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

Chen, Allan; Mills, Evan; Vine, Edward

The promotion of technologies and services for insurance loss reduction and loss prevention is as old as the fields of insurance and risk management. This report addresses a new category of risk management opportunity involving technologies and procedures that use energy more efficiently or supply renewable energy. While the economic benefits of these measures are of interest to energy consumers seeking to reduce their energy expenditures, we have found that they also offer a novel and largely untapped pathway for achieving traditional risk management objectives. Most of the technologies described in this report were supported by government- sponsored RD&D programsmore » over many years of effort. These technologies have many benefits, including insurance loss reduction and prevention. The insurance and risk management communities could take advantage of these technologies, either independently or in cost-sharing partnerships with existing R&D programs. In this report, we present a compilation of energy-efficiency and renewable energy projects (e.g., energy-efficient halogen torchiere replacements) and techniques (e.g., infrared cameras to detect fire hazards) that are currently being investigated at the U.S. Department of Energy's national laboratories and which the insurance and risk management communities could encourage their customers to use to address their short-term and long-term needs. Once the loss-prevention benefits of these technologies and techniques (many of which are not yet available in the marketplace) are sufficiently demonstrated, insurers can promote their use through informational programs and perhaps financial incentives (e.g., risk-adjusted insurance premium schemes) through the insurance regulatory and rate-making processes. We identified 78 technologies and techniques being investigated by nine national laboratories which can help to reduce insurance losses and manage risks, especially those associated with power failures, fire and wind damage, and home or workplace indoor air quality hazards. All help to reduce insurance losses in one or more of the following categories: boiler and machinery, builder's risk, business interruption, commercial property insurance, completed operations liability, comprehensive general liability, contractors liability, environmental liability, product liability, professional liability, service interruption, workers' compensation, health/life insurance, and homeowners insurance. We identify examples of existing collaborations between the national laboratories and the insurance industry, and indicate research activities being conducted by the insurance and risk management communities that would benefit from the work of the national laboratories. We also describe some of the risk factors associated with energy-efficient and renewable energy technologies. For the future, significant progress could be made through interdisciplinary collaborative applied research (i.e., integrating the actuarial sciences with the "physical" or "engineering" sciences). This collaboration could be sponsored jointly by the U.S. Department of Energy and the insurance and risk management communities (as well as working through the insurance regulatory and rate-making processes).« less

SLFP: a stochastic linear fractional programming approach for sustainable waste management.

PubMed

Zhu, H; Huang, G H

2011-12-01

A stochastic linear fractional programming (SLFP) approach is developed for supporting sustainable municipal solid waste management under uncertainty. The SLFP method can solve ratio optimization problems associated with random information, where chance-constrained programming is integrated into a linear fractional programming framework. It has advantages in: (1) comparing objectives of two aspects, (2) reflecting system efficiency, (3) dealing with uncertainty expressed as probability distributions, and (4) providing optimal-ratio solutions under different system-reliability conditions. The method is applied to a case study of waste flow allocation within a municipal solid waste (MSW) management system. The obtained solutions are useful for identifying sustainable MSW management schemes with maximized system efficiency under various constraint-violation risks. The results indicate that SLFP can support in-depth analysis of the interrelationships among system efficiency, system cost and system-failure risk. Copyright © 2011 Elsevier Ltd. All rights reserved.

How to manage future groundwater resource of China under climate change and urbanization: An optimal stage investment design from modern portfolio theory.

PubMed

Hua, Shanshan; Liang, Jie; Zeng, Guangming; Xu, Min; Zhang, Chang; Yuan, Yujie; Li, Xiaodong; Li, Ping; Liu, Jiayu; Huang, Lu

2015-11-15

Groundwater management in China has been facing challenges from both climate change and urbanization and is considered as a national priority nowadays. However, unprecedented uncertainty exists in future scenarios making it difficult to formulate management planning paradigms. In this paper, we apply modern portfolio theory (MPT) to formulate an optimal stage investment of groundwater contamination remediation in China. This approach generates optimal weights of investment to each stage of the groundwater management and helps maximize expected return while minimizing overall risk in the future. We find that the efficient frontier of investment displays an upward-sloping shape in risk-return space. The expected value of groundwater vulnerability index increases from 0.6118 to 0.6230 following with the risk of uncertainty increased from 0.0118 to 0.0297. If management investment is constrained not to exceed certain total cost until 2050 year, the efficient frontier could help decision makers make the most appropriate choice on the trade-off between risk and return. Copyright © 2015 Elsevier Ltd. All rights reserved.

Risk management modeling and its application in maritime safety

NASA Astrophysics Data System (ADS)

Qin, Ting-Rong; Chen, Wei-Jiong; Zeng, Xiang-Kun

2008-12-01

Quantified risk assessment (QRA) needs mathematicization of risk theory. However, attention has been paid almost exclusively to applications of assessment methods, which has led to neglect of research into fundamental theories, such as the relationships among risk, safety, danger, and so on. In order to solve this problem, as a first step, fundamental theoretical relationships about risk and risk management were analyzed for this paper in the light of mathematics, and then illustrated with some charts. Second, man-machine-environment-management (MMEM) theory was introduced into risk theory to analyze some properties of risk. On the basis of this, a three-dimensional model of risk management was established that includes: a goal dimension; a management dimension; an operation dimension. This goal management operation (GMO) model was explained and then emphasis was laid on the discussion of the risk flowchart (operation dimension), which lays the groundwork for further study of risk management and qualitative and quantitative assessment. Next, the relationship between Formal Safety Assessment (FSA) and Risk Management was researched. This revealed that the FSA method, which the international maritime organization (IMO) is actively spreading, comes from Risk Management theory. Finally, conclusion were made about how to apply this risk management method to concrete fields efficiently and conveniently, as well as areas where further research is required.

A quality risk management model approach for cell therapy manufacturing.

PubMed

Lopez, Fabio; Di Bartolo, Chiara; Piazza, Tommaso; Passannanti, Antonino; Gerlach, Jörg C; Gridelli, Bruno; Triolo, Fabio

2010-12-01

International regulatory authorities view risk management as an essential production need for the development of innovative, somatic cell-based therapies in regenerative medicine. The available risk management guidelines, however, provide little guidance on specific risk analysis approaches and procedures applicable in clinical cell therapy manufacturing. This raises a number of problems. Cell manufacturing is a poorly automated process, prone to operator-introduced variations, and affected by heterogeneity of the processed organs/tissues and lot-dependent variability of reagent (e.g., collagenase) efficiency. In this study, the principal challenges faced in a cell-based product manufacturing context (i.e., high dependence on human intervention and absence of reference standards for acceptable risk levels) are identified and addressed, and a risk management model approach applicable to manufacturing of cells for clinical use is described for the first time. The use of the heuristic and pseudo-quantitative failure mode and effect analysis/failure mode and critical effect analysis risk analysis technique associated with direct estimation of severity, occurrence, and detection is, in this specific context, as effective as, but more efficient than, the analytic hierarchy process. Moreover, a severity/occurrence matrix and Pareto analysis can be successfully adopted to identify priority failure modes on which to act to mitigate risks. The application of this approach to clinical cell therapy manufacturing in regenerative medicine is also discussed. © 2010 Society for Risk Analysis.

Maximizing Energy Savings Reliability in BC Hydro Industrial Demand-side Management Programs: An Assessment of Performance Incentive Models

NASA Astrophysics Data System (ADS)

Gosman, Nathaniel

For energy utilities faced with expanded jurisdictional energy efficiency requirements and pursuing demand-side management (DSM) incentive programs in the large industrial sector, performance incentive programs can be an effective means to maximize the reliability of planned energy savings. Performance incentive programs balance the objectives of high participation rates with persistent energy savings by: (1) providing financial incentives and resources to minimize constraints to investment in energy efficiency, and (2) requiring that incentive payments be dependent on measured energy savings over time. As BC Hydro increases its DSM initiatives to meet the Clean Energy Act objective to reduce at least 66 per cent of new electricity demand with DSM by 2020, the utility is faced with a higher level of DSM risk, or uncertainties that impact the costeffective acquisition of planned energy savings. For industrial DSM incentive programs, DSM risk can be broken down into project development and project performance risks. Development risk represents the project ramp-up phase and is the risk that planned energy savings do not materialize due to low customer response to program incentives. Performance risk represents the operational phase and is the risk that planned energy savings do not persist over the effective measure life. DSM project development and performance risks are, in turn, a result of industrial economic, technological and organizational conditions, or DSM risk factors. In the BC large industrial sector, and characteristic of large industrial sectors in general, these DSM risk factors include: (1) capital constraints to investment in energy efficiency, (2) commodity price volatility, (3) limited internal staffing resources to deploy towards energy efficiency, (4) variable load, process-based energy saving potential, and (5) a lack of organizational awareness of an operation's energy efficiency over time (energy performance). This research assessed the capacity of alternative performance incentive program models to manage DSM risk in BC. Three performance incentive program models were assessed and compared to BC Hydro's current large industrial DSM incentive program, Power Smart Partners -- Transmission Project Incentives, itself a performance incentive-based program. Together, the selected program models represent a continuum of program design and implementation in terms of the schedule and level of incentives provided, the duration and rigour of measurement and verification (M&V), energy efficiency measures targeted and involvement of the private sector. A multi criteria assessment framework was developed to rank the capacity of each program model to manage BC large industrial DSM risk factors. DSM risk management rankings were then compared to program costeffectiveness, targeted energy savings potential in BC and survey results from BC industrial firms on the program models. The findings indicate that the reliability of DSM energy savings in the BC large industrial sector can be maximized through performance incentive program models that: (1) offer incentives jointly for capital and low-cost operations and maintenance (O&M) measures, (2) allow flexible lead times for project development, (3) utilize rigorous M&V methods capable of measuring variable load, process-based energy savings, (4) use moderate contract lengths that align with effective measure life, and (5) integrate energy management software tools capable of providing energy performance feedback to customers to maximize the persistence of energy savings. While this study focuses exclusively on the BC large industrial sector, the findings of this research have applicability to all energy utilities serving large, energy intensive industrial sectors.

Chemical Risk Assessment: Traditional vs Public Health Perspectives

EPA Science Inventory

Preventing adverse health impacts from exposures to environmental chemicals is fundamental to protecting individual and public health. When done efficiently and properly, chemical risk assessment enables risk management actions that minimize the incidence and impacts of environme...

Probabilistic cost-benefit analysis of disaster risk management in a development context.

PubMed

Kull, Daniel; Mechler, Reinhard; Hochrainer-Stigler, Stefan

2013-07-01

Limited studies have shown that disaster risk management (DRM) can be cost-efficient in a development context. Cost-benefit analysis (CBA) is an evaluation tool to analyse economic efficiency. This research introduces quantitative, stochastic CBA frameworks and applies them in case studies of flood and drought risk reduction in India and Pakistan, while also incorporating projected climate change impacts. DRM interventions are shown to be economically efficient, with integrated approaches more cost-effective and robust than singular interventions. The paper highlights that CBA can be a useful tool if certain issues are considered properly, including: complexities in estimating risk; data dependency of results; negative effects of interventions; and distributional aspects. The design and process of CBA must take into account specific objectives, available information, resources, and the perceptions and needs of stakeholders as transparently as possible. Intervention design and uncertainties should be qualified through dialogue, indicating that process is as important as numerical results. © 2013 The Author(s). Journal compilation © Overseas Development Institute, 2013.

Managing risk selection incentives in health sector reforms.

PubMed

Puig-Junoy, J

1999-01-01

The object of the paper is to review theoretical and empirical contributions to the optimal management of risk selection incentives ('cream skimming') in health sector reforms. The trade-off between efficiency and risk selection is fostered in health sector reforms by the introduction of competitive mechanisms such as price competition or prospective payment systems. The effects of two main forms of competition in health sector reforms are observed when health insurance is mandatory: competition in the market for health insurance, and in the market for health services. Market and government failures contribute to the assessment of the different forms of risk selection employed by insurers and providers, as the effects of selection incentives on efficiency and their proposed remedies to reduce the impact of these perverse incentives. Two European (Netherlands and Spain) and two Latin American (Chile and Colombia) case studies of health sector reforms are examined in order to observe selection incentives, their effects on efficiency and costs in the health system, and regulation policies implemented in each country to mitigate incentives to 'cream skim' good risks.

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.

Efficient GIS-based model-driven method for flood risk management and its application in central China

NASA Astrophysics Data System (ADS)

Liu, Y.; Zhou, J.; Song, L.; Zou, Q.; Guo, J.; Wang, Y.

2014-02-01

In recent years, an important development in flood management has been the focal shift from flood protection towards flood risk management. This change greatly promoted the progress of flood control research in a multidisciplinary way. Moreover, given the growing complexity and uncertainty in many decision situations of flood risk management, traditional methods, e.g., tight-coupling integration of one or more quantitative models, are not enough to provide decision support for managers. Within this context, this paper presents a beneficial methodological framework to enhance the effectiveness of decision support systems, through the dynamic adaptation of support regarding the needs of the decision-maker. In addition, we illustrate a loose-coupling technical prototype for integrating heterogeneous elements, such as multi-source data, multidisciplinary models, GIS tools and existing systems. The main innovation is the application of model-driven concepts, which put the system in a state of continuous iterative optimization. We define the new system as a model-driven decision support system (MDSS ). Two characteristics that differentiate the MDSS are as follows: (1) it is made accessible to non-technical specialists; and (2) it has a higher level of adaptability and compatibility. Furthermore, the MDSS was employed to manage the flood risk in the Jingjiang flood diversion area, located in central China near the Yangtze River. Compared with traditional solutions, we believe that this model-driven method is efficient, adaptable and flexible, and thus has bright prospects of application for comprehensive flood risk management.

41 CFR 109-1.5302 - Policies.

Code of Federal Regulations, 2011 CFR

2011-01-01

... efficient manner. High risk personal property will be managed throughout its life cycle so as to protect... transferred or disposed unless it receives a high risk assessment and is handled accordingly. ...

41 CFR 109-1.5302 - Policies.

Code of Federal Regulations, 2014 CFR

2014-01-01

... efficient manner. High risk personal property will be managed throughout its life cycle so as to protect... 41 Public Contracts and Property Management 3 2014-01-01 2014-01-01 false Policies. 109-1.5302 Section 109-1.5302 Public Contracts and Property Management Federal Property Management Regulations System...

Risk assessment, identification, and notification (RAIN) system : a novel approach for traffic management.

DOT National Transportation Integrated Search

2009-08-31

Primary research focused on the design and development of an energy-efficient Risk Notification Message Dissemination Protocol (RNMDP) for vehicular ad hoc networks (VANETs). RNMDP propagates Risk Notification Messages (RNMs) from a location of origi...

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

CERT Resiliency Engineering Framework

DTIC Science & Technology

2007-03-01

Heightened threat level and increasing uncertainty Shorter-lived skills 5 Operational risk management problems Poor planning and execution No asset...increasingly effective & efficient Today’s operational environment No operational boundaries Pervasive & rapidly changing technology Dynamic & expanding risks ...management function Seen as a technical function or responsibility Searching for magic bullet: CobiT , ITIL, ISO17799, NFP1600 Poorly defined and measured

Global theory and the nature of risk, Part 2. Towards a choice-based model of managed care.

PubMed

Emery, D W

1999-01-01

Orthodox managed care depends on top-down, command and control techniques to squeeze efficiency out of the system. But for every unit of economic good this approach produces, two or three bad units come as result. The key to moving to an environment where value and efficiency become self-sustaining is to structurally recognize the medicoeconomic reality of medicine: the episode of care. The episode forms a natural unit of analysis that not only renders costs and outcomes information translucent and accessible, but it also forms the natural conduit through which premium dollars can find their optimal value. By bifurcating probability risk from technical risk and allocating them in the ex ante and ex post markets, respectively, health care insurers and providers return to their rightful economic roles, and to their appropriate fiduciary duties. And patients regain some semblance of reasonable sovereignty in managing their own medical affairs.

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.

Transient ischaemic attacks clinics provide equivalent and more efficient care than early in-hospital assessment.

PubMed

Martínez-Martínez, M M; Martínez-Sánchez, P; Fuentes, B; Cazorla-García, R; Ruiz-Ares, G; Correas-Callero, E; Lara-Lara, M; Díez-Tejedor, E

2013-02-01

Clinics for early management of transient ischaemic attacks (TIAs) have been developed in some stroke centres, resulting in reduced recurrence rates compared to appointment-based outpatient management, thus saving on hospitalization. We analysed the care process, recurrence rates and economic impact of the first year of work in our early-management TIA clinic and compared these with our previous in-hospital study protocols for low- and moderate-risk TIA patients. This was a prospective evaluation of the management of low- to moderate-risk TIA patients, comparing a new TIA clinic model (2010) with a previous hospitalization model (2009). Demographic data, vascular risk factor profiles, diagnostic test performance, secondary prevention measures, final aetiological diagnoses and cerebrovascular recurrences at 7 and 90 days were compared between in-hospital and TIA clinic assessed patients. We also carried out an economic comparison of the costs of each model's process. Two hundred and eleven low- to moderate-risk TIA patients were included, of whom 40.8% were hospitalized. There were no differences between the TIA clinic assessed and in-hospital assessed patients in terms of risk factor diagnosis and secondary prevention measures. The stroke recurrence rate (2.4% vs. 1.2%; P = 0.65) was low and similar for both groups (CI 95%, 0.214-20.436; P = 0.52). Cost per patient was €393.28 for clinic versus €1931.18 for in-hospital management. Outpatient management resulted in a 77.8% reduction in hospitalizations. Transient ischaemic attacks clinics are efficient for the early management of low- to moderate-risk TIA patients compared to in-hospital assessment, with no higher recurrence rates and at almost one-fifth the cost. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

Environmental audits and process flow mapping to assess management of solid waste and wastewater from a healthcare facility: an Italian case study.

PubMed

Vaccari, Mentore; Montasser, Waleed; Tudor, Terry; Leone, Luigi

2017-05-01

In Europe, there are an increasing number of policy and legislative drivers for a more sustainable approach to the management of natural resources as well as for the mitigation of environmental health risks. However, despite significant progress in recent years, there is still some way to go to achieve circularity of process, as well as risk mitigation within organisations. Using a case study of the Gardone Val Trompia hospital in northern Italy, this manuscript offers a novel holistic examination of strategies to enhance resource efficiency and environmental health within a key sector, i.e. the healthcare sector. Through the use of environmental audits and process flow mapping, trends in waste and wastewater arisings and the associated financial and environmental costs and risks were identified. Recommendations for developing more resource efficient approaches as well as mitigating the environmental and public health risks are suggested. These include strategies for improved resource efficiency (including reduction in the hazardous waste) and reduced environmental impacts during the containment, transport and treatment of the waste.

Safety and compliance-related hazards in the medical practice: Part one.

PubMed

Calway, R C

2001-01-01

Safety and risk management hazards are a fact of life for the medical practice, and the costs of these incidents can place the group at significant risk of liability. Good compliance and risk management programs help minimize these incidents, improve staff morale, increase a practice's visibility in the community, and positively affect the practice's financial and operational bottom line performance. Medical practices that implement effective safety and risk management programs can realize savings in staffing costs, operational efficiency, morale, insurance premiums, and improved third-party relationships while at the same time avoiding embarrassing risks, fines, and liability. This article outlines some of the most common safety and risk management-related deficiencies seen in medical practices today. The author explains how to remedy these deficiencies and provides a self-test tool to enable the reader to assess areas within his or her own practice in need of attention.

Effective and efficient implementation of alternative project delivery : research summary.

DOT National Transportation Integrated Search

2017-05-01

Alternative project delivery (APD) methods such as Design Build (DB) and Construction Manager at Risk (CMAR), are used by state departments of transportation to improve the efficiency and effectiveness of project delivery. The Maryland Department of ...

Cyber crime: can a standard risk analysis help in the challenges facing business continuity managers?

PubMed

Vande Putte, Danny; Verhelst, Marc

Risk management has never been easy. Finding efficient mitigating measures is not always straightforward. Finding measures for cyber crime, however, is a really huge challenge because cyber threats are changing all the time. As the sophistication of these threats is growing, their impact increases. Moreover, society and its economy have become increasingly dependent on information and communication technologies. Standard risk analysis methodologies will help to score the cyber risk and to place it in the risk tolerance matrix. This will allow business continuity managers to figure out if there is still a gap with the maximum tolerable outage for time-critical business processes and if extra business continuity measures are necessary to fill the gap.

Occupational health management: an audit tool.

PubMed

Shelmerdine, L; Williams, N

2003-03-01

Organizations must manage occupational health risks in the workplace and the UK Health & Safety Executive (HSE) has published guidance on successful health and safety management. This paper describes a method of using the published guidance to audit the management of occupational health and safety, first at an organizational level and, secondly, to audit an occupational health service provider's role in the management of health risks. The paper outlines the legal framework in the UK for health risk management and describes the development and use of a tool for qualitative auditing of the efficiency, effectiveness and reliability of occupational health service provision within an organization. The audit tool is presented as a question set and the paper concludes with discussion of the strengths and weaknesses of using this tool, and recommendations on its use.

Primary care physician management, referral, and relations with specialists concerning patients at risk for cancer due to family history.

PubMed

Wood, M E; Flynn, B S; Stockdale, A

2013-01-01

Risk stratification based on family history is a feature of screening guidelines for a number of cancers and referral guidelines for genetic counseling/testing for cancer risk. Our aim was to describe primary care physician perceptions of their role in managing cancer risk based on family history. Structured interviews were conducted by a medical anthropologist with primary care physicians in 3 settings in 2 north-eastern states. Transcripts were systematically analyzed by a research team to identify major themes expressed by participants. Forty interviews were conducted from May 2003 through May 2006. Physicians provided a diversity of views on roles in management of cancer risk based on family history, management practices and patient responses to risk information. They also provided a wide range of perspectives on criteria used for referral to specialists, types of specialists referred to and expected management roles for referred patients. Some primary care physicians appeared to make effective use of family history information for cancer risk management, but many in this sample did not. Increased focus on efficient assessment tools based on recognized guidelines, accessible guides to management options, and patient education and decision aids may be useful directions to facilitate broader use of family history information for cancer risk management. Copyright © 2013 S. Karger AG, Basel.

Asset Management: Roof Maintenance and Facility Energy Retrofits

DTIC Science & Technology

2012-03-01

vapor low emission coatings. Floor finishes completed in ceramic stone tile were the most efficient floor coverings. Fixed insulated fiberglass window...been coined Asset Management which utilizes organizational levels of service, business case analysis, and risk analysis to address urgent...Force have left a number of facility systems such as roofs at risk to disrepair due to a lack of maintenance. Under the principles of asset

Integrated Risk Management Within NASA Programs/Projects

NASA Technical Reports Server (NTRS)

Connley, Warren; Rad, Adrian; Botzum, Stephen

2004-01-01

As NASA Project Risk Management activities continue to evolve, the need to successfully integrate risk management processes across the life cycle, between functional disciplines, stakeholders, various management policies, and within cost, schedule and performance requirements/constraints become more evident and important. Today's programs and projects are complex undertakings that include a myriad of processes, tools, techniques, management arrangements and other variables all of which must function together in order to achieve mission success. The perception and impact of risk may vary significantly among stakeholders and may influence decisions that may have unintended consequences on the project during a future phase of the life cycle. In these cases, risks may be unintentionally and/or arbitrarily transferred to others without the benefit of a comprehensive systemic risk assessment. Integrating risk across people, processes, and project requirements/constraints serves to enhance decisions, strengthen communication pathways, and reinforce the ability of the project team to identify and manage risks across the broad spectrum of project management responsibilities. The ability to identify risks in all areas of project management increases the likelihood a project will identify significant issues before they become problems and allows projects to make effective and efficient use of shrinking resources. By getting a total team integrated risk effort, applying a disciplined and rigorous process, along with understanding project requirements/constraints provides the opportunity for more effective risk management. Applying an integrated approach to risk management makes it possible to do a better job at balancing safety, cost, schedule, operational performance and other elements of risk. This paper will examine how people, processes, and project requirements/constraints can be integrated across the project lifecycle for better risk management and ultimately improve the chances for mission success.

High-risk population health management--achieving improved patient outcomes and near-term financial results.

PubMed

Lynch, J P; Forman, S A; Graff, S; Gunby, M C

2000-07-01

A managed care organization sought to achieve efficiencies in care delivery and cost savings by anticipating and better caring for its frail and least stable members. Time sequence case study of program intervention across an entire managed care population in its first year compared with the prior baseline year. Key attributes of the intervention included predictive registries of at-risk members based on existing data, relentless focus on the high-risk group, an integrated clinical and psychosocial approach to assessments and are planning, a reengineered care management process, secured Internet applications enabling rapid implementation and broad connectivity, and population-based outcomes metrics derived from widely used measures of resource utilization and functional status. Concentrating on the highest-risk group, which averaged just 1.1% prevalence in the total membership, yielded bottom line results. When the year before program implementation (July 1997 through June 1998) was compared with the subsequent year, the total population's annualized commercial admission rate was reduced 5.3%, and seniors' was reduced 3.0%. A claims-paid analysis exclusively of the highest-risk group revealed that their efficiencies and savings overwhelmingly contributed to the membershipwide effect. This subgroup's costs dropped 35.7% from preprogram levels of $2590 per member per month (excluding pharmaceuticals). During the same time, patient-derived cross-sectional functional status rose 12.5%. A sharply focused, Internet-deployed case management strategy achieved economic and functional status results on a population basis and produced systemwide savings in its first year of implementation.

Comprehensive managed care evaluation.

PubMed

Bushick, B

1992-01-01

To optimize the benefits of managed care delivery systems, employers must identify and reward those systems that are most efficient and effective. At the same time, their deeper involvement in system design and management exposes employers to greater potential liability. Employers thus need to better evaluate their managed care programs in order to enhance the benefits and minimize the risks.

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

Mediterranean Storms: An Integrated Approach of Risk Management

NASA Astrophysics Data System (ADS)

Karageorgou, H.; Riza, E.; Linos, A.; Papanikolaou, D.

2010-09-01

Disaster by UN definition is "a serious disruption of the functioning of a community or a society, involving widespread human, material, economic, or environmental losses and impacts, which exceeds the ability of the affected community or society to cope using only its own resources". Mediterranean storms induce flash floods caused by excessive amounts of rainfall within a short lasting period of time. The intensity and duration of precipitation, region geomorphology, urbanization and different governmental emergency management structures trigger different consequences between Mediterranean countries. The integrated approach in management of storm risk represents a holistic perspective including interactions between government, science and technology institutions, developing agencies, private sector, NGOs and public. Local authorities and national government are responsible for the design, preparation and decision on storm risk management policies and strategies considering scientific risk identifying, assessing and understanding. Efficient governance management requires satisfied response to early warning systems, functionality of the affected systems upon which society depends and appropriate focus on variable interest, beliefs, values and ideologies between social groups. Also an appropriate balancing of benefits and costs in an efficient and equitable manner is important for the governance risk management. Natural sciences in corporation with the engineering science have developed effective early prediction, warning and monitoring systems on storm and flood risk. The health sciences use prediction systems for health related hazards and consequences and the social sciences research estimates the human resilience during disasters and the factors which affect and determine the human behavior. Also social sciences survey the response of public to early warning messages, the appropriate communicative methods to distributing messages and mechanisms to improve public response. The available and applied science and technology in prediction and early warning systems rely on the close collaboration between scientists and policy makers to achieve effective disaster prevention of human life and mitigation of damages. Developing agencies approach risk management as an integral part of development and encourage activities and measures to reduce the exposure and vulnerability to natural hazards through early warning systems, building codes, land use plans and disaster sensitive development plans. The human settlement and investment in high risk floodplains place greater numbers of people and economic assets in danger of being affected by storms and floods. Disasters and development are highly inter-related. Recurrent disasters and frequent localized disasters erode development and conversely the development processes can reduce disaster risk, or create new risks. The private sector participation in risk reduction efforts can help local communities mitigate disasters and increases the benefits of the businesses. The private insurance sector is highly involved in the prevention of disaster caused by natural hazards especially storms and floods. The collaboration between academic community and the insurance sector indicates the linkages between the mutual insurance actions and risk culture. Also tourism industry and private critical infrastructure sector get involved in prevention measures and activities against storm and flood risks to build sustainable functionality and keep public trust. NGOs focus on social, cultural, environmental, educational, or health issues in disaster management and their members are educated and experienced on their area of operations. The staff of local and national NGOs is familiar with culture, languages, governance structures, social networks, climate and geography of the affected area and holds a unique understanding of the specific problems of the affected population. Additionally, NGO’s operations do not suffer from bureaucracy and therefore are able to deploy on very short notice. The public awareness, behavior and response to disasters depend on the knowledge about the risk, the understanding of the information and the translation of what it means in their own particular circumstances. The majority of people judges the information to be credible and discusses the meaning of information with trusted family members, friends and colleagues to decide the next action. Well educated people, efficient management of previous experiences, successful communication methods and trust on government and authorities contribute towards efficient public response on disasters.

Hydrological modelling in a drinking water catchment area as a means of evaluating pathogen risk reduction

NASA Astrophysics Data System (ADS)

Bergion, Viktor; Sokolova, Ekaterina; Åström, Johan; Lindhe, Andreas; Sörén, Kaisa; Rosén, Lars

2017-01-01

Waterborne outbreaks of gastrointestinal diseases are of great concern to drinking water producers and can give rise to substantial costs to the society. The World Health Organisation promotes an approach where the emphasis is on mitigating risks close to the contamination source. In order to handle microbial risks efficiently, there is a need for systematic risk management. In this paper we present a framework for microbial risk management of drinking water systems. The framework incorporates cost-benefit analysis as a decision support method. The hydrological Soil and Water Assessment Tool (SWAT) model, which was set up for the Stäket catchment area in Sweden, was used to simulate the effects of four different mitigation measures on microbial concentrations. The modelling results showed that the two mitigation measures that resulted in a significant (p < 0.05) reduction of Cryptosporidium spp. and Escherichia coli concentrations were a vegetative filter strip linked to cropland and improved treatment (by one Log10 unit) at the wastewater treatment plants. The mitigation measure with a vegetative filter strip linked to grazing areas resulted in a significant reduction of Cryptosporidium spp., but not of E. coli concentrations. The mitigation measure with enhancing the removal efficiency of all on-site wastewater treatment systems (total removal of 2 Log10 units) did not achieve any significant reduction of E. coli or Cryptosporidium spp. concentrations. The SWAT model was useful when characterising the effect of different mitigation measures on microbial concentrations. Hydrological modelling implemented within an appropriate risk management framework is a key decision support element as it identifies the most efficient alternative for microbial risk reduction.

Risk-trading in flood management: An economic model.

PubMed

Chang, Chiung Ting

2017-09-15

Although flood management is no longer exclusively a topic of engineering, flood mitigation continues to be associated with hard engineering options. Flood adaptation or the capacity to adapt to flood risk, as well as a demand for internalizing externalities caused by flood risk between regions, complicate flood management activities. Even though integrated river basin management has long been recommended to resolve the above issues, it has proven difficult to apply widely, and sometimes even to bring into existence. This article explores how internalization of externalities as well as the realization of integrated river basin management can be encouraged via the use of a market-based approach, namely a flood risk trading program. In addition to maintaining efficiency of optimal resource allocation, a flood risk trading program may also provide a more equitable distribution of benefits by facilitating decentralization. This article employs a graphical analysis to show how flood risk trading can be implemented to encourage mitigation measures that increase infiltration and storage capacity. A theoretical model is presented to demonstrate the economic conditions necessary for flood risk trading. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Interview study on autonomous chemical management system and the contribution of occupational health specialists in companies].

PubMed

Mori, Koji; Takebayashi, Toru

2004-09-01

Under the circumstance that autonomous risk management for chemicals is required in Japan, it is necessary to define fundamental steps for developing chemical management system that are applicable in various types of companies and to understand the effective contribution of chemical or occupational health specialists to the system. For the purposes, we conducted interviews with companies which have an advanced chemical management system in Japan. As the result, each company had a certain policy about detailedness level of collected hazard and exposure information, and also had an efficient risk management system to ensure workers' health in depending on the business type and situations. Moreover, it was commonly observed that the specialists played major roles in developing tools for risk assessment and control, and then business lines led execution of the risk management with their supports. Based on the interviews, we showed a hypothesis of basic steps in introducing autonomous chemical risk management system at the workplaces. It is necessary to verify the hypothesis and to develop a simple system that is applicable to middle or small size companies as the next step.

Effective Risk Management in Innovative Projects: A Case Study of the Construction of Energy-efficient, Sustainable Building of the Laboratory of Intelligent Building in Cracow

NASA Astrophysics Data System (ADS)

Krechowicz, Maria

2017-10-01

Many construction projects fail to meet deadlines or they exceed the assumed budget. This scenario is particularly common in the case of innovative projects, in which too late identification of a high risk of delays and exceeding the assumed costs makes a potentially profitable project untenable. A high risk level, far exceeding the level of risk in standard non-innovative projects, is a characteristic feature of the realization phase of innovative projects. This is associated not only with greater complexity of the design and construction phases, but also with the problems with application of new technologies and prototype solutions, lack of qualified personnel with suitable expertise in specialized areas, and with the ability to properly identify the gaps between available and required knowledge and skills. This paper discusses the process of effective risk management in innovative projects on the example of the realization phase of an innovative, energy-efficient and sustainable building of the Laboratory of Intelligent Building in Cracow - DLJM Lab, from the point of view of DORBUD S.A., its general contractor. In this paper, a new approach to risk management process for innovative construction projects is proposed. Risk management process was divided into five stages: gathering information, identification of the important unwanted events, first risk assessment, development and choice of risk reaction strategies, assessment of the residual risk after introducing risk reactions. 18 unwanted events in an innovative construction project were identified. The first risk assessment was carried out using two-parametric risk matrix, in which the probability of unwanted event occurrence and its consequences were analysed. Three levels of risks were defined: tolerable, controlled and uncontrolled. Risk reactions to each defined unwanted event were developed. The following risk reaction types were considered: risk retention, risk reduction, risk transfer and risk elimination. Three-parametric risk matrix was developed to make it possible to assess risk after implementing risk reactions. The possibility of implementing risk management was inversely proportional to the probability of unwanted event occurrence and its contribution to the project outcome. Introducing this risk management strategy allowed to significantly reduce the risk of the innovative construction project. It proved to be an effective tool to reduce risk to an acceptable level. It had a significant contribution to carrying out the project within the assumed time, budget and quality standards.

[Maturity Levels of Quality and Risk Management at the University Hospital Schleswig-Holstein].

PubMed

Jussli-Melchers, Jill; Hilbert, Carsten; Jahnke, Iris; Wehkamp, Kai; Rogge, Annette; Freitag-Wolf, Sandra; Kahla-Witzsch, Heike A; Scholz, Jens; Petzina, Rainer

2018-05-16

Quality and risk management in hospitals are not only required by law but also for an optimal patient-centered and process-optimized patient care. To evaluate the maturity levels of quality and risk management at the University Hospital Schleswig-Holstein (UKSH), a structured analytical tool was developed for easy and efficient application. Four criteria concerning quality management - quality assurance (QS), critical incident reporting system (CIRS), complaint management (BM) and process management (PM) - were evaluated with a structured questionnaire. Self-assessment and external assessment were performed to classify the maturity levels at the UKSH (location Kiel and Lübeck). Every quality item was graded into four categories from "A" (fully implemented) to "D" (not implemented at all). First of all, an external assessment was initiated by the head of the department of quality and risk management. Thereafter, a self-assessment was performed by 46 clinical units of the UKSH. Discrepancies were resolved in a collegial dialogue. Based on these data, overall maturity levels were obtained for every clinical unit. The overall maturity level "A" was reached by three out of 46 (6.5%) clinical units. No unit was graded with maturity level "D". 50% out of all units reached level "B" and 43.5% level "C". The distribution of the four different quality criteria revealed a good implementation of complaint management (maturity levels "A" and "B" in 78.3%), whereas the levels for CIRS were "C" and "D" in 73.9%. Quality assurance and process management showed quite similar distributions for the levels of maturity "B" and "C" (87% QS; 91% PM). The structured analytical tool revealed maturity levels of 46 clinical units of the UKSH and defined the maturity levels of four relevant quality criteria (QS, CIRS, BM, PM). As a consequence, extensive procedures were implemented to raise the standard of quality and risk management. In future, maturity levels will be reevaluated every two years. This qualitative maturity level model enables in a simple and efficient way precise statements concerning presence, manifestation and development of quality and risk management. © Georg Thieme Verlag KG Stuttgart · New York.

A Risk Management Framework to Characterize Black Swan Risks: A Case Study of Lightning Effects on Insensitive High Explosives

NASA Astrophysics Data System (ADS)

Sanders, Gary A.

Effective and efficient risk management processes include the use of high fidelity modeling and simulation during the concept exploration phase as part of the technology and risk assessment activities, with testing and evaluation tasks occurring in later design development phases. However, some safety requirements and design architectures may be dominated by the low probability/high consequence "Black Swan" vulnerabilities that require very early testing to characterize and efficiently mitigate. Failure to address these unique risks has led to catastrophic systems failures including the space shuttle Challenger, Deepwater Horizon, Fukushima nuclear reactor, and Katrina dike failures. Discovering and addressing these risks later in the design and development process can be very costly or even lead to project cancellation. This paper examines the need for risk management process adoption of early hazard phenomenology testing to inform the technical risk assessment, requirements definition and conceptual design. A case study of the lightning design vulnerability of the insensitive high explosives being used in construction, mining, demolition, and defense industries will be presented to examine the impact of this vulnerability testing during the concept exploration phase of the design effort. While these insensitive high explosives are far less sensitive to accidental initiation by fire, impact, friction or even electrical stimuli, their full range of sensitivities have not been characterized and ensuring safe engineering design and operations during events such as lightning storms requires vulnerability testing during the risk assessment phase.

Risk Analysis for Resource Planning Optimization

NASA Technical Reports Server (NTRS)

Chueng, Kar-Ming

2008-01-01

The main purpose of this paper is to introduce a risk management approach that allows planners to quantify the risk and efficiency tradeoff in the presence of uncertainties, and to make forward-looking choices in the development and execution of the plan. Demonstrate a planning and risk analysis framework that tightly integrates mathematical optimization, empirical simulation, and theoretical analysis techniques to solve complex problems.

Risk management assessment of Health Maintenance Organisations participating in the National Health Insurance Scheme

PubMed Central

Campbell, Princess Christina; Korie, Patrick Chukwuemeka; Nnaji, Feziechukwu Collins

2014-01-01

Background: The National Health Insurance Scheme (NHIS), operated majorly in Nigeria by health maintenance organisations (HMOs), took off formally in June 2005. In view of the inherent risks in the operation of any social health insurance, it is necessary to efficiently manage these risks for sustainability of the scheme. Consequently the risk-management strategies deployed by HMOs need regular assessment. This study assessed the risk management in the Nigeria social health insurance scheme among HMOs. Materials and Methods: Cross-sectional survey of 33 HMOs participating in the NHIS. Results: Utilisation of standard risk-management strategies by the HMOs was 11 (52.6%). The other risk-management strategies not utilised in the NHIS 10 (47.4%) were risk equalisation and reinsurance. As high as 11 (52.4%) of participating HMOs had a weak enrollee base (less than 30,000 and poor monthly premium and these impacted negatively on the HMOs such that a large percentage 12 (54.1%) were unable to meet up with their financial obligations. Most of the HMOs 15 (71.4%) participated in the Millennium development goal (MDG) maternal and child health insurance programme. Conclusions: Weak enrollee base and poor monthly premium predisposed the HMOs to financial risk which impacted negatively on the overall performance in service delivery in the NHIS, further worsened by the non-utilisation of risk equalisation and reinsurance as risk-management strategies in the NHIS. There is need to make the scheme compulsory and introduce risk equalisation and reinsurance. PMID:25298605

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.

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.

Retrieval medicine: a review and guide for UK practitioners. Part 2: safety in patient retrieval systems

PubMed Central

Hearns, S; Shirley, P J

2006-01-01

Retrieval and transfer of critically ill and injured patients is a high risk activity. Risk can be minimised with robust safety and clinical governance systems in place. This article describes the various governance systems that can be employed to optimise safety and efficiency in retrieval services. These include operating procedure development, equipment management, communications procedures, crew resource management, significant event analysis, audit and training. PMID:17130608

Risk management and lessons learned solutions for satellite product assurance

NASA Astrophysics Data System (ADS)

Larrère, Jean-Luc

2004-08-01

The historic trend of the space industry towards lower cost programmes and more generally a better economic efficiency raises a difficult question to the quality assurance community: how to achieve the same—or better—mission success rate while drastically reducing the cost of programmes, hence the cost and level of quality assurance activities. EADS Astrium Earth Observation and Science (France) Business Unit have experimented Risk Management and Lessons Learned on their satellite programmes to achieve this goal. Risk analysis and management are deployed from the programme proposal phase through the development and operations phases. Results of the analysis and the corresponding risk mitigation actions are used to tailor the product assurance programme and activities. Lessons learned have been deployed as a systematic process to collect positive and negative experience from past and on-going programmes and feed them into new programmes. Monitoring and justification of their implementation in programmes is done under supervision from the BU quality assurance function. Control of the system is ensured by the company internal review system. Deployment of these methods has shown that the quality assurance function becomes more integrated in the programme team and development process and that its tasks gain focus and efficiency while minimising the risks associated with new space programmes.

Stakeholder views on flood risk management in Hungary's Upper Tisza Basin.

PubMed

Vari, Anna; Linnerooth-Bayer, Joanne; Ferencz, Zoltan

2003-06-01

With escalating costs of flood mitigation and relief, a challenge for the Hungarian government is to develop a flood mitigation and insurance/relief system that is viewed as efficient and fair by the many stakeholders involved. To aid policymakers in this task, this article reports on a recent study to elicit stakeholder views on flood risk management in the Upper Tisza Basin, including views on appropriate means of reducing losses and for transferring the residual losses from the direct victims to taxpayers or an insurance pool. This study is part of a project to develop an integrated approach to flood risk management coordinated by the International Institute of Applied Systems Analysis (IIASA) in collaboration with Swedish and Hungarian researchers. The discussion begins by describing the background of flood risk management problems in the Upper Tisza Basin. The results of interviews carried out with selected key stakeholders and the results of a public survey eliciting views on flood risk management are reported. The final section draws conclusions on incorporating stakeholder views into a flood risk management model, which will be used to illustrate policy paths at an upcoming stakeholder workshop. The conclusions are also of direct interest to Hungarian policymakers.

Using price data to consider risk in the evaluation of forest management investments.

Treesearch

David C. Baumgartner; Carol A. Hyldahl

1991-01-01

Shows how existing information on the historic prices of various timber species and products can be used to provide a measure of the market risk, return, and efficient portfolios of alternative forestry investments using examples from three Midwestern states.

Risk management consideration in the bioeconomy

Treesearch

Camilla Abbati de Assis; Ronalds Gonzalez; Stephen Kelley; Hasan Jameel; Ted Bilek; Jesse Daystar; Robert Handfield; Jay Golden; Jeff Prestemon; Damien Singh

2017-01-01

In investing in a new venture, companies aim to increase their competitiveness and generate value in scenarios where volatile markets, geopolitical instabilities, and disruptive technologies create uncertainty and risk. The biobased industry poses additional challenges as it competes in a mature, highly efficient market, dominated by...

A tool for efficient, model-independent management optimization under uncertainty

USGS Publications Warehouse

White, Jeremy; Fienen, Michael N.; Barlow, Paul M.; Welter, Dave E.

2018-01-01

To fill a need for risk-based environmental management optimization, we have developed PESTPP-OPT, a model-independent tool for resource management optimization under uncertainty. PESTPP-OPT solves a sequential linear programming (SLP) problem and also implements (optional) efficient, “on-the-fly” (without user intervention) first-order, second-moment (FOSM) uncertainty techniques to estimate model-derived constraint uncertainty. Combined with a user-specified risk value, the constraint uncertainty estimates are used to form chance-constraints for the SLP solution process, so that any optimal solution includes contributions from model input and observation uncertainty. In this way, a “single answer” that includes uncertainty is yielded from the modeling analysis. PESTPP-OPT uses the familiar PEST/PEST++ model interface protocols, which makes it widely applicable to many modeling analyses. The use of PESTPP-OPT is demonstrated with a synthetic, integrated surface-water/groundwater model. The function and implications of chance constraints for this synthetic model are discussed.

The future of monitoring in clinical research - a holistic approach: linking risk-based monitoring with quality management principles.

PubMed

Ansmann, Eva B; Hecht, Arthur; Henn, Doris K; Leptien, Sabine; Stelzer, Hans Günther

2013-01-01

Since several years risk-based monitoring is the new "magic bullet" for improvement in clinical research. Lots of authors in clinical research ranging from industry and academia to authorities are keen on demonstrating better monitoring-efficiency by reducing monitoring visits, monitoring time on site, monitoring costs and so on, always arguing with the use of risk-based monitoring principles. Mostly forgotten is the fact, that the use of risk-based monitoring is only adequate if all mandatory prerequisites at site and for the monitor and the sponsor are fulfilled.Based on the relevant chapter in ICH GCP (International Conference on Harmonisation of technical requirements for registration of pharmaceuticals for human use - Good Clinical Practice) this publication takes a holistic approach by identifying and describing the requirements for future monitoring and the use of risk-based monitoring. As the authors are operational managers as well as QA (Quality Assurance) experts, both aspects are represented to come up with efficient and qualitative ways of future monitoring according to ICH GCP.

The connection between long-term and short-term risk management strategies: 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.

2014-04-01

The need for continuous adaptation to complex and unforeseen events requires enhancing the links between planning and preparedness phases to reduce future risks in the most efficient way. In this context, the legal-administrative and cultural context has to be taken into account. This is why four case study areas of the CHANGES1 project (Nehoiu Valley in Romania, Ubaye Valley in France, Val Canale in Italy, and Wieprzówka catchment in Poland) serve as examples to highlight currently implemented risk management strategies for land-use planning and emergency preparedness. The strategies described in this paper were identified by means of exploratory and informal interviews in each study site. Results reveal that a dearth or, in very few cases, a weak link exists between spatial planners and emergency managers. Management strategies could benefit from formally intensifying coordination and cooperation between emergency services and spatial planning authorities. Moreover, limited financial funds urge for a more efficient use of resources and better coordination towards long-term activities. The research indicates potential benefits to establishing or, in some cases, strengthening this link and provides suggestions for further development in the form of information and decision support systems as a key connection point. Aside from the existent information systems for emergency management, it was found that a common platform, which integrates involvement of these and other relevant actors could enhance this connection and address expressed stakeholder needs. 1 Marie Curie ITN CHANGES - Changing Hydro-meteorological Risks as Analyzed by a New Generation of European Scientists.

Achieving Privacy in a Federated Identity Management System

NASA Astrophysics Data System (ADS)

Landau, Susan; Le van Gong, Hubert; Wilton, Robin

Federated identity management allows a user to efficiently authenticate and use identity information from data distributed across multiple domains. The sharing of data across domains blurs security boundaries and potentially creates privacy risks. We examine privacy risks and fundamental privacy protections of federated identity- management systems. The protections include minimal disclosure and providing PII only on a “need-to-know” basis. We then look at the Liberty Alliance system and analyze previous privacy critiques of that system. We show how law and policy provide privacy protections in federated identity-management systems, and that privacy threats are best handled using a combination of technology and law/policy tools.

2015/2016 Quality Risk Management Benchmarking Survey.

PubMed

Waldron, Kelly; Ramnarine, Emma; Hartman, Jeffrey

2017-01-01

This paper investigates the concept of quality risk management (QRM) maturity as it applies to the pharmaceutical and biopharmaceutical industries, using the results and analysis from a QRM benchmarking survey conducted in 2015 and 2016. QRM maturity can be defined as the effectiveness and efficiency of a quality risk management program, moving beyond "check-the-box" compliance with guidelines such as ICH Q9 Quality Risk Management , to explore the value QRM brings to business and quality operations. While significant progress has been made towards full adoption of QRM principles and practices across industry, the full benefits of QRM have not yet been fully realized. The results of the QRM Benchmarking Survey indicate that the pharmaceutical and biopharmaceutical industries are approximately halfway along the journey towards full QRM maturity. LAY ABSTRACT: The management of risks associated with medicinal product quality and patient safety are an important focus for the pharmaceutical and biopharmaceutical industries. These risks are identified, analyzed, and controlled through a defined process called quality risk management (QRM), which seeks to protect the patient from potential quality-related risks. This paper summarizes the outcomes of a comprehensive survey of industry practitioners performed in 2015 and 2016 that aimed to benchmark the level of maturity with regard to the application of QRM. The survey results and subsequent analysis revealed that the pharmaceutical and biopharmaceutical industries have made significant progress in the management of quality risks over the last ten years, and they are roughly halfway towards reaching full maturity of QRM. © PDA, Inc. 2017.

Computers in medicine. Virtual rehabilitation: dream or reality?

PubMed

Berra, Kathy

2006-08-01

Coronary heart disease is the number one cause of death for men and women in the United States and internationally. Identification of persons at risk for cardiovascular disease and reduction of cardiovascular risk factors are key factors in managing this tremendous societal burden. The internet holds great promise in helping to identify and manage persons at high risk of a cardiac or vascular event. The Internet has the capability to assess risk and provide support for cardiovascular risk reduction for large numbers of persons in a cost effective and time efficient manner. The purpose of this report is to describe important advances in the use of the Internet in identifying persons at risk for a cardiovascular event and in the Internet's ability to provide interventions designed to reduce this risk.

Risk Management using Dependency Stucture Matrix

NASA Astrophysics Data System (ADS)

Petković, Ivan

2011-09-01

An efficient method based on dependency structure matrix (DSM) analysis is given for ranking risks in a complex system or process whose entities are mutually dependent. This rank is determined according to the element's values of the unique positive eigenvector which corresponds to the matrix spectral radius modeling the considered engineering system. For demonstration, the risk problem of NASA's robotic spacecraft is analyzed.

The risk concept and its application in natural hazard risk management in Switzerland

NASA Astrophysics Data System (ADS)

Bründl, M.; Romang, H. E.; Bischof, N.; Rheinberger, C. M.

2009-05-01

Over the last ten years, a risk-based approach to manage natural hazards - termed the risk concept - has been introduced to the management of natural hazards in Switzerland. Large natural hazard events, new political initiatives and limited financial resources have led to the development and introduction of new planning instruments and software tools that should support natural hazard engineers and planners to effectively and efficiently deal with natural hazards. Our experience with these new instruments suggests an improved integration of the risk concept into the community of natural hazard engineers and planners. Important factors for the acceptance of these new instruments are the integration of end-users during the development process, the knowledge exchange between science, developers and end-users as well as training and education courses for users. Further improvements require the maintenance of this knowledge exchange and a mindful adaptation of the instruments to case-specific circumstances.

GNSS-based emergency management system

NASA Astrophysics Data System (ADS)

Wu, Yuhang; Chen, Xiuwan; Ma, Lei

2009-06-01

Public safety and public service is a particularly challenging task. The questions of how to use the limited resources efficiently, how to improve the Government's emergency rapid response and ability of risk resistance, and how to provide a more efficient emergency service for the public, have increasingly become the focus to strengthen urban management. Emergency Response Management System is a highly efficient and powerful command system dealing with natural and social disasters, by using all aspects of the force being gathered in a short period of time, sudden events can be handled efficiently, and further development of the incident can be controlled. In this paper, based on the analysis of development status of the emergency management system at home and abroad, and the key technologies of the emergency management system based on GNSS, research and development on emergency command system based on GNSS has been done. Meanwhile, test in Sichuan earthquake has also been carried out. Practice in Sichuan province earthquake relief work has proved that the emergency management command system based on GNSS can play the advantage function and exert the maximum potential, and can play the role of "lifeline" in the critical moment.

Risk assessment techniques with applicability in marine engineering

NASA Astrophysics Data System (ADS)

Rudenko, E.; Panaitescu, F. V.; Panaitescu, M.

2015-11-01

Nowadays risk management is a carefully planned process. The task of risk management is organically woven into the general problem of increasing the efficiency of business. Passive attitude to risk and awareness of its existence are replaced by active management techniques. Risk assessment is one of the most important stages of risk management, since for risk management it is necessary first to analyze and evaluate risk. There are many definitions of this notion but in general case risk assessment refers to the systematic process of identifying the factors and types of risk and their quantitative assessment, i.e. risk analysis methodology combines mutually complementary quantitative and qualitative approaches. Purpose of the work: In this paper we will consider as risk assessment technique Fault Tree analysis (FTA). The objectives are: understand purpose of FTA, understand and apply rules of Boolean algebra, analyse a simple system using FTA, FTA advantages and disadvantages. Research and methodology: The main purpose is to help identify potential causes of system failures before the failures actually occur. We can evaluate the probability of the Top event.The steps of this analize are: the system's examination from Top to Down, the use of symbols to represent events, the use of mathematical tools for critical areas, the use of Fault tree logic diagrams to identify the cause of the Top event. Results: In the finally of study it will be obtained: critical areas, Fault tree logical diagrams and the probability of the Top event. These results can be used for the risk assessment analyses.

Development of an Item Unique Identification Strategy for the Legacy Components of the US Marine Corps M1A1 Abrams Tank

DTIC Science & Technology

2008-12-03

and efficiency) criteria will merit a high-risk designation . The DoD’s inventory management, later expanded in 2003 to include DoD supply chain...management,3 is not only one of the fourteen charter designations on the first high-risk list issued in 1993, it has also been on every biennial update...and logistics support data. Furthermore, the top-down design of the centralized information repository (IUID Registry) is perhaps the greatest

Airway management in cervical spine injury

PubMed Central

Austin, Naola; Krishnamoorthy, Vijay; Dagal, Arman

2014-01-01

To minimize risk of spinal cord injury, airway management providers must understand the anatomic and functional relationship between the airway, cervical column, and spinal cord. Patients with known or suspected cervical spine injury may require emergent intubation for airway protection and ventilatory support or elective intubation for surgery with or without rigid neck stabilization (i.e., halo). To provide safe and efficient care in these patients, practitioners must identify high-risk patients, be comfortable with available methods of airway adjuncts, and know how airway maneuvers, neck stabilization, and positioning affect the cervical spine. This review discusses the risks and benefits of various airway management strategies as well as specific concerns that affect patients with known or suspected cervical spine injury. PMID:24741498

Intensive care unit without walls: seeking patient safety by improving the efficiency of the system.

PubMed

Gordo, F; Abella, A

2014-10-01

The term "ICU without walls" refers to innovative management in Intensive Care, based on two key elements: (1) collaboration of all medical and nursing staff involved in patient care during hospitalization and (2) technological support for severity early detection protocols by identifying patients at risk of deterioration throughout the hospital, based on the assessment of vital signs and/or laboratory test values, with the clear aim of improving critical patient safety in the hospitalization process. At present, it can be affirmed that there is important work to be done in the detection of severity and early intervention in patients at risk of organ dysfunction. Such work must be adapted to the circumstances of each center and should include training in the detection of severity, multidisciplinary work in the complete patient clinical process, and the use of technological systems allowing intervention on the basis of monitored laboratory and physiological parameters, with effective and efficient use of the information generated. Not only must information be generated, but also efficient management of such information must also be achieved. It is necessary to improve our activity through innovation in management procedures that facilitate the work of the intensivist, in collaboration with other specialists, throughout the hospital environment. Innovation is furthermore required in the efficient management of the information generated in hospitals, through intelligent and directed usage of the new available technology. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

[Development of Monitoring System for Infant Incubator Based on IOT Technology].

PubMed

Wang, Wenfeng; Peng, Dunlu; Gu, Nan

2017-05-30

IOT(Internet of things) is a relatively new technology, more and more integrated into our lives. In this paper we use infant incubator for example, introduce the application of IOT technology to reduce the risk of the use of medical devices, and through the dynamic management to improve the management level and efficiency. Put forward a method of medical equipment linked. Combined with the point of IOT technology and sensor technology, we find out the actual needs of the management and use of infant incubator. For the dynamic management of medical equipment, we use sensors to control risk points. The system meets the needs of the hospital and patients in many areas.

Evaluation of the Commitment to Living (CTL) curriculum: a 3-hour training for mental health professionals to address suicide risk.

PubMed

Pisani, Anthony R; Cross, Wendi F; Watts, Arthur; Conner, Kenneth

2012-01-01

Finding effective and efficient options for training mental health professionals to assess and manage suicide risk is a high priority. To test whether an innovative, brief workshop can improve provider knowledge, confidence, and written risk assessment in a multidisciplinary sample of ambulatory and acute services professionals and trainees. We conducted a pre/post evaluation of a 3 h workshop designed to improve clinical competence in suicide risk assessment by using visual concept mapping, medical records documentation, and site-specific crisis response options. Participants (N = 338 diverse mental health professionals) completed pre- and postworkshop questionnaires measuring their knowledge and confidence. Before and after the workshop, participants completed documentation for a clinical vignette. Trained coders rated the quality of risk assessment formulation before and after training. Participants' knowledge, confidence, and objectively-rated documentation skills improved significantly (p < .001), with large effect sizes. Participants' expectation of their ability to transfer workshop content to their clinical practice was high (mean = 4.10 on 1-5 scale). Commitment to Living is a promising, innovative, and efficient curriculum for educating practicing clinicians to assess and respond to suicide risk. Well-designed, brief, suicide risk management programs can improve clinicians' knowledge, confidence, and skill.

Reviewing the economic efficiency of disaster risk management

NASA Astrophysics Data System (ADS)

Mechler, Reinhard

2013-04-01

There is a lot of rhetoric suggesting that disaster risk management (DRM) pays, yet surprisingly little in the way of hard facts. Cost-benefit analysis (CBA) is one major tool that can provide quantitative information about the prioritization of disaster risk management (DRM) (and climate adaptation) based on economic principles. Yet, on a global scale, there has been surprisingly little robust evidence on the economic efficiency and benefits of risk management measures. This review shows that for the limited evidence reported the economic case for DRM across a range of hazards is strong and that the benefits of investing in DRM outweigh the costs of doing so, on average, by about four times the cost in terms of avoided and reduced losses. Most studies using a CBA approach focus on structural DRM and most information has been made available on physical flood prevention. There have been some limited studies on preparedness and risk financing. The global evidence base is limited and estimates appear not very solid, and overall, in line with the conclusion of the recent IPCC SREX report, there is limited evidence and medium agreement across the literature. Some of the factors behind the limited robustness are inherent to CBA more widely: these challenges comprise the inability to price intangibles, evaluating strategies rather than single projects, difficulties in assessing softer rather than infrastructure-related options, choices regarding a proper discount rate, lack of accounting for the distribution of benefits and costs and difficulties with assessing nonmarket values such as those related to health, the environment, or public goods. Although techniques exist to address some of these challenges, they are not very likely to easily go away. Other challenges associated specifically with DRM, such as the need and difficulty to undertake risk -based analysis can be overcome, and there have been manuals and reports providing a way forward. In an age of austerity, cost-benefit analysis continues to be an important tool for prioritising efficient DRM measures, yet with a shifting emphasis from infrastructure-based options (hard resilience) to preparedness and systemic interventions (soft resilience), other tools such as cost-effectiveness analysis, multi-criteria analysis and robust decision-making approaches deserve more attention.

[Quality Management for Surgeons: The Knowledge of Basic Contexts and Innovative Strategies Promotes the Competitiveness of Clinical Department].

PubMed

Hellmann, Wolfgang

2017-12-01

Efficient quality management aiming to achieve high quality in patient care is crucial to the success of a surgery department. This requires the knowledge of relevant terms und contexts of quality management. Implementation remains difficult in the light of demographic change and skills shortage. If a hospital has an efficient internal quality management in place, this should be used as a supplementary instrument. Otherwise it is the (sole) task of a specialist department to ensure quality for patients, employees, and cooperative partners. This paper provides basic knowledge on quality management, risk management, and quality assurance in the context of relevant medical terms. It demonstrates new ways for implementation on the level of a surgery department, and introduces a new model of quality. Georg Thieme Verlag KG Stuttgart · New York.

Towards integrated crisis support of regional emergency networks.

PubMed

Caro, D H

1999-01-01

Emergency and crisis management pose multidimensional information systems challenges for communities across North America. In the quest to reduce mortality and morbidity risks and to increase the level of crisis preparedness, regional emergency management networks have evolved. Integrated Crisis Support Systems (ICSS) are enabling information technologies that assist emergency managers by enhancing the ability to strategically manage and control these regional emergency networks efficiently and effectively. This article underscores the ICCS development, control and leadership issues and their promising implications for regional emergency management networks.

An optimization-based approach for facility energy management with uncertainties, and, Power portfolio optimization in deregulated electricity markets with risk management

NASA Astrophysics Data System (ADS)

Xu, Jun

Topic 1. An Optimization-Based Approach for Facility Energy Management with Uncertainties. Effective energy management for facilities is becoming increasingly important in view of the rising energy costs, the government mandate on the reduction of energy consumption, and the human comfort requirements. This part of dissertation presents a daily energy management formulation and the corresponding solution methodology for HVAC systems. The problem is to minimize the energy and demand costs through the control of HVAC units while satisfying human comfort, system dynamics, load limit constraints, and other requirements. The problem is difficult in view of the fact that the system is nonlinear, time-varying, building-dependent, and uncertain; and that the direct control of a large number of HVAC components is difficult. In this work, HVAC setpoints are the control variables developed on top of a Direct Digital Control (DDC) system. A method that combines Lagrangian relaxation, neural networks, stochastic dynamic programming, and heuristics is developed to predict the system dynamics and uncontrollable load, and to optimize the setpoints. Numerical testing and prototype implementation results show that our method can effectively reduce total costs, manage uncertainties, and shed the load, is computationally efficient. Furthermore, it is significantly better than existing methods. Topic 2. Power Portfolio Optimization in Deregulated Electricity Markets with Risk Management. In a deregulated electric power system, multiple markets of different time scales exist with various power supply instruments. A load serving entity (LSE) has multiple choices from these instruments to meet its load obligations. In view of the large amount of power involved, the complex market structure, risks in such volatile markets, stringent constraints to be satisfied, and the long time horizon, a power portfolio optimization problem is of critical importance but difficulty for an LSE to serve the load, maximize its profit, and manage risks. In this topic, a mid-term power portfolio optimization problem with risk management is presented. Key instruments are considered, risk terms based on semi-variances of spot market transactions are introduced, and penalties on load obligation violations are added to the objective function to improve algorithm convergence and constraint satisfaction. To overcome the inseparability of the resulting problem, a surrogate optimization framework is developed enabling a decomposition and coordination approach. Numerical testing results show that our method effectively provides decisions for various instruments to maximize profit, manage risks, and is computationally efficient.

An analysis of the public perception of flood risk on the Belgian coast.

PubMed

Kellens, Wim; Zaalberg, Ruud; Neutens, Tijs; Vanneuville, Wouter; De Maeyer, Philippe

2011-07-01

In recent years, perception of flood risks has become an important topic to policy makers concerned with risk management and safety issues. Knowledge of the public risk perception is considered a crucial aspect in modern flood risk management as it steers the development of effective and efficient flood mitigation strategies. This study aimed at gaining insight into the perception of flood risks along the Belgian coast. Given the importance of the tourism industry on the Belgian coast, the survey considered both inhabitants and residential tourists. Based on actual expert's risk assessments, a high and a low risk area were selected for the study. Risk perception was assessed on the basis of scaled items regarding storm surges and coastal flood risks. In addition, various personal and residence characteristics were measured. Using multiple regression analysis, risk perception was found to be primarily influenced by actual flood risk estimates, age, gender, and experience with previous flood hazards. © 2011 Society for Risk Analysis.

[Hospital risk management from the viewpoint of insurers].

PubMed

Gausmann, Peter; Petry, Franz Michael

2004-10-01

The present article deals with the significance of risk management in hospitals from the viewpoint of liability insurers. From the perspective of insurance companies, the liability risk of a hospital and its personnel has considerably increased during the past 25 years. The present risk situation is characterized by a growing number of reported liability cases, as well as by an enormous increase of average compensation claims. This development has led some insurance companies to financial deficits in the segment of hospital liability. While some insurers have withdrawn their activities from this market segment, others have reacted by raising their premiums. Since in Germany the premiums usually depend on the number of beds held by a hospital, the problem of rising premiums is exacerbated by the general increase of the number of clinical cases in the face of a parallel reduction of the number of beds. In the process of finding new criteria or methods for adequate premium calculation, a key role will be played by the individual future risk development of a hospital and by the evaluation of this risk by its insurance company. An extensive system of clinical quality management supported by elements of risk management will have persistent positive effects on the development of individual insurance premiums and on the insurability of clinical liability. Risk management is defined as the totality of measures taken by a company to identify risks that could lead to reduced success. Clinical risk management must be regarded in the context of a general trend that is not limited to the field of health service. In this process, the handling of errors and their causes plays a central role. Further variants of hospital risk management are the technical and economic risk management, both of which are increasingly important and are in part implemented in the German legislation. Clinical risk management has originated from the U.S., where as early as in the nineteen-seventies instruments and methods have been developed to avoid errors. Important application fields are anesthetics, surgery, orthopedics, and obstetrics. Risk management is primarily a task of the internal personnel of a hospital. The support by external consultants promises additional benefits for the hospital. Measures of classical risk management usually are essential elements of any quality management system; as such, they are therefore certifiable. Certification alone, however, does not prove the sustained efficiency of a risk-prevention system.

Relationship Between Labor and Delivery Unit Management Practices and Maternal Outcomes.

PubMed

Plough, Avery C; Galvin, Grace; Li, Zhonghe; Lipsitz, Stuart R; Alidina, Shehnaz; Henrich, Natalie J; Hirschhorn, Lisa R; Berry, William R; Gawande, Atul A; Peter, Doris; McDonald, Rory; Caldwell, Donna L; Muri, Janet H; Bingham, Debra; Caughey, Aaron B; Declercq, Eugene R; Shah, Neel T

2017-08-01

To define, measure, and characterize key competencies of managing labor and delivery units in the United States and assess the associations between unit management and maternal outcomes. We developed and administered a management measurement instrument using structured telephone interviews with both the primary nurse and physician managers at 53 diverse hospitals across the United States. A trained interviewer scored the managers' interview responses based on management practices that ranged from most reactive (lowest scores) to most proactive (highest scores). We established instrument validity by conducting site visits among a subsample of 11 hospitals and established reliability using interrater comparison. Using a factor analysis, we identified three themes of management competencies: management of unit culture, patient flow, and nursing. We constructed patient-level regressions to assess the independent association between these management themes and maternal outcomes. Proactive management of unit culture and nursing was associated with a significantly higher risk of primary cesarean delivery in low-risk patients (relative risk [RR] 1.30, 95% CI 1.02-1.66 and RR 1.47, 95% CI 1.13-1.92, respectively). Proactive management of unit culture was also associated with a significantly higher risk of prolonged length of stay (RR 4.13, 95% CI 1.98-8.64), postpartum hemorrhage (RR 2.57, 95% CI 1.58-4.18), and blood transfusion (RR 1.87, 95% CI 1.12-3.13). Proactive management of patient flow and nursing was associated with a significantly lower risk of prolonged length of stay (RR 0.23, 95% CI 0.12-0.46 and RR 0.27, 95% CI 0.11-0.62, respectively). Labor and delivery unit management varies dramatically across and within hospitals in the United States. Some proactive management practices may be associated with increased risk of primary cesarean delivery and maternal morbidity. Other proactive management practices may be associated with decreased risk of prolonged length of stay, indicating a potential opportunity to safely improve labor and delivery unit efficiency.

Time-Varying, Multi-Scale Adaptive System Reliability Analysis of Lifeline Infrastructure Networks

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

Gearhart, Jared Lee; Kurtz, Nolan Scot

2014-09-01

The majority of current societal and economic needs world-wide are met by the existing networked, civil infrastructure. Because the cost of managing such infrastructure is high and increases with time, risk-informed decision making is essential for those with management responsibilities for these systems. To address such concerns, a methodology that accounts for new information, deterioration, component models, component importance, group importance, network reliability, hierarchical structure organization, and efficiency concerns has been developed. This methodology analyzes the use of new information through the lens of adaptive Importance Sampling for structural reliability problems. Deterioration, multi-scale bridge models, and time-variant component importance aremore » investigated for a specific network. Furthermore, both bridge and pipeline networks are studied for group and component importance, as well as for hierarchical structures in the context of specific networks. Efficiency is the primary driver throughout this study. With this risk-informed approach, those responsible for management can address deteriorating infrastructure networks in an organized manner.« less

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.

