considered to have a relatively low annual risk of rupture. However, should it occur, aneurysmal subarachnoid hemorrhage can lead to significant morbidity and mortality. Our understanding of the natural history and treatment outcomes of cerebral aneurysms has significantly increased over the last few decades, but choosing the optimal management for each patient requires the careful consideration of numerous medical, clinical and anatomic factors. The purpose of this review is to help physicians and caregivers, who may participate in the diagnosis, counseling and triage of patients with brain aneurysms, understand the basic elements of decision making. We discuss natural history, risk factors, screening, presentation, diagnosis, and their implications on aneurysm management and long-term follow-up. We also provide an overview of the risks and benefits of currently available treatment options.

Assessing the assessments: Pharmaceuticals in the environment

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

Enick, O.V.; Moore, M.M.

2007-11-15

The relatively new issue of pharmaceutical contamination of the environment offers the opportunity to explore the application of values to the construction, communication and management of risk. The still-developing regulatory policies regarding environmental contamination with pharmaceuticals provide fertile ground for the introduction of values into the definition and management of risk. In this report, we summarize the current knowledge regarding pharmaceutical contamination of the environment and discuss specific attributes of pharmaceuticals that require special consideration. We then present an analysis showing that if values are incorporated into assessing, characterizing and managing risk, the results of risk assessments will more accuratelymore » reflect the needs of various stakeholders. Originating from an acknowledgement of the inherent uncertainty and value-laden nature of risk assessment, the precautionary principle (and later, the multi-criteria, integrated risk assessment), provides a direction for further research and policy development.« less

12 CFR 217.122 - Qualification requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... related processes; (ii) Have and document a process (which must capture business environment and internal... current business activities, risk profile, technological processes, and risk management processes; and (ii... assessment systems. (D) Business environment and internal control factors. The Board-regulated institution...

12 CFR 3.122 - Qualification requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... related processes; (ii) Have and document a process (which must capture business environment and internal... association's current business activities, risk profile, technological processes, and risk management...) Business environment and internal control factors. The national bank or Federal savings association must...

12 CFR 324.122 - Qualification requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... related processes; (ii) Have and document a process (which must capture business environment and internal... current business activities, risk profile, technological processes, and risk management processes; and (ii... assessment systems. (D) Business environment and internal control factors. The FDIC-supervised institution...

Radiation hazards in scoliosis management

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

Drummond, D.; Ranallo, F.; Lonstein, J.

1983-10-01

Safe radiography in scoliosis management is based on a sound knowledge of 1) the radiographic imaging process, 2) the degree of risk to the patient from radiation exposure, and 3) the radiographic requirements to both evaluate and follow patients with spine deformity. This paper is a current review of the subject and work done at the authors' centers. It includes recommendations for reducing the radiation risk while maintaining necessary diagnostic information.

Update LADOTD policy on pile driving vibration management.

DOT National Transportation Integrated Search

2012-02-01

The main objective of this project was to update the current Louisiana Department of Transportation and Development (LADOTD) policy on pile driving vibration risk management with a focus on how to determine an appropriate vibration monitoring area. T...

Science in the city: Urban trees, forests, and people

Treesearch

Kathleen L. Wolf

2016-01-01

The article, intended for professional and manager audiences, is an overview of current research in urban forestry. Topics include tree science, forest risks, forest management and assessment, ecosystem services, and urban socio-ecological systems (including governance and stewardship).

Worksite-based cardiovascular risk screening and management: a feasibility study.

PubMed

Padwal, Raj; Rashead, Mohammad; Snider, Jonathan; Morrin, Louise; Lehman, Agnes; Campbell, Norm Rc

2017-01-01

Established cardiovascular risk factors are highly prevalent and contribute substantially to cardiovascular morbidity and mortality because they remain uncontrolled in many Canadians. Worksite-based cardiovascular risk factor screening and management represent a largely untapped strategy for optimizing risk factor control. In a 2-phase collaborative demonstration project between Alberta Health Services (AHS) and the Alberta Newsprint Company (ANC), ANC employees were offered cardiovascular risk factor screening and management. Screening was performed at the worksite by AHS nurses, who collected baseline history, performed automated blood pressure measurement and point-of-care testing for lipids and A1c, and calculated 10-year Framingham risk. Employees with a Framingham risk score of ≥10% and uncontrolled blood pressure, dyslipidemia, or smoking were offered 6 months of pharmacist case management to optimize their risk factor control. In total, 87 of 190 (46%) employees volunteered to undergo cardiovascular risk factor screening. Mean age was 44.5±11.9 years, 73 (83.9%) were male, 14 (16.1%) had hypertension, 4 (4.6%) had diabetes, 12 (13.8%) were current smokers, and 9 (10%) had dyslipidemia. Of 36 employees with an estimated Framingham risk score of ≥10%, 21 (58%) agreed to receive case management and 15 (42%) attended baseline and 6-month follow-up case management visits. Statistically significant reductions in left arm systolic blood pressure (-8.0±12.4 mmHg; p =0.03) and triglyceride levels (-0.8±1.4 mmol/L; p =0.04) occurred following case management. These findings demonstrate the feasibility and usefulness of collaborative, worksite-based cardiovascular risk factor screening and management. Expansion of this type of partnership in a cost-effective manner is warranted.

Impact of age on cardiovascular risk: implications for cardiovascular disease management.

PubMed

Tuomilehto, Jaakko

2004-05-01

Cardiovascular disease (CVD) represents a major global healthcare problem. The prevalence of this condition increases with age. As many countries around the world are experiencing an increase in the proportion of elderly people in the population, this raises serious issues for cardiac and cerebrovascular disease prevention and management. A wealth of data has established smoking, dyslipidemia, hypertension and type 2 diabetes as major risk factors for cardiac and cerebrovascular events. This article reviews the evidence that links these metabolic risk factors with an increased risk of complications, and assesses the data concerning how risk changes with age. This review also focuses on how these conditions can be optimally managed and whether treatment outcomes are affected by age. The current status of research is assessed and issues which remain to be resolved are highlighted.

Demand management: enabling patients to use medical care appropriately.

PubMed

Vickery, D M; Lynch, W D

1995-05-01

A rationale is presented for considering demand management as well as supply management (managed care) in the current debate on health care reform. Demand management is the support of individuals so that they may make rational health and medical decisions based on a consideration of benefits and risks. The concept of demand for medical services is examined within a theoretical framework of four components: morbidity, perceived need, patient preference, and nonhealth motives. Two components, perceived need and patient preference, are suggested to offer considerable potential for making utilization more appropriate and reducing costs. Current demand services and potential hazards related to their continued expansion are discussed.

A review on current status of municipal solid waste management in India.

PubMed

Gupta, Neha; Yadav, Krishna Kumar; Kumar, Vinit

2015-11-01

Municipal solid waste management is a major environmental issue in India. Due to rapid increase in urbanization, industrialization and population, the generation rate of municipal solid waste in Indian cities and towns is also increased. Mismanagement of municipal solid waste can cause adverse environmental impacts, public health risk and other socio-economic problem. This paper presents an overview of current status of solid waste management in India which can help the competent authorities responsible for municipal solid waste management and researchers to prepare more efficient plans. Copyright © 2015. Published by Elsevier B.V.

Risk Analysis Related to Quality Management Principles

NASA Astrophysics Data System (ADS)

Vykydal, David; Halfarová, Petra; Nenadál, Jaroslav; Plura, Jiří; Hekelová, Edita

2012-12-01

Efficient and effective implementation of quality management principles asks for a responsible approach from top managers' perspectives. A study of the current state of affairs in Czech organizations discovers a lot of shortcomings in this field that can be changed to vary managerial risks. The article identifies and analyses some of them and gives short guidance for appropriate treatment. Text of the article reflects the authors' experience as well as knowledge obtained from the systematic analysis of industrial companies' environments.

GAR Global Risk Assessment

NASA Astrophysics Data System (ADS)

Maskrey, Andrew; Safaie, Sahar

2015-04-01

Disaster risk management strategies, policies and actions need to be based on evidence of current disaster loss and risk patterns, past trends and future projections, and underlying risk factors. Faced with competing demands for resources, at any level it is only possible to priorities a range of disaster risk management strategies and investments with adequate understanding of realised losses, current and future risk levels and impacts on economic growth and social wellbeing as well as cost and impact of the strategy. The mapping and understanding of the global risk landscape has been greatly enhanced by the latest iteration of the GAR Global Risk Assessment and the objective of this submission is to present the GAR global risk assessment which contributed to Global Assessment Report (GAR) 2015. This initiative which has been led by UNISDR, was conducted by a consortium of technical institutions from around the world and has covered earthquake, cyclone, riverine flood, and tsunami probabilistic risk for all countries of the world. In addition, the risks associated with volcanic ash in the Asia-Pacific region, drought in various countries in sub-Saharan Africa and climate change in a number of countries have been calculated. The presentation will share thee results as well as the experience including the challenges faced in technical elements as well as the process and recommendations for the future of such endeavour.

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.

Synthetic biology R&D risks: Social-institutional contexts matter!

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

Wolfe, Amy K.; Bjornstad, David J.; Shumpert, Barry L.

Social and institutional analyses currently are missing from considerations of synthetic biology R&D-related biosafety, which instead have bioethics, governance, or technical orientations. Social and institutional context shapes standard practice. Here, analyzing context helps identify circumstances that create, amplify, or diminish risk, thereby revealing new opportunities for avoiding or managing those risks.

Synthetic biology R&D risks: Social-institutional contexts matter!

DOE PAGES

Wolfe, Amy K.; Bjornstad, David J.; Shumpert, Barry L.; ...

2016-02-15

Social and institutional analyses currently are missing from considerations of synthetic biology R&D-related biosafety, which instead have bioethics, governance, or technical orientations. Social and institutional context shapes standard practice. Here, analyzing context helps identify circumstances that create, amplify, or diminish risk, thereby revealing new opportunities for avoiding or managing those risks.

78 FR 73577 - Self-Regulatory Organizations; BATS Exchange, Inc.; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-06

...)(ii). Overview Currently, the Exchange's Risk Monitor Mechanism operates by the System maintaining a... Makers and other Users with greater control and flexibility with respect to managing risk and the manner...'', in order to modify the risk monitoring functionality offered to all Users \\5\\ of the BATS equity...

Heart failure disease management programs: a cost-effectiveness analysis.

PubMed

Chan, David C; Heidenreich, Paul A; Weinstein, Milton C; Fonarow, Gregg C

2008-02-01

Heart failure (HF) disease management programs have shown impressive reductions in hospitalizations and mortality, but in studies limited to short time frames and high-risk patient populations. Current guidelines thus only recommend disease management targeted to high-risk patients with HF. This study applied a new technique to infer the degree to which clinical trials have targeted patients by risk based on observed rates of hospitalization and death. A Markov model was used to assess the incremental life expectancy and cost of providing disease management for high-risk to low-risk patients. Sensitivity analyses of various long-term scenarios and of reduced effectiveness in low-risk patients were also considered. The incremental cost-effectiveness ratio of extending coverage to all patients was $9700 per life-year gained in the base case. In aggregate, universal coverage almost quadrupled life-years saved as compared to coverage of only the highest quintile of risk. A worst case analysis with simultaneous conservative assumptions yielded an incremental cost-effectiveness ratio of $110,000 per life-year gained. In a probabilistic sensitivity analysis, 99.74% of possible incremental cost-effectiveness ratios were <$50,000 per life-year gained. Heart failure disease management programs are likely cost-effective in the long-term along the whole spectrum of patient risk. Health gains could be extended by enrolling a broader group of patients with HF in disease management.

Use of risk stratification to guide ambulatory management of neutropenic fever. Australian Consensus Guidelines 2011 Steering Committee.

PubMed

Worth, L J; Lingaratnam, S; Taylor, A; Hayward, A M; Morrissey, S; Cooney, J; Bastick, P A; Eek, R W; Wei, A; Thursky, K A

2011-01-01

Utilization of risk-stratification tools in the setting of neutropenic fever is currently limited by inadequate knowledge and lack of awareness. Within this context, the approach to management of low-risk patients with neutropenic fever is inconsistent with the available evidence across many Australian treating centres. These clinical guidelines define and clarify an accepted standard of care for this patient group given the current evidence base. The Multinational Association for Supportive Care in Cancer risk index is presented as the preferred risk assessment tool for determining patient risk. Suitability of ambulatory care within specific patient populations is discussed, with defined eligibility criteria provided to guide clinical decision-making. Detailed recommendations for implementing appropriate ambulatory strategies, such as early discharge and outpatient antibiotic therapy, are also provided. Due consideration is given to infrastructural requirements and other supportive measures at a resourcing and operational level. An analysis of the relevant health economics is also presented. © 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.

Quality management in European screening laboratories in blood establishments: A view of current approaches and trends.

PubMed

Pereira, Paulo; Westgard, James O; Encarnação, Pedro; Seghatchian, Jerard; de Sousa, Gracinda

2015-04-01

The screening laboratory has a critical role in the post-transfusion safety. The success of its targets and efficiency depends on the management system used. Even though the European Union directive 2002/98/EC requires a quality management system in blood establishments, its requirements for screening laboratories are generic. Complementary approaches are needed to implement a quality management system focused on screening laboratories. This article briefly discusses the current good manufacturing practices and good laboratory practices, as well as the trends in quality management system standards. ISO 9001 is widely accepted in some European Union blood establishments as the quality management standard, however this is not synonymous of its successful application. The ISO "risk-based thinking" is interrelated with the quality risk-management process of the EuBIS "Standards and criteria for the inspection of blood establishments". ISO 15189 should be the next step on the quality assurance of a screening laboratory, since it is focused on medical laboratory. To standardize the quality management systems in blood establishments' screening laboratories, new national and European claims focused on technical requirements following ISO 15189 is needed. Copyright © 2015 Elsevier Ltd. All rights reserved.

75 FR 33385 - Agency Information Collection Activities: Proposed Information Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-11

... the types of internal controls and risk management procedures that the agencies (OCC, Board of... information collection unless it displays a currently valid Office of Management and Budget (OMB) control..., please send a copy of your comments to OCC Desk Officer, 1557-0229, by mail to U.S. Office of Management...

Review of guidance on recurrence risk management for general practitioners in breast cancer, colorectal cancer and melanoma guidelines.

PubMed

Spronk, Inge; Korevaar, Joke C; Burgers, Jako S; Albreht, Tit; Schellevis, François G

2017-04-01

General practitioners (GPs) will face cancer recurrences more frequently due to the rising number of cancer survivors and greater involvement of GPs in the follow-up care. Currently, GPs are uncertain about managing recurrence risks and may need more guidance. To explore what guidance is available for GPs on managing recurrence risks for breast cancer, colorectal cancer and melanoma, and to examine whether recurrence risk management differs between these tumour types. Breast cancer, colorectal cancer and melanoma clinical practice guidelines were identified via searches on internet and the literature, and experts were approached to identify guidelines. Guidance on recurrence risk management that was (potentially) relevant for GPs was extracted and summarized into topics. We included 24 breast cancer, 21 colorectal cancer and 15 melanoma guidelines. Identified topics on recurrence risk management were rather similar among the three tumour types. The main issue in the guidelines was recurrence detection through consecutive diagnostic testing. Guidelines agree on both routine and nonroutine tests, but, recommended frequencies for follow-up are inconsistent, except for mammography screening for breast cancer. Only six guidelines provided targeted guidance for GPs. This inventory shows that recurrence risk management has overlapping areas between tumour types, making it more feasible for GPs to provide this care. However, few guidance on recurrence risk management is specific for GPs. Recommendations on time intervals of consecutive diagnostic tests are inconsistent, making it difficult for GPs to manage recurrence risks and illustrating the need for more guidance targeted for GPs. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Managing major chemical accidents in China: towards effective risk information.

PubMed

He, Guizhen; Zhang, Lei; Lu, Yonglong; Mol, Arthur P J

2011-03-15

Chemical industries, from their very inception, have been controversial due to the high risks they impose on safety of human beings and the environment. Recent decades have witnessed increasing impacts of the accelerating expansion of chemical industries and chemical accidents have become a major contributor to environmental and health risks in China. This calls for the establishment of an effective chemical risk management system, which requires reliable, accurate and comprehensive data in the first place. However, the current chemical accident-related data system is highly fragmented and incomplete, as different responsible authorities adopt different data collection standards and procedures for different purposes. In building a more comprehensive, integrated and effective information system, this article: (i) reviews and assesses the existing data sources and data management, (ii) analyzes data on 976 recorded major hazardous chemical accidents in China over the last 40 years, and (iii) identifies the improvements required for developing integrated risk management in China. Copyright © 2011 Elsevier B.V. All rights reserved.

Cardiovascular risk in rheumatoid arthritis: assessment, management and next steps

PubMed Central

Zegkos, Thomas; Kitas, George; Dimitroulas, Theodoros

2016-01-01

Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality which cannot be fully explained by traditional CV risk factors; cumulative inflammatory burden and antirheumatic medication-related cardiotoxicity seem to be important contributors. Despite the acknowledgment and appreciation of CV disease burden in RA, optimal management of individuals with RA represents a challenging task which remains suboptimal. To address this need, the European League Against Rheumatism (EULAR) published recommendations suggesting the adaptation of traditional risk scores by using a multiplication factor of 1.5 if two of three specific criteria are fulfilled. Such guidance requires proper coordination of several medical specialties, including general practitioners, rheumatologists, cardiologists, exercise physiologists and psychologists to achieve a desirable result. Tight control of disease activity, management of traditional risk factors and lifestyle modification represent, amongst others, the most important steps in improving CV disease outcomes in RA patients. Rather than enumerating studies and guidelines, this review attempts to critically appraise current literature, highlighting future perspectives of CV risk management in RA. PMID:27247635

A risk analysis for production processes with disposable bioreactors.

PubMed

Merseburger, Tobias; Pahl, Ina; Müller, Daniel; Tanner, Markus

2014-01-01

: Quality management systems are, as a rule, tightly defined systems that conserve existing processes and therefore guarantee compliance with quality standards. But maintaining quality also includes introducing new enhanced production methods and making use of the latest findings of bioscience. The advances in biotechnology and single-use manufacturing methods for producing new drugs especially impose new challenges on quality management, as quality standards have not yet been set. New methods to ensure patient safety have to be established, as it is insufficient to rely only on current rules. A concept of qualification, validation, and manufacturing procedures based on risk management needs to be established and realized in pharmaceutical production. The chapter starts with an introduction to the regulatory background of the manufacture of medicinal products. It then continues with key methods of risk management. Hazards associated with the production of medicinal products with single-use equipment are described with a focus on bioreactors, storage containers, and connecting devices. The hazards are subsequently evaluated and criteria for risk evaluation are presented. This chapter concludes with aspects of industrial application of quality risk management.

Risk assessment for pyrrolizidine alkaloids detected in (herbal) teas and plant food supplements.

PubMed

Chen, Lu; Mulder, Patrick P J; Louisse, Jochem; Peijnenburg, Ad; Wesseling, Sebas; Rietjens, Ivonne M C M

2017-06-01

Pyrrolizidine alkaloids (PAs) are plant metabolites present in some botanical preparations, with especially 1,2-unsaturated PAs being of concern because they are genotoxic carcinogens. This study presents an overview of tumour data on PAs and points of departure (PODs) derived from them, corroborating that the BMDL 10 for lasiocarpine represents a conservative POD for risk assessment. A risk assessment using this BMDL 10 and mean levels of PAs reported in literature for (herbal) teas, indicates that consumption of one cup of tea a day would result in MOE values lower than 10 000 for several types of (herbal) teas, indicating a priority for risk management for these products A refined risk assessment using interim relative potency (REP) factors showed that based on the mean PA levels, 7(54%) of 13 types of (herbal) teas and 1 (14%) of 7 types of plant food supplements (PFS) resulted in MOE values lower than 10 000, indicating a priority for risk management also for these products in particular. This includes both preparations containing PA-producing and non-PA-producing plants. Our study provides insight in the current state-of-the art and limitations in the risk assessment of PA-containing food products, especially (herbal) teas and PFS, indicating that PAs in food presents a field of interest for current and future risk management. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Role of the Occupational Physician in Corporate Management of Health Risks: An Important Aspect of Corporate Social Responsibility (CSR).

PubMed

Sugita, Minoru; Miyakawa, Michiko

2016-01-01

There are various risks involved in corporate activities conducted both within and outside the corporation. Among these, health risks are very important and should be managed effectively as an integral part of corporate social responsibility (CSR). A corporation is responsible for health impairments caused by its activities and suffers great moral and economic loss when they occur. It is essential that corporate management takes proper preventive measures against such risks. Occupational physicians possess substantial knowledge of health risks in corporations. In this study, we examine the role of occupational physicians in the management of corporate health risks. Information was obtained from articles in print and on the Internet. Health risks due to corporate activities involve not only the employees of the corporation but also individuals outside the corporation. Each corporation should effectively use available resources to manage health risks. Occupational physicians are one such valuable resource. However, many corporations do not actively involve occupational physicians in health risk management. According to a current Japanese law, health risks for employees in corporations are managed by occupational physicians, but in general, health risks outside corporations are not. The 1984 Bhopal Disaster in India is an example in which physicians of the corporation were only minimally, if at all, involved in assessing and treating impaired health outside the corporation. The role of occupational physicians should be expanded to include management of health risks outside the corporation. This places a greater burden on the physicians and they must make the effort to train in many academic fields in order to better understand the entire context of health risks due to corporate activities. Some occupational physicians may be hesitant to take on such added responsibilities. Some corporations may not recognize the overall health risks due to its activities and do not understand the merit of occupational physicians working with the management to decrease health risks. However, an occupational physician is an important member of the corporation, so he/she must be involved in the management of health risks not only within the corporation itself, but also outside the corporation from the viewpoint of CSR. Effective management of health risks due to corporate activities should be widely discussed among occupational physicians, business entrepreneurs and managers of the division in charge of corporate health risk management as well as stakeholders. The authors propose expanding the role of occupational physicians to actively manage health risks not only inside but also outside the corporations.

Risk alignment in health care quality and financing: optimizing value.

PubMed

Granata, A V

1998-01-01

How should health care best consolidate rational cost control while preserving and enhancing quality? That is, how can a system best optimize value? A limitation of many current health management modalities may be that the power to control health spending has been expropriated from physician providers, while they are still fully responsible for quality. Assigning responsibility without authority is a significant predicament. There are growing indications that well-organized, well-managed groups of high quality physicians may be able to directly manage both types of risk-quality and financial. The best way to optimize responsibility and authority, and to control financial and quality risks, is to place such responsibility and authority within the same entity.

Current evaluation and management of spondylolysis and spondylolisthesis.

PubMed

McTimoney, C A Michelle; Micheli, Lyle J

2003-02-01

Spondylolysis occurs with a prevalence of 4% to 6% in the general population. Although the etiology of this lesion is still unclear, it has been shown to have both hereditary and acquired risk factors, with an increased prevalence in men and athletes participating in certain high-risk sports. Spondylolisthesis occurs in a significant proportion of individuals with bilateral spondylolysis. Predicting risk factors for progression of the slip in spondylolisthesis has proven difficult. Multiple imaging techniques are helpful in the diagnosis of spondylolysis and spondylolisthesis, with recent research addressing the utility of magnetic resonance imaging in the diagnosis and management of pars lesions. The management guidelines have remained largely unchanged since early recommendations. Recently, the addition of a bone growth stimulator to the management of difficult cases has shown promise.

Healthcare waste management: current practices in selected healthcare facilities, Botswana.

PubMed

Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew

2008-01-01

Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

Requirement Metrics for Risk Identification

NASA Technical Reports Server (NTRS)

Hammer, Theodore; Huffman, Lenore; Wilson, William; Rosenberg, Linda; Hyatt, Lawrence

1996-01-01

The Software Assurance Technology Center (SATC) is part of the Office of Mission Assurance of the Goddard Space Flight Center (GSFC). The SATC's mission is to assist National Aeronautics and Space Administration (NASA) projects to improve the quality of software which they acquire or develop. The SATC's efforts are currently focused on the development and use of metric methodologies and tools that identify and assess risks associated with software performance and scheduled delivery. This starts at the requirements phase, where the SATC, in conjunction with software projects at GSFC and other NASA centers is working to identify tools and metric methodologies to assist project managers in identifying and mitigating risks. This paper discusses requirement metrics currently being used at NASA in a collaborative effort between the SATC and the Quality Assurance Office at GSFC to utilize the information available through the application of requirements management tools.

Influenza pandemic periodicity, virus recycling, and the art of risk assessment.

PubMed

Dowdle, Walter R

2006-01-01

Influenza pandemic risk assessment is an uncertain art. The theory that influenza A virus pandemics occur every 10 to 11 years and seroarcheologic evidence of virus recycling set the stage in early 1976 for risk assessment and risk management of the Fort Dix, New Jersey, swine influenza outbreak. Additional data and passage of time proved the theory untenable. Much has been learned about influenza A virus and its natural history since 1976, but the exact conditions that lead to the emergence of a pandemic strain are still unknown. Current avian influenza events parallel those of swine influenza in 1976 but on a larger and more complex scale. Pre- and post-pandemic risk assessment and risk management are continuous but separate public health functions.

Social transformation in transdisciplinary natural hazard management

NASA Astrophysics Data System (ADS)

Attems, Marie-Sophie; Fuchs, Sven; Thaler, Thomas

2017-04-01

Due to annual increases of natural hazard losses, there is a discussion among authorities and communities in Europe on innovative solutions to increase resilience, and consequently, business-as-usual in risk management practices is often questioned. Therefore, the current situation of risk management requests a societal transformation to response adequately and effectively to the new global dynamics. An emerging concept is the implementation of multiple-use mitigation systems against hazards such as floods, avalanches and land-slides. However, one key aspect refers to the involvement of knowledge outside academic research. Therefore, transdisciplinary knowledge can be used to discuss vital factors which are needed to upscale the implementation of multiple-use mitigation measures. The method used in this contribution is an explorative scenario analysis applied in Austria and processes the knowledge gained in transdisciplinary workshops. The scenario analysis combines qualitative data and the quantitative relations in order to generate a set of plausible future outcomes. The goal is to establish a small amount of consistent scenarios, which are efficient and thereby representative as well as significantly different from each other. The results of the discussions among relevant stakeholders within the workshops and a subsequent quantitative analysis, showed that vital variables influencing the multiple use of mitigation measures are the (1) current legislation, (2) risk acceptance among authorities and the public, (3) land-use pressure, (4) the demand for innovative solutions, (5) the available technical standards and possibilities and (6) finally the policy entrepreneurship. Four different scenarios were the final result of the analysis. Concluding the results, in order to make multiple-use alleviations systems possible contemporary settings concerning risk management strategies will have to change in the future. Legislation and thereby current barriers have to be altered in order to create a possibility for innovative solutions. If the state of the art in technical perspectives allows constructions with limited additional risk, multiple-use structures are an option in risk management. The present and future land-use pressure also intensifies the economic interest in finding and accepting such measures.

Global risk & global challenges - Space as a game changer for socioeconomic sustainable development

NASA Astrophysics Data System (ADS)

Lehnert, Christopher; Karlsson, Evelina; Giannopapa, Christina

2017-11-01

The world's societies at the beginning of the 21st century are better off than ever before. (Gapminder, 2015) At the same time, the world is also threatened by global challenges where space as a tool has and can play a pivotal role in meeting those challenges. The challenges range from climate change, over mass unemployment, to terrorism or migration - to name but a few. Space activities have started to respond to this changing world, not only by providing a deeper understanding of our universe, but by using space as an additional sphere and sector, through which humankind can increase and secure its wealth - it is thus game changing in the way we sustain humanity's existence. This paper is meant to capture this development. In the first part, an overview is given on the risks that humankind is facing. The second part describes the way that space can be used as a tool to prevent and manage these risks. The overview in the first part is based on the examination of the most recent reports and overall strategies of key International Governmental Organisations and Non-Governmental Organisations that are involved in agenda-setting, policy formulation and implementation. The second part includes an overview on current activities of the European Space Agency (ESA) that play a role in responding to these risks. To better understand ESA's activities that contain humanity's risks, a standard classification for risks management is used, which distinguishes between four components: Identification, Assessment, Management and Communication (Renn, 2005). The analysis reveals how space activities already today play a pivotal role in all four types of risk management. Space activities contribute very tangible to the management of risks through its space mission, but also in a more indirect way, as providing the technical backbone for stable and reliable cooperation in the international governance arena, and serve as crucial economic stimulator. The overall results show that space activities touch upon every aspect of responding to the humanity's risks. Especially in the identification and the preventive management of humanity's risks, space systems are a crucial enabler. They are also an important part in dealing with risks related to scarcity of resources. It is thus important that current levels of investments into space infrastructure are maintained, as the benefits of space activities is essential to humankind's existence and that upon further programmatic decisions, stakeholders involved with the management of risks are being consulted.

The Decision Support Matrix (DSM) Approach to Reducing Risk of Flooding and Water Pollution in Farmed Landscapes

NASA Astrophysics Data System (ADS)

Hewett, Caspar J. M.; Quinn, Paul; Wilkinson, Mark

2014-05-01

Intense farming plays a key role in contributing to problems such as increased flood risk, soil erosion and poor water quality. This means that there is great potential for agricultural practitioners to play a major part in reducing multiple risks through better land-use management. Greater understanding by farmers, land managers, practitioners and policy-makers of the ways in which farmed landscapes contribute to risks and the ways in which those risks might be mitigated can be an essential component in improving practice. The Decision Support Matrix (DSM) approach involves the development of a range of visualization and communication tools to help compare the risks associated with different farming practices and explore options to manage runoff. DSMs are simple decision support systems intended for use by the non-expert which combine expert hydrological evidence with local knowledge of runoff patterns. They are developed through direct engagement with stakeholders, ensuring that the examples and language used makes sense to end-users. A key element of the tools is that they show the current conditions of the land and describe extremes of land-use management within a hydrological and agricultural land-management context. The tools include conceptual models of a series of pre-determined runoff scenarios, providing the end-user with a variety of potential land management practices and runoff management options. Visual examples of different farming practices are used to illustrate the impact of good and bad practice on specific problems such as nutrient export or risk of flooding. These show both how current conditions cause problems downstream and how systems are vulnerable to changes in climate and land-use intensification. The level of risk associated with a particular land management option is represented by a mapping on a two- or three-dimensional matrix. Interactive spreadsheet-based tools are developed in which multiple questions allow the user to explore different management options and see the impact of decisions plotted as a risk level on the DSM. They employ a ranking methodology combined with a simple mapping of information onto a visual matrix. A nominal scoring system is used to rank higher or lower runoff risk. The end-user can then assess numerous land use and runoff management options to lower risk. The objective is to encourage policy makers, catchment managers and farmers to produce resilient local landscapes at minimal cost. A number of DSMs have been developed successfully over a number of years working with a variety of stakeholders in the UK, including the Phosphorus Export Risk Matrix (PERM), The Nitrate Export Risk Matrix (NO3RM) and arable and livestock versions of the Floods and Agriculture Risk Matrix (FARM) (available from http://research.ncl.ac.uk/thefarm). Despite uncertainty, the tools do contribute to stakeholders having greater confidence in making decisions to make landscapes more resilient. DSMs have been taken up widely in the UK by bodies such as the Environment Agency and Defra, and have been successfully employed within wider decision support frameworks alongside modelling at multiple scales. Such tools could be used in similar farmed landscapes internationally.

Use of documentary sources on past flood events for flood risk management and land planning

NASA Astrophysics Data System (ADS)

Cœur, Denis; Lang, Michel

2008-09-01

The knowledge of past catastrophic events can improve flood risk mitigation policy, with a better awareness against risk. As such historical information is usually available in Europe for the past five centuries, historians are able to understand how past society dealt with flood risk, and hydrologists can include information on past floods into an adapted probabilistic framework. In France, Flood Risk Mitigation Maps are based either on the largest historical known flood event or on the 100-year flood event if it is greater. Two actions can be suggested in terms of promoting the use of historical information for flood risk management: (1) the development of a regional flood data base, with both historical and current data, in order to get a good feedback on recent events and to improve the flood risk education and awareness; (2) the commitment to keep a persistent/perennial management of a reference network of hydrometeorological observations for climate change studies.

The use and role of predictive systems in disease management.

PubMed

Gent, David H; Mahaffee, Walter F; McRoberts, Neil; Pfender, William F

2013-01-01

Disease predictive systems are intended to be management aids. With a few exceptions, these systems typically do not have direct sustained use by growers. Rather, their impact is mostly pedagogic and indirect, improving recommendations from farm advisers and shaping management concepts. The degree to which a system is consulted depends on the amount of perceived new, actionable information that is consistent with the objectives of the user. Often this involves avoiding risks associated with costly disease outbreaks. Adoption is sensitive to the correspondence between the information a system delivers and the information needed to manage a particular pathosystem at an acceptable financial risk; details of the approach used to predict disease risk are less important. The continuing challenge for researchers is to construct tools relevant to farmers and their advisers that improve upon their current management skill. This goal requires an appreciation of growers' decision calculus in managing disease problems and, more broadly, their overall farm enterprise management.

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

Ha, Kyoo-Man, E-mail: ha1999@hotmail.com

In Korea, there is a pervasive feeling of invincibility to the point that people and organizations do not believe that disasters can strike them. This has impact on the level of preparedness for disasters. This study aims to delve into how Korea has to change its governmental policies/practices with some private partners' efforts to mitigate disaster risks. A case study was utilized as the major methodology by comparing exclusive management with inclusive management. These two approaches have been comparatively analyzed via four variables, namely the central government, the local governments, the incident commander, and other stakeholders. The major finding ismore » that Korea's practices and policies have to evolve from the current exclusive management into future-oriented inclusive management. Moreover, the importance of communication, cooperation, collaboration, and multi-discipline coordination is discussed. Additionally, the problem of reductionism and equal participation among all stakeholders, as well as the resistance from vested interests, are recognized and elaborated for Korea and the international community. - Highlights: • Only a few stakeholders in Korea believe that disaster can happen to anyone. This study aims to delve into how Korea has to change its current practices to mitigate disaster risks. • To compare exclusive management with inclusive management, we have examined four comparative variables, namely the central government's policy, local government's strategy, the incident commander's post, and other stakeholders' efforts. • The major finding is that Korea's practices and policies have to evolve from the current exclusive management into future-oriented inclusive management.« less

Report: EPA Needs to Improve Recording Information Technology Investments and Issue a Policy Covering All Investments

EPA Pesticide Factsheets

Report #15-P-0292, September 22, 2015. The EPA management of its $334 million in IT investments is noncompliant with its current policy. Thus, the EPA is at risk of not managing taxpayer dollars properly.

[MANAGEMENT OF HEALTHCARE WASTE IN THE HOSPITAL SETTING. UNDERSTANDING RISK MANAGEMENT].

PubMed

Galimany-Masclans, Jordi; Torres-Egea, Pilar; Sancho-Agredano, Raúl; Girbau-García, Ma Rosa; Fabrellas, Núria; Torrens-Garcia, Ma Llum; Martínez-Estalella, Gemma

2015-05-01

The sanitary waste represents a potential hazard for health workers. Given the high risk of infection in labor accidents, the correct management of sanitary waste minimizes this risk and improves labor and environment conditions. To identify risk perception with health professionals in relation to the advanced sorting and management of healthcare waste (HW). The current study is a descriptive, cross-sectional. The sample size was 177 health workers (nurse assistants, nurses, physicians, lab technicians) from three hospitals in Barcelona (Catalonia). Homemade questionnaire and questions with a free and spontaneous association and incomplete sentences were used to analyze labor variables, perception of risk and personal security through a Likert scale. Using a score from 1 (the lowest perception of risk) to 5 (the high perception of risk) to assess the risk perception, the average value for nurse assistants, nurses, physicians, and lab technicians was 3.71, 3.75, 3.83 and 4.03, respectively. Referring to items with free and spontaneous response association, 44.8% of workers consider HW as a biohazard, 29.6% consider it as waste material, 22.1% state that it must be managed properly and 3.5% described it as unknown residues. The results suggest that all health professionals generally have a perception of high risk. The lab technicians have a higher perception of the real risk of inadequate management of HW A 63.2% report that everyone has to make a proper management to preserve their occupational health; the 59% consider that the HW are a biological risk to the general population and only the 47.8% that are harmful to public health. Although it should be noted that only 44.8% think that HW are toxic and dangerous.

Connecting Hazard Analysts and Risk Managers to Sensor Information.

PubMed

Le Cozannet, Gonéri; Hosford, Steven; Douglas, John; Serrano, Jean-Jacques; Coraboeuf, Damien; Comte, Jérémie

2008-06-11

Hazard analysts and risk managers of natural perils, such as earthquakes, landslides and floods, need to access information from sensor networks surveying their regions of interest. However, currently information about these networks is difficult to obtain and is available in varying formats, thereby restricting accesses and consequently possibly leading to decision-making based on limited information. As a response to this issue, state-of-the-art interoperable catalogues are being currently developed within the framework of the Group on Earth Observations (GEO) workplan. This article provides an overview of the prototype catalogue that was developed to improve access to information about the sensor networks surveying geological hazards (geohazards), such as earthquakes, landslides and volcanoes.

Connecting Hazard Analysts and Risk Managers to Sensor Information

PubMed Central

Le Cozannet, Gonéri; Hosford, Steven; Douglas, John; Serrano, Jean-Jacques; Coraboeuf, Damien; Comte, Jérémie

2008-01-01

Hazard analysts and risk managers of natural perils, such as earthquakes, landslides and floods, need to access information from sensor networks surveying their regions of interest. However, currently information about these networks is difficult to obtain and is available in varying formats, thereby restricting accesses and consequently possibly leading to decision-making based on limited information. As a response to this issue, state-of-the-art interoperable catalogues are being currently developed within the framework of the Group on Earth Observations (GEO) workplan. This article provides an overview of the prototype catalogue that was developed to improve access to information about the sensor networks surveying geological hazards (geohazards), such as earthquakes, landslides and volcanoes. PMID:27879915

Benchmarking CIN3+ risk as the basis for incorporating HPV and Pap cotesting into cervical screening and management guidelines

PubMed Central

Katki, Hormuzd A.; Schiffman, Mark; Castle, Philip E.; Fetterman, Barbara; Poitras, Nancy E.; Lorey, Thomas; Cheung, Li C.; Raine-Bennett, Tina R.; Gage, Julia C.; Kinney, Walter K.

2013-01-01

Objective In 2012, the United States Preventive Services Task Force (USPSTF) and a consensus of 25 organizations endorsed concurrent cytology and HPV testing (“cotesting”) for cervical cancer screening. Past screening and management guidelines were implicitly based on risks defined by Pap-alone, without consideration of HPV test results. To promote management that is consistent with accepted practice, new guidelines incorporating cotesting should aim to achieve equal management of women at equal risk of cervical intraepithelial neoplasia grade 3 and cancer (CIN3+). Methods We estimated cumulative 5-year risks of CIN3+ for 965,360 women aged 30–64 undergoing cotesting at Kaiser Permanente Northern California 2003–2010. We calculated the implicit risk thresholds for Pap-alone and applied them for new management guidance on HPV and Pap cotesting, citing 2 examples: HPV-positive/ASC-US and HPV-negative/Pap-negative. We call this guidance process “benchmarking”. Results LSIL, for which immediate colposcopy is prescribed, carries 5-year CIN3+ risk of 5.2%, suggesting that test results with similar risks should be managed with colposcopy. Similarly, ASC-US (2.6% risk) is managed with 6–12 month follow-up and Pap-negative (0.26% risk) is managed with 3-year follow-up. The 5-year CIN3+ risk for women with HPV-positive/ASC-US was 6.8% (95%CI 6.2% to 7.6%). This is greater than the 5.2% risk implicitly leading to referral to colposcopy, consistent with current management recommendations that HPV-positive/ASC-US should be referred for immediate colposcopy. The 5-year CIN3+ risk for women with HPV-negative/Pap-negative was 0.08% (95%CI 0.07% to 0.09%), far below the 0.26% implicitly required for a 3-year return and justifying a longer (e.g., 5-year) return. Conclusions Using the principle of “equal management of equal risks,” benchmarking to implicit risk thresholds based on Pap-alone can be used to achieve safe and consistent incorporation of cotesting. PMID:23519302

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.

Managing the interface with marketing to improve delivery of pharmacovigilance within the pharmaceutical industry.

PubMed

Edwards, Brian

2004-01-01

The pharmaceutical industry is under pressure to improve the scientific quality of its decisions concerning the benefit and risks of its products while ensuring compliance with acceptable standards of marketing. All those in a pharmaceutical company who currently work within pharmacovigilance should be encouraged to lead from the front to examine ongoing marketing activities to see how they can be adapted more towards pharmacovigilance and risk management. The current irony is that the personnel who have the greatest influence on benefit-risk decisions of a product are not necessarily those who acknowledge that they are performing pharmacovigilance. Indeed, for all concerned, whether their orientation is scientific and commercial, effective communication with prescribers and consumers usually underpins product success. Also, a substantial 'marketing' budget is culturally acceptable for the pharmaceutical industry so it is logical to assume that resource for postmarketing activity is often made available. Given these realities, I suggest we should strive for an integrated marketing and risk-management plan based on the best available evidence and that being fully aware and in control of the safety issues for your products is the best way to commercialise them successfully. This approach can still be consistent with other corporate responsibilities such as trying to reduce the financial burden of product development. If this article stimulates further debate about how the pharmaceutical industry can more effectively organise resources and operations to support pharmacovigilance, risk management, and marketing, then it will have achieved its purpose.

Management of carotid stenosis in women

PubMed Central

Brown, Martin M.; Didier, Leys; Howard, Virginia J.; Moore, Wesley S.; Paciaroni, Maurizio; Ringleb, Peter; Rockman, Caron; Caso, Valeria

2013-01-01

Objective: Specific guidelines for management of cerebrovascular risk in women are currently lacking. This study aims to provide a consensus expert opinion to help make clinical decisions in women with carotid stenosis. Methods: Proposals for the use of carotid endarterectomy (CEA), carotid stenting (CAS), and medical therapy for stroke prevention in women with carotid stenosis were provided by a group of 9 international experts with consensus method. Results: Symptomatic women with severe carotid stenosis can be managed by CEA provided that the perioperative risk of the operators is low (<4%). Periprocedural stroke risks may be increased in symptomatic women if revascularization is performed by CAS; however, the choice of CAS vs CEA can be tailored in subgroups best fit for each procedure (e.g., women with restenosis or severe coronary disease, best suited for CAS; women with tortuous vessels or old age, best suited for CEA). There is currently limited evidence to consider medical therapy alone as the best choice for women with neurologically severe asymptomatic carotid stenosis, who should be best managed within randomized trials including a medical arm. Medical management and cardiovascular risk factor control must be implemented in all women with carotid stenosis in periprocedural period and lifelong regardless of whether or not intervention is planned. Conclusions: The suggestions provided in this article may constitute a decision-making basis for planning treatment of carotid stenosis in women. Most recommendations are of limited strength; however, it is unlikely that new robust data will emerge soon to induce relevant changes. PMID:23751919

Periodontal Management by Risk Assessment: A Pragmatic Approach.

PubMed

Mullins, Joanna M; Even, Joshua B; White, Joel M

2016-06-01

An evidence-based periodontal disease risk assessment and diagnosis system has been developed and combined with a clinical decision support and management program to improve treatment and measure patient outcomes. There is little agreement on a universally accepted periodontal risk assessment, periodontal diagnosis, and treatment management tool and their incorporation into dental practice to improve patient care. This article highlights the development and use of a practical periodontal management and risk assessment program that can be implemented in dental settings. The approach taken by Willamette Dental Group to develop a periodontal disease risk assessment, periodontal diagnosis, and treatment management tool is described using evidence-based best practices. With goals of standardized treatment interventions while maintaining personalized care and improved communication, this process is described to facilitate its incorporation into other dental settings. Current electronic health records can be leveraged to enhance patient-centered care through the use of risk assessments and standardized guidelines to more effectively assess, diagnose, and treat patients to improve outcomes. Dental hygienists, and other committed providers, with their emphasis on prevention of periodontal disease can be principal drivers in creation and implementation of periodontal risk assessments and personalized treatment planning. Willamette Dental Group believes that such evidence-based tools can advance dentistry to new diagnostic and treatment standards. Copyright © 2016 Elsevier Inc. All rights reserved.

75 FR 82317 - Risk-Based Capital Standards: Advanced Capital Adequacy Framework-Basel II; Establishment of a...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-30

... collection unless it displays a currently valid Office of Management and Budget (OMB) control number. Each of... CORPORATION 12 CFR Part 325 RIN 3064-AD58 Risk-Based Capital Standards: Advanced Capital Adequacy Framework--Basel II; Establishment of a Risk-Based Capital Floor AGENCY: Office of the Comptroller of the Currency...

75 FR 51531 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-20

... controls and risk management procedures that the agencies (OCC, Board of Governors of the Federal Reserve... collection unless it displays a currently valid Office of Management and Budget (OMB) control number. The OCC... of your comments to OCC Desk Officer, 1557-0229, by mail to U.S. Office of Management and Budget, 725...

Aligning smoke management with ecological and public health goals

Treesearch

Jonathan W. Long; Leland W. Tarnay; Malcolm P. North

2017-01-01

Past and current forest management affects wildland fire smoke impacts on downwind human populations. However, mismatches between the scale of benefits and risks make it difficult to proactively manage wildland fires to promote both ecological and public health. Building on recent literature and advances in modeling smoke and health effects, we outline a framework to...

Epilepsy and psychosis: a practical approach.

PubMed

Maguire, Melissa; Singh, Jasvinder; Marson, Anthony

2018-04-01

The psychoses of epilepsy can be classified according to their temporal relationship with seizures, namely as ictal, postictal and interictal psychosis. Interictal psychosis is the most common and may resemble schizophrenia. They can be challenging to diagnose and to manage, especially given the perception that some antipsychotic drugs may exacerbate seizures, while some antiepileptic medications may worsen psychosis. The current uncertainty around their best management means that some patients may not receive appropriate care. We propose a practical stepwise approach to managing psychosis in patients with epilepsy, summarising the key clinical features. We provide a framework for diagnosis, investigation and management of psychosis in the acute and long term. We also summarise the available evidence on the risk of psychosis with current antiepileptic drugs and the risk of seizures with antipsychotic drugs. © 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.

Evolution of diabetes management in the 21st century: the contribution of quality of life measurement in Asians.

PubMed

Goh, Shereen Giap Kah; Rusli, Bin Nordin; Khalid, Bin Abdul Kadir

2015-01-01

Diabetes mellitus (DM) is a complex and chronic disease with multiple complications leading to increased mortality and poor quality of life. Current studies have shown that lowering glycosylated haemoglobin (HbA1c) confers protection against microvascular complications. However, with more intensive glucose control to achieve HbA1c of less than 6.5%, there seems to be a significant increased risk of mortality and cardiovascular events. The current recommendation worldwide is for "tailoring" of DM management to risk and also quality of Life (QOL) which is a crucial component in determining the success or failure of DM management. In Asia, DM has become a health crisis but there is a lack of QOL assessment tool that is specific for Asians with wide spectrum of ethnicity, languages, religions and socio-economic differences. In this review, we discuss the evolution of DM management over the decade and the issues pertaining to QOL among people living with diabetes in Asia.

Latest Developments and Future Perspectives in the Field Of Obesity.

PubMed

Pérez-Pevida, Belén; Miras, Alexander D

2017-04-01

The prevalence of obesity is increasing exponentially worldwide, becoming an international public health issue that affects quality of life, increases the risk of illness and raises healthcare costs in countries in all parts of the world. In this editorial, we analyse the latest progress in the management of obesity and associated cardiovascular risk factors, and summarise the latest randomised controlled trials that have had the biggest influence on the current changes we are experiencing in obesity management.

