Sample records for facility risks reduced

  1. Proliferation resistance assessments during the design phase of a recycling facility as a means of reducing proliferation risks

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

    Lindell, M.A.; Grape, S.; Haekansson, A.

    The sustainability criterion for Gen IV nuclear energy systems inherently presumes the availability of efficient fuel recycling capabilities. One area for research on advanced fuel recycling concerns safeguards aspects of this type of facilities. Since a recycling facility may be considered as sensitive from a non-proliferation perspective, it is important to address these issues early in the design process, according to the principle of Safeguards By Design. Presented in this paper is a mode of procedure, where assessments of the proliferation resistance (PR) of a recycling facility for fast reactor fuel have been performed so as to identify the weakestmore » barriers to proliferation of nuclear material. Two supplementing established methodologies have been applied; TOPS (Technological Opportunities to increase Proliferation resistance of nuclear power Systems) and PR-PP (Proliferation Resistance and Physical Protection evaluation methodology). The chosen fuel recycling facility belongs to a small Gen IV lead-cooled fast reactor system that is under study in Sweden. A schematic design of the recycling facility, where actinides are separated using solvent extraction, has been examined. The PR assessment methodologies make it possible to pinpoint areas in which the facility can be improved in order to reduce the risk of diversion. The initial facility design may then be slightly modified and/or safeguards measures may be introduced to reduce the total identified proliferation risk. After each modification of design and/or safeguards implementation, a new PR assessment of the revised system can then be carried out. This way, each modification can be evaluated and new ways to further enhance the proliferation resistance can be identified. This type of iterative procedure may support Safeguards By Design in the planning of new recycling plants and other nuclear facilities. (authors)« less

  2. Can facility delivery reduce the risk of intrapartum complications-related perinatal mortality? Findings from a cohort study.

    PubMed

    Khanam, Rasheda; Baqui, Abdullah H; Syed, Mamun Ibne Moin; Harrison, Meagan; Begum, Nazma; Quaiyum, Abdul; Saha, Samir K; Ahmed, Saifuddin

    2018-06-01

    Intrapartum complications increase the risk of perinatal deaths. However, population-based data from developing countries assessing the contribution of intrapartum complications to perinatal deaths is scarce. Using data from a cohort of pregnant women followed between 2011 and 2013 in Bangladesh, this study examined the rate and types of intrapartum complications, the association of intrapartum complications with perinatal mortality, and if facility delivery modified the risk of intrapartum-related perinatal deaths. Trained community health workers (CHWs) made two-monthly home visits to identify pregnant women, visited them twice during pregnancy and 10 times in the first two months postpartum. During prenatal visits, CHWs collected data on women's prior obstetric history, socio-demographic status, and complications during pregnancy. They collected data on intrapartum complications, delivery care, and pregnancy outcome during the first postnatal visit within 7 days of delivery. We examined the association of intrapartum complications and facility delivery with perinatal mortality by estimating odds ratios (OR) and 95% confidence intervals (CI) adjusting for covariates using multivariable logistic regression analysis. The overall facility delivery rate was low (3922/24 271; 16.2%). Any intrapartum complications among pregnant women were 20.9% (5,061/24,271) and perinatal mortality was 64.7 per 1000 birth. Compared to women who delivered at home, the risk of perinatal mortality was 2.4 times higher (OR = 2.40; 95% CI = 2.08-2.76) when delivered in a public health facility and 1.3 times higher (OR = 1.32, 95% CI = 1.06-1.64) when delivered in a private health facility. Compared to women who had no intrapartum complications and delivered at home, women with intrapartum complications who delivered at home had a substantially higher risk of perinatal mortality (OR = 3.45; 95% CI = 3.04-3.91). Compared to women with intrapartum complications who

  3. Reducing drinking water supply chemical contamination: risks from underground storage tanks.

    PubMed

    Enander, Richard T; Hanumara, R Choudary; Kobayashi, Hisanori; Gagnon, Ronald N; Park, Eugene; Vallot, Christopher; Genovesi, Richard

    2012-12-01

    Drinking water supplies are at risk of contamination from a variety of physical, chemical, and biological sources. Ranked among these threats are hazardous material releases from leaking or improperly managed underground storage tanks located at municipal, commercial, and industrial facilities. To reduce human health and environmental risks associated with the subsurface storage of hazardous materials, government agencies have taken a variety of legislative and regulatory actions--which date back more than 25 years and include the establishment of rigorous equipment/technology/operational requirements and facility-by-facility inspection and enforcement programs. Given a history of more than 470,000 underground storage tank releases nationwide, the U.S. Environmental Protection Agency continues to report that 7,300 new leaks were found in federal fiscal year 2008, while nearly 103,000 old leaks remain to be cleaned up. In this article, we report on an alternate evidence-based intervention approach for reducing potential releases from the storage of petroleum products (gasoline, diesel, kerosene, heating/fuel oil, and waste oil) in underground tanks at commercial facilities located in Rhode Island. The objective of this study was to evaluate whether a new regulatory model can be used as a cost-effective alternative to traditional facility-by-facility inspection and enforcement programs for underground storage tanks. We conclude that the alternative model, using an emphasis on technical assistance tools, can produce measurable improvements in compliance performance, is a cost-effective adjunct to traditional facility-by-facility inspection and enforcement programs, and has the potential to allow regulatory agencies to decrease their frequency of inspections among low risk facilities without sacrificing compliance performance or increasing public health risks. © 2012 Society for Risk Analysis.

  4. Does vibration training reduce the fall risk profile of frail older people admitted to a rehabilitation facility? A randomised controlled trial.

    PubMed

    Parsons, J; Mathieson, S; Jull, A; Parsons, M

    2016-01-01

    To determine the effect of Vibration Training (VT) on functional ability and falls risk among a group of frail older people admitted to an inpatient rehabilitation unit in a regional hospital in New Zealand. A randomized controlled trial of 56 participants (mean 82.01 years in the intervention group and 81.76 years in the control group). VT targeting lower limb muscles with a frequency 30-50 Hz occurred three times per week until discharge. Amplitude progressively increased from 2 to 5 mm to allow the programme to be individually tailored to the participant. The control group received usual care physiotherapy sessions. Outcome measures were: Physiological profile assessment (PPA); and Functional Independence measure (FIM) and Modified Falls Efficacy Scale (MFES). There was a statistically significant difference observed between the two groups in terms of FIM score (F = 5.09, p = 0.03) and MFES (F = 3.52, p = 0.007) but no difference was observed in terms of PPA scores (F = 0.96, p = 0.36). Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of VT in conjunction with usual care physiotherapy in terms of improved functional ability. The study design and the small dosage of VT provided may have precluded any change in falls risk among participants. Vibration training (VT) may assist in reducing the risk of falling among at risk older people. Current pressures on health systems (ageing population, reduced hospital length of stay) necessitate the development of innovative strategies to maximise the rehabilitation potential of older people. Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of vibration training in conjunction with usual care physiotherapy in terms of improved functional ability.

  5. What Are Nursing Facilities Doing to Reduce Potentially Avoidable Hospitalizations?

    PubMed

    Daras, Laura Coots; Wang, Joyce M; Ingber, Melvin J; Ormond, Catherine; Breg, Nathaniel W; Khatutsky, Galina; Feng, Zhanlian

    2017-05-01

    Hospitalizations among nursing facility residents are frequent and often potentially avoidable. A number of initiatives and interventions have been developed to reduce excessive hospitalizations; however, little is known about the specific approaches nursing facilities use to address this issue. The objective of this study is to better understand which types of interventions nursing facilities have introduced to reduce potentially avoidable hospitalizations of long-stay nursing facility residents. Cross-sectional survey. 236 nursing facilities from 7 states. Nursing facility administrators. Web-based survey to measure whether facilities introduced any policies or procedures designed specifically to reduce potentially avoidable hospitalizations of long-stay nursing facility residents between 2011 and 2015. We surveyed facilities about seven types of interventions and quality improvement activities related to reducing avoidable hospitalizations, including use of Interventions to Reduce Acute Care Transfers (INTERACT) and American Medical Directors Association tools. Ninety-five percent of responding nursing facilities reported having introduced at least one new policy or procedure to reduce nursing facility resident hospitalizations since January 2011. The most common practice reported was hospitalization rate tracking or review, followed by standardized communication tools, such as Situation, Background, Assessment, Recommendation (SBAR). We found some variation in the extent and types of these reported interventions. Nearly all facilities surveyed reported having introduced a variety of initiatives to reduce potentially avoidable hospitalizations, likely driven by federal, state, and corporate initiatives to decrease hospital admissions and readmissions. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.

  6. Risk management study for the retired Hanford Site facilities: Qualitative risk evaluation for the retired Hanford Site facilities. Volume 3

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

    Coles, G.A.; Shultz, M.V.; Taylor, W.E.

    1993-09-01

    This document provides a risk evaluation of the 100 and 200 Area retired, surplus facilities on the Hanford Site. Also included are the related data that were compiled by the risk evaluation team during investigations performed on the facilities. Results are the product of a major effort performed in fiscal year 1993 to produce qualitative information that characterizes certain risks associated with these facilities. The retired facilities investigated for this evaluation are located in the 100 and 200 Areas of the 1,450-km{sup 2} (570-mi{sup 2}) Hanford Site. The Hanford Site is a semiarid tract of land in southeastern Washington State.more » The nearest population center is Richland, Washington, (population 32,000) 30-km (20 mi) southeast of the 200 Area. During walkdown investigations of these facilities, data on real and potential hazards that threatened human health or safety or created potential environmental release issues were identified by the risk evaluation team. Using these findings, the team categorized the identified hazards by facility and evaluated the risk associated with each hazard. The factors contributing to each risk, and the consequence and likelihood of harm associated with each hazard also are included in this evaluation.« less

  7. Design of Work Facilities for Reducing Musculoskeletal Disorders Risk in Paper Pallet Assembly Station

    NASA Astrophysics Data System (ADS)

    Mardi Safitri, Dian; Arfi Nabila, Zahra; Azmi, Nora

    2018-03-01

    Musculoskeletal Disorders (MSD) is one of the ergonomic risks due to manual activity, non-neutral posture and repetitive motion. The purpose of this study is to measure risk and implement ergonomic interventions to reduce the risk of MSD on the paper pallet assembly work station. Measurements to work posture are done by Ovako Working Posture Analysis (OWAS) methods and Rapid Entire Body Assessment (REBA) method, while the measurement of work repetitiveness was using Strain Index (SI) method. Assembly processes operators are identified has the highest risk level. OWAS score, Strain Index, and REBA values are 4, 20.25, and 11. Ergonomic improvements are needed to reduce that level of risk. Proposed improvements will be developed using the Quality Function Deployment (QFD) method applied with Axiomatic House of Quality (AHOQ) and Morphological Chart. As the result, risk level based on OWAS score & REBA score turn out from 4 & 11 to be 1 & 2. Biomechanics analysis of the operator also shows the decreasing values for L4-L5 moment, compression, joint shear, and joint moment strength.

  8. Understanding the impact of supervision on reducing medication risks: an interview study in long-term elderly care.

    PubMed

    Vermeulen, J A; Kleefstra, S M; Zijp, E M; Kool, R B

    2017-07-06

    In 2009, the Dutch Health Care Inspectorate (IGZ) observed several serious risks to safety involving medication within elderly care facilities. However, by 2011, high risks had been reduced in almost all the organisations we visited. And yet the IGZ analysed too the alarming increase in the number of incidents arising in the self-reported national indicator of medication safety between 2009 and 2010. The aim of this study was to understand the factors that can explain this contradiction between the increase in self-reported medication incidents and the observation of the IGZ in reducing the risks to medication safety through supervision. We interviewed health care professionals of ten care facilities, visited by the IGZ, who were involved in, or responsible for, the improvement of medication safety in their institutions. As outcome measures we used the rate of medication safety risk per facility; the perceptions of the participant with regard to the reports of medication incidents; the level of medication safety of the facility; the measures used to improve medication safety; and the supervision of medication safety. This was a mixed methods study, qualitative in that we used semi-structured interviews, and quantitative, by calculating risks for the different organisations we visited. The findings from both study methods resulted in a comprehensive view and an in-depth understanding of this contradiction. The contradiction between the increase in self-reported medication incidents and the observation of reduced risks was explained by three themes: activities designed to improve medication safety, the reporting of medication incidents, and, lastly, the impact of supervision. The focus of the IGZ on issues of medication safety stimulated most elderly care facilities to reduce medication risks. Also, a change in the culture of reporting incidents caused an increase in the number of reported incidents. Supervision contributed to an improvement in actions geared towards

  9. Cost-Effectiveness Analysis of Interventions to Reduce Risk of Aspiration in Elderly Cancer Survivors Residing in Skilled Nursing Facilities.

    PubMed

    Mantravadi, S

    2017-04-01

    Aspiration can occur in patients of any age group, but it can be prevented. The primary population at risk is made up of survivors of cancer because of their increased risk of mucositis, mucosal atrophy, and dysphagia associated with chemotherapy, radiotherapy, and the disease process itself. The rate of incidence of aspiration cannot be quantified, because minor cases of aspiration often go unreported. Sequelae ensuing from aspirations can include pneumonia, end-stage kidney disease, dialysis, and death. Analyses of cost, decision-tree modeling, and cost effectiveness were performed to compare a hypothetical, interventional model based on best practices with usual (standard) care. A societal perspective was used as the economic view point. Direct costs, caregiver time, and market values for wages were estimated for the 2 interventions. Effectiveness values for the cost-effectiveness and decision-tree analyses were obtained from the literature. The incremental-cost-effectiveness ratio was calculated and used to compare the intervention with usual care. The interventional method was more costly but more effective than usual care. A sensitivity analysis considered the uncertainty of event probability (aspiration vs no aspiration). The interventional protocol for aspiration reduction continued to be more cost effective than usual care. Aspiration takes a financial toll on all facets of health care, including on nurses, skilled nursing facilities, patients, their families, and insurers, among others. Implementing guidelines that describe best practices for aspiration appears to be a cost-effective strategy for reducing aspirations among cancer survivors - especially elderly patients - who live in skilled nursing facilities.

  10. Bioaerosol releases from compost facilities: Evaluating passive and active source terms at a green waste facility for improved risk assessments

    NASA Astrophysics Data System (ADS)

    Taha, M. P. M.; Drew, G. H.; Longhurst, P. J.; Smith, R.; Pollard, S. J. T.

    The passive and active release of bioaerosols during green waste composting, measured at source is reported for a commercial composting facility in South East (SE) England as part of a research programme focused on improving risk assessments at composting facilities. Aspergillus fumigatus and actinomycetes concentrations of 9.8-36.8×10 6 and 18.9-36.0×10 6 cfu m -3, respectively, measured during the active turning of green waste compost, were typically 3-log higher than previously reported concentrations from static compost windrows. Source depletion curves constructed for A. fumigatus during compost turning and modelled using SCREEN3 suggest that bioaerosol concentrations could reduce to background concentrations of 10 3 cfu m -3 within 100 m of this site. Authentic source term data produced from this study will help to refine the risk assessment methodologies that support improved permitting of compost facilities.

  11. Reducing health risk assigned to organic emissions from a chemical weapons incinerator.

    PubMed

    Laman, David M; Weiler, B Douglas; Skeen, Rodney S

    2013-03-01

    Organic emissions from a chemical weapons incinerator have been characterized with an improved set of analytical methods to reduce the human health risk assigned to operations of the facility. A gas chromatography/mass selective detection method with substantially reduced detection limits has been used in conjunction with scanning electron microscopy/energy dispersive X-ray spectrometry and Fourier transform infrared microscopy to improve the speciation of semi-volatile and non-volatile organics emitted from the incinerator. The reduced detection limits have allowed a significant reduction in the assumed polycyclic aromatic hydrocarbon (PAH) and aminobiphenyl (ABP) emission rates used as inputs to the human health risk assessment for the incinerator. A mean factor of 17 decrease in assigned human health risk is realized for six common local exposure scenarios as a result of the reduced PAH and ABP detection limits.

  12. Reducing the Risk of Human Space Missions with INTEGRITY

    NASA Technical Reports Server (NTRS)

    Jones, Harry W.; Dillon-Merill, Robin L.; Tri, Terry O.; Henninger, Donald L.

    2003-01-01

    The INTEGRITY Program will design and operate a test bed facility to help prepare for future beyond-LEO missions. The purpose of INTEGRITY is to enable future missions by developing, testing, and demonstrating advanced human space systems. INTEGRITY will also implement and validate advanced management techniques including risk analysis and mitigation. One important way INTEGRITY will help enable future missions is by reducing their risk. A risk analysis of human space missions is important in defining the steps that INTEGRITY should take to mitigate risk. This paper describes how a Probabilistic Risk Assessment (PRA) of human space missions will help support the planning and development of INTEGRITY to maximize its benefits to future missions. PRA is a systematic methodology to decompose the system into subsystems and components, to quantify the failure risk as a function of the design elements and their corresponding probability of failure. PRA provides a quantitative estimate of the probability of failure of the system, including an assessment and display of the degree of uncertainty surrounding the probability. PRA provides a basis for understanding the impacts of decisions that affect safety, reliability, performance, and cost. Risks with both high probability and high impact are identified as top priority. The PRA of human missions beyond Earth orbit will help indicate how the risk of future human space missions can be reduced by integrating and testing systems in INTEGRITY.

  13. Site-wide seismic risk model for Savannah River Site nuclear facilities

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

    Eide, S.A.; Shay, R.S.; Durant, W.S.

    1993-09-01

    The 200,000 acre Savannah River Site (SRS) has nearly 30 nuclear facilities spread throughout the site. The safety of each facility has been established in facility-specific safety analysis reports (SARs). Each SAR contains an analysis of risk from seismic events to both on-site workers and the off-site population. Both radiological and chemical releases are considered, and air and water pathways are modeled. Risks to the general public are generally characterized by evaluating exposure to the maximally exposed individual located at the SRS boundary and to the off-site population located within 50 miles. Although the SARs are appropriate methods for studyingmore » individual facility risks, there is a class of accident initiators that can simultaneously affect several of all of the facilities, Examples include seismic events, strong winds or tornados, floods, and loss of off-site electrical power. Overall risk to the off-site population from such initiators is not covered by the individual SARs. In such cases multiple facility radionuclide or chemical releases could occur, and off-site exposure would be greater than that indicated in a single facility SAR. As a step towards an overall site-wide risk model that adequately addresses multiple facility releases, a site-wide seismic model for determining off-site risk has been developed for nuclear facilities at the SRS. Risk from seismic events up to the design basis earthquake (DBE) of 0.2 g (frequency of 2.0E-4/yr) is covered by the model. Present plans include expanding the scope of the model to include other types of initiators that can simultaneously affect multiple facilities.« less

  14. Capabilities and constraints of NASA's ground-based reduced gravity facilities

    NASA Technical Reports Server (NTRS)

    Lekan, Jack; Neumann, Eric S.; Sotos, Raymond G.

    1993-01-01

    The ground-based reduced gravity facilities of NASA have been utilized to support numerous investigations addressing various processes and phenomina in several disciplines for the past 30 years. These facilities, which include drop towers, drop tubes, aircraft, and sounding rockets are able to provide a low gravity environment (gravitational levels that range from 10(exp -2)g to 10(exp -6)g) by creating a free fall or semi-free fall condition where the force of gravity on an experiment is offset by its linear acceleration during the 'fall' (drop or parabola). The low gravity condition obtained on the ground is the same as that of an orbiting spacecraft which is in a state of perpetual free fall. The gravitational levels and associated duration times associated with the full spectrum of reduced gravity facilities including spaced-based facilities are summarized. Even though ground-based facilities offer a relatively short experiment time, this available test time has been found to be sufficient to advance the scientific understanding of many phenomena and to provide meaningful hardware tests during the flight experiment development process. Also, since experiments can be quickly repeated in these facilities, multistep phenomena that have longer characteristic times associated with them can sometimes be examined in a step-by-step process. There is a large body of literature which has reported the study results achieved through using reduced-gravity data obtained from the facilities.

  15. Proposal for a new categorization of aseptic processing facilities based on risk assessment scores.

    PubMed

    Katayama, Hirohito; Toda, Atsushi; Tokunaga, Yuji; Katoh, Shigeo

    2008-01-01

    Risk assessment of aseptic processing facilities was performed using two published risk assessment tools. Calculated risk scores were compared with experimental test results, including environmental monitoring and media fill run results, in three different types of facilities. The two risk assessment tools used gave a generally similar outcome. However, depending on the tool used, variations were observed in the relative scores between the facilities. For the facility yielding the lowest risk scores, the corresponding experimental test results showed no contamination, indicating that these ordinal testing methods are insufficient to evaluate this kind of facility. A conventional facility having acceptable aseptic processing lines gave relatively high risk scores. The facility showing a rather high risk score demonstrated the usefulness of conventional microbiological test methods. Considering the significant gaps observed in calculated risk scores and in the ordinal microbiological test results between advanced and conventional facilities, we propose a facility categorization based on risk assessment. The most important risk factor in aseptic processing is human intervention. When human intervention is eliminated from the process by advanced hardware design, the aseptic processing facility can be classified into a new risk category that is better suited for assuring sterility based on a new set of criteria rather than on currently used microbiological analysis. To fully benefit from advanced technologies, we propose three risk categories for these aseptic facilities.

  16. Dietitians employed by health care facilities preferred a HACCP system over irradiation or chemical rinses for reducing risk of foodborne disease.

    PubMed

    Giamalva, J N; Redfern, M; Bailey, W C

    1998-08-01

    To survey dietitians in health care facilities about the acceptability of alternative meat and poultry processing methods designed to reduce the risk of foodborne disease and their willingness to pay for these processes. A geographically representative sample of 600 members of The American Dietetic Association who work in health care facilities. The response rate was 250 completed questionnaires from 592 eligible subjects (42%). A mail survey was used to gather information on the acceptability of a Hazard Analysis and Critical Control Point (HACCP) system, chemical rinses, and irradiation for increasing the safety of food. Discrete choice contingent valuation was used to determine the acceptability at current prices and at 5, 10, and 25 cents per pound above current prices. Logistic regression was used to estimate mean willingness to pay (the maximum amount respondents are willing to pay) for each process. A simultaneous equations regression model was used to estimate the effects of other variables on acceptability. Respondents expressed a high level of concern for food safety in health care facilities. The estimated mean willingness to pay was highest for a HACCP system and lowest for chemical rinses. The successful adoption of alternative methods to increase food safety depends on their acceptance by foodservice professionals. The professionals sampled were most accepting of a HACCP system, somewhat less accepting of irradiation, and least accepting of new chemical rinses. Poultry and beef processors and government agencies concerned with food safety may want to take into account the attitudes of foodservice professionals.

  17. Reducing Proliferation Rick Through Multinational Fuel Cycle Facilities

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

    Amanda Rynes

    2010-11-01

    With the prospect of rapid expansion of the nuclear energy industry and the ongoing concern over weapons proliferation, there is a growing need for a viable alternative to traditional nation-based fuel production facilities. While some in the international community remain apprehensive, the advantages of multinational fuel cycle facilities are becoming increasingly apparent, with states on both sides of the supply chain able to garner the security and financial benefits of such facilities. Proliferation risk is minimized by eliminating the need of states to establish indigenous fuel production capabilities and the concept's structure provides an additional internationally monitored barrier against themore » misuse or diversion of nuclear materials. This article gives a brief description of the arguments for and against the implementation of a complete multinational fuel cycle.« less

  18. Effect of Community Engagement Interventions on Patient Safety and Risk Reduction Efforts in Primary Health Facilities: Evidence from Ghana.

    PubMed

    Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Spieker, Nicole; Arhinful, Daniel Kojo; Ogink, Alice; van Ostenberg, Paul; Rinke de Wit, Tobias F

    2015-01-01

    Patient safety and quality care remain major challenges to Ghana's healthcare system. Like many health systems in Africa, this is largely because demand for healthcare is outstripping available human and material resource capacity of healthcare facilities and new investment is insufficient. In the light of these demand and supply constraints, systematic community engagement (SCE) in healthcare quality assessment can be a feasible and cost effective option to augment existing quality improvement interventions. SCE entails structured use of existing community groups to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements identified and rewards provided if the quality gaps are closed. This paper evaluates whether or not SCE, through the assessment of health service quality, improves patient safety and risk reduction efforts by staff in healthcare facilities. A randomized control trail was conducted in 64 primary healthcare facilities in the Greater Accra and Western regions of Ghana. Patient risk assessments were conducted in 32 randomly assigned intervention and control facilities. Multivariate multiple regression test was used to determine effect of the SCE interventions on staff efforts towards reducing patient risk. Spearman correlation test was used to ascertain associations between types of community groups engaged and risk assessment scores of healthcare facilities. Clinic staff efforts towards increasing patient safety and reducing risk improved significantly in intervention facilities especially in the areas of leadership/accountability (Coef. = 10.4, p<0.05) and staff competencies (Coef. = 7.1, p<0.05). Improvement in service utilization and health resources could not be attributed to the interventions because these were outside the control of the study and might have been influenced by institutional or national level developments between the baseline and follow-up period. Community

  19. Dairy food supplementation may reduce malnutrition risk in institutionalised elderly.

    PubMed

    Iuliano, Sandra; Poon, Shirley; Wang, Xiaofang; Bui, Minh; Seeman, Ego

    2017-01-01

    Malnutrition in institutionalised elderly increases morbidity and care costs. Meat and dairy foods are high-quality protein sources so adequate intakes may reduce malnutrition risk. We aimed to determine whether inadequate intakes of meat and dairy foods contribute to malnutrition in institutionalised elderly. This cross-sectional study involved 215 elderly residents (70·2 % females, mean age 85·8 years) from twenty-one aged-care facilities in Melbourne, Australia. Dietary intake was assessed using observed plate waste. Food groups and serving sizes were based on the Australian Guide to Healthy Eating. Nutrient content was analysed using a computerised nutrient analysis software (Xyris). Malnutrition risk was assessed using the Mini Nutrition Assessment (MNA) tool; a score between 24 and 30 indicates normal nutritional status. Data were analysed using robust regression. Mean MNA score was 21·6 (sd 2·7). In total, 68 % of residents were malnourished or at risk of malnutrition (MNA score≤23·5). Protein intake was 87 (sd 28) % of the Australian recommended dietary intake (RDI). Consumption averaged 1 serving each of dairy foods and meat daily. Number of dairy and meat servings related to proportion of protein RDI (both P24 points). Provision of meat and dairy foods did not meet recommended levels. On the basis of current dietary intakes in aged-care residents, increasing consumption of dairy foods to the recommended four servings daily ensures protein adequacy and may reduce malnutrition risk in institutionalised elderly, and so reduce risk of comorbidities and costs associated with malnutrition.

  20. Environmental equity: Reducing risk for all communities. Volume 2. Supporting document

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

    NONE

    1992-06-01

    In targeting its protection efforts to reduce the most serious risks, the Agency has begun to examine how the patterns of environmental problems converge on different places, how the people who live in those places are affected, and how environmental programs should be refined to address identified differences. A community surrounded by Multiple sources of air pollution, ringed by waste treatment facilities and landfills, and whose residences contain lead-based paint clearly faces higher than average potential environmental risks. It is in this context that concerns have been raised about the relative risk burden borne by low-income and racial minority communities.more » Examination of these differences in risk burden and how government agencies respond is known as environmental equity. Although there are many types of equity, this report focuses on racial and socioeconomic equity.« less

  1. Challenges Associated With Managing Suicide Risk in Long-Term Care Facilities.

    PubMed

    O'Riley, Alisa; Nadorff, Michael R; Conwell, Yeates; Edelstein, Barry

    2013-06-01

    Little information about suicidal ideation and behavior in long-term care (LTC) facilities is available. Nonetheless, the implementation of the Minimum Data Set 3.0 requires that LTC facilities screen their residents for suicide risk and have protocols in place to effectively manage residents' responses. In this article, the authors briefly discuss the risk factors of suicide in the elderly and the problems that suicidal ideation and behavior pose in the LTC environment. The authors explain issues that arise when trying to manage suicide risk in the elderly LTC population with general, traditional approaches. These inherent issues make it difficult to develop an effective protocol for managing suicide risk in LTC facilities, leading the authors to propose their own framework for assessing and managing suicide risk in the LTC setting.

  2. 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.

  3. Challenges and Consequences of Reduced Skilled Nursing Facility Lengths of Stay.

    PubMed

    Tyler, Denise A; McHugh, John P; Shield, Renée R; Winblad, Ulrika; Gadbois, Emily A; Mor, Vincent

    2018-06-05

    To identify the challenges that reductions in length of stay (LOS) pose for skilled nursing facilities (SNFs) and their postacute care (PAC) patients. Seventy interviews with staff in 25 SNFs in eight U.S. cities, LOS data for patients in those SNFs. Data were qualitatively analyzed, and key themes were identified. Interview data from SNFs with and without reductions in median risk-adjusted LOS were compared and contrasted. We conducted 70 semistructured interviews. LOS data were derived from minimum dataset (MDS) admission records available for all patients in all U.S. SNFs from 2012 to 2014. Challenges reported regardless of reductions in LOS included frequent and more complicated re-authorization processes, patients becoming responsible for costs, and discharging patients whom staff felt were unsafe at home. Challenges related to reduced LOS included SNFs being pressured to discharge patients within certain time limits. Some SNFs reported instituting programs and processes for following up with patients after discharge. These programs helped alleviate concerns about patients, but they resulted in nonreimbursable costs for facilities. The push for shorter LOS has resulted in unexpected challenges and costs for SNFs and possible unintended consequences for PAC patients. © Health Research and Educational Trust.

  4. Effect of Community Engagement Interventions on Patient Safety and Risk Reduction Efforts in Primary Health Facilities: Evidence from Ghana

    PubMed Central

    Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Spieker, Nicole; Arhinful, Daniel Kojo; Ogink, Alice; van Ostenberg, Paul; Rinke de Wit, Tobias F.

    2015-01-01

    Background Patient safety and quality care remain major challenges to Ghana’s healthcare system. Like many health systems in Africa, this is largely because demand for healthcare is outstripping available human and material resource capacity of healthcare facilities and new investment is insufficient. In the light of these demand and supply constraints, systematic community engagement (SCE) in healthcare quality assessment can be a feasible and cost effective option to augment existing quality improvement interventions. SCE entails structured use of existing community groups to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements identified and rewards provided if the quality gaps are closed. Purpose This paper evaluates whether or not SCE, through the assessment of health service quality, improves patient safety and risk reduction efforts by staff in healthcare facilities. Methods A randomized control trail was conducted in 64 primary healthcare facilities in the Greater Accra and Western regions of Ghana. Patient risk assessments were conducted in 32 randomly assigned intervention and control facilities. Multivariate multiple regression test was used to determine effect of the SCE interventions on staff efforts towards reducing patient risk. Spearman correlation test was used to ascertain associations between types of community groups engaged and risk assessment scores of healthcare facilities. Findings Clinic staff efforts towards increasing patient safety and reducing risk improved significantly in intervention facilities especially in the areas of leadership/accountability (Coef. = 10.4, p<0.05) and staff competencies (Coef. = 7.1, p<0.05). Improvement in service utilization and health resources could not be attributed to the interventions because these were outside the control of the study and might have been influenced by institutional or national level developments between the

  5. Residential proximity to industrial combustion facilities and risk of non-Hodgkin lymphoma: a case–control study

    PubMed Central

    2013-01-01

    Background Residence near municipal solid waste incinerators, a major historical source of dioxin emissions, has been associated with increased risk of non-Hodgkin lymphoma (NHL) in European studies. The aim of our study was to evaluate residence near industrial combustion facilities and estimates of dioxin emissions in relation to NHL risk in the United States. Methods We conducted a population-based case–control study of NHL (1998–2000) in four National Cancer Institute-Surveillance Epidemiology and End Results centers (Detroit, Iowa, Los Angeles, Seattle). Residential histories 15 years before diagnosis (similar date for controls) were linked to an Environmental Protection Agency database of dioxin-emitting facilities for 969 cases and 749 controls. We evaluated proximity (3 and 5 km) to 10 facility types that accounted for >85% of U.S. emissions and a distance-weighted average emission index (AEI [ng toxic equivalency quotient (TEQ)/year]). Results Proximity to any dioxin-emitting facility was not associated with NHL risk (3 km OR = 1.0, 95% CI 0.8-1.3). Risk was elevated for residence near cement kilns (5 km OR = 1.7, 95% CI 0.8-3.3; 3 km OR = 3.8, 95% CI 1.1-14.0) and reduced for residence near municipal solid waste incinerators (5 km OR = 0.5, 95% CI 0.3-0.9; 3 km OR = 0.3, 95% CI 0.1-1.4). The AEI was not associated with risk of NHL overall. Risk for marginal zone lymphoma was increased for the highest versus lowest quartile (5 km OR = 2.6, 95% CI 1.0-6.8; 3 km OR = 3.0, 95% CI 1.1-8.3). Conclusions Overall, we found no association with residential exposure to dioxins and NHL risk. However, findings for high emissions and marginal zone lymphoma and for specific facility types and all NHL provide some evidence of an association and deserve future study. PMID:23433489

  6. R2 TRI facilities with 1999-2011 risk related estimates throughout the census blockgroup

    EPA Pesticide Factsheets

    This dataset delineates the distribution of estimate risk from the TRI facilities for 1999 - 2011 throughout the census blockgroup of the region using Office of Pollution, Prevention & Toxics (OPPT)'s Risk-Screening Environmental Indicators model (RSEI). The model uses the reported quantities of TRI releases of chemicals to estimate the impacts associated with each type of air release or transfer by every TRI facility.The RSEI was run to generate the estimate risk for each TRI facility in the region. The result from the model is joined to the TRI spatial data. Estimate risk values for each census block group were calculated based on the inverse distance of all the facilities which are within a 50 km radius of the census block group centroid. The estimate risk value for each census block group thus is an aggregated value that takes into account the estimate potential risk of all the facilities within the searching radius (50km).

  7. Who delivers where? The effect of obstetric risk on facility delivery in East Africa.

    PubMed

    Virgo, Sandra; Gon, Giorgia; Cavallaro, Francesca L; Graham, Wendy; Woodd, Susannah

    2017-09-01

    Skilled attendance at birth is key for the survival of pregnant women. This study investigates whether women at increased risk of maternal and newborn complications in four East African countries are more likely to deliver in a health facility than those at lower risk. Demographic and Health Survey data for Kenya 2014, Rwanda 2014-15, Tanzania 2015-16 and Uganda 2011 were used to study women with a live birth in the three years preceding the survey. A three-level obstetric risk index was created using known risk factors. Generalised linear Poisson regression was used to investigate the association between obstetric risk and facility delivery. We analysed data from 13 119 women across the four countries of whom 42-45% were considered at medium risk and 12-17% at high risk, and the remainder were at low risk. In Rwanda, 93% of all women delivered in facilities but this was lower (59-66%) in the other three countries. There was no association between a woman's obstetric risk level and her place of delivery in any country; greater wealth and more education were, however, independently strongly associated with facility delivery. In four East African countries, women at higher obstetric risk were not more likely to deliver in a facility than those with lower risk. This calls for a renewed focus on antenatal risk screening and improved communication on birth planning to ensure women with an increased chance of maternal and newborn complications are supported to deliver in facilities with skilled care. © 2017 John Wiley & Sons Ltd.

  8. NSR&D Program Fiscal Year (FY) 2015 Call for Proposals Mitigation of Seismic Risk at Nuclear Facilities using Seismic Isolation

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

    Coleman, Justin

    2015-02-01

    Seismic isolation (SI) has the potential to drastically reduce seismic response of structures, systems, or components (SSCs) and therefore the risk associated with large seismic events (large seismic event could be defined as the design basis earthquake (DBE) and/or the beyond design basis earthquake (BDBE) depending on the site location). This would correspond to a potential increase in nuclear safety by minimizing the structural response and thus minimizing the risk of material release during large seismic events that have uncertainty associated with their magnitude and frequency. The national consensus standard America Society of Civil Engineers (ASCE) Standard 4, Seismic Analysismore » of Safety Related Nuclear Structures recently incorporated language and commentary for seismically isolating a large light water reactor or similar large nuclear structure. Some potential benefits of SI are: 1) substantially decoupling the SSC from the earthquake hazard thus decreasing risk of material release during large earthquakes, 2) cost savings for the facility and/or equipment, and 3) applicability to both nuclear (current and next generation) and high hazard non-nuclear facilities. Issue: To date no one has evaluated how the benefit of seismic risk reduction reduces cost to construct a nuclear facility. Objective: Use seismic probabilistic risk assessment (SPRA) to evaluate the reduction in seismic risk and estimate potential cost savings of seismic isolation of a generic nuclear facility. This project would leverage ongoing Idaho National Laboratory (INL) activities that are developing advanced (SPRA) methods using Nonlinear Soil-Structure Interaction (NLSSI) analysis. Technical Approach: The proposed study is intended to obtain an estimate on the reduction in seismic risk and construction cost that might be achieved by seismically isolating a nuclear facility. The nuclear facility is a representative pressurized water reactor building nuclear power plant (NPP

  9. Suicide risk in long-term care facilities: a systematic review.

    PubMed

    Mezuk, Briana; Rock, Andrew; Lohman, Matthew C; Choi, Moon

    2014-12-01

    Suicide risk is highest in later life; however, little is known about the risk of suicide among older adults in long-term care facilities (e.g., nursing homes and assisted living facilities). The goal of this paper is to review and synthesize the descriptive and analytic epidemiology of suicide in long-term care settings over the past 25 years. Four databases (PubMed, CINAHL Plus, Web of Knowledge, and EBSCOHost Academic Search Complete) were searched for empirical studies of suicide risk in nursing homes, assisted living, and other residential facilities from 1985 to 2013. Of the 4073 unique research articles identified, 37 were selected for inclusion in this review. Of the included reports, 21 were cross-sectional, 8 cohort, 3 qualitative, and 5 intervention studies. Most studies indicate that suicidal thoughts (active and passive) are common among residents (prevalence in the past month: 5-33%), although completed suicide is rare. Correlates of suicidal thoughts among long-term care residents include depression, social isolation, loneliness, and functional decline. Most studies examined only individual-level correlates of suicide, although there is suggestive evidence that organizational characteristics (e.g., bed size and staffing) may also be relevant. Existing research on suicide risk in long-term care facilities is limited but suggests that this is an important issue for clinicians and medical directors to be aware of and address. Research is needed on suicide risk in assisted living and other non-nursing home residential settings, as well as the potential role of organizational characteristics on emotional well-being for residents. Copyright © 2014 John Wiley & Sons, Ltd.

  10. Suicide risk in long-term care facilities: A systematic review

    PubMed Central

    Mezuk, Briana; Rock, Andrew; Lohman, Matthew C.; Choi, Moon

    2014-01-01

    Objective Suicide risk is highest in later life, however, little is known about the risk of suicide among older adults in long-term care facilities (e.g., nursing homes, assisted living facilities). The goal of this paper is to review and synthesize the descriptive and analytic epidemiology of suicide in long-term care settings over the past 25 years. Methods Four databases (PubMed, CINAHL Plus, Web of Knowledge, and EBSCOHost) were searched for empirical studies of suicide risk in nursing homes, assisted living, and other residential facilities from 1985 to 2013. Of the 4,073 unique research articles identified, 36 were selected for inclusion in this review. Results Of the included reports, 20were cross-sectional, 10 were longitudinal, three qualitative, and five were intervention studies. Most studies indicate that suicidal thoughts (active and passive) are common among residents (prevalence in the past month: 5 – 33%), although completed suicide is rare. Correlates of suicidal thoughts among long-term care residents include depression, social isolation, loneliness, and functional decline. Most studies examined only individual-level correlates of suicide, although there is suggestive evidence that organizational characteristics (e.g., bed size, staffing) may also be relevant. Conclusions Existing research on suicide risk in long-term care facilities is limited, but suggests that this is an important issue for clinicians and medical directors to be aware of and address. Research is needed on suicide risk in assisted living and other non-nursing home residential settings, as well as the potential role of organizational characteristics on emotional well-being for residents. PMID:24854089

  11. Unanticipated potential cancer risk near metal recycling facilities

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

    Raun, Loren, E-mail: raun@rice.edu; Pepple, Karl, E-mail: pepple.karl@epa.gov; Hoyt, Daniel, E-mail: hoyt.daniel@epa.gov

    2013-07-15

    Metal recycling is an important growing industry. Prior to this study, area sources consisting of metal recycling facilities fell in a category of limited regulatory scrutiny because of assumed low levels of annual emissions. Initiating with community complaints of nuisance from smoke, dust and odor, the Houston Department of Health and Human Services (HDHHS) began a monitoring program outside metal recycler facilities and found metal particulates in outdoor ambient air at levels which could pose a carcinogenic human health risk. In a study of five similar metal recycler facilities which used a torch cutting process, air downwind and outside themore » facility was sampled for eight hours between 6 and 10 times each over 18 months using a mobile laboratory. Ten background locations were also sampled. Iron, manganese, copper, chromium, nickel, lead, cobalt, cadmium and mercury were detected downwind of the metal recyclers at frequencies ranging from 100% of the time for iron to 2% of the time for mercury. Of these metals, chromium, nickel, lead, cobalt, cadmium and mercury were not detected in any sample in the background. Two pairs of samples were analyzed for total chromium and hexavalent chromium to establish a ratio of the fraction of hexavalent chromium in total chromium. This fraction was used to estimate hexavalent chromium at all locations. The carcinogenic risk posed to a residential receptor from metal particulate matter concentrations in the ambient air attributed to the metal recyclers was estimated from each of the five facilities in an effort to rank the importance of this source and inform the need for further investigation. The total risk from these area sources ranged from an increased cancer risk of 1 in 1,000,000 to 6 in 10,000 using the 95th upper confidence limit of the mean of the carcinogenic metal particulate matter concentration, assuming the point of the exposure is the sample location for a residential receptor after accounting for wind

  12. Hurricane risk mitigation - High Pressure Gas Facility

    NASA Image and Video Library

    2008-07-29

    A worker pours concrete as part of a nitrogen risk mitigation project at the High Pressure Gas Facility at Stennis Space Center. The concrete slab will provide the foundation needed to place new pumps at the site and is part of ongoing hurricane-related mitigation work at Stennis.

  13. Hurricane risk mitigation - High Pressure Gas Facility

    NASA Technical Reports Server (NTRS)

    2008-01-01

    A worker pours concrete as part of a nitrogen risk mitigation project at the High Pressure Gas Facility at Stennis Space Center. The concrete slab will provide the foundation needed to place new pumps at the site and is part of ongoing hurricane-related mitigation work at Stennis.

  14. Terrorism-related risk management for health care facilities.

    PubMed

    Reid, Daniel J; Reid, William H

    2005-01-01

    Clinicians should have a basic understanding of the physical and financial risk to mental health facilities related to external threat, such as (but not necessarily limited to) terrorism. Patient care and accessibility to mental health services rest not only on clinical skills, but on a place to practice them and an organized system supported by staff, physical facilities and funding. Clinicians who have some familiarity with the non-clinical requirements for care are in a position to support non-clinical staff in preventing care from being interrupted by external threats or events such as terrorist activity, and/or serving at the interface of facility operations and direct clinical care. Readers should note that this article is an introduction to the topic and cannot address all local, state, and national standards for hospital safety, or insurance providers' individual facility requirements.

  15. Human health risk characterization of petroleum coke calcining facility emissions.

    PubMed

    Singh, Davinderjit; Johnson, Giffe T; Harbison, Raymond D

    2015-12-01

    Calcining processes including handling and storage of raw petroleum coke may result in Particulate Matter (PM) and gaseous emissions. Concerns have been raised over the potential association between particulate and aerosol pollution and adverse respiratory health effects including decrements in lung function. This risk characterization evaluated the exposure concentrations of ambient air pollutants including PM10 and gaseous pollutants from a petroleum coke calciner facility. The ambient air pollutant levels were collected through monitors installed at multiple locations in the vicinity of the facility. The measured and modeled particulate levels in ambient air from the calciner facility were compared to standards protective of public health. The results indicated that exposure levels were, on occasions at sites farther from the facility, higher than the public health limit of 150 μg/m(3) 24-h average for PM10. However, the carbon fraction demonstrated that the contribution from the calciner facility was de minimis. Exposure levels of the modeled SO2, CO, NOx and PM10 concentrations were also below public health air quality standards. These results demonstrate that emissions from calcining processes involving petroleum coke, at facilities that are well controlled, are below regulatory standards and are not expected to produce a public health risk. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Conventional Reduced Risk Pesticide Program

    EPA Pesticide Factsheets

    Find out about the Conventional Reduced Risk Pesticide Program, which expedites the review and regulatory decision-making process of conventional pesticides that pose less risk to human health and the environment than existing conventional alternatives.

  17. Analyses in support of risk-informed natural gas vehicle maintenance facility codes and standards :

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

    Ekoto, Isaac W.; Blaylock, Myra L.; LaFleur, Angela Christine

    2014-03-01

    Safety standards development for maintenance facilities of liquid and compressed gas fueled large-scale vehicles is required to ensure proper facility design and operation envelopes. Standard development organizations are utilizing risk-informed concepts to develop natural gas vehicle (NGV) codes and standards so that maintenance facilities meet acceptable risk levels. The present report summarizes Phase I work for existing NGV repair facility code requirements and highlights inconsistencies that need quantitative analysis into their effectiveness. A Hazardous and Operability study was performed to identify key scenarios of interest. Finally, scenario analyses were performed using detailed simulations and modeling to estimate the overpressure hazardsmore » from HAZOP defined scenarios. The results from Phase I will be used to identify significant risk contributors at NGV maintenance facilities, and are expected to form the basis for follow-on quantitative risk analysis work to address specific code requirements and identify effective accident prevention and mitigation strategies.« less

  18. 6 CFR 27.200 - Information regarding security risk for a chemical facility.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 6 Domestic Security 1 2010-01-01 2010-01-01 false Information regarding security risk for a chemical facility. 27.200 Section 27.200 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS Chemical Facility Security Program § 27.200 Information...

  19. Validation of Fall Risk Assessment Specific to the Inpatient Rehabilitation Facility Setting.

    PubMed

    Thomas, Dan; Pavic, Andrea; Bisaccia, Erin; Grotts, Jonathan

    2016-09-01

    To evaluate and compare the Morse Fall Scale (MFS) and the Casa Colina Fall Risk Assessment Scale (CCFRA) for identification of patients at risk for falling in an acute inpatient rehabilitation facility. The primary objective of this study was to perform a retrospective validation study of the CCFRAS, specifically for use in the inpatient rehabilitation facility (IRF) setting. Retrospective validation study. The study was approved under expedited review by the local Institutional Review Board. Data were collected on all patients admitted to Cottage Rehabiliation Hospital (CRH), a 38-bed acute inpatient rehabilitation hospital, from March 2012 to August 2013. Patients were excluded from the study if they had a length of stay less than 3 days or age less than 18. The area under the receiver operating characteristic curve (AUC) and the diagnostic odds ratio were used to examine the differences between the MFS and CCFRAS. AUC between fall scales was compared using the DeLong Test. There were 931 patients included in the study with 62 (6.7%) patient falls. The average age of the population was 68.8 with 503 males (51.2%). The AUC was 0.595 and 0.713 for the MFS and CCFRAS, respectively (0.006). The diagnostic odds ratio of the MFS was 2.0 and 3.6 for the CCFRAS using the recommended cutoffs of 45 for the MFS and 80 for the CCFRAS. The CCFRAS appears to be a better tool in detecting fallers vs. nonfallers specific to the IRF setting. The assessment and identification of patients at high risk for falling is important to implement specific precautions and care for these patients to reduce their risk of falling. The CCFRAS is more clinically relevant in identifying patients at high risk for falling in the IRF setting compared to other fall risk assessments. Implementation of this scale may lead to a reduction in fall rate and injuries from falls as it more appropriately identifies patients at high risk for falling. © 2015 Association of Rehabilitation Nurses.

  20. RCRA Facility Investigation/Remedial Investigation Report with Baseline Risk Assessment for the Fire Department Hose Training Facility (904-113G)

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

    Palmer, E.

    1997-04-01

    This report documents the Resource Conservation and Recovery Act (RCRA) Facility Investigation/Remedial Investigation/Baseline Risk Assessment (RFI/RI/BRA) for the Fire Department Hose Training Facility (FDTF) (904-113G).

  1. Can psychiatric liaison reduce neuroleptic use and reduce health service utilization for dementia patients residing in care facilities.

    PubMed

    Ballard, Clive; Powell, Ian; James, Ian; Reichelt, Katharina; Myint, Pat; Potkins, Dawn; Bannister, Carol; Lana, Marisa; Howard, Robert; O'Brien, John; Swann, Alan; Robinson, Damian; Shrimanker, Jay; Barber, Robert

    2002-02-01

    The quality of care and overuse of neuroleptic medication in care environments are major issues in the care of elderly people with dementia. The quality of care (Dementia Care Mapping), the severity of Behavioural and Psychological Symptoms (BPSD--Neuropsychiatric Inventory), expressive language skills (Sheffield Acquired Language Disorder scale), service utilization and use of neuroleptic drugs was compared over 9 months between six care facilities receiving a psychiatric liaison service and three facilities receiving the usual clinical support, using a single blind design. There was a significant reduction in neuroleptic usage in the facilities receiving the liaison service (McNemar test p<0.0001), but not amongst those receiving standard clinical support (McNemar test p=0.07). There were also significantly less GP contacts (t=3.9 p=0.0001) for residents in the facilities receiving the liaison service, and a three fold reduction in psychiatric in-patient bed usage (Bed days per person 0.6 vs. 1.5). Residents in care facilities receiving the liaison service experienced significantly less deterioration in expressive language skills (t=2.2 p=0.03), but there were no significant differences in BPSD or wellbeing. A resource efficient psychiatric liaison service can reduce neuroleptic drug use and reduce some aspects of health service utilization; but a more extensive intervention is probably required to improve the overall quality of care. Copyright 2002 John Wiley & Sons, Ltd.

  2. Facility Management as a Way of Reducing Costs in Transport Companies

    NASA Astrophysics Data System (ADS)

    Matusova, Dominika; Gogolova, Martina

    2017-10-01

    For facility management exists a several interpretations. These interpretations emerged progressively. At the time of the notion of facility management was designed to manage an administrative building, in the United States (US). They can ensure their operation and maintenance. From the US, this trend is further moved to Europe and now it start becoming a current and actual topic also in Slovakia. Facility management is contractually agreed scheme of services, semantically recalls traditional building management. There by finally pushed for activities related to real estates. For facility management is fundamental - certification and certification systems. Therefore, is essential to know, the cost structure of certification. The most commonly occurring austerity measures include: heat pumps, use of renewable energy, solar panels and water savings. These measures can reduce the cost.

  3. DEVELOPMENT OF THE METAL FINISHING FACILITY RISK SCREENING TOOL (MFFRST)

    EPA Science Inventory

    Recently the US EPA completed the development of the first version of the Metal Finishing Facility Risk Screening Tool (MFFRST) and has made this product available to the general public. MFFRST calculates the air emissions from a metal plating line and determines the risk to bot...

  4. Hemodialysis patients receiving a greater Kt dose than recommended have reduced mortality and hospitalization risk.

    PubMed

    Maduell, Francisco; Ramos, Rosa; Varas, Javier; Martin-Malo, Alejandro; Molina, Manuel; Pérez-Garcia, Rafael; Marcelli, Daniele; Moreso, Francesc; Aljama, Pedro; Merello, Jose Ignacio

    2016-12-01

    Achieving an adequate dialysis dose is one of the key goals for dialysis treatments. Here we assessed whether patients receiving the current cleared plasma volume (Kt), individualized for body surface area per recommendations, had improved survival and reduced hospitalizations at 2 years of follow-up. Additionally, we assessed whether patients receiving a greater dose gained more benefit. This prospective, observational, multicenter study included 6129 patients in 65 Fresenius Medical Care Spanish facilities. Patients were classified monthly into 1 of 10 risk groups based on the difference between achieved and target Kt. Patient groups with a more negative relationship were significantly older with a higher percentage of diabetes mellitus and catheter access. Treatment dialysis time, effective blood flow, and percentage of on-line hemodiafiltration were significantly higher in groups with a higher dose. The mortality risk profile showed a progressive increase when achieved minus target Kt became more negative but was significantly lower in the group with 1 to 3 L clearance above target Kt and in groups with greater increases above target Kt. Additionally, hospitalization risk appeared significantly reduced in groups receiving 9 L or more above the minimum target. Thus, prescribing an additional 3 L or more above the minimum Kt dose could potentially reduce mortality risk, and 9 L or more reduce hospitalization risk. As such, future prospective studies are required to confirm these dose effect findings. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

  5. Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review.

    PubMed

    Bunn, Diane; Jimoh, Florence; Wilsher, Stephanie Howard; Hooper, Lee

    2015-02-01

    To assess the efficacy of interventions and environmental factors on increasing fluid intake or reducing dehydration risk in older people living in long-term care facilities. Systematic review of intervention and observational studies. Thirteen electronic databases were searched from inception until September 2013 in all languages. References of included papers and reviews were checked. Intervention and observational studies investigating modifiable factors to increase fluid intake and/or reduce dehydration risk in older people (≥65 years) living in long-term care facilities who could drink orally. Two reviewers independently screened, selected, abstracted data, and assessed risk of bias from included studies; narrative synthesis was performed. A total of 4328 titles and abstracts were identified, 325 full-text articles were obtained and 23 were included in the review. Nineteen intervention and 4 observational studies from 7 countries investigated factors at the resident, institutional, or policy level. Overall, the studies were at high risk of bias due to selection and attrition bias and lack of valid outcome measures of fluid intake and dehydration assessment. Reported findings from 6 of the 9 intervention studies investigating the effect of multicomponent strategies on fluid intake or dehydration described a positive effect. Components included greater choice and availability of beverages, increased staff awareness, and increased staff assistance with drinking and toileting. Implementation of the US Resident Assessment Instrument reduced dehydration prevalence from 3% to 1%, P = .01. Two smaller studies reported positive effects: one on fluid intake in 9 men with Alzheimer disease using high-contrast red cups, the other involved supplementing 13 mildly dehydrated residents with oral hydration solution over 5 days to reduce dehydration. Modifications to the dining environment, advice to residents, presentation of beverages, and mode of delivery (straw vs beaker

  6. Biotechnology System Facility: Risk Mitigation on Mir

    NASA Technical Reports Server (NTRS)

    Gonda, Steve R., III; Galloway, Steve R.

    2003-01-01

    NASA is working with its international partners to develop space vehicles and facilities that will give researchers the opportunity to conduct scientific investigations in space. As part of this activity, NASA's Biotechnology Cell Science Program (BCSP) at the Johnson Space Center (JSC) is developing a world-class biotechnology laboratory facility for the International Space Station (ISS). This report describes the BCSP, including the role of the BTS. We identify the purpose and objectives of the BTS and a detailed description of BTS facility design and operational concept, BTS facility and experiment-specific hardware, and scientific investigations conducted in the facility. We identify the objectives, methods, and results of risk mitigation investigations of the effects of microgravity and cosmic radiation on the BTS data acquisition and control system. These results may apply to many other space experiments that use commercial, terrestrial-based data acquisition technology. Another focal point is a description of the end-to-end process of integrating and operating biotechnology experiments on a variety of space vehicles. The identification of lessons learned that can be applied to future biotechnology experiments is an overall theme of the report. We include a brief summary of the science results, but this is not the focus of the report. The report provides some discussion on the successful 130-day tissue engineering experiment performed in BTS on Mir and describes a seminal gene array investigation that identified a set of unique genes that are activated in space.

  7. Validation of a model for ranking aquaculture facilities for risk-based disease surveillance.

    PubMed

    Diserens, Nicolas; Falzon, Laura Cristina; von Siebenthal, Beat; Schüpbach-Regula, Gertraud; Wahli, Thomas

    2017-09-15

    A semi-quantitative model for risk ranking of aquaculture facilities in Switzerland with regard to the introduction and spread of Viral Haemorrhagic Septicaemia (VHS) and Infectious Haematopoietic Necrosis (IHN) was developed in a previous study (Diserens et al., 2013). The objective of the present study was to validate this model using data collected during field visits on aquaculture sites in four Swiss cantons compared to data collected through a questionnaire in the previous study. A discrepancy between the values obtained with the two different methods was found in 32.8% of the parameters, resulting in a significant difference (p<0.001) in the risk classification of the facilities. As data gathered exclusively by means of a questionnaire are not of sufficient quality to perform a risk-based surveillance of aquaculture facilities a combination of questionnaires and farm inspections is proposed. A web-based reporting system could be advantageous for the factors which were identified as being more likely to vary over time, in particular for factors considering fish movements, which showed a marginally significant difference in their risk scores (p≥0.1) within a six- month period. Nevertheless, the model proved to be stable over the considered period of time as no substantial fluctuations in the risk categorisation were observed (Kappa agreement of 0.77).Finally, the model proved to be suitable to deliver a reliable risk ranking of Swiss aquaculture facilities according to their risk of getting infected with or spreading of VHS and IHN, as the five facilities that tested positive for these diseases in the last ten years were ranked as medium or high risk. Moreover, because the seven fish farms that were infected with Infectious Pancreatic Necrosis (IPN) during the same period also belonged to the risk categories medium and high, the classification appeared to correlate with the occurrence of this third viral fish disease. Copyright © 2017 Elsevier B.V. All

  8. Cancer risks near nuclear facilities: the importance of research design and explicit study hypotheses.

    PubMed

    Wing, Steve; Richardson, David B; Hoffmann, Wolfgang

    2011-04-01

    In April 2010, the U.S. Nuclear Regulatory Commission asked the National Academy of Sciences to update a 1990 study of cancer risks near nuclear facilities. Prior research on this topic has suffered from problems in hypothesis formulation and research design. We review epidemiologic principles used in studies of generic exposure-response associations and in studies of specific sources of exposure. We then describe logical problems with assumptions, formation of testable hypotheses, and interpretation of evidence in previous research on cancer risks near nuclear facilities. Advancement of knowledge about cancer risks near nuclear facilities depends on testing specific hypotheses grounded in physical and biological mechanisms of exposure and susceptibility while considering sample size and ability to adequately quantify exposure, ascertain cancer cases, and evaluate plausible confounders. Next steps in advancing knowledge about cancer risks near nuclear facilities require studies of childhood cancer incidence, focus on in utero and early childhood exposures, use of specific geographic information, and consideration of pathways for transport and uptake of radionuclides. Studies of cancer mortality among adults, cancers with long latencies, large geographic zones, and populations that reside at large distances from nuclear facilities are better suited for public relations than for scientific purposes.

  9. Development of risk-based decision methodology for facility design.

    DOT National Transportation Integrated Search

    2014-06-01

    This report develops a methodology for CDOT to use in the risk analysis of various types of facilities and provides : illustrative examples for the use of the proposed framework. An overview of the current practices and applications to : illustrate t...

  10. Cancer Risks near Nuclear Facilities: The Importance of Research Design and Explicit Study Hypotheses

    PubMed Central

    Wing, Steve; Richardson, David B.; Hoffmann, Wolfgang

    2011-01-01

    Background In April 2010, the U.S. Nuclear Regulatory Commission asked the National Academy of Sciences to update a 1990 study of cancer risks near nuclear facilities. Prior research on this topic has suffered from problems in hypothesis formulation and research design. Objectives We review epidemiologic principles used in studies of generic exposure–response associations and in studies of specific sources of exposure. We then describe logical problems with assumptions, formation of testable hypotheses, and interpretation of evidence in previous research on cancer risks near nuclear facilities. Discussion Advancement of knowledge about cancer risks near nuclear facilities depends on testing specific hypotheses grounded in physical and biological mechanisms of exposure and susceptibility while considering sample size and ability to adequately quantify exposure, ascertain cancer cases, and evaluate plausible confounders. Conclusions Next steps in advancing knowledge about cancer risks near nuclear facilities require studies of childhood cancer incidence, focus on in utero and early childhood exposures, use of specific geographic information, and consideration of pathways for transport and uptake of radionuclides. Studies of cancer mortality among adults, cancers with long latencies, large geographic zones, and populations that reside at large distances from nuclear facilities are better suited for public relations than for scientific purposes. PMID:21147606

  11. THE USEPA'S METAL FINISHING FACILITY RISK SCREENING TOOL (MFFRST)

    EPA Science Inventory

    The US Environmetal ProtectionAgenccy's Metal Finishing
    Facility Risk Screening Tool (MFFRST)

    William M. Barrett Jr, Ph.D. , P.E. ; Paul Harten, Ph.D.1, and Matthew Lorber

    The US Environmental Protection Agency completed the development of the first version of...

  12. Exemestane Reduces Breast Cancer Risk in High-Risk Postmenopausal Women

    Cancer.gov

    Clinical trial results presented at the 2011 ASCO annual meeting showed that the aromatase inhibitor exemestane—used to treat early and advanced breast cancer—substantially reduced the risk of invasive breast cancer in high-risk postmenopausal women.

  13. Jumping combined exercise programs reduce fall risk and improve balance and life quality of elderly people who live in a long-term care facility.

    PubMed

    Cakar, E; Dincer, U; Kiralp, M Z; Cakar, D B; Durmus, O; Kilac, H; Soydan, F C; Sevinc, S; Alper, C

    2010-03-01

    The objective of this study was to determine whether regular combined exercise program, which consists strength, stretching and aerobic exercises and additional jumping training, improve balance, fall risk, quality of life and depression status of older people living in a residential care. A total of 168 residents who live in a long term care facility were screened. The trial began with 78 eligible participants and they were randomly grouped as combined exercises program (COM) group that includes stretching, strength and aerobic exercises, and COM plus jumping (COMpJ) group. 66 of the participants finished the trial. The groups were convened three times a week for six weeks. Each group had a warm-up, effective training and a cooling down periods. The total exercising time was no longer than 45 minutes in each group. Berg balance test and Biodex Balance System for the assessment of the dynamic balance and fall risk, short form 36 (SF 36) for the health related quality of life and Geriatric Depression Scale (GDS) for evaluation of the depression status were used. The balance improvement and fall risk reduction were observed in both of the groups at the end of the trial; however, the improvements were statistically better in jumping combined group. Also health related quality of life improved in both groups. Regular group exercise in a long term care facility have several beneficial effects on the elderly residents in regard to balance improvement, fall risk reduction and quality of life. The addition of jumping to strength, stretching and aerobic exercises provides important contributions to balance improvement and fall risk reduction.

  14. Site specific risk assessment of an energy-from-waste/thermal treatment facility in Durham Region, Ontario, Canada. Part B: Ecological risk assessment.

    PubMed

    Ollson, Christopher A; Whitfield Aslund, Melissa L; Knopper, Loren D; Dan, Tereza

    2014-01-01

    The regions of Durham and York in Ontario, Canada have partnered to construct an energy-from-waste (EFW) thermal treatment facility as part of a long term strategy for the management of their municipal solid waste. In this paper we present the results of a comprehensive ecological risk assessment (ERA) for this planned facility, based on baseline sampling and site specific modeling to predict facility-related emissions, which was subsequently accepted by regulatory authorities. Emissions were estimated for both the approved initial operating design capacity of the facility (140,000 tonnes per year) and the maximum design capacity (400,000 tonnes per year). In general, calculated ecological hazard quotients (EHQs) and screening ratios (SRs) for receptors did not exceed the benchmark value (1.0). The only exceedances noted were generally due to existing baseline media concentrations, which did not differ from those expected for similar unimpacted sites in Ontario. This suggests that these exceedances reflect conservative assumptions applied in the risk assessment rather than actual potential risk. However, under predicted upset conditions at 400,000 tonnes per year (i.e., facility start-up, shutdown, and loss of air pollution control), a potential unacceptable risk was estimated for freshwater receptors with respect to benzo(g,h,i)perylene (SR=1.1), which could not be attributed to baseline conditions. Although this slight exceedance reflects a conservative worst-case scenario (upset conditions coinciding with worst-case meteorological conditions), further investigation of potential ecological risk should be performed if this facility is expanded to the maximum operating capacity in the future. © 2013.

  15. Facile electrodeposition of reduced graphene oxide hydrogels for high-performance supercapacitors

    NASA Astrophysics Data System (ADS)

    Pham, Viet Hung; Gebre, Tesfaye; Dickerson, James H.

    2015-03-01

    We report both a facile, scalable method to prepare reduced graphene oxide hydrogels through the electrodeposition of graphene oxide and its use as an electrode for high-performance supercapacitors. Such systems exhibited specific capacitances of 147 and 223 F g-1 at a current density of 10 A g-1 when using H2SO4 and H2SO4 + hydroquinone redox electrolytes, respectively.We report both a facile, scalable method to prepare reduced graphene oxide hydrogels through the electrodeposition of graphene oxide and its use as an electrode for high-performance supercapacitors. Such systems exhibited specific capacitances of 147 and 223 F g-1 at a current density of 10 A g-1 when using H2SO4 and H2SO4 + hydroquinone redox electrolytes, respectively. Electronic supplementary information (ESI) available: GO synthesis, characterization, fabrication of ERGO supercapacitor and electrochemical measurement, elemental composition, TGA and XRD of GO and ERGO. See DOI: 10.1039/c4nr07508k

  16. Reducing environmental risk associated with laboratory decommissioning and property transfer.

    PubMed

    Dufault, R; Abelquist, E; Crooks, S; Demers, D; DiBerardinis, L; Franklin, T; Horowitz, M; Petullo, C; Sturchio, G

    2000-12-01

    The need for more or less space is a common laboratory problem. Solutions may include renovating existing space, leaving or demolishing old space, or acquiring new space or property for building. All of these options carry potential environmental risk. Such risk can be the result of activities related to the laboratory facility or property (e.g., asbestos, underground storage tanks, lead paint), or the research associated with it (e.g., radioactive, microbiological, and chemical contamination). Regardless of the option chosen to solve the space problem, the potential environmental risk must be mitigated and the laboratory space and/or property must be decommissioned or rendered safe prior to any renovation, demolition, or property transfer activities. Not mitigating the environmental risk through a decommissioning process can incur significant financial liability for any costs associated with future decommissioning cleanup activities. Out of necessity, a functioning system, environmental due diligence auditing, has evolved over time to assess environmental risk and reduce associated financial liability. This system involves a 4-phase approach to identify, document, manage, and clean up areas of environmental concern or liability, including contamination. Environmental due diligence auditing includes a) historical site assessment, b) characterization assessment, c) remedial effort and d) final status survey. General practice standards from the American Society for Testing and Materials are available for conducting the first two phases. However, standards have not yet been developed for conducting the third and final phases of the environmental due diligence auditing process. Individuals involved in laboratory decommissioning work in the biomedical research industry consider this a key weakness.

  17. Reducing environmental risk associated with laboratory decommissioning and property transfer.

    PubMed Central

    Dufault, R; Abelquist, E; Crooks, S; Demers, D; DiBerardinis, L; Franklin, T; Horowitz, M; Petullo, C; Sturchio, G

    2000-01-01

    The need for more or less space is a common laboratory problem. Solutions may include renovating existing space, leaving or demolishing old space, or acquiring new space or property for building. All of these options carry potential environmental risk. Such risk can be the result of activities related to the laboratory facility or property (e.g., asbestos, underground storage tanks, lead paint), or the research associated with it (e.g., radioactive, microbiological, and chemical contamination). Regardless of the option chosen to solve the space problem, the potential environmental risk must be mitigated and the laboratory space and/or property must be decommissioned or rendered safe prior to any renovation, demolition, or property transfer activities. Not mitigating the environmental risk through a decommissioning process can incur significant financial liability for any costs associated with future decommissioning cleanup activities. Out of necessity, a functioning system, environmental due diligence auditing, has evolved over time to assess environmental risk and reduce associated financial liability. This system involves a 4-phase approach to identify, document, manage, and clean up areas of environmental concern or liability, including contamination. Environmental due diligence auditing includes a) historical site assessment, b) characterization assessment, c) remedial effort and d) final status survey. General practice standards from the American Society for Testing and Materials are available for conducting the first two phases. However, standards have not yet been developed for conducting the third and final phases of the environmental due diligence auditing process. Individuals involved in laboratory decommissioning work in the biomedical research industry consider this a key weakness. PMID:11121365

  18. DEVELOPMENT OF THE METAL FINISHING FACILITY RISK SCREENING TOOL

    EPA Science Inventory

    Enhancement of the US Environmental Protection Agency's
    Metal Finishing Facility Risk Screening Tool (MFFRST)

    William M. Barrett Jr, Ph.D., P.E. , P.E.; Paul Harten, Ph.D.1, Matt Lorber , Charles Peck , and Steve Schwartz, P.E., Q.E.P.3

    Recently, the US Environ...

  19. Initiatives to Reduce Earthquake Risk of Developing Countries

    NASA Astrophysics Data System (ADS)

    Tucker, B. E.

    2008-12-01

    The seventeen-year-and-counting history of the Palo Alto-based nonprofit organization GeoHazards International (GHI) is the story of many initiatives within a larger initiative to increase the societal impact of geophysics and civil engineering. GHI's mission is to reduce death and suffering due to earthquakes and other natural hazards in the world's most vulnerable communities through preparedness, mitigation and advocacy. GHI works by raising awareness in these communities about their risk and about affordable methods to manage it, identifying and strengthening institutions in these communities to manage their risk, and advocating improvement in natural disaster management. Some of GHI's successful initiatives include: (1) creating an earthquake scenario for Quito, Ecuador that describes in lay terms the consequences for that city of a probable earthquake; (2) improving the curricula of Pakistani university courses about seismic retrofitting; (3) training employees of the Public Works Department of Delhi, India on assessing the seismic vulnerability of critical facilities such as a school, a hospital, a police headquarters, and city hall; (4) assessing the vulnerability of the Library of Tibetan Works and Archives in Dharamsala, India; (5) developing a seismic hazard reduction plan for a nonprofit organization in Kathmandu, Nepal that works to manage Nepal's seismic risk; and (6) assisting in the formulation of a resolution by the Council of the Organization for Economic Cooperation and Development (OECD) to promote school earthquake safety among OECD member countries. GHI's most important resource, in addition to its staff and Board of Trustees, is its members and volunteer advisors, who include some of the world's leading earth scientists, earthquake engineers, urban planners and architects, from the academic, public, private and nonprofit sectors. GHI is planning several exciting initiatives in the near future. One would oversee the design and construction of

  20. Diet components can suppress inflammation and reduce cancer risk.

    PubMed

    Hardman, W Elaine

    2014-06-01

    Epidemiology studies indicate that diet or specific dietary components can reduce the risk for cancer, cardiovascular disease and diabetes. An underlying cause of these diseases is chronic inflammation. Dietary components that are beneficial against disease seem to have multiple mechanisms of action and many also have a common mechanism of reducing inflammation, often via the NFκB pathway. Thus, a plant based diet can contain many components that reduce inflammation and can reduce the risk for developing all three of these chronic diseases. We summarize dietary components that have been shown to reduce cancer risk and two studies that show that dietary walnut can reduce cancer growth and development. Part of the mechanism for the anticancer benefit of walnut was by suppressing the activation of NFκB. In this brief review, we focus on reduction of cancer risk by dietary components and the relationship to suppression of inflammation. However, it should be remembered that most dietary components have multiple beneficial mechanisms of action that can be additive and that suppression of chronic inflammation should reduce the risk for all three chronic diseases.

  1. Containerless Processing in Reduced Gravity Using the TEMPUS Facility

    NASA Technical Reports Server (NTRS)

    Roger, Jan R.; Robinson, Michael B.

    1996-01-01

    Containerless processing provides a high purity environment for the study of high-temperature, very reactive materials. It is an important method which provides access to the metastable state of an undercooled melt. In the absence of container walls, the nucleation rate is greatly reduced and undercooling up to (Tm-Tn)/Tm approx. 0.2 can be obtained, where Tm and Tn are the melting and nucleation temperatures, respectively. Electromagnetic levitation represents a method particularly well-suited for the study of metallic melts. The TEMPUS facility is a research instrument designed to perform electromagnetic levitation studies in reduced gravity. It provides temperatures up to 2600 C, levitation of several grams of material and access to the undercooled state for an extended period of time (up to hours).

  2. Reducing the Risk of Dangerous Chemicals Getting into the Wrong Hands

    ERIC Educational Resources Information Center

    Matthews, Nancy

    2008-01-01

    Under the Department of Homeland Security (DHS) Appropriations Act of 2007, DHS has the authority and funding to regulate security at facilities storing chemicals considered to be high-risk (P. L. 109-295, Section 550). This article discusses the Department's efforts to enhance the security of facilities that store chemicals that could be stolen…

  3. Chemical facility vulnerability assessment project.

    PubMed

    Jaeger, Calvin D

    2003-11-14

    Sandia National Laboratories, under the direction of the Office of Science and Technology, National Institute of Justice, conducted the chemical facility vulnerability assessment (CFVA) project. The primary objective of this project was to develop, test and validate a vulnerability assessment methodology (VAM) for determining the security of chemical facilities against terrorist or criminal attacks (VAM-CF). The project also included a report to the Department of Justice for Congress that in addition to describing the VAM-CF also addressed general observations related to security practices, threats and risks at chemical facilities and chemical transport. In the development of the VAM-CF Sandia leveraged the experience gained from the use and development of VAs in other areas and the input from the chemical industry and Federal agencies. The VAM-CF is a systematic, risk-based approach where risk is a function of the severity of consequences of an undesired event, the attack potential, and the likelihood of adversary success in causing the undesired event. For the purpose of the VAM-CF analyses Risk is a function of S, L(A), and L(AS), where S is the severity of consequence of an event, L(A) is the attack potential and L(AS) likelihood of adversary success in causing a catastrophic event. The VAM-CF consists of 13 basic steps. It involves an initial screening step, which helps to identify and prioritize facilities for further analysis. This step is similar to the prioritization approach developed by the American Chemistry Council (ACC). Other steps help to determine the components of the risk equation and ultimately the risk. The VAM-CF process involves identifying the hazardous chemicals and processes at a chemical facility. It helps chemical facilities to focus their attention on the most critical areas. The VAM-CF is not a quantitative analysis but, rather, compares relative security risks. If the risks are deemed too high, recommendations are developed for

  4. Dual-Spool Turbine Facility Design Overview

    NASA Technical Reports Server (NTRS)

    Giel, Paul; Pachlhofer, Pete

    2003-01-01

    The next generation of aircraft engines, both commercial and military, will attempt to capitalize on the benefits of close-coupled, vaneless, counter-rotating turbine systems. Experience has shown that significant risks and challenges are present with close-coupled systems in terms of efficiency and durability. The UEET program needs to demonstrate aerodynamic loading and efficiency goals for close-coupled, reduced-stage HP/LP turbine systems as a Level 1 Milestone for FY05. No research facility exists in the U.S. to provide risk reduction for successful development of close-coupled, high and low pressure turbine systems for the next generations of engines. To meet these objectives, the design, construction, and integrated systems testing of a Dual-Spool Turbine Facility (DSTF) facility has been initiated at the NASA Glenn Research Center. The facility will be a warm (-IOOO'F), continuous flow facility for overall aerodynamic performance and detailed flow field measurement acquisition. The facility will have state-of-the-art instrumentation to capture flow physics details. Accurate and reliable speed control will be achieved by utilizing the existing Variable Frequency Drive System. Utilization of this and other existing GRC centralized utilities will reduce the overall construction costs. The design allows for future installation of a turbine inlet combustor profile simulator. This presentation details the objectives of the facility and the concepts used in specifying its capabilities. Some preliminary design results will be presented along with a discussion of plans and schedules.

  5. Suicide Risk in Nursing Homes and Assisted Living Facilities: 2003-2011.

    PubMed

    Mezuk, Briana; Lohman, Matthew; Leslie, Marc; Powell, Virginia

    2015-07-01

    We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide. Data come from the Virginia Violent Death Reporting System (2003-2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis. Incidence of suicide was 14.16 per 100 000 in nursing homes and 15.66 in the community. Better performance on Nursing Home Compare quality metrics was associated with higher odds of suicide in nursing homes (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.21, 3.14). Larger facility size was associated with higher suicide risk in assisted living facilities (OR = 1.01; 95% CI = 1.00, 1.01). Text narratives identified 38 decedents anticipating transitioning into LTC and 16 whose loved one recently transitioned or resided in LTC. LTC may be an important point of engagement in suicide prevention.

  6. Residential Proximity to Industrial Facilities and Risk of Non-Hodgkin Lymphoma

    PubMed Central

    De Roos, AJ; Davis, S; Colt, JS; Blair, A; Airola, M; Severson, RK; Cozen, W; Cerhan, JR; Hartge, P; Nuckols, JR; Ward, MH

    2009-01-01

    Industrial pollution has been suspected as a cause of non-Hodgkin lymphoma (NHL), based on associations with chemical exposures in occupational studies. We conducted a case-control study of NHL in four SEER regions of the United States, in which residential locations of 864 cases and 684 controls during the 10 years before recruitment were used to characterize proximity to industrial facilities reporting chemical releases to the Environmental Protection Agency's Toxics Release Inventory (TRI). For each of 15 types of industry (by 2-digit SIC code), we evaluated the risk of NHL associated with having lived within 2 miles of a facility, the distance to the nearest facility (categories of ≤0.5-mile, >0.5-1.0, >1.0-2.0, >2 [referent]), and the duration of residence within 2 miles (10 years, 1-9, 0 [referent]), using logistic regression. Increased risk of NHL was observed in relation to lumber and wood products facilities (SIC 24) for the shortest distance of residential proximity (≤0.5-mile: odds ratio [OR]=2.2, 95% confidence interval [CI]: 0.4-11.8) or longest duration (10 years: OR=1.9, 95% CI: 0.8-4.8); the association with lumber facilities was more apparent for diffuse large B-cell lymphoma (lived within 2 miles: OR=1.7, 95% CI: 1.0-3.0) than for follicular lymphoma (OR=1.1, 95% CI: 0.5-2.2). We also observed elevated ORs for the chemical (SIC 28, 10 years: OR=1.5, 95% CI: 1.1-2.0), petroleum (SIC 29, 10 years: OR=1.9, 95% CI: 1.0-3.6), rubber/miscellaneous plastics products (SIC 30, ≤0.5-mile: OR=2.7, 95% CI: 1.0-7.4), and primary metal (SIC 33, lived within 2 miles: OR=1.3, 95% CI: 1.0-1.6) industries; however, patterns of risk were inconsistent between distance and duration metrics. This study does not provide strong evidence that living near manufacturing industries increases NHL risk. However, future studies designed to include greater numbers of persons living near specific types of industries, along with fate-transport modeling of chemical releases

  7. Risk Management Technique for design and operation of facilities and equipment

    NASA Technical Reports Server (NTRS)

    Fedor, O. H.; Parsons, W. N.; Coutinho, J. De S.