Disaster Risk Management and Measurement Indicators for Cultural Heritage in Taiwan

NASA Astrophysics Data System (ADS)

Yen, Y. N.; Cheng, C. F.; Cheng, H. M.

2015-08-01

Under the influence of global climate change, the risk preparedness has become a universal issue in different research fields. In the conservation of cultural heritage, disaster risk management is becoming one of the major research topics. Besides researches on the theory and mechanism of disaster risk management, the tools for the performance of site managers to protect cultural heritage is another important issue that needs development. UNESCO and ICOMOS have released some important documents on disaster risk management including its concept, identification, evaluation, mitigation, monitoring and resilience, etc. However, there is a big gap between concept and implementation in Taiwan. Presently there are 2000 monuments in Taiwan that hardly meet the modern code. First, based on international documents released, this research presents 13 disaster indicators on monuments and their environments. Next, 345 monuments in northern Taiwan are taken as examples to evaluate their risk situations with indicators designed in 2011. Some positive recommendations were given at the same time. As a result, a comparative evaluation was completed in 2012 and some key issues are found, such as too many electrical facilities, lack of efficient firefighting equipment, and a shortage of management mechanism, just to name a few. Through the improvement of the management, some major risk can be mitigated. In 2013~14, this research took 23 national monuments from the 345 monuments to evaluate their risk situations and compare the differences between national and local monuments. Results show that almost all management mechanisms in the national monuments have been established and are running well. However, problems like inappropriate electrical facilities and insufficient monitoring equipment remain. In addition, the performance of private monuments is not as good as public ones. Based on the collected information and evaluation, this research develops safety measures of heritage conservation in two aspects. One is for researchers to measure the risk of the heritage; the other is for site managers to manage the risk of their monument with ease. In conclusion, intendants of monuments in Taiwan have to develop more disaster risk management ideas to mitigate and prevent risks. In the meantime, the management and monitoring mechanisms available are helpful tools for risk mitigation. The awareness and training of the site managers are important issues for the implementation of risk prevention.

Air Force Research Laboratory Success Stories. A Review of 2001

DTIC Science & Technology

2001-01-01

object damage (FOD) and less risk to aircraft and pilots. This technology provides a cost avoidance of over $100 million above and beyond the savings in...semiconductor devices. Consequently, this new generation of lasers results in a substantial reduction of risk in developing compact, efficient sources for...Operational Toxicology Branch in the IPSC ensures that research conducted provides risk managers (Air Force/insulation and logistics, and base

A risk explicit interval linear programming model for uncertainty-based environmental economic optimization in the Lake Fuxian watershed, China.

PubMed

Zhang, Xiaoling; Huang, Kai; Zou, Rui; Liu, Yong; Yu, Yajuan

2013-01-01

The conflict of water environment protection and economic development has brought severe water pollution and restricted the sustainable development in the watershed. A risk explicit interval linear programming (REILP) method was used to solve integrated watershed environmental-economic optimization problem. Interval linear programming (ILP) and REILP models for uncertainty-based environmental economic optimization at the watershed scale were developed for the management of Lake Fuxian watershed, China. Scenario analysis was introduced into model solution process to ensure the practicality and operability of optimization schemes. Decision makers' preferences for risk levels can be expressed through inputting different discrete aspiration level values into the REILP model in three periods under two scenarios. Through balancing the optimal system returns and corresponding system risks, decision makers can develop an efficient industrial restructuring scheme based directly on the window of "low risk and high return efficiency" in the trade-off curve. The representative schemes at the turning points of two scenarios were interpreted and compared to identify a preferable planning alternative, which has the relatively low risks and nearly maximum benefits. This study provides new insights and proposes a tool, which was REILP, for decision makers to develop an effectively environmental economic optimization scheme in integrated watershed management.

Application of Lean Healthcare methodology in a urology department of a tertiary hospital as a tool for improving efficiency.

PubMed

Boronat, F; Budia, A; Broseta, E; Ruiz-Cerdá, J L; Vivas-Consuelo, D

To describe the application of the Lean methodology as a method for continuously improving the efficiency of a urology department in a tertiary hospital. The implementation of the Lean Healthcare methodology in a urology department was conducted in 3 phases: 1) team training and improvement of feedback among the practitioners, 2) management by process and superspecialisation and 3) improvement of indicators (continuous improvement). The indicators were obtained from the Hospital's information systems. The main source of information was the Balanced Scorecard for health systems management (CUIDISS). The comparison with other autonomous and national urology departments was performed through the same platform with the help of the Hospital's records department (IASIST). A baseline was established with the indicators obtained in 2011 for the comparative analysis of the results after implementing the Lean Healthcare methodology. The implementation of this methodology translated into high practitioner satisfaction, improved quality indicators reaching a risk-adjusted complication index (RACI) of 0.59 and a risk-adjusted mortality rate (RAMR) of 0.24 in 4 years. A value of 0.61 was reached with the efficiency indicator (risk-adjusted length of stay [RALOS] index), with a savings of 2869 stays compared with national Benchmarking (IASIST). The risk-adjusted readmissions index (RARI) was the only indicator above the standard, with a value of 1.36 but with progressive annual improvement of the same. The Lean methodology can be effectively applied to a urology department of a tertiary hospital to improve efficiency, obtaining significant and continuous improvements in all its indicators, as well as practitioner satisfaction. Team training, management by process, continuous improvement and delegation of responsibilities has been shown to be the fundamental pillars of this methodology. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Using prospective hazard analysis to assess an active shooter emergency operations plan.

PubMed

Card, Alan J; Harrison, Heidi; Ward, James; Clarkson, P John

2012-01-01

Most risk management activity in the healthcare sector is retrospective, based on learning from experience. This is feasible where the risks are routine, but emergency operations plans (EOP) guide the response to events that are both high risk and rare. Under these circumstances, it is important to get the response right the first time, but learning from experience is usually not an option. This case study presents the rationale for taking a proactive approach to improving healthcare organizations' EOP. It demonstrates how the Prospective Hazard Analysis (PHA) Toolkit can drive organizational learning and argues that this toolkit may lead to more efficient improvement than drills and exercises. © 2012 American Society for Healthcare Risk Management of the American Hospital Association.

78 FR 79053 - Self-Regulatory Organizations; NYSE MKT LLC; Notice of Filing and Immediate Effectiveness of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-27

... discretion to the member organizations to define pre-set risk thresholds. The tools are designed to act as a... comments more efficiently, please use only one method. The Commission will post all comments on the... To Offer Risk Management Tools Designed To Allow Member Organizations To Monitor and Address Exposure...

Optimal allocation of conservation effort among subpopulations of a threatened species: how important is patch quality?

PubMed

Chauvenet, Aliénor L M; Baxter, Peter W J; McDonald-Madden, Eve; Possingham, Hugh P

2010-04-01

Money is often a limiting factor in conservation, and attempting to conserve endangered species can be costly. Consequently, a framework for optimizing fiscally constrained conservation decisions for a single species is needed. In this paper we find the optimal budget allocation among isolated subpopulations of a threatened species to minimize local extinction probability. We solve the problem using stochastic dynamic programming, derive a useful and simple alternative guideline for allocating funds, and test its performance using forward simulation. The model considers subpopulations that persist in habitat patches of differing quality, which in our model is reflected in different relationships between money invested and extinction risk. We discover that, in most cases, subpopulations that are less efficient to manage should receive more money than those that are more efficient to manage, due to higher investment needed to reduce extinction risk. Our simple investment guideline performs almost as well as the exact optimal strategy. We illustrate our approach with a case study of the management of the Sumatran tiger, Panthera tigris sumatrae, in Kerinci Seblat National Park (KSNP), Indonesia. We find that different budgets should be allocated to the separate tiger subpopulations in KSNP. The subpopulation that is not at risk of extinction does not require any management investment. Based on the combination of risks of extinction and habitat quality, the optimal allocation for these particular tiger subpopulations is an unusual case: subpopulations that occur in higher-quality habitat (more efficient to manage) should receive more funds than the remaining subpopulation that is in lower-quality habitat. Because the yearly budget allocated to the KSNP for tiger conservation is small, to guarantee the persistence of all the subpopulations that are currently under threat we need to prioritize those that are easier to save. When allocating resources among subpopulations of a threatened species, the combined effects of differences in habitat quality, cost of action, and current subpopulation probability of extinction need to be integrated. We provide a useful guideline for allocating resources among isolated subpopulations of any threatened species.

Is the inherent potential of maize roots efficient for soil phosphorus acquisition?

PubMed

Deng, Yan; Chen, Keru; Teng, Wan; Zhan, Ai; Tong, Yiping; Feng, Gu; Cui, Zhenling; Zhang, Fusuo; Chen, Xinping

2014-01-01

Sustainable agriculture requires improved phosphorus (P) management to reduce the overreliance on P fertilization. Despite intensive research of root adaptive mechanisms for improving P acquisition, the inherent potential of roots for efficient P acquisition remains unfulfilled, especially in intensive agriculture, while current P management generally focuses on agronomic and environmental concerns. Here, we investigated how levels of soil P affect the inherent potential of maize (Zea mays L.) roots to obtain P from soil. Responses of root morphology, arbuscular mycorrhizal colonization, and phosphate transporters were characterized and related to agronomic traits in pot and field experiments with soil P supply from deficiency to excess. Critical soil Olsen-P level for maize growth approximated 3.2 mg kg(-1), and the threshold indicating a significant environmental risk was about 15 mg kg(-1), which represented the lower and upper levels of soil P recommended in current P management. However, most root adaptations involved with P acquisition were triggered when soil Olsen-P was below 10 mg kg(-1), indicating a threshold for maximum root inherent potential. Therefore, to maintain efficient inherent potential of roots for P acquisition, we suggest that the target upper level of soil P in intensive agriculture should be reduced from the environmental risk threshold to the point maximizing the inherent potential of roots.

Is the Inherent Potential of Maize Roots Efficient for Soil Phosphorus Acquisition?

PubMed Central

Deng, Yan; Chen, Keru; Teng, Wan; Zhan, Ai; Tong, Yiping; Feng, Gu; Cui, Zhenling; Zhang, Fusuo; Chen, Xinping

2014-01-01

Sustainable agriculture requires improved phosphorus (P) management to reduce the overreliance on P fertilization. Despite intensive research of root adaptive mechanisms for improving P acquisition, the inherent potential of roots for efficient P acquisition remains unfulfilled, especially in intensive agriculture, while current P management generally focuses on agronomic and environmental concerns. Here, we investigated how levels of soil P affect the inherent potential of maize (Zea mays L.) roots to obtain P from soil. Responses of root morphology, arbuscular mycorrhizal colonization, and phosphate transporters were characterized and related to agronomic traits in pot and field experiments with soil P supply from deficiency to excess. Critical soil Olsen-P level for maize growth approximated 3.2 mg kg−1, and the threshold indicating a significant environmental risk was about 15 mg kg−1, which represented the lower and upper levels of soil P recommended in current P management. However, most root adaptations involved with P acquisition were triggered when soil Olsen-P was below 10 mg kg−1, indicating a threshold for maximum root inherent potential. Therefore, to maintain efficient inherent potential of roots for P acquisition, we suggest that the target upper level of soil P in intensive agriculture should be reduced from the environmental risk threshold to the point maximizing the inherent potential of roots. PMID:24594677

A Proposal of Operational Risk Management Method Using FMEA for Drug Manufacturing Computerized System

NASA Astrophysics Data System (ADS)

Takahashi, Masakazu; Nanba, Reiji; Fukue, Yoshinori

This paper proposes operational Risk Management (RM) method using Failure Mode and Effects Analysis (FMEA) for drug manufacturing computerlized system (DMCS). The quality of drug must not be influenced by failures and operational mistakes of DMCS. To avoid such situation, DMCS has to be conducted enough risk assessment and taken precautions. We propose operational RM method using FMEA for DMCS. To propose the method, we gathered and compared the FMEA results of DMCS, and develop a list that contains failure modes, failures and countermeasures. To apply this list, we can conduct RM in design phase, find failures, and conduct countermeasures efficiently. Additionally, we can find some failures that have not been found yet.

The science of laboratory and project management in regulated bioanalysis.

PubMed

Unger, Steve; Lloyd, Thomas; Tan, Melvin; Hou, Jingguo; Wells, Edward

2014-05-01

Pharmaceutical drug development is a complex and lengthy process, requiring excellent project and laboratory management skills. Bioanalysis anchors drug safety and efficacy with systemic and site of action exposures. Development of scientific talent and a willingness to innovate or adopt new technology is essential. Taking unnecessary risks, however, should be avoided. Scientists must strategically assess all risks and find means to minimize or negate them. Laboratory Managers must keep abreast of ever-changing technology. Investments in instrumentation and laboratory design are critical catalysts to efficiency and safety. Matrix management requires regular communication between Project Managers and Laboratory Managers. When properly executed, it aligns the best resources at the right times for a successful outcome. Attention to detail is a critical aspect that separates excellent laboratories. Each assay is unique and requires attention in its development, validation and execution. Methods, training and facilities are the foundation of a bioanalytical laboratory.

The management of risk. Part 4: Resolving complaints.

PubMed

Collier, Andrew

2014-06-01

Patient complaints invariably cause concern and distress. Whilst prevention should be the primary objective, this is not always possible. This final article in the series describes strategies for the management and resolution of complaints, as well as the advantages of good complaint handling. Clinical Relevance: Early and efficient resolution of complaints will reduce stress to all members of the dental team.

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.

Knowledge management in the QbD paradigm: manufacturing of biotech therapeutics.

PubMed

Herwig, Christoph; Garcia-Aponte, Oscar F; Golabgir, Aydin; Rathore, Anurag S

2015-07-01

In the quality by design (QbD) paradigm, global regulatory agencies have introduced the concepts of quality risk management and knowledge management (KM) as enablers for an enhanced pharmaceutical quality system. Although the concept of quality risk management has been well elucidated in the literature, the topic of KM has received relatively scant attention. In this paper we present an opinion on KM in the QbD paradigm as it relates to the manufacturing of biotech therapeutic products. Both academic and industrial viewpoints have been considered and key gaps have been elucidated. The authors conclude that there is an urgent need for the biotech industry to create efficient KM approaches if they wish to be successful in QbD implementation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Risk segmentation: goal or problem?

PubMed

Feldman, R; Dowd, B

2000-07-01

This paper traces the evolution of economists' views about risk segmentation in health insurance markets. Originally seen as a desirable goal, risk segmentation has come to be viewed as leading to abnormal profits, wasted resources, and inefficient limitations on coverage and services. We suggest that risk segmentation may be efficient if one takes an ex post view (i.e., after consumers' risks are known). From this perspective, managed care may be a much better method for achieving risk segmentation than limitations on coverage. The most serious objection to risk segmentation is the ex ante concern that it undermines long-term insurance contracts that would protect consumers against changes in lifetime risk.

Using risk elasticity to prioritize risk reduction strategies for geographical areas and industry sectors.

PubMed

Li, Pei-Chiun; Ma, Hwong-Wen

2016-01-25

The total quantity of chemical emissions does not take into account their chemical toxicity, and fails to be an accurate indicator of the potential impact on human health. The sources of released contaminants, and therefore, the potential risk, also differ based on geography. Because of the complexity of the risk, there is no integrated method to evaluate the effectiveness of risk reduction. Therefore, this study developed a method to incorporate the spatial variability of emissions into human health risk assessment to evaluate how to effectively reduce risk using risk elasticity analysis. Risk elasticity analysis, the percentage change in risk in response to the percentage change in emissions, was adopted in this study to evaluate the effectiveness and efficiency of risk reduction. The results show that the main industry sectors are different in each area, and that high emission in an area does not correspond to high risk. Decreasing the high emissions of certain sectors in an area does not result in efficient risk reduction in this area. This method can provide more holistic information for risk management, prevent the development of increased risk, and prioritize the risk reduction strategies. Copyright © 2015 Elsevier B.V. All rights reserved.

Engineering a mobile health tool for resource-poor settings to assess and manage cardiovascular disease risk: SMARThealth study.

PubMed

Raghu, Arvind; Praveen, Devarsetty; Peiris, David; Tarassenko, Lionel; Clifford, Gari

2015-04-29

The incidence of chronic diseases in low- and middle-income countries is rapidly increasing both in urban and rural regions. A major challenge for health systems globally is to develop innovative solutions for the prevention and control of these diseases. This paper discusses the development and pilot testing of SMARTHealth, a mobile-based, point-of-care Clinical Decision Support (CDS) tool to assess and manage cardiovascular disease (CVD) risk in resource-constrained settings. Through pilot testing, the preliminary acceptability, utility, and efficiency of the CDS tool was obtained. The CDS tool was part of an mHealth system comprising a mobile application that consisted of an evidence-based risk prediction and management algorithm, and a server-side electronic medical record system. Through an agile development process and user-centred design approach, key features of the mobile application that fitted the requirements of the end users and environment were obtained. A comprehensive analytics framework facilitated a data-driven approach to investigate four areas, namely, system efficiency, end-user variability, manual data entry errors, and usefulness of point-of-care management recommendations to the healthcare worker. A four-point Likert scale was used at the end of every risk assessment to gauge ease-of-use of the system. The system was field-tested with eleven village healthcare workers and three Primary Health Centre doctors, who screened a total of 292 adults aged 40 years and above. 34% of participants screened by health workers were identified by the CDS tool to be high CVD risk and referred to a doctor. In-depth analysis of user interactions found the CDS tool feasible for use and easily integrable into the workflow of healthcare workers. Following completion of the pilot, further technical enhancements were implemented to improve uptake of the mHealth platform. It will then be evaluated for effectiveness and cost-effectiveness in a cluster randomized controlled trial involving 54 southern Indian villages and over 16000 individuals at high CVD risk. An evidence-based CVD risk prediction and management tool was used to develop an mHealth platform in rural India for CVD screening and management with proper engagement of health care providers and local communities. With over a third of screened participants being high risk, there is a need to demonstrate the clinical impact of the mHealth platform so that it could contribute to improved CVD detection in high risk low resource settings.

Investigating the connections between health lean management and clinical risk management.

PubMed

Crema, Maria; Verbano, Chiara

2015-01-01

The purpose of this paper is to investigate connections and overlaps between health lean management (HLM) and clinical risk management (CRM) understanding whether and how these two approaches can be combined together to pursue efficiency and patient safety improvements simultaneously. A systematic literature review has been carried out. Searching in academic databases, papers that focus not only on HLM, but also on clinical errors and risk reduction, were included. The general characteristics of the selected papers were analysed and a content analysis was conducted. In most of the papers, pursing objectives of HLM and CRM and adopting tools and practices of both approaches, results of quality and, particularly, of safety improvements were obtained. A two-way arrow between HLM and CRM emerged but so far, none of the studies has been focused on the relationship between HLM and CRM. Results highlight an emerging research stream, with many useful theoretical and practical implications and opportunities for further research.

Opportunities for Improved Management Efficiency of the Head Start Program: Performance Evaluation and High Risk Determination.

ERIC Educational Resources Information Center

Gall, Mary Sheila

This report provides results of a review of the methodology used by the Office of Human Development Services (HDS) to measure Head Start performance and to control high risk Head Start agencies. The review was performed at HDS headquarters and regional locations nationwide. The review was based on a sample of 200 Head Start agencies and focused on…

Veterans Justice Outreach Program: VA Could Improve Management by Establishing Performance Measures and Fully Assessing Risks

DTIC Science & Technology

2016-04-01

Assessing Risks Report to Congressional Requesters April 2016 GAO-16-393 United States Government Accountability Office United States...Government Accountability Office Highlights of GAO-16-393, a report to congressional requesters April 2016 VETERANS JUSTICE OUTREACH PROGRAM...quality, timeliness, efficiency, cost of service, and outcome. GAO, Tax Administration: IRS Needs to Further Refine Its Tax Filing Season

Executive Guide: Information Security Management. Learning From Leading Organizations

DTIC Science & Technology

1998-05-01

data. In September 1996, we reported that audit reports and agency self - assessments issued during the previous 2 years showed that weak information...company has developed an efficient and disciplined process for ensuring that information security-related risks to business operations are considered and...protection group at the utility was required to approve all new applications to indicate that risks had been adequately considered. Providing self

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.

Why projects often fail even with high cost contingencies

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

Kujawski, Edouard

2002-02-28

In this note we assume that the individual risks have been adequately quantified and the total project cost contingency adequately computed to ensure an agreed-to probability or confidence level that the total project cost estimate will not be exceeded. But even projects that implement such a process are likely to result in significant cost overruns and/or project failure if the project manager allocates the contingencies to the individual subsystems. The intuitive and mathematically valid solution is to maintain a project-wide contingency and to distribute it to the individual risks on an as-needed basis. Such an approach ensures cost-efficient risk management,more » and projects that implement it are more likely to succeed and to cost less. We illustrate these ideas using a simplified project with two independent risks. The formulation can readily be extended to multiple risks.« less

Relationships of efficiency to reproductive disorders in Danish milk production: a stochastic frontier analysis.

PubMed

Lawson, L G; Bruun, J; Coelli, T; Agger, J F; Lund, M

2004-01-01

Relationships of various reproductive disorders and milk production performance of Danish dairy farms were investigated. A stochastic frontier production function was estimated using data collected in 1998 from 514 Danish dairy farms. Measures of farm-level milk production efficiency relative to this production frontier were obtained, and relationships between milk production efficiency and the incidence risk of reproductive disorders were examined. There were moderate positive relationships between milk production efficiency and retained placenta, induction of estrus, uterine infections, ovarian cysts, and induction of birth. Inclusion of reproductive management variables showed that these moderate relationships disappeared, but directions of coefficients for almost all those variables remained the same. Dystocia showed a weak negative correlation with milk production efficiency. Farms that were mainly managed by young farmers had the highest average efficiency scores. The estimated milk losses due to inefficiency averaged 1142, 488, and 256 kg of energy-corrected milk per cow, respectively, for low-, medium-, and high-efficiency herds. It is concluded that the availability of younger cows, which enabled farmers to replace cows with reproductive disorders, contributed to high cow productivity in efficient farms. Thus, a high replacement rate more than compensates for the possible negative effect of reproductive disorders. The use of frontier production and efficiency/inefficiency functions to analyze herd data may enable dairy advisors to identify inefficient herds and to simulate the effect of alternative management procedures on the individual herd's efficiency.

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

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.

Development of an Item Unique Identification Strategy for the Legacy Components of the US Marine Corps M1A1 Abrams Tank

DTIC Science & Technology

2008-12-01

than $1 billion is at risk) and qualitative (i.e., significantly reduced effectiveness and efficiency) criteria will merit a high-risk designation ...management,3 is not only one of the fourteen charter designations on the first high- risk list issued in 1993, it has also been on every biennial...Furthermore, the top-down design of the centralized information repository (IUID Registry) is perhaps the greatest benefit of the IUID vision, as it

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...

Risk based management of invading plant disease

USDA-ARS?s Scientific Manuscript database

Effective control of new and emerging plant disease remains a key challenge. Attempts to eradicate pathogens often involve removal of all plants within a fixed distance of detected infected hosts, targeting asymptomatic infection. Here we develop and test potentially more efficient, epidemiologicall...

Risk of diarrhoea from shallow groundwater contaminated with enteropathogens in the Kathmandu Valley, Nepal.

PubMed

Shrestha, Sadhana; Haramoto, Eiji; Malla, Rabin; Nishida, Kei

2015-03-01

Shallow groundwater is the main water source among many alternatives in the Kathmandu Valley, Nepal, which has a rapidly growing population and intermittent piped water supply. Although human pathogens are detected in groundwater, its health effects are unclear. We estimated risk of diarrhoea from shallow groundwater use using quantitative microbial risk assessment. Escherichia coli, Giardia cyst and Cryptosporidium oocyst levels were analysed in dug and tube wells samples. E. coli concentrations were converted to those of enteropathogenic E. coli (EPEC). Risks from EPEC in dug wells and from Cryptosporidium and Giardia in both dug and tube wells were higher than the acceptable limit (<10⁻⁴ infections/person-year) for both drinking and bathing exposures. Risk from protozoan enteropathogens increased the total risk 10,000 times, indicating that ignoring protozoans could lead to serious risk underestimation. Bathing exposure considerably increased risk, indicating that it is an important pathway. Point-of-use (POU) water treatment decreased the risk six-fold and decreased risk overestimation. Because removal efficiency of POU water treatment has the largest impact on total risk, increasing the coverage and efficiency of POU water treatment could be a practical risk management strategy in the Kathmandu Valley and similar settings.

The Expert and the Lay Public: Reflections on Influenza A (H1N1) and the Risk Society

PubMed Central

Williams-Jones, Bryn

2012-01-01

Trust between the lay public and scientific experts is a key element to ensuring the efficient implementation of emergency public health measures. In modern risk societies, the management and elimination of risk have become preeminent drivers of public policy. In this context, the protection of public trust is a complex task. Those actors involved in public health decision-making and implementation (e.g., mass vaccination for influenza A virus) are confronted with growing pressures and responsibility to act. However, they also need to accept the limits of their own expertise and recognize the ability of lay publics to understand and be responsible for public health. Such a shared responsibility for risk management, if grounded in participative public debates, can arguably strengthen public trust in public health authorities and interventions. PMID:22397338

Index-Based Insurance Contracts to FOSTER Cooperation Between Agents Exposed to Uncorrelated Drought and Flooding Risks

NASA Astrophysics Data System (ADS)

Denaro, S.; Giuliani, M.; Castelletti, A.; Characklis, G. W.

2017-12-01

Worldwide, conflict over shared water resources is exacerbated by population growth, economic development and climate change. In multi-purpose water systems, stakeholders can face higher financial risks as a consequence of increased hydrological uncertainty and recurrent extreme events. In this context, a financial hedging tool able to bundle together the uncorrelated risks faced by different stakeholders may be an efficient solution to both foster cooperation and manage the financial losses associated with extreme events. In this work we explore the potential of risk diversification strategies involving index-based insurance joint contract solutions, to manage financial risk in a multi-purpose water system prone to both drought and flood risk. Risk diversification can allow for reduced insurance premiums in situations in which the bundled risks are entirely, or mostly, uncorrelated. Jointly covering flood and drought related risks from competing users in the same geographic area represents a novel application. The approach is demonstrated using a case study on Lake Maggiore, a regulated lake whose management is highly controversial due to numerous and competing human activities. In particular we focus on the ongoing conflict among the lakeshore population, affected by flood risk, and the downstream farmers' districts, facing drought related losses. Results are promising and indicate that bundling uncorrelated risks from competing users is beneficial to both promoting insurance premium affordability and facilitating collaboration schemes at the catchment scale.

Optimization of protocol design: a path to efficient, lower cost clinical trial execution

PubMed Central

Malikova, Marina A

2016-01-01

Managing clinical trials requires strategic planning and efficient execution. In order to achieve a timely delivery of important clinical trials’ outcomes, it is useful to establish standardized trial management guidelines and develop robust scoring methodology for evaluation of study protocol complexity. This review will explore the challenges clinical teams face in developing protocols to ensure that the right patients are enrolled and the right data are collected to demonstrate that a drug is safe and efficacious, while managing study costs and study complexity based on proposed comprehensive scoring model. Key factors to consider when developing protocols and techniques to minimize complexity will be discussed. A methodology to identify processes at planning phase, approaches to increase fiscal return and mitigate fiscal compliance risk for clinical trials will be addressed. PMID:28031939

A method to determine the protection zone of chemical industrial park considering air quality, health risk and environmental risk: a case study.

PubMed

Shi, Jingang; Zhang, Mingbo; Li, Dong; Liu, Jia

2018-04-01

In China, chemical enterprises are required to cluster into a large number of chemical industrial parks (CIPs), which increase risks and threats to the environment and human being's health due to aggregation of the complicated chemical process and huge unit scale. Setting a scientific and reasonable protection zone around CIP is a very efficient way to protect surrounding people's health. A method was designed to determine the comprehensive protection zone of CIP, taking into account multiple factors: air quality, health risk and environmental risk. By establishing a comprehensive and multi-levels index system, the protection zone and the corresponding environmental risk management countermeasures can be proposed hierarchically, which are very important to the development and environmental risk management of CIP. A CIP located in coastal area of Shandong Province was studied, and it is turned out that the method to determine the protection zone of chemical industrial park considering air quality, health risk and environmental risk has great advantages compared with other methods.

Disaster management and the critical thinking skills of local emergency managers: correlations with age, gender, education, and years in occupation.

PubMed

Peerbolte, Stacy L; Collins, Matthew Lloyd

2013-01-01

Emergency managers must be able to think critically in order to identify and anticipate situations, solve problems, make judgements and decisions effectively and efficiently, and assume and manage risk. Heretofore, a critical thinking skills assessment of local emergency managers had yet to be conducted that tested for correlations among age, gender, education, and years in occupation. An exploratory descriptive research design, using the Watson-Glaser Critical Thinking Appraisal-Short Form (WGCTA-S), was employed to determine the extent to which a sample of 54 local emergency managers demonstrated the critical thinking skills associated with the ability to assume and manage risk as compared to the critical thinking scores of a group of 4,790 peer-level managers drawn from an archival WGCTA-S database. This exploratory design suggests that the local emergency managers, surveyed in this study, had lower WGCTA-S critical thinking scores than their equivalents in the archival database with the exception of those in the high education and high experience group. © 2013 The Author(s). Journal compilation © Overseas Development Institute, 2013.

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.

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.

Risks of municipal solid waste incineration: an environmental perspective.

PubMed

Denison, R A; Silbergeld, E K

1988-09-01

The central focus of the debate over incineration of municipal solid waste (MSW) has shifted from its apparent management advantages to unresolved risk issues. This shift is a result of the lack of comprehensive consideration of risks associated with incineration. We discuss the need to expand incinerator risk assessment beyond the limited view of incinerators as stationary air pollution sources to encompass the following: other products of incineration, ash in particular, and pollutants other than dioxins, metals in particular; routes of exposure in addition to direct inhalation; health effects in addition to cancer; and the cumulative nature of exposure and health effects induced by many incinerator-associated pollutants. Rational MSW management planning requires that the limitations as well as advantages of incineration be recognized. Incineration is a waste-processing--not a waste disposal--technology, and its products pose substantial management and disposal problems of their own. Consideration of the nature of these products suggests that incineration is ill-suited to manage the municipal wastestream in its entirety. In particular, incineration greatly enhances the mobility and bioavailability of toxic metals present in MSW. These factors suggest that incineration must be viewed as only one component in an integrated MSW management system. The potential for source reduction, separation, and recycling to increase the safety and efficiency of incineration should be counted among their many benefits. Risk considerations dictate that alternatives to the use of toxic metals at the production stage also be examined in designing an effective, long-term MSW management strategy.

Measuring Security Effectiveness and Efficiency at U.S. Commercial Airports

DTIC Science & Technology

2013-03-01

formative program evaluation and policy analysis to investigate current airport security programs. It identifies innovative public administration and...policy-analysis tools that could provide potential benefits to airport security . These tools will complement the System Based Risk Management framework if

AIR QUALITY MODELING AT NEIGHBORHOOD SCALES TO IMPROVE HUMAN EXPOSURE ASSESSMENT

EPA Science Inventory

Air quality modeling is an integral component of risk assessment and of subsequent development of effective and efficient management of air quality. Urban areas introduce of fresh sources of pollutants into regional background producing significant spatial variability of the co...

Engine management during NTRE start up

NASA Technical Reports Server (NTRS)

Bulman, Mel; Saltzman, Dave

1993-01-01

The topics are presented in viewgraph form and include the following: total engine system management critical to successful nuclear thermal rocket engine (NTRE) start up; NERVA type engine start windows; reactor power control; heterogeneous reactor cooling; propellant feed system dynamics; integrated NTRE start sequence; moderator cooling loop and efficient NTRE starting; analytical simulation and low risk engine development; accurate simulation through dynamic coupling of physical processes; and integrated NTRE and mission performance.

Chronic diseases are not being managed effectively in either high-risk or low-risk populations in South Africa.

PubMed

Brand, Martin; Woodiwiss, Angela J; Michel, Frederic; Booysens, Hendrik L; Majane, Olebogeng H I; Maseko, Muzi J; Veller, Martin G; Norton, Gavin R

2013-07-29

Primary healthcare is the foundation of a country's healthcare system. Without an efficient and cost-effective programme, the level of healthcare offered across all levels of health management is adversely affected. To analyse the effectiveness of the management of hypertension and diabetes mellitus (DM) among two distinct patient populations, one with significant cardiovascular risk factors and the other without. We performed a case control study of a high-risk group of patients presenting with chronic critical limb ischaemia (CLI) to the Divisions of Vascular Surgery at Charlotte Maxeke Johannesburg Academic Hospital and Chris Hani Baragwanath Academic Hospital, and a randomly selected group of 'healthy' community participants from Johannesburg's South Western Townships (Soweto). We assessed 217 patients with CLI and 1 030 participants from the community. We assessed the number of patients who were not achieving their therapeuatic targets, among those known to be hypertensive (CLI: 44.7%; community: 59.9%) and diabetic (CLI: 83.5%; community: 66%). Undiagnosed diabetes affected 10.8% of patients with CLI and 11% of the community sample. Traditional vascular risk factors are managed poorly at both primary healthcare and at tertiary care levels. There is a need to identify factors that will address this issue.

From chemical risk assessment to environmental resources management: the challenge for mining.

PubMed

Voulvoulis, Nikolaos; Skolout, John W F; Oates, Christopher J; Plant, Jane A

2013-11-01

On top of significant improvements and progress made through science and engineering in the last century to increase efficiency and reduce impacts of mining to the environment, risk assessment has an important role to play in further reducing such impacts and preventing and mitigating risks. This paper reflects on how risk assessment can improve planning, monitoring and management in mining and mineral processing operations focusing on the importance of better understanding source-pathway-receptor linkages for all stages of mining. However, in light of the ever-growing consumption and demand for raw materials from mining, the need to manage environmental resources more sustainably is becoming increasingly important. The paper therefore assesses how mining can form an integral part of wider sustainable resources management, with the need for re-assessing the potential of mining in the context of sustainable management of natural capital, and with a renewed focus on its the role from a systems perspective. The need for understanding demand and pressure on resources, followed by appropriate pricing that is inclusive of all environmental costs, with new opportunities for mining in the wastes we generate, is also discussed. Findings demonstrate the need for a life cycle perspective in closing the loop between mining, production, consumption and waste generation as the way forward.

[How the information system can contribute to the implementation of a risk management program in a hospital?].

PubMed

Staccini, P; Quaranta, J F; Staccini-Myx, A; Veyres, P; Jambou, P

2003-09-01

Nowadays, information system is recognised as one of the key points of the management strategy. An information system is regarded conceptualised as a mean to link 3 aspects of a firm (structure, organisation rules and staff). Its design and implementation have to meet the objectives of medical and economical evaluation, especially risk management objectives. In order to identify, analyse, reduce and prevent the occurrence of adverse events, and also to measure the efficacy and efficiency of the production of care services, the design of information systems should be based on a process analysis in order to describe and classify all the working practices within the hospital. According to various methodologies (usually top-down analysis), each process can be divided into activities. Each activity (especially each care activity) can be described according to its potential risks and expected results. For care professionals performing a task, the access to official or internal guidelines and the adverse events reporting forms has also to be defined. Putting together all the elements of such a process analysis will contribute to integrate, into daily practice, the management of risks, supported by the information system.

Assessment of urban pluvial flood risk and efficiency of adaptation options through simulations - A new generation of urban planning tools

NASA Astrophysics Data System (ADS)

Löwe, Roland; Urich, Christian; Sto. Domingo, Nina; Mark, Ole; Deletic, Ana; Arnbjerg-Nielsen, Karsten

2017-07-01

We present a new framework for flexible testing of flood risk adaptation strategies in a variety of urban development and climate scenarios. This framework couples the 1D-2D hydrodynamic simulation package MIKE FLOOD with the agent-based urban development model DAnCE4Water and provides the possibility to systematically test various flood risk adaptation measures ranging from large infrastructure changes over decentralised water management to urban planning policies. We have tested the framework in a case study in Melbourne, Australia considering 9 scenarios for urban development and climate and 32 potential combinations of flood adaptation measures. We found that the performance of adaptation measures strongly depended on the considered climate and urban development scenario and the other implementation measures implemented, suggesting that adaptive strategies are preferable over one-off investments. Urban planning policies proved to be an efficient means for the reduction of flood risk, while implementing property buyback and pipe increases in a guideline-oriented manner was too costly. Random variations in location and time point of urban development could have significant impact on flood risk and would in some cases outweigh the benefits of less efficient adaptation strategies. The results of our setup can serve as an input for robust decision making frameworks and thus support the identification of flood risk adaptation measures that are economically efficient and robust to variations of climate and urban layout.

Risk management and statistical multivariate analysis approach for design and optimization of satranidazole nanoparticles.

PubMed

Dhat, Shalaka; Pund, Swati; Kokare, Chandrakant; Sharma, Pankaj; Shrivastava, Birendra

2017-01-01

Rapidly evolving technical and regulatory landscapes of the pharmaceutical product development necessitates risk management with application of multivariate analysis using Process Analytical Technology (PAT) and Quality by Design (QbD). Poorly soluble, high dose drug, Satranidazole was optimally nanoprecipitated (SAT-NP) employing principles of Formulation by Design (FbD). The potential risk factors influencing the critical quality attributes (CQA) of SAT-NP were identified using Ishikawa diagram. Plackett-Burman screening design was adopted to screen the eight critical formulation and process parameters influencing the mean particle size, zeta potential and dissolution efficiency at 30min in pH7.4 dissolution medium. Pareto charts (individual and cumulative) revealed three most critical factors influencing CQA of SAT-NP viz. aqueous stabilizer (Polyvinyl alcohol), release modifier (Eudragit® S 100) and volume of aqueous phase. The levels of these three critical formulation attributes were optimized by FbD within established design space to minimize mean particle size, poly dispersity index, and maximize encapsulation efficiency of SAT-NP. Lenth's and Bayesian analysis along with mathematical modeling of results allowed identification and quantification of critical formulation attributes significantly active on the selected CQAs. The optimized SAT-NP exhibited mean particle size; 216nm, polydispersity index; 0.250, zeta potential; -3.75mV and encapsulation efficiency; 78.3%. The product was lyophilized using mannitol to form readily redispersible powder. X-ray diffraction analysis confirmed the conversion of crystalline SAT to amorphous form. In vitro release of SAT-NP in gradually pH changing media showed <20% release in pH1.2 and pH6.8 in 5h, while, complete release (>95%) in pH7.4 in next 3h, indicative of burst release after a lag time. This investigation demonstrated effective application of risk management and QbD tools in developing site-specific release SAT-NP by nanoprecipitation. Copyright © 2016 Elsevier B.V. All rights reserved.

Risk of equine infectious disease transmission by non-race horse movements in Japan.

PubMed

Hayama, Yoko; Kobayashi, Sota; Nishida, Takeshi; Nishiguchi, Akiko; Tsutsui, Toshiyuki

2010-07-01

For determining surveillance programs or infectious disease countermeasures, risk evaluation approaches have been recently undertaken in the field of animal health. In the present study, to help establish efficient and effective surveillance and countermeasures for equine infectious diseases, we evaluated the potential risk of equine infectious disease transmission in non-race horses from the viewpoints of horse movements and health management practices by conducting a survey of non-race horse holdings. From the survey, the non-race horse population was classified into the following five sectors based on their purposes: the equestrian sector, private owner sector, exhibition sector, fattening sector and others. Our survey results showed that the equestrian and private owner sectors had the largest population sizes, and movements between and within these sectors occurred quite frequently, while there was little movement in the other sectors. Qualitative evaluation showed that the equestrian and private owner sectors had relatively high risks of equine infectious disease transmission through horse movements. Therefore, it would be effective to concentrate on these two sectors when implementing surveillance or preventative measures. Special priority should be given to the private owner sector because this sector has not implemented inspection and vaccination well compared with the equestrian sector, which possesses a high compliance rate for these practices. This qualitative risk evaluation focused on horse movements and health management practices could provide a basis for further risk evaluation to establish efficient and effective surveillance and countermeasures for equine infectious diseases.

[Clinical and managerial autonomy. Perception of the coordinators of the health centers in Mallorca, Spain].

PubMed

Tamborero Cao, Gaspar; Gómez Nadal, Amalia; García Pineda, Atanasio; Miguélez Chamorro, Angélica; Canet Martorell, Rosa; Esteva Cantó, Magdalena

2011-12-01

The self-management has been linked with increased efficiency and job satisfaction. Before any changes aimed at a more autonomous management is important to know the position of professionals and managers. objective: To assess the importance attached by the coordinators of the health centers (HC) to the clinical and managerial autonomy, knowing their decision making capacity and their expectations about the feasibility of implementing a project of self-management. cross-sectional study, application questionnaire. Primary Care, 2009. All the coordinators of the HC of Mallorca (N = 47). 27 questions that explore the coordinator's opinion about the importance of the components of the self-management, its ability to present intervention, the propensity / aversion to risk, leadership, and the feasibility of a self-management. response rate: 42/47 (89,4%). 42 (100%) attaches the highest importance to the management of human resources, 41 (97,6%) to demand management and 40 (95,2%) to the management of waiting lists. 15 (35,7%) would take a financial risk, 14 (33,3%) were considered trained and 18 (42,9%) were willing to lead a process of self-management. 14 (33,3%) thought that the professionals in your team would not be interested in a process of self-management and 29 (69%) believed that others could develop HC of Mallorca. The respondents were coordinators have a limited ability to decide on the components of the self-management, being risk averse and make a little leadership ability and willingness to self-management projects.

Risk preferences in strategic wildfire decision making: a choice experiment with U.S. wildfire managers.

PubMed

Wibbenmeyer, Matthew J; Hand, Michael S; Calkin, David E; Venn, Tyron J; Thompson, Matthew P

2013-06-01

Federal policy has embraced risa management as an appropriate paradigm for wildfire management. Economic theory suggests that over repeated wildfire events, potential economic costs and risas of ecological damage are optimally balanced when management decisions are free from biases, risa aversion, and risa seeking. Of primary concern in this article is how managers respond to wildfire risa, including the potential effect of wildfires (on ecological values, structures, and safety) and the likelihood of different fire outcomes. We use responses to a choice experiment questionnaire of U.S. federal wildfire managers to measure attitudes toward several components of wildfire risa and to test whether observed risa attitudes are consistent with the efficient allocation of wildfire suppression resources. Our results indicate that fire managers' decisions are consistent with nonexpected utility theories of decisions under risa. Managers may overallocate firefighting resources when the likelihood or potential magnitude of damage from fires is low, and sensitivity to changes in the probability of fire outcomes depends on whether probabilities are close to one or zero and the magnitude of the potential harm. © 2012 Society for Risk Analysis.

Endocrine disrupting compounds in drinking water supply system and human health risk implication.

PubMed

Wee, Sze Yee; Aris, Ahmad Zaharin

2017-09-01

To date, experimental and epidemiological evidence of endocrine disrupting compounds (EDCs) adversely affecting human and animal populations has been widely debated. Notably, human health risk assessment is required for risk mitigation. The lack of human health risk assessment and management may thus unreliably regulate the quality of water resources and efficiency of treatment processes. Therefore, drinking water supply systems (DWSSs) may be still unwarranted in assuring safe access to potable drinking water. Drinking water supply, such as tap water, is an additional and crucial route of human exposure to the health risks associated with EDCs. A holistic system, incorporating continuous research in DWSS monitoring and management using multi-barrier approach, is proposed as a preventive measure to reduce human exposure to the risks associated with EDCs through drinking water consumption. The occurrence of EDCs in DWSSs and corresponding human health risk implications are analyzed using the Needs, Approaches, Benefits, and Challenges (NABC) method. Therefore, this review may act as a supportive tool in protecting human health and environmental quality from EDCs, which is essential for decision-making regarding environmental monitoring and management purposes. Subsequently, the public could have sustainable access to safer and more reliable drinking water. Copyright © 2017 Elsevier Ltd. All rights reserved.

Managing the potential risks of using bacteria-laden water in mineral processing to protect freshwater.

PubMed

Liu, Wenying; Moran, Chris J; Vink, Sue

2013-06-18

The minerals industry is being driven to access multiple water sources and increase water reuse to minimize freshwater withdrawal. Bacteria-laden water, such as treated effluent, has been increasingly used as an alternative to freshwater for mineral processing, in particular flotation, where conditions are favorable for bacterial growth. However, the risk posed by bacteria to flotation efficiency is poorly understood. This could be a barrier to the ongoing use of this water source. This study tested the potential of a previously published risk-based approach as a management tool to both assist mine sites in quantifying the risk from bacteria, and finding system-wide cost-effective solutions for risk mitigation. The result shows that the solution of adjusting the flotation chemical regime could only partly control the risk. The second solution of using tailings as an absorbent was shown to be effective in the laboratory in reducing bacterial concentration and thus removing the threat to flotation recovery. The best solution is likely to combine internal and external approaches, that is, inside and outside processing plants. Findings in this study contribute possible methods applicable to managing the risk from water-borne bacteria to plant operations that choose to use bacteria-containing water, when attempting to minimize freshwater use, and avoiding the undesirable consequences of increasing its use.

Risk Protection, Service Use, and Health Outcomes under Colombia’s Health Insurance Program for the Poor

PubMed Central

Miller, Grant; Pinto, Diana

2013-01-01

Unexpected medical care spending imposes considerable financial risk on developing country households. Based on managed care models of health insurance in wealthy countries, Colombia’s Régimen Subsidiado is a publicly financed insurance program targeted to the poor, aiming both to provide risk protection and to promote allocative efficiency in the use of medical care. Using a “fuzzy” regression discontinuity design, we find that the program has shielded the poor from some financial risk while increasing the use of traditionally under-utilized preventive services – with measurable health gains. PMID:25346799

Study of Agricultural Product Options Pricing

NASA Astrophysics Data System (ADS)

HONG, Qiu

2017-09-01

China is a large agricultural country, and the healthy development of agriculture is related to the stability of the whole society. The agricultural production and management of agricultural products are confronted with many risks, especially the market risks. Option contract is the object of option market transaction, so it is very important to study the option contract of agricultural products. Option trading separates the risk and profit, so that the trader can avoid the risk while retaining the opportunity to obtain income. The option has the characteristics of low transaction cost, simple and efficient, so it is suitable for small and medium investors.

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.

Modeling for Integrated Science Management and Resilient Systems Development

NASA Technical Reports Server (NTRS)

Shelhamer, M.; Mindock, J.; Lumpkins, S.

2014-01-01

Many physiological, environmental, and operational risks exist for crewmembers during spaceflight. An understanding of these risks from an integrated perspective is required to provide effective and efficient mitigations during future exploration missions that typically have stringent limitations on resources available, such as mass, power, and crew time. The Human Research Program (HRP) is in the early stages of developing collaborative modeling approaches for the purposes of managing its science portfolio in an integrated manner to support cross-disciplinary risk mitigation strategies and to enable resilient human and engineered systems in the spaceflight environment. In this talk, we will share ideas being explored from fields such as network science, complexity theory, and system-of-systems modeling. Initial work on tools to support these explorations will be discussed briefly, along with ideas for future efforts.

Developing Methods Using ToxCast Data for the Classification and Prioritization of Antimicrobials and Inerts

EPA Science Inventory

Improved chemical risk management and increased efficiency of chemical prioritization, classification and assessment are major goals within EPA. Towards achieving these goals, EPA's ToxCast™ research program has been designed to rapidly screen hundreds to thousands of chemicals' ...

Analyzing the impact of intermodal-related risk to the design and management of biofuel supply chain.

DOT National Transportation Integrated Search

2014-12-01

The objective of this project is to design decision-support tools for identifying : biorefinery locations that ensure a cost-efficient and reliable supply chain. We built : mathematical models which take into consideration the benefits (such as acces...

Recent advances in the management of transient ischemic attacks

PubMed Central

Gomez, Camilo R.; Schneck, Michael J.; Biller, Jose

2017-01-01

Significant advances in our understanding of transient ischemic attack (TIA) have taken place since it was first recognized as a major risk factor for stroke during the late 1950's. Recently, numerous studies have consistently shown that patients who have experienced a TIA constitute a heterogeneous population, with multiple causative factors as well as an average 5–10% risk of suffering a stroke during the 30 days that follow the index event. These two attributes have driven the most important changes in the management of TIA patients over the last decade, with particular attention paid to effective stroke risk stratification, efficient and comprehensive diagnostic assessment, and a sound therapeutic approach, destined to reduce the risk of subsequent ischemic stroke. This review is an outline of these changes, including a discussion of their advantages and disadvantages, and references to how new trends are likely to influence the future care of these patients. PMID:29263784

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.

Can't get no satisfaction? Will pay for performance help?: toward an economic framework for understanding performance-based risk-sharing agreements for innovative medical products.

PubMed

Towse, Adrian; Garrison, Louis P

2010-01-01

This article examines performance-based risk-sharing agreements for pharmaceuticals from a theoretical economic perspective. We position these agreements as a form of coverage with evidence development. New performance-based risk sharing could produce a more efficient market equilibrium, achieved by adjustment of the price post-launch to reflect outcomes combined with a new approach to the post-launch costs of evidence collection. For this to happen, the party best able to manage or to bear specific risks must do so. Willingness to bear risk will depend not only on ability to manage it, but on the degree of risk aversion. We identify three related frameworks that provide relevant insights: value of information, real option theory and money-back guarantees. We identify four categories of risk sharing: budget impact, price discounting, outcomes uncertainty and subgroup uncertainty. We conclude that a value of information/real option framework is likely to be the most helpful approach for understanding the costs and benefits of risk sharing. There are a number of factors that are likely to be crucial in determining if performance-based or risk-sharing agreements are efficient and likely to become more important in the future: (i) the cost and practicality of post-launch evidence collection relative to pre-launch; (ii) the feasibility of coverage with evidence development without a pre-agreed contract as to how the evidence will be used to adjust price, revenues or use, in which uncertainty around the pay-off to additional research will reduce the incentive for the manufacturer to collect the information; (iii) the difficulty of writing and policing risk-sharing agreements; (iv) the degree of risk aversion (and therefore opportunity to trade) on the part of payers and manufacturers; and (v) the extent of transferability of data from one country setting to another to support coverage with evidence development in a risk-sharing framework. There is no doubt that--in principle--risk sharing can provide manufacturers and payers additional real options that increase overall efficiency. Given the lack of empirical evidence on the success of schemes already agreed and on the issues we set out above, it is too early to tell if the recent surge of interest in these arrangements is likely to be a trend or only a fad.

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.

Controlling Inventory: Real-World Mathematical Modeling

ERIC Educational Resources Information Center

Edwards, Thomas G.; Özgün-Koca, S. Asli; Chelst, Kenneth R.

2013-01-01

Amazon, Walmart, and other large-scale retailers owe their success partly to efficient inventory management. For such firms, holding too little inventory risks losing sales, whereas holding idle inventory wastes money. Therefore profits hinge on the inventory level chosen. In this activity, students investigate a simplified inventory-control…

Improving laboratory efficiencies to scale-up HIV viral load testing.

PubMed

Alemnji, George; Onyebujoh, Philip; Nkengasong, John N

2017-03-01

Viral load measurement is a key indicator that determines patients' response to treatment and risk for disease progression. Efforts are ongoing in different countries to scale-up access to viral load testing to meet the Joint United Nations Programme on HIV and AIDS target of achieving 90% viral suppression among HIV-infected patients receiving antiretroviral therapy. However, the impact of these initiatives may be challenged by increased inefficiencies along the viral load testing spectrum. This will translate to increased costs and ineffectiveness of scale-up approaches. This review describes different parameters that could be addressed across the viral load testing spectrum aimed at improving efficiencies and utilizing test results for patient management. Though progress is being made in some countries to scale-up viral load, many others still face numerous challenges that may affect scale-up efficiencies: weak demand creation, ineffective supply chain management systems; poor specimen referral systems; inadequate data and quality management systems; and weak laboratory-clinical interface leading to diminished uptake of test results. In scaling up access to viral load testing, there should be a renewed focus to address efficiencies across the entire spectrum, including factors related to access, uptake, and impact of test results.

Applications for radio-frequency identification technology in the perioperative setting.

PubMed

Zhao, Tiyu; Zhang, Xiaoxiang; Zeng, Lili; Xia, Shuyan; Hinton, Antentor Othrell; Li, Xiuyun

2014-06-01

We implemented a two-year project to develop a security-gated management system for the perioperative setting using radio-frequency identification (RFID) technology to enhance the management efficiency of the OR. We installed RFID readers beside the entrances to the OR and changing areas to receive and process signals from the RFID tags that we sewed into surgical scrub attire and shoes. The system also required integrating automatic access control panels, computerized lockers, light-emitting diode (LED) information screens, wireless networks, and an information system. By doing this, we are able to control the flow of personnel and materials more effectively, reduce OR costs, optimize the registration and attire-changing process for personnel, and improve management efficiency. We also anticipate this system will improve patient safety by reducing the risk of surgical site infection. Application of security-gated management systems is an important and effective way to help ensure a clean, convenient, and safe management process to manage costs in the perioperative area and promote patient safety. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

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.

Drug residues in urban water: A database for ecotoxicological risk management.

PubMed

Destrieux, Doriane; Laurent, François; Budzinski, Hélène; Pedelucq, Julie; Vervier, Philippe; Gerino, Magali

2017-12-31

Human-use drug residues (DR) are only partially eliminated by waste water treatment plants (WWTPs), so that residual amounts can reach natural waters and cause environmental hazards. In order to properly manage these hazards in the aquatic environment, a database is made available that integrates the concentration ranges for DR, which cause adverse effects for aquatic organisms, and the temporal variations of the ecotoxicological risks. To implement this database for the ecotoxicological risk assessment (ERA database), the required information for each DR is the predicted no effect concentrations (PNECs), along with the predicted environmental concentrations (PECs). The risk assessment is based on the ratio between the PNECs and the PECs. Adverse effect data or PNECs have been found in the publicly available literature for 45 substances. These ecotoxicity test data have been extracted from 125 different sources. This ERA database contains 1157 adverse effect data and 287 PNECs. The efficiency of this ERA database was tested with a data set coming from a simultaneous survey of WWTPs and the natural environment. In this data set, 26 DR were searched for in two WWTPs and in the river. On five sampling dates, concentrations measured in the river for 10 DR could pose environmental problems of which 7 were measured only downstream of WWTP outlets. From scientific literature and measurements, data implementation with unit homogenisation in a single database facilitates the actual ecotoxicological risk assessment, and may be useful for further risk coming from data arising from the future field survey. Moreover, the accumulation of a large ecotoxicity data set in a single database should not only improve knowledge of higher risk molecules but also supply an objective tool to help the rapid and efficient evaluation of the risk. Copyright © 2017 Elsevier B.V. All rights reserved.

Traceability System For Agricultural Productsbased on Rfid and Mobile Technology

NASA Astrophysics Data System (ADS)

Sugahara, Koji

In agriculture, it is required to establish and integrate food traceability systems and risk management systems in order to improve food safety in the entire food chain. The integrated traceability system for agricultural products was developed, based on innovative technology of RFID and mobile computing. In order to identify individual products on the distribution process efficiently,small RFID tags with unique ID and handy RFID readers were applied. On the distribution process, the RFID tags are checked by using the readers, and transit records of the products are stored to the database via wireless LAN.Regarding agricultural production, the recent issues of pesticides misuse affect consumer confidence in food safety. The Navigation System for Appropriate Pesticide Use (Nouyaku-navi) was developed, which is available in the fields by Internet cell-phones. Based on it, agricultural risk management systems have been developed. These systems collaborate with traceability systems and they can be applied for process control and risk management in agriculture.

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.

A review of health and safety leadership and managerial practices on modern dairy farms.

PubMed

Hagevoort, G Robert; Douphrate, David I; Reynolds, Stephen J

2013-01-01

As modern dairy operations around the world expand, farmers are increasingly reliant on greater automation and larger numbers of hired labor to milk cows and perform other essential farm tasks. Dairy farming is among the most dangerous occupations, with high rates of injury, illness, and employee turnover. Lower education levels, illiteracy, and limited language proficiency increase the possibility of injury or death associated with higher risk occupations such as dairy. Sustaining a healthy, productive workforce is a critical component of risk management; however, many owners and managers have not received formal training in employee management or occupational health and safety. Optimal dairy farming management should address milk production that is sustainable and responsible from the animal welfare, social, economic, and environmental perspectives. Each of these aspects is interdependent with each other and with a sustainable, healthy, productive workforce. Very few studies address the effectiveness of risk management in the dairy industry. Studies suggest that labor management practices are a potential competitive advantage for dairy farms, but the connection with efficiency, productivity, and profitability has not been clearly demonstrated. Transformational leadership has been associated with improved safety climate and reduced incidence of injury, whereas passive leadership styles have opposite effects. There is a need to develop and evaluate the effectiveness of safety-specific transformational leadership among dairy owners and managers. A systematic approach to risk management should address worker health and safety as an integral component of production, food safety, and animal welfare. A successful program must address the cultural and linguistic barriers associated with immigrant workers.

Time-varying long term memory in the European Union stock markets

NASA Astrophysics Data System (ADS)

Sensoy, Ahmet; Tabak, Benjamin M.

2015-10-01

This paper proposes a new efficiency index to model time-varying inefficiency in stock markets. We focus on European stock markets and show that they have different degrees of time-varying efficiency. We observe that the 2008 global financial crisis has an adverse effect on almost all EU stock markets. However, the Eurozone sovereign debt crisis has a significant adverse effect only on the markets in France, Spain and Greece. For the late members, joining EU does not have a uniform effect on stock market efficiency. Our results have important implications for policy makers, investors, risk managers and academics.

Reducing Transaction Costs for Energy Efficiency Investments and Analysis of Economic Risk Associated With Building Performance Uncertainties: Small Buildings and Small Portfolios Program

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

Langner, R.; Hendron, B.; Bonnema, E.

2014-08-01

The small buildings and small portfolios (SBSP) sector face a number of barriers that inhibit SBSP owners from adopting energy efficiency solutions. This pilot project focused on overcoming two of the largest barriers to financing energy efficiency in small buildings: disproportionately high transaction costs and unknown or unacceptable risk. Solutions to these barriers can often be at odds, because inexpensive turnkey solutions are often not sufficiently tailored to the unique circumstances of each building, reducing confidence that the expected energy savings will be achieved. To address these barriers, NREL worked with two innovative, forward-thinking lead partners, Michigan Saves and Energi,more » to develop technical solutions that provide a quick and easy process to encourage energy efficiency investments while managing risk. The pilot project was broken into two stages: the first stage focused on reducing transaction costs, and the second stage focused on reducing performance risk. In the first stage, NREL worked with the non-profit organization, Michigan Saves, to analyze the effects of 8 energy efficiency measures (EEMs) on 81 different baseline small office building models in Holland, Michigan (climate zone 5A). The results of this analysis (totaling over 30,000 cases) are summarized in a simple spreadsheet tool that enables users to easily sort through the results and find appropriate small office EEM packages that meet a particular energy savings threshold and are likely to be cost-effective.« less

Impact of food processing and detoxification treatments on mycotoxin contamination.

PubMed

Karlovsky, Petr; Suman, Michele; Berthiller, Franz; De Meester, Johan; Eisenbrand, Gerhard; Perrin, Irène; Oswald, Isabelle P; Speijers, Gerrit; Chiodini, Alessandro; Recker, Tobias; Dussort, Pierre

2016-11-01

Mycotoxins are fungal metabolites commonly occurring in food, which pose a health risk to the consumer. Maximum levels for major mycotoxins allowed in food have been established worldwide. Good agricultural practices, plant disease management, and adequate storage conditions limit mycotoxin levels in the food chain yet do not eliminate mycotoxins completely. Food processing can further reduce mycotoxin levels by physical removal and decontamination by chemical or enzymatic transformation of mycotoxins into less toxic products. Physical removal of mycotoxins is very efficient: manual sorting of grains, nuts, and fruits by farmers as well as automatic sorting by the industry significantly lowers the mean mycotoxin content. Further processing such as milling, steeping, and extrusion can also reduce mycotoxin content. Mycotoxins can be detoxified chemically by reacting with food components and technical aids; these reactions are facilitated by high temperature and alkaline or acidic conditions. Detoxification of mycotoxins can also be achieved enzymatically. Some enzymes able to transform mycotoxins naturally occur in food commodities or are produced during fermentation but more efficient detoxification can be achieved by deliberate introduction of purified enzymes. We recommend integrating evaluation of processing technologies for their impact on mycotoxins into risk management. Processing steps proven to mitigate mycotoxin contamination should be used whenever necessary. Development of detoxification technologies for high-risk commodities should be a priority for research. While physical techniques currently offer the most efficient post-harvest reduction of mycotoxin content in food, biotechnology possesses the largest potential for future developments.

Verification of recursive probabilistic integration (RPI) method for fatigue life management using non-destructive inspections

NASA Astrophysics Data System (ADS)

Chen, Tzikang J.; Shiao, Michael

2016-04-01

This paper verified a generic and efficient assessment concept for probabilistic fatigue life management. The concept is developed based on an integration of damage tolerance methodology, simulations methods1, 2, and a probabilistic algorithm RPI (recursive probability integration)3-9 considering maintenance for damage tolerance and risk-based fatigue life management. RPI is an efficient semi-analytical probabilistic method for risk assessment subjected to various uncertainties such as the variability in material properties including crack growth rate, initial flaw size, repair quality, random process modeling of flight loads for failure analysis, and inspection reliability represented by probability of detection (POD). In addition, unlike traditional Monte Carlo simulations (MCS) which requires a rerun of MCS when maintenance plan is changed, RPI can repeatedly use a small set of baseline random crack growth histories excluding maintenance related parameters from a single MCS for various maintenance plans. In order to fully appreciate the RPI method, a verification procedure was performed. In this study, MC simulations in the orders of several hundred billions were conducted for various flight conditions, material properties, and inspection scheduling, POD and repair/replacement strategies. Since the MC simulations are time-consuming methods, the simulations were conducted parallelly on DoD High Performance Computers (HPC) using a specialized random number generator for parallel computing. The study has shown that RPI method is several orders of magnitude more efficient than traditional Monte Carlo simulations.

[Investigation into the capacity for risk identification, assessment, and mitigation in managing public health emergencies in China].

PubMed

Hu, Guo-qing; Rao, Ke-qin; Sun, Zhen-qiu

2007-08-01

To investigate the capacity for risk identification, assessment, and mitigation in public health emergency management in China. Four provinces were randomly selected using stratified sampling. All the municipalities under these four provinces were assessed using the 3rd subscale (Risk Identification, Risk Assessment, and Risk Mitigation) of Preparedness and Response Capacity Questionnaire for Public Health Emergencies Used in Provincial or Municipal Governments, which was developed by the Center for Health Statistics and Information, Ministry of Health of the People's Republic of China. Sixty of 66 questionnaires (90.91%) were collected. Among 60 investigated municipalities, 35 (58%) identified the potential public health emergencies, 17 (28%) assessed the risks for the identified emergencies, and 5 (8%) conducted risk assessments for the locally accident-prone factories, mines, corporations, and big establishments, 6 (10%) identified the priorities in public health emergency management based on risk assessment, 6 (10%) developed special prevention strategies for main public health emergencies, 3 (5%) assessed the vulnerability of local residents to public health emergencies, and 34 (57%) assessed or were assessing the preparedness and response capacity for public health emergencies in the past 2 years. The mean of standard total score for risk identification, assessment, and mitigation was 24.05 (95% CI: 18.32, 29.77). Risk identification, assessment, and mitigation still require further improvement in China, and both the central and local authorities should implement more effective and efficient measures.

[Seclusion and mechanical restraints in psychiatric care: Prescriptions procedures, pharmacological management, and monitoring].

PubMed

Tezenas du Montcel, Chloé; Kowal, Célia; Leherle, Audrey; Kabbaj, Soraya; Frajerman, Ariel; Le Guen, Emmanuel; Hamdani, Nora; Schürhoff, Franck; Leboyer, Marion; Pelissolo, Antoine; Pignon, Baptiste

2018-04-18

We will briefly summarize the French recommendations concerning the use of seclusion and mechanical restraint. Acute agitation and aggression or self-injurious activity during psychotic and manic episodes are the main indication of prescription of the coercive measures. Their prescriptions respect specific modalities that will be explained. Although they proved to be efficient, seclusion and restrain need to stay a last resort option, considering the risk of physical complications and psychological consequences. Specific pharmacological prescription will necessarily be associated with coercive measures and we present prescription guidelines. Finally, physical complications need to be prevented and we submit specific protocol concerning constipation and thromboembolic risk management. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

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?

Predicting long-term performance of engineered geologic carbon dioxide storage systems to inform decisions amidst uncertainty

NASA Astrophysics Data System (ADS)

Pawar, R.

2016-12-01

Risk assessment and risk management of engineered geologic CO2 storage systems is an area of active investigation. The potential geologic CO2 storage systems currently under consideration are inherently heterogeneous and have limited to no characterization data. Effective risk management decisions to ensure safe, long-term CO2 storage requires assessing and quantifying risks while taking into account the uncertainties in a storage site's characteristics. The key decisions are typically related to definition of area of review, effective monitoring strategy and monitoring duration, potential of leakage and associated impacts, etc. A quantitative methodology for predicting a sequestration site's long-term performance is critical for making key decisions necessary for successful deployment of commercial scale geologic storage projects where projects will require quantitative assessments of potential long-term liabilities. An integrated assessment modeling (IAM) paradigm which treats a geologic CO2 storage site as a system made up of various linked subsystems can be used to predict long-term performance. The subsystems include storage reservoir, seals, potential leakage pathways (such as wellbores, natural fractures/faults) and receptors (such as shallow groundwater aquifers). CO2 movement within each of the subsystems and resulting interactions are captured through reduced order models (ROMs). The ROMs capture the complex physical/chemical interactions resulting due to CO2 movement and interactions but are computationally extremely efficient. The computational efficiency allows for performing Monte Carlo simulations necessary for quantitative probabilistic risk assessment. We have used the IAM to predict long-term performance of geologic CO2 sequestration systems and to answer questions related to probability of leakage of CO2 through wellbores, impact of CO2/brine leakage into shallow aquifer, etc. Answers to such questions are critical in making key risk management decisions. A systematic uncertainty quantification approach can been used to understand how uncertain parameters associated with different subsystems (e.g., reservoir permeability, wellbore cement permeability, wellbore density, etc.) impact the overall site performance predictions.

A Proposed Approach for Screening Level Assessment of Risk to Songbird Populations from Pesticide Application in Cotton Fields

EPA Science Inventory

Due to complex population dynamics and migration behaviors, the well-being of animal populations that host human diseases sometimes varies across landscapes in ways that cannot be deduced from geographic abundance patterns alone. In such cases, efficient management of ecologica...

Brent Olson - Director, Office of Internal Audit | NREL

Science.gov Websites

improve the effectiveness and efficiency of governance, risk management, and control processes. Using this the Treadway Commission's 2013 Internal Control Framework, Standards for Internal Control in the additional certifications from IIA including Certified Internal Auditor (CIA); Certification in Control Self

Innovation & Risk Management Result in Energy and Life-Cycle Savings.

ERIC Educational Resources Information Center

Anstrand, David E.; Singh, J. B.