Cooperative Crisis Management and Avian Influenza. A Risk Assessment Guide for International Contagious Disease Prevention and Risk Mitigation

DTIC Science & Technology

2006-03-01

with a decrease in trade restrictions between neighboring countries, make it easier for microbes , disease- causing insects, and infected animals to...with a collection of information if it does not display a currently valid OMB control number. 1. REPORT DATE MAR 2006 2. REPORT TYPE 3. DATES COVERED...are important aspects of managing external perceptions. External perceptions can cause unaffected countries to consider more drastic measures for

Risk management perspective for climate service development - Results from a study on Finnish organizations

NASA Astrophysics Data System (ADS)

Harjanne, Atte; Haavisto, Riina; Tuomenvirta, Heikki; Gregow, Hilppa

2017-10-01

Weather, climate and climate change can cause significant risks to businesses and public administration. However, understanding these processes can also create opportunities. Information can help to manage these risks and opportunities, but in order to do so, it must be in line with how risk management and decision making works. To better understand how climate risks and opportunities are reflected in different organizational processes and what types of information is needed and used, we conducted a study on the perceptions and management of weather and climate risks in Finnish organizations and on their use of weather and climate information. In addition, we collected feedback on how the existing climate information tools should be developed. Data on climate risk management was collected in an online survey and in one full-day workshop. The survey was aimed to the Finnish public and private organizations who use weather and climate data and altogether 118 responses were collected. The workshop consisted of two parts: weather and climate risk management processes in general and the development of the current information tools to further address user needs.

We found that climate risk management in organizations is quite diverse and often de-centralized and that external experts are considered the most useful sources of information. Consequently, users emphasize the need for networks of expertise and sector-specific information tools. Creating such services requires input and information sharing from the user side as well. Better temporal and spatial accuracy is naturally asked for, but users also stressed the need for transparency when it comes to communicating uncertainties, and the availability and up-to-datedness of information. Our results illustrate that weather and climate risks compete and blend in with other risks and changes perceived by the organizations and supporting information is sought from different types of sources. Thus the design and evaluation of climate services should take into account the context of existing and developing processes in organizational risk management.

Capacity planning for electronic waste management facilities under uncertainty: multi-objective multi-time-step model development.

PubMed

Poonam Khanijo Ahluwalia; Nema, Arvind K

2011-07-01

Selection of optimum locations for locating new facilities and decision regarding capacities at the proposed facilities is a major concern for municipal authorities/managers. The decision as to whether a single facility is preferred over multiple facilities of smaller capacities would vary with varying priorities to cost and associated risks such as environmental or health risk or risk perceived by the society. Currently management of waste streams such as that of computer waste is being done using rudimentary practices and is flourishing as an unorganized sector, mainly as backyard workshops in many cities of developing nations such as India. Uncertainty in the quantification of computer waste generation is another major concern due to the informal setup of present computer waste management scenario. Hence, there is a need to simultaneously address uncertainty in waste generation quantities while analyzing the tradeoffs between cost and associated risks. The present study aimed to address the above-mentioned issues in a multi-time-step, multi-objective decision-support model, which can address multiple objectives of cost, environmental risk, socially perceived risk and health risk, while selecting the optimum configuration of existing and proposed facilities (location and capacities).

Applying the lessons of high risk industries to health care.

PubMed

Hudson, P

2003-12-01

High risk industries such as commercial aviation and the oil and gas industry have achieved exemplary safety performance. This paper reviews how they have managed to do that. The primary reasons are the positive attitudes towards safety and the operation of effective formal safety management systems. The safety culture provides an important explanation of why such organisations perform well. An evolutionary model of safety culture is provided in which there is a range of cultures from the pathological through the reactive to the calculative. Later, the proactive culture can evolve towards the generative organisation, an alternative description of the high reliability organisation. The current status of health care is reviewed, arguing that it has a much higher level of accidents and has a reactive culture, lagging behind both high risk industries studied in both attitude and systematic management of patient risks.

Regulating the unknown: Managing the occupational health risks of nanomedical technologies and nanopharmaceuticals in the research laboratory

NASA Astrophysics Data System (ADS)

Ersin, Ozlem Hacer

Novel technologies and their resultant products demand fresh ways of thinking about pre-market risk analysis and post-market surveillance. A regulatory framework that is responsive to emerging knowledge about the hazards of novel technologies offers repeatable and transparent processes and remains economically and socially feasible. Workers are an especially vulnerable population who are exposed to unknown hazards of novel technologies and serve often as unwitting sentinels of impending risks. This Grounded Theory-based case study identifies gaps in our current ability to regulate novel technologies so as to minimize occupational health risks and offers necessary modifications for an environment that is conducive to proper regulation. Nanopharmaceuticals and the nano-based technologies at their base are used by way of exemplar technologies that are currently taxing the ability of the regulatory system to provide adequate oversight. Ambiguities of definition, absence of a tracking system (of who is doing nanotechnology research), and the paucity of scientific evidence to support risk management efforts are among the findings of the study and need to be addressed as ameliorative steps toward an effective regulatory structure.

Systematic implementation of clinical risk management in a large university hospital: the impact of risk managers.

PubMed

Sendlhofer, Gerald; Brunner, Gernot; Tax, Christa; Falzberger, Gebhard; Smolle, Josef; Leitgeb, Karina; Kober, Brigitte; Kamolz, Lars Peter

2015-01-01

For health care systems in recent years, patient safety has increasingly become a priority issue. National and international strategies have been considered to attempt to overcome the most prominent hazards while patients are receiving health care. Thereby, clinical risk management (CRM) plays a dominant role in enabling the identification, analysis, and management of potential risks. CRM implementation into routine procedures within complex hospital organizations is challenging, as in the past, organizational change strategies using a top-down approach have often failed. Therefore, one of our main objectives was to educate a certain number of risk managers in facilitating CRM using a bottom-up approach. To achieve our primary purpose, five project strands were developed, and consequently followed, introducing CRM: corporate governance, risk management (RM) training, CRM process, information, and involvement. The core part of the CRM process involved the education of risk managers within each organizational unit. To account for the size of the existing organization, we assumed that a minimum of 1 % of the workforce had to be trained in RM to disseminate the continuous improvement of quality and safety. Following a roll-out plan, CRM was introduced in each unit and potential risks were identified. Alongside the changes in the corporate governance, a hospital-wide CRM process was introduced resulting in 158 trained risk managers correlating to 2.0 % of the total workforce. Currently, risk managers are present in every unit and have identified 360 operational risks. Among those, 176 risks were scored as strategic and clustered together into top risks. Effective meeting structures and opportunities to share information and knowledge were introduced. Thus far, 31 units have been externally audited in CRM. The CRM approach is unique with respect to its dimension; members of all health care professions were trained to be able to identify potential risks. A network of risk managers supported the centrally coordinated CRM process. There is a strong commitment among management, academia, clinicians, and administration to foster cooperation. The introduction of CRM led to a visible shift with regard to patient safety culture throughout the entire organization. Still, there is a long way to go to keep people engaged in CRM and work on national and international patient safety initiatives to continuously decrease potential hazards.

Policy, practice and decision making for zoonotic disease management: water and Cryptosporidium.

PubMed

Austin, Zoë; Alcock, Ruth E; Christley, Robert M; Haygarth, Philip M; Heathwaite, A Louise; Latham, Sophia M; Mort, Maggie; Oliver, David M; Pickup, Roger; Wastling, Jonathan M; Wynne, Brian

2012-04-01

Decision making for zoonotic disease management should be based on many forms of appropriate data and sources of evidence. However, the criteria and timing for policy response and the resulting management decisions are often altered when a disease outbreak occurs and captures full media attention. In the case of waterborne disease, such as the robust protozoa, Cryptosporidium spp, exposure can cause significant human health risks and preventing exposure by maintaining high standards of biological and chemical water quality remains a priority for water companies in the UK. Little has been documented on how knowledge and information is translated between the many stakeholders involved in the management of Cryptosporidium, which is surprising given the different drivers that have shaped management decisions. Such information, coupled with the uncertainties that surround these data is essential for improving future management strategies that minimise disease outbreaks. Here, we examine the interplay between scientific information, the media, and emergent government and company policies to examine these issues using qualitative and quantitative data relating to Cryptosporidium management decisions by a water company in the North West of England. Our results show that political and media influences are powerful drivers of management decisions if fuelled by high profile outbreaks. Furthermore, the strength of the scientific evidence is often constrained by uncertainties in the data, and in the way knowledge is translated between policy levels during established risk management procedures. In particular, under or over-estimating risk during risk assessment procedures together with uncertainty regarding risk factors within the wider environment, was found to restrict the knowledge-base for decision-making in Cryptosporidium management. Our findings highlight some key current and future challenges facing the management of such diseases that are widely applicable to other risk management situations. Copyright © 2011 Elsevier Ltd. All rights reserved.

Computer-Aided Nodule Assessment and Risk Yield Risk Management of Adenocarcinoma: The Future of Imaging?

PubMed

Foley, Finbar; Rajagopalan, Srinivasan; Raghunath, Sushravya M; Boland, Jennifer M; Karwoski, Ronald A; Maldonado, Fabien; Bartholmai, Brian J; Peikert, Tobias

2016-01-01

Increased clinical use of chest high-resolution computed tomography results in increased identification of lung adenocarcinomas and persistent subsolid opacities. However, these lesions range from very indolent to extremely aggressive tumors. Clinically relevant diagnostic tools to noninvasively risk stratify and guide individualized management of these lesions are lacking. Research efforts investigating semiquantitative measures to decrease interrater and intrarater variability are emerging, and in some cases steps have been taken to automate this process. However, many such methods currently are still suboptimal, require validation and are not yet clinically applicable. The computer-aided nodule assessment and risk yield software application represents a validated tool for the automated, quantitative, and noninvasive tool for risk stratification of adenocarcinoma lung nodules. Computer-aided nodule assessment and risk yield correlates well with consensus histology and postsurgical patient outcomes, and therefore may help to guide individualized patient management, for example, in identification of nodules amenable to radiological surveillance, or in need of adjunctive therapy. Copyright © 2016 Elsevier Inc. All rights reserved.

Robust Decision Making Approach to Managing Water Resource Risks (Invited)

NASA Astrophysics Data System (ADS)

Lempert, R.

2010-12-01

The IPCC and US National Academies of Science have recommended iterative risk management as the best approach for water management and many other types of climate-related decisions. Such an approach does not rely on a single set of judgments at any one time but rather actively updates and refines strategies as new information emerges. In addition, the approach emphasizes that a portfolio of different types of responses, rather than any single action, often provides the best means to manage uncertainty. Implementing an iterative risk management approach can however prove difficult in actual decision support applications. This talk will suggest that robust decision making (RDM) provides a particularly useful set of quantitative methods for implementing iterative risk management. This RDM approach is currently being used in a wide variety of water management applications. RDM employs three key concepts that differentiate it from most types of probabilistic risk analysis: 1) characterizing uncertainty with multiple views of the future (which can include sets of probability distributions) rather than a single probabilistic best-estimate, 2) employing a robustness rather than an optimality criterion to assess alternative policies, and 3) organizing the analysis with a vulnerability and response option framework, rather than a predict-then-act framework. This talk will summarize the RDM approach, describe its use in several different types of water management applications, and compare the results to those obtained with other methods.

Ductal carcinoma in situ of the breast: can biomarkers improve current management?

PubMed

Bartlett, John M S; Nofech-Moses, Sharon; Rakovitch, Eileen

2014-01-01

Screening for invasive cancer has led to a marked increase in the detection of ductal carcinoma in situ (DCIS). DCIS is, if appropriately managed, a low-risk disease which has a small chance of impacting on patient life expectancy. However, despite significant advances in prognostic marker development in invasive breast cancer, there are no validated diagnostic assays to inform treatment choice for women with DCIS. Therefore we are unable to target effective treatment strategies to women at high risk and avoid over-treatment of women at low risk of progression to invasive breast cancer. Paradoxically, one effect of this uncertainty is undertreatment of some women. We review current practice and research in the field to identify key challenges in the management of DCIS. The impact of clinical research, particularly on the over and undertreatment of women with DCIS is assessed. We note slow progress toward development of diagnostic biomarkers and highlight key opportunities to accelerate advances in this area. DCIS is a low-risk disease, its incidence is increasing, and current treatment is effective. However, many women are either over- or undertreated. Despite repeated calls for development of diagnostic biomarkers, progress in this area has been slow, reflecting a relative lack of investment of research effort and funding. Given the low event rate in treated patients and the lateness of recurrences, many previous studies have only limited power to identify independent prognostic and predictive biomarkers. However, the potential for such biomarkers to personalize treatment for DCIS is extremely high.

Clinical Adoption of Prognostic Biomarkers The Case for Heart Failure

PubMed Central

Kalogeropoulos, Andreas P.; Georgiopoulou, Vasiliki V.; Butler, Javed

2013-01-01

The recent explosion of scientific knowledge and technological progress has led to the discovery of a large array of circulating molecules commonly referred to as biomarkers. Biomarkers in heart failure research have been used to provide pathophysiological insights, aid in establishing the diagnosis, refine prognosis, guide management, and target treatment. However, beyond diagnostic applications of natriuretic peptides, there are currently few widely recognized applications for biomarkers in heart failure. This represents a remarkable discordance considering the number of molecules that have been shown to correlate with outcomes, refine risk prediction, or track disease severity in heart failure in the past decade. In this article, we use a broad framework proposed for cardiovascular risk markers to summarize the current state of biomarker development for heart failure patients. We utilize this framework to identify the challenges of biomarker adoption for risk prediction, disease management, and treatment selection for heart failure and suggest considerations for future research. PMID:22824105

Occupational exposures to human immunodeficiency virus, hepatitis B virus, and hepatitis C virus: risk, prevention, and management.

PubMed

Cleveland, Jennifer L; Cardo, Denise M

2003-10-01

Current data indicate that the risk for transmitting bloodborne pathogens in dental health care settings is low. Pre-exposure hepatitis B vaccination and the use of standard precautions to prevent exposure to blood are the most effective strategies for preventing DHCP from occupational infection with HIV, HBV or HCV. Each dental health care facility should develop a comprehensive written program for preventing and managing occupational exposures to blood that: (1) describes the types of blood exposures that may place DHCP at risk for infection; (2) outlines procedures for promptly reporting and evaluating such exposures; and (3) identifies a health care professional who is qualified to provide counseling and perform all medical evaluations and procedures in accordance with the most current USPHS recommendations. Finally, resources should be available that permit rapid access to clinical care, testing, counseling, and PEP for exposed DHCP and the testing and counseling of source patients.

Exploring local risk managers' use of flood hazard maps for risk communication purposes in Baden-Württemberg

NASA Astrophysics Data System (ADS)

Kjellgren, S.

2013-07-01

In response to the EU Floods Directive (2007/60/EC), flood hazard maps are currently produced all over Europe, reflecting a wider shift in focus from "flood protection" to "risk management", for which not only public authorities but also populations at risk are seen as responsible. By providing a visual image of the foreseen consequences of flooding, flood hazard maps can enhance people's knowledge about flood risk, making them more capable of an adequate response. Current literature, however, questions the maps' awareness raising capacity, arguing that their content and design are rarely adjusted to laypeople's needs. This paper wants to complement this perspective with a focus on risk communication by studying how these tools are disseminated and marketed to the public in the first place. Judging from communication theory, simply making hazard maps publicly available is unlikely to lead to attitudinal or behavioral effects, since this typically requires two-way communication and material or symbolic incentives. Consequently, it is relevant to investigate whether and how local risk managers, who are well positioned to interact with the local population, make use of flood hazard maps for risk communication purposes. A qualitative case study of this issue in the German state of Baden-Württemberg suggests that many municipalities lack a clear strategy for using this new information tool for hazard and risk communication. Four barriers in this regard are identified: perceived disinterest/sufficient awareness on behalf of the population at risk; unwillingness to cause worry or distress; lack of skills and resources; and insufficient support. These barriers are important to address - in research as well as in practice - since it is only if flood hazard maps are used to enhance local knowledge resources that they can be expected to contribute to social capacity building.

Storage management in Ada. Three reports. Volume 1: Storage management in Ada as a risk to the development of reliable software. Volume 2: Relevant aspects of language. Volume 3: Requirements of the language versus manifestations of current implementations

NASA Technical Reports Server (NTRS)

Auty, David

1988-01-01

The risk to the development of program reliability is derived from the use of a new language and from the potential use of new storage management techniques. With Ada and associated support software, there is a lack of established guidelines and procedures, drawn from experience and common usage, which assume reliable behavior. The risk is identified and clarified. In order to provide a framework for future consideration of dynamic storage management on Ada, a description of the relevant aspects of the language is presented in two sections: Program data sources, and declaration and allocation in Ada. Storage-management characteristics of the Ada language and storage-management characteristics of Ada implementations are differentiated. Terms that are used are defined in a narrow and precise sense. The storage-management implications of the Ada language are described. The storage-management options available to the Ada implementor and the implications of the implementor's choice for the Ada programmer are also described.

Risk management frameworks for human health and environmental risks.

PubMed

Jardine, Cindy; Hrudey, Steve; Shortreed, John; Craig, Lorraine; Krewski, Daniel; Furgal, Chris; McColl, Stephen

2003-01-01

A comprehensive analytical review of the risk assessment, risk management, and risk communication approaches currently being undertaken by key national, provincial/state, territorial, and international agencies was conducted. The information acquired for review was used to identify the differences, commonalities, strengths, and weaknesses among the various approaches, and to identify elements that should be included in an effective, current, and comprehensive approach applicable to environmental, human health and occupational health risks. More than 80 agencies, organizations, and advisory councils, encompassing more than 100 risk documents, were examined during the period from February 2000 until November 2002. An overview was made of the most important general frameworks for risk assessment, risk management, and risk communication for human health and ecological risk, and for occupational health risk. In addition, frameworks for specific applications were reviewed and summarized, including those for (1)contaminated sites; (2) northern contaminants; (3) priority substances; (4) standards development; (5) food safety; (6) medical devices; (7) prescription drug use; (8) emergency response; (9) transportation; (10) risk communication. Twelve frameworks were selected for more extensive review on the basis of representation of the areas of human health, ecological, and occupational health risk; relevance to Canadian risk management needs; representation of comprehensive and well-defined approaches; generalizability with their risk areas; representation of "state of the art" in Canada, the United States, and/or internationally; and extent of usage of potential usage within Canada. These 12 frameworks were: 1. Framework for Environmental Health Risk Management (US Presidential/Congressional Commission on Risk Assessment and Risk Management, 1997). 2. Health Risk Determination: The Challenge of Health Protection (Health and Welfare Canada, 1990). 3. Health Canada Decision-Making Framework for Identifying, Assessing and Managing Health Risks (Health Canada, 2000). 4. Canadian Environmental Protection Act: Human Health Risk Assessment of Priority Substances(Health Canada, 1994). 5. CSA-Q8550 Risk Management: Guidelines for Decision-Makers (Canada Standards Association, 1997). 6. Risk Assessment in the Federal Government: Managing the Process (US National Research Council, 1983). 7. Understanding Risk: Informing Decisions in a Democratic Society (US National Research Council, 1996). 8. Environmental Health Risk Assessment (enHealth Council of Australia, 2002). 9. A Framework for Ecological Risk Assessment (CCME, 1996). 10. Ecological Risk Assessments of Priority Substances Under the Canadian Environmental Protection Act (Environment Canada, 1996).11. Guidelines for Ecological Risk Assessment (US EPA, 1998b). 12. Proposed Model for Occupational Health Risk Assessment and Management (Rampal & Sadhra, 1999). Based on the extensive review of these frameworks, seven key elements that should be included in a comprehensive framework for human health, ecological, and occupational risk assessment and management were identified: 1. Problem formulation stage. 2. Stakeholder involvement. 3. Communication. 4. Quantitative risk assessment components. 5. Iteration and evaluation. 6. Informed decision making. 7. Flexibility. On the basis of this overarching approach to risk management, the following "checklist" to ensure a good risk management decision is proposed: - Make sure you're solving the right problem. - Consider the problem and the risk within the full context of the situation, using a broad perspective. - Acknowledge, incorporate, and balance the multiple dimensions of risk. - Ensure the highest degree of reliability for all components of the risk management process. - Involve interested and effected parties from the outset of the process. - Commit to honest and open communication between all parties. - Employ continuous evaluation throughout the process (formative, process, and outcome evaluation), and be prepared to change the decision if new information becomes available. Comprehensive and sound principles are critical to providing structure and integrity to risk management frameworks. Guiding principles are intended to provide an ethical grounding for considering the many factors involved in risk management decision making. Ten principles are proposed to guide risk management decision making. The first four principles were adapted and modified from Hattis (1996) along with the addition of two more principles by Hrudey (2000). These have been supplemented by another four principles to make the 10 presented. The principles are based in fundamental ethical principles and values. These principles are intended to be aspirational rather than prescriptive--their application requires flexibility and practical judgement. Risk management is inherently a process in search of balance among competing interests and concerns. Each risk management decision will be "balancing act" of competing priorities, and trade-offs may sometimes have to be made between seemingly conflicting principles. The 10 decision-making principles, with the corresponding ethical principle in italics are: 1. Do more good than harm (beneficence, nonmalificence).- The ultimate goal of good risk management is to prevent or minimize risk, or to "do good" as much as possible. 2. Fair process of decision making (fairness, natural justice). - Risk management must be just, equitable, impartial, unbiased, dispassionate, and objective as far as possible given the circumstances of each situation. 3. Ensure an equitable distribution of risk (equity). - An equitable process of risk management would ensure fair outcomes and equal treatment of all concerned through an equal distribution of benefits and burdens (includes the concept of distributive justice, i.e., equal opportunities for all individuals). 4. Seek optimal use of limited risk management resources (utility). - Optimal risk management demands using limited resources where they will achieve the most risk reduction of overall benefit. 5. Promise no more risk management that can be delivered (honesty).- Unrealistic expectations of risk management can be avoided with honest and candid public accounting of what we know and don't know, and what we can and can't do using risk assessment and risk management. 6. Impose no more risk that you would tolerate yourself (the Golden Rule). - The Golden Rule is important in risk management because it forces decision makers to abandon complete detachment from their decisions so they may understand the perspectives of those affected. 7. Be cautious in the face of uncertainty ("better safe than sorry"). - Risk management must adopt a cautious approach when faced with a potentially serous risk, even if the evidence is uncertain. 8. Foster informed risk decision making for all stakeholders (autonomy). - Fostering autonomous decision making involves both providing people with the opportunity to participate, and full and honest disclosure of all the information required for informed decisions. 9. Risk management processes must be flexible and evolutionary to be open to new knowledge and understanding (evolution, evaluation, iterative process). - The incorporation of new evidence requires that risk management be a flexible, evolutionary, and iterative process, and that evaluation is employed at the beginning and througthout the process. 10. the complete elimination fo risk is not possible (life is not risk free).- Risk is pervasive in our society, and cannot be totally eliminated despite an oft-expressed public desire for "zero risk". However, the level of risk that may ve tolerable by any individual is dependent on values of beliefs, as well as scientific information. Each agency must continue to employ a process that meets the needs of their specific application of risk management. A single approach cannot satisfy the diverse areas to which risk decisions are being applied. However, with increasing experience in the application of the approaches, we are evolving to a common understanding of the essential elements and principles required for successful risk assessment, risk management, and risk communication. Risk management will continue to be a balancing act of competing priorities and needs. Flexibility and good judgement are ultimately the key to successfully making appropriate risk decisions.

DEVELOPING TOOLS FOR MONITORED NATURAL RECOVERY OF PCB-CONTAMINATED SEDIMENTS AT LAKE HARTWELL, SC

EPA Science Inventory

Contaminated sediments pose a risk to human health and the environment . The management of this risk is currently limited practically to three technologies: dredging, capping, and natural recovery. Monitored natural recovery relies on the natural burial and removal mechanisms to...

40 CFR 152.412 - Waivers and refunds.

Code of Federal Regulations, 2011 CFR

2011-07-01

... include, but are not limited to, pesticides offering unique advantages for reducing public health risks, those that significantly reduce a current environmental risk, or a product with extraordinary utility for use in Integrated Pest Management (IPM). [53 FR 19114, May 26, 1988, as amended at 58 FR 34203...

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.

An agent based architecture for high-risk neonate management at neonatal intensive care unit.

PubMed

Malak, Jaleh Shoshtarian; Safdari, Reza; Zeraati, Hojjat; Nayeri, Fatemeh Sadat; Mohammadzadeh, Niloofar; Farajollah, Seide Sedighe Seied

2018-01-01

In recent years, the use of new tools and technologies has decreased the neonatal mortality rate. Despite the positive effect of using these technologies, the decisions are complex and uncertain in critical conditions when the neonate is preterm or has a low birth weight or malformations. There is a need to automate the high-risk neonate management process by creating real-time and more precise decision support tools. To create a collaborative and real-time environment to manage neonates with critical conditions at the NICU (Neonatal Intensive Care Unit) and to overcome high-risk neonate management weaknesses by applying a multi agent based analysis and design methodology as a new solution for NICU management. This study was a basic research for medical informatics method development that was carried out in 2017. The requirement analysis was done by reviewing articles on NICU Decision Support Systems. PubMed, Science Direct, and IEEE databases were searched. Only English articles published after 1990 were included; also, a needs assessment was done by reviewing the extracted features and current processes at the NICU environment where the research was conducted. We analyzed the requirements and identified the main system roles (agents) and interactions by a comparative study of existing NICU decision support systems. The Universal Multi Agent Platform (UMAP) was applied to implement a prototype of our multi agent based high-risk neonate management architecture. Local environment agents interacted inside a container and each container interacted with external resources, including other NICU systems and consultation centers. In the NICU container, the main identified agents were reception, monitoring, NICU registry, and outcome prediction, which interacted with human agents including nurses and physicians. Managing patients at the NICU units requires online data collection, real-time collaboration, and management of many components. Multi agent systems are applied as a well-known solution for management, coordination, modeling, and control of NICU processes. We are currently working on an outcome prediction module using artificial intelligence techniques for neonatal mortality risk prediction. The full implementation of the proposed architecture and evaluation is considered the future work.

Patient safety in external beam radiotherapy, results of the ACCIRAD project: Current status of proactive risk assessment, reactive analysis of events, and reporting and learning systems in Europe.

PubMed

Malicki, Julian; Bly, Ritva; Bulot, Mireille; Godet, Jean-Luc; Jahnen, Andreas; Krengli, Marco; Maingon, Philippe; Prieto Martin, Carlos; Przybylska, Kamila; Skrobała, Agnieszka; Valero, Marc; Jarvinen, Hannu

2017-04-01

To describe the current status of implementation of European directives for risk management in radiotherapy and to assess variability in risk management in the following areas: 1) in-country regulatory framework; 2) proactive risk assessment; (3) reactive analysis of events; and (4) reporting and learning systems. The original data were collected as part of the ACCIRAD project through two online surveys. Risk assessment criteria are closely associated with quality assurance programs. Only 9/32 responding countries (28%) with national regulations reported clear "requirements" for proactive risk assessment and/or reactive risk analysis, with wide variability in assessment methods. Reporting of adverse error events is mandatory in most (70%) but not all surveyed countries. Most European countries have taken steps to implement European directives designed to reduce the probability and magnitude of accidents in radiotherapy. Variability between countries is substantial in terms of legal frameworks, tools used to conduct proactive risk assessment and reactive analysis of events, and in the reporting and learning systems utilized. These findings underscore the need for greater harmonisation in common terminology, classification and reporting practices across Europe to improve patient safety and to enable more reliable inter-country comparisons. Copyright © 2017 Elsevier B.V. All rights reserved.

Modelling fatigue and the use of fatigue models in work settings.

PubMed

Dawson, Drew; Ian Noy, Y; Härmä, Mikko; Akerstedt, Torbjorn; Belenky, Gregory

2011-03-01

In recent years, theoretical models of the sleep and circadian system developed in laboratory settings have been adapted to predict fatigue and, by inference, performance. This is typically done using the timing of prior sleep and waking or working hours as the primary input and the time course of the predicted variables as the primary output. The aim of these models is to provide employers, unions and regulators with quantitative information on the likely average level of fatigue, or risk, associated with a given pattern of work and sleep with the goal of better managing the risk of fatigue-related errors and accidents/incidents. The first part of this review summarises the variables known to influence workplace fatigue and draws attention to the considerable variability attributable to individual and task variables not included in current models. The second part reviews the current fatigue models described in the scientific and technical literature and classifies them according to whether they predict fatigue directly by using the timing of prior sleep and wake (one-step models) or indirectly by using work schedules to infer an average sleep-wake pattern that is then used to predict fatigue (two-step models). The third part of the review looks at the current use of fatigue models in field settings by organizations and regulators. Given their limitations it is suggested that the current generation of models may be appropriate for use as one element in a fatigue risk management system. The final section of the review looks at the future of these models and recommends a standardised approach for their use as an element of the 'defenses-in-depth' approach to fatigue risk management. Copyright © 2010 Elsevier Ltd. All rights reserved.

Medical Data Architecture (MDA) Project Status

NASA Technical Reports Server (NTRS)

Krihak, M.; Middour, C.; Gurram, M.; Wolfe, S.; Marker, N.; Winther, S.; Ronzano, K.; Bolles, D.; Toscano, W.; Shaw, T.

2018-01-01

The Medical Data Architecture (MDA) project supports the Exploration Medical Capability (ExMC) risk to minimize or reduce the risk of adverse health outcomes and decrements in performance due to in-flight medical capabilities on human exploration missions. To mitigate this risk, the ExMC MDA project addresses the technical limitations identified in ExMC Gap Med 07: We do not have the capability to comprehensively process medically-relevant information to support medical operations during exploration missions. This gap identifies that the current in-flight medical data management includes a combination of data collection and distribution methods that are minimally integrated with on-board medical devices and systems. Furthermore, there are a variety of data sources and methods of data collection. For an exploration mission, the seamless management of such data will enable a more medically autonomous crew than the current paradigm. The medical system requirements are being developed in parallel with the exploration mission architecture and vehicle design. ExMC has recognized that in order to make informed decisions about a medical data architecture framework, current methods for medical data management must not only be understood, but an architecture must also be identified that provides the crew with actionable insight to medical conditions. This medical data architecture will provide the necessary functionality to address the challenges of executing a self-contained medical system that approaches crew health care delivery without assistance from ground support. Hence, the products supported by current prototype development will directly inform exploration medical system requirements.

Medical Data Architecture Project Status

NASA Technical Reports Server (NTRS)

Krihak, M.; Middour, C.; Gurram, M.; Wolfe, S.; Marker, N.; Winther, S.; Ronzano, K.; Bolles, D.; Toscano, W.; Shaw, T.

2018-01-01

The Medical Data Architecture (MDA) project supports the Exploration Medical Capability (ExMC) risk to minimize or reduce the risk of adverse health outcomes and decrements in performance due to in-flight medical capabilities on human exploration missions. To mitigate this risk, the ExMC MDA project addresses the technical limitations identified in ExMC Gap Med 07: We do not have the capability to comprehensively process medically-relevant information to support medical operations during exploration missions. This gap identifies that the current in-flight medical data management includes a combination of data collection and distribution methods that are minimally integrated with on-board medical devices and systems. Furthermore, there are a variety of data sources and methods of data collection. For an exploration mission, the seamless management of such data will enable a more medically autonomous crew than the current paradigm. The medical system requirements are being developed in parallel with the exploration mission architecture and vehicle design. ExMC has recognized that in order to make informed decisions about a medical data architecture framework, current methods for medical data management must not only be understood, but an architecture must also be identified that provides the crew with actionable insight to medical conditions. This medical data architecture will provide the necessary functionality to address the challenges of executing a self-contained medical system that approaches crew health care delivery without assistance from ground support. Hence, the products supported by current prototype development will directly inform exploration medical system requirements.

Risk management in obstetric care for family physicians: results of a 10-year project.

PubMed

Nesbitt, Thomas S; Hixon, Allen; Tanji, Jeffrey L; Scherger, Joseph E; Abbott, Dana

2003-01-01

Malpractice issues within the United States remain a critical factor for family physicians providing obstetric care. Although tort reform is being widely discussed, little has been written regarding the malpractice crisis from a risk management perspective. Between 1989 and 1998, a 10-year risk management study at the UC Davis Health System provided a unique collaboration between researchers, a mutual insurance carrier and family physicians practicing obstetrics. Physicians were asked to comply with standardized clinical guidelines, attend continuing medical education (CME) seminars, and submit obstetric medical records for review. Feedback analysis was provided to each physician on their records, and the insurance carrier tracked interim malpractice claims. One hundred and ninety-four physicians participated, attending to 32,831 births. Compliance with project guidelines was 91%. Five closed obstetric cases were reported with only one settlement reported to the National Provider Data Bank. Physicians believed the project was beneficial to their practices. Family physicians practicing obstetrics are willing to participate in a collaborative risk management program and are compliant with standardized clinical guidelines. The monetary award for successful malpractice claims was relatively low. This collaborative risk management model may offer a potential solution to the current malpractice crisis.

The genetic basis of Lynch syndrome and its implications for clinical practice and risk management

PubMed Central

Cohen, Stephanie A; Leininger, Anna

2014-01-01

Lynch syndrome is the most common cause of hereditary colon cancer, and accounts for as much as 3% of all colon and endometrial cancers. The identification and management of individuals with Lynch syndrome have evolved over the past 20 years, yet the syndrome remains vastly underdiagnosed. It is important for clinicians to recognize individuals and families who are at risk in order to be able to manage them appropriately and reduce their morbidity and mortality from this condition. This review will touch on the history of Lynch syndrome, the current knowledge of genotype–phenotype correlations, the cancers associated with Lynch syndrome, and management of individuals who are gene carriers. PMID:25161364

Managing risk and marginalizing identities: on the society-of-captives thesis and the harm of social dis-ease.

PubMed

Arrigo, Bruce A

2013-06-01

This article develops the constitutive features of the society-of-captives thesis as suggested by Arrigo and Milovanovic, and Arrigo, Bersot, and Sellers. The relevance of this thesis is briefly explored in relation to the institutional and community-based treatment philosophies that currently inform the mental health and criminal justice systems. This exploration specifies how risk (being human and doing humanness differently) is managed symbolically, linguistically, materially, and culturally. The management of this risk extends to the kept as well as to their keepers, regulators, and watchers (i.e., the society of captives). This article calls for a new clinical praxis (being/doing a critical mindfulness) designed to overcome the totalizing madness (the harm of social dis-ease) that follows from managing risk fearfully and marginalizing identities desperately as reified recursively through society's captivity. The ethical underpinnings of this clinical praxis represent an emergent direction for undertaking correctional policy reform.

Putting Climate Adaptation on the Map: Developing Spatial Management Strategies for Whitebark Pine in the Greater Yellowstone Ecosystem.

PubMed

Ireland, Kathryn B; Hansen, Andrew J; Keane, Robert E; Legg, Kristin; Gump, Robert L

2018-06-01

Natural resource managers face the need to develop strategies to adapt to projected future climates. Few existing climate adaptation frameworks prescribe where to place management actions to be most effective under anticipated future climate conditions. We developed an approach to spatially allocate climate adaptation actions and applied the method to whitebark pine (WBP; Pinus albicaulis) in the Greater Yellowstone Ecosystem (GYE). WBP is expected to be vulnerable to climate-mediated shifts in suitable habitat, pests, pathogens, and fire. We spatially prioritized management actions aimed at mitigating climate impacts to WBP under two management strategies: (1) current management and (2) climate-informed management. The current strategy reflected management actions permissible under existing policy and access constraints. Our goal was to understand how consideration of climate might alter the placement of management actions, so the climate-informed strategies did not include these constraints. The spatial distribution of actions differed among the current and climate-informed management strategies, with 33-60% more wilderness area prioritized for action under climate-informed management. High priority areas for implementing management actions include the 1-8% of the GYE where current and climate-informed management agreed, since this is where actions are most likely to be successful in the long-term and where current management permits implementation. Areas where climate-informed strategies agreed with one another but not with current management (6-22% of the GYE) are potential locations for experimental testing of management actions. Our method for spatial climate adaptation planning is applicable to any species for which information regarding climate vulnerability and climate-mediated risk factors is available.

Putting Climate Adaptation on the Map: Developing Spatial Management Strategies for Whitebark Pine in the Greater Yellowstone Ecosystem

NASA Astrophysics Data System (ADS)

Ireland, Kathryn B.; Hansen, Andrew J.; Keane, Robert E.; Legg, Kristin; Gump, Robert L.

2018-06-01

Natural resource managers face the need to develop strategies to adapt to projected future climates. Few existing climate adaptation frameworks prescribe where to place management actions to be most effective under anticipated future climate conditions. We developed an approach to spatially allocate climate adaptation actions and applied the method to whitebark pine (WBP; Pinus albicaulis) in the Greater Yellowstone Ecosystem (GYE). WBP is expected to be vulnerable to climate-mediated shifts in suitable habitat, pests, pathogens, and fire. We spatially prioritized management actions aimed at mitigating climate impacts to WBP under two management strategies: (1) current management and (2) climate-informed management. The current strategy reflected management actions permissible under existing policy and access constraints. Our goal was to understand how consideration of climate might alter the placement of management actions, so the climate-informed strategies did not include these constraints. The spatial distribution of actions differed among the current and climate-informed management strategies, with 33-60% more wilderness area prioritized for action under climate-informed management. High priority areas for implementing management actions include the 1-8% of the GYE where current and climate-informed management agreed, since this is where actions are most likely to be successful in the long-term and where current management permits implementation. Areas where climate-informed strategies agreed with one another but not with current management (6-22% of the GYE) are potential locations for experimental testing of management actions. Our method for spatial climate adaptation planning is applicable to any species for which information regarding climate vulnerability and climate-mediated risk factors is available.

Improving flood risk mapping in Italy: the FloodRisk open-source software

NASA Astrophysics Data System (ADS)

Albano, Raffaele; Mancusi, Leonardo; Craciun, Iulia; Sole, Aurelia; Ozunu, Alexandru

2017-04-01

Time and again, floods around the world illustrate the devastating impact they can have on societies. Furthermore, the expectation that the flood damages can increase over time with climate, land-use change and social growth in flood prone-areas has raised the public and other stakeholders' (governments, international organization, re-insurance companies and emergency responders) awareness for the need to manage risks in order to mitigate their causes and consequences. In this light, the choice of appropriate measures, the assessment of the costs and effects of such measures, and their prioritization are crucial for decision makers. As a result, a priori flood risk assessment has become a key part of flood management practices with the aim of minimizing the total costs related to the risk management cycle. In this context, The EU Flood Directive 2007/60 requires the delineation of flood risk maps on the bases of most appropriate and advanced tools, with particular attention on limiting required economic efforts. The main aim of these risk maps is to provide the required knowledge for the development of flood risk management plans (FRMPs) by considering both costs and benefits of alternatives and results from consultation with all interested parties. In this context, this research project developed a free and open-source (FOSS) GIS software, called FloodRisk, to operatively support stakeholders in their compliance with the FRMPs. FloodRisk aims to facilitate the development of risk maps and the evaluation and management of current and future flood risk for multi-purpose applications. This new approach overcomes the limits of the expert-drive qualitative (EDQ) approach currently adopted in several European countries, such as Italy, which does not permit a suitable evaluation of the effectiveness of risk mitigation strategies, because the vulnerability component cannot be properly assessed. Moreover, FloodRisk is also able to involve the citizens in the flood management process, enhancing their awareness. This FOSS approach can promotes transparency and accountability through a process of "guided discovery". Moreover, the immediacy with which information is presented by the qualitative flood risk map, can facilitate and speed up the process of knowledge acquisition. An application of FloodRisk model is showed on a pilot case in "Serio" Valley, (North Italy), and its strengths and limits, in terms of additional efforts required in its application compared with EDQ procedure, have been highlighted focusing on the utility of the results provided for the development of FRMPs. Although they still present limits which prevent the FloodRisk application without critically consider the peculiarities of the investigated area in terms of available knowledge on hazard, exposure and vulnerability, the proposed approach surely produces an increase in available knowledge of flood risk and its drivers. This further information cannot be neglected for defining risk mitigation objectives and strategies. Hence, considering the ongoing efforts in the improvement of data availability and quality, FloodRisk could be a suitable tool for the next revision of flood risk maps due by December 2019, supporting effectively Italian and EU practitioners in the delineation of FRMPs (and for flood risk management in general).

The management of women at high risk for the development of breast cancer: risk estimation and preventative strategies.

PubMed

Sakorafas, George H

2003-04-01

Despite recent progress in the diagnostic and therapeutic approaches to the management of women with breast cancer, at least one third of these women will ultimately die from their disease. This resulted in a new focus on breast cancer prevention, especially for the woman designed as "high-risk". The continuing challenge is to identify reliable markers to accurately recognize this group of women, who are more likely to develop breast cancer. This will allow a targeted specific counseling and the application of preventative measures. Management options in high-risk women include intensive cancer surveillance, chemoprevention (mainly using tamoxifen), and prophylactic surgery (preferentially total mastectomy). Cancer surveillance is the most preferred management option. Currently, no data exists comparing prophylactic mastectomy vs. surveillance vs. chemoprevention. Thus, despite significant advances in our understanding of the biology of breast cancer, many questions remain unanswered concerning the optimal management of the high-risk woman. Patient counseling has a central role in the decision-making process and should be based on a multidisciplinary approach. The individual woman will make the final decision based on the amount of risk she is willing to accept. It is hoped that other preventative methods, such as gene therapy based on an accurate identification of specific genetic changes, will be developed in the future.

EVALUATION OF A NURSE-LED HYPERTENSION MANAGEMENT INTERVENTION IN AUSTRALIAN GENERAL PRACTICE: THE IMPRESS INTERVENTION.

PubMed

Stephen, Catherine

2016-08-01

Hypertension is currently the most frequently seen condition in Australian general practice (Britt et al. 2015). Of the 4.6 million Australians living with hypertension, many struggle to keep their blood pressure under control and are at increased risk of renal failure, cardiovascular disease and premature death (Australian Institute of Health and Welfare, 2015; Cadilhac et al. 2012). The General Practice Nurse (GPN) has a significant role to play in supporting self-management and lifestyle risk factor reduction.

Survey of management of acute, traumatic compartment syndrome of the leg in Australia.

PubMed

Wall, Christopher J; Richardson, Martin D; Lowe, Adrian J; Brand, Caroline; Lynch, Joan; de Steiger, Richard N

2007-09-01

Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency and is associated with significant morbidity if not diagnosed promptly and treated effectively. Despite the urgency of effective management to minimize the risk of adverse outcomes, there is currently little consensus in the published reports as to what constitutes best practice in the management of acute limb compartment syndrome. A structured survey was sent to all currently practising orthopaedic surgeons and accredited orthopaedic registrars in Australia to assess their current practice in the management of acute, traumatic compartment syndrome of the leg. Questions were related to key decision nodes in the management process, as identified in a literature review. These included identification of patients at high risk, diagnosis of the condition in alert and unconscious patients, optimal timeframe and technique for carrying out a fasciotomy and management of fasciotomy wounds. A total of 264 valid responses were received, a response rate of 29% of all eligible respondents. The results indicated considerable variation in management of acute compartment syndrome of the leg, in particular in the utilization of compartment pressure measurement and the appropriate pressure threshold for fasciotomy. Of the 78% of respondents who regularly measured compartment pressure, 33% used an absolute pressure threshold, 28% used a differential pressure threshold and 39% took both into consideration. There is variation in the management of acute, traumatic compartment syndrome of the leg in Australia. The development of evidence-based clinical practice guidelines may be beneficial.

Risk based requirements for long term stewardship: A proof-of-principle analysis of an analytic method tested on selected Hanford locations

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

Jarvis, T.T.; Andrews, W.B.; Buck, J.W.

1998-03-01

Since 1989, the Department of Energy`s (DOE) Environmental Management (EM) Program has managed the environmental legacy of US nuclear weapons production, research and testing at 137 facilities in 31 states and one US territory. The EM program has conducted several studies on the public risks posed by contaminated sites at these facilities. In Risks and the Risk Debate [DOE, 1995a], the Department analyzed the risks at sites before, during, and after remediation work by the EM program. The results indicated that aside from a few urgent risks, most hazards present little inherent risk because physical and active site management controlsmore » limit both the releases of site contaminants, and public access to these hazards. Without these controls, these sites would pose greater risks to the public. Past risk reports, however, provided little information about post-cleanup risk, primarily because of uncertainty about future site uses and site characteristics at the end of planned cleanup activities. This is of concern because in many cases current cleanup technologies, and remedies, will last a shorter period of time than the waste itself and the resulting contamination will remain hazardous.« less

Using Risk Assessment Methodologies to Meet Management Objectives

NASA Technical Reports Server (NTRS)

DeMott, D. L.

2015-01-01

Current decision making involves numerous possible combinations of technology elements, safety and health issues, operational aspects and process considerations to satisfy program goals. Identifying potential risk considerations as part of the management decision making process provides additional tools to make more informed management decision. Adapting and using risk assessment methodologies can generate new perspectives on various risk and safety concerns that are not immediately apparent. Safety and operational risks can be identified and final decisions can balance these considerations with cost and schedule risks. Additional assessments can also show likelihood of event occurrence and event consequence to provide a more informed basis for decision making, as well as cost effective mitigation strategies. Methodologies available to perform Risk Assessments range from qualitative identification of risk potential, to detailed assessments where quantitative probabilities are calculated. Methodology used should be based on factors that include: 1) type of industry and industry standards, 2) tasks, tools, and environment 3) type and availability of data and 4) industry views and requirements regarding risk & reliability. Risk Assessments are a tool for decision makers to understand potential consequences and be in a position to reduce, mitigate or eliminate costly mistakes or catastrophic failures.

Tsunami Risk Management in Pacific Island Countries and Territories (PICTs): Some Issues, Challenges and Ways Forward

NASA Astrophysics Data System (ADS)

Dominey-Howes, Dale; Goff, James

2013-09-01

The Pacific is well known for producing tsunamis, and events such as the 2011 Tōhoku-oki, Japan disaster demonstrate the vulnerability of coastal communities. We review what is known about the current state of tsunami risk management for Pacific Island countries and territories (PICTs), identify the issues and challenges associated with affecting meaningful tsunami disaster risk reduction (DRR) efforts and outline strategies and possible ways forward. Small island states are scattered across the vast Pacific region and these states have to varying degrees been affected by not only large tsunamis originating in circum-Pacific subduction zones, but also more regionally devastating events. Having outlined and described what is meant by the risk management process, the various problems associated with our current understanding of this process are examined. The poorly understood hazard related to local, regional and distant sources is investigated and the dominant focus on seismic events at the expense of other tsunami source types is noted. We reflect on the challenges of undertaking numerical modelling from generation to inundation and specifically detail the problems as they relate to PICTs. This is followed by an exploration of the challenges associated with mapping exposure and estimating vulnerability in low-lying coastal areas. The latter part of the paper is devoted to exploring what mitigation of the tsunami risk can look like and draw upon good practice cases as exemplars of the actions that can be taken from the local to regional level. Importantly, given the diversity of PICTs, no one approach will suit all places. The paper closes by making a series of recommendations to assist PICTs and the wider tsunami research community in thinking through improvements to their tsunami risk management processes and the research that can underpin these efforts.

Anticoagulants for secondary prevention after acute myocardial infarction: lessons from the past decade

PubMed Central

Atar, Dan; Bode, Christoph; Stuerzenbecher, André; Verheugt, Freek W A

2014-01-01

The impact of an acute coronary syndrome (ACS) event, such as an acute myocardial infarction (MI), is not limited to the acute management phase; patients face an elevated risk of residual atherothrombotic events that commonly requires chronic management for months or even years. Significant advances have been made in both the acute and chronic management of patients with acute MI over the past decade, resulting in improved prognoses. One of the hallmarks of modern treatment strategies is more aggressive antiplatelet treatment regimens. However, the risks of further ACS events, stroke and premature death remain elevated in these patients, and addressing this residual risk is challenging owing to interpatient variability, differences in management strategies between centres and countries, incomplete understanding of the specific pathophysiology of post-ACS thrombosis and limitations of current therapeutic approaches. The recent approval in Europe of the direct oral anticoagulant rivaroxaban for use in this setting in combination with clopidogrel and acetylsalicylic acid offers another strategy to consider in the management of these patients, and clinical strategies in this area continue to evolve. In this review, we chart the progress made over the past decade in reducing the burden of secondary thromboembolic events after acute MI and discuss the current position of and future perspectives on the inclusion of oral anticoagulants into care pathways in this setting. PMID:24494730

Sequential use of simulation and optimization in analysis and planning

Treesearch

Hans R. Zuuring; Jimmie D. Chew; J. Greg Jones

2000-01-01

Management activities are analyzed at landscape scales employing both simulation and optimization. SIMPPLLE, a stochastic simulation modeling system, is initially applied to assess the risks associated with a specific natural process occurring on the current landscape without management treatments, but with fire suppression. These simulation results are input into...