    1975-01-01

    The Risk Management System collects information from engineering, operating, and management personnel to identify potentially hazardous conditions. This information is used in risk analysis, problem resolution, and contingency planning. The resulting hazard accountability system enables management to monitor all identified hazards. Data from this system are examined in project reviews so that management can decide to eliminate or accept these risks. This technique is particularly effective in improving the management of risks in large, complex, high-energy facilities. These improvements are needed for increased cooperation among industry, regulatory agencies, and the public.

  8. Diet components can suppress inflammation and reduce cancer risk

    PubMed Central

    2014-01-01

    Epidemiology studies indicate that diet or specific dietary components can reduce the risk for cancer, cardiovascular disease and diabetes. An underlying cause of these diseases is chronic inflammation. Dietary components that are beneficial against disease seem to have multiple mechanisms of action and many also have a common mechanism of reducing inflammation, often via the NFκB pathway. Thus, a plant based diet can contain many components that reduce inflammation and can reduce the risk for developing all three of these chronic diseases. We summarize dietary components that have been shown to reduce cancer risk and two studies that show that dietary walnut can reduce cancer growth and development. Part of the mechanism for the anticancer benefit of walnut was by suppressing the activation of NFκB. In this brief review, we focus on reduction of cancer risk by dietary components and the relationship to suppression of inflammation. However, it should be remembered that most dietary components have multiple beneficial mechanisms of action that can be additive and that suppression of chronic inflammation should reduce the risk for all three chronic diseases. PMID:24944766

  9. Relationship Between Perceived Risk of Falling and Adoption of Precautions to Reduce Fall Risk.

    PubMed

    Blalock, Susan J; Gildner, Paula L; Jones, Jennifer L; Bowling, James M; Casteel, Carri H

    2016-06-01

    To better understand the relationship between perceived risk of falling and awareness and adoption of four specific precautions that older adults have taken to reduce this risk. Cross-sectional. Data were collected in in-person interviews conducted in the homes of study participants. Interviews conducted between March 2011 and September 2013 and lasted an average of 60-90 minutes. A stratified sampling strategy designed to enroll an equal number of homebound and nonhomebound participants was used. All participants (N = 164) were recruited from central North Carolina. Participants were asked about 1-year fall history, perceived risk of falling, restriction of activities because of fear of falling, awareness of four recommended fall prevention behaviors (exercise, annual medication review, bathroom grab bars, safe footwear), and current practice of these behaviors. In bivariate analyses, individuals who were aware of two behaviors recommended to reduce the risk of falling (exercise, use of safe footwear) and had adopted these behaviors perceived their risk of falling as lower than individuals who were aware of the recommended behaviors but had not adopted them. Moreover, in multivariate analyses, individuals who did not know that exercise is recommended to reduce the risk of falling perceived their risk of falling as lower than those who were aware of this recommendation and had adopted it. Individuals were least likely to be aware that medication reviews and exercise are recommended to reduce fall risk. Awareness of behaviors recommended to reduce fall risk appears necessary for adoption of these behaviors to reduce perceived risk. Fall-prevention campaigns should emphasize behaviors where awareness is low. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  10. Does Metformin Reduce Cancer Risks? Methodologic Considerations.

    PubMed

    Golozar, Asieh; Liu, Shuiqing; Lin, Joeseph A; Peairs, Kimberly; Yeh, Hsin-Chieh

    2016-01-01

    The substantial burden of cancer and diabetes and the association between the two conditions has been a motivation for researchers to look for targeted strategies that can simultaneously affect both diseases and reduce their overlapping burden. In the absence of randomized clinical trials, researchers have taken advantage of the availability and richness of administrative databases and electronic medical records to investigate the effects of drugs on cancer risk among diabetic individuals. The majority of these studies suggest that metformin could potentially reduce cancer risk. However, the validity of this purported reduction in cancer risk is limited by several methodological flaws either in the study design or in the analysis. Whether metformin use decreases cancer risk relies heavily on the availability of valid data sources with complete information on confounders, accurate assessment of drug use, appropriate study design, and robust analytical techniques. The majority of the observational studies assessing the association between metformin and cancer risk suffer from methodological shortcomings and efforts to address these issues have been incomplete. Future investigations on the association between metformin and cancer risk should clearly address the methodological issues due to confounding by indication, prevalent user bias, and time-related biases. Although the proposed strategies do not guarantee a bias-free estimate for the association between metformin and cancer, they will reduce synthesis of and reporting of erroneous results.

  11. 137Cs Radiological risk estimation of NSD facility at Karawang site by using RESRAD onsite application: effect of cover thickness

    NASA Astrophysics Data System (ADS)

    Setiawan, B.; Prihastuti, S.; Moersidik, S. S.

    2018-02-01

    The operational of near surface disposal facility during waste packages loading activity into the facility, or in a monitoring activity around disposal facility at Karawang area is predicted to give a radiological risk to radiation workers. The thickness of disposal facility cover system affected the number of radiological risk of workers. Due to this reason, a radiological risk estimation needs to be considered. RESRAD onsite code is applied for this purpose by analyse the individual accepted dose and radiological risk data of radiation workers. The obtained results and then are compared with radiation protection reference in accordance with national regulation. In this case, the data from the experimental result of Karawang clay as host of disposal facility such as Kd value of 137Cs was used. Results showed that the thickness of the cover layer of disposal facility affected to the radiological risk which accepted by workers in a near surface disposal facility.

  12. Risk assessment associated to possible concrete degradation of a near surface disposal facility

    NASA Astrophysics Data System (ADS)

    Capra, B.; Billard, Y.; Wacquier, W.; Gens, R.

    2013-07-01

    This article outlines a risk analysis of possible concrete degradation performed in the framework of the preparation of the Safety Report of ONDRAF/NIRAS, the Belgian Agency for Radioactive Waste and Enriched Fissile Materials, for the construction and operation of a near surface disposal facility of category A waste - short-lived low and intermediate level waste - in Dessel. The main degradation mechanism considered is the carbonation of different concrete components over different periods (from the building phase up to 2000 years), which induces corrosion of the rebars. A dedicated methodology mixing risk analysis and numerical modeling of concrete carbonation has been developed to assess the critical risks of the disposal facility at different periods. According to the results obtained, risk mapping was used to assess the impact of carbonation of concrete on the different components at the different stages. The most important risk is related to an extreme situation with complete removal of the earth cover and side embankment.

  13. Risk assessment of CST-7 proposed waste treatment and storage facilities Volume I: Limited-scope probabilistic risk assessment (PRA) of proposed CST-7 waste treatment & storage facilities. Volume II: Preliminary hazards analysis of proposed CST-7 waste storage & treatment facilities

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

    Sasser, K.

    1994-06-01

    In FY 1993, the Los Alamos National Laboratory Waste Management Group [CST-7 (formerly EM-7)] requested the Probabilistic Risk and Hazards Analysis Group [TSA-11 (formerly N-6)] to conduct a study of the hazards associated with several CST-7 facilities. Among these facilities are the Hazardous Waste Treatment Facility (HWTF), the HWTF Drum Storage Building (DSB), and the Mixed Waste Receiving and Storage Facility (MWRSF), which are proposed for construction beginning in 1996. These facilities are needed to upgrade the Laboratory`s storage capability for hazardous and mixed wastes and to provide treatment capabilities for wastes in cases where offsite treatment is not availablemore » or desirable. These facilities will assist Los Alamos in complying with federal and state requlations.« less

  14. Risk-based maintenance of ethylene oxide production facilities.

    PubMed

    Khan, Faisal I; Haddara, Mahmoud R

    2004-05-20

    This paper discusses a methodology for the design of an optimum inspection and maintenance program. The methodology, called risk-based maintenance (RBM) is based on integrating a reliability approach and a risk assessment strategy to obtain an optimum maintenance schedule. First, the likely equipment failure scenarios are formulated. Out of many likely failure scenarios, the ones, which are most probable, are subjected to a detailed study. Detailed consequence analysis is done for the selected scenarios. Subsequently, these failure scenarios are subjected to a fault tree analysis to determine their probabilities. Finally, risk is computed by combining the results of the consequence and the probability analyses. The calculated risk is compared against known acceptable criteria. The frequencies of the maintenance tasks are obtained by minimizing the estimated risk. A case study involving an ethylene oxide production facility is presented. Out of the five most hazardous units considered, the pipeline used for the transportation of the ethylene is found to have the highest risk. Using available failure data and a lognormal reliability distribution function human health risk factors are calculated. Both societal risk factors and individual risk factors exceeded the acceptable risk criteria. To determine an optimal maintenance interval, a reverse fault tree analysis was used. The maintenance interval was determined such that the original high risk is brought down to an acceptable level. A sensitivity analysis is also undertaken to study the impact of changing the distribution of the reliability model as well as the error in the distribution parameters on the maintenance interval.

  15. Reducing cancer risk in rural communities through supermarket interventions.

    PubMed

    McCool, Barent N; Lyford, Conrad P; Hensarling, Natalie; Pence, Barbara; McCool, Audrey C; Thapa, Janani; Belasco, Eric; Carter, Tyra M

    2013-09-01

    Cancer risk is high, and prevention efforts are often minimal in rural communities. Feasible means of encouraging lifestyles that will reduce cancer risk for residents of rural communities are needed. This project developed and tested a model that could be feasibly adopted by rural communities to reduce cancer risk. This model focuses on incorporating multi-faceted cancer risk education in the local supermarket. As the supermarket functions both as the primary food source and an information source in small rural communities, the supermarket focus encourages the development of a community environment supportive of lifestyles that should reduce residents' risk for cancer. The actions taken to implement the model and the challenges that communities would have in implementing the model are identified.

  16. Mistreatment in Assisted Living Facilities: Complaints, Substantiations, and Risk Factors

    ERIC Educational Resources Information Center

    Phillips, Linda R.; Guo, Guifang

    2011-01-01

    Purpose of the Study: Use archived public data from Arizona to explore relationships among selected institutional and resident risk and situation-specific factors and complaints and substantiated allegations of various types of mistreatment in assisted living facilities (ALFs). Design and Methods: An exploratory/descriptive 2-group design was…

  17. REDUCING CHILDREN'S RISK FROM LEAD IN SOIL

    EPA Science Inventory

    Traditional methods for reducing risk from elevated levels of soil Pb involves removal, covering, or dilution by mixing with uncontaminated soil. Believing that in situ remediation techniques are viable alternatives, the EPA=s National Risk Management Research Laboratory (NRMRL) ...

  18. Site specific risk assessment of an energy-from-waste thermal treatment facility in Durham Region, Ontario, Canada. Part A: Human health risk assessment.

    PubMed

    Ollson, Christopher A; Knopper, Loren D; Whitfield Aslund, Melissa L; Jayasinghe, Ruwan

    2014-01-01

    The regions of Durham and York in Ontario, Canada have partnered to construct an energy-from-waste thermal treatment facility as part of a long term strategy for the management of their municipal solid waste. This paper presents the results of a comprehensive human health risk assessment for this facility. This assessment was based on extensive sampling of baseline environmental conditions (e.g., collection and analysis of air, soil, water, and biota samples) as well as detailed site specific modeling to predict facility-related emissions of 87 identified contaminants of potential concern. Emissions were estimated for both the approved initial operating design capacity of the facility (140,000 tonnes per year) and for the maximum design capacity (400,000 tonnes per year). For the 140,000 tonnes per year scenario, this assessment indicated that facility-related emissions are unlikely to cause adverse health risks to local residents, farmers, or other receptors (e.g., recreational users). For the 400,000 tonnes per year scenarios, slightly elevated risks were noted with respect to inhalation (hydrogen chloride) and infant consumption of breast milk (dioxins and furans), but only during predicted 'upset conditions' (i.e. facility start-up, shutdown, and loss of air pollution control) that represent unusual and/or transient occurrences. However, current provincial regulations require that additional environmental screening would be mandatory prior to expansion of the facility beyond the initial approved capacity (140,000 tonnes per year). Therefore, the potential risks due to upset conditions for the 400,000 tonnes per year scenario should be more closely investigated if future expansion is pursued. © 2013.

  19. The care of Filipino juvenile offenders in residential facilities evaluated using the risk-need-responsivity model.

    PubMed

    Spruit, Anouk; Wissink, Inge B; Stams, Geert Jan J M

    2016-01-01

    According to the risk-need-responsivity model of offender, assessment and rehabilitation treatment should target specific factors that are related to re-offending. This study evaluates the residential care of Filipino juvenile offenders using the risk-need-responsivity model. Risk analyses and criminogenic needs assessments (parenting style, aggression, relationships with peers, empathy, and moral reasoning) have been conducted using data of 55 juvenile offenders in four residential facilities. The psychological care has been assessed using a checklist. Statistical analyses showed that juvenile offenders had a high risk of re-offending, high aggression, difficulties in making pro-social friends, and a delayed socio-moral development. The psychological programs in the residential facilities were evaluated to be poor. The availability of the psychological care in the facilities fitted poorly with the characteristics of the juvenile offenders and did not comply with the risk-need-responsivity model. Implications for research and practice are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Fact Sheet for Friction Materials Manufacturing Facilities Residual Risk and Technology Review

    EPA Pesticide Factsheets

    proposed amendments to the National Emission Standards for Hazardous Air Pollutants (NESHAP) for Friction Materials Manufacturing Facilities to address the results of the residual risk and technology review

  1. Nutritional strategies to reduce falls risk in older people.

    PubMed

    Nash, Louise; Bergin, Nick

    2018-03-23

    A literature review found an association between increased falls risk and malnutrition, sarcopenia, vitamin D deficiency and dehydration. Strategies to identify, prevent and treat these conditions can help to reduce falls risk in at-risk groups such as frail, older people. Nurses can reduce falls risk in older people by raising awareness of risk factors and embedding nutritional strategies in local falls reduction strategies. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  2. Managing facility risk: external threats and health care organizations.

    PubMed

    Reid, Daniel J; Reid, William H

    2014-01-01

    Clinicians and clinical administrators should have a basic understanding of physical and financial risk to mental health facilities related to external physical threat, including actions usually viewed as "terrorism" and much more common sources of violence. This article refers to threats from mentally ill persons and those acting out of bizarre or misguided "revenge," extortionists and other outright criminals, and perpetrators usually identified as domestic or international terrorists. The principles apply both to relatively small and contained acts (such as a patient or ex-patient attacking a staff member) and to much larger events (such as bombings and armed attack), and are relevant to facilities both within and outside the U.S. Patient care and accessibility to mental health services rest not only on clinical skills, but also on a place to practice them and an organized system supported by staff, physical facilities, and funding. Clinicians who have some familiarity with the non-clinical requirements for care are in a position to support non-clinical staff in preventing care from being interrupted by external threats or events such as terrorist activity, and/or to serve at the interface of facility operations and direct clinical care. Readers should note that this article is an introduction to the topic and cannot address all local, state and national standards for hospital safety, or insurance providers' individual facility requirements. Copyright © 2014 John Wiley & Sons, Ltd.

  3. Incidence, Risks, and Types of Infections in Pediatric Long-term Care Facilities.

    PubMed

    Saiman, Lisa; Maykowski, Philip; Murray, Meghan; Cohen, Bevin; Neu, Natalie; Jia, Haomioa; Hutcheon, Gordon; Simpser, Edwin; Mosiello, Linda; Alba, Luis; Larson, Elaine

    2017-09-01

    The population of infants, children, and adolescents cared for at pediatric long-term care facilities is increasing in complexity and size and thus consumes substantial health care resources. Infections are a significant cause of morbidity and mortality in this population, but few recent data describe their incidence and effects. To describe the types of infections diagnosed in residents of pediatric long-term care facilities, calculate infection rates, and identify risk factors for respiratory tract infections (RTIs). This prospective cohort study, which was part of a larger trial called Keep It Clean for Kids, was conducted from September 1, 2012, to December 31, 2015, at 3 pediatric long-term care facilities in New York. Residents of the facilities who were 21 years or younger and either residents or admitted during the study period (n = 717) were enrolled in the study. Medical records were reviewed to identify infections diagnosed by site clinicians. Incidence of infections, such as RTIs; skin and soft-tissue infections; chronic comorbid conditions, including neurologic and respiratory disorders; and device use, including gastrostomy tubes and tracheostomies, was determined. Risk factors for RTIs were assessed by generalized linear mixed method regression modeling. The 717 residents had a median (interquartile range) age at enrollment of 2.6 (0.4-9.1) years; 358 (49.9%) were male. Four hundred twenty-eight residents (59.7%) had feeding tubes and 215 (30.0%) had tracheostomies. Most chronic comorbid conditions were musculoskeletal or ambulation (532 residents [74.2%]), neurologic (505 [70.4%]), respiratory (361 [50.3%]), and gastrointestinal (230 [32.1%]) disorders, and 460 residents (64.2%) had 4 or more chronic comorbid conditions. Site clinicians diagnosed 2052 infections during the 3-year study period. Respiratory tract infections were most common and were diagnosed in 1291 residents (62.9%). The overall infection rate was 5.3 infections per 1000

  4. Suicide Risk in Nursing Homes and Assisted Living Facilities: 2003–2011

    PubMed Central

    Lohman, Matthew; Leslie, Marc; Powell, Virginia

    2015-01-01

    Objectives. We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide. Methods. Data come from the Virginia Violent Death Reporting System (2003–2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis. Results. Incidence of suicide was 14.16 per 100 000 in nursing homes and 15.66 in the community. Better performance on Nursing Home Compare quality metrics was associated with higher odds of suicide in nursing homes (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.21, 3.14). Larger facility size was associated with higher suicide risk in assisted living facilities (OR = 1.01; 95% CI = 1.00, 1.01). Text narratives identified 38 decedents anticipating transitioning into LTC and 16 whose loved one recently transitioned or resided in LTC. Conclusions. LTC may be an important point of engagement in suicide prevention. PMID:25973805

  5. Reducing Risk in DoD Software-Intensive Systems Development

    DTIC Science & Technology

    2016-03-01

    intensive systems development risk. This research addresses the use of the Technical Readiness Assessment (TRA) using the nine-level software Technology...The software TRLs are ineffective in reducing technical risk for the software component development. • Without the software TRLs, there is no...effective method to perform software TRA or reduce the technical development risk. The software component will behave as a new, untried technology in nearly

  6. Impact of Breast Density Legislation on Breast Cancer Risk Assessment and Supplemental Screening: A Survey of 110 Radiology Facilities.

    PubMed

    Nayak, Lina; Miyake, Kanae K; Leung, Jessica W T; Price, Elissa R; Liu, Yueyi I; Joe, Bonnie N; Sickles, Edward A; Thomas, William R; Lipson, Jafi A; Daniel, Bruce L; Hargreaves, Jonathan; Brenner, R James; Bassett, Lawrence W; Ojeda-Fournier, Haydee; Lindfors, Karen K; Feig, Stephen A; Ikeda, Debra M

    2016-09-01

    Breast density notification laws, passed in 19 states as of October 2014, mandate that patients be informed of their breast density. The purpose of this study is to assess the impact of this legislation on radiology practices, including performance of breast cancer risk assessment and supplemental screening studies. A 20-question anonymous web-based survey was emailed to radiologists in the Society of Breast Imaging between August 2013 and March 2014. Statistical analysis was performed using Fisher's exact test. Around 121 radiologists from 110 facilities in 34 USA states and 1 Canadian site responded. About 50% (55/110) of facilities had breast density legislation, 36% of facilities (39/109) performed breast cancer risk assessment (one facility did not respond). Risk assessment was performed as a new task in response to density legislation in 40% (6/15) of facilities in states with notification laws. However, there was no significant difference in performing risk assessment between facilities in states with a law and those without (p < 0.831). In anticipation of breast density legislation, 33% (16/48), 6% (3/48), and 6% (3/48) of facilities in states with laws implemented handheld whole breast ultrasound (WBUS), automated WBUS, and tomosynthesis, respectively. The ratio of facilities offering handheld WBUS was significantly higher in states with a law than in states without (p < 0.001). In response to breast density legislation, more than 33% of facilities are offering supplemental screening with WBUS and tomosynthesis, and many are performing formal risk assessment for determining patient management. © 2016 Wiley Periodicals, Inc.

  7. Accessibility of sports facilities for persons with reduced mobility and assessment of their motivation for practice.

    PubMed

    Sá, Maria Manuel; Azevedo, Rui; Martins, Maria Cristina; Machado, Osvaldo; Tavares, João

    2012-01-01

    This study aims to create awareness, both within the scientific community and among providers of sports facilities, for individuals with impaired or reduced mobility, promoting the development of technical solutions that allow greater autonomy and social integration of people with disabilities. The purpose of this work is, on the one hand, to evaluate the accessibility of sports facilities for people with reduced mobility and, on the other hand, to investigate why this user group has such low rates of participation in sporting activities. Firstly, using the Portuguese norms and legislation transcribed from European Community directives, a check list was created comprising all the items that sports facilities should abide by in order to provide accessibility and safety to people with reduced mobility. Another questionnaire was designed aimed at this user group, with questions pertaining to their desire and ability to use sports facilities. This questionnaire was distributed in Portugal, in the greater metropolitan area of Porto, to users of Rehabilitation Centres and Physiotherapy Clinics. The results obtained from the check-list showed the compliances and non-compliances of the respective sports facilities, proving that many barriers preventing the participation of people with reduced mobility still exist. Twenty-four people with permanent impairment of the lower extremities (paraplegia) answered the questionnaire pertaining to the desire and ability to perform physical activity. Two individuals (8%) had sporting activities available to them in their area of residence and only five (21%) performed any physical activity. The main reason given for not taking part in any activity was the lack of adapted sports facilities. All the participants felt that taking part in sports is beneficial. The benefits stated were: general well-being and development of the psychomotor component (e.g. coordination, balance, body posture), of physical condition (e.g. strength, resistance

  8. Potential advantages associated with implementing a risk-based inspection program by a nuclear facility

    NASA Astrophysics Data System (ADS)

    McNeill, Alexander, III; Balkey, Kenneth R.

    1995-05-01

    The current inservice inspection activities at a U.S. nuclear facility are based upon the American Society of Mechanical Engineers (ASME) Boiler and Pressure Vessel Code, Section XI. The Code selects examination locations based upon a sampling criteria which includes component geometry, stress, and usage among other criteria. This can result in a significant number of required examinations. As a result of regulatory action each nuclear facility has conducted probabilistic risk assessments (PRA) or individual plant examinations (IPE), producing plant specific risk-based information. Several initiatives have been introduced to apply this new plant risk information. Among these initiatives is risk-based inservice inspection. A code case has been introduced for piping inspections based upon this new risk- based technology. This effort brought forward to the ASME Section XI Code committee, has been initiated and championed by the ASME Research Task Force on Risk-Based Inspection Guidelines -- LWR Nuclear Power Plant Application. Preliminary assessments associated with the code case have revealed that potential advantages exist in a risk-based inservice inspection program with regard to a number of exams, risk, personnel exposure, and cost.

  9. Colonoscopy Reduces Risk of Death from Colorectal Cancer in High-Risk Patients

    Cancer.gov

    Long-term results from the National Polyp Study confirm that removing precancerous adenomas not only reduces the risk of colorectal cancer but also reduces the number of deaths from the disease by more than half.

  10. Breastfeeding Reduces Childhood Obesity Risks.

    PubMed

    Wang, Liang; Collins, Candice; Ratliff, Melanie; Xie, Bin; Wang, Youfa

    2017-06-01

    The present study examined the effects of breastfeeding and its duration on the development of childhood obesity from 24 months through grade 6. U.S. longitudinal data collected from 1234 children were analyzed using logistic regression models and generalized estimating equation (GEE). Child height and weight were measured six times at ages of 24 months, 36 months, 54 months, grade 1, grade 3, and grade 6. During the early 1990s, prevalence of breastfeeding was low in the United States, 60% and 48% at 1 and 6 months, respectively. Nonsmoking, white, married mothers with both parents in the household, and with income above the poverty line, were more likely to breastfeed at 1 month of age of their babies. Obesity rate of the children increased with age from 24 months to grade 6. Logistic regression showed that breastfeeding at month 1 was associated with 53% (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.30-0.73) and 47% (OR: 0.53, 95% CI: 0.36-0.78) decreased risks for childhood obesity at grades 1 and 6, respectively. GEE analysis showed that breastfeeding at 1 month reduced risk for childhood obesity by 36% (95% CI: 0.47-0.88) from ages 24 months through grade 6. Regarding breastfeeding duration, more than 6 months (vs. never) was associated with a decreased risk for childhood obesity by 42% (OR: 0.58, 95% CI: 0.36-0.94). Breastfeeding at 1 month and more than 6 months reduced the risk of childhood obesity. Rate of breastfeeding was low in the United States in the 1990s, which may have had long-term implications on children.

  11. Reducing the price of treatment for multidrug-resistant tuberculosis through the Global Drug Facility.

    PubMed

    Lunte, Kaspars; Cordier-Lassalle, Thierry; Keravec, Joel

    2015-04-01

    Many countries have limited experience of securing the best prices for drugs and have little negotiating power. This is particularly true for the complex, lengthy and expensive regimens used to treat multidrug-resistant tuberculosis. The Stop TB Partnership's Global Drug Facility is dedicated to improving worldwide access to antituberculosis medicines and diagnostic techniques that meet international quality standards. The Global Drug Facility is able to secure price reductions through competitive tendering among prequalified drug manufacturers and by consolidating orders to achieve large purchase volumes. Consolidating the market in this way increases the incentives for suppliers of quality-assured medicines. In 2013 the Global Drug Facility reduced the price of the second-line drugs it supplies for multidrug-resistant tuberculosis: the overall cost of the longest and most expensive treatment regimen for a patient decreased by 26% - from 7890 United States dollars (US$) in 2011 to US$ 5822 in 2013. The price of treatment for multidrug-resistant tuberculosis supplied by the Global Drug Facility was reduced by consolidating orders to achieve large purchase volumes, by international, competitive bidding and by the existence of donor-funded medicine stockpiles. The rise in the number of suppliers of internationally quality-assured drugs was also important. The savings achieved from lower drug costs could be used to increase the number of patients on high-quality treatment.

  12. Dose and Dose Risk Caused by Natural Phenomena - Proposed Powder Metallurgy Core Manufacturing Facility

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

    Holmes, W.G.

    2001-08-16

    The offsite radiological effects from high velocity straight winds, tornadoes, and earthquakes have been estimated for a proposed facility for manufacturing enriched uranium fuel cores by powder metallurgy. Projected doses range up to 30 mrem/event to the maximum offsite individual for high winds and up to 85 mrem/event for very severe earthquakes. Even under conservative assumptions on meteorological conditions, the maximum offsite dose would be about 20 per cent of the DOE limit for accidents involving enriched uranium storage facilities. The total dose risk is low and is dominated by the risk from earthquakes. This report discusses this test.

  13. Differences in Colonoscopy Quality Among Facilities: Development of a Post-Colonoscopy Risk-Standardized Rate of Unplanned Hospital Visits.

    PubMed

    Ranasinghe, Isuru; Parzynski, Craig S; Searfoss, Rana; Montague, Julia; Lin, Zhenqiu; Allen, John; Vender, Ronald; Bhat, Kanchana; Ross, Joseph S; Bernheim, Susannah; Krumholz, Harlan M; Drye, Elizabeth E

    2016-01-01

    Colonoscopy is a common procedure, yet little is known about variations in colonoscopy quality among outpatient facilities. We developed an outcome measure to profile outpatient facilities by estimating risk-standardized rates of unplanned hospital visits within 7 days of colonoscopy. We used a 20% sample of 2010 Medicare outpatient colonoscopy claims (331,880 colonoscopies performed at 8140 facilities) from patients ≥65 years or older, and developed a patient-level logistic regression model to estimate the risk of unplanned hospital visits (ie, emergency department visits, observation stays, and inpatient admissions) within 7 days of colonoscopy. We then used the patient-level risk model variables and hierarchical logistic regression to estimate facility rates of risk-standardized unplanned hospital visits using data from the Healthcare Cost and Utilization Project (325,811 colonoscopies at 992 facilities), from 4 states containing 100% of colonoscopies per facility. Outpatient colonoscopies were followed by 5412 unplanned hospital visits within 7 days (16.3/1000 colonoscopies). Hemorrhage, abdominal pain, and perforation were the most common causes of unplanned hospital visits. Fifteen variables were independently associated with unplanned hospital visits (c = 0.67). A history of fluid and electrolyte imbalance (odds ratio [OR] = 1.43; 95% confidence interval [CI]: 1.29-1.58), psychiatric disorders (OR = 1.34; 95% CI: 1.22-1.46), and, in the absence of prior arrhythmia, increasing age past 65 years (aged >85 years vs 65-69 years: OR = 1.87; 95% CI: 1.54-2.28) were most strongly associated. The facility risk-standardized unplanned hospital visits calculated using Healthcare Cost and Utilization Project data showed significant variation (median 12.3/1000; 5th-95th percentile, 10.5-14.6/1000). Median risk-standardized unplanned hospital visits were comparable between ambulatory surgery centers and hospital outpatient departments (each was 10.2/1000), and

  14. Race, region and risk: An examination of minority proximity to noxious facilities

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

    Nieves, A.L.; Nieves, L.A.

    1996-04-01

    The past decade has given rise to terms like environmental racism, eco-racism, and environmental inequities to characterize a disproportional distribution of environmental disamenities among minority communities. Much of the literature supports the contention that racial and ethnic minorities and low-income groups bear a disproportionate burden of risk from hazardous activities and substances in the environment. This study expands the scope of prior studies by employing county-level data for the entire nation and including a broad range of facility types associated with environmental disamenities. In addition, it addresses the issue of the distribution of noxious facilities among white and non-white populationsmore » in an attempt to determine the relative exposure to risk among different racial and ethnic groups. In addition, the authors also explore the relative importance of nonurban versus urban residence.« less

  15. Joint Strike Figher Acquisition: Mature Critical Technologies Needed to Reduce Risks

    DTIC Science & Technology

    2001-10-01

    Reduce Risks GAO-02-39 Report Documentation Page Report Date 00OCT2001 Report Type N/A Dates Covered (from... to) - Title and Subtitle JOINT STRIKE...FIGHTER ACQUISITION: Mature Critical Technologies Needed to Reduce Risks Contract Number Grant Number Program Element Number Author(s) Project...1Joint Strike Fighter Acquisition: Development Schedule Should Be Changed to Reduce Risks (GAO/T-NSIAD-00-132

  16. Community outreach at biomedical research facilities.

    PubMed

    Goldman, M; Hedetniemi, J N; Herbert, E R; Sassaman, J S; Walker, B C

    2000-12-01

    For biomedical researchers to fulfill their responsibility for protecting the environment, they must do more than meet the scientific challenge of reducing the number and volume of hazardous materials used in their laboratories and the engineering challenge of reducing pollution and shifting to cleaner energy sources. They must also meet the public relations challenge of informing and involving their neighbors in these efforts. The experience of the Office of Community Liaison of the National Institutes of Health (NIH) in meeting the latter challenge offers a model and several valuable lessons for other biomedical research facilities to follow. This paper is based on presentations by an expert panel during the Leadership Conference on Biomedical Research and the Environment held 1--2 November 1999 at NIH, Bethesda, Maryland. The risks perceived by community members are often quite different from those identified by officials at the biomedical research facility. The best antidote for misconceptions is more and better information. If community organizations are to be informed participants in the decision-making process, they need a simple but robust mechanism for identifying and evaluating the environmental hazards in their community. Local government can and should be an active and fully informed partner in planning and emergency preparedness. In some cases this can reduce the regulatory burden on the biomedical research facility. In other cases it might simplify and expedite the permitting process or help the facility disseminate reliable information to the community. When a particular risk, real or perceived, is of special concern to the community, community members should be involved in the design, implementation, and evaluation of targeted risk assessment activities. Only by doing so will the community have confidence in the results of those activities. NIH has involved community members in joint efforts to deal with topics as varied as recycling and soil

  17. Mitigating risks related to facilities management.

    PubMed

    O'Neill, Daniel P; Scarborough, Sydney

    2013-07-01

    By looking at metrics focusing on the functionality, age, capital investment, transparency, and sustainability (FACTS) of their organizations' facilities, facilities management teams can build potential business cases to justify upgrading the facilities. A FACTS analysis can ensure that capital spent on facilities will produce a higher or more certain ROI than alternatives. A consistent process for managing spending helps to avoid unexpected spikes that cost the enterprise more in the long run.

  18. Financial incentives for reducing proliferation risks

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

    Weise, Rachel A.; Hund, Gretchen

    This article submitted for publication to the Bulletin of Atomic Scientists explains the possible financial incentives for financial institutions and large integrators to reduce nuclear proliferation risks by including anti-proliferation measures in their due diligence and requiring their suppliers to meet heightened compliance standards. Because manufacturers of dual-use nuclear goods are diverse and numerous outreach is difficult. However, financial institutions and large integrators work with nearly all dual-use manufacturers, making financial institutions and integrators well-positioned to increase awareness of proliferation and trafficking risks throughout the nuclear supply chain

  19. Periodontal disease with treatment reduces subsequent cancer risks.

    PubMed

    Hwang, Ing-Ming; Sun, Li-Min; Lin, Cheng-Li; Lee, Chun-Feng; Kao, Chia-Hung

    2014-10-01

    The aim of our study was to evaluate the relationship between routine treatment of periodontal disease (PD) and the subsequent risks for cancers in Taiwan. Study participants were selected from the Taiwan National Health Insurance (NHI) system database. The PD with a routine treatment cohort contained 38 902 patients. For each treatment cohort participant, two age- and sex-matched comparison (control) cohort participants were randomly selected. Cox's proportional hazards regression analysis was used to estimate the effects of PD with treatment on the subsequent risk of cancer. The overall risk of developing cancer was significantly lower in the treatment cohort than in the patients without treatment (adjusted Hazard ratio = 0.72, 95% confidence interval = 0.68-0.76). The risks of developing most gastrointestinal tract, lung, gynecological and brain malignancies were significantly lower in the treatment cohort than in the comparison cohort. In contrast, the risks of prostate and thyroid cancers were significantly higher in the treatment cohort than in the comparison cohort. Our findings suggest that PD with treatment is associated with a significantly reduced overall risk of cancer and reduced risks of certain types of cancers. © The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  20. Risk-reducing Surgery in Women at Risk for Familial Breast or Ovarian Cancer

    PubMed Central

    Rhiem, K.; Pfeifer, K.; Schmutzler, R. K.; Kiechle, M.

    2012-01-01

    An estimated 5 % of breast cancers and 10 % of ovarian cancers may be due to inherited autosomal dominant breast and ovarian cancer alleles BRCA1 und BRCA2. According to population-based studies 1 or 2 women per 1000 carry such a risk allele. The cumulative cancer risk for healthy women with a BRCA-mutation is between 60 and 85 % for breast cancer and between 20 and 60 % for ovarian cancer. Recent studies have reported an increased risk for contralateral breast cancer in women after unilateral breast cancer. Since 1997 the German Cancer Aid has supported an interdisciplinary approach for high-risk women consisting of genetic testing, counselling and prevention in 12 specialised centres. Since 2005 this concept has received additional support from health insurance companies, and results have been assessed with regard to outcomes (e.g. reduced mortality due to more intensive early diagnosis). The number of centres has increased to 15 at various university hospitals. These interdisciplinary centres offer women the opportunity to participate in a structured screening programme for the early diagnosis of breast cancer and provide non-directive counselling on the options for risk-reducing surgery, e.g., prophylactic bilateral salpingo-oophorectomy, prophylactic bilateral mastectomy or contralateral prophylactic mastectomy after unilateral breast cancer. Such surgical interventions can significantly reduce the risk of disease, the respective disease-specific mortality and – particularly prophylactic bilateral salpingo-oophorectomy – total mortality in BRCA-mutation carriers. PMID:26640291

  1. The efficiency of asset management strategies to reduce urban flood risk.

    PubMed

    ten Veldhuis, J A E; Clemens, F H L R

    2011-01-01

    In this study, three asset management strategies were compared with respect to their efficiency to reduce flood risk. Data from call centres at two municipalities were used to quantify urban flood risks associated with three causes of urban flooding: gully pot blockage, sewer pipe blockage and sewer overloading. The efficiency of three flood reduction strategies was assessed based on their effect on the causes contributing to flood risk. The sensitivity of the results to uncertainty in the data source, citizens' calls, was analysed through incorporation of uncertainty ranges taken from customer complaint literature. Based on the available data it could be shown that increasing gully pot blockage is the most efficient action to reduce flood risk, given data uncertainty. If differences between cause incidences are large, as in the presented case study, call data are sufficient to decide how flood risk can be most efficiently reduced. According to the results of this analysis, enlargement of sewer pipes is not an efficient strategy to reduce flood risk, because flood risk associated with sewer overloading is small compared to other failure mechanisms.

  2. Societal acceptance of controversial facilities: The role of two public participation strategies---negotiation and risk communication

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

    Wolfe, A.K.

    Public participation in decision making about the siting of controversial facilities is viewed in contradictory ways by different groups of people. Some see public participation as an impediment, while others think it is an important mechanism in gaining societal acceptance for eventual siting. This paper discusses two strategies for obtaining societal acceptance--- negotiation and risk communication---in light of the extent to which they (1) involve members of the public; (2) focus on risk-related issues; and (3) contribute to decisions to site controversial facilities. The paper presents an integrated conceptual model for public participation in siting decisions that incorporates risk asmore » well as social, political, and historical contexts. 20 refs., 1 fig.« less

  3. 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.

  4. 6 CFR 27.205 - Determination that a chemical facility “presents a high level of security risk.”

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 6 Domestic Security 1 2010-01-01 2010-01-01 false Determination that a chemical facility âpresents a high level of security risk.â 27.205 Section 27.205 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS Chemical Facility Security...

  5. Risk perception and public acceptance toward a highly protested Waste-to-Energy facility.

    PubMed

    Ren, Xiangyu; Che, Yue; Yang, Kai; Tao, Yun

    2016-02-01

    The application of Waste-to-Energy treatment in Municipal Solid Waste faces strong protest by local communities, especially in cities with high population densities. This study introduces insight into the public awareness, acceptance and risk perception toward Waste-to-Energy through a structured questionnaire survey around a Waste-to-Energy facility in Shanghai, China. The Dichotomous-Choice contingent valuation method was applied to study the willingness to accept of residents as an indicator of risk perception and tolerance. The factors influencing risk perception and the protest response choice were analyzed. The geographical distributions of the acceptance of Waste-to-Energy facility and protest response were explored using geographical information systems. The findings of the research indicated an encouraging vision of promoting Waste-to-Energy, considering its benefits of renewable energy and the conservation of land. A high percentage of protest willingness to accept (50.94%) was highlighted with the effect of income, opinion about Waste-to-Energy, gender and perceived impact. The fuzzy classification among people with different opinions on compensation (valid 0, positive or protest willingness to accept) revealed the existing yet rejected demand of compensation among protesters. Geographical distribution in the public attitude can also be observed. Finally significant statistical relation between knowledge and risk perception indicates the need of risk communication, as well as involving public into whole management process. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Analyses in Support of Risk-Informed Natural Gas Vehicle Maintenance Facility Codes and Standards: Phase II.

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

    Blaylock, Myra L.; LaFleur, Chris Bensdotter; Muna, Alice Baca

    Safety standards development for maintenance facilities of liquid and compressed natural gas fueled vehicles is required to ensure proper facility design and operating procedures. Standard development organizations are utilizing risk-informed concepts to develop natural gas vehicle (NGV) codes and standards so that maintenance facilities meet acceptable risk levels. The present report summarizes Phase II work for existing NGV repair facility code requirements and highlights inconsistencies that need quantitative analysis into their effectiveness. A Hazardous and Operability study was performed to identify key scenarios of interest using risk ranking. Detailed simulations and modeling were performed to estimate the location and behaviormore » of natural gas releases based on these scenarios. Specific code conflicts were identified, and ineffective code requirements were highlighted and resolutions proposed. These include ventilation rate basis on area or volume, as well as a ceiling offset which seems ineffective at protecting against flammable gas concentrations. ACKNOWLEDGEMENTS The authors gratefully acknowledge Bill Houf (SNL -- Retired) for his assistance with the set-up and post-processing of the numerical simulations. The authors also acknowledge Doug Horne (retired) for his helpful discussions. We would also like to acknowledge the support from the Clean Cities program of DOE's Vehicle Technology Office.« less

  7. Report of the New England Task Force on Reducing Heart Disease and Stroke Risk.

    PubMed Central

    Havas, S; Wozenski, S; Deprez, R; Miller, L; Charman, R; Hamrell, M; Green, L; Benn, S

    1989-01-01

    Five years ago, a task force on reducing risk for heart disease and stroke was established by the six New England States. The task force included representatives from State public health departments, academia, the corporate sector, and voluntary organizations. This article is the final report of the task force. Heart disease and cerebrovascular disease are major causes of mortality in the New England region. Heart disease causes nearly 40 percent of all deaths in each of the six States and cerebrovascular disease, 7 percent of the deaths. Major risk factors for ischemic heart disease that have been identified--elevated serum cholesterol, high blood pressure, and cigarette smoking--are caused largely by lifestyle behaviors. Similarly, cerebrovascular disease results largely from uncontrolled high blood pressure, much of which is attributable to unhealthy lifestyle behaviors. In a series of studies evidence has accumulated that the reduction or elimination of these risk factors results in a decline in mortality rates. Many intervention programs have been mounted in the region, but there has been no population-wide effort to attack these risk factors. The task force proposed a broad range of activities for New Englanders at sites in the community and in health facilities. These activities would promote not smoking, exercising regularly, and maintaining desirable levels of serum cholesterol and blood pressure. PMID:2495547

  8. Risk-reducing mastectomy for the prevention of primary breast cancer.

    PubMed

    Carbine, Nora E; Lostumbo, Liz; Wallace, Judi; Ko, Henry

    2018-04-05

    Recent progress in understanding the genetic basis of breast cancer and widely publicized reports of celebrities undergoing risk-reducing mastectomy (RRM) have increased interest in RRM as a method of preventing breast cancer. This is an update of a Cochrane Review first published in 2004 and previously updated in 2006 and 2010. (i) To determine whether risk-reducing mastectomy reduces death rates from any cause in women who have never had breast cancer and in women who have a history of breast cancer in one breast, and (ii) to examine the effect of risk-reducing mastectomy on other endpoints, including breast cancer incidence, breast cancer mortality, disease-free survival, physical morbidity, and psychosocial outcomes. For this Review update, we searched Cochrane Breast Cancer's Specialized Register, MEDLINE, Embase and the WHO International Clinical Trials Registry Platform (ICTRP) on 9 July 2016. We included studies in English. Participants included women at risk for breast cancer in at least one breast. Interventions included all types of mastectomy performed for the purpose of preventing breast cancer. At least two review authors independently abstracted data from each report. We summarized data descriptively; quantitative meta-analysis was not feasible due to heterogeneity of study designs and insufficient reporting. We analyzed data separately for bilateral risk-reducing mastectomy (BRRM) and contralateral risk-reducing mastectomy (CRRM). Four review authors assessed the methodological quality to determine whether or not the methods used sufficiently minimized selection bias, performance bias, detection bias, and attrition bias. All 61 included studies were observational studies with some methodological limitations; randomized trials were absent. The studies presented data on 15,077 women with a wide range of risk factors for breast cancer, who underwent RRM.Twenty-one BRRM studies looking at the incidence of breast cancer or disease-specific mortality, or

  9. Reducing uncertainty in risk modeling for methylmercury exposure

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

    Ponce, R.; Egeland, G.; Middaugh, J.

    The biomagnification and bioaccumulation of methylmercury in marine species represents a challenge for risk assessment related to the consumption of subsistence foods in Alaska. Because of the profound impact that food consumption advisories have on indigenous peoples seeking to preserve a way of life, there is a need to reduce uncertainty in risk assessment. Thus, research was initiated to reduce the uncertainty in assessing the health risks associated with the consumption of subsistence foods. Because marine subsistence foods typically contain elevated levels of methylmercury, preliminary research efforts have focused on methylmercury as the principal chemical of concern. Of particular interestmore » are the antagonistic effects of selenium on methylmercury toxicity. Because of this antagonism, methylmercury exposure through the consumption of marine mammal meat (with high selenium) may not be as toxic as comparable exposures through other sources of dietary intake, such as in the contaminated bread episode of Iraq (containing relatively low selenium). This hypothesis is supported by animal experiments showing reduced toxicity of methylmercury associated with marine mammal meat, by the antagonistic influence of selenium on methylmercury toxicity, and by negative clinical findings in adult populations exposed to methylmercury through a marine diet not subject to industrial contamination. Exploratory model development is underway to identify potential improvements and applications of current deterministic and probabilistic models, particularly by incorporating selenium as an antagonist in risk modeling methods.« less

  10. [Strategies for reducing risks in smoking: opportunity or threat].

    PubMed

    Córdoba, Rodrigo; Nerín, Isabel

    2009-12-01

    The smoking control policies recommended by the World Health Organisation have achieved a slight decrease in smoking prevalence in the developed countries, although associated mortality is still very high. The use of tobacco products other than cigarettes and even medicinal nicotine (known as nicotine replacement therapy (NRT)) has been proposed as a risk reduction strategy. Among the tobacco products with less individual risk than cigarettes would be any type of tobacco without smoke (smokeless) with a low content in nitrosamines and modified cigarettes; both forms included under the PREP (Potentially Reduced Exposure Products) concept. The idea would be to promote these products among those who cannot quit smoking or wish to reduce their risk without giving up nicotine intake. The possible effects of risk reduction strategies, including PREP, on the decreased prevalence and morbidity and mortality are reviewed, and the possible implications that this measure could have in our country are analysed. Tobacco control measures in Spain are recent and still insufficient. Therefore, the current priority in Spain is the development of policies of control that have shown to more than effective. The marketing and advertising of new tobacco products, even with reduced potential risk, seems more a serious threat than an opportunity for the development of smoking control policies.

  11. Are environmental risk estimations linked to the actual environmental impact? Application to an oil handling facility (NE Spain).

    PubMed

    Valdor, Paloma F; Puente, Araceli; Gómez, Aina G; Ondiviela, Bárbara; Juanes, José A

    2017-01-30

    The environmental risk analysis of aquatic systems includes the evaluation of the likelihood that adverse ecological effects may occur as a result of exposure to one or more stressors. In harbor areas, pollution is provided by a complex mixture of substances with different levels of toxicity, persistence and bioaccumulation, which complicates the hazards characterization and their multiple effects. A study of the relationship between the environmental impact and the environmental risk assessment at a specific isolated oil handling facility was undertaken. The environmental risk of the oil handling facility, considering the consequences of specific pollutants, was estimated and the associated environmental impact was quantified based on a 'weights of evidence' approach. The contamination quantified at the potentially affected area around the monobuoy of Tarragona has proved to be related with environmental risk estimations but the lines of evidence obtained do not allow us to assert that the activity developed at this facility has an associated environmental impact. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Evaluating Shielding Effectiveness for Reducing Space Radiation Cancer Risks

    NASA Technical Reports Server (NTRS)

    Cucinotta, Francis A.; Kim, Myung-Hee Y.; Ren, Lei

    2007-01-01

    We discuss calculations of probability distribution functions (PDF) representing uncertainties in projecting fatal cancer risk from galactic cosmic rays (GCR) and solar particle events (SPE). The PDF s are used in significance tests of the effectiveness of potential radiation shielding approaches. Uncertainties in risk coefficients determined from epidemiology data, dose and dose-rate reduction factors, quality factors, and physics models of radiation environments are considered in models of cancer risk PDF s. Competing mortality risks and functional correlations in radiation quality factor uncertainties are treated in the calculations. We show that the cancer risk uncertainty, defined as the ratio of the 95% confidence level (CL) to the point estimate is about 4-fold for lunar and Mars mission risk projections. For short-stay lunar missions (<180 d), SPE s present the most significant risk, however one that is mitigated effectively by shielding, especially for carbon composites structures with high hydrogen content. In contrast, for long duration lunar (>180 d) or Mars missions, GCR risks may exceed radiation risk limits, with 95% CL s exceeding 10% fatal risk for males and females on a Mars mission. For reducing GCR cancer risks, shielding materials are marginally effective because of the penetrating nature of GCR and secondary radiation produced in tissue by relativistic particles. At the present time, polyethylene or carbon composite shielding can not be shown to significantly reduce risk compared to aluminum shielding based on a significance test that accounts for radiobiology uncertainties in GCR risk projection.

  13. Nosocomial infections in geriatric long-term-care and rehabilitation facilities: exploration in the development of a risk index for epidemiological surveillance.

    PubMed

    Golliot, F; Astagneau, P; Cassou, B; Okra, N; Rothan-Tondeur, M; Brücker, G

    2001-12-01

    To compute a risk index for nosocomial infection (NI) surveillance in geriatric long-term-care facilities (LTCFs) and rehabilitation facilities. Analysis of data collected during the French national prevalence survey on NIs conducted in 1996. Risk indices were constructed based on the patient case-mix defined according to risk factors for NIs identified in the elderly. 248 geriatric units in 77 hospitals located in northern France. All hospital inpatients on the day of the survey were included. Data from 11,254 patients were recorded. The overall rate of infected patients was 9.9%. Urinary tract, respiratory tract, and skin were the most common infection sites in both rehabilitation facilities and LTCFs. Eleven risk indices, categorizing patients in 3 to 7 levels of increasing NI risk, ranging from 2.7% to 36.2%, were obtained. Indices offered risk adjustment according to NI rate stratification and clinical relevance of risk factors such as indwelling devices, open bedsores, swallowing disorders, sphincter incontinence, lack of mobility, immunodeficiency, or rehabilitation activity. The optimal index should be tailored to the strategy selected for NI surveillance in geriatric facilities in view of available financial and human resources.

  14. Effects of communicating DNA-based disease risk estimates on risk-reducing behaviours.

    PubMed

    Marteau, Theresa M; French, David P; Griffin, Simon J; Prevost, A T; Sutton, Stephen; Watkinson, Clare; Attwood, Sophie; Hollands, Gareth J

    2010-10-06

    There are high expectations regarding the potential for the communication of DNA-based disease risk estimates to motivate behaviour change. To assess the effects of communicating DNA-based disease risk estimates on risk-reducing behaviours and motivation to undertake such behaviours. We searched the following databases using keywords and medical subject headings: Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4 2010), MEDLINE (1950 to April 2010), EMBASE (1980 to April 2010), PsycINFO (1985 to April 2010) using OVID SP, and CINAHL (EBSCO) (1982 to April 2010). We also searched reference lists, conducted forward citation searches of potentially eligible articles and contacted authors of relevant studies for suggestions. There were no language restrictions. Unpublished or in press articles were eligible for inclusion. Randomised or quasi-randomised controlled trials involving adults (aged 18 years and over) in which one group received actual (clinical studies) or imagined (analogue studies) personalised DNA-based disease risk estimates for diseases for which the risk could plausibly be reduced by behavioural change. Eligible studies had to include a primary outcome measure of risk-reducing behaviour or motivation (e.g. intention) to alter such behaviour. Two review authors searched for studies and independently extracted data. We assessed risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. For continuous outcome measures, we report effect sizes as standardised mean differences (SMDs). For dichotomous outcome measures, we report effect sizes as odds ratios (ORs). We obtained pooled effect sizes with 95% confidence intervals (CIs) using the random effects model applied on the scale of standardised differences and log odds ratios. We examined 5384 abstracts and identified 21 studies as potentially eligible. Following a full text analysis, we included 14 papers reporting results of 7 clinical

  15. A facile and green preparation of reduced graphene oxide using Eucalyptus leaf extract

    NASA Astrophysics Data System (ADS)

    Li, Chengyang; Zhuang, Zechao; Jin, Xiaoying; Chen, Zuliang

    2017-11-01

    In this paper, a green and facile synthesis of reduced graphene oxide (GO) by Eucalyptus leaf extract (EL-RGO) was investigated, which was characterized with ultraviolet-visible spectroscopy (UV), Raman spectroscopy, X-ray diffraction (XRD), scanning electron microscope (SEM), atomic force microscopy (AFM), X-ray photoelectron spectroscopy (XPS) and Thermal gravimetric analysis (TG). Eucalyptus leaf extract also play both reducing and capping stabilizing agents prepared EL-RGO as shown a good stability and electrochemical properties. This approach could provide an alternative method to prepare EL-RGO in large-scale production. Moreover, the good electrochemical property and biocompatibility can be used in various applications. In addition, the merit of this study is that both the oxidized products and the reducing agents are environmental friendly by green reduction.

  16. Healthy eating and reduced risk of cognitive decline

    PubMed Central

    Dehghan, Mahshid; O'Donnell, Martin; Anderson, Craig; Teo, Koon; Gao, Peggy; Sleight, Peter; Dagenais, Gilles; Probstfield, Jeffrey L.; Mente, Andrew; Yusuf, Salim

    2015-01-01

    Objective: We sought to determine the association of dietary factors and risk of cognitive decline in a population at high risk of cardiovascular disease. Methods: Baseline dietary intake and measures of the Mini-Mental State Examination were recorded in 27,860 men and women who were enrolled in 2 international parallel trials of the ONTARGET (Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial) and TRANSCEND (Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease) studies. We measured diet quality using the modified Alternative Healthy Eating Index. Cox proportional hazards regression was used to determine the association between diet quality and risk of ≥3-point decline in Mini-Mental State Examination score, and reported as hazard ratio with 95% confidence intervals with adjustment for covariates. Results: During 56 months of follow-up, 4,699 cases of cognitive decline occurred. We observed lower risk of cognitive decline among those in the healthiest dietary quintile of modified Alternative Healthy Eating Index compared with lowest quintile (hazard ratio 0.76, 95% confidence interval 0.66–0.86, Q5 vs Q1). Lower risk of cognitive decline was consistent regardless of baseline cognitive level. Conclusion: We found that higher diet quality was associated with a reduced risk of cognitive decline. Improved diet quality represents an important potential target for reducing the global burden of cognitive decline. PMID:25948720

  17. Motivation to Reduce Risk Behaviors While in Prison: Qualitative Analysis of Interviews with Current and Formerly Incarcerated Women

    PubMed Central

    Abad, Neetu; Carry, Monique; Herbst, Jeffrey H.; Fogel, Catherine I.

    2015-01-01

    Prison is an environment in which programs can be implemented to change harmful behaviors among high-risk populations. Incarcerated women experience high rates of HIV and other sexually transmitted diseases (STDs), yet little research has examined women’s motivation to reduce risky behaviors during incarceration. In-depth individual interviews were conducted with former and current women prisoners in two North Carolina correctional facilities and analyzed to identify barriers and facilitators of behavior change while in prison. Analyses revealed key motivators of behavior change: Viewing prison as a place to recover from past trauma, removing oneself from negative social networks, gaining access to needed mental and physical health services, and engaging in self-care and self-reflection. Barriers to behavior change include fear of recidivism, stigma of being in prison, and return to undesirable social networks post-release. Moreover, women noted that the provision of mental health services, educational enhancement and housing assistance could help them reduce engagement in high-risk behaviors after their incarceration. These findings can be incorporated into HIV/STD risk reduction interventions to facilitate positive behavior change among incarcerated women prisoners. Prison itself is a tremendous education in the need for patience and perseverance. It is above all a test of one’s commitment.—Nelson Mandela, 1995 PMID:26693183

  18. Motivation to Reduce Risk Behaviors While in Prison: Qualitative Analysis of Interviews with Current and Formerly Incarcerated Women.

    PubMed

    Abad, Neetu; Carry, Monique; Herbst, Jeffrey H; Fogel, Catherine I

    2013-10-01

    Prison is an environment in which programs can be implemented to change harmful behaviors among high-risk populations. Incarcerated women experience high rates of HIV and other sexually transmitted diseases (STDs), yet little research has examined women's motivation to reduce risky behaviors during incarceration. In-depth individual interviews were conducted with former and current women prisoners in two North Carolina correctional facilities and analyzed to identify barriers and facilitators of behavior change while in prison. Analyses revealed key motivators of behavior change: Viewing prison as a place to recover from past trauma, removing oneself from negative social networks, gaining access to needed mental and physical health services, and engaging in self-care and self-reflection. Barriers to behavior change include fear of recidivism, stigma of being in prison, and return to undesirable social networks post-release. Moreover, women noted that the provision of mental health services, educational enhancement and housing assistance could help them reduce engagement in high-risk behaviors after their incarceration. These findings can be incorporated into HIV/STD risk reduction interventions to facilitate positive behavior change among incarcerated women prisoners. Prison itself is a tremendous education in the need for patience and perseverance. It is above all a test of one's commitment.-Nelson Mandela, 1995.

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

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

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

    1998-01-01

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

  20. Containerless Processing in Reduced Gravity Using the TEMPUS Facility during MSL-1 and MSL-1R

    NASA Technical Reports Server (NTRS)

    Rogers, Jan R.

    1998-01-01

    Containerless processing provides a high purity environment for the study of high-temperature, very reactive materials. It is an important method which provides access to the metastable state of an undercooled melt. In the absence of container walls, the nucleation rate is greatly reduced and undercooling up to (Tm-Tn)/Tm approx. equal to 0.2 can be obtained, where Tm and Tn are the melting and nucleation temperatures, respectively. Electromagnetic levitation represents a method particularly well-suited for the study of metallic melts. The TEMPUS (Tiegelfreies ElektroMagnetisches Prozessieren Unter Schwerelosgkeit) facility is a research instrument designed to perform electromagnetic levitation studies in reduced gravity. TEMPUS is a joint undertaking between DARA, the German Space Agency, and the Microgravity Science and Applications Division of NASA. The George C. Marshall Space Flight Center provides the leadership for scientific and management efforts which support the four US PI teams which performed experiments in the TEMPUS facility. The facility is sensitive to accelerations in the 1-10 Hz range. This became evident during the MSL-1 mission. Analysis of accelerometer and video data indicated that loss of sample control occurred during crew exercise periods which created disturbances in this frequency range. Prior to the MSL-1R flight the TEMPUS team, the accelerometer support groups and the mission operations team developed a strategy to provide for the operation of the facility without such disturbances. The successful implementation of this plan led to the highly successful operation of this facility during MSL-1R.

  1. Reducing Hospital Readmissions Through Preferred Networks Of Skilled Nursing Facilities

    PubMed Central

    Foster, Andrew; Mor, Vincent; Shield, Renée R.; Trivedi, Amal N.; Wetle, Terrie; Zinn, Jacqueline S.; Tyler, Denise A.

    2017-01-01

    Establishing preferred provider networks of skilled nursing facilities (SNFs) is one approach hospital administrators are using to reduce excess thirty-day readmissions and avoid Medicare penalties or to reduce beneficiaries’ costs as part of value-based payment models. However, hospitals are also required to provide patients at discharge with a list of Medicare-eligible providers and cannot explicitly restrict patient choice. This requirement complicates the development of a SNF network. Furthermore, there is little evidence about the effectiveness of network development in reducing readmission rates. We used a concurrent mixed-methods approach, combining Medicare claims data for the period 2009–13 with qualitative data gathered from interviews during site visits to hospitals in eight US markets in March–October 2015, to examine changes in rehospitalization rates and differences in practices between hospitals that did and did not develop formal SNF networks. Four hospitals had developed formal SNF networks as part of their care management efforts. These hospitals saw a relative reduction from 2009 to 2013 in readmission rates for patients discharged to SNFs that was 4.5 percentage points greater than the reduction for hospitals without formal networks. Interviews revealed that those with networks expanded existing relationships with SNFs, effectively managed patient data, and exercised a looser interpretation of patient choice. PMID:28874486

  2. Reducing the Risks for Contrast-Induced Nephropathy

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

    Stacul, Fulvio

    2005-12-15

    Contrast-induced nephropathy (CIN) is one of the most serious adverse events associated with the use of contrast media (CM). Patients who develop this complication can have increased morbidity, higher rates of mortality, lengthy hospital stays, and poor long-term outcomes. Although CIN cannot be eliminated, the chances of developing this condition can be reduced by using appropriate prevention strategies. An important first step to reduce the chance of CIN is to identify risk factors associated with this condition. Patients with a previously elevated serum creatinine level, especially when secondary to diabetic nephropathy, are at great risk for developing CIN. Other patient-relatedmore » risk factors include concurrent use of nephrotoxic medications, dehydration, congestive heart failure, age greater than 70 years, and probably the presence of diabetes mellitus even if serum creatinine is normal. Adequate hydration is widely accepted as an important prophylactic measure for preventing CIN, but the optimal hydration regimen is still debatable. The risk of CIN increases with greater doses of CM, as well as with the type of CM used. A high-osmolar CM poses a greater risk of CIN than does a low-osmolar CM and, as recent but limited data suggest, the use of an iso-osmolar CM is less nephrotoxic than a low-osmolar CM in patients with renal impairment following intra-arterial procedures, although this finding needs to be verified in future clinical studies. Pharmacologic agents such as calcium channel blockers, dopamine, atrial natriuretic peptide, fenoldopam, prostaglandin E1, and endothelin receptor antagonist have not been proven effective against CIN development. Controversies still exist on the possible effectiveness of theophylline and N-acetylcysteine. Simple strategies for the prevention of CIN in at-risk patients are reviewed and unproven interventions are discussed.« less

  3. A central storage facility to reduce pesticide suicides--a feasibility study from India.

    PubMed

    Vijayakumar, Lakshmi; Jeyaseelan, Lakshmanan; Kumar, Shuba; Mohanraj, Rani; Devika, Shanmugasundaram; Manikandan, Sarojini

    2013-09-16

    Pesticide suicides are considered the single most important means of suicide worldwide. Centralized pesticide storage facilities have the possible advantage of delaying access to pesticides thereby reducing suicides. We undertook this study to examine the feasibility and acceptability of a centralized pesticide storage facility as a preventive intervention strategy in reducing pesticide suicides. A community randomized controlled feasibility study using a mixed methods approach involving a household survey; focus group discussions (FGDs) and surveillance were undertaken. The study was carried out in a district in southern India. Eight villages that engaged in floriculture were identified. Using the lottery method two were randomized to be the intervention sites and two villages constituted the control site. Two centralized storage facilities were constructed with local involvement and lockable storage boxes were constructed. The household survey conducted at baseline and one and a half years later documented information on sociodemographic data, pesticide usage, storage and suicides. At baseline 4446 individuals (1097 households) in the intervention and 3307 individuals (782 households) in the control sites were recruited while at follow up there were 4308 individuals (1063 households) in the intervention and 2673 individuals (632 households) in the control sites. There were differences in baseline characteristics and imbalances in the prevalence of suicides between intervention and control sites as this was a small feasibility study.The results from the FGDs revealed that most participants found the storage facility to be both useful and acceptable. In addition to protecting against wastage, they felt that it had also helped prevent pesticide suicides as the pesticides stored here were not as easily and readily accessible. The primary analyses were done on an Intention to Treat basis. Following the intervention, the differences between sites in changes in combined

  4. Reducing shingle waste at a manufacturing facility: 1990 MNTAP summer intern report

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

    Menke, D.

    1990-12-31

    CertainTeed manufactures roofing shingles at it`s Shakopee, MN facility. Two process coating lines, and one assembly line, produce fifteen shingle types in fifteen different colors. The wastes generated by this process were the result of planned and unplanned variations in the continuous production process. Planned variations included changes in color, while felt breaks were common unplanned variations. Five options were identified that could reduce the amount of waste generated: Using a standard procedure for recovering from felt breaks, Creating a process cushion to maintain continuous production in the event of temporary shutdowns, An automated color change process, Manufacture of amore » new product from waste material, Minor process changes to reduce the frequency of breaks.« less

  5. Mitigating flood exposure: Reducing disaster risk and trauma signature.

    PubMed

    Shultz, James M; McLean, Andrew; Herberman Mash, Holly B; Rosen, Alexa; Kelly, Fiona; Solo-Gabriele, Helena M; Youngs, Georgia A; Jensen, Jessica; Bernal, Oscar; Neria, Yuval

    2013-01-01

    Introduction. In 2011, following heavy winter snowfall, two cities bordering two rivers in North Dakota, USA faced major flood threats. Flooding was foreseeable and predictable although the extent of risk was uncertain. One community, Fargo, situated in a shallow river basin, successfully mitigated and prevented flooding. For the other community, Minot, located in a deep river valley, prevention was not possible and downtown businesses and one-quarter of the homes were inundated, in the city's worst flood on record. We aimed at contrasting the respective hazards, vulnerabilities, stressors, psychological risk factors, psychosocial consequences, and disaster risk reduction strategies under conditions where flood prevention was, and was not, possible. Methods . We applied the "trauma signature analysis" (TSIG) approach to compare the hazard profiles, identify salient disaster stressors, document the key components of disaster risk reduction response, and examine indicators of community resilience. Results . Two demographically-comparable communities, Fargo and Minot, faced challenging river flood threats and exhibited effective coordination across community sectors. We examined the implementation of disaster risk reduction strategies in situations where coordinated citizen action was able to prevent disaster impact (hazard avoidance) compared to the more common scenario when unpreventable disaster strikes, causing destruction, harm, and distress. Across a range of indicators, it is clear that successful mitigation diminishes both physical and psychological impact, thereby reducing the trauma signature of the event. Conclusion . In contrast to experience of historic flooding in Minot, the city of Fargo succeeded in reducing the trauma signature by way of reducing risk through mitigation.

  6. Reducing Organic Contamination in NASA JSC Astromaterial Curation Facility

    NASA Technical Reports Server (NTRS)

    Calaway, M. J.; Allen, C. C.; Allton, J. H.

    2013-01-01

    Future robotic and human spaceflight missions to the Moon, Mars, asteroids and comets will require handling and storing astromaterial samples with minimal inorganic and organic contamination to preserve the scientific integrity of each sample. Much was learned from the rigorous attempts to minimize and monitor organic contamination during Apollo, but it was not adequate for current analytical requirements; thus [1]. OSIRIS-REx, Hayabusa-2, and future Mars sample return will require better protocols for reducing organic contamination. Future isolation con-tainment systems for astromaterials, possibly nitrogen enriched gloveboxes, must be able to reduce organic and inorganic cross-contamination. In 2012, a baseline study established the current state of organic cleanliness in gloveboxes used by NASA JSC astromaterials curation labs that could be used as a benchmark for future mission designs [2, 3]. After standard ultra-pure water (UPW) cleaning, the majority of organic contaminates found were hydrocarbons, plasticizers, silicones, and solvents. Hydro-carbons loads (> C7) ranged from 1.9 to 11.8 ng/cm2 for TD-GC-MS wafer exposure analyses and 5.0 to 19.5 ng/L for TD-GC-MS adsorbent tube exposure. Plasticizers included < 0.6 ng/cm2 of DBP, DEP, TXIB, and DIBP. Silicones included < 0.5 ng/cm2 of cyclo(Me2SiO)x (x = 6, 8, 9, 10) and siloxane. Solvents included < 1.0 ng/cm2 of 2-cyclohexen-1-one, 3,5,5-trimethyl- (Isopho-rone), N-formylpiperidine, and 2-(2-butoxyethoxy) ethanol. In addition, DBF, rubber/polymer additive was found at < 0.2 ng/cm2 and caprolactam, nylon-6 at < 0.6 ng/cm2. Reducing Organics: The Apollo program was the last sam-ple return mission to place high-level organic requirements and biological containment protocols on a curation facility. The high vacuum complex F-201 glovebox in the Lunar Receiving Labora-tory used ethyl alcohol (190 proof), 3:1 benzene/methanol (nano grade solution), and heat sterilization at 130degC for 48 hours to reduce organic

  7. Ten Years Experience In Geo-Databases For Linear Facilities Risk Assessment (Lfra)

    NASA Astrophysics Data System (ADS)

    Oboni, F.

    2003-04-01

    Keywords: geo-environmental, database, ISO14000, management, decision-making, risk, pipelines, roads, railroads, loss control, SAR, hazard identification ABSTRACT: During the past decades, characterized by the development of the Risk Management (RM) culture, a variety of different RM models have been proposed by governmental agencies in various parts of the world. The most structured models appear to have originated in the field of environmental RM. These models are briefly reviewed in the first section of the paper focusing the attention on the difference between Hazard Management and Risk Management and the need to use databases in order to allow retrieval of specific information and effective updating. The core of the paper reviews a number of different RM approaches, based on extensions of geo-databases, specifically developed for linear facilities (LF) in transportation corridors since the early 90s in Switzerland, Italy, Canada, the US and South America. The applications are compared in terms of methodology, capabilities and resources necessary to their implementation. The paper then focuses the attention on the level of detail that applications and related data have to attain. Common pitfalls related to decision making based on hazards rather than on risks are discussed. The paper focuses the last sections on the description of the next generation of linear facility RA application, including examples of results and discussion of future methodological research. It is shown that geo-databases should be linked to loss control and accident reports in order to maximize their benefits. The links between RA and ISO 14000 (environmental management code) are explicitly considered.

  8. Proactive Motor Control Reduces Monetary Risk Taking in Gambling

    PubMed Central

    Adams, Rachel; Chambers, Christopher D.

    2012-01-01

    Less supervision by the executive system after disruption of the right prefrontal cortex leads to increased risk taking in gambling because superficially attractive—but risky—choices are not suppressed. Similarly, people might gamble more in multitask situations than in single-task situations because concurrent executive processes usually interfere with each other. In the study reported here, we used a novel monetary decision-making paradigm to investigate whether multitasking could reduce rather than increase risk taking in gambling. We found that performing a task that induced cautious motor responding reduced gambling in a multitask situation (Experiment 1). We then found that a short period of inhibitory training lessened risk taking in gambling at least 2 hr later (Experiments 2 and 3). Our findings indicate that proactive motor control strongly affects monetary risk taking in gambling. The link between control systems at different cognitive levels might be exploited to develop new methods for rehabilitation of addiction and impulse-control disorders. PMID:22692336

  9. Reducing Operating Costs by Optimizing Space in Facilities

    DTIC Science & Technology

    2012-03-01

    Base level 5 engineering units will provide facility floor plans, furniture layouts, and staffing documentation as necessary. One obstacle...due to the quantity and diverse locations. Base level engineering units provided facility floor plans, furniture layouts, and staffing documentation... furniture purchases and placement 5. Follow a quality systematic process in all decisions The per person costs can be better understood with a real

  10. REDUCING CHILDREN'S RISK TO SOIL LEAD: SUMMARY OF A FIELD EXPERIMENT TO REDUCE SOIL LEAD BIOAVAILABILITY

    EPA Science Inventory

    Reducing risks associated with Pb in soil has typically been accomplished by soil removal, covering, or dilution by mixing with uncontaminated soil. EPA's National Risk Management Research Laboratory (NRMRL) and DuPont Corporation established a collaborative effort to evaluation...

  11. Cost-effectiveness of risk-reducing surgeries in preventing hereditary breast and ovarian cancer.

    PubMed

    Schrauder, Michael G; Brunel-Geuder, Lisa; Häberle, Lothar; Wunderle, Marius; Hoyer, Juliane; Reis, André; Schulz-Wendtland, Rüdiger; Beckmann, Matthias W; Lux, Michael P

    2017-04-01

    Risk-reducing surgeries are a feasible option for mitigating the risk in individuals with inherited susceptibility to cancer, but are the procedures cost-effective in the current health-care system in Germany? This study compared the health-care costs for bilateral risk-reducing mastectomy (BRRM) and risk-reducing (bilateral) salpingo-oophorectomy (RRSO) with cancer treatment costs that could potentially be prevented. The analysis is based on interdisciplinary consultations with individuals with a high familial risk for breast and ovarian cancer at the University Breast Center for Franconia (Germany) between 2009 and 2013 (370 consultations; 44 patients with BRCA1 mutations and 26 with BRCA2 mutations). Health-care costs for risk-reducing surgeries in BRCA mutation carriers were calculated as reimbursements in the German diagnosis-related groups (DRG) hospital pricing system. These costs for the health-care system were compared with the potential cancer treatment costs that could possibly be prevented by risk-reducing surgeries. Long-term health-care costs can be reduced by risk-reducing surgeries after genetic testing in BRCA mutation carriers. The health-care system in Germany would have saved € 136,295 if BRRM had been performed and € 791,653 if RRSO had been performed before the development of cancer in only 50% of the 70 mutation carriers seen in our center. Moreover, in patients with combined RRSO and BRRM (without breast reconstruction), one further life-year for a 40-year-old BRCA mutation carrier would cost € 2,183. Intensive care, including risk-reducing surgeries in BRCA mutation carriers, is cost-effective from the point of view of the health-care system in Germany. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Risk factors for visual impairment and blindness amongst black adult diabetics receiving treatment at Government healthcare facilities in Mopani District, Limpopo province, South Africa.

    PubMed

    Mabaso, Raymond G; Oduntan, Olalekan A

    2014-11-21

    Diabetes mellitus (DM) is a common systemic disease amongst Black South Africans. It may lead to diabetic retinopathy (DR), a common cause of visual impairment (VI) and blindness. DR may signifiantly increase the prevalence of VI and blindness. To assess risk factors for VI and blindness amongst a black diabetic South African population aged ≥ 40 years. The study was conducted in seven Government healthcare facilities (two hospitals, four clinics and one health centre) in Mopani District, Limpopo province, South Africa. This was a cross-sectional health facility-based quantitative study. Structured interviews were used to obtain information, which included sociodemographic profie, knowledge about DM and its ocular complications, presence of hypertension and accessibility to health facilities. Subsequently participants were examined for VI and blindness using an autorefractor, pinhole disc, ophthalmoscope and logMAR visual acuity chart. Anthropometric measurements (height, weight and waist) were also taken. Associations between 31 risk factors and VI as well as blindness were statistically examined. Participants (N = 225) included 161 women and 64 men aged 40-90 years (mean 61.5 ± 10.49 years); 41.3% of them had VI and 3.6% were blind. Cataracts (76.8%) and DR (7.1%) were the common causes of compensated VI and blindness. Risk factors that were associated with VI and blindness were age, monthly income, compliance with losing weight and physical activity. Findings suggest that lifestyle intervention and appropriate eyecare programmes may reduce VI and blindness in this population.

  13. Reducing Risk for the Next Generation Nuclear Plant

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

    John M. Beck II; Harold J. Heydt; Emmanuel O. Opare

    2010-07-01

    The Next Generation Nuclear Plant (NGNP) Project, managed by the Idaho National Laboratory (INL), is directed by the Energy Policy Act of 2005, to research, develop, design, construct, and operate a prototype forth generation nuclear reactor to meet the needs of the 21st Century. As with all large projects developing and deploying new technologies, the NGNP has numerous risks that need to be identified, tracked, mitigated, and reduced in order for successful project completion. A Risk Management Plan (RMP) was created to outline the process the INL is using to manage the risks and reduction strategies for the NGNP Project.more » Integral to the RMP is the development and use of a Risk Management System (RMS). The RMS is a tool that supports management and monitoring of the project risks. The RMS does not only contain a risk register, but other functionality that allows decision makers, engineering staff, and technology researchers to review and monitor the risks as the project matures.« less

  14. Implementation of Home based management of malaria in children reduces the work load for peripheral health facilities in a rural district of Burkina Faso.

    PubMed

    Tiono, Alfred B; Kaboré, Youssouf; Traoré, Abdoulaye; Convelbo, Nathalie; Pagnoni, Franco; Sirima, Sodiomon B

    2008-10-03

    Home Management of Malaria (HMM) is one of the key strategies to reduce the burden of malaria for vulnerable population in endemic countries. It is based on the evidence that well-trained communities health workers can provide prompt and adequate care to patients close to their homes. The strategy has been shown to reduce malaria mortality and severe morbidity and has been adopted by the World Health Organization as a cornerstone of malaria control in Africa. However, the potential fall-out of this community-based strategy on the work burden at the peripheral health facilities level has never been investigated. A two-arm interventional study was conducted in a rural health district of Burkina Faso. The HMM strategy has been implemented in seven community clinics catchment's area (intervention arm). For the other seven community clinics in the control arm, no HMM intervention was implemented. In each of the study arms, presumptive treatment was provided for episodes of fevers/malaria (defined operationally as malaria). The study drug was artemether-lumefantrine, which was sold at a subsidized price by community health workers/Key opinion leaders at the community level and by the pharmacists at the health facility level. The outcome measured was the proportion of malaria cases among all health facility attendance (all causes diseases) in both arms throughout the high transmission season. A total of 7,621 children were enrolled in the intervention arm and 7,605 in the control arm. During the study period, the proportions of malaria cases among all health facility attendance (all causes diseases) were 21.0%, (445/2,111, 95% CI [19.3%-22.7%]) and 70.7% (2,595/3,671, 95% CI 68.5%-71.5%), respectively in the intervention and control arms (p < 0.0001). The relative risk ratio for a fever/malaria episode to be treated at the HF level was 30% (0.30 < RR < 0.32). The number of malaria episodes treated in the intervention arm was much higher than in the control arm (6,661 vs

  15. Reducing Hospital Readmissions Through Preferred Networks Of Skilled Nursing Facilities.

    PubMed

    McHugh, John P; Foster, Andrew; Mor, Vincent; Shield, Renée R; Trivedi, Amal N; Wetle, Terrie; Zinn, Jacqueline S; Tyler, Denise A

    2017-09-01

    Establishing preferred provider networks of skilled nursing facilities (SNFs) is one approach hospital administrators are using to reduce excess thirty-day readmissions and avoid Medicare penalties or to reduce beneficiaries' costs as part of value-based payment models. However, hospitals are also required to provide patients at discharge with a list of Medicare-eligible providers and cannot explicitly restrict patient choice. This requirement complicates the development of a SNF network. Furthermore, there is little evidence about the effectiveness of network development in reducing readmission rates. We used a concurrent mixed-methods approach, combining Medicare claims data for the period 2009-13 with qualitative data gathered from interviews during site visits to hospitals in eight US markets in March-October 2015, to examine changes in rehospitalization rates and differences in practices between hospitals that did and did not develop formal SNF networks. Four hospitals had developed formal SNF networks as part of their care management efforts. These hospitals saw a relative reduction from 2009 to 2013 in readmission rates for patients discharged to SNFs that was 4.5 percentage points greater than the reduction for hospitals without formal networks. Interviews revealed that those with networks expanded existing relationships with SNFs, effectively managed patient data, and exercised a looser interpretation of patient choice. Project HOPE—The People-to-People Health Foundation, Inc.

  16. Reducing Communication Apprehension among At-Risk Children.

    ERIC Educational Resources Information Center

    Ayres, Debbie M.; And Others

    1995-01-01

    Investigates whether a videotape designed to reduce public speaking apprehension (PSA) could be used to help at-risk students cope with PSA. Finds that the videotape condition was associated with lower levels of trait communication apprehension, state communication apprehension, and negative thinking than the placebo and control conditions. (SR)

  17. Integrating chemical, toxicological and clinical research to assess the potential of reducing health risks associated with cigarette smoking through reducing toxicant emissions.