1999-01-01

Examines a Pennsylvania school's successful planning, design, and bidding process for acquiring a geothermal heat pump (GHP)system whose subsequent efficiency became award-winning for environmental excellence. Charts and statistical tables describe the GHP's energy savings. Concluding comments review the lessons learned from the process. (GR)

An Integrated Approach to Thermal Management of International Space Station Logistics Flights, Improving the Efficiency

NASA Technical Reports Server (NTRS)

Holladay, Jon; Day, Greg; Roberts, Barry; Leahy, Frank

2003-01-01

The efficiency of re-useable aerospace systems requires a focus on the total operations process rather than just orbital performance. For the Multi-Purpose Logistics Module this activity included special attention to terrestrial conditions both pre-launch and post-landing and how they inter-relate to the mission profile. Several of the efficiencies implemented for the MPLM Mission Engineering were NASA firsts and all served to improve the overall operations activities. This paper will provide an explanation of how various issues were addressed and the resulting solutions. Topics range from statistical analysis of over 30 years of atmospheric data at the launch and landing site to a new approach for operations with the Shuttle Carrier Aircraft. In each situation the goal was to "tune" the thermal management of the overall flight system for minimizing requirement risk while optimizing power and energy performance.

Nanoparticle risk management and cost evaluation: a general framework

NASA Astrophysics Data System (ADS)

Fleury, Dominique; Bomfim, João A. S.; Metz, Sébastien; Bouillard, Jacques X.; Brignon, Jean-Marc

2011-07-01

Industrial production of nano-objects has been growing fast during the last decade and a wide range of products containing nanoparticles (NPs) is proposed to the public in various markets (automotive, electronics, textiles...). The issues encountered in monitoring the presence of nano-objects in any media cause a major difficulty for controlling the risk associated to the production stage. It is therefore very difficult to assess the efficiency of prevention and mitigation solutions, which potentially leads to overestimate the level of the protection barriers that are recommended. The extra costs in adding nano-objects to the process, especially that of nanosafety, must be estimated and optimized to ensure the competitiveness of the future production lines and associated products. The risk management and cost evaluation methods presented herein have been designed for application in a pilot production line of injection-moulded nanocomposites.

[Role of socio-economy and management in sustainable transmission control of schistosomiasis in Taoyuan County, Hunan Province, China].

PubMed

Luo, Zhi-Hong; Li, Sheng-Ming; Zhou, Xiao-Nong; Yi, Ping; Ren, Guang-Hui; Franziska, Bieri; Zhao, Zheng-Yuan; Hou, Xun-Ya; Ren, Mao-Yuan; Li, Yi-Yi; Dong, Ru-Lan; Zeng, Jin-Yuan; She, Shu-Ping

2013-02-01

To clarify the role of socio-economy and management in the sustainable schistosomiasis-control in Taoyuan County, an endemic area in hilly region, Hunan Province, China. From 1996 to 2011, the data of socio-economy, the management of schistosomiasis control organizations, environment, and the changes in schistosomiasis prevalence were collected in Taoyuan County where schistosomiasis transmission had been controlled since 2008. A sampling survey of schistosomiasis prevalence of human and bovine was performed in 2011 to verify the current status of schistosomiasis transmission. All the data were analyzed statistically to evaluate the role of socio-economy and management in the sustainable schistosomiasis control. During the period from 1998 to 2012, the socio-economy including the residents' productive mode and daily life in Taoyuan County improved dramatically, but the recurrence risk of schistosomiasis endemic still existed due to the retuning of out-going workers and the migrating population. Moreover, the introduction of exotic species of plants and animals may increase the risk. The low running cost of schistosomiasis control organization as well as the efficient and adequate resource allocation in the county was in line with the national requirement to strengthen the rural grass-roots public health system. The harmonious development of socio-economy and the scientific and efficient health system in Taoyuan County are the key factors for the sustainable transmission control of schistosomiasis.

Scope for improved eco-efficiency varies among diverse cropping systems.

PubMed

Carberry, Peter S; Liang, Wei-li; Twomlow, Stephen; Holzworth, Dean P; Dimes, John P; McClelland, Tim; Huth, Neil I; Chen, Fu; Hochman, Zvi; Keating, Brian A

2013-05-21

Global food security requires eco-efficient agriculture to produce the required food and fiber products concomitant with ecologically efficient use of resources. This eco-efficiency concept is used to diagnose the state of agricultural production in China (irrigated wheat-maize double-cropping systems), Zimbabwe (rainfed maize systems), and Australia (rainfed wheat systems). More than 3,000 surveyed crop yields in these three countries were compared against simulated grain yields at farmer-specified levels of nitrogen (N) input. Many Australian commercial wheat farmers are both close to existing production frontiers and gain little prospective return from increasing their N input. Significant losses of N from their systems, either as nitrous oxide emissions or as nitrate leached from the soil profile, are infrequent and at low intensities relative to their level of grain production. These Australian farmers operate close to eco-efficient frontiers in regard to N, and so innovations in technologies and practices are essential to increasing their production without added economic or environmental risks. In contrast, many Chinese farmers can reduce N input without sacrificing production through more efficient use of their fertilizer input. In fact, there are real prospects for the double-cropping systems on the North China Plain to achieve both production increases and reduced environmental risks. Zimbabwean farmers have the opportunity for significant production increases by both improving their technical efficiency and increasing their level of input; however, doing so will require improved management expertise and greater access to institutional support for addressing the higher risks. This paper shows that pathways for achieving improved eco-efficiency will differ among diverse cropping systems.

Scope for improved eco-efficiency varies among diverse cropping systems

PubMed Central

Carberry, Peter S.; Liang, Wei-li; Twomlow, Stephen; Holzworth, Dean P.; Dimes, John P.; McClelland, Tim; Huth, Neil I.; Chen, Fu; Hochman, Zvi; Keating, Brian A.

2013-01-01

Global food security requires eco-efficient agriculture to produce the required food and fiber products concomitant with ecologically efficient use of resources. This eco-efficiency concept is used to diagnose the state of agricultural production in China (irrigated wheat–maize double-cropping systems), Zimbabwe (rainfed maize systems), and Australia (rainfed wheat systems). More than 3,000 surveyed crop yields in these three countries were compared against simulated grain yields at farmer-specified levels of nitrogen (N) input. Many Australian commercial wheat farmers are both close to existing production frontiers and gain little prospective return from increasing their N input. Significant losses of N from their systems, either as nitrous oxide emissions or as nitrate leached from the soil profile, are infrequent and at low intensities relative to their level of grain production. These Australian farmers operate close to eco-efficient frontiers in regard to N, and so innovations in technologies and practices are essential to increasing their production without added economic or environmental risks. In contrast, many Chinese farmers can reduce N input without sacrificing production through more efficient use of their fertilizer input. In fact, there are real prospects for the double-cropping systems on the North China Plain to achieve both production increases and reduced environmental risks. Zimbabwean farmers have the opportunity for significant production increases by both improving their technical efficiency and increasing their level of input; however, doing so will require improved management expertise and greater access to institutional support for addressing the higher risks. This paper shows that pathways for achieving improved eco-efficiency will differ among diverse cropping systems. PMID:23671071

Simulating long-term effectiveness and efficiency of management scenarios for an invasive grass

USGS Publications Warehouse

Jarnevich, Catherine S.; Holcombe, Tracy R.; Cullinane Thomas, Catherine; Frid, Leonardo; Olsson, Aaryn D.

2015-01-01

Resource managers are often faced with trade-offs in allocating limited resources to manage plant invasions. These decisions must often be made with uncertainty about the location of infestations, their rate of spread and effectiveness of management actions. Landscape level simulation tools such as state-and-transition simulation models (STSMs) can be used to evaluate the potential long term consequences of alternative management strategies and help identify those strategies that make efficient use of resources. We analyzed alternative management scenarios for African buffelgrass (Pennisetum ciliare syn. Cenchrus ciliaris) at Ironwood Forest National Monument, Arizona using a spatially explicit STSM implemented in the Tool for Exploratory Landscape Scenario Analyses (TELSA). Buffelgrass is an invasive grass that is spreading rapidly in the Sonoran Desert, affecting multiple habitats and jurisdictions. This invasion is creating a novel fire risk and transforming natural ecosystems. The model used in this application incorporates buffelgrass dispersal and establishment and management actions and effectiveness including inventory, treatment and post-treatment maintenance. We simulated 11 alternative scenarios developed in consultation with buffelgrass managers and other stakeholders. The scenarios vary according to the total budget allocated for management and the allocation of that budget between different kinds of management actions. Scenario results suggest that to achieve an actual reduction and stabilization of buffelgrass populations, management unconstrained by fiscal restrictions and across all jurisdictions and private lands is required; without broad and aggressive management, buffelgrass populations are expected to increase over time. However, results also suggest that large upfront investments can achieve control results that require relatively minimal spending in the future. Investing the necessary funds upfront to control the invasion results in the most efficient use of resources to achieve lowest invaded acreage in the long-term.

A data-driven approach to quality risk management.

PubMed

Alemayehu, Demissie; Alvir, Jose; Levenstein, Marcia; Nickerson, David

2013-10-01

An effective clinical trial strategy to ensure patient safety as well as trial quality and efficiency involves an integrated approach, including prospective identification of risk factors, mitigation of the risks through proper study design and execution, and assessment of quality metrics in real-time. Such an integrated quality management plan may also be enhanced by using data-driven techniques to identify risk factors that are most relevant in predicting quality issues associated with a trial. In this paper, we illustrate such an approach using data collected from actual clinical trials. Several statistical methods were employed, including the Wilcoxon rank-sum test and logistic regression, to identify the presence of association between risk factors and the occurrence of quality issues, applied to data on quality of clinical trials sponsored by Pfizer. ONLY A SUBSET OF THE RISK FACTORS HAD A SIGNIFICANT ASSOCIATION WITH QUALITY ISSUES, AND INCLUDED: Whether study used Placebo, whether an agent was a biologic, unusual packaging label, complex dosing, and over 25 planned procedures. Proper implementation of the strategy can help to optimize resource utilization without compromising trial integrity and patient safety.

Flood risk change in some European, African and Asian catchments

NASA Astrophysics Data System (ADS)

Kreibich, Heidi

2017-04-01

In light of the expected increase of flood risk in large parts of the world due to climate change and globally increasing exposure, efficient integrated flood risk management needs to be implemented. Societies learn from floods, and consequently improve their risk management. Such learning can occur through 'focusing events', i.e. events that provide a sudden, strong push for action. For example, the 1953 North Sea flood triggered the Delta Works in The Netherlands and the construction of the Thames Barrier. We show how societies have learnt from focusing events in river systems, by a semi-quantitative assessment of eight paired flood events around the world, i.e. consecutive floods that occurred in the same catchments, with the second flood causing significantly lower damage. We unravel the main mechanisms underlying these eight success stories of risk reduction. Across all case studies, we find that lower damage caused by the second event was mainly due to significant reductions in vulnerability. The role of changes in exposure is less apparent; positive and negative changes are reported. In some cases, significant investments in flood protection between the floods have played a large role in exposure and damage reduction. Reduction of vulnerability seems to be a key for better risk reduction via integrated flood risk management. Thus, we need to redouble efforts to improve our understanding of vulnerability.

Organizational Determinants of Workplace Violence Against Hospital Workers.

PubMed

Arnetz, Judith; Hamblin, Lydia E; Sudan, Sukhesh; Arnetz, Bengt

2018-04-17

To identify organizational factors contributing to workplace violence in hospitals. A questionnaire survey was conducted in 2013 among employees in a Midwestern hospital system (n = 446 respondents). Questions concerned employees' experiences of violence at work in the previous year and perceptions of the organizational safety climate. Logistic regressions examined staff interaction and safety climate factors associated with verbal and physical violence, respectively. Interpersonal conflict was a risk factor for verbal violence (OR 1.49, 95% CI 1.04-2.12, p < .05) and low work efficiency was a risk factor for physical violence (OR .98, 0.97-0.99). A poor violence prevention climate was a risk factor for verbal (OR 0.48, 0.36-0.65, p < .001) and physical (OR 0.60, 0.45-0.82, p < .05) violence. Interventions should aim at improving coworker relationships, work efficiency, and management promotion of the hospital violence prevention climate.

Evaluating nanotechnology opportunities and risks through integration of life-cycle and risk assessment.

PubMed

Tsang, Michael P; Kikuchi-Uehara, Emi; Sonnemann, Guido W; Aymonier, Cyril; Hirao, Masahiko

2017-08-04

It has been some 15 years since the topics of sustainability and nanotechnologies first appeared together in the scientific literature and became a focus of organizations' research and policy developments. On the one hand, this focus is directed towards approaches and tools for risk assessment and management and on the other hand towards life-cycle thinking and assessment. Comparable to their application for regular chemicals, each tool is seen to serve separate objectives as it relates to evaluating nanotechnologies' safety or resource efficiency, respectively. While nanomaterials may provide resource efficient production and consumption, this must balance any potential hazards they pose across their life-cycles. This Perspective advocates for integrating these two tools at the methodological level for achieving this objective, and it explains what advantages and challenges this offers decision-makers while highlighting what research is needed to further enhance integration.

Global case management: Scotland. Real-time monitoring of patient flow as an instrument to optimize quality of care in acute receiving units.

PubMed

Thuemmler, Christoph; Morris, Carole

2005-01-01

Recent audits within our hospital suggest that especially during peak phases the patient flow from our acute admission units downstream into hospital beds is not directed in the most efficient way and patients may be placed inappropriately. This inevitably causes time delays and potentially increases the risk of malpractice as patients have to spend an extended period of time in admission areas with a high workload and very busy staff. Using latest information technology, such as wireless local area networks and handheld devices, can improve the efficiency of patient management and can increase the quality of care by helping to avoid unnecessary treatment delays in overcrowded admission areas.

Evaluation of advanced cooling therapy's esophageal cooling device for core temperature control.

PubMed

Naiman, Melissa; Shanley, Patrick; Garrett, Frank; Kulstad, Erik

2016-05-01

Managing core temperature is critical to patient outcomes in a wide range of clinical scenarios. Previous devices designed to perform temperature management required a trade-off between invasiveness and temperature modulation efficiency. The Esophageal Cooling Device, made by Advanced Cooling Therapy (Chicago, IL), was developed to optimize warming and cooling efficiency through an easy and low risk procedure that leverages heat transfer through convection and conduction. Clinical data from cardiac arrest, fever, and critical burn patients indicate that the Esophageal Cooling Device performs very well both in terms of temperature modulation (cooling rates of approximately 1.3°C/hour, warming of up to 0.5°C/hour) and maintaining temperature stability (variation around goal temperature ± 0.3°C). Physicians have reported that device performance is comparable to the performance of intravascular temperature management techniques and superior to the performance of surface devices, while avoiding the downsides associated with both.

Risk assessment of sewer condition using artificial intelligence tools: application to the SANEST sewer system.

PubMed

Sousa, V; Matos, J P; Almeida, N; Saldanha Matos, J

2014-01-01

Operation, maintenance and rehabilitation comprise the main concerns of wastewater infrastructure asset management. Given the nature of the service provided by a wastewater system and the characteristics of the supporting infrastructure, technical issues are relevant to support asset management decisions. In particular, in densely urbanized areas served by large, complex and aging sewer networks, the sustainability of the infrastructures largely depends on the implementation of an efficient asset management system. The efficiency of such a system may be enhanced with technical decision support tools. This paper describes the role of artificial intelligence tools such as artificial neural networks and support vector machines for assisting the planning of operation and maintenance activities of wastewater infrastructures. A case study of the application of this type of tool to the wastewater infrastructures of Sistema de Saneamento da Costa do Estoril is presented.

Estimation and evaluation of management options to control and/or reduce the risk of not complying with commercial sterility.

PubMed

Pujol, Laure; Albert, Isabelle; Magras, Catherine; Johnson, Nicholas Brian; Membré, Jeanne-Marie

2015-11-20

In a previous study, a modular process risk model, from the raw material reception to the final product storage, was built to estimate the risk of a UHT-aseptic line of not complying with commercial sterility (Pujol et al., 2015). This present study was focused on demonstrating how the model (updated version with uncertainty and variability separated and 2(nd) order Monte Carlo procedure run) could be used to assess quantitatively the influence of management options. This assessment was done in three steps: pinpoint which process step had the highest influence on the risk, identify which management option(s) could be the most effective to control and/or reduce the risk, and finally evaluate quantitatively the influence of changing process setting(s) on the risk. For Bacillus cereus, it was identified that during post-process storage in an aseptic tank, there was potentially an air re-contamination due to filter efficiency loss (efficiency loss due to successive in-place sterilizations after cleaning operations), followed by B. cereus growth. Two options were then evaluated: i) reducing by one fifth of the number of filter sterilizations before renewing the filters, ii) designing new UHT-aseptic lines without an aseptic tank, i.e. without a storage period after the thermal process and before filling. Considering the uncertainty in the model, it was not possible to confirm whether these options had a significant influence on the risk associated with B. cereus. On the other hand, for Geobacillus stearothermophilus, combinations of heat-treatment time and temperature enabling the control or reduction in risk by a factor of ca. 100 were determined; for ease of operational implementation, they were presented graphically in the form of iso-risk curves. For instance, it was established that a heat treatment of 138°C for 31s (instead of 138°C for 25s) enabled a reduction in risk to 18×10(-8) (95% CI=[10; 34]×10(-8)), instead of 578×10(-8) (95% CI=[429; 754]×10(-8)) initially. In conclusion, a modular risk model, as the one exemplified here with a UHT-aseptic line, is a valuable tool in process design and operation, bringing definitive quantitative elements into the decision making process. Copyright © 2015 Elsevier B.V. All rights reserved.

Guidelines for Risk-Based Changeover of Biopharma Multi-Product Facilities.

PubMed

Lynch, Rob; Barabani, David; Bellorado, Kathy; Canisius, Peter; Heathcote, Doug; Johnson, Alan; Wyman, Ned; Parry, Derek Willison

2018-01-01

In multi-product biopharma facilities, the protection from product contamination due to the manufacture of multiple products simultaneously is paramount to assure product quality. To that end, the use of traditional changeover methods (elastomer change-out, full sampling, etc.) have been widely used within the industry and have been accepted by regulatory agencies. However, with the endorsement of Quality Risk Management (1), the use of risk-based approaches may be applied to assess and continuously improve established changeover processes. All processes, including changeover, can be improved with investment (money/resources), parallel activities, equipment design improvements, and standardization. However, processes can also be improved by eliminating waste. For product changeover, waste is any activity not needed for the new process or that does not provide added assurance of the quality of the subsequent product. The application of a risk-based approach to changeover aligns with the principles of Quality Risk Management. Through the use of risk assessments, the appropriate changeover controls can be identified and controlled to assure product quality is maintained. Likewise, the use of risk assessments and risk-based approaches may be used to improve operational efficiency, reduce waste, and permit concurrent manufacturing of products. © PDA, Inc. 2018.

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.

Environmental Risk Assessment: Spatial Analysis of Chemical Hazards and Risks in South Korea

NASA Astrophysics Data System (ADS)

Yu, H.; Heo, S.; Kim, M.; Lee, W. K.; Jong-Ryeul, S.

2017-12-01

This study identified chemical hazard and risk levels in Korea by analyzing the spatial distribution of chemical factories and accidents. The number of chemical factories and accidents in 5-km2 grids were used as the attribute value for spatial analysis. First, semi-variograms were conducted to examine spatial distribution patterns and to identify spatial autocorrelation of chemical factories and accidents. Semi-variograms explained that the spatial distribution of chemical factories and accidents were spatially autocorrelated. Second, the results of the semi-variograms were used in Ordinary Kriging to estimate chemical hazard and risk level. The level values were extracted from the Ordinary Kriging result and their spatial similarity was examined by juxtaposing the two values with respect to their location. Six peaks were identified in both the hazard and risk estimation result, and the peaks correlated with major cities in Korea. Third, the estimated hazard and risk levels were classified with geometrical interval and could be classified into four quadrants: Low Hazard and Low Risk (LHLR), Low Hazard and High Risk (LHHR), High Hazard and Low Risk (HHLR), and High Hazard and High Risk (HHHR). The 4 groups identified different chemical safety management issues in Korea; relatively safe LHLR group, many chemical reseller factories were found in HHLR group, chemical transportation accidents were in the LHHR group, and an abundance of factories and accidents were in the HHHR group. Each quadrant represented different safety management obstacles in Korea, and studying spatial differences can support the establishment of an efficient risk management plan.

Informational system as an instrument for assessing the performance of the quality management system

NASA Astrophysics Data System (ADS)

Rohan, R.; Roşu, M. M.

2017-08-01

At present there is used a significant number of techniques and methods for diagnosis and management analysis which support the decision-making process. All these methods facilitate reaching the objectives for improving the results through efficiency, quality and customer satisfaction. By developing a methodology for analysing the problems identified in the macro-productive companies there can be brought outstanding benefits to the management and there are offered new perspectives on the critical influencing factors within a system. Through this paper we present an effective management strategy, applicable to an organization with productive profile in order to design an informational system aimed to manage one of its most important and complex systems, namely the coordination of the quality management system. The informational organisation of the quality management system on management principles, ensures an optimization of the informational energy consumption, allowing the management to deal with the following: to ascertain the current situation; to seize the opportunities, but also the potential risks afferent to the organisation policy; to observe the strengths and weaknesses; to take appropriate decisions and then to control the effects obtained. In this way, the decisional factors are able to better understand the available opportunities and to base more efficiently the process of choosing the alternatives.

Improving self-management of cancer risk factors, underscreening for cancer and depression among general practice patients: study protocol of a randomised controlled trial

PubMed Central

Carey, Mariko; Sanson-Fisher, Rob; Oldmeadow, Christopher; Mansfield, Elise; Walsh, Justin

2016-01-01

Introduction General practitioners have a key role in reducing cancer risk factors, screening for cancer and managing depression. Given the time-limited nature of consultations, a new and more time-efficient approach is needed which addresses multiple health needs simultaneously, and encourages patient self-management to address health risks. The aim of this cluster randomised controlled trial is to test the effectiveness of a patient feedback intervention in improving patient self-management of health needs related to smoking, risky alcohol consumption and underscreening for cancers at 1 month follow-up. Methods and analysis Adult general practice patients will be invited to participate in a baseline survey to assess cancer risk factors, screening needs and depression. A total of 360 participants identified by the baseline survey as having at least one health need (a self-reported cancer risk factor, underscreening for cancer, or an elevated depression score) will be randomised to an intervention or control group. Participants in the intervention group will receive tailored printed feedback summarising their identified health needs and recommended self-management actions to address these. All participants will be invited to complete a telephone interview 1 month following recruitment to assess self-management actions taken in relation to health needs identified in the baseline survey. Control group participants will receive tailored printed feedback on their identified health needs after their follow-up interview. A logistic regression model, with group allocation as the main predictor, will be used to assess the impact of the intervention on self-management actions. Ethical considerations and dissemination Participants identified as being at risk of depression will be advised to speak with their doctor. Results will be disseminated via publication in peer-reviewed journals. The study has been approved by the University of Newcastle Human Research Ethics Committee. Trial registration number ACTRN12616001443482. PMID:27864255

Alternatives: the right medicine for your portfolio?

PubMed

Doody, Dennis

2006-01-01

Because they often play an active role in developing their portfolio companies' strategies, private capital investment managers can add significant value to companies in their portfolio. The relative inefficiency of private capital markets can give savvy investors an edge that they can not so easily gain in the more efficient public markets. Originally created as a means to reduce volatility, hedge funds should not be seen as the high-risk bets that they are widely perceived to be. Most hedge funds actually are concerned with protecting downside risk.

Occupational safety and health in Japan: current situations and the future.

PubMed

Sakurai, Haruhiko

2012-01-01

The Industrial Safety and Health Law enacted in 1972 has contributed much to the progress of occupational safety and health (OSH) activities. Many indicators including death and illness statistics show continued improvement up to date. The establishment of OSH organization within enterprises and 5-yr administrative programs formulated by the Ministry of Health, Labour, and Welfare (MHLW) were important factors for satisfactory management. The past programs indicate that the weight of self regulation in comparison to legal control gradually increased since late 1990s. In spite of the past achievement, many hazards such as overwork, mental stress, chemical agents and others still remain to be prevented. The systematic risk assessment of unregulated chemicals by the MHLW proved to be an effective scheme for risk-based management and to deserve continued implementation. The size of human resources for OSH was estimated at 1.5 million. In view of the adverse effect on OSH by economic, social and political environment in the future, the importance of the efficiency of OSH management was indicated. Since the efficiency depends on the competence of OSH personnel and the level of scientific basis, it was concluded that the fundamental policy for the future should give high priority to education and research.

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

Knowledge communication: a key to successful crisis management.

PubMed

Johansson, Anders; Härenstam, Malin

2013-09-01

A winning concept of crisis management can be summarized in 2 words: knowledge communication. If decision makers, communicators, experts, and the public understand what the crisis is about and share their knowledge, the process of handling it will be optimized. Effective crisis communication implies the necessity of an unhindered but purposeful exchange of information within and between authorities, organizations, media, involved individuals, and groups before, during, and after a crisis. This article focuses on the importance of the before, or prevention, part of a crisis since it holds a rich possibility to enhance the chances for successful crisis management of a bioterrorism incident. An extended perspective on crisis communication efficiently links to a more thorough understanding of risk perception with various stakeholders and the public, which also will be helpful for situational awareness. Furthermore, the grounded baseline for the dialogue type of crisis communication suitable in modern society and to modern social media is achieved by linking to those risk communication efforts that are made. The link between risk and crisis should be afforded more attention since, especially in biosecurity, there would be no crisis without risk negligence and poor or malfunctioning preventive efforts.

Risk-based management of invading plant disease.

PubMed

Hyatt-Twynam, Samuel R; Parnell, Stephen; Stutt, Richard O J H; Gottwald, Tim R; Gilligan, Christopher A; Cunniffe, Nik J

2017-05-01

Effective control of plant disease remains a key challenge. Eradication attempts often involve removal of host plants within a certain radius of detection, targeting asymptomatic infection. Here we develop and test potentially more effective, epidemiologically motivated, control strategies, using a mathematical model previously fitted to the spread of citrus canker in Florida. We test risk-based control, which preferentially removes hosts expected to cause a high number of infections in the remaining host population. Removals then depend on past patterns of pathogen spread and host removal, which might be nontransparent to affected stakeholders. This motivates a variable radius strategy, which approximates risk-based control via removal radii that vary by location, but which are fixed in advance of any epidemic. Risk-based control outperforms variable radius control, which in turn outperforms constant radius removal. This result is robust to changes in disease spread parameters and initial patterns of susceptible host plants. However, efficiency degrades if epidemiological parameters are incorrectly characterised. Risk-based control including additional epidemiology can be used to improve disease management, but it requires good prior knowledge for optimal performance. This focuses attention on gaining maximal information from past epidemics, on understanding model transferability between locations and on adaptive management strategies that change over time. © 2017 The Authors. New Phytologist © 2017 New Phytologist Trust.

Controlling Legal Risk for Effective Hospital Management

PubMed Central

Park, Hyun Jun; Cho, Duk Young; Park, Yong Sug; Kim, Sun Wook; Park, Jae-Hong

2016-01-01

Purpose To analyze the types of medical malpractice, medical errors, and medical disputes in a university hospital for the proposal of countermeasures that maximize the efficiency of hospital management, medical departments, and healthcare providers. Materials and Methods This study retrospectively reviewed and analyzed 55 closed civil lawsuits among 64 medical lawsuit cases carried out in Pusan National University Hospital from January 2000 to April 2013 using medical records, petitions, briefs, and data from the Medical Dispute Mediation Committee. Results Of 55 civil lawsuits, men were the main plaintiffs in 31 cases (56.4%). The average period from medical malpractice to malpractice proceeding was 16.5 months (range, 1 month to 6.4 years), and the average period from malpractice proceeding to the disposition of a lawsuit was 21.7 months (range, 1 month to 4 years and 11 months). Conclusions Hospitals can effectively manage their legal risks by implementing a systematic medical system, eliminating risk factors in administrative service, educating all hospital employees on preventative strategies, and improving customer service. Furthermore, efforts should be made to establish standard coping strategies to manage medical disputes and malpractice lawsuits, operate alternative dispute resolution methods including the Medical Dispute Mediation Committee, create a compliance support center, deploy a specialized workforce including improved legal services for employees, and specialize the management-level tasks of the hospital. PMID:27169130

FEES: design of a Fire Economics Evaluation System

Treesearch

Thomas J. Mills; Frederick W. Bratten

1982-01-01

The Fire Economics Evaluation System (FEES)--a simulation model--is being designed for long-term planning application by all public agencies with wildland fire management responsibilities. A fully operational version of FEES will be capable of estimating the economic efficiency, fire-induced changes in resource outputs, and risk characteristics of a range of fire...

Other Perspectives for Developing Exposure Estimates: “SHEDS-Lite: Rapid Scenario-Based ExposurePredictions for Chemicals with Near-Field and Dietary Pathways”

EPA Science Inventory

Creative advances in exposure science are needed to support efficient and effective evaluation and management of chemical risks, particularly for chemicals in consumer products. This presentation will describe the development of EPA’s screening-level, probabilistic SHEDS-Li...

Preventing Stalled Quality Improvement Teams: A Written Test of Project Selectionability.

ERIC Educational Resources Information Center

Bacdayan, Paul

2002-01-01

Discusses organizations' use of quality improvement teams in total quality management and how they can benefit from training team personnel in how to select projects with a low risk of stalling. Describes an efficient written assessment test of project selection ability designed for those who conduct evaluations of training sessions. (Author/LRW)

Multiplicity in public health supply systems: a learning agenda.

PubMed

Bornbusch, Alan; Bates, James

2013-08-01

Supply chain integration-merging products for health programs into a single supply chain-tends to be the dominant model in health sector reform. However, multiplicity in a supply system may be justified as a risk management strategy that can better ensure product availability, advance specific health program objectives, and increase efficiency.

78 FR 5462 - Agency Information Collection Activities; Submission for Office of Management and Budget Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-25

... these decisionmaking processes will be applied by FDA to help design effective communication strategies..., beliefs, and behaviors--and use risk communications; (2) more efficiently and effectively design messages... provided about the design and methodology of the pretests and the studies to effectively comment on the...

Environmental Technology Verification: Biological Inactivation Efficiency by HVAC In-Duct Ultraviolet Light Systems--American Ultraviolet Corporation, DC24-6-120 [EPA600etv08005

EPA Science Inventory

The Air Pollution Control Technology Verification Center (APCT Center) is operated by RTI International (RTI), in cooperation with EPA's National Risk Management Research Laboratory. The APCT Center conducts verifications of technologies that clean air in ventilation systems, inc...

Developing the U.S. Wildland Fire Decision Support System

Treesearch

Erin Noonan-Wright; Tonja S. Opperman; Mark A. Finney; Tom Zimmerman; Robert C. Seli; Lisa M. Elenz; David E. Calkin; John R. Fiedler

2011-01-01

A new decision support tool, the Wildland Fire Decision Support System (WFDSS) has been developed to support risk-informed decision-making for individual fires in the United States. WFDSS accesses national weather data and forecasts, fire behavior prediction, economic assessment, smoke management assessment, and landscape databases to efficiently formulate and apply...

Impacts of Autonomous Adaptations on the Hydrological Drought Under Climate Change Condition

NASA Astrophysics Data System (ADS)

Oki, T.; Satoh, Y.; Pokhrel, Y. N.; KIM, H.; Yoshimura, K.

2014-12-01

Because of expected effects of climate changes on quantity and spatial distribution of available water resources, assessment of the changes in the balance between the demand and supply of water resources is critical for some regions. Historically, water deficiencies were overcome by planned water management such as dam regulation and irrigation. But only few studies have investigated the effect of anthropogenic factors on the risk of imbalance of water demand and supply under climate change conditions. Therefore, estimation of the potential deficiency in existing infrastructures under water-environment change is needed to support our society to adapt against future climate changes. This study aims to estimate the impacts of climate changes on the risk of water scarcity projected based on CMIP5 RCP scenarios and the efficiency of autonomous adaptation by anthropogenic water management, such as reservoir operation and irrigation using ground water. First, tendencies of the changes in water scarcity under climate change are estimated by an improved land surface model, which integrates natural water cycles and human activities. Second, the efficiencies of human-developed infrastructure are analyzed by comparing the naturalized and fully anthropogenic offline simulations. It was found that number of hydrological drought days will be increased and decreased in approximately 70 % and 24 % of global land, respectively, considering anthropogenic water management, however, they are approximately 82 % and 16 %, respectively, under naturalized condition without anthropogenic water management. The differences indicate how autonomous adaptation through anthropogenic water management can reduce the impacts of climate change. Also, adequate enhancement of infrastructure is necessary against expected water scarcity under climate change because such positive and negative effects of artificial water regulation show comparable impact on water scarcity risk to that of climate change in regions where human activity is significant, even if it is under the worst-case RCP8.5 scenario. More realistic assessment of the impacts of climate change on water resources and the cost estimation of how much economic investments are needed to maintain the current level of the risks of water scarcity are necessary.

Assessing knowledge, performance, and efficiency for hospital waste management-a comparison of government and private hospitals in Pakistan.

PubMed

Ali, Mustafa; Wang, Wenping; Chaudhry, Nawaz; Geng, Yong; Ashraf, Uzma

2017-04-01

Proper management of healthcare waste is a critical concern in many countries of the world. Rapid urbanization and population growth rates pose serious challenges to healthcare waste management infrastructure in such countries. This study was aimed at assessing the situation of hospital waste management in a major city of Pakistan. Simple random sampling was used to select 12 government and private hospitals in the city. Field visits, physical measurements, and questionnaire survey method were used for data collection. Information was obtained regarding hospital waste generation, segregation, collection, storage, transportation, and disposal. Data envelopment analysis (DEA) was used to classify the hospitals on the basis of their relative waste management efficiencies. The weighted average total waste generation at the surveyed hospitals was discovered to be 1.53 kg/patient/day of which 75.15% consisted of general waste and the remaining consisted of biomedical waste. Of the total waste, 24.54% came from the public hospital and the remaining came from the private hospitals. DEA showed that seven of the surveyed hospitals had scale or pure technical inefficiencies in their waste management activities. The public hospital was relatively less efficient than most of the private hospitals in these activities. Results of the questionnaire survey showed that none of the surveyed hospitals was carrying out waste management in strict compliance with government regulations. Moreover, hospital staff at all the surveyed hospitals had low level of knowledge regarding safe hospital waste management practices. The current situation should be rectified in order to avoid environmental and epidemiological risks.

Cities and “budget-based” management of the energy-water-climate nexus: Case studies in transportation policy, infrastructure systems, and urban utility risk management

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

Sperling, Joshua B.; Ramaswami, Anu

This article reviews city case studies to inform a framework for developing urban infrastructure design standards and policy instruments that together aim to pursue energy efficiency and greenhouse gas mitigation through city carbon budgets and water use efficiency and climate risk adaptation through city water budgets. Here, this article also proposes combining carbon and water budgeting at the city-scale for achieving successful coupled city carbon and water budget (CCCWB) programs. Under a CCCWB program, key actors including local governments, infrastructure designers/operators, and households would be assigned a GHG emissions and water 'budget' and be required by state or federal levelsmore » to keep within this budget through the use of flexibility mechanisms, incentive programs, and sanctions. Multiple incentives and cross-scale governance arrangements would be tied to energy-water systems integration, resource-efficient transportation and infrastructure development, and effective monitoring and management of energy use, emissions, climate risks to, and security of energy-water-transport-food and other critical systems. As a first step to promote strategies for CCCWB development, we systematically review approaches of and shortcomings to existing budget-based programs in the UK and US, and suggest improvements in three areas: measurement, modeling effectiveness of interventions for staying within a budget, and governance. To date, the majority of climate action or sustainability plans by cities, while mentioning climate impacts as a premise for the plan, do not address these impacts in the plan. They focus primarily on GHG mitigation while ignoring resource depletion challenges and energy-climate-water linkages, whereby water supplies can begin to limit energy production and energy shifts to mitigate climate change can limit water availability. Coupled carbon-water budget plans, programs, and policies - described in this study- may address these concerns as well as the emerging trends that will exacerbate these problems - e.g., including population growth, climatic changes, and emerging policy choices that are not coordinated. Cities and 'Budget-Based' Management of the Energy-Water-Climate Nexus: Case Studies to Inform Strategy for Integrated Performance- and Incentive-Based Design and Policy Instruments.« less

Towards more efficient burn care: Identifying factors associated with good quality of life post-burn.

PubMed

Finlay, V; Phillips, M; Allison, G T; Wood, F M; Ching, D; Wicaksono, D; Plowman, S; Hendrie, D; Edgar, D W

2015-11-01

As minor burn patients constitute the vast majority of a developed nation case-mix, streamlining care for this group can promote efficiency from a service-wide perspective. This study tested the hypothesis that a predictive nomogram model that estimates likelihood of good long-term quality of life (QoL) post-burn is a valid way to optimise patient selection and risk management when applying a streamlined model of care. A sample of 224 burn patients managed by the Burn Service of Western Australia who provided both short and long-term outcomes was used to estimate the probability of achieving a good QoL defined as 150 out of a possible 160 points on the Burn Specific Health Scale-Brief (BSHS-B) at least six months from injury. A multivariate logistic regression analysis produced a predictive model provisioned as a nomogram for clinical application. A second, independent cohort of consecutive patients (n=106) was used to validate the predictive merit of the nomogram. Male gender (p=0.02), conservative management (p=0.03), upper limb burn (p=0.04) and high BSHS-B score within one month of burn (p<0.001) were significant predictors of good outcome at six months and beyond. A Receiver Operating Curve (ROC) analysis demonstrated excellent (90%) accuracy overall. At 80% probability of good outcome, the false positive risk was 14%. The nomogram was validated by running a second ROC analysis of the model in an independent cohort. The analysis confirmed high (86%) overall accuracy of the model, the risk of false positive was reduced to 10% at a lower (70%) probability. This affirms the stability of the nomogram model in different patient groups over time. An investigation of the effect of missing data on sample selection determined that a greater proportion of younger patients with smaller TBSA burns were excluded due to loss to follow up. For clinicians managing comparable burn populations, the BSWA burns nomogram is an effective tool to assist the selection of patients to a streamlined care pathway with the aim of improving efficiency of service delivery. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Cities and “budget-based” management of the energy-water-climate nexus: Case studies in transportation policy, infrastructure systems, and urban utility risk management

DOE PAGES

Sperling, Joshua B.; Ramaswami, Anu

2017-11-03

This article reviews city case studies to inform a framework for developing urban infrastructure design standards and policy instruments that together aim to pursue energy efficiency and greenhouse gas mitigation through city carbon budgets and water use efficiency and climate risk adaptation through city water budgets. Here, this article also proposes combining carbon and water budgeting at the city-scale for achieving successful coupled city carbon and water budget (CCCWB) programs. Under a CCCWB program, key actors including local governments, infrastructure designers/operators, and households would be assigned a GHG emissions and water 'budget' and be required by state or federal levelsmore » to keep within this budget through the use of flexibility mechanisms, incentive programs, and sanctions. Multiple incentives and cross-scale governance arrangements would be tied to energy-water systems integration, resource-efficient transportation and infrastructure development, and effective monitoring and management of energy use, emissions, climate risks to, and security of energy-water-transport-food and other critical systems. As a first step to promote strategies for CCCWB development, we systematically review approaches of and shortcomings to existing budget-based programs in the UK and US, and suggest improvements in three areas: measurement, modeling effectiveness of interventions for staying within a budget, and governance. To date, the majority of climate action or sustainability plans by cities, while mentioning climate impacts as a premise for the plan, do not address these impacts in the plan. They focus primarily on GHG mitigation while ignoring resource depletion challenges and energy-climate-water linkages, whereby water supplies can begin to limit energy production and energy shifts to mitigate climate change can limit water availability. Coupled carbon-water budget plans, programs, and policies - described in this study- may address these concerns as well as the emerging trends that will exacerbate these problems - e.g., including population growth, climatic changes, and emerging policy choices that are not coordinated. Cities and 'Budget-Based' Management of the Energy-Water-Climate Nexus: Case Studies to Inform Strategy for Integrated Performance- and Incentive-Based Design and Policy Instruments.« less

Multihazard risk analysis and disaster planning for emergency services as a basis for efficient provision in the case of natural hazards - case study municipality of Au, Austria

NASA Astrophysics Data System (ADS)

Maltzkait, Anika; Pfurtscheller, Clemens

2014-05-01

Multihazard risk analysis and disaster planning for emergency services as a basis for efficient provision in the case of natural hazards - case study municipality of Au, Austria A. Maltzkait (1) & C. Pfurtscheller (1) (1) Institute for Interdisciplinary Mountain Research (IGF), Austrian Academy of Sciences, Innsbruck, Austria The extreme flood events of 2002, 2005 and 2013 in Austria underlined the importance of local emergency services being able to withstand and reduce the adverse impacts of natural hazards. Although for legal reasons municipal emergency and crisis management plans exist in Austria, they mostly do not cover risk analyses of natural hazards - a sound, comparable assessment to identify and evaluate risks. Moreover, total losses and operational emergencies triggered by natural hazards have increased in recent decades. Given sparse public funds, objective budget decisions are needed to ensure the efficient provision of operating resources, like personnel, vehicles and equipment in the case of natural hazards. We present a case study of the municipality of Au, Austria, which was hardly affected during the 2005 floods. Our approach is primarily based on a qualitative risk analysis, combining existing hazard plans, GIS data, field mapping and data on operational efforts of the fire departments. The risk analysis includes a map of phenomena discussed in a workshop with local experts and a list of risks as well as a risk matrix prepared at that workshop. On the basis for the exact requirements for technical and non-technical mitigation measures for each natural hazard risk were analysed in close collaboration with members of the municipal operation control and members of the local emergency services (fire brigade, Red Cross). The measures includes warning, evacuation and, technical interventions with heavy equipment and personnel. These results are used, first, to improve the municipal emergency and crisis management plan by providing a risk map, and a list of risks and, second, to check if the local emergency forces can cope with the different risk scenarios using locally available resources. The emergency response plans will identify possible resource deficiencies in personnel, vehicles and equipment. As qualitative methods and data are used, uncertainties in the study emerged in finding definitions for safety targets, in the construction of the different risk scenarios, in the inherent uncertainty beyond the probability of occurrence and the intensity of natural hazards, also in the case of the expectable losses. Finally, we used available studies and expert interviews to develop objective rules for investment decisions for the fire departments and the Red Cross to present an empirically sound basis for the efficient provision of intervention in the case of natural hazards for the municipality of Au. Again, the regulations for objective provision were developed in close collaboration with the emergency services.

A one health framework for estimating the economic costs of zoonotic diseases on society.

PubMed

Narrod, Clare; Zinsstag, Jakob; Tiongco, Marites

2012-06-01

This article presents an integrated epidemiological and economic framework for assessing zoonoses using a "one health" concept. The framework allows for an understanding of the cross-sector economic impact of zoonoses using modified risk analysis and detailing a range of analytical tools. The goal of the framework is to link the analysis outputs of animal and human disease transmission models, economic impact models and evaluation of risk management options to gain improved understanding of factors affecting the adoption of risk management strategies so that investment planning includes the most promising interventions (or sets of interventions) in an integrated fashion. A more complete understanding of the costs of the disease and the costs and benefits of control measures would promote broader implementation of the most efficient and effective control measures, contributing to improved animal and human health, better livelihood outcomes for the poor and macroeconomic growth.

Changes in nitrogen budget and potential risk to the environment over 20years (1990-2010) in the agroecosystems of the Haihe Basin, China.

PubMed

Zheng, Mengmeng; Zheng, Hua; Wu, Yingxia; Xiao, Yi; Du, Yihua; Xu, Weihua; Lu, Fei; Wang, Xiaoke; Ouyang, Zhiyun

2015-02-01

The nitrogen balance can serve as an indicator of the risk to the environment of nitrogen loss from agricultural land. To investigate the temporal and spatial changes in agricultural nitrogen application and its potential threat to the environment of the Haihe Basin in China, we used a database of county-level agricultural statistics to calculate agricultural nitrogen input, output, surplus intensity, and use efficiency. Chemical fertilizer nitrogen input increased by 51.7% from 1990 to 2000 and by 37.2% from 2000 to 2010, concomitant with increasing crop yields. Simultaneously, the nitrogen surplus intensity increased by 53.5% from 1990 to 2000 and by 16.5% from 2000 to 2010, presenting a continuously increased environmental risk. Nitrogen use efficiency decreased from 0.46 in 1990 to 0.42 in 2000 and remained constant at 0.42 in 2010, partly due to fertilizer composition and type improvement. This level indicates that more than half of nitrogen inputs are lost in agroecosystems. Our results suggest that although the improvement in fertilizer composition and types has partially offset the decrease in nitrogen use efficiency, the environmental risk has still increased gradually over the past 20 years, along with the increase in crop yields and nitrogen application. It is important to achieve a better nitrogen balance through more effective management to significantly reduce the environmental risk, decrease nitrogen surplus intensity, and increase nitrogen use efficiency without sacrificing crop yields. Copyright © 2014. Published by Elsevier B.V.

Development of hydrate risk quantification in oil and gas production

NASA Astrophysics Data System (ADS)

Chaudhari, Piyush N.

Subsea flowlines that transport hydrocarbons from wellhead to the processing facility face issues from solid deposits such as hydrates, waxes, asphaltenes, etc. The solid deposits not only affect the production but also pose a safety concern; thus, flow assurance is significantly important in designing and operating subsea oil and gas production. In most subsea oil and gas operations, gas hydrates form at high pressure and low temperature conditions, causing the risk of plugging flowlines, with a undesirable impact on production. Over the years, the oil and gas industry has shifted their perspective from hydrate avoidance to hydrate management given several parameters such as production facility, production chemistry, economic and environmental concerns. Thus, understanding the level of hydrate risk associated with subsea flowlines is an important in developing efficient hydrate management techniques. In the past, hydrate formation models were developed for various flow-systems (e.g., oil dominated, water dominated, and gas dominated) present in the oil and gas production. The objective of this research is to extend the application of the present hydrate prediction models for assessing the hydrate risk associated with subsea flowlines that are prone to hydrate formation. It involves a novel approach for developing quantitative hydrate risk models based on the conceptual models built from the qualitative knowledge obtained from experimental studies. A comprehensive hydrate risk model, that ranks the hydrate risk associated with the subsea production system as a function of time, hydrates, and several other parameters, which account for inertial, viscous, interfacial forces acting on the flow-system, is developed for oil dominated and condensate systems. The hydrate plugging risk for water dominated systems is successfully modeled using The Colorado School of Mines Hydrate Flow Assurance Tool (CSMHyFAST). It is found that CSMHyFAST can be used as a screening tool in order to reduce the parametric study that may require a long duration of time using The Colorado School of Mines Hydrate Kinetic Model (CSMHyK). The evolution of the hydrate plugging risk along flowline-riser systems is modeled for steady state and transient operations considering the effect of several critical parameters such as oil-hydrate slip, duration of shut-in, and water droplet size on a subsea tieback system. This research presents a novel platform for quantification of the hydrate plugging risk, which in-turn will play an important role in improving and optimizing current hydrate management strategies. The predictive strength of the hydrate risk quantification and hydrate prediction models will have a significant impact on flow assurance engineering and design with respect to building safe and efficient hydrate management techniques for future deep-water developments.

Automated systems to identify relevant documents in product risk management

PubMed Central

2012-01-01

Background Product risk management involves critical assessment of the risks and benefits of health products circulating in the market. One of the important sources of safety information is the primary literature, especially for newer products which regulatory authorities have relatively little experience with. Although the primary literature provides vast and diverse information, only a small proportion of which is useful for product risk assessment work. Hence, the aim of this study is to explore the possibility of using text mining to automate the identification of useful articles, which will reduce the time taken for literature search and hence improving work efficiency. In this study, term-frequency inverse document-frequency values were computed for predictors extracted from the titles and abstracts of articles related to three tumour necrosis factors-alpha blockers. A general automated system was developed using only general predictors and was tested for its generalizability using articles related to four other drug classes. Several specific automated systems were developed using both general and specific predictors and training sets of different sizes in order to determine the minimum number of articles required for developing such systems. Results The general automated system had an area under the curve value of 0.731 and was able to rank 34.6% and 46.2% of the total number of 'useful' articles among the first 10% and 20% of the articles presented to the evaluators when tested on the generalizability set. However, its use may be limited by the subjective definition of useful articles. For the specific automated system, it was found that only 20 articles were required to develop a specific automated system with a prediction performance (AUC 0.748) that was better than that of general automated system. Conclusions Specific automated systems can be developed rapidly and avoid problems caused by subjective definition of useful articles. Thus the efficiency of product risk management can be improved with the use of specific automated systems. PMID:22380483

The report of Task Group 100 of the AAPM: Application of risk analysis methods to radiation therapy quality management

PubMed Central

Huq, M. Saiful; Fraass, Benedick A.; Dunscombe, Peter B.; Gibbons, John P.; Mundt, Arno J.; Mutic, Sasa; Palta, Jatinder R.; Rath, Frank; Thomadsen, Bruce R.; Williamson, Jeffrey F.; Yorke, Ellen D.

2016-01-01

The increasing complexity of modern radiation therapy planning and delivery challenges traditional prescriptive quality management (QM) methods, such as many of those included in guidelines published by organizations such as the AAPM, ASTRO, ACR, ESTRO, and IAEA. These prescriptive guidelines have traditionally focused on monitoring all aspects of the functional performance of radiotherapy (RT) equipment by comparing parameters against tolerances set at strict but achievable values. Many errors that occur in radiation oncology are not due to failures in devices and software; rather they are failures in workflow and process. A systematic understanding of the likelihood and clinical impact of possible failures throughout a course of radiotherapy is needed to direct limit QM resources efficiently to produce maximum safety and quality of patient care. Task Group 100 of the AAPM has taken a broad view of these issues and has developed a framework for designing QM activities, based on estimates of the probability of identified failures and their clinical outcome through the RT planning and delivery process. The Task Group has chosen a specific radiotherapy process required for “intensity modulated radiation therapy (IMRT)” as a case study. The goal of this work is to apply modern risk-based analysis techniques to this complex RT process in order to demonstrate to the RT community that such techniques may help identify more effective and efficient ways to enhance the safety and quality of our treatment processes. The task group generated by consensus an example quality management program strategy for the IMRT process performed at the institution of one of the authors. This report describes the methodology and nomenclature developed, presents the process maps, FMEAs, fault trees, and QM programs developed, and makes suggestions on how this information could be used in the clinic. The development and implementation of risk-assessment techniques will make radiation therapy safer and more efficient. PMID:27370140

The report of Task Group 100 of the AAPM: Application of risk analysis methods to radiation therapy quality management

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

Huq, M. Saiful, E-mail: HUQS@UPMC.EDU

The increasing complexity of modern radiation therapy planning and delivery challenges traditional prescriptive quality management (QM) methods, such as many of those included in guidelines published by organizations such as the AAPM, ASTRO, ACR, ESTRO, and IAEA. These prescriptive guidelines have traditionally focused on monitoring all aspects of the functional performance of radiotherapy (RT) equipment by comparing parameters against tolerances set at strict but achievable values. Many errors that occur in radiation oncology are not due to failures in devices and software; rather they are failures in workflow and process. A systematic understanding of the likelihood and clinical impact ofmore » possible failures throughout a course of radiotherapy is needed to direct limit QM resources efficiently to produce maximum safety and quality of patient care. Task Group 100 of the AAPM has taken a broad view of these issues and has developed a framework for designing QM activities, based on estimates of the probability of identified failures and their clinical outcome through the RT planning and delivery process. The Task Group has chosen a specific radiotherapy process required for “intensity modulated radiation therapy (IMRT)” as a case study. The goal of this work is to apply modern risk-based analysis techniques to this complex RT process in order to demonstrate to the RT community that such techniques may help identify more effective and efficient ways to enhance the safety and quality of our treatment processes. The task group generated by consensus an example quality management program strategy for the IMRT process performed at the institution of one of the authors. This report describes the methodology and nomenclature developed, presents the process maps, FMEAs, fault trees, and QM programs developed, and makes suggestions on how this information could be used in the clinic. The development and implementation of risk-assessment techniques will make radiation therapy safer and more efficient.« less

The report of Task Group 100 of the AAPM: Application of risk analysis methods to radiation therapy quality management.

PubMed

Huq, M Saiful; Fraass, Benedick A; Dunscombe, Peter B; Gibbons, John P; Ibbott, Geoffrey S; Mundt, Arno J; Mutic, Sasa; Palta, Jatinder R; Rath, Frank; Thomadsen, Bruce R; Williamson, Jeffrey F; Yorke, Ellen D

2016-07-01

The increasing complexity of modern radiation therapy planning and delivery challenges traditional prescriptive quality management (QM) methods, such as many of those included in guidelines published by organizations such as the AAPM, ASTRO, ACR, ESTRO, and IAEA. These prescriptive guidelines have traditionally focused on monitoring all aspects of the functional performance of radiotherapy (RT) equipment by comparing parameters against tolerances set at strict but achievable values. Many errors that occur in radiation oncology are not due to failures in devices and software; rather they are failures in workflow and process. A systematic understanding of the likelihood and clinical impact of possible failures throughout a course of radiotherapy is needed to direct limit QM resources efficiently to produce maximum safety and quality of patient care. Task Group 100 of the AAPM has taken a broad view of these issues and has developed a framework for designing QM activities, based on estimates of the probability of identified failures and their clinical outcome through the RT planning and delivery process. The Task Group has chosen a specific radiotherapy process required for "intensity modulated radiation therapy (IMRT)" as a case study. The goal of this work is to apply modern risk-based analysis techniques to this complex RT process in order to demonstrate to the RT community that such techniques may help identify more effective and efficient ways to enhance the safety and quality of our treatment processes. The task group generated by consensus an example quality management program strategy for the IMRT process performed at the institution of one of the authors. This report describes the methodology and nomenclature developed, presents the process maps, FMEAs, fault trees, and QM programs developed, and makes suggestions on how this information could be used in the clinic. The development and implementation of risk-assessment techniques will make radiation therapy safer and more efficient.

Exploring heterogeneous market hypothesis using realized volatility

NASA Astrophysics Data System (ADS)

Chin, Wen Cheong; Isa, Zaidi; Mohd Nor, Abu Hassan Shaari

2013-04-01

This study investigates the heterogeneous market hypothesis using high frequency data. The cascaded heterogeneous trading activities with different time durations are modelled by the heterogeneous autoregressive framework. The empirical study indicated the presence of long memory behaviour and predictability elements in the financial time series which supported heterogeneous market hypothesis. Besides the common sum-of-square intraday realized volatility, we also advocated two power variation realized volatilities in forecast evaluation and risk measurement in order to overcome the possible abrupt jumps during the credit crisis. Finally, the empirical results are used in determining the market risk using the value-at-risk approach. The findings of this study have implications for informationally market efficiency analysis, portfolio strategies and risk managements.

OptiPhy, a technical-economic optimisation model for improving the management of plant protection practices in agriculture: a decision-support tool for controlling the toxicity risks related to pesticides.

PubMed

Mghirbi, Oussama; LE Grusse, Philippe; Fabre, Jacques; Mandart, Elisabeth; Bord, Jean-Paul

2017-03-01

The health, environmental and socio-economic issues related to the massive use of plant protection products are a concern for all the stakeholders involved in the agricultural sector. These stakeholders, including farmers and territorial actors, have expressed a need for decision-support tools for the management of diffuse pollution related to plant protection practices and their impacts. To meet the needs expressed by the public authorities and the territorial actors for such decision-support tools, we have developed a technical-economic model "OptiPhy" for risk mitigation based on indicators of pesticide toxicity risk to applicator health (IRSA) and to the environment (IRTE), under the constraint of suitable economic outcomes. This technical-economic optimisation model is based on linear programming techniques and offers various scenarios to help the different actors in choosing plant protection products, depending on their different levels of constraints and aspirations. The health and environmental risk indicators can be broken down into sub-indicators so that management can be tailored to the context. This model for technical-economic optimisation and management of plant protection practices can analyse scenarios for the reduction of pesticide-related risks by proposing combinations of substitution PPPs, according to criteria of efficiency, economic performance and vulnerability of the natural environment. The results of the scenarios obtained on real ITKs in different cropping systems show that it is possible to reduce the PPP pressure (TFI) and reduce toxicity risks to applicator health (IRSA) and to the environment (IRTE) by up to approximately 50 %.

The need to implement the landscape of fear within rodent pest management strategies

PubMed Central

Belmain, Steven R; Singleton, Grant R; Groot Koerkamp, Peter WG; Meerburg, Bastiaan G

2017-01-01

Abstract Current reactive pest management methods have serious drawbacks such as the heavy reliance on chemicals, emerging genetic rodenticide resistance and high secondary exposure risks. Rodent control needs to be based on pest species ecology and ethology to facilitate the development of ecologically based rodent management (EBRM). An important aspect of EBRM is a strong understanding of rodent pest species ecology, behaviour and spatiotemporal factors. Gaining insight into the behaviour of pest species is a key aspect of EBRM. The landscape of fear (LOF) is a mapping of the spatial variation in the foraging cost arising from the risk of predation, and reflects the levels of fear a prey species perceives at different locations within its home range. In practice, the LOF maps habitat use as a result of perceived fear, which shows where bait or traps are most likely to be encountered and used by rodents. Several studies have linked perceived predation risk of foraging animals with quitting‐harvest rates or giving‐up densities (GUDs). GUDs have been used to reflect foraging behaviour strategies of predator avoidance, but to our knowledge very few papers have directly used GUDs in relation to pest management strategies. An opportunity for rodent control strategies lies in the integration of the LOF of rodents in EBRM methodologies. Rodent management could be more efficient and effective by concentrating on those areas where rodents perceive the least levels of predation risk. © 2017 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. PMID:28556521

Risk assessment and management of Chlamydia psittaci in poultry processing plants.

PubMed

Deschuyffeleer, Thomas P G; Tyberghien, Laurens F V; Dickx, Veerle L C; Geens, Tom; Saelen, Jacques M M M; Vanrompay, Daisy C G; Braeckman, Lutgard A C M

2012-04-01

Chlamydia psittaci causes respiratory disease in poultry and can be transmitted to humans. Historical outbreaks of psittacosis in poultry workers indicated the need for higher awareness and an efficient risk assessment and management. This group reviewed relevant previous research, practical guidelines, and European directives. Subsequently, basic suggestions were made on how to assess and manage the risk of psittacosis in poultry processing plants based on a classical four-step approach. Collective and personal protective measures as well as the role of occupational medicine are described. Despite the finding that exposure is found in every branch, abattoir workstations seem to be associated with the highest prevalence of psittacosis. Complete eradication is difficult to achieve. Ventilation, cleaning, hand hygiene, and personal protective equipment are the most important protective measures to limit and control exposure to C. psittaci. Adequate information, communication, and health surveillance belong to the responsibilities of the occupational physician. Future challenges lay in the rigorous reporting of infections in both poultry and poultry workers and in the development of an avian and human vaccine.

A 21st Century Roadmap for Human Health Risk Assessment ...

EPA Pesticide Factsheets

For decades human health risk assessment has depended primarily on animal testing to predict adverse effects in humans, but that paradigm has come under question because of calls for more accurate information, less use of animals, and more efficient use of resources. Moreover, the disproportionate use of hazard information has overshadowed the important role of exposure science in determinations of human safety. In addition, major risk assessments lack the clarity and transparency that hinder an understanding of the analysis and communication of key safety messages. To help answer these challenges, the HESI-managed RISK21 project was initiated to develop a scientific, transparent, and efficient approach to the evolving world of human health risk assessment. RISK21 involved over 120 participants from 12 countries, 15 government institutions, 20 universities, 2 non-governmental organizations, and 12 corporations. RISK21 developed a tiered approach that is problem formulation-based, makes maximum use of prior knowledge, and is led by exposure science to produce a highly transparent and flexible visualization of and approach to assessing human safety and risk. The general principles underlying the RISK21 approach as well as an overview of the RISK21 Roadmap are presented here. This paper will be followed by a series of publications that will articulate the details that comprise this systematic approach. The purpose of this manuscript is to provide an overview

Increasing value and reducing waste in biomedical research regulation and management

PubMed Central

Salman, Rustam Al-Shahi; Beller, Elaine; Kagan, Jonathan; Hemminki, Elina; Phillips, Robert S; Savulescu, Julian; Macleod, Malcolm; Wisely, Janet; Chalmers, Iain

2014-01-01

After identification of an important research question and selection of an appropriate study design, waste can arise from the regulation, governance, and management of biomedical research. Obtaining regulatory and governance approval has become increasingly burdensome and disproportionate to the conceivable risks to research participants. Regulation and governance involve interventions that are assumed to be justified in the interests of patients and the public, but they can actually compromise these interests. Inefficient management of the procedural conduct of research is wasteful, especially if it results in poor recruitment and retention of participants in well designed studies addressing important questions. These sources of waste can be minimised if the following four recommendations are addressed. First, regulators should use their influence to reduce other causes of waste and inefficiency in research. Second, regulators and policy makers should work with researchers, patients, and health professionals to streamline and harmonise the laws, regulations, guidelines, and processes that govern whether and how research can be done, and ensure that they are proportionate to the plausible risks associated with the research. Third, researchers and research managers should increase the efficiency of recruitment, retention, data monitoring, and data sharing in research through use of research designs known to reduce inefficiencies, and further research should be done to learn how efficiency can be increased. Finally, everyone, particularly those responsible for health-care systems, should promote integration of research into everyday clinical practice. Regulators and researchers should monitor adherence to each of these recommendations and publish metrics. PMID:24411646

Innovative Technologies for Efficient Pharmacotherapeutic Management in Space

NASA Technical Reports Server (NTRS)

Putcha, Lakshmi; Daniels, Vernie

2014-01-01

Current and future Space exploration missions and extended human presence in space aboard the ISS will expose crew to risks that differ both quantitatively and qualitatively from those encountered before by space travelers and will impose an unknown risk of safety and crew health. The technology development challenges for optimizing therapeutics in space must include the development of pharmaceuticals with extended stability, optimal efficacy and bioavailability with minimal toxicity and side effects. Innovative technology development goals may include sustained/chronic delivery preventive health care products and vaccines, low-cost high-efficiency noninvasive, non-oral dosage forms with radio-protective formulation matrices and dispensing technologies coupled with self-reliant tracking technologies for quality assurance and quality control assessment. These revolutionary advances in pharmaceutical technology will assure human presence in space and healthy living on Earth. Additionally, the Joint Commission on Accreditation of Healthcare Organizations advocates the use of health information technologies to effectively execute all aspects of medication management (prescribing, dispensing, and administration). The advent of personalized medicine and highly streamlined treatment regimens stimulated interest in new technologies for medication management. Intelligent monitoring devices enhance medication accountability compliance, enable effective drug use, and offer appropriate storage and security conditions for dangerous drug and controlled substance medications in remote sites where traditional pharmacies are unavailable. These features are ideal for Exploration Medical Capabilities. This presentation will highlight current novel commercial off-the-shelf (COTS) intelligent medication management devices for the unique dispensing, therapeutic drug monitoring, medication tracking, and drug delivery demands of exploration space medical operations.

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

Crolley, R.; Thompson, M.

There has been a need for a faster and cheaper deployment model for information technology (IT) solutions to address waste management needs at US Department of Energy (DOE) complex sites for years. Budget constraints, challenges in deploying new technologies, frequent travel, and increased job demands for existing employees have prevented IT organizations from staying abreast of new technologies or deploying them quickly. Despite such challenges, IT organizations have added significant value to waste management handling through better worker safety, tracking, characterization, and disposition at DOE complex sites. Systems developed for site-specific missions have broad applicability to waste management challenges andmore » in many cases have been expanded to meet other waste missions. Radio frequency identification (RFID) and global positioning satellite (GPS)-enabled solutions have reduced the risk of radiation exposure and safety risks. New web-based and mobile applications have enabled precision characterization and control of nuclear materials. These solutions have also improved operational efficiencies and shortened schedules, reduced cost, and improved regulatory compliance. Collaboration between US Department of Energy (DOE) complex sites is improving time to delivery and cost efficiencies for waste management missions with new information technologies (IT) such as wireless computing, global positioning satellite (GPS), and radio frequency identification (RFID). Integrated solutions developed at separate DOE complex sites by new technology Centers of Excellence (CoE) have increased material control and accountability, worker safety, and environmental sustainability. CoEs offer other DOE sister sites significant cost and time savings by leveraging their technology expertise in project scoping, implementation, and ongoing operations.« less

The need to implement the landscape of fear within rodent pest management strategies.

PubMed

Krijger, Inge M; Belmain, Steven R; Singleton, Grant R; Groot Koerkamp, Peter Wg; Meerburg, Bastiaan G

2017-12-01

Current reactive pest management methods have serious drawbacks such as the heavy reliance on chemicals, emerging genetic rodenticide resistance and high secondary exposure risks. Rodent control needs to be based on pest species ecology and ethology to facilitate the development of ecologically based rodent management (EBRM). An important aspect of EBRM is a strong understanding of rodent pest species ecology, behaviour and spatiotemporal factors. Gaining insight into the behaviour of pest species is a key aspect of EBRM. The landscape of fear (LOF) is a mapping of the spatial variation in the foraging cost arising from the risk of predation, and reflects the levels of fear a prey species perceives at different locations within its home range. In practice, the LOF maps habitat use as a result of perceived fear, which shows where bait or traps are most likely to be encountered and used by rodents. Several studies have linked perceived predation risk of foraging animals with quitting-harvest rates or giving-up densities (GUDs). GUDs have been used to reflect foraging behaviour strategies of predator avoidance, but to our knowledge very few papers have directly used GUDs in relation to pest management strategies. An opportunity for rodent control strategies lies in the integration of the LOF of rodents in EBRM methodologies. Rodent management could be more efficient and effective by concentrating on those areas where rodents perceive the least levels of predation risk. © 2017 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. © 2017 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Risk Assessment Overview

NASA Technical Reports Server (NTRS)

Prassinos, Peter G.; Lyver, John W., IV; Bui, Chinh T.

2011-01-01

Risk assessment is used in many industries to identify and manage risks. Initially developed for use on aeronautical and nuclear systems, risk assessment has been applied to transportation, chemical, computer, financial, and security systems among others. It is used to gain an understanding of the weaknesses or vulnerabilities in a system so modification can be made to increase operability, efficiency, and safety and to reduce failure and down-time. Risk assessment results are primary inputs to risk-informed decision making; where risk information including uncertainty is used along with other pertinent information to assist management in the decision-making process. Therefore, to be useful, a risk assessment must be directed at specific objectives. As the world embraces the globalization of trade and manufacturing, understanding the associated risk become important to decision making. Applying risk assessment techniques to a global system of development, manufacturing, and transportation can provide insight into how the system can fail, the likelihood of system failure and the consequences of system failure. The risk assessment can identify those elements that contribute most to risk and identify measures to prevent and mitigate failures, disruptions, and damaging outcomes. In addition, risk associated with public and environment impact can be identified. The risk insights gained can be applied to making decisions concerning suitable development and manufacturing locations, supply chains, and transportation strategies. While risk assessment has been mostly applied to mechanical and electrical systems, the concepts and techniques can be applied across other systems and activities. This paper provides a basic overview of the development of a risk assessment.

A Quantitative Risk Analysis Framework for Evaluating and Monitoring Operational Reliability of Cloud Computing

ERIC Educational Resources Information Center

Islam, Muhammad Faysal

2013-01-01

Cloud computing offers the advantage of on-demand, reliable and cost efficient computing solutions without the capital investment and management resources to build and maintain in-house data centers and network infrastructures. Scalability of cloud solutions enable consumers to upgrade or downsize their services as needed. In a cloud environment,…

Characterising resource use and potential inefficiencies during large-fire suppression in the western US

Treesearch

Hari Katuwal; Christopher J. Dunn; David E. Calkin

2017-01-01

Currently, limited research on large-fire suppression effectiveness suggests fire managers may over-allocate resources relative to values to be protected. Coupled with observations that weather may be more important than resource abundance to achieve control objectives, resource use may be driven more by risk aversion than efficiency. To explore this potential, we...

The Role of a Research Administration Program in Adverse Event Reporting

ERIC Educational Resources Information Center

Fedor, Carol; Cola, Philip; Polites, Stephanie

2007-01-01

The reporting, analysis, and management of adverse events (AEs) provide an ongoing assessment of risk in the context of a clinical trial and enhance the protection of human research participants and the informed consent process. Effective and efficient review of AEs has been a long-standing challenge for Institutional Review Boards (IRBs) and…

Investigating Alternatives to the Fish Early Life-Stage Test: A Strategy for Discovering and Annotating Adverse Outcome Pathways for Early Fish Development

EPA Science Inventory

The fish early life-stage (FELS) test (OECD Test Guideline 210) is the primary test used internationally to estimate chronic fish toxicity in support of ecological risk assessments and chemical management programs. As part of an on-going effort to develop efficient and cost-effec...