Tips for Dealing with Behavior Management Issues

ERIC Educational Resources Information Center

Bechtel, Pamela A.; Stevens, Lisa A.; Brett, Christine E. W.

2012-01-01

The increased diversity of today's students included in P-12 physical education classes creates new challenges in behavior management for physical education teachers. Currently more students with identified at-risk behaviors, as well as more students with physical or mental disabilities, are placed in general physical education classes. This…

Adaptive management for mitigating Cryptosporidium risk in source water: a case study in an agricultural catchment in South Australia.

PubMed

Bryan, Brett A; Kandulu, John; Deere, Daniel A; White, Monique; Frizenschaf, Jacqueline; Crossman, Neville D

2009-07-01

Water-borne pathogens such as Cryptosporidium pose a significant human health risk and catchments provide the first critical pollution 'barrier' in mitigating risk in drinking water supply. In this paper we apply an adaptive management framework to mitigating Cryptosporidium risk in source water using a case study of the Myponga catchment in South Australia. Firstly, we evaluated the effectiveness of past water quality management programs in relation to the adoption of practices by landholders using a socio-economic survey of land use and management in the catchment. The impact of past management on the mitigation of Cryptosporidium risk in source water was also evaluated based on analysis of water quality monitoring data. Quantitative risk assessment was used in planning the next round of management in the adaptive cycle. Specifically, a pathogen budget model was used to identify the major remaining sources of Cryptosporidium in the catchment and estimate the mitigation impact of 30 alternative catchment management scenarios. Survey results show that earlier programs have resulted in the comprehensive adoption of best management practices by dairy farmers including exclusion of stock from watercourses and effluent management from 2000 to 2007. Whilst median Cryptosporidium concentrations in source water have decreased since 2004 they remain above target levels and put pressure on other barriers to mitigate risk, particularly the treatment plant. Non-dairy calves were identified as the major remaining source of Cryptosporidium in the Myponga catchment. The restriction of watercourse access of non-dairy calves could achieve a further reduction in Cryptosporidium export to the Myponga reservoir of around 90% from current levels. The adaptive management framework applied in this study was useful in guiding learning from past management, and in analysing, planning and refocusing the next round of catchment management strategies to achieve water quality targets.

Epilepsy during pregnancy: focus on management strategies

PubMed Central

Borgelt, Laura M; Hart, Felecia M; Bainbridge, Jacquelyn L

2016-01-01

In the US, more than one million women with epilepsy are of childbearing age and have over 20,000 babies each year. Patients with epilepsy who become pregnant are at risk of complications, including changes in seizure frequency, maternal morbidity and mortality, and congenital anomalies due to antiepileptic drug exposure. Appropriate management of epilepsy during pregnancy may involve frequent monitoring of antiepileptic drug serum concentrations, potential preconception switching of antiepileptic medications, making dose adjustments, minimizing peak drug concentration with more frequent dosing, and avoiding potentially teratogenic medications. Ideally, preconception planning will be done to minimize risks to both the mother and fetus during pregnancy. It is important to recognize benefits and risks of current and emerging therapies, especially with revised pregnancy labeling in prescription drug product information. This review will outline risks for epilepsy during pregnancy, review various recommendations from leading organizations, and provide an evidence-based approach for managing patients with epilepsy before, during, and after pregnancy. PMID:27703396

Integrity management of offshore structures and its implication on computation of structural action effects and resistance

NASA Astrophysics Data System (ADS)

Moan, T.

2017-12-01

An overview of integrity management of offshore structures, with emphasis on the oil and gas energy sector, is given. Based on relevant accident experiences and means to control the associated risks, accidents are categorized from a technical-physical as well as human and organizational point of view. Structural risk relates to extreme actions as well as structural degradation. Risk mitigation measures, including adequate design criteria, inspection, repair and maintenance as well as quality assurance and control of engineering processes, are briefly outlined. The current status of risk and reliability methodology to aid decisions in the integrity management is briefly reviewed. Finally, the need to balance the uncertainties in data, methods and computational efforts and the cautious use and quality assurance and control in applying high fidelity methods to avoid human errors, is emphasized, and with a plea to develop both high fidelity as well as efficient, simplified methods for design.

Applying the lessons of high risk industries to health care

PubMed Central

Hudson, P

2003-01-01

High risk industries such as commercial aviation and the oil and gas industry have achieved exemplary safety performance. This paper reviews how they have managed to do that. The primary reasons are the positive attitudes towards safety and the operation of effective formal safety management systems. The safety culture provides an important explanation of why such organisations perform well. An evolutionary model of safety culture is provided in which there is a range of cultures from the pathological through the reactive to the calculative. Later, the proactive culture can evolve towards the generative organisation, an alternative description of the high reliability organisation. The current status of health care is reviewed, arguing that it has a much higher level of accidents and has a reactive culture, lagging behind both high risk industries studied in both attitude and systematic management of patient risks. PMID:14645741

Imaging X-Ray Polarimetry Explorer (IXPE) Risk Management

NASA Technical Reports Server (NTRS)

Alexander, Cheryl; Deininger, William D.; Baggett, Randy; Primo, Attina; Bowen, Mike; Cowart, Chris; Del Monte, Ettore; Ingram, Lindsey; Kalinowski, William; Kelley, Anthony;

Statin myopathy: the fly in the ointment for the prevention of cardiovascular disease in the 21st century?

PubMed

Keen, Helen I; Krishnarajah, Janakan; Bates, Timothy R; Watts, Gerald F

2014-09-01

Cardiovascular disease (CVD) remains the leading cause of death in industrialized nations. Despite clear evidence of CVD risk reduction with HMG-CoA reductase inhibitors (statins), the side effects of these medications, particularly myopathy, limit their effectiveness. Studies into the mechanisms, aetiology and management of statin myopathy are limited by lack of an internationally agreed clinical definition and tools for assessing outcomes. Currently there is a paucity of evidence to guide the management of patients affected by statin myopathy; with the exception of dose reduction, there is little evidence that other strategies can improve statin tolerance, and even less evidence to suggest these alternate dosing strategies reduce cardiovascular risk. This review will cover current definitions, clinical presentations, risk factors, pathogenesis and management. PubMed was searched (English language, to 2014) for key articles pertaining to statin myopathy. This review then briefly describes our experience of managing this condition in a tertiary lipid disorders clinic, in the setting of limited guiding evidence. Knowledge gaps in the field of statin myopathy are identified and future research directions are suggested. We urge the need for international attention to address this important, but largely neglected clinical problem, that if unresolved will remain an impediment to the effective prevention and treatment of CVD.

Cardiovascular Update: Risk, Guidelines, and Recommendations.

PubMed

Pearson, Tamera

2015-09-01

This article provides an update of the current status of cardiovascular disease (CVD) in the United States, including a brief review of the underlying pathophysiology and epidemiology. This article presents a discussion of the latest American Heart Association guidelines that introduce the concept of promoting ideal cardiovascular health, defined by seven identified metrics. Specific CVD risk factors and utilization of the 10-year CVD event prediction calculator are discussed. In addition, current management recommendations of health-related conditions that increase risk for CVD, such as hypertension and hypercholesterolemia, are provided. Finally, a discussion of detailed evidence-based lifestyle recommendations to promote cardiovascular health and reduce CVD risks concludes the update. © 2015 The Author(s).

Methadone, QTc prolongation and torsades de pointes: Current concepts, management and a hidden twist in the tale?

PubMed

Mujtaba, Sobia; Romero, Jorge; Taub, Cynthia C

2013-12-01

Methadone is a drug that has found widespread utility in the management of opioid addiction and pain. Along with its popularity, methadone has also earned an infamous reputation for causing prolongation of the QT interval and an increased risk of torsades de pointes. In this article we will give a brief overview of the long QT syndromes, followed by an in-depth look at the current pathophysiologic mechanisms of methadone induced QT prolongation, a review of the existing literature and the current concepts regarding the prevention and management of methadone induced torsades de pointes. In addition, we explore the idea and implications of a genetic link between methadone induced prolongation of the QT interval and torsades de pointes.

Intrauterine transfusion and non-invasive treatment options for hemolytic disease of the fetus and newborn - review on current management and outcome.

PubMed

Zwiers, Carolien; van Kamp, Inge; Oepkes, Dick; Lopriore, Enrico

2017-04-01

Hemolytic disease of the fetus and newborn (HDFN) remains a serious pregnancy complication which can lead to severe fetal anemia, hydrops and perinatal death. Areas covered: This review focusses on the current prenatal management, treatment with intrauterine transfusion (IUT) and promising non-invasive treatment options for HDFN. Expert commentary: IUTs are the cornerstone in prenatal management of HDFN and have significantly improved perinatal outcome in the past decades. IUT is now a relatively safe procedure, however the risk of complications is still high when performed early in the second trimester. Non-invasive management using intravenous immunoglobulin may be a safe alternative and requires further investigation.

Evaluating nonindigenous species management in a Bayesian networks derived relative risk framework for Padilla Bay, WA, USA.

PubMed

Herring, Carlie E; Stinson, Jonah; Landis, Wayne G

2015-10-01

Many coastal regions are encountering issues with the spread of nonindigenous species (NIS). In this study, we conducted a regional risk assessment using a Bayesian network relative risk model (BN-RRM) to analyze multiple vectors of NIS introductions to Padilla Bay, Washington, a National Estuarine Research Reserve. We had 3 objectives in this study. The 1st objective was to determine whether the BN-RRM could be used to calculate risk from NIS introductions for Padilla Bay. Our 2nd objective was to determine which regions and endpoints were at greatest risk from NIS introductions. Our 3rd objective was to incorporate a management option into the model and predict endpoint risk if it were to be implemented. Eradication can occur at different stages of NIS invasions, such as the elimination of these species before being introduced to the habitat or removal of the species after settlement. We incorporated the ballast water treatment management scenario into the model, observed the risk to the endpoints, and compared this risk with the initial risk estimates. The model results indicated that the southern portion of the bay was at greatest risk because of NIS. Changes in community composition, Dungeness crab, and eelgrass were the endpoints most at risk from NIS introductions. The currents node, which controls the exposure of NIS to the bay from the surrounding marine environment, was the parameter that had the greatest influence on risk. The ballast water management scenario displayed an approximate 1% reduction in risk in this Padilla Bay case study. The models we developed provide an adaptable template for decision makers interested in managing NIS in other coastal regions and large bodies of water. © 2015 SETAC.

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.

Managing risk during care transitions when approaching end of life: A qualitative study of patients' and health care professionals' decision making.

PubMed

Coombs, Maureen A; Parker, Roses; de Vries, Kay

2017-07-01

Increasing importance is being placed on the coordination of services at the end of life. To describe decision-making processes that influence transitions in care when approaching the end of life. Qualitative study using field observations and longitudinal semi-structured interviews. Field observations were undertaken in three sites: a residential care home, a medical assessment unit and a general medical unit in New Zealand. The Supportive and Palliative Care Indicators Tool was used to identify participants with advanced and progressive illness. Patients and family members were interviewed on recruitment and 3-4 months later. Four weeks of fieldwork were conducted in each site. A total of 40 interviews were conducted: 29 initial interviews and 11 follow-up interviews. Thematic analysis was undertaken. Managing risk was an important factor that influenced transitions in care. Patients and health care staff held different perspectives on how such risks were managed. At home, patients tolerated increasing risk and used specific support measures to manage often escalating health and social problems. In contrast, decisions about discharge in hospital were driven by hospital staff who were risk-adverse. Availability of community and carer services supported risk management while a perceived need for early discharge decision making in hospital and making 'safe' discharge options informed hospital discharge decisions. While managing risk is an important factor during care transitions, patients should be able to make choices on how to live with risk at the end of life. This requires reconsideration of transitional care and current discharge planning processes at the end of life.

Retinopathy of prematurity: a review of risk factors and their clinical significance.

PubMed

Kim, Sang Jin; Port, Alexander D; Swan, Ryan; Campbell, J Peter; Chan, R V Paul; Chiang, Michael F

2018-04-19

Retinopathy of prematurity (ROP) is a retinal vasoproliferative disease that affects premature infants. Despite improvements in neonatal care and management guidelines, ROP remains a leading cause of childhood blindness worldwide. Current screening guidelines are primarily based on two risk factors: birth weight and gestational age; however, many investigators have suggested other risk factors, including maternal factors, prenatal and perinatal factors, demographics, medical interventions, comorbidities of prematurity, nutrition, and genetic factors. We review the existing literature addressing various possible ROP risk factors. Although there have been contradictory reports, and the risk may vary between different populations, understanding ROP risk factors is essential to develop predictive models, to gain insights into pathophysiology of retinal vascular diseases and diseases of prematurity, and to determine future directions in management of and research in ROP. Copyright © 2018 Elsevier Inc. 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.

Study of Current Practice and Future Advancements in Blood Management and Effectiveness of a Multimodality Training Program on Improving Transfusion Knowledge, Practice and Outcomes

DTIC Science & Technology

2012-08-01

to trauma, surgery or blood diseases such as anemia, hemophilia or sickle- cell disease. But transfusions carry risks. Current practices are often...Blood Management Topic 4: Diagnosis of Red cell disorders and oxygen carrying capacity Topic 5: Diagnosis of Disorders in homeostasis Topic 6...the Clinical Transfusion Medicine Committee of the AABB. Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB. Ann Intern Med

Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk.

PubMed

Sauerland, Carmel; Engelking, Constance; Wickham, Rita; Corbi, Dominick

2006-11-27

To review the literature regarding the incidence, current practice, guideline recommendations, nursing management, and knowledge gaps relevant to vesicant extravasation. Published research articles, books, case reports, and national guidelines. Vesicant extravasation is a relatively rare but significant complication of chemotherapy administration. Extravasation may have a range of consequences that can cause serious physical and quality-of-life effects. Knowledge of risk factors and preventive measures can reduce patient risk. Data-based and empirical management strategies such as immediate local measures (agent withdrawal, comfort measures, and medical interventions) may minimize risk for extravasation, as well as lead to timely recognition and management and decreased morbidity should extravasation occur. Vesicant extravasation and sequelae constitute a complex patient problem that clinicians should strive to prevent or to minimize injury should it occur. To this end, clinicians must demonstrate awareness of risks and use specialized knowledge while administering vesicant agents. Only nurses knowledgeable about extravasation and skilled in associated techniques should assume responsibility for vesicant administration.

Considerations to improve the safety of cervical spine manual therapy.

PubMed

Hutting, Nathan; Kerry, Roger; Coppieters, Michel W; Scholten-Peeters, Gwendolijne G M

2018-02-01

Manipulation and mobilisation of the cervical spine are well established interventions in the management of patients with headache and/or neck pain. However, their benefits are accompanied by potential, yet rare risks in terms of serious adverse events, including neurovascular insult to the brain. A recent international framework for risk assessment and management offers directions in the mitigation of this risk by facilitating sound clinical reasoning. The aim of this article is to critically reflect on and summarize the current knowledge about cervical spine manual therapy and to provide guidance for clinical reasoning for cervical spine manual therapy. Copyright © 2017 Elsevier Ltd. All rights reserved.

A single-center experience and review of the literature: 64 cases of phyllodes tumors to better understand risk factors and disease management.

PubMed

Lightner, Amy L; Shurell, Elizabeth; Dawson, Nicole; Omidvar, Yasaman; Foster, Nova

2015-03-01

Phyllodes tumors of the breast are rare fibroepithelial tumors that are characterized as benign, borderline, or malignant based on cellular characteristics such as stromal overgrowth and number of mitoses. Currently, there is a lack of consensus on risk factors and management of patients with phyllodes tumors, which has led to variation in treatment patterns as well as patient outcomes across many institutions. This study seeks to understand the clinicopathologic features, risk factors for local and metastatic recurrence, and clinical outcomes of patients with phyllodes tumors to better define optimal treatment patterns.

Canadian Association of General Surgeons position statement: recommendations for surgeons with blood-borne communicable diseases.

PubMed

Cleary, Sean; Doucette, Karen; Doig, Christopher J; Coffin, Carla; Grant, David; Dixon, Elijah

2016-04-01

The potential for transmission of hematogenously transmitted pathogens during exposure-prone procedures is a clinically important concern to both patients and surgeons. There is inconsistency among regulatory bodies in Canada regarding the management of infection risk among surgeons, particularly with regard to screening and the postexposure management of infected surgeons. The Canadian Association of General Surgeons commissioned a task force to review the evidence regarding the management of blood-borne pathogens and transmission risk during surgical procedures. The results of this review indicate a need for several jurisdictions to update their guidelines to reflect current evidence-based practices.

Evaluation of the Eological Management and Enhancement Alernative for Remediation of the K1007-P1 Pond

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

Peterson, M.J.

2005-10-31

An evaluation of the human and ecological risks associated with the P1 Pond and surrounding environs was conducted as part of the ETTP Site-Wide Remedial Investigation. The RI provides the basis for the focus on PCBs as the most important unacceptable risk to human and ecological health in the pond. Other P1 contaminants, media, or pathways of risk to receptors are identified in the RI, but are not addressed as a major risk reduction goal for the ETTP Site-Wide Feasibility Study. Therefore, the goal of the Ecological Management alternative is to reduce unacceptable risks associated with PCBs in fish. Manymore » of the actions proposed for this alternative, however, are likely to reduce risks associated with other contaminants and their pathways. The high PCB concentrations in fish from the P1 Pond are most certainly due in part to the current ecological condition of the pond that maximizes PCB biomagnification. This basic assumption and the factors contributing to it were evaluated by conducting an intensive field study of the P1 Pond in the summer of 2004 (for a thorough presentation of current P1 Pond biological conditions, see Peterson et al. 2005). Major hypotheses regarding the P1 Pond's current fish community, PCB fate and transport processes, pond vegetation, and limnological conditions that contribute to the high PCB levels in fish were validated by the study (Appendix A), The results of the 2004 ecological assessment, in concert with long-term datasets obtained as part of the ETTP Biological Monitoring and Abatement Program (BMAP) and recent abiotic sampling for the RI, provide the basis for the assessment of current conditions.« less

PROACTIVE DEFENSE FOR EVOLVING SUPPLY CHAIN COUNTERFEITING

DTIC Science & Technology

2015-12-01

Mohana . "DOD’s Current Infosec Strategy Is "Patch and Pray"" Newsgroup. October 1, 2015. Defense One. Rostami, Masoud, Farinaz Koushanfar, and...Managing Supply Chain Risk Effectively. Technical paper. RESIL. 17. Ravindranath, Mohana . "DOD’s Current Infosec Strategy Is "Patch and Pray

Using landscape epidemiological models to understand the distribution of chronic wasting disease in the Midwestern USA

USGS Publications Warehouse

Robinson, Stacie J.; Samuel, Michael D.; Rolley, Robert E.; Shelton, Paul

2013-01-01

Animal movement across the landscape plays a critical role in the ecology of infectious wildlife diseases. Dispersing animals can spread pathogens between infected areas and naïve populations. While tracking free-ranging animals over the geographic scales relevant to landscape-level disease management is challenging, landscape features that influence gene flow among wildlife populations may also influence the contact rates and disease spread between populations. We used spatial diffusion and barriers to white-tailed deer gene flow, identified through landscape genetics, to model the distribution of chronic wasting disease (CWD) in the infected region of southern Wisconsin and northern Illinois, USA. Our generalized linear model showed that risk of CWD infection declined exponentially with distance from current outbreaks, and inclusion of gene flow barriers dramatically improved fit and predictive power of the model. Our results indicate that CWD is spreading across the Midwestern landscape from these two endemic foci, but spread is strongly influenced by highways and rivers that also reduce deer gene flow. We used our model to plot a risk map, providing important information for CWD management by identifying likely routes of disease spread and providing a tool for prioritizing disease monitoring and containment efforts. The current analysis may serve as a framework for modeling future disease risk drawing on genetic information to investigate barriers to spread and extending management and monitoring beyond currently affected regions.

Venous Thromboembolism Prophylaxis in Outpatient Lower Limb Fractures and Injuries.

PubMed

Ajwani, Sanil H; Shaw, Alex; Naiz, Osamah; Bhaskar, Deepu; Charalambous, Charalambos P

2016-05-05

The risk of venous thromboembolism (VTE) is a preventable complication of trauma in ambulatory patients requiring temporary lower limb immobilisation. We introduced a VTE risk assessment and management tool in fracture clinics, to help improve appropriate VTE management of trauma patients that do not require hospitalisation. This was based on guidelines published by the College of Emergency Medicine (UK). Clinicians were asked to follow the screening tool and manage patients as per the pathway. We aimed to determine the rate of VTE risk assessment and management of outpatient fracture patients following the introduction of the new assessment tool. We prospectively evaluated a cohort of lower limb fracture patients presenting to a fracture clinic following the introduction of the new VTE risk assessment group and compared it to a retrospective cohort treated prior to the new tool. Prior to introduction of the new assessment tool only 5 of 30 (16.7%) patients were assessed for VTE risk. After introduction of the VTE screening tool, 27 of 28 patients (96.4%) were assessed for VTE risk (P<0.001). We are able to show that implementing a VTE screening tool in an orthopaedic outpatient fracture clinic to patients with lower limb trauma requiring temporary limb immobilisation can improve VTE risk assessment in accordance with current guidelines.

Cost-Effectiveness Analysis of Using Loss of Heterozygosity to Manage Premalignant Oral Dysplasia in British Columbia, Canada.

PubMed

Cromwell, Ian; Regier, Dean A; Peacock, Stuart J; Poh, Catherine F

2016-09-01

Management of low-grade oral dysplasias (LGDs) is complicated, as only a small percentage of lesions will progress to invasive disease. The current standard of care requires patients to undergo regular monitoring of their lesions, with intervention occurring as a response to meaningful clinical changes. Recent improvements in molecular technologies and understanding of the biology of LGDs may allow clinicians to manage lesions based on their genome-guided risk. We used a decision-analytic Markov model to estimate the cost-effectiveness of risk-stratified care using a genomic assay. In the experimental arm, patients with LGDs were managed according to their risk profile using the assay, with low- and intermediate-risk patients given longer screening intervals and high-risk patients immediately treated with surgery. Patients in the comparator arm had standard care (biannual follow-up appointments at an oral cancer clinic). Incremental costs and outcomes in life-years gained (LYG) and quality-adjusted life-years (QALY) were calculated based on the results in each arm. The mean cost of assay-guided management was $8,123 (95% confidence interval [CI] $2,973 to $23,062 in 2013 Canadian dollars) less than the cost of standard care. This difference was driven largely by reductions in resource use among people who did not develop cancer. Mean incremental effectiveness was 0.18 LYG (95% CI 0.08 to 0.39) or 0.64 QALY (95% CI 0.46 to 0.89). Sensitivity analysis suggests that these findings are robust to both expected and extreme variation in all parameter values. Use of the assay-guided management strategy costs less and is more effective than standard management of LGDs. The findings of this study strongly suggest that the use of a risk-stratification method such as a genomic assay can result in improved quality-adjusted survival outcomes for patients with low-grade oral dysplasia (LGD). The use of such an assay in this study provides "precision medicine," allowing for a change in follow-up frequency or early intervention as compared with current standard care. As genomic technologies become more common in cancer care, it is hoped that such an assay, once validated, will become part of a new model for the standard management of LGDs in similar health systems. ©AlphaMed Press.

Current Indications for Implantable Cardioverter Defibrillators in Non-Ischemic Cardiomyopathies and Channelopathies.

PubMed

González-Torrecilla, Esteban; Arenal, Angel; Atienza, Felipe; Datino, Tomás; Bravo, Loreto; Ruiz, Pablo; Ávila, Pablo; Fernández-Avilés, Francisco

2015-01-01

Current indications for implantable cardioverter defibrillators (ICDs) in patients with channelopathies and cardiomyopathies of non-ischemic origin are mainly based on non-randomized evidence. In patients with nonischemic dilated cardiomyopathy (NIDCM), there is a tendency towards a beneficial effect on total mortality of ICD therapy in patients with significant left ventricular (LV) dysfunction. Although an important reduction in sudden cardiac death (SCD) seems to be clearly demonstrated in these patients, a net beneficial effect on total mortality is unclear mostly in cases with good functional status. Risk stratification has been changing over the last two decades in patients with hypertrophic cardiomyopathy (HCM). Its risk profile has been delineated in parallel with the beneficial effect of ICD in high risk patients. Observational results based on "appropriate" ICD interventions do support its usefulness both in primary and secondary SCD prevention in these patients. Novel risk models quantify the rate of sudden cardiac death in these patients on individual basis. Less clear risk stratification is available for cases of arrhythmogenic right ventricular cardiomyopathy (ARVC) and in other uncommon familiar cardiomyopathies. Main features of risk stratification vary among the different channelopathies (long QT syndrome -LQTS-, Brugada syndrome, etc) with great debate on the management of asymptomatic patients. For most familiar cardiomyopathies, ICD therapy is the only accepted strategy in the prevention of SCD. So far, genetic testing has a limited role in risk evaluation and management of the individual patient. This review aims to summarize these criticisms and to refine the current indications of ICD implantation in patients with cardiomyopathies and major channelopathies.

Risk Management in Construction Project: Taking Fairness into Account

NASA Astrophysics Data System (ADS)

Górecki, Jarosław; Bizon-Górecka, Jadwiga

2017-10-01

Risk management requires a comprehensive review of possible hazards, their possible outcomes as well as some recommendations about minimizing the risk. The study emphasises that the project risk management refers to an analysis of the risk factors and a creation of the strategy minimising negative effects of the risk. It was pointed out that a construction project is this kind of projects that can be defined as a unique process of high complexity (design documentation, various stages of creating the building), which has clearly defined time frames and a given financial limit. It is executed as a team work, by qualified or highly qualified specialists of different matters, for example masonry, precast, etc. Additionally, it requires a use of modern equipment and an adequate preparation of the investment. Therefore, the risk management focuses on the problems allowing for troubleshooting. A basis of the risk management is to recognise the fundamentals, which are crucial for the construction project management, i.e. an object perspective, including technological, supporting and management processes as well as an entity perspective - project stakeholders. Construction projects require also an acquaintance with the specificity of the branch. The article refers to the risk management in construction project and, in particular, a phenomenon of participants’ fairness in such projects. The problem of fairness of the entities involved in a project should be understood as a fair play, according to the arrangements agreed in a contract and compatible with current formal procedures and social rules. It was indicated that fairness can be treated as an important factor in predicting the success of such projects. Interviews conducted among contractors in Kuyavian-Pomeranian region showed varied fairness requirements put to individual participants of construction projects. The article presents results of the research. It shows a desired attitude of the surveyed enterprises towards a problem of the fair behaviour. These behaviours, relating to individual stakeholders, have been underlined in different phases of the construction projects’ life cycle.

[Integrated Management Area of Vascular Risk: A new organisational model for global control of risk factors].

PubMed

Armario, P; Jericó, C; Vila, L; Freixa, R; Martin-Castillejos, C; Rotllan, M

Cardiovascular disease (CVD), is a major cause of morbidity and mortality that increases the cost of care. Currently there is a low degree of control of the main cardiovascular risk factors, although we have a good therapeutic arsenal. To achieve the improvement of this reality, a good coordination and multidisciplinary participation are essential. The development of new organizational models such as the Integrated Management Area of Vascular Risk can facilitate the therapeutic harmonization and unification of the health messages offered by different levels of care, based on clinical practice guidelines, in order to provide patient-centred integrated care. Copyright © 2016 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

Can we ensure the safe use of known human teratogens? Introduction of generic isotretinoin in the US as an example.

PubMed

Honein, Margaret A; Moore, Cynthia A; Erickson, J David

2004-01-01

The prescription of known teratogenic medications requires a careful balance between allowing women access to medications that they might need and avoiding unnecessary exposure to these medications during pregnancy because of their devastating fetal effects. Isotretinoin, a potent human teratogen, is of particular concern because of its widespread use among reproductive-aged women and the dramatic increase in use from 1992 through 2000. A revised risk management system was implemented in 2002 because of concerns about the continued occurrence of isotretinoin-exposed pregnancies. However, the recent approval of three generic versions of isotretinoin in the US has further complicated risk management and raises concerns that use might increase further if the lower cost of generics serves to increase accessibility. There are now four separate isotretinoin risk management systems in the US, each with its own distinct packaging, though the requirements for and substance of each are identical. Some additional concrete steps could be taken to minimise any unnecessary use of isotretinoin and help allow an adequate assessment of the current risk management systems. In addition to being familiar with and following all aspects of the current risk management system, physicians could choose to limit the use of isotretinoin to those who meet the labelled indications in order to reduce the number of exposed pregnancies. All four companies currently marketing isotretinoin in the US could jointly and voluntarily establish a consolidated, mandatory registration and follow-up of all women of reproductive potential who receive an isotretinoin prescription. Mandatory registration has many challenges, but it could allow a clear accounting of the total number of women for whom follow-up information is and is not available. Although the companies cannot be legally compelled to use a consolidated approach, the use of a single registry for the originator's product and all generic brands would allow identification of duplicates and also avoid the confusion that is introduced by providing materials that not only look different, but also have different addresses, contact information and names for participation in follow-up surveys. This is particularly important because women might take more than one version of isotretinoin during a single course of therapy or might receive a different programme's materials from their doctor than from the pharmacy. Though the introduction of generic versions of isotretinoin further complicates risk management, the companies marketing isotretinoin have an opportunity to work together to demonstrate their commitment to both limit the occurrence of exposed pregnancies and conduct a meaningful evaluation of the occurrence of pregnancies exposed to isotretinoin.

Wildfire Risk Management: Challenges and Opportunities

NASA Astrophysics Data System (ADS)

Thompson, M.; Calkin, D. E.; Hand, M. S.; Kreitler, J.

2014-12-01

In this presentation we address federal wildfire risk management largely through the lens of economics, targeting questions related to costs, effectiveness, efficiency, and tradeoffs. Beyond risks to resources and assets such as wildlife habitat, watersheds, and homes, wildfires present financial risk and budgetary instability for federal wildfire management agencies due to highly variable annual suppression costs. Despite its variability, the costs of wildfire management have continued to escalate and account for an ever-growing share of overall agency budgets, compromising abilities to attain other objectives related to forest health, recreation, timber management, etc. Trends associated with a changing climate and human expansion into fire-prone areas could lead to additional suppression costs in the future, only further highlighting the need for an ability to evaluate economic tradeoffs in investments across the wildfire management spectrum. Critically, these economic analyses need to accurately capture the complex spatial and stochastic aspects of wildfire, the inherent uncertainty associated with monetizing environmental impacts of wildfire, the costs and effectiveness of alternative management policies, and linkages between pre-fire investments and active incident management. Investing in hazardous fuels reduction and forest restoration in particular is a major policy lever for pre-fire risk mitigation, and will be a primary focus of our presentation. Evaluating alternative fuel management and suppression policies could provide opportunities for significant efficiency improvements in the development of risk-informed management fire management strategies. Better understanding tradeoffs of fire impacts and costs can help inform policy questions such as how much of the landscape to treat and how to balance investments in treating new areas versus maintaining previous investments. We will summarize current data needs, knowledge gaps, and other factors influencing research and development on this critically important topic. Specifically we will focus on how to embed simulation models within an economic framework, how to link fire models with models of wildfire management expenditures, how to evaluate alternative management policies, and how to measure cost-effectiveness.

76 FR 53683 - Draft Guidance for Industry on Oversight of Clinical Investigations: A Risk-Based Approach to...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-29

... risk-based approach to the oversight of clinical investigations. It does not create or confer any... a range of approaches to monitoring. FDA currently has OMB approval for the information collection... Interested persons may submit to the Division of Dockets Management (see ADDRESSES) either electronic or...

Student Event Policies: A Review of Institutional Responses.

ERIC Educational Resources Information Center

Gifford, Denise; Pregliasco, Bridgette; Mardis, James M.

2002-01-01

Examines social event risk reduction practices currently in place at sample colleges. Results indicate that the majority of colleges studied do have some sort of social event risk management practices in place. Results are described and recommendations for development of a campus social event policy are provided. (Contains 17 references and 2…

Revision of the 590 nutrient management standard: SERA-17 recommendations

USDA-ARS?s Scientific Manuscript database

In late 2009, NRCS requested a Working Group within SERA-17 be established to review and revise the 590 Nutrient Management Conservation Standard. This was in response to growing concern in certain areas of the U.S., that current risk assessment tools were not bringing about as great a change in pho...

International trade standards for commodities and products derived from animals: the need for a system that integrates food safety and animal disease risk management.

PubMed

Thomson, G R; Penrith, M-L; Atkinson, M W; Thalwitzer, S; Mancuso, A; Atkinson, S J; Osofsky, S A

2013-12-01

A case is made for greater emphasis to be placed on value chain management as an alternative to geographically based disease risk mitigation for trade in commodities and products derived from animals. The geographic approach is dependent upon achievement of freedom in countries or zones from infectious agents that cause so-called transboundary animal diseases, while value chain-based risk management depends upon mitigation of animal disease hazards potentially associated with specific commodities or products irrespective of the locality of production. This commodity-specific approach is founded on the same principles upon which international food safety standards are based, viz. hazard analysis critical control points (HACCP). Broader acceptance of a value chain approach enables animal disease risk management to be combined with food safety management by the integration of commodity-based trade and HACCP methodologies and thereby facilitates 'farm to fork' quality assurance. The latter is increasingly recognized as indispensable to food safety assurance and is therefore a pre-condition to safe trade. The biological principles upon which HACCP and commodity-based trade are based are essentially identical, potentially simplifying sanitary control in contrast to current separate international sanitary standards for food safety and animal disease risks that are difficult to reconcile. A value chain approach would not only enable more effective integration of food safety and animal disease risk management of foodstuffs derived from animals but would also ameliorate adverse environmental and associated socio-economic consequences of current sanitary standards based on the geographic distribution of animal infections. This is especially the case where vast veterinary cordon fencing systems are relied upon to separate livestock and wildlife as is the case in much of southern Africa. A value chain approach would thus be particularly beneficial to under-developed regions of the world such as southern Africa specifically and sub-Saharan Africa more generally where it would reduce incompatibility between attempts to expand and commercialize livestock production and the need to conserve the subcontinent's unparalleled wildlife and wilderness resources. © 2013 Blackwell Verlag GmbH.

Current strategies for the diagnosis and management of chronic lymphocytic leukemia (CLL), with a focus on poor-risk CLL: A review.

PubMed

Clanahan, Fabienne Mc; Dreger, Peter

2011-06-05

Despite substantial advancement in the understanding and treatment of chronic lymphocytic leukemia (CLL), a standard curative approach does not exist. The choice of treatment is generally based on the existence of biological and genetic factors associated with the prediction of prognosis, individual response to therapy, and duration of remission. About 20% of patients that require treatment have an aggressive disease course and die within a few years, despite early initiation of intensive therapy (poor-risk CLL). Poor-risk CLL can be predicted by the presence of genomic markers, and the quality and duration of response to purine-analogue-based treatment. Within this patient subgroup alternative treatment approaches such as alemtuzumab or new substances such as flavopiridol or IMiDs® should be considered. To date, the only treatment bearing curative potential is allogeneic stem cell transplantation; in contrast to conventional immunochemotherapy, it can provide long-term disease control, even in patients with del 17p or other unfavorable biological and clinical risk factors. The aim of this review was to outline the current strategies for the diagnosis and management of CLL, with a focus on high-risk CLL.

Management of radon: a review of ICRP recommendations.

PubMed

Vaillant, Ludovic; Bataille, Céline

2012-09-01

This article proposes a review of past and current ICRP publications dealing with the management of radon exposures. Its main objective is to identify and discuss the driving factors that have been used by the Commission during the last 50 years so as to better appreciate current issues regarding radon exposure management. The analysis shows that major evolutions took place in very recent years. As far as the management of radon exposures is concerned, ICRP recommended, until ICRP Publication 103 (ICRP 2007 ICRP Publication 103; Ann. ICRP 37), to use action levels and to consider only exposures above these levels. The Commission has reviewed its approach and now proposes to manage any radon exposure through the application of the optimisation principle and associated reference levels. As far as the assessment of the radon risk is concerned, it appears that the successive changes made by ICRP did not have a strong impact on the values of radon gas concentration recommended as action levels either in dwellings or in workplaces. The major change occurred in late 2009 with the publication of the ICRP Statement on Radon, which acknowledged that the radon risk has been underestimated by a factor of 2, thus inducing a major revision of radon reference levels.

Managing side effects of JAK inhibitors for myelofibrosis in clinical practice.

PubMed

Saeed, Iram; McLornan, Donal; Harrison, Claire N

2017-07-01

Myelofibrosis (MF) is characterized by bone marrow fibrosis, abnormalities in peripheral counts, extramedullary hematopoiesis, splenomegaly and an increased risk of transformation to acute myeloid leukaemia. The disease course is often heterogeneous and management can range from observation alone through to allogeneic stem cell transplantation. As of 2017, the only approved medication for MF remains the JAK Inhibitor (JAKi), ruxolitinib (Novartis Pharmaceuticals, Basel, Switzerland; Incyte, Wilmington, Detroit, USA) although several others have reached advanced stages of clinical trials. Areas covered: In this review, we focus on the management of both common and uncommon side effects arising from the use of currently approved and clinical trial JAKi. Most of the discussion concerns ruxolitinib although we also cover both pacritinib (CTI BioPharma) and momelotinib (Gilead Sciences, Foster City, California) which have been in recent large, multinational phase III trials. The various approaches to management of JAKi-related side effects are discussed - with particular emphasis to anaemia, thrombocytopaenia and infection risk. Expert commentary: JAK inhibitors are effective in many individuals with MF and have revolutionized the current treatment paradigm. The side effect profile, in the most, is predictable and manageable with high degrees of clinical surveillance and dose modifications.

The management of patients with limited-stage classical Hodgkin lymphoma.

PubMed

Gospodarowicz, Mary K; Meyer, Ralph M

2006-01-01

The term limited-stage Hodgkin lymphoma refers to those patients with stage I-II disease and an absence of bulky disease. Among those patients with classical Hodgkin lymphoma, approximately one-third of patients will fall into this category. As long-term disease control can now be anticipated in more than 90% of these patients, management strategies must increasingly address the need to reduce the long-term treatment-related risks. Current treatment options include use of combined modality therapy that includes an abbreviated course of chemotherapy and involved-field radiation or treatment with chemotherapy, currently consisting of ABVD, as a single modality. The choice of treatment between these two options involves specific trade-offs that must balance issues of disease control against long-term risk of late effects.

Risk-informed radioactive waste classification and reclassification.

PubMed

Croff, Allen G

2006-11-01

Radioactive waste classification systems have been developed to allow wastes having similar hazards to be grouped for purposes of storage, treatment, packaging, transportation, and/or disposal. As recommended in the National Council on Radiation Protection and Measurements' Report No. 139, Risk-Based Classification of Radioactive and Hazardous Chemical Wastes, a preferred classification system would be based primarily on the health risks to the public that arise from waste disposal and secondarily on other attributes such as the near-term practicalities of managing a waste, i.e., the waste classification system would be risk informed. The current U.S. radioactive waste classification system is not risk informed because key definitions--especially that of high-level waste--are based on the source of the waste instead of its inherent characteristics related to risk. A second important reason for concluding the existing U.S. radioactive waste classification system is not risk informed is there are no general principles or provisions for exempting materials from being classified as radioactive waste which would then allow management without regard to its radioactivity. This paper elaborates the current system for classifying and reclassifying radioactive wastes in the United States, analyzes the extent to which the system is risk informed and the ramifications of its not being so, and provides observations on potential future direction of efforts to address shortcomings in the U.S. radioactive waste classification system as of 2004.

Homophobia and Communal Coping for HIV risk management among Gay Men in Relationships

PubMed Central

Stachowski, Courtney; Stephenson, Rob

2015-01-01

Men who have sex with men (MSM) remain disproportionately affected by the HIV epidemic in the US and estimates suggest that one to two-thirds of new infections occur among main partners. Previous research has focused on individual MSM and their risk for HIV, yet couples’ ability to manage risk has been largely understudied. In particular, the role that homophobia plays in shaping the ability of gay male couples to cope with HIV risk is currently under-studied. A sample of 447 gay/bisexual men with main partners was taken from a 2011 survey of gay and bisexual men in Atlanta. Linear regression models were fitted for three couples’ coping outcome scales (outcome efficacy, couple efficacy, communal coping) and included indicators of homophobia (internalized homophobia and homophobic discrimination). Findings indicate that reporting of increased levels of internalized homophobia were consistently associated with decreased outcome measures of couples’ coping ability regarding risk management. The results highlight the role that homophobia plays in gay male couples’ relationships and HIV risk, extending the existing literature in the field of same-sex relationships as influenced by homophobia. PMID:25614049

Predicting bycatch hotspots for endangered leatherback turtles on longlines in the Pacific Ocean.

PubMed

Roe, John H; Morreale, Stephen J; Paladino, Frank V; Shillinger, George L; Benson, Scott R; Eckert, Scott A; Bailey, Helen; Tomillo, Pilar Santidrián; Bograd, Steven J; Eguchi, Tomoharu; Dutton, Peter H; Seminoff, Jeffrey A; Block, Barbara A; Spotila, James R

2014-02-22

Fisheries bycatch is a critical source of mortality for rapidly declining populations of leatherback turtles, Dermochelys coriacea. We integrated use-intensity distributions for 135 satellite-tracked adult turtles with longline fishing effort to estimate predicted bycatch risk over space and time in the Pacific Ocean. Areas of predicted bycatch risk did not overlap for eastern and western Pacific nesting populations, warranting their consideration as distinct management units with respect to fisheries bycatch. For western Pacific nesting populations, we identified several areas of high risk in the north and central Pacific, but greatest risk was adjacent to primary nesting beaches in tropical seas of Indo-Pacific islands, largely confined to several exclusive economic zones under the jurisdiction of national authorities. For eastern Pacific nesting populations, we identified moderate risk associated with migrations to nesting beaches, but the greatest risk was in the South Pacific Gyre, a broad pelagic zone outside national waters where management is currently lacking and may prove difficult to implement. Efforts should focus on these predicted hotspots to develop more targeted management approaches to alleviate leatherback bycatch.

Predicting bycatch hotspots for endangered leatherback turtles on longlines in the Pacific Ocean

PubMed Central

Roe, John H.; Morreale, Stephen J.; Paladino, Frank V.; Shillinger, George L.; Benson, Scott R.; Eckert, Scott A.; Bailey, Helen; Tomillo, Pilar Santidrián; Bograd, Steven J.; Eguchi, Tomoharu; Dutton, Peter H.; Seminoff, Jeffrey A.; Block, Barbara A.; Spotila, James R.

2014-01-01

Fisheries bycatch is a critical source of mortality for rapidly declining populations of leatherback turtles, Dermochelys coriacea. We integrated use-intensity distributions for 135 satellite-tracked adult turtles with longline fishing effort to estimate predicted bycatch risk over space and time in the Pacific Ocean. Areas of predicted bycatch risk did not overlap for eastern and western Pacific nesting populations, warranting their consideration as distinct management units with respect to fisheries bycatch. For western Pacific nesting populations, we identified several areas of high risk in the north and central Pacific, but greatest risk was adjacent to primary nesting beaches in tropical seas of Indo-Pacific islands, largely confined to several exclusive economic zones under the jurisdiction of national authorities. For eastern Pacific nesting populations, we identified moderate risk associated with migrations to nesting beaches, but the greatest risk was in the South Pacific Gyre, a broad pelagic zone outside national waters where management is currently lacking and may prove difficult to implement. Efforts should focus on these predicted hotspots to develop more targeted management approaches to alleviate leatherback bycatch. PMID:24403331

Homophobia and communal coping for HIV risk management among gay men in relationships.

PubMed

Stachowski, Courtney; Stephenson, Rob

2015-02-01

Men who have sex with men (MSM) remain disproportionately affected by the HIV epidemic in the US and estimates suggest that one to two-thirds of new infections occur among main partners. Previous research has focused on individual MSM and their risk for HIV, yet couples' ability to manage risk has been largely understudied. In particular, the role that homophobia plays in shaping the ability of gay male couples to cope with HIV risk is currently understudied. A sample of 447 gay/bisexual men with main partners was taken from a 2011 survey of gay and bisexual men in Atlanta. Linear regression models were fitted for three couples' coping outcome scales (outcome efficacy, couple efficacy, communal coping) and included indicators of homophobia (internalized homophobia and homophobic discrimination). Findings indicate that reporting of increased levels of internalized homophobia were consistently associated with decreased outcome measures of couples' coping ability regarding risk management. The results highlight the role that homophobia plays in gay male couples' relationships and HIV risk, extending the existing literature in the field of same-sex relationships as influenced by homophobia.

Risky business.

PubMed

Baram, M

1996-10-01

In prior studies by high-level commissions, emphasis was given to improving the scientific basis and institutional procedures for risk assessment and risk regulation within existing statutory frameworks. Recommendations have led to slow but steady progress. This study is considerably different. It emphasizes a public health approach for efficient use of resources in a new flexible framework for risk management, reductionist approaches to risk assessment and characterization, increased public involvement, and various methods for managing such public involvement. It provides a mix of aspirations and concepts, procedures, and "shop floor rules" for putting the new system of risk management into practice. Concerns remain, however, that bright lines and other rules are at odds with the report's professed aspirations for meaningful public involvement; that ad hoc institutional arrangements for putting each risk in a situational context may not be an efficient use of public and private resources; that techniques for managing stakeholder involvement will be seen as manipulative and may even increase public mistrust and anxieties about risk; and that reductionism by the regulatory clients of risk assessment could diminish progress in the environmental health sciences. Says Lucier, "The goal of risk assessment should be to prevent environmentally or occupationally mediated diseases or injury. This point is not made sufficiently clear in the commission's report. Nevertheless, the report does an admirable job of attempting to merge science, common sense, public perception, public health, economics, and stakeholder interests into a regulatory policy strategy." He continues, "The merging of these diverse inputs will never be easy and should never be overly prescriptive. The complete integration of all relevant information into the risk assessment and risk management process will require greater reliance on expert judgment to make decisions that are timely, that are based on appropriate peer review, that are consistent with public health priorities, that do not create unnecessary regulatory burdens, and that are understandable by the public." The commission's report provides an alternative vision of risk management that incorporates popular political and social trends. Thorough evaluation of the report's recommendations will, at the very least, focus scrutiny on current risk assessment and risk management practices and perhaps produce better solutions.

Risky business.

PubMed Central

Baram, M

1996-01-01

In prior studies by high-level commissions, emphasis was given to improving the scientific basis and institutional procedures for risk assessment and risk regulation within existing statutory frameworks. Recommendations have led to slow but steady progress. This study is considerably different. It emphasizes a public health approach for efficient use of resources in a new flexible framework for risk management, reductionist approaches to risk assessment and characterization, increased public involvement, and various methods for managing such public involvement. It provides a mix of aspirations and concepts, procedures, and "shop floor rules" for putting the new system of risk management into practice. Concerns remain, however, that bright lines and other rules are at odds with the report's professed aspirations for meaningful public involvement; that ad hoc institutional arrangements for putting each risk in a situational context may not be an efficient use of public and private resources; that techniques for managing stakeholder involvement will be seen as manipulative and may even increase public mistrust and anxieties about risk; and that reductionism by the regulatory clients of risk assessment could diminish progress in the environmental health sciences. Says Lucier, "The goal of risk assessment should be to prevent environmentally or occupationally mediated diseases or injury. This point is not made sufficiently clear in the commission's report. Nevertheless, the report does an admirable job of attempting to merge science, common sense, public perception, public health, economics, and stakeholder interests into a regulatory policy strategy." He continues, "The merging of these diverse inputs will never be easy and should never be overly prescriptive. The complete integration of all relevant information into the risk assessment and risk management process will require greater reliance on expert judgment to make decisions that are timely, that are based on appropriate peer review, that are consistent with public health priorities, that do not create unnecessary regulatory burdens, and that are understandable by the public." The commission's report provides an alternative vision of risk management that incorporates popular political and social trends. Thorough evaluation of the report's recommendations will, at the very least, focus scrutiny on current risk assessment and risk management practices and perhaps produce better solutions. PMID:8930543

2012 AAPS National Biotech Conference Open Forum: a perspective on the current state of immunogenicity prediction and risk management.