    PubMed

    McAdam, Kevin; Murphy, James; Eldridge, Alison; Meredith, Clive; Proctor, Christopher

    2018-06-01

    The concept of a risk continuum for tobacco and nicotine products has been proposed, which differentiates products according to their propensity to reduce toxicant exposure and risk. Cigarettes are deemed the most risky and medicinal nicotine the least. We assessed whether a Reduced-Toxicant Prototype (RTP) cigarette could sufficiently reduce exposure to toxicants versus conventional cigarettes to be considered a distinct category in the risk continuum. We present findings from both pre-clinical and clinical studies in order to examine the potential for reduced smoke toxicant emissions to lower health risks associated with cigarette smoking. We conclude that current toxicant reducing technologies are unable to reduce toxicant emissions sufficiently to manifest beneficial disease-relevant changes in smokers. These findings point to a minimum toxicant exposure standard that future potentially reduced risk products would need to meet to be considered for full biological assessment. The RTP met WHO TobReg proposed limits on cigarette toxicant emissions, however the absence of beneficial disease relevant changes in smokers after six months reduced toxicant cigarette use, does not provide evidence that these regulatory proposals will positively impact risks of smoking related diseases. Greater toxicant reductions, such as those that can be achieved in next generation products e.g. tobacco heating products and electronic cigarettes are likely to be necessary to clearly reduce risks compared with conventional cigarettes. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  18. Acid-reducing vagotomy is associated with reduced risk of subsequent ischemic heart disease in complicated peptic ulcer

    PubMed Central

    Wu, Shih-Chi; Fang, Chu-Wen; Chen, William Tzu-Liang; Muo, Chih-Hsin

    2016-01-01

    Abstract Persistent exacerbation of a peptic ulcer may lead to a complicated peptic ulcer (perforation or/and bleeding). The management of complicated peptic ulcers has shifted from acid-reducing vagotomy, drainage, and gastrectomy to simple local suture or non-operative (endoscopic/angiographic) hemostasis. We were interested in the long-term effects of this trend change. In this study, complicated peptic ulcer patients who received acid-reducing vagotomy were compared with those who received simple suture/hemostasis to determine the risk of ischemic heart disease (IHD). This retrospective cohort study analyzed 335,680 peptic ulcer patients recorded from 2000 to 2006 versus 335,680 age-, sex-, comorbidity-, and index-year matched comparisons. Patients with Helicobacter pylori (HP) infection were excluded. In order to identify the effect of vagus nerve severance, patients who received gastrectomy or antrectomy were also excluded. The incidence of IHD in both cohorts, and in the complicated peptic ulcer patients who received acid-reducing vagotomy versus those who received simple suture or hemostasis was evaluated. The overall incidence of IHD was higher in patients with peptic ulcer than those without peptic ulcer (17.00 vs 12.06 per 1000 person-years), with an adjusted hazard ratio (aHR) of 1.46 based on multivariable Cox proportional hazards regression analysis controlling for age, sex, Charlson's comorbidity index, and death (competing risk). While comparing peptic ulcer patients with acid-reducing vagotomy to those with simple suture/hemostasis or those without surgical treatment, the aHR (0.58) was the lowest in the acid-reducing vagotomy group. Patients with peptic ulcer have an elevated risk of IHD. However, complicated peptic ulcer patients who received acid-reducing vagotomy were associated with reduced risk of developing IHD. PMID:27977613

  19. 6 CFR 27.205 - Determination that a chemical facility “presents a high level of security risk.”

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... a high level of security risk.â 27.205 Section 27.205 Domestic Security DEPARTMENT OF HOMELAND... Program § 27.205 Determination that a chemical facility “presents a high level of security risk.” (a... a high level of security risk based on any information available (including any information...

  20. Reducing the risk of burns during electroconvulsive therapy.

    PubMed

    2011-10-01

    Poor contact between electroconvulsive therapy (ECT) electrodes and the skin can result in patient burns during ECT treatment. Proper site preparation and electrode application are essential to ensure adequate contact and to reduce the risk of burns.

  1. Facility-Level Characteristics Associated with Serious Suicide Attempts and Deaths from Suicide in Juvenile Justice Residential Facilities

    ERIC Educational Resources Information Center

    Gallagher, Catherine A.; Dobrin, Adam

    2006-01-01

    Little is known about how facility-level characteristics affect the risk of suicide and suicide attempts in juvenile justice residential facilities. This leaves facility administrators and mental health providers without evidence-based guidance on how the facility itself affects risks. The current study uses data from two recently developed…

  2. Saturated Fatty Acids and Cardiovascular Disease: Replacements for Saturated Fat to Reduce Cardiovascular Risk

    PubMed Central

    Briggs, Michelle A.; Petersen, Kristina S.; Kris-Etherton, Penny M.

    2017-01-01

    Dietary recommendations to decrease the risk of cardiovascular disease (CVD) have focused on reducing intake of saturated fatty acids (SFA) for more than 50 years. While the 2015–2020 Dietary Guidelines for Americans advise substituting both monounsaturated and polyunsaturated fatty acids for SFA, evidence supports other nutrient substitutions that will also reduce CVD risk. For example, replacing SFA with whole grains, but not refined carbohydrates, reduces CVD risk. Replacing SFA with protein, especially plant protein, may also reduce CVD risk. While dairy fat (milk, cheese) is associated with a slightly lower CVD risk compared to meat, dairy fat results in a significantly greater CVD risk relative to unsaturated fatty acids. As research continues, we will refine our understanding of dietary patterns associated with lower CVD risk. PMID:28635680

  3. Meta-analysis: Does garlic intake reduce risk of gastric cancer?

    PubMed

    Kodali, R T; Eslick, Guy D

    2015-01-01

    In the past 2 decades, various epidemiological studies investigated whether garlic can positively modify the risk of gastric cancer. Garlic contains numerous sulfide compounds, including diallyl trisulfide, which have anticarcinogenic properties. We conducted a meta-analysis to determine if garlic intake reduces the risk of gastric cancer. An electronic search of MEDLINE, PubMed, and EMBASE to June 2014 was completed. There were 14 case control studies, 2 randomized controlled studies, and 1 cohort study that fulfilled our inclusion criteria. We used a random effects model to calculate pooled odds ratios (OR) and 95% confidence intervals (CIs) for risk of gastric cancer with garlic consumption. Meta-analysis of a total of 8,621 cases and 14,889 controls was conducted. Significant variability in duration of garlic intake and reference categories for amount of intake was noted. High, low, and any garlic intake were all associated with reduced risk of gastric cancer. High intake had the most significant risk reduction, OR = 0.49 (95% CI: 0.38-0.62). Heterogeneity was low (I² = 30.85, P = 0.17). A more modest risk reduction was associated with low intake, OR = 0.75 (95% CI: 0.58-0.97). Half of the studies did not separate garlic intake into high or low amounts, intake was only noted as consumption vs. non-consumption. Any amount of consumption still showed a risk reduction similar to low intake, OR = 0.77 (95% CI: 0.60-1.00). Low and any amount of consumption showed moderate heterogeneity (58% and 45%, respectively). Garlic intake appears to be associated with reduced risk of gastric cancer. Further high quality studies are required to confirm this finding and to assess the amount of garlic that needs to be consumed for protective effect.

  4. REDUCING CHILDREN'S RISK TO SOIL LEAD: SUMMARY OF A FIELD EXPERIMENT TO REDUCE SOIL LEAD BIOAVAILABILITY (ABSTRACT)

    EPA Science Inventory

    Reducing risks associated with Pb in soil has typically been accomplished by soil removal, covering, or dilution by mixing with uncontaminated soil. EPA's National Risk Management Research Laboratory (NRMRL) and DuPont Corporation established a collaborative effort to evaluation...

  5. Health Benefits and Risks of Pets in Nursing Homes: A Survey of Facilities in Ohio.

    PubMed

    Stull, Jason W; Hoffman, Cydney C; Landers, Timothy

    2018-05-01

    Pets are encountered in nursing homes and although they provide health benefits to individuals, they are also a source of health risks. The current study aimed to determine the frequency and types of animals in nursing homes, perceived benefits, and content of policies addressing health risks. Ninety-five administrators from unique nursing homes in Ohio completed an online survey addressing perceived benefits and risks of animals and policies in place. Animals were permitted in 99% of nursing homes, with dogs (95%), cats (85%), birds (71%), fish (55%), and farm animals (40%) most frequently reported. Respondents perceived animal interactions resulted in high health benefits for residents. Most facilities (70/75; 93%) reported having an animal policy, yet important gaps were frequently identified in the content of policies. Most respondents (75%) did not report health and safety concerns with animals in facilities. Best practice guidelines and policies should be developed and implemented in nursing homes to address requirements for different animal ownership models, range of animal species, and staff knowledge. [Journal of Gerontological Nursing, 44(5), 39-45.]. Copyright 2018, SLACK Incorporated.

  6. Risk factors for visual impairment and blindness amongst black adult diabetics receiving treatment at Government healthcare facilities in Mopani District, Limpopo province, South Africa

    PubMed Central

    Oduntan, Olalekan A.

    2014-01-01

    Abstract Background Diabetes mellitus (DM) is a common systemic disease amongst Black South Africans. It may lead to diabetic retinopathy (DR), a common cause of visual impairment (VI) and blindness. DR may significantly increase the prevalence of VI and blindness. Aim To assess risk factors for VI and blindness amongst a black diabetic South African population aged ≥ 40 years. Setting The study was conducted in seven Government healthcare facilities (two hospitals, four clinics and one health centre) in Mopani District, Limpopo province, South Africa. Methods This was a cross-sectional health facility-based quantitative study. Structured interviews were used to obtain information, which included sociodemographic profile, knowledge about DM and its ocular complications, presence of hypertension and accessibility to health facilities. Subsequently participants were examined for VI and blindness using an autorefractor, pinhole disc, ophthalmoscope and logMAR visual acuity chart. Anthropometric measurements (height, weight and waist) were also taken. Associations between 31 risk factors and VI as well as blindness were statistically examined. Results Participants (N = 225) included 161 women and 64 men aged 40–90 years (mean 61.5 ± 10.49 years); 41.3% of them had VI and 3.6% were blind. Cataracts (76.8%) and DR (7.1%) were the common causes of compensated VI and blindness. Risk factors that were associated with VI and blindness were age, monthly income, compliance with losing weight and physical activity. Conclusion Findings suggest that lifestyle intervention and appropriate eyecare programmes may reduce VI and blindness in this population. PMID:26245418

  7. Reducing software security risk through an integrated approach research initiative model based verification of the Secure Socket Layer (SSL) Protocol

    NASA Technical Reports Server (NTRS)

    Powell, John D.

    2003-01-01

    This document discusses the verification of the Secure Socket Layer (SSL) communication protocol as a demonstration of the Model Based Verification (MBV) portion of the verification instrument set being developed under the Reducing Software Security Risk (RSSR) Trough an Integrated Approach research initiative. Code Q of the National Aeronautics and Space Administration (NASA) funds this project. The NASA Goddard Independent Verification and Validation (IV&V) facility manages this research program at the NASA agency level and the Assurance Technology Program Office (ATPO) manages the research locally at the Jet Propulsion Laboratory (California institute of Technology) where the research is being carried out.

  8. Environmental risk analysis of oil handling facilities in port areas. Application to Tarragona harbor (NE Spain).

    PubMed

    Valdor, Paloma F; Gómez, Aina G; Puente, Araceli

    2015-01-15

    Diffuse pollution from oil spills is a widespread problem in port areas (as a result of fuel supply, navigation and loading/unloading activities). This article presents a method to assess the environmental risk of oil handling facilities in port areas. The method is based on (i) identification of environmental hazards, (ii) characterization of meteorological and oceanographic conditions, (iii) characterization of environmental risk scenarios, and (iv) assessment of environmental risk. The procedure has been tested by application to the Tarragona harbor. The results show that the method is capable of representing (i) specific local pollution cases (i.e., discriminating between products and quantities released by a discharge source), (ii) oceanographic and meteorological conditions (selecting a representative subset data), and (iii) potentially affected areas in probabilistic terms. Accordingly, it can inform the design of monitoring plans to study and control the environmental impact of these facilities, as well as the design of contingency plans. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Petroleum and hazardous material releases from industrial facilities associated with Hurricane Katrina.

    PubMed

    Santella, Nicholas; Steinberg, Laura J; Sengul, Hatice

    2010-04-01

    Hurricane Katrina struck an area dense with industry, causing numerous releases of petroleum and hazardous materials. This study integrates information from a number of sources to describe the frequency, causes, and effects of these releases in order to inform analysis of risk from future hurricanes. Over 200 onshore releases of hazardous chemicals, petroleum, or natural gas were reported. Storm surge was responsible for the majority of petroleum releases and failure of storage tanks was the most common mechanism of release. Of the smaller number of hazardous chemical releases reported, many were associated with flaring from plant startup, shutdown, or process upset. In areas impacted by storm surge, 10% of the facilities within the Risk Management Plan (RMP) and Toxic Release Inventory (TRI) databases and 28% of SIC 1311 facilities experienced accidental releases. In areas subject only to hurricane strength winds, a lower fraction (1% of RMP and TRI and 10% of SIC 1311 facilities) experienced a release while 1% of all facility types reported a release in areas that experienced tropical storm strength winds. Of industrial facilities surveyed, more experienced indirect disruptions such as displacement of workers, loss of electricity and communication systems, and difficulty acquiring supplies and contractors for operations or reconstruction (55%), than experienced releases. To reduce the risk of hazardous material releases and speed the return to normal operations under these difficult conditions, greater attention should be devoted to risk-based facility design and improved prevention and response planning.

  10. An Interprofessional Approach to Reducing the Risk of Falls Through Enhanced Collaborative Practice

    PubMed Central

    Eckstrom, Elizabeth; Neal, Margaret B.; Cotrell, Vicki; Casey, Colleen M.; McKenzie, Glenise; Morgove, Megan W.; DeLander, Gary E.; Simonson, William; Lasater, Kathie

    2016-01-01

    Falls are the leading cause of accidental deaths in older adults and are a growing public health concern. The American Geriatrics Society/British Geriatrics Society (AGS/BGS) published guidelines for falls screening and risk reduction, yet few primary care providers report following any guidelines for falls prevention. This manuscript describes a project that engaged an interprofessional (IP) teaching team to support IP clinical teams to reduce fall risk in older adults via implementation of the AGS/BGS guidelines. Twenty-five IP clinical teams with representatives from medicine, nursing, pharmacy, and social work were recruited from ambulatory, long-term care, hospital, and home health settings for a structured intervention: a 4-hour training workshop plus “coaching” for implementation for one year. The workshop focused on evidence-based strategies to decrease the risk of falls, including screening for falls; assessing gait, balance, orthostatics and other medical conditions; exercise including tai chi; vitamin D supplementation; medication review and reduction; and environmental assessment. Quantitative and qualitative data were collected via chart review, coaching plans and field notes, and post-intervention structured interviews of participants. Site visits and coaching field notes confirmed uptake of the strategies. Chart reviews showed a significant improvement in adoption of all falls prevention strategies except vitamin D supplementation. Long-term care facilities were more likely to address environmental concerns and add tai chi classes while ambulatory settings were more likely to initiate falls screening. The intervention demonstrated that interprofessional practice change to target falls prevention can be incorporated into primary care and long-term care settings. PMID:27467774

  11. A historical application of social amplification of risk model: Economic impacts of risk events at nuclear weapons facilities?

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

    Metz, W.C.

    1996-12-31

    Public perceptions of risk have proven to be a critical barrier to the federal government`s extensive, decade-long, technical and scientific effort to site facilities for the interim storage and permanent disposal of high-level radioactive waste (HLW). The negative imagery, fear, and anxiety that are linked to ``nuclear`` and ``radioactive`` technologies, activities, and facilities by the public originate from the personal realities and experiences of individuals and the information they receive. These perceptions continue to be a perplexing problem for those responsible for making decisions about federal nuclear waste management policies and programs. The problem of understanding and addressing public perceptionsmore » is made even more difficult because there are decidedly different opinions about HLW held by the public and nuclear industry and radiation health experts.« less

  12. Risk and Resilience: Girls' Experiences Navigating Space and Relationships in a Secure Residential Facility

    ERIC Educational Resources Information Center

    Simonsen, Amy E.

    2010-01-01

    The purpose of this qualitative study was to examine how adolescent girls with diagnosed learning and emotional disabilities described themselves as they negotiated various environments and relationships within a secure residential facility. The goal was to explore how conditions and interactions in these environments promoted both risk and…

  13. Cigarette smoking risk-reducing beliefs: Findings from the United States Health Information National Trends Survey.

    PubMed

    Kaufman, Annette R; Coa, Kisha I; Nguyen, Anh B

    2017-09-01

    Cigarette smoking risk-reducing beliefs are ideas that certain health promoting behaviors (e.g., exercise) may mitigate the risks associated with smoking. The objective of this study was to describe smoking risk-reducing beliefs and the belief that quitting can reduce the harmful effects of smoking among the U.S. adult population and the associations between these beliefs, current smoking status, and sociodemographics. Data were from the Health Information National Trends Survey 4 (HINTS 4) Cycles 3 and 4 (2013-2014; N=6862). Descriptive analyses were conducted to examine bivariate associations among the quit smoking belief, smoking risk-reducing beliefs, and covariates. Weighted ordinal logistic regression models examined the adjusted associations between smoking status and sociodemographics, with quit smoking belief and risk-reducing beliefs. Eighty-two percent of the population reported that quitting cigarette smoking can help reduce the harmful effects of smoking a lot: former smokers and individuals with higher educational attainment were more likely to endorse this belief than never smokers and those with lower educational attainment. Many people endorsed smoking risk-reducing beliefs about exercise (79.3%), fruits and vegetables (71.8%), vitamins (67.2%), and sleep (68.5%). Former smokers were less likely to subscribe to these beliefs than never smokers. Vulnerable populations who may be most at risk of smoking attributable morbidity and mortality were more likely to endorse risk-reducing beliefs. Future studies are needed to better understand how risk-reducing beliefs are formed and if modifying these beliefs may help to reduce cigarette smoking in the U.S. Published by Elsevier Inc.

  14. Transforming Wartime Contracting: Controlling Costs, Reducing Risks

    DTIC Science & Technology

    2011-08-01

    reduce the risk of awarding contracts to companies with questionable capability to perform. Expansion of investigative authority and jurisdiction ...A forcing function is needed to ensure widespread and effective adoption of contingency-contracting reform. Otherwise, agency inertia , resistance to...inflamed because jurisdiction over contractors is ambiguous, legal accountability is uncertain, and a clear command-and-control structure is absent. A

  15. How do women at increased breast cancer risk perceive and decide between risks of cancer and risk-reducing treatments? A synthesis of qualitative research.

    PubMed

    Fielden, Hannah G; Brown, Stephen L; Saini, Pooja; Beesley, Helen; Salmon, Peter

    2017-09-01

    Risk-reducing procedures can be offered to people at increased cancer risk, but many procedures can have iatrogenic effects. People therefore need to weigh risks associated with both cancer and the risk-reduction procedure in their decisions. By reviewing relevant literature on breast cancer (BC) risk reduction, we aimed to understand how women at relatively high risk of BC perceive their risk and how their risk perceptions influence their decisions about risk reduction. Synthesis of 15 qualitative studies obtained from systematic searches of SCOPUS, Web of Knowledge, PsychINFO, and Medline electronic databases (inception-June 2015). Women did not think about risk probabilistically. Instead, they allocated themselves to broad risk categories, typically influenced by their own or familial experiences of BC. In deciding about risk-reduction procedures, some women reported weighing the risks and benefits, but papers did not describe how they did so. For many women, however, an overriding wish to reduce intense worry about BC led them to choose aggressive risk-reducing procedures without such deliberation. Reasoning that categorisation is a fundamental aspect of risk perception, we argue that patients can be encouraged to develop more nuanced and accurate categorisations of their own risk through their interactions with clinicians. Empirically-based ethical reflection is required to determine whether and when it is appropriate to provide risk-reduction procedures to alleviate worry. © 2016 The Authors. Psycho-Oncology Published by John Wiley & Sons Ltd.

  16. Shear-reducing insoles to prevent foot ulceration in high-risk diabetic patients.

    PubMed

    Lavery, Lawrence A; LaFontaine, Javier; Higgins, Kevin R; Lanctot, Dan R; Constantinides, George

    2012-11-01

    To enhance the learner's competence with knowledge of the effectiveness of shear-reducing insoles for prevention of foot ulceration in patients with high-risk diabetes. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Demonstrate knowledge of foot ulceration risk, risk factors, incidence, and prevention.2. Apply knowledge gained from reviewing this study and a literature review about the use of shear-reducing insoles to patient scenarios. The objective of this study was to evaluate the effectiveness of a shear-reducing insole compared with a standard insole design to prevent foot ulceration in high-risk patients with diabetes. A total of 299 patients with diabetic neuropathy and loss of protective sensation, foot deformity, or history of foot ulceration were randomized into a standard therapy group (n = 150) or a shear-reducing insole group (n = 149). Patients were evaluated for 18 months. Standard therapy group consisted of therapeutic footwear, diabetic foot education, and regular foot evaluation by a podiatrist. The shear-reducing insole group included a novel insole designed to reduce both pressure and shear on the sole of the foot. Insoles were replaced every 4 months in both groups. The primary clinical outcome was foot ulceration. The authors used Cox proportional hazards regression to evaluate time to ulceration. There were 2 significant factors from the Cox regression model: insole treatment and history of a foot complication. The standard therapy group was about 3.5 times more likely to develop an ulcer compared with shear-reducing insole group (hazard ratio, 3.47; 95% confidence interval, 0.96-12.67). These results suggest that a shear-reducing insole is more effective than traditional insoles to prevent foot ulcers in high-risk persons with diabetes.

  17. Seismic risk analysis for the Babcock and Wilcox facility, Leechburg, Pennsylvania

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

    Not Available

    1977-10-21

    The results of a detailed seismic risk analysis of the Babcock and Wilcox Plutonium Fuel Fabrication facility at Leechburg, Pennsylvania are presented. This report focuses on earthquakes; the other natural hazards, being addressed in separate reports, are severe weather (strong winds and tornados) and floods. The calculational method used is based on Cornell's work (1968); it has been previously applied to safety evaluations of major projects. The historical seismic record was established after a review of available literature, consultation with operators of local seismic arrays and examination of appropriate seismic data bases. Because of the aseismicity of the region aroundmore » the site, an analysis different from the conventional closest approach in a tectonic province was adapted. Earthquakes as far from the site as 1,000 km were included, as were the possibility of earthquakes at the site. In addition, various uncertainties in the input were explicitly considered in the analysis. The results of the risk analysis, which include a Bayesian estimate of the uncertainties, are presented, expressed as return period accelerations. The best estimate curve indicates that the Babcock and Wilcox facility will experience 0.05 g every 220 years and 0.10 g every 1400 years. The bounding curves roughly represent the one standard deviation confidence limits about the best estimate, reflecting the uncertainty in certain of the input. Detailed examination of the results show that the accelerations are very insensitive to the details of the source region geometries or the historical earthquake statistics in each region and that each of the source regions contributes almost equally to the cumulative risk at the site. If required for structural analysis, acceleration response spectra for the site can be constructed by scaling the mean response spectrum for alluvium in WASH 1255 by these peak accelerations.« less

  18. Quantitative risk analysis of oil storage facilities in seismic areas.

    PubMed

    Fabbrocino, Giovanni; Iervolino, Iunio; Orlando, Francesca; Salzano, Ernesto

    2005-08-31

    Quantitative risk analysis (QRA) of industrial facilities has to take into account multiple hazards threatening critical equipment. Nevertheless, engineering procedures able to evaluate quantitatively the effect of seismic action are not well established. Indeed, relevant industrial accidents may be triggered by loss of containment following ground shaking or other relevant natural hazards, either directly or through cascade effects ('domino effects'). The issue of integrating structural seismic risk into quantitative probabilistic seismic risk analysis (QpsRA) is addressed in this paper by a representative study case regarding an oil storage plant with a number of atmospheric steel tanks containing flammable substances. Empirical seismic fragility curves and probit functions, properly defined both for building-like and non building-like industrial components, have been crossed with outcomes of probabilistic seismic hazard analysis (PSHA) for a test site located in south Italy. Once the seismic failure probabilities have been quantified, consequence analysis has been performed for those events which may be triggered by the loss of containment following seismic action. Results are combined by means of a specific developed code in terms of local risk contour plots, i.e. the contour line for the probability of fatal injures at any point (x, y) in the analysed area. Finally, a comparison with QRA obtained by considering only process-related top events is reported for reference.

  19. Profile of hepatitis B and C virus infection in prisoners in Lubuk Pakam correctional facilities

    NASA Astrophysics Data System (ADS)

    Rey, I.; Saragih, R. H.; Effendi-YS, R.; Sembiring, J.; Siregar, G. A.; Zain, L. H.

    2018-03-01

    Prisoners in correctional facilities are predisposed to chronic viral infections because of their high-risk behaviors or unsafe lifestyle. The economic and public health burden of chronic hepatitis B and C and its sequelae need to be addressed, such as by finding the risk factors and therefore reducing the spread of HCV and HBV infection in prisons. This study aimed to see the profile of Hepatitis B and C Virus Infection in prisoners in Lubuk Pakam Correctional Facilities. This cross-sectional study was in Lubuk Pakam Correctional Facilities in 2016. From 1114 prisoners in Lubuk Pakam correctional facility, we randomly examined 120 prisoners for HBV and HCV serology markers. From 120 prisoners, six prisoners were HBV positive, 21 prisoners were HCV positive and one prisoner positive for both HCV and HBV infection. The most common risk factors for prisoners getting HBV infection are tattoos and free sex (36.4% and 36.4%, respectively). The most common risk factors for HCV infection in prisoners are tattoos and free sex (40% and 35%, respectively).

  20. Review of methods to prevent and reduce the risk of Lyme disease.

    PubMed

    Lindsay, L R; Ogden, N H; Schofield, S W

    2015-06-04

    Cases of Lyme disease and areas with self-sustaining populations of vector ticks are increasing in Canada. This trend is expected to continue. Preventing Lyme disease will therefore become relevant to an increasing number of Canadians. To summarize methods for reducing the risk of tick bites and preventing transmission once a tick is feeding. A literature search was conducted to identify methods to reduce the risk of tick bites and the abundance of vector ticks, as well as the risk of becoming infected with the Lyme disease pathogen, Borrelia burgdorferi (BB), if bitten by a vector tick. Current approaches to reducing the risk of tick bites or preventing infection with BB once bitten are largely reliant on the individual. They include use of topical repellents, use of protective clothing, avoidance of risk areas and removing ticks soon (ideally within a day) after they attach. These methods are efficacious, but constrained by user adherence. Other approaches such as landscape modification or the use of acaricides to control ticks, have shown promise in other countries, but have not been widely adopted in Canada. Lyme disease will continue to present a threat in Canada. In additional to the existing interventions for prevention of tick bites and Lyme disease, there is a need for new tools to help reduce the risk of Lyme disease to Canadians.

  1. Targeting high-risk employees may reduce cardiovascular racial disparities.

    PubMed

    Burke, James F; Vijan, Sandeep; Chekan, Lynette A; Makowiec, Ted M; Thomas, Laurita; Morgenstern, Lewis B

    2014-09-01

    A possible remedy for health disparities is for employers to promote cardiovascular health among minority employees. We sought to quantify the financial return to employers of interventions to improve minority health, and to determine whether a race- or risk-targeted strategy was better. Retrospective claims-based cohort analysis. Unconditional per-person costs attributable to stroke and myocardial infarction (MI) were estimated for University of Michigan employees from 2006 to 2009 using a 2-part model. The model was then used to predict the costs of cardiovascular disease to the University for 2 subgroups of employees-minorities and high-risk patients-and to calculate cost-savings thresholds: the point at which the costs of hypothetical interventions (eg, workplace fitness programs) would equal the cost savings from stroke/ MI prevention. Of the 38,314 enrollees, 10% were African American. Estimated unconditional payments for stroke/MI were almost the same in African Americans ($128 per employee per year; 95% CI, $79-$177) and whites ($128 per employee per year; 95% CI, $101- $156), including higher event rates and lower payments per event in African Americans. Targeting the highest risk decile with interventions to reduce stroke/MI would result in a substantially higher cost-savings threshold ($81) compared with targeting African Americans ($13). An unanticipated consequence of risk-based targeting is that African Americans would substantially benefit: an intervention targeted at the top risk decile would prevent 75% of the events in African Americans, just as would an intervention that exclusively targeted African Americans. Targeting all high-risk employees for cardiovascular risk reduction may be a win-win-win situation for employers: improving health, decreasing costs, and reducing disparities.

  2. School-based programs to reduce sexual risk-taking behaviors.

    PubMed

    Kirby, D

    1992-09-01

    This article reviews the major approaches implemented during the last two decades to reduce sexual risk-taking behaviors, examines their evidence for success, and provides several recommendations for effective programs and program evaluations. This article does not discuss more broad-based sexuality education programs which address sexuality in a broader context. Instead, this article focuses primarily on programs that educators believed would reduce unprotected sexual intercourse.

  3. Increased risk of eczema but reduced risk of early wheezy disorder from exclusive breast-feeding in high-risk infants.

    PubMed

    Giwercman, Charlotte; Halkjaer, Liselotte B; Jensen, Signe Marie; Bønnelykke, Klaus; Lauritzen, Lotte; Bisgaard, Hans

    2010-04-01

    Breast-feeding is recommended for the prevention of eczema, asthma, and allergy, particularly in high-risk families, but recent studies have raised concern that this may not protect children and may even increase the risk. However, disease risk, disease manifestation, lifestyle, and the choice to breast-feed are interrelated, and therefore, analyzing true causal effects presents a number of methodologic challenges. First, to assess the effect from duration of exclusive breast-feeding on the development of eczema and wheezy disorders during the first 2 years of life in a high-risk clinical birth cohort. Second, to assess any influence from the fatty acid composition of mother's milk on the risk from breast-feeding. We studied disease development during the first two years of life of the 411 infants from the Copenhagen Study on Asthma in Childhood (COPSAC) birth cohort, born to mothers with a history of asthma. We analyzed the effect from duration of breast-feeding before disease onset on the disease risk, avoiding the effect from disease-related modification of exposure (inverse causation). Polyunsaturated fatty acids were measured in breast milk. Breast-feeding significantly increased the risk of eczema adjusted for demographics, filaggrin variants, parents' eczema, and pets at home (N = 306; relative risk, 2.09; 95% CI 1.15-3.80; P = .016) but reduced the risk of wheezy episodes (relative risk, 0.67; 95% CI 0.48-0.96; P = .021) and of severe wheezy exacerbation (relative risk, 0.16; 95% CI 0.03-1.01; P = .051). There was no association between the fatty acid composition of mother's milk and the risk of eczema or wheeze. The risk of eczema was increased in infants with increasing duration of breast-feeding. In contrast, the risk of wheezy disorder and severe wheezy exacerbations was reduced. There were no significant effects from the fatty acid composition of the breast milk on risk of eczema or wheezy disorders. Copyright (c) 2010 American Academy of Allergy

  4. Comparison of human exposure pathways in an urban brownfield: reduced risk from paving roads.

    PubMed

    James, Kyle; Farrell, Richard E; Siciliano, Steven D

    2012-10-01

    Risk assessments often do not quantify the risk associated with soil inhalation. This pathway generally makes a negligible contribution to the cumulative risk, because soil ingestion is typically the dominant exposure pathway. Conditions in northern or rural centers in Canada characterized by large areas of exposed soil, including unpaved roads, favor the resuspension of soil particles, making soil inhalation a relevant risk pathway. The authors determined and compared human exposure to metals and polycyclic aromatic hydrocarbons (PAHs) from soil ingestion and inhalation and analyzed the carcinogenic and noncarcinogenic risks before and after roads were paved in a northern community. To determine the inhalation exposure, three size fractions of airborne particulate matter were collected (total suspended particulates [TSP], particulate matter with an aerodynamic diameter less than 10 µm [PM10], and particulate matter with an aerodynamic diameter less than 2.5 µm [PM2.5]) before and after roads were paved. Road paving reduced the concentration of many airborne contaminants by 25 to 75%, thus reducing risk. For example, before paving, the carcinogenic risk associated with inhalation of Cr was 3.4 excess cancers per 100,000 people exposed, whereas after paving, this risk was reduced to 1.6 in 100,000. Paving roads reduced the concentrations of total suspended particulates (TSP; p < 0.1) and PM10 (p < 0.05) but not PM25. Consequently, the ingestion of inhaled soil particles was substantially reduced. The authors conclude that resuspended soil is likely an important source of risk for many northern communities and that paving roads is an effective method of reducing risk from the inhalation of soil particles. Copyright © 2012 SETAC.

  5. Reduced cancer risk in vegetarians: an analysis of recent reports.

    PubMed

    Lanou, Amy Joy; Svenson, Barbara

    2010-12-20

    This report reviews current evidence regarding the relationship between vegetarian eating patterns and cancer risk. Although plant-based diets including vegetarian and vegan diets are generally considered to be cancer protective, very few studies have directly addressed this question. Most large prospective observational studies show that vegetarian diets are at least modestly cancer protective (10%-12% reduction in overall cancer risk) although results for specific cancers are less clear. No long-term randomized clinical trials have been conducted to address this relationship. However, a broad body of evidence links specific plant foods such as fruits and vegetables, plant constituents such as fiber, antioxidants and other phytochemicals, and achieving and maintaining a healthy weight to reduced risk of cancer diagnosis and recurrence. Also, research links the consumption of meat, especially red and processed meats, to increased risk of several types of cancer. Vegetarian and vegan diets increase beneficial plant foods and plant constituents, eliminate the intake of red and processed meat, and aid in achieving and maintaining a healthy weight. The direct and indirect evidence taken together suggests that vegetarian diets are a useful strategy for reducing risk of cancer.

  6. Reduced cancer risk in vegetarians: an analysis of recent reports

    PubMed Central

    Lanou, Amy Joy; Svenson, Barbara

    2011-01-01

    This report reviews current evidence regarding the relationship between vegetarian eating patterns and cancer risk. Although plant-based diets including vegetarian and vegan diets are generally considered to be cancer protective, very few studies have directly addressed this question. Most large prospective observational studies show that vegetarian diets are at least modestly cancer protective (10%–12% reduction in overall cancer risk) although results for specific cancers are less clear. No long-term randomized clinical trials have been conducted to address this relationship. However, a broad body of evidence links specific plant foods such as fruits and vegetables, plant constituents such as fiber, antioxidants and other phytochemicals, and achieving and maintaining a healthy weight to reduced risk of cancer diagnosis and recurrence. Also, research links the consumption of meat, especially red and processed meats, to increased risk of several types of cancer. Vegetarian and vegan diets increase beneficial plant foods and plant constituents, eliminate the intake of red and processed meat, and aid in achieving and maintaining a healthy weight. The direct and indirect evidence taken together suggests that vegetarian diets are a useful strategy for reducing risk of cancer. PMID:21407994

  7. Contamination Sources Effects Analysis (CSEA) - A Tool to Balance Cost/Schedule While Managing Facility Availability

    NASA Technical Reports Server (NTRS)

    Wilcox, Margaret

    2008-01-01

    A CSEA is similar to a Failure Modes Effects Analysis (FMEA). A CSEA tracks risk, deterrence, and occurrence of sources of contamination and their mitigation plans. Documentation is provided spanning mechanical and electrical assembly, precision cleaning, thermal vacuum bake-out, and thermal vacuum testing. These facilities all may play a role in contamination budgeting and reduction ultimately affecting test and flight. With a CSEA, visibility can be given to availability of these facilities, test sequencing and trade-offs. A cross-functional team including specialty engineering, contamination control, electrostatic dissipation, manufacturing, testing, and material engineering participate in an exercise that identifies contaminants and minimizes the complexity of scheduling these facilities considering their volatile schedules. Care can be taken in an efficient manner to insure correct cleaning processes are employed. The result is reduction in cycle time ("schedule hits"), reduced cost due to rework, reduced risk and improved communication and quality while achieving adherence to the Contamination Control Plan.

  8. An assessment of risk posed by a Campylobacter-positive puppy living in an Australian residential aged-care facility.

    PubMed

    Moffatt, Cameron; Appuhamy, Ranil; Andrew, Will; Wynn, Sandy; Roberts, Jan; Kennedy, Karina

    2014-01-01

    In April and June 2012, two outbreaks of Campylobacter gastroenteritis were investigated in an Australian aged-care facility (ACF); a Campylobacter-positive puppy was identified as a potential source of infection. An expert panel was convened to assess transmission risk from the puppy to elderly residents and to guide further public health action. Criteria considered as part of the panel's assessment included the puppy's infectivity, the bacterium's transmissibility, puppy-resident contact, infection control and cleaning practices and animal management at the facility. A literature review was used to assist the panel, with a final risk being determined using a likelihood and consequence matrix. The panel determined that the setting and low infective dose made transmission likely despite varying degrees of contact between the puppy and cases. While infection control practices were generally appropriate, the facility's animal policy did not adequately address potential zoonotic risk. In summary, puppies should not be considered as companion animals in ACFs due to high rates of Campylobacter carriage and the underlying susceptibility of the elderly. Infection control and animal policies in ACFs should reflect an awareness of zoonotic disease potential.

  9. Are facilities following best practices of pediatric abdominal CT scans?

    PubMed

    Nosek, Amy E; Hartin, Charles W; Bass, Kathryn D; Glick, Philip L; Caty, Michael G; Dayton, Merril T; Ozgediz, Doruk E

    2013-05-01

    Established guidelines for pediatric abdominal CT scans include reduced radiation dosage to minimize cancer risk and the use of intravenous (IV) contrast to obtain the highest-quality diagnostic images. We wish to determine if these practices are being used at nonpediatric facilities that transfer children to a pediatric facility. Children transferred to a tertiary pediatric facility over a 16-mo period with abdominal CT scans performed for evaluation of possible appendicitis were retrospectively reviewed for demographics, diagnosis, radiation dosage, CT contrast use, and scan quality. If CT scans were repeated, the radiation dosage between facilities was compared using Student t-test. Ninety-one consecutive children transferred from 29 different facilities had retrievable CT scan images and clinical information. Half of CT scans from transferring institutions used IV contrast. Due to poor quality or inconclusive CT scans, 19 patients required a change in management. Children received significantly less radiation at our institution compared to the referring adult facility for the same body area scanned on the same child (9.7 mSv versus 19.9 mSv, P = 0.0079). Pediatric facilities may be using less radiation per CT scan due to a heightened awareness of radiation risks and specific pediatric CT scanning protocols. The benefits of IV contrast for the diagnostic yield of pediatric CT scans should be considered to obtain the best possible image and to prevent additional imaging. Every facility performing pediatric CT scans should minimize radiation exposure, and pediatric facilities should provide feedback and education to other facilities scanning children. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Reducing stillbirths in Ethiopia: Results of an intervention programme.

    PubMed

    Lindtjørn, Bernt; Mitike, Demissew; Zidda, Zillo; Yaya, Yaliso

    2018-01-01

    Previous studies from South Ethiopia have shown that interventions that focus on intrapartum care substantially reduce maternal mortality and there is a need to operationalize health packages that could reduce stillbirths. The aim of this paper is to evaluate if a programme that aimed to improve maternal health, and mainly focusing on strengthening intrapartum care, also would reduce the number of stillbirths, and to estimate if there are other indicators that explains high stillbirth rates. Our study used a "continuum of care" approach and focussed on providing essential antenatal and obstetric services in communities through health extension workers, at antenatal and health facility services. In this follow up study, which includes the same 38.312 births registered by community health workers, shows that interventions focusing on improved intrapartum care can also reduce stillbirths (by 46%; from 14.5 to 7.8 per 1000 births). Other risk factors for stillbirths are mainly related to complications during delivery and illnesses during pregnancy. We show that focusing on Comprehensive Emergency Obstetric Care and antenatal services reduces stillbirths. However, the study also underlines that illnesses during pregnancy and complications during delivery still represent the main risk factors for stillbirths. This indicates that obstetric care need still to be strengthened, should include the continuum of care from home to the health facility, make care accessible to all, and reduce delays.

  11. Policies for Reducing Coastal Risk on the East and Gulf Coasts

    NASA Astrophysics Data System (ADS)

    Glickson, D.; Johnson, S.

    2014-12-01

    Hurricane- and coastal storm-related economic losses have increased substantially over the past century, largely due to expanding population and development in susceptible coastal areas. Concurrent with this growth, the federal government has assumed an increasing proportion of the financial responsibility associated with U.S. coastal storms, which may discourage state and local governments from taking appropriate actions to reduce risk and enhance resilience. Strategies to manage coastal storm risks fall into two categories: reducing the probability of flooding or wave impact (such as seawalls, storm surge barriers, beach nourishment, dune building, restoration/expansion of oyster reefs, salt marshes, and mangroves) and reducing the number or vulnerability of people or structures (such as relocation, land-use planning, and elevating or floodproofing buildings). Over the past century, most coastal risk management programs have emphasized coastal armoring, while doing little to decrease development in harm's way. This National Research Council report calls for the development of a national vision for managing coastal risks that includes a long-term view, regional solutions, and recognition of all benefits. A national coastal risk assessment is needed to identify high priority areas. Benefit-cost analysis provides a reasonable framework to evaluate national investments in coastal risk reduction, if constrained by other important environmental, social, and life-safety factors. Extensive collaboration and additional policy changes will be necessary to move from a nation that is primarily reactive to coastal disasters to one that invests wisely in coastal risk reduction and builds resilience among coastal communities.

  12. Risk of fractures in an intermediate care facility for persons with mental retardation.

    PubMed

    Tannenbaum, T N; Lipworth, L; Baker, S

    1989-01-01

    The epidemiology of fractures among 553 residents of an intermediate care facility for persons with mental retardation was examined. In a 10-month period, 61 fractures occurred among 55 residents; application of fracture rates in the United States revealed an expected number of 15 fractures among the 553 residents, p less than .001. Although 52% of fractures involved small bones of the hands and feet, elderly residents were more likely to fracture major bones and to suffer their fractures from a fall than were younger residents. The relationship between potential risk factors and fracture risk were examined and implications for preventive and rehabilitative measures discussed.

  13. Reducing mortality risk by targeting specific air pollution sources: Suva, Fiji.

    PubMed

    Isley, C F; Nelson, P F; Taylor, M P; Stelcer, E; Atanacio, A J; Cohen, D D; Mani, F S; Maata, M

    2018-01-15

    Health implications of air pollution vary dependent upon pollutant sources. This work determines the value, in terms of reduced mortality, of reducing ambient particulate matter (PM 2.5 : effective aerodynamic diameter 2.5μm or less) concentration due to different emission sources. Suva, a Pacific Island city with substantial input from combustion sources, is used as a case-study. Elemental concentration was determined, by ion beam analysis, for PM 2.5 samples from Suva, spanning one year. Sources of PM 2.5 have been quantified by positive matrix factorisation. A review of recent literature has been carried out to delineate the mortality risk associated with these sources. Risk factors have then been applied for Suva, to calculate the possible mortality reduction that may be achieved through reduction in pollutant levels. Higher risk ratios for black carbon and sulphur resulted in mortality predictions for PM 2.5 from fossil fuel combustion, road vehicle emissions and waste burning that surpass predictions for these sources based on health risk of PM 2.5 mass alone. Predicted mortality for Suva from fossil fuel smoke exceeds the national toll from road accidents in Fiji. The greatest benefit for Suva, in terms of reduced mortality, is likely to be accomplished by reducing emissions from fossil fuel combustion (diesel), vehicles and waste burning. Copyright © 2017. Published by Elsevier B.V.

  14. Breast-feeding reduces the risk for childhood eczema.

    PubMed

    Kull, Inger; Böhme, Maria; Wahlgren, Carl-Fredrik; Nordvall, Lennart; Pershagen, Göran; Wickman, Magnus

    2005-09-01

    The evidence for a preventive effect of breast-feeding on the development of eczema in childhood remains controversial. To investigate the effect of breast-feeding in various phenotypes of eczema to 4 years. A birth cohort of 4089 children made up the study base. Data on breast-feeding, allergic symptoms, and potential confounders were obtained from questionnaires when the children were 2 months and 1, 2, and 4 years old. At 4 years, blood specific IgE was analyzed. Children with symptoms of eczema and asthma during the period of breast-feeding were excluded in most analyses on risk assessment of eczema and asthma, respectively, to avoid disease-related modification of exposure. Exclusive breast-feeding for >or=4 months reduced the risk for eczema at the age of 4 years (odds ratio [OR], 0.78; 95% CI, 0.63--0.96) irrespective of combination with asthma, sensitization to common allergens, or parental allergic disease. This decreased risk was most evident for children with onset of eczema during the first 2 years persisting to 4 years (OR, 0.59; 95% CI, 0.45--0.77). Among children with early-onset eczema, irrespective of persistency, followed by late onset of asthma or early-onset asthma irrespective of persistency, followed by late-onset eczema to 4 years, a protective effect of breast-feeding was also seen (OR, 0.48; 95% CI, 0.30--0.76). Breast-feeding 4 months or more reduces the risk for eczema and onset of the allergy march to age 4.

  15. Reducing cooling energy consumption in data centres and critical facilities

    NASA Astrophysics Data System (ADS)

    Cross, Gareth

    Given the rise of our everyday reliance on computers in all walks of life, from checking the train times to paying our credit card bills online, the need for computational power is ever increasing. Other than the ever-increasing performance of home Personal Computers (PC's) this reliance has given rise to a new phenomenon in the last 10 years ago. The data centre. Data centres contain vast arrays of IT cabinets loaded with servers that perform millions of computational equations every second. It is these data centres that allow us to continue with our reliance on the internet and the PC. As more and more data centres become necessary due to the increase in computing processing power required for the everyday activities we all take for granted so the energy consumed by these data centres rises. Not only are more and more data centres being constructed daily, but operators are also looking at ways to squeeze more processing from their existing data centres. This in turn leads to greater heat outputs and therefore requires more cooling. Cooling data centres requires a sizeable energy input, indeed to many megawatts per data centre site. Given the large amounts of money dependant on the successful operation of data centres, in particular for data centres operated by financial institutions, the onus is predominantly on ensuring the data centres operate with no technical glitches rather than in an energy conscious fashion. This report aims to investigate the ways and means of reducing energy consumption within data centres without compromising the technology the data centres are designed to house. As well as discussing the individual merits of the technologies and their implementation technical calculations will be undertaken where necessary to determine the levels of energy saving, if any, from each proposal. To enable comparison between each proposal any design calculations within this report will be undertaken against a notional data facility. This data facility will

  16. Study Shows Aspirin Reduces Colorectal Cancer in Those at High Risk

    Cancer.gov

    Findings from the first large clinical trial of its kind indicate that taking high doses of aspirin daily for at least 2 years substantially reduces the risk of colorectal cancer among people at increased risk of the disease.

  17. An Interprofessional Approach to Reducing the Risk of Falls Through Enhanced Collaborative Practice.

    PubMed

    Eckstrom, Elizabeth; Neal, Margaret B; Cotrell, Vicki; Casey, Colleen M; McKenzie, Glenise; Morgove, Megan W; DeLander, Gary E; Simonson, William; Lasater, Kathie

    2016-08-01

    Falls are the leading cause of accidental deaths in older adults and are a growing public health concern. The American Geriatrics Society (AGS) and British Geriatrics Society (BGS) published guidelines for falls screening and risk reduction, yet few primary care providers report following any guidelines for falls prevention. This article describes a project that engaged an interprofessional teaching team to support interprofessional clinical teams to reduce fall risk in older adults by implementing the AGS/BGS guidelines. Twenty-five interprofessional clinical teams with representatives from medicine, nursing, pharmacy, and social work were recruited from ambulatory, long-term care, hospital, and home health settings for a structured intervention: a 4-hour training workshop plus coaching for implementation for 1 year. The workshop focused on evidence-based strategies to decrease the risk of falls, including screening for falls; assessing gait, balance, orthostatic blood pressure, and other medical conditions; exercise including tai chi; vitamin D supplementation; medication review and reduction; and environmental assessment. Quantitative and qualitative data were collected using chart reviews, coaching plans and field notes, and postintervention structured interviews of participants. Site visits and coaching field notes confirmed uptake of the strategies. Chart reviews showed significant improvement in adoption of all falls prevention strategies except vitamin D supplementation. Long-term care facilities were more likely to address environmental concerns and add tai chi classes, and ambulatory settings were more likely to initiate falls screening. The intervention demonstrated that interprofessional practice change to target falls prevention can be incorporated into primary care and long-term care settings. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  18. Natural disturbance reduces disease risk in endangered rainforest frog populations

    PubMed Central

    Roznik, Elizabeth A.; Sapsford, Sarah J.; Pike, David A.; Schwarzkopf, Lin; Alford, Ross A.

    2015-01-01

    Natural disturbances can drive disease dynamics in animal populations by altering the microclimates experienced by hosts and their pathogens. Many pathogens are highly sensitive to temperature and moisture, and therefore small changes in habitat structure can alter the microclimate in ways that increase or decrease infection prevalence and intensity in host populations. Here we show that a reduction of rainforest canopy cover caused by a severe tropical cyclone decreased the risk of endangered rainforest frogs (Litoria rheocola) becoming infected by a fungal pathogen (Batrachochytrium dendrobatidis). Reductions in canopy cover increased the temperatures and rates of evaporative water loss in frog microhabitats, which reduced B. dendrobatidis infection risk in frogs by an average of 11–28% in cyclone-damaged areas, relative to unaffected areas. Natural disturbances to the rainforest canopy can therefore provide an immediate benefit to frogs by altering the microclimate in ways that reduce infection risk. This could increase host survival and reduce the probability of epidemic disease outbreaks. For amphibian populations under immediate threat from this pathogen, targeted manipulation of canopy cover could increase the availability of warmer, drier microclimates and therefore tip the balance from host extinction to coexistence. PMID:26294048

  19. Natural disturbance reduces disease risk in endangered rainforest frog populations.

    PubMed

    Roznik, Elizabeth A; Sapsford, Sarah J; Pike, David A; Schwarzkopf, Lin; Alford, Ross A

    2015-08-21

    Natural disturbances can drive disease dynamics in animal populations by altering the microclimates experienced by hosts and their pathogens. Many pathogens are highly sensitive to temperature and moisture, and therefore small changes in habitat structure can alter the microclimate in ways that increase or decrease infection prevalence and intensity in host populations. Here we show that a reduction of rainforest canopy cover caused by a severe tropical cyclone decreased the risk of endangered rainforest frogs (Litoria rheocola) becoming infected by a fungal pathogen (Batrachochytrium dendrobatidis). Reductions in canopy cover increased the temperatures and rates of evaporative water loss in frog microhabitats, which reduced B. dendrobatidis infection risk in frogs by an average of 11-28% in cyclone-damaged areas, relative to unaffected areas. Natural disturbances to the rainforest canopy can therefore provide an immediate benefit to frogs by altering the microclimate in ways that reduce infection risk. This could increase host survival and reduce the probability of epidemic disease outbreaks. For amphibian populations under immediate threat from this pathogen, targeted manipulation of canopy cover could increase the availability of warmer, drier microclimates and therefore tip the balance from host extinction to coexistence.

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

    PubMed

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

    2011-01-01

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

  1. Phenology Information Contributes to Reduce Temporal Basis Risk in Agricultural Weather Index Insurance.

    PubMed

    Dalhaus, Tobias; Musshoff, Oliver; Finger, Robert

    2018-01-08

    Weather risks are an essential and increasingly important driver of agricultural income volatility. Agricultural insurances contribute to support farmers to cope with these risks. Among these insurances, weather index insurances (WII) are an innovative tool to cope with climatic risks in agriculture. Using WII, farmers receive an indemnification not based on actual yield reductions but are compensated based on a measured weather index, such as rainfall at a nearby weather station. The discrepancy between experienced losses and actual indemnification, basis risk, is a key challenge. In particular, specifications of WII used so far do not capture critical plant growth phases adequately. Here, we contribute to reduce basis risk by proposing novel procedures how occurrence dates and shifts of growth phases over time and space can be considered and test for their risk reducing potential. Our empirical example addresses drought risks in the critical growth phase around the anthesis stage in winter wheat production in Germany. We find spatially explicit, public and open databases of phenology reports to contribute to reduce basis risk and thus improve the attractiveness of WII. In contrast, we find growth stage modelling based on growing degree days (thermal time) not to result in significant improvements.

  2. Effects of a Family Intervention in Reducing HIV Risk Behaviors Among High-Risk Hispanic Adolescents

    PubMed Central

    Prado, Guillermo; Pantin, Hilda; Huang, Shi; Cordova, David; Tapia, Maria I.; Velazquez, Maria-Rosa; Calfee, Meghan; Malcolm, Shandey; Arzon, Margaret; Villamar, Juan; Jimenez, Giselle Leon; Cano, Nicole; Brown, C. Hendricks; Estrada, Yannine

    2013-01-01

    Objective To determine the efficacy of a family intervention in reducing human immunodeficiency virus (HIV) risk behaviors among Hispanic delinquent adolescents. Design Randomized controlled trial. Setting Miami–Dade County Public School System and Miami–Dade County’s Department of Juvenile Services, Florida. Participants A total of 242 Hispanic delinquent youth aged 12 to 17 years and their primary caregivers completed outcome assessments at baseline and 3 months after intervention. Intervention Participants were randomized to either Familias Unidas (120 participants), a Hispanic-specific, family intervention designed to reduce HIV risk behaviors among Hispanic youth, or a community practice control condition (122 participants). Main Outcome Measures Self-reported measures included unprotected sexual behavior, engaging in sex while under the influence of alcohol and/or drugs, number of sexual partners, and incidence of sexually transmitted diseases. Family functioning (eg, parent-adolescent communication, positive parenting, and parental monitoring) was also assessed via self-report measures. Results Compared with community practice, Familias Unidas was efficacious in increasing condom use during vaginal and anal sex during the past 90 days, reducing the number of days adolescents were under the influence of drugs or alcohol and had sex without a condom, reducing sexual partners, and preventing unprotected anal sex at the last sexual intercourse. Familias Unidas was also efficacious, relative to community practice, in increasing family functioning and most notably in increasing parent-adolescent communication and positive parenting. Conclusion These results suggest that culturally tailored, family-centered prevention interventions may be appropriate and efficacious in reducing HIV risk behaviors among Hispanic delinquent adolescents. Trial Registration clinicaltrials.gov Identifier: NCT01257022 PMID:21969363

  3. Motivators and barriers of tamoxifen use as risk-reducing medication amongst women at increased breast cancer risk: a systematic literature review.

    PubMed

    Meiser, B; Wong, W K T; Peate, M; Julian-Reynier, C; Kirk, J; Mitchell, G

    2017-01-01

    Selective estrogen receptor modulators, such as tamoxifen, reduce breast cancer risk by up to 50% in women at increased risk for breast cancer. Despite tamoxifen's well-established efficacy, many studies show that most women are not taking up tamoxifen. This systematic literature review aimed to identify the motivators and barriers to tamoxifen use 's amongst high-risk women. Using MEDLINE, PsycINFO, and Embase plus reviewing reference lists of relevant articles published between 1995 and 2016, 31 studies (published in 35 articles) were identified, which addressed high-risk women's decisions about risk-reducing medication to prevent breast cancer and were peer-reviewed primary clinical studies. A range of factors were identified as motivators of, and barriers to, tamoxifen uptake including: perceived risk, breast-cancer-related anxiety, health professional recommendation, perceived drug effectiveness, concerns about side-effects, knowledge and access to information about side-effects, beliefs about the role of risk-reducing medication, provision of a biomarker, preference for other forms of breast cancer risk reduction, previous treatment experience, concerns about randomization in clinical trial protocols and finally altruism. Results indicate that the decision for high-risk women regarding tamoxifen use or non-use as a risk-reducing medication is not straightforward. Support of women making this decision is essential and needs to encompass the full range of factors, both informational and psychological.

  4. Risk-based decision making for terrorism applications.

    PubMed

    Dillon, Robin L; Liebe, Robert M; Bestafka, Thomas

    2009-03-01

    This article describes the anti-terrorism risk-based decision aid (ARDA), a risk-based decision-making approach for prioritizing anti-terrorism measures. The ARDA model was developed as part of a larger effort to assess investments for protecting U.S. Navy assets at risk and determine whether the most effective anti-terrorism alternatives are being used to reduce the risk to the facilities and war-fighting assets. With ARDA and some support from subject matter experts, we examine thousands of scenarios composed of 15 attack modes against 160 facility types on two installations and hundreds of portfolios of 22 mitigation alternatives. ARDA uses multiattribute utility theory to solve some of the commonly identified challenges in security risk analysis. This article describes the process and documents lessons learned from applying the ARDA model for this application.

  5. On-road bicycle facilities and bicycle crashes in Iowa, 2007-2010.

    PubMed

    Hamann, Cara; Peek-Asa, Corinne

    2013-07-01

    An average of 611 deaths and over 47,000 bicyclists are injured in traffic-related crashes in the United States each year. Efforts to increase bicycle safety are needed to reduce and prevent injuries and fatalities, especially as trends indicate that ridership is increasing rapidly. The objective of this study was to evaluate the effect of bicycle-specific roadway facilities (e.g., signage and bicycle lanes) in reducing bicycle crashes. We conducted a case site-control site study of 147 bicycle crash-sites identified from the Iowa Department of Transportation crash database from 2007 to 2010 and 147 matched non-crash sites. Control sites were randomly selected from intersections matched to case sites on neighborhood (census block group) and road classification (arterial, feeder, collector, etc.). We examined crash risk by any on-road bicycle facility present and by facility type (pavement markings--bicycle lanes and shared lane arrows, bicycle-specific signage, and the combination of markings and signage), controlling for bicycle volume, motor vehicle volume, street width, sidewalks, and traffic controls. A total of 11.6% of case sites and 15.0% of controls had an on-road bicycle facility. Case intersections had higher bicycle volume (3.52 vs. 3.34 per 30 min) and motor vehicle volume (248.77 vs. 205.76 per 30 min) than controls. Our results are suggestive that the presence of an on-road bicycle facility decreases crash risk by as much as 60% with a bicycle lane or shared lane arrow (OR=0.40, 95% CI=0.09-1.82) and 38% with bicycle-specific signage (OR=0.62, 95% CI=0.15-2.58). Investments in bicycle-specific pavement markings and signage have been shown to be beneficial to traffic flow, and our results suggest that they may also reduce the number of bicycle-motor vehicle crashes and subsequent injuries and fatalities. As a relatively low-cost traffic feature, community considerations for further implementation of these facilities are justified. Copyright © 2012

  6. The impact of communicating genetic risks of disease on risk-reducing health behaviour: systematic review with meta-analysis.

    PubMed

    Hollands, Gareth J; French, David P; Griffin, Simon J; Prevost, A Toby; Sutton, Stephen; King, Sarah; Marteau, Theresa M

    2016-03-15

    To assess the impact of communicating DNA based disease risk estimates on risk-reducing health behaviours and motivation to engage in such behaviours. Systematic review with meta-analysis, using Cochrane methods. Medline, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials up to 25 February 2015. Backward and forward citation searches were also conducted. Randomised and quasi-randomised controlled trials involving adults in which one group received personalised DNA based estimates of disease risk for conditions where risk could be reduced by behaviour change. Eligible studies included a measure of risk-reducing behaviour. We examined 10,515 abstracts and included 18 studies that reported on seven behavioural outcomes, including smoking cessation (six studies; n=2663), diet (seven studies; n=1784), and physical activity (six studies; n=1704). Meta-analysis revealed no significant effects of communicating DNA based risk estimates on smoking cessation (odds ratio 0.92, 95% confidence interval 0.63 to 1.35, P=0.67), diet (standardised mean difference 0.12, 95% confidence interval -0.00 to 0.24, P=0.05), or physical activity (standardised mean difference -0.03, 95% confidence interval -0.13 to 0.08, P=0.62). There were also no effects on any other behaviours (alcohol use, medication use, sun protection behaviours, and attendance at screening or behavioural support programmes) or on motivation to change behaviour, and no adverse effects, such as depression and anxiety. Subgroup analyses provided no clear evidence that communication of a risk-conferring genotype affected behaviour more than communication of the absence of such a genotype. However, studies were predominantly at high or unclear risk of bias, and evidence was typically of low quality. Expectations that communicating DNA based risk estimates changes behaviour is not supported by existing evidence. These results do not support use of genetic testing or the search for risk

  7. INCINERATION RESEARCH FACILITY

    EPA Science Inventory

    The Cincinnati-based Risk Reduction Engineering Laboratory, ORD, U.S. EPA operates the Incineration Research Facility *IRF) in Jefferson, Arkansas. This facility's pilot-scale experimental incineration systems include a Rotary Kiln System and a Liquid Injection System. Each syste...

  8. Reducing risk where tectonic plates collide

    USGS Publications Warehouse

    Gomberg, Joan S.; Ludwig, Kristin A.

    2017-06-19

    Most of the world’s earthquakes, tsunamis, landslides, and volcanic eruptions are caused by the continuous motions of the many tectonic plates that make up the Earth’s outer shell. The most powerful of these natural hazards occur in subduction zones, where two plates collide and one is thrust beneath another. The U.S. Geological Survey’s (USGS) “Reducing Risk Where Tectonic Plates Collide—A USGS Plan to Advance Subduction Zone Science” is a blueprint for building the crucial scientific foundation needed to inform the policies and practices that can make our Nation more resilient to subduction zone-related hazards.

  9. What can individuals do to reduce personal health risks from air pollution?

    PubMed Central

    Laumbach, Robert; Meng, Qingyu

    2015-01-01

    In many areas of the world, concentrations of ambient air pollutants exceed levels associated with increased risk of acute and chronic health problems. While effective policies to reduce emissions at their sources are clearly preferable, some evidence supports the effectiveness of individual actions to reduce exposure and health risks. Personal exposure to ambient air pollution can be reduced on high air pollution days by staying indoors, reducing outdoor air infiltration to indoors, cleaning indoor air with air filters, and limiting physical exertion, especially outdoors and near air pollution sources. Limited evidence suggests that the use of respirators may be effective in some circumstances. Awareness of air pollution levels is facilitated by a growing number of public air quality alert systems. Avoiding exposure to air pollutants is especially important for susceptible individuals with chronic cardiovascular or pulmonary disease, children, and the elderly. Research on mechanisms underlying the adverse health effects of air pollution have suggested potential pharmaceutical or chemopreventive interventions, such as antioxidant or antithrombotic agents, but in the absence of data on health outcomes, no sound recommendations can be made for primary prevention. Health care providers and their patients should carefully consider individual circumstances related to outdoor and indoor air pollutant exposure levels and susceptibility to those air pollutants when deciding on a course of action to reduce personal exposure and health risks from ambient air pollutants. Careful consideration is especially warranted when interventions may have unintended negative consequences, such as when efforts to avoid exposure to air pollutants lead to reduced physical activity or when there is evidence that dietary supplements, such as antioxidants, have potential adverse health effects. These potential complications of partially effective personal interventions to reduce exposure or

  10. What can individuals do to reduce personal health risks from air pollution?

    PubMed

    Laumbach, Robert; Meng, Qingyu; Kipen, Howard

    2015-01-01

    In many areas of the world, concentrations of ambient air pollutants exceed levels associated with increased risk of acute and chronic health problems. While effective policies to reduce emissions at their sources are clearly preferable, some evidence supports the effectiveness of individual actions to reduce exposure and health risks. Personal exposure to ambient air pollution can be reduced on high air pollution days by staying indoors, reducing outdoor air infiltration to indoors, cleaning indoor air with air filters, and limiting physical exertion, especially outdoors and near air pollution sources. Limited evidence suggests that the use of respirators may be effective in some circumstances. Awareness of air pollution levels is facilitated by a growing number of public air quality alert systems. Avoiding exposure to air pollutants is especially important for susceptible individuals with chronic cardiovascular or pulmonary disease, children, and the elderly. Research on mechanisms underlying the adverse health effects of air pollution have suggested potential pharmaceutical or chemopreventive interventions, such as antioxidant or antithrombotic agents, but in the absence of data on health outcomes, no sound recommendations can be made for primary prevention. Health care providers and their patients should carefully consider individual circumstances related to outdoor and indoor air pollutant exposure levels and susceptibility to those air pollutants when deciding on a course of action to reduce personal exposure and health risks from ambient air pollutants. Careful consideration is especially warranted when interventions may have unintended negative consequences, such as when efforts to avoid exposure to air pollutants lead to reduced physical activity or when there is evidence that dietary supplements, such as antioxidants, have potential adverse health effects. These potential complications of partially effective personal interventions to reduce exposure or

  11. Extreme Geohazards: Reducing the Disaster Risk and Increasing Resilience

    NASA Astrophysics Data System (ADS)

    Plag, Hans-Peter; Stein, Seth; Brocklebank, Sean; Jules-Plag, Shelley; Marsh, Stuart; Campus, Paola

    2013-04-01

    Extreme geohazards have the potential to escalate the global sustainability crisis and put us close to the boundaries of the safe operating space for humanity. Exposure of human assets to geohazards has increased dramatically in recent decades, and the sensitivity of the built environment and the embedded socio-economic fabric have changed. We are putting the urban environment, including megacities, in harm's way. Paradoxically, innovation during recent decades, in particular, urban innovation, has increased the disaster risk and coupled this risk to the sustainability crisis. Only more innovation can reduce disaster risk and lead us out of the sustainability crisis. Extreme geohazards (volcanic eruptions, earthquakes, tsunamis) that occurred regularly throughout the last few millennia mostly did not cause major disasters because population density was low and the built environment was not sprawling into hazardous areas to the same extent as today. Similar extreme events today would cause unparalleled damage on a global scale and could worsen the sustainability crisis. Simulation of these extreme hazards under present conditions can help to assess the disaster risk. The Geohazards Community of Practice of the Group on Earth Observations (GEO) with support from the European Science Foundation is preparing a white paper assessing the contemporary disaster risks associated with extreme geohazards and developing a vision for science and society to engage in deliberations addressing this risk (see http://www.geohazcop.org/projects/extgeowp). Risk awareness and monitoring is highly uneven across the world, and this creates two kinds of problems. Firstly, potential hazards are much more closely monitored in wealthy countries than in the developing world. But the largest hazards are global in nature, and it is critical to get as much forewarning as possible to develop an effective response. The disasters and near-misses of the past show that adherence to scientific

  12. Reducing Risk Behaviors Linked to Noncommunicable Diseases in Mongolia: A Randomized Controlled Trial

    PubMed Central

    Wang, Wei; Riedel, Marion; Witte, Susan S.

    2013-01-01

    Objectives. We tested the efficacy of a 6-session, evidence-based health promotion intervention aimed at reducing noncommunicable disease (NCD) risk behaviors. Methods. Two hundred male and female factory workers in Ulaanbaatar, Mongolia were randomly assigned to groups receiving either the health promotion intervention or a time-matched financial literacy control intervention. Results. The health promotion intervention increased daily fruit and vegetable intake and physical activity, increased readiness for NCD risk behavior reduction and health promotion knowledge, and reduced the number of daily alcoholic drinks and diabetes symptoms 3 months after the intervention. Conclusions. The findings support the efficacy of the intervention to reduce risk behaviors associated with NCDs. Dissemination of the intervention may improve productivity, reduce costs of health services, and better the quality of life for Mongolians. PMID:23865647

  13. Damage-reducing measures to manage flood risks in a changing climate

    NASA Astrophysics Data System (ADS)

    Kreibich, Heidi; Bubeck, Philip; Van Vliet, Mathijs; De Moel, Hans

    2014-05-01

    Damage due to floods has increased during the last few decades, and further increases are expected in several regions due to climate change and a growing vulnerability. To address the projected increase in flood risk, a combination of structural and non-structural flood risk mitigation measures is considered as a promising adaptation strategy. Such a combination takes into account that flood defence systems may fail, and prepare for unexpected crisis situations via land-use planning, building construction, evacuation and disaster response. Non-structural flood risk mitigation measures like shielding with water shutters or sand bags, building fortification or safeguarding of hazardous substances are often voluntary: they demand self-dependent action by the population at risk (Bubeck et al. 2012; 2013). It is believed that these measures are especially effective in areas with frequent flood events and low flood water levels, but some types of measures showed a significant damage-reducing effect also during extreme flood events, such as the Elbe River flood in August 2002 in Germany (Kreibich et al. 2005; 2011). Despite the growing importance of damage-reducing measures, information is still scarce about factors that motivate people to undertake such measures, the state of implementation of various non-structural measures in different countries and their damage reducing effects. Thus, we collected information and undertook an international review about this topic in the framework of the Dutch KfC project "Climate proof flood risk management". The contribution will present an overview about the available information on damage-reducing measures and draw conclusions for practical flood risk management in a changing climate. References: Bubeck, P., Botzen, W. J. W., Suu, L. T. T., Aerts, J. C. J. H. (2012): Do flood risk perceptions provide useful insights for flood risk management? Findings from central Vietnam. Journal of Flood Risk Management, 5, 4, 295-302 Bubeck, P

  14. THE USEPA'S METAL FINISHING FACILITY RISK SCREENING TOOL (MFFRST) AND POLLUTION PREVENTION TOOL (MFFP2T)

    EPA Science Inventory

    This presentation will provide an overview of the USEPA's Metal Finishing Facility Risk Screening Tool, including a discussion of the models used and outputs. The tool is currently being expanded to include pollution prevention considerations as part of the model. The current st...

  15. Pharmacist intervention reduces gastropathy risk in patients using NSAIDs.

    PubMed

    Ibañez-Cuevas, Victoria; Lopez-Briz, Eduardo; Guardiola-Chorro, M Teresa

    2008-12-01

    To establish a detection and intervention strategy in order to reduce the number of non-steroidal anti-inflammatory drug (NSAIDs) users at risk of gastropathy from receiving either inadequate or no gastroprotection. Community Pharmacies in Valencia, Spain. Prospective longitudinal intervention study without control group carried out by 79 Community Pharmacies. Patients over 18 who asked for any systemic NSAID were interviewed according to standard procedure. Pharmacist intervention was carried out when a patient at risk of serious NSAID-induced gastrointestinal complications due to inadequate or no gastric protection was identified. The doctor responsible was informed in order to then be able to assess the need to prescribe gastroprotection or change it if inadequate. In the case of over-the-counter (OTC) drugs, pharmacist intervention mainly involved replacing NSAIDs for safer medications. Firstly, the number of patients who had no prescribed gastroprotection or inadequate gastroprotection was determined. Pharmacist intervention then brought about changes in pharmacotherapy in this situation. Of the 6,965 patients who asked for NSAIDs during the study period, 3,054 (43.9%) presented NSAID gastropathy risk factors. 35.6% of the latter (1,089) were not prescribed gastroprotection or were prescribed inadequate gastroprotection. Pharmacist intervention was carried out in 1,075 of these cases. On 391 occasions such risk situations were reported to doctors, who accepted pharmacist intervention on 309 occasions (79.0%) and then either prescribed gastroprotection (77% of cases); changed it (13.9%); withdrew the NSAID (5.8%) or substituted it (3.2%). 235 Pharmacist interventions took place when dispensing OTC NSAIDs. Our strategy allowed us to identify a large number of patients who asked for NSAIDs in Community Pharmacies and who were at risk of NSAID gastropathy, as they received either inadequate gastroprotection or no gastroprotection whatsoever. Moreover, the

  16. Risk factors for Chlamydia among young women in a northern california juvenile detention facility: implications for community intervention.

    PubMed

    McDonnell, Diana D; Levy, Vivian; Morton, Theresa J M

    2009-02-01

    Chlamydia infections are increasing in California, with rates highest in young women aged 15 to 24. Juvenile detention facilities are important venues for screening high-risk youth who may not otherwise access care. We, therefore, sought to identify risk factors for urogenital chlamydia among young women in a county juvenile detention facility between 2002 and 2005. With the state Chlamydia Screening Project (ClaSP), young women booked into the county detention facility were offered urine-based screening for urogenital chlamydia. Demographics, sexual history, and behavioral risk factors were self-reported through questionnaires completed during specimen collection. Nine hundred and thirty-nine young women were screened for chlamydia. The 5% positivity rate remained steady over the 33-month study. Vaginal sex was reported by 82% of women, oral sex by 50%, and anal sex by 30%. Only 9% reporting anal sex always used condoms. In multivariate analysis, little distinguished those with urogenital chlamydia. Women from the southern region of the county (adjusted odds ratio, 3.5; 1.4-8.7) and surrounding urban centers (3.7; 1.2-11.4) had higher odds of infection, as did those with 2 to 3 lifetime partners (3.2; 1.2-8.2)-although there was no linear relationship between partner number and infection. Those who had been in drug/alcohol treatment had lower odds of infection (0.1; 0.01-0.6). Our findings support universal chlamydia testing of young women detainees. The high prevalence of unprotected anal sex highlights an important modifiable HIV risk behavior in these adolescents. Risk factors reported here should inform the integration of prevention and treatment services in correctional settings and substance abuse treatment centers.

  17. Sustainable Survival for adolescents living with HIV: do SDG-aligned provisions reduce potential mortality risk?

    PubMed

    Cluver, Lucie; Pantelic, Marija; Orkin, Mark; Toska, Elona; Medley, Sally; Sherr, Lorraine

    2018-02-01

    The Sustainable Development Goals (SDGs) present a groundbreaking global development agenda to protect the most vulnerable. Adolescents living with HIV in Sub-Saharan Africa continue to experience extreme health vulnerabilities, but we know little about the impacts of SDG-aligned provisions on their health. This study tests associations of provisions aligned with five SDGs with potential mortality risks. Clinical and interview data were gathered from N = 1060 adolescents living with HIV in rural and urban South Africa in 2014 to 2015. All ART-initiated adolescents from 53 government health facilities were identified, and traced in their communities to include those defaulting and lost-to-follow-up. Potential mortality risk was assessed as either: viral suppression failure (1000+ copies/ml) using patient file records, or adolescent self-report of diagnosed but untreated tuberculosis or symptomatic pulmonary tuberculosis. SDG-aligned provisions were measured through adolescent interviews. Provisions aligned with SDGs 1&2 (no poverty and zero hunger) were operationalized as access to basic necessities, social protection and food security; An SDG 3-aligned provision (ensure healthy lives) was having a healthy primary caregiver; An SDG 8-aligned provision (employment for all) was employment of a household member; An SDG 16-aligned provision (protection from violence) was protection from physical, sexual or emotional abuse. Research partners included the South African national government, UNICEF and Pediatric and Adolescent Treatment for Africa. 20.8% of adolescents living with HIV had potential mortality risk - i.e. viral suppression failure, symptomatic untreated TB, or both. All SDG-aligned provisions were significantly associated with reduced potential mortality risk: SDG 1&2 (OR 0.599 CI 0.361 to 0.994); SDG 3 (OR 0.577 CI 0.411 to 0.808); SDG 8 (OR 0.602 CI 0.440 to 0.823) and SDG 16 (OR 0.686 CI 0.505 to 0.933). Access to multiple SDG-aligned provisions showed a

  18. Active fans and grizzly bears: Reducing risks for wilderness campers

    NASA Astrophysics Data System (ADS)

    Sakals, M. E.; Wilford, D. J.; Wellwood, D. W.; MacDougall, S. A.

    2010-03-01

    Active geomorphic fans experience debris flows, debris floods and/or floods (hydrogeomorphic processes) that can be hazards to humans. Grizzly bears ( Ursus arctos) can also be a hazard to humans. This paper presents the results of a cross-disciplinary study that analyzed both hydrogeomorphic and grizzly bear hazards to wilderness campers on geomorphic fans along a popular hiking trail in Kluane National Park and Reserve in southwestern Yukon Territory, Canada. Based on the results, a method is proposed to reduce the risks to campers associated with camping on fans. The method includes both landscape and site scales and is based on easily understood and readily available information regarding weather, vegetation, stream bank conditions, and bear ecology and behaviour. Educating wilderness campers and providing a method of decision-making to reduce risk supports Parks Canada's public safety program; a program based on the principle of user self-sufficiency. Reducing grizzly bear-human conflicts complements the efforts of Parks Canada to ensure a healthy grizzly bear population.

  19. Reducing Metabolic Syndrome Risk Using a Personalized Wellness Program.

    PubMed

    Steinberg, Gregory; Scott, Adam; Honcz, Joseph; Spettell, Claire; Pradhan, Susil

    2015-12-01

    The aim of this study was to determine the impact of a targeted, personalized wellness program on reducing employees' future risk of metabolic syndrome. Aetna piloted a year-long program that included a limited genetic profile, a traditional psychosocial assessment, and high-intensity coaching in a randomized controlled study of Aetna employees with an increased risk for metabolic syndrome. Sustained employee engagement of 50% over the course of 1 year; 76% of participating employees lost an average of 10 pounds (4.5 kg) (P < 0.001 vs baseline weight), and there were trends in improved clinical outcomes relative to three of five metabolic factors. Average health care costs were reduced by $122 per participant per month, resulting in a positive return on investment in the program's first year. At scale, such programs would be expected to lead to significant downstream reduction in major clinical events and costs.

  20. A surety engineering framework to reduce cognitive systems risks.

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

    Caudell, Thomas P.; Peercy, David Eugene; Caldera, Eva O.

    Cognitive science research investigates the advancement of human cognition and neuroscience capabilities. Addressing risks associated with these advancements can counter potential program failures, legal and ethical issues, constraints to scientific research, and product vulnerabilities. Survey results, focus group discussions, cognitive science experts, and surety researchers concur technical risks exist that could impact cognitive science research in areas such as medicine, privacy, human enhancement, law and policy, military applications, and national security (SAND2006-6895). This SAND report documents a surety engineering framework and a process for identifying cognitive system technical, ethical, legal and societal risks and applying appropriate surety methods to reducemore » such risks. The framework consists of several models: Specification, Design, Evaluation, Risk, and Maturity. Two detailed case studies are included to illustrate the use of the process and framework. Several Appendices provide detailed information on existing cognitive system architectures; ethical, legal, and societal risk research; surety methods and technologies; and educing information research with a case study vignette. The process and framework provide a model for how cognitive systems research and full-scale product development can apply surety engineering to reduce perceived and actual risks.« less

  1. Education to reduce potentially harmful medication use among residents of assisted living facilities: a randomized controlled trial.