Spatiotemporal Visualization of Tsunami Waves Using Kml on Google Earth

NASA Astrophysics Data System (ADS)

Mohammadi, H.; Delavar, M. R.; Sharifi, M. A.; Pirooz, M. D.

2017-09-01

Disaster risk is a function of hazard and vulnerability. Risk is defined as the expected losses, including lives, personal injuries, property damages, and economic disruptions, due to a particular hazard for a given area and time period. Risk assessment is one of the key elements of a natural disaster management strategy as it allows for better disaster mitigation and preparation. It provides input for informed decision making, and increases risk awareness among decision makers and other stakeholders. Virtual globes such as Google Earth can be used as a visualization tool. Proper spatiotemporal graphical representations of the concerned risk significantly reduces the amount of effort to visualize the impact of the risk and improves the efficiency of the decision-making process to mitigate the impact of the risk. The spatiotemporal visualization of tsunami waves for disaster management process is an attractive topic in geosciences to assist investigation of areas at tsunami risk. In this paper, a method for coupling virtual globes with tsunami wave arrival time models is presented. In this process we have shown 2D+Time of tsunami waves for propagation and inundation of tsunami waves, both coastal line deformation, and the flooded areas. In addition, the worst case scenario of tsunami on Chabahar port derived from tsunami modelling is also presented using KML on google earth.

A data-driven approach to quality risk management

PubMed Central

Alemayehu, Demissie; Alvir, Jose; Levenstein, Marcia; Nickerson, David

2013-01-01

Aim: An effective clinical trial strategy to ensure patient safety as well as trial quality and efficiency involves an integrated approach, including prospective identification of risk factors, mitigation of the risks through proper study design and execution, and assessment of quality metrics in real-time. Such an integrated quality management plan may also be enhanced by using data-driven techniques to identify risk factors that are most relevant in predicting quality issues associated with a trial. In this paper, we illustrate such an approach using data collected from actual clinical trials. Materials and Methods: Several statistical methods were employed, including the Wilcoxon rank-sum test and logistic regression, to identify the presence of association between risk factors and the occurrence of quality issues, applied to data on quality of clinical trials sponsored by Pfizer. Results: Only a subset of the risk factors had a significant association with quality issues, and included: Whether study used Placebo, whether an agent was a biologic, unusual packaging label, complex dosing, and over 25 planned procedures. Conclusion: Proper implementation of the strategy can help to optimize resource utilization without compromising trial integrity and patient safety. PMID:24312890

Multi-criteria decision assessments using Subjective Logic: Methodology and the case of urban water strategies

NASA Astrophysics Data System (ADS)

Moglia, Magnus; Sharma, Ashok K.; Maheepala, Shiroma

2012-07-01

SummaryPlanning of regional and urban water resources, and in particular with Integrated Urban Water Management approaches, often considers inter-relationships between human uses of water, the health of the natural environment as well as the cost of various management strategies. Decision makers hence typically need to consider a combination of social, environmental and economic goals. The types of strategies employed can include water efficiency measures, water sensitive urban design, stormwater management, or catchment management. Therefore, decision makers need to choose between different scenarios and to evaluate them against a number of criteria. This type of problem has a discipline devoted to it, i.e. Multi-Criteria Decision Analysis, which has often been applied in water management contexts. This paper describes the application of Subjective Logic in a basic Bayesian Network to a Multi-Criteria Decision Analysis problem. By doing this, it outlines a novel methodology that explicitly incorporates uncertainty and information reliability. The application of the methodology to a known case study context allows for exploration. By making uncertainty and reliability of assessments explicit, it allows for assessing risks of various options, and this may help in alleviating cognitive biases and move towards a well formulated risk management policy.

Value-based formulas for purchasing. PEHP's designated service provider program: value-based purchasing through global fees.

PubMed

Emery, D W

1997-01-01

In many circles, managed care and capitation have become synonymous; unfortunately, the assumptions informing capitation are based on a flawed unidimensional model of risk. PEHP of Utah has rejected the unidimensional model and has therefore embraced a multidimensional model of risk that suggests that global fees are the optimal purchasing modality. A globally priced episode of care forms a natural unit of analysis that enhances purchasing clarity, allows providers to more efficiently focus on the Marginal Rate of Technical Substitution, and conforms to the multidimensional reality of risk. Most importantly, global fees simultaneously maximize patient choice and provider cost consciousness.

Incident command structure using a daily management system and the Centers for Disease Control and Prevention's Patient Notification Toolkit drives effective response to an infection control breach.

PubMed

Schoonover, Heather; Haydon, Kristin

2018-06-14

When breaches in infection control occur, it is imperative that organizations respond in a manner that is effective, efficient, and rebuilds trust with patients. Readers will learn how the incident command structure, daily management system, and the Centers for Disease Control and Prevention's Patient Notification Toolkit were used to drive an effective response to an infection control breach-resulting in 92% of affected patients completing the recommended testing for hepatitis B, hepatitis C, and human immunodeficiency virus. © 2018 American Society for Healthcare Risk Management of the American Hospital Association.

Internet pharmaceutical sales: attributes, concerns, and future forecast.

PubMed

Bruckel, Katy; Capozzoli, Ernest A

2003-01-01

Internet pharmaceutical sales continue to skyrocket as healthcare providers and consumers are increasingly relying on the efficiencies and convenience that is available via such transactions. Managed care companies, increasing demands to reduce healthcare inefficiencies while maximizing the quality of patient care is a significant contributing factor to the expanding utilization and success of online pharmaceutical sales. However, with the expansion of Internet pharmaceutical sales, healthcare providers, pharmacy benefit management and insurance companies, and consumers realize new opportunities and risks. This paper will review the attributes and concerns associated with online pharmaceutical sales, discussing current and pending legislation intended to more effectively manage these parameters.

What is a global manager?

PubMed

Bartlett, C A; Ghoshal, S

1992-01-01

To compete around the world, a company needs three strategic capabilities: global-scale efficiency, local responsiveness, and the ability to leverage learning worldwide. No single "global" manager can build these capabilities. Rather, groups of specialized managers must integrate assets, resources, and people in diverse operating units. Such managers are made, not born. And how to make them is--and must be--the foremost question for corporate managers. Drawing on their research with leading transnational corporations, Christopher Bartlett and Sumantra Ghoshal identify three types of global managers. They also illustrate the responsibilities each position involves through a close look at the careers of successful executives: Leif Johansson of Electrolux, Howard Gottlieb of NEC, and Wahib Zaki of Procter & Gamble. The first type is the global business or product-division manager who must build worldwide efficiency and competitiveness. These managers recognize cross-border opportunities and risks as well as link activities and capabilities around the world. The second is the country manager whose unit is the building block for worldwide operations. These managers are responsible for understanding and interpreting local markets, building local resources and capabilities, and contributing to--and participating in--the development of global strategy. Finally, there are worldwide functional specialists--the managers whose potential is least appreciated in many traditional multinational companies. To transfer expertise from one unit to another and leverage learning, these managers must scan the company for good ideas and best practice, cross-pollinate among units, and champion innovations with worldwide applications.

Grain production versus resource and environmental costs: towards increasing sustainability of nutrient use in China.

PubMed

Jiao, Xiaoqiang; Lyu, Yang; Wu, Xiaobin; Li, Haigang; Cheng, Lingyun; Zhang, Chaochun; Yuan, Lixing; Jiang, Rongfeng; Jiang, Baiwen; Rengel, Zed; Zhang, Fusuo; Davies, William J; Shen, Jianbo

2016-09-01

Over the past five decades, Chinese grain production has increased 4-fold, from 110 Mt in 1961 to 557 Mt in 2014, with less than 9% of the world's arable land feeding 22% of the world's population, indicating a substantial contribution to global food security. However, compared with developed economies, such as the USA and the European Union, more than half of the increased crop production in China can be attributed to a rapid increase in the consumption of chemicals, particularly fertilizers. Excessive fertilization has caused low nutrient use efficiency and high environmental costs in grain production. We analysed the key requirements underpinning increased sustainability of crop production in China, as follows: (i) enhance nutrient use efficiency and reduce nutrient losses by fertilizing roots not soil to maximize root/rhizosphere efficiency with innovative root zone nutrient management; (ii) improve crop productivity and resource use efficiency by matching the best agronomic management practices with crop improvement; and (iii) promote technology transfer of the root zone nutrient management to achieve the target of high yields and high efficiency with low environmental risks on a broad scale. Coordinating grain production and environmental protection by increasing the sustainability of nutrient use will be a key step in achieving sustainable crop production in Chinese agriculture. © The Author 2016. Published by Oxford University Press on behalf of the Society for Experimental Biology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Flood risk governance arrangements in Europe

NASA Astrophysics Data System (ADS)

Matczak, P.; Lewandowski, J.; Choryński, A.; Szwed, M.; Kundzewicz, Z. W.

2015-06-01

The STAR-FLOOD (Strengthening and Redesigning European Flood Risk Practices Towards Appropriate and Resilient Flood Risk Governance Arrangements) project, funded by the European Commission, investigates strategies for dealing with flood risk in six European countries: Belgium, the UK, France, the Netherlands, Poland and Sweden and in 18 vulnerable urban regions in these countries. The project aims to describe, analyse, explain, and evaluate the main similarities and differences between the selected EU Member States in terms of development and performance of flood risk governance arrangements. It also discusses the scientific and societal importance of these similarities and differences. Attention is paid to identification and characterization of shifts in flood risk governance arrangements and in flood risk management strategies and to determination of triggering factors and restraining factors. An assessment of a change of resilience and appropriateness (legitimacy, effectiveness, efficiency) of flood risk governance arrangements in Poland is presented and comparison with other European countries is offered.

Integrating Land Cover Modeling and Adaptive Management to Conserve Endangered Species and Reduce Catastrophic Fire Risk

NASA Technical Reports Server (NTRS)

Breininger, David; Duncan, Brean; Eaton, Mitchell; Johnson, Fred; Nichols, James

2014-01-01

Land cover modeling is used to inform land management, but most often via a two-step process where science informs how management alternatives can influence resources and then decision makers can use this to make decisions. A more efficient process is to directly integrate science and decision making, where science allows us to learn to better accomplish management objectives and is developed to address specific decisions. Co-development of management and science is especially productive when decisions are complicated by multiple objectives and impeded by uncertainty. Multiple objectives can be met by specification of tradeoffs, and relevant uncertainty can be addressed through targeted science (i.e., models and monitoring). We describe how to integrate habitat and fuels monitoring with decision making focused on dual objectives of managing for endangered species and minimizing catastrophic fire risk. Under certain conditions, both objectives might be achieved by a similar management policy, but habitat trajectories suggest tradeoffs. Knowledge about system responses to actions can be informed by applying competing management actions to different land units in the same system state and by ideas about fire behavior. Monitoring and management integration is important to optimize state-specific management decisions and increase knowledge about system responses. We believe this approach has broad utility for and cover modeling programs intended to inform decision making.

A clinical decision rule and D-dimer testing to rule out upper extremity deep vein thrombosis in high-risk patients.

PubMed

van Es, Nick; Bleker, Suzanne M; Di Nisio, Marcello; Kleinjan, Ankie; Beyer-Westendorf, Jan; Camporese, Giuseppe; Kamphuisen, Pieter W; Büller, Harry R; Bossuyt, Patrick M

2016-12-01

In a management study, a diagnostic algorithm consisting of a clinical decision rule, D-dimer, and ultrasonography was shown to safely exclude upper extremity deep vein thrombosis (UEDVT). Efficiency may be lower in high-risk subgroups: those with a central venous catheter or pacemaker, inpatients, cancer, and elderly patients. Data of 406 patients with suspected UEDVT enrolled in a prospective management study were used for the present analysis. The aim was to evaluate the efficiency of the algorithm in subgroups, defined as the proportion of patients in whom imaging could be safely withheld based on the combination of a decision rule result indicating "UEDVT unlikely" and a normal D-dimer result. The strategy excluded UEDVT in 87 of 406 patients (21%); ultrasonography was withheld in these patients and none developed UEDVT during 3months of follow-up. In contrast, ultrasonography could be withheld in only 4 of 92 patients with a catheter or pacemaker (4.3%; 95% CI: 1.7% to 11%) and in 4 of 83 inpatients (4.8%; 95% CI: 1.9% to 12%). The efficiency was 11% in patients with cancer and 13% in those older than 75years. Although the combination of a decision rule and D-dimer testing is safe in excluding UEDVT in the overall population of patients with suspected UEDVT, its efficiency appears limited in some subgroups, in particular those with a central venous catheter or pacemaker, and inpatients. Copyright © 2016 Elsevier Ltd. All rights reserved.

Balancing research and funding using value of information and portfolio tools for nanomaterial risk classification.

PubMed

Bates, Matthew E; Keisler, Jeffrey M; Zussblatt, Niels P; Plourde, Kenton J; Wender, Ben A; Linkov, Igor

2016-02-01

Risk research for nanomaterials is currently prioritized by means of expert workshops and other deliberative processes. However, analytical techniques that quantify and compare alternative research investments are increasingly recommended. Here, we apply value of information and portfolio decision analysis-methods commonly applied in financial and operations management-to prioritize risk research for multiwalled carbon nanotubes and nanoparticulate silver and titanium dioxide. We modify the widely accepted CB Nanotool hazard evaluation framework, which combines nano- and bulk-material properties into a hazard score, to operate probabilistically with uncertain inputs. Literature is reviewed to develop uncertain estimates for each input parameter, and a Monte Carlo simulation is applied to assess how different research strategies can improve hazard classification. The relative cost of each research experiment is elicited from experts, which enables identification of efficient research portfolios-combinations of experiments that lead to the greatest improvement in hazard classification at the lowest cost. Nanoparticle shape, diameter, solubility and surface reactivity were most frequently identified within efficient portfolios in our results.

Drainage Basins as Large-Scale Field Laboratories of Change: Hydro-biogeochemical- economic Model Study Support for Water Pollution and Eutrophication Management Under Uncertainty

NASA Astrophysics Data System (ADS)

Destouni, G.

2008-12-01

Excess nutrient and pollutant releases from various point and diffuse sources at and below the land surface, associated with land use, industry and households, pose serious eutrophication and pollution risks to inland and coastal water ecosystems worldwide. These risks must be assessed, for instance according to the EU Water Framework Directive (WFD). The WFD demands economically efficient, basin-scale water management for achieving and maintaining good physico-chemical and ecological status in all the inland and coastal waters of EU member states. This paper synthesizes a series of hydro-biogeochemical and linked economic efficiency studies of basin-scale waterborne nutrient and pollutant flows, the development over the last decades up to the current levels of these flows, the main monitoring and modelling uncertainties associated with their quantification, and the effectiveness and economic efficiency of different possible abatement strategies for abating them in order to meet WFD requirements and other environmental goals on local, national and international levels under climate and other regional change. The studies include different Swedish and Baltic Sea drainage basins. Main findings include quantification of near-coastal monitoring gaps and long-term nutrient and pollutant memory in the subsurface (soil-groundwater-sediment) water systems of drainage basins. The former may significantly mask nutrient and pollutant loads to the sea while the latter may continue to uphold large loads to inland and coastal waters long time after source mitigation. A methodology is presented for finding a rational trade-off between the two resource-demanding options to reduce, or accept and explicitly account for the uncertainties implied by these monitoring gaps and long-term nutrient-pollution memories and time lags, and other knowledge, data and model uncertainties that limit the effectiveness and efficiency of water pollution and eutrophication management.

Challenges in the Management of a Patient with Myxoedema Coma in Ghana: A Case Report.

PubMed

Akpalu, Josephine; Atiase, Yacoba; Yorke, Ernest; Fiscian, Henrietta; Kootin-Sanwu, Cecilia; Akpalu, Albert

2017-03-01

Myxoedema coma is a rare life-threatening disease, and it is essential that it is managed appropriately to reduce the associated high mortality. However, in the setting where efficient healthcare delivery is hampered by inadequacies, the management of such cases may pose a significant challenge. We present the case of a middle-aged woman diagnosed with myxoedema coma and severe hyponatremia. The case report highlights some of the challenges that may be encountered during the management of myxoedema coma in similar settings and outlines the management strategies undertaken to overcome them in the absence of national guidelines. It also brings to the fore the need for clinicians to look out for clinical features suggestive of hypothyroidism particularly among high risk individuals for early diagnosis and treatment. None declared.

Evaluating efficiency-equality tradeoffs for mobile source control strategies in an urban area

PubMed Central

Levy, Jonathan I.; Greco, Susan L.; Melly, Steven J.; Mukhi, Neha

2013-01-01

In environmental risk management, there are often interests in maximizing public health benefits (efficiency) and addressing inequality in the distribution of health outcomes. However, both dimensions are not generally considered within a single analytical framework. In this study, we estimate both total population health benefits and changes in quantitative indicators of health inequality for a number of alternative spatial distributions of diesel particulate filter retrofits across half of an urban bus fleet in Boston, Massachusetts. We focus on the impact of emissions controls on primary fine particulate matter (PM2.5) emissions, modeling the effect on PM2.5 concentrations and premature mortality. Given spatial heterogeneity in baseline mortality rates, we apply the Atkinson index and other inequality indicators to quantify changes in the distribution of mortality risk. Across the different spatial distributions of control strategies, the public health benefits varied by more than a factor of two, related to factors such as mileage driven per day, population density near roadways, and baseline mortality rates in exposed populations. Changes in health inequality indicators varied across control strategies, with the subset of optimal strategies considering both efficiency and equality generally robust across different parametric assumptions and inequality indicators. Our analysis demonstrates the viability of formal analytical approaches to jointly address both efficiency and equality in risk assessment, providing a tool for decision-makers who wish to consider both issues. PMID:18793281

Nature-based flood risk management -challenges in implementing catchment-wide management concepts

NASA Astrophysics Data System (ADS)

Thaler, Thomas; Fuchs, Sven

2017-04-01

Traditionally, flood risk management focused on coping with the flow at a given point by, for example, building dikes or straightening the watercourse. Increasingly the emphasis has shifted to measures within the flood plain to delay the flow through storage. As such the fluent boundaries imposed by the behaviour of the catchment at a certain point are relocated upstream by the human intervention. Therefore, the implementation of flood storages and the use of natural retention areas are promoted as mitigation measures to support sustainable flood risk management. They aimed at reducing the effluent boundaries on the floodplain by increasing the effluent boundaries upstream. However, beyond the simple change of practices it is indeed often a question of land use change which is at stake in water management. As such, it poses the questions on how to govern both water and land to satisfy the different stakeholders. Nature-based strategies often follow with voluntary agreements, which are promoted as an alternative instrument to the traditional top-down command and control regulation. Voluntary agreements aim at bringing more efficiency, participatory and transparency in solving problems between different social groups. In natural hazard risk management voluntary agreements are now receiving high interests to complement the existing policy instruments in order to achieve the objectives the EU WFD and of the Floods Directive. This paper investigates the use of voluntary agreements as an alternative instrument to the traditional top-down command and control regulation in the implementation of flood storages in Austria. The paper provides a framework of analysis to reveal barriers and opportunities associated with such approach. The paper concludes that institution and power are the central elements to tackle for allowing the success of voluntary agreement.

Engineered nanomaterials: toward effective safety management in research laboratories.

PubMed

Groso, Amela; Petri-Fink, Alke; Rothen-Rutishauser, Barbara; Hofmann, Heinrich; Meyer, Thierry

2016-03-15

It is still unknown which types of nanomaterials and associated doses represent an actual danger to humans and environment. Meanwhile, there is consensus on applying the precautionary principle to these novel materials until more information is available. To deal with the rapid evolution of research, including the fast turnover of collaborators, a user-friendly and easy-to-apply risk assessment tool offering adequate preventive and protective measures has to be provided. Based on new information concerning the hazards of engineered nanomaterials, we improved a previously developed risk assessment tool by following a simple scheme to gain in efficiency. In the first step, using a logical decision tree, one of the three hazard levels, from H1 to H3, is assigned to the nanomaterial. Using a combination of decision trees and matrices, the second step links the hazard with the emission and exposure potential to assign one of the three nanorisk levels (Nano 3 highest risk; Nano 1 lowest risk) to the activity. These operations are repeated at each process step, leading to the laboratory classification. The third step provides detailed preventive and protective measures for the determined level of nanorisk. We developed an adapted simple and intuitive method for nanomaterial risk management in research laboratories. It allows classifying the nanoactivities into three levels, additionally proposing concrete preventive and protective measures and associated actions. This method is a valuable tool for all the participants in nanomaterial safety. The users experience an essential learning opportunity and increase their safety awareness. Laboratory managers have a reliable tool to obtain an overview of the operations involving nanomaterials in their laboratories; this is essential, as they are responsible for the employee safety, but are sometimes unaware of the works performed. Bringing this risk to a three-band scale (like other types of risks such as biological, radiation, chemical, etc.) facilitates the management for occupational health and safety specialists. Institutes and school managers can obtain the necessary information to implement an adequate safety management system. Having an easy-to-use tool enables a dialog between all these partners, whose semantic and priorities in terms of safety are often different.

The MARINA Risk Assessment Strategy: A Flexible Strategy for Efficient Information Collection and Risk Assessment of Nanomaterials

PubMed Central

Bos, Peter M. J.; Gottardo, Stefania; Scott-Fordsmand, Janeck J.; van Tongeren, Martie; Semenzin, Elena; Fernandes, Teresa F.; Hristozov, Danail; Hund-Rinke, Kerstin; Hunt, Neil; Irfan, Muhammad-Adeel; Landsiedel, Robert; Peijnenburg, Willie J. G. M.; Sánchez Jiménez, Araceli; van Kesteren, Petra C. E.; Oomen, Agnes G.

2015-01-01

An engineered nanomaterial (ENM) may actually consist of a population of primary particles, aggregates and agglomerates of various sizes. Furthermore, their physico-chemical characteristics may change during the various life-cycle stages. It will probably not be feasible to test all varieties of all ENMs for possible health and environmental risks. There is therefore a need to further develop the approaches for risk assessment of ENMs. Within the EU FP7 project Managing Risks of Nanoparticles (MARINA) a two-phase risk assessment strategy has been developed. In Phase 1 (Problem framing) a base set of information is considered, relevant exposure scenarios (RESs) are identified and the scope for Phase 2 (Risk assessment) is established. The relevance of an RES is indicated by information on exposure, fate/kinetics and/or hazard; these three domains are included as separate pillars that contain specific tools. Phase 2 consists of an iterative process of risk characterization, identification of data needs and integrated collection and evaluation of data on the three domains, until sufficient information is obtained to conclude on possible risks in a RES. Only data are generated that are considered to be needed for the purpose of risk assessment. A fourth pillar, risk characterization, is defined and it contains risk assessment tools. This strategy describes a flexible and efficient approach for data collection and risk assessment which is essential to ensure safety of ENMs. Further developments are needed to provide guidance and make the MARINA Risk Assessment Strategy operational. Case studies will be needed to refine the strategy. PMID:26633430

The MARINA Risk Assessment Strategy: A Flexible Strategy for Efficient Information Collection and Risk Assessment of Nanomaterials.

PubMed

Bos, Peter M J; Gottardo, Stefania; Scott-Fordsmand, Janeck J; van Tongeren, Martie; Semenzin, Elena; Fernandes, Teresa F; Hristozov, Danail; Hund-Rinke, Kerstin; Hunt, Neil; Irfan, Muhammad-Adeel; Landsiedel, Robert; Peijnenburg, Willie J G M; Sánchez Jiménez, Araceli; van Kesteren, Petra C E; Oomen, Agnes G

2015-11-27

An engineered nanomaterial (ENM) may actually consist of a population of primary particles, aggregates and agglomerates of various sizes. Furthermore, their physico-chemical characteristics may change during the various life-cycle stages. It will probably not be feasible to test all varieties of all ENMs for possible health and environmental risks. There is therefore a need to further develop the approaches for risk assessment of ENMs. Within the EU FP7 project Managing Risks of Nanoparticles (MARINA) a two-phase risk assessment strategy has been developed. In Phase 1 (Problem framing) a base set of information is considered, relevant exposure scenarios (RESs) are identified and the scope for Phase 2 (Risk assessment) is established. The relevance of an RES is indicated by information on exposure, fate/kinetics and/or hazard; these three domains are included as separate pillars that contain specific tools. Phase 2 consists of an iterative process of risk characterization, identification of data needs and integrated collection and evaluation of data on the three domains, until sufficient information is obtained to conclude on possible risks in a RES. Only data are generated that are considered to be needed for the purpose of risk assessment. A fourth pillar, risk characterization, is defined and it contains risk assessment tools. This strategy describes a flexible and efficient approach for data collection and risk assessment which is essential to ensure safety of ENMs. Further developments are needed to provide guidance and make the MARINA Risk Assessment Strategy operational. Case studies will be needed to refine the strategy.

[Process orientation as a tool of strategic approaches to corporate governance and integrated management systems].

PubMed

Sens, Brigitte

2010-01-01

The concept of general process orientation as an instrument of organisation development is the core principle of quality management philosophy, i.e. the learning organisation. Accordingly, prestigious quality awards and certification systems focus on process configuration and continual improvement. In German health care organisations, particularly in hospitals, this general process orientation has not been widely implemented yet - despite enormous change dynamics and the requirements of both quality and economic efficiency of health care processes. But based on a consistent process architecture that considers key processes as well as management and support processes, the strategy of excellent health service provision including quality, safety and transparency can be realised in daily operative work. The core elements of quality (e.g., evidence-based medicine), patient safety and risk management, environmental management, health and safety at work can be embedded in daily health care processes as an integrated management system (the "all in one system" principle). Sustainable advantages and benefits for patients, staff, and the organisation will result: stable, high-quality, efficient, and indicator-based health care processes. Hospitals with their broad variety of complex health care procedures should now exploit the full potential of total process orientation. Copyright © 2010. Published by Elsevier GmbH.

Research on the method of information system risk state estimation based on clustering particle filter

NASA Astrophysics Data System (ADS)

Cui, Jia; Hong, Bei; Jiang, Xuepeng; Chen, Qinghua

2017-05-01

With the purpose of reinforcing correlation analysis of risk assessment threat factors, a dynamic assessment method of safety risks based on particle filtering is proposed, which takes threat analysis as the core. Based on the risk assessment standards, the method selects threat indicates, applies a particle filtering algorithm to calculate influencing weight of threat indications, and confirms information system risk levels by combining with state estimation theory. In order to improve the calculating efficiency of the particle filtering algorithm, the k-means cluster algorithm is introduced to the particle filtering algorithm. By clustering all particles, the author regards centroid as the representative to operate, so as to reduce calculated amount. The empirical experience indicates that the method can embody the relation of mutual dependence and influence in risk elements reasonably. Under the circumstance of limited information, it provides the scientific basis on fabricating a risk management control strategy.

Utilizing the PPET Mnemonic to Guide Classroom-Level PBIS for Students with or At Risk for EBD across Classroom Settings

ERIC Educational Resources Information Center

Hunter, William C.; Barton-Arwood, Sally; Jasper, Andrea; Murley, Renee; Clements, Tarol

2017-01-01

In this article, the authors discuss how the emphasis on classroom-level Positive Behavior Interventions and Supports strategies can establish a foundation for an efficient classroom management program and be utilized as a resource. The strategies described are physical classroom, procedures and rules, explicit timing, and transition (PETT…

Simple-Minded Accountability Measures Create Failing Schools in Disadvantaged Contexts: A Case Study of a Swedish Junior High School

ERIC Educational Resources Information Center

Allodi, Mara Westling

2013-01-01

The principles of new public management -- market mechanisms, accountability and standards -- have been applied in the education system. These methods are supposed to increase efficiency, but there is also a risk of negative consequences from the services provided if the measures of performance target a reduced range of goals, ignore relevant…

Duties and functions of veterinary public health for the management of food safety: present needs and evaluation of efficiency.

PubMed

Trevisani, M; Rosmini, R

2008-09-01

Functions of veterinarians in the context of food safety assurance have changed very much in the last ten years as a consequence of new legislation. The aim of this review is to evaluate the management tools in veterinary public health that shall be used in response to the actual need and consider some possible key performance indicators. This review involved an examination of the legislation, guidelines and literature, which was then discussed to analyse the actual need, the strategies and the procedures with which the public veterinary service shall comply. The management of information gathered at different stages of the food chain, from both food production operators and veterinary inspectors operating in primary production, food processing and feed production should be exchanged and integrated in a database, not only to produce annual reports and plan national sampling plans, but also to verify and validate the effectiveness of procedures and strategies implemented by food safety operators to control risks. Further, the surveillance data from environmental agencies and human epidemiological units should be used for assessing risks and addressing management options.

Technical note: Efficient online source identification algorithm for integration within a contamination event management system

NASA Astrophysics Data System (ADS)

Deuerlein, Jochen; Meyer-Harries, Lea; Guth, Nicolai

2017-07-01

Drinking water distribution networks are part of critical infrastructures and are exposed to a number of different risks. One of them is the risk of unintended or deliberate contamination of the drinking water within the pipe network. Over the past decade research has focused on the development of new sensors that are able to detect malicious substances in the network and early warning systems for contamination. In addition to the optimal placement of sensors, the automatic identification of the source of a contamination is an important component of an early warning and event management system for security enhancement of water supply networks. Many publications deal with the algorithmic development; however, only little information exists about the integration within a comprehensive real-time event detection and management system. In the following the analytical solution and the software implementation of a real-time source identification module and its integration within a web-based event management system are described. The development was part of the SAFEWATER project, which was funded under FP 7 of the European Commission.

Identification of ballast water discharge profiles of a port to enable effective ballast water management and environmental studies

NASA Astrophysics Data System (ADS)

David, Matej; Gollasch, Stephan; Penko, Ludvik

2018-03-01

Information about the profile of ballast water discharges in a port is one of the basic elements of the decision making process in ballast water risk assessment and management, and supports the evaluation of dimensions and processes of aquatic species invasions with vessels ballast water. In the lack of ballast water reporting, ballast water discharge assessments need to be conducted. In this study we have assessed and compared ballast water discharge profiles of two ports with different maritime traffic and cargo profiles, the Port of Hamburg (Germany) and the Muuga Harbour, Port of Tallinn (Estonia). This study shows methods and approaches which can be used to assess volumes and donor ports of ballast water discharges for a port at the level of each vessel call. These methods and approaches can be applied to any port to support the implementation of feasible and efficient ballast water management measures and to enable environmental studies including long-term accumulation risks of disinfection by-products from ballast water management systems making use of active substances, as well as for discharges of other chemical compounds.

Integrated approach for managing health risks at work--the role of occupational health nurses.

PubMed

Marinescu, Luiza G

2007-02-01

Currently, many organizations are using a department-centered approach to manage health risks at work. In such a model, segregated departments are providing employee benefits such as health insurance, workers' compensation, and short- and long-term disability or benefits addressing work-life issues. In recent years, a new model has emerged: health and productivity management (HPM). This is an employee-centered, integrated approach, designed to increase efficiency, reduce competition for scarce resources, and increase employee participation in prevention activities. Evidence suggests that corporations using integrated HPM programs achieve better health outcomes for their employees, with consequent increased productivity and decreased absenteeism. Occupational health nurses are well positioned to assume leadership roles in their organizations by coordinating efforts and programs across departments that offer health, wellness, and safety benefits. To assume their role as change agents to improve employees' health, nurses should start using the language of business more often by improving their communication skills, computer skills, and ability to quantify and articulate results of programs and services to senior management.

eLearning for health system leadership and management capacity building: a protocol for a systematic review

PubMed Central

Tudor Car, Lorainne; Atun, Rifat

2017-01-01

Introduction Health leadership and management capacity are essential for health system strengthening and for attaining universal health coverage by optimising the existing human, technological and financial resources. However, in health systems, health leadership and management training is not widely available. The use of information technology for education (ie, eLearning) could help address this training gap by enabling flexible, efficient and scalable health leadership and management training. We present a protocol for a systematic review on the effectiveness of eLearning for health leadership and management capacity building in improving health system outcomes. Methodology and analysis We will follow the Cochrane Collaboration methodology. We will search for experimental studies focused on the use of any type of eLearning modality for health management and leadership capacity building in all types of health workforce cadres. The primary outcomes of interest will be health outcomes, financial risk protection and user satisfaction. In addition, secondary outcomes of interest include the attainment of health system objectives of improved equity, efficiency, effectiveness and responsiveness. We will search relevant databases of published and grey literature as well as clinical trials registries from 1990 onwards without language restrictions. Two review authors will screen references, extract data and perform risk of bias assessment independently. Contingent on the heterogeneity of the collated literature, we will perform either a meta-analysis or a narrative synthesis of the collated data. Ethics and dissemination The systematic review will aim to inform policy makers, investors, health professionals, technologists and educators about the existing evidence, potential gaps in literature and the impact of eLearning for health leadership and management capacity building on health system outcomes. We will disseminate the review findings by publishing it as a peer-reviewed journal manuscript and conference abstracts. Trial registration number PROSPERO CRD42017056998 PMID:28827265

eLearning for health system leadership and management capacity building: a protocol for a systematic review.

PubMed

Tudor Car, Lorainne; Atun, Rifat

2017-08-21

Health leadership and management capacity are essential for health system strengthening and for attaining universal health coverage by optimising the existing human, technological and financial resources. However, in health systems, health leadership and management training is not widely available. The use of information technology for education (ie, eLearning) could help address this training gap by enabling flexible, efficient and scalable health leadership and management training. We present a protocol for a systematic review on the effectiveness of eLearning for health leadership and management capacity building in improving health system outcomes. We will follow the Cochrane Collaboration methodology. We will search for experimental studies focused on the use of any type of eLearning modality for health management and leadership capacity building in all types of health workforce cadres. The primary outcomes of interest will be health outcomes, financial risk protection and user satisfaction. In addition, secondary outcomes of interest include the attainment of health system objectives of improved equity, efficiency, effectiveness and responsiveness. We will search relevant databases of published and grey literature as well as clinical trials registries from 1990 onwards without language restrictions. Two review authors will screen references, extract data and perform risk of bias assessment independently. Contingent on the heterogeneity of the collated literature, we will perform either a meta-analysis or a narrative synthesis of the collated data. The systematic review will aim to inform policy makers, investors, health professionals, technologists and educators about the existing evidence, potential gaps in literature and the impact of eLearning for health leadership and management capacity building on health system outcomes. We will disseminate the review findings by publishing it as a peer-reviewed journal manuscript and conference abstracts. PROSPERO CRD42017056998. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Efficiency of laparoscopic vs endoscopic management in cholelithiasis and choledocholithiasis. Is there any difference?

PubMed

Herrera-Ramírez, María de Los Angeles; López-Acevedo, Hugo; Gómez-Peña, Gustavo Adolfo; Mata-Quintero, Carlos Javier

Concomitant cholelithiasis and choledocholithiasis is a disease where incidence increases with age and can have serious complications such as pancreatitis, cholangitis and liver abscesses, but its management is controversial, because there are minimally invasive laparoscopic and endoscopic surgical procedures. To compare the efficiency in the management of cholelithiasis and choledocholithiasis with laparoscopic cholecystectomy with common bile duct exploration vs cholangiopancreatography endoscopic retrograde+laparoscopic cholecystectomy. Retrospective analysis of a five year observational, cross sectional multicenter study of patients with cholelithiasis and concomitant high risk of choledocholithiasis who were divided into two groups and the efficiency of both procedures was compared. Group 1 underwent laparoscopic cholecystectomy with common bile duct exploration and group 2 underwent cholangiopancreatography endoscopic retrograde+laparoscopic cholecystectomy. 40 patients, 20 were included in each group, we found p=0.10 in terms of operating time; when we compared hospital days we found p=0.63; the success of stone extraction by study group we obtained was p=0.15; the complications presented by group was p=0.1 and the number of hospitalizations by group was p ≤ 0.05 demonstrating statistical significance. Both approaches have the same efficiency in the management of cholelithiasis and choledocholithiasis in terms of operating time, success in extracting stone, days of hospitalization, postoperative complications and conversion to open surgery. However the laparoscopic approach is favourable because it reduces the number of surgical anaesthetic events and the number of hospital admissions. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Lessons learnt from past Flash Floods and Debris Flow events to propose future strategies on risk management

NASA Astrophysics Data System (ADS)

Cabello, Angels; Velasco, Marc; Escaler, Isabel

2010-05-01

Floods, including flash floods and debris flow events, are one of the most important hazards in Europe regarding both economic and life loss. Moreover, changes in precipitation patterns and intensity are very likely to increase due to the observed and predicted global warming, rising the risk in areas that are already vulnerable to floods. Therefore, it is very important to carry out new strategies to improve flood protection, but it is also crucial to take into account historical data to identify high risk areas. The main objective of this paper is to show a comparative analysis of the flood risk management information compiled in four test-bed basins (Llobregat, Guadalhorce, Gardon d'Anduze and Linth basins) from three different European countries (Spain, France and Switzerland) and to identify which are the lessons learnt from their past experiences in order to propose future strategies on risk management. This work is part of the EU 7th FP project IMPRINTS which aims at reducing loss of life and economic damage through the improvement of the preparedness and the operational risk management of flash flood and debris flow (FF & DF) events. The methodology followed includes the following steps: o Specific survey on the effectivity of the implemented emergency plans and risk management procedures sent to the test-bed basin authorities that participate in the project o Analysis of the answers from the questionnaire and further research on their methodologies for risk evaluation o Compilation of available follow-up studies carried out after major flood events in the four test-bed basins analyzed o Collection of the lessons learnt through a comparative analysis of the previous information o Recommendations for future strategies on risk management based on lessons learnt and management gaps detected through the process As the Floods Directive (FD) already states, the flood risks associated to FF & DF events should be assessed through the elaboration of Flood Risk Management Plans (FRMP) with tailored solutions for each basin, evaluating their flood mitigation potential, promoting environmental objectives and increasing the efficiency of the already adopted measures. The FRMP should focus on prevention (and protection), preparedness and response, and these have been the three main risk management phases of a flood crisis that have been assessed when extracting the lessons learnt from past events. Lessons learnt concerning dissemination through the three previously mentioned phases and also related to education initiatives have also been included. A common response to most of the events described in this paper was to upgrade the meteorological and hydrological forecasting systems, making the forecasting lead-time as large as possible. Another common recommendation from the test-beds was the need to implement and accomplish the land use regulations. All the basins also detected that structural measures are necessary to increase the population's protection level, but replacing the traditional safety mentality by a risk culture based on a comprehensive analysis of the flood risk. The four basins studied have also highlighted the importance of collecting information when FF & DF events occur and creating historic databases that will provide extremely useful information in the future.

[Risk and risk management in aviation].

PubMed

Müller, Manfred

2004-10-01

RISK MANAGEMENT: The large proportion of human errors in aviation accidents suggested the solution--at first sight brilliant--to replace the fallible human being by an "infallible" digitally-operating computer. However, even after the introduction of the so-called HITEC-airplanes, the factor human error still accounts for 75% of all accidents. Thus, if the computer is ruled out as the ultimate safety system, how else can complex operations involving quick and difficult decisions be controlled? OPTIMIZED TEAM INTERACTION/PARALLEL CONNECTION OF THOUGHT MACHINES: Since a single person is always "highly error-prone", support and control have to be guaranteed by a second person. The independent work of mind results in a safety network that more efficiently cushions human errors. NON-PUNITIVE ERROR MANAGEMENT: To be able to tackle the actual problems, the open discussion of intervened errors must not be endangered by the threat of punishment. It has been shown in the past that progress is primarily achieved by investigating and following up mistakes, failures and catastrophes shortly after they happened. HUMAN FACTOR RESEARCH PROJECT: A comprehensive survey showed the following result: By far the most frequent safety-critical situation (37.8% of all events) consists of the following combination of risk factors: 1. A complication develops. 2. In this situation of increased stress a human error occurs. 3. The negative effects of the error cannot be corrected or eased because there are deficiencies in team interaction on the flight deck. This means, for example, that a negative social climate has the effect of a "turbocharger" when a human error occurs. It needs to be pointed out that a negative social climate is not identical with a dispute. In many cases the working climate is burdened without the responsible person even noticing it: A first negative impression, too much or too little respect, contempt, misunderstandings, not expressing unclear concern, etc. can considerably reduce the efficiency of a team.

Why herd size matters - mitigating the effects of livestock crashes.

PubMed

Næss, Marius Warg; Bårdsen, Bård-Jørgen

2013-01-01

Analysing the effect of pastoral risk management strategies provides insights into a system of subsistence that have persevered in marginal areas for hundreds to thousands of years and may shed light into the future of around 200 million households in the face of climate change. This study investigated the efficiency of herd accumulation as a buffer strategy by analysing changes in livestock holdings during an environmental crisis in the Saami reindeer husbandry in Norway. We found a positive relationship between: (1) pre- and post-collapse herd size; and (2) pre-collapse herd size and the number of animals lost during the collapse, indicating that herd accumulation is an effective but costly strategy. Policies that fail to incorporate the risk-beneficial aspect of herd accumulation will have a limited effect and may indeed fail entirely. In the context of climate change, official policies that incorporate pastoral risk management strategies may be the only solution for ensuring their continued existence.

Health risks from exposure to Legionella in reclaimed water aerosols: Toilet flushing, spray irrigation, and cooling towers.

PubMed

Hamilton, Kerry A; Hamilton, Mark T; Johnson, William; Jjemba, Patrick; Bukhari, Zia; LeChevallier, Mark; Haas, Charles N

2018-05-01

The use of reclaimed water brings new challenges for the water industry in terms of maintaining water quality while increasing sustainability. Increased attention has been devoted to opportunistic pathogens, especially Legionella pneumophila, due to its growing importance as a portion of the waterborne disease burden in the United States. Infection occurs when a person inhales a mist containing Legionella bacteria. The top three uses for reclaimed water (cooling towers, spray irrigation, and toilet flushing) that generate aerosols were evaluated for Legionella health risks in reclaimed water using quantitative microbial risk assessment (QMRA). Risks are compared using data from nineteen United States reclaimed water utilities measured with culture-based methods, quantitative PCR (qPCR), and ethidium-monoazide-qPCR. Median toilet flushing annual infection risks exceeded 10 -4 considering multiple toilet types, while median clinical severity infection risks did not exceed this value. Sprinkler and cooling tower risks varied depending on meteorological conditions and operational characteristics such as drift eliminator performance. However, the greatest differences between risk scenarios were due to 1) the dose response model used (infection or clinical severity infection) 2) population at risk considered (residential or occupational) and 3) differences in laboratory analytical method. Theoretical setback distances necessary to achieve a median annual infection risk level of 10 -4 are proposed for spray irrigation and cooling towers. In both cooling tower and sprinkler cases, Legionella infection risks were non-trivial at potentially large setback distances, and indicate other simultaneous management practices could be needed to manage risks. The sensitivity analysis indicated that the most influential factors for variability in risks were the concentration of Legionella and aerosol partitioning and/or efficiency across all models, highlighting the importance of strategies to manage Legionella occurrence in reclaimed water. Copyright © 2018 Elsevier Ltd. All rights reserved.

Rationale for combination therapy in hypertension management: focus on angiotensin receptor blockers and thiazide diuretics.

PubMed

Nash, David T

2007-04-01

Despite recognition that hypertension is a major risk factor for cardiovascular events and mortality, blood pressure control rates remain low in the US population. Reflecting clinical trial results, hypertension management guidelines assert the clinical benefit of achieving current blood pressure goals and indicate that most patients will require 2 or more drugs to reach goal. Well-designed drug combinations counter hypertension via complementary mechanisms that increase antihypertensive efficacy, potentially with lower rates of adverse events than higher dose monotherapy regimens. Lower adverse event rates, in turn, may contribute to greater adherence with treatment. The combination of a low-dose diuretic with agents that block the effects of the renin-angiotensin system (RAS), such as angiotensin receptor blockers, has been found in numerous clinical trials to be highly effective for lowering blood pressure in patients with uncomplicated as well as high-risk hypertension, with a comparable favorable side effect profile compared with monotherapy. Moreover, agents that block the RAS are associated with a lower risk of new-onset diabetes mellitus than other antihypertensive classes. Complementary combinations of antihypertensive agents provide an efficient and effective approach to hypertension management.

Minimal intervention dentistry: part 3. Paediatric dental care--prevention and management protocols using caries risk assessment for infants and young children.

PubMed

Ramos-Gomez, F J; Crystal, Y O; Domejean, S; Featherstone, J D B

2012-11-01

Recent increases in caries prevalence in young children throughout the world highlight the need for a simple but effective infant oral care programme. This programme needs to include a medical disease prevention management model with an early establishment of a dental home and a treatment approach based on individual patient risk. This article presents an updated approach with practical forms and tools based on the principles of caries management by risk assessment, CAMBRA. This method will aid the general practitioner to develop and maintain a comprehensive protocol adequate for infant and young children oral care visits. Perinatal oral health is vitally important in preventing early childhood caries (ECC) in young children. Providing dental treatment to expectant mothers and their young children in a 'dual parallel track' is an effective innovative strategy and an efficient practice builder. It promotes prevention rather than intervention, and this may be the best way to achieve long-lasting oral health for young patients. General dental practice can adopt easy protocols that will promote early preventive visits and anticipatory guidance/counselling rather than waiting for the need for restorative treatment.

Application of a risk analysis method to different technologies for producing a monoclonal antibody employed in hepatitis B vaccine manufacturing.

PubMed

Milá, Lorely; Valdés, Rodolfo; Tamayo, Andrés; Padilla, Sigifredo; Ferro, Williams

2012-03-01

CB.Hep-1 monoclonal antibody (mAb) is used for a recombinant Hepatitis B vaccine manufacturing, which is included in a worldwide vaccination program against Hepatitis B disease. The use of this mAb as immunoligand has been addressed into one of the most efficient steps of active pharmaceutical ingredient purification process. Regarding this, Quality Risk Management (QRM) provides an excellent framework for the risk management use in pharmaceutical manufacturing and quality decision-making applications. Consequently, this study sought applying a prospective risk analysis methodology Failure Mode Effects Analysis (FMEA) as QRM tool for analyzing different CB.Hep-1 mAb manufacturing technologies. As main conclusions FMEA was successfully used to assess risks associated with potential problems in CB.Hep-1 mAb manufacturing processes. The severity and occurrence of risks analysis evidenced that the percentage of very high severe risks ranged 31.0-38.7% of all risks and the huge majority of risks have a very low occurrence level (61.9-83.3%) in all assessed technologies. Finally, additive Risk Priority Number, was descending ordered as follow: transgenic plants (2636), ascites (2577), transgenic animals (2046) and hollow fiber bioreactors (1654), which also corroborated that in vitro technology, should be the technology of choice for CB.Hep-1 mAb manufacturing in terms of risks and mAb molecule quality. Copyright © 2011 The International Alliance for Biological Standardization. Published by Elsevier Ltd. All rights reserved.

Higher energy efficient homes are associated with increased risk of doctor diagnosed asthma in a UK subpopulation.

PubMed

Sharpe, Richard A; Thornton, Christopher R; Nikolaou, Vasilis; Osborne, Nicholas J

2015-02-01

The United Kingdom (UK) has one of the highest prevalence of asthma in the world, which represents a significant economic and societal burden. Reduced ventilation resulting from increased energy efficiency measures acts as a modifier for mould contamination and risk of allergic diseases. To our knowledge no previous study has combined detailed asset management property and health data together to assess the impact of household energy efficiency (using the UK Government's Standard Assessment Procedure) on asthma outcomes in an adult population residing in social housing. Postal questionnaires were sent to 3867 social housing properties to collect demographic, health and environmental information on all occupants. Detailed property data, residency periods, indices of multiple deprivation (IMD) and household energy efficiency ratings were also investigated. Logistic regression was used to calculate odds ratios and confidence intervals while allowing for clustering of individuals coming from the same location. Eighteen percent of our target social housing population were recruited into our study. Adults had a mean age of 59 (SD±17.3) years and there was a higher percentage of female (59%) and single occupancy (58%) respondents. Housing demographic characteristics were representative of the target homes. A unit increase in household Standard Assessment Procedure (SAP) rating was associated with a 2% increased risk of current asthma, with the greatest risk in homes with SAP >71. We assessed exposure to mould and found that the presence of a mouldy/musty odour was associated with a two-fold increased risk of asthma (OR 2.2 95%; CI 1.3-3.8). A unit increase in SAP led to a 4-5% reduction in the risk of visible mould growth and a mouldy/musty odour. In contrast to previous research, we report that residing in energy efficient homes may increase the risk of adult asthma. We report that mould contamination increased the risk of asthma, which is in agreement with existing knowledge. Exposure to mould contamination could not fully explain the association between increased energy efficiency and asthma. Our findings may be explained by increased energy efficiency combined with the provision of inadequate heating, ventilation, and increased concentrations of other biological, chemical and physical contaminants. This is likely to be modified by a complex interaction between occupant behaviours and changes to the built environment. Our findings may also be confounded by our response rate, demographic and behavioural differences between those residing in low versus high energy efficient homes, and use of self-reported exposures and outcomes. Energy efficiency may increase the risk of current adult asthma in a population residing in social housing. This association was not significantly modified by the presence of visible mould growth, although further research is needed to investigate the interaction between other demographic and housing characteristic risk factors, especially the impact of fuel poverty on indoor exposures and health outcomes. A multidisciplinary approach is required to assess the interaction between energy efficiency measures and fuel poverty behaviours on health outcomes prior to the delivery of physical interventions aimed at improving the built environment. Policy incentives are required to address fuel poverty issues alongside measures to achieve SAP ratings of 71 or greater, which must be delivered with the provision of adequate heating and ventilation strategies to minimise indoor dampness. Changes in the built environment without changes in behaviour of domicile residents may lead to negative health outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.

Risk adjustment and the fear of markets: the case of Belgium.

PubMed

Schokkaert, E; Van de Voorde, C

2000-02-01

In Belgium the management and administration of the compulsory and universal health insurance is left to a limited number of non-governmental non-profit sickness funds. Since 1995 these sickness funds are partially financed in a prospective way. The risk adjustment scheme is based on a regression model to explain medical expenditures for different social groups. Medical supply is taken out of the formula to construct risk-adjusted capitation payments. The risk-adjustment formula still leaves scope for risk selection. At the same time, the sickness funds were not given the instruments to exert a real influence on expenditures and the health insurance market has not been opened for new entrants. As a consequence, Belgium runs the danger of ending up in a situation with little incentives for efficiency and considerable profits from cream skimming.

Rounding, work intensification and new public management.

PubMed

Willis, Eileen; Toffoli, Luisa; Henderson, Julie; Couzner, Leah; Hamilton, Patricia; Verrall, Claire; Blackman, Ian

2016-06-01

In this study, we argue that contemporary nursing care has been overtaken by new public management strategies aimed at curtailing budgets in the public hospital sector in Australia. Drawing on qualitative interviews with 15 nurses from one public acute hospital with supporting documentary evidence, we demonstrate what happens to nursing work when management imposes rounding as a risk reduction strategy. In the case study outlined rounding was introduced across all wards in response to missed care, which in turn arose as a result of work intensification produced by efficiency, productivity, effectiveness and accountability demands. Rounding is a commercially sponsored practice consistent with new public management. Our study illustrates the impact that new public management strategies such as rounding have on how nurses work, both in terms of work intensity and in who controls their labour. © 2015 John Wiley & Sons Ltd.

Vessel traffic safety in busy waterways: A case study of accidents in western shenzhen port.

PubMed

Mou, J M; Chen, P F; He, Y X; Yip, Tsz Leung; Li, W H; Tang, J; Zhang, H Z

2016-08-03

Throughout the world, busy waterways near large ports witness heavy vessel traffic in recent decades. The waterways are characterized by high risk in terms of loss of life, property, and pollution to environment. To facilitate maritime safety management with satisfactory efficiency and efficacy, the authors propose a framework of safety indexes to evaluate the risk level in busy waterways according to the accident severity, fatality rate and special indicators of maritime transportation. The safety indexes consist of Safety Evaluation Index (SEI) and Safety Warning Index (SWI), and are derived from the proposed risk criteria of Chinese vessel traffic. As a case study, data on vessel traffic accidents reported in the Western Shenzhen Port, South China from 1995 to 2015 are analyzed. The actual risk level of this area during the period is calculated under the framework. The implementation of the safety indexes indicate that the risk criteria and safety indexes are practicable and effective for the vessel traffic management. The methodology based on long-term accident data can significantly support the risk analysis in the macroscopic perspective for busy ports and waterways, such that SWI can act as threshold to trigger actions, while SEI can act as an indicator to measure safety status. Copyright © 2016 Elsevier Ltd. All rights reserved.

A Risk Explicit Interval Linear Programming Model for Uncertainty-Based Environmental Economic Optimization in the Lake Fuxian Watershed, China

PubMed Central

Zou, Rui; Liu, Yong; Yu, Yajuan

2013-01-01

The conflict of water environment protection and economic development has brought severe water pollution and restricted the sustainable development in the watershed. A risk explicit interval linear programming (REILP) method was used to solve integrated watershed environmental-economic optimization problem. Interval linear programming (ILP) and REILP models for uncertainty-based environmental economic optimization at the watershed scale were developed for the management of Lake Fuxian watershed, China. Scenario analysis was introduced into model solution process to ensure the practicality and operability of optimization schemes. Decision makers' preferences for risk levels can be expressed through inputting different discrete aspiration level values into the REILP model in three periods under two scenarios. Through balancing the optimal system returns and corresponding system risks, decision makers can develop an efficient industrial restructuring scheme based directly on the window of “low risk and high return efficiency” in the trade-off curve. The representative schemes at the turning points of two scenarios were interpreted and compared to identify a preferable planning alternative, which has the relatively low risks and nearly maximum benefits. This study provides new insights and proposes a tool, which was REILP, for decision makers to develop an effectively environmental economic optimization scheme in integrated watershed management. PMID:24191144

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.

Credit Risk Evaluation of Power Market Players with Random Forest

NASA Astrophysics Data System (ADS)

Umezawa, Yasushi; Mori, Hiroyuki

A new method is proposed for credit risk evaluation in a power market. The credit risk evaluation is to measure the bankruptcy risk of the company. The power system liberalization results in new environment that puts emphasis on the profit maximization and the risk minimization. There is a high probability that the electricity transaction causes a risk between companies. So, power market players are concerned with the risk minimization. As a management strategy, a risk index is requested to evaluate the worth of the business partner. This paper proposes a new method for evaluating the credit risk with Random Forest (RF) that makes ensemble learning for the decision tree. RF is one of efficient data mining technique in clustering data and extracting relationship between input and output data. In addition, the method of generating pseudo-measurements is proposed to improve the performance of RF. The proposed method is successfully applied to real financial data of energy utilities in the power market. A comparison is made between the proposed and the conventional methods.

Integrating land cover modeling and adaptive management to conserve endangered species and reduce catastrophic fire risk

USGS Publications Warehouse

Breininger, David; Duncan, Brean; Eaton, Mitchell J.; Johnson, Fred; Nichols, James

2014-01-01

Land cover modeling is used to inform land management, but most often via a two-step process, where science informs how management alternatives can influence resources, and then, decision makers can use this information to make decisions. A more efficient process is to directly integrate science and decision-making, where science allows us to learn in order to better accomplish management objectives and is developed to address specific decisions. Co-development of management and science is especially productive when decisions are complicated by multiple objectives and impeded by uncertainty. Multiple objectives can be met by the specification of tradeoffs, and relevant uncertainty can be addressed through targeted science (i.e., models and monitoring). We describe how to integrate habitat and fuel monitoring with decision-making focused on the dual objectives of managing for endangered species and minimizing catastrophic fire risk. Under certain conditions, both objectives might be achieved by a similar management policy; other conditions require tradeoffs between objectives. Knowledge about system responses to actions can be informed by developing hypotheses based on ideas about fire behavior and then applying competing management actions to different land units in the same system state. Monitoring and management integration is important to optimize state-specific management decisions and to increase knowledge about system responses. We believe this approach has broad utility and identifies a clear role for land cover modeling programs intended to inform decision-making.

Urban Flood Risk Insurance Models as a Strategy for Proactive Water Management Policies

NASA Astrophysics Data System (ADS)

Graciosa, M. C.; Mendiondo, E. M.

2006-12-01

To improve the water management through hydrological sciences, novel integration strategies could be underpinned to bridge up both engineering and economics. This is especially significant in developing nations where hydrologic extremes are expressive while the financial resources to mitigate that variability are scarce. One example of this problem is related to floods and their global and regional consequences. Floods mainly cause disasters in terms of human and material losses. In 2002, more than 30% of extreme climatic events occurred worldwide were floods, representing 42% of fatalities and 66% of material losses, mostly related to reactive policies. Throughout the last century, hydrological variability and rapidly growing of urban areas have developed new environmental problems in Brazilian cities, such as inundation occurrences on non-planned river basins. One of the causes of flood impacts is that public funds (national, state or municipal) have barely introduced wise proactive polices to follow up rapidly growing urban areas. Inexistent flood-risk-transfer mechanisms have caused the so-called `flood poverty cycle' due to reactive polices that have been increasing flood losses and, sometimes, became flood disasters. Flood risk management (FRM) is part of pro-active policies to mitigate inundation losses, in order to sustain environmental, social and economic aspects. Concepts and principles of FRM are part of a process that encompasses three phases: (1) preparedness stage, that consists in structural and non-structural actions to prevent and protect potential risk areas, such as early warning systems and scenarios development; (2) control stage, that refers to help actions and protection facilities during the event, and (3) restoration stage, that is related to rebuild affected areas, restore the river dynamics and transfer the socio-economic risks through flood insurances. Flood risk insurances agree to the goals of losses mitigation programs. Their use is more common in basins affected by alluvial floods. However, most of losses occur in urban areas, as a consequence of flash floods. Quantification of losses is an important basis of flood mitigation programs. It is also a complex task, which involves setting values on not easily quantifiable goods and determining risk and damage curves. This work proposes a flood insurance risk model coupled with a hydrological model as an incentive-based mechanism for achieving economically efficient flood management to be applied in Brazilian urban basins. It consists of integrating an insurance model and hydrological modeling of peak discharge warnings. It sets up curves, such as: water level versus discharge, water level versus inundation areas, and inundation area versus damage. It considers the prediction of future scenarios in order to evaluate the behavior of the insurance fund under climate variability. By using different probability distribution is compared the solvency and efficiency of the flood insurance fund for each premium-covered situation. The methodology is outlined to provide resources for the FRM restoration phase. Results are depicted from an experimental river basin sited on a rapid growing urban area, with some lessons learned valid to approach in other urban basins. This example is envisaged to foster resilience in the integration of hydrological science with policy and economic approaches. KEY WORDS: Flood risks management; flood insurance; hydrological modeling.

Predictive Modeling of Risk Associated with Temperature Extremes over Continental US

NASA Astrophysics Data System (ADS)

Kravtsov, S.; Roebber, P.; Brazauskas, V.

2016-12-01

We build an extremely statistically accurate, essentially bias-free empirical emulator of atmospheric surface temperature and apply it for meteorological risk assessment over the domain of continental US. The resulting prediction scheme achieves an order-of-magnitude or larger gain of numerical efficiency compared with the schemes based on high-resolution dynamical atmospheric models, leading to unprecedented accuracy of the estimated risk distributions. The empirical model construction methodology is based on our earlier work, but is further modified to account for the influence of large-scale, global climate change on regional US weather and climate. The resulting estimates of the time-dependent, spatially extended probability of temperature extremes over the simulation period can be used as a risk management tool by insurance companies and regulatory governmental agencies.

[Manual rotation of occiput posterior presentation].

PubMed

Le Ray, C; Goffinet, F

2011-10-01

Delivery in occiput posterior position is associated with a higher risk of cesarean section, operative vaginal delivery and severe perineal tears. We report the technic of manual rotation described by Tarnier and Chantreuil and used daily in our maternity center. Only five studies were published on this topic; all of them demonstrate that manual rotation decreases the risk of cesarean section. Moreover, it could decrease the risk of prolonged second stage, chorioamnionitis and third and fourth degree tears in comparison with expectant management. However, manual rotation is associated with a two-fold higher risk of cervical and vaginal lacerations. Manual rotation performed with an adequate technic is an efficient and safe manœuvre to avoid complications associated with occiput posterior vaginal delivery. Copyright © 2011. Published by Elsevier SAS.

Waste collection in developing countries - Tackling occupational safety and health hazards at their source

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

Bleck, Daniela, E-mail: bleck.daniela@baua.bund.de; Wettberg, Wieland, E-mail: wettberg.wieland@baua.bund.de

2012-11-15

Waste management procedures in developing countries are associated with occupational safety and health risks. Gastro-intestinal infections, respiratory and skin diseases as well as muscular-skeletal problems and cutting injuries are commonly found among waste workers around the globe. In order to find efficient, sustainable solutions to reduce occupational risks of waste workers, a methodological risk assessment has to be performed and counteractive measures have to be developed according to an internationally acknowledged hierarchy. From a case study in Addis Ababa, Ethiopia suggestions for the transferral of collected household waste into roadside containers are given. With construction of ramps to dump collectedmore » household waste straight into roadside containers and an adaptation of pushcarts and collection procedures, the risk is tackled at the source.« less

Stingray Failure Mode, Effects and Criticality Analysis: WEC Risk Registers

DOE Data Explorer

Ken Rhinefrank

2016-07-25

Analysis method to systematically identify all potential failure modes and their effects on the Stingray WEC system. This analysis is incorporated early in the development cycle such that the mitigation of the identified failure modes can be achieved cost effectively and efficiently. The FMECA can begin once there is enough detail to functions and failure modes of a given system, and its interfaces with other systems. The FMECA occurs coincidently with the design process and is an iterative process which allows for design changes to overcome deficiencies in the analysis.Risk Registers for major subsystems completed according to the methodology described in "Failure Mode Effects and Criticality Analysis Risk Reduction Program Plan.pdf" document below, in compliance with the DOE Risk Management Framework developed by NREL.

High-intensity interval training for improving postprandial hyperglycemia.

PubMed

Little, Jonathan P; Francois, Monique E

2014-12-01

High-intensity interval training (HIIT) has garnered attention in recent years as a time-efficient exercise option for improving cardiovascular and metabolic health. New research demonstrates that HIIT may be particularly effective for improving postprandial hyperglycemia in individuals with, or at risk for, type 2 diabetes (T2D). These findings have clinical relevance because elevated postprandial hyperglycemia is a significant risk factor for cardiovascular morbidity and mortality. This article summarizes the latest evidence demonstrating that HIIT can improve postprandial glucose control to highlight the potential application of HIIT in the prevention and management of T2D and associated cardiovascular complications.

NASA Heavy Lift Rotorcraft Systems Investigation

NASA Technical Reports Server (NTRS)

Johnson, Wayne; Yamauchi, Gloria K.; Watts, Michael E.

2005-01-01

The NASA Heavy Lift Rotorcraft Systems Investigation examined in depth several rotorcraft configurations for large civil transport, designed to meet the technology goals of the NASA Vehicle Systems Program. The investigation identified the Large Civil Tiltrotor as the configuration with the best potential to meet the technology goals. The design presented was economically competitive, with the potential for substantial impact on the air transportation system. The keys to achieving a competitive aircraft were low drag airframe and low disk loading rotors; structural weight reduction, for both airframe and rotors; drive system weight reduction; improved engine efficiency; low maintenance design; and manufacturing cost comparable to fixed-wing aircraft. Risk reduction plans were developed to provide the strategic direction to support a heavy-lift rotorcraft development. The following high risk areas were identified for heavy lift rotorcraft: high torque, light weight drive system; high performance, structurally efficient rotor/wing system; low noise aircraft; and super-integrated vehicle management system.

Is treatment with liraglutide efficient?

PubMed

Mezquita Raya, Pedro; Reyes García, Rebeca

2014-04-01

In the current context of limited economic and health resources, efficiency of drug treatments is of paramount importance, and their clinical effects and related direct costs should therefore be analyzed. Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist approved for the treatment of type 2 diabetes mellitus (T2DM) which, in addition to its normoglycemic effects, induces a significant improvement in body weight and several cardiovascular risk factors. The aim of this narrative review is to summarize the available evidence about the effects of liraglutide upon cardiovascular risk factors and how these improve its cost-effectiveness profile. Despite the relatively higher cost of liraglutide as compared to other alternative therapies, liraglutide has been shown to be cost-effective when clinical indicators and total costs associated to T2DM management are analyzed. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

Designs and Technology Requirements for Civil Heavy Lift Rotorcraft

NASA Technical Reports Server (NTRS)

Johnson, Wayne; Yamauchi, Gloria K.; Watts, Michael E.

2006-01-01

The NASA Heavy Lift Rotorcraft Systems Investigation examined in depth several rotorcraft configurations for large civil transport, designed to meet the technology goals of the NASA Vehicle Systems Program. The investigation identified the Large Civil Tiltrotor as the configuration with the best potential to meet the technology goals. The design presented was economically competitive, with the potential for substantial impact on the air transportation system. The keys to achieving a competitive aircraft were low drag airframe and low disk loading rotors; structural weight reduction, for both airframe and rotors; drive system weight reduction; improved engine efficiency; low maintenance design; and manufacturing cost comparable to fixed-wing aircraft. Risk reduction plans were developed to provide the strategic direction to support a heavy-lift rotorcraft development. The following high risk areas were identified for heavy lift rotorcraft: high torque, light weight drive system; high performance, structurally efficient rotor/wing system; low noise aircraft; and super-integrated vehicle management system.

The Careful Puppet Master: Reducing risk and fortifying acceptance testing with Jenkins CI

NASA Astrophysics Data System (ADS)

Smith, Jason A.; Richman, Gabriel; DeStefano, John; Pryor, James; Rao, Tejas; Strecker-Kellogg, William; Wong, Tony

2015-12-01

Centralized configuration management, including the use of automation tools such as Puppet, can greatly increase provisioning speed and efficiency when configuring new systems or making changes to existing systems, reduce duplication of work, and improve automated processes. However, centralized management also brings with it a level of inherent risk: a single change in just one file can quickly be pushed out to thousands of computers and, if that change is not properly and thoroughly tested and contains an error, could result in catastrophic damage to many services, potentially bringing an entire computer facility offline. Change management procedures can—and should—be formalized in order to prevent such accidents. However, like the configuration management process itself, if such procedures are not automated, they can be difficult to enforce strictly. Therefore, to reduce the risk of merging potentially harmful changes into our production Puppet environment, we have created an automated testing system, which includes the Jenkins CI tool, to manage our Puppet testing process. This system includes the proposed changes and runs Puppet on a pool of dozens of RedHat Enterprise Virtualization (RHEV) virtual machines (VMs) that replicate most of our important production services for the purpose of testing. This paper describes our automated test system and how it hooks into our production approval process for automatic acceptance testing. All pending changes that have been pushed to production must pass this validation process before they can be approved and merged into production.

A study of the application of permeable pavements as a sustainable technique for the mitigation of soil sealing in cities: A case study in the south of Spain.

PubMed

Rodríguez-Rojas, M I; Huertas-Fernández, F; Moreno, B; Martínez, G; Grindlay, A L

2018-01-01

The use of 'Sustainable Urban Drainage Systems' (SuDS) has become a more sustainable alternative for managing stormwater, greatly reducing the effects of soil sealing. However, the lack of monitored projects is a barrier to their implementation, as the companies which manage sewer systems cannot quantify the impact and cost-efficiency of SuDS. This paper presents a project developed in the south of Spain, in which the hydrological performance of 3 types of permeable pavements has been analyzed. The efficiencies obtained (over 70%), are higher than or similar to the efficiencies of vegetated SuDS, demonstrating the capacity of these pavements for delaying catchment area response and slow flow velocities, reducing the operating costs of sewer systems and the flood risk, while also ensuring service conditions for cities and safety for pedestrian and vehicular circulation. This pilot site has generated results which are sufficiently consistent so as to be representative, and serve as a reference for other cities with a similar climate. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Nature of Natural Hazards Communication (Invited)

NASA Astrophysics Data System (ADS)

Kontar, Y. Y.