PubMed

Rajadhyaksha, Manoj; Subramanyam, Meena; Rup, Bonnie

2013-10-01

The immunogenicity profile of a biotherapeutic is determined by multiple product-, process- or manufacturing-, patient- and treatment-related factors and the bioanalytical methodology used to monitor for immunogenicity. This creates a complex situation that limits direct correlation of individual factors to observed immunogenicity rates. Therefore, mechanistic understanding of how these factors individually or in concert could influence the overall incidence and clinical risk of immunogenicity is crucial to provide the best benefit/risk profile for a given biotherapeutic in a given indication and to inform risk mitigation strategies. Advances in the field of immunogenicity have included development of best practices for monitoring anti-drug antibody development, categorization of risk factors contributing to immunogenicity, development of predictive tools, and development of effective strategies for risk management and mitigation. Thus, the opportunity to ask "where we are now and where we would like to go from here?" was the main driver for organizing an Open Forum on Improving Immunogenicity Risk Prediction and Management, conducted at the 2012 American Association of Pharmaceutical Scientists' (AAPS) National Biotechnology Conference in San Diego. The main objectives of the Forum include the following: to understand the nature of immunogenicity risk factors, to identify analytical tools used and animal models and management strategies needed to improve their predictive value, and finally to identify collaboration opportunities to improve the reliability of risk prediction, mitigation, and management. This meeting report provides the Forum participant's and author's perspectives on the barriers to advancing this field and recommendations for overcoming these barriers through collaborative efforts.

Assessing Interventions to Manage West Nile Virus Using Multi-Criteria Decision Analysis with Risk Scenarios

PubMed Central

Hongoh, Valerie; Campagna, Céline; Panic, Mirna; Samuel, Onil; Gosselin, Pierre; Waaub, Jean-Philippe; Ravel, André; Samoura, Karim; Michel, Pascal

2016-01-01

The recent emergence of West Nile virus (WNV) in North America highlights vulnerability to climate sensitive diseases and stresses the importance of preventive efforts to reduce their public health impact. Effective prevention involves reducing environmental risk of exposure and increasing adoption of preventive behaviours, both of which depend on knowledge and acceptance of such measures. When making operational decisions about disease prevention and control, public health must take into account a wide range of operational, environmental, social and economic considerations in addition to intervention effectiveness. The current study aimed to identify, assess and rank possible risk reduction measures taking into account a broad set of criteria and perspectives applicable to the management of WNV in Quebec under increasing transmission risk scenarios, some of which may be related to ongoing warming in higher-latitude regions. A participatory approach was used to collect information on categories of concern to relevant stakeholders with respect to WNV prevention and control. Multi-criteria decision analysis was applied to examine stakeholder perspectives and their effect on strategy rankings under increasing transmission risk scenarios. Twenty-three preventive interventions were retained for evaluation using eighteen criteria identified by stakeholders. Combined evaluations revealed that, at an individual-level, inspecting window screen integrity, wearing light colored, long clothing, eliminating peridomestic larval sites and reducing outdoor activities at peak times were top interventions under six WNV transmission scenarios. At a regional-level, the use of larvicides was a preferred strategy in five out of six scenarios, while use of adulticides and dissemination of sterile male mosquitoes were found to be among the least favoured interventions in almost all scenarios. Our findings suggest that continued public health efforts aimed at reinforcing individual-level preventive behaviours combined with the application of larvicides to manage the risk of WNV infection are the interventions most acceptable and effective at reaching current management objectives now and under future theoretical transmission risk. PMID:27494136

Role of the Internet in Anticipating and Mitigating Earthquake Catastrophes, and the Emergence of Personal Risk Management (Invited)

NASA Astrophysics Data System (ADS)

Rundle, J. B.; Holliday, J. R.; Donnellan, A.; Graves, W.; Tiampo, K. F.; Klein, W.

2009-12-01

Risks from natural and financial catastrophes are currently managed by a combination of large public and private institutions. Public institutions usually are comprised of government agencies that conduct studies, formulate policies and guidelines, enforce regulations, and make “official” forecasts. Private institutions include insurance and reinsurance companies, and financial service companies that underwrite catastrophe (“cat”) bonds, and make private forecasts. Although decisions about allocating resources and developing solutions are made by large institutions, the costs of dealing with catastrophes generally fall for the most part on businesses and the general public. Information on potential risks is generally available to the public for some hazards but not others. For example, in the case of weather, private forecast services are provided by www.weather.com and www.wunderground.com. For earthquakes in California (only), the official forecast is the WGCEP-USGS forecast, but provided in a format that is difficult for the public to use. Other privately made forecasts are currently available, for example by the JPL QuakeSim and Russian groups, but these efforts are limited. As more of the world’s population moves increasingly into major seismic zones, new strategies are needed to allow individuals to manage their personal risk from large and damaging earthquakes. Examples include individual mitigation measures such as retrofitting, as well as microinsurance in both developing and developed countries, as well as other financial strategies. We argue that the “long tail” of the internet offers an ideal, and greatly underutilized mechanism to reach out to consumers and to provide them with the information and tools they need to confront and manage seismic hazard and risk on an individual, personalized basis. Information of this type includes not only global hazard forecasts, which are now possible, but also global risk estimation. Additionally, social networking tools are available that will allow self-organizing, disaster-resilient communities to arise as emergent structures from the underlying nonlinear social dynamics. In this talk, we argue that the current style of risk management is not making adequate use of modern internet technology, and that significantly more can be done. We suggest several avenues to proceed, in particular making use of the internet for earthquake forecast and information delivery, as well as tracking forecast validation and verification on a real-time basis. We also show examples of forecasts delivered over the internet, and describe how these are made.

The safety experience of New Zealand adventure tourism operators.

PubMed

Bentley, Tim A; Page, Stephen; Walker, Linda

2004-01-01

This survey examined parameters of the New Zealand adventure tourism industry client injury risk. The research also sought to establish priorities for intervention to reduce adventure tourism risk, and identify client injury control measures currently in place (or absent) in the New Zealand adventure tourism industry, with a view to establishing guidelines for the development of effective adventure tourism safety management systems. This 2003 survey builds upon an exploratory study of New Zealand adventure tourism safety conducted by us during 1999. A postal questionnaire was used to survey all identifiable New Zealand adventure tourism operators. The questionnaire asked respondents about their recorded client injury experience, perceptions of client injury risk factors, safety management practices, and barriers to safety. Some 27 adventure tourism activities were represented among the responding sample (n=96). The highest client injury risk was reported in the snow sports, bungee jumping and horse riding sectors, although serious underreporting of minor injuries was evident across the industry. Slips, trips and falls (STF) were the major client injury mechanisms, and a range of risk factors for client injuries were identified. Safety management measures were inconsistently applied across the industry. The industry should consider the implications of poor injury reporting standards and safety management practices generally. Specifically, the industry should consider risk management that focuses on minor (e.g., STF) as well as catastrophic events.

High-risk multiple myeloma: a multifaceted entity, multiple therapeutic challenges.

PubMed

Muchtar, Eli; Magen, Hila; Gertz, Morie A

2017-06-01

The term high-risk multiple myeloma is aimed to identify a heterogeneous group of patients who are more likely to progress and die early of their disease. Therefore, recognition of these patients is crucial. With the increase in the number of treatment options, the outcome for high-risk patients has probably improved, although the true extent of this improvement remains unknown, due to both the heterogeneous components of high-risk disease and its under-representation in clinical trials. In this article, we review the definitions of high-risk disease, emphasizing the fact that no single definition can represent the entire high-risk population. In the second part, we review the treatment options available for the management of high-risk myeloma as well as our general approach for high-risk disease. In light of the poor prognosis associated with high-risk myeloma, even in the current era, new approaches for the management of this subset of patients are needed.

Making Better Re/Insurance Underwriting and Capital Management Decisions with Public-Private-Academic Partnerships

NASA Astrophysics Data System (ADS)

Michel, G.; Gunasekera, R.; Werner, A.; Galy, H.

2012-04-01

Similar to 2001, 2004, and 2005, 2011 was another year of unexpected international catastrophe events, in which insured losses were more than twice the expected long-term annual average catastrophe losses of USD 30 to 40bn. Key catastrophe events that significantly contributed these losses included the Mw 9.0 Great Tohoku earthquake and tsunami, the Jan. 2011 floods in Queensland, the October 2011 floods in Thailand, the Mw 6.1 Christchurch earthquake and Convective system (Tornado) in United States. However, despite considerable progress in catastrophe modelling, the advent of global catastrophe models, increasing risk model coverage and skill in the detailed modelling, the above mentioned events were not satisfactorily modelled by the current mainstream Re/Insurance catastrophe models. This presentation therefore address problems in models and incomplete understanding identified from recent catastrophic events by considering: i) the current modelling environment, and ii) how the current processes could be improved via: a) the understanding of risk within science networks such as the Willis Research Network, and b) the integration of risk model results from available insurance catastrophe models and tools. This presentation aims to highlight the needed improvements in decision making and market practices, thereby advancing the current management of risk in the Re/Insurance industry. This also increases the need for better integration of Public-Private-Academic partnerships and tools to provide better estimates of not only financial loss but also humanitarian and infrastructural losses as well.

How Primary Care Providers Talk to Patients about Genome Sequencing Results: Risk, Rationale, and Recommendation.

PubMed

Vassy, Jason L; Davis, J Kelly; Kirby, Christine; Richardson, Ian J; Green, Robert C; McGuire, Amy L; Ubel, Peter A

2018-06-01

Genomics will play an increasingly prominent role in clinical medicine. To describe how primary care physicians (PCPs) discuss and make clinical recommendations about genome sequencing results. Qualitative analysis. PCPs and their generally healthy patients undergoing genome sequencing. Patients received clinical genome reports that included four categories of results: monogenic disease risk variants (if present), carrier status, five pharmacogenetics results, and polygenic risk estimates for eight cardiometabolic traits. Patients' office visits with their PCPs were audio-recorded, and summative content analysis was used to describe how PCPs discussed genomic results. For each genomic result discussed in 48 PCP-patient visits, we identified a "take-home" message (recommendation), categorized as continuing current management, further treatment, further evaluation, behavior change, remembering for future care, or sharing with family members. We analyzed how PCPs came to each recommendation by identifying 1) how they described the risk or importance of the given result and 2) the rationale they gave for translating that risk into a specific recommendation. Quantitative analysis showed that continuing current management was the most commonly coded recommendation across results overall (492/749, 66%) and for each individual result type except monogenic disease risk results. Pharmacogenetics was the most common result type to prompt a recommendation to remember for future care (94/119, 79%); carrier status was the most common type prompting a recommendation to share with family members (45/54, 83%); and polygenic results were the most common type prompting a behavior change recommendation (55/58, 95%). One-fifth of recommendation codes associated with monogenic results were for further evaluation (6/24, 25%). Rationales for these recommendations included patient context, family context, and scientific/clinical limitations of sequencing. PCPs distinguish substantive differences among categories of genome sequencing results and use clinical judgment to justify continuing current management in generally healthy patients with genomic results.

Internationally coordinated multi-mission planning is now critical to sustain the space-based rainfall observations needed for managing floods globally

NASA Astrophysics Data System (ADS)

Reed, Patrick M.; Chaney, Nathaniel W.; Herman, Jonathan D.; Ferringer, Matthew P.; Wood, Eric F.

2015-02-01

At present 4 of 10 dedicated rainfall observing satellite systems have exceeded their design life, some by more than a decade. Here, we show operational implications for flood management of a ‘collapse’ of space-based rainfall observing infrastructure as well as the high-value opportunities for a globally coordinated portfolio of satellite missions and data services. Results show that the current portfolio of rainfall missions fails to meet operational data needs for flood management, even when assuming a perfectly coordinated data product from all current rainfall-focused missions (i.e., the full portfolio). In the full portfolio, satellite-based rainfall data deficits vary across the globe and may preclude climate adaptation in locations vulnerable to increasing flood risks. Moreover, removing satellites that are currently beyond their design life (i.e., the reduced portfolio) dramatically increases data deficits globally and could cause entire high intensity flood events to be unobserved. Recovery from the reduced portfolio is possible with internationally coordinated replenishment of as few as 2 of the 4 satellite systems beyond their design life, yielding rainfall data coverages that outperform the current full portfolio (i.e., an optimized portfolio of eight satellites can outperform ten satellites). This work demonstrates the potential for internationally coordinated satellite replenishment and data services to substantially enhance the cost-effectiveness, sustainability and operational value of space-based rainfall observations in managing evolving flood risks.

Health benefits of 'grow your own' food in urban areas: implications for contaminated land risk assessment and risk management?

PubMed

Leake, Jonathan R; Adam-Bradford, Andrew; Rigby, Janette E

2009-12-21

Compelling evidence of major health benefits of fruit and vegetable consumption, physical activity, and outdoor interaction with 'greenspace' have emerged in the past decade - all of which combine to give major potential health benefits from 'grow-your-own' (GYO) in urban areas. However, neither current risk assessment models nor risk management strategies for GYO in allotments and gardens give any consideration to these health benefits, despite their potential often to more than fully compensate the risks. Although urban environments are more contaminated by heavy metals, arsenic, polyaromatic hydrocarbons and dioxins than most rural agricultural areas, evidence is lacking for adverse health outcomes of GYO in UK urban areas. Rarely do pollutants in GYO food exceed statutory limits set for commercial food, and few people obtain the majority of their food from GYO. In the UK, soil contamination thresholds triggering closure or remediation of allotment and garden sites are based on precautionary principles, generating 'scares' that may negatively impact public health disproportionately to the actual health risks of exposure to toxins through own-grown food. By contrast, the health benefits of GYO are a direct counterpoint to the escalating public health crisis of 'obesity and sloth' caused by eating an excess of saturated fats, inadequate consumption of fresh fruit and vegetables combined with a lack of exercise. These are now amongst the most important preventable causes of illness and death. The health and wider societal benefits of 'grow-your-own' thus reveal a major limitation in current risk assessment methodologies which, in only considering risks, are unable to predict whether GYO on particular sites will, overall, have positive, negative, or no net effects on human health. This highlights a more general need for a new generation of risk assessment tools that also predict overall consequences for health to more effectively guide risk management in our increasingly risk-averse culture.

A fuzzy model for assessing risk of occupational safety in the processing industry.

PubMed

Tadic, Danijela; Djapan, Marko; Misita, Mirjana; Stefanovic, Miladin; Milanovic, Dragan D

2012-01-01

Managing occupational safety in any kind of industry, especially in processing, is very important and complex. This paper develops a new method for occupational risk assessment in the presence of uncertainties. Uncertain values of hazardous factors and consequence frequencies are described with linguistic expressions defined by a safety management team. They are modeled with fuzzy sets. Consequence severities depend on current hazardous factors, and their values are calculated with the proposed procedure. The proposed model is tested with real-life data from fruit processing firms in Central Serbia.

Psychosocial risks: is risk management strategic enough in business and policy making?

PubMed

Langenhan, Melissa K; Leka, Stavroula; Jain, Aditya

2013-06-01

In times of continuous change and volatile markets, organizations are increasingly characterized by downsizing, work intensification, and resource rationalization. This has resulted in diversification, and the emergence of new risks within the field of occupational health and safety, with an important impact. This paper focuses on one such type of risk in the modern workplace-psychosocial risks. The current study aimed to explore stakeholder perspectives, regarding the extent to which psychosocial risks are incorporated into strategic risk management practices, at both the business and policy level. Semi-structured interviews were conducted with 14 professionals, representing employer, expert, policy maker, and trade union stakeholder perspectives. It was found that the majority of organizations do not sufficiently, if at all, understand and incorporate psychosocial risks into strategic decision making, whereby the key barrier related to practical difficulties of not knowing how to manage psychosocial risks adequately. The study found that there is a need to close the gap between policy and practice on a number of levels. Future recommendations comprise a policy framework and infrastructure underpinned by educational initiatives, partnerships, and networks to drive a shift in attitudes toward recognizing the duality of the concept of risk (including both potential negative and positive outcomes) and moving beyond simple regulatory compliance.

Psychosocial Risks: Is Risk Management Strategic Enough in Business and Policy Making?

PubMed Central

Langenhan, Melissa K.; Leka, Stavroula; Jain, Aditya

2013-01-01

Background In times of continuous change and volatile markets, organizations are increasingly characterized by downsizing, work intensification, and resource rationalization. This has resulted in diversification, and the emergence of new risks within the field of occupational health and safety, with an important impact. This paper focuses on one such type of risk in the modern workplace—psychosocial risks. The current study aimed to explore stakeholder perspectives, regarding the extent to which psychosocial risks are incorporated into strategic risk management practices, at both the business and policy level. Methods Semi-structured interviews were conducted with 14 professionals, representing employer, expert, policy maker, and trade union stakeholder perspectives. Results It was found that the majority of organizations do not sufficiently, if at all, understand and incorporate psychosocial risks into strategic decision making, whereby the key barrier related to practical difficulties of not knowing how to manage psychosocial risks adequately. Conclusion The study found that there is a need to close the gap between policy and practice on a number of levels. Future recommendations comprise a policy framework and infrastructure underpinned by educational initiatives, partnerships, and networks to drive a shift in attitudes toward recognizing the duality of the concept of risk (including both potential negative and positive outcomes) and moving beyond simple regulatory compliance. PMID:23961331

Exposure assessment and risk management of engineered nanoparticles: Investigation in semiconductor wafer processing

NASA Astrophysics Data System (ADS)

Shepard, Michele N.

Engineered nanomaterials (ENMs) are currently used in hundreds of commercial products and industrial processes, with more applications being investigated. Nanomaterials have unique properties that differ from bulk materials. While these properties may enable technological advancements, the potential risks of ENMs to people and the environment are not yet fully understood. Certain low solubility nanoparticles are more toxic than their bulk material, such that existing occupational exposure limits may not be sufficiently protective for workers. Risk assessments are currently challenging due to gaps in data on the numerous emerging materials and applications as well as method uncertainties and limitations. Chemical mechanical planarization (CMP) processes with engineered nanoparticle abrasives are used for research and commercial manufacturing applications in the semiconductor and related industries. Despite growing use, no published studies addressed occupational exposures to nanoparticles associated with CMP or risk assessment and management practices for these scenarios. Additional studies are needed to evaluate potential sources of workplace exposure or emission, as well as to help test and refine assessment methods. This research was conducted to: identify the lifecycle stages and potential exposure sources for ENMs in CMP processes; characterize worker exposure; determine recommended engineering controls and compare risk assessment models. The study included workplace air and surface sampling and an evaluation of qualitative risk banding approaches. Exposure assessment results indicated the potential for worker contact with ENMs on workplace surfaces but did not identify nanoparticles readily dispersed in air during work tasks. Some increases in respirable particle concentrations were identified, but not consistently. Measured aerosol concentrations by number and mass were well below current reference values for poorly soluble low toxicity nanoparticles. From application and evaluation of qualitative risk assessment approaches, differences in control banding models and results were identified, although output generally agreed with conclusions from air sampling as to whether an upgrade in site engineering controls was recommended. This research helped to improve understanding of potential worker exposures to ENMs in CMP processes, as well as the methods for risk assessment and management of metal oxide nanoparticles in occupational environments.

Surgical timing of treating injured extremities: an evolving concept of urgency.

PubMed

Crist, Brett D; Ferguson, Tania; Murtha, Yvonne M; Lee, Mark A

2013-01-01

The management of some orthopaedic extremity injuries has changed over the past decade because of changing resource availability and the risks of complications. It is helpful to review the current literature regarding orthopaedic extremity emergencies and urgencies. The effects of the techniques of damage control orthopaedic techniques and the concept of the orthopaedic trauma room have also affected the management of these injuries. The available literature indicates that the remaining true orthopaedic extremity emergencies include compartment syndrome and vascular injuries associated with fractures and dislocations. Orthopaedic urgencies include open fracture management, femoral neck fractures in young patients treated with open reduction and internal fixation, and talus fractures that are open or those with impending skin compromise. Deciding when the definitive management of orthopaedic extremity injuries will occur has evolved as the concept of damage control orthopaedics has become more commonly accepted. Patient survival rates have improved with current resuscitative protocols. Definitive fixation of extremity injuries should be delayed until the patient's physiologic and extremity soft-tissue status allows for appropriate definitive management while minimizing the risks of complications. In patients with semiurgent orthopaedic injuries, the use of an orthopaedic trauma room has led to more efficient care of patients, fewer complications, and better time management for surgeons who perform on-call service for patients with traumatic orthopaedic injuries.

Modeling insurer-homeowner interactions in managing natural disaster risk.

PubMed

Kesete, Yohannes; Peng, Jiazhen; Gao, Yang; Shan, Xiaojun; Davidson, Rachel A; Nozick, Linda K; Kruse, Jamie

2014-06-01

The current system for managing natural disaster risk in the United States is problematic for both homeowners and insurers. Homeowners are often uninsured or underinsured against natural disaster losses, and typically do not invest in retrofits that can reduce losses. Insurers often do not want to insure against these losses, which are some of their biggest exposures and can cause an undesirably high chance of insolvency. There is a need to design an improved system that acknowledges the different perspectives of the stakeholders. In this article, we introduce a new modeling framework to help understand and manage the insurer's role in catastrophe risk management. The framework includes a new game-theoretic optimization model of insurer decisions that interacts with a utility-based homeowner decision model and is integrated with a regional catastrophe loss estimation model. Reinsurer and government roles are represented as bounds on the insurer-insured interactions. We demonstrate the model for a full-scale case study for hurricane risk to residential buildings in eastern North Carolina; present the results from the perspectives of all stakeholders-primary insurers, homeowners (insured and uninsured), and reinsurers; and examine the effect of key parameters on the results. © 2014 Society for Risk Analysis.

Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice.

PubMed

Slemon, Allie; Jenkins, Emily; Bungay, Vicky

2017-10-01

The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self-harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re-centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re-evaluating the risk management culture that gives rise to and legitimizes harmful practices. © 2017 The Authors Nursing Inquiry published by John Wiley & Sons Ltd.

Illness-Specific Risk-Taking in Adolescence: A Missing Piece of the Nonadherence Puzzle for Youth With Type 1 Diabetes?

PubMed Central

Anderson, Barbara J.; Schwartz, David D.

2017-01-01

Risky behavior is often at its lifetime peak in adolescence. Chronic illness creates additional opportunities for risk because nonadherence behaviors can jeopardize adolescents’ health. Adolescents with type 1 diabetes could engage in risky behavior around insulin administration that would put them in danger of severe health consequences. It is possible that some nonadherence behaviors observed in adolescents with type 1 diabetes may result from youth taking risks with their medical treatment. Illness-specific risk-taking behaviors are not captured in most assessments of adherence, which primarily focus on frequency of adherence behaviors. This article reviews current models of general risk-taking and their implications for diabetes management. The authors argue that illness-specific risk-taking may be an important, understudied aspect of illness management that can inform future studies and treatment of nonadherence in adolescents with type 1 diabetes. PMID:28270709

GIS and local knowledge in disaster management: a case study of flood risk mapping in Viet Nam.

PubMed

Tran, Phong; Shaw, Rajib; Chantry, Guillaume; Norton, John

2009-03-01

Linking community knowledge with modern techniques to record and analyse risk related data is one way of engaging and mobilising community capacity. This paper discusses the use of the Geographic Information System (GIS) at the local level and the need for integrating modern technology and indigenous knowledge into disaster management. It suggests a way to mobilise available human and technical resources in order to strengthen a good partnership between local communities and local and national institutions. The paper also analyses the current vulnerability of two communes by correlating hazard risk and loss/damage caused by disasters and the contribution that domestic risk maps in the community can make to reduce this risk. The disadvantages, advantages and lessons learned from the GIS flood risk mapping project are presented through the case study of the Quang Tho Commune in Thua Thien Hue province, central Viet Nam.

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

Management and outcomes of 27 pregnancies in women with myeloproliferative neoplasms.

PubMed

Lapoirie, Joëlle; Contis, Anne; Guy, Alexandre; Lifermann, François; Viallard, Jean-François; Sentilhes, Loïc; James, Chloé; Duffau, Pierre

2018-06-26

Philadelphia-negative myeloproliferative neoplasms (MPNs) greatly increase the risk of maternal and fetal complications during pregnancy. Currently, international agreements regarding the management of these women are lacking. Our study aimed to assess the current management and outcomes of MPN pregnancies in a French cohort. We retrospectively analyzed 27 pregnancies in women with MPNs that were associated with a specific mutation. Nineteen pregnancies in nine women with essential thrombocythemia and eight pregnancies in five women with polycythemia vera were identified. Our study showed 70% live births, but only 30% uneventful pregnancies. Fetal complications were mainly early spontaneous abortions (22%), fetal growth restriction (15%), and premature delivery (15%). Maternal issues were divided between thrombosis (15%) and hemorrhages (11%). High rates of preeclampsia and hemolysis, elevated liver enzymes, and low platelet count syndrome (15%) were reported. Uterine artery Doppler was performed in 70% pregnancies. Abnormal Doppler results were found in 43% pregnancies. Pregnancies with high platelet counts and packed cell volume remaining static or increasing ended with fetal death and utero-placental dysfunction. According to expert consensus, most of the pregnancies (67%) could be stratified in the high risk group and had a bad obstetrical outcome, with 50% standard-risk pregnancies versus 22% high-risk pregnancies that were uneventful. Higher risk pregnancies were prescribed heparin and/or interferon α in 72%. The prognosis of these pregnancies remains very bad and may be improved by a more effective collaboration between specialists as well as a therapeutic intensification including heparin and interferon α.

Anticoagulants for secondary prevention after acute myocardial infarction: lessons from the past decade.

PubMed

Atar, Dan; Bode, Christoph; Stuerzenbecher, André; Verheugt, Freek W A

2014-08-01

The impact of an acute coronary syndrome (ACS) event, such as an acute myocardial infarction (MI), is not limited to the acute management phase; patients face an elevated risk of residual atherothrombotic events that commonly requires chronic management for months or even years. Significant advances have been made in both the acute and chronic management of patients with acute MI over the past decade, resulting in improved prognoses. One of the hallmarks of modern treatment strategies is more aggressive antiplatelet treatment regimens. However, the risks of further ACS events, stroke and premature death remain elevated in these patients, and addressing this residual risk is challenging owing to interpatient variability, differences in management strategies between centres and countries, incomplete understanding of the specific pathophysiology of post-ACS thrombosis and limitations of current therapeutic approaches. The recent approval in Europe of the direct oral anticoagulant rivaroxaban for use in this setting in combination with clopidogrel and acetylsalicylic acid offers another strategy to consider in the management of these patients, and clinical strategies in this area continue to evolve. In this review, we chart the progress made over the past decade in reducing the burden of secondary thromboembolic events after acute MI and discuss the current position of and future perspectives on the inclusion of oral anticoagulants into care pathways in this setting. © 2014 The Authors. Fundamental & Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of Société Française de Pharmacologie et de Thérapeutique.

Recruitment and treatment practices for help-seeking "prodromal" patients.

PubMed

McGlashan, Thomas H; Addington, Jean; Cannon, Tyrone; Heinimaa, Markus; McGorry, Patrick; O'Brien, Mary; Penn, David; Perkins, Diana; Salokangas, Raimo K R; Walsh, Barbara; Woods, Scott W; Yung, Alison

2007-05-01

The prodrome of psychosis has become a target for early identification and for treatments that address both symptoms and risk for future psychosis. Interest and activity in this realm is now worldwide. Clinical trials with rigorous methodology have only just begun, making treatment guidelines premature. Despite the sparse evidence base, treatments are currently applied to patients in the new prodromal clinics, usually treatments developed for established psychosis and modified for the prodromal phase. This communication will describe representative samplings of how treatment-seeking prodromal patients are currently recruited and treated in prodromal clinics worldwide. Recruitment includes how prodromal patients are sought, initially evaluated, apprised of their high-risk status, and informed of the risks and benefits of prodromal treatments and how their mental state is monitored over time. The treatment modalities offered (and described) include engagement, supportive therapy, case management, stress management, cognitive behavioral treatment, family-based treatment, antipsychotic pharmacotherapy, and non-antipsychotic pharmacotherapy. References for details are noted.

Reconstruction of the 1945 Wieringermeer Flood

NASA Astrophysics Data System (ADS)

Hoes, O. A. C.; Hut, R. W.; van de Giesen, N. C.; Boomgaard, M.

2013-03-01

The present state-of-the-art in flood risk assessment focuses on breach models, flood propagation models, and economic modelling of flood damage. However, models need to be validated with real data to avoid erroneous conclusions. Such reference data can either be historic data, or can be obtained from controlled experiments. The inundation of the Wieringermeer polder in the Netherlands in April 1945 is one of the few examples for which sufficient historical information is available. The objective of this article is to compare the flood simulation with flood data from 1945. The context, the breach growth process and the flood propagation are explained. Key findings for current flood risk management addresses the importance of the drainage canal network during the inundation of a polder, and the uncertainty that follows from not knowing the breach growth parameters. This case study shows that historical floods provide valuable data for the validation of models and reveal lessons that are applicable in current day flood risk management.

Stratospheric controlled perturbation experiment: a small-scale experiment to improve understanding of the risks of solar geoengineering

PubMed Central

Dykema, John A.; Keith, David W.; Anderson, James G.; Weisenstein, Debra

2014-01-01

Although solar radiation management (SRM) through stratospheric aerosol methods has the potential to mitigate impacts of climate change, our current knowledge of stratospheric processes suggests that these methods may entail significant risks. In addition to the risks associated with current knowledge, the possibility of ‘unknown unknowns’ exists that could significantly alter the risk assessment relative to our current understanding. While laboratory experimentation can improve the current state of knowledge and atmospheric models can assess large-scale climate response, they cannot capture possible unknown chemistry or represent the full range of interactive atmospheric chemical physics. Small-scale, in situ experimentation under well-regulated circumstances can begin to remove some of these uncertainties. This experiment—provisionally titled the stratospheric controlled perturbation experiment—is under development and will only proceed with transparent and predominantly governmental funding and independent risk assessment. We describe the scientific and technical foundation for performing, under external oversight, small-scale experiments to quantify the risks posed by SRM to activation of halogen species and subsequent erosion of stratospheric ozone. The paper's scope includes selection of the measurement platform, relevant aspects of stratospheric meteorology, operational considerations and instrument design and engineering. PMID:25404681

Stratospheric controlled perturbation experiment: a small-scale experiment to improve understanding of the risks of solar geoengineering.

PubMed

Dykema, John A; Keith, David W; Anderson, James G; Weisenstein, Debra

2014-12-28

Although solar radiation management (SRM) through stratospheric aerosol methods has the potential to mitigate impacts of climate change, our current knowledge of stratospheric processes suggests that these methods may entail significant risks. In addition to the risks associated with current knowledge, the possibility of 'unknown unknowns' exists that could significantly alter the risk assessment relative to our current understanding. While laboratory experimentation can improve the current state of knowledge and atmospheric models can assess large-scale climate response, they cannot capture possible unknown chemistry or represent the full range of interactive atmospheric chemical physics. Small-scale, in situ experimentation under well-regulated circumstances can begin to remove some of these uncertainties. This experiment-provisionally titled the stratospheric controlled perturbation experiment-is under development and will only proceed with transparent and predominantly governmental funding and independent risk assessment. We describe the scientific and technical foundation for performing, under external oversight, small-scale experiments to quantify the risks posed by SRM to activation of halogen species and subsequent erosion of stratospheric ozone. The paper's scope includes selection of the measurement platform, relevant aspects of stratospheric meteorology, operational considerations and instrument design and engineering.

Methadone, QTc prolongation and torsades de pointes: Current concepts, management and a hidden twist in the tale?

PubMed Central

Mujtaba, Sobia; Romero, Jorge; Taub, Cynthia C.

2013-01-01

Methadone is a drug that has found widespread utility in the management of opioid addiction and pain. Along with its popularity, methadone has also earned an infamous reputation for causing prolongation of the QT interval and an increased risk of torsades de pointes. In this article we will give a brief overview of the long QT syndromes, followed by an in-depth look at the current pathophysiologic mechanisms of methadone induced QT prolongation, a review of the existing literature and the current concepts regarding the prevention and management of methadone induced torsades de pointes. In addition, we explore the idea and implications of a genetic link between methadone induced prolongation of the QT interval and torsades de pointes. PMID:24653586

Proceedings from the 2001 NASA Occupational Health Conference: Risk Assessment and Management in 2001

NASA Technical Reports Server (NTRS)

Roberson, Sheri (Editor); Kelly, Bruce (Editor); Gettleman, Alan G. (Technical Monitor)

2001-01-01

This Conference convened approximately 86 registered participants of invited guest speakers, NASA presenters, and a broad spectrum of the Occupational Health disciplines representing NASA Headquarters and all NASA Field Centers. Two days' Professional Development Courses on Exposure Assessment Strategies and Statistics and on Advanced Cardiac Life Support training and recertification preceded the Conference. With the theme, 'Risk Assessment and Management in 2001,' conferees were first provided updates from the Program Principal Center Office and the Headquarters Office. Plenary sessions elaborated on several topics: biological terrorism, OSHA recordability, Workers' Compensation issues, Federal ergonomic standards, bridging aerospace medicine and occupational health-especially in management of risk in spaceflight, and EAP operations with mission failures. A keynote address dealt with resiliency skills for 21st century workers and two NASA astronaut speakers highlighted a tour of the Johnson Space Center. During discipline specific breakout sessions, current issues in occupational health management and policy, credentialing and privileging, health risk assessment, measurement and standardization, audits, database development, prevention and rehabilitation, international travel and infection control, employee assistance, nursing process, and environmental health were presented.

Probabilistic framework for product design optimization and risk management

NASA Astrophysics Data System (ADS)

Keski-Rahkonen, J. K.

2018-05-01

Probabilistic methods have gradually gained ground within engineering practices but currently it is still the industry standard to use deterministic safety margin approaches to dimensioning components and qualitative methods to manage product risks. These methods are suitable for baseline design work but quantitative risk management and product reliability optimization require more advanced predictive approaches. Ample research has been published on how to predict failure probabilities for mechanical components and furthermore to optimize reliability through life cycle cost analysis. This paper reviews the literature for existing methods and tries to harness their best features and simplify the process to be applicable in practical engineering work. Recommended process applies Monte Carlo method on top of load-resistance models to estimate failure probabilities. Furthermore, it adds on existing literature by introducing a practical framework to use probabilistic models in quantitative risk management and product life cycle costs optimization. The main focus is on mechanical failure modes due to the well-developed methods used to predict these types of failures. However, the same framework can be applied on any type of failure mode as long as predictive models can be developed.

The Social Work Ethics Audit: A Risk-Management Strategy.

ERIC Educational Resources Information Center

Reamer, Frederic G.

2000-01-01

Article integrates current knowledge on social work ethics and introduces the concept of a social work ethics audit to aid social workers in their efforts to identify pertinent ethical issues; review and assess the adequacy of their current ethics-related practices; modify their practices as needed; and monitor the implementation of these changes.…

Biosecurity for animal facilities and associated laboratories.

PubMed

Richmond, Jonathan Y; Nesby-O'Dell, Shanna

2003-01-01

Although working with human pathogens and zoonotic agents has always carried a certain degree of danger, current events have resulted in an increased focus on the subject, including new regulations. The authors discuss a number of risk assessment and management activities that animal research facilities should use to evaluate strengthen their current programs.

Concussion management in US college football: progress and pitfalls

PubMed Central

Kroshus, Emily

2015-01-01

Reducing the frequency and severity of concussions from sport is an important issue in public health currently addressed by a multifaceted approach. Given the large number of participants and the comparatively high risk of injury, American football is an important sport to consider when examining concussion management practices. Focusing on American football at the collegiate level, this manuscript describes current research regarding concussion epidemiology, policy, implementation of clinical diagnosis, management and return-to-play standards and athlete concussion education. Although American collegiate sports leagues have put forth concussion-related policies in recent years, the implementation of these policies and related effects on athlete concussion education, clinical management of concussion and ultimately athlete health outcomes are not well understood. Additional research is needed. PMID:27064258

Communication of medical product risk: how effective is effective enough?

PubMed

Goldman, Stephen A

2004-01-01

Ever-increasing attention is being paid worldwide to the safety of medical products, and the risks associated with their use. The integral role of risk communication in overall risk management is demonstrated by several recent market withdrawals of drugs, in which a perceived incapability of healthcare systems to manage well-characterised, avoidable risks was a significant factor. With advances in clinical pharmacology, pharmacogenomics and pharmacoepidemiology expanding our knowledge of medical products, effective delivery of the latest safety-related information to health professionals and consumers becomes even more imperative. In this regard, it is important to evaluate whether current modes of risk communication lead to desired changes in relevant behaviours such as prescribing or drug monitoring, particularly in context with which achieved level of effectiveness is deemed acceptable. This is crucial, as there have been product-specific risk communication efforts that achieved a fair degree of success, yet were not seen as effective enough to prevent market withdrawal of the medical product in question. In the service of improving public health through enhanced risk communication, it is essential to critically assess current methods, both as to results achieved (or not), and whether each method is applicable to the various types of risks associated with medical product use. Furthermore, just as combining methods may well improve overall risk communication, there are societal and psychological factors that must be considered in attempting to maximise effectiveness. However, in assessing risk communication effectiveness, the particular benefit- risk relationship of any individual medical product must also be part of the evaluative process.

Competing risks and the development of adaptive management plans for water resources: Field reconnaissance investigation of risks to fishes and other aquatic biota exposed to endocrine disrupting chemicals (edcs) in lake mead, Nevada USA

USGS Publications Warehouse

Linder, G.; Little, E.E.

2009-01-01

The analysis and characterization of competing risks for water resources rely on a wide spectrum of tools to evaluate hazards and risks associated with their management. For example, waters of the lower Colorado River stored in reservoirs such as Lake Mead present a wide range of competing risks related to water quantity and water quality. These risks are often interdependent and complicated by competing uses of source waters for sustaining biological resources and for supporting a range of agricultural, municipal, recreational, and industrial uses. USGS is currently conducting a series of interdisciplinary case-studies on water quality of Lake Mead and its source waters. In this case-study we examine selected constituents potentially entering the Lake Mead system, particularly endocrine disrupting chemicals (EDCs). Worldwide, a number of environmental EDCs have been identified that affect reproduction, development, and adaptive behaviors in a wide range of organisms. Many EDCs are minimally affected by current treatment technologies and occur in treated sewage effluents. Several EDCs have been detected in Lake Mead, and several substances have been identified that are of concern because of potential impacts to the aquatic biota, including the sport fishery of Lake Mead and endangered razorback suckers (Xyrauchen texanus) that occur in the Colorado River system. For example, altered biomarkers relevant to reproduction and thyroid function in fishes have been observed and may be predictive of impaired metabolism and development. Few studies, however, have addressed whether such EDC-induced responses observed in the field have an ecologically significant effect on the reproductive success of fishes. To identify potential linkages between EDCs and species of management concern, the risk analysis and characterization in this reconnaissance study focused on effects (and attendant uncertainties) that might be expressed by exposed populations. In addition, risk reduction measures that may be of interest to resource managers are considered relative to emerging contaminants in treated effluents, interdependencies among biological resources at risk, and uses of reservoir waters derived from multiple inflows of widely varying qualities. ??2009 ASCE.

Risk stratification following acute myocardial infarction.

PubMed

Singh, Mandeep

2007-07-01

This article reviews the current risk assessment models available for patients presenting with myocardial infarction (MI). These practical tools enhance the health care provider's ability to rapidly and accurately assess patient risk from the event or revascularization therapy, and are of paramount importance in managing patients presenting with MI. This article highlights the models used for ST-elevation MI (STEMI) and non-ST elevation MI (NSTEMI) and provides an additional description of models used to assess risks after primary angioplasty (ie, angioplasty performed for STEMI).

Calculation Package for the Analysis of Performance of Cells 1-6, with Underdrain, of the Environmental Management Waste Management Facility Oak Ridge, Tennessee

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

Gonzales D.

2010-03-30

This calculation package presents the results of an assessment of the performance of the 6 cell design of the Environmental Management Waste Management Facility (EMWMF). The calculations show that the new cell 6 design at the EMWMF meets the current WAC requirement. QA/QC steps were taken to verify the input/output data for the risk model and data transfer from modeling output files to tables and calculation.

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.

Implications of global climate change for the assessment and management of human health risks of chemicals in the natural environment.

PubMed

Balbus, John M; Boxall, Alistair B A; Fenske, Richard A; McKone, Thomas E; Zeise, Lauren

2013-01-01

Global climate change (GCC) is likely to alter the degree of human exposure to pollutants and the response of human populations to these exposures, meaning that risks of pollutants could change in the future. The present study, therefore, explores how GCC might affect the different steps in the pathway from a chemical source in the environment through to impacts on human health and evaluates the implications for existing risk-assessment and management practices. In certain parts of the world, GCC is predicted to increase the level of exposure of many environmental pollutants due to direct and indirect effects on the use patterns and transport and fate of chemicals. Changes in human behavior will also affect how humans come into contact with contaminated air, water, and food. Dietary changes, psychosocial stress, and coexposure to stressors such as high temperatures are likely to increase the vulnerability of humans to chemicals. These changes are likely to have significant implications for current practices for chemical assessment. Assumptions used in current exposure-assessment models may no longer apply, and existing monitoring methods may not be robust enough to detect adverse episodic changes in exposures. Organizations responsible for the assessment and management of health risks of chemicals therefore need to be more proactive and consider the implications of GCC for their procedures and processes. Copyright © 2012 SETAC.

77 FR 63299 - Notice of Intent To Prepare a Joint Environmental Impact Statement/Environmental Impact Report...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-16

... operation rules of Folsom Dam and Reservoir to reduce flood risk to the Sacramento area by utilizing the... the Dam's new flood operations plan, with the intention of meeting flood risk management objectives... direction to reduce Folsom Reservoir variable space allocation from the current operating range of 400,000...

Researcher Identity in Transition: Signals to Identify and Manage Spheres of Activity in a Risk-Career

ERIC Educational Resources Information Center

Castelló, Montserrat; Kobayashi, Sofie; McGinn, Michelle K.; Pechar, Hans; Vekkaila, Jenna; Wisker, Gina

2015-01-01

Within the current higher education context, early career researchers (ECRs) face a "risk-career" in which predictable, stable academic careers have become increasingly rare. Traditional milestones to signal progress toward a sustainable research career are disappearing or subject to reinterpretation, and ECRs need to attend to new or…

Risk mitigation measures for diffuse pesticide entry into aquatic ecosystems: proposal of a guide to identify appropriate measures on a catchment scale.

PubMed

Bereswill, Renja; Streloke, Martin; Schulz, Ralf

2014-04-01

Measures to mitigate the risk of pesticide entry into aquatic ecosystems are becoming increasingly more important in the management of hot spots of pesticide transfer; such management, for example, is required by the European Union's directive for the sustainable use of pesticides (2009/128/EC). Measures beyond those currently stipulated for pesticide product authorization may be needed. A concise compilation of the appropriate measures for users (that are primarily farmers but also, e.g., regulators and farm extension services) and a guide for practically identifying these measures at the catchment scale is currently not available. Therefore, a proposal was developed for a guide focusing on the most important diffuse entry pathways (spray drift and runoff). Based on a survey of exposure-relevant landscape parameters (i.e., the riparian buffer strip width, riparian vegetation type, density of ground vegetation cover, coverage of the water body with aquatic macrophytes, field slope, and existence of concentrated flow paths), a set of risk mitigation measures focusing on the specific situation of pollution of a water body catchment can be identified. The user can then choose risk mitigation measures to implement, assisted by evaluations of their efficiency in reducing pesticide entry, feasibility, and expected acceptability to farmers. Currently, 12 landscape-related measures and 6 application-related measures are included. The present guide presents a step toward the practical implementation of risk mitigation measures for reducing pesticide entry in aquatic ecosystems. © 2013 SETAC.

Climate change effects on wildland fire risk in the Northeastern and Great Lakes states predicted by a downscaled multi-model ensemble

NASA Astrophysics Data System (ADS)

Kerr, Gaige Hunter; DeGaetano, Arthur T.; Stoof, Cathelijne R.; Ward, Daniel

2018-01-01

This study is among the first to investigate wildland fire risk in the Northeastern and the Great Lakes states under a changing climate. We use a multi-model ensemble (MME) of regional climate models from the Coordinated Regional Downscaling Experiment (CORDEX) together with the Canadian Forest Fire Weather Index System (CFFWIS) to understand changes in wildland fire risk through differences between historical simulations and future projections. Our results are relatively homogeneous across the focus region and indicate modest increases in the magnitude of fire weather indices (FWIs) during northern hemisphere summer. The most pronounced changes occur in the date of the initialization of CFFWIS and peak of the wildland fire season, which in the future are trending earlier in the year, and in the significant increases in the length of high-risk episodes, defined by the number of consecutive days with FWIs above the current 95th percentile. Further analyses show that these changes are most closely linked to expected changes in the focus region's temperature and precipitation. These findings relate to the current understanding of particulate matter vis-à-vis wildfires and have implications for human health and local and regional changes in radiative forcings. When considering current fire management strategies which could be challenged by increasing wildland fire risk, fire management agencies could adapt new strategies to improve awareness, prevention, and resilience to mitigate potential impacts to critical infrastructure and population.

Managed Moves: School and Local Authority Staff Perceptions of Processes, Success and Challenges

ERIC Educational Resources Information Center

Bagley, Christopher; Hallam, Susan

2015-01-01

The current research aimed to increase understanding of the processes of managed moves for children at risk of exclusion from school, particularly exploring what contributed to success and the nature of the challenges experienced. The study was conducted in one English local authority where 11 school staff and 5 local authority staff were…

Towards enhanced risk management: Planning, decision making and monitoring of US wildfire response

Treesearch

Christopher J. Dunn; David E. Calkin; Matthew P. Thompson

2017-01-01

Wildfire’s economic, ecological and social impacts are on the rise, fostering the realisation that business-as-usual fire management in the United States is not sustainable. Current response strategies may be inefficient and contributing to unnecessary responder exposure to hazardous conditions, but significant knowledge gaps constrain clear and comprehensive...

Integrated risk framework for onsite wastewater treatment systems.

PubMed

Carroll, Steven; Goonetilleke, Ashantha; Thomas, Evan; Hargreaves, Megan; Frost, Ray; Dawes, Les

2006-08-01

Onsite wastewater treatment systems (OWTS) are becoming increasingly important for the treatment and dispersal of effluent in new urbanised developments that are not serviced by centralised wastewater collection and treatment systems. However, the current standards and guidelines adopted by many local authorities for assessing suitable site and soil conditions for OWTS are increasingly coming under scrutiny due to the public health and environmental impacts caused by poorly performing systems, in particular septic tank-soil adsorption systems. In order to achieve sustainable onsite wastewater treatment with minimal impacts on the environment and public health, more appropriate means of assessment are required. This paper highlights an integrated risk based approach for assessing the inherent hazards associated with OWTS in order to manage and mitigate the environmental and public health risks inherent with onsite wastewater treatment. In developing a sound and cohesive integrated risk framework for OWTS, several key issues must be recognised. These include the inclusion of relevant stakeholders throughout framework development, the integration of scientific knowledge, data and analysis with risk assessment and management ideals, and identification of the appropriate performance goals for successful management and mitigation of associated risks. These issues were addressed in the development of the risk framework to provide a generic approach to assessing risk from OWTS. The utilisation of the developed risk framework for achieving more appropriate assessment and management techniques for OWTS is presented in a case study for the Gold Coast region, Queensland State, Australia.