    PubMed

    Pitkälä, Kaisu H; Juola, Anna-Liisa; Kautiainen, Hannu; Soini, Helena; Finne-Soveri, U Harriet; Bell, J Simon; Björkman, Mikko

    2014-12-01

    The objectives of this study were (1) to investigate the effect of nurse training on the use of potentially harmful medications; and (2) to explore the effect of nurse training on residents' health-related quality of life (HRQoL), health service utilization, and mortality. A randomized controlled trial. In total, 227 residents in 20 wards of assisted living facilities in Helsinki were recruited. The 20 wards were randomized into those in which (1) staff received two 4-hour training sessions on appropriate medication treatment (intervention group), and (2) staff received no additional training and continued to provide routine care (control group). Two 4-hour interactive training sessions for nursing staff based on constructive learning theory to recognize potentially harmful medications and corresponding adverse drug events. Use of potentially harmful medications, HRQoL assessed using the 15 dimensional instrument of health-related quality of life, health service utilization, and mortality assessed at baseline, and 6 and 12 months. During the 12-month follow-up, the mean number of potentially harmful medications decreased in the intervention wards [-0.43, 95% confidence interval (CI) -0.71 to -0.15] but remained constant in the control wards (+0.11, 95% CI -0.09 to +0.31) (P = .004, adjusted for age, sex, and comorbidities). HRQoL declined more slowly in the intervention wards (-0.038 (95% CI -0.054 to -0.022) than in the control wards (-0.072 (95% CI -0.089 to -0.055) (P = .005, adjusted for age, sex, and comorbidities). Residents of the intervention wards had significantly less hospital days (1.4 days/person/year, 95% CI 1.2-1.6) than in the control wards (2.3 days/person/year; 95% CI 2.1-2.7) (relative risk 0.60, 95% CI 0.49-0.75, P < .001, adjusted for age, sex, and comorbidities). Activating learning methods directed at nurses in charge of comprehensive care can reduce the use of harmful medications, maintain HRQoL, and reduce hospitalization in residents of

  2. Strontium ranelate reduces the risk of vertebral fractures in patients with osteopenia.

    PubMed

    Seeman, Ego; Devogelaer, Jean-Pierre; Lorenc, Roman; Spector, Timothy; Brixen, Kim; Balogh, Adam; Stucki, Gerold; Reginster, Jean-Yves

    2008-03-01

    Many fractures occur in women with moderate fracture risk caused by osteopenia. Strontium ranelate was studied in 1431 postmenopausal women with osteopenia. Vertebral fracture risk reduction of 41-59% was shown depending on the site and fracture status at baseline. This is the first report of antivertebral fracture efficacy in women with vertebral osteopenia. Women with osteoporosis are at high risk for fracture. However, more than one half of all fractures in the community originate from the larger population at more moderate risk of fracture caused by osteopenia. Despite this, evidence for antifracture efficacy in these persons is limited. The aim of this study was to determine whether strontium ranelate, a new drug that reduces fracture risk in women with osteoporosis, is also effective in women with osteopenia. Data from the Spinal Osteoporosis Therapeutic Intervention study (SOTI; n = 1649) and the TReatment Of Peripheral OSteoporosis (TROPOS; n = 5091) were pooled to evaluate the antivertebral fracture efficacy of strontium ranelate in women with lumbar spine (LS) osteopenia with any BMD value at the femoral neck (FN; N = 1166) and in 265 women with osteopenia at both sites (intention-to-treat analysis). The women were randomized to strontium ranelate 2 g/d orally or placebo for 3 yr. No group differences were present in baseline characteristics that may influence fracture outcome independent of therapy. In women with LS osteopenia, treatment reduced the risk of vertebral fracture by 41% (RR = 0.59; 95% CI, 0.43-0.82), by 59% (RR = 0.41; 95% CI, 0.17-0.99) in the 447 patients with no prevalent fractures, and by 38% (RR = 0.62; 95% CI, 0.44-0.88) in the 719 patients with prevalent fractures. In women with osteopenia at both sites, treatment reduced the risk of fracture by 52% (RR = 0.48; 95% CI, 0.24-0.96). Strontium ranelate safely reduces the risk of vertebral fractures in women with osteopenia with or without a prevalent fracture.

  3. An Approach to Reducing Risk through School System Intervention.

    ERIC Educational Resources Information Center

    Gottfredson, Gary D.; Gottfredson, Denise C.

    This paper provides school district administrators with a structured method for developing school programs aimed at reducing the risk of adolescent dropout. The methodology encompasses problem definition, fact finding, mission management, overcoming inertia, cohering programs tied to theory, feasible goal-setting, and normative personnel…

  4. Enhanced preventive programme at a beryllium oxide ceramics facility reduces beryllium sensitisation among new workers

    PubMed Central

    Cummings, Kristin J; Deubner, David C; Day, Gregory A; Henneberger, Paul K; Kitt, Margaret M; Kent, Michael S; Kreiss, Kathleen; Schuler, Christine R

    2007-01-01

    Background A 1998 survey at a beryllium oxide ceramics manufacturing facility found that 10% of workers hired in the previous 6 years had beryllium sensitisation as determined by the beryllium lymphocyte proliferation test (BeLPT). In response, the facility implemented an enhanced preventive programme to reduce sensitisation, including increased respiratory and dermal protection and particle migration control. Aim To assess the programme's effectiveness in preventing sensitisation. Methods In 2000, the facility began testing newly hired workers for beryllium sensitisation with the BeLPT at time of hire and during employment. The sensitisation rate and prevalence for workers hired from 2000 to 2004 were compared with that for workers hired from 1993 to 1998, who were tested in the 1998 survey. Facility environmental conditions for both time periods were evaluated. Results Newly hired workers in both cohorts worked for a mean of 16 months. Of the 97 workers hired from 2000 to 2004 with at least one employment BeLPT result, four had abnormal results at time of hire and one became sensitised during employment. Of the 69 workers hired from 1993 to 1998 and tested in 1998, six were found to be sensitised. The sensitisation rate for the 2000–4 workers was 0.7–2.7/1000 person‐months of employment, and that for the 1993–8 workers was 5.6/1000 person‐months, at least 2.1 (95% confidence interval (CI) 0.6 to 8.4) and up to 8.2 (95% CI 1.2 to 188.8) times higher than that for the 2000–4 workers. The sensitisation prevalence for the 2000–4 workers was 1% and that for the 1993–8 workers was 8.7%, 8.4 (95% CI 1.04 to 68.49) times higher than that for the 2000–4 workers. Airborne beryllium levels for production workers for the two time periods were similar. Conclusions A comprehensive preventive programme reduced beryllium sensitisation in new workers during the first years of employment, despite airborne beryllium levels for production workers that were

  5. Risk management at the stage of design of high-rise construction facilities

    NASA Astrophysics Data System (ADS)

    Politi, Violetta

    2018-03-01

    This paper describes the assessment of the probabilistic risk of an accident formed in the process of designing a technically complex facility. It considers values of conditional probabilities of the compliance of load-bearing structures with safety requirements, provides an approximate list of significant errors of the designer and analyzes the relationship between the degree of compliance and the level of danger of errors. It describes and proposes for implementation the regulated procedures related to the assessment of the safety level of constructive solutions and the reliability of the construction process participants.

  6. The importance of public sector health facility-level data for monitoring changes in maternal mortality risks among communities: the case of pakistan.

    PubMed

    Jain, Anrudh K; Sathar, Zeba; Salim, Momina; Shah, Zakir Hussain

    2013-09-01

    This paper illustrates the importance of monitoring health facility-level information to monitor changes in maternal mortality risks. The annual facility-level maternal mortality ratios (MMRs), complications to live births ratios and case fatality ratios (CFRs) were computed from data recorded during 2007 and 2009 in 31 upgraded public sector health facilities across Pakistan. The facility-level MMR declined by about 18%; both the number of Caesarean sections and the episodes of complications as a percentage of live births increased; and CFR based on Caesarean sections and episodes of complications declined by 29% and 37%, respectively. The observed increases in the proportion of women with complications among those who come to these facilities point to a reduction in the delay in reaching facilities (first and second delays; Thaddeus & Maine, 1994); the decrease in CFRs points to improvements in treating obstetric complications and a reduction in the delay in receiving treatment once at facilities (the third delay). These findings point to a decline in maternal mortality risks among communities served by these facilities. A system of woman-level data collection instituted at health facilities with comprehensive emergency obstetric care is essential to monitor changes in the effects of any reduction in the three delays and any improvement in quality of care or the effectiveness of treating pregnancy-related complications among women reaching these facilities. Such a system of information gathering at these health facilities would also help policymakers and programme mangers to measure and improve the effectiveness of safe-motherhood initiatives and to monitor progress being made toward achieving the fifth Millennium Development Goal.

  7. Characterization of exposure to silver nanoparticles in a manufacturing facility

    NASA Astrophysics Data System (ADS)

    Park, Junsu; Kwak, Byoung Kyu; Bae, Eunjoo; Lee, Jeongjin; Kim, Younghun; Choi, Kyunghee; Yi, Jongheop

    2009-10-01

    An assessment of the extent of exposure to nanomaterials in the workplace will be helpful in improving the occupational safety of workers. It is essential that the exposure data in the workplace are concerned with risk management to evaluate and reduce worker exposure. In a manufacturing facility dealing with nanomaterials, some exposure data for gas-phase reactions are available, but much less information is available regarding liquid-phase reactions. Although the potential for inhaling nanomaterials in a liquid-phase process is less than that for gas-phase, the risks of exposure during wet-chemistry processes are not negligible. In this study, we monitored and analyzed the exposure characteristics of silver nanoparticles during a liquid-phase process in a commercial production facility. Based on the measured exposure data, the source of Ag nanoparticles emitted during the production processes was indentified and a mechanism for the growth of Ag nanoparticle released is proposed. The data reported in this study could be used to establish occupational safety guidelines in the nanotechnology workplace, especially in a liquid-phase production facility.

  8. Computer Security: Improvements Needed to Reduce Risk to Critical Federal Operations and Assets

    DTIC Science & Technology

    2001-11-09

    COMPUTER SECURITY Improvements Needed to Reduce Risk to Critical Federal Operations and Assets Statement of Robert F. Dacey Director, Information...Improvements Needed to Reduce Risk to Critical Federal Operations and Assets Contract Number Grant Number Program Element Number Author(s...The benefits have been enormous. Vast amounts of information are now literally at our fingertips, facilitating research on virtually every topic

  9. The Potential Role of Tree Diversity in Reducing Shallow Landslide Risk.

    PubMed

    Kobayashi, Yuta; Mori, Akira S

    2017-05-01

    Recently, interest in utilizing ecosystems for disaster risk reduction has increased, even though there remains considerable uncertainty regarding the role of ecosystems in buffering against natural hazards. This ecosystem role can be considered an ecosystem service. Although a strong body of evidence shows that biodiversity enhances ecosystem services, there are only a few studies of the relationship between biodiversity and the role of the ecosystem in reducing the risk of natural disasters. To explore the desired state of an ecosystem for disaster risk reduction we applied the finding that biodiversity enhances ecosystem services to evaluate the role of woody vegetation in reducing the frequency and severity of shallow landslides. Using information related to shallow landslides and woody vegetation in Japan as a case study, we compared the severity of shallow landslides (i.e., landslide volume) with tree species richness. Although we provide no direct evidence that tree species richness reduces shallow landslide volume, we found that the predictability of the model, which evaluated relationships between landslide volume and environmental variables in watersheds throughout the Japanese Archipelago, increased with tree species richness. This finding suggests that biodiversity is likely associated with shallow landslide risk reduction, emphasizing a possible reduction of spatial and temporal uncertainty in the roles of woody vegetation. Our study identifies a need for socioecological systems to build new approaches found on the functionality of such ecosystems.

  10. Combat Casualties and Severe Shock: Risk Factors for Death at Role 3 Military Facilities.

    PubMed

    Buehner, Michelle F; Eastridge, Brian J; Aden, James K; DuBose, Joseph J; Blackbourne, Lorne H; Cestero, Ramon F

    2017-09-01

    Although significant research has been conducted on combat casualties receiving blood products, there is limited data for the subpopulation presenting in shock. The purpose of this study was to evaluate combat casualties arriving to a role 3 facility with an initial systolic blood pressure (SBP) ≤ 90 in order to identify clinical characteristics and associations between presentation, transfusion therapy, and mortality outcomes. The Department of Defense Trauma Registry was queried from 2001 to 2010 for trauma-related casualties who arrived at a role 3 combat surgical facility with a SBP ≤ 90. Transfers from role 2 facilities were excluded. Data captured included demographics, admission vital signs, laboratory values, blood products, and mortality. Relationships between admission physiology, blood product utilization, and mortality were developed. Independent associations between variables were determined by logistic regression analysis. 1,703 patients were identified who met our inclusion criteria and composite mortality was 23%. Mortality in those receiving a balanced transfusion ratio was 18% versus 27% (p < 0.0001). Hypotensive casualties who survived were significantly more likely to have a higher presenting Glasgow Coma Score (GCS), temperature, SBP, shock index, and pH. In addition, this group was also more likely to have a lower international normalized ratio, pCO2, and base deficit (p < 0.001). Age, heart rate, and pulse pressure were not significantly different between groups. Independent predictors of mortality included Injury Severity Score, presentation GCS, and initial pH value (p < 0.0001). In contrast, independent predictors of survival included those with above-knee amputation and a balanced transfusion (p < 0.0001). Combat casualties hypotensive on arrival to surgical facilities have a significant expected mortality. Those receiving balanced transfusions demonstrated improved survival. Of the five independent risk factors, pH, GCS, and the

  11. LLRW disposal facility siting approaches: Connecticut`s innovative volunteer approach

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

    Forcella, D.; Gingerich, R.E.; Holeman, G.R.

    1994-12-31

    The Connecticut Hazardous Waste Management Service (CHWMS) has embarked on a volunteer approach to siting a LLRW disposal facility in Connecticut. This effort comes after an unsuccessful effort to site a facility using a step-wise, criteria-based site screening process that was a classic example of the decide/announce/defend approach. While some of the specific features of the CHWMS` volunteer process reflect the unique challenge presented by the state`s physical characteristics, political structure and recent unsuccessful siting experience, the basic elements of the process are applicable to siting LLRW disposal facilities in many parts of the United States. The CHWMS` volunteer processmore » is structured to reduce the {open_quotes}outrage{close_quotes} dimension of two of the variables that affect the public`s perception of risk. The two variables are the degree to which the risk is taken on voluntarily (voluntary risks are accepted more readily than those that are imposed) and the amount of control one has over the risk (risks under individual control are accepted more readily than those under government control). In the volunteer process, the CHWMS will only consider sites that have been been voluntarily offered by the community in which they are located and the CHWMS will share control over the development and operation of the facility with the community. In addition to these elements which have broad applicability, the CHWMS has tailored the volunteer approach to take advantage of the unique opportunities made possible by the earlier statewide site screening process. Specifically, the approach presents a {open_quotes}win-win{close_quotes} situation for elected officials in many communities if they decide to participate in the process.« less

  12. Facility-level association of preoperative stress testing and postoperative adverse cardiac events.

    PubMed

    Valle, Javier A; Graham, Laura; Thiruvoipati, Thejasvi; Grunwald, Gary; Armstrong, Ehrin J; Maddox, Thomas M; Hawn, Mary T; Bradley, Steven M

    2018-06-22

    Despite limited indications, preoperative stress testing is often used prior to non-cardiac surgery. Patient-level analyses of stress testing and outcomes are limited by case mix and selection bias. Therefore, we sought to describe facility-level rates of preoperative stress testing for non-cardiac surgery, and to determine the association between facility-level preoperative stress testing and postoperative major adverse cardiac events (MACE). We identified patients undergoing non-cardiac surgery within 2 years of percutaneous coronary intervention in the Veterans Affairs (VA) Health Care System, from 2004 to 2011, facility-level rates of preoperative stress testing and postoperative MACE (death, myocardial infarction (MI) or revascularisation within 30 days). We determined risk-standardised facility-level rates of stress testing and postoperative MACE, and the relationship between facility-level preoperative stress testing and postoperative MACE. Among 29 937 patients undergoing non-cardiac surgery at 131 VA facilities, the median facility rate of preoperative stress testing was 13.2% (IQR 9.7%-15.9%; range 6.0%-21.5%), and 30-day postoperative MACE was 4.0% (IQR 2.4%-5.4%). After risk standardisation, the median facility-level rate of stress testing was 12.7% (IQR 8.4%-17.4%) and postoperative MACE was 3.8% (IQR 2.3%-5.6%). There was no correlation between risk-standardised stress testing and composite MACE at the facility level (r=0.022, p=0.81), or with individual outcomes of death, MI or revascularisation. In a national cohort of veterans undergoing non-cardiac surgery, we observed substantial variation in facility-level rates of preoperative stress testing. Facilities with higher rates of preoperative stress testing were not associated with better postoperative outcomes. These findings suggest an opportunity to reduce variation in preoperative stress testing without sacrificing patient outcomes. © Article author(s) (or their employer(s) unless otherwise

  13. PGD to reduce reproductive risk: the case of mitochondrial DNA disorders.

    PubMed

    Bredenoord, A L; Dondorp, W; Pennings, G; De Die-Smulders, C E M; De Wert, G

    2008-11-01

    This paper discusses the pros and cons of introducing PGD for mitochondrial DNA (mtDNA) disorders such as NARP (Neurogenic muscle weakness, Ataxia, Retinis Pigmentosa)/Leigh, MELAS (Mitochondrial myopathy, Encephalopathy, Lactic acidosis, and Stroke-like episodes), private mtDNA mutations and LHON (Leber Hereditary Optic Neuropathy). Although there is little experience with PGD for mtDNA disorders, it is reasonable to assume that in many cases, the best one can achieve is the selection of the 'least' affected embryos for transfer. So instead of 'promising' parents a healthy child, PGD in these cases can only aim at reducing reproductive risk. From an ethical point of view, this raises challenging questions about parental and medical responsibilities. The main argument in favour of PGD is that it offers couples at risk the opportunity of reducing their chances of having a severely affected child. Potential objections are manifold, but we conclude that none of them supplies convincing moral arguments to regard risk-reducing PGD as unacceptable. Nevertheless, introducing this new application of PGD in clinical practice will raise further complex issues of determining conditions for its responsible use.

  14. Recirculating Air Filtration Significantly Reduces Exposure to Airborne Nanoparticles

    PubMed Central

    Pui, David Y.H.; Qi, Chaolong; Stanley, Nick; Oberdörster, Günter; Maynard, Andrew

    2008-01-01

    Background Airborne nanoparticles from vehicle emissions have been associated with adverse effects in people with pulmonary and cardiovascular disease, and toxicologic studies have shown that nanoparticles can be more hazardous than their larger-scale counterparts. Recirculating air filtration in automobiles and houses may provide a low-cost solution to reducing exposures in many cases, thus reducing possible health risks. Objectives We investigated the effectiveness of recirculating air filtration on reducing exposure to incidental and intentionally produced airborne nanoparticles under two scenarios while driving in traffic, and while generating nanomaterials using gas-phase synthesis. Methods We tested the recirculating air filtration in two commercial vehicles when driving in traffic, as well as in a nonventilation room with a nanoparticle generator, simulating a nanomaterial production facility. We also measured the time-resolved aerosol size distribution during the in-car recirculation to investigate how recirculating air filtration affects particles of different sizes. We developed a recirculation model to describe the aerosol concentration change during recirculation. Results The use of inexpensive, low-efficiency filters in recirculation systems is shown to reduce nanoparticle concentrations to below levels found in a typical office within 3 min while driving through heavy traffic, and within 20 min in a simulated nanomaterial production facility. Conclusions Development and application of this technology could lead to significant reductions in airborne nanoparticle exposure, reducing possible risks to health and providing solutions for generating nanomaterials safely. PMID:18629306

  15. Outcome after reduced chemotherapy for intermediate-risk neuroblastoma.

    PubMed

    Baker, David L; Schmidt, Mary L; Cohn, Susan L; Maris, John M; London, Wendy B; Buxton, Allen; Stram, Daniel; Castleberry, Robert P; Shimada, Hiroyuki; Sandler, Anthony; Shamberger, Robert C; Look, A Thomas; Reynolds, C Patrick; Seeger, Robert C; Matthay, Katherine K

    2010-09-30

    The survival rate among patients with intermediate-risk neuroblastoma who receive dose-intensive chemotherapy is excellent, but the survival rate among patients who receive reduced doses of chemotherapy for shorter periods of time is not known. We conducted a prospective, phase 3, nonrandomized trial to determine whether a 3-year estimated overall survival of more than 90% could be maintained with reductions in the duration of therapy and drug doses, using a tumor biology-based therapy assignment. Eligible patients had newly diagnosed, intermediate-risk neuroblastoma without MYCN amplification; these patients included infants (<365 days of age) who had stage 3 or 4 disease, children (≥365 days of age) who had stage 3 tumors with favorable histopathological features, and infants who had stage 4S disease with a diploid DNA index or unfavorable histopathological features. Patients who had disease with favorable histopathological features and hyperdiploidy were assigned to four cycles of chemotherapy, and those with an incomplete response or either unfavorable feature were assigned to eight cycles. Between 1997 and 2005, a total of 479 eligible patients were enrolled in this trial (270 patients with stage 3 disease, 178 with stage 4 disease, and 31 with stage 4S disease). A total of 323 patients had tumors with favorable biologic features, and 141 had tumors with unfavorable biologic features. Ploidy, but not histopathological features, was significantly predictive of the outcome. Severe adverse events without disease progression occurred in 10 patients (2.1%), including secondary leukemia (in 3 patients), death from infection (in 3 patients), and death at surgery (in 4 patients). The 3-year estimate (±SE) of overall survival for the entire group was 96±1%, with an overall survival rate of 98±1% among patients who had tumors with favorable biologic features and 93±2% among patients who had tumors with unfavorable biologic features. A very high rate of survival

  16. Reduced Incidence of Invasive Breast Cancer With Raloxifene Among Women at Increased Coronary Risk

    PubMed Central

    Grady, Deborah; Cauley, Jane A.; Geiger, Mary Jane; Kornitzer, Marcel; Mosca, Lori; Collins, Peter; Wenger, Nanette K.; Song, Jingli; Mershon, John; Barrett-Connor, Elizabeth

    2013-01-01

    Background In the Raloxifene Use for The Heart trial, 10 101 postmenopausal women with coronary heart disease (CHD) or multiple CHD risk factors were randomly assigned to 60 mg/d raloxifene or to placebo and followed for a median of 5.6 years. Raloxifene, a selective estrogen receptor modulator, was found to reduce the risk of invasive breast cancer and vertebral fractures but not the risk of cardiovascular events. Here, we provide further details about breast cancer incidence by tumor characteristics, duration of treatment, and subgroup. Methods Reported breast cancer was adjudicated by an independent committee based on medical records and pathology reports. The primary analyses used Cox proportional hazards models with time to first breast cancer as the outcome. Subgroup effects were analyzed using similar models with terms for treatment by subgroup. All statistical tests were two-sided. Results As previously reported, raloxifene reduced the incidence of invasive breast cancer by 44% (hazard ratio [HR] = 0.56; 95% confidence interval [CI] = 0.38 to 0.83; absolute risk reduction = 1.2 invasive breast cancers per 1000 women treated for 1 year). The lower incidence of invasive breast cancer reflected a 55% lower incidence of invasive estrogen receptor (ER)–positive tumors (HR = 0.45; 95% CI = 0.28 to 0.72). However, raloxifene treatment did not reduce the incidence of noninvasive breast cancer or of invasive ER-negative breast cancer. The reduced incidence of invasive breast cancer was similar across subgroups, including those defined by age, body mass index, family history of breast cancer, prior use of postmenopausal hormones, and 5-year estimated risk of invasive breast cancer. Conclusion Raloxifene reduces risk of invasive ER-positive breast cancer regardless of a woman's baseline breast cancer risk but does not reduce risk of noninvasive or ER-negative breast cancers. These results confirm those of the Multiple Outcomes of Raloxifene Evaluation, a previous

  17. Coffee consumption and reduced risk of hepatocellular carcinoma: findings from the Singapore Chinese Health Study

    PubMed Central

    Johnson, Shane; Koh, Woon-Puay; Wang, Renwei; Govindarajan, Sugantha; Yu, Mimi C.

    2012-01-01

    Background Coffee consumption has been associated with reduced markers of hepatic cell damage, reduced risk of chronic liver disease, and cirrhosis across a variety of populations. Data on the association between coffee consumption and risk of hepatocellular carcinoma (HCC), especially in high-risk populations, are sparse. Methods This study examines the relationship between coffee and caffeine consumption, and the risk of developing HCC within the Singapore Chinese Health Study, a prospective cohort of 63,257 middle-aged and older Chinese men and women, a relatively high-risk population for HCC. Baseline data on coffee consumption and other dietary and lifestyle factors were collected through inperson interviews at enrollment between 1993 and 1998. Results As of 31 December 2006, 362 cohort participants had developed HCC. High levels of coffee or caffeine consumption were associated with reduced risk of HCC (p for trend < 0.05). Compared with non-drinkers of coffee, individuals who consumed three or more cups of coffee per day experienced a statistically significant 44% reduction in risk of HCC (hazard ratio 0.56, 95% confidence interval, 0.31–1.00, p = .049) after adjustment for potential confounders and tea consumption. Conclusion These data suggest that coffee consumption may reduce the risk of developing HCC in Chinese in Singapore. PMID:21258859

  18. Coffee consumption and reduced risk of hepatocellular carcinoma: findings from the Singapore Chinese Health Study.

    PubMed

    Johnson, Shane; Koh, Woon-Puay; Wang, Renwei; Govindarajan, Sugantha; Yu, Mimi C; Yuan, Jian-Min

    2011-03-01

    Coffee consumption has been associated with reduced markers of hepatic cell damage, reduced risk of chronic liver disease, and cirrhosis across a variety of populations. Data on the association between coffee consumption and risk of hepatocellular carcinoma (HCC), especially in high-risk populations, are sparse. This study examines the relationship between coffee and caffeine consumption, and the risk of developing HCC within the Singapore Chinese Health Study, a prospective cohort of 63,257 middle-aged and older Chinese men and women, a relatively high-risk population for HCC. Baseline data on coffee consumption and other dietary and lifestyle factors were collected through in-person interviews at enrollment between 1993 and 1998. As of 31 December 2006, 362 cohort participants had developed HCC. High levels of coffee or caffeine consumption were associated with reduced risk of HCC (p for trend < 0.05). Compared with non-drinkers of coffee, individuals who consumed three or more cups of coffee per day experienced a statistically significant 44% reduction in risk of HCC (hazard ratio 0.56, 95% confidence interval, 0.31-1.00, p = .049) after adjustment for potential confounders and tea consumption. These data suggest that coffee consumption may reduce the risk of developing HCC in Chinese in Singapore.

  19. Can the Gila River reduce risk in the Colorado River Basin?

    NASA Astrophysics Data System (ADS)

    Wade, L. C.; Rajagopalan, B.; Lukas, J.; Kanzer, D.

    2012-12-01

    The Colorado River is the most important source of water in the southwest United States and Northern Mexico, providing water to approximately 35 million people and 4-5 million acres of irrigated lands. To manage the water resources of the basin, estimated to be about 17 million acre-feet (MAF) of undepleted supplies per year, managers use reservoir facilities that can store more than 60 MAF. As the demands on the water resources of the basin approach or exceed the average annual supply, and with average flow projected to decrease due to climate change, smart water management is vital for its sustainability. To quantify the future risk of depleting reservoir storage, Rajagopalan et al. (2009) developed a water-balance model and ran it under scenarios based on historical, paleo-reconstructed and future projections of flows, and different management alternatives. That study did not consider the impact of the Gila River, which enters the Colorado River below all major reservoirs and U.S. diversions. Due to intensive use in Central Arizona, the Gila only has significant inflows to the Colorado in wet years. However, these irregular inflows could beneficially influence system reliability in the US by helping to meet a portion of the 1.5 MAF delivery obligations to Mexico. To help quantify the potential system reliability benefit of the Gila River, we modify the Rajagopalan et al (2009) model to incorporate simulated Gila River inflows. These new data inputs to the water balance model are based on historical flows and tree-ring reconstructions of flow in the Upper Colorado River Basin (at Lee's Ferry), the Lower Colorado River Basin (tributary inflows), and the intermittent flows from the Gila River which are generated using extreme value analysis methods. Incorporating Gila River inflows, although they are highly variable and intermittent, reduces the modeled cumulative risk of reservoir depletion by 4 to 11% by 2057, depending on the demand schedule, reservoir operation

  20. [Estimation of cost-saving for reducing radioactive waste from nuclear medicine facilities by implementing decay in storage (DIS) in Japan].

    PubMed

    Kida, Tetsuo; Hiraki, Hitoshi; Yamaguchi, Ichirou; Fujibuchi, Toshioh; Watanabe, Hiroshi

    2012-01-01

    DIS has not yet been implemented in Japan as of 2011. Therefore, even if risk was negligible, medical institutions have to entrust radioactive temporal waste disposal to Japan Radio Isotopes Association (JRIA) in the current situation. To decide whether DIS should be implemented in Japan or not, cost-saving effect of DIS was estimated by comparing the cost that nuclear medical facilities pay. By implementing DIS, the total annual cost for all nuclear medical facilities in Japan is estimated to be decreased to 30 million yen or less from 710 million yen. DIS would save 680 million yen (96%) per year.

  1. The Role of Hedonic Behavior in Reducing Perceived Risk

    PubMed Central

    Jia, Jayson S.; Jia, Jianmin; Hsee, Christopher K.; Shiv, Baba

    2016-01-01

    Understanding how human populations naturally respond to and cope with risk is important for fields ranging from psychology to public health. We used geophysical and individual-level mobile-phone data (mobile-apps, telecommunications, and Web usage) of 157,358 victims of the 2013 Ya’an earthquake to diagnose the effects of the disaster and investigate how experiencing real risk (at different levels of intensity) changes behavior. Rather than limiting human activity, higher earthquake intensity resulted in graded increases in usage of communications apps (e.g., social networking, messaging), functional apps (e.g., informational tools), and hedonic apps (e.g., music, videos, games). Combining mobile data with a field survey (N = 2,000) completed 1 week after the earthquake, we use an instrumental-variable approach to show that only increases in hedonic behavior reduced perceived risk. Thus, hedonic behavior could potentially serve as a population-scale coping and recovery strategy that is often missing in risk management and policy considerations. PMID:27881710

  2. The Role of Hedonic Behavior in Reducing Perceived Risk.

    PubMed

    Jia, Jayson S; Jia, Jianmin; Hsee, Christopher K; Shiv, Baba

    2017-01-01

    Understanding how human populations naturally respond to and cope with risk is important for fields ranging from psychology to public health. We used geophysical and individual-level mobile-phone data (mobile-apps, telecommunications, and Web usage) of 157,358 victims of the 2013 Ya'an earthquake to diagnose the effects of the disaster and investigate how experiencing real risk (at different levels of intensity) changes behavior. Rather than limiting human activity, higher earthquake intensity resulted in graded increases in usage of communications apps (e.g., social networking, messaging), functional apps (e.g., informational tools), and hedonic apps (e.g., music, videos, games). Combining mobile data with a field survey ( N = 2,000) completed 1 week after the earthquake, we use an instrumental-variable approach to show that only increases in hedonic behavior reduced perceived risk. Thus, hedonic behavior could potentially serve as a population-scale coping and recovery strategy that is often missing in risk management and policy considerations.

  3. Reducing Homicide Risk in Indianapolis between 1997 and 2000

    PubMed Central

    McGarrell, Edmund F.

    2010-01-01

    Rates of homicide risk are not evenly distributed across the US population. Prior research indicates that young males in disadvantaged urban neighborhoods are particularly vulnerable to lethal violence. The traditional criminal justice response to violent crime in the urban context has the potential to exacerbate problems, particularly when broad-based arrest sweeps and general deterrence initiatives are the standard models used by law enforcement. Recent studies suggest that alternative intervention approaches that use both specific deterrence combined with improving pro-social opportunities has shown promise in reducing violent crime in these high-risk contexts. This paper examines the changes in homicide patterns for the highest-risk populations in Indianapolis after a “pulling levers” intervention was implemented in the late 1990s to address youth, gang, and gun violence. Multilevel growth curve regression models controlling for a linear trend over time, important structural correlates of homicide across urban neighborhoods, and between-neighborhood variance estimates showed that homicide rates involving the highest-risk populations (i.e., actors 15 to 24 years old) were most likely to experience a statistically significant and substantive reduction after the intervention was implemented (IRR = 0.48, 95% CI = 0.29 – 0.78). Among male actors in this age range, Black male homicide rates (IRR = 0.41, 95% CI = 0.25 – 0.70) and White male rates (IRR = 0.38, 95% CI = 0.15 – 0.79) declined substantially more than homicide rates involving actors outside the 15 to 24 years age range (IRR = 0.95, 95% CI = 0.54 – 1.69). In addition, neighborhoods where specific, community-level strategies were implemented had statistically significant and substantive high-risk homicide rate declines. We conclude that further extension of the pulling levers framework appears warranted in light of the recent findings. Alternative

  4. Change IS Possible: Reducing High-Risk Drinking Using a Collaborative Improvement Model.

    PubMed

    Lanter, Patricia L; Wolff, Kristina B; Johnson, Lisa C; Ercolano, Ellyn M; Kilmer, Jason R; Provost, Lloyd

    2015-01-01

    To describe the adoption of public health and improvement methodologies to address college students' high-risk drinking behaviors and to aid in prevention efforts. Members of 32 colleges and universities, content experts, and staff members of the National College Health Improvement Program (NCHIP). A 2-year learning collaborative developed by NCHIP trained individuals from 32 different college and universities in using the Plan-Do-Study-Act cycle as a method to create and implement initiatives aimed at reducing students' high-risk drinking behaviors and related harms. Participants experienced success ranging from noteworthy increases in type and amount of interventions directed at reducing high-risk drinking, to creating collaboratives across campus, the local community, and stakeholders. Challenges related to data collection and creating lasting cultural change remain. The use of quality improvement methodologies and creation of a national collaborative successfully effected meaningful change in high-risk drinking behaviors on college campuses.

  5. Urinary tract infections and reduced risk of bladder cancer in Los Angeles.

    PubMed

    Jiang, X; Castelao, J E; Groshen, S; Cortessis, V K; Shibata, D; Conti, D V; Yuan, J-M; Pike, M C; Gago-Dominguez, M

    2009-03-10

    We investigated the association between urinary tract infections (UTIs) and transitional cell carcinoma of the bladder in a population-based case-control study in Los Angeles covering 1586 cases and age-, gender-, and race-matched neighbourhood controls. A history of bladder infection was associated with a reduced risk of bladder cancer among women (odds ratio (OR), 0.66; 95% confidence interval (CI), 0.46-0.96). No effect was found in men, perhaps due to power limitations. A greater reduction in bladder cancer risk was observed among women with multiple infections (OR, 0.37; 95% CI, 0.18-0.78). Exclusion of subjects with a history of diabetes, kidney or bladder stones did not change the inverse association. A history of kidney infections was not associated with bladder cancer risk, but there was a weak association between a history of other UTIs and slightly increased risk among men. Our results suggest that a history of bladder infection is associated with a reduced risk of bladder cancer among women. Cytotoxicity from antibiotics commonly used to treat bladder infections is proposed as one possible explanation.

  6. Acid-reducing vagotomy is associated with reduced risk of subsequent ischemic heart disease in complicated peptic ulcer: An Asian population study.

    PubMed

    Wu, Shih-Chi; Fang, Chu-Wen; Chen, William Tzu-Liang; Muo, Chih-Hsin

    2016-12-01

    Persistent exacerbation of a peptic ulcer may lead to a complicated peptic ulcer (perforation or/and bleeding). The management of complicated peptic ulcers has shifted from acid-reducing vagotomy, drainage, and gastrectomy to simple local suture or non-operative (endoscopic/angiographic) hemostasis. We were interested in the long-term effects of this trend change. In this study, complicated peptic ulcer patients who received acid-reducing vagotomy were compared with those who received simple suture/hemostasis to determine the risk of ischemic heart disease (IHD).This retrospective cohort study analyzed 335,680 peptic ulcer patients recorded from 2000 to 2006 versus 335,680 age-, sex-, comorbidity-, and index-year matched comparisons. Patients with Helicobacter pylori (HP) infection were excluded. In order to identify the effect of vagus nerve severance, patients who received gastrectomy or antrectomy were also excluded. The incidence of IHD in both cohorts, and in the complicated peptic ulcer patients who received acid-reducing vagotomy versus those who received simple suture or hemostasis was evaluated.The overall incidence of IHD was higher in patients with peptic ulcer than those without peptic ulcer (17.00 vs 12.06 per 1000 person-years), with an adjusted hazard ratio (aHR) of 1.46 based on multivariable Cox proportional hazards regression analysis controlling for age, sex, Charlson's comorbidity index, and death (competing risk). While comparing peptic ulcer patients with acid-reducing vagotomy to those with simple suture/hemostasis or those without surgical treatment, the aHR (0.58) was the lowest in the acid-reducing vagotomy group.Patients with peptic ulcer have an elevated risk of IHD. However, complicated peptic ulcer patients who received acid-reducing vagotomy were associated with reduced risk of developing IHD.

  7. How School Facilities Managers and Business Officials Are Reducing Operating Costs and Saving Money. Energy-Smart Building Choices.

    ERIC Educational Resources Information Center

    Department of Energy, Washington, DC.

    This guide addresses contributions that school facility administrators and business officials can make in an effort to reduce operating costs and free up money for capital improvements. The guide explores opportunities available to utilize energy-saving strategies at any stage in a building's life, from its initial design phase through renovation.…

  8. Maternal HIV-1 envelope–specific antibody responses and reduced risk of perinatal transmission

    PubMed Central

    Permar, Sallie R.; Fong, Youyi; Vandergrift, Nathan; Fouda, Genevieve G.; Gilbert, Peter; Parks, Robert; Jaeger, Frederick H.; Pollara, Justin; Martelli, Amanda; Liebl, Brooke E.; Lloyd, Krissey; Yates, Nicole L.; Overman, R. Glenn; Shen, Xiaoying; Whitaker, Kaylan; Chen, Haiyan; Pritchett, Jamie; Solomon, Erika; Friberg, Emma; Marshall, Dawn J.; Whitesides, John F.; Gurley, Thaddeus C.; Von Holle, Tarra; Martinez, David R.; Cai, Fangping; Kumar, Amit; Xia, Shi-Mao; Lu, Xiaozhi; Louzao, Raul; Wilkes, Samantha; Datta, Saheli; Sarzotti-Kelsoe, Marcella; Liao, Hua-Xin; Ferrari, Guido; Alam, S. Munir; Montefiori, David C.; Denny, Thomas N.; Moody, M. Anthony; Tomaras, Georgia D.; Gao, Feng; Haynes, Barton F.

    2015-01-01

    Despite the wide availability of antiretroviral drugs, more than 250,000 infants are vertically infected with HIV-1 annually, emphasizing the need for additional interventions to eliminate pediatric HIV-1 infections. Here, we aimed to define humoral immune correlates of risk of mother-to-child transmission (MTCT) of HIV-1, including responses associated with protection in the RV144 vaccine trial. Eighty-three untreated, HIV-1–transmitting mothers and 165 propensity score–matched nontransmitting mothers were selected from the Women and Infants Transmission Study (WITS) of US nonbreastfeeding, HIV-1–infected mothers. In a multivariable logistic regression model, the magnitude of the maternal IgG responses specific for the third variable loop (V3) of the HIV-1 envelope was predictive of a reduced risk of MTCT. Neutralizing Ab responses against easy-to-neutralize (tier 1) HIV-1 strains also predicted a reduced risk of peripartum transmission in secondary analyses. Moreover, recombinant maternal V3–specific IgG mAbs mediated neutralization of autologous HIV-1 isolates. Thus, common V3-specific Ab responses in maternal plasma predicted a reduced risk of MTCT and mediated autologous virus neutralization, suggesting that boosting these maternal Ab responses may further reduce HIV-1 MTCT. PMID:26053661

  9. Facile synthesis of hierarchical dendritic PtPd nanogarlands supported on reduced graphene oxide with enhanced electrocatalytic properties

    NASA Astrophysics Data System (ADS)

    Li, Shan-Shan; Zheng, Jie-Ning; Ma, Xiaohong; Hu, Yuan-Yuan; Wang, Ai-Jun; Chen, Jian-Rong; Feng, Jiu-Ju

    2014-05-01

    A simple and facile method is developed for one-pot preparation of hierarchical dendritic PtPd nanogarlands supported on reduced graphene oxide (PtPd/RGO) at room temperature, without using any seed, organic solvent, or complex apparatus. It is found that octylphenoxypolyethoxyethanol (NP-40) as a soft template and its amount are critical to the formation of PtPd garlands. The as-prepared nanocomposites are further applied to methanol and ethanol oxidation with significantly enhanced electrocatalytic activity and better stability in alkaline media.A simple and facile method is developed for one-pot preparation of hierarchical dendritic PtPd nanogarlands supported on reduced graphene oxide (PtPd/RGO) at room temperature, without using any seed, organic solvent, or complex apparatus. It is found that octylphenoxypolyethoxyethanol (NP-40) as a soft template and its amount are critical to the formation of PtPd garlands. The as-prepared nanocomposites are further applied to methanol and ethanol oxidation with significantly enhanced electrocatalytic activity and better stability in alkaline media. Electronic supplementary information (ESI) available: Experimental section, Fig. S1-S12 and Tables S1 and S2. See DOI: 10.1039/c3nr06808k

  10. Motor Behavior Reflects Reduced Hemispheric Asymmetry in the Psychosis Risk Period

    PubMed Central

    Dean, Derek J.; Orr, Joseph M.; Newberry, Raeana E.; Mittal, Vijay A.

    2015-01-01

    Background A body of work focusing on brain connectivity, language dominance, and motor laterality research suggests reduced hemispheric asymmetry is a core feature in schizophrenia. However, there is little consensus about whether reduced dominance is present in those at ultrahigh risk (UHR) for psychosis. Methods A total of 94 demonstrated right-handed neuroleptic free participants (38 UHR and 56 matched healthy controls) were assessed with structured clinical interviews and completed an innovative handwriting task using a digital tablet computer. A laterality quotient (LQ) was calculated using kinematic variables from the participant’s left and right hands. A subset of the sample (26 UHR and 29 controls) returned after 12-months to complete clinical interviews in order to examine relationships between handwriting laterality and progression of psychosis risk symptoms. Results The UHR group showed decreased dextrality compared to healthy controls. At the 12-month follow-up, decreased dextrality accounted for 8% of the variance in worsened positive symptoms within the UHR group. Conclusion The current results suggest that disrupted cerebral dominance is also present in the ultrahigh risk period and that decreased dextrality may serve as a novel biomarker for the progression of psychosis risk. PMID:26492987

  11. EPA Recognized for Research on Reducing Risks to Drinking ...

    EPA Pesticide Factsheets

    Technical Brief Threat Ensemble Vulnerability Assessment (TEVA) among finalists for Edelman Award On February 7, 2008, the Institute for Operations Research and the Management Sciences (INFORMS ® of Hanover, MD) announced that a TEVA Research project is one of six finalists vying for this year’s prestigious Franz Edelman Award. The project is called “Reducing Security Risks in American Drinking Water Systems.” Edelman Award Information This is the thirty-seventh year of the Edelman competition. Every year, the competition recognizes outstanding operations research-based projects that transform companies, entire industries, and people’s lives. Operations research uses advanced analytical methods to make optimal decisions in order to solve complex problems. The winner of the award will be announced in mid-April 2008. Past Edelman Award finalists include Travelocity; IBM; Merrill Lynch; the Memorial Sloan-Kettering Cancer Center; and Georgia Tech. The winning team for 2007 reduced both patient suffering and health care costs from the treatment of prostate and breast cancer. The Edelman competition attests to the contributions of operations research in the profit and nonprofit sectors. It is estimated that the cumulative dollar benefits from Edelman finalist projects between 1984 and 2006 reached the $100 billion mark. TEVA Research Program The TEVA research program has focused on reducing the security risks to drinking water systems. Ad

  12. Preconceptional motivational interviewing interventions to reduce alcohol-exposed pregnancy risk.

    PubMed

    Ingersoll, Karen S; Ceperich, Sherry D; Hettema, Jennifer E; Farrell-Carnahan, Leah; Penberthy, J Kim

    2013-04-01

    Alcohol exposed pregnancy (AEP) is a leading cause of preventable birth defects. While randomized controlled trials (RCTs) have shown that multi-session motivational interviewing-based interventions reduce AEP risk, a one-session intervention could facilitate broader implementation. The purposes of this study were to: (1) test a one-session motivational AEP prevention intervention for community women and (2) compare outcomes to previous RCTs. Participants at risk for AEP (N=217) were randomized to motivational interviewing+assessment feedback (EARLY), informational video, or informational brochure conditions. Outcomes were drinks per drinking day (DDD), ineffective contraception rate, and AEP risk at 3 and 6 months. All interventions were associated with decreased DDD, ineffective contraception rate, and AEP risk. Participants who received EARLY had larger absolute risk reductions in ineffective contraception and AEP risk, but not DDD. Effect sizes were compared to previous RCTs. The one-session EARLY intervention had less powerful effects than multi-session AEP prevention interventions among community women, but may provide a new option in a continuum of preventive care. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. AIDS and behavioral change to reduce risk: a review.

    PubMed Central

    Becker, M H; Joseph, J G

    1988-01-01

    Published reports describing behavioral changes in response to the threat of AIDS (acquired immunodeficiency syndrome) are reviewed. These studies demonstrate rapid, profound, but expectably incomplete alterations in the behavior of both homosexual/bisexual males and intravenous drug users. This is true in the highest risk metropolitan areas such as New York City and in areas with lower AIDS incidence. Risk reduction is occurring more frequently through the modification of sexual or drug-use behavior than through its elimination. In contrast to aggregate data, longitudinal descriptions of individual behavior demonstrate considerable instability or recidivism. Behavioral change in the potentially vulnerable heterosexual adolescent and young adult populations is less common, as is risk reduction among urban minorities. Reports of AIDS-related knowledge and attitudes generally parallel the pattern of behavioral changes. Nonetheless, few studies investigate the relationship of knowledge and attitudes to risk reduction. Future studies should provide much-needed information about the determinants as well as the magnitude of behavioral changes required to reduce the further spread of AIDS. PMID:3279837

  14. Modeling risk of occupational zoonotic influenza infection in swine workers.

    PubMed

    Paccha, Blanca; Jones, Rachael M; Gibbs, Shawn; Kane, Michael J; Torremorell, Montserrat; Neira-Ramirez, Victor; Rabinowitz, Peter M

    2016-08-01

    Zoonotic transmission of influenza A virus (IAV) between swine and workers in swine production facilities may play a role in the emergence of novel influenza strains with pandemic potential. Guidelines to prevent transmission of influenza to swine workers have been developed but there is a need for evidence-based decision-making about protective measures such as respiratory protection. A mathematical model was applied to estimate the risk of occupational IAV exposure to swine workers by contact and airborne transmission, and to evaluate the use of respirators to reduce transmission.  The Markov model was used to simulate the transport and exposure of workers to IAV in a swine facility. A dose-response function was used to estimate the risk of infection. This approach is similar to methods previously used to estimate the risk of infection in human health care settings. This study uses concentration of virus in air from field measurements collected during outbreaks of influenza in commercial swine facilities, and analyzed by polymerase chain reaction.  It was found that spending 25 min working in a barn during an influenza outbreak in a swine herd could be sufficient to cause zoonotic infection in a worker. However, this risk estimate was sensitive to estimates of viral infectivity to humans. Wearing an excellent fitting N95 respirator reduced this risk, but with high aerosol levels the predicted risk of infection remained high under certain assumptions.  The results of this analysis indicate that under the conditions studied, swine workers are at risk of zoonotic influenza infection. The use of an N95 respirator could reduce such risk. These findings have implications for risk assessment and preventive programs targeting swine workers. The exact level of risk remains uncertain, since our model may have overestimated the viability or infectivity of IAV. Additionally, the potential for partial immunity in swine workers associated with repeated low

  15. Reduced risk of sudden death from chest wall blows (commotio cordis) with safety baseballs.

    PubMed

    Link, Mark S; Maron, Barry J; Wang, Paul J; Pandian, Natesa G; VanderBrink, Brian A; Estes, N A Mark

    2002-05-01

    In an experimental model of sudden death from baseball chest wall impact (commotio cordis), we sought to determine if sudden death by baseball impact could be reduced with safety baseballs. Sudden cardiac death can occur after chest wall impact with a baseball (commotio cordis). Whether softer-than-standard (safety) baseballs reduce the risk of sudden death is unresolved from the available human data. In a juvenile swine model, ventricular fibrillation (VF) has been shown to be induced reproducibly by precordial impact with a 30-mph baseball 10 to 30 ms before the T-wave peak, and this likelihood was reduced with the softest safety baseballs (T-balls). To further test whether safety baseballs would reduce the risk of sudden death at velocities more relevant to youth sports competition, we used our swine model of commotio cordis to test baseballs propelled at the 40-mph velocity commonly attained in that sport. Forty animals received up to 3 chest wall impacts at 40 mph during the vulnerable period of repolarization for VF with 1 of 3 different safety baseballs of varying hardness, and also by a standard baseball. Safety baseballs propelled at 40 mph significantly reduced the risk for VF. The softest safety baseballs triggered VF in only 11% of impacts, compared with 19% and 22% with safety baseballs of intermediate hardness, and 69% with standard baseballs. In this experimental model of low-energy chest wall impact, safety baseballs reduced (but did not abolish) the risk of sudden cardiac death. More universal use of these safety baseballs may decrease the risk of sudden death on the playing field for young athletes.

  16. Pneumococcal vaccination reduces the risk of community-acquired pneumonia in children.

    PubMed

    Hasegawa, Junko; Mori, Mitsuru; Ohnishi, Hirofumi; Tsugawa, Takeshi; Hori, Tsukasa; Yoto, Yuko; Tsutsumi, Hiroyuki

    2017-03-01

    The seven-valent pneumococcal conjugate vaccine (PCV7) was introduced to Japan in 2009, after which there was a rapid decline in invasive pneumococcal disease. There are few data, however, on the effectiveness of PCV7 against community-acquired pneumonia (CAP). We conducted an ambispective cohort study among children aged 0-6 years old who attended day-care centers. A total of 624 children at 10 day-care centers in Sapporo, Japan participated in the study. The parents reported whether their child had received PCV7 one or more times, as well as the exact dates of vaccination from records in maternal and child health handbooks marked by pediatricians. Each CAP event was reported by parents according to doctor diagnosis. A Cox proportional hazards regression model was used to calculate the hazard ratio (HR) and 95%CI of CAP incidence reduced by PCV7 inoculation. During the observational period, 94 subjects contracted CAP. After adjusting for potentially confounding variables, inoculation with PCV7 was significantly associated with a reduced risk of CAP (HR, 0.22; 95%CI: 0.13-0.34). On stratified analysis by age, PCV7 was significantly associated with a reduced risk of CAP in both children aged <3 years (HR, 0.31; 95%CI: 0.14-0.71), and those ≥3 years (HR, 0.20; 95%CI: 0.09-0.43). PCV7 is highly effective in reducing the risk of CAP in children attending day-care centers. © 2016 Japan Pediatric Society.

  17. Influences on Adaptive Planning to Reduce Flood Risks among Parishes in South Louisiana.

    PubMed

    Paille, Mary; Reams, Margaret; Argote, Jennifer; Lam, Nina S-N; Kirby, Ryan

    2016-02-01

    Residents of south Louisiana face a range of increasing, climate-related flood exposure risks that could be reduced through local floodplain management and hazard mitigation planning. A major incentive for community planning to reduce exposure to flood risks is offered by the Community Rating System (CRS) of the National Flood Insurance Program (NFIP). The NFIP encourages local collective action by offering reduced flood insurance premiums for individual policy holders of communities where suggested risk-reducing measures have been implemented. This preliminary analysis examines the extent to which parishes (counties) in southern Louisiana have implemented the suggested policy actions and identifies key factors that account for variation in the implementation of the measures. More measures implemented results in higher CRS scores. Potential influences on scores include socioeconomic attributes of residents, government capacity, average elevation and past flood events. The results of multiple regression analysis indicate that higher CRS scores are associated most closely with higher median housing values. Furthermore, higher scores are found in parishes with more local municipalities that participate in the CRS program. The number of floods in the last five years and the revenue base of the parish does not appear to influence CRS scores. The results shed light on the conditions under which local adaptive planning to mitigate increasing flood risks is more likely to be implemented and offer insights for program administrators, researchers and community stakeholders.

  18. Reducing The Risk Of Fires In Conveyor Transport

    NASA Astrophysics Data System (ADS)

    Cheremushkina, M. S.; Poddubniy, D. A.

    2017-01-01

    The paper deals with the actual problem of increasing the safety of operation of belt conveyors in mines. Was developed the control algorithm that meets the technical requirements of the mine belt conveyors, reduces the risk of fires of conveyors belt, and enables energy and resource savings taking into account random sort of traffic. The most effective method of decision such tasks is the construction of control systems with the use of variable speed drives for asynchronous motors. Was designed the mathematical model of the system "variable speed multiengine drive - conveyor - control system of conveyors", that takes into account the dynamic processes occurring in the elements of the transport system, provides an assessment of the energy efficiency of application the developed algorithms, which allows to reduce the dynamic overload in the belt to (15-20)%.

  19. Leisure-Time Running Reduces All-Cause and Cardiovascular Mortality Risk

    PubMed Central

    Lee, Duck-chul; Pate, Russell R.; Lavie, Carl J.; Sui, Xuemei; Church, Timothy S.; Blair, Steven N.

    2014-01-01

    Background Although running is a popular leisure-time physical activity, little is known about the long-term effects of running on mortality. The dose-response relations between running, as well as the change in running behaviors over time and mortality remain uncertain. Objectives We examined the associations of running with all-cause and cardiovascular mortality risks in 55,137 adults, aged 18 to 100 years (mean age, 44). Methods Running was assessed on the medical history questionnaire by leisure-time activity. Results During a mean follow-up of 15 years, 3,413 all-cause and 1,217 cardiovascular deaths occurred. Approximately, 24% of adults participated in running in this population. Compared with non-runners, runners had 30% and 45% lower adjusted risks of all-cause and cardiovascular mortality, respectively, with a 3-year life expectancy benefit. In dose-response analyses, the mortality benefits in runners were similar across quintiles of running time, distance, frequency, amount, and speed, compared with non-runners. Weekly running even <51 minutes, <6 miles, 1-2 times, <506 metabolic equivalent-minutes, or <6 mph was sufficient to reduce risk of mortality, compared with not running. In the analyses of change in running behaviors and mortality, persistent runners had the most significant benefits with 29% and 50% lower risks of all-cause and cardiovascular mortality, respectively, compared with never-runners. Conclusions Running, even 5-10 minutes per day and slow speeds <6 mph, is associated with markedly reduced risks of death from all causes and cardiovascular disease. This study may motivate healthy but sedentary individuals to begin and continue running for substantial and attainable mortality benefits. PMID:25082581

  20. Perceptions of Risk of Developing Skin Cancer for Diverse Audiences: Enhancing Relevance of Sun Protection to Reduce the Risk.

    PubMed

    Robinson, June K; Friedewald, John; Gordon, Elisa J

    2016-03-01

    Sixty-five percent of kidney transplant recipients (KTRs) develop squamous cell carcinoma (SCC). Perceptions of risk of developing skin cancer, amelioration of this risk with sun protection, and having choices among sun protection strategies may enhance sun protection use by KTRS, who are at greater risk than the general population. Thirty KTRs stratified among non-Hispanic Whites, non-Hispanic Blacks, and Hispanic/Latinos evaluated three versions of the interactive, web-based, electronic sun protection program and suggested refinements. The sequence of content presentation prepared the participant to accept the credibility, accuracy, and relevance of the message. Beginning with informing participants that using sun protection reduces the chance of developing skin cancer made the information credible to KTRs. Showing skin cancer on all skin types and patient testimonials enhanced participants' awareness of their susceptibility to develop skin cancer and primed patients to receive their personal risk of developing skin cancer. Coupling presentation of knowledge about the benefits of sun protection in reducing the risk of developing skin cancer with the personal risk of getting the disease was essential to KTRs believing that they could influence their health outcome.

  1. The interplay between gait, falls and cognition: can cognitive therapy reduce fall risk?

    PubMed Central

    Segev-Jacubovski, Orit; Herman, Talia; Yogev-Seligmann, Galit; Mirelman, Anat; Giladi, Nir; Hausdorff, Jeffrey M

    2011-01-01

    In this article, we briefly summarize the incidence and significant consequences of falls among older adults, the insufficient effectiveness of commonly used multifactorial interventions and the evidence linking falls and cognitive function. Recent pharmacologic and nonpharmacologic studies that evaluated the effects of cognitive therapy on fall risk are reviewed. The results of this article illustrate the potential utility of multiple, diverse forms of cognitive therapy for reducing fall risk. The article also indicates that large-scale, randomized controlled trials are warranted and that additional research is needed to better understand the pathophysiologic mechanisms underlying the interplay between human mobility, fall risk and cognitive function. Nonetheless, we suggest that multimodality interventions that combine motor and cognitive therapy should, eventually, be incorporated into clinical practice to enable older adults and patients to move safer and with a reduced fall risk. PMID:21721921

  2. Association Between Hospital Admission Risk Profile Score and Skilled Nursing or Acute Rehabilitation Facility Discharges in Hospitalized Older Adults.

    PubMed

    Liu, Stephen K; Montgomery, Justin; Yan, Yu; Mecchella, John N; Bartels, Stephen J; Masutani, Rebecca; Batsis, John A

    2016-10-01

    To evaluate whether the Hospital Admission Risk Profile (HARP) score is associated with skilled nursing or acute rehabilitation facility discharge after an acute hospitalization. Retrospective cohort study. Inpatient unit of a rural academic medical center. Hospitalized individuals aged 70 and older from October 1, 2013 to June 1, 2014. Participant age at the time of admission, modified Folstein Mini-Mental State Examination score, and self-reported instrumental activities of daily living 2 weeks before admission were used to calculate HARP score. The primary predictor was HARP score, and the primary outcome was discharge disposition (home, facility, deceased). Multivariate analysis was used to evaluate the association between HARP score and discharge disposition, adjusting for age, sex, comorbidities, and length of stay. Four hundred twenty-eight individuals admitted from home were screened and their HARP scores were categorized as low (n = 162, 37.8%), intermediate (n = 157, 36.7%), or high (n = 109, 25.5%). Participants with high HARP scores were significantly more likely to be discharged to a facility (55%) than those with low HARP scores (20%) (P < .001). After adjustment, participants with high HARP scores were more than four times as likely as those with low scores to be discharged to a facility (odds ratio = 4.58, 95% confidence interval = 2.42-8.66). In a population of older hospitalized adults, HARP score (using readily available admission information) identifies individuals at greater risk of skilled nursing or acute rehabilitation facility discharge. Early identification for potential facility discharges may allow for targeted interventions to prevent functional decline, improve informed shared decision-making about post-acute care needs, and expedite discharge planning. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  3. Hypotheses and fundamental study design characteristics for evaluating potential reduced-risk tobacco products. Part I: Heuristic.

    PubMed

    Murrelle, Lenn; Coggins, Christopher R E; Gennings, Chris; Carchman, Richard A; Carter, Walter H; Davies, Bruce D; Krauss, Marc R; Lee, Peter N; Schleef, Raymond R; Zedler, Barbara K; Heidbreder, Christian

    2010-06-01

    The risk-reducing effect of a potential reduced-risk tobacco product (PRRP) can be investigated conceptually in a long-term, prospective study of disease risks among cigarette smokers who switch to a PRRP and in appropriate comparison groups. Our objective was to provide guidance for establishing the fundamental design characteristics of a study intended to (1) determine if switching to a PRRP reduces the risk of lung cancer (LC) compared with continued cigarette smoking, and (2) compare, using a non-inferiority approach, the reduction in LC risk among smokers who switched to a PRRP to the reduction in risk among smokers who quit smoking entirely. Using standard statistical methods applied to published data on LC incidence after smoking cessation, we show that the sample size and duration required for a study designed to evaluate the potential for LC risk reduction for an already marketed PRRP, compared with continued smoking, varies depending on the LC risk-reducing effectiveness of the PRRP, from a 5-year study with 8000-30,000 subjects to a 15-year study with <5000 to 10,000 subjects. To assess non-inferiority to quitting, the required sample size tends to be about 10 times greater, again depending on the effectiveness of the PRRP. (c) 2009 Elsevier Inc. All rights reserved.

  4. Does non-pharmacological therapy for antenatal depression reduce risks for the infant?

    PubMed

    Jarde, A; Morais, M; Kingston, D; Giallo, R; Giglia, L; MacQueen, G; Wang, Y; Beyene, J; McDonald, S D

    2016-06-01

    Depression during pregnancy has been associated with an increased risk of adverse outcomes for the infant such as preterm birth. These risks are not reduced with pharmacological treatment, but the effect of non-pharmacological therapies is unknown. We performed a systematic review to assess the risk of adverse perinatal outcomes in non-pharmacologically treated depressed women compared to non-depressed women. We found no studies that met our inclusion criteria, highlighting a critical need for research on this topic.

  5. 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

  6. Evaluating Potential Human Health Risks Associated with the Development of Utility-Scale Solar Energy Facilities on Contaminated Sites

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

    Cheng, J. -J.; Chang, Y. -S.; Hartmann, H.

    2013-09-01

    This report presents a general methodology for obtaining preliminary estimates of the potential human health risks associated with developing a utility-scale solar energy facility on a contaminated site, based on potential exposures to contaminants in soils (including transport of those contaminants into the air).

  7. Leisure-time running reduces all-cause and cardiovascular mortality risk.

    PubMed

    Lee, Duck-Chul; Pate, Russell R; Lavie, Carl J; Sui, Xuemei; Church, Timothy S; Blair, Steven N

    2014-08-05

    Although running is a popular leisure-time physical activity, little is known about the long-term effects of running on mortality. The dose-response relations between running, as well as the change in running behaviors over time, and mortality remain uncertain. We examined the associations of running with all-cause and cardiovascular mortality risks in 55,137 adults, 18 to 100 years of age (mean age 44 years). Running was assessed on a medical history questionnaire by leisure-time activity. During a mean follow-up of 15 years, 3,413 all-cause and 1,217 cardiovascular deaths occurred. Approximately 24% of adults participated in running in this population. Compared with nonrunners, runners had 30% and 45% lower adjusted risks of all-cause and cardiovascular mortality, respectively, with a 3-year life expectancy benefit. In dose-response analyses, the mortality benefits in runners were similar across quintiles of running time, distance, frequency, amount, and speed, compared with nonrunners. Weekly running even <51 min, <6 miles, 1 to 2 times, <506 metabolic equivalent-minutes, or <6 miles/h was sufficient to reduce risk of mortality, compared with not running. In the analyses of change in running behaviors and mortality, persistent runners had the most significant benefits, with 29% and 50% lower risks of all-cause and cardiovascular mortality, respectively, compared with never-runners. Running, even 5 to 10 min/day and at slow speeds <6 miles/h, is associated with markedly reduced risks of death from all causes and cardiovascular disease. This study may motivate healthy but sedentary individuals to begin and continue running for substantial and attainable mortality benefits. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  8. Influences on Adaptive Planning to Reduce Flood Risks among Parishes in South Louisiana

    PubMed Central

    Paille, Mary; Reams, Margaret; Argote, Jennifer; Lam, Nina S.-N.; Kirby, Ryan

    2016-01-01

    Residents of south Louisiana face a range of increasing, climate-related flood exposure risks that could be reduced through local floodplain management and hazard mitigation planning. A major incentive for community planning to reduce exposure to flood risks is offered by the Community Rating System (CRS) of the National Flood Insurance Program (NFIP). The NFIP encourages local collective action by offering reduced flood insurance premiums for individual policy holders of communities where suggested risk-reducing measures have been implemented. This preliminary analysis examines the extent to which parishes (counties) in southern Louisiana have implemented the suggested policy actions and identifies key factors that account for variation in the implementation of the measures. More measures implemented results in higher CRS scores. Potential influences on scores include socioeconomic attributes of residents, government capacity, average elevation and past flood events. The results of multiple regression analysis indicate that higher CRS scores are associated most closely with higher median housing values. Furthermore, higher scores are found in parishes with more local municipalities that participate in the CRS program. The number of floods in the last five years and the revenue base of the parish does not appear to influence CRS scores. The results shed light on the conditions under which local adaptive planning to mitigate increasing flood risks is more likely to be implemented and offer insights for program administrators, researchers and community stakeholders. PMID:27330828

  9. Personalized technologist dose audit feedback for reducing patient radiation exposure from CT.

    PubMed

    Miglioretti, Diana L; Zhang, Yue; Johnson, Eric; Lee, Choonsik; Morin, Richard L; Vanneman, Nicholas; Smith-Bindman, Rebecca

    2014-03-01

    The aim of this study was to determine whether providing radiologic technologists with audit feedback on doses from CT examinations they conduct and education on dose-reduction strategies reduces patients' radiation exposure. This prospective, controlled pilot study was conducted within an integrated health care system from November 2010 to October 2011. Ten technologists at 2 facilities received personalized dose audit reports and education on dose-reduction strategies; 9 technologists at a control facility received no intervention. Radiation exposure was measured by the dose-length product (DLP) from CT scans performed before (n = 1,630) and after (n = 1,499) the intervention and compared using quantile regression. Technologists were surveyed before and after the intervention. For abdominal CT, DLPs decreased by 3% to 12% at intervention facilities but not at the control facility. For brain CT, DLPs significantly decreased by 7% to 12% at one intervention facility; did not change at the second intervention facility, which had the lowest preintervention DLPs; and increased at the control facility. Technologists were more likely to report always thinking about radiation exposure and associated cancer risk and optimizing settings to reduce exposure after the intervention. Personalized audit feedback and education can change technologists' attitudes about, and awareness of, radiation and can lower patient radiation exposure from CT imaging. Copyright © 2014 American College of Radiology. All rights reserved.

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

    PubMed

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

    2014-10-01

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

  11. ART Attrition across Health Facilities Implementing Option B+ in Haiti.

    PubMed

    Myrtil, Martine Pamphile; Puttkammer, Nancy; Gloyd, Stephen; Robinson, Julia; Yuhas, Krista; Domercant, Jean Wysler; Honoré, Jean Guy; Francois, Kesner

    2018-01-01

    Describing factors related to high attrition is important in order to improve the implementation of the Option B+ strategy in Haiti. We conducted a retrospective cohort study to describe the variability of antiretroviral therapy (ART) retention across health facilities among pregnant and lactating women and assess for differences in ART retention between Option B+ clients and other ART patients. There were 1989 Option B+ clients who initiated ART in 45 health facilities. The percentage of attrition varied from 9% to 81% across the facilities. The largest health facilities had 38% higher risk of attrition (relative risk [RR]: 1.38, 95% confidence interval [CI]: 1.08-1.77, P = .009). Private institutions had 18% less risk of attrition (RR: 0.82, 95% CI: 0.70-0.96, P = .020). Health facilities located in the West department and the South region had lower risk of attrition. Being on treatment in a large or public health facility or a facility located in the North region was a significant risk factor associated with high attrition among Option B+ clients. The implementation of the Option B+ strategy must be reevaluated in order to effectively eliminate mother-to-child HIV transmission.

  12. Facility-Level Variation in Hospitalization, Mortality, and Costs in the 30 Days After Percutaneous Coronary Intervention: Insights on Short-Term Healthcare Value From the Veterans Affairs Clinical Assessment, Reporting, and Tracking System (VA CART) Program.

    PubMed

    Bradley, Steven M; O'Donnell, Colin I; Grunwald, Gary K; Liu, Chuan-Fen; Hebert, Paul L; Maddox, Thomas M; Jesse, Robert L; Fihn, Stephan D; Rumsfeld, John S; Ho, P Michael

    2015-07-14

    Policies to reduce unnecessary hospitalizations after percutaneous coronary intervention (PCI) are intended to improve healthcare value by reducing costs while maintaining patient outcomes. Whether facility-level hospitalization rates after PCI are associated with cost of care is unknown. We studied 32,080 patients who received PCI at any 1 of 62 Veterans Affairs hospitals from 2008 to 2011. We identified facility outliers for 30-day risk-standardized hospitalization, mortality, and cost. Compared with the risk-standardized average, 2 hospitals (3.2%) had a lower-than-expected hospitalization rate, and 2 hospitals (3.2%) had a higher-than-expected hospitalization rate. We observed no statistically significant variation in facility-level risk-standardized mortality. The facility-level unadjusted median per patient 30-day total cost was $23,820 (interquartile range, $19,604-$29,958). Compared with the risk-standardized average, 17 hospitals (27.4%) had lower-than-expected costs, and 14 hospitals (22.6%) had higher-than-expected costs. At the facility level, the index PCI accounted for 83.1% of the total cost (range, 60.3%-92.2%), whereas hospitalization after PCI accounted for only 5.8% (range, 2.0%-12.7%) of the 30-day total cost. Facilities with higher hospitalization rates were not more expensive (Spearman ρ=0.16; 95% confidence interval, -0.09 to 0.39; P=0.21). In this national study, hospitalizations in the 30 day after PCI accounted for only 5.8% of 30-day cost, and facility-level cost was not correlated with hospitalization rates. This challenges the focus on reducing hospitalizations after PCI as an effective means of improving healthcare value. Opportunities remain to improve PCI value by reducing the variation in total cost of PCI without compromising patient outcomes. © 2015 American Heart Association, Inc.

  13. Effects of radon mitigation vs smoking cessation in reducing radon-related risk of lung cancer.

    PubMed Central

    Mendez, D; Warner, K E; Courant, P N

    1998-01-01

    OBJECTIVES: The purpose of this paper is to provide smokers with information on the relative benefits of mitigating radon and quitting smoking in reducing radon-related lung cancer risk. METHODS: The standard radon risk model, linked with models characterizing residential radon exposure and patterns of moving to new homes, was used to estimate the risk reduction produced by remediating high-radon homes, quitting smoking, or both. RESULTS: Quitting smoking reduces lung cancer risk from radon more than does reduction of radon exposure itself. CONCLUSIONS: Smokers should understand that, in addition to producing other health benefits, quitting smoking dominates strategies to deal with the problem posed by radon. PMID:9585753

  14. Psychosocial factors and uptake of risk-reducing salpingo-oophorectomy in women at high risk for ovarian cancer.

    PubMed

    Meiser, Bettina; Price, Melanie A; Butow, Phyllis N; Karatas, Janan; Wilson, Judy; Heiniger, Louise; Baylock, Brandi; Charles, Margaret; McLachlan, Sue-Anne; Phillips, Kelly-Anne

    2013-03-01

    Bilateral risk-reducing salpingo-oophorectomy (RRSO) has been shown to significantly reduce the risk of ovarian cancer. This study assessed factors predicting uptake of RRSO. Women participating in a large multiple-case breast cancer family cohort study who were at increased risk for ovarian and fallopian tube cancer (i.e. BRCA1 or BRCA2 mutation carrier or family history including at least one first- or second-degree relative with ovarian or fallopian tube cancer), with no personal history of cancer and with at least one ovary in situ at cohort enrolment, were eligible for this study. Women who knew they did not carry the BRCA1 or BRCA2 mutation segregating in their family (true negatives) were excluded. Sociodemographic, biological and psychosocial factors, including cancer-specific anxiety, perceived ovarian cancer risk, optimism and social support, were assessed using self-administered questionnaires and interviews at cohort enrolment. RRSO uptake was self-reported every three years during systematic follow-up. Of 2,859 women, 571 were eligible. Mean age was 43.3 years; 62 women (10.9 %) had RRSO a median of two years after cohort entry. Factors predicting RRSO were: being parous (OR 3.3, p = 0.015); knowing one's mutation positive status (OR 2.9, p < 0.001) and having a mother and/or sister who died from ovarian cancer (OR 2.5, p = 0.013). Psychological variables measured at cohort entry were not associated with RRSO. These results suggest that women at high risk for ovarian cancer make decisions about RRSO based on risk and individual socio-demographic characteristics, rather than in response to psychological factors such as anxiety.

  15. Identifying and reducing risk factors related to trainee-client sexual misconduct.

    PubMed

    Hamilton, J C; Spruill, J

    1999-06-01

    Sexual misconduct involving therapists-in-training and their clients is addressed. Personal and situational factors that may constitute risk factors for the development of inappropriate sexual activity between trainees and their clients are identified. Although there may be certain characteristics that put particular students at risk for such involvement, the authors believe this risk is more strongly related to systemic, programmatic, and pedagogic characteristics of the environments in which students train. Examples include, respectively, the decline of concern over transference and countertransference, failure to include education about client-therapist sexual attraction and the consequences of sexual misconduct in graduate psychology curricula, and the reluctance of supervisors to deal straightforwardly with trainees' sexual feelings. Suggestions for reducing risks for client-therapist sexual misconduct are directed toward these situational factors.

  16. Workplace Interventions to Reduce Obesity and Cardiometabolic Risk

    PubMed Central

    Thorndike, Anne N.

    2012-01-01

    The worksite is ideal for implementing interventions to reduce obesity and cardiometabolic risk factors. Although worksite health promotion is not new, employer-sponsored wellness programs have become more widespread due to the rising prevalence and high cost of obesity. Over the past two decades, employers and researchers focused efforts on individual-based programs to change employees’ nutrition and exercise behaviors, but more recently, the worksite environment has been targeted. Overall, there is good evidence that individual-based worksite programs can produce modest weight loss, but the evidence for effects on other risk factors and on long-term health outcomes and costs is inconsistent. There is less evidence for the benefit of environmental-based interventions, and more data will be needed to establish conclusions about the benefits of these types of interventions. A major challenge for employers and researchers in the future will be to find the balance between effectiveness and economic viability of worksite wellness programs. PMID:22708000

  17. Workplace Interventions to Reduce Obesity and Cardiometabolic Risk.

    PubMed

    Thorndike, Anne N

    2011-02-01

    The worksite is ideal for implementing interventions to reduce obesity and cardiometabolic risk factors. Although worksite health promotion is not new, employer-sponsored wellness programs have become more widespread due to the rising prevalence and high cost of obesity. Over the past two decades, employers and researchers focused efforts on individual-based programs to change employees' nutrition and exercise behaviors, but more recently, the worksite environment has been targeted. Overall, there is good evidence that individual-based worksite programs can produce modest weight loss, but the evidence for effects on other risk factors and on long-term health outcomes and costs is inconsistent. There is less evidence for the benefit of environmental-based interventions, and more data will be needed to establish conclusions about the benefits of these types of interventions. A major challenge for employers and researchers in the future will be to find the balance between effectiveness and economic viability of worksite wellness programs.

  18. The Effectiveness of Different Diet Strategies to Reduce Type 2 Diabetes Risk in Youth

    PubMed Central

    Gow, Megan L.; Garnett, Sarah P.; Baur, Louise A.; Lister, Natalie B.

    2016-01-01

    Type 2 diabetes in children and adolescents has become a prominent clinical issue in recent decades. Increasing numbers of young people have risk factors for type 2 diabetes, particularly obesity, indicating the need for effective type 2 diabetes prevention strategies. The aim of this review was to identify specific dietary strategies that optimize improvements in risk factors for type 2 diabetes in youth and hence reduce the risk of type 2 diabetes development. Our review of the current literature indicates that dietary interventions lead to weight loss when intervention adherence is high. However, in addition to weight loss, a diet that is reduced in carbohydrates may optimize improvements in other type 2 diabetes risk factors, including insulin resistance and hyperglycemia. While further research is needed to confirm this finding, reduced carbohydrate diets may include a very low-carbohydrate diet, a very low-energy diet, a lower-glycemic-index diet, and/or an intermittent fasting diet. This array of dietary strategies provides a suite of intervention options for clinicians to recommend to young people at risk of type 2 diabetes. However, these findings are in contrast to current guidelines for the prevention of type 2 diabetes in adults which recommends a low-fat, high-carbohydrate diet. PMID:27517953

  19. Can helmet design reduce the risk of concussion in football?

    PubMed

    Rowson, Steven; Duma, Stefan M; Greenwald, Richard M; Beckwith, Jonathan G; Chu, Jeffrey J; Guskiewicz, Kevin M; Mihalik, Jason P; Crisco, Joseph J; Wilcox, Bethany J; McAllister, Thomas W; Maerlender, Arthur C; Broglio, Steven P; Schnebel, Brock; Anderson, Scott; Brolinson, P Gunnar

    2014-04-01

    Of all sports, football accounts for the highest incidence of concussion in the US due to the large number of athletes participating and the nature of the sport. While there is general agreement that concussion incidence can be reduced through rule changes and teaching proper tackling technique, there remains debate as to whether helmet design may also reduce the incidence of concussion. A retrospective analysis was performed of head impact data collected from 1833 collegiate football players who were instrumented with helmet-mounted accelerometer arrays for games and practices. Data were collected between 2005 and 2010 from 8 collegiate football teams: Virginia Tech, University of North Carolina, University of Oklahoma, Dartmouth College, Brown University, University of Minnesota, Indiana University, and University of Illinois. Concussion rates were compared between players wearing Riddell VSR4 and Riddell Revolution helmets while controlling for the head impact exposure of each player. A total of 1,281,444 head impacts were recorded, from which 64 concussions were diagnosed. The relative risk of sustaining a concussion in a Revolution helmet compared with a VSR4 helmet was 46.1% (95% CI 28.1%-75.8%). When controlling for each player's exposure to head impact, a significant difference was found between concussion rates for players in VSR4 and Revolution helmets (χ(2) = 4.68, p = 0.0305). This study illustrates that differences in the ability to reduce concussion risk exist between helmet models in football. Although helmet design may never prevent all concussions from occurring in football, evidence illustrates that it can reduce the incidence of this injury.

  20. Risk factors associated with reduced work productivity among people with chronic knee pain.

    PubMed

    Agaliotis, M; Fransen, M; Bridgett, L; Nairn, L; Votrubec, M; Jan, S; Heard, R; Mackey, M

    2013-09-01

    To determine the burden and risk factors associated with reduced work productivity among people with chronic knee pain. A longitudinal study, nested within a randomised controlled trial (RCT) evaluating the long-term effects of dietary supplements, was conducted among people with chronic knee pain in paid employment (n = 360). Participants recorded days off work (absenteeism) and reduced productivity while at work (presenteeism) for seven days every two months over a 12-month period in a study specific diary. Examined risk factors included knee pain severity, occupational group, radiographic disease severity, physical activity, body mass index (BMI), health-related quality of life (SF-12) and co-morbidity. Over the 12-month follow up period, 50 (14%) participants reported one or more days off work due to knee problems, while 283 (79%) reported reduced productivity while at work (presenteeism <100%). In multivariate analysis, the only significant risk factor for absenteeism was having an SF-12 Mental Component Summary (MCS) score <40 (OR: 2.49 [95% CI: 1.03-5.98]). Significant risk factors for presenteeism included; reporting an; SF-12 Physical Component Summary (PCS) score <50 (OR: 1.99 [95% CI: 1.05-3.76]), semi-manual labour (OR: 2.23 [1.09-4.59]) or manual labour (OR: 6.40 [1.44-28.35]) or a high maximum knee pain (4-6 out of 10) (OR: 2.29 [1.17-4.46]). This longitudinal study found that among this cohort of people with chronic knee pain, the burden of reduced work productivity is mainly attributable to presenteeism rather absenteeism. This study demonstrated that effective strategies to increase work productivity should focus on reducing knee pain or physical disability especially among workers in manual or semi-manual labour. © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  1. Reducing the Risk of Internalizing Symptoms among High-risk Hispanic Youth through a Family Intervention: A Randomized Controlled Trial.