2013-12-01

Some of the many issues of interest to natural hazards professionals include the analysis of proactive approaches to the governance of risk from natural hazards and approaches to broaden the scope of public policies related to the management of risks from natural hazards, as well as including emergency and environmental management, community development and spatial planning related to natural hazards. During the talk we will present results of scientific review, analysis and synthesis, which emphasize same new trends in communication of the natural hazards theories and practices within an up-to-the-minute context of new environmental and climate change issues, new technologies, and a new focus on resiliency. The presentation is divided into five sections that focus on natural hazards communication in terms of education, risk management, public discourse, engaging the public, theoretical perspectives, and new media. It includes results of case studies and best practices. It delves into natural hazards communication theories, including diffusion, argumentation, and constructivism, to name a few. The presentation will provide information about: (1) A manual of natural hazards communication for scientists, policymakers, and media; (2) An up-to-the-minute context of environmental hazards, new technologies & political landscape; (3) A work by natural hazards scientists for geoscientists working with social scientists and communication principles; (4) A work underpinned by key natural hazards communication theories and interspersed with pragmatic solutions; (5) A work that crosses traditional natural hazards boundaries: international, interdisciplinary, theoretical/applied. We will further explore how spatial planning can contribute to risk governance by influencing the occupation of natural hazard-prone areas, and review the central role of emergency management in risk policy. The goal of this presentation is to contribute to the augmentation of the conceptual framework of risk governance and increase the awareness of practitioners and decision-makers to the need to adopt proactive policies, leading to a more integrated, participative, and adaptive governance that can respond more efficiently to the increasing uncertainty resulting from escalating natural hazards risk exposure.

Handbook for Volcanic Risk Management: an outcome from MIAVITA project

NASA Astrophysics Data System (ADS)

Bignami, Christian; Bosi, Vittorio; Costantini, Licia; Cristiani, Chiara; Lavigne, Franck; Thierry, Pierre

2013-04-01

Volcanic eruptions are one of the most impressive, violent and dramatic agents of change on Earth, threatening hundreds of millions of people. The crises management implies a strong cooperation among the main stakeholders (e.g., civil protection authorities, scientific institutions, operational forces). Considering the great amount of different actions required during the whole volcanic cycle (e.g., preparedness, unrest phase, crisis management, resilience), the role and responsibilities of stakeholders should be clarified in advance. In particular, the role of scientists, fundamental in all the phases, should be well discussed with the other stakeholders and well defined, for every country. This will allow a better management and response, and contribute to avoid misunderstanding. The new "Handbook for Volcanic Risk Management" issued by the MIAVITA European project, funded by the European Commission (Mitigate and Assess risk from Volcanic Impact on Terrain and human Activities) gives a contribution to that. Indeed, this handbook aims at synthesizing the acquired knowledge on volcanic risk management, such as prevention, preparedness, mitigation, intervention, crisis management and resilience, in a practical and useful way. It promotes the creation of an ideal bridge between different actors involved in risk management, improving and facilitating interactions among authorities and scientists. This work is based on current scientific research and the shared experience of the different MIAVITA project partners as well as on international good practices previously recommended. The handbook is composed of six sections. The first one briefly explains the global volcanic context and the principles of corresponding risk management. Section 2 contains a description of volcanic phenomena, damage and understanding size and effects that can be expected. Sections 3, 4 and 5 meet preparation and prevention issues and describe actions to be undertaken during the response phase of the volcano in order to improve the preparedness of stakeholders and population and to minimize the effects of future eruptions. The last one, section 6, deals with crisis management and shows some recovery examples. In sections 4, 5 and 6, the readers can find the proposed definition of roles and responsibilities for the main actors, and some insights and good practices to improve the capability of the civil protection system to better include the scientific communities. Suggestions are also given in order to develop a common training in order to have efficient communication with the media, setting up a collaborative approach with the media itself, with the civil protection authorities, and with the public. The handbook It is presently available for free on the following websites: http://miavita.brgm.fr, http://www.ingv.it/en, www.protezionecivile.it.

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.

Designing the role of the embedded care manager.

PubMed

Hines, Patricia; Mercury, Marge

2013-01-01

: The role of the professional case manager is changing rapidly. Health reform has called upon the industry to ensure that care is delivered in an efficient, effective, and high-quality and low cost manner. As a means to achieve this objective, health plans and health systems are moving the care manager out of a centralized location within their organizations to "embedding" them into physician offices. This move enables the care manager to work alongside the primary care physicians and their high-risk patients. This article discusses the framework for designing and implementing an embedded care manager role into a physician practice. Key elements of the program are discussed. IMPLICATIONS FOR CARE MANAGEMENT:: Historically care management has played a foundational role in improving the quality of care for individuals and populations via the efficient and effective use of resources. Now with the goals of health care reform, a successful transition from a volume-based to value-based reimbursement system requires primary care physicians to welcome care managers into their practices to improve patient care, quality, and costs through care coordination across health care settings and populations. : As patient-centered medical homes and integrated delivery systems formulate their plans for population health management, their efforts have included embedding a care manager in the primary practice setting. Having care managers embedded at the physician offices increases their ability to collaborate with the physician and their staff in the implementation and monitoring care plans for their patients. : Implementing an embedded care manager into an existing physician's practice requires the following:Although the embedded care manager is a highly evolving role, physician groups are beginning to realize the benefits from their care management collaborations. Examples cited include improved outreach and coordination, patient adherence to care plans, and improved quality of life.

Risk Factors for Intimate Partner Violence: A Comparison of Antisocial and Family-Only Perpetrators.

PubMed

Petersson, Joakim; Strand, Susanne; Selenius, Heidi

2016-03-27

Subtyping male perpetrators of intimate partner violence (IPV) based on their generality of violence could facilitate the difficult task of matching perpetrator subtype with efficient risk management strategies. As such, the aim of the present study was to compare antisocial and family-only male perpetrators of interpersonal violence in terms of (a) demographic and legal characteristics, (b) risk factors for violence, and (c) assessed risk and the importance of specific risk factors for violence. A quantitative design was used in this retrospective register study on data obtained from the Swedish police. Risk assessments performed with the Swedish version of the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER) and police registers were used. A sample of 657 male alleged IPV perpetrators were classified asantisocial(n= 341) orfamily-only(n= 316) based on their generality of violence. The results showed that the antisocial perpetrators were significantly younger, as well as more psychologically abusive. Antisocial perpetrators also had significantly more present risk factors for IPV, and were assessed with a significantly higher risk for acute and severe or deadly IPV, compared with the family-only perpetrators. The subtypes also evidenced unique risk factors with a significant impact on elevated risk for acute and severe or deadly such violence. Key findings in the present study concerned the subtypes evidencing unique risk factors increasing the risk for acute and severe or deadly IPV. Major implications of this study include the findings of such unique "red flag" risk factors for each subtype. To prevent future IPV, it is vital for the risk assessor to be aware of these red flags when making decisions about risk, as well as risk management strategies. © The Author(s) 2016.

Risk-based remediation of polluted sites: A critical perspective.

PubMed

Kuppusamy, Saranya; Venkateswarlu, Kadiyala; Megharaj, Mallavarapu; Mayilswami, Srinithi; Lee, Yong Bok

2017-11-01

Sites contaminated with chemical pollutants represent a growing challenge, and remediation of such lands is of international concern. Risk-based land management (RBLM) is an emerging approach that integrates risk assessment practices with more traditional site-specific investigations and remediation activities. Developing countries are yet to adopt RBLM strategies for remediation. RBLM is considered to be practical, scientifically defensible and cost-efficient. However, it is inherently limited by: firstly, the accuracy of risk assessment models used; secondly, ramifications of the fact that they are more likely to leave contamination in place; and thirdly, uncertainties involved and having to consider the total concentrations of all contaminants in soils that overestimate the potential risks from exposure to the contaminants. Consideration of contaminant bioavailability as the underlying basis for risk assessment and setting remediation goals of those contaminated lands that pose a risk to environmental and human health may lead to the development of a more sophisticated risk-based approach. However, employing the bioavailability concept in RBLM has not been extensively studied and/or legalized. This review highlights the extent of global land contamination, and the concept of risk-based assessment and management of contaminated sites including its advantages and disadvantages. Furthermore, the concept of bioavailability-based RBLM strategy has been proposed, and the challenges of RBLM and the priority areas for future research are summarized. Thus, the present review may help achieve a better understanding and successful implementation of a sustainable bioavailability-based RBLM strategy. Copyright © 2017 Elsevier Ltd. All rights reserved.

A new Geo-Information Architecture for Risk Management in the Alps

NASA Astrophysics Data System (ADS)

Baruffini, Mi.; Thuering, M.

2009-04-01

During the last decades land-use increased significantly in the Swiss (and European) mountain regions. Due to the scarceness of areas suitable for development, anthropic activities were extended into areas prone to natural hazards such as avalanches, debris flows and rockfalls (Smith 2001). Furthermore, the transalpine transport system necessity to develop effective links in an important area collides with the need to ensure the safety of travelers and the health of the population. Consequently, an increase in losses due to hazards can be observed. To mitigate these associated losses, both traditional protective measures and land-use planning policies are to be developed and implemented to optimize future investments. Efficient protection alternatives can be obtained considering the concept of integral risk management. Risk analysis, as the central part of risk management, has become gradually a generally accepted approach for the assessment of current and future scenarios (Loat & Zimmermann 2004). The procedure aims at risk reduction which can be reached by conventional mitigation on one hand and the implementation of land-use planning on the other hand: a combination of active and passive mitigation measures is applied to prevent damage to buildings, people and infrastructures. As part of the Swiss National Science Foundation Project 54 "Evaluation of the optimal resilience for vulnerable infrastructure networks - An interdisciplinary pilot study on the transalpine transportation corridors" we study the vulnerability of infrastructures due to natural hazards. The project aims to study various natural hazards (and later, even man-made) and to obtain an evaluation of the resilience according to an interdisciplinary approach, considering the possible damage by means of risk criteria and pointing out the feasibility of conceivable measures to reduce potential damage. The project consists of a geoscientific part and an application. The fist part consists in studying the dangers (natural) and related risks in terms of infrastructure vulnerability. The application considers different types of danger (logically intersected with the transport infrastructure) and compares them with fixed values to obtain a so-called deficit. As framework we adopt The Swiss system for risk analysis of gravitational natural hazards (BUWAL 1999). In this way the project develops a methodology that makes possible a risk analysis aiming to optimize the infrastructure vulnerability and therefore allows to obtain a model designed to optimize the functionality of the network infrastructure. A simulation environment, RiskBox, is developed within the open-source GIS environment GRASS (Geographic Resources Analysis Support System) and a database (PostgreSQL) in order to manage a infrastructure data catalog. The targeted simulation environment includes the elements that identify the consecutive steps of risk analysis: hazard - vulnerability - risk. The initial results of the experimental case study show how useful a GIS-based system, which identify the risk of any single vulnerable element in the corridor and to assess the risk to the global system on the basis of priorities of the actors involved, can be for effective and efficient disaster response management, as explained in (ARMONIA Project 2007). In our work we wanted to highlight the complexity of the risk analysis methodology, difficulty that is amplified by many peculiarities in the mountain areas. In particular, the illustrative performed process can give an overview of the interests and the need to act to reduce vulnerability and the hazardous nature of the Gotthard corridor. We present the concept and current state of development of our project and our application to the testbed, the Alps-crossing corridor of St. Gotthard. REFERENCES ARMONIA Project 2007: Land use plans in Risky areas fro Unwise to Wise Practices - Materials 2nd conference. Politecnico di Milano. BUWAL 1999: Risikoanalyse bei gravitativen Naturgefahren - Methode, Fallbeispiele und Daten (Risk analyses for gravitational natural hazards). Bundesamt für Umwelt, Wald und Landschaft (BUWAL). Umwelt-Materialen Nr. 107, 1-244. Loat, R. & Zimmermann, M. 2004 : La gestion des risques en Suisse (Risk Management in Switzerland). In: Veyret, Y., Garry, G., Meschinet de Richemont, N. & Armand Colin (eds) 2002: Colloque Arche de la Défense 22-24 octobre 2002, dans Risques naturels et aménagement en Europe, 108-120. Smith, K. 2001: Environmental hazards. Assessing the risk and reducing disaster. Third edition. London

Cyber security risk management: public policy implications of correlated risk, imperfect ability to prove loss, and observability of self-protection.

PubMed

Oğüt, Hulisi; Raghunathan, Srinivasan; Menon, Nirup

2011-03-01

The correlated nature of security breach risks, the imperfect ability to prove loss from a breach to an insurer, and the inability of insurers and external agents to observe firms' self-protection efforts have posed significant challenges to cyber security risk management. Our analysis finds that a firm invests less than the social optimal levels in self-protection and in insurance when risks are correlated and the ability to prove loss is imperfect. We find that the appropriate social intervention policy to induce a firm to invest at socially optimal levels depends on whether insurers can verify a firm's self-protection levels. If self-protection of a firm is observable to an insurer so that it can design a contract that is contingent on the self-protection level, then self-protection and insurance behave as complements. In this case, a social planner can induce a firm to choose the socially optimal self-protection and insurance levels by offering a subsidy on self-protection. We also find that providing a subsidy on insurance does not provide a similar inducement to a firm. If self-protection of a firm is not observable to an insurer, then self-protection and insurance behave as substitutes. In this case, a social planner should tax the insurance premium to achieve socially optimal results. The results of our analysis hold regardless of whether the insurance market is perfectly competitive or not, implying that solely reforming the currently imperfect insurance market is insufficient to achieve the efficient outcome in cyber security risk management. © 2010 Society for Risk Analysis.

Data-Driven Identification of Risk Factors of Patient Satisfaction at a Large Urban Academic Medical Center.

PubMed

Li, Li; Lee, Nathan J; Glicksberg, Benjamin S; Radbill, Brian D; Dudley, Joel T

2016-01-01

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is the first publicly reported nationwide survey to evaluate and compare hospitals. Increasing patient satisfaction is an important goal as it aims to achieve a more effective and efficient healthcare delivery system. In this study, we develop and apply an integrative, data-driven approach to identify clinical risk factors that associate with patient satisfaction outcomes. We included 1,771 unique adult patients who completed the HCAHPS survey and were discharged from the inpatient Medicine service from 2010 to 2012. We collected 266 clinical features including patient demographics, lab measurements, medications, disease categories, and procedures. We developed and applied a data-driven approach to identify risk factors that associate with patient satisfaction outcomes. We identify 102 significant risk factors associating with 18 surveyed questions. The most significantly recurrent clinical risk factors were: self-evaluation of health, education level, Asian, White, treatment in BMT oncology division, being prescribed a new medication. Patients who were prescribed pregabalin were less satisfied particularly in relation to communication with nurses and pain management. Explanation of medication usage was associated with communication with nurses (q = 0.001); however, explanation of medication side effects was associated with communication with doctors (q = 0.003). Overall hospital rating was associated with hospital environment, communication with doctors, and communication about medicines. However, patient likelihood to recommend hospital was associated with hospital environment, communication about medicines, pain management, and communication with nurse. Our study identified a number of putatively novel clinical risk factors for patient satisfaction that suggest new opportunities to better understand and manage patient satisfaction. Hospitals can use a data-driven approach to identify clinical risk factors for poor patient satisfaction to support development of specific interventions to improve patients' experience of care.

Organizing and managing care in a changing health system.

PubMed

Kohn, L T

2000-04-01

To examine ways in which the management and organization of medical care is changing in response to the shifting incentives created by managed care. Site visits conducted in 12 randomly selected communities in 1996/ 1997. Approximately 35-60 interviews were conducted per site with key informants in healthcare and community organizations; about half were with providers. A standardized interview protocol was implemented across all sites, enabling cross-site comparisons. Multiple respondents were interviewed on each issue. A great deal of experimentation and apparent duplication exist in efforts to develop programs to influence physician practice patterns. Responsibility for managing care is being contested by health plans, medical groups and hospitals, as each seeks to accrue the savings that can result from the more efficient delivery of care. To manage the financial and clinical risk, providers are aggressively consolidating and reorganizing. Most significant was the rapid formation of intermediary organizations, such as independent practice arrangements (IPAs), physician-hospital organizations (PHOs), or management services organizations (MSOs), for contracting with managed care organizations. Managed care appears to have only a modest effect on how healthcare organizations deliver medical care, despite the profound effect that managed care has on how providers are organized. Rather than improving the efficiency of healthcare organizations, provider efforts to build large systems and become indispensable to health plans are exacerbating problems of excess capacity. It is not clear if new organizational arrangements will help providers manage the changing incentives they face, or if their intent is to blunt the effects of the incentives by forming larger organizations to improve their bargaining power and resist change.

Informing climate-related decisions in complex river basins: A comparative assessment

NASA Astrophysics Data System (ADS)

Pulwarty, R. S.; Bark, R. H.; Maia, R.; Udall, B.

2010-12-01

Integrated water resources management provides an important governance framework to achieve climate-related adaptation measures across socio-economic, environmental and administrative systems. Adaptation includes technical changes that improve water use efficiency, early warning, demand management (e.g. through metering and pricing), and institutional changes that improve the tradability of water rights. Supply-side strategies generally involve increases in storage capacity, abstraction from watercourses, and water transfers. Incentives for improving water-use efficiency, hold considerable promise for water savings and the reallocation of water to highly valued uses. However, conflicts exist between processes and goals of water management and governance. These militate against the effectiveness of using scientific information to meet short-term needs in the context of reducing longer-term vulnerabilities such as for “increasing water supply while meeting environmental needs.” A complete analysis of the effects of climate change on human water uses would consider cross-sector interactions, including the impacts of transfers of the use of water from one sector to another. In this presentation we will review the challenges and lessons provided in water resources management in the context of a changing climate. Lessons are drawn from watersheds around the world including the Colorado, Columbia, Murray-Darling, Guadiana and others. We explore how watershed managers and researchers are attempting to address the risks associated with climatic change and potential surprises. In spite of numerous climate impacts studies the management of the cumulative impacts of extremes (droughts, floods etc.) remains reactive and crisis-driven. Most recommendations stay within the applied sciences realm of technological interventions and supply driven approaches. Clearly more is needed to inform an integrated watershed management approaches in which adaptive management functions as an operational tool for learning. The barriers to implementing adaptation measures include the inability of some natural systems to adapt at the rate of combined demographic pressures and climate, incomplete understanding and quantifying of water demands, and impediments to the flow of timely and reliable knowledge and information relevant for decision makers. Mechanisms to expand this range of choice include: Anticipatory coordination within development plans (e.g. adaptive management within integrated watershed and coastal zone plans). Developing usable climate risk management triggers for early warning of potential conflicts in agriculture, water, energy, health, environment , and coastal zones, including a mixed portfolio of past data and scenario-based approaches Developing and employing water efficient technologies. Actively engaging communities and states in mainstreaming climate information such as in the development of scenarios that link climate and development goals Future needs include exploration of alternate integration models and overlying policy structures that could, together, facilitate and sustain shared learning as climate varies and change

Urban water infrastructure asset management - a structured approach in four water utilities.

PubMed

Cardoso, M A; Silva, M Santos; Coelho, S T; Almeida, M C; Covas, D I C

2012-01-01

Water services are a strategic sector of large social and economic relevance. It is therefore essential that they are managed rationally and efficiently. Advanced water supply and wastewater infrastructure asset management (IAM) is key in achieving adequate levels of service in the future, particularly with regard to reliable and high quality drinking water supply, prevention of urban flooding, efficient use of natural resources and prevention of pollution. This paper presents a methodology for supporting the development of urban water IAM, developed during the AWARE-P project as well as an appraisal of its implementation in four water utilities. Both water supply and wastewater systems were considered. Due to the different contexts and features of the utilities, the main concerns vary from case to case; some problems essentially are related to performance, others to risk. Cost is a common deciding factor. The paper describes the procedure applied, focusing on the diversity of drivers, constraints, benefits and outcomes. It also points out the main challenges and the results obtained through the implementation of a structured procedure for supporting urban water IAM.

Enhanced surveillance strategies for detecting and monitoring chronic wasting disease in free-ranging cervids

USGS Publications Warehouse

Walsh, Daniel P.

2012-01-01

The purpose of this document is to provide wildlife management agencies with the foundation upon which they can build scientifically rigorous and cost-effective surveillance and monitoring programs for chronic wasting disease (CWD) or refine their existing programs. The first chapter provides an overview of potential demographic and spatial risk factors of susceptible wildlife populations that may be exploited for CWD surveillance and monitoring. The information contained in this chapter explores historic as well as recent developments in our understanding of CWD disease dynamics. It also contains many literature references for readers who may desire a more thorough review of the topics or CWD in general. The second chapter examines methods for enhancing efforts to detect CWD on the landscape where it is not presently known to exist and focuses on the efficiency and cost-effectiveness of the surveillance program. Specifically, it describes the means of exploiting current knowledge of demographic and spatial risk factors, as described in the first chapter, through a two-stage surveillance scheme that utilizes traditional design-based sampling approaches and novel statistical methods to incorporate information about the attributes of the landscape, environment, populations and individual animals into CWD surveillance activities. By accounting for these attributes, efficiencies can be gained and cost-savings can be realized. The final chapter is unique in relation to the first two chapters. Its focus is on designing programs to monitor CWD once it is discovered within a jurisdiction. Unlike the prior chapters that are more detailed or prescriptive, this chapter by design is considerably more general because providing comprehensive direction for creating monitoring programs for jurisdictions without consideration of their monitoring goals, sociopolitical constraints, or their biological systems, is not possible. Therefore, the authors draw upon their collective experiences implementing disease-monitoring programs to present the important questions to consider, potential tools, and various strategies for those wildlife management agencies endeavoring to create or maintain a CWD monitoring program. Its intent is to aid readers in creating efficient and cost-effective monitoring programs, while avoiding potential pitfalls. It is hoped that these three chapters will be useful tools for wildlife managers struggling to implement efficient and effective CWD disease management programs.

Specialist Cohort Event Monitoring studies: a new study method for risk management in pharmacovigilance.

PubMed

Layton, Deborah; Shakir, Saad A W

2015-02-01

The evolving regulatory landscape has heightened the need for innovative, proactive, efficient and more meaningful solutions for 'real-world' post-authorization safety studies (PASS) that not only align with risk management objectives to gather additional safety monitoring information or assess a pattern of drug utilization, but also satisfy key regulatory requirements for marketing authorization holder risk management planning and execution needs. There is a need for data capture across the primary care and secondary care interface, or for exploring use of new medicines in secondary care to support conducting PASS. To fulfil this need, event monitoring has evolved. The Specialist Cohort Event Monitoring (SCEM) study is a new application that enables a cohort of patients prescribed a medicine in the hospital and secondary care settings to be monitored. The method also permits the inclusion of a comparator cohort of patients receiving standard care, or another counterfactual comparator group, to be monitored concurrently, depending on the study question. The approach has been developed in parallel with the new legislative requirement for pharmaceutical companies to undertake a risk management plan as part of post-authorization safety monitoring. SCEM studies recognize that the study population comprises those patients who may have treatment initiated under the care of specialist health care professionals and who are more complex in terms of underlying disease, co-morbidities and concomitant medications than the general disease population treated in primary care. The aims of this paper are to discuss the SCEM new-user study design, rationale and features that aim to address possible bias (such as selection bias) and current applications.

Hospital free cash flow.

PubMed

Kauer, R T; Silvers, J B

1991-01-01

Hospital managers may find it difficult to admit their investments have been suboptimal, but such investments often lead to poor returns and less future cash. Inappropriate use of free cash flow produces large transaction costs of exit. The relative efficiency of investor-owned and tax-exempt hospitals in the product market for hospital services is examined as the free cash flow theory is used to explore capital-market conditions of hospitals. Hypotheses concerning the current competitive conditions in the industry are set forth, and the implications of free cash flow for risk, capital-market efficiency, and the cost of capital to tax-exempt institution is compared to capital-market norms.

Oncological outcomes of metastatic testicular cancers under centralized management through regional medical network.

PubMed

Inai, Hiromu; Kawai, Koji; Kojima, Takahiro; Joraku, Akira; Shimazui, Toru; Yamauchi, Atsushi; Miyagawa, Tomoaki; Endo, Tsuyoshi; Fukuhara, Yoshiharu; Miyazaki, Jun; Uchida, Katsunori; Nishiyama, Hiroyuki

2013-12-01

To investigate the dose intensity of induction chemotherapy and oncological outcomes of metastatic testicular cancer under centralized management through a regional medical network. We retrospectively analyzed the outcomes of 86 metastatic testicular cancer patients who were given induction chemotherapy at Tsukuba University Hospital and four branch hospitals between January 2000 and November 2010. Principally, management of patients with poor-prognosis disease and patients having risk factors for bleomycin, etoposide and cisplatin were referred to Tsukuba University Hospital before chemotherapy. For high-risk groups, etoposide and cisplatin or etoposide, ifosfamide and cisplatin was used as an alternative to bleomycin, etoposide and cisplatin. Overall, 56 and 30 patients were treated at Tsukuba University Hospital and branch hospitals, respectively. Forty-seven, 18 and 21 patients were classified with good-, intermediate- and poor-prognosis disease, respectively, according to the International Germ Cell Cancer Collaborative Group criteria. Eighteen of the 21 patients (86%) with poor-prognosis disease were treated at Tsukuba University Hospital from the beginning of induction chemotherapy. Induction chemotherapy with a high relative dose intensity was possible in most patients. The average relative dose intensity of each drug was >0.96. Treatment procedures other than induction chemotherapy were efficiently centralized; 74% of post-chemotherapy surgery and all second-line or subsequent chemotherapies were performed at Tsukuba University Hospital. The 5-year overall survival rates of the good-, intermediate- and poor-prognosis groups were 97, 93 and 84%, respectively. Induction chemotherapy with high relative dose intensity, post-chemotherapy surgery and salvage chemotherapy was accomplished efficiently through centralization of management. Oncological outcomes were excellent, especially in patients with poor-prognosis disease, whose 5-year OS reached 84%.

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.

The design of optimal electric power demand management contracts

NASA Astrophysics Data System (ADS)

Fahrioglu, Murat

1999-11-01

Our society derives a quantifiable benefit from electric power. In particular, forced outages or blackouts have enormous consequences on society, one of which is loss of economic surplus. Electric utilities try to provide reliable supply of electric power to their customers. Maximum customer benefit derives from minimum cost and sufficient supply availability. Customers willing to share in "availability risk" can derive further benefit by participating in controlled outage programs. Specifically, whenever utilities foresee dangerous loading patterns, there is a need for a rapid reduction in demand either system-wide or at specific locations. The utility needs to get relief in order to solve its problems quickly and efficiently. This relief can come from customers who agree to curtail their loads upon request in exchange for an incentive fee. This thesis shows how utilities can get efficient load relief while maximizing their economic benefit. This work also shows how estimated customer cost functions can be calibrated, using existing utility data, to help in designing efficient demand management contracts. In order to design such contracts, optimal mechanism design is adopted from "Game Theory" and applied to the interaction between a utility and its customers. The idea behind mechanism design is to design an incentive structure that encourages customers to sign up for the right contract and reveal their true value of power. If a utility has demand management contracts with customers at critical locations, most operational problems can be solved efficiently. This thesis illustrates how locational attributes of customers incorporated into demand management contract design can have a significant impact in solving system problems. This kind of demand management contracts can also be used by an Independent System Operator (ISO). During times of congestion a loss of economic surplus occurs. When the market is too slow or cannot help relieve congestion, demand management can help solve the problem. Another tool the ISO requires for security purposes is reserves. Even though demand management contracts may not be a good substitute for spinning reserves, they are adequate to augment or replace supplemental and backup reserves.

a Public Platform for Geospatial Data Sharing for Disaster Risk Management

NASA Astrophysics Data System (ADS)

Balbo, S.; Boccardo, P.; Dalmasso, S.; Pasquali, P.

2013-01-01

Several studies have been conducted in Africa to assist local governments in addressing the risk situation related to natural hazards. Geospatial data containing information on vulnerability, impacts, climate change, disaster risk reduction is usually part of the output of such studies and is valuable to national and international organizations to reduce the risks and mitigate the impacts of disasters. Nevertheless this data isn't efficiently widely distributed and often resides in remote storage solutions hardly reachable. Spatial Data Infrastructures are technical solutions capable to solve this issue, by storing geospatial data and making them widely available through the internet. Among these solutions, GeoNode, an open source online platform for geospatial data sharing, has been developed in recent years. GeoNode is a platform for the management and publication of geospatial data. It brings together mature and stable open-source software projects under a consistent and easy-to-use interface allowing users, with little training, to quickly and easily share data and create interactive maps. GeoNode data management tools allow for integrated creation of data, metadata, and map visualizations. Each dataset in the system can be shared publicly or restricted to allow access to only specific users. Social features like user profiles and commenting and rating systems allow for the development of communities around each platform to facilitate the use, management, and quality control of the data the GeoNode instance contains (http://geonode.org/). This paper presents a case study scenario of setting up a Web platform based on GeoNode. It is a public platform called MASDAP and promoted by the Government of Malawi in order to support development of the country and build resilience against natural disasters. A substantial amount of geospatial data has already been collected about hydrogeological risk, as well as several other-disasters related information. Moreover this platform will help to ensure that the data created by a number of past or ongoing projects is maintained and that this information remains accessible and useful. An Integrated Flood Risk Management Plan for a river basin has already been included in the platform and other data from future disaster risk management projects will be added as well.

Sustainable Confined Disposal Facilities for Long-term Management of Dredged Material

DTIC Science & Technology

2010-07-01

need to resort to a full-blown risk assessment . Ideally, a set of look-up criteria could be developed for beneficial use applications where no direct...EPA-905-R-99-006. Assessment and Remediation of Contaminated Sediments Program. Chicago, IL: Great Lakes National Program Office. Olin-Estes, T. J...maintenance dredging Hydrodynamic modeling to assess benefits, adjust cuts, and optimize dredging time intervals Dredge more efficiently Silent

Managing Uncertainty and Risk in Public-sector Investments

DTIC Science & Technology

2007-04-30

parameters with the most predictive power. There are, of course , methods other than market-based Capital Asset Pricing for determining asset...harness new information as it becomes available. For private-sector firms, prices provide two important types of information: 1. The rate at which...based valuation, thus providing a basis for testing the validity of using the internal efficiencies to derive a “synthetic price” for the value of a

Infrasound array criteria for automatic detection and front velocity estimation of snow avalanches: towards a real-time early-warning system

NASA Astrophysics Data System (ADS)

Marchetti, E.; Ripepe, M.; Ulivieri, G.; Kogelnig, A.

2015-11-01

Avalanche risk management is strongly related to the ability to identify and timely report the occurrence of snow avalanches. Infrasound has been applied to avalanche research and monitoring for the last 20 years but it never turned into an operational tool to identify clear signals related to avalanches. We present here a method based on the analysis of infrasound signals recorded by a small aperture array in Ischgl (Austria), which provides a significant improvement to overcome this limit. The method is based on array-derived wave parameters, such as back azimuth and apparent velocity. The method defines threshold criteria for automatic avalanche identification by considering avalanches as a moving source of infrasound. We validate the efficiency of the automatic infrasound detection with continuous observations with Doppler radar and we show how the velocity of a snow avalanche in any given path around the array can be efficiently derived. Our results indicate that a proper infrasound array analysis allows a robust, real-time, remote detection of snow avalanches that is able to provide the number and the time of occurrence of snow avalanches occurring all around the array, which represent key information for a proper validation of avalanche forecast models and risk management in a given area.

Advanced uncertainty modelling for container port risk analysis.

PubMed

Alyami, Hani; Yang, Zaili; Riahi, Ramin; Bonsall, Stephen; Wang, Jin

2016-08-13

Globalization has led to a rapid increase of container movements in seaports. Risks in seaports need to be appropriately addressed to ensure economic wealth, operational efficiency, and personnel safety. As a result, the safety performance of a Container Terminal Operational System (CTOS) plays a growing role in improving the efficiency of international trade. This paper proposes a novel method to facilitate the application of Failure Mode and Effects Analysis (FMEA) in assessing the safety performance of CTOS. The new approach is developed through incorporating a Fuzzy Rule-Based Bayesian Network (FRBN) with Evidential Reasoning (ER) in a complementary manner. The former provides a realistic and flexible method to describe input failure information for risk estimates of individual hazardous events (HEs) at the bottom level of a risk analysis hierarchy. The latter is used to aggregate HEs safety estimates collectively, allowing dynamic risk-based decision support in CTOS from a systematic perspective. The novel feature of the proposed method, compared to those in traditional port risk analysis lies in a dynamic model capable of dealing with continually changing operational conditions in ports. More importantly, a new sensitivity analysis method is developed and carried out to rank the HEs by taking into account their specific risk estimations (locally) and their Risk Influence (RI) to a port's safety system (globally). Due to its generality, the new approach can be tailored for a wide range of applications in different safety and reliability engineering and management systems, particularly when real time risk ranking is required to measure, predict, and improve the associated system safety performance. Copyright © 2016 Elsevier Ltd. All rights reserved.

Robotics crosscutting program: Technology summary

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

NONE

The Office of Environmental Management (EM) is responsible for cleaning up the legacy of radioactive and chemically hazardous waste at contaminated sites and facilities throughout the U.S. Department of Energy (DOE) nuclear weapons complex, preventing further environmental contamination, and instituting responsible environmental management. Initial efforts to achieve this mission resulted in the establishment of environmental restoration and waste management programs. However, as EM began to execute its responsibilities, decision makers became aware that the complexity and magnitude of this mission could not be achieved efficiently, affordably, safely, or reasonably with existing technology. Once the need for advanced cleanup technologies becamemore » evident, EM established an aggressive, innovative program of applied research and technology development. The Office of Technology Development (OTD) was established in November 1989 to advance new and improved environmental restoration and waste management technologies that would reduce risks to workers, the public, and the environment; reduce cleanup costs; and devise methods to correct cleanup problems that currently have no solutions. In 1996, OTD added two new responsibilities - management of a Congressionally mandated environmental science program and development of risk policy, requirements, and guidance. OTD was renamed the Office of Science and Technology (OST). This documents presents information concerning robotics tank waste retrieval overview, robotic chemical analysis automation, robotics decontamination and dismantlement, and robotics crosscutting and advanced technology.« less

The Biggest Loser Thinks Long-Term: Recency as a Predictor of Success in Weight Management.

PubMed

Koritzky, Gilly; Rice, Chantelle; Dieterle, Camille; Bechara, Antoine

2015-01-01

Only a minority of participants in behavioral weight management lose weight significantly. The ability to predict who is likely to benefit from weight management can improve the efficiency of obesity treatment. Identifying predictors of weight loss can also reveal potential ways to improve existing treatments. We propose a neuro-psychological model that is focused on recency: the reliance on recent information at the expense of time-distant information. Forty-four weight-management patients completed a decision-making task and their recency level was estimated by a mathematical model. Impulsivity and risk-taking were also measured for comparison. Weight loss was measured in the end of the 16-week intervention. Consistent with our hypothesis, successful dieters (n = 12) had lower recency scores than unsuccessful ones (n = 32; p = 0.006). Successful and unsuccessful dieters were similar in their demographics, intelligence, risk taking, impulsivity, and delay of gratification. We conclude that dieters who process time-distant information in their decision making are more likely to lose weight than those who are high in recency. We argue that having low recency facilitates future-oriented thinking, and thereby contributes to behavior change treatment adherence. Our findings underline the importance of choosing the right treatment for every individual, and outline a way to improve weight-management processes for more patients.

Econometric analysis of the impact of the relationship of GDP and the pension capital

NASA Astrophysics Data System (ADS)

Nepp, A. N.; Amiryan, A. A.

2016-12-01

The article demonstrates the impact of institutional risks on indicators of compulsory pension insurance and describes the results of a comparative analysis of investment risks faced by the pension systems of the Russian Federation and OECD countries. Efficiency of private companies managing pension funds in Russia and OECD countries is compared and analyzed to show the necessity to liberalize requirements placed on investments of pension savings funds. On the basis of the available statistical data, the article puts forward and discusses the hypothesis that increasing of the basic indicators of the pension system is possible by reducing its institutional risks. It is concluded that if the institutional risks are reduced and the level of trust increases, there will be enhance growth in the pension system key indicators, such as pension payments and the replacement rate.

Performance evaluation of inpatient service in Beijing: a horizontal comparison with risk adjustment based on Diagnosis Related Groups.

PubMed

Jian, Weiyan; Huang, Yinmin; Hu, Mu; Zhang, Xiumei

2009-04-30

The medical performance evaluation, which provides a basis for rational decision-making, is an important part of medical service research. Current progress with health services reform in China is far from satisfactory, without sufficient regulation. To achieve better progress, an effective tool for evaluating medical performance needs to be established. In view of this, this study attempted to develop such a tool appropriate for the Chinese context. Data was collected from the front pages of medical records (FPMR) of all large general public hospitals (21 hospitals) in the third and fourth quarter of 2007. Locally developed Diagnosis Related Groups (DRGs) were introduced as a tool for risk adjustment and performance evaluation indicators were established: Charge Efficiency Index (CEI), Time Efficiency Index (TEI) and inpatient mortality of low-risk group cases (IMLRG), to reflect respectively work efficiency and medical service quality. Using these indicators, the inpatient services' performance was horizontally compared among hospitals. Case-mix Index (CMI) was used to adjust efficiency indices and then produce adjusted CEI (aCEI) and adjusted TEI (aTEI). Poisson distribution analysis was used to test the statistical significance of the IMLRG differences between different hospitals. Using the aCEI, aTEI and IMLRG scores for the 21 hospitals, Hospital A and C had relatively good overall performance because their medical charges were lower, LOS shorter and IMLRG smaller. The performance of Hospital P and Q was the worst due to their relatively high charge level, long LOS and high IMLRG. Various performance problems also existed in the other hospitals. It is possible to develop an accurate and easy to run performance evaluation system using Case-Mix as the tool for risk adjustment, choosing indicators close to consumers and managers, and utilizing routine report forms as the basic information source. To keep such a system running effectively, it is necessary to improve the reliability of clinical information and the risk-adjustment ability of Case-Mix.

Medical error disclosure: from the therapeutic alliance to risk management: the vision of the new Italian code of medical ethics

PubMed Central

2014-01-01

Background The Italian code of medical deontology recently approved stipulates that physicians have the duty to inform the patient of each unwanted event and its causes, and to identify, report and evaluate adverse events and errors. Thus the obligation to supply information continues to widen, in some way extending beyond the doctor-patient relationship to become an essential tool for improving the quality of professional services. Discussion The new deontological precepts intersect two areas in which the figure of the physician is paramount. On the one hand is the need for maximum integrity towards the patient, in the name of the doctor’s own, and the other’s (the patient’s) dignity and liberty; on the other is the physician’s developing role in the strategies of the health system to achieve efficacy, quality, reliability and efficiency, to reduce errors and adverse events and to manage clinical risk. Summary In Italy, due to guidelines issued by the Ministry of Health and to the new code of medical deontology, the role of physicians becomes a part of a complex strategy of risk management based on a system focused approach in which increasing transparency regarding adverse outcomes and full disclosure of health- related negative events represent a key factor. PMID:25023339

Medical error disclosure: from the therapeutic alliance to risk management: the vision of the new Italian code of medical ethics.

PubMed

Turillazzi, Emanuela; Neri, Margherita

2014-07-15

The Italian code of medical deontology recently approved stipulates that physicians have the duty to inform the patient of each unwanted event and its causes, and to identify, report and evaluate adverse events and errors. Thus the obligation to supply information continues to widen, in some way extending beyond the doctor-patient relationship to become an essential tool for improving the quality of professional services. The new deontological precepts intersect two areas in which the figure of the physician is paramount. On the one hand is the need for maximum integrity towards the patient, in the name of the doctor's own, and the other's (the patient's) dignity and liberty; on the other is the physician's developing role in the strategies of the health system to achieve efficacy, quality, reliability and efficiency, to reduce errors and adverse events and to manage clinical risk. In Italy, due to guidelines issued by the Ministry of Health and to the new code of medical deontology, the role of physicians becomes a part of a complex strategy of risk management based on a system focused approach in which increasing transparency regarding adverse outcomes and full disclosure of health- related negative events represent a key factor.

Managing Financial Risk to Hydropower in Snow Dominated Systems: A Hetch Hetchy Case Study

NASA Astrophysics Data System (ADS)

Hamilton, A. L.; Characklis, G. W.; Reed, P. M.

2017-12-01

Hydropower generation in snow dominated systems is vulnerable to severe shortfalls in years with low snowpack. Meanwhile, generators are also vulnerable to variability in electricity demand and wholesale electricity prices, both of which can be impacted by factors such as temperature and natural gas price. Year-to-year variability in these underlying stochastic variables leads to financial volatility and the threat of low revenue periods, which can be highly disruptive for generators with large fixed operating costs and debt service. In this research, the Hetch Hetchy Power system is used to characterize financial risk in a snow dominated hydropower system. Owned and operated by the San Francisco Public Utilities Commission, Hetch Hetchy generates power for its own municipal operations and sells excess power to irrigation districts, as well as on the wholesale market. This investigation considers the effects of variability in snowpack, temperature, and natural gas price on Hetch Hetchy Power's yearly revenues. This information is then used to evaluate the effectiveness of various financial risk management tools for hedging against revenue variability. These tools are designed to mitigate against all three potential forms of financial risk (i.e. low hydropower generation, low electricity demand, and low/high electricity price) and include temperature-based derivative contracts, natural gas price-based derivative contracts, and a novel form of snowpack-based index insurance contract. These are incorporated into a comprehensive risk management portfolio, along with self-insurance in which the utility buffers yearly revenue volatility using a contingency fund. By adaptively managing the portfolio strategy, a utility can efficiently spread yearly risks over a multi-year time horizon. The Borg Multiobjective Evolutionary Algorithm is used to generate a set of Pareto optimal portfolio strategies, which are used to compare the tradeoffs in objectives such as expected revenues, low revenues, revenue volatility, and portfolio complexity.

[The economics of preventing psycho-social risks].

PubMed

Golzio, Luigi

2014-01-01

The aim of the essay is to show the SHIELD methodology for helping the firm management to improve the risks prevention policy. It has been tested in the field with positive results. SHIELD is a cost-benefit analysis application to compare prevention and non-prevention costs, which arise from non-market risks. In the economic perspective safety risks (which include psycho-social risks) are non-market ones as they cause injures to workers during the job. SHIELD (Social Health Indicators for Economic Labour Decisions), is the original method proposed by the author. It is a cost benefits analysis application, which compares safety prevention and non-prevention costs. The comparison allow stop management to evaluate the efficiency of the current safety prevention policy as it helps top management to answer to the policy question: how much to invest in prevention costs? The costs comparison is obtained through the reclassification of safety costs between prevention and non-prevention costs (which are composed by claim damages and penalty sanction costs). SHIELD has been tested empirically in four companies operating in the agribusiness sector during a research financed by the Assessorato all'Agricoltura and INAI Regionale of Emilia Romagna Region. Results are postive: it has been found that the increase of prevention costs causes the cut of non-prevention costs in all companies looked into, as assumed by the high reliability organization theory. SHIELD can be applied to all companies which must have an accounting system by law, no matter of the industry they act. Its application has limited costs as SHIELD doesn't need changes in the accounting system. Safety costs sustained by the company are simply reclassified in prevention and non-prevention costs. The comparison of these two costs categories has been appreciated by top management of companies investigated as a useful support to decide the risks prevention policy for the company. The SHIELD original feature compared with others cost benefit analysis application is to compute registered costs in the company accounting system.

An Integrated Approach to Identification, Assessment and Management of Watershed-Scale Risk for Sustainable Water Use Through Reuse and Recycling

NASA Astrophysics Data System (ADS)

Hunter, C. K.; Bolster, D.; Gironas, J. A.

2014-12-01

Water resources are essential to development, not only economically but also socially, politically and ecologically. With growing demand and potentially shrinking supply, water scarcity is one of the most pressing socio-ecological problems of the 21st century. Considering implications of global change and the complexity of interrelated systems, uncertain future conditions compound problems associated with water stress, requiring hydrologic models to re-examine traditional water resource planning and management. The Copiapó water basin, located in the Atacama Desert of northern Chile exhibits a complex resource management scenario. With annual average precipitation of only 28 mm, water intensive sectors such as export agriculture, extensive mining, and a growing population have depleted the aquifeŕs reserves to near critical levels. Being that global climate change models predict a decrease in already scarce precipitation, and that growing population and economies demand will likely increase, the real future situation might be even worse than that predicted. A viable option for alleviation of water stress, water reuse and recycling has evolved through technological innovation to feasibly meet hydraulic needs with reclaimed water. For the proper application of these methods for resource management, however, stakeholders must possess tools by which to quantify hydrologic risk, understand its factors of causation, and choose between competing management scenarios and technologies so as to optimize productivity. While previous investigations have addressed similar problems, they often overlook aspects of forecasting uncertainty, proposing solutions that while accurate under specific scenarios, lack robustness to withstand future variations. Using the WEAP (Water Evaluation and Planning) platform for hydrologic modeling, this study proposes a methodology, applicable to other stressed watersheds, to quantify inherent risk in water management positions, while considering uncertainties in supply (climate change), demand (market variations), and measurement (risk definition). Applied to the Copaipó case study, this methodology proposes the solution of a 30% demand decrease within the agricultural sector through urban wastewater recycling and increased irrigation efficiency.

Evaluating the impact and risk of pluvial flash flood on intra-urban road network: A case study in the city center of Shanghai, China

NASA Astrophysics Data System (ADS)

Yin, Jie; Yu, Dapeng; Yin, Zhane; Liu, Min; He, Qing

2016-06-01

Urban pluvial flood are attracting growing public concern due to rising intense precipitation and increasing consequences. Accurate risk assessment is critical to an efficient urban pluvial flood management, particularly in transportation sector. This paper describes an integrated methodology, which initially makes use of high resolution 2D inundation modeling and flood depth-dependent measure to evaluate the potential impact and risk of pluvial flash flood on road network in the city center of Shanghai, China. Intensity-Duration-Frequency relationships of Shanghai rainstorm and Chicago Design Storm are combined to generate ensemble rainfall scenarios. A hydrodynamic model (FloodMap-HydroInundation2D) is used to simulate overland flow and flood inundation for each scenario. Furthermore, road impact and risk assessment are respectively conducted by a new proposed algorithm and proxy. Results suggest that the flood response is a function of spatio-temporal distribution of precipitation and local characteristics (i.e. drainage and topography), and pluvial flash flood is found to lead to proportionate but nonlinear impact on intra-urban road inundation risk. The approach tested here would provide more detailed flood information for smart management of urban street network and may be applied to other big cities where road flood risk is evolving in the context of climate change and urbanization.

Livestock Disease Management for Trading Across Different Regulatory Regimes.

PubMed

Bate, Andrew M; Jones, Glyn; Kleczkowski, Adam; Naylor, Rebecca; Timmis, Jon; White, Piran C L; Touza, Julia

2018-02-12

The maintenance of livestock health depends on the combined actions of many different actors, both within and across different regulatory frameworks. Prior work recognised that private risk management choices have the ability to reduce the spread of infection to trading partners. We evaluate the efficiency of farmers' alternative biosecurity choices in terms of their own-benefits from unilateral strategies and quantify the impact they may have in filtering the disease externality of trade. We use bovine viral diarrhoea (BVD) in England and Scotland as a case study, since this provides an example of a situation where contrasting strategies for BVD management occur between selling and purchasing farms. We use an agent-based bioeconomic model to assess the payoff dependence of farmers connected by trade but using different BVD management strategies. We compare three disease management actions: test-cull, test-cull with vaccination and vaccination alone. For a two-farm trading situation, all actions carried out by the selling farm provide substantial benefits to the purchasing farm in terms of disease avoided, with the greatest benefit resulting from test-culling with vaccination on the selling farm. Likewise, unilateral disease strategies by purchasers can be effective in reducing disease risks created through trade. We conclude that regulation needs to balance the trade-off between private gains from those bearing the disease management costs and the positive spillover effects on others.

A priority system model for sanitation management in food service establishments.

PubMed

Wodi, B E; Mill, R A

1985-12-01

We set out to develop a sanitation management scheme that will enable health regulatory authorities to utilize available personnel more efficiently in the regulation of the food service industry given the current budgetary and manpower constraints. Previous analyses of the Annual Food Service Establishment Sanitation Inspection Summary records from a large County Department of Health for fiscal years 1979, 1980, and 1981 indicated a cut-off point at about two to four visits for a productive follow-up sanitation inspection of food service establishments. Revisits after this point seemed counter-productive. Revisits of up to 13 times in some establishments and a high uninspection rate of others were noted. The above data, the population at risk for each establishment (generated by a prescribed method), and various control criteria were integrated into the model. Application of the model to a sample of 82 food service establishments was successful in ensuring that those operations that pose high risk to patrons are given priority in a sanitation management program while also facilitating the inspection of all food service establishments within a jurisdiction at some point.

A priority system model for sanitation management in food service establishments.

PubMed Central

Wodi, B E; Mill, R A

1985-01-01

We set out to develop a sanitation management scheme that will enable health regulatory authorities to utilize available personnel more efficiently in the regulation of the food service industry given the current budgetary and manpower constraints. Previous analyses of the Annual Food Service Establishment Sanitation Inspection Summary records from a large County Department of Health for fiscal years 1979, 1980, and 1981 indicated a cut-off point at about two to four visits for a productive follow-up sanitation inspection of food service establishments. Revisits after this point seemed counter-productive. Revisits of up to 13 times in some establishments and a high uninspection rate of others were noted. The above data, the population at risk for each establishment (generated by a prescribed method), and various control criteria were integrated into the model. Application of the model to a sample of 82 food service establishments was successful in ensuring that those operations that pose high risk to patrons are given priority in a sanitation management program while also facilitating the inspection of all food service establishments within a jurisdiction at some point. PMID:4061711

Energy Efficient Building Management | Climate Neutral Research Campuses |

Science.gov Websites

NREL Efficient Building Management Energy Efficient Building Management As campuses complete generate the greatest climate impact. Energy efficient management in the existing stock of buildings is the following links go to sections that describe how an energy buildings management and maintenance program may

Pros and cons of practice-owned and office-based ambulatory surgery centers.

PubMed

Bert, J M

2000-01-01

A detailed feasibility analysis is imperative to ensure the success of a practice-owned ASC. Analysis of the payer mix and the market relating to surgical volume that can be performed at the ASC is imperative. If overbuilding, overequipping, and overstaffing are avoided and the group has adequate volume that can be managed at the ASC, the facility should be a success. Building a practice-owned ASC without an accurate and detailed financial feasibility and payer study can place the endeavor at risk. A well-planned, economically constructed and properly managed ASC will result in an efficient and successful ancillary service for the orthopedic group practice.

Preparing data for analysis using microsoft Excel.

PubMed

Elliott, Alan C; Hynan, Linda S; Reisch, Joan S; Smith, Janet P

2006-09-01

A critical component essential to good research is the accurate and efficient collection and preparation of data for analysis. Most medical researchers have little or no training in data management, often causing not only excessive time spent cleaning data but also a risk that the data set contains collection or recording errors. The implementation of simple guidelines based on techniques used by professional data management teams will save researchers time and money and result in a data set better suited to answer research questions. Because Microsoft Excel is often used by researchers to collect data, specific techniques that can be implemented in Excel are presented.

A program-management plan with critical-path definition for Combustion Augmentation with Thermionic Energy Conversion (CATEC)

NASA Technical Reports Server (NTRS)

Morris, J. F.; Merrill, O. S.; Reddy, H. K.

1981-01-01

Thermionic energy conversion (TEC) is discussed. In recent TEC-topping analyses, overall plant efficiency (OPE) and cost of electricity (COE) improved slightly with current capabilities and substantially with fully matured technologies. Enhanced credibility derives from proven hot-corrosion protection for TEC by silicon-carbide clads in fossil fuel combustion products. Combustion augmentation with TEC (CATEC) affords minimal cost and plant perturbation, but with smaller OPE and COE improvements than more conventional topping applications. Risk minimization as well as comparative simplicity and convenience, favor CATEC for early market penetration. A program-management plan is proposed. Inputs, characteristics, outputs and capabilities are discussed.

A program-management plan with critical-path definition for Combustion Augmentation with Thermionic Energy Conversion (CATEC)

NASA Astrophysics Data System (ADS)

Morris, J. F.; Merrill, O. S.; Reddy, H. K.

Thermionic energy conversion (TEC) is discussed. In recent TEC-topping analyses, overall plant efficiency (OPE) and cost of electricity (COE) improved slightly with current capabilities and substantially with fully matured technologies. Enhanced credibility derives from proven hot-corrosion protection for TEC by silicon-carbide clads in fossil fuel combustion products. Combustion augmentation with TEC (CATEC) affords minimal cost and plant perturbation, but with smaller OPE and COE improvements than more conventional topping applications. Risk minimization as well as comparative simplicity and convenience, favor CATEC for early market penetration. A program-management plan is proposed. Inputs, characteristics, outputs and capabilities are discussed.

Bioinformatics for Exploration

NASA Technical Reports Server (NTRS)

Johnson, Kathy A.

2006-01-01

For the purpose of this paper, bioinformatics is defined as the application of computer technology to the management of biological information. It can be thought of as the science of developing computer databases and algorithms to facilitate and expedite biological research. This is a crosscutting capability that supports nearly all human health areas ranging from computational modeling, to pharmacodynamics research projects, to decision support systems within autonomous medical care. Bioinformatics serves to increase the efficiency and effectiveness of the life sciences research program. It provides data, information, and knowledge capture which further supports management of the bioastronautics research roadmap - identifying gaps that still remain and enabling the determination of which risks have been addressed.

[Official position of the Chilean Society of Climacteric on the management of climacteric women].

PubMed

Blümel, Juan Enrique; Aravena, Hernán; Brantes, Sergio; Cruzat, Luis; Lavín, Pablo; Montaño, René; Navarrete, Isidoro; Osorio, Eduardo

2010-05-01

The health of many women is affected in the climacteric period, either by symptoms that deteriorate their life quality (QL) or by chronic diseases that affect their life expectancy. Therefore, it is mandatory to evaluate these two aspects, having as core objectives for any eventual therapeutic intervention, the improvement of QL and the reduction of cardiovascular risk and fractures. To evaluate QL it is mandatory to follow structured interviews that weigh systematically climacteric symptoms such as the Menopause Rating Scale (MRS). The paradigm of the metabolic syndrome constitutes a suitable frame to evaluate cardiovascular risk. Age, a low body weight, a history of fractures and steroid use are risk factors for fractures. A proper evaluation will allow the detection of patients with a low QL or a high risk for chronic disease, therefore identifying those women who require therapy. The clinical management should include recommendations to improve lifestyles, increase physical activity, avoidance of smoking and to follow a low calorie diet rich in vegetables and fruits. Hormonal therapy is the most efficient treatment to improve the QL and its risk is minimized when it is used in low doses or by the transdermal route. Tibolone is an alternative, especially useful in patients with mood disorders and sexual dysfunction. Vaginal estrogens are also a good option, when urogenital symptoms are the main complaint. Some antidepressants can be an effective therapy in patients with vasomotor symptoms who are not willing or cannot use estrogens. The effectiveness of any alternative therapy for menopausal symptoms has not been demonstrated. Dyslipidemia, hypertension, obesity and insulin resistance should be managed according to guidelines. Calcium and vitamin D have positive effects on bone density and certain tendency to reduce vertebral fractures. Bisphosphonates decrease the risk of vertebral fractures.

Geospatial Investigation into Groundwater Pollution and Water Quality Supported by Satellite Data: A Case Study from the Evros River (Eastern Mediterranean)

NASA Astrophysics Data System (ADS)

Elias, Dimitriou; Angeliki, Mentzafou; Vasiliki, Markogianni; Maria, Tzortziou; Christina, Zeri

2014-06-01

Managing water resources, in terms of both quality and quantity, in transboundary rivers is a difficult and challenging task that requires efficient cross-border cooperation and transparency. Groundwater pollution risk assessment and mapping techniques over the full catchment area are important tools that could be used as part of these water resource management efforts, to estimate pollution pressures and optimize land planning processes. The Evros river catchment is the second largest river in Eastern Europe and sustains a population of 3.6 million people in three different countries (Bulgaria, Turkey and Greece). This study provides detailed information on the main pollution sources and pressures in the Evros catchment and, for the first time, applies, assesses and evaluates a groundwater pollution risk mapping technique using satellite observations (Landsat NDVI) and an extensive dataset of field measurements covering different seasons and multiple years. We found that approximately 40 % of the Greek part of the Evros catchment is characterized as of high and very high pollution risk, while 14 % of the study area is classified as of moderate risk. Both the modeled and measured water quality status of the river showed large spatiotemporal variations consistent with the strong anthropogenic pressures in this system, especially on the northern and central segments of the catchment. The pollutants identified illustrate inputs of agrochemicals and urban wastes in the river. High correlation coefficients ( R between 0.79 and 0.85) were found between estimated pollution risks and measured concentrations of those chemical parameters that are mainly attributed to anthropogenic activities rather than in situ biogeochemical processes. The pollution risk method described here could be used elsewhere as a decision support tool for mitigating the impact of hazardous human activities and improving management of groundwater resources.

Using a Novel Spatial Tool to Inform Invasive Species Early Detection and Rapid Response Efforts

NASA Astrophysics Data System (ADS)

Davidson, Alisha D.; Fusaro, Abigail J.; Kashian, Donna R.

2015-07-01

Management of invasive species has increasingly emphasized the importance of early detection and rapid response (EDRR) programs in limiting introductions, establishment, and impacts. These programs require an understanding of vector and species spatial dynamics to prioritize monitoring sites and efficiently allocate resources. Yet managers often lack the empirical data necessary to make these decisions. We developed an empirical mapping tool that can facilitate development of EDRR programs through identifying high-risk locations, particularly within the recreational boating vector. We demonstrated the utility of this tool in the Great Lakes watershed. We surveyed boaters to identify trips among water bodies and to quantify behaviors associated with high likelihood of species transfer (e.g., not removing organic materials from boat trailers) during that trip. We mapped water bodies with high-risk inbound and outbound boater movements using ArcGIS. We also tested for differences in high-risk behaviors based on demographic variables to understand risk differences among boater groups. Incorporation of boater behavior led to identification of additional high-risk water bodies compared to using the number of trips alone. Therefore, the number of trips itself may not fully reflect the likelihood of invasion. This tool can be broadly applied in other geographic contexts and with different taxa, and can be adjusted according to varying levels of information concerning the vector or species of interest. The methodology is straightforward and can be followed after a basic introduction to ArcGIS software. The visual nature of the mapping tool will facilitate site prioritization by managers and stakeholders from diverse backgrounds.

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.

Are cardiovascular disease risk assessment and management programmes cost effective? A systematic review of the evidence.

PubMed

Lee, John Tayu; Lawson, Kenny D; Wan, Yizhou; Majeed, Azeem; Morris, Stephen; Soljak, Michael; Millett, Christopher

2017-06-01

The World Health Organization recommends that countries implement population-wide cardiovascular disease (CVD) risk assessment and management programmes. The aim of this study was to conduct a systematic review to evaluate whether this recommendation is supported by cost-effectiveness evidence. Published economic evaluations were identified via electronic medical and social science databases (including Medline, Web of Science, and the NHS Economic Evaluation Database) from inception to March 2016. Study quality was evaluated using a modified version of the Consolidated Health Economic Evaluation Reporting Standards. Fourteen economic evaluations were included: five studies based on randomised controlled trials, seven studies based on observational studies and two studies using hypothetical modelling synthesizing secondary data. Trial based studies measured CVD risk factor changes over 1 to 3years, with modelled projections of longer term events. Programmes were either not, or only, cost-effective under non-verified assumptions such as sustained risk factor changes. Most observational and hypothetical studies suggested programmes were likely to be cost-effective; however, study deigns are subject to bias and subsequent empirical evidence has contradicted key assumptions. No studies assessed impacts on inequalities. In conclusion, recommendations for population-wide risk assessment and management programmes lack a robust, real world, evidence basis. Given implementation is resource intensive there is a need for robust economic evaluation, ideally conducted alongside trials, to assess cost effectiveness. Further, the efficiency and equity impact of different delivery models should be investigated, and also the combination of targeted screening with whole population interventions recognising that there multiple approaches to prevention. Copyright © 2017. Published by Elsevier Inc.

An epidemiologic perspective on a case management program.

PubMed

Kahler, Deborah; Salber, Patricia; Wilson, Thomas

2010-01-01

to improve a case management (CM) program using the principles and tools of epidemiology. Specifically, to use epidemiology to describe the population being managed, to analyze factors influencing outcomes, to assess the degree to which the CM process (or intervention) is related to those outcomes, to utilize the findings in order to make recommendations (to take action) for both better evaluation and improved and more efficient CM process, to provide an estimate of the impact of the CM program based on the comparison of pre-CM and post-CM interventions, and finally to discuss the caveat that pre-CM period probably does not provide a prediction of patterns to be expected in the post-CM period had CM not been present (an ideal, but difficult-to-find referent population for this kind of effectiveness analysis). a Medicare Advantage health plan. there were a total of 12,185 individuals who met the continuous enrollment requirement of 6 months (28 days) prior to initial contact with the CM department and 6 months after the contact date: 53% were female; the average age was 73.9 (standard deviation = ± 9.5). There was a linear relationship between the average "dose" of CM-as measured by the number of times a case manager had contact with a case-and the risk profile of the case-as measured by a standard risk assessment tool provided by the Centers for Medicare & Medicaid Services. The month-to-month costs for the study population prior to CM showed a sharp rise in the month prior to the initial contact with CM and a sharp decline beginning before the contact. This pattern was consistent across different risk profiles and our operational definition of CM "dose."The average costs 6 months prior to CM were higher than the average costs 6 months after the CM. The difference in cost varied by "dose" category. When coupled with the number of cases per dosage category, the greatest value for the CM program was in the management of moderate risk cases called two to four times.However, some of the overall decline that begins prior to the initial CM contact is likely attributed to "regression to the mean" (i.e., costs may have shown a decline in spite of CM) but not all. Subsequent studies will be designed to assess the degree to which this is the case by including an equivalent referent; ideally, one that has not experienced CM or, in the absence of that, one that experienced a different kind of CM so that a valid "comparative effectiveness" study can be conducted. the "dose" of CM to its cases was in synch with an independent assessment of risk of the cases. This implies that case managers were directing their resources to those in need. However, case managers and CM processes are a limited resource and it is of interest for management to allocate those CM resources in the most efficient way possible. Methods of assessment based on individual experiences of case managers can be improved with structured, population-based assessment. These population-based tools, according to the principles of epidemiology, will be used to better allocate CM resources for optimized impact on patient populations in the future.

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.

MO-E-9A-01: Risk Based Quality Management: TG100 In Action

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

Huq, M; Palta, J; Dunscombe, P

2014-06-15

One of the goals of quality management in radiation therapy is to gain high confidence that patients will receive the prescribed treatment correctly. To accomplish these goals professional societies such as the American Association of Physicists in Medicine (AAPM) has published many quality assurance (QA), quality control (QC), and quality management (QM) guidance documents. In general, the recommendations provided in these documents have emphasized on performing device-specific QA at the expense of process flow and protection of the patient against catastrophic errors. Analyses of radiation therapy incidents find that they are most often caused by flaws in the overall therapymore » process, from initial consult through final treatment, than by isolated hardware or computer failures detectable by traditional physics QA. This challenge is shared by many intrinsically hazardous industries. Risk assessment tools and analysis techniques have been developed to define, identify, and eliminate known and/or potential failures, problems, or errors, from a system, process and/or service before they reach the customer. These include, but are not limited to, process mapping, failure modes and effects analysis (FMEA), fault tree analysis (FTA), and establishment of a quality management program that best avoids the faults and risks that have been identified in the overall process. These tools can be easily adapted to radiation therapy practices because of their simplicity and effectiveness to provide efficient ways to enhance the safety and quality of treatment processes. Task group 100 (TG100) of AAPM has developed a risk-based quality management program that uses these tools. This session will be devoted to a discussion of these tools and how these tools can be used in a given radiotherapy clinic to develop a risk based QM program. Learning Objectives: Learn how to design a process map for a radiotherapy process. Learn how to perform a FMEA analysis for a given process. Learn what Fault tree analysis is all about. Learn how to design a quality management program based upon the information obtained from process mapping, FMEA and FTA.« less

Flood Early Warning in Bridge Management System: from idea to implementation

NASA Astrophysics Data System (ADS)

Kerin, Igor; Bekić, Damir; Michalis, Panagiotis; Šolman, Hrvoje; Cahill, Paul; Gilja, Gordon; Pakrashi, Vikram; Lapthorne, John; McKeogh, Eamon

2017-04-01

Recent advances in computational speed, cloud systems and GPRS data are some of the factors that have resulted in an increased number of operational and fully automatized Flood Early Warning Systems (FEWS). Flood forecasting is becoming a well-recognised solution for flood management as an indirect measure for minimising the risk should preventive or defence measures prove ineffective or are not feasible for implementation. Public acceptance of FEWS as a standalone solution is still considered to be at low level. Further public engagement regarding engineering risks and providing timely notifications and warnings can, however, establish the true value of such a system to the society in general. Flood risks can be direct, resulting in damage to buildings, infrastructure and natural resources, or indirect, which can be related to disaster losses leading to declines in commercial output or revenue and impact on wellbeing of people, typically from disruptions to the flow of goods and services. Flood risk and structural risks are closely related, thereby impacting the maintenance and management of bridges assets over watercourses. Many studies indicate that most bridge collapses are related to hydraulic effects and consequently scour issues (i.e. the removal of riverbed around bridge foundations due to flowing water). Consequently, hydraulic, hydrologic and geotechnical expertise and knowledge can lead to introducing FEWS as a key tool for Bridge Scour Management System (BSMS), forming a part of a BMS. The implementation of this concept was initiated with the EU/FP7 funded project BRIDGE SMS. The project introduces BSMS into the overall BMS to develop a reliable decision support tool which would efficiently manage bridge failure risks in a cost-effective way. This is accomplished through the development of FEWS, alongside monitoring systems that can provide important information about environmental and structural conditions at the catchment area and bridge site respectively. The recorded rainfall from instrumentation deployed over a catchment is used as input data for hydrological modelling and now-casting, which results in flow hydrographs at the bridge containing flow rates and water level information. Soil moisture data is also used to determine the appropriate hydrological model set-up, such as dry, medium or saturated catchment conditions. The output from the hydrological model is a now-cast flow hydrograph, with a lag time of up to 24 hours. Discharge hydrograph is correlated to water levels using an existing rating curve and to the flow velocity using discharge-flow velocity curve. Water levels and flow rates are correlated to the flow velocity which provide the basis for the prediction of scour depth. FEWS in BMS introduces readiness for extreme flood events, pointing out key indicators prior to an event. Also, by considering climate change effects which is resulting in more extreme weather phenomena's, FEWS provides important information about bridge safety and assists to coordinate resources in an efficient and cost-effective way. Acknowledgement The authors wish to acknowledge the financial support of the European Commission, through the Marie-Curie Industry-Academia Partnership and Pathways Network BRIDGE SMS (Intelligent Bridge Assessment Maintenance and Management System) - FP7-People-2013-IAPP- 612517.

Management of recurrent vulvo-vaginal candidosis as a chronic illness.