Integrated Risk Framework for Onsite Wastewater Treatment Systems

NASA Astrophysics Data System (ADS)

Carroll, Steven; Goonetilleke, Ashantha; Thomas, Evan; Hargreaves, Megan; Frost, Ray; Dawes, Les

2006-08-01

Onsite wastewater treatment systems (OWTS) are becoming increasingly important for the treatment and dispersal of effluent in new urbanised developments that are not serviced by centralised wastewater collection and treatment systems. However, the current standards and guidelines adopted by many local authorities for assessing suitable site and soil conditions for OWTS are increasingly coming under scrutiny due to the public health and environmental impacts caused by poorly performing systems, in particular septic tank-soil adsorption systems. In order to achieve sustainable onsite wastewater treatment with minimal impacts on the environment and public health, more appropriate means of assessment are required. This paper highlights an integrated risk based approach for assessing the inherent hazards associated with OWTS in order to manage and mitigate the environmental and public health risks inherent with onsite wastewater treatment. In developing a sound and cohesive integrated risk framework for OWTS, several key issues must be recognised. These include the inclusion of relevant stakeholders throughout framework development, the integration of scientific knowledge, data and analysis with risk assessment and management ideals, and identification of the appropriate performance goals for successful management and mitigation of associated risks. These issues were addressed in the development of the risk framework to provide a generic approach to assessing risk from OWTS. The utilisation of the developed risk framework for achieving more appropriate assessment and management techniques for OWTS is presented in a case study for the Gold Coast region, Queensland State, Australia.

Review of clinical practice guidelines for the management of LDL-related risk.

PubMed

Morris, Pamela B; Ballantyne, Christie M; Birtcher, Kim K; Dunn, Steven P; Urbina, Elaine M

2014-07-15

Managing risk related to low-density lipoprotein (LDL) is vital in therapy for patients at risk for atherosclerotic cardiovascular disease (ASCVD) events given its important etiologic role in atherogenesis. Despite decades of research showing reduction of ASCVD risk with multiple approaches to lowering of LDL cholesterol, there continue to be significant gaps in care with inadequate numbers of patients receiving standard of care lipid-lowering therapy. Confusion regarding implementation of the multiple published clinical practice guidelines has been identified as one contributor to suboptimal management of LDL-related risk. This review summarizes the current guidelines for reduction of LDL-related cardiovascular risk provided by a number of major professional societies, which have broad applicability to diverse populations worldwide. Statements have varied in the process and methodology of development of recommendations, the grading system for level and strength of evidence, the inclusion or exclusion of expert opinion, the suggested ASCVD risk assessment tool, the lipoproteins recommended for risk assessment, and the lipoprotein targets of therapy. The similarities and differences among important guidelines in the United States and internationally are discussed, with recommendations for future strategies to improve consistency in approaches to LDL-related ASCVD risk and to reduce gaps in implementation of evidence-based therapies. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

From dynamic ocean management to climate-ready management: a case study using blue whales in the northeast Pacific.

NASA Astrophysics Data System (ADS)

Hazen, E. L.

2016-02-01

Highly migratory species regularly traverse human-imposed boundaries including exclusive economic zones and marine protected areas, thus are difficult to manage using traditional spatial approaches. Blue whales (Balaenoptera musculus) are seasonal visitors to the California Current System that target a single prey resource, krill (Euphausia pacifica, Thysanoessa spinifera), and migrate large distances to find and exploit ephemeral prey patches. Successful management of blue whales requires improved understanding of how fine-scale foraging ecology translates to population abundances. Specifically, sub-lethal factors such as anthropogenic noise and climate change, and lethal factors such as ship strikes may be limiting recovery and can be difficult to account for in current management strategies. Here we use an extensive dataset of fine-scale accelerometers (55) and broad-scale satellite tags (104) deployed on Northeast Pacific blue whales to examine the energetics of foraging, overlap with human risk, and projections of future habitat with climate change. We quantify the importance of dense prey patches (> 100 krill per cubic meter) for blue whale energetics and fitness. Distribution models can be used in concert with industry and regional offices to produce dynamic rules to reduce vessel interactions. We propose telemetry data are ripe for use in establishing dynamic management approaches that account for daily to seasonal management areas to minimize anthropogenic risks, and are also adaptable to long-term climate-driven changes in habitat.

From dynamic ocean management to climate-ready management: a case study using blue whales in the northeast Pacific.

NASA Astrophysics Data System (ADS)

Hazen, E. L.

2016-12-01

Highly migratory species regularly traverse human-imposed boundaries including exclusive economic zones and marine protected areas, thus are difficult to manage using traditional spatial approaches. Blue whales (Balaenoptera musculus) are seasonal visitors to the California Current System that target a single prey resource, krill (Euphausia pacifica, Thysanoessa spinifera), and migrate large distances to find and exploit ephemeral prey patches. Successful management of blue whales requires improved understanding of how fine-scale foraging ecology translates to population abundances. Specifically, sub-lethal factors such as anthropogenic noise and climate change, and lethal factors such as ship strikes may be limiting recovery and can be difficult to account for in current management strategies. Here we use an extensive dataset of fine-scale accelerometers (55) and broad-scale satellite tags (104) deployed on Northeast Pacific blue whales to examine the energetics of foraging, overlap with human risk, and projections of future habitat with climate change. We quantify the importance of dense prey patches (> 100 krill per cubic meter) for blue whale energetics and fitness. Distribution models can be used in concert with industry and regional offices to produce dynamic rules to reduce vessel interactions. We propose telemetry data are ripe for use in establishing dynamic management approaches that account for daily to seasonal management areas to minimize anthropogenic risks, and are also adaptable to long-term climate-driven changes in habitat.

[Clinical risk management in german hospitals - does size really matter?].

PubMed

Bohnet-Joschko, S; Jandeck, L M; Zippel, C; Andersen, M; Krummenauer, F

2011-06-01

In the last years, German hospitals have implemented different measures to increase patient safety. Special importance has been attached to near miss reporting systems (critical incident reporting system, CIRS) as instruments for risk identification in health care, instruments that promise high potential for organisational learning. To gain insight into the current status of critical incident reporting systems and other instruments for clinical risk management, a survey among 341 hospitals was carried out in 2009. Questions covered a process of six steps: from risk strategy to methods for risk identification, to risk analysis and risk assessment, to risk controlling and risk monitoring. Structured telephone interviews were conducted with 341 German hospitals, featuring in their statutory quality reports certain predefined key terms that indicated the concluded or planned implementation of clinical risk management. The main objective of those interviews was to check the relation between status/organisation of self-reported risk management and both operator (private, public, NPO) and size of hospital. The implementation of near miss reporting systems (CIRS) in German hospitals has been constantly rising since 2004: in 2009, 54 % of the interviewed hospitals reported an implemented CIRS; of these, 72 % reported the system to be hospital-wide. An association between CIRS and private, public or NPO-operator could not be detected (Fisher p = 1.000); however, the degree of CIRS implementation was significantly increasing with the size of the hospital, i.e., the number of beds (Fisher p = 0.008): only 38 % of the hospitals with less than 100 beds reported CIRS implementation against 52 % of those between 100 to 500 beds, and 67 % of those with more than 500 beds. While 62 % of the hospitals interviewed reported the maintenance of a risk management committee, only 14 % reported the implementation of risk analysing techniques. As to clinical risk management, 92 % of the hospitals see potential for internal improvement; 44 % have already communicated with external consultants. While identification of clinical risks with near miss and other incident reporting systems meets increasing acceptance, the learning potential based on incident reporting is not yet appropriately being used. There is a deficit regarding systematic and comprehensive risk assessment and controlling; this will have to be met by improving the organisational framework for clinical risk management. © Georg Thieme Verlag KG Stuttgart · New York.

Environmental risk management for radiological accidents: integrating risk assessment and decision analysis for remediation at different spatial scales.

PubMed

Yatsalo, Boris; Sullivan, Terrence; Didenko, Vladimir; Linkov, Igor

2011-07-01

The consequences of the Tohuku earthquake and subsequent tsunami in March 2011 caused a loss of power at the Fukushima Daiichi nuclear power plant, in Japan, and led to the release of radioactive materials into the environment. Although the full extent of the contamination is not currently known, the highly complex nature of the environmental contamination (radionuclides in water, soil, and agricultural produce) typical of nuclear accidents requires a detailed geospatial analysis of information with the ability to extrapolate across different scales with applications to risk assessment models and decision making support. This article briefly summarizes the approach used to inform risk-based land management and remediation decision making after the Chernobyl, Soviet Ukraine, accident in 1986. Copyright © 2011 SETAC.

Allocating responsibility for environmental risks: A comparative analysis of examples from water governance.

PubMed

Doorn, Neelke

2017-03-01

The focus of the present study is on the allocation of responsibilities for addressing environmental risks in transboundary water governance. Effective environmental management in transboundary situations requires coordinated and cooperative action among diverse individuals and organizations. Currently, little insight exists on how to foster collective action such that individuals and organizations take the responsibility to address transboundary environmental risks. On the basis of 4 cases of transboundary water governance, it will be shown how certain allocation principles are more likely to encourage cooperative action. The main lesson from these case studies is that the allocation of responsibilities should be seen as a risk distribution problem, including considerations of effectiveness, efficiency, and fairness. Integr Environ Assess Manag 2017;13:371-375. © 2016 SETAC. © 2016 SETAC.

Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association.

PubMed

Canobbio, Mary M; Warnes, Carole A; Aboulhosn, Jamil; Connolly, Heidi M; Khanna, Amber; Koos, Brian J; Mital, Seema; Rose, Carl; Silversides, Candice; Stout, Karen

2017-02-21

Today, most female children born with congenital heart disease will reach childbearing age. For many women with complex congenital heart disease, carrying a pregnancy carries a moderate to high risk for both the mother and her fetus. Many such women, however, do not have access to adult congenital heart disease tertiary centers with experienced reproductive programs. Therefore, it is important that all practitioners who will be managing these women have current information not only on preconception counseling and diagnostic evaluation to determine maternal and fetal risk but also on how to manage them once they are pregnant and when to refer them to a regional center with expertise in pregnancy management. © 2017 American Heart Association, Inc.

Dynamic Data Management Based on Archival Process Integration at the Centre for Environmental Data Archival

NASA Astrophysics Data System (ADS)

Conway, Esther; Waterfall, Alison; Pepler, Sam; Newey, Charles

2015-04-01

In this paper we decribe a business process modelling approach to the integration of exisiting archival activities. We provide a high level overview of existing practice and discuss how procedures can be extended and supported through the description of preservation state. The aim of which is to faciliate the dynamic controlled management of scientific data through its lifecycle. The main types of archival processes considered are: • Management processes that govern the operation of an archive. These management processes include archival governance (preservation state management, selection of archival candidates and strategic management) . • Operational processes that constitute the core activities of the archive which maintain the value of research assets. These operational processes are the acquisition, ingestion, deletion, generation of metadata and preservation actvities, • Supporting processes, which include planning, risk analysis and monitoring of the community/preservation environment. We then proceed by describing the feasability testing of extended risk management and planning procedures which integrate current practices. This was done through the CEDA Archival Format Audit which inspected British Atmospherics Data Centre and National Earth Observation Data Centre Archival holdings. These holdings are extensive, comprising of around 2PB of data and 137 million individual files which were analysed and characterised in terms of format based risk. We are then able to present an overview of the risk burden faced by a large scale archive attempting to maintain the usability of heterogeneous environmental data sets. We conclude by presenting a dynamic data management information model that is capable of describing the preservation state of archival holdings throughout the data lifecycle. We provide discussion of the following core model entities and their relationships: • Aspirational entities, which include Data Entity definitions and their associated Preservation Objectives. • Risk entities, which act as drivers for change within the data lifecycle. These include Acquisitional Risks, Technical Risks, Strategic Risks and External Risks • Plan entities, which detail the actions to bring about change within an archive. These include Acquisition Plans, Preservation Plans and Monitoring plans • The Result entities describe the successful outcomes of the executed plans. These include Acquisitions, Mitigations and Accepted Risks.

Assessing the Health-Care Risk: The Clinical-VaR, a Key Indicator for Sound Management.

PubMed

Jiménez-Rodríguez, Enrique; Feria-Domínguez, José Manuel; Sebastián-Lacave, Alonso

2018-03-30

Clinical risk includes any undesirable situation or operational factor that may have negative consequences for patient safety or capable of causing an adverse event (AE). The AE, intentional or unintentionally, may be related to the human factor, that is, medical errors (MEs). Therefore, the importance of the health-care risk management is a current and relevant issue on the agenda of many public and private institutions. The objective of the management has been evolving from the identification of AE to the assessment of cost-effective and efficient measures that improve the quality control through monitoring. Consequently, the goal of this paper is to propose a Key Risk Indicator (KRI) that enhances the advancement of the health-care management system. Thus, the application of the Value at Risk (VaR) concept in combination to the Loss Distribution Approach (LDA) is proved to be a proactive tool, within the frame of balanced scorecard (BSC), in health organizations. For this purpose, the historical events recorded in the Algo-OpData ® database (Algorithmics Inc., Toronto, ON, Canada, IBM, Armonk, NY, USA) have been used. The analysis highlights the importance of risk in the financials outcomes of the sector. The results of paper show the usefulness of the Clinical-VaR to identify and monitor the risk and sustainability of the implemented controls.

Assessing the Health-Care Risk: The Clinical-VaR, a Key Indicator for Sound Management

PubMed Central

Jiménez-Rodríguez, Enrique; Sebastián-Lacave, Alonso

2018-01-01

Clinical risk includes any undesirable situation or operational factor that may have negative consequences for patient safety or capable of causing an adverse event (AE). The AE, intentional or unintentionally, may be related to the human factor, that is, medical errors (MEs). Therefore, the importance of the health-care risk management is a current and relevant issue on the agenda of many public and private institutions. The objective of the management has been evolving from the identification of AE to the assessment of cost-effective and efficient measures that improve the quality control through monitoring. Consequently, the goal of this paper is to propose a Key Risk Indicator (KRI) that enhances the advancement of the health-care management system. Thus, the application of the Value at Risk (VaR) concept in combination to the Loss Distribution Approach (LDA) is proved to be a proactive tool, within the frame of balanced scorecard (BSC), in health organizations. For this purpose, the historical events recorded in the Algo-OpData® database (Algorithmics Inc., Toronto, ON, Canada, IBM, Armonk, NY, USA) have been used. The analysis highlights the importance of risk in the financials outcomes of the sector. The results of paper show the usefulness of the Clinical-VaR to identify and monitor the risk and sustainability of the implemented controls. PMID:29601529

Identifying and managing the risks of medical ionizing radiation in endourology.

PubMed

Yecies, Todd; Averch, Timothy D; Semins, Michelle J

2018-02-01

The risks of exposure to medical ionizing radiation is of increasing concern both among medical professionals and the general public. Patients with nephrolithiasis are exposed to high levels of ionizing radiation through both diagnostic and therapeutic modalities. Endourologists who perform a high-volume of fluoroscopy guided procedures are also exposed to significant quantities of ionizing radiation. The combination of judicious use of radiation-based imaging modalities, application of new imaging techniques such as ultra-low dose computed tomography (CT) scan, and modifying use of current technology such as increasing ultrasound and pulsed fluoroscopy utilization offers the possibility of significantly reducing radiation exposure. We present a review of the literature regarding the risks of medical ionizing radiation to patients and surgeons as it pertains to the field of endourology and interventions that can be performed to limit this exposure. A review of the current state of the literature was performed using MEDLINE and PubMed. Interventions designed to limit patient and surgeon radiation exposure were identified and analyzed. Summaries of the data were compiled and synthesized in the body of the text. While no level 1 evidence exists demonstrating the risk of secondary malignancy with radiation exposure, the preponderance of evidence suggests a dose and age dependent increase in malignancy risk from ionizing radiation. Patients with nephrolithiasis were exposed to an average effective dose of 37mSv over a 2 year period. Multiple evidence-based interventions to limit patient and surgeon radiation exposure and associated risk were identified. Current evidence suggest an age and dose dependent risk of secondary malignancy from ionizing radiation. Urologists must act in accordance with ALARA principles to safely manage nephrolithiasis while minimizing radiation exposure.

Denial of risk: The effects of positive impression management on risk assessments for psychopathic and nonpsychopathic offenders.

PubMed

Gillard, Nathan D; Rogers, Richard

2015-01-01

Risk assessments for offenders often combine past records with current clinical findings from observations, interviews, and test data. Conclusions based on these risk assessments are highly consequential, sometimes resulting in increased criminal sentences or prolonged hospitalization. Therefore, many offenders are motivated to intentionally minimize risk factors and their negative consequences. Positive impression management (PIM) is especially likely to occur in offenders with high psychopathic traits because goal-directed deception is reflected in several of psychopathy's core traits of the disorder, such as manipulativeness, glibness, and superficial charm. However, this connection appears to be based on the conceptual understanding of psychopathy, and has rarely been examined empirically for either frequency of or success at deception. The current study examined the ability of a jail sample to intentionally minimize risk factors and related criminal attributes using a repeated measures, simulation design. In general, offenders were able to effectively use PIM to lower scores on the HCR-20 and the Self-Appraisal Questionnaire (SAQ), while the Psychological Inventory of Criminal Thinking Styles (PICTS), as a measure of cognitive styles, was more resistant to such minimization. Psychopathic traits, especially high Factor 1 scores (i.e., affective/interpersonal), were associated with greater PIM. Important differences in the willingness and ability to use deception were found based on the (a) mode of administration (i.e., interview vs. self-report) and (b) level of psychopathy as measured by the Psychopathy Checklist - Revised (PCL-R). The important implications of this research are discussed for risk assessment procedures regarding likely areas of deception and its detection. The current research also informs the growing literature on the connection between psychopathic traits and deception. Copyright © 2015 Elsevier Ltd. All rights reserved.

Expectant management of veterans with early-stage prostate cancer.

PubMed

Filson, Christopher P; Shelton, Jeremy B; Tan, Hung-Jui; Kwan, Lorna; Skolarus, Ted A; Saigal, Christopher S; Litwin, Mark S

2016-02-15

For certain men with low-risk prostate cancer, aggressive treatment results in marginal survival benefits while exposing them to urinary and sexual side effects. Nevertheless, expectant management has been underused. In the current study, the authors evaluated the association between various factors and expectant management use among veterans diagnosed with prostate cancer. The authors identified men diagnosed with prostate cancer in 2008. The outcome of interest was use of expectant management, based on documentation captured through an in-depth chart review. Multivariable regression models were fit to examine associations between use of expectant management and patient demographics, cancer severity, and facility characteristics. The authors assessed variation across 21 tertiary care regions and 52 facilities by generating predicted probabilities for receipt of expectant management. Expectant management was more common among patients aged ≥75 years (40% vs 27% for those aged < 55 years; odds ratio, 2.57) and those with low-risk tumors (49% vs 20% for patients with high-risk tumors; odds ratio, 5.35). There was no association noted between patient comorbidity and receipt of expectant management (P = .90). There were also no associations found between facility factors and use of expectant management (all P>.05). Among ideal candidates for expectant management, receipt of expectant management varied considerably across individual facilities (0%-85%; P<.001). Patient age and tumor risk were found to be more strongly associated with use of expectant management than patient comorbidity. Although use of expectant management appears broadly appropriate, there was variation in expectant management noted between hospitals that was apparently not attributable to facility factors. Research determining the basis of this variation, with a focus on providers, will be critical to help optimize prostate cancer treatment for veterans. © 2015 American Cancer Society.

Cardiovascular risk factors and dementia.

PubMed

Fillit, Howard; Nash, David T; Rundek, Tatjana; Zuckerman, Andrea

2008-06-01

Dementias, such as Alzheimer's disease (AD) and vascular dementia, are disorders of aging populations and represent a significant economic burden. Evidence is accumulating to suggest that cardiovascular disease (CVD) risk factors may be instrumental in the development of dementia. The goal of this review was to discuss the relationship between specific CVD risk factors and dementia and how current treatment strategies for dementia should focus on reducing CVD risks. We conducted a review of the literature for the simultaneous presence of 2 major topics, cardiovascular risk factors and dementia (eg, AD). Special emphasis was placed on clinical outcome studies examining the effects of treatments of pharmacologically modifiable CVD risk factors on dementia and cognitive impairment. Lifestyle risk factors for CVD, such as obesity, lack of exercise, smoking, and certain psychosocial factors, have been associated with an increased risk of cognitive decline and dementia. Some evidence suggests that effectively managing these factors may prevent cognitive decline/dementia. Randomized, placebo-controlled trials of antihypertensive medications have found that such therapy may reduce the risk of cognitive decline, and limited data suggest a benefit for patients with AD. Some small open-label and randomized clinical trials of statins have observed positive effects on cognitive function; larger studies of statins in patients with AD are ongoing. Although more research is needed, current evidence indicates an association between CVD risk factors--such as hypertension, dyslipidemia, and diabetes mellitus--and cognitive decline/dementia. From a clinical perspective, these data further support the rationale for physicians to provide effective management of CVD risk factors and for patients to be compliant with such recommendations to possibly prevent cognitive decline/dementia.

Performance of diagnosis-based risk adjustment measures in a population of sick Australians.

PubMed

Duckett, S J; Agius, P A

2002-12-01

Australia is beginning to explore 'managed competition' as an organising framework for the health care system. This requires setting fair capitation rates, i.e. rates that adjust for the risk profile of covered lives. This paper tests two US-developed risk adjustment approaches using Australian data. Data from the 'co-ordinated care' dataset (which incorporates all service costs of 16,538 participants in a large health service research project conducted in 1996-99) were grouped into homogenous risk categories using risk adjustment 'grouper software'. The grouper products yielded three sets of homogenous categories: Diagnostic Groups and Diagnostic cost Groups. A two-stage analysis of predictive power was used: probability of any service use in the concurrent year, next year and the year after (logistic regression) and, for service users, a regression of logged cost of service use. The independent variables were diagnosis gender, a SES variable and the Age, gender and diagnosis-based risk adjustment measures explain around 40-45% of variation in costs of service use in the current year for untrimmed data (compared with around 15% for age and gender alone). Prediction of subsequent use is much poorer (around 20%). Using more information to assign people to risk categories generally improves prediction. Predictive power of diagnosis-base risk adjusters on this Australian dataset is similar to that found in Low predictive power carries policy risks of cream skimming rather than managing population health and care. Competitive funding models with risk adjustment on prior year experience could reduce system efficiency if implemented with current risk adjustment technology.

Structured decision making for managing pneumonia epizootics in bighorn sheep

USGS Publications Warehouse

Sells, Sarah N.; Mitchell, Michael S.; Edwards, Victoria L.; Gude, Justin A.; Anderson, Neil J.

2016-01-01

Good decision-making is essential to conserving wildlife populations. Although there may be multiple ways to address a problem, perfect solutions rarely exist. Managers are therefore tasked with identifying decisions that will best achieve desired outcomes. Structured decision making (SDM) is a method of decision analysis used to identify the most effective, efficient, and realistic decisions while accounting for values and priorities of the decision maker. The stepwise process includes identifying the management problem, defining objectives for solving the problem, developing alternative approaches to achieve the objectives, and formally evaluating which alternative is most likely to accomplish the objectives. The SDM process can be more effective than informal decision-making because it provides a transparent way to quantitatively evaluate decisions for addressing multiple management objectives while incorporating science, uncertainty, and risk tolerance. To illustrate the application of this process to a management need, we present an SDM-based decision tool developed to identify optimal decisions for proactively managing risk of pneumonia epizootics in bighorn sheep (Ovis canadensis) in Montana. Pneumonia epizootics are a major challenge for managers due to long-term impacts to herds, epistemic uncertainty in timing and location of future epizootics, and consequent difficulty knowing how or when to manage risk. The decision tool facilitates analysis of alternative decisions for how to manage herds based on predictions from a risk model, herd-specific objectives, and predicted costs and benefits of each alternative. Decision analyses for 2 example herds revealed that meeting management objectives necessitates specific approaches unique to each herd. The analyses showed how and under what circumstances the alternatives are optimal compared to other approaches and current management. Managers can be confident that these decisions are effective, efficient, and realistic because they explicitly account for important considerations managers implicitly weigh when making decisions, including competing management objectives, uncertainty in potential outcomes, and risk tolerance.

Building a Practical Framework for Enterprise-Wide Security Management

DTIC Science & Technology

2004-04-28

management. They have found that current efforts to manage security vulnerabilities and security risks only take an enterprise so far, with results...analyzed reports to determine the cause of the increase. Slide 5 © 2004 by Carnegie Mellon University Version 1.0 Secure IT 2004 - page 5 Attack...Nearly 1 in 5 of those surveyed reported that none of their IT staff have any formal security training. [A survey of 896 Computing Technology

MID-ATLANTIC REGIONAL VULNERABILITY ASSESSMENT

EPA Science Inventory

ORD's Regional Vulnerability Assessment (REVA) Program is developing and demonstrating approaches to assess current and future environmental vulnerabilities so that risk management activities can be targeted. The sister program to EMA.P (Environmental Monitoring Assessment Progr...

CANARY Risk Management of Adenocarcinoma: The Future of Imaging?

PubMed Central

Foley, Finbar; Rajagopalan, Srinivasan; Raghunath, Sushravya M; Boland, Jennifer M; Karwoski, Ronald A.; Maldonado, Fabien; Bartholmai, Brian J; Peikert, Tobias

2016-01-01

Increased clinical utilization of chest high resolution computed tomography results in increased identification of lung adenocarcinomas and persistent sub-solid opacities. However, these lesions range from very indolent to extremely aggressive tumors. Clinically relevant diagnostic tools to non-invasively risk stratify and guide individualized management of these lesions are lacking. Research efforts investigating semi-quantitative measures to decrease inter- and intra-rater variability are emerging, and in some cases steps have been taken to automate this process. However, many such methods currently are still sub-optimal, require validation and are not yet clinically applicable. The Computer-Aided Nodule Assessment and Risk Yield (CANARY) software application represents a validated tool for the automated, quantitative, non-invasive tool for risk stratification of adenocarcinoma lung nodules. CANARY correlates well with consensus histology and post-surgical patient outcomes and therefore may help to guide individualized patient management e.g. in identification of nodules amenable to radiological surveillance, or in need of adjunctive therapy. PMID:27568149

Perioperative Management of Patients with Inflammatory Rheumatic Diseases Undergoing Major Orthopaedic Surgery: A Practical Overview.

PubMed

Gualtierotti, Roberta; Parisi, Marco; Ingegnoli, Francesca

2018-04-01

Patients with inflammatory rheumatic diseases often need orthopaedic surgery due to joint involvement. Total hip replacement and total knee replacement are frequent surgical procedures in these patients. Due to the complexity of the inflammatory rheumatic diseases, the perioperative management of these patients must envisage a multidisciplinary approach. The frequent association with extraarticular comorbidities must be considered when evaluating perioperative risk of the patient and should guide the clinician in the decision-making process. However, guidelines of different medical societies may vary and are sometimes contradictory. Orthopaedics should collaborate with rheumatologists, anaesthesiologists and, when needed, cardiologists and haematologists with the common aim of minimising perioperative risk in patients with inflammatory rheumatic diseases. The aim of this review is to provide the reader with simple practical recommendations regarding perioperative management of drugs such as disease-modifying anti-rheumatic drugs, corticosteroids, non-steroidal anti-inflammatory drugs and tools for a risk stratification for cardiovascular and thromboembolic risk based on current evidence for patients with inflammatory rheumatic diseases.

Reviewing Bayesian Networks potentials for climate change impacts assessment and management: A multi-risk perspective.

PubMed

Sperotto, Anna; Molina, José-Luis; Torresan, Silvia; Critto, Andrea; Marcomini, Antonio

2017-11-01

The evaluation and management of climate change impacts on natural and human systems required the adoption of a multi-risk perspective in which the effect of multiple stressors, processes and interconnections are simultaneously modelled. Despite Bayesian Networks (BNs) are popular integrated modelling tools to deal with uncertain and complex domains, their application in the context of climate change still represent a limited explored field. The paper, drawing on the review of existing applications in the field of environmental management, discusses the potential and limitation of applying BNs to improve current climate change risk assessment procedures. Main potentials include the advantage to consider multiple stressors and endpoints in the same framework, their flexibility in dealing and communicate with the uncertainty of climate projections and the opportunity to perform scenario analysis. Some limitations (i.e. representation of temporal and spatial dynamics, quantitative validation), however, should be overcome to boost BNs use in climate change impacts assessment and management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Detection and Management of Diabetes in England: Results from the Health Survey for England.

PubMed

Xiao, Mimi; O'Neill, Ciaran

2017-10-01

As part of a control strategy current guidance in the UK recommends more intense surveillance of HbA1C levels among those of South-east Asian or Chinese ethnicity above specified BMI thresholds. The objective of this study was to determine whether disparities in the identification and control of diabetes in England persisted despite these guidelines and assess current strategies in light of these findings. Data were extracted from the 2013 Health Survey for England that included ethnicity, BMI status and HbA1C levels. Descriptive statistics and logistic regression analyses were used to examine relationships among undetected diabetes, poorly controlled diabetes and a range of covariates including ethnicity and BMI. Concentration indices were used to examine the socio-economic gradient in disease detection and control among and between ethnic groups. In regression models that controlled for a range of covariates Asians were found to have a 5% point higher risk of undetected diabetes than Whites. With respect to disease management, Bangladeshis and Pakistanis were found to be at a 28% point and 21% point higher risk of poor disease control respectively than Whites. Concentration indices revealed better disease control among more affluent Whites than poor Whites, no significant pattern between income and disease management was found among Pakistanis and poorer disease control was more evident among more affluent than poorer Bangladeshis. In the UK current guidance recommends practitioners consider testing for diabetes among South-east Asians and Chinese where BMI exceeds 23. Our findings suggest that the risk experienced by Asians in disease detection is independent of BMI and may warrant a more active screening policy than currently recommended. With respect to disease management, our findings suggest that Indians and Pakistanis experience particularly high levels of poor disease control that may also be usefully reflected in guidance.

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.

Wyoming Basin Rapid Ecoregional Assessment

USGS Publications Warehouse

Carr, Natasha B.; Means, Robert E.

2013-01-01

The overall goal of the Wyoming Basin Rapid Ecoregional Assessment (REA) is to provide information that supports regional planning and analysis for the management of ecological resources. The REA provides an assessment of baseline ecological conditions, an evaluation of current risks from drivers of ecosystem change (including energy development, fire, and invasive species), and a predictive capacity for evaluating future risks (including climate change). Additionally, the REA may be used for identifying priority areas for conservation or restoration and for assessing cumulative effects of multiple land uses. The Wyoming Basin REA will address Management Questions developed by the Bureau of Land Management and other agency partners for 8 major biomes and 19 species or species assemblages. The maps developed for addressing Management Questions will be integrated into overall maps of landscape-level ecological values and risks. The maps can be used to address the goals of the REA at a number of levels: for individual species, species assemblages, aquatic and terrestrial systems, and for the entire ecoregion. This allows flexibility in how the products of the REA are compiled to inform planning and management actions across a broad range of spatial scales.

When bad things happen: adverse event reporting and disclosure as patient safety and risk management tools in the neonatal intensive care unit.

PubMed

Donn, Steven M; McDonnell, William M

2012-01-01

The Institute of Medicine has recommended a change in culture from "name and blame" to patient safety. This will require system redesign to identify and address errors, establish performance standards, and set safety expectations. This approach, however, is at odds with the present medical malpractice (tort) system. The current system is outcomes-based, meaning that health care providers and institutions are often sued despite providing appropriate care. Nevertheless, the focus should remain to provide the safest patient care. Effective peer review may be hindered by the present tort system. Reporting of medical errors is a key piece of peer review and education, and both anonymous reporting and confidential reporting of errors have potential disadvantages. Diagnostic and treatment errors continue to be the leading sources of allegations of malpractice in pediatrics, and the neonatal intensive care unit is uniquely vulnerable. Most errors result from systems failures rather than human error. Risk management can be an effective process to identify, evaluate, and address problems that may injure patients, lead to malpractice claims, and result in financial losses. Risk management identifies risk or potential risk, calculates the probability of an adverse event arising from a risk, estimates the impact of the adverse event, and attempts to control the risk. Implementation of a successful risk management program requires a positive attitude, sufficient knowledge base, and a commitment to improvement. Transparency in the disclosure of medical errors and a strategy of prospective risk management in dealing with medical errors may result in a substantial reduction in medical malpractice lawsuits, lower litigation costs, and a more safety-conscious environment. Thieme Medical Publishers, Inc.

New risk metrics and mathematical tools for risk analysis: Current and future challenges

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

Skandamis, Panagiotis N., E-mail: pskan@aua.gr; Andritsos, Nikolaos, E-mail: pskan@aua.gr; Psomas, Antonios, E-mail: pskan@aua.gr

The current status of the food safety supply world wide, has led Food and Agriculture Organization (FAO) and World Health Organization (WHO) to establishing Risk Analysis as the single framework for building food safety control programs. A series of guidelines and reports that detail out the various steps in Risk Analysis, namely Risk Management, Risk Assessment and Risk Communication is available. The Risk Analysis approach enables integration between operational food management systems, such as Hazard Analysis Critical Control Points, public health and governmental decisions. To do that, a series of new Risk Metrics has been established as follows: i) themore » Appropriate Level of Protection (ALOP), which indicates the maximum numbers of illnesses in a population per annum, defined by quantitative risk assessments, and used to establish; ii) Food Safety Objective (FSO), which sets the maximum frequency and/or concentration of a hazard in a food at the time of consumption that provides or contributes to the ALOP. Given that ALOP is rather a metric of the public health tolerable burden (it addresses the total ‘failure’ that may be handled at a national level), it is difficult to be interpreted into control measures applied at the manufacturing level. Thus, a series of specific objectives and criteria for performance of individual processes and products have been established, all of them assisting in the achievement of FSO and hence, ALOP. In order to achieve FSO, tools quantifying the effect of processes and intrinsic properties of foods on survival and growth of pathogens are essential. In this context, predictive microbiology and risk assessment have offered an important assistance to Food Safety Management. Predictive modelling is the basis of exposure assessment and the development of stochastic and kinetic models, which are also available in the form of Web-based applications, e.g., COMBASE and Microbial Responses Viewer), or introduced into user-friendly softwares, (e.g., Seafood Spoilage Predictor) have evolved the use of information systems in the food safety management. Such tools are updateable with new food-pathogen specific models containing cardinal parameters and multiple dependent variables, including plate counts, concentration of metabolic products, or even expression levels of certain genes. Then, these tools may further serve as decision-support tools which may assist in product logistics, based on their scientifically-based and “momentary” expressed spoilage and safety level.« less

New risk metrics and mathematical tools for risk analysis: Current and future challenges

NASA Astrophysics Data System (ADS)

Skandamis, Panagiotis N.; Andritsos, Nikolaos; Psomas, Antonios; Paramythiotis, Spyridon

2015-01-01

The current status of the food safety supply world wide, has led Food and Agriculture Organization (FAO) and World Health Organization (WHO) to establishing Risk Analysis as the single framework for building food safety control programs. A series of guidelines and reports that detail out the various steps in Risk Analysis, namely Risk Management, Risk Assessment and Risk Communication is available. The Risk Analysis approach enables integration between operational food management systems, such as Hazard Analysis Critical Control Points, public health and governmental decisions. To do that, a series of new Risk Metrics has been established as follows: i) the Appropriate Level of Protection (ALOP), which indicates the maximum numbers of illnesses in a population per annum, defined by quantitative risk assessments, and used to establish; ii) Food Safety Objective (FSO), which sets the maximum frequency and/or concentration of a hazard in a food at the time of consumption that provides or contributes to the ALOP. Given that ALOP is rather a metric of the public health tolerable burden (it addresses the total `failure' that may be handled at a national level), it is difficult to be interpreted into control measures applied at the manufacturing level. Thus, a series of specific objectives and criteria for performance of individual processes and products have been established, all of them assisting in the achievement of FSO and hence, ALOP. In order to achieve FSO, tools quantifying the effect of processes and intrinsic properties of foods on survival and growth of pathogens are essential. In this context, predictive microbiology and risk assessment have offered an important assistance to Food Safety Management. Predictive modelling is the basis of exposure assessment and the development of stochastic and kinetic models, which are also available in the form of Web-based applications, e.g., COMBASE and Microbial Responses Viewer), or introduced into user-friendly softwares, (e.g., Seafood Spoilage Predictor) have evolved the use of information systems in the food safety management. Such tools are updateable with new food-pathogen specific models containing cardinal parameters and multiple dependent variables, including plate counts, concentration of metabolic products, or even expression levels of certain genes. Then, these tools may further serve as decision-support tools which may assist in product logistics, based on their scientifically-based and "momentary" expressed spoilage and safety level.

Do Health Professionals Need Additional Competencies for Stratified Cancer Prevention Based on Genetic Risk Profiling?

PubMed Central

Chowdhury, Susmita; Henneman, Lidewij; Dent, Tom; Hall, Alison; Burton, Alice; Pharoah, Paul; Pashayan, Nora; Burton, Hilary

2015-01-01

There is growing evidence that inclusion of genetic information about known common susceptibility variants may enable population risk-stratification and personalized prevention for common diseases including cancer. This would require the inclusion of genetic testing as an integral part of individual risk assessment of an asymptomatic individual. Front line health professionals would be expected to interact with and assist asymptomatic individuals through the risk stratification process. In that case, additional knowledge and skills may be needed. Current guidelines and frameworks for genetic competencies of non-specialist health professionals place an emphasis on rare inherited genetic diseases. For common diseases, health professionals do use risk assessment tools but such tools currently do not assess genetic susceptibility of individuals. In this article, we compare the skills and knowledge needed by non-genetic health professionals, if risk-stratified prevention is implemented, with existing competence recommendations from the UK, USA and Europe, in order to assess the gaps in current competences. We found that health professionals would benefit from understanding the contribution of common genetic variations in disease risk, the rationale for a risk-stratified prevention pathway, and the implications of using genomic information in risk-assessment and risk management of asymptomatic individuals for common disease prevention. PMID:26068647

Assessing and managing breast cancer risk: clinicians' current practice and future needs.

PubMed

Collins, Ian M; Steel, Emma; Mann, G Bruce; Emery, Jon D; Bickerstaffe, Adrian; Trainer, Alison; Butow, Phyllis; Pirotta, Marie; Antoniou, Antonis C; Cuzick, Jack; Hopper, John; Phillips, Kelly-Anne; Keogh, Louise A

2014-10-01

Decision support tools for the assessment and management of breast cancer risk may improve uptake of prevention strategies. End-user input in the design of such tools is critical to increase clinical use. Before developing such a computerized tool, we examined clinicians' practice and future needs. Twelve breast surgeons, 12 primary care physicians and 5 practice nurses participated in 4 focus groups. These were recorded, coded, and analyzed to identify key themes. Participants identified difficulties assessing risk, including a lack of available tools to standardize practice. Most expressed confidence identifying women at potentially high risk, but not moderate risk. Participants felt a tool could especially reassure young women at average risk. Desirable features included: evidence-based, accessible (e.g. web-based), and displaying absolute (not relative) risks in multiple formats. The potential to create anxiety was a concern. Development of future tools should address these issues to optimize translation of knowledge into clinical practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

Brugada syndrome: diagnosis, risk stratification, and management.

PubMed

Adler, Arnon

2016-01-01

Asymptomatic patients with Brugada syndrome (BrS) have a small, but not trivial, risk of cardiac events. Their risk stratification and its impact on their management are controversial. The review focuses on the clinical aspects of BrS with special emphasis on the asymptomatic patient. Emerging data suggest that drug and fever-induced type I Brugada patterns are more common than previously appreciated. Although preliminary, these data may imply that asymptomatic patients with induced Brugada pattern are at an even lower risk than currently estimated.The latest data regarding induced ventricular arrhythmias during electrophysiological studies support its use as an indication for an implantable cardioverter defibrillator; however, this issue remains highly controversial.Several new risk markers, such as presence of the Brugada pattern in infero-lateral leads or the concomitant finding of an early repolarization pattern, have recently been proposed. Most asymptomatic BrS patients are at low risk of cardiac events. The presence of new risk markers in this population may prompt consideration of primary prevention measures; however, data supporting this approach are still limited.

Can Cardiovascular Epidemiology and Clinical Trials Close the Risk Management Gap Between Diabetes and Prediabetes?

PubMed

Perreault, Leigh; Færch, Kristine; Gregg, Edward W

2017-09-01

We reviewed published literature to determine the relationship between A1c and cardiovascular disease (CVD) and summarize the need and implications for CVD risk reduction with interventions, focusing in the prediabetic A1c range (<6.5%). Strong evidence supports a continuous relationship between A1c and CVD-even below the current levels of A1c-defined prediabetes and after adjustment for known risk factors for CVD. Clinical trials have demonstrated a reduction in CV morbidity and/or mortality when interventions are invoked in the prediabetic A1c range. Guidelines advocating CV risk factor management in prediabetes have not been widely adopted, subsequently leading to comparable coronary heart disease risk between people with prediabetes (HR = 1.9, 95% CI 1.7-2.1 vs normoglycemia) and diabetes itself (HR=2.0, 95% CI 1.8-2.2 vs no diabetes). This review highlights the missed opportunity to utilize multiple risk factor interventions to reduce CVD in high-risk people with prediabetes.

Risk-based requirements management framework with applications to assurance cases

NASA Astrophysics Data System (ADS)

Feng, D.; Eyster, C.

The current regulatory approach for assuring device safety primarily focuses on compliance with prescriptive safety regulations and relevant safety standards. This approach, however, does not always lead to a safe system design even though safety regulations and standards have been met. In the medical device industry, several high profile recalls involving infusion pumps have prompted the regulatory agency to reconsider how device safety should be managed, reviewed and approved. An assurance case has been cited as a promising tool to address this growing concern. Assurance cases have been used in safety-critical systems for some time. Most assurance cases, if not all, in literature today are developed in an ad hoc fashion, independent from risk management and requirement development. An assurance case is a resource-intensive endeavor that requires additional effort and documentation from equipment manufacturers. Without a well-organized requirements infrastructure in place, such “ additional effort” can be substantial, to the point where the cost of adoption outweighs the benefit of adoption. In this paper, the authors present a Risk-Based Requirements and Assurance Management (RBRAM) methodology. The RBRAM is an elaborate framework that combines Risk-Based Requirements Management (RBRM) with assurance case methods. Such an integrated framework can help manufacturers leverage an existing risk management to present a comprehensive assurance case with minimal additional effort while providing a supplementary means to reexamine the integrity of the system design in terms of the mission objective. Although the example used is from the medical industry, the authors believe that the RBRAM methodology underlines the fundamental principle of risk management, and offers a simple, yet effective framework applicable to aerospace industry, perhaps, to any industry.

Context-Dependent Pathways of the Transmission of Risk from Communities to Individuals

PubMed Central

Lamont, Andrea E.; Van Horn, M. Lee; Hawkins, J. David

2016-01-01

Research has consistently documented the role of environmental risk factors in the onset of delinquent behavior among youth. Less is known about the processes through which these contextual risks are translated to individual youth behavior. The aim of the current study is to examine the role of family risk factors in the transmission of community risk. Data was obtained from a nationally representative sample of over 30,000 middle school youth and community key informants (CKI). A multilevel, moderated mediation model was estimated with family risk as the moderator of the effect of CKI ratings of community risk on youth perceptions of risk. Results showed that when youth came from low risk families (measured by parental use of positive family management strategies), youth perceptions of risk mediated the effects of community risk on youth delinquency; however, there was no evidence of a significant mediated effect under conditions of high risk (measured by poor family management). This appears to be because youth from high-risk families perceived their neighborhoods as high-risk, regardless of actual levels of risk (as reported by CKI). This study finds that the relationship between communities and adolescent behavior is complex and interacts with the family environment. PMID:25300758

In Search of Perfect Foresight? Policy Bias, Management of Unknowns, and What Has Changed in Science Policy Since the Tohoku Disaster.

PubMed

Mochizuki, Junko; Komendantova, Nadejda

2017-02-01

The failure to foresee the catastrophic earthquakes, tsunamis, and nuclear accident of 2011 has been perceived by many in Japan as a fundamental shortcoming of modern disaster risk science. Hampered by a variety of cognitive and institutional biases, the conventional disaster risk management planning based on the "known risks" led to the cascading failures of the interlinked disaster risk management (DRM) apparatus. This realization led to a major rethinking in the use of science for policy and the incorporations of lessons learned in the country's new DRM policy. This study reviews publicly available documents on expert committee discussions and scientific articles to identify what continuities and changes have been made in the use of scientific knowledge in Japanese risk management. In general, the prior influence of cognitive bias (e.g., overreliance on documented hazard risks) has been largely recognized, and increased attention is now being paid to the incorporation of less documented but known risks. This has led to upward adjustments in estimated damages from future risks and recognition of the need for further strengthening of DRM policy. At the same time, there remains significant continuity in the way scientific knowledge is perceived to provide sufficient and justifiable grounds for the development and implementation of DRM policy. The emphasis on "evidence-based policy" in earthquake and tsunami risk reduction measures continues, despite the critical reflections of a group of scientists who advocate for a major rethinking of the country's science-policy institution respecting the limitations of the current state science. © 2016 Society for Risk Analysis.

Integrating Physical Actions and Financial Instruments to Manage Environmental Financial Risk

NASA Astrophysics Data System (ADS)

Foster, B.

2016-12-01

Exposure to extreme weather events can be reduced through physical actions (e.g., dams/reservoirs) or mitigated financially (e.g., insurance). Often physical actions involve investments in expensive infrastructure that reduce exposure, but whose benefits are only occasionally realized. Financial risk management does not reduce the impacts of an event, but rather redistributes them temporally, albeit at a cost. Nonetheless, these costs are typically much smaller, at least in the short run, than those incurred for physical actions. Financial strategies are also more flexible than physical ones in the face of an uncertain future. Financial contracts specifically designed to manage extreme environmental risks are becoming more common and can either replace or complement infrastructural investments as part of a risk management portfolio. In order to make optimal decisions as to the relative levels of physical and financial risk mitigation to employ, it is necessary to understand the relative merits of each strategy. This research develops a method for analyzing tradeoffs between physical and financial risk management strategies. We identify the unique cost and benefit properties of each strategy and integrate them into a single model that details the tradeoffs involved in various portfolios of physical and financial strategies. These methods are then applied to evaluate decisions to pursue emergency dredging during drought on the Mississippi River, which is used to mitigate the increased costs and/or reduced revenues barge operators face when water levels are low. Currently the U.S. Army Corps of Engineers funds most emergency dredging operations during major droughts and they are considering more intensive strategies for future droughts. Barge carriers and shippers though could manage at least some portion of their financial risks through a series of existing and experimental financial contracts. This work involves the formulation of these experimental contracts and the development of methods to evaluate integrated portfolios of physical and financial risk management strategies.

Update on the Management of High-Risk Penetrating Keratoplasty.

PubMed

Jabbehdari, Sayena; Rafii, Alireza Baradaran; Yazdanpanah, Ghasem; Hamrah, Pedram; Holland, Edward J; Djalilian, Ali R

2017-03-01

In this article, we review the indications and latest management of high-risk penetrating keratoplasty. Despite the immune-privilege status of the cornea, immune-mediated graft rejection still remains the leading cause of corneal graft failure. This is particularly a problem in the high-risk graft recipients, namely patients with previous graft failure due to rejection and those with inflamed and vascularized corneal beds. A number of strategies including both local and systemic immunosuppression are currently used to increase the success rate of high-risk corneal grafts. Moreover, in cases of limbal stem cell deficiency, limbal stem cells transplantation is employed. Corticosteroids are still the top medication for prevention and treatment in cases of corneal graft rejection. Single and combined administration of immunosuppressive agents e.g. tacrolimus, cyclosporine and mycophenolate are promising adjunctive therapies for prolonging graft survival. In the future, cellular and molecular therapies should allow us to achieve immunologic tolerance even in high-risk grafts.