    PubMed

    Perrino, Tatiana; Pantin, Hilda; Huang, Shi; Brincks, Ahnalee; Brown, C Hendricks; Prado, Guillermo

    2016-03-01

    Familias Unidas is an intervention that has been found to be efficacious in preventing and reducing substance use, sexual risk, and problem behaviors among Hispanic youth. While it does not specifically target youth internalizing symptoms, the intervention works to strengthen parenting and family factors associated with reduced risk of internalizing symptoms (i.e., depression, anxiety symptoms). This study examines the effects of Familias Unidas on internalizing symptoms among high-risk youth, as well as the role of family level factors in the intervention's effects. A total of 242 12-17-year-old Hispanic youth with a history of delinquency and their primary caregivers were recruited from the school and juvenile justice systems, and randomly assigned to the Familias Unidas intervention or community practice control. A linear latent growth model was used to examine intervention effects on the trajectory of adolescent internalizing symptoms from baseline to 6 and 12 months post-baseline. Results show that the Familias Unidas intervention was more efficacious than control in reducing youth internalizing symptoms. Baseline youth externalizing and internalizing symptoms did not moderate the intervention's effects on the trajectory of youth internalizing symptoms. While parent-adolescent communication did not significantly moderate the intervention's effects, changes in parent-adolescent communication mediated the intervention's effects on internalizing symptoms, showing stronger intervention effects for youth starting with poorer communication. Findings indicate that the Familias Unidas intervention can reduce internalizing symptoms among high-risk Hispanic youth, and that improving parent-youth communication, a protective family factor, may be one of the mechanisms by which the intervention influences youth internalizing symptoms. © 2015 Family Process Institute.

  2. Compensation for risks: host community benefits in siting locally unwanted facilities

    NASA Astrophysics Data System (ADS)

    Himmelberger, Jeffery J.; Ratick, Samuel J.; White, Allen L.

    1991-09-01

    This article analyzes the recent negotiations connected with siting 24 solid-waste landfills in Wisconsin. We examine the association between the type and amount of compensation paid to host communities by facility developers and the size of facilities, certain facility characteristics, the timing of negotiated agreements, the size of the host community, and the socioeconomic status of the host area. Our findings suggest that the level of compensation after adjusting for landfill capacity is positively associated with the percentage of total facility capacity dedicated to host community use, positively associated with the percentage of people of the host area who are in poverty, and larger for public facilities that accept municipal wastes. Other explanatory variables we examined, whose association with levels of compensation proved statistically insignificant, were facility size, facility status (new vs expansion), facility use (countyonly vs multicounty), timing of negotiation, host community size, and the host area education level, population density, and per capita income. We discuss the policy implications of our principal findings and future research questions in light of the persistent opposition surrounding the siting of solid-waste and other waste-management facilities.

  3. Risk reducing mastectomy, breast reconstruction and patient satisfaction in Norwegian BRCA1/2 mutation carriers.

    PubMed

    Hagen, Anne Irene; Mæhle, Lovise; Vedå, Nina; Vetti, Hildegunn Høberg; Stormorken, Astrid; Ludvigsen, Trond; Guntvedt, Bente; Isern, Anne Elisabeth; Schlichting, Ellen; Kleppe, Geir; Bofin, Anna; Gullestad, Hans Petter; Møller, Pål

    2014-02-01

    The aim of this study was to evaluate the outcome of risk-reducing mastectomy in BRCA1/2 mutation carriers with and without breast cancer. Uptake, methods of operation and reconstruction, complications, patient satisfaction and histopathological findings were registered at all five departments of genetics in Norway. Data from 267 affected and unaffected BRCA1/2 mutation carriers were analyzed, including a study-specific questionnaire returned by 178 mutation carriers. There was a steady increase in the uptake of risk-reducing mastectomies during the study period. Complications were observed in 106/266 (39.7%) women. Patient satisfaction was high. The majority of women expressed great relief after risk-reducing mastectomy and would have chosen the same option again. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Comparative research on NIMBY risk acceptability between Chinese and Japanese college students.

    PubMed

    Wu, Yunqing; Zhai, Guofang; Li, Shasha; Ren, Chongqiang; Tsuchida, Shoji

    2014-10-01

    Along with the progressive acceleration of urbanization, the need to identify potentially troublesome "Not In My Back Yard" (NIMBY) facilities in the city is inevitable. To resolve NIMBY conflict, it is important to know people's NIMBY risk acceptability for these facilities. A questionnaire survey was used among Chinese and Japanese college students to identify NIMBY risk acceptability. LISREL was used to construct a structural equation model to analyze the difference in NIMBY risk acceptability between the Chinese and Japanese college students. Factors that may affect NIMBY risk acceptability were analyzed: "perceiving utility," "perceiving risk," "trust in government," "reasonable compensation," and "procedural justice." The findings show that Japanese students' concerns were greater than Chinese students' concerns. Perceiving utility and perceiving risk were the most important factors that affect people's NIMBY risk acceptability, followed by procedural justice, trust in government, and reasonable compensation. There is a difference between the different cultural backgrounds in confronting the risk: Chinese students focus more on the reputation and value of real estate, while Japanese students pay more attention to environmental pollution and damage to health. Furthermore, cultural influences play a role in students' risk perception. To improve the risk acceptability for NIMBY facilities and provide a basis for resolving NIMBY conflicts, it is necessary to ensure the benefits of the NIMBY facility while reducing environmental pollution. The findings of this study may be of interest for policy makers and practitioners to devise future NIMBY strategies.

  5. Risk factors for fecal colonization with multiple distinct strains of Escherichia coli among long-term care facility residents.

    PubMed

    Lautenbach, Ebbing; Tolomeo, Pam; Black, Nicole; Maslow, Joel N

    2009-05-01

    Of 49 long-term care facility residents, 21 (43%) were colonized with 2 or more distinct strains of Escherichia coli. There were no significant risk factors for colonization with multiple strains of E. coli. These results suggest that future efforts to efficiently identify the diversity of colonizing strains will be challenging.

  6. Risk Factors for Fecal Colonization with Multiple Distinct Strains of Escherichia coli Among Long-Term Care Facility Residents

    PubMed Central

    Lautenbach, Ebbing; Tolomeo, Pam; Black, Nicole; Maslow, Joel N.

    2009-01-01

    Of 49 long-term care facility residents, 21 (43%) were colonized with two or more distinct strains of Escherichia coli. There were no significant risk factors for colonization with multiple strains of E. coli. These results suggest future efforts to efficiently identify diversity of colonizing strains will be challenging. PMID:19292660

  7. The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in patients with dyslipidemia.

    PubMed

    Fruchart, Jean-Charles; Sacks, Frank; Hermans, Michel P; Assmann, Gerd; Brown, W Virgil; Ceska, Richard; Chapman, M John; Dodson, Paul M; Fioretto, Paola; Ginsberg, Henry N; Kadowaki, Takashi; Lablanche, Jean-Marc; Marx, Nikolaus; Plutzky, Jorge; Reiner, Zeljko; Rosenson, Robert S; Staels, Bart; Stock, Jane K; Sy, Rody; Wanner, Christoph; Zambon, Alberto; Zimmet, Paul

    2008-11-17

    Despite achieving targets for low-density lipoprotein (LDL) cholesterol, blood pressure, and glycemia in accordance with current standards of care, patients with dyslipidemia remain at high residual risk of vascular events. Atherogenic dyslipidemia, characterized by elevated triglycerides and low levels of high-density lipoprotein (HDL) cholesterol, often with elevated apolipoprotein B and non-HDL cholesterol, is common in patients with established cardiovascular disease (CVD), type 2 diabetes mellitus, or metabolic syndrome and contributes to both macrovascular and microvascular residual risk. However, atherogenic dyslipidemia is largely underdiagnosed and undertreated in clinical practice. The Residual Risk Reduction Initiative (R3i) was established to address this highly relevant clinical issue. The aims of this position paper are (1) to highlight evidence that atherogenic dyslipidemia is associated with residual macrovascular and microvascular risk in patients at high risk for CVD, despite current standards of care for dyslipidemia and diabetes; and (2) to recommend therapeutic intervention for reducing this residual vascular risk supported by evidence and expert consensus. Lifestyle modification with nutrition and exercise is an important, effective, and underutilized first step in reducing residual vascular risk. Therapeutic intervention aimed at achievement of all lipid targets is also often required. Combination lipid-modifying therapy, with the addition of niacin, a fibrate, or omega-3 fatty acids to statin therapy, increases the probability of achieving all lipid goals. Outcomes studies are in progress to evaluate whether these combination treatment strategies translate to a clinical benefit greater than that achieved with statins alone. The R3i highlights the need to address with lifestyle and/or pharmacotherapy the high level of residual risk of CVD events and microvascular complications among patients with dyslipidemia receiving therapy for high levels

  8. NIH study finds regular aspirin use may reduce ovarian cancer risk

    Cancer.gov

    Women who take aspirin daily may reduce their risk of ovarian cancer by 20 percent, according to a study by scientists at the National Cancer Institute (NCI), part of the National Institutes of Health. However, further research is needed before clinical r

  9. Risk-reducing surgery on the uterine adnexa: timing and type of surgical treatment, and pathology report.

    PubMed

    Signorelli, Mauro; Bogani, Giorgio; Ditto, Antonino; Martinelli, Fabio; Chiappa, Valentina; Lopez, Carlos; Scaffa, Cono; Lorusso, Domenica; Raspagliesi, Francesco

    2016-10-01

    Inherited mutations in BRCA1 and BRCA2 increase significantly the risk of developing breast and ovarian cancers, and they have been associated with increased risks of developing other types of cancer. Although screening programs have been implemented in order to detect cancers at the early stage, they resulted ineffective. To date, risk-reducing bilateral salpingo-oophorectomy represents the only procedure allowing reducing the incidence of ovarian cancer and increasing survival among BRCA1 and -2 mutation carriers. In the present review we will discuss the advantages and disadvantages related to the execution of prophylactic surgery, thus underlying possible beneficial and detrimental effects of this kind of surgery in premenopausal women. Additionally, we will investigate further therapeutic strategies aimed to reduce the risk of developing ovarian cancer, without affected patients' hormonal status.

  10. A Multifaceted School-based Intervention to Reduce Risk for Type 2 Diabetes in At-Risk Youth

    PubMed Central

    Grey, Margaret; Jaser, Sarah S.; Holl, Marita G.; Jefferson, Vanessa; Dziura, James; Northrup, Veronika

    2009-01-01

    Objective To evaluate the impact of a multifaceted, school-based intervention on inner city youth at high risk for type 2 diabetes mellitus (T2DM) and to determine whether the addition of coping skills training (CST) and health coaching improves outcomes. Method 198 students in New Haven, CT at risk for T2DM (BMI > 85th percentile and family history of diabetes) were randomized by school to an educational intervention with or without the addition of CST and health coaching. Students were enrolled from 2004–2007 and followed for 12 months. Results Students in both groups showed some improvement in anthropometric measures, lipids, and depressive symptoms over 12 months. BMI was not improved by the intervention. Students who received CST showed greater improvement on some indicators of metabolic risk than students who received education only. Conclusion A multifaceted, school-based intervention may hold promise for reducing metabolic risk in urban, minority youth. PMID:19643125

  11. Assessing the Risk of Occult Cancer and 30-day Morbidity in Women Undergoing Risk-reducing Surgery: A Prospective Experience.

    PubMed

    Bogani, Giorgio; Tagliabue, Elena; Signorelli, Mauro; Chiappa, Valentina; Carcangiu, Maria Luisa; Paolini, Biagio; Casarin, Jvan; Scaffa, Cono; Gennaro, Massimiliano; Martinelli, Fabio; Borghi, Chiara; Ditto, Antonino; Lorusso, Domenica; Raspagliesi, Francesco

    To investigate the incidence and predictive factors of 30-day surgery-related morbidity and occult precancerous and cancerous conditions for women undergoing risk-reducing surgery. A prospective study (Canadian Task Force classification II-1). A gynecologic oncology referral center. Breast-related cancer antigen (BRCA) mutation carriers and BRCAX patients (those with a significant family history of breast and ovarian cancer). Minimally invasive risk-reduction surgery. Overall, 85 women underwent risk-reducing surgery: 30 (35%) and 55 (65%) had hysterectomy plus bilateral salpingo-oophorectomy (BSO) and BSO alone, respectively. Overall, in 6 (7%) patients, the final pathology revealed unexpected cancer: 3 early-stage ovarian/fallopian tube cancers, 2 advanced-stage ovarian cancers (stage IIIA and IIIB), and 1 serous endometrial carcinoma. Additionally, 3 (3.6%) patients had incidental finding of serous tubal intraepithelial carcinoma. Four (4.7%) postoperative complications within 30 days from surgery were registered, including fever (n = 3) and postoperative ileus (n = 1); no severe (grade 3 or more) complications were observed. All complications were managed conservatively. The presence of occult cancer was the only factor predicting the development of postoperative complications (p = .02). Minimally invasive risk-reducing surgery is a safe and effective strategy to manage BRCA mutation carriers. Patients should benefit from an appropriate counseling about the high prevalence of undiagnosed cancers observed at the time of surgery. Copyright © 2017 AAGL. Published by Elsevier Inc. All rights reserved.

  12. Reducing safety risk among underserved caregivers with an Alzheimer's home safety program.

    PubMed

    Levy-Storms, Lené; Cherry, Debra L; Lee, Linda J; Wolf, Sheldon M

    2017-09-01

    Older adults living with Alzheimer's disease (AD) experience more of the types of accidents and injuries prevalent among older adults. Relatively few studies specifically on safety risks have included older adults of color and tested interventions. This pilot study tested the feasibility and evaluability of educating Hispanic and African American caregivers of patients living with AD about reducing safety risks in their homes. This outpatient memory clinic-based intervention study included a pre-/post-test survey design with two nonequivalent groups and predominately serves Hispanic and African Americans. Of 60 eligible caregivers, 67% participated in a tailored, safety training class with an optional follow-up call. The results indicate a reduction in some safety risks compared to baseline and/or a no intervention group, respectively, including leaving patients at home alone part-time (p < .01 and p < .01), getting lost (p < .05 and p < .05), going outdoors alone less often (p < .05 and p < .01), and giving themselves medicine (p < .05 and p < .01). At post-test, 47 clinically significant instances occurred, in which caregivers who participated in the intervention self-reported patients living with AD to be 'completely safe' in one or more of the safety risk items compared to 8 instances among those who did not. This pilot pre/post design with non-equivalent groups study needs refinement in a future randomized control trial. Despite limitations, this pilot study demonstrates the first feasible and evaluable intervention with both statistically and clinically significant results that suggest potential for reducing safety risks among at-risk minority patients living with AD in future research.

  13. Security culture for nuclear facilities

    NASA Astrophysics Data System (ADS)

    Gupta, Deeksha; Bajramovic, Edita

    2017-01-01

    Natural radioactive elements are part of our environment and radioactivity is a natural phenomenon. There are numerous beneficial applications of radioactive elements (radioisotopes) and radiation, starting from power generation to usages in medical, industrial and agriculture applications. But the risk of radiation exposure is always attached to operational workers, the public and the environment. Hence, this risk has to be assessed and controlled. The main goal of safety and security measures is to protect human life, health, and the environment. Currently, nuclear security considerations became essential along with nuclear safety as nuclear facilities are facing rapidly increase in cybersecurity risks. Therefore, prevention and adequate protection of nuclear facilities from cyberattacks is the major task. Historically, nuclear safety is well defined by IAEA guidelines while nuclear security is just gradually being addressed by some new guidance, especially the IAEA Nuclear Security Series (NSS), IEC 62645 and some national regulations. At the overall level, IAEA NSS 7 describes nuclear security as deterrence and detection of, and response to, theft, sabotage, unauthorized access, illegal transfer or other malicious acts involving nuclear, other radioactive substances and their associated facilities. Nuclear security should be included throughout nuclear facilities. Proper implementation of a nuclear security culture leads to staff vigilance and a high level of security posture. Nuclear security also depends on policy makers, regulators, managers, individual employees and members of public. Therefore, proper education and security awareness are essential in keeping nuclear facilities safe and secure.

  14. Interventions to reduce zoonotic and pandemic risks from avian influenza in Asia

    PubMed Central

    Peiris, Malik; Cowling, Benjamin J.; Wu, Joseph T.; Feng, Luzhao; Guan, Yi; Yu, Hongjie; Leung, Gabriel M.

    2017-01-01

    Summary Novel influenza viruses continue to emerge posing zoonotic and potentially pandemic threats, avian influenza A/H7N9 being the most recent example. While closure of live poultry markets in mainland China was effective at aborting A/H7N9 outbreaks temporarily, they are difficult to sustain, given the current poultry production and marketing systems in China. We summarise interventions taken in mainland China to date. We provide evidence for other more sustainable but effective interventions in the live poultry market (LPM) systems that reduce risk of zoonotic influenza including “rest days” in LPM and banning live poultry in markets overnight. On the longer term, separation of live ducks and geese from terrestrial poultry in LPM systems can reduce the risk of emergence of zoonotic, epizootic (and potentially pandemic) viruses at source. Given evidence that A/H7N9 is now endemic in over half of the provinces in mainland China, and will continue to cause recurrent zoonotic disease in the winter months, such interventions should receive high priority in China as well as other Asian countries which are at risk of introduction of A/H7N9 through cross-border poultry movements. Such generic measures are likely to reduce current as well as future threats from zoonotic influenza. PMID:26654122

  15. Risk-based Prioritization of Facility Decommissioning and Environmental Restoration Projects in the National Nuclear Legacy Liabilities Program at the Chalk River Laboratory - 13564

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

    Nelson, Jerel G.; Kruzic, Michael; Castillo, Carlos

    2013-07-01

    Chalk River Laboratory (CRL), located in Ontario Canada, has a large number of remediation projects currently in the Nuclear Legacy Liabilities Program (NLLP), including hundreds of facility decommissioning projects and over one hundred environmental remediation projects, all to be executed over the next 70 years. Atomic Energy of Canada Limited (AECL) utilized WorleyParsons to prioritize the NLLP projects at the CRL through a risk-based prioritization and ranking process, using the WorleyParsons Sequencing Unit Prioritization and Estimating Risk Model (SUPERmodel). The prioritization project made use of the SUPERmodel which has been previously used for other large-scale site prioritization and sequencing ofmore » facilities at nuclear laboratories in the United States. The process included development and vetting of risk parameter matrices as well as confirmation/validation of project risks. Detailed sensitivity studies were also conducted to understand the impacts that risk parameter weighting and scoring had on prioritization. The repeatable prioritization process yielded an objective, risk-based and technically defendable process for prioritization that gained concurrence from all stakeholders, including Natural Resources Canada (NRCan) who is responsible for the oversight of the NLLP. (authors)« less

  16. Radiological Risk Assessments for Occupational Exposure at Fuel Fabrication Facility in AlTuwaitha Site Baghdad – Iraq by using RESRAD Computer Code

    NASA Astrophysics Data System (ADS)

    Ibrahim, Ziadoon H.; Ibrahim, S. A.; Mohammed, M. K.; Shaban, A. H.

    2018-05-01

    The purpose of this study is to evaluate the radiological risks for workers for one year of their activities at Fuel Fabrication Facility (FFF) so as to make the necessary protection to prevent or minimize risks resulted from these activities this site now is under the Iraqi decommissioning program (40). Soil samples surface and subsurface were collected from different positions of this facility and analyzed by gamma rays spectroscopy technique High Purity Germanium detector (HPGe) was used. It was found out admixture of radioactive isotopes (232Th 40K 238U 235U137Cs) according to the laboratory results the highest values were (975758) for 238U (21203) for 235U (218) for 232Th (4046) for 40K and (129) for 137Cs in (Bqkg1) unit. The annual total radiation dose and risks were estimated by using RESRAD (onsite) 70 computer code. The highest total radiation dose was (5617μSv/year) in area that represented by soil sample (S7) and the radiological risks morbidity and mortality (118E02 8661E03) respectively in the same area

  17. Webinar Presentation: EPA Actions to Reduce Children's Health Risks from Environmental Factors

    EPA Pesticide Factsheets

    This presentation, EPA Actions to Reduce Children's Health Risks from Environmental Factors, was given at the NIEHS/EPA Children's Centers 2015 Webinar Series: The Significance of Children’s Environmental Health Research Through Collaboration.

  18. Different Patterns of Risk Reducing Decisions in Affected or Unaffected BRCA Pathogenic Variant Carriers.

    PubMed

    Lee, Eun-Gyeong; Kang, Hyok Jo; Lim, Myong Cheol; Park, Boyoung; Park, Soo Jin; Jung, So-Youn; Lee, Seeyoun; Kang, Han-Sung; Park, Sang-Yoon; Park, Boram; Joo, Jungnam; Han, Jai Hong; Kong, Sun-Young; Lee, Eun Sook

    2018-05-04

    The purpose of this study was to investigate decision patterns to reduce the risks of BRCA-related breast and gynecologic cancers in carriers of BRCA pathogenic variants. We found a change in risk-reducing (RR) management patterns after December 2012, when the National Health Insurance System (NHIS) of Korea began to pay for BRCA testing and risk-reducing salpingo-oophorectomy (RRSO) in pathogenic-variant carriers. The study group consisted of 992 patients, including 705 with breast cancer (BC), 23 with ovarian cancer (OC), 10 with both, and 254 relatives of high-risk patients who underwent BRCA testing at the National Cancer Center of Korea from January 2008 to December 2016.We analyzed patterns of and factors in RR management. Of the 992 patients, 220 (22.2%) were carriers of BRCA pathogenic variants. About 92.3% (203/220) had a family history of BC and/or OC, which significantly differed between BRCA1 and BRCA2 carriers (p<0.001). All 41 male carriers chose surveillance. Of the 179 female carriers, 59 (71.1%) of the 83 carriers with BC and the 39 (49.4%) of 79 unaffected carriers underwent RR management. None of the carriers affected with OC underwent RR management. Of the management types, RRSO had the highest rate (42.5%) of patient choice. The rate of risk-reducing surgery was significantly higher after 2013 than before 2013 (46.3% [74/160] vs. 31.6% [6/19], p<0.001). RRSO was the preferred management for carriers of BRCA pathogenic variants. The most important factors in treatment choice were NHIS reimbursement and/or the severity of illness.

  19. Risk dishabituation: in repeated gambling, risk is reduced following low-probability "surprising" events (wins or losses).

    PubMed

    Demaree, Heath A; Burns, Kevin J; Dedonno, Michael A; Agarwala, Edward K; Everhart, D Erik

    2012-06-01

    In path-dependent risk taking, like playing a slot machine, the wager on one trial may be affected by the outcome of the preceding trial. Previous studies have shown that a person's risk-taking preferences may change as a result of the preceding trial (win or loss). For example, the "house money effect" suggests that risk taking may increase after a win, whereas the "break even effect" posits that risk taking increases after a loss. Independent of those findings, a person's emotional state has been found to influence risk taking. For example, the "mood maintenance hypothesis" supports the notion that positive affect decreases risk taking, and related research finds that increased negative affect increases risk taking. Because winning and losing may influence one's emotional state, we sought to investigate how both previous outcomes, as well as a person's emotional responses to those outcomes, independently influence subsequent risk taking. To do this, data were collected using three simplified slot machines where the chance of winning each trial was set to 13%, 50%, and 87%, respectively. Evidence for the break even and house money effects were found on the 13% and 87% games, respectively. Likewise, emotional valence was found to predict risk taking on these two tasks, with emotional valence fully explaining the break even effect observed on the 13% game. In addition to these results, the present research revealed that risk taking is reduced following low-probability ("surprising") events (i.e., a win in the 13% condition or loss in the 87% condition). Dubbed "risk dishabituation," this phenomenon is discussed, along with its likely corresponding emotional experience--surprise.

  20. Reducing infection risk in implant-based breast-reconstruction surgery: challenges and solutions

    PubMed Central

    Ooi, Adrian SH; Song, David H

    2016-01-01

    Implant-based procedures are the most commonly performed method for postmastectomy breast reconstruction. While donor-site morbidity is low, these procedures are associated with a higher risk of reconstructive loss. Many of these are related to infection of the implant, which can lead to prolonged antibiotic treatment, undesired additional surgical procedures, and unsatisfactory results. This review combines a summary of the recent literature regarding implant-related breast-reconstruction infections and combines this with a practical approach to the patient and surgery aimed at reducing this risk. Prevention of infection begins with appropriate reconstructive choice based on an assessment and optimization of risk factors. These include patient and disease characteristics, such as smoking, obesity, large breast size, and immediate reconstructive procedures, as well as adjuvant therapy, such as radiotherapy and chemotherapy. For implant-based breast reconstruction, preoperative planning and organization is key to reducing infection. A logical and consistent intraoperative and postoperative surgical protocol, including appropriate antibiotic choice, mastectomy-pocket creation, implant handling, and considered acellular dermal matrix use contribute toward the reduction of breast-implant infections. PMID:27621667

  1. Specifying the ovarian cancer risk threshold of 'premenopausal risk-reducing salpingo-oophorectomy' for ovarian cancer prevention: a cost-effectiveness analysis.

    PubMed

    Manchanda, Ranjit; Legood, Rosa; Antoniou, Antonis C; Gordeev, Vladimir S; Menon, Usha

    2016-09-01

    Risk-reducing salpingo-oophorectomy (RRSO) is the most effective intervention to prevent ovarian cancer (OC). It is only available to high-risk women with >10% lifetime OC risk. This threshold has not been formally tested for cost-effectiveness. To specify the OC risk thresholds for RRSO being cost-effective for preventing OC in premenopausal women. The costs as well as effects of surgical prevention ('RRSO') were compared over a lifetime with 'no RRSO' using a decision analysis model. RRSO was undertaken in premenopausal women >40 years. The model was evaluated at lifetime OC risk levels: 2%, 4%, 5%, 6%, 8% and 10%. Costs and outcomes are discounted at 3.5%. Uncertainty in the model was assessed using both deterministic sensitivity analysis and probabilistic sensitivity analysis (PSA). Outcomes included in the analyses were OC, breast cancer (BC) and additional deaths from coronary heart disease. Total costs and effects were estimated in terms of quality-adjusted life-years (QALYs); incidence of OC and BC; as well as incremental cost-effectiveness ratio (ICER). Published literature, Nurses Health Study, British National Formulary, Cancer Research UK, National Institute for Health and Care Excellence guidelines and National Health Service reference costs. The time horizon is lifetime and perspective: payer. Premenopausal RRSO is cost-effective at 4% OC risk (life expectancy gained=42.7 days, ICER=£19 536/QALY) with benefits largely driven by reduction in BC risk. RRSO remains cost-effective at >8.2% OC risk without hormone replacement therapy (ICER=£29 071/QALY, life expectancy gained=21.8 days) or 6%if BC risk reduction=0 (ICER=£27 212/QALY, life expectancy gained=35.3 days). Sensitivity analysis indicated results are not impacted much by costs of surgical prevention or treatment of OC/ BC or cardiovascular disease. However, results were sensitive to RRSO utility scores. Additionally, 37%, 61%, 74%, 84%, 96% and 99.5% simulations on PSA are cost

  2. Summary of findings from the evaluation of a pilot medically supervised safer injecting facility

    PubMed Central

    Wood, Evan; Tyndall, Mark W.; Montaner, Julio S.; Kerr, Thomas

    2006-01-01

    In many cities, infectious disease and overdose epidemics are occurring among illicit injection drug users (IDUs). To reduce these concerns, Vancouver opened a supervised safer injecting facility in September 2003. Within the facility, people inject pre-obtained illicit drugs under the supervision of medical staff. The program was granted a legal exemption by the Canadian government on the condition that a 3-year scientific evaluation of its impacts be conducted. In this review, we summarize the findings from evaluations in those 3 years, including characteristics of IDUs at the facility, public injection drug use and publicly discarded syringes, HIV risk behaviour, use of addiction treatment services and other community resources, and drug-related crime rates. Vancouver's safer injecting facility has been associated with an array of community and public health benefits without evidence of adverse impacts. These findings should be useful to other cities considering supervised injecting facilities and to governments considering regulating their use. PMID:17116909

  3. Evaluation of an initiative to reduce radiation exposure from CT to children in a non-pediatric-focused facility.

    PubMed

    Blumfield, Einat; Zember, Jonathan; Guelfguat, Mark; Blumfield, Amit; Goldman, Harold

    2015-12-01

    We would like to share our experience of reducing pediatric radiation exposure. Much of the recent literature regarding successes of reducing radiation exposure has come from dedicated children's hospitals. Nonetheless, over the past two decades, there has been a considerable increase in CT imaging of children in the USA, predominantly in non-pediatric-focused facilities where the majority of children are treated. In our institution, two general hospitals with limited pediatric services, a dedicated initiative intended to reduce children's exposure to CT radiation was started by pediatric radiologists in 2005. The initiative addressed multiple issues including eliminating multiphase studies, decreasing inappropriate scans, educating referring providers, training residents and technologists, replacing CT with ultrasound or MRI, and ensuring availability of pediatric radiologists for consultation. During the study period, the total number of CT scans decreased by 24 %. When accounting for the number of scans per visit to the emergency department (ED), the numbers of abdominal and head CT scans decreased by 37.2 and 35.2 %, respectively. For abdominal scans, the average number of phases per scan decreased from 1.70 to 1.04. Upon surveying the pediatric ED staff, it was revealed that the most influential factors on ordering of scans were daily communication with pediatric radiologists, followed by journal articles and lectures by pediatric radiologists. We concluded that a non-pediatric-focused facility can achieve dramatic reduction in CT radiation exposure to children; however, this is most effectively achieved through a dedicated, multidisciplinary process led by pediatric radiologists.

  4. Adequate nutrient intake can reduce cardiovascular disease risk in African Americans.

    PubMed

    Reusser, Molly E; DiRienzo, Douglas B; Miller, Gregory D; McCarron, David A

    2003-03-01

    Cardiovascular disease kills nearly as many Americans each year as the next seven leading causes of death combined. The prevalence of cardiovascular disease and most of its associated risk factors is markedly higher and increasing more rapidly among African Americans than in any other racial or ethnic group. Improving these statistics may be simply a matter of improving diet quality. In recent years, a substantial and growing body of evidence has revealed that dietary patterns complete in all food groups, including nutrient-rich dairy products, are essential for preventing and reducing cardiovascular disease and the conditions that contribute to it. Several cardiovascular risk factors, including hypertension, insulin resistance syndrome, and obesity, have been shown to be positively influenced by dietary patterns that include adequate intake of dairy products. The benefits of nutrient-rich dietary patterns have been specifically tested in randomized, controlled trials emphasizing African American populations. These studies demonstrated proportionally greater benefits for African Americans without evidence of adverse effects such as symptoms of lactose intolerance. As currently promoted for the prevention of certain cancers and osteoporosis, regular consumption of diets that meet recommended nutrient intake levels might also be the most effective approach for reducing cardiovascular disease risk in African Americans.

  5. Wind Energy Facilities

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

    Laurie, Carol

    2017-02-01

    This book takes readers inside the places where daily discoveries shape the next generation of wind power systems. Energy Department laboratory facilities span the United States and offer wind research capabilities to meet industry needs. The facilities described in this book make it possible for industry players to increase reliability, improve efficiency, and reduce the cost of wind energy -- one discovery at a time. Whether you require blade testing or resource characterization, grid integration or high-performance computing, Department of Energy laboratory facilities offer a variety of capabilities to meet your wind research needs.

  6. Wind Energy Facilities

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

    Office of Energy Efficiency and Renewable Energy

    This book takes readers inside the places where daily discoveries shape the next generation of wind power systems. Energy Department laboratory facilities span the United States and offer wind research capabilities to meet industry needs. The facilities described in this book make it possible for industry players to increase reliability, improve efficiency, and reduce the cost of wind energy -- one discovery at a time. Whether you require blade testing or resource characterization, grid integration or high-performance computing, Department of Energy laboratory facilities offer a variety of capabilities to meet your wind research needs.

  7. Is There Room for Prevention? Examining the Effect of Outpatient Facility Type on the Risk of Surgical Site Infection.

    PubMed

    Parikh, Rishi; Pollock, Daniel; Sharma, Jyotirmay; Edwards, Jonathan

    2016-10-01

    OBJECTIVE We compared risk for surgical site infection (SSI) following surgical breast procedures among 2 patient groups: those whose procedures were performed in ambulatory surgery centers (ASCs) and those whose procedures were performed in hospital-based outpatient facilities. DESIGN Cohort study using National Healthcare Safety Network (NHSN) SSI data for breast procedures performed from 2010 to 2014. METHODS Unconditional multivariate logistic regression was used to examine the association between facility type and breast SSI, adjusting for American Society of Anesthesiologists (ASA) Physical Status Classification, patient age, and duration of procedure. Other potential adjustment factors examined were wound classification, anesthesia use, and gender. RESULTS Among 124,021 total outpatient breast procedures performed between 2010 and 2014, 110,987 procedure reports submitted to the NHSN provided complete covariate data and were included in the analysis. Breast procedures performed in ASCs carried a lower risk of SSI compared with those performed in hospital-based outpatient settings. For patients aged ≤51 years, the adjusted risk ratio was 0.36 (95% CI, 0.25-0.50) and for patients >51 years old, the adjusted risk ratio was 0.32 (95% CI, 0.21-0.49). CONCLUSIONS SSI risk following breast procedures was significantly lower among ASC patients than among hospital-based outpatients. These findings should be placed in the context of study limitations, including the possibility of incomplete ascertainment of SSIs and shortcomings in the data available to control for differences in patient case mix. Additional studies are needed to better understand the role of procedural settings in SSI risk following breast procedures and to identify prevention opportunities. Infect Control Hosp Epidemiol 2016;1-7.

  8. A collision risk model to predict avian fatalities at wind facilities: an example using golden eagles, Aquila chrysaetos

    USGS Publications Warehouse

    New, Leslie; Bjerre, Emily; Millsap, Brian A.; Otto, Mark C.; Runge, Michael C.

    2015-01-01

    Wind power is a major candidate in the search for clean, renewable energy. Beyond the technical and economic challenges of wind energy development are environmental issues that may restrict its growth. Avian fatalities due to collisions with rotating turbine blades are a leading concern and there is considerable uncertainty surrounding avian collision risk at wind facilities. This uncertainty is not reflected in many models currently used to predict the avian fatalities that would result from proposed wind developments. We introduce a method to predict fatalities at wind facilities, based on pre-construction monitoring. Our method can directly incorporate uncertainty into the estimates of avian fatalities and can be updated if information on the true number of fatalities becomes available from post-construction carcass monitoring. Our model considers only three parameters: hazardous footprint, bird exposure to turbines and collision probability. By using a Bayesian analytical framework we account for uncertainties in these values, which are then reflected in our predictions and can be reduced through subsequent data collection. The simplicity of our approach makes it accessible to ecologists concerned with the impact of wind development, as well as to managers, policy makers and industry interested in its implementation in real-world decision contexts. We demonstrate the utility of our method by predicting golden eagle (Aquila chrysaetos) fatalities at a wind installation in the United States. Using pre-construction data, we predicted 7.48 eagle fatalities year-1 (95% CI: (1.1, 19.81)). The U.S. Fish and Wildlife Service uses the 80th quantile (11.0 eagle fatalities year-1) in their permitting process to ensure there is only a 20% chance a wind facility exceeds the authorized fatalities. Once data were available from two-years of post-construction monitoring, we updated the fatality estimate to 4.8 eagle fatalities year-1 (95% CI: (1.76, 9.4); 80th quantile, 6

  9. A Collision Risk Model to Predict Avian Fatalities at Wind Facilities: An Example Using Golden Eagles, Aquila chrysaetos

    PubMed Central

    New, Leslie; Bjerre, Emily; Millsap, Brian; Otto, Mark C.; Runge, Michael C.

    2015-01-01

    Wind power is a major candidate in the search for clean, renewable energy. Beyond the technical and economic challenges of wind energy development are environmental issues that may restrict its growth. Avian fatalities due to collisions with rotating turbine blades are a leading concern and there is considerable uncertainty surrounding avian collision risk at wind facilities. This uncertainty is not reflected in many models currently used to predict the avian fatalities that would result from proposed wind developments. We introduce a method to predict fatalities at wind facilities, based on pre-construction monitoring. Our method can directly incorporate uncertainty into the estimates of avian fatalities and can be updated if information on the true number of fatalities becomes available from post-construction carcass monitoring. Our model considers only three parameters: hazardous footprint, bird exposure to turbines and collision probability. By using a Bayesian analytical framework we account for uncertainties in these values, which are then reflected in our predictions and can be reduced through subsequent data collection. The simplicity of our approach makes it accessible to ecologists concerned with the impact of wind development, as well as to managers, policy makers and industry interested in its implementation in real-world decision contexts. We demonstrate the utility of our method by predicting golden eagle (Aquila chrysaetos) fatalities at a wind installation in the United States. Using pre-construction data, we predicted 7.48 eagle fatalities year-1 (95% CI: (1.1, 19.81)). The U.S. Fish and Wildlife Service uses the 80th quantile (11.0 eagle fatalities year-1) in their permitting process to ensure there is only a 20% chance a wind facility exceeds the authorized fatalities. Once data were available from two-years of post-construction monitoring, we updated the fatality estimate to 4.8 eagle fatalities year-1 (95% CI: (1.76, 9.4); 80th quantile, 6

  10. A Collision Risk Model to Predict Avian Fatalities at Wind Facilities: An Example Using Golden Eagles, Aquila chrysaetos.

    PubMed

    New, Leslie; Bjerre, Emily; Millsap, Brian; Otto, Mark C; Runge, Michael C

    2015-01-01

    Wind power is a major candidate in the search for clean, renewable energy. Beyond the technical and economic challenges of wind energy development are environmental issues that may restrict its growth. Avian fatalities due to collisions with rotating turbine blades are a leading concern and there is considerable uncertainty surrounding avian collision risk at wind facilities. This uncertainty is not reflected in many models currently used to predict the avian fatalities that would result from proposed wind developments. We introduce a method to predict fatalities at wind facilities, based on pre-construction monitoring. Our method can directly incorporate uncertainty into the estimates of avian fatalities and can be updated if information on the true number of fatalities becomes available from post-construction carcass monitoring. Our model considers only three parameters: hazardous footprint, bird exposure to turbines and collision probability. By using a Bayesian analytical framework we account for uncertainties in these values, which are then reflected in our predictions and can be reduced through subsequent data collection. The simplicity of our approach makes it accessible to ecologists concerned with the impact of wind development, as well as to managers, policy makers and industry interested in its implementation in real-world decision contexts. We demonstrate the utility of our method by predicting golden eagle (Aquila chrysaetos) fatalities at a wind installation in the United States. Using pre-construction data, we predicted 7.48 eagle fatalities year-1 (95% CI: (1.1, 19.81)). The U.S. Fish and Wildlife Service uses the 80th quantile (11.0 eagle fatalities year-1) in their permitting process to ensure there is only a 20% chance a wind facility exceeds the authorized fatalities. Once data were available from two-years of post-construction monitoring, we updated the fatality estimate to 4.8 eagle fatalities year-1 (95% CI: (1.76, 9.4); 80th quantile, 6

  11. Do risk assessment tools help manage and reduce risk of violence and reoffending? A systematic review.

    PubMed

    Viljoen, Jodi L; Cochrane, Dana M; Jonnson, Melissa R

    2018-06-01

    Although it is widely believed that risk assessment tools can help manage risk of violence and offending, it is unclear what evidence exists to support this view. As such, we conducted a systematic review and narrative synthesis. To identify studies, we searched 13 databases, reviewed reference lists, and contacted experts. Through this review, we identified 73 published and unpublished studies (N = 31,551 psychiatric patients and offenders, N = 10,002 professionals) that examined either professionals' risk management efforts following the use of a tool, or rates of violence or offending following the implementation of a tool. These studies included a variety of populations (e.g., adults, adolescents), tools, and study designs. The primary findings were as follows: (a) despite some promising findings, professionals do not consistently adhere to tools or apply them to guide their risk management efforts; (b) following the use of a tool, match to the risk principle is moderate and match to the needs principle is limited, as many needs remained unaddressed; (c) there is insufficient evidence to conclude that tools directly reduce violence or reoffending, as findings are mixed; and (d) tools appear to have a more beneficial impact on risk management when agencies use careful implementation procedures and provide staff with training and guidelines related to risk management. In sum, although risk assessment tools may be an important starting point, they do not guarantee effective treatment or risk management. However, certain strategies may bolster their utility. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  12. Reducing hospital-acquired heel ulcer rates in an acute care facility: an evaluation of a nurse-driven performance improvement project.

    PubMed

    McElhinny, Mary Louise; Hooper, Christine

    2008-01-01

    A nurse-driven performance improvement project designed to reduce the incidence of hospital-acquired ulcers of the heel in an acute care setting was evaluated. This was a descriptive evaluative study using secondary data analysis. Data were collected in 2004, prior to implementation of the prevention project and compared to results obtained in 2006, after the project was implemented. Data were collected in a 172-bed, not-for-profit inpatient acute care facility in North Central California. All medical-surgical inpatients aged 18 years and older were included in the samples. Data were collected on 113 inpatients prior to implementation of the project in 2004. Data were also collected on a sample of 124 inpatients in 2006. The prevalence and incidence of heel pressure ulcers were obtained through skin surveys prior to implementation of the prevention program and following its implementation. Results from 2004 were compared to data collected in 2006 after introduction of the Braden Scale for Predicting Pressure Sore Risk. Heel pressure ulcers were staged using the National Pressure Ulcer Advisory Panel (NPUAP) staging system and recommendations provided by the Agency for Health Care Quality Research (AHRQ) clinical practice guidelines. The incidence of hospital-acquired heel pressure ulcers in 2004 was 13.5% (4 of 37 patients). After implementation of the program in 2006, the incidence of hospital-acquired heel pressure ulcers was 13.8% (5 of 36 patients). The intervention did not appear to receive adequate staff nurse support needed to make the project successful. Factors that influenced the lack of support may have included: (1) educational method used, (2) lack of organization approved, evidenced-based standardized protocols for prevention and treatment of heel ulcers, and (3) failure of facility management to convey the importance as well as their support for the project.

  13. Reducing drug–herb interaction risk with a computerized reminder system

    PubMed Central

    Lin, Sheng-Shing; Tsai, Chiu-Lin; Tu, Ching-Yeh; Hsieh, Ching-Liang

    2015-01-01

    Background Traditional Chinese medicine (TCM) and Western medicine are both popular in Taiwan. Approximately 14.1% of Taiwanese residents use Western drugs and Chinese herbs concurrently; therefore, drug–herb interaction is critical to patient safety. This paper presents a new procedure for reducing the risk of drug interactions. Methods Hospital computer systems are modified to ensure that drug–herb interactions are automatically detected when a TCM practitioner is writing a prescription. A pop-up reminder appears, warning of interactions, and the practitioner may adjust doses, delete herbs, or leave the prescription unchanged. A pharmacist will receive interaction information through the system and provide health education to the patient. Results During the 2011–2013 study period, 256 patients received 891 herbal prescriptions with potential drug–herb interactions. Three of the 50 patients who concurrently used ginseng and antidiabetic drugs manifested hypoglycemia (fasting blood sugar level ≤70 mg/dL). Conclusion Drug–herb interactions can cause adverse reactions. A computerized reminder system can enable TCM practitioners to reduce the risk of drug–herb interactions. In addition, health education for patients is crucial in avoiding adverse reaction by the interactions. PMID:25733840

  14. Does Chocolate Intake During Pregnancy Reduce the Risks of Preeclampsia and Gestational Hypertension?

    PubMed Central

    Saftlas, Audrey F.; Triche, Elizabeth W.; Beydoun, Hind; Bracken, Michael B.

    2010-01-01

    Purpose Chocolate consumption is associated with favorable levels of blood pressure and other cardiovascular disease risk markers. We analyzed a prospective cohort study to determine if regular chocolate intake during pregnancy is associated with reduced risks of preeclampsia and gestational hypertension (GH). Methods Subjects were recruited from 13 prenatal care practices in Connecticut (1988-1991). In-person interviews were administered at <16 weeks gestation to ascertain risk factors for adverse pregnancy outcomes. Hospital delivery and prenatal records were abstracted to classify preeclampsia (n=58), GH (n=158), and normotensive pregnancies (n=2351). Chocolate consumption (servings/week) during the 1st and 3rd trimesters was ascertained at initial interview and immediately postpartum, respectively. Consumers of <1 serving/week comprised the referent group. Adjusted odds ratios (aOR) were estimated using logistic regression. Results Chocolate intake was more frequent among normotensives (80.7%) than preeclamptics (62.5%) or GH women (75.8%), and associated with reduced odds of preeclampsia (1st trimester: aOR=0.55, 95% CI: 0.32-0.95; 3rd trimester: aOR=0.56, 95% CI: 0.32-0.97). Only 1st trimester intake was associated with reduced odds of GH (aOR=0.65, 95% CI: 0.45-0.87). Conclusions These findings provide additional evidence of the benefits of chocolate. Prospective studies are needed to confirm and delineate protective effects of chocolate intake on risk of preeclampsia. PMID:20609337

  15. Does chocolate intake during pregnancy reduce the risks of preeclampsia and gestational hypertension?

    PubMed

    Saftlas, Audrey F; Triche, Elizabeth W; Beydoun, Hind; Bracken, Michael B

    2010-08-01

    Chocolate consumption is associated with favorable levels of blood pressure and other cardiovascular disease risk markers. We analyzed a prospective cohort study to determine whether regular chocolate intake during pregnancy is associated with reduced risks of preeclampsia and gestational hypertension (GH). Subjects were recruited from 13 prenatal care practices in Connecticut (1988-1991). In-person interviews were administered at <16 weeks' gestation to ascertain risk factors for adverse pregnancy outcomes. Hospital delivery and prenatal records were abstracted to classify preeclampsia (n = 58), GH (n = 158), and normotensive pregnancies (n = 2351). Chocolate consumption (servings/week) during the first and third trimesters was ascertained at initial interview and immediately postpartum, respectively. Consumers of less than 1 serving/week comprised the referent group. Adjusted odds ratios (aORs) were estimated by the use of logistic regression. Chocolate intake was more frequent among normotensive (80.7%) than preeclamptic (62.5%) or GH women (75.8%), and associated with reduced odds of preeclampsia (first trimester: aOR, 0.55; 95% confidence interval [95% CI], 0.32-0.95; third trimester: aOR, 0.56; 95% CI, 0.32-0.97). Only first trimester intake was associated with reduced odds of GH (aOR,0.65; 95% CI, 0.45-0.87). These findings provide additional evidence of the benefits of chocolate. Prospective studies are needed to confirm and delineate protective effects of chocolate intake on risk of preeclampsia. 2010 Elsevier Inc. All rights reserved.

  16. Provision of individualised obstetric risk advice to increase health facility usage by women at risk of a complicated delivery: a cohort study of women in the rural highlands of West Ethiopia.

    PubMed

    Ballard, K; Gari, L; Mosisa, H; Wright, J

    2013-07-01

    To determine whether the provision of individualised obstetric risk advice would increase health facility usage in women at life-threatening risk of a complicated delivery in Ethiopia, where maternal mortality has remained high and static for a decade and where, although the government has increased the number of health facilities, 90% of women deliver their babies at home. A prospective cohort study. Rural Ethiopian highlands. A total of 294 pregnant women at 32 weeks or more of gestation. Before being provided with individualised risk advice, women were asked about their birth plans, and in particular, their planned delivery place. Those identified as being at risk of a complicated delivery were followed up to find out whether they altered their birth plans. A change in birthplace. Women identified as being at high risk of a complicated delivery significantly changed their plans (P < 0.01), with 34 (89%) women delivering in hospital. Women with a medium risk did not significantly change their birth plans (P = 0.082), with 35 (36%) delivering at home. Women with a high parity were less likely to change their birth plans compared with primigravid women (odds ratio 0.53; 95% confidence interval 0.34-0.83) and high-risk women were more likely to change their plans compared with medium-risk women (odds ratio 6.2; 95% confidence interval 1.8-21.6). Providing simple, individualised advice about the risks of a complicated delivery leads to high-risk women delivering in hospital. Embedding this into the current antenatal care system in Ethiopia could significantly decrease maternal mortality. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG.

  17. Reducing risks to children in vehicles with passenger airbags.

    PubMed

    Graham, J D; Goldie, S J; Segui-Gomez, M; Thompson, K M; Nelson, T; Glass, R; Simpson, A; Woerner, L G

    1998-07-01

    This review examines the risk that passenger airbags pose for children and discusses behavioral and technologic measures aimed at protecting children from airbag deployment. Although airbags reduce fatal crash injuries among adult drivers and passengers, this safety technology increases mortality risk among children younger than age 12. The magnitude of the risk is multiplied when children are unrestrained or restrained improperly. As new vehicles are resold to buyers who tend to be less safety-conscious than new car owners, the number of children endangered by passenger airbag deployment may increase. For vehicles already in the fleet, strong measures are required to secure children in the rear seat and increase the proper use of appropriate restraint systems through police enforcement of laws. One promising strategy is to amend child passenger safety laws to require that parents secure children in the rear seats. For future vehicles, a mandatory performance standard should be adopted that suppresses airbag deployment automatically if a child is located in the front passenger seat. Other promising improvements in airbag design also are discussed. Major changes in passenger airbag design must be evaluated in a broad analytical framework that considers the welfare of adults as well as children.

  18. Artistic occupations are associated with a reduced risk of Parkinson's disease.

    PubMed

    Haaxma, Charlotte A; Borm, George F; van der Linden, Dimitri; Kappelle, Arnoud C; Bloem, Bastiaan R

    2015-09-01

    Parkinson's disease (PD) is preceded by a premotor phase of unknown duration. Dopaminergic degeneration during this phase may lead to subtle cognitive and behavioural changes, such as decreased novelty seeking. Consequently, premotor subjects might be most comfortable in jobs that do not require optimal dopamine levels, leading to an overrepresentation in structured and predictable occupations, or an underrepresentation in artistic occupations. In a case-control study, 750 men with PD (onset ≥40 years) and 1300 healthy men completed a validated questionnaire about their lifetime occupational status. Occupations were classified using the RIASEC model. Odds ratios (ORs) were calculated for the conventional and artistic categories, both for the most recent occupation before symptom onset, and for the very first occupation. Because farming has been associated with a PD risk, ORs were calculated separately for farming. A reduced risk of PD was found for men with an artistic occupation late in life (OR 0.14, 95% CI 0.04-0.53), while an artistic first occupation did not prevent PD (OR 0.72, CI 0.32-1.59). Conventional occupations showed no increased risk (recent: OR 1.07, CI 0.70-1.64; first: OR 1.14, CI 0.77-1.71). In support of previous reports, farming was associated with an increased risk of PD (recent: OR 2.6, CI 1.4-4.6; first: OR 2.7, CI 1.6-4.5). PD patients were older than controls, but various statistical corrections for age all lead to similar results. Artistic occupations late in life are associated with a reduced risk of subsequent PD, perhaps because this reflects a better preserved dopaminergic state. No initial occupation predicted PD, suggesting that the premotor phase starts later in life.

  19. Drug-nutrient interactions in three long-term-care facilities.

    PubMed

    Lewis, C W; Frongillo, E A; Roe, D A

    1995-03-01

    To assess the risk of drug-nutrient interactions (DNIs) in three long-term-care facilities. Retrospective audit of charts. Three long-term-care facilities in central New York State. Fifty-three patients selected randomly from each facility. Data were collected from the medical record of each patient for a period of 6 months. A computerized algorithm was used to assess the risk for DNIs. Mean drug use, most frequently consumed drugs, incidence of potential DNIs, and the most commonly observed potential DNIs are reported. In facilities A, B, and C, respectively, patients consumed a mean of 4.86, 4.04, and 5.27 drugs per patient per month and were at risk for a mean of 1.43, 2.69, and 1.43 potential DNIs per patient per month. The most commonly observed potential DNIs were gastrointestinal interactions affecting drug bioavailability and interactions affecting electrolyte status. Patients in long-term-care facilities, who are primarily elderly and chronically ill and who consume multiple medications, are at notable risk for certain DNIs. Efforts need to be made to ensure appropriate pharmacologic and nutrition therapies as well as adequate and timely monitoring of patients in these facilities. Dietitians can play an important role in training other health professionals and in designing policies to prevent DNIs.

  20. Integration of Biosafety into Core Facility Management

    PubMed Central

    Fontes, Benjamin

    2013-01-01

    This presentation will discuss the implementation of biosafety policies for small, medium and large core laboratories with primary shared objectives of ensuring the control of biohazards to protect core facility operators and assure conformity with applicable state and federal policies, standards and guidelines. Of paramount importance is the educational process to inform core laboratories of biosafety principles and policies and to illustrate the technology and process pathways of the core laboratory for biosafety professionals. Elevating awareness of biohazards and the biosafety regulatory landscape among core facility operators is essential for the establishment of a framework for both project and material risk assessment. The goal of the biohazard risk assessment process is to identify the biohazard risk management parameters to conduct the procedure safely and in compliance with applicable regulations. An evaluation of the containment, protective equipment and work practices for the procedure for the level of risk identified is facilitated by the establishment of a core facility registration form for work with biohazards and other biological materials with potential risk. The final step in the biocontainment process is the assumption of Principal Investigator role with full responsibility for the structure of the site-specific biosafety program plan by core facility leadership. The presentation will provide example biohazard protocol reviews and accompanying containment measures for core laboratories at Yale University.

  1. Safe system approach to reducing serious injury risk in motorcyclist collisions with fixed hazards.

    PubMed

    Bambach, M R; Mitchell, R J

    2015-01-01

    Collisions with fixed objects in the roadway environment account for a substantial proportion of motorcyclist fatalities. Many studies have identified individual roadway environment and/or motorcyclist characteristics that are associated with the severity of the injury outcome, including the presence of roadside barriers, helmet use, alcohol use and speeding. However, no studies have reported the cumulative benefit of such characteristics on motorcycling safety. The safe system approach recognises that the system must work as a whole to reduce the net injury risk to road users to an acceptable level, including the four system cornerstone areas of roadways, speeds, vehicles and people. The aim of the present paper is to consider these cornerstone areas concomitantly, and quantitatively assess the serious injury risk of motorcyclists in fixed object collisions using this holistic approach. A total of 1006 Australian and 15,727 (weighted) United States motorcyclist-fixed object collisions were collected retrospectively, and the serious injury risks associated with roadside barriers, helmet use, alcohol use and speeding were assessed both individually and concomitantly. The results indicate that if safety efforts are made in each of the safe system cornerstone areas, the combined effect is to substantially reduce the serious injury risk of fixed hazards to motorcyclists. The holistic approach is shown to reduce the serious injury risk considerably more than each of the safety efforts considered individually. These results promote the use of a safe system approach to motorcycling safety. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. EFEHR - the European Facilities for Earthquake Hazard and Risk: beyond the web-platform

    NASA Astrophysics Data System (ADS)

    Danciu, Laurentiu; Wiemer, Stefan; Haslinger, Florian; Kastli, Philipp; Giardini, Domenico

    2017-04-01

    European Facilities for Earthquake Hazard and Risk (EEFEHR) represents the sustainable community resource for seismic hazard and risk in Europe. The EFEHR web platform is the main gateway to access data, models and tools as well as provide expertise relevant for assessment of seismic hazard and risk. The main services (databases and web-platform) are hosted at ETH Zurich and operated by the Swiss Seismological Service (Schweizerischer Erdbebendienst SED). EFEHR web-portal (www.efehr.org) collects and displays (i) harmonized datasets necessary for hazard and risk modeling, e.g. seismic catalogues, fault compilations, site amplifications, vulnerabilities, inventories; (ii) extensive seismic hazard products, namely hazard curves, uniform hazard spectra and maps for national and regional assessments. (ii) standardized configuration files for re-computing the regional seismic hazard models; (iv) relevant documentation of harmonized datasets, models and web-services. Today, EFEHR distributes full output of the 2013 European Seismic Hazard Model, ESHM13, as developed within the SHARE project (http://www.share-eu.org/); the latest results of the 2014 Earthquake Model of the Middle East (EMME14), derived within the EMME Project (www.emme-gem.org); the 2001 Global Seismic Hazard Assessment Project (GSHAP) results and the 2015 updates of the Swiss Seismic Hazard. New datasets related to either seismic hazard or risk will be incorporated as they become available. We present the currents status of the EFEHR platform, with focus on the challenges, summaries of the up-to-date datasets, user experience and feedback, as well as the roadmap to future technological innovation beyond the web-platform development. We also show the new services foreseen to fully integrate with the seismological core services of European Plate Observing System (EPOS).

  3. Does opioid substitution treatment in prisons reduce injecting-related HIV risk behaviours? A systematic review.

    PubMed

    Larney, Sarah

    2010-02-01

    To review systematically the evidence on opioid substitution treatment (OST) in prisons in reducing injecting-related human immunodeficiency virus (HIV) risk behaviours. Systematic review in accordance with guidelines of the Cochrane Collaboration. Electronic databases were searched to identify studies of prison-based opioid substitution treatment programmes that included assessment of effects of prison OST on injecting drug use, sharing of needles and syringes and HIV incidence. Published data were used to calculate risk ratios for outcomes of interest. Risk ratios were not pooled due to the low number of studies and differences in study designs. Five studies were included in the review. Poor follow-up rates were reported in two studies, and representativeness of the sample was uncertain in the remaining three studies. Compared to inmates in control conditions, for treated inmates the risk of injecting drug use was reduced by 55-75% and risk of needle and syringe sharing was reduced by 47-73%. No study reported a direct effect of prison OST on HIV incidence. There may be a role for OST in preventing HIV transmission in prisons, but methodologically rigorous research addressing this question specifically is required. OST should be implemented in prisons as part of comprehensive HIV prevention programmes that also provide condoms and sterile injecting and tattooing equipment.

  4. An Innovative Approach for Decreasing Fall Trauma Admissions from Geriatric Living Facilities: Preliminary Investigation.

    PubMed

    Evans, Tracy; Gross, Brian; Rittenhouse, Katelyn; Harnish, Carissa; Vellucci, Ashley; Bupp, Katherine; Horst, Michael; Miller, Jo Ann; Baier, Ron; Chandler, Roxanne; Rogers, Frederick B

    2015-12-01

    Geriatric living facilities have been associated with a high rate of falls. We sought to develop an innovative intervention approach targeting geriatric living facilities that would reduce geriatric fall admissions to our Level II trauma center. In 2011, a Trauma Prevention Taskforce visited 5 of 28 local geriatric living facilities to present a fall prevention protocol composed of three sections: fall education, risk factor identification, and fall prevention strategies. To determine the impact of the intervention, the trauma registry was queried for all geriatric fall admissions attributed to patients living at local geriatric living facilities. The fall admission rate (total fall admissions/total beds) of the pre-intervention period (2010-2011) was compared with that of the postintervention period (2012-2013) at the 5 intervention and 23 control facilities. A P value < 0.05 was considered statistically significant. From 2010 to 2013, there were 487 fall admissions attributed to local geriatric living facilities (intervention: 179 fall admissions; control: 308 fall admissions). The unadjusted fall rate decreased at intervention facilities from 8.9 fall admissions/bed pre-intervention to 8.1 fall admissions/bed postintervention, whereas fall admission rates increased at control sites from 5.9 to 7.7 fall admissions/bed during the same period [control/intervention odds ratio (OR), 95% confidence interval (CI) = 1.32, 1.05-1.67; period OR, 95%CI = 1.55, 1.18-2.04, P = 0.002; interaction of control/intervention group and period OR 95% CI = 0.68, 0.46-1.00, P = 0.047]. An aggressive intervention program targeting high-risk geriatric living facilities resulted in a statistically significant decrease in geriatric fall admissions to our Level II trauma center.

  5. Multidimensional team-based intervention using musical cues to reduce odds of facility-acquired pressure ulcers in long-term care: a paired randomized intervention study.

    PubMed

    Yap, Tracey L; Kennerly, Susan M; Simmons, Mark R; Buncher, Charles R; Miller, Elaine; Kim, Jay; Yap, Winston Y

    2013-09-01

    To test the effectiveness of a pressure ulcer (PU) prevention intervention featuring musical cues to remind all long-term care (LTC) staff (nursing and ancillary) to help every resident move or reposition every 2 hours. Twelve-month paired-facility two-arm (with one-arm crossover) randomized intervention trial. Ten midwestern U.S. LTC facilities. Four treatment facilities received intervention during Months 1 to 12, four comparison facilities received intervention during Months 7 to 12, and two pseudo-control facilities received no intervention. LTC facility residents (N = 1,928). All facility staff received in-person education, video, and handouts, and visiting family members received informational pamphlets on PU prevention and an intervention featuring musical cues. Nurse-led multidisciplinary staff teams presented the cues as prompts for staff and family to reposition residents or remind them to move. Musical selections (with and without lyrics) customized to facility preferences were played daily over the facility intercom or public address system every 2 hours for the 12-hour daytime period. Primary outcome measure was the frequency of new facility-acquired PUs divided by the total number of facility Minimum Data Set (MDS) resident assessments conducted during the study period. Odds of a new PU were lower in intervention facilities (P = .08) for MDS 2.0 assessments and were significantly lower (P = .05) for MDS 3.0. Mean odds ratios suggested intervention facility residents were 45% less likely than comparison facility residents to develop a new PU. Customized musical cues that prompt multidisciplinary staff teams to encourage or enable movement of all residents hold promise for reducing facility-acquired PUs in LTC settings. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

  6. Facile synthesis of iron oxides/reduced graphene oxide composites: application for electromagnetic wave absorption at high temperature.

    PubMed

    Zhang, Lili; Yu, Xinxin; Hu, Hongrui; Li, Yang; Wu, Mingzai; Wang, Zhongzhu; Li, Guang; Sun, Zhaoqi; Chen, Changle

    2015-03-19

    Iron oxides/reduced graphene oxide composites were synthesized by facile thermochemical reactions of graphite oxide and FeSO4 · 7H2O. By adjusting reaction temperature, α-Fe2O3/reduced graphene oxide and Fe3O4/reduced graphene oxide composites can be obtained conveniently. Graphene oxide and reduced graphene oxide sheets were demonstrated to regulate the phase transition from α-Fe2O3 to Fe3O4 via γ-Fe2O3, which was reported for the first time. The hydroxyl groups attached on the graphene oxide sheets and H2 gas generated during the annealing of graphene oxide are believed to play an important role during these phase transformations. These samples showed good electromagnetic wave absorption performance due to their electromagnetic complementary effect. These samples possess much better electromagnetic wave absorption properties than the mixture of separately prepared Fe3O4 with rGO, suggesting the crucial role of synthetic method in determining the product properties. Also, these samples perform much better than commercial absorbers. Most importantly, the great stability of these composites is highly advantageous for applications as electromagnetic wave absorption materials at high temperatures.

  7. Facile synthesis of iron oxides/reduced graphene oxide composites: application for electromagnetic wave absorption at high temperature

    PubMed Central

    Zhang, Lili; Yu, Xinxin; Hu, Hongrui; Li, Yang; Wu, Mingzai; Wang, Zhongzhu; Li, Guang; Sun, Zhaoqi; Chen, Changle

    2015-01-01

    Iron oxides/reduced graphene oxide composites were synthesized by facile thermochemical reactions of graphite oxide and FeSO4·7H2O. By adjusting reaction temperature, α-Fe2O3/reduced graphene oxide and Fe3O4/reduced graphene oxide composites can be obtained conveniently. Graphene oxide and reduced graphene oxide sheets were demonstrated to regulate the phase transition from α-Fe2O3 to Fe3O4 via γ-Fe2O3, which was reported for the first time. The hydroxyl groups attached on the graphene oxide sheets and H2 gas generated during the annealing of graphene oxide are believed to play an important role during these phase transformations. These samples showed good electromagnetic wave absorption performance due to their electromagnetic complementary effect. These samples possess much better electromagnetic wave absorption properties than the mixture of separately prepared Fe3O4 with rGO, suggesting the crucial role of synthetic method in determining the product properties. Also, these samples perform much better than commercial absorbers. Most importantly, the great stability of these composites is highly advantageous for applications as electromagnetic wave absorption materials at high temperatures. PMID:25788158

  8. Reducing risk of spinal haematoma from spinal and epidural pain procedures.

    PubMed

    Breivik, Harald; Norum, Hilde; Fenger-Eriksen, Christian; Alahuhta, Seppo; Vigfússon, Gísli; Thomas, Owain; Lagerkranser, Michael

    2018-04-25

    Central neuraxial blocks (CNB: epidural, spinal and their combinations) and other spinal pain procedures can cause serious harm to the spinal cord in patients on antihaemostatic drugs or who have other risk-factors for bleeding in the spinal canal. The purpose of this narrative review is to provide a practise advisory on how to reduce risk of spinal cord injury from spinal haematoma (SH) during CNBs and other spinal pain procedures. Scandinavian guidelines from 2010 are part of the background for this practise advisory. We searched recent guidelines, PubMed (MEDLINE), SCOPUS and EMBASE for new and relevant randomised controlled trials (RCT), case-reports and original articles concerning benefits of neuraxial blocks, risks of SH due to anti-haemostatic drugs, patient-related risk factors, especially renal impairment with delayed excretion of antihaemostatic drugs, and specific risk factors related to the neuraxial pain procedures. Epidural and spinal analgesic techniques, as well as their combination provide superior analgesia and reduce the risk of postoperative and obstetric morbidity and mortality. Spinal pain procedure can be highly effective for cancer patients, less so for chronic non-cancer patients. We did not identify any RCT with SH as outcome. We evaluated risks and recommend precautions for SH when patients are treated with antiplatelet, anticoagulant, or fibrinolytic drugs, when patients' comorbidities may increase risks, and when procedure-specific risk factors are present. Inserting and withdrawing epidural catheters appear to have similar risks for initiating a SH. Invasive neuraxial pain procedures, e.g. spinal cord stimulation, have higher risks of bleeding than traditional neuraxial blocks. We recommend robust monitoring routines and treatment protocol to ensure early diagnosis and effective treatment of SH should this rare but potentially serious complication occur. When neuraxial analgesia is considered for a patient on anti

  9. Prevalence and work-related risk factors for reduced activities and absenteeism due to low back symptoms.

    PubMed

    Widanarko, Baiduri; Legg, Stephen; Stevenson, Mark; Devereux, Jason; Eng, Amanda; 't Mannetje, Andrea; Cheng, Soo; Pearce, Neil

    2012-07-01

    Although quite a lot is known about the risk factors for low back symptoms (LBS), less is known about the risk factors for the consequences of LBS. A sample of 3003 men and women randomly selected from the New Zealand Electoral Roll, were interviewed by telephone about self reported physical, psychosocial, organizational, environmental factors and the consequences of LBS (i.e. self-reported reduced activities and absenteeism). The 12-month period prevalence of reduced activities and absenteeism were 18% and 9%, respectively. Lifting (OR 1.79 95% CI 1.16-2.77) increased the risk of reduced activities. Working in awkward/tiring positions (OR 2.11 95% CI 1.20-3.70) and in a cold/damp environment (OR 2.18 95% CI 1.11-4.28) increased the risk of absenteeism. Among those with LBS, reduced activities increased with working in a hot/warm environment (OR 2.14 95% CI 1.22-3.76) and absenteeism was increased with work in awkward/tiring positions (OR 2.06 95% CI 1.13-3.77), tight deadlines (OR 1.89 95% CI 1.02-3.50), and a hot/warm environment (OR 3.35 95% CI 1.68-6.68). Interventions to reduce the consequences of LBS should aim to reduce awkward/tiring positions, lifting and work in a cold/damp environment. For individuals with LBS, additional focus should be to reduce tight deadlines, and work in hot/warm environments. Copyright © 2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  10. Facile synthesis of porous Pt-Pd nanospheres supported on reduced graphene oxide nanosheets for enhanced methanol electrooxidation

    NASA Astrophysics Data System (ADS)

    Li, Shan-Shan; Lv, Jing-Jing; Hu, Yuan-Yuan; Zheng, Jie-Ning; Chen, Jian-Rong; Wang, Ai-Jun; Feng, Jiu-Ju

    2014-02-01

    In this study, a simple, facile, and effective wet-chemical strategy was developed in the synthesis of uniform porous Pt-Pd nanospheres (Pt-Pd NSs) supported on reduced graphene oxide nanosheets (RGOs) under ambient temperature, where octylphenoxypolye thoxyethanol (NP-40) is used as a soft template, without any seed, organic solvent or special instruments. The as-prepared nanocomposites display enhanced electrocatalytic activity and good stability toward methanol oxidation, compared with commercial Pd/C and Pt/C catalysts. This strategy may open a new route to design and prepare advanced electrocatalysts for fuel cells.

  11. Life Sciences Centrifuge Facility assessment

    NASA Technical Reports Server (NTRS)

    Benson, Robert H.

    1994-01-01

    This report provides an assessment of the status of the Centrifuge Facility being developed by ARC for flight on the International Space Station Alpha. The assessment includes technical status, schedules, budgets, project management, performance of facility relative to science requirements, and identifies risks and issues that need to be considered in future development activities.

  12. A Framework to Reduce Infectious Disease Risk from Urban Poultry in the United States

    PubMed Central

    Tobin, Molly R.; Goldshear, Jesse L.; Price, Lance B.; Graham, Jay P.

    2015-01-01

    Objectives Backyard poultry ownership is increasingly common in U.S. cities and is regulated at the local level. Human contact with live poultry is a well-known risk for infection with zoonotic pathogens, notably Salmonella, yet the ability of local jurisdictions to reduce the risk of infectious disease transmission from poultry to humans is unstudied. We reviewed urban poultry ordinances in the United States and reported Salmonella outbreaks from backyard poultry to identify regulatory gaps in preventing zoonotic pathogen transmission. Based on this analysis, we propose regulatory guidelines for U.S. cities to reduce infectious disease risk from backyard poultry ownership. Methods We assessed local ordinances in the 150 most populous U.S. jurisdictions for content related to noncommercial poultry ownership using online resources and communications with government officials. We also performed a literature review using publicly available data sources to identify human infectious disease outbreaks caused by contact with backyard poultry. Results Of the cities reviewed, 93% (n=139) permit poultry in some capacity. Most urban poultry ordinances share common characteristics focused on reducing nuisance to neighbors. Ordinances do not address many pathways of transmission relevant to poultry-to-human transmission of pathogens, such as manure management. Conclusions To reduce the risk of pathogen exposure from backyard poultry, urban ordinances should incorporate the following seven components: limited flock size, composting of manure in sealed containers, prohibition of slaughter, required veterinary care to sick birds, appropriate disposal of dead birds, annual permits linked to consumer education, and a registry of poultry owners. PMID:26346104

  13. Limited Effectiveness of Diabetes Risk Assessment Tools in Seniors' Facility Residents.

    PubMed

    Featherstone, Travis; Eurich, Dean T; Simpson, Scot H

    2017-03-01

    Undiagnosed diabetes can create significant management issues for seniors. To evaluate the effectiveness of two diabetes risk surveys-the Canadian Diabetes Risk Assessment Questionnaire (CANRISK) and the Finnish Diabetes Risk Score (FINDRISC)-to identify elevated blood glucose levels in seniors. A cross-sectional study was conducted in senior living facilities in Edmonton, Alberta, Canada. Those with known diabetes, without capacity, considered frail, or unable to communicate in English were excluded. Participants completed the CANRISK and FINDRISC surveys and had their glycated hemoglobin A 1c (HbA 1c ) measured. Correlations between seniors with elevated risk on the surveys and an HbA 1c value of 6.5% or higher or 6.0% and higher were assessed. In this study, 290 residents participated; their mean age was 84.3 ± 7.3 years, 82 (28%) were men, and their mean HbA 1c level was 5.7% ± 0.4%. Mean CANRISK score was 29.4 ± 8.0, and of the 254 (88%) considered to be moderate or high risk, 10 (4%) had an HbA 1c level of 6.5% or higher and 49 (19%) had an HbA 1c level of 6.0% or higher. Mean FINDRISC score was 10.8 ± 4.2, and of the 58 (20%) considered to be high or very high risk, 4 (7%) had an HbA 1c level of 6.5% or higher and 15 (26%) had an HbA 1c level of 6.0% or higher. The area under the receiver-operating characteristic curve was 0.57 (95% confidence interval 0.42-0.72) for the CANRISK survey identifying participants with an HbA 1c level of 6.5% or higher and 0.59 (95% confidence interval 0.51-0.67) for identifying participants with an HbA 1c level of 6.0% or higher. Similar characteristics were observed for the FINDRISC survey. In this group of seniors with no known diabetes history, mean HbA 1c level approximated that in the general population and neither survey effectively identified those with elevated blood glucose levels. These findings should be confirmed in a larger study; nevertheless, routine use of these surveys as a diabetes screening strategy does

  14. Dietary Cholesterol Increases the Risk whereas PUFAs Reduce the Risk of Active Tuberculosis in Singapore Chinese12

    PubMed Central

    Soh, Avril Z; Chee, Cynthia BE; Wang, Yee-Tang; Yuan, Jian-Min; Koh, Woon-Puay

    2016-01-01

    Background: Experimental studies suggest that cholesterol enhances the intracellular survival of Mycobacterium tuberculosis, whereas marine ω-3 (n–3) and ω-6 (n–6) fatty acids (FAs) may modulate responses to M. tuberculosis in macrophage and animal models. However, there are no epidemiologic data from prospective studies of the relation between dietary cholesterol and FAs and the risk of developing active tuberculosis. Objective: We aimed to investigate the relation between dietary intake of cholesterol and FAs and the risk of active tuberculosis in a prospective cohort in Singapore. Methods: We analyzed data from the Singapore Chinese Health Study, a cohort of 63,257 Chinese men and women aged 45–74 y recruited between 1993 and 1998. Dietary intake of cholesterol and FAs was determined with the use of a validated food-frequency questionnaire. Incident cases of active tuberculosis were identified via linkage with the nationwide tuberculosis registry. Analysis was performed with the use of Cox proportional hazards models. Results: As of 31 December 2013, 1136 incident cases of active tuberculosis were identified. Dietary cholesterol was positively associated with an increased risk of active tuberculosis in a dose-dependent manner. Compared with the lowest intake quartile, the HR was 1.22 (95% CI: 1.00, 1.47) for the highest quartile (P-trend = 0.04). Conversely, dietary marine n–3 and n–6 FAs were associated with a reduced risk of active tuberculosis in a dose-dependent manner. Compared with the lowest quartile, the HR for the highest intake quartile was 0.77 (95% CI: 0.62, 0.95) for marine n–3 FAs (P-trend = 0.01) and 0.82 (95% CI: 0.68, 0.98) for n–6 FAs (P-trend = 0.03). There was no association with saturated, monounsaturated, or plant-based n–3 FA intake. Conclusion: Dietary intake of cholesterol may increase the risk of active tuberculosis, whereas marine n–3 and n–6 FAs may reduce the risk of active tuberculosis in the Chinese population

  15. Work plan for the Isotopes Facilities Deactivation Project at Oak Ridge National Laboratory, Oak Ridge, Tennessee

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

    NONE

    1995-08-01

    The purpose of the Isotopes Facilities Deactivation Project (IFDP) is to place former isotopes production facilities at the Oak Ridge National Laboratory in a safe, stable, and environmentally sound condition; suitable for an extended period of minimum surveillance and maintenance (S and M) and as quickly and economical as possible. Implementation and completion of the deactivation project will further reduce the risks to the environment and to public safety and health. Furthermore, completion of the project will result in significant S and M cost savings in future years. The IFDP work plan defines the project schedule, the cost estimate, andmore » the technical approach for the project. A companion document, the EFDP management plan, has been prepared to document the project objectives, define organizational relationships and responsibilities, and outline the management control systems to be employed in the management of the project. The project has adopted the strategy of deactivating the simple facilities first, to reduce the scope of the project and to gain experience before addressing more difficult facilities. A decision support system is being developed to identify the activities that best promote the project mission and result in the largest cost savings. This work plan will be reviewed and revised annually. Deactivation of EFDP Facilities was initiated in FY 1994 and will be completed in FY 2000. The schedule for deactivation of facilities is shown. The total cost of the project is estimated to be $51M. The costs are summarized. Upon completion of deactivation, annual S and M costs of these facilities will be reduced from the current level of $5M per year to less than $1M per year.« less

  16. Why Integrate Educational and Community Facilities?

    ERIC Educational Resources Information Center

    Fessas-Emmanouil, Helen D.

    1978-01-01

    Discusses coordination of educational and community facilities in order to encourage more rational investments and more efficient use of premises. Such coordination may reduce the economic burden imposed upon citizens for the provision of separate facilities for school and community. However, implementation of such a facility presupposes radical…

  17. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial.

    PubMed

    Lappe, Joan M; Travers-Gustafson, Dianne; Davies, K Michael; Recker, Robert R; Heaney, Robert P

    2007-06-01

    Numerous observational studies have found supplemental calcium and vitamin D to be associated with reduced risk of common cancers. However, interventional studies to test this effect are lacking. The purpose of this analysis was to determine the efficacy of calcium alone and calcium plus vitamin D in reducing incident cancer risk of all types. This was a 4-y, population-based, double-blind, randomized placebo-controlled trial. The primary outcome was fracture incidence, and the principal secondary outcome was cancer incidence. The subjects were 1179 community-dwelling women randomly selected from the population of healthy postmenopausal women aged >55 y in a 9-county rural area of Nebraska centered at latitude 41.4 degrees N. Subjects were randomly assigned to receive 1400-1500 mg supplemental calcium/d alone (Ca-only), supplemental calcium plus 1100 IU vitamin D3/d (Ca + D), or placebo. When analyzed by intention to treat, cancer incidence was lower in the Ca + D women than in the placebo control subjects (P < 0.03). With the use of logistic regression, the unadjusted relative risks (RR) of incident cancer in the Ca + D and Ca-only groups were 0.402 (P = 0.01) and 0.532 (P = 0.06), respectively. When analysis was confined to cancers diagnosed after the first 12 mo, RR for the Ca + D group fell to 0.232 (CI: 0.09, 0.60; P < 0.005) but did not change significantly for the Ca-only group. In multiple logistic regression models, both treatment and serum 25-hydroxyvitamin D concentrations were significant, independent predictors of cancer risk. Improving calcium and vitamin D nutritional status substantially reduces all-cancer risk in postmenopausal women. This trial was registered at clinicaltrials.gov as NCT00352170.