PubMed

Donders, Gilbert G G; Bellen, Gert; Mendling, Werner

2010-01-01

For sporadic acute Candida vaginitis, any oral or local antifungal therapy can be used. For women with recurrent vulvo-vaginal candidosis (RVC), on the other hand, such simple approaches are insufficient, regardless of the product chosen. Instead, RVC should be managed as any other chronic disease and requires long-term, prophylactic, suppressive antifungal treatment. A regimen using individualized, decreasing doses of oral fluconazole (the ReCiDiF regimen) was proven to be highly efficient and offered great comfort to the patients. During this regimen, it is crucial that patients are carefully examined by anamnestic, clinical, microscopic and culture-proven absence of Candida. If a relapse occurs, the medication is adjusted and efforts are taken to find a possible triggering factor for the reactivation of the infection. Care has to be taken not to accumulate 'don't do's', unless the efficiency of a measure has been proven, by trying to eliminate one risk factor at a time for 2 months. Known possible triggers to be kept in mind are (1) antibiotic use, (2) use of specific contraceptives, especially combined contraceptive pills, (3) disturbed glucose metabolism, (4) the use of personal hygienic products, and (5) tight clothing or plastic panty liners. In therapy-resistant cases, non-albicans infection must be ruled out, and alternative therapies should be tried. Boric acid is proven to be efficient in most of these resistant cases, but other non-azoles like amphotericin B, flucytosine, gentian violet, and even caspofungin may have to be tried. As a final remark it has to be said that many patients feel poorly understood and inefficiently managed by many care-givers, increasing their feelings of guilt and sexual inferiority. Therefore, attention has to be given to take the disease seriously, follow strict treatment regimens, and advise precisely and based on individual evidence concerning any possible risk factors for recurrence. In case of therapy-resistant vulvo-vaginitis, reconsider your diagnosis and/or consider referral to specialized therapists. Copyright © 2010 S. Karger AG, Basel.

NASA's Risk Management System

NASA Technical Reports Server (NTRS)

Perera, Jeevan S.

2011-01-01

Leadership is key to success. Phased-approach for implementation of risk management is necessary. Risk management system will be simple, accessible and promote communication of information to all relevant stakeholders for optimal resource allocation and risk mitigation. Risk management should be used by all team members to manage risks -- risk office personnel. Each group is assigned Risk Integrators who are facilitators for effective risk management. Risks will be managed at the lowest-level feasible, elevate only those risks that require coordination or management from above. Risk reporting and communication is an essential element of risk management and will combine both qualitative and quantitative elements. Risk informed decision making should be introduced to all levels of management. Provide necessary checks and balances to insure that risks are caught/identified and dealt with in a timely manner. Many supporting tools, processes & training must be deployed for effective risk management implementation. Process improvement must be included in the risk processes.

Risk Management Issues - An Aerospace Perspective

NASA Technical Reports Server (NTRS)

Perera, Jeevan S.

2011-01-01

Phased-approach for implementation of risk management is necessary. Risk management system will be simple, accessible and promote communication of information to all relevant stakeholders for optimal resource allocation and risk mitigation. Risk management should be used by all team members to manage risks--risk office personnel. Each group is assigned Risk Integrators who are facilitators for effective risk management. Risks will be managed at the lowest-level feasible, elevate only those risks that require coordination or management from above. Risk reporting and communication is an essential element of risk management and will combine both qualitative and quantitative elements.. Risk informed decision making should be introduced to all levels of management. Provide necessary checks and balances to insure that risks are caught/identified and dealt with in a timely manner, Many supporting tools, processes & training must be deployed for effective risk management implementation. Process improvement must be included in the risk processes.

Finite element probabilistic risk assessment of transmission line insulation flashovers caused by lightning strokes

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

Bacvarov, D.C.

1981-01-01

A new method for probabilistic risk assessment of transmission line insulation flashovers caused by lightning strokes is presented. The utilized approach of applying the finite element method for probabilistic risk assessment is demonstrated to be very powerful. The reasons for this are two. First, the finite element method is inherently suitable for analysis of three dimensional spaces where the parameters, such as three variate probability densities of the lightning currents, are non-uniformly distributed. Second, the finite element method permits non-uniform discretization of the three dimensional probability spaces thus yielding high accuracy in critical regions, such as the area of themore » low probability events, while at the same time maintaining coarse discretization in the non-critical areas to keep the number of grid points and the size of the problem to a manageable low level. The finite element probabilistic risk assessment method presented here is based on a new multidimensional search algorithm. It utilizes an efficient iterative technique for finite element interpolation of the transmission line insulation flashover criteria computed with an electro-magnetic transients program. Compared to other available methods the new finite element probabilistic risk assessment method is significantly more accurate and approximately two orders of magnitude computationally more efficient. The method is especially suited for accurate assessment of rare, very low probability events.« less

Ship Maintenance Processes with Collaborative Product Lifecycle Management and 3D Terrestrial Laser Scanning Tools: Reducing Costs and Increasing Productivity

DTIC Science & Technology

2011-09-20

optimal portfolio point on the efficient frontier, for example, Portfolio B on the chart in Figure A1. Then, by subsequently changing some of the ... optimized portfolio controlling for risk using the IRM methodology and tool suite. Results indicate that both rapid and incremental implementation...Results of the KVA and SD scenario analysis provided the financial information required to forecast an optimized

[Diseases transmitted through water for human consumption].

PubMed

Franco, E; Dentamaro, M

2003-01-01

The water for human consumption maintains a biological risk and can transmit diseases. The classical waterborne and the presently frequent diseases caused by protozoi Giardia and Cryptosporidium are considered and Arcobacter butzleri, a new waterborne pathogen, is described. Many measures have been adopted by institutions to ensure the quality of the drinking water. Managers and public health operators is working in order to verify the efficiency of more suitable indicators for its monitoring.

Federal Reserve Could Improve the Efficiency of Bank Holding Company Inspections.

DTIC Science & Technology

1981-08-18

examiners have the essential qualifications and experience needed to perform many such tasks, and it would seem to require little additional effort...activities and where the holding company and subsidiary bank management are essentially the same. (See p. 32.) AGENCY COMMENTS The Federal Reserve has...consider- ably more complex and thus moe difficult to evaluate. Most small companies are tax shells and operate essentially as banks. The risk in small

NASA's Risk Management System

NASA Technical Reports Server (NTRS)

Perera, Jeevan S.

2013-01-01

Phased-approach for implementation of risk management is necessary. Risk management system will be simple, accessible and promote communication of information to all relevant stakeholders for optimal resource allocation and risk mitigation. Risk management should be used by all team members to manage risks - not just risk office personnel. Each group/department is assigned Risk Integrators who are facilitators for effective risk management. Risks will be managed at the lowest-level feasible, elevate only those risks that require coordination or management from above. Risk informed decision making should be introduced to all levels of management. ? Provide necessary checks and balances to insure that risks are caught/identified and dealt with in a timely manner. Many supporting tools, processes & training must be deployed for effective risk management implementation. Process improvement must be included in the risk processes.

[Use of local estrogenotherapy in urology and pelviperineology: A systematic review].

PubMed

Benoit, T; Leguevaque, P; Roumiguié, M; Beauval, J B; Malavaud, B; Soulié, M; Rischmann, P; Gourdy, P; Arnal, J F; Game, X

2015-09-01

To conduct a literature review of the efficiency of vaginal local estrogenotherapy (LE) on genitourinary disorders related to menopause and those side effects. A literature review was conducted using Pubmed database using the keywords vaginal estrogen, urinary incontinence, urgency, urinary tract infection, vulvar and vaginal atrophy, dyspareunia, breast cancer, endometrial cancer, thrombosis. The most relevant articles were selected and analyzed. The LE demonstrates its efficiency on preventing urinary tract infections, treatment of overactive bladder and vaginal disorders of postmenopausal women in controlled studies or meta-analysis level of evidence 1. Local side effects (discharge, erythema, vaginal bleeding, etc.) are rare. The systemic diffusion of low dose LE is limited and allowed to prescribe it to postmenopausal women without special supervision. However, using LE might be avoided in women with a history of oncological breast due to the lack of controlled studies evaluating the risk of developing breast cancer under LE. Except for high-risk women, LE does not increase the risk of thrombosis. Vaginal administration of low dose of estrogen is an effective and safe treatment in the management of postmenopausal genitourinary disorders. However, using LE for women with history of breast cancer or high risk of thrombisis should be avoided. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Quantitative option analysis for implementation and management of landfills.

PubMed

Kerestecioğlu, Merih

2016-09-01

The selection of the most feasible strategy for implementation of landfills is a challenging step. Potential implementation options of landfills cover a wide range, from conventional construction contracts to the concessions. Montenegro, seeking to improve the efficiency of the public services while maintaining affordability, was considering privatisation as a way to reduce public spending on service provision. In this study, to determine the most feasible model for construction and operation of a regional landfill, a quantitative risk analysis was implemented with four steps: (i) development of a global risk matrix; (ii) assignment of qualitative probabilities of occurrences and magnitude of impacts; (iii) determination of the risks to be mitigated, monitored, controlled or ignored; (iv) reduction of the main risk elements; and (v) incorporation of quantitative estimates of probability of occurrence and expected impact for each risk element in the reduced risk matrix. The evaluated scenarios were: (i) construction and operation of the regional landfill by the public sector; (ii) construction and operation of the landfill by private sector and transfer of the ownership to the public sector after a pre-defined period; and (iii) operation of the landfill by the private sector, without ownership. The quantitative risk assessment concluded that introduction of a public private partnership is not the most feasible option, unlike the common belief in several public institutions in developing countries. A management contract for the first years of operation was advised to be implemented, after which, a long term operating contract may follow. © The Author(s) 2016.

Life cycle cost-based risk model for energy performance contracting retrofits

NASA Astrophysics Data System (ADS)

Berghorn, George H.

Buildings account for 41% of the primary energy consumption in the United States, nearly half of which is accounted for by commercial buildings. Among the greatest energy users are those in the municipalities, universities, schools, and hospitals (MUSH) market. Correctional facilities are in the upper half of all commercial building types for energy intensity. Public agencies have experienced reduced capital budgets to fund retrofits; this has led to the increased use of energy performance contracts (EPC), which are implemented by energy services companies (ESCOs). These companies guarantee a minimum amount of energy savings resulting from the retrofit activities, which in essence transfers performance risk from the owner to the contractor. Building retrofits in the MUSH market, especially correctional facilities, are well-suited to EPC, yet despite this potential and their high energy intensities, efficiency improvements lag behind that of other public building types. Complexities in project execution, lack of support for data requests and sub-metering, and conflicting project objectives have been cited as reasons for this lag effect. As a result, project-level risks must be understood in order to support wider adoption of retrofits in the public market, in particular the correctional facility sub-market. The goal of this research is to understand risks related to the execution of energy efficiency retrofits delivered via EPC in the MUSH market. To achieve this goal, in-depth analysis and improved understanding was sought with regard to ESCO risks that are unique to EPC in this market. The proposed work contributes to this understanding by developing a life cycle cost-based risk model to improve project decision making with regard to risk control and reduction. The specific objectives of the research are: (1) to perform an exploratory analysis of the EPC retrofit process and identify key areas of performance risk requiring in-depth analysis; (2) to construct a framework describing the sources of and mitigation strategies employed for assessing key risks in EPC retrofits; (3) to develop a strategy for analyzing and evaluating risks for EPC retrofits focused on managing expected costs throughout the project life cycle, and use data collected through this strategy to develop and parameterize a risk model; and (4) to demonstrate the applicability of the proposed life cost-based risk model through a pilot application to a case study site. Five major contributions to the body of knowledge resulting from the research include: (1) a consensus-based assessment of ESCO risk management; (2) characterization of EPC retrofit risks borne by ESCOs; (3) an empirical evaluation of scenario failure mode and effects analysis and its application to this domain; (4) development and pilot application of a life cycle cost-based risk model; and (5) future expansion of the research approach to other domains. The researcher envisions that full implementation of the research will further encourage the growth of the energy services industry, and support focused retrofits in complex building types that typically can benefit the most from such work. Ultimately, this will reduce the energy consumption of public sector buildings to levels that are more fitting with the global principles of sustainability and responsible management of constrained resources.

The development and implementation of the Chronic Care Management Programme in Counties Manukau.

PubMed

Wellingham, John; Tracey, Jocelyn; Rea, Harold; Gribben, Barry

2003-02-21

To develop an effective and efficient process for the seamless delivery of care for targeted patients with specific chronic diseases. To reduce inexplicable variation and maximise use of available resources by implementing evidence-based care processes. To develop a programme that is acceptable and applicable to the Counties Manukau region. A model for the management of people with chronic diseases was developed. Model components and potential interventions were piloted. For each disease project, a return on investment was calculated and external evaluation was undertaken. The initial model was subsequently modified and individual disease projects aligned to it. The final Chronic Care Management model, agreed in September 2001, described a single common process. Key components were the targeting of high risk patients, organisation of cost effective interventions into a system of care, and an integrated care server acting as a data warehouse with a rules engine, providing flags and reminders. Return on investment analysis suggested potential savings for each disease component from $277 to $980 per person per annum. For selected chronic diseases, introduction of an integrated chronic care management programme, based on internationally accepted best practice processes and interventions can make significant savings, reducing morbidity and improving the efficiency of health delivery in the Counties Manukau region.

[Managerial autonomy in primary care: position of health professionals in Mallorca].

PubMed

Tamborero, Gaspar; Esteva, Magdalena; March, Sebastià; Guillén, Mireia

2015-02-01

To assess the knowledge, perceptions, expectations and attitudes of Primary Care (PC) professionals in Mallorca on managerial autonomy. Cross-sectional study based on an ad hoc, anonymous questionnaire, distributed online, from June-July 2013. PC Mallorca. PC healthcare professionals (n=1,097). Knowledge of self-management skills, requirements, and future scenarios of the centers with management autonomy (CMA); impact of self-management, commitment and willingness to take risks, and to become a CMA. Response rate: 49.8% (546/1097), with 10.9% showing a high level of knowledge of self-management. The core competencies of a CMA were internal organizational capacity (87.5%) and selection of staff (81.1%). The CMA future was envisaged with motivated and involved professionals (72.6%), efficient results (66%), better quality of care (59.4%), and better training (52.8%). The benefits of self-management were considered important, for individual practitioners and for the improvement of PC in Mallorca (46.8%). The main requirements of the CMA were to have: trained managers (92.6%), budget allocation systems (87.5%), and appropriate management contracts (86.1%). They preferred that the CMA should depend on the Administration (62.7%), and had a personal interest in becoming a CMA (56.9%), but without taking on excessive commitments (waiving statutory regime, financial risk). These data provide hitherto unknown information of great importance, which could contribute to a more rational planning and participatory implementation of CMA in our midst. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Operationalising resilience to drought: Multi-layered safety for flooding applied to droughts

NASA Astrophysics Data System (ADS)

Rijke, Jeroen; Smith, Jennifer Vessels; Gersonius, Berry; van Herk, Sebastiaan; Pathirana, Assela; Ashley, Richard; Wong, Tony; Zevenbergen, Chris

2014-11-01

This paper sets out a way of thinking about how to prepare for and respond to droughts in a holistic way using a framework developed for managing floods. It shows how the multi-layered safety (MLS) approach for flood resilience can be utilised in the context of drought in a way that three layers of intervention can be distinguished for operationalising drought resilience: (1) protection against water shortage through augmentation and diversification of water supplies; (2) prevention of damage in case of water shortage through increased efficiency of water use and timely asset maintenance; (3) preparedness for future water shortages through mechanisms to reduce the use of water and adopt innovative water technologies. Application of MLS to the cities of Adelaide, Melbourne and Sydney shows that recent water reforms in these cities were primarily focused on protection measures that aim to reduce the hazard source or exposure to insufficient water supplies. Prevention and preparedness measures could be considered in defining interventions that aim to further increase the drought resilience of these cities. Although further research is needed, the application suggests that MLS can be applied to the context of drought risk management. The MLS framework can be used to classify the suite of plans deployed by a city to manage future drought risks and can be considered a planning tool to identify opportunities for increasing the level of redundancy and hence resilience of the drought risk management system.

[Economic rehabilitation management among patients with chronic low back pain].

PubMed

Seitz, R; Schweikert, B; Jacobi, E; Tschirdewahn, B; Leidl, R

2001-12-01

Back pain causes high costs to society. In Germany, these amount to an estimated total of 5 billion euro of direct costs per year and 13 billion euro of indirect costs, the latter being caused by incapacity to work. The purpose of this study is to develop a concept for economic rehabilitation management. This concept is based on the managed care approach and aims at improving efficiency of care. The concept development consists of a theoretical and an empirical part. The method of the theoretical part is based on a systematic literature review on managed care (not included in this article), health systems research and the analysis of economic incentives. For the empirical investigation, long term effects and costs were calculated. For the evaluation of effects, we psychometrically tested and used the EuroQol (EQ-5D) as a measure of health-related quality of life (HRQL). The calculation of costs (both direct and indirect) is based on routine data of payers, a cost diary and the internal cost accounting systems of rehabilitation clinics. We statistically analysed the cost distribution and identified predictors of the management targets (e.g., costs of care) by means of regression analyses. The market-driven managed care approach is based on three tools: (1) a primary care system with case management and gatekeeping, (2) direct influence on providers by utilisation review and setting guidelines, and (3) indirect influence by setting supply-side economic incentives via the remuneration mode. The third managed care tool is most important when managing the rehabilitation of working age patients with chronic low back pain from an economic point of view. This concept consists of three components: (1) a case-based budget for direct costs; this is a prospective remuneration mode for an integrated primary care network including a rehabilitation facility, (2) retrospective bonus payments which are related to savings of indirect costs, and (3) retrospective bonus payments which are related to the effectiveness of rehabilitation, i.e. gains in HRQL. Common features of the three management components are a long-term perspective (e.g., from admission to a rehabilitation clinic until six months after discharge) and risk-adjustment of the three management targets (i.e., direct and indirect costs and gains in HRQL) in order to avoid selection and to limit the financial risk for providers. The EuroQol instrument shows acceptable psychometric properties in the rehabilitation setting for back pain patients. This instrument may yield two kinds of preference-based index values, one reflecting the preferences of the general population and one those of the patient. The Pearson correlation of these two approaches is fair, but there is a systematic difference. Empirical investigation shows that the distribution of both direct and indirect costs is skewed to the right. Statistically relevant predictors of the management targets are incapacity to work and HRQL at admission. Economic rehabilitation management might help to save money and to improve health outcomes, thus increasing the efficiency of care. The results of our empirical studies show the feasibility of tools for the economic management of rehabilitation. Risk adjustment of the management components is of paramount importance.

Principles for the formation of an effective concept of multifunctional high-rise construction investment projects

NASA Astrophysics Data System (ADS)

Beliakov, Sergei

2018-03-01

Investment projects of high-rise construction have a number of features that determine specific risks and additional opportunities that require analysis and accounting in the formation of an effective project concept. The most significant features of high-rise construction include long construction time, complexity of technical and technological solutions, complexity of decisions on the organization of construction and operation, high cost of construction and operation, complexity in determining the ratio of areas designed to accommodate different functional areas, when organizing and coordinating the operation of the facility, with internal zoning. Taking into account the specificity of high-rise construction, among the factors determining the effectiveness of projects, it is advisable to consider as key factors: organizational, technological and investment factors. Within the framework of the article, the author singled out key particular functions for each group of factors under consideration, and also developed a system of principles for the formation of an effective concept of multifunctional high-rise construction investment projects, including the principle of logistic efficiency, the principle of optimal functional zoning, the principle of efficiency of equipment use, the principle of optimizing technological processes, the principle maximization of income, the principle of fund management, the principle of risk management . The model of formation of an effective concept of investment projects of multifunctional high-rise construction developed by the author can contribute to the development of methodological tools in the field of managing the implementation of high-rise construction projects, taking into account their specificity in the current economic conditions.

Damage assessment of bridge infrastructure subjected to flood-related hazards

NASA Astrophysics Data System (ADS)

Michalis, Panagiotis; Cahill, Paul; Bekić, Damir; Kerin, Igor; Pakrashi, Vikram; Lapthorne, John; Morais, João Gonçalo Martins Paulo; McKeogh, Eamon

2017-04-01

Transportation assets represent a critical component of society's infrastructure systems. Flood-related hazards are considered one of the main climate change impacts on highway and railway infrastructure, threatening the security and functionality of transportation systems. Of such hazards, flood-induced scour is a primarily cause of bridge collapses worldwide and one of the most complex and challenging water flow and erosion phenomena, leading to structural instability and ultimately catastrophic failures. Evaluation of scour risk under severe flood events is a particularly challenging issue considering that depth of foundations is very difficult to evaluate in water environment. The continual inspection, assessment and maintenance of bridges and other hydraulic structures under extreme flood events requires a multidisciplinary approach, including knowledge and expertise of hydraulics, hydrology, structural engineering, geotechnics and infrastructure management. The large number of bridges under a single management unit also highlights the need for efficient management, information sharing and self-informing systems to provide reliable, cost-effective flood and scour risk management. The "Intelligent Bridge Assessment Maintenance and Management System" (BRIDGE SMS) is an EU/FP7 funded project which aims to couple state-of-the art scientific expertise in multidisciplinary engineering sectors with industrial knowledge in infrastructure management. This involves the application of integrated low-cost structural health monitoring systems to provide real-time information towards the development of an intelligent decision support tool and a web-based platform to assess and efficiently manage bridge assets. This study documents the technological experience and presents results obtained from the application of sensing systems focusing on the damage assessment of water-hazards at bridges over watercourses in Ireland. The applied instrumentation is interfaced with an open-source platform that can offer a more economical remote monitoring solution. The results presented in this investigation provide an important guide for a multidisciplinary approach to bridge monitoring and can be used as a benchmark for the field application of cost-effective and robust sensing methods. This will deliver key information regarding the impact of water-related hazards at bridge structures through an integrated structural health monitoring and management system. Acknowledgement: The authors wish to acknowledge the financial support of the European Commission, through the Marie Curie action Industry-Academia Partnership and Pathways Network BRIDGE SMS (Intelligent Bridge Assessment Maintenance and Management System) - FP7-People-2013-IAPP- 612517.

Development of efficiency module of organization of Arctic sea cargo transportation with application of neural network technologies

NASA Astrophysics Data System (ADS)

Sobolevskaya, E. Yu; Glushkov, S. V.; Levchenko, N. G.; Orlov, A. P.

2018-05-01

The analysis of software intended for organizing and managing the processes of sea cargo transportation has been carried out. The shortcomings of information resources are presented, for the organization of work in the Arctic and Subarctic regions of the Far East: the lack of decision support systems, the lack of factor analysis to calculate the time and cost of delivery. The architecture of the module for calculating the effectiveness of the organization of sea cargo transportation has been developed. The simulation process has been considered, which is based on the neural network. The main classification factors with their weighting coefficients have been identified. The architecture of the neural network has been developed to calculate the efficiency of the organization of sea cargo transportation in Arctic conditions. The architecture of the intellectual system of organization of sea cargo transportation has been developed, taking into account the difficult navigation conditions in the Arctic. Its implementation will allow one to provide the management of the shipping company with predictive analytics; to support decision-making; to calculate the most efficient delivery route; to provide on demand online transportation forecast, to minimize the shipping cost, delays in transit, and risks to cargo safety.

Inside the volcanic boiler room: knowledge exchange among stakeholders of volcanic unrest

NASA Astrophysics Data System (ADS)

Gottsmann, Joachim; Christie, Ryerson; Bretton, Richard

2014-05-01

The knowledge of the causative links between subsurface processes, resulting monitoring signals and imminent eruption is incomplete. As a consequence, hazard assessment and risk mitigation strategies are subject to uncertainty. Discussion of unrest and pre-eruptive scenarios with uncertain outcomes are central during the discourse between a variety of stakeholders in volcanic unrest including scientists, emergency managers, policy makers and the public. Drawing from research within the EC FP7 VUELCO project, we argue that knowledge exchange amongst the different stakeholders of volcanic unrest evolves along three dimensions: 1) the identification of knowledge holders (including local communities) and their needs and expectations, 2) vehicles of communication and 3) trust. In preparing products that feed into risk assessment and management, scientists need to ensure that their deliverables are timely, accurate, clear, understandable and cater to the expectations of emergency managers. The means and content of communication amongst stakeholders need to be defined and adhered to. Finally, efficient and effective interaction between stakeholders is ideally based on mutual trust between those that generate knowledge and those that receive knowledge. For scientists, this entails contextualising volcanic hazard and risk in the framework of environmental and social values. Periods of volcanic quiescence are ideally suited to test established protocols of engagement between stakeholders in preparation for crises situations. The different roles of stakeholders and associated rules of engagement can be scrutinised and reviewed in antecessum rather than ad-hoc during a crisis situation to avoid issues related to distrust, loss of credibility and overall poor risk management. We will discuss these themes drawing from exploitation of research results from Mexico and Ecuador.

Generalizable open source urban water portfolio simulation framework demonstrated using a multi-objective risk-based planning benchmark problem.

NASA Astrophysics Data System (ADS)

Trindade, B. C.; Reed, P. M.

2017-12-01

The growing access and reduced cost for computing power in recent years has promoted rapid development and application of multi-objective water supply portfolio planning. As this trend continues there is a pressing need for flexible risk-based simulation frameworks and improved algorithm benchmarking for emerging classes of water supply planning and management problems. This work contributes the Water Utilities Management and Planning (WUMP) model: a generalizable and open source simulation framework designed to capture how water utilities can minimize operational and financial risks by regionally coordinating planning and management choices, i.e. making more efficient and coordinated use of restrictions, water transfers and financial hedging combined with possible construction of new infrastructure. We introduce the WUMP simulation framework as part of a new multi-objective benchmark problem for planning and management of regionally integrated water utility companies. In this problem, a group of fictitious water utilities seek to balance the use of the mentioned reliability driven actions (e.g., restrictions, water transfers and infrastructure pathways) and their inherent financial risks. Several traits of this problem make it ideal for a benchmark problem, namely the presence of (1) strong non-linearities and discontinuities in the Pareto front caused by the step-wise nature of the decision making formulation and by the abrupt addition of storage through infrastructure construction, (2) noise due to the stochastic nature of the streamflows and water demands, and (3) non-separability resulting from the cooperative formulation of the problem, in which decisions made by stakeholder may substantially impact others. Both the open source WUMP simulation framework and its demonstration in a challenging benchmarking example hold value for promoting broader advances in urban water supply portfolio planning for regions confronting change.

Space Station: NASA's software development approach increases safety and cost risks. Report to the Chairman, Committee on Science, Space, and Technology, House of Representatives

NASA Astrophysics Data System (ADS)

1992-06-01

The House Committee on Science, Space, and Technology asked NASA to study software development issues for the space station. How well NASA has implemented key software engineering practices for the station was asked. Specifically, the objectives were to determine: (1) if independent verification and validation techniques are being used to ensure that critical software meets specified requirements and functions; (2) if NASA has incorporated software risk management techniques into program; (3) whether standards are in place that will prescribe a disciplined, uniform approach to software development; and (4) if software support tools will help, as intended, to maximize efficiency in developing and maintaining the software. To meet the objectives, NASA proceeded: (1) reviewing and analyzing software development objectives and strategies contained in NASA conference publications; (2) reviewing and analyzing NASA, other government, and industry guidelines for establishing good software development practices; (3) reviewing and analyzing technical proposals and contracts; (4) reviewing and analyzing software management plans, risk management plans, and program requirements; (4) reviewing and analyzing reports prepared by NASA and contractor officials that identified key issues and challenges facing the program; (5) obtaining expert opinions on what constitutes appropriate independent V-and-V and software risk management activities; (6) interviewing program officials at NASA headquarters in Washington, DC; at the Space Station Program Office in Reston, Virginia; and at the three work package centers; Johnson in Houston, Texas; Marshall in Huntsville, Alabama; and Lewis in Cleveland, Ohio; and (7) interviewing contractor officials doing work for NASA at Johnson and Marshall. The audit work was performed in accordance with generally accepted government auditing standards, between April 1991 and May 1992.

Evaluation of wholesale electric power market rules and financial risk management by agent-based simulations

NASA Astrophysics Data System (ADS)

Yu, Nanpeng

As U.S. regional electricity markets continue to refine their market structures, designs and rules of operation in various ways, two critical issues are emerging. First, although much experience has been gained and costly and valuable lessons have been learned, there is still a lack of a systematic platform for evaluation of the impact of a new market design from both engineering and economic points of view. Second, the transition from a monopoly paradigm characterized by a guaranteed rate of return to a competitive market created various unfamiliar financial risks for various market participants, especially for the Investor Owned Utilities (IOUs) and Independent Power Producers (IPPs). This dissertation uses agent-based simulation methods to tackle the market rules evaluation and financial risk management problems. The California energy crisis in 2000-01 showed what could happen to an electricity market if it did not go through a comprehensive and rigorous testing before its implementation. Due to the complexity of the market structure, strategic interaction between the participants, and the underlying physics, it is difficult to fully evaluate the implications of potential changes to market rules. This dissertation presents a flexible and integrative method to assess market designs through agent-based simulations. Realistic simulation scenarios on a 225-bus system are constructed for evaluation of the proposed PJM-like market power mitigation rules of the California electricity market. Simulation results show that in the absence of market power mitigation, generation company (GenCo) agents facilitated by Q-learning are able to exploit the market flaws and make significantly higher profits relative to the competitive benchmark. The incorporation of PJM-like local market power mitigation rules is shown to be effective in suppressing the exercise of market power. The importance of financial risk management is exemplified by the recent financial crisis. In this dissertation, basic financial risk management concepts relevant for wholesale electric power markets are carefully explained and illustrated. In addition, the financial risk management problem in wholesale electric power markets is generalized as a four-stage process. Within the proposed financial risk management framework, the critical problem of financial bilateral contract negotiation is addressed. This dissertation analyzes a financial bilateral contract negotiation process between a generating company and a load-serving entity in a wholesale electric power market with congestion managed by locational marginal pricing. Nash bargaining theory is used to model a Pareto-efficient settlement point. The model predicts negotiation results under varied conditions and identifies circumstances in which the two parties might fail to reach an agreement. Both analysis and agent-based simulation are used to gain insight regarding how relative risk aversion and biased price estimates influence negotiated outcomes. These results should provide useful guidance to market participants in their bilateral contract negotiation processes.

Integrated risk reduction framework to improve railway hazardous materials transportation safety.

PubMed

Liu, Xiang; Saat, M Rapik; Barkan, Christopher P L

2013-09-15

Rail transportation plays a critical role to safely and efficiently transport hazardous materials. A number of strategies have been implemented or are being developed to reduce the risk of hazardous materials release from train accidents. Each of these risk reduction strategies has its safety benefit and corresponding implementation cost. However, the cost effectiveness of the integration of different risk reduction strategies is not well understood. Meanwhile, there has been growing interest in the U.S. rail industry and government to best allocate resources for improving hazardous materials transportation safety. This paper presents an optimization model that considers the combination of two types of risk reduction strategies, broken rail prevention and tank car safety design enhancement. A Pareto-optimality technique is used to maximize risk reduction at a given level of investment. The framework presented in this paper can be adapted to address a broader set of risk reduction strategies and is intended to assist decision makers for local, regional and system-wide risk management of rail hazardous materials transportation. Copyright © 2013 Elsevier B.V. All rights reserved.

Increasing stress on disaster-risk finance due to large floods

NASA Astrophysics Data System (ADS)

Jongman, Brenden; Hochrainer-Stigler, Stefan; Feyen, Luc; Aerts, Jeroen C. J. H.; Mechler, Reinhard; Botzen, W. J. Wouter; Bouwer, Laurens M.; Pflug, Georg; Rojas, Rodrigo; Ward, Philip J.

2014-04-01

Recent major flood disasters have shown that single extreme events can affect multiple countries simultaneously, which puts high pressure on trans-national risk reduction and risk transfer mechanisms. So far, little is known about such flood hazard interdependencies across regions and the corresponding joint risks at regional to continental scales. Reliable information on correlated loss probabilities is crucial for developing robust insurance schemes and public adaptation funds, and for enhancing our understanding of climate change impacts. Here we show that extreme discharges are strongly correlated across European river basins. We present probabilistic trends in continental flood risk, and demonstrate that observed extreme flood losses could more than double in frequency by 2050 under future climate change and socio-economic development. We suggest that risk management for these increasing losses is largely feasible, and we demonstrate that risk can be shared by expanding risk transfer financing, reduced by investing in flood protection, or absorbed by enhanced solidarity between countries. We conclude that these measures have vastly different efficiency, equity and acceptability implications, which need to be taken into account in broader consultation, for which our analysis provides a basis.

Remote Sensing for Risk Assessment of Via Iulia Augusta in Albenga

NASA Astrophysics Data System (ADS)

Van Meerbeek, Lore; Barazzetti, Luigi

2017-04-01

Today, the field of cultural heritage faces many challenges: cultural heritage is always at risk and heritage recording can be time-consuming and result in low accuracy. These challenges were visible during the risk assessment of Via Iulia Augusta in Albenga (Liguria, Italy). The traces of Via Iulia Augusta, a former Roman Road, connect several cultural heritage resources in Albenga's landscape. The cultural significance of these heritage sites is at risk. Threats and disturbances related to humans, development, site management, nature and climate were observed during the onsite visit. These impacts can be sudden or part of a very slow process, resulting in reduced values on cultural, social, economic and ecological level. Nature and climate (change) in Albenga impact the heritage sites the most. Water-related problems such as flooding and surface runoff have always been present in Albenga, but the amount seems to increase year by year due to global warming and is supposed to become even more critical in the future. The first step towards a risk management plan is recording and documenting these cultural heritage sites at risk. Heritage recording provides valuable documentation of the primary source, the cultural heritage itself. The produced ground plans, elevations, sections and details are the most important primary information source for every research. However, the size and complexity of the cultural heritage, the required accuracy and the time span could have a negative influence on heritage recording and documentation. This paper demonstrates the potential of remote sensing techniques for cultural heritage at risk. On site surveys with GPS, Unmanned Aerial Vehicle and photo camera gave reliable information of the heritage resources and its state of conservation. WorldView-2 Satellite images, extracted at different time periods, gave insight in the evolution of the cultural landscape in Albenga. This information resulted in several conclusions. First of all, the used remote sensing tools proved to be time-efficient and effective since they are able to gather a large amount of data with a high accuracy on a relative short time. Secondly, they are non-destructive techniques and fit in this sense within the concepts of preventive conservation. They do not decrease heritage's cultural significance. Third, aerial orthophotos, created with the use of photogrammetry, give insight on the state of conservation of heritage sites. They give the ability to monitor the risks and the threats of the site, as part of a risk management method. Finally, multi-spectral satellite images extracted at different time periods, made it possible to carry out studies on land use evolution. The results revealed that Albenga is subjected by urban sprawl. This uncontrolled development is threatening the intrinsic values of the cultural landscape and the cultural heritage sites along the Via Iulia Augusta. In conclusion, remote sensing tools proved to be time-efficient, accurate, non-destructive, recording and monitoring tools which provide information on the state of conservation of heritage sites and the evolution of cultural landscapes. This information is extremely useful when managing threats and disturbances at cultural heritage sites.

Concepts for risk-based surveillance in the field of veterinary medicine and veterinary public health: Review of current approaches

PubMed Central

Stärk, Katharina DC; Regula, Gertraud; Hernandez, Jorge; Knopf, Lea; Fuchs, Klemens; Morris, Roger S; Davies, Peter

2006-01-01

Background Emerging animal and zoonotic diseases and increasing international trade have resulted in an increased demand for veterinary surveillance systems. However, human and financial resources available to support government veterinary services are becoming more and more limited in many countries world-wide. Intuitively, issues that present higher risks merit higher priority for surveillance resources as investments will yield higher benefit-cost ratios. The rapid rate of acceptance of this core concept of risk-based surveillance has outpaced the development of its theoretical and practical bases. Discussion The principal objectives of risk-based veterinary surveillance are to identify surveillance needs to protect the health of livestock and consumers, to set priorities, and to allocate resources effectively and efficiently. An important goal is to achieve a higher benefit-cost ratio with existing or reduced resources. We propose to define risk-based surveillance systems as those that apply risk assessment methods in different steps of traditional surveillance design for early detection and management of diseases or hazards. In risk-based designs, public health, economic and trade consequences of diseases play an important role in selection of diseases or hazards. Furthermore, certain strata of the population of interest have a higher probability to be sampled for detection of diseases or hazards. Evaluation of risk-based surveillance systems shall prove that the efficacy of risk-based systems is equal or higher than traditional systems; however, the efficiency (benefit-cost ratio) shall be higher in risk-based surveillance systems. Summary Risk-based surveillance considerations are useful to support both strategic and operational decision making. This article highlights applications of risk-based surveillance systems in the veterinary field including food safety. Examples are provided for risk-based hazard selection, risk-based selection of sampling strata as well as sample size calculation based on risk considerations. PMID:16507106

Restructuring Primary Health Care Markets in New Zealand: from Welfare Benefits to Insurance Markets

PubMed Central

Howell, Bronwyn

2005-01-01

Background New Zealand's Primary Health Care Strategy (NZPHCS) was introduced in 2002. Its features are substantial increases in government funding delivered as capitation payments, and newly-created service-purchasing agencies. The objectives are to reduce health disparities and to improve health outcomes. Analysis The NZPHCS changes New Zealand's publicly-funded primary health care payments from targeted welfare benefits to universal, risk-rated insurance premium subsidies. Patient contributions change from fee-for-service top-ups to insurance premium top-ups, and are collected by service providers who, depending upon their contracts with purchasers, may also be either insurance agents or risk-bearing insurance companies. The change invokes the tensions associated with allocating risk-bearing amongst providers, patients and insurance companies that accompany all insurance-based funding instruments. These include increases in existing incentives for over-consumption and new incentives for insurers to limit their exposure to variations in patient health states by engaging in active patient pool selection. The New Zealand scheme is complex, but closely resembles United States insurance-based, risk-rated managed care schemes. The key difference is that unlike classic managed care models, where provider remuneration is determined by the insurer, the historic right for general practitioners to autonomously set patient charges alters the fiscal incentives normally available to managed care organisations. Consequently, the insurance role is being devolved to individual service providers with very small patient pools, who must recoup the premium top-ups from insured individuals. Premium top-ups are being collected only from those individuals consuming care, in proportion to the number of times care is sought. Co-payments thus constitute perfectly risk-rated premium levies set by inefficiently small insurers, raising questions about the efficiency and equity of a 'universal' insurance system pooling total population demands and costs. The efficacy of using financial incentives to constrain costs and encourage innovation when providers retain the right to arbitrarily recoup costs directly from patients, is also questioned. Results Initial evidence suggests that total costs are higher than initially expected, and prices to some patients have risen substantially under the NZPHCS. Limited competition and NZPHCS governance requirements mean current institutional arrangements are unlikely to facilitate efficiency improvements. System design changes therefore appear indicated. PMID:16144544

The Australian experience in dental classification.

PubMed

Mahoney, Greg

2008-01-01

The Australian Defence Health Service uses a disease-risk management strategy to achieve two goals: first, to identify Australian Defence Force (ADF) members who are at high risk of developing an adverse health event, and second, to deliver intervention strategies efficiently so that maximum benefits for health within the ADF are achieved with the least cost. The present dental classification system utilized by the ADF, while an excellent dental triage tool, has been found not to be predictive of an ADF member having an adverse dental event in the following 12-month period. Clearly, there is a need for further research to establish a predictive risk-based dental classification system. This risk assessment must be sensitive enough to accurately estimate the probability that an ADF member will experience dental pain, dysfunction, or other adverse dental events within a forthcoming period, typically 12 months. Furthermore, there needs to be better epidemiological data collected in the field to assist in the research.

Energy and human health.

PubMed

Smith, Kirk R; Frumkin, Howard; Balakrishnan, Kalpana; Butler, Colin D; Chafe, Zoë A; Fairlie, Ian; Kinney, Patrick; Kjellstrom, Tord; Mauzerall, Denise L; McKone, Thomas E; McMichael, Anthony J; Schneider, Mycle

2013-01-01

Energy use is central to human society and provides many health benefits. But each source of energy entails some health risks. This article reviews the health impacts of each major source of energy, focusing on those with major implications for the burden of disease globally. The biggest health impacts accrue to the harvesting and burning of solid fuels, coal and biomass, mainly in the form of occupational health risks and household and general ambient air pollution. Lack of access to clean fuels and electricity in the world's poor households is a particularly serious risk for health. Although energy efficiency brings many benefits, it also entails some health risks, as do renewable energy systems, if not managed carefully. We do not review health impacts of climate change itself, which are due mostly to climate-altering pollutants from energy systems, but do discuss the potential for achieving near-term health cobenefits by reducing certain climate-related emissions.

A GIS-based approach for comparative analysis of potential fire risk assessment

NASA Astrophysics Data System (ADS)

Sun, Ying; Hu, Lieqiu; Liu, Huiping

2007-06-01

Urban fires are one of the most important sources of property loss and human casualty and therefore it is necessary to assess the potential fire risk with consideration of urban community safety. Two evaluation models are proposed, both of which are integrated with GIS. One is the single factor model concerning the accessibility of fire passage and the other is grey clustering approach based on the multifactor system. In the latter model, fourteen factors are introduced and divided into four categories involving security management, evacuation facility, construction resistance and fire fighting capability. A case study on campus of Beijing Normal University is presented to express the potential risk assessment models in details. A comparative analysis of the two models is carried out to validate the accuracy. The results are approximately consistent with each other. Moreover, modeling with GIS promotes the efficiency the potential risk assessment.

Findings from an Organizational Network Analysis to Support Local Public Health Management

PubMed Central

Caldwell, Michael; Rockoff, Maxine L.; Gebbie, Kristine; Carley, Kathleen M.; Bakken, Suzanne

2008-01-01

We assessed the feasibility of using organizational network analysis in a local public health organization. The research setting was an urban/suburban county health department with 156 employees. The goal of the research was to study communication and information flow in the department and to assess the technique for public health management. Network data were derived from survey questionnaires. Computational analysis was performed with the Organizational Risk Analyzer. Analysis revealed centralized communication, limited interdependencies, potential knowledge loss through retirement, and possible informational silos. The findings suggested opportunities for more cross program coordination but also suggested the presences of potentially efficient communication paths and potentially beneficial social connectedness. Managers found the findings useful to support decision making. Public health organizations must be effective in an increasingly complex environment. Network analysis can help build public health capacity for complex system management. PMID:18481183

Implementing a resource management program for accreditation process at the medical laboratory.

PubMed

Yenice, Sedef

2009-03-01

To plan for and provide adequate resources to meet the mission and goals of a medical laboratory in compliance with the requirements for laboratory accreditation by Joint Commission International. The related policies and procedures were developed based on standard requirements for resource management. Competency assessment provided continuing education and performance feedback to laboratory employees. Laboratory areas were designed for the efficient and safe performance of laboratory work. A physical environment was built up where hazards were controlled and personnel activities were managed to reduce the risk of injuries. An Employees Occupational Safety and Health Program (EOSHP) was developed to address all types of hazardous materials and wastes. Guidelines were defined to verify that the methods would produce accurate and reliable results. An active resource management program will be an effective way of assuring that systems are in control and continuous improvement is in progress.

Management of Hyperglycemia During Enteral and Parenteral Nutrition Therapy

PubMed Central

Umpierrez, Guillermo E.

2013-01-01

Hyperglycemia is a frequent complication of enteral and parenteral nutrition in hospitalized patients. Extensive evidence from observational studies indicates that the development of hyperglycemia during parenteral and enteral nutrition is associated with an increased risk of death and infectious complications. There are no specific guidelines recommending glycemic targets and effective strategies for the management of hyperglycemia during specialized nutritional support. Managing hyperglycemia in these patients should include optimization of carbohydrate content and administration of intravenous or subcutaneous insulin therapy. The administration of continuous insulin infusion and insulin addition to nutrition bag are efficient approaches to control hyperglycemia during parenteral nutrition. Subcutaneous administration of long-acting insulin with scheduled or corrective doses of short-acting insulin is superior to the sliding scale insulin strategy in patients receiving enteral feedings. Randomized controlled studies are needed to evaluate safe and effective therapeutic strategies for the management of hyperglycemia in patients receiving nutritional support. PMID:23065369

Clinical decisions in patients with diabetes and other cardiovascular risk factors. A statement of the Spanish Society of Internal Medicine.

PubMed

Gómez-Huelgas, R; Pérez-Jiménez, F; Serrano-Ríos, M; González-Santos, P; Román, P; Camafort, M; Conthe, P; García-Alegría, J; Guijarro, R; López-Miranda, J; Tirado-Miranda, R; Valdivielso, P

2014-05-01

Although the mortality associated to cardiovascular diseases (CVD) has been reduced in the last decades, CVD remains the main cause of mortality in Spain and they are associated with an important morbidity and a huge economic burden. The increasing prevalence of obesity and diabetes could be slowing down the mortality reduction in Spain. Clinicians have often difficulty making clinical decisions due to the multiple clinical guidelines available. Moreover, in the current context of economic crisis it is critical to promote an efficient use of diagnostic and therapeutic proceedings to ensure the viability of public health care systems. The Spanish Society of Internal Medicine (SEMI) has coordinated a consensus document to answer questions of daily practice with the aim of facilitating physicians' decision-making in the management of diabetes and cardiovascular risk factors from a cost-efficiency point of view. Copyright © 2013 Elsevier España, S.L. All rights reserved.

New strategies for the development of lipid-lowering therapies to reduce cardiovascular risk.

PubMed

Graham, Ian; Shear, Chuck; De Graeff, Pieter; Boulton, Caroline; Catapano, Alberico L; Stough, Wendy Gattis; Carlsson, Stefan C; De Backer, Guy; Emmerich, Joseph; Greenfeder, Scott; Kim, Albert M; Lautsch, Dominik; Nguyen, Tu; Nissen, Steven E; Prasad, Krishna; Ray, Kausik K; Robinson, Jennifer G; Sasiela, William J; Bruins Slot, Karsten; Stroes, Erik; Thuren, Tom; Van der Schueren, Bart; Velkovski-Rouyer, Maja; Wasserman, Scott M; Wiklund, Olov; Zouridakis, Emmanouil

2018-04-01

The very high occurrence of cardiovascular events presents a major public health issue, because treatment remains suboptimal. Lowering LDL cholesterol (LDL-C) with statins or ezetimibe in combination with a statin reduces major adverse cardiovascular events. The cardiovascular risk reduction in relation to the absolute LDL-C reduction is linear for most interventions without evidence of attenuation or increase in risk at low LDL-C levels. Opportunities for innovation in dyslipidaemia treatment should address the substantial risk of lipid-associated cardiovascular events among patients optimally treated per guidelines but who cannot achieve LDL-C goals and who could benefit from additional LDL-C-lowering therapy or experience side effects of statins. Fresh approaches are needed to identify promising drug targets early and develop them efficiently. The Cardiovascular Round Table of the European Society of Cardiology (ESC) convened a workshop to discuss new lipid-lowering strategies for cardiovascular risk reduction. Opportunities to improve treatment approaches and the efficient study of new therapies were explored. Circulating biomarkers may not be fully reliable proxy indicators of the relationship between treatment effect and clinical outcome. Mendelian randomization studies may better inform development strategies and refine treatment targets before Phase 3. Trials should match the drug to appropriate lipid and patient profile, and guidelines may move towards a precision-based approach to individual patient management. Stakeholder collaboration is needed to ensure continued innovation and better international coordination of both regulatory aspects and guidelines. It should be noted that risk may also be addressed through increased attention to other risk factors such as smoking, hypertension, overweight, and inactivity.

Energy services in the information age: The convergence of energy, communications, and information technologies

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

Centolella, P.A.

1998-07-01

Most of the economic efficiency benefits of electric restructuring--consumer choice based on price and risk preferences, efficient capacity utilization, capacity expansion that reflects marketability, and innovative products--depend upon consumer access to information and opportunities to respond to time- and location-specific prices and customized products. Information and communications technologies from back-room data management centers to intelligent consumer gateways will play an essential role in marketing energy services in a retail access environment. This paper describes the role of information and communications technology in electric industry restructuring and retailing of energy services. It includes a survey of economic analyses on the likelymore » variability in competitive generation prices and consumer responses if such prices are effectively communicated. The paper describes the potential benefits and cost savings associated with flexible consumer responses to price variability. It identifies consumer loads and preferences. Finally, the paper describes the building blocks of information systems being developed to facilitate price-responsive energy management and provide a range of other energy services. Intelligent gateways, analytical tools for facility load prediction and optimizing energy management responses, and electronic commerce applications are discussed.« less

Applying Required Navigation Performance Concept for Traffic Management of Small Unmanned Aircraft Systems

NASA Technical Reports Server (NTRS)

Jung, Jaewoo; D'Souza, Sarah N.; Johnson, Marcus A.; Ishihara, Abraham K.; Modi, Hemil C.; Nikaido, Ben; Hasseeb, Hashmatullah

2016-01-01

In anticipation of a rapid increase in the number of civil Unmanned Aircraft System(UAS) operations, NASA is researching prototype technologies for a UAS Traffic Management (UTM) system that will investigate airspace integration requirements for enabling safe, efficient low-altitude operations. One aspect a UTM system must consider is the correlation between UAS operations (such as vehicles, operation areas and durations), UAS performance requirements, and the risk to people and property in the operational area. This paper investigates the potential application of the International Civil Aviation Organizations (ICAO) Required Navigation Performance (RNP) concept to relate operational risk with trajectory conformance requirements. The approach is to first define a method to quantify operational risk and then define the RNP level requirement as a function of the operational risk. Greater operational risk corresponds to more accurate RNP level, or smaller tolerable Total System Error (TSE). Data from 19 small UAS flights are used to develop and validate a formula that defines this relationship. An approach to assessing UAS-RNP conformance capability using vehicle modeling and wind field simulation is developed to investigate how this formula may be applied in a future UTM system. The results indicate the modeled vehicles flight path is robust to the simulated wind variation, and it can meet RNP level requirements calculated by the formula. The results also indicate how vehicle-modeling fidelity may be improved to adequately verify assessed RNP level.

The Biggest Loser Thinks Long-Term: Recency as a Predictor of Success in Weight Management

PubMed Central

Koritzky, Gilly; Rice, Chantelle; Dieterle, Camille; Bechara, Antoine

2015-01-01

Only a minority of participants in behavioral weight management lose weight significantly. The ability to predict who is likely to benefit from weight management can improve the efficiency of obesity treatment. Identifying predictors of weight loss can also reveal potential ways to improve existing treatments. We propose a neuro-psychological model that is focused on recency: the reliance on recent information at the expense of time-distant information. Forty-four weight-management patients completed a decision-making task and their recency level was estimated by a mathematical model. Impulsivity and risk-taking were also measured for comparison. Weight loss was measured in the end of the 16-week intervention. Consistent with our hypothesis, successful dieters (n = 12) had lower recency scores than unsuccessful ones (n = 32; p = 0.006). Successful and unsuccessful dieters were similar in their demographics, intelligence, risk taking, impulsivity, and delay of gratification. We conclude that dieters who process time-distant information in their decision making are more likely to lose weight than those who are high in recency. We argue that having low recency facilitates future-oriented thinking, and thereby contributes to behavior change treatment adherence. Our findings underline the importance of choosing the right treatment for every individual, and outline a way to improve weight-management processes for more patients. PMID:26696930

Testing REACH draft technical guidance notes for conducting chemical safety assessments-the experience of a downstream user of a preparation.

PubMed

Gade, Anne Lill; Ovrebø, Steinar; Hylland, Ketil

2008-07-01

The goal of REACH is the safe use of chemicals. This study examines the efficiency and usefulness of two draft technical guidance notes in the REACH Interim Project 3.2-2 for the development of the chemical safety report and exposure scenarios. A case study was carried out for a paint system for protection of structural steel. The focuses of the study were risk assessment of preparations based on Derived No Effect Level (DNEL) and Predicted No Effect Concentrations (PNEC) and on effective and accurate communication in the supply chain. Exposure scenarios and generic descriptions of uses, risk management measures, and exposure determinants were developed. The study showed that communication formats, software tools, and guidelines for chemical risk assessment need further adjustment to preparations and real-life situations. Web platforms may simplify such communication. The downstream formulator needs basic substance data from the substance manufacturer during the pre-registration phase to develop exposure scenarios for preparations. Default values need to be communicated in the supply chain because these were critical for the derivation of applicable risk management demands. The current guidelines which rely on the available toxicological knowledge are insufficient to advise downstream users on how to develop exposure scenarios for preparations.

ePORT, NASA's Computer Database Program for System Safety Risk Management Oversight (Electronic Project Online Risk Tool)

NASA Technical Reports Server (NTRS)

Johnson, Paul W.

2008-01-01

ePORT (electronic Project Online Risk Tool) provides a systematic approach to using an electronic database program to manage a program/project risk management processes. This presentation will briefly cover the standard risk management procedures, then thoroughly cover NASA's Risk Management tool called ePORT. This electronic Project Online Risk Tool (ePORT) is a web-based risk management program that provides a common framework to capture and manage risks, independent of a programs/projects size and budget. It is used to thoroughly cover the risk management paradigm providing standardized evaluation criterion for common management reporting, ePORT improves Product Line, Center and Corporate Management insight, simplifies program/project manager reporting, and maintains an archive of data for historical reference.

Continuous Risk Management: An Overview

NASA Technical Reports Server (NTRS)

Rosenberg, Linda; Hammer, Theodore F.

1999-01-01

Software risk management is important because it helps avoid disasters, rework, and overkill, but more importantly because it stimulates win-win situations. The objectives of software risk management are to identify, address, and eliminate software risk items before they become threats to success or major sources of rework. In general, good project managers are also good managers of risk. It makes good business sense for all software development projects to incorporate risk management as part of project management. The Software Assurance Technology Center (SATC) at NASA GSFC has been tasked with the responsibility for developing and teaching a systems level course for risk management that provides information on how to implement risk management. The course was developed in conjunction with the Software Engineering Institute at Carnegie Mellon University, then tailored to the NASA systems community. This is an introductory tutorial to continuous risk management based on this course. The rational for continuous risk management and how it is incorporated into project management are discussed. The risk management structure of six functions is discussed in sufficient depth for managers to understand what is involved in risk management and how it is implemented. These functions include: (1) Identify the risks in a specific format; (2) Analyze the risk probability, impact/severity, and timeframe; (3) Plan the approach; (4) Track the risk through data compilation and analysis; (5) Control and monitor the risk; (6) Communicate and document the process and decisions.

Probability concepts in quality risk management.

PubMed

Claycamp, H Gregg

2012-01-01

Essentially any concept of risk is built on fundamental concepts of chance, likelihood, or probability. Although risk is generally a probability of loss of something of value, given that a risk-generating event will occur or has occurred, it is ironic that the quality risk management literature and guidelines on quality risk management tools are relatively silent on the meaning and uses of "probability." The probability concept is typically applied by risk managers as a combination of frequency-based calculation and a "degree of belief" meaning of probability. Probability as a concept that is crucial for understanding and managing risk is discussed through examples from the most general, scenario-defining and ranking tools that use probability implicitly to more specific probabilistic tools in risk management. A rich history of probability in risk management applied to other fields suggests that high-quality risk management decisions benefit from the implementation of more thoughtful probability concepts in both risk modeling and risk management. Essentially any concept of risk is built on fundamental concepts of chance, likelihood, or probability. Although "risk" generally describes a probability of loss of something of value, given that a risk-generating event will occur or has occurred, it is ironic that the quality risk management literature and guidelines on quality risk management methodologies and respective tools focus on managing severity but are relatively silent on the in-depth meaning and uses of "probability." Pharmaceutical manufacturers are expanding their use of quality risk management to identify and manage risks to the patient that might occur in phases of the pharmaceutical life cycle from drug development to manufacture, marketing to product discontinuation. A probability concept is typically applied by risk managers as a combination of data-based measures of probability and a subjective "degree of belief" meaning of probability. Probability as a concept that is crucial for understanding and managing risk is discussed through examples from the most general, scenario-defining and ranking tools that use probability implicitly to more specific probabilistic tools in risk management.

Spatial tools for managing hemlock woolly adelgid in the southern Appalachians

NASA Astrophysics Data System (ADS)

Koch, Frank Henry, Jr.

The hemlock woolly adelgid (Adelges tsugae) has recently spread into the southern Appalachians. This insect attacks both native hemlock species (Tsuga canadensis and T. caroliniana ), has no natural enemies, and can kill hemlocks within four years. Biological control displays promise for combating the pest, but counter-measures are impeded because adelgid and hemlock distribution patterns have been detailed poorly. We developed a spatial management system to better target control efforts, with two components: (1) a protocol for mapping hemlock stands, and (2) a technique to map areas at risk of imminent infestation. To construct a hemlock classifier, we used topographically normalized satellite images from Great Smoky Mountains National Park. Employing a decision tree approach that supplemented image spectral data with several environmental variables, we generated rules distinguishing hemlock areas from other forest types. We then implemented these rules in a geographic information system and generated hemlock distribution maps. Assessment yielded an overall thematic accuracy of 90% for one study area, and 75% accuracy in capturing hemlocks in a second study area. To map areas at risk, we combined first-year infestation locations from Great Smoky Mountains National Park and the Blue Ridge Parkway with points from uninfested hemlock stands, recording a suite of environmental variables for each point. We applied four different multivariate classification techniques to generate models from this sample predicting locations with high infestation risk, and used the resulting models to generate risk maps for the study region. All techniques performed well, accurately capturing 70--90% of training and validation samples, with the logistic regression model best balancing accuracy and regional applicability. Areas close to trails, roads, and streams appear to have the highest initial risk, perhaps due to bird- or human-mediated dispersal. Both components of our management system are general enough for use throughout the southern Appalachians. Overlay of derived maps will allow forest managers to reduce the area where they must focus their control efforts and thus allocate resources more efficiently.

Assessing the potential of economic instruments for managing drought risk at river basin scale

NASA Astrophysics Data System (ADS)

Pulido-Velazquez, M.; Lopez-Nicolas, A.; Macian-Sorribes, H.

2015-12-01

Economic instruments work as incentives to adapt individual decisions to collectively agreed goals. Different types of economic instruments have been applied to manage water resources, such as water-related taxes and charges (water pricing, environmental taxes, etc.), subsidies, markets or voluntary agreements. Hydroeconomic models (HEM) provide useful insight on optimal strategies for coping with droughts by simultaneously analysing engineering, hydrology and economics of water resources management. We use HEMs for evaluating the potential of economic instruments on managing drought risk at river basin scale, considering three criteria for assessing drought risk: reliability, resilience and vulnerability. HEMs allow to calculate water scarcity costs as the economic losses due to water deliveries below the target demands, which can be used as a vulnerability descriptor of drought risk. Two generic hydroeconomic DSS tools, SIMGAMS and OPTIGAMS ( both programmed in GAMS) have been developed to evaluate water scarcity cost at river basin scale based on simulation and optimization approaches. The simulation tool SIMGAMS allocates water according to the system priorities and operating rules, and evaluate the scarcity costs using economic demand functions. The optimization tool allocates water resources for maximizing net benefits (minimizing total water scarcity plus operating cost of water use). SIMGAS allows to simulate incentive water pricing policies based on water availability in the system (scarcity pricing), while OPTIGAMS is used to simulate the effect of ideal water markets by economic optimization. These tools have been applied to the Jucar river system (Spain), highly regulated and with high share of water use for crop irrigation (greater than 80%), where water scarcity, irregular hydrology and groundwater overdraft cause droughts to have significant economic, social and environmental consequences. An econometric model was first used to explain the variation of the production value of irrigated agriculture during droughts, assessing revenue responses to varying crop prices and water availability. Hydroeconomic approaches were then used to show the potential of economic instruments in setting incentives for a more efficient management of water resources systems.

Estimating the NIH efficient frontier.

PubMed

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

2012-01-01

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

Evolution and Implementation of the NASA Robotic Conjunction Assessment Risk Analysis Concept of Operations

NASA Astrophysics Data System (ADS)

Newman, L.; Hejduk, M.; Frigm, R.; Duncan, M.

2014-09-01

On-orbit collisions pose a significant mission risk to satellites operating in the space environment. Recognizing the likelihood and consequence of on-orbit collisions, NASA has taken several proactive measures to mitigate the risk of both a catastrophic loss of mission and the increase in the space debris population. In fall 2004, NASA GSFC established an Agency-wide, institutionalized process and service for identifying and reacting to predicted close approaches. The team responsible for executing this mission is the NASA Robotic Conjunction Assessment Risk Analysis (CARA) team. By fall 2005, this process had resulted in the execution of the first collision avoidance maneuver by a NASA unmanned satellite. In February 2008, NASA adopted a policy, documented in NASA Procedural Requirement 8715.6a Process for Limiting Orbital Debris that directed maneuverable satellites to have such an on-orbit collision mitigation process. In 2009, NASA decided to require support for all operational satellites. By January 2014, the CARA team has processed nearly 500,000 close approach messages from the Joint Space Operations Center (JSpOC) and has assisted our mission customers with planning and executing over 75 collision avoidance maneuvers for unmanned satellites in LEO, GEO, and HEO orbital regimes. With the increase in number of operational missions supported; growth in the orbital debris environment due to events such as the intentional destruction of the Fengyun 1-C satellite in 2007 and collision between Iridium-33 and Cosmos-2251; and improvements to the United States Space Surveillance Network (SSN) and its ability to track, catalog, and screen against small debris objects, the demands on the CARA process have consequently required the CARA Concept of Operations (CONOPS) to evolve to manage those demands. This evolution is centered on the ability to effectively and efficiently manage JSpOC, CARA, and Mission Operations resources, applying operational and analytical efforts for conjunction events that pose significant collision risk and rapidly discarding conjunction events that do not. While the overall CARA methodology is largely unaffected, this CONOPS evolution manifests itself in several aspects of the CARA process: required data and information, communication of those data and information, and courses of actions based on those data and information. The changes affect all relevant stakeholders, including the CARA team at NASA GSFC, GSFC-dedicated Orbital Safety Analysts at the JSpOC, and Mission Operations flight teams and management. In each step of the CARA process, the CONOPS ensures that necessary (whether situational or actionable) information be sent to stakeholders to facilitate an effective and efficient management of resources and appropriate protection of data. The most significant paradigm shift is the movement to risk-based reporting. Since the consequence of the on-orbit collision scenario can be catastrophic, the CARA risk-based framework hinges on the collision probability, Pc, as the encapsulation of collision risk. This CONOPS characterizes collision risk as Red (high collision risk), Yellow (potential for becoming a high collision risk), or Green (low collision risk) based on the operationally-computed Pc. Using this risk characterization schema, the amount and content of conjunction information and analyses is determined and communicated to mission stakeholders. Major technical analyses that have been conducted in support of this CONOPS include defining risk-based thresholds for red, yellow, and green criteria; determining when conjunction-related information may not be mature enough to be actionable; and accounting for uncertainties in all the inputs to the process so that a nuanced assessment of risk can be made. This paper summarizes the analyses executed and decisions rendered during the implementation of this evolved CONOPS. Historical conjunction events of note are used as example scenarios of each risk characterization.

Optimization of business processes in banks through flexible workflow

NASA Astrophysics Data System (ADS)

Postolache, V.

2017-08-01

This article describes an integrated business model of a commercial bank. There are examples of components that go into its composition: wooden models and business processes, strategic goals, organizational structure, system architecture, operational and marketing risk models, etc. The practice has shown that the development and implementation of the integrated business model of the bank significantly increase operating efficiency and its management, ensures organizational and technology stable development. Considering the evolution of business processes in the banking sector, should be analysed their common characteristics. From the author’s point of view, a business process is a set of various activities of a commercial bank in which “Input” is one or more financial and material resources, as a result of this activity and “output” is created by banking product, which is some value to consumer. Using workflow technology, management business process efficiency issue is a matter of managing the integration of resources and sequence of actions aimed at achieving this goal. In turn, it implies management of jobs or functions’ interaction, synchronizing of the assignments periods, reducing delays in the transmission of the results etc. Workflow technology is very important for managers at all levels, as they can use it to easily strengthen the control over what is happening in a particular unit, and in the bank as a whole. The manager is able to plan, to implement rules, to interact within the framework of the company’s procedures and tasks entrusted to the system of the distribution function and execution control, alert on the implementation and issuance of the statistical data on the effectiveness of operating procedures. Development and active use of the integrated bank business model is one of the key success factors that contribute to long-term and stable development of the bank, increase employee efficiency and business processes, implement the strategic objectives.

Chemical Risk Assessment: Traditional vs Public Health Perspectives

PubMed Central

Axelrad, Daniel A.; Bahadori, Tina; Bussard, David; Cascio, Wayne E.; Deener, Kacee; Dix, David; Thomas, Russell S.; Kavlock, Robert J.; Burke, Thomas A.

2017-01-01

Preventing adverse health effects of environmental chemical exposure is fundamental to protecting individual and public health. When done efficiently and properly, chemical risk assessment enables risk management actions that minimize the incidence and effects of environmentally induced diseases related to chemical exposure. However, traditional chemical risk assessment is faced with multiple challenges with respect to predicting and preventing disease in human populations, and epidemiological studies increasingly report observations of adverse health effects at exposure levels predicted from animal studies to be safe for humans. This discordance reinforces concerns about the adequacy of contemporary risk assessment practices for protecting public health. It is becoming clear that to protect public health more effectively, future risk assessments will need to use the full range of available data, draw on innovative methods to integrate diverse data streams, and consider health endpoints that also reflect the range of subtle effects and morbidities observed in human populations. Considering these factors, there is a need to reframe chemical risk assessment to be more clearly aligned with the public health goal of minimizing environmental exposures associated with disease. PMID:28520487

Gender, Race, and Risk: Intersectional Risk Management in the Sale of Sex Online.

PubMed

Moorman, Jessica D; Harrison, Kristen

2016-09-01

Sex worker experience of risk (e.g., physical violence or rape) is shaped by race, gender, and context. For web-based sex workers, experience of risk is comparatively minimal; what is unclear is how web-based sex workers manage risk and if online advertising plays a role in risk management. Building on intersectionality theory and research exploring risk management in sex work, we content-analyzed 600 escort advertisements from Backpage.com ( http://www.backpage.com ) to explore risk management in web-based sex work. To guide our research we asked: Do advertisements contain risk management messages? Does the use of risk management messaging differ by sex worker race or gender? Which groups have the highest overall use of risk management messages? Through a multivariate analysis of covariance (MANCOVA) we found that advertisements contained risk management messages and that uses of these phrases varied by race and gender. Blacks, women, and transgender women drove the use of risk management messages. Black and White transgender women had the highest overall use of these phrases. We conclude that risk management is an intersectional practice and that the use of risk management messages is a venue-specific manifestation of broader risk management priorities found in all venues where sex is sold.

Dealing with the white death: avalanche risk management for traffic routes.

PubMed

Rheinberger, Christoph M; Bründl, Michael; Rhyner, Jakob

2009-01-01

This article discusses mitigation strategies to protect traffic routes from snow avalanches. Up to now, mitigation of snow avalanches on many roads and railways in the Alps has relied on avalanche sheds, which require large initial investments resulting in high opportunity costs. Therefore, avalanche risk managers have increasingly adopted organizational mitigation measures such as warning systems and closure policies instead. The effectiveness of these measures is, however, greatly dependent on human decisions. In this article, we present a method for optimizing avalanche mitigation for traffic routes in terms of both their risk reduction impact and their net benefit to society. First, we introduce a generic framework for assessing avalanche risk and for quantifying the impact of mitigation. This allows for sound cost-benefit comparisons between alternative mitigation strategies. Second, we illustrate the framework with a case study from Switzerland. Our findings suggest that site-specific characteristics of avalanche paths, as well as the economic importance of a traffic route, are decisive for the choice of optimal mitigation strategies. On routes endangered by few avalanche paths with frequent avalanche occurrences, structural measures are most efficient, whereas reliance on organizational mitigation is often the most appropriate strategy on routes endangered by many paths with infrequent or fuzzy avalanche risk. Finally, keeping a traffic route open may be very important for tourism or the transport industry. Hence, local economic value may promote the use of a hybrid strategy that combines organizational and structural measures to optimize the resource allocation of avalanche risk mitigation.

Application of ICH Q9 Quality Risk Management Tools for Advanced Development of Hot Melt Coated Multiparticulate Systems.