Development and validation of risk models and molecular diagnostics to permit personalized management of cancer.

PubMed

Pu, Xia; Ye, Yuanqing; Wu, Xifeng

2014-01-01

Despite the advances made in cancer management over the past few decades, improvements in cancer diagnosis and prognosis are still poor, highlighting the need for individualized strategies. Toward this goal, risk prediction models and molecular diagnostic tools have been developed, tailoring each step of risk assessment from diagnosis to treatment and clinical outcomes based on the individual's clinical, epidemiological, and molecular profiles. These approaches hold increasing promise for delivering a new paradigm to maximize the efficiency of cancer surveillance and efficacy of treatment. However, they require stringent study design, methodology development, comprehensive assessment of biomarkers and risk factors, and extensive validation to ensure their overall usefulness for clinical translation. In the current study, the authors conducted a systematic review using breast cancer as an example and provide general guidelines for risk prediction models and molecular diagnostic tools, including development, assessment, and validation. © 2013 American Cancer Society.

Pharmaceutical supply chain risk assessment in Iran using analytic hierarchy process (AHP) and simple additive weighting (SAW) methods.

PubMed

Jaberidoost, Mona; Olfat, Laya; Hosseini, Alireza; Kebriaeezadeh, Abbas; Abdollahi, Mohammad; Alaeddini, Mahdi; Dinarvand, Rassoul

2015-01-01

Pharmaceutical supply chain is a significant component of the health system in supplying medicines, particularly in countries where main drugs are provided by local pharmaceutical companies. No previous studies exist assessing risks and disruptions in pharmaceutical companies while assessing the pharmaceutical supply chain. Any risks affecting the pharmaceutical companies could disrupt supply medicines and health system efficiency. The goal of this study was the risk assessment in pharmaceutical industry in Iran considering process's priority, hazard and probability of risks. The study was carried out in 4 phases; risk identification through literature review, risk identification in Iranian pharmaceutical companies through interview with experts, risk analysis through a questionnaire and consultation with experts using group analytic hierarchy process (AHP) method and rating scale (RS) and risk evaluation of simple additive weighting (SAW) method. In total, 86 main risks were identified in the pharmaceutical supply chain with perspective of pharmaceutical companies classified in 11 classes. The majority of risks described in this study were related to the financial and economic category. Also financial management was found to be the most important factor for consideration. Although pharmaceutical industry and supply chain were affected by current political conditions in Iran during the study time, but half of total risks in the pharmaceutical supply chain were found to be internal risks which could be fixed by companies, internally. Likewise, political status and related risks forced companies to focus more on financial and supply management resulting in less attention to quality management.

Managing Ada development

NASA Technical Reports Server (NTRS)

Green, James R.

1986-01-01

The Ada programming language was developed under the sponsorship of the Department of Defense to address the soaring costs associated with software development and maintenance. Ada is powerful, and yet to take full advantage of its power, it is sufficiently complex and different from current programming approaches that there is considerable risk associated with committing a program to be done in Ada. There are also few programs of any substantial size that have been implemented using Ada that may be studied to determine those management methods that resulted in a successful Ada project. The items presented are the author's opinions which have been formed as a result of going through an experience software development. The difficulties faced, risks assumed, management methods applied, and lessons learned, and most importantly, the techniques that were successful are all valuable sources of management information for those managers ready to assume major Ada developments projects.

Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients: A Guidance Report and Clinical Checklist by the Consensus on Managing Modifiable Risk in Transplantation (COMMIT) Group.

PubMed

Neuberger, James M; Bechstein, Wolf O; Kuypers, Dirk R J; Burra, Patrizia; Citterio, Franco; De Geest, Sabina; Duvoux, Christophe; Jardine, Alan G; Kamar, Nassim; Krämer, Bernhard K; Metselaar, Herold J; Nevens, Frederik; Pirenne, Jacques; Rodríguez-Perálvarez, Manuel L; Samuel, Didier; Schneeberger, Stefan; Serón, Daniel; Trunečka, Pavel; Tisone, Giuseppe; van Gelder, Teun

2017-04-01

Short-term patient and graft outcomes continue to improve after kidney and liver transplantation, with 1-year survival rates over 80%; however, improving longer-term outcomes remains a challenge. Improving the function of grafts and health of recipients would not only enhance quality and length of life, but would also reduce the need for retransplantation, and thus increase the number of organs available for transplant. The clinical transplant community needs to identify and manage those patient modifiable factors, to decrease the risk of graft failure, and improve longer-term outcomes.COMMIT was formed in 2015 and is composed of 20 leading kidney and liver transplant specialists from 9 countries across Europe. The group's remit is to provide expert guidance for the long-term management of kidney and liver transplant patients, with the aim of improving outcomes by minimizing modifiable risks associated with poor graft and patient survival posttransplant.The objective of this supplement is to provide specific, practical recommendations, through the discussion of current evidence and best practice, for the management of modifiable risks in those kidney and liver transplant patients who have survived the first postoperative year. In addition, the provision of a checklist increases the clinical utility and accessibility of these recommendations, by offering a systematic and efficient way to implement screening and monitoring of modifiable risks in the clinical setting.

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.

Coordination of short-term and long-term mitigation measures of hydro-meteorological risks: the importance of establishing a link between emergency management and spatial planning

NASA Astrophysics Data System (ADS)

Prenger-Berninghoff, Kathrin; Cortes, V. Juliette; Aye, Zar Chi; Sprague, Teresa

2013-04-01

The management of natural hazards involves, as generally known, the four stages of the risk management cycle: Prevention, preparedness, response and recovery. Accordingly, the mitigation of disasters can be performed in terms of short-term and long-term purposes. Whereas emergency management or civil protection helps to strengthen a community's capacity to be better prepared for natural hazards and to better respond in case a disaster strikes, thus addressing the short-term perspective, spatial planning serves long-term planning goals and can therefore implement long-term prevention measures. A purposefully applied risk mitigation strategy requires coordination of short-term and long-term mitigation measures and thus an effective coordination of emergency management and spatial planning. Several actors are involved in risk management and should consequently be linked throughout the whole risk management cycle. However, these actors, partly because of a historically fragmented administrative system, are hardly connected to each other, with spatial planning only having a negligible role compared to other actors1, a problem to which Young (2002) referred to as the "problem of interplay". In contrast, information transfer and decision-taking happen at the same time and are not coordinated among different actors. This applies to the prevention and preparedness phase as well as to the recovery phase, which basically constitutes the prevention phase for the next disaster2. Since investments in both risk prevention and emergency preparedness and response are considered necessary, a better coordination of the two approaches is required. In this regard, Decision Support Systems (DSS) can be useful in order to provide support in the decision-making aspect of risk management. The research work currently undertaken examines the problem of interplay in the four case study areas of the Marie Curie ITN, CHANGES3. The link between different risk management actors will be explored by means of exploratory questionnaires and interviews with government agencies, local administrations, community and research organizations on each study site. First results provided will address the general role of spatial planning in risk management. Additionally, preliminary observations are made in regard to the coordination of emergency preparedness and long-term spatial planning activities. The observations consider that integration facilitates proactive strategies that aim at preventing disaster occurrence and promote interaction between involved parties. Finally, consideration is given to the potential use of a DSS tool to cover both aspects of spatial planning and emergency management in the risk management cycle.

Meet EPA Scientist Heriberto Cabezas, Ph.D.

EPA Pesticide Factsheets

Heriberto Cabezas, Ph.D. is currently the Senior Science Advisor to the Sustainable Technology Division in EPA's National Risk Management Research Lab, where he works to advance the application of science and technologies to address sustainability.

Risky Assessments: Participant Suicidality and Distress Associated with Research Assessments in a Treatment Study of Suicidal Behavior

ERIC Educational Resources Information Center

Reynolds, Sarah K.; Lindenboim, Noam; Comtois, Katherine Anne; Murray, Angela; Linehan, Marsha M.

2006-01-01

The purpose of this study was to examine patterns of self-reported suicidality and distress during research assessments in a sample of 63 women meeting criteria for borderline personality disorder and current and chronic suicidality. The risk management protocol we used during the two-year study period (University of Washington Risk Assessment…

Stroke Epidemiology and Risk Factor Management.

PubMed

Guzik, Amy; Bushnell, Cheryl

2017-02-01

Death from stroke has decreased over the past decade, with stroke now the fifth leading cause of death in the United States. In addition, the incidence of new and recurrent stroke is declining, likely because of the increased use of specific prevention medications, such as statins and antihypertensives. Despite these positive trends in incidence and mortality, many strokes remain preventable. The major modifiable risk factors are hypertension, diabetes mellitus, tobacco smoking, and hyperlipidemia, as well as lifestyle factors, such as obesity, poor diet/nutrition, and physical inactivity. This article reviews the current recommendations for the management of each of these modifiable risk factors. It has been documented that some blood pressure medications may increase variability of blood pressure and ultimately increase the risk for stroke. Stroke prevention typically includes antiplatelet therapy (unless an indication for anticoagulation exists), so the most recent evidence supporting use of these drugs is reviewed. In addition, emerging risk factors, such as obstructive sleep apnea, electronic cigarettes, and elevated lipoprotein (a), are discussed. Overall, secondary stroke prevention includes a multifactorial approach. This article incorporates evidence from guidelines and published studies and uses an illustrative case study throughout the article to provide examples of secondary prevention management of stroke risk factors.

Epidemiology of ischemic heart disease in HIV.

PubMed

Triant, Virginia A; Grinspoon, Steven K

2017-11-01

The purpose of this review is to summarize and synthesize recent data on the risk of ischemic heart disease (IHD) in HIV-infected individuals. Recent studies in the field demonstrate an increasing impact of cardiovascular disease (CVD) on morbidity and mortality in HIV relative to AIDS-related diagnoses. Studies continue to support an approximately 1.5 to two-fold increased risk of IHD conferred by HIV, with specific risk varying by sex and virologic/immunologic status. Risk factors include both traditional CVD risk factors and novel, HIV-specific factors including inflammation and immune activation. Specific antiretroviral therapy (ART) drugs may increase CVD risk, yet the net effect of ART with viral suppression is beneficial with regard to CVD risk. Management of cardiovascular risk and prevention of CVD is complex, because current general population strategies target traditional CVD risk factors only. Extensive investigation is being directed at developing tailored CVD risk prediction algorithms and interventions to reduce CVD risk in HIV. Increased IHD risk is a significant clinical and public health challenge in HIV. The development and application of HIV-specific interventions to manage CVD risk factors and reduce CVD risk will improve the long-term health of this ageing population.

US strategy for forest management adaptation to climate change: building a framework for decision making

Treesearch

V. Alaric Sample; Jessica E. Halofsky; David L. Peterson

2014-01-01

This paper describes methods developed to (1) assess current risks, vulnerabilities, and gaps in knowledge; (2) engage internal agency resources and external partners in the development of options and solutions; and (3) manage forest resources for resilience, not just in terms of natural ecosystems but in affected human communities as well. We describe an approach...

An Evaluation of a Short Cognitive-Behavioural Anger Management Intervention for Pupils at Risk of Exclusion

ERIC Educational Resources Information Center

Humphrey, Neil; Brooks, A. George

2006-01-01

An increasing number of children and young people are being excluded from school as a direct result of anger management problems. The research literature suggests that short cognitive-behavioural intervention programmes may be effective in helping young people understand and control their anger. The aim of the current study was to evaluate the…

Pest Private Eye: Using an Interactive Role-Playing Video Game to Teach about Pests and Integrated Pest Management

ERIC Educational Resources Information Center

Bauer, Erin; Ogg, Clyde

2011-01-01

The trend toward encouraging adoption of Integrated Pest Management (IPM) in schools has increased in the last decade. Because IPM helps reduce risk of human pesticide exposure, reduce allergens and asthma triggers, save energy, and protect the environment, it's essential that IPM awareness continue not only with current school administrators,…

Risks and risk governance in unconventional shale gas development.

PubMed

Small, Mitchell J; Stern, Paul C; Bomberg, Elizabeth; Christopherson, Susan M; Goldstein, Bernard D; Israel, Andrei L; Jackson, Robert B; Krupnick, Alan; Mauter, Meagan S; Nash, Jennifer; North, D Warner; Olmstead, Sheila M; Prakash, Aseem; Rabe, Barry; Richardson, Nathan; Tierney, Susan; Webler, Thomas; Wong-Parodi, Gabrielle; Zielinska, Barbara

2014-01-01

A broad assessment is provided of the current state of knowledge regarding the risks associated with shale gas development and their governance. For the principal domains of risk, we identify observed and potential hazards and promising mitigation options to address them, characterizing current knowledge and research needs. Important unresolved research questions are identified for each area of risk; however, certain domains exhibit especially acute deficits of knowledge and attention, including integrated studies of public health, ecosystems, air quality, socioeconomic impacts on communities, and climate change. For these, current research and analysis are insufficient to either confirm or preclude important impacts. The rapidly evolving landscape of shale gas governance in the U.S. is also assessed, noting challenges and opportunities associated with the current decentralized (state-focused) system of regulation. We briefly review emerging approaches to shale gas governance in other nations, and consider new governance initiatives and options in the U.S. involving voluntary industry certification, comprehensive development plans, financial instruments, and possible future federal roles. In order to encompass the multiple relevant disciplines, address the complexities of the evolving shale gas system and reduce the many key uncertainties needed for improved management, a coordinated multiagency federal research effort will need to be implemented.

Clinical risk management in mental health: a qualitative study of main risks and related organizational management practices.

PubMed

Briner, Matthias; Manser, Tanja

2013-02-04

A scientific understanding of clinical risk management (CRM) in mental health care is essential for building safer health systems and for improving patient safety. While evidence on patient safety and CRM in physical health care has increased, there is limited research on these issues in mental health care. This qualitative study provides an overview of the most important clinical risks in mental health and related organizational management practices. We conducted in-depth expert interviews with professionals responsible for CRM in psychiatric hospitals. Interviews were transcribed and analyzed applying qualitative content analysis to thematically sort the identified risks. The main concerns for CRM in mental health are a) violence and self-destructive behavior (i.e. protecting patients and staff from other patients, and patients from themselves), b) treatment errors, especially in the process of therapy, and c) risks associated with mental illnesses (e.g. psychosis or depression). This study identified critical differences to CRM in hospitals for physical disorder and challenges specific to CRM in mental health. Firstly, many psychiatric patients do not believe that they are ill and are therefore in hospital against their will. Secondly, staff safety is a much more prominent theme for CRM in mental health care as it is directly related to the specifics of mental illnesses. The current study contributes to the understanding of patient safety and raises awareness for CRM in mental health. The mental health specific overview of central risks and related organizational management practices offers a valuable basis for CRM development in mental health and an addition to CRM in general.

Potential for the use of mHealth in the management of cardiovascular disease in Kerala: a qualitative study.

PubMed

Smith, Rebecca; Menon, Jaideep; Rajeev, Jaya G; Feinberg, Leo; Kumar, Raman Krishan; Banerjee, Amitava

2015-11-17

To assess the potential for using mHealth in cardiovascular disease (CVD) management in Kerala by exploring: (1) experiences and challenges of current CVD management; (2) current mobile phone use; (3) expectations of and barriers to mobile phone use in CVD management. Qualitative, semistructured, individual interviews. 5 primary health centres in Ernakulam district, Kerala, India. 15 participants in total from 3 stakeholder groups: 5 patients with CVD and/or its risk factors, 5 physicians treating CVD and 5 Accredited Social Health Activists (ASHAs). Patients were sampled for maximum variation on the basis of age, sex, CVD diagnoses and risk factors. All participants had access to a mobile phone. The main themes identified relating to the current challenges of CVD were poor patient disease knowledge, difficulties in implementing primary prevention and poor patient lifestyles. Participants noted phone calls as the main function of current mobile phone use. The expectations of mHealth use are to: improve accessibility to healthcare knowledge; provide reminders of appointments, medication and lifestyle changes; save time, money and travel; and improve ASHA job efficacy. All perceived barriers to mHealth were noted within physician interviews. These included fears of mobile phones negatively affecting physicians' roles, the usability of mobile phones, radiation and the need for physical consultations. There are three main potential uses of mHealth in this population: (1) as an educational tool, to improve health education and lifestyle behaviours; (2) to optimise the use of limited resources, by overcoming geographical barriers and financial constraints; (3) to improve use of healthcare, by providing appointment and treatment reminders in order to improve disease prevention and management. Successful mHealth design, which takes barriers into account, may complement current practice and optimise use of limited resources. 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/

Potential for the use of mHealth in the management of cardiovascular disease in Kerala: a qualitative study

PubMed Central

Smith, Rebecca; Menon, Jaideep; Rajeev, Jaya G; Feinberg, Leo; Kumar, Raman Krishan; Banerjee, Amitava

2015-01-01

Objectives To assess the potential for using mHealth in cardiovascular disease (CVD) management in Kerala by exploring: (1) experiences and challenges of current CVD management; (2) current mobile phone use; (3) expectations of and barriers to mobile phone use in CVD management. Design Qualitative, semistructured, individual interviews. Setting 5 primary health centres in Ernakulam district, Kerala, India. Participants 15 participants in total from 3 stakeholder groups: 5 patients with CVD and/or its risk factors, 5 physicians treating CVD and 5 Accredited Social Health Activists (ASHAs). Patients were sampled for maximum variation on the basis of age, sex, CVD diagnoses and risk factors. All participants had access to a mobile phone. Results The main themes identified relating to the current challenges of CVD were poor patient disease knowledge, difficulties in implementing primary prevention and poor patient lifestyles. Participants noted phone calls as the main function of current mobile phone use. The expectations of mHealth use are to: improve accessibility to healthcare knowledge; provide reminders of appointments, medication and lifestyle changes; save time, money and travel; and improve ASHA job efficacy. All perceived barriers to mHealth were noted within physician interviews. These included fears of mobile phones negatively affecting physicians’ roles, the usability of mobile phones, radiation and the need for physical consultations. Conclusions There are three main potential uses of mHealth in this population: (1) as an educational tool, to improve health education and lifestyle behaviours; (2) to optimise the use of limited resources, by overcoming geographical barriers and financial constraints; (3) to improve use of healthcare, by providing appointment and treatment reminders in order to improve disease prevention and management. Successful mHealth design, which takes barriers into account, may complement current practice and optimise use of limited resources. PMID:26576813

Management of refractory anti-phospholipid syndrome.

PubMed

Scoble, Tina; Wijetilleka, Sonali; Khamashta, Munther A

2011-09-01

Anti-phospholipid syndrome (APS) is an autoimmune prothrombotic disorder characterised by the predisposition to venous and/or arterial thrombosis and obstetric morbidity. Management of APS centres on attenuating the procoagulant state whilst balancing the risks of anticoagulant therapy. Cases of recurrent thromboses and obstetric complications occur despite optimum therapy. Alternative therapies for refractory cases are subject to disparity among clinicians due to the current lack of clinical evidence present. This review aims to address the current management strategies for refractory thrombotic and obstetric cases and future therapeutic interventions. The role and current clinical evidence of using long term low molecular weight heparin (LMWH) as an alternative to warfarin therapy for refractory thromboses is evaluated. Potential alternatives for thromboses including statins, hydroxychloroquine, Rituximab are reviewed as well as the additional avenues to target in the future as the pathogenic mechanisms of APS are unveiled. The optimal management for refractory obstetric APS cases is subject to controversy. This review focuses and assesses the current evidence for the uses of low dose prednisolone, intravenous immunoglobulin and hydroxycholoroquine in obstetric cases. The treatment modalities for the management of refractory APS require further clinical evidence. Copyright © 2011 Elsevier B.V. All rights reserved.

Geo-hydrological risk management for civil protection purposes in the urban area of Genoa (Liguria, NW Italy)

NASA Astrophysics Data System (ADS)

Brandolini, P.; Cevasco, A.; Firpo, M.; Robbiano, A.; Sacchini, A.

2012-04-01

Over the past century the municipal area of Genoa has been affected by recurring flood events and several landslides that have caused severe damage to urbanized areas on both the coastal-fluvial plains and surrounding slopes, sometimes involving human casualties. The analysis of past events' annual distribution indicates that these phenomena have occurred with rising frequency in the last seventy years, following the main land use change due to the development of harbour, industrial, and residential areas, which has strongly impacted geomorphological processes. Consequently, in Genoa, civil protection activities are taking on an increasing importance for geo-hydrological risk mitigation. The current legislative framework assigns a key role in disaster prevention to municipalities, emergency plan development, as well as response action coordination in disaster situations. In view of the geomorphological and environmental complexity of the study area and referring to environmental laws, geo-hydrological risk mitigation strategies adopted by local administrators for civil protection purposes are presented as examples of current land/urban management related to geo-hydrological hazards. Adopted measures have proven to be effective on several levels (planning, management, structure, understanding, and publication) in different cases. Nevertheless, the last flooding event (4 November 2011) has shown that communication and public information concerning the perception of geo-hydrological hazard can be improved.

How to reduce the vulnerability of properties threatened by flood?

NASA Astrophysics Data System (ADS)

Vinet, Freddy; Leone, Frederic; Pelletier, Hugo; Queral, Fanny

2010-05-01

Over the last 20 or 30 years, increasing flood damage has compelled stakeholders to reconsider flood prevention. Indeed, the increase in damage emphasizes the failure of the current flood management policies based on river channel management instead of the mitigation of the flood risk. In the aftermath of the recent disasters in France and Europe, national and local authorities fostered an increasing number of initiatives geared towards reducing risks and rectifying the way of managing flood risks. All experts are now convinced that we must reduce risk through the mitigation of vulnerability. In this purpose, the French government and some river basin authorities try to develop programmes and laws intended to reduce the vulnerability of flood-prone buildings, mostly by retrofitting them. Through the results of field studies conducted in France, this presentation focuses on pros and cons of retrofitting. As of now, if many assessment of the vulnerability of buildings have been conducted, only a few huge retrofitting programmes have actually been implemented. Many bottlenecks emerge when implementing concrete measures. These difficulties include technical problems, cost, and the reluctance of many property owners... On the long run, retrofitting may be an efficient way to prevent damage to buildings threatened by floodwater. However current programmes fail to address the specificities of the local context in which such actions are implemented, e.g. accurate appraisal of flooding conditions, awareness of risk, vulnerability of people... The key is to involve all local actors including people threatened by flooding rather than to impose general and inappropriate measures.

Rationale and methods of the European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA).

PubMed

Rodríguez-Artalejo, Fernando; Guallar, Eliseo; Borghi, Claudio; Dallongeville, Jean; De Backer, Guy; Halcox, Julian P; Hernández-Vecino, Ramón; Jiménez, Francisco Javier; Massó-González, Elvira L; Perk, Joep; Steg, Philippe Gabriel; Banegas, José R

2010-06-30

The EURIKA study aims to assess the status of primary prevention of cardiovascular disease (CVD) across Europe. Specifically, it will determine the degree of control of cardiovascular risk factors in current clinical practice in relation to the European guidelines on cardiovascular prevention. It will also assess physicians' knowledge and attitudes about CVD prevention as well as the barriers impeding effective risk factor management in clinical practice. Cross-sectional study conducted simultaneously in 12 countries across Europe. The study has two components: firstly at the physician level, assessing eight hundred and nine primary care and specialist physicians with a daily practice in CVD prevention. A physician specific questionnaire captures information regarding physician demographics, practice settings, cardiovascular prevention beliefs and management. Secondly at the patient level, including 7641 patients aged 50 years or older, free of clinical CVD and with at least one classical risk factor, enrolled by the participating physicians. A patient-specific questionnaire captures information from clinical records and patient interview regarding sociodemographic data, CVD risk factors, and current medications. Finally, each patient provides a fasting blood sample, which is sent to a central laboratory for measuring serum lipids, apolipoproteins, hemoglobin-A1c, and inflammatory biomarkers. Primary prevention of CVD is an extremely important clinical issue, with preventable circulatory diseases remaining the leading cause of major disease burden. The EURIKA study will provide key information to assess effectiveness of and attitudes toward primary prevention of CVD in Europe. A transnational study creates opportunities for benchmarking good clinical practice across countries and improving outcomes. (ClinicalTrials.gov number, NCT00882336).

[Management of vascular risk factors in patients older than 80].

PubMed

Gómez-Huelgas, Ricardo; Martínez-Sellés, Manuel; Formiga, Francesc; Alemán Sánchez, José Juan; Camafort, Miguel; Galve, Enrique; Gil, Pedro; Lobos, José María

2014-08-04

The number of patients older than 80 years is steadily increasing and it represents the main basis for increasing population figures in developed countries. Cardiovascular diseases are the leading causes of mortality and disability causes result in a huge burden of disease in elderly people. However, available scientific evidence to support decision-making on cardiovascular prevention in elderly patients is scarce. Currently available risk assessment scales cannot be applied to elderly people. They are focused on cardiovascular mortality risk and do not provide information on factors with a proven prognostic value in the very old (functioning disability, dementia). Elderly people are a highly heterogeneous population, with a variety of co-morbidities, as well as several functional and cognitive impairment degrees. Furthermore, aging-associated physiological changes and common use of multiple drugs result in an increased risk of adverse drug reactions. Thus, drug use should always be based on a risk/benefit assessment in the elderly. Therefore, therapeutic decision-making in the very old must be an individually tailored and based on an appropriate clinical judgement and a comprehensive geriatric assessment. The current consensus report aims to present a proposal for clinical practices in the primary and secondary cardiovascular prevention in the very old and to provide a number of recommendations on lifestyle changes and drug therapy for the management of major cardiovascular risk factors. Copyright © 2014 Elsevier España, S.L. All rights reserved.

Oral antiplatelet agents for the management of acute coronary syndromes: A review for nurses and allied healthcare professionals.

PubMed

Gesheff, Tania; Barbour, Cescelle

2017-02-01

We review the use of oral antiplatelet (OAP) therapies in acute coronary syndrome (ACS) management for nurse practitioners (NPs), focusing on current guideline recommendations. Treatment guidelines and clinical articles from PubMed. Guidelines recommend that dual antiplatelet therapy with a P2Y 12 inhibitor and aspirin be initiated for ACS management. The P2Y 12 inhibitor clopidogrel has established efficacy, but is associated with suboptimal and delayed platelet inhibition and variability in response. The newer P2Y 12 inhibitors prasugrel and ticagrelor have demonstrated superior efficacy outcomes versus clopidogrel. Consequently, non-ST-segment elevation ACS (NSTE-ACS) guidelines now recommend that ticagrelor be used in preference to clopidogrel for patients treated with stents or managed medically. Because of their higher potency, prasugrel and ticagrelor are associated with increased bleeding rates versus clopidogrel, but with no increased risk of severe or life-threatening bleeding. Guidelines recommend dual antiplatelet therapy be continued ≥12 months in both medically managed and stented ACS patients, and in some cases beyond this, in absence of high bleeding risk. Updated guidelines assign preference to ticagrelor over clopidogrel for maintenance therapy in patients with NSTE-ACS and ST-elevation myocardial infarction. Enhanced NP understanding of OAP agents and current guidelines could contribute to improved ACS patient management. ©2017 American Association of Nurse Practitioners.

Evaluating Partnerships to Enhance Disaster Risk Management using Multi-Criteria Analysis: An Application at the Pan-European Level

NASA Astrophysics Data System (ADS)

Hochrainer-Stigler, Stefan; Lorant, Anna

2018-01-01

Disaster risk is increasingly recognized as a major development challenge. Recent calls emphasize the need to proactively engage in disaster risk reduction, as well as to establish new partnerships between private and public sector entities in order to decrease current and future risks. Very often such potential partnerships have to meet different objectives reflecting on the priorities of stakeholders involved. Consequently, potential partnerships need to be assessed on multiple criteria to determine weakest links and greatest threats in collaboration. This paper takes a supranational multi-sector partnership perspective, and considers possible ways to enhance disaster risk management in the European Union by better coordination between the European Union Solidarity Fund, risk reduction efforts, and insurance mechanisms. Based on flood risk estimates we employ a risk-layer approach to determine set of options for new partnerships and test them in a high-level workshop via a novel cardinal ranking based multi-criteria approach. Whilst transformative changes receive good overall scores, we also find that the incorporation of risk into budget planning is an essential condition for successful partnerships.

Using Geographical Information Systems (GIS) as an instrument of water resource management: a case study from a GIS-based Water Safety Plan in Germany.

PubMed

Wienand, I; Nolting, U; Kistemann, T

2009-01-01

Following international developments and the new WHO Drinking Water Guidelines (WHO 2004) a process-orientated concept for risk, monitoring and incident management has been developed and implemented in this study. The concept will be reviewed with special consideration for resource protection (first barrier of the multi-barrier system) and in turn, for the Water Safety Plan (WSP) which adequately considers-beyond the current framework of legal requirements-possible new hygienic-microbiologically relevant risks (especially emerging pathogens) for the drinking water supply. The development of a WSP within the framework of risk, monitoring and incident management includes the application of Geographical Information Systems (GIS). In the present study, GIS was used for visualization and spatial analysis in decisive steps in the WSP. The detailed process of GIS-supported implementation included the identification of local participants and their tasks and interactions as an essential part of risk management. A detailed ecological investigation of drinking water conditions in the catchment area was conducted in addition to hazard identification, risk assessment and the monitoring of control measures. The main task of our study was to find out in which steps of the WSP the implementation of GIS could be integrated as a useful, and perhaps even an essential tool.

Cardiac health: primary prevention of heart disease in women.

PubMed

Turk, Melanie Warziski; Tuite, Patricia K; Burke, Lora E

2009-09-01

Heart disease is the number one cause of death among women. Although 450,000 women die annually from heart disease, this fact is unknown to many women. Because heart disease is frequently preventable, increasing awareness of personal risk and preventative measures is a key element of health care for women. Nurse clinicians can evaluate, educate, and counsel women regarding their risk for this pervasive disease and promote behavior changes that will decrease that risk. Research evidence supports that lifestyle behaviors are the cornerstone of heart disease prevention. This article presents current evidence for the prevention of heart disease related to dietary intake, physical activity, weight management, smoking cessation, blood pressure control, and lipid management. Guidelines for implementing findings in clinical practice are discussed.

Oral mucositis: etiology, and clinical and pharmaceutical management.

PubMed

Zur, Eyal

2012-01-01

Oral mucosal damage is one of the common and worst side effects of radiotherapy and chemotherapy treatment for cancer. With prevalence between 10% and 100%, depending on the cytotoxic and/or radiotherapy regimen and patient-associated variables, this morbid condition represents a significant problem in oncology. This article addresses oral mucositis and discusses its prevalence, risk factors, clinical and economical impacts, etiology, and clinical management in view of the most recent evidence. Despite clear progress and the development of clinical guidelines on this topic, what we currently have to offer to patients to manage mucositis and oropharyngeal pain is still inadequate. This article offers two compounded preparations supported by evidence-based data to treat oral mucositis. Expansion of the knowledge of the pathogenesis of mucositis as well as a better insight into individual risk factors will provide opportunities to improve management strategies.

The Role of Athletic Trainers in Preventing and Managing Posttraumatic Osteoarthritis in Physically Active Populations: a Consensus Statement of the Athletic Trainers' Osteoarthritis Consortiuma

PubMed Central

Cameron, Kenneth L.; DiStefano, Lindsey J.; Driban, Jeffrey B.; Pietrosimone, Brian; Thomas, Abbey C.; Tourville, Timothy W.; Consortium, Athletic Trainers' Osteoarthritis

2017-01-01

Objective:  To provide athletic trainers with a fundamental understanding of the pathogenesis and risk factors associated with the development of posttraumatic osteoarthritis (PTOA) as well as the best current recommendations for preventing and managing this condition. Background:  Posttraumatic osteoarthritis, or osteoarthritis that develops secondary to joint injury, accounts for approximately 5.5 million US cases annually. A young athlete with a joint injury is at high risk for PTOA before the age of 40, which could lead to the patient living more than half of his or her life with a painful and disabling disorder. Given our frequent contact with physically active people who often sustain traumatic joint injuries, athletic trainers are in a unique position to help prevent and manage PTOA. We can, therefore, regularly monitor joint health in at-risk patients and implement early therapies as necessary. Recommendations:  The recommendations for preventing and managing PTOA are based on the best available evidence. Primary injury prevention, self-management strategies, maintenance of a healthy body weight, and an appropriate level of physical activity should be encouraged among those at risk for PTOA after acute traumatic joint injury. Education of athletic trainers and patients regarding PTOA is also critical for effective prevention and management of this disease. PMID:28653866

Perspectives on the management of antiplatelet therapy in patients with coronary artery disease requiring cardiac and noncardiac surgery.

PubMed

Franchi, Francesco; Rollini, Fabiana; Angiolillo, Dominick J

2014-11-01

To provide an updated overview on the management of antiplatelet therapy in patients with coronary stents undergoing cardiac and noncardiac surgery. Surgical procedures are frequently performed in patients with coronary stents and are associated with an increased risk of ischemic and bleeding complications in the perioperative period. Given the lack of well-designed prospective randomized trials, guidelines recommendations are currently derived from observational studies and expert consensus. Defining the optimal balance between the risk of thrombotic events following discontinuation of antiplatelet therapy and the risk of hemorrhagic complications of having a surgical procedure while on antiplatelet therapy is pivotal. Elective surgery should be postponed for at least 4 weeks after bare metal stent implantation and 6-12 months after drug-eluting stent. If this is not possible, aspirin should be continued in the perioperative period, although the management of P2Y₁₂ inhibitors should be individualized according to the individual patient and type of surgery. In the absence of well-defined recommendations deriving from prospective randomized clinical trials, the perioperative management of antiplatelet therapy should be based on the balance between the specific thrombotic and hemorrhagic risks that characterize each patient and each surgical procedure.

Current progress on understanding the impact of mercury on human health.

PubMed

Ha, Eunhee; Basu, Niladri; Bose-O'Reilly, Stephan; Dórea, José G; McSorley, Emeir; Sakamoto, Mineshi; Chan, Hing Man

2017-01-01

Mercury pollution and its impacts on human health is of global concern. The authors of this paper were members of the Plenary Panel on Human Health in the 12th International Conference on Mercury as a Global Pollutant held in Korea in June 2015. The Panel was asked by the conference organizers to address two questions: what is the current understanding of the impacts of mercury exposure on human health and what information is needed to evaluate the effectiveness of the Minamata Convention in lowering exposure and preventing adverse effects. The authors conducted a critical review of the literature published since January 2012 and discussed the current state-of-knowledge in the following areas: environmental exposure and/or risk assessment; kinetics and biomonitoring; effects on children development; effects on adult general populations; effects on artisanal and small-scale gold miners (ASGM); effects on dental workers; risk of ethylmercury in thimerosal-containing vaccines; interactions with nutrients; genetic determinants and; risk communication and management. Knowledge gaps in each area were identified and recommendations for future research were made. The Panel concluded that more knowledge synthesis efforts are needed to translate the research results into management tools for health professionals and policy makers. Copyright © 2016 Elsevier Inc. All rights reserved.

Biologically Based Restorative Management of Tooth Wear

PubMed Central

Kelleher, Martin G. D.; Bomfim, Deborah I.; Austin, Rupert S.

2012-01-01

The prevalence and severity of tooth wear is increasing in industrialised nations. Yet, there is no high-level evidence to support or refute any therapeutic intervention. In the absence of such evidence, many currently prevailing management strategies for tooth wear may be failing in their duty of care to first and foremost improve the oral health of patients with this disease. This paper promotes biologically sound approaches to the management of tooth wear on the basis of current best evidence of the aetiology and clinical features of this disease. The relative risks and benefits of the varying approaches to managing tooth wear are discussed with reference to long-term follow-up studies. Using reference to ethical standards such as “The Daughter Test”, this paper presents case reports of patients with moderate-to-severe levels of tooth wear managed in line with these biologically sound principles. PMID:22315608

Current trends in the management of anaemia in solid tumours and haematological malignancies.

PubMed

van Eeden, Ronwyn; Rapoport, Bernardo L

2016-06-01

Anaemia is a common problem in patients with solid tumors and haematological malignancies. Certain cancer therapies also contribute to anaemia. This article reviews the pathophysiology of cancer-related anaemia, investigation of a cancer patient with anaemia as well as how anaemia impacts patients in terms of quality of life, disease-related outcomes and treatment choices. Different treatments for anaemia include transfusions, erythropoiesis-stimulating agents (ESA) and iron therapy. Within this context, we review the advantages and disadvantages concerning anaemia management in cancer patients as well as the risk-benefit ratio of different treatment choices, particularly the increased risk of thromboembolic events of ESAs and concern around mortality and effect on tumor growth. This review is aimed at guiding treating physicians to make the best evidence-based treatment choices according to the product label and according to current guidelines for patients with cancer-related anaemia.

In search of robust flood risk management alternatives for the Netherlands

NASA Astrophysics Data System (ADS)

Klijn, F.; Knoop, J. M.; Ligtvoet, W.; Mens, M. J. P.

2012-05-01

The Netherlands' policy for flood risk management is being revised in view of a sustainable development against a background of climate change, sea level rise and increasing socio-economic vulnerability to floods. This calls for a thorough policy analysis, which can only be adequate when there is agreement about the "framing" of the problem and about the strategic alternatives that should be taken into account. In support of this framing, we performed an exploratory policy analysis, applying future climate and socio-economic scenarios to account for the autonomous development of flood risks, and defined a number of different strategic alternatives for flood risk management at the national level. These alternatives, ranging from flood protection by brute force to reduction of the vulnerability by spatial planning only, were compared with continuation of the current policy on a number of criteria, comprising costs, the reduction of fatality risk and economic risk, and their robustness in relation to uncertainties. We found that a change of policy away from conventional embankments towards gaining control over the flooding process by making the embankments unbreachable is attractive. By thus influencing exposure to flooding, the fatality risk can be effectively reduced at even lower net societal costs than by continuation of the present policy or by raising the protection standards where cost-effective.

Current Strategies for Managing Providers Infected with Bloodborne Pathogens

PubMed Central

Turkel, Sarah; Henderson, David K.

2016-01-01

Background In 1991 CDC issued guidelines to reduce risks for provider-to-patient transmission of bloodborne pathogens. These guidelines, unchanged since 1991, recommend management strategies for hepatitis B ‘e’ antigen-positive providers and for providers infected with human immunodeficiency virus (HIV); they do not address hepatitis-C-virus (HCV)-infected providers. Objective We summarize current state practices and surveyed state health departments to determine: 1) if state policies have been modified since 1991; 2), if state laws require prospective notification of patients and/or expert review panels to manage infected providers; 3) the frequency with which infected-providers issues come to the attention of state health departments; and 4) how state health departments intervene. Methods We reviewed all 50 states’ laws and guidelines to determine current practices and conducted a structured telephone survey of all state health departments. Results Whereas only 19 states require infected providers to notify patients of the providers’ bloodborne pathogen infection, these 19 states require notification under highly varied circumstances. Only ten of 50 state health department officials identified these issues as requiring significant departmental effort. No state law or guideline incorporates information about providers’ viral burdens as part of the risk assessment. Only 3/50 States have modified policies or laws since initial passage; and only 1/50 discusses the management of HCV-infected providers.. Conclusions These results identify a need for incorporating contemporary scientific information into guidelines and also suggest that infected-provider issues are not occurring commonly, are not being detected, or that they are being managed at levels below the state health department. PMID:21515972

Market characteristics and awareness of managed care options among elderly beneficiaries enrolled in traditional Medicare.

PubMed

Mittler, Jessica N; Landon, Bruce E; Zaslavsky, Alan M; Cleary, Paul D

2011-10-14

Medicare beneficiaries' awareness of Medicare managed care plans is critical for realizing the potential benefits of coverage choices. To assess the relationships of the number of Medicare risk plans, managed care penetration, and stability of plans in an area with traditional Medicare beneficiaries' awareness of the program. Cross-sectional analysis of Medicare Current Beneficiary Survey data about beneficiaries' awareness and knowledge of Medicare managed care plan availability. Logistic regression models used to assess the relationships between awareness and market characteristics. Traditional Medicare beneficiaries (n = 3,597) who had never been enrolled in Medicare managed care, but had at least one plan available in their area in 2002, and excluding beneficiaries under 65, receiving Medicaid, or with end stage renal disease. Traditional Medicare beneficiaries' knowledge of Medicare managed care plans in general and in their area. Having more Medicare risk plans available was significantly associated with greater awareness, and having an intermediate number of plans (2-4) was significantly associated with more accurate knowledge of Medicare risk plan availability than was having fewer or more plans. Medicare may have more success engaging consumers in choice and capturing the benefits of plan competition by more actively selecting and managing the plan choice set. Public Domain.

Market Characteristics and Awareness of Managed Care Options Among Elderly Beneficiaries Enrolled in Traditional Medicare

PubMed Central

Mittler, Jessica N.; Landon, Bruce E.; Zaslavsky, Alan M.; Cleary, Paul D.

2011-01-01

Background Medicare beneficiaries' awareness of Medicare managed care plans is critical for realizing the potential benefits of coverage choices. Objectives To assess the relationships of the number of Medicare risk plans, managed care penetration, and stability of plans in an area with traditional Medicare beneficiaries' awareness of the program. Research Design Cross-sectional analysis of Medicare Current Beneficiary Survey data about beneficiaries' awareness and knowledge of Medicare managed care plan availability. Logistic regression models used to assess the relationships between awareness and market characteristics. Subjects Traditional Medicare beneficiaries (n = 3,597) who had never been enrolled in Medicare managed care, but had at least one plan available in their area in 2002, and excluding beneficiaries under 65, receiving Medicaid, or with end stage renal disease. Measures Traditional Medicare beneficiaries' knowledge of Medicare managed care plans in general and in their area. Results Having more Medicare risk plans available was significantly associated with greater awareness, and having an intermediate number of plans (2-4) was significantly associated with more accurate knowledge of Medicare risk plan availability than was having fewer or more plans. Conclusions Medicare may have more success engaging consumers in choice and capturing the benefits of plan competition by more actively selecting and managing the plan choice set. PMID:22340776

Between Oais and Agile a Dynamic Data Management Approach

NASA Astrophysics Data System (ADS)

Bennett, V. L.; Conway, E. A.; Waterfall, A. M.; Pepler, S.

2015-12-01

In this paper we decribe an approach to the integration of existing archival activities which lies between compliance with the more rigid OAIS/TRAC standards and a more flexible "Agile" approach to the curation and preservation of Earth Observation data. We provide a high level overview of existing practice and discuss how these procedures can be extended and supported through the description of preservation state. The aim of which is to facilitate the dynamic controlled management of scientific data through its lifecycle. While processes are considered they are not statically defined but rather driven by human interactions in the form of risk management/review procedure that produce actionable plans, which are responsive to change. We then proceed by describing the feasibility testing of extended risk management and planning procedures which integrate current practices. This was done through the CEDA Archival Format Audit which inspected British Atmospheric Data Centre and NERC Earth Observation Data Centre Archival holdings. These holdings are extensive, comprising of around 2 Petabytes of data and 137 million individual files, which were analysed and characterised in terms of format, based risk. We are then able to present an overview of the format based risk burden faced by a large scale archive attempting to maintain the usability of heterogeneous environmental data sets We continue by presenting a dynamic data management information model and provide discussion of the following core model entities and their relationships: Aspirational entities, which include Data Entity definitions and their associated Preservation Objectives. Risk entities, which act as drivers for change within the data lifecycle. These include Acquisitional Risks, Technical Risks, Strategic Risks and External Risks Plan entities, which detail the actions to bring about change within an archive. These include Acquisition Plans, Preservation Plans and Monitoring plans which support responsive interactions with the community. The Result entities describe the outcomes of the plans. This includes Acquisitions. Mitigations and Accepted Risks. With risk acceptance permitting imperfect but functional solutions that can be realistically supported within an archives resource levels

PEER REVIEW SUPPORTING THE STANDARDS FOR THE ...

EPA Pesticide Factsheets

EPA has been working on developing risk assessments to assist regulators, industry, and the public in evaluating the environmental risks associated with Fossil Fuel Combustion Waste(s) (FFCW) management/disposal in landfills, surface impoundments, other disposal procedures and beneficial uses. The U.S. Environmental Protection Agency (EPA) is evaluating management options for solid wastes from coal combustion (e.g., fly ash, bottom ash, slag). As part of this effort, EPA has prepared the Draft Human and Ecological Risk Assessment of Coal Combustion Wastes. The purpose of this draft risk assessment is to identify and quantify human health and ecological risks that may be associated with current disposal practices for high-volume coal combustion waste (CCW), including fly ash, bottom ash, boiler slag, flue gas desulfurization (FGD) sludge, coal refuse waste, and wastes from fluidized-bed combustion (FBC) units. These risk estimates will help inform EPA’s decisions about how to treat CCW under Subtitle D of the Resource Conservation and Recovery Act.

Brachial-Ankle PWV: Current Status and Future Directions as a Useful Marker in the Management of Cardiovascular Disease and/or Cardiovascular Risk Factors.

PubMed

Tomiyama, Hirofumi; Matsumoto, Chisa; Shiina, Kazuki; Yamashina, Akira

2016-01-01

Since 2001, brachial-ankle pulse wave velocity (brachial-ankle PWV) measurement has been applied for risk stratification of patients with atherosclerotic cardiovascular disease and/or its risk factors in Japan. Measurement of the brachial-ankle PWV is simple and well standardized, and its reproducibility and accuracy are acceptable. Several cross-sectional studies have demonstrated a significant correlation between the brachial-ankle PWV and known risk factors for cardiovascular disease; the correlation is stronger in subjects with cardiovascular disease than in those without cardiovascular disease. We conducted a meta-analysis, which demonstrated that the brachial-ankle PWV is an independent predictor of future cardiovascular events. Furthermore, the treatment of cardiovascular risk factors and lifestyle modifications have been shown to improve the brachial-ankle PWV. Thus, at present, brachial-ankle PWV is close to being considered as a useful marker in the management of atherosclerotic cardiovascular disease and/or its risk factors.

Risk assessment principle for engineered nanotechnology in food and drug.

PubMed

Hwang, Myungsil; Lee, Eun Ji; Kweon, Se Young; Park, Mi Sun; Jeong, Ji Yoon; Um, Jun Ho; Kim, Sun Ah; Han, Bum Suk; Lee, Kwang Ho; Yoon, Hae Jung

2012-06-01

While the ability to develop nanomaterials and incorporate them into products is advancing rapidly worldwide, understanding of the potential health safety effects of nanomaterials has proceeded at a much slower pace. Since 2008, Korea Food and Drug Administration (KFDA) started an investigation to prepare "Strategic Action Plan" to evaluate safety and nano risk management associated with foods, drugs, medical devices and cosmetics using nano-scale materials. Although there are some studies related to potential risk of nanomaterials, physical-chemical characterization of nanomaterials is not clear yet and these do not offer enough information due to their limitations. Their uncertainties make it impossible to determine whether nanomaterials are actually hazardous to human. According to the above mention, we have some problems to conduct the human exposure risk assessment currently. On the other hand, uncertainty about safety may lead to polarized public debate and to businesses unwillingness for further nanotechnology investigation. Therefore, the criteria and methods to assess possible adverse effects of nanomaterials have been vigorously taken into consideration by many international organizations: the World Health Organization, the Organization for Economic and Commercial Development and the European Commission. The object of this study was to develop risk assessment principles for safety management of future nanoproducts and also to identify areas of research to strengthen risk assessment for nanomaterials. The research roadmaps which were proposed in this study will be helpful to fill up the current gaps in knowledge relevant nano risk assessment.

Development of a GIS-based spill management information system.