  18. Industrial Processes to Reduce Generation of Hazardous Waste at DoD Facilities. Phase 2 Report. Evaluation of 18 Case Studies.

    DTIC Science & Technology

    1985-07-15

    oxidize 13 .. . . . . . .- .. . ..-.-........ ~ -. trivalent chromium to hexavalent chromium and to selectively precipitate cation impurities from the...plating facilities. Chromium must be reduced to its trivalent state before it can be removed by precipitation as a hydroxide. Reduction is normally...conversion of hexavalent to trivalent chromium prior to precipitation. Trivalent solutions are typically less concentrated (22 g/L versus 150 g/L for

  19. Routine delivery of artemisinin-based combination treatment at fixed health facilities reduces malaria prevalence in Tanzania: an observational study

    PubMed Central

    2012-01-01

    Background Artemisinin-based combination therapy (ACT) has been promoted as a means to reduce malaria transmission due to their ability to kill both asexual blood stages of malaria parasites, which sustain infections over long periods and the immature derived sexual stages responsible for infecting mosquitoes and onward transmission. Early studies reported a temporal association between ACT introduction and reduced malaria transmission in a number of ecological settings. However, these reports have come from areas with low to moderate malaria transmission, been confounded by the presence of other interventions or environmental changes that may have reduced malaria transmission, and have not included a comparison group without ACT. This report presents results from the first large-scale observational study to assess the impact of case management with ACT on population-level measures of malaria endemicity in an area with intense transmission where the benefits of effective infection clearance might be compromised by frequent and repeated re-infection. Methods A pre-post observational study with a non-randomized comparison group was conducted at two sites in Tanzania. Both sites used sulphadoxine-pyrimethamine (SP) monotherapy as a first-line anti-malarial from mid-2001 through 2002. In 2003, the ACT, artesunate (AS) co-administered with SP (AS + SP), was introduced in all fixed health facilities in the intervention site, including both public and registered non-governmental facilities. Population-level prevalence of Plasmodium falciparum asexual parasitaemia and gametocytaemia were assessed using light microscopy from samples collected during representative household surveys in 2001, 2002, 2004, 2005 and 2006. Findings Among 37,309 observations included in the analysis, annual asexual parasitaemia prevalence in persons of all ages ranged from 11% to 28% and gametocytaemia prevalence ranged from <1% to 2% between the two sites and across the five survey years. A

  20. Strontium ranelate reduces the risk of vertebral and nonvertebral fractures in women eighty years of age and older.

    PubMed

    Seeman, Ego; Vellas, Bruno; Benhamou, Claude; Aquino, Jean Pierre; Semler, Jutta; Kaufman, Jean Marc; Hoszowski, Krzysztof; Varela, Alfredo Roces; Fiore, Carmelo; Brixen, Kim; Reginster, Jean Yves; Boonen, Steven

    2006-07-01

    Strontium ranelate produces an early and sustained reduction of both vertebral and nonvertebral fractures in patients > or = 80 years of age. About 25-30% of the population burden of all fragility fractures in the community arise from women > or = 80 years of age, because this population is at high risk for all types of fracture, particularly nonvertebral fractures. Despite this, evidence that therapies reduce the risk of both vertebral and nonvertebral fractures in this group is lacking. The aim of this study was to determine whether strontium ranelate, an agent that reduces the risk of vertebral and nonvertebral fractures in postmenopausal women >50 years of age, also reduces fractures in the elderly. An analysis based on preplanned pooling of data from two international, phase III, randomized, placebo-controlled, double-blind studies (the Spinal Osteoporosis Therapeutic Intervention [SOTI] and TReatment Of Peripheral OSteoporosis [TROPOS]) included 1488 women between 80 and 100 years of age followed for 3 years. Yearly spinal X-rays were performed in 895 patients. Only radiographically confirmed nonvertebral fractures were included. Baseline characteristics did not differ in placebo and treatment arms. In the intent-to-treat analysis, the risk of vertebral, nonvertebral, and clinical (symptomatic vertebral and nonvertebral) fractures was reduced within 1 year by 59% (p = 0.002), 41% (p = 0.027), and 37% (p = 0.012), respectively. At the end of 3 years, vertebral, nonvertebral, and clinical fracture risks were reduced by 32% (p = 0.013), 31% (p = 0.011), and 22% (p = 0.040), respectively. The medication was well tolerated, and the safety profile was similar to that in younger patients. Treatment with strontium ranelate safely reduces the risk of vertebral and nonvertebral fractures in women with osteoporosis > or = 80 years of age. Even in the oldest old, it is not too late to reduce fracture risk.

  1. Computational Analyses in Support of Sub-scale Diffuser Testing for the A-3 Facility. Part 2; Unsteady Analyses and Risk Assessment

    NASA Technical Reports Server (NTRS)

    Ahuja, Vineet; Hosangadi, Ashvin; Allgood, Daniel

    2008-01-01

    Simulation technology can play an important role in rocket engine test facility design and development by assessing risks, providing analysis of dynamic pressure and thermal loads, identifying failure modes and predicting anomalous behavior of critical systems. This is especially true for facilities such as the proposed A-3 facility at NASA SSC because of a challenging operating envelope linked to variable throttle conditions at relatively low chamber pressures. Design Support of the feasibility of operating conditions and procedures is critical in such cases due to the possibility of startup/shutdown transients, moving shock structures, unsteady shock-boundary layer interactions and engine and diffuser unstart modes that can result in catastrophic failure. Analyses of such systems is difficult due to resolution requirements needed to accurately capture moving shock structures, shock-boundary layer interactions, two-phase flow regimes and engine unstart modes. In a companion paper, we will demonstrate with the use of CFD, steady analyses advanced capability to evaluate supersonic diffuser and steam ejector performance in the sub-scale A-3 facility. In this paper we will address transient issues with the operation of the facility especially at startup and shutdown, and assess risks related to afterburning due to the interaction of a fuel rich plume with oxygen that is a by-product of the steam ejectors. The primary areas that will be addressed in this paper are: (1) analyses of unstart modes due to flow transients especially during startup/ignition, (2) engine safety during the shutdown process (3) interaction of steam ejectors with the primary plume i.e. flow transients as well as probability of afterburning. In this abstract we discuss unsteady analyses of the engine shutdown process. However, the final paper will include analyses of a staged startup, drawdown of the engine test cell pressure, and risk assessment of potential afterburning in the facility. Unsteady

  2. Reduced Risk of Disease During Postsecondary Dengue Virus Infections

    PubMed Central

    Olkowski, Sandra; Forshey, Brett M.; Morrison, Amy C.; Rocha, Claudio; Vilcarromero, Stalin; Halsey, Eric S.; Kochel, Tadeusz J.; Scott, Thomas W.; Stoddard, Steven T.

    2013-01-01

    Background. Antibodies induced by infection with any 1 of 4 dengue virus (DENV) serotypes (DENV-1–4) may influence the clinical outcome of subsequent heterologous infections. To quantify potential cross-protective effects, we estimated disease risk as a function of DENV infection, using data from longitudinal studies performed from September 2006 through February 2011 in Iquitos, Peru, during periods of DENV-3 and DENV-4 transmission. Methods. DENV infections before and during the study period were determined by analysis of serial serum samples with virus neutralization tests. Third and fourth infections were classified as postsecondary infections. Dengue fever cases were detected by door-to-door surveillance for acute febrile illness. Results. Among susceptible participants, 39% (420/1077) and 53% (1595/2997) seroconverted to DENV-3 and DENV-4, respectively. Disease was detected in 7% of DENV-3 infections and 10% of DENV-4 infections. Disease during postsecondary infections was reduced by 93% for DENV-3 and 64% for DENV-4, compared with primary and secondary infections. Despite lower disease rates, postsecondary infections constituted a significant proportion of apparent infections (14% [for DENV-3 infections], 45% [for DENV-4 infections]). Conclusions. Preexisting heterotypic antibodies markedly reduced but did not eliminate the risk of disease in this study population. These results improve understanding of how preinfection history can be associated with dengue outcomes and DENV transmission dynamics. PMID:23776195

  3. Opening a New Lipid “Apo-thecary”: Incorporating Apolipoproteins as Potential Risk Factors and Treatment Targets to Reduce Cardiovascular Risk

    PubMed Central

    Jacobson, Terry A.

    2011-01-01

    Statins (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors) represent the cornerstone of drug therapy to reduce low-density lipoprotein (LDL) cholesterol and cardiovascular risk. However, even optimal statin management of LDL cholesterol leaves many patients with residual cardiovascular risk, in part because statins are more effective in reducing LDL cholesterol than apolipoprotein B (Apo B). Apo B may be a better marker of atherogenic risk than LDL cholesterol because Apo B measures the total number of all atherogenic particles (total atherosclerotic burden), including LDL, very low-density lipoprotein, intermediate-density lipoprotein, remnant lipoproteins, and lipoprotein(a). To determine whether Apo B is a better indicator of baseline cardiovascular risk and residual risk after lipid therapy compared with LDL cholesterol, a MEDLINE search of the literature published in English from January 1, 1975, through December 1, 2010, was conducted. On the basis of data from most population studies, elevated Apo B was more strongly associated with incident coronary heart disease than similarly elevated LDL cholesterol. Apo B was also a superior benchmark (vs LDL cholesterol) of statins' cardioprotective efficacy in both primary-prevention and secondary-prevention trials. To minimize cardiovascular risk among persons with hypercholesterolemia or dyslipidemia, the best available evidence suggests that intensive therapy with statins should be initiated to achieve the lowest possible Apo B level (with adequate drug toleration) and then other therapies (eg, niacin, bile acid resins, ezetimibe) added to potentiate these Apo B–lowering effects. In future consensus lipid-lowering treatment guidelines, Apo B should be considered as an index of residual risk, a potential parameter of treatment efficacy, and a treatment target to minimize risk of coronary heart disease. PMID:21803958

  4. Webinar Presentation: Environmental Exposures and Health Risks in California Child Care Facilities: First Steps to Improve Environmental Health where Children Spend Time

    EPA Pesticide Factsheets

    This presentation, Environmental Exposures and Health Risks in California Child Care Facilities: First Steps to Improve Environmental Health where Children Spend Time, was given at the NIEHS/EPA Children's Centers 2016 Webinar Series: Exposome.

  5. Interior design for ambulatory care facilities: how to reduce stress and anxiety in patients and families.

    PubMed

    Frasca-Beaulieu, K

    1999-01-01

    The following article illustrates some important factors to consider when designing ambulatory care facilities (ACFs), and focuses on how wayfinding, noise control, privacy, security, color and lighting, general ambience, textures, and nature can have a profound influence on patient and family stress, consumer satisfaction, health and well-being. Other important design issues: convenience and accessibility, accommodation to various populations, consumer and family focus, patient education, image, as well as current equipment needs and future growth are examined in light of the prevailing trends in health care delivery. In sum, this feature explores the important stress-reducing and health-promoting elements involved in successful ACF design.

  6. Balance training reduces falls risk in older individuals with type 2 diabetes.

    PubMed

    Morrison, Steven; Colberg, Sheri R; Mariano, Mira; Parson, Henri K; Vinik, Arthur I

    2010-04-01

    This study assessed the effects of balance/strength training on falls risk and posture in older individuals with type 2 diabetes. Sixteen individuals with type 2 diabetes and 21 age-matched control subjects (aged 50-75 years) participated. Postural stability and falls risk was assessed before and after a 6-week exercise program. Diabetic individuals had significantly higher falls risk score compared with control subjects. The diabetic group also exhibited evidence of mild-to-moderate neuropathy, slower reaction times, and increased postural sway. Following exercise, the diabetic group showed significant improvements in leg strength, faster reaction times, decreased sway, and, consequently, reduced falls risk. Older individuals with diabetes had impaired balance, slower reactions, and consequently a higher falls risk than age-matched control subjects. However, all these variables improved after resistance/balance training. Together these results demonstrate that structured exercise has wide-spread positive effects on physiological function for older individuals with type 2 diabetes.

  7. Balance Training Reduces Falls Risk in Older Individuals With Type 2 Diabetes

    PubMed Central

    Morrison, Steven; Colberg, Sheri R.; Mariano, Mira; Parson, Henri K.; Vinik, Arthur I.

    2010-01-01

    OBJECTIVE This study assessed the effects of balance/strength training on falls risk and posture in older individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS Sixteen individuals with type 2 diabetes and 21 age-matched control subjects (aged 50–75 years) participated. Postural stability and falls risk was assessed before and after a 6-week exercise program. RESULTS Diabetic individuals had significantly higher falls risk score compared with control subjects. The diabetic group also exhibited evidence of mild-to-moderate neuropathy, slower reaction times, and increased postural sway. Following exercise, the diabetic group showed significant improvements in leg strength, faster reaction times, decreased sway, and, consequently, reduced falls risk. CONCLUSIONS Older individuals with diabetes had impaired balance, slower reactions, and consequently a higher falls risk than age-matched control subjects. However, all these variables improved after resistance/balance training. Together these results demonstrate that structured exercise has wide-spread positive effects on physiological function for older individuals with type 2 diabetes. PMID:20097781

  8. Analysis of local acceptance of a radioactive waste disposal facility.

    PubMed

    Chung, Ji Bum; Kim, Hong-Kew; Rho, Sam Kew

    2008-08-01

    Like many other countries in the world, Korea has struggled to site a facility for radioactive waste for almost 30 years because of the strong opposition from local residents. Finally, in 2005, Gyeongju was established as the first Korean site for a radioactive waste facility. The objectives of this research are to verify Gyeongju citizens' average level of risk perception of a radioactive waste disposal facility as compared to other risks, and to explore the best model for predicting respondents' acceptance level using variables related to cost-benefit, risk perception, and political process. For this purpose, a survey is conducted among Gyeongju residents, the results of which are as follows. First, the local residents' risk perception of an accident in a radioactive waste disposal facility is ranked seventh among a total of 13 risks, which implies that nuclear-related risk is not perceived very highly by Gyeongju residents; however, its characteristics are still somewhat negative. Second, the comparative regression analyses show that the cost-benefit and political process models are more suitable for explaining the respondents' level of acceptance than the risk perception model. This may be the result of the current economic depression in Gyeongju, residents' familiarity with the nuclear industry, or cultural characteristics of risk tolerance.

  9. A computer-assisted motivational social network intervention to reduce alcohol, drug and HIV risk behaviors among Housing First residents.

    PubMed

    Kennedy, David P; Hunter, Sarah B; Chan Osilla, Karen; Maksabedian, Ervant; Golinelli, Daniela; Tucker, Joan S

    2016-03-15

    Individuals transitioning from homelessness to housing face challenges to reducing alcohol, drug and HIV risk behaviors. To aid in this transition, this study developed and will test a computer-assisted intervention that delivers personalized social network feedback by an intervention facilitator trained in motivational interviewing (MI). The intervention goal is to enhance motivation to reduce high risk alcohol and other drug (AOD) use and reduce HIV risk behaviors. In this Stage 1b pilot trial, 60 individuals that are transitioning from homelessness to housing will be randomly assigned to the intervention or control condition. The intervention condition consists of four biweekly social network sessions conducted using MI. AOD use and HIV risk behaviors will be monitored prior to and immediately following the intervention and compared to control participants' behaviors to explore whether the intervention was associated with any systematic changes in AOD use or HIV risk behaviors. Social network health interventions are an innovative approach for reducing future AOD use and HIV risk problems, but little is known about their feasibility, acceptability, and efficacy. The current study develops and pilot-tests a computer-assisted intervention that incorporates social network visualizations and MI techniques to reduce high risk AOD use and HIV behaviors among the formerly homeless. CLINICALTRIALS. NCT02140359.

  10. [Conditions of effective correctional treatment for reducing recidivism: Focusing on risk principle].

    PubMed

    Mori, Takemi; Takahashi, Masaru; Ohbuchi, Ken-ichi

    2016-10-01

    Research on correctional treatment based on the risk principle (Andrews & Bonta, 2010) has found that the intensity of intervention matched with the risk level of offenders’ recidivism is successful to reduce recidivism. However, there is no research dealing with this issue in a non-Western context. The purpose of this study was to examine the validity of the risk principle in rehabilitation for Japanese juvenile delinquents. The sample was 321 Japanese male inmates of the juvenile detention and assessment centers. They were followed for an average of 573 days after discharge to assess recidivism. Among high-risk juvenile delinquents, those who were treated in the juvenile training school showed significantly lower rates of recidivism than those who were placed under community supervision, while among low risk juveniles, there was no significant difference in recidivism between the two treatment conditions. The results indicate that the risk principle is valid for the correctional treatment of Japanese juvenile delinquents, suggesting its cross-cultural universality. Implications for juvenile justice policies and directions for future research are discussed.

  11. A screening level risk assessment of the indirect impacts from the Columbus Waste to Energy facility in Columbus, Ohio

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

    Lorber, M.; Cleverly, D.; Schaum, J.

    1996-12-31

    Testing for emissions of dioxins from the stack of the Columbus, Ohio Waste to Energy (WTE) municipal solid waste combustion facility in 1992 implied that dioxin emissions could approach 1,000 grams of dioxin toxic equivalents (TEQs) per year. The incinerator has been in operation since the early 1980s. Several varying activities to further evaluate or curtail emissions were conducted by local, state and federal agencies in 1994. Also in that year, US EPA`s Region 5 issued an emergency order under Section 7003 of RCRA requiring the facility to install maximum Achievable Control Technology (MACT). As part of their justification formore » this emergency order, Region 5 used a screening level risk assessment of potential indirect impacts. This paper describes this assessment. The exposure setting is a hypothetical dairy farm where individuals on the farm obtain their beef, milk, and vegetables from home sources. A 70-year exposure scenario is considered, which includes 45 years of facility operation at the pre- and post-MACT emission rates, followed by 25 years of impact due to residual soil concentrations. Soil dermal contact, inhalation, and breast milk exposures were also considered for this assessment. The source term, or dioxin loadings to this setting, were derived from air dispersion modeling of emissions from the Columbus WTE. A key finding of the assessment was that exposures to dioxin in beef and milk dominated the estimated risks, with excess cancer risk form these two pathways estimated at 2.8 {times} 10{sup {minus}4}. A second key finding was that over 90% of a lifetime of impact from these two pathways, and the inhalation and vegetable ingestion pathways, has already occurred due to pre-MACT emissions.« less

  12. School-based programs to reduce sexual risk behaviors: a review of effectiveness.

    PubMed Central

    Kirby, D; Short, L; Collins, J; Rugg, D; Kolbe, L; Howard, M; Miller, B; Sonenstein, F; Zabin, L S

    1994-01-01

    This review was undertaken in recognition of the mounting public health and social problems associated with adolescent sexual behavior and the importance of basing school-affiliated programs designed to reduce sexual risk-taking behavior on sound research. The authors were commissioned by the Division of Adolescent and School Health within the Centers for Disease Control and Prevention, Public Health Service, to review carefully the research on these programs and to assess their impact on behavior. The authors identified 23 studies of school-based programs that were published in professional journals and measured program impact on behavior. They then summarized the results of those studies, identifying the distinguishing characteristics of effective programs, and citing important research questions to be addressed in the future. Not all sex and AIDS education programs had significant effects on adolescent sexual risk-taking behavior, but specific programs did delay the initiation of intercourse, reduce the frequency of intercourse, reduce the number of sexual partners, or increase the use of condoms or other contraceptives. These effective programs have the potential to reduce exposure to unintended pregnancy and sexually transmitted disease, including HIV infection. These programs should be replicated widely in U.S. schools. Additional research is needed to improve the effectiveness of programs and to clarify the most important characteristics of effective programs. PMID:8190857

  13. Mental Health Disorders, Suicide Risk, and Treatment seeking among Formerly Deployed National Guardand Reserve Service Member seen in Non VA Facilities

    DTIC Science & Technology

    2016-10-01

    1 AWARD NUMBER: W81XWH-15-1-0506 TITLE: Mental Health Disorders, Suicide Risk, and Treatment seeking among Formerly Deployed National Guard... Suicide Risk, and Treatment seeking among Formerly Deployed National Guard and Reserve Service Member seen in Non-VA Facilities 5b. GRANT NUMBER W81XWH...and Reserve veterans. The prevalence of current PTSD was 7% (95% CI = 5.7-8.5). Preliminary analyses indicated that PTSD, depression , mental health

  14. Mission Risk Reduction Regulatory Change Management

    NASA Technical Reports Server (NTRS)

    Scroggins, Sharon

    2007-01-01

    NASA Headquarters Environmental Management Division supports NASA's mission to pioneer the future in space exploration, scientific discovery, and aeronautics research by integrating environmental considerations into programs and projects early-on, thereby proactively reducing NASA's exposure to institutional, programmatic and operational risk. As part of this effort, NASA established the Principal Center for Regulatory Risk Analysis and Communication (RRAC PC) as a resource for detecting, analyzing, and communicating environmental regulatory risks to the NASA stakeholder community. The RRAC PC focuses on detecting emerging environmental regulations and other operational change drivers that may pose risks to NASA programs and facilities, and effectively communicating the potential risks. For example, regulatory change may restrict how and where certain activities or operations may be conducted. Regulatory change can also directly affect the ability to use certain materials by mandating a production phase-out or restricting usage applications of certain materials. Regulatory change can result in significant adverse impacts to NASA programs and facilities due to NASA's stringent performance requirements for materials and components related to human-rated space vehicles. Even if a regulation does not directly affect NASA operations, U.S. and international regulations can pose program risks indirectly through requirements levied on manufacturers and vendors of components and materials. For example, manufacturers can change their formulations to comply with new regulatory requirements. Such changes can require time-consuming and costly requalification certification for use in human spaceflight programs. The RRAC PC has implemented a system for proactively managing regulatory change to minimize potential adverse impacts to NASA programs and facilities. This presentation highlights the process utilized by the RRACPC to communicate regulatory change and the associated

  15. Improving treatment intensification to reduce cardiovascular disease risk: a cluster randomized trial

    PubMed Central

    2012-01-01

    Background Blood pressure, lipid, and glycemic control are essential for reducing cardiovascular disease (CVD) risk. Many health care systems have successfully shifted aspects of chronic disease management, including population-based outreach programs designed to address CVD risk factor control, to non-physicians. The purpose of this study is to evaluate provision of new information to non-physician outreach teams on need for treatment intensification in patients with increased CVD risk. Methods Cluster randomized trial (July 1-December 31, 2008) in Kaiser Permanente Northern California registry of members with diabetes mellitus, prior CVD diagnoses and/or chronic kidney disease who were high-priority for treatment intensification: blood pressure ≥ 140 mmHg systolic, LDL-cholesterol ≥ 130 mg/dl, or hemoglobin A1c ≥ 9%; adherent to current medications; no recent treatment intensification). Randomization units were medical center-based outreach teams (4 intervention; 4 control). For intervention teams, priority flags for intensification were added monthly to the registry database with recommended next pharmacotherapeutic steps for each eligible patient. Control teams used the same database without this information. Outcomes included 3-month rates of treatment intensification and risk factor levels during follow-up. Results Baseline risk factor control rates were high (82-90%). In eligible patients, the intervention was associated with significantly greater 3-month intensification rates for blood pressure (34.1 vs. 30.6%) and LDL-cholesterol (28.0 vs 22.7%), but not A1c. No effects on risk factors were observed at 3 months or 12 months follow-up. Intervention teams initiated outreach for only 45-47% of high-priority patients, but also for 27-30% of lower-priority patients. Teams reported difficulties adapting prior outreach strategies to incorporate the new information. Conclusions Information enhancement did not improve risk factor control

  16. Living with fire: How social scientists are helping wildland-urban interface communities reduce wildfire risk

    Treesearch

    Brian Cooke; Daniel Williams; Travis Paveglio; Matthew Carroll

    2016-01-01

    Reducing wildfire risk to lives and property is a critical issue for policy makers, land managers, and citizens who reside in high-risk fire areas of the United States - this is especially the case in the Rocky Mountain region and other western states. In order for a wildfire risk reduction effort to be effective in a U.S. wildland-urban interface (WUI)...

  17. Vitamin D and reduced risk of breast cancer: a population-based case-control study.

    PubMed

    Knight, Julia A; Lesosky, Maia; Barnett, Heidi; Raboud, Janet M; Vieth, Reinhold

    2007-03-01

    Vitamin D, antiproliferative and proapoptotic in breast cancer cell lines, can reduce the development of mammary tumors in carcinogen-exposed rats. Current evidence in humans is limited with some suggestion that vitamin D-related factors may reduce the risk of breast cancer. We conducted a population-based case-control study to assess the evidence for a relationship between sources of vitamin D and breast cancer risk. Women with newly diagnosed invasive breast cancer were identified from the Ontario Cancer Registry. Women without breast cancer were identified through randomly selected residential telephone numbers. Telephone interviews were completed for 972 cases and 1,135 controls. Odds ratios (OR) and 95% confidence intervals (CI) for vitamin D-related variables were estimated using unconditional logistic regression with adjustment for potential confounders. Reduced breast cancer risks were associated with increasing sun exposure from ages 10 to 19 (e.g., OR, 0.65; 95% CI, 0.50-0.85 for the highest quartile of outdoor activities versus the lowest; P for trend = 0.0006). Reduced risk was also associated with cod liver oil use (OR, 0.76; 95% CI, 0.62-0.92) and increasing milk consumption (OR, 0.62 95% CI 0.45-0.86 for >or=10 glasses per week versus none; P for trend = 0.0004). There was weaker evidence for associations from ages 20 to 29 and no evidence for ages 45 to 54. We found strong evidence to support the hypothesis that vitamin D could help prevent breast cancer. However, our results suggest that exposure earlier in life, particularly during breast development, maybe most relevant. These results should be confirmed.

  18. Facile, low temperature synthesis of SnO2/reduced graphene oxide nanocomposite as anode material for lithium-ion batteries

    NASA Astrophysics Data System (ADS)

    Hou, Chau-Chung; Brahma, Sanjaya; Weng, Shao-Chieh; Chang, Chia-Chin; Huang, Jow-Lay

    2017-08-01

    We demonstrate a facile, single step, low temperature and energy efficient strategy for the synthesis of SnO2-reduced graphene oxide (RGO) nanocomposite where the crystallization of SnO2 nanoparticles and the reduction of graphene oxide takes place simultaneously by an in situ chemical reduction process. The electrochemical property of the SnO2-RGO composite prepared by using low concentrations of reducing agent shows better Li storage performance, good rate capability (378 mAh g-1 at 3200 mA g-1) and stable capacitance (522 mAh g-1 after 50 cycles). Increasing the reductant concentration lead to crystallization of high concentration of SnO2 nanoparticle aggregation and degrade the Li ion storage property.

  19. Can breast cancer patients use soyafoods to help reduce risk of CHD?

    PubMed

    Messina, Mark; Messina, Virginia; Jenkins, David J A

    2012-09-01

    Over the past 20 years, the popularity of soyafoods has increased in part because of research suggesting that these foods convey health benefits independent of their nutrient content. For example, in 1999, the US Food and Drug Administration approved a health-claim for soyafoods and CHD based on the hypocholesterolaemic effects of soya protein. However, soyafoods have become controversial in recent years because of concerns that their uniquely rich phyto-oestrogen (isoflavone) content may cause untoward effects in some individuals. Most notable in this regard is the concern that soyafoods are contraindicated for breast cancer patients and women at high risk of developing this disease. Furthermore, the hypocholesterolaemic effects of soya protein have been challenged. However, the results of recently published meta-analyses indicate that soya protein directly lowers circulating LDL-cholesterol levels by approximately 4 %. There is also intriguing evidence that soyafoods reduce CHD risk independent of their effects on lipid levels. In regard to the breast cancer controversy, recently published clinical and epidemiological data do not support observations in rodents that soyabean isoflavones increase breast cancer risk. In postmenopausal women, isoflavone exposure does not adversely affect breast tissue density or breast cell proliferation. Furthermore, both US and Chinese prospective epidemiological studies show that post-diagnosis soya consumption is associated with an improved prognosis. Therefore, soyafoods should be considered by women as healthy foods to include in diets aimed at reducing the risk of CHD regardless of their breast cancer status.

  20. Failure mode and effect analysis in blood transfusion: a proactive tool to reduce risks.

    PubMed

    Lu, Yao; Teng, Fang; Zhou, Jie; Wen, Aiqing; Bi, Yutian

    2013-12-01

    The aim of blood transfusion risk management is to improve the quality of blood products and to assure patient safety. We utilize failure mode and effect analysis (FMEA), a tool employed for evaluating risks and identifying preventive measures to reduce the risks in blood transfusion. The failure modes and effects occurring throughout the whole process of blood transfusion were studied. Each failure mode was evaluated using three scores: severity of effect (S), likelihood of occurrence (O), and probability of detection (D). Risk priority numbers (RPNs) were calculated by multiplying the S, O, and D scores. The plan-do-check-act cycle was also used for continuous improvement. Analysis has showed that failure modes with the highest RPNs, and therefore the greatest risk, were insufficient preoperative assessment of the blood product requirement (RPN, 245), preparation time before infusion of more than 30 minutes (RPN, 240), blood transfusion reaction occurring during the transfusion process (RPN, 224), blood plasma abuse (RPN, 180), and insufficient and/or incorrect clinical information on request form (RPN, 126). After implementation of preventative measures and reassessment, a reduction in RPN was detected with each risk. The failure mode with the second highest RPN, namely, preparation time before infusion of more than 30 minutes, was shown in detail to prove the efficiency of this tool. FMEA evaluation model is a useful tool in proactively analyzing and reducing the risks associated with the blood transfusion procedure. © 2013 American Association of Blood Banks.

  1. PROVIDING SOLUTIONS FOR A BETTER TOMORROW: REDUCING THE RISKS ASSOCIATED WITH LEAD IN SOIL; URL:

    EPA Science Inventory

    This brief publication describes, in general language, the health risks associated with exposure to soil and dust contaminated with lead as well as an innovative method to immobilize lead contaminants in the soil (and thereby reduce the risk of exposure) at Superfund sites. Also ...

  2. Summary Report of Ecological Risk Assessment for the Operation of the Explosives Waste Treatment Facility at Site 300 of the Lawrence Livermore National Laboratory.

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

    Gallegos, Gretchen M.; Terusaki, Stan H.

    2013-12-01

    An ecological risk assessment is required as part of the Resource Recovery and Conservation Act (RCRA) permit renewal process for Miscellaneous Units subject to 22 CCR 66270.23. This risk assessment is prepared in support of the RCRA permit renewal for the Explosives Waste Treatment Facility (EWTF) at Site 300 of the Lawrence Livermore National Laboratory (LLNL). LLNL collected soil samples and used the resulting data to produce a scoping-level ecological risk assessment pursuant to the Department of Toxic Substances Control, Guidance for Ecological Risk Assessment at Hazardous Waste Sites and Permitted Facilities, Part A: Overview, July 4, 1996. The scoping-levelmore » ecological risk assessment provides a framework to determine the potential interaction between ecological receptors and chemicals of concern from hazardous waste treatment operations in the area of EWTF. A scoping-level ecological risk assessment includes the step of conducting soil sampling in the area of the treatment units. The Sampling Plan in Support of the Human Health and Ecological Risk Assessment for the Operation of the Explosives Waste Treatment Facility at Site 300 of the Lawrence Livermore National Laboratory, (Terusaki, 2007), outlines the EWTF project-specific soil sampling requirements. Soil samples were obtained and analyzed for constituents from four chemical groups: furans, explosives, semi-volatiles and metals. Analytical results showed that furans, explosives and semi-volatiles were not detected; therefore, no further analysis was conducted. The soil samples did show the presence of metals. Soil samples analyzed for metals were compared to site-wide background levels, which had been developed for site -wide cleanup activities pursuant to the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA). Total metal concentrations from 28 discrete soil samples obtained in the EWTF area were all below CERCLA-developed background levels. Therefore, following DTSC

  3. Ecological risk assessment of landfill air emissions from a hazardous waste management facility in Ontario

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

    Durda, J.L.; Suit-Kowalski, L.; Preziosi, D.

    1997-12-31

    An ecological risk assessment was conducted to evaluate the potential for adverse environmental impacts associated with chemicals released to air as a result of a proposed expansion of a hazardous waste landfill in Ontario. The purpose of the risk assessment was to characterize ecological risks associated with the proposed expansion relative to those associated with the existing landfill and those that would exist if the current landfill was completely closed and background conditions prevailed. The ecological risk assessment was one part of a comprehensive environmental impact assessment of the proposed landfill continuation that was being performed under the requirements ofmore » Ontario`s Environmental Assessment Act. Air monitoring data from the facility were used to identify a list of 141 chemicals potentially released during landfill continuation, as well as to characterize current emissions and background chemical levels. An ecological risk-based chemical screening process that considered background concentration, source strength, environmental partitioning, bioaccumulation potential, and toxicity was used to select a group of 23 chemicals for detailed evaluation in the ecological risk assessment. Dispersion, deposition, partitioning and bioaccumulation modeling were used to predict potential exposures in ecological receptors. Receptors were selected for evaluation based on regional habitat characteristics, exposure potential, toxicant sensitivity, ecological significance, population status, and societal value. Livestock and agricultural crop and pasture species were key receptors for the assessment, given the highly agricultural nature of the study area. In addition, native wildlife species, including the endangered Henslow`s sparrow and the regionally vulnerable pugnose minnow, also were considered.« less

  4. Assessment of environmental risk for red mud storage facility in China: a case study in Shandong Province.

    PubMed

    Wen, Zhi-Chao; Ma, Shu-Hua; Zheng, Shi-Li; Zhang, Yi; Liang, Yan

    2016-06-01

    Red mud storage facility (RM-SF) pollution remains a serious problem in China mainly due to the RM's huge quantity, little recyclability, and high alkalinity. And, there is also a risk of dam failure because almost all RM-SFs are processed by damming. In order to address this challenge and improve the level of risk management, it is necessary to evaluate the environmental risk of RM-SFs systematically. So, this paper firstly designs a comprehensive evaluation index system with a three-level evaluation index in the terms of RM characteristics, RM-SF characteristics, ambient environment of RM-SF, the management of RM-SF, and the application aspect of RM by the analytic hierarchy process (AHP) method. Then, a case of RM-SF from a typical alumina production enterprise is studied according to this system, as is assisted by several experts from different fields when determining the weights of all indicators. The results show that the risk of selected RM-SF primarily depends on the former factors, that is, RM and RM-SF characteristics, while the contributions of the other factors are quite smaller.

  5. Reduced risk of UC in families affected by appendicitis: a Danish national cohort study.

    PubMed

    Nyboe Andersen, Nynne; Gørtz, Sanne; Frisch, Morten; Jess, Tine

    2017-08-01

    The possible aetiological link between appendicitis and UC remains unclear. In order to investigate the hereditary component of the association, we studied the risk of UC in family members of individuals with appendicitis. A cohort of 7.1 million individuals was established by linkage of national registers in Denmark with data on kinship and diagnoses of appendicitis and UC. Poisson regression models were used to calculate first hospital contact rate ratios (RR) for UC with 95% CIs between individuals with or without relatives with a history of appendicitis. During 174 million person-years of follow-up between 1977 and 2011, a total of 190 004 cohort members developed appendicitis and 45 202 developed UC. Individuals having a first-degree relative with appendicitis before age 20 years had significantly reduced risk of UC (RR 0.90; 95% CI 0.86 to 0.95); this association was stronger in individuals with a family predisposition to UC (RR 0.66; 95% CI 0.51 to 0.83). Individuals with a first-degree relative diagnosed with appendicitis before age 20 years are at reduced risk of UC, particularly when there is a family predisposition to UC. Our findings question a previously hypothesised direct protective influence of appendicitis on inflammation of the large bowel. Rather, genetic or environmental factors linked to an increased risk of appendicitis while being protective against UC may explain the repeatedly reported reduced relative risk of UC in individuals with a history of appendicitis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  6. The Feasibility of Interventions to Reduce HIV Risk and Drug Use among Heterosexual Methamphetamine Users.

    PubMed

    Corsi, Karen F; Lehman, Wayne E; Min, Sung-Joon; Lance, Shannon P; Speer, Nicole; Booth, Robert E; Shoptaw, Steve

    2012-06-04

    This paper reports on a feasibility study that examined contingency management among out-of-treatment, heterosexual methamphetamine users and the reduction of drug use and HIV risk. Fifty-eight meth users were recruited through street outreach in Denver from November 2006 through March 2007. The low sample size reflects that this was a pilot study to see if CM is feasible in an out-of-treatment, street-recruited population of meth users. Secondary aims were to examine if reductions and drug use and risk behavior could be found. Subjects were randomly assigned to contingency management (CM) or CM plus strengths-based case management (CM/SBCM), with follow-up at 4 and 8 months. Participants were primarily White (90%), 52% male and averaged 38 years old. Eighty-three percent attended at least one CM session, with 29% attending at least fifteen. All participants reduced meth use significantly at follow-up. Those who attended more sessions submitted more stimulant-free urines than those who attended fewer sessions. Participants assigned to CM/SBCM attended more sessions and earned more vouchers than clients in CM. Similarly, participants reported reduced needle-sharing and sex risk. Findings demonstrate that CM and SBCM may help meth users reduce drug use and HIV risk.

  7. The Feasibility of Interventions to Reduce HIV Risk and Drug Use among Heterosexual Methamphetamine Users

    PubMed Central

    Corsi, Karen F.; Lehman, Wayne E.; Min, Sung-Joon; Lance, Shannon P.; Speer, Nicole; Booth, Robert E.; Shoptaw, Steve

    2013-01-01

    This paper reports on a feasibility study that examined contingency management among out-of-treatment, heterosexual methamphetamine users and the reduction of drug use and HIV risk. Fifty-eight meth users were recruited through street outreach in Denver from November 2006 through March 2007. The low sample size reflects that this was a pilot study to see if CM is feasible in an out-of-treatment, street-recruited population of meth users. Secondary aims were to examine if reductions and drug use and risk behavior could be found. Subjects were randomly assigned to contingency management (CM) or CM plus strengths-based case management (CM/SBCM), with follow-up at 4 and 8 months. Participants were primarily White (90%), 52% male and averaged 38 years old. Eighty-three percent attended at least one CM session, with 29% attending at least fifteen. All participants reduced meth use significantly at follow-up. Those who attended more sessions submitted more stimulant-free urines than those who attended fewer sessions. Participants assigned to CM/SBCM attended more sessions and earned more vouchers than clients in CM. Similarly, participants reported reduced needle-sharing and sex risk. Findings demonstrate that CM and SBCM may help meth users reduce drug use and HIV risk. PMID:23493796

  8. Water safety in healthcare facilities. The Vieste Charter.

    PubMed

    Bonadonna, L; Cannarozzi de Grazia, M; Capolongo, S; Casini, B; Cristina, M L; Daniele, G; D'Alessandro, D; De Giglio, O; Di Benedetto, A; Di Vittorio, G; Ferretti, E; Frascolla, B; La Rosa, G; La Sala, L; Lopuzzo, M G; Lucentini, L; Montagna, M T; Moscato, U; Pasquarella, C; Prencipe, R; Ricci, M L; Romano Spica, V; Signorelli, C; Veschetti, E

    2017-01-01

    The Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health (GISIO-SItI) and the Local Health Authority of Foggia, Apulia, Italy, after the National Convention "Safe water in healthcare facilities" held in Vieste-Pugnochiuso on 27-28 May 2016, present the "Vieste Charter", drawn up in collaboration with experts from the National Institute of Health and the Ministry of Health. This paper considers the risk factors that may affect the water safety in healthcare facilities and reports the current regulatory frameworks governing the management of installations and the quality of the water. The Authors promote a careful analysis of the risks that characterize the health facilities, for the control of which specific actions are recommended in various areas, including water safety plans; approval of treatments; healthcare facilities responsibility, installation and maintenance of facilities; multidisciplinary approach; education and research; regional and national coordination; communication.

  9. Can change in high-density lipoprotein cholesterol levels reduce cardiovascular risk?

    PubMed

    Dean, Bonnie B; Borenstein, Jeff E; Henning, James M; Knight, Kevin; Merz, C Noel Bairey

    2004-06-01

    The cardiovascular risk reduction observed in many trials of lipid-lowering agents is greater than expected on the basis of observed low-density lipoprotein cholesterol (LDL-C) level reductions. Our objective was to explore the degree to which high-density lipoprotein cholesterol (HDL-C) level changes explain cardiovascular risk reduction. A systematic review identified trials of lipid-lowering agents reporting changes in HDL-C and LDL-C levels and the incidence of coronary heart disease (CHD). The observed relative risk reduction (RRR) in CHD morbidity and mortality rates was calculated. The expected RRR, given the treatment effect on total cholesterol level, was calculated for each trial with logistic regression coefficients from observational studies. The difference between observed and expected RRR was plotted against the change in HDL-C level, and a least-squares regression line was calculated. Fifty-one trials were identified. Nineteen statin trials addressed the association of HDL-C with CHD. Limited numbers of trials of other therapies precluded additional analyses. Among statin trials, therapy reduced total cholesterol levels as much as 32% and LDL-C levels as much as 45%. HDL-C level increases were <10%. Treatment effect on HDL-C levels was not a significant linear predictor of the difference in observed and expected CHD mortality rates, although we observed a trend in this direction (P =.08). Similarly, HDL-C effect was not a significant linear predictor of the difference between observed and expected RRRs for CHD morbidity (P =.20). Although a linear trend toward greater risk reduction was observed with greater effects on HDL-C, differences were not statistically significant. The narrow range of HDL-C level increases in the statin trials likely reduced our ability to detect a beneficial HDL-C effect, if present.

  10. Risk behaviors and sports facilities do not explain socioeconomic differences in childhood obesity: a cross-sectional study.

    PubMed

    Albaladejo, Romana; Villanueva, Rosa; Navalpotro, Lourdes; Ortega, Paloma; Astasio, Paloma; Regidor, Enrique

    2014-11-19

    To assess whether the relationship between neighborhood socioeconomic context of residence and childhood obesity is explained by family socioeconomic position, risk behaviors and availability of sports facilities. Based on the income and educational level of residents in the neighborhoods of the city of Madrid, two indicators of socioeconomic context were calculated using the information about income and education and grouped into quartiles. In a sample of 727 children aged 6-15 years, the relationship of these indicators with overweight and obesity was studied using multilevel logit models. With respect to children and adolescents living in neighborhoods having higher per capita incomes or higher population percentages with university education those living in neighborhoods having lower per capita incomes or lower population percentages with university education had age- and sex-adjusted odds ratios (ORs) of overweight that were 1.84 (95% CI, 1.03-3.29) and 1.68 (0.95-2.94) times higher, respectively. After adjustment for family socioeconomic position, unhealthy diet and physical inactivity, these ORs fell to 1.80 (0.99-3.29) and 1.56 (0.87-2.79), respectively. In the case of obesity, the age- and sex-adjusted ORs in these quartiles of both indicators of socioeconomic context were 3.35 (1.06-10.60) and 3.29 (1.03-10.52), respectively, rising to 3.77 (1.12-12.70) and 3.42 (1.00-11.68) after adjustment for the remaining variables. The highest OR was observed in the third quartile, except in the case of the relationship between per capita income and obesity. No relationship between the number of sport facilities per 1,000 population and physical inactivity was observed. The socioeconomic context is associated with obesity but not with overweight children in Madrid. The relationship is not explained by family socioeconomic position, risk behaviors and availability of sports facilities.

  11. Primary Dietary Intervention Study to Reduce the Risk of Islet Autoimmunity in Children at Increased Risk for Type 1 Diabetes

    PubMed Central

    Hummel, Sandra; Pflüger, Maren; Hummel, Michael; Bonifacio, Ezio; Ziegler, Anette-G.

    2011-01-01

    OBJECTIVE To determine whether delaying the introduction of gluten in infants with a genetic risk of islet autoimmunity is feasible, safe, and may reduce the risk of type 1 diabetes–associated islet autoimmunity. RESEARCH DESIGN AND METHODS A total of 150 infants with a first-degree family history of type 1 diabetes and a risk HLA genotype were randomly assigned to a first gluten exposure at age 6 months (control group) or 12 months (late-exposure group) and were followed 3 monthly until the age of 3 years and yearly thereafter for safety (for growth and autoantibodies to transglutaminase C [TGCAs]), islet autoantibodies to insulin, GAD, insulinoma-associated protein 2, and type 1 diabetes. RESULTS Adherence to the dietary-intervention protocol was reported from 70% of families. During the first 3 years, weight and height were similar in children in the control and late-exposure groups, as was the probability of developing TGCAs (14 vs. 4%; P = 0.1). Eleven children in the control group and 13 children in the late-exposure group developed islet autoantibodies (3-year risk: 12 vs. 13%; P = 0.6). Seven children developed diabetes, including four in the late-exposure group. No significant differences were observed when children were analyzed as per protocol on the basis of the reported first gluten exposure of the children. CONCLUSIONS Delaying gluten exposure until the age of 12 months is safe but does not substantially reduce the risk for islet autoimmunity in genetically at-risk children. PMID:21515839

  12. Reducing adolescent clients' anger in a residential substance abuse treatment facility.

    PubMed

    Adelman, Robert; McGee, Patricia; Power, Robert; Hanson, Cathy

    2005-06-01

    Sundown Ranch, a residential behavioral health care treatment facility for adolescents, tracked the progress and results of treatment by selecting performance measures from a psychosocial screening inventory. The temper scale was one of the two highest scales at admission and the highest scale at discharge. A clinical performance improvement (PI) project was conducted to assess improvements in clients' ability to manage anger after the incorporation of Rational Emotive Behavior Therapy (REBT) into treatment. Eighteen months of baseline data (July 1, 1999 - February 1, 2001) were collected, and 20 months of data (May 1, 2001 - December 31, 2002) were collected after the introduction of the PI activity. In all, data were collected for 541 consecutive admissions. A comparison of five successive quarterly reviews indicated average scores of 1.4 standard deviations (SDs) above the mean on the temper scale before the PI activity and .45 SD above the mean after. The performance threshold of reduction of the average temper scale score to < or =1 SD was met for 17 of 20 months. The fact that the PI activity reduced the temper scale elevations by almost one full SD is highly suggestive of the efficacy of REBT with the treatment population. After the project was completed, REBT was promoted as an additional therapeutic modality within the treatment program.

  13. Ergonomics and simulation-based approach in improving facility layout

    NASA Astrophysics Data System (ADS)

    Abad, Jocelyn D.

    2018-02-01

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

  14. Pressure ulcer prevention in long-term-care facilities: a pilot study implementing standardized nurse aide documentation and feedback reports.

    PubMed

    Horn, Susan D; Sharkey, Siobhan S; Hudak, Sandra; Gassaway, Julie; James, Roberta; Spector, William

    2010-03-01

    To design and facilitate implementation of practice-based evidence changes associated with decreases in pressure ulcer (PrU) development in long-term-care (LTC) facilities and promote these practices as part of routine care. Pre/post observational study. Frail older adult residents in 11 US LTC facilities. Project facilitators assisted frontline multidisciplinary teams (certified nurse aides [CNAs], nurses, and dietitians/dietary aides) to develop streamlined standardized CNA documentation and weekly reports to identify high-risk residents and to integrate clinical reports into day-to-day practice and clinical decision making. The program was called "Real-Time Optimal Care Plans for Nursing Home QI" (Real-Time). Prevalence of PrUs using Centers for Medicare & Medicaid Services (CMS) quality measures (QMs), number of in-house-acquired PrUs, and number and completeness of CNA documentation forms. Seven study LTC facilities that reported data to CMS experienced a combined 33% (SD, 36.1%) reduction in the CMS high-risk PrU QM in 18 months and reduction in newly occurring PrUs (number of ulcers in the fourth quarter of 2003: range, 2-19; and in the third quarter of 2005: range, 1-6). Five of these LTC facilities that fully implemented Real-Time experienced a combined 48.1% (SD, 23.4%) reduction in the CMS high-risk PrU QM. Ten facilities reduced by an average of 2 to 5 their number of CNA documentation forms; CNA weekly documentation completeness reached a consistent level of 90% to 95%, and 8 facilities integrated the use of 2 to 4 weekly project reports in routine clinical decision making. Quality improvement efforts that provide access to focused and timely clinical information, facilitate change, and promote staff working together in multidisciplinary teams impacted clinical outcomes. Prevention of PrUs showed a trend of improvement in facilities that fully integrated tools to identify high-risk residents into day-to-day practice. CNA documentation facilitated

  15. Reducing stroke in women with risk factor management: blood pressure and cholesterol.

    PubMed

    Baghshomali, Sanam; Bushnell, Cheryl

    2014-09-01

    Stroke is a major cause of death and disability in adults worldwide. Prevention focused on modifiable risk factors, such as hypertension and hyperlipidemia, has shown them to be of significant importance in decreasing the risk of stroke. Multiple studies have brought to light the differences between men and women with regards to stroke and these risk factors. Women have a higher prevalence of stroke, mortality and disability and it has been shown that preventive and treatment options are not as comprehensive for women. Hence, it is of great necessity to evaluate and summarize the differences in gender and stroke risk factors in order to target disparities and optimize prevention, especially because women have a higher lifetime risk of stroke. The purpose of this review is to summarize sex differences in the prevalence of hypertension and hyperlipidemia. In addition, we will review the sex differences in stroke prevention effectiveness and adherence to blood pressure and cholesterol medications, and suggest future directions for research to reduce the burden of stroke in women.

  16. Long-stay in short-stay inpatient facilities: risk factors and barriers to discharge

    PubMed Central

    Gigantesco, Antonella; de Girolamo, Giovanni; Santone, Giovanni; Miglio, Rossella; Picardi, Angelo

    2009-01-01

    Background The aim of the present study was to assess the characteristics of long-stay inpatients in public and private Italian acute inpatient facilities, to identify risk factors and correlates of the long duration of hospital stay in these patients, and to identify possible barriers to alternative placements. Methods All patients in 130 Italian public and private psychiatric inpatient units who had been hospitalized for more than 3 months during a specific index period were assessed with standardized assessment instruments and compared to patients discharged during the same index period, but staying in hospital for less than 3 months (short-stay inpatients). Assessed domains included demographic, clinical, and treatment characteristics, as well as process of care. Logistic regression analysis was used to identify specific variables predicting inpatient long-stay status. Reasons for delaying patient discharge, as reported by treatment teams, were also analyzed. Results No overall differences between long-stay and short-stay patients emerged in terms of symptom severity or diagnostic status. Admission to a private inpatient facility and display of violent behavior during hospital stay were the most powerful predictors of long-stay. Lack of housing and a shortage of community support were the reasons most commonly cited by treatment teams as barriers to discharge. Conclusion Extra-clinical factors are important determinants of prolonged hospitalization in acute inpatient settings. PMID:19698136

  17. Layout Improvement Study to Reduce Staff Walking Distance in a Large Health Care Facility: How to Not Walk an Extra 4740 Miles.

    PubMed

    Ley-Chavez, Adriana; Hmar-Lagroun, Tatiana; Douglas-Ntagha, Pamela; Cumbo, Charlotte L

    2016-01-01

    Inefficient facility layouts have been found to be a challenge in health care, with excessive walking adding to the demands of staff and creating delays, which can impact the quality of care. Minimizing unnecessary transportation during care delivery improves efficiency, reduces delays, and frees up resources for use on value-added activities. This article presents a methodology and application of facility design to improve responsiveness and efficiency at a large hospital. The approach described provides the opportunity to improve existing layouts in facilities in which the floor plan is already defined, but there is some flexibility to relocate key areas. The existing physical constraints and work flows are studied and taken into consideration, and the volume of traffic flow throughout the facility guides the decision of where to relocate areas for maximum efficiency. Details on the steps followed and general recommendations to perform the necessary process and data analyses are provided. We achieved a 34.8% reduction in distance walked (4740 miles saved per year) and a 30% reduction in floors traveled in elevators (344 931 floors, which translate to 842 hours spent using elevators) by relocating 4 areas in which frequently used resources are housed.

  18. Risk management technique for liquefied natural gas facilities

    NASA Technical Reports Server (NTRS)

    Fedor, O. H.; Parsons, W. N.

    1975-01-01

    Checklists have been compiled for planning, design, construction, startup and debugging, and operation of liquefied natural gas facilities. Lists include references to pertinent safety regulations. Methods described are applicable to handling of other hazardous materials.

  19. Mild traumatic brain injury is associated with reduced cortical thickness in those at risk for Alzheimer's disease.

    PubMed

    Hayes, Jasmeet P; Logue, Mark W; Sadeh, Naomi; Spielberg, Jeffrey M; Verfaellie, Mieke; Hayes, Scott M; Reagan, Andrew; Salat, David H; Wolf, Erika J; McGlinchey, Regina E; Milberg, William P; Stone, Annjanette; Schichman, Steven A; Miller, Mark W

    2017-03-01

    Moderate-to-severe traumatic brain injury is one of the strongest environmental risk factors for the development of neurodegenerative diseases such as late-onset Alzheimer's disease, although it is unclear whether mild traumatic brain injury, or concussion, also confers risk. This study examined mild traumatic brain injury and genetic risk as predictors of reduced cortical thickness in brain regions previously associated with early Alzheimer's disease, and their relationship with episodic memory. Participants were 160 Iraq and Afghanistan War veterans between the ages of 19 and 58, many of whom carried mild traumatic brain injury and post-traumatic stress disorder diagnoses. Whole-genome polygenic risk scores for the development of Alzheimer's disease were calculated using summary statistics from the largest Alzheimer's disease genome-wide association study to date. Results showed that mild traumatic brain injury moderated the relationship between genetic risk for Alzheimer's disease and cortical thickness, such that individuals with mild traumatic brain injury and high genetic risk showed reduced cortical thickness in Alzheimer's disease-vulnerable regions. Among males with mild traumatic brain injury, high genetic risk for Alzheimer's disease was associated with cortical thinning as a function of time since injury. A moderated mediation analysis showed that mild traumatic brain injury and high genetic risk indirectly influenced episodic memory performance through cortical thickness, suggesting that cortical thinning in Alzheimer's disease-vulnerable brain regions is a mechanism for reduced memory performance. Finally, analyses that examined the apolipoprotein E4 allele, post-traumatic stress disorder, and genetic risk for schizophrenia and depression confirmed the specificity of the Alzheimer's disease polygenic risk finding. These results provide evidence that mild traumatic brain injury is associated with greater neurodegeneration and reduced memory performance

  20. 78 FR 48029 - Improving Chemical Facility Safety and Security

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-07

    ... responding to risks in chemical facilities (including during pre-inspection, inspection execution, post.... Sec. 2. Establishment of the Chemical Facility Safety and Security Working Group. (a) There is established a Chemical Facility Safety and Security Working Group (Working Group) co-chaired by the Secretary...

  1. Health Care Facilities Resilient to Climate Change Impacts

    PubMed Central

    Paterson, Jaclyn; Berry, Peter; Ebi, Kristie; Varangu, Linda

    2014-01-01

    Climate change will increase the frequency and magnitude of extreme weather events and create risks that will impact health care facilities. Health care facilities will need to assess climate change risks and adopt adaptive management strategies to be resilient, but guidance tools are lacking. In this study, a toolkit was developed for health care facility officials to assess the resiliency of their facility to climate change impacts. A mixed methods approach was used to develop climate change resiliency indicators to inform the development of the toolkit. The toolkit consists of a checklist for officials who work in areas of emergency management, facilities management and health care services and supply chain management, a facilitator’s guide for administering the checklist, and a resource guidebook to inform adaptation. Six health care facilities representing three provinces in Canada piloted the checklist. Senior level officials with expertise in the aforementioned areas were invited to review the checklist, provide feedback during qualitative interviews and review the final toolkit at a stakeholder workshop. The toolkit helps health care facility officials identify gaps in climate change preparedness, direct allocation of adaptation resources and inform strategic planning to increase resiliency to climate change. PMID:25522050

  2. Relative risk of reducing the lifetime blood donation deferral for men who have had sex with men versus currently tolerated transfusion risks.

    PubMed

    Vamvakas, Eleftherios C

    2011-01-01

    The risks of known and emerging transfusion-transmitted infections (TTIs) from reducing the current lifetime blood donation deferral for men who have had sex with men (MSM) to 1 or 5 years were compared to the risk from continuing to transfuse in the United States 12.5% of platelet doses as pooled whole-blood-derived (rather than single-donor) platelets. Assumptions made in mathematical models and blood donor/transfusion studies of the risks of TTIs since 2000 were evaluated. The number of HIV, hepatitis B virus, or hepatitis C virus TTIs from reducing the MSM deferral to 1 year is, respectively, 0.88, 2.94, or 66.9, many more than 10 times smaller than the risk from pooled platelets. If erroneous release of HIV-positive units (a risk independent of a donor's source of infection) is not considered, the MSM risk is 1 HIV-infectious donation per 17 to 56 million MSM donations. Any purportedly increased risk of human herpesvirus-8 transmission from MSM donors is far smaller than the risk of transfusion-associated sepsis from pooled platelets. Single-donor platelets from MSM after 5 years' abstinence are as safe or 5 times safer than our current pooled platelets--if the next TTI to emerge were transmitted, respectively, sexually or by another route. Thus, acceptance of MSM as blood donors after 1 or 5 years' abstinence may result in a postulated increase in risk that is so much smaller than the currently tolerated transfusion risk and so small in absolute terms that the ethical question of fairness to the MSM group justifies the change in policy. Copyright © 2011 Elsevier Inc. All rights reserved.

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

    PubMed

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

    2006-11-27

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

  4. Reducing hospital readmission rates: current strategies and future directions.

    PubMed

    Kripalani, Sunil; Theobald, Cecelia N; Anctil, Beth; Vasilevskis, Eduard E

    2014-01-01

    New financial penalties for institutions with high readmission rates have intensified efforts to reduce rehospitalization. Several interventions that involve multiple components (e.g., patient needs assessment, medication reconciliation, patient education, arranging timely outpatient appointments, and providing telephone follow-up) have successfully reduced readmission rates for patients discharged to home. The effect of interventions on readmission rates is related to the number of components implemented; single-component interventions are unlikely to reduce readmissions significantly. For patients discharged to postacute care facilities, multicomponent interventions have reduced readmissions through enhanced communication, medication safety, advanced care planning, and enhanced training to manage medical conditions that commonly precipitate readmission. To help hospitals direct resources and services to patients with greater likelihood of readmission, risk-stratification methods are available. Future work should better define the roles of home-based services, information technology, mental health care, caregiver support, community partnerships, and new transitional care personnel.

  5. The targeting of nutritionally at-risk children attending a primary health care facility in the Western Cape Province of South Africa.

    PubMed

    Schoeman, S E; Hendricks, M K; Hattingh, S P; Benadé, A J S; Laubscher, J A; Dhansay, M A

    2006-12-01

    The aim of this study was to determine the practices of primary health care (PHC) nurses in targeting nutritionally at-risk infants and children for intervention at a PHC facility in a peri-urban area of the Western Cape Province of South Africa. Nutritional risk status of infants and children <6 years of age was based on criteria specified in standardised nutrition case management guidelines developed for PHC facilities in the province. Children were identified as being nutritionally at-risk if their weight was below the 3rd centile, their birth weight was less than 2500 g, and their growth curve showed flattening or dropping off for at least two consecutive monthly visits. The study assessed the practices of nurses in identifying children who were nutritionally at-risk and the entry of these children into the food supplementation programme (formerly the Protein-Energy Malnutrition Scheme) of the health facility. Structured interviews were conducted with nurses to determine their knowledge of the case management guidelines; interviews were also conducted with caregivers to determine their sociodemographic status. One hundred and thirty-four children were enrolled in the study. The mean age of their caregivers was 29.5 (standard deviation 7.5) years and only 47 (38%) were married. Of the caregivers, 77% were unemployed, 46% had poor household food security and 40% were financially dependent on non-family members. Significantly more children were nutritionally at-risk if the caregiver was unemployed (54%) compared with employed (32%) (P=0.04) and when there was household food insecurity (63%) compared with household food security (37%) (P<0.004). Significantly more children were found not to be nutritionally at-risk if the caregiver was financially self-supporting or supported by their partners (61%) compared with those who were financially dependent on non-family members (35%) (P=0.003). The weight results of the nurses and the researcher differed significantly (P

  6. USING THE DELPHI TECHNIQUE TO DEVELOP EFFECTIVENESS INDICATORS FOR SOCIAL MARKETING COMMUNICATION TO REDUCE HEALTH-RISK BEHAVIORS AMONG YOUTH.

    PubMed

    Vantamay, Nottakrit

    2015-09-01

    This study aimed to develop effectiveness indicators for social marketing communication to reduce health-risk behaviors among Thai youth by using the Delphi technique. The Delphi technique is a research approach used to gain consensus through a series of two or more rounds of questionnaire surveys where information and results are fed back to panel members between each round and it has been extensively used to generate many indicators relevant to health behaviors. The Delphi technique was conducted in 3 rounds by consulting a panel of 15 experts in the field of social marketing communication for public health campaigns in Thailand. We found forty-nine effectiveness indicators in eight core components reached consensus. These components were: 1) attitude about health-risk behavior reduction, 2) subjective norms, 3) perceived behavioral control, 4) intention to reduce health-risk behaviors, 5) practices for reducing health-risk behaviors, 6) knowledge about the dangers and impact of health-risk behaviors, 7) campaign brand equity, and 8) communication networks. These effectiveness indicators could be applied by health promotion organizations for evaluating the effectiveness of social marketing communication to effectively reduce health-risk behaviors among youth.

  7. Reduced risk-taking behavior as a trait feature of anxiety.

    PubMed

    Giorgetta, Cinzia; Grecucci, Alessandro; Zuanon, Sophia; Perini, Laura; Balestrieri, Matteo; Bonini, Nicolao; Sanfey, Alan G; Brambilla, Paolo

    2012-12-01

    Affect can have a significant influence on decision-making processes and subsequent choice. One particularly relevant type of negative affect is anxiety, which serves to enhance responses to threatening stimuli or situations. In its exaggerated form, it can lead to psychiatric disorders, with detrimental consequences for quality of life, including the ability to make choices. This study investigated, for the first time, how pathological anxiety affects risk-taking behavior. In this study, 20 anxious participants meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for either generalized anxiety disorder (n = 10) and for panic attack disorder (n = 10), as well as 20 matched nonanxious controls, performed a gambling task. To investigate the tendency toward either a risk-seeking or a risk-averse behavior, we employed a task that did not allow for learning from outcomes. Anxious participants made significantly fewer risky choices than matched nonanxious participants. Specifically, they become risk-avoidant after gains. Moreover, anxious participants not only were less happy after gains but were also less sad after losses, and they also evinced less desire to change their choices after losses than did nonanxious participants. Importantly, whereas the desire to switch choice was followed by actual choice switch for all participants, happiness directly predicted subsequent risky choices, particularly in the nonanxious participants. Further analyses revealed that the anxious participants' risk-avoidance behavior was independent of different types of anxiety disorder (panic attack disorder and generalized anxiety disorder) as well as of the effects of psychotropic drugs treatment. This study demonstrates a specific role for anxiety in individual decision making. In particular, hypersensitivity to potential threats and pessimistic evaluation of future events reduced risk-taking behavior. PsycINFO Database Record (c) 2012 APA, all rights

  8. Quantitative Estimation of Risks for Production Unit Based on OSHMS and Process Resilience

    NASA Astrophysics Data System (ADS)

    Nyambayar, D.; Koshijima, I.; Eguchi, H.

    2017-06-01

    Three principal elements in the production field of chemical/petrochemical industry are (i) Production Units, (ii) Production Plant Personnel and (iii) Production Support System (computer system introduced for improving productivity). Each principal element has production process resilience, i.e. a capability to restrain disruptive signals occurred in and out of the production field. In each principal element, risk assessment is indispensable for the production field. In a production facility, the occupational safety and health management system (Hereafter, referred to as OSHMS) has been introduced to reduce a risk of accidents and troubles that may occur during production. In OSHMS, a risk assessment is specified to reduce a potential risk in the production facility such as a factory, and PDCA activities are required for a continual improvement of safety production environments. However, there is no clear statement to adopt the OSHMS standard into the production field. This study introduces a metric to estimate the resilience of the production field by using the resilience generated by the production plant personnel and the result of the risk assessment in the production field. A method for evaluating how OSHMS functions are systematically installed in the production field is also discussed based on the resilience of the three principal elements.

  9. Porous NiCo2O4 nanosheets/reduced graphene oxide composite: facile synthesis and excellent capacitive performance for supercapacitors.

    PubMed

    Ma, Lianbo; Shen, Xiaoping; Ji, Zhenyuan; Cai, Xiaoqing; Zhu, Guoxing; Chen, Kangmin

    2015-02-15

    A composite with porous NiCo2O4 nanosheets attached on reduced graphene oxide (RGO) sheets is synthesized through a facile solution-based method combined with a simple thermal annealing process. The capacitive performances of the as-prepared NiCo2O4/RGO (NCG) composites as electrode materials are investigated. It is found that the NCG composites exhibit a high specific capacitance up to 1186.3 F g(-1) at the current density of 0.5 A g(-1), and superior cycling stability with about 97% of the initial capacitance after 100 cycles. The greatly enhanced capacitive performance of the NCG electrode can be attributed to the existence of RGO support, which serves as both conductive channels and active interface. The approach used in the synthesis provides a facile route for preparing graphene-binary metal oxide electrode materials. The remarkable capacitive performance of NCG composites will undoubtedly make them be attractive for high performance energy storage applications. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. The effect of an Internet-based intervention designed to reduce HIV/AIDS sexual risk among Mexican adolescents.

    PubMed

    Castillo-Arcos, Lubia Del Carmen; Benavides-Torres, Raquel Alicia; López-Rosales, Fuensanta; Onofre-Rodríguez, Dora Julia; Valdez-Montero, Carolina; Maas-Góngora, Lucely

    2016-01-01

    The purpose of the study was to evaluate the effect of an Internet-based intervention to reduce sexual risk behaviors and increase resilience to sexual risk behaviors among Mexican adolescents, a key HIV/AIDS risk group. The study had a quasi-experimental design with single-stage cluster sampling. Participants ages 14-17 were stratified by gender and randomly assigned to either receive intervention "Connect" (which included face-to-face and Internet-based sessions designed to reduce sexual risk behaviors and increase resilience to sexual risk) or control (a general educational video on reducing health risks). A total of 9 survey instruments were administered online through SurveyMonkey pre- and post-intervention to assess changes in sexual risk and protective factors as well as two outcomes of interest: risky sexual behaviors and resilience. Pearson correlation assessed instrument reliability while multivariable linear regression models assessed two study hypotheses: (1) the effect of the intervention on sexual behavior and resilience is mediated by adolescent age, gender, and sexual experience and (2) risk and protective factors are mediators between the intervention and sexual behavior. The sample was composed of 193 adolescents between 14 and 17 years old (n = 96 in the control group and n = 97 in the experimental group). Survey instruments were reliable. Age was associated with pre-to-post test changes in sexual resilience (β = -6.10, p = .019), which partially mediated the effect of the intervention on sexual resilience (β = 5.70, p = .034). Social support was associated with pre-to-post test changes in risky sexual behavior (β = -0.17, p = .039). Intervention "Connect" was independently associated with improved self-reported resilience to risky sexual behaviors, though not with a reduction in those behaviors in multivariate analyses. This is the first Internet-based intervention designed to reduce HIV/AIDS sexual risk among

  11. Safety analysis, risk assessment, and risk acceptance criteria

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

    Jamali, K.; Stack, D.W.; Sullivan, L.H.

    1997-08-01

    This paper discusses a number of topics that relate safety analysis as documented in the Department of Energy (DOE) safety analysis reports (SARs), probabilistic risk assessments (PRA) as characterized primarily in the context of the techniques that have assumed some level of formality in commercial nuclear power plant applications, and risk acceptance criteria as an outgrowth of PRA applications. DOE SARs of interest are those that are prepared for DOE facilities under DOE Order 5480.23 and the implementing guidance in DOE STD-3009-94. It must be noted that the primary area of application for DOE STD-3009 is existing DOE facilities andmore » that certain modifications of the STD-3009 approach are necessary in SARs for new facilities. Moreover, it is the hazard analysis (HA) and accident analysis (AA) portions of these SARs that are relevant to the present discussions. Although PRAs can be qualitative in nature, PRA as used in this paper refers more generally to all quantitative risk assessments and their underlying methods. HA as used in this paper refers more generally to all qualitative risk assessments and their underlying methods that have been in use in hazardous facilities other than nuclear power plants. This discussion includes both quantitative and qualitative risk assessment methods. PRA has been used, improved, developed, and refined since the Reactor Safety Study (WASH-1400) was published in 1975 by the Nuclear Regulatory Commission (NRC). Much debate has ensued since WASH-1400 on exactly what the role of PRA should be in plant design, reactor licensing, `ensuring` plant and process safety, and a large number of other decisions that must be made for potentially hazardous activities. Of particular interest in this area is whether the risks quantified using PRA should be compared with numerical risk acceptance criteria (RACs) to determine whether a facility is `safe.` Use of RACs requires quantitative estimates of consequence frequency and magnitude.« less

  12. Bird Mortality in Oil Field Wastewater Disposal Facilities

    NASA Astrophysics Data System (ADS)

    Ramirez, Pedro

    2010-11-01

    Commercial and centralized oilfield wastewater disposal facilities (COWDFs) are used in the Western United States for the disposal of formation water produced from oil and natural gas wells. In Colorado, New Mexico, Utah, and Wyoming, COWDFs use large evaporation ponds to dispose of the wastewater. Birds are attracted to these large evaporation ponds which, if not managed properly, can cause wildlife mortality. The U.S. Fish and Wildlife Service (USFWS) and the U.S. Environmental Protection Agency (EPA) conducted 154 field inspections of 28 COWDFs in Wyoming from March 1998 through September 2008 and documented mortality of birds and other wildlife in 9 COWDFs. Of 269 bird carcasses recovered from COWDFs, grebes (Family Podicipedidae) and waterfowl (Anatidae) were the most frequent casualties. Most mortalities were attributed to oil on evaporation ponds, but sodium toxicity and surfactants were the suspected causes of mortality at three COWDFs. Although the oil industry and state and federal regulators have made much progress in reducing bird mortality in oil and gas production facilities, significant mortality incidents continue in COWDFs, particularly older facilities permitted in the early 1980’s. Inadequate operation and management of these COWDFs generally results in the discharge of oil into the large evaporation ponds which poses a risk for birds and other wildlife.

  13. Bird mortality in oil field wastewater disposal facilities.

    PubMed

    Ramirez, Pedro

    2010-11-01

    Commercial and centralized oilfield wastewater disposal facilities (COWDFs) are used in the Western United States for the disposal of formation water produced from oil and natural gas wells. In Colorado, New Mexico, Utah, and Wyoming, COWDFs use large evaporation ponds to dispose of the wastewater. Birds are attracted to these large evaporation ponds which, if not managed properly, can cause wildlife mortality. The U.S. Fish and Wildlife Service (USFWS) and the U.S. Environmental Protection Agency (EPA) conducted 154 field inspections of 28 COWDFs in Wyoming from March 1998 through September 2008 and documented mortality of birds and other wildlife in 9 COWDFs. Of 269 bird carcasses recovered from COWDFs, grebes (Family Podicipedidae) and waterfowl (Anatidae) were the most frequent casualties. Most mortalities were attributed to oil on evaporation ponds, but sodium toxicity and surfactants were the suspected causes of mortality at three COWDFs. Although the oil industry and state and federal regulators have made much progress in reducing bird mortality in oil and gas production facilities, significant mortality incidents continue in COWDFs, particularly older facilities permitted in the early 1980's. Inadequate operation and management of these COWDFs generally results in the discharge of oil into the large evaporation ponds which poses a risk for birds and other wildlife.

  14. Reducing Preconception Risks among African American Women with Conversational Agent Technology

    PubMed Central

    Jack, Brian; Bickmore, Timothy; Hempstead, Megan; Yinusa-Nyahkoon, Leanne; Sadikova, Ekaterina; Mitchell, Suzanne; Gardiner, Paula; Adigun, Fatima; Penti, Brian; Schulman, Daniel; Damus, Karla

    2016-01-01

    improve their health (64%). CONCLUSION Among a group of reproductive age African American women, use of the Gabby system was associated with a significant reduction in identified PCH risks. More research is needed to determine if Gabby can impact risk status among a larger, more socio-demographically diverse group of black women and if reducing the number of risks is clinically significant. PMID:26152434

  15. Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association

    PubMed Central

    Florez, Hermes; Huang, Elbert S.; Kalyani, Rita R.; Mupanomunda, Maria; Pandya, Naushira; Swift, Carrie S.; Taveira, Tracey H.; Haas, Linda B.

    2016-01-01

    Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life. PMID:26798150

  16. How can inequalities in mortality be reduced? A quantitative analysis of 6 risk factors in 21 European populations.

    PubMed

    Eikemo, Terje A; Hoffmann, Rasmus; Kulik, Margarete C; Kulhánová, Ivana; Toch-Marquardt, Marlen; Menvielle, Gwenn; Looman, Caspar; Jasilionis, Domantas; Martikainen, Pekka; Lundberg, Olle; Mackenbach, Johan P

    2014-01-01

    Socioeconomic inequalities in mortality are one of the greatest challenges for health policy in all European countries, but the potential for reducing these inequalities is unclear. We therefore quantified the impact of equalizing the distribution of six risk factors for mortality: smoking, overweight, lack of physical exercise, lack of social participation, low income, and economic inactivity. We collected and harmonized data on mortality and risk factors by educational level for 21 European populations in the early 2000s. The impact of the risk factors on mortality in each educational group was determined using Population Attributable Fractions. We estimated the impact on inequalities in mortality of two scenarios: a theoretical upward levelling scenario in which inequalities in the risk factor were completely eliminated, and a more realistic best practice scenario, in which inequalities in the risk factor were reduced to those seen in the country with the smallest inequalities for that risk factor. In general, upward levelling of inequalities in smoking, low income and economic inactivity hold the greatest potential for reducing inequalities in mortality. While the importance of low income is similar across Europe, smoking is more important in the North and East, and overweight in the South. On the basis of best practice scenarios the potential for reducing inequalities in mortality is often smaller, but still substantial in many countries for smoking and physical inactivity. Theoretically, there is a great potential for reducing inequalities in mortality in most European countries, for example by equity-oriented tobacco control policies, income redistribution and employment policies. Although it is necessary to achieve substantial degrees of upward levelling to make a notable difference for inequalities in mortality, the existence of best practice countries with more favourable distributions for some of these risk factors suggests that this is feasible.

  17. How Can Inequalities in Mortality Be Reduced? A Quantitative Analysis of 6 Risk Factors in 21 European Populations

    PubMed Central

    Eikemo, Terje A.; Hoffmann, Rasmus; Kulik, Margarete C.; Kulhánová, Ivana; Toch-Marquardt, Marlen; Menvielle, Gwenn; Looman, Caspar; Jasilionis, Domantas; Martikainen, Pekka; Lundberg, Olle; Mackenbach, Johan P.

    2014-01-01

    Background Socioeconomic inequalities in mortality are one of the greatest challenges for health policy in all European countries, but the potential for reducing these inequalities is unclear. We therefore quantified the impact of equalizing the distribution of six risk factors for mortality: smoking, overweight, lack of physical exercise, lack of social participation, low income, and economic inactivity. Methods We collected and harmonized data on mortality and risk factors by educational level for 21 European populations in the early 2000s. The impact of the risk factors on mortality in each educational group was determined using Population Attributable Fractions. We estimated the impact on inequalities in mortality of two scenarios: a theoretical upward levelling scenario in which inequalities in the risk factor were completely eliminated, and a more realistic best practice scenario, in which inequalities in the risk factor were reduced to those seen in the country with the smallest inequalities for that risk factor. Findings In general, upward levelling of inequalities in smoking, low income and economic inactivity hold the greatest potential for reducing inequalities in mortality. While the importance of low income is similar across Europe, smoking is more important in the North and East, and overweight in the South. On the basis of best practice scenarios the potential for reducing inequalities in mortality is often smaller, but still substantial in many countries for smoking and physical inactivity. Interpretation Theoretically, there is a great potential for reducing inequalities in mortality in most European countries, for example by equity-oriented tobacco control policies, income redistribution and employment policies. Although it is necessary to achieve substantial degrees of upward levelling to make a notable difference for inequalities in mortality, the existence of best practice countries with more favourable distributions for some of these risk

  18. Electrostatic hazards of charging of bedclothes and ignition in medical facilities.

    PubMed

    Endo, Yuta; Ohsawa, Atsushi; Yamaguma, Mizuki

    2018-02-26

    We investigated the charge generated on bedclothes (cotton and polyester) during bedding exchange with different humidities and the ignitability of an alcohol-based hand sanitizer (72.3 mass% ethanol) due to static spark with different temperatures to identify the hazards of electrostatic shocks and ignitions occurring previously in medical facilities. The results indicated that charging of the polyester bedclothes may induce a human body potential of over about 10 kV, resulting in shocks even at a relative humidity of 50%, and a human body potential of higher than about 8 kV can cause a risk for the ignition of the hand sanitizer. The grounding of human bodies via footwear and flooring, therefore, is essential to avoid such hazards (or to reduce such risks).