PubMed

Stocker, Elena; Becker, Karin; Hate, Siddhi; Hohl, Roland; Schiemenz, Wolfgang; Sacher, Stephan; Zimmer, Andreas; Salar-Behzadi, Sharareh

2017-01-01

This study aimed to apply quality risk management based on the The International Conference on Harmonisation guideline Q9 for the early development stage of hot melt coated multiparticulate systems for oral administration. N-acetylcysteine crystals were coated with a formulation composing tripalmitin and polysorbate 65. The critical quality attributes (CQAs) were initially prioritized using failure mode and effects analysis. The CQAs of the coated material were defined as particle size, taste-masking efficiency, and immediate release profile. The hot melt coated process was characterized via a flowchart, based on the identified potential critical process parameters (CPPs) and their impact on the CQAs. These CPPs were prioritized using a process failure mode, effects, and criticality analysis and their critical impact on the CQAs was experimentally confirmed using a statistical design of experiments. Spray rate, atomization air pressure, and air flow rate were identified as CPPs. Coating amount and content of polysorbate 65 in the coating formulation were identified as critical material attributes. A hazard and critical control points analysis was applied to define control strategies at the critical process points. A fault tree analysis evaluated causes for potential process failures. We successfully demonstrated that a standardized quality risk management approach optimizes the product development sustainability and supports the regulatory aspects. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Asset management in theory and practice.

PubMed

Mace, J D

1998-01-01

Managing capital-intensive imaging environments continues to be a challenge for nearly all administrators. Asset management, the strategic management of equipment inventory, must include planning, assessment, procurement, utilization review, maintenance, repair and disposal of equipment to reduce costs and improve efficiency. It must involve some shared risk between the facility and the provider, whether an original equipment manufacturer (OEM) or independent service organization (ISO). An absence of risk in the arrangement implies the provider is offering service management or consulting. A case study reports on three hospitals in the OhioHealth system. Their immediate goal, as they began to investigate asset management: cut costs immediately. A cross-functional team from the three hospitals began its investigation of various options, including working with ISOs, OEMs and development of inhouse clinical engineering. After developing a process to evaluate vendors, the team was able to score each against their cost-reduction potential, quality and implementation skills. The team narrowed its selection quickly to two multivendor service providers. An initial contract guaranteed savings of 20 percent of the annual budget, with a projected two to five percent additional savings. OEM relationships were moved to a time-and-materials basis, and ISOs were used in selected areas. In addition, the internal inhouse clinical engineering services group was moved into a "first call" approach in some areas. That expanded role resulted in savings and improved response time. The process, although not without its problems, was viewed favorably overall.

Risk management and measuring productivity with POAS--point of act system.

PubMed

Akiyama, Masanori; Kondo, Tatsuya

2007-01-01

The concept of our system is not only to manage material flows, but also to provide an integrated management resource, a means of correcting errors in medical treatment, and applications to EBM through the data mining of medical records. Prior to the development of this system, electronic processing systems in hospitals did a poor job of accurately grasping medical practice and medical material flows. With POAS (Point of Act System), hospital managers can solve the so-called, "man, money, material, and information" issues inherent in the costs of healthcare. The POAS system synchronizes with each department system, from finance and accounting, to pharmacy, to imaging, and allows information exchange. We can manage Man, Material, Money and Information completely by this system. Our analysis has shown that this system has a remarkable investment effect - saving over four million dollars per year - through cost savings in logistics and business process efficiencies. In addition, the quality of care has been improved dramatically while error rates have been reduced - nearly to zero in some cases.

Safety Risk Knowledge Elicitation in Support of Aeronautical R and D Portfolio Management: A Case Study

NASA Technical Reports Server (NTRS)

Shih, Ann T.; Ancel, Ersin; Jones, Sharon Monica; Reveley, Mary S.; Luxhoj, James T.

2012-01-01

Aviation is a problem domain characterized by a high level of system complexity and uncertainty. Safety risk analysis in such a domain is especially challenging given the multitude of operations and diverse stakeholders. The Federal Aviation Administration (FAA) projects that by 2025 air traffic will increase by more than 50 percent with 1.1 billion passengers a year and more than 85,000 flights every 24 hours contributing to further delays and congestion in the sky (Circelli, 2011). This increased system complexity necessitates the application of structured safety risk analysis methods to understand and eliminate where possible, reduce, and/or mitigate risk factors. The use of expert judgments for probabilistic safety analysis in such a complex domain is necessary especially when evaluating the projected impact of future technologies, capabilities, and procedures for which current operational data may be scarce. Management of an R&D product portfolio in such a dynamic domain needs a systematic process to elicit these expert judgments, process modeling results, perform sensitivity analyses, and efficiently communicate the modeling results to decision makers. In this paper a case study focusing on the application of an R&D portfolio of aeronautical products intended to mitigate aircraft Loss of Control (LOC) accidents is presented. In particular, the knowledge elicitation process with three subject matter experts who contributed to the safety risk model is emphasized. The application and refinement of a verbal-numerical scale for conditional probability elicitation in a Bayesian Belief Network (BBN) is discussed. The preliminary findings from this initial step of a three-part elicitation are important to project management practitioners as they illustrate the vital contribution of systematic knowledge elicitation in complex domains.

Peritoneal dialysis associated infections: An update on diagnosis and management

PubMed Central

Akoh, Jacob A

2012-01-01

Peritoneal dialysis (PD) is associated with a high risk of infection of the peritoneum, subcutaneous tunnel and catheter exit site. Although quality standards demand an infection rate < 0.67 episodes/patient/year on dialysis, the reported overall rate of PD associated infection is 0.24-1.66 episodes/patient/year. It is estimated that for every 0.5-per-year increase in peritonitis rate, the risk of death increases by 4% and 18% of the episodes resulted in removal of the PD catheter and 3.5% resulted in death. Improved diagnosis, increased awareness of causative agents in addition to other measures will facilitate prompt management of PD associated infection and salvage of PD modality. The aims of this review are to determine the magnitude of the infection problem, identify possible risk factors and provide an update on the diagnosis and management of PD associated infection. Gram-positive cocci such as Staphylococcus epidermidis, other coagulase negative staphylococcoci, and Staphylococcus aureus (S. aureus) are the most frequent aetiological agents of PD-associated peritonitis worldwide. Empiric antibiotic therapy must cover both gram-positive and gram-negative organisms. However, use of systemic vancomycin and ciprofloxacin administration for example, is a simple and efficient first-line protocol antibiotic therapy for PD peritonitis - success rate of 77%. However, for fungal PD peritonitis, it is now standard practice to remove PD catheters in addition to antifungal treatment for a minimum of 3 wk and subsequent transfer to hemodialysis. To prevent PD associated infections, prophylactic antibiotic administration before catheter placement, adequate patient training, exit-site care, and treatment for S. aureus nasal carriage should be employed. Mupirocin treatment can reduce the risk of exit site infection by 46% but it cannot decrease the risk of peritonitis due to all organisms. PMID:24175248

A multi-disciplinary approach for the integrated assessment of multiple risks in delta areas.

NASA Astrophysics Data System (ADS)

Sperotto, Anna; Torresan, Silvia; Critto, Andrea; Marcomini, Antonio

2016-04-01

The assessment of climate change related risks is notoriously difficult due to the complex and uncertain combinations of hazardous events that might happen, the multiplicity of physical processes involved, the continuous changes and interactions of environmental and socio-economic systems. One important challenge lies in predicting and modelling cascades of natural and man -made hazard events which can be triggered by climate change, encompassing different spatial and temporal scales. Another regard the potentially difficult integration of environmental, social and economic disciplines in the multi-risk concept. Finally, the effective interaction between scientists and stakeholders is essential to ensure that multi-risk knowledge is translated into efficient adaptation and management strategies. The assessment is even more complex at the scale of deltaic systems which are particularly vulnerable to global environmental changes, due to the fragile equilibrium between the presence of valuable natural ecosystems and relevant economic activities. Improving our capacity to assess the combined effects of multiple hazards (e.g. sea-level rise, storm surges, reduction in sediment load, local subsidence, saltwater intrusion) is therefore essential to identify timely opportunities for adaptation. A holistic multi-risk approach is here proposed to integrate terminology, metrics and methodologies from different research fields (i.e. environmental, social and economic sciences) thus creating shared knowledge areas to advance multi risk assessment and management in delta regions. A first testing of the approach, including the application of Bayesian network analysis for the assessment of impacts of climate change on key natural systems (e.g. wetlands, protected areas, beaches) and socio-economic activities (e.g. agriculture, tourism), is applied in the Po river delta in Northern Italy. The approach is based on a bottom-up process involving local stakeholders early in different stages of the multi-risk assessment process (i.e. identification of objectives, collection of data, definition of risk thresholds and indicators). The results of the assessment will allow the development of multi-risk scenarios enabling the evaluation and prioritization of risk management and adaptation options under changing climate conditions.

Large-scale model-based assessment of deer-vehicle collision risk.

PubMed

Hothorn, Torsten; Brandl, Roland; Müller, Jörg

2012-01-01

Ungulates, in particular the Central European roe deer Capreolus capreolus and the North American white-tailed deer Odocoileus virginianus, are economically and ecologically important. The two species are risk factors for deer-vehicle collisions and as browsers of palatable trees have implications for forest regeneration. However, no large-scale management systems for ungulates have been implemented, mainly because of the high efforts and costs associated with attempts to estimate population sizes of free-living ungulates living in a complex landscape. Attempts to directly estimate population sizes of deer are problematic owing to poor data quality and lack of spatial representation on larger scales. We used data on >74,000 deer-vehicle collisions observed in 2006 and 2009 in Bavaria, Germany, to model the local risk of deer-vehicle collisions and to investigate the relationship between deer-vehicle collisions and both environmental conditions and browsing intensities. An innovative modelling approach for the number of deer-vehicle collisions, which allows nonlinear environment-deer relationships and assessment of spatial heterogeneity, was the basis for estimating the local risk of collisions for specific road types on the scale of Bavarian municipalities. Based on this risk model, we propose a new "deer-vehicle collision index" for deer management. We show that the risk of deer-vehicle collisions is positively correlated to browsing intensity and to harvest numbers. Overall, our results demonstrate that the number of deer-vehicle collisions can be predicted with high precision on the scale of municipalities. In the densely populated and intensively used landscapes of Central Europe and North America, a model-based risk assessment for deer-vehicle collisions provides a cost-efficient instrument for deer management on the landscape scale. The measures derived from our model provide valuable information for planning road protection and defining hunting quota. Open-source software implementing the model can be used to transfer our modelling approach to wildlife-vehicle collisions elsewhere.

Large-Scale Model-Based Assessment of Deer-Vehicle Collision Risk

PubMed Central

Hothorn, Torsten; Brandl, Roland; Müller, Jörg

2012-01-01

Ungulates, in particular the Central European roe deer Capreolus capreolus and the North American white-tailed deer Odocoileus virginianus, are economically and ecologically important. The two species are risk factors for deer–vehicle collisions and as browsers of palatable trees have implications for forest regeneration. However, no large-scale management systems for ungulates have been implemented, mainly because of the high efforts and costs associated with attempts to estimate population sizes of free-living ungulates living in a complex landscape. Attempts to directly estimate population sizes of deer are problematic owing to poor data quality and lack of spatial representation on larger scales. We used data on 74,000 deer–vehicle collisions observed in 2006 and 2009 in Bavaria, Germany, to model the local risk of deer–vehicle collisions and to investigate the relationship between deer–vehicle collisions and both environmental conditions and browsing intensities. An innovative modelling approach for the number of deer–vehicle collisions, which allows nonlinear environment–deer relationships and assessment of spatial heterogeneity, was the basis for estimating the local risk of collisions for specific road types on the scale of Bavarian municipalities. Based on this risk model, we propose a new “deer–vehicle collision index” for deer management. We show that the risk of deer–vehicle collisions is positively correlated to browsing intensity and to harvest numbers. Overall, our results demonstrate that the number of deer–vehicle collisions can be predicted with high precision on the scale of municipalities. In the densely populated and intensively used landscapes of Central Europe and North America, a model-based risk assessment for deer–vehicle collisions provides a cost-efficient instrument for deer management on the landscape scale. The measures derived from our model provide valuable information for planning road protection and defining hunting quota. Open-source software implementing the model can be used to transfer our modelling approach to wildlife–vehicle collisions elsewhere. PMID:22359535

Project Risk Management

NASA Technical Reports Server (NTRS)

Jr., R. F. Miles

1995-01-01

Project risk management is primarily concerned with performance, reliability, cost, and schedule. Environmental risk management is primarily concerned with human health and ecological hazards and likelihoods. This paper discusses project risk management and compares it to environmental risk management, both with respect to goals and implementation. The approach of the Jet Propulsion Laboratory to risk management is presented as an example of a project risk management approach that is an extension to NASA NHB 7120.5: Management of Major System Programs and Projects.

Risk Based Inspection Methodology and Software Applied to Atmospheric Storage Tanks

NASA Astrophysics Data System (ADS)

Topalis, P.; Korneliussen, G.; Hermanrud, J.; Steo, Y.

2012-05-01

A new risk-based inspection (RBI) methodology and software is presented in this paper. The objective of this work is to allow management of the inspections of atmospheric storage tanks in the most efficient way, while, at the same time, accident risks are minimized. The software has been built on the new risk framework architecture, a generic platform facilitating efficient and integrated development of software applications using risk models. The framework includes a library of risk models and the user interface is automatically produced on the basis of editable schemas. This risk-framework-based RBI tool has been applied in the context of RBI for above-ground atmospheric storage tanks (AST) but it has been designed with the objective of being generic enough to allow extension to the process plants in general. This RBI methodology is an evolution of an approach and mathematical models developed for Det Norske Veritas (DNV) and the American Petroleum Institute (API). The methodology assesses damage mechanism potential, degradation rates, probability of failure (PoF), consequence of failure (CoF) in terms of environmental damage and financial loss, risk and inspection intervals and techniques. The scope includes assessment of the tank floor for soil-side external corrosion and product-side internal corrosion and the tank shell courses for atmospheric corrosion and internal thinning. It also includes preliminary assessment for brittle fracture and cracking. The data are structured according to an asset hierarchy including Plant, Production Unit, Process Unit, Tag, Part and Inspection levels and the data are inherited / defaulted seamlessly from a higher hierarchy level to a lower level. The user interface includes synchronized hierarchy tree browsing, dynamic editor and grid-view editing and active reports with drill-in capability.

[Preoperative fasting and fluid management in pediatric patients].

PubMed

Sumiyoshi, Rieko

2013-09-01

Preoperative fasting is principally intended to minimize the risk of pulmonary aspiration of gastric contents and facilitate the safe and efficient conduct of anesthesia. Liberalization of fasting guidelines has been implemented in most countries. In general, clear fluids are allowed up to 2h before anesthesia, and light meals up to 6h. In infants, most recommendations now allow breast milk feeding up to 4h and other kinds of milk up to 6h. Recently, the concept of preoperative oral rehydration using a carbohydrate-rich beverage up to 2h has also gained support. Drinking carbohydrate-rich fluids before elective surgery may reduce dehydration, improve hemodynamic stability under anesthesia, facilitate intravenous access, maintain glucose homeostasis, reduce patient irritability, and improve child and parent satisfaction. These guidelines apply to healthy children only. Exclusion criteria included obesity, diabetes, gastroesophageal reflux, ileus, bowel obstruction and emergency care. In particular, trauma and other emergency cases are at higher risk for aspiration regardless of fasting interval and should be managed appropriately.

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

Kapuscinski, A.R.; Hallerman, E.M.

Among the many methodologies encompassing biotechnology in aquaculture, this report addresses: the production of genetically modified aquatic organisms (aquatic GMOs) by gene transfer, chromosome set manipulation, or hybridization or protoplast fusion between species; new health management tools, including DNA-Based diagnostics and recombinant DNA vaccines; Marker-assisted selection; cryopreservation; and stock marking. These methodologies pose a wide range of potential economic benefits for aquaculture by providing improved or new means to affect the mix of necessary material inputs, enhance production efficiency, or improve product quality. Advances in aquaculture through biotechnology could simulate growth of the aquaculture industry to provide a larger proportionmore » of consummer demand, and thereby reduce pressure and natural stocks from over-harvest. Judicious application of gamete cryopreservation and chromosome set manipulations to achieve sterilization could reduce environmental risks of some aquaculture operations. Given the significant losses to disease in many aquaculture enterprises, potential benefits of DNA-based health management tools are very high and appear to pose no major environmental risks or social concerns.« less

Medicine shortages: a commentary on causes and mitigation strategies.

PubMed

Iyengar, Swathi; Hedman, Lisa; Forte, Gilles; Hill, Suzanne

2016-09-29

Shortages of medicines and vaccines have been reported in countries of all income levels in recent years. Shortages can result from one or multiple causes, including shortages of raw materials, manufacturing capacity problems, industry consolidation, marketing practices, and procurement and supply chain management. Existing approaches to mitigate shortages include advance notice systems managed through medicine regulatory authorities, special programmes that track medicines, and interventions to improve efficiency of the medicine supply chain. Redistribution of supplies at the national level can mitigate some shortages in the short term. International redistribution and exceptional regulatory approvals may be used in limited circumstances, with the understanding that such approaches are complex and may introduce cost and quality risks. If it is necessary to prioritise patients to receive a medicine that is in shortage, evidence-based practice should be used to ensure optimal allocation. Important steps in reducing medicine shortages and their impact include identifying medicines that are most at risk, developing reporting systems to share information on current and emerging shortages, and improving data from medicine supply chains.

Assessing the joint impact of DNAPL source-zone behavior and degradation products on the probabilistic characterization of human health risk

NASA Astrophysics Data System (ADS)

Henri, Christopher V.; Fernàndez-Garcia, Daniel; de Barros, Felipe P. J.

2016-02-01

The release of industrial contaminants into the subsurface has led to a rapid degradation of groundwater resources. Contamination caused by Dense Non-Aqueous Phase Liquids (DNAPLs) is particularly severe owing to their limited solubility, slow dissolution and in many cases high toxicity. A greater insight into how the DNAPL source zone behavior and the contaminant release towards the aquifer impact human health risk is crucial for an appropriate risk management. Risk analysis is further complicated by the uncertainty in aquifer properties and contaminant conditions. This study focuses on the impact of the DNAPL release mode on the human health risk propagation along the aquifer under uncertain conditions. Contaminant concentrations released from the source zone are described using a screening approach with a set of parameters representing several scenarios of DNAPL architecture. The uncertainty in the hydraulic properties is systematically accounted for by high-resolution Monte Carlo simulations. We simulate the release and the transport of the chlorinated solvent perchloroethylene and its carcinogenic degradation products in randomly heterogeneous porous media. The human health risk posed by the chemical mixture of these contaminants is characterized by the low-order statistics and the probability density function of common risk metrics. We show that the zone of high risk (hot spot) is independent of the DNAPL mass release mode, and that the risk amplitude is mostly controlled by heterogeneities and by the source zone architecture. The risk is lower and less uncertain when the source zone is formed mostly by ganglia than by pools. We also illustrate how the source zone efficiency (intensity of the water flux crossing the source zone) affects the risk posed by an exposure to the chemical mixture. Results display that high source zone efficiencies are counter-intuitively beneficial, decreasing the risk because of a reduction in the time available for the production of the highly toxic subspecies.

An Extensible Information Grid for Risk Management

NASA Technical Reports Server (NTRS)

Maluf, David A.; Bell, David G.

2003-01-01

This paper describes recent work on developing an extensible information grid for risk management at NASA - a RISK INFORMATION GRID. This grid is being developed by integrating information grid technology with risk management processes for a variety of risk related applications. To date, RISK GRID applications are being developed for three main NASA processes: risk management - a closed-loop iterative process for explicit risk management, program/project management - a proactive process that includes risk management, and mishap management - a feedback loop for learning from historical risks that escaped other processes. This is enabled through an architecture involving an extensible database, structuring information with XML, schemaless mapping of XML, and secure server-mediated communication using standard protocols.

Material availability and the supply chain: risks, effects, and responses.

PubMed

Alonso, Elisa; Gregory, Jeremy; Field, Frank; Kirchain, Randolph

2007-10-01

Many authors suggest that market forces are inadequate to successfully manage the problems of resource availability and use. The fundamental question is whether these inadequacies are intrinsic to the market or if they arise from a failure of firms to detect and respond to subtle market signals. This paper explores the latter by describing (1) mechanisms that can limit materials availability, (2) effects of such limits on the firm, (3) preliminary metrics to diagnose these risks, and (4) strategies to reduce a firm's risk exposure. Case analyses of two materials systems are used to suggestthat private firm interests, when properly informed, can motivate strategies that drive toward sustainable materials use. These strategies include (1) improving production efficiency, (2) developing technology to use more sustainable substitute materials, and (3) facilitating a more effective materials recycling infrastructure.

Assessing and Managing Multiple Risks in a Changing World ...

EPA Pesticide Factsheets

Roskilde University hosted a November 2015 workshop on “Environmental Risk – Assessing and Managing Multiple Risks in a Changing World”. Thirty attendees from 9 countries developed consensus recommendations regarding: implementation of a common currency (ecosystem services) for holistic environmental risk assessment and management; improvements to risk assessment and management in a complex, human-modified, and changing world; appropriate development of protection goals in a 2-stage process involving both universal and site-, region-, or problem-specific protection goals; addressing societal issues; risk management information needs; conducting risk assessment of risk management; and development of adaptive and flexible regulatory systems. We encourage both cross- and inter-disciplinary approaches to address 10 recommendations: 1) adopt ecosystem services as a common currency for risk assessment and management; 2) consider cumulative stressors (chemical and non-chemical) and determine which dominate to best manage and restore ecosystem services; 3) fully integrate risk managers and communities of interest into the risk assessment process; 4) fully integrate risk assessors and communities of interest into the risk management process; 5) consider socio-economics and increase transparency in both risk assessment and risk management; 6) recognize the ethical rights of humans and ecosystems to an adequate level of protection; 7) determine relevant reference con

Using an Integrated Hydrologic-Economic Model to Develop Minimum Cost Water Supply Portfolios and Manage Supply Risk

NASA Astrophysics Data System (ADS)

Characklis, G. W.; Ramsey, J.

2004-12-01

Water scarcity has become a reality in many areas as a result of population growth, fewer available sources, and reduced tolerance for the environmental impacts of developing the new supplies that do exist. As a result, successfully managing future water supply risk will become more dependent on coordinating the use of existing resources. Toward that end, flexible supply strategies that can rapidly respond to hydrologic variability will provide communities with increasing economic advantages, particularly if the frequency of more extreme events (e.g., drought) increases due to global climate change. Markets for established commodities (e.g., oil, gas) often provide a framework for efficiently responding to changes in supply and demand. Water markets, however, have remained relatively crude, with most transactions involving permanent transfers and long regulatory processes. Recently, interest in the use of flexible short-term transfers (e.g., leases, options) has begun to motivate consideration of more sophisticated strategies for managing supply risk, strategies similar to those used in more mature markets. In this case, communities can benefit from some of the advantages that water enjoys over other commodities, in particular, the ability to accurately characterize the stochastic nature of supply and demand through hydrologic modeling. Hydrologic-economic models are developed for two different water scarce regions supporting active water markets: Edward Aquifer and Lower Rio Grande Valley. These models are used to construct portfolios of water supply transfers (e.g., permanent transfers, options, and spot leases) that minimize the cost of meeting a probabilistic reliability constraint. Real and simulated spot price distributions allow each type of transfer to be priced in a manner consistent with financial theory (e.g., Black-Scholes). Market simulations are integrated with hydrologic models such that variability in supply and demand are linked with price behavior. Decisions on when and how much water to lease (or exercise, in the case of options) are made on the basis of anticipatory rules based on the ratio of expected supply to expected demand, and are used to evaluate the economic consequences of a utilityAƒAøAøâ_sA¬Aøâ_zAøs attitude toward risk. The marginal cost of supply reliability is also explored by varying the water supply reliability constraint, an important consideration as the rising expense of new source development may encourage some communities to accept a nominal number of supply shortfalls. Results demonstrate how changes in the distribution of various transfer types within a portfolio can affect its cost and reliability. Results also suggest that substantial savings can be obtained through the use of market-based risk management strategies, with optimal portfolio costs averaging as much as 35 percent less than the costs of meeting reliability targets through the maintenance of firm capacity. Both the conceptual and modeling approach described in this work are likely to have increasing application as water scarcity continues to drive the search for more efficient approaches to water resource management.

Rice crop risk map in Babahoyo canton (Ecuador)

NASA Astrophysics Data System (ADS)

Valverde Arias, Omar; Tarquis, Ana; Garrido, Alberto

2016-04-01

It is widely known that extreme climatic phenomena occur with more intensity and frequency. This fact has put more pressure over farming, making agricultural and livestock production riskier. In order to reduce hazards and economic loses that could jeopardize farmer's incomes and even its business continuity, it is very important to implement agriculture risk management plans by governments and institutions. One of the main strategies is transfer risk by agriculture insurance. Agriculture insurance based in indexes has a significant growth in the last decade. And consist in a comparison between measured index values with a defined threshold that triggers damage losses. However, based index insurance could not be based on an isolated measurement. It is necessary to be integrated in a complete monitoring system that uses many sources of information and tools. For example, index influence areas, crop production risk maps, crop yields, claim statistics, and so on. Crop production risk is related with yield variation of crops and livestock, due to weather, pests, diseases, and other factors that affect both the quantity and quality of commodities produced. This is the risk which farmers invest more time managing, and it is completely under their control. The aim of this study is generate a crop risk map of rice that can provide risk manager important information about the status of crop facing production risks. Then, based on this information, it will be possible to make best decisions to deal with production risk. The rice crop risk map was generated qualifying a 1:25000 scale soil and climatic map of Babahoyo canton, which is located in coast region of Ecuador, where rice is one of the main crops. The methodology to obtain crop risk map starts by establishing rice crop requirements and indentifying the risks associated with this crop. A second step is to evaluate soil and climatic conditions of the study area related to optimal crop requirements. Based on it, we can determinate which level of rice crop requirement is met. Finally we have established rice crop zones classified as: suitable, moderate suitable, marginal suitable and unsuitable. Several methods have been used to estimate the degree with which crop requirements are satisfied, pondering weights of limiting factors to adequate crop conditions. Better conditions for cropping in a specific area imply less risk in production. In this case, crop will be less affected by pests and disease, although this closely depends on crop management. Farmers have to invest less money to produce and could increase their benefit. Results are showed and discussed with the aim to study the efficiency and potential of this risk map.

Systematic analysis of natural hazards along infrastructure networks using a GIS-tool for risk assessment

NASA Astrophysics Data System (ADS)

Baruffini, Mirko

2010-05-01

Due to the topographical conditions in Switzerland, the highways and the railway lines are frequently exposed to natural hazards as rockfalls, debris flows, landslides, avalanches and others. With the rising incidence of those natural hazards, protection measures become an important political issue. However, they are costly, and maximal protection is most probably not economically feasible. Furthermore risks are distributed in space and time. Consequently, important decision problems to the public sector decision makers are derived. This asks for a high level of surveillance and preservation along the transalpine lines. Efficient protection alternatives can be obtained consequently considering the concept of integral risk management. Risk analysis, as the central part of risk management, has become gradually a generally accepted approach for the assessment of current and future scenarios (Loat & Zimmermann 2004). The procedure aims at risk reduction which can be reached by conventional mitigation on one hand and the implementation of land-use planning on the other hand: a combination of active and passive mitigation measures is applied to prevent damage to buildings, people and infrastructures. With a Geographical Information System adapted to run with a tool developed to manage Risk analysis it is possible to survey the data in time and space, obtaining an important system for managing natural risks. As a framework, we adopt the Swiss system for risk analysis of gravitational natural hazards (BUWAL 1999). It offers a complete framework for the analysis and assessment of risks due to natural hazards, ranging from hazard assessment for gravitational natural hazards, such as landslides, collapses, rockfalls, floodings, debris flows and avalanches, to vulnerability assessment and risk analysis, and the integration into land use planning at the cantonal and municipality level. The scheme is limited to the direct consequences of natural hazards. Thus, we develop a system which integrates the procedures for a complete risk analysis in a Geographic Information System (GIS) toolbox, in order to be applied to our testbed, the Alps-crossing corridor of St. Gotthard. The simulation environment is developed within ArcObjects, the development platform for ArcGIS. The topic of ArcObjects usually emerges when users realize that programming ArcObjects can actually reduce the amount of repetitive work, streamline the workflow, and even produce functionalities that are not easily available in ArcGIS. We have adopted Visual Basic for Applications (VBA) for programming ArcObjects. Because VBA is already embedded within ArcMap and ArcCatalog, it is convenient for ArcGIS users to program ArcObjects in VBA. Our tool visualises the obtained data by an analysis of historical data (aerial photo imagery, field surveys, documentation of past events) or an environmental modeling (estimations of the area affected by a given event), and event such as route number and route position and thematic maps. As a result of this step the record appears in WebGIS. The user can select a specific area to overview previous hazards in the region. After performing the analysis, a double click on the visualised infrastructures opens the corresponding results. The constantly updated risk maps show all sites that require more protection against natural hazards. The final goal of our work is to offer a versatile tool for risk analysis which can be applied to different situations. Today our GIS application mainly centralises the documentation of natural hazards. Additionally the system offers information about natural hazard at the Gotthard line. It is very flexible and can be used as a simple program to model the expansion of natural hazards, as a program of quantitatively estimate risks or as a detailed analysis at a municipality level. The tool is extensible and can be expanded with additional modules. The initial results of the experimental case study show how useful a GIS-based system can be for effective and efficient disaster response management. In the coming years our GIS application will be a data base containing all information needed for the evaluation of risk sites along the Gotthard line. Our GIS application can help the technical management to decide about protection measures because of, in addition to the visualisation, tools for spatial data analysis will be available. REFERENCES Bründl M. (Ed.) 2009 : Risikokonzept für Naturgefahren - Leitfaden. Nationale Plattform für Naturgefahren PLANAT, Bern. 416 S. BUWAL 1999: Risikoanalyse bei gravitativen Naturgefahren - Methode, Fallbeispiele und Daten (Risk analyses for gravitational natural hazards). Bundesamt für Umwelt, Wald und Landschaft (BUWAL). Umwelt-Materialen Nr. 107, 1-244. Loat, R. & Zimmermann, M. 2004: La gestion des risques en Suisse (Risk Management in Switzerland). In: Veyret, Y., Garry, G., Meschinet de Richemont, N. & Armand Colin (eds) 2002: Colloque Arche de la Défense 22-24 octobre 2002, dans Risques naturels et aménagement en Europe, 108-120. Maggi R. et al, 2009: Evaluation of the optimal resilience for vulnerable infrastructure networks. An interdisciplinary pilot study on the transalpine transportation corridors, NRP 54 "Sustainable Development of the Built Environment", Projekt Nr. 405 440, Final Scientific Report, Lugano

Lynch syndrome: barriers to and facilitators of screening and disease management.

PubMed

Watkins, Kathy E; Way, Christine Y; Fiander, Jacqueline J; Meadus, Robert J; Esplen, Mary Jane; Green, Jane S; Ludlow, Valerie C; Etchegary, Holly A; Parfrey, Patrick S

2011-09-07

Lynch syndrome is a hereditary cancer with confirmed carriers at high risk for colorectal (CRC) and extracolonic cancers. The purpose of the current study was to develop a greater understanding of the factors influencing decisions about disease management post-genetic testing. The study used a grounded theory approach to data collection and analysis as part of a multiphase project examining the psychosocial and behavioral impact of predictive DNA testing for Lynch syndrome. Individual and small group interviews were conducted with individuals from 10 families with the MSH2 intron 5 splice site mutation or exon 8 deletion. The data from confirmed carriers (n = 23) were subjected to re-analysis to identify key barriers to and/or facilitators of screening and disease management. Thematic analysis identified personal, health care provider and health care system factors as dominant barriers to and/or facilitators of managing Lynch syndrome. Person-centered factors reflect risk perceptions and decision-making, and enduring screening/disease management. The perceived knowledge and clinical management skills of health care providers also influenced participation in recommended protocols. The health care system barriers/facilitators are defined in terms of continuity of care and coordination of services among providers. Individuals with Lynch syndrome often encounter multiple barriers to and facilitators of disease management that go beyond the individual to the provider and health care system levels. The current organization and implementation of health care services are inadequate. A coordinated system of local services capable of providing integrated, efficient health care and follow-up, populated by providers with knowledge of hereditary cancer, is necessary to maintain optimal health.

How to assess extreme weather impacts - case European transport network

NASA Astrophysics Data System (ADS)

Leviäkangas, P.

2010-09-01

To assess the impacts of climate change and preparing for impacts is a process. This process we must understand and learn to apply. EWENT (Extreme Weather impacts on European Networks of Transport) will be a test bench for one prospective approach. It has the following main components: 1) identifying what is "extreme", 2) assessing the change in the probabilities, 3) constructing the causal impact models, 4) finding appropriate methods of pricing and costing, 5) finding alternative strategy option, 6) assessing the efficiency of strategy option. This process follows actually the steps of standardized risk management process. Each step is challenging, but if EWENT project succeeds to assess the extreme weather impacts on European transport networks, it is one possible benchmark how to carry out similar analyses in other regions and on country level. EWENT approach could particularly useful for weather and climate information service providers, offering tools for transport authorities and financiers to assess weather risks, and then rationally managing the risks. EWENT project is financed by the European Commission and participated by met-service organisations and transport research institutes from different parts of Europe. The presentation will explain EWENT approach in detail and bring forth the findings of the first work packages.

Aspects Concerning The Rules And The Investigation Of Traffic Accidents As Work Accidents

NASA Astrophysics Data System (ADS)

Tarnu, Lucian Ioan

2015-07-01

When Romania joined the European Union, it was imposed that the Romanian legislation in the field of the security and health at work be in line with the European one. The concept of health as it is defined by the International Body of Health, refers to a good physical, mental and social condition. The improvement of the activity of preventing the traffic accidents as work accidents must have as basis the correct and accurate evaluation of risks of getting injured. The goal of the activity of prevention and protection is to ensure the best working conditions, the prevention of accidents and occupational diseases and the adjustment to the scientific and technological progress. In the road transport sector, as in any other sector, it is very important to pay attention to working conditions to ensure a workforce motivated and well qualified. Some features make it a more difficult sector risk management than other sectors. However, if one takes into account how it works in practice this sector and the characteristics of drivers and how they work routinely, risks, dangers and threats can be managed efficiently and with great success.

Hypocalcaemia following total thyroidectomy: early post-operative parathyroid hormone assay as a risk stratification and management tool.

PubMed

Islam, S; Al Maqbali, T; Howe, D; Campbell, J

2014-03-01

To develop a practical, efficient and predictive algorithm to manage potential or actual post-operative hypocalcaemia after complete thyroidectomy, using a single post-operative parathyroid hormone assay. This paper reports a prospective study of 59 patients who underwent total or completion thyroidectomy over a period of 24 months. Parathyroid hormone levels were checked post-operatively on the day of surgery, and all patients were evaluated for hypocalcaemia both clinically and biochemically with serial corrected calcium measurements. No patient with an early post-operative parathyroid hormone level of 23 ng/l or more (i.e. approximately twice the lower limit of the normal range) developed hypocalcaemia. All the patients who initially had post-operative hypocalcaemia but had an early parathyroid hormone level of 8 ng/l or more (i.e. approximately two-thirds of the lower limit of the normal range) had complete resolution of their hypocalcaemia within three months. Early post-operative parathyroid hormone measurement can reliably predict patients at risk of post-thyroidectomy hypocalcaemia, and predict those patients expected to recover from temporary hypocalcaemia. A suggested post-operative management algorithm is presented.

GERIHCO "Gestion des Risques et Histoire des Coulées Boueuses" - Risk Management and History of Muddy Floods / An interdisciplinary approach to understand the muddy floods risk (Alsace - France)

NASA Astrophysics Data System (ADS)

Heitz, C.; Rozan, A.; Auzet, A.; Koller, R.; Wintz, M.

2012-12-01

The interdisciplinary research program GERIHCO started in 2005 with a pool of a dozen researchers from disciplines as different as economy, sociology, geography, agronomy, … interested in the study of the risk of muddy floods in the Alsatian region. The main issues studied are related to: (1) The study of the physical processes of muddy floods and the agronomic measures that can decrease the hazard show that the cultural practices without ploughing have positive effects on runoff and erosion. But there are some known consequences of these practices on agronomic issues such as: biological activity in the soil and sanitary situation in the fields (weeds and parasites, for instance). We assess the level of pesticides employment under such cultural practices. Is it more/less important and does it impact the environment more than in conventional systems? Two indicators are used: I-PHY (INDIGO software®) and TFI, Treatment Frequency Index. (2) The economic analyses of the adoption of reduced tillage aims to carry out an economic analysis of the reduced tillage implementation for Alsatian crops farms, by using technical and economic indicators derived from SYSTERRE®. The main results show that reduced tillage - maintains yield levels, reduces working time and gasoil consumptions, maintains a direct margin compared to ploughing system. (3) The sociological analysis of the farmers' behaviors deals with the understanding of their behaviors face to soil erosion and environmental issues. The sociological study focuses on the farmers points of view, which are the very last stakeholders in the risk management decision system. Surveys and individual interviews have been conducted in 3 villages, frequently concerned by muddy floods. (4) The study of the perception of protective measures and the modelling their efficiency highlight that several measures can be taken to decrease the risk: agronomic measures, policy measures, economic measures,...A dialogue between all stakeholders has to be initiate to define the best practices and the best way to manage muddy floods and their damages. The psychosocial analyse (based on questionnaires) allows us to understand the agents' behaviors and then to identify the potential protective measures they should adopt. Surveys among farmers highlight their willingness to set up fascines in their fields. The results show that: they perceive fascines as a "solution of emergency", negative aspects mainly concern the cost, the integration in the landscape and the care and maintenance of the fascines, there is a lack of information dealing with the protective measures and their efficiency. All the results show that the management of a natural disaster occurring every year in some cases and damaging inhabitants as well as farmers has to be managed with a collaborative approach: all actors have to be involved in the settlement of mitigation measures. The financial support of the local Water Agency allows us to implement the different studies and then to communicate largely the results of the program. This investment also shows the interest of such an approach in risk studies.

Situation-Dependent Medical Device Risk Estimation: Design and Evaluation of an Equipment Management Center For Vendor-Independent Integrated Operating Rooms.

PubMed

Maktabi, Marianne; Neumuth, Thomas

2017-12-22

The complexity of surgical interventions and the number of technologies involved are constantly rising. Hospital staff has to learn how to handle new medical devices efficiently. However, if medical device-related incidents occur, the patient treatment is delayed. Patient safety could therefore be supported by an optimized assistance system that helps improve the management of technical equipment by nonmedical hospital staff. We developed a system for the optimal monitoring of networked medical device activity and maintenance requirements, which works in conjunction with a vendor-independent integrated operating room and an accurate surgical intervention Time And Resource Management System. An integrated situation-dependent risk assessment system gives the medical engineers optimal awareness of the medical devices in the operating room. A qualitative and quantitative survey among ten medical engineers from three different hospitals was performed to evaluate the approach. A series of 25 questions was used to evaluate various aspects of our system as well as the system currently used. Moreover, the respondents were asked to perform five tasks related to system supervision and incident handling. Our system received a very positive feedback. The evaluation studies showed that the integration of information, the structured presentation of information, and the assistance modules provide valuable support to medical engineers. An automated operating room monitoring system with an integrated risk assessment and Time And Resource Management System module is a new way to assist the staff being outside of a vendor-independent integrated operating room, who are nevertheless involved in processes in the operating room.

Injection device-related risk management toward safe administration of medications: experience in a university teaching hospital in The People's Republic of China.

PubMed

Zhu, Ling-Ling; Li, Wei; Song, Ping; Zhou, Quan

2014-01-01

The use of injection devices to administer intravenous or subcutaneous medications is common practice throughout a variety of health care settings. Studies suggest that one-half of all harmful medication errors originate during drug administration; of those errors, about two-thirds involve injectables. Therefore, injection device management is pivotal to safe administration of medications. In this article, the authors summarize the relevant experiences by retrospective analysis of injection device-related near misses and adverse events in the Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, People's Republic of China. Injection device-related near misses and adverse events comprised the following: 1) improper selection of needle diameter for subcutaneous injection, material of infusion sets, and pore size of in-line filter; 2) complications associated with vascular access; 3) incidents induced by absence of efficient electronic pump management and infusion tube management; and 4) liquid leakage of chemotherapeutic infusion around the syringe needle. Safe injection drug use was enhanced by multidisciplinary collaboration, especially among pharmacists and nurses; drafting of clinical pathways in selection of vascular access; application of approaches such as root cause analysis using a fishbone diagram; plan-do-check-act and quality control circle; and construction of a culture of spontaneous reporting of near misses and adverse events. Pharmacists must be professional in regards to medication management and use. The depth, breadth, and efficiency of cooperation between nurses and pharmacists are pivotal to injection safety.

Chemical leasing business models: a contribution to the effective risk management of chemical substances.

PubMed

Ohl, Cornelia; Moser, Frank

2007-08-01

Chemicals indisputably contribute greatly to the well-being of modern societies. Apart from such benefits, however, chemicals often pose serious threats to human health and the environment when improperly handled. Therefore, the European Commission has proposed a regulatory framework for the Registration, Evaluation and Authorization of Chemicals (REACH) that requires companies using chemicals to gather pertinent information on the properties of these substances. In this article, we argue that the crucial aspect of this information management may be the honesty and accuracy of the transfer of relevant knowledge from the producer of a chemical to its user. This may be particularly true if the application of potentially hazardous chemicals is not part of the user's core competency. Against this background, we maintain that the traditional sales concept provides no incentives for transferring this knowledge. The reason is that increased user knowledge of a chemical's properties may raise the efficiency of its application. That is, excessive and unnecessary usage will be eliminated. This, in turn, would lower the amount of chemicals sold and in competitive markets directly decrease profits of the producer. Through the introduction of chemical leasing business models, we attempt to present a strategy to overcome the incentive structure of classical sales models, which is counterproductive for the transfer of knowledge. By introducing two models (a Model A that differs least and a Model B that differs most from traditional sales concepts), we demonstrate that chemical leasing business models are capable of accomplishing the goal of Registration, Evaluation and Authorization of Chemicals: to effectively manage the risk of chemicals by reducing the total quantity of chemicals used, either by a transfer of applicable knowledge from the lessor to the lessee (Model A) or by efficient application of the chemical by the lessor him/herself (Model B).

A web-based electronic patient record (ePR) system for data integration in movement analysis research on wheel-chair users to minimize shoulder pain

NASA Astrophysics Data System (ADS)

Deshpande, Ruchi R.; Requejo, Philip; Sutisna, Erry; Wang, Ximing; Liu, Margaret; McNitt-Gray, Sarah; Ruparel, Puja; Liu, Brent J.

2012-02-01

Patients confined to manual wheel-chairs are at an added risk of shoulder injury. There is a need for developing optimal bio-mechanical techniques for wheel-chair propulsion through movement analysis. Data collected is diverse and in need of normalization and integration. Current databases are ad-hoc and do not provide flexibility, extensibility and ease of access. The need for an efficient means to retrieve specific trial data, display it and compare data from multiple trials is unmet through lack of data association and synchronicity. We propose the development of a robust web-based ePR system that will enhance workflow and facilitate efficient data management.

Towards a theory of tiered testing.

PubMed

Hansson, Sven Ove; Rudén, Christina

2007-06-01

Tiered testing is an essential part of any resource-efficient strategy for the toxicity testing of a large number of chemicals, which is required for instance in the risk management of general (industrial) chemicals, In spite of this, no general theory seems to be available for the combination of single tests into efficient tiered testing systems. A first outline of such a theory is developed. It is argued that chemical, toxicological, and decision-theoretical knowledge should be combined in the construction of such a theory. A decision-theoretical approach for the optimization of test systems is introduced. It is based on expected utility maximization with simplified assumptions covering factual and value-related information that is usually missing in the development of test systems.

An Integrative Behavioral Health Care Model Using Automated SBIRT and Care Coordination in Community Health Care.

PubMed

Dwinnells, Ronald; Misik, Lauren

2017-10-01

Efficient and effective integration of behavioral health programs in a community health care practice emphasizes patient-centered medical home principles to improve quality of care. A prospective, 3-period, interrupted time series study was used to explore which of 3 different integrative behavioral health care screening and management processes were the most efficient and effective in prompting behavioral health screening, identification, interventions, and referrals in a community health practice. A total of 99.5% ( P < .001) of medical patients completed behavioral health screenings; brief intervention rates nearly doubled to 83% ( P < .001) and 100% ( P < .001) of identified at-risk patients had referrals made using a combination of electronic tablets, electronic medical record, and behavioral health care coordination.

Assessing and managing multiple risks in a changing world ...

EPA Pesticide Factsheets

Roskilde University (Denmark) hosted a November 2015 workshop, Environmental Risk—Assessing and Managing Multiple Risks in a Changing World. This Focus article presents the consensus recommendations of 30 attendees from 9 countries regarding implementation of a common currency (ecosystem services) for holistic environmental risk assessment and management; improvements to risk assessment and management in a complex, human-modified, and changing world; appropriate development of protection goals in a 2-stage process; dealing with societal issues; risk-management information needs; conducting risk assessment of risk management; and development of adaptive and flexible regulatory systems. The authors encourage both cross-disciplinary and interdisciplinary approaches to address their 10 recommendations: 1) adopt ecosystem services as a common currency for risk assessment and management; 2) consider cumulative stressors (chemical and nonchemical) and determine which dominate to best manage and restore ecosystem services; 3) fully integrate risk managers and communities of interest into the risk-assessment process; 4) fully integrate risk assessors and communities of interest into the risk-management process; 5) consider socioeconomics and increased transparency in both risk assessment and risk management; 6) recognize the ethical rights of humans and ecosystems to an adequate level of protection; 7) determine relevant reference conditions and the proper ecological c

Performance evaluation of inpatient service in Beijing: a horizontal comparison with risk adjustment based on Diagnosis Related Groups

PubMed Central

Jian, Weiyan; Huang, Yinmin; Hu, Mu; Zhang, Xiumei

2009-01-01

Background The medical performance evaluation, which provides a basis for rational decision-making, is an important part of medical service research. Current progress with health services reform in China is far from satisfactory, without sufficient regulation. To achieve better progress, an effective tool for evaluating medical performance needs to be established. In view of this, this study attempted to develop such a tool appropriate for the Chinese context. Methods Data was collected from the front pages of medical records (FPMR) of all large general public hospitals (21 hospitals) in the third and fourth quarter of 2007. Locally developed Diagnosis Related Groups (DRGs) were introduced as a tool for risk adjustment and performance evaluation indicators were established: Charge Efficiency Index (CEI), Time Efficiency Index (TEI) and inpatient mortality of low-risk group cases (IMLRG), to reflect respectively work efficiency and medical service quality. Using these indicators, the inpatient services' performance was horizontally compared among hospitals. Case-mix Index (CMI) was used to adjust efficiency indices and then produce adjusted CEI (aCEI) and adjusted TEI (aTEI). Poisson distribution analysis was used to test the statistical significance of the IMLRG differences between different hospitals. Results Using the aCEI, aTEI and IMLRG scores for the 21 hospitals, Hospital A and C had relatively good overall performance because their medical charges were lower, LOS shorter and IMLRG smaller. The performance of Hospital P and Q was the worst due to their relatively high charge level, long LOS and high IMLRG. Various performance problems also existed in the other hospitals. Conclusion It is possible to develop an accurate and easy to run performance evaluation system using Case-Mix as the tool for risk adjustment, choosing indicators close to consumers and managers, and utilizing routine report forms as the basic information source. To keep such a system running effectively, it is necessary to improve the reliability of clinical information and the risk-adjustment ability of Case-Mix. PMID:19402913

Prediction of chronic post-operative pain: pre-operative DNIC testing identifies patients at risk.

PubMed

Yarnitsky, David; Crispel, Yonathan; Eisenberg, Elon; Granovsky, Yelena; Ben-Nun, Alon; Sprecher, Elliot; Best, Lael-Anson; Granot, Michal

2008-08-15

Surgical and medical procedures, mainly those associated with nerve injuries, may lead to chronic persistent pain. Currently, one cannot predict which patients undergoing such procedures are 'at risk' to develop chronic pain. We hypothesized that the endogenous analgesia system is key to determining the pattern of handling noxious events, and therefore testing diffuse noxious inhibitory control (DNIC) will predict susceptibility to develop chronic post-thoracotomy pain (CPTP). Pre-operative psychophysical tests, including DNIC assessment (pain reduction during exposure to another noxious stimulus at remote body area), were conducted in 62 patients, who were followed 29.0+/-16.9 weeks after thoracotomy. Logistic regression revealed that pre-operatively assessed DNIC efficiency and acute post-operative pain intensity were two independent predictors for CPTP. Efficient DNIC predicted lower risk of CPTP, with OR 0.52 (0.33-0.77 95% CI, p=0.0024), i.e., a 10-point numerical pain scale (NPS) reduction halves the chance to develop chronic pain. Higher acute pain intensity indicated OR of 1.80 (1.28-2.77, p=0.0024) predicting nearly a double chance to develop chronic pain for each 10-point increase. The other psychophysical measures, pain thresholds and supra-threshold pain magnitudes, did not predict CPTP. For prediction of acute post-operative pain intensity, DNIC efficiency was not found significant. Effectiveness of the endogenous analgesia system obtained at a pain-free state, therefore, seems to reflect the individual's ability to tackle noxious events, identifying patients 'at risk' to develop post-intervention chronic pain. Applying this diagnostic approach before procedures that might generate pain may allow individually tailored pain prevention and management, which may substantially reduce suffering.

Newly emerging resource efficiency manager programs

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

Wolf, S.; Howell, C.

1997-12-31

Many facilities in the northwest such as K--12 schools, community colleges, and military installations are implementing resource-efficiency awareness programs. These programs are generally referred to as resource efficiency manager (REM) or resource conservation manager (RCM) programs. Resource efficiency management is a systems approach to managing a facility`s energy, water, and solid waste. Its aim is to reduce utility budgets by focusing on behavioral changes, maintenance and operation procedures, resource accounting, education and training, and a comprehensive awareness campaign that involves everyone in the organization.

BRICK v0.2, a simple, accessible, and transparent model framework for climate and regional sea-level projections

NASA Astrophysics Data System (ADS)

Wong, Tony E.; Bakker, Alexander M. R.; Ruckert, Kelsey; Applegate, Patrick; Slangen, Aimée B. A.; Keller, Klaus

2017-07-01

Simple models can play pivotal roles in the quantification and framing of uncertainties surrounding climate change and sea-level rise. They are computationally efficient, transparent, and easy to reproduce. These qualities also make simple models useful for the characterization of risk. Simple model codes are increasingly distributed as open source, as well as actively shared and guided. Alas, computer codes used in the geosciences can often be hard to access, run, modify (e.g., with regards to assumptions and model components), and review. Here, we describe the simple model framework BRICK (Building blocks for Relevant Ice and Climate Knowledge) v0.2 and its underlying design principles. The paper adds detail to an earlier published model setup and discusses the inclusion of a land water storage component. The framework largely builds on existing models and allows for projections of global mean temperature as well as regional sea levels and coastal flood risk. BRICK is written in R and Fortran. BRICK gives special attention to the model values of transparency, accessibility, and flexibility in order to mitigate the above-mentioned issues while maintaining a high degree of computational efficiency. We demonstrate the flexibility of this framework through simple model intercomparison experiments. Furthermore, we demonstrate that BRICK is suitable for risk assessment applications by using a didactic example in local flood risk management.

Waste Management Strategy for Dismantling Waste to Reduce Costs for Power Plant Decommissioning - 13543

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

Larsson, Arne; Lidar, Per; Bergh, Niklas

2013-07-01

Decommissioning of nuclear power plants generates large volumes of radioactive or potentially radioactive waste. The proper management of the dismantling waste plays an important role for the time needed for the dismantling phase and thus is critical to the decommissioning cost. An efficient and thorough process for inventorying, characterization and categorization of the waste provides a sound basis for the planning process. As part of comprehensive decommissioning studies for Nordic NPPs, Westinghouse has developed the decommissioning inventories that have been used for estimations of the duration of specific work packages and the corresponding costs. As part of creating the designmore » basis for a national repository for decommissioning waste, the total production of different categories of waste packages has also been predicted. Studsvik has developed a risk based concept for categorization and handling of the generated waste using six different categories with a span from extremely small risk for radiological contamination to high level waste. The two companies have recently joined their skills in the area of decommissioning on selected market in a consortium named 'ndcon' to further strengthen the proposed process. Depending on the risk for radiological contamination or the radiological properties and other properties of importance for waste management, treatment routes are proposed with well-defined and proven methods for on-site or off-site treatment, activity determination and conditioning. The system is based on a graded approach philosophy aiming for high confidence and sustainability, aiming for re-use and recycling where found applicable. The objective is to establish a process where all dismantled material has a pre-determined treatment route. These routes should through measurements, categorization, treatment, conditioning, intermediate storage and final disposal be designed to provide a steady, un-disturbed flow of material to avoid interruptions. Bottle-necks in the process causes increased space requirements and will have negative impact on the project schedule, which increases not only the cost but also the dose exposure to personnel. For these reasons it is critical to create a process that transfers material into conditioned waste ready for disposal as quickly as possible. To a certain extent the decommissioning program should be led by the waste management process. With the objective to reduce time for handling of dismantled material at site and to efficiently and environmental-friendly use waste management methods (clearance for re-use followed by clearance for recycling), the costs for the plant decommissioning could be reduced as well as time needed for performing the decommissioning project. Also, risks for delays would be reduced with a well-defined handling scheme which limits surprises. Delays are a major cost driver for decommissioning projects. (authors)« less

Waste management strategy for cost effective and environmentally friendly NPP decommissioning

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

Per Lidar; Arne Larsson; Niklas Bergh

2013-07-01

Decommissioning of nuclear power plants generates large volumes of radioactive or potentially radioactive waste. The proper management of the dismantling waste plays an important role for the time needed for the dismantling phase and thus is critical to the decommissioning cost. An efficient and thorough process for inventorying, characterization and categorization of the waste provides a sound basis for the planning process. As part of comprehensive decommissioning studies for Nordic NPPs, Westinghouse has developed the decommissioning inventories that have been used for estimations of the duration of specific work packages and the corresponding costs. As part of creating the designmore » basis for a national repository for decommissioning waste, the total production of different categories of waste packages has also been predicted. Studsvik has developed a risk based concept for categorization and handling of the generated waste using six different categories with a span from extremely small risk for radiological contamination to high level waste. The two companies have recently joined their skills in the area of decommissioning on selected market in a consortium named ndcon to further strengthen the proposed process. Depending on the risk for radiological contamination or the radiological properties and other properties of importance for waste management, treatment routes are proposed with well-defined and proven methods for on-site or off-site treatment, activity determination and conditioning. The system is based on a graded approach philosophy aiming for high confidence and sustainability, aiming for re-use and recycling where found applicable. The objective is to establish a process where all dismantled material has a pre-determined treatment route. These routes should through measurements, categorization, treatment, conditioning, intermediate storage and final disposal be designed to provide a steady, un-disturbed flow of material to avoid interruptions. Bottle-necks in the process causes increased space requirements and will have negative impact on the project schedule, which increases not only the cost but also the dose exposure to personnel. For these reasons it is critical to create a process that transfers material into conditioned waste ready for disposal as quickly as possible. To a certain extent the decommissioning program should be led by the waste management process. With the objective to reduce time for handling of dismantled material at site and to efficiently and environmental-friendly use waste management methods (clearance for re-use followed by clearance for recycling), the costs for the plant decommissioning could be reduced as well as time needed for performing the decommissioning project. Also, risks for delays would be reduced with a well-defined handling scheme which limits surprises. Delays are a major cost driver for decommissioning projects. (authors)« less

The health hazard assessment process in support of joint weapon system acquisitions.

PubMed

Kluchinsky, Timothy A; Jokel, Charles R; Cambre, John V; Goddard, Donald E; Batts, Robert W

2013-01-01

Since 1981, the Army's HHA Program has provided an invaluable service to combat developers and materiel program managers by providing recommendations designed to eliminate or control health hazards associated with materiel and weapon systems. The program has consistently strived to improve its services by providing more meaningful and efficient assistance to the acquisition community. In the uncertain fiscal times ahead, the Army's HHA Program will continue to provide valuable and cost-effective solutions to mitigate the health risks of weapons systems.

Preservation of Biospecimens at Ambient Temperature: Special Focus on Nucleic Acids and Opportunities for the Biobanking Community.

PubMed

Muller, Rolf; Betsou, Fay; Barnes, Michael G; Harding, Keith; Bonnet, Jacques; Kofanova, Olga; Crowe, John H

2016-04-01

Several approaches to the preservation of biological materials at ambient temperature and the relative impact on sample stability and degradation are reviewed, with a focus on nucleic acids. This appraisal is undertaken within the framework of biobank risk, quality management systems, and accreditation, with a view to assessing how best to apply ambient temperature sample storage to ensure stability, reduce costs, improve handling logistics, and increase the efficiency of biobank procedures.

Self-ordering and complexity in epizonal mineral deposits

USGS Publications Warehouse

Henley, Richard W.; Berger, Byron R.

2000-01-01

Giant deposits are relatively rare and develop where efficient metal deposition is spatially focused by repetitive brittle failure in active fault arrays. Some brief case histories are provided for epithermal, replacement, and porphyry mineralization. These highlight how rock competency contrasts and feedback between processes, rather than any single component of a hydrothermal system, govern the size of individual deposits. In turn, the recognition of the probabilistic nature of mineralization provides a firmer foundation through which exploration investment and risk management decisions can be made.

Risk Management.

ERIC Educational Resources Information Center

Randal, L. Nathan

This chapter of "Principles of School Business Management" presents an overview of risk management for school districts. The chapter first discusses four fundamental elements of risk management: (1) identifying and measuring risks; (2) reducing or eliminating risks; (3) transferring unassumable risks; and (4) assuming remaining risks.…

Making an IMPAKT; Improving care of Chronic Kidney Disease patients in the community through collaborative working and utilizing Information Technology.

PubMed

Xu, Gang; Major, Rupert; Shepherd, David; Brunskill, Nigel

2017-01-01

Chronic kidney disease (CKD) is a serious long-term condition, which if left untreated causes significant cardiovascular sequele. It is well recognized management of modifiable risk factors, such as blood pressure (BP), can lead to improved long-term outcomes. A novel information technology (IT) solution presents a possible solution to help clinicians in the community identify and manage at risk patients more efficiently. The IMproving Patient care and Awareness of Kidney disease progression Together (IMPAKT) IT tool was used to identify patients with CKD and uncontrolled hypertension in the community. A CKD nurse utilized the tool at primary care practices to identify patients who warranted potential intervention and disseminated this information to clinical staff. Blood pressure management targets and incidence of coded CKD were used to evaluate the project. Altogether 48 practices participated in an 18 month project from April 2014, and data from 20 practices, with a total adult population of 121,362, was available for analysis. Two full consecutive QI (Quality Improvement) audit cycles were completed. There was an increase in the mean recorded prevalence of coded CKD patients over the course of the project. Similarly, there was an increase in the percentage of patients with BP been recorded and importantly there was an accompanying significant increase in CKD patients achieving BP targets. At the end of the project an additional 345 individuals with CKD achieved better blood pressure control. This could potentially prevent 9 cardiovascular events in the CKD group, translating to a cost saving of £320,000 for the 20 practices involved. The most significant change in clinical markers occurred during cycle 1 of the audit, the improvement was maintained throughout cycle 2 of the audit. Our results show the real-life clinical impact of a relatively simple and easy to implement QI project, to help improve outcomes in patients with CKD. This was achieved through more efficient working by targeting of high-risk groups, and improved communication between primary/secondary care. The project could be adapted for other chronic disease conditions. Despite the recorded improvements in blood pressure management, a large proportion of high-risk patients remained above ideal blood pressure, additional interventions in this area need to be explored. Through collaborative and multi-professional working and utilizing IT resources, we have shown it is possible to deliver measurable and sustainable improvements in blood pressure control for patients with CKD in a real life clinical setting.

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

Hobbs, R.E.

In large facilities, successful energy management cannot be measured by a few projects, no matter how significant the energy savings. Large facilities today are comprised of extensive energy consuming systems. For every energy project developed, two more projects remain to be discovered. The successful energy manager is one who has completed ten projects, or twenty, or thirty, and is still finding more projects to do. Nothing is assumed to be as efficient as possible, and no part of any system is ignored. The successful energy manager is willing to take risks, not of being fired, but to use imagination, studymore » engineering theory, exercise common sense, develop concept designs, calculate savings, sell projects to management, control designers, study equipment performance, pre-select contractors, manage the contractor efforts, solve inherent problems along the way, and then optimize the project after acceptance when the designers and contractors all walk off. Once the successful energy manager establishes his credibility, his problem becomes finding enough time to get the projects rolling as he dreams them up. He sees what others do not. As they say in the North, only the lead dog sees new scenery.« less

Communicating Risk to Program Managers

NASA Technical Reports Server (NTRS)

Shivers, C. Herbert

2005-01-01

Program Managers (PM) can protect program resources and improve chances of success by anticipating, understanding and managing risks. Understanding the range of potential risks helps one to avoid or manage the risks. A PM must choose which risks to accept to reduce fire fighting, must meet the expectations of stakeholders consistently, and avoid falling into costly "black holes" that may open. A good risk management process provides the PM more confidence to seize opportunities save money, meet schedule, even improve relationships with people important to the program. Evidence of managing risk and sound internal controls can mean better support from superiors for the program by building a trust and reputation from being on top of issues. Risk managers have an obligation to provide the PM with the best information possible to allow the benefits to be realized (Small Business Consortium, 2004). The Institute for Chartered Accountants in England and Wales sees very important benefits for companies in providing better information about what they do to assess and manage key business risks. Such information will: a) provide practical forward-looking information; b) reduce the cost of capital; c) encourage better risk management; and d) improve accountability for stewardship, investor protection and the usefulness of financial reporting. We are particularly convinced that enhanced risk reporting will help listed companies obtain capital at the lowest possible cost (The Institute of Chartered Accountants in England &Wales, June 2002). Risk managers can take a significant role in quantifying the success of their department and communicating those figures to executive (program) management levels while pushing for a broader risk management role. Overall, risk managers must show that risk management work matters in the most crucial place-the bottom line- as they prove risk management can be a profit center (Sullivan, 2004).

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.

Uncertainty in surface water flood risk modelling

NASA Astrophysics Data System (ADS)

Butler, J. B.; Martin, D. N.; Roberts, E.; Domuah, R.

2009-04-01

Two thirds of the flooding that occurred in the UK during summer 2007 was as a result of surface water (otherwise known as ‘pluvial') rather than river or coastal flooding. In response, the Environment Agency and Interim Pitt Reviews have highlighted the need for surface water risk mapping and warning tools to identify, and prepare for, flooding induced by heavy rainfall events. This need is compounded by the likely increase in rainfall intensities due to climate change. The Association of British Insurers has called for the Environment Agency to commission nationwide flood risk maps showing the relative risk of flooding from all sources. At the wider European scale, the recently-published EC Directive on the assessment and management of flood risks will require Member States to evaluate, map and model flood risk from a variety of sources. As such, there is now a clear and immediate requirement for the development of techniques for assessing and managing surface water flood risk across large areas. This paper describes an approach for integrating rainfall, drainage network and high-resolution topographic data using Flowroute™, a high-resolution flood mapping and modelling platform, to produce deterministic surface water flood risk maps. Information is provided from UK case studies to enable assessment and validation of modelled results using historical flood information and insurance claims data. Flowroute was co-developed with flood scientists at Cambridge University specifically to simulate river dynamics and floodplain inundation in complex, congested urban areas in a highly computationally efficient manner. It utilises high-resolution topographic information to route flows around individual buildings so as to enable the prediction of flood depths, extents, durations and velocities. As such, the model forms an ideal platform for the development of surface water flood risk modelling and mapping capabilities. The 2-dimensional component of Flowroute employs uniform flow formulae (Manning's Equation) to direct flow over the model domain, sourcing water from the channel or sea so as to provide a detailed representation of river and coastal flood risk. The initial development step was to include spatially-distributed rainfall as a new source term within the model domain. This required optimisation to improve computational efficiency, given the ubiquity of ‘wet' cells early on in the simulation. Collaboration with UK water companies has provided detailed drainage information, and from this a simplified representation of the drainage system has been included in the model via the inclusion of sinks and sources of water from the drainage network. This approach has clear advantages relative to a fully coupled method both in terms of reduced input data requirements and computational overhead. Further, given the difficulties associated with obtaining drainage information over large areas, tests were conducted to evaluate uncertainties associated with excluding drainage information and the impact that this has upon flood model predictions. This information can be used, for example, to inform insurance underwriting strategies and loss estimation as well as for emergency response and planning purposes. The Flowroute surface-water flood risk platform enables efficient mapping of areas sensitive to flooding from high-intensity rainfall events due to topography and drainage infrastructure. As such, the technology has widespread potential for use as a risk mapping tool by the UK Environment Agency, European Member States, water authorities, local governments and the insurance industry. Keywords: Surface water flooding, Model Uncertainty, Insurance Underwriting, Flood inundation modelling, Risk mapping.

A watershed scale assessment of the impacts of suburban turf management on runoff water quality

NASA Astrophysics Data System (ADS)

Bachman, M.; Inamdar, S. P.; Barton, S.; Duke, J.; Tallamy, D.; Bruck, J.

2014-12-01

Steadily increasing rates of urbanization have raised concerns about the negative impacts of urban runoff on receiving surface water quality. These concerns have been further amplified by landscaping paradigms that encourage high-input, intensively-managed and mono-culture turf and lawn landscapes. We conducted a watershed-scale assessment of turf management practices on water quality vis-à-vis less-intensive management practices that preserve and enhance more diverse and native vegetation. The study treatments with existing/established vegetation and landscaping practices included turf, urban, forest, meadow, and a mixed site with a professional golf course. Stream water sampling was performed during baseflow and storm events. Highest nutrient (nitrate and total nitrogen) concentrations in runoff were observed for the mixed watershed draining the golf course. In contrast, nutrient concentrations in baseflow from the turf watershed were lower than expected and were comparable to those measured in the surrounding meadow and forest sites. Runoff losses from the turf site may have been minimal due to the optimal quality of management implemented. Total nitrogen concentrations from the turf site increased sharply during the first storms following fertilization, suggesting that despite optimal management there exists a risk for nutrient runoff following fertilization. Dissolved organic carbon (DOC) concentrations from the turf site were elevated and aromatic in content while the mixed watershed site yielded more labile DOM. Overall, this study suggests that turf lawns, when managed properly, pose minimal environmental risk to surrounding surface waters. Based on the results of this study, providing homeowners with increased information regarding best management practices for lawn maintenance may serve as a cost-efficient method for reducing suburban runoff pollution.

Cognitive mapping tools: review and risk management needs.

PubMed

Wood, Matthew D; Bostrom, Ann; Bridges, Todd; Linkov, Igor

2012-08-01

Risk managers are increasingly interested in incorporating stakeholder beliefs and other human factors into the planning process. Effective risk assessment and management requires understanding perceptions and beliefs of involved stakeholders, and how these beliefs give rise to actions that influence risk management decisions. Formal analyses of risk manager and stakeholder cognitions represent an important first step. Techniques for diagramming stakeholder mental models provide one tool for risk managers to better understand stakeholder beliefs and perceptions concerning risk, and to leverage this new understanding in developing risk management strategies. This article reviews three methodologies for assessing and diagramming stakeholder mental models--decision-analysis-based mental modeling, concept mapping, and semantic web analysis--and assesses them with regard to their ability to address risk manager needs. © 2012 Society for Risk Analysis.

Chemical Risk Assessment: Traditional vs Public Health ...

EPA Pesticide Factsheets

Preventing adverse health impacts from exposures to environmental chemicals is fundamental to protecting individual and public health. When done efficiently and properly, chemical risk assessment enables risk management actions that minimize the incidence and impacts of environmentally-induced diseases related to chemical exposure. However, traditional chemical risk assessment is faced with multiple challenges with respect to predicting and preventing disease in human populations, and epidemiological studies increasingly report observations of adverse health effects at exposure levels predicted from animal studies to be safe for humans. This discordance reinforces concerns about the adequacy of contemporary risk assessment practices (Birnbaum, Burke, & Jones, 2016) for protecting public health. It is becoming clear that to protect public health more effectively, future risk assessments will need to use the full range of available data, draw on innovative methods to integrate diverse data streams, and consider health endpoints that also reflect the range of subtle effects and morbidities observed in human populations. Given these factors, there is a need to reframe chemical risk assessment to be more clearly aligned with the public health goal of minimizing environmental exposures associated with disease. Preventing adverse health impacts from exposures to environmental chemicals is fundamental to protecting individual and public health. Chemical risk assessments

The short- to medium-term predictive accuracy of static and dynamic risk assessment measures in a secure forensic hospital.