PubMed

Martin, Paul H; LeBoeuf, Eugene J; Daniel, Edsel B; Dobbins, James P; Abkowitz, Mark D

2004-08-30

Spill Management Information System (SMIS) is a geographic information system (GIS)-based decision support system designed to effectively manage the risks associated with accidental or intentional releases of a hazardous material into an inland waterway. SMIS provides critical planning and impact information to emergency responders in anticipation of, or following such an incident. SMIS couples GIS and database management systems (DBMS) with the 2-D surface water model CE-QUAL-W2 Version 3.1 and the air contaminant model Computer-Aided Management of Emergency Operations (CAMEO) while retaining full GIS risk analysis and interpretive capabilities. Live 'real-time' data links are established within the spill management software to utilize current meteorological information and flowrates within the waterway. Capabilities include rapid modification of modeling conditions to allow for immediate scenario analysis and evaluation of 'what-if' scenarios. The functionality of the model is illustrated through a case study of the Cheatham Reach of the Cumberland River near Nashville, TN.

Unanswered clinical questions in the management of cardiometabolic risk in the elderly: a statement of the Spanish Society of Internal Medicine.

PubMed

Gómez-Huelgas, Ricardo; Giner-Galvañ, Vicente; Mostaza, José M; Cuende, José I; de Miguel-Yanes, Jose M; Rovira, Eduardo; Sánchez-Fuentes, Demetrio; Suárez Fernández, Carmen; Román Sánchez, Pilar

2014-12-18

Despite the progressive increase in life expectancy and the relationship between aging with multi-morbidities and the increased use of healthcare resources, current clinical practice guidelines (CPG) on cardiometabolic risk cannot be adequately applied to elderly subjects with multiple chronic conditions. Its management frequently becomes complicated by both, an excessive use of medications that may lead to overtreatment, drug interactions and increased toxicity, and errors in dosage and non-compliance. Concerned by this gap, the Spanish Society of Internal Medicine created a group of independent experts on cardiometabolic risk who discussed what they considered to be unanswered questions in the management of elderly patients. Current guidelines do not specifically address the problem of elderly with multiple chronic conditions. For this reason, the combined use of the limited available evidence, clinical experience and common sense, could all help us to address this unmet need. In very old people, life expectancy and functionality are the most important factors for guiding potential treatments. Their higher propensity to develop serious adverse events and their shorter lifespan could prevent them from obtaining the potential benefits of the interventions administered. In this document, experts on cardiometabolic risk factors have established a number of consensual recommendations that have taken into account international guidelines and clinical experience, and have also considered the more effective use of healthcare resources. This document is intended to provide general recommendations for clinicians and to promote the effective use of procedures and medications.

IMPLICATIONS OF GLOBAL CLIMATE CHANGE FOR THE ASSESSMENT AND MANAGEMENT OF HUMAN HEALTH RISKS OF CHEMICALS IN THE NATURAL ENVIRONMENT

PubMed Central

Balbus, John M; Boxall, Alistair BA; Fenske, Richard A; McKone, Thomas E; Zeise, Lauren

2013-01-01

Global climate change (GCC) is likely to alter the degree of human exposure to pollutants and the response of human populations to these exposures, meaning that risks of pollutants could change in the future. The present study, therefore, explores how GCC might affect the different steps in the pathway from a chemical source in the environment through to impacts on human health and evaluates the implications for existing risk-assessment and management practices. In certain parts of the world, GCC is predicted to increase the level of exposure of many environmental pollutants due to direct and indirect effects on the use patterns and transport and fate of chemicals. Changes in human behavior will also affect how humans come into contact with contaminated air, water, and food. Dietary changes, psychosocial stress, and coexposure to stressors such as high temperatures are likely to increase the vulnerability of humans to chemicals. These changes are likely to have significant implications for current practices for chemical assessment. Assumptions used in current exposure-assessment models may no longer apply, and existing monitoring methods may not be robust enough to detect adverse episodic changes in exposures. Organizations responsible for the assessment and management of health risks of chemicals therefore need to be more proactive and consider the implications of GCC for their procedures and processes. Environ. Toxicol. Chem. 2013;32:62–78. © 2012 SETAC PMID:23147420

Consensus recommendations for preventing and managing bleeding complications associated with novel oral anticoagulants in singapore.

PubMed

Ng, Heng Joo; Chee, Yen Lin; Ponnudurai, Kuperan; Lim, Lay Cheng; Tan, Daryl; Tay, Jam Chin; Handa, Pankaj Kumar; Akbar Ali, Mufeedha; Lee, Lai Heng

2013-11-01

Novel oral anticoagulants (NOACs) have at least equivalent efficacy compared to standard anticoagulants with similar bleeding risk. Optimal management strategies for bleeding complications associated with NOACs are currently unestablished. A working group comprising haematologists and vascular medicine specialists representing the major institutions in Singapore was convened to produce this consensus recommendation. A Medline and EMBASE search was conducted for articles related to the 3 available NOACs (dabigatran, rivaroxaban, apixaban), bleeding and its management. Additional information was obtained from the product monographs and bibliographic search of articles identified. The NOACs still has substantial interactions with a number of drugs for which concomitant administration should best be avoided. As they are renally excreted, albeit to different degrees, NOACs should not be prescribed to patients with creatinine clearance of <30 mLs/min. Meticulous consideration of risk versus benefits should be exercised before starting a patient on a NOAC. In patients presenting with bleeding, risk stratification of the severity of bleeding as well as identification of the source of bleeding should be performed. In life-threatening bleeds, recombinant activated factor VIIa and prothrombin complex may be considered although their effectiveness is currently unsupported by firm clinical evidence. The NOACs have varying effect on the prothrombin time and activated partial thromboplastin time which has to be interpreted with caution. Routine monitoring of drug level is not usually required. NOACs are an important advancement in antithrombotic management and careful patient selection and monitoring will permit optimisation of their potential and limit bleeding events.

Technological advances in caries diagnosis.

PubMed

Rochlen, Glenn K; Wolff, Mark S

2011-07-01

Understanding the nature of the caries lesion, disease activity, and the patient's caries risk are all used in determining the nature of dental care to be delivered. An examination should include a health and social history and clinical examination using appropriate technologies. This allows proper assessment and suggests a logical management intervention. Minimally invasive dentistry is a concept based on an assessment of a patient's caries risk and the application of the current therapies to prevent, control, and treat the disease. The history of the dental examination and the variety of current technologies are discussed. Copyright © 2011 Elsevier Inc. All rights reserved.

High-risk behaviour in hypomanic states.

PubMed

Fletcher, Kathryn; Parker, Gordon; Paterson, Amelia; Synnott, Howe

2013-08-15

Risk-taking behaviours during hypomanic states are recognised, however the high-risk nature of some behaviours-including the potential for harm to both the individual and others-has not been detailed in the research literature. The current study examines risk-taking behaviours and their consequences (including their potential for impairment) in those with a bipolar II condition. Participants were recruited from the Sydney-based Black Dog Institute Depression Clinic. Diagnostic assignment of bipolar II disorder was based on clinician judgement and formal DSM-IV criteria. Participants completed a series of detailed questions assessing previous risk-taking behaviours during hypomanic states. The sample comprised a total of 93 participants. Risk-taking behaviours during hypomania included spending significant amounts of money, excessive alcohol or drug use, dangerous driving and endangering sexual activities. Key consequences included interpersonal conflict, substantial financial burden and feelings of guilt, shame and remorse. Despite recognition of the risks and consequences associated with hypomanic behaviours, less than one-fifth of participants agreed that hypomania should be treated because of the associated risks. Study limitations included a cross-sectional design, reliance on self-report information, lack of controlling for current mood state, and comprised a tertiary referral sample that may be weighted to more severe cases. Findings may therefore not be generalisable and require replication. Risk-taking behaviours during hypomania are common, and often linked with serious consequences. Whilst hypomania is often enjoyed and romanticised by patients-leading to ambivalence around treatment of such states-careful consideration of the impact of risk-taking behaviour is necessary, while the study raises the question as to what is 'impairment' in hypomania. Findings should advance clinical management by identifying those high-risk behaviours that would benefit from pre-emptive weighting in developing individual's wellbeing plans for managing the condition. Copyright © 2013 Elsevier B.V. All rights reserved.

Lifestyle and socio-demographic factors associated with high-risk HPV infection in UK women

PubMed Central

Cotton, S C; Sharp, L; Seth, R; Masson, L F; Little, J; Cruickshank, M E; Neal, K; Waugh, N

2007-01-01

The world age-standardised prevalence of high-risk HPV (hrHPV) infection among 5038 UK women aged 20–59 years, with a low-grade smear during 1999–2002, assessed for eligibility for TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) was 34.2%. High-risk HPV prevalence decreased with increasing age, from 61% at ages 20–24 years to 14–15% in those over 50 years. The age-standardised prevalence was 15.1, 30.7 and 52.7%, respectively, in women with a current normal, borderline nuclear abnormalities (BNA) and mild smear. In overall multivariate analyses, tertiary education, previous pregnancy and childbirth were associated with reduced hrHPV infection risk. Risk of infection was increased in non-white women, women not married/cohabiting, hormonal contraceptives users and current smokers. In stratified analyses, current smear status and age remained associated with hrHPV infection. Data of this type are relevant to the debate on human papillomavirus (HPV) testing in screening and development of HPV vaccination programmes. PMID:17519896

Clinical pharmacy cardiac risk service for managing patients with coronary artery disease in a health maintenance organization.

PubMed

Sandhoff, Brian G; Nies, Leslie K; Olson, Kari L; Nash, James D; Rasmussen, Jon R; Merenich, John A

2007-01-01

A clinical pharmacy service for managing the treatment of coronary artery disease in a health maintenance organization is described. Despite the proven benefits of aggressive risk factor modification for patients with coronary artery disease (CAD), there remains a treatment gap between consensus- and evidence-based recommendations and their application in patient care. In 1998, Kaiser Permanente of Colorado developed the Clinical Pharmacy Cardiac Risk Service (CPCRS) to focus on the long-term management of patients with CAD to improve clinical outcomes. The primary goals of the CPCRS are to increase the number of CAD patients on lipid-lowering therapy, manage medications shown to decrease the risk of future CAD-related events, assist in the monitoring and control of other diseases that increase cardiovascular risk, provide patient education and recommendations for nonpharmacologic therapy, and act as a CAD information resource for physicians and other health care providers. Using an electronic medical record and tracking database, the service works in close collaboration with primary care physicians, cardiologists, cardiac rehabilitation nurses, and other health care providers to reduce cardiac risk in the CAD population. Particular attention is given to dyslipidemia, blood pressure, diabetes mellitus, and tobacco cessation. Treatment with evidence-based regimens is initiated and adjusted as necessary. Over 11,000 patients are currently being followed by the CPCRS. A clinical pharmacy service in a large health maintenance organization provides cardiac risk reduction for patients with CAD and helps close treatment gaps that may exist for these patients.

Subclinical hypothyroidism in childhood - current knowledge and open issues.

PubMed

Salerno, Mariacarolina; Capalbo, Donatella; Cerbone, Manuela; De Luca, Filippo

2016-12-01

Subclinical hypothyroidism is defined as serum levels of TSH above the upper limit of the reference range, in the presence of normal concentrations of total T 4 or free T 4 . This biochemical profile might be an indication of mild hypothyroidism, with a potential increased risk of metabolic abnormalities and cardiovascular disease recorded among adults. Whether subclinical hypothyroidism results in adverse health outcomes among children is a matter of debate and so management of this condition remains challenging. Mild forms of untreated subclinical hypothyroidism do not seem to be associated with impairments in growth, bone health or neurocognitive outcome. However, ongoing scientific investigations have highlighted the presence of subtle proatherogenic abnormalities among children with modest elevations in their TSH levels. Although current findings are insufficient to recommend levothyroxine treatment for all children with mild asymptomatic forms of subclinical hypothyroidism, they highlight the potential need for assessment of cardiovascular risk among children with this condition. Increased understanding of the early metabolic risk factors associated with subclinical hypothyroidism in childhood will help to improve the management of affected individuals.

Current treatment for vitreous floaters.

PubMed

Sendrowski, David P; Bronstein, Mark A

2010-03-01

Vitreous floaters are a common complaint in the ophthalmic care setting. Patients seek explanation and advice regarding possible treatment options. Because the condition is considered benign, ophthalmic care practitioners have little to offer regarding treatment options. The majority of cases encountered are managed with patient education and reassurance. Although almost all patients accept the conservative management option, there is a small subset of patients who may desire a more aggressive treatment intervention for resolution of their visual symptoms. Information with regard to treatment options is readily available to patients through Internet searches and non-peer reviewed educational Web sites. The risks and benefits for these treatment options are not fully covered. Management of floaters should include education regarding "off-label" procedures as well as discussion about benefits and risks associated with such treatment options. It is vital that eye care practitioners advise and counsel patients with symptomatic floaters for optimum ocular health care. This article reviews the current conventional and "off-label" treatment options for symptomatic patients with vitreous floaters. Copyright (c) 2010 American Optometric Association. Published by Elsevier Inc. All rights reserved.

Developing Coastal Adaptation to Climate Change in the New York City Infrastructure-Shed: Process, Approach, Tools, and Strategies

NASA Technical Reports Server (NTRS)

Rosenzweig, Cynthia; Solecki, William D.; Blake, Reginald; Bowman, Malcolm; Faris, Craig; Gornitz, Vivien; Horton, Radley; Jacob, Klaus; LeBlanc, Alice; Leichenko, Robin;

Diagnostic and therapeutic management of hepatocellular carcinoma

PubMed Central

Bellissimo, Francesco; Pinzone, Marilia Rita; Cacopardo, Bruno; Nunnari, Giuseppe

2015-01-01

Hepatocellular carcinoma (HCC) is an increasing health problem, representing the second cause of cancer-related mortality worldwide. The major risk factor for HCC is cirrhosis. In developing countries, viral hepatitis represent the major risk factor, whereas in developed countries, the epidemic of obesity, diabetes and nonalcoholic steatohepatitis contribute to the observed increase in HCC incidence. Cirrhotic patients are recommended to undergo HCC surveillance by abdominal ultrasounds at 6-mo intervals. The current diagnostic algorithms for HCC rely on typical radiological hallmarks in dynamic contrast-enhanced imaging, while the use of α-fetoprotein as an independent tool for HCC surveillance is not recommended by current guidelines due to its low sensitivity and specificity. Early diagnosis is crucial for curative treatments. Surgical resection, radiofrequency ablation and liver transplantation are considered the cornerstones of curative therapy, while for patients with more advanced HCC recommended options include sorafenib and trans-arterial chemo-embolization. A multidisciplinary team, consisting of hepatologists, surgeons, radiologists, oncologists and pathologists, is fundamental for a correct management. In this paper, we review the diagnostic and therapeutic management of HCC, with a focus on the most recent evidences and recommendations from guidelines. PMID:26576088

Current approach to STD management in women.

PubMed

Amaral, E

1998-12-01

HIV infection was recognized as a new sexually transmitted disease (STD) at the beginning of the last decade. The knowledge of risk factors for sexual transmission of HIV changed the focus on STD to a broader perspective for prevention and control of HIV infection, and consequently of STD. Barriers to STD control include cultural aspects, difficulties in changing sexual behavior, asymptomatic disease in women and expensive and inaccessible tests for diagnosis. The classical clinical approach based on etiologic treatment has never been achieved by developing countries. The international community has been searching for new approaches. Syndromic management and mass treatment are strategies recently found as useful. Nevertheless the best approach to endocervicitis by Neisseria gonorrhoeae and Chlamydia trachomatis remain problematic. Then, the current approach to STD management must include: prompt attention to every patient seeking care for STD; early diagnosis and treatment; delivery of short term treatment at the clinic; education on STD/HIV; screening for other STDs with pre- and post-test counseling; counseling on risk reduction; provision of condoms; integration of STD services with family planning, prenatal and gynecological services.

Analogs and the BHP Risk Reduction Strategy for Future Spaceflight Missions

NASA Technical Reports Server (NTRS)

Whitmire, Sandra; Leveton, Lauren

2011-01-01

In preparation for future exploration missions to distant destinations (e.g., Moon, Near Earth Objects (NEO), and Mars), the NASA Human Research Program s (HRP) Behavioral Health and Performance Element (BHP) conducts and supports research to address four human health risks: Risk of Behavioral Conditions; Risk of Psychiatric Conditions; Risk of Performance Decrements Due to Inadequate Cooperation, Coordination, Communication, and Psychosocial Adaptation within a Team; and Risk of Performance Errors due to Sleep Loss, Fatigue, Circadian Desynchronization, and Work Overload (HRP Science Management Plan, 2008). BHP Research, in collaboration with internal and external research investigators, as well as subject matter experts within NASA operations including flight surgeons, astronauts, and mission planners and others within the Mission Operations Directorate (MOD), identifies knowledge and technology gaps within each Risk. BHP Research subsequently manages and conducts research tasks to address and close the gaps, either through risk assessment and quantification, or the development of countermeasures and monitoring technologies. The resulting deliverables, in many instances, also support current Medical Operations and/or Mission Operations for the International Space Station (ISS).

The incidence of phlebitis with intravenous amiodarone at guideline dose recommendations.

PubMed

Slim, Ahmad M; Roth, Jason E; Duffy, Benjamin; Boyd, Sheri Y N; Rubal, Bernard J

2007-12-01

Postoperative atrial fibrillation following cardiothoracic surgery is common and frequently managed with intravenous (IV) amiodarone. Phlebitis is the most common complication with peripheral infusion of this agent. Current practice guidelines for peripheral IV administration of <2 mg/mL amiodarone were established to reduce the risk of phlebitis. The present study examines the incidence of phlebitis in a postoperative patient population given current dose recommendations. A total of 273 patient charts were reviewed. The incidence of phlebitis in patients given IV amiodarone (n = 36) was 13.9% (95% confidence interval, 2.6-25.2%; p = 0.001). Logistic regression analysis with backward elimination of other therapeutic risk factors suggests that the odds ratio for phlebitis using current dose regimens without IV filters is 19-fold greater than baseline risk in this population. Phlebitis remains a significant complication associated with peripheral infusion of amiodarone within recommended dosing limits.

Reconsideration of Secondary Risk Management Strategies in Patients with Ischemic Heart Disease.

PubMed

Kashiyama, Kuninobu; Sonoda, Shinjo; Otsuji, Yutaka

2017-01-01

The main risk factors in ischemic heart diseases, including myocardial infarction, are hypertension, dyslipidemia, diabetes, obesity and smoking. The incidence of ischemic heart disease in Japan has been lower than that in Western countries because of differences in lifestyle and the anatomy of the coronary arteries, but the situation has been changing recently because of the westernization of lifestyle. Cardiovascular diseases have become the second most common cause of death in Japan, and 40% of those deaths are attributed to ischemic heart disease. Patients with a history of myocardial infarction, especially, have an increased risk of re-infarction, so strict management of coronary risk factors is important for the prevention of secondary ischemic heart disease. Although there are many guidelines about how to manage the risk factors, there are still many problems. Although lipid management has been demonstrated to have a protective effect against coronary artery disease and arteriosclerotic guidelines have been developed, it is reported that only about one third of patients achieved the low-density lipoprotein (LDL) target value under secondary prevention. Moreover, it is unclear whether the lower target value is required for high-risk patients. Recent research on diabetes has reported increased mortality in patients with intensive glycemic control. We should discuss when to start treatment, which medicine to use, and to what extent we should manage glycemic control. Strict management based on current therapeutic guidelines is effective for secondary prevention of ischemic heart disease, with target values of less than 135/85 mmHg for home blood pressure, less than 100 mg/dl for LDL-C, more than 40 mg/dl for HDL-C, less than 150 mg/dl for TG, and, for diabetic patients, less than 7.0% for HbA1c (NGSP).

Using the CAUSE Model to Understand Public Communication about Water Risks: Perspectives from Texas Groundwater District Officials on Drought and Availability.

PubMed

VanDyke, Matthew S; King, Andy J

2017-12-05

Public communication about drought and water availability risks poses challenges to a potentially disinterested public. Water management professionals, though, have a responsibility to work with the public to engage in communication about water and environmental risks. Because limited research in water management examines organizational communication practices and perceptions, insights into research and practice can be gained through investigation of current applications of these risk communication efforts. Guided by the CAUSE model, which explains common goals in communicating risk information to the public (e.g., creating Confidence, generating Awareness, enhancing Understanding, gaining Satisfaction, and motivating Enactment), semistructured interviews of professionals (N = 25) employed by Texas groundwater conservation districts were conducted. The interviews examined how CAUSE model considerations factor in to communication about drought and water availability risks. These data suggest that many work to build constituents' confidence in their districts. Although audiences and constituents living in drought-prone areas were reported as being engaged with water availability risks and solutions, many district officials noted constituents' lack of perceived risk and engagement. Some managers also indicated that public understanding was a secondary concern of their primary responsibilities and that the public often seemed apathetic about technical details related to water conservation risks. Overall, results suggest complicated dynamics between officials and the public regarding information access and motivation. The article also outlines extensions of the CAUSE model and implications for improving public communication about drought and water availability risks. © 2017 Society for Risk Analysis.

Type 2 Endoleaks Post-EVAR: Current Evidence for Rupture Risk, Intervention and Outcomes of Treatment

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

Chung, Raymond, E-mail: rchung@doctors.org.uk; Morgan, Robert A., E-mail: Robert.Morgan@stgeorges.nhs.uk

Type 2 endoleaks (EL2) are the most commonly encountered endoleaks following EVAR. Despite two decades of experience, there remains considerable variation in the management of EL2 with controversies ranging from if to treat, when to treat and how to treat. Here, we summarise the available evidence, describe the treatment techniques available and offer guidelines for management.

The Impact of Perceived Barriers, Academic Anxiety, and Resource Management Strategies on Achievement in First-Year Community College Students

ERIC Educational Resources Information Center

Heller, Monica L.; Cassady, Jerrell C.

2017-01-01

The current study explored the impact of internal and external barriers (e.g., academic anxiety, employment) that place subgroups of college students at risk for academic failure in the first year. The mitigating potential of academic resource management strategies (e.g., time-study environment) was also examined. In a sample of 885 first-semester…

Change in Level of Service Inventory-Ontario Revised (LSI-OR) Risk Scores Over Time: An Examination of Overall Growth Curves and Subscale-Dependent Growth Curves.

PubMed

Day, David M; Wilson, Holly A; Bodwin, Kelly; Monson, Candice M

2017-10-01

The dynamic nature of risk to re-offend is an important issue in the management of offenders and has stimulated extensive research into dynamic risk factors that can alter an individual's overall risk to re-offend if addressed. However, few studies have examined the relative importance of these dynamic risk factors, complicating the task of developing case management and treatment plans that will effect the most change. Using a large, high-risk sample and multi-wave data of a common risk assessment tool, the Level of Service Inventory-Ontario Revised (LSI-OR), the current study investigated the relationship among criminogenic risk factors and their role in influencing the overall risk score. Results indicated a diverse pattern of effects on the eight subscale scores, specifically suggesting that changes on Procriminal Attitude/Orientation, Criminal History, and Leisure/Recreation subscales resulted in a quicker rate of change to the overall risk score over time. These results suggest that some factors may be driving the change in overall risk and could potentially effect the most change if prioritized for intervention. Practical implications and implications for further research are discussed.

Enhancing Interdisciplinary Human System Risk Research Through Modeling and Network Approaches

NASA Technical Reports Server (NTRS)

Mindock, Jennifer; Lumpkins, Sarah; Shelhamer, Mark

2015-01-01

NASA's Human Research Program (HRP) supports research to reduce human health and performance risks inherent in future human space exploration missions. Understanding risk outcomes and contributing factors in an integrated manner allows HRP research to support development of efficient and effective mitigations from cross-disciplinary perspectives, and to enable resilient human and engineered systems for spaceflight. The purpose of this work is to support scientific collaborations and research portfolio management by utilizing modeling for analysis and visualization of current and potential future interdisciplinary efforts.

Exogenous and endogenous hormones and breast cancer

PubMed Central

ChenMD, Wendy Y.

2008-01-01

Exposure to higher levels of both exogenous and endogenous hormone is associated with breast cancer risk. Because of the association between breast cancer and HRT, only the minimal duration of HRT use is recommended for symptom control, and it is not recommended for chronic disease management. Current research issues include the role of progestins, other types of HRT, duration of unopposed estrogen use, and characteristics of cancers that develop on HRT. Circulating sex steroid levels are associated with breast cancer risk, but multiple issues need to be addressed before they are used routinely in clinical practice. Current research issues include measurement of levels for routine clinical practice, integration with standard breast cancer risk models and genetic polymorphism data, and applicability to estrogen-receptor-negative cancers. PMID:18971119

Sickness absence management: encouraging attendance or 'risk-taking' presenteeism in employees with chronic illness?

PubMed

Munir, Fehmidah; Yarker, Joanna; Haslam, Cheryl

2008-01-01

To investigate the organizational perspectives on the effectiveness of their attendance management policies for chronically ill employees. A mixed-method approach was employed involving questionnaire survey with employees and in-depth interviews with key stakeholders of the organizational policies. Participants reported that attendance management polices and the point at which systems were triggered, posed problems for employees managing chronic illness. These systems presented risk to health: employees were more likely to turn up for work despite feeling unwell (presenteeism) to avoid a disciplinary situation but absence-related support was only provided once illness progressed to long-term sick leave. Attendance management polices also raised ethical concerns for 'forced' illness disclosure and immense pressures on line managers to manage attendance. Participants felt their current attendance management polices were unfavourable toward those managing a chronic illness. The policies heavily focused on attendance despite illness and on providing return to work support following long-term sick leave. Drawing on the results, the authors conclude that attendance management should promote job retention rather than merely prevent absence per se. They outline areas of improvement in the attendance management of employees with chronic illness.

Rational risk-based decision support for drinking water well managers by optimized monitoring designs

NASA Astrophysics Data System (ADS)

Enzenhöfer, R.; Geiges, A.; Nowak, W.

2011-12-01

Advection-based well-head protection zones are commonly used to manage the contamination risk of drinking water wells. Considering the insufficient knowledge about hazards and transport properties within the catchment, current Water Safety Plans recommend that catchment managers and stakeholders know, control and monitor all possible hazards within the catchments and perform rational risk-based decisions. Our goal is to supply catchment managers with the required probabilistic risk information, and to generate tools that allow for optimal and rational allocation of resources between improved monitoring versus extended safety margins and risk mitigation measures. To support risk managers with the indispensable information, we address the epistemic uncertainty of advective-dispersive solute transport and well vulnerability (Enzenhoefer et al., 2011) within a stochastic simulation framework. Our framework can separate between uncertainty of contaminant location and actual dilution of peak concentrations by resolving heterogeneity with high-resolution Monte-Carlo simulation. To keep computational costs low, we solve the reverse temporal moment transport equation. Only in post-processing, we recover the time-dependent solute breakthrough curves and the deduced well vulnerability criteria from temporal moments by non-linear optimization. Our first step towards optimal risk management is optimal positioning of sampling locations and optimal choice of data types to reduce best the epistemic prediction uncertainty for well-head delineation, using the cross-bred Likelihood Uncertainty Estimator (CLUE, Leube et al., 2011) for optimal sampling design. Better monitoring leads to more reliable and realistic protection zones and thus helps catchment managers to better justify smaller, yet conservative safety margins. In order to allow an optimal choice in sampling strategies, we compare the trade-off in monitoring versus the delineation costs by accounting for ill-delineated fractions of protection zones. Within an illustrative simplified 2D synthetic test case, we demonstrate our concept, involving synthetic transmissivity and head measurements for conditioning. We demonstrate the worth of optimally collected data in the context of protection zone delineation by assessing the reduced areal demand of delineated area at user-specified risk acceptance level. Results indicate that, thanks to optimally collected data, risk-aware delineation can be made at low to moderate additional costs compared to conventional delineation strategies.

Percutaneous pigtail catheter in the treatment of pneumothorax in major burns: the best alternative? Case report and review of literature.

PubMed

Sebastian, Raul; Ghanem, Omar; Diroma, Frank; Milner, Stephen M; Gerold, Kevin B; Price, Leigh A

2015-05-01

Multiple factors place burn patients at a high risk of pneumothorax development. Currently, no specific recommendations for the management of pneumothorax in large total body surface area (TBSA) burn patients exist. We present a case of a major burn patient who developed pneumothorax after central line insertion. After the traditional large bore (24 Fr) chest tube failed to resolve the pneumothorax, the pneumothorax was ultimately managed by a percutaneous placed pigtail catheter thoracostomy placement and resulted in its complete resolution. We will review the current recommendations of pneumothorax treatment and will highlight on the use of pigtail catheters in pneumothorax management in burn patients. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

In the face of increasing subspecialisation, how does the specialty ensure that the management of ENT emergencies is timely, appropriate and safe?

PubMed

Rouhani, M J

2016-06-01

The field of ENT surgery is one of the most varied specialties, with numerous subspecialties and continuing divergence. With this evolution there comes, however, a risk that specialists become de-skilled in certain areas. In the case of ENT emergencies, this can be particularly dangerous. Current guidance from relevant UK professional membership bodies regarding emergency surgery provision was inspected and a literature search was performed to identify studies relating to management of ENT emergencies in the context of increasing subspecialisation. The specialty currently has provisions in place to ensure timely, appropriate and safe management of emergencies, in the form of guidelines and emergency clinics; however, there is scope for improvement of the system.

An Integrated Web-based Decision Support System in Disaster Risk Management

NASA Astrophysics Data System (ADS)

Aye, Z. C.; Jaboyedoff, M.; Derron, M. H.

2012-04-01

Nowadays, web based decision support systems (DSS) play an essential role in disaster risk management because of their supporting abilities which help the decision makers to improve their performances and make better decisions without needing to solve complex problems while reducing human resources and time. Since the decision making process is one of the main factors which highly influence the damages and losses of society, it is extremely important to make right decisions at right time by combining available risk information with advanced web technology of Geographic Information System (GIS) and Decision Support System (DSS). This paper presents an integrated web-based decision support system (DSS) of how to use risk information in risk management efficiently and effectively while highlighting the importance of a decision support system in the field of risk reduction. Beyond the conventional systems, it provides the users to define their own strategies starting from risk identification to the risk reduction, which leads to an integrated approach in risk management. In addition, it also considers the complexity of changing environment from different perspectives and sectors with diverse stakeholders' involvement in the development process. The aim of this platform is to contribute a part towards the natural hazards and geosciences society by developing an open-source web platform where the users can analyze risk profiles and make decisions by performing cost benefit analysis, Environmental Impact Assessment (EIA) and Strategic Environmental Assessment (SEA) with the support of others tools and resources provided. There are different access rights to the system depending on the user profiles and their responsibilities. The system is still under development and the current version provides maps viewing, basic GIS functionality, assessment of important infrastructures (e.g. bridge, hospital, etc.) affected by landslides and visualization of the impact-probability matrix in terms of socio-economic dimension.

Current management of symptomatic intracranial stenosis.

PubMed

Taylor, Robert A; Weigele, John B; Kasner, Scott E

2011-08-01

Intracranial arterial stenosis (IAS) is the cause of about 10% of all ischemic strokes in the United States, but may account for about 40% of strokes in some populations. After a stroke or transient ischemic attack due to IAS, patients face a 12% annual risk of recurrent stroke on medical therapy, with most strokes occurring in the first year. Warfarin is no better than aspirin in preventing recurrent strokes but poses a higher risk of serious bleeding and death. Groups with the highest risk of recurrent stroke are those with high-grade (≥ 70%) stenosis, those with recent symptom onset, those with symptoms precipitated by hemodynamic maneuvers, and women. Endovascular treatment of IAS is a rapidly evolving therapeutic option. Antiplatelet agents are currently recommended as the primary treatment for symptomatic IAS, with endovascular therapy reserved for appropriate high-risk cases refractory to medical therapy.

Medical treatment of lower urinary tract symptoms/benign prostatic hyperplasia: anything new in 2015.

PubMed

Schauer, Ingrid; Madersbacher, Stephan

2015-01-01

The purpose of this study is to provide an update on recent developments regarding the medical management of male lower urinary tract symptoms (LUTS). Silodosin improves storage/voiding symptoms and nocturia and is effective within the framework of a trial without a catheter. 5α-reductase inhibitors (5ARIs) are not associated with male breast cancer development. Alcohol consumption seems to increase the risk of high-grade prostate cancer under 5ARIs. The combination of α-blocker and 5ARIs remains a well established concept for benign prostatic hyperplasia/LUTS patients with an enhanced risk of disease progression. Tadalafil 5 mg/day monotherapy is a valid option particularly for men with LUTS and erectile dysfunction; the combination of Tadalafil 5 mg/day with a 5ARI is an interesting approach. The fixed-dose combination of α-blocker and antimuscarinic provides advantages regarding storage symptom improvement. This approach is currently primarily recommended as an add-on strategy. Mirabegron opens new horizons in the management of male LUTS and has no negative (but also no positive) urodynamic effects. Several encouraging novel approaches are currently in the experimental phase and might enhance our therapeutic armamentarium in the near future. The recent literature refines our knowledge on current therapeutic options and provides further evidence for an individualized, risk-adapted approach for male LUTS mainly depending on symptoms status, comorbidities (i.e. erectile dysfunction) and risk of disease progression.

AN OVERVIEW OF EPA'S COMBUSTION RESEARCH PROGRAM

EPA Science Inventory

The Air Pollution Technology Branch (APTB) of the U.S. Environmental Protection Agency's National Risk Management Research Laboratory, located in Research Triangle Park, North Carolina, performs a variety of combustion related research. Currently APTB's focus is on mercury from c...

Guideline-adherence and perspectives in the acute management of unstable angina - Initial results from the German chest pain unit registry.

PubMed

Breuckmann, Frank; Hochadel, Matthias; Darius, Harald; Giannitsis, Evangelos; Münzel, Thomas; Maier, Lars S; Schmitt, Claus; Schumacher, Burghard; Heusch, Gerd; Voigtländer, Thomas; Mudra, Harald; Senges, Jochen

2015-08-01

We investigated the current management of unstable angina pectoris (UAP) in certified chest pain units (CPUs) in Germany and focused on the European Society of Cardiology (ESC) guideline-adherence in the timing of invasive strategies or choice of conservative treatment options. More specifically, we analyzed differences in clinical outcome with respect to guideline-adherence. Prospective data from 1400 UAP patients were collected. Analyses of high-risk criteria with indication for invasive management and 3-month clinical outcome data were performed. Guideline-adherence was tested for a primarily conservative strategy as well as for percutaneous coronary intervention (PCI) within <24 and <72h after admission. Overall guideline-conforming management was performed in 38.2%. In UAP patients at risk, undertreatment caused by an insufficient consideration of risk criteria was obvious in 78%. Reciprocally, overtreatment in the absence of adequate risk markers was performed in 27%, whereas a guideline-conforming primarily conservative strategy was chosen in 73% of the low-risk patients. Together, the 3-month major adverse coronary and cerebrovascular events (MACCE) were low (3.6%). Nonetheless, guideline-conforming treatment was even associated with significantly lower MACCE rates (1.6% vs. 4.0%, p<0.05). The data suggest an inadequate adherence to ESC guidelines in nearly two thirds of the patients, particularly in those patients at high to intermediate risk with secondary risk factors, emphasizing the need for further attention to consistent risk profiling in the CPU and its certification process. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Treating pulmonary embolism in Pacific Asia with direct oral anticoagulants.

PubMed

Cohen, Alexander; Jeyaindran, Sinnadurai; Kim, Jae Yeol; Park, Kihyuk; Sompradeekul, Suree; Tambunan, Karmel L; Tran, Huyen; Tsai, I-Chen; Ward, Christopher; Wong, Raymond

2015-08-01

Pulmonary embolism (PE) is the principal preventable cause of in-hospital deaths. Prevalence of PE in Asians is uncertain but undoubtedly underestimated. Asians and Caucasians have similar non-genetic risk factors for PE, and there is mounting evidence that PE affects Asians much more commonly than previously supposed; incidence, especially among high-risk patients, may approach that in Caucasians. Furthermore, PE incidence in Asia is increasing, due to both increased ascertainment, and also population ageing and growing numbers of patients with predisposing risk factors. Despite being warranted, thromboprophylaxis for high-risk patients is not routine in Pacific Asian countries/regions. There also appears to be scope to implement venous thromboembolism (VTE) management guidelines more assiduously. Anticoagulants, primarily heparins and warfarin, have been the mainstays of VTE management for years; however, these agents have limitations that complicate routine use. The complexity of current guidelines has been another barrier to applying evidence-based recommendations in everyday practice. Updated management approaches have considerable potential to improve outcomes. New oral anticoagulants that are easier to administer, require no, or much less, monitoring or dose-adjustment and have a favourable risk/benefit profile compared with conventional modalities, may offer an alternative with the potential to simplify VTE management. However, more information is required on practical management and the occurrence and treatment of bleeding complications. Increasing recognition of the burden of PE and new therapeutic modalities are altering the VTE management landscape in Pacific Asia. Consequently, there is a need to further raise awareness and bridge gaps between the latest evidence and clinical practice. Copyright © 2015. Published by Elsevier Ltd.

The connection between long-term and short-term risk management strategies for flood and landslide hazards: examples from land-use planning and emergency management in four European case studies

NASA Astrophysics Data System (ADS)

Prenger-Berninghoff, K.; Cortes, V. J.; Sprague, T.; Aye, Z. C.; Greiving, S.; Głowacki, W.; Sterlacchini, S.

2014-12-01

Adaptation to complex and unforeseen events requires enhancing the links between planning and preparedness phases to reduce future risks in the most efficient way. In this context, the legal-administrative and cultural context has to be taken into account. This is why four case study areas of the CHANGES1 project (Nehoiu Valley in Romania, Ubaye Valley in France, Val Canale in Italy, and Wieprzówka catchment in Poland) serve as examples to highlight currently implemented risk management strategies for land-use planning and emergency preparedness. The focus is particularly on flood and landslide hazards. The strategies described in this paper were identified by means of exploratory and informal interviews in each study site. Results reveal that a dearth or, in very few cases, a weak link exists between spatial planners and emergency managers. Management strategies could benefit from formally intensifying coordination and cooperation between emergency services and spatial planning authorities. Moreover, limited financial funds urge for a more efficient use of resources and better coordination towards long-term activities. The research indicates potential benefits to establishing or, in some cases, strengthening this link through contextual changes, e.g., in organizational or administrative structures, that facilitate proper interaction between risk management and spatial planning. It also provides suggestions for further development in the form of information and decision support systems as a key connection point. 1 Marie Curie ITN CHANGES - Changing Hydro-meteorological Risks as Analyzed by a New Generation of European Scientists

Clinical risk management in mental health: a qualitative study of main risks and related organizational management practices

PubMed Central

2013-01-01

Background A scientific understanding of clinical risk management (CRM) in mental health care is essential for building safer health systems and for improving patient safety. While evidence on patient safety and CRM in physical health care has increased, there is limited research on these issues in mental health care. This qualitative study provides an overview of the most important clinical risks in mental health and related organizational management practices. Methods We conducted in-depth expert interviews with professionals responsible for CRM in psychiatric hospitals. Interviews were transcribed and analyzed applying qualitative content analysis to thematically sort the identified risks. Results The main concerns for CRM in mental health are a) violence and self-destructive behavior (i.e. protecting patients and staff from other patients, and patients from themselves), b) treatment errors, especially in the process of therapy, and c) risks associated with mental illnesses (e.g. psychosis or depression). This study identified critical differences to CRM in hospitals for physical disorder and challenges specific to CRM in mental health. Firstly, many psychiatric patients do not believe that they are ill and are therefore in hospital against their will. Secondly, staff safety is a much more prominent theme for CRM in mental health care as it is directly related to the specifics of mental illnesses. Conclusions The current study contributes to the understanding of patient safety and raises awareness for CRM in mental health. The mental health specific overview of central risks and related organizational management practices offers a valuable basis for CRM development in mental health and an addition to CRM in general. PMID:23379842

Error management for musicians: an interdisciplinary conceptual framework

PubMed Central

Kruse-Weber, Silke; Parncutt, Richard

2014-01-01

Musicians tend to strive for flawless performance and perfection, avoiding errors at all costs. Dealing with errors while practicing or performing is often frustrating and can lead to anger and despair, which can explain musicians’ generally negative attitude toward errors and the tendency to aim for flawless learning in instrumental music education. But even the best performances are rarely error-free, and research in general pedagogy and psychology has shown that errors provide useful information for the learning process. Research in instrumental pedagogy is still neglecting error issues; the benefits of risk management (before the error) and error management (during and after the error) are still underestimated. It follows that dealing with errors is a key aspect of music practice at home, teaching, and performance in public. And yet, to be innovative, or to make their performance extraordinary, musicians need to risk errors. Currently, most music students only acquire the ability to manage errors implicitly – or not at all. A more constructive, creative, and differentiated culture of errors would balance error tolerance and risk-taking against error prevention in ways that enhance music practice and music performance. The teaching environment should lay the foundation for the development of such an approach. In this contribution, we survey recent research in aviation, medicine, economics, psychology, and interdisciplinary decision theory that has demonstrated that specific error-management training can promote metacognitive skills that lead to better adaptive transfer and better performance skills. We summarize how this research can be applied to music, and survey-relevant research that is specifically tailored to the needs of musicians, including generic guidelines for risk and error management in music teaching and performance. On this basis, we develop a conceptual framework for risk management that can provide orientation for further music education and musicians at all levels. PMID:25120501

Error management for musicians: an interdisciplinary conceptual framework.

PubMed

Kruse-Weber, Silke; Parncutt, Richard

2014-01-01

Musicians tend to strive for flawless performance and perfection, avoiding errors at all costs. Dealing with errors while practicing or performing is often frustrating and can lead to anger and despair, which can explain musicians' generally negative attitude toward errors and the tendency to aim for flawless learning in instrumental music education. But even the best performances are rarely error-free, and research in general pedagogy and psychology has shown that errors provide useful information for the learning process. Research in instrumental pedagogy is still neglecting error issues; the benefits of risk management (before the error) and error management (during and after the error) are still underestimated. It follows that dealing with errors is a key aspect of music practice at home, teaching, and performance in public. And yet, to be innovative, or to make their performance extraordinary, musicians need to risk errors. Currently, most music students only acquire the ability to manage errors implicitly - or not at all. A more constructive, creative, and differentiated culture of errors would balance error tolerance and risk-taking against error prevention in ways that enhance music practice and music performance. The teaching environment should lay the foundation for the development of such an approach. In this contribution, we survey recent research in aviation, medicine, economics, psychology, and interdisciplinary decision theory that has demonstrated that specific error-management training can promote metacognitive skills that lead to better adaptive transfer and better performance skills. We summarize how this research can be applied to music, and survey-relevant research that is specifically tailored to the needs of musicians, including generic guidelines for risk and error management in music teaching and performance. On this basis, we develop a conceptual framework for risk management that can provide orientation for further music education and musicians at all levels.

Role of risk stratification by SPECT, PET, and hybrid imaging in guiding management of stable patients with ischaemic heart disease: expert panel of the EANM cardiovascular committee and EACVI.

PubMed

Acampa, Wanda; Gaemperli, Oliver; Gimelli, Alessia; Knaapen, Paul; Schindler, Thomas H; Verberne, Hein J; Zellweger, Michael J

2015-12-01

Risk stratification has become increasingly important in the management of patients with suspected or known ischaemic heart disease (IHD). Recent guidelines recommend that these patients have their care driven by risk assessment. The purpose of this position statement is to summarize current evidence on the value of cardiac single-photon emission computed tomography, positron emission tomography, and hybrid imaging in risk stratifying asymptomatic or symptomatic patients with suspected IHD, patients with stable disease, patients after coronary revascularization, heart failure patients, and specific patient population. In addition, this position statement evaluates the impact of imaging results on clinical decision-making and thereby its role in patient management. The document represents the opinion of the European Association of Nuclear Medicine (EANM) Cardiovascular Committee and of the European Association of Cardiovascular Imaging (EACVI) and intends to stimulate future research in this field. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

A framework for combining social impact assessment and risk assessment

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

Mahmoudi, Hossein, E-mail: mahmoudi@uni-hohenheim.de; Environmental Sciences Research Institute, Shahid Beheshti University, G.C.; Renn, Ortwin

An increasing focus on integrative approaches is one of the current trends in impact assessment. There is potential to combine impact assessment with various other forms of assessment, such as risk assessment, to make impact assessment and the management of social risks more effective. We identify the common features of social impact assessment (SIA) and social risk assessment (SRA), and discuss the merits of a combined approach. A hybrid model combining SIA and SRA to form a new approach called, ‘risk and social impact assessment’ (RSIA) is introduced. RSIA expands the capacity of SIA to evaluate and manage the socialmore » impacts of risky projects such as nuclear energy as well as natural hazards and disasters such as droughts and floods. We outline the three stages of RSIA, namely: impact identification, impact assessment, and impact management. -- Highlights: • A hybrid model to combine SIA and SRA namely RSIA is proposed. • RSIA can provide the proper mechanism to assess social impacts of natural hazards. • RSIA can play the role of ex-post as well as ex-ante assessment. • For some complicated and sensitive cases like nuclear energy, conducting a RSIA is necessary.« less

Synthesis and review: delivering on conservation promises: the challenges of managing and measuring conservation outcomes

NASA Astrophysics Data System (ADS)

Adams, Vanessa M.; Game, Edward T.; Bode, Michael

2014-08-01

Growing threats and limited resources have always been the financial realities of biodiversity conservation. As the conservation sector has matured, however, the accountability of conservation investments has become an increasingly debated topic, with two key topics being driven to the forefront of the discourse: understanding how to manage the risks associated with our conservation investments and demonstrating that our investments are making a difference through evidence-based analyses. A better understanding of the uncertainties associated with conservation decisions is a central component of managing risks to investments that is often neglected. This focus issue presents both theoretical and applied approaches to quantifying and managing risks. Furthermore, transparent and replicable approaches to measuring impacts of conservation investments are noticeably absent in many conservation programs globally. This focus issue contains state of the art conservation program impact evaluations that both demonstrate how these methods can be used to measure outcomes as well as directing future investments. This focus issue thus brings together current thinking and case studies that can provide a valuable resource for directing future conservation investments.

Emotions at work: what is the link to patient and staff safety? Implications for nurse managers in the NHS.

PubMed

Smith, Pam; Pearson, Pauline H; Ross, Fiona

2009-03-01

This paper sets the discussion of emotions at work within the modern NHS and the current prioritisation of creating a safety culture within the service. The paper focuses on the work of students, frontline nurses and their managers drawing on recent studies of patient safety in the curriculum, and governance and incentives in the care of patients with complex long term conditions. The primary research featured in the paper combined a case study design with focus groups, interviews and observation. In the patient safety research the importance of physical and emotional safety emerged as a key finding both for users and professionals. In the governance and incentives research, risk emerged as a key concern for managers, frontline workers and users. The recognition of emotions and the importance of emotional labour at an individual and organizational level managed by emotionally intelligent leaders played an important role in promoting worker and patient safety and reducing workplace risk. Nurse managers need to be aware of the emotional complexities of their organizations in order to set up systems to support the emotional wellbeing of professionals and users which in turn ensures safety and reduces risk.

Health plans and selection: formal risk adjustment vs. market design and contracts.

PubMed

Frank, R G; Rosenthal, M B

2001-01-01

In this paper, we explore the demand for risk adjustment by health plans that contract with private employers by considering the conditions under which plans might value risk adjustment. Three factors reduce the value of risk adjustment from the plans' point of view. First, only a relatively small segment of privately insured Americans face a choice of competing health plans. Second, health plans share much of their insurance risk with payers, providers, and reinsurers. Third, de facto experience rating that occurs during the premium negotiation process and management of coverage appear to substitute for risk adjustment. While the current environment has not generated much demand for risk adjustment, we reflect on its future potential.