  19. SIMPLE DECISION RULES REDUCE REINJURY RISK AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    PubMed Central

    Grindem, Hege; Snyder-Mackler, Lynn; Moksnes, Håvard; Engebretsen, Lars; Risberg, May Arna

    2016-01-01

    Background Knee reinjury after anterior cruciate ligament (ACL) reconstruction is common and increases the risk of osteoarthritis. There is sparse evidence to guide return to sport (RTS) decisions in this population. Objectives To assess the relationship between knee reinjury after ACL reconstruction and 1) return to level I sports, 2) timing of return to sports, and 3) knee function prior to return. Methods 106 patients who participated in pivoting sports participated in this prospective two year cohort study. Sports participation and knee reinjury were recorded monthly. Knee function was assessed with the Knee Outcome Survey–Activities of Daily Living Scale, global rating scale of function, and quadriceps strength and hop test symmetry. Pass RTS criteria was defined as scores >90 on all tests, failure as failing any. Results Patients who returned to level I sports had 4.32 (p=0.048) higher reinjury rate than those who did not. The reinjury rate was significantly reduced by 51 % for each month RTS was delayed until 9 months after surgery, after which no further risk reduction was observed. 38.2 % of those who failed RTS criteria suffered reinjuries versus 5.6 % of those who passed (HR: 0.16, p=0.075). More symmetrical quadriceps strength prior to return significantly reduced the knee reinjury rate. Conclusion Returning to level I sports after ACL reconstruction leads to a more than 4-fold increase in reinjury rates over 2 years. Return to sport 9 months or later after surgery and more symmetrical quadriceps strength prior to return substantially reduces the reinjury rate. PMID:27162233

  20. Exposure to airborne fungi during sorting of recyclable plastics in waste treatment facilities.

    PubMed

    Černá, Kristýna; Wittlingerová, Zdeňka; Zimová, Magdaléna; Janovský, Zdeněk

    2017-02-28

    In working environment of waste treatment facilities, employees are exposed to high concentrations of airborne microorganisms. Fungi constitute an essential part of them. This study aims at evaluating the diurnal variation in concentrations and species composition of the fungal contamination in 2 plastic waste sorting facilities in different seasons. Air samples from the 2 sorting facilities were collected through the membrane filters method on 4 different types of cultivation media. Isolated fungi were classified to genera or species by using a light microscopy. Overall, the highest concentrations of airborne fungi were recorded in summer (9.1×103-9.0×105 colony-forming units (CFU)/m3), while the lowest ones in winter (2.7×103-2.9×105 CFU/m3). The concentration increased from the beginning of the work shift and reached a plateau after 6-7 h of the sorting. The most frequently isolated airborne fungi were those of the genera Penicillium and Aspergillus. The turnover of fungal species between seasons was relatively high as well as changes in the number of detected species, but potentially toxigenic and allergenic fungi were detected in both facilities during all seasons. Generally, high concentrations of airborne fungi were detected in the working environment of plastic waste sorting facilities, which raises the question of health risk taken by the employees. Based on our results, the use of protective equipment by employees is recommended and preventive measures should be introduced into the working environment of waste sorting facilities to reduce health risk for employees. Med Pr 2017;68(1):1-9. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  1. Using Simulation to Compare 4 Categories of Intervention for Reducing Cardiovascular Disease Risks

    PubMed Central

    Homer, Jack; Trogdon, Justin; Wile, Kristina; Orenstein, Diane

    2014-01-01

    The Prevention Impacts Simulation Model (PRISM) projects the multiyear impacts of 22 different interventions aimed at reducing risk of cardiovascular disease. We grouped these into 4 categories: clinical, behavioral support, health promotion and access, and taxes and regulation. We simulated impacts for the United States overall and also for a less-advantaged county with a higher death rate. Of the 4 categories of intervention, taxes and regulation reduce costs the most in the short term (through 2020) and long term (through 2040) and reduce deaths the most in the long term; they are second to clinical interventions in reducing deaths in the short term. All 4 categories combined were required to bring costs and deaths in the less-advantaged county down to the national level. PMID:24832142

  2. Insulin use increases risk of asthma but metformin use reduces the risk in patients with diabetes in a Taiwanese population cohort.

    PubMed

    Chen, Chiung-Zuei; Hsu, Chih-Hui; Li, Chung-Yi; Hsiue, Tzuen-Ren

    2017-12-01

    Recent reports have suggested that insulin promotes airway smooth muscle contraction and enhances airway hyperresponsiveness, which are cardinal features of asthma. In contrast, metformin can reduce both airway inflammatory and remodeling properties. However, these results are all from in vitro and animal studies. This study investigated whether diabetes and various antidiabetic agents associate with the risk of asthma. We used a retrospective population-based cohort study using Taiwan's National Health Insurance claim database from 2000 to 2010 and a Cox proportional hazards regression model to compare the incidence of asthma between patients with diabetes (n = 19,428) and a matched non-diabetic group (n = 38,856). We also used a case-control study nested from the above cohort including 1,982 incident cases of asthma and 1,982 age- and sex-matched controls. A time density sampling technique was used to assess the effects of various antidiabetic agents on the risk of asthma. The incidence of asthma was significantly higher in the diabetic cohort than that in the non-diabetic cohort after adjustment for age, sex, and obesity, with a hazard ratio of 1.30 (95% confidence interval [CI]: 1.24-1.38). Insulin was found to increase the risk of asthma among diabetic patients (odds ratio [OR] 2.23; 95% CI: 1.52-3.58). In contrast, the use of metformin correlated with a decreased risk of asthma (OR 0.75; 95% CI: 0.60-0.95). Individuals with diabetes are at an increased risk of asthma. Insulin may further increase the risk of asthma, but the risk could possibly be reduced by using metformin.

  3. Development of Risk Insights for Regulatory Review of a Near-Surface Disposal Facility for Radioactive Waste

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

    Esh, D.W.; Ridge, A.C.; Thaggard, M.

    2006-07-01

    Section 3116 of the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005 (NDAA) requires the Department of Energy (DOE) to consult with the Nuclear Regulatory Commission (NRC) about non-High Level Waste (HLW) determinations. In its consultative role, NRC performs technical reviews of DOE's waste determinations but does not have regulatory authority over DOE's waste disposal activities. The safety of disposal is evaluated by comparing predicted disposal facility performance to the performance objectives specified in NRC regulations for the disposal of low-level waste (10 CFR Part 61 Subpart C). The performance objectives contain criteria for protection of themore » public, protection of inadvertent intruders, protection of workers, and stability of the disposal site after closure. The potential radiological dose to receptors typically is evaluated with a performance assessment (PA) model that simulates the release of radionuclides from the disposal site, transport of radionuclides through the environment, and exposure of potential receptors to residual contamination for thousands of years. This paper describes NRC's development and use of independent performance assessment modeling to facilitate review of DOE's non-HLW determination for the Saltstone Disposal Facility (SDF) at the Savannah River Site. NRC's review of the safety of near-surface disposal of radioactive waste at the SDF was facilitated and focused by risk insights developed with an independent PA model. The main components of NRC's performance assessment model are presented. The development of risk insights that allow the staff to focus review efforts on those areas that are most important to satisfying the performance objectives is discussed. Uncertainty analysis was performed of the full stochastic model using genetic variable selection algorithms. The results of the uncertainty analysis were then used to guide the development of simulations of other scenarios to understand the

  4. Indicators of Dysphagia in Aged Care Facilities

    ERIC Educational Resources Information Center

    Pu, Dai; Murry, Thomas; Wong, May C. M.; Yiu, Edwin M. L.; Chan, Karen M. K.

    2017-01-01

    Purpose: The current cross-sectional study aimed to investigate risk factors for dysphagia in elderly individuals in aged care facilities. Method: A total of 878 individuals from 42 aged care facilities were recruited for this study. The dependent outcome was speech therapist-determined swallowing function. Independent factors were Eating…

  5. Online social integration is associated with reduced mortality risk.

    PubMed

    Hobbs, William R; Burke, Moira; Christakis, Nicholas A; Fowler, James H

    2016-11-15

    Social interactions increasingly take place online. Friendships and other offline social ties have been repeatedly associated with human longevity, but online interactions might have different properties. Here, we reference 12 million social media profiles against California Department of Public Health vital records and use longitudinal statistical models to assess whether social media use is associated with longer life. The results show that receiving requests to connect as friends online is associated with reduced mortality but initiating friendships is not. Additionally, online behaviors that indicate face-to-face social activity (like posting photos) are associated with reduced mortality, but online-only behaviors (like sending messages) have a nonlinear relationship, where moderate use is associated with the lowest mortality. These results suggest that online social integration is linked to lower risk for a wide variety of critical health problems. Although this is an associational study, it may be an important step in understanding how, on a global scale, online social networks might be adapted to improve modern populations' social and physical health.

  6. Online social integration is associated with reduced mortality risk

    PubMed Central

    Hobbs, William R.; Burke, Moira; Christakis, Nicholas A.; Fowler, James H.

    2016-01-01

    Social interactions increasingly take place online. Friendships and other offline social ties have been repeatedly associated with human longevity, but online interactions might have different properties. Here, we reference 12 million social media profiles against California Department of Public Health vital records and use longitudinal statistical models to assess whether social media use is associated with longer life. The results show that receiving requests to connect as friends online is associated with reduced mortality but initiating friendships is not. Additionally, online behaviors that indicate face-to-face social activity (like posting photos) are associated with reduced mortality, but online-only behaviors (like sending messages) have a nonlinear relationship, where moderate use is associated with the lowest mortality. These results suggest that online social integration is linked to lower risk for a wide variety of critical health problems. Although this is an associational study, it may be an important step in understanding how, on a global scale, online social networks might be adapted to improve modern populations’ social and physical health. PMID:27799553

  7. Insights and perspectives on dietary modifications to reduce the risk of cardiovascular disease

    USDA-ARS?s Scientific Manuscript database

    This article summarizes presentations from, “Insights and Perspectives on Dietary Modifications to Reduce the Risk of Cardiovascular Disease”, a symposium held at the American Society for Nutrition (ASN) Annual Meeting and Scientific Sessions in conjunction with Experimental Biology 2014 in San Dieg...

  8. Unique Tuft Test Facility Dramatically Reduces Brush Seal Development Costs

    NASA Technical Reports Server (NTRS)

    Fellenstein, James A.

    1997-01-01

    Brush seals have been incorporated in the latest turbine engines to reduce leakage and improve efficiency. However, the life of these seals is limited by wear. Studies have shown that optimal sealing characteristics for a brush seal occur before the interference fit between the brush and shaft is excessively worn. Research to develop improved tribopairs (brush and coating) with reduced wear and lower friction has been hindered by the lack of an accurate, low-cost, efficient test methodology. Estimated costs for evaluating a new material combination in an engine company seal test program are on the order of $100,000. To address this need, the NASA Lewis Research Center designed, built, and validated a unique, innovative brush seal tuft tester that slides a single tuft of brush seal wire against a rotating shaft under controlled loads, speeds, and temperatures comparable to those in turbine engines. As an initial screening tool, the brush seal tuft tester can tribologicaly evaluate candidate seal materials for 1/10th the cost of full-scale seal tests. Previous to the development of the brush seal tuft tester facility, most relevant tribological data had been obtained from full-scale seal tests conducted primarily to determine seal leakage characteristics. However, from a tribological point of view, these tests included the confounding effects of varying contact pressures, bristle flaring, high-temperature oxidation, and varying bristle contact angles. These confounding effects are overcome in tuft testing. The interface contact pressures can be either constant or varying depending on the tuft mounting device, and bristle wear can be measured optically with inscribed witness marks. In a recent cooperative program with a U.S. turbine engine manufacturer, five metallic wire candidates were tested against a plasma-sprayed Nichrome-bonded chrome carbide. The wire materials used during this collaboration were either nickel-chrome- or cobaltchrome-based superalloys. These

  9. Malpractice risk and cost are significantly reduced after tort reform.

    PubMed

    Stewart, Ronald M; Geoghegan, Kathy; Myers, John G; Sirinek, Kenneth R; Corneille, Michael G; Mueller, Deborah; Dent, Daniel L; Wolf, Steven E; Pruitt, Basil A

    2011-04-01

    Rising medical malpractice premiums have reached a crisis point in many areas of the United States. In 2003 the Texas legislature passed a comprehensive package of tort reform laws that included a cap at $250,000 on noneconomic damages in most medical malpractice cases. We hypothesized that tort reform laws significantly reduce the risk of malpractice lawsuit in an academic medical center. We compared malpractice prevalence, incidence, and liability costs before and after comprehensive state tort reform measures were implemented. Two prospectively maintained institutional databases were used to calculate and characterize malpractice risk: a surgical operation database and a risk management and malpractice database. Risk groups were divided into pretort reform (1992 to 2004) and post-tort reform groups (2004 to the present). Operative procedures were included for elective, urgent, and emergency general surgery procedures. During the study period, 98,513 general surgical procedures were performed. A total of 28 lawsuits (25 pre-reform, 3 postreform) were filed, naming general surgery faculty or residents. The prevalence of lawsuits filed/100,000 procedures performed is as follows: before reform, 40 lawsuits/100,000 procedures, and after reform, 8 lawsuits/100,000 procedures (p < 0.01, relative risk 0.21 [95% CI 0.063 to 0.62]). Virtually all of the liability and defense cost was in the pretort reform period: $595,000/year versus $515/year in the postreform group (p < 0.01). Implementation of comprehensive tort reform in Texas was associated with a significant decrease in the prevalence and cost of surgical malpractice lawsuits at one academic medical center. Copyright © 2011. Published by Elsevier Inc.

  10. [French recommendations on control measures to reduce the infectious risk in immunocompromised patients].

    PubMed

    Zahar, J-R; Jolivet, S; Adam, H; Dananché, C; Lizon, J; Alfandari, S; Boulestreau, H; Baghdadi, N; Bay, J-O; Bénéteau, A-M; Bougnoux, M-E; Brenier-Pinchart, M-P; Dalle, J-H; Fournier, S; Fuzibet, J-G; Kauffmann-Lacroix, C; Le Guinche, I; Lepelletier, D; Loukili, N; Lory, A; Morvan, M; Oumedaly, R; Ribaud, P; Rohrlich, P; Vanhems, P; Aho, S; Vanjak, D; Gangneux, J-P

    2017-12-01

    The increase use of immunosuppressive treatments in patients with solid cancer and/or inflammatory diseases requires revisiting our practices for the prevention of infectious risk in the care setting. A review of the literature by a multidisciplinary working group at the beginning of 2014 wished to answer the following 4 questions to improve healthcare immunocompromised patients: (I) How can we define immunocompromised patients with high, intermediate and low infectious risk, (II) which air treatment should be recommended for this specific population? (III) What additional precautions should be recommended for immunocompromised patients at risk for infection? (IV) Which global environmental control should be recommended? Based on data from the literature and using the GRADE method, we propose 15 recommendations that could help to reduce the risk of infection in these exposed populations. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  11. Low-Cost, Class D Testing of Spacecraft Photovoltaic Systems Can Reduce Risk

    NASA Technical Reports Server (NTRS)

    Forgione, Joshua B.; Kojima, Gilbert K.; Hanel, Robert; Mallinson, Mark

    2014-01-01

    The end-to-end verification of a spacecraft photovoltaic power generation system requires light! A lowcost, portable, and end-to-end photovoltaic-system test appropriate for NASA's new generation of Class D missions is presented. High risk, low-cost, and quick-turn satellites rarely have the resources to execute the traditional approaches from higher-class (A-C) missions. The Class D approach, as demonstrated on the Lunar Atmospheric and Dust Environment Explorer (LADEE), utilizes a portable, metalhalide, theatre lamp for an end-to-end photovoltaic system test. While not as precise and comprehensive as the traditional Large Area Pulsed Solar Simulator (LAPSS) test, the LADEE method leverages minimal resources into an ongoing assessment program that can be applied through numerous stages of the mission. The project takes a true Class D approach in assessing the technical value of a costly, highfidelity performance test versus a simpler approach with less programmatic risk. The resources required are a fraction of that for a LAPSS test, and is easy to repeat due to its portability. Further, the test equipment can be handed down to future projects without building an on-site facility. At the vanguard of Class D missions, the LADEE team frequently wrestled with and challenged the status quo. The philosophy of risk avoidance at all cost, typical to Class A-C missions, simply could not be executed. This innovative and simple testing solution is contextualized to NASA Class D programs and a specific risk encountered during development of the LADEE Electrical Power System (EPS). Selection of the appropriate lamp and safety concerns are discussed, with examples of test results. Combined with the vendor's panellevel data and periodic inspection, the method ensures system integrity from Integration and Test (I&T) through launch. Following launch, mission operations tools are utilized to assess system performance based on a scant amount of available data.

  12. Non-sedentary Lifestyle Can Reduce Hip Fracture Risk among Older Caucasians Adults: The Adventist Health Study-2.

    PubMed

    Lousuebsakul-Matthews, Vichuda; Thorpe, Donna; Knutsen, Raymond; Beeson, W Larry; Fraser, Gary E; Knutsen, Synnove F

    2015-01-01

    The beneficial effect of physical activity on reducing hip fracture risk has been supported in many previous studies. The present cohort study explores the relationship between total daily physical activity expressed as MET-hour/day and hip fracture risk among men over 50 years of age and postmenopausal women (n=22,836). Associations between self-reported hip fracture incidence and total daily physical activity and selected lifestyle factors were assessed using Cox proportional hazard regression. In gender-specific multivariable models, total activity above average (≥ 51 MET-hours per day for men, ≥ 48 MET-hours per day for women) compared to those with sedentary lifestyle (< 40 MET-hours per day) reduced the risk of hip fracture by 60% among men (HR=0.40, 95%CI: 0.23-0.70) (Ptrend=0.002) and 48% among women (HR=0.52, 95%CI: 0.32-0.84) (Ptrend=0.01). Our findings suggest that a moderate level of physical activity and avoiding a sedentary lifestyle can reduce the risk of hip fracture among the elderly.

  13. Statins Reduce the Risks of Relapse to Addiction in Rats

    PubMed Central

    Chauvet, Claudia; Nicolas, Celine; Lafay-Chebassier, Claire; Jaber, Mohamed; Thiriet, Nathalie; Solinas, Marcello

    2016-01-01

    Statins are drugs that have been used for decades in humans for the treatment of hypercholesterolemia. More recently, several lines of evidence demonstrate that statins, in addition to their peripheral effects, produce a wide variety of effects in the brain and may be beneficial in neurological and psychiatric conditions. In this study, we allowed rats to self-administer cocaine for several weeks and, at the end of self-administration training, we treated them with low doses of statins daily for a 21-day period of abstinence. Chronic administration of brain-penetrating statins, simvastatin (1 mg/kg) and atorvastatin (1 mg/kg), reduced cocaine seeking compared with vehicle, whereas administration of pravastatin (2 mg/kg), a statin with low brain penetrability, did not. Importantly, the effects of brain-penetrating statins persisted even after discontinuation of the treatment and were specific for drug seeking because drug taking was not altered by simvastatin treatment. Finally, the effects of simvastatin were found to generalize to another drug of abuse such as nicotine, but not to food reward, and to reinstatement of cocaine seeking induced by stress. These results demonstrate that brain-penetrating statins can reduce risks of relapse to addiction. Given their well-known safety profile in humans, statins could be a novel effective treatment for relapse to cocaine and nicotine addiction and their use could be implemented in clinical settings without major health risks. PMID:26466819

  14. Reducing risk for anxiety and depression in adolescents: Effects of a single-session intervention teaching that personality can change

    PubMed Central

    Schleider, Jessica L.; Weisz, John R.

    2016-01-01

    Efforts to reduce youth mental health problems have advanced greatly but have not lowered overall rates of youth mental illness. Thus, a need exists for disseminable, mechanism-targeted approaches to reducing risk of youth psychopathology. Accordingly, we conducted a randomized-controlled trial testing whether a single-session intervention teaching growth personality mindsets (the belief that personality is malleable) reduced known risk factors for anxiety and depression in adolescents experiencing or at risk for internalizing problems (N=96, ages 12-15). Compared to a supportive-therapy control, a 30-minute computer-guided mindset intervention strengthened adolescents’ perceived control; this improvement was associated with increases in growth mindsets. Further, electrodermal activity recovery slopes showed that youths receiving the mindset intervention recovered from a lab-based social stressor over three times as fast as control group youths. Improvements in growth mindsets and perceived control were linked with faster stress recovery. Results suggest a disseminable strategy for reducing internalizing problem risk among adolescents. PMID:27697671

  15. The precautionary principle: what is the risk of reusing disposable drops in routine ophthalmology consultations and what are the costs of reducing this risk to zero?

    PubMed

    Somner, J E A; Cavanagh, D J; Wong, K K Y; Whitelaw, M; Thomson, T; Mansfield, D

    2010-02-01

    Instilling eye drops is a ubiquitous procedure in eye clinics. This audit aimed to assess the risk of contamination of disposable droppers and to quantify the financial and waste implications of reducing this risk to zero by using disposable droppers only once. A total of 100 disposable Minims were used to place one drop in each eye of 70 patients. The dropper tip was then cultured for aerobic and anaerobic microbes. Coagulase-negative staphylococcus was cultured from five samples. The contamination rate per drop application was 2.5%. The risk of cross-contamination with coagulase-negative staphylococcus would be between 1 : 400 and 1 : 80 if the bottle was reused once or six times. Reducing this risk to zero costs between pound2.75 and pound4.6 million per annum and generates between 6.85 and 11.42 more tonnes of paper waste and between 12.69 and 21.15 more tonnes of plastic waste than a strategy that reuses the disposable dropper. Reducing the risk of dropper contamination and subsequent cross infection has financial and environmental costs. As exposure to coagulase-negative staphylococcus is not necessarily associated with infection, it would be useful to decide acceptable risk levels for a given cost to maximise both cost-effectiveness and patient safety.

  16. Urban hospital 'clusters' do shift high-risk procedures to key facilities, but more could be done.

    PubMed

    Luke, Roice D; Luke, Tyler; Muller, Nancy

    2011-09-01

    Since the 1990s, rapid consolidation in the hospital sector has resulted in the vast majority of hospitals joining systems that already had a considerable presence within their markets. We refer to these important local and regional systems as "clusters." To determine whether hospital clusters have taken measurable steps aimed at improving the quality of care-specifically, by concentrating low-volume, high-complexity services within selected "lead" facilities-this study examined within-cluster concentrations of high-risk cases for seven surgical procedures. We found that lead hospitals on average performed fairly high percentages of the procedures per cluster, ranging from 59 percent for esophagectomy to 87 percent for aortic valve replacement. The numbers indicate that hospitals might need to work with rival facilities outside their cluster to concentrate cases for the lowest-volume procedures, such as esophagectomies, whereas coordination among cluster members might be sufficient for higher-volume procedures. The results imply that policy makers should focus on clusters' potential for restructuring care and further coordinating services across hospitals in local areas.

  17. Development of cloud-operating platform for detention facility design

    NASA Astrophysics Data System (ADS)

    Tun Lee, Kwan; Hung, Meng-Chiu; Tseng, Wei-Fan; Chan, Yi-Ping

    2017-04-01

    In the past 20 years, the population of Taiwan has accumulated in urban areas. The land development has changed the hydrological environment and resulted in the increase of surface runoff and shortened the time to peak discharge. The change of runoff characteristics increases the flood risk and reduces resilient ability of the city during flood. Considering that engineering measures may not be easy to implement in populated cities, detention facilities set on building basements have been proposed to compromise the increase of surface runoff resulting from development activities. In this study, a web-based operational platform has been developed to integrate the GIS technologies, hydrological analyses, as well as relevant regulations for the design of detention facilities. The design procedure embedded in the system includes a prior selection of type and size of the detention facility, integrated hydrological analysis for the developing site, and inspection of relevant regulations. After login the platform, designers can access the system database to retrieve road maps, land use coverages, and storm sewer information. Once the type, size, inlet, and outlet of the detention facility are assigned, the system can acquire the rainfall intensity-duration-frequency information from adjacent rain gauges to perform hydrological analyses for the developing site. The increase of the runoff volume due to the development and the reduction of the outflow peak through the construction of the detention facility can be estimated. The outflow peak at the target site is then checked with relevant regulations to confirm the suitability of the detention facility design. The proposed web-based platform can provide a concise layout of the detention facility and the drainageway of the developing site on a graphical interface. The design information can also be delivered directly through a web link to authorities for inspecting to simplify the complex administrative procedures.

  18. A Pilot RCT of an Internet Intervention to Reduce the Risk of Alcohol-Exposed Pregnancy.

    PubMed

    Ingersoll, Karen; Frederick, Christina; MacDonnell, Kirsten; Ritterband, Lee; Lord, Holly; Jones, Brogan; Truwit, Lauren

    2018-06-01

    Preventing alcohol-exposed pregnancies (AEPs) could reduce the incidence of fetal alcohol spectrum disorders. Previous face-to-face interventions significantly reduced risk for AEP, but a scalable intervention is needed to reach more women at risk. This study compared a 6 Core automated, interactive, and tailored Internet intervention, the Contraception and Alcohol Risk Reduction Internet Intervention (CARRII), to a static patient education (PE) website for its effect on AEP risk. Participants were recruited online to a pilot randomized clinical trial (RCT) with baseline, 9 weeks posttreatment, and 6-month (6-M) follow-up assessments. Seventy-one women completed online questionnaires and telephone interviews and were randomized to CARRII (n = 36) or PE (n = 35). Primary outcomes were rates of risky drinking, unprotected sex episodes, and AEP risk, collected from online prospective diaries. CARRII participants showed significant reductions in rate of unprotected sex from pretreatment (88.9%) to posttreatment (70.6%) (p < 0.04) and to 6-M follow-up (51.5%) (p = 0.001); rate of risky drinking from pretreatment (75.0%) to posttreatment (50.0%) (p < 0.02), but insignificant change from pretreatment to 6-M follow-up (57.6%) (p < 0.09); and rate of AEP risk from pretreatment (66.7%) to posttreatment (32.4%) (p = 0.001) and to 6-M follow-up (30.3%) (p = 0.005). PE participants demonstrated no significant changes on all 3 variables across all time points. Intent-to-treat group-by-time tests were not significant, but power was limited by missing diaries. Over 72% of CARRII participants completed all 6 Cores. Exploratory analyses suggest that higher program utilization is related to change. These data show that CARRII was acceptable, feasible, promising to reduce AEP risk, and merits further testing in a fully powered RCT. Copyright © 2018 by the Research Society on Alcoholism.

  19. [Possible role of genetic factors on reduced risk for gastric cancer among duodenal ulcer patients].

    PubMed

    Matsuda, Koichi; Tanikawa, Chizu; Nakamura, Yusuke

    2013-08-01

    Although H. pylori causes both gastric cancer and peptic ulcer, duodenal ulcer patients were known to have low risk for gastric cancer. Recently the association of PSCA and ABO with duodenal ulcer were identified by GWAS in the Japanese population. A T-allele of SNP rs2294008 in the PSCA promoter creates the upstream translational initiation codon and affects the protein localization from cytoplasm to cell surface. A T-allele of SNP rs2294008 increased gastric cancer risk but reduced duodenal ulcer risk. In addition, blood type O was shown to increase risk for duodenal ulcer, while blood type A was associated with gastric cancer risk in the Caucasian population. Our finding would partially explain low risk of gastric cancer among duodenal ulcer patients.

  20. Reduced COPD Exacerbation Risk Correlates With Improved FEV1: A Meta-Regression Analysis.

    PubMed

    Zider, Alexander D; Wang, Xiaoyan; Buhr, Russell G; Sirichana, Worawan; Barjaktarevic, Igor Z; Cooper, Christopher B

    2017-09-01

    The mechanism by which various classes of medication reduce COPD exacerbation risk remains unknown. We hypothesized a correlation between reduced exacerbation risk and improvement in airway patency as measured according to FEV 1 . By systematic review, COPD trials were identified that reported therapeutic changes in predose FEV 1 (dFEV 1 ) and occurrence of moderate to severe exacerbations. Using meta-regression analysis, a model was generated with dFEV 1 as the moderator variable and the absolute difference in exacerbation rate (RD), ratio of exacerbation rates (RRs), or hazard ratio (HR) as dependent variables. The analysis of RD and RR included 119,227 patients, and the HR analysis included 73,475 patients. For every 100-mL change in predose FEV 1 , the HR decreased by 21% (95% CI, 17-26; P < .001; R 2  = 0.85) and the absolute exacerbation rate decreased by 0.06 per patient per year (95% CI, 0.02-0.11; P = .009; R 2  = 0.05), which corresponded to an RR of 0.86 (95% CI, 0.81-0.91; P < .001; R 2  = 0.20). The relationship with exacerbation risk remained statistically significant across multiple subgroup analyses. A significant correlation between increased FEV 1 and lower COPD exacerbation risk suggests that airway patency is an important mechanism responsible for this effect. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  1. Evaluating Process Effectiveness to Reduce Risk

    NASA Technical Reports Server (NTRS)

    Shepherd, Christena C.

    2017-01-01

    It is well documented that government agencies do not have the same incentive as the private sector to focus on process effectiveness and continual improvement of those processes. It is also well documented whenever government agencies fail to deliver efficient, effective, consistent, and fair services to the citizens. In spite of the various "reinventing government" and "effectiveness initiatives" of the past decades, and in spite of the efforts on the part of many agencies to improve, government in general still lags behind industry in creating a culture of effective processes and systems. While the tragic events that unfolded recently in Flint, Michigan, teach us that running government "like a business" does not always take the needs of the citizenry into account, there are many lessons and techniques from the private sector that government agencies can use to improve. The incentive to improve, while mandated by various administrations1, needs to come from within the workforce, in order to effectively take root. The best, most effective incentive is to reduce, control or eliminate risk. Government agencies face some of the same risks as the private sector, while some are unique. While ISO 310002 has been around since 2009, risk has taken on increased visibility within the private sector with the advent of the emphasis on risk-based thinking in ISO 9001:20153. The relationship between risk-based thinking and effective processes is simple and direct. Those processes that are well thought out and standardized (i.e. Plan-Do-Check-Act), will have taken into account the applicable policy, statutory, regulatory, safety, quality and technical parameters, which may not occur to someone performing the process with minimal experience or training; and thus protect the employees, the public and the agency from statutory and regulatory violations; delay in providing services; non-delivery of services; harm to public or employee safety and health; cost overruns; breaches in

  2. R&D for a Soft X-Ray Free Electron Laser Facility

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

    Corlett, John; Attwood, David; Byrd, John

    2009-06-08

    Several recent reports have identified the scientific requirements for a future soft x-ray light source, and a high-repetition-rate free-electron laser (FEL) facility that is responsive to these requirements is now on the horizon. R&D in some critical areas is needed, however, to demonstrate technical performance, thus reducing technical risks and construction costs. Such a facility most likely will be based on a CW superconducting linear accelerator with beam supplied by a high-brightness, high-repetition-rate photocathode electron gun operating in CW mode, and on an array of FELs to which the accelerated beam is distributed, each operating at high repetition rate andmore » with even pulse spacing. Dependent on experimental requirements, the individual FELs can be configured for either self-amplified spontaneous emission (SASE), seeded, or oscillator mode of operation, including the use of high-gain harmonic generation (HGHG), echo-enhanced harmonic generation (EEHG), harmonic cascade, or other configurations. In this White Paper we identify the overall accelerator R&D needs, and highlight the most important pre-construction R&D tasks required to value-engineer the design configuration and deliverables for such a facility. In Section 1.4 we identify the comprehensive R&D ultimately needed. We identify below the highest-priority requirements for understanding machine performance and reduce risk and costs at this pre-conceptual design stage. Details of implementing the required tasks will be the subject of future evaluation. Our highest-priority R&D program is the injector, which must be capable of delivering a beam with bunches up to a nanocoulomb at MHz repetition rate and with normalized emittance {le} 1 mm {center_dot} mrad. This will require integrated accelerating structure, cathode, and laser systems development. Cathode materials will impact the choice of laser technology in wavelength and energy per pulse, as well as vacuum requirements in the

  3. Nuclear Rocket Facility Decommissioning Project: Controlled Explosive Demolition of Neutron Activated Shield Wall

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

    Michael R. Kruzic

    2007-09-16

    Located in Area 25 of the Nevada Test Site (NTS), the Test Cell A (TCA) Facility was used in the early to mid-1960s for the testing of nuclear rocket engines, as part of the Nuclear Rocket Development Program, to further space travel. Nuclear rocket testing resulted in the activation of materials around the reactors and the release of fission products and fuel particles in the immediate area. Identified as Corrective Action Unit 115, the TCA facility was decontaminated and decommissioned (D&D) from December 2004 to July 2005 using the Streamlined Approach for Environmental Restoration (SAFER) process, under the ''Federal Facilitymore » Agreement and Consent Order''. The SAFER process allows environmental remediation and facility closure activities (i.e., decommissioning) to occur simultaneously provided technical decisions are made by an experienced decision maker within the site conceptual site model, identified in the Data Quality Objective process. Facility closure involved a seven-step decommissioning strategy. Key lessons learned from the project included: (1) Targeted preliminary investigation activities provided a more solid technical approach, reduced surprises and scope creep, and made the working environment safer for the D&D worker. (2) Early identification of risks and uncertainties provided opportunities for risk management and mitigation planning to address challenges and unanticipated conditions. (3) Team reviews provided an excellent mechanism to consider all aspects of the task, integrated safety into activity performance, increase team unity and ''buy-in'' and promoted innovative and time saving ideas. (4) Development of CED protocols ensured safety and control. (5) The same proven D&D strategy is now being employed on the larger ''sister'' facility, Test Cell C.« less

  4. Potential mediating pathways through which sports participation relates to reduced risk of suicidal ideation.

    PubMed

    Taliaferro, Lindsay A; Rienzo, Barbara A; Miller, M David; Pigg, R Morgan; Dodd, Virginia J

    2010-09-01

    Suicide ranks as the third leading cause of death for American youth. Researchers examining sport participation and suicidal behavior have regularly found inverse relationships. This study represents the first effort to test a model depicting potential mechanisms through which sport participation relates to reduced risk of suicidal ideation. The participants were 450 undergraduate students. Measures assessed participants' involvement in university-run sports and other activities; frequency of physical activity; and perceived social support, self-esteem, depression, hopelessness, loneliness, and suicidal ideation. Regression analyses confirmed a path model and tested for mediation effects. Vigorous activity mediated relationships between sport participation and self-esteem and depression; and self-esteem and depression mediated the relationship between vigorous activity and suicidal ideation. Social support mediated relationships between sport participation and depression, hopelessness, and loneliness; and each of these risk factors partially mediated the relationship between social support and suicidal ideation. However no variable fully mediated the relationship between sport participation and suicidal ideation. This study provides a foundation for research designed to examine pathways through which sport participation relates to reduced risk of suicidal behavior.

  5. Higher dietary folate intake reduces the breast cancer risk: a systematic review and meta-analysis

    PubMed Central

    Chen, P; Li, C; Li, X; Li, J; Chu, R; Wang, H

    2014-01-01

    Background: Many epidemiological studies have investigated the association between folate intake, circulating folate level and risk of breast cancer; however, the findings were inconsistent between the studies. Methods: We searched the PubMed and MEDLINE databases updated to January, 2014 and performed the systematic review and meta-analysis of the published epidemiological studies to assess the associations between folate intake level, circulating folate level and the overall risk of breast cancer. Results: In all, 16 eligible prospective studies with a total of 744 068 participants and 26 205 breast cancer patients and 26 case–control studies with a total of 16 826 cases and 21 820 controls that have evaluated the association between folate intake and breast cancer risk were identified. Pooled analysis of the prospective studies and case–control studies suggested a potential nonlinearity relationship for dietary folate intake and breast cancer risk. Prospective studies indicated a U-shaped relationship for the dietary folate intake and breast cancer risk. Women with daily dietary folate intake between 153 and 400 μg showed a significant reduced breast cancer risk compared with those <153 μg, but not for those >400 μg. The case–control studies also suggested a significantly negative correlation between the dietary folate intake level and the breast cancer risk. Increased dietary folate intake reduced breast cancer risk for women with higher alcohol intake level, but not for those with lower alcohol intake. No significant association between circulating folate level and breast cancer risk was found when the results of 8 identified studies with 5924 participants were pooled. Conclusions: Our studies suggested that folate may have preventive effects against breast cancer risk, especially for those with higher alcohol consumption level; however, the dose and timing are critical and more studies are warranted to further elucidate the questions

  6. Credibility gap? Parents' beliefs about reducing the risk of cot death.

    PubMed

    Epstein, Joyce; Jolly, Clare

    2009-11-01

    This paper reports on findings from a survey of awareness and credibility of risk factors for sudden infant death and adherence to infant care advice, conducted with 506 mothers of children aged from six months to three years in England in 2007. The survey confirmed that many parents failed to follow recommended infant care practices to reduce the risk of cot death, such as supine sleeping and sleeping the baby in a cot in the same room as them. Notably, substantial proportions of mothers did not believe the evidence-based safe infant care messages that they have heard--about a fifth were not persuaded that exposing a baby to tobacco smoke increases the risk of cot death, over a quarter were not persuaded that prone sleeping is risky, and almost half were not persuaded that side sleeping is risky. The findings are discussed in the context of wider cultural issues bearing on the credibility of health advice. Practical suggestions for health visitors and other community practitioners include innovative ways to involve young, at-risk parents and credible influences upon them such as grandparents, alongside the use and promotion of new free resources from the Foundation for the Study of Infant Deaths.

  7. The HEART score is useful to predict cardiovascular risks and reduces unnecessary cardiac imaging in low-risk patients with acute chest pain.

    PubMed

    Dai, Siping; Huang, Bo; Zou, Yunliang; Guo, Jianbin; Liu, Ziyong; Pi, Dangyu; Qiu, Yunhong; Xiao, Chun

    2018-06-01

    The present study was to investigate whether the HEART score can be used to evaluate cardiovascular risks and reduce unnecessary cardiac imaging in China.Acute coronary syndrome patients with the thrombosis in myocardial infarction risk score < 2 were enrolled in the emergency department. Baseline data were collected and a HEART score was determined in each participant during the indexed emergency visit. Participants were follow-up for 30 days after discharge and the studied endpoints included acute myocardial infarction, cardiovascular mortality and all-cause mortality.A total of 244 patients were enrolled and 2 was loss of follow-up. The mean age was 50.4 years old and male patients accounted for 64.5%. Substernal pain and featured as pressure of the pain accounted for 34.3% and 39.3%, respectively. After 30 days' follow-up, no patient in the low-risk HEART score group and 2 patients (1.5%) in the high risk HEART score group had cardiovascular events. The sensitivity of HEART score to predict cardiovascular events was 100% and the specificity was 46.7%. The potential unnecessary cardiac testing was 46.3%. Cox proportional hazards regression analysis showed that per one category increase of the HEART score was associated with nearly 1.3-fold risk of cardiovascular events.In the low-risk acute chest pain patients, the HEART score is useful to physicians in evaluating the risk of cardiovascular events within the first 30 days. In addition, the HEART score is also useful in reducing the unnecessary cardiac imaging.

  8. Reducing cardiovascular risk factors in non-selected outpatients with schizophrenia.

    PubMed

    Hansen, Mette Vinther; Hjorth, Peter; Kristiansen, Christina Blanner; Vandborg, Kirsten; Gustafsson, Lea Nørgaard; Munk-Jørgensen, Povl

    2016-06-01

    Cardiovascular diseases are the most common causes of premature death in patients with schizophrenia. We aimed at reducing cardiovascular risk factors in non-selected outpatients with schizophrenia using methods proven effective in short-term trials. Furthermore, we examined whether any baseline characteristics were associated with positive outcomes. All outpatients treated for schizophrenia at two Danish hospitals were included in this 1-year follow-up study. The patients were offered health interventions both individually and in groups. Weight, waist circumference, blood glucose and lipids and information on smoking and alcohol were obtained. On average, small significant increases in body mass index (BMI) and waist circumferences were observed while small non-significant improvements in other cardiovascular risk factors were seen. Patients with high baseline BMI and patients with duration of treated illness beyond 2 years had significantly better intervention outcomes. Our results show that it was difficult to improve physical health in a group of non-selected patients with schizophrenia as part of routine care. The patients were not easily motivated to participate in the interventions, and it was difficult to monitor the recommended metabolic risk measures in the patient group. Future research should focus on simple strategies in health promotion that can be integrated into routine care. © The Author(s) 2016.

  9. Reducing cardiovascular risk factors in non-selected outpatients with schizophrenia.

    PubMed

    Hansen, Mette Vinther; Hjorth, Peter; Kristiansen, Christina Blanner; Vandborg, Kirsten; Gustafsson, Lea Nørgaard; Munk-Jørgensen, Povl

    2016-06-01

    Cardiovascular diseases are the most common causes of premature death in patients with schizophrenia. We aimed at reducing cardiovascular risk factors in non-selected outpatients with schizophrenia using methods proven effective in short-term trials. Furthermore, we examined whether any baseline characteristics were associated with positive outcomes. All outpatients treated for schizophrenia at two Danish hospitals were included in this 1-year follow-up study. The patients were offered health interventions both individually and in groups. Weight, waist circumference, blood glucose, serum lipids, and information on smoking and alcohol were obtained. On average, small significant increases in body mass index (BMI) and waist circumferences were observed while small non-significant improvements in other cardiovascular risk factors were seen. Patients with high baseline BMI and patients with duration of treated illness beyond 2 years had significantly better intervention outcomes. Our results show that it was difficult to improve physical health in a group of non-selected patients with schizophrenia as part of routine care. The patients were not easily motivated to participate in the interventions, and it was difficult to monitor the recommended metabolic risk measures in the patient group. Future research should focus on simple strategies in health promotion that can be integrated into routine care. © The Author(s) 2016.

  10. Action plan to reduce perinatal mortality.

    PubMed

    Bhakoo, O N; Kumar, R

    1990-01-01

    The government of India has set a goal of reducing perinatal mortality from its current rate of 48/1000 to 30-35/1000 by the year 2000. Perinatal deaths result from maternal malnutrition, inadequate prenatal care, complications of delivery, and infections in the postpartum period. Since reductions in perinatal mortality require attention to social, economic, and behavioral factors, as well as improvements in the health care delivery system, a comprehensive strategy is required. Social measures, such as raising the age at marriage to 18 years for females, improving the nutritional status of adolescent girls, reducing the strenuousness of work during pregnancy, improving female literacy, raising women's status in the society and thus in the family, and poverty alleviation programs, would all help eliminate the extent of complications of pregnancy. Measures required to enhance infant survival include improved prenatal care, prenatal tetanus toxoid immunization, use of sterile disposable cord care kits, the provision of mucus extractors and resuscitation materials to birth attendants, the creation of neonatal care units in health facilities, and more efficient referral of high-risk newborns and mothers. Since 90% of births in rural India take place at home priority must be given to training traditional birth attendants in the identification of high risk factors during pregnancy, delivery, and the newborn period.

  11. The 'bankability' of the new waste technologies: an econometric method for risk sharing in private finance waste contracts.

    PubMed

    Black, I; Seaton, R; Chackiath, S; Wagland, S T; Pollard, S J T; Longhurst, P J

    2011-12-01

    The identification of risk and its appropriate allocation to partners in project consortia is essential for minimizing overall project risks, ensuring timely delivery and maximizing benefit for money invested. Risk management guidance available from government bodies, especially in the UK, does not specify methodologies for quantitative risk assessment, nor does it offer a procedure for allocating risk among project partners. Here, a methodology to quantify project risk and potential approaches to allocating risk and their implications are discussed. Construction and operation of a waste management facility through a public-private finance contract are discussed. Public-private partnership contracts are special purpose vehicle (SPV) financing methods promoted by the UK government to boost private sector investment in facilities for public service enhancement. Our findings question the appropriateness of using standard deviation as a measure for project risk and confirm the concept of portfolio theory, suggesting the pooling of risk can reduce total risk and its impact.

  12. Psychosocial interventions for reducing injection and sexual risk behaviour for preventing HIV in drug users.

    PubMed

    Meader, Nicholas; Li, Ryan; Des Jarlais, Don C; Pilling, Stephen

    2010-01-20

    Drug users (including both injection drug users and crack cocaine users), are at high levels of risk for contracting HIV. Therefore it is important to reduce the injection and/or sexual risk behaviours of these groups both for the benefit of themselves and for society as a whole. To assess the efficacy of multi-session psychosocial interventions in comparison with standard education and minimal intervention controls for the reduction of injection and sexual risk behaviour. Electronic searches were conducted of a number of bibliographic databases (including Cochrane Library, CINAHL, MEDLINE, PsycINFO). In addition, other methods of locating papers were employed including contacting various authors working in the field of HIV risk reduction and examining reference lists of applicable papers identified in the electronic search. The inclusion criteria consisted of randomised and quazi-randomised trials assessing the efficacy of psychosocial interventions in the reduction of injection and sexual risk behaviour for people who misused opiates, cocaine, or a combination of these drugs. Two authors independently assessed the eligibility of studies identified by the search strategy, quality assessed these studies and extracted the data. A total of 35 trials met the eligibility criteria of the review providing data on 11,867 participants. There were minimal differences identified between multi-session psychosocial interventions and standard educational interventions for both injection and sexual risk behaviour. Although it should be noted there were large pre-post changes for both groups suggesting both were effective in reducing risk behaviours. In addition, there was some evidence of benefit for multi-session psychosocial interventions when compared with minimal controls. Subgroup analyses suggest that people in formal treatment are likely to respond to multi-session psychosocial interventions. It also appears single-gender groups may be associated with greater benefit

  13. Intake of Japanese and Chinese teas reduces risk of Parkinson's disease.

    PubMed

    Tanaka, Keiko; Miyake, Yoshihiro; Fukushima, Wakaba; Sasaki, Satoshi; Kiyohara, Chikako; Tsuboi, Yoshio; Yamada, Tatsuo; Oeda, Tomoko; Miki, Takami; Kawamura, Nobutoshi; Sakae, Nobutaka; Fukuyama, Hidenao; Hirota, Yoshio; Nagai, Masaki

    2011-07-01

    Studies that have addressed the association between the intake of coffee or caffeine and Parkinson's disease (PD) were conducted mainly in Western countries. Little is known about this relationship in an Asian population. Therefore, we performed an assessment of the association of the intake of coffee, other caffeine-containing beverages, and caffeine with the risk of PD in Japan. The study involved 249 PD cases and 368 control subjects. Information on dietary factors was obtained through a self-administered diet history questionnaire. Adjustment was made for sex, age, region of residence, educational level, pack-years of smoking, body mass index, the dietary glycemic index, and intake of cholesterol, vitamin E, β-carotene, vitamin B(6,) alcohol, and iron. Intake of coffee, black tea, and Japanese and Chinese teas was significantly inversely associated with the risk of PD: the adjusted odds ratios in comparison of the highest with the lowest quartile were 0.52, 0.58, and 0.59, respectively (95% confidence intervals = 0.30-0.90, 0.35-0.97, and 0.35-0.995, respectively). A clear inverse dose-response relationship between total caffeine intake and PD risk was observed. We confirmed that the intake of coffee and caffeine reduced the risk of PD. Furthermore, this is the first study to show a significant inverse relationship between the intake of Japanese and Chinese teas and the risk of PD. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Dissonance-based eating disorder program reduces cardiac risk: A preliminary trial.

    PubMed

    Green, Melinda A; Willis, Mary; Fernandez-Kong, Kristen; Reyes, Shuhan; Linkhart, Ruby; Johnson, Molly; Thorne, Tyler; Kroska, Emily; Woodward, Halley; Lindberg, Jessica

    2017-04-01

    We conducted a randomized, controlled preliminary trial to examine the effect of a dissonance-based eating disorder program on eating disorder symptoms and cardiac risk indices in a community sample of women with subclinical and clinical symptoms (N = 47), examining the efficacy of the program in both the indicated prevention and treatment realms. Eating disorder symptoms, body mass index, and biomarkers of cardiac risk were examined in dissonance and assessment-only control conditions at baseline, postintervention, and 2-month follow-up. Specifically, we assessed mean R wave amplitude, QT interval length, vagal tone (high frequency spectral power of heart rate variability), and sympathetic tone (low/high frequency spectral power ratio) via electocardiography (ECG) at each assessment period. We predicted a statistically significant 2 (condition: control, dissonance) × 3 (time: baseline, postintervention, 2-month follow-up) interaction in the mixed factorial MANOVA results. Results confirmed this hypothesis. Eating disorder symptoms and cardiac risk indices decreased significantly among participants in the dissonance condition at postintervention and 2-month follow-up compared with baseline. Results provide support for the efficacy of a dissonance-based program in the reduction of eating disorder symptoms and cardiac risk indices among women with subclinical and clinical eating disorder symptoms. Findings establish the efficaciousness of this dissonance-based approach in the indicated prevention and treatment realms and establish its efficacy in reducing cardiac risk indicators. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  15. Forest species diversity reduces disease risk in a generalist plant pathogen invasion

    USGS Publications Warehouse

    Haas, Sarah E.; Hooten, Mevin B.; Rizzo, David M.; Meentemeyer, Ross K.

    2011-01-01

    Empirical evidence suggests that biodiversity loss can increase disease transmission, yet our understanding of the 'diversity-disease hypothesis' for generalist pathogens in natural ecosystems is limited. We used a landscape epidemiological approach to examine two scenarios regarding diversity effects on the emerging plant pathogen Phytophthora ramorum across a broad, heterogeneous ecoregion: (1) an amplification effect exists where disease risk is greater in areas with higher plant diversity due to the pathogen's wide host range, or (2) a dilution effect where risk is reduced with increasing diversity due to lower competency of alternative hosts. We found evidence for pathogen dilution, whereby disease risk was lower in sites with higher species diversity, after accounting for potentially confounding effects of host density and landscape heterogeneity. Our results suggest that although nearly all plants in the ecosystem are hosts, alternative hosts may dilute disease transmission by competent hosts, thereby buffering forest health from infectious disease.

  16. Reducing the Risk for Child Abuse by Developing and Implementing a Parenting Program for Teenage Mothers.

    ERIC Educational Resources Information Center

    Doetsch, Patricia

    Adolescent parents are unprepared for parenthood. Their lack of preparedness places their children at risk for maltreatment. This educational program was designed to enhance the parenting skills of adolescent mothers thereby reducing the risk for maltreatment among their children. This parenting skills training program consisted of six weekly…

  17. Human Health and Ecological Risk Assessment for the Operation of the Explosives Waste Treatment Facility at Site 300 of the Lawrence Livermore National Laboratory

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

    Gallegos, G; Daniels, J; Wegrecki, A

    2007-10-01

    This document contains the human health and ecological risk assessment for the Resource Recovery and Conservation Act (RCRA) permit renewal for the Explosives Waste Treatment Facility (EWTF). Volume 1 is the text of the risk assessment, and Volume 2 (provided on a compact disc) is the supporting modeling data. The EWTF is operated by the Lawrence Livermore National Laboratory (LLNL) at Site 300, which is located in the foothills between the cities of Livermore and Tracy, approximately 17 miles east of Livermore and 8 miles southwest of Tracy. Figure 1 is a map of the San Francisco Bay Area, showingmore » the location of Site 300 and other points of reference. One of the principal activities of Site 300 is to test what are known as 'high explosives' for nuclear weapons. These are the highly energetic materials that provide the force to drive fissionable material to criticality. LLNL scientists develop and test the explosives and the integrated non-nuclear components in support of the United States nuclear stockpile stewardship program as well as in support of conventional weapons and the aircraft, mining, oil exploration, and construction industries. Many Site 300 facilities are used in support of high explosives research. Some facilities are used in the chemical formulation of explosives; others are locations where explosive charges are mechanically pressed; others are locations where the materials are inspected radiographically for such defects as cracks and voids. Finally, some facilities are locations where the machined charges are assembled before they are sent to the onsite test firing facilities, and additional facilities are locations where materials are stored. Wastes generated from high-explosives research are treated by open burning (OB) and open detonation (OD). OB and OD treatments are necessary because they are the safest methods for treating explosives wastes generated at these facilities, and they eliminate the requirement for further handling and

  18. Obesity in young age is a risk factor for preeclampsia: a facility based case-control study, northwest Ethiopia.

    PubMed

    Endeshaw, Mulualem; Abebe, Fantu; Worku, Solomon; Menber, Lalem; Assress, Muluken; Assefa, Muluken

    2016-08-19

    Preeclampsia is one of the most commonly encountered hypertensive disorders of pregnancy. For many years, obesity has been suggested to play a role in preeclampsia. However, the hypotheses have been diverse and often revealed inconsistent results. This study has aimed to estimate the effect of obesity and dietary habits on preeclampsia in Bahir Dar City, north-western Ethiopia. A facility-based unmatched case-control study was conducted on 453 (151 cases and 302 controls) pregnant women, attending antenatal care or skilled delivery at Bahir Dar City. Data were collected through face to face interviews and measurements of mid-upper-arm circumference (MUAC) at the time of the interviews. Data were cleaned and entered into IBM SPSS version 20 and later analyzed using STATA version 12. Univariate and multivariate logistic regression analyses were employed to estimate the effect of independent variables on preeclampsia. Stratified analysis was conducted to check for presence of confounding and/or effect modification between covariates. The odds of preeclampsia were higher among obese (MUAC ≥25 cm) women than their leaner counterparts (AOR = 3.33, 95 % CI: 1.87, 5.79). Obesity was also found to have a similar magnitude of risk for late onset preeclampsia (AOR = 3.63, 95 % CI: 1.89, 6.97). When stratified by age, the effect of obesity on overall and late onset preeclampsia was significant among young (age < 35 years) women (COR = 1.81, 95 % CI: 1.11, 2.99) and (COR = 2.09, 95 % CI: 1.16, 3.86), respectively. As the age groups became more homogenous through adjusted stratification, obesity showed a particularly significant effect in women age ≤24 and 25-29 years; (AOR = 2.31, 95 % CI: 1.06, 5.12) and (AOR = 3.66, 95 % CI: 1.37, 10.87) respectively. Similarly, the effect of obesity on late onset preeclampsia was evident among younger women age ≤24 and 25-29 years; (AOR = 3.16, 95 % CI: 1.21, 8.24) and (AOR = 1.98, 95 % CI: 1.16, 3

  19. The experience of women carriers of BRCA mutations following risk-reducing surgery: A cultural perspective.

    PubMed

    Mahat-Shamir, Michal; Possick, Chaya

    2017-04-01

    In this qualitative study, we examine the experience of 13 Jewish Israeli women carriers of BRCA mutations following risk-reducing surgery. Thematic analysis of in-depth, semi-structured interview texts yielded three themes: (a) dialectic of vulnerability and control, (b) presentation of self as a "normal" woman, and (c) genetic chain of negative life events and guilt. Aspects of Israeli culture impacting participants' experiences are: personal and collective responsibility, the shift toward consumerism, and pro-natal ideology. The findings may be useful for health practitioners working with other nationalities with similar cultural characteristics and to prompt practitioners to explore their own and their patients' perceptions regarding women's risk-reducing surgery and genetic illnesses.

  20. The KnowRISK project: Tools and strategies to reduce non-structural damage

    NASA Astrophysics Data System (ADS)

    Sousa Oliveira, Carlos; Lopes, Mário; Mota de Sá, Francisco; Amaral Ferreia, Mónica; Candeias, Paulo; Campos Costa, Alfredo; Rupakhety, Rajesh; Meroni, Fabrizio; Azzaro, Raffaele; D'Amico, Salvatore; Langer, Horst; Musacchio, Gemma; Sousa Silva, Delta; Falsaperla, Susanna; Scarfì, Luciano; Tusa, Giuseppina; Tuvé, Tiziana

    2016-04-01

    The project KnowRISK (Know your city, Reduce seISmic risK through non-structural elements) is financed by the European Commission to develop prevention measures that may reduce non-structural damage in urban areas. Pilot areas of the project are within the three European participating countries, namely Portugal, Iceland and Italy. Non-structural components of a building include all those components that are not part of the structural system, more specifically the architectural, mechanical, electrical, and plumbing systems, as well as furniture, fixtures, equipment, and contents. Windows, partitions, granite veneer, piping, ceilings, air conditioning ducts and equipment, elevators, computer and hospital equipment, file cabinets, and retail merchandise are all examples of non-structural components that are vulnerable to earthquake damage. We will use the experience gained during past earthquakes, which struck in particular Iceland, Italy and Portugal (Azores). Securing the non-structural elements improves the safety during an earthquake and saves lives. This paper aims at identifying non-structural seismic protection measures in the pilot areas and to develop a portfolio of good practices for the most common and serious non-structural vulnerabilities. This systematic identification and the portfolio will be achieved through a "cross-knowledge" strategy based on previous researches, evidence of non-structural damage in past earthquakes. Shake table tests of a group of non-structural elements will be performed. These tests will be filmed and, jointly with portfolio, will serve as didactic supporting tools to be used in workshops with building construction stakeholders and in risk communication activities. A Practical Guide for non-structural risk reduction will be specifically prepared for citizens on the basis of the outputs of the project, taking into account the local culture and needs of each participating country.

  1. Buffet test in the National Transonic Facility

    NASA Technical Reports Server (NTRS)

    Young, Clarence P., Jr.; Hergert, Dennis W.; Butler, Thomas W.; Herring, Fred M.

    1992-01-01

    A buffet test of a commercial transport model was accomplished in the National Transonic Facility at the NASA Langley Research Center. This aeroelastic test was unprecedented for this wind tunnel and posed a high risk for the facility. Presented here are the test results from a structural dynamics and aeroelastic response point of view. The activities required for the safety analysis and risk assessment are described. The test was conducted in the same manner as a flutter test and employed on-board dynamic instrumentation, real time dynamic data monitoring, and automatic and manual tunnel interlock systems for protecting the model.

  2. Awareness regarding risk factors, symptoms and treatment facilities for cancer in selected states of India.

    PubMed

    Raj, Sherin; Piang, Lam Khan; Nair, K S; Tiwari, V K; Kaur, H; Singh, Bacchu

    2012-01-01

    To study the level of awareness and knowledge about cancers and associated risk factors among households in selected states of India. In the study 3070 households were interviewed from six states viz, West Bengal, Kerala, Madhya Pradesh, Rajasthan and Mizoram. Knowledge of cancers other than those related to tobacco was very low (prostate 8%, colon 11% ) among the communities, with a poor awareness of warning signs and symptoms. The knowledge varied from state to state. It is found that the major source of information related to cancers was television (38%) followed by friends and relatives (36%). Only about 15 % of respondents had knowledge about cancer awareness camps organized in their districts but they did not have knowledge about the organizers of the camp. Findings suggested a strong need for strengthening of DCCP. It is important to create awareness among community through educational programs on cancer prevention, preventable cancer risk factors, benefits of early diagnosis, and availability of screening facilities. Integration of District Cancer Control activities with NRHM could be the most cost-effective strategy to prevent cancers and rural population.

  3. Comparative risk assessments for the production and interim storage of glass and ceramic waste forms: Defense waste processing facility

    NASA Astrophysics Data System (ADS)

    Huang, J. C.; Wright, W. V.

    1982-04-01

    The Defense Waste Processing Facility (DWPF) for immobilizing nuclear high level waste (HLW) is scheduled to be built. High level waste is produced when reactor components are subjected to chemical separation operations. Two candidates for immobilizing this HLW are borosilicate glass and crystalline ceramic, either being contained in weld sealed stainless steel canisters. A number of technical analyses are being conducted to support a selection between these two waste forms. The risks associated with the manufacture and interim storage of these two forms in the DWPF are compared. Process information used in the risk analysis was taken primarily from a DWPF processibility analysis. The DWPF environmental analysis provided much of the necessary environmental information.

  4. Evaluating and understanding fish health risks and their consequences in propagated and free-ranging fish populations

    USGS Publications Warehouse

    Moffitt, C.M.; Haukenes, A.H.; Williams, C.J.

    2005-01-01

    Fishery managers and resource conservationists are increasingly interested in understanding the fish health and disease risks of free-ranging fishes and whether propagated fishes or features and practices used at fish culture facilities pose a health risk to free-ranging populations. Disease agents are present in most both captive and all free-ranging fish populations, but the consequences and extent of infections in free-ranging populations are often difficult to measure, control, and understand. Sampling methods, protocols, and assay techniques developed to assess the health of captive populations are not as applicable for assessments of free-ranging fishes. The use of chemicals and therapeutics to control diseases and parasites in propagated fishes likely reduces the risk of introducing specific pathogens into the environment, but control measures may have localized effects on the environment surrounding fish culture facilities. To understand health risks of propagated and free ranging fishes, we must consider fish populations, culture facilities, fish releases, and their interactions within the greater geospatial features of the aquatic environment. ?? 2004 by the American Fisheries Society.

  5. Buffet test in the National Transonic Facility

    NASA Technical Reports Server (NTRS)

    Young, Clarence P., Jr.; Hergert, Dennis W.; Butler, Thomas W.; Herring, Fred M.

    1992-01-01

    A buffet test of a commercial transport model was accomplished in the National Transonic Facility at the NASA Langley Research Center. This aeroelastic test was unprecedented for this wind tunnel and posed a high risk to the facility. This paper presents the test results from a structural dynamics and aeroelastic response point of view and describes the activities required for the safety analysis and risk assessment. The test was conducted in the same manner as a flutter test and employed onboard dynamic instrumentation, real time dynamic data monitoring, automatic, and manual tunnel interlock systems for protecting the model. The procedures and test techniques employed for this test are expected to serve as the basis for future aeroelastic testing in the National Transonic Facility. This test program was a cooperative effort between the Boeing Commercial Airplane Company and the NASA Langley Research Center.

  6. Reduced-risk pest management programs for eastern U.S. peach orchards: effects on arthropod predators, parasitoids, and select pests.

    PubMed

    Biddinger, David J; Leslie, Timothy W; Joshi, Neelendra K

    2014-06-01

    We developed new integrated pest management programs for eastern U.S. peaches with minimal use of organophosphates. From 2002-2005, we assessed the ecological impacts of these reduced-risk programs versus grower standard conventional programs that still relied primarily on the use of organophosphorous and carbamate insecticides. Using a split-plot design replicated at four commercial Pennsylvania peach orchards, we quantified pesticide rates, environmental impact, and arthropod community response. We used Environmental Impact Quotient (EIQ) analysis based on the growers' pesticide records from each orchard to calculate seasonal cumulative EIQ field ratings for all years. Ecological effects of the reduced-risk and conventional program were also measured as the abundance and diversity of nontarget arthropod predators, parasitoids, and selected pest taxa. Pesticide inputs and EIQ values were substantially lower in reduced-risk programs compared with conventional spray programs. Arthropod arrays differed significantly between pest management programs: most beneficial predator and parasitoid taxa were positively associated with the reduced-risk program and negatively associated with the standard grower program. Regardless of the pest management program, we observed significant differences in species arrays in the peach tree canopy compared with the ground cover of the orchards, but the arthropod community did not differ among the field sites or based on distance from the edge of the orchard. We conclude that reduced-risk programs not only provide control comparable with that of conventional programs, but they also reduce negative environmental effects while conserving key arthropod biological control agents within eastern U.S. peach orchards.

  7. Reducing the Risk of Tick-Borne Diseases through Smart, Safe and Sustainable Pest Control

    EPA Pesticide Factsheets

    Each year PestWise programs form new partnerships to address ongoing and emerging issues. Reducing the risk from ticks and tick-borne disease is an issue of importance and EPA is contributing to a larger federal effort.

  8. A Proposed Set of Metrics to Reduce Patient Safety Risk From Within the Anatomic Pathology Laboratory

    PubMed Central

    Banks, Peter; Brown, Richard; Laslowski, Alex; Daniels, Yvonne; Branton, Phil; Carpenter, John; Zarbo, Richard; Forsyth, Ramses; Liu, Yan-hui; Kohl, Shane; Diebold, Joachim; Masuda, Shinobu; Plummer, Tim

    2017-01-01

    Background: Anatomic pathology laboratory workflow consists of 3 major specimen handling processes. Among the workflow are preanalytic, analytic, and postanalytic phases that contain multistep subprocesses with great impact on patient care. A worldwide representation of experts came together to create a system of metrics, as a basis for laboratories worldwide, to help them evaluate and improve specimen handling to reduce patient safety risk. Method: Members of the Initiative for Anatomic Pathology Laboratory Patient Safety (IAPLPS) pooled their extensive expertise to generate a list of metrics highlighting processes with high and low risk for adverse patient outcomes. Results: Our group developed a universal, comprehensive list of 47 metrics for patient specimen handling in the anatomic pathology laboratory. Steps within the specimen workflow sequence are categorized as high or low risk. In general, steps associated with the potential for specimen misidentification correspond to the high-risk grouping and merit greater focus within quality management systems. Primarily workflow measures related to operational efficiency can be considered low risk. Conclusion: Our group intends to advance the widespread use of these metrics in anatomic pathology laboratories to reduce patient safety risk and improve patient care with development of best practices and interlaboratory error reporting programs. PMID:28340232

  9. A Proposed Set of Metrics to Reduce Patient Safety Risk From Within the Anatomic Pathology Laboratory.

    PubMed

    Banks, Peter; Brown, Richard; Laslowski, Alex; Daniels, Yvonne; Branton, Phil; Carpenter, John; Zarbo, Richard; Forsyth, Ramses; Liu, Yan-Hui; Kohl, Shane; Diebold, Joachim; Masuda, Shinobu; Plummer, Tim; Dennis, Eslie

    2017-05-01

    Anatomic pathology laboratory workflow consists of 3 major specimen handling processes. Among the workflow are preanalytic, analytic, and postanalytic phases that contain multistep subprocesses with great impact on patient care. A worldwide representation of experts came together to create a system of metrics, as a basis for laboratories worldwide, to help them evaluate and improve specimen handling to reduce patient safety risk. Members of the Initiative for Anatomic Pathology Laboratory Patient Safety (IAPLPS) pooled their extensive expertise to generate a list of metrics highlighting processes with high and low risk for adverse patient outcomes. : Our group developed a universal, comprehensive list of 47 metrics for patient specimen handling in the anatomic pathology laboratory. Steps within the specimen workflow sequence are categorized as high or low risk. In general, steps associated with the potential for specimen misidentification correspond to the high-risk grouping and merit greater focus within quality management systems. Primarily workflow measures related to operational efficiency can be considered low risk. Our group intends to advance the widespread use of these metrics in anatomic pathology laboratories to reduce patient safety risk and improve patient care with development of best practices and interlaboratory error reporting programs. © American Society for Clinical Pathology 2017.

  10. Association of U.S. Dialysis Facility Neighborhood Characteristics with Facility-Level Kidney Transplantation

    PubMed Central

    Plantinga, Laura; Pastan, Stephen; Kramer, Michael; McClellan, Ann; Krisher, Jenna; Patzer, Rachel E.

    2014-01-01

    Background Improving access to optimal healthcare may depend on attributes of neighborhoods where patients receive healthcare services. We investigated whether characteristics of dialysis facility neighborhoods—where most patients with end-stage renal disease are treated—were associated with facility-level kidney transplantation. Methods We examined the association between census tract (neighborhood)-level sociodemographic factors and facility-level kidney transplantation rate in 3,983 U.S. dialysis facilities with reported kidney transplantation rates. Number of kidney transplants and total person-years contributed at the facility level in 2007-2010 were obtained from the Dialysis Facility Report and linked to census tract data on sociodemographic characteristics from the American Community Survey 2006-2010 by dialysis facility location. We used multivariable Poisson models with generalized estimating equations to estimate associations between neighborhood characteristics and transplant incidence. Results U.S. dialysis facilities were located in neighborhoods with substantially greater proportions of black and poor residents, relative to the national average. Most facility neighborhood characteristics were associated with transplant, with incidence rate ratios (95% CI) for standardized increments (in percentage) of neighborhood exposures of: living in poverty, 0.88 (0.84-0.92), black race, 0.83 (0.78-0.89); high school graduates, 1.22 (1.17-1.26); and unemployed, 0.90 (0.85-0.95). Conclusion Dialysis facility neighborhood characteristics may be modestly associated with facility rates of kidney transplantation. The success of dialysis facility interventions to improve access to kidney transplantation may partially depend on reducing neighborhood-level barriers. PMID:25196018

  11. Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association.

    PubMed

    Munshi, Medha N; Florez, Hermes; Huang, Elbert S; Kalyani, Rita R; Mupanomunda, Maria; Pandya, Naushira; Swift, Carrie S; Taveira, Tracey H; Haas, Linda B

    2016-02-01

    Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly

  12. Reducing the risk of HIV infection among South African sex workers: socioeconomic and gender barriers.

    PubMed Central

    Karim, Q A; Karim, S S; Soldan, K; Zondi, M

    1995-01-01

    OBJECTIVES. The social context within which women engaged in sex work at a popular truck stop in South Africa are placed at risk of human immunodeficiency virus (HIV) infection and the factors that influence their ability to reduce their risk were assessed. METHODS. Using qualitative and quantitative techniques, an elected sex worker from within the group collected all data. RESULTS. Given the various pressing needs for basic survival, the risk of HIV infection is viewed as one more burden imposed on these women by their lack of social, legal, and economic power. Violence, or the threat thereof, plays an important role in their disempowerment. In the few instances in which sex workers were able to insist on condom use, it resulted in a decrease in earnings, loss of clients, and physical abuse. CONCLUSIONS. Recommendations to reduce the sex workers' risk for HIV infection include negotiation and communication skills to enable them to persuade their clients to use condoms; development of strategies through which they can maximally use their group strength to facilitate unified action; and accessibility of protective methods they can use and control, such as intravaginal microbicides. PMID:7485664

  13. Reducing the risk of HIV infection among South African sex workers: socioeconomic and gender barriers.

    PubMed

    Karim, Q A; Karim, S S; Soldan, K; Zondi, M

    1995-11-01

    The social context within which women engaged in sex work at a popular truck stop in South Africa are placed at risk of human immunodeficiency virus (HIV) infection and the factors that influence their ability to reduce their risk were assessed. Using qualitative and quantitative techniques, an elected sex worker from within the group collected all data. Given the various pressing needs for basic survival, the risk of HIV infection is viewed as one more burden imposed on these women by their lack of social, legal, and economic power. Violence, or the threat thereof, plays an important role in their disempowerment. In the few instances in which sex workers were able to insist on condom use, it resulted in a decrease in earnings, loss of clients, and physical abuse. Recommendations to reduce the sex workers' risk for HIV infection include negotiation and communication skills to enable them to persuade their clients to use condoms; development of strategies through which they can maximally use their group strength to facilitate unified action; and accessibility of protective methods they can use and control, such as intravaginal microbicides.

  14. Improved E-ELT subsystem and component specifications, thanks to M1 test facility

    NASA Astrophysics Data System (ADS)

    Dimmler, M.; Marrero, J.; Leveque, S.; Barriga, Pablo; Sedghi, B.; Kornweibel, N.

    2014-07-01

    During the last 2 years ESO has operated the "M1 Test Facility", a test stand consisting of a representative section of the E-ELT primary mirror equipped with 4 complete prototype segment subunits including sensors, actuators and control system. The purpose of the test facility is twofold: it serves to study and get familiar with component and system aspects like calibration, alignment and handling procedures and suitable control strategies on real hardware long before the primary mirror (hereafter M1) components are commissioned. Secondly, and of major benefit to the project, it offered the possibility to evaluate component and subsystem performance and interface issues in a system context in such detail, that issues could be identified early enough to feed back into the subsystem and component specifications. This considerably reduces risk and cost of the production units and allows refocusing the project team on important issues for the follow-up of the production contracts. Experiences are presented in which areas the results of the M1 Test Facility particularly helped to improve subsystem specifications and areas, where additional tests were adopted independent of the main test facility. Presented are the key experiences of the M1 Test Facility which lead to improved specifications or identified the need for additional testing outside of the M1 Test Facility.

  15. Food groups associated with a reduced risk of 15-year all-cause death.

    PubMed

    Bongard, V; Arveiler, D; Dallongeville, J; Ruidavets, J-B; Wagner, A; Simon, C; Marécaux, N; Ferrières, J

    2016-06-01

    Long-term observational cohorts provide the opportunity to investigate the potential impact of dietary patterns on death. We aimed to investigate all-cause death according to the consumption of selected food groups, and then to identify those independently associated with reduced mortality. Population survey of middle-aged men randomly selected in the period 1995-1997 from the general population of three French areas and followed over a median of 14.8 years. Dietary data were collected through a 3-day food record. Cox modeling was used to assess the risk of death according to selected foods groups after extensive adjustment for confounders, including a diet quality index. The study population comprised 960 men (mean age 55.5 ±6.2 years). After a median follow-up of 14.8 (interquartile range 14.3-15.2) years, 150 (15.6%) subjects had died. Food groups that remained independently predictive of a lower risk of death after extensive adjustment were an above-median consumption of milk (adjusted relative risk: 0.61, 95% confidence interval (CI): 0.43-0.86, P-value=0.005), fruits and vegetables (0.68, 0.46-0.98, P-value=0.041) and a moderate consumption of yogurts and cottage cheese (0.50, 95% CI: 0.31-0.81, P-value=0.005), other cheeses (0.62, 0.39-0.97, P-value=0.036) and bread (0.57, 0.37-0.89, P-value=0.014). Besides, there was a nonsignificant trend for a higher risk of death associated with highest sodium intakes. Consumption of food groups that largely match recommendations is associated with a reduced risk of all-cause death in men. A diet providing moderate amounts of diverse food groups appears associated with the highest life expectancy.

  16. The Aged Residential Care Healthcare Utilization Study (ARCHUS): a multidisciplinary, cluster randomized controlled trial designed to reduce acute avoidable hospitalizations from long-term care facilities.

    PubMed

    Connolly, Martin J; Boyd, Michal; Broad, Joanna B; Kerse, Ngaire; Lumley, Thomas; Whitehead, Noeline; Foster, Susan

    2015-01-01

    To assess effect of a complex, multidisciplinary intervention aimed at reducing avoidable acute hospitalization of residents of residential aged care (RAC) facilities. Cluster randomized controlled trial. RAC facilities with higher than expected hospitalizations in Auckland, New Zealand, were recruited and randomized to intervention or control. A total of 1998 residents of 18 intervention facilities and 18 control facilities. A facility-based complex intervention of 9 months' duration. The intervention comprised gerontology nurse specialist (GNS)-led staff education, facility bench-marking, GNS resident review, and multidisciplinary (geriatrician, primary-care physician, pharmacist, GNS, and facility nurse) discussion of residents selected using standard criteria. Primary end point was avoidable hospitalizations. Secondary end points were all acute admissions, mortality, and acute bed-days. Follow-up was for a total of 14 months. The intervention did not affect main study end points: number of acute avoidable hospital admissions (RR 1.07; 95% CI 0.85-1.36; P = .59) or mortality (RR 1.11; 95% CI 0.76-1.61; P = .62). This multidisciplinary intervention, packaging selected case review, and staff education had no overall impact on acute hospital admissions or mortality. This may have considerable implications for resourcing in the acute and RAC sectors in the face of population aging. Australian and New Zealand Clinical Trials Registry (ACTRN12611000187943). Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  17. Rice Bran Extract Reduces the Risk of Atherosclerosis in Post-Menopausal Vietnamese Women.

    PubMed

    Nhung, Bui Thi; Tuyen, Le Danh; Linh, Vu Anh; Anh, Nguyen Do Van; Nga, Tran Thuy; Thuc, Vu Thi Minh; Yui, Kei; Ito, Yukihiko; Nakashima, Yuri; Yamamoto, Shigeru

    2016-01-01

    We investigated whether pre-germinated brown rice bran extract containing acylated steryl glucosides (PSG) reduces the risk of atherosclerosis in post-menopausal Vietnamese women. A total of 60 post-menopausal Vietnamese women (45-65 y old) with high LDL cholesterol levels (over 140 mg/dL) were randomly divided into PSG (n=30) and placebo (n=30) groups. The subjects in the PSG group were assigned a daily intake of 6 capsules containing 50 mg PSG, and the subjects in the placebo group were assigned a daily intake of 6 capsules containing corn oil for 6 mo. Before baseline and after month 2, month 4, and month 6 of the intervention, we conducted anthropometric measurements, blood biochemical examinations, a nutrition survey, and physical activity, flow-mediated dilation (FMD), and cardio-ankle vascular index (CAVI) measurements. Serum LDL cholesterol concentrations were significantly reduced from 163.6±25.3 (mg/dL) to 135.9±26.8 (mg/dL) compared to the placebo group (p<0.001). FMD values of the placebo group were significantly reduced from 6.6±5.1 (%) to 4.7±2.6 (%) compared to the PSG group (p<0.05). Tumor necrosis factor (TNF)-α concentrations in the PSG group were significantly reduced from 19.8±11 (pg/mL) to 10.6±5.5 (pg/mL) compared to the placebo group (p<0.05). The findings suggest that PSG may improve LDL cholesterol, TNF-α levels, and FMD values. PSG might be considered in reducing the risk of atherosclerosis in post-menopausal Vietnamese women with high LDL cholesterol.

  18. RESULTS OF THE ENVIRONMENTAL MANAGEMENT (EM) CORPORATE PROJECT TEAM DISPOSING WASTE & REDUCING RISK

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

    SHRADER, T.A.; KNERR, R.

    2005-01-31

    In 2002, the US Department of Energy's (DOE) Office of Environmental Management (EM) released the Top-To-Bottom Review of cognizant clean-up activities around the DOE Complex. The review contained a number of recommendations for changing the way EM operates in order to reduce environmental risk by significantly accelerating clean-up at the DOE-EM sites. In order to develop and implement these recommendations, a number of corporate project teams were formed to identify, evaluate, and initiate implementation of alternatives for the different aspects of clean-up. In August 2002, a corporate team was formed to review all aspects of the management, treatment, and disposalmore » of low level radioactive waste (LLW), mixed low level radioactive waste (MLLW), transuranic waste (TRU), and hazardous waste (HW). Over the next 21 months, the Corporate Project Team: Disposing Waste, Reducing Risk, developed a number of alternatives for implementing the recommendations of the Top-To-Bottom Review based on information developed during numerous site visits and interviews with complex and industry personnel. With input from over a dozen EM sites at various stages of clean-up, the team identified the barriers to the treatment and disposal of low level waste, mixed low level waste, and transuranic waste. Once identified, preliminary design alternatives were developed and presented to the Acquisition Authority (for this project, the Assistant Secretary for Environmental Management) for review and approval. Once the preliminary design was approved, the team down selected to seven key alternatives which were subsequently fully developed in the Project Execution Plan. The seven most viable alternatives were: (1) creation of an Executive Waste Disposal Board; (2) projectizing the disposal of low level waste and mixed low level waste; (3) creation of a National Consolidation and Acceleration Facility for waste; (4) improvements to the Broad Spectrum contract; (5) improvements to the

  19. Inequality in diabetes-related hospital admissions in England by socioeconomic deprivation and ethnicity: facility-based cross-sectional analysis.

    PubMed

    Nishino, Yoshitaka; Gilmour, Stuart; Shibuya, Kenji

    2015-01-01

    To investigate the effect of social deprivation and ethnicity on inpatient admissions due to diabetes in England. Facility-based cross-sectional analysis. National Health Service (NHS) trusts in England reporting inpatient admissions with better than 80% data reporting quality from 2010-2011 (355 facilities). Non-obstetric patients over 16 years old in all NHS facilities in England. The sample size after exclusions was 5,147,859 all-cause admissions. The relative risk of inpatient admissions and readmissions due to diabetes adjusted for confounders. There were 445,504 diabetes-related hospital admissions in England in 2010, giving a directly (age-sex) standardized rate of 1049.0 per 100,000 population (95% confidence interval (CI): 1046.0-1052.1). The relative risk of inpatient admission in the most deprived quintile was 2.08 times higher than that of the least deprived quintile (95% CI: 2.02-2.14), and the effect of deprivation varied across ethnicities. About 30.1% of patients admitted due to diabetes were readmitted at least once due to diabetes. South Asians showed 2.62 times (95% CI: 2.51-2.74) higher admission risk. Readmission risk increased with IMD among white British but not other ethnicities. South Asians showed slightly lower risk of readmission than white British (0.86, 95% CI: 0.80-0.94). More deprived areas had higher rates of inpatient admissions and readmissions due to diabetes. South Asian British showed higher admission risk and lower readmission risk than white British. However, there was almost no difference by ethnicity in readmission due to diabetes. Higher rates of admission among deprived people may not necessarily reflect higher prevalence, but higher admission rates in south Asian British may be explained by their higher prevalence because their lower readmission risk suggests no inequality in primary care to prevent readmission. Better interventions in poorer areas, are needed to reduce these inequalities.