PubMed

Chu, Chi Meng; Thomas, Stuart D M; Ogloff, James R P; Daffern, Michael

2013-04-01

Although violence risk assessment knowledge and practice has advanced over the past few decades, it remains practically difficult to decide which measures clinicians should use to assess and make decisions about the violence potential of individuals on an ongoing basis, particularly in the short to medium term. Within this context, this study sought to compare the predictive accuracy of dynamic risk assessment measures for violence with static risk assessment measures over the short term (up to 1 month) and medium term (up to 6 months) in a forensic psychiatric inpatient setting. Results showed that dynamic measures were generally more accurate than static measures for short- to medium-term predictions of inpatient aggression. These findings highlight the necessity of using risk assessment measures that are sensitive to important clinical risk state variables to improve the short- to medium-term prediction of aggression within the forensic inpatient setting. Such knowledge can assist with the development of more accurate and efficient risk assessment procedures, including the selection of appropriate risk assessment instruments to manage and prevent the violence of offenders with mental illnesses during inpatient treatment.

Empirical analysis of farmers' drought risk perception: objective factors, personal circumstances, and social influence.

PubMed

Duinen, Rianne van; Filatova, Tatiana; Geurts, Peter; Veen, Anne van der

2015-04-01

Drought-induced water shortage and salinization are a global threat to agricultural production. With climate change, drought risk is expected to increase as drought events are assumed to occur more frequently and to become more severe. The agricultural sector's adaptive capacity largely depends on farmers' drought risk perceptions. Understanding the formation of farmers' drought risk perceptions is a prerequisite to designing effective and efficient public drought risk management strategies. Various strands of literature point at different factors shaping individual risk perceptions. Economic theory points at objective risk variables, whereas psychology and sociology identify subjective risk variables. This study investigates and compares the contribution of objective and subjective factors in explaining farmers' drought risk perception by means of survey data analysis. Data on risk perceptions, farm characteristics, and various other personality traits were collected from farmers located in the southwest Netherlands. From comparing the explanatory power of objective and subjective risk factors in separate models and a full model of risk perception, it can be concluded that farmers' risk perceptions are shaped by both rational and emotional factors. In a full risk perception model, being located in an area with external water supply, owning fields with salinization issues, cultivating drought-/salt-sensitive crops, farm revenue, drought risk experience, and perceived control are significant explanatory variables of farmers' drought risk perceptions. © 2014 Society for Risk Analysis.

Enhanced Capabilities for Subcritical Experiments (ECSE) Risk Management Plan

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

Urban, Mary Elizabeth

Risk is a factor, element, constraint, or course of action that introduces an uncertainty of outcome that could impact project objectives. Risk is an inherent part of all activities, whether the activity is simple and small, or large and complex. Risk management is a process that identifies, evaluates, handles, and monitors risks that have the potential to affect project success. The risk management process spans the entire project, from its initiation to its successful completion and closeout, including both technical and programmatic (non-technical) risks. This Risk Management Plan (RMP) defines the process to be used for identifying, evaluating, handling, andmore » monitoring risks as part of the overall management of the Enhanced Capabilities for Subcritical Experiments (ECSE) ‘Project’. Given the changing nature of the project environment, risk management is essentially an ongoing and iterative process, which applies the best efforts of a knowledgeable project staff to a suite of focused and prioritized concerns. The risk management process itself must be continually applied throughout the project life cycle. This document was prepared in accordance with DOE O 413.3B, Program and Project Management for the Acquisition of Capital Assets, its associated guide for risk management DOE G 413.3-7, Risk Management Guide, and LANL ADPM AP-350-204, Risk and Opportunity Management.« less

12 CFR 1710.19 - Compliance and risk management programs; compliance with other laws.

Code of Federal Regulations, 2011 CFR

2011-01-01

... management program. (1) An Enterprise shall establish and maintain a risk management program that is reasonably designed to manage the risks of the operations of the Enterprise. (2) The risk management program... executive officer of the Enterprise. The risk management officer shall report regularly to the board of...

Distance Education, Efficiency and Scientific Management: Some Doubts. ESTR Occasional Paper Number 12.

ERIC Educational Resources Information Center

Campion, Mick

The theme of the 1983 Australian and South Pacific External Studies Association concerned developing efficient teaching-learning systems and efficient management systems. Such an emphasis on efficiency was symptomatic in the United States' educational arena to a commitment to the practices of scientific management. The central role accorded to…

Improving interMediAte Risk management. MARK study

PubMed Central

2011-01-01

Background Cardiovascular risk functions fail to identify more than 50% of patients who develop cardiovascular disease. This is especially evident in the intermediate-risk patients in which clinical management becomes difficult. Our purpose is to analyze if ankle-brachial index (ABI), measures of arterial stiffness, postprandial glucose, glycosylated hemoglobin, self-measured blood pressure and presence of comorbidity are independently associated to incidence of vascular events and whether they can improve the predictive capacity of current risk equations in the intermediate-risk population. Methods/Design This project involves 3 groups belonging to REDIAPP (RETICS RD06/0018) from 3 Spanish regions. We will recruit a multicenter cohort of 2688 patients at intermediate risk (coronary risk between 5 and 15% or vascular death risk between 3-5% over 10 years) and no history of atherosclerotic disease, selected at random. We will record socio-demographic data, information on diet, physical activity, comorbidity and intermittent claudication. We will measure ABI, pulse wave velocity and cardio ankle vascular index at rest and after a light intensity exercise. Blood pressure and anthropometric data will be also recorded. We will also quantify lipids, glucose and glycosylated hemoglobin in a fasting blood sample and postprandial capillary glucose. Eighteen months after the recruitment, patients will be followed up to determine the incidence of vascular events (later follow-ups are planned at 5 and 10 years). We will analyze whether the new proposed risk factors contribute to improve the risk functions based on classic risk factors. Discussion Primary prevention of cardiovascular diseases is a priority in public health policy of developed and developing countries. The fundamental strategy consists in identifying people in a high risk situation in which preventive measures are effective and efficient. Improvement of these predictions in our country will have an immediate, clinical and welfare impact and a short term public health effect. Trial Registration Clinical Trials.gov Identifier: NCT01428934 PMID:21992621

Assessing and managing multiple risks in a changing world-The Roskilde recommendations.

PubMed

Selck, Henriette; Adamsen, Peter B; Backhaus, Thomas; Banta, Gary T; Bruce, Peter K H; Burton, G Allen; Butts, Michael B; Boegh, Eva; Clague, John J; Dinh, Khuong V; Doorn, Neelke; Gunnarsson, Jonas S; Hauggaard-Nielsen, Henrik; Hazlerigg, Charles; Hunka, Agnieszka D; Jensen, John; Lin, Yan; Loureiro, Susana; Miraglia, Simona; Munns, Wayne R; Nadim, Farrokh; Palmqvist, Annemette; Rämö, Robert A; Seaby, Lauren P; Syberg, Kristian; Tangaa, Stine R; Thit, Amalie; Windfeld, Ronja; Zalewski, Maciej; Chapman, Peter M

2017-01-01

Roskilde University (Denmark) hosted a November 2015 workshop, Environmental Risk-Assessing and Managing Multiple Risks in a Changing World. This Focus article presents the consensus recommendations of 30 attendees from 9 countries regarding implementation of a common currency (ecosystem services) for holistic environmental risk assessment and management; improvements to risk assessment and management in a complex, human-modified, and changing world; appropriate development of protection goals in a 2-stage process; dealing with societal issues; risk-management information needs; conducting risk assessment of risk management; and development of adaptive and flexible regulatory systems. The authors encourage both cross-disciplinary and interdisciplinary approaches to address their 10 recommendations: 1) adopt ecosystem services as a common currency for risk assessment and management; 2) consider cumulative stressors (chemical and nonchemical) and determine which dominate to best manage and restore ecosystem services; 3) fully integrate risk managers and communities of interest into the risk-assessment process; 4) fully integrate risk assessors and communities of interest into the risk-management process; 5) consider socioeconomics and increased transparency in both risk assessment and risk management; 6) recognize the ethical rights of humans and ecosystems to an adequate level of protection; 7) determine relevant reference conditions and the proper ecological context for assessments in human-modified systems; 8) assess risks and benefits to humans and the ecosystem and consider unintended consequences of management actions; 9) avoid excessive conservatism or possible underprotection resulting from sole reliance on binary, numerical benchmarks; and 10) develop adaptive risk-management and regulatory goals based on ranges of uncertainty. Environ Toxicol Chem 2017;36:7-16. © 2016 SETAC. © 2016 SETAC.

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.

Transfer of analytical procedures: a panel of strategies selected for risk management, with emphasis on an integrated equivalence-based comparative testing approach.

PubMed

Agut, C; Caron, A; Giordano, C; Hoffman, D; Ségalini, A

2011-09-10

In 2001, a multidisciplinary team made of analytical scientists and statisticians at Sanofi-aventis has published a methodology which has governed, from that time, the transfers from R&D sites to Manufacturing sites of the release monographs. This article provides an overview of the recent adaptations brought to this original methodology taking advantage of our experience and the new regulatory framework, and, in particular, the risk management perspective introduced by ICH Q9. Although some alternate strategies have been introduced in our practices, the comparative testing one, based equivalence testing as statistical approach, remains the standard for assays lying on very critical quality attributes. This is conducted with the concern to control the most important consumer's risk involved at two levels in analytical decisions in the frame of transfer studies: risk, for the receiving laboratory, to take poor release decisions with the analytical method and risk, for the sending laboratory, to accredit such a receiving laboratory on account of its insufficient performances with the method. Among the enhancements to the comparative studies, the manuscript presents the process settled within our company for a better integration of the transfer study into the method life-cycle, just as proposals of generic acceptance criteria and designs for assay and related substances methods. While maintaining rigor and selectivity of the original approach, these improvements tend towards an increased efficiency in the transfer operations. Copyright © 2011 Elsevier B.V. All rights reserved.

Emergency management and homeland security: Exploring the relationship.

PubMed

Kahan, Jerome H

2015-01-01

In the years after the 9/11 tragedy, the United States continues to face risks from all forms of major disasters, from potentially dangerous terrorist attacks to catastrophic acts of nature. Professionals in the fields of emergency management and homeland security have responsibilities for ensuring that all levels of government, urban areas and communities, nongovernmental organizations, businesses, and individual citizens are prepared to deal with such hazards though actions that reduce risks to lives and property. Regrettably, the overall efficiency and effectiveness of the nation's ability to deal with disasters is unnecessarily challenged by the absence of a common understanding on how these fields are related in the workforce and educational arenas. Complicating matters further is the fact that neither of these fields has developed agreed definitions. In many ways, homeland security and emergency management have come to represent two different worlds and cultures. These conditions can have a deleterious effect on preparedness planning for public and private stakeholders across the nation when coordinated responses among federal, state, and local activities are essential for dealing with consequential hazards. This article demonstrates that the fields of emergency management and homeland security share many responsibilities but are not identical in scope or skills. It argues that emergency management should be considered a critical subset of the far broader and more strategic field of homeland security. From analytically based conclusions, it recommends five steps that be taken to bring these fields closer together to benefit more from their synergist relationship as well as from their individual contributions.

Invited review: Practical feeding management recommendations to mitigate the risk of subacute ruminal acidosis in dairy cattle.

PubMed

Humer, E; Petri, R M; Aschenbach, J R; Bradford, B J; Penner, G B; Tafaj, M; Südekum, K-H; Zebeli, Q

2018-02-01

Rumen health is of vital importance in ensuring healthy and efficient dairy cattle production. Current feeding programs for cattle recommend concentrate-rich diets to meet the high nutritional needs of cows during lactation and enhance cost-efficiency. These diets, however, can impair rumen health. The term "subacute ruminal acidosis" (SARA) is often used as a synonym for poor rumen health. In this review, we first describe the physiological demands of cattle for dietary physically effective fiber. We also provide background information on the importance of enhancing salivary secretions and short-chain fatty acid absorption across the stratified squamous epithelium of the rumen; thus, preventing the disruption of the ruminal acid-base balance, a process that paves the way for acidification of the rumen. On-farm evaluation of dietary fiber adequacy is challenging for both nutritionists and veterinarians; therefore, this review provides practical recommendations on how to evaluate the physical effectiveness of the diet based on differences in particle size distribution, fiber content, and the type of concentrate fed, both when the latter is part of total mixed ration and when it is supplemented in partial mixed rations. Besides considering the absolute amount of physically effective fiber and starch types in the diet, we highlight the role of several feeding management factors that affect rumen health and should be considered to control and mitigate SARA. Most importantly, transitional feeding to ensure gradual adaptation of the ruminal epithelium and microbiota; monitoring and careful management of particle size distribution; controlling feed sorting, meal size, and meal frequency; and paying special attention to primiparous cows are some of the feeding management tools that can help in sustaining rumen health in high-producing dairy herds. Supplementation of feed additives including yeast products, phytogenic compounds, and buffers may help attenuate SARA, especially during stress periods when the risk of a deficiency of physically effective fiber in the diet is high, such as during early lactation. However, the usage of feed additives cannot fully compensate for suboptimal feeding management. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Risk Management for Human Support Technology Development

NASA Technical Reports Server (NTRS)

jones, Harry

2005-01-01

NASA requires continuous risk management for all programs and projects. The risk management process identifies risks, analyzes their impact, prioritizes them, develops and carries out plans to mitigate or accept them, tracks risks and mitigation plans, and communicates and documents risk information. Project risk management is driven by the project goal and is performed by the entire team. Risk management begins early in the formulation phase with initial risk identification and development of a risk management plan and continues throughout the project life cycle. This paper describes the risk management approach that is suggested for use in NASA's Human Support Technology Development. The first step in risk management is to identify the detailed technical and programmatic risks specific to a project. Each individual risk should be described in detail. The identified risks are summarized in a complete risk list. Risk analysis provides estimates of the likelihood and the qualitative impact of a risk. The likelihood and impact of the risk are used to define its priority location in the risk matrix. The approaches for responding to risk are either to mitigate it by eliminating or reducing the effect or likelihood of a risk, to accept it with a documented rationale and contingency plan, or to research or monitor the risk, The Human Support Technology Development program includes many projects with independently achievable goals. Each project must do independent risk management, considering all its risks together and trading them against performance, budget, and schedule. Since the program can succeed even if some projects fail, the program risk has a complex dependence on the individual project risks.

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

NASA Technical Reports Server (NTRS)

Witkowski, Mona M.

2002-01-01

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

Blue and green infrastructures implementation to solve stormwater management issues in a new urban development project - a modelling approach

NASA Astrophysics Data System (ADS)

Versini, Pierre-Antoine; Tchiguirinskaia, Ioulia; Schertzer, Daniel

2016-04-01

Concentrating buildings and socio-economic activities, urban areas are particularly vulnerable to hydrological risks. Modification in climate may intensify already existing issues concerning stormwater management (due to impervious area) and water supply (due to the increase of the population). In this context, water use efficiency and best water management practices are key-issues in the urban environment already stressed. Blue and green infrastructures are nature-based solutions that provide synergy of the blue and green systems to provide multifunctional solutions and multiple benefits: increased amenity, urban heat island improvement, biodiversity, reduced energy requirements... They are particularly efficient to reduce the potential impact of new and existing developments with respect to stormwater and/or water supply issues. The Multi-Hydro distributed rainfall-runoff model represents an adapted tool to manage the impacts of such infrastructures at the urban basin scale. It is a numerical platform that makes several models interact, each of them representing a specific portion of the water cycle in an urban environment: surface runoff and infiltration depending on a land use classification, sub-surface processes and sewer network drainage. Multi-Hydro is still being developed at the Ecole des Ponts (open access from https://hmco.enpc.fr/Tools-Training/Tools/Multi-Hydro.php) to take into account the wide complexity of urban environments. The latest advancements have made possible the representation of several blue and green infrastructures (green roof, basin, swale). Applied in a new urban development project located in the Paris region, Multi-Hydro has been used to simulate the impact of blue and green infrastructures implementation. It was particularly focused on their ability to fulfil regulation rules established by local stormwater managers in order to connect the parcel to the sewer network. The results show that a combination of several blue and green infrastructures, if they are widely implemented, could represent an efficient tool to ensure regulation rules at the parcel scale.

Data Envelopment Analysis (DEA) Model in Operation Management

NASA Astrophysics Data System (ADS)

Malik, Meilisa; Efendi, Syahril; Zarlis, Muhammad

2018-01-01

Quality management is an effective system in operation management to develops, maintains, and improves quality from groups of companies that allow marketing, production, and service at the most economycal level as well as ensuring customer satisfication. Many companies are practicing quality management to improve their bussiness performance. One of performance measurement is through measurement of efficiency. One of the tools can be used to assess efficiency of companies performance is Data Envelopment Analysis (DEA). The aim of this paper is using Data Envelopment Analysis (DEA) model to assess efficiency of quality management. In this paper will be explained CCR, BCC, and SBM models to assess efficiency of quality management.

Quantification and site-specification of the support practice factor when mapping soil erosion risk associated with olive plantations in the Mediterranean island of Crete.

PubMed

Karydas, Christos G; Sekuloska, Tijana; Silleos, Georgios N

2009-02-01

Due to inappropriate agricultural management practices, soil erosion is becoming one of the most dangerous forms of soil degradation in many olive farming areas in the Mediterranean region, leading to significant decrease of soil fertility and yield. In order to prevent further soil degradation, proper measures are necessary to be locally implemented. In this perspective, an increase in the spatial accuracy of remote sensing datasets and advanced image analysis are significant tools necessary and efficient for mapping soil erosion risk on a fine scale. In this study, the Revised Universal Soil Loss Equation (RUSLE) was implemented in the spatial domain using GIS, while a very high resolution satellite image, namely a QuickBird image, was used for deriving cover management (C) and support practice (P) factors, in order to map the risk of soil erosion in Kolymvari, a typical olive farming area in the island of Crete, Greece. The results comprised a risk map of soil erosion when P factor was taken uniform (conventional approach) and a risk map when P factor was quantified site-specifically using object-oriented image analysis. The results showed that the QuickBird image was necessary in order to achieve site-specificity of the P factor and therefore to support fine scale mapping of soil erosion risk in an olive cultivation area, such as the one of Kolymvari in Crete. Increasing the accuracy of the QB image classification will further improve the resulted soil erosion mapping.

Approaches to Quality Risk Management When Using Single-Use Systems in the Manufacture of Biologics.

PubMed

Ishii-Watabe, Akiko; Hirose, Akihiko; Katori, Noriko; Hashii, Norikata; Arai, Susumu; Awatsu, Hirotoshi; Eiza, Akira; Hara, Yoshiaki; Hattori, Hideshi; Inoue, Tomomi; Isono, Tetsuya; Iwakura, Masahiro; Kajihara, Daisuke; Kasahara, Nobuo; Matsuda, Hiroyuki; Murakami, Sei; Nakagawa, Taishiro; Okumura, Takehiro; Omasa, Takeshi; Takuma, Shinya; Terashima, Iyo; Tsukahara, Masayoshi; Tsutsui, Maiko; Yano, Takahiro; Kawasaki, Nana

2015-10-01

Biologics manufacturing technology has made great progress in the last decade. One of the most promising new technologies is the single-use system, which has improved the efficiency of biologics manufacturing processes. To ensure safety of biologics when employing such single-use systems in the manufacturing process, various issues need to be considered including possible extractables/leachables and particles arising from the components used in single-use systems. Japanese pharmaceutical manufacturers, together with single-use suppliers, members of the academia and regulatory authorities have discussed the risks of using single-use systems and established control strategies for the quality assurance of biologics. In this study, we describe approaches for quality risk management when employing single-use systems in the manufacturing of biologics. We consider the potential impact of impurities related to single-use components on drug safety and the potential impact of the single-use system on other critical quality attributes as well as the stable supply of biologics. We also suggest a risk-mitigating strategy combining multiple control methods which includes the selection of appropriate single-use components, their inspections upon receipt and before releasing for use and qualification of single-use systems. Communication between suppliers of single-use systems and the users, as well as change controls in the facilities both of suppliers and users, are also important in risk-mitigating strategies. Implementing these control strategies can mitigate the risks attributed to the use of single-use systems. This study will be useful in promoting the development of biologics as well as in ensuring their safety, quality and stable supply.

Frameworks and tools for risk assessment of manufactured nanomaterials.

PubMed

Hristozov, Danail; Gottardo, Stefania; Semenzin, Elena; Oomen, Agnes; Bos, Peter; Peijnenburg, Willie; van Tongeren, Martie; Nowack, Bernd; Hunt, Neil; Brunelli, Andrea; Scott-Fordsmand, Janeck J; Tran, Lang; Marcomini, Antonio

2016-10-01

Commercialization of nanotechnologies entails a regulatory requirement for understanding their environmental, health and safety (EHS) risks. Today we face challenges to assess these risks, which emerge from uncertainties around the interactions of manufactured nanomaterials (MNs) with humans and the environment. In order to reduce these uncertainties, it is necessary to generate sound scientific data on hazard and exposure by means of relevant frameworks and tools. The development of such approaches to facilitate the risk assessment (RA) of MNs has become a dynamic area of research. The aim of this paper was to review and critically analyse these approaches against a set of relevant criteria. The analysis concluded that none of the reviewed frameworks were able to fulfill all evaluation criteria. Many of the existing modelling tools are designed to provide screening-level assessments rather than to support regulatory RA and risk management. Nevertheless, there is a tendency towards developing more quantitative, higher-tier models, capable of incorporating uncertainty into their analyses. There is also a trend towards developing validated experimental protocols for material identification and hazard testing, reproducible across laboratories. These tools could enable a shift from a costly case-by-case RA of MNs towards a targeted, flexible and efficient process, based on grouping and read-across strategies and compliant with the 3R (Replacement, Reduction, Refinement) principles. In order to facilitate this process, it is important to transform the current efforts on developing databases and computational models into creating an integrated data and tools infrastructure to support the risk assessment and management of MNs. Copyright © 2016 Elsevier Ltd. All rights reserved.

Local stakeholders' perception of landslide and flood risks in Iasi County, Romania

NASA Astrophysics Data System (ADS)

Ciprian Margarint, Mihai; Niculita, Mihai; Rosu, Lucian

2015-04-01

Risk perception is an important issue for an efficient management and mitigation measures of natural hazards and theirs negative consequences on social and economic activity. At administrative unit scale (LAU2), local stakeholders play an effective role in case of an emergency situation, regarding the warning and alerting the population, collaboration with specialized institution and managing material assistance during and after the crisis. In addition they are among the best connoisseurs of local community and places, and consequently they could substantial help the national level forces during emergency situations. These issues argues the high degree of responsibilities assigned to Romanian mayors, and is reflected in the legislation in terms of evaluation of damages produced and the management of natural hazards, like landslide and floods. Also their degree of awareness can assess more accurately the collective perception against the individual one. In this work we have assessed the local stakeholders' perception for natural risks in general, and particularly for landslides and floods. We have tested the discrepancies of the specific risks perception and an assessment of correspondence between scientific outputs versus the subjective judgement the administrative decision makers. This approach was based on a questionnaire which was applied in the summer of 2014, to all 98 mayors from Iasi County, north-east Romania. It contained 12 questions structured in a specific mode, from general to particular. The assessment of the answers provided from the commune halls, was realized with integration in a GIS environment of codes assigned to each question, and the overlay with the scientific outputs regarding landslide occurrence and susceptibility and floods risk maps. The differences between the outputs of the questionnaires and the scientific outputs of landslide and flood risk was further analyzed and interpreted. There were registered large variations of answers and important discrepancies between scientific results and the stakeholders' estimations, both for landslides and flood components. Farther multicriterial analysis (clustering method) was applied for highlighting a correspondance between the distance to certain risk areas and stakeholders perception. As a main conclusion we can state that the decision makers perception is strongly influenced by their personal and recent experiences but also by the distance to the source of risk.

Risk Management

DTIC Science & Technology

2011-06-02

actively attack the risks, they will actively attack you.” -Tom Gib Why do Risk Management? 8 “The first step in the risk management process is to...opportunities to manage and improve our chances of success. - Roger Vanscoy “If you do not actively attack the risks, they will actively attack ...our risks provides opportunities to manage and improve our chances of success. - Roger Vanscoy “If you do not actively attack the risks, they will

A spatial DB model to simulate the road network efficiency in hydrogeological emergency

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

Michele, Mangiameli, E-mail: michele.mangiameli@dica.unict.it; Giuseppe, Mussumeci

We deal with the theme of the simulation of risk analysis using a technological approach based on the integration of exclusively free and open source tools: PostgreSQL as Database Management System (DBMS) and Quantum GIS-GRASS as Geographic Information System (GIS) platform. The case study is represented by a seismic land in Sicily characterized by steep slopes and frequent instability phenomena. This area includes a city of about 30.000 inhabitants (Enna) that lies on the top of a mountain at about 990 m a.s.l.. The access to the city is assured by few and very winding roads that are also highly vulnerablemore » to seismic and hydrogeological hazards. When exceptional rainfall events occur, the loss of efficiency of these roads should compromise timeliness and effectiveness of rescue operations. The data of the sample area have been structured into the adopted DBMS, and the connection to the GIS functionalities allows simulating the exceptional events. We analyzed the hazard, vulnerability and exposure related to these events and calculated the final risk defining three classes for each scenario: low (L), medium (M) and high (H). This study can be a valuable tool to prioritize risk levels and set priorities for intervention to the main road networks.« less

The genome projects: implications for dental practice and education.

PubMed

Wright, J T; Hart, T C

2002-05-01

Information from the Human Genome Project (HGP) and the integration of information from related areas of study and technology will dramatically change health care for the craniofacial complex. Approaches to risk assessment and diagnosis, prevention, early intervention, and management of craniofacial conditions are and will continue to evolve through the application of this new knowledge. While this information will advance our health care abilities, it is clear that the dental profession will face challenges regarding the acquisition, application, transfer, and effective and efficient use of this knowledge with regards to dental research, dental education, and clinical practice. Unraveling the human genomic sequence now allows accurate diagnosis of numerous craniofacial conditions. However, the greatest oral disease burden results from dental caries and periodontal disease that are complex disorders having both hereditary and environmental factors determining disease risk, progression, and course. Disease risk assessment, prevention, and therapy, based on knowledge from the HGP, will likely vary markedly for the different complex conditions affecting the head and neck. Integration of Information from the human genome, comparative and microbial genomics, proteomics, bioinformatics, and related technologies will provide the basis for proactive prevention and intervention and novel and more efficient treatment approaches. Oral health care practitioners will increasingly require knowledge of human genetics and the application of new molecular-based diagnostic and therapeutic technologies.

A spatial DB model to simulate the road network efficiency in hydrogeological emergency

NASA Astrophysics Data System (ADS)

Michele, Mangiameli; Giuseppe, Mussumeci

2015-12-01

We deal with the theme of the simulation of risk analysis using a technological approach based on the integration of exclusively free and open source tools: PostgreSQL as Database Management System (DBMS) and Quantum GIS-GRASS as Geographic Information System (GIS) platform. The case study is represented by a seismic land in Sicily characterized by steep slopes and frequent instability phenomena. This area includes a city of about 30.000 inhabitants (Enna) that lies on the top of a mountain at about 990 m a.s.l.. The access to the city is assured by few and very winding roads that are also highly vulnerable to seismic and hydrogeological hazards. When exceptional rainfall events occur, the loss of efficiency of these roads should compromise timeliness and effectiveness of rescue operations. The data of the sample area have been structured into the adopted DBMS, and the connection to the GIS functionalities allows simulating the exceptional events. We analyzed the hazard, vulnerability and exposure related to these events and calculated the final risk defining three classes for each scenario: low (L), medium (M) and high (H). This study can be a valuable tool to prioritize risk levels and set priorities for intervention to the main road networks..

A review of risk management process in construction projects of developing countries

NASA Astrophysics Data System (ADS)

Bahamid, R. A.; Doh, S. I.

2017-11-01

In the construction industry, risk management concept is a less popular technique. There are three main stages in the systematic approach to risk management in construction industry. These stages include: a) risk response; b) risk analysis and evaluation; and c) risk identification. The high risk related to construction business affects each of its participants; while operational analysis and management of construction related risks remain an enormous task to practitioners of the industry. This paper tends towards reviewing the existing literature on construction project risk managements in developing countries specifically on risk management process. The literature lacks ample risk management process approach capable of capturing risk impact on diverse project objectives. This literature review aims at discovering the frequently used techniques in risk identification and analysis. It also attempts to identify response to clarifying the different classifications of risk sources in the existing literature of developing countries, and to identify the future research directions on project risks in the area of construction in developing countries.

78 FR 49663 - Enhanced Risk Management Standards for Systemically Important Derivatives Clearing Organizations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-15

... objectives and principles for these risk management standards are to: (1) Promote risk management; (2... international risk management standards set by CPSS-IOSCO's Principles and Recommendations.\\64\\ The Board did... COMMODITY FUTURES TRADING COMMISSION 17 CFR Part 39 RIN 3038-AC98 Enhanced Risk Management...

Sustaining a Mature Risk Management Process: Ensuring the International Space Station for a Vibrant Future

NASA Technical Reports Server (NTRS)

Raftery, Michael; Carter-Journet, Katrina

2013-01-01

The International Space Station (ISS) risk management methodology is an example of a mature and sustainable process. Risk management is a systematic approach used to proactively identify, analyze, plan, track, control, communicate, and document risks to help management make risk-informed decisions that increase the likelihood of achieving program objectives. The ISS has been operating in space for over 14 years and permanently crewed for over 12 years. It is the longest surviving habitable vehicle in low Earth orbit history. Without a mature and proven risk management plan, it would be increasingly difficult to achieve mission success throughout the life of the ISS Program. A successful risk management process must be able to adapt to a dynamic program. As ISS program-level decision processes have evolved, so too has the ISS risk management process continued to innovate, improve, and adapt. Constant adaptation of risk management tools and an ever-improving process is essential to the continued success of the ISS Program. Above all, sustained support from program management is vital to risk management continued effectiveness. Risk management is valued and stressed as an important process by the ISS Program.

Public Sector Reform and Governance for Adaptation: Implications of New Public Management for Adaptive Capacity in Mexico and Norway

NASA Astrophysics Data System (ADS)

Eakin, Hallie; Eriksen, Siri; Eikeland, Per-Ove; Øyen, Cecilie

2011-03-01

Although many governments are assuming the responsibility of initiating adaptation policy in relation to climate change, the compatibility of "governance-for-adaptation" with the current paradigms of public administration has generally been overlooked. Over the last several decades, countries around the globe have embraced variants of the philosophy of administration broadly called "New Public Management" (NPM) in an effort to improve administrative efficiencies and the provision of public services. Using evidence from a case study of reforms in the building sector in Norway, and a case study of water and flood risk management in central Mexico, we analyze the implications of the adoption of the tenets of NPM for adaptive capacity. Our cases illustrate that some of the key attributes associated with governance for adaptation—namely, technical and financial capacities; institutional memory, learning and knowledge; and participation and accountability—have been eroded by NPM reforms. Despite improvements in specific operational tasks of the public sector in each case, we show that the success of NPM reforms presumes the existence of core elements of governance that have often been found lacking, including solid institutional frameworks and accountability. Our analysis illustrates the importance of considering both longer-term adaptive capacities and short-term efficiency goals in public sector administration reform.

Public sector reform and governance for adaptation: implications of new public management for adaptive capacity in Mexico and Norway.

PubMed

Eakin, Hallie; Eriksen, Siri; Eikeland, Per-Ove; Øyen, Cecilie

2011-03-01

Although many governments are assuming the responsibility of initiating adaptation policy in relation to climate change, the compatibility of "governance-for-adaptation" with the current paradigms of public administration has generally been overlooked. Over the last several decades, countries around the globe have embraced variants of the philosophy of administration broadly called "New Public Management" (NPM) in an effort to improve administrative efficiencies and the provision of public services. Using evidence from a case study of reforms in the building sector in Norway, and a case study of water and flood risk management in central Mexico, we analyze the implications of the adoption of the tenets of NPM for adaptive capacity. Our cases illustrate that some of the key attributes associated with governance for adaptation--namely, technical and financial capacities; institutional memory, learning and knowledge; and participation and accountability--have been eroded by NPM reforms. Despite improvements in specific operational tasks of the public sector in each case, we show that the success of NPM reforms presumes the existence of core elements of governance that have often been found lacking, including solid institutional frameworks and accountability. Our analysis illustrates the importance of considering both longer-term adaptive capacities and short-term efficiency goals in public sector administration reform.

Reconceptualizing INRM in understanding environmental risks from food production systems.

PubMed

Pandey, Chitra; Diwan, Hema

2018-02-15

Sustainable agri-development is composed of soil fertility maintenance, nutrient use efficiency and resource use efficiency. In this regard, the present study aims to address the complex dynamics of farm-soil and the water nexus for integrated natural resource management by understanding the fertilizer use decision of farmers. In addition to the monitoring of soil quality parameters, that is, the total nitrogen and nitrate concentrations, factor analysis was used to explore the drivers of high fertilizer use in the most agriculturally intensive region of India. The results classified economic benefits, intrinsic and extrinsic motivations, resource-related aspects, institutional set-up and passivity towards environmental quality as major entry points for integrated natural resource management. Although the economic benefit in the form of the affordability of nitrogenous fertilizers was found to be the most critical rationale for fertilizer use, passivity towards environmental quality emerged as a factor of interest. Because short-term economic benefits outweigh concerns for environmental quality, our research suggests that outreach educational programs on sustainable farm practices can be instrumental in resource management. Support of the farming community by governmental/non-governmental agricultural agencies to formulate site-specific recommendations can significantly mitigate fertilizer-induced non-point pollution. Copyright © 2017 Elsevier B.V. All rights reserved.

Integrating Soluble Biomarkers and Imaging Technologies in the Identification of Vulnerable Atherosclerotic Patients

PubMed Central

Páramo, José A.; Rodríguez JA, José A.; Orbe, Josune

2006-01-01

The clinical utility of a biomarker depends on its ability to identify high-risk individuals to optimally manage the patient. A new biomarker would be of clinical value if it is accurate and reliable, provides good sensitivity and specificity, and is available for widespread application. Data are accumulating on the potential clinical utility of integrating imaging technologies and circulating biomarkers for the identification of vulnerable (high-risk) cardiovascular patients. A multi-biomarker strategy consisting of markers of inflammation, hemostasis and thrombosis, proteolysis and oxidative stress, combined with new imaging modalities (optical coherence tomography, virtual histology plus IVUS, PET) can increase our ability to identify such thombosis-prone patients. In an ideal scenario, cardiovascular biomarkers and imaging combined will provide a better diagnostic tool to identify high-risk individuals and also more efficient methods for effective therapies to reduce such cardiovascular risk. However, additional studies are required in order to show that this approach can contribute to improved diagnostic and therapeutic of atherosclerotic disease. PMID:19690647

Integrating soluble biomarkers and imaging technologies in the identification of vulnerable atherosclerotic patients.

PubMed

Páramo, José A; Rodríguez Ja, José A; Orbe, Josune

2007-02-07

The clinical utility of a biomarker depends on its ability to identify high-risk individuals to optimally manage the patient. A new biomarker would be of clinical value if it is accurate and reliable, provides good sensitivity and specificity, and is available for widespread application. Data are accumulating on the potential clinical utility of integrating imaging technologies and circulating biomarkers for the identification of vulnerable (high-risk) cardiovascular patients. A multi-biomarker strategy consisting of markers of inflammation, hemostasis and thrombosis, proteolysis and oxidative stress, combined with new imaging modalities (optical coherence tomography, virtual histology plus IVUS, PET) can increase our ability to identify such thombosis-prone patients. In an ideal scenario, cardiovascular biomarkers and imaging combined will provide a better diagnostic tool to identify high-risk individuals and also more efficient methods for effective therapies to reduce such cardiovascular risk. However, additional studies are required in order to show that this approach can contribute to improved diagnostic and therapeutic of atherosclerotic disease.

A globally-distributed alien invasive species poses risks to United States imperiled species.

PubMed

McClure, Meredith L; Burdett, Christopher L; Farnsworth, Matthew L; Sweeney, Steven J; Miller, Ryan S

2018-03-28

In the midst of Earth's sixth mass extinction event, non-native species are a driving factor in many imperiled species' declines. One of the most widespread and destructive alien invasive species in the world, wild pigs (Sus scrofa) threaten native species through predation, habitat destruction, competition, and disease transmission. We show that wild pigs co-occur with up to 87.2% of imperiled species in the contiguous U.S. identified as susceptible to their direct impacts, and we project increases in both the number of species at risk and the geographic extent of risks by 2025. Wild pigs may therefore present a severe threat to U.S. imperiled species, with serious implications for management of at-risk species throughout wild pigs' global distribution. We offer guidance for efficient allocation of research effort and conservation resources across species and regions using a simple approach that can be applied to wild pigs and other alien invasive species globally.

Physical security and IT convergence: Managing the cyber-related risks.

PubMed

McCreight, Tim; Leece, Doug

The convergence of physical security devices into the corporate network is increasing, due to the perceived economic benefits and efficiencies gained from using one enterprise network. Bringing these two networks together is not without risk. Physical devices like closed circuit television cameras (CCTV), card access readers, and heating, ventilation and air conditioning controllers (HVAC) are typically not secured to the standards we expect for corporate computer networks. These devices can pose significant risks to the corporate network by creating new avenues to exploit vulnerabilities in less-than-secure implementations of physical systems. The ASIS Information Technology Security Council (ITSC) developed a white paper describing steps organisations can take to reduce the risks this convergence can pose, and presented these concepts at the 2015 ASIS/ISC2 Congress in Anaheim, California. 1 This paper expands upon the six characteristics described by ITSC, and provides business continuity planners with information on how to apply these recommendations to physical security devices that use the corporate network.

[Is the cognitive-behavioural therapy an effective strategy also in the prevention of post partum depression? a critical review].

PubMed

Nardi, Bernardo; Laurenzi, Sabrina; Di Nicolò, Marzia; Bellantuono, Cesario

2012-01-01

The aim of this study was to evaluate the efficacy of cognitive-behavioural therapy (CBT) in the prevention of post partum depression (PPD) in pregnant women at risk. PubMed, Medline, PsychInfo, Embase, and the Cochrane Library databases were searched from January 1991 to June 2011 to review studies on the efficacy of CBT in the prevention of PD. The literature analyzed recommends that depression in pregnancy requires an efficient management to provide mother's symptoms relief as well as to prevent PD. While several studies demonstrated the efficacy of CBT in the treatment of PD, only a few controlled studies focused on its efficacy in the prevention of PD in women identified at risk during pregnancy. The efficacy of CBT in preventing PD in pregnant women at risk is supported by only a few studies, presenting some methodological flaws. Better designed trials are needed to strongly support the efficacy of such psychotherapeutic preventive strategy in women at risk for PD.

A Note on Trader Sharpe Ratios

PubMed Central

Coates, John M.; Page, Lionel

2009-01-01

Traders in the financial world are assessed by the amount of money they make and, increasingly, by the amount of money they make per unit of risk taken, a measure known as the Sharpe Ratio. Little is known about the average Sharpe Ratio among traders, but the Efficient Market Hypothesis suggests that traders, like asset managers, should not outperform the broad market. Here we report the findings of a study conducted in the City of London which shows that a population of experienced traders attain Sharpe Ratios significantly higher than the broad market. To explain this anomaly we examine a surrogate marker of prenatal androgen exposure, the second-to-fourth finger length ratio (2D∶4D), which has previously been identified as predicting a trader's long term profitability. We find that it predicts the amount of risk taken by traders but not their Sharpe Ratios. We do, however, find that the traders' Sharpe Ratios increase markedly with the number of years they have traded, a result suggesting that learning plays a role in increasing the returns of traders. Our findings present anomalous data for the Efficient Markets Hypothesis. PMID:19946367

A note on trader Sharpe Ratios.

PubMed

Coates, John M; Page, Lionel

2009-11-25

Traders in the financial world are assessed by the amount of money they make and, increasingly, by the amount of money they make per unit of risk taken, a measure known as the Sharpe Ratio. Little is known about the average Sharpe Ratio among traders, but the Efficient Market Hypothesis suggests that traders, like asset managers, should not outperform the broad market. Here we report the findings of a study conducted in the City of London which shows that a population of experienced traders attain Sharpe Ratios significantly higher than the broad market. To explain this anomaly we examine a surrogate marker of prenatal androgen exposure, the second-to-fourth finger length ratio (2D:4D), which has previously been identified as predicting a trader's long term profitability. We find that it predicts the amount of risk taken by traders but not their Sharpe Ratios. We do, however, find that the traders' Sharpe Ratios increase markedly with the number of years they have traded, a result suggesting that learning plays a role in increasing the returns of traders. Our findings present anomalous data for the Efficient Markets Hypothesis.

Lean Production as an Innovative Approach to Construction

NASA Astrophysics Data System (ADS)

Spišáková, Marcela; Kozlovská, Mária

2013-06-01

Lean production presents a new approach to the construction management which has enabled enterprises to attain very high levels of efficiency, competitiveness and flexibility in production systems. Nowadays, a number of industrial processes are managed in accordance with these advanced management principles [1]. The principles of lean production are applied within the integrated design and delivery solutions (IDDS) and prefabricated construction. IDDS uses collaborative work processes and enhanced skills, with integrated data, information, and knowledge management to minimize structural and process inefficiencies and to enhance the value delivered during design, build, and operation, and across projects. Prefabrication presents a one of opportunities for construction methods, which allows the compliance with principles of sustainable design, provides the potential benefits such as faster construction, fewer housing defects, reduction in energy use and waste and elimination of environmental and safety risks. This paper presents the lean production within the IDDS and its potential in the modern prefabrication. There is created a field providing of benefits of lean production in construction industry.

Giving sustainable agriculture really good odds through innovative rainfall index insurance

NASA Astrophysics Data System (ADS)

Muneepeerakul, C. P.; Muneepeerakul, R.

2017-12-01

Population growth, increasing demands for food, and increasingly uncertain and limited water availability amidst competing demands for water by other users and the environment call for a novel approach to manage water in food production systems to be developed now. Tapping into broad popularity of crop insurance as a risk management intervention, we propose an innovative rainfall index insurance program as a novel systems approach that addresses water conservation in food production systems by exploiting two common currencies that tie the food production systems and others together, namely water and money. Our novel methodology allows for optimizing diverse farm and financial strategies together, revealing strategy portfolios that result in greater water use efficiency and higher incomes at a lower level of water use. Furthermore, it allows targeted interventions to achieve reduction in irrigation water, while providing financial protection to farmers against the increasing uncertainty in water availability. Not only would such a tool result in efficiently less use of water, it would also encourage diversification in farm practices, which reduces the farm's vulnerability against crop price volatility and pest or disease outbreaks and contributes to more sustainable agriculture.

Radiation risk and human space exploration.

PubMed

Schimmerling, W; Cucinotta, F A; Wilson, J W

2003-01-01

Radiation protection is essential to enable humans to live and work safely in space. Predictions about the nature and magnitude of the risks posed by space radiation are subject to very large uncertainties. Prudent use of worst-case scenarios may impose unacceptable constraints on shielding mass for spacecraft or habitats, tours of duty of crews on Space Station, and on the radius and duration of sorties on planetary surfaces. The NASA Space Radiation Health Program has been devised to develop the knowledge required to accurately predict and to efficiently manage radiation risk. The knowledge will be acquired by means of a peer-reviewed, largely ground-based and investigator-initiated, basic science research program. The NASA Strategic Plan to accomplish these objectives in a manner consistent with the high priority assigned to the protection and health maintenance of crews will be presented. Published by Elsevier Science Ltd on behalf of COSPAR.

Overview of NASA's space radiation research program.

PubMed

Schimmerling, Walter

2003-06-01

NASA is developing the knowledge required to accurately predict and to efficiently manage radiation risk in space. The strategy employed has three research components: (1) ground-based simulation of space radiation components to develop a science-based understanding of radiation risk; (2) space-based measurements of the radiation environment on planetary surfaces and interplanetary space, as well as use of space platforms to validate predictions; and, (3) implementation of countermeasures to mitigate risk. NASA intends to significantly expand its support of ground-based radiation research in line with completion of the Booster Applications Facility at Brookhaven National Laboratory, expected in summer of 2003. A joint research solicitation with the Department of Energy is under way and other interagency collaborations are being considered. In addition, a Space Radiation Initiative has been submitted by the Administration to Congress that would provide answers to most questions related to the International Space Station within the next 10 years.

Radiation risk and human space exploration

NASA Technical Reports Server (NTRS)

Schimmerling, W.; Cucinotta, F. A.; Wilson, J. W.

2003-01-01

Radiation protection is essential to enable humans to live and work safely in space. Predictions about the nature and magnitude of the risks posed by space radiation are subject to very large uncertainties. Prudent use of worst-case scenarios may impose unacceptable constraints on shielding mass for spacecraft or habitats, tours of duty of crews on Space Station, and on the radius and duration of sorties on planetary surfaces. The NASA Space Radiation Health Program has been devised to develop the knowledge required to accurately predict and to efficiently manage radiation risk. The knowledge will be acquired by means of a peer-reviewed, largely ground-based and investigator-initiated, basic science research program. The NASA Strategic Plan to accomplish these objectives in a manner consistent with the high priority assigned to the protection and health maintenance of crews will be presented. Published by Elsevier Science Ltd on behalf of COSPAR.

Impact of computer-assisted data collection, evaluation and management on the cancer genetic counselor's time providing patient care.

PubMed

Cohen, Stephanie A; McIlvried, Dawn E

2011-06-01

Cancer genetic counseling sessions traditionally encompass collecting medical and family history information, evaluating that information for the likelihood of a genetic predisposition for a hereditary cancer syndrome, conveying that information to the patient, offering genetic testing when appropriate, obtaining consent and subsequently documenting the encounter with a clinic note and pedigree. Software programs exist to collect family and medical history information electronically, intending to improve efficiency and simplicity of collecting, managing and storing this data. This study compares the genetic counselor's time spent in cancer genetic counseling tasks in a traditional model and one using computer-assisted data collection, which is then used to generate a pedigree, risk assessment and consult note. Genetic counselor time spent collecting family and medical history and providing face-to-face counseling for a new patient session decreased from an average of 85-69 min when using the computer-assisted data collection. However, there was no statistically significant change in overall genetic counselor time on all aspects of the genetic counseling process, due to an increased amount of time spent generating an electronic pedigree and consult note. Improvements in the computer program's technical design would potentially minimize data manipulation. Certain aspects of this program, such as electronic collection of family history and risk assessment, appear effective in improving cancer genetic counseling efficiency while others, such as generating an electronic pedigree and consult note, do not.

Risk management.

PubMed

Chambers, David W

2010-01-01

Every plan contains risk. To proceed without planning some means of managing that risk is to court failure. The basic logic of risk is explained. It consists in identifying a threshold where some corrective action is necessary, the probability of exceeding that threshold, and the attendant cost should the undesired outcome occur. This is the probable cost of failure. Various risk categories in dentistry are identified, including lack of liquidity; poor quality; equipment or procedure failures; employee slips; competitive environments; new regulations; unreliable suppliers, partners, and patients; and threats to one's reputation. It is prudent to make investments in risk management to the extent that the cost of managing the risk is less than the probable loss due to risk failure and when risk management strategies can be matched to type of risk. Four risk management strategies are discussed: insurance, reducing the probability of failure, reducing the costs of failure, and learning. A risk management accounting of the financial meltdown of October 2008 is provided.

[The implementation of strategy of medicinal support in multi-type hospital].

PubMed

Ludupova, E Yu

2016-01-01

The article presents brief review of implementation of strategy of medicinal support of population of the Russian Federation and experience of application of at the level of regional hospital. The necessity and importance of implementation into practice of hospitals of methodology of pharmaco-economical management of medicinal care using modern technologies of XYZ-, ABC and VEN-analysis is demonstrated. The stages of development and implementation of process of medicinal support of multifield hospital applying principles of system of quality management (processing and systemic approaches, risk management) on the basis of standards ISO 9001 are described. The significance of monitoring of results ofprocess of medicinal support of the basis of implementation of priority target programs (prevention of venous thrombo-embolic complications, system od control of anti-bacterial therapy) are demonstrated in relation to multi-field hospital using technique of ATC/DDD-analysis for evaluating indices of effectiveness and efficiency.

Performance Evaluation of UHF RFID Technologies for Real-Time Bus Recognition in the Taipei Bus Station

PubMed Central

Own, Chung-Ming; Lee, Da-Sheng; Wang, Ti-Ho; Wang, De-Jun; Ting, Yu-Lun

2013-01-01

Transport stations such as airports, ports, and railways have adopted blocked-type pathway management to process and control travel systems in a one-directional manner. However, this excludes highway transportation where large buses have great variability and mobility; thus, an instant influx of numerous buses increases risks and complicates station management. Focusing on Taipei Bus Station, this study employed RFID technology to develop a system platform integrated with modern information technology that has numerous characteristics. This modern information technology comprised the following systems: ultra-high frequency (UHF) radio-frequency identification (RFID), ultrasound and license number identification, and backstage graphic controls. In conclusion, the system enabled management, bus companies, and passengers to experience the national bus station's new generation technology, which provides diverse information and synchronization functions. Furthermore, this technology reached a new milestone in the energy-saving and efficiency-increasing performance of Taiwan's buses. PMID:23778192

Green supply chain management strategy selection using analytic network process: case study at PT XYZ

NASA Astrophysics Data System (ADS)

Adelina, W.; Kusumastuti, R. D.

2017-01-01

This study is about business strategy selection for green supply chain management (GSCM) for PT XYZ by using Analytic Network Process (ANP). GSCM is initiated as a response to reduce environmental impacts from industrial activities. The purposes of this study are identifying criteria and sub criteria in selecting GSCM Strategy, and analysing a suitable GSCM strategy for PT XYZ. This study proposes ANP network with 6 criteria and 29 sub criteria, which are obtained from the literature and experts’ judgements. One of the six criteria contains GSCM strategy options, namely risk-based strategy, efficiency-based strategy, innovation-based strategy, and closed loop strategy. ANP solves complex GSCM strategy-selection by using a more structured process and considering green perspectives from experts. The result indicates that innovation-based strategy is the most suitable green supply chain management strategy for PT XYZ.

Research on Risk Management and Power Supplying Enterprise Control

NASA Astrophysics Data System (ADS)

Shen, Jianfei; Wang, Yige

2017-09-01

This paper derived from the background that electric power enterprises strengthen their risk management under requirements of the government. For the power industry, we explained the risk management theory, analysed current macro environment as well as basic situation, then classified and interpreted the main risks. In a case study on a power bureau, we established a risk management system based on deep understanding about the characteristics of its organization system and risk management function. Then, we focused on risks in operation as well as incorrupt government construction to give a more effective framework of the risk management system. Finally, we came up with the problems and specific countermeasures in risk management, which provided a reference for other electric power enterprises.

Calysto: Risk Management for Commercial Manned Spaceflight

NASA Technical Reports Server (NTRS)

Dillaman, Gary

2012-01-01

The Calysto: Risk Management for Commercial Manned Spaceflight study analyzes risk management in large enterprises and how to effectively communicate risks across organizations. The Calysto Risk Management tool developed by NASA's Kennedy Space Center's SharePoint team is used and referenced throughout the study. Calysto is a web-base tool built on Microsoft's SharePoint platform. The risk management process at NASA is examined and incorporated in the study. Using risk management standards from industry and specific organizations at the Kennedy Space Center, three methods of communicating and elevating risk are examined. Each method describes details of the effectiveness and plausibility of using the method in the Calysto Risk Management Tool. At the end of the study suggestions are made for future renditions of Calysto.

Influence of green supply chain risk management on performance of Chinese manufacturing enterprises

NASA Astrophysics Data System (ADS)

Zhang, Dongying; Yuting, Duan; Junyi, Shen

2017-12-01

This paper briefly introduces the background of the research on the impact of green supply chain risk management on corporate performance, reviews the relevant research literature at home and abroad, and uses the gray relational analysis to analyze the impact of the green supply chain risk management on enterprise performance based on 26 industry-related statistical data, from purchasing risk management performance,manufacturing risk management performance and marketing risk management performance.

Understanding growers' decisions to manage invasive pathogens at the farm level.

PubMed

Breukers, Annemarie; van Asseldonk, Marcel; Bremmer, Johan; Beekman, Volkert

2012-06-01

Globalization causes plant production systems to be increasingly threatened by invasive pests and pathogens. Much research is devoted to support management of these risks. Yet, the role of growers' perceptions and behavior in risk management has remained insufficiently analyzed. This article aims to fill this gap by addressing risk management of invasive pathogens from a sociopsychological perspective. An analytical framework based on the Theory of Planned Behavior was used to explain growers' decisions on voluntary risk management measures. Survey information from 303 Dutch horticultural growers was statistically analyzed, including regression and cluster analysis. It appeared that growers were generally willing to apply risk management measures, and that poor risk management was mainly due to perceived barriers, such as high costs and doubts regarding efficacy of management measures. The management measures applied varied considerably among growers, depending on production sector and farm-specific circumstances. Growers' risk perception was found to play a role in their risk management, although the causal relation remained unclear. These results underscore the need to apply a holistic perspective to farm level management of invasive pathogen risk, considering the entire package of management measures and accounting for sector- and farm-specific circumstances. Moreover, they demonstrate that invasive pathogen risk management can benefit from a multidisciplinary approach that incorporates growers' perceptions and behavior.

IEC 61511 and the capital project process--a protective management system approach.

PubMed

Summers, Angela E

2006-03-17

This year, the process industry has reached an important milestone in process safety-the acceptance of an internationally recognized standard for safety instrumented systems (SIS). This standard, IEC 61511, documents good engineering practice for the assessment, design, operation, maintenance, and management of SISs. The foundation of the standard is established by several requirements in Part 1, Clauses 5-7, which cover the development of a management system aimed at ensuring that functional safety is achieved. The management system includes a quality assurance process for the entire SIS lifecycle, requiring the development of procedures, identification of resources and acquisition of tools. For maximum benefit, the deliverables and quality control checks required by the standard should be integrated into the capital project process, addressing safety, environmental, plant productivity, and asset protection. Industry has become inundated with a multitude of programs focusing on safety, quality, and cost performance. This paper introduces a protective management system, which builds upon the work process identified in IEC 61511. Typical capital project phases are integrated with the management system to yield one comprehensive program to efficiently manage process risk. Finally, the paper highlights areas where internal practices or guidelines should be developed to improve program performance and cost effectiveness.

Health promotion and disease prevention: a look at demand management programs.

PubMed

Fronstin, P

1996-09-01

This Issue Brief describes employers' efforts to contain health expenditures through demand management programs. These programs are designed to reduce utilization by focusing on disease prevention and health promotion. Demand management includes work site health promotion, wellness programs, and access management. Work site health promotion is a comprehensive approach to improving health and includes awareness, health education, behavioral change, and organizational health initiatives. Wellness programs usually include stress management, smoking cessation, weight management, back care, health screenings, nutrition education, work place safety, prenatal and well baby care, CPR and first aid classes, and employee assistance programs (EAPs). These programs are often viewed positively by workers and can have long-term benefits for employers above and beyond health care cost containment. Demand management can benefit employers by increasing productivity, employee retention, and employee morale and by reducing turnover, absenteeism, future medical claims, and ultimately expenditures on health care. Even though a growing number of employers are offering wellness programs, only 37 percent of full-time workers employed in medium and large private establishments were eligible for wellness programs by 1993. However, a recent survey found that 88 percent of major employers have introduced some form of health promotion, disease prevention, or early intervention initiative to encourage healthy lifestyles among their salaried employees. Distinctions must be drawn between short- and long-term strategies. Demand management can be thought of as a short-term strategy when the focus of the program is on creating more appropriate and efficient health care utilization. Disease prevention is characterized by longer-term health improvement objectives. Whether the purpose is to reduce utilization in the short term or in the long term, the ultimate goal remains the same: to reduce health care expenditures while improving overall health. This goal can be achieved through the use of health risk appraisals, organizational health risk appraisals, high risk programs, awareness programs, medical call centers, return to work programs, EAPs, and smoking cessation programs. Studies of a health program's cost effectiveness must disentangle the effects of many competing factors on cost effectiveness. For example, a health risk appraisal program may identify health problems of which the patient and the health care provider were unaware, resulting in the treatment of these health problems. At the same time, the employer may have switched from a nonmanaged pharmaceutical program to a managed program with incentives for participants to utilize generic and/or mail order drugs. As a result, when evaluating a health promotion program, the long-run impact on the program's cost effectiveness is most important.

Risk Management Implementation Tool

NASA Technical Reports Server (NTRS)

Wright, Shayla L.

2004-01-01

Continuous Risk Management (CM) is a software engineering practice with processes, methods, and tools for managing risk in a project. It provides a controlled environment for practical decision making, in order to assess continually what could go wrong, determine which risk are important to deal with, implement strategies to deal with those risk and assure the measure effectiveness of the implemented strategies. Continuous Risk Management provides many training workshops and courses to teach the staff how to implement risk management to their various experiments and projects. The steps of the CRM process are identification, analysis, planning, tracking, and control. These steps and the various methods and tools that go along with them, identification, and dealing with risk is clear-cut. The office that I worked in was the Risk Management Office (RMO). The RMO at NASA works hard to uphold NASA s mission of exploration and advancement of scientific knowledge and technology by defining and reducing program risk. The RMO is one of the divisions that fall under the Safety and Assurance Directorate (SAAD). I worked under Cynthia Calhoun, Flight Software Systems Engineer. My task was to develop a help screen for the Continuous Risk Management Implementation Tool (RMIT). The Risk Management Implementation Tool will be used by many NASA managers to identify, analyze, track, control, and communicate risks in their programs and projects. The RMIT will provide a means for NASA to continuously assess risks. The goals and purposes for this tool is to provide a simple means to manage risks, be used by program and project managers throughout NASA for managing risk, and to take an aggressive approach to advertise and advocate the use of RMIT at each NASA center.

Peri-operative management of high-risk paediatric adenotonsillectomy patients: A survey of 35 UK tertiary referral centres.

PubMed

Cheong, Ryan Chin Taw; Bowles, Philippe; Moore, Andrew; Watts, Simon

2017-05-01

Peri-operative management of high-risk paediatric patients undergoing adenotonsillectomy for treatment of obstructive sleep apnoea varies between tertiary referral hospitals. 'Day of surgery cancellation' (DoSC) rates of up to 11% have been reported due to pre-booked critical care being unavailable on the day of surgery as a result of competing needs from other hospital departments. We report the results of a survey of peri-operative management in UK tertiary care centres of high-risk paediatric patients undergoing adenotonsillectomy for obstructive sleep apnoea (OSA). An 8-point questionnaire was developed using a cloud-based software platform (www.surveymonkey.com). A web-link to the survey was embedded in a customised e-mail which was sent via secure server to the Clinical Leads for Paediatric Otolaryngology at 35 United Kingdom (UK) Tertiary referral centres. The survey response rate was 60% (n = 21). Almost all (94.1%) of centres considered paediatric critical care facilities to be limited, with 70.6% (n = 12) stating that DoSC often occurred due to unavailable paediatric critical care capacity. There was variation between tertiary referral units in the practice applied for pre-booking critical care beds (our survey identifies 6 variations) (Table 1). The most frequent selection method reported (47.1%) was at the discretion of the booking clinician at the time of listing the patient for surgery. In the context of limited critical care resources, variation in practice and difficulty in accurately predicting which patients will require post-operative critical care beds, a review and consensus on best practice in the peri-operative management of high risk paediatric adenotonsillectomy patients may offer a safe means of reducing cancellations and improving patient care, resource allocation and hospital efficiency. Copyright © 2017 Elsevier B.V. All rights reserved.

Information Risk Management and Resilience

NASA Astrophysics Data System (ADS)

Dynes, Scott

Are the levels of information risk management efforts within and between firms correlated with the resilience of the firms to information disruptions? This paper examines the question by considering the results of field studies of information risk management practices at organizations and in supply chains. The organizations investigated differ greatly in the degree of coupling from a general and information risk management standpoint, as well as in the levels of internal awareness and activity regarding information risk management. The comparison of the levels of information risk management in the firms and their actual or inferred resilience indicates that a formal information risk management approach is not necessary for resilience in certain sectors.

Optimal medical outcomes with limited liability: risk management principles for medical practices at the intersection of medicine, law, and business.

PubMed

Paterick, Timothy J; Paterick, Timothy E; Waterhouse, Blake E

2007-01-01

Physicians practice at the intersection of medicine, law, and business. Each discipline creates its own challenges for the practicing physician: to practice efficient, effective medicine; to limit potential liability; and to create a positive financial outcome. Those challenges increase with escalating costs and reduced reimbursements. In this paper, the common clinical presentation of chest pain has been used to create a paradigm to educate physicians to understand efficient and effective approaches to diagnosis and treatment, and how effective communication with patients and meticulous documentation of all medical encounters can limit the potential for liability. Ultimately, given today's reimbursement formulas, physicians must also understand the cost of testing, in relation to its benefits, in an attempt to yield a positive financial outcome.

Hypertension: New perspective on its definition and clinical management by bedtime therapy substantially reduces cardiovascular disease risk.

PubMed

Hermida, Ramón C; Ayala, Diana E; Fernández, José R; Mojón, Artemio; Smolensky, Michael H

2018-05-01

Diagnosis of hypertension-elevated blood pressure (BP) associated with increased cardiovascular disease (CVD) risk-and its management for decades have been based primarily on single time-of-day office BP measurements (OBPM) assumed representative of systolic (SBP) and diastolic BP (DBP) during the entire 24-hours span. Around-the-clock ambulatory blood pressure monitoring (ABPM), however, reveals BP undergoes 24-hours patterning characterized in normotensives and uncomplicated hypertensives by striking morning-time rise, 2 daytime peaks-one ~2-3 hours after awakening and the other early evening, small midafternoon nadir and 10-20% decline (BP dipping) in the asleep BP mean relative to the wake-time BP mean. A growing number of outcome trials substantiate correlation between BP and target organ damage, vascular and other risks is greater for the ABPM-derived asleep BP mean, independent and stronger predictor of CVD risk, than daytime OBPM or ABPM-derived awake BP. Additionally, bedtime hypertension chronotherapy, that is, ingestion of ≥1 conventional hypertension medications at bedtime to achieve efficient attenuation of asleep BP, better reduces total CVD events by 61% and major events (CVD death, myocardial infarction, ischaemic and haemorrhagic stroke) by 67%-even in more vulnerable chronic kidney disease, diabetes and resistant hypertension patients-than customary on-awaking therapy that targets wake-time BP. Such findings of around-the-clock ABPM and bedtime hypertension outcome trials, consistently indicating greater importance of asleep BP than daytime OBPM or ambulatory awake BP, call for a new definition of true arterial hypertension plus modern approaches for its diagnosis and management. © 2018 Stichting European Society for Clinical Investigation Journal Foundation.

Research on Risk Manage of Power Construction Project Based on Bayesian Network

NASA Astrophysics Data System (ADS)

Jia, Zhengyuan; Fan, Zhou; Li, Yong

With China's changing economic structure and increasingly fierce competition in the market, the uncertainty and risk factors in the projects of electric power construction are increasingly complex, the projects will face huge risks or even fail if we don't consider or ignore these risk factors. Therefore, risk management in the projects of electric power construction plays an important role. The paper emphatically elaborated the influence of cost risk in electric power projects through study overall risk management and the behavior of individual in risk management, and introduced the Bayesian network to the project risk management. The paper obtained the order of key factors according to both scene analysis and causal analysis for effective risk management.

Advanced Endoscopic Imaging for Surveillance for Dysplasia and Colorectal Cancer in inflammatory Bowel Disease: Could the Pathologist be Further Helped?

PubMed Central

Sinagra, Emanuele; Tomasello, Giovanni; Raimondo, Dario; Sturm, Andreas; Giunta, Marco; Messina, Marco; Damiano, Giuseppe; Palumbo, Vincenzo D.; Spinelli, Gabriele; Rossi, Francesca; Facella, Tiziana; Marasà, Salvatore; Cottone, Mario; Lo Monte, Attilio I.

2014-01-01

Patients with inflammatory bowel disease (IBD) have an increased risk of developing intestinal cancer. The magnitude of that increased risk as well as how best to mitigate it remain a topic of ongoing investigation in the field. It is important to quantify the risk of colorectal cancer in association with IBD. The reported risk varies widely between studies. This is partly due to the different methodologies used in the studies. Because of the limitations of surveillance strategies based on the detection of dysplasia, advanced endoscopic imaging and techniques involving the detection of alterations in mucosal antigens and genetic abnormalities are being investigated. Development of new biomarkers, predicting future occurrence of colonic neoplasia may lead to more biomarker-based surveillance. There are promising results that may lead to more efficient surveillance in IBD patients and more general acceptance of its use. A multidisciplinary approach, involving in particular endoscopists and pathologists, together with a centralized patient management, could help to optimize treatments and follow-up measures, both of which could help to reduce the IBD-associated cancer risk. PMID:24496155

Sufentanil sublingual tablet system for the management of postoperative pain.

PubMed

Babazade, Rovnat; Turan, Alparslan

2016-12-01

Intravenous patient-controlled opioid analgesia has been an important improvement in addressing insufficient management of acute postoperative pain for over 40 years. However, there are number of weaknesses for intravenous patient-controlled analgesia, including operator and device error, intravenous line patency issues, and risk of catheter-related infection, all of which contribute to the complications and increase in cost of care. The sublingual sufentanil tablet system is a major evolution in both drug and technological management of postoperative pain. Areas covered: We reviewed the use of the sublingual sufentanil tablet system in management of moderate to severe postoperative pain in hospitalized patients, with a particular focus on the pharmacological properties of sufentanil and clinical use in different surgical patients. Expert opinion: The sublingual sufentanil tablet system can decrease intravenous opioid based patient-controlled analgesia related complications and safety issues. Current clinical studies have demonstrated this noninvasive-novel system to be safe and effective in management of acute pain in the postsurgical setting. Researchers should focus on comparing it with other available patient controlled analgesia modalities and evaluating the efficiency and cost effectiveness of the sublingual sufentanil tablet system.

Catchment scale assessment of risk posed by traffic generated heavy metals and polycyclic aromatic hydrocarbons.

PubMed

Ma, Yukun; McGree, James; Liu, An; Deilami, Kaveh; Egodawatta, Prasanna; Goonetilleke, Ashantha

2017-10-01

Heavy metals (HMs) and polycyclic aromatic hydrocarbons (PAHs) are among the most toxic chemical pollutants present in urban stormwater. Consequently, urban stormwater reuse is constrained due to the human health risk posed by these pollutants. This study developed a scientifically robust approach to assess the risk to human health posed by HMs and PAHs in urban stormwater in order to enhance its reuse. Accordingly, an innovative methodology was created consisting of four stages: quantification of traffic and land use parameters; estimation of pollutant concentrations for model development; risk assessment, and risk map presentation. This methodology will contribute to catchment scale assessment of the risk associated with urban stormwater and for risk mitigation. The risk map developed provides a simple and efficient approach to identify the critical areas within a large catchment. The study also found that heavy molecular weight PAHs (PAHs with 5-6 benzene rings) in urban stormwater pose higher risk to human health compared to light molecular PAHs (PAHs with 2-4 benzene rings). These outcomes will facilitate the development of practical approaches for applying appropriate mitigation measures for the safe management of urban stormwater pollution and for the identification of enhanced reuse opportunities. Copyright © 2017 Elsevier Inc. All rights reserved.

12 CFR 917.3 - Risk management.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 8 2012-01-01 2012-01-01 false Risk management. 917.3 Section 917.3 Banks and Banking FEDERAL HOUSING FINANCE BOARD GOVERNANCE AND MANAGEMENT OF THE FEDERAL HOME LOAN BANKS POWERS AND RESPONSIBILITIES OF BANK BOARDS OF DIRECTORS AND SENIOR MANAGEMENT § 917.3 Risk management. (a) Risk management...