Risky Business: The Science and Art of Radiation Risk Communication in the High Risk Context of Space Travel

NASA Technical Reports Server (NTRS)

Elgart, Shona Robin; Shavers, Mark; Huff, Janice; Patel, Zarana; Semones, Edward

2016-01-01

Successfully communicating the complex risks associated with radiation exposure is a difficult undertaking; communicating those risks within the high-risk context of space travel is uniquely challenging. Since the potential risks of space radiation exposure are not expected to be realized until much later in life, it is hard to draw comparisons between other spaceflight risks such as hypoxia and microgravity-induced bone loss. Additionally, unlike other spaceflight risks, there is currently no established mechanism to mitigate the risks of incurred radiation exposure such as carcinogenesis. Despite these challenges, it is the duty of the Space Radiation Analysis Group (SRAG) at NASA's Johnson Space Center to provide astronauts with the appropriate information to effectively convey the risks associated with exposure to the space radiation environment. To this end, astronauts and their flight surgeons are provided with an annual radiation risk report documenting the astronaut's individual radiation exposures from space travel, medical, and internal radiological procedures throughout the astronaut's career. In an effort to improve this communication and education tool, this paper critically reviews the current report style and explores alternative report styles to define best methods to appropriately communicate risk to astronauts, flight surgeons, and management.

Managing Opioid Addiction Risk in Plastic Surgery during the Perioperative Period.

PubMed

Demsey, Daniel; Carr, Nicholas J; Clarke, Hance; Vipler, Sharon

2017-10-01

Opioid addiction is a public health crisis that affects all areas of medicine. Large numbers of the population across all racial and economic demographics misuse prescription opioids and use illicit opioids. The current understanding is that opioid misuse is a disease that requires treatment, and is not an issue of choice or character. Use of opioid medication is a necessary part of postoperative analgesia, but many physicians are unsure of how to do this safely given the risk of patients developing an opioid misuse disorder. This review gives an update of the current state of the opioid crisis, explains how current surgeons' prescribing practices are contributing to it, and gives recommendations on how to use opioid medication safely in the perioperative period.

Male osteoporosis: clinical approach and management in family practice

PubMed Central

Goh, Lay Hoon; How, Choon How; Lau, Tang Ching

2014-01-01

In Singapore, male osteoporosis is gaining greater importance due to our ageing population. Family physicians should screen for osteoporosis in elderly men and men with risk factors or secondary causes for the condition. A bone mineral density (BMD) test is used for diagnosis. FRAX® can be used to predict the absolute ten-year fracture risk. Management includes reduction of risk factors or secondary causes, fall prevention, appropriate physical activity and a diet adequate in calcium and vitamin D. Referrals to specialists for evaluation and therapy can be considered, particularly for younger men with more severe disease. Current first-line drug treatment includes bisphosphonates and teriparatide. Testosterone increases BMD of the spine, but data on fracture risk reduction is unavailable. Public and physician education with the involvement of health authorities can create greater awareness of this silent condition, which can lead to complications, morbidity and death, if left untreated. PMID:25091882

Risk as a Resource - A New Paradigm

NASA Technical Reports Server (NTRS)

Gindorf, Thomas E.

1996-01-01

NASA must change dramatically because of the current United States federal budget climate. The American people and their elected officials have mandated a smaller, more efficient and effective government. For the past decade, NASA's budget had grown at or slightly above the rate of inflation. In that era, taking all steps to avoid the risk of failure was the rule. Spacecraft development was characterized by extensive analyses, numerous reviews, and multiple conservative tests. This methodology was consistent with the long available schedules for developing hardware and software for very large, billion dollar spacecraft. Those days are over. The time when every identifiable step was taken to avoid risk is being replaced by a new paradigm which manages risk in much the same way as other resources (schedule, performance, or dollars) are managed. While success is paramount to survival, it can no longer be bought with a large growing NASA budget.

Management of post-operative Crohn's disease in 2017: where do we go from here?

PubMed

Nguyen, Vu; Kanth, Rajan; Gazo, Joshua; Sorrentino, Dario

2016-11-01

Postoperative recurrence (POR) of Crohn's disease is common after surgical resection. How to best manage POR remains uncertain. Areas covered: In this review, we will first describe the natural course and the best modalities to diagnose this surgical sequela. We will then focus on the potential risk factors for relapse and highlight the main shortcomings in the current study designs and endoscopic and clinical scoring systems, which may partly explain the unexpected outcomes of recent clinical trials. Finally, we will propose a strategy to address the management of POR. Expert commentary: Anti-tumor necrosis factor (Anti-TNF) agents are the most effective therapy to prevent POR in Crohn's disease. Patient risk stratification and active monitoring with scheduled ileocolonoscopy are cornerstones of optimal POR management. Further studies are needed to address areas of uncertainty including timing and duration of therapy and the role of therapeutic drug monitoring in this setting.

Quality, risk management and governance in mental health: an overview.

PubMed

Callaly, Tom; Arya, Dinesh; Minas, Harry

2005-03-01

To consider the origin, current emphasis and relevance of the concepts of quality, risk management and clinical governance in mental health. Increasingly, health service boards and management teams are required to give attention to clinical governance rather than corporate governance alone. Clinical governance is a unifying quality concept that aims to produce a structure and systems to assure and improve the quality of clinical services by promoting an integrated and organization-wide approach towards continuous quality improvement. Many psychiatrists will find the reduction in clinical autonomy, the need to consider the welfare of the whole population as well as the individual patient for whom they are responsible, and the requirement that they play a part in a complex systems approach to quality improvement to be a challenge. Avoiding or ignoring this challenge will potentially lead to conflict with modern management approaches and increased loss of influence on future developments in mental health services.

Barriers to Innovation in Urban Wastewater Utilities: Attitudes of Managers in California.

PubMed

Kiparsky, Michael; Thompson, Barton H; Binz, Christian; Sedlak, David L; Tummers, Lars; Truffer, Bernhard

2016-06-01

In many regions of the world, urban water systems will need to transition into fundamentally different forms to address current stressors and meet impending challenges-faster innovation will need to be part of these transitions. To assess the innovation deficit in urban water organizations and to identify means for supporting innovation, we surveyed wastewater utility managers in California. Our results reveal insights about the attitudes towards innovation among decision makers, and how perceptions at the level of individual managers might create disincentives for experimentation. Although managers reported feeling relatively unhindered organizationally, they also spend less time on innovation than they feel they should. The most frequently reported barriers to innovation included cost and financing; risk and risk aversion; and regulatory compliance. Considering these results in the context of prior research on innovation systems, we conclude that collective action may be required to address underinvestment in innovation.

Barriers to Innovation in Urban Wastewater Utilities: Attitudes of Managers in California

NASA Astrophysics Data System (ADS)

Kiparsky, Michael; Thompson, Barton H.; Binz, Christian; Sedlak, David L.; Tummers, Lars; Truffer, Bernhard

2016-06-01

In many regions of the world, urban water systems will need to transition into fundamentally different forms to address current stressors and meet impending challenges—faster innovation will need to be part of these transitions. To assess the innovation deficit in urban water organizations and to identify means for supporting innovation, we surveyed wastewater utility managers in California. Our results reveal insights about the attitudes towards innovation among decision makers, and how perceptions at the level of individual managers might create disincentives for experimentation. Although managers reported feeling relatively unhindered organizationally, they also spend less time on innovation than they feel they should. The most frequently reported barriers to innovation included cost and financing; risk and risk aversion; and regulatory compliance. Considering these results in the context of prior research on innovation systems, we conclude that collective action may be required to address underinvestment in innovation.

Integrating gender medicine into the workplace health and safety policy in the scientific research institutions: a mandatory task.

PubMed

Giammarioli, Anna Maria; Siracusano, Alessandra; Sorrentino, Eugenio; Bettoni, Monica; Malorni, Walter

2012-01-01

Gender medicine is a multi-faceted field of investigation integrating various aspects of psycho-social and biological sciences but it mainly deals with the impact of the gender on human physiology, pathophysiology, and clinical features of diseases. In Italy, the Decree Law 81/2008 recently introduced the gender issue in the risk assessment at the workplaces. This review briefly describes our current knowledge on gender medicine and on the Italian legislation in risk management. Public or private scientific institutions should be the first to pay attention to the safety of their workers, who are simultaneously subjected to biological, chemical and physical agents. Main tasks of risk management in scientific research institutions are here analyzed and discussed in a gender perspective.

Epidemiology and prevention of stroke: a worldwide perspective

PubMed Central

Kuklina, Elena V; Tong, Xin; George, Mary G; Bansil, Pooja

2015-01-01

This paper reviews how epidemiological studies during the last 5 years have advanced our knowledge in addressing the global stroke epidemic. The specific objectives were to review the current evidence supporting management of ten major modifiable risk factors for prevention of stroke: hypertension, current smoking, diabetes, obesity, poor diet, physical inactivity, atrial fibrillation, excessive alcohol consumption, abnormal lipid profile and psychosocial stress/depression. PMID:22288675

A global framework for future costs and benefits of river-flood protection in urban areas

NASA Astrophysics Data System (ADS)

Ward, Philip J.; Jongman, Brenden; Aerts, Jeroen C. J. H.; Bates, Paul D.; Botzen, Wouter J. W.; Diaz Loaiza, Andres; Hallegatte, Stephane; Kind, Jarl M.; Kwadijk, Jaap; Scussolini, Paolo; Winsemius, Hessel C.

2017-09-01

Floods cause billions of dollars of damage each year, and flood risks are expected to increase due to socio-economic development, subsidence, and climate change. Implementing additional flood risk management measures can limit losses, protecting people and livelihoods. Whilst several models have been developed to assess global-scale river-flood risk, methods for evaluating flood risk management investments globally are lacking. Here, we present a framework for assessing costs and benefits of structural flood protection measures in urban areas around the world. We demonstrate its use under different assumptions of current and future climate change and socio-economic development. Under these assumptions, investments in dykes may be economically attractive for reducing risk in large parts of the world, but not everywhere. In some regions, economically efficient investments could reduce future flood risk below today’s levels, in spite of climate change and economic growth. We also demonstrate the sensitivity of the results to different assumptions and parameters. The framework can be used to identify regions where river-flood protection investments should be prioritized, or where other risk-reducing strategies should be emphasized.

Nutritional Health Considerations for Persons with Spinal Cord Injury.

PubMed

Bigford, Gregory; Nash, Mark S

2017-01-01

Chronic spinal cord injury (SCI) often results in morbidity and mortality due to all-cause cardiovascular disease (CVD) and comorbid endocrine disorders. Several component risk factors for CVD, described as the cardiometabolic syndrome (CMS), are prevalent in SCI, with the individual risks of obesity and insulin resistance known to advance the disease prognosis to a greater extent than other established risks. Notably, adiposity and insulin resistance are attributed in large part to a commonly observed maladaptive dietary/nutritional profile. Although there are no evidence-based nutritional guidelines to address the CMS risk in SCI, contemporary treatment strategies advocate more comprehensive lifestyle management that includes sustained nutritional guidance as a necessary component for overall health management. This monograph describes factors in SCI that contribute to CMS risks, the current nutritional profile and its contribution to CMS risks, and effective treatment strategies including the adaptability of the Diabetes Prevention Program (DPP) to SCI. Establishing appropriate nutritional guidelines and recommendations will play an important role in addressing the CMS risks in SCI and preserving optimal long-term health.

Caring for teens with chronic illness: risky business?

PubMed

Louis-Jacques, Jennifer; Samples, Cathryn

2011-08-01

With advances in medicine, more children with chronic illness are reaching adolescence and young adulthood. Research has shown that this group is not immune to the behavioral risks endorsed by healthy adolescents. Recent literature exploring the etiology of risk behaviors and their impact on chronic illness is presented. Risk taking may be the result of differential maturation of two distinct parts of the adolescent brain. Risk taking can be considered normal in adolescents with chronic illness, but there is some evidence that chronic illness affects normal psychosocial development. Moreover, evidence supports that chronic illness can lead to disparities in risk education and assessment because of disease focused management rather than a more comprehensive approach. Youth living with chronic illnesses face unique challenges in accomplishing the developmental tasks of adolescence. These challenges include risk behaviors, which jeopardize current and future health. The reasons for risk taking are multifactorial and require providers to make the adolescent and not the illness the center of management. More research is needed on how to improve developmentally appropriate and relevant interventions to aid in safe passage into adulthood.

Engineered nanomaterials: exposures, hazards, and risk prevention

PubMed Central

2011-01-01

Nanotechnology presents the possibility of revolutionizing many aspects of our lives. People in many settings (academic, small and large industrial, and the general public in industrialized nations) are either developing or using engineered nanomaterials (ENMs) or ENM-containing products. However, our understanding of the occupational, health and safety aspects of ENMs is still in its formative stage. A survey of the literature indicates the available information is incomplete, many of the early findings have not been independently verified, and some may have been over-interpreted. This review describes ENMs briefly, their application, the ENM workforce, the major routes of human exposure, some examples of uptake and adverse effects, what little has been reported on occupational exposure assessment, and approaches to minimize exposure and health hazards. These latter approaches include engineering controls such as fume hoods and personal protective equipment. Results showing the effectiveness - or lack thereof - of some of these controls are also included. This review is presented in the context of the Risk Assessment/Risk Management framework, as a paradigm to systematically work through issues regarding human health hazards of ENMs. Examples are discussed of current knowledge of nanoscale materials for each component of the Risk Assessment/Risk Management framework. Given the notable lack of information, current recommendations to minimize exposure and hazards are largely based on common sense, knowledge by analogy to ultrafine material toxicity, and general health and safety recommendations. This review may serve as an overview for health and safety personnel, management, and ENM workers to establish and maintain a safe work environment. Small start-up companies and research institutions with limited personnel or expertise in nanotechnology health and safety issues may find this review particularly useful. PMID:21418643

An observational study to evaluate the clinical practice of cardiovascular risk management among hypertensive patients in Turkey.

PubMed

Kozan, Omer

2011-09-01

We evaluated clinical practice in cardiovascular risk management and related patient compliance among Turkish hypertensive patients. This noninterventional, observational study included 1023 patients (620 women, 403 men; mean age 58.4 ± 10.6 years) with essential hypertension, from 50 centers across Turkey. Patients were evaluated at a cross-sectional phase and a follow-up phase of nine months. Data obtained at the cross-sectional phase included patient demographics, medical and past history, cardiovascular risk status, and current practice patterns regarding cardiovascular risk management. The mean duration of hypertension was 8.1 ± 7.1 years. The mean body mass index was 30.3 ± 5.2 kg/m2 and systolic and diastolic blood pressures (BP) were 147.8 ± 22.4 and 88.9 ± 12.5 mmHg, respectively. Ten-year coronary heart disease risk and risk level were significantly higher in males, and significantly increased in the presence of diabetes, metabolic syndrome, and renal disease and/or microalbuminuria (p<0.05). In past year history of cardiovascular risk management, 7.3% of the patients did not have BP measurements; no diet was recommended to 15.6%; 79.3% had high BP levels, and patient compliance with antihypertensive drug treatment and dietary recommendations were 87.7% and 62.5%, respectively. A similar profile was observed for dyslipidemia and diabetes mellitus. The physicians' efforts to motivate the patients to quit smoking, to lose weight, and involve in physical exercise were far below satisfactory levels, and the patients' compliance rates with these recommendations were even lower. Our study demonstrates that hypertensive patients are not adequately evaluated for cardiovascular risk, which is significantly increased in the presence of various cardiovascular risk factors such as diabetes, metabolic syndrome, and renal disease.

Data Model for Multi Hazard Risk Assessment Spatial Support Decision System

NASA Astrophysics Data System (ADS)

Andrejchenko, Vera; Bakker, Wim; van Westen, Cees

2014-05-01

The goal of the CHANGES Spatial Decision Support System is to support end-users in making decisions related to risk reduction measures for areas at risk from multiple hydro-meteorological hazards. The crucial parts in the design of the system are the user requirements, the data model, the data storage and management, and the relationships between the objects in the system. The implementation of the data model is carried out entirely with an open source database management system with a spatial extension. The web application is implemented using open source geospatial technologies with PostGIS as the database, Python for scripting, and Geoserver and javascript libraries for visualization and the client-side user-interface. The model can handle information from different study areas (currently, study areas from France, Romania, Italia and Poland are considered). Furthermore, the data model handles information about administrative units, projects accessible by different types of users, user-defined hazard types (floods, snow avalanches, debris flows, etc.), hazard intensity maps of different return periods, spatial probability maps, elements at risk maps (buildings, land parcels, linear features etc.), economic and population vulnerability information dependent on the hazard type and the type of the element at risk, in the form of vulnerability curves. The system has an inbuilt database of vulnerability curves, but users can also add their own ones. Included in the model is the management of a combination of different scenarios (e.g. related to climate change, land use change or population change) and alternatives (possible risk-reduction measures), as well as data-structures for saving the calculated economic or population loss or exposure per element at risk, aggregation of the loss and exposure using the administrative unit maps, and finally, producing the risk maps. The risk data can be used for cost-benefit analysis (CBA) and multi-criteria evaluation (SMCE). The data model includes data-structures for CBA and SMCE. The model is at the stage where risk and cost-benefit calculations can be stored but the remaining part is currently under development. Multi-criteria information, user management and the relation of these with the rest of the model is our next step. Having a carefully designed data model plays a crucial role in the development of the whole system for rapid development, keeping the data consistent, and in the end, support the end-user in making good decisions in risk-reduction measures related to multiple natural hazards. This work is part of the EU FP7 Marie Curie ITN "CHANGES"project (www.changes-itn.edu)

NATO/CCMS PILOT STUDY ON CLEAN PRODUCTS & PROCESSES

EPA Science Inventory

Led by the United States, represented by the U.S. Environmental Protection Agency's (EPA's) National Risk Management Research Laboratory, the Pilot Study on Clean Products and Processes was instituted to create an international forum where current trends, developments, and expert...

17 CFR 240.17i-5 - Record creation, maintenance, and access requirements for supervised investment bank holding...

Code of Federal Regulations, 2010 CFR

2010-04-01

... shall make and keep current the following records: (1) A record reflecting the results of stress tests...; and (5) Records documenting the system of internal risk management controls required to be established...

17 CFR 240.17i-5 - Record creation, maintenance, and access requirements for supervised investment bank holding...

Code of Federal Regulations, 2013 CFR

2013-04-01

... shall make and keep current the following records: (1) A record reflecting the results of stress tests...; and (5) Records documenting the system of internal risk management controls required to be established...

17 CFR 240.17i-5 - Record creation, maintenance, and access requirements for supervised investment bank holding...

Code of Federal Regulations, 2012 CFR

2012-04-01

... shall make and keep current the following records: (1) A record reflecting the results of stress tests...; and (5) Records documenting the system of internal risk management controls required to be established...

17 CFR 240.17i-5 - Record creation, maintenance, and access requirements for supervised investment bank holding...

Code of Federal Regulations, 2011 CFR

2011-04-01

... shall make and keep current the following records: (1) A record reflecting the results of stress tests...; and (5) Records documenting the system of internal risk management controls required to be established...

GREENSCOPE: A Method for Modeling Chemical Process Sustainability

EPA Science Inventory

Current work within the U.S. Environmental Protection Agency’s National Risk Management Research Laboratory is focused on the development of a method for modeling chemical process sustainability. The GREENSCOPE methodology, defined for the four bases of Environment, Economics, Ef...

Evaluating non-detection risk associated with metabarcoding approaches for rare metabarcoding approaches

EPA Science Inventory

Early detection of non-indigenous species (NIS), newly introduced species at low abundance in the monitoring area, can strengthen current management strategies including NIS control and eradication. A practical early detection strategy requires achieving balance between efficient...

Advances in Hereditary Colorectal and Pancreatic Cancer

PubMed Central

Underhill, Meghan L.; Germansky, Katharine A.; Yurgelun, Matthew B.

2017-01-01

Purpose Innovations in genetic medicine have lead to improvements in the early detection, prevention, and treatment of cancer for patients with inherited risks of gastrointestinal cancer, particularly hereditary colorectal cancer and hereditary pancreatic cancer. Methods This review provides an update on recent data and key advances that have improved the identification, understanding, and management of patients with hereditary colorectal cancer and hereditary pancreatic cancer. Findings This review details recent and emerging data that highlight the developing landscape of genetics in hereditary colorectal and pancreatic cancer risk. A summary is provided of the current state-of-the-art practices for identifying, evaluating, and managing patients with suspected hereditary colorectal cancer and pancreatic cancer risk. The impact of next-generation sequencing technologies in the clinical diagnosis of hereditary gastrointestinal cancer and also in discovery efforts of novel genes linked to familial cancer risk are discussed. Emerging targeted therapies that may play a particularly important role in the treatment of patients with hereditary forms of colorectal cancer and pancreatic cancer are also reviewed. Current approaches for pancreatic cancer screening and the psychosocial impact of such procedures are also detailed. Implications Given the availability of novel diagnostic, risk-reducing, and therapeutic strategies that exist for patients with hereditary risk for colorectal or pancreatic cancer, it is imperative that clinicians be vigilant about evaluating patients for hereditary cancer syndromes. Continuing to advance genetics research in hereditary gastrointestinal cancers will allow for more progress to be made in personalized medicine and prevention. PMID:27045993

Current practice in airway management: A descriptive evaluation.

PubMed

Kjonegaard, Rebecca; Fields, Willa; King, Major L

2010-03-01

Ventilator-associated pneumonia, a common complication of mechanical ventilation, could be reduced if health care workers implemented evidence-based practices that decrease the risk for this complication. To determine current practice and differences in practices between registered nurses and respiratory therapists in managing patients receiving mechanical ventilation. A descriptive comparative design was used. A convenience sample of 41 registered nurses and 25 respiratory therapists who manage critical care patients treated with mechanical ventilation at Sharp Grossmont Hospital, La Mesa, California, completed a survey on suctioning techniques and airway management practices. Descriptive and inferential statistics were used to analyze the data. Significant differences existed between nurses and respiratory therapists for hyperoxygenation before suctioning (P =.03). In the 2 groups, nurses used the ventilator for hyper-oxygenation more often, and respiratory therapists used a bag-valve device more often (P =.03). Respiratory therapists instilled saline (P <.001) and rinsed the closed system with saline after suctioning (P =.003) more often than nurses did. Nurses suctioned oral secretions (P <.001) and the nose of orally intubated patients (P =.01), brushed patients' teeth with a toothbrush (P<.001), and used oral swabs to clean the mouth (P <.001) more frequently than respiratory therapists did. Nurses and respiratory therapists differed significantly in the management of patients receiving mechanical ventilation. To reduce the risk of ventilator-associated pneumonia, both nurses and respiratory therapists must be consistent in using best practices when managing patients treated with mechanical ventilation.

Wyoming Basin Rapid Ecoregional Assessment: Work Plan

USGS Publications Warehouse

Carr, Natasha B.; Garman, Steven L.; Walters, Annika; Ray, Andrea; Melcher, Cynthia P.; Wesner, Jeff S.; O’Donnell, Michael S.; Sherrill, Kirk R.; Babel, Nils C.; Bowen, Zachary H.

2013-01-01

The overall goal of the Rapid Ecoregional Assessments (REAs) being conducted for the Bureau of Land Management (BLM) is to provide information that supports regional planning and analysis for the management of ecological resources. The REA provides an assessment of baseline ecological conditions, an evaluation of current risks from drivers of ecosystem change, and a predictive capacity for evaluating future risks. The REA also may be used for identifying priority areas for conservation or restoration and for assessing the cumulative effects of a variety of land uses. There are several components of the REAs. Management Questions, developed by the BLM and partners for the ecoregion, identify the information needed for addressing land-management responsibilities. Conservation Elements represent regionally significant aquatic and terrestrial species and communities that are to be conserved and (or) restored. The REA also will evaluate major drivers of ecosystem change (Change Agents) currently affecting or likely to affect the status of Conservation Elements. We selected 8 major biomes and 19 species or species assemblages to be included as Conservation Elements. We will address the four primary Change Agents—development, fire, invasive species, and climate change—required for the REA. The purpose of the work plan for the Wyoming Basin REA is to document the selection process for, and final list of, Management Questions, Conservation Elements, and Change Agents. The work plan also presents the overall assessment framework that will be used to assess the status of Conservation Elements and answer Management Questions.

Case Management to Reduce Cardiovascular Disease Risk in American Indians and Alaska Natives With Diabetes: Results From the Special Diabetes Program for Indians Healthy Heart Demonstration Project

PubMed Central

Jiang, Luohua; Manson, Spero M.; Beals, Janette; Henderson, William; Pratte, Katherine; Acton, Kelly J.; Roubideaux, Yvette

2014-01-01

Objectives. We evaluated cardiovascular disease (CVD) risk factors in American Indians/Alaska Natives (AI/ANs) with diabetes in the Special Diabetes Program for Indians Healthy Heart (SDPI-HH) Demonstration Project. Methods. Multidisciplinary teams implemented an intensive case management intervention among 30 health care programs serving 138 tribes. The project recruited 3373 participants, with and without current CVD, between 2006 and 2009. We examined data collected at baseline and 1 year later to determine whether improvements occurred in CVD risk factors and in Framingham coronary heart disease (CHD) risk scores, aspirin use, and smoking status. Results. A1c levels decreased an average of 0.2% (P < .001). Systolic and diastolic blood pressure, low-density lipoprotein (LDL) cholesterol, and triglyceride levels decreased, with the largest significant reduction in LDL cholesterol (∆ = −5.29 mg/dL; P < .001). Average Framingham CHD risk scores also decreased significantly. Aspirin therapy increased significantly, and smoking decreased. Participants with more case management visits had significantly greater reductions in LDL cholesterol and A1c values. Conclusions. SDPI-HH successfully translated an intensive case management intervention. Creative retention strategies and an improved understanding of organizational challenges are needed for future Indian health translational efforts. PMID:25211728

Multi-criteria decision analysis and environmental risk assessment for nanomaterials

NASA Astrophysics Data System (ADS)

Linkov, Igor; Satterstrom, F. Kyle; Steevens, Jeffery; Ferguson, Elizabeth; Pleus, Richard C.

2007-08-01

Nanotechnology is a broad and complex discipline that holds great promise for innovations that can benefit mankind. Yet, one must not overlook the wide array of factors involved in managing nanomaterial development, ranging from the technical specifications of the material to possible adverse effects in humans. Other opportunities to evaluate benefits and risks are inherent in environmental health and safety (EHS) issues related to nanotechnology. However, there is currently no structured approach for making justifiable and transparent decisions with explicit trade-offs between the many factors that need to be taken into account. While many possible decision-making approaches exist, we believe that multi-criteria decision analysis (MCDA) is a powerful and scientifically sound decision analytical framework for nanomaterial risk assessment and management. This paper combines state-of-the-art research in MCDA methods applicable to nanotechnology with a hypothetical case study for nanomaterial management. The example shows how MCDA application can balance societal benefits against unintended side effects and risks, and how it can also bring together multiple lines of evidence to estimate the likely toxicity and risk of nanomaterials given limited information on physical and chemical properties. The essential contribution of MCDA is to link this performance information with decision criteria and weightings elicited from scientists and managers, allowing visualization and quantification of the trade-offs involved in the decision-making process.

Spinal intramedullary ependymoma: surgical approaches and outcome.

PubMed

Borges, Lawrence F

2018-02-01

Intramedullary ependymomas are uncommon tumors that can occur within the medullary substance of the spinal cord. Despite this difficult location, they are typically benign tumors that can most often be removed completely with an acceptable surgical risk. Therefore, the recommended management approach is usually surgical excision. This review will consider the historical context in which surgeons began treating these tumors and then review the more recent literature that guides their current management.

Perioperative aspirin management after POISE-2: some answers, but questions remain.

PubMed

Gerstein, Neal Stuart; Carey, Michael Christopher; Cigarroa, Joaquin E; Schulman, Peter M

2015-03-01

Aspirin constitutes important uninterrupted lifelong therapy for many patients with cardiovascular (CV) disease or significant (CV) risk factors. However, whether aspirin should be continued or withheld in patients undergoing noncardiac surgery is a common clinical conundrum that balances the potential of aspirin for decreasing thrombotic risk with its possibility for increasing perioperative blood loss. In this focused review, we describe the role of aspirin in treating and preventing cardiovascular disease, summarize the most important literature on the perioperative use of aspirin (including the recently published PeriOperative ISchemic Evaluation [POISE]-2 trial), and offer current recommendations for managing aspirin during the perioperative period. POISE-2 suggests that aspirin administration during the perioperative period does not change the risk of a cardiovascular event and may result in increased bleeding. However, these findings are tempered by a number of methodological issues related to the study. On the basis of currently available literature, including POISE-2, aspirin should not be administered to patients undergoing surgery unless there is a definitive guideline-based primary or secondary prevention indication. Aside from closed-space procedures, intramedullary spine surgery, or possibly prostate surgery, moderate-risk patients taking lifelong aspirin for a guideline-based primary or secondary indication may warrant continuation of their aspirin throughout the perioperative period.

Quasi-extinction risk and population targets for the Eastern, migratory population of monarch butterflies (Danaus plexippus)

USGS Publications Warehouse

Semmens, Brice X.; Semmens, Darius J.; Thogmartin, Wayne E.; Wiederholt, Ruscena; Lopez-Hoffman, Laura; Diffendorfer, James E.; Pleasants, John M.; Oberhauser, Karen S.; Taylor, Orley R.

2016-01-01

The Eastern, migratory population of monarch butterflies (Danaus plexippus), an iconic North American insect, has declined by ~80% over the last decade. The monarch’s multi-generational migration between overwintering grounds in central Mexico and the summer breeding grounds in the northern U.S. and southern Canada is celebrated in all three countries and creates shared management responsibilities across North America. Here we present a novel Bayesian multivariate auto-regressive state-space model to assess quasi-extinction risk and aid in the establishment of a target population size for monarch conservation planning. We find that, given a range of plausible quasi-extinction thresholds, the population has a substantial probability of quasi-extinction, from 11–57% over 20 years, although uncertainty in these estimates is large. Exceptionally high population stochasticity, declining numbers, and a small current population size act in concert to drive this risk. An approximately 5-fold increase of the monarch population size (relative to the winter of 2014–15) is necessary to halve the current risk of quasi-extinction across all thresholds considered. Conserving the monarch migration thus requires active management to reverse population declines, and the establishment of an ambitious target population size goal to buffer against future environmentally driven variability.

Decision making for animal health and welfare: integrating risk-benefit analysis with prospect theory.

PubMed

Hansson, Helena; Lagerkvist, Carl Johan

2014-06-01

This study integrated risk-benefit analysis with prospect theory with the overall objective of identifying the type of management behavior represented by farmers' choices of mastitis control options (MCOs). Two exploratory factor analyses, based on 163 and 175 Swedish farmers, respectively, highlighted attitudes to MCOs related to: (1) grouping cows and applying milking order to prevent spread of existing infection and (2) working in a precautionary way to prevent mastitis occurring. This was interpreted as being based on (1) reactive management behavior on detection of udder-health problems in individual cows and (2) proactive management behavior to prevent mastitis developing. Farmers' assessments of these MCOs were found to be based on asymmetrical evaluations of risks and benefits, suggesting that farmers' management behavior depends on their individual reference point. In particular, attitudes to MCOs related to grouping cows and applying milking order to prevent the spread of mastitis once infected cows were detected were stronger in the risk domain than in the benefit domain, in accordance with loss aversion. In contrast, attitudes to MCOs related to working in a precautionary way to prevent cows from becoming infected in the first place were stronger in the benefit domain than in the risk domain, in accordance with reverse loss aversion. These findings are of practical importance for farmers and agribusiness and in public health protection work to reduce the current extensive use of antibiotics in dairy herds. © 2013 Society for Risk Analysis.

MAVEN Information Security Governance, Risk Management, and Compliance (GRC): Lessons Learned

NASA Technical Reports Server (NTRS)

Takamura, Eduardo; Gomez-Rosa, Carlos A.; Mangum, Kevin; Wasiak, Fran

2014-01-01

As the first interplanetary mission managed by the NASA Goddard Space Flight Center, the Mars Atmosphere and Volatile EvolutioN (MAVEN) had three IT security goals for its ground system: COMPLIANCE, (IT) RISK REDUCTION, and COST REDUCTION. In a multiorganizational environment in which government, industry and academia work together in support of the ground system and mission operations, information security governance, risk management, and compliance (GRC) becomes a challenge as each component of the ground system has and follows its own set of IT security requirements. These requirements are not necessarily the same or even similar to each other's, making the auditing of the ground system security a challenging feat. A combination of standards-based information security management based on the National Institute of Standards and Technology (NIST) Risk Management Framework (RMF), due diligence by the Mission's leadership, and effective collaboration among all elements of the ground system enabled MAVEN to successfully meet NASA's requirements for IT security, and therefore meet Federal Information Security Management Act (FISMA) mandate on the Agency. Throughout the implementation of GRC on MAVEN during the early stages of the mission development, the Project faced many challenges some of which have been identified in this paper. The purpose of this paper is to document these challenges, and provide a brief analysis of the lessons MAVEN learned. The historical information documented herein, derived from an internal pre-launch lessons learned analysis, can be used by current and future missions and organizations implementing and auditing GRC.

Pharmacological management of anticancer agent extravasation: A single institutional guideline.

PubMed

Kimmel, Jaime; Fleming, Patrick; Cuellar, Sandra; Anderson, Jennifer; Haaf, Christina Mactal

2018-03-01

Although the risk of extravasation of a chemotherapy (anticancer) medication is low, the complications associated with these events can have a significant impact on morbidity and health care costs. Institutions that administer anticancer agents should ideally have a current guideline on the proper management of the inadvertent administration of these toxic medications into tissues surrounding blood vessels. It is imperative that the health care team involved in administering drugs used to treat cancer be educated on the risk factors, preventative strategies and treatment of anticancer extravasations, as well as practice safe and proper administration techniques. Anticancer agents are generally divided into classes based on their ability to cause tissue damage. The review of current published guidelines and available literature reveals a lack of consensus on how these medications should be classified. In addition, many recently approved drugs for the treatment of cancer may lack data to support their classification and management of extravasation events. The treatment of the majority of extravasations of anticancer agents involves nonpharmacological measures, potentially in the ambulatory care setting. Antidotes are available for the extravasation of a minority of vesicant agents in order to mitigate tissue damage. Due to the limited data and lack of consensus in published guidelines, a working group was established to put forth an institutional guideline on the management of anticancer extravasations.

Inflammatory and Other Biomarkers: Role in Pathophysiology and Prediction of Gestational Diabetes Mellitus

PubMed Central

Abell, Sally K.; De Courten, Barbora; Boyle, Jacqueline A.; Teede, Helena J.

2015-01-01

Understanding pathophysiology and identifying mothers at risk of major pregnancy complications is vital to effective prevention and optimal management. However, in current antenatal care, understanding of pathophysiology of complications is limited. In gestational diabetes mellitus (GDM), risk prediction is mostly based on maternal history and clinical risk factors and may not optimally identify high risk pregnancies. Hence, universal screening is widely recommended. Here, we will explore the literature on GDM and biomarkers including inflammatory markers, adipokines, endothelial function and lipids to advance understanding of pathophysiology and explore risk prediction, with a goal to guide prevention and treatment of GDM. PMID:26110385

Update on the Management of High-Risk Penetrating Keratoplasty

PubMed Central

Jabbehdari, Sayena; Rafii, Alireza Baradaran; Yazdanpanah, Ghasem; Hamrah, Pedram; Holland, Edward J.; Djalilian, Ali R

2017-01-01

Purpose of review In this article, we review the indications and latest management of high-risk penetrating keratoplasty. Recent findings Despite the immune-privilege status of the cornea, immune-mediated graft rejection still remains the leading cause of corneal graft failure. This is particularly a problem in the high-risk graft recipients, namely patients with previous graft failure due to rejection and those with inflamed and vascularized corneal beds. A number of strategies including both local and systemic immunosuppression are currently used to increase the success rate of high-risk corneal grafts. Moreover, in cases of limbal stem cell deficiency, limbal stem cells transplantation is employed. Summary Corticosteroids are still the top medication for prevention and treatment in cases of corneal graft rejection. Single and combined administration of immunosuppressive agents e.g. tacrolimus, cyclosporine and mycophenolate are promising adjunctive therapies for prolonging graft survival. In the future, cellular and molecular therapies should allow us to achieve immunologic tolerance even in high-risk grafts. PMID:28959505

Genetics: Implications for Prevention and Management of Coronary Artery Disease.

PubMed

Assimes, Themistocles L; Roberts, Robert

2016-12-27

An exciting new era has dawned for the prevention and management of coronary artery disease (CAD) utilizing genetic risk variants. The recent identification of over 60 susceptibility loci for CAD confirms not only the importance of established risk factors, but also the existence of many novel causal pathways that are expected to improve our understanding of the genetic basis of CAD and facilitate the development of new therapeutic agents over time. Concurrently, Mendelian randomization studies have provided intriguing insights on the causal relationship between CAD-related traits, and highlight the potential benefits of long-term modifications of risk factors. Last, genetic risk scores of CAD may serve not only as prognostic, but also as predictive markers, and carry the potential to considerably improve the delivery of established prevention strategies. This review will summarize the evolution and discovery of genetic risk variants for CAD and their current and future clinical applications. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Management strategies in pancreatic cancer.

PubMed

Campen, Christopher J; Dragovich, Tomislav; Baker, Amanda F

2011-04-01

Current first-line and adjuvant chemotherapeutic strategies for management of patients with pancreatic cancer are reviewed. Pancreatic adenocarcinoma is the 10th most prevalent cancer and the fourth most common cause of cancer deaths in the United States. More than 80% of patients with pancreatic cancer are diagnosed with locally advanced or metastatic disease and are not candidates for surgery; these patients often require multimodal treatment. The most widely used chemotherapy for such patients, as well as patients requiring adjuvant therapy after surgery, is gemcitabine or gemcitabine-based chemotherapy. All current chemotherapies for pancreatic cancer are associated with dose-limiting hematologic toxicity and other adverse effects that require ongoing monitoring and dosage adjustment to balance the benefits and risks of treatment. Pharmacists can play an important role in monitoring and providing drug information and guidance to patients and oncologists. Current investigational strategies include efforts to improve chemotherapy response rates and outcomes through modulation of cell signaling pathways and use of nanotechnology to improve drug delivery. Current management of pancreatic cancer is multifaceted, involving anticancer therapy, supportive care, and toxicity management. Standard systemic therapy with gemcitabine as a single agent or in combination with other cytotoxic agents provides modest benefits in terms of response and symptom control.

Phase polyphenism and preventative locust management.

PubMed

Sword, Gregory A; Lecoq, Michel; Simpson, Stephen J

2010-08-01

The ecology of phase polyphenism plays a major role in locust swarm formation. We describe how recent advances in the understanding of phase polyphenism can be combined with existing management approaches as part of a preventative Desert locust management strategy. We start with a brief overview of phase polyphenism with particular emphasis on the role that resource distribution patterns play in the process of locust phase change. We then review current perspective on preventative locust management, and conclude by proposing a framework for quantitatively assessing the risk that phase change will occur in local locust populations. Importantly, the data required to implement this framework can be readily collected with little additional effort or cost just by slightly modifying locust habitat survey protocols that are already in operation. Incorporating gregarization risk assessment into existing preventative management strategies stands to make a considerable contribution toward realizing sustainable goals of reductions in the pesticide, manpower and financial support necessary to combat Desert locust upsurges, outbreaks and ultimately plagues. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Pre-eclampsia part 2: prediction, prevention and management

PubMed Central

Chaiworapongsa, Tinnakorn; Chaemsaithong, Piya; Korzeniewski, Steven J.; Yeo, Lami; Romero, Roberto

2018-01-01

An antiangiogenic state might constitute a terminal pathway for the multiple aetiologies of pre-eclampsia, especially those resulting from placental abnormalities. The levels of angiogenic and antiangiogenic proteins in maternal blood change prior to a diagnosis of pre-eclampsia, correlate with disease severity and have prognostic value in identifying women who will develop maternal and/or perinatal complications. Potential interventions exist to ameliorate the imbalance of angiogenesis and, hence, might provide opportunities to improve maternal and/or perinatal outcomes in pre-eclampsia. Current strategies for managing pre-eclampsia consist of controlling hypertension, preventing seizures and timely delivery of the fetus. Prediction of pre-eclampsia in the first trimester is of great interest, as early administration of aspirin might reduce the risk of pre-eclampsia, albeit modestly. Combinations of biomarkers typically predict pre-eclampsia better than single biomarkers; however, the encouraging initial results of biomarker studies require external validation in other populations before they can be used to facilitate intervention in patients identified as at increased risk. Angiogenic and antiangiogenic factors might also be useful in triage of symptomatic patients with suspected pre-eclampsia, differentiating pre-eclampsia from exacerbations of pre-existing medical conditions and performing risk assessment in asymptomatic women. This Review article discusses the performance of predictive and prognostic biomarkers for pre-eclampsia, current strategies for preventing and managing the condition and its long-term consequences. PMID:25003612

Bite the apple, get driven out of the garden: A risky story telling at the ASME town meeting

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

Majumdar, K.C.

1994-11-01

Risk, the all-encompassing four-letter word became a widely used household cliche and an institutional mantra in the nineties. Risk analysis models from the Garden of Eden to the Capitol Hill lawn have made a number of sharp paradigm shifts to evolve itself as a decision-making tool from individual risk perception to societal risk-based regulatory media. Risk always coexists with benefit and is arbitrated by costs. Risk-benefit analysis has been in use in business and industry in economic ventures for a long time. Only recently risk management in its current state of development, evolved as a regulatory tool for controlling largemore » technological systems that have potential impacts on the health and safety of the public and on the sustainability of the ecology and the environment. This paper summarizes the evolution of the risk management concepts and models in industry and the regulatory agencies in the US over the last three decades. It also discusses the benefits and limitations of this evolving discipline as it is applied to high-risk technologies from the nuclear power plant and petrochemical industry, etc. to nuclear weapons technology.« less

Implementation of the 2013 American College of Cardiology/American Heart Association Blood Cholesterol Guideline Including Data From the Improved Reduction of Outcomes: Vytorin Efficacy International Trial

PubMed Central

Ziaeian, Boback; Dinkler, John; Watson, Karol

2015-01-01

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in developed countries. The management of blood cholesterol through use of 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors (statins) in at-risk patients is a pillar of medical therapy for the primary and secondary prevention of cardiovascular disease. The recent 2013 American College of Cardiology/American Heart Association guideline on managing blood cholesterol provides an important framework for the effective implementation of risk-reduction strategies. The guideline identifies four cohorts of patients with proven benefits from statin therapy and streamlines the dosing and monitoring recommendations based on evidence from published, randomized controlled trials. Primary care physicians and cardiologists play key roles in identifying populations at elevated ASCVD risk. In providing a practical management overview of the current blood cholesterol guideline, we facilitate more informed discussions on treatment options between healthcare providers and their patients. PMID:26198559

Pulmonary manifestations of rheumatologic diseases.

PubMed

Cidon, Michal; Bansal, Manvi; Hartl, Dominik

2017-06-01

The present review intends to provide an overview of the diversity and complexity of pulmonary manifestations of rheumatologic diseases and gaps in knowledge to effectively manage them. Diffuse lung disease in children with rheumatologic diseases represents a heterogeneous group of autoimmune disorders. Despite their significant morbidity and mortality, we have limited understanding about their pathogenesis. Here, we provide an overview of the pathophysiology and current management approach of these disorders, highlighting tools which assist with diagnosis, risk stratification and therapy. In this context, we address the need to develop a standardized approach to diagnose at-risk patients with rheumatologic disease and to predict their progression and the need to develop robust studies which evaluate the factors and interventions that influence pulmonary disease outcome. Diffuse lung disease in children with rheumatologic diseases represents a heterogeneous group of severe autoimmune disorders. By adopting a collaborative research approach among multicenters to help diagnose, risk stratify, and understand disease progression, effective management decisions can be optimized to improve clinical outcome.

Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

PubMed

Boustière, C; Veitch, A; Vanbiervliet, G; Bulois, P; Deprez, P; Laquiere, A; Laugier, R; Lesur, G; Mosler, P; Nalet, B; Napoleon, B; Rembacken, B; Ajzenberg, N; Collet, J P; Baron, T; Dumonceau, J-M

2011-05-01

With the increasing use of antiplatelet agents (APA), their management during the periendoscopic period has become a more common and more difficult problem. The increase in use is due to the availability of new drugs and the widespread use of drug-eluting coronary stents. Acute coronary syndromes can occur when APA therapy is withheld for noncardiovascular interventions. Guidelines about APA management during the periendoscopic period are traditionally based on assessments of the procedure-related risk of bleeding and the risk of thrombosis if APA are stopped. New data allow better assessment of these risks, of the necessary duration of APA discontinuation before endoscopy, of the use of alternative procedures (mostly for endoscopic retrograde cholangiopancreatography [ERCP]), and of endoscopic methods that can be used to prevent bleeding (following colonic polypectomy). This guideline makes graded, evidence-based, recommendations for the management of APA for all currently performed endoscopic procedures. A short summary and two tables are included for quick reference. © Georg Thieme Verlag KG Stuttgart · New York.

Use of the Coronary Artery Calcium Score in Discussion of Initiation of Statin Therapy in Primary Prevention.

PubMed

Michos, Erin D; Blaha, Michael J; Blumenthal, Roger S

2017-12-01

Clinical guidelines for instituting pharmacotherapy for the primary prevention of atherosclerotic cardiovascular disease (ASCVD), specifically lipid management and aspirin, have long been based on absolute risk. However, lipid management in the current era remains challenging to both patients and clinicians in the setting of somewhat discordant recommendations from various organizations. All guidelines endorse the use of statins for primary prevention for those at sufficient absolute risk, and treatment recommendations are generally "risk-based" rather than exclusively targeting specific low-density lipoprotein cholesterol levels. Nonetheless, guidelines differ in relation to the risk threshold for initiation and the intensity of statin treatment. The key concept of the clinician-patient risk discussion introduced in the 2013 American College of Cardiology/American Heart Association cholesterol guidelines is a process that addresses the potential for ASCVD risk reduction with statin treatment, potential for adverse treatment effects, patient preferences, encouragement of heart-healthy lifestyle, and management of other risk factors. However, operationalizing the clinician-patient risk discussion requires effective communication of the most accurate and personalized risk information. In this article, we review our treatment approach for the appropriate use of coronary artery calcium testing in the intermediate-risk patient to guide shared decision making. The decision to initiate or intensify statin therapy may be uncertain across a broad range of estimated 10-year ASCVD risk of 5% to 20%, and coronary artery calcium testing can reclassify risk upward or downward in approximately 50% of this group to inform the risk discussion. We conclude with 2 case-based examples of uncertain risk and uncertain statin therapeutic benefit to illustrate execution of the clinician-patient risk discussion. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Effect of HIV/AIDS on the control environment.

PubMed

Coetzee, Philna

2006-07-01

The management of organizations is responsible for risk management and control systems. HIV/AIDS could be a great threat in the achievement of strategic business objectives, implicating a great concern for management. Management needs to understand this possible risk. This study aims to identify the effect that HIV/AIDS could have on the different elements of the control environment. The archival research method was used. It was established that no formal research was conducted to date on the effect of HIV/AIDS on the control environment as a whole. Various studies have included the effect of HIV/AIDS on certain factors of the control environment. These studies will be discussed briefly to identify relevant findings. The study indicated that the disease could affect various aspects of the control environment, namely: competency of the workforce (e.g. productivity, quality of work, absenteeism, loss of skills and knowledge, training and recruitment, etc.); organizational structure (e.g. increase use of technology labour, disruption of processes, level of employees affected by the disease); human resource (HR) policies and practices (e.g. legislation applicable, prevention and awareness programmes, compensation and benefits). Research limitation: HIV/AIDS is a relatively new potential risk to organizations. Knowledge of the disease is limited. HIV/AIDS is also a very sensitive issue as people fear the disease and do not like to discuss its existence. Government determined that it should be a non-notifiable disease and the disease is currently greatly stigmatized. The databases of companies investigated by other research studies were not developed to gather all the relevant information. Management should be aware that HIV/AIDS poses a possible risk to organizations. Data on the effect of HIV/AIDS should be gathered and used in the decision-making process on how to manage this risk. To be able to fulfil this duty, management first has to determine: whether HIV/AIDS is a risk; the relevant cost involved that the disease is costing the organization; how to control these costs.