  20. Immediate Antiretroviral Therapy Reduces Risk of Infection-Related Cancer During Early HIV Infection.

    PubMed

    Borges, Álvaro H; Neuhaus, Jacqueline; Babiker, Abdel G; Henry, Keith; Jain, Mamta K; Palfreeman, Adrian; Mugyenyi, Peter; Domingo, Pere; Hoffmann, Christian; Read, Tim R H; Pujari, Sanjay; Meulbroek, Michael; Johnson, Margaret; Wilkin, Timothy; Mitsuyasu, Ronald

    2016-12-15

     In the Strategic Timing of Antiretroviral Treatment (START) study, immediate combination antiretroviral therapy (cART) initiation reduced cancer risk by 64%. We hypothesized that risk reduction was higher for infection-related cancer and determined by differences in CD4 cell counts and human immunodeficiency virus (HIV) RNA between the study arms.  Incident malignancies in START were categorized into infection-related and infection-unrelated cancer. We used Cox models to assess factors associated with both cancer categories. We used sequential adjustment for baseline covariates, cancer risk factors, and HIV-specific variables to investigate potential mediators of cancer risk reduction with immediate cART.  There were 14 cancers among persons randomized to immediate cART (6 infection-related and 8 infection-unrelated) and 39 cancers in the deferred arm (23 infection-related and 16 infection-unrelated); hazard ratios of immediate vs deferred cART initiation were 0.26 (95% confidence interval [CI], .11-.64) for infection-related and 0.49 (95% CI, .21-1.15) for infection-unrelated cancer. Independent predictors of infection-related cancer were older age, higher body mass index, low- to middle-income region, HIV RNA, and baseline CD8 cell count. Older age and baseline CD8 cell count were independent predictors of infection-unrelated cancer. Adjustment for latest HIV RNA level had little impact on the protective effect of immediate cART on infection-related cancer. Adjustment for latest HIV RNA level, but not for CD4 cell count or cancer risk factors, attenuated the effect of immediate cART on infection-unrelated cancer.  Immediate cART initiation significantly reduces risk of cancer. Although limited by small sample size, this benefit does not appear to be solely attributable to HIV RNA suppression and may be also mediated by other mechanisms. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights

  1. Vitamin C in breast milk may reduce the risk of atopy in the infant.

    PubMed

    Hoppu, U; Rinne, M; Salo-Väänänen, P; Lampi, A-M; Piironen, V; Isolauri, E

    2005-01-01

    To assess the effects of maternal dietary and supplement intake of vitamins C and E on breast milk antioxidant composition (vitamin C, alpha-tocopherol and beta-carotene) and their protective potential against the development of atopy in the infant. Mothers with atopic disease were recruited at the end of gestation and maternal sensitization was assessed by skin-prick testing. The 4-day food records of the mothers and breast milk samples were collected at the infants' age of 1 month. Infants' atopy was defined by the presence of atopic dermatitis during the first year of life and a positive skin-prick test reaction at 12 months of age (n=34). Maternal intake of vitamin C in diet but not as supplement was shown to determine the concentration of vitamin C in breast milk. A higher concentration of vitamin C in breast milk was associated with a reduced risk of atopy in the infant (OR=0.30; 95% CI 0.09-0.94; P=0.038), whereas alpha-tocopherol had no consistent relationship with atopy. The group at risk of suboptimal vitamin C supply from breast milk was identified as infants whose mothers suffer from food hypersensitivity. A maternal diet rich in natural sources of vitamin C during breastfeeding could reduce the risk of atopy in high-risk infants.

  2. Preventing Airborne Disease Transmission: Review of Methods for Ventilation Design in Health Care Facilities

    PubMed Central

    Aliabadi, Amir A.; Rogak, Steven N.; Bartlett, Karen H.; Green, Sheldon I.

    2011-01-01

    Health care facility ventilation design greatly affects disease transmission by aerosols. The desire to control infection in hospitals and at the same time to reduce their carbon footprint motivates the use of unconventional solutions for building design and associated control measures. This paper considers indoor sources and types of infectious aerosols, and pathogen viability and infectivity behaviors in response to environmental conditions. Aerosol dispersion, heat and mass transfer, deposition in the respiratory tract, and infection mechanisms are discussed, with an emphasis on experimental and modeling approaches. Key building design parameters are described that include types of ventilation systems (mixing, displacement, natural and hybrid), air exchange rate, temperature and relative humidity, air flow distribution structure, occupancy, engineered disinfection of air (filtration and UV radiation), and architectural programming (source and activity management) for health care facilities. The paper describes major findings and suggests future research needs in methods for ventilation design of health care facilities to prevent airborne infection risk. PMID:22162813

  3. Preventing airborne disease transmission: review of methods for ventilation design in health care facilities.

    PubMed

    Aliabadi, Amir A; Rogak, Steven N; Bartlett, Karen H; Green, Sheldon I

    2011-01-01

    Health care facility ventilation design greatly affects disease transmission by aerosols. The desire to control infection in hospitals and at the same time to reduce their carbon footprint motivates the use of unconventional solutions for building design and associated control measures. This paper considers indoor sources and types of infectious aerosols, and pathogen viability and infectivity behaviors in response to environmental conditions. Aerosol dispersion, heat and mass transfer, deposition in the respiratory tract, and infection mechanisms are discussed, with an emphasis on experimental and modeling approaches. Key building design parameters are described that include types of ventilation systems (mixing, displacement, natural and hybrid), air exchange rate, temperature and relative humidity, air flow distribution structure, occupancy, engineered disinfection of air (filtration and UV radiation), and architectural programming (source and activity management) for health care facilities. The paper describes major findings and suggests future research needs in methods for ventilation design of health care facilities to prevent airborne infection risk.

  4. Environmental Risk Profiling of the Volta Delta, Ghana

    NASA Astrophysics Data System (ADS)

    Nyarko, B. K.; Appeaning-Addo, K.; Amisigo, B.

    2017-12-01

    Volta Delta communities find it difficult to absorb or bear risk at different levels, because of the physical and economic impacts of environmental hazards. In this regards various agencies and organizations have in recent years launched initiatives to measure and identify risk areas with a set of indicators and indices. The theory underpinning this study is concepts of Modern Portfolio Theory (MPT). The Cox proportional hazards regression model will be used as the model for the risk profile. Finding the optimal level of environmental risk for activities in the Volta Delta considering the risk required, risk capacity and risk tolerance. Using data from different sources, an environmental risk profile was developed for the Volta Delta. The result indicates that risks are distributed across the Delta. However, areas that have government interventions, such as sea defense system and irrigation facilities have less threat. In addition wealthy areas do effectively reduce the threat of any form of disaster.

  5. Reducing Environmental Risks by Information Disclosure: Evidence in Residential Lead Paint Disclosure Rule

    ERIC Educational Resources Information Center

    Bae, Hyunhoe

    2012-01-01

    Recently, there has been a surge in environmental regulations that require information disclosure. However, existing empirical evidence is limited to certain applications and has yet to generalize the effectiveness of this approach as a policy strategy to reduce environmental risks. This study evaluates the disclosure rule of the residential lead…

  6. Understanding your supply chain to reduce the risk of supply chain disruption.

    PubMed

    Wildgoose, Nick; Brennan, Patrick; Thompson, Simon

    2012-01-01

    Supply chains are at the heart of the way in which organisations operate and compete today; they also play a critical role in overall organisation performance. In the context of increasingly complex and global supply chains, the actions taken to drive down costs are likely to drive risk into the supply chain. The frequency of supply chain disruptions is high and this paper offers practical advice to help reduce the frequency and cost associated with these. There is advice to help with the understanding of how to identify critical suppliers. The reader is guided through comprehensive risk assessment and mitigation approaches and a selection of practical risk solutions and tools that you can use is described. There is a section on the 'dos and don'ts' relating to supplier due diligence. For those organisations facing the challenge of drawing up a business case relating to investment in improving supply chain resiliency, there is also a section outlining some of the business benefits of improving supply chain resiliency.

  7. EPA Facility Registry Service (FRS): CAMDBS

    EPA Pesticide Factsheets

    This web feature service contains location and facility identification information from EPA's Facility Registry Service (FRS) for the subset of facilities that link to the Clean Air Markets Division Business System (CAMDBS). Administered by the EPA Clean Air Markets Division, within the Office of Air and Radiation, CAMDBS supports the implementation of market-based air pollution control programs, including the Acid Rain Program and regional programs designed to reduce the transport of ozone. FRS identifies and geospatially locates facilities, sites or places subject to environmental regulations or of environmental interest. Using vigorous verification and data management procedures, FRS integrates facility data from EPA's national program systems, other federal agencies, and State and tribal master facility records and provides EPA with a centrally managed, single source of comprehensive and authoritative information on facilities. This data set contains the subset of FRS integrated facilities that link to CAMDBS facilities once the CAMDBS data has been integrated into the FRS database. Additional information on FRS is available at the EPA website https://www.epa.gov/enviro/facility-registry-service-frs.

  8. Low-Cost, Class D Testing of Spacecraft Photovoltaic Systems Can Reduce Risk

    NASA Technical Reports Server (NTRS)

    Forgione, Joshua B.; Kojima, Gilbert K.; Hanel, Robert; Mallinson, Mark V.

    2014-01-01

    at the appropriate solar array switch in the power system. A metal-halide bulb, infrared imagers, and onboard spacecraft measurements are utilized to minimize risk of thermal damage during test. Data is provided to support test results for both passing and marginal panels. Prior to encapsulation in the launch vehicle, each panel is inspected for damage by the panel manufacturer. Cracked cells or other damage is amended on-site. Because the photovoltaic test system is inexpensive and portable, each repaired panel can be re-verified immediately. Post-launch, the photovoltaic system is again characterized for per-panel deviations from the manufacturer's performance test. This proved especially tricky as the LADEE spacecraft performs only one current measurement on the entire array. The algorithm for Matlab tools to assess panel performance based on spacecraft attitude is discussed. While not as precise and comprehensive as LAPSS, the LADEE approach leverages minimal resources into an ongoing assessment program that can be applied through numerous stages of the mission. The project takes a true Class D approach in assessing the technical value of a spacecraft level performance test versus the programmatic risk of shipping the spacecraft to another facility. The resources required are a fraction of that for a LAPSS test, and is easy to repeat. Further, the test equipment can be handed down to future projects without building an on-site facility.

  9. Dialysis Facility Safety: Processes and Opportunities.

    PubMed

    Garrick, Renee; Morey, Rishikesh

    2015-01-01

    Unintentional human errors are the source of most safety breaches in complex, high-risk environments. The environment of dialysis care is extremely complex. Dialysis patients have unique and changing physiology, and the processes required for their routine care involve numerous open-ended interfaces between providers and an assortment of technologically advanced equipment. Communication errors, both within the dialysis facility and during care transitions, and lapses in compliance with policies and procedures are frequent areas of safety risk. Some events, such as air emboli and needle dislodgments occur infrequently, but are serious risks. Other adverse events include medication errors, patient falls, catheter and access-related infections, access infiltrations and prolonged bleeding. A robust safety system should evaluate how multiple, sequential errors might align to cause harm. Systems of care can be improved by sharing the results of root cause analyses, and "good catches." Failure mode effects and analyses can be used to proactively identify and mitigate areas of highest risk, and methods drawn from cognitive psychology, simulation training, and human factor engineering can be used to advance facility safety. © 2015 Wiley Periodicals, Inc.

  10. Does the Consumption of Green Tea Reduce the Risk of Lung Cancer Among Smokers?

    PubMed Central

    Liang, Wenbin; Binns, Colin W.; Jian, Le

    2007-01-01

    Experimental and epidemiological studies were reviewed to assess whether the consumption of green tea could reduce the risk of lung cancer in smokers. Articles published since 1990 were located by searching electronic databases PubMed, Ovid and Science Direct, using keywords ‘lung cancer’, ‘tea’ and ‘smoking’ without any restriction on language. After relevant articles had been located, further papers were obtained from their reference lists. Evidence from experimental studies (in vitro animal and human trials) suggested that regular intake of green tea may be protective against tobacco carcinogens. However, the mechanism behind the protective effect is only partly understood. In most of the epidemiological studies reviewed, the green tea exposure was within 5 years of the interview or follow-up, which would coincide with the induction period and latent period of lung cancer. Longer term studies are thus needed to further quantify the cancer risk. There is some evidence suggesting regular intake of green tea at high level (>3 cups per day) may reduce the risk of smokers developing lung cancer. Improvement in measuring green tea intake is required in order to confirm the evidence from epidemiological studies. PMID:17342237

  11. Conditional Economic Incentives for Reducing HIV Risk Behaviors: Integration of Psychology and Behavioral Economics

    PubMed Central

    Operario, Don; Kuo, Caroline C.; Sosa-Rubí, Sandra G.; Gálarraga, Omar

    2014-01-01

    Objective This paper reviews psychology and behavioral economic approaches to HIV prevention, and examines the integration and application of these approaches in conditional economic incentive (CEI) programs for reducing HIV risk behavior. Methods We discuss the history of HIV prevention approaches, highlighting the important insights and limitations of psychological theories. We provide an overview of the theoretical tenets of behavioral economics that are relevant to HIV prevention, and utilize CEIs as an illustrative example of how traditional psychological theories end behavioral economics can be combined into new approaches for HIV prevention. Results Behavioral economic interventions can complement psychological frameworks for reducing HIV risk by introducing unique theoretical understandings about the conditions under which risky decisions are amenable to intervention. Findings from illustrative CEI programs show mixed but generally promising effects of economic interventions on HIV and STI prevalence, HIV testing, HIV medication adherence, and drug use. Conclusion CEI programs can complement psychological interventions for HIV prevention and behavioral risk reduction. To maximize program effectiveness, CEI programs must be designed according to contextual and population-specific factors that may determine intervention applicability and success. PMID:24001243

  12. Conditional economic incentives for reducing HIV risk behaviors: integration of psychology and behavioral economics.

    PubMed

    Operario, Don; Kuo, Caroline; Sosa-Rubí, Sandra G; Gálarraga, Omar

    2013-09-01

    This article reviews psychology and behavioral economic approaches to HIV prevention, and examines the integration and application of these approaches in conditional economic incentive (CEI) programs for reducing HIV risk behavior. We discuss the history of HIV prevention approaches, highlighting the important insights and limitations of psychological theories. We provide an overview of the theoretical tenets of behavioral economics that are relevant to HIV prevention, and utilize CEIs as an illustrative example of how traditional psychological theories and behavioral economics can be combined into new approaches for HIV prevention. Behavioral economic interventions can complement psychological frameworks for reducing HIV risk by introducing unique theoretical understandings about the conditions under which risky decisions are amenable to intervention. Findings from illustrative CEI programs show mixed but generally promising effects of economic interventions on HIV and sexually transmitted infection (STI) prevalence, HIV testing, HIV medication adherence, and drug use. CEI programs can complement psychological interventions for HIV prevention and behavioral risk reduction. To maximize program effectiveness, CEI programs must be designed according to contextual and population-specific factors that may determine intervention applicability and success. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  13. A Community Health Advisor Program to reduce cardiovascular risk among rural African-American women

    PubMed Central

    Cornell, C. E.; Littleton, M. A.; Greene, P. G.; Pulley, L.; Brownstein, J. N.; Sanderson, B. K.; Stalker, V. G.; Matson-Koffman, D.; Struempler, B.; Raczynski, J. M.

    2009-01-01

    The Uniontown, Alabama Community Health Project trained and facilitated Community Health Advisors (CHAs) in conducting a theory-based intervention designed to reduce the risk for cardiovascular disease (CVD) among rural African-American women. The multiphased project included formative evaluation and community organization, CHA recruitment and training, community intervention and maintenance. Formative data collected to develop the training, intervention and evaluation methods and materials indicated the need for programs to increase knowledge, skills and resources for changing behaviors that increase the risk of CVD. CHAs worked in partnership with staff to develop, implement, evaluate and maintain strategies to reduce risk for CVD in women and to influence city officials, business owners and community coalitions to facilitate project activities. Process data documented sustained increases in social capital and community capacity to address health-related issues, as well as improvements in the community’s physical infrastructure. This project is unique in that it documents that a comprehensive CHA-based intervention for CVD can facilitate wide-reaching changes in capacity to address health issues in a rural community that include improvements in community infrastructure and are sustained beyond the scope of the originally funded intervention. PMID:19047648

  14. Promoting "Healthy Futures" to Reduce Risk Behaviors in Urban Youth: A Randomized Controlled Trial.

    PubMed

    Lindstrom Johnson, Sarah; Jones, Vanya; Cheng, Tina L

    2015-09-01

    There is increasing evidence of the interconnection between educational and health outcomes. Unfortunately wide disparities exist by both socioeconomic status and race/ethnicity in educational and vocational success. This study sought to promote urban youths' career readiness as a way to reduce involvement in risk behaviors. Two hundred primarily African-American youth (ages 14-21) were recruited from a pediatric primary care clinic. Youth randomized to the intervention received three motivational interviewing sessions focused around expectations and planning for the future. Baseline and 6-month follow-up assessments included measures of career readiness and risk behavior involvement (i.e., physical fighting, alcohol and marijuana use). At 6-months, youth randomized to the intervention condition showed increased confidence in their ability to perform the behaviors needed to reach their college/career goals. Additionally, youth randomized to the intervention arm showed decreased fighting behavior (adjusted rate ratio: .27) and marijuana use (adjusted rate ratio: .61). Assisting urban youth in thinking and planning about their future holds promise as a way to reduce their involvement in risk behaviors. This study also demonstrated that motivational interviewing could be used to promote positive behaviors (i.e., career readiness).

  15. Investigating reduced bag weight as an effective risk mediator for mason tenders.

    PubMed

    Davis, Kermit G; Kotowski, Susan E; Albers, James; Marras, William S

    2010-10-01

    Masonry workers face some of the highest physical demands in the construction industry where large bags of masonry material weighing 42.7 kg are commonly handled by mason tenders who mix the mortar, distribute mortar and bricks/blocks, and erect/dismantle scaffolding throughout the day. The objective of this study was to determine the effectiveness of using half-weight bags (21.4 kg) on reducing the biomechanical loading, physiological response, and perceived exertions. Ten male subjects performed asymmetric lifting tasks simulating unloading bags from a pallet. Muscle activity, trunk kinematics, heart rate, blood pressure and subjective rating data were collected. Spine loads were predicted from a well-validated EMG-assisted model. Bag weight, lift type, bag height at origin, and asymmetry at destination significantly impacted the spine loads. While there was a 50% reduction in bag weight, the peak loads for the half-weight bags were only 25% less than the more available full-weight bags (a reduction of about 320 N of shear and 1000 N of compression). Lifts allowing movement of the feet reduced the loads by about 22% in shear and 27% in compression compared to constrained postures. Interestingly, cumulative spine loads were greater for the lighter bags than the heavy bags ( approximately 40%). The subjective ratings of exertion and risk were significantly lower for the lighter bags. RELEVANCE TO INDUSTRY: The reduction in peak spine loading for the half-weight bags, particularly at the higher heights and when the feet were allowed to move could significantly reduce the injuries of masonry workers. However, there were trade-offs with cumulative loads that may minimize the reduced risk. Overall, given the limited amount of time lifting bags, the reduction of peak loads.

  16. Cost-effectiveness of essential newborn care training in urban first-level facilities.

    PubMed

    Manasyan, Albert; Chomba, Elwyn; McClure, Elizabeth M; Wright, Linda L; Krzywanski, Sara; Carlo, Waldemar A

    2011-05-01

    To determine the cost-effectiveness of the World Health Organization (WHO) Essential Newborn Care (ENC) training of health care providers in first-level facilities in the 2 largest cities in Zambia. Data were extracted from a study in which the effectiveness of the ENC training was evaluated (including universal precautions and cleanliness, routine neonatal care, resuscitation, thermoregulation, breastfeeding, skin-to-skin care, care of the small infant, danger signs, and common illnesses). The costs to train an ENC instructor for each first-level delivery facility and the costs of salary/benefits for 2 coordinators responsible for maintenance of the program were recorded in 2005 US dollars. The incremental costs per life gained and per disability-adjusted life-year averted were calculated. A 5-day ENC training-of-trainers was conducted in Lusaka, Zambia, to certify 18 college-trained midwives as ENC instructors. The instructors trained all clinic midwives working in their first-level facilities as part of a before-and-after study of the effect of ENC training on early neonatal mortality conducted from Oct 2004 to Nov 2006. All-cause 7-day (early) neonatal mortality decreased from 11.5 per 1000 to 6.8 per 1000 live births after ENC training of the clinic midwives (relative risk: 0.59; 95% confidence interval: 0.48-0.77; P < .001; 40 615 births). The intervention costs were $208 per life saved and $5.24 per disability-adjusted life-year averted. ENC training of clinic midwives who provide care in low-risk facilities is a low-cost intervention that can reduce early neonatal mortality in these settings.

  17. Reduced Kidney Function Is Associated With Cardiometabolic Risk Factors, Prevalent and Predicted Risk of Cardiovascular Disease in Chinese Adults: Results From the REACTION Study.

    PubMed

    Lu, Jieli; Mu, Yiming; Su, Qing; Shi, Lixin; Liu, Chao; Zhao, Jiajun; Chen, Lulu; Li, Qiang; Yang, Tao; Yan, Li; Wan, Qin; Wu, Shengli; Liu, Yan; Wang, Guixia; Luo, Zuojie; Tang, Xulei; Chen, Gang; Huo, Yanan; Gao, Zhengnan; Ye, Zhen; Wang, Youmin; Qin, Guijun; Deng, Huacong; Yu, Xuefeng; Shen, Feixia; Chen, Li; Zhao, Liebin; Sun, Jichao; Sun, Wanwan; Wang, Tiange; Du, Rui; Lin, Lin; Dai, Meng; Xu, Yu; Xu, Min; Bi, Yufang; Lai, Shenghan; Li, Donghui; Wang, Weiqing; Ning, Guang

    2016-07-22

    Chronic kidney disease (CKD) increases cardiovascular disease (CVD) risk. However, the association of mildly reduced kidney function with CVD risk is unclear. This study investigated the association of estimated glomerular filtration rate (eGFR) with prevalent CVDs, 10-year Framingham risk for coronary heart disease (CHD), and 10-year risk of atherosclerotic cardiovascular diseases (ASCVD) in 239 832 participants from the baseline of the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal study. With an interviewer-assisted questionnaire, we collected information on CVD, including reported CHD, stroke, or myocardial infarction. Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation was used to calculate eGFR. Compared with individuals with normal eGFR (≥90 mL/min per 1.73 m(2)), those with decreased eGFR (75-89, 60-74, and <60 mL/min per 1.73 m(2)) had higher risk of prevalent obesity, diabetes mellitus, hypertension, and dyslipidemia in both men and women (P for trend all <0.001). Moreover, a significantly higher 10-year Framingham risk for CHD and 10-year risk for ASCVD was observed in both men and women with mildly decreased eGFR (60-89 mL/min per 1.73 m(2)). Even mildly reduced eGFR (under 90 mL/min per 1.73 m(2)) is associated with elevated 10-year Framingham risk for CHD and 10-year ASCVD risk among Chinese adults. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  18. Adhering to a national surgical care bundle reduces the risk of surgical site infections

    PubMed Central

    Hopmans, Titia E. M.; Soetens, Loes C.; Wille, Jan C.; Geerlings, Suzanne E.; Vos, Margreet C.; van Benthem, Birgit H. B.; de Greeff, Sabine C.

    2017-01-01

    Background In 2008, a bundle of care to prevent Surgical Site Infections (SSIs) was introduced in the Netherlands. The bundle consisted of four elements: antibiotic prophylaxis according to local guidelines, no hair removal, normothermia and ‘hygiene discipline’ in the operating room (i.e. number of door movements). Dutch hospitals were advised to implement the bundle and to measure the outcome. This study’s goal was to assess how effective the bundle was in reducing SSI risk. Methods Hospitals assessed whether their staff complied with each of the bundle elements and voluntary reported compliance data to the national SSI surveillance network (PREZIES). From PREZIES data, we selected data from 2009 to 2014 relating to 13 types of surgical procedures. We excluded surgeries with missing (non)compliance data, and calculated for each remaining surgery with reported (non)compliance data the level of compliance with the bundle (that is, being compliant with 0, 1, 2, 3, or 4 of the elements). Subsequently, we used this level of compliance to assess the effect of bundle compliance on the SSI risk, using multilevel logistic regression techniques. Results 217 489 surgeries were included, of which 62 486 surgeries (29%) had complete bundle reporting. Within this group, the SSI risk was significantly lower for surgeries with complete bundle compliance compared to surgeries with lower compliance levels. Odds ratios ranged from 0.63 to 0.86 (risk reduction of 14% to 37%), while a 13% risk reduction was demonstrated for each point increase in compliance-level. Sensitivity analysis indicated that due to analysing reported bundles only, we probably underestimated the total effect of implementing the bundle. Conclusions This study demonstrated that adhering to a surgical care bundle significantly reduced the risk of SSIs. Reporting of and compliance with the bundle compliance can, however, still be improved. Therefore an even greater effect might be achieved. PMID:28877223

  19. Basis for Interim Operation for Fuel Supply Shutdown Facility

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

    BENECKE, M.W.

    2003-02-03

    This document establishes the Basis for Interim Operation (BIO) for the Fuel Supply Shutdown Facility (FSS) as managed by the 300 Area Deactivation Project (300 ADP) organization in accordance with the requirements of the Project Hanford Management Contract procedure (PHMC) HNF-PRO-700, ''Safety Analysis and Technical Safety Requirements''. A hazard classification (Benecke 2003a) has been prepared for the facility in accordance with DOE-STD-1027-92 resulting in the assignment of Hazard Category 3 for FSS Facility buildings that store N Reactor fuel materials (303-B, 3712, and 3716). All others are designated Industrial buildings. It is concluded that the risks associated with the currentmore » and planned operational mode of the FSS Facility (uranium storage, uranium repackaging and shipment, cleanup, and transition activities, etc.) are acceptable. The potential radiological dose and toxicological consequences for a range of credible uranium storage building have been analyzed using Hanford accepted methods. Risk Class designations are summarized for representative events in Table 1.6-1. Mitigation was not considered for any event except the random fire event that exceeds predicted consequences based on existing source and combustible loading because of an inadvertent increase in combustible loading. For that event, a housekeeping program to manage transient combustibles is credited to reduce the probability. An additional administrative control is established to protect assumptions regarding source term by limiting inventories of fuel and combustible materials. Another is established to maintain the criticality safety program. Additional defense-in-depth controls are established to perform fire protection system testing, inspection, and maintenance to ensure predicted availability of those systems, and to maintain the radiological control program. It is also concluded that because an accidental nuclear criticality is not credible based on the low uranium

  20. Taking Risk Assessment and Management to the Next Level: Program-Level Risk Analysis to Enable Solid Decision-Making on Priorities and Funding

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

    Nelson, J. G.; Morton, R. L.; Castillo, C.

    2011-02-01

    A multi-level (facility and programmatic) risk assessment was conducted for the facilities in the Nevada National Security Site (NNSS) Readiness in Technical Base and Facilities (RTBF) Program and results were included in a new Risk Management Plan (RMP), which was incorporated into the fiscal year (FY) 2010 Integrated Plans. Risks, risk events, probability, consequence(s), and mitigation strategies were identified and captured, for most scope areas (i.e., risk categories) during the facilitated risk workshops. Risk mitigations (i.e., efforts in addition to existing controls) were identified during the facilitated risk workshops when the risk event was identified. Risk mitigation strategies fell intomore » two broad categories: threats or opportunities. Improvement projects were identified and linked to specific risks they mitigate, making the connection of risk reduction through investments for the annual Site Execution Plan. Due to the amount of that was collected, analysis to be performed, and reports to be generated, a Risk Assessment/ Management Tool (RAMtool) database was developed to analyze the risks in real-time, at multiple levels, which reinforced the site-level risk management process and procedures. The RAMtool database was developed and designed to assist in the capturing and analysis of the key elements of risk: probability, consequence, and impact. The RAMtool calculates the facility-level and programmatic-level risk factors to enable a side-by-side comparison to see where the facility manager and program manager should focus their risk reduction efforts and funding. This enables them to make solid decisions on priorities and funding to maximize the risk reduction. A more active risk management process was developed where risks and opportunities are actively managed, monitored, and controlled by each facility more aggressively and frequently. risk owners have the responsibility and accountability to manage their assigned risk in real-time, using

  1. Assessing the security vulnerabilities of correctional facilities

    NASA Astrophysics Data System (ADS)

    Spencer, Debra D.; Morrison, G. Steve

    1998-12-01

    The National Institute of Justice has tasked their satellite facility at Sandia National Laboratories and their Southeast Regional Technology Center in Charleston, South Carolina to devise new procedures and tools for helping correctional facilities to assess their security vulnerabilities. Thus, a team is visiting selected correctional facilities and performing vulnerability assessments. A vulnerability assessment helps identify the easiest paths for inmate escape, for introduction of contraband such as drugs or weapons, for unexpected intrusion from outside of the facility, and for the perpetration of violent acts on other inmates and correctional employees. In addition, the vulnerability assessment helps to quantify the security risks for the facility. From these assessments will come better procedures for performing vulnerability assessments in general at other correctional facilities, as well as the development of tools to assist with the performance of such vulnerability assessments.

  2. Improving performance of HVAC systems to reduce exposure to aerosolized infectious agents in buildings; recommendations to reduce risks posed by biological attacks.

    PubMed

    Hitchcock, Penny J; Mair, Michael; Inglesby, Thomas V; Gross, Jonathan; Henderson, D A; O'Toole, Tara; Ahern-Seronde, Joa; Bahnfleth, William P; Brennan, Terry; Burroughs, H E Barney; Davidson, Cliff; Delp, William; Ensor, David S; Gomory, Ralph; Olsiewski, Paula; Samet, Jonathan M; Smith, William M; Streifel, Andrew J; White, Ronald H; Woods, James E

    2006-01-01

    The prospect of biological attacks is a growing strategic threat. Covert aerosol attacks inside a building are of particular concern. In the summer of 2005, the Center for Biosecurity of the University of Pittsburgh Medical Center convened a Working Group to determine what steps could be taken to reduce the risk of exposure of building occupants after an aerosol release of a biological weapon. The Working Group was composed of subject matter experts in air filtration, building ventilation and pressurization, air conditioning and air distribution, biosecurity, building design and operation, building decontamination and restoration, economics, medicine, public health, and public policy. The group focused on functions of the heating, ventilation, and air conditioning systems in commercial or public buildings that could reduce the risk of exposure to deleterious aerosols following biological attacks. The Working Group's recommendations for building owners are based on the use of currently available, off-the-shelf technologies. These recommendations are modest in expense and could be implemented immediately. It is also the Working Group's judgment that the commitment and stewardship of a lead government agency is essential to secure the necessary financial and human resources and to plan and build a comprehensive, effective program to reduce exposure to aerosolized infectious agents in buildings.

  3. Reduced risk for placental malaria in iron deficient women

    PubMed Central

    2011-01-01

    Background Nutritional iron deficiency may limit iron availability to the malaria parasite reducing infection risk, and/or impair host immunity thereby increasing this risk. In pregnant women, there is evidence of an adverse effect with iron supplementation, but the few reported studies are strongly confounded. Methods A case control study in pregnant Malawian women was undertaken in Chikhwawa southern Malawi in order to describe iron status in relation to placental malaria controlling for several confounding factors. Pregnancy characteristics were obtained and a blood sample at delivery. A full blood count was performed and serum ferritin and transferrin receptor quantified by enzyme-linked immunoassay. DNA analysis was used to identify genetic polymorphisms for ABO phenotype, hemoglobin HbS, and glucose -6 phosphate dehydrogenase deficiency. Placental tissue was obtained and malaria histology classified as active, past or no malaria infection. Results 112 cases with placental malaria were identified and 110 women with no evidence of placental infection. Iron deficiency was less frequent in women with placental Plasmodium falciparum infection. In those with acute, chronic or past placental infections the odds ratio for iron deficiency was 0.4, 95% CI 0.2-0.8, p = 0.01; for acute and chronic infections 0.4, 0.2-0.8, p = 0.006; for acute infection 0.3, 0.1-0.7, p = 0.001. The association was greater in multigravidae. Conclusion Women with either acute, or acute and chronic placental malaria were less likely to have iron deficiency than women without placental malaria infection There is a priority to establish if reversing iron deficiency through iron supplementation programs either prior to or during pregnancy enhances malaria risk. PMID:21345193

  4. Enhancing Supportive-Educative Nursing Systems to Reduce Risk of Post-Breast Cancer Lymphedema.

    PubMed

    Armer, Jane M; Shook, Robin P; Schneider, Melanie K; Brooks, Constance W; Peterson, Julie; Stewart, Bob R

    2009-10-01

    This study describes the use of data regarding self-care agency to enhance a supportive-educative nursing system for breast cancer survivors to reduce the risk of developing lymphedema post surgery. Impetus for this study came from the analysis of participant feedback from a parent study (Lance Armstrong Foundation pilot study) that sought to plan an educational program for nurses that will improve their supportive-educative nursing system when working with breast cancer survivors. The goal is to enable these women to reduce the risk of lymphedema post surgery. The parent study examined a bundled behavioral-educative intervention, which included standard lymphedema education coupled with Modified Manual Lymph Drainage (MMLD) to reduce the risk of developing lymphedema in newly-diagnosed breast cancer survivors. Based upon the feedback received from the parent study, the research team recognized that many of the participants were not fully following the recommendations of the intervention protocol. In order for nurses to help patients develop self-care agency (SCA) (Orem, 2001) to engage in actions that addressed the self-care requisites associated with post-breast cancer surgery, these nurses needed to refine their intervention skills. Prior to the development of a program for the nurses, the research team conducted a study to explore the state of power related to SCA of the study participants. The information obtained from this was then used in the development of an educational program for bundled intervention. Both motivational interviewing (Miller & Rollnick, 2002) and solution-focused therapy (Berg & DeJong, 1996) were incorporated into the educational program for the research nurse team to strengthen and improve supportive-educative nursing systems. Supportive-educative systems of care that integrate self-care deficit nursing theory, motivational interviewing, and solution-focused therapy can assist patients to develop and sustain self-care agency.

  5. Enhancing Supportive-Educative Nursing Systems to Reduce Risk of Post-Breast Cancer Lymphedema

    PubMed Central

    Armer, Jane M.; Shook, Robin P.; Schneider, Melanie K; Brooks, Constance W.; Peterson, Julie; Stewart, Bob R

    2010-01-01

    This study describes the use of data regarding self-care agency to enhance a supportive-educative nursing system for breast cancer survivors to reduce the risk of developing lymphedema post surgery. Impetus for this study came from the analysis of participant feedback from a parent study (Lance Armstrong Foundation pilot study) that sought to plan an educational program for nurses that will improve their supportive-educative nursing system when working with breast cancer survivors. The goal is to enable these women to reduce the risk of lymphedema post surgery. The parent study examined a bundled behavioral-educative intervention, which included standard lymphedema education coupled with Modified Manual Lymph Drainage (MMLD) to reduce the risk of developing lymphedema in newly-diagnosed breast cancer survivors. Based upon the feedback received from the parent study, the research team recognized that many of the participants were not fully following the recommendations of the intervention protocol. In order for nurses to help patients develop self-care agency (SCA) (Orem, 2001) to engage in actions that addressed the self-care requisites associated with post-breast cancer surgery, these nurses needed to refine their intervention skills. Prior to the development of a program for the nurses, the research team conducted a study to explore the state of power related to SCA of the study participants. The information obtained from this was then used in the development of an educational program for bundled intervention. Both motivational interviewing (Miller & Rollnick, 2002) and solution-focused therapy (Berg & DeJong, 1996) were incorporated into the educational program for the research nurse team to strengthen and improve supportive-educative nursing systems. Supportive-educative systems of care that integrate self-care deficit nursing theory, motivational interviewing, and solution-focused therapy can assist patients to develop and sustain self-care agency. PMID

  6. Instrumentation Strategies to Reduce the Risks of Proximal Junctional Kyphosis in Adult Scoliosis: A Detailed Biomechanical Analysis.

    PubMed

    Aubin, Carl-Eric; Cammarata, Marco; Wang, Xiaoyu; Mac-Thiong, Jean-Marc

    2015-05-01

    Biomechanical analysis of proximal junctional kyphosis (PJK) through numerical simulations. Assessment of the effect of sagittal alignment, the upper instrumented vertebral level (UIV), and 4 other surgical variables on biomechanical indices related to the PJK risks. Despite retrospective clinical studies, biomechanical analysis of individual parameters associated with PJK is lacking to support instrumentation strategies to reduce the PJK risks. Instrumentations of 6 adult scoliosis cases with different operative strategies were simulated (1,152 simulations). Proximal junctional (PJ) angle and flexion loads were evaluated against the sagittal alignment and the proximal instrumentation level. Instrumenting 1 more proximal vertebra allowed the PJ angle, proximal moment, and force to be reduced by 18%, 25%, and 16%, respectively. Shifting sagittal alignment by 20 mm posteriorly increased the PJ angle and proximal moment by 16% and 22%, and increased the equivalent posterior extensor force by 37%. Bilateral complete facetectomy, posterior ligaments resection, and the combination of the 2 resulted in an increase of the PJ angle (by 10%, 28%, and 53%, respectively), flexion forces (by 4%, 12%, and 22%, respectively), and proximal moments (by 16%, 44%, and 83%, respectively). Transverse process hooks at UIV compared with pedicle screws allowed 26% lower PJ angle and flexion loads. The use of proximal transition rods with proximal diameter reduced from 5.5 to 4 mm slightly reduced PJ angle, flexion force, and moment (less than 8%). The increase in sagittal rod curvature from 10° to 40° increased the PJ angle (from 6% to 19%), flexion force (from 3% to 10%), and moment (from 9% to 27%). Simulated posteriorly shifted sagittal alignment was associated with higher PJK risks, whereas extending instrumentation proximally allowed a lower mechanical risk of PJK. Preserving PJ intervertebral elements and using a more flexible anchorage at UIV help reduce the biomechanical risks

  7. Reducing sickness absence from work due to low back pain: how well do intervention strategies match modifiable risk factors?

    PubMed

    Shaw, William S; Linton, Steven J; Pransky, Glenn

    2006-12-01

    To assess, from the review literature, the extent to which effective strategies for reducing work absence after acute low back pain (LBP) match empirical risk factors. From 17 recent review articles (2000-2005), disability risk factors and interventions were cross-tabulated to assess levels of relative concordance. Potentially modifiable risk factors included 23 variables describing 3 workplace and 3 personal domains. Effective interventions included 25 strategies that were personal (physical or behavioral), engineering, or administrative in nature. There was a strong risk factor concordance for workplace technical and organizational interventions, graded activity exposure, and cognitive restructuring of pain beliefs. There was less risk factor concordance for exercise, back education, and RTW coordination. Few interventions focused on relieving emotional distress or improving job dissatisfaction, two well-supported risk factors. Gaps between the epidemiological and intervention research of back disability prevention could be reduced by testing mediators of intervention effects or by stratifying outcomes according to pre-intervention risk factors.

  8. The KnowRISK project - Know your city, Reduce seISmic risK through non-structural elements

    NASA Astrophysics Data System (ADS)

    Sousa Oliveria, Carlos; Amaral Ferreira, Mónica; Lopez, Mário; Sousa Silva, Delta; Musacchio, Gemma; Rupakhety, Rajesh; Falsaperla, Susanna; Meroni, Fabrizio; Langer, Horst

    2016-04-01

    Historically, there is a tendency to focus on seismic structural performance of buildings, neglecting the potential for damage of non-structural elements. In particular, non-structural elements of buildings are their architectural parts (i.e. partitions, ceilings, cladding), electrical and mechanical components (i.e., distribution panels, piping, plumbing), and contents (e.g., furniture, bookcases, computers and desktop equipment). Damage of these elements often contributes significantly to earthquake impacts. In the 1999 Izmit Earthquake, Turkey, 50% of the injuries and 3% of human losses were caused by non-structural failures. In the 2010-2011 Christchurch Earthquakes (New Zealand), 40% of building damage was induced by non-structural malfunctions. Around 70%-85% of construction cost goes into these elements, and their damage can strongly influence the ability of communities to cope with and recover from earthquakes. The project Know your city, Reduce seISmic risK through non-structural elements (KnowRISK) aims at facilitating local communities' access to expert knowledge on non-structural seismic protection solutions. The project will study seismic scenarios critical for non-structural damage, produce a portfolio of non-structural protection measures and investigate the level of awareness in specific communities. We will implement risk communication strategies that will take into account the social and cultural background and a participatory approach to raise awareness in local communities. The paradox between the progress of scientific knowledge and the ongoing increase of losses from natural disasters worldwide is a well-identified gap in the UN Hyogo Framework for Action 2005-2015, in which one of the main priorities is the investment on "knowledge use, innovation and education to build a culture of safety and resilience". The KnowRISK is well aligned with these priorities and will contribute to participatory action aimed at: i) transferring expert knowledge

  9. Effectiveness of Cranberry Capsules to Prevent Urinary Tract Infections in Vulnerable Older Persons: A Double-Blind Randomized Placebo-Controlled Trial in Long-Term Care Facilities

    PubMed Central

    Caljouw, Monique A A; van den Hout, Wilbert B; Putter, Hein; Achterberg, Wilco P; Cools, Herman J M; Gussekloo, Jacobijn

    2014-01-01

    Objectives To determine whether cranberry capsules prevent urinary tract infection (UTI) in long-term care facility (LTCF) residents. Design Double-blind randomized placebo-controlled multicenter trial. Setting Long-term care facilities (LTCFs). Participants LTCF residents (N = 928; 703 women, median age 84). Measurements Cranberry and placebo capsules were taken twice daily for 12 months. Participants were stratified according to UTI risk (risk factors included long-term catheterization, diabetes mellitus, ≥1 UTI in preceding year). Main outcomes were incidence of UTI according to a clinical definition and a strict definition. Results In participants with high UTI risk at baseline (n = 516), the incidence of clinically defined UTI was lower with cranberry capsules than with placebo (62.8 vs 84.8 per 100 person-years at risk, P = .04); the treatment effect was 0.74 (95% confidence interval (CI) = 0.57–0.97). For the strict definition, the treatment effect was 1.02 (95% CI = 0.68–1.55). No difference in UTI incidence between cranberry and placebo was found in participants with low UTI risk (n = 412). Conclusion In LTCF residents with high UTI risk at baseline, taking cranberry capsules twice daily reduces the incidence of clinically defined UTI, although it does not reduce the incidence of strictly defined UTI. No difference in incidence of UTI was found in residents with low UTI risk. PMID:25180378

  10. A Deterministic Model to Quantify Risk and Guide Mitigation Strategies to Reduce Bluetongue Virus Transmission in California Dairy Cattle

    PubMed Central

    Mayo, Christie; Shelley, Courtney; MacLachlan, N. James; Gardner, Ian; Hartley, David; Barker, Christopher

    2016-01-01

    The global distribution of bluetongue virus (BTV) has been changing recently, perhaps as a result of climate change. To evaluate the risk of BTV infection and transmission in a BTV-endemic region of California, sentinel dairy cows were evaluated for BTV infection, and populations of Culicoides vectors were collected at different sites using carbon dioxide. A deterministic model was developed to quantify risk and guide future mitigation strategies to reduce BTV infection in California dairy cattle. The greatest risk of BTV transmission was predicted within the warm Central Valley of California that contains the highest density of dairy cattle in the United States. Temperature and parameters associated with Culicoides vectors (transmission probabilities, carrying capacity, and survivorship) had the greatest effect on BTV’s basic reproduction number, R0. Based on these analyses, optimal control strategies for reducing BTV infection risk in dairy cattle will be highly reliant upon early efforts to reduce vector abundance during the months prior to peak transmission. PMID:27812161

  11. Identification of User Facility Related Publications

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

    Patton, Robert M; Stahl, Christopher G; Wells, Jack C

    2012-01-01

    Scientific user facilities provide physical resources and technical support that enable scientists to conduct experiments or simulations pertinent to their respective research. One metric for evaluating the scientific value or impact of a facility is the number of publications by users as a direct result of using that facility. Unfortunately, for a variety of reasons, capturing accurate values for this metric proves time consuming and error-prone. This work describes a new approach that leverages automated browser technology combined with text analytics to reduce the time and error involved in identifying publications related to user facilities. With this approach, scientific usermore » facilities gain more accurate measures of their impact as well as insight into policy revisions for user access.« less

  12. Serum cholesterol and risk of high-grade prostate cancer: results from the REDUCE study.

    PubMed

    Jamnagerwalla, Juzar; Howard, Lauren E; Allott, Emma H; Vidal, Adriana C; Moreira, Daniel M; Castro-Santamaria, Ramiro; Andriole, Gerald L; Freeman, Michael R; Freedland, Stephen J

    2017-12-27

    Epidemiologic evidence for a serum cholesterol-prostate cancer link is mixed. Prostate-specific antigen (PSA) is positively correlated with cholesterol, potentially increasing PSA-driven biopsy recommendations in men with high cholesterol, though biopsy compliance may be lower in men with comorbid conditions. These potential biases may affect PSA-driven biopsy rates and subsequent prostate cancer detection in men with high serum cholesterol. Our objective was to test the association between serum cholesterol and prostate cancer risk in men receiving PSA independent, study-mandated prostate biopsies. We conducted a post hoc analysis of data from 4974 non-statin users in REDUCE, a randomized trial in men with elevated PSA and a negative baseline biopsy. Men underwent 2- and 4-year trial-mandated prostate biopsies. Associations between baseline serum levels of total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and prostate cancer risk, overall and by Gleason grade (<7 vs. ≥7), were examined using multivariable logistic regression. High total serum cholesterol was associated with an increased risk of high-grade prostate cancer diagnosis (OR per 10 mg/dL 1.05; 95% CI 1.00-1.09; p = 0.048), but cholesterol was unrelated to either overall or low-grade prostate cancer risk (p-values >0.185). There was no association between serum LDL and overall, low- or high-grade prostate cancer risk (p-values >0.137). In contrast, elevated serum HDL was associated with increased risk of both overall (OR per 10 mg/dL 1.08; 95% CI 1.01-1.16; p = 0.033) and high-grade prostate cancer (OR per 10 mg/dL 1.14; 95% CI 1.01-1.28; p = 0.034). In REDUCE, where all men received PSA independent, trial-mandated biopsies thus ensuring complete prostate cancer ascertainment, high total serum cholesterol and high HDL were associated with increased risk of high-grade prostate cancer, supporting a cholesterol-prostate cancer link.

  13. [Air transport biomechanical risk: reduced mobility passengers' handling].

    PubMed

    Draicchio, F; Campoli, G; Silvetti, A; Badellino, E; Forzano, F; Ranavolo, A; Iavicoli, S; Campagna, G; Raffaele, G; Gismondi, M

    2012-01-01

    As the airport traffic increases there is a continuous increase of passengers with different motor disabilities. Disabled passenger's assistance causes a biomechanical overload in airport workers. Some disabled passengers are classified by IATA as WCHC (wheel chair in cabin or Charlie). Our study, was performed in one of the most important Italian airport on Charlie passengers (about 10% of all assistances). We identified four critical points: 1) wheelchair and baggage moving (unstable load), 2) inclined ramps with worker's backwards steps and braked wheelchair to prevent passenger tipping or falling, 3) transfer from standard wheelchair to bicycle wheelchair, specifically designed for the aisle; 4.) transfer from bicycle wheelchair to aircraft seat. The last two points required sometimes to lift passengers over the armrest and positioning them on a window side seat, causing a serious increase of biomechanical load. For each critical point we have proposed technical and organizational measures to reduce airport worker's biomechanical risk.

  14. Provider adherence to first antenatal care guidelines and risk of pregnancy complications in public sector facilities: a Ghanaian cohort study.

    PubMed

    Amoakoh-Coleman, Mary; Klipstein-Grobusch, Kerstin; Agyepong, Irene Akua; Kayode, Gbenga A; Grobbee, Diederick E; Ansah, Evelyn K

    2016-11-24

    Guideline utilization aims at improvement in quality of care and better health outcomes. The objective of the current study was to determine the effect of provider complete adherence to the first antenatal care guidelines on the risk of maternal and neonatal complications in a low resource setting. Women delivering in 11 health facilities in the Greater Accra region of Ghana were recruited into a cohort study. Their first antenatal visit records were reviewed to assess providers' adherence to the guidelines, using a thirteen-point checklist. Information on their socio-demographic characteristics and previous pregnancy history was collected. Participants were followed up for 6 weeks post-partum to complete data collection on outcomes. The incidence of maternal and neonatal complications was estimated. The effects of complete adherence on risk of maternal and neonatal complications were estimated and expressed as relative risks (RRs) with their 95% confidence intervals (CI) adjusted for a potential clustering effect of health facilities. Overall, 926 women were followed up to 6 weeks post-partum. Mean age (SD) of participants was 28.2 (5.4) years. Complete adherence to guidelines pertained to the care of 48.5% of women. Incidence of preterm deliveries, low birth weight, stillbirths and neonatal mortality were 5.3, 6.1, 0.4 and 1.4% respectively. Complete adherence to the guidelines decreased risk of any neonatal complication [0.72 (0.65-0.93); p = 0.01] and delivery complication [0.66 (0.44-0.99), p = 0.04]. Complete provider adherence to antenatal care guidelines at first antenatal visit influences delivery and neonatal outcomes. While there is the need to explore and understand explanatory mechanisms for these observations, programs that promote complete adherence to guidelines will improve the pregnancy outcomes.

  15. Nonsteroidal Anti-Inflammatory Drug Use is Not Associated With Reduced Risk of Barrett's Esophagus

    PubMed Central

    Thrift, Aaron P.; Anderson, Lesley A.; Murray, Liam J.; Cook, Michael B.; Shaheen, Nicholas J.; Rubenstein, Joel H.; El-Serag, Hashem B.; Vaughan, Thomas L.; Schneider, Jennifer L.; Whiteman, David C.; Corley, Douglas A.

    2016-01-01

    OBJECTIVES Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a reduced risk of esophageal adenocarcinoma. Epidemiological studies examining the association between NSAID use and the risk of the precursor lesion, Barrett's esophagus, have been inconclusive. METHODS We analyzed pooled individual-level participant data from six case-control studies of Barrett's esophagus in the Barrett's and Esophageal Adenocarcinoma Consortium (BEACON). We compared medication use from 1474 patients with Barrett's esophagus separately with two control groups: 2256 population-based controls and 2018 gastroesophageal reflux disease (GERD) controls. Study-specific odds ratios (OR) and 95% confidence intervals (CI) were estimated using multivariable logistic regression models and were combined using a random effects meta-analytic model. RESULTS Regular (at least once weekly) use of any NSAIDs was not associated with the risk of Barrett's esophagus (vs. population-based controls, adjusted OR = 1.00, 95% CI = 0.76–1.32; I2=61%; vs. GERD controls, adjusted OR = 0.99, 95% CI = 0.82–1.19; I2=19%). Similar null findings were observed among individuals who took aspirin or non-aspirin NSAIDs. We also found no association with highest levels of frequency (at least daily use) and duration (≥5 years) of NSAID use. There was evidence of moderate between-study heterogeneity; however, associations with NSAID use remained non-significant in “leave-one-out” sensitivity analyses. CONCLUSIONS Use of NSAIDs was not associated with the risk of Barrett's esophagus. The previously reported inverse association between NSAID use and esophageal adenocarcinoma may be through reducing the risk of neoplastic progression in patients with Barrett's esophagus. PMID:27575711

  16. Fine particulate matter (PM2.5) in a compost facility: heavy metal contaminations and health risk assessment, Tehran, Iran.

    PubMed

    Kermani, Majid; Farzadkia, Mahdi; Kalantari, Roshanak Rezaei; Bahmani, Zohreh

    2018-06-01

    The aim of this study was to evaluate the concentration of PM 2.5 particles, potential sources, and determination of health risk assessment of heavy metals in various parts of composting facilities of Tehran's Kahrizak. A total of 60 PM 2.5 particle samples were collected every 3 days from January to March 2016. To analyze the heavy metals, inductively coupled plasma atomic emission spectroscopy (ICP-AES) was applied. SEM-EDX analysis indicated that metals of Al, Si, Mg, Na, Au, S, Ca, K, and Co were dominant in the structure of particles. The concentration of PM 2.5 was found to be the highest in the final processing site (c), followed by primary processing site (a) and the aerated site (b). The mean concentrations of Al and Fe in all sampling sites of a, b, and c were 7.46 ± 2.73, 1.48 ± 0.59, 24.30 ± 8.23 μg/m 3 and 4.97 ± 2.83, 1.33 ± 0.48, 16.48 ± 7.36, respectively. The enrichment factor order of the trace elements was as follows: Cd > As > Pb > Zn > Cu > V > Cr > Ni > Mn > Fe > Al, with the highest EF value exceeding 10,000 for Cd at the a site. For all sampling sites in composting facilities, the cancer risk was more than > 1 × 10 -4 as posed by the total of five carcinogenic metals (Pb, Cr, As, Ni, and Cd), indicating that risk factors were not negligible.

  17. Reducing the extinction risk of stochastic populations via nondemographic noise

    NASA Astrophysics Data System (ADS)

    Be'er, Shay; Assaf, Michael

    2018-02-01

    We consider nondemographic noise in the form of uncertainty in the reaction step size and reveal a dramatic effect this noise may have on the stability of self-regulating populations. Employing the reaction scheme m A →k A but allowing, e.g., the product number k to be a priori unknown and sampled from a given distribution, we show that such nondemographic noise can greatly reduce the population's extinction risk compared to the fixed k case. Our analysis is tested against numerical simulations, and by using empirical data of different species, we argue that certain distributions may be more evolutionary beneficial than others.

  18. Estimating earthquake-induced failure probability and downtime of critical facilities.

    PubMed

    Porter, Keith; Ramer, Kyle

    2012-01-01

    Fault trees have long been used to estimate failure risk in earthquakes, especially for nuclear power plants (NPPs). One interesting application is that one can assess and manage the probability that two facilities - a primary and backup - would be simultaneously rendered inoperative in a single earthquake. Another is that one can calculate the probabilistic time required to restore a facility to functionality, and the probability that, during any given planning period, the facility would be rendered inoperative for any specified duration. A large new peer-reviewed library of component damageability and repair-time data for the first time enables fault trees to be used to calculate the seismic risk of operational failure and downtime for a wide variety of buildings other than NPPs. With the new library, seismic risk of both the failure probability and probabilistic downtime can be assessed and managed, considering the facility's unique combination of structural and non-structural components, their seismic installation conditions, and the other systems on which the facility relies. An example is offered of real computer data centres operated by a California utility. The fault trees were created and tested in collaboration with utility operators, and the failure probability and downtime results validated in several ways.

  19. Reducing Risks to Women Linked to Shift Work, Long Work Hours, and Related Workplace Sleep and Fatigue Issues.

    PubMed

    Caruso, Claire C

    2015-10-01

    In the United States, an estimated 12% to 28% of working women are on shift work schedules, and 12% work more than 48 hours per week. Shift work and long work hours are associated with many health and safety risks, including obesity, injuries, and negative reproductive outcomes. Over time, the worker is at risk for developing a wide range of chronic diseases. These work schedules can also strain personal relationships, owing to fatigue and poor mood from sleep deprivation and reduced quality time to spend with family and friends. Worker errors from fatigue can lead to reduced quality of goods and services, negatively impacting the employer. In addition, mistakes by fatigued workers can have far-reaching negative effects on the community, ranging from medical care errors to motor vehicle crashes and industrial disasters that endanger others. To reduce the many risks that are linked to these demanding work hours, the National Institute for Occupational Safety and Health (NIOSH) conducts research, develops guidance and authoritative recommendations, and translates and disseminates scientific information to protect workers, their families, employers, and the community. The key message to reduce these risks is making sleep a priority in the employer's systems for organizing work and in the worker's personal life. The NIOSH website has freely available online training programs with suggestions for workers and their managers to help them better cope with this workplace hazard.

  20. [Potential vulnerability to flooding at public health facilities in four northern regions of Peru].

    PubMed

    Hernández-Vásquez, Akram; Arroyo-Hernández, Hugo; Bendezú-Quispe, Guido; Díaz-Seijas, Deysi; Vilcarromero, Stalin; Rubilar-González, Juan; Gutierrez-Lagos, Edith

    2016-03-01

    In order to determine the potential vulnerability of public health facilities in four northern regions of Peru to the possible effects of El Niño-Southern Oscillation (ENSO) phenomenon. An exploratory spatial analysis was performed using the geo-referenced points for at-risk areas based on the activation of gullies that were reported by the National Water Authority, and the location of the four regional public health facilities of the Ministry of Health. Concentric areas of influence were simulate from the points of risk towards the public health facilities using radii of 200, 1000 and 1500 meters. The Tumbes region would be the most affected with 37.2% of its health facilities being affected by floods and landslides. The I-2 and I-3 categories of health facilities appeared to be the most affected with 28.9% and 31.6% respectively. Therefore, public health facilities near the risk zones may be affected by the ENSO.

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

    PubMed

    Poonam Khanijo Ahluwalia; Nema, Arvind K

    2011-07-01

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

  2. Reducing the Risk of Human Missions to Mars Through Testing

    NASA Astrophysics Data System (ADS)

    Drake, Bret G.

    2007-07-01

    The NASA Deputy Administrator charted an internal NASA planning group to develop the rationale for exploration beyond low-Earth orbit. This team, termed the Exploration Blueprint, performed architecture analyses to develop roadmaps for how to accomplish the first steps beyond Low-Earth Orbit through the human exploration of Mars. Following the results of the Exploration Blueprint study, the NASA Administrator asked for a recommendation on the next steps in human and robotic exploration. Much of the focus during this period was on integrating the results from the previous studies into more concrete implementation strategies in order to understand the relationship between NASA programs, timing, and resulting budgetary implications. This resulted in an integrated approach including lunar surface operations to retire risk of human Mars missions, maximum use of common and modular systems including what was termed the exploration transfer vehicle, Earth orbit and lunar surface demonstrations of long-life systems, collaboration of human and robotic missions to vastly increase mission return, and high-efficiency transportation systems (nuclear) for deep-space transportation and power. The data provided in this summary presentation was developed to begin to address one of the key elements of the emerging implementation strategy, namely how lunar missions help retire risk of human missions to Mars. During this process the scope of the activity broadened into the issue of how testing in general, in various venues including the moon, can help reduce the risk for Mars missions.

  3. A systematic review of effective interventions for reducing multiple health risk behaviors in adolescence.

    PubMed

    Hale, Daniel R; Fitzgerald-Yau, Natasha; Viner, Russell Mark

    2014-05-01

    We systematically searched 9 biomedical and social science databases (1980-2012) for primary and secondary interventions that prevented or reduced 2 or more adolescent health risk behaviors (tobacco use, alcohol use, illicit drug use, risky sexual behavior, aggressive acts). We identified 44 randomized controlled trials of universal or selective interventions and were effective for multiple health risk behaviors. Most were school based, conducted in the United States, and effective for multiple forms of substance use. Effects were small, in line with findings for other universal prevention programs. In some studies, effects for more than 1 health risk behavior only emerged at long-term follow-up. Integrated prevention programs are feasible and effective and may be more efficient than discrete prevention strategies.

  4. A Systematic Review of Effective Interventions for Reducing Multiple Health Risk Behaviors in Adolescence

    PubMed Central

    Fitzgerald-Yau, Natasha; Viner, Russell Mark

    2014-01-01

    We systematically searched 9 biomedical and social science databases (1980–2012) for primary and secondary interventions that prevented or reduced 2 or more adolescent health risk behaviors (tobacco use, alcohol use, illicit drug use, risky sexual behavior, aggressive acts). We identified 44 randomized controlled trials of universal or selective interventions and were effective for multiple health risk behaviors. Most were school based, conducted in the United States, and effective for multiple forms of substance use. Effects were small, in line with findings for other universal prevention programs. In some studies, effects for more than 1 health risk behavior only emerged at long-term follow-up. Integrated prevention programs are feasible and effective and may be more efficient than discrete prevention strategies. PMID:24625172

  5. Physical therapy approaches to reduce fall and fracture risk among older adults.

    PubMed

    Karinkanta, Saija; Piirtola, Maarit; Sievänen, Harri; Uusi-Rasi, Kirsti; Kannus, Pekka

    2010-07-01

    Falls and fall-related injuries, such as fractures, are a growing problem among older adults, often causing longstanding pain, functional impairments, reduced quality of life and excess health-care costs and mortality. These problems have led to a variety of single component or multicomponent intervention strategies to prevent falls and subsequent injuries. The most effective physical therapy approach for the prevention of falls and fractures in community-dwelling older adults is regular multicomponent exercise; a combination of balance and strength training has shown the most success. Home-hazard assessment and modification, as well as assistive devices, such as canes and walkers, might be useful for older people at a high risk of falls. Hip protectors are effective in nursing home residents and potentially among other high-risk individuals. In addition, use of anti-slip shoe devices in icy conditions seems beneficial for older people walking outdoors. To be effective, multifactorial preventive programs should include an exercise component accompanied by individually tailored measures focused on high-risk populations. In this Review, we focus on evidence-based physical therapy approaches, including exercise, vibration training and improvements of safety at home and during periods of mobility. Additionally, the benefits of multifaceted interventions, which include risk factor assessment, dietary supplements, elements of physical therapy and exercise, are addressed.

  6. Using the Design for Demise Philosophy to Reduce Casualty Risk Due to Reentering Spacecraft

    NASA Technical Reports Server (NTRS)

    Kelley, R. L.

    2012-01-01

    Recently the reentry of a number of vehicles has garnered public attention due to their risk of human casualty due to fragments surviving reentry. In order to minimize this risk for their vehicles, a number of NASA programs have actively sought to minimize the number of components likely to survive reentry at the end of their spacecraft's life in order to meet and/or exceed NASA safety standards for controlled and uncontrolled reentering vehicles. This philosophy, referred to as "Design for Demise" or D4D, has steadily been adopted, to at least some degree, by numerous programs. The result is that many programs are requesting evaluations of components at the early stages of vehicle design, as they strive to find ways to reduce the number surviving components while ensuring that the components meet the performance requirements of their mission. This paper will discuss some of the methods that have been employed to ensure that the consequences of the vehicle s end-of-life are considered at the beginning of the design process. In addition this paper will discuss the technical challenges overcome, as well as some of the more creative solutions which have been utilized to reduce casualty risk.

  7. Investing: reducing risks to enhance returns.

    PubMed

    West, J; Glickman, S; Seidner, A G

    1996-09-01

    The financial assets of a healthcare organization can present many opportunities for investment. In order to develop a profitable investment program that avoids risky speculation, however, healthcare financial managers must fully understand the nature and risks of their organizations' investments. They must define and monitor their investment objectives, limitations, levels of acceptable risk and policies and conditions through a statement of investment policy and comprehensive investment guidelines.

  8. Preeclampsia-Associated Hormonal Profiles and Reduced Breast Cancer Risk Among Older Mothers

    DTIC Science & Technology

    2003-04-01

    Preeclampsia has been linked to reduced breast cancer risk, and this reduction may be especially marked among women who bear their first child later...in life. In this ongoing case-control study, we examine the hormonal profiles of older Colorado mothers with and without a history of preeclampsia in...premenopausal, and are free of serious chronic disease. Cases are 14 Denver area women who experienced preeclampsia in their first pregnancy; controls are 13

  9. Information security management system planning for CBRN facilities

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

    Lenaeu, Joseph D.; O'Neil, Lori Ross; Leitch, Rosalyn M.

    The focus of this document is to provide guidance for the development of information security management system planning documents at chemical, biological, radiological, or nuclear (CBRN) facilities. It describes a risk-based approach for planning information security programs based on the sensitivity of the data developed, processed, communicated, and stored on facility information systems.

  10. A New Approach to Establish a Cell Line with Reduced Risk of Endogenous Retroviruses

    PubMed Central

    Fukuma, Aiko; Yoshikawa, Rokusuke; Miyazawa, Takayuki; Yasuda, Jiro

    2013-01-01

    Endogenous retroviruses (ERVs) are integrated as DNA proviruses in the genomes of all mammalian species. Several ERVs are replication-competent and produced as fully infectious viruses from host cell. Thus, live-attenuated vaccines and biological substances have been prepared using the cell lines which may produce ERV. Indeed, we recently reported that several commercial live-attenuated vaccines for pets were contaminated with the infectious feline endogenous retrovirus, RD-114. In this study, to establish a cell line for vaccine manufacture with reduced risk of ERVs, we generated a cell line stably expressing human tetherin (Teth-CRFK cells). The release of infectious ERV from Teth-CRFK cells was suppressed to undetectable levels, while the production of parvovirus in Teth-CRFK cells was similar to that in parental CRFK cells. These observations suggest that Teth-CRFK cells will be useful as a cell line for the manufacture of live-attenuated vaccines or biological substances with reduced risk of ERV. PMID:23585909

  11. A new approach to establish a cell line with reduced risk of endogenous retroviruses.

    PubMed

    Fukuma, Aiko; Yoshikawa, Rokusuke; Miyazawa, Takayuki; Yasuda, Jiro

    2013-01-01

    Endogenous retroviruses (ERVs) are integrated as DNA proviruses in the genomes of all mammalian species. Several ERVs are replication-competent and produced as fully infectious viruses from host cell. Thus, live-attenuated vaccines and biological substances have been prepared using the cell lines which may produce ERV. Indeed, we recently reported that several commercial live-attenuated vaccines for pets were contaminated with the infectious feline endogenous retrovirus, RD-114. In this study, to establish a cell line for vaccine manufacture with reduced risk of ERVs, we generated a cell line stably expressing human tetherin (Teth-CRFK cells). The release of infectious ERV from Teth-CRFK cells was suppressed to undetectable levels, while the production of parvovirus in Teth-CRFK cells was similar to that in parental CRFK cells. These observations suggest that Teth-CRFK cells will be useful as a cell line for the manufacture of live-attenuated vaccines or biological substances with reduced risk of ERV.

  12. Managing Annual Flood Risk and Reducing Socioeconomic Flood Impacts in Rural Arctic through Science-Community Collaborations

    NASA Astrophysics Data System (ADS)

    Kontar, Y. Y.

    2016-12-01

    Multiple Arctic riverine communities face flood risk every spring. Within hours floodwater and ice debris destroy entire communities, displacing hundreds of people. In FY 2015-2016 an international project entitled Reducing Spring Flood Impacts for Wellbeing of Communities of the North was successfully conducted with the goal to identify best practices in managing the risk and reducing the socioeconomic impacts of floods associated with spring river ice breakup. In this presentation, we will elaborate on socioeconomic impacts of breakup floods, including long-term evacuation of population, loss of means of livelihoods, and ecosystem resource loss. We will also compare and contrast spring flood risk management and reduction strategies and their effectiveness in Alaska and Sakha Republic (Siberia), Russia. The findings are based on surveys completed by the representatives of adverse populations in two flood-prone communities in Alaska and Sakha Republic, as well as a series of roundtable discussions and interviews between social and geoscientists, emergency managers, and community leaders.

  13. Exercise Interventions for Preventing Falls Among Older People in Care Facilities: A Meta-Analysis.

    PubMed

    Lee, Seon Heui; Kim, Hee Sun

    2017-02-01

    Falls in older people are a common problem, often leading to considerable morbidity. However, the overall effect of exercise interventions on fall prevention in care facilities remains controversial. To evaluate the effectiveness of exercise interventions on the rate of falls and number of fallers in care facilities. A meta-analysis was conducted of randomized controlled trials published up to December 2014. Eight databases were searched including Ovid-Medline, Embase, CINAHL, Cochrane Library, KoreaMed, KMbase, KISS, and KisTi. Two investigators independently extracted data and assessed study quality. Twenty-one studies were selected, that included 5,540 participants. Fifteen studies included exercise as a single intervention, whereas the remaining six included exercise combined with two or more fall interventions tailored to each resident's fall risk (i.e., medication review, environmental modification or staff education). Meta-analysis showed that exercise had a preventive effect on the rate of falls (risk ratio [RR] 0.81, 95% CI 0.68-0.97). This effect was stronger when exercise combined with other fall interventions on the rate of falls (RR 0.61, 95% CI 0.52-0.72) and on the number of fallers (RR 0.85, 95% CI 0.77-0.95). Exercise interventions including balance training (i.e., gait, balance, and functional training; or balance and strength) resulted in reduced the rate of falls. Sensitivity analyses indicated that exercise interventions resulted in reduced numbers of recurrent fallers (RR 0.71, 95% CI 0.53-0.97). This review provides an important basis for developing evidence-based exercise intervention protocols for older people living in care facilities. Exercise programs, which are combined with tailored other fall interventions and challenge balance training to improve balance skills, should be applied to frail older people with functional limitations in institutional settings. © 2016 Sigma Theta Tau International.

  14. Preliminary volcanic hazards evaluation for Los Alamos National Laboratory Facilities and Operations : current state of knowledge and proposed path forward

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

    Keating, Gordon N.; Schultz-Fellenz, Emily S.; Miller, Elizabeth D.

    2010-09-01

    The integration of available information on the volcanic history of the region surrounding Los Alamos National Laboratory indicates that the Laboratory is at risk from volcanic hazards. Volcanism in the vicinity of the Laboratory is unlikely within the lifetime of the facility (ca. 50–100 years) but cannot be ruled out. This evaluation provides a preliminary estimate of recurrence rates for volcanic activity. If further assessment of the hazard is deemed beneficial to reduce risk uncertainty, the next step would be to convene a formal probabilistic volcanic hazards assessment.

  15. Food and plant bioactives for reducing cardiometabolic disease risk: an evidence based approach.

    PubMed

    Cicero, Arrigo F G; Fogacci, Federica; Colletti, Alessandro

    2017-06-21

    Cardiovascular diseases (CVDs) are one of the major causes of mortality and disability in Western countries. Prevention is known to be the cornerstone to lessen the incidence of CVDs and also to reduce the economic burden of both the citizen and the healthcare system. "Interventional medicine" certainly puts lifestyle modification as the first therapeutic step, including a healthy diet and physical activity. Secondly, a large body of research individuated a number of food and plant bioactives, which are potentially efficacious in preventing and reducing some highly prevalent CV risk factors, such as hypercholesterolemia, hypertension, vascular inflammation and vascular compliance. Some lipid- and blood pressure-lowering bioactives were studied for their impact on human vascular health, particularly as regards endothelial function and arterial stiffness. Several nutraceuticals showed additive or synergistic properties in combination, sometimes (but not always) allowing a reduction of the administered dose of extracts and determining a "multi-factorial" final effect on many cardiovascular risk factors. Thus, this review focuses on available evidence regarding the effects of berberine, plant sterols, green tea extract, soy, curcumin, cocoa, pycnogenol, lycopene, olive oil, soluble fibers, garlic, resveratrol, beetroot, mineral salts and vitamins on the lipid profile, blood pressure, inflammatory and endothelial markers, and vascular compliance. Future clinical research studies will have to focus more on middle term modification of the instrumental markers of vascular aging than on short-term effects on indirect laboratory risk markers.

  16. A family intervention to reduce sexual risk behavior, substance use, and delinquency among newly homeless youth.

    PubMed

    Milburn, Norweeta G; Iribarren, Francisco Javier; Rice, Eric; Lightfoot, Marguerita; Solorio, Rosa; Rotheram-Borus, Mary Jane; Desmond, Katherine; Lee, Alex; Alexander, Kwame; Maresca, Katherine; Eastmen, Karen; Arnold, Elizabeth Mayfield; Duan, Naihua

    2012-04-01

    We evaluate the efficacy of a short family intervention in reducing sexual risk behavior, drug use, and delinquent behaviors among homeless youth. A randomized controlled trial of 151 families with a homeless adolescent aged 12 to 17 years. Between March 2006 and June 2009, adolescents were recruited from diverse sites in Southern California and were assessed at recruitment (baseline), and at 3, 6, and 12 months later. Families were randomly assigned to an intervention condition with five weekly home-based intervention sessions or a control condition (standard care). Main outcome measures reflect self-reported sexual risk behavior, substance use, and delinquent behaviors over the past 90 days. Sexual risk behavior (e.g., mean number of partners; p < .001), alcohol use (p = .003), hard drug use (p < .001), and delinquent behaviors (p = .001) decreased significantly more during 12 months in the intervention condition compared with the control condition. Marijuana use, however, significantly increased in the intervention condition compared with the control condition (p < .001). An intervention to reengage families of homeless youth has significant benefits in reducing risk over 12 months. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  17. Red wine consumption not associated with reduced risk of colorectal cancer.

    PubMed

    Chao, Chun; Haque, Reina; Caan, Bette J; Poon, Kwun-Yee T; Tseng, Hung-Fu; Quinn, Virginia P

    2010-01-01

    Red wine contains polyphenol antioxidants that inhibit colorectal cancer (CRC) development in animal studies. We investigated the effect of red wine intake on risk of CRC in the California Men's Health Study (CMHS). CMHS is a prospective, multiethnic cohort of middle-aged men who were members of the Kaiser Permanente (KP) California Health Plans and completed study questionnaires between 2002-2003. Incident CRC were identified from the health plan cancer registries through the end of 2007 (n = 287). To properly account for potential confounding by previous endoscopy screening, we restricted the primary analyses to CMHS men continuously enrolled in KP between 1998-2002 (n = 43,483 and CRC = 176). We used multivariable Cox regression to adjust for important confounders. We did not find an inverse association between moderate red wine intake and risk of CRC. The hazard ratio for consuming >/=1 drink/day (average = 2 drinks/day) was 1.16, 95% confidence intervals 0.56-2.40. There was no linear dose-response. The lack of clear association for red wine intake was consistently observed when we stratified the analyses by CRC stage at diagnosis and cancer site (colon or rectum). Moderate red wine consumption was not associated with reduced risk of colorectal cancer in this population of middle-aged men.

  18. Risk factors for generally reduced productivity--a prospective cohort study of young adults with neck or upper-extremity musculoskeletal symptoms.

    PubMed

    Boström, Maria; Dellve, Lotta; Thomée, Sara; Hagberg, Mats

    2008-04-01

    This study prospectively assessed the importance of individual conditions and computer use during school or work and leisure time as risk factors for self-reported generally reduced productivity due to musculoskeletal complaints among young adults with musculoskeletal symptoms in the neck or upper extremities. A cohort of 2914 young adults (18-25 years, vocational school and college or university students) responded to an internet-based questionnaire concerning musculoskeletal symptoms related to individual conditions and computer use during school or work and leisure time that possibly affected general productivity. Prevalence ratios (PR) were used to assess prospective risk factors for generally reduced productivity. The selected study sample (N=1051) had reported neck or upper-extremity symptoms. At baseline, 280 of them reported reduced productivity. A follow-up of the 771 who reported no reduced productivity was carried out after 1 year. Risk factors for self-reported generally reduced productivity for those followed-up were symptoms in two or three locations or dimensions for the upper back or neck and the shoulders, arms, wrists, or hands [PR 2.30, 95% confidence interval (95% CI) 1.40-3.78], symptoms persisting longer than 90 days in the shoulders, arms, wrists, or hands (PR 2.50, 95% CI 1.12-5.58), current symptoms in the shoulders, arms, wrists, or hands (PR 1.78, 95% CI 1.10-2.90) and computer use 8-14 hours/week during leisure time (PR 2.32, 95% CI 1.20-4.47). A stronger relationship was found if three or four risk factors were present. For women, a relationship was found between generally reduced productivity and widespread and current symptoms in the upper extremities. The main risk factors for generally reduced productivity due to musculoskeletal symptoms among young adults in this study were chronic symptoms in the upper extremities and widespread symptoms in the neck and upper extremities.

  19. Risk-based targeting: A new approach in environmental protection

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

    Fox, C.A.

    1995-12-31

    Risk-based targeting has recently emerged as an effective tool to help prioritize efforts to identify and manage geographic areas, chemicals, facilities, and agricultural activities that cause the most environmental degradation. This paper focuses on how the Environmental Protection Agency (EPA) has recently used risk-based targeting to identify and screen Federal, industrial, commercial and municipal facilities which contribute to probable human health (fish consumption advisories and contaminated fish tissue) and aquatic life (contaminated sediments) impacts. Preliminary results identified several hundred potential contributors of problem chemicals to probable impacts within the same river reach in 1991--93. Analysis by industry sector showed thatmore » the majority of the facilities identified were publicly owned treatment works (POTWs), in addition to industry organic and inorganic chemical manufacturers, petroleum refineries, and electric services, coatings, engravings, and allied services, among others. Both compliant and non-compliant potentially contributing facilities were identified to some extent in all EPA regions. Additional results identifying possible linkages of other pollutant sources to probable impacts, as well as estimation of potential exposure of these contaminants to minority and/or poverty populations are also presented. Out of these analyses, a number of short and long-term strategies are being developed that EPA may use to reduce loadings of problem contaminants to impacted waterbodies.« less

  20. Evidence from facility level inputs to improve quality of care for maternal and newborn health: interventions and findings

    PubMed Central

    2014-01-01

    Most of the maternal and newborn deaths occur at birth or within 24 hours of birth. Therefore, essential lifesaving interventions need to be delivered at basic or comprehensive emergency obstetric care facilities. Facilities provide complex interventions including advice on referrals, post discharge care, long-term management of chronic conditions along with staff training, managerial and administrative support to other facilities. This paper reviews the effectiveness of facility level inputs for improving maternal and newborn health outcomes. We considered all available systematic reviews published before May 2013 on the pre-defined facility level interventions and included 32 systematic reviews. Findings suggest that additional social support during pregnancy and labour significantly decreased the risk of antenatal hospital admission, intrapartum analgesia, dissatisfaction, labour duration, cesarean delivery and instrumental vaginal birth. However, it did not have any impact on pregnancy outcomes. Continued midwifery care from early pregnancy to postpartum period was associated with reduced medical procedures during labour and shorter length of stay. Facility based stress training and management interventions to maintain well performing and motivated workforce, significantly reduced job stress and improved job satisfaction while the interventions tailored to address identified barriers to change improved the desired practice. We found limited and inconclusive evidence for the impacts of physical environment, exit interviews and organizational culture modifications. At the facility level, specialized midwifery teams and social support during pregnancy and labour have demonstrated conclusive benefits in improving maternal newborn health outcomes. However, the generalizability of these findings is limited to high income countries. Future programs in resource limited settings should utilize these findings to implement relevant interventions tailored to their needs